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Sci Rep. 2025 Sep 30;15(1):33802. doi: 10.1038/s41598-025-04047-8.

ABSTRACT

We aimed to determine the postoperative gastrointestinal tract dysfunction and intraoperative hemodynamic effects of ultrasound-guided retrolaminar block in patients undergoing percutaneous nephrolithotomy. Fifty-eight adult patients were randomly divided into 2 groups preoperatively: Group RLB (n = 28) underwent ultrasound-guided retrolaminar block with 20 mL 0.5% bupivacaine. Group Control (n = 30) patients without block application. Primary outcome measure was abdominal Perlas score by ultrasound. Secondary outcome measures were time to first oral feeding, flatus, defecation, mobilization; duration of hospital stay; I-FEED (intake, feeling nauseated, emesis, physical examination, duration of symptoms) Score values; Patient Satisfaction Score; duration of postoperative rescue analgesia; Visual Analog Scale scores; intraoperative heart rate and mean arterial pressures. Patients in Group RLB exhibited significantly lower intraoperative opioid consumption (61.11 ± 21.18 µg, p < 0.001) and a prolonged time to rescue analgesia (13.35 ± 4.06 min). VAS scores were consistently lower postoperatively, and patient satisfaction was high. Additionally, the Group RLB demonstrated reduced gastric content volume at 6 h postoperatively (p = 0.004) and a lower I-FEED score (2.35 ± 0.91, p < 0.05), indicating improved gastrointestinal function. Heart rate and mean arterial pressure were also significantly reduced in Group RLB. Retrolaminar block has shown positive effects on postoperative pain management, gastrointestinal tract function and hemodynamic stability in PCNL. Lower opioid consumption, faster bowel movements and longer-lasting analgesic effect improved patient satisfaction and provided adequate postoperative pain control. These findings support the use of RLB as a safe and effective analgesic method in PCNL surgery.

PMID:41027977 | PMC:PMC12484968 | DOI:10.1038/s41598-025-04047-8

Commun Med (Lond). 2025 Sep 29;5(1):402. doi: 10.1038/s43856-025-01098-w.

ABSTRACT

BACKGROUND: Coronary artery bypass grafting(CABG) has long been the preferred treatment for left main coronary artery disease(LMCAD), although percutaneous coronary intervention(PCI) has been increasingly utilized. Despite numerous investigations seeking to identify the optimal revascularization strategy for LMCAD, limitations in sample size or follow-up duration have hindered definitive conclusions. Herein, we compare the long-term outcomes up to 14 years after CABG or PCI for patients with LMCAD.

METHODS: Data was retrospectively collected from a provincial database. The inclusion criteria is patients ≥18 years old, with LMCAD, and revascularization with CABG or PCI. The primary outcome is all-cause mortality. Secondary outcomes are any rehospitalization, myocardial infarction (MI), stroke, or repeat revascularization. Outcomes are adjusted for age, sex, and clinical comorbidities. The average age of the patients was 67 ± 9 years for the CABG patients and 71 ± 11 years for the PCI patients. 84.7% of the CABG patients and 71.5% of the PCI patients were male.

RESULTS: 5580 patients are identified with LMCAD between 2009 and 2018. 1706 patients (1180 CABG; 526 PCI) are included in the final analysis and followed until March 31, 2023. Rates of mortality at longest follow-up of 14 years are 40.0% for CABG and 58.4% for PCI (adjusted hazard ratio(aHR) 0.58, 95% confidence interval(CI) 0.48-0.70, p < 0.001). Rates of MI (10.7% vs 22.3%, aHR 0.40, 95% CI 0.29-0.55, p < 0.001) and repeat revascularization (5.4%vs16.3%, aHR 0.25, 95% CI 0.18-0.36, p < 0.001) favor CABG over PCI.

CONCLUSIONS: Patients with LMCAD undergoing CABG experience significant benefit over PCI in terms of long-term mortality, MI, and required repeat revascularization. These finding suggest CABG should remain the preferred revascularization strategy for patients with LMCAD and acceptable surgical risk. Future studies should explore evolving PCI techniques and their impact on long-term outcomes.

PMID:41023142 | PMC:PMC12480625 | DOI:10.1038/s43856-025-01098-w

BMJ Open. 2025 Sep 28;15(9):e104578. doi: 10.1136/bmjopen-2025-104578.

ABSTRACT

INTRODUCTION: Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease, particularly in patients with multivessel disease. Connecting the saphenous vein graft (SVG) to the right internal mammary artery (RIMA) instead of the aorta has been proposed as an alternative approach to minimise aortic manipulation and potentially improve graft patency. This study aims to determine whether the RIMA-SVG technique is non-inferior to the conventional Aorta (Ao)-SVG approach in terms of 1-year graft patency, while also comparing perioperative complications and short-term clinical outcomes.

METHODS AND ANALYSIS: This non-inferiority, single-centre, prospective, double-blind, randomised clinical trial will enrol 300 patients undergoing CABG. Participants will be randomised into two surgical groups (RIMA-SVG vs Ao-SVG). The primary outcome is the 1-year SVG patency rate, assessed using coronary CT angiography. Secondary outcomes include perioperative complications, all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), and surgical site infections occurring during hospitalisation and up to 1 year postoperatively. Randomisation will be computer-generated, and all procedures will be performed by experienced surgeons. Patients will be followed up 12 months post-surgery. Non-inferiority will be established if the upper bound of the one-sided 97.5% CI for the difference in graft occlusion rates is less than the prespecified non-inferiority margin of 10%.

ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Second Hospital of Jilin University (No. 460) and registered at ClinicalTrials.gov (NCT06787651). All participants will provide written informed consent before enrolment. To ensure data integrity and minimise bias, randomisation details will be concealed from researchers until surgery, and data analysts will remain blinded to group assignments. The findings will be disseminated through academic journals and conference presentations to promote knowledge sharing and clinical application in the field of cardiovascular surgery.

TRIAL REGISTRATION NUMBER: NCT06787651.

PMID:41022447 | PMC:PMC12481333 | DOI:10.1136/bmjopen-2025-104578

Nan Fang Yi Ke Da Xue Xue Bao. 2025 Sept 20;45(9):1850-1858. doi: 10.12122/j.issn.1673-4254.2025.09.05.

ABSTRACT

OBJECTIVES: To verify whether hesperetin (Hes) alleviates doxorubicin (DOX)-induced cardiotoxicity by reducing inflammation via regulating the AMPK/NLRP3 pathway.

METHODS: C57/bl6 mice and H9c2 cells treated with DOX to mimic cardiotoxicity were randomly divided into Sham (or control) group, DOX group, DOX+Hes group, DOX+Hes+compound C (CC, an AMPK inhibitor) group. Cardiac function and myocardial pathologies of the mice were evaluated, and the changes in H9c2 cell morphology and viability were assessed. Lactate dehydrogenase (LDH) activity in mouse myocardial tissues and H9c2 cells was measured using ELISA, and H9c2 cell apoptosis was detected with TUNEL staining. In both H9c2 cells and the myocardial tissues of the mice, cellular expression levels of TNF-α, IL-6 and IL-1β mRNAs and cleaved caspase-3, Bcl2, Bax, IL-1β, IL-18, p-AMPK, AMPK, p-mTOR, mTOR, NLRP3, ASC and caspase-1 proteins were detected using RT-PCR and Western blotting.

RESULTS: DOX treatment caused cell swelling, decreased cell viability and increased LDH activity in H9c2 cells, resulting also in significantly increased cell apoptosis and cleaved caspase-3 expression and decreased Bcl2/Bax ratio. The DOX-treated mice showed obvious myocardial fiber swelling and inflammatory infiltration, decreased cardiac function and significantly increased myocardial LDH activity. In H9c2 cells, DOX treatment significantly increased the mRNA expressions of TNF-α, IL-6 and IL-1β and protein expressions of IL-1β and IL-18, lowered the expressions of p-AMPK and p-mTOR, and increased the expressions of NLRP3, ASC and caspase-1. Hes treatment obviously reduced these toxic effects of DOX in H9c2 cells, but its protective effects were blocked by application of compound C.

CONCLUSIONS: Hes reduces DOX-induced cardiotoxicity by inhibiting inflammation via regulating the AMPK/NLRP3 pathway.

PMID:41022595 | PMC:PMC12479266 | DOI:10.12122/j.issn.1673-4254.2025.09.05

Am J Cardiol. 2025 Sep 27:S0002-9149(25)00595-8. doi: 10.1016/j.amjcard.2025.09.039. Online ahead of print.

ABSTRACT

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) provide proven cardiovascular benefits in type 2 diabetes mellitus (T2DM) and heart failure, but their effects in patients with peripheral artery disease (PAD) remain unclear. PAD is common in T2DM and increases the risk of adverse cardiovascular and limb outcomes. This meta-analysis assessed the impact of GLP-1 RAs on cardiovascular and limb-related outcomes in patients with T2DM and PAD. A systematic search of PubMed, Cochrane CENTRAL, ScienceDirect, and ClinicalTrials.gov was conducted through May 24, 2025. Primary outcomes included all-cause mortality (ACM) and cardiovascular mortality (CVM). Secondary outcomes were major adverse cardiovascular events (MACE),), myocardial infarction, stroke, major adverse limb events (MALE), glycemic control (HbA1c), body weight, and adverse events. Pooled risk ratios and mean differences were calculated using random-effects models. Six randomized controlled trials, including 7,645 participants met the inclusion criteria. GLP-1 RAs significantly reduced ACM (RR 0.83, 95% CI 0.70-0.99, p = 0.04, I² = 0%), MACE (RR 0.86, 95% CI 0.76-0.98, p = 0.02, I² = 0%), and improved HbA1c (MD -0.72%, p = 0.02), with no significant effect on weight, MALE, CVM, myocardial infarction, or stroke. In conclusion, GLP-1 RAs lower MACE and ACM in patients with T2DM and PAD but do not clearly benefit limb-specific outcomes, highlighting the need for larger, PAD-focused trials to clarify their role in limb protection.

PMID:41022246 | DOI:10.1016/j.amjcard.2025.09.039

Sci Rep. 2025 Sep 29;15(1):33527. doi: 10.1038/s41598-025-18015-9.

ABSTRACT

Urgent-start peritoneal dialysis (USPD) has been identified as the efficient approach to initiate renal replacement treatment in end-stage renal disease patients. Cardiovascular mortality of urgent dialysis is an important issue. The present work focused on assessing risk factors related to cardiovascular death in USPD patients. We carried out the present multicenter retrospective cohort study in Northeast China, included adults initiating USPD between 2013 and 2019. Follow-up was conducted in every patient till the occurrence events below: technical failure, death, loss-to-follow-up, and renal transplantation. There were altogether 1549 cases enrolled into this work. Among them, 123 encountered cardiovascular death. Upon multivariate regression, predictors of cardiovascular death included advanced age (HR 1.045, 95% CI [1.031, 1.060]; p < 0.001), higher eGFR (HR 1.084, 95% CI [1.052, 1.117]; p = 0.001), combined with DM (HR 1.471, 95% CI [1.026, 2.110]; p = 0.036), and advanced HF stage (class III versus class 0-I, HR 5.262; 95% CI [3.281, 8.437]; p < 0.001; class IV versus class 0-I, HR 6.409; 95% CI [4.145, 9.912]; p < 0.001). In addition, the predictors of cardiovascular death in diabetic USPD patients included advanced age (HR 1.052, 95% CI [1.027, 1.078]; p < 0.001) and advanced HF stages (class III versus class 0-I, HR 7.843; 95% CI [4.249, 14.476]; p < 0.001; class IV versus class 0-I, HR 5.285; 95% CI [2.880, 9.698]; p < 0.001). Moreover, the predictors of cardiovascular death in elderly USPD patients were advanced age (HR 1.045, 95% CI [1.016, 1.075]; p < 0.001) and advanced HF stages (class III versus class 0-I, HR 3.407; 95% CI [1.911, 6.073]; p < 0.001; class IV versus class 0-I, HR 5.039; 95% CI [2.982, 8.516]; p < 0.001). Risk factors related to cardiovascular death included advanced age, higher eGFR, combined with diabetes, and advanced heart failure stages among USPD patients.

PMID:41022908 | PMC:PMC12480178 | DOI:10.1038/s41598-025-18015-9

BMJ Open. 2025 Sep 28;15(9):e104578. doi: 10.1136/bmjopen-2025-104578.

ABSTRACT

INTRODUCTION: Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease, particularly in patients with multivessel disease. Connecting the saphenous vein graft (SVG) to the right internal mammary artery (RIMA) instead of the aorta has been proposed as an alternative approach to minimise aortic manipulation and potentially improve graft patency. This study aims to determine whether the RIMA-SVG technique is non-inferior to the conventional Aorta (Ao)-SVG approach in terms of 1-year graft patency, while also comparing perioperative complications and short-term clinical outcomes.

METHODS AND ANALYSIS: This non-inferiority, single-centre, prospective, double-blind, randomised clinical trial will enrol 300 patients undergoing CABG. Participants will be randomised into two surgical groups (RIMA-SVG vs Ao-SVG). The primary outcome is the 1-year SVG patency rate, assessed using coronary CT angiography. Secondary outcomes include perioperative complications, all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), and surgical site infections occurring during hospitalisation and up to 1 year postoperatively. Randomisation will be computer-generated, and all procedures will be performed by experienced surgeons. Patients will be followed up 12 months post-surgery. Non-inferiority will be established if the upper bound of the one-sided 97.5% CI for the difference in graft occlusion rates is less than the prespecified non-inferiority margin of 10%.

ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Second Hospital of Jilin University (No. 460) and registered at ClinicalTrials.gov (NCT06787651). All participants will provide written informed consent before enrolment. To ensure data integrity and minimise bias, randomisation details will be concealed from researchers until surgery, and data analysts will remain blinded to group assignments. The findings will be disseminated through academic journals and conference presentations to promote knowledge sharing and clinical application in the field of cardiovascular surgery.

TRIAL REGISTRATION NUMBER: NCT06787651.

PMID:41022447 | PMC:PMC12481333 | DOI:10.1136/bmjopen-2025-104578

Transplant Cell Ther. 2025 Sep 27:S2666-6367(25)01475-7. doi: 10.1016/j.jtct.2025.09.042. Online ahead of print.

ABSTRACT

BACKGROUND: Antithymocyte globulin (ATG, Thymoglobulin) infusion may result in infusional side effects (ISEs) resembling cytokine release syndrome.

OBJECTIVE: To determine cytokines associated with ISEs, factors predicting the ISEs, and the impact of ISEs on hematopoietic cell transplant (HCT) outcomes.

STUDY DESIGN AND METHODS: We studied 211 allogeneic HCT recipients who received three infusions of ATG, on day -2, -1 and 0. The focus was on the first infusion. ISE was defined as maximum temperature ≥38°C, maximum heart rate >125/min, minimum systolic blood pressure <90 mmHg, or supplemental oxygen use between the start of the first infusion and the start of the second infusion. In 158 of the 211 patients we determined the post-first infusion serum levels of 34 cytokines using Luminex, and compared the levels in patients with vs without an ISE using signed rank test with Bonferroni correction for multiple comparisons. In all 211 patients we compared those with vs without an ISE in overall survival (OS), relapse-free survival (RFS), and moderate to severe chronic graft-vs-host disease (cGVHD)- and relapse-free survival (cGRFS) using Cox regression, as well as in the incidences of acute GVHD (aGVHD), cGVHD, relapse, and nonrelapse death using Fine-Gray regression.

RESULTS: An ISE occurred in 93 (44%) patients. Levels of the following cytokines were significantly higher in patients with vs without an ISE: interleukin-1 receptor antagonist (IL1-RA) (30166 vs 6394 pg/ml, P<.001), interleukin-6 (IL-6) (188 vs 49 pg/ml, P<.001), and interferon gamma induced protein-10 (IP-10) (106 vs 70 pt/ml, P=.004). Patients with vs without an ISE did not differ in weight, body mass index, day -2 leukocyte, neutrophil, monocyte, or lymphocyte count, post-first infusion ATG level, or ATG area under the time-concentration curve (AUC). Compared to patients without an ISE, patients with an ISE did not have a significantly different OS (hazard ratio (HR)=0.83, P=0.43), RFS (HR=0.85, P=.38), or cGRFS (HR=1.01, P=0.98). There was also no significant difference in the incidence of grade 2-4 aGVHD, grade 3-4 aGVHD, moderate to severe cGVHD, relapse, or nonrelapse death.

CONCLUSION: IL-6, IP-10, and IL1-RA appear to be involved in the pathogenesis of ISEs. ISEs appear to have no significant impact on HCT outcomes.

PMID:41022356 | DOI:10.1016/j.jtct.2025.09.042

J Card Fail. 2025 Sep 27:S1071-9164(25)00381-1. doi: 10.1016/j.cardfail.2025.09.002. Online ahead of print.

ABSTRACT

BACKGROUND: Invasive hemodynamics may facilitate outpatient identification of ambulatory advanced HF. We analyzed cardiac failure risk stratified by four hemodynamic profiles recorded during implantation of the pulmonary artery pressure (PAP) sensor, CardioMEMS™ HF system.

METHODS: This multicenter, retrospective cohort study included HFrEF patients who underwent PAP sensor implantation from 2015 to 2022. Hemodynamic profiles were categorized using the Stevenson HF classification, defining "cold" (impaired systemic perfusion) as cardiac index <2.2L/min/m2; and "wet" (hemodynamic congestion) as pulmonary capillary wedge pressure ≥18mmHg. The primary endpoint was 1-year cardiac failure, including all-cause mortality, inotrope dependence, need for durable VAD or heart transplantation.

RESULTS: Among 512 patients (median age 71 years, 28% female, 77% NYHA class III, median NT-proBNP 2554 pg/mL), the hemodynamic profiles were as follows: 30% Warm-Dry, 22% Warm-Wet, 21% Cold-Dry, and 27% Cold-Wet. Overall, 118 patients (23%) experienced cardiac failure, of which 57 required chronic inotrope, durable VAD implantation, or heart transplantation and 61 died with medical therapy. One-year event-free survival differed across the profiles: Warm-Dry (90%), Warm-Wet (74%), Cold-Dry (80%), and Cold-Wet (61%) (P<0.001). Multivariable analysis (reference: Warm-Dry) showed increased cardiac failure risk in Cold-Wet (adjusted HR [95%CI]: 4.4 [2.4-7.8], P<0.001), Cold-Dry (adjusted HR [95%CI]: 2.2 [1.1-4.2], P=0.019), and Warm-Wet (adjusted HR [95%CI]: 2.8 [1.5-5.4], P=0.001).

CONCLUSION: At time of PAP sensor placement, an abnormal hemodynamic profile - especially Cold-Wet - was associated with increased cardiac failure risk, indicating subgroups who might have already progressed to ambulatory advanced heart failure.

PMID:41022266 | DOI:10.1016/j.cardfail.2025.09.002

Expert Opin Drug Saf. 2025 Sep 30:1-8. doi: 10.1080/14740338.2025.2568242. Online ahead of print.

ABSTRACT

BACKGROUND: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, is used for heart failure with reduced ejection fraction. Emerging evidence suggests potential ototoxicity, including hearing loss and vestibular disorders, which remain underreported and poorly characterized.

RESEARCH DESIGN AND METHODS: Our objective was to compare auditory adverse event (AE) reports associated with sacubitril/valsartan versus those associated with lisinopril and losartan. A retrospective active-comparator disproportionality analysis was conducted using individual case safety reports (ICSRs) from the U.S. FDA Adverse Event Reporting System (FAERS) via OpenFDA (2015Q3-2023Q3). The Medical Dictionary for Regulatory Activities (MedDRA) terms identified AEs related to hearing impairment, vestibular disorders, and hypoacusis. Adjusted reporting odds ratios (aRORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusting for age, sex, hypertension, and heart failure. Bayesian methods complemented the analysis.

RESULTS: Among 55,101 ICSRs, 28,091 involved sacubitril/valsartan, with 590 (1.07%) reports of hearing impairment and 4,732 (8.58%) vestibular disorders. Compared to lisinopril, sacubitril/valsartan had higher aRORs for hearing impairment (2.35), vestibular disorders (2.58), and hypoacusis (15.03). Similar elevated risks were found versus losartan. Bayesian analysis confirmed these patterns.

CONCLUSIONS: Sacubitril/valsartan may be associated with a higher risk of auditory AEs than lisinopril and losartan. These findings warrant further confirmation through pharmacoepidemiologic studies.

PMID:41017677 | DOI:10.1080/14740338.2025.2568242

Anaesth Crit Care Pain Med. 2025 Sep 27:101614. doi: 10.1016/j.accpm.2025.101614. Online ahead of print.

ABSTRACT

BACKGROUND: Anaesthesia is crucial in ensuring patient comfort and safety during surgical procedures by inducing a temporary loss of sensation, memory, and consciousness. However, its multifaceted nature presents challenges in defining its aims and expected outcomes. This study aimed to establish a consensus on anaesthesia's definition and core aims using a structured Delphi process.

METHODS: We conducted a modified three-round eDelphi method involving 23 international experts. Participants engaged in iterative online surveys to refine a consensus definition and aims. Consensus was predefined as achieving ≥80% agreement. The process included external expert reviews to enhance objectivity and validity. Statistical analyses included median, interquartile range (IQR), and agreement percentages.

RESULTS: The Delphi process resulted in consensus on 49 aims and a refined definition of anaesthesia. The final definition emphasises safe, effective, individualised, patient-centred, and empathetic care, ensuring optimal surgical conditions while enhancing patient outcomes. Key aims included preoperative optimisation, stress and pain reduction, organ function preservation, prompt emergence and recovery, interdisciplinary teamwork, continuous outcome assessment, and sustainability in anaesthesia practices. The final agreement rate for the updated definition was 82.6% (median: 10, IQR: 9-10). Additionally, environmental sustainability was recognised as an integral aim.

CONCLUSION: The consensus developed in this study provides a structured framework for defining anaesthesia's objectives, improving patient-centred care, guiding clinical practice, and fostering research. By incorporating sustainability and long-term patient outcomes, the consensus supports the evolution of precision anaesthesia. Future research will validate these defined aims in various perioperative settings and refine the consensus based on real-world applications.

PMID:41022202 | DOI:10.1016/j.accpm.2025.101614

Crit Care Nurs Q. 2025 Oct-Dec 01;48(4):389-400. doi: 10.1097/CNQ.0000000000000577. Epub 2025 Aug 22.

ABSTRACT

Respiratory complications are among the most common issues post coronary artery bypass grafting (CABG), with atelectasis being one of the most serious respiratory consequences. This study aims to evaluate the association between positive end-expiratory pressure (PEEP) levels and post-CABG atelectasis, investigate demographic risk factors associated with atelectasis, and determine the timing pattern of atelectasis development. A retrospective analysis was conducted on data from 268 CABG patients. Three PEEP levels-5, 8, and 10 cm H2O were considered. Demographic information and postoperative outcomes were collected using a self-developed data collection tool. The study took place at a tertiary care hospital in Nablus, West Bank. Higher PEEP levels, especially at 10 cm H2O, were associated with a reduction in pulmonary atelectasis. Smoking emerged as a significant factor influencing atelectasis, while interventions such as spirometry and early thoracic drainage showed positive effects in reducing the incidence of atelectasis. Furthermore, higher PEEP levels were associated with a shorter hospital stay after CABG. This study has highlighted the importance of optimal PEEP adjustment in improving respiratory outcomes and reducing recovery time post-CABG.

PMID:41021683 | DOI:10.1097/CNQ.0000000000000577

Am Heart J Plus. 2025 Sep 13;59:100610. doi: 10.1016/j.ahjo.2025.100610. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Inflammation is associated with an increased risk of adverse cardiovascular events in patients with coronary artery disease (CAD). Colchicine is an anti-inflammatory drug that can be used to improve clinical outcomes in patients with CAD.

METHODS: A systematic literature search was conducted across PubMed/MEDLINE, Embase, and Cochrane CENTRAL up to August 2025 to identify randomized controlled trials (RCTs) that reported clinical outcomes with the use of colchicine in CAD. Data for outcomes was extracted and summary estimates were generated using a random effects model.

RESULTS: 16 RCTs were included reporting data for 20,601 patients. The pooled analysis demonstrated a non-significant difference between colchicine and control groups for reducing all-cause death (RR: 0.97; 95 % CI, 0.78-1.22), cardiovascular death (RR: 0.98; 95 % CI, 0.79-1.21), and stroke (RR: 0.67; 95 % CI, 0.39-1.15). However, colchicine significantly reduced the risk of myocardial infarction (RR: 0.74; 95 % CI, 0.59-0.93), and ischemia-driven revascularization (RR = 0.72; 95 % CI, 0.53-0.99) at the expense of an increased risk of gastrointestinal adverse events (RR = 1.83; 95 % CI, 1.38-2.43) as compared to control.

CONCLUSION: Colchicine does not reduce the relative risk of all-cause and cardiovascular death in patients with CAD. However, it can reduce the risk of myocardial infarction and ischemia drive revascularization. Additional trial data are required to confirm these findings.

PMID:41019029 | PMC:PMC12465056 | DOI:10.1016/j.ahjo.2025.100610

Open Forum Infect Dis. 2025 Sep 15;12(9):ofaf561. doi: 10.1093/ofid/ofaf561. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: It is unknown whether delayed antiretroviral therapy (ART) initiation worsens CVD outcomes in people with HIV (PHIV). This study compared CVD event rates between PHIV who were randomized to receive immediate versus deferred ART.

METHODS: ART-naïve adult PHIV with CD4+ counts > 500 cells/µL were randomized to immediate versus deferred ART initiation. Event rates for the main composite CVD outcome (myocardial infarction, coronary artery disease requiring revascularization, stroke and CVD-related death) were estimated for: (i) pre-2016 (treatment arms as designed); (ii) post-1Jan2016 (ART use similar across arms); and (iii) entire study follow-up period. Subgroup analyses were performed according to baseline characteristics.

RESULTS: Among 4684 participants (median age 36 years, 27% female, 30% Black race), 32% were smokers and 17% had a BMI ≥ 30 kg/m2. Comorbidities included hypertension (19%), dyslipidemia (8%), diabetes (3%); 0.8% had a history of CVD. The median time to ART initiation was 2.5 years (interquartile range [IQR] 1.6-3.5 years) in the deferred arm and 7 days (IQR 2-17 days) in the immediate arm. Over the entire study follow-up period (median follow-up of 9.3 years), 71 participants (35 immediate, 36 deferred) experienced a CVD event with no difference in CVD event rates between the immediate and deferred arms (0.17 vs 0.17 per 100 person-years, respectively); these findings were consistent across the pre-2016 and post-1Jan2016 periods. There were 58 CVD events among males (33 immediate; 25 deferred) and 13 among females (2 immediate; 11 deferred). A possible benefit of immediate ART was seen in females but not males (Hazard Ratio = 0.19 [95% confidence interval: 0.04-0.86] vs 1.33 [0.79-2.24]; interaction P-value = .014), though numbers of events were low.

CONCLUSIONS: Early versus deferred ART initiation was not associated with reduced CVD events. The potential benefit associated with immediate ART in female participants warrants further evaluation.

PMID:41018697 | PMC:PMC12461870 | DOI:10.1093/ofid/ofaf561

Cureus. 2025 Aug 28;17(8):e91175. doi: 10.7759/cureus.91175. eCollection 2025 Aug.

ABSTRACT

Background Acute coronary syndrome (ACS) is a common emergency presentation. The C-reactive protein-to-albumin ratio (CAR) serves as a composite marker reflecting both systemic inflammation and nutritional status and may enhance prognostic accuracy in myocardial infarction (MI). Objective To assess the prognostic utility of the CAR in predicting disease severity and major adverse cardiac events (MACE) among patients with ST-elevation myocardial infarction (STEMI). Methodology A cross-sectional, observational, prospective study was conducted on 203 patients with STEMI who presented to the outpatient and emergency departments between November 2023 and May 2025. Demographic and clinical data were collected. Thrombolysis in myocardial infarction (TIMI) scores were calculated, and serum C-reactive protein and albumin levels were measured within 24 hours of admission. The primary outcome was in-hospital mortality, while MACE, including reinfarction, revascularization, heart failure, and death, was assessed at 28 days through follow-up. Results Among the participants, the in-hospital mortality rate was 14 (6.9%), and the 28-day incidence of MACE was 38 (18.7%). Notably, MACE occurred more frequently in patients with elevated CAR, even among those with lower TIMI scores, suggesting that CAR may be a more sensitive early predictor of adverse outcomes. CAR demonstrated superior prognostic performance, with an area under the curve (AUC) of 0.726 compared with 0.668 for the TIMI score. Conclusions A CAR threshold greater than 0.568 was identified as clinically useful for early risk stratification in patients with STEMI. These findings support the integration of CAR into routine assessments to improve early prognostic evaluation and guide clinical decision-making.

PMID:41018414 | PMC:PMC12476131 | DOI:10.7759/cureus.91175

Cureus. 2025 Aug 27;17(8):e91092. doi: 10.7759/cureus.91092. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: Coronary microvascular dysfunction (CMD) is increasingly recognized as a contributor to adverse cardiovascular outcomes in patients with diabetes mellitus (DM), yet it remains underdiagnosed. This is largely because routine evaluation is limited by the need for complex, time-consuming, and not routinely performed diagnostic methods, which primarily focus on macrovascular disease.

OBJECTIVE: To prospectively evaluate the association between CMD and major adverse cardiovascular events (MACE) - defined as myocardial infarction, hospitalization for heart failure, and cardiovascular death - in patients with type 2 diabetes without obstructive coronary artery disease (CAD).

METHODOLOGY: We conducted a prospective observational study at Shifa College of Medicine, Islamabad, from August 2022 to July 2024. A total of 264 adults with type 2 DM of five or more years' duration and non-obstructive CAD (<50% stenosis on angiography/CT) were consecutively enrolled. Exclusion criteria included type 1 diabetes, left ventricular ejection fraction <50%, significant structural or valvular heart disease, prior revascularization, acute coronary syndrome at baseline, and incomplete data. CMD was diagnosed using transthoracic Doppler echocardiography, with coronary flow reserve (CFR) <2.0 considered abnormal in accordance with current consensus. CFR was measured in the left anterior descending artery by two independent operators blinded to outcomes, with reproducibility assessed in a subset. Patients were followed for 24 months; loss to follow-up (7.95%) was excluded from survival analyses. Multivariate Cox regression adjusting for age, sex, hypertension, dyslipidemia, BMI, and diabetes duration was performed, with hazard ratios (HR) and 95% confidence intervals (CI) reported.

RESULTS: Among 264 patients (mean age 58.0 ± 8.1 years, 56.8% male), 142 (53.8%) had CMD. Follow-up was completed in 243 patients (CMD: 128, non-CMD: 115). CMD patients experienced significantly more MACE (29.7% vs. 10.4%, p<0.001). On multivariate analysis, CMD remained an independent predictor of MACE (HR 2.41, 95% CI 1.39-4.16, p=0.002), myocardial infarction (HR 2.28, 95% CI 1.01-5.16, p=0.047), and heart failure hospitalization (HR 2.85, 95% CI 1.19-6.80, p=0.018). Cardiovascular mortality was higher in CMD (7.8% vs. 2.6%), while non-cardiovascular mortality was similar between groups. Event-free survival was significantly shorter in CMD patients on Kaplan-Meier analysis.

CONCLUSION: CMD strongly and independently predicts long-term adverse cardiovascular outcomes in patients with type 2 diabetes without obstructive CAD, even after adjusting for conventional risk factors such as hypertension and smoking. Early detection of CMD using CFR assessment may improve risk stratification and guide preventive management in this high-risk population.

PMID:41018312 | PMC:PMC12465086 | DOI:10.7759/cureus.91092

Redox Rep. 2025 Dec;30(1):2565033. doi: 10.1080/13510002.2025.2565033. Epub 2025 Sep 29.

ABSTRACT

OBJECTIVES: Doxorubicin (DOX) induces dose-dependent cardiotoxicity, primarily through oxidative stress and metabolic dysregulation. Although NAD+ deficiency has been implicated in cardiovascular pathology, its role in DOX-induced cardiotoxicity (DIC) remains poorly understood. This study investigated NAD+ metabolism dysregulation as a redox-sensitive mechanism in DIC pathogenesis.

METHODS: Human cardiomyocytes (AC16), mouse atrial myocytes (HL-1), and C57BL/6 mice were used to establish the DIC model. The role and mechanism of NAD+ in DIC were investigated using a range of methods.

RESULTS: Using integrated in vitro and in vivo models, we demonstrated that DOX induces myocardial oxidative damage accompanied by NAD+ depletion. Exogenous NAD+ supplementation mitigated the DOX-induced cardiomyocyte death and redox imbalance. Mechanistically, pharmacological CD38 inhibition with 78C or genetic silencing failed to restore the NAD+ pool, whereas nicotinamide mononucleotide adenylyltransferase 3 (NMNAT3) overexpression, combined with nicotinamide mononucleotide (NMN) administration, effectively rescued NAD+ levels and attenuated oxidative stress. Computational and functional analyses identified FOXO1 as a transcriptional repressor of NMNAT3 following DOX exposure.

CONCLUSION: This study establishes the dysregulation of the FOXO1-NMNAT3 axis as a key mechanism underlying NAD+ depletion in DIC. Targeting this axis through NAD+ replenishment, particularly by activating NMNAT3, offers a novel redox-based therapeutic strategy against DIC.

PMID:41021886 | PMC:PMC12481541 | DOI:10.1080/13510002.2025.2565033

PLoS One. 2025 Sep 29;20(9):e0333083. doi: 10.1371/journal.pone.0333083. eCollection 2025.

ABSTRACT

This study aimed to evaluate the safety and efficacy of a modified, bloodless Del Nido (DN) cardioplegia solution in patients undergoing isolated aortic valve replacement (AVR). A total of 370 patients who underwent isolated AVR between 2015 and 2022 were retrospectively analyzed. Patients were categorized into two groups based on the cardioplegia solution used: the bloodless DN group (N = 180) and the histidine-tryptophan-ketoglutarate (HTK) group (N = 190). To reduce selection bias and adjust for baseline differences, inverse probability of treatment weighting analysis was performed. There was no significant difference in in-hospital mortality between the two groups (HTK vs. DN: 1.2% vs. 0.9%, P = 0.554). However, the rate of spontaneous sinus rhythm restoration without the need for defibrillation following aortic cross-clamp release was significantly higher in the DN group (40.0% vs. 75.2%, P < 0.001). Additionally, the initial postoperative lactate level (3.0 ± 2.6 mmol/L vs. 2.2 ± 1.4 mmol/L, P = 0.002), and the incidence of low cardiac output syndrome (9.4% vs. 1.7%, P < 0.001) were significantly lower in the DN group compared to the HTK group. Other postoperative morbidities did not differ significantly between the groups. The modified bloodless Del Nido cardioplegia demonstrated favorable myocardial protection and early clinical outcomes compared to HTK solution in patients undergoing isolated AVR. These findings suggest that the bloodless Del Nido technique may be a viable alternative, although further validation in larger, prospective studies is warranted.

PMID:41021556 | PMC:PMC12478951 | DOI:10.1371/journal.pone.0333083

Postgrad Med J. 2025 Sep 29:qgaf163. doi: 10.1093/postmj/qgaf163. Online ahead of print.

ABSTRACT

BACKGROUND: New-onset atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI) is associated with higher risks of stroke and mortality. However, current guidelines lack specific antithrombotic recommendations for this population. This study aimed to explore the association between rivaroxaban and the prognosis of patients with AMI and new-onset AF.

METHODS: This retrospective cohort study included patients with AMI and new-onset AF receiving dual antiplatelet therapy between August 2016 and June 2023 in Tianjin, China. New-onset AF (transient or nontransient) was defined as the first diagnosis of AF following AMI. The primary outcome was stroke.

RESULTS: 2477 patients were identified, including 141 rivaroxaban users and 2336 patients without oral anticoagulants (OAC). Over a median follow-up of 922 days, rivaroxaban users had a 5.7% lower risk of stroke than non-OAC users, although this was not statistically significant (19.9% vs. 25.6%; P = .152). Despite the suggestion of a protective trend, multivariable Cox regression showed that rivaroxaban use was not associated with a lower risk of stroke (hazard ratio, 0.77; 95% confidence interval, 0.52-1.13, P = .187). After propensity score matching, 155 transient (rivaroxaban: 42; non-OAC: 113) and 295 nontransient AF patients (rivaroxaban: 85; non-OAC: 210) were included. No significant association was observed between rivaroxaban and stroke, ischemic stroke, hemorrhagic stroke, all-cause mortality, cardiovascular mortality, bleeding, or major bleeding.

CONCLUSION: No significant association was observed between rivaroxaban and clinical outcomes in patients with AMI and new-onset AF. Given the small sample size and limited statistical power, the findings are exploratory and require further validation. Key messages What is already known on this topic: Evidence from previous studies indicates that acute myocardial infarction (AMI) patients with new-onset atrial fibrillation (AF) are associated with higher risks of ischemic stroke and mortality. However, the association between rivaroxaban and the prognosis of patients with AMI and new-onset AF remains uncertain. What this study adds: Among patients with AMI and new-onset AF receiving dual antiplatelet therapy, no significant differences were observed between rivaroxaban users and non-oral anticoagulant users in terms of the risks of stroke, ischemic stroke, hemorrhagic stroke, all-cause mortality, cardiovascular mortality, bleeding, or major bleeding. However, these results should be interpreted with caution due to the small sample size and limited statistical power of the study. How this study might affect research, practice or policy: Future prospective large-scale studies and randomized controlled trials are needed to further examine the role of rivaroxaban and other types of oral anticoagulants in patients with AMI and new-onset AF.

PMID:41020767 | DOI:10.1093/postmj/qgaf163

Oxid Med Cell Longev. 2025 Sep 18;2025:7786043. doi: 10.1155/omcl/7786043. eCollection 2025.

ABSTRACT

Doxorubicin (Doxo) is an anthracycline widely used as a chemotherapeutic agent for many solid and hematological cancers. Its clinical use is limited due to a cumulative dose-dependent and irreversible cardiotoxicity that can cause progressive cardiomyopathy and congestive heart failure. A cardioprotective therapy that can decrease heart damage without reducing the anticancer efficacy during Doxo therapy is of utmost importance. Anthocyanins (ACNs) are renowned cardioprotective agents thanks to their antioxidant and anti-inflammatory properties. An ACN-rich diet from purple corn, which mainly contains cyanidin 3-glucoside (C3G) and its acetylated derivatives, has been previously shown to be effective in reducing Doxo-induced cardiotoxicity in mice. Aiming at unveiling the molecular mechanisms involved in ACN protection, we considered the fibroblast growth factor 21/AMP-activated protein kinase/SIRTUIN1 (FGF21/AMPK/SIRT1)/p53 pathway in murine HL-1 cardiomyocytes treated with Doxo in the presence or absence of purple corn extract (RED). Our work shows that Doxo-induced AMPK activation is restored to control levels by the RED extract. p53 acetylation was increased by the RED extract and upon Sirt1 silencing, indicating that p53 acetylation is SIRT1-dependent and suggesting that the RED extract may affect SIRT1 activity through AMPK. Notably, increased p53 acetylation led to decreased levels of cleaved-caspase 3 and Puma and p21 transcript levels, indicating a reduced level of apoptosis. The RED-induced cardioprotection and p53 acetylation were confirmed in mouse primary cardiomyocytes. In conclusion, the RED extract may prevent cardiomyocytes apoptosis through the modulation of AMPK and acetylation of p53.

PMID:41018278 | PMC:PMC12463520 | DOI:10.1155/omcl/7786043