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Circ Arrhythm Electrophysiol. 2025 Jun 25:e013670. doi: 10.1161/CIRCEP.124.013670. Online ahead of print.

ABSTRACT

BACKGROUND: Differences in cardiac sarcoidosis between racial groups remain understudied. Therefore, this study aims to explore race differences in patients with cardiac sarcoidosis.

METHODS: We analyzed data from the Cardiac Sarcoidosis Consortium, an international registry including over 25 centers. The primary clinical outcome was a composite end point of all-cause mortality, left ventricular assist device implantation, heart transplantation, or implantable cardioverter defibrillator therapy.

RESULTS: A total of 619 patients were included in the study (362 White, 193 Black, and 64 other races). Black patients were diagnosed with cardiac sarcoidosis at a younger age (50.5±11.8 versus 53.7±10.5 years old; P=0.010) compared with White patients. Left ventricular ejection fraction was significantly lower in Black patients (44.6±15.4 versus 48.3±14.0; P=0.008). In addition, extracardiac involvement in the lungs (80.3% versus 72.7%; P=0.046), skin (22.8% versus 12.4%; p=0.002), and eyes (13.5% versus 5.5%; P=0.001) was more prevalent in Black patients. Patients had significantly higher rates of hypertension (69.9% versus 50.6%; P<0.001), diabetes (37.8% versus 21.0%; P<0.001), smoking (40.9% versus 26.8%; P<0.001), chronic obstructive pulmonary disease or emphysema (15.5% versus 4.1%; P<0.001), and chronic kidney disease (25.9% versus 12.4%; P<0.001). The treatment patterns including glucocorticoid (71% versus 74.3%; P=0.4), glucocorticoid-sparing (53.4% versus 59.9%; P=0.14), and implantable cardioverter defibrillator or cardiac resynchronization implantation (75.6% versus 73.8%; P=0.63), were similar. No significant differences were found in the primary outcome (29.5% in Black versus 28.5% in White; P=0.79). Subgroup analysis of the primary outcome also revealed no significant differences in both the left ventricular ejection fraction >35% group (24.1% in Black versus 25.9% in White; P=0.72) and the left ventricular ejection fraction ≤35% group (51% versus 42.5%; P=0.35).

CONCLUSIONS: Black patients with cardiac sarcoidosis exhibited significantly higher rates of lung, skin, and eye involvement and comorbidities, but had similar cardiac clinical outcomes and all-cause mortality compared with White patients. Nonetheless, ascertainment bias cannot be excluded.

PMID:40557494 | DOI:10.1161/CIRCEP.124.013670

Ann Surg Open. 2025 Jun 13;6(2):e582. doi: 10.1097/AS9.0000000000000582. eCollection 2025 Jun.

ABSTRACT

OBJECTIVE: To assess the outcomes of a pair of kidneys from a single donor used for simultaneous heart-kidney transplantation (SHKT) or kidney after heart transplantation (KAH).

BACKGROUND: An Increase in kidney dysfunction among heart transplant candidates has led to an increased need for SHKT and KAH. The risk of early kidney graft loss and mortality is higher in SHKT compared with kidney-alone recipients.

METHODS: Among adult kidney transplant recipients from Oct 2014 to Oct 2022, outcomes were compared between paired kidney-alone vs SHKT and kidney-alone vs KAH. Paired kidney models were used to mitigate differences among donor risk factors. Differential graft years were calculated using restricted mean survival analysis.

RESULTS: A total of 1220 pairs of kidney-alone and SHKT recipients and 441 pairs of kidney-alone and KAH recipients were identified. Among the paired donor kidneys, graft survival was significantly lower in SHKT recipients compared with kidney-alone recipients at 1-year post-transplant (96.1% vs 89.3%; P < 0.001) and at 3-year post-transplant (83.9% vs 78.8%; P < 0.001). This resulted in lower mean graft years [SHKT (3.98 years, standard error = 0.06) vs kidney-alone (4.55 years, standard error = 0.04); P < 0.001] and an additional loss of 57 kidney graft years per 100 transplants (P < 0.01) during the study period. There was no difference in graft survival of paired kidneys in kidney-alone vs KAH recipients with additional loss of 17 kidney graft years per 100 transplants (P = 0.20).

CONCLUSIONS: Optimal recipient selection for kidney after heart transplant under the new safety-net policy may help mitigate the significant risk of kidney graft failure among SHKT recipients.

PMID:40557359 | PMC:PMC12185088 | DOI:10.1097/AS9.0000000000000582

J Investig Med. 2025 Jun 24:10815589251355173. doi: 10.1177/10815589251355173. Online ahead of print.

ABSTRACT

Lung transplantation (LTx) is a vital treatment option for patients with end-stage lung diseases, significantly enhancing survival rates and quality of life. Nonetheless, chronic lung allograft dysfunction (CLAD) remains the primary cause of long-term morbidity and mortality in LTx recipients, posing substantial challenges to patient outcomes and healthcare systems. Despite progress in surgical methods and immunosuppressive treatments, CLAD management is complicated by its multifaceted, potentially irreversible nature. This review delves into critical aspects such as short telomere syndrome (STS), innovations in early detection, and adjunctive therapeutic approaches, offering insights into strategies that may extend the survival of LTx recipients. STS exacerbates CLAD by accelerating cellular aging and hindering tissue repair, necessitating a multidisciplinary approach involving pulmonologists, geneticists, hepatologists, and hematologists to devise comprehensive care plans. The review emphasizes dynamic magnetic resonance imaging as a promising tool for early CLAD detection, enhancing patient monitoring capabilities. Additionally, it examines the roles of extracorporeal photopheresis (ECP), total lymphoid irradiation (TLI), and anti-thymocyte globulins as adjunctive therapies, advocating for their inclusion in standard treatment protocols. This could lead to broader adoption and insurance coverage. Furthermore, we attempt to provide a framework to help decide which adjunctive treatments should be pursued based on the available evidence. By assessing these strategies and highlighting the importance of personalized care, this review aims to guide future research and clinical practice, ultimately improving CLAD management in lung transplant recipients.

PMID:40556056 | DOI:10.1177/10815589251355173

Spine Deform. 2025 Jun 25. doi: 10.1007/s43390-025-01132-w. Online ahead of print.

ABSTRACT

INTRODUCTION: Though chest tube removal at the completion of an endoscopic thoracic procedure is well accepted in the pediatric and adult general surgery literature, this practice has never been studied in pediatric patients treated with anterior vertebral tethering (AVT) for AIS. This study retrospectively analyzed pulmonary complications in a large series of AIS patients consecutively treated with chest tube removal at the completion of AVT. The rate of pulmonary complication in this series was then compared with the published rate of pulmonary complication in patients managed with chest tube retention after AVT.

METHODS: A retrospective review of all AIS patients treated with AVT over a twelve year period yielded 257 consecutive patients (248 primary/9 revision) with 349 curves. Out of a total of 349 chest tubes placed intraoperatively, as a routine step of the procedure, 323 were removed at procedure completion while 26 were maintained for 2-5 days post-operatively as warranted. Patient charts, radiographs, and CT scans were reviewed to confirm any pulmonary complications.

RESULTS: In 257 AIS patients treated with AVT, 233 had chest tube removal at the completion of AVT with 4 (1.7%) peri-operative and 8 (3.4%) delayed pulmonary complications. Peri-operative complications included one symptomatic pneumothorax noted in the operating room that required chest tube reinsertion; one static pneumothorax that resolved without intervention; and two significant pleural effusions that resolved over time without intervention. Delayed complications included seven pleural effusions that occurred 2-6 weeks post-operatively and one chylothorax that occurred 1 week post-operatively. Several clinically significant pleural effusions (4/7) required thoracentesis or chest tube drainage but subsequently resolved. The chylothorax required chest tube drainage, dietary fat restriction, and treatment with octreotide. In 24 patients, 26 chest tubes were retained for 2-5 days post-op for a persistent air leak with presumed parenchymal injury (14), revision with significant adhesions (6), bleeding disorder (2), or diaphragmatic repair related to renal eventration (1) or congenital diaphragmic hernia (1).

CONCLUSION: This study demonstrated the relative safety of immediate chest tube removal at the completion of AVT in AIS patients. The rate of pulmonary complication in 233 patients with chest tube removal at the completion of AVT was 5.1% which compared favorably with a published rate of 10-11% after chest tube retention. In 24 patients with an indication for chest tube retention at the completion of AVT, chest tube retention for 2-5 days resulted in no pulmonary complications.

PMID:40560514 | DOI:10.1007/s43390-025-01132-w

Tomography. 2025 May 28;11(6):62. doi: 10.3390/tomography11060062.

ABSTRACT

Aortic valve stenosis (AS) is a valvular heart disease that imposes a high afterload on the left ventricle (LV) due to restricted opening of the aortic valve, resulting in LV hypertrophy. Severe AS can lead to syncope, angina pectoris, and heart failure. The number of patients with AS has been increasing due to aging populations, the growing prevalence of lifestyle-related diseases, and advances in diagnostic technologies. Therefore, accurate diagnosis and appropriate treatment of AS are essential. In recent years, transcatheter aortic valve implantation (TAVI) has become feasible, and the number of procedures has rapidly increased, particularly among elderly patients. As treatment options for AS expand and diversify, detailed pre-procedural evaluation has become increasingly important. In particular, diagnostic imaging modalities such as computed tomography (CT) have advanced significantly, with notable improvements in image quality. With recent advancements in CT technology-such as increased detector rows, faster gantry rotation speeds, new image reconstruction methods, and the introduction of dual-energy imaging-the scope of cardiac assessment has expanded beyond the coronary arteries to include valves, myocardium, and the entire heart. This includes evaluating restricted AV opening and cardiac function using four-dimensional imaging, assessing AV annulus diameter and AS severity via calcium scoring with a novel motion correction algorithm, and detecting myocardial damage through late-phase contrast imaging using new reconstruction techniques. In cases of pre-TAVI evaluation or congenital bicuspid valves, CT is also valuable for assessing extracardiac structures, such as access routes and associated congenital heart anomalies. In addition, recent advancements in CT technology have made it possible to significantly reduce radiation exposure during cardiac imaging. CT has become an extremely useful tool for comprehensive cardiac evaluation in patients with aortic stenosis, especially those being considered for surgical treatment.

PMID:40560008 | PMC:PMC12196544 | DOI:10.3390/tomography11060062

Open Vet J. 2025 May;15(5):2259-2264. doi: 10.5455/OVJ.2025.v15.i5.43. Epub 2025 May 31.

ABSTRACT

BACKGROUND: Peritoneopericardial hernias (PPHs) are congenital malformations characterized by continuity defects between the diaphragm and the peritoneum that allow the transposition of abdominal organs into the thoracic cavity. These malformations can lead to clinical, gastroenterological, and respiratory problems, such as vomiting, dyspnea, and tachypnea. They can be congenital, and patients develop clinical signs at a young age or can be diagnosed as incidental when no complications occur. Furthermore, other malformations, such as cryptorchidism and cardiac interventricular communication, can present with congenital HPP.

CASE DESCRIPTION: This article reports a case of PPH in association with a ventricular septal defect (VSD) in a pediatric canine patient. The dog, a female Shih Tzu, aged 2 months, presented with cyanosis, low weight, decreased body condition score (3/9), and underdevelopment in comparison with other puppies of the same litter. At physical examination, all parameters were within the normal range; however, there was a sound at the base of the heart during auscultation, and echocardiographic examination displayed VSD. Due to the dyspnea, thoracic radiography was performed, and the suspicion of PPH was confirmed. Peritoneopericardial hernioplasty surgery was indicated for a 2-month-old patient. During the surgical procedure, it was not necessary to enter the thoracic cavity in order to close the defect, and suture surgery was performed through the abdominal cavity accessed in the subxiphoidal region. Despite the high risks associated with the procedure, no intraoperative or anesthetic complications occurred.

CONCLUSION: The hernioplasty procedure was considered successful, and the patient's development and body condition score improvement, with the surgical procedure resolving all signs of respiratory distress.

PMID:40557092 | PMC:PMC12184471 | DOI:10.5455/OVJ.2025.v15.i5.43

Cardiol Young. 2025 Jun 25:1-7. doi: 10.1017/S1047951125001969. Online ahead of print.

ABSTRACT

OBJECTIVE: The Pediatric Acute Care Cardiology Collaborative (PAC3) previously showed decreased postoperative chest tube duration and length of stay in children undergoing 9 Society of Thoracic Surgeons benchmark operations. Here we report how these gains were sustained over time and spread to 8 additional centers within the PAC3 network.

METHODS: Patient data were prospectively collected across baseline and intervention phases at the original 9 centres (Pioneer) and 8 new centres (Spread). The Pioneer baseline phase was 6/2017-6/2018 and Spread was 5/2019-9/2019. The Pioneer intervention phase was 7/2018-7/2021 and Spread 10/2019-7/2021. The primary outcome measure was postoperative chest tube duration in hours, with the aim of 20% overall reduction. Balancing measures included chest tube reinsertion and readmission for pleural effusion. Statistical process control methods and traditional statistics were used to analyse outcomes over time.

RESULTS: Among 5,042 patients at 17 centres, demographics were comparable. The Pioneer cohort (n = 3,383) sustained a 22.6% reduction in mean chest tube duration (from 91.9 hours to 70.5 hours), while the Spread cohort (n = 1,659) showed a 9.7% reduction (from 73.1 hours to 66.0 hours) in the first 13 months following intervention. Across both cohorts, rates of reinsertion (2.0% versus 2.1%, p = 0.869) and readmission for effusion did not change (0.3% versus 0.5%, p = 0.285).

CONCLUSIONS: This multicenter prospective quality improvement study demonstrated sustained reduction in chest tube duration at 9 centres while successfully spreading improvement to 8 additional centres. This project serves as a model for post-operative multicentre quality improvement across a large cohort of congenital cardiac surgery patients.

PMID:40556264 | DOI:10.1017/S1047951125001969

Tomography. 2025 May 28;11(6):62. doi: 10.3390/tomography11060062.

ABSTRACT

Aortic valve stenosis (AS) is a valvular heart disease that imposes a high afterload on the left ventricle (LV) due to restricted opening of the aortic valve, resulting in LV hypertrophy. Severe AS can lead to syncope, angina pectoris, and heart failure. The number of patients with AS has been increasing due to aging populations, the growing prevalence of lifestyle-related diseases, and advances in diagnostic technologies. Therefore, accurate diagnosis and appropriate treatment of AS are essential. In recent years, transcatheter aortic valve implantation (TAVI) has become feasible, and the number of procedures has rapidly increased, particularly among elderly patients. As treatment options for AS expand and diversify, detailed pre-procedural evaluation has become increasingly important. In particular, diagnostic imaging modalities such as computed tomography (CT) have advanced significantly, with notable improvements in image quality. With recent advancements in CT technology-such as increased detector rows, faster gantry rotation speeds, new image reconstruction methods, and the introduction of dual-energy imaging-the scope of cardiac assessment has expanded beyond the coronary arteries to include valves, myocardium, and the entire heart. This includes evaluating restricted AV opening and cardiac function using four-dimensional imaging, assessing AV annulus diameter and AS severity via calcium scoring with a novel motion correction algorithm, and detecting myocardial damage through late-phase contrast imaging using new reconstruction techniques. In cases of pre-TAVI evaluation or congenital bicuspid valves, CT is also valuable for assessing extracardiac structures, such as access routes and associated congenital heart anomalies. In addition, recent advancements in CT technology have made it possible to significantly reduce radiation exposure during cardiac imaging. CT has become an extremely useful tool for comprehensive cardiac evaluation in patients with aortic stenosis, especially those being considered for surgical treatment.

PMID:40560008 | PMC:PMC12196544 | DOI:10.3390/tomography11060062

J Cardiovasc Dev Dis. 2025 Jun 17;12(6):230. doi: 10.3390/jcdd12060230.

ABSTRACT

Rising morbidity and mortality from cardiovascular disease (CVD) have increased interest in precision and preventive management to reduce long-term sequelae. While retinal imaging has traditionally been recognized for identifying vascular changes in systemic conditions such as hypertension and type 2 diabetes mellitus, a new ophthalmologic field, cardiac-oculomics, has associated retinal biomarker changes with other cardiovascular diseases with retinal manifestations. Several imaging modalities visualize the retina, including color fundus photography (CFP), optical coherence tomography (OCT), and OCT angiography (OCTA), which visualize the retinal surface, the individual retinal layers, and the microvasculature within those layers, respectively. In these modalities, imaging-derived biomarkers can present due to CVD and have been linked to the presence, progression, or risk of developing a range of CVD, including hypertension, carotid artery disease, valvular heart disease, cerebral infarction, atrial fibrillation, and heart failure. Promising artificial intelligence (AI) models have been developed to complement existing risk-prediction tools, but standardization and clinical trials are needed for clinical adoption. Beyond risk estimation, there is growing interest in assessing real-time cardiovascular status to track vascular changes following pharmacotherapy, surgery, or acute decompensation. This review offers an up-to-date assessment of the cardiac-oculomics literature and aims to raise awareness among cardiologists and encourage interdepartmental collaboration.

PMID:40558665 | PMC:PMC12194434 | DOI:10.3390/jcdd12060230

J Am Heart Assoc. 2025 Jul;14(13):e040556. doi: 10.1161/JAHA.124.040556. Epub 2025 Jun 25.

NO ABSTRACT

PMID:40557791 | DOI:10.1161/JAHA.124.040556

JAMA Cardiol. 2025 Jun 25:e251920. doi: 10.1001/jamacardio.2025.1920. Online ahead of print.

ABSTRACT

IMPORTANCE: The STOP-or-NOT randomized clinical trial compared the outcomes of continuing vs discontinuing renin-angiotensin system inhibitors (RASi) prior to major noncardiac surgery and found no difference in the postoperative risk of death or major complications, but it remains unclear whether preoperative cardiovascular risk stratification influences the response to this intervention. This post hoc analysis explores whether preoperative cardiovascular risk stratification affects the outcomes in patients who continue vs discontinue RASi use before major surgery.

OBJECTIVE: To evaluate whether preoperative cardiovascular risk stratification affects the strategy of RASi management before major noncardiac surgery.

DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc analysis of the multicenter STOP-or-NOT randomized clinical trial, conducted across 40 hospitals in France between January 2018 and April 2023, with follow-up for 28 days postoperatively. Data analysis was performed from September 2024 to January 2025. The participants were patients who had been treated with RASi for at least 3 months and were scheduled for major noncardiac surgery.

INTERVENTION: Patients were randomized to either continue RASi until the day of surgery or to discontinue RASi 48 hours prior to surgery.

MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of all-cause mortality and major postoperative complications. Secondary outcomes were major adverse cardiovascular events and acute kidney injury. Cardiovascular risk stratification was assessed with the Revised Cardiac Risk Index (RCRI), American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index, and systolic blood pressure prior to randomization.

RESULTS: Among the 2222 patients (median [IQR] age, 68 [61-73] years; 771 [35%] female), 1107 were randomized to RASi continuation and 1115 were randomized to RASi discontinuation. Using the RCRI, 592 patients were categorized as low risk (0 points), 1095 as intermediate-low risk (1 point), 418 as intermediate-high risk (2 points), and 117 as high risk (≥3 points). Using the AUB-HAS2 Cardiac Risk Index, 1049 patients were categorized as low risk (0 points), 727 as intermediate-low risk (1 point), 333 as intermediate-high risk (2 points), and 113 as high risk (≥3 points). A total of 2132 patients were split into 4 quartiles of preoperative systolic blood pressure. The risk of postoperative complications and major adverse cardiovascular events varied with RCRI score. However, a strategy of RASi continuation vs discontinuation was not associated with a higher risk of postoperative complications.

CONCLUSIONS: This study found that preoperative cardiovascular risk did not affect patient outcomes with respect to the strategy of continuing vs discontinuing RASi before major noncardiac surgery, suggesting that the decision to continue or discontinue RASi should not be influenced by a patient's preoperative cardiovascular risk assessment.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03374449.

PMID:40560582 | PMC:PMC12199175 | DOI:10.1001/jamacardio.2025.1920

Metabolites. 2025 Jun 5;15(6):371. doi: 10.3390/metabo15060371.

ABSTRACT

Nitazenes represent an emerging class of new synthetic opioids characterized by a high-potency μ-opioid receptor (MOR) agonist activity. Background: We report two 20-year-old males who presented with severe neurorespiratory depression with typical opioid syndrome, but no opioid identification based on routine blood and urine screening tests. The first patient recovered with supportive care, mechanical ventilation, and naloxone infusion, whereas the second patient developed post-anoxic cardiac arrest and died from brain death. Methods: A complementary comprehensive toxicological screening using liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS) was performed, and data were processed using a dedicated molecular network strategy to profile the metabolites. Results: Protonitazene and protonitazepyne, two nitazenes differing in their ethylamine moieties (i.e., a diethyl versus a pyrrolidine substitution, respectively), were identified. We found an extensive metabolism of protonitazene, leading to the identification of multiple phase I (resulting from hydroxylation, N-desethylation, and O-despropylation) and phase II (resulting from glucuronidation) metabolites. By contrast, protonitazepyne metabolism appeared limited, with one metabolite annotated confidently, protonitazepyne acid, which resulted from the oxidative pyrrolidine ring cleavage. Concusions: To conclude, nitazene detection is highly challenging due to its extensive structural and metabolic diversity. Our findings highlight the contribution of the untargeted LC-HRMS screening approach and suggest that diagnostic product ions can serve as robust markers for nitazene identification.

PMID:40559395 | PMC:PMC12195359 | DOI:10.3390/metabo15060371

J Am Heart Assoc. 2025 Jul;14(13):e039541. doi: 10.1161/JAHA.124.039541. Epub 2025 Jun 23.

ABSTRACT

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used in cardiogenic shock, but sex-specific outcomes remain unclear. This study investigated in-hospital mortality differences by sex among patients receiving extracorporeal cardiopulmonary resuscitation (ECPR).

METHODS: We retrospectively reviewed adults with cardiogenic shock treated with VA-ECMO at National Taiwan University Hospital between 2010 and 2021. After propensity score matching to improve comparability between groups, survival outcomes were assessed using Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate the effect of sex on in-hospital mortality.

RESULTS: Of the 1329 patients (average age: 57.1±15.0 years; 953 men), 670 underwent VA-ECMO for ECPR. Women in the VA-ECMO group exhibited a lower prevalence of out-of-hospital cardiac arrest (6.7% versus 10.7%, P=0.031), a lower body mass index (24.0±4.4 versus 25.0±4.3, P<0.001), and lower rates of diabetes (26.2% versus 33.2%, P=0.017) and coronary artery disease (20.9% versus 28.6%, P=0.005) after propensity score matching. No discernible sex differences were observed in the baseline characteristics of the ECPR subgroup. Kaplan-Meier analyses showed no significant sex differences in mortality for VA-ECMO (log-rank P=0.1), but significant disparities were noted for ECPR (log-rank P=0.006). In the ECPR group, female patients exhibited higher mortality rates compared with men (hazard ratio, 1.37 [95% CI, 1.09-1.72]; P=0.007), independent of Survival After Veno-Arterial ECMO score severity.

CONCLUSIONS: Women who underwent ECPR had higher in-hospital mortality rates regardless of the severity of their Survival After Veno-Arterial ECMO scores, despite the absence of significant sex differences in VA-ECMO mortality. This emphasizes the necessity for sex-based strategies in ECPR administration.

PMID:40551319 | DOI:10.1161/JAHA.124.039541

Am J Cardiovasc Drugs. 2025 Jun 24. doi: 10.1007/s40256-025-00739-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Whether ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) carry distinct prognoses after discharge remains a matter of debate. This study aimed to compare 1-year clinical outcomes between patients with STEMI and NSTEMI in a large, real-world cohort.

METHODS: Among 23,270 patients with acute coronary syndrome enrolled in the international PRAISE registry between 2003 and 2019, we included 21,789 patients with a diagnosis of either STEMI or NSTEMI. Clinical characteristics, discharge medications, and outcomes at 1 year were analyzed. The primary outcomes were all-cause mortality, re-infarction, and major bleeding. Multivariable logistic regression and propensity score matching were used to adjust for confounding. Subgroup and interaction analyses were also performed.

RESULTS: The cohort included 12,365 patients with STEMI and 9424 patients with NSTEMI. At baseline, patients with NSTEMI had more comorbidities, cardiovascular risk factors (except diabetes), and prior revascularization. Patients with STEMI were more frequently treated with statins, beta-blockers, and renin-angiotensin-aldosterone system inhibitors at discharge. At 1-year follow-up, overall outcomes were comparable between groups. Nonfatal reinfarction occurred more frequently in patients with NSTEMI (3.4% versus 2.8%, p = 0.022), but this association was not significant after adjustment (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.65-1.24, p = 0.519). Results from propensity score-matched analyses confirmed the absence of prognostic differences. Subgroup analyses revealed significant interactions for diabetes mellitus and completeness of revascularization.

CONCLUSIONS: After accounting for clinical and therapeutic variables, 1-year outcomes were largely similar in patients with STEMI and NSTEMI. Differences in reinfarction risk appear to be driven by baseline characteristics and treatment patterns, rather than infarct type itself.

PMID:40555879 | DOI:10.1007/s40256-025-00739-8

JACC Adv. 2025 Jun 18;4(7):101913. doi: 10.1016/j.jacadv.2025.101913. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with chest pain who are very low risk, defined by a History, Electrocardiogram, Age, and Risk factors (HEAR) score ≤1, may not require troponin testing.

OBJECTIVES: The aim of this study was to determine whether troponin testing is needed in patients with HEAR scores ≤1 in a multisite U.S.

METHODS: We conducted an observational cohort study using the Wake Forest Chest Pain Registry. Patients ≥18 years old with HEART Pathway assessments and high-sensitivity troponin testing were accrued from 5 U.S. emergency departments (November 1, 2020-July 7, 2022). HEAR scores were prospectively completed by the treating clinician for patients with no known coronary artery disease and a nonischemic electrocardiogram. The outcome was 30-day major adverse cardiovascular events (MACE) (death, myocardial infarction [MI], and revascularization). The proportion of patients with HEAR scores ≤1 with MACE within 30 days was determined, and test characteristics were calculated. The net reclassification improvement index for troponin testing among patients with HEAR scores ≤1 was determined.

RESULTS: Among 9,105 patients, 17.2% (1,565/9,105) had a HEAR score ≤1. At 30 days, MACE occurred in 0.7% (11/1,565; 95% CI: 0.4-1.3), with 3 deaths, 8 MIs, and 1 revascularization. The sensitivity and negative predictive value for 30-day MACE in patients with a HEAR score ≤1 were 97.9% (95% CI: 96.2-98.9) and 99.3% (95% CI: 98.7-99.6). Troponin testing correctly reclassified 8 with death, MI, or revascularization. Troponin was elevated among 74 without MACE, yielding a nonsignificant net reclassification improvement index of 0.7% (95% CI: -0.4 to 1.8).

CONCLUSIONS: Patients with no known coronary artery disease, a nonischemic electrocardiogram, and a HEAR score ≤1 had a missed MACE rate <1%. Troponin testing identified additional patients with MACE but did not significantly improve risk stratification accuracy.

PMID:40554408 | DOI:10.1016/j.jacadv.2025.101913

Front Cardiovasc Med. 2025 Jun 9;12:1515916. doi: 10.3389/fcvm.2025.1515916. eCollection 2025.

ABSTRACT

AIMS: This study aimed to confirm the correlation between lipoprotein(a) [Lp(a)] and major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) combined with heart failure with preserved ejection fraction (HFpEF).

METHODS: This retrospective study was conducted at the First Affiliated Hospital of Dalian Medical University and included 399 patients who were diagnosed with AMI combined with HFpEF and who were hospitalised and underwent percutaneous coronary intervention (PCI) treatment between January 1, 2018, and January 1, 2023. Based on Lp(a) levels, patients were divided into three tertiles: T1 (≤356 mg/L), T2 [356 mg/L < Lp(a) ≤ 487 mg/L], and T3 (>487 mg/L). The study employed univariate and multivariate Cox regression analysis, subgroup analysis, and receiver operating characteristic (ROC) curve analysis to evaluate the correlation between Lp(a) and MACE.

RESULTS: Compared to the non-MACE group, the MACE group had higher levels of Lp(a) (P < 0.001). Tertile-based analysis of Lp(a) levels showed that as Lp(a) increased, the incidence of MACE, rehospitalization due to worsening HF, non-fatal recurrent MI, and unplanned repeat revascularization all increased significantly (all P < 0.05). During an average follow-up period of 30.5 months, multivariate Cox regression analysis confirmed that Lp(a) consistently remained an independent predictor of MACE across unadjusted, partially adjusted, and fully adjusted models (all P < 0.05). Further component analysis indicated that Lp(a) was significantly associated with cardiac death, rehospitalization due to worsening HF, and non-fatal recurrent MI, with the highest risk observed in the T3 group. Subgroup analysis further demonstrated that the association between elevated Lp(a) and MACE remained statistically significant across various strata (all P < 0.05). ROC curve analysis revealed that the area under the curve (AUC) for Lp(a) in predicting MACE was 0.662 (95% CI: 0.607-0.718), which was higher than that of systolic blood pressure (AUC = 0.560) and fasting plasma glucose (AUC = 0.543), but not significantly different from age (AUC = 0.610, P = 0.211).

CONCLUSIONS: In patients with AMI combined with HFpEF, elevated Lp(a) levels were significantly associated with an increased risk of MACE, and this association remained consistent across multiple subgroups.

PMID:40552189 | PMC:PMC12183255 | DOI:10.3389/fcvm.2025.1515916

Cell Death Differ. 2025 Jun 24. doi: 10.1038/s41418-025-01540-5. Online ahead of print.

ABSTRACT

Activation of the intrinsic regenerative potential of adult mammalian hearts by promoting cardiomyocyte proliferation holds great potential in heart repair. CAND1 (Cullin-associated and neddylation-dissociated protein 1) functions as a critical regulator of cellular protein homeostasis by fine-tuning the ubiquitinated degradation of specific abnormally expressed protein substrates. Here, we identified that cardiac-specific transgenic overexpression of CAND1 reduced the infarct size, restored cardiac function, and promoted cardiomyocyte proliferation after myocardial infarction in juvenile (7-day-old) and adult (8-week-old) mice. Conversely, CAND1 deficiency blunted the regenerative capacity of neonatal hearts after apex resection. MS and functional verification demonstrated that CAND1 enhanced the assembly of Cullin1, FBXW11(F-box/WD repeat-containing protein 11), and Mob1b (Mps one binder kinase activator 1b) complexes, and thus promotes the degradation of Mob1b. The ubiquitination of Mob1b occurred at K108 and was linked by K48 of ubiquitin. Mob1b deletion partially rescued the loss of regenerative capacity in neonatal hearts induced by CAND1 deficiency and improved cardiac function in adult mice post-MI. Moreover, CAND1 promoted the proliferation of human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs). Our data demonstrate that CAND1 promotes cardiomyocyte proliferation via FBXW11-mediated K48-linked ubiquitination degradation of Mob1b, and improves heart regeneration after cardiac injury. The findings provide a novel strategy to promote cardiac regeneration and repair. Schematic diagram of the role of CAND1 in regulating ubiquitination and degradation of Mob1b and cardiomyocyte proliferation and heart regeneration. Under CAND1-High condition, CAND1 promotes the incorporation of Cullin1, FBXW11, and Mob1b complexes, and accelerates SCFFBXW11-mediated K48-linked ubiquitination of Mob1b at the K108 site, which leads to the degradation of Mob1b and thus suppresses the Hippo signaling pathway and facilitates cardiomyocyte proliferation and heart regeneration post-MI.

PMID:40555744 | DOI:10.1038/s41418-025-01540-5

J Cardiovasc Transl Res. 2025 Jun 24. doi: 10.1007/s12265-025-10647-6. Online ahead of print.

ABSTRACT

The acute pathophysiological changes after myocardial ischemia complicated by cardiogenic shock (CS) remain poorly defined, especially regarding compensatory mechanisms and myocardial mitochondrial function. We investigated immediate cardiovascular and mitochondrial effects in a porcine model of ischemic CS. CS was induced in 32 Danish Landrace pigs (60 kg) via repeated microembolization of the left coronary artery until a 30% reduction in cardiac output (CO) or mixed venous saturation. Monitoring included pulmonary artery and left ventricular pressure-volume catheters, with analysis of endomyocardial biopsies and arterial, mixed venous, and coronary sinus blood samples. CO deteriorated promptly due to decreased stroke volume. Contractility declined, and afterload increased, causing rapid ventriculo-arterial decoupling. Forward flow parameters were compromised prior to pressure-parameters. Diastolic function was impaired and mitochondrial damage was observed. CS rapidly impairs LV hemodynamic and mitochondrial function, highlighting the importance of monitoring forward flow and targeting mitochondrial function in treatment.

PMID:40555857 | DOI:10.1007/s12265-025-10647-6

Ann Vasc Surg. 2025 Jun 17:S0890-5096(25)00424-8. doi: 10.1016/j.avsg.2025.05.054. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to create a risk score for the development of perioperative myocardial infarction (MI) following carotid endarterectomy (CEA) utilizing weighted variables from the Vascular Qualitative Initiative (VQI) database, which have a multivariable significant association with the event.

METHODS: The VQI CEA module was queried between January 2003 and October 2023 and 192,547 procedures met the study inclusion criteria. Both symptomatic and asymptomatic patients were included. An internal VQI validation cohort was similarly created with the same exclusion criteria utilizing CEA performed between November 2023 and October 2024, over which time period 17,449 individuals met the inclusion criteria. The primary study outcome was perioperative MI at CEA. Univariable analysis was conducted followed by binary logistic regression analysis utilizing significant univariable factors. Regression beta-coefficient was used to create a weighted risk score for MI and internal validation with testing at each risk score was conducted. Mortality rates in long-term follow up for those with vs. without MI was investigated.

RESULTS: MI occurred in 0.7% of cases (N=1299). The following factors had a significant (P<.05) multivariable association with perioperative MI for CEA : female sex; advancing age; rural home status; diabetes; history (Hx) of coronary artery disease (CAD); MI or angina pectoris within 6 months of surgery; coronary artery bypass grafting (CABG) >5 years ago; congestive heart failure regardless of severity; renal insufficiency; positive stress test within two years; anemia; Hx of peripheral arterial disease intervention; prior CEA or carotid artery stenting; dual antiplatelet therapy at time of presentation; modified Rankin score ≥2 at time of CEA; and urgent/emergent CEA. Not having had a Hx of prior MI in combination with having no current CAD symptom was protective (P<.001) for perioperative MI. There was significant escalation noted with increasing risk score as patients with scores of ≤5 experienced MI in just 0.2% of cases whereas patients with risk scores of >25 experienced MI at a >20 times higher rate of 4.1%. AUC analysis for the risk score had a value of 0.70. Application of the risk score to the validation cohort resulted in a similar AUC value of 0.72.

CONCLUSIONS: A risk score for the event of perioperative MI at the time of CEA has been developed that has good accuracy. Patients experiencing perioperative MI have a significantly increased 5-year mortality rate relative to those without. Given the significant impact of perioperative MI on long-term survival, this risk score has important implications for perioperative cardiac risk assessment and optimization strategies.

PMID:40553834 | DOI:10.1016/j.avsg.2025.05.054

Cardiovasc Hematol Disord Drug Targets. 2025 Jun 19. doi: 10.2174/011871529X367923250609171115. Online ahead of print.

ABSTRACT

INTRODUCTION: Oroxylin A is primarily sourced from the roots of Scutellaria baicalensis, a medicinal plant commonly used in traditional Chinese medicine. It can also be found in other Scutellaria species. The plant's rich bioactive profile makes it a significant source of various flavonoids, including Oroxylin A.

AIM: The proposed aim of this study is to investigate in-vitro anti-oxidant activity, toxicity studies and in-vitro cardioprotective activity of Oroxylin-A against Doxorubicin mediated myocardial damage on H9c2.

METHODS: The total phenolic content was estimated using Folin-Ciocalteu test and in-vitro activity was performed using DPPH assay. Acute toxicity studies were performed according to OECD 423 guidelines. In vitro cardioprotective activity was performed on H9c2 cells and was estimated for the biomarkers.

RESULTS: Oroxylin-A showed good antioxidant activity. No abnormalities were found in animals upon its usage, indicating that Oroxylin-A was safe at 2000 mg/kg. 150ug/ml of Oroxylin-A significantly increased the cell viability up to 99% and also decreased the LDH and ROS generation indicating that Oroxylin-A showed significant cardioprotective activity on H9c2 cells.

CONCLUSION: This research underscores the potential of Oroxylin A as a candidate for further investigation as a cardioprotective agent. Also, the present study contributes to the growing body of knowledge aimed at identifying natural compounds that may offer protective effects against myocardial damage, providing hope for future therapeutic interventions in the field of cardiovascular medicine.

PMID:40551683 | DOI:10.2174/011871529X367923250609171115