Agregador de feeds

J Extra Corpor Technol. 2025 Jun;57(2):82-88. doi: 10.1051/ject/2025007. Epub 2025 Jun 16.

ABSTRACT

INTRODUCTION: Perfusion safety in cardiothoracic surgery is critical, particularly in Pakistan where variability in practice standards exists. This survey investigates the current perfusion practices among Pakistani perfusionists, focusing on the adherence to safety standards during cardiopulmonary bypass (CPB) procedures.

METHODS: The survey was conducted over two weeks to explore key areas of perfusion practice, including the use of bubble detectors, level detectors, arterial filters, and saturation monitoring during CPB procedures. Out of approximately 350 practicing perfusionists in Pakistan, 66 responded, resulting in a response rate of 18.9%. The data was collected through an online platform, ensuring anonymity and voluntary participation. The survey included mainly Yes/No questions. To ensure reliability and validity, the questionnaire was reviewed by experts, pilot tested, and refined based on feedback, ensuring it was effective in gathering meaningful insights.

RESULTS: The survey results indicate a variable use of essential safety devices such as bubble and level detectors, arterial filters, and continuous venous saturation and cerebral saturation monitoring. While some perfusionists adhere to recommended safety protocols, gaps in the use of critical monitoring equipment were evident.

CONCLUSION: The findings highlight the need for standardized perfusion practices in Pakistan to ensure safety and efficacy during CPB. Addressing the gaps in the use of safety and monitoring equipment could lead to improved patient outcomes. Further research is needed to explore the barriers to uniform safety standards and to develop strategies for enhancing perfusion safety across the country.

PMID:40523135 | PMC:PMC12169702 | DOI:10.1051/ject/2025007

J Extra Corpor Technol. 2025 Jun;57(2):66-73. doi: 10.1051/ject/2024037. Epub 2025 Jun 16.

ABSTRACT

Medical procedural registries are uniquely positioned to support shared decision-making through risk prediction modeling, support quality assessment and improvement through performance benchmarking, and provide public reporting of evidence-based practices and outcomes. For example, the Centers for Disease Control and Prevention (CDC) consulted the Extracorporeal Life Support Organization (ELSO) registry to assess the severity of the swine flu outbreak in 2009-2010. The development and growth of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has positively contributed to the congenital heart surgery community by developing objective mortality STAT categories and complexity stratification for operations, a common nomenclature for classifying operations and reporting the costs associated with complications for nine benchmark operations. Within the setting of adult cardiac surgery, the Perfusion Down Under Collaborative has used its registry to develop quality improvement initiatives, including those related to the management of arterial outlet temperature, glucose, and arterial pCO2. The PERForm registry leverages data from nearly 50 US hospitals to support targeted quality improvement initiatives within the setting of adult cardiac surgery. The PERForm registry participants receive benchmark reports and participate in quarterly collaborative learning meetings noted for unblinding hospital performance data. In 2014, with no current congenital cardiopulmonary bypass (CPB) registries, various experts within the congenital perfusion community and leaders from the PERForm registry began working to develop a pediatric perfusion registry. From this work, the PediPERForm Learning Network (PLN) and its associated congenital perfusion registry became active and began collecting data in October 2021.

PMID:40523133 | PMC:PMC12169737 | DOI:10.1051/ject/2024037

Circulation. 2025 Jun 17;151(24):1752-1754. doi: 10.1161/CIRCULATIONAHA.124.073533. Epub 2025 Jun 16.

NO ABSTRACT

PMID:40523048 | DOI:10.1161/CIRCULATIONAHA.124.073533

J Am Heart Assoc. 2025 Jun 17;14(12):e039673. doi: 10.1161/JAHA.124.039673. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: Fulminant myocarditis is life-threatening and often requires mechanical circulatory support. Predicting its clinical course is crucial, yet data on early recovery predictors, particularly with veno-arterial extracorporeal membrane oxygenation, remain lacking.

METHODS AND RESULTS: We aimed to identify prognostic factors of early recovery in fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation by retrospective analysis of a nationwide registry in Japan. Early recovery was defined as successful weaning from mechanical circulatory support within 7 days and discharge without heart transplantation or long-term mechanical circulatory support. A total of 343 patients were analyzed; 71 were classified as early recovery and 272 as nonearly recovery. The early recovery group was significantly younger, had higher white blood cell counts, and lower creatine kinase-myocardial band level than the nonearly recovery group. To enhance clinical interpretability, we dichotomized continuous variables using optimal cutoff values derived from the Youden index. Multivariable logistic regression analysis showed the independent factors of early recovery were age ≤40 years (odds ratio [OR], 3.25), white blood cell count ≥11 000/μL (OR, 3.10), and creatine kinase-myocardial band ≤61 U/L (OR, 2.46), and if all conditions were fulfilled, the early recovery rate increased to 61.5%. Additionally, although not statistically significant, the number of rehospitalization with cardiovascular causes, death, or heart transplantation at 1-year follow-up was higher in the nonearly recovery group.

CONCLUSIONS: Our study suggested younger patients who have a strong inflammatory response but less myocardial damage on admission could recover earlier. Conversely, in cases where mechanical circulatory support duration is prolonged, careful monitoring is required for prolonged left ventricular dysfunction and subsequent prognosis.

REGISTRATION: URL: https://www.umin.ac.jp/; Unique identifier: UMIN000039763.

PMID:40521639 | DOI:10.1161/JAHA.124.039673

Basic Res Cardiol. 2025 Jun 15. doi: 10.1007/s00395-025-01122-z. Online ahead of print.

ABSTRACT

Ferroptosis is an important cause of cardiomyocyte loss and cardiac dysfunction. Cathelicidin-related antimicrobial peptide (CRAMP) is an endogenous polypeptide that regulates oxidative stress in the body and is involved in ferroptosis. However, its specific role and mechanism in ferroptosis are unclear. To analyze the role of CRAMP in ferroptosis, we first analyzed its expression in infarcted myocardial tissues, and verified its role in ferroptosis in vitro through overexpression and knock-down techniques. The activity and expression of cathepsin L (CTSL) and its effect on ferroptosis were analyzed to verify whether CTSL participated in ferroptosis as a downstream of CRAMP. Protein disulfide isomerase family A member 4 (PDIA4) was screened as an interacting protein of CTSL by using the database, and the role of PDIA4 in ferroptosis was analyzed by gene knockdown and overexpression. Finally, the regulatory mechanism of CRAMP in ferroptosis was verified in vivo by mouse myocardial infarction model. CRAMP levels were reduced in both infarcted cardiac tissues and cardiomyocytes exposed to ferroptosis inducers. The overexpression of CRAMP or pretreatment of LL-37 alleviated cardiomyocyte ferroptosis, whereas CRAMP knockdown exacerbated cell death. Under ferroptotic stress, the expression of CTSL was elevated. CRAMP inhibited ferroptosis by antagonizing the CTSL activity. Abnormal increase in CTSL activity and levels caused PDIA4 to decrease. Overexpression of PDIA4 inhibited ferroptosis induced by CTSL, while knocking down PDIA4 counteracted the protection of CRAMP. In vivo, both CRAMP overexpression and administration of CRAMP peptide significantly ameliorated myocardial injury and improved cardiac function. CRAMP increases PDIA4 levels by inhibiting the activity of CTSL and antagonizes ferroptosis in cardiomyocytes. Targeting CRAMP offers innovative therapeutic strategies and insights for the prevention and management of myocardial injury.

PMID:40517353 | DOI:10.1007/s00395-025-01122-z

J Cardiothorac Vasc Anesth. 2025 May 15:S1053-0770(25)00375-1. doi: 10.1053/j.jvca.2025.05.016. Online ahead of print.

NO ABSTRACT

PMID:40518335 | DOI:10.1053/j.jvca.2025.05.016

J Cardiothorac Vasc Anesth. 2025 May 24:S1053-0770(25)00431-8. doi: 10.1053/j.jvca.2025.05.041. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the relationship between the pulmonary-to-systemic-blood-flow ratio (Qp/Qs) and the cross-sectional area (CSA) and diameter of the right internal jugular vein (RIJV) in pediatric patients with congenital heart disease using multivariate analysis.

DESIGN: Retrospective study.

SETTING: Operating room of a tertiary children's hospital.

PARTICIPANTS: Pediatric patients aged <10 years with congenital heart disease who underwent cardiovascular surgery under general anesthesia.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Multiple linear regression analyses were performed, with the CSA of the RIJV as the primary outcome and the anteroposterior and transverse diameters of the RIJV as secondary outcomes. These were designated as dependent variables, while Qp/Qs served as the independent variable. The analyses were adjusted for the following factors: weight, sex, postbidirectional Glenn operation, preoperative diuretic use, number of previous median sternotomies, single ventricle, trisomy 21, superior vena cava pressure, systolic blood pressure, heart rate, hemoglobin concentration, partial pressure of carbon dioxide, pH of arterial blood, and cardiac index. The adjusted regression coefficient estimates for Qp/Qs were as follows: 0.88 (95% confidence interval: 0.84-0.94, p < 0.001), 0.94 (95% confidence interval: 0.92-0.97, p < 0.001), and 0.94 (95% confidence interval: 0.91-0.97, p < 0.001) in the CSA, anteroposterior diameter, and transverse diameter of the RIJV, respectively.

CONCLUSIONS: A higher Qp/Qs was associated with a smaller CSA, as well as reduced anteroposterior and transverse diameters of the RIJV. Specifically, for each unit increase in Qp/Qs, the CSA of the RIJV decreased by approximately 12%.

PMID:40518334 | DOI:10.1053/j.jvca.2025.05.041

Int J Cardiol. 2025 Jun 16;437:133496. doi: 10.1016/j.ijcard.2025.133496. Online ahead of print.

ABSTRACT

BACKGROUND: Recent randomized trials have suggested that immediate complete revascularization (ICR) is a viable alternative to staged complete revascularization (SCR) in patients with acute coronary syndrome (ACS) and multivessel disease. However, long-term outcomes comparing ICR with SCR in ST-segment elevation (STE) and non-ST-segment elevation (NSTE) ACS remain unclear.

METHODS: This study analyzes 2-year follow-up data from the BIOVASC trial, randomizing ACS patients to ICR or SCR. The primary composite endpoint includes all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, and cerebrovascular events. Secondary endpoints evaluate these outcomes individually. Cox regression assessed if STE/NSTE-ACS diagnosis influences treatment effect.

RESULTS: In 608 STE-ACS patients, the 2-year cumulative incidence of the primary composite endpoint was 10.9 % (ICR) and 11.7 % (SCR) (risk difference [RD] 0.8 %, 95 % confidence interval [CI] -4.3 % to 5.9 %; P = 0.71). In NSTE-ACS, cumulative incidence was 13.5 % (ICR) and 12.8 % (SCR) (RD -0.7 %, 95 % CI -5.1 % to 3.7 %; P = 0.90). No differential effect was observed comparing ICR with SCR between STE- and NSTE-ACS.

CONCLUSIONS: ICR did not sustain a significant benefit in terms of the primary and secondary outcomes at 2 years follow-up. In addition, no differential effect of ICR versus SCR was observed between STE-ACS and NSTE-ACS after 2 years follow-up. However, there seems to be a late catch-up in the cumulative event rate in patients randomized to ICR.

PMID:40516659 | DOI:10.1016/j.ijcard.2025.133496

Acta Biomater. 2025 Jun 12:S1742-7061(25)00433-7. doi: 10.1016/j.actbio.2025.06.018. Online ahead of print.

ABSTRACT

Copper overload induces a unique form of cell death called cuproptosis via mitochondrial ROS accumulation. Following myocardial infarction (MI), copper ion levels rise significantly in infarcted tissue. Cardiomyocytes, highly sensitive to copper, respond through activation and nuclear translocation of LRP6, which interacts with ALKBH5 to suppress m6A modification of ferredoxin 1 (FDX1), thereby exacerbating copper toxicity. LRP6 also facilitates copper influx, further promoting cuproptosis. High-throughput screening identified chrysin-7-O-glucuronide (C7Og) as a potent LRP6 inhibitor that mitigates cuproptosis without compromising cardiac protective effects. Moreover, a Janus hydrogel enhanced with benzalkonium chloride-modified tannic acid improves tissue adhesion and glucose delivery. A myocardial patch integrating C7Og within this hydrogel significantly reduced infarct size and improved cardiac function in both rat and Bama miniature pig models, highlighting strong translational potential for MI therapy. STATEMENT OF SIGNIFICANCE: This study uncovers a mechanism of copper-induced cell death, termed cuproptosis, in myocardial infarction (MI). It identifies low-density lipoprotein receptor-related protein 6 (LRP6) as a key regulator of copper influx and cuproptosis, revealing a potential target for mitigating copper toxicity in cardiac tissue. Chrysin-7-O-glucuronide (C7Og), a potent LRP6 inhibitor, offers a promising strategy to prevent LRP6-mediated cell death while preserving its protective role in cardiac function. Encapsulating C7Og in a Janus hydrogel enhances its delivery and adhesion, demonstrating significant efficacy in reducing myocardial damage and improving cardiac function in rat and Bama miniature pig models. This work offers new insights into copper homeostasis and presents a potential therapeutic approach for MI treatment.

PMID:40516843 | DOI:10.1016/j.actbio.2025.06.018

Heart Lung Circ. 2025 Jun 13:S1443-9506(25)00135-0. doi: 10.1016/j.hlc.2025.01.010. Online ahead of print.

ABSTRACT

AIM: Atrial septal defects (ASD) are the most common congenital cardiac malformations. Over the preceding decades, a host of minimally invasive and interventional techniques for ASD closure have emerged. Minimally invasive ASD (MIASD) repair utilises thoracotomies, endoscopic, robotic, and even beating heart approaches to facilitate MIASD repair. We performed a systematic review to summarise the literature describing the outcomes of patients following MIASD repair.

METHOD: PubMed, Medline, and Scopus were searched by two authors for manuscripts describing outcomes following MIASD repair. Overall, 1,972 titles were screened, 1,945 were excluded, and 27 were included in the review. The primary outcome was mortality and secondary outcomes included postoperative morbidity.

RESULTS: Measures of mortality were largely limited to 30 days postoperatively, with 0% mortality reported for MIASD up to 30 days. Rates of postoperative morbidity were low in both sternotomy and MIASD groups, with no consistent differences identified. Rates of intensive care unit and hospital stay were consistently reported to be lower with MIASD than with the conventional approach.

CONCLUSIONS: MIASD repairs have continued to evolve and improve. Among the various approaches to MIASD repair, all have been associated with low rates of morbidity and mortality. Surgical ASD repair continues to be versatile, allowing for repair of all manner of ASDs, and allowing for the concomitant management of other cardiac conditions. Regular advancements in this field, including the optimisation and development of surgical techniques with regular evaluation of patient outcomes, will ensure appropriate patient selection and optimisation of outcomes for patients with ASD.

PMID:40517112 | DOI:10.1016/j.hlc.2025.01.010

Resuscitation. 2025 Jun 16:110676. doi: 10.1016/j.resuscitation.2025.110676. Online ahead of print.

ABSTRACT

INTRODUCTION: Interposed abdominal compression CPR (IAC-CPR) is an American Heart Association Class IIb recommended adjunct to standard CPR (S-CPR) that employs abdominal counter-pulsation during the "diastolic" (release) phase of thoracic compressions. Animal and adult studies have demonstrated IAC-CPR augmentation of venous return to the right heart with enhanced cardiac output, and increased diastolic blood pressure (DBP) with improved retrograde flow to the coronary arteries and brain. We hypothesized that IAC-CPR (compared with S-CPR) would result in higher DBP which has been associated with improved survival outcomes in pediatric cardiac intensive care unit (PCICU) patients.

METHODS: As participants in a prospective, multicenter, quality assurance collaborative (PediRes-Q.org) from Dec 2020 - July 2024, three participating PCICU sites used IAC-CPR within usual care, and systematically collected hemodynamic data from 1 to 2 min sequential epochs of S-CPR and IAC-CPR within the same patient. IAC-CPR training via video (https://youtu.be/cd3Gxu7Maqk), digital slide presentation, and in-person mannequin demonstration of technique competency at each participating center were required. Single rescuer resuscitation of children ≤ 3 years old proceeded with S-CPR for 1-2 min, followed by 1-2 min of IAC-CPR. Choice of CPR technique for the remainder of the cardiac arrest event was then left to the clinical care team. Hemodynamic waveforms from epochs of S-CPR and IAC-CPR were compared. Return of spontaneous circulation (ROSC), return of circulation (ROC) with ECMO, and survival to hospital discharge or to 30 days were recorded. Neurological outcome was assessed pre-arrest and at hospital discharge by the Pediatric Cerebral Performance Category (PCPC) score. Favorable neurologic outcome was considered PCPC category 1-2, or no change from pre-arrest baseline.

RESULTS: Seventeen infants with complex congenital heart disease were included, the majority of which (14/17) were single ventricle patients who experienced arrest postoperatively. Intervention analyses demonstrated a DBP increase of 11.6 mmHg during IAC-CPR versus S-CPR (95% CI [2.2-21.1], p = 0.018, adjusted for non-stationarity and correlations in individual time series). Peak systolic blood pressure (SBP) increased by 15.4 mmHg during IAC-CPR versus S-CPR (95% CI [0.51 - 30.2], p = 0.044, adjusted for non-stationarity and correlations in individual time series). ROSC was achieved in 11/17 (65%), and ROC with ECMO in 5/17 (29%). Survival to hospital discharge or to 30 days occurred in 8/17 (47%), and all had a favorable neurologic outcome. No complications attributable to IAC-CPR were found.

CONCLUSIONS: IAC-CPR was associated with significant improvements in both DBP and SBP compared to S-CPR technique in pediatric ICU patients with complex congenital heart disease. This underscores the need for study of IAC-CPR hemodynamics and outcomes in a broader cohort of cardiac and non-cardiac pediatric patients.

PMID:40516688 | DOI:10.1016/j.resuscitation.2025.110676

Int J Cardiol. 2025 Jun 12:133515. doi: 10.1016/j.ijcard.2025.133515. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary arterial hypertension (PAH) is a severe disease with significant genetic predisposition. While genetic architecture and clinical implications in pediatric PAH remain unclear.

METHODS: We retrospectively analyzed clinical and genetic data from 218 pediatric PAH patients including 115 idiopathic/heritable PAH (IPAH/HPAH) and 103 PAH associated with congenital heart disease (PAH-CHD) admitted to our center between 2011 and 2023.

RESULTS: 50.0 % of the cohort carried genetic variations, with BMPR2 being the most prevalent (16.5 % in whole and 27.8 % in IPAH/HPAH). Compared to IPAH/HPAH, PAH-CHD showed a distinct mutation profile. Five hotspot mutation sites in 4 PAH-causing genes (BMPR2, ACVRL1, SOX17, KCNK3) were identified, resulting in altered charged amino acid residues or protein truncations. Patients with pathogenic or likely pathogenic (P/LP) mutations in definitive PAH-causing genes (affected mutation carriers) had a higher proportion of high-risk profile, more severe right ventricular enlargement and lower TAPSE, while patients with P/LP mutations in PAH-associated genes showed similar clinical features. Affected mutation carriers also had a poorer prognosis compared to non-carriers and received more aggressive therapeutic interventions. BMPR2 mutation carriers were older at diagnosis and had lower cardiac index compared to other mutation carriers.

CONCLUSION: This study unveiled a different genetic landscape of pediatric PAH in China, and underscored the importance of genetic screening for early risk stratification. A distinct mutation profile in PAH-CHD from IPAH/HPAH patients was found, which warrants further investigation on the identification of predisposing genes for each subpopulation, thus providing new insights into pathogenesis and therapeutic approaches of PAH.

PMID:40516660 | DOI:10.1016/j.ijcard.2025.133515

Metabolomics. 2025 Jun 14;21(4):80. doi: 10.1007/s11306-025-02276-6.

ABSTRACT

INTRODUCTION: Amino acids (AAs) serve diverse roles, and insufficient delivery is associated with worse outcomes in ill patients. In the case of congenital heart disease (CHD) surgery with cardiopulmonary bypass (CPB), AA levels are often dysregulated. Changes at the individual AA level, impact of clinical factors, and association with outcomes are less understood.

OBJECTIVES: We evaluated AA levels at multiple timepoints, the impact of pre-operative nutrition on these levels, and their association with the combined outcome: cardiac arrest, death, mechanical circulatory support, or ICU length of stay (LOS) above the 75% quantile of the cohort.

METHODS: Infants < 120 days undergoing CHD surgery with CPB were evaluated, excluding those < 2 kg or 34 weeks corrected gestational age. Relative AA quantification was performed pre-operatively, during rewarming, and 24 h post-ICU admission. Partial least squares discriminant analysis was used to compare AA levels between timepoints and feeding status. Univariate and multivariate analysis assessed for association with the combined outcome.

RESULTS: 16 of 19 AAs decreased during rewarming with 11 continuing to decrease at 24 h. Patients who did not receive enteral feeds pre-operatively had lower levels of certain AAs. Univariate analysis identified that decreased levels of glutamine, aspartate, and glutamate, and increased phenylalanine and lysine levels, were associated with increased risk of the combined outcome.

CONCLUSION: AA levels decreased following CPB and are impacted by pre-operative feeding status. Decreased levels of certain AAs are associated with increased risk of the combined outcome. Emphasizing pre-operative enteral nutrition and post-operative AA supplementation could improve outcomes in this population.

PMID:40515782 | DOI:10.1007/s11306-025-02276-6

Pediatr Nephrol. 2025 Jun 14. doi: 10.1007/s00467-025-06846-7. Online ahead of print.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) and dysnatremia following pediatric cardiac surgery are common conditions associated with worse outcomes. While the multifactorial etiology of AKI is well-known, the role of concomitant dysnatremia is limited. This study aims to describe the occurrence of AKI, its association with the length of stay in the intensive care unit (ICU-LOS), and the impact of dysnatremia in the context of AKI.

METHODS: Retrospective study comprising 228 congenital heart procedures in 213 infants at Rigshospitalet, Copenhagen, Denmark, from 2017 to 2019. AKI development was evaluated separately in neonates and infants > 1 month and its impact on ICU-LOS. Risk factors for AKI were analyzed across age groups using the univariate and multivariate logistic regression analysis.

RESULTS: AKI occurred in 61% of neonates and 62% of infants. Severity was comparable across age groups, except for KDIGO-stage 3, where seven out of eight children treated with peritoneal dialysis were neonates. Urine output was well-preserved despite AKI development, but children with AKI required more than double the furosemide dose. In multivariate analysis, prolonged cardiopulmonary bypass (CPB) duration, higher furosemide doses, and hypernatremia were independently associated with AKI. AKI was only associated with prolonged ICU-LOS in infants, while hyponatremia was associated with prolonged ICU-LOS in all individuals with AKI.

CONCLUSIONS: AKI occurs frequently in neonates and infants after congenital heart surgery but is only associated with prolonged ICU-LOS in infants. The co-occurrence of AKI and hyponatremia leads to longer ICU-LOS in both neonates and infants. Independent predictors of AKI were prolonged CPB duration, hypernatremia, and reduced furosemide sensitivity.

PMID:40515779 | DOI:10.1007/s00467-025-06846-7

Heart Rhythm. 2025 Jun 12:S1547-5271(25)02550-0. doi: 10.1016/j.hrthm.2025.06.004. Online ahead of print.

ABSTRACT

BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) in the presence of atrial fibrillation (AF) is common, with concerns AF recurrence will precipitate acute decompensation. However, the impact of AF recurrence following catheter ablation (CA) on HF is not well understood.

OBJECTIVE: We sought to examine the clinical outcomes and hospitalisation patterns in AF HFrEF patients following CA.

METHODS: This multicentre study reports the re-admission outcomes for patients with AF and HFrEF (LVEF≤40%) following CA.

RESULTS: 231 patients (60.5±11.1years, 37 females, mean LVEF 30.7±7.1%, persistent AF 87.9%) with AF and HFrEF underwent CA. At 3.0 years follow-up, recurrent AF occurred in 120 (51.9%) and complete LV systolic recovery (LVEF≥50%) in 125 (54%) patients. There were 366 hospitalisations amongst 123 patients: 240 cardiac and 126 non-cardiac. Arrhythmia related hospitalisations occurred in 179: 151 recurrent atrial arrhythmia without HF, 4 AF with HF, 3 supraventricular tachycardia and 21 ventricular arrhythmia. Other cardiac hospitalisations (61) included: HF without AF recurrence (24), cardiac device insertions (24), ischemic heart disease (8), pericarditis (3) and cardiac valvular surgery (2). On univariable analysis, the absence of LVEF recovery post ablation (OR=1.32, 95% CI=1.11-12.55 P=0.03), persistent AF versus paroxysmal AF recurrence (OR=1.76, 95% CI=1.21-27.72 P=0.03), ischemic cardiomyopathy (OR=3.62, 95% CI=1.16-11.30 P=0.02), and furosemide use (OR=4.96, 95% CI=1.55-15.91 P<0.01) were associated with future HF hospitalisation.

CONCLUSION: After catheter ablation, it is uncommon for patients with AF and HFrEF to present with recurrent AF and HF, but more commonly present with HF without AF, or AF without HF.

PMID:40516777 | DOI:10.1016/j.hrthm.2025.06.004

Metabolomics. 2025 Jun 14;21(4):80. doi: 10.1007/s11306-025-02276-6.

ABSTRACT

INTRODUCTION: Amino acids (AAs) serve diverse roles, and insufficient delivery is associated with worse outcomes in ill patients. In the case of congenital heart disease (CHD) surgery with cardiopulmonary bypass (CPB), AA levels are often dysregulated. Changes at the individual AA level, impact of clinical factors, and association with outcomes are less understood.

OBJECTIVES: We evaluated AA levels at multiple timepoints, the impact of pre-operative nutrition on these levels, and their association with the combined outcome: cardiac arrest, death, mechanical circulatory support, or ICU length of stay (LOS) above the 75% quantile of the cohort.

METHODS: Infants < 120 days undergoing CHD surgery with CPB were evaluated, excluding those < 2 kg or 34 weeks corrected gestational age. Relative AA quantification was performed pre-operatively, during rewarming, and 24 h post-ICU admission. Partial least squares discriminant analysis was used to compare AA levels between timepoints and feeding status. Univariate and multivariate analysis assessed for association with the combined outcome.

RESULTS: 16 of 19 AAs decreased during rewarming with 11 continuing to decrease at 24 h. Patients who did not receive enteral feeds pre-operatively had lower levels of certain AAs. Univariate analysis identified that decreased levels of glutamine, aspartate, and glutamate, and increased phenylalanine and lysine levels, were associated with increased risk of the combined outcome.

CONCLUSION: AA levels decreased following CPB and are impacted by pre-operative feeding status. Decreased levels of certain AAs are associated with increased risk of the combined outcome. Emphasizing pre-operative enteral nutrition and post-operative AA supplementation could improve outcomes in this population.

PMID:40515782 | DOI:10.1007/s11306-025-02276-6

J Anesth. 2025 Jun 13. doi: 10.1007/s00540-025-03526-6. Online ahead of print.

ABSTRACT

PURPOSE: Phase angle (PA), derived from bioelectrical impedance-analysis (BIA) has emerged as a reliable marker predicting clinical outcomes. This prospective observational study investigated the association between PA and a composite in-hospital outcome in major abdominal surgery.

METHODS: Each patient underwent BIA before surgery (PApre), immediately postoperatively (PApost), and 1 day postoperatively (PAPOD1). Specific assessment for frailty and nutrition status was performed before surgery. Patient outcomes were assessed using a composite adverse outcome comprising death, myocardial infarction, revascularization, stroke, hemodynamic instability, acute kidney injury, pulmonary complications, delirium, ileus, and surgical complications during hospitalization. One-year complication, including all-cause mortality, myocardial infarction, stroke, surgical complications, and readmission after discharge within the year were also assessed.

RESULTS: A total of 122 adults who underwent major abdominal surgery were enrolled from July 2019 and April 2021. Twenty-three patients (53.5%) in the lower PA group (PA < 5) experienced in-hospital complications compared to 38 patients (34.2%) in the higher PA group (PA ≥ 5) (relative risk, 1.6; 95% confidence interval [CI], 1.0 to 2.4; p = 0.038). PApre was significantly associated with in-hospital complications (odds ratio, 0.491; 95% CI, 0.279 to 0.862; p < 0.001). Patients with lower PApre had a higher degree of frailty, and poor nutritional status. However, PApre was not significantly associated with 1-year composite complications.

CONCLUSION: Low PApre was associated with adverse postoperative outcomes after major abdominal surgery. PA can be a reliable prognostic factor to predict in-hospital complications in patients undergoing major abdominal surgery, serving as an alternative surrogate to frailty indices and nutritional markers.

TRIAL REGISTRATION: Clinical Research Information Services of the Republic of Korea (CRIS identifier: KCT0004160).

PMID:40514407 | DOI:10.1007/s00540-025-03526-6

Sci Rep. 2025 Jun 13;15(1):20068. doi: 10.1038/s41598-025-87667-4.

ABSTRACT

This study reports the 15th year follow-up of a previously reported monocentric, randomized controlled trial comparing the effectiveness of yoga vs. conventional exercise-based cardiac rehabilitation (CR) on mortality and major adverse cardiovascular outcomes in middle-aged, male patients who underwent coronary artery bypass graft surgery (CABG). Three hundred male patients, aged 53.32 (SD, 6.72) years, were recruited for CABG at Narayana Institute of Cardiac Sciences, India, in 2005, followed by random assignment into a yoga-based cardiac rehabilitation program (YCRP) or conventional exercise-based cardiac rehabilitation program (CCRP). This legacy study reports the extended follow-up outcomes for all-cause mortality and cardiovascular events for a median of 14·14 years (IQR 13.82-14.47) since randomisation in 2005. The YCRP group received lectures on yoga philosophy combined with sequential phase-wise administration of yoga modules suited for their pre-and post-operative health status with gradual phase-wise addition of physical postures to initially administered relaxation-based techniques, under continued home-based practice model monitored telephonically until 12 months post-surgery related discharge from the hospital. The CCRP group received conventional exercise-based cardiac rehabilitation with similar phase-wise administration. Both study groups were under continued outpatient department-based care with 6 monthly review sessions until 2020. The exploratory follow-up outcomes [the all-cause mortality, and the major adverse cardiac events (MACE)] were analyzed using an intention-to-treat approach comparing the initially randomized study groups. MACE was a composite of cardiovascular death, nonfatal myocardial infarction, or stroke. The study staff determined the occurrence of death from the medical records or telephonic calls and ascertained it by matching and identifying information reported by participants/or their family members. The Cox proportional hazard estimates and Kaplan-Meier Curve with Log-rank test estimates were used to compare the mortality and MACE outcomes between the study groups. Participants of the YCRP group exhibited significantly reduced risk of all-cause mortality [HR = 0.41 (95% CI = 0.16-0.91, P = 0.02)] and trends of reduction in MACE outcomes [HR = 0.57 (95% CI = 0·30-1.04, P = 0.065)] compared to the CCRP. No significant interaction effects were observed between the intervention and the baseline covariates, such as age, ejection fraction values, or presence of comorbidities. This first-ever long-term follow-up established the survival advantage of the YCRP over CCRP for patients who underwent coronary artery bypass graft surgery (CABG). The results support the utility of yoga-based CR as an alternative to CCRP in low-resource settings.

PMID:40514390 | PMC:PMC12166042 | DOI:10.1038/s41598-025-87667-4

Cardiovasc Revasc Med. 2025 Jun 6:S1553-8389(25)00292-1. doi: 10.1016/j.carrev.2025.06.007. Online ahead of print.

NO ABSTRACT

PMID:40514315 | DOI:10.1016/j.carrev.2025.06.007

JACC Case Rep. 2025 Jun 11;30(14):103632. doi: 10.1016/j.jaccas.2025.103632.

ABSTRACT

Two patients presented with chronic coronary syndrome and type B Wellens electrocardiography with preserved left ventricular ejection fraction according to transthoracic echocardiography. Further myocardial systolic function assessment by means of left ventricular global longitudinal strain (LVGLS) and myocardial work index (MWI) showed reduced peak systolic strain and MWI value in the left anterior descending (LAD) coronary territory. Invasive coronary angiography found significant proximal LAD stenosis in both patients, and revascularization with stent placement was performed with good result (TIMI flow grade III). In the follow-up, improvement in LVGLS and MWI after LAD revascularization was observed in both cases.

PMID:40514128 | DOI:10.1016/j.jaccas.2025.103632