Reviews In Cardiovascular Medicine[JOURNAL]
Sun
200 papers
Malnutrition Severity Drives Mortality in Geriatric Heart Failure: A Multicenter Extreme Gradient Boosting Analysis.
Chen Y, He M, He M … +2 more , Yuan Z, Chen X
Rev Cardiovasc Med · 2026 May · PMID 42238633 · Full text
BACKGROUND: Heart failure (HF) and malnutrition frequently coexist in older patients (≥65 years) and are major determinants of in-hospital mortality. However, predictive models specifically addressing this high-risk popu...
BACKGROUND: Heart failure (HF) and malnutrition frequently coexist in older patients (≥65 years) and are major determinants of in-hospital mortality. However, predictive models specifically addressing this high-risk population remain limited. Therefore, this study aimed to develop and validate a personalized machine learning model to assess key risk factors. METHODS: This study was a multicenter retrospective investigation that collected clinical data from older patients with HF and malnutrition admitted to two Chinese tertiary hospitals. Key predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, followed by development of an extreme gradient boosting (XGBoost) model. Model performance was assessed using receiver operating characteristic (ROC) curve analysis, accuracy, sensitivity, specificity, and F1 score. Shapley additive explanation (SHAP) analysis was applied to provide interpretable feature importance. Moreover, the robustness of the model was externally validated in an independent cohort. RESULTS: The final analysis included 1080 older patients with HF and malnutrition, among whom 244 experienced in-hospital mortality, yielding an in-hospital mortality rate of 22.6%. The XGBoost model achieved high area under the curve (AUC) values (training: 0.979, 95% confidence interval (CI): 0.969-0.990; validation: 0.890, 95% CI: 0.844-0.937; test: 0.936, 95% CI: 0.899-0.974). SHAP analysis highlighted the Geriatric Nutritional Risk Index (GNRI) as the primary predictive factor, with secondary contributions from inflammatory profiles and traditional cardiorenal and electrolyte markers. CONCLUSIONS: The constructed XGBoost model demonstrated robust predictive performance. The SHAP analysis provided a clear visualization of key risk factors, thereby providing a valuable reference for clinical risk assessment.
Gender-Specific Associations Between Sex Hormones and Cardiovascular Disease: A Systematic Review and Meta-Analysis.
Wang W, Zhu L, Qi M … +1 more , Yu J
Rev Cardiovasc Med · 2026 May · PMID 42238632 · Full text
BACKGROUND: Sex hormones play a critical role in the development of cardiovascular disease (CVD); however, the associations between specific circulating sex hormones and cardiovascular outcomes differ by sex, and the evi...
BACKGROUND: Sex hormones play a critical role in the development of cardiovascular disease (CVD); however, the associations between specific circulating sex hormones and cardiovascular outcomes differ by sex, and the evidence remains inconclusive. METHODS: A systematic review and meta-analysis of 23 prospective cohort studies was conducted to examine the associations between sex hormones and cardiovascular outcomes. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted, and random- or fixed-effects models were applied based on heterogeneity. Subgroup analyses were performed by hormone type, age, and sex. RESULTS: In men, higher total testosterone (TT) levels were associated with a reduced risk of CVD. No consistent associations were found between sex hormone-binding globulin (SHBG), calculated free testosterone (cFT), and estradiol with CVD. In women, elevated TT and cFT were linked to increased CVD risk. Estradiol exhibited a modest and uncertain protective effect. An outcome-specific analysis revealed that higher dehydroepiandrosterone (DHEA) levels were linked to an increased risk of heart failure, while SHBG was associated with reduced cardiovascular mortality. Conversely, higher estradiol concentrations correlated with increased cardiovascular mortality. CONCLUSIONS: Sex hormones exert complex, sex-specific, and outcome-dependent effects on cardiovascular risk. In men, higher testosterone levels are associated with lower overall CVD risk, whereas in women, these levels are linked to higher CVD and heart failure risk. Estradiol demonstrated a protective trend against major adverse cardiovascular events (MACEs), yet was linked to increased cardiovascular mortality. Higher SHBG levels are associated with lower cardiovascular mortality, whereas higher DHEA levels correlate with increased heart failure risk. Together, these findings underscore the importance of integrating sex, age, and endocrine context into cardiovascular risk stratification and prevention strategies. THE PROSPERO REGISTRATION: CRD42024551055, Registration Link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024551055.
Type 1 Diabetes and Cardiovascular Risk: The Current Management Strategies.
Manoj RJ, Aravind A, Fernandez CJ … +1 more , Pappachan JM
Rev Cardiovasc Med · 2026 May · PMID 42238631 · Full text
Cardiovascular disease (CVD) is the most common cause of morbidity and excess mortality in patients with diabetes. However, CVD risk varies across the different forms of diabetes mellitus owing to underlying pathobiologi...
Cardiovascular disease (CVD) is the most common cause of morbidity and excess mortality in patients with diabetes. However, CVD risk varies across the different forms of diabetes mellitus owing to underlying pathobiological mechanisms. In the asymptomatic phase of prediabetes and early stages of type 2 diabetes mellitus (T2DM)-the most common form of diabetes-CVD may already be established; meanwhile, the first diagnosis of T2DM in some patients may be established only when the patients are evaluated for risk factors contributing to CVD. In contrast, type 1 diabetes mellitus (T1DM) typically presents with symptoms at the disease onset and is usually associated with a low prevalence and risk for CVD at the time of diagnosis. With good metabolic control, the CVD risk in patients with T1DM can be mitigated to some extent. While the pathophysiology and prognosis of CVD among patients with T2DM have been extensively studied and are well characterized, important uncertainties remain regarding these aspects in patients with T1DM. This clinical update review compiles the current evidence base for the evaluation and management of CVD in patients with T1DM.
Efficacy and Safety of Inclisiran-An Assessment of the Consistency Between Randomized Controlled Trials and Real-World Evidence: A Systematic Review.
Lin Y, Wang H, Yang H … +1 more , Li Z
Rev Cardiovasc Med · 2026 May · PMID 42238630 · Full text
BACKGROUND: This study aimed to compare the consistency in low-density lipoprotein cholesterol (LDL-C) reduction and the safety profile of the novel lipid-lowering agent inclisiran between randomized controlled trials (R...
BACKGROUND: This study aimed to compare the consistency in low-density lipoprotein cholesterol (LDL-C) reduction and the safety profile of the novel lipid-lowering agent inclisiran between randomized controlled trials (RCTs) and real-world evidence (RWE). METHODS: A systematic search of the PubMed, Embase, and Web of Science databases (2022-2025) identified three RCTs (n = 1833) and five RWE studies (n = 805). LDL-C reduction in the RCTs at 540 days was compared with that observed at 90 days in the RWE studies. Subgroup analyses were performed for patients with and without diabetes. RESULTS: Four of the five RWE studies showed complete overlap of confidence intervals with the RCT results. Weighted regression analysis demonstrated a strong positive association between the reduction in LDL-C reported in the RCTs and RWE studies (R = 0.774; = 0.004). The diabetic subgroup exhibited significantly greater LDL-C reduction than the overall RWE population ( = 0.003), with absolute differences ranging from 2.3% to 4.8% compared with corresponding RCTs. Safety profiles were comparable across study types, with differences in adverse event incidence of less than 5%. Injection-site reactions were the most frequently reported adverse events. CONCLUSION: Inclisiran demonstrated highly consistent LDL-C-lowering efficacy and a comparable safety profile across both RCTs and real-world settings. THE PROSPERO REGISTRATION: CRD42024618982, URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024618982.
General Anaesthesia Versus Conscious Sedation in Transcatheter Aortic Valve Implantation: Differences in Pulmonary Infections.
Bergmann A, Warkentin H, Hildebrandt F … +7 more , Fliegenschmidt J, Hulde N, Rudolph T, Scholtz S, Piper C, Bleiziffer S, von Dossow V
Rev Cardiovasc Med · 2026 May · PMID 42238629 · Full text
BACKGROUND: Patients undergoing transfemoral aortic valve replacement are particularly vulnerable and require a more sophisticated anesthetic therapeutic approach. According to the literature, no study has directly compa...
BACKGROUND: Patients undergoing transfemoral aortic valve replacement are particularly vulnerable and require a more sophisticated anesthetic therapeutic approach. According to the literature, no study has directly compared general anaesthesia with conscious analgosedation using postoperative infections as the primary endpoint. METHODS: Patients undergoing transcatheter aortic valve implantation (TAVI) were analyzed retrospectively. A total of 3313 patients from a large heart center in Western Europe were included in this study. One group received general anaesthesia, and the other group received analgosedation for TAVI. The primary outcome was postinterventional pneumonia; secondary outcomes included myocardial infarction, renal failure, stroke, and 30-day mortality. Propensity score matching using 16 matching criteria yielded over 1000 pairs. RESULTS: No difference was observed in the incidence of postinterventional pneumonia ( = 0.148). The occurrence of myocardial infarction ( = 0.2) and stroke ( = 0.4) also did not differ significantly between the two groups. In contrast, the need for transient renal replacement therapy ( = 0.02) and 30-day mortality ( = 0.02) were lower in the analgosedation group. CONCLUSIONS: Regarding postinterventional pneumonia, general anaesthesia can be used as safely as analgosedation during TAVI. However, since renal failure requiring temporary replacement therapy and mortality are both increased with general anaesthesia, analgosedation should be the standard of care for TAVI in high-volume centers. The anesthetic regimen must be determined on an individual basis and discussed during the heart team briefing. The conversion to, or primary use of, general anaesthesia when clinically indicated is safe. Overall, ensuring the continuous presence of a senior consultant anesthetist, specifically trained in cardiac anaesthesia, throughout the procedure is essential.
Cardiac Structural and Functional Evaluation Using a Heart Motion Correction Algorithm for Coronary Computed Tomography Angiography in Patients With High Heart Rates.
Chen X, Dong Y, Sun A … +7 more , Xu H, Ge X, Wu R, Ying S, Zhang X, Yuan J, Pan J
Rev Cardiovasc Med · 2026 May · PMID 42238628 · Full text
BACKGROUND: The heart motion correction algorithm used in current multi-slice computed tomography (CT) is sufficient for coronary artery imaging in patients with high heart rates. However, the effect of this algorithm on...
BACKGROUND: The heart motion correction algorithm used in current multi-slice computed tomography (CT) is sufficient for coronary artery imaging in patients with high heart rates. However, the effect of this algorithm on the image quality in whole-cardiac-cycle reconstructions remains unclear. Therefore, this study aimed to investigate image quality, segmentation performance, and cardiac structure and function assessment using a heart motion correction algorithm for coronary CT angiography in patients with rapid heart rates. METHODS: This study retrospectively collected data from 58 consecutive patients with high heart rates (≥80 beats/min), of whom 36 also underwent cardiac magnetic resonance (CMR) imaging. CT images were reconstructed from 0% to 100% in 5% increments using the standard reconstruction (STD) and second-generation snapshot freeze (SSF2) protocols, and then processed by an automatic heart segmentation algorithm. Image quality, segmentation performance, cardiac volumes, and functional parameters were compared between protocols. RESULTS: Compared with the STD protocol, the SSF2 protocol yielded a higher image quality score (3.91 ± 0.29 vs. 3.84 ± 0.37; < 0.01), a steeper edge rise slope (41.71 ± 19.03 vs. 25.59 ± 13.16; < 0.01), and lower entropy (4.12 ± 0.48 vs. 4.40 ± 0.28; < 0.01). For left ventricular end-diastolic volume, the intraclass correlation coefficient (ICC) between automatic segmentation and manual contouring for the SSF2 protocol was 0.96, and the coefficient of variation was 7.84%. In contrast, the coefficients of variation for left ventricular end-systolic volume were poor (48.24% for STD and 48.18% for SSF2). Differences in global circumferential strain (-13.30 ± 3.42 vs. -15.01 ± 4.44; < 0.01) and global longitudinal strain (-11.80 ± 4.83 vs. -13.01 ± 4.36; < 0.01) between SSF2 and CMR were statistically significant, although correlations (ICC = 0.90 and 0.85, respectively) were good. CONCLUSIONS: SSF2 significantly improves image quality, structure, and function, and enables strain assessment in whole-cardiac-cycle reconstructions in patients with high heart rates. SSF2 also demonstrates superior performance over the STD protocol for evaluating myocardial strain.
Sodium-Glucose Cotransporter 2 Inhibitors Shorten Echocardiography-Derived Total Atrial Conduction Time in Patients With Type 2 Diabetes Mellitus: A Prospective Pilot Study.
Taştan E, Kayan F, Beskisiz S
Rev Cardiovasc Med · 2026 May · PMID 42238627 · Full text
BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). Structural and electrical atrial remodeling are among th...
BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). Structural and electrical atrial remodeling are among the myocardial alterations associated with diabetes. Total atrial conduction time (TACT), derived from echocardiography, serves as a marker of atrial remodeling. However, the effect of SGLT2i on TACT remains unclear. METHODS: In this prospective, single-center pilot study, 130 patients with T2DM and preserved left ventricular ejection fraction were enrolled between March and December 2022. After excluding patients who discontinued therapy or met other exclusion criteria, 107 patients (57 treated with dapagliflozin and 50 with empagliflozin) were included in the analysis. Echocardiographic and laboratory evaluations were performed at baseline and six months after initiation of SGLT2i therapy. TACT was defined as the mean time between the onset of the P wave in lead II and the peak A' wave on tissue Doppler imaging (PA-TDI). Paired statistical tests, correlation analyses, and multiple linear regression were used to identify independent predictors of Δ TACT. RESULTS: After six months of SGLT2i therapy, significant reductions were observed in blood pressure, lipid levels, glycated hemoglobin (HbA1c), and body mass index values (all < 0.05). Moreover, echocardiography demonstrated significant decreases in the E/e' ratios and mean PA-TDI duration ( < 0.001). The Δ lateral E/e' ratio and Δ body mass index (BMI) values were independently associated with Δ TACT ( = 0.001 and = 0.026, respectively). The mean duration of SGLT2i use was 183 days. CONCLUSIONS: SGLT2i therapy was associated with a significant reduction in TACT among T2DM patients, suggesting potential improvements in atrial remodeling and diastolic function. These findings support the hypothesis that the cardiovascular benefits of SGLT2i may extend to atrial conduction properties. Nonetheless, larger randomized studies are warranted to confirm these observations.
Pathological Structural Alterations of Serous Cell Cilia in the Parietal Pericardium of Patients With Heart Failure Induced by Dilated Cardiomyopathy.
Liu Y, Xu Y, Chen Y … +5 more , Yu Y, Liu Z, Zhang X, Yang B, Guo Z
Rev Cardiovasc Med · 2026 May · PMID 42238626 · Full text
BACKGROUND: This study aimed to examine pathological surface structural changes in serous cells of the pericardial parietal layer in patients with heart failure due to dilated cardiomyopathy. METHODS: Pericardial tissues...
BACKGROUND: This study aimed to examine pathological surface structural changes in serous cells of the pericardial parietal layer in patients with heart failure due to dilated cardiomyopathy. METHODS: Pericardial tissues from five patients with dilated cardiomyopathy-induced heart failure (case group) and two heart donors (control group) were analyzed using histological methods, scanning electron microscopy (SEM), transmission electron microscopy (TEM), and immunofluorescence. RESULTS: In both groups, mesothelial cells in the parietal pericardium were classified as flat, oval, or short columnar, typically forming a single layer, occasionally multiple layers. Most cells exhibited a brush-like border on the surface facing the pericardial cavity. A layer of flattened fibroblasts was observed beneath the basement membrane. Polygonal cells extended protrusions to contact adjacent cells. Mesothelial cells were further divided into ciliated and non-ciliated types. Most cells displayed numerous typical cilia on their surface, whereas non-ciliated cells extended processes that spanned one or more cells to connect with distant cells. TEM revealed that most ciliated mesothelial cells had uniformly arranged cilia, with visible microtubules in some. Tight junctions, intermediate junctions, and desmosomes were present along the lateral surfaces of mesothelial cells, and the basement membrane appeared uniform. Compared with normal pericardial mesothelium, mesothelial cells from patients exhibited increased numbers of cilia, ciliary edema, microtubule dissolution within cilia, and elevated expression of β-tubulin. CONCLUSIONS: Abundant cilia are present on the surface of mesothelial cells in the parietal pericardium of both healthy individuals and patients. Heart failure induced by dilated cardiomyopathy can severely damage the morphology and ultrastructure of mesothelial cilia, leading to reduced ciliary motility and impaired secretion and absorption, thereby disrupting pericardial fluid production and reflux.
The Brain-Heart Connection in Takotsubo Syndrome: A Neurobiological Perspective.
Qi L, Wang W
Rev Cardiovasc Med · 2026 May · PMID 42238625 · Full text
Abstract loading — click title to view on PubMed.
"From Surface to Substrate: Advancing VT Ablation Strategies for Deep Arrhythmic Substrates"-A Review of Emerging Techniques in Intramural Lesion Formation.
Akrawinthawong K, Jakulla RS, Yamada T
Rev Cardiovasc Med · 2026 May · PMID 42238624 · Full text
Intramural ventricular tachycardia represents a formidable frontier in catheter ablation, where the arrhythmogenic substrate resides deep within the myocardial wall, often beyond the reach of conventional energy delivery...
Intramural ventricular tachycardia represents a formidable frontier in catheter ablation, where the arrhythmogenic substrate resides deep within the myocardial wall, often beyond the reach of conventional energy delivery. Achieving durable lesion formation in this setting requires a strategic balance between transmural efficacy and procedural safety. This review synthesizes the evolving landscape of intramural ventricular tachycardia ablation, detailing contemporary techniques, including bipolar ablation, needle-based approaches, simultaneous endocardial-epicardial delivery, and emerging energy modalities, each tailored to overcome the limitations of lesion depth and tissue heterogeneity. We examine diagnostic criteria, imaging adjuncts, and electroanatomic mapping strategies that guide procedural planning and highlight innovations aimed at enhancing lesion depth without compromising adjacent structures. By integrating current evidence and expert practice, this article offers a comprehensive framework for navigating the complexities of intramural ventricular tachycardia ablation and advancing outcomes in this challenging domain.
Indirect Treatment Comparison of Riociguat Replacement Therapy and Selexipag Add-on Therapy in Patients With Pulmonary Arterial Hypertension: Results From a Systematic Review.
An JE, Cho J, Kim MJ … +8 more , Lee AY, Sim WJ, Hong GU, Lee SH, Kim DS, Yi SY, Lee KM, Yu SY
Rev Cardiovasc Med · 2026 May · PMID 42238623 · Full text
BACKGROUND: Despite standard combination therapy with endothelin receptor antagonists (ERAs) and phosphodiesterase-5 inhibitors (PDE5is), many patients with pulmonary arterial hypertension (PAH) show inadequate therapeut...
BACKGROUND: Despite standard combination therapy with endothelin receptor antagonists (ERAs) and phosphodiesterase-5 inhibitors (PDE5is), many patients with pulmonary arterial hypertension (PAH) show inadequate therapeutic responses. Riociguat (a soluble guanylate cyclase stimulator) and selexipag (a prostacyclin receptor agonist) are both approved as next-step therapies; however, their comparative effectiveness and safety remain unknown due to the lack of head-to-head trials. We aimed to compare the therapeutic effects of riociguat replacement and selexipag add-on therapy through an indirect treatment comparison. METHODS: Randomized controlled trials (RCTs) involving patients with PAH receiving either riociguat or selexipag were identified through a systematic search of PubMed, EMBASE, and the Cochrane Library up to 04 November 2025. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Study quality was assessed with Cochrane's Risk of Bias 2.0 tool. Indirect treatment comparisons using Bucher's method were conducted within a common comparator (ERA + PDE5i) framework. RESULTS: Three RCTs (four publications) were included: REPLACE, GRIPHON (main and post-hoc analyses), and a phase II trial. The overall risk of bias was low, except for the phase II trial, which had unclear risk due to its small sample size. Indirect comparisons showed no significant differences between the therapies for any outcome. The hazard ratio for clinical worsening was 0.167 (95% confidence interval [CI]: 0.0019-1.495, = 0.1066). Mean differences for 6-min walk distance and N-terminal pro-B-type natriuretic peptide were 10.64 m (95% CI: -9.158 to 30.438, = 0.2920) and -46.62 pg/mL (95% CI: -307.826 to 214.586, = 0.7263). The relative risk of overall adverse events was 1.07 (95% CI: 0.90-1.27, = 0.453). Subgroup analyses of patients receiving baseline ERA + PDE5i therapy and those classified as World Health Organization functional class III also showed no significant differences. CONCLUSIONS: We found no significant differences between riociguat replacement and selexipag add-on therapy. These findings provide comparative data to help clinicians and patients make informed treatment decisions. Further head-to-head trials are needed to confirm comparative effectiveness. This review adhered to PRISMA 2020 guidelines. THE PROSPERO REGISTRATION: CRD42024524391 https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524391.
Contemporary Transcatheter Approaches to Mitral Regurgitation.
Theofilis P, Iliakis P, Dimitriadis K … +9 more , Karakasis P, Vlachakis PK, Dri E, Pamporis K, Antonopoulos A, Aggeli C, Aznaouridis K, Tousoulis D, Tsioufis K
Rev Cardiovasc Med · 2026 May · PMID 42238622 · Full text
Mitral regurgitation (MR) is a prevalent and prognostically relevant valvular disease, especially in patients with heart failure, in whom MR contributes to adverse remodeling, increased symptom burden, and higher mortali...
Mitral regurgitation (MR) is a prevalent and prognostically relevant valvular disease, especially in patients with heart failure, in whom MR contributes to adverse remodeling, increased symptom burden, and higher mortality. Surgical repair or replacement remains the standard of care for suitable candidates, but many patients are excluded because of advanced age, comorbidities, or high surgical risk. Transcatheter methods have emerged as transformative alternatives, including mitral transcatheter edge-to-edge repair (MTEER) with devices such as MitraClip and PASCAL, annuloplasty-based devices such as Carillon and Cardioband, and transcatheter mitral valve replacement (TMVR) with devices such as Tendyne, Intrepid, and others under development. Data from randomized trials and registries have established that MTEER lowers hospital readmission rates and improves mortality in carefully selected secondary MR subjects, and that device upgrades improve procedural success and anatomical versatility. Annuloplasty provides targeted repair for functional MR with annular dilation, whereas TMVR offers an alternative for anatomically complex cases or those ineligible for MTEER, albeit with distinct procedural risks. Management of severe mitral annular calcification remains difficult and demands meticulous pre-procedural planning and customized device strategies. Careful patient selection based on MR etiology, proportionality, ventricular function, and anatomical suitability is essential for optimizing outcomes in this rapidly evolving field.
Exploration of the Clinical Assessment and Prognostic Value of Society for Cardiovascular Angiography and Intervention Shock Staging in Patients With Acute Myocardial Infarction and Cardiogenic Shock on Veno-arterial Extracorporeal Membrane Oxygenation Support.
Dong K, Zhao J, Pan C … +6 more , Cai W, Ma J, Bai N, Wei J, Lu A, Bai M
Rev Cardiovasc Med · 2026 May · PMID 42238621 · Full text
BACKGROUND: Although the Society for Cardiovascular Angiography and Intervention (SCAI) five-stage system provides a structured approach to shock assessment, the prognostic utility of this system in patients with acute m...
BACKGROUND: Although the Society for Cardiovascular Angiography and Intervention (SCAI) five-stage system provides a structured approach to shock assessment, the prognostic utility of this system in patients with acute myocardial infarction and cardiogenic shock (AMICS) supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO), particularly when combined with dynamic cardiac biomarkers, has not been fully validated. METHODS: This single-center, hospital-based, prospective registry study, we continuously enrolled patients with AMICS who received VA-ECMO support at the Cardiac Centre of the First Hospital of Lanzhou University between January 2020 and October 2023, using data from the Chinese Society of Extracorporeal Life Support (CSECLS) registry. Patients were assigned to Stage D or E groups according to the SCAI shock staging system. Clinical characteristics and biomarkers were compared between the two groups, and a multivariate logistic regression model was used to examine the associations among shock stage, cardiac biomarkers, and in-hospital mortality. RESULTS: This study included 119 patients with AMICS receiving VA-ECMO support, of whom 78 were classified as Stage D and 41 as Stage E. Compared with Stage D patients, Stage E patients had lower VA-ECMO survival scores (-10 vs -2; < 0.001), left ventricular ejection fraction (EF) (0.26 vs 0.33, = 0.050), and high-density lipoprotein cholesterol (HDL-C) levels (0.78 vs 0.89; = 0.013). However, Stage E patients had a higher incidence of ventricular tachycardia and fibrillation (53.7% vs 34.6%, = 0.045), as well as higher glucose levels (14.85 vs 9.54; = 0.016), triglyceride-glucose index (2.29 vs 1.72, = 0.011) and lactate concentration (12.9 vs 9.1; = 0.016). Cardiac troponin I, myoglobin and creatine kinase-MB levels, as well as the associated temporal variation patterns, differed significantly between the two groups. In-hospital mortality rate was significantly higher in Stage E patients than in Stage D individuals (78% vs 53.8%; = 0.010). Multivariate logistic regression analysis showed that combining SCAI shock staging with age, troponin I 6-0, and myoglobin 24-0 significantly improved the prediction of mortality risk (area under the receiver operating characteristic (ROC) curve = 0.791). The 1-year follow-up survival rate was higher in Stage D patients (37.2%) than in Stage E individuals (19.5%). CONCLUSION: Combining SCAI shock staging with the dynamic monitoring of cardiac biomarkers facilitates the early risk stratification in patients with AMICS receiving VA-ECMO support, and demonstrates good predictive value for in-hospital mortality.
Preserve or Cover? The Isolated Left Vertebral Artery in Totally Endovascular Zone 2 TEVAR.
Marzano A, di Marzo L, Mansour W
Rev Cardiovasc Med · 2026 May · PMID 42238620 · Full text
Abstract loading — click title to view on PubMed.
Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Myocardial Infarction and Elevated Platelet Counts: A Multicenter Comparative Analysis of Ischemic Outcomes.
Ji FJ, Shao X, Gu TS … +9 more , Zhang YK, Hu ST, Jiang C, Zhang JK, Wu X, Rha SW, Liu X, Liu T, Chen KY
Rev Cardiovasc Med · 2026 May · PMID 42238619 · Full text
BACKGROUND: Dual antiplatelet therapy is essential for managing ST-elevation myocardial infarction (STEMI); however, the optimal choice of P2Y12 inhibitor in patients with thrombocytosis remains unclear. Therefore, this...
BACKGROUND: Dual antiplatelet therapy is essential for managing ST-elevation myocardial infarction (STEMI); however, the optimal choice of P2Y12 inhibitor in patients with thrombocytosis remains unclear. Therefore, this study aimed to compare the effects of clopidogrel and ticagrelor on the prognosis of patients with STEMI and platelet counts exceeding 350 × 10/L. METHODS: Utilizing data from the Tianjin Health and Medical Big Data platform (2010-2023), this retrospective cohort study included patients with acute myocardial infarction from 82 hospitals. After propensity score matching, 461 patients were assigned to two groups: ticagrelor and clopidogrel. Kaplan-Meier curves and Cox regression analyses were employed to evaluate outcomes, with major adverse cardiac and cerebrovascular events (MACCEs) as the primary outcome. Secondary outcomes included net adverse clinical events (NACEs), all-cause mortality, cardiac mortality, recurrent non-fatal myocardial infarction, coronary revascularization, cerebral infarction, and bleeding events (Bleeding Academic Research Consortium (BARC) types 3-5). A MACCE was defined as a composite of cardiac mortality, recurrent non-fatal myocardial infarction, and cerebral infarction, while a NACE encompassed a MACCE plus bleeding events (BARC types 3-5). RESULTS: Ticagrelor significantly reduced MACCEs (6.9% versus 12.1%; = 0.008), all-cause mortality (3.9% versus 9.5%; < 0.001), cardiac mortality (3.5% versus 7.4%; = 0.0096), and NACEs (8.2% versus 13.0%; = 0.021) compared with clopidogrel. Exploratory multivariable analysis confirmed an independent association of ticagrelor with reduced risks of MACCEs (adjusted hazard ratio (aHR) = 0.59; 95% confidence interval (CI), 0.37-0.93), NACEs (aHR = 0.64; 95% CI, 0.42-0.98), and all-cause mortality (aHR = 0.47; 95% CI, 0.26-0.83). CONCLUSIONS: Ticagrelor was associated with superior clinical outcomes in patients with STEMI and elevated admission platelet counts (≥350 × 10/L) compared with clopidogrel. In contrast to genetic testing, which is costly, time-consuming (≥24-72 hours), and impractical in emergencies, this simple, universally available platelet count threshold offers an immediate, practical biomarker for selecting potent P2Y12 inhibition in acute settings.
Levosimendan in Cardiogenic Shock: A Review of Mechanisms, Clinical Evidence, and Therapeutic Use.
Salvini S, Trivelloni V, Monaco I … +7 more , Bouhaik FS, Chouarfia I, Guefrachi I, Bencharef Y, Sedrati M, Mouhand C, Bottigliero D
Rev Cardiovasc Med · 2026 May · PMID 42238618 · Full text
Levosimendan is a calcium-sensitizing inodilator that has attracted renewed attention for a potential role in the management of cardiogenic shock (CS). The pharmacological profile of levosimendan differs markedly from th...
Levosimendan is a calcium-sensitizing inodilator that has attracted renewed attention for a potential role in the management of cardiogenic shock (CS). The pharmacological profile of levosimendan differs markedly from that of adrenergic inotropes: levosimendan augments contractile force without increasing intracellular calcium or myocardial oxygen demand and, through activation of ATP-sensitive (KATP) potassium channels, produces systemic and coronary vasodilation. Experimental and clinical data also suggest additional protective effects, including modulation of inflammatory pathways, anti-apoptotic activity, and improved mitochondrial function. Although these mechanisms translate into consistent hemodynamic improvement across several studies, large, randomized trials have not demonstrated a consistent survival advantage, likely due to differences in patient selection, treatment timing, and concomitant therapies. Nevertheless, certain clinical groups, such as patients who fail to respond to catecholamines, individuals on chronic β-blockers, and selected perioperative or mechanically supported patients, appear more likely to benefit. Therefore, current guidance favors an individualized rather than universal approach to levosimendan use. Several ongoing investigations, including trials in extracorporeal membrane oxygenation (ECMO)-supported patients and those with septic cardiomyopathy, may help clarify the optimal indications and timing for levosimendan use. This review integrates mechanistic, clinical, and safety data to identify patient profiles most suited to levosimendan therapy and to outline areas where further study is needed.
Cardiac Magnetic Resonance Imaging in Alcohol-Related Myocardial Injury: A Comprehensive Review.
Xu L, Deng W, Xu Z … +1 more , Ren H
Rev Cardiovasc Med · 2026 May · PMID 42238617 · Full text
Alcoholic myocardial injury is a well-defined cardiac pathological condition associated with prolonged heavy alcohol use, characterized mainly by myocardial dilation and impaired contractile function, and may ultimately...
Alcoholic myocardial injury is a well-defined cardiac pathological condition associated with prolonged heavy alcohol use, characterized mainly by myocardial dilation and impaired contractile function, and may ultimately progress to heart failure. An early diagnosis and an accurate assessment of this condition are fundamental. Cardiac magnetic resonance (CMR) is a multiparametric imaging modality that offers high soft-tissue contrast resolution and can accurately quantify cardiac chamber volumes and functional parameters. CMR also enables visualization of pathological myocardial changes, including edema, inflammation, and fibrosis, through multimodal imaging techniques. This article reviews the clinical application of CMR in the evaluation of alcoholic myocardial injury, highlighting the advantages of this technique in the quantitative assessment of myocardial structural and functional abnormalities, detection of myocardial edema and fibrosis, and prognostic stratification. Overall, this study aimed to provide an evidence-based reference to support early diagnosis and timely therapeutic intervention in this condition.
Long-Term Lesion Progression After Left Main Distal Bifurcation Stenting: Insights From Bifurcation Angle Variation Throughout the Cardiac Cycle.
Chen E, Hu D, Zheng H … +4 more , Chen L, Hu M, Chen L, Cai W
Rev Cardiovasc Med · 2026 May · PMID 42238616 · Full text
BACKGROUND: The clinical impact of changes in the bifurcation angle throughout the cardiac cycle (BA) after percutaneous coronary intervention (PCI) for left main coronary bifurcation lesions (LMCBLs) remains controversi...
BACKGROUND: The clinical impact of changes in the bifurcation angle throughout the cardiac cycle (BA) after percutaneous coronary intervention (PCI) for left main coronary bifurcation lesions (LMCBLs) remains controversial, and the associated long-term evolution post-stenting remains unknown. Therefore, this study aimed to evaluate temporal changes in the BA and the related impact on lesion progression in patients undergoing single- or dual-stenting. METHODS: Proximal (PBA) and distal (DBA) bifurcation angles were quantified throughout the cardiac cycle using two-dimensional quantitative coronary angiography at optimal views before the procedure, immediately after, and at long-term follow-up. These measurements represented the absolute difference between the end-diastolic and end-systolic angles for the left main (LM) to the left circumflex (LCX) and for the left anterior descending (LAD) to the LCX. Lesion progression was assessed from increases in diameter stenosis percentage (iDS%) from post-procedure to follow-up. RESULTS: A total of 284 patients underwent single-stenting (LM-LAD), and 84 underwent dual stenting (LM-LAD-LCX). Changes in the PBA were unaffected by interventional strategies or time. The DBA was narrowed post-stenting in all patients, but rebounded to pre-procedural levels during follow-up in the single-stenting group. In contrast, the DBA remained at post-procedural levels in the dual-stenting group. Lesion progression was more pronounced in patients with dual stenting, particularly in the LCX. The pre-procedural PBA correlated linearly with the iDS%-LCX metric in the dual stenting. CONCLUSIONS: The PBA remained stable over time and across strategies, whereas the DBA decreased post-stenting. During follow-up, the DBA rebounded in the single-stenting group but remained low in the dual-stenting group. The pre-procedural PBA represents an independent anatomical risk marker for future LCX progression in patients with dual-stented LMCBLs.
A Pathophysiology-Integrated Nomogram to Predict Tricuspid Regurgitation Progression After Isolated Mitral Valve Surgery: A Retrospective Cohort Study.
Pan Y, Kang Y, Lin H … +2 more , Lin Z, Chen L
Rev Cardiovasc Med · 2026 May · PMID 42238615 · Full text
BACKGROUND: Functional tricuspid regurgitation (FTR) frequently progresses after isolated mitral valve (MV) surgery in patients with pre-existing annular dilation, leading to adverse long-term outcomes. Notably, current...
BACKGROUND: Functional tricuspid regurgitation (FTR) frequently progresses after isolated mitral valve (MV) surgery in patients with pre-existing annular dilation, leading to adverse long-term outcomes. Notably, current guideline recommendations for concomitant tricuspid valve intervention, based primarily on annular size, lack precision for individualized risk prediction and may lead to both overtreatment and undertreatment. METHODS: This retrospective, single-center cohort study included 398 patients with mild FTR and tricuspid annular dilation (>40 mm) who underwent isolated MV surgery (2010-2018). The primary endpoint was progression to at least moderate tricuspid regurgitation (TR) on the follow-up echocardiography. Multivariable logistic regression identified independent predictors. A nomogram was developed and internally validated via bootstrapping. Model performance was assessed using discrimination (area under the curve [AUC]), calibration (calibration plots and mean absolute error), and clinical utility (decision curve analysis [DCA] and clinical impact curve [CIC]). RESULTS: TR progression occurred in 119 patients (29.9%) over a median follow-up of 5.2 years (interquartile range: 3.1-7.4). Multivariable analysis identified four independent preoperative predictors: atrial fibrillation type (paroxysmal: odds ratio [OR] 2.764, 95% confidence interval [CI] 1.682-4.532; persistent: OR: 3.422, 95% CI: 2.081-5.625; permanent: OR: 2.345, 95% CI: 1.404-3.917; all < 0.001), tricuspid annular diameter index (per 1 mm/m increase: OR: 2.531, 95% CI: 1.767-3.649; < 0.001), pulmonary artery systolic pressure (per 5 mmHg increase: OR: 3.246, 95% CI: 2.191-4.800; < 0.001), and left atrial volume index (per 5 mL/m increase: OR: 1.876, 95% CI: 1.287-2.733; = 0.001). The resulting nomogram demonstrated good discrimination, with an optimism-corrected AUC of 0.732 (95% CI: 0.701-0.763) following internal validation with 1000 bootstrap resamples (apparent AUC: 0.744; 95% CI: 0.712-0.797). The model also showed excellent calibration (calibration slope: 0.94; calibration-in-the-large: -0.03; Brier score: 0.152). DCA confirmed a superior net benefit relative to treat-all or no treatment strategies across threshold probabilities of 20-70%, with an optimal threshold of 45% for clinical decision-making. CONCLUSIONS: This study developed and internally validated a pathophysiology-integrated nomogram accurately predicting the risk of TR progression after isolated MV surgery. This tool, which incorporates readily available preoperative variables, facilitates personalized risk stratification and evidence-based decision-making regarding concomitant tricuspid intervention, thereby potentially optimizing long-term outcomes for patients with functional tricuspid regurgitation.
Prognostic Value of Left-Ventricular Filling Pressure Estimated by Cardiovascular Magnetic Resonance in Patients With Acute ST-Segment Elevation Myocardial Infarction.
Li W, Bo K, Zhou Z … +5 more , Gao Y, Li S, Ren Y, Wang H, Xu L
Rev Cardiovasc Med · 2026 May · PMID 42238614 · Full text
BACKGROUND: Left-ventricular filling pressure estimated using cardiovascular magnetic resonance (LVFP) provides a noninvasive measure of diastolic function and has demonstrated prognostic value comparable to invasive ass...
BACKGROUND: Left-ventricular filling pressure estimated using cardiovascular magnetic resonance (LVFP) provides a noninvasive measure of diastolic function and has demonstrated prognostic value comparable to invasive assessment in heart failure populations. However, data on LVFP in patients following acute ST-segment elevation myocardial infarction (ASTEMI) are limited. Thus, this study aimed to evaluate the diagnostic and prognostic implications of LVFP in a cohort of patients with ASTEMI. METHODS: This study included 296 patients with ASTEMI who underwent cardiovascular magnetic resonance (CMR) after percutaneous coronary intervention (PCI). The primary clinical endpoint was major adverse cardiac events (MACEs), defined as a composite of death, reinfarction, and heart failure. Univariable and multivariable Cox regression analyses were used to determine the association between LVFP and MACEs. Receiver operating characteristic curve and Kaplan-Meier analyses were performed to evaluate the prognostic value of LVFP in patients with ASTEMI. RESULTS: During a median follow-up of 1563 days (interquartile range: 1442-1714 days), 38 patients (12.84%) experienced MACEs. These patients exhibited significantly higher CMR-derived LVFP values than those without MACEs (14.57 [13.17-15.99] vs. 13.30 [12.05-14.51] mmHg; < 0.001). Moreover, the Youden index identified an optimal LVFP cutoff of 14.30 mmHg for high-risk classification ( < 0.001). In univariable Cox regression analysis, each 1 mmHg increase in LVFP was associated with a significantly higher risk of MACEs (hazard ratio [HR]: 1.31; 95% confidence interval [CI]: 1.14-1.51; < 0.001). This association remained robust in multivariable models after adjustment for baseline covariates, left-ventricular ejection fraction, and infarct size (% of LV mass) (HR: 1.25 per 1 mmHg increase; 95% CI, 1.07-1.46; < 0.01). The multivariable regression model yielded a Harrell C-index of 0.77, indicating strong discriminative ability for predicting MACEs. CONCLUSIONS: LVFP independently predicts long-term MACEs after ASTEMI, supporting the use of this approach in post-PCI risk stratification.
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