BMC Cardiovascular Disorders最新文献

{"title":"Medication non-adherence among heart failure patients: a multi-hospital, multi-dimensional analytical study in Punjab, Pakistan.","authors":"Muhammad Arshed, Hafsa Arshad, Mehwish Kiran, Hina Lateef, Syed Mehmood Ul Hassan, Syed Muhammad Fauzan Ali, Muhammad Farooq Umer, Javeria Saleem, Ali Hassan Gillani, Ali Jawa, Yu Fang","doi":"10.1186/s12872-026-06142-8","DOIUrl":"10.1186/s12872-026-06142-8","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) has been a significant health problem among the population, with a significant impact on morbidity, mortality, and health care expenditure across the world. In Pakistan, HF-specific non-adherence data are limited, which restricts clinicians to come up with interventions that can be used to address the at-risk population. Accordingly, the newly-conducted study intended to determine the incidence of medication non-adherence and predictors at various levels (sociodemographic, clinical, treatment-related, and behavioral) among heart failure patients.</p><p><strong>Methods: </strong>This survey was a cross-sectional questionnaire survey among 9,377 eligible patients between January 2024 and April 2025 in 20 public and private healthcare facilities across Punjab, Pakistan. The primary outcome was non-adherence to medications assessed through the Self-Efficacy for Appropriate Medication Scale (SEAMS) and self-reported number of pills. Study variables were summarized using descriptive statistics. Chi-square/Fisher's exact test, independent t-test/ANOVA, and a generalized linear model (GLM) with a logit link function (multivariable logistic regression) were employed to assess associations with demographic characteristics. Seaborn and Matplotlib were used to create a heatmap and an odds ratio plot, respectively.</p><p><strong>Results: </strong>Non-adherence to medication is alarmingly prevalent among heart failure (Hf) patients in Punjab, Pakistan (50.1%), and the mean SEAMS score was 31.65 ± 7.69, indicating moderate to high levels of self-efficacy in medication-taking behavior. Socio-demographic predictors including female gender (AOR = 1.415, 95% CI: 1.039 - 1.926), primary and secondary education (AOR = 1.285, 95% CI: 1.074-1.481), monthly income 10,000-25000 (AOR = 1.292, 95% CI: 0.616-0.993), no health insurance (AOR = 1.276, 95% CI: 1.138-1.430) had increased odds of non-adherence. Clinical and health-related predictors such as the presence of comorbidities, especially diabetes (AOR = 1.164, 95% CI: 1.0511.428), and non-hospitalized patients (AOR = 1.236, 95% CI: 1.122-1.362).</p><p><strong>Conclusion: </strong>Non-adherence to medication is extremely common in heart failure patients and depends on various sociodemographic, clinical, and behavioral factors. Specific interventions to deal with these determinants can aid in improving adherence and clinical outcomes.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219906","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":"Predictive value of the C-reactive protein-triglyceride-glucose index for late atrial fibrillation recurrence after radiofrequency catheter ablation: a retrospective cohort study.","authors":"Su-Yuan He, Ming-Hu Zhao, Yuan Qin, Ju-Gang Chen","doi":"10.1186/s12872-026-06238-1","DOIUrl":"10.1186/s12872-026-06238-1","url":null,"abstract":"<p><strong>Background: </strong>The C-reactive protein-triglyceride-glucose index (CTI) has been reported to be positively associated with cardiovascular disease, stroke, and other adverse outcomes. However, the association between CTI and late atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) has not been well established.</p><p><strong>Methods: </strong>A total of 591 patients with AF who underwent RFCA were retrospectively enrolled. CTI was calculated using triglycerides, fasting plasma glucose, and C-reactive protein. The primary endpoint was late AF recurrence during postoperative follow-up. The association between CTI and late AF recurrence after RFCA was assessed using restricted cubic spline (RCS) analysis and univariate and multivariable logistic regression analyses. Receiver operating characteristic curve analysis and the DeLong test were conducted to assess the predictive performance of CTI. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were adopted to evaluate its incremental predictive value. The Hosmer-Lemeshow test and Bootstrap-calibrated curves were used to verify model calibration and goodness-of-fit. Subgroup analyses were conducted to examine potential variations in the association between CTI and AF recurrence across subgroups. Subgroup analyses were conducted to examine potential variations in the association between CTI and AF recurrence across subgroups.</p><p><strong>Results: </strong>All patients were followed for 1 year postoperatively, during which 92 cases of AF recurrence were documented. Higher CTI levels were positively associated with an increased risk of AF recurrence. RCS analysis suggested that the nonlinear test did not reach statistical significance (p for non-linear = 0.072), while a trend toward nonlinearity was observed, which may be explained by the limited number of outcome events. After multivariable adjustment, CTI remained independently and positively associated with AF recurrence, with an odds ratio of 6.20 per one-unit increase in CTI (95% CI: 3.56-10.77; p < 0.001). Subgroup and interaction analyses yielded findings consistent with the primary results.</p><p><strong>Conclusions: </strong>CTI was identified as a potentially valuable predictive indicator for late AF recurrence following RFCA.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547870","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":"Explainable machine learning and unsupervised anatomical phenotyping of mitral valve prolapse in patients with severe mitral regurgitation.","authors":"Pooya Eini, Homa Serpoush, Mohammad Rezayee","doi":"10.1186/s12872-026-06331-5","DOIUrl":"10.1186/s12872-026-06331-5","url":null,"abstract":"<p><strong>Background: </strong>Mitral annular disjunction (MAD) is increasingly recognized in mitral valve prolapse (MVP), but its anatomical embedding within degenerative MVP remains incompletely defined. We assessed whether explainable supervised learning and unsupervised clustering could identify MAD-associated MVP phenotypes.</p><p><strong>Methods: </strong>We analyzed a public surgical cohort of 979 patients with MVP and clinically significant mitral regurgitation. Etiology was classified as Barlow disease (BD) or fibroelastic deficiency (FED). Logistic regression, Random Forest and XGBoost were evaluated for MAD prediction using nested cross-validation with threshold optimization, and assessed for discrimination, calibration and net benefit (decision-curve analysis). XGBoost explainability was assessed using SHAP. UMAP-based clustering using anatomical and clinical variables (excluding MAD and etiology from the input) was performed, with prespecified cluster-number and stability sensitivity analyses.</p><p><strong>Results: </strong>Unsupervised phenotyping identified three anatomical clusters. The smallest cluster (n = 91, 9.3%) showed the highest MAD prevalence (36.3% vs. 12.0% and 15.8%), marked BD enrichment (95.6%), universal bileaflet prolapse and ≥ 4-scallop involvement, larger MV diameters and less chordal rupture; this phenotype was reproducible across UMAP settings. Supervised models showed only moderate MAD discrimination (XGBoost AUROC 0.695 ± 0.057; PR-AUC 0.314 ± 0.066), with modest calibration (Brier 0.13-0.20; slopes < 1) and limited net benefit, and were therefore interpreted as explanatory rather than diagnostic. SHAP identified BD status as the strongest contributor, followed by number of prolapsing scallops, mitral valve diameters, LV volumes and bileaflet prolapse.</p><p><strong>Conclusion: </strong>Explainable and unsupervised analyses concordantly identified a MAD-enriched, BD-dominant bileaflet/multiscallop MVP phenotype, supporting the concept that MAD is embedded within broader annular-leaflet remodeling rather than being an isolated binary abnormality. These findings require prospective, multimodality, outcome-linked external validation before clinical application.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191456","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 C-reactive protein-triglyceride-glucose index and incident cardiometabolic multimorbidity in postmenopausal women: insights from the China Health and Retirement Longitudinal Study (CHARLS).","authors":"Liu Wang, Chun Luo, Yanxiao Shao, Xiaohui Xie, Xiaoqin Huang","doi":"10.1186/s12872-026-06150-8","DOIUrl":"10.1186/s12872-026-06150-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiometabolic multimorbidity (CMM), defined as the coexistence of at least two cardiometabolic diseases, is an increasing public health burden. Postmenopausal women may be particularly vulnerable because menopause-related metabolic and inflammatory changes can intensify cardiometabolic risk. However, simple tools for early CMM risk prediction in this population remain limited. The C-reactive protein-triglyceride-glucose index (CTI) integrates inflammatory status and insulin resistance, but its association with incident CMM in postmenopausal women has not been fully evaluated. We therefore investigated the relationship between CTI and new-onset CMM and assessed its predictive performance and potential clinical utility when combined with other clinical variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). The study included 2972 postmenopausal women (aged ≥45 years) without CMM at baseline, with a mean follow-up duration of 103.53 months. The association between CTI and the risk of CMM was assessed using a multivariate Cox regression model. The dose-response relationship was examined through restricted cubic splines (RCS), and the cumulative incidence of CMM across different CTI level groups was compared using the Kaplan-Meier curve. Subgroup and sensitivity analyses, which included repeated validation with the third wave as the baseline, reanalysis after excluding missing values, and stratification by age and menopausal age, were conducted to confirm the robustness of the findings. The predictive performance and incremental value of CTI were evaluated using the receiver operating characteristic (ROC) curve, net reclassification improvement index (NRI), and integrated discrimination improvement index (IDI). Additionally, a nomogram was constructed based on variables selected through LASSO regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 395 participants (13.3%) developed new-onset CMM during follow-up. Multivariate Cox regression analysis indicated that for each 1-unit increase in CTI, the risk of CMM rose by 95% (HR=1.95, 95%CI: 1.66-2.30). In comparison to the lowest quartile group of CTI, the highest quartile group had a higher risk of CMM (HR=3.91, 95%CI: 2.62-5.82, P for trend &lt;0.001). RCS analysis suggested a positive linear association between CTI and the risk of CMM (P-overall &lt;0.001, P-nonlinear = 0.577). The Kaplan-Meier curve showed a higher cumulative incidence of CMM in the high CTI group (log-rank P &lt;0.001). Subgroup analysis indicated that the association between CTI and CMM was more pronounced in postmenopausal women under 60 years of age (interaction P=0.003). The results of the sensitivity analysis were consistent with those of the primary analysis. The AUC of CTI for predicting CMM was 0.649 (95%CI: 0.621-0.678), higher than that of TyG (0.616), CRP (0.612), FBG (0.638), and TG (0.582). Following the inclusion of CTI,","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219960","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":"Preoperative platelet-related inflammatory burden is associated with delayed early hemodynamic recovery following minimally invasive cardiac surgery.","authors":"Bekir Boğachan Akkaya, Enis Burak Gül, Gizem Işık, Abdülkadir Yılmaz, Mustafa Akdi, Sinan Sabit Kocabeyoğlu, Hayrettin Levent Mavioğlu","doi":"10.1186/s12872-026-06341-3","DOIUrl":"10.1186/s12872-026-06341-3","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive cardiac surgery (MICS) is associated with reduced surgical trauma and improved postoperative recovery; however, early hemodynamic recovery remains variable and may be influenced by patient-related biological factors. This study evaluated the association between preoperative inflammatory biomarkers and delayed early postoperative recovery following MICS.</p><p><strong>Methods: </strong>This retrospective observational study included 166 consecutive patients undergoing thoracotomy-based MICS at a single tertiary center between January 2020 and January 2026. Preoperative inflammatory indices, including platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII), were calculated from routine laboratory parameters. The primary endpoint was prolonged postoperative inotropic support (> 24 h); vasopressor-only therapy administered for vasoplegia or isolated blood pressure support was not counted. Multivariable complete-case logistic regression (n = 154), receiver operating characteristic (ROC) analysis, and sensitivity analyses were performed.</p><p><strong>Results: </strong>Prolonged inotropic support was needed in 41 patients (24.7%). Patients requiring prolonged support were older, had a higher prevalence of hypertension, and had longer cardiopulmonary bypass duration in univariable comparisons. LVEF was numerically lower but did not reach conventional statistical significance. PLR and SII were significantly higher in these patients (p = 0.003 and p = 0.010, respectively). In separate adjusted models, both PLR > = 142 and SII > = 462 were associated with prolonged support. In the combined complete-case model including both biomarkers, PLR > = 142 remained independently associated with prolonged support (OR 4.18, 95% CI 1.30-13.40, p = 0.016), whereas SII > = 462 did not (OR 1.66, 95% CI 0.52-5.31, p = 0.391). ROC analysis showed modest discrimination (PLR AUC 0.655, 95% CI 0.564-0.753, p = 0.003; SII AUC 0.634, 95% CI 0.538-0.729, p = 0.010). No significant associations were observed between inflammatory biomarkers and early mortality, acute kidney injury, or postoperative atrial fibrillation.</p><p><strong>Conclusion: </strong>Preoperative platelet-related inflammatory burden, as reflected by PLR, was associated with delayed early postoperative hemodynamic recovery following MICS. However, the discriminatory performance of PLR was modest, and this biomarker should be interpreted as a complementary risk indicator rather than a stand-alone decision-making tool. These findings are exploratory and require prospective validation in independent cohorts.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219933","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":"Analysis of myocardial work in different obesity phenotypes and its association with epicardial adipose tissue.","authors":"Zhenjiang Wang, Chaodi Tan, Zhuoxin Lyu, Zhuzhi Wen, Tao Wu, Dengfeng Geng, Shaoxin Zheng","doi":"10.1186/s12872-026-06298-3","DOIUrl":"10.1186/s12872-026-06298-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate subclinical cardiac dysfunction across distinct obesity phenotypes using myocardial work (MW) indices, and to investigate the moderating role of epicardial adipose tissue (EAT) on MW impairment.</p><p><strong>Methods: </strong>One hundred ninety-two participants were categorized by BMI and metabolic status into four groups: metabolically healthy normal weight (MHNW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obesity (MUO). MW indices were measured using speckle-tracking echocardiography. EAT volume was quantified from ECG-gated CT scans. Associations were analyzed using ANCOVA and regression models.</p><p><strong>Results: </strong>Despite no significant differences in left ventricular ejection fraction (LVEF) among the groups, MUNW and MUO individuals exhibited significantly impaired MW, characterized by lower global work index (GWI), global constructive work (GCW), and global work efficiency (GWE), alongside higher global waste work (GWW), compared with MHNW controls. MHO patients showed significantly better MW profiles than MUNW and MUO groups. EAT volume was increased in all obesity phenotype groups. Although no direct association was found between EAT volume and MW indices, EAT volume significantly moderated the relationship between Metabolically Unhealthy (MUH) and both GWE and GWW.</p><p><strong>Conclusions: </strong>MW detects subclinical dysfunction earlier than LVEF across obesity phenotypes, with impairment progressively worsening from MHO to MUNW to MUO. In metabolically unhealthy individuals with increased EAT volume, more pronounced reductions in GWE and elevations in GWW were observed.</p><p><strong>Trial rrgistration: </strong>This study has been registered in the Chinese Clinical Trial Registry under the registration number ChiCTR2500100754 (registration date: April 15, 2025).</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219992","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":"Dual residual risk of lipid and inflammation: a prospective analysis of RCII on hypertension incidence and cardiovascular prognosis in Chinese and UK populations.","authors":"Lerui Wang, Siyuan Wen, Zhiyi Ma, Boda Zhou","doi":"10.1186/s12872-026-06322-6","DOIUrl":"10.1186/s12872-026-06322-6","url":null,"abstract":"<p><strong>Background: </strong>Residual cardiovascular risk remains a significant clinical challenge despite the intensive management of conventional risk factors. This study aimed to evaluate the impact of the Remnant Cholesterol-Inflammation Index (RCII)-a novel metric integrating dyslipidemia and systemic inflammation-on the incidence of hypertension and its subsequent cardiovascular sequelae.</p><p><strong>Methods: </strong>We leveraged data from two large-scale prospective cohorts. The China Health and Retirement Longitudinal Study (CHARLS) included a cross-sectional cohort for prevalent hypertension (N = 8,650) and a longitudinal incident-hypertension cohort (N = 5,022). The UK Biobank (UKB) included 273,122 participants with hypertension at baseline. Multivariable logistic regression and Cox proportional hazards models were used to assess incident hypertension and long-term adverse outcomes (all-cause mortality, major adverse cardiovascular events [MACE], and cardiovascular death), respectively.</p><p><strong>Results: </strong>In the CHARLS cohort, high RCII was associated with a higher risk of incident hypertension in the fully adjusted model (OR, 1.346; 95% CI, 1.192-1.519). In quartile analysis, the highest RCII quartile was also associated with incident hypertension compared with the lowest quartile (OR, 1.364; 95% CI, 1.150-1.618; P for trend < 0.001). In the UKB cohort, compared with participants in the lowest RCII quartile, those in the highest quartile had higher risks of MACE (HR, 1.273; 95% CI, 1.232-1.315), all-cause mortality (HR, 1.214; 95% CI, 1.169-1.261), and cardiovascular death (HR, 1.284; 95% CI, 1.205-1.368) in fully adjusted complete-case models. Joint-effect analysis showed that concurrent elevation of remnant cholesterol and systemic inflammation was associated with the highest risk of MACE in UKB (HR, 1.16; 95% CI, 1.12-1.20). Exploratory mediation analyses suggested possible indirect pathways involving insulin resistance and oxidative stress.</p><p><strong>Conclusions: </strong>RCII was associated with both incident hypertension and adverse prognosis among hypertensive participants. These findings support RCII as a complementary lipid-inflammatory residual-risk marker; however, external validation and decision-utility studies are needed before clinical implementation.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535121","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":"Exploratory analysis of a Phase I cardiac rehabilitation pathway on anxiety and autonomy in patients undergoing PCI: a narrative nursing and transactional stress-coping perspective.","authors":"Yanna Wang, Yongyin Guan, Jinling Chen, Fengyi Wu, Mei Chen, Xiaoyan Chen, Yingyi Lei, Xiaodong Zhu","doi":"10.1186/s12872-026-06302-w","DOIUrl":"10.1186/s12872-026-06302-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims and objectives: &lt;/strong&gt;This exploratory secondary analysis of a randomized controlled trial - originally powered for medication adherence - investigated associations of a nurse-led Phase I cardiac rehabilitation pathway, integrated with narrative nursing, with anxiety and autonomy following percutaneous coronary intervention (PCI). All psychological analyses are exploratory and intended for hypothesis generation, not causal inference. Findings were interpreted within the transactional model of stress and coping, complemented by narrative nursing theory, focusing on how narrative engagement may help patients reconstruct a sense of control, confidence, and active participation during recovery-addressing narrative foreclosure and supporting autonomy beyond symptom alleviation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Phase I cardiac rehabilitation is essential for percutaneous coronary intervention patient, yet standardized nurse-led protocols are lacking and psychological effects remain incompletely understood. Routine care typically delivers didactic education without attending to patients' fears and self-doubt, potentially trapping them in narrative foreclosure. Narrative medicine suggests that providers acting as story witnesses may help transform stagnant trauma narratives into open recovery narratives, reducing threat perception and fostering engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A 6-month, parallel-group, assessor-blinded randomized controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This exploratory analysis enrolled 162 post-PCI patients, who were randomized to an intervention group (n = 81) or a control group (n = 81). The intervention group received a nurse-led, structured Phase I cardiac rehabilitation pathway developed from evidence-based principles and adapted to local practice, supplemented with narrative nursing modules targeting the relief of narrative foreclosure. The control group received conventional care. Outcomes were assessed using the Cardiac Rehabilitation Inventory at baseline, 7 days post-discharge, and at 1, 3, and 6 months, and were analyzed using repeated-measures analysis of variance (ANOVA), with ANCOVA applied for outcomes with baseline imbalances. All analyses of psychological outcomes were exploratory.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After baseline adjustment, the intervention group showed significantly lower process anxiety at all follow-ups (F = 7.323, P = 0.008). For outcome anxiety, neither the group main effect (F = 2.088, P = 0.151) nor group × time interaction (F = 0.439, P = 0.725) reached significance, though the intervention group maintained numerically lower scores. For autonomy, significant main effects of time (F = 90.900, P &lt; 0.001) and group (F = 36.843, P &lt; 0.001), and a significant time × group interaction (F = 27.814, P &lt; 0.001) were observed, with between-group differences widening over six months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this exploratory analysis, a nurse-led pathw","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547804","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":"Endoscopic versus open radial artery harvesting for coronary artery bypass grafting: an updated systematic review, meta-analysis, and GRADE assessment.","authors":"Tayyaba Ikram Qazi, Aleena Amir Malik, Mariya Khan, Muhammad Yahya, Yashfa Asad, Sarah Idrees, Muhammad Uzair Gull, Abbas Khan, Faiza Munir, Abdul Saboor Khan, Atiqullah Sadaqat, Muhammad Maaz Amjad, Pari Kotak, Muhammad Ahmad Akif Rauf, Sajid Rehman, Muhammad Yasir, Muhammad Huzaifa Khattak, Hamza Wazir Khan, Asia Batool, Haris Wazir Khan, Bilal Wazir Khan","doi":"10.1186/s12872-026-06326-2","DOIUrl":"10.1186/s12872-026-06326-2","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic radial artery harvesting (ERAH) is a minimally invasive alternative to open radial artery harvesting (ORAH) for coronary artery bypass grafting (CABG), though concerns persist regarding graft patency and neurological outcomes.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched through February 21, 2026. Randomized controlled trials and propensity-matched observational studies were included. Risk of bias was assessed using ROB 2 and the Newcastle-Ottawa Scale; certainty of evidence was evaluated using GRADE. Pooled risk ratios and mean differences with 95% confidence intervals were calculated using a random-effects model.</p><p><strong>Results: </strong>ERAH significantly reduced wound complications (RR = 0.61, 95% CI: 0.39-0.96) and wound infections (RR = 0.57, 95% CI: 0.35-0.93), though this benefit did not persist in RCT-only analysis. Neurological complications were reduced after sensitivity analysis (RR = 0.44, 95% CI: 0.34-0.57). Graft patency was comparable (RR = 1.01, 95% CI: 0.90-1.14), with no significant differences in mortality, MACCE, or myocardial infarction. Observational data showed modest reductions in cardiopulmonary bypass time and hospital stay.</p><p><strong>Conclusions: </strong>ERAH demonstrates comparable graft patency and major clinical outcomes to ORAH. Donor-site benefits suggested by observational studies are not consistently supported by randomized evidence. Large trials with standardized outcomes and long-term follow-up are needed.</p><p><strong>Trial registration: </strong>PROSPERO, CRD420261334767.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547873","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":"Vericiguat for heart failure with reduced ejection fraction on quadruple therapy without recent worsening heart failure: an exploratory real-world cohort study.","authors":"Peng Han, Yuan Ning, Bohui Zhang, Xi Zhang, Che Wang, Tiantong Yu, Yan Chen, Boda Zhu, Youhu Chen, Genrui Chen, Shuai Zhao, Chengxiang Li, Yan Chen, Kun Lian","doi":"10.1186/s12872-026-06319-1","DOIUrl":"10.1186/s12872-026-06319-1","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with reduced ejection fraction (HFrEF) patients remain at substantial risk despite quadruple guideline-directed medical therapy (GDMT [ARNI + SGLT2 inhibitor + β-blocker + MRA]). Data on vericiguat in stable HFrEF patients without recent worsening heart failure receiving contemporary quadruple GDMT are limited. This observational study aimed to explore the efficacy and safety of vericiguat in this population.</p><p><strong>Methods: </strong>A total of 450 adult patients with LVEF < 45% were enrolled (200 received quadruple GDMT plus vericiguat, 250 received quadruple GDMT alone). After 1:1 propensity score matching (PSM), 144 well-matched pairs were identified. The primary outcome was the composite of cardiovascular death or first HF hospitalization within 12 months. Secondary outcomes included changes in NYHA functional class, KCCQ-12 scores, and occurrence of hypotension. Due to the non-randomized design, all efficacy findings except the primary composite endpoint are considered exploratory.</p><p><strong>Trial registration: </strong>ChiCTR, ChiCTR2500095278. Registered 4 January 2025. Retrospectively registered.</p><p><strong>Results: </strong>Over 12 months, the primary composite endpoint occurred in 5.56% of the vericiguat group versus 9.03% of the control group (P = 0.365; HR 0.616, 95% CI 0.255-1.486). No statistically significant differences were observed for cardiovascular death or all-cause mortality. Exploratory analyses showed that the vericiguat group had higher KCCQ-12 Overall Summary Scores (91.61 ± 9.56 vs. 87.93 ± 11.25, P = 0.003) and a greater proportion achieving a ≥ 5-point improvement (94.44% vs. 81.25%, P = 0.001). NYHA functional class distribution also differed between groups (P = 0.029). Hypotension rates were similar between groups.</p><p><strong>Conclusion: </strong>Among HFrEF patients without recent worsening, vericiguat did not significantly reduce the primary composite endpoint at 12 months. Exploratory observations suggest potential associations with improved quality of life and functional class without increased hypotension risk. These hypothesis‑generating findings require confirmation in adequately powered randomized controlled trials.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547902","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}