BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental...BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.METHODS This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla.Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.RESULTS A greater percentage of parents whose child had a heart defect had anxiety symptoms(50.0%)than did those whose child had no heart defect(24.0%),and the difference in proportions was statistically significant(χ^(2)=7.250,P=0.007).A greater percentage of parents whose child had a heart defect had suicidal ideation(28.0%)than did those whose child had no heart defect(8.0%),and the difference in proportions was statistically significant(χ^(2)=6.775 P=0.009).A positive correlation was elicited between anxiety and suicide ideation,and this correlation was statistically significant(r=0.748,P<0.001).A positive correlation was elicited between depression and suicidal ideation scores,and this was statistically significant(r=0.617,P<0.001).CONCLUSION There is strong interconnectivity between anxiety and depression with suicidal ideation.There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide.In addition,policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.展开更多
BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend ...Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.展开更多
Heart disease remains a leading cause of mortality worldwide,emphasizing the urgent need for reliable and interpretable predictive models to support early diagnosis and timely intervention.However,existing Deep Learni...Heart disease remains a leading cause of mortality worldwide,emphasizing the urgent need for reliable and interpretable predictive models to support early diagnosis and timely intervention.However,existing Deep Learning(DL)approaches often face several limitations,including inefficient feature extraction,class imbalance,suboptimal classification performance,and limited interpretability,which collectively hinder their deployment in clinical settings.To address these challenges,we propose a novel DL framework for heart disease prediction that integrates a comprehensive preprocessing pipeline with an advanced classification architecture.The preprocessing stage involves label encoding and feature scaling.To address the issue of class imbalance inherent in the personal key indicators of the heart disease dataset,the localized random affine shadowsampling technique is employed,which enhances minority class representation while minimizing overfitting.At the core of the framework lies the Deep Residual Network(DeepResNet),which employs hierarchical residual transformations to facilitate efficient feature extraction and capture complex,non-linear relationships in the data.Experimental results demonstrate that the proposed model significantly outperforms existing techniques,achieving improvements of 3.26%in accuracy,3.16%in area under the receiver operating characteristics,1.09%in recall,and 1.07%in F1-score.Furthermore,robustness is validated using 10-fold crossvalidation,confirming the model’s generalizability across diverse data distributions.Moreover,model interpretability is ensured through the integration of Shapley additive explanations and local interpretable model-agnostic explanations,offering valuable insights into the contribution of individual features to model predictions.Overall,the proposed DL framework presents a robust,interpretable,and clinically applicable solution for heart disease prediction.展开更多
Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present majo...Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present major limitation.Mechanical valves require lifelong anticoagulation due to thrombogenicity,while bioprosthetic valves suffer from structural degeneration and limited durability.Polymeric Heart Valves(PHVs)have emerged as promising alternatives,aiming to integrate the mechanical resilience of synthetic materials with the biocompatibility and hemodynamic performance of natural valves.Recent studies have explored advanced polymers such as Polyhedral Oligomeric Silsesquioxane–Polycarbonate–Urea–Urethane(POSS-PCU),Silicone–Polyurethane Urea(SiPUU),and nanocomposites like Polyvinyl Alcohol(PVA)and SIBS for their enhanced thromboresistance,calcification resistance,and long-term mechanical durability.Complementary to material innovation,fabrication methods such as 3D printing,Melt Electrospinning Writing(MEW),and Focused Rotary Jet Spinning(FRJS)offer patient-specific designs and microstructural control.This review systematically compares traditional and next-generation prostheses,examines mechanical and biological performance,and discusses critical design challenges including porosity,thrombogenicity,and leaflet calcification.Finite Element Analysis(FEA)and Computational Fluid Dynamics(CFD)are highlighted for optimizing design and simulating physiological conditions.By presenting recent preclinical progress and manufacturing strategies,this review outlines a translational roadmap toward clinically viable,biomimetic polymeric heart valves capable of addressing the needs of both adult and pediatric patients.Compared to traditional bioprosthetic tissues,advanced polymers offer better resistance to calcification,reduced thrombogenicity,and tunable mechanical properties.展开更多
BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-...BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed.Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded.Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.RESULTS Data were available for 260 patients and 224 patients at 1-year and 3-year posttransplant respectively.At 1-year,abnormal hemodynamic parameters were common with 24%patients having right atrial pressure(RAP)>10 mmHg,52%with mean pulmonary artery pressure>20 mmHg,and 12%with pulmonary capillary wedge pressure(PCWP)>18 mmHg.Similar abnormalities were noted at 3-year post-transplant.Recipient body mass index(BMI)demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis(P<0.001 for both).Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.CONCLUSION Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.展开更多
BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hos...BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hospitalists.This study compared the impact of optimal medical therapy in HF(OMT-HF)certification on GDMT implementation and patient outcomes between an intervention group(IG)of hospitalists and a standard-of-care comparison group(SOC-CG).METHODS This study was implemented from November 2022 to May 2023.Hospitalized car-diology patients with HF and left ventricular ejection fraction≤40%were rando-mized to IG or SOC-CG.Exclusion criteria included patients in cardiogenic shock,unable to consent,or at high risk.Follow-up was at 30 days post-discharge.Diffe-rences between groups were analyzed using Fisher’s exact test for categorical va-riables and Wilcoxon rank-sum or unpaired t-test for continuous variables.Chan-ges in Minnesota Living with Heart Failure Questionnaire(MLWHFQ)scores were evaluated using a paired t-test.RESULTS IG patients had lower readmission rates[9(42.85%)vs 11(17.46%),P=0.03]and a decreased trend in mortality 30-day post discharge.IG patients also showed greater mean improvements in total(-27.03±24.59 vs-5.85±23.52,P<0.001),physical(-13.8±12.3 vs-2.71±11.16,P<0.001)and emotional(-4.76±8.10 vs-1.42±5.98)dimensions on the MLWHFQ compared to SOC-CG,however,change in emotional dimension did not reach statistical significance.CONCLUSION Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life,mortality and readmission rates.Larger prospective studies are warranted to validate these findings.展开更多
Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory proces...Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.展开更多
BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extraco...BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.展开更多
According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(C...According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.展开更多
Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and si...Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.展开更多
At an age when most teens are figuring out high school,Siddharth is already shaping the future of medical tech.The 14⁃year⁃old boy from Dallas has created an AI⁃powered app,Circadian AI,capable of detecting heart dise...At an age when most teens are figuring out high school,Siddharth is already shaping the future of medical tech.The 14⁃year⁃old boy from Dallas has created an AI⁃powered app,Circadian AI,capable of detecting heart disease in just 7 seconds using only a smartphone's microphone.展开更多
BACKGROUND Persistent sinus tachycardia affects up to 40%of patients after heart transplantation and is linked with graft dysfunction,impaired diastolic filling,and increased morbidity.Conventional rate-limiting thera...BACKGROUND Persistent sinus tachycardia affects up to 40%of patients after heart transplantation and is linked with graft dysfunction,impaired diastolic filling,and increased morbidity.Conventional rate-limiting therapies such as betablockers and calcium channel blockers are quite often contraindicated due to risks of bradyarrhythmia or hypotension.Ivabradine,a selective I(f)channel inhibitor,reduces heart rate(HR)without negative inotropic or hypotensive effects.AIM To evaluate the efficacy and safety of ivabradine in heart transplant recipients.METHODS A comprehensive search of PubMed,EMBASE,Scopus,Cochrane Library,and Google Scholar was conducted from inception to April 15,2025.Eligible studies evaluated ivabradine in heart transplant recipient vs placebo or metoprolol,reporting HR,mortality,left ventricular mass(LVM),or safety.Data were independently extracted by two reviewers,and quality was assessed.Review Manager 5.4 performed pooled analyses using random-effects models.Mean differences(MD)or standardized MD(SMD)were calculated for continuous outcomes,and risk ratios for dichotomous outcomes.RESULTS Of 415 records identified,four studies comprising 264 patients(126 ivabradine,138 control)met the inclusion criteria.Ivabradine significantly reduced resting HR compared with controls(MD=-11.06 beats per minute;95%CI:-19.50 to-2.62;P<0.00001;I^(2)=93%).Sensitivity analysis demonstrated consistent findings(SMD=-6.74;95%CI:-9.23 to-4.24;I^(2)=0%).No significant difference in all-cause mortality was observed(MD=0.52;95%CI:0.17-1.64;P=0.27;I^(2)=85%).Pooled analysis of LVM revealed no significant effect of ivabradine(MD=-3.57 g;95%CI:-29.21 to 22.08;P=0.79;I^(2)=73%),with sensitivity analysis confirming neutrality.Adverse events were rare and mostly comparable between groups.CONCLUSION Ivabradine reduces HR effectively in heart transplant recipients without added adverse outcomes,supporting its use as safe and well-tolerated alternative when conventional agents are unsuitable.Despite potential clinical benefit,small sample size and heterogeneity the need for larger randomized trials to confirm long-term outcomes and establish ivabradine’s role in post-transplant care.展开更多
In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complicati...In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.展开更多
Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when disc...Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when discussing falls as multiple factors associated with heart failure(HF)aetiology and treatment are assumedly implicated in falls occurrence.A retrospective study reported a 14%increased risk of falls among OPLHF,and prospective data has shown that up to 40%of HF patients may experience a fall within a year from diagnosis.展开更多
BACKGROUND Single-ventricle congenital heart disease often requires the Fontan procedure,which can lead to Fontan-associated liver disease(FALD)and multi-organ failure.Combined heart-liver transplantation(CHLT)is a po...BACKGROUND Single-ventricle congenital heart disease often requires the Fontan procedure,which can lead to Fontan-associated liver disease(FALD)and multi-organ failure.Combined heart-liver transplantation(CHLT)is a potential lifesaving option for these patients.AIMTo investigate the outcomes and complications of CHLT in patients with failing Fontan physiology.METHODSSeven retrospective studies of 121 patients undergoing CHLT were systematically reviewed. Quality was assessedwith the Newcastle-Ottawa Scale. A meta-analysis using random-effects models to calculate odds ratios (ORs) ormean differences (MDs) with 95% confidence intervals.RESULTSThe pooled 30-day, 1-year, 5-year, and 10-year survival rates after CHLT were 92.6%, 86.78%, 81.17%, and 77.8%,respectively. The mean intensive care unit and total hospital lengths of stay were 8.46 and 28.16 days. Meanischemic time was 267.29 minutes, while cardiopulmonary bypass time was 260.27 minutes. Infections (30%), renalreplacement therapy (36.84%), and graft rejection (12.34%) were notable complications. Compared to orthotopicheart transplantation (OHT), CHLT significantly reduced mortality (OR: 0.30, P = 0.009) and ischemic time (MD:–65.93 minutes), with no major differences in perioperative morbidity.CONCLUSIONCHLT offers a survival advantage over OHT for patients with FALD and failing Fontan physiology. Futureprospective studies are warranted to refine eligibility and improve long-term survival.展开更多
BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact...BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.METHODS The Organ Procurement and Transplant Network database was queried from 2006 to March 2024.Four groups were created stratifying by donor age(>55 years)and recipient age(>60 years).Kaplan-Meier curves and Cox regression models were used.RESULTS One thousand fifty out of 39868 transplants(2.6%)were performed utilizing hearts from older donors.The rate of older donor hearts in younger recipients was only 1.8%,while the older donor hearts were used 4.0%in older recipients(P<0.001).Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality[hazard ratio(HR):1.64(95%CI:1.42-1.90)and 1.42(95%CI:1.34-1.51)],while old donor/young recipient was not.Within each recipient age group,the older recipient groups showed greater differences in 1-and 5-year survival probabilities(80.4%and 67.4%with old donors,89.2%and 76.8%with young donors)than younger recipient groups(90.3%and 77.5%with old donors,92.2%and 80.3%with young donors).CONCLUSION This study demonstrates the higher utilization of older donor hearts(aged more than 55)in older recipients.Paradoxically,the combination of older donor hearts with older recipients is associated with a higher risk of mortality.However,these organs remain valuable options across all recipient age groups in current context of organ shortage.展开更多
文摘BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.METHODS This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla.Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.RESULTS A greater percentage of parents whose child had a heart defect had anxiety symptoms(50.0%)than did those whose child had no heart defect(24.0%),and the difference in proportions was statistically significant(χ^(2)=7.250,P=0.007).A greater percentage of parents whose child had a heart defect had suicidal ideation(28.0%)than did those whose child had no heart defect(8.0%),and the difference in proportions was statistically significant(χ^(2)=6.775 P=0.009).A positive correlation was elicited between anxiety and suicide ideation,and this correlation was statistically significant(r=0.748,P<0.001).A positive correlation was elicited between depression and suicidal ideation scores,and this was statistically significant(r=0.617,P<0.001).CONCLUSION There is strong interconnectivity between anxiety and depression with suicidal ideation.There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide.In addition,policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
基金supported by the Sanming Project of Medicine in Shenzhen[SZZYSM202206001]National Natural Science Foundation of China[82004320 and 82374383]+3 种基金Natural Science Foundation of Guangdong Province of China[2022A1515011710 and 2022A1515010679]Shenzhen Science and Technology Innovation Committee[JCYJ20220530141407017 and JCYJ20240813153619026]2024 High-quality Development Research Project of Shenzhen Bao’an Public Hospital[YNXM2024078]and Shenzhen Bao’an Chinese Medicine Hospital Research Program[BAZYY20220702].
文摘Background:“Qi deficiency”(a pathological state where the body’s vital energy(Qi)is insufficient or weakened,impairing physiological functions and diminishing the body’s ability to perform daily activities,defend against illness,and maintain homeostasis)syndrome is considered a critical syndrome in traditional Chinese medicine(TCM)and is associated with poor prognosis in heart failure(HF).This study investigates the clinical,metabolic,and transcriptomic differences between heart failure patients with and without Qi deficiency syndrome.Methods:56 heart failure patients were evaluated using a Qi deficiency syndrome scale and divided into Qi deficiency syndrome(QD)and non-Qi deficiency(non-QD)groups based on the median score.Clinical characteristics,including baseline N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),total diuretic use during hospitalization,and 90-day rehospitalization rates,were compared between the groups.Differentially expressed genes(DEGs)and differential metabolites were identified,followed by enrichment analyses and validation using qPCR and Western blot in AC16 cardiomyocytes.Results:QD patients exhibited significantly higher NT-proBNP levels,lower LVEF,and increased 90-day rehospitalization rates.Metabolomic profiling revealed lipid metabolism disruptions,notably in linoleic acid and phospholipid pathways.Transcriptomic analysis highlighted 17 DEGs,including CISD2,a critical mitochondrial regulator,which was downregulated in QD patients.Correlation analysis identified significant associations between DEGs(e.g.,CISD2,BPGM)and lipid metabolites such as PC(16:0/P-16:0).Functional knockdown of CISD2 in AC16 cells led to upregulation of lipid oxidation enzymes ALOX15 and CYP1A2,linking CISD2 dysfunction to lipid metabolic dysregulation.Conclusion:Qi deficiency is associated with more severe heart failure symptoms,worse prognosis,and distinct metabolic and transcriptomic profiles,particularly in lipid metabolism.CISD2 emerges as a potential therapeutic target,offering new avenues for integrating molecular insights with TCM approaches to optimize HF management.
基金funded by Ongoing Research Funding Program for Project number(ORF-2025-648),King Saud University,Riyadh,Saudi Arabia.
文摘Heart disease remains a leading cause of mortality worldwide,emphasizing the urgent need for reliable and interpretable predictive models to support early diagnosis and timely intervention.However,existing Deep Learning(DL)approaches often face several limitations,including inefficient feature extraction,class imbalance,suboptimal classification performance,and limited interpretability,which collectively hinder their deployment in clinical settings.To address these challenges,we propose a novel DL framework for heart disease prediction that integrates a comprehensive preprocessing pipeline with an advanced classification architecture.The preprocessing stage involves label encoding and feature scaling.To address the issue of class imbalance inherent in the personal key indicators of the heart disease dataset,the localized random affine shadowsampling technique is employed,which enhances minority class representation while minimizing overfitting.At the core of the framework lies the Deep Residual Network(DeepResNet),which employs hierarchical residual transformations to facilitate efficient feature extraction and capture complex,non-linear relationships in the data.Experimental results demonstrate that the proposed model significantly outperforms existing techniques,achieving improvements of 3.26%in accuracy,3.16%in area under the receiver operating characteristics,1.09%in recall,and 1.07%in F1-score.Furthermore,robustness is validated using 10-fold crossvalidation,confirming the model’s generalizability across diverse data distributions.Moreover,model interpretability is ensured through the integration of Shapley additive explanations and local interpretable model-agnostic explanations,offering valuable insights into the contribution of individual features to model predictions.Overall,the proposed DL framework presents a robust,interpretable,and clinically applicable solution for heart disease prediction.
文摘Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present major limitation.Mechanical valves require lifelong anticoagulation due to thrombogenicity,while bioprosthetic valves suffer from structural degeneration and limited durability.Polymeric Heart Valves(PHVs)have emerged as promising alternatives,aiming to integrate the mechanical resilience of synthetic materials with the biocompatibility and hemodynamic performance of natural valves.Recent studies have explored advanced polymers such as Polyhedral Oligomeric Silsesquioxane–Polycarbonate–Urea–Urethane(POSS-PCU),Silicone–Polyurethane Urea(SiPUU),and nanocomposites like Polyvinyl Alcohol(PVA)and SIBS for their enhanced thromboresistance,calcification resistance,and long-term mechanical durability.Complementary to material innovation,fabrication methods such as 3D printing,Melt Electrospinning Writing(MEW),and Focused Rotary Jet Spinning(FRJS)offer patient-specific designs and microstructural control.This review systematically compares traditional and next-generation prostheses,examines mechanical and biological performance,and discusses critical design challenges including porosity,thrombogenicity,and leaflet calcification.Finite Element Analysis(FEA)and Computational Fluid Dynamics(CFD)are highlighted for optimizing design and simulating physiological conditions.By presenting recent preclinical progress and manufacturing strategies,this review outlines a translational roadmap toward clinically viable,biomimetic polymeric heart valves capable of addressing the needs of both adult and pediatric patients.Compared to traditional bioprosthetic tissues,advanced polymers offer better resistance to calcification,reduced thrombogenicity,and tunable mechanical properties.
文摘BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed.Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded.Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.RESULTS Data were available for 260 patients and 224 patients at 1-year and 3-year posttransplant respectively.At 1-year,abnormal hemodynamic parameters were common with 24%patients having right atrial pressure(RAP)>10 mmHg,52%with mean pulmonary artery pressure>20 mmHg,and 12%with pulmonary capillary wedge pressure(PCWP)>18 mmHg.Similar abnormalities were noted at 3-year post-transplant.Recipient body mass index(BMI)demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis(P<0.001 for both).Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.CONCLUSION Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.
基金Supported by Houston Methodist DeBakey Heart and Vascular Center Grant.
文摘BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hospitalists.This study compared the impact of optimal medical therapy in HF(OMT-HF)certification on GDMT implementation and patient outcomes between an intervention group(IG)of hospitalists and a standard-of-care comparison group(SOC-CG).METHODS This study was implemented from November 2022 to May 2023.Hospitalized car-diology patients with HF and left ventricular ejection fraction≤40%were rando-mized to IG or SOC-CG.Exclusion criteria included patients in cardiogenic shock,unable to consent,or at high risk.Follow-up was at 30 days post-discharge.Diffe-rences between groups were analyzed using Fisher’s exact test for categorical va-riables and Wilcoxon rank-sum or unpaired t-test for continuous variables.Chan-ges in Minnesota Living with Heart Failure Questionnaire(MLWHFQ)scores were evaluated using a paired t-test.RESULTS IG patients had lower readmission rates[9(42.85%)vs 11(17.46%),P=0.03]and a decreased trend in mortality 30-day post discharge.IG patients also showed greater mean improvements in total(-27.03±24.59 vs-5.85±23.52,P<0.001),physical(-13.8±12.3 vs-2.71±11.16,P<0.001)and emotional(-4.76±8.10 vs-1.42±5.98)dimensions on the MLWHFQ compared to SOC-CG,however,change in emotional dimension did not reach statistical significance.CONCLUSION Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life,mortality and readmission rates.Larger prospective studies are warranted to validate these findings.
基金Supported by Wenzhou Science Technology Bureau Foundation,No.2022Y0726.
文摘Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.
文摘BACKGROUND Advanced heart failure and transplant(AHFTC)teams are crucial in the management of patients in cardiogenic shock.We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation(ECMO)support.AIM To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.METHODS We conducted a retrospective cohort study of 51 patients placed on veno-venous(VV)and veno-arterial(VA)ECMO between January 2015 and February 2023 at our institution.We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management,including patient selection.Our primary outcome measure was survival to 30 days post hospital discharge.RESULTS For combined VA and VV ECMO patients,survival to 30 days post discharge in the AHFTC cohort was significantly higher(67%vs 30%,P=0.01),largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group(64%vs 20%,P=0.05).CONCLUSION This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients.Further studies are needed to validate this impact.
文摘According to the Japanese Ministry of Health,Labour,and Welfare,14.2%of people were aged>75 years in Japan in 2018,and this number continues to rise.With population aging,the incidence of congestive heart failure(CHF)is also increasing.[1–3]Reports have shown that the presence of cognitive impairment(CI)in patients with CHF is associated with poor prognosis,[4–6]and the degree of CI is related to CHF severity.
文摘Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.
文摘At an age when most teens are figuring out high school,Siddharth is already shaping the future of medical tech.The 14⁃year⁃old boy from Dallas has created an AI⁃powered app,Circadian AI,capable of detecting heart disease in just 7 seconds using only a smartphone's microphone.
文摘BACKGROUND Persistent sinus tachycardia affects up to 40%of patients after heart transplantation and is linked with graft dysfunction,impaired diastolic filling,and increased morbidity.Conventional rate-limiting therapies such as betablockers and calcium channel blockers are quite often contraindicated due to risks of bradyarrhythmia or hypotension.Ivabradine,a selective I(f)channel inhibitor,reduces heart rate(HR)without negative inotropic or hypotensive effects.AIM To evaluate the efficacy and safety of ivabradine in heart transplant recipients.METHODS A comprehensive search of PubMed,EMBASE,Scopus,Cochrane Library,and Google Scholar was conducted from inception to April 15,2025.Eligible studies evaluated ivabradine in heart transplant recipient vs placebo or metoprolol,reporting HR,mortality,left ventricular mass(LVM),or safety.Data were independently extracted by two reviewers,and quality was assessed.Review Manager 5.4 performed pooled analyses using random-effects models.Mean differences(MD)or standardized MD(SMD)were calculated for continuous outcomes,and risk ratios for dichotomous outcomes.RESULTS Of 415 records identified,four studies comprising 264 patients(126 ivabradine,138 control)met the inclusion criteria.Ivabradine significantly reduced resting HR compared with controls(MD=-11.06 beats per minute;95%CI:-19.50 to-2.62;P<0.00001;I^(2)=93%).Sensitivity analysis demonstrated consistent findings(SMD=-6.74;95%CI:-9.23 to-4.24;I^(2)=0%).No significant difference in all-cause mortality was observed(MD=0.52;95%CI:0.17-1.64;P=0.27;I^(2)=85%).Pooled analysis of LVM revealed no significant effect of ivabradine(MD=-3.57 g;95%CI:-29.21 to 22.08;P=0.79;I^(2)=73%),with sensitivity analysis confirming neutrality.Adverse events were rare and mostly comparable between groups.CONCLUSION Ivabradine reduces HR effectively in heart transplant recipients without added adverse outcomes,supporting its use as safe and well-tolerated alternative when conventional agents are unsuitable.Despite potential clinical benefit,small sample size and heterogeneity the need for larger randomized trials to confirm long-term outcomes and establish ivabradine’s role in post-transplant care.
基金National High Level Hospital Clinical Research Funding(2022-PUMCH-B-098)CAMS Innovation Fund for Medical Sciences (2021-I2M-1-003)。
文摘In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure(HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.
文摘Falls remain a prevalent source of injury in daily life and underlying aetiology of falls are often complex and multi-factorial.[1,2]Older persons living with heart failure(OPLHF)are of a particular interest when discussing falls as multiple factors associated with heart failure(HF)aetiology and treatment are assumedly implicated in falls occurrence.A retrospective study reported a 14%increased risk of falls among OPLHF,and prospective data has shown that up to 40%of HF patients may experience a fall within a year from diagnosis.
文摘BACKGROUND Single-ventricle congenital heart disease often requires the Fontan procedure,which can lead to Fontan-associated liver disease(FALD)and multi-organ failure.Combined heart-liver transplantation(CHLT)is a potential lifesaving option for these patients.AIMTo investigate the outcomes and complications of CHLT in patients with failing Fontan physiology.METHODSSeven retrospective studies of 121 patients undergoing CHLT were systematically reviewed. Quality was assessedwith the Newcastle-Ottawa Scale. A meta-analysis using random-effects models to calculate odds ratios (ORs) ormean differences (MDs) with 95% confidence intervals.RESULTSThe pooled 30-day, 1-year, 5-year, and 10-year survival rates after CHLT were 92.6%, 86.78%, 81.17%, and 77.8%,respectively. The mean intensive care unit and total hospital lengths of stay were 8.46 and 28.16 days. Meanischemic time was 267.29 minutes, while cardiopulmonary bypass time was 260.27 minutes. Infections (30%), renalreplacement therapy (36.84%), and graft rejection (12.34%) were notable complications. Compared to orthotopicheart transplantation (OHT), CHLT significantly reduced mortality (OR: 0.30, P = 0.009) and ischemic time (MD:–65.93 minutes), with no major differences in perioperative morbidity.CONCLUSIONCHLT offers a survival advantage over OHT for patients with FALD and failing Fontan physiology. Futureprospective studies are warranted to refine eligibility and improve long-term survival.
基金Supported by The Jewel and Frank Benson Family Endowment.
文摘BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.METHODS The Organ Procurement and Transplant Network database was queried from 2006 to March 2024.Four groups were created stratifying by donor age(>55 years)and recipient age(>60 years).Kaplan-Meier curves and Cox regression models were used.RESULTS One thousand fifty out of 39868 transplants(2.6%)were performed utilizing hearts from older donors.The rate of older donor hearts in younger recipients was only 1.8%,while the older donor hearts were used 4.0%in older recipients(P<0.001).Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality[hazard ratio(HR):1.64(95%CI:1.42-1.90)and 1.42(95%CI:1.34-1.51)],while old donor/young recipient was not.Within each recipient age group,the older recipient groups showed greater differences in 1-and 5-year survival probabilities(80.4%and 67.4%with old donors,89.2%and 76.8%with young donors)than younger recipient groups(90.3%and 77.5%with old donors,92.2%and 80.3%with young donors).CONCLUSION This study demonstrates the higher utilization of older donor hearts(aged more than 55)in older recipients.Paradoxically,the combination of older donor hearts with older recipients is associated with a higher risk of mortality.However,these organs remain valuable options across all recipient age groups in current context of organ shortage.
