Reviews In Cardiovascular Medicine[JOURNAL]
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200 papers
Exercise Stress Echocardiography: A Dynamic Assessment for an Evolving Landscape.
Vilela EM, Sampaio F, Ribeiro J … +1 more , Fontes-Carvalho R
Rev Cardiovasc Med · 2026 Jan · PMID 41659117 · Full text
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Optimization of Venoarterial Extracorporeal Membrane Oxygenation Weaning: Hemodynamic Targets, Predictive Indicators, and Future Algorithm.
Li Y, Zhu Y, Wu Z
Rev Cardiovasc Med · 2026 Jan · PMID 41659116 · Full text
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving intervention for patients with refractory cardiogenic shock or cardiac arrest. However, weaning from VA-ECMO remains challenging and significant...
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving intervention for patients with refractory cardiogenic shock or cardiac arrest. However, weaning from VA-ECMO remains challenging and significantly affects patient prognosis. This systematic review examined the multifactorial determinants underlying successful VA-ECMO weaning, highlighting the critical need for integrated evaluation of biventricular function, hemodynamic stability, and microcirculatory perfusion. Key predictive parameters encompass both macrocirculatory indices (including left and right ventricular performance) and metabolic parameters, all of which collectively inform evidence-based weaning decisions. Advanced imaging techniques and multidimensional assessment tools have emerged as promising strategies for optimizing weaning protocols. Pharmacological strategies and precise volume optimization are important for improving weaning success. However, gaps in standardized weaning protocols and bridging therapy algorithms highlight critical, unmet needs. Thus, future efforts should focus on developing dynamic predictive models that incorporate real-time hemodynamic data and on the clinical implementation of microcirculatory assessment technologies.
Trend Dynamics of Rheumatic Heart Disease Burden, 1990-2019: Insights From Age-Period-Cohort Modeling and Projections.
Liu Z, Liu Z, Li Z … +5 more , Zhang F, Ouyang W, Wang S, Jing S, Pan X
Rev Cardiovasc Med · 2026 Jan · PMID 41659115 · Full text
BACKGROUND: Rheumatic heart disease (RHD) is a global autoimmune disease that contributes significantly to cardiovascular mortality. However, a comprehensive investigation into age-specific mortality patterns across dive...
BACKGROUND: Rheumatic heart disease (RHD) is a global autoimmune disease that contributes significantly to cardiovascular mortality. However, a comprehensive investigation into age-specific mortality patterns across diverse regions remains limited. To address this issue, this study aimed to investigate alterations in RHD mortality and disease burden measured by disability-adjusted life years (DALY), and modifiable risk factors across 204 countries and regions during the preceding three decades. Additionally, this study endeavored to forecast the trends for RHD in the coming decade and to explore the associations with the age, period, and birth cohort by analyzing data from the Global Burden of Disease (GBD) 2019. METHODS: We present up-to-date mortality and DALY data for RHD sourced from the GBD 2019 data. We employed the age-period-cohort (APC) model to assess local and net drift, as well as the influences of age, period, and birth cohort. Additionally, we examine modifiable risk factors and provide projections for RHD mortality trends in the coming decade. RESULTS: Age-standardized mortality rates for RHD exhibited a net drift ranging from -5.59 (95% confidence interval (CI): -5.84 to -5.34) in high-middle sociodemographic index (SDI) regions, to -2.34 (95% CI: -2.42 to -2.25) in low SDI regions. Comparable trends were observed with DALY. High systolic blood pressure was the major metabolic risk factor in both 1990 and 2019. Projections indicate a global reduction in RHD mortality rates over the coming decade. Nevertheless, individuals in low-SDI regions are projected to bear a substantial mortality burden in both 2019 and 2029, accentuating a widening sex disparity. CONCLUSIONS: In summary, this study found that age, period, and birth cohort effects for RHD were positive globally, except for low SDI regions. The widening health disparities between regions indicate an imminent threat of significant disease burden. Thus, this study underscores the imperative requirement for targeted interventions, enhanced healthcare accessibility, and sex-sensitive strategies to alleviate the burden of death and disability associated with RHD, particularly in low SDI regions.
Current Evidence on the Potential Role of Endothelial in Pulmonary Vascular Remodeling Associated With Pulmonary Hypertension.
Zhang X, Yang J, Yang Z … +6 more , Liu T, Zeng B, Ma M, Liu Y, Xu S, Xing X
Rev Cardiovasc Med · 2026 Jan · PMID 41659114 · Full text
Pulmonary hypertension (PH) is characterized by an abnormally high pressure within the pulmonary arteries, which can be attributed to various factors. Severe diseases affecting pulmonary vessels may result in heart failu...
Pulmonary hypertension (PH) is characterized by an abnormally high pressure within the pulmonary arteries, which can be attributed to various factors. Severe diseases affecting pulmonary vessels may result in heart failure and potentially lead to death; these conditions are linked to significant mortality and unfavorable outcomes. Approximately 1% of adults worldwide have PH, and this condition may affect up to 10% of people older than 65 years. Currently, the mechanisms involved in the development of PH are not fully known and are thought to result from multiple coordinated factors. This lack of understanding remains a bottleneck in clinical practice. Numerous studies have confirmed that pulmonary artery endothelial cell (PAEC) dysfunction plays an important role in occlusive pulmonary vascular remodeling and the pathogenesis of PH. Src homology region 2 domain-containing phosphatase-1 () is a regulatory molecule that negatively modulates various cellular mediators and growth factors, primarily playing a negative regulatory role in signal transduction pathways. This review mainly presents an in-depth exploration of the key signaling pathways through which regulates the expression of endothelial cells (ECs), thereby influencing various physiological functions, including proliferation, migration, oxidative stress, angiogenesis, apoptosis, autophagy, the inflammatory response, and vascular permeability. Furthermore, the potential mechanisms through which endothelial plays a role in pulmonary vascular remodeling in PH are discussed. These findings underscore as an encouraging therapeutic target for preventing and managing PH.
The Prognostic Gender-Related Value of the Systemic Immune-Inflammation Index in Patients With Acute Coronary Syndrome.
Kofos C, Papazoglou AS, Fyntanidou B … +14 more , Samaras A, Stachteas P, Nasoufidou A, Apostolopoulou A, Karakasis P, Arvanitaki A, Bantidos MG, Moysidis DV, Stalikas N, Patoulias D, Tzikas A, Kassimis G, Fragakis N, Karagiannidis E
Rev Cardiovasc Med · 2026 Jan · PMID 41659113 · Full text
BACKGROUND: Inflammation has recently been identified as a critical regulator of the pathophysiology and prognosis of acute coronary syndrome (ACS). The systemic immune-inflammation index (SII), derived from platelet, ne...
BACKGROUND: Inflammation has recently been identified as a critical regulator of the pathophysiology and prognosis of acute coronary syndrome (ACS). The systemic immune-inflammation index (SII), derived from platelet, neutrophil, and lymphocyte counts, has gained attention as a potential marker for predicting adverse outcomes in cardiovascular diseases. However, the prognostic value of the SII, particularly in relation to gender differences, has not been extensively studied. METHODS: Thus, we conducted a retrospective cohort study of 835 patients hospitalized for ACS at Hippokration Hospital, Thessaloniki, Greece, between 2017 and 2023. The SII was calculated using blood samples taken at admission. Logistic and Cox regression models were used to evaluate the relationship between the SII and all-cause mortality, with stratified analyses conducted according to gender. Receiver operating characteristic (ROC) analysis, Kaplan-Meier survival curves, and restricted cubic spline (RCS) modeling were also performed to assess the discriminative ability and non-linear associations of the SII with mortality. RESULTS: A total of 835 patients were included, with a median follow-up of 25 months. An elevated SII was independently associated with increased long-term mortality, with patients in the highest SII quartile exhibiting a 2.3-fold higher risk of death compared to those in the lowest quartile (adjusted hazard ratio (aHR) = 2.31, 95% confidence interval (CI): 1.60-3.32; < 0.001). The optimal cut-off value for the SII was identified as 1864.19. Gender-stratified analyses revealed a stronger prognostic value in women compared to men (area under the curve (AUC) = 0.70 vs 0.58; = 0.018). The Kaplan-Meier and Cox regression analyses confirmed significantly worse survival for patients with SII levels above this threshold ( < 0.05). The RCS modeling demonstrated a non-linear relationship between the SII and mortality, with a marked increase in risk at higher levels of the SII, especially in women. CONCLUSIONS: The SII is a simple, easily accessible biomarker that independently predicts mortality in ACS patients, with notable gender-specific differences in the prognostic value of the SII. Nonetheless, incorporating SII into routine risk assessment could enhance risk stratification and improve personalized treatment strategies, particularly in settings with limited resources.
Association of Attenuated Plaques Detected by Intravascular Ultrasound With Plaque Calcification Assessed by Computed Tomography Angiography.
Zhao Y, Li J, Dou W … +2 more , Yuan J, Huang X
Rev Cardiovasc Med · 2026 Jan · PMID 41659112 · Full text
BACKGROUND: Coronary artery calcium (CAC) reflects the overall atherosclerotic burden. The CAC density is inversely associated with plaque vulnerability. Intravascular ultrasound (IVUS)-defined attenuated plaques represe...
BACKGROUND: Coronary artery calcium (CAC) reflects the overall atherosclerotic burden. The CAC density is inversely associated with plaque vulnerability. Intravascular ultrasound (IVUS)-defined attenuated plaques represent unstable lesions, which are linked to adverse clinical outcomes. Meanwhile, the determination as to whether coronary computed tomography angiography (CCTA)-derived CAC metrics can serve as noninvasive markers of attenuated plaques remains uncertain. METHODS: This retrospective study included coronary artery disease (CAD) patients who underwent both CCTA and IVUS between January 2023 and December 2024 at our medical center. CCTA was used to quantify plaque volume, density, and composition (lipid, fiber, and calcium), while IVUS was employed to characterize the plaques as attenuated and non-attenuated. RESULTS: Among 94 patients with 150 coronary plaques, calcium volume showed a very strong correlation with total plaque volume ( = 0.953, < 0.0001). Meanwhile, attenuated plaques exhibited significantly lower calcium density (321.00 vs. 499.00 Hounsfield units (HU); = 0.0004), calcium volume (55.20 vs. 168.10 mm; = 0.003), and calcium percentage (33.30% vs. 55.40%; = 0.015) compared with the non-attenuated plaques. Multivariate logistic regression analysis identified lower CAC density as the only independent predictor of IVUS-confirmed attenuated plaques (odds ratio = 0.994, 95% confidence interval (CI): 0.990-0.997; = 0.0002). The area under the receiver operating characteristic (AUROC) curve for CAC density in diagnosing attenuated plaques was 0.735 (95% CI: 0.603-0.868; = 0.0004). At a cutoff of 461.50 HU, the sensitivity and specificity were 81.8% and 66.1%, respectively. CONCLUSION: CCTA-derived CAC volume reflects the atherosclerosis (AS) burden, while lower CAC density independently predicts IVUS-confirmed attenuated plaques. A higher CAC density was associated with plaque stability, suggesting that the CCTA-derived CAC density may serve as a noninvasive marker of plaque stability, aiding in the assessment of plaque vulnerability and risk stratification.
Challenges and Optimization of Percutaneous Coronary Interventions for Coronary Bifurcation Lesions.
An X, Qin Z, Ren Z … +6 more , Zhao W, Fu C, Dong L, Lv H, Li X, Fu Q
Rev Cardiovasc Med · 2026 Jan · PMID 41659111 · Full text
The complex anatomy of coronary bifurcation lesions (CBLs) remains a major challenge in percutaneous coronary interventions (PCIs). Currently, the single-stent strategy offers procedural simplicity; however, this strateg...
The complex anatomy of coronary bifurcation lesions (CBLs) remains a major challenge in percutaneous coronary interventions (PCIs). Currently, the single-stent strategy offers procedural simplicity; however, this strategy carries a higher risk of side-branch occlusion. Conversely, the two-stent technique improves branch coverage but is associated with increased risks of metal carina formation and late stent thrombosis. This article reviews the technical key points and indications of the provisional stent, T-stent, Crush, and Culotte techniques. Moreover, this article focuses on discussing the core challenges of different methods according to anatomical characteristics, post-dilatation stent morphology, and procedural variability of lesions during PCI. Furthermore, corresponding optimization strategies were explored to guide individualized treatment of CBLs using the Visual Risk Prediction of Side-branch Occlusion in Coronary Bifurcation Intervention (V-RESOLVE) score, functional assessments, and intracoronary imaging combined with the DEFINITION criteria.
Combined Triglyceride-Glucose and Triglyceride-Glucose-Body Mass Index with B-Type Natriuretic Peptide for Enhanced Prediction of Major Adverse Cardiovascular Events in ST-Elevation Myocardial Infarction Patients: A Retrospective Cohort Study.
Huang J, Zhang J, Li L … +8 more , Chen M, Li Y, Yu X, Dong S, Wang Q, Chen J, Yang Q, Xu S
Rev Cardiovasc Med · 2026 Jan · PMID 41659110 · Full text
BACKGROUND: Metabolic dysfunction significantly influences cardiovascular outcomes following ST-elevation myocardial infarction (STEMI). The triglyceride-glucose (TyG) index and triglyceride-glucose-body mass index (TyG-...
BACKGROUND: Metabolic dysfunction significantly influences cardiovascular outcomes following ST-elevation myocardial infarction (STEMI). The triglyceride-glucose (TyG) index and triglyceride-glucose-body mass index (TyG-BMI) serve as surrogate markers of insulin resistance, whereas B-type natriuretic peptide (BNP) levels reflect cardiac dysfunction. However, the combined prognostic value of these biomarkers for predicting major adverse cardiovascular events (MACEs) in patients with STEMI remains underexplored. METHODS: We conducted a retrospective cohort study of 1177 consecutive patients with STEMI who underwent percutaneous coronary intervention between August 2018 and December 2023. Patients were stratified into four groups based on the TyG index (cutoff: 7.2), TyG-BMI (cutoff: 186), and BNP level (cutoff: 300 pg/mL). The primary endpoint was MACEs, defined as a composite of all-cause mortality, nonfatal myocardial infarction, ischemia-driven repeat revascularization, heart failure hospitalization, and cerebrovascular events. Cox proportional hazards models with progressive adjustment were employed to assess independent and combined prognostic significance. RESULTS: A total of 483 patients (41.0%) experienced MACEs during a median follow-up of 461 days (interquartile range (IQR): 79-672). Patients with both an elevated TyG index (≥7.2) and a high BNP concentration (≥300 pg/mL) demonstrated the highest cardiovascular risk profile and a more than twofold increased MACE risk (hazard ratio (HR) 2.18, 95% confidence interval (CI): 1.57-3.03; < 0.001) compared with the reference group (those with a low TyG index and low BNP concentration). Similarly, patients with elevated TyG-BMIs (≥186) and BNP levels had an 81% increased risk (HR 1.81, 95% CI: 1.30-2.51; < 0.001). Meanwhile, the combined TyG index + BNP model demonstrated superior predictive accuracy (area under the curve (AUC): 0.67) compared with the individual biomarkers and the established Global Registry of Acute Coronary Events (GRACE) score (AUC: 0.58). Subgroup analyses revealed particularly pronounced associations in older patients, females, and those with hypertension. CONCLUSIONS: The combination of the TyG index or TyG-BMI with BNP provides enhanced prognostic stratification for predicting MACEs in STEMI patients, offering superior discriminatory capacity compared with that of individual biomarkers. This integrated approach may facilitate personalized risk assessment and guide therapeutic decision-making in clinical practice.
Recent Advances in the Study of Diabetic Cardiac Autonomic Neuropathy.
Wang N, Zhang J
Rev Cardiovasc Med · 2026 Jan · PMID 41659109 · Full text
Diabetic cardiac autonomic neuropathy (DCAN) is a common and serious complication of diabetes, and its early diagnosis and treatment are important for preventing cardiovascular events. At present, its diagnosis is mainly...
Diabetic cardiac autonomic neuropathy (DCAN) is a common and serious complication of diabetes, and its early diagnosis and treatment are important for preventing cardiovascular events. At present, its diagnosis is mainly based on multiple functional investigations, such as heart rate variability (HRV) and cardiovascular reflex test. However, these methods are cumbersome to perform, time-consuming, and readily affected by patient cooperation and operator technique, resulting in limited clinical application. More importantly, DCAN still lacks standardized early diagnostic criteria and specific biomarkers. In recent years, the integration of multi-index diagnosis such as HRV, electrocardiograms (ECGs), continuous glucose monitoring (CGM) and machine-learning algorithms has improved the accuracy of early screening and prognosis. Here, we systematically review the latest research progress in relation to the pathological mechanism, diagnosis and treatment of DCAN, with a focus on novel biomarkers, therapeutic targets, and the potential for individualized treatment. This review provides new insights into DCAN, as well as the basis for early diagnosis and precise intervention.
From Daily Routines to Cardiovascular Health: The Untapped Potential of Incidental Physical Activity.
Huang Y, Luo L, Luo X … +2 more , Zhang L, Zhang C
Rev Cardiovasc Med · 2026 Jan · PMID 41659108 · Full text
Cardiovascular diseases (CVDs) represent the primary cause of death worldwide, thereby demanding effective preventive measures. Incidental physical activity (IPA), which encompasses non-exercise movements naturally integ...
Cardiovascular diseases (CVDs) represent the primary cause of death worldwide, thereby demanding effective preventive measures. Incidental physical activity (IPA), which encompasses non-exercise movements naturally integrated into daily routines, offers a practical and promising strategy for reducing CVD risk. Research, particularly from the UK Biobank, has consistently highlighted the cardiovascular advantages of IPA across diverse populations. However, systematic guidelines for integrating IPA into cardiovascular care are limited. Thus, this review aims to provide a comprehensive synthesis of IPA, including a definition, classification by intensity, current evidence linking IPA to cardiovascular health, and the underlying mechanisms involved. Present research underscores the extensive benefits of IPA, particularly the pronounced effectiveness of vigorous IPA (VIPA). However, approaching these findings with caution is essential, especially considering the limited representation of individuals predisposed to exercise-induced sudden cardiac events in middle-aged and older cohorts. Therefore, while the advantages of IPA are clear, further investigation is warranted to understand the implications of IPA for all populations. In conclusion, we recommend integrating IPA as a complementary strategy alongside structured exercise in clinical practice. However, emphasizing risk mitigation strategies for VIPA is crucial, particularly for at-risk individuals. This review aims to provide practical guidance on the effective implementation of IPA in cardiovascular health management.
Olink Proteomics in Heart Failure: A Comprehensive Review of Applications From Biomarker Discovery to Pathophysiological Insights and Clinical Implementation.
Zheng Z, Gong Z, Gu J
Rev Cardiovasc Med · 2026 Jan · PMID 41659107 · Full text
Heart failure (HF) remains a global health challenge characterised by significant clinical heterogeneity, necessitating more precise tools for diagnosis and risk stratification. Olink proteomics, a high-throughput platfo...
Heart failure (HF) remains a global health challenge characterised by significant clinical heterogeneity, necessitating more precise tools for diagnosis and risk stratification. Olink proteomics, a high-throughput platform based on proximity extension assays (PEAs), has emerged as a powerful technology for exploring the molecular landscape of HF. Despite a growing number of studies utilising this platform, a comprehensive synthesis of its clinical and mechanistic contributions is still lacking. This review systematically examines the application of Olink proteomics across the HF continuum. We synthesised evidence regarding its role in biomarker discovery for early detection and prognosis, its ability to dissect key pathophysiological pathways such as inflammation and fibrosis, and its emerging potential to guide precision medicine. By critically evaluating technological advances, current challenges, and future directions, this review concludes that Olink proteomics is pivotal for transitioning HF management from a phenotype-driven to a mechanism-based paradigm, paving the way for targeted therapies and improved patient outcomes.
Exploration of Anesthetic Strategies for Transcatheter Tricuspid Valve Intervention.
Lin S, Guan Y
Rev Cardiovasc Med · 2026 Jan · PMID 41659106 · Full text
Tricuspid regurgitation (TR) is a critical factor in the progression of right heart failure. Although conventional open surgery remains the definitive treatment, the application of this technique is significantly limited...
Tricuspid regurgitation (TR) is a critical factor in the progression of right heart failure. Although conventional open surgery remains the definitive treatment, the application of this technique is significantly limited in older and high-risk patients due to frequent comorbidities, including impaired right ventricular functional reserve, pulmonary hypertension, and multi-organ dysfunction, which lead to substantially increased surgical risks. Transcatheter tricuspid valve intervention (TTVI), which achieves anatomical correction through minimally invasive approaches, has emerged as an effective alternative strategy for patients deemed ineligible for surgery. During these procedures, anesthesiologists face three core challenges: susceptibility to acute changes in the preload of the right ventricle, a high risk of circulatory collapse (particularly in functional TR with right ventricular decompensation), and the precise integration of intraoperative transesophageal echocardiography (TEE) with hemodynamic monitoring. Consequently, anesthesiologists who become experts in the pathological staging of TR, key points of image-guided device implantation, and warning indicators of circulatory collapse can help maintain perioperative stability. Moreover, gaining a thorough understanding of the pathological progression of tricuspid valve disease, improving the assessment of right heart function, and optimizing the TTVI process and management capabilities are crucial for improving patient outcomes. Thus, establishing a perioperative anesthetic strategy focused on right heart protection may reduce cardiovascular-related complications and all-cause mortality.
Exploration of the Role of Cilostazol in Brugada Syndrome: Mechanisms, Therapeutic Potential, and Implications in the Prevention of Ventricular Arrhythmias.
Iqbal M, Putra ICS, Karwiky G … +1 more , Achmad C
Rev Cardiovasc Med · 2026 Jan · PMID 41659105 · Full text
Despite the relatively low incidence of Brugada syndrome (BrS) globally, the risk of sudden cardiac death remains alarmingly high, reaching rates of up to 28%. According to current clinical guidelines, implantable cardio...
Despite the relatively low incidence of Brugada syndrome (BrS) globally, the risk of sudden cardiac death remains alarmingly high, reaching rates of up to 28%. According to current clinical guidelines, implantable cardioverter defibrillators (ICDs) are recommended for high-risk patients. Meanwhile, pharmacological interventions must be used as a backup owing to the limited access to ICDs by eligible patients. Cilostazol, an adenosine uptake inhibitor and phosphodiesterase III inhibitor, has been suggested to reduce the risk of ventricular arrhythmias in BrS patients by stabilizing the action potential dome and lowering the epicardial-to-endocardial repolarization gradient, consequently decreasing the probability of phase II re-entry. However, the effectiveness of cilostazol in this situation has been questioned due to the existence of contradictory results from different case reports. Thus, this literature review aims to synthesize current evidence regarding the potential of cilostazol to lower the risk of ventricular arrhythmias in patients with BrS.
Electrocardiographic Characteristics of Escape Rhythm During Complete Atrioventricular Block After Transcatheter Aortic Valve Replacement.
Loewenstein I, Yagel O, Shrem M … +8 more , Lichtenstein D, Elbaz-Greener G, Tovia-Brodie O, Ben-Shoshan J, Planer D, Michowitz Y, Konigstein M, Belhassen B
Rev Cardiovasc Med · 2026 Jan · PMID 41659104 · Full text
BACKGROUND: Complete atrioventricular block (CAVB) following transcatheter aortic valve replacement (TAVR) is primarily attributed to mechanical compression of the penetrating or branching portions of the His bundle, and...
BACKGROUND: Complete atrioventricular block (CAVB) following transcatheter aortic valve replacement (TAVR) is primarily attributed to mechanical compression of the penetrating or branching portions of the His bundle, and less commonly, the atrioventricular (AV) node. This study aimed to characterize the electrocardiographic features of stable escape rhythms (ERs) occurring during CAVB after TAVR. METHODS: This retrospective study analyzed 12-lead electrocardiograms (ECGs) obtained at three time points: before TAVR (ECG 1), after TAVR but before CAVB (ECG 2), and during CAVB (ECG 3). The ERs on ECG 3 were classified as AV junctional if the rate was 40-60 beats per minute (bpm) and, compared with ECG 2, if the QRS morphology matched in ≥10/12 leads, the QRS duration differed by <10 ms, and the frontal QRS axis differed by <30°. The ERs not meeting these criteria were considered ventricular in origin. Three patients with ERs <40 bpm but matching AV junctional morphology were included in the AV junctional group. ECG 2 was unavailable in 12 patients. RESULTS: Among the 58 patients included, 56.9% had no conduction abnormalities on baseline ECG 1. Following TAVR (ECG 2), left and right bundle branch blocks were observed in 69.6% and 17.4% of the patients, respectively. During CAVB (ECG 3), the ERs were presumed to originate from the AV junction in 23 patients (39.6%), from the ventricles in 28 (48.3%), and had an undetermined origin in 7 (12.1%). CONCLUSIONS: Consistent with the anatomical regions commonly affected by the prosthetic aortic valve during TAVR, a substantial proportion of patients exhibited ERs likely originating from the AV junction, suggesting a potential role for conduction system pacing in managing CAVB in this setting of patients.
The Impact of Pre-Operative Aneurysm Diameter on Mortality After Standard and Complex Endovascular Aortic Repair.
Nana P, Apostolidis G, Torrealba JI … +3 more , Panuccio G, Behrendt CA, Kölbel T
Rev Cardiovasc Med · 2026 Jan · PMID 41659103 · Full text
BACKGROUND: Various anatomical factors have been related to mortality after endovascular aortic aneurysm repair (EVAR). This systematic review investigated the impact of the pre-operative maximum aortic aneurysm diameter...
BACKGROUND: Various anatomical factors have been related to mortality after endovascular aortic aneurysm repair (EVAR). This systematic review investigated the impact of the pre-operative maximum aortic aneurysm diameter on mortality after standard and complex EVAR. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed to search the MEDLINE, EMBASE, via Ovid and CENTRAL databases, until 31st July 2025. Randomized controlled trials and observational studies were eligible if they were published between 2015 and 2025 and reported on the association of the pre-operative maximum aortic aneurysm diameter with a 30-day and midterm mortality follow-up in standard and complex EVAR patients. The Newcastle-Ottawa Scale assessed the risk of bias. The primary outcome was the impact of the pre-operative maximum aortic aneurysm diameter on 30-day mortality after standard and complex EVAR. RESULTS: From 1182 studies, 25 were included; 19 reporting on standard (130,476) patients and six on complex EVAR (14,097) patients. A significant heterogeneity in terms of maximum pre-operative aortic aneurysm diameter threshold to identify larger aneurysms was detected. Regarding standard EVAR, eight studies evaluated the impact of the pre-operative maximum abdominal aortic aneurysm (AAA) diameter on 30-day mortality (smaller: 0.3-13.2% vs. larger: 0.7-20.8%) with conflicting outcomes. Four studies (4/8 studies; 50%) concluded that a larger diameter was related to higher 30-day mortality in patients with standard EVAR, while four showed no statistical significance. Two out of five standard EVAR studies that investigated the pre-operative AAA diameter as an independent predictor for 30-day mortality confirmed this finding. During the mid-term follow-up, ten studies showed that the pre-operative maximum AAA diameter was independently related to mortality after standard EVAR. In complex EVAR, four out of six studies showed that the 30-day mortality was higher (smaller: 0.5-7.0% vs. larger: 4.0-15.0%) in larger aortic aneurysms, including juxta-, para-, supra-renal, and thoracoabdominal aortic aneurysms. Four out of five (80.0%) studies showed that a larger diameter was an independent predictor for follow-up mortality after complex EVAR. CONCLUSIONS: The pre-operative aortic aneurysm diameter seems to be related to mortality after standard or complex EVAR. However, the impact of the pre-operative aortic aneurysm diameter on mortality seems to be more prominent in complex EVAR cases, with 80% of studies confirming this finding.
Pathogenesis and Therapeutic Advances in Heart Failure with Preserved Ejection Fraction.
Fan X, Ma J, Zhao X … +1 more , Yu J
Rev Cardiovasc Med · 2026 Jan · PMID 41659102 · Full text
Heart failure with preserved ejection fraction (HFpEF) has progressively emerged as the predominant form of heart failure. Thus, studies on the underlying mechanisms of HFpEF have shifted from pathophysiological to molec...
Heart failure with preserved ejection fraction (HFpEF) has progressively emerged as the predominant form of heart failure. Thus, studies on the underlying mechanisms of HFpEF have shifted from pathophysiological to molecular factors. Meanwhile, previous studies have primarily focused on inflammation, oxidative stress, metabolic dysregulation, and impaired cardiac compliance (manifesting as ventricular hypertrophy and interstitial fibrosis). In addition to conventional guideline-directed medical therapies, novel therapeutic strategies targeting these aforementioned pathogenic pathways have been investigated. This review aimed to summarize recent progress in HFpEF pathogenesis and emerging treatment approaches, offering insights for developing novel diagnostic and management strategies.
Prognostic Factors and Implantable Cardioverter-Defibrillator Outcomes in Transthyretin Cardiac Amyloidosis: A Comprehensive Retrospective Study.
Raslan MA, Nabi HA, Odeh NB … +5 more , Alatout MH, Baqal O, Abbas MT, El Masry HZ, Sorajja D
Rev Cardiovasc Med · 2026 Jan · PMID 41659101 · Full text
BACKGROUND: Transthyretin (TTR) cardiac amyloidosis is a progressive cardiomyopathy with high mortality; however, the role of implantable cardioverter-defibrillators (ICDs) in this population remains unclear. METHODS: Th...
BACKGROUND: Transthyretin (TTR) cardiac amyloidosis is a progressive cardiomyopathy with high mortality; however, the role of implantable cardioverter-defibrillators (ICDs) in this population remains unclear. METHODS: This retrospective cohort study included patients with confirmed TTR cardiac amyloidosis, with or without ICDs, from January 1, 2001, to December 31, 2024, across all three Mayo Clinic sites (Arizona, Florida, and Minnesota). Diagnosis was confirmed by endomyocardial biopsy or abnormal technetium pyrophosphate (PYP) scintigraphy. A 1:4 propensity score-matched cohort of non-ischemic cardiomyopathy (NICM) patients with ICDs served as a control group. The primary outcome was all-cause mortality, comparing transthyretin cardiac amyloidosis (TTR-CA) patients by ICD status and against matched NICM patients. Secondary analyses evaluated predictors of mortality, including the use of tafamidis and the indication for ICD (primary vs. secondary prevention). Kaplan-Meier and Cox regression analyses were used to assess predictors of survival and mortality. RESULTS: A total of 463 patients with confirmed TTR cardiac amyloidosis were included. The median follow-up duration was 7.4 years (interquartile range (IQR): 5.3-9.2 years) for the non-ICD group and 6.8 years (IQR: 4.5-9.0 years) for the ICD group. The median age was 74.5 years (IQR: 68.0-80.0 years), and 92.9% of patients were male. Among them, 206 (44.5%) received ICDs and 257 (55.5%) did not. ICD recipients were younger (71.0 vs. 77.0 years; = 0.001) and had higher rates of hypertension (62.6% vs. 45.6%; = 0.001), chronic kidney disease (CKD) (62.6% vs. 44.4%; = 0.001), and diabetes (30.1% vs. 21.8%; = 0.043). Median left ventricular ejection fraction was lower in the ICD groups (43% vs. 54%; = 0.007), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were higher in the ICD group (2259.0 pg/mL vs. 1503.0 pg/mL; = 0.007). Among ICD recipients, 157 (76.2%) received the device for primary prevention, while 48 (23.3%) received the ICD for secondary prevention. Appropriate shocks were delivered in 22 patients (10.6%), primarily for ventricular tachycardia (n = 18) and ventricular fibrillation (n = 4). Inappropriate shocks occurred in six patients (3.0%), and 12 patients (5.8%) experienced device-related complications. Over 10 years of follow-up, ICD implantation did not confer a survival benefit for patients with TTR-CA compared to those without an ICD ( = 0.74). In contrast, a 1:4 propensity-matched NICM cohort with ICDs, which had a median follow-up of 7.1 years (IQR: 4.6-8.8 years), showed significantly improved survival than TTR-CA patients with ICDs ( = 0.034). Among the TTR-CA patients with ICDs, neither the use of tafamidis ( = 0.10) nor the ICD indication (primary vs. secondary prevention; = 0.85) influenced mortality. In the Cox regression analysis, predictors of mortality in TTR-CA patients included older age (hazard ratio (HR) 1.048; = 0.001), CKD (HR 1.637; = 0.029), troponin T >50 ng/L (HR 1.594; = 0.031), NT-proBNP >3000 pg/mL (HR 1.514; = 0.050), and ejection fraction <40% (HR 1.935; = 0.003). ICD implantation was not associated with improved survival (HR 0.932; = 0.763). CONCLUSIONS: In conclusion, our data suggest that ICD therapy may not provide a significant overall survival benefit in older TTR-CA patients with impaired pump function; thus, prospective studies are warranted before any changes to clinical practice are considered. Key predictors of mortality included reduced ejection fraction and elevated cardiac biomarkers. Additional prospective studies are needed to clarify the role of ICDs in treatment strategies for patients with TTR-CA.
Heterogeneity and Clinical Translation of Cardiac-Derived Extracellular Vesicles in Heart Failure: From Mechanisms to Precision Therapeutics.
Li XL, Wan ZX, Jiang H … +6 more , Luo Y, Chen MT, Hu HY, Liu QY, Luo G, Liu MN
Rev Cardiovasc Med · 2026 Jan · PMID 41659100 · Full text
Heart failure (HF) represents a class of cardiovascular diseases that poses a serious threat to global health. Although current pharmacological and device-based therapies have exhibited some progress, significant challen...
Heart failure (HF) represents a class of cardiovascular diseases that poses a serious threat to global health. Although current pharmacological and device-based therapies have exhibited some progress, significant challenges remain, including suboptimal treatment responses and the inability to effectively halt disease progression. Extracellular vesicles (EVs) are nanoscale membranous particles actively secreted by cells, which are capable of transporting bioactive molecules such as nucleic acids and proteins to mediate intercellular communication. Owing to the broad cellular origins and excellent biocompatibility of EVs, these particles offer extensive therapeutic potential. This review systematically elaborates on the key aspects of EVs, including the core molecular composition of these particles, as well as the biogenesis pathways and functional regulatory mechanisms involved. We further dissect the functional heterogeneity of EVs derived from cardiomyocytes, cardiac fibroblasts, endothelial cells, and immune cells in HF, highlighting the dual roles of EVs in either promoting or counteracting disease progression via cargo-dependent mechanisms. Additionally, we explore the translational applications of EVs in the diagnosis and treatment of HF, covering EV isolation, characterization, and scalable production strategies. The potential use of EVs as biomarkers, as well as the precision engineering of EVs for targeted clinical therapy, are also critically discussed.
Causal Associations Between Gut Microbes and Heart Failure Across Multiple Etiologies: A Mendelian Randomization Study.
Xu X, Anwar S, Shang Y … +2 more , Guo X, Cui X
Rev Cardiovasc Med · 2026 Jan · PMID 41659099 · Full text
BACKGROUND: Gut microbiota are associated with heart failure (HF); however, the causal relationship between gut microbial communities and HF of varying etiologies remains incompletely established. METHODS: This study lev...
BACKGROUND: Gut microbiota are associated with heart failure (HF); however, the causal relationship between gut microbial communities and HF of varying etiologies remains incompletely established. METHODS: This study leveraged two-sample Mendelian randomization (MR) to investigate whether genetically determined gut microbiota features causally influence HF and its related subtypes. Instrumental variables (IVs) for gut microbiota were derived from a large-scale, genome-wide association study (GWAS) of microbial traits conducted by the MiBioGen consortium, which included 18,340 individuals. Summary statistics for HF and its subtypes were extracted from the FinnGen Release 7, encompassing 19,350 all-cause HF cases and 288,996 controls. The Wald ratio and inverse-variance weighted analyses were applied to calculate the causal estimates. RESULTS: A total of 19 single-nucleotide polymorphisms (SNPs) corresponding to 18 gut microbial taxa were selected as IVs. A significant inverse causal association was identified between the family and the risk of hypertensive heart disease (odds ratio (OR): 0.355, 95% confidence interval (CI): 0.193-0.656; < 0.001; q = 0.018). Several additional taxa showed suggestive causal associations with HF or its precursor conditions, although these did not survive multiple-testing correction. CONCLUSIONS: Genetically predicted enrichment of is causally associated with a lower risk of hypertensive heart disease. These MR findings warrant a mechanistic dissection of -mediated pathways as a potential therapeutic lever for the prevention and treatment of hypertension-mediated HF.
Association Between Growth Differentiation Factor-15 and Coagulation Parameters in Male Chinese Patients With Coronary Artery Disease.
Liu H, Lyu Y, Dai W … +1 more , Li Y
Rev Cardiovasc Med · 2026 Jan · PMID 41659098 · Full text
BACKGROUND: Growth differentiation factor-15 (GDF-15) has emerged as a novel biomarker for coronary artery disease (CAD). Although the hypercoagulable state is recognized as a biological mechanism that triggers cardiac e...
BACKGROUND: Growth differentiation factor-15 (GDF-15) has emerged as a novel biomarker for coronary artery disease (CAD). Although the hypercoagulable state is recognized as a biological mechanism that triggers cardiac events in CAD, the relationship between GDF-15 and coagulation parameters in patients with CAD remains unclear. Thus, this study aimed to investigate the potential relationship between GDF-15 and coagulation parameters in male Chinese patients with CAD. METHODS: In total, 892 subjects were enrolled between January 2020 and December 2020, including 592 with CAD and 300 controls. The serum levels of GDF-15, blood cell count, glucose, serum lipids, and coagulation parameters were measured. Kruskal-Wallis or one-way ANOVA with post hoc tests (Holm-Sidak and Dunn's tests), as well as univariate/multivariate linear regression analyses, were used to determine the correlation between GDF-15 and coagulation parameters in male patients with CAD. RESULTS: Compared to controls, patients with acute myocardial infarction (AMI) and stable angina (SA) showed significantly higher levels of GDF-15 ( < 0.05). Multivariate linear regression revealed that GDF-15 levels were positively associated with activated partial thromboplastin time (APTT) in patients with CAD (β = 0.109, = 0.024), and inversely associated with antithrombin III (AT3) (β = -0.113, = 0.028) in an adjusted multivariate regression model. Meanwhile, in a multivariate regression model adjusted for other variables, the GDF-15 levels in patients with SA were inversely associated with AT3 (β = -0.191, = 0.036). After adjusting for confounders, the GDF-15 levels were positively associated with APTT (β = 0.174, = 0.002) and inversely associated with monocyte count (β = -0.159, = 0.025) in patients with AMI. CONCLUSIONS: Elevated levels of GDF-15 in male CAD patients are associated with altered coagulation parameters, suggesting that GDF-15 may serve as a compensatory marker for coagulation parameter instability. These results underscore the potential clinical value of GDF-15 as a novel biomarker for assessing the coagulation status in patients with CAD, especially in the acute coronary syndrome (ACS) subgroup.
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