2025年 · 第05卷第04期

Objective: This study aimed to explore the impact of aortic annulus angulation on outcomes in patients with bicuspid aortic valves (BAVs) undergoing transcatheter aortic valve replacement (TAVR) with new-generation valves. Methods: A retrospective study was conducted among patients who underwent TAVR with new-generation self-expandable (SE) or balloon-expandable (BE) transcatheter heart valves (THVs) at West China Hospital between January 2018 and November 2022. Their CT scans, from which the annulus angulation was derived, and other clinical information were retrieved through the electronic patient record system. The mean annulus angulation of the whole cohort served as the cut-off value for further group assignment. The primary endpoint was device success at 30 d. Secondary endpoints included the need for >1 THV, vascular complications, permanent pacemaker implantation, paravalvular leak of at least mild severity, 30-day and 6-month mortality, etc. Multivariable logistic regression analysis was performed to identify independent predictors of the clinical outcomes. Results: A total of 180 patients were included in the study, 137 with SE THVs and 43 with BE THVs. The annulus angulation of all patients was 55.6° ± 10.0°, therefore, the patients were further stratified by 56°. Among the 43 BE THV recipients, the annulus angulation ≥ 56° group was older, shorter, had less valve calcification, and larger sinotubular junction and maximal ascending aorta diameters (all P < 0.05); however, the primary and secondary endpoints did not differ significantly between the annulus angulation < 56° and ≥ 56° groups. Among the 137 SE THV recipients, despite larger maximal ascending aorta diameters in annulus angulation ≥ 56° group ((43.4 ± 4.3) mm vs. (41.3 ± 4.0) mm; P = 0.003), it did not influence device success at 30 d, the requirement for >1 THV, vascular complications, paravalvular leak of at least mild severity, and 6-month mortality (all P > 0.05). However, the SE THV group with annulus angulation ≥ 56° had a higher incidence of permanent pacemaker implantation (27.6% vs. 8.9%, P = 0.004). Annulus angulation ≥57° was an independent predictor of permanent pacemaker implantation in patients with BAV receiving SE TAVR (odds ratio: 3.28, 95% confidence interval: 1.28-8.40; P = 0.01). Conclusion: Increased annulus angulation did not influence device success for both new-generation BE and SE THVs in patients with BAV. However, increased annulus angulation was associated with a higher risk of permanent pacemaker implantation in patients undergoing SE TAVR, while no such association was observed in those who underwent BE TAVR.

The predictors and clinical outcomes of Percutaneous Coronary Intervention in patients with suspected coronary heart disease with COmorbid major DEpressive disorder (PCI CODE) study employs a prospective, multidisciplinary, observational design to evaluate clinical outcomes post-percutaneous coronary intervention (PCI) between coronary heart disease (CHD) patients with or without major depressive disorder (MDD). This study is registered with ClinicalTrials.gov (NCT03852082). During enrollment, all consecutive individuals aged ≥18 years who are clinically suspected of CHD and scheduled for coronary angiography at Nanjing First Hospital are our observational cohort. After completing the self-rated Patient Health Questionnaire, undergoing a clinical MDD diagnosis by a psychiatrist when indicated, and having CHD confirmed by interventional cardiologists, participants in the PCI arm are stratified into 2 groups: CHD patients with MDD and CHD patients without MDD. The primary composite endpoint is the 1-year and 5-year incidence of major adverse cardiac events including all-cause death, non-fatal myocardial infarction, and any coronary revascularization. The secondary endpoints comprise individual events, including all-cause death, cardiovascular death, non-fatal myocardial infarction, any coronary revascularization, stent thrombosis, in-stent restenosis, cardiac-related rehospitalization, non-cardiac-related rehospitalization, or stroke. The PCI CODE study, which hypothesizes that certain biomarker combinations may correlate with a higher incidence of major adverse cardiac events at 1 and 5 years post-PCI, seeks to identify the key determinants that lead to poorer prognoses following PCI in patients with CHD and comorbid MDD compared to those without MDD.

Heart failure (HF) is a complex clinical syndrome caused by a range of diseases and has multiple comorbidities. As the final stage of many cardiovascular diseases, HF has become a significant global public health issue, marked by high prevalence, mortality, and healthcare costs. HF prevalence is increasing globally due to aging populations and rising cardiometabolic risks. Despite extensive research in Western countries, there is still limited data on HF epidemiology in Asia and Africa, with notable regional differences observed. The present review summarizes the current understanding of HF, including updated definitions, epidemiology, outcomes, and management strategies in China and globally. The goal of the present review is to provide insights that may help to improve prevention and treatment for patients with HF.

Heart failure (HF) is an escalating global health challenge, characterized by high morbidity and mortality rates, poor quality of life, and a substantial economic and health burden. Major risk factors, including hypertension, diabetes, and unhealthy lifestyle choices, contribute to the increasing burden of HF. Addressing these challenges is crucial for developing effective prevention and management strategies that mitigate the impact of HF on individuals and healthcare systems worldwide.

The diagnosis and management of heart failure (HF) are continually evolving. Emerging biomarkers provide insights into the pathophysiology of HF and have recognized prognostic and diagnostic value. Additionally, the relationship between HF and the gut microbiota and their metabolites has been increasingly investigated, showing that dysbiosis can exacerbate cardiac dysfunction through systemic inflammation and metabolic disturbances. The role of magnetic resonance imaging in the early diagnosis of HF is discussed, showcasing its ability to provide detailed assessments of cardiac structure, function, and myocardial tissue. Furthermore, lung ultrasound is highlighted as an effective, non-invasive tool for evaluating pulmonary congestion in acute HF scenarios, offering real-time insights to guide clinical decision-making. Lastly, the potential applications of artificial intelligence in predicting outcomes in HF are addressed, demonstrating how artificial intelligence-driven models can enhance risk stratification and individualized management. This review underscores the significance of integrating these novel diagnostic and predictive methodologies to improve patient care in the management of HF.

Heart failure is a complex and multifaceted disease resulting from a range of causes, including ischemic heart disease, hypertension, valvular heart disease, and arrhythmia. The pathogenesis of heart failure involves neuroendocrine activation, dysregulated myocardial metabolism, inflammation, and endothelial cell injury. The prevention of heart failure centers on managing the underlying diseases, mitigating risk factors, and preventing complications. This review mainly addresses the etiology, risk factors, and preventive approaches related to this condition.

Cardiovascular implantable electronic devices (CIEDs) are essential in the management of chronic heart failure, which remains a major cause of morbidity and mortality despite guideline-directed medical therapy. By targeting mechanisms beyond pharmacological control, CIEDs improve outcomes through resynchronization, arrhythmia prevention, and contractility modulation. Cardiac resynchronization therapy enhances ventricular synchrony, with conduction system pacing emerging as a physiological alternative to biventricular pacing. Implantable cardioverter-defibrillators remain central to the prevention of sudden cardiac death, while sub-cutaneous implantable cardioverter-defibrillators extend options for patients with limited venous access or an elevated infection risk. Cardiac contractility modulation represents an innovative approach for moderate ventricular dysfunction, augmenting contractility without inducing arrhythmias. Collectively, these therapies complement medical treatment and highlight the importance of individualized, patient-centered strategies to improve survival, functional capacity, and quality of life in patients with heart failure, underscoring the expanding clinical relevance of CIEDs.

Patients with heart failure frequently have comorbidities, particularly diabetes and kidney diseases. When selecting anti-heart failure drugs in the presence of other diseases, it is necessary to consider their benefits for co-existing conditions. Similarly, treatments for comorbidities must account for their benefits for heart failure. Based on current research findings, a list of recommended and contraindicated medications for heart failure patients with comorbid diabetes and kidney diseases has been compiled, and the principles of drug use when heart failure is complicated by other diseases are summarized.

Heart failure (HF) is a terminal dysfunctional stage of various types of heart disease that affects the quality of life and lifespan of patients significantly. Over the past decade, a substantial amount of research has been dedicated to HF treatment. However, an increasing number of studies have emphasized the importance of the post-discharge management of HF, which involves the participation of patients and professional teams. For patients, adhering to recommendations for HF management is essential for quality of life. For professional teams, educating patients and establishing comprehensive support networks also have auxiliary roles in reducing HF-related mortality. This review emphasizes the importance of patient education, outlines key self-management strategies for HF, and advocates for the development of comprehensive support networks.

Recent advancements in signaling pathways and cellular crosstalk have led to a surge in innovative treatments targeting various mechanisms in heart failure. This review explores 3 particularly promising therapeutic targets: inflammation, metabolism, and neurohormonal regulation. These areas have garnered attention due to their potential to improve clinical outcomes and inform translational studies. Furthermore, the integration of high-throughput and multi-omics technologies has significantly advanced the field of cardiovascular regeneration, facilitating its progression toward clinical practice. By examining these mechanisms and the latest research developments, this review aims to provide insights into the future of heart failure therapies and their potential impact on patient care.