Cardiology in Review最新文献

{"title":"Social Isolation and Loneliness Across the Cardiovascular Disease Spectrum: A Narrative Review of Evidence, Mechanisms, and Clinical Implications.","authors":"Sharanya Kaushik, Imran Aziz Naeem, Shreyas Nandyal, Rohan Gajjar, Adrian Nubla, Abel Tenaw Tasamma, Arfa Imran, Bahaa Salama, William H Frishman, Wilbert S Aronow","doi":"10.1097/CRD.0000000000001505","DOIUrl":"https://doi.org/10.1097/CRD.0000000000001505","url":null,"abstract":"<p><p>Social isolation is the objective paucity of social ties; loneliness is the subjective distress of relationships falling short of what one desires. Both are common, affecting roughly a quarter to a third of older adults, and both have cardiovascular consequences through several mechanisms, with some estimates suggesting an increase of 29% in coronary heart disease risk and 21-23% in heart failure hospitalization. We review the evidence for social isolation and loneliness' impact on cardiovascular disease separately for ischemic heart disease, heart failure, arrhythmia and sudden cardiac death, and stress- and substance-related cardiomyopathies. We also highlight plausible mechanisms by which social isolation and loneliness are linked to downstream adverse cardiovascular events, limitations with existing evidence, societal guidance, and policy frameworks currently aimed at addressing them. The evidence is densest for ischemic heart disease, though the largest cohort shows a 43% excess risk of myocardial infarction attenuating by approximately 84% to nonsignificance after full adjustment, and Mendelian randomization estimates a far smaller effect. The prognostic signal is more consistent than the etiologic one, with low functional social support carrying a pooled hazard ratio of 1.59 in established coronary disease. In heart failure, objective isolation rather than loneliness predicts post-diagnosis mortality, mainly in women, consistent with a self-care-dependent behavioral pathway.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized Antiplatelet Therapy After Percutaneous Coronary Intervention for Acute Coronary Syndrome: Current SAPT Strategies and the Potential Role of Indobufen.","authors":"Jiahui Chai, Xuebo Li, Qian Liu, Yang Li, Jie Jian, Yanli Cheng","doi":"10.1097/CRD.0000000000001498","DOIUrl":"https://doi.org/10.1097/CRD.0000000000001498","url":null,"abstract":"<p><p>Acute coronary syndrome requires effective antiplatelet therapy after percutaneous coronary intervention (PCI), while contemporary patients often present with overlapping ischemic and bleeding risks. This clinical complexity has shifted post-PCI management from fixed-duration dual antiplatelet therapy (DAPT) toward individualized strategies based on DAPT duration, single antiplatelet therapy (SAPT) selection, and aspirin withdrawal. Aspirin is traditionally the default maintenance agent after DAPT, although long-term aspirin use is limited by gastrointestinal intolerance, mucosal injury, and bleeding risk. P2Y12 inhibitor monotherapy represents an important aspirin-free strategy, with clinical application influenced by drug potency, genetic variability, tolerability, cost, and adherence. Indobufen, a reversible cyclooxygenase-targeting antiplatelet agent, has reemerged as a potential aspirin alternative by suppressing thromboxane A2 generation through a mechanism distinct from that of aspirin. Current evidence suggests that indobufen-based DAPT may provide comparable ischemic protection with fewer bleeding or gastrointestinal adverse events in selected PCI patients, particularly those with aspirin intolerance, gastrointestinal vulnerability, or high bleeding risk. These patients often present with multiple high-risk features that simultaneously elevate both ischemic and bleeding risks, underscoring the need for careful risk stratification. Most available studies have evaluated indobufen as an aspirin substitute within DAPT rather than as SAPT after DAPT discontinuation. From a pharmacoeconomic perspective, indobufen is more expensive than aspirin, although this must be weighed against potential benefits in bleeding reduction. Future randomized trials are needed to define the optimal DAPT-to-SAPT strategy and clarify the clinical position of indobufen in acute coronary syndrome-PCI.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended Dual Antiplatelet Therapy Versus Aspirin Monotherapy After Drug-Eluting Stent Implantation: A Systematic Review and Meta-Analysis With GRADE Evaluation and Trial Sequential Analysis.","authors":"Muhammad Abdullah Ali, Adil Nawaz, Furqan Ahmad Sethi, Umama Alam, Faryal Ali, Zohiba Khalil, Muhammad Usama, Junaid Imran, Areeba Inam, Khushal Khan, Muhammad Ibrahim, Hassaan Abid","doi":"10.1097/CRD.0000000000001492","DOIUrl":"https://doi.org/10.1097/CRD.0000000000001492","url":null,"abstract":"<p><p>The optimal duration of dual antiplatelet therapy (DAPT) following drug-eluting stent implantation remains uncertain. We evaluated extended DAPT versus aspirin monotherapy in patients who completed approximately 12 months of uneventful DAPT after percutaneous coronary intervention. PubMed, Embase, and Web of Science were searched through August 2026 for randomized controlled trials comparing these strategies. The primary outcome was myocardial infarction (MI); secondary outcomes included all-cause mortality, cardiac death, stent thrombosis, repeat revascularization, stroke, and clinically relevant bleeding (Bleeding Academic Research Consortium type 2-5). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a Mantel-Haenszel random-effects model. Certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE), and trial sequential analysis was performed for MI. Six trials involving 28,601 patients were included. Extended DAPT significantly reduced MI compared with aspirin monotherapy (RR, 0.66; 95% CI, 0.51-0.85; P = 0.001; I2 = 37%). No significant differences were observed in all-cause mortality, cardiac death, stent thrombosis, repeat revascularization, or stroke. Clinically relevant bleeding was also not significantly different (RR, 1.19; 95% CI, 0.66-2.15; P = 0.56), although substantial heterogeneity was observed (I2 = 87%) and certainty was low. GRADE certainty was high for MI, cardiac death, and repeat revascularization; moderate for all-cause mortality; and low for stent thrombosis and bleeding. Trial sequential analysis for MI crossed the conventional significance boundary but not the trial sequential monitoring boundary or required information size. Extended DAPT may reduce MI, but individualized assessment of ischemic and bleeding risk remains important, and further adequately powered trials are warranted.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Von Willebrand Factor Biomarkers in Prosthetic Valve Dysfunction: An Adjunct to Imaging and Hemodynamic Assessment.","authors":"Sameed Arshad, Sabir Khan, Muhammad Zahid","doi":"10.1097/CRD.0000000000001496","DOIUrl":"https://doi.org/10.1097/CRD.0000000000001496","url":null,"abstract":"<p><p>Imaging remains the foundation of prosthetic valve surveillance because it identifies valve morphology, lesion mechanism, and hemodynamic severity. However, acoustic shadowing, eccentric or multiple regurgitant jets, loading conditions, and reader variability can complicate assessment, particularly for paravalvular regurgitation after transcatheter aortic valve replacement. High shear stress unfolds von Willebrand factor (VWF), promotes proteolysis of its high-molecular-weight multimers, and produces a measurable defect in primary hemostasis. Multimer analysis, closure time with adenosine diphosphate (CT-ADP), and the VWF activity-to-antigen ratio therefore provide a biologic signal of abnormal flow rather than an anatomic image. Prospective studies show that VWF abnormalities track residual paravalvular regurgitation during transcatheter aortic valve replacement, occur with dysfunctional prostheses, change after mitral paravalvular-leak repair, and are associated with bleeding. The evidence nevertheless remains observational; most diagnostic cohorts are small and single-center, thresholds lack independent validation, assays are vulnerable to hematologic and preanalytic confounding, and no completed randomized trial has shown that VWF-guided management improves outcomes. VWF testing is best viewed as an investigational adjunct when imaging and the clinical picture are discordant or when prosthetic dysfunction coexists with otherwise unexplained bleeding. It should not replace guideline-directed echocardiography or be used for routine surveillance outside research protocols.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Outcomes of Acute Normovolemic Hemodilution in Cardiac Surgery: Evidence From Randomized Controlled Trials.","authors":"Jawaria Hassan, Hafsa Azam, Pardeep Kumar, Warda Nasir, Ibrahim Ahmed, Sarmad Elahi Chatta, Muhammad Salar Khan Jadoon, Fnu Laiba, Sayan Zafar, Muhammad Sufian, Syed Muqeet Haider Bukhari, Khushal Ali Khan, Anas M Din Bashir, Komal Kumari","doi":"10.1097/CRD.0000000000001495","DOIUrl":"https://doi.org/10.1097/CRD.0000000000001495","url":null,"abstract":"<p><p>Acute normovolemic hemodilution (ANH) is a blood conservation strategy used in cardiac surgery, but its efficacy in reducing allogeneic blood transfusion remains debated. This systematic review and meta-analysis updates the existing evidence by incorporating recent randomized controlled trials (RCTs) to provide a contemporary assessment of ANH's impact on perioperative transfusion outcomes. We searched PubMed/MEDLINE, Scopus, and Cochrane Central up to August 2025 for RCTs comparing ANH to standard care in adult cardiac surgery. Primary outcomes were the number of allogeneic red blood cell units transfused, the rate of allogeneic blood transfusion, and estimated total blood loss. Data were pooled using random-effects models, and subgroup analyses were performed by type of surgery. Thirty-one RCTs involving 4426 patients (ANH = 2242, control = 2184) were included. ANH significantly reduced the rate of allogeneic blood transfusion (risk ratio 0.75, 95% confidence interval [CI] 0.66-0.87; P < 0.0001), the number of allogeneic red blood cell units transfused (standardized mean difference -0.42, 95% CI -0.64 to -0.20; P = 0.0001), and estimated total blood loss (standardized mean difference -0.42, 95% CI -0.63 to -0.21; P < 0.0001). Substantial heterogeneity was observed. Subgroup analysis demonstrated that benefits were most consistent in patients undergoing coronary artery bypass grafting. In patients undergoing cardiac surgery, particularly coronary artery bypass grafting, ANH reduces exposure to allogeneic blood transfusion and decreases perioperative blood loss. Despite significant heterogeneity across studies, these findings support the inclusion of ANH within multimodal blood management protocols. Further large, high-quality RCTs with standardized protocols are warranted to confirm its role in modern practice.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter-Directed Thrombolysis Plus Anticoagulation versus Anticoagulation Alone for Acute Intermediate-Risk Pulmonary Embolism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Abdulrahman Kareem AlTuwayhir, Bader Alshammari, Mohamed Abuelazm, Abdullah S Mirza, Adeeb Bazuhair","doi":"10.1097/CRD.0000000000001486","DOIUrl":"10.1097/CRD.0000000000001486","url":null,"abstract":"<p><p>Systemic anticoagulation is the standard initial therapy for intermediate-risk pulmonary embolism (PE) but fails to reverse right ventricular (RV) overload rapidly. While full-dose systemic thrombolysis accelerates RV recovery, it carries an unacceptable risk of major hemorrhage. Catheter-directed thrombolysis (CDT) offers a targeted, low-dose alternative to improve hemodynamics safely. A comprehensive search of PubMed, Web of Science, CENTRAL, Scopus, and Embase was conducted up to May 2026. Mean differences (MD) and risk ratios (RR) were pooled using a random-effects model. PROSPERO ID: CRD420261402147. Six RCTs involving 886 patients were included. CDT was associated with a significantly greater reduction in the RV/LV ratio than anticoagulation alone (MD: -0.11, 95% CI: [-0.21, -0.00]; P < 0.05). Also, CDT significantly reduced the risk of early cardiorespiratory deterioration (RR: 0.36, 95% CI [0.19, 0.68]; P < 0.001). There was no significant increase in major bleeding (RR: 1.52, 95% CI [0.71, 3.24]; P = 0.28) or intracranial hemorrhage. However, CDT significantly increased the risk of any bleeding ( P = 0.02) and vascular access-site complications/hematomas ( P = 0.02). Mortality did not differ between the two groups. Adding CDT to standard systemic anticoagulation led to a statistically significant reduction in the RV/LV ratio compared with anticoagulation alone, with a significantly lower risk of early hemodynamic and cardiorespiratory deterioration, without increasing the risk of major bleeding or intracranial hemorrhage in patients with acute intermediate-risk PE. However, larger RCTs with longer follow-up are required to provide a clearer picture of its sustained effects on hard clinical outcomes.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension Management in Breastfeeding Patients: Balancing Maternal Blood Pressure Control and Infant Safety.","authors":"Tzvi Greenberg, Dov Brodkin, William H Frishman, Wilbert S Aronow","doi":"10.1097/CRD.0000000000001489","DOIUrl":"https://doi.org/10.1097/CRD.0000000000001489","url":null,"abstract":"<p><p>Hypertension is a leading cause of death and disability in the United States, affecting nearly half of all Americans, according to the NIH. Postpartum hypertension is a clinically important form of hypertension that can be preexisting or arise during or after pregnancy. While there are many medications available to manage it, many of them have side effects that can affect the patient, lactation, the nursing infant, or a combination of these factors. This review summarizes the available lactation safety data for commonly used antihypertensive medications, including breast milk concentrations, relative infant dose, infant serum levels, and reported maternal and infant outcomes. Based on the available evidence, medications are categorized according to their compatibility with breastfeeding, and a practical clinical framework is proposed to guide medication selection. Overall, calcium channel blockers, selected beta-blockers, and angiotensin-converting enzyme inhibitors demonstrated favorable safety profiles in lactating patients, whereas diuretics, clonidine, and angiotensin receptor blockers should be used with greater caution because of higher infant exposure, potential effects on lactation, reported adverse effects, or limited evidence. These data were mainly sourced from published pharmacokinetic and clinical studies, as summarized in LactMed, the NIH's Drugs and Lactation Database, which compiles lactation safety data for various medications.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Renin-Angiotensin System Inhibitors on Postoperative Outcomes Following Coronary Artery Bypass Grafting: A Systematic Review.","authors":"Ahmed Mansour, Ahmed Elazab, Ahmed Elbataa, Abdalhakim Shubietah, Mohamed Hamouda Elkasaby, Elsayed Balbaa, Ahmed Hamdy G Ali, Ahmed Farid Gadelmawla, Ahmed Emara, Hamza A Abdul-Hafez, Mohammed A Elbahloul, Ahmed W Hageen, Mohammed Mhanna, William H Frishman, Wilbert S Aronow","doi":"10.1097/CRD.0000000000001488","DOIUrl":"10.1097/CRD.0000000000001488","url":null,"abstract":"<p><p>Patients undergoing coronary artery bypass grafting (CABG) remain at high risk of major adverse cardiovascular events and death despite successful revascularization, and the role of renin-angiotensin system inhibitors (RASi), comprising angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, in this setting is not clearly defined. We systematically reviewed the effect of RASi initiated within 30 days after CABG on postoperative outcomes. PubMed, Web of Science, Scopus, and the Cochrane Library were searched through May 2025 for randomized controlled trials and observational studies comparing patients who received RASi after CABG, alone or with other cardiovascular medications, with those who did not. Five studies (3 RCTs and 2 retrospective cohorts) comprising 47,821 patients (28,917 RASi recipients and 18,904 controls) were included. RASi use after CABG was generally associated with a lower rate of major adverse cardiovascular events, with the largest reductions observed in patients with heart failure. The effect on all-cause mortality was inconsistent: 2 studies reported a reduced risk, whereas 2 reported no significant difference. Cardiovascular mortality findings were similarly variable, with 1 study showing a marked reduction, 1 an early increase in the composite endpoint that attenuated over longer follow-up, and 1 no significant change.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Iron Supplementation in Heart Failure with Preserved Ejection Fraction: A Systematic Review.","authors":"Arfaan Sheriff, Alex R Qin, Abyaan Sheriff","doi":"10.1097/CRD.0000000000001479","DOIUrl":"https://doi.org/10.1097/CRD.0000000000001479","url":null,"abstract":"<p><p>Iron deficiency affects approximately half of patients with heart failure with preserved ejection fraction (HFpEF) and impairs functional capacity, yet evidence for intravenous (IV) iron in this population is limited. We evaluated the effect of IV iron on functional, biochemical, biomarker, and clinical outcomes in HFpEF. This systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and was prospectively registered [International Prospective Register of Systematic Reviews (PROSPERO) CRD420261360828]. Four databases were searched on April 11, 2026. Eligible studies enrolled adults with HFpEF and iron deficiency receiving IV iron, with at least 4 weeks of follow-up. Two reviewers independently screened records, extracted data, and assessed risk of bias. Because few studies were eligible and heterogeneity was substantial, findings were synthesized narratively without meta-analysis in accordance with the synthesis without meta-analysis guideline, and certainty was rated using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven reports of 6 studies were included: 1 randomized trial, 2 controlled observational studies, and 3 single-arm before-after studies. Across studies, IV iron consistently increased ferritin, transferrin saturation, and hemoglobin. The randomized trial improved 6-minute walking distance but not functional class or quality of life, and was stopped early. Effects on natriuretic peptide concentrations were inconsistent. The 2 controlled studies disagreed on clinical events: a propensity-matched analysis reported fewer hospitalizations, whereas a registry found no benefit. Certainty of evidence ranged from very low to moderate. In HFpEF, IV iron reliably corrects iron indices, but a clinical benefit remains unproven, and the evidence base is sparse and largely uncontrolled. Adequately powered randomized trials are required.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil Percentage-to-Albumin Ratio and Heart Failure Mortality: A Systematic Review.","authors":"Parth Adrejiya, Aditi Bhanushali, Pooja Suchday, Scott Landman, Apurva C Popat, Swetang J Shah, Dhaval S Patel, Rupak Desai, Wael Aljaroudi, Rami Khouzam, Brian Howard","doi":"10.1097/CRD.0000000000001484","DOIUrl":"https://doi.org/10.1097/CRD.0000000000001484","url":null,"abstract":"<p><p>Inflammation and malnutrition are important contributors to adverse outcomes in heart failure (HF). The neutrophil percentage-to-albumin ratio (NPAR), derived from routinely available laboratory parameters, integrates inflammatory burden and nutritional status and may provide prognostic value. We conducted a systematic review in accordance with the PRISMA 2020 guidelines to evaluate the association between baseline or admission NPAR and all-cause mortality in adults with HF. Two independent reviewers performed study selection and data extraction, and methodological quality was assessed using the Newcastle-Ottawa Scale. Because of heterogeneity in study populations, NPAR cutoff values, and outcome definitions, meta-analysis was not performed and findings were synthesized narratively. Five observational cohort studies comprising more than 4900 patients were included. Across all studies, elevated NPAR was consistently associated with increased short-term (30-90 days) and long-term (1-5 years) all-cause mortality in diverse HF populations, with reported hazard ratios ranging from 1.52 to 2.18. Several studies also demonstrated superior prognostic performance of NPAR compared with neutrophil percentage or serum albumin alone. However, reported NPAR cutoff values varied and remain unstandardized. Elevated NPAR is consistently associated with increased all-cause mortality in patients with HF and may serve as a simple, cost-effective tool for clinical risk stratification. Prospective studies are needed to establish standardized thresholds and validate its prognostic utility across HF phenotypes and clinical settings.</p>","PeriodicalId":9549,"journal":{"name":"Cardiology in Review","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}