2025年 · 第05卷第03期

Objective: To investigate the correlation between maternal serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and gestational duration in pregnant women with pulmonary hypertension (PH). Methods: The study included pregnant individuals with PH stemming from mitral valve stenosis and mitral valve regurgitation (post-capillary PH) or pulmonary arterial hypertension (pre-capillary PH) who were admitted to Guangdong Provincial People’s Hospital between January 1, 2014 and December 31, 2020. In this retrospective cohort study, maternal serum NT-proBNP levels during pregnancy, along with other clinical data, were obtained from structured electronic medical records. These data included gestational age at delivery, echocardiographic parameters, laboratory findings, gestational duration, delivery mode, and other relevant clinical variables. Univariate and multivariate regression analyses were conducted to assess the association between NT-proBNP levels and gestational duration. Adjustments were made for potential confounding factors, and curve fitting and threshold effect analysis were employed to identify tangent points. Furthermore, stratified analyses were performed based on tricuspid regurgitation velocity, maternal age, and parity. Results: A total of 64 patients with post-capillary PH and 74 patients with pre-capillary PH were included in this study. Among patients with post-capillary PH, the results of multivariate regression analysis indicated a significant association between maternal NT-proBNP levels and gestational duration (β = -0.03, 95% confidence interval (CI) -0.05 to 0.00, P = 0.02). The fitted curve demonstrated a negative correlation between maternal NT-proBNP levels and gestational duration, with a significant break point at 379.9 ng/L (P < 0.05). In the post-capillary PH group, the stratified analysis revealed a regression coefficient of -0.05 (95% CI:-0.06 to -0.04, P = 0.001) in patients with a tricuspid regurgitation velocity >340 mm/s. For patients >35 years old, the regression coefficient was -0.03 (95% CI -0.06 to -0.01, P = 0.02). In multiparous women, the regression coefficient was -0.03 (95% CI-0.06 to 0.00, P = 0.03). Conclusion: In pregnant women with pulmonary hypertension, maternal NT-proBNP levels are associated with gestational duration, particularly with an increased risk of preterm labor.

Objective: This study aimed to explore the causal link between olive intake and the occurrence of coronary heart disease (CHD) using Mendelian randomization (MR). Methods: In this study, genome-wide association study data from IEU OpenGWAS were employed. A 2-sample MR analysis was used to determine the causal association of olive intake with CHD and cardiovascular outcomes (myocardial infarction, heart failure, stroke, and death due to cardiac causes). The data for olive intake included 64,949 samples and 9,851,867 single nucleotide polymorphisms (SNPs), the data for CHD included 361,194 samples and 13,295,130 SNPs; The data for myocardial infarction included 361,194 samples and 12,640,541 SNPs, the heart failure include 208,178 samples and 16,380,422 SNPs, the data for stroke included 361,194 samples and 12,404,026 SNPs, and the data for death due to cardiac causes included 361,194 samples and 10,071,648 SNPs. Additionally, a 2-step, 2-sample MR approach was used for mediation analysis to determine whether lipid traits mediate the causal association between olive intake and CHD. The data for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, and apolipoprotein A1 included 115,078 samples and 12,321,875 SNPs, while the data for triglycerides included 21,545 samples and 11,871,391 SNPs. Cochran’s Q test was applied to examine potential heterogeneity, and the MR-Egger method was used to assess horizontal pleiotropy among SNPs. Leave-one-out analysis was performed as a sensitivity analysis to evaluate the robustness of the results. Results: For each standard deviation increase in olive intake, the risk of CHD decreased by a substantial 1.9% (odds ratio (OR) = 0.981, 95% confidence interval (CI): 0.963 to 0.998, P = 0.031), the risk of myocardial infarction was significantly reduced by 1.6% (OR = 0.984, 95% CI: 0.969 to 0.999, P = 0.032), and the risk of heart failure declined by 62.1% (OR = 0.379, 95% CI: 0.192 to 0.746, P = 0.005). Furthermore, mediation analysis with MR indicated that lipid traits did not mediate the causal relationship between olive intake and CHD. Conclusion: There is a negative correlation between olive intake and the incidence of CHD, and this relationship is not mediated by lipid traits. Olive intake was also negatively associated with some cardiovascular outcomes, suggesting that increasing olive intake holds significant value in preventing the onset and progression of CHD.

Objective: This study aimed to investigate the feasibility, efficacy, and safety of using a miniature mobile integrated cabin-theatre equipped with angiography and surgical operating room capabilities, and to explore its therapeutic scope, effectiveness, and operational mode. Methods: A miniature mobile integrated operating cabin-theatre was deployed across 15 hospitals in 15 cities or counties in China from April 2012 to November 2024. The interventions and outcomes of interventional and minimally invasive surgical procedures were prospectively observed and evaluated; perioperative complications were documented, and the stability, adaptability, and mobility of the integrated system were assessed. Results: A total of 133 procedures were successfully performed, 130 of which were interventional and 3 minimally invasive. The angiography machine showed good imaging performance without any equipment failures, loosening, or damage, with normal chamber unfolding. One patient experienced a fever the day after laparoscopy, while none of the other patients exhibited perioperative complications such as infection, surgical site bleeding/hematoma, or reperfusion arrhythmia. The instrument was easily manipulated, aligning with the needs of clinical intervention and surgery, and was perceived by patients as being a comfortable environment, with no psychological or other obvious discomfort. Conclusions: The miniature mobile integrated cabin-theatre, comprising an angiography machine and an operating room, allows interventional or minimally invasive surgical procedures to be performed smoothly and safely. It can also provide rapid and efficient on-site treatment of acute and critical illnesses across multiple body systems, including the cardiovascular, cerebrovascular, and gastrointestinal systems.

Evidence-based treatment strategies for patients with cardiovascular disease and diabetes have been updated in recent years. However, substantial gaps remain between guideline recommendations and clinical practice, which justify the urgent need to improve the quality of care for patients with these conditions. The Chinese Society of Cardiology and the Chinese Society of Diabetes, in collaboration with the American Heart Association and the American Diabetes Association, designed the China Diabetes Cardiovascular project. The China Diabetes Cardiovascular project is a nationwide registry study aimed at improving the quality of care for patients with acute coronary syndrome and diabetes in China. Launched in 2021, this project has enrolled 36 hospitals across mainland China. Patients with a primary discharge diagnosis of comorbid acute coronary syndrome and diabetes will be eligible to participate. Pre-defined performance measures will be adopted to evaluate the quality of care for these patients. Multiple quality improvement strategies will be adopted, including providing monthly quality reports based on these measures, conducting a series of training courses, and distributing educational materials. A comprehensive dataset, encompassing patients' characteristics, medical history, treatment before and during the current hospitalization, and discharge medications for secondary prevention, will be collected through a web-based data collection platform. This project has the potential to improve the quality of care and reduce the care disparities in the management of patients with these diseases. Moreover, with its comprehensive data collection, this project will provide a strong foundation for exploring key clinical questions.

Atherosclerosis, a leading cause of cardiovascular morbidity and mortality, is driven by lipid accumulation and inflammation within arterial walls. While statins have been pivotal in managing this condition by lowering low-density lipoprotein cholesterol, limitations such as statin intolerance and genetic variability highlight the need for innovative therapeutic strategies. Conjugation synthesis, which involves the chemical linkage of statins with polymers, nanoparticles, or bioactive molecules, represents a promising strategy to enhance the pharmacokinetics and pharmacodynamics of these agents. This approach improves drug solubility, stability, bioavailability, and targeted delivery, resulting in superior low-density lipoprotein cholesterol reduction, enhanced plaque stabilization, and reduced systemic side effects compared to traditional statins therapies. Studies have shown that polymer-based and nanotechnology conjugations not only optimize drug delivery but also minimize adverse effects, potentially transforming the treatment landscape of atherosclerosis. As research advances, these next-generation therapies have the potential to provide more personalized and effective treatment options for patients.

The electrocardiogram (ECG) is a non-invasive and cost-effective screening tool that is widely available and has been incorporated into many pre-participation screening programs for athletes. Despite historical criticisms regarding its suboptimal specificity, which could impact cost-effectiveness, the ECG remains a fundamental diagnostic method. Over the last 2 decades, significant research has focused on distinguishing pathological from physiological ECG patterns, the latter associated with the "athlete’s heart". The most recent guidelines for ECG interpretation in athletes include the International Criteria, published in 2017, which categorize ECG findings into common (training related), uncommon (training unrelated), and a "borderline" sub-group, with findings that do not necessitate further investigation when isolated. Premature ventricular beats (PVBs), although often overlooked, are a frequent cause of secondary investigations in athletes, especially when detected during exercise testing. Recent advances over the past decade have refined diagnostic methodologies, placing greater emphasis on morphological features, exercise relationships, and reproducibility, rather than solely on the count of PVBs. This evolution aims to enhance stratification for further investigations, such as cardiac magnetic resonance, which is crucial within this updated diagnostic framework, as it identifies pathologies causing sudden cardiac death during exercise. This review aims to provide a modern revision of the interpretation of ECGs and PVBs, incorporating a historical excursus to trace the evolution of these criteria. It is designed to offer clinicians a practical key for enhanced diagnostic precision in athlete screenings, reflecting both past insights and current advances.

Hypertension remains a major global health challenge and a leading threat to cardiovascular health. Among the key mechanisms contributing to the development of hypertension, impaired autonomic regulation of the cardiovascular system is particularly prominent. Extensive evidence supports the pivotal role of the autonomic nervous system in maintaining cardiovascular homeostasis. This review integrates findings from experimental and clinical studies to elucidate the complex relationship between autonomic dysfunction and hypertension. It further analyzes the underlying physiological and molecular mechanisms, summarizes recent research advances, and highlights the fundamental factors that contribute to the onset of hypertension. These insights aim to support the development of innovative prevention and treatment strategies for hypertension.

Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, despite advancements in guideline-directed medical therapies (GDMTs). A major obstacle to optimal HF management is clinical inertia, defined as the failure of health care providers to initiate or intensify therapy when indicated. This review examined the current state, contributing factors, and strategies for overcoming clinical inertia in HF. Studies have revealed substantial treatment gaps, with sub-optimal prescription rates and dosing of GDMT classes, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor-neprilysin inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. These treatment gaps persist over time and are associated with increased patient mortality and hospitalizations as well as reduced quality of life. Multiple factors contribute to clinical inertia, including patient-related factors (medication adherence and treatment understanding), provider-related factors (guideline familiarity, concerns regarding side effects, complex treatment decision-making), and health care system-related factors (fragmented care models and quality assessment frameworks). Strategies for overcoming clinical inertia involve patient empowerment through education and shared decision-making, provider education and clinical decision support tools, and redesigning HF care delivery. Specialized HF management systems, multidisciplinary collaboration, remote monitoring, and digital tools can promote guideline adherence. Continuous quality improvement by integrating research and practice is also essential. Addressing clinical inertia requires a multifaceted approach targeting patients, providers, and health care systems. By implementing targeted strategies, health care systems can bridge the evidence-practice gap, optimize GDMT utilization, and ultimately improve outcomes for this vulnerable patient population.

Although percutaneous pulmonary artery denervation (PADN) has demonstrated long-term benefits in combined post- and pre-capillary pulmonary hypertension, its usefulness for isolated post-capillary pulmonary hypertension (IpcPH) remains unclear. This report presents 2 cases of IpcPH due to left heart failure who underwent PADN treatment following an insufficient response to optimized conventional therapy. This case study illustrates how PADN, when combined with heart failure guideline-directed medical therapy, may represent a promising treatment option for IpcPH.