Reviews in cardiovascular medicine最新文献

{"title":"Associations Between the Modified Cardiometabolic Index and Stroke in Patients With Different Glucose Metabolism Statuses: Evidence From a Nationally Representative Survey.","authors":"Tingting Deng, Guiling Wu, Xinghuan Liang, Yajuan Peng, Zhiyuan Dong, Yu Shen, Yingfen Qin","doi":"10.31083/RCM45989","DOIUrl":"https://doi.org/10.31083/RCM45989","url":null,"abstract":"<p><strong>Background: </strong>The association between the modified cardiometabolic index (MCMI) and the risk of incident stroke across patients with different glycemic statuses remains unclear. This study aimed to investigate the relationship between baseline MCMI levels and incident stroke in Chinese middle-aged and older adults with varying glucose metabolism states.</p><p><strong>Methods: </strong>Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018. Kaplan-Meier curves, multivariable Cox proportional hazards models, and restricted cubic spline analyses were employed to assess the relationship between the MCMI and stroke risk stratified by glycemic status. Subgroup and sensitivity analyses were performed to confirm the robustness of the findings.</p><p><strong>Results: </strong>A total of 7455 participants were included. A total of 457 individuals (6.13%) experienced stroke events during a median follow-up of 7 years. A significant linear association was observed between a higher MCMI and increased stroke risk. A nonlinear relationship was detected among participants with normal glucose regulation (NGR), with a sharp increase in risk beyond an MCMI threshold of 1.904 (hazard ratio (HR) = 1.85; 95% confidence interval (CI): 1.24-2.76; <i>p</i> = 0.003). An increased MCMI was also associated with increased stroke risk in individuals with prediabetes (HR = 1.34, 95% CI: 1.03-1.75) but not in individuals with diabetes. The associations varied across subgroups according to gender, residence, body mass index, and use of cardiovascular medications. Sensitivity analyses supported the stability of the results.</p><p><strong>Conclusion: </strong>An elevated MCMI is positively associated with incident stroke, particularly in individuals with NGR or prediabetes. Early identification of a high MCMI may be valuable for stroke prevention, risk stratification, and timely intervention in community populations.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"45989"},"PeriodicalIF":1.3,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594222","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":"Sex-Specific Heart Rate Variability Associations With Vitamin B12, Folate, and Iron Status.","authors":"Mehmet Özyaşar, Selçuk Öztürk, Tolga Memioğlu, Mehmet Inanir","doi":"10.31083/RCM50065","DOIUrl":"https://doi.org/10.31083/RCM50065","url":null,"abstract":"<p><strong>Background: </strong>The sex-specific impact of micronutrient status on heart rate variability (HRV) in adults presenting with palpitations to cardiology outpatient clinics remains unclear. Thus, this study aimed to assess the demographic and biochemical determinants of HRV in a clinical cohort of patients presenting with complaints of palpitations.</p><p><strong>Methods: </strong>This retrospective study included 213 adults aged 18-65 years who presented with palpitations and underwent 24-hour Holter monitoring at our institution between 2023 and 2024. Patients with cardiovascular disease, known arrhythmias, chronic inflammatory conditions, renal dysfunction, or use of medications that affected autonomic function were excluded from the study. Demographic variables, laboratory parameters, and HRV indices were statistically analyzed. The standard deviation of all normal-to-normal intervals (SDNN) was the primary HRV parameter used in both univariate and multivariate linear regression analyses.</p><p><strong>Results: </strong>The SDNN was significantly lower in women and older adults. In the univariate analyses, age (<i>β</i> = -0.203; <i>p</i> = 0.003), male sex (<i>β</i> = 0.529; <i>p</i> < 0.001), ferritin, serum iron, folate, and Vitamin B12 were all associated with the SDNN. However, in the multivariable model, only male sex (<i>β</i> = 0.467; <i>p</i> < 0.001), iron-binding capacity (IBC) (<i>β</i> = -0.377; <i>p</i> < 0.001), and folate (<i>β</i> = 0.117; <i>p</i> = 0.037) remained independent predictors. Elevated IBC, reflecting functional iron deficiency, was strongly associated with a reduced SDNN, whereas higher folate levels were associated with better autonomic modulation.</p><p><strong>Conclusions: </strong>In patients presenting with palpitations, the SDNN is influenced by both demographic factors and biochemical markers of iron metabolism. Elevated IBC, reflecting alterations in iron metabolism and iron availability, was associated with impaired autonomic regulation, even in the absence of overt anemia. In contrast, adequate folate status appeared to support a more favorable autonomic function. These findings highlight the importance of integrating iron-vitamin assessment into the evaluation of autonomic function and underscore the need for prospective studies to determine whether correcting these abnormalities can improve HRV and clinical outcomes.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"50065"},"PeriodicalIF":1.3,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594268","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":"Sex Differences in Outcomes After Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Narrative Synthesis.","authors":"Antonio Marzano, Federico Flora, Jihad Jabbour, Ombretta Martinelli, Simone Cuozzo","doi":"10.31083/RCM47920","DOIUrl":"https://doi.org/10.31083/RCM47920","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Abdominal aortic aneurysm (AAA) is less prevalent in women, yet rupture occurs owing to smaller diameters, leading to higher mortality rates; moreover, higher mortality rates also occur in women after aneurysm repair procedures. Meanwhile, whether women derive comparable benefit from endovascular aneurysm repair (EVAR) remains uncertain, partly because of anatomical constraints, such as smaller-caliber access vessels and more angulated proximal necks. This review evaluates sex-specific perioperative and long-term outcomes after EVAR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was conducted as a systematic review with narrative synthesis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework. A comprehensive search was conducted in the PubMed/MEDLINE and Scopus databases for studies published between January 2000 and September 2025. Search strings combined controlled vocabulary and free-text terms for \"abdominal aortic aneurysm\", \"endovascular aneurysm repair\", and \"sex\" or \"gender\" or \"female\". A predefined Population, Intervention, Comparison, Outcome (PICO) model was used to guide study selection. Comparative observational cohorts, registry or claims analyses, and EVAR-focused meta-analyses reporting sex-stratified outcomes were eligible. Articles were restricted to English. Outcomes included perioperative mortality, major complications, reintervention, and long-term survival. Given the heterogeneity and the availability of recent pooled analyses, quantitative synthesis favored adjusted estimates from high-quality meta-analyses and registries, and no new pooled meta-analysis was performed to avoid data duplication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 15 studies met the inclusion criteria, encompassing more than 500,000 EVAR procedures. Women consistently exhibited higher early mortality and morbidity after standard infrarenal EVAR. The largest EVAR-focused meta-analysis reported an odds ratio (OR) for 30-day mortality of 1.73 (95% confidence interval (CI) 1.32-2.26) and in-hospital mortality OR of 1.90 (1.43-2.53) for women versus men, with increased risks of limb ischemia (~2.4-fold), renal (OR ~1.7), and cardiac complications (OR ~1.7). Long-term all-cause mortality was higher in women (hazard ratio (HR) 1.23, 95% CI 1.09-1.38). Contemporary registry data indicated similar adjusted mortality but persistently greater access-related morbidity in women, including higher rates of limb ischemia (5.3% vs. 3.2%) and major bleeding (22.0% vs. 15.9%). Perioperative mortality and complications were approximately two-fold higher in women following complex EVAR, defined as fenestrated and/or branched endovascular repair (F/BEVAR) for juxtarenal, pararenal, suprarenal, or thoracoabdominal aneurysms. Additionally, survival remained inferior in those with a ruptured AAA (8-year survival: 36.7% vs. 49.5%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Women undergoing EVAR contin","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"47920"},"PeriodicalIF":1.3,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594124","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":"Diagnostic and Prognostic Value of Arterial Blood Gas and Electrolyte Analyses in Heart Failure.","authors":"Nardi Tetaj, Andrea Segreti, Francesco Piccirillo, Michele Pelullo, Simone Pasquale Crispino, Martina Ciancio, Gian Paolo Ussia, Francesco Grigioni","doi":"10.31083/RCM47958","DOIUrl":"https://doi.org/10.31083/RCM47958","url":null,"abstract":"<p><p>Heart failure (HF) is a multifaceted clinical syndrome that frequently precipitates disturbances in perfusion, ventilation, and metabolic regulation, all of which are rapidly detectable through arterial blood gas (ABG) analysis. Meanwhile, clinical markers such as lactate, arterial pH, arterial partial pressure of carbon dioxide (PaCO₂), arterial partial pressure of oxygen (PaO₂), bicarbonate, and electrolyte concentrations provide dynamic insight into the pathophysiologic status of patients and can serve as early indicators of decompensation. This review evaluates the clinical significance of key ABG and electrolyte parameters in both acute and chronic HF, emphasizing the prognostic value of the analyses, contribution to risk stratification, and utility in guiding therapy. In acute HF and cardiogenic shock, hyperlactatemia and acidosis are associated with increased mortality and the need for hemodynamic or ventilatory support. Furthermore, electrolyte abnormalities, particularly those involving sodium and potassium, are common and driven by neurohormonal activation, pharmacological therapies, and volume shifts. Therefore, integrating ABG and electrolyte monitoring into routine HF management can enhance diagnostic precision and support timely, targeted interventions. This narrative review synthesizes current evidence and proposes a practical framework for interpreting ABG results in the context of contemporary HF care.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"47958"},"PeriodicalIF":1.3,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594212","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":"<i>ZNF460</i> Promotes <i>GSDME</i>-Driven Pyroptosis via <i>PKM2</i> Transcriptional Activation in Aortic Dissection.","authors":"Quanlin Yang, Xin Shao, Zihe Zheng, Mingliang Li, Changbo Xiao, Bo Chen, Guowei Tu, Ben Huang, Xiaofu Dai","doi":"10.31083/RCM48463","DOIUrl":"https://doi.org/10.31083/RCM48463","url":null,"abstract":"<p><strong>Background: </strong>Aortic dissection (AD) is a cardiovascular emergency with high mortality; however, the underlying molecular pathophysiology of AD remains incompletely understood. Pyroptosis, a proinflammatory form of programmed cell death, contributes to vascular injury; nonetheless, the upstream transcriptional regulation of pyroptosis in AD is similarly poorly defined.</p><p><strong>Methods: </strong>Differentially expressed genes were identified in aortic tissues from AD patients (Gene Expression Omnibus (GEO) datasets) using bioinformatics analyses, with a focus on cell death-related candidates. <i>In vivo</i> AD mouse models and <i>in vitro</i> vascular smooth muscle cell (VSMC) systems were employed to investigate the roles of these genes in AD. Potential transcription factors for <i>pyruvate kinase M2</i> (<i>PKM2</i>) were predicted using the Just Another Simple Array Retrieval/Simple API for Repository (JASPAR) and University of California, Santa Cruz (UCSC) databases, and validated by luciferase reporter and chromatin immunoprecipitation assays. Gain- and loss-of-function approaches were used to dissect the zinc finger protein 460 (ZNF460)-PKM2-gasdermin E (GSDME) axis and the associated impact on pyroptosis and AD progression.</p><p><strong>Results: </strong><i>PKM2</i> expression was markedly elevated in AD tissues. <i>PKM2</i> silencing suppressed GSDME cleavage, attenuated VSMC pyroptosis, and mitigated experimental AD, whereas <i>PKM2</i> overexpression aggravated these outcomes. GSDME upregulation rescued pyroptosis in <i>PKM2</i>-depleted cells. Mechanistically, the transcription factor ZNF460 directly bound to the <i>PKM2</i> promoter, enhancing <i>PKM2</i> transcription and activating downstream GSDME-mediated pyroptosis. <i>ZNF460</i> knockdown reduced pyroptotic cell death and preserved aortic wall integrity <i>in vivo</i>.</p><p><strong>Conclusions: </strong>This study identifies ZNF460 as a novel upstream regulator of <i>PKM2</i> that drives GSDME-dependent pyroptosis, thereby exacerbating AD progression. Targeting the ZNF460-PKM2-GSDME axis may represent a promising therapeutic strategy for preventing pyroptosis-driven vascular damage in AD.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"48463"},"PeriodicalIF":1.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594211","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 Association Between Serum FGF21 Level and Coronary Artery Calcification: Impact of the Degree of Insulin Resistance.","authors":"Cong Wang, Yingkai Li, Hongyu Peng, Jinghua Liu","doi":"10.31083/RCM46781","DOIUrl":"https://doi.org/10.31083/RCM46781","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery calcification (CAC) is a strong predictor of long-term adverse outcomes in patients with coronary artery disease (CAD). Meanwhile, insulin resistance (IR) is a key metabolic disorder that accelerates CAC progression through multiple pathways. Fibroblast growth factor 21 (FGF21) improves glucolipid metabolism and has been associated with vascular calcification. However, the relationship between serum FGF21 level and CAC severity in patients with varying degrees of IR remains unclear.</p><p><strong>Methods: </strong>A total of 128 patients with CAD who underwent preprocedural coronary computed tomography angiography and percutaneous coronary intervention were enrolled. Patients were stratified by triglyceride-glucose (TyG) index into high (TyG >8.62, n = 62) and low (TyG ≤8.62, n = 66) groups. Associations between FGF21 levels and severe CAC were analyzed under varying degrees of IR.</p><p><strong>Results: </strong>In patients with a TyG index >8.62, serum FGF21 levels were significantly lower in those with severe CAC, and were negatively correlated with CAC scores. Multivariable analysis revealed that serum FGF21 levels were independently associated with severe CAC (odds ratio (OR) per 1-standard deviation (SD) increase: 0.261; 95% confidence interval (CI): 0.073, 0.933; <i>p</i> < 0.05). In contrast, serum FGF21 levels among patients with a TyG index ≤8.62 did not differ significantly between the severe and non-severe CAC groups, and no independent association between serum FGF21 level and severe CAC was observed after adjustment. Importantly, a significant interaction was observed between the TyG index and FGF21 level (<i>p</i> for interaction = 0.035). Moreover, the protective association between FGF21 and CAC was primarily observed in patients with a high TyG index.</p><p><strong>Conclusions: </strong>Lower serum FGF21 levels in patients with CAD can identify individuals at increased risk of severe CAC, particularly among those with a higher degree of IR. Serum FGF21 levels may serve as a novel biomarker for CAC risk stratification in metabolically susceptible patients.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"46781"},"PeriodicalIF":1.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594203","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":"Coronary Artery Ectasia Presenting as ST-Elevation Myocardial Infarction: An Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Strategy and Case-Based Review.","authors":"Qianfeng Xiong, Shaoyong Chen, Wenbo Li, Yaowu Xie","doi":"10.31083/RCM46098","DOIUrl":"https://doi.org/10.31083/RCM46098","url":null,"abstract":"<p><p>Coronary artery ectasia (CAE) is characterized by abnormal, localized, or diffuse dilatation of the coronary vasculature and is an increasingly recognized anatomical entity encountered during coronary angiography. Although often associated with atherosclerosis, the exact pathogenesis of CAE remains unknown; hence, an optimal management strategy is difficult to establish and remains highly controversial due to a lack of high-quality randomized controlled trial evidence. Current therapeutic modalities include medical therapy, percutaneous coronary intervention (PCI), and surgical options. We present a review, supported by a representative case of ST-elevation myocardial infarction (STEMI) in a patient with CAE, as a systematic summary of the clinical and angiographic features of the condition. We discuss contemporary treatment approaches, especially how to navigate antithrombotic strategies and the role of intravascular ultrasound (IVUS)-guided PCI.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"46098"},"PeriodicalIF":1.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594266","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":"Pathways of Care for Patients Who Undergo Primary Percutaneous Coronary Intervention for STEMI: A Review of \"<i>Ideal</i>\" vs. \"<i>Real-world</i>\" Clinical Scenarios.","authors":"Chun Shing Kwok, Rahul Potluri, Jaydeep Sarma, Kevin R Bainey, Josip Andelo Borovac","doi":"10.31083/RCM47494","DOIUrl":"https://doi.org/10.31083/RCM47494","url":null,"abstract":"<p><p>Care processes and outcomes for patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remain heterogeneous. A \"patient pathway\" framework-defined as the sequence of clinically relevant events from symptom onset through diagnosis, reperfusion, and early recovery-can help identify real-world points of failure and opportunities for system-level improvement. In this narrative review, we contrast an \"ideal\" STEMI pathway with the pathways commonly observed in routine practice for patients treated with primary PCI, and we contextualize deviations from best practice from patient, clinician, health service, and societal perspectives. From the patient's perspective, the priority is rapid symptom recognition and seeking care; however, delays are frequent, particularly in individuals with mild, atypical, or non-classical presentations, prolonging total ischemic time and increasing myocardial injury. Clinicians aim to diagnose STEMI promptly and initiate evidence-based therapy and reperfusion without delay, yet diagnostic uncertainty and competing differentials can contribute to missed or late diagnoses. Health systems seek to provide timely, efficient, and cost-effective emergency revascularization, but performance is influenced by pre-hospital logistics, triage, catheterization laboratory availability, and inter-hospital transfer processes. At the societal level, STEMI imposes substantial mortality, morbidity, and economic burden through premature death and disability. We synthesize evidence on delays to revascularization, misdiagnosis, populations at risk for atypical presentation, and pragmatic interventions to improve care. We conclude that pathway-based analyses offer a structured approach to defining desirable STEMI care trajectories and to reducing missed opportunities for better outcomes.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"47494"},"PeriodicalIF":1.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593976","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":"Mitochondrial Calcium Dysregulation and Targeted Therapies in Heart Failure.","authors":"Mengting Liu, Yunpeng Jin","doi":"10.31083/RCM46211","DOIUrl":"https://doi.org/10.31083/RCM46211","url":null,"abstract":"<p><p>Heart failure (HF) is steadily increasing in prevalence and poses a major global health challenge, with substantial medical and economic burdens. HF represents the terminal stage of diverse cardiac disorders and is characterized by poor prognosis despite the availability of conventional pharmacological treatments, underscoring the urgent need for novel therapeutic approaches. Accumulating evidence highlights a strong association between HF and mitochondrial dysfunction, of which dysregulated mitochondrial calcium (mCa²⁺) homeostasis plays a pivotal role in disease pathogenesis. Ca²⁺ serves as an essential signaling messenger that regulates energy metabolism and also governs cell survival and myocardial contractility. Thus, this review introduces the mechanisms of mCa²⁺ uptake and efflux and the association of these processes with HF and emerging therapeutic strategies. We also discuss mCa²⁺ uniporter (MCU) inhibitors and Elamipretide, a mitochondria-targeted peptide. Collectively, this work provides novel insights and preclinical evidence supporting mitochondria-based interventions for HF.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"46211"},"PeriodicalIF":1.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594324","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":"Synergistic Cardiopulmonary Protection of Endothelin Receptor Antagonists Combined With Soluble Guanylate Cyclase Agonists in High-Risk Coronary Syndrome With Pulmonary Hypertension.","authors":"Liyue Zhao, Xinli Pang","doi":"10.31083/RCM46401","DOIUrl":"https://doi.org/10.31083/RCM46401","url":null,"abstract":"<p><strong>Background: </strong>The prognosis and long-term survival of high-risk coronary syndrome patients with pulmonary hypertension (PH) remain unsatisfactory, and limited research has evaluated the synergistic therapeutic effects of endothelin receptor antagonists (ERAs) combined with soluble guanylate cyclase agonists (sGCAs). This study aimed to assess the synergistic cardiopulmonary protective effects and clinical safety of ERA combined with sGCA therapy in patients with high-risk coronary syndrome complicated by PH.</p><p><strong>Methods: </strong>This retrospective controlled study included 132 patients with high-risk coronary syndrome and PH who were admitted between January 2019 and December 2023. After exclusion criteria were applied, 119 patients were analyzed and categorized into a control group (ambrisentan monotherapy, n = 58) and an experimental group (ambrisentan plus riociguat, n = 61) according to the associated treatment strategy. Primary endpoints included 6-minute walk distance (6MWD), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and the World Health Organization-related functional class (WHO-FC). Secondary endpoints included cardiac index (CI), left ventricular end-diastolic diameter (LVEDD), tricuspid annular plane systolic excursion (TAPSE), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), Borg dyspnea score (BDS), and the incidence of adverse events.</p><p><strong>Results: </strong>Baseline characteristics between the two groups were comparable (all <i>p</i> > 0.05). Following treatment, the 6MWD, CI, and TAPSE values significantly improved in both groups (all <i>p</i> < 0.05), with greater improvements observed in the experimental group (95% CI: -3.61 to -0.05, <i>p</i> = 0.044; 95% CI: -0.20 to -0.004, <i>p</i> = 0.039; 95% CI: -0.29 to -0.07, <i>p</i> = 0.001). The NT-proBNP, LVEDD, mPAP, PVR, and BDS values decreased in both cohorts (all <i>p</i> < 0.05), with more pronounced reductions in the experimental group (95% CI: 0.02-3.5, <i>p</i> = 0.048; 95% CI: 0.03-0.21, <i>p</i> = 0.012; 95% CI: 0.02-2.03, <i>p</i> = 0.046; 95% CI: 0.65-4.30, <i>p</i> = 0.008; 95% CI: 0.06-0.78, <i>p</i> = 0.022). The proportion of individuals in the WHO-FC classes III-IV was lower in the experimental group (95% CI: 1.05-4.56, <i>p</i> = 0.035). No statistically significant difference in adverse-event incidence was observed between groups (95% CI: 0.73-5.03, <i>p</i> = 0.184).</p><p><strong>Conclusion: </strong>Combination therapy with ambrisentan and riociguat effectively improved cardiopulmonary function and clinical outcomes in patients with high-risk coronary syndrome and PH, offering a promising therapeutic strategy for this population. This study is a single-center retrospective study, which inherently limits the credibility of causal inference; therefore, the results need to be further verified by multi-center, large-sample prospective studies.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 3","pages":"46401"},"PeriodicalIF":1.3,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594289","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}