Reviews In Cardiovascular Medicine[JOURNAL]
Sun
200 papers
The Association Between Serum FGF21 Level and Coronary Artery Calcification: Impact of the Degree of Insulin Resistance.
Wang C, Li Y, Peng H … +1 more , Liu J
Rev Cardiovasc Med · 2026 Mar · PMID 41923752 · Full text
BACKGROUND: Coronary artery calcification (CAC) is a strong predictor of long-term adverse outcomes in patients with coronary artery disease (CAD). Meanwhile, insulin resistance (IR) is a key metabolic disorder that acce...
BACKGROUND: Coronary artery calcification (CAC) is a strong predictor of long-term adverse outcomes in patients with coronary artery disease (CAD). Meanwhile, insulin resistance (IR) is a key metabolic disorder that accelerates CAC progression through multiple pathways. Fibroblast growth factor 21 (FGF21) improves glucolipid metabolism and has been associated with vascular calcification. However, the relationship between serum FGF21 level and CAC severity in patients with varying degrees of IR remains unclear. METHODS: A total of 128 patients with CAD who underwent preprocedural coronary computed tomography angiography and percutaneous coronary intervention were enrolled. Patients were stratified by triglyceride-glucose (TyG) index into high (TyG >8.62, n = 62) and low (TyG ≤8.62, n = 66) groups. Associations between FGF21 levels and severe CAC were analyzed under varying degrees of IR. RESULTS: In patients with a TyG index >8.62, serum FGF21 levels were significantly lower in those with severe CAC, and were negatively correlated with CAC scores. Multivariable analysis revealed that serum FGF21 levels were independently associated with severe CAC (odds ratio (OR) per 1-standard deviation (SD) increase: 0.261; 95% confidence interval (CI): 0.073, 0.933; < 0.05). In contrast, serum FGF21 levels among patients with a TyG index ≤8.62 did not differ significantly between the severe and non-severe CAC groups, and no independent association between serum FGF21 level and severe CAC was observed after adjustment. Importantly, a significant interaction was observed between the TyG index and FGF21 level ( for interaction = 0.035). Moreover, the protective association between FGF21 and CAC was primarily observed in patients with a high TyG index. CONCLUSIONS: Lower serum FGF21 levels in patients with CAD can identify individuals at increased risk of severe CAC, particularly among those with a higher degree of IR. Serum FGF21 levels may serve as a novel biomarker for CAC risk stratification in metabolically susceptible patients.
Hemolysis in Pulsed Field Ablation for Atrial Fibrillation: A Narrative Review.
Cersosimo A, Pierucci N, Mariani MV … +4 more , Matteucci A, Parato AG, La Fazia VM, Natale A
Rev Cardiovasc Med · 2026 Mar · PMID 41923751 · Full text
Pulsed field ablation (PFA) has emerged as a promising non-thermal energy source for treating atrial fibrillation (AF), demonstrating comparable efficacy to traditional thermal ablation techniques while offering an impro...
Pulsed field ablation (PFA) has emerged as a promising non-thermal energy source for treating atrial fibrillation (AF), demonstrating comparable efficacy to traditional thermal ablation techniques while offering an improved safety profile. However, recent evidence suggests that PFA may be associated with intravascular hemolysis, a complication that can potentially lead to acute kidney injury (AKI). This review aims to provide a comprehensive overview of the mechanisms of hemolysis associated with PFA and to summarize current strategies to mitigate the risk of AKI. The delivery of high-voltage electrical pulses during PFA can induce red blood cell lysis, resulting in elevated circulating free hemoglobin. The extent of hemolysis has been shown to correlate with several procedural variables, including peak output voltage, catheter-tissue contact quality, and, particularly, the number of energy applications delivered. Recent studies have highlighted that adequate preprocedural hydration may effectively reduce the incidence of AKI by promoting renal clearance of hemolytic products. Although hemolysis appears to be an unavoidable effect of pulsed field ablation, the clinical consequences associated with hemolysis, particularly AKI, can be significantly reduced with preventive measures.
Associations Between the Modified Cardiometabolic Index and Stroke in Patients With Different Glucose Metabolism Statuses: Evidence From a Nationally Representative Survey.
Deng T, Wu G, Liang X … +4 more , Peng Y, Dong Z, Shen Y, Qin Y
Rev Cardiovasc Med · 2026 Mar · PMID 41923750 · Full text
BACKGROUND: The association between the modified cardiometabolic index (MCMI) and the risk of incident stroke across patients with different glycemic statuses remains unclear. This study aimed to investigate the relation...
BACKGROUND: The association between the modified cardiometabolic index (MCMI) and the risk of incident stroke across patients with different glycemic statuses remains unclear. This study aimed to investigate the relationship between baseline MCMI levels and incident stroke in Chinese middle-aged and older adults with varying glucose metabolism states. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018. Kaplan-Meier curves, multivariable Cox proportional hazards models, and restricted cubic spline analyses were employed to assess the relationship between the MCMI and stroke risk stratified by glycemic status. Subgroup and sensitivity analyses were performed to confirm the robustness of the findings. RESULTS: A total of 7455 participants were included. A total of 457 individuals (6.13%) experienced stroke events during a median follow-up of 7 years. A significant linear association was observed between a higher MCMI and increased stroke risk. A nonlinear relationship was detected among participants with normal glucose regulation (NGR), with a sharp increase in risk beyond an MCMI threshold of 1.904 (hazard ratio (HR) = 1.85; 95% confidence interval (CI): 1.24-2.76; = 0.003). An increased MCMI was also associated with increased stroke risk in individuals with prediabetes (HR = 1.34, 95% CI: 1.03-1.75) but not in individuals with diabetes. The associations varied across subgroups according to gender, residence, body mass index, and use of cardiovascular medications. Sensitivity analyses supported the stability of the results. CONCLUSION: An elevated MCMI is positively associated with incident stroke, particularly in individuals with NGR or prediabetes. Early identification of a high MCMI may be valuable for stroke prevention, risk stratification, and timely intervention in community populations.
Proprotein Convertase Subtilisin/Kexin Type 9 and Atherosclerotic Plaque Progression: A Systematic Review and Meta-Analysis of Intravascular Imaging Studies.
Theofilis P, Vlachakis PK, Karakasis P … +6 more , Iliakis P, Pamporis K, Oikonomou E, Dimitriadis K, Tsioufis K, Tousoulis D
Rev Cardiovasc Med · 2026 Mar · PMID 41923749 · Full text
BACKGROUND: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) have emerged as a promising class of medications, primarily recognized for inducing potent cholesterol-lowering effects. In addition to the e...
BACKGROUND: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) have emerged as a promising class of medications, primarily recognized for inducing potent cholesterol-lowering effects. In addition to the established role of these inhibitors in reducing low-density lipoprotein cholesterol levels, recent studies suggest that PCSK9is may also modify coronary atherosclerotic plaques. Therefore, this meta-analysis aimed to comprehensively synthesize data from relevant clinical studies and trials investigating the effects of PCSK9is on coronary atherosclerotic plaque characteristics. METHODS: We performed a literature search for studies assessing the evolution of coronary atherosclerotic plaques after treatment with a PCSK9i compared with a control group. We excluded reviews, editorials, case reports/case series, and studies that did not use PCSK9is or lacked a control group. The main outcomes of interest were changes in percent atheroma volume (PAV), total atheroma volume (TAV), minimal fibrous cap thickness (FCT), lipid arc, and the number of patients with improved PAVs at follow-up. Effect sizes are presented as a standardized mean difference (SMD) or risk ratio (RR) alongside the corresponding 95% confidence intervals (CIs) and were pooled based on a random-effects model. Publication bias was assessed by funnel plot inspection and Egger's regression test. RESULTS: The literature search yielded 142 results. After applying the exclusion criteria, nine studies were selected for data extraction and inclusion in the meta-analysis. Concerning the intravascular ultrasound findings, PCSK9is significantly reduced the TAV (MD -7.09 mm, 95% CI -11.36 to -2.81; = 0.01) and induced non-significant reductions in the PAV (MD -1.91%, 95% CI -5.08 to 1.25; = 0.17); meanwhile, a greater proportion of patients treated with PCSK9 inhibitors exhibited an improvement in the PAV (RR 1.30, 95% CI 1.19 to 1.42; < 0.001). For optical coherence tomography parameters, patients treated with PCSK9 inhibitors showed an increase in minimal FCT (MD 36.25 μm, 95% CI 0.75 to 71.75; = 0.047) and a non-significant decrease in lipid arc (MD -17.64°, 95% CI -49.73 to 14.44; = 0.14). CONCLUSIONS: This meta-analysis suggests that PCSK9i therapy may be associated with modest favorable changes in selected intravascular imaging markers of coronary atherosclerotic plaque burden and stability.
Congenital Heart Disease and Pulmonary Arterial Hypertension: Current Perspectives.
Blanca-Jover E, Contreras-Chova F, Jerez-Calero A … +2 more , Uberos-Fernandez J, Pérez-Lara L
Rev Cardiovasc Med · 2026 Mar · PMID 41923748 · Full text
Pulmonary arterial hypertension (PAH) is the most serious complication of congenital heart disease (CHD), constituting a heterogeneous clinical entity classified within Group 1 of the Clinical Classification of Pulmonary...
Pulmonary arterial hypertension (PAH) is the most serious complication of congenital heart disease (CHD), constituting a heterogeneous clinical entity classified within Group 1 of the Clinical Classification of Pulmonary Hypertension (PH). PAH associated with congenital heart disease (PAH-CHD) affects approximately 3-10% of patients with CHD and accounts for up to one-third of all PAH cases in the adult population. This review provides an educational and up-to-date perspective on the epidemiology, pathophysiology, diagnosis, and management of PAH-CHD. The updated haemodynamic definitions of the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines (mean pulmonary artery pressure (PAP) ≥20 mmHg) and the importance of contemporary registries (COMPERA-CHD, HOPE) in defining prognosis are discussed. The pathophysiology is explored in depth, from initial shear stress to the imbalance in the three canonical pathways that regulate pulmonary vascular functions (endothelin, nitric oxide, prostacyclin), the role of inflammation and metabolism, and the central importance of the TGF-β/BMPR2 genetic pathway, which has led to new disease-modifying therapies. Moreover, this review addresses the crucial clinical distinction between paediatric management, constrained by limited evidence, and adult management (ACHD), with a focus on the multisystem disorder of Eisenmenger syndrome (ES) and the challenges of care transition. The gold-standard diagnostic (right heart catheterisation), the 'treat and repair' strategy in the haemodynamic 'grey zone', and the complex risk stratification in this population are also analysed. Additionally, the evidence from key trials (BREATHE-5, MAESTRO, REPLACE) and the paradigm shift towards initial combination therapy (AMBITION) are reviewed from a therapeutic perspective. Finally, the most significant advance is highlighted: Sotatercept, a vascular remodelling reversal agent (STELLAR study), concluding with a review of chronic complications and prospects in the field.
Coronary Artery Ectasia Presenting as ST-Elevation Myocardial Infarction: An Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Strategy and Case-Based Review.
Xiong Q, Chen S, Li W … +1 more , Xie Y
Rev Cardiovasc Med · 2026 Mar · PMID 41923747 · Full text
Coronary artery ectasia (CAE) is characterized by abnormal, localized, or diffuse dilatation of the coronary vasculature and is an increasingly recognized anatomical entity encountered during coronary angiography. Althou...
Coronary artery ectasia (CAE) is characterized by abnormal, localized, or diffuse dilatation of the coronary vasculature and is an increasingly recognized anatomical entity encountered during coronary angiography. Although often associated with atherosclerosis, the exact pathogenesis of CAE remains unknown; hence, an optimal management strategy is difficult to establish and remains highly controversial due to a lack of high-quality randomized controlled trial evidence. Current therapeutic modalities include medical therapy, percutaneous coronary intervention (PCI), and surgical options. We present a review, supported by a representative case of ST-elevation myocardial infarction (STEMI) in a patient with CAE, as a systematic summary of the clinical and angiographic features of the condition. We discuss contemporary treatment approaches, especially how to navigate antithrombotic strategies and the role of intravascular ultrasound (IVUS)-guided PCI.
Sex Differences in Outcomes After Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Narrative Synthesis.
Marzano A, Flora F, Jabbour J … +2 more , Martinelli O, Cuozzo S
Rev Cardiovasc Med · 2026 Mar · PMID 41923746 · Full text
BACKGROUND: Abdominal aortic aneurysm (AAA) is less prevalent in women, yet rupture occurs owing to smaller diameters, leading to higher mortality rates; moreover, higher mortality rates also occur in women after aneurys...
BACKGROUND: Abdominal aortic aneurysm (AAA) is less prevalent in women, yet rupture occurs owing to smaller diameters, leading to higher mortality rates; moreover, higher mortality rates also occur in women after aneurysm repair procedures. Meanwhile, whether women derive comparable benefit from endovascular aneurysm repair (EVAR) remains uncertain, partly because of anatomical constraints, such as smaller-caliber access vessels and more angulated proximal necks. This review evaluates sex-specific perioperative and long-term outcomes after EVAR. METHODS: This study was conducted as a systematic review with narrative synthesis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework. A comprehensive search was conducted in the PubMed/MEDLINE and Scopus databases for studies published between January 2000 and September 2025. Search strings combined controlled vocabulary and free-text terms for "abdominal aortic aneurysm", "endovascular aneurysm repair", and "sex" or "gender" or "female". A predefined Population, Intervention, Comparison, Outcome (PICO) model was used to guide study selection. Comparative observational cohorts, registry or claims analyses, and EVAR-focused meta-analyses reporting sex-stratified outcomes were eligible. Articles were restricted to English. Outcomes included perioperative mortality, major complications, reintervention, and long-term survival. Given the heterogeneity and the availability of recent pooled analyses, quantitative synthesis favored adjusted estimates from high-quality meta-analyses and registries, and no new pooled meta-analysis was performed to avoid data duplication. RESULTS: A total of 15 studies met the inclusion criteria, encompassing more than 500,000 EVAR procedures. Women consistently exhibited higher early mortality and morbidity after standard infrarenal EVAR. The largest EVAR-focused meta-analysis reported an odds ratio (OR) for 30-day mortality of 1.73 (95% confidence interval (CI) 1.32-2.26) and in-hospital mortality OR of 1.90 (1.43-2.53) for women versus men, with increased risks of limb ischemia (~2.4-fold), renal (OR ~1.7), and cardiac complications (OR ~1.7). Long-term all-cause mortality was higher in women (hazard ratio (HR) 1.23, 95% CI 1.09-1.38). Contemporary registry data indicated similar adjusted mortality but persistently greater access-related morbidity in women, including higher rates of limb ischemia (5.3% vs. 3.2%) and major bleeding (22.0% vs. 15.9%). Perioperative mortality and complications were approximately two-fold higher in women following complex EVAR, defined as fenestrated and/or branched endovascular repair (F/BEVAR) for juxtarenal, pararenal, suprarenal, or thoracoabdominal aneurysms. Additionally, survival remained inferior in those with a ruptured AAA (8-year survival: 36.7% vs. 49.5%). CONCLUSIONS: Women undergoing EVAR continue to experience higher perioperative morbidity and less favorable long-term outcomes compared with men, despite advances in device technology and perioperative care. These disparities largely reflect anatomical and physiological differences, delayed presentation, and underrepresentation in clinical trials and registries. This systematic review and narrative synthesis clarifies sex-specific differences in outcomes after standard infrarenal EVAR and complex F/BEVAR, integrating evidence from contemporary device eras. Sex-aware imaging, individualized access planning, and device design tailored to smaller anatomy are critical to achieving equitable outcomes in endovascular aortic repair.
Shared Binding Properties Between a Therapeutic Antibody and Anti-Transthyretin Antibodies From Transthyretin Cardiac Amyloidosis Patients: Translational Implications for Future Clinical Trials.
George J, Benaim C, Fassler M
Rev Cardiovasc Med · 2026 Mar · PMID 41923745 · Full text
BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CA) results from the extracellular deposition of misfolded transthyretin (mis-TTR) and promotes progressive cardiac dysfunction. Current therapies, such as stabilizers...
BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CA) results from the extracellular deposition of misfolded transthyretin (mis-TTR) and promotes progressive cardiac dysfunction. Current therapies, such as stabilizers and silencers, reduce further fibril accumulation but fail to clear existing deposits. Monoclonal antibodies (mAbs) targeting mis-TTR have emerged as promising disease-modifying agents, supported by recent observations of circulating anti-TTR antibodies in patients who exhibited spontaneous clinical improvement. METHODS: This study aimed to purify natural anti-TTR antibodies from two ATTR-CA patients and compare the respective binding properties to those of a previously described therapeutic anti-TTR mAb fragment (Ab-A F(ab')). Statistical significance was determined using Student's -test. RESULTS: Both natural antibodies and the Ab-A F(ab') demonstrated high-affinity binding to misfolded TTR (n = 3), while the competition assays revealed dose-dependent inhibition, indicating shared epitope recognition. CONCLUSIONS: These findings provide translational evidence that therapeutic anti-TTR mAbs may mimic naturally protective antibodies, suggesting that these antibodies could promote amyloid clearance and deliver true disease-modifying benefits in ATTR-CA.
Contributions of Biological Aging to Longitudinal Incidence and Dynamic Progression of Atrial Fibrillation: A Prospective Cohort Study.
Fan Z, Liu X, Wu H … +2 more , Yang C, Yang J
Rev Cardiovasc Med · 2026 Mar · PMID 41923744 · Full text
BACKGROUND: The role of biological aging in the progression of atrial fibrillation (AF) remains unclear. Therefore, the present study aimed to investigate the influence of biological aging markers on transitions from hea...
BACKGROUND: The role of biological aging in the progression of atrial fibrillation (AF) remains unclear. Therefore, the present study aimed to investigate the influence of biological aging markers on transitions from health to AF, complications, and death. METHODS: Two UK Biobank datasets were analyzed: 260,198 participants for the Klemera-Doubal method for biological age (KDM-BA) and PhenoAge analyses, and 339,603 for telomere length analyses, excluding those with AF, complications (heart failure, myocardial infarction, cerebral infarction, dementia, and arterial embolic diseases) at baseline. The present study employed a multi-state model to evaluate the associations between biological aging markers and the progression of AF. Mediation analyses were utilized to assess the role of systemic inflammation. RESULTS: During the follow-up period, 9.51-9.67% of patients in the two datasets developed AF, among whom 17.59-17.85% progressed to complications, with 8.20-10.83% of these patients dying from AF-related complications. In comparison with Q1, Q4 of the KDM-BA and PhenoAge analyses was associated with elevated risks across transitions, particularly from baseline to AF (hazard ratios (HR): 1.09, 95% confidence interval (CI): 1.04-1.14; HR: 1.30, 95% CI: 1.25-1.35), baseline to death (HR: 1.10, 95% CI: 1.04-1.16; HR: 1.11, 95% CI: 1.06-1.16), and AF to complication (HR: 1.75, 95% CI: 1.58-1.94; HR: 1.52, 95% CI: 1.37-1.68). Moreover, Q4 of the telomere length analyses showed protective effects against AF onset (HR: 0.83, 95% CI: 0.80-0.86), progression to complications (HR: 0.78, 95% CI: 0.72-0.84), and from baseline to death (HR: 0.91, 95% CI: 0.88-0.94). Systemic inflammation was associated with up to 29.95% of these associations. CONCLUSIONS: Associations were found between biological aging markers (higher KDM-BA and PhenoAge, and shorter telomere length) and the risk of AF transitions, particularly with respect to an increased risk of AF and progression to complications. These findings underscore the importance of biological age in AF risk stratification and prevention.
Mitochondrial Calcium Dysregulation and Targeted Therapies in Heart Failure.
Liu M, Jin Y
Rev Cardiovasc Med · 2026 Mar · PMID 41923743 · Full text
Heart failure (HF) is steadily increasing in prevalence and poses a major global health challenge, with substantial medical and economic burdens. HF represents the terminal stage of diverse cardiac disorders and is chara...
Heart failure (HF) is steadily increasing in prevalence and poses a major global health challenge, with substantial medical and economic burdens. HF represents the terminal stage of diverse cardiac disorders and is characterized by poor prognosis despite the availability of conventional pharmacological treatments, underscoring the urgent need for novel therapeutic approaches. Accumulating evidence highlights a strong association between HF and mitochondrial dysfunction, of which dysregulated mitochondrial calcium (mCa) homeostasis plays a pivotal role in disease pathogenesis. Ca serves as an essential signaling messenger that regulates energy metabolism and also governs cell survival and myocardial contractility. Thus, this review introduces the mechanisms of mCa uptake and efflux and the association of these processes with HF and emerging therapeutic strategies. We also discuss mCa uniporter (MCU) inhibitors and Elamipretide, a mitochondria-targeted peptide. Collectively, this work provides novel insights and preclinical evidence supporting mitochondria-based interventions for HF.
Disruption of the Fibroinflammatory Loop: A Therapeutic Strategy for Cardiac Fibrosis in Non-Ischemic Cardiomyopathy.
Qiu H, Gladysheva IP
Rev Cardiovasc Med · 2026 Mar · PMID 41923742 · Full text
In non-ischemic cardiomyopathy, inflammation is closely associated with cardiac fibrosis, which significantly contributes to adverse outcomes and promotes heart failure (HF). Recent mechanistic studies have demonstrated...
In non-ischemic cardiomyopathy, inflammation is closely associated with cardiac fibrosis, which significantly contributes to adverse outcomes and promotes heart failure (HF). Recent mechanistic studies have demonstrated that interactions between fibrotic and inflammatory pathways create a dynamic, self-perpetuating fibroinflammatory loop, thereby accelerating disease progression. New mono or combination therapies that target this cycle by blocking specific inflammatory signals, modulating the immune response, and altering extracellular matrix (ECM) stiffness may halt or even reverse fibrosis. This opinion article discusses critical recent discoveries, current obstacles, and future opportunities in developing inflammation-focused treatments for cardiac fibrosis in non-ischemic cardiomyopathies.
Diagnostic and Prognostic Value of Arterial Blood Gas and Electrolyte Analyses in Heart Failure.
Tetaj N, Segreti A, Piccirillo F … +5 more , Pelullo M, Crispino SP, Ciancio M, Ussia GP, Grigioni F
Rev Cardiovasc Med · 2026 Mar · PMID 41923741 · Full text
Heart failure (HF) is a multifaceted clinical syndrome that frequently precipitates disturbances in perfusion, ventilation, and metabolic regulation, all of which are rapidly detectable through arterial blood gas (ABG) a...
Heart failure (HF) is a multifaceted clinical syndrome that frequently precipitates disturbances in perfusion, ventilation, and metabolic regulation, all of which are rapidly detectable through arterial blood gas (ABG) analysis. Meanwhile, clinical markers such as lactate, arterial pH, arterial partial pressure of carbon dioxide (PaCO), arterial partial pressure of oxygen (PaO), bicarbonate, and electrolyte concentrations provide dynamic insight into the pathophysiologic status of patients and can serve as early indicators of decompensation. This review evaluates the clinical significance of key ABG and electrolyte parameters in both acute and chronic HF, emphasizing the prognostic value of the analyses, contribution to risk stratification, and utility in guiding therapy. In acute HF and cardiogenic shock, hyperlactatemia and acidosis are associated with increased mortality and the need for hemodynamic or ventilatory support. Furthermore, electrolyte abnormalities, particularly those involving sodium and potassium, are common and driven by neurohormonal activation, pharmacological therapies, and volume shifts. Therefore, integrating ABG and electrolyte monitoring into routine HF management can enhance diagnostic precision and support timely, targeted interventions. This narrative review synthesizes current evidence and proposes a practical framework for interpreting ABG results in the context of contemporary HF care.
Representation of Women in Atrial Fibrillation Clinical Trials: A Systematic Review.
Ibrahim R, Pham HN, Kanaan C … +11 more , Alhwarat B, Sainbayar E, Soin S, Ayoub C, Chieffo A, Sharma G, Protheroe J, Lee JZ, Arsanjani R, Lee K, Mamas MA
Rev Cardiovasc Med · 2026 Mar · PMID 41923740 · Full text
BACKGROUND: Disparities exist in the representation of genders in cardiovascular clinical trials. Atrial fibrillation (AF) is associated with significant morbidity and mortality; however, understanding regarding the repr...
BACKGROUND: Disparities exist in the representation of genders in cardiovascular clinical trials. Atrial fibrillation (AF) is associated with significant morbidity and mortality; however, understanding regarding the representation of women in AF-related clinical trials remains limited. Therefore, this systematic review sought to evaluate the representation of women in AF-related clinical trials. METHODS: We conducted a systematic review of clinical trials using the PubMed, Scopus, and EMBASE databases from 1996 to January 1st, 2024, focusing on AF-related lifestyle interventions, pharmacological treatments, catheter ablation, and device therapies for AF. Data extraction and analysis encompassed trial characteristics, participant demographics, and funding sources. The primary outcome was the prevalence of female enrollees, quantified through participation-to-prevalence ratios (PPRs). This was estimated overall and stratified by funding source, intervention type, and enrollment region. RESULTS: Of the 103 clinical trials involving 218,322 participants (39.5% female), the PPR ranged from 0.00 to 1.73, with an average PPR of 1.03. Meanwhile, 43% of the trials exhibited female under-representation (PPR, <0.8). University-funded trials showed higher female enrollment (mean PPR, 0.951) compared to industry/government-funded trials (mean PPR, 0.800). No differences were observed in the representation of women when comparing enrollment regions or intervention types. CONCLUSIONS: Despite advancements in AF management, gender disparities persist in AF-related clinical trial representation, particularly in industry/government-funded studies compared to university-funded trials. Thus, addressing implicit biases and enforcing sex equality guidelines are critical steps toward more inclusive cardiovascular research.
Synergistic Cardiopulmonary Protection of Endothelin Receptor Antagonists Combined With Soluble Guanylate Cyclase Agonists in High-Risk Coronary Syndrome With Pulmonary Hypertension.
Zhao L, Pang X
Rev Cardiovasc Med · 2026 Mar · PMID 41923739 · Full text
BACKGROUND: The prognosis and long-term survival of high-risk coronary syndrome patients with pulmonary hypertension (PH) remain unsatisfactory, and limited research has evaluated the synergistic therapeutic effects of e...
BACKGROUND: The prognosis and long-term survival of high-risk coronary syndrome patients with pulmonary hypertension (PH) remain unsatisfactory, and limited research has evaluated the synergistic therapeutic effects of endothelin receptor antagonists (ERAs) combined with soluble guanylate cyclase agonists (sGCAs). This study aimed to assess the synergistic cardiopulmonary protective effects and clinical safety of ERA combined with sGCA therapy in patients with high-risk coronary syndrome complicated by PH. METHODS: This retrospective controlled study included 132 patients with high-risk coronary syndrome and PH who were admitted between January 2019 and December 2023. After exclusion criteria were applied, 119 patients were analyzed and categorized into a control group (ambrisentan monotherapy, n = 58) and an experimental group (ambrisentan plus riociguat, n = 61) according to the associated treatment strategy. Primary endpoints included 6-minute walk distance (6MWD), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and the World Health Organization-related functional class (WHO-FC). Secondary endpoints included cardiac index (CI), left ventricular end-diastolic diameter (LVEDD), tricuspid annular plane systolic excursion (TAPSE), mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), Borg dyspnea score (BDS), and the incidence of adverse events. RESULTS: Baseline characteristics between the two groups were comparable (all > 0.05). Following treatment, the 6MWD, CI, and TAPSE values significantly improved in both groups (all < 0.05), with greater improvements observed in the experimental group (95% CI: -3.61 to -0.05, = 0.044; 95% CI: -0.20 to -0.004, = 0.039; 95% CI: -0.29 to -0.07, = 0.001). The NT-proBNP, LVEDD, mPAP, PVR, and BDS values decreased in both cohorts (all < 0.05), with more pronounced reductions in the experimental group (95% CI: 0.02-3.5, = 0.048; 95% CI: 0.03-0.21, = 0.012; 95% CI: 0.02-2.03, = 0.046; 95% CI: 0.65-4.30, = 0.008; 95% CI: 0.06-0.78, = 0.022). The proportion of individuals in the WHO-FC classes III-IV was lower in the experimental group (95% CI: 1.05-4.56, = 0.035). No statistically significant difference in adverse-event incidence was observed between groups (95% CI: 0.73-5.03, = 0.184). CONCLUSION: Combination therapy with ambrisentan and riociguat effectively improved cardiopulmonary function and clinical outcomes in patients with high-risk coronary syndrome and PH, offering a promising therapeutic strategy for this population. This study is a single-center retrospective study, which inherently limits the credibility of causal inference; therefore, the results need to be further verified by multi-center, large-sample prospective studies.
Molecular Mechanisms and Therapeutic Strategies in Heart Failure Due to Dystrophin Deficiency: A Comprehensive Review.
Yu W, Wang W, Luo F … +3 more , Zhao Y, Wu Q, Li P
Rev Cardiovasc Med · 2026 Mar · PMID 41923738 · Full text
Dystrophin deficiency is the core pathological feature of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). Indeed, a deficiency in dystrophin results in the progressive degeneration of skeletal musc...
Dystrophin deficiency is the core pathological feature of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). Indeed, a deficiency in dystrophin results in the progressive degeneration of skeletal muscle and severely compromises the structure and function of cardiomyocytes, eventually leading to dilated cardiomyopathy and heart failure. Thus, this review provides an in-depth analysis of the molecular mechanisms underlying dystrophin-deficient cardiomyopathy, including membrane instability, calcium dysregulation, mitochondrial dysfunction, and fibrosis. The role of inflammatory responses in disease progression is also discussed. In addition, we evaluate current and emerging therapeutic strategies, including gene therapy, pharmacological interventions, and regenerative medicine approaches, and highlight recent preclinical and clinical trial data. Finally, we explore future directions in precision medicine, novel biomarkers for early detection, and combination treatment regimens, to provide a comprehensive resource for clinicians and researchers working in this challenging field.
Biomarker-Guided Versus Clinically Guided Management Strategies for Heart Failure: A Systematic Review and Meta-Analysis.
Zhou H, Liu T, Lan F … +3 more , Liu K, Wei X, Xu Y
Rev Cardiovasc Med · 2026 Mar · PMID 41923737 · Full text
BACKGROUND: The clinical value of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy for improving outcomes in patients with heart failure (HF) remains controversial....
BACKGROUND: The clinical value of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy for improving outcomes in patients with heart failure (HF) remains controversial. Thus, this meta-analysis synthesizes the available evidence from randomized controlled trials (RCTs) to determine whether a biomarker-guided strategy reduces all-cause mortality and HF-related hospitalizations compared with clinically guided management. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science databases from inception to May 2025 for RCTs comparing biomarker-guided versus clinically guided management in patients with HF. Pooled risk ratios (RRs) were calculated using a random-effects model. We performed extensive supplementary analyses, including a subgroup analysis, sensitivity analysis, and trial sequential analysis (TSA). RESULTS: We included 17 articles (reporting on 17 distinct RCTs) comprising 5069 patients. The primary meta-analysis showed that biomarker-guided therapy was associated with a significant reduction in all-cause mortality (RR 0.84, 95% confidence interval (CI) 0.73-0.96; I = 12.2%) and HF-related hospitalizations (RR 0.79, 95% CI 0.65-0.96; I = 53.7%). However, the robustness of these findings was undermined by subsequent analyses. Meanwhile, a sensitivity analysis restricted to studies with a low risk of bias rendered the mortality benefit non-significant (RR 0.90, 95% CI 0.79-1.03). Egger's test indicated potential publication bias ( = 0.0285), and TSA suggested the cumulative evidence was insufficient to draw a definitive conclusion. CONCLUSIONS: Although there is a trend toward benefit, the existing evidence for biomarker-guided HF therapy is deemed "very low" quality based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment. The results were compromised by methodological deficiencies in primary studies and potential publication bias. Therefore, the evidence is inadequate to support the routine use of this strategy in clinical practice. Further large-scale, high-quality RCTs are warranted. THE PROSPERO REGISTRATION: CRD420250652134, https://www.crd.york.ac.uk/PROSPERO/view/CRD420250652134.
Promotes -Driven Pyroptosis via Transcriptional Activation in Aortic Dissection.
Yang Q, Shao X, Zheng Z … +6 more , Li M, Xiao C, Chen B, Tu G, Huang B, Dai X
Rev Cardiovasc Med · 2026 Mar · PMID 41923736 · Full text
BACKGROUND: Aortic dissection (AD) is a cardiovascular emergency with high mortality; however, the underlying molecular pathophysiology of AD remains incompletely understood. Pyroptosis, a proinflammatory form of program...
BACKGROUND: Aortic dissection (AD) is a cardiovascular emergency with high mortality; however, the underlying molecular pathophysiology of AD remains incompletely understood. Pyroptosis, a proinflammatory form of programmed cell death, contributes to vascular injury; nonetheless, the upstream transcriptional regulation of pyroptosis in AD is similarly poorly defined. METHODS: Differentially expressed genes were identified in aortic tissues from AD patients (Gene Expression Omnibus (GEO) datasets) using bioinformatics analyses, with a focus on cell death-related candidates. AD mouse models and vascular smooth muscle cell (VSMC) systems were employed to investigate the roles of these genes in AD. Potential transcription factors for () were predicted using the Just Another Simple Array Retrieval/Simple API for Repository (JASPAR) and University of California, Santa Cruz (UCSC) databases, and validated by luciferase reporter and chromatin immunoprecipitation assays. Gain- and loss-of-function approaches were used to dissect the zinc finger protein 460 (ZNF460)-PKM2-gasdermin E (GSDME) axis and the associated impact on pyroptosis and AD progression. RESULTS: expression was markedly elevated in AD tissues. silencing suppressed GSDME cleavage, attenuated VSMC pyroptosis, and mitigated experimental AD, whereas overexpression aggravated these outcomes. GSDME upregulation rescued pyroptosis in -depleted cells. Mechanistically, the transcription factor ZNF460 directly bound to the promoter, enhancing transcription and activating downstream GSDME-mediated pyroptosis. knockdown reduced pyroptotic cell death and preserved aortic wall integrity . CONCLUSIONS: This study identifies ZNF460 as a novel upstream regulator of that drives GSDME-dependent pyroptosis, thereby exacerbating AD progression. Targeting the ZNF460-PKM2-GSDME axis may represent a promising therapeutic strategy for preventing pyroptosis-driven vascular damage in AD.
Percutaneous Closure of Patent Foramen Ovale is Associated With Improvement of Migraine.
Ge XM, Han KN, Gao F … +2 more , Wang ZJ, Zhou YJ
Rev Cardiovasc Med · 2026 Mar · PMID 41923735 · Full text
BACKGROUND: Patent foramen ovale (PFO) is the most common congenital heart defect and has been linked to migraines; however, the relationship between PFO and migraine remains controversial. This study aimed to evaluate w...
BACKGROUND: Patent foramen ovale (PFO) is the most common congenital heart defect and has been linked to migraines; however, the relationship between PFO and migraine remains controversial. This study aimed to evaluate whether percutaneous PFO closure alleviates migraines and explore the association between PFO and migraine. METHODS: Data from 5581 inpatients with PFO were collected between 2015 and 2020. A total of 71 stroke-free adults with PFO (45 with closure and 26 without) were included. Self-reported migraine history, frequency, and severity (0-10) were assessed. Outcomes were compared between patients with and without PFO closure, and logistic regression was used to examine the relationship between PFO closure and migraine improvement. RESULTS: PFO closure significantly reduced migraine frequency and severity, with greater improvements observed after 2 years ( 0.001). Logistic regression showed that PFO closure was associated with a higher likelihood of migraine improvement than non-closure (odds ratio (OR): 5.57, 95% confidence interval (CI): 1.76-17.68; = 0.004). This association persisted after adjusting for multiple risk factors ( = 0.005). CONCLUSION: Percutaneous PFO closure significantly improved migraines by reducing both frequency and severity, supporting a potential association between PFO and migraine.
Concomitant Intra-Aortic Balloon Pump Throughout Extracorporeal Cardiopulmonary Resuscitation: A Meta-Analysis of Cohorts.
Liu H, Wang L, Fu H … +5 more , Wang H, Hao X, Du Z, Li C, Hou X
Rev Cardiovasc Med · 2026 Mar · PMID 41923734 · Full text
BACKGROUND: Inconsistent reports exist regarding the efficacy of using a concomitant intra-aortic balloon pump (IABP) among cardiac arrest (CA) patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Thu...
BACKGROUND: Inconsistent reports exist regarding the efficacy of using a concomitant intra-aortic balloon pump (IABP) among cardiac arrest (CA) patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Thus, this review was conducted to summarize the prognoses of adult ECPR patients with concurrent IABP. METHODS: Data were gathered from PubMed, Embase, MEDLINE, Web of Science, and Cochrane databases. Cohorts of adult patients receiving ECPR with or without IABP, reporting short-term mortality, neurological outcomes, or extracorporeal membrane oxygenation (ECMO) weaning rates, were recruited. Characteristics of the study population and the above-mentioned outcomes were extracted. A random-effects model was used to pool the data. Subgroup analyses were conducted in the propensity score-matching (PSM) population. RESULTS: Nine cohorts with 5260 adult ECPR patients were included. In-hospital/30-day mortality, neurological performances of survivors, and ECMO weaning outcomes were not significantly different between populations with and without IABP. Nevertheless, younger patients with IABP showed an apparent improvement in in-hospital/30-day mortality. Similar findings were demonstrated in the analyses of PSM cohorts. High heterogeneity was present in the total cohort. CONCLUSIONS: In ECPR populations, concomitant IABP did not influence short-term survival, neurological, or ECMO weaning outcomes in the total cohort. However, IABP exhibited a survival benefit in the younger ECPR population. Further research in specific populations is warranted to validate and endorse our aggregated data. THE PROSPERO REGISTRATION: CRD42024528761, Registration Link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024528761.
Sex-Specific Heart Rate Variability Associations With Vitamin B12, Folate, and Iron Status.
Özyaşar M, Öztürk S, Memioğlu T … +1 more , Inanir M
Rev Cardiovasc Med · 2026 Mar · PMID 41923733 · Full text
BACKGROUND: The sex-specific impact of micronutrient status on heart rate variability (HRV) in adults presenting with palpitations to cardiology outpatient clinics remains unclear. Thus, this study aimed to assess the de...
BACKGROUND: The sex-specific impact of micronutrient status on heart rate variability (HRV) in adults presenting with palpitations to cardiology outpatient clinics remains unclear. Thus, this study aimed to assess the demographic and biochemical determinants of HRV in a clinical cohort of patients presenting with complaints of palpitations. METHODS: This retrospective study included 213 adults aged 18-65 years who presented with palpitations and underwent 24-hour Holter monitoring at our institution between 2023 and 2024. Patients with cardiovascular disease, known arrhythmias, chronic inflammatory conditions, renal dysfunction, or use of medications that affected autonomic function were excluded from the study. Demographic variables, laboratory parameters, and HRV indices were statistically analyzed. The standard deviation of all normal-to-normal intervals (SDNN) was the primary HRV parameter used in both univariate and multivariate linear regression analyses. RESULTS: The SDNN was significantly lower in women and older adults. In the univariate analyses, age ( = -0.203; = 0.003), male sex ( = 0.529; < 0.001), ferritin, serum iron, folate, and Vitamin B12 were all associated with the SDNN. However, in the multivariable model, only male sex ( = 0.467; < 0.001), iron-binding capacity (IBC) ( = -0.377; < 0.001), and folate ( = 0.117; = 0.037) remained independent predictors. Elevated IBC, reflecting functional iron deficiency, was strongly associated with a reduced SDNN, whereas higher folate levels were associated with better autonomic modulation. CONCLUSIONS: In patients presenting with palpitations, the SDNN is influenced by both demographic factors and biochemical markers of iron metabolism. Elevated IBC, reflecting alterations in iron metabolism and iron availability, was associated with impaired autonomic regulation, even in the absence of overt anemia. In contrast, adequate folate status appeared to support a more favorable autonomic function. These findings highlight the importance of integrating iron-vitamin assessment into the evaluation of autonomic function and underscore the need for prospective studies to determine whether correcting these abnormalities can improve HRV and clinical outcomes.
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