Agregador de feeds

J Am Heart Assoc. 2025 Sep 25:e043042. doi: 10.1161/JAHA.125.043042. Online ahead of print.

ABSTRACT

BACKGROUND: Creation of a partial cavopulmonary anasthomosis in patients with isolated right-sided heart failure or patients with cyanosis and intracardial right-to-left shunt and reduced blood flow in the pulmonary circulation may provide a significant improvement in exercise capacity and also facilitate the performance of activities of daily living in patients with a deteriorated clinical condition. However, surgical partial cavopulmonary connection creation may be a high-risk procedure in this patient group. An interventional partial cavopulmonary connection may provide a less invasive treatment modality for these patients. The aim of the study was a retrospective evaluation of patients who underwent the creation of an interventional partial cavopulmonary connection.

METHODS: Each patient who was qualified for treatment underwent a preinterventional computed tomography scan with 3-dimensional reconstruction for improved procedure planning. As a preparation preceding the interventional partial cavopulmonary connection, a prestent (bare metal stent) was implanted into the superior vena cava during cardiac catheterization in most cases. The perforation was performed with the use of needle punctures as a straightforward method in all cases. Thereafter, a covered stent was implanted, connecting the superior vena cava and the right pulmonary artery.

RESULTS: Between July 2019 and July 2024, 14 patients (male n=6, 43%) underwent an interventional partial cavopulmonary connection. The indication for treatment was deteriorated clinical condition (n=12, 86%) or significant cyanosis (n=2, 14%). The procedure was performed successfully in all cases. The median follow-up time was 19.8 months (minimum 2.7; maximum 65.6).

CONCLUSIONS: Our study shows that transcatheter creation of partial cavopulmonary connection provides a promising treatment modality for selected adult patients with right-sided heart failure and may lead to clinical improvement in this patient group.

PMID:40996081 | DOI:10.1161/JAHA.125.043042

Saudi J Anaesth. 2025 Oct-Dec;19(4):628-630. doi: 10.4103/sja.sja_12_25. Epub 2025 Sep 3.

ABSTRACT

Noonan syndrome (NS) is an autosomal dominant multisystem disorder characterized by congenital cardiac defects, craniofacial anomalies, and hematological abnormalities. With an incidence of 1 in 1000 to 2500 live births, NS is one of the most common syndromes associated with congenital heart disease, second only to trisomy 21. Pregnant patients with NS present unique anesthetic challenges due to the syndrome's diverse manifestations and the physiological changes of pregnancy. This report describes a 28-year-old woman with NS who underwent elective cesarean delivery at 36 weeks of gestation. Her medical history included repaired congenital heart defects, pulmonary stenosis, severe scoliosis, and asthma. Spinal anesthesia was successfully employed using a low-dose combination of local anesthetics and opioids to achieve effective sensory block while maintaining hemodynamic stability. The patient's normal coagulation profile allowed neuraxial anesthesia to be a feasible option despite potential technical difficulties associated with spinal abnormalities. This case underscores the importance of a multidisciplinary approach to pregnant patients with NS, including comprehensive preoperative evaluation and individualized anesthetic planning. Neuraxial anesthesia can be a safe and effective option when tailored to the patient's specific physiology, ensuring optimal maternal and fetal outcomes while minimizing risks.

PMID:40994481 | PMC:PMC12456655 | DOI:10.4103/sja.sja_12_25

Br J Hosp Med (Lond). 2025 Sep 25;86(9):1-14. doi: 10.12968/hmed.2025.0284. Epub 2025 Sep 15.

ABSTRACT

Congenital pulmonary airway malformation (CPAM) is a rare cystic lung anomaly in newborns. It can range from asymptomatic to causing life-threatening respiratory distress. However, severe respiratory failure occurring in the immediate neonatal period is uncommon. We report the case of a neonate with CPAM who developed respiratory failure requiring urgent surgical management. The case aims to highlight the importance of early diagnosis and surgical intervention in neonates presenting with severe CPAM to prevent fatal outcomes and support complete recovery. A 29-hour-old male neonate was admitted with cyanosis and severe respiratory distress at birth. His oxygen saturation was only 50% on supplemental oxygen. Chest X-ray and computed tomography (CT) scan revealed a massive multicystic lesion in the left lung consistent with CPAM, with mediastinal shift and compression of the right lung. The baby was intubated and placed on mechanical ventilation, but his respiratory status remained critical. Emergent surgical resection of the left upper lobe was performed. Histopathological examination confirmed a mixed Type I and Type II CPAM. Following early surgical lobectomy, the neonate's respiratory status improved rapidly. He was weaned from the ventilator without difficulty, and mediastinal structures returned to midline. Post-operative course was uneventful, and the infant was discharged in good condition within two weeks. Follow-up at four years showed normal respiratory function, normal pulmonary development on imaging, and no evidence of recurrent pulmonary disease. Early diagnosis and intervention of neonatal CPAM are crucial in the presence of severe respiratory compromise. This case illustrates that urgent surgical resection was effective in correcting respiratory failure caused by a large CPAM, and complete recovery is achievable. Clinicians should consider congenital lung malformations when assessing newborns with unexplained respiratory distress.

PMID:40994381 | DOI:10.12968/hmed.2025.0284

Cardiol Young. 2025 Sep 25:1-6. doi: 10.1017/S1047951125109529. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the feasibility of developing and implementing a multidisciplinary bootcamp for early-career Paediatric Cardiac Critical Care practitioners.

SETTING: A one-day pre-conference bootcamp at the Pediatric Cardiac Intensive Care Society Annual Meeting in December 2022.

SUBJECTS: Physicians, fellows, nurses, advanced practice registered nurses, and respiratory therapists who work primarily in paediatric cardiac critical care units.

METHODS: A modified Delphi needs assessment with interprofessional content experts for the development of a mixed didactic and simulation-based bootcamp at the Pediatric Cardiac Intensive Care Society Annual Meeting in December 2022, with pre- and post-testing to evaluate knowledge gain and additional surveys to assess perceived value.

RESULTS: Eighty-three course participants came from a variety of professions and represented institutions nationally and internationally. Most participants (77%) had two or more years of professional experience, aligning with the bootcamp's focus on advanced learners. The bootcamp received strong participant evaluations: 84.1% (37/44) strongly agreed that the bootcamp improved their clinical knowledge. Ninety-seven percent (43/44) reported increased confidence in the ability to care for paediatric cardiac critical care patients. The bootcamp demonstrated a significant improvement in participant knowledge, with pre-test scores averaging 54.9% (95% CI: 49.9-59.9) compared to post-test scores of 64.5% (95% CI: 59.7-69.2), achieving statistical significance (p < 0.05).

CONCLUSIONS: Our pilot bootcamp has shown an improvement in immediate knowledge retention with valuable insights gathered to enhance future bootcamps. The results of this advanced interprofessional bootcamp evaluation will inform future iterations for providers in paediatric cardiac critical care.

PMID:40994242 | DOI:10.1017/S1047951125109529

Cardiol Young. 2025 Sep 25:1-7. doi: 10.1017/S1047951125109359. Online ahead of print.

ABSTRACT

BACKGROUND: Right ventricular outflow tract stenting is a palliative treatment option in symptomatic infants with tetralogy of Fallot or with pulmonary atresia with ventricular septal defect. Predominantly bare metal stents are used for this procedure. The authors sought to assess the efficacy and safety of using the covered coronary stent grafts for the right ventricular outflow tract stenting.

METHODS: Between November 2017 and July 2021, the covered coronary stent graft was used to widen the right ventricular outflow tract in 20 symptomatic patients (pulmonary atresia with ventricular septal defect n = 5, tetralogy of Fallot n = 15).

RESULTS: All stent grafts were implanted successfully. The median time of palliation was 156 (43-1578) days. Eleven patients required stent redilation. Fifteen patients required additional stent implantation to relieve a proximal obstruction in the right ventricular outflow tract. There were three complications observed: right ventricular outflow tract perforation (n = 1), stent embolisation (n = 1), and main pulmonary aneurysm (n = 1). Oxygen saturation improved immediately after the procedure. During the follow-up time, all stents were patent, and we observed a significant increase in the diameters of the pulmonary arteries. Sixteen patients had corrective surgery performed with complete and easy removal of the implanted stents.

CONCLUSIONS: Stenting of the right ventricular outflow tract with stent grafts was safe and effective and provided a durable method of palliation. Utilisation of the covered coronary stent graft facilitated surgical removal of the implanted stent during the surgical correction.

PMID:40994230 | DOI:10.1017/S1047951125109359

Catheter Cardiovasc Interv. 2025 Sep 25. doi: 10.1002/ccd.70213. Online ahead of print.

ABSTRACT

Aortic regurgitation (AR) develops in up to 25%-30% of patients with left ventricular assist device (LVAD). Treatment remains challenging since surgery confers significant peri-operative risk and the lack of valvular calcification renders transfemoral transcatheter aortic valve implantation (TF-TAVI) with non-dedicated devices technically challenging. We present a case series wherein a TF J-Valve system, a dedicated transcatheter heart valve for pure AR, emerges as an alternative treatment for AR in patients with an LVAD. We demonstrate successful deployment even in the presence of challenging anatomy including aortic root thrombus. Technical considerations when performing TF-TAVI in LVAD patients are discussed.

PMID:40995838 | DOI:10.1002/ccd.70213

JACC Cardiovasc Interv. 2025 Sep 22;18(18):2209-2221. doi: 10.1016/j.jcin.2025.07.036.

ABSTRACT

BACKGROUND: Drug-coated balloons (DCBs) are increasingly used in percutaneous coronary intervention (PCI). Their application for chronic total occlusions (CTOs) is a promising option to limit stent length in diffuse disease and avoid stent underexpansion and malapposition in negatively remodeled distal vessel segments.

OBJECTIVES: The aim of this study was to analyze CTO PCI procedures recorded in ERCTO (European Registry of Chronic Total Occlusion) to investigate frequency of use, patient and lesion characteristics, and in-hospital outcomes of DCBs.

METHODS: CTO cases entered into the database from 2016 to 2023 were examined and categorized according to DCB use. DCB-treated patients were further divided into 2 groups: DCBs only and DCBs in association with drug-eluting stents. To minimize the potential impact of confounding factors, 1:1 propensity score matching was applied.

RESULTS: Of 40,449 CTO PCIs performed at 184 centers, DCBs were used in 2,506 (6.2%), increasing from 3.4% (n = 185 of 5,498) in 2016 to 14.9% (n = 705 of 4,722) in 2023. In-hospital complications were infrequent, but DCB-treated CTOs had significantly lower rates of pericardial tamponade (0.1% [n = 2 of 2,506] vs 0.4% [n = 169 of 37,943]; P = 0.006). After propensity score matching, DCB use led to reduced drug-eluting stent length (44.2 ± 36.9 mm [95% CI: 42.7-45.7 mm] vs 58.1 ± 35.9 mm [95% CI: 56.7-59.5] mm; P < 0.001). Contrast volume was lower in the DCB-treated patients (202.4 ± 109.8 mL [95% CI: 198.1-206.7 mL] vs 211.6 ± 123 mL [95% CI: 206.8-216.4 mL]; P = 0.005).

CONCLUSIONS: The use of DCBs in CTO recanalization is increasing and is associated with a reduction in the length of stents implanted, as well as a decrease in contrast volume and a lower rate of pericardial tamponade.

PMID:40992801 | DOI:10.1016/j.jcin.2025.07.036

JACC Cardiovasc Interv. 2025 Sep 22;18(18):2197-2205. doi: 10.1016/j.jcin.2025.07.024.

ABSTRACT

BACKGROUND: Robust evidence on optimal stent expansion using intravascular ultrasound (IVUS) is still lacking.

OBJECTIVES: The aim of this study was to validate the impact of different criteria for IVUS-defined optimal stent expansion on 1-year clinical outcomes after percutaneous coronary intervention (PCI).

METHODS: Individual patient data from 3 randomized trials were aggregated for this analysis. Patients (n = 6,290) were classified into 3 groups: optimized PCI by IVUS, nonoptimized PCI by IVUS, and angiography-guided PCI. The primary endpoint was target vessel failure (TVF) at 1 year, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization.

RESULTS: Angiography-guided PCI was performed in 3,208 patients. Optimal stent expansion was evaluated in 3,082 patients with IVUS-guided PCI. For the absolute criterion of minimal stent area (MSA) >5.5 mm2 indicating optimal stent expansion, the optimized PCI group had a lower incidence of TVF (1.45% vs 3.86% vs 5.07%) compared with the nonoptimized PCI group (adjusted HR: 0.45; 95% CI: 0.26-0.75; P = 0.002) and the angiography-guided PCI group (adjusted HR: 0.35; 95% CI: 0.22-0.54; P < 0.001). Relative criteria did not show a significantly different TVF incidence between the optimized and nonoptimized PCI groups. In particular, the absolute criterion of MSA >5.5 mm2 was associated with a significant reduction of the composite of cardiac death or target vessel myocardial infarction (0.54% in the optimized PCI group vs 1.59% in the nonoptimized PCI group; adjusted HR: 0.39; 95% CI: 0.17-0.91; P = 0.028).

CONCLUSIONS: Post-PCI stent expansion meeting an absolute criterion of MSA >5.5 mm2 was associated with the most favorable clinical outcomes. (Effect of Intravascular Ultrasound in Patients Receiving Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: An Individual Patient Data Meta-Analysis of IVUS-XPL, ULTIMATE and IVUS-ACS Randomized Trials; CRD42024559794).

PMID:40992799 | DOI:10.1016/j.jcin.2025.07.024

Open Heart. 2025 Sep 23;12(2):e003673. doi: 10.1136/openhrt-2025-003673.

ABSTRACT

BACKGROUND: Postoperative cerebral infarction following coronary artery bypass grafting (CABG) for multivessel coronary artery disease (CAD) is a major complication and is associated with insulin resistance (IR). This study used the Triglyceride-Glucose (TyG) Index, a robust indicator of IR, to assess its association with cerebral infarction and other adverse events in patients with off-pump CABG (OPCABG).

METHODS: This retrospective observational study included 3654 CAD cases from eight centres across China. The primary outcome was postoperative cerebral infarction. The predictive role of the TyG Index was evaluated using multivariate logistic regression and restricted cubic spline regression. Receiver operating characteristics analysis was conducted to assess its impact on model performance.

RESULTS: A total of 89 patients experienced postoperative cerebral infarction. After adjusting for confounding factors, the TyG Index, whether treated as a categorical variable (OR=2.23, 95% CI 1.24 to 4.02) or a continuous variable (OR=1.80, 95% CI 1.29 to 2.51), was found to be a significant independent risk factor for postoperative cerebral infarction (both p<0.001). The restricted cubic splines regression model revealed a linear dose-response association between the TyG Index and the risk of postoperative cerebral infarction (p for non-linearity=0.861). Subgroup analysis did not indicate any interactions among subgroups (p for interaction >0.05). Incorporating the TyG Index yielded a modest but statistically significant improvement in discrimination for postoperative cerebral infarction (area under the receiver operating characteristics curve 0.724 vs 0.708; p<0.001).

CONCLUSIONS: IR reflected by an elevated TyG Index predicts the risk of postoperative cerebral infarction in patients undergoing OPCABG.

TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry: Chictr2400085741.

PMID:40992796 | PMC:PMC12458668 | DOI:10.1136/openhrt-2025-003673

Am J Cardiol. 2025 Sep 22:S0002-9149(25)00567-3. doi: 10.1016/j.amjcard.2025.09.013. Online ahead of print.

ABSTRACT

This study sought to assess sex differences in timely diagnosis (time-to-ECG) and treatment (time-to-percutaneous coronary intervention (PCI)) of ST-elevation myocardial infarction (STEMI) and Non-STEMI (NSTEMI) patients utilizing a retrospective cross-sectional analysis of 1098 STEMI (306 females and 792 males) and 2,179 NSTEMI (747 females, 1432 males) patients that presented to 2 urban EDs between January 2022 and December 2024 was performed. Sex differences in time-to-ECG were assessed in both STEMI and NSTEMI patients, whereas differences in time-to-PCI were assessed in STEMI patients only. Time-to-ECG and time-to-PCI were compared continuously, as well as categorically (ECG delay = time-to-ECG > 10 min and PCI delay = time-to-PCI > 90 min or >120 min when a transfer occurred). Median time-to-ECG was 3.0 min shorter for male STEMI and NSTEMI patients. Males also had a reduced likelihood of an ECG delay (OR: 0.64 [95% CI: 0.51 - 0.82]). Sex disparities remained when assessing only patients with a chief complaint of chest pain (OR:0.74 [95% CI: 0.56 - 0.97]). Male STEMI patients also had a shorter wait time for PCI compared to females (walk-in: 1:26:00 vs. 1:41:00, transfer: 2:19:30 vs. 2:44:30, respectively). However, sex was not a significant predictor of PCI delay after controlling for time-to-ECG. In conclusion, sex disparities were found in time-to-ECG for STEMI and NSTEMI patents, as well as time-to-PCI for STEMI patients. However, sex was not significantly associated with PCI delay after controlling for time-to-ECG. This highlights the importance of timely diagnosis to ensure timely revascularization in acute myocardial infarction patients.

PMID:40992532 | DOI:10.1016/j.amjcard.2025.09.013

Am J Cardiol. 2025 Sep 22:S0002-9149(25)00563-6. doi: 10.1016/j.amjcard.2025.09.016. Online ahead of print.

ABSTRACT

There is limited data on the incidence and outcomes of ST-segment elevation myocardial infarction (STEMI) due to the left main coronary artery (LMCA) lesions. We aimed to examine the trends and outcomes of STEMI due to LMCA lesions. The Nationwide Readmissions Database was utilized to identify hospitalizations with LMCA STEMI between January 2016 and December 2022. The primary outcome was all-cause in-hospital mortality during index admission. Among 1,528,764 weighted hospitalizations with STEMI from 2016 to 2022, 4,885 (0.3%) were due to LMCA lesions, of which 2,156 (44.1%) had cardiogenic shock (CS). The number of LMCA STEMI hospitalizations and the incidence of CS increased over time. Mechanical circulatory support was used in 78.8% of the patients with LMCA STEMI and CS, with intra-aortic balloon pump being the most common modality (63%). Impella utilization increased from 4.5% in Q1 2016 to 34% in Q4 2022. Revascularization was performed in 78.2% of cases, with percutaneous coronary intervention (PCI) being the most common revascularization modality (62.1%). Among those who had PCI, intravascular imaging (IVI) was used in 18.3%, with a significant increase from 9.6% in Q1 2016 to 26.3% in Q4 2022. All-cause in-hospital mortality was 25.5% and was significantly higher among CS patients (43.4% vs. 11.4%, P<0.001). In conclusion, the incidence of LMCA STEMI increased from 2016 to 2022 with nearly half of the patients developing CS. IVI use in LMCA PCI was low (18.3%) but increased over time. More than 1 in 4 patients with LMCA STEMI died during the index hospitalization.

PMID:40992531 | DOI:10.1016/j.amjcard.2025.09.016

Am J Cardiol. 2025 Sep 22:S0002-9149(25)00568-5. doi: 10.1016/j.amjcard.2025.09.020. Online ahead of print.

ABSTRACT

This study investigated whether cardiovascular magnetic resonance (CMR)-derived atrial strain parameters are associated with new-onset cerebrovascular events in patients with reperfused ST-segment elevation myocardial infarction (STEMI). In this retrospective analysis, CMR scans of 211 consecutive STEMI patients (77% male; mean age 64.5 ± 10.3 years) who underwent coronary revascularization were assessed. The primary endpoint was the occurrence of acute ischemic stroke or transient ischemic attack, collectively defined as cerebrovascular events. Atrial strain was analyzed offline from standard cine steady-state free precession sequences, focusing on left atrial (LA) reservoir, conduit, and booster strain. Over a median follow-up of 25 months (interquartile range 13-36), 23 patients (11%) experienced cerebrovascular events. In multivariable Cox regression analysis, LA reservoir and conduit strain were independent predictors of these events, irrespective of cardiovascular risk factors, LA volume, thrombus presence, and incident atrial fibrillation (HR: 0.84; 95% CI: 0.77-0.91; p = 0.001 and HR: 0.74; 95% CI: 0.63-0.87; p = 0.001, respectively). In conclusion, CMR-derived LA reservoir and conduit strain are independently associated with increased risk of cerebrovascular events, and their integration into the clinical assessment of STEMI patients may improve risk stratification.

PMID:40992528 | DOI:10.1016/j.amjcard.2025.09.020

Ann Vasc Surg. 2025 Sep 22:S0890-5096(25)00619-3. doi: 10.1016/j.avsg.2025.09.014. Online ahead of print.

ABSTRACT

OBJECTIVE: Postoperative stroke and myocardial infarction (MI) are associated with devastating postoperative morbidity and mortality, therefore limiting the protective effect of carotid revascularization procedures. Moreover, there seems to be a relationship between the severity of stroke and the type of carotid revascularization technique. We aim to investigate the impact of in-hospital stroke or MI on one-year survival following carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR).

METHODS: This is a retrospective analysis of patients undergoing CEA, TFCAS, and TCAR in the VQI database (2016-2023). Our primary outcome was one-year mortality in patients who developed in-hospital stroke or MI following carotid revascularization. Kaplan-Meier survival estimate and multivariable Cox regression analysis were applied to calculate hazard ratios (HR) after adjusting for potential confounders. Additionally, we conducted sub-analyses based on patients' symptomatic status.

RESULTS: Our study included 125,513 (61.8%) CEA, 25,875 (12.8%) TFCAS, and 51,545 (25.4%) TCAR. Compared to patients who did not have a postoperative stroke, the hazard of 1-year mortality was higher for those who did have a stroke following CEA (adjusted hazards ratio [aHR] = 5.9[95%CI:5.1-6.8] P<0.001), TFCAS (aHR=4.2[95%CI:3.7-5.3] P<0.001), and TCAR (aHR=5.2[95%CI:4.1-6.5] P<0.001). The hazards of 1-year mortality after in-hospital MI were also higher following CEA (aHR=3.8[95%CI:3.1- 4.6] P<0.001), TFCAS (aHR=3.5[95%CI:2.3- 5.5] P<0.001), and TCAR (aHR=5.1[95%CI:3.6- 7.2] P<0.001). This trend persisted in sub-analysis based on symptomatic status. At one year, TFCAS showed the lowest survival following an in-hospital stroke or MI. There was no significant difference in one-year mortality among patients who developed in-hospital stroke between TCAR and CEA (aHR=0.93[95%CI:0.73- 1.2] P=0.55). On the other hand, TFCAS was associated with a 50% higher mortality hazard than CEA (aHR=1.5[95%CI:1.1-2.1] P=0.003), and TCAR was associated with a 30% reduction in one-year mortality compared to TFCAS (aHR=0.7[95%CI:0.55-0.94] P=0.015) among patients who developed in-hospital stroke.

CONCLUSION: This large multicenter study reveals critical insights into the impact of in-hospital major adverse events on one-year survival following carotid revascularization. The analysis indicates a significant increase in the hazard of one-year mortality following in-hospital stroke and MI. In patients who developed in-hospital stroke or MI, there was no significant difference in one-year survival between TCAR and CEA. On the contrary, among patients who developed in-hospital stroke or MI, TFCAS was associated with significantly higher mortality compared to CEA and TCAR. This study highlights the importance of selecting the appropriate revascularization method for each patient to improve one-year survival.

PMID:40992493 | DOI:10.1016/j.avsg.2025.09.014

Bioact Mater. 2025 Sep 7;54:648-665. doi: 10.1016/j.bioactmat.2025.08.041. eCollection 2025 Dec.

ABSTRACT

Heart failure resulting from myocardial infarction (MI) is a leading global health concern. Current revascularization therapies cannot fully restore the infarcted myocardium or prevent maladaptive ventricular remodeling. Traditional Chinese medicine with its multitarget regulation and favorable biosafety shows a promising therapeutic potential. Tanshinone IIA (TIIA) and formononetin (FM), two bioactive compounds derived from Salvia miltiorrhiza and Astragalus membranaceus, respectively, exhibit antioxidant, anti-inflammatory, and proangiogenic effects. Herein, a neutrophil-targeted nanomedicine (TF-5NP) was developed to deliver TIIA and FM to the infarcted myocardium for mitigating oxidative damage and promoting angiogenesis. TF-5NP was synthesized by coassembling bis-5-hydroxytryptamine-modified 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-polyethylene glycol-carboxylic acid with cholesterol and lipid 1,2-distearoyl-sn-glycero-3-phosphoglycerol, which binds to troponin in the infarcted myocardium. This nanomedicine reduces inflammation and cardiomyocyte damage and improves cardiac function in porcine MI models, with therapeutic effects lasting for ∼28 d. These findings suggest that TF-5NP use is a promising approach for treating post-MI maladaptive remodeling and heart failure.

PMID:40988940 | PMC:PMC12451291 | DOI:10.1016/j.bioactmat.2025.08.041

Catheter Cardiovasc Interv. 2025 Sep 23. doi: 10.1002/ccd.70189. Online ahead of print.

ABSTRACT

BACKGROUND: Target lesion calcification is known to influence the percutaneous coronary intervention (PCI) outcomes. This study aimed to assess the impact of calcium fractures after balloon angioplasty on the PCI results as well as the long-term clinical outcomes.

METHODS: We formed a prospective, multicenter registry that enrolled 268 patients who underwent PCI to lesions with moderate to severe calcification. Balloon dilatation and subsequent drug eluting stent implantation were performed with optical coherence tomography (OCT) guidance in every case. Serial OCT images just before and after balloon angioplasty, and after stent implantation were analyzed at 1-mm intervals by an independent core laboratory. The primary endpoint was the relationship between calcium fracture after balloon angioplasty and stent expansion. The secondary endpoint was target vessel failure (TVF) at 1 year, defined as a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization.

RESULTS: A total of 242 patients were analyzed. Of these, OCT analysis was performed in 147 patients with a complete OCT data set. Calcium fractures were observed in 28 patients (19%) at the minimal lumen area site. The percent stent expansion was greater in lesions with calcium fracture than those without (99 ± 26% vs. 91 ± 18%, p = 0.039). In 229 patients who underwent clinical follow-up at 1 year, TVF occurred in 23 patients (10.0%).

CONCLUSION: The OCT-guided PCI strategy demonstrated acceptable acute and 1-year clinical outcomes. The presence of calcium fractures after balloon angioplasty may have a potential impact on acute results after DES implantation in calcified lesions.

PMID:40988477 | DOI:10.1002/ccd.70189

Medicine (Baltimore). 2025 Sep 19;104(38):e44556. doi: 10.1097/MD.0000000000044556.

ABSTRACT

Heart valve disease is one of the important factors leading to heart failure and cardiovascular death. Double valve replacement (DVR) and tricuspid valve plasty (TVP) have become important surgical approaches for treating severe valve lesions. However, combining with other surgeries may increase perioperative risk and have an impact on the long-term prognosis of patients. To address the complexity of postoperative outcomes in cardiac surgery, this study employs a combination of traditional statistical methods and machine learning techniques to assess risk factors. The primary aim was to investigate the effects of DVR + TVP and combined surgery on postoperative survival and adverse outcomes. Patients who underwent DVR + TVP surgery, they were divided into 4 groups: DVR + TVP, MAZE + TVP, coronary artery bypass grafting (CABG) + TVP, or ascending aortic surgery (AAS) + TVP. Kaplan-Meier survival analysis was used to evaluate the impact of different surgical approaches on postoperative survival rate, Cox proportional hazards regression model was used to analyze contribution of postoperative complications and reoperation to the mortality risk. A neural network model was used to identify factors affecting postoperative mortality risk of patients, to evaluate role of perioperative biomarkers in predicting postoperative mortality risk. The survival rate of patients in AAS + TVP group was the lowest (2.5%), while that in TVP group was the highest (78.8%). Postoperative complications and reoperation were independent predictors of postoperative death. The mortality risk of patients with complications was 2.164 times that of patients without complications (hazard ratio (HR) = 2.164, 95% confidence interval (CI): 1.275-3.671, P = .004), underwent reoperation had a 2.6-fold increased risk of mortality (HR = 2.599, 95% CI: 1.221-5.532, P = .013). Postoperative biomarkers (lactate dehydrogenase (LDH), D-dimer) were significantly associated with postoperative mortality risk. When using neural network model to evaluate the postoperative mortality risk, age (2.0783) and length of stay in the intensive care unit (ICU) (2.0135) were the most important predictors, the area under the curve value of the model was 0.79. Different surgical approaches have a significant impact on postoperative survival rate and the incidence of complications in patients undergoing DVR + TVP. Complications and reoperation are independent factors for poor prognosis. Perioperative biomarkers (LDH, D-dimer) have important value in predicting postoperative mortality risk. The machine learning model based on neural networks can effectively predict postoperative adverse outcomes.

PMID:40988293 | PMC:PMC12459530 | DOI:10.1097/MD.0000000000044556

Medicine (Baltimore). 2025 Sep 19;104(38):e44625. doi: 10.1097/MD.0000000000044625.

ABSTRACT

RATIONALE: Very late stent thrombosis (VLST) is associated with high mortality rates. The use of endoluminal imaging to identify the causes of VLST is crucial. Here, we report a case of VLST occurring 7 times over 14 years, wherein both stent fracture and malapposition were confirmed by endoluminal imaging.

PATIENT CONCERNS: A 66-year-old male patient had experienced sudden, recurrent myocardial infarctions 7 times over a period of 14 years, receiving 5 stents and 2 drug-coated balloons. An Electrocardiogram showed stent thrombosis-segment elevation in the inferior wall leads. Emergency coronary angiography demonstrated total occlusion of the proximal right coronary artery. Anticoagulation, thrombus aspiration and intracoronary thrombolysis were performed to treat the coronary thrombosis.

DIAGNOSES: The etiology of VLST was confirmed as stent fracture and malapposition, based on endoluminal imaging.

INTERVENTIONS: Stent implantation was performed following balloon angioplasty using a non-compliant balloon.

OUTCOMES: The patient remained asymptomatic and free of adverse cardiovascular events during an 18-month follow-up.

LESSONS: "Three-step" strategy is suggested for VLST management. Therefore, endoluminal imaging is important.

PMID:40988234 | PMC:PMC12459456 | DOI:10.1097/MD.0000000000044625

Nat Commun. 2025 Sep 24;16(1):8363. doi: 10.1038/s41467-025-62285-w.

ABSTRACT

During development, myocardial contractile force and intracardiac hemodynamic shear stress coordinate the initiation of trabeculation. While Snail family genes are well-recognized transcription factors of epithelial-to-mesenchymal transition, snai1b-positive cardiomyocytes are sparsely distributed in the ventricle of zebrafish at 4 days post-fertilization. Isoproterenol treatment significantly increases the number of snai1b-positive cardiomyocytes, of which 80% are Notch-negative. CRISPR-activation of snai1b leads to 51.6% cardiomyocytes forming trabeculae, whereas CRISPR-repression reduces trabecular cardiomyocytes to 6.7% under isoproterenol. In addition, 36.7% of snai1b-repressed cardiomyocytes undergo apical delamination. 4-D strain analysis demonstrates that isoproterenol increases the myocardial strain along radial trabecular ridges in alignment with the snai1b expression and Notch-ErbB2-mediated trabeculation. Single-cell and spatial transcriptomics reveal that these snai1b-positive cardiomyocytes are devoid of some epithelial-to-mesenchymal transition-related phenotypes, such as Col1a2 production and induction by ErbB2 or TGF-β. Thus, we uncover snai1b-positive cardiomyocytes that are mechanically activated to initiate delamination for cardiac trabeculation.

PMID:40993149 | DOI:10.1038/s41467-025-62285-w

Open Heart. 2025 Sep 23;12(2):e003648. doi: 10.1136/openhrt-2025-003648.

ABSTRACT

BACKGROUND: Sudden cardiac death (SCD) is a common cause of cardiovascular mortality, often triggered by ventricular arrhythmias in the setting of myocardial vulnerability. The wearable cardioverter-defibrillator (WCD) offers temporary protection against SCD, particularly when an implantable device is contraindicated or premature.

OBJECTIVES: We conducted a comprehensive meta-analysis to assess the effectiveness of the WCD in appropriately terminating life-threatening arrhythmias such as sustained ventricular tachycardia (VT) and ventricular fibrillation (VF), preventing sudden cardiac death.

METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically reviewed 40 studies comprising 59 647 adults fitted with a WCD for primary or secondary SCD prevention. Random-effects meta-analysis, subgroup analysis, meta-regression and sensitivity analyses were performed.

RESULTS: The pooled incidence of appropriate WCD intervention was 3% (95% CI 2% to 3%), with substantial heterogeneity (I²=88.9%). The prediction interval ranged from 1% to 8%, indicating that future studies conducted in selected high-risk populations may observe significantly higher WCD intervention. Life-threatening arrhythmias were higher during early follow-up (≤60 days). An appropriate daily WCD wearing time significantly influenced the results. Gender, age, ejection fraction and study design were not significant modifiers. No publication bias was detected.

CONCLUSIONS: The WCD represents an effective strategy for preventing SCD in early high-risk settings, with its benefit closely linked to adherence and appropriate patient selection.

PMID:40992797 | PMC:PMC12458791 | DOI:10.1136/openhrt-2025-003648

Ann Vasc Surg. 2025 Sep 22:S0890-5096(25)00619-3. doi: 10.1016/j.avsg.2025.09.014. Online ahead of print.

ABSTRACT

OBJECTIVE: Postoperative stroke and myocardial infarction (MI) are associated with devastating postoperative morbidity and mortality, therefore limiting the protective effect of carotid revascularization procedures. Moreover, there seems to be a relationship between the severity of stroke and the type of carotid revascularization technique. We aim to investigate the impact of in-hospital stroke or MI on one-year survival following carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR).

METHODS: This is a retrospective analysis of patients undergoing CEA, TFCAS, and TCAR in the VQI database (2016-2023). Our primary outcome was one-year mortality in patients who developed in-hospital stroke or MI following carotid revascularization. Kaplan-Meier survival estimate and multivariable Cox regression analysis were applied to calculate hazard ratios (HR) after adjusting for potential confounders. Additionally, we conducted sub-analyses based on patients' symptomatic status.

RESULTS: Our study included 125,513 (61.8%) CEA, 25,875 (12.8%) TFCAS, and 51,545 (25.4%) TCAR. Compared to patients who did not have a postoperative stroke, the hazard of 1-year mortality was higher for those who did have a stroke following CEA (adjusted hazards ratio [aHR] = 5.9[95%CI:5.1-6.8] P<0.001), TFCAS (aHR=4.2[95%CI:3.7-5.3] P<0.001), and TCAR (aHR=5.2[95%CI:4.1-6.5] P<0.001). The hazards of 1-year mortality after in-hospital MI were also higher following CEA (aHR=3.8[95%CI:3.1- 4.6] P<0.001), TFCAS (aHR=3.5[95%CI:2.3- 5.5] P<0.001), and TCAR (aHR=5.1[95%CI:3.6- 7.2] P<0.001). This trend persisted in sub-analysis based on symptomatic status. At one year, TFCAS showed the lowest survival following an in-hospital stroke or MI. There was no significant difference in one-year mortality among patients who developed in-hospital stroke between TCAR and CEA (aHR=0.93[95%CI:0.73- 1.2] P=0.55). On the other hand, TFCAS was associated with a 50% higher mortality hazard than CEA (aHR=1.5[95%CI:1.1-2.1] P=0.003), and TCAR was associated with a 30% reduction in one-year mortality compared to TFCAS (aHR=0.7[95%CI:0.55-0.94] P=0.015) among patients who developed in-hospital stroke.

CONCLUSION: This large multicenter study reveals critical insights into the impact of in-hospital major adverse events on one-year survival following carotid revascularization. The analysis indicates a significant increase in the hazard of one-year mortality following in-hospital stroke and MI. In patients who developed in-hospital stroke or MI, there was no significant difference in one-year survival between TCAR and CEA. On the contrary, among patients who developed in-hospital stroke or MI, TFCAS was associated with significantly higher mortality compared to CEA and TCAR. This study highlights the importance of selecting the appropriate revascularization method for each patient to improve one-year survival.

PMID:40992493 | DOI:10.1016/j.avsg.2025.09.014