BMC Cardiovascular Disorders最新文献

{"title":"Utilization and dose optimization of beta-blockers in chronic heart failure therapy: a mixed-methods study.","authors":"Sisay Sitotaw Anberbr, Tilaye Arega Moges, Abebech Tewabe Gelaye, Aragaw Dagnew Lakew, Samuel Berihun Dagnew, Gebremariam Wulie Geremew, Getachew Yitayew Tarekegn, Fisseha Nigussie Dagnew","doi":"10.1186/s12872-025-04901-7","DOIUrl":"10.1186/s12872-025-04901-7","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with reduced ejection fraction (HFrEF) represents a significant global health burden, affecting over 64 million individuals and resulting in substantial morbidity and mortality, particularly in resource-limited settings such as Ethiopia. The utilization of evidence-based beta-blockers (BBs) is paramount for enhancing clinical outcomes, yet their implementation and optimal dosing remain suboptimal. The study aimed to systematically assess the patterns of BB utilization and dosage optimization in HFrEF patients at the University of Gondar Comprehensive Specialized Hospital (UOG-CSH) while identifying critical determinants influencing their effective application.</p><p><strong>Methods: </strong>This study employed a hospital-based, retrospective cohort design conducted from September 2018 to August 2023 G.C. The study included adult patients with HFrEF, aged ≥ 18 years, and an ejection fraction (EF) of ≤ 40%. A total sample size of 420 patients was determined using a systematic random sampling technique. Data were collected through structured questionnaires capturing socio-demographic details, clinical characteristics, and medication usage. Quantitative analysis was performed using SPSS version 27.0, applying binary logistic regression to identify factors associated with BB utilization and optimal dosing. The study rigorously followed the latest (2022) American Heart Association (AHA) and (2021) ESC guideline recommendations. Qualitative insights were gathered through semi-structured interviews with nine physicians and analyzed thematically to explore barriers and facilitators in BB management.</p><p><strong>Results: </strong>Among the total of 420 patients with HFrEF 220 (52.4%) were on evidence-based BBs. Of those receiving evidence-based BBs, only 22 (10%) were taking the optimal dose. Factors significantly associated with BB use included age ≥ 65 years (AOR = 0.39, 95%CI: 0.23-0.67), ischemic heart disease (AOR = 3.78, 95%CI: 1.92-7.47), atrial fibrillation (AOR = 1.31, 95%CI: 1.11-6.55), hyperthyroidism (AOR = 5.78, 95%CI: 1.99-16.76), and duration of HF ≥ 3 years (AOR = 1.24, 95%CI: 1.01-3.07). For optimal dosing, valvular heart disease (AOR = 3.40, 95%CI: 1.15-10.04), number of comorbidities ≥ 2 (AOR = 7.27, 95%CI: 1.53-34.57), and duration of HF ≥ 3 years (AOR = 1.20, 95%CI: 1.38-3.71) were identified as significant predictors. Qualitative findings illuminated persistent barriers, including inadequate medication availability, suboptimal adherence to clinical practice guidelines, and patient compliance challenges.</p><p><strong>Conclusion: </strong>The study highlights a significant therapeutic utilization gap in BBs, with only 10% of patients achieving optimal dosing. It recommends comprehensive training programs, strict adherence to guidelines, and improved medication accessibility.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"440"},"PeriodicalIF":2.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between semi-automatic and manual left atrial strain analysis in patients undergoing CABG: feasibility, reproducibility, and clinical implications.","authors":"Yong-Huai Wang, Cui-Ting Zhao, Lan-Ting Zhao, Shuo Liu, Shi-Tong Wang, Li-Xin Mu, Chun-Yan Ma","doi":"10.1186/s12872-025-04899-y","DOIUrl":"10.1186/s12872-025-04899-y","url":null,"abstract":"<p><strong>Background: </strong>Left atrial (LA) strain, a powerful parameter for assessing LA function, is underused in routine clinical practice because it requires expertise and time. The novel semi-automated method for the measurement of LA strain may circumvent these limitations. Hence, we investigated the feasibility, reproducibility, and clinical implications of the semi-automated method.</p><p><strong>Methods: </strong>We prospectively enrolled 190 patients referred for coronary artery bypass grafting (CABG). LA strain was measured using the fully semi-automated and manual methods from the same apical four-chamber view 3 days before CABG. Patients were followed up every 6 months for major adverse cardiovascular and cerebrovascular events (MACCE).</p><p><strong>Results: </strong>Manual border corrections were required in 26% of patients because of poor tracking quality. Measurement time was significantly shorter with the semi-automated method. Excellent intra- and inter-observer measurement agreement with minimal bias were observed for LA strain measured using the semi-automated method, which were better than those for LA strain measured using the manual method. Moreover, measured LA strain using the semi-automated method had a greater correlation coefficient with the LA ejection fraction and prediction power for left ventricular diastolic dysfunction. Over a median follow-up of 22.4 months, MACCE occurred in 36 (19.0%) patients. LA strain measured using both methods showed comparable usefulness for predicting MACCE.</p><p><strong>Conclusions: </strong>The novel semi-automated method rapidly measures LA strain with excellent reproducibility and has clinical application comparable to the manual method. This method may have the potential to be integrated into routine clinical practice and facilitate the implementation of LA strain.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"438"},"PeriodicalIF":2.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between homocysteine levels and blood pressure variability with early renal injury marker NGAL in patients with H-type hypertension.","authors":"Xuanhao Lu, Li Guo, Xiulan Sun, Runrun Fan, Xinping Wang, Yanping He","doi":"10.1186/s12872-025-04883-6","DOIUrl":"10.1186/s12872-025-04883-6","url":null,"abstract":"<p><strong>Background: </strong>H-type hypertension (HTH), characterized by hypertension and hyperhomocysteinemia, may accelerate renal injury. Blood pressure variability (BPV) could exacerbate this process, while neutrophil gelatinase-associated lipocalin (NGAL) serves as an early kidney injury marker.</p><p><strong>Objectives: </strong>We aimed to determine whether homocysteine (HCY) levels and BPV independently and interactively predict NGAL in patients with H-type hypertension.</p><p><strong>Methods: </strong>In this retrospective study 300 participants with H-type hypertension (mean age 60.3 ± 8.1 years; 53.3% male) underwent 24-hour ambulatory blood pressure monitoring to derive BPV (SD of systolic BP), and fasting blood samples to measure HCY and NGAL. Multiple regression models assessed the associations between homocysteine, BPV and NGAL, adjusting for age, sex, body mass index, and estimated glomerular filtration rate. An interaction term (high HCY ≥ 25 µmol/L × BPV-SD) tested effect modification.</p><p><strong>Results: </strong>Mean homocysteine, BPV-SD, and NGAL values were 26.5 ± 7.1 µmol/L, 13.1 ± 2.6 mmHg, and 145 ± 60 ng/mL, respectively. HCY and BPV-SD correlated with NGAL (p < 0.001). In adjusted models, HCY (β = 1.4, p = 0.010) and BPV-SD (β = 2.7, p = 0.003) remained significant predictors of higher NGAL. A significant interaction (β = 2.4, p = 0.001) indicated that the effect of BPV on NGAL was greater among those with higher HCY (≥ 25 µmol/L).</p><p><strong>Conclusions: </strong>Elevated HCY and BPV contribute to increased NGAL in HTH, and their interaction suggests particular risk for renal injury when both factors remain high. Our study indicated that lowering HCY and stabilizing BPV could be associated with reduce kidney injury, which requires future interventional studies.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"439"},"PeriodicalIF":2.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empagliflozin ameliorates RSL3-induced ferroptosis in vascular endothelial cells via the NRF2/HO-1 pathway.","authors":"ZiLin Wang, SiMiao Liu, JiaHao Shi, Di Chen, ShaoLin Li, ShengQin Yu, SiXu Liu, KaiJing Yang, Wan Zhang, Xue Gao, ShuYing Zhang","doi":"10.1186/s12872-025-04890-7","DOIUrl":"10.1186/s12872-025-04890-7","url":null,"abstract":"<p><p>Endothelial cell dysfunction is a fundamental injury of atherosclerosis cardiovascular disease (ASCVD), closely linked to ferroptosis, which is a novel type of cell death induced by iron-dependent lipid peroxidation. Several clinical trials have suggested that empagliflozin, a selective inhibitor of sodium glucose co-transporter 2, reduces the risk of hospitalization for heart failure and cardiovascular death in patients with type 2 diabetes. However, little is known about the mechanism of EMPA in endothelial cell ferroptosis in ASCVD. The aim of the present study was to evaluate the potential mechanism of EMPA against ferroptosis induced by RAS-selective lethal 3 (RSL3) in endothelial cells.EA.hy926 human umbilical vein endothelial cells were cultured in vitro and were divided into four groups: The Control, RSL3, RSL3 + low-concentration EMPA intervention and RSL3 + high-concentration EMPA intervention groups. Iron-dependent lipid peroxidation was assessed by detecting the fluorescence intensity of ferrous ion (Fe²⁺), lipid reactive oxygen species (ROS) and content of malondialdehyde (MDA). The expression of ferroptosis-related genes was assessed by RT-qPCR and western blotting. siRNA nuclear factor erythroid 2-related factor 2 (NRF2) was transfected into EA.hy926 cells to measure the expression of target genes.It was demonstrated that the level of MDA, Fe²⁺ and lipid ROS was higher in the RSL3-treated group compared with the EMPA intervention group, while EMPA markedly mitigated that effect. In addition, EMPA can reverse the RSL3-induced low expression of glutathione peroxidase 4 (GPX4) and high expression of ACSL4 in endothelial cells, as evidenced by the upregulation of nuclear factor transcription factor nuclear factor, erythroid 2 (NFE2)-related factor 2 and heme oxygenase-1 expression, while siNRF2 transfection impaired the antiferroptosis effect of EMPA. The present study indicated that EMPA may inhibit RSL3-induced ferroptosis in endothelial cells by activating the NRF2/heme oxygenase 1 gene pathway.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"437"},"PeriodicalIF":2.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between left atrial remodeling and early renal impairment in asymptomatic patients with type 2 diabetes.","authors":"Mingxia Gong, Min Xu, Suoya Pan, Xiaohong Jiang","doi":"10.1186/s12872-025-04900-8","DOIUrl":"10.1186/s12872-025-04900-8","url":null,"abstract":"<p><strong>Background and aims: </strong>To quantitatively assess the alterations in left atrial morphology and function in patients with asymptomatic type 2 diabetes mellitus (T2DM) via 4D-Auto Left Atrial Quantification analysis (4D Auto LAQ), investigate their correlation with diabetic nephropathy (DN), and evaluate the predictive value for major adverse cardiovascular event (MACE).</p><p><strong>Methods: </strong>A cohort of 449 asymptomatic T2DM patients was categorized into four groups: those without DN(G0) and those with DN, which was further subdivided into stages G1, G2, and G3. Through 4D-Auto LAQ analysis, we quantified the left atrial (LA) volume as well as the longitudinal and circumferential strains during the reservoir, conduit, and contraction phases. Additionally, we investigated the association between LA volume, strain parameters, and glomerular filtration rate (GFR). Among the participants, 190 patients in the DN group were followed up. The primary endpoint for follow-up was defined as the first occurrence of non-fatal acute myocardial infarction, stroke, congestive heart failure, or cardiac death.</p><p><strong>Results: </strong>(1) Analysis of variance indicated no statistically significant differences in echocardiographic data for left ventricular size or function across groups. (2) Correlation analysis after multivariable adjustment revealed that the LA minimal volume index (LAVImin) increased with the progression of DN, while the absolute value of the LA strain index(reservoir and conduit period) decreased as renal damage worsened, exhibiting a highly significant correlation with the GFR (P < 0.01). (3) Univariate and multivariate Cox regression analyses revealed that: LAVmin, LASr, GFR, and HbA1c were associated with MACEs in patients with DN. Incorporating LAVmin and LASr into the basic model significantly enhanced the predictive value for MACEs in DN patients (with an area under the curve (AUC) of 0.818, sensitivity of 78.6%, specificity of 85.4%).</p><p><strong>Conclusion: </strong>The increase in LA volume and weakened reservoir and conduit function in T2DM patients dynamically reflect the severity of renal damage. LAVImin and LASr are associated with the occurrence of MACEs in asymptomatic type 2 diabetes patients with early renal damage.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"436"},"PeriodicalIF":2.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac cephalalgia-headache as an atypical presentation of ST-segment elevation myocardial infarction: a case report.","authors":"Udayanga Andadola, Subhani Poornima, Gamini Galappatthy","doi":"10.1186/s12872-025-04898-z","DOIUrl":"10.1186/s12872-025-04898-z","url":null,"abstract":"<p><strong>Background: </strong>Ischaemic heart disease commonly presents with chest pain and autonomic symptoms; however, atypical manifestations can occur. Cardiac cephalalgia is a rare presentation of acute coronary syndrome, characterised by a migraine-like headache triggered by myocardial ischaemia. Diagnosis requires a high index of suspicion.</p><p><strong>Case presentation: </strong>We describe a 47-year-old man with diabetes and a history of smoking who presented with an acute, severe frontotemporal headache accompanied by nausea and vomiting. Electrocardiography revealed ST-segment elevation in the inferior leads. Coronary angiography demonstrated multivessel coronary artery disease involving the right coronary artery and the left anterior descending artery. A subsequent measurement of serum troponin I confirmed myocardial injury. Both arteries were successfully stented, leading to clinical improvement and resolution of the headache.</p><p><strong>Conclusions: </strong>This case highlights the importance of considering cardiac causes in patients presenting with severe headaches particularly in those with cardiovascular risk factors.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"435"},"PeriodicalIF":2.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 outcomes of cardiac resynchronization therapy and implantable cardioverter defibrillators in elderly patients with heart failure.","authors":"Yanxiao Su, Zonglei Wu, Chao Luan, Feifei Chen, Fenglan Huang, Jinqiu Liu","doi":"10.1186/s12872-025-04863-w","DOIUrl":"10.1186/s12872-025-04863-w","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to describe the safety and efficacy of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) in elderly patients with heart failure.</p><p><strong>Methods and results: </strong>Patients with heart failure who received CRT or ICDs implantation for the first time from 2010 to 2021 were retrospectively studied. 48 of the 115 patients (41.7%) who underwent CRT implantation and 61 of the 174 patients (35.1%) who underwent ICDs implantation were ≥ 70 years old; these patients were defined as \"elderly\". The incidence of procedure-related complications was did not differ between elderly and young patients. The median follow-up times of the CRT group and ICDs group were 45 (30,74) and 51 (30,79) months, respectively. There was no significant difference in the superresponse rate, response rate, heart failure readmission rate, all-cause death rate, or cardiac death rate between elderly and young patients. The largest changes in LVEF and LVEDD occurred at 3 years after implantation, and the effect of reversing left ventricular remodeling lasted for five years after implantation. In the ICDs group, no significant difference was observed in the correct discharge ratio between elderly and young patients. However, elderly patients exhibited a significantly higher all-cause mortality rate compared to their younger counterparts (31% vs. 18%, P = 0.035). The survival curves diverged after 5 years, yet no statistically significant difference was found in cardiac death rates between the two groups (16% vs. 14%, P = 0.522). The COX regression model suggested that age ≥ 70 years old and chronic kidney disease were independent risk factors for all-cause death (HR = 1.963, 3.165, P = 0.041, 0.003), while LVEF ≤ 20% was an independent risk factor for cardiac death (HR = 3.562, P = 0.004).</p><p><strong>Conclusion: </strong>Implantation of CRT and ICDs in elderly patients with heart failure is safe. Age should not be a criterion for preventing CRT implantation. The prognosis of ICDs implantation in elderly patients is strongly affected by noncardiogenic factors, and the long-term benefit is worse than that in young patients.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"434"},"PeriodicalIF":2.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise-based interventions for preventing and treating cancer therapy-related cardiovascular toxicity: a systematic review and meta-analysis.","authors":"Qun Wang, Zehao Huang, Sek Ying Chair","doi":"10.1186/s12872-025-04865-8","DOIUrl":"10.1186/s12872-025-04865-8","url":null,"abstract":"<p><strong>Purpose: </strong>This review aimed to evaluate the effects of exercise-based interventions on cancer therapy-related cardiovascular toxicity (CTR-CVT) in individuals with cancer.</p><p><strong>Methods: </strong>Four databases (MEDLINE, Embase, Web of Science, and CENTRAL) were searched to identify eligible studies. Randomized controlled trials examining the effects of exercise-based interventions on CTR-CVT in cancer patients published in English were included. The risk of bias of included studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. The meta-analysis was performed using statistical software R. The PRISMA statement was followed.</p><p><strong>Results: </strong>Thirty studies with 2484 participants were included. Our findings revealed that compared to the control group, exercise-based intervention improved VO_2peak (mean difference [MD]: 1.62, 95% confidence interval [CI]: 0.94 to 2.30), resting diastolic blood pressure (MD: -4.43, 95% CI: -8.72 to -0.13), and resting heart rate (MD=-3.74, 95% CI: -6.59, -0.89) among individuals with cancer. Evidence on other study outcomes remains unclear.</p><p><strong>Conclusion: </strong>The findings of this review demonstrate the potential role of exercises in preventing and treating CTR-CVT. Further research is warranted to strengthen the current evidence and fill the gaps identified in this review.</p><p><strong>Registration: </strong>The review protocol was registered in PROSPERO (ID: CRD42022380550).</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"433"},"PeriodicalIF":2.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute thrombosis of an atrial flow regulator in a failing Fontan circulation: recanalization and management.","authors":"Raymond N Haddad, Ahmed Adel Hassan, Mahmoud Al Soufi, Mohamed Kasem","doi":"10.1186/s12872-025-04876-5","DOIUrl":"10.1186/s12872-025-04876-5","url":null,"abstract":"<p><p>We report the case of an 11-year-old boy with situs inversus, interrupted inferior vena cava with azygos continuation, persistent left superior vena cava with absent bridging vein, congenitally corrected transposition of the great arteries, pulmonary atresia, and ventricular septal defect. He underwent a Kawashima shunt at age 1 and fenestrated extracardiac conduit Fontan completion at age 9, delayed due to loss to follow-up while living abroad. Fifteen months post-op, the patient was diagnosed with plastic bronchitis. Cardiac catheterization revealed elevated Fontan pressures and proximal left pulmonary artery stenosis, which was stented (AndraTec 38 mm Optimus-XL). Although fenestration creation was considered, the procedure was initially delayed allowing for a trial of medical management. Four months later, a 6 mm Occlutech atrial flow regulator (AFR) was placed transjugularly, but thrombosis occurred 48 h later. Transjugular catheter-based clot aspiration (Penumbra Lightning^® 7) and stenting (10/20 mm Cook Formula stent) followed by sequential high-pressure ballooning increased the fenestration diameter, improving symptoms and hemodynamics. He had a favorable recovery with significant improvements and remained stable at 13 weeks of follow-up.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"432"},"PeriodicalIF":2.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reassessing single-stent techniques for isolated left anterior descending ostial disease: a two-year intravascular ultrasound-guided retrospective comparison of precise ostial, floating, and crossover stenting strategies.","authors":"Xi Wu, Mingxing Wu, Haobo Huang, Zhe Liu, He Huang, Lei Wang","doi":"10.1186/s12872-025-04894-3","DOIUrl":"10.1186/s12872-025-04894-3","url":null,"abstract":"<p><strong>Background/objectives: </strong>Percutaneous coronary intervention (PCI) for isolated left anterior descending (LAD) ostial lesions remains challenging, with limited comparative data on stenting strategies. We aimed to evaluate the procedural and long-term outcomes of three single-stent techniques: precise ostial stenting (POS), floating stenting (FS), and crossover stenting (CS).</p><p><strong>Methods: </strong>In this retrospective study, 116 patients with isolated LAD ostial disease underwent intravascular ultrasound (IVUS)-guided PCI using one of the three strategies. Baseline characteristics, procedural details, IVUS findings, and major adverse cardiac and cerebrovascular events (MACCEs) over two years were compared.</p><p><strong>Results: </strong>Compared to POS and FS, CS resulted in larger minimal stent area at the ostium, and a higher rate of complete stent coverage (100% vs. 39.5% and 23.1%, p < 0.001). At 2-year follow-up, MACCE rates were significantly lower in the CS group (2.6%) compared to FS (13.5%) and POS (15.8%, p = 0.039), mainly due to reduced target lesion revascularization. FS showed improved coverage compared to POS, but inferior angiographic outcomes and higher event rates than CS.</p><p><strong>Conclusions: </strong>In IVUS-guided PCI for isolated LAD ostial lesions, CS offers superior ostial coverage and clinical outcomes. FS may serve as a compromise when anatomical constraints limit crossover. These findings support a tailored strategy based on lesion characteristics and IVUS assessment.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"431"},"PeriodicalIF":2.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}