Reviews in cardiovascular medicine最新文献

{"title":"Development Track of Compliance With Dual Antiplatelet Therapy and Analysis of Potential Categories in Patients With ACS After PCI.","authors":"Xiaoqing Zheng, Ya Wang, Hongxing Wang, Minfang Guan, Xiaosong Chen, Shasha Li, Wanluan Zhang, Jiamiao Hu, Qiaoling Ye, Qinhong Xu","doi":"10.31083/RCM37270","DOIUrl":"10.31083/RCM37270","url":null,"abstract":"<p><strong>Background: </strong>To explore the potential categories of compliance development track of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) using growth mixture modeling (GMM) to analyze its predictive factors, providing evidence for dynamic adherence monitoring and tailored interventions.</p><p><strong>Methods: </strong>A total of 150 patients with ACS after PCI were selected by convenience sampling. Patients were studied using Self-Efficacy for Appropriate Medication Use Scale (SEAMS), family APGAR index (APGAR), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-2 (PHQ-2) at baseline. The compliance of patients with DAPT was assessed using Morisky Medication Adherence Scales-8 (MMAS-8) at 1, 3, 6, 9, and 12 months after discharge. The mixed model of latent variable growth was used to identify the development track of compliance. Multiple logistic regression was used to analyze the predictive factors of different development track categories.</p><p><strong>Results: </strong>Two development track categories of DAPT compliance in patients with ACS after PCI were identified in the low compliance-decreased group (7.41%) and the persistent high compliance group (92.59%). Multivariate logistic regression analysis showed that age ≥60 years, body mass index (BMI), and the family APGAR index were the predictive factors of different development track categories of DAPT compliance in patients with ACS after PCI.</p><p><strong>Conclusion: </strong>Significant population heterogeneity was observed in the development track of DAPT in ACS patients within 12 months after PCI. The compliance of most patients remained stable, and only a few remained at a low level and showed a significant downward trend. Based on these predictive factors, healthcare personnel can identify patients in the low compliance-decreased group early and implement targeted and specific interventions to improve DAPT compliance of ACS patients after PCI.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"37270"},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030416","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":"Efficacy and Safety of Aldosterone Synthase Inhibitors for Resistant Hypertension: A Systematic Review and Meta-Analysis.","authors":"Ying Zhang, Chuanying Huang, Lidi Liu, Miaomiao Wu, Haiqi Song, Shize Wan, Yonglang Cheng, Xiaoyang Liao, Dongze Li","doi":"10.31083/RCM39555","DOIUrl":"10.31083/RCM39555","url":null,"abstract":"<p><strong>Background: </strong>Compared to patients with controllable hypertension, those with resistant hypertension (RH) have a higher incidence of cardiovascular complications, including stroke, left ventricular hypertrophy, and congestive heart failure. Therefore, an urgent need exists for improved management and control, along with more effective medications. Aldosterone synthase inhibitors (ASIs) are newly emerging drugs that have gradually attracted an increasing amount of attention.</p><p><strong>Methods: </strong>The Cochrane Library, PubMed, Embase, and ClinicalTrials.gov databases were systematically searched to identify all literature on ASIs and resistant hypertension. Additionally, the reference lists of the included articles were manually searched. The quality of the identified studies was assessed using the Cochrane Bias Risk Tool.</p><p><strong>Results: </strong>This study comprised four randomized controlled trials (RCTs), involving 776 participants. Different doses of ASIs were used, with treatment durations ranging from 7 to 12 weeks. The selected study population included individuals with resistant hypertension and healthy adults. Systolic blood pressure (SBP) had a pooled effect size of standardized mean difference (SMD) = -0.24, with a 95% confidence interval (CI) of [-0.46, -0.03], indicating a statistically significant difference (<i>p</i> = 0.026); however, diastolic blood pressure (DBP) had a pooled effect size of SMD = -0.13, with a 95% CI of [-0.40, 0.15], indicating no significant difference (<i>p</i> = 0.359). Similarly, subgroup analyses yielded comparable results. Notably, the risk of adverse events in the ASI group was greater than that in the control group, with a risk ratio of 1.32 and a 95% CI of [1.04, 1.66], indicating a significant difference (<i>p</i> = 0.02). There was no statistically significant difference in severe adverse events between the treatment group and the control group (<i>p</i> = 0.532).</p><p><strong>Conclusions: </strong>ASIs have shown benefits in controlling SBP in patients with resistant hypertension, although their effects on DBP appear to be limited. Given the observation period of only 12 weeks, the potential for increased adverse event risks with their use warrants further attention. Considering the relatively small number of trials included and the limited sample size in this study, future research should focus on expanding the sample size and extending the follow-up duration to more precisely define the clinical role and value of ASIs. Additionally, further investigation into the underlying mechanisms of action of these inhibitors is necessary to provide theoretical support for optimizing treatment strategies for resistant hypertension and related conditions.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"39555"},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030496","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":"Transcoronary Sinus Therapy for Coronary Microvascular Dysfunction.","authors":"Jingjing Rao, Yue Wang, Lina Tan, Liangbo Hu, Xiaocong Zeng","doi":"10.31083/RCM38565","DOIUrl":"10.31083/RCM38565","url":null,"abstract":"<p><p>Coronary microvascular disease has been found to increase the incidence of the composite endpoint for cardiovascular events and affect coronary revascularization. Coronary microvascular disease is often accompanied by epicardial disease, and despite successful revascularization and optimal medications, coronary microvascular disease may lead to reduced exercise tolerance and worsening clinical symptoms. Moreover, despite advances in percutaneous coronary intervention for coronary revascularization, the management of microvascular obstruction in reperfused myocardial tissue remains challenging and is a high-risk procedure. Previous studies have identified the coronary venous system as a new avenue for treating coronary microvascular obstructions associated with revascularization. Current data suggest that coronary sinus interventions, which primarily include coronary sinus reducer and pressure-controlled intermittent coronary sinus occlusion interventions, can provide significant clinical aid in 70-80% of patients with refractory angina pectoris and acute myocardial infarction who suffer from microvascular disease with no possibility of revascularization by modulating coronary venous pressures. However, a recent randomized trial demonstrated no difference in infarct size reduction between the pressure-controlled intermittent coronary sinus occlusion-assisted and conventional primary percutaneous coronary intervention groups. This article reviews recent advancements in coronary sinus-based therapeutic approaches for coronary microvascular disease.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"38565"},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030598","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":"Artificial Intelligence in Cardiac Treatment Decision-Making: An Evaluation of the Performance of ChatGPT Versus the Heart Team in Coronary Revascularization.","authors":"Serkan Mola, Alp Yıldırım, Enis Burak Gül","doi":"10.31083/RCM38705","DOIUrl":"10.31083/RCM38705","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the performance of two versions of ChatGPT (o1 and 4o) in making decisions about coronary revascularization and to compare the recommendations of these versions with those of a multidisciplinary Heart Team. Moreover, the study aimed to assess whether the decisions generated by ChatGPT, based on the internal knowledge base of the system and clinical guidelines, align with expert recommendations in real-world coronary artery disease management. Given the increasing prevalence and processing capabilities of large language models, such as ChatGPT, this comparison offers insights into the potential applicability of these systems in complex clinical decision-making.</p><p><strong>Methods: </strong>We conducted a retrospective study at a single center, which included 128 patients who underwent coronary angiography between August and September 2024. The demographics, medical history, current medications, echocardiographic findings, and angiographic findings for each patient were provided to the two ChatGPT versions. The two models were then asked to choose one of three treatment options: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy, and to justify their choice. Performance was assessed using metrics such as accuracy, sensitivity, specificity, precision, F1 score, Cohen's kappa, and Shannon's entropy.</p><p><strong>Results: </strong>The Heart Team recommended CABG for 78.1% of the patients, PCI for 12.5%, and medical therapy for 9.4%. ChatGPT o1 demonstrated higher sensitivity in identifying patients who needed CABG (82%) but lower sensitivity for PCI (43.7%), whereas ChatGPT 4o performed better in recognizing PCI candidates (68.7%) but was less accurate for CABG cases (43%). Both models struggled to identify patients suitable for medical therapy, with no correct predictions in this category. Agreement with the Heart Team was low (Cohen's kappa: 0.17 for o1 and 0.03 for 4o). Notably, these errors were often attributed to the limited understanding of the model in a clinical context and the inability to analyze angiographic images directly.</p><p><strong>Conclusion: </strong>While ChatGPT-based artificial intelligence (AI) models show promise in assisting with cardiac care decisions, the current limitations of these models emphasize the need for further development. Incorporating imaging data and enhancing comprehension of clinical context is essential to improve the reliability of these AI models in real-world medical settings.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"38705"},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030317","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":"Factors Affecting the Quality of Non-contrast Coronary Magnetic Resonance Angiography Images: Challenges and Change.","authors":"Wei Deng, Shichu Liang, Feidan Yu, Caiyun Han, Hong Ren","doi":"10.31083/RCM37487","DOIUrl":"10.31083/RCM37487","url":null,"abstract":"<p><p>Cardiovascular diseases (CVDs) are the main cause of mortality worldwide, with coronary artery disease (CAD) noted as one of the major causes of CVD. An early and accurate diagnosis is important for improved outcomes in CAD patients. Invasive coronary angiography and coronary computed tomography angiography are accurate diagnostic tools for CAD. However, these examination methods possess limitations, including invasiveness and use of ionizing radiation, which limit their application in certain population groups. Meanwhile, coronary magnetic resonance angiography (CMRA) represents a noninvasive method that provides high-resolution coronary artery images without ionizing radiation and contrast agents. Nonetheless, the quality of CMRA images depends on numerous physiological and technical factors. This review analyzes the main factors that affect CMRA image quality and provides theoretical and technical insights for better clinical application of CMRA in CAD diagnoses.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"37487"},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030433","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 of Oxidative Balance Score With All-Cause and Cardiovascular Mortality Among Hypertensive Adults.","authors":"Bing Hu, Xin He, Yanxiang Sun, Tong Liu, Fei Li, Li Feng, Yuli Huang","doi":"10.31083/RCM37415","DOIUrl":"10.31083/RCM37415","url":null,"abstract":"<p><strong>Background: </strong>The Oxidative Balance Score (OBS) is a new measure for assessing systemic oxidative stress, where higher scores indicate increased exposure to antioxidants. However, the relationship between the OBS and mortality in individuals with hypertension remains unclear.</p><p><strong>Methods: </strong>This study evaluated 8151 hypertensive individuals from the National Health and Nutrition Examination Survey (NHANES) (2001-2018), utilizing data from the National Death Index, tracked through December 31, 2019. The association between OBS and mortality (cardiovascular and all-cause) was examined using multivariable Cox regression models.</p><p><strong>Results: </strong>During a median follow-up of 9.7 years, which included 1692 deaths (461 of which were cardiovascular), multivariable Cox regression showed the highest quartile of OBS had significantly lower rates of all-cause mortality (hazard ratio (HR) 0.761, 95% CI: 0.635-0.912) and cardiovascular mortality (HR 0.553, 95% CI: 0.388-0.788) compared to those in the lowest quartile. An increase of one unit in the OBS was associated with a 1.9% reduction in all-cause mortality risk and a 3.7% reduction in cardiovascular mortality risk. This relationship remained consistent across various subgroup analyses, and spline regression supported a linear inverse trend.</p><p><strong>Conclusions: </strong>For adults with hypertension, an elevated OBS is independently associated with a lower risk of mortality both from all-cause and cardiovascular diseases, suggesting that higher antioxidant levels may be protective.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"37415"},"PeriodicalIF":1.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030460","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 Systemic Immune-Inflammation Index Predicts Long-Term Outcomes in Patients With Unstable Angina and Diabetes After Revascularization.","authors":"Xiaowen Bo, Tian Zhou, Hao Zhang, Siyuan Chen, Ning Yin, Donghui Zhao, Shujuan Cheng, Jinghua Liu, Qian Fan","doi":"10.31083/RCM36261","DOIUrl":"10.31083/RCM36261","url":null,"abstract":"<p><strong>Background: </strong>The incidence of unstable angina (UA), a type of cardiovascular disease (CVD), has increased in recent years. Meanwhile, timely percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA) procedures are crucial for patients with UA who also have diabetes mellitus (DM). Additionally, exploring other factors that may influence the prognosis of these patients could provide long-term benefits. The systemic immune-inflammation index (SII), a novel marker for assessing inflammation levels, has been shown to correlate with the long-term prognosis of various diseases. Thus, this study aimed to investigate the predictive value of the SII for the long-term prognosis of patients with UA and DM after revascularization.</p><p><strong>Methods: </strong>A total of 937 UA patients who underwent revascularization, of which 359 also had DM, were included in this study. Patients were divided into two groups: the low SII group (<622.675 × 10⁹/L; n = 219, 61.0%) and the high SII group (≥622.675 × 10⁹/L; n = 140, 39.0%). The primary outcome was the frequency of major adverse cardiovascular and cerebrovascular events (MACCEs). The secondary outcome was the incidence of all-cause death.</p><p><strong>Results: </strong>Of the 359 patients who visited our institution between January 2018 and January 2020, 23 patients (10.5%) in the low SII group experienced MACCEs, whereas 34 cases (24.3%) in the high SII group experienced MACCEs, showing a statistically significant difference (<i>p</i> < 0.001). After conducting univariate and multivariate regression analyses on the endpoint events, we identified several risk factors for MACCEs. These risk factors included high SII levels, a history of myocardial infarction (MI), prior PCI or coronary artery bypass grafting (CABG), elevated brain natriuretic peptide (BNP), and the lack of angiotensin-converting enzyme inhibitors (ACEI) or statin use. Upon adjusting for covariates including age, sex, body mass index (BMI), BNP, smoking, hypertension, PCI or CABG history, MI history, statin use, ACEI use, and the presence of three-vessel coronary disease, only high SII levels remained a risk factor for MACCEs (HR: 0.155, 95% CI: 0.063-0.382; <i>p</i> = 0.001). However, high SII levels were not identified as a risk factor for other individual endpoint events, including non-fatal stroke, cardiovascular death, non-fatal MI, or cardiac rehospitalization.</p><p><strong>Conclusion: </strong>Elevated SII levels following percutaneous intervention are associated with poor outcomes in patients with UA and DM. Therefore, regular monitoring and controlling inflammation levels may help improve long-term outcomes.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"36261"},"PeriodicalIF":1.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030501","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":"Transcatheter Tricuspid Valve Interventions to Manage Tricuspid Regurgitation: A Narrative Review.","authors":"Sara Veneziano, Sabrina Trippoli, Andrea Messori, Vincenzo Calderone, Eugenia Piragine","doi":"10.31083/RCM39915","DOIUrl":"10.31083/RCM39915","url":null,"abstract":"<p><p>Medical devices for tricuspid regurgitation have emerged as viable treatment options for patients who do not respond to drug therapy or who are unsuitable for open-heart surgery due to high surgical risk. Recently, numerous new medical devices have been proposed and approved for use. Therefore, comprehensive reviews of the literature on the current medical devices for tricuspid regurgitation are necessary. This paper subsequently describes all medical devices used for transcatheter tricuspid valve interventions, providing an updated overview of the current options for managing tricuspid regurgitation, a common valvular heart disease associated with changes in the configuration and function of the tricuspid valve. Over 70 million people worldwide suffer from tricuspid regurgitation, with an estimated mortality rate of 0.51 deaths per 10,000 person-years. However, delays in diagnosis and treatment frequently contribute to disease progression. Meanwhile, the growing health and economic burden of tricuspid regurgitation has led to the urgent need for new therapeutic strategies to overcome the limitations of pharmacological and surgical approaches. In this scenario, transcatheter tricuspid valve interventions represent a promising option for patients with severe tricuspid regurgitation, considered inoperable due to excessive surgical risk. Medical devices designed for these innovative approaches are classified into two main groups: transcatheter tricuspid valve repair and replacement systems. This review presents the technological characteristics of medical devices and the results of studies on their clinical efficacy and safety, thereby supporting the use of transcatheter tricuspid valve repair/replacement systems in clinical practice.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"39915"},"PeriodicalIF":1.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030592","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":"Rapid Atrial Pacing After TAVI for Pacemaker Prediction.","authors":"Leonidas Koliastasis, Ioannis Doundoulakis, Dimitrios Tsiachris, Luigi Pannone, Ioannis Skalidis, Quentin de Hemptinne, Panagiotis Xaplanteris, Konstantinos Toutouzas, Carlo de Asmundis","doi":"10.31083/RCM39074","DOIUrl":"10.31083/RCM39074","url":null,"abstract":"<p><p>Despite continued advancements in transcatheter aortic valve implantation (TAVI) techniques, the incidence of permanent pacemaker implantation (PPI) remains substantial. Established predictors of PPI include advanced age, pre-existing electrocardiographic conduction abnormalities, prosthetic valve type, implantation depth, and anatomical parameters, such as membranous septum length, which are currently under active investigation. In routine clinical practice, the management strategy often involves the temporary placement of a transvenous pacemaker lead, followed by a period of observation. While widely implemented, this approach introduces clinical uncertainty and may contribute to prolonged hospitalization, particularly given the not infrequent occurrence of delayed high-degree atrioventricular (AV) block. A novel diagnostic method emerging from electrophysiological evaluation is rapid atrial pacing performed post-TAVI, which aims to assess susceptibility to Wenckebach-type AV block. Two observational studies have evaluated this technique, utilizing an upper pacing threshold of 120 beats per minute as a cutoff to identify patients at risk of requiring permanent pacing. Moreover, this method is cost-effective, technically straightforward, and time-efficient; preliminary findings suggest this technique possesses a high negative predictive value. However, additional prospective data are required to validate the clinical utility of this technique and inform the development of standardized implementation. An upcoming clinical study (NCT06189976) is anticipated to provide valuable insights.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 8","pages":"39074"},"PeriodicalIF":1.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030546","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":"Short-term Effects of High Thoracic Epidural Blockade in Patients With Ischemic Heart Disease and Heart Failure: A Systematic Review and Data Synthesis.","authors":"Daoyu Guo, Mei Chen, Chen Zhu, Yang Liu","doi":"10.31083/RCM37886","DOIUrl":"10.31083/RCM37886","url":null,"abstract":"<p><strong>Background: </strong>High thoracic epidural blockade (HTEB) with local anti-sympathetic effects modulates cardiac performance in patients undergoing cardiac or non-cardiac surgeries. However, the short-term cardio-protective effects of HTEB in non-operative patients with ischemic heart disease (IHD) and heart failure (HF) remain unclear. Our study aimed to pool evidence regarding the benefits of adjunctive HTEB intervention in patients with IHD and HF.</p><p><strong>Methods: </strong>Exposures were defined as non-operative patients with IHD and HF who received adjunctive HTEB intervention and/or conventional medical treatment (CMT). The primary outcomes were clinical recovery indicator assessments, electrocardiographic and ultrasonic index improvement, laboratory tests, and hemodynamic benefits provided by adjunctive HTEB treatment. The secondary outcome was the effectiveness rate and adverse side effects after HTEB intervention. The pooled analyses of continuous variables were conducted using a fixed-effects model and the effects were represented by the weighted mean difference (WMD) and a 95% confidence interval (CI). The effective rates of HTEB treatment were represented using odds ratios (ORs, 95% CI) or effect size (ES, 95% CI). The I² statistic was used to identify any inconsistency in the pooled results from individual trials. A meta-regression and subgroup analysis were conducted when inconsistencies in individual trials were detected.</p><p><strong>Results: </strong>HTEB treatment was associated with a significant 10% increase in left ventricular ejection fraction (summary WMD, 9.651 [95% CI: 9.082 to 10.220]), a decline in neuroendocrine hormone levels, myocardial ischemia relief, improvement in hemodynamics, and the reversal of decompensated cardiac remodeling. HTEB treatment is more effective than conventional medical treatment (odds ratio, 5.114 [95% CI: 3.189 to 8.203]) in treating HF and angina pectoris.</p><p><strong>Conclusions: </strong>Our results suggest that HTEB intervention may be a complementary approach for cardiac rehabilitation in patients with IHD and HF. However, more data are necessary to confirm these findings due to the significant heterogeneity of the included studies.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 7","pages":"37886"},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800090","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}