Cardiovascular diagnosis and therapy最新文献

Background: Sudden cardiac death (SCD) is associated with severe electrocardiogram (ECG) abnormalities. Current prediction relies heavily on static ECG parameters, limiting accuracy. This study aimed to explore dynamic ECG parameters, particularly the S-wave area and its circadian variations, as novel markers for SCD risk prediction.

Methods: All participants were divided into three different SCD risk groups based on their disease status at the time of enrollment. Dynamic single-lead ECG data was collected continuously for 24 hours and segmented into 1,440 one-minute intervals with time information tags from 0:00 to 24:00. Forty-two ECG parameters, including the S-wave area, were analyzed. Randomly selected 70% of the samples from Sun Yat-sen Memorial Hospital to construct training set and remaining samples to construct independent test set. Student's t-test was used to compare the expression differences of ECG parameters in different SCD risks patients at different time points within a day. Repeatedly attempted to establish multivariate logistics regression models combining different time points and ECG parameters and performed five-fold cross validation sequentially. Selected time point-ECG parameter combined model with the highest AUC to conduct further univariate logistic regression and calculate odds ratio (OR) of each time point-ECG parameter combination.

Results: From September 2017 to December 2020, 289 participants were enrolled: 43 at high risk of SCD (SCDHR), 138 with heart failure (HF), and 108 healthy controls (HC). Significant circadian variations in ECG parameters were observed. In the SCDHR group, key parameters significantly increased during 16:00-22:00, while the HF group showed distinct changes from 21:00-06:00. Logistic regression achieved robust performance in distinguishing groups: SCDHR vs. HC (AUC =0.887 training; AUC =0.747, accuracy =0.755, precision =0.800 test), SCDHR vs. HF (AUC =0.857 training; AUC =0.714, accuracy =0.681, precision =0.280 test) and HF vs. HC (AUC =0.965 training; AUC =0.842, accuracy =0.704, precision =0.867 test). Decision curve analysis and calibration curve showed good clinical performance of three logistics models for each comparison pair.

Conclusions: Dynamic ECG parameters, especially time-dependent variations in the S-wave area, were strongly associated with the SCD risk. They may develop into promising markers enhancing predictive accuracy for SCD stratification after further large-scale and prospective validation.

Background: Medial arterial calcification (MAC) increases vascular stiffness and reduces arterial compliance, often leading to serious systemic vascular diseases. However, research progress in this field has been limited by the lack of effective animal models. To address this gap and facilitate MAC research, this study established a novel experimental animal model of MAC in wild-type C57BL/6J mice and developed corresponding pathological grading standards.

Methods: To establish an optimal MAC modeling protocol, we systematically compared key parameters, including wire diameter, modeling duration, and combination with a vitamin D₃ (VD₃) diet. The resulting model was then subjected to interventional treatments with various calcification inhibitors. For pathological assessment, a four-tier histopathological grading system was established to categorize calcification severity based on its extent and distribution. Tissue sections were analyzed by hematoxylin and eosin and Von Kossa staining. The expression of inflammatory factors and bone-related proteins was analyzed by immunohistochemistry (IHC), while macrophage markers (CD68, CD86) were further characterized by immunofluorescence (IF).

Results: The most effective method was identified as endothelial injury of the common carotid artery (CCA) using a 0.45 mm rough guide wire combined with a VD₃ diet for 3 months, achieving a 100% MAC incidence. Compared with those in the sham group, the CCAs of the mice in the experimental group were infiltrated with activated macrophages and inflammatory factors such as interleukin-1beta (IL-1β) and interleukin-6 (IL-6). Calcifcation inhibitors etidronate and SNF472 significantly prevented MAC occurrence, showing inhibition rates of 45.45% (P=0.006) and 50% (P=0.002), respectively, conpared to the VD₃ group (Fisher's exact test).

Conclusions: This study not only establishes a MAC animal model by inducing injury to the CCA combined with a VD₃ diet but also introduces a corresponding pathological scoring system. Together, this model, coupled with this associated grading method, provides a valuable toolset for future basic medical research, drug screening, and investigations into the genetic mechanisms of MAC.

Background: The association between hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve replacement (TAVR) and the risk of cerebrovascular events has attracted much attention. Although previous studies have reported that the incidence of HALT after TAVR in patients with bicuspid aortic valve (BAV) is comparable to that in patients with tricuspid aortic valve (TAV), the specific contributing factors remain incompletely understood. This study aimed to investigate the incidence, predictors, and prognosis of HALT in a TAVR cohort of young patients with 50-50% bicuspid-TAV anatomy.

Methods: We retrospectively analyzed consecutive patients with severe symptomatic aortic stenosis who underwent the TAVR procedure between May 2012 and January 2021 in West China Hospital, Sichuan University. Multislice computed tomography (MSCT) was employed to evaluate the early HALT post-TAVR at discharge. Echocardiograms were conducted at baseline, upon discharge, 30 days after the procedure, and at 1-year follow-up. Patients were grouped according to the presence of HALT at discharge. The baseline data, procedural details, and clinical outcomes of the patients were compared, and then multivariate regression analysis was performed.

Results: We ultimately enrolled 605 patients undergoing TAVR for severe symptomatic aortic stenosis, of whom 79 (13.1%) developed HALT during hospitalization. The incidence of HALT was significantly higher in patients with BAV than in those with TAV (15.9% vs. 10.2%; P=0.04). In the multivariate analysis, BAV was identified as an independent predictor of HALT [odds ratio (OR) =2.148; 95% confidence interval (CI): 1.283-3.596; P=0.004]. The other independent predictors included coronary artery disease (OR =1.810; 95% CI: 1.091-2.768; P=0.02), higher body mass index (OR =0.912; 95% CI: 0.846-0.982; P=0.02), postdilation (OR =0.552; 95% CI: 0.327-0.934; P=0.03), bioprosthetic valve size >23 mm (OR =1.965; 95% CI: 1.013-3.813; P=0.05), and the presence of a greater-than-mild paravalvular leak (OR =0.28; 95% CI: 0.13-0.62; P=0.001). In terms of clinical outcomes, there were no significant differences in stroke or death between the HALT group or the non-HALT group at 30 days or 1 year.

Conclusions: BAV was associated with higher risk of early HALT after TAVR, whereas the presence of HALT was not associated with stroke or death at 1 year. The underlying mechanisms and long-term prognosis of HALT after TAVR in patients with BAV remain to be further investigated.

Background: Aortic regurgitation (AR) is a common valvular disease, but data comparing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) for pure native AR are limited. The aim of this study is to provide more robust evidence for employing TAVR in patients with pure native AR.

Methods: This retrospective cohort study included 208 elderly patients (≥65 years) with pure native AR who underwent elective aortic valve replacement (SAVR or TAVR, all patients underwent TAVR procedure using the J-Valve™ system) between January 2018 and June 2023 at Beijing Anzhen Hospital, China. Safety and hemodynamic outcomes were assessed up to 3.1 years [interquartile range (IQR), 1.9-4.8 years], with propensity score weighting used to adjust for confounders.

Results: The median ages were 74.0 in the TAVR group and 68.0 in the SAVR group. SAVR patients were younger and had fewer comorbidities. The all-cause mortality in the TAVR group during the in-hospital period was significantly higher than the SAVR group after adjustment (15.8% vs. 6.6%; P=0.003), while there was no statistical difference in cardiac mortality between the two groups (4.3% vs. 3.3%; P=0.58). The TAVR group saw more adverse results in terms of the requirement for a permanent pacemaker (11.5% vs. 0.0%; P<0.001) and vascular complications (8.7% vs. 0.0%; P<0.001) during the in-hospital period after adjustment. No significant statistical difference all-cause stroke, acute myocardial infarction, and aortic valve redo both during the in-hospital period and follow-up. Before discharge, TAVR patients had significantly larger effective orifice area (EOA) [median 2.1 (IQR, 2.0-2.2) vs. 1.6 (IQR, 1.5-1.8) cm²; P<0.001] and EOA index [median 1.2 (IQR, 1.1-1.3) vs. 0.9 (IQR, 0.8-1.0) cm²/m²; P<0.001] compared to SAVR patients. The maximum aortic valve velocity [median 180.6 (IQR, 151.0-208.0) vs. 236.1 (IQR, 212.0-253.0) cm/s; P<0.001] and pressure gradient [median 13.9 (IQR, 9.0-17.0) vs. 23.2 (IQR, 19.0-27.0) mmHg; P<0.001] were also lower in the TAVR group before discharge. These hemodynamic advantages persisted during follow-up.

Conclusions: TAVR patients with pure native AR were older, had more comorbidities, and had higher Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores than SAVR patients. Cardiac mortality was similar between groups during hospitalization and follow-up. TAVR is a safe and effective treatment for elderly patients with pure native AR, providing superior hemodynamic performance and the potential for improved long-term outcomes.

Background: In Africa alone, 500,000 live newborns are born each year with congenital heart disease (CHD). Sub-Saharan Africa contributes a larger portion of these numbers. The prevalence of delayed diagnosis in Ethiopia is unknown. The aim of this study was to determine the magnitude of delayed diagnosis of CHD and associated factors at Tikur Anbessa Specialized Hospital (TASH).

Methods: This study was conducted in TASH at the Department of Pediatrics and Child Health from June 1 to October 30, 2023. TASH is the tertiary and largest hospital in the country, located in the capital city, Ethiopia. An appropriate diagnosis of CHD is usually made after referral to the hospital. A cross-sectional study design was employed. The data were collected via the KoboToolbox and exported to SPSS version 29 for analysis. Descriptive statistics were used to examine participants' sociodemographic, socioeconomic and clinical characteristics. Binary and multivariate logistic regression analyses were used to assess associations between variables.

Results: Out of 228 study participants, 121 (53.1%) had a delayed diagnosis of CHD. The majority of patients (n=39, 83%) with cyanotic heart diseases were diagnosed late. The proportion of delayed diagnoses among patients with acyanotic CHDs was 45.4% (n=82). The median age at diagnosis for patients with acyanotic CHD was 6 months [interquartile range (IQR), 1.5-24 months], whereas the median age at diagnosis for patients with cyanotic CHD was 9 months (IQR, 1.5-29 months). The probability of a delayed diagnosis of CHD was 2.34 [95% confidence interval (CI): 1.05-5.25], 4.47 (95% CI: 1.29-17.59), 2.79 (95% CI: 1.49-5.19) and 6.84 (95% CI: 2.86-16.34) times greater respectively for lack of optimal antenatal care (ANC) visits, no obstetric ultrasound, traditional birth attendant and cyanotic CHDs.

Conclusions: The magnitude of delayed CHD diagnosis was unacceptably high (53.1%). The factors associated with delayed diagnosis were ANC visits, obstetric ultrasound, type of birth attendant and type of CHD.

Background: Thoracic aortic fenestration is one of the methods employed for aortic arch reconstruction. To address the technical complexities of conventional fenestrated thoracic endovascular aortic repair (f-TEVAR) for aortic diseases involving the arch, we developed a streamlined approach using a novel physician-modified Relay nonbare stent graft (Terumo Aortic), eliminating the need for time-consuming marker suturing or guidewire-assisted fenestration alignment. This study evaluated the clinical application of this minimalist modification protocol.

Methods: This retrospective cohort study analyzed 33 patients undergoing minimalist f-TEVAR with Relay nonbare stent-grafts between January 2023 and December 2023 in Beijing Anzhen Hospital, with precise preoperative electrocardiography-gated, computed tomography angiography-guided fenestration planning being applied. The stent graft's proprietary self-alignment mechanism enabled marker-free orientation via its precurved design and 12/6 o'clock markers. Intraoperative modifications included partial deployment, low-temperature fenestration punching, and simplified resheathing with dual-layer delivery. The primary endpoints were technical success, stent-graft modification time, fluoroscopy time, procedure time, endoleak rate, procedure-related complications, length of stay, and 30-day and late mortality.

Results: The cohort (mean age 63.2±10.6 years; 75.8% male) comprised patients with variety of aortic diseases, including penetrating ulcers (42.4%), type-B dissections (27.3%), non-A non-B dissections (18.2%), and aneurysms (12.1%). The modified protocol proved to be efficient : the graft modification time was 6.8±1.8 minutes, the fluoroscopy exposure was 8.2±3.9 minutes, and the total procedure time was 57.9±13.1 minutes. All procedures achieved technical success (100%), with no instances of endoleak, retrograde dissection, or neurological complications. All patients survived after a mean follow-up of 12.6±3.7 months. Supra-arch branches were all patent by the end of follow-up.

Conclusions: Our experience demonstrates that the Relay nonbare stent-graft self-aligning design enables safe and efficient fenestration while maintaining excellent sealing properties and branch vessel patency. This stent-graft selection strategy provides a reliable foundation for simplified arch repair, potentially expanding the accessibility of complex endovascular aortic interventions.

Background: Aortopathies do not only occur in acquired heart disease but are often associated with congenital heart defects (CHD) or hereditary connective tissue disease (HCTD). Individuals diagnosed with these conditions have an increased risk of life-threatening events, such as aortic dissection or rupture. The diagnosis of an aortopathy or the occurrence of complications are life-changing and psychologically stressful events, possibly inducing post-traumatic stress symptoms (PTSS) and a reduced quality of life (QoL). This study aimed to estimate the prevalence of PTSS and QoL related to cardiological parameters in adults with aortopathies and CHD or HCTD.

Methods: This retrospective epidemiological cross-sectional study enrolled 137 adults with aortopathies and CHD or HCTD between May 2024 and October 2024. PTSS and QoL were assessed using the Posttraumatic Diagnostic Scale, the Impact of Event Scale-Revised, the Short Form-36, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The reasons for PTSS were explored using free-text responses. Descriptive analyses were performed to assess measures of central tendency and distribution. To examine differences and associations, non-parametric tests and Spearman's rank correlation were applied, and logistic regression models were used to further investigate medical and psychological associations.

Results: Overall, 5.8% (n=8) to 7.3% (n=10) of the enrolled patients [mean age: 41.1±10.8 (18 to 63) years; 54% women] showed elevated PTSS indicative of clinical concern related to their aortopathy. Between pre-existing psychological disorders and PTSS, a significant association could be observed (odds ratio: 9.71, P=0.007). Cardiac parameters were not significantly associated with developing PTSS. Free-text responses showed a wide range of distressing events, ranging from anxiety, pain or shock to physical limitations. Overall QoL was good, although patients with PTSS showed a lower QoL (MLHFQ: 12.30 vs. 21.90, P=0.004).

Conclusions: Despite the low prevalence of PTSS and generally good QoL, our findings underscore the importance of incorporating psychological screening into standard care for patients with CHD or HCTD with aortopathies. A holistic approach that goes beyond the medical management of aortopathies and includes comprehensive psychological support is essential in optimizing patient outcomes.

Background: The association between hepatitis B virus (HBV) infection and cardiovascular disease (CVD) remains uncertain. This study aimed to investigate the impact of HBV infection on 13 major adverse cardiovascular events (MACEs) among patients with CVD with or without statin use.

Methods: A prospective cohort study was conducted to examine the cardiovascular, metabolic [atherogenic index (AI) and atherogenic index of plasma (AIP)], hepatic [albumin-bilirubin index (ALBI) score and fibrosis 4 index (FIB-4)] and inflammatory parameters [complete blood count-derived inflammation indices (CBCIIs)] in patients with HBV-cardiovascular comorbidity. In total, 45,013 individuals participated in the baseline survey between June 2020 and August 2023 at The First Affiliated Hospital of Xi'an Jiaotong University. The patients were categorized into two groups according to their surface antigen status. Finally, a sample size of 496 participants was included in the study: patients with coexisting CVD and HBV (n=271) and patients with CVD alone (n=225). In hierarchical analyses, the Breslow-Day test assessed model conformance, while the Mantel-Haenszel test performed stratified Chi-squared testing. To control for potential confounders, logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for MACEs.

Results: HBV infection served as a protective factor of coronary heart disease (CHD) (OR =0.27; 95% CI: 0.12-0.60; P=0.001) and angina pectoris (AP) (OR =0.56; 95% CI: 0.36-0.86; P=0.008). Conversely, HBV infection elevated the risk of acute myocardial infarction (AMI) (OR =2.24, 95% CI: 1.40-3.57; P=0.001). Our study also suggests that statin therapy can lead to a dose-dependent decrease in liver fibrosis, and an increase in the atherogenicity index and systemic inflammatory response among patients with CVD.

Conclusions: Our findings suggest that patients with CVD who also have HBV infection may experience a reduction in MACEs when treated with statins. The observed improvements in hepatic function, atherosclerotic burden, and systemic inflammation associated with statin therapy may contribute to the favorable cardiovascular outcomes among individuals with CVD. This study demonstrates that in CVD patients infected with HBV, concurrent monitoring of metabolic and inflammatory parameters can help reduce the risk of MACEs. Future studies will focus on determining quantitative relationships between individual metabolic or inflammatory indicators and MACEs in larger cohorts.

Cardiac magnetic resonance (CMR) imaging has become a crucial diagnostic and prognostic tool for assessing myocardial health, especially in pediatric patients with congenital heart disease. This review focuses on the role of CMR in myocardial tissue characterization, particularly its ability to detect and quantify fibrosis using techniques such as late gadolinium enhancement (LGE), T1 and T2 mapping, and extra-cellular volume (ECV) measurements. CMR offers superior anatomical and functional information, complementing traditional imaging modalities by enabling detailed visualization of native myocardial edema, interstitial fibrosis, and other tissue changes. These advanced imaging techniques are particularly useful in diagnosing conditions such as myocarditis, cardiac allograft rejection, Kawasaki disease (KD), and other cardiomyopathic processes. In pediatric myocarditis, CMR has demonstrated strong diagnostic utility, with T1 and ECV values helping to differentiate between healthy controls and patients with acute myocarditis, while also predicting disease severity and outcomes. In the context of cardiac transplant, T1 mapping, shows promise in detecting early signs of rejection, providing a less invasive alternative to endomyocardial biopsy. Additionally, CMR has been employed to monitor myocardial damage in KD, where it detects increased ECV in both coronary-affected and remote myocardial areas. The review also discusses CMR's application in tracking myocardial fibrosis in pediatric cardiomyopathies, highlighting its potential as a prognostic marker for heart failure progression. Despite its advantages, challenges remain in standardizing imaging protocols across disease states and establishing comprehensive guidelines for routine use. The future of CMR in pediatric cardiology lies in its ability to improve early diagnosis, guide personalized treatment, and enhance long-term monitoring of heart conditions, ultimately improving patient outcomes.