BACKGROUND Long-term antipsychotic therapy in psychiatric patients carries significant cardiovascular risks,including QT interval prolongation,myocardial injury,and functional impairment.Guanxinning,a traditional Chin...BACKGROUND Long-term antipsychotic therapy in psychiatric patients carries significant cardiovascular risks,including QT interval prolongation,myocardial injury,and functional impairment.Guanxinning,a traditional Chinese medicine formulation,has demonstrated cardioprotective potential in preclinical studies,but clinical evidence in this population remains limited.AIM To evaluate the cardioprotective effects of Guanxinning against antipsychotic-induced cardiac injury in long-term hospitalized psychiatric patients.METHODS A randomized,double-blind,placebo-controlled trial was conducted with 120 psychiatric inpatients receiving chronic antipsychotic therapy.Participants were allocated to:Intervention group:Conventional antipsychotics+Guanxinning tablets(0.38 g×4 tablets,ter in die);Control group:Conventional antipsychotics+identical placebo;Cardiac assessments at baseline and 12 months included:Electrocardiography(corrected QT interval),echocardiography(left ventricular ejection fraction,left ventricular end-diastolic diameter),serum biomarkers(cardiac troponin I,B-type natriuretic peptide,superoxide dismutase,malondialdehyde,high-sensitivity C-reactive protein).RESULTS Compared to controls,the Guanxinning group showed:Electrophysiological improvement:Corrected QT shortening(438±25 milliseconds vs 465±30 milliseconds,P<0.01).Functional enhancement:Left ventricular ejection fraction increase(58.5%±5.2%vs 53.8%±4.8%,P<0.05),left ventricular end-diastolic diameter reduction(49.8±3.5 mm vs 52.6±3.8 mm,P<0.05),Biochemical modulation:Reduced myocardial injury markers(cardiac troponin I:0.009 ng/mL vs 0.014 ng/mL;B-type natriuretic peptide:52 pg/mL vs 78 pg/mL,P<0.001),improved oxidative stress(superoxide dismutase:↑13.3 U/mL;malondialdehyde:↓0.9 nmol/mL,P<0.001),attenuated inflammation(high-sensitivity C-reactive protein:2.0 mg/L vs 3.2 mg/L,P<0.001).CONCLUSION Guanxinning significantly mitigates antipsychotic-induced cardiac injury in psychiatric patients,demonstrating:Normalization of electrophysiological parameters,Preservation of systolic/diastolic function,suppression of oxidative stress and inflammation.These findings support its clinical application as an adjunctive cardioprotective therapy,potentially through inhibition of myocardial apoptosis and antioxidant upregulation.展开更多
Human cardiac organoids have revolutionized the study of cardiac development,disease modeling,drug discovery,and regenerative therapies.This review systematically discusses strategies and progress in the construction ...Human cardiac organoids have revolutionized the study of cardiac development,disease modeling,drug discovery,and regenerative therapies.This review systematically discusses strategies and progress in the construction of cardiac organoids,categorizing them into three main types:cardiac spheroids,self-organizing/assembloid organoids,and organoid-on-a-chip systems.This review uniquely integrates the advances in vascularization,organ-on-chip design,and environmental cardiotoxicity modeling within cardiac organoid platforms,offering a critical synthesis that is absent in the literature.In the context of escalating environmental threats to cardiovascular health,there is an urgent need for physiologically relevant models to accurately identify cardiac toxicants and elucidate their underlying mechanisms of action.This review highlights advances in cardiac organoid applications for disease modeling—including congenital heart defects and acquired cardiovascular diseases—drug development,toxicity screening,and the study of environmentally induced cardiovascular pathogenesis.In addition,it critically examines ongoing challenges and underscores opportunities brought by bioengineering approaches.Finally,we propose future directions for developing standardized cardiac organoid platforms with clinical predictability,aiming to expand the utility of this technology across broader research applications.展开更多
Global brain ischemia and neurological deficit are consequences of cardiac arrest that lead to high mortality.Despite advancements in resuscitation science,our limited understanding of the cellular and molecular mecha...Global brain ischemia and neurological deficit are consequences of cardiac arrest that lead to high mortality.Despite advancements in resuscitation science,our limited understanding of the cellular and molecular mechanisms underlying post-cardiac arrest brain injury have hindered the development of effective neuroprotective strategies.Previous studies primarily focused on neuronal death,potentially overlooking the contributions of non-neuronal cells and intercellular communication to the pathophysiology of cardiac arrest-induced brain injury.To address these gaps,we hypothesized that single-cell transcriptomic analysis could uncover previously unidentified cellular subpopulations,altered cell communication networks,and novel molecular mechanisms involved in post-cardiac arrest brain injury.In this study,we performed a single-cell transcriptomic analysis of the hippocampus from pigs with ventricular fibrillation-induced cardiac arrest at 6 and 24 hours following the return of spontaneous circulation,and from sham control pigs.Sequencing results revealed changes in the proportions of different cell types,suggesting post-arrest disruption in the blood-brain barrier and infiltration of neutrophils.These results were validated through western blotting,quantitative reverse transcription-polymerase chain reaction,and immunofluorescence staining.We also identified and validated a unique subcluster of activated microglia with high expression of S100A8,which increased over time following cardiac arrest.This subcluster simultaneously exhibited significant M1/M2 polarization and expressed key functional genes related to chemokines and interleukins.Additionally,we revealed the post-cardiac arrest dysfunction of oligodendrocytes and the differentiation of oligodendrocyte precursor cells into oligodendrocytes.Cell communication analysis identified enhanced post-cardiac arrest communication between neutrophils and microglia that was mediated by neutrophil-derived resistin,driving pro-inflammatory microglial polarization.Our findings provide a comprehensive single-cell map of the post-cardiac arrest hippocampus,offering potential novel targets for neuroprotection and repair following cardiac arrest.展开更多
Objective:To investigate the antifibrotic effects of curcumin in a transverse aortic constriction(TAC)mouse model and elucidate its molecular mechanisms.Methods:Male C57BL/6 mice underwent TAC and received vehicle,low...Objective:To investigate the antifibrotic effects of curcumin in a transverse aortic constriction(TAC)mouse model and elucidate its molecular mechanisms.Methods:Male C57BL/6 mice underwent TAC and received vehicle,low-dose curcumin(50 mg/kg),high-dose curcumin(200 mg/kg),high-dose curcumin plus a scrambled control antagomir,or high-dose curcumin plus anti-miR-29b treatments.Cardiac function was assessed by echocardiography.Fibrosis was evaluated by histology,collagen volume fraction,and hydroxyproline content.Expression of miR-29b,HDAC4,and fibrosis-related markers(Col1a1,Col3a1,TGF-β1)was measured by quantitative RT-PCR and Western blotting assays.Myocardial procollagen type I carboxy-terminal propeptide was determined by ELISA,and HDAC4-specific enzymatic activity was assayed using a fluorogenic kit.Results:Curcumin improved cardiac function,reduced fibrosis,restored miR-29b expression,and suppressed HDAC4 expression and activity in a dose-dependent manner.Furthermore,curcumin decreased myocardial procollagen type I carboxy-terminal propeptide levels,confirming reduced collagen synthesis.Anti-miR-29b administration partially abrogated the antifibrotic and cardioprotective effects of curcumin.Conclusions:Curcumin attenuates pressure overload-induced cardiac fibrosis and dysfunction in a TAC mouse model via modulation of the miR-29b/HDAC4 axis and suppression of collagen synthesis.展开更多
As the prevalence of obesity increases dramatically,obesity-associated cardiac dysfunction constitutes a considerable challenge to human health.This study aimed to identify more useful lipid/inflammatory markers to pr...As the prevalence of obesity increases dramatically,obesity-associated cardiac dysfunction constitutes a considerable challenge to human health.This study aimed to identify more useful lipid/inflammatory markers to predict the risk of obesity-associated cardiac dysfunction.By retrospectively analyzing the clinical characteristics of 5648 cardiac disease patients,we found that both the plasma level of high-density lipoprotein cholesterol(HDLC)and the blood monocyte count were significantly associated with impairment of the left ventricular ejection fraction(LVEF).Univariate and multivariate regression analyses revealed that the monocyte to HDL-C ratio(MHR)was a more powerful predictor of the risk of LVEF decline than either HDL-C or monocyte alone.Mediation analysis further revealed a mediating effect of a high MHR on the decline in obesity-associated cardiac systolic function.Collectively,our results demonstrate a superior role of MHR in predicting the risk of an obesityassociated decline in cardiac systolic function among routine metabolic/inflammatory markers.展开更多
BACKGROUND Postoperative atrial fibrillation(POAF)is a complication after cardiac surgeries associated with increased morbidity and hospital stay.Surgical cardiac dener-vation,which reduces autonomic input to the hear...BACKGROUND Postoperative atrial fibrillation(POAF)is a complication after cardiac surgeries associated with increased morbidity and hospital stay.Surgical cardiac dener-vation,which reduces autonomic input to the heart,has been proposed as a good preventive against POAF.However,evidence on its effectiveness remains incon-sistent.AIM To evaluate the impact of surgical cardiac denervation on the incidence of POAF and related clinical outcomes.METHODS This meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search was conducted across PubMed,Cochrane,ScienceDirect,and EMBASE up to April 2025 using a preformed search strategy using Medical Subject Headings terms and free-text keywords.Risk of bias assessment was done via Risk of Bias 2.0 and Risk Of Bias In Non-randomized Studies-of Interventions tools.Study analysis was performed using Review Manager version 5.4,with heterogeneity assessed via I^(2) values and appropriate fixed-or randomeffects models applied.RESULTS Five studies(N=1266)were included,with 627 patients undergoing cardiac denervation and 639 serving as controls.Denervation did not significantly reduce overall POAF[odds ratio=0.71;95%confidence interval(CI):0.32-1.58;P=0.40;I^(2)=83%],but was associated with a significant reduction in persistent atrial fibrillation(odds ratio=0.19;95%CI:0.10-0.36;P<0.00001;I^(2)=0%).Among secondary outcomes,only postoperative serum magnesium levels significantly reduced the denervation group(mean difference:-0.07 mmol/L;95%CI:-0.08 to-0.06;P<0.00001).Other outcomes,such as reoperation for bleeding,stroke/transient ischemic attack,length of hospital stay,30-day mortality,and postoperative drainage,did not show any significant difference.CONCLUSION Surgical cardiac denervation does not significantly reduce overall POAF but does lower the incidence of persistent atrial fibrillation.It is also shown to decrease serum magnesium levels.Other outcomes,such as stroke,reoperation,and hospital stay,showed no significant differences.展开更多
Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythm...Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythmia as the primary manifestation of cardiac metastasis of RCC with only two cases reported.[1,2]We add to the literature the third case,the diagnosis of which was only possible with cardiac magnetic resonance(CMR).展开更多
Cardiac arrest can lead to severe neurological impairment as a result of inflammation,mitochondrial dysfunction,and post-cardiopulmonary resuscitation neurological damage.Hypoxic preconditioning has been shown to impr...Cardiac arrest can lead to severe neurological impairment as a result of inflammation,mitochondrial dysfunction,and post-cardiopulmonary resuscitation neurological damage.Hypoxic preconditioning has been shown to improve migration and survival of bone marrow–derived mesenchymal stem cells and reduce pyroptosis after cardiac arrest,but the specific mechanisms by which hypoxia-preconditioned bone marrow–derived mesenchymal stem cells protect against brain injury after cardiac arrest are unknown.To this end,we established an in vitro co-culture model of bone marrow–derived mesenchymal stem cells and oxygen–glucose deprived primary neurons and found that hypoxic preconditioning enhanced the protective effect of bone marrow stromal stem cells against neuronal pyroptosis,possibly through inhibition of the MAPK and nuclear factor κB pathways.Subsequently,we transplanted hypoxia-preconditioned bone marrow–derived mesenchymal stem cells into the lateral ventricle after the return of spontaneous circulation in an 8-minute cardiac arrest rat model induced by asphyxia.The results showed that hypoxia-preconditioned bone marrow–derived mesenchymal stem cells significantly reduced cardiac arrest–induced neuronal pyroptosis,oxidative stress,and mitochondrial damage,whereas knockdown of the liver isoform of phosphofructokinase in bone marrow–derived mesenchymal stem cells inhibited these effects.To conclude,hypoxia-preconditioned bone marrow–derived mesenchymal stem cells offer a promising therapeutic approach for neuronal injury following cardiac arrest,and their beneficial effects are potentially associated with increased expression of the liver isoform of phosphofructokinase following hypoxic preconditioning.展开更多
Cardiac arrest(CA)is a critical condition in the field of cardiovascular medicine.Despite successful resuscitation,patients continue to have a high mortality rate,largely due to post CA syndrome(PCAS).However,the inju...Cardiac arrest(CA)is a critical condition in the field of cardiovascular medicine.Despite successful resuscitation,patients continue to have a high mortality rate,largely due to post CA syndrome(PCAS).However,the injury and pathophysiological mechanisms underlying PCAS remain unclear.Experimental animal models are valuable tools for exploring the etiology,pathogenesis,and potential interventions for CA and PCAS.Current CA animal models include electrical induction of ventricular fibrillation(VF),myocardial infarction,high potassium,asphyxia,and hemorrhagic shock.Although these models do not fully replicate the complexity of clinical CA,the mechanistic insights they provide remain highly relevant,including post-CA brain injury(PCABI),post-CA myocardial dysfunction(PAMD),systemic ischaemia/reperfusion injury(IRI),and the persistent precipitating pathology.Summarizing the methods of establishing CA models,the challenges encountered in the modeling process,and the mechanisms of PCAS can provide a foundation for developing standardized CA modeling protocols.展开更多
Cardiac sarcoidosis(CS)is a rare but serious manifestation of sarcoidosis that can lead to significant morbidity and mortality due to arrhythmias and heart failure.The inflammatory process in CS is characterized by th...Cardiac sarcoidosis(CS)is a rare but serious manifestation of sarcoidosis that can lead to significant morbidity and mortality due to arrhythmias and heart failure.The inflammatory process in CS is characterized by the formation of noncaseating granulomas in the myocardium,which can disrupt normal cardiac function and conduction.Corticosteroids are the primary therapeutic agents used to manage CS,particularly during the acute inflammatory phase,as they help reduce inflammation and improve cardiac function.However,the long-term use of steroids poses risks,including opportunistic infections and metabolic complications.Advanced imaging techniques,such as cardiac magnetic resonance imaging and positron emission tomography,play a crucial role in diagnosing CS and assessing myocardial involvement.These imaging modalities also aid in risk stratification for arrhythmic events,guiding therapeutic decisions such as the initiation of steroid therapy and the potential placement of implantable cardioverterdefibrillators.This review synthesizes current evidence regarding the role of steroid therapy in managing CS and its implications for cardiac arrhythmias,emphasizing the need for individualized treatment strategies to optimize patient outcomes.展开更多
Objective:To systematically evaluate the impact of phase I cardiac rehabilitation exercise prescriptions on cardiac function levels in patients after coronary intervention.Methods:Seven Chinese and English databases,i...Objective:To systematically evaluate the impact of phase I cardiac rehabilitation exercise prescriptions on cardiac function levels in patients after coronary intervention.Methods:Seven Chinese and English databases,including Cochrane Library,PubMed,Web of Science,ESC(European Society of Cardiology),and CNKI,as well as professional association websites,were searched using computers,with manual searching as a complement.Relevant literature published from the establishment of the database to February 2025 was retrieved.Two researchers independently screened the literature,extracted data,and evaluated the quality of the literature.Meta-analysis was performed using RevMan 5.3 software.Results:A total of 8 articles were included,involving 843 patients.Meta-analysis results showed that compared with routine nursing,phase I cardiac rehabilitation exercise prescriptions helped increase the 6-minute walking distance in patients after coronary intervention[MD=0.84,95%CI(0.57,1.10),P<0.001],increase the level of left ventricular ejection fraction in patients after coronary intervention[MD=0.67,95%CI(0.33,1.00),P<0.001],and cardiac rehabilitation combined with respiratory rehabilitation exercise could improve the level of left ventricular ejection fraction in patients after coronary intervention[MD=0.58,95%CI(0.40,0.76),P<0.001].Conclusion:The implementation of phase I cardiac rehabilitation exercise prescriptions can help improve cardiac function levels in patients after coronary intervention.However,the standardization of outcome evaluation indicators needs to be improved,and the long-term effects of rehabilitation still require verification through a large number of high-quality studies.展开更多
Many studies have shown the negative relationship between long term exposure to PM_(2.5)and cardiac dysfunction.Recently,studies have shown that even a single exposure of PM_(2.5)from air sample in permissible range c...Many studies have shown the negative relationship between long term exposure to PM_(2.5)and cardiac dysfunction.Recently,studies have shown that even a single exposure of PM_(2.5)from air sample in permissible range can induce very mild cardiac pathological changes.In the present study,we revisited the toxic effect of PM_(2.5)on rat heart by adopting single and multiple exposure durations.FemaleWistar ratswere exposed to PM_(2.5)at a concentration of 250μg/m3 daily for 3 hr for single(1 day)and multiple(7,14,21 days)durations.The major pathological changes noted in 21 days exposed myocardium comprised of an elevated ST segment(the segment between the S wave and the T wave),development of cardiac fibrosis,hypertrophy,cardiac injury,tissue inflammation and declined cardiac function.With 14 days exposed heart,the electrocardiograms(ECG),data showed insignificantly declined heart rate and an increased QT(the time from the start of the Q wave to the end of the T wave)interval along with mild fibrosis,hypertrophy and lesser number of TUNEL positive cells.On the other hand,single-and 7-days exposure to PM_(2.5)did not impart any significant changes in the myocardium.To determine the reversibility potential of PM_(2.5)induced cardiotoxicity,a washout period of 24 hours was adopted and all observed changes in the myocardium were reversed till day 7,but not in 14-and 21-days exposed samples.Based on the above findings we concluded that PM_(2.5)associated cardiac dysfunction is the cumulative outcome of ineffective cardiac adaptive and repair process that accumulate additively over the time due to prolonged exposure durations.展开更多
BACKGROUND A key cardiac magnetic resonance(CMR)challenge is breath-holding duration,difficult for cardiac patients.AIM To evaluate whether artificial intelligence-assisted compressed sensing CINE(AICS-CINE)reduces im...BACKGROUND A key cardiac magnetic resonance(CMR)challenge is breath-holding duration,difficult for cardiac patients.AIM To evaluate whether artificial intelligence-assisted compressed sensing CINE(AICS-CINE)reduces image acquisition time of CMR compared to conventional CINE(C-CINE).METHODS Cardio-oncology patients(n=60)and healthy volunteers(n=29)underwent sequential C-CINE and AI-CS-CINE with a 1.5-T scanner.Acquisition time,visual image quality assessment,and biventricular metrics(end-diastolic volume,endsystolic volume,stroke volume,ejection fraction,left ventricular mass,and wall thickness)were analyzed and compared between C-CINE and AI-CS-CINE with Bland–Altman analysis,and calculation of intraclass coefficient(ICC).RESULTS In 89 participants(58.5±16.8 years,42 males,47 females),total AI-CS-CINE acquisition and reconstruction time(37 seconds)was 84%faster than C-CINE(238 seconds).C-CINE required repeats in 23%(20/89)of cases(approximately 8 minutes lost),while AI-CS-CINE only needed one repeat(1%;2 seconds lost).AICS-CINE had slightly lower contrast but preserved structural clarity.Bland-Altman plots and ICC(0.73≤r≤0.98)showed strong agreement for left ventricle(LV)and right ventricle(RV)metrics,including those in the cardiac amyloidosis subgroup(n=31).AI-CS-CINE enabled faster,easier imaging in patients with claustrophobia,dyspnea,arrhythmias,or restlessness.Motion-artifacted C-CINE images were reliably interpreted from AI-CS-CINE.CONCLUSION AI-CS-CINE accelerated CMR image acquisition and reconstruction,preserved anatomical detail,and diminished impact of patient-related motion.Quantitative AI-CS-CINE metrics agreed closely with C-CINE in cardio-oncology patients,including the cardiac amyloidosis cohort,as well as healthy volunteers regardless of left and right ventricular size and function.AI-CS-CINE significantly enhanced CMR workflow,particularly in challenging cases.The strong analytical concordance underscores reliability and robustness of AI-CS-CINE as a valuable tool.展开更多
BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemothe...BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.展开更多
BACKGROUND Cardiac magnetic resonance(CMR)has been reported to identify myocardial damage inducing out-of-hospital cardiac arrest(OHCA).However,the usefulness of CMR may be affected by the medical institutions,patient...BACKGROUND Cardiac magnetic resonance(CMR)has been reported to identify myocardial damage inducing out-of-hospital cardiac arrest(OHCA).However,the usefulness of CMR may be affected by the medical institutions,patients’ages,and myocardial diseases.AIM To clarify the clinical usefulness and limitation of CMR for identifying myocardial damage in the survivors of OHCA in midtown.METHODS Nineteen patients underwent CMR to detect myocardial damage related to OHCA in the midtown of a capital city.Cine,T1 and T2 mapping,T2-weighted,and late gadolinium enhancement(LGE)imaging were acquired using a 1.5 T scanner.We described the clinical characteristics of the survivors of OHCA and evaluated usefulness of CMR for identifying myocardial damage related to OHCA.RESULTS Among 19 patients experiencing OHCA,7 experienced it in trains or on railway platforms,4 while practicing sports,and 4 during their daily work.Ten of the 19 survivors were diagnosed with coronary vasospasm(CVS),in whom CMR failed to depict its characteristic findings.CMR was useful for identifying myocardial damage associated with hypertrophic cardiomyopathy(HCM)or myocardial infarction(MI).LGE was related to serious ventricular arrhythmias after implantable cardioverter defibrillator(ICD)installation in 3 patients(CVS,2;HCM,1).CONCLUSION CMR is useful for identifying myocardial damage of HCM or MI inducing OHCA and predicting ventricular arrhythmias after ICD implantation but has limited capability for detecting myocardial damage of CVS.展开更多
Sudden cardiac death(SCD)is one of the most devastating sequelae of myocardial diseases and can be the initial symptom in younger athletes or middle-aged busi-nesspeople.An implantable cardioverter defibrillator(ICD)p...Sudden cardiac death(SCD)is one of the most devastating sequelae of myocardial diseases and can be the initial symptom in younger athletes or middle-aged busi-nesspeople.An implantable cardioverter defibrillator(ICD)prevents SCD and dramatically reduces the arrhythmic events in these patients;hence,the risk strati-fication for the SCD is important.In survivors of out-of-hospital cardiac arrest,identification of its etiologies is required to select the appropriate treat-ments following ICD installation.Cardiac magnetic resonance imaging(MRI)is useful for evaluating the morphology and function of the heart and for tissue character-ization,MRI can therefore be used to stratify the risk of SCD associated with various myocardial diseases and leads to primary prevention using ICD.MRI can predict arrhythmic events,which suggest the progression of myocardial damage,following secondary prevention.In this review,we provide a clinical and MRI focused update and MRI protocol for the primary and secondary prevention of SCD.We summarize the contribution and limitations of cardiac MRI for pre-vention SCD using ICD implantation.展开更多
Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52...Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52.5 to 97.1 per 100,000 population.[1,2]Survival-to-discharge rates for OHCA and in-hospital cardiac arrest(IHCA)are not satisfactory,with ranges of 1.2%-9.9%and 9.1%-19.1%,respectively.展开更多
BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances s...BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances survival,the role of implantable cardioverter-defibrillators(ICDs)alongside CRT in patients with non-ischemic cardiomyopathy(NICM)remains controversial.To evaluate and compare the outcomes of CRT with ICD(CRT-D)versus CRT with pacemaker-only(CRT-P)in individuals diagnosed with NICM,with a specific focus on the elderly.METHODS A comprehensive search of PubMed,Embase,and the Cochrane Central Register of Controlled Trials was conducted in January 2024.Studies comparing CRT-D and CRT-P in patients with NICM were included,with subgroup analyses focusing on patients aged 75 years and older.RESULTS Twelve studies,including two randomized clinical trials,with a total of 62,145 patients and 16,754 pooled death events(9,171 in CRT-D and 7,583 in CRT-P),were analyzed.CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P(pooled OR=0.72;95%CI:0.61-0.85;P<0.01),with significant heterogeneity(I2=83%).RCT subgroup analysis,was not statistically significant(pooled OR=0.82;95%CI:0.64-1.06;P=0.41;I2=0%).In patients older than 75 years,no significant difference in mortality risk was observed(pooled OR 0.96;95%CI:0.81-1.15;I2=39%).CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality.However,this benefit does not extend to cardiovascular mortality,likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure.The survival advantage of CRT-D is most pronounced in younger patients,with those over 75 years of age deriving less benefit.This highlights the importance of careful patient selection,considering age and comorbidities,when deciding on ICD implantation in NICM patients.展开更多
Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,...Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,as it can cause serious long-term cardiovascular and cerebrovascular complications that affect their quality of life[1].Survey data indicate that the overall incidence rate of intraoperative CA in patients undergoing thoracic surgery in China is currently 0.138%[2].This rate is expected to increase because of the increasing proportion of older individuals(age>60 years)in the population,as well as the increasing pulmonary surgery rates.However,the incidence rate during the perianesthetic period in older patients undergoing thoracic surgery has not yet been comprehensively reported.展开更多
Coronary artery disease and aortic valve stenosis are highly prevalent cardio-vascular diseases worldwide,resulting in substantial morbidity and mortality.Surgical interventions,such as coronary artery bypass grafting...Coronary artery disease and aortic valve stenosis are highly prevalent cardio-vascular diseases worldwide,resulting in substantial morbidity and mortality.Surgical interventions,such as coronary artery bypass grafting and surgical aortic valve replacement,offer significant therapeutic benefits,including enhanced postoperative quality of life(QoL)and functional capacity,which are key indi-cators of surgical success.This editorial reviews recent studies on postoperative QoL and functional outcomes in patients undergoing cardiac surgery.Factors such as preoperative health,age,intensive care unit stay duration,surgical risk,and perioperative complications could influence these outcomes.Cardiac rehabil-itation is pivotal in enhancing patient function,reducing frailty and improving long-term QoL.展开更多
基金Supported by the Special Project for Supporting the Development of Biomedicine and Health Industry in Hangzhou City,No.2022WJC123Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project,No.2022ZA143.
文摘BACKGROUND Long-term antipsychotic therapy in psychiatric patients carries significant cardiovascular risks,including QT interval prolongation,myocardial injury,and functional impairment.Guanxinning,a traditional Chinese medicine formulation,has demonstrated cardioprotective potential in preclinical studies,but clinical evidence in this population remains limited.AIM To evaluate the cardioprotective effects of Guanxinning against antipsychotic-induced cardiac injury in long-term hospitalized psychiatric patients.METHODS A randomized,double-blind,placebo-controlled trial was conducted with 120 psychiatric inpatients receiving chronic antipsychotic therapy.Participants were allocated to:Intervention group:Conventional antipsychotics+Guanxinning tablets(0.38 g×4 tablets,ter in die);Control group:Conventional antipsychotics+identical placebo;Cardiac assessments at baseline and 12 months included:Electrocardiography(corrected QT interval),echocardiography(left ventricular ejection fraction,left ventricular end-diastolic diameter),serum biomarkers(cardiac troponin I,B-type natriuretic peptide,superoxide dismutase,malondialdehyde,high-sensitivity C-reactive protein).RESULTS Compared to controls,the Guanxinning group showed:Electrophysiological improvement:Corrected QT shortening(438±25 milliseconds vs 465±30 milliseconds,P<0.01).Functional enhancement:Left ventricular ejection fraction increase(58.5%±5.2%vs 53.8%±4.8%,P<0.05),left ventricular end-diastolic diameter reduction(49.8±3.5 mm vs 52.6±3.8 mm,P<0.05),Biochemical modulation:Reduced myocardial injury markers(cardiac troponin I:0.009 ng/mL vs 0.014 ng/mL;B-type natriuretic peptide:52 pg/mL vs 78 pg/mL,P<0.001),improved oxidative stress(superoxide dismutase:↑13.3 U/mL;malondialdehyde:↓0.9 nmol/mL,P<0.001),attenuated inflammation(high-sensitivity C-reactive protein:2.0 mg/L vs 3.2 mg/L,P<0.001).CONCLUSION Guanxinning significantly mitigates antipsychotic-induced cardiac injury in psychiatric patients,demonstrating:Normalization of electrophysiological parameters,Preservation of systolic/diastolic function,suppression of oxidative stress and inflammation.These findings support its clinical application as an adjunctive cardioprotective therapy,potentially through inhibition of myocardial apoptosis and antioxidant upregulation.
基金supported by the Innovation Promotion Program of NHC and Shanghai Key Labs,SIBPT(grant number PT2025-01)。
文摘Human cardiac organoids have revolutionized the study of cardiac development,disease modeling,drug discovery,and regenerative therapies.This review systematically discusses strategies and progress in the construction of cardiac organoids,categorizing them into three main types:cardiac spheroids,self-organizing/assembloid organoids,and organoid-on-a-chip systems.This review uniquely integrates the advances in vascularization,organ-on-chip design,and environmental cardiotoxicity modeling within cardiac organoid platforms,offering a critical synthesis that is absent in the literature.In the context of escalating environmental threats to cardiovascular health,there is an urgent need for physiologically relevant models to accurately identify cardiac toxicants and elucidate their underlying mechanisms of action.This review highlights advances in cardiac organoid applications for disease modeling—including congenital heart defects and acquired cardiovascular diseases—drug development,toxicity screening,and the study of environmentally induced cardiovascular pathogenesis.In addition,it critically examines ongoing challenges and underscores opportunities brought by bioengineering approaches.Finally,we propose future directions for developing standardized cardiac organoid platforms with clinical predictability,aiming to expand the utility of this technology across broader research applications.
基金supported by the National Science Foundation of China,Nos.82325031(to FX),82030059(to YC),82102290(to YG),U23A20485(to YC)Noncommunicable Chronic Diseases-National Science and Technology Major Project,No.2023ZD0505504(to FX),2023ZD0505500(to YC)the Key R&D Program of Shandong Province,No.2022ZLGX03(to YC).
文摘Global brain ischemia and neurological deficit are consequences of cardiac arrest that lead to high mortality.Despite advancements in resuscitation science,our limited understanding of the cellular and molecular mechanisms underlying post-cardiac arrest brain injury have hindered the development of effective neuroprotective strategies.Previous studies primarily focused on neuronal death,potentially overlooking the contributions of non-neuronal cells and intercellular communication to the pathophysiology of cardiac arrest-induced brain injury.To address these gaps,we hypothesized that single-cell transcriptomic analysis could uncover previously unidentified cellular subpopulations,altered cell communication networks,and novel molecular mechanisms involved in post-cardiac arrest brain injury.In this study,we performed a single-cell transcriptomic analysis of the hippocampus from pigs with ventricular fibrillation-induced cardiac arrest at 6 and 24 hours following the return of spontaneous circulation,and from sham control pigs.Sequencing results revealed changes in the proportions of different cell types,suggesting post-arrest disruption in the blood-brain barrier and infiltration of neutrophils.These results were validated through western blotting,quantitative reverse transcription-polymerase chain reaction,and immunofluorescence staining.We also identified and validated a unique subcluster of activated microglia with high expression of S100A8,which increased over time following cardiac arrest.This subcluster simultaneously exhibited significant M1/M2 polarization and expressed key functional genes related to chemokines and interleukins.Additionally,we revealed the post-cardiac arrest dysfunction of oligodendrocytes and the differentiation of oligodendrocyte precursor cells into oligodendrocytes.Cell communication analysis identified enhanced post-cardiac arrest communication between neutrophils and microglia that was mediated by neutrophil-derived resistin,driving pro-inflammatory microglial polarization.Our findings provide a comprehensive single-cell map of the post-cardiac arrest hippocampus,offering potential novel targets for neuroprotection and repair following cardiac arrest.
基金supported by China International Medical Foundation(Z-2019-42-1908-4)Natural Science Basic Research Program of Shaanxi Province(2019JM-440).
文摘Objective:To investigate the antifibrotic effects of curcumin in a transverse aortic constriction(TAC)mouse model and elucidate its molecular mechanisms.Methods:Male C57BL/6 mice underwent TAC and received vehicle,low-dose curcumin(50 mg/kg),high-dose curcumin(200 mg/kg),high-dose curcumin plus a scrambled control antagomir,or high-dose curcumin plus anti-miR-29b treatments.Cardiac function was assessed by echocardiography.Fibrosis was evaluated by histology,collagen volume fraction,and hydroxyproline content.Expression of miR-29b,HDAC4,and fibrosis-related markers(Col1a1,Col3a1,TGF-β1)was measured by quantitative RT-PCR and Western blotting assays.Myocardial procollagen type I carboxy-terminal propeptide was determined by ELISA,and HDAC4-specific enzymatic activity was assayed using a fluorogenic kit.Results:Curcumin improved cardiac function,reduced fibrosis,restored miR-29b expression,and suppressed HDAC4 expression and activity in a dose-dependent manner.Furthermore,curcumin decreased myocardial procollagen type I carboxy-terminal propeptide levels,confirming reduced collagen synthesis.Anti-miR-29b administration partially abrogated the antifibrotic and cardioprotective effects of curcumin.Conclusions:Curcumin attenuates pressure overload-induced cardiac fibrosis and dysfunction in a TAC mouse model via modulation of the miR-29b/HDAC4 axis and suppression of collagen synthesis.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.82430018 to Q.C.,82270361 and 82570402 to H.Z.)the Nanjing Medical University Undergraduate Innovation and Entrepreneurship Training Program Fund(Grant No.202410312138Y to C.Z.)the Basic Sciences of Jiangsu Higher Education Institutions(Grant No.22KJA310002 to H.Z.)。
文摘As the prevalence of obesity increases dramatically,obesity-associated cardiac dysfunction constitutes a considerable challenge to human health.This study aimed to identify more useful lipid/inflammatory markers to predict the risk of obesity-associated cardiac dysfunction.By retrospectively analyzing the clinical characteristics of 5648 cardiac disease patients,we found that both the plasma level of high-density lipoprotein cholesterol(HDLC)and the blood monocyte count were significantly associated with impairment of the left ventricular ejection fraction(LVEF).Univariate and multivariate regression analyses revealed that the monocyte to HDL-C ratio(MHR)was a more powerful predictor of the risk of LVEF decline than either HDL-C or monocyte alone.Mediation analysis further revealed a mediating effect of a high MHR on the decline in obesity-associated cardiac systolic function.Collectively,our results demonstrate a superior role of MHR in predicting the risk of an obesityassociated decline in cardiac systolic function among routine metabolic/inflammatory markers.
文摘BACKGROUND Postoperative atrial fibrillation(POAF)is a complication after cardiac surgeries associated with increased morbidity and hospital stay.Surgical cardiac dener-vation,which reduces autonomic input to the heart,has been proposed as a good preventive against POAF.However,evidence on its effectiveness remains incon-sistent.AIM To evaluate the impact of surgical cardiac denervation on the incidence of POAF and related clinical outcomes.METHODS This meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search was conducted across PubMed,Cochrane,ScienceDirect,and EMBASE up to April 2025 using a preformed search strategy using Medical Subject Headings terms and free-text keywords.Risk of bias assessment was done via Risk of Bias 2.0 and Risk Of Bias In Non-randomized Studies-of Interventions tools.Study analysis was performed using Review Manager version 5.4,with heterogeneity assessed via I^(2) values and appropriate fixed-or randomeffects models applied.RESULTS Five studies(N=1266)were included,with 627 patients undergoing cardiac denervation and 639 serving as controls.Denervation did not significantly reduce overall POAF[odds ratio=0.71;95%confidence interval(CI):0.32-1.58;P=0.40;I^(2)=83%],but was associated with a significant reduction in persistent atrial fibrillation(odds ratio=0.19;95%CI:0.10-0.36;P<0.00001;I^(2)=0%).Among secondary outcomes,only postoperative serum magnesium levels significantly reduced the denervation group(mean difference:-0.07 mmol/L;95%CI:-0.08 to-0.06;P<0.00001).Other outcomes,such as reoperation for bleeding,stroke/transient ischemic attack,length of hospital stay,30-day mortality,and postoperative drainage,did not show any significant difference.CONCLUSION Surgical cardiac denervation does not significantly reduce overall POAF but does lower the incidence of persistent atrial fibrillation.It is also shown to decrease serum magnesium levels.Other outcomes,such as stroke,reoperation,and hospital stay,showed no significant differences.
文摘Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythmia as the primary manifestation of cardiac metastasis of RCC with only two cases reported.[1,2]We add to the literature the third case,the diagnosis of which was only possible with cardiac magnetic resonance(CMR).
基金supported by the Natural Science Fund of Fujian Province,No.2020J011058(to JK)the Project of Fujian Provincial Hospital for High-level Hospital Construction,No.2020HSJJ12(to JK)+1 种基金the Fujian Provincial Finance Department Special Fund,No.(2021)848(to FC)the Fujian Provincial Major Scientific and Technological Special Projects on Health,No.2022ZD01008(to FC).
文摘Cardiac arrest can lead to severe neurological impairment as a result of inflammation,mitochondrial dysfunction,and post-cardiopulmonary resuscitation neurological damage.Hypoxic preconditioning has been shown to improve migration and survival of bone marrow–derived mesenchymal stem cells and reduce pyroptosis after cardiac arrest,but the specific mechanisms by which hypoxia-preconditioned bone marrow–derived mesenchymal stem cells protect against brain injury after cardiac arrest are unknown.To this end,we established an in vitro co-culture model of bone marrow–derived mesenchymal stem cells and oxygen–glucose deprived primary neurons and found that hypoxic preconditioning enhanced the protective effect of bone marrow stromal stem cells against neuronal pyroptosis,possibly through inhibition of the MAPK and nuclear factor κB pathways.Subsequently,we transplanted hypoxia-preconditioned bone marrow–derived mesenchymal stem cells into the lateral ventricle after the return of spontaneous circulation in an 8-minute cardiac arrest rat model induced by asphyxia.The results showed that hypoxia-preconditioned bone marrow–derived mesenchymal stem cells significantly reduced cardiac arrest–induced neuronal pyroptosis,oxidative stress,and mitochondrial damage,whereas knockdown of the liver isoform of phosphofructokinase in bone marrow–derived mesenchymal stem cells inhibited these effects.To conclude,hypoxia-preconditioned bone marrow–derived mesenchymal stem cells offer a promising therapeutic approach for neuronal injury following cardiac arrest,and their beneficial effects are potentially associated with increased expression of the liver isoform of phosphofructokinase following hypoxic preconditioning.
基金supported by the National Key Research and Development Program(2021YFC3002205)the Postgraduate Research and Innovation Program of Tianjin Municipal Education Commission(2022BKY113),China.
文摘Cardiac arrest(CA)is a critical condition in the field of cardiovascular medicine.Despite successful resuscitation,patients continue to have a high mortality rate,largely due to post CA syndrome(PCAS).However,the injury and pathophysiological mechanisms underlying PCAS remain unclear.Experimental animal models are valuable tools for exploring the etiology,pathogenesis,and potential interventions for CA and PCAS.Current CA animal models include electrical induction of ventricular fibrillation(VF),myocardial infarction,high potassium,asphyxia,and hemorrhagic shock.Although these models do not fully replicate the complexity of clinical CA,the mechanistic insights they provide remain highly relevant,including post-CA brain injury(PCABI),post-CA myocardial dysfunction(PAMD),systemic ischaemia/reperfusion injury(IRI),and the persistent precipitating pathology.Summarizing the methods of establishing CA models,the challenges encountered in the modeling process,and the mechanisms of PCAS can provide a foundation for developing standardized CA modeling protocols.
文摘Cardiac sarcoidosis(CS)is a rare but serious manifestation of sarcoidosis that can lead to significant morbidity and mortality due to arrhythmias and heart failure.The inflammatory process in CS is characterized by the formation of noncaseating granulomas in the myocardium,which can disrupt normal cardiac function and conduction.Corticosteroids are the primary therapeutic agents used to manage CS,particularly during the acute inflammatory phase,as they help reduce inflammation and improve cardiac function.However,the long-term use of steroids poses risks,including opportunistic infections and metabolic complications.Advanced imaging techniques,such as cardiac magnetic resonance imaging and positron emission tomography,play a crucial role in diagnosing CS and assessing myocardial involvement.These imaging modalities also aid in risk stratification for arrhythmic events,guiding therapeutic decisions such as the initiation of steroid therapy and the potential placement of implantable cardioverterdefibrillators.This review synthesizes current evidence regarding the role of steroid therapy in managing CS and its implications for cardiac arrhythmias,emphasizing the need for individualized treatment strategies to optimize patient outcomes.
基金Science Research Fund Project of Yunnan Provincial Department of Education(Project No.:2024J0832)Science Research Fund Project of Yunnan Provincial Department of Education(Project No.:2025Y1186)。
文摘Objective:To systematically evaluate the impact of phase I cardiac rehabilitation exercise prescriptions on cardiac function levels in patients after coronary intervention.Methods:Seven Chinese and English databases,including Cochrane Library,PubMed,Web of Science,ESC(European Society of Cardiology),and CNKI,as well as professional association websites,were searched using computers,with manual searching as a complement.Relevant literature published from the establishment of the database to February 2025 was retrieved.Two researchers independently screened the literature,extracted data,and evaluated the quality of the literature.Meta-analysis was performed using RevMan 5.3 software.Results:A total of 8 articles were included,involving 843 patients.Meta-analysis results showed that compared with routine nursing,phase I cardiac rehabilitation exercise prescriptions helped increase the 6-minute walking distance in patients after coronary intervention[MD=0.84,95%CI(0.57,1.10),P<0.001],increase the level of left ventricular ejection fraction in patients after coronary intervention[MD=0.67,95%CI(0.33,1.00),P<0.001],and cardiac rehabilitation combined with respiratory rehabilitation exercise could improve the level of left ventricular ejection fraction in patients after coronary intervention[MD=0.58,95%CI(0.40,0.76),P<0.001].Conclusion:The implementation of phase I cardiac rehabilitation exercise prescriptions can help improve cardiac function levels in patients after coronary intervention.However,the standardization of outcome evaluation indicators needs to be improved,and the long-term effects of rehabilitation still require verification through a large number of high-quality studies.
基金the Indian Council of Medical Research(No.3/1/2(22)/Env/2021-NCD-II)Department of science and technology,India(CRG/2021/000227)for funding this research.
文摘Many studies have shown the negative relationship between long term exposure to PM_(2.5)and cardiac dysfunction.Recently,studies have shown that even a single exposure of PM_(2.5)from air sample in permissible range can induce very mild cardiac pathological changes.In the present study,we revisited the toxic effect of PM_(2.5)on rat heart by adopting single and multiple exposure durations.FemaleWistar ratswere exposed to PM_(2.5)at a concentration of 250μg/m3 daily for 3 hr for single(1 day)and multiple(7,14,21 days)durations.The major pathological changes noted in 21 days exposed myocardium comprised of an elevated ST segment(the segment between the S wave and the T wave),development of cardiac fibrosis,hypertrophy,cardiac injury,tissue inflammation and declined cardiac function.With 14 days exposed heart,the electrocardiograms(ECG),data showed insignificantly declined heart rate and an increased QT(the time from the start of the Q wave to the end of the T wave)interval along with mild fibrosis,hypertrophy and lesser number of TUNEL positive cells.On the other hand,single-and 7-days exposure to PM_(2.5)did not impart any significant changes in the myocardium.To determine the reversibility potential of PM_(2.5)induced cardiotoxicity,a washout period of 24 hours was adopted and all observed changes in the myocardium were reversed till day 7,but not in 14-and 21-days exposed samples.Based on the above findings we concluded that PM_(2.5)associated cardiac dysfunction is the cumulative outcome of ineffective cardiac adaptive and repair process that accumulate additively over the time due to prolonged exposure durations.
基金Supported by James Russell Hornsby and Jun Xiong Fund and United Imaging Healthcare.
文摘BACKGROUND A key cardiac magnetic resonance(CMR)challenge is breath-holding duration,difficult for cardiac patients.AIM To evaluate whether artificial intelligence-assisted compressed sensing CINE(AICS-CINE)reduces image acquisition time of CMR compared to conventional CINE(C-CINE).METHODS Cardio-oncology patients(n=60)and healthy volunteers(n=29)underwent sequential C-CINE and AI-CS-CINE with a 1.5-T scanner.Acquisition time,visual image quality assessment,and biventricular metrics(end-diastolic volume,endsystolic volume,stroke volume,ejection fraction,left ventricular mass,and wall thickness)were analyzed and compared between C-CINE and AI-CS-CINE with Bland–Altman analysis,and calculation of intraclass coefficient(ICC).RESULTS In 89 participants(58.5±16.8 years,42 males,47 females),total AI-CS-CINE acquisition and reconstruction time(37 seconds)was 84%faster than C-CINE(238 seconds).C-CINE required repeats in 23%(20/89)of cases(approximately 8 minutes lost),while AI-CS-CINE only needed one repeat(1%;2 seconds lost).AICS-CINE had slightly lower contrast but preserved structural clarity.Bland-Altman plots and ICC(0.73≤r≤0.98)showed strong agreement for left ventricle(LV)and right ventricle(RV)metrics,including those in the cardiac amyloidosis subgroup(n=31).AI-CS-CINE enabled faster,easier imaging in patients with claustrophobia,dyspnea,arrhythmias,or restlessness.Motion-artifacted C-CINE images were reliably interpreted from AI-CS-CINE.CONCLUSION AI-CS-CINE accelerated CMR image acquisition and reconstruction,preserved anatomical detail,and diminished impact of patient-related motion.Quantitative AI-CS-CINE metrics agreed closely with C-CINE in cardio-oncology patients,including the cardiac amyloidosis cohort,as well as healthy volunteers regardless of left and right ventricular size and function.AI-CS-CINE significantly enhanced CMR workflow,particularly in challenging cases.The strong analytical concordance underscores reliability and robustness of AI-CS-CINE as a valuable tool.
文摘BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.
文摘BACKGROUND Cardiac magnetic resonance(CMR)has been reported to identify myocardial damage inducing out-of-hospital cardiac arrest(OHCA).However,the usefulness of CMR may be affected by the medical institutions,patients’ages,and myocardial diseases.AIM To clarify the clinical usefulness and limitation of CMR for identifying myocardial damage in the survivors of OHCA in midtown.METHODS Nineteen patients underwent CMR to detect myocardial damage related to OHCA in the midtown of a capital city.Cine,T1 and T2 mapping,T2-weighted,and late gadolinium enhancement(LGE)imaging were acquired using a 1.5 T scanner.We described the clinical characteristics of the survivors of OHCA and evaluated usefulness of CMR for identifying myocardial damage related to OHCA.RESULTS Among 19 patients experiencing OHCA,7 experienced it in trains or on railway platforms,4 while practicing sports,and 4 during their daily work.Ten of the 19 survivors were diagnosed with coronary vasospasm(CVS),in whom CMR failed to depict its characteristic findings.CMR was useful for identifying myocardial damage associated with hypertrophic cardiomyopathy(HCM)or myocardial infarction(MI).LGE was related to serious ventricular arrhythmias after implantable cardioverter defibrillator(ICD)installation in 3 patients(CVS,2;HCM,1).CONCLUSION CMR is useful for identifying myocardial damage of HCM or MI inducing OHCA and predicting ventricular arrhythmias after ICD implantation but has limited capability for detecting myocardial damage of CVS.
文摘Sudden cardiac death(SCD)is one of the most devastating sequelae of myocardial diseases and can be the initial symptom in younger athletes or middle-aged busi-nesspeople.An implantable cardioverter defibrillator(ICD)prevents SCD and dramatically reduces the arrhythmic events in these patients;hence,the risk strati-fication for the SCD is important.In survivors of out-of-hospital cardiac arrest,identification of its etiologies is required to select the appropriate treat-ments following ICD installation.Cardiac magnetic resonance imaging(MRI)is useful for evaluating the morphology and function of the heart and for tissue character-ization,MRI can therefore be used to stratify the risk of SCD associated with various myocardial diseases and leads to primary prevention using ICD.MRI can predict arrhythmic events,which suggest the progression of myocardial damage,following secondary prevention.In this review,we provide a clinical and MRI focused update and MRI protocol for the primary and secondary prevention of SCD.We summarize the contribution and limitations of cardiac MRI for pre-vention SCD using ICD implantation.
文摘Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52.5 to 97.1 per 100,000 population.[1,2]Survival-to-discharge rates for OHCA and in-hospital cardiac arrest(IHCA)are not satisfactory,with ranges of 1.2%-9.9%and 9.1%-19.1%,respectively.
文摘BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances survival,the role of implantable cardioverter-defibrillators(ICDs)alongside CRT in patients with non-ischemic cardiomyopathy(NICM)remains controversial.To evaluate and compare the outcomes of CRT with ICD(CRT-D)versus CRT with pacemaker-only(CRT-P)in individuals diagnosed with NICM,with a specific focus on the elderly.METHODS A comprehensive search of PubMed,Embase,and the Cochrane Central Register of Controlled Trials was conducted in January 2024.Studies comparing CRT-D and CRT-P in patients with NICM were included,with subgroup analyses focusing on patients aged 75 years and older.RESULTS Twelve studies,including two randomized clinical trials,with a total of 62,145 patients and 16,754 pooled death events(9,171 in CRT-D and 7,583 in CRT-P),were analyzed.CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P(pooled OR=0.72;95%CI:0.61-0.85;P<0.01),with significant heterogeneity(I2=83%).RCT subgroup analysis,was not statistically significant(pooled OR=0.82;95%CI:0.64-1.06;P=0.41;I2=0%).In patients older than 75 years,no significant difference in mortality risk was observed(pooled OR 0.96;95%CI:0.81-1.15;I2=39%).CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality.However,this benefit does not extend to cardiovascular mortality,likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure.The survival advantage of CRT-D is most pronounced in younger patients,with those over 75 years of age deriving less benefit.This highlights the importance of careful patient selection,considering age and comorbidities,when deciding on ICD implantation in NICM patients.
基金supported by the Regional Science Foundation Project of the National Natural Science Foundation of China(Project No:82160157)the Beijing High-Level Public Health Technology Talent Construction Project(Project No.:Leading Talents-03-10).
文摘Cardiac arrest(CA)is considered a state of clinical death in which the heart suddenly loses its ability to effectively expel blood,resulting in circulatory and respiratory arrest.CA is often catastrophic for patients,as it can cause serious long-term cardiovascular and cerebrovascular complications that affect their quality of life[1].Survey data indicate that the overall incidence rate of intraoperative CA in patients undergoing thoracic surgery in China is currently 0.138%[2].This rate is expected to increase because of the increasing proportion of older individuals(age>60 years)in the population,as well as the increasing pulmonary surgery rates.However,the incidence rate during the perianesthetic period in older patients undergoing thoracic surgery has not yet been comprehensively reported.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘Coronary artery disease and aortic valve stenosis are highly prevalent cardio-vascular diseases worldwide,resulting in substantial morbidity and mortality.Surgical interventions,such as coronary artery bypass grafting and surgical aortic valve replacement,offer significant therapeutic benefits,including enhanced postoperative quality of life(QoL)and functional capacity,which are key indi-cators of surgical success.This editorial reviews recent studies on postoperative QoL and functional outcomes in patients undergoing cardiac surgery.Factors such as preoperative health,age,intensive care unit stay duration,surgical risk,and perioperative complications could influence these outcomes.Cardiac rehabil-itation is pivotal in enhancing patient function,reducing frailty and improving long-term QoL.
