Giant Solitary Fibrous Tumor of the Ascending Aortic Wall Causing Reversible Heart Failure: A Case Report and Review of the Literature.

A 56-year-old woman was admitted to our hospital with a 2-week history of chest tightness and fatigue, and an echocardiogram revealed a massive polyserous cavity effusion. A massive (13.5 cm maximum diameter) intrapericardial mass was discovered using computed tomography (CT) and cardiovascular magnetic resonance imaging (MRI) in the ascending aortic wall. A pericardial biopsy was performed and diagnosed as a solitary fibrous tumor (SFT). After successful mass resection, an immunohistochemical test was positive for CD34, STAT-6, CD34, and Bcl2, which indicates a giant benign solitary fibrous tumor of the ascending aortic wall. After three years of follow-up, the patient is symptom-free, and histological indications of malignancy were absent. A giant benign solitary fibrous tumor is extremely rare in the heart, especially from the ascending aorta wall, and experience with this tumor location is limited, so close follow-up at regular intervals is considered necessary. We present this case, followed by a literature review on SFTs involving the heart and management approaches.

Prediction of no reflow phenomenon in percutaneous coronary intervention with optical coherence tomography and analysis of risk factors.

Objective :To investigate the predictive value of no reflow phenomenon in interventional therapy by measuring plaque quantitatively with optical coherence tomography (OCT).  Methods:196 patients with acute ST segment elevation myocardial infarction who visited the Department of Cardiology of the Second Affiliated Hospital of Zhengzhou University from January 2020 to January 2022 were selected as the study objects. According to whether there was no reflow during the operation, they were divided into no reflow group (46 cases) and normal flow group (150 cases). Systematically collect general clinical data and coronary angiography related data of patients through inpatient cases, measure fiber cap thickness and lipid core angle of diseased vascular plaque through optical coherence tomography, and analyze the relationship between fiber cap thickness and no reflow phenomenon   Results:BMI, LDL, phospholipase A, the proportion of family history of coronary heart disease, and the thrombus load in the no reflow group were higher than those in the normal flow group (P<0.05), while the thickness of the fibrous cap was lower than that in the normal flow group (P<0.05); Further multivariate logistic regression analysis showed that fiber cap thickness, phospholipase A and severe thrombosis load were independent risk factors for non reflow phenomenon (P<0.05); Further ROC curve analysis found that the thickness of fiber cap had a high predictive value for no reflow phenomenon, and the best cutoff value for no reflow was 95, AUC: 0.926 (95% CI: 0.891-0.961, P<0.001). Conclusions: Optical coherence tomography can predict the occurrence of no reflow phenomenon by measuring the fiber cap thickness quantitatively. The prediction effect is the best when the fiber cap thickness is 95.

Stem cell-derived extracellular vesicles for myocardial infarction: a meta-analysis of controlled animal studies.

AimsStem cell-derived extracellular vesicles (EVs) have emerged as a promising therapy for myocardial infarction, but its effects remain incompletely understood. We aim to systematically review the efficacy of EVs on myocardial infarction in both small and large animals.MethodsOn April 5, 2018, we searched the PubMed, Embase and Web of Science databases using variations of "myocardial infarction" and "extracellular vesicle". Controlled studies about the treatment effects of stem cell-derived EVs in myocardial infarction animal model were included. Meta-regression analysis was used to reveal the factors affecting the EVs treatments.ResultsOf 1210 studies retrieved, 24 were eligible for meta-analysis. EVs injection was associated with the improvements of left ventricular ejection fraction (12.65%), fractional shortening (7.54%) and the reduction of infarct size/area at risk (-15.55%). Meta-regression analysis did not reveal the association between treatment efficacy and type of stem cell, ligation-to-injection interval, route of delivery, dosage of delivery or follow-up period (all P values > 0.05). The median quality score of eligible studies was only 1, indicating potential risks of bias.ConclusionStem cell-derived EVs improve cardiac function and reduce infarct size in myocardial infarction animals, but current pool-up study reveals no associations between common factors and treatment effects.

Heart Failure with Preserved Ejection Fraction Trials Have Heterogeneous Control Groups: a Comparison of Kaplan-Meier Curves.

PURPOSE: Previous studies have evaluated intra-study heterogeneities of heart failure with preserved ejection fraction (HFpEF), but inter-study heterogeneities remain poorly understood. We investigate the heterogeneities of outcomes among control groups of HFpEF trials. METHODS: We included randomized controlled trials recruiting HFpEF patients with ejection fraction ≥ 40% and reporting Kaplan-Meier curves for at least 36 months. The Kaplan-Meier curves of control groups were extracted and calculated for hazard ratios and 95% confidence intervals. Two virtual trials were developed to validate the reliability and accuracy of our method. RESULTS: Of 4161 studies, we included six trials containing 7682 HFpEF patients in control groups. The DIG trial had the highest all-cause mortality, cardiovascular mortality, heart failure mortality, and composite endpoints of cardiovascular mortality and heart failure hospitalization (all p < 0.001). The TOPCAT trial had the lowest all-cause mortality, cardiovascular mortality, heart failure hospitalization, and composite of cardiovascular mortality and heart failure hospitalization (all p < 0.001). Adoption of different ejection fraction cut-off values for HFpEF diagnosis did not significantly change the outcomes of control groups in the DIG trial (45% vs. 50%: hazard ratio, 1.05, 95% confidence interval, 0.97-1.13, p = 0.271), or in the CHARM-Preserved trial (40% vs. 50%: hazard ratio, 1.01, 95% confidence interval, 0.93-1.09, p = 0.864) during 36-month follow-up. CONCLUSIONS: The control groups of HFpEF trials have heterogeneous outcomes. Future trials should consider these heterogeneities when designing protocols.