BMC Cardiovascular Disorders[JOURNAL]
Sun
200 papers
Impact of transient return of spontaneous circulation and downtime on neurological outcomes following extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a single-center retrospective study.
Homma T, Shibata T, Murotani K … +6 more , Matsushima Y, Shibao K, Hori K, Otsuka M, Takasu O, Fukumoto Y
BMC Cardiovasc Disord · 2026 Jun · PMID 42237219 · Full text
BACKGROUND: Despite recent advancements in cardiopulmonary resuscitation (CPR), the prognosis of out-of-hospital cardiac arrest (OHCA) remains poor. Extracorporeal cardiopulmonary resuscitation (ECPR) offers potential be...
BACKGROUND: Despite recent advancements in cardiopulmonary resuscitation (CPR), the prognosis of out-of-hospital cardiac arrest (OHCA) remains poor. Extracorporeal cardiopulmonary resuscitation (ECPR) offers potential benefits to improve outcomes of patients with refractory OHCA. Identifying the factors associated with neurological outcomes at 180 days and their interactions remains critical for optimizing patient selection. METHODS: This single-center retrospective study analyzed consecutive patients with OHCA treated with ECPR at Kurume University Hospital between 2016 and 2023. Factors associated with the neurological outcomes at 180 days were evaluated using logistic regression and decision tree analyses. RESULTS: A total of 65 patients were included. Favorable neurological outcomes at 180 days were recorded in 18 (27.7%) patients. Transient return of spontaneous circulation (ROSC) (adjusted odds ratio (aOR): 8.37, 95% confidence interval (CI): 2.20-38.79) and shorter downtime (aOR: 0.95, 95% CI: 0.90-0.99) were independently associated with favorable neurological outcomes. Decision tree analysis revealed that the presence of transient ROSC and bystander CPR are upstream factors associated with favorable neurological outcomes, and that the absence of transient ROSC with prolonged downtime was associated with unfavorable outcomes. CONCLUSION: Transient ROSC and shorter downtime were independently associated with favorable neurological outcomes at 180 days in patients treated with ECPR. Using a decision-tree model, we visualized how these key factors interact to influence long-term neurological recovery, highlighting their potential importance in refining the patient selection process for ECPR.
A radiomics model based on CTA subtraction imaging for differentiating symptomatic and asymptomatic carotid plaques: a retrospective study.
Deng C, Wang X, Zhu R … +1 more , Wu S
BMC Cardiovasc Disord · 2026 Jun · PMID 42231212 · Full text
OBJECTIVE: This study compared radiomics models constructed from carotid artery CTA subtraction images. Two ROI delineation strategies were employed: the global vascular wall and the semi-global vascular wall, which focu...
OBJECTIVE: This study compared radiomics models constructed from carotid artery CTA subtraction images. Two ROI delineation strategies were employed: the global vascular wall and the semi-global vascular wall, which focuses on the plaque enrichment side at the vascular plaque site. The objective was to differentiate between symptomatic and asymptomatic internal carotid artery plaques. Additionally, the study aimed to investigate the differences between the two strategies to assess their potential clinical applications and pathways for transformation. METHODS: This retrospective study included 129 patients with carotid plaques, comprising 65 symptomatic and 64 asymptomatic cases. CTA and non-contrast images were coregistered, subtracted, and subsequently fused to generate the final CTA subtraction images. Using the carotid slice with the largest plaque as the reference, the full-circumference vascular wall, the half-circumference vascular wall (plaque-enriched side), and adjacent layers were delineated to generate two ROIs, which were then combined into a three-dimensional volume ROI. Radiomics features were extracted from each ROI, and feature selection was performed using LASSO regression. SVM models were constructed based on the selected features. Model performance in distinguishing symptomatic versus asymptomatic plaques was evaluated using AUC and accuracy. RESULT: A total of 1,834 features were extracted from each ROI method. Eight features from the full-circumference ROI and 33 from the semi-circumference ROI were selected for modeling. The SVM models demonstrated strong discriminatory performance. In the training set, AUCs reached 0.871 (95% CI: 0.80-0.93) for the full-circumference ROI and 0.979 (95% CI: 0.95-0.99) for the semi-circumference ROI. Corresponding test-set AUCs were 0.893 (95% CI: 0.77-1.00) and 0.899 (95% CI: 0.78-1.00), respectively. Model accuracies were 0.806 and 0.913 in the training set and 0.846 for both ROI models in the test set. CONCLUSION: Radiomics models utilizing half-week and full-week vascular wall ROIs demonstrate strong discriminatory performance in distinguishing between symptomatic and asymptomatic carotid plaques, with overall performance being comparable. The delineation of full-week vascular wall ROIs is relatively straightforward, suggesting greater potential for clinical application.
Association between intrarenal venous flow and postoperative acute kidney injury in cardiac surgery patients following cardiopulmonary bypass: a prospective cohort study.
Zhao J, Li Z, Wang W … +3 more , Fu S, Fu Q, Fu S
BMC Cardiovasc Disord · 2026 Jun · PMID 42231193 · Full text
OBJECTIVE: Postoperative acute kidney injury (AKI) after cardiac surgery is a major complication that worsens patient outcomes and increases healthcare costs. This study aimed to investigate the association between intra...
OBJECTIVE: Postoperative acute kidney injury (AKI) after cardiac surgery is a major complication that worsens patient outcomes and increases healthcare costs. This study aimed to investigate the association between intrarenal venous flow (IRVF) and the risk of postoperative AKI, duration of mechanical ventilation, and intensive care unit (ICU) length of stay. METHODS: This prospective observational cohort study enrolled patients undergoing cardiopulmonary bypass (CPB) cardiac surgery at a provincial tertiary hospital in Zhejiang Province from 1 April 2022 to 31 March 2023. Clinical, laboratory and ultrasonographic data were collected. The primary outcome was AKI within 7 days after surgery; secondary outcomes were duration of mechanical ventilation and ICU length of stay. Covariates were selected using LASSO and Boruta algorithms. Multivariable logistic regression assessed the association between IRVF grade and AKI. Receiver operating characteristic (ROC) and calibration curves evaluated predictive performance, and sensitivity analyses tested the robustness of findings. Violin plots and bar charts compared ventilation duration and ICU stay across IRVF grades. RESULTS: Among the 240 patients included, 59 (24.6%) developed AKI after surgery. In multivariable analysis, IRVF grade was associated with postoperative AKI. After full adjustment, patients with IRVF grade 3 had 6.35 times higher odds of AKI than those with grade 1 (OR 6.35, 95% CI 2.37-17.02; P < 0.001). Sensitivity analyses confirmed the robustness of this association. The IRVF-based model showed modest discrimination (AUC 0.688, 95% CI 0.614-0.761) and acceptable calibration. AKI predominantly occurred in patients with IRVF grades 2 and 3. Patients with IRVF grade 3 had a significantly longer mean duration of mechanical ventilation. Mean ICU length of stay was longer for grades 2 and 3, although only the difference between grades 1 and 2 reached statistical significance. CONCLUSION: IRVF is associated with AKI following CPB cardiac surgery and correlates with prolonged mechanical ventilation and extended ICU length of stay. Bedside assessment of IRVF has the potential to serve as a useful tool for early risk stratification of postoperative AKI.
Correction: The effect of dapagliflozin on cardiorespiratory fitness in patients with coronary heart disease and type 2 diabetes mellitus following PCI: a single-center prospective randomized controlled study.
Yang J, Li X, Tang L … +11 more , Fan W, Li A, Zhou W, Pang J, Yuan Q, Zhong M, Hou J, Wang L, Liao W, Liu X, Cardiovascular B
BMC Cardiovasc Disord · 2026 Jun · PMID 42231188 · Full text
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Atypical de winter pattern preceding anterior STEMI: clinical judgement beyond rigid ECG criteria.
Oravský R, Novák M, Pokorný J … +1 more , Krejčí J
BMC Cardiovasc Disord · 2026 Jun · PMID 42231176 · Full text
BACKGROUND: The de Winter ECG pattern should raise strong suspicion for an unstable thrombotic culprit lesion associated with high-risk anterior ischemia requiring urgent expert evaluation - classically involving the pro...
BACKGROUND: The de Winter ECG pattern should raise strong suspicion for an unstable thrombotic culprit lesion associated with high-risk anterior ischemia requiring urgent expert evaluation - classically involving the proximal left anterior descending artery (LAD) - that frequently does not fulfil conventional ST-segment elevation criteria and is therefore regarded as a STEMI equivalent. CASE PRESENTATION: We report the case of an 85-year-old woman with sudden-onset chest pain radiating to both shoulders. The prehospital 12-lead ECG showed atypical de Winter pattern, prompting direct transport to a PCI-capable centre and administration of antiplatelet and anticoagulant therapy. On arrival, symptoms partially improved; however, repeat ECG evolved into typical anterior ST-segment elevation. Urgent coronary angiography demonstrated an 80% ostial LAD stenosis with thrombus, successfully treated with direct PCI and drug-eluting stent implantation. CONCLUSION: This case illustrates the dynamic nature of the de Winter-like pattern and underscores that early recognition of STEMI equivalents is crucial to minimise reperfusion delays. On the other hand, it should be emphasized that causality between this precise ECG phenotype and specific angiographic anatomy cannot be generalized from a single case report, atypical de Winter-like morphologies remain incompletely standardized, and broader prospective validation of atypical STEMI-equivalent phenotypes remains limited.
Recognizing red flags in genetic cardiomyopathy: the importance of genetic testing.
Gerges S, Chouairi S, Naoufal R
BMC Cardiovasc Disord · 2026 Jun · PMID 42231175 · Full text
BACKGROUND: Despite the known genetic pathogenic variants involved in dilated cardiomyopathy (DCM), clinical practice often considers genetic testing as a secondary step rather than a diagnostic priority. In this report,...
BACKGROUND: Despite the known genetic pathogenic variants involved in dilated cardiomyopathy (DCM), clinical practice often considers genetic testing as a secondary step rather than a diagnostic priority. In this report, we present a series of cases from our experience in Lebanon where the aggressive nature of specific genotypes, particularly Lamin A/C (LMNA) pathogenic genetic variants, was initially masked by the standard heart failure management. METHODS: The patients' medical records were reviewed for clinical presentation, disease progression and complications, as well as relevant diagnostic studies and genetic findings. The genetic analysis of the patients was performed through a comprehensive next-generation sequencing (NGS)-based multigene cardiac panel. CASES PRESENTATION: We describe the clinical presentations of three patients with genetic cardiomyopathies who rapidly progressed from conduction system diseases to life-threatening arrhythmias, a trajectory that might have been altered by earlier genetic identification. CONCLUSION: These cases highlight the importance of identifying "red flags" for genetic cardiomyopathies in the early disease stages. By sharing these findings, we aim to show that performing genetic evaluation early in the diagnostic process is a clinical necessity rather than a classification task since it is essential for managing patients and screening families to prevent avoidable mortality.
Association of dietary patterns with all-cause and cause-specific mortality in a high cardiovascular risk population in China.
Lv Y, Xie X, Liu Y … +3 more , Yin L, Yin L, Li X
BMC Cardiovasc Disord · 2026 Jun · PMID 42226134 · Full text
PURPOSE: This study investigated dietary patterns among populations at high risk for cardiovascular disease (CVD) in Hunan Province and examined their associations with mortality. METHODS: Data were obtained from the Chi...
PURPOSE: This study investigated dietary patterns among populations at high risk for cardiovascular disease (CVD) in Hunan Province and examined their associations with mortality. METHODS: Data were obtained from the China Health Evaluation and Risk Reduction through Nationwide Teamwork (ChinaHEART) project conducted between 2014 and 2023. A total of 46,239 individuals aged 35-75 years at high risk for CVD were included in the analysis. Major dietary patterns were identified using exploratory factor analysis with principal components analysis and Varimax rotation. Factor scores were calculated using the regression method. Each participant was then assigned to the dietary pattern with the highest score, and adherence to each pattern was further evaluated by quartiles of factor scores (Q1-Q4). Cox proportional hazards regression models were fitted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with sequential adjustment for demographic characteristics, lifestyle factors, and cardiometabolic conditions. RESULTS: During a median follow-up of 45 months (range: 3-81 months), 792 all-cause deaths were recorded among 46,239 participants. Compared with the "Rice Pattern", greater adherence to the "Meat, Eggs, and Fresh Vegetables Pattern" was associated with lower risks of all-cause mortality (HR = 0.64, 95% CI: 0.50-0.82; P < 0.001) and chronic cardiovascular disease mortality (HR = 0.44, 95% CI: 0.24-0.77; P < 0.01). Similar patterns of association were observed in subgroup analyses and were generally consistent in sensitivity analyses. CONCLUSION: These findings provide evidence-based support for dietary guidance in high-risk populations and have important implications for the prevention and management of cardiovascular disease.
Successful airway management via laryngeal mask airway for a child with CHARGE syndrome undergoing cardiac surgery: a case report.
Wang L, Jia Y, Wang R
BMC Cardiovasc Disord · 2026 Jun · PMID 42226127 · Full text
BACKGROUND: Airway abnormalities complicate the anesthesia management of patients with congenital heart disease. CASE PRESENTATION: The report described a case of CHARGE syndrome diagnosed in a 5-year-old girl with diffi...
BACKGROUND: Airway abnormalities complicate the anesthesia management of patients with congenital heart disease. CASE PRESENTATION: The report described a case of CHARGE syndrome diagnosed in a 5-year-old girl with difficult airway, in whom anesthesia was managed successfully using a laryngeal mask airway to undergo cardiac surgery with cardiopulmonary bypass. CONCLUSIONS: In carefully selected cases, laryngeal mask airway may serve as a rescue airway option for CHARGE syndrome patients undergoing cardiac surgery with cardiopulmonary bypass when tracheal intubation is not achievable, provided that thorough preoperative planning and comprehensive contingency measures are in place.
Associations of chronic pain and genetic risks with incident atrial fibrillation: a prospective cohort study.
Lou Z, Wang Y, Sun M … +11 more , Li G, Li J, Shi Y, Sun Z, Liu B, Zhao H, Ma Z, Han Q, He Q, Qiao S, Shen Y
BMC Cardiovasc Disord · 2026 Jun · PMID 42226125 · Full text
BACKGROUND: Current knowledge on whether chronic pain contributes to atrial fibrillation (AF) risk, especially under varying genetic susceptibilities, is limited. This study aimed to explore the association between chron...
BACKGROUND: Current knowledge on whether chronic pain contributes to atrial fibrillation (AF) risk, especially under varying genetic susceptibilities, is limited. This study aimed to explore the association between chronic pain and AF risk and assess the combined impact of chronic pain and genetic susceptibility to AF, as defined by polygenic risk scores (PRS), in the UK Biobank cohort. METHODS: We analyzed data from 290,345 UK Biobank participants who were initially AF-free. Based on pain duration and location, participants were categorized into four groups: no pain, short-term pain, chronic localized pain, and chronic widespread pain (CWP). Genetic susceptibility to AF was quantified using PRS, categorizing individuals into low, intermediate, and high genetic risk groups. Cox proportional hazard regression analyses were conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for assessing the risk of AF about chronic pain and genetic susceptibility. RESULTS: Over a median follow-up of 14.2 years, 19,998 participants (6.9%) developed AF. All pain categories were associated with a statistically significant increased risk of AF compared with the no pain category. Both chronic pain and higher PRS were independently associated with incident AF. Joint analyses revealed that, in the high genetic risk group, individuals with chronic localized pain and CWP had HRs of 3.52 (95% CI: 3.25-3.81) and 3.32 (95% CI: 2.71-4.08), respectively, compared to the low genetic risk and no pain group. CONCLUSIONS: Chronic pain and PRS were independently associated with an increased risk of AF, and individuals with combined exposures had the highest risk.
Defusing a ticking time bomb: percutaneous intervention for a giant coronary pseudoaneurysm - a case report.
Ahmad Hatib A, Ang AS, Low RJB
BMC Cardiovasc Disord · 2026 Jun · PMID 42226119 · Full text
BACKGROUND: Giant coronary pseudoaneurysms (PSAs) are extremely rare and typically managed surgically. Our case demonstrates an alternative approach with percutaneous intervention using covered stents. A 62-year-old male...
BACKGROUND: Giant coronary pseudoaneurysms (PSAs) are extremely rare and typically managed surgically. Our case demonstrates an alternative approach with percutaneous intervention using covered stents. A 62-year-old male underwent percutaneous coronary intervention (PCI) to the left main (LM) and left anterior descending (LAD) arteries for non-ST elevation myocardial infarction (NSTEMI) complicated by cardiogenic shock in the setting of concurrent Methicillin-Sensitive Staphylococcus Aureus (MSSA) bacteraemia. During the planned staged PCI to the right coronary artery (RCA), a relook angiogram of the left coronary system revealed a giant LM-LAD PSA with evidence of coronary steal phenomenon. The staged procedure was aborted to allow for further evaluation and characterisation of the PSA. This was done through multi-modality cardiac imaging including transthoracic echocardiography (TTE) and computed tomography coronary angiography (CTCA). After a HEART team discussion, it was decided that the PSA would be treated percutaneously. This was done successfully with intravascular ultrasound (IVUS) guidance and deployment of covered stents from the LM-LAD. Repeat TTE images on day 1 post procedure showed thrombi formation within the PSA cavity and the interval TTE done 3 months post procedure showed complete resolution of the PSA. The patient remained symptom free and tolerating regular dialysis sessions. He unfortunately declined repeat CTCA imaging in the interim. DISCUSSION: This showcases the importance of multi-modality imaging and a multidisciplinary approach in managing an unusual presentation of coronary PSA. The use of covered stents for treatment is feasible and allowed successful treatment of the giant PSA, avoiding potentially catastrophic complications. TAKE HOME MESSAGES: Coronary PSAs are rare and associated with fatal complications. This case highlights the successful treatment of a giant coronary PSA percutaneously using covered stents.
Expression profile of apolipoproteins (APOE) and endothelin-1 (ET-1) genes in ischemic heart disease.
Sharif S, Saqib M, Rafaqat S … +3 more , Anum L, Cojic M, Klisic A
BMC Cardiovasc Disord · 2026 Jun · PMID 42226116 · Full text
Ischemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide, characterized by atherosclerosis and functional alterations in coronary circulation. Endothelin (ET-1), a potent vasoconstrictor,...
Ischemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide, characterized by atherosclerosis and functional alterations in coronary circulation. Endothelin (ET-1), a potent vasoconstrictor, is implicated in coronary artery vasoconstriction, myocardial ischemia, and atherosclerosis through its mitogenic effects. The APOE is associated with increased LDL cholesterol, triglycerides, and heightened IHD risk. This study aimed to investigate the expression profiles of APOE and ET-1 genes and their association with IHD. A total of 200 samples were recruited, categorized into disease (n = 100) and control (n = 100) groups. RNA was extracted from the blood samples and after quantification of RNA by Nanodrop. cDNA was synthesized followed by expression analysis of APOE and ET -1 genes by Real Time PCR, followed by statistical analysis. The APOE and IHD gene expression was increased in IHD group. Linear regression analysis indicated that BMI is an important factor in the expression of APOE. Odds ratio analysis further supported a significant association of these genes with an increased likelihood of ischemic heart disease.
Triglyceride-glucose index and reduced kidney function in hypertensive Nigerian adults: independent association within the cardio-renal continuum.
Amadi CE, Akanbi PO, Okwah M … +2 more , Mbakwem AC, Ajuluchukwu JN
BMC Cardiovasc Disord · 2026 Jun · PMID 42226108 · Full text
BACKGROUND: Reduced kidney function is a major contributor to cardiovascular morbidity and mortality worldwide, particularly among individuals with hypertension. The triglyceride-glucose (TyG) index, a surrogate marker o...
BACKGROUND: Reduced kidney function is a major contributor to cardiovascular morbidity and mortality worldwide, particularly among individuals with hypertension. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has been associated with renal dysfunction in multiple populations; however, data from Sub-Saharan Africa remain limited. We examined the association between the TyG index and reduced kidney function among hypertensive Nigerian adults. METHODS: In this cross-sectional study, 1,470 consecutively presenting hypertensive adults aged ≥ 18 years at a cardiac center in Lagos, Nigeria (2009-2024) were analyzed. Individuals with known diabetes, fasting glucose ≥ 126 mg/dL, pregnancy, acute kidney injury, or incomplete data were excluded. Reduced kidney function was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² using the CKD-EPI 2021 race-free equation. The TyG index was analyzed as quartiles and as a standardized continuous variable. Multivariable logistic regression models were constructed. Sensitivity analyses included adjustment for HbA1c and exclusion of participants with HbA1c ≥ 6.5%. Restricted cubic spline and receiver operating characteristic analyses were performed. Estimated 10-year cardiovascular risk was calculated using the Framingham Risk Score. RESULTS: Reduced kidney function was present in 36.7% of participants. Compared with the lowest TyG index quartile, individuals in the highest quartile had higher odds of reduced kidney function (fully adjusted OR 3.14; 95% CI 2.25-4.39). Each 1-standard deviation increase in TyG index was associated with higher odds (adjusted OR 1.49; 95% CI 1.31-1.70). The association remained robust after adjustment for HbA1c and exclusion of participants with elevated HbA1c. Restricted cubic spline analysis demonstrated a log-linear relationship (p for non-linearity = 0.43). The TyG index showed modest discrimination (AUC 0.664). CONCLUSIONS: Higher TyG index values are independently associated with reduced kidney function in hypertensive Nigerian adults, supporting a graded relationship between metabolic dysfunction and renal impairment. The TyG index may serve as a simple adjunct tool for cardio-renal risk stratification in resource-limited settings.
Effects of different exercise modes on cardiopulmonary function in patients with coronary artery disease: a systematic review and meta-analysis.
Lu J, Liu D, Pi P … +4 more , Bai X, Yang J, Fu Y, Li W
BMC Cardiovasc Disord · 2026 May · PMID 42218418 · Full text
OBJECTIVE: Exercise interventions present advantageous outcomes for patients with Coronary Artery Disease (CAD). Nevertheless, there is a persistent discourse surrounding the optimal exercise modality, particularly in CT...
OBJECTIVE: Exercise interventions present advantageous outcomes for patients with Coronary Artery Disease (CAD). Nevertheless, there is a persistent discourse surrounding the optimal exercise modality, particularly in CTE. This research employed meta-analysis to identify the most effective exercises for improving cardiorespiratory fitness in CAD patients. METHODS: This systematic review comprehensively searched databases like Web of Science, PubMed, Embase, SPORTDiscus, Cochrane Library, CNKI, and Wanfang for RCTs on exercise interventions in CAD patients published from January 1, 2010, to December 31, 2023. Two researchers screened the literature and extracted data using predefined criteria. The included studies were then assessed for quality, subgroup analysis, sensitivity analysis, and publication bias evaluation. RESULTS: This study included 23 literatures with a total of 1,730 CAD patients. The evaluated exercise modalities comprised aerobic exercise (AE), high-intensity interval training (HIIT), aerobic combined with resistance exercise (AE&RE), Chinese traditional exercise (CTE), and aerobic combined with Chinese traditional exercise (AE&CTE). The results demonstrated that exercise intervention had a significant impact on various physiological parameters, including oxygen consumption peak (VO) (MD = 2.86, 95%CI: 2.00 ~ 3.73, P < 0.001), oxygen pulse (O) (MD = 1.55, 95%CI: 0.57 ~ 2.53, P < 0.01), left ventricular ejection fraction (LVEF) (MD = 3.56, 95%CI: 1.61 ~ 5.52, P < 0.01), and anaerobic threshold (AT) (MD = 2.00, 95%CI: 1.16 ~ 2.84, P < 0.01), with significant improvements observed. Subgroup analysis found that all exercise modalities (AE&CTE, HIIT, AE&RE, and AE) were associated with significant improvements in VO, with AE&CTE (MD = 3.62) and HIIT (MD = 3.60) showing numerically larger effect sizes, followed by AE&RE (MD = 2.67) and AE (MD = 2.59). LVEF improvements were observed across AE&RE (MD = 2.49) and AE subgroups (MD = 3.05), while O showed increase in the AE&CTE (MD = 2.16) and AE&RE subgroups (MD = 1.03). For AT, AE&RE (MD = 2.03) demonstrated notable improvements. CONCLUSIONS: Exercise intervention significantly improves VO, O, LVEF, and AT in patients with CAD. Numerically larger effect estimates were observed for AE&CTE and HIIT on VO, for AE&CTE and AE&RE on O, and for AE&RE on LVEF and AT. In clinical or rehabilitation settings, exercise prescriptions should be tailored to the individual patient's specific functional deficits and therapeutic objectives.
Differential effects of calcium channel blockers combined with various opioids on length of stay in hypertensive cardiac surgery patients: analysis of the MIMIC-IV database.
Li X, Liu H, Lin Q … +1 more , Zhang Y
BMC Cardiovasc Disord · 2026 May · PMID 42218372 · Full text
OBJECTIVE: The co-administration of calcium channel blockers (CCB) and opioids is common in hypertensive patients undergoing cardiac surgery. This study aimed to investigate the association between combinations of CCB wi...
OBJECTIVE: The co-administration of calcium channel blockers (CCB) and opioids is common in hypertensive patients undergoing cardiac surgery. This study aimed to investigate the association between combinations of CCB with different opioids and length of stay (LOS) in this population. METHODS: This retrospective study included 2,093 hypertensive adult patients who underwent cardiac surgery, drawn from the MIMIC-IV database. Potential covariates were systematically screened through univariate logistic regression and LASSO regression. Subsequently, generalized linear model (GLM) and multivariable logistic regression analyses were employed to evaluate the association between different CCB-opioids combinations and LOS. To further explore heterogeneity, subgroup analyses and interaction analyses were conducted. RESULTS: GLM revealed that the concomitant use of CCB with morphine (β = 4.354, 95%CI: 2.535-6.173), oxycodone (β = 2.418, 95%CI: 0.943-3.893), and tramadol (β = 2.382, 95%CI: 1.340-3.427) was significantly associated with prolonged LOS compared to CCB use alone. Notably, among these three opioid drugs, the CCB-oxycodone combination showed a robust association with prolonged hospital stay across the majority of adjusted logistic regression models. Subgroup analyses identified significant interaction effects (P for interaction < 0.001), showing that the association between CCB-oxycodone and extending LOS was substantially stronger in patients undergoing valve surgery and those with a CCI score > 5. CONCLUSION: Co-administration of CCB and oxycodone is robustly associated with prolonged LOS in hypertensive cardiac surgery patients. These findings highlight the necessity of individualized analgesic strategies to mitigate drug interaction risks.
Prevalence and characteristics of coronary anomalies in Bulgarian patients undergoing coronary angiography.
Grigorov R, Yambolov S, Borisov I … +2 more , Nikolov N, Georgiev S
BMC Cardiovasc Disord · 2026 May · PMID 42216177 · Full text
BACKGROUND: Coronary artery anomalies (CAAs) are rare congenital abnormalities with variable reported prevalence. Data from Eastern Europe remain limited. This study assessed the prevalence and characteristics of CAAs in...
BACKGROUND: Coronary artery anomalies (CAAs) are rare congenital abnormalities with variable reported prevalence. Data from Eastern Europe remain limited. This study assessed the prevalence and characteristics of CAAs in a large Bulgarian angiographic cohort. METHODS: We retrospectively analyzed 9 567 consecutive patients who underwent diagnostic coronary angiography between January 2014 and July 2025 at a single tertiary center. CAAs were classified according to the Angelini system into anomalies of origin and course, intrinsic anomalies and anomalies of termination. Prevalence was calculated both including and excluding myocardial bridges and commonly considered benign anatomical variants. RESULTS: Overall, 530 anomalies were identified (5.5%), including 396 myocardial bridges (4.1%). After exclusion of myocardial bridges and anatomical variants, 83 patients had true CAAs (0.87%). Anomalies of origin and course predominated (63.9%), most commonly involving anomalous origin of the left circumflex artery from the right coronary sinus or right coronary artery (0.32% of the population). Coronary fistulae accounted for 36.1% of anomalies (0.31%). High-risk, Rigatelli class III anomalies were uncommon (9.6%). CONCLUSION: The prevalence and distribution of CAAs in this Bulgarian cohort are consistent with international data. As shown in previous studies, the reported prevalence was strongly influenced by the classification system applied and by the inclusion or exclusion of myocardial bridges and selected anatomical variants, underscoring the need for standardized definitions in future research.
C-reactive protein-to-albumin ratio and the mortality of patients with heart failure: a meta-analysis.
Wang Y, Yuan Z
BMC Cardiovasc Disord · 2026 May · PMID 42216136 · Full text
BACKGROUND: The C-reactive protein-to-albumin ratio (CAR) reflects the interplay between systemic inflammation and nutritional status, and has recently been proposed as a prognostic biomarker in heart failure (HF). Howev...
BACKGROUND: The C-reactive protein-to-albumin ratio (CAR) reflects the interplay between systemic inflammation and nutritional status, and has recently been proposed as a prognostic biomarker in heart failure (HF). However, its association with mortality risk across acute decompensated HF (ADHF) and chronic HF (CHF) populations remains uncertain. This meta-analysis evaluated the relationship between baseline CAR and all-cause mortality in HF. METHODS: PubMed, Embase, Web of Science, CNKI, and Wanfang were searched for relevant longitudinal studies. Risk ratios (RRs) were pooled using a random-effects model accounting for heterogeneity. Prespecified subgroup and meta-regression analyses were performed to evaluate the influence of study characteristics. RESULTS: Twelve cohort studies involving 6,377 patients were included. High CAR was associated with a significantly increased risk of mortality (RR = 2.34, 95% CI 1.86-2.93), with moderate heterogeneity (I² = 66%). Notably, the association was weaker in prospective studies (RR = 1.45) compared with retrospective studies (RR = 2.50). Subgroup findings were consistent across regions (Asian: RR = 2.62; Western: RR = 1.87), HF phenotype (ADHF: RR = 2.15; CHF: RR = 2.47), age (< 65 years: RR = 2.36; ≥65 years: RR = 2.33), CAR cutoff (< 0.5 mg/g: RR = 2.60; ≥0.5 mg/g: RR = 2.16), follow-up duration (< 30 months: RR = 2.20; ≥30 months: RR = 2.45), and analytic model (univariate: RR = 2.71; multivariate: RR = 1.99). Meta-regression identified no significant moderators. CONCLUSIONS: Elevated baseline CAR is consistently associated with higher mortality risk in patients with HF. However, the strength of this association appears lower in prospective studies, suggesting that the overall pooled estimate may be influenced by biases inherent to retrospective designs. In addition, the clinical utility of CAR for risk stratification of patients with HF requires further validation in well-designed prospective studies.
Association of plasma ADMA, FABP4 levels, and AIP with increased cardiovascular disease risk in Graves' disease: an exploratory pilot study.
Bulbul N, Yilmaz MO, Oguzman H … +1 more , Dogan S
BMC Cardiovasc Disord · 2026 May · PMID 42216133 · Full text
BACKGROUND: Graves' disease is an autoimmune disorder characterized by hyperthyroidism and is often associated with diffuse goiter, Graves' ophthalmopathy, antithyroid peroxidase antibodies, TSH receptor antibodies, and...
BACKGROUND: Graves' disease is an autoimmune disorder characterized by hyperthyroidism and is often associated with diffuse goiter, Graves' ophthalmopathy, antithyroid peroxidase antibodies, TSH receptor antibodies, and high serum thyroxine (T4) and triiodothyronine (T3) levels. Hyperthyroidism causes changes in the cardiovascular system that can be explained by the direct effects of thyroid hormones on vascular smooth muscle cells and cardiomyocytes. On the one hand, heart rate, myocardial contractility, preload, blood volume, and tissue thermogenesis increase, while on the other hand, afterload and systemic vascular resistance decrease. OBJECTIVES: The aim of this exploratory pilot study was to investigate cardiovascular disease risk in patients with Graves' disease by evaluating the relationship between thyroid hormone levels and plasma Asymmetric Dimethylarginine (ADMA), Fatty Acid-Binding Protein 4 (FABP4), Atherogenic Index of Plasma (AIP), and Castelli Risk Index (CRI). METHODS: This study was designed as a cross-sectional study between January 2023 and January 2024 at the Endocrinology and Metabolism Department of Adana City Training and Research Hospital. The study included 30 newly diagnosed patients with Graves' disease, aged 18-65 years, who were recruited from the clinic. The diagnosis was confirmed clinically, biochemically, and through sonographic evaluation. As a control group, 30 euthyroid individuals aged 18-65 years, without thyroid disease, cardiac disease, hypertension, diabetes, or impaired glucose tolerance were selected. Demographic data, including age and gender, were recorded, and Body Mass Index (BMI) was calculated. Blood samples were collected to measure routine parameters such as Thyroid-Stimulating Hormone (TSH), Free Triiodothyronine (fT3), Free Thyroxine (fT4), Thyroid Receptor Antibodies (TRAB), Glucose, Blood Urea Nitrogen (BUN), Creatinine, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), HDL, LDL, Total Cholesterol, and Triglycerides. In addition, the levels of ADMA and FABP4 were analyzed. The Atherogenic Index of Plasma (AIP) and Castelli Risk Index (CRI) were calculated. RESULTS: FABP4 levels were significantly higher in patients compared with the control group (10.03 ± 1.63 vs. 8.99 ± 1.24, p = 0.009). ADMA was significantly correlated with BMI (r = 0.402, p = 0.019), CRP (r = 0.479, p = 0.001), BUN (r = 0.462, p = 0.003), LDL (r = 0.443, p = 0.012), Total Cholesterol (r = 0.508, p = 0.004), and fT4 (r = 0.455, p = 0.005). Notably, ADMA had a strong positive correlation with FABP4 (r = 0.531, p < 0.001), CRI (r = 0.622, p < 0.001), and AIP (r = 0.642, p < 0.001). FABP4 was positively correlated with BMI (r = 0.514, p = 0.002), glucose (r = 0.577, p < 0.001), and TG (r = 0.614, p < 0.001). CRI was positively correlated with gender (Male) (r = 0.548, p = 0.003), BMI (r = 0.621, p < 0.001), glucose (r = 0.578, p < 0.001), and triglycerides (r = 0.949, p < 0.001). AIP showed a strong positive correlation with TG (r = 0.949, p < 0.001), BMI (r = 0.612, p < 0.001), Glucose (r = 0.576, p < 0.001), and Gender (Male) (r = 0.548, p = 0.003). ADMA demonstrated low discriminatory performance AUC of 0.614, with a cut-off value of > 132.9. It had a sensitivity and specificity of 75%, but the p-value was not significant (p = 0.145). FABP4 had a cut-off of > 8.47, with a sensitivity of 86% and specificity of 68% (AUC: 0.690, 95% CI: 0.551-0.829, p = 0.015). CRI had a cut-off value of > 3.27, with a sensitivity of 60% and specificity of 79% (AUC: 0.726, 95% CI: 0.620-0.832, p = 0.001). AIP showed a cut-off value of > 0.66, with sensitivity of 59% and specificity of 73% (AUC: 0.695, 95% CI: 0.587-0.803, p = 0.001). CONCLUSION: The findings suggest that biomarkers like FABP4, AIP, and CRI may provide insights into cardiovascular risk assessment in Graves' disease. However, further studies with larger cohorts are needed to validate these associations.
Endovascular repair for complicated Azzizadeh Grade III blunt traumatic aortic injury: a single-center cohort study of thoracic injuries with a separate abdominal subgroup.
Hou C, Xu Z, Wang C
BMC Cardiovasc Disord · 2026 May · PMID 42216132 · Full text
BACKGROUND: The optimal management of Azzizadeh Grade III blunt traumatic aortic injury (BTAI) is debated, with a clinical dilemma persisting particularly for hemodynamically stable patients. This study evaluates a risk-...
BACKGROUND: The optimal management of Azzizadeh Grade III blunt traumatic aortic injury (BTAI) is debated, with a clinical dilemma persisting particularly for hemodynamically stable patients. This study evaluates a risk-stratified protocol guiding intervention versus surveillance in a cohort that included both stable and unstable patients. METHODS: We retrospectively analyzed consecutive patients with Grade III BTAI (2014-2023) managed per a multidisciplinary protocol: thoracic endovascular aortic repair (TEVAR) for complicated thoracic injuries, and endovascular aortic repair (EVAR) for complicated abdominal injuries; surveillance for uncomplicated ones. Thoracic and abdominal injuries were analyzed separately. Hemodynamic stability was defined as systolic blood pressure ≥ 90 mmHg without vasopressor support. RESULTS: Among 36 patients (mean age 53.7 ± 16.3 years, 83.3% male), 30 had thoracic aortic injuries and 6 had isolated abdominal aortic injuries. Twelve patients (33.3%) were hemodynamically unstable on presentation, all of whom underwent urgent endovascular repair. Of the 30 thoracic injuries, 27 (90.0%) underwent TEVAR with 100% technical success and 96.3% 30-day survival; three patients did not immediately undergo TEVAR: two were planned for urgent repair but died preoperatively from overwhelming polytrauma, and only one highly selected patient was managed with non-operative surveillance and remained stable at 24 months. All 6 abdominal injuries underwent EVAR with 100% survival. 30-day overall survival was 91.7% (33/36). A thoracic "triad" (rib fracture, lung contusion, myocardial injury) was observed in 73.3% of thoracic cases. This finding represents a purely descriptive observation; because no trauma control group was included, the triad cannot be used for diagnosis, screening, or risk prediction. CONCLUSION: TEVAR/EVAR is safe and effective for the majority of Grade III BTAI with complicating features, achieving 96.3% 30-day survival in our thoracic cohort. Non-operative management was employed in only one highly selected patient, who remained stable at 24 months; two other patients who were planned for urgent TEVAR died preoperatively from polytrauma. This study cannot evaluate the safety, feasibility, or selection criteria for non-operative management of Grade III BTAI. Thus, although surveillance has been reported in isolated cases, this approach remains unvalidated and should not be broadly applied based on current evidence. The thoracic "triad" should prompt consideration of aortic imaging.
Comparison of cardiac computed tomography and transesophageal echocardiography for left atrial appendage thrombus detection.
Ateş AH, Zakariyayev S, Çöteli C … +8 more , Karakulak UN, Doğan M, Basarir HB, Ardalı S, Yorgun H, Özer N, Hazırolan T, Aytemir K
BMC Cardiovasc Disord · 2026 May · PMID 42216113 · Full text
BACKGROUND AND OBJECTIVE: Pulmonary vein isolation (PVI) is a common intervention for symptomatic atrial fibrillation (AF). Transesophageal echocardiography (TEE) and cardiac computed tomography (CCT) are commonly used p...
BACKGROUND AND OBJECTIVE: Pulmonary vein isolation (PVI) is a common intervention for symptomatic atrial fibrillation (AF). Transesophageal echocardiography (TEE) and cardiac computed tomography (CCT) are commonly used pre-PVI to assess left atrial (LA) and left atrial appendage (LAA) thrombus and visualize LA and pulmonary vein anatomy. This retrospective study aims to compare CCT and TEE in detecting LAA thrombus in patients with symptomatic paroxysmal or persistent AF scheduled for PVI. METHODS: Seven hundred five patients underwent routine TEE and CCT within 24 h. Patients with prior LAA thrombus, cardioembolic stroke, or contraindications to TEE were excluded. The presence or absence of LAA thrombus and other potential thrombus-inducing factors were evaluated using TEE and CCT, and the diagnostic performance of the two imaging modalities was compared. RESULTS: Most patients had paroxysmal AF (54.2%) and a high CHA₂DS₂-VASc score (47.6%). TEE detected LAA thrombus in 1.8%, while 7% had SEC without thrombus. Cardiac CT scans showed LAA filling defects in 17.2%. Using TEE as the reference, CCT demonstrated high sensitivity (92.3%) and negative predictive value (99.8%), but low specificity (84.2%) and positive predictive value (9.9%) for LAA thrombus detection. CONCLUSION: The study supports CCT as a reliable imaging method for excluding LAA thrombus in AF patients scheduled for PVI. In cases where CCT shows no thrombus and adequate anticoagulation is ensured, catheter ablation and DCCV procedures can be safely considered.
Nomogram prediction of acute kidney injury following modified Morrow myectomy in hypertrophic obstructive cardiomyopathy: insights from 12 years of outcomes.
Zeng X, Liang Y, Wu Y … +10 more , Wu H, Wang R, Huang P, Xu X, Zeng Y, Huang M, Song X, Chen J, Lei L, Guo H
BMC Cardiovasc Disord · 2026 May · PMID 42215887 · Full text
OBJECTIVE: This study explored the incidence and risk factors of acute kidney injury (AKI) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing modified Morrow septal myectomy and developed a risk p...
OBJECTIVE: This study explored the incidence and risk factors of acute kidney injury (AKI) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing modified Morrow septal myectomy and developed a risk prediction model to optimize perioperative management. METHODS: A retrospective cohort of HOCM patients who underwent modified Morrow procedure between 2012 and 2024 was analyzed. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and patients were grouped into AKI and non-AKI cohorts. Univariate analysis followed by binary logistic regression identified independent predictors of AKI, which informed the development of a nomogram-based prediction model. Model performance was assessed using the concordance index (C-index), calibration curves, and decision curve analysis. RESULTS: Among 270 patients, 54 (20%) developed AKI, including 24, 12, and 18 patients classified as stage 1, stage 2, and stage 3 respectively, with 15 requiring hemodialysis. Independent predictors included preoperative creatinine (OR = 1.069, P < 0.001), postoperative 48-h alanine aminotransferase (ALT) (OR = 1.001, P = 0.021), total bilirubin (TBIL) (OR = 1.036, P = 0.015), pulmonary infection (OR = 9.432, P < 0.001), and red blood cell transfusion (OR = 1.246, P = 0.002). The logistic model achieved 81.13% sensitivity, 87.91% specificity, and an AUC of 0.904 (95% CI: 0.862 ~ 0.936). The nomogram showed excellent accuracy, with a C-index of 0.890. CONCLUSION: AKI is a frequent and severe complication after modified Morrow myectomy in HOCM. Identifying high-risk patients and addressing modifiable factors may improve perioperative management and outcomes.
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