Agregador de feeds

Heart Vessels. 2025 Oct 6. doi: 10.1007/s00380-025-02604-9. Online ahead of print.

ABSTRACT

Vascular endothelial function plays an important role in the pathophysiology of acute coronary syndrome (ACS). Plaque erosion (PE) and plaque rupture (PR) are the two major mechanisms of ACS; however, how the vascular endothelial function differs between these etiologies is not well understood. Flow-mediated dilation (FMD) is a method used to evaluate the endothelial function. We aimed to assess endothelial function using FMD in patients with PE and PR. ACS patients (N = 160) who underwent primary percutaneous coronary intervention (PCI) with optical frequency domain imaging (OFDI) and FMD assessment were retrospectively enrolled. Culprit plaques were categorized as PE or PR based on OFDI. Based on the median value of FMD (4.1%) in our data, patients were classified into high-FMD (> 4.1%) and low-FMD (≤ 4.1%) groups. Based on the plaque type and FMD values, the patients were divided into PR-HighFMD (N = 48), PR-LowFMD (N = 47), PE-HighFMD (N = 33), and PE-LowFMD (N = 32) groups, and then the clinical characteristics were compared. Major adverse cardiac events (MACE) were defined as cardiovascular death, nonfatal myocardial infarction, stroke, ischemia-driven revascularization, hospitalization for angina or heart failure. FMD was similarly impaired in the PE and PR groups (4.2% vs. 4.1%, P = 0.85). Most clinical characteristics did not differ between the groups. The PR-HighFMD group showed the highest MACE-free survival, followed by the PE-LowFMD (HR = 2.62, CI = 0.58-11.7, P = 0.21), PE-HighFMD (HR = 3.18, CI = 0.76-13.3, P = 0.11), and PR-LowFMD (HR = 5.44, CI = 1.55-19.1, P = 0.008) groups. FMD is likely to have a prognostic impact on patients with ACS, which might vary depending on the culprit lesion.

PMID:41051435 | DOI:10.1007/s00380-025-02604-9

Acta Clin Croat. 2024 Dec;63(3-4):611-618. doi: 10.20471/acc.2024.63.03-04.20.

ABSTRACT

The aim of the study was to determine major adverse cardiac events (MACE) related to the percutaneous coronary intervention (PCI) on saphenous vein graft (SVG) with a second-generation drug eluting stents in patients with previous coronary artery bypass graft (CABG). The research was conducted as a unicenter retrospective observational study which analyzed consecutive patients of both genders who had PCI on SVG from January 1, 2016 until June 30, 2019. The aim was to investigate the occurrence of MACE defined as development of periprocedural myocardial infarction, acute heart failure in the first 24 hours after PCI, unstable angina after PCI, periprocedural stroke, contrast induced nephropathy, death, acute/subacute/late stent thrombosis, and target lesion revascularization. The study included 97 consecutive patients. MACE was recorded in 20.6% of patients, more often in patients with thrombolysis in myocardial infarction grade flow ≤2. High thrombus burden (HTB) was detected in 44.3% of patients and it significantly contributed to the development of MACE. In conclusion, PCI on SVG is a highly challenging procedure, especially in patients with an acute coronary syndrome. In patients who have HTB recorded in SVG, the usage of thrombus aspiration and distal protection device can reduce the frequency of no-reflow phenomenon and consequential MACE.

PMID:41050241 | PMC:PMC12490448 | DOI:10.20471/acc.2024.63.03-04.20

Am J Prev Cardiol. 2025 Aug 19;23:101080. doi: 10.1016/j.ajpc.2025.101080. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: : Smoking is a preventable risk factor for incident cardiovascular disease. The impact of smoking status and potential benefits of smoking cessation in a distinct population with myocardial infarction with nonobstructive coronary arteries (MINOCA) remain poorly understood.

METHODS: : In this prospective single-center cohort study, 1179 patients with MINOCA were classified as non-, ex-, or current smokers based on smoking status at baseline. Current smokers were further categorized as persistent smokers or quitters due to their continued tobacco use or cessation within 1 year after MI. The primary endpoint was major adverse cardiovascular events (MACE), a composite of death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure.

RESULTS: : At multivariate Cox analysis, current smoking was independently associated with an increased risk of MACE compared to non-smokers over the median follow-up of 41.7 months [adjusted hazard ratio (aHR) 1.53; 95 % confidence interval (CI): 1.22-1.89, p < 0.001], whereas ex-smokers had a similar risk of MACE to non-smokers. Current smokers with ≥10 pack-years of exposure had a higher risk of MACE, and a near-linear trend was noted between cumulative smoking and MACE risk. Individuals who continued smoking had a significantly higher risk of MACE compared to quitters (aHR 1.70; 95 % CI: 1.17-2.47, p = 0.005). The benefits of smoking cessation remained consistent in subgroup and sensitivity analyses. Smokers who had substantial cigarette reduction or switched to E-cigarettes might also have a lower risk of MACE.

CONCLUSIONS: : Current smokers had worse outcomes as compared to non-smokers after MINOCA. Smoking cessation was associated with a reduced risk of adverse events, indicating the necessity of sustained smoking cessation in MINOCA population.

PMID:41049512 | PMC:PMC12490529 | DOI:10.1016/j.ajpc.2025.101080

Am Heart J Plus. 2025 Sep 18;59:100621. doi: 10.1016/j.ahjo.2025.100621. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Postoperative atrial fibrillation (POAF) can occur in up to 53.1 % of patients undergoing cardiac surgery. This serious condition has been associated with increased risk of morbidity and mortality during the initial weeks after the procedure. In this updated meta-analysis, we aim to study the impact of POAF on outcomes in patients undergoing CABG surgery.

METHODS: We searched PubMed, Scopus, Cochrane Library, and WOS from inception till April 15, 2024. The pooled effect sizes were mean difference (MD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes and a 95 % confidence interval (CI).

RESULTS: A total of 247,270 patients from 50 studies were included. Mean age ranged between 56.5 and 76 years and mean follow-up time duration ranged from six months to 15 years. In-hospital, 30-days, and long-term mortality were significantly higher in patients with POAF compared to patients without POAF with (OR: 2.37; 95 % CI: 1.45-3.87; P = 0.0033), (OR: 2.33; 95 % CI: 1.74-3.13; P < 0.01), and (OR: 2.15; 95 % CI: 1.8-2.54; P < 0.01respectively. In terms of stroke, both short- and long-term strokes were significantly higher in patients with POAF with (OR: 2.54; 95 % CI: 2.05-3.15; P < 0.01) and (OR: 1.92; 95 % CI: 1.37-2.68; P < 0.0007), respectively. Although POAF has significant longer hospital and intensive care unit stay and higher risk for post-operative renal failure and myocardial infarction, there was no significant difference in revascularization and reintubation rates in patients with POAF with (OR: 1.11; 95 % CI: 0.48-2.54; P = 0.656) and (OR: 2.72; 95 % CI: 0.86-8.67; P = 0.0742), respectively. The need for intra-aortic balloon pump was higher in POAF group with (OR: 1.84; 95 % CI: 1.42-2.37; P < 0.01) as well as the risk of developing heart failure with OR: 1.8; 95 % CI: 1.43-2.26; P = 0.0012.

CONCLUSION: Our findings suggest that POAF group may be associated with higher short-term mortality, long-term mortality, and length of hospital and ICU stay in patients undergoing CABG. Furthermore, there was a higher association between POAF and some postoperative complications such as stroke, acute renal failure, acute heart failure, and pneumonia. However, POAF did not seem to significantly affect rates of acute MI and reintubation.

PMID:41049259 | PMC:PMC12494572 | DOI:10.1016/j.ahjo.2025.100621

Eur Heart J Open. 2025 Sep 17;5(5):oeaf118. doi: 10.1093/ehjopen/oeaf118. eCollection 2025 Sep.

ABSTRACT

AIMS: Over recent decades, numerous measures have been implemented to improve treatment and timely intervention for ST-elevation myocardial infarction (STEMI). For deeper insights into the current state of care, this study investigates whether patient outcomes differ based on the timing of presentation (on-hours vs. off-hours) for primary percutaneous coronary intervention (PCI) for STEMI.

METHODS AND RESULTS: Data from STEMI PCIs performed from 2017 to October 2020, as registered within the Netherlands Heart Registration (NHR), were analysed. Off-hours presentation was defined as arrival at the catheterization laboratory (cath lab) on weekends, during working days between 17.00 and 08.00, or Monday between midnight and 08.00. Short-term outcomes included 30-day all-cause mortality and acute MI within 30 days. Long-term outcomes included all-cause mortality rates up till 5 years after PCI, target vessel revascularization within 1 year, and repeat revascularization with elective or non-STEMI PCI. The study included 19 090 STEMI patients from 17 centres, with 11 719 (61.4%) PCIs performed on-hours. No significant difference in 30-day mortality was observed between on-hours and off-hours patients (5.7% vs. 5.8%). On-hours patients had a longer time from symptom onset to cath lab arrival (≤6 h: 80.2% vs. 84.4%, P < 0.001) and were less likely to present with out-of-hospital cardiac arrest (7.6% vs. 9.5%, P < 0.001). No statistically significant differences in long-term outcomes were observed after adjusting for confounders.

CONCLUSION: Outcomes after primary PCI for STEMI are comparable between on-hours and off-hours presentations. The quality of care appears to be independent of time of arrival at the cath lab.

PMID:41048405 | PMC:PMC12492485 | DOI:10.1093/ehjopen/oeaf118

MedComm (2020). 2025 Oct 4;6(10):e70407. doi: 10.1002/mco2.70407. eCollection 2025 Oct.

ABSTRACT

The substantial loss of cardiomyocytes resulting from myocardial infarction leads to pathological remodeling of the heart and the onset of heart failure. Promoting heart regeneration is therefore a critical therapeutic goal for repairing damaged cardiac tissue. Over the past two decades, the utilization of cardiac stem cells for heart regeneration has emerged as a focal point of research. However, the related mechanisms and efficacy remain constrained by poor integration and survival. Concurrently, genetic lineage tracing has definitively shown that the adult mammalian heart lacks significant endogenous stem cells. It is now widely accepted that heart regeneration primarily arises from the proliferation of pre-existing adult cardiomyocytes. This review systematically summarizes the physiological and microenvironmental changes during the developmental process of cardiomyocytes, elucidates the intrinsic and extrinsic molecular biological mechanisms that regulate cardiomyocyte proliferation, and discusses exogenous cell transplantation therapy, potentially endogenous pharmacological and genetic approaches, as well as promising bioengineering and cross-disciplinary methods. By synthesizing these multifaceted advances, this review aims to clarify important issues that require further elucidation in this field, thereby advancing the depth of research on heart regeneration and its clinical translational applications.

PMID:41049268 | PMC:PMC12495452 | DOI:10.1002/mco2.70407

Int J Biol Macromol. 2025 Oct 4:148069. doi: 10.1016/j.ijbiomac.2025.148069. Online ahead of print.

ABSTRACT

Global warming increases the risk of heart failure and sudden death in humans and animals due to heat stress (HS). HSP90 is important in maintaining protein structure and regulating ER homeostasis during HS. However, the exact mechanism of HS-induced myocardial injury and the specific regulatory role of HSP90 remain largely unclear. Therefore, we established the HS model using broilers and chicken primary myocardial cells (CPMCs) sensitive to HS and intervened with the ERS activator (tunicamycin, TM) or inhibitor (4-Phenylbutyric acid, 4-PBA), and the autophagy activator (Rapamycin) or antagonist (3-MA). The results showed that HS caused abnormal cardiac morphology and structure in broilers. Mechanistically, ERS, autophagy, and apoptosis were significantly promoted by HS in both the myocardial tissue and cardiomyocytes. However, intervention with TM or 4-PBA significantly exacerbated or reversed these changes, while Rapamycin or 3-MA alleviated or promoted apoptosis. Moreover, HSP90 directly regulates ERS by interacting with IRE1α or PERK. HSP90 knockdown enhances ERS-mediated autophagy and apoptosis, while HSP90 overexpression reverses these effects. In conclusion, the present research suggested that HS triggers ERS-mediated protective autophagy in broiler cardiomyocytes, which is beneficial for inhibiting apoptosis. Activating HSP90 may be a promising strategy to ameliorate HS-induced cardiac injury.

PMID:41052563 | DOI:10.1016/j.ijbiomac.2025.148069

J Pharmacol Exp Ther. 2025 Sep 10;392(10):103703. doi: 10.1016/j.jpet.2025.103703. Online ahead of print.

ABSTRACT

Sepsis is a life-threatening organ dysfunction syndrome triggered by infection and uncontrolled inflammatory responses, with sepsis-associated myocardial dysfunction being a leading cause of mortality and morbidity. Metformin, a widely prescribed antihyperglycemic drug, has shown emerging protective effects beyond glucose control. In this study, we investigated the protective role of metformin against LPS-induced injury and inflammation in H9C2 and AC16 cardiomyocytes and explored the underlying mechanisms. LPS stimulation significantly reduced cell viability, promoted apoptosis, and upregulated proinflammatory cytokines (TNFα, IL-6, and IL-1β) in H9C2 and AC16 cells. Metformin treatment markedly alleviated these effects, indicating its protective role against LPS-induced cytotoxicity and inflammation. Mechanistically, metformin significantly upregulated microRNA miR-497-5p, which directly suppressed β-transducin repeat containing E3 ubiquitin-protein ligase (BTRC) expression, leading to inhibition of IκBα degradation and NF-κB pathway activation. Importantly, miR-497-5p knockdown or BTRC overexpression partially reversed the protective effects of metformin, restoring NF-κB signaling and inflammatory cytokine production. These findings collectively demonstrate that metformin protects H9C2 and AC16 cardiomyocytes from LPS-induced injury through miR-497-5p/BTRC axis-mediated suppression of NF-κB activation and highlight the functional importance of miR-497-5p and BTRC in this regulatory process. SIGNIFICANCE STATEMENT: This study highlights the protective effects of metformin against LPS-induced H9C2 and AC16 cell injury and inflammation, revealing a novel mechanism involving miR-497-5p/BTRC axis-mediated NF-κB pathway inhibition. These findings offer insights into potential therapeutic strategies for sepsis-associated myocardial dysfunction.

PMID:41052485 | DOI:10.1016/j.jpet.2025.103703

Acta Clin Croat. 2024 Dec;63(3-4):611-618. doi: 10.20471/acc.2024.63.03-04.20.

ABSTRACT

The aim of the study was to determine major adverse cardiac events (MACE) related to the percutaneous coronary intervention (PCI) on saphenous vein graft (SVG) with a second-generation drug eluting stents in patients with previous coronary artery bypass graft (CABG). The research was conducted as a unicenter retrospective observational study which analyzed consecutive patients of both genders who had PCI on SVG from January 1, 2016 until June 30, 2019. The aim was to investigate the occurrence of MACE defined as development of periprocedural myocardial infarction, acute heart failure in the first 24 hours after PCI, unstable angina after PCI, periprocedural stroke, contrast induced nephropathy, death, acute/subacute/late stent thrombosis, and target lesion revascularization. The study included 97 consecutive patients. MACE was recorded in 20.6% of patients, more often in patients with thrombolysis in myocardial infarction grade flow ≤2. High thrombus burden (HTB) was detected in 44.3% of patients and it significantly contributed to the development of MACE. In conclusion, PCI on SVG is a highly challenging procedure, especially in patients with an acute coronary syndrome. In patients who have HTB recorded in SVG, the usage of thrombus aspiration and distal protection device can reduce the frequency of no-reflow phenomenon and consequential MACE.

PMID:41050241 | PMC:PMC12490448 | DOI:10.20471/acc.2024.63.03-04.20

Nat Rev Cardiol. 2025 Oct 6. doi: 10.1038/s41569-025-01220-4. Online ahead of print.

ABSTRACT

The growing epidemics of metabolic-dysfunction-associated steatotic liver disease, type 2 diabetes mellitus, obesity and cardiovascular disease are inextricably linked. Cardiovascular-liver-metabolic (CLM) diseases coexist and interact to constitute a synergy of epidemics (a syndemic), with shared mechanisms and socioeconomic influences. The goal of this Review is to construct this complex public-health issue into a unified framework, using epidemiological data to illustrate the current burden of disease and the trends in the CLM syndemic and to make projections for the future. We also discuss the challenges of promoting CLM health and the need for shared solutions. The proposed micro-meso-macro framework integrates strategies to improve risk prediction and precision prevention and to disentangle the competing risks within the CLM construct (micro), while keeping communities at the heart of CLM health promotion by ensuring access to healthy foods, healthy environments and metabolic interventions (meso). In addition, we propose interventions to eliminate inequities in the social and commercial determinants of health, from communities to healthcare systems (macro). Thus, multisystem interventions could address the trajectories of the CLM disease epidemics simultaneously.

PMID:41053364 | DOI:10.1038/s41569-025-01220-4

Cardiovasc Res. 2025 Oct 6:cvaf179. doi: 10.1093/cvr/cvaf179. Online ahead of print.

ABSTRACT

Anthracycline cardiotoxicity is a severe chemotherapeutic side effect that can lead to heart failure in cancer patients and survivors. Chronomodulated chemotherapy is a promising preventive strategy that encompasses the adjustment of anthracycline administration time to the circadian rhythms (24-hour rhythms) of the body. Circadian rhythms play a major role in cardiovascular physiology and disease and may lead to a time-dependent variation in cardiac sensitivity to anthracyclines. In this review, all available evidence on the topic of chronomodulated anthracyclines for cardiotoxicity reduction and/or oncological efficacy enhancement is summarized. In total, 3 in vitro studies, 12 animal studies, and 9 clinical studies were included. Potential mechanistic explanations involved 24-hour variation in oxidative stress regulation, DNA damage repair, and systemic or intracellular pharmacokinetics. We identified a hypothesized optimal time frame from 3 to 11 AM for anthracycline administration in humans, based on extrapolation of findings in animal studies.

PMID:41052913 | DOI:10.1093/cvr/cvaf179

Diabetes Res Clin Pract. 2025 Oct 4;229:112931. doi: 10.1016/j.diabres.2025.112931. Online ahead of print.

ABSTRACT

AIMS: Following up on a prior placebo-controlled trial (NCT03889236), we examined the effects of an oral glycocalyx-mimetic supplement and a fasting-mimicking diet (FMD) on three urinary peptidomic-based classifiers, which indicate future heart failure (HF2), coronary artery disease (CAD160), and chronic kidney disease (CKD273) risk in South-Asian Surinamese adults with type 2 diabetes mellitus.

METHODS: Forty-four participants were randomly allocated to one of three 12-week interventions: daily glycocalyx-mimetic capsules (n = 18), placebo (n = 14), or a five-day FMD repeated every four weeks (n = 12). Baseline and week-12 urine were profiled via capillary electrophoresis-mass spectrometry (CE-MS). The pre-validated support vector machine (SVM) classifiers (HF2, CAD160, CKD273) produced risk scores that were evaluated through paired t-tests for each group. Peptide-level changes were analyzed using paired Wilcoxon signed-rank tests, and all p-values were Benjamini-Hochberg corrected (α = 0.05).

RESULTS: Glycocalyx-mimetic supplementation significantly reduced HF2 scores (mean Δ = -0.58, 95 % CI -0.83 to -0.33, adjusted p < 0.001) and altered the abundance of 17 peptides, primarily decreasing collagen-derived fragments, suggesting improved extracellular-matrix turnover. The risk scores for CAD160 and CKD273 remained unchanged. FMD and placebo did not produce any meaningful changes in classifier scores.

CONCLUSIONS: In this cohort, glycocalyx-mimetic supplementation improved the urinary peptidomic signature associated with heart-failure risk, whereas an FMD did not. Urinary peptidomics offers a sensitive molecular method for monitoring the effects of (dietary) interventions.

PMID:41052726 | DOI:10.1016/j.diabres.2025.112931

Transpl Immunol. 2025 Oct 4:102308. doi: 10.1016/j.trim.2025.102308. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney transplant recipients experience heightened systemic inflammation, and biomarkers such as interleukin-6 (IL-6), C-reactive protein (CRP), and high-sensitivity CRP (hsCRP) have been proposed as prognostic indicators.

OBJECTIVE: This meta-analysis evaluates the associations between IL-6, CRP, and hsCRP levels and all-cause mortality, cardiovascular events, and graft dysfunction in kidney transplant recipients.

METHODS: A comprehensive search of PubMed, Web of Science, Scopus, Ovid MEDLINE, and the Cochrane Library until October 11, 2024, identified eligible studies reporting associations between IL-6, CRP, or hsCRP and clinical outcomes in adult kidney transplant recipients.

RESULTS: The systematic review included 40 studies, with 18 meeting criteria for meta-analysis. Elevated IL-6 was associated with a higher risk of graft dysfunction (HR 1.53, 95 % CI 1.28-1.83; I2 = 0 %) and all-cause mortality (HR 1.66, 95 % CI 1.05-2.61; I2 = 97.2 %), but not cardiovascular events. CRP was associated with all-cause mortality (HR 2.07, 95 % CI 1.59-2.70; I2 = 0 %) and cardiovascular events (HR 6.89, 95 % CI 2.52-18.85; I2 = 0 %), but not cardiovascular mortality or graft dysfunction. Elevated hsCRP was associated with all-cause mortality (HR 1.29, 95 % CI 1.15-1.44; I2 = 61 %), but not with cardiovascular events or graft dysfunction.

CONCLUSIONS: Among kidney transplant recipients, elevated levels of IL-6, CRP, and hsCRP were significantly associated with increased all-cause mortality, though the association of IL-6 with all-cause mortality showed substantial heterogeneity and should be interpreted with caution. IL-6 also emerged as a predictor of graft dysfunction, while CRP demonstrated a strong association with cardiovascular events. These findings highlight the potential role of inflammatory biomarkers, particularly IL-6 and CRP, in post-transplant risk stratification; however, further studies are needed to establish causality and clarify their clinical utility.

PMID:41052640 | DOI:10.1016/j.trim.2025.102308

Ultrasound J. 2025 Oct 6;17(1):46. doi: 10.1186/s13089-025-00448-y.

ABSTRACT

BACKGROUND: Pulsus alternans (PA) is an intriguing phenomenon and a clinically rare entity. Accurately assessing cardiac function in patients with PA remains challenging. This study aims to investigate the myocardial mechanical characteristics and non-invasive hemodynamic profiles of PA patients using multiple echocardiographic imaging modalities.

METHODS: Clinical and echocardiographic data were retrospectively analysed from 16 patients diagnosed with PA by echocardiography at our hospital between January 2021 and May 2025. In this study, the characteristics of PA were elaborated by multiple echocardiographic methods, and the non-invasive hemodynamic profile was determined by pulse-wave Doppler.

RESULTS: Sixteen patients were enrolled. Seven were classified as NYHA class III and six as class IV. Elevated levels of NT-proBNP and hs-cTNT were observed in most patients. Follow-up ranged from 1 to 44 months, and five patients experienced adverse outcomes, including heart transplantation, rehospitalisation, and death. Within this cohort, three patients exhibited biventricular PA, while 13 patients presented with left ventricular (LV) PA. Key hemodynamic parameters varied significantly: LVOT-VTIstrong beat ranged from 11.3 cm to 29.2 cm, LVOT-VTIweak beat from 6.8 cm to 22.1 cm, and the variation rate between strong and weak beats (∆LVOT-VTI) ranged from 19 to 52%. Global longitudinal strain (GLS) was significantly reduced in 14 patients (range: - 1.2% to - 10.4%), while peak strain dispersion (PSD) increased (range: 47 ms to 117.5 ms). Two patients were excluded from strain analysis due to suboptimal imaging. Hemodynamic parameters (LVOT-VTIstrong beat, LVOT-VTIweak beat and ∆LVOT-VTI) showed strong correlations with GLS in PA patients (r = 0.806, P = 0.001; r = 0.642, P = 0.018 and r = 0.611, P = 0.027, respectively). NT-proBNP was significantly positively related to adverse outcomes in PA patients (r = 0.669, P = 0.012).

CONCLUSION: Echocardiography is essential for evaluating cardiac function in patients with PA. This study used multiple echocardiographic methods to delineate the characteristics of this intriguing clinical phenomenon. Non-invasive hemodynamic parameters are potentially important for prognosis assessment, and myocardial strain assessment provides valuable insights into myocardial mechanical features. A comprehensive analysis using multimodality imaging is crucial for accurately identifying this disease, potentially enhancing the understanding of the pathophysiological mechanism of PA.

PMID:41051648 | PMC:PMC12500491 | DOI:10.1186/s13089-025-00448-y

Clin Transplant. 2025 Oct;39(10):e70336. doi: 10.1111/ctr.70336.

ABSTRACT

BACKGROUND: Transplant teams may be better prepared to entertain DCD offers with a priori prediction of prolonged warm ischemia time (WIT) and deploy perfusion strategies (PS) to mitigate the risk of WIT.

METHODS: All potential adult Maastricht-III DCDs in one Organ Procurement Organization from January 2016 to July 2024 were reviewed. Data were obtained from UNOS DonorNet. Cases with missing variables were excluded. The most recent clinical values prior to withdrawal of life support treatment (WLST) were utilized. Logistic regression assessed the likelihood of DCD progression within 30 min after WLST.

RESULTS: From a total of 748 potential DCDs, 350 were assessed after exclusion criteria. One hundred and seventy-one (49%) progressed within 30 min. Forty percent (n = 140) of the sample was used for training and 60% (n = 160) for validation. Potassium (OR: 3.01; 95% CI: [1.39, 6.5], p = 0.005), sodium (OR: 1.23; 95% CI: [1.01, 1.50], p = 0.036); body mass index (OR: 1.68; 95% CI: [1.39, 2.03], p = 0.0001) and heart rate (OR: 1.54; 95% CI: [1.24, 1.92], p = 0.0001) positively correlated with progression. Age (OR: 0.71; 95% CI: [0.58, 0.86], p = 0.0006); presence of pupillary reflexes (OR: 0.81; 95% CI:[0.68, 0.92], p = 0.007); presence of corneal reflexes (OR: 0.27; 95% CI: [0.22, 0.34], p = 0.001); and presence of overbreathing the ventilator (OR: 0.39; 95% CI: [0.32, 0.48], p = 0.001) negatively correlated with progression. Discrimination was excellent (NPV 89%; PPV 88%).

CONCLUSIONS: DonorNet variables predict progression to circulatory death within 30 min. If there is an indication that a DCD will not progress within a 30-min threshold, then early discussion of PS may decrease the risk of a dry run.

PMID:41051386 | DOI:10.1111/ctr.70336

Interdiscip Cardiovasc Thorac Surg. 2025 Oct 6:ivaf239. doi: 10.1093/icvts/ivaf239. Online ahead of print.

ABSTRACT

We report Europe's longest documented heart perfusion using the Transmedics Organ Care System (OCS) during a heart transplantation. A 55-year-old patient with end-stage heart failure received a donor heart after 536 min (8 h 55 min) of OCS perfusion and a total out-of-body time of 676 min (11 h 16 min). Due to adverse weather, air transport was not possible, necessitating an extended ground-based journey. Despite initial vasospasm, perfusion parameters remained stable. The heart demonstrated immediate post-transplant function without need of mechanical support. This case demonstrates the potential of the OCS to extend preservation times beyond conventional limits, increasing access to viable donor organs and optimizing transplantation outcomes.

PMID:41051264 | DOI:10.1093/icvts/ivaf239

Front Immunol. 2025 Sep 19;16:1685682. doi: 10.3389/fimmu.2025.1685682. eCollection 2025.

ABSTRACT

Xenotransplantation has experienced major clinical advancements over the past three years. Yet, despite potent immunosuppressive regimens combining B-cell depleting therapies, T cell activation blockade, complement inhibition, and high-dose steroids, signs of antibody-mediated and cellular rejection were seen in the few pig-to human heart and kidney xenotransplants. Considering the recent success of chimeric antigen receptor T cell therapies in severe refractory autoimmune diseases, there are windows for opportunities to develop novel approaches to reduce the burden of immunosuppression. In this line, regulatory T cell (Treg) therapy is an attractive strategy, as Tregs could be genetically modified to recognize pig organs. In this brief review, we summarize the lessons learned from Tregs therapies in allotransplantation, update on the recent development in Treg research for xenotransplantation, and discuss future perspectives of humanizing pigs with human leukocyte antigens to promote tolerance using engineered Tregs.

PMID:41050672 | PMC:PMC12491223 | DOI:10.3389/fimmu.2025.1685682

Eur Heart J Case Rep. 2025 Sep 16;9(10):ytaf448. doi: 10.1093/ehjcr/ytaf448. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: Severe aortic insufficiency (AI) after catheter ablation (CA) for ventricular tachycardias (VTs) via a retrograde aortic (RA) approach in patients with left ventricular assist devices (LVADs) has not been reported and is not well recognized.

CASE SUMMARY: A 59-year-old man with dilated cardiomyopathy underwent LVAD implantation as a bridge to transplantation. After 6 months, the drug-resistant VTs increased, and CA was performed via the RA approach since echocardiography showed that the aortic valve was still occasionally open with only trivial AI. After mapping and ablation of the left ventricle (LV), the VTs were acutely suppressed. However, the patient was readmitted to our hospital 8 days later with worsening heart failure. The AI had progressed from trivial to severe and did not improve despite medical therapy; therefore, a surgical aortic valvuloplasty was performed. Since then, the heart failure has resolved for 12 months without AI.

DISCUSSION: This is the first report of a patient with an LVAD who underwent CA via an RA approach for VTs and subsequently developed heart failure due to severe AI that required open-heart surgery. In patients with LVADs, aortic valves may be prone to catheter-induced deformation or injury, and continuous aspiration of the LV by LVADs can lead to significant AI, requiring open-heart surgery. This study demonstrated a real case in which it was important to consider these potential risks when selecting the LV approach as well as during and after the procedures via an RA approach, especially in patients with LVADs.

PMID:41050537 | PMC:PMC12495030 | DOI:10.1093/ehjcr/ytaf448

Eur Heart J Case Rep. 2025 Sep 19;9(10):ytaf478. doi: 10.1093/ehjcr/ytaf478. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: Post-infarction ventricular septal defect (VSD) is a rare but life-threatening complication of myocardial infarction, in severe cases needing heart transplantation. The Aeson Total Artificial Heart (TAH), a bioprosthetic device designed to replace both ventricles, offers an alternative for patients unsuitable for conventional therapies.

CASE SUMMARY: A 69-year-old male presented in cardiogenic shock following an inferior wall ST-elevation myocardial infarction complicated by a large VSD. Initial support included extracorporeal life system. Surgical repair was unfeasible due to the defect's size and proximity to the atrioventricular valve, leaving insufficient rim for septal reconstruction. Total artificial heart implantation was the only viable option, used as bridge-to-decision therapy given the patient's advanced age. Post-operative recovery was prolonged, but the patient was successfully transferred to an inpatient rehabilitation facility, where structured physiotherapy, endurance, resistance, and mobility training led to significant functional improvement. Close collaboration with a mechanical circulatory support perfusionist resolved recurring TAH alarms related to intraventricular pressure and communication issues adapting the diuretic and antihypertensive medication. The patient was discharged home in stable condition, achieving substantial physical recovery and independence in managing the device.

DISCUSSION: The Aeson TAH proved to be a safe and effective therapy, in particular, as bridge-to-decision therapy in this complex case of post-infarction VSD. Inpatient cardiac rehabilitation played a pivotal role in optimizing physical recovery, managing device-related challenges, and preparing the early transition to an independent living. This case highlights the potential of advanced bioprosthetic solutions and the benefits of a structured rehabilitation system in managing severe cardiac conditions. Further research is needed to evaluate the long-term outcomes and broader applicability of the Aeson TAH.

PMID:41050533 | PMC:PMC12495036 | DOI:10.1093/ehjcr/ytaf478

iScience. 2025 Aug 27;28(9):113449. doi: 10.1016/j.isci.2025.113449. eCollection 2025 Sep 19.

ABSTRACT

Hepatic mitochondrial maladaptation features the transition from metabolic dysfunction-associated steatotic liver disease (MASLD) to Steatohepatitis (MASH) up to fibrosis/cirrhosis. However, it is still unexplored whether mitochondrial alterations also affect adipose tissue, muscle and heart during disease progression. C57Bl/6 mice were fed an AMLN diet to recapitulate the human MASLD spectrum. In the liver, TEM depicted a progressive morphologic dysfunction of mitochondria, which appeared swollen in MASH, with disorganized cristae/matrix loss in MASH-fibrosis. The mitophagy pathway was reduced in MASH-fibrosis, thus explaining the accumulation of damaged mitochondria, whereas mitochondrial complexes activities alongside OXPHOS protein levels and ATP production were dampened across the disease in liver, adipose, muscle, and cardiac tissues. Finally, the release of cell-free circulating mitochondrial DNA into the bloodstream reflected tissue mitochondrial impairment. In sum, we demonstrated that alterations in mitochondrial morphology, life cycle, and activity feature all disease stages in the liver but also in other tissues engaged in MASLD evolution.

PMID:41050429 | PMC:PMC12495477 | DOI:10.1016/j.isci.2025.113449