Cardiovascular diagnosis and therapy最新文献

Background: Preserving the pulmonary valve during tetralogy of Fallot (TOF) repair via a right subaxillary approach is important as it reduces pulmonary regurgitation, maintains right ventricular function, and minimizes long-term complications, thereby improving patient outcomes. It is also innovative as it combines minimally invasive techniques with advanced surgical precision, offering better cosmetic results and expanding surgical options for complex congenital heart defects. This study aimed to evaluate the clinical outcomes of right subaxillary mini-incision procedures for TOF transatrial repair with pulmonary valve preservation.

Methods: The cases of 20 pediatric patients diagnosed with TOF who underwent right subaxillary mini-incision transatrial repair with pulmonary valve preservation at the Sixth Medical Center of the Chinese People's Liberation Army General Hospital from August 2020 to February 2022 were reviewed. The patients included 14 males and six females, with a mean age of 41.8±34.9 months, body weight of 14.6±6.2 kg, body surface area of 0.67±0.24 m², McGoon ratio (echocardiography) of 1.9±0.4, and McGoon ratio [cardiac computerized tomography (CT)] of 1.9±0.3. T-tests were used, with a one-tailed P value of <0.05 considered statistically significant. The primary outcome measures included pressure gradients across the pulmonary valve and right ventricular outflow tract (RVOT), assessed immediately postoperatively and at 1 week, 3, 6, and 12 months. The secondary outcome measures included mortality rate and the degree of pulmonary valve regurgitation. Postoperative follow-up includes regular telephone calls and outpatient visits at 3, 6, and 12 months thereafter to monitor cardiac function, pulmonary valve performance, and overall recovery.

Results: All 20 patients survived the procedure and were discharged uneventfully, with no severe complications during hospitalization. Median cardiopulmonary bypass (CPB) time is 139 minutes (range, 77-334 minutes), and median aortic clamp time is 105 minutes (range, 44-242 minutes). The significant decreases were observed postoperatively in mean pressure gradients across the RVOT (6.1±3.2 vs. 45.6±33.4 mmHg, P<0.05) and the pulmonary valve (19.0±12.3 vs. 59.4±27.7 mmHg, P<0.05). The mean pulmonary subvalvular diameter was significantly wider (13.0±2.7 vs. 5.5±3.6 mm, P<0.05), and all the pulmonary and tricuspid valves demonstrated mild insufficiency. The median follow-up was 11.6 months (range, 3.1-20.8 months), and the follow-up rate was 100% (20/20). No major complications occurred during this period, and all patients recovered well.

Conclusions: The right subaxillary mini-incision procedure is technically feasible for TOF transatrial repair with pulmonary valve preservation. This technique may offer advantages including reduced trauma, faster recovery, shorter ho

Background: Coronary artery fistula (CAF) is a rare vascular anomaly characterized by an abnormal shunt originating from a coronary artery and terminating at an atypical endpoint, typically involving dilated and tortuous vessels. The increased shunt flow can lead to a "coronary steal" phenomenon, resulting in angina pectoris. At present, the complications of CAF other than fistula steal need to be paid more attention, especially aneurysm rupture, thrombosis, and myocardial infarction. CAF may be accompanied by aneurysms, but it is seldomly reported that the aneurysm is giant with thrombosis and possibly relevant to myocardial infarction.

Case description: A 51-year-old female who presented stomachache, chest pain, and palpitation had been indicated as having right coronary artery (RCA)-right ventricle (RV) fistula by echocardiography four years prior. Echocardiography showed dilatation of the RCA and a hypoechoic mass originating from the RCA, with left-to-right septal shunt at the atrial septum. Coronary computed tomography angiography (CCTA) examinations showed a dilated RCA, and a mass which compressed the RV, together with contrast filling defects. The follow-up CCTA four years later revealed nodular calcification of the aneurysm and cinematic rendering reconstruction showed that the aneurysm appeared as a fruit growing on the coronary artery tree. Further cardiac magnetic resonance (CMR) revealed a mass located at the right atrioventricular sulcus, and deformation of the RV with preserved biventricular ejection fraction. Subendocardial late gadolinium enhancement of the basal inferior wall suggested myocardial infarction. Subsequent surgical procedures confirmed and closed the RCA-RV fistula and an aneurysm, as well as the atrial septal defect (ASD). The patient was free of cardiovascular events during the follow-up of 1 year and 3 months.

Conclusions: This case of CAF accompanied by a giant aneurysm with thrombus formation suggested critical value of multimodal imaging, especially cinematic volume rendering reconstruction and multiparametric CMR imaging in the follow-up, preoperative assessment, and complication evaluation.

Background: Exosomes show promise as biomarkers for essential hypertension (EH) progression and complications. However, existing studies on dysregulation of exosomal biomarkers in hypertension lack consistency. Thus, we conducted a comprehensive systematic review to synthesize evidence on exosomal biomarkers associated with EH.

Methods: We performed an exhaustive search across PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and Chinese Clinical Trial Registry. Our search encompassed all available Chinese and English records from their inception through August 14^th, 2025, without any restrictions on study design. The primary outcome focused on exosomal microRNA (miRNA) alterations, with secondary analyses of other cargo types (e.g., proteins). We employed the Joanna Briggs Institute (JBI) critical appraisal tool and the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to assess the risk of bias. Due to the limitations of the data in the included studies, we conducted a qualitative narrative synthesis to summarize key study characteristics and synthesize their principal findings. The protocol was prospectively registered on PROSPERO (CRD42023470885).

Results: The qualitative analysis included 11 identified studies, which revealed moderate-to-high methodological quality (JBI: 6 moderate, 4 high), with one study exhibiting a moderate risk of bias (ROBINS-I). This systematic review revealed that exosomal biomarkers in blood and urine had diagnostic potential for hypertension and its complications. Evidence suggested that exosomal biomarkers were associated with hypertensive vascular dysfunction (e.g., increased miR-320d/423-5p) and may provide a molecular basis for precise typing of hypertension (platelet-derived extracellular vesicles). Notably, exosomal biomarkers may serve as indicators of target organ damage, reflecting early renal injury (decreased miR-26a-5p) and cognitive dysfunction (decreased miR-330-3p) in hypertension.

Conclusions: This systematic review highlights the value of blood and urine exosomal biomarkers in the early diagnosis, precise typing, and monitoring of target organ damage in hypertension and its complications. Future studies should systematically compare exosomal biomarkers with conventional markers using standardized protocols. Methodological improvements should focus on expanding larger sample sizes, enhancing reporting completeness and transparency, and standardizing data-sharing practices.

Distal radial access (DRA) is a relatively novel approach in interventional cardiology and represents an evolution of transradial techniques. This approach involves accessing the distal radial artery (DRart) in the anatomical snuffbox, offering an alternative to traditional radial and femoral access, with demonstrated benefits over conventional transradial access (TRA), such as a lower rate of radial artery occlusion, shorter hemostasis time, and improved patient comfort. DRA is technically more demanding compared to TRA. The smaller size of the DRart and the anatomical landmarks that surround it make it more difficult to cannulate, especially for operators who are less experienced with the approach. This increased difficulty can result in higher initial failure rates and longer procedural times, all of which contribute to a steeper learning curve. This review aims to provide a comprehensive guide to the use of DRA for the interventional cardiologist to take full advantage of the approach by summarizing current evidence and experienced operator recommendations, focusing on practical recommendations on techniques to improve procedural success, minimize complications, and optimize results.

Background: Spontaneous coronary artery dissection (SCAD) is a poorly-studied cause of acute coronary syndrome (ACS), particularly in women. SCAD is a rare cause of ACS that can lead to myocardial injury due to SCAD. This review evaluates optimal antiplatelet therapy for SCAD patients. There is no clear consensus regarding the optimum antiplatelet medication regimen and treatment duration for SCAD despite current American Heart Association (AHA) consensus guidelines recommending 12-month regimen of dual antiplatelet therapy (DAPT) consisting of a P2Y12 inhibitor and aspirin for patients following myocardial infarction (MI). The objective of this study was to evaluate the safety and effectiveness of DAPT compared to using a single antiplatelet therapy (SAPT) as part of the medical armamentarium to treat SCAD.

Methods: This review included only observational studies published in English and excluded randomized controlled trials. A comprehensive search of PubMed, Ovid, and SCOPUS was conducted to identify studies that examined SCAD outcomes including mortality, recurrence, and major adverse cardiovascular events (MACEs) between 2000-2023 after antiplatelet therapy was administered. Based on the documentation in various studies, only 17 relevant studies were identified in which SAPT (primarily aspirin) and DAPT (aspirin combined with a P2Y₁₂ inhibitor) were administered. SCAD for SAPT and DAPT groups were analyzed by calculating the mean, standard deviation (SD), range, and 95% confidence intervals (CIs). Results were reported as mean ± SD, with CIs indicating precision. Studies lacking comprehensive data on concurrent cardiovascular medication use (e.g., beta-blockers, statins) or key outcome measures were excluded.

Results: DAPT treatment was associated with a worse prognosis than SAPT 12 months after patients presented with SCAD. A key observation was the prevalence of antiplatelet treatment in SCAD patients, with DAPT prescribed in the majority of cases. DAPT demonstrated significantly higher rates of mortality (4.96% vs. 1.55%), MACE (12.13% vs. 6.91%), and hospitalizations for angina (23.75% vs. 2.60%) compared to SAPT. SCAD recurrence was also more frequent in the DAPT group (5.54% vs. 2.33%). These adverse outcomes, primarily driven by increased non-fatal MI and unplanned percutaneous coronary interventions (PCIs), highlight the challenges of DAPT in SCAD management.

Conclusions: In patients treated with antiplatelet therapy, adverse events that include unstable angina, mortality, and repeat revascularization were greater in patients with more aggressive antiplatelet therapy consisting for safety and efficacy of DAPT compared with these treated with SAPT.

Background: The impact of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) on myocardial function remains controversial. This study aims to evaluate changes in myocardial function following CTO-PCI using cardiac magnetic resonance (CMR) imaging and to identify the patient subgroups that derive the greatest benefit from CTO artery recanalization.

Methods: We retrospectively screened 652 patients diagnosed with single-vessel CTO through coronary angiography at Beijing Anzhen Hospital between December 2014 and July 2023. Among these, 303 patients underwent baseline CMR imaging, and 115 completed follow-up imaging. A total of 108 patients met the inclusion criteria, with 71 receiving PCI and 37 undergoing optimal medical therapy (OMT). Myocardial viability and cardiac function indices, including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and late gadolinium enhancement (LGE) were assessed using CMR. In the subgroup analysis, patients were categorized by LVEF based on clinical consensus (normal: ≥50%; decreased: <50%). Paired t-tests or non-parametric tests were used to compare pre- and post-treatment cardiac function, and Cox regression analysis was performed to identify factors influencing myocardial functional recovery.

Results: There were no significant differences between the PCI and OMT groups in baseline characteristics, including age (56.96±10.69 vs. 54.16±11.32 years, P=0.21) and gender distribution [57 (80.3%) vs. 33 (89.2%), P=0.24]. No differences were observed between the PCI and OMT groups in LVEF (61.00%±9.40% vs. 59.68%±9.33%, P=0.50), LVEDV (126.53±31.41 vs. 125.93±29.26 mL, P=0.93), or LVESV [47.09 (35.22, 61.11) vs. 51.41 (36.73, 62.07) mL, P=0.68] at a median follow-up time of 12 months. Additionally, no changes in LVEF, LVEDV, or LVESV were found following PCI (P>0.05). However, in patients with baseline LVEF <50% and segmental LGE ≤50%, LVEF improved post-PCI [46.93% (40.14%, 47.49%) vs. 61.13% (47.48%, 64.54%), P=0.01]. In patients with baseline LVEF <50% and segmental LGE >50%, LVEF was not significantly affected by PCI [43.22% (40.23%, 45.54%) vs. 46.03% (40.75%, 59.06%), P=0.11]. Patients with LVEF ≥50% showed no myocardial function improvements post-PCI, regardless of segmental LGE percentages (P>0.05).

Conclusions: Baseline LVEF and myocardial viability assessed via quantitative CMR imaging before CTO-PCI may help select patients who will benefit from the procedure. Although overall LVEF did not improve following CTO-PCI, patients with baseline LVEF <50% and segmental LGE ≤50% benefited more, suggesting the procedure can enhance myocardial function recovery in certain patient groups and confirming the safety and efficacy of CTO-PCI.

Background: Cardiac rehabilitation (CR) has been shown to be an effective treatment for patients with heart failure (HF). However, the effect of different modes of CR delivery on HF remains unclear. The purpose of this study is to perform a large-scale pairwise and network meta-analysis (NMA) on the impact of various exercise types on patients with HF using multiple indicators.

Methods: Randomized controlled trials (RCTs) published between 2000 and October 2023 were systematically searched in PubMed (Medline), the Cochrane Library and Web of Science. Statistical analysis was performed by STATASE16 with the network pack. The primary outcomes focused on functional capacity and health-related quality of life (QoL), such as peak VO₂, six-minute walk test (6MWT), maximum workload, left ventricular ejection fraction (LVEF), maximum heart rate (MHR), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores. All relevant studies reported well-defined or accessible exposures and presented clear data on any one or more of the six items above before and after exercise rehabilitation.

Results: In total, 122 RCTs were ultimately included in the final analysis. Pairwise analyses revealed aerobic training (AT) can improve peak VO₂ (2.49 mL/kg/min) and LVEF (2.97%). High-intensity interval training (HIIT) was associated with an improvement in peak VO₂ (3.91 mL/kg/min), LVEF (6.68%), 6MWT (65.4 m) and MLHFQ score (-10.34). As shown in the NMA, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for peak VO₂, was HIIT (SUCRA: 90.8%), strength training (ST) (74.7%), AT (64.4%), combined training (CT) (41.7%) and inspiratory muscle training (IMT) (18.3%). The order of effectiveness for LVEF based on SCURA values was HIIT (90.5%), AT (77.8%), CT (50.3%), ST (49.9%) and IMT (7.7%).

Conclusions: Various types of exercise, especially HIIT, can improve QoL, cardiac function, LVEF, and exercise tolerance in patients with HF. The results of this analysis should inform future exercise guideline personalized recommendations and prescriptions for HF patients.

Background: While mitral annular disjunction (MAD) is associated with mitral valve prolapse (MVP) and ventricular arrhythmia (VA), its prevalence and clinical implication in subjects with normal heart remain unclear. Therefore, this study aimed to assess the incidence and characteristics of MAD in apparently normal hearts (ANH) confirmed by comprehensive cardiac magnetic resonance (CMR), and to explore its impact on myocardial contraction and potential association with VA.

Methods: This retrospective cohort study was conducted on 444 patients who underwent CMR at a tertiary care center between January 2017 and March 2023. The study included both outpatient and inpatient individuals, who were consecutively enrolled. These patients were divided into two cohorts: a primary cohort consisting of 374 ANH individuals, and a control cohort of 70 isolated MVP patients. MAD was assessed by two radiologists on CMR. Demographic characteristics and medical history were collected from an electronic medical record database. The endpoints were composite events, defined as sudden cardiac deaths (SCD), aborted SCD, ablation therapy for VA, and implantation of an implantable cardioverter-defibrillator (ICD). Cardiac function parameters were analyzed using cvi42 software. The key statistical analysis was performed using the univariate and multivariate logistic regression. A P value <0.05 was considered statistically significant.

Results: The final analysis included 374 ANH individuals [185 female (49.5%)] with an average age of 35.5±16.1 years (range, 9-76 years). The prevalence of MAD in the ANH group was 43.9%, commonly located at the anterior (7.4%), antero-lateral (6.5%) and inferior wall (41.7%), and was infrequent at the inferolateral wall (2.7%). There were no statistically significant differences in the history of syncope and hypertension between ANH individuals with and without MAD (P=0.83 and P=0.45, respectively). There were 131 patients (35.0%) experienced VA in the 374 ANH individuals. Multivariable logistic regression analysis showed that VA and female sex were independently associated with MAD (P=0.001 and P=0.03, respectively), while cardiac strain parameters were not (all P>0.05). The ANH patients with VA, when compared to those without VA, showed a higher frequency of inferolateral MAD (5.2% vs. 1.3%, P=0.04) and a longer MAD (3.1±1.1 vs. 2.2±1.5 mm, P=0.006), respectively, and these two factors were independently associated with the higher risk for VA.

Conclusions: MAD is a common finding in normal adult hearts when assessed by CMR. Although MAD at the inferolateral wall is rare, it is found to be associated with VA. Based on our findings, further investigation may be warranted for patients with MAD at the inferolateral wall, particularly when arrhythmic symptoms are present.