Reviews in cardiovascular medicine最新文献

{"title":"Obstructive Sleep Apnoea and Atrial Fibrillation: Current Evidence and Emerging Research Directions.","authors":"Paweł Basiukiewicz, Shaoije Chen, Mark T Mills, Piotr Futyma","doi":"10.31083/RCM50804","DOIUrl":"10.31083/RCM50804","url":null,"abstract":"<p><p>This review summarizes current knowledge on the coexistence of obstructive sleep apnoea and atrial fibrillation. A narrative review of the literature was conducted to identify relevant clinical and mechanistic studies. Obstructive sleep apnoea is highly prevalent among patients with atrial fibrillation and adversely affects rhythm-control outcomes. The interplay between these two conditions is of significant clinical importance, as obstructive sleep apnoea contributes to the development and progression of arrhythmias through multiple pathophysiological mechanisms: mechanical atrial stretch, immune activation and low-grade inflammation, autonomic dysregulation, oxidative stress, and systemic hypoxia. These mechanisms promote the initiation, maintenance, and treatment resistance of atrial fibrillation. Multimodal management strategies aimed at this harmful interplay may improve outcomes in patients with atrial fibrillation and include lifestyle and dietary interventions, pharmacometabolic therapies, particularly glucagon-like peptide-1 receptor agonists, continuous positive airway pressure therapy, and, in selected cases, catheter ablation strategies, potentially extended to the ganglionated plexi. Collectively, these approaches may contribute to the restoration and maintenance of sinus rhythm.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"50804"},"PeriodicalIF":2.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887248","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":"Percentage of Low-Attenuation Epicardial Adipose Volume (LAAV%) as an Independent Predictor of Coronary Microvascular Dysfunction: A Retrospective Cohort Study.","authors":"Hui Ding, Linlin Sun, Shuangxiang Lin, Xincheng Li, Haipeng Liu, Zhen Wang","doi":"10.31083/RCM50334","DOIUrl":"10.31083/RCM50334","url":null,"abstract":"<p><strong>Background: </strong>Clinically, coronary microvascular dysfunction (CMD) remains a significant diagnostic challenge because the associated symptoms frequently overlap with obstructive coronary artery disease (CAD). This condition may contribute to cardiac ischemic events regardless of the presence of obstructive epicardial lesions. While inflammatory pathways, particularly those involving epicardial adipose tissue (EAT) accumulation, play a central role in the development of CMD, the specific influence of EAT quality, as reflected in the associated density-based composition, remains poorly understood.</p><p><strong>Methods: </strong>This retrospective study (n = 155) analyzed a single primary vessel per patient to ensure independence of data. Based on invasive physiological assessment, patients were stratified into an isolated CMD group (n = 81), defined as fractional flow reserve (FFR) ≥0.75 with coronary flow reserve (CFR) <2.5 and/or index of microcirculatory resistance (IMR) ≥25 and a non-CMD control group (n = 74), which included patients with obstructive CAD (FFR <0.75, stenosis >50%) and those with normal physiology. Quantitative assessment using coronary computed tomography angiography (CCTA) applied a range of -190 to -15 Hounsfield units (HU). Perivascular inflammation was evaluated by measuring the low-attenuation adipose volume (LAAV) (<-75 HU) as a percentage of total EAT (LAAV%). Independent determinants of CMD were identified using multivariable logistic regression models.</p><p><strong>Results: </strong>Multivariable analysis identified standardized LAAV% as the primary independent predictor of CMD. Specifically, each one-standard deviation (SD) increase in LAAV% was associated with a 147.1% increase in odds of CMD (odds ratios (OR) = 2.471, 95% confidence interval (CI): 1.577-4.128, <i>p</i> < 0.001). The predictive framework demonstrated robust performance (area under the receiver operating characteristic curve (AUC) = 0.810). Additional significant risk factors included body mass index (BMI) (OR = 1.380) and smoking history (OR = 4.005, <i>p</i> = 0.023).</p><p><strong>Conclusions: </strong>Low-attenuation areas of EAT, particularly as quantified by standardized LAAV%, are strong independent predictors of CMD. The integration of LAAV% into non-invasive risk assessments may improve diagnostic accuracy and help inform targeted interventions for CMD.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"50334"},"PeriodicalIF":2.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887720","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":"Vascular Smooth Muscle Cell Plasticity in Atherosclerosis: Mechanisms, Recent Advances, and Therapeutic Implications.","authors":"Tianhan Li, Xinyao Niu, Liaoxun Lu, Yinming Liang, Lichen Zhang","doi":"10.31083/RCM50363","DOIUrl":"10.31083/RCM50363","url":null,"abstract":"<p><p>Atherosclerosis, the fundamental pathological basis of most cardiovascular diseases which remain the leading cause of global mortality, is driven by both lipid accumulation and dynamic cellular reprogramming within the vessel wall. Central to this process is the remarkable phenotypic plasticity of vascular smooth muscle cells (VSMCs). Far from being terminally differentiated, VSMCs undergo profound transitions from a contractile state to diverse states, including synthetic, macrophage-like, foam cell-like, and fibroblast-like states, which critically influence plaque formation, stability, and rupture. This review synthesizes the multilayered molecular mechanisms governing VSMC plasticity, encompassing transcriptional networks, epigenetic reprogramming, and microenvironmental cues. Moreover, this review highlights recent breakthroughs enabled by single-cell omics and lineage tracing, that have revealed unprecedented heterogeneity and clonal expansion of VSMCs within atherosclerotic lesions. Furthermore, we explore the translational potential of targeting VSMC plasticity, and discuss emerging strategies, including phenotype-specific modulation, immunotherapy, nanomedicine, and senotherapeutics. Finally, we outline future directions focused on dynamic regulatory networks, spatial pathophysiology, and the integration of aging biology to advance precision medicine in atherosclerosis. In summary, VSMC phenotypic plasticity is a core mechanism underlying the initiation and progression of atherosclerosis. Precise modulation of this process holds promise for overcoming current therapeutic limitations and driving a paradigm shift toward mechanism-guided personalized therapy for cardiovascular diseases.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 8","pages":"50363"},"PeriodicalIF":2.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888424","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 Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Stenosis: A Systematic Review and Meta-Analysis.","authors":"Fang-Hui Zhu, Xi Peng, Yun-Qi Zhang, Nan Chen, Xiao-Han Zhao, Hui-Ping Zhang","doi":"10.31083/RCM49401","DOIUrl":"10.31083/RCM49401","url":null,"abstract":"<p><strong>Background: </strong>Although the bicuspid aortic valve (BAV) is a major cause of aortic stenosis (AS), limited evidence exists regarding the safety and efficacy of transcatheter aortic valve replacement (TAVR) in BAV patients. This study aimed to compare TAVR outcomes between BAV and tricuspid aortic valve (TAV) cohorts.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Web of Science, Embase, and the Cochrane Library to identify studies reporting 1-year follow-up outcomes. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were derived from a random-effects model.</p><p><strong>Results: </strong>The analysis included 31 studies involving 192,691 patients. Patients with BAV were younger than those with TAV (71.2 vs. 73.2 years, <i>p</i> < 0.01) and exhibited lower society of thoracic surgeons (STS) scores (3.5% vs. 4.3%, <i>p</i> < 0.05). Compared with TAV, BAV was associated with a lower likelihood of device success (OR = 0.80; 95% CI 0.65-0.98; <i>p</i> = 0.03) and an increased risk of moderate/severe paravalvular leak (PVL) (OR = 1.39; 95% CI 1.22-1.58; <i>p</i> < 0.01). No significant differences were observed in in-hospital mortality (OR = 1.10, 95% CI 0.86-1.42; <i>p</i> = 0.44), or major peri-procedural complications between the two cohorts. At 30 days, all-cause mortality (OR = 1.19, 95% CI 0.96-1.47, <i>p</i> = 0.11) and cardiovascular mortality (OR = 1.59, 95% CI 0.87-2.90; <i>p</i> = 0.13) were similar between BAV and TAV groups. While 1-year cardiovascular mortality showed no significant difference (OR = 0.70, 95% CI 0.42-1.16; <i>p</i> = 0.17), BAV patients exhibited a significant reduction in 1-year all-cause mortality (OR = 0.84, 95% CI 0.73-0.97; <i>p</i> = 0.01). This survival benefit was consistent in propensity-score matched cohorts (OR = 0.78, 95% CI 0.64-0.95; <i>p</i> = 0.01). Subgroup analysis further identified distinct survival advantages for BAV patients who were younger (OR = 0.82, 95% CI 0.71-0.95, <i>p</i> = 0.01), had lower STS scores (OR = 0.68, 95% CI 0.50-0.92, <i>p</i> = 0.01), or received balloon-expandable valves (OR = 0.76, 95% CI 0.61-0.94, <i>p</i> = 0.01). Notably, 1-year all-cause mortality rates were similar when stratified by aortic diameter or paravalvular leak (PVL) incidence.</p><p><strong>Conclusion: </strong>This meta-analysis demonstrated that TAVR had similar safety and efficacy profiles for BAV and TAV patients. Additionally, BAV patients undergoing TAVR exhibited a reduced 1-year all-cause mortality compared to TAV patients.</p><p><strong>The prospero registration: </strong>CRD42025618185, https://www.crd.york.ac.uk/PROSPERO/view/CRD42025618185.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 7","pages":"49401"},"PeriodicalIF":2.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631364","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":"Cardiovascular Disease, Sleep-Disordered Breathing, and Artificial Intelligence: From Neutral Trials to Precision Sleep Cardiology.","authors":"Zhihua Huang, Jingjing Xiang, Zhihui Zhao, Qing Zhao, Anqi Duan, Zhaohong Sun, Lisheng Xu, Wenzhen Yao, Wenyu Zhang, Qi Wang, Luyang Gao, Xin Li, Yijia Wang, Sicong Li, Huiyi Liu, Chenhong An, Qin Luo, Zhihong Liu","doi":"10.31083/RCM50419","DOIUrl":"10.31083/RCM50419","url":null,"abstract":"<p><p>Sleep-disordered breathing (SDB), which includes both obstructive and central sleep apnea, is highly prevalent among patients with cardiovascular disease (CVD). Moreover, SDB contributes significantly to the development and progression of hypertension, coronary artery disease, arrhythmias, heart failure, and various cardiovascular and cerebrovascular events. However, despite strong mechanistic links involving intermittent hypoxemia, sympathetic activation, intrathoracic pressure fluctuations, and systemic inflammation, clinical trials of SDB treatment have yielded in neutral or even adverse cardiovascular outcomes. These results underscore the need for refined phenotyping, risk stratification, and personalized management. Artificial intelligence (AI) has emerged as a promising tool to address these challenges. In this review, we evaluate the mechanistic pathways through which SDB affects cardiovascular health and critically examine AI-based methods to enhance screening, outcome prediction, and treatment optimization. Applications include automated detection using clinical and biosignal data, cardiovascular risk prediction through machine-learning models based on sleep parameters, and AI-guided therapy personalization. Furthermore, we emphasize translational relevance by comparing model performance, identifying high-risk phenotypes, and exploring the potential for integration into clinical workflows. AI-enabled tools may help bridge the gap between pathophysiological understanding and improved outcomes by facilitating earlier diagnosis, tailored interventions, and proactive monitoring. Future studies should focus on prospective validation, regulatory pathways, and equitable deployment across populations.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 7","pages":"50419"},"PeriodicalIF":2.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631489","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":"Immunothrombotic Dysregulation in Pediatric Patients Receiving Veno-arterial ECMO After Cardiac Surgery: Insights From Platelet Activation and T Cell Immune Profiling.","authors":"Junfeng Guo, Zhongtao Du, Bo Xu, Xiaofang Yang, Meng Xin, Xing Hao, Chenglong Li, Hong Wang, Xiaotong Hou","doi":"10.31083/RCM49903","DOIUrl":"10.31083/RCM49903","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have demonstrated that both cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are often associated with adverse outcomes or immune dysregulation when platelet counts decline during support. Moreover, the severity of thrombocytopenia generally correlates with a worse clinical prognosis. However, the underlying mechanisms remain incompletely understood. Previous research has attributed this phenomenon to hemodynamic alterations during CPB and ECMO, as well as anticoagulant-induced abnormal platelet activation. Based on our clinical observations, we question the completeness of this explanation and propose an alternative hypothesis: sustained platelet activation during ECMO serves as an initiating factor that contributes to both progressive thrombocytopenia and immune dysfunction throughout the support period.</p><p><strong>Methods: </strong>We investigated platelet activation status, degranulation capacity, and T cell subset dynamics in patients receiving ECMO support. Flow cytometry was used to assess platelet surface markers, reticulated platelet proportions, and T cell subset distributions.</p><p><strong>Results: </strong>We demonstrate that platelets exhibit excessive activation during ECMO, accompanied by a gradual decline in their degranulation capacity. Notably, even with an increased proportion of newly formed platelets, this functional impairment persists. Furthermore, we observed significant alterations in Helper T cell Type 1 (Th1) and CD8+ T cell populations during ECMO support.</p><p><strong>Conclusions: </strong>Our findings suggest that aberrantly activated platelets during ECMO amplify the specific recognition of platelet antigens by CD8+ T cells via modulating the differentiation bias of CD4+ T cells, particularly Th1 cells, ultimately leading to platelet depletion. These results suggest that early interventions targeting abnormal platelet activation may represent a potentially effective therapeutic strategy to mitigate ECMO-associated thrombocytopenia.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 7","pages":"49903"},"PeriodicalIF":2.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631145","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 Antithrombotic Therapy After Percutaneous Coronary Intervention: Secondary Prevention Beyond One Year.","authors":"Mohamed Abdelgader, Roann Khalid, Kartik Yadav, Sama Ehab Salah Ahmed, Murugapathy Veerasamy, Arka Das, Heerajnarain Bulluck","doi":"10.31083/RCM51947","DOIUrl":"10.31083/RCM51947","url":null,"abstract":"<p><p>The early period following percutaneous coronary intervention (PCI), particularly the first days to weeks after stent implantation, is characterized by heightened device-related thrombotic risk, and dual antiplatelet therapy (DAPT) during this phase is well established. With contemporary drug-eluting stents (DES) and abbreviated DAPT strategies, late stent-related events have become less frequent, and long-term risk increasingly reflects underlying systemic atherosclerotic disease. Beyond 12 months, the risk profile shifts further: late events increasingly reflect progressive atherosclerosis and systemic vascular disease rather than stent-related thrombosis. This review synthesizes contemporary evidence on long-term antiplatelet and antithrombotic therapy after PCI, with a focus on the period beyond one year. We evaluate the data supporting for lifelong aspirin as the traditional default strategy, as well as the emerging evidence that P2Y₁₂ inhibitor monotherapy may be superior to aspirin in selected post-PCI populations (HOST-EXAM, HOST-EXAM Extended, PANTHER, SMART-CHOICE 3). This review also examines the role of prolonged DAPT in selected high-risk patients (DAPT Trial, PEGASUS-Thrombolysis in Myocardial Infarction (TIMI) 54) and the paradigm of dual-pathway inhibition with low-dose rivaroxaban plus aspirin (COMPASS, VOYAGER-peripheral artery disease (PAD)). In addition, the review considers protease-activated receptor (PAR) antagonism (TRA 2°P-TIMI 50) and precision-based strategies, including <i>CYP2C19</i> genotype-guided therapy. Special populations, such as patients with diabetes, chronic kidney disease (CKD), polyvascular disease, and those requiring concomitant oral anticoagulation, present distinct long-term management challenges. Thus, novel targets, including factor XIa inhibitors and PAR-4 antagonists, may further refine the antithrombotic approach. Overall, the optimal long-term strategy after PCI is increasingly defined not by fixed timelines but by the dynamic balance between ischemic and bleeding risk.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 7","pages":"51947"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631330","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":"Correlation Between Interatrial Septal In Situ Thrombus and Stroke Evaluated by Transesophageal Echocardiography.","authors":"Bin Wang, Shuang Wang, Minxin Zhang, Kehan Ding, Shuixing Zhang","doi":"10.31083/RCM50472","DOIUrl":"10.31083/RCM50472","url":null,"abstract":"<p><strong>Background: </strong>Patent foramen ovale (PFO) is a crucial etiology of cryptogenic stroke, with paradoxical embolism recognized as its classic pathogenic mechanism. However, the origin of most emboli remains unclear. This study aimed to detect the presence and location of <i>in situ</i> thrombus on the interatrial septum in patients with PFO using contrast-enhanced transesophageal echocardiography (c-TEE) and analyze its correlation with stroke and migraine, thereby providing novel insights into the pathogenesis of PFO-related diseases.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 3343 patients who underwent TEE examination between March 2021 and December 2024. Patients were divided into the <i>in situ</i> thrombus group (n = 62) and the non-<i>in situ</i> thrombus group (n = 1211) based on TEE findings. According to clinical symptoms, patients were categorized into the stroke group (n = 210), the migraine group (n = 633), and the asymptomatic group (n = 430). TEE was used to comprehensively assess the location, size, and quantity of the <i>in situ</i> thrombus. The anatomical parameters and hemodynamic parameters of PFO were compared among different groups.</p><p><strong>Results: </strong>Among 1273 PFO patients, the overall detection rate of <i>in situ</i> thrombus on the interatrial septum by TEE was 4.56% (62/1273). The detection rate of <i>in situ</i> thrombus in the stroke group (11.90%, 25/210) was significantly higher than that in the migraine group (2.53%, 16/633) and the asymptomatic group (3.95%, 17/430) (<i>p</i> < 0.001). In situ thrombus was most commonly located on the right atrial surface of the interatrial septum (69.0%, 40/62). The PFO diameter in the thrombus group was significantly larger than that in the non-thrombus group (<i>p</i> = 0.0033), and the shunt velocity was also significantly higher (<i>p</i> < 0.001). At the same time, no significant difference in PFO length was observed between the two groups. All patients with a detected <i>in situ</i> thrombus had negative findings on lower-extremity venous ultrasonography. After PFO closure, the rate of symptom improvement in the stroke group was significantly higher than in the migraine group (95.68% vs 52.80%, <i>p</i> < 0.005).</p><p><strong>Conclusions: </strong>c-TEE is an effective method for detecting <i>in-situ</i> thrombus in the atrial septum in patients with PFO, and such thrombus may play an important role in PFO-related stroke. PFO closure may be effective in stroke patients with concomitant <i>in-situ</i> thrombus. In clinical practice, routine risk stratification should be performed in patients with PFO, with an emphasis on identifying high-risk features and <i>in situ</i> thrombus lesions, to provide a basis for individualized treatment decisions.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 7","pages":"50472"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631582","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":"Insulin Resistance Indices and Subclinical Left Ventricular Systolic Dysfunction in Adults: A Systematic Review and Meta-Analysis.","authors":"Hao Li, Yuke Ma, Lei Zhao","doi":"10.31083/RCM49364","DOIUrl":"10.31083/RCM49364","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance (IR) is a key characteristic of cardiometabolic disease and may contribute to subclinical ventricular dysfunction before the development of overt heart failure. Studies have reported heterogeneous results regarding the associations between IR indices and myocardial strain. Thus, this review synthesized the available evidence on the relationships between IR indices and subclinical left ventricular systolic dysfunction in adults.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Web of Science Core Collection, and the Cochrane Library from inception to 1 December 2025 for observational studies involving adults that reported associations between IR indices and speckle-tracking echocardiography-derived strain parameters. Eligible exposures included commonly used IR indices, such as the homeostatic model assessment of insulin resistance (HOMA-IR), the triglyceride-glucose (TyG) index, the metabolic score for insulin resistance (METS-IR), and lipid-based ratios. The primary outcome was global longitudinal strain (|GLS|). Right ventricular strain was summarized narratively because only one study reported this condition. Adjusted odds ratios (ORs) for subclinical LV systolic dysfunction per unit increase in an IR index and mean differences (MDs) in |GLS| between the highest and lowest IR categories were synthesized using random effects models with Hartung-Knapp adjustment.</p><p><strong>Results: </strong>Four studies reporting fully adjusted ORs per unit increase in an IR index showed a consistent positive association with subclinical LV systolic dysfunction. The pooled OR per unit increase in the IR index was 1.36 (95% confidence interval (CI): 1.20 to 1.53; I² = 0%). Five studies comparing GLS across IR quartiles reported that participants in the highest quartile had worse LV systolic function than those in the lowest quartile. The random-effects pooled MD in GLS (Q4 vs. Q1) was -1.58 percentage points (95% CI: -2.22 to -0.93), indicating a lower strain magnitude (worse subclinical systolic function) in the highest IR group.</p><p><strong>Conclusions: </strong>Higher IR indices were independently associated with lower GLS values, indicating worse subclinical LV systolic function. The association was directionally consistent across IR metrics, but the supportingevidence remains limited, prospective validation and interventional studies are needed.</p><p><strong>The prospero registration: </strong>CRD420251251563, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251251563.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 7","pages":"49364"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631310","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 Role of Atherectomy in Lesion Preparation for Peripheral Artery Disease: Evolution of Technologies, Available Devices, and Contemporary Evidence.","authors":"Solon Antoniades, Grigorios Korosoglou","doi":"10.31083/RCM51145","DOIUrl":"10.31083/RCM51145","url":null,"abstract":"<p><p>Atherectomy has become an established tool for lesion preparation in the endovascular treatment of peripheral artery disease (PAD), particularly for complex and heavily calcified lesions. Despite the widespread clinical use of atherectomy, the long-term benefits of this tool remain controversial, and the available evidence is heterogeneous. This review aimed to provide a clinically oriented, expert-driven narrative evaluation of peripheral atherectomy, including the historical evolution, currently available technologies, and the contemporary clinical role of the procedure, while integrating randomized and real-world evidence to support rational patient and lesion selection. A narrative literature review was conducted based on continuous expert monitoring since 2021 and targeted PubMed searches using combinations of the terms \"peripheral artery disease\", \"atherectomy\", \"critical limb ischemia\", and \"intermittent claudication\". Randomized controlled trials, meta-analyses, major registries, and high-quality observational studies were identified, selected based on clinical relevance and methodological quality, and synthesized accordingly. Randomized trials have consistently shown that atherectomy does not provide superior long-term patency or limb salvage compared with balloon angioplasty, stenting, or drug-coated balloons (DCB). However, atherectomy has demonstrated reproducible procedural advantages across multiple studies, including greater luminal gain, fewer dissections, and less need for bailout stenting. Observational and registry data further suggest potential benefits in selected scenarios, particularly for heavily calcified lesions, long-segment occlusions, in-stent restenosis (ISR), and anatomically challenging mobile segments. Current evidence does not support the routine use of atherectomy in PAD. Nevertheless, when applied selectively in appropriately chosen patients and lesions, atherectomy represents a valuable strategy for vessel preparation. The responsible use of atherectomy requires careful integration of the available evidence with operator expertise, awareness of alternative technologies, and consideration of procedural risks and reimbursement issues.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"27 7","pages":"51145"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631324","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}