World Journal of Cardiology最新文献

{"title":"Clinical application and expansion of paclitaxel-coated balloons in coronary atherosclerotic disease.","authors":"A-Xiu Huang, Hong-Ying Xie, Gang Luo, Le Hong, Yun-Long Zhou, Yun Wang, De-Kui Gao","doi":"10.4330/wjc.v18.i1.108975","DOIUrl":"https://doi.org/10.4330/wjc.v18.i1.108975","url":null,"abstract":"<p><p>Drug-coated balloon angioplasty has become one of the important means of interventional treatment for atherosclerotic cardiovascular diseases, and its application in clinical practice is becoming more and more common. Although several expert consensuses and a small number of scattered guideline recommendations have been issued, there is a lack of comprehensive and systematic guideline guidance. However, relevant clinical research and practice are still making continuous progress. This article reviews the clinical research progress of the indications for the treatment of coronary artery stenosis with paclitaxel drug-coated balloons, focusing on introducing its application overview and techniques in in-stent restenosis, bifurcation lesions, new lesions in large and small blood vessels, acute and chronic coronary syndromes and other situations, the management of special complications, and the dual antiplatelet strategy after drug balloon angioplasty, revealing new perspectives on the use of drug-coated balloons in different coronary artery disease scenarios. This article also discusses the cellular and molecular mechanisms related to the anti-atherosclerotic and anti-restenosis effects of paclitaxel, with the hope of providing direct guidance for the daily clinical practice of cardiologists and interventionalists.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"18 1","pages":"108975"},"PeriodicalIF":2.8,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12836059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094286","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":"Fixed <i>vs</i> weight-based heparin dosing in stable patients undergoing diagnostic coronary physiology studies.","authors":"Kristoffer Ken Ralota, Deniz Tuncer, Nay Min Htun, Rohit Samuel, Vivek Gupta, Robert Lew, Jamie Layland","doi":"10.4330/wjc.v18.i1.112321","DOIUrl":"https://doi.org/10.4330/wjc.v18.i1.112321","url":null,"abstract":"<p><strong>Background: </strong>Unfractionated heparin (UFH) is routinely used during coronary angiography, but the optimal dosing strategy for diagnostic coronary physiology procedures such as fractional flow reserve or microvascular assessment in stable patients remains unclear. While weight-based dosing is standard in percutaneous coronary intervention, a fixed-dose approach may simplify workflow.</p><p><strong>Aim: </strong>To compare bleeding and thromboembolic outcomes between fixed-dose and weight-based UFH during diagnostic coronary physiology procedures without percutaneous coronary intervention.</p><p><strong>Methods: </strong>We conducted a retrospective single-center study of 128 patients undergoing fractional flow reserve or microvascular testing from January 2021 to February 2024. Patients received either fixed-dose (5000 IU) or weight-based (70-100 IU/kg) UFH. The primary outcome was a composite of thromboembolic complications: Radial artery occlusion, stroke, or periprocedural myocardial infarction. Secondary outcomes included bleeding (Bleeding Academic Research Consortium criteria), association with patient characteristics, access site, and length of stay.</p><p><strong>Results: </strong>Of 128 patients, 78 received fixed-dose and 50 received weight-based UFH. No thromboembolic events occurred in either group. Bleeding (all Bleeding Academic Research Consortium 1-2) occurred in 15% overall, with no significant difference between groups (15% <i>vs</i> 12%, <i>P</i> = 0.47). No significant association between bleeding and patient age, sex, weight, body mass index, access site, antiplatelet, or anticoagulant use. Median hospital stay was 1 day in both groups.</p><p><strong>Conclusion: </strong>In this exploratory study, a fixed 5000 IU UFH regimen appeared to be a safe and practical alternative to weight-based dosing in diagnostic coronary physiology procedures. Larger prospective studies are warranted to confirm these findings.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"18 1","pages":"112321"},"PeriodicalIF":2.8,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12836055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094126","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":"Coronary computed tomography angiography adipose tissue attenuation in diabetic patients with myocardial ischemia and non-obstructive coronary arteries.","authors":"Kai-Xiang Su, Si-Yu Jiang, Cai-Feng Pang, Fan Yang, Yu-Qing Tang, Xiao-Gang Li, Wen-Feng He, Rui Li","doi":"10.4330/wjc.v18.i1.112857","DOIUrl":"https://doi.org/10.4330/wjc.v18.i1.112857","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) substantially increases the risk of cardiovascular disease, including ischemia with non-obstructive coronary artery disease (INOCA). Coronary computed tomography angiography (CCTA) enables early detection of coronary abnormalities; however, it may fail to identify INOCA due to the absence of overt stenosis. Pericoronary adipose tissue attenuation (PCATa) values derived from CCTA in the proximal segments of the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) serve as effective imaging biomarkers for coronary inflammation. However, its clinical use for identifying INOCA in patients with T2DM remains poorly defined.</p><p><strong>Aim: </strong>To investigate PCATa differences and their diagnostic value for identifying INOCA in patients with T2DM.</p><p><strong>Methods: </strong>This retrospective study involved 228 T2DM patients underwent CCTA and 120 healthy individuals. The mean PCATa values within the proximal segments of the three major coronary arteries were compared between groups. Further subgroup analysis was performed to assess the differences in PCTAa and clinical characteristics between T2DM patients with and without INOCA. Logistic regression analysis was conducted to identify the independent risk factors for INOCA, and the receiver operating characteristic curves were generated to evaluate the diagnostic performance of each indicator.</p><p><strong>Results: </strong>Compared with controls, T2DM patients exhibited significantly higher PCATa values in all three major coronary arteries. Among them, those with concomitant INOCA showed further increases compared to those without INOCA (all <i>P</i> < 0.05). Multivariate logistic regression identified age; female sex; elevated glycated hemoglobin; and increased PCATa in the LAD, LCX, and RCA as independent risk factors for INOCA. Receiver operating characteristic analysis showed good diagnostic performance for PCATa [LAD area under the curve (AUC) = 0.809; LCX AUC = 0.777; RCA AUC = 0.758], outperforming traditional clinical indicators (AUC = 0.731). Combining PCATa with clinical parameters yielded the highest diagnostic accuracy (LAD AUC = 0.851; LCX AUC = 0.842; RCA AUC = 0.841).</p><p><strong>Conclusion: </strong>Elevated proximal PCATa is an independent risk factor for INOCA in T2DM. Combining PCATa with clinical data improves diagnostic performance in this population.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"18 1","pages":"112857"},"PeriodicalIF":2.8,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093463","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":"Non-operative management of blunt traumatic aortic injuries.","authors":"Veysel Embel, Muhammad Saad Hafeez, Larissa Russo, Nasim Ahmed","doi":"10.4330/wjc.v18.i1.111254","DOIUrl":"https://doi.org/10.4330/wjc.v18.i1.111254","url":null,"abstract":"<p><strong>Background: </strong>Blunt traumatic aortic injury (BTAI) is a life-threatening injury, commonly associated with high-speed motor vehicle collisions. Historically, open surgical repair was the standard treatment, however with the advancement of endovascular techniques such as thoracic endovascular aortic repair (TEVAR), management strategies shifted towards endovascular repairs. Non-operative management (NOM) strategies are also favored for patients with low-grade injuries and particularly high-grade injuries recently. The Society for Vascular Surgery (SVS) 2011 guidelines recommend that grade I injuries should be managed non-operatively; newer studies also support NOM for grade II injuries.</p><p><strong>Aim: </strong>To review higher-grade injuries. NOM can be favored for selected patients with grade III injuries.</p><p><strong>Methods: </strong>A retrospective review of literature to assess NOM in BTAI, using the PubMed, CINHAL, EBSCO, and Google Scholar databases, included articles published in the last 20 years between January 2003 and December 2023. Studies included Cohort studies, case-control studies, and observational studies. Two authors independently screened the titles, abstracts, and performed data extraction. Outcomes were compared by the type of treatment: NOM <i>vs</i> endovascular repair (TEVAR) <i>vs</i> open repair.</p><p><strong>Results: </strong>We identified 27 studies in our review that met the selection criteria. Most of the studies were based on retrospective analysis of institutional data, and only 16 papers reported BTAI in accordance with SVS reporting standards. A trend of increasing mortality across the BTAI grade was observed. There were heterogeneous results regarding outcomes after non-operative compared with endovascular and surgical repair. For grade I and II BTAI, NOM was associated with lower mortality, reduced rates of unplanned intervention, and resolution of pathology on follow-up. There were reports of NOM of grade III BTAI with reasonable outcomes and a high rate of resolution on follow-up, but data were limited due to very few studies focusing on this subgroup.</p><p><strong>Conclusion: </strong>This review article provides the most up-to-date literature. Currently literature supporting the NOM for low-grade BTAI (grades I and II) treatment. Current SVS guidelines recommend endovascular repair for grade III BTAI patients; however, a few studies showed that grade III BTAI can be managed non-operatively with active surveillance in a selected group of patients. Literature requires further studies to compare NOM <i>vs</i> TEVAR in higher-grade BTAI population.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"18 1","pages":"111254"},"PeriodicalIF":2.8,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094203","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":"Cardiac myxoma and its implications for cardioembolic stroke.","authors":"Bin Cai, Man-Li Qiao, Dan Miao, Guang-Zhi Liu","doi":"10.4330/wjc.v17.i12.112396","DOIUrl":"10.4330/wjc.v17.i12.112396","url":null,"abstract":"<p><p>Cardiac myxoma (CM) is the most common type of primary cardiac tumor and a major embolic source of cardioembolic stroke. Two potential causative mechanisms are associated with CM-related ischemic stroke (CM-IS): Embolism from detached tumor debris and metastatic infiltration. The risk factors for embolism from CM remain unclear and are widely debated in the literature. CM-IS often initially presents with central nervous system complications. Diagnosis requires a comprehensive assessment of clinical manifestations, imaging findings, and laboratory test results, with histopathological examination required for a definitive diagnosis. Surgical resection of myxoma is the most effective CM-IS treatment, although the optimal timing and approach remain controversial. This review consolidates the current knowledge on CM-IS, identifies critical risk factors for embolic complications, and discusses contemporary treatment strategies, emphasizing the need for individualized management protocols and further research to improve outcomes in affected patients.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 12","pages":"112396"},"PeriodicalIF":2.8,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890045","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":"Comparison of beta-blockers <i>vs</i> calcium channel blockers in heart failure with preserved ejection fraction.","authors":"Moaz Mansoor, Faisal Nabi Depar, Hafiz Usama Talha, Haroon Ur Rashid, Ahmad Ashraf, Muhammad Nouman, Mohammad Abbas, Maaz Tariq Abbasi, Ali Sher","doi":"10.4330/wjc.v17.i12.115254","DOIUrl":"10.4330/wjc.v17.i12.115254","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of heart failure cases and is associated with high morbidity and mortality. Beta-blockers (BB) and calcium channel blockers (CCB) are commonly used for symptom control and comorbidity management, but their comparative effectiveness and safety remain unclear.</p><p><strong>Aim: </strong>To compare the effectiveness and safety of BB <i>vs</i> CCB in patients with HFpEF using simulated real-world data and propensity score-matched analyses.</p><p><strong>Methods: </strong>Simulated data for 4000 HFpEF patients (2000 BB, 2000 CCB) were generated based on distributions extracted from electronic medical records spanning 2014-2023. Inclusion criteria included adults with left ventricular ejection fraction ≥ 50% and initiation of BB or CCB. Effectiveness outcomes encompassed mortality, heart failure hospitalizations, and changes in clinical parameters. Safety outcomes included bradycardia, hypotension, and drug discontinuation. Statistical analyses used <i>t</i>-tests, <i>χ</i> ² tests, Cox proportional hazards models for hazard ratios (HR), and incidence rate ratios (IRR) in R software. Propensity score matching (PSM) was performed to balance baseline characteristics, with outcomes reassessed in the matched cohort.</p><p><strong>Results: </strong>Baseline characteristics were largely balanced, with minor differences in sex, chronic kidney disease, systolic blood pressure, and left atrial volume index. BB demonstrated lower all-cause mortality (crude HR 0.78, 95%CI: 0.70-0.87, <i>P</i> = 0.003), heart failure hospitalization (crude HR 0.86, 95%CI: 0.77-0.96, <i>P</i> = 0.031), and composite endpoint (crude HR 0.85, 95%CI: 0.79-0.91, <i>P</i> < 0.001) rates compared to CCB. IRR for heart failure hospitalizations and emergency visits favored BB. Safety profiles showed higher symptomatic bradycardia (9.2% <i>vs</i> 4.9%, <i>P</i> < 0.001) and drug discontinuation (11.3% <i>vs</i> 9.3%, <i>P</i> = 0.043) with BB, and higher hypotension (7.2% <i>vs</i> 11.5%, <i>P</i> < 0.001) with CCB. Matched analyses showed all-cause mortality rates of 0.0622 per person-year for BB <i>vs</i> 0.0649 for CCB (HR 0.96, 95%CI: 0.85-1.08), heart failure hospitalization rates of 0.0751 <i>vs</i> 0.0888 (HR 0.84, 95%CI: 0.75-0.94), and IRR for number of heart failure hospitalizations of 1.65 for CCB <i>vs</i> BB (95%CI: 1.51-1.80, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>BB may offer potential advantages in reducing mortality and hospitalizations in HFpEF compared to CCB, with distinct safety considerations. PSM confirmed these trends with reduced confounding. Personalized therapy is recommended, warranting prospective trials for validation.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 12","pages":"115254"},"PeriodicalIF":2.8,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890101","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":"Complex interrelationship and therapeutic advances in diabetic patients with atrial fibrillation.","authors":"Aikaterini-Eleftheria Karanikola, Dimitrios Tsiachris, Nikos Argyriou, Michail Botis, Konstantinos Pamporis, Panagiotis Xydis, Christos Fragoulis, Athanasios Kordalis, Konstantinos Tsioufis","doi":"10.4330/wjc.v17.i12.114575","DOIUrl":"10.4330/wjc.v17.i12.114575","url":null,"abstract":"<p><p>Diabetes mellitus and atrial fibrillation (AF) are two global epidemics that frequently coexist, with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis. Pathophysiological mechanisms underlying this relationship include chronic inflammation, oxidative stress, atrial remodeling, autonomic dysfunction, advanced glycation end-products and epicardial adiposity. Management remains challenging; however, recent advances offer promise, including guideline-directed anticoagulation, tailored rate and rhythm control, and particularly, novel antidiabetic therapies, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, may improve AF outcomes. A comprehensive, individualized approach is essential to mitigate morbidity and mortality in this high-risk population.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 12","pages":"114575"},"PeriodicalIF":2.8,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890090","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":"Coronary drug-coated balloons: Current evidence and emerging trends.","authors":"Monika Bhandari, Akshyaya Pradhan, Suresh Behera, Alok Kumar Singh","doi":"10.4330/wjc.v17.i12.111468","DOIUrl":"10.4330/wjc.v17.i12.111468","url":null,"abstract":"<p><p>Percutaneous coronary intervention (PCI) for coronary and peripheral stenoses has advanced rapidly over the past three decades, driven by a series of innovative techniques since the introduction of the first balloon angioplasty. Significant progress in stent technology, beginning with bare-metal stents and followed by drug-eluting stents, has expanded the scope for successful revascularisation in complex lesions. However, challenges such as late stent thrombosis and in-stent restenosis (ISR) persist. Thus, further improvement in PCI techniques and devices is essential to achieve better patient outcomes. In recent years, drug-coated balloons (DCBs) have emerged as a promising alternative designed to overcome the limitations associated with drug-eluting stents, including the risks of late stent thrombosis, ISR, and the need for prolonged dual antiplatelet therapy. Several DCBs have been evaluated for both coronary and peripheral lesions, showing encouraging results in preclinical and clinical studies. DCBs have demonstrated efficacy in the treatment of ISR and have shown potential in other clinical scenarios, such as small-vessel disease and diffuse lesions. In this review, we present the underlying technology, mechanisms of action, key preclinical findings, emerging clinical indications, recent trial outcomes, and future perspectives of DCBs as they continue to define their role in PCI.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 12","pages":"111468"},"PeriodicalIF":2.8,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890120","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":"Racial disparities in the mortality and health-care resource utilization of heart failure patients with chronic obstructive pulmonary disease.","authors":"Farah Yasmin, Afia Salman, Muhammad Sohaib Asghar, Abdul Moeed, Maryam Shaharyar, M Chadi Alraies","doi":"10.4330/wjc.v17.i12.111150","DOIUrl":"10.4330/wjc.v17.i12.111150","url":null,"abstract":"<p><p>Increased mortality rates in chronic obstructive pulmonary disease (COPD) patients with heart failure (HF) are believed to be driven by various factors, including disparities in access to healthcare services and shifting dynamics of the population characteristics. In this study, we examined the racial and ethnic disparities in the clinical outcomes of HF in COPD patients in the United States, analyzing data from the Nationwide Inpatient Sample database. The database was searched retrospectively from 2016 to 2022 to identify COPD and HF patients by International Classification of Diseases-10 codes. A total of 2445545 individuals were included of which 76% were Whites, 16% were Blacks, 5% Hispanics and 3% others. Whites were significantly older than other populations (<i>P</i> < 0.001), and a significantly higher proportion of Blacks were females compared to other racial groups. Regarding clinical outcomes, Black COPD patients with HF had the lowest mortality rates while it was similar between Whites and Hispanics (<i>P</i> < 0.001). Compared to Whites, the adjusted odds ratio was significantly lower for Blacks, 0.797 [95% confidence interval (CI): 0.783-0.812; <i>P</i> < 0.001] and Hispanics, 0.956 (95%CI: 0.932-0.981; <i>P</i> = 0.001). Other racial groups had significantly higher mortality compared to Whites, with an adjusted odds ratio of 1.131 (95%CI: 1.099-1.164; <i>P</i> < 0.001). Individuals from other racial groups had significantly longer hospital stay, and hospitalization cost adjusted for inflation. Cardiac arrest was the strongest predictor (<i>P</i> < 0.001) for in-hospital mortality in all racial groups.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 12","pages":"111150"},"PeriodicalIF":2.8,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889954","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":"Logistic regression-based risk prediction of aortic adverse remodeling following thoracic endovascular aortic repair in patients with aortic dissection.","authors":"Lian-Feng Wang, Hong-Jiang Zhu, Cong Wang, Feng Yan, Chang-Zhen Qu","doi":"10.4330/wjc.v17.i12.112978","DOIUrl":"10.4330/wjc.v17.i12.112978","url":null,"abstract":"<p><strong>Background: </strong>Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD), significantly impacting long-term survival. Accurate risk prediction is essential for optimized clinical management.</p><p><strong>Aim: </strong>To develop and validate a logistic regression-based risk prediction model for aortic adverse remodeling following TEVAR in patients with TBAD.</p><p><strong>Methods: </strong>This retrospective observational cohort study analyzed 140 TBAD patients undergoing TEVAR at a tertiary center (2019-2024). Based on European guidelines, patients were categorized into adverse remodeling (aortic growth rate > 2.9 mm/year, <i>n</i> = 45) and favorable remodeling groups (<i>n</i> = 95). Comprehensive variables (clinical/imaging/surgical) were analyzed using multivariable logistic regression to develop a predictive model. Model performance was assessed <i>via</i> receiver operating characteristic-area under the curve (AUC) and Hosmer-Lemeshow tests.</p><p><strong>Results: </strong>Multivariable analysis identified several strong independent predictors of negative aortic remodeling. Larger false lumen diameter at the primary entry tear [odds ratio (OR): 1.561, 95%CI: 1.197-2.035; <i>P</i> = 0.001] and patency of the false lumen (OR: 5.639, 95%CI: 4.372-8.181; <i>P</i> = 0.004) were significant risk factors. False lumen involvement extending to the thoracoabdominal aorta was identified as the strongest predictor, significantly increasing the risk of adverse remodeling (OR: 11.751, 95%CI: 9.841-15.612; <i>P</i> = 0.001). Conversely, false lumen involvement confined to the thoracic aorta demonstrated a significant protective effect (OR: 0.925, 95%CI: 0.614-0.831; <i>P</i> = 0.015). The prediction model exhibited excellent discrimination (AUC = 0.968) and calibration (Hosmer-Lemeshow <i>P</i> = 0.824).</p><p><strong>Conclusion: </strong>This validated risk prediction model identifies aortic adverse remodeling with high accuracy using routinely available clinical parameters. False lumen involvement thoracoabdominal aorta is the strongest predictor (11.751-fold increased risk). The tool enables preoperative risk stratification to guide tailored TEVAR strategies and improve long-term outcomes.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 12","pages":"112978"},"PeriodicalIF":2.8,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890088","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}