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J Invasive Cardiol. 2025 Jun 5. doi: 10.25270/jic/25.00142. Online ahead of print.

NO ABSTRACT

PMID:40532221 | DOI:10.25270/jic/25.00142

Braz J Cardiovasc Surg. 2025 Jun 18;40(4):e20240442. doi: 10.21470/1678-9741-2024-0442.

ABSTRACT

INTRODUCTION: The Norwood operation has transformed the approach to hypoplastic left heart syndrome and its variants. Given the complexity of this procedure, postoperative residual injuries are prevalent.

OBJECTIVE: To evaluate the impact of significant residual injuries on clinical outcomes and mortality in Norwood procedure patients at a high-volume tertiary center in a developing nation using the technical performance score (TPS).

METHODS: This single-center, retrospective study included patients who underwent the Norwood procedure between December 2018 and February 2023. Data on demographics, echocardiograms, complications, intensive care unit stay, and mortality were collected. Logistic regression and linear analyses assessed the impact of TPS on outcomes.

RESULTS: Of 69 patients, nine (13%) were excluded due to incomplete echocardiographic data, leaving 60 (87%) for TPS classification. Among them, 28 (47%) were male. TPS classification was as follows: 40 (66%) in class 1 (excellent), five (8.3%) in class 2 (adequate), and 15 (25%) in class 3 (inadequate), indicating significant residual lesions or need for reintervention. The 30-day mortality rate was 21.6%, increasing to 41.6% before the next stage. In TPS class 3, 30-day mortality was 33% vs. 17% in classes 1 and 2 (P = 0.27). Interstage mortality was 60% in class 3 compared to 35% in other groups (P = 0.13). Major complications were significantly higher in TPS class 3 (93% vs. 55.5%, P = 0.04).

CONCLUSION: TPS effectively predicts major complications post-Norwood and serves as a valuable tool for improving patient outcomes.

PMID:40530992 | PMC:PMC12175616 | DOI:10.21470/1678-9741-2024-0442

J Thorac Dis. 2025 May 30;17(5):2980-2988. doi: 10.21037/jtd-2024-2185. Epub 2025 May 28.

ABSTRACT

BACKGROUND: Various surgical techniques have been reported for repairing Ebstein anomaly. Cone repair provides nearly anatomical tricuspid valve (TV) reconstruction with promising outcomes. We reviewed our experience with cone repair to evaluate biventricular remodeling and the outcomes of the annular support procedure.

METHODS: Between January 2008 and December 2021, cone repair was performed in 33 consecutive patients with Ebstein anomaly. Mean age was 32.0±16.8 years (range, 1.1-66.8 years). Previous TV repair had been performed in two patients with the Hetzer and the Carpentier techniques (6%). Severe tricuspid regurgitation (TR) was observed in 32 patients (97%). Twenty patients had preoperative magnetic resonance imaging (MRI) data; 15 patients had postoperative MRI data.

RESULTS: Modifications included the addition of an annuloplasty band (21 patients with pericardial strips, two patients with prosthetic rings) in 23 patients (69.7%) and papillary muscle repositioning in one patient (3%). Bidirectional cavopulmonary anastomosis was performed in two patients (6%), with one of them undergoing a Fontan operation in the third postoperative years. No mortality was observed. The mean follow-up duration was 7.5±4.6 years. Two patients (6%) required late TV re-repair in the first and sixth postoperative years. At follow-up, five patients (16.1%) reported no or trivial TR, 16 (51.6%) had mild TR, and 5 (16.1%) had mild to moderate TR. Freedom from late TV reoperation was 78.8%±13.4% at 5 years. The TV reoperation rate was significantly low in the patients who underwent tricuspid annuloplasty with a band (P=0.02). Preoperative and postoperative MRI data demonstrated a significant right ventricular (RV) volume decrease after cone repair [RV end-diastolic volume index (mL/m2): preoperative/postoperative =207.4±40.2/105.5±41.3, P=0.001]. Left ventricular ejection fraction (LVEF) remained unchanged after cone repair, while left ventricular stroke volume (LVSV) significantly increased [LVEF (%): preoperative/postoperative =60.8±5.3/61.2±5.4, P=0.10; LVSV (mL): preoperative/postoperative =64.0±1.8/71.4±12.7, P=0.041].

CONCLUSIONS: Cone repair for Ebstein anomaly has low mortality and morbidity rates. The addition of an annuloplasty band was associated with a low incidence of the TV reoperation. Moreover, cone repair might impact left ventricular function due to ventricular interdependency. Longer follow-up is essential to determine the late durability of cone repair and both ventricular functional changes.

PMID:40529772 | PMC:PMC12170008 | DOI:10.21037/jtd-2024-2185

J Med Case Rep. 2025 Jun 18;19(1):280. doi: 10.1186/s13256-025-05241-y.

ABSTRACT

BACKGROUND: Right-sided infective endocarditis is a rare clinical entity, with isolated pulmonary valve infective endocarditis being extremely uncommon. Infective endocarditis carries a high mortality rate and significant complications, making early identification and prompt management crucial in improving outcomes. This case highlights an unusual presentation of right-sided infective endocarditis isolated to the pulmonic valve in a pediatric patient with no apparent preexisting heart disease.

CASE PRESENTATION: A 7-year-old girl of Yoruba ethnicity presented with septicemic illness, congestive heart failure, and no evidence of congenital cardiac lesion, underlying valvular disease, or identifiable predisposing factors. She had underweight malnutrition, cachexia, and severe respiratory distress. Echocardiography, which was delayed due to resource limitations, ultimately revealed isolated myxomatous vegetation on the pulmonary valve, dilated right cardiac chambers, and pulmonary hypertension. Blood cultures grew Pseudomonas aeruginosa. The patient was managed with antimicrobial agents, an anticardiac failure regimen, antiplatelets, and supportive therapy. Management was complicated by financial constraints, which delayed optimal intervention.

CONCLUSION: Although isolated pulmonary valve infective endocarditis is rare in the pediatric population, particularly in the absence of identifiable heart disease, a high index of suspicion is essential. Early diagnosis via echocardiography and prompt, adequate treatment are crucial for favorable outcomes. Awareness of potential diagnostic delays and financial barriers can aid in optimizing timely intervention and improving prognosis.

PMID:40533870 | PMC:PMC12178004 | DOI:10.1186/s13256-025-05241-y

BMJ Open. 2025 Jun 18;15(6):e096538. doi: 10.1136/bmjopen-2024-096538.

ABSTRACT

OBJECTIVE: To evaluate the impact of heart valve clinics (HVCs) versus standard of care (SOC) on disease detection, timing of intervention and clinical outcomes in patients with valvular heart disease (VHD).

DESIGN: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42024518787).

DATA SOURCES: PubMed, Embase, Web of Science, Scopus and the Cochrane Library from inception to 1 May 2025.

ELIGIBILITY CRITERIA: Randomised controlled trials or cohort studies comparing patients managed in HVCs with those receiving SOC, and reporting on outcomes such as mortality, cardiac events, time to symptom reporting or symptom severity. Studies were excluded if they lacked detailed HVC protocols, single-arm designs or were published as abstracts only.

DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened titles, abstracts and full texts, with discrepancies resolved by a senior adjudicator. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. Meta-analysis was not conducted due to heterogeneity among studies.

RESULTS: Three high-quality prospective cohort studies (N=1082) were included. Two studies reported mortality and cardiac events: one, a before-and-after controlled trial (n=382), recorded 11 deaths in the HVC group; the other reported 4 deaths in the HVC group (n=156) versus 17 deaths in the SOC group (n=156) (p<0.05). Additionally, two studies found that HVCs significantly reduced the interval between symptom onset and reporting (p<0.05), as well as the proportion of patients presenting with severe symptoms (defined as New York Heart Association (NYHA) class or Canadian Cardiovascular Society (CCS) class ≥III).

CONCLUSION: HVCs facilitate stratified and precise management of the whole-life cycle of patients with VHD, enhancing early detection and referral, and leading to reduced mortality and major cardiac events compared with SOC.

PMID:40533205 | PMC:PMC12182144 | DOI:10.1136/bmjopen-2024-096538

J Thorac Dis. 2025 May 30;17(5):3073-3084. doi: 10.21037/jtd-24-1667. Epub 2025 May 28.

ABSTRACT

BACKGROUND: Sutureless aortic valve replacement (S-AVR) is a surgical alternative to conventional aortic valve replacement (C-AVR), recognized for its efficacy and clinical superiority in the treatment of valvular disease. Its use is gradually increasing not only in single-valve procedures but also in multiple valve surgeries. This study aimed to evaluate our experience with the Perceval S-AVR combined with mitral and tricuspid valve surgery such as multiple valve surgery, focusing on the clinical outcomes and operative time.

METHODS: Between January 2017 and December 2022, 141 patients underwent surgical aortic valve replacement (AVR) using the bioprosthetic aortic valve at our institution. Of them, 42 patients (29.8%) underwent S-AVR with multivalve surgery. After 1:1 propensity score matching, 42 patients were selected as study subjects in each group. The primary endpoints were 30-day and follow-up mortality and major valve-related adverse events, such as structural valve dysfunction, valve thrombus, endocarditis, stroke, re-intervention, and pacemaker implantation.

RESULTS: In matched cohort, the mean age 74.3±4.2 and 74.2±6.2 years in C-AVR and S-AVR groups, respectively. The in-hospital mortality rates were 2.4% and 0% (P>0.999), and follow-up mortality rates were 4.8% and 7.1% (P>0.99) in C-AVR and S-AVR groups, respectively. Paravalvular leakage and abnormal pressure acceleration were absent in both the groups, and the incidence of postoperative valve-related adverse events did not vary between the groups. The operation time, including for the mitral valve, tricuspid valve, and arrhythmia surgeries, was significantly shorter in the S-AVR group after matching (mean cardiopulmonary bypass time: 132.52±39.20 vs. 115.50±25.70 minutes, P=0.001; mean aortic cross clamp time: 100.90±32.12 vs. 80.38±18.81 minutes, P<0.001).

CONCLUSIONS: S-AVR may be considered a viable option in cases requiring multiple valve surgery, as it can reduce operation time without compromising clinical outcomes.

PMID:40529743 | PMC:PMC12169998 | DOI:10.21037/jtd-24-1667

Braz J Cardiovasc Surg. 2025 Jun 18;40(4):e20240039. doi: 10.21470/1678-9741-2024-0039.

ABSTRACT

INTRODUCTION: The present study evaluated systemic microcirculatory alterations occurring in the early postoperative period of cardiopulmonary bypass-assisted heart valve surgery compared to preoperative parameters through noninvasive point-of-care microcirculatory imaging of the sublingual area using incident dark field imaging.

METHODS: This was a single-center cross-sectional observational study that included 23 patients aged 49 ± 13 years. Sublingual microcirculatory density and perfusion were evaluated using a handheld camera based on incident dark field imaging before surgery and in the early postoperative period.

RESULTS: The total number of capillary vessels (1029 ± 13, P=0.0006), total length of capillary vessels (29.4 ± 3.2 mm, P=0.0005), and capillary vessel density (16.8 ± 1.8 mm/mm2, P=0.0005) were all higher after surgery. On the other hand, the total number of noncapillary vessels (85 ± 34, P=0.05), total length of noncapillary vessels (1.9 ± 0.8 mm, P=0.07), and noncapillary vessel density (1.1 ± 0.5 mm/mm2, P=0.07) were similar before and after surgery. The total number of capillary vessels was higher after surgery (1109 ± 92) in patients who received milrinone infusion (P=0.002) but not in patients who did not receive milrinone (986 ± 129, P=0.05).

CONCLUSION: After cardiac valve surgery, there was an improvement in microvascular parameters concerning capillary vessels and in the total number of microvessels. Moreover, significant positive correlations were found between the use of milrinone and these parameters. The study demonstrated the usefulness of handheld cameras for bedside evaluation of the microcirculation.

PMID:40530991 | PMC:PMC12175618 | DOI:10.21470/1678-9741-2024-0039

Pediatr Cardiol. 2025 Jun 18. doi: 10.1007/s00246-025-03920-7. Online ahead of print.

ABSTRACT

Extubation on the operating table is increasingly utilized to minimize ventilator-associated complications and promote early recovery in pediatric cardiac surgery. However, its safety across diverse congenital heart disease (CHD) populations remains insufficiently defined. To evaluate the feasibility, safety, and clinical outcomes of on-table extubation across a broad spectrum of corrective and palliative congenital heart surgeries in children. This retrospective multicenter study included 986 pediatric patients (aged 7 days to 16 years) who underwent on-table extubation after CHD surgery between 2019 and 2025. Patients were grouped as corrective (n = 632) or palliative (n = 354) cases. Primary outcomes were reintubation and mortality. Secondary outcomes included ICU and hospital stay durations, and incidence of ventilator-associated pneumonia (VAP). Overall reintubation and mortality rates were 5.78 and 1.22%, respectively. Corrective procedures demonstrated significantly lower reintubation (4.11%) and mortality (0.63%) compared to palliative surgeries (8.76 and 2.26%, respectively; p < 0.01 and p < 0.05). Highest complication rates were observed in HLHS (reintubation and mortality 40%) and aortopulmonary shunt (53.13 and 21.88%). In contrast, Glenn and Fontan procedures showed low reintubation (1.69, 2.91%) and minimal mortality. No cases of VAP were reported. Mean ICU and hospital stays were 3.69 and 9.7 days. Of the 57 reintubation events, 23 (40.4%) occurred within 6 h of extubation, suggesting extubation failure, while 34 (59.6%) occurred between 6 and 24 h, potentially due to secondary complications. Early reintubations (0-6 h) were more common in aortopulmonary shunt (17 cases) and coarctation/IAA repair (3 cases), whereas later reintubations (6-24 h) predominated in ToF (5 cases), truncus arteriosus (4 cases), and TGA (3 cases). A moderate correlation was found between reintubation and mortality (Spearman's r = 0.45, p < 0.01). On-table extubation is a safe and feasible strategy in pediatric cardiac surgery, particularly in corrective procedures and select single-ventricle palliation. However, caution is warranted in high-risk physiologies such as HLHS and shunt-dependent circulation. Careful perioperative evaluation remains essential for optimal outcomes.

PMID:40533645 | DOI:10.1007/s00246-025-03920-7

A A Pract. 2025 Jun 17;19(6):e02000. doi: 10.1213/XAA.0000000000002000. eCollection 2025 Jun 1.

ABSTRACT

The serratus posterior superior intercostal plane block (SPSIPB) is a novel regional anesthesia technique providing broad dermatomal coverage. We present 2 patients who underwent coronary artery bypass grafting via median sternotomy and received bilateral SPSIPB for postoperative analgesia. Both patients exhibited effective pain control with low numeric rating scale scores and minimal morphine consumption (8 mg and 10 mg, respectively) within the first 24 postoperative hours, without any complications. These findings support the potential role of SPSIPB as a safe and effective component of multimodal analgesia in cardiac surgery, particularly in patients at increased risk for neuraxial techniques. .

PMID:40525732 | DOI:10.1213/XAA.0000000000002000

Ann Thorac Surg Short Rep. 2024 Nov 14;3(2):402-407. doi: 10.1016/j.atssr.2024.10.024. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Despite sternum sparing and without cardiopulmonary bypass, the actual value of minimally invasive coronary surgery (MICS) is still debatable. This study aimed to compare the completeness of revascularization and intermediate-term outcomes of MICS with conventional sternotomy coronary artery bypass grafting (CABG).

METHODS: Two groups of 244 patients each receiving MICS-CABG and sternotomy-CABG between November 2015 and March 2019 were matched by propensity score matching. The completeness of revascularization and major adverse cardiovascular and cerebrovascular events (MACCE; a composite of death, myocardial infarction, stroke, or repeated target vessel revascularization) were compared between the groups.

RESULTS: In the MICS-CABG group, the percentages of bypassed vessels 2, 3, and ≥4 were 53.7%, 36.1%, and 10.2%, respectively. Completeness of revascularization (95.5% vs 96.3%; P = .65) was comparable between MICS-CABG and sternotomy-CABG groups. Postprocedural angiography revealed an overall patency of 96.2% (578/601) for the MICS-CABG group. At 5 years, rates of MACCE (19.9% vs 22.1%; hazard ratio [HR], 0.80; 95% CI, 0.49-1.32; P = .39), death (10.6% vs 12.9%; HR, 0.87; 95% CI, 0.46-1.65; P = .67), myocardial infarction (5.6% vs 4.2%; HR, 0.82; 95% CI, 0.27-2.52; P = .73), stroke (6.7% vs 6.6%; HR, 1.11; 95% CI, 0.43-2.86; P = .83), and repeated target vessel revascularization (1.9% vs 1.8%; HR, 0.85; 95% CI, 0.17-3.15; P = .84) were similar between MICS-CABG and sternotomy-CABG.

CONCLUSIONS: MICS-CABG, which appeared to yield noninferior completeness of revascularization and intermediate-term MACCE compared with sternotomy-CABG, could be an alternative for patients with multivessel coronary diseases.

PMID:40525194 | PMC:PMC12167539 | DOI:10.1016/j.atssr.2024.10.024

Ann Thorac Surg Short Rep. 2025 Jan 9;3(2):385-389. doi: 10.1016/j.atssr.2024.12.014. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Open repair for aortic arch aneurysms is the gold standard, but prolonged circulatory arrest time and aortic cross-clamp time heighten complication risks. Our team adopted a modified frozen elephant trunk (FET) implantation technique simplifying the complex arch procedure.

METHODS: The FET technique, like open and endovascular surgeries, is an evolving procedure in aortic arch repair and complex aortic pathologies. Our FET technique involves bilateral axillary artery cannulation for cardiopulmonary bypass, debranching of arch vessels with antegrade cerebral perfusion prior to circulatory arrest, and FET implantation. The circulatory arrest required only for distal graft to arch anastomosis in zones 0 to II. An early cross-clamp release after completion proximal graft to aorta anastomosis minimizes cross-clamp time and provides rapid myocardial perfusion. Mild hypothermia 28°C and 2-layer suture technique for aortic anastomosis facilitates bleeding control.

RESULTS: From end 2022 to beginning of 2024, we implanted 7 FET devices using this technique. The average cardiopulmonary bypass time was 231.6 minutes, with an aortic cross-clamp time of 84.6 minutes and a cardiopulmonary assist time of 31.1 minutes. Concomitant revascularization was performed in 28.6% of cases, with no instances of cerebrovascular accidents, reoperation for bleeding, or 30-day mortality reported.

CONCLUSIONS: We found our modified technique to be a comprehensive and simple solution for FET procedures, enhancing surgical outcomes and reducing risks.

PMID:40525183 | PMC:PMC12167568 | DOI:10.1016/j.atssr.2024.12.014

Curr Cardiol Rep. 2025 Jun 17;27(1):95. doi: 10.1007/s11886-025-02235-6.

ABSTRACT

AIM: In this review, we discuss the regenerative processes in the heart, focusing on non-cardiomyocyte cell populations (fibroblasts, immune cells, and endothelial cells) in zebrafish and mammals. We highlight the role of signaling pathways in heart repair and the potential for therapeutic strategies based on these mechanisms.

PURPOSE OF REVIEW: The review examines key molecular and cellular mechanisms in cardiac regeneration, with a focus on fibroblasts, immune modulation, and endothelial function, to identify strategies for enhancing heart repair.

RECENT FINDINGS: Recent advancements in characterization of different cell types at the single cell level, along with the discovery of regeneration enhancer elements, have opened new avenues for cardiac regeneration. Targeting the epicardium, along with fibroblast activation, immune modulation, and endothelial signaling, may offer therapeutic strategies to enhance heart regeneration by supporting cardiomyocytes in mice and humans. While non-cardiomyocytes in zebrafish contribute to heart regeneration, in mice and humans, these cells often drive fibrosis instead. Understanding these species-specific differences is crucial for optimizing therapeutic approaches to treat cardiac injury and prevent fibrosis.

PMID:40527972 | PMC:PMC12174244 | DOI:10.1007/s11886-025-02235-6

Acta Pharmacol Sin. 2025 Jun 17. doi: 10.1038/s41401-025-01593-9. Online ahead of print.

ABSTRACT

Ischaemic heart disease is an important cause of death in humans, and resupply of blood to damaged myocardium can exacerbate the risk of cardiac I/R injury. Circular RNAs (circRNAs) play an important role in cardiovascular disease. In this study we investigated the regulatory role of circDhx32 in the progression of I/R injury. Cardiac I/R model was established in mice by ligating the left anterior descending coronary artery (LAD) for 45 min, followed by blood reperfusion for 24 h or 2 weeks. For in vitro study, neonatal mouse ventricular cardiomyocytes were subjected to hypoxia-reoxygenation (H/R) assault. CircDhx32 was significantly upregulated in I/R-treated mice and H/R-treated cardiomyocytes. Cardiomyocyte-specific knockdown of circDhx32 ameliorated the pathological outcomes of cardiac I/R injury including improved cardiac function, reduced infarct size and reduced release of cardiac injury biomarkers. The protective effects of circDhx32 silencing were also observed in cardiomyocytes after H/R. We demonstrated that ALKBH5 functioned as an m6A demethylase, removing the m6A modification sites of circDhx32. Reduced m6A modification inhibited recognition and binding by the m6A readers YTHDF2 and YTHDC1, leading to circDhx32 degradation and diminished nucleoplasmic export under pathological conditions. Elevated circDhx32 inhibited the transcriptional activation of AdipoR1 by binding to FOXO1. Conversely, circDhx32 deficiency alleviated the inflammatory responses in I/R-treated mice and H/R-treated cardiomyocytes including decreased mRNA expression levels and release of inflammatory cytokines such as IL-6, TNF-α and IL-1β potentially through modulation of the AdipoR1-AMPK-NF-κB signaling pathway. In conclusion, ALKBH5 acted as m6A eraser accompanied by the m6A readers YTHDF2 and YTHDC1 to promote high expression and nuclear retention of circDhx32 under pathological conditions. CircDhx32 regulated the inflammatory responses to cardiac I/R injury by targeting the AdipoR1-AMPK-NF-κB signaling pathway, which competed with AdipoR1 for FOXO1. These results reveal a novel mechanism underlying cardiac ischaemic injury, and circDhx32 is expected to be a potential therapeutic target for early intervention in ischaemic cardiac disease.

PMID:40528033 | DOI:10.1038/s41401-025-01593-9

Mol Biol Rep. 2025 Jun 17;52(1):606. doi: 10.1007/s11033-025-10713-x.

ABSTRACT

Necroptosis is a regulated form of programmed cell death. It is integral to the development of various diseases, such as neurological disorders, lung injuries, liver fibrosis, and testicular toxicity. This process is orchestrated by essential molecular pathways that involve receptor-interacting protein kinases (RIP1/RIP3) and mixed lineage kinase domain-like protein (MLKL), which lead to membrane disruption, the release of damage-associated molecular patterns (DAMPs), and subsequent inflammation. Melatonin, recognized for its potent antioxidant and anti-inflammatory properties, has emerged as a promising therapeutic agent that can inhibit necroptosis through various mechanisms. In neurological diseases such as intracerebral hemorrhage, traumatic brain injury, and cerebral ischemia-reperfusion, melatonin suppresses necroptosis by downregulating RIP1/RIP3/MLKL signaling, upregulating A20 (TNFAIP3), and inhibiting the HMGB1/TLR4/NF-κB pathway. In lung disorders, melatonin attenuates cadmium- and LPS-induced necroptosis by modulating the Ang-II axis, reducing TNF-α-mediated signaling, and acting through MT1/MT2 receptors. In liver fibrosis models, melatonin inhibits RIP1-RIP3 necrosome formation, reduces oxidative stress, and decreases DAMPs-mediated immune responses. Similarly, in testicular toxicity induced by tetrabromobisphenol A (TBBPA), melatonin suppresses necroptosis by inhibiting the several pathways and reducing ROS overproduction. These findings highlight melatonin's ability to modulate necroptosis across diverse tissues, offering protection against inflammation, oxidative stress, and cell death. By targeting necroptosis-related pathways, melatonin presents a versatile therapeutic strategy for treating diseases characterized by excessive cell death and inflammation, including stroke, myocardial infarction, pancreatitis, and autoimmune disorders. This review underscores the potential of melatonin as a novel intervention for necroptosis-related pathologies, emphasizing its role in restoring cellular homeostasis and mitigating tissue damage.

PMID:40526280 | DOI:10.1007/s11033-025-10713-x

Echocardiography. 2025 Jun;42(6):e70221. doi: 10.1111/echo.70221.

ABSTRACT

BACKGROUND: Coronary artery disease (CAD) is one of the causes of morbidity and death worldwide. Recently, speckle tracking technologies allowed the assessment of the strain of each myocardial segment in an automated method that may decrease inter-operator variability.

OBJECTIVE: To compare the effectiveness of two-dimensional speckle tracking global longitudinal strain (GLS) during dobutamine stress echocardiography (DSE) with myocardial perfusion imaging (MPI) using single photon emission computed tomography (MPI SPECT) in the diagnosis of CAD.

METHODS: A cross-sectional study was conducted involving 103 patients with CAD suspicion. Each participant underwent MPI SPECT and GLS measurements at rest and during peak dobutamine stress. The outcomes from GLS-DSE and MPI SPECT were then compared against the results of ICA as the reference standard for diagnosis.

RESULTS: The mean age of included patients was 57.79 ± 8.08 years. The MPI-SPECT defect size results demonstrated a highly significant (p value < 0.001) and strong positive correlation with the number of affected vessels in invasive coronary angiography (ICA). The sensitivity and specificity of the MPI SPECT were 90.62% and 92.96%, respectively, with a PPV of 85.29% and an NPV of 95.65%. Additionally, a highly significant (p value < 0.001) and strong negative correlation was observed between GLS values at peak DSE and the number of affected vessels in ICA. GLS at peak DSE had 78.12% sensitivity and 88.73% specificity with PPV 75.76% and NPV 90%.

CONCLUSION: GLS at peak DSE looks to be another noninvasive tool for the assessment of patients with suspected CAD, with the benefits of being a quick, non-expensive, and radiation-free test.

PMID:40526261 | DOI:10.1111/echo.70221

J Med Virol. 2025 Jun;97(6):e70440. doi: 10.1002/jmv.70440.

ABSTRACT

Viral myocarditis is characterized by inflammatory cell infiltration and myocardial damage. However, the involvement of immune cells and the interaction between immune cells and stromal cells remain poorly understood. We successfully established a mouse model of viral myocarditis induced by Coxsackievirus B3 (CVB3) and systematically analyzed immune cell infiltration and myocardial injury at different time points. Single-cell RNA sequencing (scRNA-seq) was performed at the peak of immune cell infiltration to characterize the immune landscape of infected cardiac tissue and peripheral blood mononuclear cells (PBMCs). Macrophage depletion and vascular endothelial growth factor receptor (VEGFR) inhibition were performed to validate the immune-stromal crosstalk. Peak immune cell infiltration and myocardial injury occurred on the 7th day of infection. scRNA-seq revealed that endothelial cells and mononuclear phagocytes (MNPs) were the most substantially expanded cell populations in the hearts of mice with viral infection. Trem2 macrophage, characterized by tissue repair gene signatures, was the predominant MNP subcluster in the infected heart, while tip cells and capillaries were the most expanded endothelial cell clusters. Cell-cell communication analysis identified increased macrophage-endothelial cell interactions during CVB3 infection. Macrophage-derived VEGFA secretion, partially induced by CVB3 infection and apoptotic cardiomyocyte debris, promoted angiogenesis, while macrophage depletion resulted in reduced VEGFA secretion and endothelial proliferation. Moreover, inhibition of VEGFR exacerbated cardiac dysfunction, highlighting the protective role of angiogenesis in myocarditis progression. In summary, these results elucidated a cardioprotective role of macrophage-driven angiogenesis via vascular endothelial growth factor signaling during viral myocarditis, providing new insights into therapeutic strategies for inflammatory heart diseases.

PMID:40525609 | DOI:10.1002/jmv.70440

Cureus. 2025 May 17;17(5):e84268. doi: 10.7759/cureus.84268. eCollection 2025 May.

ABSTRACT

Penetrating cardiac injuries (PCI) from gunshot wounds are among the most fatal forms of trauma, with prehospital mortality rates exceeding 90%. While the right ventricle is most commonly affected due to its anterior location, retained intracardiac projectiles are rarely encountered and pose significant management challenges. Cardiac tamponade, though potentially fatal, can sometimes provide a protective mechanism by limiting hemorrhage. The decision to surgically remove retained bullets remains controversial, particularly in hemodynamically stable patients. We report the case of a 51-year-old male who sustained multiple gunshot wounds, including a thoracic injury with an 8 mm bullet fragment retained in the right ventricle. On arrival, the patient was hemodynamically stable despite imaging revealing a pericardial effusion and a sternal fracture. A median sternotomy with pericardiotomy was performed, revealing a right ventricular epicardial wound without active bleeding. Due to the absence of cardiopulmonary bypass, the intracardiac bullet was not removed. The patient received prophylactic heparin and was monitored with imaging and serial exams. He was discharged without complications. This case highlights a rare presentation of PCI without overt tamponade physiology, despite the presence of a pericardial effusion. The patient remained stable throughout hospitalization, supporting the hypothesis that tamponade can temporarily contain hemorrhage. Conservative management of retained intracardiac projectiles may be appropriate in select patients, particularly when the projectile is embedded in the trabeculated myocardium and the risk of embolization is low. Literature suggests that long-term outcomes can be favorable with nonoperative management in stable cases. This case reinforces the importance of rapid surgical intervention for PCI, even in stable patients, and supports individualized, conservative management of retained cardiac projectiles in the absence of cardiopulmonary bypass. Further research is needed to define standardized protocols for managing intracardiac foreign bodies in trauma.

PMID:40525047 | PMC:PMC12168663 | DOI:10.7759/cureus.84268

Case Rep Cardiol. 2025 Jun 7;2025:3481920. doi: 10.1155/cric/3481920. eCollection 2025.

ABSTRACT

Mechanical circulatory support devices, such as the Impella catheter (Abiomed, Danvers, Massachusetts), continue to become more commonplace in patients undergoing high-risk percutaneous coronary intervention (PCI) or those in cardiogenic shock. Thrombus in the left ventricle is a contraindication to Impella placement. Here, we present a patient with an anterior ST elevation myocardial infarction who underwent primary PCI with subsequent development of cardiogenic shock followed by Impella placement, who then later developed an LV thrombus. The Impella was removed after placement of a Sentinel cerebral protection device (Boston Scientific, Massachusetts). The left carotid filter of the Sentinel captured a thrombus fragment. The patient did not have any neurological compromise. This case represents the first report of actual capture of LV thrombus by a Sentinel system in this context. The case suggests the potential value of the Sentinel cerebral protection device to lower the risk of an embolic event during Impella removal in selective clinical scenarios.

PMID:40524828 | PMC:PMC12170058 | DOI:10.1155/cric/3481920

JACC Heart Fail. 2025 Jun 16;13(8):102495. doi: 10.1016/j.jchf.2025.03.039. Online ahead of print.

ABSTRACT

BACKGROUND: Recent advances in heart procurement techniques have facilitated the utilization of hearts obtained after circulatory death. However, discerning the population that stands to benefit most requires an understanding of waitlist outcomes.

OBJECTIVES: The objective of this study was to evaluate waitlist and post-transplant outcomes among patients listed for donation after circulatory death (DCD) hearts in the United States, stratified by listing status.

METHODS: The UNOS (United Network for Organ Sharing) database was queried for all adult patients waitlisted for isolated heart transplantation between October 2018 and June 2024. Patients were stratified by approval for donation after brain death vs DCD hearts. DCD patients were subdivided into those who were DCD candidates at time of listing or later during their waitlist period. Waitlist and post-transplant outcomes were compared using Fine & Gray and Kaplan-Meier analyses.

RESULTS: A total of 24,970 patients were identified; of these, 8,191 (33%) were listed as DCD candidates. DCD status 2, 3, 4, and 6 patients were more likely to be transplanted and less likely to die on the waitlist. There were no differences in post-transplant survival in any group. Receipt of a DCD heart was not predictive of mortality. Patients initially listed as DCD candidates were significantly more likely to be transplanted than those who became DCD candidates later during their waitlist course.

CONCLUSIONS: With exception of status 1, patients waitlisted for DCD hearts experience shorter waitlist duration, improved rates of transplantation, and comparable long-term survival with donation after brain death recipients.

PMID:40527153 | DOI:10.1016/j.jchf.2025.03.039

Metab Syndr Relat Disord. 2025 Jun 17. doi: 10.1089/met.2025.0028. Online ahead of print.

ABSTRACT

Background: Metabolic syndrome (MetS) is increasingly prevalent globally and is linked to inflammation in cardiac tissues. Cardiac allograft vasculopathy (CAV) is a significant inflammatory condition and a leading cause of graft failure after orthotopic heart transplantation (OHT). The relationship between MetS and CAV remains poorly understood. Methods: A literature search was conducted from inception to September 2024, including studies that reported associations between MetS or its components (obesity, hypertension, dyslipidemia, and diabetes mellitus) and CAV. The primary endpoint was the development of CAV after OHT. Results were presented as odds ratios (OR) or hazard ratios (HR) with 95% confidence intervals (CI), employing both random and fixed-effect models based on heterogeneity. Results: A total of 16 studies involving 3,366 patients were included. The prevalence of MetS was high before OHT (32%, 95% CI: 24-41%, I2 = 75%) and increased after OHT (37%, 95% CI: 18-61%, I2 = 83%). MetS was significantly associated with CAV (OR = 1.99, 95% CI: 1.28-3.09, I2 = 36%). Key components of MetS linked to CAV included obesity (OR = 1.54, 95% CI: 1.11-2.13, I2 = 0%) and dyslipidemia (OR = 1.87, 95% CI: 1.49-2.36, I2 = 0%). New-onset diabetes mellitus after transplantation increases the risk of CAV with an HR of 1.71 (95% CI: 1.56-1.88, I2 = 0%). Conclusion: The high prevalence of MetS both before and after OHT is associated with an increased risk of CAV, highlighting the need for targeted interventions to manage MetS in heart transplant recipients.

PMID:40526466 | DOI:10.1089/met.2025.0028