Cardiovascular diagnosis and therapy最新文献

{"title":"Influencing factors of hypotension during plasma exchange in patients with neuroimmunological diseases: a retrospective cohort study.","authors":"Sulian Gu, Dandan Wei, Ling Yu","doi":"10.21037/cdt-24-456","DOIUrl":"10.21037/cdt-24-456","url":null,"abstract":"<p><strong>Background: </strong>Hypotension frequently occurs in patients who are undergoing plasma exchange procedures. However, the prevalence, clinical manifestations, and determinants of hypotension during plasma exchange in patients with neuroimmunological disorders have not been fully elucidated. The aim of this retrospective cohort study was to evaluate the current status and influencing factors of hypotension during plasma exchange in patients with neuroimmunological diseases, to provide insights for clinical care.</p><p><strong>Methods: </strong>This study encompasses patients diagnosed with neuroimmunological disorders who received plasma exchange treatment at a tertiary hospital in Nanjing, China, over a period from February 1, 2023, to April 30, 2024. The demographic characteristics and clinical profiles of these patients were subjected to a comprehensive analysis. To ascertain the factors influencing the development of hypotension during plasma exchange, a logistic regression analysis was performed.</p><p><strong>Results: </strong>A total of 206 patients with neuroimmunological diseases were included, the incidence of hypotension during plasma exchange in patients with neuroimmunological diseases was 33.01% (68/206). There were statistical differences in the age, use of sedative drugs during plasma exchange, pre-plasma exchange systolic blood pressure and serum calcium between hypotension and control group. Logistic regression analysis indicated that age [odds ratio (OR) =2.851, 95% confidence interval (CI): 1.978-3.194], use of sedative drugs during plasma exchange (OR =3.175, 95% CI: 2.363-4.425), pre-plasma exchange systolic blood pressure (OR =0.857, 95% CI: 0.410-0.932), and serum calcium (OR =0.791, 95% CI: 0.340-0.895) were the influencing factors of hypotension during plasma exchange in patients with neuroimmune diseases.</p><p><strong>Conclusions: </strong>The incidence of hypotension during plasma exchange in patients with neuroimmune diseases is relatively high. Health care providers should actively take measures against factors associated with hypotension to reduce its occurrence during plasma exchange.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"414-422"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092867","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":"Beta-blockers in post-myocardial infarction with preserved ejection fraction: systematic review and meta-analysis.","authors":"Rafael Alessandro Ferreira Gomes, Ludmila Cristina Camilo Furtado, Marcela Vasconcelos Montenegro, Dário Celestino Sobral Filho","doi":"10.21037/cdt-24-368","DOIUrl":"10.21037/cdt-24-368","url":null,"abstract":"<p><strong>Background: </strong>Myocardial infarction (MI) remains one of the main causes of mortality worldwide. Beta-blockers (BBs) are an essential component in the pharmacological treatment for MI. The long-term role of BB in patients with preserved left ventricular ejection fraction (LVEF) is not yet well established. Thus, we performed a systematic review and meta-analysis to synthesize the impact of long-term use of BB on reducing mortality in patients with preserved LVEF after MI.</p><p><strong>Methods: </strong>This study adhered to the guidelines outlined by the Cochrane Collaboration and the PRISMA statement. The predefined research protocol was registered in PROSPERO under the ID CRD42024554630. A systematic search was conducted in Embase, the Cochrane Central Register of Controlled Trials, and PubMed for studies published in English up to September 1, 2024, using the succeeding medical subject terms: 'myocardial infarction', 'preserved ejection fraction', and 'beta-blockers'. Data were extracted for: (I) death from any cause; (II) death from cardiovascular causes; (III) MI; (IV) stroke; and (V) hospitalization for heart failure (HF). The risk of bias of each article was analyzed using the tool risk of bias in non-randomized studies of interventions (ROBINS-I) and risk-of-bias tool for randomized trials (RoB2). These outcomes were compared using pooled hazard ratios (HRs) to maintain the integrity of time-to-event data from individual studies.</p><p><strong>Results: </strong>A total of 85,607 patients from 11 studies were included in this meta-analysis, of whom 65,790 (76.8%) were using BBs after MI with preserved ejection fraction. The use of BBs demonstrated a significant reduction in all-cause mortality in the global analysis of the included studies [HR =0.81; 95% confidence interval (CI): 0.67-0.98; P=0.03]. However, when performing sensitivity analyses to assess the impact of methodological biases and the robustness of the results, this reduction was no longer significant (HR =0.79; 95% CI: 0.62-1.02; P=0.07). Regarding reinfarction, there was no difference between BB users and non-users (HR =1.00; 95% CI: 0.92-1.09; P>0.99). Similarly, hospitalization for HF showed no significant variation between groups (HR =1.05; 95% CI: 0.89-1.24; P=0.55). Stroke incidence was also comparable between the groups, though with substantial heterogeneity (I²=60%). Heterogeneity was otherwise low for the outcomes of reinfarction, and hospitalization for HF (I²<25%). Subgroup analyses revealed no differences in outcomes when stratified by age, sex, hypertension, or diabetes.</p><p><strong>Conclusions: </strong>Long-term BB use in patients with preserved LVEF after MI did not decrease all-cause mortality, cardiovascular mortality, or major adverse cardiac events (MACEs). There was also no identified reduction in hospitalizations for HF, MI, or stroke in the average follow-up of 3 years.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"398-413"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092831","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":"Investigating the causal relationship between genetically determined metabolites and ischemic stroke functional outcomes: a Mendelian randomization study.","authors":"Xiaobei Zhang, Gehong Liang, Ying Zheng, Xiaokun Wang, Weihao Luo, Guiyue Wang, Yiqing Yin","doi":"10.21037/cdt-24-369","DOIUrl":"10.21037/cdt-24-369","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ischemic stroke functional outcomes are critical determinants of recovery quality; however, our understanding of the underlying metabolic influences remains incomplete. Mendelian randomization (MR) is ideal for inferring causal links between metabolites and ischemic stroke outcomes by using genetic variants to reduce confounding and reverse causality. This study explored the causal relationships between genetically determined metabolites and functional recovery after stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this study, we employed a two-sample MR framework to investigate the influence of plasma metabolites on ischemic stroke functional outcomes. We analyzed outcome data derived from a comprehensive genome-wide association study (GWAS) that included 6,165 stroke patients. The baseline group data were adjusted for ancestry, age, sex, and ischemic stroke severity using the National Institutes of Health Stroke Scale (NIHSS). The primary outcome was 3-month dependence or death defined as a modified Rankin Scale (mRS) of 3-6. The exposures consisted of a comprehensive set of 1,400 metabolites and instrumental variables (IVs) that exhibited strong genetic associations with minimal indications of pleiotropic effects were selected. IVs are selected based on genomic significance level P&lt;1×10&lt;sup&gt;-6&lt;/sup&gt;. These IVs were then correlated with the patient data in the adjusted group to conduct MR analyses using the inverse-variance weighted (IVW), MR-Egger regression, weighted-median, weighted-mode, and simple-mode methods. To ensure the reliability of our findings, the MR analysis was repeated in the baseline group to confirm the consistence of the identified causality. Moreover, various sensitivity analyses were conducted, such as tests for horizontal pleiotropy, heterogeneity, and leave-one-out analyses, to further confirm the robustness of our results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Using the IVW method, our study identified 59 metabolites with potentially causal relationships to ischemic stroke functional outcomes. Notably, the positive causal link between X-17146 and ischemic stroke functional outcomes, which had an odds ratio (OR) of 0.48 [95% confidence interval (CI): 0.35-0.68, P&lt;0.001], remained significant even after applying false discovery rate (FDR) corrections (P&lt;sub&gt;FDR&lt;/sub&gt;=0.02). And only X-17146 remained significant after FDR. Eight metabolites or ratios demonstrated a causal relationship with post-stroke functional outcomes in both the adjusted and baseline groups. Sensitivity tests showed a lack of heterogeneity and pleiotropy in all positive results of the above main analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings suggest that specific metabolites have a causative impact on the functional recovery process ischemic stroke, and provide a foundation for further research into personalized treatment strategies that address these metabolic pathways. Future studies should aim to validate these resul","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"362-374"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092933","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":"Effectiveness of intravenous administration of a combination of sufentanil and esketamine on post-cardiac surgery pain management and depression: a randomized controlled trial.","authors":"Sen Xu, Tianyu Liang, Weicai Xu","doi":"10.21037/cdt-24-312","DOIUrl":"10.21037/cdt-24-312","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiac surgery often results in significant postoperative pain, which can lead to complications and prolonged recovery. Pain and depression are closely linked, with effective pain management potentially reducing the risk of depression. Combining sufentanil, an opioid, with esketamine, a medication with both analgesic and antidepressant effects, may improve pain control and mood in postoperative patients. While promising in other surgeries, their effects in cardiac surgery remain unclear. This study explores how sufentanil and esketamine work together to manage pain and reduce depression after cardiac surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A randomized controlled clinical trial was conducted from January 2021 to December 2023, involving 104 patients who underwent cardiac surgery. Patients [aged 61-64 years, body mass index (BMI) &lt;30 kg/m&lt;sup&gt;2&lt;/sup&gt;, American Society of Anesthesiologists (ASA) I-II, the snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and male gender (STOP-Bang) score &lt;3] were randomly assigned to a control group (n=52) receiving 2.5 µg/kg sufentanil or an experimental group (n=52) receiving 2.0 µg/kg sufentanil with 2 mg/kg esketamine via a central venous catheter for 48 h postoperatively. Exclusion criteria included allergies to fentanyl or etomidate, central nervous system diseases, recent opioid use, liver/kidney failure, or severe respiratory conditions. Outcome measures included patient-controlled intravenous analgesia (PCIA) pump usage, pain scores, clinical indicators, depressive symptoms, adverse events, and satisfaction levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The experimental group had significantly fewer PCIA pump button presses (2.41±0.72) than the control group (6.20±1.31) (P&lt;0.001). Visual analog pain scores were lower in the experimental group at multiple postoperative time points (P&lt;0.05). Hamilton Depression Rating Scale (HAMD) scores were significantly lower in the experimental group (7.52±4.24) compared to the control group (13.84±2.76) (P&lt;0.05), as were Hamilton Anxiety Rating Scale (HAMA) scores (8.84±2.13 &lt;i&gt;vs.&lt;/i&gt; 12.64±3.25, P&lt;0.05). Heart rate and mean arterial pressure were higher at postoperative time points T2, T3, and T4 in the experimental group (P&lt;0.05), but no difference was observed at T1 (P&gt;0.05) (T1 =4 h, T2 =8 h, T3 =24 h, T4 =48 h post-surgery). Oxygen saturation showed no significant difference between groups (P&gt;0.05). Adverse reactions occurred in 13.46% of the experimental group and 19.23% of the control group, with no statistically significant difference (P&gt;0.05). Patient and surgeon satisfaction scores were uniformly high on a five-point scale (both groups had median =5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The combined administration of sufentanil and esketamine effectively managed pain and significantly reduced depressive symptoms in post-cardiac surgery patients. The experimental group demonstrated red","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"291-301"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092888","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":"Aneurysm of the fetal right ventricular free wall progressing to hypoplastic right heart syndrome: prenatal diagnosis, maternal digoxin therapy, and successful surgical intervention-a case report.","authors":"Krzysztof Serafin, Agnieszka A Nocun, Jacek Kolcz, Agata P Bochenska, Emilia Gasiorowska, Marcin T Wiechec","doi":"10.21037/cdt-24-477","DOIUrl":"10.21037/cdt-24-477","url":null,"abstract":"<p><strong>Background: </strong>Congenital right ventricular aneurysm (CVA) and diverticulum (CVD) are rare heart diseases that can be diagnosed prenatally. Data on the natural progression of ventricular aneurysms or diverticula identified during fetal life remains scarce, with insights primarily derived from a limited number of case reports and case series. This case report aims to highlight the diagnosis, management, and outcomes of a rare right ventricular free wall aneurysm progressing to hypoplastic right heart syndrome (HRHS), utilizing advanced fetal imaging and prenatal therapy. These findings provide valuable perspective on the underlying cause, diagnostic approaches, and treatment strategy for rare cardiac anomaly.</p><p><strong>Case description: </strong>The aneurysm of the right ventricular free wall was diagnosed 13 weeks of gestation during prenatal ultrasound of the fetus in the first trimester. At the time of diagnosis, severe tricuspid valve stenosis with severe tricuspid regurgitation, critical pulmonary stenosis, pericardial effusion, ascites, and secondary flow reversal in the ductus venosus was found. Genetic testing using microarray-based comparative genomic hybridization (aCGH) on amniotic fluid samples showed no genomic imbalance. Digoxin treatment was initiated at 13 weeks of gestation, starting with a loading dose of 1,200 micrograms, followed by a maintenance dose of 375 micrograms daily, to address signs of fetal heart failure. The <i>fetal</i>HQ^® software was utilized to assess the size and contractility of both the right and left ventricles, focusing on global and segmental strain measurements. The gradual reduction in right ventricular cardiac output led to the progression of HRHS with pulmonary atresia. At 39 weeks of gestation, a female newborn weighing 2,480 g was delivered in good condition, with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Prostaglandin E1 treatment was initiated postnatally to maintain ductal patency. Postnatal echocardiography and angio-computed tomography (CT) confirmed the prenatal diagnosis, revealing a right ventricle-to-right coronary artery (RCA) fistula and interruption of RCA perfusion continuity. The newborn underwent successful first-stage palliation with a Blalock-Taussig shunt to establish systemic-pulmonary circulation. Follow-up during the interstage period showed the child remained in good clinical condition, with no significant complications reported.</p><p><strong>Conclusions: </strong>CVAs are rare but significant anomalies with potential for severe hemodynamic consequences. Multidisciplinary approaches integrating advanced imaging techniques, prenatal counseling, and tailored postnatal management are essential for optimizing outcomes.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 2","pages":"509-521"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092523","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":"Association between the ratio of high-density lipoprotein cholesterol to apolipoprotein A-I and in-stent neoatherosclerosis: an optical coherence tomography study.","authors":"Ning Gu, Yu Zeng, Xianping Long, Zhijiang Liu, Zhenglong Wang, Wei Zhang, Du Yang, Jingsong Yuan, Lei Chen, Ranzun Zhao, Bei Shi","doi":"10.21037/cdt-24-328","DOIUrl":"10.21037/cdt-24-328","url":null,"abstract":"<p><strong>Background: </strong>In-stent neoatherosclerosis (ISNA) is an important cause of in-stent restenosis (ISR) with drug-eluting stent (DES) implants. High-density lipoprotein cholesterol (HDL-C) is associated with ISNA. However, few studies have focused on the functionalities of HDL-C composition, and till date, optical coherence tomography (OCT) has not been used to analyze the relationship between ISNA incidence and HDL-C-to-apolipoprotein A-I ratio (HAR) in patients with DES implants and ISR (DES-ISR). This study aimed to clarify the association between HAR and ISNA.</p><p><strong>Methods: </strong>This single-center, retrospective study included patients admitted to the Affiliated Hospital of Zunyi Medical University. A total of 216 patients with 220 ISR lesions who underwent OCT for the culprit stent were included between July 2018 and November 2022. Based on HAR at admission, 33rd and 66th percentiles were identified as the cut-off points, and all eligible patients were divided into three groups: Tertile 1 (HAR ≤0.836; n=71), Tertile 2 (0.836< HAR <0.932; n=73), and Tertile 3 (HAR ≥0.932; n=72). Baseline characteristics and angiographic and OCT features were compared between the different groups. In addition, univariate and multivariate logistic regression models were used to assess the association of HAR with ISNA and in-stent thin-cap fibroatheroma (TCFA).</p><p><strong>Results: </strong>Angiographic characteristics and quantitative OCT assessment values did not differ significantly among the groups. The incidences of ISNA (62.0% <i>vs.</i> 52.1% <i>vs.</i> 37.5%, P=0.01) and in-stent TCFA (35.2% <i>vs.</i> 27.4% <i>vs.</i> 15.3%, P=0.02) were significantly lower in the third tertile of the HAR group than in the first or second tertiles. The multifactor logistic regression model revealed that the highest tertile group had a reduced risk of ISNA [hazard ratio (HR) =0.185, 95% confidence interval (CI): 0.081-0.421; P<0.001] and TCFA (HR =0.197, 95% CI: 0.075-0.517; P<0.001) compared with the lowest tertile group.</p><p><strong>Conclusions: </strong>OCT revealed high HAR levels to be negatively correlated with the incidences of ISNA and TCFA in patients with ISR. HAR is a better indicator of ISNA and plaque fragility than HDL-C itself, thus providing a marker and pathway for better prevention of ISNA.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"116-127"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668982","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":"Risk of malignancy in adult patients with congenital heart disease: a clinical practice review.","authors":"Fumie Takechi, Yasutaka Kawasoe, Shigeru Tateno, Ryota Ebata, Hiromichi Hamada, Koichiro Niwa","doi":"10.21037/cdt-24-388","DOIUrl":"10.21037/cdt-24-388","url":null,"abstract":"<p><p>This paper presents case studies of adult patients with congenital heart disease (CHD) who developed cancer and also discusses relevant epidemiological studies, risk factors, and reports on early detection. Herein, we describe three cases: a 63-year-old man with an atrial septal defect and multiple myeloma; a 48-year-old man with tetralogy of Fallot and colorectal cancer; and a 25-year-old man with Fontan circulation and hepatocellular carcinoma (HCC). Previous studies have found that the incidence of cancer in adult patients with CHD is higher than that in the general population. The management of adult patients with CHD complicated by cancer requires careful attention because cancer treatment alone can affect the survival prognosis and quality of life, as well as the pathophysiology and treatment of underlying heart disease. Apart from known risk factors in the non-CHD population, specific risk factors have been reported, such as genetic abnormalities, low-dose ionizing radiation exposure, early thymectomy, Fontan-associated liver disease, and hypoxia. Encouraging patients to participate in cancer screening and avoid known risk factors is essential in daily practice for the early diagnosis and prevention of cancer. It is also important to be vigilant for initial signs that are indicative of cancer as well as avoidable risk factors.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"195-206"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669094","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":"One-year patency rates of saphenous vein grafts harvested using the no-touch technique in off-pump coronary artery bypass grafting.","authors":"Ji-Qiang Bu, Jian-Jun Gu, Teng-Yue Zhao, Yu Liu, Guo-Li Zhang, Zi-Ying Chen","doi":"10.21037/cdt-24-295","DOIUrl":"10.21037/cdt-24-295","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) is an effective and durable treatment for coronary artery atherosclerotic heart disease. However, stenosis or occlusion of vein grafts frequently occurs after CABG, posing a significant challenge in postoperative management. This study aims to evaluate the clinical efficacy of saphenous vein graft (SVG) harvesting using the no-touch technique during off-pump CABG (OPCABG).</p><p><strong>Methods: </strong>In this prospective study, a comparative analysis of 1-year postoperative graft patency rates between left internal mammary artery (LIMA) grafts and SVGs harvested using the no-touch technique was conducted. The recruiting and data collection period was between June 2018 and December 2020. The study included 140 patients who underwent OPCABG at the Heart Center of The Second Hospital of Hebei Medical University. The primary outcomes assessed were the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs), which encompassed all-cause mortality, sudden cardiac death, acute myocardial infarction, recurrent angina, coronary revascularization, cerebral infarction, and cerebral hemorrhage, as well as the 1-year graft patency rate.</p><p><strong>Results: </strong>No MACCEs occurred during the perioperative period, and all patients survived to discharge. During follow-up, two patients died, and 10 were lost to follow-up. Of the 128 patients who underwent coronary computed tomography angiography at the 1-year follow-up, there were no statistically significant differences in patency rates between SVGs and LIMA grafts (94.5% <i>vs.</i> 97.7%, P=0.15). Similarly, for end-to-side anastomosis, SVG and LIMA graft patency rates were comparable (93.9% <i>vs.</i> 97.7%, P=0.11). Among these patients, three cases (2.3%) of recurrent angina were reported, predominantly in those with occluded LIMA grafts, while one case of dyspnea was observed in a patient with an occluded SVG.</p><p><strong>Conclusions: </strong>The 1-year patency rate of SVGs harvested using the no-touch technique was similar to that of LIMA grafts. Further research is warranted to explore the long-term effects of the no-touch technique on SVG patency.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"50-60"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669087","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":"Advances in Chinese herbal medicine in modulating mitochondria to treat myocardial ischemia-reperfusion injury: a narrative review.","authors":"Yushi Tian, Xiaoyang Hu, Tingyu Zhang, Bojia Li, Qiang Fu, Ji Li","doi":"10.21037/cdt-24-346","DOIUrl":"10.21037/cdt-24-346","url":null,"abstract":"<p><strong>Background and objective: </strong>The urgent need to identify pathways that can mitigate myocardial ischemia-reperfusion injury (MIRI) has become a central focus in cardiovascular treatment. Chinese herbal medicine (CHM), renowned for its multi-component, multi-channel, and multi-target therapeutic properties, holds significant promise in the management of MIRI. Mitochondria, as pivotal players in MIRI, have been shown to be effectively modulated by CHM through various mechanisms. The objective of this narrative review is to underscore the critical role of mitochondria in MIRI and to provide an up-to-date overview of the latest research advancements in utilizing CHM to treat MIRI by targeting mitochondrial morphology and function.</p><p><strong>Methods: </strong>The PubMed and the China National Knowledge Infrastructure (CNKI) databases were searched using keywords related to MIRI. Relevant English-language articles published from January 2019 to July 2024 were included in this narrative review.</p><p><strong>Key content and findings: </strong>Mitochondria are intimately linked to MIRI. The mechanisms involve the regulation of mitochondrial biogenesis and energy metabolism, the functionality of the mitochondrial respiratory chain, resistance to oxidative stress-induced damage, the maintenance of mitochondrial homeostasis, the modulation of calcium ion homeostasis, the preservation of mitochondrial membrane potential, the opening of adenosine triphosphate (ATP)-sensitive potassium channels, and the effective control over the opening of the mitochondrial permeability transition pore, all of which contribute to the balance between autophagy and apoptosis in cardiomyocytes. Various effective monomers of CHM, extracts of CHM, compounds, and proprietary Chinese medicine have demonstrated promising therapeutic potential in basic research, among them, tonic and blood-activating CHMs account for the largest proportion.</p><p><strong>Conclusions: </strong>The prospect of CHM targeting mitochondria for the treatment of MIRI is promising, yet it necessitates overcoming challenges such as low bioavailability and inadequate mechanistic research. By integrating traditional Chinese medicine theories with modern scientific technologies, it is imperative to delve deeper into and optimize the pharmacodynamics, pharmacokinetics, and clinical applications of these herbs.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"207-232"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668979","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":"Association between lipoprotein(a) and atherosclerosis with different diabetic status: a cross-sectional study in a Chinese population.","authors":"Guoli Yang, Yue Luo, Kanghua Ma, Bao Yang, Ping Tang, Min Zhang, Qian Dong, Min Mao","doi":"10.21037/cdt-24-410","DOIUrl":"10.21037/cdt-24-410","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) [Lp(a)] levels and diabetic status have been recognized as risk factors for atherosclerosis. However, no studies on atherosclerosis have integrated these two indicators. This study aimed to evaluate the relationship between Lp(a) levels, diabetic status, and their combined effects on subclinical atherosclerosis.</p><p><strong>Methods: </strong>This cross-sectional study included patients presenting with a first episode of chest pain at the First Affiliated Hospital of Chongqing Medical University from June 2018 to February 2022. All participants underwent coronary computed tomography angiography (CCTA) and carotid ultrasound to evaluate subclinical atherosclerosis. Logistic regression analysis was used to examine the associations of Lp(a) levels and diabetic status-both individually and in combination-with coronary artery calcium (CAC) and carotid arteriopathy.</p><p><strong>Results: </strong>Among 912 patients, 473 (51.9%) had CAC and 637 (69.8%) had carotid arteriopathy. After adjusting the confounding variables, elevated Lp(a) levels associated with CAC [odds ratio (OR) 1.51, 95% confidence interval (CI): 1.02-2.24, P=0.040] and carotid arteriopathy (OR 1.77, 95% CI: 1.10-2.86, P=0.02) were statistically significant. After combining diabetic status, almost all Lp(a) levels were significantly associated with CAC and CAC score categories (CAC scores: 0.1-99.9, 100-399.9, ≥400) in the diabetes mellitus (DM) group. In this group, the highest risk for CAC and the most severe CAC score categories were observed in patients with Lp(a) levels of >300 mg/L. Among patients with DM, in the lower Lp(a) level group, the prevalence and severity of CAC were more pronounced than those in the medium Lp(a) level group. Additionally, in patients with DM only, elevated Lp(a) levels were associated with carotid arteriopathy (OR 3.38, 95% CI: 1.24-9.20; P=0.02), increased carotid intima-media thickness (cIMT; OR 3.67, 95% CI: 1.10-12.30; P=0.04), and stable/vulnerable carotid plaque (OR 3.39, 95% CI: 1.09-10.55; P=0.04; OR 3.21, 95% CI: 1.07-9.65; P=0.04). However, there were no significant differences between prediabetes and CAC or carotid arteriopathy.</p><p><strong>Conclusions: </strong>In patients with chest pain and DM without cardiovascular disease (CVD), Lp(a) level was significantly associated with subclinical atherosclerosis and had a synergistic effect with DM. Notably, lower Lp(a) levels in patients with DM may lead to an additional subclinical atherosclerosis risk, whereas prediabetes does not show the same association. Therefore, these findings highlight the importance of formulating early preventive strategies for subclinical atherosclerosis based on Lp(a) levels and diabetic status.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"100-115"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668981","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}