Agregador de feeds

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

JHLT Open. 2025 Sep 5;10:100383. doi: 10.1016/j.jhlto.2025.100383. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Donation-after-circulatory-death (DCD) heart procurement is enlarging the donor pool, yet its safety in adults with congenital heart disease (ACHD) is uncertain. We compared early (90-day) and mid-term (3-year) graft outcomes after DCD versus donation-after-brain-death (DBD) heart transplantation in ACHD recipients.

METHODS: Using the United Network for Organ Sharing registry (1 January 2018 - 1 April 2025), we identified adults (≥18 y) with ACHD undergoing isolated heart transplantation. Retransplants and multiorgan procedures were excluded. The primary endpoint was graft failure (death or retransplant). Survival was analysed with Kaplan-Meier curves, multivariable Cox models, and 1:1 nearest-neighbor propensity-score matching (caliper = 0.25 SD) adjusting for donor and recipient age, sex, body-mass index, renal and hepatic function, support devices, listing status, prior sternotomy, and regional ACHD center volume.

RESULTS: Among 726 ACHD transplants, 61 (8.4%) used DCD grafts and 665 (91.6%) used DBD grafts. Baseline clinical characteristics were similar, although DCD grafts had longer ischemic times (median 5.3 h vs 3.8 h, p < 0.001) and more frequent exvivo perfusion (65% vs 5.8%). Unadjusted 90-day and 3-year graft survival were lower after DCD (log-rank p = 0.009 and 0.040, respectively). On multivariable analysis, DCD procurement remained an independent risk factor for graft failure at 90 days (HR 2.56, 95% CI 1.23-5.17) and 3 years (HR 2.11, 95% CI 1.03-3.50).Propensity-matched analysis (n = 148) confirmed inferior 90-day survival for DCD recipients (log-rank p = 0.020). Post-operative morbidity and length of stay did not differ between groups.

CONCLUSIONS: In the early US experience, ACHD recipients of DCD hearts experienced significantly worse short- and mid-term graft survival than those receiving DBD hearts, despite comparable peri-operative morbidity. Until preservation strategies further mitigate warm-ischemic injury, careful candidate selection is warranted when allocating DCD grafts to complex ACHD patients.

PMID:41049570 | PMC:PMC12495479 | DOI:10.1016/j.jhlto.2025.100383

JHLT Open. 2025 Sep 4;10:100384. doi: 10.1016/j.jhlto.2025.100384. eCollection 2025 Nov.

ABSTRACT

Living allogenic valve transplantation (LAVT) refers to transplantation of viable human heart valves in an orthotopic or heterotopic fashion and has recently garnered significant interest for children in need of a living, growing, regenerating valve replacement option. However, at present, there is no standardized approach for establishing and implementing such a program. We provide a practical, step-by-step blueprint of the operational, administrative and regulatory requirements needed to establish an LAVT program based on our center's experience.

PMID:41049569 | PMC:PMC12489827 | DOI:10.1016/j.jhlto.2025.100384

Int J Med Sci. 2025 Sep 3;22(15):3946-3957. doi: 10.7150/ijms.118408. eCollection 2025.

ABSTRACT

Heart failure remains one of the leading causes of morbidity and mortality worldwide. Conventional treatment strategies, while beneficial, face numerous limitations. Drug therapies may lead to resistance, while device-based treatments such as LVAD and ICD carry risks of infection, bleeding, device failure, and high costs. For end-stage heart failure, heart transplantation is further constrained by donor shortages and immune rejection. In contrast, cell-based therapies have emerged as a promising alternative. Recent studies have highlighted the critical role of the epicardium and epicardium-derived cells (EPDCs) in cardiac regeneration. These cells contribute to heart repair through multiple mechanisms, including direct cell therapy, the development of epicardium-based biomaterials, and integration with gene therapy approaches. This review outlines the anatomical structure and biological functions of the epicardium, explores the regenerative potential of the epicardium and EPDCs, and evaluates their application in heart failure treatment. Furthermore, it discusses the translational potential and current challenges associated with epicardial-based therapies, offering novel insights and strategies for heart failure management.

PMID:41049437 | PMC:PMC12492376 | DOI:10.7150/ijms.118408

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

Expert Rev Mol Diagn. 2025 Oct 6. doi: 10.1080/14737159.2025.2570245. Online ahead of print.

ABSTRACT

INTRODUCTION: Calcifying carotid artery atheromas (CCAAs) identified on standard dental panoramic radiographs (DPRs) have been presented as potential disease markers for cardiovascular disease (CVD). CCAAs are further linked to several systemic disease processes (i.e. diabetes) that are also associated with periodontitis. The active matrix metalloproteinase-8 (aMMP-8) mouthrinse point-of-care-test has been multiply globally validated for periodontitis disease diagnostics. Calprotectin can inhibit matrix metalloproteinases and also exert significant anti-microbial activities. Recently, calprotectin has been suggested as a potential biomarker of endovascular inflammation.

AREAS COVERED: This special report considers a combination of mouthrinse aMMP-8 and calprotectin in periodontitis disease diagnostics at the dentist's office for simultaneously identifying at-risk patients of diabetes and CVD reviewing recent PubMed indexed findings comparing disease diagnostics by aMMP-8 and calprotectin individually and combined.

EXPERT OPINION: By combining CCAA-DPRs analysis with oral fluid mouthrinse aMMP-8 and calprotectin lateral-flow immunoassays as point-of-care/chair-side testing's, especially by the polynomial-algorithm-machine-learning technology (including computer vision), can provide a modern noninvasive, safe, economical diagnostic AI-tool. This tool can be utilized for on-line real-time screening of the interlinked processes involving stroke-, CVD-, diabetic- and periodontal disease cascades. Accordingly, identified at-risk patients are then referred for necessary medical and dental interventions.

PMID:41048171 | DOI:10.1080/14737159.2025.2570245

Ann Thorac Surg. 2025 Oct 4:S0003-4975(25)00948-8. doi: 10.1016/j.athoracsur.2025.08.070. Online ahead of print.

ABSTRACT

BACKGROUND: We intended to identify whether the lateral tunnel (LT) and extra-cardiac conduit (ECC) Fontan provide similar short-term outcomes in contemporary data.

METHODS: Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent a primary LT or ECC from 2012 to 2022 were included. Hospital mortality, 30 days readmission, and complications were investigated.

RESULTS: There were 11,429 Fontan procedures performed in 133 centers: 2,012 LT (18%) and 9,417 ECC (82%). Only 3% of surgeons (9) were exclusively performing LT while 57% (190) surgeons were exclusively performing ECC and 40% (132) were using both techniques. Similarly, only one hospital performed LT exclusively, while 37% (50) performed the ECC and 62% (82) used both techniques. The age at the time of the Fontan surgery was younger in the LT group (p<0.001). Fenestration was made in 85% of patients with LT and 57% of patients with ECC (p<0.001). The operative mortality (1.1% for LT vs 1.3% for ECC; p= 0.49) was similar. Patients undergoing ECC had higher rate of 30-day readmission (1445 (18%) vs 220 (14%), p< 0.001), prolonged length of stay >30days (583 (6%) vs 78 (4%), p< 0.001), pleural effusion requiring drainage (1147 (17%) vs 140 (13%), p< 0.001), chylothorax (864 (13%) vs 98 (9%), p< 0.001), and stroke (117 (1.8%) vs 9 (0.9%)), p=0.03).

CONCLUSIONS: In conclusion, the Lateral Tunnel Fontan has similar mortality and lower short-term complication rates than the extra-cardiac conduit Fontan, but the latter has become the most frequently performed technique.

PMID:41052666 | DOI:10.1016/j.athoracsur.2025.08.070

BJA Educ. 2025 Oct;25(10):400-410. doi: 10.1016/j.bjae.2025.07.003. Epub 2025 Aug 12.

NO ABSTRACT

PMID:41050565 | PMC:PMC12491798 | DOI:10.1016/j.bjae.2025.07.003

CASE (Phila). 2025 Jul 18;9(9):301-304. doi: 10.1016/j.case.2025.05.003. eCollection 2025 Sep.

ABSTRACT

PMID:41049621 | PMC:PMC12490570 | DOI:10.1016/j.case.2025.05.003

Respirol Case Rep. 2025 Oct 2;13(10):e70369. doi: 10.1002/rcr2.70369. eCollection 2025 Oct.

ABSTRACT

Phrenic nerve injury is a recognised complication of congenital cardiac surgery in children, potentially leading to diaphragmatic paralysis and long-term respiratory dysfunction. Diaphragmatic plication is performed to improve lung mechanics, but its mid-term outcomes remain underexplored. The objective was to assess mid-term pulmonary function in children who underwent diaphragmatic plication for phrenic nerve palsy following congenital heart surgery. This retrospective case series included five children who received left diaphragmatic plication between 2011 and 2021 at a tertiary paediatric centre. Pulmonary function was evaluated using spirometry, plethysmography, and the 6-min walk test (6MWT), and compared to predicted normative values. At a mean follow-up of 5 years, forced volume capacity (FVC), forced expiratory volume (FEV1), vital capacity (VC), and total lung capacity (TLC) were significantly lower than predicted (p < 0.05). FEV1/FVC, residual volume (RV), and forced residual capacity (FRC) were not significantly different. All patients completed the 6MWT (> 300 m), though post-exercise oxygen saturation declined significantly (p = 0.011). Diaphragmatic plication leads to a restrictive pattern and exercise-induced desaturation despite preserved walking capacity.

PMID:41049032 | PMC:PMC12490969 | DOI:10.1002/rcr2.70369

Cureus. 2025 Sep 1;17(9):e91440. doi: 10.7759/cureus.91440. eCollection 2025 Sep.

ABSTRACT

BACKGROUND & AIMS: This study analyses the practice gap in addressing tricuspid regurgitation (TR) in patients undergoing left-sided valve surgery.

METHODS: This is a retrospective cohort study of patients operated on between January 2015 and December 2018. A total of 1,129 patients underwent left-sided valve operations for rheumatic aetiology. Tricuspid valve repair (TVr) was performed in 68 patients. Patients with follow-up data and isolated or predominantly mitral valve replacement were divided based on the severity of TR: Group 1 (n = 771), patients with mild TR; Group 2 (n = 109), patients with severe TR and severe pulmonary arterial hypertension (PAH); Group 3 (n = 33), patients with severe TR and non-severe PAH; and Group 4 (n = 68), patients with moderate to severe TR and a dilated tricuspid valve annulus. Group 4 patients received TVr. The primary endpoint was the appearance of severe TR at follow-up.

RESULTS: The mean age of the whole cohort of 1,129 patients (n = 598 (53%) males and n = 531 (47%) females) was 35.42 ± 13.91 years. Mean follow-up of 27.3 ± 18.9 months was available for 1,061 patients. The primary endpoint was observed in 6.3%, 21.1%, 49.5%, and 23.5% of patients, respectively, from Group 1 to Group 4. Preoperatively, mild TR was observed in 771, moderate in 147, and severe in 143 patients who completed follow-up. The primary endpoint was more common in patients with moderate TR (p = 0.04). The American Heart Association (AHA) and American College of Cardiology (ACC) collaborate to produce clinical practice guidelines providing evidence-based recommendations to improve cardiovascular health. These guidelines are the official policy of both organisations and are intended to provide a foundation for quality cardiovascular care globally, though the focus is on US medical practice. There was a departure from the recommendation in 66.6% of cases (Groups 2 and 3) involving patients with severe TR (Groups 2-4). The emergence of severe TR in Groups 2 and 4 was similar, even though patients in Group 2 did not receive TVr, contrary to the recommendation.

CONCLUSION: The appearance of severe TR during follow-up for patients with preoperatively severe TR with severe pulmonary hypertension (PH) was similar, irrespective of whether TVr was performed. This group should be further investigated regarding the need for TVr.

PMID:41050007 | PMC:PMC12489015 | DOI:10.7759/cureus.91440

Am J Case Rep. 2025 Oct 6;26:e949607. doi: 10.12659/AJCR.949607.

ABSTRACT

BACKGROUND Witnessed hypothermic cardiac arrest is a rare injury with high mortality, particularly at extreme temperatures. We describe a case of witnessed accidental hypothermia with a profoundly low core temperature of 20°C, resulting in pre-hospital cardiac arrest. The patient was successfully treated with cardiopulmonary bypass rewarming, but the clinical course was further complicated by a liver injury from device-assisted cardiopulmonary resuscitation (CPR), necessitating exploratory laparotomy. CASE REPORT A 30-year-old man was found roadside in -15°C weather and suffered pre-hospital cardiac arrest, witnessed by emergency medical personnel. Rewarming treatment with cardiopulmonary bypass was performed at our level-1 trauma center after the patient presented with a core temperature of 20°C and underwent 195 minutes of CPR. Intraoperatively, he was noted to have constant loss of volume on bypass as well as a tense, distended abdomen. Exploratory laparotomy was performed showing hemoperitoneum from a liver laceration secondary to CPR with a Lund University Cardiopulmonary Assist System (LUCAS) device. Delayed sternal and abdominal closure was performed with definitive closure occurring on hospital day 3. The patient experienced full neurologic recovery and was discharged home on hospital day 23. CONCLUSIONS Extracorporeal rewarming is a definitive treatment for cardiac arrest from accidental severe hypothermia and can be accomplished with cardiopulmonary bypass. Providers should have heightened clinical suspicion for solid organ injury when CPR is facilitated by a LUCAS device rather than manual compressions. Disproportionately low return volumes on the cardiopulmonary bypass circuit should prompt consideration of a differential diagnosis which in post-resuscitation patients can include traumatic hemoperitoneum.

PMID:41052020 | DOI:10.12659/AJCR.949607

Intensive Care Med. 2025 Oct 6. doi: 10.1007/s00134-025-08142-2. Online ahead of print.

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is providing an increasingly important therapy for patients in severe heart and lung failure. Care of these patients is complex, with changes in circulation that mean standard advanced life support algorithms may not always be applicable. Through collaboration between all UK ECMO centres and eight national societies, we have assessed the current evidence base and, using a modified Delphi process, produced national guidelines on the management of emergencies on ECMO. The guidelines focus on the recognition of cardiac arrest, team prioritisation, and early ECMO troubleshooting for key life-saving interventions. The guidelines are applicable to all staff and types of ECMO performed in the UK and should be utilised in conjunction with appropriate training. In summary, the joint British societies and ECMO centres working group present the UK guideline for the management of emergencies in ECMO.

PMID:41051555 | DOI:10.1007/s00134-025-08142-2

Ann Med. 2025 Dec;57(1):2568722. doi: 10.1080/07853890.2025.2568722. Epub 2025 Oct 6.

ABSTRACT

BACKGROUND: Cardiomyopathy is a significant cause of mortality in dystrophinopathy, and early detection and intervention are critical to reduce the disease burden. Currently, cardiomyopathy detection primarily relies on echocardiography and cardiac magnetic resonance imaging (CMR), which are inconvenient for paediatric patients and those in remote areas. Uric acid (UA) is associated with various heart diseases and serves as a biomarker of injury severity, but its level changes and connection with myocardial injury in dystrophic cardiomyopathy remain unclear. Therefore, we investigated the relationship between UA and cardiomyopathy in dystrophinopathy, as its early detection may offer a more straightforward method for monitoring cardiac health.

METHOD: A total of 71 dystrophinopathy patients underwent biochemical, genetic, and echocardiography assessments to correlate UA, gene mutations types, and cardiac parameters.

RESULT: Patients with hyperuricaemia showed larger atria and ventricles, and thicker left ventricular walls compared to those with normal UA levels. This was reflected in increased left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left atrial diameter (LAD), right ventricular diameter (RVD), left ventricular posterior wall thickness (LVPWT), and interventricular septal thickness (IVST). Multivariate linear regression analysis revealed an independent positive correlation between UA and these echocardiographic parameters.

CONCLUSION: Elevated serum UA levels were independently associated with cardiac morphological changes, including cardiac dilation and left ventricular remodelling in dystrophinopathy patients. Consequently, UA may be considered as a potential biomarker for cardiomyopathy in dystrophinopathy.

PMID:41047935 | PMC:PMC12502115 | DOI:10.1080/07853890.2025.2568722

Kardiol Pol. 2025 Oct 6. doi: 10.33963/v.phj.108921. Online ahead of print.

NO ABSTRACT

PMID:41048077 | DOI:10.33963/v.phj.108921

Circ Genom Precis Med. 2025 Oct 6:e005192. doi: 10.1161/CIRCGEN.125.005192. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a relatively rare but debilitating diagnosis in the pediatric population, and patients with end-stage HCM require heart transplantation. Here, we have examined the transcriptome in ventricular tissue from this patient group to identify cell states and underlying cellular processes unique to pediatric HCM.

METHODS: We performed single-nucleus RNA sequencing on explanted hearts at transplant in 3 pediatric patients with end-stage HCM and compared findings to pediatric control and adult HCM.

RESULTS: We identified distinct underlying cellular processes in cardiomyocytes, fibroblasts, endothelial cells, and myeloid cells compared with controls. Pediatric HCM was enriched in cardiomyocytes exhibiting stressed myocardium gene signatures and underlying pathways associated with cardiac hypertrophy; cardiac fibroblasts exhibited activation signatures and compared with adult patients, exhibited heightened downstream processes associated with fibrosis and a unique, myofibroblast-like cluster with increased metabolic stress and antiapoptotic properties. We noted depletion of tissue-resident macrophages and increased vascular remodeling in endothelial cells in pediatric HCM.

CONCLUSIONS: Our analysis provides the first single-nucleus analysis focused on end-stage pediatric HCM. Fibroblast-mediated cellular processes were the most prominent in pediatric HCM, which had more downstream processes associated with fibrosis than did adult HCM.

PMID:41048033 | DOI:10.1161/CIRCGEN.125.005192

Curr Cardiol Rev. 2025 Oct 2. doi: 10.2174/011573403X394902250911111958. Online ahead of print.

ABSTRACT

INTRODUCTION: Sex-based differences in outcomes among patients with heart failure with reduced ejection fraction (HFrEF) treated with sodium-glucose cotransporter 2 inhibitors (SGLT2is) remain underexplored. This study aimed to evaluate sex-specific differences in cardiovascular outcomes in patients with HFrEF receiving SGLT2 inhibitors alongside guidelinedirected medical therapy (GDMT).

METHODS: We conducted a retrospective cohort study using the TriNetX global research network. Adults with HFrEF treated with SGLT2is and GDMT were stratified by sex. Propensity score matching (PSM) was used to balance baseline demographics, comorbidities, medications, and laboratory data. Primary outcomes were all-cause mortality and acute heart failure (HF) events; secondary outcomes included hospitalizations, arrhythmias, renal outcomes, and advanced therapies.

RESULTS: After PSM, 17,408 male and 17,408 female patients were analyzed. Male patients had lower odds of acute HF events (aOR: 0.949; 95% CI: 0.909-0.991), all-cause hospitalizations (aOR: 0.933; 95% CI: 0.895-0.973), and renal failure (aOR: 0.915; 95% CI: 0.870-0.962). No significant differences were observed in all-cause mortality (aOR: 1.003; 95% CI: 0.926-1.087) or heart transplantation, although LVAD use was more frequent in males (aOR: 1.416; 95% CI: 1.053-1.905).

DISCUSSION: The findings highlighted potential sex-based disparities in outcomes for patients with HFrEF on SGLT2is. Differential prescribing patterns, comorbidity burden, or timing of therapy initiation may contribute to observed differences.

CONCLUSION: Among HFrEF patients treated with SGLT2is, males experienced lower risks of HF events, hospitalizations, and renal failure compared to females, despite similar mortality. Further research is needed to understand and address sex-specific disparities in HFrEF management.

PMID:41047672 | DOI:10.2174/011573403X394902250911111958

Circ Genom Precis Med. 2025 Oct 6:e005192. doi: 10.1161/CIRCGEN.125.005192. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a relatively rare but debilitating diagnosis in the pediatric population, and patients with end-stage HCM require heart transplantation. Here, we have examined the transcriptome in ventricular tissue from this patient group to identify cell states and underlying cellular processes unique to pediatric HCM.

METHODS: We performed single-nucleus RNA sequencing on explanted hearts at transplant in 3 pediatric patients with end-stage HCM and compared findings to pediatric control and adult HCM.

RESULTS: We identified distinct underlying cellular processes in cardiomyocytes, fibroblasts, endothelial cells, and myeloid cells compared with controls. Pediatric HCM was enriched in cardiomyocytes exhibiting stressed myocardium gene signatures and underlying pathways associated with cardiac hypertrophy; cardiac fibroblasts exhibited activation signatures and compared with adult patients, exhibited heightened downstream processes associated with fibrosis and a unique, myofibroblast-like cluster with increased metabolic stress and antiapoptotic properties. We noted depletion of tissue-resident macrophages and increased vascular remodeling in endothelial cells in pediatric HCM.

CONCLUSIONS: Our analysis provides the first single-nucleus analysis focused on end-stage pediatric HCM. Fibroblast-mediated cellular processes were the most prominent in pediatric HCM, which had more downstream processes associated with fibrosis than did adult HCM.

PMID:41048033 | DOI:10.1161/CIRCGEN.125.005192

BMC Biomed Eng. 2025 Oct 6;7(1):14. doi: 10.1186/s42490-025-00101-8.

ABSTRACT

BACKGROUND: Continuous cardiac output (CCO) monitoring using pulmonary artery (PA) thermodilution and newly introduced beat-to-beat cardiac output (CO) monitoring technologies exhibits different response time delays. These differences can hinder accurate comparisons of their trending abilities. To address this, we applied moving average processing to the beat-to-beat CO monitor data to evaluate its effect on trending assessment accuracy. This study aimed to confirm the effectiveness of moving average processing for such comparisons.

RESULTS: This was a single-center, retrospective, observational study conducted at a 916-bed university hospital. A total of 20 patients undergoing kidney transplantation were included. We analyzed the trending ability of arterial pressure cardiac index (APCI) and estimated continuous cardiac index (esCCI) relative to continuous cardiac index (CCI) derived from PA thermodilution. Trending ability was assessed using a Polar plot and Bland-Altman analyses. A wide range of moving average windows (0–60 min) was applied to APCI and esCCI. The polar concordance rate at 30° exceeded 92% for moving average windows between 20 and 30 min, with APCI peaking between 21 and 27 min. These improvements reflected both time-shifting and filtering effects of the moving average process.

CONCLUSIONS: Moving average processing over 20 to 30 min significantly enhanced concordance between esCCI and reference CCI, with APCI demonstrating similarly high concordance in the same time window. This approach effectively compensates for differences in response time delays between CO monitoring modalities, enabling more accurate assessment of trending ability.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s42490-025-00101-8.

PMID:41047412 | PMC:PMC12498450 | DOI:10.1186/s42490-025-00101-8

Am J Cardiol. 2025 Oct 3:S0002-9149(25)00556-9. doi: 10.1016/j.amjcard.2025.09.008. Online ahead of print.

ABSTRACT

Surgical revascularization is still considered the gold standard for patients with complex coronary artery disease and left ventricular dysfunction. The advent of Impella has sparked growing interest, yet current evidence on its efficacy remains inconclusive. All studies reporting outcomes beyond 30 days outcomes of pPCI with any Impella device were included. Pooled effect of estimated outcomes was calculated according to a random-effect model with generic inverse variance weighting. Primary endpoint was all-cause mortality. Secondary outcomes were myocardial infarction, repeat revascularization, rehospitalization for heart failure and stroke. Six studies globally encompassing 1,581 patients were included in the quantitative analysis. Median age was 70 years old (IQR 69 to 72) with a median left ventricular ejection fraction (LVEF) of 27 % (SD ± 6) and a SYNTAX SCORE of 31 (IQR 29 to 35). Impella 2.5 was the most common micro axial flow pump used to support high-risk PCI. All-cause of death was observed in 13.4% (95% CI: 10.4 to 16.4) of patients at 6 months median follow-up. Myocardial infarction occurred in 5.8% (95% CI 3.4 to 8.1) of patients, repeat revascularization in 9.1% (95% CI: 4.8 to 13.3) of patients, stroke in 1.6% (IQR 1.2 to 2.1) of patients and, finally, heart failure rehospitalization in 8.4% (95% CI 3.3 to 13.6) of patients. In conclusion, for high-risk patients, PCI with the Impella device represented a viable strategy with an acceptable risk profile when surgical revascularization is not an option, and a poor prognosis is predicted.

PMID:41046995 | DOI:10.1016/j.amjcard.2025.09.008