Cardiovascular diagnosis and therapy最新文献

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.

Background: There is a lack of evidence on association between gender specific differences in obesity and cardiovascular risk after isolated surgical aortic valve replacement (AVR) and its impact on outcomes and long-term survival. The aim of this study was to assess the impact of obesity on perioperative outcomes and long-term survival after isolated AVR.

Methods: In this retrospective, single-centre study, we included all patients who underwent isolated AVR between April 2000 and December 2019 from the cardiac surgery database of the Southampton General Hospital (Patient Administration System, e-CAMIS, Yeadon, Leeds, UK). Patients with infective endocarditis, re-sternotomy, other concomitant cardiac procedures, homografts, autografts and emergency operations were excluded. Univariable regression analysis was performed to identify predictors of in-hospital mortality. Hazard ratios were calculated using a Cox proportional hazards model.

Results: Total of 2,398 patients were included in the study and two groups of patients were compared: body mass index (BMI) 25-34.9 kg/m² (n=2,000) and BMI ≥35 kg/m² (n=398) based on sensitivity modelling. Actuarial survival was comparable across BMI groups at 12.5and 12.7 years for BMI 25-34.9 kg/m² and BMI ≥35 kg/m², respectively (P=0.75 log-rank). Long-term survival was specifically worse for patients with high BMI and composite cardiovascular risk of hypertension, diabetes mellitus, and current smoking [hazard ratio (HR) 1.93, 95% confidence interval (CI): 1.45-2.58, P<0.001] and patients with moderate-to-severe patient prosthesis mismatch (PPM) (effective orifice areas index ≤0.85 cm²/m²) (HR 1.17 95% CI: 0.98-1.39, P=0.08). Median survival time for females was 11.5 years [interquartile range (IQR): 10.3-12.3 years] versus 14.2 years (IQR: 12.7-15.7 years) for males (log-rank P=0.006), although gender was not a significant predictor of long-term survival after adjusting for covariates. Moderate-severe PPM was associated with significantly worse survival in females (log-rank P<0.01), compared to males for whom this difference was not significant (log-rank P=0.21).

Conclusions: Obesity with composite risk factors (hypertension, diabetes mellitus and active smoking) is associated with adverse survival. We did not observe gender-specific differences in long-term survival among specific BMI groups of patients.

Background: In intensive care units (ICUs), managing septic shock requires maintaining adequate tissue perfusion with vasopressors, most commonly norepinephrine, while avoiding under or over-dosing that can worsen hypotension, organ injury, and adverse effects. Bedside vasopressor titration often depends on clinician judgment and simple rules, with limited tools providing individualized, time-aware guidance or early warning of impending hypotension. ChronoSynthNet aimed to create a data-driven model that learns from routine electronic health record (EHR) time-series data to personalize vasopressor therapy and anticipate deterioration. To develop and validate a dual-task deep learning model that predicts real-time norepinephrine requirements and detects hypotension early in adults with septic shock.

Methods: We performed a retrospective cohort analysis using the Medical Information Mart for Intensive Care [MIMIC-IV (2008-2019)] database. Eligible adult ICU stays met Sepsis-3 criteria, received norepinephrine, and had adequate time-series data. ChronoSynthNet integrates a shared Transformer encoder, long short-term memory (LSTM) layers, and a dynamic feature-weighting network to learn cross-variable and temporal relationships. The dataset was split 80/20 into training and internal test sets, with five-fold cross-validation on training data. Classification performance for early hypotension detection was assessed using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), precision, recall, and specificity; norepinephrine rate prediction performance was assessed using mean squared error (MSE). Ninety-five percent confidence intervals (95% CIs) were calculated for AUROC, recall, and specificity on the internal test set using bootstrap and Wilson methods.

Results: ChronoSynthNet achieved AUROC of 0.89 (95% CI: 0.836-0.938) for hypotension classification and MSE of 0.0213 (95% CI: 0.0192-0.0234) for predicting the norepinephrine infusion rate. The model demonstrated high specificity (97%, 95% CI: 96.3-98.3%) and precision (92%, 95% CI: 90.3-93.7%), with a recall of 74% (95% CI: 71.3-76.7%). Hypotension events were predicted a median of 3.5 hours in advance.

Conclusions: ChronoSynthNet demonstrated strong performance in early hypotension detection and norepinephrine dose forecasting in ICU patients with septic shock. These findings support its potential role in aiding real-time vasopressor titration and early recognition of hemodynamic instability; prospective multicenter validation is needed before clinical deployment.

Background: Vascular calcification (VC) is a common high-risk factor for cardiovascular disease and is mainly caused by the deposition of calcium (Ca²⁺), phosphorus, and other minerals on the walls of arteries and veins; however, its specific pathogenic mechanism is still unclear. The aim of the present study was to explore the effect of large-conductance calcium and voltage-activated potassium (BK) channels in regulating VC.

Methods: In this study, primary vascular smooth muscle cells (VSMCs) isolated from the rat or murine thoracic aorta were treated with calcifying media and NS1619 and 3-methyladenine (3-MA) and divided into the following five groups: (I) the control group; (II) the control + NS1619 group; (III) the calcify group; (IV) the calcify + NS1619 group; (V) the calcify + NS1619+3-MA group. Twelve male C57BL/6 mice (20-25 g) were treated with vitamin D and NS1619 and divided into the following four groups: (I) the control group; (II) the vitamin D model group; (III) the vitamin D +5 mg/kg NS1619 group; and (IV) the vitamin D +10 mg/kg NS1619 group. Gene expression, protein expression and the size and concentration of MVs were tested by quantitative polymerase chain reaction (qPCR), Western blot (WB), immunohistochemistry and nanoparticle tracking analysis (NTA), respectively.

Results: We found that BK channels regulate VC. BK channel downregulation was observed in samples from animal and cell models of VC. Both the application of the BK channel agonist NS1619 and BK overexpression modulated the expression of Runt-related transcription factor 2 (Runx2) and alpha-smooth muscle actin (α-SMA) by suppressing matrix vesicles (MVs) formation and secretion, consequently improving VC in VSMCs. However, intervention with the autophagy inhibitor 3-MA appeared to regulate the secretion of MVs and simultaneously weakened the therapeutic effect of NS1619 on calcification.

Conclusions: Although our experimental sample size is small, we still speculate that BK channel agonists might inhibit the secretion of MVs by activating autophagy, thereby alleviating VC. BK channels may be applied in clinical practice and become a potential target for treating VC.