Cureus. 2025 May 23;17(5):e84680. doi: 10.7759/cureus.84680. eCollection 2025 May.
ABSTRACT
Burkitt lymphoma (BL) is a highly aggressive B-cell non-Hodgkin lymphoma (NHL) that rarely occurs as a post-transplant lymphoproliferative disorder (PTLD), especially in the elderly. We report a rare case of BL in a male in his 70s who developed BL several years following heart transplantation in the setting of chronic immunosuppression. He initially presented with signs and symptoms of severe hypercalcemia and retroperitoneal lymphadenopathy, which was biopsied to confirm the diagnosis. Treatment was initiated with rituximab and intrathecal methotrexate; however, his hospital course was complicated by a sigmoid microperforation due to a newly formed colonic fistula. This is an unusual case of Epstein-Barr virus (EBV) reactivation causing PTLD and underscores the importance of considering aggressive lymphomas in immunocompromised elderly patients following solid organ transplantation.
PMID:40546500 | PMC:PMC12182806 | DOI:10.7759/cureus.84680
Oral Dis. 2025 Jun 22. doi: 10.1111/odi.70012. Online ahead of print.
ABSTRACT
BACKGROUND: Kidney transplant recipients (KTRs) experience immune modulation, which may lead to graft rejection and other adverse outcomes. Although serum cytokines are well-established systemic immune markers, the role of salivary biomarkers has never been reported in the literature.
OBJECTIVE: To investigate salivary and serum cytokine levels in KTRs and their correlations with clinical outcomes over time.
MATERIALS AND METHODS: We evaluated the same group of 38 KTRs at T1 (< 6 months post-transplantation) and T2 (> 6 months post-transplantation). Samples were analysed with Human 6-Plex Cytokine Panel (Luminex) and clinical data were collected from medical records. Statistical analyses included Wilcoxon tests, Fisher's exact tests, Spearman's correlation, and Benjamini-Hochberg procedure for multiple comparisons (p < 0.05 significant).
RESULTS: Serum cytokines showed lower IFN-γ levels in cardiac events and associations of TNF-α, IL-8, and IL-10 with cytomegalovirus (CMV), BK polyomavirus (BKPyV) viremia and anaemia. Salivary cytokines showed distinct profiles, with elevated levels of TNF-α in anaemia and IL-8 in patients with diarrhoea. Those not experiencing acute rejection in both cases showed reduced salivary IL-8 levels.
CONCLUSIONS: Integrating serum and salivary measurements highlighted the potential of salivary biomarkers, particularly TNF-α and IL-8, in complementing traditional blood-based assays and other invasive monitoring methods in kidney transplantation.
PMID:40545713 | DOI:10.1111/odi.70012
Catheter Cardiovasc Interv. 2025 Jun 22. doi: 10.1002/ccd.31698. Online ahead of print.
ABSTRACT
Cardiogenic shock (CS) remains a high morbidity and mortality condition worldwide frequently complicating acute myocardial infarction (AMI) and decompensated heart failure (HF). Within the management of CS, mechanical circulatory support (MCS) devices play a critical role in maintaining hemodynamic stability, preserving end-organ perfusion and bridging patients through to recovery, implantation of durable support or transplantation. Despite their use, optimal timing of initiation, as well as patient and device selection remain unclear. This review explores the current landscape of MCS devices, surrounding evidence and key distinctions between devices. With increasing acknowledgment for the heterogeneity of CS, understanding the strengths and limitations of each device remains crucial to improving outcomes in this high-risk population.
PMID:40545708 | DOI:10.1002/ccd.31698
Transplantation. 2025 Jun 23. doi: 10.1097/TP.0000000000005377. Online ahead of print.
ABSTRACT
BACKGROUND: There is a growing population of solid organ transplant (SOT) survivors who subsequently require a hematopoietic cell transplant (HCT), although there are limited data on survival, risk factors for SOT graft loss, and death in this cohort.
METHODS: This retrospective Center for International Blood and Marrow Transplant Research study included recipients of SOT followed by HCT between 1989 and 2017. HCT data were merged with organ transplant data from the Organ Procurement and Transplantation Network.
RESULTS: Eighty-three patients with an SOT underwent an HCT. Organs transplanted included heart/lung (thoracic, n = 15), kidney (n = 42), and liver (n = 26); 24 patients (29%) received a living donor graft and 59 (71%) a deceased graft. Forty-one patients (49.4%) received an allogeneic HCT and 42 (50.6%) an autologous HCT. Three-year overall survival (OS) from HCT in the entire cohort was 38.6%. There were no significant differences in OS by SOT type, although 3-y OS appeared lowest in the kidney SOT group at 29.9%, compared with liver SOT at 40.6% and thoracic SOT at 58.2%. The incidence of SOT graft failure 3 y post-HCT was 59.1%. There were no significant differences in SOT graft failure by organ type: 3-y failure probability 67.2% for kidney, 56.5% for liver, and 46.2% for thoracic. Shared risk factors for death and graft failure included HCT indication (leukemia, lymphoma, and nonmalignant diseases), HCT type (allogeneic), and SOT type (kidney).
CONCLUSIONS: Although some SOT recipients may benefit from HCT, the incidence of SOT graft failure was high and OS was poor, particularly after allogeneic HCT.
PMID:40545567 | DOI:10.1097/TP.0000000000005377
Cureus. 2025 May 22;17(5):e84605. doi: 10.7759/cureus.84605. eCollection 2025 May.
ABSTRACT
Tracheoesophageal fistula (TEF) is a rare, pathological connection between the trachea and esophagus that can be acquired or congenital. Acquired TEF typically occurs due to iatrogenic injuries. There is often a delay in diagnosis due to the rare nature of this condition. These patients have a very high mortality rate, and a multidisciplinary strategy is required for the management of TEF involving specialists from interventional pulmonology, gastroenterology, and thoracic surgery. The clinical features, diagnosis, and management of nine patients with TEF are covered in this article. Eight patients were diagnosed with acquired TEF and one with a recurrence of congenital TEF. Our experience shows that, when patients develop TEF, it is usually a terminal event, and major procedures cannot be tolerated due to multiple comorbidities and ventilator dependency. Thus, these patients are managed with palliative treatment to improve their quality of life. Although surgical intervention is the gold standard for patients with acquired TEF, it is considered feasible in very few cases, so this article focuses primarily on interventional therapy rather than surgery.
PMID:40546474 | PMC:PMC12181819 | DOI:10.7759/cureus.84605
Cureus. 2025 May 22;17(5):e84655. doi: 10.7759/cureus.84655. eCollection 2025 May.
ABSTRACT
Background Significant valve disease requires surgical intervention, either valve repair or valve replacement. For minor disease, balloon dilation is a possibility. The choice between mechanical and bioprosthetic valves requires a judgment regarding the benefits and risks of each procedure. A mechanical prosthetic valve requires lifelong anticoagulation, whereas a bioprosthetic valve tends to degenerate over a few years, with faster degeneration observed in younger patients. Objective To assess the survival outcomes, postoperative complications, and reoperation rates in patients who underwent prosthetic mechanical valve replacement with acenocoumarol and low-dose aspirin (75 mg), with adequate International Normalized Ratio (INR) monitoring. Methods and materials This was a retrospective study involving data from patients who underwent mechanical cardiac valve replacement between 1971 and 2022. This study adhered to the principles outlined in the Declaration of Helsinki and received approval from the institutional ethics review board of Bombay Hospital (Regn. No: ECR/296/Inst/MH/2013; Date: 08/12/2021). Results A total of 768 patients were included. The mean overall survival rate was 35.2%, and it was higher in men than in women. The majority of patients belonged to a younger age group (≤18 years: 6.3%, 19-40 years: 47.7%, 41-60 years: 42.2%, >60 years: 3.9%). The mean overall survival rate was higher in men (37.4%) than in women (28.4%). In the first year post-surgery, females experienced Major Adverse Cardiac and Cerebrovascular Events (MACCE) at a rate of 11.1 person-years, while males had none. Among patients classified as New York Heart Association (NYHA) class III, the incidence rate of MACCE was 2.7 person-years, whereas for NYHA class IV patients, it was 8.3 person-years. These trends persisted to some extent at the fifth year post-surgery. Conclusion Survival outcomes were influenced by factors such as age, sex, type of valve replacement, and NYHA class, with certain subgroups showing better survival rates. The first year post-surgery presented a higher incidence of MACCE, which declined over time. Mechanical valve replacement with appropriate anticoagulation can offer favorable long-term outcomes, particularly in younger patients. However, early postoperative risks, especially in women and those with advanced heart failure, highlight the need for individualized care and close monitoring. Future research should aim to refine patient selection, explore sex-based outcome disparities, and optimize anticoagulation strategies to further improve survival and quality of life in this population.
PMID:40546510 | PMC:PMC12182600 | DOI:10.7759/cureus.84655
BMJ Case Rep. 2025 Jun 22;18(6):e265337. doi: 10.1136/bcr-2025-265337.
ABSTRACT
Congenital tracheobronchomegaly, also known as Mounier-Kuhn syndrome (MKS), is an uncommon illness characterised by dilatation of the major bronchi and recurrent chest infections. Tracheobronchomegaly may also be accompanied by tracheal and bronchial diverticula. We report the case of a middle-aged woman with a complaint of uterine prolapse for which a hysterectomy is planned. The patient complained of recurrent cough with expectoration for the last 6 years; hence, a radiograph of the chest and CT of the thorax were advised. A radiograph of the chest and thoracic CT showed dilation and numerous diverticula of the trachea and bronchi that suggested MKS. Management of MKS in symptomatic patients is supportive but is only used to treat contagious exacerbations with antibiotics and respiratory exercise to clear secretions. Here is an attempt to reach out to the cause of uterine prolapse in this patient with MKS and correlating these two conditions.
PMID:40545290 | DOI:10.1136/bcr-2025-265337
Diabetes Care. 2025 Jun 22:dc250942. doi: 10.2337/dc25-0942. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate the clinical efficacy of intensive LDL cholesterol (LDL-C) lowering in type 1 diabetes mellitus (T1DM).
RESEARCH DESIGN AND METHODS: Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) randomized participants with atherosclerotic cardiovascular disease (ASCVD) on statins to evolocumab or placebo (median follow-up 2.2 years). The primary end point (PEP) was cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization.
RESULTS: Of 27,564 participants, 10,834 (39.3%) had type 2 diabetes mellitus (T2DM), and 197 (0.7%) had T1DM. In the placebo arm, there was a stepwise increase in the 2.5-year PEP Kaplan-Meier rate from 11.0% to 15.2% to 20.4% in participants with no diabetes, T2DM, and T1DM, respectively (P < 0.0001). Hazard ratios for PEP with evolocumab were 0.87 (95% CI 0.79-0.96), 0.84 (0.75-0.93), and 0.66 (0.32-1.38) in the no diabetes, T2DM, and T1DM groups, and absolute risk reduction was 1.3%, 2.5%, and 7.3%, respectively.
CONCLUSIONS: Intensive LDL-C lowering may provide substantial clinical benefit in individuals with T1DM and ASCVD. Additional randomized controlled cardiovascular outcomes trials are needed in this population.
PMID:40544474 | DOI:10.2337/dc25-0942
Orv Hetil. 2025 Jun 22;166(25):963-969. doi: 10.1556/650.2025.33315. Print 2025 Jun 22.
ABSTRACT
Bevezetés: A szívinfarktusos betegek kezelésének eredményességét, életkilátásait jelentősen befolyásolja a teljes ischaemiás idő, amelyet a panasz kezdetétől az ér megnyitásáig számítunk. Célkitűzés: Vizsgálatunkban a teljes ischaemiás idő összetevőinek hosszát elemeztük, és összehasonlítottuk az 5 évvel korábbi vizsgálat eredményeivel. Módszer: 2022. 07. 01. és 2023. 06. 30. közötti időszakban 8705 (4334 [49,8%] STEMI, 3428 [39,4%] nő) infarktusos beteget regisztráltunk, akiknél a teljes ischaemiás idő összetevőinek számításához minden adat rendelkezésre állt. Az idők esetén a mediánértéket és a nevezetes kvartiliseket (alsó kavartilis Q1 és felső kvartilis Q3) adtuk meg, előző tanulmányunkhoz hasonlóan. A diagnózist a kórházi kezelés során állapították meg a kezelőorvosok az érvényes kritériumok alapján. Vizsgáltuk a panasz kezdetétől a mentőszolgálat értesítéséig eltelt időt (a beteg késlekedése), a mentő helyszínre érkezésének (M1) és a helyszíni ellátás (M2) idejét, valamint a helyszínről a kórházi felvételéig eltelt időt (M3). A kórházi ellátás értékelésénél a felvétel és az ér megnyitása között eltelt időt („ajtó–tű idő”) adtuk meg. Az adatokat országos és megyei bontásban is megadtuk. Eredmények: STEMI-betegeknél országosan a betegek késésének mediánértéke 140 perc (Q1: 51; Q3: 458) volt. A mentő helyszínre érkezési idejének mediánértéke 13,2 perc (Q1: 8,0; Q3: 21,1), a helyszíni ellátás idejének mediánértéke 25,5 perc (Q1: 17,6; Q3: 34,9), a helyszínről a kórházba érkezés idejének mediánértéke 31,0 perc (Q1: 19,5; Q3: 43,7) volt. A helyszínre érkezés tartománya 8,8–17,9 perc között változott a különböző megyékben. STEMI-betegeknél a medián ajtó–tű idő országosan 51,5 perc (Q1: 28,7; Q3: 121,7) volt. Az NSTEMI-csoportban a betegek késlekedésének mediánértéke 373 perc (Q1: 106; Q3: 1184), a helyszínre érkezési idő 14,2 perc (Q1: 8,5; Q3: 24,8) volt. STEMI esetén a betegek késlekedése – a korábbival összehasonlítva – közel 40 perccel nőtt (101 vs. 140 perc), a mentő helyszínre érkezésének mediánértéke (13,0 vs. 13,2 perc) érdemben nem változott. Az ajtó–tű idő a jelen vizsgálatban közel 15 perccel volt hosszabb, mint korábban (37,0 vs. 51,5 perc). A STEMI-betegcsoportban a kezelések 4,1%-ában 2 órán belül, 38,3%-ában 4 órán belül került sor az ér megnyitására. Következtetés: A teljes ischaemiás idő tekintetében a betegek késlekedése a meghatározó tényező, emiatt a kezelések jelentős részében nem az optimális időben került sor a revascularisatióra. Orv Hetil. 2025; 166(25): 963–969.
PMID:40544442 | DOI:10.1556/650.2025.33315
Toxicol Appl Pharmacol. 2025 Jun 20;502:117448. doi: 10.1016/j.taap.2025.117448. Online ahead of print.
ABSTRACT
Pyroptosis is one of the major forms of cardiomyocyte death following ischemia/reperfusion (I/R). Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1)/Tumor necrosis factor receptor associated factor 6 (TRAF6) pathway is involved in cardiomyocyte pyroptosis in mouse heart following I/R, and telaprevir, a hepatitis C virus protease inhibitor, has been predicted as a potential inhibitor of MALT1. This study aims to explore the effect of telaprevir on I/R-induced cardiomyocyte pyroptosis. The C57BL/6J mouse was subjected to 45 min-ischemia plus 24 h-reperfusion to establish the myocardial I/R injury model, while H9c2 cardiomyocytes were exposed to hypoxia for 8 h plus reoxygenation for 24 h (H/R) to simulate the I/R pathological process in vitro. Compared to the control group, pyroptosis was significantly increased in the I/R-treated mouse heart or the H/R-treated cardiomyocytes, evidenced by the elevated GSDMD and caspase-11 cleavage. Compared to the vehicle, telaprevir reduced myocardial infarcted size and cleavage of caspase-11 and gasdermin D (GSDMD) in mouse heart following I/R and cultured cardiomyocytes subjected to H/R in a dose-dependent manner. Mechanistically, telaprevir inhibited the recruitment of TRAF6 by MALT1, concomitant with the reduced recruitment of caspase-11 by TRAF6, and in turn, attenuated caspase-11 K63 poly-ubiquitination and activation, which was further confirmed by knockdown of TRAF6. Based on these results, we concluded that telaprevir could protect mouse heart against I/R injury by reducing caspase-11-dependent pyroptosis through inhibition of MALT1/TRAF6 pathway.
PMID:40545203 | DOI:10.1016/j.taap.2025.117448
Cell Signal. 2025 Jun 20;134:111956. doi: 10.1016/j.cellsig.2025.111956. Online ahead of print.
ABSTRACT
Endogenous ghrelin and its synthetic mimetics are peptide growth hormone (GH) secretagogues (GHSs) that exert a variety of cardioprotective effects. There are experimental evidence suggesting the beneficial effects of GHSs on ischemia/ reperfusion (I/R) injury, myocardial infarction (MI), heart failure (HF), isoproterenol-induced injury, and doxorubicin-induced cardiotoxicity. The effects of GHS were mediated by improving contractility and cardiac output, vasodilation, boosting cardiac antioxidant potential, reducing infarct size, and inhibition of cardiac apoptosis and fibrosis. The existing literatures have confirmed the improvement of cardiac function, attenuation of inflammation, rebalancing the autonomic nervous system (ANS), suppression of cardiac remodeling, improving arrhythmia and HF by GHS in experimental animal models and clinical patients. However, the molecular mechanisms of GHS on HF have not been fully elucidated. Here, we summarize available recent data on improving HF by GHS through molecular signaling pathways, to propose a novel strategy for the prevention and treatment of HF.
PMID:40545112 | DOI:10.1016/j.cellsig.2025.111956
Int J Cardiol. 2025 Jun 20:133521. doi: 10.1016/j.ijcard.2025.133521. Online ahead of print.
NO ABSTRACT
PMID:40544878 | DOI:10.1016/j.ijcard.2025.133521
Cardiorenal Med. 2025 Jun 20:1-25. doi: 10.1159/000546924. Online ahead of print.
ABSTRACT
BACKGROUND: Heart failure (HF) prevalence is increasing, and its prognosis worsens in the presence of other comorbidities. Up to 70% of patients develop cardio-renal syndrome (CRS), which is associated with diuretic resistance or kidney deterioration over time. Peritoneal dialysis (PD) for ultrafiltration (PD-UF) could be a potential therapeutic option in CRS, although its long-term outcomes have not been described.
METHODS: Retrospective registry study of the Catalan Renal Registry on patients with PD-UF indication between 2013-2022. Baseline clinical characteristics and follow-up until December/2022 was studied.
RESULTS: Of the 1874 incident patients on PD,198(10.6%) were PD-UF,73.2% of the patients were male and the mean age was70.7±9.3 years. Median eGFR at start was 22.6 [IQR14.8-32.8] ml/min·1.73m2 and 75.0% have an eGFR above 15 ml/min·1.73m2. Previous history of ischemic heart disease, arrhythmia or cardiac surgery was recorded, 57.6% of patients had ≥2 of these pathologies. The most common HF etiology was ischemic heart disease in 21.7% of patients. Median overall patient survival was 21 months [IQR17.3-24.3]. Technique survival at one year was 94.8%, and 27 patients were transferred to other renal replacement therapy (hemodialysis or kidney transplantation). In the cox multivariate analysis, age>75 years (HR 1.76[95%CI 1.20-2.59]), mild frailty (HR2.18[95%CI 1.17-2.59]), severe frailty (HR 17.62[95%CI 1.20-55.48]) and the burden of cardiac disease (2 categories HR 2.17[95%CI 1.05-4.47]; 3 categories HR 2.26 [95%CI 1.05-4.89]) were associated with poor overall survival. Technique survival was associated with eGFR (<30 ml/min·1.73m2 HR 5.64[95%CI 1.32-24.18]) and body mass index (<20 kg/m2 HR 6.53 [95%CI 1.06-40.12]) at baseline.
CONCLUSION: PD-HF is a feasible option in patients with advanced HF and CRS. The complexity of this population increases with older age, frailty and higher cardiac burden.
PMID:40544832 | DOI:10.1159/000546924
J Thorac Cardiovasc Surg. 2025 Jun 20:S0022-5223(25)00535-5. doi: 10.1016/j.jtcvs.2025.06.015. Online ahead of print.
ABSTRACT
OBJECTIVE: Orthotopic heart transplant is the definitive option for pediatric patients with end-stage heart failure. Unfortunately, the greatest contributor to waitlist mortality has been a shortage of available hearts for transplant. Donation after circulatory death with normothermic regional perfusion may mitigate this supply-demand mismatch.
METHODS: Donation after circulatory death with normothermic regional perfusion recipients were matched to similar donation after brain death recipients. Primary end points included 1-year survival, and episodes of primary graft dysfunction at 1 year. Secondary end points included treated rejection at 1 year and ventricular systolic and diastolic function on echocardiogram at time of discharge. Elevated filling pressures or decreased cardiac output were also examined via cardiac catheterization data at time of endomyocardial biopsy at 1 year.
RESULTS: Twelve donation after circulatory death procurements were attempted and nine hearts procured. Donor cardiac arrest and cardiac function prior to procurement were similar in both groups. Donation after brain death recipients spent more time on the waitlist. Following transplant, biventricular function was similar in both groups at time of discharge and at 1-year follow-up. There were no differences between groups with regard to primary graft dysfunction or instances of treated rejection at 1 year.
CONCLUSIONS: This study represents the largest single-institution cohort of pediatric recipients of hearts obtained following donation after circulatory death with normothermic regional perfusion compared to demographically similar donation after brain death cardiac transplant recipients. These results are indicative of equivalent outcomes at 1-year, suggesting that donation after circulatory death with normothermic regional perfusion is a viable method to expand the pediatric cardiac donor pool.
PMID:40545233 | DOI:10.1016/j.jtcvs.2025.06.015
J Cardiothorac Surg. 2025 Jun 21;20(1):266. doi: 10.1186/s13019-025-03512-9.
ABSTRACT
BACKGROUND: Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.
METHODS: PubMed, Google Scholar, and Cochrane Library were searched until May 2024 for studies comparing the radial and femoral approaches in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, and hospital stay. Generic inverse variance (GIV) was used to pool the risk ratio for dichotomous outcomes and mean difference (MD) for the continuous outcomes, with corresponding 95% confidence intervals (CIs).
RESULTS: Twelve studies including 15,700 patients with a mean age of 77.77 years in the radial group and 74.04 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was a significantly lower risk (RR: 0.23; 95% CI [0.12, 0.41]; p < 0.00001) in the radial group as compared to the femoral group. From the secondary outcomes, radial access was found to have significantly lower MACE (RR:0.80; 95% CI [0.68, 0.93]; p = 0.004), shorter procedural time (MD: -6.95; 95% CI [-11.52, -2.38], p = 0.003) and hospital stay (MD: -2.8; 95% CI [-5.56, -0.04], p = 0.05) as compared to femoral group. In contrast, all the other secondary outcomes were found to be insignificant.
CONCLUSION: Rotational atherectomy using the radial approach has a significantly lower rate of major vascular site bleeding and MACE and is associated with significantly shorter procedural time and hospital stay.
PMID:40544305 | PMC:PMC12182652 | DOI:10.1186/s13019-025-03512-9
Cardiovasc Revasc Med. 2025 Jun 13:S1553-8389(25)00296-9. doi: 10.1016/j.carrev.2025.06.010. Online ahead of print.
ABSTRACT
Advancements in percutaneous coronary intervention (PCI) technology and post-PCI patient management have led to improvements in clinical outcomes in coronary artery disease patients. At the forefront of these advancements is intravascular imaging - reduced risks of death, myocardial infarction, repeat revascularization, and stent thrombosis have been demonstrated with intravascular imaging-guided PCI compared with angiography guidance alone. The latest 2024 European Society of Cardiology chronic coronary syndrome guidelines and the 2025 American College of Cardiology/American Heart Association acute coronary syndrome guidelines provide a Class I recommendation for use of intravascular imaging in complex PCI. At the recently concluded Cardiovascular Research Technologies 2025 Meeting, a dedicated session titled "Beyond the Guidelines - Intravascular Imaging Guidance of PCI, Diagnosis and Treatment" was conducted to address gaps in the existing guidelines. This review summarizes the scenarios not covered by the current guidelines, key takeaways from the discussion by the expert panel, and the audience's perspective on critical questions needed for future guideline developments.
PMID:40544127 | DOI:10.1016/j.carrev.2025.06.010
Can J Cardiol. 2025 Jun 19:S0828-282X(25)00391-5. doi: 10.1016/j.cjca.2025.06.008. Online ahead of print.
ABSTRACT
BACKGROUND: A 2022 meta-analysis concluded colchicine reduced the cardiac risk in secondary prevention. Nevertheless, a large, randomized clinical trial (RCT) continued to randomize patients to colchicine or placebo and in 2025 published findings of no benefit. Bayesian sequential analyses and hierarchical meta-analysis can assist in understanding not only the interpretation of this latest trial but also the totality of the evidence.
METHODS: A systematic review and Bayesian meta-analysis including the recent CLEAR trial results was performed. The primary outcome was major adverse cardiovascular events (MACE), a composite of death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization. Bayesian sequential analyses were performed with vague (result dominated by CLEAR), fully informative (based on all previous studies), and "focused" (considering only the largest and most similar previous trial) priors and results compared with a hierarchical meta-analysis. The probabilities of clinically meaningful results were based on > absolute 15% MACE reduction.
RESULTS: While the 2022 meta-analysis suggested a statistically significant MACE decrease with colchicine, the Bayesian reanalysis showed a 95% credible interval (95% CrI 0.26, 1.70) for the next study, justifying CLEAR continuation. The Bayesian sequential analyses using vague, all-inclusive, and focused priors showed 58%, 100% and 92% probabilities respectively of MACE decrease with colchicine. Clinically meaningful probability decreases, based on > absolute 15% reduction, were smaller, ranging between 2% to 41%.
CONCLUSIONS: Bayesian analyses offer advantages in trial design and interpretation, suggesting some benefit for colchicine in secondary cardiovascular prevention, but considerably less certainty of its clinical importance.
PMID:40543648 | DOI:10.1016/j.cjca.2025.06.008
J Endovasc Ther. 2025 Jun 21:15266028251325054. doi: 10.1177/15266028251325054. Online ahead of print.
ABSTRACT
OBJECTIVE: Carotid artery restenosis can occur after both carotid artery stenting (CAS) and carotid endarterectomy (CEA). This systematic review and meta-analysis aim to determine which revascularization technique, CAS, or CEA, is superior for treating primary carotid restenosis, irrespective of the initial revascularization method used.
DESIGN: Systematic review and meta-analysis.
METHODS: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRALs) databases were searched for eligible studies on December 19th, 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Primary endpoint was the occurrence of transient ischemic attack (TIA) or any stroke. Secondary endpoints were technical success, death within 30 days, myocardial infarction (MI), local complications, cerebral hyperperfusion syndrome (CHS), cranial nerve injury (CNI), dys-/arrythmia, secondary restenosis, repeat revascularization, and long-term survival. Results were adjusted for symptomatic status and primary treatment strategy.
RESULTS: Nineteen studies comprising 10,171 procedures in 10,041 patients were included. Baseline characteristics were comparable between groups. Main findings were (1) No difference in primary outcome; however, if adjusted for symptomatic status the rate of TIA/any stroke is higher (OR: 2.05, 95% CI: 1.29-3.27, p < 0.01) after CEA compared to CAS; (2) Significant higher rate of MI (OR: 1.85, 95% CI: 1.19-2.86, p < 0.01) after CEA; (3) Besides CNI, which appears to be commonly temporary and occurred only after CEA (7.56%, 95% CI: 4.21%-13.22%), no significant differences in other secondary endpoints were observed between groups. Long-term risk of secondary restenosis was similar between CEA compared to CAS (OR: 0.98, 95% CI: 0.39-2.49, p = 0.95); (4) Correction for the index procedure did not affect conclusions.
CONCLUSION: Based on limited-quality studies, mostly retrospective and nonrandomized in design, both CAS and CEA represent feasible treatment approaches for patients with primary restenosis, with comparable primary outcome between the two groups. However, based on the obtained results, CAS appears to be preferable. Patients should be critically evaluated in a multidisciplinary team and further research is desirable.Clinical ImpactThis review expands on previous studies by incorporating a larger patient cohort and more recent literature while offering new insights into restenosis. Unlike earlier research, this study uniquely evaluates first repeat revascularization outcomes (CAS and CEA) independently of the initial procedure, suggesting that patient and plaque characteristics might be more influential than the primary technique. Sensitivity analysis confirmed this, as stratification by index procedure did not alter conclusions. Although lower TIA/stroke and mortality rates were observed in CAS-treated patients, these findings were not statistically significant in the overall group. These results may help guide clinical decision-making for optimal restenosis management.
PMID:40542821 | DOI:10.1177/15266028251325054
Metabolism. 2025 Jun 19;170:156332. doi: 10.1016/j.metabol.2025.156332. Online ahead of print.
ABSTRACT
Cardiovascular diseases (CVDs), the leading cause of global mortality, are now understood to be profoundly influenced by the endocrine regulatory functions of the skeletal system. Emerging evidence suggests that osteocrine factors, including fibroblast growth factor-23 (FGF23), lipocalin-2 (LCN2), Dickkopf-1 (DKK1), myeloid-derived growth factor (MYDGF), osteocalcin (OCN), and sclerostin (SOST), establish bidirectional regulatory networks with the cardiovascular system, termed the "bone-heart axis". This axis regulates critical pathological processes, including mineral metabolism, vascular calcification, and myocardial energy homeostasis. Dysregulation of this crosstalk accelerates the progression of atherosclerosis (AS), heart failure (HF), and other CVDs. Therefore, current research necessitates a paradigm shift from univariate analyses to elucidating the spatiotemporal dynamics of interorgan communication, thereby facilitating the development of precision therapeutic strategies for integrated skeletal and cardiovascular protection.
PMID:40543811 | DOI:10.1016/j.metabol.2025.156332
Arch Cardiovasc Dis. 2025 Jun 12:S1875-2136(25)00325-0. doi: 10.1016/j.acvd.2025.04.056. Online ahead of print.
ABSTRACT
BACKGROUND: Despite the widespread adoption of percutaneous pulmonary valve implantation, there remains a lack of consensus on the optimal management of peri-interventional and long-term antithrombotic therapies because of a lack of evidence.
AIM: To clarify current practices in peri/postprocedural antithrombotic strategies for percutaneous pulmonary valve implantation.
METHODS: An online survey was submitted to the Interventional Working Group of the Association for European Paediatric and Congenital Cardiology, and was completed by 76 congenital interventional cardiologists in 2023-2024.
RESULTS: Overall, 86% had standardized protocols for anticoagulation/antiaggregation. Intraprocedural heparin administration of 100IU/kg was common (83%), and postprocedural strategies mostly included acetylsalicylic acid (aspirin) (45%) or a combination of antiaggregation and anticoagulation (29%). Long-term strategies comprised antiaggregation (88%), no therapy (11%) and anticoagulation only (1%). Acetylsalicylic acid monotherapy was prescribed by 91%, whereas 9% used dual antiaggregation therapy. Dual antiaggregation therapy was continued for suspicious medical history of thrombotic complication or microthrombi for 3-6 months. Testing for acetylsalicylic acid resistance was infrequent (36%), and only if clinically indicated. When patients had pre-established anticoagulation therapy, 59% changed their strategy. Treatment changes based on valve type were rare (8%). The primary reasons for anticoagulation/antiaggregation were to increase valve longevity (26%) and for both longevity and endocarditis prophylaxis (68%). Acute valve thrombosis was reported in 11 cases.
CONCLUSIONS: The survey reveals variability in practices after percutaneous pulmonary valve implantation. Most interventional cardiologists prefer acetylsalicylic acid for postprocedural and long-term management, whereas dual antiaggregation therapy is sometimes used in specific cases. Anticoagulation is limited to pre-existing therapy cases or isolated experiences for 3 months.
PMID:40544108 | DOI:10.1016/j.acvd.2025.04.056