Agregador de feeds

Heart Vessels. 2025 Sep 27. doi: 10.1007/s00380-025-02605-8. Online ahead of print.

ABSTRACT

Fractional flow reserve (FFR) is an invasive standard, and resting full-cycle ratio (RFR), a non-hyperemic pressure ratio, is an alternative to FFR for evaluating the functional severity of coronary stenosis. However, the prognostic impact of coronary revascularization in vessels with discordant results of FFR and non-hyperemic pressure ratios remains unclear. This single-center study included 212 vessels in 191 patients with intermediate coronary stenosis and discordant results of FFR and RFR. FFR ≤ 0.80 and RFR ≤ 0.89 were considered physiologically positive. Vessels with discordant results of FFR and RFR were divided into two groups according to the revascularization strategies-the deferral and revascularization groups. The primary endpoint was target vessel failure (TVF), a composite of cardiac death and target vessel myocardial infarction and unplanned revascularization. Of the 212 vessels, 145 (68.4%) and 67 (31.6%) were categorized as the deferral and revascularization groups, respectively. The deferral group was more likely to be older and women than the revascularization group. FFR values were higher, and the rate of positive FFR was lower in the deferral group than in the revascularization group. During the median follow-up of 406 days, 12 of 212 (5.7%) developed TVF. The Kaplan-Meier analysis demonstrated that the TVF rate was significantly lower in the revascularization group than the counterpart (7.6% vs. 1.5% at 3 years, P = 0.046). In conclusion, coronary revascularization in vessels with discordant results of FFR and RFR was associated with lower TVF rates as compared with the deferral strategy.

PMID:41014328 | DOI:10.1007/s00380-025-02605-8

BMC Cardiovasc Disord. 2025 Sep 26;25(1):671. doi: 10.1186/s12872-025-05155-z.

ABSTRACT

BACKGROUND: Contemporary practice in coronary and valve interventions continues to evolve with changing indications, technology, and systems of care. I characterized statewide procedure volumes and mortality for PCI, CABG, Valve ± CABG, and TAVR using a unified, internally consistent analytic framework.

METHODS: I analyzed New York State public-use registry data (2010-2019). All PCI and Non-Emergency PCI are reported annually. Emergency PCI was derived annually at the hospital-year level as All PCI - Non-Emergency PCI; deaths and expected deaths were derived by subtraction and aggregated statewide. CABG is reported annually. Valve ± CABG and TAVR are provided as overlapping 3-year windows; I produced annualized values by averaging the per-year contribution from the two windows that include each year (single window at edges; TAVR available 2013-2019). Statewide Observed %, Expected %, O/E, and Risk-Adjusted % were computed as case-weighted aggregates. No hypothesis testing was performed.

RESULTS: From 2010 to 2019, there were 1,005,980 PCI and 171,182 CABG procedures statewide. Overall PCI volume was stable (2010: 108,070; 2019: 108,552). Within PCI, Non-Emergency comprised 835,480 (83.1%) and Emergency 170,500 (16.9%); non-emergency PCI declined modestly (2010: 93,498 → 2019: 89,654), while emergency PCI increased (2010: 14,572 → 2019: 18,898). CABG volumes were broadly stable (2010: 18,842 → 2019: 17,876). Annualized Valve ± CABG volumes declined (≈ 14,822 in 2010 → 11,893 in 2019), whereas TAVR expanded after introduction (2013: 3,703 → 2019: 9,963). Pooled risk-adjusted mortality: All PCI 1.11%, Non-Emergency PCI 0.72%, Emergency PCI 3.07%, CABG 1.53%, Valve ± CABG 3.27% (2010-2019), and TAVR 2.93% (2013-2019). Across procedures and years, O/E ≈ 1.00, indicating good model calibration.

CONCLUSIONS: Between 2010 and 2019, statewide PCI volume was stable; non-emergency PCI declined modestly, emergency PCI rose modestly, CABG volumes were broadly stable, Valve ± CABG decreased, and TAVR increased substantially with improving mortality. Overall PCI mortality remained low and largely stable, consistent with higher-risk case mix over time. These contemporary benchmarks can inform quality improvement, capacity planning, and policy while highlighting the need for continued monitoring of high-risk PCI pathways and long-term TAVR durability in younger patients.

PMID:41013313 | PMC:PMC12465987 | DOI:10.1186/s12872-025-05155-z

Medicina (Kaunas). 2025 Aug 27;61(9):1545. doi: 10.3390/medicina61091545.

ABSTRACT

Background and Objectives: Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) commonly occur after coronary artery bypass grafting (CABG) surgery, with frequent ectopics linked to atrial fibrillation risk and reduced heart function. While CABG-induced inflammation causes arrhythmogenic changes, the connection between preoperative inflammatory markers and postoperative ectopic burden has not been studied. Therefore, the aim of the present study is to evaluate the association between preoperative inflammatory biomarkers and postoperative atrial and ventricular ectopic burden, and to determine their influence on clinical outcomes following elective CABG procedures. Materials and methods: This study assessed preoperative plasma levels of highly sensitive C-reactive protein (hs-CRP), von Willebrand factor (vWF), transforming growth factor-β (TGF-β), interleukin (IL)-2, IL-1β, IL-6, IL-8, and vascular endothelial growth factor (VEGF) using the Multiplex technique in patients undergoing elective CABG. A continuous 24-h ECG Holter monitoring was performed one day before CABG, as well as on days 2, 3, and 4 post-CABG. The PACs and PVCs burdens were quantified, and correlations with clinical parameters were analyzed. Results: Preoperative plasma concentrations of vWF, TGF-β, and IL-8 exhibited significant positive correlations with postoperative PACs (p < 0.001, p = 0.03, and p < 0.001, respectively). Preprocedural hs-CRP, TGF-β, IL-6, and IL-8 levels showed significant positive associations with PVCs (p < 0.0001, p < 0.0001, p = 0.02, and p < 0.0001, respectively). However, none of the tested biomarkers could predict other postoperative outcomes, such as acute kidney injury, acute liver failure, duration of inotropic support, and days of hospitalization. Conclusions: Preoperative inflammatory biomarkers may serve as predictive tools for postoperative ectopic activity following CABG. Early identification of high-risk patients could enable prophylactic strategies and improve post-CABG outcomes.

PMID:41010936 | PMC:PMC12471965 | DOI:10.3390/medicina61091545

J Clin Med. 2025 Sep 19;14(18):6607. doi: 10.3390/jcm14186607.

ABSTRACT

Background: Kidney function is critical for cardiovascular health, and its appropriate assessment entails proper determination of prognosis in patients with chronic coronary syndromes (CCSs). However, assessment of the urinary spot albumin to creatinine ratio (uACR) is often overlooked, whereas it is crucial for determination of chronic kidney disease (CKD). This study assesses the prevalence of impaired kidney function in patients with CCS based on their eGFR and albuminuria. Methods and results: This study comprised a total of 1957 patients from seven regions in Poland, aged ≤ 80 years, who, 6-18 months earlier, were hospitalized for acute coronary syndrome or elective myocardial revascularization. Complete uACR and eGFR data were obtained from 1152 patients (median age was 67 years, and 71.23% of participants were male). The finding of albuminuria reclassified the CKD in 17% (200) patients, suggesting that a patient's risk cannot be ascertained only based on their eGFR result. CKD reclassification by albuminuria was observed in older (p < 0.001) patients with higher BPs (p = 0.008), BPd (p = 0.038), HR (p < 0.001), fasting glucose (p < 0.001), and HbA1c (p < 0.001) and decreased HDL concentration (p = 0.001); hence, this is the population where uACR assessment is particularly valuable. Conclusions: In a notable percentage of patients with CCS, their kidney function classification is changed based on their albuminuria. Therefore, it is important to include albuminuria in the routine assessment of patients with cardiovascular disease.

PMID:41010810 | PMC:PMC12470754 | DOI:10.3390/jcm14186607

Int J Mol Sci. 2025 Sep 21;26(18):9217. doi: 10.3390/ijms26189217.

ABSTRACT

Primary human endothelial cells represent an essential tool to model endothelial dysfunction and to screen interventions for its treatment. Here, we developed a protocol for the synchronous isolation of primary human saphenous vein endothelial cells (HSaVEC), human internal thoracic artery endothelial cells (HITAEC), and human microvascular endothelial cells (HMVEC) from SV and ITA utilized as conduits during coronary artery bypass graft surgery and from subcutaneous adipose tissue excised while providing an access to the heart. Treatment by collagenase type IV and magnetic separation with anti-CD31-antibody-coated beads ensured relatively high efficiency of the isolation (≈60% for HSaVEC, ≈50% for HITAEC, and ≈20% for HMVEC) and high purity (≥99%) of isolated ECs within ≈2 weeks (HSaVEC), ≈2-3 weeks (HITAEC), and ≈3-4 weeks (HMVEC). A colorimetric assay of cell viability and proliferation, as well as real-time bioimpedance monitoring using the xCELLigence instrument, demonstrated high proliferative activity in HSaVEC, HITAEC, and HMVEC, whilst the in vitro tube formation assay indicated their angiogenic potential. The isolation of HSaVEC, HITAEC, and HMVEC from patients undergoing coronary artery bypass graft surgery is a promising option to investigate endothelial heterogeneity, to interrogate endothelial responses to various stresses, and to pinpoint the optimal approaches for restoring endothelial homeostasis, thereby reproducing them within the bedside-to-bench-to-bedside concept.

PMID:41009779 | PMC:PMC12471049 | DOI:10.3390/ijms26189217

Biomedicines. 2025 Sep 15;13(9):2265. doi: 10.3390/biomedicines13092265.

ABSTRACT

Background/Objectives: Angiotensin receptor-neprilysin inhibitor (ARNI) has a well-established advantage over angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) therapy in patients (pts) with heart failure with reduced ejection fraction (HFrEF), but in pts after acute myocardial infarction (AMI) with left ventricular (LV) systolic dysfunction, the advantage of ARNI has not been clearly proven. The efficacy of ARNI is compared with that of ACEI/ARB therapy in patients with their first AMI in terms of improvement of post-infarction LV systolic function. Methods: The study was conducted as a retrospective one-center cross-sectional analysis. Overall, 1473 pts (990 M, median age 71 [64; 77]) with AMI (their first AMI, complete coronary revascularization, no prior coronary revascularization or history of HF) hospitalized in 2022-2024 were enrolled in a retrospective cross-sectional analysis. The study population was categorized into pts receiving ARNI and ACEI/ARB. Then, based on the ARNI subgroup, matching that included age, sex, and LV ejection fraction (LVEF) was performed by using the 1:1 nearest neighbor method without returning. Finally, two groups (ARNI vs. ACEI/ARB) of 30 pts were obtained and analyzed at baseline and at a 6-week follow-up. The improvement of post-infarction LV systolic function was obtained in terms of LVEF, ΔLVEF, and relative ΔLVEF values (ΔLVEF/baseline LVEF). Results: The comparison of baseline characteristics revealed borderline lower initial LVEF (30 vs. 36%, p = 0.076) and a higher frequency of SGLT-2 inhibitor use (70% vs. 36.7%, p = 0.01) in the ARNI subgroup. At the 6-week follow-up, in both subgroups, a significant improvement in the median LVEF values was achieved-from a median LVEF value of 30% (27.3; 38) to 37% (30; 43; p = 0.0008) in the ARNI subgroup and from a median LVEF value of 36% (33; 39) to 45% (42; 52; p < 0.0001) in the ACEI/ARB subgroup. The median ΔLVEF in the ACEI/ARB subgroup was higher [10% (6; 12)] than in the ARNI subgroup [6% (2; 10.25), p = 0.018]. Similarly, the median relative ΔLVEF was higher in the ACEI/ARB subgroup [30% (15.4; 40)] than in the ARNI group [17.5% (7; 31.9), p = 0.047]. The vast majority of patients, particularly in the ARNI group (99.7%), were treated with the lowest available dose of the drug. Conclusions: Our current experience in ARNI therapy after AMI is promising; however, it is limited to a small group of patients with severe impairment of LV systolic function. Regardless of the significant improvement in the baseline LVEF observed in patients receiving both ACEI/ARB and ARNI at the 6-week follow-up, the absolute and relative increases in the LVEF were higher in subjects treated with ACEI/ARB. However, the clinical benefits of ARNI therapy may emerge more gradually, and its advantages could become more apparent over a longer follow-up period. The clinical efficacy of early use of ARNI in the setting of AMI needs further evaluation.

PMID:41007826 | PMC:PMC12467660 | DOI:10.3390/biomedicines13092265

Biomedicines. 2025 Sep 14;13(9):2264. doi: 10.3390/biomedicines13092264.

ABSTRACT

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cardiac surgery, limiting patient access and altering care quality. This study evaluates changes in cardiovascular disease severity, types, and postoperative complications in patients qualifying for coronary artery bypass grafting (CABG) during the pandemic. Methods: We performed a retrospective analysis of 1499 CABG patients at our institution between March 2018 and February 2022. Patients were categorised into two groups: pre-pandemic (March 2018 to February 2020, N = 853) and pandemic (March 2020 to February 2022, N = 646). We analysed and detailed data across three major COVID-19 waves in Poland. Results: During the COVID-19 pandemic, 646 patients underwent CABG, a 24.3% decline from 853 pre-pandemic procedures. Urgent procedures increased from 37.6% to 44%, and life-saving procedures rose from 2.9% to 5.2% (p < 0.05). The use of cardiopulmonary bypass increased, along with longer procedure times (median of 279.7 min vs. 315 min; p < 0.001). The duration of mechanical ventilation increased during the pandemic period (median 12 h vs. 11 h; p < 0.05). No significant differences in postoperative complications were noted. Analysis during the three COVID-19 waves showed consistent baseline characteristics. In the second wave, life-saving CABG procedures reached 11.4%, with 17.5% of patients presenting acute coronary symptoms. Conclusions: The COVID-19 pandemic reduced CABG procedures, prioritising urgent cases. Short-term mortality odds rose, despite unchanged patient risk profiles. More multicentre research is needed to understand resource constraints on cardiac surgical outcomes and to establish guidelines for patient prioritisation in future pandemics.

PMID:41007825 | PMC:PMC12467769 | DOI:10.3390/biomedicines13092264

Biomedicines. 2025 Sep 12;13(9):2254. doi: 10.3390/biomedicines13092254.

ABSTRACT

Aims: Myocardial inflammation in cardiac amyloidosis is associated with poor clinical outcomes. This study aimed to (a) investigate the relationship between peripheral blood cytokine levels and the presence of inflammatory cells within the myocardium, and to (b) evaluate the potential of cytokines as predictors of major adverse cardiovascular events (MACE) in transthyretin (ATTR) and immunoglobulin light chain (AL) cardiac amyloidosis. Methods: Peripheral blood samples were collected from 50 patients with cardiac ATTR or AL amyloidosis between 2018 and 2023 at baseline and every three months during follow-up visits. Cytokine analysis was performed using Olink's Proximity Extension Assay. For MACE prediction analysis, only patients with MACE occurring within ±14 days of a study visit were included (n = 16). Associations were evaluated using linear models. Results: No significant associations were identified between the EMB-confirmed myocardial presence of inflammatory cells and cytokine levels. There was a trend of weak-to-moderate associations between serial blood cytokine levels and MACE, albeit this was non-significant after adjustment for multiple testing (FDR): r2 = 0.28 for PON3 (p = 0.00075, FDR = 0.28), SIGLEC1 (p = 0.00077, FDR = 0.28), and IL-6 (p = 0.00086, FDR = 0.31). Conclusions: Peripheral blood cytokine levels were not reliable biomarkers for the myocardial presence of inflammatory cells. PON3, SIGLEC1, and IL-6 demonstrated a statistically non-significant trend of a weak-to-moderate association with MACE in cardiac amyloidosis. Since we recently demonstrated that amyloidosis with an inflammatory component is associated with poor outcomes, these additional findings underscore the need for alternative approaches to identify and manage inflammation in this patient population.

PMID:41007815 | PMC:PMC12467096 | DOI:10.3390/biomedicines13092254

Heart Lung Circ. 2025 Sep 26:S1443-9506(25)00321-X. doi: 10.1016/j.hlc.2025.04.081. Online ahead of print.

ABSTRACT

BACKGROUND: Orthotopic heart transplantation (OHT) survival rates have improved with advances in immunosuppression over the last 20 years. With these improvements, there has been a greater focus on post-transplant care. Diabetes is common after transplantation and may be pre-existing (type 2 diabetes mellitus [T2DM]) or develop after transplant (post-transplant diabetes mellitus [PTDM]). The aim of this study was to compare the incidence and prevalence of diabetes in OHT recipients in two cohorts separated by 20 years.

METHODS: Retrospective audit comparing the prevalence of T2DM and cumulative 2-year incidence of PTDM in 88 consecutive OHT recipients in 1996-1998 and 141 consecutive OHT recipients in 2015-2018 at the same tertiary referral teaching hospital.

RESULTS: The prevalence of pre-transplant T2DM at the time of OHT increased three-fold between 1998 and 2018, from 6% (n=5) to 18% (n=25) respectively (p=0.009). Similarly, the incidence of PTDM increased from 16% (n=13) in 1998 to 36% (n=42) in 2018 (p=0.001). OHT recipients who developed PTDM were older in 2018 vs 1998 (mean age 52 [±11] vs 44 [±9] years; p=0.03). The mean age was not different between individuals with T2DM between the 1998 and 2018 eras. Body mass index was not different between the 1998 and 2018 eras in any of the diabetes status subgroups.

CONCLUSIONS: The incidence and prevalence of diabetes after OHT at our Australian institution has increased over 20 years. With improved OHT survival and rates of diabetes, endocrinologists should be incorporated into the care teams of heart transplant recipients. Further studies of glucose-lowering therapies in patients with diabetes after transplantation are warranted.

PMID:41015724 | DOI:10.1016/j.hlc.2025.04.081

Eur J Pediatr. 2025 Sep 27;184(10):644. doi: 10.1007/s00431-025-06505-x.

ABSTRACT

PURPOSE: This study aimed to explore the epidemiological features and outcomes of out-of-hospital cardiac arrest (OHCA) among children hospitalized in the pediatric intensive care units (PICUs) after return of spontaneous circulation (ROSC) and to determine the factors associated with the thirty-day survival (TDS) rate.

METHODS: This retrospective cohort study was conducted between January 2016 and December 2022 at two French PICUs and included patients under 18 years old hospitalized with ROSC after OHCA.

RESULTS: During the study period, 53 patients were included, 27 (51%) were males the median age was 4 years old. Drowning (n = 15, 28%) and other causes of respiratory failure (n = 9, 17%) were the most common causes of cardiac arrest. The TDS rate was 38% (n = 20), and 15 patients (75%) of the survivals were considered to have good cognitive function discharged from the PICU. Neurological dysfunction was the most common cause of death including brain death in 19 patients (35%) and withdrawal of life-sustaining therapy due to poor neurological prognosis. Witnessed cardiac arrest and length of low flow < 20 min increased the chances of survival by 4.2-fold and 5.6-fold, respectively. Asystole as the initial rhythm, epinephrine use, severe acidosis, bilateral areflexic mydriasis on admission, liver, and renal failure, and disseminated intravascular coagulation were associated with a lower TDS rate, whereas shockable rhythms were associated with a higher TDS rate.

CONCLUSION: In our study, TDS rate of children hospitalized in the PICU after OHCA with ROSC was 38%. Among most of the survivors the neurological prognosis was good. Further, the data implies that primary prevention and optimal early response remain the key strategies to improve survival after OHCA. In addition, neurological dysfunction was the most common cause of death after ROSC, highlighting the opportunity to increase organ donation for transplantation.

WHAT IS KNOWN: • Out-of-hospital cardiac arrest (OHCA) is a significant cause of morbidity and mortality in children. • Survival rates for pediatric OHCA are low and influenced by age, cause of arrest, bystander CPR, and promptness of advanced life support.

WHAT IS NEW: • Survival after return of spontaneous circulation (ROSC) following OHCA in pediatric patients is being reported for the first time in France. While the survival rate is low, the neurological prognosis of most survivors is good. • Primary prevention and optimal early response are key strategies to improve survival. The high occurrence of brain death among nonsurvivors highlights a potential opportunity for organ donation, which appears to be underutilized.

PMID:41015594 | DOI:10.1007/s00431-025-06505-x

J Heart Lung Transplant. 2025 Sep 25:S1053-2498(25)02281-8. doi: 10.1016/j.healun.2025.09.015. Online ahead of print.

NO ABSTRACT

PMID:41015400 | DOI:10.1016/j.healun.2025.09.015

Lancet. 2025 Sep 24:S0140-6736(25)01635-6. doi: 10.1016/S0140-6736(25)01635-6. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050.

METHODS: Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer.

FINDINGS: In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3).

INTERPRETATION: Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment.

FUNDING: Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.

PMID:41015051 | DOI:10.1016/S0140-6736(25)01635-6

Eur J Intern Med. 2025 Sep 26:106514. doi: 10.1016/j.ejim.2025.106514. Online ahead of print.

ABSTRACT

BACKGROUND: To provide information on adults with congenital heart disease (ACHD) undergoing non-cardiac surgeries (NCS), specific risk compared non-ACHD, independent risk factors for adverse outcome and mortality.

METHODS: Based on non-selective data including all in-hospital admissions in Germany from 2009 to 2021, all ACHD cases that underwent NCS were selected. NCS was categorized in low, medium and high-risk procedures. As primary endpoints, major adverse cardiovascular events (MACE), major infection (MIE), major bleeding (MBE), major thromboembolism (MTE), and in-hospital death were defined. Outcomes of ACHD were compared to a propensity score matched cohort of non-ACHD.

RESULTS: Overall, 15,349 inpatient ACHD cases were selected for analysis. Of those 72.3 % (n=11,094) were simple, 20.1 % (n=3,086) were moderate and 7.6 % (n=1,169) were complex ACHD. Patients with more than moderate ACHD faced a substantially higher risk for adverse outcome regarding all predefined endpoints compared to non-ACHD. Specifically, risk for MACE was increased with an Odds ratio (OR) of 1.29 (95 % CI 1.11-1.51) for moderate ACHD and OR 1.58 (95 % CI 1.23-2.02) for complex ACHD. In-hospital mortality was OR 1.39 (95 % CI 1.13-1.71) for moderate and OR 2.22 (95 % CI 1.62-3.03) for complex ACHD compared to non-ACHD.

CONCLUSIONS: Patients with more than moderate complexity ACHD are at specific risk for adverse outcomes when undergoing non-cardiac surgery. Further analyses are needed to give precise recommendations on the choice of appropriate surgical site as well as how to improve care and outcome of ACHD undergoing NCS.

PMID:41015714 | DOI:10.1016/j.ejim.2025.106514

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Sep 26;60:1030-1039. doi: 10.3760/cma.j.cn115330-20250205-00081. Online ahead of print.

ABSTRACT

根据先天性耳畸形伴发的多发畸形发生率从高到低涉及的主要专科：耳鼻咽喉头颈外科、整形外科、颌面外科、心外科、骨科与神经外科、泌尿外科、眼科、口腔正畸科、普通外科、胸外科、超声科、心理科以及产前诊断等（14个专科），来自中国25家单位（医院）的资深专家（均为学科带头人、25年以上专科工作经验），通过反复研讨，结合各专科诊治经验及本领域的最新进展，提出各专科诊疗的最佳时机，再通过综合分析多发畸形对功能、外形、心理的影响程度进行序列安排，达成共识，形成最佳诊疗时机日历表及联合诊疗专家团队。从备孕期开始到出生后的不同时段，分别列出每个时段需要进行处理的常见畸形及就诊科室，并做相关说明，指导医生和患者及家属进行选择和规划；同时参与研讨的专家组成联合诊疗团队，实现内部直接推送患者，使其获得“一站式”高水平诊疗。.

PMID:41015439 | DOI:10.3760/cma.j.cn115330-20250205-00081

Am Heart J. 2025 Sep 25:S0002-8703(25)00336-9. doi: 10.1016/j.ahj.2025.09.014. Online ahead of print.

ABSTRACT

BACKGROUND: Prophylactic steroids are often used to reduce the systemic inflammatory response to cardiopulmonary bypass in infants undergoing heart surgery. The STRESS trial found that the odds of a worse outcome did not differ between infants randomized to methylprednisolone (n=599) versus placebo (n=601) (adjusted odds ratio [OR], 0.86; P=0.14). However, secondary analyses showed possible benefits with methylprednisolone. To investigate further using a different probabilistic approach, we re-analyzed the STRESS trial using Bayesian analytics.

METHODS: We used a covariate-adjusted proportional odds model using the original STRESS trial primary endpoint, a ranked composite of death, transplant, major complication and post-op length of stay. We performed Markov Chain Monte Carlo simulations to assess the probability of benefit (OR <1) versus harm (OR >1). Primary analysis assumed a neutral probability of benefit versus harm with weak prior belief strength (nearly non-informative prior distribution). To illustrate magnitude of effect, we calculated predicted risk of death, transplant or major complications for methylprednisolone and placebo. Sensitivity analyses evaluated pessimistic (5%-30% prior likelihood of benefit), neutral and optimistic (70%-95%) prior beliefs, and controlled strength of prior belief as weak (30% variance), moderate (15%) and strong (5%). A secondary analysis derived empirical priors using data from four previous steroid trials.

RESULTS: The posterior probability of any benefit from methylprednisolone was 92% and probability of harm was 8%. Composite death or major complication occurred in 18.8% of subjects with an absolute risk difference of -2% (95% CI -3%, +1%) for methylprednisolone. Each of 9 sensitivity analyses demonstrated greater probability of benefit than harm in the methylprednisolone group with 8 of 9 demonstrating >80% probability of benefit and ≥1% absolute difference in risk of death, transplant or major complications. In secondary analysis deriving priors from previous steroid trials, results were consistent with a 95% posterior probability of benefit.

CONCLUSION: Our Bayesian re-analysis of the STRESS trial, using a range of prior beliefs, demonstrated a high probability that perioperative methylprednisolone reduces the risk of death or major complications in infants undergoing cardiopulmonary bypass compared with placebo. This more in-depth analysis expands the initial clinical evaluation of methylprednisolone provided by the STRESS trial.

TRIAL REGISTRATION: Clinicaltrials.gov: NCT03229538 (https://clinicaltrials.gov/study/NCT03229538).

PMID:41015071 | DOI:10.1016/j.ahj.2025.09.014

Eur J Intern Med. 2025 Sep 26:106514. doi: 10.1016/j.ejim.2025.106514. Online ahead of print.

ABSTRACT

BACKGROUND: To provide information on adults with congenital heart disease (ACHD) undergoing non-cardiac surgeries (NCS), specific risk compared non-ACHD, independent risk factors for adverse outcome and mortality.

METHODS: Based on non-selective data including all in-hospital admissions in Germany from 2009 to 2021, all ACHD cases that underwent NCS were selected. NCS was categorized in low, medium and high-risk procedures. As primary endpoints, major adverse cardiovascular events (MACE), major infection (MIE), major bleeding (MBE), major thromboembolism (MTE), and in-hospital death were defined. Outcomes of ACHD were compared to a propensity score matched cohort of non-ACHD.

RESULTS: Overall, 15,349 inpatient ACHD cases were selected for analysis. Of those 72.3 % (n=11,094) were simple, 20.1 % (n=3,086) were moderate and 7.6 % (n=1,169) were complex ACHD. Patients with more than moderate ACHD faced a substantially higher risk for adverse outcome regarding all predefined endpoints compared to non-ACHD. Specifically, risk for MACE was increased with an Odds ratio (OR) of 1.29 (95 % CI 1.11-1.51) for moderate ACHD and OR 1.58 (95 % CI 1.23-2.02) for complex ACHD. In-hospital mortality was OR 1.39 (95 % CI 1.13-1.71) for moderate and OR 2.22 (95 % CI 1.62-3.03) for complex ACHD compared to non-ACHD.

CONCLUSIONS: Patients with more than moderate complexity ACHD are at specific risk for adverse outcomes when undergoing non-cardiac surgery. Further analyses are needed to give precise recommendations on the choice of appropriate surgical site as well as how to improve care and outcome of ACHD undergoing NCS.

PMID:41015714 | DOI:10.1016/j.ejim.2025.106514

Bioengineering (Basel). 2025 Sep 11;12(9):970. doi: 10.3390/bioengineering12090970.

ABSTRACT

Orofacial Mesenchymal Stem Cells (OMSCs) are an attractive and promising tool for tissue regeneration, with their potential for craniofacial bone repair being a primary focus of research. A key advantage driving their clinical interest is their accessibility from tissues that are often discarded, such as exfoliated deciduous teeth, which circumvents the ethical concerns and donor site morbidity associated with other stem cell sources. The high proliferation ability and multi-differentiation capacity of OMSCs make them a unique resource for tissue engineering. Recently, OMSCs have been explored in the restoration of the heart and skin, treatment of oral mucosal lesions, and regeneration of hard connective tissues such as cartilage. Beyond their direct regenerative capabilities, OMSCs possess potent immunomodulatory functions, enabling them to regulate the immune system in various inflammatory disorders through the secretion of cytokines. This review offers an in-depth update regarding the therapeutic possibilities of OMSCs, highlighting their roles in the regeneration of bone and various tissues, outlining their immunomodulatory capabilities, and examining the essential technologies necessary for their clinical application.

PMID:41007215 | PMC:PMC12467435 | DOI:10.3390/bioengineering12090970

J Neuroinflammation. 2025 Sep 26;22(1):213. doi: 10.1186/s12974-025-03538-9.

ABSTRACT

T cell dysfunction is a pivotal driving factor in autoimmune diseases, yet its underlying regulatory mechanisms remain incompletely understood. The role of long non-coding RNAs (lncRNAs) in immune regulation has gradually been recognized, although their functional mechanisms in T cells remain elusive. This study focuses on lncBADR (LncRNA Branched-chain Amino acids Degradation Regulator), elucidating its mechanism by which it regulates branched-chain amino acids (BCAAs) metabolism to influence T cell effector functions. Mice with specific knockout of lncBADR (T celllncBADR-/-) exhibited markedly ameliorated experimental autoimmune encephalomyelitis (EAE) symptoms. Mechanistic investigations revealed that lncBADR inhibits BCAAs degradation by binding to the enzymes Mccc1 and Pcca, leading to the accumulation of BCAAs within T-cells. This, in turn, activates the mTOR-Stat1 signaling pathway, promoting IFN-γ secretion and exacerbating EAE pathology. In contrast, knockout of lncBADR restored BCAAs degradation, significantly reducing IFN-γ secretion in T cells and suppressing their pathogenic functions. Further studies demonstrated that high-BCAAs feeding partially reversed the protective effects of lncBADR knockout, indicating that lncBADR plays a crucial role in autoimmune inflammation by regulating BCAAs metabolism. This study offers new insights into targeting lncBADR or modulating BCAAs metabolism as potential therapeutic strategies for autoimmune diseases.

PMID:41013574 | PMC:PMC12465721 | DOI:10.1186/s12974-025-03538-9

Nutrients. 2025 Sep 22;17(18):3025. doi: 10.3390/nu17183025.

ABSTRACT

Background: Abnormal mitochondrial energy metabolism is a key factor in the development and progression of cardiac hypertrophy. Hopeaphenol (HP), a tetramer of the natural polyphenol resveratrol, exhibits higher biological activity than resveratrol, but its specific role in cardiac hypertrophy and underlying mechanisms remains unclear. Methods: This study explored the protective effect and mechanism of hopeaphenol on cardiac hypertrophy through in vivo and in vitro experiments. In in vivo experiments, transverse aortic constriction (TAC) was used to induce cardiac hypertrophy in mice; HE, Masson, and WGA staining were applied to observe myocardial changes, ELISA was used to detect animal serum indicators, and the Cellular Thermal Shift Assay (CETSA) was conducted to verify the interaction between hopeaphenol and AMPK. In in vitro experiments, angiotensin II (Ang II) was used to induce hypertrophy of HL-1 cardiomyocytes, and the AMPK-specific inhibitor Compound C was employed to confirm the role of the AMPK pathway. Results: In in vivo experiments, TAC-induced cardiac hypertrophy in mice was characterized by left ventricular cavity enlargement and decreased ejection fraction; hopeaphenol treatment significantly improved these cardiac function indices, and HE, Masson, and WGA staining confirmed that hopeaphenol could restore cardiomyocyte morphology and reduce fibrosis. ELISA results of animal serum showed that hopeaphenol could improve metabolic disorders in TAC mice. Furthermore, CETSA confirmed a direct interaction between hopeaphenol and AMPK. In in vitro experiments, hopeaphenol reduced Ang II-induced hypertrophy and apoptosis of HL-1 cardiomyocytes, enhanced mitochondrial membrane potential, and decreased reactive oxygen species (ROS) levels by activating the AMPK pathway; moreover, the AMPK-specific inhibitor Compound C blocked these effects. This suggests that hopeaphenol's cardioprotective effect is largely mediated by AMPK activation. Conclusions: The protective effect of hopeaphenol on cardiac hypertrophy is highly dependent on the activation of the AMPK signaling pathway, with CETSA and molecular docking supporting direct binding between hopeaphenol and AMPK; this pathway improves mitochondrial dysfunction through AMPK, thereby alleviating heart failure caused by pressure overload. This finding identifies hopeaphenol as a potential candidate for further development in the prevention and treatment of heart failure.

PMID:41010549 | PMC:PMC12472553 | DOI:10.3390/nu17183025

Int J Mol Sci. 2025 Sep 13;26(18):8937. doi: 10.3390/ijms26188937.

ABSTRACT

Proprotein Convertase Subtilisin/Kexin type 9 PCSK9 inhibitors (PCSK9i) are a novel class of cholesterol-lowering agents that also offer protection against tissue ischemia by reducing apoptosis, pyroptosis, and myocardial infarct size. This study evaluated the effects of the PCSK9 inhibitor PEP 2-8 during hypothermic perfusion (HP) in a rat model of donation after circulatory death (DCD) kidney transplantation. DCD kidneys were perfused at 4 °C for six hours with either Perf-Gen solution alone (control) or Perf-Gen supplemented with PEP 2-8. Glucose and lactate dehydrogenase (LDH) levels were measured at baseline and after six hours (T6h). At T6h, kidneys were evaluated for ischemic injury, tubular cell proliferation, apoptosis, nitrotyrosine (N-Tyr) staining, tissue ATP and LDH levels, and gene expression of PCSK9 and NOX4. Metabolomic profiling was also performed. PEP 2-8 treatment significantly reduced PCSK9 expression, decreased tubular ischemic injury and necrosis, and lowered LDH release. Treated kidneys showed enhanced tubular cell proliferation, reduced apoptosis, and diminished oxidative stress, indicated by decreased N-Tyr staining and NOX4 expression. Energy metabolism was improved, with higher tissue ATP and glucose levels observed in the PEP 2-8 group. Metabolomic analysis further supported the antioxidant effects of PEP 2-8. This is the first study to demonstrate that PEP 2-8 administered during pre-transplant hypothermic perfusion provides renal protection by improving energy metabolism and reducing oxidative stress in the context of ischemic injury.

PMID:41009504 | PMC:PMC12469581 | DOI:10.3390/ijms26188937