Reviews In Cardiovascular Medicine[JOURNAL]
Sun
200 papers
The Efficacy of Traditional Chinese Exercises in Patients With Chronic Heart Failure: An Umbrella Review and Meta-Analysis.
Zhao X, Zou R, Miao H … +16 more , Chang X, Chinda K, Chen F, Zhang M, Zhuo J, Sun X, Chen Y, Li C, He Q, Luo C, Kwok T, Xu D, Zhang Y, Zhou H, Fan X, Ong SB
Rev Cardiovasc Med · 2026 Mar · PMID 41923712 · Full text
BACKGROUND: Chronic heart failure (CHF) is a common clinical syndrome characterized by reduced exercise capacity, diminished quality of life (QoL), and unfavorable cardiovascular outcomes. Conventional cardiac rehabilita...
BACKGROUND: Chronic heart failure (CHF) is a common clinical syndrome characterized by reduced exercise capacity, diminished quality of life (QoL), and unfavorable cardiovascular outcomes. Conventional cardiac rehabilitation often requires moderate-to-high-intensity exercise, which may be tolerated poorly by many CHF patients. Low-intensity mind-body interventions, such as traditional Chinese exercises (TCEs), are potentially more suitable; however, the evidence from existing studies is fragmented and sometimes inconsistent. Thus, this study aimed to conduct an umbrella review of systematic reviews (SRs) and meta-analyses (MAs) to evaluate the effectiveness of TCEs in improving exercise capacity, QoL, and cardiovascular function in patients with CHF. METHODS: An umbrella review of SRs/MAs was conducted by searching English and Chinese databases without language limits and focusing on randomized controlled trials (RCTs) that assessed the additional benefit of TCEs in individuals with CHF. Methodological quality was appraised using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist and the Risk of Bias in Systematic Reviews (ROBIS) instrument. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to quantify the certainty of evidence. Individual trial data were retrieved, and re-meta-analyses were performed using standard statistical procedures, with publication bias assessed via Egger's test. RESULTS: A total of 15 SRs/MAs were included, encompassing 65 original trials. Our re-meta-analysis indicated that TCEs were associated with substantially longer 6-minute walk test (6-MWT) values, improved QoL measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), higher left ventricular ejection fraction (LVEF), reduced B-type natriuretic peptide (BNP) levels, and enhanced maximal oxygen consumption (VOmax). Baduanjin exhibited a particularly robust effect on lowering N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations, while Yijinjing yielded comparatively greater improvements in VOmax. Nonetheless, limitations such as suboptimal methodological quality and overlapping study samples require cautious interpretation. CONCLUSIONS: TCEs may serve as a beneficial adjunct to standard care for CHF, improving exercise capacity, QoL, and key cardiac markers. Large, rigorous RCTs with extended follow-up are needed to confirm the durability of TCEs and further define the role of these exercises in comprehensive CHF rehabilitation. THE PROSPERO REGISTRATION: CRD420251003129 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251003129).
Lactylation, Crotonylation and Succinylation: Decoding Their Roles in the Progression of Cardiovascular Disease.
Hu X, Zhang Y, Zhao Q … +2 more , Li Y, Wu X
Rev Cardiovasc Med · 2026 Feb · PMID 41789347 · Full text
Cardiovascular diseases (CVDs), such as atherosclerosis, myocardial remodeling, myocardial ischemia-reperfusion (I/R) injury, heart failure, and oxidative stress, are among the greatest threats to human health globally....
Cardiovascular diseases (CVDs), such as atherosclerosis, myocardial remodeling, myocardial ischemia-reperfusion (I/R) injury, heart failure, and oxidative stress, are among the greatest threats to human health globally. The molecular mechanisms underlying CVDs have not yet been fully elucidated, but progress has been made in research on epigenetics in CVDs. Post-translational modifications (PTMs), which involve the covalent attachment of functional groups to modulate protein structure and function, represent a critical regulatory mechanism. These modifications enhance the functional diversity of the proteome without the need for de novo protein synthesis. Traditional types of PTMs, such as phosphorylation, acetylation, and ubiquitination, are closely associated with the pathogenesis of CVDs. With the application of high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), an increasing number of novel acylation modifications have been discovered, including propionylation, butylation, crotonylation, succinylation, lactylation, and isonicotinylation. A deeper understanding of the role of PTMs in CVDs is essential for unraveling their molecular regulatory mechanisms and identifying new biomarkers and therapeutic targets. This review summarizes the mechanisms related to the occurrence and development of CVDs associated with three novel acylation modifications: crotonylation, lactylation, and succinylation.
Functional Substrate Mapping in Ablation for Scar-Related Ventricular Tachycardia.
Nakahara S, Sato H, Bradfield JS
Rev Cardiovasc Med · 2026 Feb · PMID 41789346 · Full text
Notably, most ventricular tachycardia (VT) episodes in patients with VT attributable to structural heart disease are not hemodynamically tolerated. Therefore, techniques for substrate mapping during stable intrinsic or p...
Notably, most ventricular tachycardia (VT) episodes in patients with VT attributable to structural heart disease are not hemodynamically tolerated. Therefore, techniques for substrate mapping during stable intrinsic or paced rhythm have been developed that eliminate the need to induce VT. Moreover, advances in catheter technology, enabling high-density multi-electrode mapping of abnormal electrograms, have improved the ability of electrophysiologists to identify the substrate responsible for scar-related VT. In addition to the conventional identification of late potentials and local abnormal ventricular activity (LAVA), several substrate imaging approaches have been developed, including the identification of sites of conduction slowing via isochronal late activation mapping and the modification of wavefronts by changing the pacing site. Further, a new near-field algorithm provides a degree of objectivity to the previously subjective annotations of local potential timing. Additionally, changes in the substrate within the scar, specifically the induction of a line of block and subsequent alteration of a LAVA by decremental conduction, can identify functional abnormal ventricular activity that contributes to the development and maintenance of VT and can further improve the accuracy of substrate mapping. Novel cardiac magnetic resonance imaging and computed tomography analyses, facilitated by specialized software, also provide information for non-invasive estimation of the VT isthmus location. Therefore, continued clinical implementation of these techniques and technologies has the potential to improve safety, reduce the complexity, and expand the number of patients who can safely undergo VT ablation.
Critical Care Cardiology Fellowship Training in China: Past, Present, and Future.
Liu WJ, Luo Z, Luo MH … +1 more , Tu GW
Rev Cardiovasc Med · 2026 Feb · PMID 41789345 · Full text
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Catheter Ablation vs. Medical Therapy for Ventricular Tachycardia in Ischemic Cardiomyopathy: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.
Wang SP, Yuan Y, Zhong PY … +1 more , Zhou ZY
Rev Cardiovasc Med · 2026 Feb · PMID 41789344 · Full text
BACKGROUND: Managing ischemic cardiomyopathy-related ventricular tachycardia (VT) remains clinically challenging since no definitive consensus exists regarding the optimal therapeutic approach. Therefore, this study aime...
BACKGROUND: Managing ischemic cardiomyopathy-related ventricular tachycardia (VT) remains clinically challenging since no definitive consensus exists regarding the optimal therapeutic approach. Therefore, this study aimed to assess the safety and efficacy of catheter ablation for VT in patients with ischemic cardiomyopathy. METHODS: We systematically searched the PubMed, EMBASE, and Cochrane Library databases to identify pertinent clinical trials. We selected the relative risk (RR) and mean difference (MD) as the effect measures, which were calculated using Review Manager software. Additionally, we used trial sequential analysis to assess each outcome. RESULTS: Our study included six randomized controlled trials with 1064 patients. Catheter ablation was found to reduce the risk of the composite endpoint (RR 0.83, 95% confidence interval (CI) 0.74-0.94; = 0.002), cardiac hospitalizations (RR 0.82, 95% CI 0.71-0.95; = 0.007), and adverse events (RR 0.75, 95% CI 0.62-0.91; = 0.003). Additionally, no significant differences were observed between the two groups regarding VT recurrence (RR 0.94, 95% CI 0.83-1.06; = 0.33), appropriate implantable cardioverter-defibrillator (ICD) shocks (RR 0.85, 95% CI 0.72-1.01; = 0.06), or all-cause mortality (RR 0.93, 95% CI 0.73-1.18; = 0.53). CONCLUSIONS: Catheter ablation reduced the incidence of composite endpoints, cardiac hospitalizations, and adverse events related to VT in patients with ischemic cardiomyopathy. However, no statistically significant differences were found between the two groups for VT recurrence, appropriate ICD shocks, and all-cause mortality. THE PROSPERO REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251011744.
The Associations of Anthropometric Indices With Stages and Mortality in Cardiovascular-Kidney-Metabolic Syndrome: Insights From NHANES.
Zhong M, Liu CN, Chen Y
Rev Cardiovasc Med · 2026 Feb · PMID 41789343 · Full text
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome embodies the interconnection between cardiovascular, renal, and metabolic disorders. Anthropometric indices reflect distinct aspects of obesity and may aid in st...
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome embodies the interconnection between cardiovascular, renal, and metabolic disorders. Anthropometric indices reflect distinct aspects of obesity and may aid in stratifying the severity of CKM syndrome and predicting mortality. Thus, this study aimed to assess and compare the relationships between multiple obesity-related measures and advanced CKM stages, as well as the risk of mortality. METHODS: Data included in this analysis were from the National Health and Nutrition Examination Survey (NHANES). Participants were categorized into quartiles (Q1-Q4) based on each anthropometric index. We estimated the associations with all-cause, cardiovascular, and non-cardiovascular mortality outcomes using Cox proportional hazards models, and evaluated the odds of an advanced CKM stage (stages 3/4) using logistic regression. Possible non-linear exposure-outcome patterns were further investigated through restricted cubic spline modelling. Then, to compare the predictive performance of the indices, we calculated the area under the receiver operating characteristic curve (AUC). RESULTS: We included 28,911 adults from the NHANES (1999-2018) (median age (interquartile range (IQR)) 55.0 (40.0-67.0) years, 52.5% male), comprising 21,789 in CKM stages 1-2 and 7122 in stages 3-4. The anthropometric indices varied significantly across CKM stages ( < 0.001), with body mass index, waist circumference, Weight-adjusted Waist Index (WWI), and relative fat mass increasing with disease severity. In stages 1-2, the highest quartile (Q4) of A Body Shape Index (ABSI), WWI, waist-to-height ratio (WHtR), and Conicity Index (C-index) was associated with higher all-cause and cardiovascular mortalities, often following U-shaped or J-shaped non-linear patterns. In stages 3-4, predictive strength diminished, with only the ABSI and WWI showing consistent associations with mortality. For CKM progression, the ABSI (AUC = 0.73), WWI (AUC = 0.70), and C-index (AUC = 0.69) demonstrated the best discrimination. CONCLUSIONS: This study shows that several anthropometric indices, particularly the ABSI, WWI, WHtR, and C-index, are strongly associated with advanced CKM stage and increased mortality risk. These associations were stronger for central adiposity measures than for general adiposity, suggesting the potential relevance of central fat distribution and supporting the possible role of anthropometric indices in early risk stratification and targeted intervention in CKM syndrome.
Unraveling Immune Checkpoint Inhibitor-Associated Cardiovascular Toxicities: Pathway Insights, Mechanisms, and Emerging Therapeutic Targets.
Zhang B, Muhetarijiang M, Sun X … +6 more , Wu Y, Justin R, Li Z, Chen T, Zhou D, Hu X
Rev Cardiovasc Med · 2026 Feb · PMID 41789342 · Full text
Immune checkpoints are critical regulatory molecules in the immune system that maintain self-tolerance by preventing excessive immune activation against healthy tissues while being exploited by malignant cells to promote...
Immune checkpoints are critical regulatory molecules in the immune system that maintain self-tolerance by preventing excessive immune activation against healthy tissues while being exploited by malignant cells to promote tumorigenesis and metastasis through immune evasion mechanisms. Immune checkpoint inhibitors (ICIs), represented by programmed cell death protein-1 (PD-1) inhibitors, are a revolutionary class of antitumor therapeutics that have achieved remarkable clinical success over the last decade, with the application of ICIs expanding to a broader spectrum of malignancies. Nonetheless, the administration of ICIs may induce immune dysregulation, potentially leading to the development of multiple immune-related adverse events (irAEs) across various organ systems. Cardiovascular toxicities are a series of relatively rare but severe irAEs that are drawing increasing attention. This review summarizes the latest findings in immune checkpoint signaling pathways and the potential mechanisms underlying the development of various cardiovascular toxicities associated with immunotherapies. Additionally, we also evaluate advances and novel therapeutic targets in the treatment of cardiovascular toxicities.
Critical Reappraisal of Takotsubo Syndrome (TS) and Myocarditis Association: "The Myocarditis-Like Features" Seen in TS Are Secondary Changes and not True Myocarditis.
Y-Hassan S
Rev Cardiovasc Med · 2026 Feb · PMID 41789341 · Full text
Takotsubo syndrome (TS) is an acute cardiac disease entity characterized by a reversible regional, usually circumferential, left ventricular wall motion abnormality in patients presenting with a clinical picture resembli...
Takotsubo syndrome (TS) is an acute cardiac disease entity characterized by a reversible regional, usually circumferential, left ventricular wall motion abnormality in patients presenting with a clinical picture resembling that of acute coronary syndrome with non-obstructive coronary arteries. Overwhelming evidence supports the involvement of sympathetic nervous system hyperactivation in the pathogenesis of TS. Therefore, the diagnostic pathogenic term of autonomic neurocardiogenic (ANCA) syndrome has also been introduced. An association between TS or ANCA syndrome and "myocarditis" has been reported. The definitive histopathological diagnosis of acute "myocarditis" is based on myocardial infiltration with mainly mononuclear cells and signs of non-ischemic myocyte necrosis with or without fibrosis. The radiological diagnosis of myocarditis is based on the cardiac magnetic resonance (CMR) imaging findings of hyperemia, myocardial oedema, and non-ischemic myocardial necrosis/fibrosis. These endomyocardial biopsy and CMR imaging findings may also be seen in TS or ANCA syndrome and have been interpreted as true "myocarditis". However, histopathological changes in TS or ANCA syndrome begin with hypercontraction of sarcomeres, and myocardial cells may die in a tonic state if hypercontraction is severe and persistent. This myocardial cell necrosis elicits mononuclear cell infiltration, followed by fibrosis and scarring. Mononuclear cell infiltration occurs as a response or secondary process following the development of myocardial cell necrosis. Regrettably, these histopathological "secondary myocarditis-like changes" and the consequent CMR imaging findings have been, and at times remain, misdiagnosed as true "myocarditis" for many decades. These misinterpretations have been critically reviewed, analyzed, and illustrated with revealing images and with a novel conclusion.
Paediatric Heart Transplantation in Resource-Limited Settings: A Silent Crisis.
Francis J, Dobromirescu A, Francis J
Rev Cardiovasc Med · 2026 Feb · PMID 41789340 · Full text
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Drug-Coated Balloons Beyond In-Stent Restenosis.
Gupta R, Bohra C, Vemuri KS … +5 more , Arora G, Gulati A, Ranadive I, Sharma SK, Hooda A
Rev Cardiovasc Med · 2026 Feb · PMID 41789339 · Full text
Drug-coated balloons (DCBs) are rapidly gaining prominence, owing to the associated expanding clinical applications and therapeutic potential in interventional cardiology. Moreover, a growing body of evidence from random...
Drug-coated balloons (DCBs) are rapidly gaining prominence, owing to the associated expanding clinical applications and therapeutic potential in interventional cardiology. Moreover, a growing body of evidence from randomized trials, observational studies, and meta-analyses supports the efficacy of DCBs across a broad spectrum of coronary lesions, positioning these devices as a viable, stent-free alternative to conventional strategies. DCBs aim to lower the risks inherent to stent implantation, such as stent thrombosis and in-stent restenosis (ISR), and to enable abbreviated dual antiplatelet therapy in high-bleeding-risk (HBR) patients. Although drug-eluting stents (DESs) remain the current standard in percutaneous coronary intervention, DCBs are emerging as a novel and promising option in diverse clinical settings beyond ISR, including lesions in both small and large vessels, bifurcation disease, patients with a high risk of bleeding, and even acute coronary syndromes. This article aims to provide a comprehensive review of the evolving role, evidence base, and expanding indications of DCB-related therapy beyond ISR.
Potential Similarity of Serum Cholesterol Multivariate Coefficients in the Prediction of Coronary Heart Disease Across Populations: A Review From the Seven Countries Study.
Menotti A, Puddu PE
Rev Cardiovasc Med · 2026 Feb · PMID 41789338 · Full text
This study aimed to review the unique contribution of the Seven Countries Study (SCS) of cardiovascular diseases to the possible non-heterogeneity in multivariate coefficients of serum cholesterol in predicting coronary...
This study aimed to review the unique contribution of the Seven Countries Study (SCS) of cardiovascular diseases to the possible non-heterogeneity in multivariate coefficients of serum cholesterol in predicting coronary heart disease (CHD) mortality across different populations. This study reviewed five published analyses from the SCS, which together encompassed 16 cohorts of middle-aged men from eight nations across seven countries in the USA, northern and southern Europe, and Japan. In total, these analyses included 12,763 participants and follow-up periods ranging from 25 to 60 years after the baseline examination. Serum cholesterol was measured using uniform, standardized procedures that differed from those reported in the literature. Marked differences in mortality rates were observed, with higher rates in the USA and northern Europe and lower rates in the other regions. A systematic comparison of serum cholesterol coefficients did not reveal significant heterogeneity across cohort combinations or follow-up durations of 25, 40, 50, and 60 years for CHD mortality. In all cases, coefficients were adjusted for three additional risk factors: age, cigarette smoking, and systolic blood pressure. Variations in CHD mortality rates across populations were explained by differences in serum cholesterol levels. In contrast, the magnitudes of serum cholesterol coefficients were relatively similar across groups, although not necessarily homogeneous. These findings support the idea that predictive models of CHD mortality developed for a specific population can also be applied to other populations, since the expectation, at least for serum cholesterol, is to obtain similar relative risk estimates, not absolute risk, which aligns with the limited evidence that is available in the current literature.
Evaluation of EuroSCORE II to Determine the Prognosis of Patients With Moderate-To-Severe Aortic Stenosis: A Long-Term Retrospective Study.
Cai X, Hu D, Yan B … +12 more , Chen J, Li W, Lin Y, Lin R, Ye J, Su J, Tong S, Huang X, Xie B, Zhuang X, Chen J, Li J
Rev Cardiovasc Med · 2026 Feb · PMID 41789337 · Full text
BACKGROUND: Aortic stenosis (AS) is a prevalent heart valve disease; however, morbidity and mortality are significantly reduced by aortic valve replacement (AVR). The European System for Cardiac Operative Risk Evaluation...
BACKGROUND: Aortic stenosis (AS) is a prevalent heart valve disease; however, morbidity and mortality are significantly reduced by aortic valve replacement (AVR). The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is used to assess perioperative mortality risk in patients with severe AS undergoing AVR. This study aimed to evaluate the prognostic value of EuroSCORE II for long-term all-cause mortality in Chinese patients with moderate-to-severe AS, determine whether AVR affects this prognostic value, and identify the best cut-off value for low-risk EuroSCORE II patients without AVR. METHODS: A total of 544 patients with moderate-to-severe AS were divided into four groups based on the associated EuroSCORE II value (cut-off of 4%) and whether the patient had previously undergone AVR. Kaplan-Meier survival analysis, Cox regression, and subgroup analyses were performed to assess the association between EuroSCORE II and all-cause mortality. A receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for predicting mortality. RESULTS: A total of 132 (24.3%) participants reached the endpoint during a median follow-up of 3.45 years. Patients with a EuroSCORE II ≥4% who did not undergo AVR had significantly higher all-cause mortality rates compared to other groups (55.4% vs. 6.5%, 32.7%, and 13.4%; 0.001). Kaplan-Meier analysis confirmed these findings (log-rank test, < 0.001). Cox regression showed a 6.89-fold increased risk in patients without AVR and higher EuroSCORE II values (hazard ratio (HR), 6.891; 95% confidence interval (CI), 3.083-15.401; 0.001). The optimal cut-off value for predicting mortality in patients without AVR was 2.23% (area under the curve (AUC), 0.675). CONCLUSIONS: Both EuroSCORE II (cut-off value of 4%) and AVR status were independently associated with the long-term prognosis of patients with moderate-to-severe AS. CLINICAL TRIAL REGISTRATION: NCT06069232, https://clinicaltrials.gov/study/NCT06069232.
Navigation of the Clinical Implications, Interventional Challenges, and Complexities of the Circumflex Coronary Artery: A Comprehensive Review.
Elhakim A, Hassaan A, Yassen I … +5 more , Mosaad M, Elhakim M, Bisht O, Baraka M, Saad M
Rev Cardiovasc Med · 2026 Feb · PMID 41789336 · Full text
The circumflex (Cx) coronary artery is more vulnerable to injury than other coronary arteries during procedures such as radiofrequency ablation, left atrial appendage closure, mitral valve repair, and coronary sinus-base...
The circumflex (Cx) coronary artery is more vulnerable to injury than other coronary arteries during procedures such as radiofrequency ablation, left atrial appendage closure, mitral valve repair, and coronary sinus-based mitral valve intervention. Furthermore, a lower success rate was also observed in the Cx artery during chronic occlusion recanalization. Additionally, injury to the great cardiac vein during Cx artery interventions can occur due to the highly variable and often unpredictable relationship between the great cardiac vein and the Cx artery, which occurs in approximately 30% of cases. Imaging information on the Cx artery and the associated relationship with surrounding cardiac structures is crucial for understanding spatial orientation. This knowledge aids preventive measures, accurate prediction, prompt recognition, and understanding of injury mechanisms, thereby facilitating appropriate therapeutic interventions. We present a comprehensive literature review of the clinical implications, complexities, and challenges associated with the Cx artery, which could help in management strategies and improve outcomes.
Employment of the Albumin to Alkaline Phosphatase Ratio to Predict All-cause Mortality and Cardiovascular and Cerebrovascular Mortality in Adults Aged At Least 60 Years: An Analysis From NHANES 2003-2018.
Tan Z, Zhang M, Liu L … +4 more , Li S, Xue X, Liu Y, Ren H
Rev Cardiovasc Med · 2026 Feb · PMID 41789335 · Full text
BACKGROUND: The relationship between the albumin-to-alkaline phosphatase ratio (AAPR) and all-cause and cardiovascular and cerebrovascular mortalities, in adults aged 60 years and above, remains unclear. Thus, this study...
BACKGROUND: The relationship between the albumin-to-alkaline phosphatase ratio (AAPR) and all-cause and cardiovascular and cerebrovascular mortalities, in adults aged 60 years and above, remains unclear. Thus, this study aimed to investigate the relationship between the AAPR and all-cause mortality, as well as cardiovascular and cerebrovascular prognosis, in adults aged at least 60 years. METHODS: A total of 13,603 eligible participants were included. Kaplan-Meier curves and log-rank tests were utilized to compare variations in all-cause, cardiovascular, and cerebrovascular mortalities across the AAPR quartiles. Multivariate Cox proportional hazards models and restricted cubic splines (RCS) were applied to examine the associations among the AAPR and all-cause, cardiovascular, and cerebrovascular mortalities. RESULTS: Cumulative all-cause mortality and cardiovascular and cerebrovascular mortality in the highest AAPR quartile were remarkably lower than in the lowest quartile. A higher AAPR was related to a diminished risk of all-cause mortality [hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.57-0.71] and cardiovascular and cerebrovascular mortality (HR = 0.73, 95% CI: 0.60-0.90). The AAPR showed a negative linear association with cardiovascular and cerebrovascular mortality ( for nonlinearity = 0.176). In contrast, the relationship between the AAPR and all-cause mortality followed an L-shaped pattern ( for nonlinearity < 0.001). CONCLUSIONS: The AAPR is important in predicting the risks associated with all-cause mortality and cardiovascular and cerebrovascular mortality, providing meaningful insights into mortality risk among the older adult population.
Right Ventricular Function in Patients With Significant Tricuspid Regurgitation.
Galloo X, Unger P
Rev Cardiovasc Med · 2026 Feb · PMID 41789334 · Full text
Significant tricuspid regurgitation (TR) is increasingly recognized as a major determinant of morbidity and mortality, yet the clinical impact of significant TR has long been underestimated. Assessment of right ventricul...
Significant tricuspid regurgitation (TR) is increasingly recognized as a major determinant of morbidity and mortality, yet the clinical impact of significant TR has long been underestimated. Assessment of right ventricular (RV) systolic function is central to understanding and managing TR and represents the principal determinant of symptoms, therapeutic response, and long-term outcomes. The unique sensitivity of the RV to alterations in preload and afterload leads to maladaptive remodeling, making accurate functional assessment essential for risk stratification and for optimizing the timing and type of intervention, especially given the expanding range of available surgical and transcatheter treatment options. Echocardiography remains the primary imaging modality, providing qualitative and quantitative evaluations of RV function through parameters such as tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), and tissue Doppler systolic velocity (S'). Advances in speckle-tracking echocardiography for RV free-wall longitudinal strain and in three-dimensional imaging have improved accuracy; however, all echocardiographic measures remain limited by the complex geometry of the RV. When feasible and available, cardiac magnetic resonance (CMR) imaging serves as the reference standard for precise assessment of RV volumetric and functional parameters. Impaired RV systolic function, both before and after intervention, irrespective of the imaging parameter used for the assessment, consistently predicts adverse outcomes in patients with severe TR, including heart failure progression, reduced exercise tolerance, and decreased survival. Therefore, early recognition and quantification of RV dysfunction are crucial to enable timely therapy, as interventions before the development of advanced RV impairment provide symptomatic and survival benefits. This review summarizes the pathophysiology, quantitative thresholds, and prognostic significance of RV function assessment, emphasizing the pivotal role this evaluation plays in the contemporary management of significant TR.
Prognostic Value of Estimated Glomerular Filtration Rate in Older Patients With Acute Coronary Syndrome.
Li Y, Sang T, Li Z … +6 more , Lv N, Liu J, Gu Y, Han X, Zhang W, Dang A
Rev Cardiovasc Med · 2026 Feb · PMID 41789333 · Full text
BACKGROUND: While the association between estimated glomerular filtration rate (eGFR) and cardiovascular disease has been well established in younger populations, the prognostic significance of this marker in older indiv...
BACKGROUND: While the association between estimated glomerular filtration rate (eGFR) and cardiovascular disease has been well established in younger populations, the prognostic significance of this marker in older individuals remains less well defined. Thus, this study aimed to evaluate the predictive value of eGFR in patients aged 80 years or older with acute coronary syndrome (ACS). METHODS: We enrolled 551 patients aged ≥80 years hospitalized for ACS, who had the eGFR calculated at admission. The participants were further stratified into three groups by eGFR levels: Low-eGFR group (L-eGFR, eGFR < the 20th percentile), Medium-eGFR group (M-eGFR, the 20th percentile ≤ eGFR < the 80th percentile), and High-eGFR group (H-eGFR, eGFR ≥ the 80th percentile). Major adverse cardiovascular events (MACEs) were recorded during the follow-up period. RESULTS: During a median 63-month follow-up, the L-eGFR group exhibited a higher cumulative incidence of MACEs, while the H-eGFR group showed a relatively improved prognosis compared with the M-eGFR group. A multivariate Cox regression analysis revealed that reduced eGFR levels remained independently predictive for long-term MACEs. Compared with the M-eGFR group, the L-eGFR group showed a higher risk (hazard ratio (HR) 1.542, 95% confidence interval (CI): 1.104-2.155). The H-eGFR group exhibited a protective effect (HR 0.643, 95% CI: 0.438-0.943). CONCLUSIONS: Reduced eGFR levels were independent predictors for long-term MACEs in older ACS patients. The H-eGFR group had an improved prognosis, suggesting that further exploration of the underlying mechanism linking renal function and prognosis is warranted.
Lymphocyte-To-Monocyte Ratio is Partially Mediated in Age-Related Cardiovascular Mortality in HFpEF: Immunosenescence, Inflamm-Aging, and Longevity.
Cai X, Liu M, Feng C … +10 more , Tang S, Qin P, Li Y, Wang T, He L, Lei J, Zhou Y, Guo Y, Zhuang X, Liao X
Rev Cardiovasc Med · 2026 Feb · PMID 41789332 · Full text
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is recognized as an aging-related clinical syndrome with high mortality, from which systemic inflammation could represent a primary culprit. Thus, this s...
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is recognized as an aging-related clinical syndrome with high mortality, from which systemic inflammation could represent a primary culprit. Thus, this study aimed to evaluate the association between the lymphocyte-to-monocyte ratio (LMR), a systemic inflammation marker, and clinical outcomes, and to explore the mediation effect of the LMR in the relationship between age and mortality for HFpEF. METHODS: Participants in the Real-world Data of Cardiometabolic ProtEcTion trial (RED-CARPET) trial were categorized into tertiles based on the recorded LMRs. We employed Cox regression analyses to explore the relationship between the LMR and mortality, as well as mediation analyses to determine whether the LMR serves as a mediator between aging and mortality. RESULTS: A total of 1274 inpatients with HFpEF were enrolled between May 2015 and December 2023. After a median follow-up period of 4.9 years, there were 166 recorded deaths, of which 82 were due to cardiovascular causes. In the third model, each one-unit increase in standard deviation (SD) for age was correlated with a 1.98-fold increase in the risk of overall mortality (95% confidence interval (CI), 1.66-2.35) and a 1.73-fold increase in the risk of death due to cardiovascular disease (95% CI, 1.36-2.21). Compared to patients in the first tertile of the LMR, those in the third tertile exhibited a lower risk of death (hazard ratio (HR) 0.42; 95% CI (0.27-0.65)) and cardiovascular death (HR 0.23; 95% CI (0.12-0.46)). Mediation analyses indicated that the LMR partially mediated the relationship between age and cardiovascular mortality in patients with HFpEF, with a mediation proportion of 17.9% (95% CI (7.2%-36%); < 0.001). CONCLUSIONS: The LMR may serve as a marker for mortality and is implicated in the mediation of age-related cardiovascular death in patients with HFpEF. This study offers a cost-effective predictor for HFpEF and suggests potential mechanisms related to immunosenescence and inflammation-related aging (inflamm-aging).
Statin-Mediated Modulation of Nrf2 Signaling: Mechanisms and Therapeutic Implications in Atherosclerosis.
Marzoog BA, Kopylov P
Rev Cardiovasc Med · 2026 Feb · PMID 41789331 · Full text
Statins are the cornerstone of lipid-lowering therapy and exert significant pleiotropic effects, including antioxidant and anti-inflammatory actions, which contribute to statin-mediated cardiovascular benefits. A key mec...
Statins are the cornerstone of lipid-lowering therapy and exert significant pleiotropic effects, including antioxidant and anti-inflammatory actions, which contribute to statin-mediated cardiovascular benefits. A key mechanism underlying these effects is the indirect activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) transcription factor. This review critically assesses the molecular pathways through which statins modulate Nrf2 signaling, primarily through the PI3K/Akt and ERK pathways, which results in the nuclear translocation of Nrf2 and the transactivation of a battery of cytoprotective genes (.., (), Nicotinamide Adenine Dinucleotide (Phosphate) (reduced) () (), - ()). This review synthesized evidence on the mechanism through which Nrf2 modulation stabilizes atherosclerotic plaques by mitigating oxidative stress and inflammation within the vascular wall. Furthermore, we explore the cell-type-specific effects of these findings within the complex plaque microenvironment and discuss any unresolved questions, including the therapeutic potential and pharmacokinetic challenges of combining statins with direct Nrf2 activators. Thus, by extending beyond a descriptive summary, this review provides a mechanistic integration of the statin-Nrf2 axis and identifies key frontiers for future research, emphasizing the need to harness these pleiotropic effects for improved cardiovascular outcomes.
Dietary Index for Gut Microbiota and Risk of All-Cause and Cardiovascular Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages 0-3: A Nationwide Prospective Cohort Study.
Wang Y, Huang A, Bi L … +4 more , Li S, Li Q, Zhang P, Lv T
Rev Cardiovasc Med · 2026 Feb · PMID 41789330 · Full text
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome represents a progressive disorder characterized by the interplay of cardiovascular pathologies, chronic renal impairment, and metabolic dysregulation. Therefore,...
BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome represents a progressive disorder characterized by the interplay of cardiovascular pathologies, chronic renal impairment, and metabolic dysregulation. Therefore, this study aimed to examine the relationship between the dietary index for gut microbiota (DI-GM) and mortality outcomes, including both all-cause and cardiovascular-specific mortality, in individuals classified with CKM syndrome stages 0-3. METHODS: Our study cohort consisted of 7884 adult participants aged 30-79 years from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2018. Dietary intake data obtained through 24-hour dietary recalls and food frequency questionnaires were used to calculate the DI-GM scores, incorporating both components beneficial to the microbiota and those with potentially detrimental nutritional effects. The primary and secondary endpoints were all-cause mortality and cardiovascular-related mortality, respectively. The Kaplan-Meier survival analysis, Cox proportional hazards regression models, and restricted cubic spline (RCS) techniques were employed in the statistical analyses. RESULTS: The participants had a median age of 50 years, with females comprising 52.97% of the cohort. Over a median follow-up period of 77 months, we documented 469 all-cause deaths (4.56%) and 105 cardiovascular fatalities (1.02%). Elevated beneficial scores for the DI-GM demonstrated significant inverse associations with both all-cause ( < 0.001) and cardiovascular mortality ( = 0.017). However, while the total DI-GM scores showed correlation with decreased all-cause mortality ( < 0.001), no significant association emerged for cardiovascular mortality. Following the employment of a comprehensive adjustment, the hazard ratio (HR) for the total DI-GM score and all-cause mortality was 0.90 (95% confidence interval (CI): 0.82-0.98). For the beneficial components, the HR was 0.88 (95% CI: 0.79-0.98) for all-cause mortality and 0.87 (95% CI: 0.77-0.99) for cardiovascular mortality. RCS modeling revealed a U-shaped correlation between the total DI-GM scores and all-cause mortality, which was in contrast to a linear association for the beneficial scores. The systemic inflammation index (SII) accounted for 5.29% and 8.45% of the observed associations between the total and beneficial DI-GM scores and all-cause mortality, respectively. CONCLUSIONS: Elevated DI-GM dietary scores, particularly those emphasizing food components beneficial to the gut microbiota, demonstrate protective associations against both all-cause and cardiovascular mortality in individuals with CKM syndrome in stages 0-3. These protective effects appear partially influenced by systemic inflammatory pathways.
Association Between HAVOC Score and New-Onset Atrial Fibrillation in Patients With ST-Segment Elevation Myocardial Infarction.
Zhou S, Cai D, Wang Z … +2 more , Gao X, Lu W
Rev Cardiovasc Med · 2026 Feb · PMID 41789329 · Full text
BACKGROUND: The HAVOC score is an emerging tool for estimating the risk of atrial fibrillation (AF), which has attracted growing interest. However, the use of the HAVOC score to predict in-hospital new-onset AF (NOAF) am...
BACKGROUND: The HAVOC score is an emerging tool for estimating the risk of atrial fibrillation (AF), which has attracted growing interest. However, the use of the HAVOC score to predict in-hospital new-onset AF (NOAF) among patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. Therefore, this study aimed to examine whether the HAVOC score is associated with NOAF during the index hospitalization following primary percutaneous coronary intervention (PCI) in patients with a STEMI. METHODS: We studied a consecutive cohort of patients presenting with STEMI from January 2023 to March 2025. After primary PCI, each participant underwent continuous electrocardiogram monitoring for at least 72 hours. The HAVOC score was calculated based on hypertension, age ≥75 years, valvular heart disease, peripheral vascular disease, obesity, and heart failure. RESULTS: In total, 725 patients were analyzed, with a mean age of 63.37 ± 13.16 years; of whom 72.97% were male. During the hospital stay, 70 patients (9.66%) experienced NOAF. Multivariate logistic regression analysis showed that the HAVOC score (odds ratio (OR) = 1.42, 95% confidence interval (CI): 1.28-1.59) was independently associated with NOAF. Restricted cubic spline (RCS) analysis revealed a linear dose-response relationship between the HAVOC score and NOAF ( for overall <0.001). Integrating left ventricular ejection fraction (LVEF) and the presence of left anterior descending artery stenosis enhanced the discriminatory ability of the HAVOC score for identifying NOAF (net reclassification index [NRI] = 0.353, 95% CI: 0.114-0.592; = 0.004) and improved integrated discrimination (0.024, 95% CI: 0.006-0.041; = 0.008). CONCLUSIONS: Higher HAVOC scores were independently linked to the occurrence of in-hospital NOAF among STEMI patients following PCI. NOAF risk increased with the HAVOC score, consistent with a linear dose-response across the score spectrum.
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