PLoS One. 2025 Oct 7;20(10):e0333264. doi: 10.1371/journal.pone.0333264. eCollection 2025.
ABSTRACT
Acute Myocardial Infarction (AMI) is characterized by the presence of injury caused by an ischemic event, which leads to various complications, including Heart Failure (HF), the most severe functional stage of the heart, reducing both quality of life and life expectancy. Among the factors involved in this process, essential trace elements such as zinc and selenium stand out, as they are related to cardiovascular health and may help mitigate the harmful changes resulting from AMI. The objective of this protocol is to detail the development of two systematic reviews to gather scientific evidence on the relationship between zinc and selenium and the prognosis following AMI. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline and registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the code CRD42024574424. Search strategies will be conducted using a combination of controlled and uncontrolled terms combined with Boolean operators, and the following databases will be used: MEDLINE/PubMed, EMBASE, LILACS, Scopus, Web of Science, Trip database, and World Wide Science. Cohort studies that evaluated zinc and selenium in the prognosis after AMI will be included. Two trained researchers will independently select articles, extract data, and assess the risk of bias and the quality of the evidence. A narrative synthesis will be performed, and the main findings will be presented in tables. If possible, a meta-analysis will also be conducted.
PMID:41056280 | DOI:10.1371/journal.pone.0333264
Acta Anaesthesiol Scand. 2025 Nov;69(10):e70118. doi: 10.1111/aas.70118.
ABSTRACT
BACKGROUND: Perioperative hyperoxia may be associated with increased long-term mortality, whereas perioperative antioxidants may be associated with reduced long-term mortality. This study aimed to determine if high perioperative inspiratory oxygen fraction (FiO2) (0.80) compared with normal FiO2 (0.30) would increase mortality, hospital admissions, and myocardial infarction (MI) within 1 year after surgery, and whether antioxidants compared with placebo would reduce this.
METHODS: This was the preplanned 1-year follow-up of 600 patients with cardiovascular risk factors, scheduled for noncardiac surgery. They were randomized in a 2 × 2 factorial design to perioperative FiO2 of 0.80 or 0.30 and to receive antioxidants (vitamin C and N-acetylcysteine) or matching placebo. The primary 1-year outcome was all-cause mortality, and secondary 1-year outcomes were one or more hospital admissions and MIs, respectively. All outcomes were assessed using medical records and analyzed with the Cox proportional hazards model.
RESULTS: Follow-up was completed for 594 patients (99%). Twenty-five of 298 patients (8.4%) allocated to FiO2 of 0.80 died within 1 year as compared with 17 out of 296 (5.7%) allocated to FiO2 of 0.30, HR 1.46 (95% CI, 0.79-2.70), p = 0.23. A total of 260 patients had one or more hospital admissions (44%), and seven patients had MI (1.2%) with no significant difference when comparing FiO2 of 0.80 with 0.30. Antioxidants had a HR of 0.98 (95% CI, 0.54-1.80), p = 0.96 for all-cause mortality vs. placebo. The interaction between the FiO2 and antioxidant administration was statistically significant (p = 0.04) with fatalities overrepresented in patients given 80% oxygen and placebo.
CONCLUSIONS: Differences in all-cause mortality, hospital admission, or MI were not statistically significant at 1-year follow-up for either oxygen fractions or antioxidant administration in patients undergoing major noncardiac surgery.
EDITORIAL COMMENT: In this preplanned long-term study of the VIXIE trial, no differences in total mortality, hospitalization, or myocardial infarction were found for oxygen fractions of 0.80 compared to 0.30 or antioxidant administration compared to placebo. Interestingly, the study showed a higher rate of fatalities with 80% oxygen which appeared only to be present in patients not given the antioxidant intervention, but this is hypothesis-generating and needs to be further investigated in new clinical trials.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03494387.
PMID:41055553 | PMC:PMC12503005 | DOI:10.1111/aas.70118
Magn Reson Med. 2025 Oct 7. doi: 10.1002/mrm.70130. Online ahead of print.
ABSTRACT
PURPOSE: The IEC 60601-2-33 standard provides consensus-based safety provisions for MRI equipment. Protection of patients against cardiac stimulation (CS) is based on limiting the maximum E-field induced by MRI gradient coils. In practice, this is achieved by imposing a conservative dB/dt threshold on any gradient waveform. The dB/dt-over-E-field conversion ratio currently used in IEC 60601-2-33 was derived in a homogeneous ellipsoid exposed to a uniform B-field and is 10 (T/s)*(V/m)-1. This limit is becoming increasingly restrictive in high performance clinical systems. We therefore evaluate dB/dt-over-E-field ratios in realistic body models and coils using state-of-the-art electromagnetic simulations.
METHODS: We performed two independent simulation studies in a total of 75 realistic body models and 13 commercial gradient systems and derived dB/dt-over-E-field ratios in the heart. We thresholded the E-field maps to mitigate the impact of staircasing artifacts in boundary voxels between the myocardium and the lungs.
RESULTS: Thresholding the E-field maps at the 99th percentile E-field value (E99) eliminates staircasing artifacts in both simulation studies. Study #1 predicts a larger range of dB/dt-over-E99 ratios (13-53 (T/s)*(V/m)-1) than study #2 (12-35 (T/s)*(V/m)-1). Despite differences in EM solvers, body models, coils, mesh resolution, and post-processing, both studies find similar worst-case ratios of dB/dt-over-E99 of 12-13 (T/s)*(V/m)-1.
CONCLUSION: Our simulations of dB/dt-over-E-field ratios for cardiac safety in MRI cover a large range of realistic clinical scenarios. An increase of the allowable dB/dt beyond the current CS limit in IEC 60601-2-33 may be feasible.
PMID:41055234 | DOI:10.1002/mrm.70130
J Transl Med. 2025 Oct 7;23(1):1060. doi: 10.1186/s12967-025-07099-6.
ABSTRACT
Global cerebral ischemia (GCI) caused by impaired blood flow to the brain-typically following cardiac arrest or traumatic brain injury-remains the leading cause of coma and disorders of consciousness (DoC). In certain cases, the recovery potential of these patients may be significantly underestimated. Historically, these patients were often given little hope for recovery, particularly due to longstanding, outdated dogmatic views such as the presumed absence of adult neurogenesis. However, recent advances suggest that we have been discounting ongoing mental activity in comatose patients; additionally, emerging evidence shows that some patients in coma retain the capacity for communication through non-traditional means. The authors believe that the exponential progress in the field and the increase of our understanding in neurophysiology, regenerative medicine, and the biology of cellular senescence now makes it plausible to initiate experimental interventions that offer a realistic chance of reversing disorders of consciousness. The proposed strategy involves a two-step therapeutic paradigm: first the use of senolytic approaches to remove senescent cells and reduce neuroinflammatory burden ("clear the debris"); second, stimulation of neural regeneration through stem cell therapies, combined with electrophysiologic/pharmacological stimulation. The authors propose, that this integrated approach offers a novel treatment paradigm to address the previously insurmountable challenge of coma reversal.
PMID:41057934 | DOI:10.1186/s12967-025-07099-6
BMC Med Genomics. 2025 Oct 7;18(1):151. doi: 10.1186/s12920-025-02231-3.
ABSTRACT
BACKGROUND: The intrapatient variability (IPV) of tacrolimus (Tac) has gradually become a new index for the prognosis of organ transplantation. The gene polymorphism is involved in the pharmacokinetic process of Tac. The aim of this study was to investigate the effects of genetic polymorphisms on Tac IPV and other clinical outcomes in heart transplant recipients during the early post-transplantation period.
METHODS: Our study retrospectively collected the clinical data and genotyping results of 48 heart transplant recipients. SPSS (21.0) and Graphpad Prism (8.0) were used to analyze the effect of gene polymorphism on Tac concentration (C0) and clinical outcome.
RESULTS: The CYP3A5 rs15524 AA genotype has a higher trough concentrations/dose (C0/D) value than G allele carriers, and CYP3A7 rs776744 CC genotype has a higher C0/D value than T allele carriers. Patients with The CYP3A5 rs15524 and CYP3A7 rs776744 mutants had a higher IPV. One year after heart transplantation, the mortality of wild-type and mutant CYP3A5 rs15524 patients due to rejection was 0 vs. 10.7% (P = 0.255). The mortality caused by rejection in wild-type patients and mutant patients of CYP3A7 rs776744 was 4.5% vs. 7.7% (p = 0.564).
CONCLUSIONS: Genetic polymorphisms of CYP3A5 rs15524 and CYP3A7 rs776744 affect tacrolimus metabolism in heart transplant recipients, significantly affecting Tac C0/D during the early postoperative period. In addition, gene polymorphism may be related to Tac IPV and clinical outcome in patients with early heart transplantation.
PMID:41057866 | DOI:10.1186/s12920-025-02231-3
Biomaterials. 2025 Oct 3;327:123762. doi: 10.1016/j.biomaterials.2025.123762. Online ahead of print.
ABSTRACT
Cardiac transplantation is the preferred treatment option for patients with chronic heart failure. However, acute rejection remains as a the significant challenge that leads to cardiac allograft dysfunction, resulting from immune system activation and reactive oxygen species (ROS) production by inflammatory cells. Current immunosuppressive regimens have limitations, such as systemic administration, toxicity, and inefficient inhibition of B cells, macrophages, and natural killer (NK) cells. Targeted immunosuppressant delivery via nanomaterials is a promising approach for sustained release within allografts, significantly enhancing drug efficiency. Manganese dioxide (MnO2) possesses the characteristics of chemotaxis towards inflammatory sites, scavenging ROS, and facilitating drug transport. In this study, tacrolimus (FK506)-loaded MnO2 nanoparticles (NPs) are synthesized via in-situ polymerization, using polydopamine (PDA) as an intermediate. The resulting FK506@MnO2/PDA NPs exhibit excellent safety and cytocompatibility. This targeted delivery system significantly increases FK506 accumulation in murine cardiac allografts, effectively mitigating acute rejection and prolonging allograft survival. Furthermore, the mechanism by which FK506@MnO2/PDA NPs alleviate acute rejection is investigated, validating that FK506 release inhibits T-cell activation while modulating the inflammatory environment by reducing oxidative stress and scavenging ROS. Fluorescence imaging demonstrates that FK506@MnO2/PDA NPs exhibit prolonged retention and more pronounced accumulation in cardiac allografts compared with free FK506. This study presents a novel strategy for immunosuppressive therapy following cardiac transplantation, potentially improving allograft prognosis.
PMID:41056839 | DOI:10.1016/j.biomaterials.2025.123762
Eur Heart J Cardiovasc Imaging. 2025 Oct 7:jeaf287. doi: 10.1093/ehjci/jeaf287. Online ahead of print.
ABSTRACT
AIMS: While pre-defined reference shapes have been used to assess morphological changes in the left ventricle, standardized methods for evaluating right ventricular (RV) remodeling are lacking. This study aimed to develop and test a new 3D echocardiography (3DE)-based method for quantifying RV shape in a large cohort of healthy individuals and across various disease states.
METHODS AND RESULTS: 3DE-derived RV mesh models were reconstructed in 1043 healthy subjects from the World Alliance of Societies of Echocardiography (WASE) study and in 581 patients with severe aortic stenosis (AS), heart failure with reduced ejection fraction (HFrEF), post-heart transplantation (HTX), severe primary mitral regurgitation (MR), atrial secondary tricuspid regurgitation (A-STR), tetralogy of Fallot (TOF) and pulmonary hypertension (PH). To assess global RV shape, hemi-sphericity volume ratio (HSVR) and hemi-conicity angle (HCA) were calculated, where a higher HSVR and a more acute HCA reflect more spherical and conical shapes, respectively. In the WASE population, females had more spherical RVs, whereas males had more conical RVs (p=0.028). Considering age, younger females had more conical RVs, while older individuals in both sexes showed spherical remodeling (p<0.05). Comparing disease groups with WASE controls, MR, HFrEF, and A-STR patients had more spherical RVs compared to controls (both p<0.001), while PH and TOF patients showed conical remodeling (both p<0.001). In A-STR, a more conical remodeling was associated with adverse clinical outcomes.
CONCLUSION: The proposed 3DE method comprehensively characterizes RV geometry, demonstrating demographic variation in healthy individuals and disease-specific alterations in patients, with important prognostic implications.
PMID:41056461 | DOI:10.1093/ehjci/jeaf287
Eur Heart J. 2025 Oct 7:ehaf710. doi: 10.1093/eurheartj/ehaf710. Online ahead of print.
ABSTRACT
This clinical consensus statement, developed by the Heart Failure Association of the European Society of Cardiology, offers a detailed review of the non-specific management of transthyretin amyloid cardiomyopathy (ATTR-CM). This progressive and often fatal condition is increasingly recognized as a major contributor to heart failure. This document provides advice on symptom management and enhancing quality of life, with a focus on volume management, neurohormonal modulation, and tailored use of diuretics and other supportive therapies that address the distinct pathophysiology of ATTR-CM. It also explores advanced treatment modalities such as heart transplantation and mechanical circulatory support, which play crucial roles in managing advanced stages of the disease. Furthermore, it addresses the management of aortic stenosis in the context of ATTR-CM, advising transcatheter aortic valve replacement as the preferred treatment for these patients. The advice provided in this document relies primarily on expert opinion and retrospective studies due to a notable lack of randomized clinical trials, which underscores a critical research gap and the pressing need for evidence-based treatment protocols.
PMID:41055898 | DOI:10.1093/eurheartj/ehaf710
JACC Case Rep. 2025 Oct 7:105596. doi: 10.1016/j.jaccas.2025.105596. Online ahead of print.
ABSTRACT
BACKGROUND: Implantation of two HeartMate 3 devices in a total artificial heart configuration, known as the HeartMate 6 (HM6) approach, can be used to manage severe biventricular heart failure in a patient who is not eligible for transplantation.
CASE SUMMARY: We report a case in which a young patient presented with heart failure of unknown etiology. She was initially considered a transplant candidate but then was delisted due to allosensitization and a stroke. HM6 implantation was successfully completed.
DISCUSSION: We discuss considerations for perioperative care in patients with HM6 implantation.
TAKE-HOME MESSAGE: HM6 implantation can be used to manage severe biventricular heart failure in patients who are not candidates for heart transplant.
PMID:41055626 | DOI:10.1016/j.jaccas.2025.105596
JACC Case Rep. 2025 Oct 7:105601. doi: 10.1016/j.jaccas.2025.105601. Online ahead of print.
ABSTRACT
BACKGROUND: Cardiac sarcoidosis (CS) is a rare but clinically significant condition in heart transplant recipients.
CASE SUMMARY: A 64-year-old woman with nonischemic cardiomyopathy and heart transplant presented with exertional dyspnea and new reduction in left ventricular ejection fraction. Endomyocardial biopsy, donor-specific antibodies, and imaging were concerning for antibody-mediated rejection versus CS. Empiric treatment for antibody-mediated rejection was initiated, but her left ventricular ejection fraction remained unchanged. Native heart explant was reviewed and was consistent with CS. Methotrexate was started, with clinical and radiographic improvement.
DISCUSSION: Owing to its patchy nature, CS can be difficult to diagnose on biopsy, but cardiac imaging can assist. Heart transplant recipients with known CS have similar outcomes to transplant recipients without CS if they take low-dose steroids indefinitely.
TAKE-HOME MESSAGE: The explanted heart should be extensively examined for CS in transplant recipients; if found, clinicians should prescribe CS-effective therapy indefinitely to prevent recurrence.
PMID:41055622 | DOI:10.1016/j.jaccas.2025.105601
J Clin Invest. 2025 Oct 7:e186287. doi: 10.1172/JCI186287. Online ahead of print.
ABSTRACT
Genetic factors are fundamental in the etiology of thoracic aortic aneurysm and dissection (TAAD), but the genetic cause is detected in only about 30% of cases. To define unreported TAAD-associated sequence variants, exome and gene panel sequencing was performed in 323 patients. We identified heterozygous CDKL1 variants [c.427T>C p.(Cys143Arg), c.617C>T p.(Ser206Leu), and c.404C>T p.(Thr135Met)] in 6 patients from 3 families with TAAD-spectrum disorders. CDKL1 encodes a protein kinase involved in ciliary biology. Amino acid substitutions were predicted to affect CDKL1 catalytic activity or protein binding properties. CDKL1 was expressed in vascular smooth muscle cells in normal and diseased human aortic wall tissue. Cdkl1 knockdown and transient knockout in zebrafish resulted in intersomitic vessel (ISV) malformations and aortic dilation. Co-injection of human CDKL1wildtype, but not CDKL1Cys143Arg and CDKL1Ser206Leu RNA, rescued ISV malformations. All variants affected CDKL1 kinase function and profiling data, and altered protein-protein binding properties, particularily with ciliary transport molecules. Expression of CDKL1 variants in heterologeous cells interfered with cilia formation and length, CDKL1 localization, and p38-MAPK and Vegf signaling. Our data suggest a role of CDKL1 variants in the pathogenesis of TAAD-spectrum disorders. The association between primary cilia dysregulation and TAAD expands our knowledge of the underlying molecular pathophysiology.
PMID:41056017 | DOI:10.1172/JCI186287
Crit Care Explor. 2025 Oct 3;7(10):e1327. doi: 10.1097/CCE.0000000000001327. eCollection 2025 Oct 1.
ABSTRACT
OBJECTIVE: To train and test supervised machine learning (ML) models to predict low cardiac output syndrome (LCOS) within the first 48 postoperative hours in neonates undergoing cardiothoracic surgery.
DESIGN: Retrospective observational study. An efficient tree-based gradient-boosting algorithm (LightGBM) ML models were developed to predict LCOS occurrence at 2-, 4-, 6-, and 12-hour forecasting horizons, incorporating data from the prediction time and the two preceding hours. SHapley Additive exPlanations (SHAP) analyses were used for feature importance analyses.
SETTING: Single center, January 2012 to April 2023.
PATIENTS: Neonates 28 days old or younger who underwent cardiothoracic surgery.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: A total of 181 neonates were included, with 14.9% experiencing LCOS. A multivariate time-series dataset was constructed using hourly clinical and laboratory variables recorded during the first 48 postoperative hours. The LightGBM ML models achieved area under the receiver operating characteristic curve values ranging from 0.91 to 0.98 and area under the precision-recall curve values ranging from 0.60 to 0.80 for LCOS prediction across 2-, 4-, 6-, and 12-hour forecasting horizons. SHAP analyses identified higher vasoactive inotrope score, lower urine output, and higher serum lactate as the most influential predictors.
CONCLUSIONS: This study demonstrates that the supervised machine learning models can accurately predict LCOS in neonates, offering high interpretability. The findings support further validation in multicenter settings and integration into clinical workflows to enhance postoperative critical cardiac care neonates.
PMID:41056014 | DOI:10.1097/CCE.0000000000001327
JMIR Form Res. 2025 Oct 7;9:e68710. doi: 10.2196/68710.
ABSTRACT
BACKGROUND: Heart valve surgery is associated with a high risk of perioperative complications. However, current approaches for predicting perioperative complications are all based on preoperative or intraoperative factors, without taking into account the fact that perioperative complications are multifactorial, dynamic, heterogeneous, and interdependent.
OBJECTIVE: We aimed to construct and quantify the association network among multiple perioperative complications to elucidate the possible evolution trajectories.
METHODS: This study used the data from China Cardiac Surgery Registry (CCSR), in which 37,285 patients were included in the analysis. A Bayesian network was used to analyze the associations among 12 complications. Score-based hill-climbing algorithms were used to build the structure and the association between them was quantified using conditional probabilities.
RESULTS: We obtained the network of valve surgery complications. A total of 13 nodes represented complications or death, and 34 arcs with arrows represented the directly dependent relationship between them. We identified clusters of complications that were logically related and not related and quantified the associations. The correlation coefficient between complications increases with the severity of the complications, ranging from 0.01 to 0.41. Meanwhile, the probability of death when multiple complications occurred was calculated. Even mild complications, when progressing to multiple organ dysfunction syndrome, result in a mortality rate of over 90%.
CONCLUSIONS: Our network facilitates the identification of associations among specific complications, which help to develop targeted measures to halt the cascade of complications in patients undergoing the valve surgery.
PMID:41056564 | PMC:PMC12503447 | DOI:10.2196/68710
Ir J Med Sci. 2025 Oct 7. doi: 10.1007/s11845-025-04102-3. Online ahead of print.
ABSTRACT
BACKGROUND: Preoperative anxiety adversely affects anesthetic management, hemodynamic stability, and recovery. Among modifiable perioperative variables, the impact of preoperative waiting time on anxiety and postoperative outcomes has been insufficiently explored.
AIM: To assess the relationship between waiting time and perioperative anxiety, hemodynamic responses, intraoperative opioid use, and postoperative analgesic requirements in adults undergoing elective surgery under general anesthesia.
METHODS: In this prospective observational study, 130 ASA I-II adults were evaluated in the preoperative waiting area. The Amsterdam Preoperative Anxiety and Information Scale (APAIS), systolic blood pressure, and heart rate were measured on arrival and immediately pre-induction. Waiting time was the interval between these assessments. Intraoperative fentanyl/remifentanil doses and postoperative tramadol consumption were recorded. Pearson correlation and linear regression were used (p < 0.05).
RESULTS: Longer waiting times were associated with higher pre-induction APAIS scores (r = 0.339, p < 0.001) and greater postoperative tramadol use (r = 0.333, p < 0.001). Waiting time inversely correlated with preoperative systolic blood pressure (r = - 0.253, p = 0.004). Associations with intraoperative opioid doses were not significant. Female sex, lower education, prior surgery, and negative surgical experiences were associated with higher anxiety. Midazolam premedication did not prevent anxiety escalation in patients with extended waiting times.
CONCLUSION: Preoperative waiting time is a modifiable, hospital-based factor that meaningfully influences perioperative anxiety and postoperative analgesic demand. Reducing unnecessary delays through individualized perioperative planning may enhance patient comfort, support hemodynamic stability, and reduce postoperative analgesic requirements.
PMID:41055853 | DOI:10.1007/s11845-025-04102-3
Cardiovasc Diabetol. 2025 Oct 6;24(1):385. doi: 10.1186/s12933-025-02915-1.
ABSTRACT
BACKGROUND: Cardiovascular outcome trials have shown that glucagon-like peptide 1 receptor agonists (GLP1-RAs) reduce cardiovascular event rates more effectively than placebo and in patients with type 2 diabetes at increased cardiovascular risk. However, the generalizability of these findings to real-world settings remains uncertain.
AIM: This study aimed to evaluate the real-world cardiovascular effectiveness of sustained GLP1-RA use compared to dipeptidyl peptidase 4 inhibitor (DPP-4i) over 3.5 years.
METHODS: Using Danish nationwide registries, we emulated a target trial to assess the real-world effectiveness of GLP1-RAs in a population of individuals with type 2 diabetes mirroring the inclusion and exclusion criteria from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial. The study period was 2012-2022. Outcomes included the composite of myocardial infarction, stroke, and cardiovascular mortality (3P-MACE), as well as each component individually, alongside all-cause mortality, heart failure, angina pectoris, and revascularization. Longitudinal Targeted Minimum Loss-based Estimation, a method that adjusts for both baseline and time-varying confounding, was used to estimate absolute risks of cardiovascular outcomes under sustained use of GLP1-RA and DPP 4i (active comparator), adjusting for baseline and time-varying confounding.
RESULTS: We included 6,681 people initiating GLP1-RA and 19,072 initiating DPP-4i. Accounting for baseline and time-varying confounding, sustained GLP1-RA use showed a 2.5% (95% CI 0.8-4.1%) risk reduction of 3P-MACEover 3.5 years. Risk reductions for cardiovascular mortality, all-cause mortality, heart failure, and unstable angina pectoris were 2.3% (95% CI 1.4-3.1%), 2.5% (95% CI 0.7-4.3%), 0.9% (95% CI 0.01-1.8%), and 0.7% (95% CI 0.01-1.3%), respectively. No significant differences were observed for myocardial infarction, stroke, or revascularization with risk differences of 0.1% (95% CI -1.0 to 0.8%), 0.8% (95% CI -0.2 to 1.7%), and 0.2% (95% CI -0.7-1.1%), respectively.
CONCLUSIONS: This real-world study confirms the cardiovascular benefits of GLP1-RAs over DPP-4is, particularly for reducing cardiovascular and all-cause mortality under continuous treatment exposure in patients with type 2 diabetes at increased cardiovascular risk.
PMID:41053738 | PMC:PMC12502128 | DOI:10.1186/s12933-025-02915-1
Cardiovasc Diabetol. 2025 Oct 6;24(1):385. doi: 10.1186/s12933-025-02915-1.
ABSTRACT
BACKGROUND: Cardiovascular outcome trials have shown that glucagon-like peptide 1 receptor agonists (GLP1-RAs) reduce cardiovascular event rates more effectively than placebo and in patients with type 2 diabetes at increased cardiovascular risk. However, the generalizability of these findings to real-world settings remains uncertain.
AIM: This study aimed to evaluate the real-world cardiovascular effectiveness of sustained GLP1-RA use compared to dipeptidyl peptidase 4 inhibitor (DPP-4i) over 3.5 years.
METHODS: Using Danish nationwide registries, we emulated a target trial to assess the real-world effectiveness of GLP1-RAs in a population of individuals with type 2 diabetes mirroring the inclusion and exclusion criteria from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial. The study period was 2012-2022. Outcomes included the composite of myocardial infarction, stroke, and cardiovascular mortality (3P-MACE), as well as each component individually, alongside all-cause mortality, heart failure, angina pectoris, and revascularization. Longitudinal Targeted Minimum Loss-based Estimation, a method that adjusts for both baseline and time-varying confounding, was used to estimate absolute risks of cardiovascular outcomes under sustained use of GLP1-RA and DPP 4i (active comparator), adjusting for baseline and time-varying confounding.
RESULTS: We included 6,681 people initiating GLP1-RA and 19,072 initiating DPP-4i. Accounting for baseline and time-varying confounding, sustained GLP1-RA use showed a 2.5% (95% CI 0.8-4.1%) risk reduction of 3P-MACEover 3.5 years. Risk reductions for cardiovascular mortality, all-cause mortality, heart failure, and unstable angina pectoris were 2.3% (95% CI 1.4-3.1%), 2.5% (95% CI 0.7-4.3%), 0.9% (95% CI 0.01-1.8%), and 0.7% (95% CI 0.01-1.3%), respectively. No significant differences were observed for myocardial infarction, stroke, or revascularization with risk differences of 0.1% (95% CI -1.0 to 0.8%), 0.8% (95% CI -0.2 to 1.7%), and 0.2% (95% CI -0.7-1.1%), respectively.
CONCLUSIONS: This real-world study confirms the cardiovascular benefits of GLP1-RAs over DPP-4is, particularly for reducing cardiovascular and all-cause mortality under continuous treatment exposure in patients with type 2 diabetes at increased cardiovascular risk.
PMID:41053738 | PMC:PMC12502128 | DOI:10.1186/s12933-025-02915-1
Cardiol Young. 2025 Oct 7:1-10. doi: 10.1017/S1047951125109773. Online ahead of print.
ABSTRACT
BACKGROUND: Double-outlet right ventricle is a complex congenital cardiac anomaly in which both great arteries arise predominantly from the right ventricle. Accurate anatomical evaluation is critical for surgical planning. While transthoracic echocardiography is commonly used for intracardiac assessment, its limitations in visualising extracardiac structures highlight the need for additional imaging modalities like CT angiography.
OBJECTIVE: To compare the diagnostic accuracy and clinical utility of transthoracic echocardiography and CT angiography in the pre-operative evaluation and surgical planning of infants with double-outlet right ventricle.
METHODS: This retrospective, single-centre study included 78 infants diagnosed with double-outlet right ventricle. All patients underwent both transthoracic echocardiography and CT angiography before surgical intervention. Imaging findings were compared with intraoperative surgical results to assess sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for each modality.
RESULTS: CT angiography was significantly more effective than transthoracic echocardiography in identifying extracardiac anomalies such as coronary artery anomalies (p = 0.014), aortic arch hypoplasia (p = 0.024), aortopulmonary collateral vessels (p = 0.039), anomalous pulmonary venous connections (p = 0.001), and persistent left superior vena cava (p = 0.001). In contrast, transthoracic echocardiography was more sensitive in detecting small ventricular septal defects (p = 0.035).
CONCLUSION: Transthoracic echocardiography remains the first-line modality for intracardiac evaluation in double-outlet right ventricle, but CT angiography provides superior visualisation of extracardiac structures. The combined use of both imaging techniques improves diagnostic accuracy and surgical planning, supporting better outcomes in the management of CHD.
PMID:41054313 | DOI:10.1017/S1047951125109773
Medicine (Baltimore). 2025 Oct 3;104(40):e44919. doi: 10.1097/MD.0000000000044919.
ABSTRACT
BACKGROUND: In our study, we aimed to evaluate the frequency of early postoperative sepsis, the factors affecting it and the outcomes of sepsis in patients treated in a postoperative intensive care unit (PICU).
METHODS: Postoperative patients treated in PICU between July 15, 2021 to July 14, 2022 were included in our prospective study. Patient data, demographic characteristics, operation, and anesthesia method characteristics were recorded and analyzed.
RESULTS: Eleven percent of the 1123 cases were infected, 6.4% had sepsis, and 5.3% had septic shock. It was determined that emergency operation, male gender, increased American Society of Anesthesiologists class, immunosuppression, increased frequency of peroperative blood product and colloid use, acute physiology and chronic health examination II, sequential organ failure assessment, CCI scores, blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, C-reactive protein, Na, Cl, Ca, bilirubin, INR, albumin, platelet levels were associated with infection, sepsis, and septic shock (P < .05). In patients with sepsis and septic shock, the need and duration of invasive mechanical ventilation in PICU, the need for renal replacement therapy, steroid, sedation, muscle relaxant, blood product, albumin requirement, cardiac complications, PICU, intensive care unit, and hospital mortality were found to be high (P < .05). In multivariate logistic regression analysis for mortality, acute physiology and chronic health examination II score (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.04-1.32, P = .006), sequential organ failure assessment score (OR, 1.32; 95% CI, 1.06-1.64, P = .010), body mass index (OR, 0.85; 95% CI, 0.79-0.91, P < .001), blood urea nitrogen (OR, 1.05; 95% CI, 1.02-1.07, P < .001), creatinine (OR, 0.30; 95% CI, 0.15-0.60, P = .001), K (OR, 1.98; 95% CI, 1.14-3.46, P = .015), and platelet (OR, 0.996; 95% CI, 0.993-0.999, P = .006) were independent risk factors for mortality.
CONCLUSION: In light of the results of our study, we believe that sepsis cases and mortality can be prevented through widespread quality improvement programs such as shortening the duration of mechanical ventilation in postoperative surgical patients, effective treatment of some metabolic, electrolyte and coagulation disorders during intensive care stay, and regulation of blood product and colloid use.
PMID:41054073 | DOI:10.1097/MD.0000000000044919
Sci Rep. 2025 Oct 6;15(1):34719. doi: 10.1038/s41598-025-18313-2.
ABSTRACT
Vectorcardiography (VCG) enables measurement of voltages and directions of resultant spatial vectors in the heart that are altered by myocardial ischemia. To validate the ability of VCG to detect electrophysiological effects of regional myocardial ischemia and identify blood vessels that obstruct blood flow significantly, VCG records of 37 patients who presented with unstable symptoms of ischemia requiring coronary angiography (CA) were processed and analyzed. The difference in magnitude and direction of electrical vectors were measured before and after percutaneous coronary intervention (PCI) to study the significance of changes after revascularization. Bio amplifiers recorded 3 simultaneous orthogonal lead ECG signals with low-pass frequency of 150 Hz without electronic filtration. The analogue signals were digitized and recorded for analysis. The numerical output was processed by algorithms to calculate and display the state of vectors. 36 of 37 patients showed congruence between VCG and CA results: 34 of the 36 showed changes in electrical vectors and insufficient blood supply. 2 showed no changes in electrical vectors and non-obstructive arteries on CA. 1 patient had ischemia detected by VCG, but CA was negative. Blood vessels that were opened with PCI corresponded with regions of myocardial ischemia and expected coronary blood supply on VCG interpretation.
PMID:41053096 | PMC:PMC12500967 | DOI:10.1038/s41598-025-18313-2
JAMA Netw Open. 2025 Oct 1;8(10):e2535573. doi: 10.1001/jamanetworkopen.2025.35573.
ABSTRACT
IMPORTANCE: Associations of midlife cardiovascular health (CVH), measured once, with incident cardiovascular disease (CVD) are well described. Less is known about patterns of young adulthood CVH, including its changes and associations with later-life CVD outcomes.
OBJECTIVE: To model patterns of change in population-level and individual-level CVH through young adulthood and to assess whether they are associated with incident CVD in later life.
DESIGN, SETTING, AND PARTICIPANTS: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a prospective longitudinal cohort study that enrolled Black and White participants at ages 18 to 30 years in 1985 and 1986 with subsequent follow-up examinations during the next 35 years at 4 urban US centers. Participants with at least 3 CVH measurements in young adulthood and subsequent follow-up with assessment of incident CVD events were included. Analyses were conducted from October 26, 2023, to May 15, 2024.
EXPOSURES: CVH was measured using the American Heart Association Life's Essential 8 score. Patterns of CVH change in young adulthood (from examinations at years 0 to 20) were modeled with population-level trajectories and assessed by individual-level CVH status changes.
MAIN OUTCOMES AND MEASURES: Incident CVD (myocardial infarction, heart failure, stroke, coronary revascularization, and CVD death) after year 20.
RESULTS: There were 4241 participants in young adulthood (2354 [55.5%] female, 2042 [48.1%] self-identified as Black and 2199 [51.9%] self-identified as White) with a mean (SD) baseline age of 24.9 (3.6) years. In the trajectory analysis, 4 distinct CVH trajectory patterns were identified. Compared with the persistently high CVH trajectory, the moderate-to-low declining and moderate declining CVH trajectories had substantially higher risk for incident CVD. AHRs for incident CVD events ranged from 2.15 (95% CI, 1.04-4.47) in the persistently moderate pattern to 9.96 (95% CI, 4.75-20.86) in the moderate-to-low declining pattern. In the CVH status change analysis (n = 2857), compared with stable moderate CVH in young adulthood, stable high CVH had a lower risk (adjusted hazard ratio [AHR], 0.25 [95% CI, 0.09-0.69]), and stable low CVH had a higher risk (AHR, 5.91 [95% CI, 2.38-14.66]) for incident CVD. Each 10-point decrease in Life's Essential 8 score between years 0 and 20 was associated with a 53% increase in CVD risk (AHR, 1.53 [95% CI, 1.31-1.78]).
CONCLUSIONS AND RELEVANCE: In this prospective cohort study of young adults, unfavorable patterns of CVH change through young adulthood were associated with marked elevations in risk for incident CVD. These data suggest that achieving and maintaining high CVH throughout young adulthood through strategies of primordial prevention are important for prevention of later-life CVD.
PMID:41051778 | PMC:PMC12501802 | DOI:10.1001/jamanetworkopen.2025.35573