BMC Cardiovascular Disorders[JOURNAL]
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200 papers
Efficacy of plant extracts in heart failure patients: a systematic review and network meta-analysis.
Tang T, Li G, Huang X … +1 more , Liang H
BMC Cardiovasc Disord · 2026 Jun · PMID 42277690 · Full text
OBJECTIVE: This study aimed to evaluate the therapeutic efficacy of plant extracts in patients with heart failure. METHODS: A systematic search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science to ide...
OBJECTIVE: This study aimed to evaluate the therapeutic efficacy of plant extracts in patients with heart failure. METHODS: A systematic search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science to identify randomized controlled trials (RCTs) investigating the effects of plant extracts on heart failure patients. The search period spanned from database inception to June 2024. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Tool. Statistical analyses were performed using Review Manager 5.3 and Stata 15.1. RESULTS: A total of 28 studies involving 3,650 heart failure patients were included. Network meta-analysis examined 15 distinct plant extracts: Panax ginseng and Ophiopogon japonicus extract, Water extract of stem bark of Terminalia arjuna, Astragalus extract, Panax ginseng extract, Red ginseng extract, Astragalus and Codonopsis extract, Hawthorn extract, Red ginseng Ophiopogon japonicus and Schisandra extract, Ginkgo biloba extract, Salvia miltiorrhiza extract, Rhodiola extract, Panax ginseng and Aconite extract, Centaurea behen extract, Oak wood extract, and Berberine extract. Based on the Surface Under the Cumulative Ranking Curve (SUCRA) values, Water extract of stem bark of Terminalia arjunaranked first in Number of patients with improved New York Heart Association (NYHA) classification (80.4%). Salvia miltiorrhizaextract exhibited the highest efficacy in enhancing left ventricular ejection fraction (LVEF) (89.7%), while Oak wood extract demonstrated optimal improvement in quality of life (QoL) (100%). Astragalusextract showed superior efficacy in the six-minute walk test (6MWT) (89.5%). CONCLUSION: In summary, our study supports the therapeutic potential of plant extracts for heart failure. Based on SUCRA rankings, they can be effective adjunctive therapies to improve cardiac function, quality of life, and prognosis, with different extracts offering distinct advantages. However, the limited studies for some interventions and scarce direct comparative evidence necessitate cautious interpretation. Future work should prioritize larger, high-quality RCTs for validation. TRIAL REGISTRATION: This meta-analysis was conducted in accordance with the Cochrane Handbook and the PROSPERO NMA checklist, and was registered on PROSPERO (Registration No: CRD42024609307). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-026-05793-x.
Perioperative continuous vs. interrupted oral anticoagulation in TAVR: a systematic review and meta-analysis.
Gan X, Lang Z, Meng X … +4 more , Su Y, Zhu Y, Zhao J, Bai M
BMC Cardiovasc Disord · 2026 Jun · PMID 42277686 · Full text
OBJECTIVES: To evaluate the clinical outcomes associated with continuous versus interrupted oral anticoagulation strategies during the perioperative period of transcatheter aortic valve replacement, with a focus on balan...
OBJECTIVES: To evaluate the clinical outcomes associated with continuous versus interrupted oral anticoagulation strategies during the perioperative period of transcatheter aortic valve replacement, with a focus on balancing thromboembolic and bleeding risks. METHODS: We searched PubMed, Web of Science, Cochrane Library, Scopus, Ovid and Embase up to February 2026. All studies compared continuous oral anticoagulation versus interruption of oral anticoagulation for TAVI. The primary outcomes were major bleeding, major vascular complications, and stroke. Data synthesis was performed by calculating risk ratios (RRs) or standardized mean differences (SMDs), each accompanied by 95% confidence intervals (CIs). The study was prospectively registered with PROSPERO (CRD420251070176). RESULTS: A total of five studies comprising 3,316 patients were included. Compared with interrupted anticoagulation, continued OAC was not associated with a statistically significant increase in major bleeding or major vascular complications. Continued OAC showed a borderline association with a lower risk of stroke, together with lower red blood cell transfusion and higher device success rates. However, given the limited number of studies, the predominance of retrospective evidence, and the trial sequential analysis findings, these results should be interpreted cautiously. CONCLUSION: Continuation of OAC during TAVR appears feasible and was not associated with an increased risk of major bleeding or major vascular complications in the currently available evidence. Although continued OAC showed a possible association with lower stroke and transfusion risks, the evidence remains limited and statistically fragile. Larger randomized trials are needed before definitive clinical recommendations can be made.
Severe hypercapnia and hemodynamic instability following a sudden elevation in end-tidal CO₂ during thoraco-laparoscopic esophagectomy: a case report and literature review.
Xu Y, Deng H, Zhu J … +2 more , Jiang C, Li X
BMC Cardiovasc Disord · 2026 Jun · PMID 42277684 · Full text
BACKGROUND: Establishing thoracoscopic pneumothorax in patients with extensive pleural adhesions often increases the risk of trocar-related lung injury, potentially causing abrupt extreme elevations in end-tidal carbon d...
BACKGROUND: Establishing thoracoscopic pneumothorax in patients with extensive pleural adhesions often increases the risk of trocar-related lung injury, potentially causing abrupt extreme elevations in end-tidal carbon dioxide (ETCO₂) and precipitating life-threatening hemodynamic instability. Given the rarity of such events and complication in recovery, clearer recommendations for early recognition are needed to inform subsequent perioperative management. CASE PRESENTATION: A 61-year-old male undergoing elective thoraco-laparoscopic esophagectomy for esophageal cancer who had an abrupt elevation in PCO₂ of 213 mm Hg, accompanied by severe hemodynamic instability-including hypertensive crisis, tachycardia, and subsequent progressive bradycardia during the establishment of a thoracoscopic pneumothorax. Surgical exploration revealed extensive pleural adhesions and a trocar-related injury of the right lower lung, which allowed a large volume of CO₂ to enter the alveoli and airways, resulting in a dramatic rise in PCO₂. The excessive CO₂ rapidly diffused into the pulmonary circulation, causing a significant increase in PaCO₂ and precipitating severe hypercapnia with acute hemodynamic instability. Following surgical intervention to the injured lung and after showing visible ventilation improvement, and hemodynamic stabilization, the procedure was successfully completed without any complications during recovery. CONCLUSIONS: Patients with extensive pleural adhesions are at increased risk of trocar-related lung injury during the establishment of CO₂ pneumothorax. Continuous intraoperative ETCO₂ monitoring can facilitate early detection with cases of this type. Prompt recognition, effective hemodynamic management, and appropriate use of ventilatory support are essential to prevent potentially life-threatening complications.
Does preoperative homocysteine level influence the kidney functions after coronary artery bypass grafting?
Marcinkiewicz A, Ryk A, Wiese W … +2 more , Krejca M, Fendler W
BMC Cardiovasc Disord · 2026 Jun · PMID 42277680 · Full text
BACKGROUND: Elevated homocysteine (Hcy) has been linked to endothelial dysfunction and adverse cardiovascular outcomes. However, its specific role as a risk factor for postoperative complications, especially acute kidney...
BACKGROUND: Elevated homocysteine (Hcy) has been linked to endothelial dysfunction and adverse cardiovascular outcomes. However, its specific role as a risk factor for postoperative complications, especially acute kidney injury (AKI), in patients undergoing coronary artery bypass grafting (CABG), remains insufficiently defined. What's more we took into consideration presence of diabetes mellitus as an independent risk factor of AKI or the exacerbation of pre-existing chronic kidney disease (CKD), what can modify the prevalence of this complication. METHODS: We conducted a prospective analysis of 66 patients (27 with T2DM, 39 controls) who underwent elective CABG with extracorporeal circulation. The study population consisted mainly of men (82,5%), the median age was 69 years. The majority of patients had preserved good left ventricle function. The primary outcome was the occurrence of postoperative AKI or the exacerbation of pre-existing CKD after CABG. We also analyzed the correlation of preoperative homocysteine level with perioperative myocardial injury, infections, neurological or respiratory complications. Clinical, biochemical, and postoperative data were collected for all participants. Spearman's correlation assessed associations between Hcy and laboratory parameters, while univariable and multivariable logistic regression examined relationships with complications. RESULTS: Preoperative median Hcy levels were similar in T2DM patients and controls (12.6 vs. 12.1 µmol/L, p = 0.24). In the total cohort, Hcy showed positive correlations with triglycerides (r = 0.39, p = 0.0018), C-peptide (r = 0.33, p = 0.0086), and CRP (r = 0.29, p = 0.0210), and a negative correlation with HDL cholesterol (r = - 0.31, p = 0.0149). Higher Hcy levels were significantly associated with acute kidney injury (AKI) or exacerbation of chronic kidney disease (CKD) after CABG (b = 7.14, SE = 2.11, b⁎ = 0.40, p = 0.0013). CONCLUSION: Elevated preoperative Hcy levels were associated with postoperative renal complications after CABG. Therefore, Hcy may serve as a potential biomarker of AKI or exacerbation of CKD after CABG.
Trends in cardiac implantable electronic device infections: 2015 to 2019.
Baldauf B, Bode K, Lau EW … +8 more , Giaccardi M, Assadian O, Chévalier P, Haddad C, Klöss A, Cemin R, Vonthein R, Bonnemeier H
BMC Cardiovasc Disord · 2026 Jun · PMID 42277675 · Full text
BACKGROUND: Cardiovascular implantable electronic devices (CIEDs) improve survival in patients with cardiac rhythm disorders but carry risks of complications, most notably major infections. Reported infection rates vary...
BACKGROUND: Cardiovascular implantable electronic devices (CIEDs) improve survival in patients with cardiac rhythm disorders but carry risks of complications, most notably major infections. Reported infection rates vary internationally, and contemporary large-scale data from Germany are scarce. We aimed to determine nationwide rates of CIED infection-related hospitalizations and associated mortality over a five-year period. METHODS: We analyzed administrative claims from Germany's largest statutory health insurer covering more than 27 million beneficiaries. All CIED procedures performed between January 2015 and December 2019 were identified, including initial implantations, upgrades or downgrades, generator replacements, early revisions, and device extractions. Major infections were detected using International Classification of Diseases (ICD-10-GM) and procedural codes, and stratified as generator pocket infections or lead-associated endocarditis. In-hospital mortality was determined from discharge records. RESULTS: Among 282,205 patients (57.7% male) undergoing CIED procedures, 6,577 individuals (2.33%) experienced 7,704 major infections within three months. Generator pocket infections occurred in 5,396 cases (1.91%), lead-associated endocarditis in 2,308 (0.82%), and combined infections in 1,127 patients (0.39%) within the acute 90-day observation period. CIED infections substantially increased healthcare utilization: Infected patients required substantially more procedures than non-infected patients, despite correct treatment. In-hospital mortality reached 8.36% for pocket infections and 15.0% for endocarditis. Extended follow-up in the 2015 cohort revealed a 4.33% infection-related procedure rate over five years. CONCLUSIONS: Nationwide German data reveal higher acute CIED infection rates than previously reported, with considerable mortality and procedural burden. These findings highlight an urgent need for improved prevention and management strategies.
The combined effect of arterial hypertension and coronary microvascular dysfunction in the prognosis of patients with ST-segment elevation myocardial infarction: a real-world study.
Liu S, Luo D, Wang H … +5 more , Liu H, Zhang A, Liu J, Hu X, Dong H
BMC Cardiovasc Disord · 2026 Jun · PMID 42277672 · Full text
BACKGROUND: Despite successful primary percutaneous coronary intervention (PPCI), a substantial proportion of patients with ST-segment elevation myocardial infarction (STEMI) still develop coronary microvascular dysfunct...
BACKGROUND: Despite successful primary percutaneous coronary intervention (PPCI), a substantial proportion of patients with ST-segment elevation myocardial infarction (STEMI) still develop coronary microvascular dysfunction (CMD), which is closely associated with adverse outcomes. Arterial hypertension (AH) was also associated with adverse outcomes in patients with STEMI. However, the combined prognostic value of AH and CMD in patients with STEMI remains unclear. This study aimed to assess the combined impact of AH and CMD on prognosis in patients with STEMI using the coronary angiography-derived index of microcirculatory resistance (angio-IMR). METHODS: In this retrospective, two-center study, 910 patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) were enrolled from July 2019 to August 2023. The follow-up endpoint was major adverse cardiovascular event (MACE), defined as all-cause mortality, non-fatal myocardial infarction, ischaemia-driven target vessel revascularisation (TVR), and new-onset heart failure. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate the associations of AH and coronary microvascular dysfunction with MACE. A restricted cubic spline plot was used to explore the nonlinear relationship between angio-IMR and MACE. Receiver operating characteristic curves were plotted to compare their predictive performance. Net weight classification index (NRI) and comprehensive discriminant improvement index (IDI) were used to evaluate the incremental predictive value. RESULTS: Patients with AH exhibited a higher 1-year incidence of MACE compared with non-AH patients (17.4% vs. 10.1%, P < 0.001). Among STEMI patients, those with concomitant CMD and AH showed the highest cumulative incidence of MACE (22.7%, P < 0.001). After adjusting for confounding factors, the coexistence of AH and CMD emerged as the strongest predictor of MACE among STEMI patients (hazard ratio [HR]: 3.79, 95% confidence interval [CI]: 2.009-7.146, P < 0.001). The combined model of AH and CMD demonstrated superior predictive performance compared with models including AH alone (AUC: 0.682, 95% CI: 0.675-0.689) or CMD alone (AUC: 0.703, 95% CI: 0.697-0.709), yielding the highest diagnostic efficacy (AUC: 0.713, 95% CI: 0.707-0.719). The joint model showed significant improvements in discrimination (C statistic increased from 0.699 to 0.736, P < 0.001) and reclassification (NRI = 0.142, IDI = 0.024, both P < 0.05). CONCLUSIONS: In STEMI patients undergoing PPCI, AH combined with CMD is closely associated with a higher risk of MACE and it helps to improve the risk stratification of these patients.
Development and validation of a LightGBM-based model with risk stratification for predicting early recurrence after catheter ablation for atrial fibrillation.
Ma X, Wang Y, Huang Z … +3 more , Wu H, Wei J, Gui C
BMC Cardiovasc Disord · 2026 Jun · PMID 42277671 · Full text
BACKGROUND: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia, yet tools for predicting early recurrence (ER) after catheter ablation remain limited. This study aimed to develop a machine learning model...
BACKGROUND: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia, yet tools for predicting early recurrence (ER) after catheter ablation remain limited. This study aimed to develop a machine learning model to estimate ER risk following first-time AF ablation. METHODS: In this retrospective single-center study, 519 patients undergoing initial AF ablation were enrolled (ER rate: 9.2%). Eight predictors were selected via recursive feature elimination. A LightGBM model was constructed and internally validated against logistic regression and conventional risk scores. RESULTS: The LightGBM model achieved an AUC of 0.715 in training and 0.704 in testing, showing higher discrimination than logistic regression (AUC = 0.623) and traditional scores (APPLE AUC = 0.560). SHAP analysis identified mitral regurgitation severity, age, hemoglobin, and albumin as predominant predictors. Using a Youden-derived threshold (0.099), high- and low-risk groups exhibited significantly different recurrence rates in testing(11.4% vs. 2.9%; P < 0.05). CONCLUSION: We developed a LightGBM-based model integrating structural and metabolic features that modestly improves upon conventional approaches in predicting ER after AF ablation. This tool may facilitate personalized post-procedural management. Multicenter prospective validation is warranted.
Clinical characteristics, antithrombotic strategies, and outcomes in patients with atrial fibrillation and coronary heart disease undergoing percutaneous coronary intervention: a multicenter real-world study in Chongqing, China.
Bao N, Wu J, Li Z … +2 more , Li C, Xiao H
BMC Cardiovasc Disord · 2026 Jun · PMID 42277666 · Full text
BACKGROUND: Atrial fibrillation (AF) with coronary artery disease (CAD) requiring percutaneous coronary intervention (PCI) - including both acute and chronic presentations - is common, yet the optimal antithrombotic regi...
BACKGROUND: Atrial fibrillation (AF) with coronary artery disease (CAD) requiring percutaneous coronary intervention (PCI) - including both acute and chronic presentations - is common, yet the optimal antithrombotic regimen remains unclear. This study aimed to characterize clinical features, current antithrombotic therapy, and discharge prognosis in this population. METHODS: Data were collected from three independent annual cohorts of patients with atrial fibrillation and coronary heart disease undergoing PCI (2013, 2018, and 2023). First, cross-sectional comparisons across the three years were performed to examine temporal trends in clinical characteristics and discharge antithrombotic therapy. Predictors of discharge antithrombotic therapy were then analyzed in the 2023 cohort. Second, the 2023 cohort was prospectively followed for a median of 17 months (interquartile range 9-24 months; range 0.5-32 months) to evaluate clinical outcomes according to different antithrombotic regimens and to identify independent risk factors. RESULTS: Of the 1,062 participants, 479 underwent longitudinal follow-up (median 17 months, IQR 9-24; range 0.5-32). Independent predictors of intensified antithrombotic therapy included recent PCI, proton pump inhibitor use, and statin use; independent predictors of antiplatelet therapy included recent PCI, age, liver dysfunction, left atrial diameter, proton pump inhibitor use, heart failure, and non-paroxysmal atrial fibrillation. During follow-up, anticoagulant therapy showed a trend toward higher MACCEs risk compared with intensified antithrombotic therapy (HR 1.47, 95% CI 0.97-2.24, P=0.073) and antiplatelet therapy (HR 1.33, 95% CI 0.79-2.22, P=0.280), with no significant difference between the latter two (HR 1.15, 95% CI 0.71-1.88, P=0.567). Multivariate Cox regression identified liver dysfunction, diabetes, and HAS-BLED score as independently associated with MACCEs, while higher hemoglobin and statin use were associated with lower risk. CONCLUSIONS: Over the years, more AF with CHD patients after PCI received post-discharge antithrombotic therapy. Liver dysfunction, diabetes, and a high HAS‑BLED score were independently associated with MACCEs, while statin use was associated with lower risks of all‑cause death, MI, and ischemia‑driven revascularization.
Temporal and spatial variation in hospitalizations and mortality from acute myocardial infarction in Brazil during the COVID-19 pandemic period (2020-2023).
da Silva TH, de Vasconcelos Brandão PA, Andrade LA … +9 more , Cavalcante GAG, de Lima Pinheiro K, de Melo Cavalcante IF, da Paz WS, Dantas Dos Santos A, Carmo RF, de Souza CDF, de Oliveira Baggio JA, Bezerra-Santos M
BMC Cardiovasc Disord · 2026 Jun · PMID 42277665 · Full text
BACKGROUND: The COVID-19 pandemic emerged as a major public health challenge, not only due to the high number of victims but also because of the significant rise in cardiovascular emergencies associated with the infectio...
BACKGROUND: The COVID-19 pandemic emerged as a major public health challenge, not only due to the high number of victims but also because of the significant rise in cardiovascular emergencies associated with the infection. We investigated the temporal and spatial variation in hospitalizations (2020-2023) and deaths (2020-2022) from Acute Myocardial Infarction (AMI) in Brazil during the COVID-19 pandemic. METHODS: We analyzed hospitalizations (between 2015 and 2023) and deaths (between 2015 and 2022), using data from the Mortality Information System (SIM) and the Hospital Information System (SIH) of the Brazilian Ministry of Health. Percentage change was calculated to assess whether there was an increase or decrease in hospitalizations and deaths from AMI, considering the average of the previous five years. Additionally, a Joinpoint regression model was applied to evaluate temporal trends before and after the onset of the pandemic. Spatial variations were visualized through choropleth maps. RESULTS: A consistent rise in AMI hospitalizations was observed nationwide, with percentage increases of 13.4% in 2020, 21.2% in 2021, 36.9% in 2022, and 30.9% in 2023. The Central-West region showed the highest growth rates. Regarding mortality, there was a reduction in AMI deaths in 2020 (-3.0%), followed by increases in 2021 (2.2%) and 2022 (4.6%), particularly in the North and Central-West regions. Temporal trend analysis revealed a significant increase in AMI hospitalizations in Brazil (APC = 5.7%; p < 0.05). The most pronounced growth was observed in the Central-West (APC = 10.4%; p < 0.05) and North (APC = 6.3%; p < 0.05) regions. For mortality, trends were stable during the pre-pandemic period in Brazil and in most regions, but they increased in the pandemic period in the North (APC = 2.6%; p < 0.05) and Central-west (APC = 1.6%; p < 0.05) regions. CONCLUSION: Overall, this study identified an increase in the number of hospitalizations (between 2020 and 2023) and deaths (between 2020 and 2022) due to AMI in Brazil, highlighting COVID-19's significant impact on cardiovascular health. The findings underscore the urgent need for stronger investments in health infrastructure, as well as strategic interventions to mitigate the effects of the pandemic and reduce hospitalizations and deaths in the coming years.
Serum asprosin levels as a subclinical atherosclerosis marker in patients with primary hypertension.
Özet Mİ, Acehan F, Kaygısız M … +4 more , Kurt MA, Arslan H, Yılmaz FM, Ateş İ
BMC Cardiovasc Disord · 2026 Jun · PMID 42277661 · Full text
Hypertension and subclinical atherosclerosis are major contributors to cardiovascular morbidity. Asprosin, a fasting-induced adipokine involved in glucose homeostasis and inflammation, has been proposed as a novel metabo...
Hypertension and subclinical atherosclerosis are major contributors to cardiovascular morbidity. Asprosin, a fasting-induced adipokine involved in glucose homeostasis and inflammation, has been proposed as a novel metabolic biomarker. This study investigated the relationship between serum asprosin levels and subclinical atherosclerosis in patients with primary hypertension. A total of 114 patients with primary hypertension and 62 age- and sex-matched healthy controls were enrolled between July 2022 and June 2023. Coronary artery calcium (Agatston) score was used to assess subclinical atherosclerosis. Serum asprosin concentrations were measured using the ELISA method. Correlation, regression, and ROC analyses were performed to identify determinants and discriminatory performance. Serum asprosin levels were significantly higher in hypertensive patients than in controls (3.0 ± 0.9 ng/mL vs. 2.6 ± 0.8 ng/mL, p = 0.012). In hypertensive individuals, increasing age, blood pressure, and ASCVD risk score were independently associated with higher atherosclerotic burden, whereas the neutrophil-to-lymphocyte ratio (NLR) was inversely related (p < 0.05). ROC analysis showed that serum asprosin could discriminate hypertensive patients with subclinical atherosclerosis (AUC = 0.710 [95% CI: 0.62-0.80, p = 0.001]) at a cut-off > 3.05 ng/mL, with 69% sensitivity and 72% specificity. Serum asprosin levels were elevated in patients with primary hypertension and may reflect metabolic-inflammatory alterations rather than directly indicate subclinical atherosclerosis. Given its modest discriminatory performance, serum asprosin should be considered an exploratory and complementary biomarker, not a standalone clinical tool. Larger longitudinal studies are required to validate its clinical relevance.Clinical trial numberNot applicable.
Elevated red cell distribution width as a prognostic indicator in critically ill patients with atrial fibrillation and chronic kidney disease.
Zhao Y, Pan W, Mo D … +1 more , Dai H
BMC Cardiovasc Disord · 2026 Jun · PMID 42277660 · Full text
BACKGROUND: Red cell distribution width (RDW) has emerged as an important prognostic biomarker in various cardiovascular and renal conditions. However, its specific role in critically ill patients with coexisting atrial...
BACKGROUND: Red cell distribution width (RDW) has emerged as an important prognostic biomarker in various cardiovascular and renal conditions. However, its specific role in critically ill patients with coexisting atrial fibrillation (AF) and chronic kidney disease (CKD) is not well established. This study aims to evaluate the prognostic significance of RDW in this population. METHODS: We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database, identifying 2208 patients with concomitant AF and CKD. We assessed the association between RDW levels and 28-day and 365-day mortality using multivariable Cox regression models, Kaplan-Meier survival analysis, receiver operating characteristic (ROC) curve and subgroup analyses. RESULTS: Elevated RDW was independently associated with increased risks of both 28-day and 365-day all-cause mortality after multivariable adjustment (fully adjusted Hazard Ratio [HR]: 1.15 and 1.17; all p < 0.001). Patients in the highest RDW quartile demonstrated the greatest mortality risk, with an adjusted HR of 2.46 for 28-day mortality and 2.65 for 365-day mortality. Kaplan-Meier analysis revealed significantly lower survival probabilities in higher RDW quartiles (log-rank test: p < 0.001). ROC analysis demonstrated fair predictive accuracy for RDW (Area Under the Curve [AUC]: 0.64 for 28-day and 0.68 for 365-day mortality), with optimal cut-off values of 15.35% and 15.55%, respectively. Subgroup analyses confirmed the consistent prognostic value of RDW across most patient strata and identified significant interactions with CKD stage (p for interaction < 0.001) and type 2 diabetes (p for interaction = 0.048). CONCLUSION: RDW is a valuable prognostic biomarker for identifying patients with AF and CKD who are at increased risk of both short- and long-term mortality. This supports its use in risk stratification to guide timely interventions and personalized management. CLINICAL TRIAL NUMBER: not applicable.
Psychological experiences of patients with Stanford type B aortic dissection during the preoperative waiting period: a qualitative study.
Liu C, Xie X, Hu A … +3 more , Qi W, Su Y, Zhang P
BMC Cardiovasc Disord · 2026 Jun · PMID 42277648 · Full text
BACKGROUND: Stanford type B aortic dissection (TBAD) is a life-threatening cardiovascular emergency. For patients with acute uncomplicated TBAD, elective thoracic endovascular aortic repair is often preceded by a preoper...
BACKGROUND: Stanford type B aortic dissection (TBAD) is a life-threatening cardiovascular emergency. For patients with acute uncomplicated TBAD, elective thoracic endovascular aortic repair is often preceded by a preoperative waiting period for medical stabilization. During this period, patients face ongoing risks of disease progression while definitive treatment is delayed, creating a distinct context of illness uncertainty. However, the psychological adaptation processes underlying this experience remain insufficiently understood. OBJECTIVE: This study aimed to explore the psychological experiences of patients with TBAD during the preoperative waiting period, guided by Mishel's Uncertainty in Illness Theory (UIT). METHODS: A descriptive phenomenological qualitative study was conducted between July and December 2025 at the Cardiac and Vascular Surgery Center of a tertiary hospital in Eastern China. Purposive sampling was used to recruit 17 patients awaiting elective surgery for TBAD. Data were collected through semi-structured, in-depth interviews and analyzed using Colaizzi's seven-step phenomenological method. RESULTS: The preoperative waiting period was characterized as a dynamic process of psychological adaptation. Four interrelated themes were identified: constructing illness uncertainty, appraisal of the waiting experience, coping strategies, and the dynamics of trust. CONCLUSION: Patients with TBAD experienced the preoperative waiting period as a complex process shaped by illness uncertainty, meaning appraisal, coping strategies, and trust. These findings extend the application of UIT to the context of delayed intervention for life-threatening cardiovascular disease and highlight the importance of integrated psychosocial support during preoperative waiting. Clear and consistent communication, trust-building, adaptive meaning-focused support, and individualized coping interventions may support psychological adjustment during this vulnerable period.
Interacting and joint impact of oxidative balance score and insulin resistance on cardiovascular and metabolic diseases risks: a cross-sectional, population-based study.
Du L, Liu Y, Zhu K … +4 more , Lin Z, Hua B, Peng J, Cao CM
BMC Cardiovasc Disord · 2026 Jun · PMID 42271260 · Full text
BACKGROUND: Oxidative stress and insulin resistance (IR) are risk factors for cardiovascular and metabolic diseases (CVMDs). However, the interaction between the oxidative balance score (OBS, marker of oxidative stress)...
BACKGROUND: Oxidative stress and insulin resistance (IR) are risk factors for cardiovascular and metabolic diseases (CVMDs). However, the interaction between the oxidative balance score (OBS, marker of oxidative stress), and the triglyceride-glucose index (TyG, IR surrogate), on CVMDs risk, remains largely unexplored. METHODS: This cross-sectional, population-based study used data from the National Health and Nutrition Examination Survey (NHANES, 1999-2018), examining OBS and TyG. All exposures and outcomes were ascertained at the same time point; therefore, only associational relationships are reported. The primary outcome was the prevalence of four major CVMDs-cardiovascular disease (CVD), hypertension, type 2 diabetes mellitus (T2DM), and hyperlipidemia. RESULTS: Among 17,265 participants, the prevalence rates were 8.5% for CVD, 36.9% for hypertension, 13.6% for T2DM, and 71.4% for hyperlipidemia. TyG significantly mediated the relationship between OBS and CVMD risk, with mediation proportions of 1.8% for CVD, 7.8% for hypertension, and 10.5% for T2DM. No statistically significant multiplicative or additive interactions between OBS and TyG in influencing CVMDs risk were observed. Participants with low OBS and high TyG levels had significantly increased risks for CVD, hypertension, T2DM, and hyperlipidemia, with adjusted odds ratios of 1.52 (95% confidence interval [CI]: 1.21-1.92), 1.62 (95%CI: 1.38-1.91), 2.94 (95%CI: 2.13-4.04), and 9.52 (95%CI: 7.51-12.1), respectively, compared to those with high OBS and low TyG levels. Adding OBS and TyG to traditional CVMDs risk models resulted in very small improvements in the C-statistic (ΔC <0.003 for most outcomes). CONCLUSIONS: This study suggests that TyG is associated with a mediation effect between oxidative stress on CVMDs risk and underscores the co-exposure effects of OBS and TyG on CVMDs risk, highlighting the importance of a combined OBS and TyG assessment for improved CVMDs risk stratification. Because of the cross-sectional design and the mathematical overlap between TyG and the hyperlipidemia definition, causal inferences cannot be made, and the hyperlipidemia findings require independent validation.
Vutrisiran in transthyretin amyloid cardiomyopathy: a structured review of the HELIOS-B trial and its secondary analyses.
Niazai A, Zurmati BM, Shah ST … +5 more , Hikmat G, Sohaib HU, Zainab HH, Faridzai MJK, Nisar MR
BMC Cardiovasc Disord · 2026 Jun · PMID 42271253 · Full text
BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive infiltrative cardiomyopathy caused by myocardial deposition of misfolded transthyretin, leading to heart failure, conduction abnormalities, and...
BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive infiltrative cardiomyopathy caused by myocardial deposition of misfolded transthyretin, leading to heart failure, conduction abnormalities, and functional decline. Recent therapeutic advances have shifted management toward disease-modifying strategies that target transthyretin production and stability. Vutrisiran, a subcutaneously administered small interfering RNA therapy, suppresses hepatic transthyretin synthesis and has emerged as a potential treatment option for ATTR-CM. METHODS: This structured narrative review was prospectively registered in PROSPERO (CRD420261307493) and aimed to evaluate the efficacy and safety of vutrisiran in patients with ATTR-CM. A systematic literature search was conducted on 12 February 2026 across PubMed, ScienceDirect, Google Scholar, PubMed Central, and ClinicalTrials.gov. Study selection and screening were performed independently by two reviewers in accordance with PRISMA guidelines, with disagreements resolved by consensus. The review included one primary randomized controlled trial and associated secondary and post hoc analyses. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. RESULTS: Vutrisiran reduced all-cause mortality (HR 0.65-0.72), cardiovascular events (HR 0.67-0.72), and recurrent events (RR 0.68-0.73) over a median follow-up of ~ 33 months (up to ~ 36 months). It improved functional capacity (6MWD + 26.5-32.1 m; KCCQ-OS + 5.8-8.7) and NYHA class stability/improvement (66-68% vs. 56-61%). Cardiac remodeling improved with reductions in LV mass (- 10.6 g/m²), LV wall thickness (- 0.4 mm), and improvements in LVEF (+ 1.6-2%) and GLS (+ 0.7-1.2%). Biomarkers were reduced (NT-proBNP and troponin I ratio 0.68). Benefits were greater in earlier disease stages and included fewer HF events (HR 0.73) and reduced days lost to death/hospitalization (- 32 to - 64). Safety remained favorable with low discontinuation (3.5%) and no new organ toxicity signals. CONCLUSION: Vutrisiran represents a disease-modifying therapy for transthyretin amyloidosis with cardiomyopathy, demonstrating consistent biochemical and clinical benefits alongside a generally favorable safety profile. These findings support its emerging role within the therapeutic landscape and underscore the potential of transthyretin-silencing strategies to improve patient outcomes. Nevertheless, further long-term follow-up and additional trials and real-world studies are needed to better define the durability of benefit and its optimal positioning within evolving treatment algorithms.
Perivascular fat attenuation index on coronary computed tomography angiography predicts postoperative atrial fibrillation after off-pump coronary artery bypass grafting.
Chen X, Li H, Hu H … +4 more , Wang D, Yan W, Nie P, Yang S
BMC Cardiovasc Disord · 2026 Jun · PMID 42271247 · Full text
BACKGROUND: Postoperative atrial fibrillation (POAF) is a prevalent complication following cardiac surgery, which has been associated with inflammatory activity in epicardial adipose tissue. There is a lack of effective...
BACKGROUND: Postoperative atrial fibrillation (POAF) is a prevalent complication following cardiac surgery, which has been associated with inflammatory activity in epicardial adipose tissue. There is a lack of effective means for its prediction and prevention. The fat attenuation index (FAI) serves as a non-invasive imaging biomarker capable of quantifying pericoronary adipose tissue inflammation. METHODS: In this retrospective study, patients who underwent off-pump coronary artery bypass grafting (OPCABG) and had preoperative coronary computed tomography angiography (CCTA) were included. The pericoronary FAI was measured from CCTA images. POAF was identified based on ECG monitoring within 7 days after surgery. A multivariate logistic regression model incorporating variables significant in univariate analysis and clinically relevant factors was constructed. Model performance with and without FAI was compared using the area under the curve (AUC) with DeLong's test. RESULTS: A total of 140 patients were finally included, including 41 patients (29.2%) in the POAF group and 99 patients (70.8%) in the NO-POAF group Multivariate logistic regression identified hypertension and a higher FAI around the right coronary artery as independent predictors of POAF, while history of myocardial infarction showed a trend toward significance. The inclusion of FAI (RCA) significantly improved model discrimination (AUC increased from 0.711 for the clinical model to 0.752; DeLong p = 0.049). CONCLUSIONS: The pericoronary FAI, particularly around the RCA, provides incremental predictive information and may help identify patients at elevated POAF risk; however, its precise clinical utility requires further validation.
Self-esteem in patients post-percutaneous coronary intervention: a cross-sectional examination.
Chen B, Lin Y
BMC Cardiovasc Disord · 2026 Jun · PMID 42271246 · Full text
BACKGROUND: Percutaneous coronary intervention (PCI) is a widely used therapeutic modality for coronary heart disease (CHD). This study aimed to characterize self-esteem levels and identify key factors influencing self-e...
BACKGROUND: Percutaneous coronary intervention (PCI) is a widely used therapeutic modality for coronary heart disease (CHD). This study aimed to characterize self-esteem levels and identify key factors influencing self-esteem among CHD patients following PCI. METHODS: A cross-sectional survey was conducted among CHD patients undergoing PCI at our hospital between February 2024 and January 2025. Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES), a 10-item 4-point Likert scale with a total score range of 10-40 points (higher scores indicate greater self-worth). CLINICAL TRIAL NUMBER: Not applicable. RESULTS: A total of 316 CHD patients were included. The study sample had a mean age of 62.3 ± 8.5 years, with 30.4% being female. The overall mean RSES score was 23.18 ± 3.05. Correlation analysis revealed significant associations between self-esteem and age (r = -0.610), educational level (r = 0.602), per capita monthly household income (r = 0.628), place of residence (r = 0.534), duration of CHD diagnosis (r = 0.614), and number of stents implanted (r = -0.631). Multiple linear regression confirmed these as independent factors: age (β = -0.142, 95% CI: -0.215 to -0.069), educational level (β = 0.876, 95% CI: 0.321 to 1.431), per capita monthly household income (β = 0.563, 95% CI: 0.189 to 0.937), place of residence (β = 1.245, 95% CI: 0.152 to 2.338), duration of CHD diagnosis (β = 0.987, 95% CI: 0.526 to 1.448), and number of stents implanted (β = -0.320, 95% CI: -0.451 to -0.189). Variance inflation factor (VIF) values ranged from 1.32 to 2.45 (no significant multicollinearity). CONCLUSIONS: CHD patients post-PCI exhibit self-esteem levels within the lower range of general population norms, with several factors independently influencing these scores. These findings highlight the need for targeted psychological interventions tailored to vulnerable subgroups to enhance post-PCI psychological well-being and optimize recovery outcomes.
Advanced resuscitation strategies for cardiac arrest in pregnancy: a systematic review.
Hongo T, Yumoto T, Obara T … +10 more , Hiraoka T, Kosaki Y, Jinno S, Matsuo I, Sasanami M, Miyoshi Y, Yoshihiro S, Tsuge T, Nakao A, Naito H
BMC Cardiovasc Disord · 2026 Jun · PMID 42271244 · Full text
BACKGROUND: Cardiac arrest during pregnancy is a rare, life-threatening event. The roles of resuscitative delivery (RD) and extracorporeal cardiopulmonary resuscitation (ECPR) remain unclear. This systematic review summa...
BACKGROUND: Cardiac arrest during pregnancy is a rare, life-threatening event. The roles of resuscitative delivery (RD) and extracorporeal cardiopulmonary resuscitation (ECPR) remain unclear. This systematic review summarizes maternal and neonatal outcomes according to initial resuscitation strategy. METHODS: This systematic review followed a preplanned protocol registered in the Open Science Framework and adhered to PRISMA guidelines. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi were searched from inception to May 8, 2025, without language restrictions. Cases were categorized by initial resuscitation strategy into four groups: RD-/ECPR-, RD+/ECPR-, RD-/ECPR+, and RD+/ECPR+. RESULTS: A total of 150 studies were included, comprising predominantly case reports and describing 268 pregnant patients with cardiac arrest and 274 neonates from 34 countries (2000-2025). Initial resuscitation strategies were RD-/ECPR- in 71/268 (26.5%), RD+/ECPR- in 184/268 (68.7%), RD-/ECPR + in 5/268 (1.9%), and RD+/ECPR + in 8/268 (3.0%). Favorable neurological outcomes were reported in 37/61 (61.9%), 39/146 (26.7%), 4/5 (80.0%), and 2/8 (25.0%), respectively, among cases with available data. Maternal survival beyond ICU admission (mid-term survival) was observed in 46/66 (69.7%), 69/171 (40.3%), 5/5 (100%), and 6/8 (75.0%), respectively. Neonatal survival beyond ICU admission was observed in 29/58 (50.0%), 61/101 (60.4%), 3/5 (60.0%), and 4/7 (57.1%). Among cases receiving both RD and ECPR, ECPR was initiated after RD in six cases and preceded RD in one case. CONCLUSIONS: Maternal and neonatal outcomes after cardiac arrest during pregnancy varied widely across resuscitation strategies. The available evidence is limited by small, case-based reports, highlighting the need for large registries and multicenter studies to define the optimal use and sequencing of RD and ECPR. TRIAL REGISTRATION: A preplanned protocol for systematic review has been registered in the Open Science Framework (Osf.io) [https://osf.io/9xsrt/files/osfstorage].
Prevalence of right ventricular dysfunction and its echocardiographic predictors in patients with heart failure with preserved ejection fraction: a retrospective cohort study.
Du X, Li W, Yan Y … +1 more , Zhang Q
BMC Cardiovasc Disord · 2026 Jun · PMID 42271243 · Full text
OBJECTIVE: To determine right ventricular dysfunction (RVD) prevalence in patients with heart failure and preserved ejection fraction (HFpEF); to systematically evaluate predictive values of echocardiographic parameters...
OBJECTIVE: To determine right ventricular dysfunction (RVD) prevalence in patients with heart failure and preserved ejection fraction (HFpEF); to systematically evaluate predictive values of echocardiographic parameters for RVD. METHODS: A total of 163 patients diagnosed with HFpEF between January 2022 and January 2024 were retrospectively analyzed. All patients underwent assessment of right ventricular function. RVD was characterized by the presence of either a tricuspid annular plane systolic excursion (TAPSE) below 17 mm or a right ventricular free wall strain (RV-FWS) absolute value under 20%. Baseline clinical characteristics and echocardiographic parameters were collected, including left atrial volume index (LAVI), mean ratio of early mitral inflow velocity to early diastolic mitral annular velocity (mean E/e'), systolic pulmonary artery pressure (sPAP), and right ventricular fractional area change (FAC). RESULTS: The prevalence of RVD among patients with HFpEF was 41.7% (68/163). The RVD group was characterized by substantially higher NT-proBNP levels. Echocardiographic measures including RV-FWS, sPAP, mean E/e', LAVI, TAPSE, and FAC independently predicted the occurrence of RVD. Among individual parameters, RV-FWS showed the best predictive performance. The combined predictive model incorporating the six aforementioned parameters exhibited excellent discriminatory ability. After internal validation using the bootstrap method, the corrected AUC was 0.989. CONCLUSIONS: RV-FWS and sPAP are the strongest independent echocardiographic predictors of RVD. An integrated assessment strategy combining multiparametric echocardiography with NT-proBNP measurement may substantially improve risk stratification of RVD in HFpEF.
Age-dependent associations of high-intensity statin therapy with 3-year clinical outcomes after acute myocardial infarction: longitudinal LDL-C profiles in a nationwide registry.
Kwon Y, Kim N, Kim DH … +14 more , Kim B, Park JS, Park YJ, Park BE, Kim HN, Lee JH, Yang DH, Park HS, Cho Y, Hwang KK, Joo SJ, Oh SK, Jeong MH, KAMIR-NIH (Korea Acute Myocardial Infarction Registry- National Institutes of Health) Investigators
BMC Cardiovasc Disord · 2026 Jun · PMID 42271228 · Full text
BACKGROUND: High-intensity statin therapy is an important strategy for secondary prevention after acute myocardial infarction (AMI), but its clinical benefit in very elderly patients remains uncertain. We aimed to evalua...
BACKGROUND: High-intensity statin therapy is an important strategy for secondary prevention after acute myocardial infarction (AMI), but its clinical benefit in very elderly patients remains uncertain. We aimed to evaluate whether the association of high-intensity statins with clinical outcomes differs by age in older AMI patients undergoing percutaneous coronary intervention (PCI). METHODS: Using the Korean Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH), we compared outcomes of high-intensity versus non-high-intensity statins among 4,147 patients aged ≥ 65 years treated with PCI and discharged on statins, stratified by age (65-74 years, n = 2,316; ≥75 years, n = 1,831), in overall and propensity score-matched cohorts (matched on age, sex, body mass index, Killip class, comorbidities, left ventricular ejection fraction, estimated glomerular filtration rate, baseline LDL-C, discharge medications, and procedural characteristics). The primary endpoint was 3-year major adverse cardiovascular events (MACE: all-cause death, recurrent myocardial infarction, or any coronary revascularization); the death/MI composite was a key secondary outcome. Post-discharge statin persistence, LDL-C target attainment, and longitudinal LDL-C profiles were additionally examined. RESULTS: High-intensity statins were prescribed at discharge in 748 (32.3%) patients aged 65-74 years and 520 (28.4%) aged ≥ 75 years. In the 65-74-year group, high-intensity statins were associated with lower risks of MACE (overall cohort: 13.6% vs. 18.9%, adjusted HR 0.69, 95% CI 0.55-0.87, p < 0.01; matched: 13.7% vs. 18.1%, HR 0.71, 95% CI 0.54-0.92, p = 0.01) and the death/MI composite (overall: 7.9% vs. 11.3%, adjusted HR 0.69, 95% CI 0.51-0.94, p = 0.01; matched: 8.0% vs. 10.9%, HR 0.70, 95% CI 0.49-0.99, p = 0.04). In patients aged ≥ 75 years, neither composite outcome showed a statistically evident association with statin intensity. Post-discharge high-intensity statin persistence was comparable by age. Measured-only LDL-C < 70 mg/dL attainment was similar between age groups within each statin-intensity stratum, but when missing values were treated as non-attainment, lower attainment emerged in patients aged ≥ 75 years compared with those aged 65-74 years within each statin-intensity stratum, paralleling lower follow-up measurement rates. LDL-C separation and reductions in variability were also less distinct in this age group. CONCLUSIONS: Discharge high-intensity statin therapy was associated with lower risks of the principal composite outcomes in patients aged 65-74 years but not in those aged ≥ 75 years. In very elderly patients, this attenuation may reflect residual geriatric confounding, incomplete LDL-C ascertainment, and uncertainty in sustained treatment exposure rather than absence of benefit, underscoring the need for prospective evaluation of target-oriented strategies in this population.
Ultrasonographic frequency of complex aortic plaques in patients with atrial fibrillation.
Bulut A, Koca F, Donmez Y … +3 more , Sumbul HE, Ardıç ML, Koc M
BMC Cardiovasc Disord · 2026 Jun · PMID 42265643 · Full text
BACKGROUND: The presence of aortic plaque is an important risk factor for stroke in patients with atrial fibrillation (AF). A history of vascular disease, defined as the presence of complex aortic plaque (CAP), constitut...
BACKGROUND: The presence of aortic plaque is an important risk factor for stroke in patients with atrial fibrillation (AF). A history of vascular disease, defined as the presence of complex aortic plaque (CAP), constitutes one of the components of the CHA₂DS₂-VA score. However, data regarding the frequency of abdominal aortic (AA) plaques in patients with AF are limited in the literature. Therefore, the present study aimed to investigate the prevalence of AA-CAP and its associated parameters in patients with AF. METHOD: A total of 748-patients with AF who underwent abdominal ultrasonography (US) for aortic plaque assessment were included in this study. In addition to routine clinical evaluations, all patients were assessed for the presence of AA-CAP using US. The study population was subsequently divided into two groups according to the presence or absence of AA-CAP. RESULT: AA-CAP was detected in 106 (14.2%) of the AF patients included in the study. Patients with AA-CAP were older and had higher CHA₂DS₂-VA scores and a greater burden of cardiovascular risk factors. In addition, blood pressure levels and glucose, urea, and creatinine values were higher, whereas hemoglobin levels were lower in patients with AA-CAP. In logistic regression analysis, age, CHA₂DS₂-VA score, and the presence of hypertension were found to be independently associated with AA-CAP (OR = 1.071,95%CI:1.031-1.111,p < 0.001;OR = 2.446,95%CI:1.900-3.149,p < 0.001;OR = 2.735,95%CI:1.441-5.190,p = 0.002). ROC curve analysis demonstrated that age and CHA₂DS₂-VA score, with cut-off values of 65 years and 3, respectively, identified the presence of AA-CAP with acceptable sensitivity and specificity. CONCLUSION: AA-CAP was observed at a considerable rate (14.2%) in patients with AF. Therefore, in AF patients without previously known coronary or peripheral arterial disease, assessment of AA-CAP using abdominal US may be useful for stroke risk stratification and for more accurate calculation of the CHA₂DS₂-VA score.
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