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J Cardiol. 2025 Oct 2:S0914-5087(25)00249-7. doi: 10.1016/j.jjcc.2025.09.019. Online ahead of print.

ABSTRACT

BACKGROUND: The comparative clinical outcomes of homograft (HG) and handmade polytetrafluoroethylene (PTFE) tri-leaflet valved conduit for right ventricular outflow tract reconstruction (RVOTR) in children with cyanotic congenital heart diseases remain unclear.

METHODS: We reviewed 265 consecutive patients (aged <14 years old) with cyanotic congenital heart diseases who underwent surgical intervention from 2015 to 2025 in our center (HG n = 141, PTFE n = 124). Competing risk analysis was performed for perioperative mortality, early reintervention, and re-operative conduit replacement during follow-up.

RESULTS: There were five early deaths (1.9 %). Multivariate analysis revealed a significant relationship between early mortality and preoperative left ventricular ejection fraction [hazard ratio (HR), 0.879; 95 % confidence interval (CI), 0.777-0.993; p = 0.039]. During a median follow-up of 45 months (range, 1-96), six patients (2.3 %) had reintervention on pulmonary artery by percutaneous balloon pulmonary dilation in the early postoperative period (average 7.8 months). Compared with HG conduit, patients in the PTFE group demonstrated longer conduit durability (p = 0.013) and lower reoperation rate (p = 0.049) during follow-up. Overall, freedom from reoperation for conduit dysfunction was no different for both conduits (p = 0.037). Freedom from re-operative conduit replacement at 3 and 5 years in the PTFE group was 95.2 % and 91.8 %; 90.3 % and 81.2 % in the HG group, respectively without significant difference (p = 0.37). Multivariate analysis revealed a significant relationship between reoperation and cardiopulmonary bypass time (HR, 0.989; 95 % CI, 0.979-0.999; p = 0.036), conduit size/body surface area > 25.77 mm/m2 (HR, 0.152; 95 % CI, 0.038-0.614; p = 0.008) and PTFE conduit (HR, 0.350; 95 % CI, 0.127-0.964; p = 0.042). Patients aged >34 months were associated with longer freedom from reoperation (p = 0.013).

CONCLUSION: We demonstrate excellent outcomes for RVOTR in pediatric patients with cyanotic congenital heart diseases. The handmade PTFE tri-leaflet valved conduit showed better results for reoperation and conduit durability. Younger age showed worse survival without reoperation for both conduits.

PMID:41045961 | DOI:10.1016/j.jjcc.2025.09.019

Int J Surg Case Rep. 2025 Oct 2;136:111999. doi: 10.1016/j.ijscr.2025.111999. Online ahead of print.

ABSTRACT

INTRODUCTION AND SIGNIFICANCE: Congenital Infantile Fibrosarcoma (CIFS) is an exceptionally rare pediatric malignancy, representing approximately 10 % of all soft tissue cancers in young children. Its clinical manifestations vary according to tumor location. When tumors occur in unusual anatomical sites, symptoms may be misleading and delay proper diagnosis and treatment.

CASE PRESENTATION: We report an 11-month-old male with a month-long persistent dry cough and high fever unresponsive to antibiotics. Chest CT revealed a pleural mass with mild effusion. Thoracotomy achieved complete excision (R0). Histopathology showed low-grade fibrosarcoma; immunohistochemistry was positive for Vimentin and SMA, focally CD34, and negative for S100, Desmin, and Myogenin, with low Ki-67 (<3 %). ETV6-NTRK3 fusion testing was unavailable. The patient received six cycles of adjuvant VAC chemotherapy and tolerated treatment well, with only mild transient neutropenia.

CLINICAL DISCUSSION: Diagnosis depends on histopathological and immunohistochemical analysis, as CIFS mimics several other soft tissue sarcomas. Our review of medical literature found no prior cases of CIFS originating in the pleura, underlining the uniqueness of this case. Management followed a standard multidisciplinary approach consisting of complete surgical excision and adjuvant chemotherapy (VAC protocol). At 12-month follow-up, the patient remained recurrence-free.

CONCLUSION: Persistent pneumonia-like symptoms unresponsive to standard treatment in infants should prompt consideration of underlying malignancy. Early recognition and prompt management are essential for improving outcomes in such rare presentations.

PMID:41045685 | DOI:10.1016/j.ijscr.2025.111999

Am J Hematol. 2025 Oct 4. doi: 10.1002/ajh.70074. Online ahead of print.

ABSTRACT

Viscoelastic testing (VET) has evolved significantly since its inception in the mid-20th century, when it was first developed to guide transfusion strategies in trauma and surgical patients. Initially, VET technologies such as TEG and ROTEM assessed clot formation by measuring the mechanical resistance of a pin or piston within a blood sample. Recent advances have introduced automated, cartridge-based systems and novel detection methods-including resonance frequency and ultrasound-based sonorheometry-these new systems allow for more precise, rapid, and user-friendly assessment of clot dynamics at the point of care. VET is now indicated for a wide range of clinical scenarios where complex coagulopathy is anticipated, including trauma, cardiac surgery, liver transplantation, obstetric hemorrhage, and hematologic disorders such as DIC. Its use is expanding into new populations, including pediatric cardiac surgery, patients with inflammatory bowel disease, and those with COVID-19. However, VET remains limited in its ability to reliably detect therapeutic anticoagulants and certain congenital bleeding disorders, such as von Willebrand disease and deficiencies of protein C, S, and antithrombin. Technical limitations, including potential discrepancies between in vitro and in vivo clot formation, and lack of FDA approval for pediatric use have imposed implementation barriers to centers interested in pediatric VET. Looking forward, the integration of VET data with electronic medical records, the development of predictive models, artificial intelligence, and continued innovation in platelet function assessment and detection technologies are poised to enhance the clinical utility of VET. As guidelines and evidence continue to evolve, VET is positioned to become an increasingly important tool for real-time, individualized management of coagulopathy in diverse patient populations.

PMID:41045051 | DOI:10.1002/ajh.70074

Int J Cardiol. 2025 Oct 2:133951. doi: 10.1016/j.ijcard.2025.133951. Online ahead of print.

ABSTRACT

OBJETIVE: Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable cause of pulmonary hypertension, characterized by persistent organized thrombi and micro vasculopathy leading to increased pulmonary vascular resistance and right heart failure. Pulmonary endarterectomy (PEA) remains the treatment of choice for operable patients. Although vitamin K antagonists (VKAs) are traditionally used for lifelong anticoagulation, direct oral anticoagulants (DOACs) have gained popularity despite limited evidence supporting their use in CTEPH. Histopathological assessment may provide new insights into anticoagulation effectiveness. This study aimed to evaluate the presence of recent thrombi in PEA specimens from patients using DOACs versus VKAs and to correlate these findings with surgical and hemodynamic outcomes.

METHODS: Retrospective cohort study included 115 patients with CTEPH who underwent PEA at a national referral center for the treatment of CTEPH between 2018 and 2023. Patients were categorized based on anticoagulant type (DOAC or VKA). All surgical specimens underwent histopathological evaluation. Pre- and postoperative hemodynamic and clinical data were analyzed. Statistical comparisons were performed using appropriate parametric and non-parametric tests.

RESULTS: Recent thrombi were identified in 26.2 % of patients on DOACs and 9.2 % of those on VKAs (p < 0.05). Despite the higher prevalence of thrombi in the DOAC group, no significant differences were observed in extracorporeal circulation time, cardiac arrest duration, or postoperative hemodynamic parameters between groups. Microscopic evaluation proved to be more sensitive than macroscopic analysis for detecting thrombi.

CONCLUSION: Our findings demonstrate the presence of recent thrombi in patients with CTEPH undergoing PEA. This observation raises questions regarding the use of DOACs in patients with CTEPH.

PMID:41046019 | DOI:10.1016/j.ijcard.2025.133951

J Clin Anesth. 2025 Oct 3;107:112030. doi: 10.1016/j.jclinane.2025.112030. Online ahead of print.

NO ABSTRACT

PMID:41045717 | DOI:10.1016/j.jclinane.2025.112030

Int J Cardiovasc Imaging. 2025 Oct 3. doi: 10.1007/s10554-025-03529-0. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the predictive value of hibernating myocardium (HM) proportion in total perfusion deficit (TPD) for reverse left ventricular (LV) remodeling and its prognostic significance in heart failure with reduced ejection fraction (HFrEF) patients after revascularization.

METHODS: A retrospective analysis of 201 HFrEF patients (178 males, 60.6 ± 9.3 years) who underwent gated myocardial perfusion imaging, 18F-FDG cardiac PET/CT, and echocardiography was performed. Patients were followed for a median of 13.0(7.0) months and received follow-up echocardiography 6 months post-revascularization. Reverse remodeling (RR) was defined as ≥ 10% reduction in LV end-systolic diameter (LVESD). Logistic regression identified predictors of RR, with the predictive value of HM/TPD validated in a prospective cohort (n = 30). Changes were expressed as Δ(post-pre).

RESULTS: HM/TPD independently predicted RR (OR = 1.042, 95%CI: 1.019-1.065, P < 0.001). A HM/TPD cutoff of 38.5% demonstrated significant associations with reversed LV remodeling and improved cardiac function post-revascularization, along with a favorable prognosis. The prospective cohort validated these findings. ΔTPD positively correlated with ΔHM (r = 0.825, P < 0.001).

CONCLUSIONS: Higher HM/TPD proportion in HFrEF patients was associated with an increased likelihood of RR, improved cardiac function, and favorable outcomes post-revascularization. These findings warrant further prospective investigations.

PMID:41044300 | DOI:10.1007/s10554-025-03529-0

JACC Case Rep. 2025 Oct 1;30(30):105279. doi: 10.1016/j.jaccas.2025.105279.

ABSTRACT

BACKGROUND: F-18 flurpiridaz is a novel radiotracer approved for positron emission tmography (PET) myocardial perfusion imaging. Its long half-life supports exercise stress testing, and its short positron range and high myocardial extraction fraction provide superior image resolution.

EARLY REPORTS SUMMARY: A 70-year-old man with known coronary artery disease and prior coronary revascularization underwent exercise cardiac PET with F-18 flurpiridaz for chest discomfort. PET showed ischemia in the left anterior descending and right coronary artery territories. Coronary angiography revealed a severe mid-left anterior descending lesion and a severe proximal lesion in a small-caliber right posterior descending artery.

DISCUSSION: Ischemia on PET correlated with coronary angiography and optical coherence tomography, guiding revascularization and altering clinical management.

NOVELTY: This case represents the first post-approval clinical experience of F-18 flurpiridaz with exercise cardiac PET imaging in the United States.

TAKE-HOME MESSAGE: F-18 flurpiridaz has made exercise cardiac PET feasible in the clinical setting.

PMID:41043909 | DOI:10.1016/j.jaccas.2025.105279

Cureus. 2025 Aug 31;17(8):e91368. doi: 10.7759/cureus.91368. eCollection 2025 Aug.

ABSTRACT

BACKGROUND AND OBJECTIVE: Acute coronary syndromes (ACS), particularly those affecting the left main coronary artery (LMCA), are associated with high morbidity and mortality. The objective of the present study was to investigate long-term outcomes in patients who underwent percutaneous coronary intervention (PCI) for ACS affecting the LMCA compared to those with non-LMCA involvement.

METHODS: This interventional study was conducted at the Department of Cardiology of MH Shamorita Medical College Hospital in Dhaka, Bangladesh, from January 2023 to June 2024. A total of 101 patients with ACS who underwent PCI participated in the study. Of whom, 51 were in the LMCA group and 50 were in the non-LMCA group. Follow-up assessment was done at the third, sixth, and 12th months, focusing on major adverse cardiovascular events (MACE) as the primary endpoint and persistent symptoms, repeat revascularization, and stent thrombosis as secondary endpoints.

RESULTS: The mean age of the LMCA and non-LMCA groups was 56 and 54 years, respectively, with a higher female proportion in the LMCA group. The patients in the LMCA group presented with more complex lesions, with a mean synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score of 23.6. The MACE rate was notably higher in the LMCA group at 6%, compared to 2% in the non-LMCA group (p=0.013). Myocardial infarction (MI) occurred in 4% of the LMCA group, with no events in the non-LMCA group. Persistent symptoms and repeat revascularization were also more prevalent in the LMCA group (6% and 4%, respectively, p-value <0.05).

CONCLUSIONS: Patients with ACS involving the LMCA experienced higher rates of adverse outcomes, particularly MI and repeat revascularization, following PCI compared to non-LMCA cases.

PMID:41041103 | PMC:PMC12485219 | DOI:10.7759/cureus.91368

Front Endocrinol (Lausanne). 2025 Sep 17;16:1665292. doi: 10.3389/fendo.2025.1665292. eCollection 2025.

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index is a reliable surrogate marker for insulin resistance, and is associated with cardiovascular diseases. However, the specific impact of TyG index on coronary plaque vulnerability and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. This study aimed to investigate the association of the TyG index with coronary plaque characteristics and clinical outcomes.

METHODS: Between January 2017 to December 2019, 1,831 STEMI patients who underwent optical coherence tomography imaging were retrospectively enrolled. Patients were divided into three groups based on TyG index tertiles (Group T1: <8.82, Group T2: 8.82-9.41, Group T3: ≥9.41). Major adverse cardiovascular and cerebrovascular events (MACCE) included cardiac death, non-fatal stroke, non-fatal myocardial infarction, ischemia-driven revascularization, and rehospitalization.

RESULTS: The average age was 58.7 years, and 72.1% were male. The incidence of plaque rupture, thin-cap fibroatheromas, macrophages, and the size of lipid core, increased with increasing TyG index tertiles (all P<0.05). Multivariate logistic regression analysis showed that TyG index independently predicted culprit plaque rupture (T2: OR 1.39, 95%CI 1.06-1.82; T3: OR 1.51, 95%CI 1.05-2.16; T1 as reference). During a median follow-up of 4.2 years, 541 (29.9%) patients developed MACCE. Patients in the highest TyG index tertile had a significantly higher cumulative incidence of MACCE (43.5% vs. 37.3% vs. 31.1%, P = 0.007) than the other two groups. After adjusting for clinical risk factors and coronary plaque features, the increased TyG index independently predicted MACCE (HR 1.18, 95%CI 1.00-1.38, per unit increased). This association was notable in patients without diabetes but was not demonstrable in diabetes (interaction P-value <0.05).

CONCLUSIONS: In patients with STEMI, elevated TyG index increased atherosclerotic plaque vulnerability, and independently predicted plaque rupture. A higher TyG index was an independent predictor of MACCE, especially for patients without diabetes.

PMID:41040860 | PMC:PMC12483882 | DOI:10.3389/fendo.2025.1665292

medRxiv [Preprint]. 2025 Sep 27:2025.09.22.25336403. doi: 10.1101/2025.09.22.25336403.

ABSTRACT

BACKGROUND: Revascularization for Chronic Limb-Threatening Ischemia (CLTI) may be performed with an endovascular (Endo) or open surgical (Bypass) approach.

OBJECTIVE: To evaluate the cost-effectiveness of Endo versus Bypass surgery for CLTI using data from the Best Endovascular versus Best Surgical Therapy for Patients with CLTI (BEST-CLI) trial.

METHODS: We developed an individual-level continuous time Markov model that included health states representing the occurrence of adjudicated clinical events from BEST-CLI. Rates of clinical outcomes and health utilities were derived directly from trial data. Costs came from Medicare insurance claims data and physician fee schedule. We calculated the incremental cost per life years gained, incremental quality-adjusted life years (QALYs) gained, incremental net monetary benefit (INMB) and cost per major events of amputation, revascularization, and myocardial infarction (MI) or stroke avoided over a 5- and 10-year time horizon. Sensitivity analyses were performed using a Monte Carlo simulation.

RESULTS: In base case analyses conducted over a 5-year time horizon, the mean per person direct medical costs were $227,341 (95% Credible Interval [CrI]: $173,075, $291,443) for Bypass and $243,614 (95% CrI: $190,112, $305,605) for Endo. The mean survival per person was 3.91 years (95% CrI: 3.78, 4.03) for Bypass and 3.88 years (95% CrI: 3.68, 4.06) for Endo. This resulted in Endo being dominated by Bypass surgery with respect to costs per life year gained. The mean QALYs per person were 2.48 (95% CrI: 1.11, 3.49) for Bypass and 2.54 (95% CrI: 1.39, 3.40) for Endo, resulting in an incremental costs per QALY gained of $263,973/QALY and an INMB of -$10,109 (95% CrI: -$168,908, $157,433) at a $100,000/QALY willingness-to-pay threshold for Endo vs. Bypass. The results over 10 years were consistent with those of the 5-year follow-up. In the Monte Carlo simulation, there was only a 55% chance that Bypass was more cost-effective than Endo.

CONCLUSION: In the base case analysis, Bypass was the preferred strategy with respect to survival and QALYs, at conventional willingness to pay thresholds. There was substantial uncertainty around these estimates in probabilistic sensitivity analysis, justifying future research to identify subgroups for whom each of these approaches may definitively be cost-effective.

PMID:41040676 | PMC:PMC12485972 | DOI:10.1101/2025.09.22.25336403

Cardiol Plus. 2025 Jul-Sep;10(3):217-234. doi: 10.1097/CP9.0000000000000131. Epub 2025 Sep 29.

ABSTRACT

Coronary flow improvement and myocardial ischemia relief are the primary goals of coronary revascularization. The pioneering work of Andreas Gruntzig, who demonstrated the reduction of trans-stenotic pressure gradients following percutaneous coronary intervention (PCI), marked a major milestone in the field. Since then, a variety of invasive and non-invasive techniques for assessing coronary physiology have been developed. These methods play a pivotal role in evaluating the hemodynamic significance of coronary lesions, guiding PCI planning, optimizing post-PCI outcomes, and assessing coronary microcirculation and disease patterns. This review explores the available tools for coronary physiology assessment in the catheterization laboratory and their applications in the decision-making process for coronary revascularization. In addition, it highlights recent technological advances, such as invasive and coronary image-based computational methods. These innovations enable individualized PCI treatment, aiming for complete ischemia relief through optimized morpho-functional procedural outcomes.

PMID:41040670 | PMC:PMC12487665 | DOI:10.1097/CP9.0000000000000131

J Dent Sci. 2025 Oct;20(4):2066-2075. doi: 10.1016/j.jds.2025.05.014. Epub 2025 May 29.

ABSTRACT

Currently, the concept of regeneration and regenerative therapies are already being applied clinically to treat pulpal and periodontal diseases, as well as to repair and regenerate systemic organs and tissues. During wound healing, well-developed, functional vascular networks and revascularization are fundamental factors in restoring regenerative potential. Growth factors, stem cells, and scaffolds alone or in combination are reported to contribute to successful tissue repair and engineering via cell transplantation, cell homing or other technologies. Among the growth factors, basic fibroblast growth factor (bFGF) has been found to regulate the proliferation, stemness, migration, and differentiation of vascular and mineralized tissues into various cell types through the differential activation of FGF receptors (FGFRs) and downstream signaling pathways. In addition to growth factors, various dental stem cells are widely used for the regeneration of diseased or lost dental pulp and periodontal tissues, yielding promising results. Stem cells from the apical papilla (SCAPs) and dental pulp stem cells (DPSCs), with or without bFGF, have been shown to be crucial for angiogenesis/revascularization, neuronal growth, and the repair/regeneration of the pulpo-dentin complex, apexogenesis, and may potentially be used in the future to treat various systemic diseases such as myocardial infarction, diabetes, retinopathy, and others. Further studies are needed to optimize the use of bFGF and dental stem cells such as SCAPs and DPSCs by using cell transplantation, cell homing or other technologies for tissue and organ regeneration in experimental animal models and, eventually, in clinical patients in the future.

PMID:41040621 | PMC:PMC12485421 | DOI:10.1016/j.jds.2025.05.014

J Soc Cardiovasc Angiogr Interv. 2025 Jul 29;4(9):103724. doi: 10.1016/j.jscai.2025.103724. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Bioresorbable scaffolds have been associated with inferior outcomes compared to contemporary permanent metallic drug-eluting stents (DES) for percutaneous coronary intervention, particularly within the initial years after implantation; however, their long-term performance remains uncertain. This study aimed to evaluate the long-term outcomes of Swedish patients treated with Absorb bioresorbable scaffolds (Abbott) vs contemporary DES, assessing device-related complications and examining potential late benefits. The findings seek to clarify the balance between early risks and long-term advantages of bioresorbable scaffolds in clinical practice.

METHODS: Complete data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to identify all patients receiving Absorb bioresorbable scaffolds or contemporary DES from November 4, 2011 to March 2, 2018. After 1:2 propensity score matching against modern DES, stent thrombosis, target lesion revascularization, in-stent restenosis, myocardial infarction, and all-cause mortality were analyzed. Landmark analyses were performed from 3 years onward. All patients were followed until January 17, 2022.

RESULTS: Among 1960/2406 propensity score matched patients/stents (583/802 Absorb bioresorbable scaffolds and 1377/1604 contemporary DES), bioresorbable scaffolds were associated with significantly higher early stent thrombosis, target lesion revascularization, and in-stent restenosis rates. All-cause mortality and myocardial infarction rates did not differ significantly over the entire follow-up. Beyond 3 years, the device-related outcomes converged, while myocardial infarction rates were lower with Absorb bioresorbable scaffolds than contemporary DES.

CONCLUSIONS: Absorb bioresorbable scaffolds showed inferior early clinical performance compared with contemporary DES, but after 3 years, device-related outcomes were similar, while myocardial infarction rates favored Absorb bioresorbable scaffolds. These findings suggest a complex trade-off between early device-related events and potential long-term benefits of bioresorbable scaffold-mediated vascular restoration.

PMID:41040460 | PMC:PMC12485528 | DOI:10.1016/j.jscai.2025.103724

J Soc Cardiovasc Angiogr Interv. 2025 Aug 19;4(9):103823. doi: 10.1016/j.jscai.2025.103823. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Physiologically guided revascularization improves clinical outcomes. The cutoff values for deferral with fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are the same across all coronary arteries, despite differences in coronary flow patterns. The objective was to compare deferral rates using either FFR or iFR in the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCx), and compare clinical outcomes in deferred lesions in the RCA, LAD, and LCx.

METHODS: Right coronary artery, LAD, and LCx lesions in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry that were evaluated using either FFR or iFR were included. The composite of major adverse cardiac events (MACE) within 5 years and the individual components of cardiovascular death, noncardiovascular death, myocardial infarction, target segment revascularization, and target vessel revascularization were analyzed.

RESULTS: In total, 33,241 lesions were included in the final analysis (RCA, 17.8%; LAD, 62.3%; and LCx, 19.9%). The median follow-up time was 3.4 years. The median age was 69 years, and 73.5% of patients were men. The deferral rates with iFR were 10.6% higher (P < .001) in all coronary arteries combined, 18.7% higher (P < .001) in the RCA, 9.5% higher in the LAD (P < .001), and 5.3% higher in the LCx (P = .007). No significant differences were observed in the MACE rate or its individual components at 5 years between the deferred FFR and iFR groups in any of the investigated vessels.

CONCLUSIONS: Instantaneous wave-free ratio demonstrated a higher deferral rate across all coronary arteries than those examined with FFR, which was especially pronounced in the RCA, without any associated increased risk of MACE.

PMID:41040437 | PMC:PMC12485520 | DOI:10.1016/j.jscai.2025.103823

Innovations (Phila). 2025 Oct 3:15569845251377059. doi: 10.1177/15569845251377059. Online ahead of print.

ABSTRACT

OBJECTIVE: The clinical outcomes of bilateral internal mammary arteries (BIMA) in situ were compared with Y-grafts in endoscopic coronary artery bypass grafting (endo-CABG), a less-invasive alternative to conventional CABG, providing reduced trauma and faster recovery.

METHODS: A retrospective single-center study was performed from January 2016 until February 2023 on endo-CABG patients, dividing them into in situ BIMA graft or Y-graft recipients. As endo-CABG was performed in all patients requiring surgical revascularization, this represents an unselected cohort. The primary outcome comprised freedom from major adverse cardiac and cerebrovascular events (MACCE). The secondary outcomes were target lesion revascularization (TLR) and 1-year overall survival.

RESULTS: A total of 1,328 endo-CABG patients (BIMA in situ, n = 693; Y-graft, n = 634) were included. Overall, characteristics of both groups were comparable, except that Y-graft patients had more comorbidities (diabetes mellitus and myocardial infarction), which was reflected in the EuroSCORE II. Furthermore, most Y-graft patients had triple-vessel disease and a higher number of bypasses required. The 1-year MACCE-free survival did not differ significantly between the groups (91.9% vs 89%; univariable hazard ratio [HR] = 1.42, 95% CI: 0.96 to 2.11, P = 0.079; multivariable HR = 1.07, 95% CI: 0.70 to 1.63, P = 0.771), as did the 1-year survival rate (95.7% vs 93.2%; univariable HR = 1.67, 95% CI: 1.01 to 2.75, P = 0.046; multivariable HR =1.34, 95% CI: 0.77 to 2.33, P = 0.297). TLR did not differ significantly between groups (univariable HR = 0.68, 95% CI: 0.22 to 2.08, P = 0.499) or after adjustment (multivariable HR = 0.31, 95% CI: 0.08 to 1.24, P = 0.100).

CONCLUSIONS: Creating a Y-graft for distal lesions and in cases in which more than 2 anastomoses are required serves as a favorable alternative without a difference between in situ and Y-grafts in 1-year MACCE-free survival.

PMID:41039981 | DOI:10.1177/15569845251377059

Circ Cardiovasc Interv. 2025 Oct 3:e015902. doi: 10.1161/CIRCINTERVENTIONS.125.015902. Online ahead of print.

ABSTRACT

BACKGROUND: The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) showed the superiority of complete revascularization in older patients with myocardial infarction (MI) and multivessel disease. Whether this result applies equally to patients at higher risk of ischemic events due to nonculprit lesion complexity is unclear.

METHODS: Overall, 1445 patients were randomized to culprit-only or complete revascularization. In this prespecified analysis, patients were divided into those with or without at least 1 complex nonculprit lesion. A nonculprit lesion was defined as complex if it met any of the following criteria: angiographic heavy calcification, ostial lesion, true bifurcation lesion involving side-branches >2.5 mm, in-stent restenosis, or long-lesions (estimated stent length >28 mm). The primary outcome comprised a composite of death, MI, stroke, or revascularization at 3 years. The key secondary outcome was a composite of cardiovascular death or MI. The safety outcome included a composite of contrast-associated acute kidney injury, stroke, and Bleeding Academic Research Consortium 3 to 5.

RESULTS: Overall, 641 patients (44%, complex subgroup) had at least 1 complex nonculprit lesion, whereas 804 patients (56%, noncomplex subgroup) did not. After adjustment for potential confounders, patients in the complex subgroup were at higher risk of 3-year cardiovascular death or MI (hazard risk [HR], 1.32 [95% CI, 1.01-1.74]), MI (HR, 2.33 [95% CI, 1.44-3.78]) and ischemia-driven coronary revascularization (HR, 2.28 [95% CI, 1.46-3.56]). Complete revascularization reduced the primary outcome in both the complex (HR, 0.75 [95% CI, 0.56-0.99]) and noncomplex (HR, 0.71 [95% CI, 0.53-0.95]) subgroups, with no significant interaction (P for interaction=0.625). Similarly, no evidence of heterogeneity related to nonculprit lesion complexity was observed for either key secondary or safety end points.

CONCLUSIONS: In older patients with MI and multivessel disease, physiology-guided complete revascularization reduced ischemic events, regardless of the complexity of nonculprit lesions.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03772743.

PMID:41039960 | DOI:10.1161/CIRCINTERVENTIONS.125.015902

J Dent Sci. 2025 Oct;20(4):2066-2075. doi: 10.1016/j.jds.2025.05.014. Epub 2025 May 29.

ABSTRACT

Currently, the concept of regeneration and regenerative therapies are already being applied clinically to treat pulpal and periodontal diseases, as well as to repair and regenerate systemic organs and tissues. During wound healing, well-developed, functional vascular networks and revascularization are fundamental factors in restoring regenerative potential. Growth factors, stem cells, and scaffolds alone or in combination are reported to contribute to successful tissue repair and engineering via cell transplantation, cell homing or other technologies. Among the growth factors, basic fibroblast growth factor (bFGF) has been found to regulate the proliferation, stemness, migration, and differentiation of vascular and mineralized tissues into various cell types through the differential activation of FGF receptors (FGFRs) and downstream signaling pathways. In addition to growth factors, various dental stem cells are widely used for the regeneration of diseased or lost dental pulp and periodontal tissues, yielding promising results. Stem cells from the apical papilla (SCAPs) and dental pulp stem cells (DPSCs), with or without bFGF, have been shown to be crucial for angiogenesis/revascularization, neuronal growth, and the repair/regeneration of the pulpo-dentin complex, apexogenesis, and may potentially be used in the future to treat various systemic diseases such as myocardial infarction, diabetes, retinopathy, and others. Further studies are needed to optimize the use of bFGF and dental stem cells such as SCAPs and DPSCs by using cell transplantation, cell homing or other technologies for tissue and organ regeneration in experimental animal models and, eventually, in clinical patients in the future.

PMID:41040621 | PMC:PMC12485421 | DOI:10.1016/j.jds.2025.05.014

Clin Transl Med. 2025 Oct;15(10):e70494. doi: 10.1002/ctm2.70494.

ABSTRACT

OBJECTIVES: Although extensive research on septic cardiomyopathy has been conducted, effective therapies are still limited. Ubiquitin-specific peptidase 20 (USP20), a deubiquitinating enzyme, is critical in regulating protein ubiquitination and various cellular processes. whether USP20 is involved in the pathogenesis of septic cardiomyopathy remains unclear. This study investigated the impact of USP20 on septic cardiomyopathy.

METHODS: The cardiomyocyte-specific USP20 knockout mice (USP20CKO) and NLRP3 knockout mice (NLRP3-/-) were used in the present study. A sepsis mouse model was established using lipopolysaccharide (LPS) administration and the cecal ligation and puncture (CLP) procedure. Recombinant adeno-associated virus serotype 9 (AAV9) was used to achieve overexpression of USP20. Myocardial function, histopathological changes, and pyroptosis levels in heart tissues were evaluated. Liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis and co-immunoprecipitation (co-IP) were performed to identify the molecular mechanism of USP20 in septic cardiomyopathy.

RESULTS: Our results showed that USP20 was downregulated in the myocardium of septic mice. Cardiomyocyte-specific USP20 deficiency worsened myocardial injury and cardiac dysfunction induced by LPS and CLP. LC-MS/MS analysis and co-IP revealed NLRP3 as a substrate protein of USP20. Mechanistically, USP20 removed K63-linked ubiquitin from K243 via its active site C154, inhibiting NLRP3's interaction with ASC and suppressing its activation and subsequent pyroptosis. Moreover, overexpressing USP20 in cardiomyocytes reduced LPS-induced myocardial injury. Additionally, the protective effect of USP20 against LPS-induced damage was nullified in the absence of NLRP3 in mice.

CONCLUSIONS: These findings suggest that cardiomyocyte-derived USP20 is crucial in septic cardiomyopathy progression and may serve as a novel therapeutic target for managing septic cardiomyopathy.

KEY POINTS: Cardiomyocyte-derived USP20 is crucial in septic cardiomyopathy progression. NLRP3 is identified as a substrate protein of USP20. USP20 deubiquitinates NLRP3 by removing K63-linked ubiquitin at K243 residue via its active site C154, disrupting the interaction between NLRP3 and ASC, suppressing NLRP3 activation and subsequent pyroptosis. USP20 may serve as a novel therapeutic target for managing septic cardiomyopathy.

PMID:41042219 | PMC:PMC12493026 | DOI:10.1002/ctm2.70494

Int J Mol Med. 2025 Dec;56(6):211. doi: 10.3892/ijmm.2025.5652. Epub 2025 Oct 3.

ABSTRACT

The apelin system plays a significant role in central blood pressure regulation, but its role in the neural control of myocardial protection remains poorly understood. The present study evaluated the effects of apelin‑13 in the paraventricular nucleus (PVN) on myocardial infarction (MI). In a male rat MI model, apelin‑13 expression was decreased in PVN, while Vasopressin 1a (V1a) receptor expression was increased in both PVN and nucleus tractus solitarii (NTS) and GABAA receptor (GAR)γ2 expression was increased in NTS. Cardiac function was assessed after microinjection of apelin‑13 or gene transfer of apelin‑13 into the PVN. Apelin‑13 overexpression in PVN markedly improved MI cardiac function, as evidenced by left ventricular end‑diastolic diameter, left ventricular end‑systolic diameter, left ventricular ejection fraction and left ventricular fractional shortening, along with decreased plasma noradrenaline and increased vasopressin levels. Mechanistically, both TGF‑β/Smad signaling and Bax/Bcl‑2 expression were implicated in heart tissue. Additionally, serum levels of four parasympathetic neuropeptides (somatostatin, cholecystokinin, glucagon‑like peptide‑1 and vasoactive intestinal peptide) were elevated in parallel with cardiac function improvement. Notably, V1a receptor antagonist administration in PVN/NTS or GAR agonist treatment in NTS attenuated the cardioprotective effects of apelin‑13. These findings demonstrated that PVN apelin‑13 overexpression improves cardiac function through V1a receptors (PVN/NTS) and GARγ2 (NTS), involving both parasympathetic neuroendocrine activation and modulation of myocardial apoptotic/inflammatory pathways. The present study provided novel insights into neural mechanisms of cardiovascular regulation.

PMID:41041849 | PMC:PMC12494304 | DOI:10.3892/ijmm.2025.5652

J Soc Cardiovasc Angiogr Interv. 2025 Aug 12;4(9):103867. doi: 10.1016/j.jscai.2025.103867. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: The 30-day Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) has been used to risk-stratify patients undergoing transcatheter aortic valve replacement (TAVR). Whether surgical mortality risk predicts stroke and neurocognitive outcomes following TAVR is unknown. We evaluated the association between STS-PROM and clinical outcomes, including stroke, acute brain injury on diffusion-weighted magnetic resonance imaging (DW-MRI), and cognitive decline in patients undergoing TAVR.

METHODS: Patient-level data were pooled from 4 prospective trials: (1) DEFLECT III (N = 87), (2) NeuroTAVR (N = 44), (3) REFLECT I (N = 214), and (4) REFLECT II (N = 258). All studies included patients undergoing TAVR with a protocol-mandated predischarge DW-MRI and serial cognitive and neurologic assessments. All patients were evaluated by a board-certified neurologist at baseline, postprocedure, and 30 days. Clinical outcomes, including stroke, cognitive decline (Montreal Cognitive Assessment score), death, myocardial infarction, vascular, and bleeding complications were adjudicated by the same clinical events committee. Imaging analysis was performed by a single core laboratory using identical methods. The DW-MRI measures included total lesion number, individual lesion volume, and total lesion volume. Outcomes were compared between low (STS <4), intermediate (STS 4-8), and high (STS >8) risk groups.

RESULTS: In total, 537 of 603 patients with DW-MRI and complete STS assessment undergoing transfemoral TAVR were included in this pooled analysis, of which 253 (47%) were low risk, 198 (37%) intermediate risk, and 86 (16%) high risk patients. At 30 days, high risk patients had higher rates of all-cause and cardiovascular mortality, myocardial infarction, acute kidney injury, bleeding, and vascular complications. Rates of stroke, disabling stroke, DW-MRI measures of brain injury, and cognitive decline were similar across risk categories.

CONCLUSIONS: This pooled analysis demonstrates that the STS score does not predict stroke, cognitive decline, or acute brain injury after TAVR.

PMID:41040451 | PMC:PMC12485508 | DOI:10.1016/j.jscai.2025.103867