Curr Med Chem. 2025 Sep 30. doi: 10.2174/0109298673377544250714073536. Online ahead of print.
ABSTRACT
BACKGROUND: Endothelins are a family of vasoconstrictive peptides known for their high potency. They are mainly synthesized and secreted by the endothelial cells lining the blood vessels in response to various stimuli. Their main physiological role is the regulation of vascular tone, affecting blood pressure and tissue perfusion.
OBJECTIVE: The aim of this review was to evaluate the importance of Endothelin-1 (ET-1) plasma levels as a marker in diagnosis, disease burden, or development, due to its vascular effects.
METHODS: Data from several studies in different organ systems, collected over the last thirty years, were collected. A statistical analysis was performed to reveal any similarities and differences among them.
RESULTS: ET-1 was found to be increased in arterial and pulmonary hypertension. Plasma ET-1 was elevated in patients with heart failure, autoimmune disease, chronic kidney disease, and liver failure. In all these cases, ET-1 was increased at least twice the maximum of normal plasma concentration in healthy subjects, in a similar pattern, independently of the disease background. More importantly, plasma ET-I levels increased even more according to the severity of the disease, not necessarily in a linear manner.
CONCLUSION: Endothelin-1 appears to increase similarly across various pathological conditions, making it a potential biomarker for overall human physiological status.
PMID:41031504 | DOI:10.2174/0109298673377544250714073536
Front Pharmacol. 2025 Sep 15;16:1663717. doi: 10.3389/fphar.2025.1663717. eCollection 2025.
ABSTRACT
Hyperlipidemia is correlated with the elevation of cholesterol and triglyceride levels in the blood that increase the risk of cardiovascular events, such as heart attacks and strokes. This study aimed to test the hypolipidemic activity and other health benefits of atorvastatin and safflower (Carthamus tinctorius L., family Asteraceae) on rats with induced hypercholesterolemia in a four-week study. 24 male albino rats were divided into four groups (n = 6). The first group (G1) was given a normal basal diet as a negative control, while the other rats received a high-fat diet with 5% cholesterol. The second group (G2) served as the positive control, receiving no treatment. The third group (G3) received 200 mg/kg body weight safflower aqueous extract, and the 4th group (G4) received 20 mg/kg body weight atorvastatin. The induced hypercholesterolemia significantly raised liver function enzymes, lipid peroxidation (14.9 ± 0.11 mg/dL), total cholesterol (273.3 ± 1.1 mg/dL), triglycerides (223.0 ± 4.1 mg/dL), low-density lipoproteins (204.7 ± 0.9 mg/dL), very low-density lipoproteins (44.6 ± 0.8 mg/dL), troponin, creatine kinase (CK), and adrenaline while decreased antioxidant enzymes, high-density lipoprotein (HDL), and vitamin D (11.1 ± 0.5 ng/mL). The liver and heart tissues were also significantly injured by hypercholesterolemia. Administration of atorvastatin and safflower markedly ameliorated the biochemical and histological abnormalities associated with induced hyperlipidemia, restoring them to near-normal levels. Atorvastatin treatment in G4 demonstrated superior efficacy compared to safflower extract in addressing hypercholesterolemia, despite the latter's significant hypolipidemic effect observed in G3.
PMID:41031162 | PMC:PMC12477430 | DOI:10.3389/fphar.2025.1663717
World J Nephrol. 2025 Sep 25;14(3):107415. doi: 10.5527/wjn.v14.i3.107415.
ABSTRACT
Chikungunya, a vector-borne viral disease, has become a critical global health issue due to its capacity for widespread outbreaks, especially in tropical and subtropical regions, and its recent global expansion. The resurgence of Chikungunya virus (CHIKV) in Karachi, Pakistan, has amplified public health challenges, driven by factors such as urbanization, climate change, and socioeconomic vulnerabilities, including limited healthcare infrastructure. Clinically, the disease primarily manifests with fever, rash, and debilitating joint pain, which often leads to prolonged discomfort and decreased quality of life. However, emerging evidence points to atypical and severe complications affecting the neurological, cardiac, and kidney systems, increasing the risk of morbidity and mortality. Kidney involvement in Chikungunya is of particular concern, with acute kidney injury being identified as a critical complication. Timely diagnosis of the infection and early identification of individuals at heightened risk of progressing to severe kidney dysfunction is crucial to improving patient outcomes. Such individuals often include those with pre-existing kidney conditions or other underlying comorbidities, making them more susceptible to complications. This narrative review aims to synthesize and expand upon the current understanding of the mechanisms underlying CHIKV-induced kidney injury. These mechanisms encompass direct viral invasion of kidney tissue, immune-mediated inflammatory responses that inadvertently damage the kidneys, and the aggravation of pre-existing kidney pathologies. Furthermore, the complex interplay between the virus and the host's immune system may exacerbate kidney complications, highlighting the multifaceted nature of CHIKV pathophysiology.
PMID:41030918 | PMC:PMC12477685 | DOI:10.5527/wjn.v14.i3.107415
Respir Med Case Rep. 2025 Sep 16;58:102291. doi: 10.1016/j.rmcr.2025.102291. eCollection 2025.
ABSTRACT
This case report describes a 45-year-old female with HHT type 1 (ENG mutation) and congenital heart disease (sinus venosus atrial septal defect and partial anomalous pulmonary venous return), diagnosed with severe PAH at age 16. Despite long-term treatment with epoprostenol, treprostinil, macitentan, and tadalafil, her condition progressed, leading to evaluation for lung transplantation. In May 2024, sotatercept, a novel TGF-β superfamily ligand trap, was initiated, resulting in significant improvement in exertional capacity and quality of life. The patient experienced increased epistaxis frequency (2-4 episodes/week), though hemoglobin levels rose from 13.0 to 15.4 g/dL. No new telangiectasias or other adverse events were noted. This is the first reported case of sotatercept use in PAH with HHT, highlighting its potential efficacy but also the need for careful monitoring due to increased bleeding risk.
PMID:41030324 | PMC:PMC12477927 | DOI:10.1016/j.rmcr.2025.102291
Nat Med. 2025 Sep 30. doi: 10.1038/s41591-025-03956-5. Online ahead of print.
ABSTRACT
Critical care syndromes such as sepsis, acute respiratory distress syndrome (ARDS) and trauma continue to have unacceptably high morbidity and mortality, with progress limited by the inherent heterogeneity within syndromic illnesses. Although numerous immune endotypes have been proposed for sepsis and critical care, the similarities and differences between these endotypes remain unclear, hindering clinical translation. The SUBSPACE consortium is an international consortium that aims to advance precision medicine in critical care through the sharing of transcriptomic data. Here, evaluating the overlap of existing immune endotypes in sepsis across >7,074 samples from 37 independent cohorts, we developed cell-type-specific gene expression signatures to quantify dysregulation within immune compartments. Myeloid and lymphoid dysregulation were associated with disease severity and mortality across all cohorts. Importantly, this dysregulation was also observed in patients with ARDS, trauma and burns, suggesting a conserved mechanism across various critical illness syndromes. Moreover, analysis of randomized controlled trial data revealed that myeloid and lymphoid dysregulation are associated with differential mortality in patients treated with anakinra in the SAVE-MORE trial (n = 452) and corticosteroids in the VICTAS (n = 89) and VANISH (n = 117) trials, underscoring their prognostic and therapeutic implications. In conclusion, our proposed immunology-based framework for quantifying cellular compartment dysregulation offers a potentially valuable tool for understanding immune dysregulation in critical illness with prognostic and therapeutic significance.
PMID:41028543 | DOI:10.1038/s41591-025-03956-5
Nat Med. 2025 Sep 30. doi: 10.1038/s41591-025-03933-y. Online ahead of print.
ABSTRACT
Lack of reliable diagnostics for the presence, type and severity of infection in patients presenting to emergency departments with non-specific symptoms poses considerable challenges. We developed TriVerity, which uses isothermal amplification of 29 mRNAs and machine learning algorithms on the Myrna instrument to determine likelihoods of bacterial infection, viral infection and need for critical care interventions within 7 days. To validate TriVerity, the SEPSIS-SHIELD study enrolled 1,222 patients with clinically adjudicated infection status and need for critical care intervention within 7 days as endpoints. The TriVerity Bacterial and Viral scores had higher accuracy than C-reactive protein, procalcitonin or white blood cell count for the diagnosis of bacterial infection with area under the receiver operating characteristic (AUROC) of 0.83, and viral infection (AUROC = 0.91). The TriVerity Severity score had an AUROC of 0.78 for predicting illness severity and allowed reclassification of risk for critical care interventions compared to clinical assessment (quick Sequential Organ Failure Assessment) alone. Each of the three scores had rule-in specificity >92% and rule-out sensitivity >95%. Comparison of antibiotics administration at presentation with post-follow-up adjudication found that TriVerity could potentially reduce false positives and false negatives for inappropriate antibiotics use by 60-70%. Further clinical testing in an interventional setting is needed to prove actionability and clinical benefit of TriVerity.
PMID:41028541 | DOI:10.1038/s41591-025-03933-y
Pediatr Res. 2025 Oct 1. doi: 10.1038/s41390-025-04443-w. Online ahead of print.
ABSTRACT
BACKGROUND: Early echocardiographic characteristics (EC) of congenital diaphragmatic hernia (CDH) neonates and their associations with outcomes, especially differences by laterality and size, are unknown.
METHODS: Congenital Diaphragmatic Hernia Study Group data between 2015 and 2020 were used. Early postnatal EC, including atrial and ductal shunt direction, pulmonary hypertension (PH) severity, and ventricular size and function, were assessed based on defect laterality and size. Outcomes included mortality and extracoporeal life support (ECLS) use.
RESULTS: The study population included 1777 infants. Severe PH, right-to-left shunt, left ventricular (LV) hypoplasia, right ventricular dilation, and ventricular dysfunction were more prevalent in larger defects. Independent of defect size, neonates with R-CDH had more severe PH, more bidirectional and right-to-left atrial shunt, and more biventricular (BV) dysfunction. In contrast, L-CDH neonates had more LV hypoplasia and left-to-right atrial shunt. After adjusting for defect side, larger defects were associated with LV hypoplasia and right-to-left and bidirectional atrial shunt. In multivariate analysis, right-to-left atrial shunt and BV dysfunction were associated with increased mortality, whereas bidirectional atrial shunt and BV dysfunction were associated with ECLS use.
CONCLUSIONS: CDH neonates are at increased risk for early cardiac dysfunction. EC differ by laterality and size. Management of cardiac dysfunction in CDH may improve outcomes.
IMPACT: Cardiac dysfunction has emerged as a factor contributing to adverse outcomes in congenital diaphragmatic hernia (CDH). However, there are limited data on the impact of defect size, laterality, and severity of postnatal cardiac dysfunction on outcomes. Echocardiographic characteristics in the first two days of life differ by defect laterality and size. Right-to-left atrial shunt and biventricular dysfunction are associated with increased mortality. Bidirectional atrial shunt and biventricular dysfunction were associated with extracorporeal life support use. Our results support the need for standardized cardiac function assessment in critically ill neonates with CDH. Future strategies to identify and manage these diverse hemodynamic profiles are needed to improve outcomes.
PMID:41034644 | DOI:10.1038/s41390-025-04443-w
Pediatr Cardiol. 2025 Oct 1. doi: 10.1007/s00246-025-04049-3. Online ahead of print.
ABSTRACT
Arginine-vasopressin (AVP) stimulates adrenocorticotropic hormone (ACTH) secretion and may contribute to the stress response after surgery. Its endocrine effects in children undergoing congenital heart surgery remain unclear. We prospectively evaluated 49 children (median age 8 months, IQR 5-59 months; median weight 11.0 kg, IQR 7.2-26.3 kg) after corrective cardiac surgery with cardiopulmonary bypass. Patients receiving AVP within 48 h postoperatively (n = 23) were compared with those not treated (n = 26). Baseline hormone levels (AVP, ACTH, cortisol, cortisol-binding globulin) were measured. Serial cortisol, ACTH, sodium, and glucose levels were analyzed. Time-series linear regression models examined associations between AVP therapy and adjusting for covariates such as cortisol, ACTH, CBG, and AVP levels. Baseline did not differ between groups. AVP therapy was not associated with significant differences in ACTH or cortisol over time. A non-significant trend toward higher cortisol was observed in AVP-treated patients. Regression analyses demonstrated significant associations between ACTH and cortisol (coefficient = 0.0325, p < 0.01), cortisol and systolic blood pressure (coefficient = 0.005, p < 0.01), and baseline AVP level with systolic blood pressure (coefficient = 0.003, p < 0.01) and renal oxygen extraction ratio (coefficient = 0.124, p = 0.01) and hormone levels. In this prospective cohort of children after congenital heart surgery, AVP therapy did not significantly alter ACTH or cortisol levels. Cortisol and baseline AVP levels were independently associated with hemodynamic markers. These findings suggest that the hemodynamic benefit of AVP is unlikely to be mediated through hypothalamic-pituitary-adrenal axis activation. Larger studies are needed to confirm these results.
PMID:41034421 | DOI:10.1007/s00246-025-04049-3
Pediatr Cardiol. 2025 Oct 1. doi: 10.1007/s00246-025-04038-6. Online ahead of print.
ABSTRACT
Systemic sirolimus (SS) is an mTOR inhibitor used in the management of pediatric intraluminal pulmonary vein stenosis (PVS). SS initiation, monitoring, including patient compliance with toxicity surveillance, and potential adverse events (AE) in PVS patients are under reported. A single-center retrospective cohort study of consecutive patients who were initiated on SS for PVS from January 1, 2020 to December 31, 2024 was performed. Fifty patients with a median age of 7 months (range 2-165) received SS for PVS (median number of stenotic veins; n = 3 (1-4)) for a median duration of 18 months (1-60). The median time to therapeutic level was 9 days [IQR 3, 20] with two never achieving therapeutic values. In patients who received SS for at least 6 months (n = 39), the median number of blood draws and number of dose adjustments in the first 6 months were 14 [IQR 5, 27] and 3 [1, 7], respectively. Most levels among patients (75%; [IQR 64, 84]) did not require a dose adjustment. Toxicity surveillance compliance increased from 58% [IQR 42, 83] to 79% [IQR 62.5, 92] (p = 0.22) following transitioning ownership of SS management to a dedicated PVS team. Eighteen percent (9/50) of patients had an AE potentially related to SS; SS was discontinued in three. PVS patients receiving SS have high, but variable rates of therapeutic levels and SS discontinuation due to AEs is uncommon. Compliance with safety labs may improve with ownership by a dedicated monitoring team.
PMID:41034420 | DOI:10.1007/s00246-025-04038-6
Int Heart J. 2025;66(5):805-812. doi: 10.1536/ihj.25-244.
ABSTRACT
Although the safety and efficacy of transcatheter atrial septal defect (ASD) closure has been reported in elderly patients, postprocedural outcomes in elderly patients with long-standing persistent atrial fibrillation (AF) have not been fully assessed. The aim of this study was to elucidate the cardiac remodeling process and symptom improvement after transcatheter ASD closure in elderly patients with AF (AF-ASD) compared to those in sinus rhythm (SR-ASD).We enrolled 52 patients aged > 70 years out of 253 consecutive patients who underwent transcatheter ASD closure. We retrospectively analyzed serial echocardiograms, New York Heart Association (NYHA) functional classification, and plasma brain natriuretic peptide (BNP) levels from baseline to 1 year after the procedure.With respect to the right-sided chambers, significant reverse remodeling began immediately after the procedure and continued in both groups up to 1 year after the procedure. Left ventricular augmentation was comparable in both groups. Left atrial volume increase was prominent in the AF-ASD group, with a statistically significant difference compared with the SR-ASD group from 2 days to 1 year after the procedure (all P < 0.05). NYHA functional classification improved in both groups. Plasma BNP levels decreased only in the AF-ASD group from baseline to 1 year (median value [interquartile range], 336.2 pg/mL [145.1-491.4] to 173.8 pg/mL [73.6-261.7], P = 0.032).Transcatheter ASD closure is an effective treatment for heart failure in elderly patients with ASD and long-standing persistent AF.
PMID:41034026 | DOI:10.1536/ihj.25-244
World J Pediatr Congenit Heart Surg. 2025 Oct 1:21501351251375444. doi: 10.1177/21501351251375444. Online ahead of print.
ABSTRACT
Objectives: This study aimed to report the incidence of cardiac arrest and in-hospital mortality after pediatric congenital heart surgery in a middle-income country. Methods: This retrospective cohort study was conducted in Thailand. Patients <18 years of age who underwent congenital heart surgery between 2014 and 2019 and experienced cardiac arrest following surgery during the same hospital stay were included. We examined the characteristics of patients who experienced cardiac arrest and its management to determine the mortality-associated factors following cardiac arrest. Results: Overall, 116 cases of cardiac arrest following 1,928 congenital heart surgery operations were included, which resulted in 93/116 (80%) deaths. The incidence of cardiac arrest and in-hospital mortality per 100 patients (95% confidence interval) were 6.0% [116/1,928 (5.0%-7.2%)] and 4.8% [93/1,928 (4.0%-5.9%)], respectively. The incidence of cardiac arrest was higher in neonates (33.6%, 47/140), high-risk STAT 5 surgery (54.8%, 23/43), and emergent/urgent surgery (25.4%, 81/319). Most cardiac arrests occurred within 24 h (66/116, 57%) and in the intensive care unit (90/116, 78%). The most common cause of cardiac arrest was cardiovascular-related (74.1%, 86/116). Multivariable analysis showed the factors associated with mortality (adjusted odds ratio, [95% confidence interval]) included cardiac arrest after 72 h (5.594 [1.073-29.167]), multiple cardiac arrests (10.231 [1.884-55.566]), and every minute increase in cardiopulmonary resuscitation (1.027 [1.005-1.048]). Conclusions: Congenital heart surgery at our middle income cardiac surgical center was associated with relatively high incidence rates of cardiac arrest and in-hospital mortality, and a very high mortality rate following cardiac arrest. The mortality-associated factors after cardiac arrest were cardiac arrest after 72 h, multiple cardiac arrests, and longer duration of cardiopulmonary resuscitation.
PMID:41032652 | DOI:10.1177/21501351251375444
Anesth Analg. 2025 Oct 1. doi: 10.1213/ANE.0000000000007754. Online ahead of print.
ABSTRACT
BACKGROUND: Previous studies have shown that regional anesthesia (RA) use versus placebo control is associated with less postsurgical opioid requirements and improved pain scores. This trial compared a novel combination of bilateral pecto-intercostal fascial plane and unilateral rectus sheath blocks to an active comparator of surgeon-administered local anesthetic wound infiltration in children undergoing septal defect repair. The study tested the hypothesis that RA use would result in less opioid use and lower pain intensity compared to wound infiltration.
METHODS: This double-blind, randomized, parallel group, single-center trial included children (<18 years) undergoing primary atrial septal defect (ASD) or ventricular septal defect (VSD) repair. Participants were randomized to RA consisting of ultrasound-guided pecto-intercostal fascial plane and rectus sheath blocks or no-block, consisting of local anesthetic wound infiltration. Both groups received 1.5 mL/kg of ropivacaine 0.2% for the intervention. The primary outcome was opioid use (oral morphine milligram equivalents [MME]/kg) 0-12 hours after surgery. Secondary outcomes were opioid use at additional time points, pain (0-10 scale) between 0 and 48 hours (area under the curve [AUC]), and hospital length of stay (LOS).
RESULTS: Data analysis included 42 children (24 RA, 18 infiltration), age 3.3 ± 2.7 years (mean ± standard deviation [SD]; median, 3; range, 4 months-10 years). Opioid use (MME/kg mean ± SD) 0-12 hours after surgery was 0.44 ± 0.19 in the RA group compared to 0.83 ± 0.39 in the infiltration group (mean difference -0.39; 95% confidence interval [CI], -0.59 to -0.18; P = .001). Total postoperative opioid use from 0 to 48 hours after surgery was 0.95 ± 0.40 in the RA group compared to 1.57 ± 0.75 in the infiltration group (mean difference -0.64; 95% CI, -1.02 to -0.22, P = .004). Pain intensity AUC (0-48 hours) was 45.0 ± 26.8 in the RA group compared to 94.5 ± 55.7 in the infiltration group (mean difference -49.5 [-78.9 to -20.1]; P = .002). Opioid use between 12 and 48 hours and hospital LOS was not different between groups.
CONCLUSIONS: This single-center study showed that the combined pecto-intercostal fascial plane and rectus sheath blocks were opioid-sparing and provided superior pain control compared to contemporary practice of local anesthetic infiltration in children following septal defect repair. This investigation strengthens the evidence to support RA use to improve postoperative pain in this population.
PMID:41032451 | DOI:10.1213/ANE.0000000000007754
Cureus. 2025 Aug 30;17(8):e91294. doi: 10.7759/cureus.91294. eCollection 2025 Aug.
ABSTRACT
Pediatric thoracic surgery has undergone significant changes and improvements due to the evolution of minimally invasive techniques, robotic-assisted interventions, and enhanced patient care. Enhanced thoracic surgical interventions progressed in pediatric thoracic tumors, airway management, chest wall reconstruction, and lung transplantation. Key areas for improvement include the adoption of enhanced recovery protocols, enhancing long-term outcomes, and integrating emerging technologies such as 3D printing and artificial intelligence. Despite the advancement in these fields, challenges still exist, underscoring the importance of high and specialized training, multidisciplinary collaboration, and future and continued research to optimize patient outcomes and shape the future of pediatric thoracic surgery. Emerging evidence supports standardized perioperative pathways tailored to children, including multimodal opioid-sparing analgesia, early mobilization, and proactive pulmonary physiotherapy. Advances in imaging and intraoperative navigation are refining lesion localization and resection margins while minimizing collateral trauma. Simulation-based training, competency benchmarks, and international registries can consolidate quality and safety. Equitable access across resource-limited settings, family-centered care, and long-term surveillance for functional, psychosocial, and oncologic outcomes remain priorities. Finally, telemedicine-enabled follow-up and data-driven decision support promise precision and continuity of care.
PMID:41030723 | PMC:PMC12478633 | DOI:10.7759/cureus.91294
Interdiscip Cardiovasc Thorac Surg. 2025 Oct 6;40(10):ivaf212. doi: 10.1093/icvts/ivaf212.
ABSTRACT
Surgical innovation through first-in-human (FIH) procedures, such as partial heart transplantation, plays an important role in advancing clinical care. However, these procedures frequently proceed without formal ethical oversight. We conducted a systematic PubMed search yielding 48 FIH congenital cardiac case reports (1990-2025), then screened each article for 10 predefined oversight-related terms covering regulatory bodies, ethics, and innovation boards. Only 15 procedures (30.6%) documented any oversight language. Although recent innovations demonstrate a modest increase in formal oversight, there remains a paucity of structured review for these novel procedures. These findings highlight persistent gaps in the governance and transparency of high-risk surgical innovation.
PMID:41029027 | PMC:PMC12500323 | DOI:10.1093/icvts/ivaf212
Cureus. 2025 Aug 30;17(8):e91270. doi: 10.7759/cureus.91270. eCollection 2025 Aug.
ABSTRACT
Infective endocarditis (IE) in people who inject drugs (PWID) has emerged as a growing public health concern. It entails two main issues future medicine will have to face: an increase in patients with substance abuse and the evolution of new microbial threats. The analysis of characteristics of the disease in this group of patients enables us to draw differentiating points. IE in PWID predominantly involves the right side of the heart, mainly the tricuspid valve. The prevalence of the disease is high in developed countries, in regions with a strong impact of drug abuse, particularly in the younger part of populations facing socioeconomic difficulties linked to changing life conditions in postindustrial economic systems. Staphylococcus aureus is by far the most frequent pathogen responsible for the infection in these patients, proportionally outnumbering the prevalence of this species in non-drug users. Also, higher rates of Gram-negative and fungal infections are posing a serious challenge in the treatment process. The Duke Criteria remain the common diagnostic methodology in all cases of IE, with echocardiography - both transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) - being staples for imaging. The identification of the pathogen includes both standard microbiologic blood culture tests and the use of advanced biomolecular methods. Management in an optimal therapeutic process requires targeted antimicrobial therapy, which in many cases has to be supported by invasive surgical or percutaneous interventions. The widening spectrum of surgical procedures, such as percutaneous vegetation debulking, transcatheter valve-in-valve implantation, or minimally invasive cardiac surgery, represents a positive change for patients in poor clinical condition who are not suitable for standard cardiothoracic procedures.. While short-term survival seems promising at first, the long-term results are still dissatisfying. The main area for improvement is the need for a multidisciplinary approach that integrates infection management and prevention with addiction treatment. An innovative approach combining these factors could lead to a better prognosis in PWID with IE in the future.
PMID:41030729 | PMC:PMC12477519 | DOI:10.7759/cureus.91270
J Cardiothorac Surg. 2025 Sep 30;20(1):353. doi: 10.1186/s13019-025-03625-1.
NO ABSTRACT
PMID:41029744 | PMC:PMC12487582 | DOI:10.1186/s13019-025-03625-1
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
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
BMC Cardiovasc Disord. 2025 Sep 29;25(1):705. doi: 10.1186/s12872-025-05183-9.
ABSTRACT
BACKGROUND: Renal ischemic/reperfusion (I/R) injury leads to acute kidney injury with multiple organ damage. Klotho has anti-inflammatory and antioxidant capacities and protects the heart and kidneys against I/R injury. This study aimed to determine whether Klotho is involved in the cardioprotective effect of limb ischemic per-conditioning (LIPerC) during renal I/R injury.
METHODS: Sprague-Dawley rats were randomly divided into three groups: Sham, I/R underwent bilateral occlusions of the renal pedicles for 60 min followed by reperfusion for 24 h, and LIPerc + I/R, which underwent cyclic I/R of the left femoral artery performed during renal ischemia. After 24 h, plasma, urine, and kidney and heart tissue were collected. Renal and cardiac functional biomarkers, soluble Klotho, oxidative stress, and inflammatory mediators were assessed.
RESULTS: Renal I/R injury caused a decrease in soluble Klotho and increased blood urea nitrogen, creatinine, troponin I, and LDH (p < 0.01). Moreover, it established oxidative stress and histopathological changes in the kidney and myocardium. The levels of TNF-α and NF-κB were upregulated, and Klotho (p < 0.01) was downregulated in the post-I/R cardiac tissue. LIPerC improved the histopathological changes and suppressed the oxidative status and inflammation. LIPerC could not compensate for the Klotho expression in the heart tissue. However, correlations between plasma levels and heart expression of Klotho with oxidative and inflammatory signals could confirm the role of Klotho in the healing effect of LIPerC on remote cardiac injury.
CONCLUSION: LIPerC may potentially ameliorate the remote cardiac dysfunction induced by renal I/R injury by modulating oxidative and inflammatory signals associated with the Klotho protein.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-025-05183-9.
PMID:41023844 | PMC:PMC12482132 | DOI:10.1186/s12872-025-05183-9
BMC Cardiovasc Disord. 2025 Sep 29;25(1):707. doi: 10.1186/s12872-025-05189-3.
ABSTRACT
INTRODUCTION: Cardiac disease (CD) is a leading cause of death worldwide. Longitudinal studies often involve multiple patient biomarkers measured over time. Simultaneous monitoring of these biomarkers alongside time-to-death outcomes is crucial for understanding disease progression and informing clinical decision-making.
METHODS: This study apply Bayesian joint model (BJM) to analyze multiple longitudinal biomarkers alongside time-to-death data and identify factors influencing the survival of cardiac patients. The data comes from Cardiac Center-Ethiopia, which comprises 323 children diagnosed with cardiac disease. The data contains biomarkers; systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) alongside time-to-death outcomes.
RESULTS: The Bayesian Joint Model with current value and slope association structures provided the best fit for the data. The findings indicated that both the current levels and the rate of change in biomarkers were significantly associated with patient survival. Lower biomarker levels were linked to a higher probability of survival, whereas elevated levels were associated with an increased risk of mortality. Factors such as low oxygen saturation, uncorrected cardiac surgery, reduced ejection fraction, and lower hemoglobin levels negatively impacted biomarker profiles and shortened survival time. Additionally, patients with congenital heart conditions and those experiencing undernutrition exhibited lower survival probabilities.
CONCLUSIONS: The findings underscore the crucial role of identifying and utilizing biomarkers to improve survival of patients. We recommend the use of BJM with current value and slope association structures for analyzing longitudinal and time-to-event data to identify factors influencing the survival of patients.
PMID:41023812 | PMC:PMC12482821 | DOI:10.1186/s12872-025-05189-3