Cardiovascular diagnosis and therapy最新文献

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.

Congenital heart defects (CHD) are the most common inborn cardiac anomalies, with approximately 1.35 million children born each year worldwide. Advances in medical treatment over recent decades have reduced mortality, yet morbidity remains high. Many patients now survive into adulthood but continue to have chronic heart disease and often develop complications such as heart failure, arrhythmias, pulmonary hypertension, and acquired cardiac and non-cardiac comorbidities, all of which require ongoing specialized care. Additionally, many adults with CHD (ACHD) lead a sedentary lifestyle, are overweight, and experience mental health issues, further affecting their well-being and quality of life. In this context, preventive, prehabilitative, and rehabilitative measures play an important role in reducing cardiovascular risks and enhancing overall quality of life. Preventive strategies aim to improve physical fitness, address health risks early, and support long-term well-being. Prehabilitation involves a structured, multimodal approach designed to strengthen physical and psychological resilience before planned medical interventions, thereby reducing complications and recovery times. Rehabilitation, on the other hand, facilitates recovery after treatment and promotes sustained health improvements over time. The German Pension Insurance provides programs aimed at enhancing physical fitness, promoting mental well-being, and improving quality of life, with a focus on maintaining employability and supporting occupational reintegration. However, available offerings are often not tailored to the specific needs of the heterogenous group of ACHD, limiting their potential effectiveness. The present article highlights the importance of cardiological prevention and prehabilitation in ACHD, focusing on the role of the German Pension Insurance system in helping affected adults remain employed and improve their quality of life. It explores how services can be better adapted to their needs and suggests that tailored programs, interdisciplinary collaboration, and ongoing research are essential for improving long-term outcomes in ACHD.

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.

Background: The association between the cardiometabolic index (CMI) and mortality in individuals with diabetes or prediabetes remains unclear. This study sought to explore the association between the baseline CMI and all-cause mortality and cardiovascular disease (CVD) mortality in United States (U.S.) adults with diabetes or prediabetes.

Methods: This cohort study examined the data of 17,992 individuals, aged 18 years and older, with diabetes and prediabetes, who had participated in the National Health and Nutrition Examination Survey (NHANES; 2003-2018). Kaplan-Meier curve, Cox proportional hazards model, and restricted cubic spline (RCS) curve analyses were conducted to explore the relationship between the CMI and all-cause mortality and CVD mortality. Subgroup and sensitivity analyses were conducted to check the robustness of the main findings.

Results: During 137,687 person-years of follow-up (median: 7.4 years), a total of 2,718 all-cause deaths and 891 CVD-related deaths were recorded. In the multivariate adjusted models, the CMI was positively associated with the risk of all-cause mortality and CVD mortality. Specifically, the hazard ratio (HR) estimates for all-cause death and 95% confidence intervals (CIs) for the low to high CMI quartiles were 1.00 (reference), 1.056 (0.875-1.274), 1.156 (0.912-1.464), and 1.42 (1.080-1.867), respectively. While the CVD mortality HRs were 1.00 (reference), 1.041 (0.768-1.41), 1.077 (0.771-1.503), and 1.29 (0.836-1.99), respectively. The RCS analysis showed that the baseline CMI was approximately U-shaped in relation to all-cause mortality (P_nonlinear<0.001) and CVD mortality (P_nonlinear=0.03) in the participants with diabetes and prediabetes. The subgroup analysis revealed a clear interaction between the CMI and all-cause mortality based on age and sex (P=0.01 and P=0.003, respectively). It also revealed a significant interaction between the CMI and CVD mortality based on smoking status and diabetes status (P=0.02 and P=0.01, respectively).

Conclusions: The CMI demonstrated predictive value for the risk of all-cause mortality and CVD mortality among U.S. participants with prediabetes and diabetes. The relationship between the CMI and long-term mortality exhibited an approximately U-shaped pattern, highlighting its potential as a robust indicator for mortality risk stratification in this population.

Background: Time-of-flight magnetic resonance angiography (TOF MRA) is a widely recognized noninvasive diagnostic tool of moyamoya angiopathy (MMA). 3.0 T TOF MRA may lack the precision needed to evaluate collaterals in MMA, whereas 5.0 T TOF MRA may enable better visualization of collateral vessels. This study compared the efficacy of 5.0 T and 3.0 T TOF MRA in assessing collateral circulation in patients with MMA.

Methods: A total of 21 patients diagnosed with MMA [male 11; mean age: 35 years (range, 18-57 years)] was included in this study. Qualitative assessments encompassed imaging of the terminal internal carotid arteries (ICAs), distal middle cerebral arteries (MCAs), moyamoya vessels (MMVs), and leptomeningeal anastomosis (LMA) collaterals, using digital subtraction angiography (DSA) as a reference. A semi-quantitative grading system was employed with both 5.0 T and 3.0 T MRI to assess MMV visibility and LMA collaterals, using MMV area scores and leptomeningeal system scores.

Results: The 5.0 T TOF MRA showed better scores for visualization of distal MCAs, MMVs, and LMA collaterals than 3.0 T TOF MRA (P<0.05 for both observers). The 5.0 T TOF MRA demonstrated superior detection capabilities. It showed higher MMV area scores, indicating better visibility of MMVs (z=4.41, P<0.001), and higher leptomeningeal system scores (z=3.72, P<0.001) compared to 3.0 T MRA.

Conclusions: The 5.0 T TOF MRA demonstrates potential as an assessment tool for MMA, providing enhanced visualization of abnormal vascular networks.

Background: Minimally invasive mitral valve surgery (MIMVS) has become the standard procedure for treating mitral valve pathologies. However, the existing cardiac risk model fails to consider the distinctive perfusion and ventilation techniques of MIMVS, leading to inaccurate prediction of perioperative risks. This study aimed to identify the perioperative risk factors for major adverse cardiovascular events (MACEs) in MIMVS and develop a predictive model based on these factors.

Methods: This single-center retrospective study recruited 480 patients undergoing MIMVS at Beijing Anzhen Hospital between April 2010 and May 2024 and collected data on 79 perioperative clinical variables. The primary outcome was MACE within 30 days postoperatively. Univariate Cox regression analysis was used to analyze the associations between variables and outcomes, whereas elastic net regression was used to develop a risk prediction model (CompliMit Score) for MACE. The model was validated using 200 bootstrap replicates.

Results: The 30-day MACE rate was 12%, and 31 clinical variables significantly correlated with MACE: 13 preoperatively, 9 intraoperatively, and 9 postoperatively. From these, we developed the CompliMit Score, which included 14 risk factors identified through elastic net regression. The CompliMit Score identified more high-risk patients for MACE than the European System for Cardiac Operative Risk Evaluation II {area under the curve: 0.92 [95% confidence interval (CI): 0.88-0.96] vs. 0.67 (95% CI: 0.59-0.75)}, and internal validation confirmed its superior predictive performance.

Conclusions: Factors influencing MIMVS prognosis included preoperative, intraoperative, and postoperative variables. The newly developed CompliMit Score effectively identified patients who are at high risk of perioperative MACE, thus facilitating targeted postoperative care and resource allocation.

Background and objective: Cardiovascular diseases, particularly coronary atherosclerosis, pose a major health burden, with plaque rupture and erosion contributing to acute coronary syndrome (ACS). Platelet adhesion and aggregation are key in thrombosis, making them critical therapeutic targets. This study aimed to elucidate the regulatory role of annexin A7 (ANXA7) in the progression of coronary atherosclerosis.

Methods: A literature review was performed using PubMed and Google Scholar. Clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews were considered. Articles published in languages other than English with limited text availability were excluded.

Key content and findings: ANXA7 plays a crucial role in coronary atherosclerosis by regulating endothelial stability, inflammatory metabolism, and Ca²⁺ mobilization, which influences platelet activation and lipid metabolism. Its potential to prevent thrombosis without impairing hemostasis may offer a breakthrough in platelet therapy for coronary artery disease (CAD).

Conclusions: As a multifunctional regulatory factor, ANXA7 participates in coronary atherosclerosis progression through calcium signaling modulation and inflammatory metabolic regulation, with its unique "antithrombotic without compromising hemostasis" property holding promise to overcome current therapeutic limitations in CAD. Further investigation into the role of ANXA7 in coronary atherosclerosis is crucial for elucidating its pathogenic mechanisms and exploring potential clinical applications.

Background: miRNA-29b affects angiogenesis and cardiac fibrosis, processes relevant to the pathophysiology of myocardial infarction (MI). This study aimed to investigate the accuracy of miRNA-29b in diagnosing acute myocardial infarction (AMI) and its association with postinfarction cardiac function.

Methods: A total of 106 patients with AMI admitted to the Department of Cardiology of Hebei General Hospital between January 2023 and July 2024 were prospectively enrolled within 24 hours of symptom onset. Indicators including circulating miRNA-29b levels [detected via real-time quantitative polymerase chain reaction (RT-qPCR)], myocardial enzymes, vascular endothelial growth factor (VEGF), and tumor necrosis factor-α (TNF-α) were assessed at baseline. Cardiac function was assessed by echocardiography. Left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVEDs), and left ventricular posterior wall thickness at end-diastole (LVPWd) and end-systole (LVPWs) were also measured. Based on echocardiography, patients with AMI (n=106) were divided into an abnormal cardiac function (ACF) group (LVEF <50%; n=50) or a normal cardiac function (NCF) group (LVEF ≥50%; n=56). Thirty healthy participants were selected as the control group. Variables were compared with independent samples t-tests. Correlation and receiver operating characteristic (ROC) curve analyses were also conducted.

Results: There was no significant differences in baseline demographic or clinical characteristics between the AMI and control groups; however, the control group, compared with the AMI group, had lower levels of low-density lipoprotein cholesterol (2.72±0.58 vs. 3.53±0.77 mmol/L; P<0.001) and fasting blood glucose (7.00±1.61 vs. 8.77±2.37 mmol/L; P<0.001). Moreover, the relative blood miRNA-29b expression was significantly lower in the AMI group than in the control group (0.31±0.16 vs. 0.73±0.40; P<0.01), and the expression was lower in the ACF group than in the NCF group (0.24±0.15 vs. 0.39±0.14; P<0.01). Correlation analysis showed that miRNA-29b was positively correlated with LVEF [r=0.608; P<0.001; 95% confidence interval (CI): 0.494-0.701] and LVFS (r=0.583; P<0.001; 95% CI: 0.448-0.702). Conversely, it was negatively correlated with cardiac troponin T (cTnT) level (r=-0.687; P<0.001; 95% CI: -0.769 to -0.610), creatine kinase-MB (r=-0.626; P<0.001; 95% CI: -0.744 to -0.488), VEGF (r=-0.581; P<0.001, 95% CI: -0.708 to -0.422), TNF-α (r=-0.527; P<0.001; 95% CI: -0.658 to -0.369), LVEDd (r=-0.451; P<0.001; 95% CI: -0.578 to -0.284), and LVEDs (r=-0.462; P<0.001; 95% CI: -0.593 to -0.330). ROC analysis indicated good diagnostic performance of miRNA-29b for AMI [area under the curve (AUC) =0.853; 95% CI: 0.767-0.939], and miRNA-29b also showed predictive value for post

Background: Pain is one of the most important symptoms affecting quality of life in patients with venous malformations. Alcohol embolization is a common approach among other treatment modalities. However, the benefits and complications of this therapy require rigorous evaluation in the face of emerging alternative treatments. The aim of this study was to evaluate the efficacy of alcohol embolization in pain management compared with non-invasive treatment, and to explore associated complications.

Methods: We performed a retrospective, comparative study at the Vascular Malformation Center, University Hospital of Bern, from 2008 to 2022. Consecutive patients with peripheral venous malformations were included, one group underwent alcohol embolization and the other group received non-invasive treatment including counseling for compression stockings, physical therapy and anticoagulation. Decision to treat was made jointly by the clinician and the patient, after discussing the potential harms and benefits. Pain levels were measured using the 0-10 Numerical Rating Scale on every scheduled visit. Inverse probability of treatment weights were used to adjust for confounders such as severity of malformation indicated by number of tissues affected, localization, presence of hypertrophic tissue, history of thrombophlebitis, age, and level of pain at the initial visit. The primary outcome was change in maximal pain level, and secondary outcomes included changes in mean and minimal pain levels within 1 year of follow-up.

Results: A total of 227 patients were included in the analysis, 86 in the intervention group and 141 in the control group. Over the course of one year, both the control and alcohol embolization groups experienced reductions in pain. The control group showed a reduction in maximal pain from 4.42 by 0.95 points, with an additional non-significant reduction of 0.99 points in the alcohol embolization group [estimate: -0.0027 per day, 95% confidence interval (CI): -0.0061, 0.0007, P=0.12]. However, alcohol embolization led to a more pronounced and significant reduction in mean and minimal pain, with additional reductions of 1.06 (-0.0029 per day, 95% CI: -0.0055, -0.0003, P=0.02) and 0.69 points per year (-0.0019 per day, 95% CI: -0.0035, -0.0004, P=0.01), respectively. Seven minor and five major complications occurred in the alcohol embolization group.

Conclusions: Non-invasive treatment helps patients with venous malformations to manage maximal pain effectively. Alcohol embolization results in a faster and more pronounced reduction in mean and minimal pain levels, but we found no statistical evidence of an advantage of alcohol embolization for reducing maximal pain. Treatment efficacy did not appear to be influenced by gender, age, or previous treatment history. To adequately assess the efficacy of new therapies, future trials should include both disease-specif