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Eur J Cardiothorac Surg. 2025 Sep 23:ezaf315. doi: 10.1093/ejcts/ezaf315. Online ahead of print.

ABSTRACT

OBJECTIVES: Donation after circulatory-determined death (DCD) heart transplantation has increased the number of hearts available for transplantation by 30-40%. This may be associated with improved clinical outcomes for patients waiting for transplantation. We compare clinical outcomes from registration on the transplant waiting list before and after establishment of a DCD heart transplant program.

METHODS: Observational cohort study of all patients listed for heart transplantation at a single centre for three years before (cohort one) and three years after (cohort two) the start of a DCD heart transplant program. Outcome measures included heart transplantation, removal from waiting list due to death or deterioration, removal from waiting list due to improvement or patient choice, and need for mechanical circulatory support after listing for heart transplantation.

RESULTS: 129 patients were registered on the waiting list in cohort one and 146 patients in cohort two. Patients in cohort one underwent 91 DBD and 12 DCD heart transplants. Patients in cohort two underwent 102 DBD and 32 DBD heart transplants. Compared with cohort one, patients in cohort two had a shorter waiting time for transplantation (45 vs 77 days, P = 0.001) and an increased cumulative incidence of transplantation (P < 0.001). When all patients had reached an end-point, patients in cohort two had a lower likelihood of death or removal from waiting list due to deterioration (6% vs 18%, P = 0.011) and fewer patients in cohort two required mechanical circulatory support after listing (4.1% vs 13.9%, P = 0.007).

CONCLUSIONS: In a single centre, introduction of a DCD heart transplant program was associated with shorter waiting times for heart transplantation and a lower likelihood of death/deterioration or requirement for mechanical circulatory support whilst waiting for heart transplantation.

PMID:40985735 | DOI:10.1093/ejcts/ezaf315

J Cardiovasc Surg (Torino). 2025 Aug;66(4):308-315. doi: 10.23736/S0021-9509.25.13252-7.

ABSTRACT

BACKGROUND: The aim of this study was to compare the postoperative morbidity and mortality between total replacement of the aortic arch using the frozen elephant trunk technique versus replacement of the hemiarch in patients with acute type A aortic dissection and dissection of arch branch vessels without cerebral malperfusion.

METHODS: Between January 2015 and April 2023, 156 patients with acute type A aortic dissections were treated in our Center. Only patients with TAE2M2- (Type A or Type non-A non-B, with entry tear in arch aorta extend to arch branch vessels dissection without symptoms) were included. Patients were analyzed according to the surgical techniques: FET or hemiarch replacement.

RESULTS: Forty-two patients were included in our study. In hospital mortality was similar between the groups (FET: 12%, Hemiarch: 0%; P=0.2593). Survival at 5 years was 88% in the FET group and 94.1% in the hemiarch group (P=0.5243). Patients treated with FET showed a higher incidence of additional procedures on the remaining aorta (36.4% versus 0%, P=0.0056). Stroke with permanent neurologic dysfunction were similar between the groups (FET 8% and Hemiarch 11.8%; P=1.0000).

CONCLUSIONS: FET and hemiarch replacement showed similar short- and mid-term results. The FET technique offers advantages for distal aorta protection and future endovascular interventions but is associated with longer circulatory arrest and higher transfusion requirements. No significant survival or neurological benefits were observed for FET over ODA in the absence of malperfusion.

PMID:40985630 | DOI:10.23736/S0021-9509.25.13252-7

J Eur Acad Dermatol Venereol. 2025 Sep 23. doi: 10.1111/jdv.70067. Online ahead of print.

ABSTRACT

BACKGROUND: Alopecia areata (AA) is an autoimmune condition leading to hair loss. Baricitinib, a Janus kinase (JAK) inhibitor, has demonstrated efficacy in controlled clinical trials, but real-world data on its long-term effectiveness and safety remain limited.

OBJECTIVES: This study aimed to assess the real-life effectiveness and safety of baricitinib 4 mg daily in Italian adult patients with severe AA over a 48-week treatment period.

METHODS: We conducted a 48-week retrospective, observational, multicenter study across 27 Italian university hospitals. Adult patients (18-65 years) with severe AA (Severity of Alopecia Tool [SALT] score ≥ 50) who initiated baricitinib 4 mg daily treatment between November 2022 and October 2023 were included. Effectiveness was measured by the percentage of patients achieving SALT ≤20 at week 48. Secondary outcomes included changes in mean SALT score, trichoscopic findings, patient-reported quality of life (Skindex-16, Hospital Anxiety and Depression Scale [HADS]), and Clinician-Reported Outcomes (ClinRO) for eyebrows and eyelashes. Adverse events were also documented.

RESULTS: A total of 253 patients (66.8% females, mean age 40.0 ± 12.6 years) were included. By week 48, 63.2% achieved SALT ≤20, and 75.5% achieved SALT ≤30. The mean SALT score significantly decreased from 93.7 ± 14.1 at baseline to 26.5 ± 33.0 at week 48 (p < 0.001). Trichoscopic assessment showed a decline in yellow dots (97.6%-50.2%), black dots (43.5%-9.1%), and dystrophic hairs (14.6%-4.3%), whilst regrowing hairs increased (7.1%-80.2%). Skindex-16 scores improved significantly (57.1 ± 25.0 to 30.0 ± 17.8, p < 0.001), as did HADS Anxiety (8.21 ± 9.38 to 4.62 ± 4.21, p < 0.001) and HADS Depression (6.36 ± 4.55 to 3.70 ± 4.11, p < 0.001). Adverse events were reported in 9.4% of patients.

CONCLUSION: This real-world study confirms the effectiveness of baricitinib in achieving significant hair regrowth and improving psychological well-being in severe AA patients.

PMID:40985491 | DOI:10.1111/jdv.70067

Eur Heart J Cardiovasc Imaging. 2025 Sep 23:jeaf281. doi: 10.1093/ehjci/jeaf281. Online ahead of print.

NO ABSTRACT

PMID:40985273 | DOI:10.1093/ehjci/jeaf281

CNS Neurosci Ther. 2025 Sep;31(9):e70621. doi: 10.1111/cns.70621.

ABSTRACT

AIM: To investigate whether genetically modifying human umbilical cord-derived mesenchymal stem cells (MSC) to overexpress the CXCR4 receptor can enhance their therapeutic efficacy for treating brain injury following cardiac arrest (CA).

METHODS: MSC were engineered to overexpress CXCR4 (CXCR4-MSC) via lentiviral transduction. The migration capacity of these cells was tested using in vitro chemotaxis assays. In a rat model of CA/CPR, the homing ability of CXCR4-MSC to the brain was tracked in vivo, and their therapeutic effects on neuronal death and neurological recovery were assessed. The role of exosomes and their impact on key proteins (NLRP3, ASC, GSDMD) in the pyroptosis pathway was also investigated.

RESULT: CXCR4 overexpression significantly enhanced the migration of MSC in vitro and their homing to injured brain tissue in vivo. Treatment with CXCR4-MSC markedly reduced neuronal death and improved neurological recovery in resuscitated rats. This was accompanied by decreased expression of NLRP3. Furthermore, exosomes derived from CXCR4-MSC were found to suppress pyroptosis-related proteins (NLRP3/ASC/GSDMD) in post-CPR neurons, an effect that was reversed upon exosome inhibition.

CONCLUSION: Genetic modification to overexpress CXCR4 enhances the therapeutic efficacy of MSC for CA-induced brain injury by promoting their migration to the brain via the CXCL12/CXCR4 axis. A key mechanism of this protection is exosome-mediated inhibition of neuronal pyroptosis.

PMID:40984643 | PMC:PMC12454672 | DOI:10.1111/cns.70621

Ann Transplant. 2025 Sep 23;30:e949664. doi: 10.12659/AOT.949664.

ABSTRACT

BACKGROUND Patients with chronic kidney disease (CKD) have a markedly increased cardiovascular risk, largely due to persistent endothelial dysfunction (ED). Kidney transplantation improves cardiovascular status, but whether transplant type-living donor (LDT) or cadaver donor transplantation (CDT)-differentially affects coronary endothelial function remains unclear. MATERIAL AND METHODS In this prospective observational study, 75 kidney transplant recipients (LDT: n=50; CDT: n=25) and 25 healthy controls (HC) underwent CFVR measurement at baseline (CFVR-1) and 6 months post-transplantation (CFVR-2). Left ventricular ejection fraction (LV-EF), diameters, and NT-proBNP were also assessed. Group comparisons and pre-/post-transplant changes were analyzed. RESULTS Baseline CFVR was higher in HC than in transplant groups (p0.05), but CFVR-1 0.05). A ≥10% EF increase occurred in 36% of patients in each group. CONCLUSIONS Kidney transplantation improves coronary endothelial function and cardiac performance regardless of donor type, though severe baseline CFVR impairment is more common in cadaveric recipients.

PMID:40984640 | DOI:10.12659/AOT.949664

Eur J Prev Cardiol. 2025 Sep 23:zwaf603. doi: 10.1093/eurjpc/zwaf603. Online ahead of print.

NO ABSTRACT

PMID:40986814 | DOI:10.1093/eurjpc/zwaf603

Eur J Cardiothorac Surg. 2025 Sep 23:ezaf310. doi: 10.1093/ejcts/ezaf310. Online ahead of print.

ABSTRACT

OBJECTIVES: Currently available materials in congenital cardiac surgery (CCS) are far from optimal, as they do not facilitate growth, remodelling, or renewal, resulting in poorer long-term outcomes due to material-related limitations. Bacterial cellulose (BC), a biogenic polymer-based material produced by Acetobacter xylinum, has emerged as a promising alternative exhibiting excellent bio- and hemocompatibility. This study aimed to develop BC specifically for application in CCS by modifying culturing conditions to enhance its biomechanical resilience.

METHODS: BC was produced according to a standard protocol, and its biomechanical properties were evaluated using inflation pressure testing, thickness measurement, and uniaxial tensile testing. To improve these characteristics, two modifications, a change in the growth media composition and an extended incubation time, were implemented and subsequently evaluated in five further test series. The long-term durability of BC patches was assessed in a fatigue tester for 20 ± 0.5 million cycles, and potential structural damage was investigated using scanning electron microscopy.

RESULTS: Utilizing the two modifications, BC patches demonstrated a capability to reach and maintain pressures exceeding 1000 mmHg with a durability of 100% (n = 24), compared to the standard 20.8% (n = 24) at 500 mmHg. The maximum tensile strength was enhanced from 0.311 ± 0.057 megapascal (MPa) to 0.986 ± 0.397 MPa (p < 0.0001), with a thickness of 3.89 ± 0.95 mm (p < 0.0001). In the long-term durability testing patches endured durations equaling six months without failure while retaining structural integrity.

CONCLUSIONS: The potential of BC for use in CCS was demonstrated by enhancing its biomechanical properties through culturing modifications, warranting further investigation and development of the biomaterial.

PMID:40986395 | DOI:10.1093/ejcts/ezaf310

Cureus. 2025 Aug 19;17(8):e90534. doi: 10.7759/cureus.90534. eCollection 2025 Aug.

ABSTRACT

Anomalous aortic origin of the right coronary artery (AAORCA) is a rare congenital anomaly. Although most patients with this anomaly remain asymptomatic, it is well established that this anomaly may lead to angina, myocardial infarction (MI), or sudden cardiac death (SCD) in the absence of atherosclerotic disease. In this article, we report three cases in the Middle East that presented with syncope in two patients, as well as diaphoresis and ECG changes during a nasal septoplasty surgery in the third. All patients were diagnosed with AAORCA with interarterial course using coronary computed tomography angiography (CTA) after initial evaluation. Although medical management varied over the three cases, all patients tolerated medical management and were referred for surgical interventions. One patient underwent a surgical procedure, with positive outcome afterwards. It is important to recognize the atypical presentations of the malignant course of AAORCA and demonstrate the importance of medical and surgical management in this disease, specially in understudied areas such as the Middle East.

PMID:40984897 | PMC:PMC12450288 | DOI:10.7759/cureus.90534

SAGE Open Med Case Rep. 2025 Sep 20;13:2050313X251377213. doi: 10.1177/2050313X251377213. eCollection 2025.

ABSTRACT

Over the last decade, pectus excavatum deformities have been advocated for correction in cardiac surgery procedures due to their effectiveness and reliability. However, it is uncertain for adult congenital cardiac disease. This is the first article to describe a simultaneous repair for a 72-year-old female who had adult congenital heart disease and pectus excavatum. Preoperative cardiac catheterization found her systolic peak-to-peak gradient at the right ventricular outflow tract stenosis was 69 mmHg, caused by a severely hypertrophied muscle bundle in the right ventricle. She also had a severe pectus excavatum with a Haller Index of 5.09. We performed resection of hypertrophied right muscle bundle at the ostium infundibulum with patch augmentation of the right ventriculotomy and Nuss procedure with bilateral cryoablation. She achieved excellent outcomes in both cardiac repair and chest wall repair in the year after this simultaneous surgery.

PMID:40984887 | PMC:PMC12450259 | DOI:10.1177/2050313X251377213

Indian J Thorac Cardiovasc Surg. 2025 Oct;41(10):1493-1497. doi: 10.1007/s12055-025-01996-7. Epub 2025 Aug 5.

ABSTRACT

A 5-year-old boy with a precordial murmur was initially diagnosed with anomalous systemic arterial (ASA) supply to the left lung lower lobe combined with arterial-pulmonary venous fistula (APVF) by transthoracic echocardiography (TTE), then evaluated by computed tomography angiography (CTA) and digital subtraction angiography (DSA). He received interventional therapy and recovered well. Although ASA supply to the lung lobes combined with APVF is usually diagnosed by CTA, it may also be first diagnosed by TTE in a patient who has a significant heart murmur. Careful TTE examination can improve the diagnostic rate of this cardiovascular abnormality.

PMID:40984852 | PMC:PMC12450170 | DOI:10.1007/s12055-025-01996-7

J Magn Reson Imaging. 2025 Sep 22. doi: 10.1002/jmri.70131. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary regurgitant fraction (RF) in patients with repaired tetralogy of Fallot (rTOF) is an important indicator for therapeutic intervention. However, the impact of pulmonary artery geometry and turbulent flow on measurement accuracy is unclear.

PURPOSE: To evaluate the reliability of 4D flow MRI-derived and 2D phase contrast (2D-PC) RF assessments, identify clinically useful measurement locations, and investigate factors contributing to variability.

STUDY TYPE: Retrospective.

POPULATION/SUBJECTS: Thirty-four rTOF patients (21 female; age 45.2 ± 14.4 years).

FIELD STRENGTH/SEQUENCE: 3.0 T; balanced steady-state free precession (bSSFP) cine, time-resolved 2D-PC segmented gradient echo (2D-PC), and time-resolved velocity-sensitized 3D gradient echo with echo planar imaging readout (4D flow) sequences.

ASSESSMENT: MRI was performed before and 3 months after transcatheter pulmonary valve replacement (TPVI). Indexed right ventricular end-diastolic volume (RVEDVi) was assessed in pre/post bSSFP cine data to evaluate RV remodeling. MPA backward and forward flow volumes (BFV, FFV) and RF were measured using 2D-PC and 4D flow. Six equidistant 4D flow planes from the right ventricular outflow tract to the distal MPA were analyzed, with one additional plane matched to the 2D-PC location. MPA and vortex areas were also assessed for each 4D flow plane.

STATISTICAL TESTS: Spearman's rho assessed correlations between 2D-PC and 4D flow parameters, and area under the receiver operating characteristic curve (AUC) assessed the association between RF and the pre/post TVPI percentage change in RVEDVi.

SIGNIFICANCE: p < 0.05.

RESULTS: 2D-PC and 4D flow measurements at the matched MPA plane correlated significantly (RF: ρ = 0.65, FFV: ρ = 0.76, BFV: ρ = 0.87). RF varied by plane, and the plane 10 mm distal to the valve best associated with RVEDVi reduction after TPVI (AUC = 0.84). Changes in FFV between planes significantly correlated with dilatation and stenosis (ρ = 0.432, -0.618), whereas BFV correlated with dilatation alone (ρ = 0.581); however, vortex area enlargement showed no significant association with flow volume changes.

DATA CONCLUSION: 2D-PC and 4D flow measurements show high correlations, but 4D flow accuracy depends on plane location and geometry.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 2.

PMID:40984730 | DOI:10.1002/jmri.70131

West Afr J Med. 2025 Apr 30;42(4):330-335.

ABSTRACT

BACKGROUND AND OBJECTIVES: Aortic valve stenosis (AoS) is the most common valvular pathology in the elderly, many of whom are ineligible or high-risk for surgery due to comorbidities. Transcatheter Aortic Valve Implantation (TAVI) was developed as a less invasive alternative to Surgical Aortic Valve Replacement (SAVR) for patients with severe AoS. Its efficacy was first demonstrated in the landmark PARTNER trial, which compared TAVI to medical therapy in ineligible SAVR patients. Subsequent studies have validated its use in intermediate and low-risk groups. Despite its growing adoption, there has yet to be a report of a successful TAVI procedure in West Africa.

METHODS: The procedure involved transcatheter aortic valve implantation using radial and femoral arterial access. A 14Fr Python sheath was introduced after vessel dilation, and the valve was crimped and positioned in the aortic annulus under fluoroscopic guidance. Serial aortograms confirmed accurate placement, and haemostasis was achieved using a Proglide suture, protamine administration, and manual pressure. The patient was transferred to the ICU post-procedure for monitoring.

RESULTS: The patient's post-procedure imaging showed a well-seated valve with trivial central aortic regurgitation, no paravalvular leak, and an insignificant gradient of 12.25 mmHg. The patient remained stable, resumed anticoagulation, and was discharged with a follow-up scheduled in one week.

CONCLUSIONS: This case report details the successful prosthetic aortic valve implantation in an 83-year-old high-risk surgical candidate with hypertension and bilateral knee replacements. It marks a significant step toward adopting less invasive valvular heart disease management approaches in the region.

PMID:40987259

Eur J Neurol. 2025 Sep;32(9):e70365. doi: 10.1111/ene.70365.

ABSTRACT

BACKGROUND: Patients with non-valvular atrial fibrillation (AF) who experience an ischemic stroke despite oral anticoagulation (OAC) are at particularly high risk of recurrence, with a reported annualized ischemic stroke rate of 5.3%-8.9%. The optimal strategy for secondary prevention in these patients remains unknown.

METHODS: We reviewed all percutaneous left atrial appendage closures (LAAC) attempted in AF patients experiencing an ischemic stroke under OAC and who were prospectively collected in four European centers. All index strokes were categorized by an experienced neurologist to exclude patients with non-cardioembolic etiology or insufficient OAC. The primary endpoint was a recurrent ischemic stroke at 2 years after the procedure. Secondary endpoints included procedure-related complications and 2-year death.

RESULTS: Of 2234 patients submitted to LAAC procedure, 95 had a cardioembolic breakthrough stroke. LAAC procedures were performed at a mean of 4 months after the breakthrough stroke. The main antithrombotic therapy at discharge (83%) and at the latest follow-up (79%) consisted of OAC. At the median follow-up of 713 days, the primary endpoint occurred in 4 patients (4%). Procedure-related complications were rare (1%) whereas death occurred in 5% of patients.

CONCLUSION: LAAC procedures were safe and feasible in patients with cardioembolic breakthrough stroke. Recurrent stroke rates were lower than those reported in previous studies with OAC continuation after breakthrough stroke, suggesting a potential additive protection by LAAC on top of OAC. Results from ongoing randomized trials are required to validate our findings.

PMID:40985135 | PMC:PMC12455140 | DOI:10.1111/ene.70365

Mil Med. 2025 Sep 1;190(Supplement_2):719-728. doi: 10.1093/milmed/usaf316.

ABSTRACT

INTRODUCTION: Limb loss after combat injury is a major factor for morbidity in combat casualties. Although tourniquets clearly save lives, they can result in prolonged ischemia in large scale combat operations where evacuation from the point of injury is significantly delayed. We are developing a dedicated extracorporeal limb perfusion system suitable for organ preservation and present preliminary data on the feasibility of this approach.

MATERIALS AND METHODS: Amputated donor swine hindlimbs were perfused for 6 hours in a circulation system consisting of: containment unit, cardiotomy filter, peristaltic pump, with (OXY+) and without (OXY-) membrane oxygenator. Temperature, blood flow, pump revolutions per minute, and arterial blood gas analyses were performed hourly for 6 hours. Histology results were compared with limbs in cold storage. Statistics using SAS 9.4, 1-way mixed model with Dunnett correction and repeated measures mixed model with Tukey's adjustment (α = .05).

RESULTS: Flow rates and pump settings were consistent. After 6 hours, the OXY+ group showed higher blood pH (7.38 ± 0.70 vs. 7.03 ± 0.7, P = .006), base excess (-15.8 ± 2.0 vs. -23.2 ± 1.8 mmol/L, P = .019) and oxygen saturation (64 ± 11% vs. 18 ± 4%, P = .003) compared to the OXY- group. Similarly, the pCO2 was lower in OXY+ (18.2 ± 2.1 vs. 27.6 ± 3.5 mmHg) compared to the OXY- group. Both groups showed an increase in potassium (OXY+: 6.2 ± 0.4 to 9.15 ± 0.70 mmol/L, P < .001; OXY-: 5.5 ± 0.2 to 10.3 ± 0.5 mmol/L, P < .001) and lactate (OXY+: 9.1 ± 1.3 to 15.9 ± 1.3 mmol/L, P < .001; OXY-: 6.7 ± 0.6 to 16.78 ± 0.83 mmol/L, P < .001), with no between group difference. Histological biopsy analysis showed a reduction of sarcoplasm and sarcolemma damage in the treatment group at 6 hours.

CONCLUSIONS: Explanted limbs were successfully cannulated and perfused, and circulation was maintained at a constant flow rate with no adverse clotting events. Development of a purpose-built perfusion system is a promising avenue for limb preservation during large scale combat operations.

PMID:40984058 | DOI:10.1093/milmed/usaf316

Turk J Anaesthesiol Reanim. 2025 Sep 23. doi: 10.4274/TJAR.2025.251940. Online ahead of print.

ABSTRACT

OBJECTIVE: This descriptive survey study aims to evaluate the knowledge, attitudes, and practices of anaesthesiology specialists and residents in Türkiye regarding advanced hemodynamic monitoring in high-risk surgical patients.

METHODS: The survey, comprising 25 questions, was distributed to 960 anaesthesia professionals, with 713 completing the questionnaire.

RESULTS: The study reveals that while invasive blood pressure monitoring is widely used (96.3%), the adoption of advanced hemodynamic monitoring techniques, such as cardiac output monitoring, remains limited (12.6%). For awake high-risk surgical patients under regional anaesthesia, a significant proportion of respondents (15.1% and 37.1%) considered non-invasive blood pressure monitoring to be insufficient. Additionally, 41.1% of participants believed that stroke volume variation, pulse pressure variation, and systolic pressure variation parameters could be used to assess fluid deficits in awake patients.

CONCLUSION: High costs, technical complexity, and lack of training are identified as major barriers. The findings highlight the need for enhanced educational programs and practical training to improve the utilization of advanced hemodynamic monitoring, ultimately aiming to reduce perioperative morbidity and mortality. The study underscores the importance of integrating advanced hemodynamic monitoring into routine clinical practice and suggests the development of nationwide algorithms to standardize practices.

PMID:40984788 | DOI:10.4274/TJAR.2025.251940

Ann Transplant. 2025 Sep 23;30:e949664. doi: 10.12659/AOT.949664.

ABSTRACT

BACKGROUND Patients with chronic kidney disease (CKD) have a markedly increased cardiovascular risk, largely due to persistent endothelial dysfunction (ED). Kidney transplantation improves cardiovascular status, but whether transplant type-living donor (LDT) or cadaver donor transplantation (CDT)-differentially affects coronary endothelial function remains unclear. MATERIAL AND METHODS In this prospective observational study, 75 kidney transplant recipients (LDT: n=50; CDT: n=25) and 25 healthy controls (HC) underwent CFVR measurement at baseline (CFVR-1) and 6 months post-transplantation (CFVR-2). Left ventricular ejection fraction (LV-EF), diameters, and NT-proBNP were also assessed. Group comparisons and pre-/post-transplant changes were analyzed. RESULTS Baseline CFVR was higher in HC than in transplant groups (p0.05), but CFVR-1 0.05). A ≥10% EF increase occurred in 36% of patients in each group. CONCLUSIONS Kidney transplantation improves coronary endothelial function and cardiac performance regardless of donor type, though severe baseline CFVR impairment is more common in cadaveric recipients.

PMID:40984640 | PMC:PMC12476130 | DOI:10.12659/AOT.949664

Diabetes Res Clin Pract. 2025 Sep 20:112910. doi: 10.1016/j.diabres.2025.112910. Online ahead of print.

ABSTRACT

AIM: To compare the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP-1RAs) among adults with type 2 diabetes mellitus (T2D) at moderate cardiovascular risk.

METHODS: We emulated a target trial using claims data of adults with T2D at moderate cardiovascular risk who initiated dulaglutide, exenatide, liraglutide, or semaglutide between 01/01/2014-12/31/2021. Random treatment assignment was emulated by propensity scores and incorporated into inverse probability of treatment weighted (IPTW) Cox models. Outcomes were time to composite major adverse cardiovascular events (MACE: myocardial infarction, stroke, and all-cause mortality), expanded MACE (MACE, hospitalization for heart failure, and revascularization) and its components, and severe hypoglycemia.

RESULTS: After IPTW, 35,572 patients initiated dulaglutide, 4376 initiated exenatide, 8843 initiated liraglutide, and 33,063 initiated semaglutide. Compared to dulaglutide, semaglutide was associated with lower risk of MACE (HR 0.85, 95CI% 0.78-0.93), expanded MACE (HR 0.92, 95CI% 0.87-0.96), all-cause mortality (HR 0.81, 95CI% 0.71-0.92), stroke (HR 0.82, 95CI% 0.70-0.97), and revascularization (HR 0.93, 95CI% 0.88-0.99), while liraglutide was associated with lower risk of MACE (HR 0.84, 95CI% 0.72-0.97) and all-cause mortality (HR 0.79, 95CI% 0.64-0.99).

CONCLUSIONS: Among GLP-1RAs, semaglutide and liraglutide were associated with the greatest cardiovascular risk reduction in patients with T2D at moderate cardiovascular risk.

PMID:40983112 | DOI:10.1016/j.diabres.2025.112910

Cardiol J. 2025 Sep 22. doi: 10.5603/cj.103397. Online ahead of print.

ABSTRACT

BACKGROUND: As a result of increased life expectancy, the number of octa- and nonagenarians presenting with myocardial infarction is on the rise. These patients are often underrepresented in clinical trials. The aim of this study was to compare the presentation and outcomes of ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in patients older than 80 years.

METHODS: This retrospective study included 14758 patients above 80 years of age hospitalized with STEMI or NSTEMI who were selected from the Polish Registry of Acute Coronary Syndromes using propensity score matching (two equal size groups).

RESULTS: Patients with STEMI were more likely to undergo coronary angiography (87.80% vs. 77,03%) and revascularization (80.50% vs. 54.26%); in STEMI the culprit lesion was more likely to be located in left anterior descending artery (LAD) (31.76% vs. 44.43%) or right coronary artery (RCA) (18.41% vs. 35.29%), and NSTEMI more likely to be located in left main (4.59% vs. 1.76%) or other native artery (23.3% vs. 6.02%). Elderly patients with STEMI had higher all-cause mortality at 30-days (19.62% vs. 14.51%) and 1-year (32.00% vs. 29.54%). The difference was highly influenced by initial in-hospital mortality (17.96% vs. 12.48%). Among hospital survivors there was no difference in 30-days mortality and 1-year mortality was higher for NSTEMI hospital survivors (17.06% vs. 14.04%).

CONCLUSIONS: In patients older than 80 years of age with similar baseline characteristics, STEMI and NSTEMI had different presentation, outcomes and required different treatment strategy. ST-elevation patients had higher in-hospital mortality and NSTEMI patients had higher post-hospital mortality after 1 year.

PMID:40981748 | DOI:10.5603/cj.103397

Med Sci (Basel). 2025 Sep 5;13(3):179. doi: 10.3390/medsci13030179.

ABSTRACT

Background: Total arterial revascularization (TAR) may improve outcomes in patients with ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF). Methods: We retrospectively screened 574 adults with HFrEF (LVEF < 40%) undergoing isolated CABG across four German centers (2017-2023). After 1:1 propensity score matching, 240 patients were analyzed (120 TAR vs. 120 NTAR). The primary endpoint was in-hospital MACCE (death, MI, stroke). Key secondary endpoints included ICU/hospital length-of-stay, ventilation time, delirium, transfusion requirements, and acute kidney injury. Results: MACCE occurred in 4.1% (TAR) vs. 14.2% (NTAR) (p = 0.007). TAR was associated with shorter ICU stay (median 44.5 h vs. 90 h, p < 0.001), shorter hospital stay (10 d vs. 12 d, p = 0.002), reduced ventilation time (8 h vs. 12 h, p < 0.001), lower delirium (5.0% vs. 14.2%, p = 0.016), and fewer RBC transfusions intra-operatively (0.13 ± 0.45 vs. 0.31 ± 0.58 units, p = 0.028) and during the entire stay (0.70 ± 1.33 vs. 1.77 ± 2.91 units, p < 0.001). Conclusions: In this multicenter propensity-matched cohort, TAR was associated with lower in-hospital MACCE and more favorable perioperative outcomes compared with NTAR. Prospective studies are warranted to confirm causality and long-term benefits.

PMID:40981176 | PMC:PMC12452580 | DOI:10.3390/medsci13030179