Background:Congenital heart disease(CHD)is the most common congenital anomaly,but whether the COVID-19 pandemic affects its prevalence is unknown.We aimed to compare the incidence of CHD during the COVID-19 pandemic w...Background:Congenital heart disease(CHD)is the most common congenital anomaly,but whether the COVID-19 pandemic affects its prevalence is unknown.We aimed to compare the incidence of CHD during the COVID-19 pandemic with that before the pandemic in China.Methods:This multicenter retrospective observational study involved all newborns in seven representative cities of China between 01 September 2019,and 31 December 2021.All the newborns underwent pulse oximetry monitoring combined with cardiac murmur auscultation in the first 6 h to 72 h after birth for CHD screening.We defined fetuses born in and beyond September 2020 as the exposed group,and before as the non-exposed group.The incidence of CHD and specific heart abnormalities,including atrial septal defect(ASD)and ventricular septal defect(VSD),before and during the COVID-19 pandemic were compared.Results:The study included 492,662 newborns;217,003 newborns born before September 2020 and 275,659 newborns born in and beyond September 2020.There were 3115 patients with CHD in total during the whole study period.Of those,1055(September 2019 to August 2020)and 2060(September 2020 to December 2021)were less and more affected by the pandemic,respectively.There was a significant increase in the incidence of CHD in the early stage of the COVID-19 pandemic(7.78 per 1000 births)compared to that before the pandemic(4.86 per 1000 births)(p<0.001).The birth prevalence of ASD and VSD significantly increased during the pandemic from 3.991 per 1000 births to 4.717 per 1000 births(p=0.008)and from 1.650 per 1000 births to 3.508 per 1000 births(p<0.001),respectively.Conclusions:The incidence of CHD increased during the COVID-19 pandemic,which was possibly related to the reallocation of medical resources,increased psychological pressure,and increased socioeconomic deprivation,though underlying mechanisms remain unclear.展开更多
Purpose:This study examined the efficacy and safety of selexipag in treating pulmonary arterial hypertension(PAH)associated with congenital heart disease(CHD).Materials and Methods:We conducted a retrospective study o...Purpose:This study examined the efficacy and safety of selexipag in treating pulmonary arterial hypertension(PAH)associated with congenital heart disease(CHD).Materials and Methods:We conducted a retrospective study of patients with CHD-associated PAH,treated with selexipag since December 2017.Thirteen adult patients(mean age,45.4 years;women,77%)were treated with selexipag as add-on therapy.Baseline characteristics,World Health Organization functional class,6-minute walking distance(6MWD)test results,N-terminal pro-B-type natriuretic peptide levels,echocardiographic data,and incidence of side effects were assessed.Results:The majority of patients(12/13,92.3%)experienced more than one treatment-associated complication;one patient dropped out of the study due to intolerable myalgia.The results of 6MWD test(from 299.2±56.2 m to 363.8±86.5 m,p=0.039)and tricuspid regurgitation(TR)pressure gradient(from 84.7±20.5 mmHg to 61.6±24.0 mmHg,p=0.018)improved and remained improved after selexipag treatment in 12 patients.Based on the results of a non-invasive risk assessment,8(66.7%)patients showed improvement,3(25.0%)showed no interval change,and the status of one patient(8.3%)deteriorated.Moreover,compared to patients treated with a low dosage,patients treated with a medium-to-high dosage showed a greater increase in 6MWD results(88.3±26.4 m vs.55.3±27.6 m,p=0.043)and a greater reduction in the TR pressure gradient(-33.7±10.9 mmHg vs.-12.5±12.0 mmHg,p=0.015).Conclusion:Selexipag is an efficient pulmonary vasodilator as add-on therapy in treating CHD-associated PAH.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: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:Psychosocial functioning and quality of life(QoL)are strongly associated with outcomes in pediatric heart transplant recipients.The data in pediatric transplantation,however,is limited.This study aims to in...Background:Psychosocial functioning and quality of life(QoL)are strongly associated with outcomes in pediatric heart transplant recipients.The data in pediatric transplantation,however,is limited.This study aims to investigate the associations of perioperative anxiety and depression with postoperative complications,sociodemographic and clinical characteristics.Methods:This observational,analytical,longitudinal study included 42 pediatric participants aged 8 to 16 years old.Preoperative psychological assessments were completed by 36 children,the remaining 6 were unable to participate due to invasive ventilation,extracorporeal membrane oxygenation(ECMO),and physical debilitation.Postoperatively,all 42 subjects completed the psychosocial evaluations.Data on recipients characteristics,family characteristics and clinical parameters were collected.Anxiety and depression were assessed using the Screen for Child Anxiety Related Emotional Disorders(SCARED)and the Depression Self-Rating Scale for Children(DSRSC).The Short Form-36 Health Survey(SF-36)was applied to assess the health-related QoL.Results:Before transplantation,91.7%(33/36)of the children exhibited symptoms of anxiety,and an identical proportion(91.7%,33/36)showed signs of depression.After transplantation,the rates of anxiety and depression decreased to 35.7%(15/42)and 11.9%(5/42),respectively.Longer disease course(p=0.042),preoperative hypoalbuminemia(p=0.032),older age(p=0.024),postoperative hypertension(p=0.011),and postoperative CRRT(p=0.015)result in depression symptoms.Preoperative hypoalbuminemia(p=0.032)was also more common in the anxiety group.Additionally,children with psychosocial risks had significantly lower QoL scores in general health(p=0.008)and mental health(p=0.015).Conclusions:Perioperative anxiety and depression are highly prevalent among pediatric heart transplant recipients.Although significant improvements in psychosocial risks were observed at posttransplantation,approximately 40%children continued to experience psychosocial challenges.展开更多
Ambient air pollution is increasingly being recognized as a risk factor for heart failure;however,its effects on cardiac biomarkers remain unclear.This scoping review assessed the existing evidence on the association ...Ambient air pollution is increasingly being recognized as a risk factor for heart failure;however,its effects on cardiac biomarkers remain unclear.This scoping review assessed the existing evidence on the association between air pollution and cardiac biomarkers in heart failure,described the key concepts,synthesized data,and identified research gaps.Following the PRISMA-ScR guidelines,PubMed,Embase,Web of Science,and CNKI databases were searched for studies on air pollution,heart failure,and biomarkers.A total of 765 records were screened,and 81 full texts were assessed for eligibility,resulting in 15 studies.The results showed that the exposure to particulate matter was associated with elevated N-terminal pro-B-type natriuretic peptide and troponin levels.Several studies have linked particulate matter exposure to a higher cardiovascular risk and heart failure biomarkers.Inflammatory and oxidative stress markers were consistently elevated across studies,supporting the biological relevance of these associations.However,few studies have focused specifically on populations with heart failure or clinically relevant biomarkers,and the evidence for gaseous pollutants remains inconclusive.These findings highlight the need to integrate environmental risk assessment into heart failure care and inform policy efforts to reduce the pollutionrelated cardiovascular burden.Further research should address these gaps through improved exposure assessments and the integration of mechanistic evidence.展开更多
基金funded by Central Guiding Fund for Local Science and Technology Development Projects(No.2023ZY1058)the National Nature Science Foundation of China(No.82270309)both awarded to Weize Xu.
文摘Background:Congenital heart disease(CHD)is the most common congenital anomaly,but whether the COVID-19 pandemic affects its prevalence is unknown.We aimed to compare the incidence of CHD during the COVID-19 pandemic with that before the pandemic in China.Methods:This multicenter retrospective observational study involved all newborns in seven representative cities of China between 01 September 2019,and 31 December 2021.All the newborns underwent pulse oximetry monitoring combined with cardiac murmur auscultation in the first 6 h to 72 h after birth for CHD screening.We defined fetuses born in and beyond September 2020 as the exposed group,and before as the non-exposed group.The incidence of CHD and specific heart abnormalities,including atrial septal defect(ASD)and ventricular septal defect(VSD),before and during the COVID-19 pandemic were compared.Results:The study included 492,662 newborns;217,003 newborns born before September 2020 and 275,659 newborns born in and beyond September 2020.There were 3115 patients with CHD in total during the whole study period.Of those,1055(September 2019 to August 2020)and 2060(September 2020 to December 2021)were less and more affected by the pandemic,respectively.There was a significant increase in the incidence of CHD in the early stage of the COVID-19 pandemic(7.78 per 1000 births)compared to that before the pandemic(4.86 per 1000 births)(p<0.001).The birth prevalence of ASD and VSD significantly increased during the pandemic from 3.991 per 1000 births to 4.717 per 1000 births(p=0.008)and from 1.650 per 1000 births to 3.508 per 1000 births(p<0.001),respectively.Conclusions:The incidence of CHD increased during the COVID-19 pandemic,which was possibly related to the reallocation of medical resources,increased psychological pressure,and increased socioeconomic deprivation,though underlying mechanisms remain unclear.
文摘Purpose:This study examined the efficacy and safety of selexipag in treating pulmonary arterial hypertension(PAH)associated with congenital heart disease(CHD).Materials and Methods:We conducted a retrospective study of patients with CHD-associated PAH,treated with selexipag since December 2017.Thirteen adult patients(mean age,45.4 years;women,77%)were treated with selexipag as add-on therapy.Baseline characteristics,World Health Organization functional class,6-minute walking distance(6MWD)test results,N-terminal pro-B-type natriuretic peptide levels,echocardiographic data,and incidence of side effects were assessed.Results:The majority of patients(12/13,92.3%)experienced more than one treatment-associated complication;one patient dropped out of the study due to intolerable myalgia.The results of 6MWD test(from 299.2±56.2 m to 363.8±86.5 m,p=0.039)and tricuspid regurgitation(TR)pressure gradient(from 84.7±20.5 mmHg to 61.6±24.0 mmHg,p=0.018)improved and remained improved after selexipag treatment in 12 patients.Based on the results of a non-invasive risk assessment,8(66.7%)patients showed improvement,3(25.0%)showed no interval change,and the status of one patient(8.3%)deteriorated.Moreover,compared to patients treated with a low dosage,patients treated with a medium-to-high dosage showed a greater increase in 6MWD results(88.3±26.4 m vs.55.3±27.6 m,p=0.043)and a greater reduction in the TR pressure gradient(-33.7±10.9 mmHg vs.-12.5±12.0 mmHg,p=0.015).Conclusion:Selexipag is an efficient pulmonary vasodilator as add-on therapy in treating CHD-associated PAH.
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.
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:Psychosocial functioning and quality of life(QoL)are strongly associated with outcomes in pediatric heart transplant recipients.The data in pediatric transplantation,however,is limited.This study aims to investigate the associations of perioperative anxiety and depression with postoperative complications,sociodemographic and clinical characteristics.Methods:This observational,analytical,longitudinal study included 42 pediatric participants aged 8 to 16 years old.Preoperative psychological assessments were completed by 36 children,the remaining 6 were unable to participate due to invasive ventilation,extracorporeal membrane oxygenation(ECMO),and physical debilitation.Postoperatively,all 42 subjects completed the psychosocial evaluations.Data on recipients characteristics,family characteristics and clinical parameters were collected.Anxiety and depression were assessed using the Screen for Child Anxiety Related Emotional Disorders(SCARED)and the Depression Self-Rating Scale for Children(DSRSC).The Short Form-36 Health Survey(SF-36)was applied to assess the health-related QoL.Results:Before transplantation,91.7%(33/36)of the children exhibited symptoms of anxiety,and an identical proportion(91.7%,33/36)showed signs of depression.After transplantation,the rates of anxiety and depression decreased to 35.7%(15/42)and 11.9%(5/42),respectively.Longer disease course(p=0.042),preoperative hypoalbuminemia(p=0.032),older age(p=0.024),postoperative hypertension(p=0.011),and postoperative CRRT(p=0.015)result in depression symptoms.Preoperative hypoalbuminemia(p=0.032)was also more common in the anxiety group.Additionally,children with psychosocial risks had significantly lower QoL scores in general health(p=0.008)and mental health(p=0.015).Conclusions:Perioperative anxiety and depression are highly prevalent among pediatric heart transplant recipients.Although significant improvements in psychosocial risks were observed at posttransplantation,approximately 40%children continued to experience psychosocial challenges.
文摘Ambient air pollution is increasingly being recognized as a risk factor for heart failure;however,its effects on cardiac biomarkers remain unclear.This scoping review assessed the existing evidence on the association between air pollution and cardiac biomarkers in heart failure,described the key concepts,synthesized data,and identified research gaps.Following the PRISMA-ScR guidelines,PubMed,Embase,Web of Science,and CNKI databases were searched for studies on air pollution,heart failure,and biomarkers.A total of 765 records were screened,and 81 full texts were assessed for eligibility,resulting in 15 studies.The results showed that the exposure to particulate matter was associated with elevated N-terminal pro-B-type natriuretic peptide and troponin levels.Several studies have linked particulate matter exposure to a higher cardiovascular risk and heart failure biomarkers.Inflammatory and oxidative stress markers were consistently elevated across studies,supporting the biological relevance of these associations.However,few studies have focused specifically on populations with heart failure or clinically relevant biomarkers,and the evidence for gaseous pollutants remains inconclusive.These findings highlight the need to integrate environmental risk assessment into heart failure care and inform policy efforts to reduce the pollutionrelated cardiovascular burden.Further research should address these gaps through improved exposure assessments and the integration of mechanistic evidence.
