Reviews in cardiovascular medicine最新文献

{"title":"Bicuspid Aortic Valve, from the Unknown till the Perfection of the Species.","authors":"Marta Bargagna, Guido Ascione, Edoardo Zancanaro, Francesco Fioravanti, Alessandra Sala, Cinzia Trumello, Guohao Chang, Alessandro Verzini, Alessandro Castiglioni, Francesco Maisano","doi":"10.31083/j.rcm2508310","DOIUrl":"10.31083/j.rcm2508310","url":null,"abstract":"<p><p>The bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. Though most often isolated, BAV may be associated with other cardiovascular malformations. BAV-related aortopathy is the most common, sharing genetic alterations and phenotypic heterogeneity characteristics. Sometimes silent for a lifetime, BAV may manifest as aortic valve dysfunction, aortic aneurysm, or more emergent situations, such as endocarditis or aortic dissection. Its embryological origin and the characterization of the genes involved, as well as the histopathological and hemodynamic aspects of its natural history, are becoming increasingly clear. In addition, emerging evidence of rhythm disorders associated with BAV has been identified. A new international nomenclature and classification has been introduced to interpret all the advances made in recent years for the comprehension of this condition. In the guidelines, more attention has been paid to the diagnosis of BAV and related aortopathy, together with surveillance, and family screening. Surgical treatment remains the gold standard, especially in young low-risk patients, and valve repair techniques have been shown to be effective and durable. Finally, the new era of transcatheter techniques is also being applied to dysfunctional BAV, allowing the treatment of patients at high surgical risk, with increasingly promising results, and the possibility of expanding indications through the introduction of more advanced devices. This review aims to comprehensively describe the BAV conundrum, focusing on anatomy, pathophysiology, genetics, diagnosis of BAV-related disorders, and the different treatment options available in the transcatheter era.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142128154","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":"Phenotyping Refractory Cardiogenic Shock Patients Receiving Venous-Arterial Extracorporeal Membrane Oxygenation Using Machine Learning Algorithms.","authors":"Shuo Wang, Liangshan Wang, Zhongtao Du, Feng Yang, Xing Hao, Xiaomeng Wang, Chengcheng Shao, Jin Li, Hong Wang, Chenglong Li, Xiaotong Hou","doi":"10.31083/j.rcm2508303","DOIUrl":"10.31083/j.rcm2508303","url":null,"abstract":"<p><strong>Background: </strong>This study used machine learning to categorize cardiogenic shock (CS) patients treated with venous-arterial extracorporeal membrane oxygenation (VA-ECMO) into distinct phenotypes. Subsequently, it aimed to clarify the wide mortality variance observed in refractory CS, attributing it to the condition's inherent heterogeneity.</p><p><strong>Methods: </strong>This study enrolled a cohort of CS patients who received VA-ECMO support. By employing rigorous machine learning (ML) techniques, we generated and validated clusters based on determinants identified through algorithmic analysis. These clusters, characterized by distinct clinical outcomes, facilitated the examination of clinical and laboratory profiles to enhance the understanding of patient responses to VA-ECMO treatment.</p><p><strong>Results: </strong>In a study of 210 CS patients undergoing VA-ECMO treatment, 70.5% were male with a median age of 62, ranging from 53 to 67 years. Survival rates were 67.6% during VA-ECMO and 49.5% post-discharge. Patients were classified into three phenotypes based on the clinical and laboratory findings: \"platelet preserved (I)\", those with stable platelet counts, \"hyperinflammatory (II)\", those indicating significant inflammation, and \"hepatic-renal (III)\", those showing compromised liver and kidney functions. Mortality rates (25.0%, 52.8%, and 55.9% for phenotypes I, Ⅱ, and Ⅲ, respectively (<i>p</i> = 0.005)) varied significantly among these groups, highlighting the importance of phenotype identification in patient management.</p><p><strong>Conclusions: </strong>This study identified three distinct phenotypes among refractory CS patients treated using VA-ECMO, each with unique clinical characteristics and mortality risks. Thus, highlighting the importance of early detection and targeted intervention, these findings suggest that proactive management could improve outcomes for those showing critical signs.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126582","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":"Left Pulmonary Vein Trunk Length as a Robust Predictor of Long-Term Success of Atrial Fibrillation Catheter Ablation.","authors":"Jiaju Li, Zhe Wang, Fen Qin, Fangyuan Luo, Jiawei Chen, Yankun Liu, Hailong Tao, Jianzeng Dong","doi":"10.31083/j.rcm2508301","DOIUrl":"10.31083/j.rcm2508301","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency catheter ablation (RFCA) is a commonly used treatment for atrial fibrillation (AF), but the long-term recurrence rate remains relatively high. Given the inconsistent results regarding the role of left pulmonary vein (PV) ostial anatomy in post-ablative recurrence of RFCA in previous studies, we sought to investigate the role of left PV trunk length using an alternative methodology.</p><p><strong>Methods: </strong>A total of 369 AF patients undergoing catheter ablation were included. The left/right trunk length (LTL/RTL) of the PV was measured from pre-ablative computed tomography (CT) using three-dimensional reconstruction techniques. We constructed three multivariable Cox models, with the inclusion of the LTL, RTL, and no LTL/RTL, and used the Delong test, integrated discrimination index (IDI), and net reclassification index (NRI) to assess model improvement. We identified optimal cut-off values for LTL with the receiver operating characteristic (ROC) curve, and estimated outcomes using the Kaplan-Meier survival curve. We also used subgroup analysis to evaluate interactions.</p><p><strong>Results: </strong>The results of the Delong test, IDI, and NRI indicated that LTL had a favorable impact on the performance of the multivariate model. Subsequently, the multivariate Cox regression analysis identified LTL as a significant risk factor for post-ablative recurrence of AF (adjusted hazard ratio (HR) = 1.08, 95% CI: 1.05-1.12, <i>p</i> <math><mo><</mo></math> 0.001). According to the ROC curve, the optimal cut-off value for LTL is 11.15 mm, and the Kaplan-Meier estimator revealed different outcomes (<i>p</i> <math><mo><</mo></math> 0.001). We calculated <i>p</i> for interaction between LTL and other factors, and no significant interaction terms were observed.</p><p><strong>Conclusions: </strong>LTL is a robust prognostic indicator for post-ablative outcome in AF patients receiving RFCA, with a longer LTL indicating a higher risk of recurrence.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126561","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":"How to Approach Patients with Acute Chest Pain.","authors":"Kenji Inoue, Tohru Minamino","doi":"10.31083/j.rcm2508302","DOIUrl":"10.31083/j.rcm2508302","url":null,"abstract":"<p><p>Acute coronary syndrome (ACS) is associated with high mortality rates. Although the goal was to achieve a missed diagnosis rate of <math><mo><</mo></math> 1%, the actual data showed a rate of <math><mo>></mo></math> 2%. Chest pain diagnosis has remained unchanged over the years and is based on medical interviews and electrocardiograms (ECG), with biomarkers playing complementary roles. We aimed to summarize the key points of medical interviews, ECG clinics, use of biomarkers, and clinical scores, identify problems, and provide directions for future research. Medical interviews should focus on the character and location of chest pain (is it accompanied by radiating pain?) and the duration, induction, and ameliorating factors. An ECG should be recorded within 10 minutes of the presentation. The serial performance of an ECG is recommended for emergency department (ED) evaluation of suspected ACS. Characteristic ECG traces, such as Wellens syndrome and De Winter T-waves, should be understood. Therefore, troponin levels in all patients with suspected ischemic heart disease should be examined using a highly sensitive assay system. Depending on the ED facility, the patient should be risk stratified by serial measurements of cardiac troponin levels (re-testing at one hour would be preferred) to determine the appropriate time to perform an invasive strategy for a definitive diagnosis. The diagnostics should be based on Bayes' theorem; however, care should be taken to avoid the influence of heuristic bias.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142128155","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":"Idiopathic Ventricular Fibrillation - Just How Much Idiopathic is it?","authors":"Samuel Lietava, Milan Sepsi, Tomas Novotny","doi":"10.31083/j.rcm2508306","DOIUrl":"10.31083/j.rcm2508306","url":null,"abstract":"<p><p>Idiopathic ventricular fibrillation is diagnosed in survivors of sudden cardiac death that has been caused by ventricular fibrillation without known structural or electrical abnormalities, even after extensive investigation. It is a common cause of sudden death in young adults. Although idiopathic ventricular fibrillation is a diagnosis of exclusion, in many cases only a partial investigation algorithm is performed. The aim of this review is to present a comprehensive diagnostic evaluation algorithm with a focus on diagnostic assessment of inherited arrhythmic syndromes and genetic background.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126559","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":"Postoperative Kinesiophobia in Patients with Acute Type A Aortic Dissection: A Cross-Sectional Study.","authors":"Yaqiong Chen, Yanchun Peng, Xizhen Huang, Liangwan Chen, Yanjuan Lin","doi":"10.31083/j.rcm2508304","DOIUrl":"10.31083/j.rcm2508304","url":null,"abstract":"<p><strong>Background: </strong>This cross-sectional study explores postoperative kinesiophobia in patients with acute type A aortic dissection (AAAD), an understudied area. The occurrence of postoperative kinesiophobia and its relation to various factors were investigated.</p><p><strong>Methods: </strong>Patients diagnosed with AAAD and undergoing surgical treatment from January 2019 to December 2021 were selected through continuous sampling. Kinesiophobia levels were assessed using the Tampa Scale for Kinesiophobia Heart (TSK-SV-HEART). Univariate and multivariate regression analyses were employed to determine factors influencing kinesiophobia.</p><p><strong>Results: </strong>Out of 264 included patients, the mean postoperative kinesiophobia score was 38.15 (6.66), with a prevalence of 46.2%. Multivariate logistic regression revealed that education level, general self-efficacy, family care index, and facing style reduced kinesiophobia, while avoidance style and yielding style increased it.</p><p><strong>Conclusions: </strong>Postoperative kinesiophobia prevalence in AAAD patients is high and associated with diverse factors. Medical staff should remain vigilant to potential kinesiophobia during postoperative rehabilitation.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126584","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":"Atrial High-Rate Episodes and Subclinical Atrial Fibrillation: State of the Art and Clinical Questions with Complex Solutions.","authors":"Carola Griffith Brookles, Roberto De Ponti, Vincenzo Russo, Matteo Ziacchi, Gemma Pelargonio, Michela Casella, Maurelio Lauretti, Manola Vilotta, Sakis Themistoclakis, Antonio D'Onofrio, Giuseppe Boriani, Matteo Anselmino","doi":"10.31083/j.rcm2508305","DOIUrl":"10.31083/j.rcm2508305","url":null,"abstract":"<p><p>Atrial high-rate episodes (AHREs) and subclinical atrial fibrillation (AF) are frequently registered in asymptomatic patients with cardiac implantable electronic devices (CIEDs) and insertable cardiac monitors (ICMs). While an increased risk of thromboembolic events (e.g., stroke) and benefits from anticoagulation have been widely assessed in the setting of clinical AF, concerns persist about optimal clinical management of subclinical AF/AHREs. As a matter of fact, an optimal threshold of subclinical episodes' duration to predict stroke risk is still lacking and recently published randomized clinical trials assessing the impact of anticoagulation on thromboembolic events in this specific setting have shown contrasting results. The aim of this review is to summarize current evidence regarding classification and clinical impact of subclinical AF/AHREs and to discuss the latest evidence regarding the potential benefit of anticoagulation in this setting, highlighting which clinical questions are still unanswered.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126553","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":"Jailed Balloon Technique Versus Jailed Wire Technique for Side Branch Ostium Protection in Bifurcation Lesions: Evidence from Three-dimensional Optical Coherence Tomography Analysis.","authors":"JianGuo Cui, Xun Wu, QinHua Jin, YunDai Chen","doi":"10.31083/j.rcm2508300","DOIUrl":"10.31083/j.rcm2508300","url":null,"abstract":"<p><strong>Background: </strong>There is controversy regarding the effectiveness the of jailed wire technique (JWT) and jailed balloon technique (JBT) in preserving the side branch (SB) during treatment. This study compares the protective effect of JBT versus JWT on the SB ostium area in coronary bifurcation lesions using three-dimensional optical coherence tomography (3D-OCT).</p><p><strong>Methods: </strong>We obtained data from coronary heart disease patients who received OCT-guided percutaneous coronary intervention (PCI) for bifurcation lesions. The SB protection strategies were divided into JWT and JBT, with the latter further subdivided into active JBT (A-JBT) and conventional JBT (C-JBT). The primary endpoint was the SB ostium area difference measured by 3D-OCT before and after PCI. Partial correlation analysis and propensity score matching (PSM) was used to mitigate confounding biases.</p><p><strong>Results: </strong>A total of 207 bifurcation lesions from 191 patients were analyzed, including 136 lesions treated with JWT and 71 lesions treated with JBT. The SB ostium area was significantly greater in the JBT group compared to the JWT group (0.41 <math><mo>±</mo></math> 1.22 mm² vs. -0.25 <math><mo>±</mo></math> 1.40 mm², <i>p</i> = 0.001). Following 1:1 PSM to adjust for 60 pairs, the difference between groups was not statistically significant (0.28 <math><mo>±</mo></math> 1.06 mm² vs. -0.02 <math><mo>±</mo></math> 1.29 mm², <i>p</i> = 0.165). Subgroup analysis revealed that A-JBT provided superior protection in both true (0.47 <math><mo>±</mo></math> 1.22 mm² vs. -0.10 <math><mo>±</mo></math> 1.10 mm², <i>p</i> = 0.011) and non-true bifurcation lesions (0.56 <math><mo>±</mo></math> 1.43 mm² vs. -0.38 <math><mo>±</mo></math> 1.62 mm², <i>p</i> = 0.030) over JWT, while C-JBT provided protection similar to JWT. A positive partial correlation was observed between the diameter of the jailed balloon and the increase in SB ostium area (r = 0.296, <i>p</i> = 0.013).</p><p><strong>Conclusions: </strong>Overall, A-JBT, but not C-JBT, provided better protection in bifurcation lesions compared to JWT. The larger diameter of the jailed balloon, rather than the application of higher pressure, enhanced the SB protection.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126560","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":"Navigating Complications in Cardiac Pacemakers: A Comprehensive Review and Management Strategies.","authors":"Anil Sriramoju, Shruti Krishna Iyengar, Komandoor Srivathsan","doi":"10.31083/j.rcm2508299","DOIUrl":"10.31083/j.rcm2508299","url":null,"abstract":"<p><p>The landscape of cardiac pacemaker technology has undergone significant evolution over the last two decades, transitioning from simple single-chamber devices to sophisticated multi-chamber rate-responsive systems and cardioverter defibrillators. This progression has introduced a complex array of complications inherent to device implantation and operation, encompassing both mechanical and clinical challenges. These complications notably include lead dislodgment, device migration, venous thrombosis, and hemothorax, which not only affect patient outcomes but also impose substantial economic burdens. This review meticulously analyzes these complications, elucidating their mechanisms, clinical implications, and the economic consequences associated with their management. It also outlines current and emerging strategies aimed at mitigating these complications, emphasizing the need for continual updates in clinical practices and protocols. Through this discourse, the review seeks to equip clinicians with a comprehensive understanding of these complications, thereby enhancing the safety and efficacy of cardiac pacing interventions.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126564","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":"Advancements in Cardiovascular Disease Research Affected by Smoking.","authors":"Miaoxin Fu, Aihua Mei, Xinwen Min, Handong Yang, Wenwen Wu, Jixin Zhong, Chunlei Li, Jun Chen","doi":"10.31083/j.rcm2508298","DOIUrl":"10.31083/j.rcm2508298","url":null,"abstract":"<p><p>The harmful substances in tobacco are widely recognized to exert a significant detrimental impact on human health, constituting one of the most substantial global public health threats to date. Tobacco usage also ranks among the principal contributors to cardiovascular ailments, with tobacco being attributed to up to 30% of cardiovascular disease-related deaths in various countries. Cardiovascular disease is influenced by many kinds of pathogenic factors, among them, tobacco usage has led to an increased year by year incidence of cardiovascular disease. Exploring the influencing factors of harmful substances in tobacco and achieving early prevention are important means to reduce the incidence of cardiovascular diseases and maintain health. This article provides a comprehensive review of the effects of smoking on health and cardiovascular diseases.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142128152","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}