BMC Cardiovascular Disorders[JOURNAL]
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200 papers
Exploring the benefits and safety of combining nebivolol and valsartan for managing hypertension: a systematic review.
Khalid M, Majzoub WM, Ibrahim YM … +5 more , Makki H, Ibrahim E, Amin MM, Ahmed KO, Yousef BA
BMC Cardiovasc Disord · 2026 May · PMID 42215884 · Full text
BACKGROUND: Hypertension is considered the world's leading risk factor for mortality. Many individuals with hypertension need to take multiple blood pressure (BP)-lowering medications. Combining Nebivolol, a third-genera...
BACKGROUND: Hypertension is considered the world's leading risk factor for mortality. Many individuals with hypertension need to take multiple blood pressure (BP)-lowering medications. Combining Nebivolol, a third-generation beta-blocker, and Valsartan, an angiotensin receptor blocker (ARB), presents a promising therapeutic approach for BP management. Although several clinical studies have evaluated this combination, evidence regarding its overall efficacy and safety remains fragmented. This study aims to evaluate the efficacy and safety of this combination therapy. METHOD: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was conducted across PubMed, Scopus, and the Cochrane Library from inception until February 2025. The studies that met the requirements to assess the safety and effectiveness of a combination therapy of nebivolol and valsartan for the treatment of hypertension included open-label studies, crossover trials, and randomized controlled trials (RCTs). Databases searched included PubMed, Scopus, and Cochrane Library. The main topics of data extraction were the changes in systolic and diastolic blood pressure (SBP/DBP), cardiovascular events, treatment adherence, and quality-of-life measures. The risk of bias was assessed using ROB 2.0 and ROBINS-I frameworks. RESULTS: Out of 99 initially screened studies, six met the inclusion criteria, including two randomized controlled trials (one of which generated two prespecified sub-analyses), one open-label single-arm study, and one crossover trial. The results showed that combining Nebivolol and valsartan decreased SBP and DBP. The highest dose (20/320 mg) achieved a mean SBP reduction of -15.4 mmHg and a DBP reduction of -10.0 mmHg over 8 weeks. Long-term Studies of a 52-week duration showed sustained blood pressure control, with an average drop in SBP of -25.5 mmHg and a drop in DBP of -19.0 mmHg. Additionally, the combination improved heart rate variability and reduced renin-angiotensin-aldosterone system activity. Clinical trials have reported that Nebivolol has a favorable safety profile, with mild and transient symptoms, including fatigue, headache, dyspnea, insomnia, dizziness, and paresthesia, making it a patient-preferred option. CONCLUSION: This systematic review provides evidence for the safety and efficacy of the nebivolol-valsartan combination as an antihypertensive regimen. The combination is also beneficial in terms of hemodynamic parameters and overall cardiac load. Nevertheless, large-scale, long-term trials are needed to confirm these results and to define who can benefit most from this therapy.
Association of alkaline phosphatase to platelet ratio index with ICU mortality in patients with cardiac arrest.
Li Y, Lin Z, Chen Y … +9 more , Di X, Zhou F, Xia Y, Zhang P, Tang J, Liu Y, Wang X, Yuan Y, Zhao Y
BMC Cardiovasc Disord · 2026 May · PMID 42215878 · Full text
BACKGROUND AND OBJECTIVES: The present study aimed to investigate the association between the alkaline phosphatase-to-platelet ratio index (APPRI) and intensive care unit (ICU) mortality in patients with cardiac arrest (...
BACKGROUND AND OBJECTIVES: The present study aimed to investigate the association between the alkaline phosphatase-to-platelet ratio index (APPRI) and intensive care unit (ICU) mortality in patients with cardiac arrest (CA), and further explore its potential value for risk stratification in this specific population. METHODS: A total of 374 CA patients were included in our analysis. They were divided into the survivor group (n = 180) and non-survivor group (n = 194) based on ICU survival status. Baseline characteristics of the two groups were summarized and compared. Univariate and multivariate logistic regression analyses were conducted to explore the association between the alkaline APPRI and ICU mortality. Receiver operating characteristic (ROC) curve analysis was used to determine APPRI's optimal cutoff value for predicting ICU mortality. The Kaplan-Meier method was applied to estimate survival curves of different groups, with the log-rank test used to compare survival differences. RESULTS: The non-survivor group exhibited higher APPRI values than the survivor group (0.430 [0.296, 0.733] vs.0.358 [0.246, 0.533)], P < 0.001). Univariate logistic regression analysis showed that APPRI (odds ratio (OR) = 1.077, 95% confidence interval (CI): 1.013-1.146, P = 0.018) was associated with ICU mortality. Multivariate logistic regression analysis revealed that APPRI was one of the independent predictors of ICU mortality (OR = 1.110, 95% CI: 1.022-1.205, P = 0.013). The ROC curve determined the APPRI optimal cut-off value for ICU mortality to be 0.576. The Kaplan-Meier curves showed that patients with APPRI > 0.576 had a higher ICU mortality than that of patients with APPRI ≤ 0.576 (log-rank test P = 0.017). CONCLUSIONS: APPRI is independently associated with ICU mortality in patients with CA, and the index effectively stratifies CA patients at risk of ICU deat.
The persisting challenge of recurrent in-stent restenosis: a systematic review and meta-analysis of prevalence and prognostic risk factors.
Chen H, Yuan Z, Zhang S … +3 more , Hu X, Bao J, Wang G
BMC Cardiovasc Disord · 2026 May · PMID 42215856 · Full text
BACKGROUND: Recurrent in-stent restenosis (R-ISR) after percutaneous coronary intervention remains a clinically important failure mode, yet reported rates and predictors vary widely. We aimed to quantify the pooled incid...
BACKGROUND: Recurrent in-stent restenosis (R-ISR) after percutaneous coronary intervention remains a clinically important failure mode, yet reported rates and predictors vary widely. We aimed to quantify the pooled incidence of R-ISR and synthesize multivariable risk factors. METHODS: A comprehensive literature search of the electronic database was updated on May 3, 2025. Studies reporting the incidence or analyzing the risk factors of R-ISR were eligible. Study quality was assessed using the Newcastle-Ottawa Scale. Data synthesis was achieved via random-effects meta-analysis using the R studio (version 4.4.3). Subgroup analyses considered region, treatment, and follow-up, with leave-one-out sensitivity analyses. The systematic review is reported in accordance with the PRISMA 2020 checklist. RESULTS: Twenty-three studies were included. The overall pooled incidence of R-ISR was 21.7% (95%CI 17.1%-27.2%), with variations by region (highest in Europe), treatment type (lowest with DES), and follow-up duration (highest within 6 months). Significant risk factors included renal disease (OR 3.90; 95%CI 1.87-8.11), non-focal restenosis (OR 3.29; 95%CI 2.41-4.49), lesion length (OR 1.15; 95%CI 1.06-1.24), heterogeneous tissue pattern (OR 3.36; 95%CI 1.69-6.67), stent fracture (OR 2.21; 95%CI 1.29-3.79), and higher percentage diameter stenosis (OR 1.05; 95%CI 1.03-1.06). Age showed non-significant association (OR 0.96; 95%CI 0.93-1.00). CONCLUSIONS: To our knowledge, this is among the first systematic reviews and meta-analyses specifically focused on recurrent ISR after treatment of ISR lesions. Renal disease, non-focal morphology, lesion length, heterogeneous tissue pattern, stent fracture and greater post-procedural percentage diameter stenosis were consistently associated with higher risk of R-ISR. These findings support individualized treatment selection with intensified secondary prevention and closer surveillance during the first six months after the recent percutaneous coronary intervention performed for ISR. PROSPERO REGISTRATION NUMBER: CRD420251043520.
Serum free fatty acids and progression of coronary artery calcification: sex specific findings from a large U.S. cohort study.
Ramezankhani A, Hadaegh F, Esmaeili F
BMC Cardiovasc Disord · 2026 May · PMID 42210161 · Full text
BACKGROUND: Studies evaluating the longitudinal relationship between plasma free fatty acids (FFAs) and subclinical atherosclerosis remain limited. We investigated the prospective association between serum FFA levels and...
BACKGROUND: Studies evaluating the longitudinal relationship between plasma free fatty acids (FFAs) and subclinical atherosclerosis remain limited. We investigated the prospective association between serum FFA levels and the progression of coronary artery calcification (CAC) in a generally healthy, age-, sex-, and racially/ethnically diverse population. METHODS: This study utilized baseline data from the Multi-Ethnic Study of Atherosclerosis cohort, collected from 2000 to 2002, including 2988 women and 2696 men, with outcome data extending to 2012. CAC progression was defined as either the new onset of detectable CAC among participants with a baseline score of zero or a clinically meaningful increase in CAC severity among those with pre-existing CAC, based on established cut-offs. We employed Cox proportional hazards regression to calculate hazard ratios (HR) and 95% confidence intervals (95%CI) for the associations between FFAs and the CAC progression, stratified by sex. We evaluated potential non-linear relationships using restricted cubic splines. RESULTS: During the 9-year follow-up, we identified 1302 cases of CAC progression in women and 1480 cases in men. Serum FFAs were linearly associated with CAC progression in men, with a multivariable-adjusted HR of 1.41 (95% CI: 1.03-1.93) for each mmol/L increase in FFAs. Moreover, men in the highest relative to the lowest quintile of FFAs had a 20% higher risk (1.20; 1.02-1.43). Among women, we found evidence of a potential nonlinear association between FFAs and CAC progression, suggesting a threshold effect in their relationship (P non-linearity: 0.050). We observed no significant effect modification by age, body mass index, diabetes status, or hypertension in the relationship between FFAs and CAC progression. CONCLUSIONS: This study highlights a significant association between FFAs and CAC progression in both men and women, though the nature of this association differs by gender.
Semaglutide in non-diabetic obese Chinese patients with acute coronary syndrome: a multicenter retrospective study.
Jin CL, Huang L, Wei YY … +4 more , Xu YS, Zhang B, Wu J, Fan LL
BMC Cardiovasc Disord · 2026 May · PMID 42210124 · Full text
OBJECTIVE: This study aimed to assess clinical benefits of semaglutide for East Asian non-diabetic obese patients with ACS who have undergone percutaneous coronary intervention (PCI) . METHOD: This was a multicenter retr...
OBJECTIVE: This study aimed to assess clinical benefits of semaglutide for East Asian non-diabetic obese patients with ACS who have undergone percutaneous coronary intervention (PCI) . METHOD: This was a multicenter retrospective cohort study. A total of 344 non-diabetic obese patients with ACS who underwent PCI at three hospitals from May 2020 to December 2024 were enrolled (semaglutide group:112 patients, control group: 232 patients). Propensity score matching (PSM) was performed to balance the baseline data between the two groups. The primary endpoint was 6-month major adverse cardiovascular events (MACE), and secondary endpoints included dynamic changes in cardiac troponin I (cTnI) and alterations in metabolic and left ventricular ejection fraction (LVEF) at 6-month follow-up. RESULTS: After PSM, compared with the control group, the semaglutide group had lower rates of the 6-month MACE (11.6% vs. 23.2%, p = 0.034) and unplanned revascularization (4.7% vs. 13.4%, p = 0.033), and and showed faster improvement in cTnI levels. Both groups showed improvements in blood lipid profiles and LVEF post-PCI. Additionally, the semaglutide group achieved further reductions in fasting blood glucose (FBG) (5.74 ± 0.60mmol/L vs. 5.25 ± 0.43mmol/L, p < 0.0001), glycated hemoglobin (HbA1c) (5.43 ± 0.59% vs. 5.18 ± 0.50%, p = 0.016) and body mass index (BMI) (30.94 ± 1.69 kg/m²vs. 28.45 ± 2.82 kg/m², p < 0.0001). Particularly, the magnitudes of improvements in BMI (2.49 ± 3.27 kg/m²vs. 0.78 ± 2.76 kg/m², p = 0.002), FBG (0.49 ± 0.75mmol/L vs. 0.03 ± 0.83mmol/L, p < 0.0001), LDL-C (1.78 ± 1.22mmol/L vs. 0.83 ± 0.94mmol/L, p < 0.0001), TG (0.98 ± 1.02mmol/L vs. 0.63 ± 0.70mmol/L, p = 0.003) and LVEF (5.73 ± 8.07% vs. 2.66 ± 8.09%, p = 0.005) in the semaglutide group were significantly superior to those in the control group. CONCLUSIONS: Semaglutide treatment was associated with a lower 6-month MACE and favorable changes in metabolic and cardiac function in non-diabetic obese ACS patients post-PCI. These observational findings provide real-world evidence for further study. CLINICAL TRIAL REGISTRATION: This was a retrospective study, so clinical trial registration was not applicable.
Perioperative changes in diaphragm thickening fraction in cardiac surgery patients.
Yildirim G, Yildirim S
BMC Cardiovasc Disord · 2026 May · PMID 42210091 · Full text
INTRODUCTION: Diaphragmatic dysfunction is a recognized contributor to postoperative respiratory complications following cardiac surgery. Diaphragm ultrasonography has been proposed as a bedside tool to assess diaphragm...
INTRODUCTION: Diaphragmatic dysfunction is a recognized contributor to postoperative respiratory complications following cardiac surgery. Diaphragm ultrasonography has been proposed as a bedside tool to assess diaphragm function. METHODS: In this prospective study, 133 patients undergoing elective cardiac surgery were evaluated. Diaphragm thickening fraction (TF) was measured using ultrasound one day before and one day after surgery. The perioperative change in TF (ΔTF) was also calculated. The primary outcome was ICU length of stay. Multivariable linear regression analysis was performed to assess independent associations. RESULTS: Postoperative TF values decreased compared to preoperative measurements. In unadjusted analyses, diaphragm thickening fraction was not significantly associated with extubation time or ICU length of stay. Multivariable analysis demonstrated that cardiopulmonary bypass time and cross-clamp duration were independently associated with ICU stay, whereas diaphragm thickening fraction parameters were not independently associated with ICU length of stay. No significant correlation was observed between TF parameters and extubation time. ROC analysis showed limited discriminative ability of TF for predicting ICU stay (AUC < 0.70). In exploratory analysis, higher ΔTF (≥76%) was associated with shorter ICU stay; however, this finding was not confirmed after adjustment. CONCLUSION: Diaphragm thickening fraction was not an independent predictor of ICU length of stay in patients undergoing cardiac surgery. TF may reflect perioperative physiological changes rather than serve as a standalone prognostic marker.
Cardiovascular disease risk factors in women with O-desmethylangolensin producing and non-producing gut microbial metabotypes: an observational study.
Childs H, Frankenfeld CL, Dailey A … +2 more , Couch R, Slavin M
BMC Cardiovasc Disord · 2026 May · PMID 42210082 · Full text
BACKGROUND: Daidzein, an isoflavone in soy, is metabolized to O-desmethylangolensin (ODMA) by select gut bacteria. Not all individuals have gut microbiomes capable of producing ODMA, resulting in ODMA producer and non-pr...
BACKGROUND: Daidzein, an isoflavone in soy, is metabolized to O-desmethylangolensin (ODMA) by select gut bacteria. Not all individuals have gut microbiomes capable of producing ODMA, resulting in ODMA producer and non-producer metabotypes. A limited body of research suggests that ODMA producers have lower systolic blood pressure, percent body fat and total cholesterol, compared to non-producers. More work is needed to confirm this relationship in other populations. METHODS: Data from the Study of Women's Health Across the Nation (SWAN), a study of women in their middle years, was used. A subset of women who reported consumption of isoflavones in diet or supplements was included for this analysis. Urinary ODMA and daidzein of 148 participants were measured via HPLC-MS-MS to classify metabotypes: ODMA (nmol/L)/daidzein (nmol/L) = 0, non-producers (n = 23); ODMA (nmol/L)/daidzein (nmol/L) > 0 but less than 0.5, low-producers (n = 90); and ODMA (nmol/L)/daidzein (nmol/L) > 0.5, high-producers (n = 35). Multivariable linear regression models were used to compare cardiovascular disease (CVD) risk markers among groups. Models were adjusted for age, race, self-reported health, blood pressure medication, smoking, menopausal status and anthropometry. RESULTS: ODMA non-producers had higher systolic blood pressure (adj. mean difference = 7.6 mmHg, 95% CI: 1.1, 14.1, p = 0.02) compared to high producers. Another trend but not statistically significant difference observed included higher fasting serum glucose (adj. mean difference = 6.1 mg/dl, CI: -0.9, 13.2, p = 0.09) in ODMA non-producers when compared to ODMA producers. CONCLUSIONS: In this diverse sample of U.S. women, this study observed higher blood pressure in ODMA non-producers than ODMA producers. This aligns with prior work associating ODMA producers with a more favorable CVD risk profile compared to non-producers, and provides additional evidence that this gut microbial metabotype may be related to cardiovascular health.
Association between triglyceride glucose-body mass index and all-cause mortality in critically ill patients with atherosclerotic cardiovascular diseases: a retrospective cohort study using the MIMIC-IV database.
Liu Y, Fu C, Li F … +2 more , Wang H, Zhu M
BMC Cardiovasc Disord · 2026 May · PMID 42210069 · Full text
BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of cardiovascular mortality worldwide, with insulin resistance recognized as a key pathophysiological driver. While the triglyceride gl...
BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of cardiovascular mortality worldwide, with insulin resistance recognized as a key pathophysiological driver. While the triglyceride glucose-body mass index (TyG-BMI) has emerged as a promising insulin resistance marker, its prognostic value for ASCVD mortality outcomes requires further elucidation. METHODS: We conducted a retrospective cohort study of 1,637 critically ill ASCVD patients (median age 68.3 years) from the MIMIC-IV database. The primary endpoints were 30-day and 1-year mortality, with secondary assessments of 90-day and 180-day mortality. Comprehensive statistical analyses included multivariable Cox regression, restricted cubic splines (RCSs) for nonlinearity assessment, and Kaplan-Meier survival analysis. RESULTS: After full adjustment for potential confounders, elevated TyG-BMI showed significant inverse associations with both 30-day (HR 0.11, 95% CI 0.06-0.19) and 1-year mortality (HR 0.13, 95% CI 0.08-0.20). RCS analysis revealed a characteristic L-shaped dose-response relationship (nonlinear P < 0.001), while Kaplan-Meier curves demonstrated progressively improved survival across TyG-BMI quartiles (log-rank P < 0.001). CONCLUSION: This study revealed that the TyG-BMI is an independent predictor of mortality in critically ill ASCVD patients, with a distinct nonlinear protective effect. These findings support the potential clinical utility of the TyG-BMI for risk stratification in this high-risk population.
Prognostic impact of platelet count trajectories in acute decompensated heart failure: a retrospective cohort analysis.
Marcus G, Barzilay M, Maymon SL … +6 more , Kalmanovich E, Moravsky G, Minha I, Grupper A, Fuchs S, Minha S
BMC Cardiovasc Disord · 2026 May · PMID 42204661 · Full text
AIMS: To determine whether in-hospital platelet count trajectories during admission for acute decompensated heart failure (ADHF) are associated with early and longer-term outcomes after discharge. METHODS: We performed a...
AIMS: To determine whether in-hospital platelet count trajectories during admission for acute decompensated heart failure (ADHF) are associated with early and longer-term outcomes after discharge. METHODS: We performed a single-centre retrospective cohort study of adults hospitalized for ADHF (2007-2017). After excluding in-hospital deaths and cases without paired platelet measurements, 6,789 patients were analyzed from an initial 8,332. Platelet status was defined by WHO thresholds at admission and discharge and categorized into four trajectories: Normal→Normal (n = 5,453), Low→Low (n = 700), Normal→Low (n = 325), and Low→Normal (n = 311). Outcomes from the date of discharge were: 30-day readmission and 30-day mortality (binary), and time-to-event 1-year readmission and 1-year and 5-year all-cause mortality. Multivariable logistic regression modeled 30-day endpoints; Cox models estimated hazard ratios (HRs) for 1- and 5-year outcomes, adjusting for prespecified clinical covariates. A multinomial-propensity-score inverse probability weighting sensitivity analysis assessed robustness. RESULTS: Relative to the Normal→Normal group, the Normal→Low trajectory (normal platelets on admission, thrombocytopenia at discharge) was associated with higher 30-day readmission (OR 1.39, 95% CI 1.08-1.80, p = 0.011) and markedly higher 30-day mortality (OR 2.40, 95% CI 1.58-3.63, p < 0.001). It was also associated with higher 1-year mortality (HR 1.66, 95% CI 1.37-2.02, p < 0.001) and 5-year mortality (HR 1.37, 95% CI 1.21-1.56, p < 0.001), while 1-year readmission did not differ significantly. The Low→Low trajectory showed no association with 5-year mortality (HR 1.05, 95% CI 0.95-1.15, p = 0.332), and Low→Normal trended toward lower 5-year mortality (HR 0.88, 95% CI 0.77-1.01, p = 0.061). Findings were directionally consistent in inverse-probability-weighted analyses. CONCLUSIONS: In patients hospitalized with ADHF and discharged alive, a decline in platelet count from normal at admission to thrombocytopenia at discharge was associated with excess 30-day readmission and mortality and with persistent excess mortality at 1 and 5 years after discharge. The incremental discrimination over established clinical covariates was modest, indicating that platelet trajectory is unlikely to serve as a standalone risk tool. Because platelet counts are inexpensive and routinely available, the in-hospital trajectory warrants further evaluation as a candidate prognostic adjunct to established HF risk frameworks, pending prospective external validation.
Post-PCI outcomes in women with acute coronary syndrome: a systematic review and meta-analysis of risk factors.
Jiang Q, Zhang T, Geng H … +6 more , Guo T, Xia H, Shen D, Chi Y, Zhong H, Duan H
BMC Cardiovasc Disord · 2026 May · PMID 42204466 · Full text
INTRODUCTION: Acute coronary syndrome (ACS) is a serious clinical condition linked to considerable morbidity and mortality. While percutaneous coronary intervention (PCI) is the mainstay of treatment, the occurrence of a...
INTRODUCTION: Acute coronary syndrome (ACS) is a serious clinical condition linked to considerable morbidity and mortality. While percutaneous coronary intervention (PCI) is the mainstay of treatment, the occurrence of adverse cardiovascular events (MACE) following the procedure remains a significant challenge. Although numerous studies have explored risk factors for MACE in female ACS patients after PCI, inconsistent results exist due to sample size and regional variations. The purpose of this meta-analysis and systematic review is to evaluate these risk factors to obtain higher-level evidence in ACS patients. METHODS: Computerized searches were conducted in CNKI, Wanfang, VIP, China Biology Medicine disc, PubMed, Web of Science, Embase, and Cochrane Library databases to identify literature on risk factors for MACE in female patients with ACS after PCI. The search period spanned from database inception to September 2025. Based on predefined inclusion and exclusion criteria, articles were screened by reviewing titles, abstracts, and full texts. Data extraction was performed, and quality assessment was conducted independently by two researchers using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4 software and Stata 14.0. RESULTS: A total of 22 studies comprising 16,500 female patients were included. All studies were cohort studies and reported adjusted odds ratios from multivariable analyses. The meta-analysis identified eight significant risk factors for MACE in female ACS patients after PCI: advanced age (OR = 1.08, 95%CI: 1.00-1.15), decreased LVEF (OR = 1.77, 95%CI: 1.19-2.62), hypertension (OR = 1.73, 95%CI: 1.40-2.15), diabetes mellitus (OR = 1.69, 95%CI: 1.51-1.88), smoking (OR = 2.43, 95%CI: 1.74-3.39), multivessel coronary artery disease (OR = 1.69, 95%CI: 1.43-1.99), history of cerebrovascular disease (OR = 2.18, 95%CI: 1.55-3.05), and symptom-to-balloon time delay (OR = 1.33, 95%CI: 1.24-1.42) were identified as risk factors for MACE in female ACS patients with PCI management. Subgroup analyses demonstrated consistent effect sizes across geographic regions, publication years, sample sizes, and study quality levels. Meta-regression analyses identified no significant sources of heterogeneity for advanced age (I = 91%), suggesting that clinical rather than methodological factors account for this variability. Insufficient reporting in the original studies prevented a meta-analysis of female-specific risk factors, including premature menopause, gestational diabetes, and PCOS, which constitutes a critical gap in the literature. DISCUSSION: The incidence of MACE is elevated in female ACS patients following PCI. Healthcare professionals should monitor patients' clinical status promptly, develop personalized treatment strategies. Perioperative management must be enhanced, particularly for patients with comorbidities such as advanced age and diabetes, to mitigate the risk of major adverse cardiovascular events.
The association between the advanced lung cancer inflammation index and successful antegrade recanalization in patients with coronary chronic total occlusion: a retrospective cross-sectional study.
Qi B, Liu M, Yi X … +9 more , Jia Y, Tan Y, Zhang Z, Zhang T, Zheng Z, Li C, Fu Y, Cheng J, Zhao L
BMC Cardiovasc Disord · 2026 May · PMID 42204452 · Full text
BACKGROUND: Chronic total occlusion (CTO) represents one of the most challenging lesion subsets in coronary artery disease, and antegrade recanalization (AR) is the preferred approach for revascularization due to its low...
BACKGROUND: Chronic total occlusion (CTO) represents one of the most challenging lesion subsets in coronary artery disease, and antegrade recanalization (AR) is the preferred approach for revascularization due to its lower complication risk. However, predicting AR success remains clinically difficult. The Advanced Lung Cancer Inflammation Index (ALI), integrating body mass index, albumin, and neutrophil-to-lymphocyte ratio, reflects nutritional and inflammatory status, both of which may influence procedural outcomes. This study aimed to investigate the association between ALI and successful AR in CTO patients undergoing percutaneous coronary intervention (PCI). METHODS: In this retrospective cross-sectional study, 198 patients with angiographically confirmed CTO undergoing PCI between May 2024 and December 2025 were analyzed. Patients were stratified into successful AR (n = 132) and failed AR (n = 66) groups based on the final recanalization route. ALI was calculated preprocedurally. Multivariable logistic regression, generalized additive modeling (GAM), and subgroup and sensitivity analyses were performed to examine the association between ALI and AR success. Receiver operating characteristic (ROC) curves were used to evaluate the predictive capability of ALI and the Japanese CTO Registry (J-CTO) score for successful AR, with DeLong' s test to compare model differences. Confusion matrix parameters were also used to assess model performance. RESULTS: Patients in the successful AR group had significantly lower ALI values than those in the failed group (P = 0.012). Higher ALI was independently associated with lower odds of AR success in both unadjusted (OR = 0.624; 95% CI, 0.437-0.859; P = 0.006) and fully adjusted models (OR = 0.622; 95% CI, 0.416-0.879; P = 0.013). GAM confirmed an approximately linear inverse relationship between ALI and AR success (P = 0.013). Subgroup analyses showed consistent associations across clinical strata, with particularly strong effects in males and patients with prior PCI or MI. Sensitivity analysis revealed a significant dose-response trend across ALI quartiles (P for trend = 0.021), with the highest ALI quartile associated with significantly lower AR success (OR = 0.318; 95% CI, 0.121-0.96; P = 0.017). ROC curve analysis demonstrated that ALI alone had fair predictive performance for AR success (AUC = 0.608; 95% CI, 0.524-0.692), with high specificity (0.970) but low sensitivity (0.106; F1 = 0.182). The J-CTO score improved discrimination (AUC = 0.760; 95% CI, 0.696-0.823), and combining ALI with J-CTO further enhanced predictive ability (AUC = 0.798; 95% CI, 0.736-0.860; sensitivity = 0.439, specificity = 0.864, F1 = 0.513). DeLong' s test confirmed a statistically significant AUC improvement for the combined model versus J-CTO alone (ΔAUC = 0.038; 95% CI, 0.007-0.069; P = 0.017), indicating additional prognostic value of ALI. CONCLUSIONS: ALI is independently and inversely associated with the success of AR in CTO lesions. As a composite biomarker of inflammation and nutrition, ALI may help identify patients with lower probability of AR success and, when combined with the J-CTO score, enhance preprocedural assessment and procedural planning.
Exploring the association of poor social support and loneliness with cardiovascular history among lebanese residents: insights into myocardial infarction and stroke: a cross-sectional approach.
Sharaf F, Khairallah R, Osta J … +3 more , Hassan JA, Ayoub I, Deek H
BMC Cardiovasc Disord · 2026 May · PMID 42204450 · Full text
BACKGROUND: Cardiovascular diseases (CVDs), including myocardial infarction (MI) and stroke, remain among the most prevalent causes of global morbidity and mortality. Evidence suggests that psychosocial variables, especi...
BACKGROUND: Cardiovascular diseases (CVDs), including myocardial infarction (MI) and stroke, remain among the most prevalent causes of global morbidity and mortality. Evidence suggests that psychosocial variables, especially loneliness and social support, play an important role in cardiovascular health. However, this relationship has not been studied in Lebanon. OBJECTIVE: This study aims to assess the association of insufficient social support and loneliness with cardiovascular history specifically, history of MI and stroke. METHODS: A cross-sectional study that involved a self-administered questionnaire from community participants. Data were collected from people aged 50 and above with a mean age of 60.15 (SD = 9.8) years. Data collection forms included sociodemographic characteristics, Charlson's comorbidity index including cardiovascular history, The Medical Outcome Study Social Support Survey including its five domains and the Arabic translated version of the University of California Los Angeles Loneliness Scale. RESULTS: Out of the sample of 499 participants, the analysis showed that 89.6% of participants experienced high levels of loneliness, and poor levels of social support across all of the five domains of the scale. History of cardiovascular events was significantly associated with age (p < 0.001), gender (0.026), employment (p < 0.001) and marital status (p = 0.039) in addition to the living region. History of cardiovascular events was also associated with social (p < 0.001) and medical history (p < 0.001) of the participants. Loneliness was found to be significantly associated with acute cardiovascular history in the multivariate analysis (OR: 1.051, 95% CI: 1.021, 1.081, p = 0.001). CONCLUSIONS: Loneliness and low social support are strongly associated with poor cardiovascular outcomes, highlighting the need to address psychosocial factors in heart health care.
Point-of-care ultrasound for emergency pericardiocentesis: a multidimensional CUSUM analysis of the learning curve.
Tang X, Chen M, Chen Y … +2 more , Zhong C, Yang X
BMC Cardiovasc Disord · 2026 May · PMID 42192501 · Full text
BACKGROUND: Emergency point-of-care ultrasound-guided percutaneous pericardial catheter drainage (US-GPPCD) is a life-saving intervention for cardiac tamponade, yet the learning curve among novice operators in emergency...
BACKGROUND: Emergency point-of-care ultrasound-guided percutaneous pericardial catheter drainage (US-GPPCD) is a life-saving intervention for cardiac tamponade, yet the learning curve among novice operators in emergency settings remains poorly characterized, especially for multidimensional metrics and operator positioning. This study aimed to evaluate the learning curve, procedural efficiency, operator confidence, complications, and the influence of operator positioning for US-GPPCD performed by a single novice operator under direct supervision. METHODS: A total of 33 consecutive patients undergoing US-GPPCD between October 2024 and December 2025 by a single novice operator without prior independent experience were enrolled. Procedural metrics were prospectively recorded immediately post-procedure, while clinical data were retrospectively collected. Demographic and clinical characteristics, procedure time, needle insertion site localization time, operator confidence score, operator position, and complications were analyzed. Three separate cumulative sum (CUSUM) learning curves were constructed for multidimensional learning curve analysis. RESULTS: CUSUM analysis divided the learning curve into two phases: phase 1 (cases 1-14, skill-acquisition) and phase 2 (cases 15-33, skill-proficiency). Procedure time and localization time were significantly longer, and operator confidence score was significantly lower, in phase 1 than in phase 2 (all P < 0.01). The complication rate was higher in phase 1 (28.6%) than in phase 2 (5.3%), with no statistically significant difference (P = 0.14). While left-side positioning was associated with shorter procedure time in unadjusted analysis, this effect was confounded by operator experience and not significant after adjustment. CONCLUSION: In this exploratory analysis, US-GPPCD showed acceptable short-term safety under direct supervision. A significant inflection point in procedural efficiency was observed at approximately 14 cases, while operator confidence consolidated shortly thereafter. These findings provide preliminary, hypothesis-generating evidence that may inform future training protocols, but require validation across multiple operators and centers.
Impaired left atrial function increases the risk of incident atrial fibrillation and heart failure with preserved ejection fraction in hypertensive patients.
Ai Y, Long S, He L … +6 more , Li J, Xu W, Yue J, Luo J, Yang J, Shi X
BMC Cardiovasc Disord · 2026 May · PMID 42192497 · Full text
PURPOSE: Left atrial (LA) function has emerged as an important marker of LA compliance and has been associated with adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed...
PURPOSE: Left atrial (LA) function has emerged as an important marker of LA compliance and has been associated with adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to evaluate the association between impaired LA function and the risk of incident atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). HYPOTHESIS: Impaired LA function is associated with an increased risk of incident AF and HFpEF. METHODS: A total of 268 patients without a prior diagnosis of heart failure or atrial fibrillation were prospectively enrolled according to predefined inclusion and exclusion criteria. RESULTS: During a mean follow-up of 36 ± 3 months, 79 patients (29.48%) developed AF and 69 patients (25.75%) developed HFpEF, including 23 patients (8.6%) who developed both conditions. Compared with patients who remained free of both conditions, those who developed AF and/or HFpEF exhibited impaired LA function, reflected by lower LATEF, LAPEF, LAAEF, and LAEI, as well as a higher E/e' ratio (all P < 0.05). In multivariable Cox regression analyses, LAD, E/e' ratio, interventricular septal thickness (IVS), and LATEF were independently associated with incident AF. Similarly, E/e' ratio, LATEF, LAAEF, and IVS were independently associated with incident HFpEF. Patients with lower LATEF had higher risks of all-cause mortality and stroke during follow-up. CONCLUSION: Impaired LA function is associated with an increased risk of AF and HFpEF. Reduced LATEF is independently associated with these outcomes and is further associated with adverse clinical events.
Congenital heart disease in children in Hawassa, Ethiopia: a multicenter study on patterns, complications, survival, and mortality predictors.
Nasir M, Wendmagegn M, Ademu G
BMC Cardiovasc Disord · 2026 May · PMID 42192321 · Full text
BACKGROUND: Given the limited data from developing countries, this study aimed to examine the patterns of congenital heart disease, associated complications, management, survival and mortality rates, and independent pred...
BACKGROUND: Given the limited data from developing countries, this study aimed to examine the patterns of congenital heart disease, associated complications, management, survival and mortality rates, and independent predictors of mortality in children. METHODOLOGY: This retrospective multicenter follow-up study was conducted at five hospitals in Hawassa, Ethiopia, from April 1 to July 1, 2025, including children seen between January 1, 2015, and January 1, 2025. Patterns of congenital heart disease, complications, and management were summarized as frequencies and percentages. Mortality incidence was calculated per 1,000 person-years. Kaplan-Meier analysis estimated survival, and Cox proportional hazards regression identified independent mortality predictors. RESULTS: A total of 1,251 children met the inclusion criteria. Acyanotic congenital heart diseases predominated (1,110; 88.7%), with Ventricular septal defect (384; 30.7%), patent ductus arteriosus (207; 16.5%), and secundum atrial septal defect (158; 12.6%) being the most common. Over a median follow-up of 5 years (IQR: 4-7), 1,043 children (83.4%) developed at least one complication, most frequently New York Heart Association (NYHA)/Modified Ross class III/IV heart failure (HF) (204; 16.3%) and isolated pulmonary hypertension (PH) (168; 13.4%). Most children were managed medically (1,210; 96.7%), 23 (1.8%) received follow-up care only, and 18 (1.4%) underwent intervention (17 surgeries and 1 catheter-based procedure). Among the 1,013 children (81.0%) with indications for surgical or catheter-based intervention, only 18 (1.4%) actually received the procedure, indicating that the vast majority of eligible children did not undergo intervention. Overall survival was 96.6%, 95.0%, 90.2%, and 84.6% at 1, 3, 5, and 10 years, with a mortality incidence of 18.9 per 1,000 person-years (95% CI: 15.9-22.4). Mortality risk was higher in children with syndromic association (HR = 2.9; 95% CI: 2.0-4.3; p = 0.02), severe acute malnutrition (SAM) (HR = 3.3; 95% CI: 2.4-4.9; p < 0.001), severe biventricular congenital heart disease (HR = 1.8; 95% CI: 1.2-2.7; p = 0.02), severe univentricular congenital heart disease (HR = 11.5; 95% CI: 8.2-19.4; p < 0.001), NYHA/modified Ross class III/IV HF (HR = 1.9; 95% CI: 1.1-2.7; p = 0.03), PH (HR = 1.4; 95% CI: 1.2-2.3; p = 0.02), and an indication for surgical or catheter-based intervention (HR = 1.8; 95% CI: 1.1-4.1; p = 0.04). CONCLUSION: Acyanotic congenital heart diseases, mainly ventricular septal defect, patent ductus arteriosus, and secundum atrial septal defect, were most common. Over three-quarters of children developed complications, including at admission. Few received the needed surgical or catheter-based interventions. Survival was low, exceeding developed-country mortality. Syndromic features, advanced HF, PH, congenital heart disease complexity, and intervention need predicted mortality, highlighting the significance of early diagnosis and care.
Predictive value of monocyte-to-high-density lipoprotein cholesterol ratio for acute kidney injury following coronary artery bypass grafting.
Lv X, Li C, Shen T … +2 more , Zhou W, Zhu F
BMC Cardiovasc Disord · 2026 May · PMID 42192313 · Full text
OBJECTIVE: To evaluate the predictive value of preoperative monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for acute kidney injury (AKI) after coronary artery bypass grafting (CABG). METHODS: This retrospec...
OBJECTIVE: To evaluate the predictive value of preoperative monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for acute kidney injury (AKI) after coronary artery bypass grafting (CABG). METHODS: This retrospective single-center study enrolled 280 patients undergoing CABG at Shanghai East Hospital between January and December 2024. Eligible patients were aged ≥ 18 years, lacked prior chronic kidney disease, and had complete perioperative data. Preoperative MHR was calculated, and postoperative AKI was defined according to KDIGO criteria. Multivariate logistic regression identified independent predictors of AKI, with MHR standardized via Z-score transformation. Predictive performance was assessed using receiver operating characteristic (ROC) curves and 10-fold cross-validation; model calibration was evaluated using binned calibration plots and the Hosmer-Lemeshow test. The optimal MHR cutoff was determined by the Youden index, and patients were stratified accordingly. Postoperative serum creatinine trajectories were compared using linear mixed-effects models with Holm-adjusted pairwise tests. RESULTS: AKI occurred in 104 patients (37.1%). Multivariate regression revealed that preoperative MHR (per 1-SD increase: OR = 2.56, 95% CI: 1.77-3.80, p < 0.001), triglycerides (OR = 1.81, 95% CI: 1.23-2.73, p = 0.003), and blood glucose (OR = 1.21, 95% CI: 1.04-1.41, p = 0.015) were independent risk factors for post-CABG AKI. MHR yielded an AUC of 0.743 (95% CI: 0.682-0.804), outperforming triglycerides (AUC = 0.681) and glucose (AUC = 0.626). A combined model incorporating MHR, triglycerides, and glucose achieved a superior AUC of 0.782 (95% CI: 0.726-0.839), which was significantly better than individual predictors (all DeLong p < 0.05). Cross-validation confirmed robust performance (combined model AUC = 0.769), and calibration was excellent (mean absolute error = 0.006; Hosmer-Lemeshow p = 0.8149). Using the optimal cutoff (MHR > 0.658), the high-MHR group exhibited a significantly higher AKI incidence (64.29% vs. 22.53%, p < 0.001) and persistently elevated creatinine levels across all postoperative time points (CrH0-CrH72, all adjusted p ≤ 0.030). Subgroup analyses confirmed consistent associations between MHR and AKI across strata of age, cardiac function, hypertension, and diabetes, with no significant interaction effects. CONCLUSIONS: Preoperative MHR is a strong independent predictor of post-CABG AKI, with improved performance when combined with triglycerides and blood glucose.
Prognostic factors related to all-cause mortality in very long-term follow-up of patients with heart failure: the REMADHE trial extended analysis.
Bocchi EA, Guimaraes GV, Romero CE … +8 more , Ferreira SMA, Biselli B, Chizzola PR, Munhoz RT, Fukushima JT, Durães AR, Roever L, Cruz FDD
BMC Cardiovasc Disord · 2026 May · PMID 42192308 · Full text
BACKGROUND: Disease management programs (DMP) have reduced hospitalizations and improved quality of life in heart failure (HF). However, prognostic factors and survival in very long-term follow-up (> 20 years) have not b...
BACKGROUND: Disease management programs (DMP) have reduced hospitalizations and improved quality of life in heart failure (HF). However, prognostic factors and survival in very long-term follow-up (> 20 years) have not been reported. AIMS: To evaluate the long-term effects of a disease management program (DMP) on heart failure outcomes and to identify prognostic predictors of all-cause mortality in patients with HF followed for up to 23.6 years. METHODS: The REMADHE trial (NCT00505050, 2007-07-20) was a prospective, single-center, randomized trial (n = 412) comparing DMP versus usual care (C) with initial follow-up of 2.47 years. This extended analysis followed patients for 23.6 years to identify prognostic predictors of all-cause mortality. RESULTS: The all-cause mortality rate was 88.3%. HF was the first cause of death followed by sudden death. Mortality was higher in the first 6-year follow-up. The predictive variables in multivariate analysis associated with mortality were age > 52 years (P = 0.015), Chagas etiology (P = 0.010), LVEF < 45% (P = 0.008), digoxin use (P = 0.002), NYHA IV (P = 0.01), blood urea nitrogen (BUN) (P = 0.03), and lymphopenia (P = 0.005). In very long-term follow-up, DMP did not affect mortality in patients under guideline-directed medical therapy (GDMT). HF as a cause of death was more frequent in the C group (41.0% vs. 33.3% in the DMP group; P < 0.02). CONCLUSIONS: DMP was not effective in reducing very long-term mortality; however, causes of death differed between groups, with more HF-related deaths in controls. Our findings that age, LVEF, Chagas' disease, NYHA, renal function, lymphocytes, and digoxin use were associated with poor prognosis could influence future strategies to improve HF management.
Acute inferior STEMI in a unique setting: case report on anomalous circumflex and multivessel coronary artery disease.
Salah Eldin Taha H, Mamdouh Shaker M
BMC Cardiovasc Disord · 2026 May · PMID 42185974 · Full text
BACKGROUND: The majority of coronary artery anomalies are harmless and asymptomatic. However, in rare cases, they have been linked to myocardial ischemia and sudden cardiac death. One of the most frequently occurring cor...
BACKGROUND: The majority of coronary artery anomalies are harmless and asymptomatic. However, in rare cases, they have been linked to myocardial ischemia and sudden cardiac death. One of the most frequently occurring coronary anomalies is the aberrant origin of the circumflex coronary artery (Cx) from the right coronary sinus. CASE PRESENTATION: We present a case of a 59-year-old man who suffered an inferior ST-segment elevation myocardial infarction. His coronary angiography revealed severe multivessel coronary artery disease (CAD) and anomalous origin of the Cx. The case presented a diagnostic challenge regarding whether the right coronary artery (RCA) or the anomalous Cx was the primary culprit. This uncertainty was further compounded by the fact that established algorithms for differentiating the culprit artery may not be directly applicable to anomalous coronary arteries. Primary percutaneous coronary angiography (PCI) was performed on the RCA. PCI to the anomalous Cx was challenging due to difficulty in coronary engagement and wiring. This was complicated by extensive dissection, which was managed through re-wiring and the placement of multiple stents. The left anterior descending artery stenting was uneventful. The patient had a favorable final angiographic and clinical outcome and has been asymptomatic for one year. CONCLUSIONS: This case demonstrates the successful diagnosis and management of ACS in the context of multi-vessel CAD and an anomalous circumflex coronary artery. It highlights significant diagnostic challenges stemming from the lack of specific algorithms for such cases and the considerable management complexities faced during PCI. These insights underscore the critical need for tailored approaches and updated guidelines to effectively address similar intricate scenarios.
Admission and 24-hour heart rates and in-hospital outcomes in STEMI undergoing primary PCI.
Cui Y, Xu Z, Qu X … +6 more , Zhu T, Feng S, Han H, Zhang R, Yan X, Quan W
BMC Cardiovasc Disord · 2026 May · PMID 42185972 · Full text
BACKGROUND: Heart rate (HR) plays a central role in cardiac physiology and has been closely associated with major cardiovascular (CV) outcomes, including heart failure, ischemic heart disease, and cardiovascular mortalit...
BACKGROUND: Heart rate (HR) plays a central role in cardiac physiology and has been closely associated with major cardiovascular (CV) outcomes, including heart failure, ischemic heart disease, and cardiovascular mortality. However, whether HR can serve as an early predictor of in-hospital outcomes among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains unclear. This study aimed to evaluate the associations between heart rate at first medical contact (FHR), at hospital admission (AHR), and at 24 h post-admission (24 h) with adverse in-hospital outcomes. METHODS: This retrospective single-center observational study included 309 consecutive patients with STEMI who underwent PPCI between September 2018 and December 2020 at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Associations between the three HR measurements and in-hospital adverse cardiovascular events were analyzed using binary logistic regression models. Both crude models and models adjusted for conventional risk factors, biomarkers, and treatment variables were assessed. RESULTS: Both AHR and 24 h were positively associated with in-hospital CV events, predominantly acute heart failure (P < 0.05), which were predominantly driven by acute heart failure. After adjusting for potential confounders, the odds of having in-hospital CV events were significantly enhanced by an increase in AHR and 24 h (odds ratio [OR]: 1.033, 95% confidence intervals [CI]: 1.008-1.060; OR: 1.037, 95% CI: 1.003-1.071, respectively). Additionally, every 5 bpm increase in AHR and 24 h was associated with an 18.6% and a 19.8% increased risk of in-hospital CV events, respectively. In contrast, FHR showed limited predictive value for such events. CONCLUSION: Among STEMI patients undergoing PPCI, elevated admission and 24-hour heart rates are significantly associated with adverse in-hospital cardiovascular outcomes. Admission heart rate, in particular, may serve as a simple and reliable prognostic indicator for identifying patients at increased short-term risk.
Risk factors for diuretic resistance in hospitalized patients with acute decompensated heart failure: a retrospective study.
Cui Y, Liu T, Hu Y … +4 more , Wei L, Zhong Y, Zhao Y, Hu C
BMC Cardiovasc Disord · 2026 May · PMID 42185970 · Full text
OBJECTIVE: To investigate the independent risk factors for diuretic resistance (DR) and its clinical impact in hospitalized patients with acute decompensated heart failure (ADHF). METHODS: This single-center retrospectiv...
OBJECTIVE: To investigate the independent risk factors for diuretic resistance (DR) and its clinical impact in hospitalized patients with acute decompensated heart failure (ADHF). METHODS: This single-center retrospective study consecutively enrolled 387 patients with ADHF admitted between January 2022 and June 2025. Based on an operational definition (intravenous furosemide ≥ 80 mg/day with failure to achieve an average daily body weight reduction ≥ 1 kg or a net negative fluid balance ≥ 1,000 mL within 72 h), patients were classified into a DR group (n = 132) and a non-DR group (n = 255). Demographic characteristics, comorbidities, laboratory parameters at admission, and medication history were collected and compared between groups. Multivariable logistic regression analysis (backward stepwise method) was performed to identify independent risk factors for DR, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of identified factors. A nomogram was then constructed to visualize the combined predictive model. RESULTS: The incidence of DR among patients with ADHF was 34.11%. Nonsteroidal anti-inflammatory drug (NSAID) use within one week prior to admission, chronic kidney disease stage 3, and New York Heart Association (NYHA) functional class III-IV were independent risk factors for DR. Higher serum sodium levels, estimated glomerular filtration rate (eGFR), and serum albumin levels were identified as protective factors. Log-transformed and standardized N-terminal pro-B-type natriuretic peptide (NT-proBNP) was a very strong predictor of DR. Using the Youden index, the optimal cutoff value of baseline NT-proBNP for predicting DR was 1,003.19 pg/mL (sensitivity 81.06%, specificity 80.39%). CONCLUSION: NT-proBNP and eGFR demonstrate good predictive value for DR. The occurrence of DR is significantly associated with prolonged hospitalization and an increased risk of renal function deterioration.
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