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Sci Rep. 2025 Jun 20;15(1):20140. doi: 10.1038/s41598-025-04927-z.

ABSTRACT

Due to the increasing focus on neurodevelopment in children with congenital heart disease (CHD), early predictive markers are crucial for implementing interventions and improving neurodevelopmental outcomes. As postoperative delirium (PD) is known to have a long-term impact on neurocognitive function in adults, studies on the prevalence of and modifiable risk factors for PD offer new perspectives. We conducted a retrospective, single-centre study screening for PD using the Cornell Assessment of Pediatric Delirium (CAPD). We distinguished PD from iatrogenic withdrawal syndrome (IWS) by using the Withdrawal Assessment Tool 1 (WAT-1). A confirmatory, multivariate regression analysis was performed and included various pre-, intra-, and postoperative variables. The screening compliance rate was 95% among the 311 patients. The prevalence of PD was 40.2%, and 46.4% of the patients developed IWS. Infants were at the highest risk for PD (OR 2.9, p = 0.05). Prolonged mechanical ventilation > 100 h (OR 7.4, p = 0.003), infusion therapy with ketamine (OR 3.3, p = 0.009), IWS (mild: OR 7.7, p = < 0.001, severe: OR 17.0, p = < 0.001) and low cardiac output syndrome (LCOS) (OR 3.9, p = 0.02) were significant predictive risk factors for PD. Overall, PD and IWS are highly prevalent in paediatric cardiac intensive care units (pCICUs), especially in infants and children with prolonged ventilation durations who require multiple sedatives. This is one of the most extensive single-centre studies in the pCICU population, and the results revealed that IWS and lactatemia in the context of LCOS are novel predictors of PD.

PMID:40542017 | PMC:PMC12181358 | DOI:10.1038/s41598-025-04927-z

J Pediatr Surg. 2025 Jun 18:162420. doi: 10.1016/j.jpedsurg.2025.162420. Online ahead of print.

ABSTRACT

BACKGROUND: Currarino syndrome is a rare congenital condition characterized by a triad of anorectal malformation, sacral agenesis, and presacral mass, often a teratoma. Comparative outcomes of sacrococcygeal teratomas (SCTs) in Currarino versus non-syndromic cases are not well defined.

METHODS: A multicenter retrospective review of pediatric SCT resections from 2010-2020 was conducted across 11 institutions in the Midwest Pediatric Surgery Consortium. Patients were classified based on the presence or absence of Currarino syndrome. Demographic, surgical, pathologic, and long-term outcome data were analyzed. The primary outcome was tumor recurrence.

RESULTS: Of 203 patients, 25 (12.3%) had Currarino syndrome. Currarino patients were more often diagnosed postnatally (80% vs. 25%, p<0.001) and had predominantly Altman type IV tumors (87% vs. 17%, p<0.001). All tumors in the Currarino cohort were mature teratomas, while 27% of non-Currarino tumors were immature and 12% were malignant (p<0.001). Tumors in Currarino patients were significantly smaller in size (median 3.3 cm vs. 8.0 cm, p<0.001). Recurrence rates were low and comparable (4% Currarino vs. 10% non-Currarino, p=0.18). Currarino patients had higher rates of urinary incontinence (44% vs. 28%, p=0.048) and constipation (76% vs. 32%, p<0.001). Kaplan-Meier analysis showed a trend toward improved recurrence-free survival in Currarino patients, though not statistically significant.

CONCLUSIONS: Pediatric patients with Currarino-associated SCTs have excellent long-term outcomes, with low recurrence rates likely attributable to benign tumor histology and high rates of complete resection. These findings suggest that surveillance strategies may be tailored for Currarino patients to reduce unnecessary imaging and long-term follow-up burden.

STUDY DESIGN: Retrospective cohort study Level of Evidence: III.

PMID:40541662 | DOI:10.1016/j.jpedsurg.2025.162420

JACC Case Rep. 2025 Jun 18;30(15):103787. doi: 10.1016/j.jaccas.2025.103787.

ABSTRACT

Coronary artery fistulae (CAF) are rare aberrant connections between coronary arteries and the great vessels, coronary sinus, or cardiac chambers. Although most CAF are asymptomatic, patients with large, hemodynamically significant, or symptomatic fistulae might benefit from closure. Transcatheter occlusion is usually the preferred approach given that it avoids a sternotomy and cardiopulmonary bypass. However, there remain CAF with challenging features such as tortuous anatomy, large aneurysms, and concomitant cardiac disease that benefit from surgical ligation. We present 3 cases of CAF, all of which were treated by surgical ligation because of their hemodynamic and clinical significance, tortuosity, and massively dilated aneurysms. These cases illustrate the heterogeneous presentations of CAF and the varied open approaches to closure: epicardial versus intracardiac closure and with or without ligation of the involved coronary artery and distal revascularization. We present high-resolution 3-dimensional reconstructions of these impressively large fistulae and discuss the need for surgical consideration in similar cases.

PMID:40541346 | DOI:10.1016/j.jaccas.2025.103787

Pediatr Investig. 2025 Jan 3;9(2):181-184. doi: 10.1002/ped4.12459. eCollection 2025 Jun.

ABSTRACT

We recently came across an outbreak of parvovirus B19 related acute myocarditis in preschool children in a specific region in northern Greece. The children exhibited serious morbidity and mortality. All children had very poor left ventricular ejection fraction and required inotropic intensive care unit support.

PMID:40539004 | PMC:PMC12175628 | DOI:10.1002/ped4.12459

Ochsner J. 2025 Summer;25(2):116-118. doi: 10.31486/toj.24.0109.

ABSTRACT

BACKGROUND: The development of cardiac complications is common in patients with muscular dystrophy. However, advanced heart failure therapies such as implantation of durable ventricular assist devices and transplant are infrequently used in patients who develop cardiomyopathy, often because of comorbid impairments in mobility and respiratory function.

CASE REPORT: A 16-year-old male with limb-girdle muscular dystrophy type R4 presented with chronic decompensated heart failure. Recent worsening of his respiratory function and mobility were confounded by severe heart failure. In addition to our core advanced heart failure team, multidisciplinary assessment preoperatively included Neurology, Pulmonology, Genetics, and Physical Medicine and Rehabilitation. The patient underwent implantation of a HeartMate 3 left ventricular assist device and had an uneventful postoperative course. After intensive inpatient physical and occupational therapy, he was discharged home on postoperative day 16 with minimal residual heart failure symptoms and plans to continue robust outpatient physical therapy.

CONCLUSION: Patients with muscular dystrophy often have cardiac involvement; however, certain subtypes of muscular dystrophy are associated with an earlier presentation of severe life-limiting cardiomyopathy. Pediatric patients with muscular dystrophy should be considered for advanced heart failure therapies such as implantation of a durable left ventricular assist device at an appropriate center. Carefully selected patients may experience substantial improvements in their quality of life. Given the variable disease progression and life expectancy of patients with subtypes of muscular dystrophy, a thorough assessment by a multidisciplinary team is critical.

PMID:40538608 | PMC:PMC12175756 | DOI:10.31486/toj.24.0109

Innovations (Phila). 2025 Jun 19:15569845251337720. doi: 10.1177/15569845251337720. Online ahead of print.

ABSTRACT

OBJECTIVE: Partial heart transplantation (PHT) is a new procedure that delivers growing heart valve implants for children. However, awareness, attitudes, and perceptions of health care professionals regarding PHT remain unexplored.

METHODS: A national survey was conducted among members of the Congenital Heart Surgical Society, pediatric cardiac intensive care unit (ICU) directors, medical students, and organ procurement organization (OPO) representatives. The survey measured their awareness, perceptions, and attitudes toward PHT. Perceptions and attitudes were measured using a 5-point Likert scale. Statistical comparisons in ranked responses between survey questions were calculated using two-way analysis of variance, with multiple comparisons assessed by a Tukey post hoc test.

RESULTS: There were responses from 95 medical students (12.1%), 32 congenital cardiac surgeons (10.26%), 21 pediatric ICU directors (16.8%), and representatives from 8 OPOs (15%). Prior to survey distribution, 20% of students were aware of PHT. In contrast, almost all congenital heart surgeons (96.88%) and pediatric cardiologists (100%) were aware of PHT. Although surgeons and cardiologists understand the concepts of PHT, cardiologists were less likely to recommend and inform their patients about the procedure if they meet the criteria (Likert scale scores of 4.68 vs 3.14, P = 0.01 and 4.38 vs 3.69, P = 0.01, respectively). Surgeon and cardiologist perceptions regarding the use of PHT for different patient age groups were significantly different (P < 0.001).

CONCLUSIONS: Even though PHT is a relatively recent innovation, it is well known among pediatric cardiac surgeons and pediatric intensive care directors.

PMID:40538051 | DOI:10.1177/15569845251337720

JACC Case Rep. 2025 Jun 18;30(15):103679. doi: 10.1016/j.jaccas.2025.103679.

ABSTRACT

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction, distinctly from atherosclerotic disease. Conservative management is typically recommended, but the incidence of mechanical complications is poorly defined, with only 7 cases reported. We describe a 62-year-old woman with SCAD complicated by left ventricular free wall rupture. Despite initial conservative management, she developed in-hospital cardiac arrest just moments before discharge and was treated with extracorporeal membrane oxygenation (ECMO), stabilizing her condition and enabling emergency surgical repair. This case underscores the potential role of ECMO in managing SCAD with life-threatening complications and underscores the need for a tailored approach to the management of SCAD patients, which differ from classical atherosclerotic myocardial infarction.

PMID:40541339 | PMC:PMC12198654 | DOI:10.1016/j.jaccas.2025.103679

J Cardiothorac Vasc Anesth. 2025 May 29:S1053-0770(25)00440-9. doi: 10.1053/j.jvca.2025.05.053. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the analgesic efficacy of superficial parasternal intercostal plane (S-PIP) block and deep parasternal intercostal plane (D-PIP) to determine which technique provides superior pain relief in cardiac surgery.

DESIGN: A systematic search of MEDLINE (via PubMed), Scopus, Embase, Cochrane Library, Web of Science, Google Scholar, and ClinicalTrials.gov from inception until January 18, 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies that compared the S-PIP and D-PIP blocks in patients undergoing cardiac surgery. The primary outcome of the study was postoperative opioid consumption of morphine milligram equivalent (MME) at 24 hours. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 hours, time to first analgesics, incidence of postoperative nausea and vomiting (PONV), extubation time, length of stay (LOS) in the intensive care unit (ICU), and the number of patients requiring rescue analgesics.

MAIN RESULTS: Seven RCTs and 1 observational study, including a total of 510 patients, were identified. The findings demonstrated no statistically significant difference in MME at 24 hours between the S-PIP and D-PIP block groups (mean difference, -1.23; 95% confidence interval, -2.51 to 0.05; p = 0.061). Additionally, there were no significant differences in pain scores, PONV incidence, time to rescue analgesics, extubation time, or ICU LOS of stay between the 2 techniques.

CONCLUSIONS: S-PIP and D-PIP blocks provide comparable postoperative analgesic efficacy in patients undergoing cardiac surgery.

PMID:40541472 | DOI:10.1053/j.jvca.2025.05.053

Korean J Anesthesiol. 2025 Jun 20. doi: 10.4097/kja.24901. Online ahead of print.

ABSTRACT

BACKGROUND: Sugammadex reverses the effects of steroidal neuromuscular-blocking agents, such as rocuronium, by encapsulating these agents. Its cardiovascular adverse effects include QTc prolongation, hypotension, bradycardia, atrioventricular block, atrial fibrillation, and asystole. Additionally, rocuronium has cardiac side effects, such as bradycardia, hypotension, cardiac arrest, circulatory collapse, and ventricular fibrillation. Herein, we investigated the effects of sugammadex, rocuronium, and combined rocuronium + sugammadex on cardiac electrophysiological parameters.

METHODS: In vitro experiments were performed using ventricular myocytes obtained from male Wistar rats. Myocyte contraction and relaxation responses were recorded along with action potential (AP), and L-type calcium (ICaL) and potassium channel currents (Ito, Iss, and IK1).

RESULTS: Sugammadex caused dose-dependent decreases in myocyte contraction and relaxation responses. Rocuronium had no effect in this respect, whereas its co-administration with sugammadex led to decreased contraction responses. Sugammadex prolonged the AP repolarization phase, whereas rocuronium prolonged all AP phases. Co-administration of sugammadex and rocuronium did not significantly affect AP parameters. Sugammadex suppressed the peak ICaL value, while rocuronium caused an even greater decrease. Co-administration of these drugs further decreased the current-voltage characteristics of the ICaL. However, no significant effects were observed on the potassium currents.

CONCLUSIONS: Separate or combined administration of sugammadex and rocuronium had various effects on myocyte contractility, AP, and ICaL, which could cause significant changes leading to adverse cardiac events. Further experimental and clinical studies are required to understand the clinical consequences of the modulatory effects of these drugs on cardiac electrophysiological parameters.

PMID:40538088 | DOI:10.4097/kja.24901

Eur J Pediatr. 2025 Jun 20;184(7):430. doi: 10.1007/s00431-025-06274-7.

ABSTRACT

This systematic review and meta-analysis aimed to evaluate the clinical outcomes of cardiac surgery in neonates with trisomy 13 (T13) or trisomy 18 (T18) compared to those managed with palliative care. A literature search was conducted in PubMed® and EMBASE®, following PRISMA guidelines, and included five retrospective cohort studies (1627 patients). Outcomes analyzed included in-hospital mortality, survival at 12 months, length of stay (LOS), hospital discharge rates, and the need for mechanical ventilation. The meta-analysis showed that cardiac surgery significantly reduced the odds of in-hospital mortality (OR 0.12, CI 95% 0.03-0.42, p < 0.01), increased survival at 12 months (OR 19.77, CI 95% 5.12-76.36, p < 0.01), and improved discharge rates (OR 12.53, CI 95% 3.63-43.22, p < 0.01). However, limited data were available on quality of life and mechanical ventilation duration. Conclusion: Despite the positive impact of cardiac surgery on survival and discharge rates, the evidence remains low quality, as the included studies were primarily retrospective cohorts with moderate risk of bias. The findings highlight the importance of involving families in the decision-making process, given their differing perspectives on quality of life. Further high-quality studies, such as randomized controlled trials, are needed to provide stronger evidence on this topic.

PMID:40537699 | DOI:10.1007/s00431-025-06274-7

Cardiol Young. 2025 May;35(5):1082-1084. doi: 10.1017/S1047951125001751. Epub 2025 Jun 20.

ABSTRACT

Staged Fontan pathway treatment is a recognised surgical approach for managing congenital heart lesions with single ventricle physiology. Some patients necessitate communication between the tunnel and the atrium to maintain circulatory balance. During follow-up, adjustments to fenestration size may be required. While methods for enlarging or completely closing fenestrations are common, partially reducing flow through a fenestration remains challenging. We present an effective technique for partially reducing the size of a large, stented fenestration using a coronary stent and a vascular occluder.

PMID:40537442 | DOI:10.1017/S1047951125001751

Korean Circ J. 2025 May 14. doi: 10.4070/kcj.2024.0318. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Rotational atherectomy (RA) is a technique used to ablate calcified plaques. There is speculation that operators' experience with RA could play a role in the outcomes.

METHODS: From December 2015 to April 2020, patients with calcified coronary lesions requiring percutaneous coronary intervention (PCI) with RA were enrolled in a prospective, multicenter, observational registry. The patients were divided into two groups based on the number of RAs performed by their operator in the past. A propensity score matching was done for a sensitivity analysis. The primary outcome was a composite of cardiac death, myocardial infarction, and target vessel revascularization at 1 year.

RESULTS: A total of 497 patients were enrolled in the study. The calculated cutoff number of RA-PCI between the two groups was 82 cases. The more experienced group underwent PCI with less fluoroscopy time (less experienced vs. more experienced, 38.8 vs. 30.0 minutes, p<0.001), and more frequent intravascular imaging (54.6% vs. 69.0%, p=0.012). The primary outcome did not differ significantly between the groups (5.2% vs. 7.3%, hazard ratio, 1.46; 95% confidence interval [CI], 0.57-3.74; p=0.433). No significant difference in the incidence of complications was observed between the groups (5.5% vs. 7.0%, odds ratio, 1.38; 95% CI, 0.57-3.04; p=0.526). Similar results were observed in the propensity-score matched population.

CONCLUSIONS: In PCI using RA for calcified lesions, the composite outcome of cardiac death, myocardial infarction, and target vessel revascularization at 1 year was not significantly different according to RA experience among operators.

PMID:40537426 | DOI:10.4070/kcj.2024.0318

Cardiovasc Revasc Med. 2025 Jun 8:S1553-8389(25)00291-X. doi: 10.1016/j.carrev.2025.06.006. Online ahead of print.

ABSTRACT

Current guidelines recommend 6-12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention(PCI) followed by aspirinin monotherapy indefinitely. We aimed to assess efficacy and safety of Clopidogrel as compared to aspirin in patients undrgoing PCI after completing DAPT. We systematically searched 3 electronic databases and identified studies comparing clopidogrel to aspirin in post PCI population after completing DAPT. We included 7 studies with 20,360 patients. We pooled outcomes for major adverse cardiac events (MACE), typically comprising a composite of death, myocardial infarction (MI), or stroke; all-cause mortality; cardiac death; major bleeding; any stroke; ischemic stroke; hemorrhagic stroke; repeat revascularization; target-vessel revascularization (TVR); and definite stent thrombosis. Mean follow up was 12-36 months. Duration of DAPT was 1-18 months. Clopidogrel was associated with reductions in MACE than aspirin (RR: 0.82; 95 % CI: 0.69-0.98; p = 0.03), showed reduced risk of MI (RR 0.93 CI 0.60-1.44; p 0.74, I2 63%) indicating a relative reduction of 7 %, reduced strokes numerically but non-significantly (RR: 0.72; 95 % CI: 0.48-1.07; p = 0.11), RRR 28 %, all cause mortality did not exhibit a significant difference between clopidogrel and aspirin (RR: 0.99; 95 % CI: 0.67-1.44; p = 0.94). Cardiac death (RR: 0.81; 95 % CI: 0.56-1.17; p = 0.26), major bleeding (RR: 0.90; 95 % CI: 0.61-1.33; p = 0.61), reflecting a 10 % non-significant relative reduction, repeat revascularization showed no significant difference (RR: 0.95; 95 % CI: 0.74-1.23; p = 0.72) representing a slight 5 % relative reduction, target vessel revascularization did not reveal any significant differences (RR: 0.89; 95 % CI: 0.69-1.16; p = 0.40) corresponding to a non-significant relative risk reduction of 11 %, stent thrombosis demonstrated no statistically significant difference (RR: 0.78; 95 % CI: 0.27-2.31; p = 0.66) RRR of 22 %. Compared to aspirin Clopidogrel was associated with reduction in MACE with no significant differences in Mortality, Major bleeding, MI, and repeat revascularization between groups. PROSPERO REGISTRATION NUMBER: CRD420251042349.

PMID:40537309 | DOI:10.1016/j.carrev.2025.06.006

Curr Cardiol Rep. 2025 Jun 19;27(1):96. doi: 10.1007/s11886-025-02249-0.

ABSTRACT

PURPOSE OF REVIEW: To provide an overview of up-to-date treatment practices for in-stent restenosis (ISR).

RECENT FINDINGS: ISR is treated with similar effectiveness by paclitaxel drug coated balloons and second-generation drug eluting stents. Sirolimus coated balloons are an emerging technology that requires further investigation. The management of ISR remains challenging even with the newest generation of drug-eluting stents. The use of intravascular imaging is highly recommended to identify the mechanisms of stent failure and to tailor the method of treatment, whether it is plain old balloon angioplasty, plaque/calcium modifying tools such as intravascular lithotripsy or rotational atherectomy, additional drug eluting stents, or drug coated balloons. Paclitaxel drug coated balloons are the most recent technological advancement which has provided an option to treat ISR that doesn't require further layers of metal. Currently, other drug coatings are being studied but it is unclear whether these balloons are as effective as paclitaxel coated balloons, with ongoing trials designed to answer this question.

PMID:40536538 | DOI:10.1007/s11886-025-02249-0

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):955-957. doi: 10.1007/s12055-025-01973-0. Epub 2025 May 8.

ABSTRACT

In this review, we critically examine the 5-year outcomes of the Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease (FAME 3) trial. While the composite outcome of death, stroke, or myocardial infarction showed no significant difference between the two strategies at 5 years, percutaneous coronary intervention was associated with higher rates of myocardial infarction and repeat revascularization. Coronary artery bypass graft surgery demonstrated greater benefit in patients with more complex coronary lesions. These findings stress the need for cautious interpretation of the trial findings and emphasize the value of long-term follow-up in assessing meaningful differences in clinical outcomes.

PMID:40535222 | PMC:PMC12170967 | DOI:10.1007/s12055-025-01973-0

IUBMB Life. 2025 Jun;77(6):e70035. doi: 10.1002/iub.70035.

ABSTRACT

Peroxisome proliferator-activated receptors (PPARs), particularly PPAR-α and PPAR-γ, are key regulators of cardiac energy metabolism and have been implicated in cardiac remodeling. However, their roles in cardiomyocyte proliferation and hypertrophy remain incompletely understood. In this study, we investigated the effects of PPAR-α and PPAR-γ modulation on neonatal rat cardiomyocytes (NRCMs) using pharmacological agonists (WY-14643 for PPAR-α and pioglitazone for PPAR-γ) and inhibitors (MK-886 for PPAR-α and GW9662 for PPAR-γ), as well as siRNA-mediated knockdown approaches. Cardiomyocyte proliferation and hypertrophy were assessed by immunofluorescence, cell size measurements, and proliferation assays. Our findings demonstrate that PPAR-α activation significantly promotes cardiomyocyte proliferation and reduces hypertrophy, whereas PPAR-α inhibition induces hypertrophic changes and suppresses proliferation. Similarly, PPAR-γ activation enhances both proliferation and hypertrophy of cardiomyocytes, suggesting its involvement in physiological hypertrophy and a potential protective role in pathological remodeling. In contrast, pharmacological activation or genetic inhibition of PPAR-δ showed no significant effects on cardiomyocyte proliferation or hypertrophy, highlighting its distinct role in metabolic homeostasis rather than structural remodeling. PPAR-α and PPAR-γ play distinct but complementary roles in regulating cardiomyocyte proliferation and hypertrophy. These results suggest that targeting PPAR-α and PPAR-γ may represent promising therapeutic strategies for cardiac hypertrophy and heart failure. Further in vivo studies are warranted to clarify their molecular mechanisms and potential clinical applications.

PMID:40536211 | DOI:10.1002/iub.70035

Open Life Sci. 2025 Jun 17;20(1):20221026. doi: 10.1515/biol-2022-1026. eCollection 2025.

ABSTRACT

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Chemokines are a class of proteins that possess characteristics of both chemoattractants and cytokines. They play a pivotal role in CVD by regulating the recruitment of immune cells and suppressing inflammatory responses. These proteins are crucial for maintaining cardiac function and for managing myocardial cell damage under various stress conditions. Autophagy, a vital intracellular degradation mechanism, is essential for clearing misfolded proteins and damaged organelles, thus promoting cell survival during starvation and other stress conditions. A substantial body of research indicates that chemokines can modulate the development of CVD by influencing the autophagy process. Research has shown that targeting pathways such as CXCR4 and CXCL12, defective CXCL16/CXCR6, and inhibiting CX3CL1 can regulate autophagy and impact CVD. The protective role of chemokines in CVD through the modulation of autophagy may offer new perspectives for treatment.

PMID:40535169 | PMC:PMC12176010 | DOI:10.1515/biol-2022-1026

Front Cardiovasc Med. 2025 Jun 4;12:1511415. doi: 10.3389/fcvm.2025.1511415. eCollection 2025.

ABSTRACT

BACKGROUND: Hypertrophic Cardiomyopathy (HCM) is an inherited heart disease and the pathogenesis of HCM involves genetic mutations, hemodynamic stress, and metabolic factors, with myocardial fibrosis playing a crucial role in severe clinical events. IL-33/ST2 signaling pathway known for its roles in immune response and tissue repair, participates in cardiac protection and anti-cardiac fibrosis in heart failure. The role of ST2 in HCM remains unclear, and IL-33/ST2 pathway and broader inflammatory responses may be critical in HCM.

METHODS: We re-analyzed RNA sequencing data from 9 high-throughput sequencing datasets comprising myocardial tissue samples from 109 HCM patients and 210 non-HCM controls. Differential gene expression analysis, correlation analyses, and Gene Set Enrichment Analysis (GSEA) were employed to explore the biological significance of ST2-related genes and the IL-33/ST2 pathway. Immune infiltration was assessed using CIBERSORTx, and protein-protein interaction networks were constructed using the STRING database.

RESULTS: Our analysis identified 2,660 upregulated and 403 downregulated genes for HCM in the combined dataset, with significant downregulation of the ST2 gene (log2 fold change = -5.0, adjusted P-value = 9.2 × 10-¹⁴³). This downregulation was consistently observed across multiple individual studies. Correlation analysis revealed significant positive correlations between ST2 and key inflammatory mediators such as IL6 and CD163. GSEA highlighted the enrichment of pathways related to immune response, inflammation, and cardiac morphogenesis, with notable upregulation of pro-inflammatory pathways. Immune infiltration analysis revealed a significant inverse correlation between ST2 expression and regulatory T cells (r = -0.34) and a positive correlation with neutrophils (r = 0.39). Pathway analysis indicated ST2's key role in networks involving inflammatory and fibrotic responses.

CONCLUSIONS: Our findings suggest that downregulation of ST2 in HCM may be associated with a dysregulated inflammatory gene network, potentially contributing to myocardial fibrosis and remodeling. These results highlight the possible critical role of the IL-33/ST2 pathway in disease progression, offering a potential therapeutic target for managing inflammation and fibrosis in HCM.

PMID:40535153 | PMC:PMC12174446 | DOI:10.3389/fcvm.2025.1511415

J Orthop. 2025 May 29;68:191-196. doi: 10.1016/j.jor.2025.05.063. eCollection 2025 Oct.

ABSTRACT

STUDY DESIGN: Level of Evidence: Therapeutic Level III.

BACKGROUND AND OBJECTIVE: Aspirin is commonly used for VTE prophylaxis in orthopedic procedures due to its safety and cost-effectiveness. However, its association with thromboembolic outcomes in obese and morbidly obese patients undergoing LSS remains unclear, particularly in the absence of BMI-specific prophylaxis guidelines. This study evaluates whether venous thromboembolism (VTE) event rates differ by body mass index (BMI) category in patients undergoing lumbar spine surgery (LSS) treated with aspirin monotherapy.

METHODS: This retrospective cohort study leveraged the TriNetX database to identify adults undergoing LSS who received aspirin monotherapy. Patients were stratified by BMI into non-obese (<30 kg/m2) and obese (≥30 kg/m2) cohorts. After 1:1 propensity score matching, 23,139 patients were included in each group. A secondary analysis compared obese (BMI 30-39.9) and morbidly obese (≥40) subgroups. Outcomes included incidence of DVT and PE at 90 and 180 days, along with secondary complications such as hematoma and myocardial infarction.

RESULTS: Obese patients had higher observed rates of 90-day DVT (RR: 1.23, 95 % CI: 1.02-1.48) and PE (RR: 1.45, 95 % CI: 1.14-1.84) compared to non-obese patients. At 180 days, PE risk remained elevated (RR: 1.27, 95 % CI: 1.03-1.57), while DVT risk was no longer statistically significant. Morbidly obese patients had a higher 180-day PE risk than the obese group (RR: 1.54, 95 % CI: 1.03-2.29). No significant differences were observed in hematoma or myocardial infarction across groups.

CONCLUSION: Among patients undergoing LSS with aspirin monotherapy, PE risk remained elevated in obese and especially morbidly obese patients at 180 days, despite matched baseline characteristics. While differences were statistically significant, absolute risk increases were modest. These findings support the need for prospective studies to evaluate whether weight-adjusted dosing, alternative agents, or adjunctive mechanical prophylaxis may offer improved protection in high-BMI populations.

PMID:40534734 | PMC:PMC12171754 | DOI:10.1016/j.jor.2025.05.063

Front Physiol. 2025 Jun 4;16:1628944. doi: 10.3389/fphys.2025.1628944. eCollection 2025.

ABSTRACT

[This retracts the article DOI: 10.3389/fphys.2019.01445.].

PMID:40534640 | PMC:PMC12175564 | DOI:10.3389/fphys.2025.1628944