BMC Cardiovascular Disorders[JOURNAL]
Sun
200 papers
Functional mitral valve regurgitation outcomes by treatment modality: a systematic review and meta-analysis of reconstructed survival data.
Dastjerdi P, Tavakoli K, Narimani-Javid R … +9 more , Anaraki N, Shayesteh H, Hosseini Mohammadi NS, Momeni S, Nikfar R, Rahmati S, Mohsen A, Hosseini K, Soleimani H
BMC Cardiovasc Disord · 2026 Jun · PMID 42321618 · Full text
BACKGROUND: Functional mitral regurgitation (FMR) carries poor prognosis, and optimal management remains debated. Mitral Transcatheter Edge-to-Edge Repair (MTEER) is an alternative to surgical repair (SMVR) or optimized...
BACKGROUND: Functional mitral regurgitation (FMR) carries poor prognosis, and optimal management remains debated. Mitral Transcatheter Edge-to-Edge Repair (MTEER) is an alternative to surgical repair (SMVR) or optimized medical therapy (OMT), but long-term outcomes are uncertain. METHODS: PubMed, Embase, Scopus, and the Cochrane Library were searched for studies reporting Kaplan-Meier curves of MTEER, SMVR, or OMT in FMR. Individual patient data (IPD) were reconstructed using the Liu method with accuracy checks. Pooled IPD were analyzed with Cox and time-varying Cox models, landmark, time-restricted, and restricted mean survival time analyses. RESULTS: Sixteen studies (n = 4,570) were included. Patients undergoing MTEER were older and higher risk, with greater prevalence of atrial fibrillation, prior myocardial infarction, chronic kidney disease, higher EuroSCORE, and more frequent NYHA class ≥ III compared with SMVR. Over up to 60 months, both MTEER (HR: 0.65; 95% CI: 0.57-0.75; p < 0.001) and SMVR (HR: 0.39; 95% CI: 0.33-0.46; p < 0.001) significantly reduced all-cause mortality versus OMT, whereas MTEER carried higher mortality risk than SMVR (HR: 1.68; 95% CI: 1.43-1.97; p < 0.001). MTEER was less effective than SMVR in reducing recurrent MR > 2 (HR: 3.31; 95% CI: 1.62-6.75; p < 0.001) and reoperation (HR: 4.62; 95% CI: 2.22-9.61; p < 0.001). In contrast, MTEER reduced hospitalization risk by 30% compared to OMT (HR: 0.70; 95% CI: 0.64-0.77; p < 0.001) and decreased MACE by 21% (HR: 0.79; 95% CI: 0.73-0.84; p < 0.001). CONCLUSIONS: MTEER improves survival and reduces hospitalization and MACE compared with OMT but is less durable than SMVR, with higher risks of recurrent MR, reoperation, and late mortality.
Histological assessment of the intramural segment in adults with an anomalous aortic origin of a coronary artery with an interarterial course.
Verheijen DBH, Borsboom TC, Kiès P … +11 more , Egorova AD, Wisse LJ, Koolbergen DR, Putman LM, Hazekamp MG, van der Palen RLF, Jukema JW, Accord RE, Vliegen HW, de Ruiter MC, Jongbloed MRM
BMC Cardiovasc Disord · 2026 Jun · PMID 42321616 · Full text
BACKGROUND: An intramural course in an anomalous aortic origin of a coronary artery (AAOCA) is a high-risk feature for sudden cardiac death (SCD). One of the proposed mechanisms for this association involves a "flap valv...
BACKGROUND: An intramural course in an anomalous aortic origin of a coronary artery (AAOCA) is a high-risk feature for sudden cardiac death (SCD). One of the proposed mechanisms for this association involves a "flap valve" effect in the intramural segment. The (patho-)histological characteristics of this segment may contribute to risk stratification, however, current data are scarce. The aim of this study was to identify the histological features of the intramural segment and their potential relevance to vascular wall properties and the aortic valve commissure, thereby providing insights into possible functional implications of AAOCA. METHODS: This prospective multicenter study included consecutive pediatric and adult AAOCA patients who underwent surgical unroofing between 2021 and 2024. The excised arterial vascular wall tissue (i.e. the intramural segment), was immunohistochemically examined for vascular wall components. Two independent observers reviewed the data, correlating findings with preoperative CTA to assess spatial relationships with surrounding aortic and AAOCA tissues. Results were also compared with a post-mortem AAOCA specimen and control tissues. RESULTS: Fifteen patients (mean age 42.9 ± 14.0 years, age range 11-66 years, 60% female) undergoing surgery for AAOCA were included. Fourteen patients (93%) had an anomalous aortic origin of a right coronary artery (AAORCA) and one patient (7%) had an anomalous aortic origin of a left coronary artery (AAOLCA). The mean intramural segment length was 7.8 ± 3.6 mm in AAORCA and 16.0 mm in the AAOLCA. Histologically, a two-layered tunica media without interposing tunica adventitia was identified in all intramural segments. Pre-operative CTA showed a close spatial relationship of the aortic side of the intramural segment with the aortic valve commissure. In line with this, extensive fibrous tissue was observed histologically on the aortic side of the intramural segment, consistent with commissure. In contrast, the vascular wall on the coronary arterial side of the intramural segment showed overall medial degeneration, characterized by mucoid extracellular matrix accumulation (MEMA), elastic fiber fragmentation and/or loss, elastic fiber thinning, loss of smooth muscle cell nuclei, and collagen alterations. These abnormalities were more prevalent with increasing age. CONCLUSION: Histology of the intramural segment revealed structural alterations which may be consistent with reduced vascular compliance. Further studies, including post-SCD specimens, are needed to refine risk stratification.
Association of the mitochondrial regulator PGC-1α with diabetes mellitus and myocardial ischemia-reperfusion injury in coronary artery bypass grafting.
Yildiz A, Yazici S, Yildiz Z
BMC Cardiovasc Disord · 2026 Jun · PMID 42321611 · Full text
OBJECTIVES: This study aimed to evaluate whether peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) could serve as a marker of myocardial ischemia by examining its association with cross-clamp...
OBJECTIVES: This study aimed to evaluate whether peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) could serve as a marker of myocardial ischemia by examining its association with cross-clamp time, which reflects the duration of ischemia, in patients undergoing coronary artery bypass grafting (CABG). METHODS: The study included 44 adult patients who underwent open-heart surgery at the Cardiovascular Surgery Clinic between June 2024 and December 2024. Serum samples separated from the blood collected after cross-clamping and at the pump outlet were analyzed in our hospital's central laboratory for the PGC-1α study. PGC-1α levels were analyzed in terms of clinical parameters, lactate and high-sensitivity cardiac troponin T (hs-cTnT) levels of the patients. RESULTS: Preoperative PGC-1α levels did not differ significantly from postoperative levels (2.06 ± 5.75 vs. 1.43 ± 3.35, p = 0.608), whereas hs-cTnT levels increased significantly after surgery (p < 0.001). Preoperative PGC-1α showed a moderate positive correlation with DM (r = 0.366, p = 0.015) but no significant association with other clinical variables, including ICU duration (r = 0.078, p = 0.616), glucose, or HbA1c (all p > 0.05). In the multivariable analysis, DM (odds ratio [OR] = 3.060, p < 0.05) and ICU duration (OR = 1.466, p < 0.05) were independently associated with PGC-1α, whereas preoperative glucose and HbA1c were not. ROC analysis demonstrated that hs-cTnT showed a significant discriminative ability for cross-clamp time in non-DM patients (AUC = 0.844, 95% CI: 0.684-1.000, p = 0.002), whereas this relationship was not observed in DM patients. In contrast, PGC-1α did not demonstrate a significant discriminative performance in either group (AUC = 0.300-0.535, p > 0.05). CONCLUSION: PGC-1α was not associated with cross-clamp time or conventional markers of acute myocardial injury in patients undergoing coronary artery bypass grafting, indicating that it does not reflect ischemic duration. In contrast, hs-cTnT levels were significantly associated with the cross-clamp time in non-diabetic patients, whereas this relationship was not observed in diabetic individuals. The association of PGC-1α with diabetes mellitus and ICU duration suggests that it may reflect metabolic status rather than acute myocardial injury.
Direct oral anticoagulants versus vitamin K antagonists after left atrial appendage occlusion: a systematic review and meta-analysis.
Dai Y, Chang J, Guo J
BMC Cardiovasc Disord · 2026 Jun · PMID 42321609 · Full text
BACKGROUND: Non-valvular atrial fibrillation (NVAF) elevates the risk of stroke owing to thrombus development, especially in the left atrial appendage (LAA). Left atrial appendage occlusion (LAAO) provides stroke prophyl...
BACKGROUND: Non-valvular atrial fibrillation (NVAF) elevates the risk of stroke owing to thrombus development, especially in the left atrial appendage (LAA). Left atrial appendage occlusion (LAAO) provides stroke prophylaxis for those unable to tolerate prolonged anticoagulant therapy. This meta-analysis evaluates the effectiveness and safety of direct oral anticoagulants (DOACs) in comparison to vitamin K antagonists (VKAs) following LAAO, concentrating on ischemic stroke, systemic embolism (SE), severe bleeding, and device-related thrombosis. METHODS: A comprehensive literature search was conducted in Web of Science, Cochrane Library, Embase, and PubMed for studies published between 2017 and 2025. The inclusion criteria were trials involving patients undergoing LAAO who were treated with either DOAC or VKA regimens. The primary outcomes included transient ischemic attack (TIA), SE, ischemic stroke, and major hemorrhage. Any major adverse event was defined as a composite of major bleeding, stroke, SE, device-related thrombosis, and all-cause mortality, and analyzed as a secondary/exploratory outcome due to heterogeneity in component reporting across studies. Meta-analysis was performed using random-effects models for all pooled analyses, given the anticipated clinical and methodological heterogeneity across studies. Subgroup and sensitivity analyses were conducted to further assess the robustness of the findings. RESULTS: Twenty-one studies were included. DOACs had a considerably reduced incidence of serious bleeding (OR = 0.88, 95% CI: 0.80-0.98) and any major adverse event (OR = 0.88, 95% CI: 0.82-0.95) than VKAs, but there was no discernible difference in stroke or SE rates (OR = 0.86, 95% CI: 0.69-1.05). Exploratory subgroup analyses suggested potential differences in certain groups (e.g., North America, longer follow-up), but these should be interpreted as exploratory. Secondary outcomes, including peri-device leaks and device-related thrombosis, did not differ significantly between groups. CONCLUSIONS: DOACs may provide comparable thromboembolic protection with a lower risk of major bleeding than VKAs after LAAO. However, most available evidence is derived from non-randomized studies and remains subject to residual confounding, selection bias, and moderate-to-low certainty of evidence. Therefore, the observed benefits of DOACs should be interpreted cautiously. Further large-scale prospective studies and randomized controlled trials are needed to confirm these findings and inform optimal post-LAAO anticoagulation strategies.
Qualitative insights into the experiences and goals of people living with severe difficult-to-treat hypertension in Australia.
Hill M, Godsell J
BMC Cardiovasc Disord · 2026 Jun · PMID 42321603 · Full text
BACKGROUND: Over one-third of Australian adults have hypertension, and this rate increases with age. Difficult-to-treat hypertension is high blood pressure that remains above target levels despite proper medicine adheren...
BACKGROUND: Over one-third of Australian adults have hypertension, and this rate increases with age. Difficult-to-treat hypertension is high blood pressure that remains above target levels despite proper medicine adherence. This study explored the treatment experiences and goals of patients with severe difficult-to-treat hypertension to gain insights into renal denervation (RDN) as a therapeutic option. METHODS: Twelve Australian participants with severe difficult-to-treat hypertension were interviewed. Participants were recruited via a specialist recruitment company and specialist referral. Semi-structured interviews lasted about 60 min either online or by phone. Interviews were recorded and transcribed verbatim. Transcripts were analyzed using inductive and deductive thematic analysis in NVivo. RESULTS: Participants had an average age of 65 years (range: 48-75 years), 58% identified as male and all lived across Australia, primarily in metropolitan areas (n = 9; 75%). The average time since hypertension diagnosis was 22 years (range: 3-44 years) and nearly all participants had a family history of hypertension. Data analysis identified four themes regarding participants' experiences of living with severe difficult-to-treat hypertension and awareness of renal denervation therapy: (1) Diagnosis and monitoring of hypertension, (2) The impact of severe difficult-to-treat hypertension on quality of life, (3) The management of severe difficult-to-treat hypertension and (4) Awareness, perceptions and experiences with RDN. CONCLUSIONS: This study provides an in-depth understanding of the experiences of people living with severe difficult-to-treat hypertension and their treatment goals. It highlights the significant impact and stigma of living with severe difficult-to-treat hypertension, and the need to incorporate psychosocial support and patient education into the clinical management of this chronic condition.
Subintimal bailout recanalization for acute stent-jailed side branch occlusion: a single-center retrospective case series with QFR assessment.
Jia RF, Jin ZN, Tian JP … +5 more , Meng S, Yang XS, Chen YZ, Wang LF, Han J
BMC Cardiovasc Disord · 2026 Jun · PMID 42316084 · Full text
BACKGROUND: Acute side branch (SB) occlusion after main vessel (MV) stenting remains a challenging complication of bifurcation PCI, particularly when conventional true-lumen rewiring attempts fail. In such scenarios, ope...
BACKGROUND: Acute side branch (SB) occlusion after main vessel (MV) stenting remains a challenging complication of bifurcation PCI, particularly when conventional true-lumen rewiring attempts fail. In such scenarios, operators face limited standardized bailout options, and guidance on decision-making is scarce. METHODS: We retrospectively analyzed a highly selected single-center case series of patients with acute stent-jailed SB occlusion refractory to conventional rewiring who underwent chronic total occlusion (CTO)-derived subintimal bailout recanalization. A predefined technical framework was applied. Angiographic results were assessed using Thrombolysis in Myocardial Infarction(TIMI) flow, and angiography-derived quantitative flow ratio (QFR) was used as physiological confirmation of reperfusion. RESULTS: Among 9,832 PCI procedures performed between 2019 and 2023, 15 consecutive patients met the inclusion criteria. Subintimal SB recanalization was achieved in all cases, resulting in restoration of TIMI 3 flow. Postprocedural SB QFR was successfully obtained in all patients, with a mean value of 0.91 ± 0.04; all exceeded the predefined ischemic threshold (QFR ≥ 0.80). No procedure-related perforation, tamponade, or device entrapment was observed. Limited follow-up angiography and QFR data, available in two patients, demonstrated stable or improved functional values. CONCLUSIONS: In a highly selected case series managed at an experienced center, a structured subintimal bailout framework appears feasible for the treatment of acute stent-jailed SB occlusion when conventional rewiring fails. Integration of QFR provides objective physiological confirmation of SB reperfusion and may assist in procedural decision-making. These findings should be considered hypothesis-generating and warrant validation in larger, prospective studies.
Examining the association between spatial accessibility to emergency cardiac care centers and cardiovascular mortality in Georgia, United States.
Kianfar N, Yao XA, Kiani B … +1 more , Mollalo A
BMC Cardiovasc Disord · 2026 Jun · PMID 42316053 · Full text
BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of mortality in Georgia, U.S., accounting for over 21,000 deaths annually. Due to the acute nature of cardiac complications and patients' urgent need for i...
BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of mortality in Georgia, U.S., accounting for over 21,000 deaths annually. Due to the acute nature of cardiac complications and patients' urgent need for immediate medical attention, optimal access to emergency healthcare is essential. Despite this urgency, spatial accessibility to emergency cardiac care (ECC) centers and its relationship with CVD mortality remains underexplored. METHODS: We implemented an enhanced two-step floating catchment area method to explore spatial disparities in access to ECC centers in Georgia. Moreover, we proposed two complementary equity metrics, Health Disparity Index (HDI) and Localized Health Outcome Index (LHOI), to quantify disparities. We further examined the potential association between spatial access to ECC centers and CVD mortality rates using Social Vulnerability Index-adjusted ordinary least squares regression models. RESULTS: ECC centers were clustered primarily in the Atlanta Metropolitan area, while more remote and rural areas in the central and southernmost regions have the lowest access to emergency medical resources. The estimated HDI value of 0.61, along with high LHOI values observed in 64 counties, indicates substantial inequity in CVD mortality and highlights that many high-mortality counties lack adequate emergency cardiac resources. Poorer access to ECC centers was significantly associated with higher CVD mortality rates (P < 0.05). CONCLUSIONS: Our integrated framework reveals pronounced spatial disparities in access to ECC across Georgia and underscores the need for targeted, place-based interventions.
Prognostic value of controlling nutritional status score (CONUT) and prognostic nutritional index (PNI) in patients with peripheral artery disease: an evidence-based analysis.
He Y, He X, Liu M … +3 more , Gao W, Liu Y, Guo S
BMC Cardiovasc Disord · 2026 Jun · PMID 42316030 · Full text
OBJECTIVES: To evaluate the controlling nutritional status score (CONUT) and the prognostic nutritional index (PNI) prognostic value in peripheral artery disease (PAD) patients through a meta-analysis. METHODS: We search...
OBJECTIVES: To evaluate the controlling nutritional status score (CONUT) and the prognostic nutritional index (PNI) prognostic value in peripheral artery disease (PAD) patients through a meta-analysis. METHODS: We searched PubMed, Embase, Web of Science, and Cochrane databases up to November 2024. Mortality, major adverse cardiovascular events (MACE), amputation, and poor ulcer healing were extracted. Data were synthesized using odds ratios (OR) with 95% confidence intervals (CI). Sensitivity analysis assessed result stability and heterogeneity sources. All analyses were performed using Review Manager 5.4 and STATA 15.1. RESULTS: Fifteen cohort studies with 6,830 PAD patients were included. Higher CONUT scores were linked to increased mortality (12 studies, HR: 1.34; 95% CI: 1.21-1.49) and amputation risk (6 studies, OR: 1.20; 95% CI: 1.10-1.32), while higher PNI was associated with reduced mortality (3 studies, HR: 0.95; 95% CI: 0.92-0.97) and amputation risk (2 studies, OR: 0.91; 95% CI: 0.87-0.95). No significant link was found between CONUT and MACE or poor ulcer healing. Sensitivity analysis revealed instability in the association between CONUT and poor ulcer healing. CONCLUSIONS: CONUT and PNI could predict mortality and amputation risk in PAD patients, aiding early identification of high-risk individuals. Due to the study's retrospective design and potential instability, further large-scale, multicenter prospective studies are needed to confirm these findings.
Surgical treatment of giant diagonal branch aneurysms accompanied by obstructive coronary artery disease with guidance from 3D printed models: a case report.
Zhai Z, Li Q, Mo Q … +8 more , Xia Z, Xia Z, Zuo M, Yang H, Tao Y, Yu J, Tang Y, Li J
BMC Cardiovasc Disord · 2026 Jun · PMID 42316019 · Full text
BACKGROUND: Coronary artery aneurysms are focal dilatations that exceed the diameter of normal adjacent vessels by a factor of at least 1.5-fold. Multimodal imaging is essential when attempting to improve the efficacy of...
BACKGROUND: Coronary artery aneurysms are focal dilatations that exceed the diameter of normal adjacent vessels by a factor of at least 1.5-fold. Multimodal imaging is essential when attempting to improve the efficacy of curative interventions in aneurysm patients as it can facilitate the comprehensive functional and anatomical characterization of these intricate vascular lesions. In this report, we describe the case of a patient with giant diagonal branch aneurysms accompanied by obstructive coronary artery disease. Successive coronary artery bypass grafting (CABG) and surgical resection were performed to effectively treat these conditions, and these procedures were aided by the use of three-dimensional (3D) printed models of the heart. CONCLUSION: Employing computed tomography-guided reconstruction procedures in combination with the use of multiplanar, multicolor 3D printed models can enable surgeons to better assess the dimensions, source, and relationships of target vessels with adjacent tissues, thereby ensuring that preoperative planning can be completed more effectively.
A pragmatic clinical risk score for adverse outcomes in hypertrophic cardiomyopathy using routine laboratory and bedside variables.
Chen ZY, Chen JH
BMC Cardiovasc Disord · 2026 Jun · PMID 42310548 · Full text
BACKGROUND: Early risk prediction in hypertrophic cardiomyopathy (HCM) remains challenging, particularly for short-term adverse outcomes. We aimed to develop a pragmatic risk score for predicting 1-year composite adverse...
BACKGROUND: Early risk prediction in hypertrophic cardiomyopathy (HCM) remains challenging, particularly for short-term adverse outcomes. We aimed to develop a pragmatic risk score for predicting 1-year composite adverse outcomes using routinely available clinical, laboratory, arrhythmic, and echocardiographic variables. METHODS: This single-center retrospective cohort study included 1,200 Chinese adults with HCM evaluated between 2015 and 2024. The primary endpoint was a 1-year composite of sudden cardiac death (SCD) or SCD-equivalent events, heart failure hospitalization, or all-cause mortality. Candidate predictors were selected based on clinical relevance, routine availability, and prior HCM risk evidence, followed by univariate screening and multivariable logistic regression with stepwise selection. A point-based score was developed and internally validated using 1,000 bootstrap resamples and stratified 5-fold cross-validation. RESULTS: During follow-up, 120 patients experienced the composite endpoint, including heart failure hospitalization in 78 patients, SCD or SCD-equivalent events in 24, and all-cause mortality in 18. Ten predictors were included in the HCM Pragmatic Risk Score: age ≥ 60 years, nonsustained ventricular tachycardia, unexplained syncope, maximal left ventricular wall thickness ≥ 20 mm, left atrial diameter ≥ 45 mm, left ventricular outflow tract gradient ≥ 30 mmHg, left ventricular ejection fraction < 50%, NT-proBNP > 1,000 pg/mL, elevated troponin, and creatinine > 1.2 mg/dL. The score showed moderate discrimination (AUC = 0.75) and good calibration. Event rates increased across risk strata: 3.8%, 16.7%, and 77.8%. Bootstrap validation yielded an optimism-corrected AUC of 0.74. CONCLUSION: The HCM Pragmatic Risk Score may assist short-term risk stratification and follow-up planning. Because the endpoint was mainly driven by heart failure hospitalization, it should not be interpreted as a dedicated SCD prediction model or stand-alone ICD decision tool. External validation is required.
Combined AGT M235T-ACE I/D genotype and risk of essential hypertension in Vietnamese adults: a hospital-based case-control study.
Tran TT, Chau NH, Nguyen DK
BMC Cardiovasc Disord · 2026 Jun · PMID 42310546 · Full text
BACKGROUND: Essential hypertension is influenced by conventional risk factors and genetic susceptibility. We tested the prespecified hypothesis that the combined AGT M235T-ACE I/D TT/DD genotype is associated with essent...
BACKGROUND: Essential hypertension is influenced by conventional risk factors and genetic susceptibility. We tested the prespecified hypothesis that the combined AGT M235T-ACE I/D TT/DD genotype is associated with essential hypertension in Vietnamese adults. METHODS: We conducted a hospital-based case-control study among 471 Vietnamese Kinh adults at the University Medical Center, Ho Chi Minh City, Vietnam, including 238 cardiology-clinic participants with essential hypertension and 233 health-screening participants without hypertension. Hypertension was defined according to Vietnamese guideline thresholds as office systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or current antihypertensive treatment; controls had no history of hypertension, were not receiving antihypertensive medication, and had office blood pressure < 140/90 mmHg. The primary exposure was TT/DD versus non-TT/DD. Multivariable logistic regression adjusted for age, sex, overweight or obesity, diabetes mellitus, salt-rich diet, smoking, alcohol misuse, physical inactivity, and family history of hypertension. RESULTS: TT/DD was observed in 37 of 238 cases (15.55%) and 15 of 233 controls (6.44%). TT/DD was associated with hypertension in crude analysis (OR 2.67, 95% CI 1.38-5.40; p = 0.002) and remained associated after adjustment (adjusted OR 3.26, 95% CI 1.53-6.92; p = 0.002). In an exploratory six-category model using (MM + MT)/II as the reference, TT/DD was the only genotype category significantly associated with hypertension, although the estimate was imprecise (adjusted OR 3.46, 95% CI 1.24-9.70; p = 0.018). CONCLUSIONS: The combined AGT M235T-ACE I/D TT/DD genotype was associated with essential hypertension in this hospital-based Vietnamese sample. Because of the case-control design, hospital-based recruitment, covariate imbalance, and absence of external replication, the finding should be interpreted as associative and hypothesis-generating.
Development and validation of a predictive model for side branch flow impairment following stent implantation in patients with non-left main coronary bifurcation lesions: a retrospective analysis.
Wang L, Zhang H, Mei A … +6 more , Xie S, Han X, Zeng L, Liu J, Jiao Y, Zhang Y
BMC Cardiovasc Disord · 2026 Jun · PMID 42310545 · Full text
OBJECTIVES: The purpose of this study was to develop and validate a predictive model to assessing the risk of side branch flow impairment (SBFI) following stent implantation in patients with non-left main coronary bifurc...
OBJECTIVES: The purpose of this study was to develop and validate a predictive model to assessing the risk of side branch flow impairment (SBFI) following stent implantation in patients with non-left main coronary bifurcation lesions (CBLs). This model aims to provide preprocedural risk stratification and inform the selection of interventional strategies. BACKGROUND: Coronary artery bifurcation lesions constitute a particularly complex subtype of coronary artery disease that is frequently encountered in practice. Compared with non-bifurcation lesions, they are associated with greater procedural complexity and risk of procedure-related complications. PATIENTS AND METHODS: Data from 830 patients with CBL who underwent percutaneous coronary intervention (PCI) in the Affiliated Hospital of Chengde Medical University from January 2022 to December 2023 were retrospectively collected. The least absolute shrinkage and selection operator regression methods were used to screen variables, and multivariate logistic regression was used to establish a predictive model. A nomogram was built based on these factors and internally verified using the bootstrap resampling method. The C-statistic was used to verify and evaluate the discriminative ability of the model; the calibration curve was drawn, and the decision curve analysis (DCA) was performed to evaluate the calibration degree, clinical net benefit, and practicability of the model. The primary endpoint was SBFI, defined as a transient or persistent reduction in thrombolysis in myocardial infarction (TIMI) flow grade in a branch vessel following stent implantation in a major non-left main coronary artery. RESULTS: A nomogram was constructed using the selected predictors of SBFI, which included age, plaque location ipsilateral to the SB, TIMI flow grade before main vessel (MV) stenting, and N-terminal pro-brain natriuretic peptide (NT-proBNP). The discriminatory ability of the model, as assessed by the area under the curve (AUC), was 0.651. The robustness of the model was evaluated through internal validation with 1000 bootstrap replicates, resulting in a corrected AUC of 0.641. The calibration curve, evaluated by the Hosmer-Lemeshow test, showed good agreement between predictions and observations (χ = 5.765, P = 0.674). Finally, DCA indicated that the model provided clinical net benefit over a threshold probability range of 0.19-0.45. CONCLUSION: We developed and validated a predictive model for SBFI after PCI in non-left main bifurcation lesions. The model exhibited modest discriminative ability, calibration, and a positive net benefit on DCA, suggesting that it may serve as a valuable risk stratification tool in clinical practice.
Nonlinear association between metabolic score for insulin resistance (METS-IR) and prevalent hypertension: a cross-sectional study.
Jiang Y, Qin W
BMC Cardiovasc Disord · 2026 Jun · PMID 42310544 · Full text
BACKGROUND: Insulin resistance contributes to hypertension, but the relationship with the novel non-insulin-based metabolic score for insulin resistance (METS‑IR) remains unclear, particularly regarding potential nonline...
BACKGROUND: Insulin resistance contributes to hypertension, but the relationship with the novel non-insulin-based metabolic score for insulin resistance (METS‑IR) remains unclear, particularly regarding potential nonlinear patterns. METHODS: This cross‑sectional study included 1,592 participants. Associations between METS‑IR (continuous and tertiles) and prevalent hypertension were evaluated using logistic regression, restricted cubic splines, and two‑piecewise regression, adjusting for age, sex, lifestyle factors, diabetes, and NAFLD. Subgroup analyses examined effect modification. RESULTS: Prevalent hypertension was present in 943 (59.2%). Each 1-unit increase in METS-IR was associated with higher hypertension odds (OR 1.06, 95% CI 1.04-1.08). A nonlinear relationship with an inflection point at 37.58 was identified. Below the inflection point (37.58), each 1-unit increase in METS-IR was associated with a 16.7% higher odds of hypertension (OR 1.167, 95% CI 1.082-1.259); above this point, the association was attenuated but remained significant (OR 1.038, 95% CI 1.007-1.069). Significant interactions were found for sex, BMI, diabetes, and NAFLD. CONCLUSIONS: METS‑IR is independently and nonlinearly associated with prevalent hypertension, exhibiting a clear threshold effect. It may serve as a practical research indicator, particularly in individuals without overt metabolic disease, though causal inference requires prospective validation.
Predictive value of peak left atrial reservoir strain combined with left atrial appendage flow velocity for atrial fibrillation recurrence after pulsed field ablation.
Wang S, Miao J, Tang F … +4 more , Wu L, Chen W, Qin L, Zhao M
BMC Cardiovasc Disord · 2026 Jun · PMID 42310535 · Full text
BACKGROUND: The recurrence rate after ablation for atrial fibrillation (AF) remains high, and the predictive performance of existing predictors is limited. Left atrial dysfunction plays a key role in the occurrence and p...
BACKGROUND: The recurrence rate after ablation for atrial fibrillation (AF) remains high, and the predictive performance of existing predictors is limited. Left atrial dysfunction plays a key role in the occurrence and progression of AF. However, studies on predictors of recurrence after pulsed field ablation (PFA) remain relatively limited, particularly comprehensive assessments combining left atrial strain parameters with left atrial appendage flow velocity. METHODS: Clinical data from 246 patients with AF who underwent PFA between June 2021 and June 2024 were retrospectively analyzed. Preoperative peak left atrial reservoir strain (LASr) was measured using two-dimensional speckle-tracking echocardiography (2D-STE), and left atrial appendage flow velocity (LAAV) was measured using transesophageal echocardiography (TEE). The follow-up cutoff date was December 30, 2024, and the median follow-up duration was 17.3 (10.8, 25.6) months. Recurrence of AF, atrial flutter, or atrial tachycardia after the blanking period was recorded. A predefined multivariable Cox proportional hazards model was used to identify independent predictors, and model performance was evaluated using the 18-month time-dependent receiver operating characteristic (ROC) curve, Kaplan-Meier method, and bootstrap internal validation. RESULTS: During follow-up, 68 patients (27.6%) experienced recurrence of atrial arrhythmia after the blanking period. Both LASr and LAAV were lower in the recurrence group than in the non-recurrence group (both P < 0.001). Predefined multivariable Cox regression analysis showed that LASr (per 1% increase: hazard ratio [HR] = 0.891, 95% confidence interval [CI]: 0.842-0.943, P < 0.001) and LAAV (per 1 cm/s increase: HR = 0.972, 95% CI: 0.956-0.989, P = 0.001) were independent predictors of AF recurrence after PFA; AF duration did not reach statistical significance after adjustment (HR = 1.005, 95% CI: 0.996-1.014, P = 0.268). The 18-month area under the curve (AUC) of the baseline clinical model constructed with persistent AF, AF duration, and left atrial volume index (LAVI) was 0.752 (95% CI: 0.687-0.817). After adding LASr and LAAV to the baseline model, the 18-month AUC increased to 0.891 (95% CI: 0.849-0.933), outperforming the baseline model (bootstrap P < 0.001) and improving reclassification ability (net reclassification index [NRI] = 0.438, 95% CI: 0.286-0.590; integrated discrimination improvement [IDI] = 0.158, 95% CI: 0.108-0.208; both P < 0.001). Based on LASr ≤ 22.3% and LAAV ≤ 45.2 cm/s, the 18-month recurrence-free rates in the low-, intermediate-, and high-risk groups were 88.7%, 70.5%, and 36.1%, respectively. CONCLUSIONS: LASr and LAAV were independent predictors of AF recurrence after PFA, and their combination provided incremental predictive value beyond conventional clinical factors. Risk stratification based on LASr ≤ 22.3% and LAAV ≤ 45.2 cm/s may be used for preprocedural risk communication and assessment of postprocedural follow-up intensity; however, whether this approach can guide changes in ablation strategy and improve outcomes requires validation in prospective studies.
Development and validation of an interpretable machine learning model for predicting 5-year major adverse cardiovascular events in patients with coronary artery disease.
Jiang Z, Zhou H, Liu Y … +6 more , Yin H, Zhu J, Xiong X, Chang J, Wang R, Ma H
BMC Cardiovasc Disord · 2026 Jun · PMID 42310534 · Full text
BACKGROUND: Coronary artery disease (CAD) remains a major contributor to global cardiovascular mortality and accurate prognosis is critical for guiding clinical decision-making. This study aimed to develop and validate i...
BACKGROUND: Coronary artery disease (CAD) remains a major contributor to global cardiovascular mortality and accurate prognosis is critical for guiding clinical decision-making. This study aimed to develop and validate interpretable machine learning (ML) models for predicting 5-year major adverse cardiovascular events (MACE) in hospitalized CAD patients. METHODS: A prospective cohort of 705 CAD patients was included and randomly divided into training (n = 494) and validation (n = 211) sets. Key predictors were selected using least absolute shrinkage and selection operator (LASSO) regression. Four survival-based models were developed, and model performance was assessed using discrimination, calibration, and decision curve analysis. Shapley Additive Explanations (SHAP) analysis was applied to enhance model interpretability. RESULTS: A total of 705 hospitalized CAD patients were included (mean age 63.2 years; 72.5% men), of whom 221 (31.3%) developed MACEs during the 5-year follow-up. LASSO regression revealed 11 key predictors, including left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, nitrate use, CAD duration, depressive symptoms, and age. Among the four models, the random survival forest (RSF) model showed favourable discrimination performance, with C-index of 0.804 (95% CI: 0.770-0.837) in the training cohort and 0.710 (95% CI: 0.650-0.768) in the validation cohort. The RSF model also showed acceptable calibration, achieving the lowest Brier score in the validation cohort. Decision curve analysis (DCA) demonstrated that the RSF model provided potential clinical benefit over the treat-all and treat-none strategies across a wide range of risk thresholds. SHAP analysis revealed that the LVEF, age, and number of diseased vessels were the most important predictors of 5-year MACEs. CONCLUSIONS: The RSF model demonstrated relatively favourable discrimination, calibration, and clinical utility for predicting 5-year MACEs in hospitalized CAD patients. These findings suggest that ML-based approaches may assist in individualized risk stratification and guide secondary prevention strategies.
Risk stratification of 1-year atrial tachyarrhythmia recurrence after ablation in patients with persistent atrial fibrillation: ALADS-AF score.
Chen J, Zhao L, Zhang K … +7 more , Chen J, Wang Y, Ju W, Jiang C, Zhong J, Wang L, Chen M
BMC Cardiovasc Disord · 2026 Jun · PMID 42304285 · Full text
BACKGROUND: Atrial fibrillation (AF) is the most common atrial arrhythmia with high prevalence, low awareness, and low treatment rate in China. Catheter ablation (CA) is an effective treatment, but recurrence remains com...
BACKGROUND: Atrial fibrillation (AF) is the most common atrial arrhythmia with high prevalence, low awareness, and low treatment rate in China. Catheter ablation (CA) is an effective treatment, but recurrence remains common in persistent AF (PsAF). The present study aimed to develop a tool for 1-year atrial tachyarrhythmia (ATa) recurrence risk stratification after de novo CA. METHODS: This multicenter, retrospective study collected data from four Chinese hospitals between January 2015 and May 2021. Eligible patients were randomly divided in a 2:1 ratio to development (DC) and test cohorts (TC). One-year ATa recurrence status was primarily obtained from existing medical records. Candidate risk factors for recurrence were initially identified through literature review and investigator consensus. Univariable and multivariable Cox regression analyses were performed to develop the model. The model's discrimination and calibration were evaluated in both cohorts to assess performance. RESULTS: A total of 1,689 patients who underwent de novo CA were included, with 1,126 in DC and 563 in TC. The mean age was 60.5 years, 71.9% were male, the mean PsAF duration was 2.6 years, and 26.1% experienced 1-year ATa recurrence within 3-12 months post-ablation. Recurrence was associated with older age, larger Left Atrial Diameter (LAD), longer AF duration, and female sex. The ALADS-AF score (Age, LAD, Duration of AF, Sex) was developed, with scores from 0 to 30 and a C-index of 0.57. CONCLUSIONS: The ALADS-AF score is a simple and user-friendly tool for stratifying the risk of 1-year ATa recurrence in patients with PsAF after de novo CA. It may facilitate pre-procedural discussions, help set realistic expectations regarding rhythm outcomes, and support consistent follow-up planning in patients undergoing ablation for PsAF.
Triangle-like lumen in fibrosing mediastinitis-induced pulmonary vein stenosis: a case report.
Zhou C, Li B, Wang Y … +7 more , Yang Z, Li J, Wang X, Wu P, Zhang S, Zeng J, Li X
BMC Cardiovasc Disord · 2026 Jun · PMID 42304265 · Full text
BACKGROUND: Fibrosing mediastinitis (FM) is a rare chronic fibrotic disease of the mediastinum, characterized by diffuse fibrous tissue proliferation in the mediastinal space that can compress adjacent pulmonary vessels...
BACKGROUND: Fibrosing mediastinitis (FM) is a rare chronic fibrotic disease of the mediastinum, characterized by diffuse fibrous tissue proliferation in the mediastinal space that can compress adjacent pulmonary vessels bilaterally. This fibrous proliferation is the core pathological basis for simultaneous stenosis of pulmonary arteries (PAs) and pulmonary veins (PVs) in affected patients, with adhesion as a secondary pathological manifestation of FM rather than the primary cause of vascular stenosis. Fibrous tissue proliferation compresses the pulmonary veins, causing stenosis, obstructing pulmonary circulation reflux, leading to pulmonary congestion and pulmonary hypertension, with symptoms such as dyspnea and hemoptysis. Diagnosis relies on contrast-enhanced chest CT and pulmonary angiography, and multimodal endovascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can provide refined morphological details of stenotic lesions. CASE PRESENTATION: IVUS and OCT revealed a rare triangle-like lumen in FM-induced PV stenosis, a specific imaging feature that supplements the morphological data of FM-related PV stenosis and provides a new intravascular evaluation reference for such rare lesions. The combined use of IVUS and OCT helps differentiate extrinsic compression from intrinsic vascular pathology, which is critical for treatment selection. Treatment is mainly based on drugs to inhibit fibrosis, interventional procedures or surgery to relieve obstruction. CONCLUSIONS: This case suggests that a triangle-like lumen on intravascular imaging may represent a useful clue to FM-induced pulmonary vein stenosis. However, this is a single observation; the specificity of the triangle-like lumen for FM remains unknown. Combined IVUS and OCT is resource-intensive and not routinely recommended. We report this morphology solely as a potential diagnostic clue when clinical suspicion of FM exists.
Efficacy and safety of vericiguat in patients with heart failure with reduced ejection fraction and asymptomatic hypotension: insights from a multicenter observational cohort study.
Tian J, Chen S, Zhang G … +11 more , Jia X, An L, Duan X, Zhao Y, Wei C, Zhang H, Li X, Lu K, Yao G, Ye Q, Lu H
BMC Cardiovasc Disord · 2026 Jun · PMID 42304245 · Full text
BACKGROUND: Recent VICTOR study and the VICTORY pooled analysis demonstrate that vericiguat shows significant therapeutic value in a broader population of relatively stable heart failure with reduced ejection fraction (H...
BACKGROUND: Recent VICTOR study and the VICTORY pooled analysis demonstrate that vericiguat shows significant therapeutic value in a broader population of relatively stable heart failure with reduced ejection fraction (HFrEF) patients. However, the efficacy and safety of vericiguat in HFrEF patients receiving guideline-directed medical therapy (GDMT) who present with asymptomatic hypotension (systolic blood pressure (SBP) ≤ 100 mmHg) remain unclear and require further investigation. METHODS: This multicenter observational cohort study enrolled 164 patients with HFrEF and asymptomatic hypotension (SBP ≤ 100 mmHg), who voluntarily decide whether to receive vericiguat treatment. Propensity score matching (1:2) was employed to address non-random treatment allocation. The primary outcome was the first occurrence of a ≥ 30% reduction in N-terminal pro-B-type natriuretic peptide(NT-proBNP) from baseline at any assessment time point during follow-up. Kaplan-Meier (K-M) analysis and multivariable Cox regression models were applied to assess outcomes. RESULTS: A total of 61 vericiguat-treated patients and 36 controls completed the study. The incidence of significant NT-proBNP reduction in the vericiguat group was 68.8%, significantly higher than the 47.2% in the control group. Kaplan-Meier analysis demonstrated a significantly higher cumulative incidence of NT-proBNP reduction in the vericiguat group than in the control group (hazard ratio (HR) = 2.54, 95% confidence interval (CI): 1.42-4.55, P < 0.001). Multivariate Cox regression confirmed vericiguat as an independent predictor of significant NT-proBNP reduction (Model 3: HR = 2.34, 95% CI: 1.30-4.21, P = 0.004). CONCLUSION: In patients with HFrEF receiving GDMT with concomitant asymptomatic hypotension (SBP ≤ 100 mmHg), vericiguat treatment is significantly associated with a ≥ 30% reduction in NT-proBNP levels during follow-up. In terms of safety in this study, the small number of adverse events and the absence of major safety signals only suggest no statistically significant differences in safety between the two groups. Further large-scale studies with adequate statistical power are required to better evaluate the safety of vericiguat.
Relationship between depressive symptom trajectories and cardiovascular disease risk in middle-aged and older adults with cardiovascular-kidney-metabolic syndrome stages 0-3.
Yang M, Lu Y, Liu Y … +5 more , Xindian P, Chen Y, Zhang X, Hu W, Yan J
BMC Cardiovasc Disord · 2026 Jun · PMID 42304244 · Full text
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome underscores the interlinked pathophysiology of metabolic dysregulation, chronic kidney disease, and cardiovascular disease (CVD). Although depression is a key ps...
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome underscores the interlinked pathophysiology of metabolic dysregulation, chronic kidney disease, and cardiovascular disease (CVD). Although depression is a key psychosocial factor, evidence linking its longitudinal trajectories to incident CVD among middle-aged and older adults with CKM stages 0-3 remains limited. METHODS: We conducted a prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2020, including participants at CKM stages 0-3. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) across the 2011, 2013, and 2015 waves. Group-based trajectory modeling (GBTM) was applied to identify depressive symptom trajectories. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD (including heart disease and stroke). RESULTS: Among 6,152 participants (49% male, median age 58.0 years), 1,080 incident CVD events occurred during the follow-up. We identified three distinct depressive symptom trajectories: Low-stable, Moderate-stable, and Persistently-high. The cumulative incidence of CVD across these groups was 13.0%, 17.3%, and 23.1%, respectively (P < 0.001). Relative to the Low-stable group, fully adjusted Cox models revealed a significantly higher risk of incident CVD in both the Moderate-stable (HR = 1.36; 95% CI: 1.16-1.60) and Persistently-high (HR = 1.88; 95% CI: 1.57-2.24) groups. Consistent risk elevations were observed for coronary heart disease and stroke analyzed separately. CONCLUSION: In Chinese middle-aged and older adults with CKM stages 0-3, depressive symptom trajectories are heterogeneous. Both Persistently-high and Moderate-stable trajectories of elevated depressive symptoms are independently associated with an increased risk of incident CVD.
Clinical spectrum, cardiac phenotypes, and outcomes of FHL1-related cardiomyopathies: a systematic review.
Bobbio E, Caiazza M, Pisacane F … +14 more , Viscovo I, Gentile A, Monda E, De Falco C, Esposito D, Borrelli F, Losi M, Bossone E, Chen SN, Frisso G, Calabrò P, Esposito G, Lombardi R, Limongelli G
BMC Cardiovasc Disord · 2026 Jun · PMID 42304238 · Full text
BACKGROUND: Mutations in the Four-and-a-Half LIM Domains 1 (FHL1) gene are increasingly recognized as a rare cause of inherited cardiomyopathies, often associated with skeletal myopathy and adverse cardiac outcomes. The...
BACKGROUND: Mutations in the Four-and-a-Half LIM Domains 1 (FHL1) gene are increasingly recognized as a rare cause of inherited cardiomyopathies, often associated with skeletal myopathy and adverse cardiac outcomes. The phenotypic spectrum and clinical implications of FHL1 variants remain poorly defined. OBJECTIVE: To systematically review published cases of FHL1-related cardiomyopathy and characterize the clinical, genetic, and pathological features. METHODS: We conducted a systematic literature search in PubMed and EMBASE up to July 2025 using predefined criteria to identify studies reporting clinical cases of patients with FHL1 mutations and cardiac involvement. Data on genotype, phenotype, cardiac and neuromuscular features, and clinical outcomes were extracted and synthesized. RESULTS: Twenty-two studies were included, comprising 114 patients with pathogenic or likely pathogenic FHL1 mutations. Most patients were male (69%), with a median age of onset of 18 (IQR 10-26) years. Cardiac involvement consisted in left ventricular hypertrophy (56%), followed by arrhythmias (51%), and conduction abnormalities (8%). The incidence of sudden cardiac death was 7%, and heart transplantation was reported in 5% of patients. Skeletal muscle involvement was present in 75%, ranging from mild contractures to more severe myopathic phenotypes with functional impairment. Creatine kinase levels were variably elevated. Truncating variants were reported in several severe cardiac presentations in young males, while isolated cardiac disease occurred with selected variants. CONCLUSIONS: FHL1-related cardiomyopathy is a rare but important diagnosis. Genetic testing should be considered in patients with cardiac hypertrophy and neuromuscular features. Further research is needed to define prognostic markers and guide management.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe