Front Immunol. 2025 Sep 5;16:1619771. doi: 10.3389/fimmu.2025.1619771. eCollection 2025.
ABSTRACT
INTRODUCTION: Plasma donor-derived cell-free DNA (dd-cfDNA) is an emerging potential tool for diagnosing lung graft injury. This study explored the relevance of dd-cfDNA levels in different graft injuries thoroughly characterized after a well-established multidisciplinary team approach. The usefulness of bronchoalveolar lavage (BAL) dd-cfDNA in complementing detection of allograft injury was also investigated.
METHODS: Plasma dd-cfDNA was measured by next generation sequence on 127 samples from patients visited consecutively, contemporaneously with a systematic analysis of surveillance transbronchial biopsy by LASHA template, BAL analysis and immunological monitoring.
RESULTS: Patients with immunological injury exhibited the highest plasma dd-cfDNA levels (median 2.67%), with a sensitivity of 100% while patients with non-immunological insults showed a sensitivity of 28%. The combination of BAL with plasma dd-cfDNA improved the sensitivity for detecting non-immunological injury from 28% to 71%. Random forest analysis showed that plasma dd-cfDNA >1% was among the most important variables in predicting death and chronic lung allograft dysfunction.
DISCUSSION: Our data suggests that plasma dd-cfDNA is a useful tool for immunological graft injury assessment. The performance of BAL dd-cf DNA needs to be validated on larger case series. The integration of plasma dd-cfDNA with other post-transplant follow-up investigations may allow more sensitive diagnoses and appropriate graft injury management.
PMID:40977742 | PMC:PMC12447569 | DOI:10.3389/fimmu.2025.1619771
J Pediatr Gastroenterol Nutr. 2025 Sep 22. doi: 10.1002/jpn3.70213. Online ahead of print.
ABSTRACT
OBJECTIVES: Hepatic steatosis impacts the quality of grafts, affecting transplant outcomes. Rising obesity rates and subsequent donor graft steatosis further influence the organ shortage crisis in pediatric liver transplantation (LT). Our study aimed to evaluate how donor steatosis modulates the outcomes of pediatric LT.
METHODS: We analyzed the United Network of Organ Sharing database for transplanted donor grafts from January 01, 2004, to April 30, 2024. We stratified pediatric (≤18 years) LT recipients into steatotic grafts, subdivided into <30% and ≥30%. Graft failure was assessed using Kaplan-Meier curves, and Cox proportional hazards models, with Lasso regression identifying key predictive variables. Gradient-boosting decision tree was used to assess the level of likelihood importance for post-LT survival.
RESULTS: Five hundred and ninety-five pediatric LT recipients were included; 62 (10.4%) received donors with steatosis levels ≥30%. Survival rates for steatotic grafts ≥30% were 93.5% at 1 year, 89.9% at 5 years, and 84.4% at 10 years, compared to 94.7%, 89.5%, and 85.2% respectively, among steatotic grafts <30% (p = 0.72, p = 0.92, and p = 0.92). Donor age (adjusted hazard ratio [aHR]: 1.01, 95% confidence interval [CI]: 1.01-1.03), donation after cardiac death (DCD) (aHR: 10.68, 95% CI: 3.27-34.86), and recipient life support (aHR: 1.95, 95% CI: 1.19-3.20) were associated with an increased risk of mortality.
CONCLUSION: Steatotic grafts in pediatric patients had acceptable outcomes. Predictors of mortality in steatotic grafts, including donor age, DCD, and recipient life support, underscore the complex interplay of multiple factors in post-LT outcomes.
PMID:40977417 | DOI:10.1002/jpn3.70213
J Card Fail. 2025 Sep 19:S1071-9164(25)00437-3. doi: 10.1016/j.cardfail.2025.08.021. Online ahead of print.
ABSTRACT
BACKGROUND: Microvascular inflammation (MVI) following heart transplantation can occur with or without circulating anti-HLA donor-specific antibodies (DSAs). We sought to characterize the relationship between MVI, with or without accompanying DSA, and post-transplant outcomes.
METHODS: We analyzed 8,305 endomyocardial biopsies (EMB) from 832 adult and pediatric HT recipients between July 1, 2013 and October 31, 2023. EMBs were graded by consensus guidelines, with MVI defined as pAMR grade ≥1. Rejection phenotypes were classified as no rejection, isolated cellular rejection (ACR), DSA-negative MVI, and DSA-positive MVI. Cox models with time-varying covariates were constructed to evaluate associations with incident CAV and mortality, adjusting for donor and recipient age.
RESULTS: Among 832 HT recipients, 238 developed CAV and 121 died over a median follow-up of 4 years (IQR 2.3-6.4 years). Compared with individuals who never experienced biopsy-proven rejection, DSA-negative MVI was independently associated with CAV (HR, 1.47; 95% CI 1.00-2.16; P-value = 0.047). DSA-positive MVI was associated with mortality (HR 1.97; 95% CI 1.07-3.64) with DSA-negative MVI demonstrating directional-concordance (HR 1.50, 95% CI 0.87-2.57), independent of CAV (HR 1.71, 95% CI 1.13-2.58). These associations remained consistent when stratified by adult and pediatric subgroups and in a six-month landmark sensitivity analysis.
CONCLUSIONS: MVI, with or without DSA, may be harmful in HT, extending recent renal findings to thoracic transplantation. Understanding the mechanistic basis for these results will be essential for identifying novel targets for therapeutic modulation and prolonging graft survival.
PMID:40976551 | DOI:10.1016/j.cardfail.2025.08.021
Can J Cardiol. 2025 Sep 19:S0828-282X(25)01171-7. doi: 10.1016/j.cjca.2025.09.019. Online ahead of print.
ABSTRACT
Just as sex differences have been well-described across the spectrum of heart failure care, there are important sex-specific considerations for heart transplantation (HT) candidates and recipients. Data persistently show that 25-30% of HT recipients are women, highlighting barriers in referral and waitlist selection. Furthermore, women are more likely to be allo-sensitized which may limit potential donors and increase their risk for antibody-mediated rejection in the post-transplant period. Data suggest differential risk by sex for long-term complications including rejection, cardiac allograft vasculopathy (CAV), post-transplant malignancy, and renal disease post-HT. Additionally, reproductive health for female transplant recipients including contraception, pregnancy, and breastfeeding requires complex multidisciplinary planning and considerations. The purpose of the current review is to summarize existing evidence and sex-specific considerations in post-HT management and clinical outcomes, highlight ongoing gaps in the literature and propose strategies for improving equity in access and post-HT outcomes.
PMID:40976383 | DOI:10.1016/j.cjca.2025.09.019
Transplant Proc. 2025 Sep 20:S0041-1345(25)00427-0. doi: 10.1016/j.transproceed.2025.08.025. Online ahead of print.
ABSTRACT
BACKGROUND: Recently, marginal donor hearts have been applied to patients with end-stage heart failure due to rising waiting list mortality and increasing demand for donors. However, the principles of risk prevention and the usage of marginal donor hearts have yet to be clearly defined.
METHODS: A retrospective analysis was performed to investigate the outcomes of patients undergoing heart transplantation at our center between October 2019 and March 2024. Forty-four patients were enrolled and divided into the marginal donor heart group (n = 30) and the conventional donor heart group (n = 14) according to the classification criteria. The clinical data between the 2 groups were compared and analyzed.
RESULTS: There were no statistically significant differences in the postoperative length of hospitalization, ICU stay, left ventricular ejection fraction, or serum biochemical indicators between the 2 groups. Five patients died during the 3-month follow-up period. Notably, 1- and 3- month postoperative follow-up showed no significant differences in left ventricular ejection fraction, serum biochemical indicators, and mortality between the 2 groups CONCLUSION: The application of marginal donor hearts can partially alleviate the shortage of donor heart resources. It did not significantly affect patients' short-term survival or recovery.
PMID:40975674 | DOI:10.1016/j.transproceed.2025.08.025
Urol Oncol. 2025 Sep 19:S1078-1439(25)00254-6. doi: 10.1016/j.urolonc.2025.07.005. Online ahead of print.
ABSTRACT
INTRODUCTION: Transurethral resection of the bladder tumor (TURBT) followed by intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is a standard treatment for high-risk non muscle-invasive bladder cancer (NMIBC). However, due to potential risk of dissemination, current guidelines recommend caution when proposing BCG treatment in immunocompromised patients. Our aim was to assess the efficacy and safety of BCG treatment in immunocompromised patients.
MATERIALS AND METHODS: Patients aged ≥18 with a diagnosis of bladder cancer (BC) who underwent BCG therapy in 2007-2021, were identified in the MerativeTM Marketscan® Research Commercial and Medicare databases. Multivariable Cox proportion hazard regressions adjusted by relevant confounders were performed to investigate the influence of immunosuppression on the events associated with progression and recurrence of BC, both in the unmatched cohort and after 1:2 propensity score matching (PSM). Also, subgroup analysis on progression in patients without cancer other than BC was conducted.
RESULTS: Immunocompromised and immunocompetent patients had similar rates of disseminated BCG infection after intravesical immunotherapy. However, immunocompromised patients had shorter progression-free survival and higher probability of progression (aHR: 1.23, 95% CI: 1.11-1.38), as well as shorter recurrence-free survival and a higher probability of recurrence (aHR: 1.13, 95% CI: 1.05-1.20). Similar significant associations were observed in the PSM cohort. A subgroup analysis of patients without any additional oncological diagnoses beyond BC confirmed a higher likelihood of progression in the immunocompromised group (aHR: 1.34, 95% CI: 1.15-1.56).
CONCLUSIONS: BCG immunotherapy is safe in immunocompromised patients. Nevertheless, the efficacy of intravesical BCG in these patients might be suboptimal thus advocating the need for appropriate counselling and a possible lower threshold to consider radical treatment.
PMID:40975643 | DOI:10.1016/j.urolonc.2025.07.005
Bone. 2025 Sep 18;201:117653. doi: 10.1016/j.bone.2025.117653. Online ahead of print.
ABSTRACT
Chronic kidney disease-mineral and bone disorder (CKD-MBD) significantly contributes to cardiovascular morbidity and mortality in CKD patients, raising questions about the molecular mechanisms linking cardiac and bone abnormalities. In this study, adult male spontaneously hypertensive rats (SHRs) underwent 3/4 nephrectomy (Nx) to induce mild CKD-MBD, with sham-operated SHRs (SO) serving as controls. All animals were fed a standard diet containing 0.6 % phosphorus. Exhibiting renal dysfunction comparable to human CKD stage 2, Nx rats had higher levels of serum inorganic phosphate (Pi), calciprotein particles (CPPs), and myocardial phosphorus (P) without differences in serum PTH, FGF23, kidney and bone P content. Compared to controls, the experimental group showed features of lower bone turnover with reduced osteoblast and osteocyte numbers and decreased eroded perimeter, alongside myocardial hypertrophy and fibrosis. In bone and myocardium, reciprocal alterations of a tissue expression of Pi-transporters and MAPK-signals were found. Reduced bone turnover associated with a lower tissue expression of Slc20a1 (PiT1) and osteogenic Mapk1 (ERK2). In myocardium, Slc20a2 (PiT2) and phospho-ERK1/2 expression were upregulated at gene and protein levels in Nx rats versus controls. These findings suggest that, in the setting of CKD-associated Pi retention, maladaptive bone and myocardial responses are mediated by the dysregulation of Pi transporters and down-stream ERK1/2 signals.
PMID:40975510 | DOI:10.1016/j.bone.2025.117653
Front Pharmacol. 2025 Jun 18;16:1600604. doi: 10.3389/fphar.2025.1600604. eCollection 2025.
ABSTRACT
Cardiac tissue injury and repair have always been a research hotspot in the field of cardiovascular disease. Limited and lost myocardial cells are non-renewable, and the current clinical treatment effect is still poor. The stem cells-based treatment strategy for cardiomyopathy is expected to solve the current treatment pain points. A variety of stem cells have the potential to differentiate into cardiomyocytes and form cardiac tissue, and the strong paracrine activity of stem cells also plays an important role in the regulation of inflammation, oxidative stress and cardiomyocyte apoptosis in cardiac tissue. Limited by the survival rate and stem cells activity after stem cells transplantation, the effect of stem cells therapy on cardiomyopathy is still not ideal. Pretreatment of stem cells or genetic modification to enhance the adaptability of stem cells to the environment, or the use of new biomaterials to assist stem cells transplantation is an effective optimization scheme and significantly enhances the therapeutic effect of stem cells therapy for cardiomyopathy. In this review, the types of stem cells widely studied in the treatment of cardiomyopathy, the role of stem cells in the treatment of cardiomyopathy, and how to efficiently use stem cells to treat cardiomyopathy are described in detail, which provides a theoretical basis for promoting the preclinical research and clinical transformation of stem cell therapy for cardiomyopathy.
PMID:40606613 | PMC:PMC12213730 | DOI:10.3389/fphar.2025.1600604
BME Front. 2025 Jul 2;6:0151. doi: 10.34133/bmef.0151. eCollection 2025.
ABSTRACT
Objective and Impact Statement: We present a panel of virtual staining neural networks for lung and heart transplant biopsies, providing rapid and high-quality histological staining results while bypassing the traditional histochemical staining process. Introduction: Allograft rejection is a common complication of organ transplantation, which can lead to life-threatening outcomes if not promptly managed. Histological examination is the gold standard method for evaluating organ transplant rejection status, as it provides detailed insights into rejection signatures at the cellular level. Nevertheless, the traditional histochemical staining process is time-consuming, costly, and labor-intensive since transplant biopsy evaluations typically necessitate multiple stains. Furthermore, once these tissue slides are stained, they cannot be reused for other ancillary tests. More importantly, suboptimal handling of very small tissue fragments from transplant biopsies may impede their effective histochemical staining, and color variations across different laboratories or batches can hinder efficient histological analysis by pathologists. Methods: To mitigate these challenges, we developed a panel of virtual staining neural networks for lung and heart transplant biopsies, which digitally convert autofluorescence microscopic images of label-free tissue sections into their bright-field histologically stained counterparts-bypassing the traditional histochemical staining process. Specifically, we virtually generated hematoxylin and eosin (H&E), Masson's Trichrome (MT), and elastic Verhoeff-Van Gieson stains for label-free transplant lung tissue, along with H&E and MT stains for label-free transplant heart tissue. Results: Blind evaluations conducted by 3 board-certified pathologists confirmed that the virtual staining networks consistently produce high-quality histology images with high color uniformity, closely resembling their well-stained histochemical counterparts across various tissue features. The use of virtually stained images for the evaluation of transplant biopsies achieved comparable diagnostic outcomes to those obtained via traditional histochemical staining, with a concordance rate of 82.4% for lung samples and 91.7% for heart samples. Moreover, virtual staining models create multiple stains from the same autofluorescence input, eliminating structural mismatches observed between adjacent sections stained in the traditional workflow, while also saving tissue, expert time, and staining costs. Conclusion: The presented virtual staining panels provide an effective alternative to conventional histochemical staining for transplant biopsy evaluation. These virtual staining panels have the potential to enhance the clinical diagnostic workflow for organ transplant rejection and improve the performance of downstream automated models for the analysis of transplant biopsies.
PMID:40606521 | PMC:PMC12217214 | DOI:10.34133/bmef.0151
JHLT Open. 2025 May 27;9:100301. doi: 10.1016/j.jhlto.2025.100301. eCollection 2025 Aug.
ABSTRACT
Post-operative care for children and adolescents who undergo lung transplantation is a challenge because of the potential for numerous complications during this period, which can considerably impact the short- and long-term outcomes. The immediate post-operative phase is particularly critical, and complications are frequent; therefore, knowledge, early recognition, and appropriate treatment of these complications are imperative and can only be achieved through close collaboration between a wide range of medical specialties. The aim of this review is to provide an abbreviated overview of the optimal post-operative management of children in an intensive care unit, as well as to describe frequently occurring complications and their treatment.
PMID:40606299 | PMC:PMC12219461 | DOI:10.1016/j.jhlto.2025.100301
JHLT Open. 2025 Jun 3;9:100278. doi: 10.1016/j.jhlto.2025.100278. eCollection 2025 Aug.
ABSTRACT
INTRODUCTION: Ventricular septal rupture (VSR) is a devastating complication of myocardial infarction (MI), with high mortality, particularly in cardiogenic shock (CS). Heart transplantation (HT) has emerged as a potential alternative to surgery or transcatheter closure (TCC). This study evaluates contemporary trends and outcomes of HT in post-MI VSR using the National Inpatient Sample (NIS) database.
OBJECTIVES: To assess in-hospital mortality and resource utilization of HT compared to surgical repair or TCC for post-MI VSR with CS.
METHODS: We analyzed NIS data (2016-2021) for MI-VSR hospitalizations with CS. Patients undergoing HT were compared to those receiving surgical repair or TCC. Primary and secondary endpoints included in-hospital mortality (IHM), total hospital charges (TOTCHG), and length of stay (LOS). Multivariable logistic regression adjusted for age, sex, race, comorbidities, and hospital characteristics, with surgical repair as the control.
RESULTS: Of 2,514,025 acute MI hospitalizations, 4765 (0.20%) had VSR. IHM was 82% with CS vs. 60% without. Among VSR-CS patients, 30 (1.2%) underwent HT, 600 (24.1%) surgical repair, 225 (9.2%) TCC, and 1635 (65%) medical therapy. IHM was 0% for HT vs. 66% (surgery), 75% (TCC), and 97% (medical therapy). All HT patients received mechanical circulatory support [IABP (50%), Impella (27%), ECMO ± Impella (10%), ECMO (13%)].). Patients undergoing HT had an average LOS approximately 20 days longer than those treated surgically (p = 0.004; 95% CI: 13.78-47.29) and 15 days longer with TCC (p = 0.008; 95% CI: 19.32-54.23). Similarly, mean total hospital charges (TOTCHG) were higher for HT patients ($1,456,693) compared to surgical repair ($325,032; p = 0.001; 95% CI: $145,002-$634,293) and TCC ($210,032; p = 0.001; 95% CI: $119,230-$542,200).
CONCLUSIONS: From 2016 to 2021, among VSR-CS admissions in the United States, patients who underwent HT had no in-hospital mortality, in contrast to the high in-hospital-mortality observed with surgical or transcatheter closure. Despite inherent selection biases, including survival to transplantation, HT was associated with favorable outcomes compared to surgical repair. While promising, these findings are preliminary due to the small sample size and selective nature of the patient cohort. Further studies are required before HT can be broadly recommended as a primary treatment option.
PMID:40606297 | PMC:PMC12219360 | DOI:10.1016/j.jhlto.2025.100278
JHLT Open. 2025 May 30;9:100306. doi: 10.1016/j.jhlto.2025.100306. eCollection 2025 Aug.
ABSTRACT
This study evaluates global practices for managing explanted hearts, with a focus on tissue collection and biobanking protocols. A survey conducted through the International Society for Heart and Lung Transplantation (ISHLT) assessed responses from centers across Europe, North America, and Other Countries. Results demonstrated significant variability in tissue sampling, grossing protocols, and storage practices. While 78.8% of centers had grossing protocols, fewer (73.1%) adapted sampling based on pathology. Fresh tissue collection was prevalent in 63.5% of centers, but volumes varied: North America led with higher sampling rates (10-25 samples per heart), while Europe and Other Countries collected fewer samples. Coronary artery sampling also showed regional differences. Fresh tissues enable advanced molecular studies, while fixed tissues remain fundamental for histopathology. Standardized global protocols for sampling, storage, and reporting could enhance the clinical and research value of explanted hearts, optimizing post-transplant care and driving innovation in cardiac medicine.
PMID:40606294 | PMC:PMC12219514 | DOI:10.1016/j.jhlto.2025.100306
JHLT Open. 2025 Jun 2;9:100312. doi: 10.1016/j.jhlto.2025.100312. eCollection 2025 Aug.
ABSTRACT
BACKGROUND: In 2018, changes in the United Network for Organ Sharing (UNOS) allocation system led to a shift in practices, making durable left ventricular assist devices less desirable as a bridge to transplantation compared to temporary mechanical circulatory support. This study compares the composite outcome of waitlist mortality and delisting incidence at 1 year between these two support types.
METHODS: All actively listed adult patients on mechanical circulatory support listed for heart transplantation under the current UNOS system from October 2018 to October 2021 were included, excluding those with right ventricular devices, biventricular devices, total artificial hearts, and extracorporeal membrane oxygenators. The primary outcome was the composite of waitlist mortality and delisting due to clinical deterioration at 1 year. Survival analysis was conducted using Kaplan-Meier curves and multivariable Cox regression.
RESULTS: A total of 4,569 patients were included, with 1,877 on temporary mechanical circulatory support and 2,692 on left ventricular assist devices. Propensity-score matching was performed on 660 patients divided into two groups. The event rate was lower in the left ventricular assist device group compared to the temporary mechanical circulatory support group (15.9% vs 35.2%, p < 0.001). Temporary mechanical circulatory support had a significantly higher multivariable hazard ratio (HR) for outcome events (HR 3.37, p < 0.001). The HeartMate 3 (HM3) had the best outcomes compared to all other device types.
CONCLUSION: In this propensity-score-matched analysis, durable mechanical circulatory support had better outcomes than temporary mechanical circulatory support. HM3 had the lowest risk of composite outcomes.
PMID:40606293 | PMC:PMC12221459 | DOI:10.1016/j.jhlto.2025.100312
JHLT Open. 2025 May 31;9:100308. doi: 10.1016/j.jhlto.2025.100308. eCollection 2025 Aug.
ABSTRACT
BACKGROUND: In healthy hearts, left ventricular atrioventricular plane displacement (LVAVPD) measured by cardiac magnetic resonance (CMR) contributes to ∼60% of stroke volume. LVAVPD has been shown to correlate with maximal cardiac output and exercise capacity and is an independent predictor of outcomes in patients with heart failure. We aimed to assess if longitudinal pumping is altered, if LVAVPD is associated with exercise capacity, and if any difference in longitudinal pumping could be explained by the presence of a right bundle branch block (RBBB) in heart-transplanted patients.
METHOD: This single-center study included 34 heart-transplanted patients who had undergone CMR and a cardiopulmonary exercise test as part of a clinical post-transplant surveillance program. Data was compared to 34 healthy sex- and age-matched controls.
RESULTS: Heart-transplanted patients had decreased LVAVPD (10.3 vs 13.7 mm, p < 0.01), lower longitudinal contribution (46% vs 53%, p < 0.01), and lower septal contribution (-3% vs 8%, p < 0.01) to stroke volume compared to controls. Furthermore, the lateral contribution was increased (44% vs 28%, p < 0.01) in the heart-transplanted patients. Longitudinal contribution to stroke volume was neither associated with exercise capacity (p = 0.20) nor cardiac output at rest (p = 0.62). There was no difference in LVAVPD in patients with and without RBBB (p = 0.81).
CONCLUSION: Heart-transplanted patients have decreased left ventricular longitudinal function compared to healthy controls, in part compensated by an augmented lateral function. Longitudinal function is not associated with cardiac output at rest or exercise capacity in this patient group. Whether the altered pumping mechanics seen are associated with outcome remains to be investigated.
PMID:40606292 | PMC:PMC12221465 | DOI:10.1016/j.jhlto.2025.100308
Eur Heart J Case Rep. 2025 Jun 5;9(7):ytaf279. doi: 10.1093/ehjcr/ytaf279. eCollection 2025 Jul.
ABSTRACT
BACKGROUND: Primary cardiac lymphoma (PCL) involves the heart almost exclusively although it can extend to surrounding structures including the pericardium. Most PCLs in adults are of B-cell origin and their signs and symptoms are generally non-specific and depend on their location and size. In general, cancer patients usually have a slim chance of receiving heart transplantation (OHT), although it's not an absolute contraindication depending on the decision of the multidisciplinary team and the experience of each institution.
CASE SUMMARY: A 48-year-old man, with an ultimate diagnosis of primary cardiac follicular B-cell lymphoma presented to our hospital mimicking hypertrophic cardiomyopathy. He initially presented with worsening heart failure and ventricular tachycardia storm (VT-S) that required urgent cardiac OHT. The final pathological analysis of the explanted heart revealed the presence of a PCL without extra-cardiac extension. In addition to initial immunosuppression with mycophenolate mophethyl, corticosteroids, and tacrolimus, he was switched to Everolimus and dose reduction of Tacrolimus. Rituximab + Bendamustine was initiated to reduce the risk of cardiotoxicity and myelotoxicity associated to R-CHOP. The follow-up body PET-CT, trans-thoracic echocardiogram, cardiac magnetic resonance imagings and biopsies were normal. During a regular follow-up heart biopsy procedure to ascertain rejection, the patient developed torrential tricuspid regurgitation and required surgical valve replacement.
DISCUSSION: After 5.5 years of follow-up, the patient remains asymptomatic, with normal graft function, in NYHA FC I, and without oncological relapses despite receiving a modified chemotherapy regimen. Selected patients with a PCL can be managed with OHT and a modified chemotherapy regimen. They could also be followed up using a non-invasive approach to monitor rejection.
PMID:40606016 | PMC:PMC12210231 | DOI:10.1093/ehjcr/ytaf279
Adv Sci (Weinh). 2025 Jul 3:e07627. doi: 10.1002/advs.202507627. Online ahead of print.
ABSTRACT
Cardiac fibroblasts (CFs) secrete exosomes, and their cargo represents a new means of cellular communication in cardiovascular diseases, including atrial fibrillation (AF). We aimed to explore the contribution of atial CFs (ACFs)-derived exosomes to AF development. Cultured primary human ACFs (hACFs) and rat ACFs are treated with angiotensin II, and the secreted exosomes are transferred to rats. Action potential duration and L-type calcium current (ICa) are tested. Global microRNA-224-5p knock-in and fibroblast-specific microRNA-224-5p knock-in (FMKI) mice underwent an inducible AF test. Transferred exosomes of Ang II-induced hACFs and primary adult rat ACFs increased AF incidence and prolonged AF duration. The inhibitor of exosomes and knockdown of Dicer rescued the AF phenotype. MicroRNA array suggested upregulated microRNA-224-5p level in both primary adult rat ACFs and ACFs-secreted exosomes. microRNA-224-5p agonist shortened atrial effective refractory period (AERP) and promoted AF. Mechanistically, microRNA-224-5p bound to CACNA1C and inhibited its transcription. Moreover, global microRNA-224-5p knock-in and FMKI mice exhibited increased inducible AF incidence, accompanied by diminished ICa current in ACMs. Exosome microRNA-224-5p is enhanced in ACFs isolated from atria and plasma of AF patients, and positively correlated with recurrence after radiofrequency ablation. In summary, ACFs-derived exosome microRNA-224-5p contributes to AF by inhibiting CACNA1C to drive atrial electrical remodeling.
PMID:40605550 | DOI:10.1002/advs.202507627
Eur J Med Res. 2025 Jul 2;30(1):552. doi: 10.1186/s40001-025-02776-0.
ABSTRACT
Pulmonary arterial hypertension (PAH) is currently an irreversible disease, with many patients eventually progressing to right heart failure, severely affecting their quality of life and posing a life-threatening risk. Percutaneous atrial septostomy was first performed in infants with transposition of the great arteries in 1966. Since then, it has been used as a palliative treatment for patients with end-stage PAH, significantly improving their quality of life and providing a buffer period while waiting for lung transplantation. However, this method does not fundamentally alter the malignant outcomes of patients with PAH. This study reviews the development and evolution of atrial septostomy, summarises various emerging technologies, and systematically explains the mechanisms, efficacy, and prognosis of palliative treatment in patients with PAH. Furthermore, new ideas for this treatment approach are proposed with the hope that it will bring more benefits to patients with PAH in the future and be more fully utilised.
PMID:40604947 | DOI:10.1186/s40001-025-02776-0
BMC Complement Med Ther. 2025 Jul 2;25(1):216. doi: 10.1186/s12906-025-04945-4.
ABSTRACT
BACKGROUND: The patterns of Chinese medicine prescriptions, corresponding diagnoses, co-morbidities, and Western medication (WM) use among patients with cardiac or vascular-related diseases are uncertain. This research aimed to examine the patterns of Chinese medications (CMs, specifically in terms of extract granules), corresponding diagnoses, co-morbidities, and the use of WMs within specified follow-up periods among patients with potential of recurrent cardiac or vascular-related diseases and relevant outcomes.
METHODS: We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database. We enrolled patients with newly diagnosed cardiac or vascular-related diseases without cancer(s), transplantation, bleeding diagnoses, or catastrophic illness during the 2-year period prior to the corresponding diagnosis. Prior and non-prior CM users were matched based on their propensity scores. Finally, we compared the CM and WM patterns prescribed by physicians, and co-morbidities in the 6 months following the diagnosis and the secondary cardiac or vascular-related events in the 2 years following the diagnosis between the two groups using the standardized mean difference.
RESULTS: Of 191,025 patients with newly diagnosed cardiac or vascular-related diseases, 39,341 (20.60%) were prescribed CMs. Moreover, after propensity score matching, we identified 39,168 prior CM users and 39,168 non-prior CM users. Regardless of prior CM use, both groups had a relatively high rate of comorbidities; CM or specific WM use; and incidence of severe cardiovascular, cerebrovascular, or thromboembolic events (33.81% vs. 31.97%) and severe bleeding (18.32% vs. 16.57%). Only CM exposure within 6 months after the index date differed significantly between the groups (73.51% vs. 30.34%).
CONCLUSION: We found that over 30% of patients with newly diagnosed cardiac or vascular disease initiated CM use, while 73.5% of prior CM users continued. This finding highlights the need for healthcare professionals to carefully assess the risk-to-benefit ratio of CM use alongside WMs for patients with cardiac or vascular-related diseases.
PMID:40604744 | DOI:10.1186/s12906-025-04945-4
BMC Pediatr. 2025 Jul 2;25(1):508. doi: 10.1186/s12887-025-05866-4.
ABSTRACT
Restrictive cardiomyopathy (RCM) is a rare cardiac disease characterized by the predominance of severe diastolic dysfunction, normal or mildly increased ventricular wall thickness, and either normal or mildly reduced ejection fraction. All known RCM genes are localized on autosomes. In most cases, the mutations are inherited in an autosomal dominant mode or appear as de novo mutations. The present report describes a case with early-onset RCM and life-threatening arrhythmia, which was inherited in an autosomal recessive manner. The child developed ventricular arrhythmia at one month of age, and a mixed phenotype dominated by restrictive cardiomyopathy with coexistent hypertrophic cardiomyopathy (RCM - HCM) at one year of age. and required hospitalization for anti - heart failure treatment due to heart failure at three years of age. The patient suffered from ventricular fibrillation and cardiac arrest at four years of age, which was rescued by extracorporeal membrane oxygenation and subsequent heart transplantation. Whole genome sequencing of the proband revealed a novel homozygous missense variant (NM_001927.3: c.1243 C > T [p.R415W]) in the Desmin (DES) gene, which was inherited from heterozygous unaffected parents. This case further expands our knowledge of desmin-related cardiomyopathy in children.
PMID:40604581 | DOI:10.1186/s12887-025-05866-4
Ann Thorac Cardiovasc Surg. 2025;31(1). doi: 10.5761/atcs.oa.25-00075.
ABSTRACT
PURPOSE: Pericardial effusion (PE), tamponade, and atrial fibrillation are challenging complications after cardiac surgeries. This prospective randomized study was conducted to evaluate the impact of posterior pericardiotomy (PP) in the prevention of PE and cardiac tamponed after adult cardiac surgery.
METHODS: This single-center, prospective, randomized controlled trial included 330 patients undergoing open-heart surgery. They were randomly assigned to either a PP group or a control group.
RESULTS: Of 703 screened patients, 330 were enrolled from January 2022 to June 2024 (mean age: 50.2 ± 14.7 years, 64.2% males). Compared to controls, the PP group had significantly lower early and late PE (19.4% vs. 44.8%, and 4.2% vs. 17%, respectively), tamponade (2.4% vs. 11.5%), and postoperative atrial fibrillation (10.3% vs. 19.4%). PP also significantly reduced the need for surgical re-exploration, duration of mechanical ventilation, and both intensive care unit and overall hospital stays (all P <0.05). Adjusted multivariate analysis confirmed the benefits of PP after correcting for baseline imbalances in left ventricular ejection fraction and operative time. No adverse events directly attributable to PP were noted.
CONCLUSIONS: PP is a simple, safe, and effective technique for reducing postoperative PE, and cardiac tamponade after cardiac surgery.
PMID:40603058 | DOI:10.5761/atcs.oa.25-00075