Reviews in cardiovascular medicine最新文献

{"title":"ECG Screening in Athletes: A Systematic Review of Sport, Age, and Gender Variations.","authors":"Adela Caramoci, Alina Maria Smaranda, Teodora Simina Drăgoiu, Ioana Anca Bădărău","doi":"10.31083/RCM38209","DOIUrl":"10.31083/RCM38209","url":null,"abstract":"<p><strong>Background: </strong>The electrocardiogram (ECG) screening in athletes is essential due to the unique cardiac adaptations induced by intensive training. However, differentiating between physiological adaptations and pathological abnormalities remains a significant challenge, particularly when considering variations across different sports, ages, and genders.</p><p><strong>Methods: </strong>A systematic review of observational studies published between 2015 and 2025 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted from 20 studies examining ECG changes in athletes across endurance, strength, and mixed sports, encompassing both adolescent and adult populations.</p><p><strong>Results: </strong>Commonly observed ECG changes included increased QRS amplitude, T-wave inversions, and sinus bradycardia, particularly in endurance athletes, while strength-based athletes frequently exhibited left ventricular hypertrophy. Male athletes showed higher QRS voltages, longer QRS durations, and higher PR intervals, whereas female athletes demonstrated elevated resting heart rates and prolonged corrected QT interval (QTc) intervals. Adolescents who engaged in regular sports displayed fewer abnormal ECG findings than adults; however, high-intensity training in adolescent athletes was associated with right atrial enlargement and increased P-wave duration. Detraining effectively reversed certain ECG changes, including prolonged QT intervals and T-wave abnormalities, though these changes often reappeared upon resumption of intense training. Notably, <i>de</i> <i>novo</i> ECG abnormalities, such as T-wave inversions and ST-segment depression, were identified in athletes with post-COVID-19 infections. This review also highlights the financial burden of widespread ECG screening, but reinforces the importance of ECG screening in preventing sudden cardiac death (SCD) through comprehensive cardiac evaluations.</p><p><strong>Conclusion: </strong>This review emphasizes the complexity of ECG interpretation in athletes, highlighting sport-specific, gender-based, and age-related variations. The persistent high false-positive rates underscore the need for refined, sport-specific ECG guidelines. Recent recognition of sports medicine as a primary specialty within the European Union (EU) reinforces the importance of comprehensive physician training. Integrating artificial intelligence (AI) technology into ECG screening can enhance diagnostic accuracy, reduce costs, and facilitate large-scale implementation. Meanwhile, collaborative efforts among clinicians, researchers, and policymakers are essential to developing cost-effective and standardized ECG screening protocols, ensuring improved athlete care, and advancing the field of sports cardiology.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"38209"},"PeriodicalIF":1.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Metformin Alters Gut Microbiota and Serum Metabolome in Coronary Artery Disease Patients After Percutaneous Coronary Intervention to Improve 5-year Prognoses: A Multi-omics Analysis.","authors":"Ruilin Zhou, Qingyang Wu, Hao Qian, Liang Wang, Guangcheng Liu, Bin Zhang, Wei Wu, Shuyang Zhang","doi":"10.31083/RCM26835","DOIUrl":"10.31083/RCM26835","url":null,"abstract":"<p><strong>Background: </strong>About 20% of patients with coronary artery disease (CAD) experience adverse events within five years of undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction. In these patients, the impact of metformin on long-term prognosis remains uncertain.</p><p><strong>Methods: </strong>This study enrolled 22 metformin (Met)-CAD patients with diabetes mellitus (DM) who had been administered metformin for at least six months before PCI, 14 non-Met CAD-DM patients with DM who had never taken metformin or had stopped taking metformin for a year before PCI, and 22 matched healthy controls. A 5-year follow-up was conducted to collect clinical prognosis data. Fecal 16S rRNA sequencing and serum untargeted metabolomics analyses were performed. BugBase was utilized to analyze the possible functional changes in the gut microbiome. Multi-omics analysis was conducted using Spearman's correlation to explore the interactions between metformin, gut microbiome, serum metabolites, and clinical prognosis.</p><p><strong>Results: </strong>Metformin significantly lowered the 5-year major adverse cardiac events (MACEs) in Met CAD-DM patients. We found a higher abundance of <i>Bacteroides coprocola</i>, <i>Bacteroides massiliensis</i>, <i>Phascolarctobacterium succinatutens</i>, and <i>Eubacterium coprostanoligenes</i> in the Met CAD-DM patients, as well as an increase in hydroxy-alpha-sanshool (HAS) and decenoylcarnitine and a decrease in tridec-10-enoic acid, Z-vad-fmk (benzyloxycarbonyl-Val-Ala-Asp (OMe)-fluoromethylketone), 3,9-dimethyluric acid in blood serum. Multi-omics analysis revealed that alterations in the gut microbiome and serum metabolites are significantly associated with the 5-year prognosis of CAD-DM.</p><p><strong>Conclusions: </strong>Metformin significantly improved the 5-year prognosis of CAD patients following PCI. Metformin tended to have more positive effects on the commensal flora and metabolic profiles, which may explain its beneficial effects on cardiovascular health. This study revealed the potential associations between metformin and the gut microbiome, an associated alteration in serum metabolome, and the impact on the host immune system and metabolic pathways.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"26835"},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Heart Rate and Mortality Risk in Patients With Acute Aortic Dissection: A Meta-Analysis.","authors":"Tianyi Wang, Lin Sun, Zhaozhuo Niu, Jixian Wang, Yuanshan Wang","doi":"10.31083/RCM27755","DOIUrl":"10.31083/RCM27755","url":null,"abstract":"<p><strong>Background: </strong>Acute aortic dissection (AAD) is a rare but life-threatening disease, and its rapid and correct diagnosis is important. Heart rate (HR) is a risk factor for death in patients with AAD, but their relationship remains unknown. This meta-analysis aimed to evaluate whether there was a significant correlation between HR and AAD mortality risk.</p><p><strong>Methods: </strong>By searching PubMed, Embase, and Web of Science databases, the studies reporting the correlation between HR and AAD were obtained, and their methodological quality was evaluated. Relative risk (RR) with 95% confidence interval (CI) was used as the effect size. Subgroup analysis, sensitivity analysis, and publication bias test (Egger's test and funnel chart) were used to find the source of heterogeneity and evaluate the stability of the results.</p><p><strong>Results: </strong>Ten studies enrolling >4000 patients were included. Increased HR was positively correlated with increased AAD mortality risk (RR [95% CI] = 1.04 [1.01-1.07], <i>p</i> = 0.006). There was significant statistical heterogeneity among the included studies. The timing of HR monitoring, AAD type, and follow-up time were sources of heterogeneity. Sensitivity analysis showed that the combined results were stable. There was a significant publication bias in the included studies; however, the shear-fill method showed that the publication bias had little effect on the combined results (RR [95% CI] = 1.038 [1.010-1.066], <i>p</i> = 0.008).</p><p><strong>Conclusions: </strong>There was a positive relationship between increased HR and increased AAD mortality.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"27755"},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Entropy Predicts Adverse Cardiac Events in Patients with High Cardiovascular Risk and Hypertension: A Novel Imaging Parameter Derived from Late Gadolinium Enhancement.","authors":"Yunbo Zhang, Lujing Wang, Jin Wang, Xinxiang Zhao","doi":"10.31083/RCM26499","DOIUrl":"10.31083/RCM26499","url":null,"abstract":"<p><strong>Background: </strong>Entropy derived from late gadolinium enhancement (LGE) has been shown to correlate with major adverse cardiac events (MACEs) in various cardiac diseases. However, the association between myocardial entropy and MACEs in patients with hypertension (HTN) has not been reported.</p><p><strong>Methods: </strong>This study recruited 190 patients with high cardiovascular risk and essential HTN who underwent cardiac magnetic resonance (CMR) examination in our hospital between January 2020 and June 2024. HTN patients were followed up for MACEs, which were defined as hospitalization for the occurrence of heart failure, acute coronary syndromes, stroke, or all-cause death. Patients were divided into MACE and non-MACE groups. Cardiac morphology, function, and tissue characteristics were assessed using CMR, and left ventricular (LV) entropy was acquired from LGE images.</p><p><strong>Results: </strong>Of the 190 patients with HTN, 54 (28.4%) experienced a MACE over a median follow-up period of 12.0 (8.0-27.0) months. LV entropy was significantly higher in patients with MACEs than those without (5.75 ± 0.89 vs. 5.12 ± 1.26; <i>p</i> < 0.001). Furthermore, LV entropy was an independent predictor of MACE, even after adjustment for clinical risk factors (odds ratio: 1.569 (1.039-2.369); <i>p</i> = 0.032). Receiver operating characteristic curve (ROC) analysis showed the predictive value of LV entropy, with an area under the curve (AUC) of 0.663. Adding LV entropy to the clinical model resulted in a relatively higher AUC (0.813 vs. 0.806) for the prediction of MACEs; however, this was not significantly different from the clinical model alone (<i>p</i> = 0.570).</p><p><strong>Conclusions: </strong>HTN patients with MACEs presented higher LV entropy than patients without MACEs. Furthermore, as an independent predictor of MACEs, LV entropy may help the risk stratification of HTN patients with high cardiovascular risk.</p><p><strong>Clinical trial registration: </strong>ChiCTR2100049160, https://www.chictr.org.cn/showproj.html?proj=130381.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"26499"},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Residual SYNTAX Score II for Patients With Complex Coronary Disease and Chronic Renal Insufficiency After Percutaneous Coronary Intervention.","authors":"Shuaiyong Zhang, Yumeng Lei, Jingfu Chen, Youcheng Wang, Huanting Liu, Nan Guo, Yunfei Wang, Xufen Cao, Liqiu Yan","doi":"10.31083/RCM26962","DOIUrl":"10.31083/RCM26962","url":null,"abstract":"<p><strong>Background: </strong>The primary objective of this research was to determine the predictive value of the residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II (rSS-II) for long-term outcomes in individuals with complex coronary artery disease (CAD) and chronic renal insufficiency (CRI) who have undergone percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>A total of 1161 consecutive patients with complex CAD and CRI after PCI were retrospectively recruited from Cangzhou Central Hospital affiliated with Hebei Medical University between January 2014 and September 2017. The patients were stratified into three categories based on rSS-II tertiles: low rSS-II (n = 388), medium rSS-II (n = 389), and high rSS-II (n = 384). The primary endpoints were all-cause mortality (ACM) and cardiac mortality (CM), while the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), which included ACM, myocardial infarction, stroke, or unplanned revascularization. The discrimination, calibration, and clinical utility of the rSS-II for predicting long-term outcomes were examined.</p><p><strong>Results: </strong>The median follow-up period was 37 months (19 to 61 months). The Kaplan-Meier estimate rates of ACM (2.4% vs. 5.9% vs. 13.9%; <i>p</i> < 0.001) and CM (1.9% vs. 2.8% vs. 9.2%; <i>p</i> < 0.001) revealed significant differences among the three categories. Multivariate Cox regression analysis demonstrated that the rSS-II could independently predict ACM (hazard ratio: 1.08, 95% confidence interval: 1.04-1.12; <i>p</i> < 0.001) and CM (hazard ratio: 1.07, 95% confidence interval: 1.02-1.12; <i>p</i> = 0.009). The rSS-II performed satisfactorily in both discrimination (area under the curve for ACM and CM was 0.710 and 0.728, respectively) and calibration (Greenwood-Nam-D' Agostino goodness-of-fit test for long-term outcomes; <i>p</i> > 0.05 for all). Additionally, decision curve analysis showed that the rSS-II had a high net benefit for long-term outcomes over threshold probabilities, indicating its superiority in daily practice.</p><p><strong>Conclusions: </strong>The rSS-II is beneficial for predicting and stratifying the risk of long-term outcomes in individuals with complex CAD and CRI who have undergone PCI.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"26962"},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pleiotropic Role of the MicroRNA-17-92 Cluster in Cardiovascular Diseases and Cancer.","authors":"Arun Samidurai, Manu Saravanan, Virginia Villani Zwiren, Varun Kodali, Kush Savsani, Nuhash Bhuiyan, Shruti Yerramothu, Suet Ying Valerie Lau, Ena Baral, Sara Hammel, Anindita Das","doi":"10.31083/RCM27966","DOIUrl":"10.31083/RCM27966","url":null,"abstract":"<p><p>Cardiovascular diseases, including acute myocardial infarctions, heart failure, hypertension, adverse cardiac remodeling, hypertrophy, atherosclerosis, and coronary artery disease, continue to lead to global mortality rates. Annual global cancer mortality rates follow closely behind, emphasizing the need to develop novel therapeutic approaches. MicroRNAs (miRNAs), a class of short non-coding RNAs, regulate cascades of signaling pathways and their downstream targets, exerting control over numerous biological processes. Dysregulation in specific miRNAs is linked to various pathogenesis, including cancer and cardiovascular disease. Among these miRNAs, the miRNA-17-92 cluster plays versatile roles at the nexus of critical physiological and pathological processes, including cardiac diseases and malignancy. This review aimed to provide a holistic analysis of the current progress in identifying, developing, and utilizing the miRNA-17-92 cluster to combat cardiovascular diseases and cancer. The members of the miRNA-17-92 cluster exert control over numerous cellular pathways that regulate, suppress, and promote various aspects of cardiomyocyte differentiation, regeneration, and aging. Certain pathways controlled by the cluster are protective when properly expressed. Others can propagate unchecked cardiovascular disease progression and mortality due to poorly controlled over/under-regulation. Similarly, the miRNA-17-92 cluster plays critical regulatory roles in the occurrence, metastasis, and prognosis of multiple cancers, which may allow the cluster to serve as diagnostic and prognostic biomarkers of malignancy. This review provides a brief overview of the multifaceted roles of the miRNA-17-92 cluster to deliver some insight into the development of novel targeted therapeutics for cardiovascular diseases and cancer via controlling the expression of specific subsets within this cluster. Additionally, this review systematically summarizes the established molecular mechanisms of the miRNA-17-92 cluster and its therapeutic potential in dual pathological contexts, cardiovascular diseases, and cancer.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"27966"},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Density Lipoprotein Cholesterol Reductions of not Less Than 60 mg/dL Prevent Hemorrhagic Stroke in Hypertensive Populations: A Meta-analysis.","authors":"Tao Yan, Lehui Li, Ziying Zhang, Ning Cao, Yuan Xia, Yuan Shen, Haitao Ju, Xingguang Zhang, Nan Zhang","doi":"10.31083/RCM36363","DOIUrl":"10.31083/RCM36363","url":null,"abstract":"<p><strong>Background: </strong>The association between low-density lipoprotein cholesterol (LDL-C) levels and the risk of hemorrhagic stroke (HS) detected through different blood pressure statuses remains unclear. Hence, we systematically evaluated the association between LDL-C and HS in populations with and without hypertension.</p><p><strong>Methods: </strong>We searched PubMed, Cochrane Library, and Embase databases for articles written in English. Only prospective design or randomized controlled trials (RCTs) reporting effect estimates with 95% confidence intervals (CIs) for the relationship between LDL-C and HS were included. We pooled risk ratios (RRs) stratified by blood pressure status and dose-response analyses with a two-stage generalized least squares for trend estimation (GLST) model. Finally, we compared the lower and optimal groups to find the effect of very low LDL-C levels on the risk of HS.</p><p><strong>Results: </strong>We included seven randomized controlled trials and 9 prospective cohort studies involving 304,763 participants with 2125 (0.70%) HS events. The non-linear trend suggested that LDL-C levels of approximately 80 mg/dL among hypertensive patients and 115 mg/dL among non-hypertensive patients had the lowest risk of HS. Meanwhile, continually lowering LDL-C levels under the optimal (80 mg/dL for hypertensive patients and 115 mg/dL for non- hypertensive patients) LDL-C level would increase the risk of HS in the hypertensive population (RR = 1.84, 95% CI: 1.36-2.50) but not in the non-hypertensive population (RR = 1.15, 95% CI: 0.97-1.36).</p><p><strong>Conclusions: </strong>The risk of HS can be effectively reduced by controlling LDL-C levels to 60-80 mg/dL in the hypertensive population and 115 mg/dL in the non-hypertensive population. The safety range of controlling LDL-C levels to protect against HS among hypertensive patients is narrower than that among the non-hypertensive population. Additionally, controlling blood pressure might play a positive role in safeguarding against HS by lowering LDL-C levels.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"36363"},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Serum Uric Acid and Atrial Fibrillation in Patients With Hypertension: A Systematic Review and Meta-Analysis.","authors":"Nianping Tang, Zhouling Luo, Yao Ye, Gang Wu","doi":"10.31083/RCM28168","DOIUrl":"10.31083/RCM28168","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) and hypertension are associated with inflammatory response and oxidative stress. Uric acid (UA) is the product of the oxidative reaction and a surrogate indicator of oxidative stress. However, whether UA imposes a greater risk of AF in hypertensive patients remains unclear. This study sought to evaluate the evidence supporting an association between serum uric acid (SUA) and AF in patients with hypertension.</p><p><strong>Methods: </strong>The observational studies in which SUA was measured and AF was reported in hypertension were searched for in the PubMed, Cochrane Library, EMBASE, and Web of Science databases until December 31, 2023, without language restrictions. We calculated the pooled mean difference of SUA between those with and without AF in the hypertension patients.</p><p><strong>Results: </strong>A total of 5 studies were included. Three cross-sectional studies comprised 4191 patients with hypertension. The standardized mean difference (SMD) of SUA for those with AF was 0.60 (95% confidence interval (CI) 0.15-1.05) compared with those without AF. Two cohort studies evaluated 9810 individuals with hypertension, and the risk of AF was 0.03 (95% CI -0.05-0.11), which revealed no significant difference between high SUA and normal SUA.</p><p><strong>Conclusion: </strong>Our findings demonstrate a significant association between SUA and AF in patients with hypertension. Further studies are needed to investigate the underlying pathophysiological mechanisms and to assess the value of SUA as a marker or a potential target for the therapy of AF in patients with hypertension.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"28168"},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Risk Factors of In-Hospital Death Following Complex High-risk and Indicated Patients After Percutaneous Coronary Intervention Supported by Extracorporeal Membrane Oxygenation.","authors":"Wenjie Qiu, Wanying Chen, Yajun Qin, Yifang Zhou, Yuanshen Zhou","doi":"10.31083/RCM27126","DOIUrl":"10.31083/RCM27126","url":null,"abstract":"<p><strong>Background: </strong>Complex high-risk and indicated patients (CHIPs) increase the risk of in-hospital death after percutaneous coronary intervention (PCI). Extracorporeal membrane oxygenation (ECMO) support can improve survival. However, there remains a gap in knowledge regarding how to identify and manage these high-risk patients effectively to reduce mortality. This study aimed to determine the independent high-risk factors associated with increased risk of in-hospital mortality among CHIPs after PCI with ECMO support. This research focused on providing clinicians with more accurate risk assessment tools for devising more effective treatment plans for these patients.</p><p><strong>Methods: </strong>The EMBASE, PubMed, Cochrane Library, Web Of Science, Chinese Biomedical Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang databases were searched from their inception to October 1, 2024, to identify observational studies examining mortality risk amongst adult CHIPs (age ≥18 years). The primary outcome was in-hospital mortality. A meta-analysis used random-effects models to obtain summary odds ratios (ORs) with 95% confidence intervals (CIs). The Cochrane risk-of-bias tool assessed the quality of evidence.</p><p><strong>Results: </strong>Ten studies with 306 participants were included. In pooled analyses, cardiogenic shock (CS) or cardiac arrest (CA) to ECMO (mean difference (MD) : 34.61, 95% confidence interval (CI): 26.70 to 42.52; <i>p</i> < 0.00001), ECMO duration (MD : -19.93, 95% CI: -32.85 to -7.02; <i>p</i> = 0.002), type of infarction-associated coronary artery-left anterior descending (LAD; OR : 3.16, 95% CI: 1.83 to 5.47; <i>p</i> < 0.0001), body mass index (BMI; MD: 1.52, 95% CI: 1.06 to 1.97; <i>p</i> < 0.00001), lactate levels (MD: 3.15, 95% CI: 2.37 to 3.94; <i>p</i> < 0.00001), left ventricle ejection fraction (LVEF; MD: -4.09, 95% CI: -6.17 to -2.00; <i>p</i> = 0.0001), mean arterial pressure (MAP; MD: -24.92, 95% CI: -32.19 to -17.65; <i>p</i> < 0.00001), heart rate, male sex, left circumflex, and right coronary artery, were associated with in-hospital mortality.</p><p><strong>Conclusions: </strong>CHIPs with longer CS or CA to ECMO, shorter ECMO duration, LAD infarction, higher BMI, elevated lactate levels, and lower LVEF and MAP have an increased risk of in-hospital death.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"27126"},"PeriodicalIF":1.9,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Emerging Role of Computed Tomography Coronary Angiography in the Left Main Stem Percutaneous Coronary Intervention.","authors":"Asad Shabbir, Abdelrahman Attia, Nikkole Marie Weber, Mustafa Alhassan, Monika Radike, Conor M Lane, Apurva Bhavana Challa, Malgorzata Wamil","doi":"10.31083/RCM37379","DOIUrl":"10.31083/RCM37379","url":null,"abstract":"<p><p>Recent advancements in computed tomography have significantly transformed the clinical application of this technique in diagnosing and managing coronary artery disease (CAD). Computed tomography coronary angiography (CTCA) has emerged as a leading non-invasive imaging modality, often serving as the first-line investigation to exclude obstructive CAD in patients with chronic coronary syndrome. Beyond its utility in diagnosing CAD, CTCA has become instrumental in procedural planning for percutaneous coronary intervention (PCI), particularly in complex cases such as left main stem (LMS) interventions, where peri-procedural risks are elevated. This review highlights the evolving role of CTCA in LMS PCI, underscoring its clinical utility in improving procedural precision and, subsequently, patient outcomes. Recent technological advancements, including detailed multiplanar and three-dimensional (3D) reconstructions, CT-derived fractional flow reserve (CTFFR), and the integration of artificial intelligence (AI) algorithms, have expanded the capabilities of CTCA. These innovations allow for comprehensive anatomical and functional assessments, enabling precise plaque morphology, lesion complexity, and bifurcation anatomy evaluations alongside PCI simulations. By offering detailed insights into coronary vasculature and lesion characteristics, CTCA provides critical information for optimising LMS PCI strategies. This review explores the current applications and future potential of CTCA in guiding LMS PCI, highlighting its role in improving procedural planning, risk assessment, and overall management of this challenging patient population.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 5","pages":"37379"},"PeriodicalIF":1.9,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}