Hasil untuk "Diseases of the circulatory (Cardiovascular) system"

Carlo Savini, Mariafrancesca Fiorentino, Diego Sangiorgi et al.

Background: The minimally invasive approach is increasingly recognized as the standard for surgical management of mitral valve disease. Advances in endoscopic visualization and surgical instrumentation have enhanced precision while minimizing trauma, improving both functional and esthetic outcomes. This study presents a single-center experience with total endoscopic mitral valve repair (MVR) performed using two- or three-dimensional video-assisted technology. Methods: Between October 2022 and September 2025, 239 patients underwent total endoscopic MVR at our institution. Demographic, operative, and postoperative data were collected and analyzed. Results: Median age was 63 years, with 64.4% male. Median logistic EuroSCORE and EuroSCORE II were 2.53 and 0.83, respectively. Most patients were NYHA class II (54.4%), and 47.7% had pulmonary hypertension. Mitral annuloplasty was performed in 99.2% of cases; 78.6% received Gore-Tex chordae, 6.3% underwent posterior leaflet resection, and 11.7% edge-to-edge repair. Conversion to sternotomy occurred in 0.4%. In-hospital mortality was 1.3%; stroke occurred in 0.4%. Postoperative atrial fibrillation developed in 26.8%, while major complications such as sepsis (2.1%) and renal failure requiring dialysis (1.3%) were infrequent. Median ventilation time was 5 h, ICU stay was 2 days, and hospital stay was 7 days. Pre-discharge echocardiography showed ≤mild regurgitation in 99.2%. Conclusions: Total endoscopic MVR using two- or three-dimensional video assistance is safe, feasible, and yields excellent clinical, functional, and cosmetic results, with low morbidity and rapid recovery.

Umaimah Batool Mirza, Faareah Mansoor, Umna Fnu et al.

Neurocognitive dysfunction is a common but often overlooked complication in patients with Acute Coronary Syndrome (ACS). This narrative review aims to provide a comprehensive synthesis of current evidence on the prevalence, mechanisms, clinical assessment, and management strategies of cognitive impairment in ACS patients. We highlight how neurocognitive deficits including memory loss, reduced attention, and executive dysfunction arise from cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. These deficits arise from mechanisms including cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. Such impairments are associated with poorer clinical outcomes, decreased treatment adherence, and increased mortality.Routine cognitive assessment remains absent from standard ACS management, despite the availability of effective tools such as the Montreal Cognitive Assessment (MoCA), which can detect subtle cognitive deficits early in hospitalization. Integrating cognitive screening into clinical protocols enables timely interventions and better patient stratification. Management strategies should combine pharmacological treatment of cardiovascular risk factors with non-pharmacological interventions such as cognitive rehabilitation, mental health support, and lifestyle modification. Multidisciplinary collaboration between cardiology, neurology, psychology, and rehabilitation specialists is essential to address both cardiac and cognitive recovery.By integrating findings from clinical and epidemiological studies, this review underscores the need for routine cognitive screening, multidisciplinary care, and innovative interventions such as telemedicine to improve patient outcomes. Recognizing cognitive health as an integral part of ACS management offers a more holistic, patient-centered approach to recovery.

O. V. Kopylova, A. I. Ershova, A. N. Meshkov et al.

Aim. To present an approach to collection of biosamples of patients with rare and scientifically interesting clinical situations for solving the problems of personalized medicine, as well as to analyze related 8-year experience.Material and methods. The approach and a collection of biosamples of blood and its derivatives is developed at the National Medical Research Center for Therapy and Preventive Medicine within the project "Interesting Cases at the National Medical Research Center for Therapy and Preventive Medicine". The collection of biomaterial from project patients was carried out on a planned basis with the inpatient department, as well as upon referral from outpatient doctors. All included patients signed informed consent. Each biosample is accompanied by an extensive annotation, including socio-demographic, clinical, genetic and other types of data. The article presents the project results as of August 12, 2024.Results. An expert group developed 15 disease groups and related inclusion criteria. At the time of analysis, 4525 inpatients and outpatients were included in the project. Positive changes in the number of people included annually is noted. Genetic testing was performed on >2500 patients. The proposed approach allows solving a wide range of clinical and research problems in personalized medicine as follows: timely diagnosis or clarification; formation of patient cohorts to study the genetic aspects of diseases; identification of new genetic variants of hereditary diseases; development of genetic diagnostic panels; study of rare diseases; reduction of sample creation time in case of novel scientific ideas.Conclusion. The proposed approach to the collection and preservation of biosamples and related clinical, socio-demographic, genetic and other types of data in patients with rare clinical cases of scientific interest is important and effective for solving practical and research problems of personalized medicine. The algorithm is well developed, standardized and easily implemented within the clinics, regardless of their size. Preanalytical phase standardization creates the prerequisites for multicenter national and international cooperation.

Donghang He, Yuhan Li, Zefei Jiang et al.

Abstract Background Despite optimal standard therapy, residual inflammation continues to increase major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD). New immunomodulatory drugs targeting specific immune pathways have shown mixed efficacy across trials, warranting comprehensive evaluation of their role in secondary prevention. Methods We performed a systematic review and meta-analysis of 25 randomized controlled trials (RCTs) from January 1, 2014, to October 1, 2024, identified from eight databases: the cochrane library, (public medicine) pubmed, embase, web of science, china national knowledge infrastructure (CNKI), wanfang data knowledge service platform(WanFang), Weipu information database(VIP), and china biomedical literature database (SinoMed). Eligible studies assessed the efficacy of immunomodulatory agents, including colchicine, and canakinumab on MACE. Primary outcome was MACE incidence; secondary outcomes included, angina, and inflammatory biomarkers. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using fixed or random-effects models. Subgroup analyses were conducted by drug class, follow-up duration, and CHD subtype (acute vs. chronic coronary syndrome). Risk of bias was assessed via Cochrane RoB 1.0, and evidence certainty rated with GRADE. Results Overall, new immunomodulatory drugs did not significantly reduce MACE (RR = 0.92; 95% CI: [0.84,1.01]; P = 0.09; I²=60%). However, subgroup analyses revealed heterogeneous effects across drug classes. Significant reductions in MACE were observed with NLRP3 inflammasome inhibitors (RR = 0.75; 95% CI: 0.65,0.86; P < 0.0001) and interleukin-pathway inhibitors (RR = 0.86; 95% CI: 0.75,0.97; P = 0.02). In contrast, no significant reduction in MACE incidence was found in the broad-spectrum immunomodulator group, Lp-PLA2 inhibitor group, or p38 MAPK kinase inhibitor group (all P > 0.05). Besides, benefits were evident only in trials with follow-up exceeding 6 months (RR = 0.89; 95% CI: [0.82,0.98]. Secondary outcomes showed significant reductions in angina (RR = 0.72; 95%CI: [0.58,0.90], P = 0.004), revascularization (RR = 0.85; 95%CI: [0.73,0.98], P = 0.03), IL-6 (SMD = − 0.82;95༅CI: [-1.62,-0.03], P = 0.02), and neutrophil count, but no effect on (cardiac arrest)CA, all-cause mortality, incidence of gastrointestinal adverse effect and high-sensitivity c-reactive protein(hs-CRP). The quality of evidence for MACE was assessed as moderate. Conclusion Targeted anti-inflammatory therapies, particularly colchicine and canakinumab, significantly reduce MACE in CHD patients when used for longer than six months. Efficacy varies by mechanism of action, supporting precision use of NLRP3 and IL-1β inhibitors. Future trials should been focus on biomarker-guided, long-term anti-inflammatory interventions in cardiovascular care. Trial Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024597008PROSPERO : CRD42024597008.

Sapna Sharma, Yalamanchili Venkata Subrahmanyam, Harish Ranjani et al.

Shun-Ichiro Sakamoto, MD, PhD, Atsushi Hiromoto, MD, Kenji Suzuki, MD, PhD et al.

Anastomosis of the prosthetic graft to the double-barreled aorta with intimal flap fenestration is a useful technique in surgery for chronic aortic dissection. Conversely, anastomosis to the false lumen's outer wall is prone to complications such as pseudoaneurysms, but little is known about the technique of reinforcing the double-barreled aorta. In this report, we describe a surgical case of chronic aortic dissection in which an H-shaped prosthetic graft was sutured to both aortic lumens, including the intimal flap, to prevent complications at the anastomosis site.

Juemin Yu, Xiaobing Liu, Jian Zhuang

Beatrice De Lazzari, Roberto Badagliacca, Domenico Filomena et al.

This review is devoted to present the history of CARDIOSIM© software simulator platform, which was developed in Italy to simulate the human cardiovascular and respiratory system. The first version of CARDIOSIM© was developed at the Institute of Biomedical Technologies of the National Research Council in Rome. The first platform version published in 1991 ran on PC with disk operating system (MS-DOS) and was developed using the Turbo Basic language. The last version runs on PC with Microsoft Windows 10 operating system; it is implemented in Visual Basic and C++ languages. The platform has a modular structure consisting of seven different general sections, which can be assembled to reproduce different pathophysiological conditions. The software simulator can reproduce the most important circulatory phenomena in terms of pressure and volume relationships. It represents the whole circulation using a lumped-parameter model and enables the simulation of different cardiovascular conditions according to Starling’s law of the heart and a modified time-varying elastance model. Different mechanical ventilatory and circulatory devices have been implemented in the platform including thoracic artificial lung, ECMO, IABP, pulsatile and continuous right and left ventricular assist devices, biventricular pacemaker and biventricular assist devices. CARDIOSIM© is used in clinical and educational environment.

Lianyong Liu, Xinglu Zhou, Juan Chen et al.

IntroductionMetabolic syndrome-associated cardiovascular disease (MetS-CVD) is a cluster of metabolism-immunity highly integrated diseases. Emerging evidence hints that mitochondrial energy metabolism may be involved in MetS-CVD development. The physiopathological role of ATP5MG, a subunit of the F0 ATPase complex, has not been fully elucidated.MethodsIn this study, we selected ATP5MG to identify the immunity-mediated pathway and mine drugs targeting this pathway for treating MetS-CVD. Using big data from public databases, we dissected co-expressed RNA (coRNA), competing endogenous RNA (ceRNA), and interacting RNA (interRNA) genes for ATP5MG.ResultsIt was identified that ATP5MG may form ceRNA with COX5A through hsa-miR-142-5p and interplay with NDUFB8, SOD1, and MDH2 through RNA–RNA interaction under the immune pathway. We dug out 251 chemicals that may target this network and identified some of them as clinical drugs. We proposed five medicines for treating MetS-CVD. Interestingly, six drugs are being tested to treat COVID-19, which unexpectedly offers a new potential host-targeting antiviral strategy.ConclusionCollectively, we revealed the potential significance of the ATP5MG-centered network for developing drugs to treat MetS-CVD, which offers insights into the epigenetic regulation for metabolism-immunity highly integrated diseases.

Michel Galinier, Romain Itier, Anthony Matta et al.

AimsTo assess the effect of interventional specialized telemonitoring (ITM) compared to standard telemonitoring (STM) and standard of care (SC) on preventing all causes of death, cardiovascular mortality and unplanned hospitalization in heart failure (HF) patients.MethodsWe compared outcomes in three groups of HF patients followed by different modalities: SC, STM and ITM. The telemonitoring was performed by the specialized HF-cardiology staff at Toulouse University Hospital. All patients were followed with the same manner including daily weight monitoring using on-line scales, self-monitoring and reporting symptoms via a device. The difference between groups was in the management of the received alerts. In STM-group, patients were contacted by a member of telemedical center and the main responsibility for patient's therapy was taken by their primary care physicians while in the ITM-group, a cardiologist intervenes immediately in case of alerts for diuretic dose adjustment or escalation therapy or programmed hospitalization if necessary. Outcomes were compared between the three study groups and Kaplan-Meier analysis was performed.ResultsFour hundred fourteen HF-patients derived from two French cohorts (OSICAT and ETAPES) were included in this study and subsequently enrolled in the following three groups: ITM-group (n = 220), STM-group (n = 99), and SC-group (n = 95). During the mean follow-up period of 341 days, there were significantly fewer primary endpoints like unplanned hospitalization (13.6 vs. 34.3 vs. 36.8%, p &lt; 0.05), all-causes of death (4.5 vs. 20.2 vs. 16.8%, p &lt; 0.05) and cardiovascular mortality (3.2 vs. 15.2 vs. 8.4%, p &lt; 0.05) in the ITM-group. The multivariable logistic regression revealed a significant negative association between the ITM and unplanned hospitalization [OR = 0.303 95% CI (0.165–0.555), p &lt; 0.001) and all-causes of death [OR = 0.255 95% CI (0.103–0.628), p = 0.003], respectively. Kaplan Meier and log rank test showed significant difference in median event-free survival in favor of ITM-group.ConclusionsIn the ITM follow-up HF group, delivered by a cardiology team, the rate of unplanned hospitalization and all-causes of death are lower than SC or STM.

S. I. Shlyafer

The article analyzes information about patients older than working age, delivered to the hospital for emergency indications, including emergency medical teams, for diseases of the circulatory system in the Russian Federation for 2010–2019. Over 10 years in the country, there has been an increase in the proportion of patients older than working age with diseases of the circulatory system, admitted on an emergency indications to the hospital, from 43,65 to 53,0%, including by emergency medical teams — from 47,2 to 49,1%.

Joseph N. Heaton, Sohrab Singh, Matthew Li et al.

None.

John L. Jefferies

Raphael Chiarini , Carlos Eduardo Duarte, João Durval Ramalho Trigueiro Mendes Junior et al.

Introdução: O padrão de repolarização precoce (RP) tem sido tradicionalmente relacionado como uma variante benigna do eletrocardiograma (ECG). No entanto, desde 2008, quando dois estudos foram publicados por Haïssaguerre et al. e Rosso et al., com evidências de maior prevalência de RP em pessoas acometidas por fibrilação ventricular (FV) primária ou idiopática, esse paradigma tem sido contestado. Objetivo: Realizar uma profunda revisão acerca da RP e atual estado da arte acerca da estratificação de risco nesses pacientes. Métodos: Revisão da literatura acerca do tema avaliando os trabalhos publicados em revistas de alto impacto e a experiência dos especialistas sobre o assunto. Conclusão: A correlação de fatores de risco e o real valor dos vários métodos atualmente disponíveis como possíveis estratificadores de risco ainda são controversos. Avanços nas áreas da genética e biologia molecular podem futuramente auxiliar no entendimento da fisiopatologia e melhor estratificação de risco nessa população. Neste contexto, a padronização da definição e classificação da repolarização precoce mostra-se imperativa, uma vez que servirá de substrato para futuros estudos e pesquisas na área.

A. A. Grechishkin, S. V. Mayngart, A. S. Nekrasov et al.

Despite the rapid evolution in the development of endovascular surgery, the mortality of patients undergoing percutaneous coronary interventions (PCI) with high risk of severe cardiac complications and critical conditions (cardiogenic shock, cardiac arrest) remains extremely high. The success of PCI directly depends on the ability of the Heart Team to prevent and timely eliminate severe cardiac disorders. Despite the rapid evolution in the development of endovascular surgery, the mortality of patients undergoing percutaneous coronary interventions (PCI) with high risk of severe cardiac complications and critical conditions (cardiogenic shock, cardiac arrest) remains extremely high. The success of PCI directly depends on the ability of the Heart Team to prevent and timely eliminate severe cardiac disorders. Pharmacological therapy is not able to completely resist the development of severe cardiac events during PCI. In such situations the usage of devices for percutaneous mechanical circulation support (PMCS) can make an invaluable help in the treatment of this group of patients. Despite the fact that the PMCS devices are used to stabilize patients with cardiogenic shock and to provide hemodynamic support for high-risk PCI for several decades, the results of their application remain ambiguous. The purpose of this article is to review all existing literature on modern PMCS devices, available data and research results, indications for their use, and operational considerations that can ensure the decision-making process in selecting optimal PMCS devices.

Jun Wang, Xing Li, Jun Pu et al.

Abstract Background The association between mean platelet volume (MPV) and coronary plaque vulnerability in patients with non-ST-elevation ACS (NSTE-ACS) has not been investigated. We performed a retrospective study to evaluate the association between MPV and plaque vulnerability using optical coherence tomography (OCT). Methods Consecutive NSTE-ACS patients who underwent pre-intervention OCT examination in our center were included in this study. Features of coronary plaques in the culprit arteries were classified as rupture, nonrupture with thin-cap fibroatheroma (TCFA), and nonrupture and non-TCFA. ROC analyses were used to determine the predictive efficacy of MPV for plaque rupture, and multivariate logistic regression analysis was performed to evaluate the potential independent predictors of plaque vulnerability. Results Overall, 94 patients were included in this study. We identified 17 patients with plaque rupture, 10 with nonrupture with TCFA, and 67 with nonrupture and non-TCFA. ROC analyses showed that MPV ≥ 10.5 fL was predictive of plaque rupture in NSTE-ACS patients. Univariate analyses indicated that patients with higher MPV (≥ 10.5 fL) had higher body mass index and poorer lipid profiles compared to those with lower MPV. Moreover, those with higher MPV had higher incidences of plaque rupture and thrombosis (both P < 0.05). Results of multivariate analyses showed that diabetes and higher platelet distribution width (PDW) were independent risk factors of TCFA (P = 0.032 and 0.046, respectively), while diabetes, higher BMI, higher PDW, and higher MPV were independent determinants of plaque rupture in our cohorts (P all < 0.05). Conclusions Higher MPV is independently associated with higher risk of plaque rupture as evidenced by OCT in our cohort of NSTE-ACS patients.

José Emilio Traver, Inés Tejado, Javier Prieto-Arranz et al.

Sidra Masroor, Pooja Bhati, Shalini Verma et al.

Objective: To investigate the effect of combined aerobic and resistance training (CART) on heart rate variability in sedentary, hypertensive women. Participants: A total of twenty-eight hypertensive (Stage 1 and 2) sedentary women (Age 40.54 ± 4.2 yrs; Height 155.14 ± 5.4 cm; Weight 70.96 ± 10.2 kg; BMI 29.6 ± 4.4; Duration of HTN: 6.43 ± 2.5 yrs) were recruited for the study. Methods: Participants were randomly assigned to either the CART group that performed combined aerobic and resistance exercise of moderate intensity [aerobic exercise 50–80% of HRmax (maximum heart rate) and resistance exercises at 50–80% of 1 Repetition Maximum (RM)], 5 times/week for 4 weeks, or to the control group that followed conventional treatment without any supervised exercise intervention. Main outcome measures: Resting blood pressure was measured and standard heart rate variability (HRV) indices were calculated using time domain (SDNN, pNN50, RMSSD) and frequency domain (LFnu, HFnu, LF/HF and TP) analysis. Results: CART group demonstrated an increase in HFnu, TP, SDNN, and RMSSD, (p < 0.05) along with a significant decrease in LFnu, LF/HF ratio, systolic blood pressure, and diastolic blood pressure (p < 0.05). Conclusion: CART showed significant improvement in HRV parameters indicating vagal dominance in middle-aged hypertensive women. Therefore, exercise training in combined form (aerobic and resistance) may be incorporated in the management programs of the patients suffering from hypertension in order to augment improvement in their cardiac autonomic control. Keywords: Cardiac autonomic control, Exercise, Parasympathetic dominance