Therapeutic Advances in Cardiovascular Disease最新文献

{"title":"Postoperative cytotoxic cerebral edema following surgical resection of a giant right atrial aneurysm in an infant: a rare case report.","authors":"Hui Yan, Yang Zhou, Kaiyuan Li, Ruiling Feng, Bo Zhai, Zhenliang Chen","doi":"10.1177/17539447261453502","DOIUrl":"10.1177/17539447261453502","url":null,"abstract":"<p><p>This case report describes a rare case of a giant right atrial aneurysm (RAA) in a 7-month-old male infant admitted to Children's Hospital Affiliated to Zhengzhou University in July 2025. A RAA was detected during a physical examination at 2 months of age with no clinical symptoms present. Follow-up reexamination at 7 months of age revealed progressive enlargement of the RAA, and the infant thus underwent aneurysm resection plus atrial septal defect repair under cardiopulmonary bypass. Postoperative histopathological examination confirmed the diagnosis of RAA. On the second postoperative day, the infant developed neurological complications including lethargy, skew deviation, mild hemiplegia, and focal epilepsy. The hospital immediately implemented a multimodal intervention strategy involving mannitol for dehydration, glucocorticoids for anti-inflammation, antiepileptic medication, and strict fluid management. The infant achieved near-complete recovery of neurological function at discharge on the 21st postoperative day, with significant improvement in brain abnormalities on follow-up at 1 month postoperatively. This case highlights cytotoxic cerebral edema, a rare postoperative neurological complication following RAA resection in children, and emphasizes the importance of early identification and multimodal treatment for such complications, providing valuable clinical evidence for the perioperative management of pediatric cardiac surgery.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447261453502"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148101870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning curve of two-incision thoracoscopic double valve replacement: Cumulative sum analysis of postoperative outcomes and proficiency in 252 operations from a single high-volume center.","authors":"Qichen Xu, Zheng Xu, Liangwan Chen, Xiaofu Dai, Zhiqin Lin","doi":"10.1177/17539447261475835","DOIUrl":"10.1177/17539447261475835","url":null,"abstract":"<p><p>BackgroundDespite the increasing adoption of minimally invasive approaches for valvular heart disease, the learning trajectory for complex thoracoscopic double valve replacement (DVR) remains largely uncharacterized.ObjectivesTo evaluate the learning curve of two-incision thoracoscopic DVR, determine the case threshold for procedural proficiency, and identify independent predictors of major adverse surgical events (MASE).DesignRetrospective cohort study.MethodsWe evaluated 252 consecutive thoracoscopic DVR procedures performed at a single high-volume center between March 2017 and December 2024. Cumulative sum (CUSUM) analysis of cardiopulmonary bypass (CPB) time was utilized to define distinct learning phases. MASE, a composite of mortality, conversion to sternotomy, and reoperation for bleeding, served as the primary clinical outcome. Multivariate logistic regression was performed to identify independent predictors of MASE.ResultsCUSUM analysis revealed three distinct learning phases: Acquisition (cases 1-67), Acceleration (cases 68-139), and Mastery (cases 140-252). Mean CPB time decreased progressively from 187.5±34.2 to 156.3±27.6 and 138.4±18.9 minutes across the three phases (p<0.001). Concurrently, MASE rates declined significantly from 16.4% in the Acquisition phase to 4.2% in the Acceleration phase, stabilizing at 4.4% during the Mastery phase (p=0.006). A small aortic annulus emerged as the strongest independent predictor of complications (OR 467.483, p<0.001), followed by operations performed during the Acquisition phase (OR 14.564, p=0.007).ConclusionThoracoscopic DVR demonstrates a three-phase learning curve, with technical proficiency achieved after approximately 139 cases. Early procedural implementation requires risk-adapted case selection, specifically avoiding small aortic annuli during the initial experience. Because standard risk models may significantly underestimate mortality in this context, procedure-specific considerations and learning curve position are essential when evaluating candidates for this advanced minimally invasive approach.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447261475835"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the implementation of guideline-directed medical therapy in the treatment of chronic heart failure at public hospitals in Ethiopia.","authors":"Akalu Fetene, Amsalu Degu, Chalelgn Kassaw, Chala Fekadu Oljira, Kale Gubae, Tariku Shimels, Getachew Alemkere","doi":"10.1177/17539447251411121","DOIUrl":"10.1177/17539447251411121","url":null,"abstract":"<p><strong>Background: </strong>Guideline-directed medical therapy (GDMT) prolongs survival in patients with heart failure with reduced ejection fraction (HFrEF). However, different countries implement GDMT differently, and many patients are still undertreated. Therefore, this study aimed to assess GDMT utilization in patients with chronic HFrEF at the adult cardiac clinics of three selected hospitals in Addis Ababa, Ethiopia.</p><p><strong>Methods: </strong>An explanatory sequential mixed-methods (quantitative cross-sectional followed by qualitative phenomenological) study design was used to assess GDMT usage in patients with HFrEF at the study settings from September 25 to November 25, 2022. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. Adherence level was defined as good (adherence score = 1), moderate (0.5 < score <1), and poor (score ⩽0.5). Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Logistic regression model was used to determine the association. Statistical significance was declared at <i>p</i> < 0.05. Qualitative data were analyzed with MAXQDA 2020.</p><p><strong>Results: </strong>Three hundred forty-one patients were included in the quantitative study. Adherence to GDMT was good in 128 (37.5%) of the patients. Patient parameters, including female gender (adjusted odds ratio (AOR) = 0.55, 95% CI: 0.32-0.93), unable to read and write (AOR = 0.31, 95% CI: 0.11-0.86), primary education (AOR = 0.27, 95% CI: 0.12-0.63), were negatively associated with Physicians' good adherence. Hypertension was associated with lower odds of physicians' good adherence (AOR = 0.41, 95% CI: 0.21-0.78). Absence of comorbidities (other than hypertension; AOR = 2.65, 95% CI: 1.36-5.15) were positive predictors. System, patient, and physician-related factors were reported as barriers to intensifying GDMT.</p><p><strong>Conclusion: </strong>Nearly one-fourth of eligible patients were on ⩽50% of guidelines-recommended drugs. Female gender, educational level, and comorbidities were the factors associated with adherence to GDMT. System, patient, and physician-related reasons for poor adherence were identified. Multipronged interventions are required to address those adherence barriers.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447251411121"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined diagnostic value of the systemic immune-inflammation index and LDL for coronary microvascular disease: a retrospective cohort study.","authors":"Xin Shi, Jiantao Sun, Hongyu Wang, Qi Zhao, Cong Yan, Yang Cao","doi":"10.1177/17539447261469508","DOIUrl":"10.1177/17539447261469508","url":null,"abstract":"<p><strong>Background: </strong>Coronary microvascular disease (CMVD) is an important contributor to ischemic heart disease. Symptomatic patients without obstructive coronary lesions may still have microvascular ischemia, which is associated with <i>an increased risk</i> of major adverse cardiovascular events. The diagnosis of CMVD relies on coronary function testing or noninvasive imaging techniques, which are not universally available and may limit routine clinical implementation.</p><p><strong>Objectives: </strong>Growing evidence supports the notion that biological processes such as inflammation and oxidative stress drive vascular aging and contribute to microvascular dysfunction. The systemic immune-inflammation index (SII) is a marker used to assess immune-inflammatory and thrombotic status and has shown prognostic value in chronic heart failure, and acute myocardial infarction. However, its role in CMVD remains underexplored.</p><p><strong>Design: </strong>To address this gap, we retrospectively analyzed 180 patients with angina who underwent myocardial contrast stress echocardiography between January and November 2022 at the First Affiliated Hospital of Harbin Medical University.</p><p><strong>Methods: </strong>Based on coronary microcirculatory function, patients were divided into two groups: 91 with normal function and 89 with microcirculatory disorders. Clinical data and lab indicators were compared.</p><p><strong>Results: </strong>SII was significantly higher in the CMVD group (722.96 ± 354.10 vs 618.51 ± 324.50; <i>p</i> < 0.05). Logistic regression identified SII, LDL cholesterol as independent CMVD predictors. Pearson correlation demonstrated an inverse relationship between SII and coronary flow reserve, supporting its link with impaired microvascular function. Receiver operating characteristic analysis further showed that the combined SII and LDL model provided improved discriminatory performance compared with either marker alone, achieving an area under the curve of 0.76 with a sensitivity of 77.5% and specificity of 69.2%.</p><p><strong>Conclusion: </strong>SII is independently associated with CMVD and improved discriminatory performance when combined with LDL.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447261469508"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first 24-h negative fluid balance is related to lower short-term mortality but higher AKI progression in critically ill heart failure: a retrospective cohort study.","authors":"Wenhao Liu, Qian Chen, Tucheng Huang, Juanzhang Liu, Hongwei Li, Qi Guo","doi":"10.1177/17539447261457542","DOIUrl":"10.1177/17539447261457542","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines lack instruction on fluid administration for patients with critically ill heart failure (HF) in the intensive care unit.</p><p><strong>Objectives: </strong>This study aims to compare the risk of mortality and acute kidney injury (AKI) outcomes among unlimited intake, restrictive intake, and negative balance.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>A total of 3267 patients with HF not receiving renal replacement therapy were included from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and were grouped into restrictive fluid intake (the first 24-h fluid intake from 1500 to 2000 mL), negative fluid balance management (the first 24-h net output >1000 mL), and unlimited fluid control groups. The primary endpoint was 28-day mortality, and the secondary endpoints were morbidity of 48-h AKI, 7-day AKI, and AKI progression from 48 h to 7 days. The odds ratio (OR) and the 95% confidence interval (CI) were estimated by multivariable logistic regression, and mediation analyses were performed.</p><p><strong>Results: </strong>Negative fluid balance, not restrictive fluid intake, was correlated to a lower risk of 28-day mortality (OR: 0.750 (0.570-0.987), <i>p</i> = 0.040), 48-h AKI (OR: 0.207 (0.169-0.255), <i>p</i> < 0.001), and 7-day AKI (OR: 0.261 (0.207-0.330), <i>p</i> < 0.001) but was correlated to a higher risk of AKI progression (OR: 2.284 (1.835-2.843), <i>p</i> < 0.001) compared to unlimited fluid control after multivariable adjustment. The 24-h net output mediated AKI incidence and progression.</p><p><strong>Conclusion: </strong>Negative fluid balance was related to lower risk of 28-day mortality, 48-h AKI, and 7-day AKI but a higher risk of AKI progression, which requires further clinical trials for validation.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447261457542"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive off-pump coronary surgery via left mini-thoracotomy for a left coronary artery aneurysm in a female: A case report.","authors":"Akimasa Morisaki, Kokoro Yamane, Toshihiko Shibata","doi":"10.1177/17539447261493436","DOIUrl":"https://doi.org/10.1177/17539447261493436","url":null,"abstract":"<p><p>Coronary artery aneurysm is a rare condition commonly treated with conventional surgery under cardiopulmonary bypass because of its complexity. Here, we present a patient who underwent minimally invasive off-pump coronary surgery via left mini-thoracotomy for a left anterior descending artery saccular aneurysm. A Japanese woman in her late 40s, who had been treated with beta-blocker therapy for hypertrophic cardiomyopathy, and steroid and immunosuppressive therapies after renal transplantation, developed chest discomfort on effort recently. Digital Holter electrocardiography showed ST-segment depression associated with exertional dyspnea, suggesting ischemic heart disease. Coronary angiography revealed a saccular aneurysm of the left anterior descending artery that had caused ischemia due to turbulence. This patient was diagnosed with a left coronary artery aneurysm causing ischemic symptoms, which indicated surgical intervention, whereas we judged that the mild to moderate mitral valve regurgitation and mild left ventricular outflow stenosis, caused by hypertrophic cardiomyopathy, did not require surgical interventions. Then, we performed aneurysmal plication after bypass grafting to the left anterior descending by the left internal thoracic artery via left mini-thoracotomy under off-pump guidance. The patient recovered well, and the symptoms disappeared. Postoperative computed tomography angiography showed good patency of the internal thoracic artery and complete disappearance of the aneurysm. This case demonstrates the potential utility of minimally invasive off-pump coronary surgery via left mini-thoracotomy as a useful alternative for patients with simple left coronary artery aneurysms.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447261493436"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ATTR-CM: What do we know about blood levels of the TTR protein? A discussion with experts.","authors":"Mathew S Maurer, Adam Castaño","doi":"10.1177/17539447261434318","DOIUrl":"10.1177/17539447261434318","url":null,"abstract":"<p><p>Transthyretin (TTR) amyloid cardiomyopathy occurs when stable TTR, normally a 4-protein tetramer, becomes misfolded and aggregates to form amyloid fibrils that accumulate in the heart. Progressive accumulation causes cardiomyopathy, leading to arrhythmia and heart failure. Acoramidis is a high-affinity TTR stabilizer (⩾90%) evaluated in the ATTRibute-CM clinical trial. In this podcast discussion, Dr Mathew Maurer and Dr Adam Castaño provide insights into their recent analysis of prognostic implications of acoramidis-mediated changes to serum TTR (sTTR) in 557 patients and the associated implications for all-cause mortality. For the patients included in this analysis, acoramidis fully mediated a sharp and significant early rise in sTTR levels (mean 9.1 mg/dL) by day 28, sustained through month 30. Incremental changes (+5 mg/dL) in sTTR were associated with a 31.6% lower odds of mortality through month 30. This evidence strongly supports a direct association between early, sustained sTTR increases with acoramidis treatment and survival.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447261434318"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare pair: two cases of clinically isolated pulmonary artery aneurysm.","authors":"Donovan Cassidy-Nolan, Claudia Cote, Dominique de Waard, Mathieu Castonguay, Volodko Bakowsky, Christine Herman","doi":"10.1177/17539447251410305","DOIUrl":"10.1177/17539447251410305","url":null,"abstract":"<p><p>Pulmonary artery aneurysms (PAAs) are a rare pathology with potentially devastating consequences. In this case series, we describe two cases of clinically isolated pulmonary arteritis and concisely review the literature surrounding this new clinical entity. Two Caucasian women, aged 65 and 73, were referred to our cardiovascular surgery center with incidental PAAs, both growing to over 65 mm in main pulmonary artery diameter. Both participants underwent serial thoracic CT-angiograms to monitor the pulmonary artery aneurysms. Both pulmonary artery aneurysms showed an interval increase in diameter, so they were repaired surgically. The main pulmonary artery was excised in both cases and replaced with a synthetic graft. No pre- or postoperative corticosteroids were administered. Neither of our patients had systemic symptoms of giant cell arteritis or elevated inflammatory markers. In both cases, only the main pulmonary artery was replaced to minimize surgical complexity and risk; however, the left pulmonary artery of one patient began to further dilate 5 years postoperatively. Currently, no reintervention is planned. These cases represent mounting evidence for the existence of clinically isolated pulmonary arteritis leading to a pulmonary artery aneurysm. This entity is analogous to clinically isolated aortitis and may represent a subclinical smoldering vasculitis. These rare aneurysms can progress over time and require surgical intervention. In the absence of guidelines for pulmonary artery aneurysm intervention, the present cases will serve to guide further management of this rare disease.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447251410305"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12833207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional simulations for planning fenestrated/branched endografts in endovascular aneurysm repair for complex abdominal aortic aneurysm: a retrospective cohort study.","authors":"Yujing Zhang, Jing Wang, Chengliang Qu, Dongxu Cai, Li Liu, Xiaodong Li","doi":"10.1177/17539447261457539","DOIUrl":"10.1177/17539447261457539","url":null,"abstract":"<p><strong>Background: </strong>Endovascular aneurysm repair (EVAR) is used to treat patients with abdominal aortic aneurysm (AAA) who have suitable anatomy, while complex AAAs often require fenestrated and branched stent grafts, necessitating further refinement of the technique.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of fenestrated/branched EVAR (F/B-EVAR) assisted by three-dimensional (3D) printing for treating complex AAA.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study collected baseline data and clinical outcomes from patients treated with F/B-EVAR between January 2012 and June 2025. The population was divided into the 3D simulation group and the conventional measurement group. The 3D simulation group underwent a simulation to assess fenestration and branch positioning strategies. Study endpoints included procedural success rate, incidence of periprocedural complications and major adverse events, as well as procedural duration and radiation dose.</p><p><strong>Results: </strong>The mean age of patients was 70.2 ± 8.8 years, with 68.9% being male. Compared to the conventional measurement group, the 3D simulation group had a significantly higher procedural success rate (98.8% vs 91.6%, <i>p</i> < 0.001), shorter procedural duration ((115.2 ± 35.0) min vs (138.7 ± 43.7) min, <i>p</i> < 0.001), and lower radiation dose ((107.2 ± 43.9) mGy vs (144.5 ± 56.3) mGy, <i>p</i> < 0.001). Furthermore, although no significant differences were observed in the incidence of all-cause mortality and major cardiovascular adverse events during the 30-day follow-up between the two groups, the incidence of life-threatening major bleeding, major vascular complications, and acute kidney injury stage ⩾3 was significantly lower in the 3D simulation group.</p><p><strong>Conclusion: </strong>F/B-EVAR guided by 3D simulation may allow for accurate planning of fenestration and branch positioning, potentially improving procedural success rate and suggesting a potential to enhance the quality of outcomes.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447261457539"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systolic blood pressure range in patients with intermediate- to high-risk pulmonary embolism undergoing advanced treatment: a systematic review.","authors":"Hector Lopez-de la Garza, Carlos Jerjes-Sanchez, Victor E Lozano-Corres, Christian Camacho Mondragon, Maria Fernanda Reyes-Chavez, Ricardo J Estrada-Mendizabal, Jose Max Narvaez-Paliza, Victor Baylo Valdez, Cecilia Gocher Janet","doi":"10.1177/17539447251414584","DOIUrl":"10.1177/17539447251414584","url":null,"abstract":"<p><strong>Background: </strong>Despite continuous advances in management over the last two decades for pulmonary embolism (PE), treating intermediate- to high-risk PE remains challenging. There is a critical need to expand our understanding of the clinical spectrum beyond systolic blood pressure (SBP) to inform the intricate decision-making process for initiating advanced treatment in patients with intermediate- to high-risk PE.</p><p><strong>Objectives: </strong>We aimed to characterize the range of SBP values in patients with intermediate- to high-risk PE undergoing advanced therapy across different clinical settings. The secondary objective included the incidence of bleeding complications (intracranial, major, and minor).</p><p><strong>Design: </strong>We conducted a systematic review in alignment with PRISMA guidelines. The review involves a comprehensive, structured search of multiple electronic databases.</p><p><strong>Data sources and methods: </strong>We created two groups: Group 1, case reports and series, and Group 2, randomized control trials and cohorts with intermediate-risk PE who underwent advanced treatment. In addition, we performed an exploratory analysis in Group 1, created solely for descriptive purposes, to determine the frequency of the previously mentioned impending deterioration factors in the literature and further clarify their potential role in initiating advanced treatment.</p><p><strong>Results: </strong>We identified 1871 intermediate-high risk PE patients who received advanced therapy, divided into two groups: Group 1 for case reports and series, and Group 2 for randomized controlled trials and cohorts. In total, 77.1% reported SBP; the weighted average was 125.8 and 129.2 mmHg for Groups 1 and 2, respectively. The most common initial clinical presentations were dyspnea, syncope, and chest pain. In the exploratory analysis, we found that borderline SBP (110-120 mmHg), right ventricular dysfunction, and heart rate (⩾120 bpm) were the most frequent impending clinical deterioration factors.</p><p><strong>Conclusion: </strong>This systematic review shows that the SBP range for advanced treatment (129.2 and 125.8 mmHg) aligns with previous clinical models. However, it is important to recognize that while these SBP ranges may suggest practice variation, causality or definitive clinical instability cannot be inferred from aggregate data without patient-level outcomes. Outside of randomized controlled trials, clinical decision-making regarding advanced treatment may not fully align with international recommendations in real-world scenarios.</p><p><strong>Trial registration: </strong>Research Registry number: 2065.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"20 ","pages":"17539447251414584"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}