Contrast-associated acute kidney injury (CA-AKI) is an important complication of renal angiography in patients with atherosclerotic renal artery stenosis (RAS). We investigated the associations of the triglyceride–glucose (TyG) index, atherogenic coefficient (AC) and lipoprotein combined index (LCI) with CA-AKI in this population. This retrospective single-center study included 147 consecutive patients with atherosclerotic RAS undergoing renal angiography with or without renal artery intervention. CA-AKI was defined using a creatinine-based definition based on serum creatinine changes within 48–72 h after contrast exposure. Continuous variables were retained in their continuous form in the primary logistic regression analyses, and separate multivariable models were constructed for the TyG index, AC, and LCI, each adjusted for chronic kidney disease (CKD), left ventricular ejection fraction (LVEF), and contrast volume. Firth penalized logistic regression was performed as a sensitivity analysis. CA-AKI occurred in 22 patients (15.0%). In the adjusted model, a higher TyG index was associated with increased odds of CA-AKI (OR 4.263 per 1-unit increase, 95% CI 1.120–16.228; p = 0.034), whereas AC (OR 1.581, 95% CI 0.891–2.807; p = 0.118) and LCI (OR 1.047 per 10,000-unit increase, 95% CI 0.966–1.136; p = 0.264) were not significantly associated with CA-AKI. The association of the TyG index with CA-AKI remained significant in Firth penalized logistic regression (OR 3.48, 95% CI 1.17–14.33; p = 0.020). Higher contrast volume and lower LVEF were consistently associated with CA-AKI across the multivariable models. These findings suggest that the TyG index is associated with susceptibility to CA-AKI in patients with atherosclerotic RAS, although prospective validation is required before clinical application.
Early identification of patients with breast cancer who are at increased risk of treatment-related myocardial injury may support individualized cardiovascular surveillance. This retrospective study included 551 patients treated at Sun Yat-sen Memorial Hospital between January 2014 and December 2021. All patients had chest computed tomography data and at least three high-sensitivity cardiac troponin T (hs-cTnT) measurements. Early myocardial injury was defined as hs-cTnT > 14 ng/L within 6 months after treatment. Patients were randomly divided into training (n = 366) and validation (n = 185) cohorts. Candidate predictors were identified using univariable Cox regression and least absolute shrinkage and selection operator regression. A multivariable Cox model was then used to construct the nomogram. Baseline hs-cTnT, high-density lipoprotein cholesterol, thoracic aortic calcification score, and anti-human epidermal growth factor receptor 2 therapy were retained as independent predictors. In the validation cohort, the nomogram showed good discrimination, with an area under the receiver operating characteristic curve of 0.901 and a concordance index of 0.882. Calibration curves indicated agreement between predicted and observed risks. Decision curve analysis suggested clinical utility, while risk stratification identified distinct groups in both cohorts (p < 0.001). This thoracic aortic calcification-based nomogram may support the identification of patients at high risk of early myocardial injury after anticancer therapy.
The detrimental effect of cigarette smoking has become undeniable, based on decades of research. Twenty years ago, the electronic cigarette was introduced to the market and has since then been presented as the alleged healthy alternative. Clever marketing by the industry has led to a global rise in the number of users, especially adolescents and young adults. Clinicians and scholars have praised the electronic cigarette as a tool for tobacco smoke cessation, hoping for a reduction in burden on healthcare systems. Yet accumulating evidence suggests otherwise. Over the years, several in vitro and in vivo studies in animal models and humans have shown electronic cigarettes to be associated with pulmonary, cancerous and cardiovascular diseases. This review revisits the so-far available clinical evidence concerning cardiovascular diseases and discusses research gaps that still need to be addressed, specifically focusing on patients undergoing cardiac surgery.
Background: Non-alcoholic fatty liver disease (NAFLD), which is recognized under the updated nomenclature as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is increasingly prevalent in the United States and worldwide. Emerging evidence links NAFLD to an elevated risk of atrial fibrillation (AF), yet data regarding the impact of NAFLD on inpatient outcomes among patients admitted for AF remain limited. Methods: The National Inpatient Sample (NIS) from 2016 to 2019 was used to identify adult patients with a primary discharge diagnosis of AF (ICD-10: I48.x). Patients with concurrent NAFLD were compared to those without. Multivariable linear and logistic regression analyses were performed, adjusting for age, sex, race, insurance status, and Charlson Comorbidity Index. The primary outcome was inpatient all-cause mortality. Secondary outcomes included length of stay, inflation-adjusted hospital costs, discharge disposition, and in-hospital complications. Results: Of 1,891,479 weighted AF admissions, 13,840 carried a concurrent NAFLD diagnosis. Concurrent NAFLD was associated with longer length of stay (3.99 vs. 3.35 days, p < 0.001) (which is statistically significant though might be clinically insignificant) and higher hospital costs ($13,841.65 vs. $12,154.55, p = 0.046). No significant difference in inpatient mortality was observed. Conclusions: Concurrent NAFLD among AF hospitalizations is associated with greater resource utilization without a significant mortality difference, highlighting the importance of addressing this comorbidity to reduce the economic burden of AF-related hospitalizations.
Background: Although delirium is an acute confusional state, the available literature identifies impaired activities of daily living (ADL) as a predisposing factor. However, the question of whether ADL is associated with delirium in older patients with heart failure (HF) has not been evaluated. This study investigated the relationship between ADL and delirium and further explored whether HF phenotype moderates the relationship in older patients with acute decompensated HF (ADHF). Methods: In older patients with ADHF, stabilized after HF admission, handgrip strength (HGS) and 6 min walk distance (6MWD) tests were performed, and ADL was assessed using the Barthel index. Delirium during hospitalization was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Logistic regression analyses were used to estimate the association of physical activity and ADL with delirium during hospitalization in older patients with ADHF. Results: A total of 245 older patients (82.9 ± 6.0 years, 49.4% male) with ADHF (heart failure with preserved ejection fraction [HFpEF]; n = 107, 44%) were analyzed. In the group with delirium (n = 65, 26.5%), there was significant difference in Mini–Mental state examination (MMSE) score (19 vs. 25, p < 0.001), HGS (13 vs. 16 kg, p < 0.05), 6MWD (120 vs. 160 m, p < 0.05) and Barthel index (55 vs. 65, p < 0.05) compared to the group without delirium. In the HFpEF group, 6MWD (p < 0.05) and Barthel index (p < 0.001) had significant negative correlations with delirium. In the multiple logistic regression analysis adjusted for the confounders, Barthel index (Odds ratio: 0.390 per 1 standard deviation, p < 0.01) was significantly associated with delirium in the HFpEF group. Conclusions: In older ADHF patients, decreased physical activity and ADL were significantly correlated with delirium. Lower Barthel index was associated with delirium, and this association was significantly modified by HFpEF status.
Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia with a marked age-related increase in prevalence. Current guidelines recommend left atrial appendage closure (LAAC) as an alternative to long-term oral anticoagulation in selected patients at high-risk of both thromboembolic and bleeding events. Although the use of LAAC has increased substantially in recent years, its effects on cardiac function and post-procedural functional recovery remain incompletely understood. Therefore, this study aimed to evaluate changes in periprocedural cardiac function and functional parameters in patients with AF who underwent LAAC while receiving guideline-directed medical therapy. A retrospective cohort study was performed in 250 patients who underwent percutaneous LAAC at Lanzhou University Second Hospital between May 2019 and July 2025. A total of 162 patients were included in the final analysis. Echocardiographic parameters, NYHA functional class, and Barthel Index scores were compared before and after the procedure. Significant improvements were observed in several echocardiographic parameters. Post-procedural changes in NYHA functional class distribution and Barthel Index scores indicated improved functional status, with no evidence of deterioration in cardiac structure or function. These findings support the safety of LAAC with respect to cardiac functional recovery and demonstrate that the procedure does not adversely affect cardiac performance in patients with AF receiving guideline-directed medical therapy. Nevertheless, further large-scale, multi-center prospective studies are warranted to clarify the mechanisms underlying the observed improvements in cardiac function following LAAC.
Background: The Extended Fetal Cardiovascular System (EFCS) encompasses the cardiac, infracardiac, and supracardiac vascular territories that contribute to fetal cardiovascular development and function. The CASSEAL 3 × 3 framework was developed to provide a structured anatomical assessment of the EFCS. This study aimed to evaluate its feasibility, reproducibility, and diagnostic performance during first-trimester screening. Methods: In this prospective single-center study, singleton pregnancies undergoing ultrasound examination between 11 + 0 and 13 + 6 weeks of gestation were assessed using the CASSEAL 3 × 3 framework. Feasibility, examination time, use of complementary techniques, interobserver reproducibility, and diagnostic performance were evaluated. Prenatal follow-up and postnatal findings served as the reference standard. Results: A total of 288 pregnancies were included in the final analysis. Complete visualization of all nine axial views was achieved in 86.5% of examinations. Mean examination time was 12.5 ± 3.3 min. Higher gestational age increased the likelihood of complete visualization, whereas higher maternal body mass index reduced feasibility. Interobserver agreement was high, with no significant systematic differences between operators. Six suspected EFCS abnormalities were identified during first-trimester examination. Diagnostic performance demonstrated high specificity (99.64%) and negative predictive value (98.58%), whereas sensitivity was moderate and should be interpreted cautiously due to the limited number of confirmed abnormalities. Conclusions: The CASSEAL 3 × 3 framework is a feasible and reproducible approach for structured first-trimester assessment of the EFCS. Diagnostic performance estimates should be interpreted cautiously given the limited number and spectrum of confirmed abnormalities and the use of a composite reference standard without systematic postnatal echocardiography. The framework may be better suited to specialized fetal medicine settings or as an adjunct to routine first-trimester assessment rather than as a universal screening tool.
Both fibrosis and hypertrophy contribute to abnormal myocardial mechanics in hypertrophic cardiomyopathy (HCM). We sought to assess the relationships between regional structural and functional parameters in HCM by cardiac magnetic resonance (CMR). This was a retrospective single-center study of HCM patients and age-matched controls with either hypertensive heart disease (HHD) or normal CMRs. CMR feature tracking was performed to assess global and segmental 2D-radial, circumferential, and longitudinal LV strain, while native and post-contrast T1 parametric mapping analysis was performed to assess the global and regional T1 values and ECV fraction. Of 100 patients (age 56 ± 15 years; 66% male), 62 were in the HCM group and 38 in the control group (19 healthy individuals and 19 with HHD). Compared to the control group, global circumferential strain (−16.1 ± 5.9% vs. −20.8 ± 3.6%, p < 0.001) and radial strain (45.2 ± 14.1% vs. 32.1 ± 14.0%, p < 0.001) were worse in the HCM group. Among the HCM patients, there were significant correlations between segmental native T1 values at the most hypertrophied segment and global longitudinal strain (r = 0.27, p = 0.031), global circumferential strain (r = 0.34, p = 0.006), global radial strain (r = −0.29, p = 0.024), and left ventricular ejection fraction (LVEF) (r = −0.31, p = 0.014). In HCM, higher myocardial T1 at the most hypertrophied segment correlated with worse global LV myocardial strain and LVEF by CMR.
Background: Redo mitral valve replacement is a high-risk operation in which early mortality alone may underestimate postoperative burden. We evaluated whether concomitant tricuspid valve repair independently increases major adverse postoperative events after redo mitral valve replacement. Methods: Consecutive patients undergoing redo mitral valve replacement between 2019 and 2025 were retrospectively reviewed. Isolated redo mitral valve replacement was compared with redo mitral valve replacement plus concomitant tricuspid valve repair. The primary endpoint was major adverse postoperative events, defined as early mortality, acute kidney injury, cerebrovascular event, prolonged ventilation, reoperation, deep sternal infection, mechanical circulatory support, or permanent pacemaker implantation. Results: The final cohort included 249 patients: 134 underwent isolated redo mitral valve replacement and 115 underwent concomitant tricuspid valve repair. Patients receiving tricuspid valve repair were older, had higher pulmonary artery pressure, and had a longer interval from the previous operation. They also had longer ventilation, longer intensive care unit stay and higher rates of atrial fibrillation, atrioventricular block, and permanent pacemaker implantation. Early mortality was similar between groups. Major adverse postoperative events occurred in 122 patients. Concomitant tricuspid valve repair was not associated with major adverse postoperative events in univariable analysis. In multivariable analysis, concomitant tricuspid valve repair was not independently associated with MAPE. Increasing age, smoking, lower left ventricular ejection fraction, and longer cardiopulmonary bypass time remained independently associated with MAPE. Conclusions: Early major postoperative morbidity after redo mitral valve replacement was associated primarily with patient-related risk factors and operative complexity. Concomitant tricuspid valve repair was not independently associated with MAPE after adjustment for the available covariates.
Objective: Although echocardiography is the gold standard for diagnosing left ventricularoutflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM), relying solely on imaging is insufficient for precise risk stratification, particularly in borderline or atypical patients, and fails to capture systemic pathophysiological alterations. In recent years, novel inflammatory biomarkers derived from routine blood tests have shown sensitivity in capturing micro-inflammatory states; however, their specific roles in the obstructive phenotype of HCM remain unclear. This study aims to screen hematological and cardiac parameters associated with HCM obstruction and to construct an individualized predictive model. Therefore, this study aims to screen hematological and cardiac parameters associated with HCM obstruction and to develop and validate a nomogram for individualized prediction of current LVOTO risk in HCM patients. Methods: A total of 230 HCM patients hospitalized at The Central Hospital of Wuhan from January 2019 to December 2025 were retrospectively enrolled. Based on the left ventricular outflow tract pressure gradient (LVOTPG), they were divided into a non-obstruction group (n = 177) and an obstruction group (n = 53). Least absolute shrinkage and selection operator (LASSO) regression was used to screen feature variables, and multivariate logistic regression analysis was employed to identify independent predictors and construct a nomogram prediction model. The discrimination, calibration, and clinical utility of the model were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: Multivariate logistic regression analysis revealed that a history of alcohol consumption (OR = 3.68, 95% CI: 1.49–9.09), peak LVOTPG (OR = 3.96, 95% CI: 1.42–11.05), maximum ventricular wall thickness (OR = 1.02, 95% CI: 1.00–1.04), peak mitral valve E-wave velocity (OR = 1.02, 95% CI: 1.00–1.04), and neutrophil count (OR = 2.42, 95% CI: 1.13–5.21) were independent predictors of LVOTO in HCM patients. The nomogram model constructed based on these factors achieved area under the curve (AUC) values of 0.810 and 0.850 in the training and validation sets, respectively. The calibration curve demonstrated good agreement between predicted and actual probabilities, and DCA indicated that the model provided clinical net benefit within a threshold probability range of 10% to 30%. Conclusions: A nomogram integrating alcohol consumption history, peak LVOTPG, maximum ventricular wall thickness, peak mitral E-wave velocity, and neutrophil count accurately predicts LVOTO risk in HCM patients (AUC: 0.810–0.850), providing a low-cost tool for early risk stratification. External prospective validation is warranted.
Coronary slow flow (CSF) is delayed distal contrast transit on angiography without flow-limiting stenosis; disturbed sleep may impair vascular control through autonomic, endothelial, inflammatory, and metabolic pathways. We evaluated Pittsburgh Sleep Quality Index (PSQI)-based sleep quality in relation to TIMI frame count (TFC)-defined CSF. This cross-sectional study enrolled 307 adults with nonobstructive coronary arteries undergoing angiography for chest pain; PSQI referenced the preceding month, and CSF was defined by corrected TFC > 27 frames in any major vessel; 132 participants had CSF and 175 normal flow. Global PSQI score was higher in CSF (median 7.0 vs. 5.0) and poor sleep quality (score > 5) was more frequent (75.8% vs. 49.7%; both p < 0.001). The global score correlated with mean TFC overall but not within flow groups. Each PSQI point independently raised CSF odds, including after STOP-Bang adjustment, although discrimination was modest. Sleep latency and short duration raised CSF odds; poor efficiency did not. Poorer sleep quality was independently linked to this angiographic slow-flow phenotype, mainly differentiating flow categories rather than tracking frame-count burden. Because coronary microvascular function was not measured directly, these hypothesis-generating findings should prompt systematic sleep assessment and prospective studies integrating objective sleep measures with invasive coronary physiology.
Systolic anterior motion (SAM) of the mitral valve can occur either in association with or in the absence of hypertrophic obstructive cardiomyopathy (HOCM). SAM induces dynamic left ventricular outflow tract obstruction (LVOTO) and, in the majority of cases, is associated with a substantial degree of mitral regurgitation (MR) that significantly impacts patient morbidity and mortality. This narrative review explores the contemporary understanding of the pathophysiology, diagnosis, and management of SAM, focusing particularly on surgical strategies and the novel therapeutic class of cardiac myosin inhibitors. Extended septal myectomy remains the gold-standard treatment for HOCM-related SAM, yielding superior long-term outcomes compared to alcohol septal ablation (ASA). Advanced imaging modalities, including three-dimensional transesophageal echocardiography (3D-TEE), enable precise pre-operative characterization of the mitral valve apparatus. Some patients may benefit from septal reduction strategies while concomitant mitral valve interventions are generally reserved for highly selected cases with intrinsic valve pathology or persistent residual SAM, thereby avoiding unnecessary valvular manipulation and its potential hemodynamic risks. Mavacamten, a selective cardiac myosin inhibitor, represents an important advance in pharmacological management, achieving a mean LVOT gradient reduction of 37.2 mmHg in symptomatic patients. Furthermore, data from the MARVEL registry confirm the real-world clinical efficacy of mavacamten in obstructive hypertrophic cardiomyopathy, with 86% of patients successfully down-staged to NYHA functional class I–II. Although ASA serves as a viable alternative to surgery, it entails a higher risk of conduction abnormalities requiring permanent pacemaker implantation and subsequent re-intervention. Beyond classical hypertrophic SAM, this review addresses the diagnosis and management of post-mitral repair complications and non-hypertrophic variants. Optimal management and risk stratification remain an evolving field requiring a multidisciplinary Heart Team approach, leverage of advanced imaging, and adoption of novel medical therapies. Interventional strategies must be carefully tailored to maximize the efficacy-to-safety profile on an individualized patient basis.
Background: The incidence and predictors of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) during the same hospitalization remain poorly characterized, particularly in Asian populations. Methods: This single-center retrospective study included 164 consecutive patients who underwent PCI and transfemoral TAVR during the same hospitalization at Beijing Anzhen Hospital between June 2018 and October 2023. The primary objective was to evaluate the incidence of MACCE, and logistic regression analyses were used to identify its predictors. Results: Among 164 patients, the mean age was 73.9 ± 7.2 years, and 57.9% were male. Device success was 97.6% and procedural success was 89.6%. MACCE occurred in 28 patients (17.1%) within the index hospitalization or 30 days after discharge. Independent predictors of MACCE were lower baseline left ventricular ejection fraction (LVEF; OR = 0.955, 95% CI 0.920–0.992; p = 0.017) and mixed aortic stenosis and regurgitation (AS + AR; OR = 6.360, 95% CI 1.035–38.993; p = 0.038). Conclusions: A single-hospitalization PCI and TAVR strategy appeared feasible and was associated with acceptable short-term clinical outcomes in carefully selected Chinese candidates, with lower baseline LVEF and mixed AS and AR as independent predictors of MACCE. The observed clinical outcomes should be interpreted descriptively because of the lack of a contemporaneous comparator group; large-scale prospective studies are needed to further evaluate the safety and clinical benefit of this “one-stop” paradigm.
Septic cardiomyopathy is a common complication of sepsis that significantly contributes to hemodynamic instability and adverse clinical outcomes. Despite increasing understanding of its pathophysiology, there is still no specific biomarker that reliably reflects myocardial function during sepsis. Growth differentiation factor-15 (GDF-15) is a cytokine induced by cellular stress associated with inflammation, oxidative stress, and cardiovascular damage. However, the relationship between GDF-15 and echocardiographic markers of septic myocardial dysfunction remains poorly understood. The aim of this study was to examine the association of serum concentrations of GDF-15 and high-sensitivity troponin I (hs-TnI) with echocardiographic parameters of systolic and diastolic myocardial function in patients with sepsis. This prospective observational study included 50 patients with sepsis treated in the Intensive Care Unit of the Osijek Clinical Hospital Center between 2023 and 2025. GDF-15 and hs-TnI concentrations were measured at admission and during follow-up, while transthoracic echocardiography was performed at the same time points to assess myocardial function. Single concentrations of GDF-15 were not significantly associated with most conventional echocardiographic parameters, but showed a positive association with the E/A ratio. In multivariable analysis adjusted for illness severity (SOFA score), admission GDF-15 was independently associated with left ventricular longitudinal systolic function (MAPSE). Changes in GDF-15 during hospitalization were associated with echocardiographic measurements of longitudinal myocardial function obtained at admission and follow-up, including mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler systolic velocity (S′), and isovolumetric relaxation time (IVRT). In contrast, hs-TnI did not show a consistent association with echocardiographic parameters. These findings suggest that serial GDF-15 assessment may provide additional insight into myocardial functional changes during sepsis and complement the echocardiographic evaluation of septic cardiomyopathy.
Objective. Heart-team decisions in transcatheter aortic valve implantation (TAVI) lean on EuroSCORE II, yet the comorbidity burden that often drives the final choice is rarely scored. We tested a specific two-part hypothesis: whether formally quantifying comorbidity burden (via the Charlson Comorbidity Index [CCI] and a modified CCI [mCCI]) recovers prognostic value beyond EuroSCORE II for Valve Academic Research Consortium-3 (VARC-3) outcomes, and whether aggregating comorbidities preserves or dilutes the prognostic signal of individually informative predictors. Methods. In 234 consecutive patients (mean age 76.6 ± 6.1 years) undergoing TAVI for severe aortic stenosis, EuroSCORE II, CCI, and mCCI were computed before the procedure. The primary endpoint was the 30-day VARC-3 composite; secondary endpoints were individual VARC-3 outcomes and one-year mortality. We compared discrimination (AUC, DeLong test) and incremental value with bootstrapping, and analyzed survival by Kaplan–Meier/Cox regression. Results. All three scores discriminated the 30-day composite (63 patients, 26.9%) poorly (AUCs 0.50–0.54), collapsing to chance after correction; neither comorbidity index improved on EuroSCORE II (all p > 0.40). EuroSCORE II’s only meaningful signal was stage 3 acute kidney injury (AKI; AUC 0.676), where it significantly exceeded mCCI (p = 0.048). Serum albumin and chronic kidney disease (HR 2.97 for one-year mortality) were informative individually but not within an aggregate score. Conclusions. In elderly TAVI, the actionable prognostic information resided in individual markers of organ reserve—serum albumin and chronic kidney disease—that count-based comorbidity aggregation dissipated rather than concentrated. EuroSCORE II retained a focused, mechanistically coherent association with stage 3 AKI, reflecting its renal components. These findings support a shift from disease-counting toward direct measurement of organ reserve and frailty in TAVI risk assessment, and the development of TAVI-specific tools that preserve dominant individual predictors rather than averaging them into a single score.
Management of acute coronary syndromes (ACS) in the cardiac intensive care unit (CICU) requires rapid diagnosis, timely reperfusion or invasive assessment, appropriate antithrombotic therapy, and early recognition of haemodynamic, electrical, and mechanical complications. This narrative review examines contemporary evidence across ST-segment elevation and non-ST-segment elevation presentations, with emphasis on decisions during hospitalisation and early secondary prevention. High-sensitivity cardiac troponin algorithms support accelerated assessment of suspected non-ST-segment elevation ACS, whereas next-generation assays require further implementation validation. Twelve-month dual antiplatelet therapy remains the default after ACS in patients without high bleeding risk; abbreviated regimens, de-escalation, cangrelor, and combined antiplatelet–anticoagulant treatment are selective strategies. Contemporary care also includes risk-based invasive timing, complete revascularisation in suitable haemodynamically stable patients, culprit-lesion-only initial PCI in cardiogenic shock, and individualised management of frailty and renal impairment. High-intensity statin therapy, with early ezetimibe when needed, is guideline-supported. Early PCSK9 inhibition and low-dose colchicine are selective strategies, whereas SGLT2 inhibitors and GLP-1RAs are established for specific comorbid indications. hs-cTnT Gen 6 and AI-assisted tools remain evidence-evolving, while multiomics and targeted anti-inflammatory therapies remain investigational. Clear separation of guideline-supported, selective, evidence-evolving, and investigational approaches is essential for clinically appropriate ACS care.
Cardiovascular toxicity associated with anti-tumor therapies is garnering increased attention. Anti-tumor therapies may elevate the risk of acute coronary syndrome, particularly in patients with underlying subclinical atherosclerosis. In this context, a 58-year-old female patient with HER2-positive breast cancer experienced an acute ST-segment elevation myocardial infarction following chemotherapy, dual HER2-targeted therapy, and radiotherapy to the left breast. Prior to the initiation of anti-tumor treatment, chest-computed tomography had identified coronary artery calcification. Angiographic evaluation revealed subtotal occlusion of the middle segment of the left circumflex artery extending to the first obtuse marginal branch, accompanied by multivessel coronary atherosclerotic lesions. Coronary blood flow was restored following emergency interventional treatment. This case indicates that multimodal anti-tumor therapy may facilitate the progression of coronary atherosclerosis, thereby elevating the risk of acute coronary events.
Pulmonary arterial hypertension (PAH) is a severe cardiovascular disease characterized by progressively increased pulmonary vascular resistance and right heart failure. Its pathogenesis involves multiple factors, including genetic predisposition, inflammation, oxidative stress, and imbalances between cell proliferation and apoptosis. Recent studies indicate that autophagy has a context-dependent dual role in PAH. Flux-competent autophagy may be protective by clearing damaged mitochondria, limiting excessive inflammation, and maintaining metabolic homeostasis, whereas excessive autophagy initiation or impaired autophagosome-lysosome degradation may promote metabolic dysfunction, inflammatory signaling, abnormal vascular cell phenotypes, and pulmonary vascular remodeling. This focused narrative review summarizes the molecular mechanisms and key signaling pathways linking autophagy to PAH, with emphasis on PTEN-induced kinase 1 (PINK1)/Parkin-mediated mitophagy and the AMP-activated protein kinase (AMPK)/mechanistic target of rapamycin (mTOR) energy-sensing axis. It also evaluates potential therapeutic strategies targeting key nodes of autophagy, such as AMPK activators and mTOR inhibitors, along with their clinical research progress. Finally, this review provides an outlook on future research directions, emphasizing the need to further elucidate the dynamic regulatory mechanisms and cell-type specificity of autophagy in order to advance the clinical translation of autophagy-targeted precision therapies for PAH.
Objective: To create and test in a population study a behavior score, using as far as possible, procedures based on the a posteriori approach. Material and Methods: Data from the Italian Rural Areas (IRAs) of the Seven Countries Study of Cardiovascular Diseases (SCS), comprising 1712 middle-aged men enrolled in 1960 and their entry levels of smoking habits, physical fitness and dietary habits, were entered into a Principal Components Analysis, producing an individual overall behavior (factor) score. The end-points were the 62-year follow-up, approaching cohort extinction, mortality for all-cause death and five cause-specific conditions, which formed the dependent variables of a series of Cox models, whose outcome was expressed by hazard ratios for one class increase in the score, and comparing tertile 1 versus tertile 3 of the score, without and with the addition of age, systolic blood pressure, serum cholesterol and high socio-economic status as possible confounders. Results: Fatal coronary heart disease (CHD), heart diseases of uncertain etiology (HDUE), stroke, cancer (CAN), chronic bronchitis (CB) and all-cause mortality (ALL) were predicted in a significant way in the four approaches, with a relevant reduction in death rates expressed by hazard ratios ranging from 0.42 to 0.83. Moreover, the influence of the three basic behavior scores showed that CHD was the most strongly associated with them. Age at death for all-cause mortality, on the other hand, was directly related with the full and the three types of behavior score. Conclusions. A behavior score based on three common lifestyle habits created by an a posteriori approach proved to be significantly associated with various causes of death in a male population group followed-up until extinction.
Background: The mid-term prognosis after transcatheter tricuspid valve replacement (TTVR) is poorly defined, and echocardiographic predictors remain uncertain. Objectives: To describe mid-term all-cause mortality, 30-day major adverse events (MAEs), and echocardiographic risk markers of TTVR. Methods: Consecutive patients undergoing TRAVEL (Transcatheter right atrial-ventricular valve replacement With LuX-Valve) at three centers were retrospectively analyzed. Firth Cox regression was applied for mortality, and Firth logistic regression was used for exploratory MAE analyses. Results: A total of 62 patients (median age 66.5 years [61.0–72.8], 83.8% female) were included. Over a mean follow-up of 46.2 months, seven deaths (11.2%) occurred, corresponding to mid-term survival of 88.8%. Within 30 days, 14 patients (22.6%) experienced MAEs, including three deaths (4.8%), major bleeding in eight (12.9%), surgical re-exploration in seven (11.3%), repeat open-heart tricuspid valve replacement in one (1.6%), and permanent pacemaker implantation in six (9.7%). TR was reduced to mild or less in 95.2% at 1 year. Conclusions: In this LuX-Valve TTVR cohort, 30-day MAEs mainly reflected perioperative or device-related complications rather than a direct signal of baseline RV dysfunction or remodeling. LuX-Valve implantation showed favorable mid-term survival and clinically meaningful procedural effectiveness; RV-centered echocardiographic markers should be considered hypothesis-generating and require validation in larger cohorts.
