BackgroundRenal dysfunction is an important determinant of cardiovascular prognosis in patients with coronary artery disease. Estimated glomerular filtration rate (eGFR) is widely used to assess kidney function, but different equations may yield varying risk stratification results. This study aimed to compare the predictive performance of creatinine-based and cystatin C–based eGFR equations for 1-year major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary intervention (PCI).MethodsThis retrospective study included 560 patients who underwent PCI for acute coronary syndrome. Baseline clinical, laboratory, and echocardiographic variables were collected. Renal function was assessed using both creatinine-based and cystatin C–based eGFR equations. Logistic regression with backward selection based on the Akaike Information Criterion (AIC) was performed to identify independent predictors of 1-year MACE. In addition, multiple machine learning models were developed to evaluate predictive performance, and Shapley Additive Explanations (SHAP) analysis was applied to assess feature importance.ResultsDuring the 1-year follow-up, MACE occurred in 72 patients, comprising 71 repeat PCIs and one cardiac death. Equations relying on cystatin C detected a larger share of patients with impaired renal function compared with creatinine-based formulas. However, moderate-to-severe renal dysfunction defined by creatinine-based eGFR was significantly associated with an increased risk of 1-year MACE, although it was not retained as an independent predictor after AIC–based multivariable adjustment. Machine learning models demonstrated modest predictive performance overall, with logistic regression achieving the highest discriminative ability. SHAP analysis indicated that cardiovascular functional parameters and metabolic markers were the major contributors to risk prediction, while renal function indicators provided complementary prognostic information.ConclusionsCreatinine-based eGFR showed a stronger observed association with 1-year MACE after PCI than cystatin C–based eGFR in this single-center cohort; these findings do not establish clinical superiority of either equation and require external validation. Renal function assessment remains an important component of cardiovascular risk stratification, and traditional regression models performed comparably to machine learning approaches in moderately sized clinical datasets.
BackgroundAcute type A aortic dissection is a catastrophic cardiovascular emergency requiring urgent surgery. Hemiarch replacement under deep hypothermic circulatory arrest (DHCA) is a standard approach. This study compared the outcomes of two supra-aortic vessel management strategies during DHCA.MethodsThis retrospective cohort study analyzed 109 patients undergoing hemiarch replacement between May 2024 and January 2026. Patients were divided into two groups: the left subclavian artery (LSA) Occlusion Group (n = 53), in which all three arch vessels (innominate, left common carotid, and left subclavian arteries) were dissected and clamped, and the LSA Non-Occlusion Group (n = 56), in which the LSA was left untouched. Continuous and categorical variables were compared using the Mann–Whitney U test and Chi-square/Fisher's exact test, respectively. Multivariable logistic regression was performed to identify independent risk factors for perioperative cerebral infarction.ResultsPreoperative baseline characteristics were well-balanced between groups (all p > 0.05). The LSA Occlusion Group had significantly longer total surgical duration (320 vs. 273 min, p < 0.001), aortic cross-clamp time (126 vs. 104.5 min, p = 0.016), and DHCA time (26 vs. 22 min, p < 0.001). The incidence of perioperative cerebral infarction was significantly higher in the LSA Occlusion Group (22.64% vs. 7.14%, p = 0.044). Multivariable analysis confirmed that LSA occlusion was an independent risk factor for cerebral infarction (OR=4.36, 95% CI 1.24–15.30, p = 0.020). The 30-day mortality rate was numerically higher in the LSA Occlusion Group (20.75% vs. 10.71%) but did not reach statistical significance (p = 0.238). No significant differences were found in other major complications or recovery metrics.ConclusionIn this cohort, the strategy of clamping the left subclavian artery during hemiarch replacement was associated with prolonged critical intraoperative times and a significantly increased risk of perioperative cerebral infarction. LSA occlusion was identified as an independent risk factor for stroke. These findings suggest that omitting LSA manipulation may be a safer and more efficient approach, but the results require validation in larger, prospective studies.
BackgroundSubclinical carotid atherosclerosis (SCAS) is linked to cardiovascular events, yet its characteristics across various glucose metabolism statuses remain unclear. This study investigated SCAS prevalence and its association with dysglycemia in a community-dwelling population.MethodsIn this cross-sectional study (September–December 2021, Beijing), 4,964 middle-aged and elderly residents underwent 75 g oral glucose tolerance tests and were categorized into normal glucose tolerance (NGT), prediabetes [including isolated impaired fasting glucose [IFG], isolated impaired glucose tolerance [IGT], and combined IFG + IGT], and new-onset diabetes mellitus (DM). Standardized carotid ultrasonography assessed carotid intima-media thickness (CIMT) and plaque presence. Multivariable logistic regression was used to identify factors associated with SCAS in the whole cohort and in the prediabetic subgroup, with adjustment for age, sex, blood pressure, body mass index, and lipid profiles.ResultsThe cohort comprised 2,224 NGT, 2,022 prediabetes (758 IFG, 569 IGT, 695 mixed), and 718 DM participants. Anthropometric and metabolic parameters progressively worsened with increasing glucose dysregulation severity. SCAS prevalence was highest in the DM group (70.5%), followed by prediabetes (66.8%) and NGT (62.2%) (p < 0.05). Within the prediabetic cohort, SCAS was significantly more prevalent in the IGT group than the IFG group (63.5% vs. 55.8%, p < 0.05). After full adjustment, compared with NGT, both prediabetes (OR = 1.28, 95% CI: 1.10–1.49) and new-onset DM (OR = 1.52, 95% CI: 1.25–1.85) remained independently associated with SCAS (both p < 0.01). In the prediabetic subgroup, factors independently associated with SCAS included age, sex, 2 h postprandial glucose, total cholesterol, and HDL-C (protective).ConclusionThe prevalence of SCAS varies significantly across glucose metabolism statuses. Both new-onset diabetes and prediabetes—particularly the IGT phenotype—are closely associated with a higher burden of SCAS, independent of traditional cardiovascular risk factors. These findings provide a rationale for evaluating early screening strategies in future prospective studies, but prospective cohort studies are needed to establish causal relationships and to determine the clinical implications.
BackgroundCancer patients with cardiovascular comorbidities requiring contrast-based cardiac procedures face substantially amplified risk for contrast-induced nephropathy (CIN), driven by anticancer therapy-related systemic inflammation, nephrotoxicity, and endothelial dysfunction. Validated biomarker-based risk stratification tools that capture these distinct pathophysiologic mechanisms are urgently needed in cancer cardiology practice. This study evaluated the combined predictive value of C-reactive protein (CRP), procalcitonin (PCT), and microalbuminuria (MAU) for CIN development following percutaneous coronary intervention (PCI), with direct implications for cardio-oncology risk stratification.MethodsWe retrospectively analyzed 486 consecutive patients undergoing elective or urgent PCI between March 2021 and November 2024. Baseline CRP, PCT, and MAU were measured within 24 h pre-procedure. CIN was defined as serum creatinine increase ≥0.5 mg/dL or ≥25% from baseline within 48–72 h post-contrast.ResultsCIN developed in 92 patients (18.9%). All three biomarkers independently predicted CIN in multivariable analysis: CRP >10 mg/L (OR = 3.15, p < 0.001), PCT >0.05 ng/mL (OR = 2.87, p < 0.001), and MAU ≥30 mg/24 h (OR = 3.42, p < 0.001). The combined three-biomarker panel demonstrated superior discrimination (AUC = 0.856, 95% CI: 0.818–0.894) compared to individual markers (AUC 0.682–0.728) and the Mehran score (AUC = 0.714). An additive biomarker score (0–3) stratified CIN risk from 5.8% (score 0) to 50.0% (score 3), representing an approximately8.6-fold gradient.ConclusionCombined pre-procedural assessment of CRP, PCT, and MAU provided excellent discriminatory ability (AUC=0.856) for CIN prediction, substantially superior to individual biomarkers and traditional clinical risk factors. These complementary markers—capturing systemic inflammation, acute inflammatory stress, and baseline renal endothelial integrity, respectively—offer a clinically practical framework for biomarker-guided risk stratification in a general PCI population. As patients on active systemic anticancer therapy were excluded and patients with a cancer history comprised only a minority of the cohort, the potential extension of this panel to cardio-oncology practice is proposed as a mechanistically motivated hypothesis that requires dedicated validation rather than as a demonstrated application.
Heart failure (HF) is a major cardiovascular syndrome with increasing global incidence and mortality rates. Cardiomyocyte injury and ventricular remodeling are central pathological processes driving HF progression. Although several forms of regulated cell death have been implicated in HF, the mechanisms underlying cardiomyocyte injury remain poorly understood. Disulfidptosis, proposed in 2023, is a metabolism-related form of regulated cell death triggered by the depletion of the cellular reducing capacity. Evidence from tumor cell models indicates that under glucose-restricted conditions, cells with high SLC7A11 expression may exhibit insufficient NADPH production due to impaired pentose phosphate pathway (PPP) activity, resulting in disulfide stress, aberrant disulfide cross-linking of filamentous actin (F-actin), cytoskeletal collapse, and cell death. During HF progression, cardiomyocytes commonly undergo glucose metabolic remodeling, redox imbalance, and cytoskeletal abnormalities, which may create a permissive context for disulfidptosis-like injuries. However, direct experimental evidence demonstrating disulfidptosis in cardiomyocytes or the failing myocardium remains limited. Rather than treating transcriptomic associations as evidence of a defined cell-death programme, this review integrates HF-associated metabolic remodelling, impaired redox buffering, and cytoskeletal vulnerability within a testable mechanistic framework. It further defines a staged validation strategy for determining whether disulfidptosis occurs in cardiomyocytes or other myocardial cell populations.
ObjectiveThis study aimed to integrate baseline clinical characteristics and multi-dimensional echocardiographic parameters of patients with heart failure with preserved ejection fraction (HFpEF), construct and validate an individualized predictive model for the efficacy of enhanced external counterpulsation (EECP) therapy in HFpEF patients based on an automated machine learning (AutoML) framework, and develop a corresponding clinical decision support system.MethodsA retrospective cohort study design was adopted, consecutively enrolling 550 HFpEF patients who received complete EECP treatment at the cardiovascular center of two tertiary grade-A hospital between January 2018 and December 2023. An AutoML predictive framework driven by an improved Newton's downhill optimizer (INDO) was constructed, automatically performing joint optimization of feature subset selection, model algorithm selection, and hyperparameter configuration under a rigorous double-layered nested cross-validation strategy. Five benchmark models, including logistic regression, support vector machine, adaptive boosting, extreme gradient boosting, and light gradient boosting machine, were simultaneously established for performance comparison. Multi-dimensional evaluation was conducted using the area under the receiver operating characteristic curve (ROC-AUC), area under the precision-recall curve (PR-AUC), accuracy, sensitivity, specificity, F1 score, Brier score, and decision curve analysis. The robustness of features was verified through LASSO regression, and the SHAP framework was employed for model interpretability analysis.ResultsAmong the 550 HFpEF patients, significant differences were observed between the treatment-effective group and the treatment-ineffective group in terms of age, body mass index, left ventricular ejection fraction, left atrial volume index, and E/e' ratio. The AutoML model optimized based on INDO achieved a ROC-AUC of 0.9254, a PR-AUC of 0.8425, an F1 score of 0.8285, and a Brier score of 0.1206 on the independent test set, with all metrics outperforming the five benchmark models. Decision curve analysis demonstrated that the model yielded a positive net clinical benefit within a threshold probability range of 16% to 96%. SHAP interpretability analysis revealed the 6-minute walk distance (6MWD), left ventricular ejection fraction (LVEF), age (Age), left atrial volume index (LAVI), E/e' ratio, and body mass index (BMI) as key predictors influencing the efficacy of EECP therapy.ConclusionThe predictive model constructed by integrating echocardiographic parameters and clinical features based on the AutoML framework driven by the INDO optimization algorithm can relatively accurately predict the individualized efficacy of EECP therapy in HFpEF patients, providing a interpretable, and clinically actionable intelligent assessment tool for indication screening and individualized decision-making regarding EECP therapy in HFpEF patients.
BackgroundLactate in cardiogenic shock is commonly summarized by a single measurement or a two-point estimate of clearance, although its first-day pattern may offer a more interpretable account of early clinical evolution. We examined whether first-day lactate trajectories identify reproducible patterns associated with subsequent mortality.MethodsThis retrospective multicohort study used MIMIC-IV for trajectory discovery and internal prediction modeling and eICU-CRD to evaluate transportability. Adults with a first ICU admission for cardiogenic shock and at least two lactate measurements within 24 h were eligible for trajectory construction. Primary analyses were restricted to patients alive and still hospitalized at a 24-hour landmark.ResultsFour patterns were identified among 2,181 eligible MIMIC-IV patients: low-stable, moderate-decreasing, high-decreasing, and persistent-high. The 24-hour landmark risk set included 2,015 patients, with subsequent mortality ranging from 24.34% to 72.88%. Compared with low-stable, adjusted odds ratios were 2.08 [95% confidence interval (CI) 1.56–2.77] for high-decreasing and 5.81 (95% CI 3.57–9.46) for persistent-high. After centering each trajectory at its initial window, the increasing pattern remained associated with mortality after adjustment for initial lactate and clinical covariates (odds ratio 2.91, 95% CI 1.75–4.85, vs. the largest-decrease pattern). In foldwise cross-validation, the trajectory model had an area under the receiver operating characteristic curve (AUROC) of 0.724 and an area under the precision-recall curve (AUPRC) of 0.572. Last lactate and initial plus last lactate performed better (AUROC 0.734 and 0.736; AUPRC 0.592 and 0.594). Among 429 landmark-eligible eICU-CRD patients assigned to fixed MIMIC-IV centroids, mortality ranged from 25.49% to 78.12%; in 366 complete cases, the adjusted risk ratio for group 4 was 2.30 (95% CI 1.47–3.62).ConclusionFirst-day lactate trajectories provided a clinically interpretable framework for characterizing lactate burden and evolution after repeated testing. The low-stable and persistent-high extremes showed the most consistent cross-database separation, whereas the four-group partition should be interpreted as a descriptive continuum rather than four validated clinical risk classes. Simpler last-lactate summaries provided better discrimination when prediction alone was the objective.
ObjectiveTo explore the predictive value of CT pulmonary angiography (CTPA) imaging parameters combined with serum biomarkers for 30-d all-cause mortality in non-high-risk acute pulmonary embolism (APE), and to compare parameters between simplified Pulmonary Embolism Severity Index (sPESI)-based risk strata.MethodsThis retrospective study enrolled 250 first-episode non-high-risk APE patients (50 deaths, 200 survivors). CTPA-derived pulmonary artery obstruction index (PAOI), right/left ventricular diameter ratio (RV/LV), main pulmonary/ascending aorta ratio, and serum biomarkers high-sensitivity cardiac troponin I (hs-cTnI), brain natriuretic peptide (BNP), D-dimer, and blood lactate (BLa) were collected. Independent risk factors were identified using Firth penalized likelihood logistic regression to construct a nomogram, which was internally validated. The incremental predictive value over sPESI was quantified. Cox regression was used to assess prognostic values and interactions. Spearman correlation analysis was conducted for relationships between imaging and biomarkers. Patients were stratified by sPESI into intermediate-risk (≥ 1 point) and low-risk (0 points) groups for comparative and survival analyses.ResultsDeath vs. survival groups differed significantly in syncope, age >80 years, SBP <100 mmHg, PAOI, RV/LV, hs-cTnI, BNP, and BLa (P < 0.05). Independent predictors were syncope (OR = 5.846, 95% CI: 1.552–22.030), SBP <100 mmHg (OR = 6.118, 95% CI: 1.899–19.704), RV/LV (OR = 1.285, 95% CI: 1.028–1.607), BNP (OR = 1.002, 95% CI: 1.000–1.004), and BLa (OR = 2.162, 95% CI: 1.372–3.406). The nomogram showed good discrimination (AUC = 0.878), calibration, and clinical net benefit, significantly outperforming sPESI (AUC = 0.713, P < 0.001). Cox regression confirmed several predictors but sPESI was not an independent factor (HR = 0.478, P = 0.178). PAOI and RV/LV correlated positively with hs-cTnI, BNP, and BLa (r = 0.345–0.427, P < 0.001). Intermediate-risk patients had higher mortality, PAOI, RV/LV, BNP, and BLa than low-risk patients (P < 0.05).ConclusionThe nomogram incorporating syncope, SBP <100 mmHg, RV/LV, BNP, and BLa, is an effective tool for predicting 30-day mortality in non-high-risk APE patients, demonstrating superior performance over sPESI. Combining CTPA imaging and serum biomarkers offers independent and complementary prognostic information, enhancing risk stratification.
IntroductionCardiometabolic risk increases substantially in middle-aged and older women, particularly during and after the menopausal transition. Tai Chi is a low-to-moderate intensity mind-body exercise that may offer an accessible non-pharmacological strategy for cardiometabolic risk management. However, women-specific evidence and the role of exercise-prescription characteristics remain unclear. This systematic review and meta-analysis evaluated the effects of Tai Chi on cardiometabolic risk factors in middle-aged and older women and examined whether effects varied by baseline health status, comparator type, and intervention dose.MethodsPubMed, Web of Science, the Cochrane Library, Embase, and CNKI were searched from inception to September 2025 for randomized controlled trials of structured Tai Chi programmes in women aged 45 years or older. Cardiometabolic outcomes were pooled using random-effects models, with moderator, sensitivity, publication bias, and GRADE analyses conducted where appropriate.ResultsEighteen randomized controlled trials were included. Tai Chi was associated with significant reductions in systolic blood pressure, diastolic blood pressure, LDL-C, triglycerides, and total cholesterol, whereas no clear effects were observed for HDL-C or fasting blood glucose. However, heterogeneity was substantial for most significant outcomes, and prediction intervals generally crossed the null, indicating that effect magnitude and consistency may vary considerably across future comparable settings. Pulse wave velocity was summarized narratively because only two studies reported this outcome and measurement sites differed. Subgroup analyses suggested that baseline health status, comparator type, and intervention duration might partly explain heterogeneity, although these analyses were exploratory.DiscussionTai Chi may improve selected cardiometabolic outcomes in middle-aged and older women, particularly blood pressure and atherogenic lipid markers. However, the certainty and generalizability of these findings remain limited. Larger trials using standardized Tai Chi prescriptions and consistent outcome measures are needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251146060, PROSPERO, CRD420251146060.
BackgroundPost-myocardial infarction ventricular septal rupture (PIVSR) is a severe mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Current therapeutic strategies—including pharmacotherapy, surgery, and off-label use of congenital occluders—are associated with inherent limitations.ObjectivesThe primary objective of this study was to evaluate the procedural feasibility, preliminary safety, and short-term performance of a novel dedicated Ventricular Septal Reconstruction Device (VSRD) for the treatment of PIVSR.MethodsThis study employed preclinical animal studies and a prospective first-in-human (FIM) clinical study. For the animal experiments, VSD-like defect creation was attempted in 14 Labrador retrievers; 11 underwent device-placement attempts, and 10 completed implantation and detachment with the VSRS 3226 device. Five animals were assessed at day 1 and five at day 60. The canine model was used to evaluate device deliverability, deployment, anchoring, shunt reduction, and short-term local tissue response in a VSD-like defect model rather than to reproduce infarct-related PIVSR pathology. For the first-in-human study, 4 PIVSR patients were enrolled; the transjugular approach was adopted, guidance was provided by transthoracic echocardiography (TTE) combined with left ventricular angiography, and follow-up duration exceeded 6 months.ResultsIn animal experiments, 11 of 14 animals proceeded to device-placement attempts, and 10 completed implantation and detachment; no device structural malfunction or delivery-system failure was recorded. Minor residual leakage was qualitatively observed in 4/5 animals at day 1, whereas no leakage was detected in the separate five-animal day-60 group; tissue coverage consistent with endothelialization was observed at day 60, and no adverse events occurred among implanted animals during follow-up. In the first-in-human study, implantation was completed in all four patients; residual shunts were ≤2 mm during follow-up, and no high-grade atrioventricular block or permanent pacemaker implantation occurred.ConclusionsThe VSRD demonstrated procedural feasibility and acceptable short-term safety and performance in this preclinical and first-in-human experience, in selected patients and a VSD-like animal model. Larger-scale clinical studies with longer follow-up are needed to evaluate its long-term safety, effectiveness, durability, and comparative performance. These findings should be interpreted cautiously because the clinical cohort was small, highly selected, and non-comparative.
We report a 32-year-old primigravida with no prior symptoms, normal baseline ECG, and no family history of sudden death who developed ventricular fibrillation (VF) shortly after uncomplicated vaginal delivery. She received epidural ropivacaine and sufentanil during labor. Post-resuscitation ECG demonstrated coved ST-segment elevation with T-wave inversion in V1–V2, consistent with spontaneous type 1 Brugada syndrome (BrS) pattern. Echocardiography excluded structural heart disease; coronary CT angiography excluded coronary artery disease. Laboratory investigations revealed borderline hypokalemia (3.5 mmol/L) and mild hypomagnesemia (0.75 mmol/L). Clinical whole-exome sequencing revealed no pathogenic or likely pathogenic variants in established arrhythmia-associated genes. The ECG normalized two days later. An implantable cardioverter-defibrillator was implanted. This case illustrates multifactorial unmasking of latent BrS—involving ropivacaine-mediated sodium channel blockade, postpartum autonomic instability, bradycardia, and electrolyte imbalance in a genotype-negative asymptomatic woman, highlighting the importance of recognizing concealed channelopathies in peripartum cardiac arrest.
BackgroundLipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease, which remains unaddressed by current lipid-lowering therapies. Given its established role as a genetic independent cardiovascular risk factor, national and international guidelines recommend screening for Lp(a) levels, as elevated concentrations indicate a higher risk of cardiovascular events. Despite these implications and the availability of a simple standardized assay reimbursed by the Italian National Health Service, Lp(a) testing remains largely underused in the Italian clinical practice. The aim of this project was to identify barriers to Lp(a) testing in clinical practice and to develop targeted strategies to promote its incorporation into secondary cardiovascular prevention strategies in Italy, using an implementation science framework.MethodsThis project adopted a multi-method approach, using the Behavior Change Wheel (BCW) framework to identify barriers to Lp(a) testing. Barriers identified in the literature were mapped using the Capability, Opportunity, Motivation– Behavior (COM-B) model, and further characterized through the Theoretical Domains Framework. Each identified barrier was subsequently discussed and rated for perceived impact during a multidisciplinary working group involving 12 stakeholders (cardiologists, internists, lipidologists and laboratory professionals). Building on these findings, several intervention strategies were developed in line with BCW guidance and prioritized by stakeholders during a second multidisciplinary working group to ensure overall feasibility.ResultsCapability-related barriers, including limited knowledge of Lp(a) as a cardiovascular risk factor, and uncertainty about its role on patient management, were among the most influential. Opportunity barriers included the absence of approved Lp(a)-lowering treatments, and a lack of test standardization. Motivational barriers included a lack of evidence of clinical benefit of Lp(a) reduction and limited awareness of its role in patient management. To address the identified barriers, training initiatives, creation of working groups, sharing of practical tools, alignment between clinicians and laboratories, and patient support emerged as high-priority interventions.ConclusionTo promote Lp(a) testing in secondary cardiovascular prevention Italian clinical practice, this project identified behavioral barriers across all COM-B domains and designed actionable key strategies using a theory-driven approach. Future research should pilot these activities to overcome identified barriers and improve patient management.
ObjectiveTo characterize the clinicopathological features, pathological spectrum, and anatomical distribution of cardiac tumors and to evaluate the diagnostic challenges associated with these rare lesions.MethodsA retrospective analysis was performed on 124 surgically resected cardiac tumors diagnosed at the Affiliated Hospital of Zunyi Medical University between January 2012 and June 2026. Histological examination, immunohistochemistry, and fluorescence in situ hybridization (FISH), when indicated, were reviewed. All tumors were reclassified according to the 2021 WHO Classification of Thoracic Tumours. Clinicopathological characteristics and exploratory statistical analyses were performed.ResultsAmong the 124 cardiac tumors, myxoma constituted the predominant entity (104/124, 83.9%). A marked predilection for the left atrium was noted, with 78.8% of myxomas located there (82/104), significantly surpassing the frequency in the right atrium (P < 0.001). Although malignant tumors were uncommon (12 cases), they exhibited considerable histopathological diversity. Exploratory analysis revealed a higher proportion of malignant tumors in patients aged ≤ 50 years compared to older patients (19.1% vs. 3.9%, P = 0.013).ConclusionsThis single-center retrospective series highlights the diverse histopathological spectrum of cardiac tumors, affirming myxoma as the predominant tumor type with a strong left atrial predilection. Although rare, malignant tumors presented diagnostic challenges, necessitating multidisciplinary evaluation that integrates morphology, immunohistochemistry, and molecular testing. The observed age-related difference in the distribution of malignancy should be regarded as exploratory and requires further validation.
Totally implantable venous access ports (TIVAPs) are widely used to provide reliable vascular access for chemotherapy in patients with malignancies. However, they may rarely give rise to catheter-related right atrial thrombus (CRAT), a potentially life-threatening complication. Here, we report a case of a patient with breast cancer who developed a right atrial thrombus following chemotherapy administered through a TIVAP. As anticoagulation therapy failed to resolve the thrombus, the patient subsequently underwent totally thoracoscopic beating-heart thrombectomy. Multimodality imaging played a pivotal role in localizing the intracardiac mass and characterizing its features, thereby guiding surgical planning. This case demonstrates that totally thoracoscopic beating-heart surgery is a safe and feasible treatment option for CRAT, offering favorable clinical outcomes and excellent cosmetic results, with promising potential for broader clinical application.
BackgroundEpicardial adipose tissue (EAT) has been linked to cardiac conduction through direct myocardium interaction and endocrine activity. We investigated sex-specific associations between ventricular electrical activity and the molecular composition of EAT.MethodsEAT biopsies from 146 cardiac surgery patients were analysed for inflammatory cell markers (CD16, DEFA3, CXCR2, CD68, CD14), fatty acid transporters (FABP4, CD36), fibroblast-related markers (COL1A2 and PREF1), and neuroreceptor-related markers (CHRM3, CHRM2, ADRB3) using real-time PCR. High-quality electrocardiograms (ECGs) from 100 patients were analysed for 36 ventricular depolarization and repolarization parameters. Principal component analysis was used to explore the internal ECG structure. Spearman correlation with Benjamini-Hochberg correction and sex-stratified linear regression assessed ECG-EAT associations, adjusting for clinical covariates.ResultsIn females, EAT fibrotic and inflammatory profile were correlated with delayed late anteroseptal depolarization (prolonged S-wave upstroke time) in V2 (COL1A2, p= 0.642, adj.p = 0.025; DEFA3, p = 0.572, adj.p = 0.038), and V3 (COL1A2, p = 0.592; DEFA3, p = 0.629; CD16, p = 0.642; CD14, p = 0.596; CHRM3, p = 0.600; all adj.p ≤ 0.027). Linear regression models confirmed strong positive associations between the interaction ECGxSex and CD14, CD16, DEFA3, and COL1A2 (β = 1 to 5, all p ≤ 0.02). Clinical factors reduced but did not eliminate sex dependent effects. Akaike information criteria (AIC)-refined models identified coronary artery disease, hypertension, and valvular heart disease as key covariates, yet inflammatory markers (CD14 and CD16) retained sex-specific explanatory power (adjusted R2 = 0.13–0.20).ConclusionDespite similar absolute ECG values, females exhibited a stronger electrical response to the EAT inflammatory profile. These findings highlight inflammation-driven sex-specific depolarization alterations and support ECG as a simple tool to indicate adverse EAT phenotypes.
BackgroundHeart failure with reduced ejection fraction (HFrEF) represents a severe manifestation or terminal stage of various cardiac diseases. Long-term hypertension frequently leads to pathological changes such as ventricular remodeling, resulting in HFrEF. Despite continuous advancements in medications targeting hypertension complicated by HFrEF, the five-year survival rate for patients remains below 50%. Chinese Medicine (CM) demonstrates favorable long-term efficacy in managing HFrEF and reducing readmission rates. Focusing on the primary symptoms of HFrEF, we innovatively proposed the syndrome pattern “Toxic Pathogen Syndrome” and developed the effective compound formula Qi Shen Granules (QSG). This trial aims to conduct a prospective clinical study to evaluate the efficacy and safety of QSG in patients with hypertension and HFrEF.MethodsThis is a multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial. A total of 220 eligible participants with hypertension and HFrEF will be recruited and randomized in a 1:1 ratio to receive either QSG or placebo for 12 weeks. All participants received guideline-directed treatment for hypertension and HFrEF throughout the study period. The primary outcome is the improvement rate in plasma NT-proBNP levels from baseline to endpoint and the six-minute walk test. Secondary outcomes include echocardiographic parameters, NYHA functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ), and Heart Failure Toxicity Scale. Safety measures, including liver and kidney function blood tests and adverse events, were used to assess QSG safety. We also conducted follow-up assessments at weeks 26 and 52 to evaluate patient readmission rates and the occurrence of cardiovascular adverse events.DiscussionThe results of this study may establish clinical evidence supporting the therapeutic benefits and safety of QSG in the management of hypertension with HFrEF.Clinical Trial Registrationhttp://itmctr.ccebtcm.org.cn/, ITMCTR2025000665.
Introduction and objectivesLeft ventricular reverse remodeling (LVRR) after transcatheter aortic valve replacement (TAVR) is associated with outcomes, but the relevance of aortic-root geometry remains uncertain. We examined whether the annular eccentricity index (EI) and sinus of Valsalva height on computed tomography angiography (CTA) were associated with 1-year LVRR.MethodsThis retrospective secondary analysis included 115 patients with severe aortic stenosis from an 11-center cohort who underwent successful TAVR and survived to undergo evaluable preprocedural CTA and 1-year echocardiography. EI was calculated as the difference between maximum and minimum annular diameters divided by the maximum diameter. Sinus height was the mean perpendicular distance from the annular plane to the sinus tip across the three sinuses. LVRR was defined as an increase in left ventricular ejection fraction of at least 5 percentage points or a decrease in indexed left ventricular end-diastolic volume of at least 15%. A fixed multivariable logistic model adjusted for baseline ventricular function and clinical covariates; Firth bias-reduced logistic regression was used for primary inference because the smaller outcome group contained 37 patients, with conventional maximum-likelihood estimation as a sensitivity analysis.ResultsLVRR occurred in 78 patients (67.8%). In the primary Firth analysis, each 1-standard deviation (SD) decrease in EI was associated with higher odds of LVRR (adjusted odds ratio, 2.40; 95% confidence interval, 1.52–3.92; P < 0.001), as was each 1-SD increase in sinus height (adjusted odds ratio, 1.84; 95% confidence interval, 1.23–2.74; P = 0.003). Conventional maximum-likelihood estimates were directionally consistent. Model performance was lower after bootstrap optimism correction (area under the curve, 0.77 vs. 0.81 apparent).ConclusionsAmong patients who survived to undergo evaluable 1-year echocardiography, a lower EI and greater sinus height were associated with LVRR after TAVR. These hypothesis-generating associations require external validation before clinical application.
BackgroundTranscatheter Tricuspid Valve Replacement (TTVR) has emerged as a treatment option for patients with severe tricuspid regurgitation (TR) who are at high surgical risk and unsuitable for tricuspid transcatheter edge-to-edge repair (T-TEER).ObjectivesThis study aims to compare procedural, clinical and echocardiographic outcomes of two different TTVR devices: the Cardiovalve (Venus MedTech) and the EVOQUE (Edwards Lifesciences) prosthesis.MethodsWe performed a retrospective, single-center cohort analysis including all consecutive patients who were treated with TTVR. Primary endpoints included TR reduction, NYHA class and safety events according to TVARC criteria.ResultsOverall, 25 consecutive patients were included in the analysis. The Cardiovalve prosthesis was implanted in 12 patients and the EVOQUE prosthesis in 13 patients. Intraprocedural success was 100%. There was a significant reduction in TR grade (4.20 vs. 0.48; p < 0.001) and NYHA class (2.72 vs. 1.88; p = 0.004) for the overall cohort at 30-day follow-up, but no differences between the two devices (TR grade 0.50 vs. 0.46; p = 0.408 and NYHA class 1.75 vs. 2.00; p = 0.813; Cardiovalve and EVOQUE respectively). Mortality rate at 30 days was 0% in both groups. One patient in each group (8.0%) required new pacemaker implantation.ConclusionTTVR with both, the Cardiovalve and EVOQUE prothesis is an effective treatment option, leading to profound TR reduction and meaningful clinical improvement at 30-day follow-up. Patient selection and long term follow up need to be the focus of future studies.
ObjectiveTo evaluate long-term outcomes of hybrid aortic arch repair for aortic arch lesions and identify factors associated with late mortality.MethodsWe retrospectively enrolled 103 patients with aortic arch lesions who received hybrid aortic arch repair at our center between January 2010 and September 2025. General clinical data, lesion types, surgical methods, perioperative outcomes, and long-term follow-up data were collected. Based on the bypass strategy, patients were divided into an ascending aorta (AA) inflow group (n = 48) and a cervical debranching group (n = 55). Kaplan–Meier analysis and Cox proportional hazards regression were used to evaluate long-term outcomes and identify factors associated with late mortality.ResultsThe mean age was 72.0 ± 10.2 years, and 83.5% were men. Diagnoses included intramural hematoma (40.8%), type B dissection (17.5%), type A dissection (14.6%), arch aneurysm (14.6%), and penetrating ulcer (12.6%). All patients successfully completed the procedure, with no intraoperative or 30-day deaths. During a median follow-up of 75.8 months (IQR, 29–128), procedure-related stroke occurred in 8 patients (7.8%), renal dysfunction in 18 (17.5%), and spinal cord ischemia in none. Eleven patients (10.7%) died, and 8 (7.8%) underwent reintervention, mainly for retrograde type A dissection, endoleak, or new-entry dilation. Survival at 1, 3, 5, and 10 years was 98.0%, 94.6%, 89.0%, and 85.8%; freedom from reintervention was 97.9%, 94.2%, 91.5%, and 89.9%. Cervical debranching was associated with better survival than ascending aortic inflow (log-rank P = 0.024), with similar freedom from reintervention (log-rank P = 0.88). In an exploratory multivariable Cox model, older age, ascending aorta inflow, and preoperative renal dysfunction were associated with late mortality.ConclusionsHybrid aortic arch repair was associated with favorable long-term survival, durable freedom from reintervention, and acceptable neurological outcomes in this single-center cohort. The observed survival advantage in the cervical debranching group should be interpreted cautiously, as ascending aorta inflow was preferentially used in patients with more complex proximal aortic disease. These findings should be considered hypothesis-generating and require validation in larger multicenter studies.
