Cardiovascular diagnosis and therapy最新文献

{"title":"Association of left ventricular global longitudinal strain with outcomes of severe mitral regurgitation due to severe mitral annular calcification: a retrospective cohort study.","authors":"Mohammad Al Zein, Yuichiro Okushi, Shinya Unai, Gösta B Pettersson, A Marc Gillinov, Richard A Grimm, Brian P Griffin, Bo Xu","doi":"10.21037/cdt-2025-1-620","DOIUrl":"10.21037/cdt-2025-1-620","url":null,"abstract":"<p><strong>Background: </strong>Mitral annular calcification (MAC) is associated with increased mortality and a heightened risk of complications such as stroke, myocardial infarction, and arrhythmias. In advanced stages, MAC can cause severe mitral regurgitation (MR), further worsening outcomes. Prognostic markers to guide therapy in this population remain unclear. Left ventricular global longitudinal strain (LVGLS) has been linked to outcomes in MR, but its role in severe MR due to severe MAC is not well established. This study evaluated the prognostic value of LVGLS in this setting.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective study of patients with severe MAC identified from the Cleveland Clinic echocardiographic database between January 2010 and August 2023. From these, patients with mild or moderate MR and those with concomitant significant mitral stenosis (MS) were excluded. Subsequently, patients with isolated severe MR due to severe MAC were identified. Clinical and echocardiographic parameters, including LVGLS, were recorded at baseline. The primary outcome was all-cause mortality. Patients were stratified by the median LVGLS value for analysis. Survival was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Restricted cubic spline was used to evaluate potential non-linear associations between LVGLS and mortality.</p><p><strong>Results: </strong>During the study period, 10,061 patients were diagnosed with severe MAC on echocardiography at our institution. Of these, 8,912 with mild or moderate MR and 1,021 with concomitant significant MS were excluded, and 128 patients with isolated severe MR due to severe MAC were included in our study. The median follow-up was 134 days [interquartile range (IQR), 33-1,812 days]. The median age was 81 years (IQR, 71-88 years), and 35 (27.3%) were male. The median left ventricular ejection fraction (LVEF) was 63% (IQR, 56-69%), mean MR regurgitant volume was 60±20.8 mL, and median right ventricular systolic pressure was 54 mmHg (IQR, 42-71 mmHg). The median LVGLS was -14.8%±4.5%. Of the 128 patients, 45 (35.2%) underwent mitral valve intervention, 42 (93.3%) surgery and 3 (6.7%) mitral clip implantation, while 83 (64.8%) received conservative management. Among surgical cases, 37 underwent valve replacements (34 bioprosthetic) and 5 valve repairs. During follow-up, 63 patients (49.2%) died. LVGLS worse than -14.8% was associated with higher 12-month mortality (log-rank P=0.043) but not over the entire follow-up period (P=0.11). On multivariable cox regression, LVGLS was not a predictor of mortality after adjusting for other covariates [hazard ratio (HR) 1.046, 95% confidence interval (CI): 0.983-1.112].</p><p><strong>Conclusions: </strong>In severe MR due to MAC, impaired LVGLS was associated with increased short-term but not long-term mortality. The limited long-term prognostic value may reflect the low myocardial reserve in patients with severe valvul","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"68"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918361","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":"Recommendations for future research on body mass index, valve sizing, patient-prosthesis mismatch, and post-transcatheter aortic valve replacement hemodynamics.","authors":"Rafferty I Koontz, Thelsa T Weickert, John P Vavalle","doi":"10.21037/cdt-2026-0379","DOIUrl":"10.21037/cdt-2026-0379","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"75"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918483","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":"Continuous anatomical radiation modulation for the acquisition of coronary computed tomography angiography in difficult to scan patients: a prospective cohort study.","authors":"Yosef A Cohen, M Robert Peters, Mrinali Shetty, Luca Bremner, Michelle Castillo, David Bae, Cyrus Attia, Seth Uretsky, Andrew J Einstein","doi":"10.21037/cdt-2026-1-0095","DOIUrl":"10.21037/cdt-2026-1-0095","url":null,"abstract":"<p><strong>Background: </strong>A novel continuous anatomically modulated (CAM) retrospectively-gated scan mode for coronary computed tomography angiography (CCTA) modulates tube current as a function of patient anatomy, offering potential for good image quality (IQ) and radiation dose reduction in patients undergoing CCTA on a traditional scanner with significant ectopy (SE) or high heart rate (HHR) who are not candidates for prospectively-triggered scanning. We evaluated the effect of CAM on IQ and radiation dose in a large group of patients.</p><p><strong>Methods: </strong>Three hundred and twenty consecutive patients at a single center (Advanced Cardiovascular Imaging, New York, NY) undergoing CCTA were prospectively protocoled by clinicians to CAM retrospectively-gated scanning if they had SE/HHR or prospectively-triggered scanning if they had regular heart rates. IQ was graded on a 5-point scale by two readers and radiation dose-length product (DLP) evaluated. Radiation exposure was assessed using DLP, with effective dose estimated using a cardiac-specific conversion factor. Associations between patient weight and radiation dose were evaluated using log-linear regression models.</p><p><strong>Results: </strong>Of 320 patients, 166 (52%) were assigned to prospective triggering (PT) and 154 (48%) to continuous anatomically modulated retrospectively gated (CAM RG). Patients in the CAM RG group had higher heart rates throughout the scanning process. Mean DLP was higher in the CAM RG group compared with the PT group (411.6±308.9 <i>vs.</i> 324.0±208.4 mGy·cm; P=0.03), corresponding to effective doses of 10.7±8.0 <i>vs.</i> 8.4±5.4 mSv, respectively. Despite these differences, IQ remained high across all groups, with mean composite scores exceeding 4.5. When diagnostic quality was defined as an overall IQ score ≥4, the proportion of diagnostic-quality studies did not differ significantly between groups (92.8% <i>vs.</i> 89.6%, P=0.42). In adjusted logistic regression models, scan protocol was not independently associated with diagnostic-quality imaging. Patient weight demonstrated a strong association with radiation dose, with DLP increasing by approximately 13-16% per 10-lb increase in weight, independent of scan protocol.</p><p><strong>Conclusions: </strong>On a standard single-source CT scanner, CAM-based retrospectively gated CCTA provides consistently diagnostic IQ in patients with more challenging heart rate profiles, at the cost of modestly higher radiation exposure that is largely driven by patient size. CAM RG represents a practical, software-based acquisition strategy for centers without advanced CT hardware, enabling effective imaging of complex patients while maintaining acceptable radiation dose.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"66"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918492","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":"Narrative review of the current management of ectopic varices: an update.","authors":"Doo Hee Kim, Sameer Gadani, Hassan Anbari, Baljendra Kapoor","doi":"10.21037/cdt-2026-1-0083","DOIUrl":"10.21037/cdt-2026-1-0083","url":null,"abstract":"<p><strong>Background and objective: </strong>Ectopic varices are a rare complication of portal hypertension that occur outside the esophagogastric region and represent a potentially life-threatening source of gastrointestinal bleeding. Treatments are frequently guided by institutional experience rather than standardized treatment algorithms due to their rarity and variable anatomy. This narrative review summarizes the epidemiology, clinical presentation, diagnostic evaluation, and management strategies.</p><p><strong>Methods: </strong>A literature review was performed using PubMed and Google Scholar. Given that much of the available evidence consists of case reports, case series, and retrospective studies, no time restrictions were applied to the search. The search strategy broadly included studies relevant to ectopic varices, and no language restrictions were applied.</p><p><strong>Key content and findings: </strong>Ectopic varices account for small proportion of variceal hemorrhage but are associated with significant morbidity and mortality. Clinical presentation varies according to anatomic location. Cross-sectional imaging, endoscopy and angiography play important roles in diagnosis and treatment planning. In the absence of bleeding, nonselective beta-blockers are the primary medical therapy to reduce portal pressure and prevent hemorrhage. For suspected or confirmed bleeding, prompt hemodynamic stabilization is essential, and splanchnic vasoactive agents such as octreotide or terlipressin should be initiated without delay even prior to confirmatory testing. Systemic vasopressors are reserved for patients in shock. Endoscopic band ligation and sclerotherapy are first-line treatment options after initiating vasopressor therapy, although their use may be limited by anatomical accessibility. If endoscopic therapy is unsuccessful or not feasible, interventional radiology (IR) techniques such as transjugular intrahepatic portosystemic shunt (TIPS), antegrade transvenous obliteration (ATO), retrograde transvenous obliteration (RTO), and recanalization of chronically occluded visceral veins are pursued based on patient anatomy and portal hemodynamics. Surgical interventions are reserved for refractory cases.</p><p><strong>Conclusions: </strong>Management of ectopic varices requires an individualized, multidisciplinary approach that incorporates medical, endoscopic, IR, and surgical therapies.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"73"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918548","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":"Fully connected neural network model for predicting postthrombotic syndrome in patients with deep vein thrombosis.","authors":"Haowei Chen, Zhiyong Yu, Liang Li, Peng Qiu, Deyin Zhao","doi":"10.21037/cdt-2025-385","DOIUrl":"10.21037/cdt-2025-385","url":null,"abstract":"<p><strong>Background: </strong>Postthrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) and, despite anticoagulation, affects 20-50% of patients with DVT. Prediction models, primarily based on linear regression, struggle with the complex, nonlinear relationships in clinical data. This study thus aimed to develop and validate a PTS risk prediction model incorporating a fully connected neural network (FCNN) in a large DVT patient dataset to support clinical decision-making.</p><p><strong>Methods: </strong>This retrospective study used data from lower-extremity DVT cases at a single vascular surgery center. An FCNN model for predicting PTS risk was constructed via TensorFlow (Google), with feature selection, model building, and validation phases being completed. The model was evaluated according to metrics of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), as well as fivefold cross-validation.</p><p><strong>Results: </strong>Out of 212 enrolled patients with DVT, 67 (31.6%) developed PTS within 6 months of the initial DVT diagnosis. The FCNN model predicted PTS with 80.43% accuracy, demonstrating high stability and reliability. On the test set (n=46), the model achieved a sensitivity of 78.6%, a specificity of 78.1%, and an AUC of 0.82.</p><p><strong>Conclusions: </strong>The FCNN-based PTS risk prediction model is a promising artificial intelligence tool for vascular surgery and can aid in early intervention and treatment decisions in patients with DVT. Future work should include data integration from multiple centers and external validation of the model to enhance its universality and accuracy.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"67"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918507","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":"Statistical concerns regarding the validation of myocardial contraction fraction cut-off in transcatheter aortic valve replacement patients.","authors":"Senol Coskun","doi":"10.21037/cdt-2026-0232","DOIUrl":"10.21037/cdt-2026-0232","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"77"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918510","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":"Integrated single-cell RNA sequencing and mendelian randomization analysis identifies causal immune-related driver genes in the heart failure inflammatory microenvironment.","authors":"Ziwei Shan, Xiaoling Liu, Qingxuan Yang, Yuxuan Fan, Wenjuan Xiu, Yuqin Shen","doi":"10.21037/cdt-2026-0142","DOIUrl":"10.21037/cdt-2026-0142","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a major global cause of cardiovascular death and disability. Chronic inflammation and immune dysregulation are critical in its development. The cardiac immune microenvironment, especially macrophages, drives HF progression, yet its molecular mechanisms and prognostic impact are not fully clear. This study aimed to identify causal immune-related driver genes in the HF inflammatory microenvironment.</p><p><strong>Methods: </strong>We combined single-cell RNA sequencing (scRNA-seq) and Mendelian randomization (MR) to study how the inflammatory immune microenvironment affects HF risk. Using two public scRNA-seq datasets, we identified differentially expressed genes (DEGs) in HF heart tissues and selected 489 candidate genes. Causal relationships between these genes and HF were tested using expression quantitative trait loci (eQTL) data and HF genome-wide association study (GWAS) summary statistics.</p><p><strong>Results: </strong>MR analysis showed that 65 genes were causally linked to HF risk. These genes were enriched in pathways related to cardiomyopathy, leukocyte migration, natural killer (NK) cell cytotoxicity, neutrophil extracellular traps, and NF-κB signaling. HF hearts displayed increased levels of macrophages, T cells, B cells, lymphoid cells, and mast cells, while neutrophils were reduced.</p><p><strong>Conclusions: </strong>Our integrated analysis reveals the central role of the cardiac inflammatory immune microenvironment in HF and identifies 65 key genes causally associated with HF susceptibility. These genes influence specific immune pathways and cell infiltration, shaping HF progression, and provide a basis for developing new biomarkers and immune-targeted therapies.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"69"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918531","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":"Comparative hemodynamic effects of mavacamten and septal myectomy in HOCM: important methodological considerations.","authors":"Teruhiko Imamura","doi":"10.21037/cdt-2026-0276","DOIUrl":"10.21037/cdt-2026-0276","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"79"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918359","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":"Body mass index, valve size, and post-transcatheter aortic valve replacement hemodynamics: is patient-prosthesis mismatch the missing link?","authors":"Teruhiko Imamura","doi":"10.21037/cdt-2026-0295","DOIUrl":"10.21037/cdt-2026-0295","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"74"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918446","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":"Prognostic value of early cardiac magnetic resonance first-pass perfusion assessment of microcirculatory dysfunction for acute rejection after heart transplantation.","authors":"Ke Han, Yuelong Yang, Liqi Cao, Chang Liu, Chulan Ou, Caiying Mo, Chun Luo, Yingying Bao, Min Wu, Hui Liu","doi":"10.21037/cdt-2026-0215","DOIUrl":"10.21037/cdt-2026-0215","url":null,"abstract":"<p><strong>Background: </strong>Acute rejection (AR) remains a major obstacle to success after heart transplantation (HT). Impaired microcirculatory function is linked to a higher risk of AR. The value of cardiac magnetic resonance (CMR) resting first‑pass perfusion imaging for evaluating microcirculatory function to predict subsequent AR after HT remains unclear. We aimed to evaluate the prognostic value of CMR resting first‑pass perfusion parameters measured early after HT for AR.</p><p><strong>Methods: </strong>This single-center retrospective study analyzed data from 79 HT recipients, including 21 with AR [HT (AR+)] and 58 without AR [HT (AR-)], and 32 healthy volunteers. CMR examination was performed at 3 months after HT to assess myocardial perfusion. Resting first-pass perfusion parameters, including time to peak myocardial signal intensity (TTM), Upslope, and maximum signal intensity (MaxSI) were analyzed. Univariable and multivariable Cox regression analyses were performed to identify predictors of AR within 2 years after HT. Incremental prognostic value was evaluated using C-index, continuous net reclassification index (NRI), and integrated discrimination improvement (IDI). P value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>During a median follow‑up of 24 months, 21 HT recipients (26.6%) experienced AR. Patients with AR showed significantly longer TTM, lower Upslope and MaxSI at 3 months after HT compared with non‑AR patients and controls (all P<0.001). TTM [adjusted hazard ratio (aHR): 1.07 (1.04, 1.10), P<0.001], Upslope [aHR: 0.78 (0.71, 0.86), P<0.001], and MaxSI [aHR: 0.97 (0.95, 0.98), P<0.001] were independent predictors of AR after adjusting for age and body mass index (BMI). Adding TTM, Upslope, and MaxSI individually to the clinical model (age + BMI) significantly improved discriminant and reclassification ability for risk of AR (C‑index: 0.803, 0.889, 0.869 <i>vs</i>. 0.707; continuous NRI: 0.755, 1.049, 1.025; IDI: 0.139, 0.343, 0.340; all P<0.05), with Upslope demonstrating the highest incremental value.</p><p><strong>Conclusions: </strong>CMR resting first‑pass perfusion parameters acquired early after HT that reflect microcirculatory dysfunction are independent prognostic markers of AR within 2 years and provide incremental prognostic value over clinical variables to guide personalized post‑transplant management.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 4","pages":"59"},"PeriodicalIF":2.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918522","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}