Cardiovascular diagnosis and therapy最新文献

{"title":"Exploring the causal association between congenital heart disease and stroke based on two-sample Mendelian randomization.","authors":"Xiaoyong Jing, Yitian Cao, Qiang Wang","doi":"10.21037/cdt-24-422","DOIUrl":"10.21037/cdt-24-422","url":null,"abstract":"<p><strong>Background: </strong>Research into common pathological mechanisms and genetic factors is essential for better understanding, prevention and management of cardiovascular disease in congenital heart disease (CHD) survivors. This study aims to explore the possible causal associations between CHD and acquired cardiovascular diseases with the help of genetic instruments.</p><p><strong>Methods: </strong>This study utilized summary data from genome-wide association studies (GWASs) of CHD (including congenital anomalies of great vessels and heart septal defect) and seven different cardiovascular diseases, employing a two-sample Mendelian randomization (MR) design. Analysis was conducted using the inverse variance weighted method (IVW), weighted median, weighted mode, and MR-Egger regression methods. Sensitivity analysis included MR-Egger, MR-PRESO, Cochran's Q, and leave-one-out.</p><p><strong>Results: </strong>In this study, 15 instrumental variables related to CHD were selected [F-statistic =23.55 (21.27, 28.84)]. The IVW MR analysis revealed potential association between genetically predicted congenital anomalies of great vessels and higher risk of atrial fibrillation [odds ratio (OR) =1.07, 95% confidence interval (CI): 1.02-1.12, P=0.004], unspecified stroke (OR =1.07, 95% CI: 1.02-1.12, P=0.008) and ischemic stroke (OR =1.07, 95% CI: 1.01-1.14, P=0.02). No significant associations were observed between other factors. The MR-Egger regression results indicated that these analyses were not affected by horizontal pleiotropy. Leave-one-out analysis showed that the causal effects were not driven by any single mutation.</p><p><strong>Conclusions: </strong>This study found a potential causal association between exposure to congenital anomalies of great vessels and higher risk of atrial fibrillation, stroke and ischemic stroke. Discussed genetic factors might potentially help to identify a higher risk of stroke and other cardiovascular diseases.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"61-77"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669083","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":"Digging through eosinophils to identify cases of myocardial involvement-an effort well spent.","authors":"Massimo Mapelli, Benedetta Volpi, Piergiuseppe Agostoni","doi":"10.21037/cdt-24-514","DOIUrl":"10.21037/cdt-24-514","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"1-4"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669079","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 clinical research on the value of high-sensitivity cardiac troponin levels in prognostic evaluation after coronary artery bypass graft surgery: a narrative review.","authors":"Fan Zhou, Junsheng Mu","doi":"10.21037/cdt-24-461","DOIUrl":"10.21037/cdt-24-461","url":null,"abstract":"<p><strong>Background and objective: </strong>Coronary artery bypass grafting (CABG) is an effective treatment for coronary artery disease, high risk of complications, making it particularly important to assess patient prognosis. High-sensitivity cardiac troponin (hs-cTn), as a key biomarker of myocardial injury, plays an important role in evaluating the prognosis of patients after CABG. However, the optimal threshold values for hs-cTn in the current guidelines are all artificially set, lacking a unified standard. This narrative review aims to fill the knowledge gap and provide new directions for future research. This is of significant importance for optimizing the management of patients after CABG, improving prognosis, and for developing more precise and personalized treatment strategies.</p><p><strong>Methods: </strong>We conducted a structured search on PubMed, Web of Science MEDLINE and Cochrane Library using terms like \"High-Sensitivity Cardiac Troponin\", \"Coronary Artery Bypass Grafting\", \"Prognosis\", \"Mortality\", and \"Postoperative Outcomes\" to identify English-language studies from inception to 25 July 2024. This article systematically reviews recent studies on hs-cTn levels and prognostic risk factors after CABG, aiming to comprehensively sort out and analyze existing research findings.</p><p><strong>Key content and findings: </strong>Studies show that the release of hs-cTnT and hs-cTnI is related to postoperative myocardial injury/infarction and short-term mortality, but there is still controversy in the conclusions regarding long-term mortality. In addition, different studies have drawn different conclusions about the application of hs-cTnI in postoperative myocardial infarction, restenosis, and hypoxemia, as well as its association with mortality. However, a common view is that the hs-cTn cutoff values used in current clinical practice are too conservative, which may limit the accuracy of its prognosis assessment.</p><p><strong>Conclusions: </strong>Hs-cTn has significant value in the prognosis assessment of patients after CABG, but its clinical decision level often exceeds the critical values specified in the guidelines. In the future, more rigorous prospective multicenter trials need to be conducted in different populations to further determine the optimal diagnostic thresholds for hs-cTn, thereby improving the accuracy of prognosis assessment in patients after CABG.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"251-258"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669091","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":"Calcium and vitamin D supplementation impact on survival in patients with moderate concomitant aortic and mitral valve disease.","authors":"Andrew Gaballa, Adel Hajj Ali, Joseph El Dahdah, Zoran Popovic, Tom K Wang, Grant Reed, Leonardo Rodriguez, Brian Griffin, A Marc Gillinov, Samir R Kapadia, Lars G Svensson, Milind Y Desai","doi":"10.21037/cdt-24-324","DOIUrl":"10.21037/cdt-24-324","url":null,"abstract":"<p><p>Calcium supplement intake, with or without vitamin D supplementation, has risen amongst the older population, who are more likely to have deficiencies. Our aim was to investigate how the supplementation of calcium and vitamin D is associated with survival in patients with moderate concomitant aortic and mitral valve disease. A total of 3,257 patients (mean age of 71.73 years; 55.2% male; 83.1% White) were diagnosed with moderate concomitant aortic and mitral valve disease at Cleveland Clinic between January 2010 and December 2020 and were included in this study. The patients were divided into two groups based on their supplement intake. Further subgroup analysis was performed, focusing on the aortic valve, leading to the stratification of patients into two subgroups-group 1: aortic stenosis (AS) combined with either mitral stenosis or regurgitation, and group 2: aortic regurgitation (AR) combined with either mitral stenosis or regurgitation. The study's primary outcome was the combined event of all-cause mortality and heart failure hospitalization. Of the 3,257 patients who were included, 70% of them (2,273 patients) did not receive supplements, and 30% (984 patients) had received calcium and vitamin D supplementation. The supplement intake was associated with a greater risk of all-cause mortality [hazard ratio (HR), 1.114; 95% confidence interval (CI): 1.003-1.237, P=0.043], but no significant association with heart failure hospitalization was observed (HR, 1.003; 95% CI: 0.884-1.139, P=0.96). The subgroup analysis based on the aortic valve showed that among the 1,045 patients in group 1, 67% did not receive supplements, and 33% received supplementation. Calcium and vitamin D supplementation was significantly associated with a greater risk of all-cause mortality in patients with AS (HR, 1.203; 95% CI: 1.017-1.425, P=0.03). Contrarywise, in group 2 of patients with AR consisting of 2,212 patients, 71% did not receive any supplementation, and 29% received supplementation, with no significant association observed (HR, 1.044; 95% CI: 0.913-1.193, P=0.53). To conclude, in patients diagnosed with moderate concomitant aortic and mitral valve disease, the use of calcium and vitamin D supplements was associated with a greater mortality rate, particularly in AS patients.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"265-272"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668985","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":"Can machine learning predict successful chronic total occlusion crossing with primary antegrade wiring?","authors":"Takao Konishi, Teruo Sekimoto, Rika Kawakami, Diljon Chahal, Renu Virmani, Aloke V Finn","doi":"10.21037/cdt-24-509","DOIUrl":"10.21037/cdt-24-509","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"20-24"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac structural and functional damage induced and/or increasingly aggravated by aortic valve stenosis.","authors":"Michael Dandel","doi":"10.21037/cdt-24-380","DOIUrl":"10.21037/cdt-24-380","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"32-36"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669066","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 Cleveland Clinic experience of eosinophilic myocarditis in the setting of hypereosinophilic syndrome: demographics, cardiac imaging, and outcomes.","authors":"Matthew Reeder, Yuichiro Okushi, Saberio Lo Presti Vega, Rohan Prasad, Richard A Grimm, Brian P Griffin, Bo Xu","doi":"10.21037/cdt-24-347","DOIUrl":"10.21037/cdt-24-347","url":null,"abstract":"<p><strong>Background: </strong>Hypereosinophilic syndrome (HES) represents a group of disorders with eosinophil-mediated end-organ damage. Eosinophilic myocarditis (EM) represents cardiac involvement in HES. Data are limited regarding this rare condition. To better understand contemporary clinical characteristics of EM in HES, we reviewed demographics, cardiac imaging, and outcomes of this condition at our center.</p><p><strong>Methods: </strong>We performed a cross-sectional study of all patients aged >18 years with diagnosis of EM in HES at our center between September 1986 and January 2023. Relevant clinical data, including clinical presentation, medical history, medication use, comorbidities, imaging findings, and outcomes, were collected and analyzed.</p><p><strong>Results: </strong>Of 1,664 patients identified with hypereosinophilia (HE), 36 cases of clinically diagnosed HES were identified. Of the 36 patients diagnosed with HES, 11 patients (30.6%) were diagnosed with EM. Of these, six patients underwent endomyocardial biopsy (EMB). The mean age was 57±12 years and 63.6% were female. Asthma was the most common comorbidity (54.5%). Patients with EM had significantly more dyspnea (63.6%), fatigue (54.5%), and neuropathy (36.4%) compared to those without cardiac involvement. Echocardiography was performed in all patients and cardiac magnetic resonance (CMR) imaging was performed in eight patients. Left ventricular (LV) thrombus was detected more frequently by CMR (5/8, 62.5%) compared to echocardiography (3/10, 30%). Subendocardial pattern of late gadolinium enhancement (LGE) was observed in the majority of patients on CMR (6/7, 85.7%). Steroids were utilized in 90.9% of cases, and aspirin in all patients. Compared to HES patients without cardiac involvement, thromboembolic events occurred significantly more frequently (63.6% <i>vs.</i> 24.0%, P=0.02).</p><p><strong>Conclusions: </strong>In a 37-year cohort of HES-associated EM, echocardiography was the first-line imaging modality, while CMR was an essential but still under-utilized imaging modality. Patients with EM had significantly more thromboembolic events compared to HES without cardiac involvement.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1122-1133"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945372","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":"Greater than the sum of its parts: multimodality imaging in adults with congenital heart disease.","authors":"Nicholas Szugye","doi":"10.21037/cdt-24-363","DOIUrl":"10.21037/cdt-24-363","url":null,"abstract":"<p><p>As the population of adults with congenital heart disease (ACHD) grows, there also grows an expanded need for non-invasive surveillance methods to guide management and intervention. A multimodal imaging approach layers complementary insights from echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), and other modalities into a clinician's view of patient physiology. Merely applying strategies from acquired adult cardiac disease would be inadequate and potentially misleading. As data amasses in this small but growing population, investigators in the field of ACHD have discovered population-specific imaging biomarkers that identify deterioration and pivotal time points where intervention may reduce morbidity and mortality. Moreover, due to the variety of physiologies and the modest number of ACHD patients relative to that of adults with acquired heart disease, multicenter registries will be key in advancing research. The integration of well-defined imaging variables into these databases can help identify important biomarkers. Emerging technologies like computational fluid dynamics (CFD) and artificial intelligence (AI) are also primed to enhance imaging capabilities and clinical workflows, though require careful adaption as ACHD patients are not meaningfully represented in the training data for these technologies. Ultimately, a multimodal imaging approach is essential for optimizing care for ACHD patients, enabling personalized medicine where interventions can be performed before clinical deterioration occurs.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1176-1185"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945297","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 clinical diagnostic value of right-to-left shunt in cryptogenic stroke under right heart contrast echocardiography: a retrospective case-control study.","authors":"Changyin Gao, Yanjie Liu, Dong Xu","doi":"10.21037/cdt-24-288","DOIUrl":"10.21037/cdt-24-288","url":null,"abstract":"<p><strong>Background: </strong>About 30% of ischemic strokes do not have a clear cause, which is called cryptogenic stroke (CS). Increasing evidence suggests a potential link between CS and right-to-left shunt (RLS). RLS may lead to CS via paradoxical embolic mechanism. Hence, current study aims to explore the correlation between different RLS indexes and the occurrence of CS and its clinical diagnostic value in CS.</p><p><strong>Methods: </strong>A total of 117 patients diagnosed with CS from October 2020 to June 2024 were randomly collected, and 93 patients with only headache and dizziness were randomly collected as the control group. All patients underwent agitated saline contrast echocardiography (ASCE) and the semi-quantitative classification, type and duration of RLS were analyzed. Spearman correlation analysis was used to analyze the correlation between RLS grade and type and the occurrence of CS, and the correlation between RLS duration and RLS grade and type. The efficacy of different RLS grades, types and durations in the diagnosis of CS were analyzed by receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>The included population ranged in age from 20-73 years, with 90 males and 120 females. There was no significant difference in basic data (e.g., gender, smoking history, drinking history, and the number of people with hypertension and diabetes) and serum biological indicators [triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL)] between the CS group and the control group (all P>0.05). The proportion of RLS (77.78%) in the CS group was significantly higher than that in the control group (35.48%) (P<0.001). Spearman correlation analysis showed that RLS grade (r=0.569) and type (r=0.346) were significantly correlated with the occurrence of CS (both P<0.001). In addition, RLS duration was significantly correlated with RLS type (r=0.902, P<0.001), but not with RLS size (P>0.05). ROC curve analysis showed that RLS grade had the highest area under the curve (AUC) in CS diagnosis, which was 0.807 [95% confidence interval (CI): 0.748-0.866], the diagnostic sensitivity was 68.4%, and the specificity was 87.1%. In addition, the diagnostic AUC of RLS type and RLS duration in CS were similar, at 0.700 (95% CI: 0.626-0.773) and 0.707 (95% CI: 0.634-0.780), respectively.</p><p><strong>Conclusions: </strong>RLS grade and RLS type are significantly correlated with the occurrence of CS. As an auxiliary means of CS diagnosis, RLS grade can effectively reduce the misdiagnosis rate of CS, which is of great clinical significance for early detection of CS risk.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1048-1057"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945373","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":"Aortopathy in repaired tetralogy of Fallot and David procedure.","authors":"Naoko Ichikawa, Yumi Shiina, Kohei Abe, Koichiro Niwa","doi":"10.21037/cdt-24-264","DOIUrl":"10.21037/cdt-24-264","url":null,"abstract":"<p><p>Tetralogy of Fallot (TOF) is a condition that often leads to long-term enlargement of the aortic root in after surgery. The aortic dilation is believed to be caused by histological abnormalities of the aortic media and the hemodynamic characteristics of increased aortic flow, compared to pulmonary flow. Severe cyanosis, severe right ventricular outflow tract (RVOT) obstruction, older age at repair, a larger aortic size at the time of repair, and a history of an aortopulmonary shunt parameters related to long-standing volume overload of the aortic root were the reported risk factors. Right aortic arch, male sex, and the association of chromosome 22q11 deletion were also reported to be risk factors. The enlargement of the aortic root can cause aortic regurgitation (AR), leading to left ventricular dysfunction and an increased risk of aortic dissection, necessitating surgical intervention. The outcomes of aortic valve repair for AR have improved, leading to an increasing trend of choosing this approach, particularly in younger patients who would otherwise require mechanical valve replacement, thereby avoiding the need for anticoagulation therapy. The indications and timing of prophylactic aortic root replacement in adult patients with congenital heart disease have not been described, and the current consensus recommends surgical intervention for an ascending aorta with a diameter of ≥55 mm. In this review article, we focus on valve-sparing root replacement (VSRR) in TOF.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1228-1235"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945149","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}