J Cardiothorac Surg. 2025 Jun 24;20(1):272. doi: 10.1186/s13019-025-03505-8.
ABSTRACT
OBJECTIVE: To explore the application and effect of aortic annulus reconstruction (AAR) with bovine pericardium during surgical aortic valve replacement (SAVR) for severe calcific aortic stenosis (AS).
METHODS: We retrospectively reviewed 12 patients with severe calcified AS who underwent bovine pericardium aortic annulus reconstruction between January 2021 to December 2023. The average age of the patients was 58 ± 8.8 years. All patients were diagnosed with severe AS, along with aortic valve and annulus calcification, through chest computed tomography (CT) and transthoracic echocardiography (TTE) prior to surgery. After the resection of severely calcified aortic annulus tissue, all patients were given a bovine pericardial patch to repair the annular defect, and five of these patients underwent Y-incision aortic annular enlargement (AAE). The patients were followed up for a duration of 0.5 to 2 years.
RESULTS: A total of 12 patients undergoing SAVR were enrolled, and all received bovine pericardial patches to repair the annular defects, with a mean preoperative indexed effective orifice area (iEOA) of 0.58 ± 0.098 cm²/m². The average extracorporeal circulation time during the operation was 150.83 ± 34.5 min, and the average cross-clamp time was 95.42 ± 17.46 min. Postoperative evaluations indicated that the structural integrity of the valve annulus remained intact, demonstrating hemodynamic stabilization without any recorded fatalities among participants. Compared to preoperative levels, the aortic valve mean gradient (4.67 ± 1.15 vs. 59.67 ± 17.94 mmHg, P < 0.001), peak gradient (13 [10-15.75] vs. 92 [82.25-110.25] mmHg, P < 0.001), mean aortic jet velocity (99.67 ± 15.44 vs. 367.17 ± 58.13 cm/s, P < 0.001), and peak aortic jet velocity (182.25 ± 23.40 vs. 495.67 ± 61.74 cm/s, P < 0.001) significantly decreased after 0.5 years of follow-up. There were no complications such as hemolysis, perivalvular leakage, thrombosis or endocarditis during follow-up.
CONCLUSION: In patients with severe calcified AS, the AAR technique using bovine pericardium during SAVR is safe and effective, with stable hemodynamic performance and satisfactory clinical outcomes.
PMID:40556029 | PMC:PMC12186314 | DOI:10.1186/s13019-025-03505-8
J Cardiothorac Surg. 2025 Jun 25;20(1):273. doi: 10.1186/s13019-025-03491-x.
ABSTRACT
BACKGROUND: Thyroid storm (TS) is an endocrine emergency requiring aggressive medical management. In severe cases, hemodynamic instability may necessitate extracorporeal membrane oxygenation (ECMO) support as a bridge to definitive surgical treatment. ECMO is categorized into two types: venoarterial (V-A) ECMO, which provides both cardiac and pulmonary support, and venovenous (V-V) ECMO, which supports only pulmonary function. Surgery is generally not recommended for patients with unstable TS due to the high risk of complications, even when ECMO support is in place. Here, we present a case of a 44-year-old man initially improved with V-A ECMO for TS with cardiogenic shock, but later developed refractory hypoxemia due to pulmonary thromboembolism (PTE). He subsequently underwent emergency thyroidectomy with continuous support from V-V ECMO.
CASE PRESENTATION: A 44-year-old man presented to our hospital with complaints of palpitations. He had a recent history of coronavirus disease of 2019 (COVID-19) infection, which may have exacerbated undiagnosed hyperthyroidism, leading to thyroid storm and cardiogenic shock (left ventricular ejection fraction [LVEF], 13%). Heart failure improved with immediate medical management and V-A ECMO for 4 days, resulting in LVEF, 30%. V-A ECMO provide both respiratory and cardiac support, allowing myocardial recovery. Although the patient's cardiac output improved, uncontrolled tachycardia persisted. Medical treatment for hyperthyroidism-associated tachycardia was continued after V-A ECMO weaning but failed to achieve adequate rate control. Ten days after weaning V-A ECMO, the patient suddenly developed pulmonary thromboembolism and hypoxia despite ongoing heparinization. To manage refractory hypoxia, V-V ECMO was initiated, as it exclusively provides respiratory support. Given that persistent TS was the underlying cause of the patient's instability, we proceeded with thyroidectomy under general anesthesia with V-V ECMO support, despite the associated risks. On postoperative day 4, the patient was successfully weaned off V-V ECMO. By postoperative day 18, he was discharged without complications, with an improved LVEF of 52.5%.
CONCLUSIONS: This is the first reported case of total thyroidectomy performed while on V-V ECMO support for TS complicated by PTE. Although V-V ECMO is more susceptible to hemodynamic instability than V-A ECMO, this case demonstrates that thyroidectomy can be successfully performed with appropriate anesthesia management. Additionally, careful selection of the ECMO modality based on the patient's condition is crucial for optimal management.
PMID:40556009 | PMC:PMC12188653 | DOI:10.1186/s13019-025-03491-x
Eur J Med Res. 2025 Jun 23;30(1):511. doi: 10.1186/s40001-025-02796-w.
ABSTRACT
BACKGROUND: The atherogenic index of plasma (AIP) as a novel lipid biomarker has been shown to be an important predictor of atherosclerosis and coronary artery disease. However, it remains unclear whether AIP has prognostic value for patients with premature coronary artery disease (PCAD). Therefore, the present investigation aims to explore the relationship between AIP and major adverse cardiovascular events (MACE) in the PCAD population.
METHODS: A total of 721 patients with PCAD diagnosed by coronary angiography were enrolled in this study. Their AIP was calculated as log [triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C)]. The primary outcome of this study was MACE, defined as a combination of cardiovascular (CV) death, coronary artery revascularization, non-fatal myocardial infarction (MI), and non-fatal stroke.
RESULTS: After a median follow-up time of 52 months, 138 patients developed MACE. The patients in the highest AIP tertile group have a higher incidence of MACE (26.6% vs 11.8% and 19.8%, p < 0.001). The Kaplan-Meier curves demonstrated that there were significant differences in the risk of MACE among different AIP groups (log-rank p < 0.001). In addition, the multivariable Cox regression model showed that the hazard ratio of MACE in the highest tertile group was 2.27 (95% CI 1.30-3.94), and 1.33 (95% CI 1.06-1.67) for per SD increase in AIP.
CONCLUSIONS: AIP is significantly associated with the risk of MACE in patients with PCAD and serves as a novel independent prognostic marker for this population.
PMID:40551214 | PMC:PMC12183880 | DOI:10.1186/s40001-025-02796-w
Circulation. 2025 Jun 24;151(25):1767-1779. doi: 10.1161/CIRCULATIONAHA.124.071980. Epub 2025 Jun 23.
ABSTRACT
BACKGROUND: Clinical guidelines recommend different revascularization strategies for nonculprit lesions in patients with ST-segment-elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI). Whether the prevalence of untreated high-risk vulnerable plaques differs in STEMI and NSTEMI and affects their outcomes is unknown.
METHODS: In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree II), a multicenter, prospective natural history study, patients with recent myocardial infarction underwent 3-vessel coronary angiography with coregistered near-infrared spectroscopy and intravascular ultrasound after successful percutaneous coronary intervention of obstructive lesions from 2014 through 2017. Two-feature high-risk plaques were defined as those with both plaque burden ≥70% and maximum lipid core burden index over any 4-mm segment ≥324.7. The primary end point was major adverse cardiovascular events arising from untreated nonculprit lesions during a median 3.7-year follow-up.
RESULTS: Of 898 patients, 199 (22.2%) with 849 nonculprit lesions had STEMI and 699 (77.8%) with 2784 nonculprit lesions had NSTEMI. By intravascular ultrasound, the median nonculprit lesion length was 17.4 mm (interquartile range, 16.3-18.5) in STEMI and 17.7 mm (interquartile range, 17.1-18.4) in NSTEMI (P=0.63), and the median minimal lumen area was 5.5 mm2 (interquartile range, 5.3-5.7 mm2) in STEMI and 5.5 mm2 (interquartile range, 5.3-5.6 mm2) in NSTEMI (P=0.99). At the lesion level, the prevalence of 2-feature high-risk nonobstructive nonculprit plaques was slightly higher in patients with STEMI than in patients with NSTEMI (12.8% versus 10.1%; P=0.03). At the patient level, however, the prevalence of 2-feature high-risk plaques was similar in STEMI versus NSTEMI (38.8% versus 32.7%; P=0.11). The prevalence of patients with 1 or more lesions meeting at least 1 high-risk plaque criterion was also similar (plaque burden ≥70%, 63.3% versus 57.8% [P=0.16]; maximum lipid core burden index over any 4-mm segment ≥324.7, 63.3% versus 57.6% [P=0.15]). The 4-year rates of nonculprit lesion-related major adverse cardiovascular events were similar in STEMI versus NSTEMI (8.6% versus 7.8%; hazard ratio, 1.02 [95% CI, 0.57-1.81]; P=0.95), as were the rates of all major adverse cardiovascular events (14.2% versus 13.0%; hazard ratio, 1.06 [95% CI, 0.68-1.64]; P=0.80).
CONCLUSIONS: In the PROSPECT II study, the per-patient prevalence of high-risk vulnerable plaques was comparable in STEMI versus NSTEMI, as was the overall long-term incidence of nonculprit lesion-related and all major adverse cardiovascular events. These results support a similar revascularization strategy for nonculprit lesions in patients with STEMI or NSTEMI after culprit lesion management.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02171065.
PMID:40549845 | DOI:10.1161/CIRCULATIONAHA.124.071980
PLoS One. 2025 Jun 23;20(6):e0326516. doi: 10.1371/journal.pone.0326516. eCollection 2025.
ABSTRACT
Beta-blockers have been considered the cornerstone of treatment for patients with acute myocardial infarction (AMI). However, long-term benefits of vasodilating beta-blockers remain uncertain. This study aimed to investigate the long-term clinical benefits of vasodilating beta-blockers compared to conventional beta-blockers in AMI patients with mildly reduced ejection fraction (mrEF). Among 13,624 patients who enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH Registry, 2,662 AMI patients with mrEF, who were prescribed beta-blockers at discharge were selected for this study. The primary outcome was a composite of cardiac death, recurrent MI, or hospitalization for heart failure (HF) during 3-year follow up period. In the entire cohort, the use of vasodilating beta-blockers at discharge was associated with lower incidence of primary outcome at 3-year (hazard ratio [HR] 0.80; 95% confidence interval [CI], 0.62-0.98; P = 0.039) compared to the use of conventional beta-blockers at discharge. In the propensity score-matched (PSM) cohort, the use of vasodilating beta-blockers at discharge was also associated with a significantly lower incidence of primary outcome (HR, 0.66; 95% CI, 0.50-0.88; P = 0.004) compared to the use of conventional beta-blockers at discharge. Furthermore, in the PSM cohort, the use of vasodilating beta-blockers was associated with lower incidences of the cardiac death (HR, 0.60; 95% CI, 0.39-0.92; P = 0.020), hospitalization for HF (HR, 0.72; 95% CI, 0.46-0.98; P = 0.042), and all-cause death (HR, 0.67; 95% CI, 0.48-0.93; P = 0.017) compared to the use of conventional beta-blockers. However, no significant differences were observed between the groups in the incidences of recurrent MI (HR, 0.62; 95% CI, 0.34-1.14; P = 0.122), any revascularization (HR, 1.04; 95% CI, 0.76-1.42; P = 0.821), stroke (HR, 0.84; 95% CI, 0.44-1.60; P = 0.589), stent thrombosis (HR, 1.12; 95% CI, 0.40-3.11; P = 0.833). In AMI patients with mrEF, the use of vasodilating beta-blockers at discharge was associated with better long-term clinical outcomes compared to the use of conventional beta-blockers.
PMID:40549765 | PMC:PMC12184898 | DOI:10.1371/journal.pone.0326516
JAMA Intern Med. 2025 Jun 23:e252058. doi: 10.1001/jamainternmed.2025.2058. Online ahead of print.
ABSTRACT
IMPORTANCE: The optimal management strategy for older patients who present with acute coronary syndrome (ACS) remains unclear due to a paucity of randomized evidence. New large and longer-term randomized data are available.
OBJECTIVE: To test the association of an early invasive strategy vs a conservative strategy with clinical outcomes for patients 70 years or older who present with ACS.
DATA SOURCES: A literature search strategy was designed in collaboration with a medical librarian. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched ,with no language restrictions from inception through October 2024. Bibliographies of previous reviews and conference abstracts from major cardiovascular scientific meetings were handsearched.
STUDY SELECTION: Studies were deemed eligible following review by 2 independent, masked investigators if they randomly allocated patients 70 years or older who presented with ACS to early invasive or conservative management and reported clinical end points. Observational analyses were excluded. No trials were excluded based on sample size or follow-up duration.
DATA EXTRACTION AND SYNTHESIS: Data were extracted independently and in triplicate. Clinical end points were pooled in meta-analyses that applied fixed-effects and random-effects modeling to calculate summary estimates for relative risks (RRs) and hazard ratios, along with their corresponding 95% CIs.
MAIN OUTCOMES AND MEASURES: The prespecified primary end point was all-cause death. Secondary end points included recurrent myocardial infarction (MI), repeated coronary revascularization, major bleeding, cardiovascular death, death or MI, stroke, heart failure hospitalization, major adverse cardiac events, major adverse cardiovascular or cerebrovascular events, and length of hospital stay.
RESULTS: The sample size-weighted mean age of participants across included trials was 82.6 years, and 46% were female. In the pooled analysis, there was no significant difference in all-cause death between the invasive and conservative strategies (RR, 1.05; 95% CI, 0.98-1.11; P = .15; I2 = 0%). An early invasive strategy was associated with a reduced risk of recurrent MI of 22% (RR, 0.78; 95% CI, 0.67-0.91; P = .001; I2 = 0%) and repeated coronary revascularization during follow-up of 57% (RR, 0.43; 95% CI, 0.30-0.60; P < .001; I2 = 33.3%). However, an invasive strategy was associated with an increased risk of major bleeding (RR, 1.60; 95% CI, 1.01-2.53; P = .05; I2 = 16.7). No differences were observed in secondary end points. Results in the non-ST-elevation ACS population were consistent with the overall findings.
CONCLUSIONS AND RELEVANCE: The results of this systematic review and meta-analysis suggest that, in older patients with ACS, an early invasive strategy was not associated with reduced all-cause death compared with conservative management. An early invasive strategy was associated with reduced recurrent MI and repeated coronary revascularization during follow-up but increased risk of major bleeding. Competing risks associated with an early invasive strategy should be weighed in shared therapeutic decision-making for older patients with ACS.
PMID:40549394 | PMC:PMC12186514 | DOI:10.1001/jamainternmed.2025.2058
Heart Vessels. 2025 Jun 23. doi: 10.1007/s00380-025-02564-0. Online ahead of print.
ABSTRACT
Given the limited published data, we examined three-year outcomes in patients with and without diabetes mellitus (DM) in non-ST-segment elevation myocardial infarction (NSTEMI), according to left ventricular ejection fraction (LVEF). A total of 4594 patients were classified into DM (n = 1608) and non-DM (n = 2986) groups. They were further classified into heart failure with reduced EF (HFrEF, LVEF ≤ 40%), HF with mildly reduced EF (HFmrEF, LVEF 41-49%), and HF with preserved EF (HFpEF, LVEF ≥ 50%) subgroups. The primary outcome was all-cause mortality, and secondary outcomes included cardiac death (CD), non-CD (NCD), recurrent MI, any revascularization, and hospitalization for HF (HHF). In both DM and non-DM groups, in-hospital all-cause mortality rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups, but were similar between the HFmrEF and HFpEF subgroups. In the DM group, the three-year all-cause mortality (P < 0.001 for both), CD, NCD, recurrent MI, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In the non-DM group, the three-year all-cause mortality (P = 0.001 and P < 0.001, respectively), CD, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In both DM and non-DM groups, the three-year all-cause mortality and NCD rates were higher in the HFmrEF group than in the HFpEF group. Regardless of the presence of DM, the three-year outcomes were best in HFpEF, worst in HFrEF, and intermediate in HFmrEF patients.
PMID:40549147 | DOI:10.1007/s00380-025-02564-0
Clin Res Cardiol. 2025 Jun 23. doi: 10.1007/s00392-025-02700-w. Online ahead of print.
ABSTRACT
BACKGROUND: The use of drug-coated balloons (DCB) in percutaneous coronary interventions (PCI) is increasing due to potential benefits mainly by avoiding foreign material although a widespread application area beyond in-stent restenosis lacks robust clinical data to date. As such, we aimed to assess the safety and efficacy of DCBs in treating de novo lesions.
METHODS: For this analysis, we included all patients treated with DCB in a de novo lesions from 2010 to 2019 at our institution. We performed a 1:1 propensity score matching to pair each DCB intervention with a comparable DES intervention. Follow-up continued until 09/2022 to assess clinical outcomes.
RESULTS: A total of 303 patients with de novo lesion were matched to 303 patients with comparable baseline characteristics. The median follow-up time was 5.7 years (IQR 2.7-9.3). There were no significant differences in cardiovascular (CV) mortality (HR 1.01 [95% CI 0.87-1.19], p value 0.874), all-cause mortality (HR 1.05 [95% CI 0.91-1.22], p value 0.491), MACE (HR 1.10 [95% CI 0.96-1.26], p value 0.170), acute myocardial infarction (HR 1.08 [95% CI 0.90-1.19], p value 0.308), or any revascularization (HR 1.03 [95% CI 0.90-1.19], p value 0.671) between both groups. However, we observed a trend toward lower rates of target lesion revascularization in patients with small vessel disease (HR 0.84 [95% CI 0.68-1.02], p value 0.072), and in side branch lesions (HR 0.79 [95% CI 0.58-1.04], p value 0.096).
CONCLUSION: DCBs demonstrated long-term safety and efficacy in de novo lesions, with promising trends in reducing target lesion revascularization in small vessel disease and side branches.
PMID:40549036 | DOI:10.1007/s00392-025-02700-w
Eur J Clin Pharmacol. 2025 Jun 23. doi: 10.1007/s00228-025-03869-9. Online ahead of print.
ABSTRACT
BACKGROUND: Myocardial infarction (MI) triggers inflammation that affects post-MI outcomes. Colchicine shows potential in treating cardiovascular (CV) conditions; however, its role in reducing adverse CV events post-MI remains uncertain.
METHODS: We conducted a thorough search across PubMed, Embase, Web of Science from inception to February 2025 for randomized controlled trials (RCTs) comparing colchicine and control in MI patients. Outcomes were analyzed using a random-effects model to pool relative risks (RRs) and mean differences (MD) with 95% confidence intervals (CIs).
RESULTS: A total of 14 RCTs incorporating 14,326 patients were included. The incidence of adverse CV events, all-cause mortality, cardiac-specific mortality, non-cardiac specific mortality, recurrent MI, repeat revascularization and post-MI heart failure (HF), post-MI atrial fibrillation (AF), and stroke were comparable between colchicine and control groups. In both colchicine and control groups, a similar change in high-sensitivity C-reactive protein (hs-CRP) from the baseline was observed. Regarding the safety profile, both colchicine and control had overall comparable any adverse effects; however, gastrointestinal adverse events (RR: 1.74, 95% CI [1.20, 2.51], P = 0.003) were higher in the colchicine group. The incidence of myelotoxicity or infections was comparable between both groups.
CONCLUSIONS: Colchicine was not beneficial in reducing adverse CV events, mortality, recurrent MI, repeat revascularization, post-MI HF, post-MI AF, and stroke following acute MI compared to control. However, colchicine use was associated with a higher incidence of gastrointestinal adverse events, with no notable increase in any adverse effects, myelotoxicity, or infections.
PMID:40548988 | DOI:10.1007/s00228-025-03869-9
Int J Cardiol Cardiovasc Risk Prev. 2025 Jun 7;26:200444. doi: 10.1016/j.ijcrp.2025.200444. eCollection 2025 Sep.
ABSTRACT
AIM: This study aims to identify three-month and one year mortality rate, LDL level and adherence to guideline-recommended medication in patients with myocardial infarct (MI) receiving cardiac rehabilitation (CR) compared to patients who do not.
METHOD: In this retrospective study, patients hospitalized in North Denmark Regional Hospital in Hjoerring (capture population 200.000) with acute coronary syndrome between January 1st, 2017, to December 31st, 2021, were included. Baseline characteristics, initial treatment of revascularization and all-cause mortality were examined through the Danish National Patient Registry, the Regional Cardiac Rehabilitation Database, and medical chart review. Patients were grouped by revascularization (yes/no) during hospitalization and CR. Adjusted Cox proportional regression model was used to assess differences in mortality and LDL levels.
RESULTS: A total of 1209 myocardial infarction (MI) survivors were included in this study. A total of 1209 myocardial infarction (MI) survivors were included. Significant LDL reductions at 6- and 12-month follow-ups were observed in patients receiving both cardiac rehabilitation (CR) and lipid-modifying therapy at baseline (p = .001), but not in those without CR. In revascularized patients, use of multiple antithrombotic agents was lower in the no CR group at three months (57.1 % vs 78.8 %, p = .002) and one year (60 % vs 78.5 %, p = .010). Three-month mortality rate was higher among patients who did not undergo CR, both in the revascularization group (19 % vs 2 %, p = 0.001) and the non-revascularization group (18 % vs 3 %, p = 0.001).
CONCLUSION: Patients undergoing CR were associated with lower LDL-levels, higher adherence to guideline-recommended medication and lower mortality rate at three-month follow-up.
PMID:40546975 | PMC:PMC12182385 | DOI:10.1016/j.ijcrp.2025.200444
Cardiovasc Diabetol. 2025 Jun 23;24(1):260. doi: 10.1186/s12933-025-02822-5.
NO ABSTRACT
PMID:40551100 | PMC:PMC12183802 | DOI:10.1186/s12933-025-02822-5
Anal Bioanal Chem. 2025 Jun 23. doi: 10.1007/s00216-025-05969-y. Online ahead of print.
ABSTRACT
Diabetic cardiomyopathy (DCM), a cardiac complication of diabetes, is characterized by diastolic dysfunction, myocardial fibrosis, and structural remodeling. Carbonyl-containing metabolites (CCMs) play a critical role in driving DCM pathogenesis through metabolic dysfunction, oxidative stress, and lipid peroxidation. In this study, we employed an on-tissue chemical derivatization (OTCD)-based air-flow-assisted desorption electrospray ionization mass spectrometry imaging (AFADESI-MSI) approach to investigate spatial metabolic alterations of CCMs in the diabetic rat heart. This method enabled the spatial profiling of 369 CCMs-including 137 fatty aldehydes (FALs), 214 oxo fatty acids (OFAs), and 18 sterol-type lipids (STs)-across cardiac tissue sections. This expanded metabolite coverage revealed marked spatial heterogeneity in cardiac metabolism. Comparative analysis between diabetic and control rats identified 162 significantly altered CCMs, highlighting localized metabolic dysregulation associated with DCM. To explore potential therapeutic interventions, we further evaluated the metabolic impact of ferulic acid, a candidate agent for myocardial protection. High-dose ferulic acid treatment significantly modulated 43 differential CCMs, attenuated pyruvate accumulation, restored fatty aldehyde levels, and improved the profile of oxidized fatty acids. These findings suggest that ferulic acid ameliorates metabolic dysfunction by exerting antioxidant and anti-inflammatory effects, while enhancing mitochondrial function and lipid metabolism. Overall, this study demonstrates the utility of OTCD-AFADESI-MSI for spatially resolved metabolomic analysis of carbonyl stress in DCM and supports the therapeutic potential of ferulic acid in managing diabetic heart injury.
PMID:40551014 | DOI:10.1007/s00216-025-05969-y
BMJ Open. 2025 Jun 23;15(6):e096433. doi: 10.1136/bmjopen-2024-096433.
ABSTRACT
INTRODUCTION: Total hip arthroplasty (THA) is an effective treatment for severe osteoarthritis. However, THA has a high surgical risk for patients with concomitant diseases and is associated with several serious complications, such as myocardial infarction, acute kidney injury and cognitive dysfunction. This study will explore the potential protective effects of remote ischaemic preconditioning (RIPC) in cemented THA patients.
METHODS AND ANALYSIS: The PRINCIPAL study is designed as a randomised, controlled, parallel-group, blinded trial to assess the impact of RIPC in cemented THA patients. The study will compare two patient groups-one group will have the RIPC procedure, and the second will have the sham procedure. The primary outcome is the peak troponin T concentration during the three postoperative days. Secondary outcomes include markers of arterial stiffness (augmentation index (AIx), carotid-femoral pulse wave velocity, central blood pressures), neural (neuron-specific enolase, S100B) and renal injury biomarkers (estimated glomerular filtration rate, creatinine, cystatin C), markers of systemic inflammation (hypoxia-inducible factor 1-alpha, interleukin (IL)-6, IL-1β, tumour necrosis factor-alpha, IL-10) and oxidative stress (total peroxide concentration, total antioxidant capacity), as well as clinical outcome measures such as major adverse cardiovascular events and all-cause mortality.
ETHICS AND DISSEMINATION: The ethical board of the University of Tartu has granted approval for the study (no. 384T-26). The results of this study will be disseminated in international peer-reviewed journals.
TRIAL REGISTRATION NUMBER: NCT06323018.
PMID:40550717 | PMC:PMC12186052 | DOI:10.1136/bmjopen-2024-096433
Circulation. 2025 Jun 24;151(25):e1093-e1094. doi: 10.1161/CIRCULATIONAHA.125.074590. Epub 2025 Jun 23.
NO ABSTRACT
PMID:40549847 | DOI:10.1161/CIRCULATIONAHA.125.074590
Circulation. 2025 Jun 24;151(25):e1091-e1092. doi: 10.1161/CIRCULATIONAHA.124.072438. Epub 2025 Jun 23.
NO ABSTRACT
PMID:40549843 | DOI:10.1161/CIRCULATIONAHA.124.072438
World J Diabetes. 2025 Jun 15;16(6):103685. doi: 10.4239/wjd.v16.i6.103685.
ABSTRACT
BACKGROUND: Erianin is a natural bibenzyl compound extracted from Dendrobium chrysotoxum and is known for its anti-inflammatory and antioxidant properties.
AIM: To explore the possible therapeutic mechanisms of erianin and determine if it can reduce cardiac damage in mice with type 2 diabetes.
METHODS: High-fat diet and intraperitoneal injections of streptozotocin were used to induce type 2 diabetes mellitus in C57BL/6 mice. Mice were divided into different groups including control, model, and treatment with various doses of erianin (10, 20, and 40 mg/kg) as well as ML-385 + erianin group.
RESULTS: Erianin reduced oxidative stress and inflammation and alleviated diabetic cardiomyopathy through the activation of the adenosine monophosphate-activated protein kinase (AMPK)-nuclear factor erythroid 2-related factor 2 (Nrf2)-heme oxygenase-1 (HO-1) pathway. Treatments with erianin-M and erianin-H promoted weight stabilization and normalized fasting glucose levels relative to diabetic controls. Echocardiographic assessment demonstrated that erianin dose-dependently enhanced left ventricular systolic function (left ventricular ejection fraction, left ventricular fractional shortening) and mitigated ventricular remodeling (left ventricular internal diameter at end-diastole, left ventricular internal diameter at end-systole; P < 0.05 vs model group). No significant differences were observed between the ML-385 + erianin and placebo-treated groups. Histopathological examination through hematoxylin-eosin staining indicated that erianin ameliorated myocardial fiber fragmentation, structural disorganization, inflammatory cell infiltration, and cytolytic damage. Furthermore, it significantly reduced the serum levels of cardiac troponin I, creatine kinase, and its MB isoenzyme. However, the ML-385 + erianin co-treatment failed to alleviate myocardial injury. Metabolic profiling revealed erianin-mediated improvements in glycemic regulation (glycated hemoglobin: P < 0.001), plasma insulin homeostasis, and lipid metabolism (total cholesterol, triglycerides, low-density lipoprotein cholesterol reduction, and high-density lipoprotein cholesterol restoration; P < 0.05 vs model group). Proinflammatory cytokines including tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 were markedly suppressed in the erianin-M and erianin-H groups compared with the model group, whereas no significant differences were detected between the model and ML-385 + erianin groups. Oxidative stress parameters showed decreased malondialdehyde levels accompanied by elevated superoxide dismutase and catalase activities in erianin-treated groups, with the most pronounced effects in the erianin-H group (P < 0.05). Western blot analysis confirmed the significant upregulation of proteins associated with the AMPK/Nrf2/HO-1 pathway in erianin-M and erianin-H groups. These protective effects were abolished in the ML-385 + erianin co-treatment group, which showed no statistical differences from the model group.
CONCLUSION: Erianin can effectively alleviate myocardial injury in type 2 diabetic mice by activating the AMPK-Nrf2-HO-1 pathway.
PMID:40548264 | PMC:PMC12179885 | DOI:10.4239/wjd.v16.i6.103685
BMC Nephrol. 2025 Jun 23;26(1):290. doi: 10.1186/s12882-025-04264-3.
ABSTRACT
BACKGROUND: Chronic kidney disease represents an immunocompromising condition and a cause of a lower vaccine efficacy, even in patients undergoing maintenance dialysis. Recent SARS-CoV-2 outbreaks have prompted clinicians to better understand the underlying mechanisms and establish more suitable vaccination schedules.
METHODS: In a single-center, retrospective, observational study of patients undergoing maintenance dialysis in France, we studied the factors associated with the intensity of the humoral response to a SARS-CoV-2 vaccine in this population, including specific dialysis-related variables.
RESULTS: After having received three doses of SARS-CoV-2 mRNA vaccine, a cohort of 80 patients was divided into low-responders (28 patients with an anti-SARS-CoV-2 antibody level of 50-1830 AU/mL) and responders (52 patients with an antibody level > 1830 AU/mL). We found that chronic heart failure (p < 0.00001), higher performance status (p = 0.004), hypoalbuminemia (p < 0.001), lymphopenia (p = 0.003), Rhesus status positivity (p = 0.02), and absence of response to a hepatitis B virus vaccine (p = 0.02) were associated with a poor response to a third dose of SARS-CoV-2 vaccine. In contrast, none of the dialysis-related variables were associated with the vaccine response. In multivariate logistic regression, chronic heart failure (p < 0.0001) and hypoalbuminemia (p = 0.0004) remained associated with a lower humoral response to SARS-CoV-2 vaccine.
CONCLUSIONS: Our results showed that chronic heart failure and hypoalbuminemia were factors associated with a poor humoral response after three doses of SARS-CoV-2 vaccine. However, we found no association between specific dialysis-related variables and the anti-SARS-CoV-2 antibody titer.
PMID:40551111 | PMC:PMC12186387 | DOI:10.1186/s12882-025-04264-3
Medicine (Baltimore). 2025 Jun 20;104(25):e43043. doi: 10.1097/MD.0000000000043043.
ABSTRACT
RATIONALE: Heart transplantation (HT) represents the optimal treatment for patients with end-stage heart disease. However, it is prone to numerous postoperative complications, among which cardio-renal syndrome (CRS) is particularly serious and carries a high mortality rate. Continuous renal replacement therapy is an essential supportive treatment for these patients, but its efficacy is highly dependent on precise nursing management. Currently, there are few reports on the care of CRS complicating HT both domestically and internationally. This case is presented in this report to provide reference for clinical work.
PATIENT CONCERNS: This report details the case of a 31-year-old man who underwent an in situ HT due to dilated cardiomyopathy with class IV cardiac function. Following the operation, he developed CRS, which led to oliguria, rapid deterioration of renal function, and cardiac failure.
DIAGNOSES: Cardiorenal syndrome, chronic kidney disease stage 4, post-dilated cardiomyopathy surgery, HT status, heart function class IV (NYHA classification).
INTERVENTIONS: This includes implementing a personalized continuous renal replacement therapy (CRRT) program and providing excellent CRRT care; closely monitoring for rejection and the side effects of immunosuppressants; and offering comprehensive psychological support.
OUTCOMES: After undergoing CRRT for 5 weeks, the patient's 24-hour urine volume, glomerular filtration rate, and N-terminal brain natriuretic peptide precursor levels stabilized, leading to discharge with improved renal function.
LESSONS: The key to a favorable renal function prognosis is the use of CRRT for precise volume management. Careful management of internal jugular vein catheterization is crucial for preventing infections in post-heart transplant patients. Additionally, monitoring the side effects of immunosuppressive drugs and signs of rejection are essential nursing points for patients with cardiorenal syndrome. Providing psychological care in various forms to patients and their families can help improve disease outcomes and ensure long-term efficacy after transplantation.
PMID:40550023 | PMC:PMC12187291 | DOI:10.1097/MD.0000000000043043
J Vis Exp. 2025 Jun 6;(220). doi: 10.3791/68090.
ABSTRACT
The number of advanced heart failure patients who can receive a heart transplant is limited by a shortage of suitable organ donors. In efforts to expand the donor pool, alternative donation and procurement methods have been developed, including heart transplantation following donation after circulatory death (DCD HT). While short-term survival following DCD HT is non-inferior to heart transplantation with brain-dead donors, there may be an increased rate of primary graft dysfunction (PGD) associated with DCD HT allografts. The underlying etiology of PGD is multifactorial and incompletely understood. For DCD HT allografts, the period of warm ischemic injury during DCD procurement is a potential risk factor for PGD to which brain death allografts are not exposed. The functional warm ischemic time thus may be an important driver of PGD in DCD HT. However, the mechanisms underlying PGD in this clinical scenario are poorly understood at the molecular level. The work presented herein aims to describe the development and validation of a high-fidelity non-survival porcine model of DCD orthotopic heart transplantation. We hypothesize that the use of this translational large animal model is critical to elucidate molecular mechanisms contributing to PGD, as well as to investigate interventions designed to optimize allograft preservation and early performance. This model replicates the perioperative and surgical approach used in DCD HT clinically, with modifications to account for porcine anatomy and physiology. The development of this large animal surgical model will not only provide mechanistic insights into the development of PGD but also can be modified to enhance translational research efforts aimed at improving organ recovery following DCD HT.
PMID:40549678 | DOI:10.3791/68090
Mol Biol Rep. 2025 Jun 23;52(1):623. doi: 10.1007/s11033-025-10729-3.
ABSTRACT
Recently, immunogene therapy has been of great interest in cardiovascular diseases. In this regard, various immune checkpoint inhibitors (ICIs) are identified to have a crucial role in regulating inflammatory responses. The T-cell immunoglobulin and mucin-domain containing molecule-3 (TIM-3, CD366), a relatively newly discovered group of molecules with a conserved structure, has emerged as a critical immune checkpoint with significant regulatory roles in cardiovascular inflammation and atherosclerosis. This prospective review explores the importance of TIM-3 in modulating immune responses relevant to ischemic heart diseases (IHD), highlighting its interactions with inflammatory pathways such as Toll-like receptor-4 (TLR-4). TIM-3, predominantly expressed on T cells, dendritic cells, and monocytes, acts as an inhibitory receptor that quenches pro-inflammatory signaling, particularly upon binding to ligands like galectin-9. Noteworthy, recent evidence suggests that TIM-3 deficiency or dysregulation can exacerbate inflammatory cascades, contributing to the progression of IHD and related complications. Here, the therapeutic potential of targeting TIM-3 for the management of IHD, especially in the settings of systemic inflammation and post-operative complications, has been discussed. By elucidating the molecular mechanisms and translational prospects of TIM-3 modulation, this work proposes new avenues for immunotherapeutic intervention in cardiovascular disease and post-operative SIRS, warranting further research in clinical trials.
PMID:40549173 | DOI:10.1007/s11033-025-10729-3