Cardiovascular diagnosis and therapy最新文献

{"title":"Ultrasound imaging of congestion in heart failure: a narrative review.","authors":"Álvaro Gamarra, Jorge Salamanca, Pablo Díez-Villanueva, Sofia Cuenca, Jorge Vázquez, Río Jorge Aguilar, Guillermo Diego, Ana Pilar Rodríguez, Fernando Alfonso","doi":"10.21037/cdt-24-430","DOIUrl":"10.21037/cdt-24-430","url":null,"abstract":"<p><strong>Background and objective: </strong>Congestion is a key determinant in the evolution of patients with heart failure (HF), leading to higher rates of emergency visits, hospital admissions and even mortality. Both clinical and subclinical congestion have been associated with a worse prognosis, hence the importance of its correct detection, characterization and treatment. Multiparametric assessment with ultrasound imaging, lung ultrasound (LUS) and venous Doppler analysis, has emerged as a very informative and accessible diagnostic tool in HF patients throughout their evolution. This review aims to provide a practical approach for the implementation of these techniques as well as a comprehensive summary of their prognostic and therapeutic applications in specific clinical settings.</p><p><strong>Methods: </strong>Relevant literature from 1997 to 2024 on congestion evaluation and management based on ultrasonographic findings was retrieved through PubMed research. Only English publications were included.</p><p><strong>Key content and findings: </strong>Ultrasound imaging for congestion detection and management is increasingly convening attention in HF scientific literature. Observational and randomized studies exhibit consistent and reproducible results where greater degrees of congestion have been strongly associated with worse clinical short- and long-term outcomes both in acute and chronic HF. On the other hand, ultrasound imaging helps adjusting diuretic therapy with more frequent and robust evidence regarding LUS than venous Doppler analysis.</p><p><strong>Conclusions: </strong>Despite exponential growing evidence supporting the use of ultrasound imaging in HF, LUS and venous Doppler analysis are not yet routine. Forthcoming evidence may help to consolidate these techniques in the management of HF patients.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"233-250"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669105","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":"A heart failure center model helped to promote the standardized management and improve the prognosis of patients.","authors":"Zhenlong Li, Yuxia Wang, Dan Hu, Jianming Huang, Yi Zhang","doi":"10.21037/cdt-24-437","DOIUrl":"10.21037/cdt-24-437","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is the end stage of various heart disease. An increasing number of HF centers have emerged in China, which aimed to facilitate standardized, multidisciplinary, and scientific management for HF patients. The study aimed to observe whether the establishment of HF center has positive effect on standardized management and prognosis of HF patients.</p><p><strong>Methods: </strong>A before and after study was performed by randomly collecting a total of 300 cases of medical records and follow-up data in the HF database of our hospital (Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University). Referring to the certification date (December 2020) of our center, 150 cases were selected into the center group (January 2021-December 2022, after certification) and 150 cases in the control group (January 2019-December 2020, before certification). Statistical comparison between two groups was performed, which focused on indicators of standardized management [proportion of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and echocardiography performed in the diagnosis of HF, application ratio of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), β-blockers in heart failure with reduced ejection fraction (HFrEF) patients, 1 week, 1 month, 3 months and 1 year follow-up rate] and clinical prognosis indicators (NT-proBNP level, 6-minute walking distance test, heart function grading, shorter average duration in hospital) at discharge, review of relevant indicators after 1 year, readmission rate and incidence of main adverse cardiovascular and cerebrovascular events (MACCEs) in 1 year.</p><p><strong>Results: </strong>Compared to the control group, the proportion of patients using NT-proBNP (94.7% <i>vs.</i> 87.3%, P=0.03), echocardiography (88.7% <i>vs.</i> 78.7%, P=0.02), the ratio of patients using ACEI/ARB/ARNI (87.0% <i>vs.</i> 72.2%, P=0.03) and β-blocker (82.7% <i>vs.</i> 66.7%, P=0.03) before discharge, and the follow-up rate of each period after discharge (1 week, 90.7% <i>vs.</i> 80.0%, P=0.01; 1 month, 84.7% <i>vs.</i> 72.0%, P=0.01; 3 months, 76.7% <i>vs.</i> 64.0%, P=0.02; 1 year, 88.0% <i>vs.</i> 79.3%, P=0.04) was higher in the center group. Treated with standardized management, patients in the center group had a lower NT-proBNP level (1,760±934 <i>vs.</i> 2,279±1,085 pg/mL, P<0.001), a further 6-minute walking test distance (364±117 <i>vs.</i> 330±135 m, P=0.02), better cardiac function classification (2.1±0.6 <i>vs.</i> 2.3±0.7, P=0.01) and shorter average duration (7.3±2.5 <i>vs.</i> 8.9±2.1 days, P<0.001) in hospital at discharge. 1 year later, the corresponding indicators are still better than the control group, and the readmission rate (8.7% <i>vs.</i> 16.0%, P=0.02) and incidence of MACCE (4.7% <i>vs.</i> 11.3%, P=0.03) were lower.</p><p><strong>Conclusions: </strong>The HF center model can s","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"128-136"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669019","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":"Intraprocedural mitral regurgitation and gradient: key determinants of transcatheter edge-to-edge repair outcomes for primary mitral regurgitation.","authors":"Takashi Nagasaka, Mamoo Nakamura","doi":"10.21037/cdt-24-491","DOIUrl":"10.21037/cdt-24-491","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"28-31"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669085","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":"More testing, more findings: the evolving story of coronary vascular dysfunction.","authors":"Jingwen Huang, Nathaniel R Smilowitz, Arshed A Quyyumi, Puja K Mehta","doi":"10.21037/cdt-24-549","DOIUrl":"10.21037/cdt-24-549","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"11-14"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669086","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":"Hemodynamic interplay of ventricular, atrial and aortic function in patients after arterial switch operation: insights from cardiac MRI.","authors":"Anne R Schöber, Michael Jerosch-Herold, Philip Wegner, Dominik D Gabbert, Inga Voges, Jens Scheewe, Tobias Giertzsch, Karl-Patrik Kresoja, Yevheniia Artemenko, Carsten Rickers","doi":"10.21037/cdt-24-494","DOIUrl":"10.21037/cdt-24-494","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular, atrial and aortic dysfunction might be important disease drivers in patients with transposition of great arteries (TGA) that possibly influence pathophysiological processes beyond the underlying congenital disease. Therefore, this study aimed to assess their influence and relationship in TGA patients following arterial switch operation (ASO).</p><p><strong>Methods: </strong>Patients with TGA after ASO were studied with cardiac magnetic resonance imaging (CMR) to measure (I) extracellular volume fraction (ECV); (II) global peak systolic longitudinal strain (GLS); (III) left atrial reservoir function (LA-EF-reservoir) and (IV) aortic distensibility (AD). Mediation analysis was performed to model the interplay of ventricular, atrial and aortic function.</p><p><strong>Results: </strong>Eighty-one TGA patients (median age 16 years, 32% female) and 30 heart-healthy controls were included. TGA patients had significantly lower LA-EF-reservoir function (P<0.001) resulting in a shift from active to passive LA function (P<0.001), and AD was impaired in TGA patients (P<0.001). The ratio of active to passive LA function correlated with ECV (P=0.002). Both LA-EF-reservoir and AD correlated negatively with peak systolic GLS. In a mediation model, the effect of AD on peak systolic GLS encompassed both a direct effect on peak GLS (β=-0.2833), and an indirect effect mediated by LA-EF-reservoir (β=0.2087). LA-EF-reservoir had the strongest effect on ventricular function (β=-0.3193) and mediated 29% of the effect of AD on ventricular function (mediated β=-0.066).</p><p><strong>Conclusions: </strong>Post ASO, impaired LA function and AD are associated with reduced systolic left ventricular function. These relationships are mediated through both direct effects, such as the direct impact of AD on GLS, and indirect pathways, including the mediating role of LA-EF reservoir function. Consequently, impaired left atrial and aortic function should be viewed not as isolated abnormalities but as interconnected physiological processes that jointly contribute to altered ventricular performance.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"37-49"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669084","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":"Staging complex pulmonary and right heart problems in mitral annular calcification with mitral valve dysfunction.","authors":"Naoko Ichikawa, Yumi Shiina","doi":"10.21037/cdt-24-427","DOIUrl":"10.21037/cdt-24-427","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"25-27"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669099","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":"Treatment and prognosis of patients with Kawasaki disease and giant coronary artery aneurysm: a retrospective observational study.","authors":"Naoki Saito, Ryota Ebata, Kentaro Okunushi, Kumi Yasukawa, Hiromichi Hamada","doi":"10.21037/cdt-24-289","DOIUrl":"10.21037/cdt-24-289","url":null,"abstract":"<p><strong>Background: </strong>There is no established regimen for antithrombotic therapy in patients with Kawasaki disease (KD) who develop giant coronary artery aneurysm (GA). This single-center retrospective study evaluated the outcome of a unified antithrombotic regimen in these patients.</p><p><strong>Methods: </strong>Sixteen KD patients with GA onset between 1999 and 2013 were included. The patients were started on intravenous heparin and then switched to warfarin in addition to low-dose aspirin when blood tests indicated that the inflammatory response had subsided and the aneurysm had ceased dilating. The target prothrombin time-international normalized ratio (PT-INR) was 2.0-2.5. Patients with no cardiac events or thrombus formation within 2-3 years of onset were considered for discontinuation of anticoagulation and continuation on antiplatelet treatment alone.</p><p><strong>Results: </strong>The median follow-up duration was 5.8 years (range, 0.25-9.9 years). There were 7 cases of myocardial infarction, including 1 that was fatal and 1 that were asymptomatic. There was no significant difference in the day of KD treatment initiation, onset of GA, or follow-up duration between patients with cardiovascular events (CEs; n=7) and those without CEs (n=9). CEs were significantly more common in patients with larger maximum Z-score (P=0.044) and multiple GAs than in those with a single GA (P=0.007). The prothrombin time at the time of events was below the management target in 3 of the 7 patients with CEs.</p><p><strong>Conclusions: </strong>The prognosis of KD patients with GA was unsatisfactory in this study, especially in those with large and multiple GAs. In addition to antiplatelet therapy, we recommend continuation of strict anticoagulation therapy in these patients.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"78-84"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669102","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":"Optimizing the diagnostic yield of invasive coronary function testing.","authors":"A Suzanne Vink, Marcel A M Beijk","doi":"10.21037/cdt-24-426","DOIUrl":"10.21037/cdt-24-426","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"5-10"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669089","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":"Coronary microvascular dysfunction and right ventricular structure and function.","authors":"Amélie Paquin, Michael D Nelson, Janet Wei, Sauyeh K Zamani, Jenna Maughan, Galen Cook-Wiens, Martha Gulati, Chrisandra Shufelt, John W Petersen, Eileen M Handberg, Carl J Pepine, C Noel Bairey Merz","doi":"10.21037/cdt-24-303","DOIUrl":"10.21037/cdt-24-303","url":null,"abstract":"<p><p>Previous studies have suggested associations between coronary microvascular dysfunction (CMD) and alterations in left ventricular (LV) structure and function Data are however scarce regarding the right ventricular (RV). In the context of CMD, the RV could be affected via mechanisms potentially involving ischemia from CMD, shared pathophysiological milieu leading to adverse ventricular remodeling, and/or increased afterload secondary to increased LV end-diastolic pressure or heart failure with preserved ejection fraction (HFpEF) with pulmonary hypertension. We evaluated the relationship between measures of RV structure/function and invasively measured CMD in individuals with suspected ischemia and no obstructive coronary artery (INOCA) disease. We included 297 participants from the WISE-HFpEF, WISE-preHFpEF and WISE-CVD cohorts, who underwent cardiac magnetic resonance imaging (CMRI) and coronary function testing to measure coronary flow reserve (CFR) in response to adenosine and coronary blood flow change in response to acetylcholine (∆CBF). We assessed the correlation between RV parameters on CMRI and coronary microvascular function (CFR and ∆CBF). Participants had a mean age 54±11 years. Of them, 104 (39%) had hypertension, 31 (11%) had diabetes, and 18 (7%) had chronic obstructive pulmonary disease. Mean RV end-diastolic volume was 66.6±11.0 mL/m², RV ejection fraction was 62.7%±5.6% and RV longitudinal strain was -27.2%±3.5%. We found no significant correlation between RV parameters and coronary microvascular function. This is the first study to report associations between invasively measured CMD and CMRI parameters of RV structure and function among patients with suspected INOCA. Despite a large sample size, we found no significant relationship between RV structure or function and CMD. These results suggest that RV abnormalities do not precede and are not concurrent with CMD in suspected INOCA participants. Longitudinal prospective studies are needed to evaluate if RV deterioration may occur later during the course of CMD and among patients with HFpEF.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"259-264"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669068","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":"Sirolimus coated balloons in peripheral arterial disease, what's next?","authors":"Dexter Yak Seng Chan, Julian Chi Leung Wong, Tjun Yip Tang","doi":"10.21037/cdt-24-425","DOIUrl":"10.21037/cdt-24-425","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"15-19"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669097","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}