Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricl...Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricle(RV)is also affected by diabetes and may be independently responsible for adverse outcomes in diabetic patients with or without LV failure.Yu et al conducted a 30-week longitudinal evaluation of biventricular function and pathology in OVE26 diabetic mice and revealed early diastolic dysfunction preceding systolic decline,suggesting that early LV diastolic impairment precedes the later onset of systolic dysfunction.With age,the animals developed fibrosis,hypertrophy,and pulmonary arterial hypertension in the RV.The purpose of this editorial is to contextualize these findings within the existing literature by highlighting the interplay between cardiac chambers and the vasculature.We also seek to reiterate that DCM is a condition extending beyond left ventricular dysfunction.As the authors note,the right side of the heart may remain"the forgotten ventricle"in diabetic patients.We hope that the mechanisms discussed in this paper will help researchers to understand the pathogenesis of cardiovascular disease in this context and encourage clinicians to be more attentive to the associated clinical symptoms.展开更多
This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,e...This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,emphasizing innovative strategies like bioabsorbable occluders and tissue engineering to reduce complications and improve prognosis.The integration of artificial intelligence and big data analytics for treatment decision-making and personalized surgical timing models is highlighted as transformative.Our analysis underscores the need for early diagnosis and tailored interventions,proposing future research directions in molecular mechanisms,multidisciplinary collaboration,and technology integration.These innovations promise to enhance VSR management and extend to other cardiovascular diseases,heralding a new era of precision and regenerative cardiovascular medicine.展开更多
Background:Left atrioventricular coupling index(LACI)is a promising marker for predicting major adverse cardiac events in individuals with acute ST-segment elevation myocardial infarction(STEMI).However,the relationsh...Background:Left atrioventricular coupling index(LACI)is a promising marker for predicting major adverse cardiac events in individuals with acute ST-segment elevation myocardial infarction(STEMI).However,the relationship between LACI and adverse left ventricular(LV)remodeling(ALVR)in patients with STEMI remains to be fully elucidated.Methods:In this retrospective study,143 patients with STEMI who had undergone primary percutaneous coronary inter-vention(PCI)underwent cardiovascular magnetic resonance(CMR)imaging.The examinations were performed at 5±2 days(baseline)after PCI and at 6 months after STEMI.Left atrial and LV structural and functional indicators were evaluated.ALVR was defined as an increase of≥20%in LV end-diastolic volume(LVEDV)or an increase of≥15%in LV end-systolic volume at 6 months on CMR images.The patients were divided into two groups depending on the presence or absence of ALVR,and the CMR features were compared between the two groups.Results:Overall,51 patients(mean age 57±11 years;42 men)experienced ALVR after 6 months.In the univariable regression analysis,LVEDV index and LACI were significantly correlated with ALVR(odds ratio[OR]:0.989,95%confidence interval[CI]:0.979-0.999,p=0.025;OR:1.046,95%CI:1.012-1.080,p=0.007,respectively).Following adjustment for fundamental clinical variables,multivariate logistic regression analysis showed that baseline LACI was an independent predictor of ALVR at 6 months(OR:1.324,95%CI:1.055-1.662,p=0.016).Conclusions:CMR-derived LACI in patients with acute STEMI was an independent predictor of ALVR.展开更多
Takotsubo syndrome(TTS),also known as stress cardiomyopathy,occurs in approximately 2%of all patients presenting with suspected acute coronary syndrome.[1]The in-hospital mortality rate of pati-ents with TTS is report...Takotsubo syndrome(TTS),also known as stress cardiomyopathy,occurs in approximately 2%of all patients presenting with suspected acute coronary syndrome.[1]The in-hospital mortality rate of pati-ents with TTS is reported to be approximately 4%-5%.[2]This condition is commonly associated with various rhythm and conduction disturbances,such as atrial fibrillation(5%-15%),ventricular arrhythmias(4%-9%),and rarely sinus node dysfunction(1.3%).展开更多
BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden ...BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup-cholesterol and other material-on their inner walls.As a result,the heart muscle cannot receive the blood or oxygen it needs.Most heart attacks happen when a blood clot suddenly cuts off the hearts'blood supply,causing permanent heart damage.AIM To analyze the relationship between the left ventricular ejection fraction(LVEF),left ventricular strain(LVS),and coronary stenosis.METHODS A total of 190 participants were enrolled in this trail.The control group comprised 93 healthy individuals,and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021.Coronary lesions were assessed using the Gensini score,and the LVEF and LVS were measured using magnetic resonance imaging(MRI).The interaction between the LVEF and LVS was examined using a linear regression model.The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.RESULTS The LVEF of the observation group was lower than that of the control group.The left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)of the observation group were significantly higher than those of the control group(P<0.05).The longitudinal and circumferential strains(LS,CS)of the observation group were significantly higher than those of the control group;however,the radial strain(RS)of the observation group was significantly lower than that of the control group(P<0.05).LVS,LS,and CS were significantly negatively correlated with the LVEF,and RS was positively correlated with the LVEF.There were significant differences in the LVEF,LVESV,and LVEDV of patients with different Gensini scores;the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores(P<0.05).In the observation group,the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis(P<0.05).CONCLUSION The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.展开更多
Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathologi...Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathological process of ARVC,its exact contribution to cardiac fibrosis in ARVC remains unclear.In this study,we analyzed the potential contribution of gender-based differences on the distribution of the low-voltage area in an ARVC cohort undergoing an electrophysiological study,which was indicated by feature selection.Additionally,we established engineered cardiac spheroid models in vitro using patient-specific induced pluripotent stem cell(iPSC)-derived cardiomyocytes(iPSC-CMs)and iPSC-derived cardiac fibroblasts(icFBs).We elucidated the pathogenicity of abnormal splicing in the plakophilin-2(PKP2)gene caused by an intronic mutation.Additionally,pathogenic validation of the desmoglein-2(DSG2)point mutation further confirms the reliability of the models.Moreover,testosterone exacerbated the DNA damage in the mutated cardiomyocytes and further activated myofibroblasts in a chain reaction.In conclusion,we designed and constructed an in vitro three-dimensionally-engineered cardiac spheroid model of ARVC based on clinical findings and provided direct evidence of the fibrotic role of testosterone in ARVC.展开更多
Left ventricular assist device (LVAD) is being used increasingly in recent years for end stage heart failure as a bridge to transplant (BTT) and also as a destination therapy (DT). Patients with end stage heart failur...Left ventricular assist device (LVAD) is being used increasingly in recent years for end stage heart failure as a bridge to transplant (BTT) and also as a destination therapy (DT). Patients with end stage heart failure have some degree of elevated pulmonary capillary wedge pressure, causing right ventricular hypertrophy which in due course leads to decreased dilatation of the RV and fall in cardiac output & severe tricuspid regurgitation (TR) presenting with features of RV failure (RVF). Implantation of LVAD improves left heart function at the cost of right ventricular output with an incidence of 25%-30%. RVF may lead to impaired LVAD flow, difficulty in weaning from cardio-pulmonary bypass (CPB), decreased tissue perfusion and multi-organ failure. In this article we comprehended the pathophysiology leading to RVF post LVAD implantation and its preoperative predictors and the various treatment modalities for managing RVF post LVAD implantation.展开更多
Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are...Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are commonly encountered in the intensive care unit(ICU).Conditions such as acute respiratory distress syndrome,pulmonary embolism,and decompensated pulmonary arterial hypertension are associated with acute and acute-on-chronic RV failure.In the ICU,RV failure may develop or worsen in patients with parenchymal pulmonary disease who acutely experience fluctuations in preload,excessive afterload,and/or insufficient myocardial contractility,often in addition to mechanical ventilation and circulatory compromise.This dynamic clinical scenario demands early recognition and intervention tailored to an individual patient’s physiology.Distinguishing between acute and chronic RV failure in critical illness informs diagnostic workup,hemodynamic monitoring,and resuscitative efforts.This narrative review will provide an overview of common conditions associated with RV failure in critical illness,highlighting a practical,physiology-oriented approach to diagnosis and optimization of ventilator support,fluid resuscitation,vasopressor and inotrope use,and mechanical circulatory support.RV failure due to RV infarction or severe LV failure and decompensated congenital heart disease are distinct pathophysiologic entities.These conditions require distinct treatment approaches and are beyond the scope of this review.展开更多
BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and he...BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.展开更多
This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interve...This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interventions and asse-ssing treatment outcomes.Cranial ultrasound and magnetic resonance imaging(MRI)are the primary imaging modalities,providing critical insights into ventri-cular size,cerebrospinal fluid dynamics,and neurodevelopmental implications.Key parameters,including Evans’index,Levene’s index,and the Cella Media index,as well as volumetric and diffusion-based MRI techniques,have been explored for their diagnostic and prognostic value.Advances in automated image analysis and artificial intelligence have further improved measurement precision and reproducibility.Despite these developments,challenges remain in standar-dizing imaging protocols and establishing normative reference values across different pediatric populations.This review highlights the strengths and limita-tions of current imaging approaches,emphasizing the need for consistent metho-dologies to enhance diagnostic accuracy and optimize patient management in hydrocephalus.展开更多
Chlorfenapyr poisoning is associated with high mortality due to the absence of evidence-based treatment strategies or specific antidotes.[1,2]Chlorfenapyr is a novel N-substituted halogenated pyrrole pro-insecticide.T...Chlorfenapyr poisoning is associated with high mortality due to the absence of evidence-based treatment strategies or specific antidotes.[1,2]Chlorfenapyr is a novel N-substituted halogenated pyrrole pro-insecticide.The active metabolite of tralopyril(a metabolite of chlorfenapyr)can uncouple oxidative phosphorylation and impair adenosine triphosphate(ATP)production.[3]Blood purification techniques,including hemoperfusion(HP),may facilitate tralopyril clearance.[4,5]Here,we present a case of severe chlorfenapyr poisoning that was treated with intensive HP.H owever,during follow-up,we unexpectedly found a ventricular aneurysm in the left ventricle that was not fully explained by coronary artery lesions.展开更多
BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exa...BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.展开更多
BACKGROUND Right ventricular hypertrophy(RVH)occurs because of volume or pressure overload within the right ventricular(RV)system.RVH is associated with complex pathological changes,including myocardial cell injury,ap...BACKGROUND Right ventricular hypertrophy(RVH)occurs because of volume or pressure overload within the right ventricular(RV)system.RVH is associated with complex pathological changes,including myocardial cell injury,apoptosis,myocardial fibrosis,neuroendocrine disturbances,and abnormal water and liquid metabolism.Ferroptosis,a novel type of iron-dependent cell death characterized by lipid peroxide accumulation,is an important mechanism of cardiomyocyte death.However,the role of ferroptosis in RVH has rarely been studied.We hypothesize that hydrogen(H_(2)),an experimental medical gas with superior distri-bution characteristics,inhibits ferroptosis.AIM To explore the protective effect of H_(2) on RVH and the mechanism by which H_(2) regulates ferroptosis.METHODS An in vivo RVH rat model was induced by monocrotaline(MCT)in 30 male Sprague-Dawley rats.An H9C2 cell model was treated with angiotensin II to simulate pressure overload in the RV system in vitro.H_(2) was administered to rats by inhalation(2%for 3 hours daily for 21 days)and added to the cell culture medium.The Nrf2 inhibitor ML385(1μM)was used to investigate anti-ferroptotic mechanisms.RESULTS In MCT-treated rats,H_(2) inhalation decreased RVH;the RV wall thickness decreased from 3.5±0.3 mm to 2.8±0.2 mm(P<0.05)and the RV ejection fraction increased from 45±3%to 52±4%(P<0.05).In H9C2 cells,H_(2) alleviated hypertrophy.H_(2) inhibited ferroptosis by modulating the iron content,oxidative stress,and ferroptosis-related proteins,thereby restoring the Nrf2/HO-1 signaling pathway.CONCLUSION H_(2) retards RVH by inhibiting ferroptosis via Nrf2/HO-1 restoration,suggesting a new treatment strategy.展开更多
BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systo...BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systolic dysfunction(LVSD).In patients with type 2 diabetes(DM2)albuminuria is a predictor of symptomatic heart failure,but data on the relationship between GLS and albuminuria are conflicting.AIM To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.METHODS The study was performed on DM2 patients consecutively enrolled in the TESEO study.Patients with symptoms/signs of heart failure,EF<50%,coronary artery,other cardiac diseases,or non-adequate acoustic window for GLS assessment were excluded.We collected clinical data,screened for complications,and measured GLS by speckle-tracking echocardiography.Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS.Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed(GLS>-18%)LVSD.RESULTS Patients(n=193,age:60.6±8.1,male:57%)had a short DM2 duration(3.8±4.9 years)and good metabolic control(glycated haemoglobin A1c:6.5%±1.0).Preclinical GLS-LVSD was present in 21.8%of the patients.GLS values were significantly higher in patients with albuminuria(-19.88±2.16 vs-18.29±2.99,P<0.001)and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS.In logistic regression analysis,albuminuria was associated with a 6.01(95%confidence interval:1.874-19.286)increased odds ratio of GLS-LVSD,independent of age,sex,diastolic blood pressure,chronic kidney disease,EF,mitral annulus velocity lateral,uric acid,and treatments.CONCLUSION Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.展开更多
The innovative study by Zhang et al published in the World Journal of Cardiology focused on predicting 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture at high al...The innovative study by Zhang et al published in the World Journal of Cardiology focused on predicting 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture at high altitudes.Based on a retrospective analysis of 48 patients from Yunnan Province,China,the authors identified four independent predictors of mortality:Age;Elevated uric acid levels;Interleukin-6 and decreased hemoglobin.Integrating these factors into a nomogram demonstrated high predictive accuracy(area under the curve=0.939).This model addressed the critical challenge of risk stratification in the resource-limited settings typical of high-altitude areas.This editorial underscored the practical value of the nomogram for timely identification of candidates for intensive therapy and surgical intervention while emphasizing the need for model validation in multicenter cohorts to optimize the management of these patients.展开更多
BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male pa...BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.展开更多
Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complica...Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.展开更多
Background:Although Cone reconstruction has been shown to improve biventricular functionover time,postoperative right ventricular dysfunction(RVD)is frequently observed,signiffcantly affectingreoperation and long-term...Background:Although Cone reconstruction has been shown to improve biventricular functionover time,postoperative right ventricular dysfunction(RVD)is frequently observed,signiffcantly affectingreoperation and long-term prognosis.This study aims to identify the predictors for postoperative RVD.Methods:This retrospective cohort study included 51 patients with Ebstein’s anomaly who underwentthe Cone reconstruction.RVD was deffned as right ventricular fractional area change(RV-FAC)lessthan 35%and tricuspid annular plane systolic excursion(TAPSE)less than 17 mm through pre-dischargeechocardiography.Univariate and multivariate analyses were used to analyze the pre-operative predictors.Results:The median age at surgery was 37.7(±15.3)years,RVD was documented in 25 patients(49%)of the51 patients.Patients with RVD had signiffcantly higher right ventricular end-systolic volume index(RVESVi)(p=0.001),right ventricular end-diastolic volume index(RVEDVi)(p=0.03),and septal leaffet displacement(p=0.003).Multivariate analysis conffrmed that septal leaffet displacement was independently associatedwith postoperative RVD(p=0.02).Additionally,RVD was not related to the cardiopulmonary bypass time,ICU stay and total hospital time.Conclusions:This study suggests that preoperative right ventricularejection fraction(RVEF)reduction,severe septal leaffet displacement and signiffcant right ventriculardilatation are key predictors of early postoperative RVD.RVD may exacerbate tricuspid regurgitation,andthis ffnding indicates that predicting RVD may aid in identifying high-risk patients prone to recurrence oftricuspid regurgitation after Cone reconstruction.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
BACKGROUND Acute myocardial infarction(AMI)combined with ventricular septal perforation(VSR)is still a highly fatal condition in the era of reperfusion therapy.The incidence rate has decreased to 0.2%-0.4%due to the p...BACKGROUND Acute myocardial infarction(AMI)combined with ventricular septal perforation(VSR)is still a highly fatal condition in the era of reperfusion therapy.The incidence rate has decreased to 0.2%-0.4%due to the popularization of percutaneous coronary intervention.However,the risk is significantly increased for those who fail to undergo revascularization in time,and the mortality rate remains high.The current core contradiction in clinical practice lies in the selection of surgical timing,and the disparity in medical resources significantly affects prognosis.There is an urgent need to optimize the identification of high-risk populations and individualized treatment strategies.AIM To investigate the clinical features,determine the prognostic factors,and develop a predictive model for 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture(AMI-VSR)residing in high-altitude regions.METHODS This study retrospectively analyzed 48 AMI-VSR patients admitted to a Yunnan hospital from 2017 to 2024,with the establishment of survival(n=30)and mortality(n=18)groups based on patients’survival status.Risk factors were identified by univariate and multivariate logistic regression analyses.A nomogram model was developed using R software and validated via receiver operating characteristic(ROC)analysis and calibration curves.RESULTS Age,uric acid(UA),interleukin-6(IL-6),and low hemoglobin(Hb)were independent risk factors for 30-day mortality(odds ratios:1.147,1.006,1.034,and 0.941,respectively;P<0.05).The nomogram demonstrated excellent discrimination(area under the ROC curve=0.939)and calibration(Hosmer-Lemeshowχ²=2.268,P=0.971).In addition,patients’poor outcomes could be synergistically predicted by IL-6 and UA,advanced age,and reduced Hb.CONCLUSION This study highlights age,UA,IL-6,and Hb as critical predictors of mortality in AMI-VSR patients at high altitudes.The validated nomogram provides a practical tool for early risk stratification and tailored interventions,addressing gaps in managing this high-risk population in resource-limited settings.展开更多
文摘Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricle(RV)is also affected by diabetes and may be independently responsible for adverse outcomes in diabetic patients with or without LV failure.Yu et al conducted a 30-week longitudinal evaluation of biventricular function and pathology in OVE26 diabetic mice and revealed early diastolic dysfunction preceding systolic decline,suggesting that early LV diastolic impairment precedes the later onset of systolic dysfunction.With age,the animals developed fibrosis,hypertrophy,and pulmonary arterial hypertension in the RV.The purpose of this editorial is to contextualize these findings within the existing literature by highlighting the interplay between cardiac chambers and the vasculature.We also seek to reiterate that DCM is a condition extending beyond left ventricular dysfunction.As the authors note,the right side of the heart may remain"the forgotten ventricle"in diabetic patients.We hope that the mechanisms discussed in this paper will help researchers to understand the pathogenesis of cardiovascular disease in this context and encourage clinicians to be more attentive to the associated clinical symptoms.
基金Supported by Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,China,No.202401AY070001-164Yunnan Provincial Department of Science and Technology Science and Technology Plan Project—Major Science and Technology Special Projects,No.202405AJ310003.
文摘This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,emphasizing innovative strategies like bioabsorbable occluders and tissue engineering to reduce complications and improve prognosis.The integration of artificial intelligence and big data analytics for treatment decision-making and personalized surgical timing models is highlighted as transformative.Our analysis underscores the need for early diagnosis and tailored interventions,proposing future research directions in molecular mechanisms,multidisciplinary collaboration,and technology integration.These innovations promise to enhance VSR management and extend to other cardiovascular diseases,heralding a new era of precision and regenerative cardiovascular medicine.
基金supported by the National Natural Science Foundation of China(Grant 82471937)Beijing Hospitals Authority Youth Programme(Grant QML20230610).
文摘Background:Left atrioventricular coupling index(LACI)is a promising marker for predicting major adverse cardiac events in individuals with acute ST-segment elevation myocardial infarction(STEMI).However,the relationship between LACI and adverse left ventricular(LV)remodeling(ALVR)in patients with STEMI remains to be fully elucidated.Methods:In this retrospective study,143 patients with STEMI who had undergone primary percutaneous coronary inter-vention(PCI)underwent cardiovascular magnetic resonance(CMR)imaging.The examinations were performed at 5±2 days(baseline)after PCI and at 6 months after STEMI.Left atrial and LV structural and functional indicators were evaluated.ALVR was defined as an increase of≥20%in LV end-diastolic volume(LVEDV)or an increase of≥15%in LV end-systolic volume at 6 months on CMR images.The patients were divided into two groups depending on the presence or absence of ALVR,and the CMR features were compared between the two groups.Results:Overall,51 patients(mean age 57±11 years;42 men)experienced ALVR after 6 months.In the univariable regression analysis,LVEDV index and LACI were significantly correlated with ALVR(odds ratio[OR]:0.989,95%confidence interval[CI]:0.979-0.999,p=0.025;OR:1.046,95%CI:1.012-1.080,p=0.007,respectively).Following adjustment for fundamental clinical variables,multivariate logistic regression analysis showed that baseline LACI was an independent predictor of ALVR at 6 months(OR:1.324,95%CI:1.055-1.662,p=0.016).Conclusions:CMR-derived LACI in patients with acute STEMI was an independent predictor of ALVR.
文摘Takotsubo syndrome(TTS),also known as stress cardiomyopathy,occurs in approximately 2%of all patients presenting with suspected acute coronary syndrome.[1]The in-hospital mortality rate of pati-ents with TTS is reported to be approximately 4%-5%.[2]This condition is commonly associated with various rhythm and conduction disturbances,such as atrial fibrillation(5%-15%),ventricular arrhythmias(4%-9%),and rarely sinus node dysfunction(1.3%).
文摘BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup-cholesterol and other material-on their inner walls.As a result,the heart muscle cannot receive the blood or oxygen it needs.Most heart attacks happen when a blood clot suddenly cuts off the hearts'blood supply,causing permanent heart damage.AIM To analyze the relationship between the left ventricular ejection fraction(LVEF),left ventricular strain(LVS),and coronary stenosis.METHODS A total of 190 participants were enrolled in this trail.The control group comprised 93 healthy individuals,and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021.Coronary lesions were assessed using the Gensini score,and the LVEF and LVS were measured using magnetic resonance imaging(MRI).The interaction between the LVEF and LVS was examined using a linear regression model.The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.RESULTS The LVEF of the observation group was lower than that of the control group.The left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)of the observation group were significantly higher than those of the control group(P<0.05).The longitudinal and circumferential strains(LS,CS)of the observation group were significantly higher than those of the control group;however,the radial strain(RS)of the observation group was significantly lower than that of the control group(P<0.05).LVS,LS,and CS were significantly negatively correlated with the LVEF,and RS was positively correlated with the LVEF.There were significant differences in the LVEF,LVESV,and LVEDV of patients with different Gensini scores;the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores(P<0.05).In the observation group,the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis(P<0.05).CONCLUSION The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.
基金supported by the National Natural Science Foundation of China(Nos.82370322 to CC,82200352 to FZ,82300352 to YZ,22275034 to HX,and 82070343 to MLC)the Natural Science Foundation of Jiangsu Province of China(Nos.BK20220710 to FZ and BK20230733 to YZ)Postgraduate Research&Practice Innovation Program of Jiangsu Province(No.JX13414086 to HYC).
文摘Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathological process of ARVC,its exact contribution to cardiac fibrosis in ARVC remains unclear.In this study,we analyzed the potential contribution of gender-based differences on the distribution of the low-voltage area in an ARVC cohort undergoing an electrophysiological study,which was indicated by feature selection.Additionally,we established engineered cardiac spheroid models in vitro using patient-specific induced pluripotent stem cell(iPSC)-derived cardiomyocytes(iPSC-CMs)and iPSC-derived cardiac fibroblasts(icFBs).We elucidated the pathogenicity of abnormal splicing in the plakophilin-2(PKP2)gene caused by an intronic mutation.Additionally,pathogenic validation of the desmoglein-2(DSG2)point mutation further confirms the reliability of the models.Moreover,testosterone exacerbated the DNA damage in the mutated cardiomyocytes and further activated myofibroblasts in a chain reaction.In conclusion,we designed and constructed an in vitro three-dimensionally-engineered cardiac spheroid model of ARVC based on clinical findings and provided direct evidence of the fibrotic role of testosterone in ARVC.
文摘Left ventricular assist device (LVAD) is being used increasingly in recent years for end stage heart failure as a bridge to transplant (BTT) and also as a destination therapy (DT). Patients with end stage heart failure have some degree of elevated pulmonary capillary wedge pressure, causing right ventricular hypertrophy which in due course leads to decreased dilatation of the RV and fall in cardiac output & severe tricuspid regurgitation (TR) presenting with features of RV failure (RVF). Implantation of LVAD improves left heart function at the cost of right ventricular output with an incidence of 25%-30%. RVF may lead to impaired LVAD flow, difficulty in weaning from cardio-pulmonary bypass (CPB), decreased tissue perfusion and multi-organ failure. In this article we comprehended the pathophysiology leading to RVF post LVAD implantation and its preoperative predictors and the various treatment modalities for managing RVF post LVAD implantation.
文摘Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are commonly encountered in the intensive care unit(ICU).Conditions such as acute respiratory distress syndrome,pulmonary embolism,and decompensated pulmonary arterial hypertension are associated with acute and acute-on-chronic RV failure.In the ICU,RV failure may develop or worsen in patients with parenchymal pulmonary disease who acutely experience fluctuations in preload,excessive afterload,and/or insufficient myocardial contractility,often in addition to mechanical ventilation and circulatory compromise.This dynamic clinical scenario demands early recognition and intervention tailored to an individual patient’s physiology.Distinguishing between acute and chronic RV failure in critical illness informs diagnostic workup,hemodynamic monitoring,and resuscitative efforts.This narrative review will provide an overview of common conditions associated with RV failure in critical illness,highlighting a practical,physiology-oriented approach to diagnosis and optimization of ventilator support,fluid resuscitation,vasopressor and inotrope use,and mechanical circulatory support.RV failure due to RV infarction or severe LV failure and decompensated congenital heart disease are distinct pathophysiologic entities.These conditions require distinct treatment approaches and are beyond the scope of this review.
文摘BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.
文摘This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interventions and asse-ssing treatment outcomes.Cranial ultrasound and magnetic resonance imaging(MRI)are the primary imaging modalities,providing critical insights into ventri-cular size,cerebrospinal fluid dynamics,and neurodevelopmental implications.Key parameters,including Evans’index,Levene’s index,and the Cella Media index,as well as volumetric and diffusion-based MRI techniques,have been explored for their diagnostic and prognostic value.Advances in automated image analysis and artificial intelligence have further improved measurement precision and reproducibility.Despite these developments,challenges remain in standar-dizing imaging protocols and establishing normative reference values across different pediatric populations.This review highlights the strengths and limita-tions of current imaging approaches,emphasizing the need for consistent metho-dologies to enhance diagnostic accuracy and optimize patient management in hydrocephalus.
基金supported by the National Key Research and Development Program of China(2023YFC3603100 and 2023YFC3603105)"Leading Goose"R&D Program of Zhejiang(2022C03076-4).
文摘Chlorfenapyr poisoning is associated with high mortality due to the absence of evidence-based treatment strategies or specific antidotes.[1,2]Chlorfenapyr is a novel N-substituted halogenated pyrrole pro-insecticide.The active metabolite of tralopyril(a metabolite of chlorfenapyr)can uncouple oxidative phosphorylation and impair adenosine triphosphate(ATP)production.[3]Blood purification techniques,including hemoperfusion(HP),may facilitate tralopyril clearance.[4,5]Here,we present a case of severe chlorfenapyr poisoning that was treated with intensive HP.H owever,during follow-up,we unexpectedly found a ventricular aneurysm in the left ventricle that was not fully explained by coronary artery lesions.
文摘BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.
文摘BACKGROUND Right ventricular hypertrophy(RVH)occurs because of volume or pressure overload within the right ventricular(RV)system.RVH is associated with complex pathological changes,including myocardial cell injury,apoptosis,myocardial fibrosis,neuroendocrine disturbances,and abnormal water and liquid metabolism.Ferroptosis,a novel type of iron-dependent cell death characterized by lipid peroxide accumulation,is an important mechanism of cardiomyocyte death.However,the role of ferroptosis in RVH has rarely been studied.We hypothesize that hydrogen(H_(2)),an experimental medical gas with superior distri-bution characteristics,inhibits ferroptosis.AIM To explore the protective effect of H_(2) on RVH and the mechanism by which H_(2) regulates ferroptosis.METHODS An in vivo RVH rat model was induced by monocrotaline(MCT)in 30 male Sprague-Dawley rats.An H9C2 cell model was treated with angiotensin II to simulate pressure overload in the RV system in vitro.H_(2) was administered to rats by inhalation(2%for 3 hours daily for 21 days)and added to the cell culture medium.The Nrf2 inhibitor ML385(1μM)was used to investigate anti-ferroptotic mechanisms.RESULTS In MCT-treated rats,H_(2) inhalation decreased RVH;the RV wall thickness decreased from 3.5±0.3 mm to 2.8±0.2 mm(P<0.05)and the RV ejection fraction increased from 45±3%to 52±4%(P<0.05).In H9C2 cells,H_(2) alleviated hypertrophy.H_(2) inhibited ferroptosis by modulating the iron content,oxidative stress,and ferroptosis-related proteins,thereby restoring the Nrf2/HO-1 signaling pathway.CONCLUSION H_(2) retards RVH by inhibiting ferroptosis via Nrf2/HO-1 restoration,suggesting a new treatment strategy.
基金Supported by the Italian Ministry for Education,University and Research under the Programme“Dipartimenti di Eccellenza 2018-2022”Project,No.D15D18000410001Novo Nordisk“Gestione delle complicanze croniche del diabete:From bedside to bench?”,No.n1/2021.
文摘BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systolic dysfunction(LVSD).In patients with type 2 diabetes(DM2)albuminuria is a predictor of symptomatic heart failure,but data on the relationship between GLS and albuminuria are conflicting.AIM To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.METHODS The study was performed on DM2 patients consecutively enrolled in the TESEO study.Patients with symptoms/signs of heart failure,EF<50%,coronary artery,other cardiac diseases,or non-adequate acoustic window for GLS assessment were excluded.We collected clinical data,screened for complications,and measured GLS by speckle-tracking echocardiography.Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS.Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed(GLS>-18%)LVSD.RESULTS Patients(n=193,age:60.6±8.1,male:57%)had a short DM2 duration(3.8±4.9 years)and good metabolic control(glycated haemoglobin A1c:6.5%±1.0).Preclinical GLS-LVSD was present in 21.8%of the patients.GLS values were significantly higher in patients with albuminuria(-19.88±2.16 vs-18.29±2.99,P<0.001)and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS.In logistic regression analysis,albuminuria was associated with a 6.01(95%confidence interval:1.874-19.286)increased odds ratio of GLS-LVSD,independent of age,sex,diastolic blood pressure,chronic kidney disease,EF,mitral annulus velocity lateral,uric acid,and treatments.CONCLUSION Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.
文摘The innovative study by Zhang et al published in the World Journal of Cardiology focused on predicting 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture at high altitudes.Based on a retrospective analysis of 48 patients from Yunnan Province,China,the authors identified four independent predictors of mortality:Age;Elevated uric acid levels;Interleukin-6 and decreased hemoglobin.Integrating these factors into a nomogram demonstrated high predictive accuracy(area under the curve=0.939).This model addressed the critical challenge of risk stratification in the resource-limited settings typical of high-altitude areas.This editorial underscored the practical value of the nomogram for timely identification of candidates for intensive therapy and surgical intervention while emphasizing the need for model validation in multicenter cohorts to optimize the management of these patients.
文摘BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.
文摘Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.
基金funded by E Fund Congenital Heart Disease Medical Talent Cultivation and Education Fund(grant number[2023QT0009])the Science and Technology Planning Project of Guangdong Province(grant number[2023B03J1255]).
文摘Background:Although Cone reconstruction has been shown to improve biventricular functionover time,postoperative right ventricular dysfunction(RVD)is frequently observed,signiffcantly affectingreoperation and long-term prognosis.This study aims to identify the predictors for postoperative RVD.Methods:This retrospective cohort study included 51 patients with Ebstein’s anomaly who underwentthe Cone reconstruction.RVD was deffned as right ventricular fractional area change(RV-FAC)lessthan 35%and tricuspid annular plane systolic excursion(TAPSE)less than 17 mm through pre-dischargeechocardiography.Univariate and multivariate analyses were used to analyze the pre-operative predictors.Results:The median age at surgery was 37.7(±15.3)years,RVD was documented in 25 patients(49%)of the51 patients.Patients with RVD had signiffcantly higher right ventricular end-systolic volume index(RVESVi)(p=0.001),right ventricular end-diastolic volume index(RVEDVi)(p=0.03),and septal leaffet displacement(p=0.003).Multivariate analysis conffrmed that septal leaffet displacement was independently associatedwith postoperative RVD(p=0.02).Additionally,RVD was not related to the cardiopulmonary bypass time,ICU stay and total hospital time.Conclusions:This study suggests that preoperative right ventricularejection fraction(RVEF)reduction,severe septal leaffet displacement and signiffcant right ventriculardilatation are key predictors of early postoperative RVD.RVD may exacerbate tricuspid regurgitation,andthis ffnding indicates that predicting RVD may aid in identifying high-risk patients prone to recurrence oftricuspid regurgitation after Cone reconstruction.
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 Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,No.202401AY070001-164Yunnan Provincial Department of Science and Technology Science and Technology Plan Project-Major Science and Technology Special Projects,No.202405AJ310003+1 种基金Yunnan Provincial Department of Science and Technology Science and Technology Plan Project-Key Research and Development Program,No.202103AC100004Yunnan Province Science and Technology Department Key Research and Development Plan,No.202103AC100002.
文摘BACKGROUND Acute myocardial infarction(AMI)combined with ventricular septal perforation(VSR)is still a highly fatal condition in the era of reperfusion therapy.The incidence rate has decreased to 0.2%-0.4%due to the popularization of percutaneous coronary intervention.However,the risk is significantly increased for those who fail to undergo revascularization in time,and the mortality rate remains high.The current core contradiction in clinical practice lies in the selection of surgical timing,and the disparity in medical resources significantly affects prognosis.There is an urgent need to optimize the identification of high-risk populations and individualized treatment strategies.AIM To investigate the clinical features,determine the prognostic factors,and develop a predictive model for 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture(AMI-VSR)residing in high-altitude regions.METHODS This study retrospectively analyzed 48 AMI-VSR patients admitted to a Yunnan hospital from 2017 to 2024,with the establishment of survival(n=30)and mortality(n=18)groups based on patients’survival status.Risk factors were identified by univariate and multivariate logistic regression analyses.A nomogram model was developed using R software and validated via receiver operating characteristic(ROC)analysis and calibration curves.RESULTS Age,uric acid(UA),interleukin-6(IL-6),and low hemoglobin(Hb)were independent risk factors for 30-day mortality(odds ratios:1.147,1.006,1.034,and 0.941,respectively;P<0.05).The nomogram demonstrated excellent discrimination(area under the ROC curve=0.939)and calibration(Hosmer-Lemeshowχ²=2.268,P=0.971).In addition,patients’poor outcomes could be synergistically predicted by IL-6 and UA,advanced age,and reduced Hb.CONCLUSION This study highlights age,UA,IL-6,and Hb as critical predictors of mortality in AMI-VSR patients at high altitudes.The validated nomogram provides a practical tool for early risk stratification and tailored interventions,addressing gaps in managing this high-risk population in resource-limited settings.
