Cardiovascular diagnosis and therapy最新文献

Background: The safety of administering vasopressors through peripheral venous catheters (PVCs) remains controversial, primarily due to concerns regarding extravasation, thrombosis, and catheter-related infections. This study aimed to systematically summarize the prevalence of these complications through a meta-analysis.

Methods: The PubMed, Excerpta Medical Database (Embase), Cochrane Library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Wanfang (WF), Chinese Science and Technology Journal Database (VIP), and China Biology Medicine disc (CBMdisc) databases were systematically searched (from database establishment 16 August 2025) to retrieve pertinent articles, and study quality was rated via the Joanna Briggs Institute (JBI) scale and Newcastle-Ottawa Scale (NOS). The data analysis was conducted using the meta package in R, and random/fixed-effects models were applied to combine the complication rates based on heterogeneity. Sensitivity and subgroup analyses were also carried out.

Results: A total of 19 studies comprising 6,852 patients across 10 counties, including Sweden, the USA, and China, were encompassed in the meta-analysis, with the majority being intensive care unit (ICU) patients. The overall rates of extravasation, thrombosis, and infection were 1.43% [95% confidence interval (CI): 0.72-2.32%; I²=71%], 1.47% (95% CI: 0.32-3.18%; I²=86%), and 0.72% (95% CI: 0.14-1.60%; I²=63%), respectively. The subgroup analysis peripherally inserted central catheters (PICCs) carried a higher risk of thrombosis, while midline catheters (MCs) had the lowest risk of extravasation. In relation to the catheter-related infection risks, PVCs showed the lowest incidence, whereas PICCs had the highest. Limited direct comparative evidence indicated no statistically significant differences between PVCs and central venous catheters (CVCs).

Conclusions: Under standardized procedures, PVCs may be a viable option for vasopressor infusion, particularly MCs, which showed the lowest risk of extravasation. Caution is warranted with PICCs due to the potential risk of thrombosis, while traditional PVCs should be limited to short-term or emergency use. Future well-designed studies with standardized definitions are needed to strengthen the reliability and clinical applicability of the evidence.

Background: Hemoptysis is a prevalent symptom among patients with respiratory diseases, and those experiencing hemoptysis from non-bronchial artery sources are particularly susceptible to recurrence following treatment. This study aimed to evaluate the therapeutic effect of angiogram computed tomography (Angio-CT) on bronchial artery embolization (BAE) in patients with non-bronchial systemic arteries (NBSA).

Methods: This retrospective study included a total of 100 patients experiencing hemoptysis due to various etiologies between January 2020 and June 2024 in Huazhong University of Science and Technology Tongji Medical College Affiliated Union Hospital. The patients were divided into two groups: BAE treatment combined with Angio-CT group (n=60); Conventional BAE treatment group (n=40). A total of 26 and 14 patients in each group experienced hemoptysis attributed to NBSA. Clinical data were recorded, including age, gender, volume of hemoptysis, etc. Hemoptysis-free survival and overall survival were illustrated using Kaplan-Meier curves. The log-rank test was used to assess the differences in hemoptysis-free survival and overall survival between the two groups.

Results: Technical success was achieved in all patients. There were no statistical differences in clinical success rate (90.0% vs. 91.7%, P=0.78). The difference in recurrence rates between the two patient groups is statistically significant (11.7% vs. 27.5%, P=0.04). And among patients with NBSA, the Angio-CT group exhibited a higher recurrence rate without hemoptysis compared to the traditional BAE group (P=0.04). In contrast, there was no significant difference in recurrence rates between the two groups of patients without NBSA (P=0.68).

Conclusions: The application of Angio-CT in guiding the treatment of NBSA-related hemoptysis offers superior clinical outcomes compared to conventional approaches. These findings could provide valuable evidence for refining therapeutic strategies, ultimately improving patient management in hemoptysis cases.

Background and objective: Atrial fibrillation (AF) is an independent risk factor for ischemic stroke and systemic thromboembolism. Oral anticoagulation (OAC) effectively reduces stroke risk but also increases bleeding risk. Current clinical risk scores for bleeding in AF patients have only modest predictive ability and overlapping stroke and bleeding risk factors complicate treatment decisions. This narrative review aims to review and evaluate current evidence on biomarkers that can predict bleeding risk in AF patients on OAC and assess their integration into risk-scoring systems to guide more personalised clinical decision-making.

Methods: This narrative review summarises data from major clinical trials and cohort studies evaluating bleeding-related biomarkers in AF patients on OAC, including growth differentiation factor 15 (GDF-15), high-sensitivity cardiac troponin (hs-cTn), N-terminal prohormone-brain natriuretic peptide (NT-pro-BNP), interleukin-6 (IL-6), von Willebrand factor (vWF), cystatin C, and D-dimer. The prognostic value of these biomarkers, their role in risk scores (e.g., ABC-bleeding), and their ability to improve predictive accuracy were examined.

Key content and findings: In recent years, several biomarkers have shown promise in predicting bleeding risk in patients with AF on OAC. GDF-15 has consistently emerged as a strong independent marker of significant bleeding and mortality, validated in trials such as Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY), Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE), and Edoxaban Versus Warfarin in Patients with Atrial Fibrillation trial (ENGAGE AF-TIMI 48). hs-cTn and D-dimer levels are also independently associated with an increased bleeding risk and have been included in the ABC-bleeding score, which has shown superior predictive ability compared to traditional scores, such as HAS-BLED. Biomarkers such as cystatin C, which reflects renal dysfunction, vWF, and IL-6 have demonstrated associations with adverse outcomes, although their predictive abilities vary. The inclusion of these biomarkers in clinical tools has improved bleeding risk prediction. Although trials and cost-effectiveness models suggest clinical benefit, further real-world validation is required to confirm their place in everyday clinical practice.

Conclusions: Several biomarkers have demonstrated the ability to predict bleeding risk in patients with AF. Risk-scoring systems that incorporate biomarkers have improved the prediction of bleeding events. More accurate identification of patients at higher risk of bleeding allows clinicians and patients to better balance the risks of bleeding versus stroke in the setting of AF and create individualised care plans to lower the overall rate of both stroke and bleeding.

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.