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
Pulmonary hypertension associated with congenital heart disease represents a significant challenge for clinicians due to its complex pathophysiology and diverse presentation.This patient population exhibits a broad sp...Pulmonary hypertension associated with congenital heart disease represents a significant challenge for clinicians due to its complex pathophysiology and diverse presentation.This patient population exhibits a broad spectrum of anatomical and hemodynamic abnormalities,with congenital heart disease-associated pulmonary arterial hypertension(PAH-CHD)comprising a significant proportion of pediatric pulmonary hypertension(PH)cases.Although progress in diagnostic methods and treatment options has been made,PH continues to be a major contributor to illness and death among affected pediatric patients,especially when diagnosis or treatment is postponed.This review aims to equip non-specialist clinicians with a better understanding of PH associated with congenital heart disease,focusing on its pathophysiology,clinical presentation,and diagnostic criteria.Key recommendations for evaluating and managing this fragile population are presented,emphasizing the importance of early recognition and multidisciplinary collaboration.As an increasing number of congenital heart disease patients reach adulthood,understanding its lifelong impacts becomes crucial for improving outcomes and creating tailored treatment approaches.展开更多
Women with adult congenital heart disease(CHD)face unique challenges during pregnancy,as gestational cardiovascular(CV)and hemodynamic changes can exacerbate underlying cardiac conditions.While these adaptations are w...Women with adult congenital heart disease(CHD)face unique challenges during pregnancy,as gestational cardiovascular(CV)and hemodynamic changes can exacerbate underlying cardiac conditions.While these adaptations are well tole-rated in women with structurally and functionally normal hearts,they pose sig-nificant risks for those with adult CHD(ACHD),whether repaired,palliated,or with residual defects.Maternal CHD is associated with an increased risk of ad-verse CV events,including stroke,heart failure,arrhythmias,and thromboem-bolic complications during pregnancy and the peripartum period.Effective mana-gement requires a multidisciplinary team,including cardiologists,perinatologists,anesthesiologists,and other skilled care providers.Risk stratification tools such as the modified World Health Organization classification,CARPREG II,and ZA-HARA scores are useful for predicting maternal and fetal outcomes and guiding clinical decision-making.Preconception counseling plays a critical role in asse-ssing individual risks,optimizing cardiac function,and educating patients about potential complications.Future research should prioritize innovative therapies,including targeted pharmacological agents and minimally invasive interventions,alongside improved screening methods to identify high-risk patients before symp-tomatic disease manifests.This review synthesizes current literature on managing pregnant women with ACHD,highlights gaps in clinical practice,and explores future directions to enhance care.Addressing these challenges is essential to improving maternal and fetal outcomes and ensuring comprehensive,patient-centered care throughout the reproductive journey.展开更多
Today,more than 90%of children who are born with congenital heart disease survive and reach adulthood,especially in developed countries.Consequently,the population of adults with congenital heart disease has increased...Today,more than 90%of children who are born with congenital heart disease survive and reach adulthood,especially in developed countries.Consequently,the population of adults with congenital heart disease has increased signiffcantly over the last few decades.In Latin America and the Caribbean countries,this same scenario is occurring at an accelerated pace.Loss to follow-up is a global problem in adults with congenital heart disease,ranging from 30–60%.In Latin America and Caribbean countries,it is estimated that less than 10%of adults with congenital heart disease are being followed.The small number of specialists and adult congenital heart disease specialized centers,as well as virtually nonexistent transition and transfer programs,are some of the reasons for this.This article is a narrative review of the current status of the transition and transfer of young adults with congenital heart disease,with a special focus on Latin America and Caribbean countries.It describes the general concepts of transition and transfer,analyzes barriers and,ffnally,presents specialized care alternatives that would reduce losses and improve this population’s care.展开更多
Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durabl...Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.展开更多
Background:Advancements in diagnostic tools,surgical techniques,and long-termmanagement have significantly improved survival among individuals with congenital heart disease(CHD),leading to an evolving epidemiologic pr...Background:Advancements in diagnostic tools,surgical techniques,and long-termmanagement have significantly improved survival among individuals with congenital heart disease(CHD),leading to an evolving epidemiologic profile characterized by increasing procedural complexity and a growing adult CHD population.This study aimed to examine nationwide trends in CHD surgeries over a 17-year period,with a focus on temporal shifts in surgical volume,procedural complexity,and age-specific incidence.Methods:A total of 41,608 CHD surgeries and 85,417 surgical procedures performed between 2002 and 2018 were identified from a nationwide health insurance database.Temporal trends were evaluated using segmented linear regression,and age-specific standardized incidence rates were calculated per 100,000 population across three age groups:infants(<1 year),children(1-18 years),and adults(≥19 years).Results:Despite a decline in overall surgical volume(from 2523 in 2002 to 1624 in 2018),the number of surgical procedures rose markedly(from 2936 to 5402),indicating higher claims-based procedural volume per patient(i.e.,more billed procedure codes per operation),a proxy for operative intensity rather than a direct measure of clinical or system burden.This divergence was particularly notable in infants and adults,while pediatric surgical rates declined sharply.Age-specific incidence rates of surgical procedures showed a continuous rise in infants and a moderate increase in adults,whereas children demonstrated stable or declining trends.Breakpoints in temporal trends were identified in 2015 for surgeries and 2011 for procedures.Conclusions:The landscape of CHD surgery is undergoing a demographic and clinical transformation,with a shift toward early,complex operations in infants and reoperations in adults.These findings underscore the growing need for age-tailored,resource-intensive care models and long-term strategic planning to accommodate the evolving burden of CHD across the lifespan.展开更多
Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databa...Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databases including PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Database(VIP),Wanfang database,SinoMed,ClinicalTrials.gov,and American Heart Association(AHA)and European Society of Cardiology(ESC)were searched for RCTs on exercise rehabilitation in ADHF patients’vulnerable period from inception to April 2,2025.The risk of bias was assessed with Cochrane Risk of Bias 2.0,and data were analyzed in RevMan 5.3.Results:A total of seven RCTs involving 946 patients were included.The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance(6-MWTD)(SMD=0.37;95%CI:0.09,0.65;P=0.01),short physical performance battery(SPPB)score(MD=1.26;95%CI:0.82,1.70;P<0.001)and peak oxygen consumption(VO2peak)(SMD=1.43;95%CI:0.53,2.34;P=0.002),improved quality of life(QoL)(SMD=0.85;95%CI:0.07,1.64,P=0.03),reduced depression score(MD=-0.73;95%CI:1.27,-0.18;P=0.009),frailty(MD=-0.22;95%CI:-0.48,0.05;P=0.11),and decreased 6-month all-cause readmission(OR=0.67;95%CI:0.49,0.91;P=0.01).However,no statistically significantdifferences were observed between the two groups in left ventricular ejection fraction(LVEF)(MD=0.96;95%CI:-1.84,3.77;P=0.50),6-month heart failure(HF)-related readmission(OR=1.01;95%CI:0.66,1.53;P=0.98),and all-cause mortality(OR=0.63;95%CI:0.18,2.24;P=0.47).There were no adverse events reported.Conclusions:Exercise rehabilitation during the vulnerable phase improves exercise tolerance,QoL,and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients,with no reported adverse events.Although trends toward improved LVEF,HF-related readmissions,and all-cause mortality were observed.Large-scale,high-quality studies are warranted to explore individualized responses and long-term outcomes.展开更多
BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a tre...BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a trend observed even in our setting.The primary shared challenge has centered on achieving surgical success and immediate survival.The question arises about the medium-and long-term survival of patients with heart transplant in Mexico.AIM To present the results of the medium and long-term follow-up of heart transplant patients.METHODS This was a retrospective study of a single medical unit,and we selected patients who received heart transplants from July 21,1988 to September 30,2023.Selection criteria encompassed age,sex,and primary indication for heart transplantation across all groups.Patients with incomplete information or who died within 30 postoperative days were excluded.Data of primary pathology,ischemic,extracorporeal circulation,aortic cross-clamping times,length of ventilatory support,stay in postoperative therapy,hospitalization,and functional class were analyzed.RESULTS The causes of morbidity,mortality,and percentage of survival at 1,5,and 10 years were examined.Overall,257 heart transplants were performed during the study period.Of the total cases,22 with incomplete data and 47 who died within 30 postoperative days were excluded for the middle-and long-term survival analyses.Of the remaining 188 patients,heart transplantation was performed(males:146,females:42).The average age of the participants was 44.43±14.48 years.The primary indications included ischemic cardiomyopathy(42.55%)and dilated cardiomyopathy(39.36%).The mean durations of mechanical ventilator support,intensive care stay,and hospital stay were 57.55±103.50 hours,9.96±8.59 days,and 19.49±18.23 days,respectively.One-,five-,and ten-year survival rates were 90.7%,71.3%,and 60.3%,respectively.Of the patients,94%and 6%were in functional classes I and II,respectively.Infection and neurological hemorrhagic or ischemic stroke(26%)were the main causes of mortality in the first year.Subsequently,chronic rejection manifesting as graft vasculopathy increased in frequency(30%).CONCLUSION In our setting,heart transplantation yields medium-and long-term survival and quality of life outcomes comparable to those achieved by other international centers.展开更多
Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were includ...Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were included in the experiment,four were tachypaced in right ventricle apex (RVAP) and 4 were paced in right atrium after the ablation of left bundle branch to achieve left bundle branch block (RAP+LBBB).Three weeks of follow-up were conducted to observe the changes in cardiac function and myocardial staining was performed at the end of the experiment.Results:Both experimental approaches successfully established heart failure with reduced ejection fraction models,with similar trends in declining cardiac function.The RAP+LBBB group exhibited a prolonged overall ventricular activation time, delayed left ventricular activation,and lesser impact on the right ventricle.The RVAP approach led to a reduction in overall right ventricular compliance and right ve ntricular enlargement.The RAP+LBBB group exhibited significant reductions in left heart compliance (LVGLS,%:RAP+LBBB-12.60±0.12 to-5.93±1.25;RVAP-13.28±0.62to-8.05±0.63, p=0.023;LASct,%:RAP+LBBB-15.75±6.85 to-1.50±1.00;RVAP-15.75±2.87 to-10.05±6.16,p=0.035).Histological examination revealed more pronounced fibrosis in the left ventricular wall and left atrium in the RAP+LBBBgroup while the RVAP group showed more prominent fibrosis in the right ventricular myocardium.Conclusion:Both approaches establish HFrEF models with comparable trends.The RVAP group shows impaired right ventricular function,while the RAP+LBBB group exhibits more severe decreased compliance and fibrosis in left ventricle.展开更多
BACKGROUND Since being declared as a pandemic on March 11,2020,coronavirus disease 2019(COVID-19)has profoundly influenced heart and lung transplant programs,impacting donor availability,patient management,and healthc...BACKGROUND Since being declared as a pandemic on March 11,2020,coronavirus disease 2019(COVID-19)has profoundly influenced heart and lung transplant programs,impacting donor availability,patient management,and healthcare resources.This study offers a citation-based review of the research output on this subject,seeking to understand how the transplant community has responded to these challenges.Through a review of literature from the beginning of the pandemic to early 2023,we evaluate the shifts in academic emphasis and the emerging trends in heart and lung transplantation during the COVID-19 period.AIM To assess the impact of COVID-19 on heart and lung transplantation research,highlighting key themes,contri-butions,and trends in the literature during the pandemic.METHODS We conducted an extensive search of the Web of Science database on February 9,2023.We employed the terms"transplant"and"transplantation",as well as organ-specific terms like"heart","cardiac",and"lung",combined with COVID-19-related terms such as"COVID-19","coronavirus",and"SARS-CoV-2".The search encompassed public-ations from March 11,2020 to February 9,2023.Data on authors,journals,countries,institutions,and publication types(articles,reviews,conference papers,letters,notes,editorials,brief surveys,book chapters,and errata)were analyzed.The data was visualized and processed with VOSviewer 1.6.18 and Excel.RESULTS We included 847 research items.There were 392 articles(46.3%)and 88 reviews(10.3%).The studies included were referenced 7757 times,with an average of 9.17 citations per article.The majority of the publications(n=317)were conducted by institutes from the United States with highest citations(n=4948)on this subject,followed by Germany,Italy,and France.The majority of papers(n=101)were published in the Journal of Heart and Lung Transplantation.CONCLUSION To the fullest extent of our knowledge,this is the first bibliometric study of COVID-19's impact on heart and lung transplantation to offer a visual analysis of the literature in order to predict future frontiers and provide an over-view of current research hotspots.展开更多
BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes be...BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction(LVEF)and to determine the independent predictors for sustained improvement in LVEF.METHODS This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018.This were divided into two groups:HF with transient improvement in EF(HFtimpEF)and HF with sustained improvement in EF(HFsimpEF).RESULTS A total of 175 patients with HF and improved EF were included.Among them 136(77.7%)patients showed sustained improvement in LVEF.The remaining patients with HFtimpEF were predominantly males[37(94.9%)vs 101(74.3%),P=0.005]with a higher incidence of ischemic cardiomyopathy[32(82.1%)vs 68(50.4%),P=0.002],dyslipidemia[24(61.5%)vs 54(39.7%),P=0.03],and hypertension[34(87.2%)vs 93(68.4%),P=0.03]than those with HFsimpEF.The latter experienced significantly lower rates of hospitalization[39(28.7%)vs 20(51.3%),P=0.01]and diagnosis of new cardiovascular conditions during the follow-up(e.g.,acute coronary syndrome,stroke,decompensated HF,and atrial fibrillation)[14(10.3%)vs 10(25.6%),P=0.03]without a difference in emergency department visits or in-hospital death.Sustained improvement in LVEF was positively associated with being female[adjusted odds ratio(aOR)=6.8,95%confidence interval(CI):1.4-32.3,P=0.02],having non-ischemic etiology of HF(aOR=3.1,95%CI:1.03-9.3,P=0.04),and using a mineralocorticoid receptor antagonist(aOR=7.0,95%CI:1.50-31.8,P=0.01).CONCLUSION Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiova-scular conditions than patients with HFtimpEF.Sustained improvement in LVEF was positively associated with being a female,having non-ischemic etiology of HF,and using a mineralocorticoid receptor antagonist.展开更多
Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of comp...Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of complicated congenital heart diseases(CHDs).Methods:All pediatric patients diagnosed with residual PAS after surgical repair of complicated CHDs between 1996 and 2020 were retrospectively enrolled in the study.Results:A total of 41 patients(30 males,11 females;median age 5.0 years,median weight 17 kg)were followed-up for a median of 7.1 years.Follow-up echocardiography results demonstrated that the target vessel diameter increased from(3.4±1.1)mm preoperatively to(6.2±1.9)mm one year post-procedure and(6.0±1.5)mm at the final follow-up(p<0.05).The pressure gradient across the stenosis decreased from(52.6±15.8)mmHg preoperatively to(35.8±19.1)mmHg one year post-procedure and(33.1±19.7)mmHg at the final follow-up(p<0.05).Cardiac computed tomography scans indicated that target vessel/distal vessel diameter ratio increased from(0.4±0.2)pre-operatively to(0.8±0.2)one year post-procedure and(0.9±0.3)at the final follow-up(p<0.05).A total of six adverse events were documented,comprising two cases of in-stent restenosis requiring surgical reintervention,three cases of in-stent restenosis managed with regular clinical surveillance,and one case of percutaneous pulmonary valve replacement due to severe pulmonary regurgitation.Kaplan-Meier event-free survival analysis demonstrated that elevated preprocedural right ventricular systolic pressure(>72 mmHg)was significantly associated with long-term adverse events(p=0.024).Conclusion:Percutaneous stent implantation for residual PAS after surgical repair of complicated CHDs effectively relieves vessel stenosis,stabilizes cardiac function,and improves long-term prognosis in pediatric patients.In-stent restenosis remains an unresolved complication,necessitating further advancements in interventional strategies.展开更多
Metabolic-associated steatotic liver disease(MASLD)is a global health burden intricately linked to cardiovascular disease(CVD)through shared pathways-insulin resistance,dyslipidemia,and chronic inflammation.CVD has be...Metabolic-associated steatotic liver disease(MASLD)is a global health burden intricately linked to cardiovascular disease(CVD)through shared pathways-insulin resistance,dyslipidemia,and chronic inflammation.CVD has become the leading cause of mortality in MASLD,necessitating integrated management strategies.This review synthesizes evidence on bidirectional MASLD-CVD interactions and evaluates therapeutic approaches:Lifestyle modifications,pharmacotherapy(e.g.,GLP-1 receptor agonists,SGLT2 inhibitors,statins),and metabolic interventions.Despite progress,critical gaps persist in risk stratification tools,personalized treatment algorithms,and long-term outcomes of novel agents like resmetirom.A multidisciplinary care model,bridging hepatology and cardiology,is essential to address these challenges and improve patient outcomes.展开更多
Heart failure(HF)is common in patients with congenital heart disease(CHD)and there are limited medical therapies.Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are a proven medical therapy in patients with acquired ...Heart failure(HF)is common in patients with congenital heart disease(CHD)and there are limited medical therapies.Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are a proven medical therapy in patients with acquired HF,though data are limited in patients with CHD.The aim of this review is to summarize the current evidence for use of SGLT2i in patients with CHD and identify future directions for study.In available publica-tions,SGLT2i in patients with CHD seem to be well tolerated,with similar side effect profile to patients with acquired HF.Improvement in functional capacity and natriuretic peptides are mixed,though there is a signal for potential reduction in HF hospitalizations.One prospective study in patients with systemic right ventricles showed an improvement in systolic function for patients already on maximal HF medical therapy.Though lim-ited,there is emerging data on use of SGLT2i in pediatric patients with CHD and HF.Future prospective studies are needed to evaluate for clinically meaningful endpoints,including HF hospitalization,as well as evaluate the hemodynamic impact in subtypes of CHD at high risk for HF.展开更多
1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%o...1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].展开更多
Pediatric and congenital heart disease(PCHD)affects millions of children worldwide,including over one million babies born with congenital heart disease(CHD)each year and 300,000 children dying from rheumatic heart dis...Pediatric and congenital heart disease(PCHD)affects millions of children worldwide,including over one million babies born with congenital heart disease(CHD)each year and 300,000 children dying from rheumatic heart disease(RHD)yearly.Although the vast majority of children born with CHD in high-income countries now reach adulthood and RHD is nearly eradicated in these countries,most of the world cannot access the necessary care to prevent or mitigate PCHD.In low-and middle-income countries,over 90%of children with PCHD cannot receive the care they need,as over 100 countries and territories lack local cardiac surgical capacity.The unmet needs for PCHD are large,albeit still poorly quantified,resulting in a considerable socioeconomic impact at the individual and societal levels.This review highlights the extensive opportunities to improve access to and scale PCHD care by strengthening research,clinical care delivery,capacity-building,advocacy,health policy,and financing.We discuss global disparities in access to congenital heart surgery,the socioeconomic impact of untreated PCHD,and propose strategies for scaling pediatric and congenital cardiac care.Our recommendations focus on enhancing research and data collection,expanding training programs,improving healthcare infrastructure,advocating for policy changes,leveraging technological innovations,fostering international collaborations,and developing comprehensive care models.展开更多
Heart injury such as myocardial infarction leads to cardiomyocyte loss,fibrotic tissue deposition,and scar formation.These changes reduce cardiac contractility,resulting in heart failure,which causes a huge public hea...Heart injury such as myocardial infarction leads to cardiomyocyte loss,fibrotic tissue deposition,and scar formation.These changes reduce cardiac contractility,resulting in heart failure,which causes a huge public health burden.Military personnel,compared with civilians,is exposed to more stress,a risk factor for heart diseases,making cardiovascular health management and treatment innovation an important topic for military medicine.So far,medical intervention can slow down cardiovascular disease progression,but not yet induce heart regeneration.In the past decades,studies have focused on mechanisms underlying the regenerative capability of the heart and applicable approaches to reverse heart injury.Insights have emerged from studies in animal models and early clinical trials.Clinical interventions show the potential to reduce scar formation and enhance cardiomyocyte proliferation that counteracts the pathogenesis of heart disease.In this review,we discuss the signaling events controlling the regeneration of heart tissue and summarize current therapeutic approaches to promote heart regeneration after injury.展开更多
Pathological myocardial hypertrophy is a common early clinical manifestation of heart failure,with noncoding RNAs exerting regulatory influence.However,the molecular function of circular RNAs(circRNAs)in the progressi...Pathological myocardial hypertrophy is a common early clinical manifestation of heart failure,with noncoding RNAs exerting regulatory influence.However,the molecular function of circular RNAs(circRNAs)in the progression from cardiac hypertrophy to heart failure remains unclear.To uncover functional circRNAs and identify the core circRNA signaling pathway in heart failure,we construct a global triple network(microRNA,circRNA,and mRNA)based on the competitive endogenous RNA(ceRNA)theory.We observe that cardiac hypertrophy-related circRNA(circRNA CHRC),within the ceRNA network,is down-regulated in both transverse aortic constriction mice and Ang-II--treated primary mouse cardiomyocytes.Silencing circRNA CHRC increases cross-sectional cell area,atrial natriuretic peptide,andβ-myosin heavy chain levels in primary mouse cardiomyocytes.Further screening shows that circRNA CHRC targets the miR-431-5p/KLF15 axis implicated in heart failure progression in vivo and in vitro.Immunoprecipitation with anti-Ago2-RNA confirms the interaction between circRNA CHRC and miR-431-5p,while miR-431-5p mimics reverse Klf15 activation caused by circRNA CHRC overexpression.In summary,circRNA CHRC attenuates cardiac hypertrophy via sponging miR-431-5p to maintain the normal level of Klf15 expression.展开更多
BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore...BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.展开更多
Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital he...Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further validation.This study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year follow-up.Additionally,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD patients.Methods:This retrospective study included 126 PAH-CHD patients.Clinical and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact tests.Indepen-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these analyses.Results:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD patients.Prothrombin activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of 0.85.Conclusions:The simplified risk stratification method is applicable to PAH-CHD patients.Prothrombin activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.展开更多
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Pulmonary hypertension associated with congenital heart disease represents a significant challenge for clinicians due to its complex pathophysiology and diverse presentation.This patient population exhibits a broad spectrum of anatomical and hemodynamic abnormalities,with congenital heart disease-associated pulmonary arterial hypertension(PAH-CHD)comprising a significant proportion of pediatric pulmonary hypertension(PH)cases.Although progress in diagnostic methods and treatment options has been made,PH continues to be a major contributor to illness and death among affected pediatric patients,especially when diagnosis or treatment is postponed.This review aims to equip non-specialist clinicians with a better understanding of PH associated with congenital heart disease,focusing on its pathophysiology,clinical presentation,and diagnostic criteria.Key recommendations for evaluating and managing this fragile population are presented,emphasizing the importance of early recognition and multidisciplinary collaboration.As an increasing number of congenital heart disease patients reach adulthood,understanding its lifelong impacts becomes crucial for improving outcomes and creating tailored treatment approaches.
文摘Women with adult congenital heart disease(CHD)face unique challenges during pregnancy,as gestational cardiovascular(CV)and hemodynamic changes can exacerbate underlying cardiac conditions.While these adaptations are well tole-rated in women with structurally and functionally normal hearts,they pose sig-nificant risks for those with adult CHD(ACHD),whether repaired,palliated,or with residual defects.Maternal CHD is associated with an increased risk of ad-verse CV events,including stroke,heart failure,arrhythmias,and thromboem-bolic complications during pregnancy and the peripartum period.Effective mana-gement requires a multidisciplinary team,including cardiologists,perinatologists,anesthesiologists,and other skilled care providers.Risk stratification tools such as the modified World Health Organization classification,CARPREG II,and ZA-HARA scores are useful for predicting maternal and fetal outcomes and guiding clinical decision-making.Preconception counseling plays a critical role in asse-ssing individual risks,optimizing cardiac function,and educating patients about potential complications.Future research should prioritize innovative therapies,including targeted pharmacological agents and minimally invasive interventions,alongside improved screening methods to identify high-risk patients before symp-tomatic disease manifests.This review synthesizes current literature on managing pregnant women with ACHD,highlights gaps in clinical practice,and explores future directions to enhance care.Addressing these challenges is essential to improving maternal and fetal outcomes and ensuring comprehensive,patient-centered care throughout the reproductive journey.
文摘Today,more than 90%of children who are born with congenital heart disease survive and reach adulthood,especially in developed countries.Consequently,the population of adults with congenital heart disease has increased signiffcantly over the last few decades.In Latin America and the Caribbean countries,this same scenario is occurring at an accelerated pace.Loss to follow-up is a global problem in adults with congenital heart disease,ranging from 30–60%.In Latin America and Caribbean countries,it is estimated that less than 10%of adults with congenital heart disease are being followed.The small number of specialists and adult congenital heart disease specialized centers,as well as virtually nonexistent transition and transfer programs,are some of the reasons for this.This article is a narrative review of the current status of the transition and transfer of young adults with congenital heart disease,with a special focus on Latin America and Caribbean countries.It describes the general concepts of transition and transfer,analyzes barriers and,ffnally,presents specialized care alternatives that would reduce losses and improve this population’s care.
文摘Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.
文摘Background:Advancements in diagnostic tools,surgical techniques,and long-termmanagement have significantly improved survival among individuals with congenital heart disease(CHD),leading to an evolving epidemiologic profile characterized by increasing procedural complexity and a growing adult CHD population.This study aimed to examine nationwide trends in CHD surgeries over a 17-year period,with a focus on temporal shifts in surgical volume,procedural complexity,and age-specific incidence.Methods:A total of 41,608 CHD surgeries and 85,417 surgical procedures performed between 2002 and 2018 were identified from a nationwide health insurance database.Temporal trends were evaluated using segmented linear regression,and age-specific standardized incidence rates were calculated per 100,000 population across three age groups:infants(<1 year),children(1-18 years),and adults(≥19 years).Results:Despite a decline in overall surgical volume(from 2523 in 2002 to 1624 in 2018),the number of surgical procedures rose markedly(from 2936 to 5402),indicating higher claims-based procedural volume per patient(i.e.,more billed procedure codes per operation),a proxy for operative intensity rather than a direct measure of clinical or system burden.This divergence was particularly notable in infants and adults,while pediatric surgical rates declined sharply.Age-specific incidence rates of surgical procedures showed a continuous rise in infants and a moderate increase in adults,whereas children demonstrated stable or declining trends.Breakpoints in temporal trends were identified in 2015 for surgeries and 2011 for procedures.Conclusions:The landscape of CHD surgery is undergoing a demographic and clinical transformation,with a shift toward early,complex operations in infants and reoperations in adults.These findings underscore the growing need for age-tailored,resource-intensive care models and long-term strategic planning to accommodate the evolving burden of CHD across the lifespan.
基金funded by the Young Clinical Research Special Fund Project of Peking University First Hospital(No.2024YC05)。
文摘Objectives:This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery(CR)outcomes in patients with acute decompensated heart failure(ADHF).Methods:Multiple databases including PubMed,Web of Science,Embase,the Cochrane Library,CINAHL,China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical Database(VIP),Wanfang database,SinoMed,ClinicalTrials.gov,and American Heart Association(AHA)and European Society of Cardiology(ESC)were searched for RCTs on exercise rehabilitation in ADHF patients’vulnerable period from inception to April 2,2025.The risk of bias was assessed with Cochrane Risk of Bias 2.0,and data were analyzed in RevMan 5.3.Results:A total of seven RCTs involving 946 patients were included.The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance(6-MWTD)(SMD=0.37;95%CI:0.09,0.65;P=0.01),short physical performance battery(SPPB)score(MD=1.26;95%CI:0.82,1.70;P<0.001)and peak oxygen consumption(VO2peak)(SMD=1.43;95%CI:0.53,2.34;P=0.002),improved quality of life(QoL)(SMD=0.85;95%CI:0.07,1.64,P=0.03),reduced depression score(MD=-0.73;95%CI:1.27,-0.18;P=0.009),frailty(MD=-0.22;95%CI:-0.48,0.05;P=0.11),and decreased 6-month all-cause readmission(OR=0.67;95%CI:0.49,0.91;P=0.01).However,no statistically significantdifferences were observed between the two groups in left ventricular ejection fraction(LVEF)(MD=0.96;95%CI:-1.84,3.77;P=0.50),6-month heart failure(HF)-related readmission(OR=1.01;95%CI:0.66,1.53;P=0.98),and all-cause mortality(OR=0.63;95%CI:0.18,2.24;P=0.47).There were no adverse events reported.Conclusions:Exercise rehabilitation during the vulnerable phase improves exercise tolerance,QoL,and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients,with no reported adverse events.Although trends toward improved LVEF,HF-related readmissions,and all-cause mortality were observed.Large-scale,high-quality studies are warranted to explore individualized responses and long-term outcomes.
文摘BACKGROUND Heart transplantation is the last and best option for end-stage heart failure management.Early mortality rates have significantly decreased,enabling patients to survive longer with fewer complications,a trend observed even in our setting.The primary shared challenge has centered on achieving surgical success and immediate survival.The question arises about the medium-and long-term survival of patients with heart transplant in Mexico.AIM To present the results of the medium and long-term follow-up of heart transplant patients.METHODS This was a retrospective study of a single medical unit,and we selected patients who received heart transplants from July 21,1988 to September 30,2023.Selection criteria encompassed age,sex,and primary indication for heart transplantation across all groups.Patients with incomplete information or who died within 30 postoperative days were excluded.Data of primary pathology,ischemic,extracorporeal circulation,aortic cross-clamping times,length of ventilatory support,stay in postoperative therapy,hospitalization,and functional class were analyzed.RESULTS The causes of morbidity,mortality,and percentage of survival at 1,5,and 10 years were examined.Overall,257 heart transplants were performed during the study period.Of the total cases,22 with incomplete data and 47 who died within 30 postoperative days were excluded for the middle-and long-term survival analyses.Of the remaining 188 patients,heart transplantation was performed(males:146,females:42).The average age of the participants was 44.43±14.48 years.The primary indications included ischemic cardiomyopathy(42.55%)and dilated cardiomyopathy(39.36%).The mean durations of mechanical ventilator support,intensive care stay,and hospital stay were 57.55±103.50 hours,9.96±8.59 days,and 19.49±18.23 days,respectively.One-,five-,and ten-year survival rates were 90.7%,71.3%,and 60.3%,respectively.Of the patients,94%and 6%were in functional classes I and II,respectively.Infection and neurological hemorrhagic or ischemic stroke(26%)were the main causes of mortality in the first year.Subsequently,chronic rejection manifesting as graft vasculopathy increased in frequency(30%).CONCLUSION In our setting,heart transplantation yields medium-and long-term survival and quality of life outcomes comparable to those achieved by other international centers.
基金This work was financially supported by National Natural Science Foundation of China(Nos.82000325,82100325,82070349)Young Elite Scientists Sponsorship Program by Beijing Association for Science and Technology(No.BYESS2023392)+2 种基金The Beijing Gold-bridge project(No.ZZ21055)The Peking University First Hospital Seed Foundation(No.2020SF19)High-level hospital clinical research funding of Fuwai Hospital,Chinese Academy of Medical Sciences(No.2022-GSP-GG-11).
文摘Background:We investigated the similarities and differences between two experimental approaches using tachy-pacing technology to induce desynchronized heart failure in canines.Methods:A total of eight dogs were included in the experiment,four were tachypaced in right ventricle apex (RVAP) and 4 were paced in right atrium after the ablation of left bundle branch to achieve left bundle branch block (RAP+LBBB).Three weeks of follow-up were conducted to observe the changes in cardiac function and myocardial staining was performed at the end of the experiment.Results:Both experimental approaches successfully established heart failure with reduced ejection fraction models,with similar trends in declining cardiac function.The RAP+LBBB group exhibited a prolonged overall ventricular activation time, delayed left ventricular activation,and lesser impact on the right ventricle.The RVAP approach led to a reduction in overall right ventricular compliance and right ve ntricular enlargement.The RAP+LBBB group exhibited significant reductions in left heart compliance (LVGLS,%:RAP+LBBB-12.60±0.12 to-5.93±1.25;RVAP-13.28±0.62to-8.05±0.63, p=0.023;LASct,%:RAP+LBBB-15.75±6.85 to-1.50±1.00;RVAP-15.75±2.87 to-10.05±6.16,p=0.035).Histological examination revealed more pronounced fibrosis in the left ventricular wall and left atrium in the RAP+LBBBgroup while the RVAP group showed more prominent fibrosis in the right ventricular myocardium.Conclusion:Both approaches establish HFrEF models with comparable trends.The RVAP group shows impaired right ventricular function,while the RAP+LBBB group exhibits more severe decreased compliance and fibrosis in left ventricle.
文摘BACKGROUND Since being declared as a pandemic on March 11,2020,coronavirus disease 2019(COVID-19)has profoundly influenced heart and lung transplant programs,impacting donor availability,patient management,and healthcare resources.This study offers a citation-based review of the research output on this subject,seeking to understand how the transplant community has responded to these challenges.Through a review of literature from the beginning of the pandemic to early 2023,we evaluate the shifts in academic emphasis and the emerging trends in heart and lung transplantation during the COVID-19 period.AIM To assess the impact of COVID-19 on heart and lung transplantation research,highlighting key themes,contri-butions,and trends in the literature during the pandemic.METHODS We conducted an extensive search of the Web of Science database on February 9,2023.We employed the terms"transplant"and"transplantation",as well as organ-specific terms like"heart","cardiac",and"lung",combined with COVID-19-related terms such as"COVID-19","coronavirus",and"SARS-CoV-2".The search encompassed public-ations from March 11,2020 to February 9,2023.Data on authors,journals,countries,institutions,and publication types(articles,reviews,conference papers,letters,notes,editorials,brief surveys,book chapters,and errata)were analyzed.The data was visualized and processed with VOSviewer 1.6.18 and Excel.RESULTS We included 847 research items.There were 392 articles(46.3%)and 88 reviews(10.3%).The studies included were referenced 7757 times,with an average of 9.17 citations per article.The majority of the publications(n=317)were conducted by institutes from the United States with highest citations(n=4948)on this subject,followed by Germany,Italy,and France.The majority of papers(n=101)were published in the Journal of Heart and Lung Transplantation.CONCLUSION To the fullest extent of our knowledge,this is the first bibliometric study of COVID-19's impact on heart and lung transplantation to offer a visual analysis of the literature in order to predict future frontiers and provide an over-view of current research hotspots.
文摘BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction(LVEF)and to determine the independent predictors for sustained improvement in LVEF.METHODS This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018.This were divided into two groups:HF with transient improvement in EF(HFtimpEF)and HF with sustained improvement in EF(HFsimpEF).RESULTS A total of 175 patients with HF and improved EF were included.Among them 136(77.7%)patients showed sustained improvement in LVEF.The remaining patients with HFtimpEF were predominantly males[37(94.9%)vs 101(74.3%),P=0.005]with a higher incidence of ischemic cardiomyopathy[32(82.1%)vs 68(50.4%),P=0.002],dyslipidemia[24(61.5%)vs 54(39.7%),P=0.03],and hypertension[34(87.2%)vs 93(68.4%),P=0.03]than those with HFsimpEF.The latter experienced significantly lower rates of hospitalization[39(28.7%)vs 20(51.3%),P=0.01]and diagnosis of new cardiovascular conditions during the follow-up(e.g.,acute coronary syndrome,stroke,decompensated HF,and atrial fibrillation)[14(10.3%)vs 10(25.6%),P=0.03]without a difference in emergency department visits or in-hospital death.Sustained improvement in LVEF was positively associated with being female[adjusted odds ratio(aOR)=6.8,95%confidence interval(CI):1.4-32.3,P=0.02],having non-ischemic etiology of HF(aOR=3.1,95%CI:1.03-9.3,P=0.04),and using a mineralocorticoid receptor antagonist(aOR=7.0,95%CI:1.50-31.8,P=0.01).CONCLUSION Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiova-scular conditions than patients with HFtimpEF.Sustained improvement in LVEF was positively associated with being a female,having non-ischemic etiology of HF,and using a mineralocorticoid receptor antagonist.
基金approved by the Institutional Review Board of Guangdong Provincial People's Hospital(KY-Q-2022-336-03).
文摘Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of complicated congenital heart diseases(CHDs).Methods:All pediatric patients diagnosed with residual PAS after surgical repair of complicated CHDs between 1996 and 2020 were retrospectively enrolled in the study.Results:A total of 41 patients(30 males,11 females;median age 5.0 years,median weight 17 kg)were followed-up for a median of 7.1 years.Follow-up echocardiography results demonstrated that the target vessel diameter increased from(3.4±1.1)mm preoperatively to(6.2±1.9)mm one year post-procedure and(6.0±1.5)mm at the final follow-up(p<0.05).The pressure gradient across the stenosis decreased from(52.6±15.8)mmHg preoperatively to(35.8±19.1)mmHg one year post-procedure and(33.1±19.7)mmHg at the final follow-up(p<0.05).Cardiac computed tomography scans indicated that target vessel/distal vessel diameter ratio increased from(0.4±0.2)pre-operatively to(0.8±0.2)one year post-procedure and(0.9±0.3)at the final follow-up(p<0.05).A total of six adverse events were documented,comprising two cases of in-stent restenosis requiring surgical reintervention,three cases of in-stent restenosis managed with regular clinical surveillance,and one case of percutaneous pulmonary valve replacement due to severe pulmonary regurgitation.Kaplan-Meier event-free survival analysis demonstrated that elevated preprocedural right ventricular systolic pressure(>72 mmHg)was significantly associated with long-term adverse events(p=0.024).Conclusion:Percutaneous stent implantation for residual PAS after surgical repair of complicated CHDs effectively relieves vessel stenosis,stabilizes cardiac function,and improves long-term prognosis in pediatric patients.In-stent restenosis remains an unresolved complication,necessitating further advancements in interventional strategies.
文摘Metabolic-associated steatotic liver disease(MASLD)is a global health burden intricately linked to cardiovascular disease(CVD)through shared pathways-insulin resistance,dyslipidemia,and chronic inflammation.CVD has become the leading cause of mortality in MASLD,necessitating integrated management strategies.This review synthesizes evidence on bidirectional MASLD-CVD interactions and evaluates therapeutic approaches:Lifestyle modifications,pharmacotherapy(e.g.,GLP-1 receptor agonists,SGLT2 inhibitors,statins),and metabolic interventions.Despite progress,critical gaps persist in risk stratification tools,personalized treatment algorithms,and long-term outcomes of novel agents like resmetirom.A multidisciplinary care model,bridging hepatology and cardiology,is essential to address these challenges and improve patient outcomes.
文摘Heart failure(HF)is common in patients with congenital heart disease(CHD)and there are limited medical therapies.Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are a proven medical therapy in patients with acquired HF,though data are limited in patients with CHD.The aim of this review is to summarize the current evidence for use of SGLT2i in patients with CHD and identify future directions for study.In available publica-tions,SGLT2i in patients with CHD seem to be well tolerated,with similar side effect profile to patients with acquired HF.Improvement in functional capacity and natriuretic peptides are mixed,though there is a signal for potential reduction in HF hospitalizations.One prospective study in patients with systemic right ventricles showed an improvement in systolic function for patients already on maximal HF medical therapy.Though lim-ited,there is emerging data on use of SGLT2i in pediatric patients with CHD and HF.Future prospective studies are needed to evaluate for clinically meaningful endpoints,including HF hospitalization,as well as evaluate the hemodynamic impact in subtypes of CHD at high risk for HF.
文摘1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].
文摘Pediatric and congenital heart disease(PCHD)affects millions of children worldwide,including over one million babies born with congenital heart disease(CHD)each year and 300,000 children dying from rheumatic heart disease(RHD)yearly.Although the vast majority of children born with CHD in high-income countries now reach adulthood and RHD is nearly eradicated in these countries,most of the world cannot access the necessary care to prevent or mitigate PCHD.In low-and middle-income countries,over 90%of children with PCHD cannot receive the care they need,as over 100 countries and territories lack local cardiac surgical capacity.The unmet needs for PCHD are large,albeit still poorly quantified,resulting in a considerable socioeconomic impact at the individual and societal levels.This review highlights the extensive opportunities to improve access to and scale PCHD care by strengthening research,clinical care delivery,capacity-building,advocacy,health policy,and financing.We discuss global disparities in access to congenital heart surgery,the socioeconomic impact of untreated PCHD,and propose strategies for scaling pediatric and congenital cardiac care.Our recommendations focus on enhancing research and data collection,expanding training programs,improving healthcare infrastructure,advocating for policy changes,leveraging technological innovations,fostering international collaborations,and developing comprehensive care models.
基金supported by the Natural Science Foundation of Beijing,China(7214223,7212027)the Beijing Hospitals Authority Youth Programme(QML20210601)+3 种基金the Chinese Scholarship Council(CSC)scholarship(201706210415)the National Key Research and Development Program of China(2017YFC0908800)the Beijing Municipal Health Commission(PXM2020_026272_000002,PXM2020_026272_000014)the National Natural Science Foundation of China(82070293).
文摘Heart injury such as myocardial infarction leads to cardiomyocyte loss,fibrotic tissue deposition,and scar formation.These changes reduce cardiac contractility,resulting in heart failure,which causes a huge public health burden.Military personnel,compared with civilians,is exposed to more stress,a risk factor for heart diseases,making cardiovascular health management and treatment innovation an important topic for military medicine.So far,medical intervention can slow down cardiovascular disease progression,but not yet induce heart regeneration.In the past decades,studies have focused on mechanisms underlying the regenerative capability of the heart and applicable approaches to reverse heart injury.Insights have emerged from studies in animal models and early clinical trials.Clinical interventions show the potential to reduce scar formation and enhance cardiomyocyte proliferation that counteracts the pathogenesis of heart disease.In this review,we discuss the signaling events controlling the regeneration of heart tissue and summarize current therapeutic approaches to promote heart regeneration after injury.
基金supported by the National Natural Science Foundation of China(32071109,82070270,M-0048)the Shanghai Committee of Science and Technology(22ZR1463800,21ZR1467000)+1 种基金the Shanghai Jing'an District Discipline Construction Project(2021PY03)CAMS Innovation Fund for Medical Sciences(2019-I2M-5–053)。
文摘Pathological myocardial hypertrophy is a common early clinical manifestation of heart failure,with noncoding RNAs exerting regulatory influence.However,the molecular function of circular RNAs(circRNAs)in the progression from cardiac hypertrophy to heart failure remains unclear.To uncover functional circRNAs and identify the core circRNA signaling pathway in heart failure,we construct a global triple network(microRNA,circRNA,and mRNA)based on the competitive endogenous RNA(ceRNA)theory.We observe that cardiac hypertrophy-related circRNA(circRNA CHRC),within the ceRNA network,is down-regulated in both transverse aortic constriction mice and Ang-II--treated primary mouse cardiomyocytes.Silencing circRNA CHRC increases cross-sectional cell area,atrial natriuretic peptide,andβ-myosin heavy chain levels in primary mouse cardiomyocytes.Further screening shows that circRNA CHRC targets the miR-431-5p/KLF15 axis implicated in heart failure progression in vivo and in vitro.Immunoprecipitation with anti-Ago2-RNA confirms the interaction between circRNA CHRC and miR-431-5p,while miR-431-5p mimics reverse Klf15 activation caused by circRNA CHRC overexpression.In summary,circRNA CHRC attenuates cardiac hypertrophy via sponging miR-431-5p to maintain the normal level of Klf15 expression.
文摘BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.
基金This work was supported by the National Natural Science Foundation of China(82070052)the Joint Funds of the Natural Science Foundation of Gansu Province(23JRRA1544)granted to Yunshan Cao.
文摘Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further validation.This study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year follow-up.Additionally,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD patients.Methods:This retrospective study included 126 PAH-CHD patients.Clinical and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact tests.Indepen-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these analyses.Results:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD patients.Prothrombin activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of 0.85.Conclusions:The simplified risk stratification method is applicable to PAH-CHD patients.Prothrombin activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.
