http:www.cardiocirugia.sld.cu

Cardiol Plus. 2025 Jul-Sep;10(3):217-234. doi: 10.1097/CP9.0000000000000131. Epub 2025 Sep 29.

ABSTRACT

Coronary flow improvement and myocardial ischemia relief are the primary goals of coronary revascularization. The pioneering work of Andreas Gruntzig, who demonstrated the reduction of trans-stenotic pressure gradients following percutaneous coronary intervention (PCI), marked a major milestone in the field. Since then, a variety of invasive and non-invasive techniques for assessing coronary physiology have been developed. These methods play a pivotal role in evaluating the hemodynamic significance of coronary lesions, guiding PCI planning, optimizing post-PCI outcomes, and assessing coronary microcirculation and disease patterns. This review explores the available tools for coronary physiology assessment in the catheterization laboratory and their applications in the decision-making process for coronary revascularization. In addition, it highlights recent technological advances, such as invasive and coronary image-based computational methods. These innovations enable individualized PCI treatment, aiming for complete ischemia relief through optimized morpho-functional procedural outcomes.

PMID:41040670 | PMC:PMC12487665 | DOI:10.1097/CP9.0000000000000131

J Dent Sci. 2025 Oct;20(4):2066-2075. doi: 10.1016/j.jds.2025.05.014. Epub 2025 May 29.

ABSTRACT

Currently, the concept of regeneration and regenerative therapies are already being applied clinically to treat pulpal and periodontal diseases, as well as to repair and regenerate systemic organs and tissues. During wound healing, well-developed, functional vascular networks and revascularization are fundamental factors in restoring regenerative potential. Growth factors, stem cells, and scaffolds alone or in combination are reported to contribute to successful tissue repair and engineering via cell transplantation, cell homing or other technologies. Among the growth factors, basic fibroblast growth factor (bFGF) has been found to regulate the proliferation, stemness, migration, and differentiation of vascular and mineralized tissues into various cell types through the differential activation of FGF receptors (FGFRs) and downstream signaling pathways. In addition to growth factors, various dental stem cells are widely used for the regeneration of diseased or lost dental pulp and periodontal tissues, yielding promising results. Stem cells from the apical papilla (SCAPs) and dental pulp stem cells (DPSCs), with or without bFGF, have been shown to be crucial for angiogenesis/revascularization, neuronal growth, and the repair/regeneration of the pulpo-dentin complex, apexogenesis, and may potentially be used in the future to treat various systemic diseases such as myocardial infarction, diabetes, retinopathy, and others. Further studies are needed to optimize the use of bFGF and dental stem cells such as SCAPs and DPSCs by using cell transplantation, cell homing or other technologies for tissue and organ regeneration in experimental animal models and, eventually, in clinical patients in the future.

PMID:41040621 | PMC:PMC12485421 | DOI:10.1016/j.jds.2025.05.014

J Soc Cardiovasc Angiogr Interv. 2025 Jul 29;4(9):103724. doi: 10.1016/j.jscai.2025.103724. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Bioresorbable scaffolds have been associated with inferior outcomes compared to contemporary permanent metallic drug-eluting stents (DES) for percutaneous coronary intervention, particularly within the initial years after implantation; however, their long-term performance remains uncertain. This study aimed to evaluate the long-term outcomes of Swedish patients treated with Absorb bioresorbable scaffolds (Abbott) vs contemporary DES, assessing device-related complications and examining potential late benefits. The findings seek to clarify the balance between early risks and long-term advantages of bioresorbable scaffolds in clinical practice.

METHODS: Complete data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to identify all patients receiving Absorb bioresorbable scaffolds or contemporary DES from November 4, 2011 to March 2, 2018. After 1:2 propensity score matching against modern DES, stent thrombosis, target lesion revascularization, in-stent restenosis, myocardial infarction, and all-cause mortality were analyzed. Landmark analyses were performed from 3 years onward. All patients were followed until January 17, 2022.

RESULTS: Among 1960/2406 propensity score matched patients/stents (583/802 Absorb bioresorbable scaffolds and 1377/1604 contemporary DES), bioresorbable scaffolds were associated with significantly higher early stent thrombosis, target lesion revascularization, and in-stent restenosis rates. All-cause mortality and myocardial infarction rates did not differ significantly over the entire follow-up. Beyond 3 years, the device-related outcomes converged, while myocardial infarction rates were lower with Absorb bioresorbable scaffolds than contemporary DES.

CONCLUSIONS: Absorb bioresorbable scaffolds showed inferior early clinical performance compared with contemporary DES, but after 3 years, device-related outcomes were similar, while myocardial infarction rates favored Absorb bioresorbable scaffolds. These findings suggest a complex trade-off between early device-related events and potential long-term benefits of bioresorbable scaffold-mediated vascular restoration.

PMID:41040460 | PMC:PMC12485528 | DOI:10.1016/j.jscai.2025.103724

J Soc Cardiovasc Angiogr Interv. 2025 Aug 19;4(9):103823. doi: 10.1016/j.jscai.2025.103823. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Physiologically guided revascularization improves clinical outcomes. The cutoff values for deferral with fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are the same across all coronary arteries, despite differences in coronary flow patterns. The objective was to compare deferral rates using either FFR or iFR in the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCx), and compare clinical outcomes in deferred lesions in the RCA, LAD, and LCx.

METHODS: Right coronary artery, LAD, and LCx lesions in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry that were evaluated using either FFR or iFR were included. The composite of major adverse cardiac events (MACE) within 5 years and the individual components of cardiovascular death, noncardiovascular death, myocardial infarction, target segment revascularization, and target vessel revascularization were analyzed.

RESULTS: In total, 33,241 lesions were included in the final analysis (RCA, 17.8%; LAD, 62.3%; and LCx, 19.9%). The median follow-up time was 3.4 years. The median age was 69 years, and 73.5% of patients were men. The deferral rates with iFR were 10.6% higher (P < .001) in all coronary arteries combined, 18.7% higher (P < .001) in the RCA, 9.5% higher in the LAD (P < .001), and 5.3% higher in the LCx (P = .007). No significant differences were observed in the MACE rate or its individual components at 5 years between the deferred FFR and iFR groups in any of the investigated vessels.

CONCLUSIONS: Instantaneous wave-free ratio demonstrated a higher deferral rate across all coronary arteries than those examined with FFR, which was especially pronounced in the RCA, without any associated increased risk of MACE.

PMID:41040437 | PMC:PMC12485520 | DOI:10.1016/j.jscai.2025.103823

Innovations (Phila). 2025 Oct 3:15569845251377059. doi: 10.1177/15569845251377059. Online ahead of print.

ABSTRACT

OBJECTIVE: The clinical outcomes of bilateral internal mammary arteries (BIMA) in situ were compared with Y-grafts in endoscopic coronary artery bypass grafting (endo-CABG), a less-invasive alternative to conventional CABG, providing reduced trauma and faster recovery.

METHODS: A retrospective single-center study was performed from January 2016 until February 2023 on endo-CABG patients, dividing them into in situ BIMA graft or Y-graft recipients. As endo-CABG was performed in all patients requiring surgical revascularization, this represents an unselected cohort. The primary outcome comprised freedom from major adverse cardiac and cerebrovascular events (MACCE). The secondary outcomes were target lesion revascularization (TLR) and 1-year overall survival.

RESULTS: A total of 1,328 endo-CABG patients (BIMA in situ, n = 693; Y-graft, n = 634) were included. Overall, characteristics of both groups were comparable, except that Y-graft patients had more comorbidities (diabetes mellitus and myocardial infarction), which was reflected in the EuroSCORE II. Furthermore, most Y-graft patients had triple-vessel disease and a higher number of bypasses required. The 1-year MACCE-free survival did not differ significantly between the groups (91.9% vs 89%; univariable hazard ratio [HR] = 1.42, 95% CI: 0.96 to 2.11, P = 0.079; multivariable HR = 1.07, 95% CI: 0.70 to 1.63, P = 0.771), as did the 1-year survival rate (95.7% vs 93.2%; univariable HR = 1.67, 95% CI: 1.01 to 2.75, P = 0.046; multivariable HR =1.34, 95% CI: 0.77 to 2.33, P = 0.297). TLR did not differ significantly between groups (univariable HR = 0.68, 95% CI: 0.22 to 2.08, P = 0.499) or after adjustment (multivariable HR = 0.31, 95% CI: 0.08 to 1.24, P = 0.100).

CONCLUSIONS: Creating a Y-graft for distal lesions and in cases in which more than 2 anastomoses are required serves as a favorable alternative without a difference between in situ and Y-grafts in 1-year MACCE-free survival.

PMID:41039981 | DOI:10.1177/15569845251377059

Circ Cardiovasc Interv. 2025 Oct 3:e015902. doi: 10.1161/CIRCINTERVENTIONS.125.015902. Online ahead of print.

ABSTRACT

BACKGROUND: The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) showed the superiority of complete revascularization in older patients with myocardial infarction (MI) and multivessel disease. Whether this result applies equally to patients at higher risk of ischemic events due to nonculprit lesion complexity is unclear.

METHODS: Overall, 1445 patients were randomized to culprit-only or complete revascularization. In this prespecified analysis, patients were divided into those with or without at least 1 complex nonculprit lesion. A nonculprit lesion was defined as complex if it met any of the following criteria: angiographic heavy calcification, ostial lesion, true bifurcation lesion involving side-branches >2.5 mm, in-stent restenosis, or long-lesions (estimated stent length >28 mm). The primary outcome comprised a composite of death, MI, stroke, or revascularization at 3 years. The key secondary outcome was a composite of cardiovascular death or MI. The safety outcome included a composite of contrast-associated acute kidney injury, stroke, and Bleeding Academic Research Consortium 3 to 5.

RESULTS: Overall, 641 patients (44%, complex subgroup) had at least 1 complex nonculprit lesion, whereas 804 patients (56%, noncomplex subgroup) did not. After adjustment for potential confounders, patients in the complex subgroup were at higher risk of 3-year cardiovascular death or MI (hazard risk [HR], 1.32 [95% CI, 1.01-1.74]), MI (HR, 2.33 [95% CI, 1.44-3.78]) and ischemia-driven coronary revascularization (HR, 2.28 [95% CI, 1.46-3.56]). Complete revascularization reduced the primary outcome in both the complex (HR, 0.75 [95% CI, 0.56-0.99]) and noncomplex (HR, 0.71 [95% CI, 0.53-0.95]) subgroups, with no significant interaction (P for interaction=0.625). Similarly, no evidence of heterogeneity related to nonculprit lesion complexity was observed for either key secondary or safety end points.

CONCLUSIONS: In older patients with MI and multivessel disease, physiology-guided complete revascularization reduced ischemic events, regardless of the complexity of nonculprit lesions.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03772743.

PMID:41039960 | DOI:10.1161/CIRCINTERVENTIONS.125.015902

Eur Cardiol. 2025 Sep 15;20:e24. doi: 10.15420/ecr.2025.28. eCollection 2025.

ABSTRACT

Patients with stable coronary artery disease (CAD) involving ≥50% stenosis in the left main coronary artery almost invariably undergo revascularisation. However, there is lack of evidence from contemporary randomised controlled clinical trials (RCTs) supporting the superiority of this approach versus an initial strategy of intensive, multifaceted optimal medical therapy (OMT) directed at dyslipidaemic, hypertensive, thrombotic, metabolic and ischaemic targets. Current clinical practice guidelines still base their recommendations on small subsets of RCTs conducted in the 1970s and early 1980s. Given the lack of survival benefit among patients with stable, multi-vessel coronary artery disease who do versus those do not undergo routine revascularisation in the era of advanced OMT, the question arises whether the current treatment recommendations for left main disease are valid. This issue is of considerable importance; while significant left main disease is found in only 8-10% of diagnostic invasive angiography cases, it is a disease entity associated with a high risk of adverse clinical events and extensive resource use. This article discusses clinical trials data as well as challenges to address this question in the contemporary era. It highlights the complexities of trial planning and execution as it relates to both feasibility and equipoise, study design, choice of trial endpoints and duration of follow-up. The authors conclude there is a compelling need for an RCT to test the hypothesis that the current practice of routine revascularisation for all patients with LMD is superior to an initial strategy of multifaceted OMT with selective use of revascularisation.

PMID:41036022 | PMC:PMC12481371 | DOI:10.15420/ecr.2025.28

Sci Rep. 2025 Oct 1;15(1):34277. doi: 10.1038/s41598-025-16552-x.

ABSTRACT

We aimed to evaluate the prognostic value of octanoyl-carnitine in patients undergoing surgical myocardial revascularization for coronary artery disease. We conducted a retrospective analysis of an existing prospective cohort aimed at studying risk factors for vasoplegia in patients undergoing cardiac surgery with cardiopulmonary bypass. We conducted our study exclusively on patients included in the prospective cohort at Dijon University Hospital in 2021. We included 42 adult patients undergoing coronary artery bypass grafting, either alone or combined with another surgical procedure. We collected plasma samples for each patient from EDTA-anticoagulated tubes, taken as part of routine biological check-ups according to the department protocol, at three time points: preoperatively, immediately postoperatively in the intensive care unit, and on the first postoperative day. Liquid chromatography coupled with tandem mass spectrometry was used to determine plasma levels of acyl-carnitines, including octanoyl-carnitine. The primary endpoint was the occurrence of major postoperative complications (stroke, atrial fibrillation, acute kidney injury, and/or death). Fourteen patients (33%) had major postoperative complications. Octanoyl-carnitine plasma concentration significantly increased during the perioperative period and was significantly associated with major postoperative complications at all three time points in coronary artery bypass grafting patients (T1: 14.2 [11.6; 18.6] vs 21.1 [14.8; 28.0], T2: 20.9 [16.4;27.9] vs 34.8 [21.2;37.2], T3: 22.8 [13.7;30.9] vs 34.4 [30.2;41.2]; p < 0.05; in nmol/l). At baseline, octanoyl-carnitine levels were higher in patients with complications, while other acyl-carnitines showed no significant differences. Octanoyl-carnitine is associated with mitochondrial metabolism and could be evaluated alone or in conjunction with clinical scores.

PMID:41034608 | PMC:PMC12488848 | DOI:10.1038/s41598-025-16552-x

Open Heart. 2025 Sep 30;12(2):e003541. doi: 10.1136/openhrt-2025-003541.

ABSTRACT

BACKGROUND: Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist, requiring careful revascularisation strategy consideration. While surgical aortic valve replacement (SAVR) plus coronary artery bypass grafting (CABG) is traditional, transcatheter aortic valve replacement (TAVR) plus percutaneous coronary intervention (PCI) is increasingly used. The optimal strategy, particularly regarding residual CAD burden, remains unclear.

OBJECTIVES: This study investigated the impact of residual SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score (rSS) on outcomes in men and women with AS and CAD undergoing TAVR+PCI versus SAVR+CABG.

METHODS: In this retrospective study, propensity score-matched cohorts of men and women undergoing either procedure were analysed. Matching variables included age, left ventricular ejection fraction, EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) and CAD severity.

RESULTS: 398 patients (114 women and 284 men) were included. The rSS was predictive of the primary composite endpoint in the TAVR+PCI group (p=0.006 women and p<0.001 men) but not in the SAVR+CABG group. In patients achieving an rSS<8, TAVR+PCI was associated with a lower combined endpoint rate compared with SAVR+CABG, consistent across genders (p=0.02). Furthermore, TAVR+PCI demonstrated significant safety benefits, including lower rates of major bleeding in men (2.1% vs 10.6%) and stroke in women (1.8% vs 12.3%).

CONCLUSIONS: The prognostic importance of the rSS is strategy-dependent. For patients undergoing TAVR+PCI, achieving extensive revascularisation (rSS <8) is a critical procedural goal associated with improved outcomes. For patients undergoing SAVR+CABG, prognosis appears driven more by baseline clinical risk.

PMID:41033711 | PMC:PMC12496072 | DOI:10.1136/openhrt-2025-003541

Open Heart. 2025 Sep 30;12(2):e003317. doi: 10.1136/openhrt-2025-003317.

ABSTRACT

BACKGROUND: Routine invasive management by coronary angiography and revascularisation as appropriate reduces recurrent ischaemic events in non-ST-segment myocardial infarction (NSTEMI), but its mortality benefit is uncertain.

METHODS: Within this state-wide retrospective cohort study, patients with a primary diagnosis of NSTEMI were identified from the New South Wales (NSW) Admitted Patient Data Collection database between 2003 and 2020 and linked to the NSW death registry. Primary outcomes were cardiovascular (CV) and all-cause mortality among NSTEMI patients stratified by in-hospital invasive management.

RESULTS: Among 121 089 patients with NSTEMI (median age 71.4 years; 62.7% men), invasive management increased from 48.8% to 66.8% while all-cause in-hospital mortality decreased from 4.8% to 2.9% between triennial periods of 2003-2005 and 2018-2020, respectively. During the follow-up period (median 8.47 years), 47 304 (39.1%) patients died. CV mortality fell between 2003 and 2020 for those who were and were not invasively managed with greater magnitude in the former (subdistribution HR (sHR)=0.32, 95% CI 0.29 to 0.36; sHR=0.58, 95% CI 0.54 to 0.63, respectively, pinteraction<0.001). For all-cause mortality, the fall was significant for the invasively managed patients, with no plateau evident, but not in patients managed conservatively (adjusted HR (aHR)=0.56, 95% CI 0.52 to 0.61; aHR=1.00, 95% CI 0.95 to 1.06, respectively, pinteraction<0.001).

CONCLUSIONS: In patients presenting to NSW hospitals with NSTEMI between 2003 and 2020, we observed improvements in CV mortality in both invasively and conservatively managed patients while all-cause mortality improved in invasively but not conservatively managed patients. Wider implementation of routine invasive management may further improve long-term mortality among NSTEMI patients in NSW.

PMID:41033709 | PMC:PMC12496111 | DOI:10.1136/openhrt-2025-003317

Am J Case Rep. 2025 Oct 1;26:e947359. doi: 10.12659/AJCR.947359.

ABSTRACT

BACKGROUND Managing acute coronary syndrome in cancer patients poses significant challenges for cardiologists, who often encounter various complications. However, there are multiple therapeutic strategies available. The key lies in identification of the target lesion and early restoration of antegrade blood flow in cases in which it is affected. CASE REPORT We present a case of a 70-year-old man with a medical history of hypertension, type II diabetes mellitus, bioprosthetic aortic valve, coronary artery disease with prior PCI to the LAD, and metastatic prostate cancer who presented with chest pain and shortness of breath. The patient was hemodynamically unstable, with elevated lactates and troponin levels. He was diagnosed with cardiogenic shock secondary to N-STEMI. Coronary angiography revealed a high thrombotic burden at the LM bifurcation, which was managed with balloon angioplasty and medical therapy without stent implantation. Intravascular imaging with IVUS was performed 2 days later, which showed no dissections or significant stenosis. A conservative management strategy was implemented. CONCLUSIONS Cardiogenic shock is a life-threatening complication of N-STEMI, necessitating urgent coronary angiography and immediate revascularization. In certain cases, particularly those involving active malignancy, plain balloon angioplasty combined with optimal medical therapy can be a viable alternative to stent placement. Intravascular imaging assists in making the final decision. Cancer should not be considered a contraindication for invasive treatment in patients presenting with acute coronary syndrome.

PMID:41032480 | PMC:PMC12499628 | DOI:10.12659/AJCR.947359

Catheter Cardiovasc Interv. 2025 Oct 1. doi: 10.1002/ccd.70220. Online ahead of print.

ABSTRACT

BACKGROUND: The comparative outcomes of DEB vs. DES in diabetic patients undergoing PPCI are of significant clinical interest, as these patients often experience higher rates of restenosis and adverse outcomes.

AIMS: This study aimed to compare the outcomes of drug-eluting balloons (DEB) versus drug-eluting stents (DES) in diabetic patients undergoing primary percutaneous coronary intervention (PPCI).

METHODS: We conducted a retrospective analysis of 5668 diabetic patients who underwent PPCI, with 1734 patients in the DEB group and 3934 patients in the DES group. Baseline characteristics, angiographic features, and clinical outcomes, including procedural success, major adverse cardiovascular events (MACE), target lesion revascularization (TLR), restenosis, and bleeding complications, were compared between the two groups.

RESULTS: Both DEB and DES groups demonstrated high procedural success rates (97.6% and 98.4%, respectively), with no significant differences in MACE, death, myocardial infarction, or target vessel revascularization. Restenosis at 6 months occurred in 3.9% of the DEB group and 3.4% of the DES group (p = 0.21). Lesion length, diabetes duration, hypertension, and prior myocardial infarction were identified as significant predictors of adverse outcomes. Use of DES was associated with a higher risk of MACE, but this did not translate into significant differences in clinical outcomes.

CONCLUSION: Both DEB and DES are effective and safe treatment options for diabetic patients undergoing PPCI, with comparable outcomes in terms of procedural success, MACE, and restenosis.

PMID:41031463 | DOI:10.1002/ccd.70220

Cardiovasc Ther. 2025 Sep 22;2025:3713315. doi: 10.1155/cdr/3713315. eCollection 2025.

ABSTRACT

Background: Recently, the combination of rotational atherectomy (RA) with intravascular lithotripsy (IVL), known as "RotaTripsy," has been employed in the treatment of coronary lesions with severe calcification. In this article, we provide an overview of the current evidence regarding this technique, emphasizing the importance of appropriate patient and lesion selection to achieve optimal clinical outcomes, including the primary goal of improvement of stenting and enhancement of short and long-term prognosis. Methods: We performed a systematic literature search using PubMed, Embase, Web of Science, and Cochrane library up to July 2024 for studies that combined RA and IVL for coronary artery calcification lesions that were included. The retrieved articles and references of the primary articles were used to collect the basic information. SPSS 20.0 and Excel statistic software were used to conduct this scoping review. Results: A total of 25 studies consisting of 259 patients were identified. Of all the patients, 208 (80.3%) were male. Patients had an average age of 68.31 years, and 119 (45.95) patients had acute coronary syndrome. In addition, 218 (84.17%) had hypertension, 128 (49.42%) had diabetes mellitus, and 48 (18.53%) had chronic kidney disease. In the ultimate analysis, 252 patients (97.3%) successfully underwent the "RotaTripsy" procedure, with a minimal mortality rate of only 7 individuals (2.7%) during the follow-up period. Conclusions: "RotaTripsy," as an efficacious therapeutic modality, shows its unique potential for severe calcified coronary artery lesions resistant to dilation. Our research findings substantiate its feasibility, safety, and effectiveness in clinic.

PMID:41031101 | PMC:PMC12479158 | DOI:10.1155/cdr/3713315

BMC Cardiovasc Disord. 2025 Sep 30;25(1):708. doi: 10.1186/s12872-025-05136-2.

ABSTRACT

BACKGROUND: Physical activity prior to elective coronary artery bypass grafting (CABG) surgery can potentially improve postoperative outcomes. The aim of the study was to evaluate subjectively and objectively physical activity levels and dose-characteristics in free-living conditions in patients awaiting CABG surgery.

METHODS: A single-centered cross-sectional subanalysis of 32 participants awaiting elective CABG surgery. Physical activity during the preoperative period was assessed subjectively with the SQUASH questionnaire and objectively with the Sensewear activity monitor (accelerometer with physiological sensors). The Wilcoxon signed-rank test was used to assess differences and Bland-Altman plots were used to assess the agreement between the measurement methods. Descriptive statistics were used for the dose-characteristics and Cohen's Kappa for the proportion of participants fulfilling the Dutch guideline for healthy physical activity (NNGB).

RESULTS: Duration of vigorous activity was significantly higher when measured subjectively (120 min/week) than objectively (7 min/week, p = 0.001). Bland-Altman plots showed that differences between the methods increased with longer durations of moderate and total activity. The dose-characteristics of physical activity measured with the SQUASH varied widely among the participants and it consisted mainly of leisure time activities and light household activities. The percentage of participants complying with the NNGB guideline was 74% when measured subjectively and 90% when measured objectively (κ = 0.259, p = 0.089).

CONCLUSIONS: Surprisingly, both measurement methods suggest that the majority of patients awaiting CABG surgery met the recommendations of the NNGB guideline. The agreement between the methods however decreased with higher physical activity levels. Despite its limitations, the study suggests the complementary value of a subjective and objective measurement of physical activity in free-living conditions among CABG patients.

PMID:41029232 | PMC:PMC12482120 | DOI:10.1186/s12872-025-05136-2

J Imaging Inform Med. 2025 Sep 30. doi: 10.1007/s10278-025-01667-4. Online ahead of print.

ABSTRACT

This study aims to develop and assess an optimized three-dimensional convolutional neural network model (3D CNN) for predicting major cardiac events from coronary computed tomography angiography (CCTA) images in patients with suspected coronary artery disease. Patients undergoing CCTA with suspected coronary artery disease (CAD) were retrospectively included in this single-center study and split into training and test sets. The endpoint was defined as a composite of all-cause death, myocardial infarction, unstable angina, or revascularization events. Cardiovascular risk assessment relied on Morise score and the extent of CAD (eoCAD). An optimized 3D CNN mimicking the DenseNet architecture was trained on CCTA images to predict the clinical endpoints. The data was unannotated for presence of coronary plaque. A total of 5562 patients were assigned to the training group (66.4% male, median age 61.1 ± 11.2); 714 to the test group (69.3% male, 61.5 ± 11.4). Over a 7.2-year follow-up, the composite endpoint occurred in 760 training group and 83 test group patients. In the test cohort, the CNN achieved an AUC of 0.872 ± 0.020 for predicting the composite endpoint. The predictive performance improved in a stepwise manner: from an AUC of 0.652 ± 0.031 while using Morise score alone to 0.901 ± 0.016 when adding eoCAD and finally to 0.920 ± 0.015 when combining Morise score, eoCAD, and CNN (p < 0.001 and p = 0.012, respectively). Deep learning-based analysis of CCTA images improves prognostic risk stratification when combined with clinical and imaging risk factors in patients with suspected CAD.

PMID:41028565 | DOI:10.1007/s10278-025-01667-4

BMC Med Imaging. 2025 Sep 29;25(1):398. doi: 10.1186/s12880-025-01919-3.

ABSTRACT

OBJECTIVE: This study assessed the prognostic value of non-alcoholic fatty liver disease (NAFLD) in predicting major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD), using coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR).

METHODS: In this retrospective study, patients who underwent both CCTA and non-contrast liver/spleen CT at Dalian Medical University First Affiliated Hospital from January 2017 to December 2018 were included. NAFLD was diagnosed via CT and clinical history. MACE included cardiovascular/cerebrovascular death, all-cause mortality, myocardial infarction, unstable angina hospitalization, unplanned revascularization, and stroke. Patients were divided into NAFLD and non-NAFLD groups. Cox regression assessed the association between NAFLD and MACE, adjusting for cardiovascular risk factors, CCTA findings, and CT-FFR results. Subgroup and time-dependent C-index analyses evaluated prognostic performance across populations and follow-up duration.

RESULTS: Among 2,981 patients (737 with NAFLD), 408 experienced MACE over a median 68-month of follow-up. The NAFLD group had higher CAD-RADS scores, high-risk plaque, coronary calcification, and CT-FFR positivity, all p < 0.05. NAFLD independently predicted MACE (adjusted HR: 1.39; 95% CI: 1.15, 1.73; p < 0.001), especially in males, smokers, hypertensive and non-diabetic patients, and those with non-obstructive CAD or normal CT-FFR. Including NAFLD improved model performance at all time points, with C-index at 60 months of 0.753 vs. 0.727 (model2) and 0.695 (model 1), p < 0.001.

CONCLUSION: NAFLD serves as an independent prognostic indicator for MACEs in patients with suspected CAD. The incorporation of NAFLD into risk stratification models significantly enhances predictive accuracy, especially within high-risk sub-populations.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12880-025-01919-3.

PMID:41023692 | PMC:PMC12481874 | DOI:10.1186/s12880-025-01919-3

J Card Fail. 2025 Sep 28:S1071-9164(25)00428-2. doi: 10.1016/j.cardfail.2025.09.017. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have suggested that patients with ischemic etiology of heart failure (HF) and iron deficiency may derive greater benefits with intravenous ferric carboxymaltose (FCM). We aim to assess the effects of FCM versus placebo in patients with ischemic versus non-ischemic etiology of HF.

METHODS AND RESULTS: The FAIR-HF2 trial included 1105 patients with HF, with a left-ventricular ejection fraction ≤45%, and concomitant iron deficiency. Patients were randomized 1:1 to either intravenous FCM or placebo. Ischemic etiology was defined as investigator reported or prior coronary revascularization or myocardial infarction. The primary endpoints were time-to-first event of cardiovascular death or HF hospitalization, total HF hospitalizations, and time-to-first event of cardiovascular death or HF hospitalization in patients with transferrin saturation <20% at baseline. Of 1105 patients, 858 (78%) had ischemic etiology of HF. These were more frequently older, men and had more co-morbidities. For the first primary endpoint, FCM was associated with a hazard ratio (HR) of 0.85 (95%CI: 0.66-1.10, p=0.23) for ischemic HF and 0.61 (95% CI: 0.39-0.98, p=0.038) for non-ischemic HF (P-interaction=0.26). The HR for the second primary endpoint was 0.87 (95% CI: 0.63-1.21, p=0.41) for ischemic HF and 0.57 (95% CI: 0.35-0.94, p=0.028) for non-ischemic HF (P-interaction=0.17), while HR for the third primary endpoint was 0.84 (95% CI: 0.62-1.14, p=0.27) for ischemic HF and 0.63 (95% CI: 0.37-1.07, p=0.087) for non-ischemic HF (P-interaction=0.35).

CONCLUSIONS: Effect of intravenous iron supplementation is likely similar in patients with ischemic or non-ischemic etiology of HF, just like other HF guideline-directed medical therapies.

PMID:41027507 | DOI:10.1016/j.cardfail.2025.09.017

JMIR Med Inform. 2025 Sep 30;13:e72237. doi: 10.2196/72237.

ABSTRACT

BACKGROUND: Planning for coronary artery bypass grafting (CABG) necessitates advanced spatial visualization skills and consideration of multiple factors, including the depth of coronary arteries within the subepicardium, calcification levels, and pericardial adhesions.

OBJECTIVE: This study aimed to address these requirements by reconstructing a dynamic cardiovascular model, displaying it as a naked-eye hologram, and evaluating the clinical utility of this innovative visualization tool for preoperative CABG planning.

METHODS: We used preoperative 4D cardiac computed tomography angiography (4D-CCTA) data from 14 patients scheduled for CABG to develop a semiautomated workflow. This workflow enabled time-resolved segmentation of the heart chambers, epicardial adipose tissue (EAT), and coronary arteries, complete with calcium scoring. Methods for segmenting cardiac structures, quantifying coronary calcification, visualizing coronary depth within EAT, and assessing pericardial adhesions via motion analysis were incorporated. These dynamic reconstructions captured spatial relationships, coronary stenosis, calcification, and depth in EAT, as well as pericardial adhesions. Dynamic cardiovascular holograms were then generated and displayed using the Looking Glass platform (Looking Glass Factory Inc). Thirteen cardiac surgeons assessed the utility of the holographic visualization tool on a Likert scale. In addition, a surgeon visually scored pericardial adhesions using the holograms of all 21 patients (including 7 undergoing secondary cardiac surgeries) and compared these scores with actual intraoperative findings.

RESULTS: Cardiac surgeons highly rated the visualization tool for its utility in preoperative planning, with a mean Likert score of 4.57/5.0 (SD 0.5). The hologram-based scoring of pericardial adhesions showed a strong correlation with intraoperative findings (correlation coefficient r=0.786; P<.001).

CONCLUSIONS: This study delineates the structural framework of a visualization tool specifically designed for preoperative CABG planning. It produces high-quality, clinically relevant, dynamic holograms from patient-specific volumetric data, with clinical feedback confirming its practicality and effectiveness for preoperative surgical planning.

PMID:41027031 | PMC:PMC12483336 | DOI:10.2196/72237

Ann Med. 2025 Dec;57(1):2566878. doi: 10.1080/07853890.2025.2566878. Epub 2025 Sep 30.

ABSTRACT

BACKGROUND: Multivessel coronary artery disease (MVD) often requires revascularization. However, the effectiveness of various techniques in reducing stroke and achieving complete revascularization remains uncertain. This study aimed to address this gap by comparing key revascularization strategies in terms of early mortality, stroke, complete revascularization, postoperative atrial fibrillation (POAF), and renal failure.

METHODS: This study is a systematic review and network meta-analysis of 32 studies including 65,861 patients. Five revascularization techniques were compared: on-pump coronary artery bypass (ONCAB), off-pump coronary artery bypass (OPCAB), OPCAB with proximal anastomotic device (OPCAB-PAD), anaortic OPCAB (anOPCAB), and percutaneous coronary intervention (PCI). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random effects model. Risk of bias was assessed using the RoB2 and ROBINS-I tools.

RESULTS: Compared to ONCAB, early mortality was significantly lower with anOPCAB (OR: 0.57, 95% CI: 0.44-0.73), OPCAB-PAD (OR: 0.61, 95% CI: 0.40-0.92), and OPCAB (OR: 0.64, 95% CI: 0.47-0.87). Stroke risk was lowest with anOPCAB (OR: 0.29, 95% CI: 0.21-0.40) and OPCAB-PAD (OR: 0.32, 95% CI: 0.21-0.49). All surgical techniques achieved significantly more complete revascularization than PCI. Both POAF and renal failure were significantly lower with anOPCAB compared to ONCAB (POAF: OR: 0.72, 95% CI: 0.59-0.89; renal failure: OR: 0.63, 95% CI: 0.46-0.86). No significant publication bias was detected for mortality and stroke, though funnel plot asymmetry was noted for revascularization.

CONCLUSION: Off-pump techniques, particularly anOPCAB, significantly reduce stroke risk while achieving comparable revascularization success to ONCAB. PCI remains limited by incomplete revascularization, supporting its use primarily in patients at high surgical risk.

PMID:41026043 | PMC:PMC12486457 | DOI:10.1080/07853890.2025.2566878

Curr Opin Cardiol. 2025 Nov 1;40(6):448-458. doi: 10.1097/HCO.0000000000001259. Epub 2025 Oct 2.

ABSTRACT

PURPOSE OF REVIEW: Stress perfusion cardiac magnetic resonance imaging (CMR) has gained increasing adoption across North America and Europe for the evaluation of symptomatic suspected or established ischemic heart disease (IHD).

RECENT FINDINGS: Over the past decade, stress perfusion CMR has demonstrated excellent diagnostic and prognostic performance, particularly in patients at intermediate or high risk of IHD or with established coronary artery disease (CAD). After the landmark ISCHEMIA trial, stress CMR may play an important role in selecting patients for invasive management strategies and determination of revascularization technique. Artificial intelligence has streamlined CMR scanning techniques and in-line automation of quantitative pixelated perfusion maps. Quantitative stress CMR can evaluate absolute myocardial blood flow and perfusion reserve that improves risk stratification and detection of coronary microvascular disease (CMD). CMD detection may assist clinicians with diagnosis of chest pain in patients without obstructive CAD and improve prognostication and detection of pathophysiological mechanisms in a variety of cardiomyopathies.

SUMMARY: Quantitative stress perfusion CMR will play an important clinical role in evaluating patients at risk of IHD and cardiomyopathy with iterative cost and time efficiency owing to continued integration of artificial intelligence techniques. More widespread adoption will likely improve cost effective cardiac care and reduce adverse clinical outcomes.

PMID:41025335 | DOI:10.1097/HCO.0000000000001259