Cardiovascular diagnosis and therapy最新文献

{"title":"The value of miRNA-29b in the diagnosis of myocardial infarction and the evaluation of cardiac function after myocardial infarction.","authors":"Xiaoxi Wang, Xuexin Liu, Weihua Shao, Yawei Duan, Huiqing Hou","doi":"10.21037/cdt-24-561","DOIUrl":"10.21037/cdt-24-561","url":null,"abstract":"<p><strong>Background: </strong>miRNA-29b affects angiogenesis and cardiac fibrosis, processes relevant to the pathophysiology of myocardial infarction (MI). This study aimed to investigate the accuracy of miRNA-29b in diagnosing acute myocardial infarction (AMI) and its association with postinfarction cardiac function.</p><p><strong>Methods: </strong>A total of 106 patients with AMI admitted to the Department of Cardiology of Hebei General Hospital between January 2023 and July 2024 were prospectively enrolled within 24 hours of symptom onset. Indicators including circulating miRNA-29b levels [detected via real-time quantitative polymerase chain reaction (RT-qPCR)], myocardial enzymes, vascular endothelial growth factor (VEGF), and tumor necrosis factor-α (TNF-α) were assessed at baseline. Cardiac function was assessed by echocardiography. Left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVEDs), and left ventricular posterior wall thickness at end-diastole (LVPWd) and end-systole (LVPWs) were also measured. Based on echocardiography, patients with AMI (n=106) were divided into an abnormal cardiac function (ACF) group (LVEF <50%; n=50) or a normal cardiac function (NCF) group (LVEF ≥50%; n=56). Thirty healthy participants were selected as the control group. Variables were compared with independent samples t-tests. Correlation and receiver operating characteristic (ROC) curve analyses were also conducted.</p><p><strong>Results: </strong>There was no significant differences in baseline demographic or clinical characteristics between the AMI and control groups; however, the control group, compared with the AMI group, had lower levels of low-density lipoprotein cholesterol (2.72±0.58 <i>vs.</i> 3.53±0.77 mmol/L; P<0.001) and fasting blood glucose (7.00±1.61 <i>vs.</i> 8.77±2.37 mmol/L; P<0.001). Moreover, the relative blood miRNA-29b expression was significantly lower in the AMI group than in the control group (0.31±0.16 <i>vs.</i> 0.73±0.40; P<0.01), and the expression was lower in the ACF group than in the NCF group (0.24±0.15 <i>vs.</i> 0.39±0.14; P<0.01). Correlation analysis showed that miRNA-29b was positively correlated with LVEF [r=0.608; P<0.001; 95% confidence interval (CI): 0.494-0.701] and LVFS (r=0.583; P<0.001; 95% CI: 0.448-0.702). Conversely, it was negatively correlated with cardiac troponin T (cTnT) level (r=-0.687; P<0.001; 95% CI: -0.769 to -0.610), creatine kinase-MB (r=-0.626; P<0.001; 95% CI: -0.744 to -0.488), VEGF (r=-0.581; P<0.001, 95% CI: -0.708 to -0.422), TNF-α (r=-0.527; P<0.001; 95% CI: -0.658 to -0.369), LVEDd (r=-0.451; P<0.001; 95% CI: -0.578 to -0.284), and LVEDs (r=-0.462; P<0.001; 95% CI: -0.593 to -0.330). ROC analysis indicated good diagnostic performance of miRNA-29b for AMI [area under the curve (AUC) =0.853; 95% CI: 0.767-0.939], and miRNA-29b also showed predictive value for post","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 3","pages":"539-549"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625437","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":"Alcohol embolization versus non-invasive treatment for pain relief in peripheral venous malformations: a comparative study.","authors":"Aleksandra Tuleja, Yvonne Döring, Fabrice Noël Helfenstein, Themis-Areti Andreoti, Jochen Rössler, Laurence Myriam Boon, Miikka Vikkula, Fabian Haupt, Györgyi Hamvas, Sarah Maike Bernhard, Iris Baumgartner","doi":"10.21037/cdt-24-529","DOIUrl":"10.21037/cdt-24-529","url":null,"abstract":"<p><strong>Background: </strong>Pain is one of the most important symptoms affecting quality of life in patients with venous malformations. Alcohol embolization is a common approach among other treatment modalities. However, the benefits and complications of this therapy require rigorous evaluation in the face of emerging alternative treatments. The aim of this study was to evaluate the efficacy of alcohol embolization in pain management compared with non-invasive treatment, and to explore associated complications.</p><p><strong>Methods: </strong>We performed a retrospective, comparative study at the Vascular Malformation Center, University Hospital of Bern, from 2008 to 2022. Consecutive patients with peripheral venous malformations were included, one group underwent alcohol embolization and the other group received non-invasive treatment including counseling for compression stockings, physical therapy and anticoagulation. Decision to treat was made jointly by the clinician and the patient, after discussing the potential harms and benefits. Pain levels were measured using the 0-10 Numerical Rating Scale on every scheduled visit. Inverse probability of treatment weights were used to adjust for confounders such as severity of malformation indicated by number of tissues affected, localization, presence of hypertrophic tissue, history of thrombophlebitis, age, and level of pain at the initial visit. The primary outcome was change in maximal pain level, and secondary outcomes included changes in mean and minimal pain levels within 1 year of follow-up.</p><p><strong>Results: </strong>A total of 227 patients were included in the analysis, 86 in the intervention group and 141 in the control group. Over the course of one year, both the control and alcohol embolization groups experienced reductions in pain. The control group showed a reduction in maximal pain from 4.42 by 0.95 points, with an additional non-significant reduction of 0.99 points in the alcohol embolization group [estimate: -0.0027 per day, 95% confidence interval (CI): -0.0061, 0.0007, P=0.12]. However, alcohol embolization led to a more pronounced and significant reduction in mean and minimal pain, with additional reductions of 1.06 (-0.0029 per day, 95% CI: -0.0055, -0.0003, P=0.02) and 0.69 points per year (-0.0019 per day, 95% CI: -0.0035, -0.0004, P=0.01), respectively. Seven minor and five major complications occurred in the alcohol embolization group.</p><p><strong>Conclusions: </strong>Non-invasive treatment helps patients with venous malformations to manage maximal pain effectively. Alcohol embolization results in a faster and more pronounced reduction in mean and minimal pain levels, but we found no statistical evidence of an advantage of alcohol embolization for reducing maximal pain. Treatment efficacy did not appear to be influenced by gender, age, or previous treatment history. To adequately assess the efficacy of new therapies, future trials should include both disease-specif","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 3","pages":"598-609"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625335","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 of clinical features and outcomes of Chinese patients with Takotsubo syndrome and acute myocardial infarction-results from the first Chinese Takotsubo syndrome registry.","authors":"Yuxi Huang, Lingchun Lyu, Yuan Tao, Juan Lei, Yulin Wei, Liwen Wu, Mei Xu, Yusheng Liu, Lingzhi Jiang, Zhongxia Sun, Yongmin Ding, Pengfei Miao, Qianglin Guan, Feng Lv, Cunxue Pan, Chenying Lu, Yuyi Chen, Tou Kun Chong, Kan Liu, Jian Chen","doi":"10.21037/cdt-2025-8","DOIUrl":"10.21037/cdt-2025-8","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo syndrome (TTS) differs significantly from acute myocardial infarction (AMI) in clinical features and pathological mechanisms, but evidence in Asian populations remains limited. The aim of this study is to compare clinical features and outcomes between patients with TTS and AMI in the first Chinese registry of TTS (ChiTTS Registry, ChiCTR1900026725).</p><p><strong>Methods: </strong>In this multicenter 6-year retrospective cohort study (February 2016-June 2022), a total of 116 consecutive TTS patients diagnosed according to the international Takotsubo diagnostic criteria and 232 age- and sex-matched AMI patients (1:2 ratio) meeting the 2023 European Society of Cardiology guidelines criteria were enrolled from 10 tertiary medical centers across China. Clinical characteristics, in-hospital outcomes, and major adverse cardiovascular and cerebrovascular events (MACCEs) were compared between groups using Student's <i>t</i>-test or Chi-squared test. Time-to-event analysis employed Kaplan-Meier/log-rank tests with landmark analysis.</p><p><strong>Results: </strong>The median follow-up time was 1.23 [interquartile range (IQR), 0.33-2.63] years in ChiTTS Registry patients and 2.35 (IQR, 1.68-3.68) years in AMI patients. In contrast to AMI patients, TTS patients presented with more clinical manifestations associated with acute heart failure. TTS patients developed approximately twice as many in-hospital complications as AMI patients (42.2% <i>vs.</i> 20.7%, P<0.001) and experienced significantly more 100-day MACCEs (19.6% <i>vs.</i> 10.8%, P=0.03) and all-cause mortality (17.9% <i>vs.</i> 8.9%, P=0.02). In comparison to AMI patients, the landmark analysis confirmed that TTS patients developed more 100-day MACCEs [hazard ratio (HR) 1.87; 95% confidence interval (CI): 1.03-3.37; log-rank test P=0.04] and all-cause mortality (HR 2.07; 95% CI: 1.10-3.91; log-rank test P=0.02). In contrast, no significant difference was found in long-term MACCEs (HR 0.38; 95% CI: 0.13-1.09; log-rank test P=0.06) and all-cause mortality (HR 0.96; 95% CI: 0.31-2.98; log-rank test P=0.94) between TTS and AMI patients.</p><p><strong>Conclusions: </strong>In comparison to AMI patients, Chinese TTS patients developed more in-hospital complications and had a worse short-term prognosis. The cardiovascular issues in TTS patients underscore the need for effective treatment and personalized strategies to enhance outcomes and mitigate risks.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 3","pages":"563-573"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625429","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":"Left ventricular rotational abnormalities in adult patients with congenital heart disease late after Fontan procedure: detailed analysis from the CSONGRAD Registry and MAGYAR-Path Study.","authors":"Attila Nemes, Renáta Halcsik, Árpád Kormányos, Nóra Ambrus, Kálmán Havasi","doi":"10.21037/cdt-24-503","DOIUrl":"10.21037/cdt-24-503","url":null,"abstract":"<p><strong>Background: </strong>The Fontan procedure (FP) is a surgical palliation diverting blood flow from the caval veins to the pulmonary artery. The FP is used in several congenital heart diseases (CHDs), for instance in the absence of a heart valve and/or in the presence of an abnormality of a heart chamber. Since little information is available on the cardiac mechanics of FP-operated patients, the present study aimed to determine three-dimensional speckle tracking echocardiography (3DSTE)-derived basal and apical left ventricular (LV) rotations in adult patients with CHD mainly affecting the right heart late after FP.</p><p><strong>Methods: </strong>The present study comprised 15 CHD patients late after FP with a mean age of 32.6±8.0 years (5 males). Their results were compared to a group of 25 age- and gender-matched healthy individuals (mean age: 33.4±11.9 years, 8 males).</p><p><strong>Results: </strong>Regarding the type of the procedure, bidirectional Glenn procedure (BDGP), modified Kreutzer procedure (MKP) and total cavopulmonary connection were performed as final palliative procedures in 2, 3 and 8 patients, respectively. Regarding the ventricular anatomy, hypoplastic right heart syndrome (HRHS), univentricular heart (UH) and tricuspid atresia were present in 3, 5 and 5 patients, respectively. With 3DSTE, regarding the procedure, only MKP patients showed normal LV ejection fraction (EF) due to increased LV end-diastolic volume (EDV), other groups showed mildly reduced LV-EF. With 3DSTE, regarding the ventricular anatomy, UH patients had the largest LV-EDV, but no differences could be detected in mildly reduced LV-EF values between the subgroups. Regarding the procedure, BDGP patients had larger basal and apical LV rotations compared to the other groups resulting in increased LV twist. Regarding the ventricular anatomy, HRHS patients had larger basal and apical LV rotations compared to the other groups resulting in increased LV twist.</p><p><strong>Conclusions: </strong>In FP patients with CHD mainly affecting the right heart, on a group level, impaired LV-EF is associated with tendentiously lower LV twist due to reduced apical LV rotation, but characteristics of LV functional and rotational mechanics show substantial differences depending on the ventricular anatomy in CHD and the procedure performed.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 3","pages":"574-583"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625434","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":"Cardiological rehabilitation, prehabilitation, and cardiovascular prevention in adults with congenital heart defects: tasks and services of the German Pension Insurance-part 2: cardiological rehabilitation.","authors":"Juliane Barth, Oliver Dewald, Peter Ewert, Annika Freiberger, Sebastian Freilinger, Tobias Gampert, Frank Harig, Jürgen Hörer, Stefan Holdenrieder, Michael Huntgeburth, Ann-Sophie Kaemmerer-Suleiman, Niko Kohls, Nicole Nagdyman, Rhoia Neidenbach, Wolfgang Schmiedeberg, Mathieu N Suleiman, Fabian von Scheidt, Detlef Koch, Wolfgang Wagener, Dirk Mentzner, Fritz Mellert, Harald Kaemmerer","doi":"10.21037/cdt-2024-692","DOIUrl":"10.21037/cdt-2024-692","url":null,"abstract":"<p><p>Congenital heart defects (CHD) represent the most common inborn organ anomaly, with more than a million newborns affected annually. Advances in diagnostics and treatment have led to significantly improved survival rates, resulting in a growing population of an estimated 50 million adults with congenital heart defects (ACHD) worldwide. As these individuals age, they often face a high burden of morbidity and complex long-term health challenges that require specialized, lifelong care. In this context, cardiological rehabilitation (CR) becomes increasingly important, not only to reduce morbidity but also to enhance patients' quality of life and support their social and occupational integration. While CR has been extensively studied and implemented for acquired heart diseases, structured rehabilitation programs tailored to the specific needs of ACHD remain limited in clinical practice and in the scientific literature. Globally, both the availability of CR and the presence of structured concepts vary widely. CR is predominantly offered in high-income countries, with Western Europe providing the most extensive services. In many low- and middle-income countries, access to CR remains limited or is sometimes not available at all. However, even in high-income settings, targeted ACHD programs are scarce, meaning that many ACHD are treated in general CR programs that do not adequately address the complexity of CHD. The present article outlines the core components of CR, provides recommendations on how these are implemented in current practice, identifies existing limitations, and discusses how services could be better aligned with the complex medical and psychosocial needs of ACHD. It also describes the role of the German Pension Insurance in funding and providing rehabilitation services in Germany. Tailored rehabilitation programs, greater integration of ACHD expertise, and targeted research are essential to improve long-term outcomes and establish patient-centered care structures for the growing ACHD population. In this way, the present paper is intended to support the development of rehabilitation programs for countries where such structures currently do not exist.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 3","pages":"696-704"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625426","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":"Expanding diagnostic horizons: the role of multivessel coronary function testing in angina with non-obstructive coronary arteries.","authors":"Asim Shaikh, Ahmad El-Yaman, Mouaz H Al-Mallah","doi":"10.21037/cdt-24-476","DOIUrl":"10.21037/cdt-24-476","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 3","pages":"522-525"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625433","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":"Diagnosis, management, and outcome of heart failure in congenitally corrected transposition of the great arteries (ccTGA)-a narrative review.","authors":"Motoki Komori, Maria Luisa Benesch Vidal, Kenta Imai, Yuji Tominaga, Keisuke Shibagaki, Rieko Kutsuzawa, Shota Kawai, Kentaro Hayashi, Kenichi Kurosaki, Hideo Ohuchi, Kouichi Toda, Yoshikatsu Saiki, Christoph Sinning, Shigemitsu Iwai","doi":"10.21037/cdt-24-334","DOIUrl":"10.21037/cdt-24-334","url":null,"abstract":"<p><strong>Background and objective: </strong>Congenitally corrected transposition of the great arteries (ccTGA) remains a rare congenital disorder with a wide range of manifestations. The management of heart failure (HF) of the systemic right ventricle (RV), arrhythmias, heart block, and acquired cardiac conditions require a complex and multi-faceted approach. The objective of this manuscript is to present the current evidence regarding diagnostic, treatment, and management strategies for HF in ccTGA, including ventricular assist device (VAD) therapy and heart transplantation.</p><p><strong>Methods: </strong>A systematic review of the literature was conducted using PubMed, covering the period between 2010 and 2024. The search terms included \"heart failure\", \"ccTGA\", \"VAD\", \"heart transplantation\", and \"systemic RV failure\". Two clinical cases were included for illustrative purposes.</p><p><strong>Key content and findings: </strong>HF is a common occurrence in the context of ccTGA, primarily driven by progressive pressure and volume overload of the systemic RV, regurgitation of the systemic atrio-ventricular (AV) valve, and the development of arrhythmias, including complete heart block and (supra-)ventricular tachycardia. The use of HF medication is indicated for symptomatic patients, however, data on the efficacy of standardized HF medication remains limited. Timing of AV-valve replacement is essential to prevent further progression of HF.</p><p><strong>Conclusions: </strong>In ccTGA, the timing of surgery and interventional treatment approaches, the effect of pharmacological treatment in the context of HF, as well as the timing of initiation of a mechanical circulatory support, VAD and heart transplantation, are based on individualised consensus-level decisions. Optimal management remains a topic of debate due to the scarcity of outcome data. Future investigations should focus on identifying surrogate parameters for guiding treatment.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"500-508"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092881","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":"Recent progress in metabolomic analysis of acute coronary syndrome: a narrative review.","authors":"Jiaqi Liu, Tingmiao Li, Xin Qi, Chengyan He","doi":"10.21037/cdt-24-431","DOIUrl":"10.21037/cdt-24-431","url":null,"abstract":"<p><strong>Background and objective: </strong>Acute coronary syndrome (ACS) is a common cardiovascular disease in clinical practice. It is caused mainly by vulnerable plaque rupture (PR) or surface plaque erosion (PE) caused by serious thrombotic events, and eventually leads to myocardial blood supply insufficiency or necrosis. The disease has high morbidity and mortality rates. In this study, we review the literature on biomarkers of ACS metabolites and modification of disease by altering related metabolic pathways through drugs, aiming to provide clarity on potential biomarkers of disease identified to date.</p><p><strong>Methods: </strong>PubMed was used for literature review. From January 1, 2014 to December 3, 2024, English articles on clinical trials, randomized controlled trials of metabolomics studies in ACS were included.</p><p><strong>Key content and findings: </strong>In this review, we discuss the advantages and disadvantages of three techniques currently used for metabolomic analysis. In addition, the recent decade of metabolomic approaches to the discovery of potential diagnostic and prognostic biomarkers for ACS is reviewed. It was found that the metabolites changed in patients with ACS were mostly amino acids, lipids and carbohydrates. Tryptophan and glutamine can be used as potential diagnostic biomarkers. Mannitol and ceramide can be used as prognostic biomarkers. Drugs can improve disease by affecting changes in metabolites in the body.</p><p><strong>Conclusions: </strong>ACS studies based on metabolomics have demonstrated great potential for identifying disease-related metabolomic features in the discovery of potential biomarkers for diagnosis and prognosis and mechanisms of drug therapy.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"480-499"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092973","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":"Initial outcomes of novel guideline-directed pharmacotherapy for systemic right heart failure in adults with congenital heart disease.","authors":"Ann-Kristin Lassen, Yevheniia Artemenko, Michael Jerosch-Herold, Ines Kowalewski, Jakob Olfe, Arash Kheradvar, Tobias Giertzsch, Christoph Robert Sinning, Thomas S Mir, Goetz Christoph Mueller, Carsten Rickers","doi":"10.21037/cdt-24-452","DOIUrl":"10.21037/cdt-24-452","url":null,"abstract":"<p><strong>Background: </strong>The combination therapy of angiotensin-converting enzyme inhibitors (ACEi) or alternatively angiotensin receptor-neprilysin inhibitors (ARNis), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and recently sodium-glucose co-transporter 2 inhibitors (SGLT2is) has been hailed as a breakthrough in heart failure treatment for patients with structurally normal hearts, with international guidelines recommending these as first-line therapies (\"fantastic four\"). However, specific recommendations for adult with congenital heart disease (ACHD) and systemic right ventricle (sRV), who are at heightened risk for heart failure, are largely based on clinical experience or position statements, lacking robust clinical trial data. This study aims to evaluate the effectiveness and tolerability of these medications in ACHD patients with sRV.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included 21 adult patients with sRV and signs of heart failure [6 with d-transposition of the great arteries (d-TGA) post-atrial switch, 7 with congenitally corrected transposition of the great arteries (cc-TGA), and 8 with univentricular right heart in Fontan circulation]. Changes in functional New York Heart Association (NYHA) class, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, sRV function, and renal function were assessed before and after initiating or escalating heart failure pharmacotherapy with ARNi and/or SGLT2i. The median follow-up was 15 months (1.24 years).</p><p><strong>Results: </strong>The combination therapy was well tolerated among all patients, with no interruptions in therapy and no adverse effects such as hyperkalemia, renal dysfunction, or significant hypotension reported. Among the 21 patients with follow-up data, 12 were treated with the full combination of guideline-directed therapy, including ARNi and SGLT2i. NYHA class improved in 62.0% of patients (P=0.001), and the median NT-proBNP level decreased from 870 (range, 593-1,774) to 373 (range, 189-743) ng/L (P=0.001). However, no significant change in ventricular function was detected by echocardiography.</p><p><strong>Conclusions: </strong>Our preliminary findings suggest that in ACHD patients with a sRV the new guideline-directed heart failure pharmacotherapy regimen is well tolerated and leads to improvements in NYHA class and reductions in NT-proBNP levels. Further randomized studies are needed to confirm these promising results and to explore the effects of SGLT2i, either alone or in combination, in this patient population.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"336-349"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092913","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":"Development and validation of a prognostic model for early mortality risk in patients with fulminant myocarditis.","authors":"Jingjing Zhang, Chuanyu Gao, Jing Zhang, Famin Ye, Suping Guo","doi":"10.21037/cdt-2024-583","DOIUrl":"10.21037/cdt-2024-583","url":null,"abstract":"<p><strong>Background: </strong>Fulminant myocarditis (FM) is a severe, rapidly progressing disease with high mortality, and early identification of high-risk patients is crucial for improving outcomes. This study aims to identify factors associated with early mortality in FM and develop a risk prediction model for the early identification of high-risk patients.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using clinical data from 119 patients with FM who were hospitalized at Central China Fuwai Hospital between 2018 and 2023. The patients were divided into a training set (n=83) and a validation set (n=36). Predictive factors were identified through univariate analysis and least absolute shrinkage and selection operator (LASSO) Cox regression, followed by multivariate Cox regression. A nomogram was constructed, and its accuracy was validated using bootstrap and calibration curves. The discriminative ability and clinical utility of the model were assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).</p><p><strong>Results: </strong>Multivariate analysis identified respiratory symptoms, cardiopulmonary resuscitation (CPR), serum creatinine, direct bilirubin, thyroid-stimulating hormone (TSH), lactate, and left ventricular ejection fraction (LVEF) as independent predictors of early mortality. The area under the curve (AUC) for the training set was 0.907 and 0.880 on days 14 and 28, respectively, while the validation set achieved AUCs of 0.853 and 0.942 for the same time points. The overall concordance index (C-index) was 0.889 for the training set and 0.809 for the validation set. Kaplan-Meier analysis demonstrated lower mortality rates in the low-risk group. DCA demonstrated that the model provides a clinical net benefit across a range of probability thresholds, indicating its potential value in clinical decision-making.</p><p><strong>Conclusions: </strong>A predictive model has been developed and validated to identify patients who are at high-risk with FM, based on seven key predictive factors.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"318-335"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092850","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}