The impact of uric acid on acute coronary syndrome prognosis in elderly patients

BACKGROUND

Uric acid (UA) plays an important role in cardiovascular diseases, yet its implications in elderly patients remains incompletely understood. This study aimed to explore the impact of UA on the prognosis in advanced-age patients with acute coronary syndrome (ACS).

METHODS

We included 526 patients aged 80 and older who were diagnosed with ACS. The UA levels were measured at admission, and patients were divided into four groups based on quartiles of UA levels. Major adverse cardiovascular events (MACE) during follow-up were recorded.

RESULTS

The median UA level was 344.09 μmol/L, while the median follow-up duration was 64 months. Kaplan-Meier curves demonstrated a higher cumulative incidence of MACE during long-term follow-up in the Q4 group (Log-rank p < 0.05). Cox regression analysis revealed an independent correlation between UA levels and an increased risk of MACE (HR 1.002, 95%CI 1.000-1.003, p = 0.021). The ROC curve indicated that the optimal UA value for predicting MACE was 324.25 μmol/L. After matching through PSM, the MACE-free survival rate was lower in both hyperuricemia group (UA> 420.00 μmol/L) and high UA group (324.25 μmol/L < UA≤ 420.00 μmol/L) compared to the control group. Both hyperuricemia and high UA levels were independent risk factors for long-term MACE in advanced-age ACS patients, with HR values of 1.546 (1.049-2.280, p = 0.028) and 1.491 (1.011-2.198, p = 0.044), respectively.

CONCLUSION

Elevated UA levels were identified as independent risk factors for MACE in elderly patients with ACS. The optimal predictive value of UA for poor cardiovascular prognosis was significantly lower than the traditional definition of hyperuricemia.

Restoration of vascular dysfunction resulting from maternal high-fat diet via modulation of the NLRP3/IL-1β axis

This study investigated the impact of maternal high-fat diet on vascular function and endothelial homeostasis in offspring. We found that offspring exposed to maternal high-fat diet exhibited elevated blood pressure, impaired abdominal aortic vascular function, and endothelial homeostasis imbalance. These changes were accompanied by increased levels of reactive oxygen species (ROS) and upregulation of pro-inflammatory cytokines (including IL-1β, TNF-α, IL-6, and IL-10). Treatment with NLRP3 or IL-1β inhibitors prevented the deterioration in vascular function, reduced endothelial NO production, and inflammation induced by maternal high-fat diet exposure compared to the control group. The findings suggest that during pregnancy, mitigating the vascular impairments in offspring induced by maternal high-fat diet can be achieved by inhibiting the NLRP3/IL-1β pathway.

New cardiovascular disease markers in patients with familial hypercholesterolemia carriers of genetic variants

Objectives

Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by elevated levels of low-density lipoprotein cholesterol (LDLc). The early diagnosis of FH can reduce unfavorable outcomes in this population, but genetic study is not available in all populations. This study aimed to evaluate new cardiovascular plasma markers (GDF-15, CXCL16, FABP3, FABP4, LIGHT, sCD14, ucMGP), as well as Lp(a) levels, in individuals genetically characterized for FH, classified according to treatment with statins.

Methods

Sequencing was performed by next generation sequencing (NGS) for 17 ICs and by the Sanger method for 120 relatives. Lp(a) was measured by turbidimetry and the other cardiovascular markers by the multiplex method for Luminex®. Statistical analyses were performed using the R Platform version 4.2.2 program.

Results

86 individuals carrying FH genetic variants and 51 non-carrier family members were identified. Lp(a) showed higher levels in the group with variants and was correlated to LDLc levels. FABP3 levels were higher in the group carrying variants using statins compared to the group without statins. The non-carrier group using statins showed higher levels of FABP4 compared to the carrier group using statins. The markers GDF-15, CXCL16, LGHT, sCD14 and ucMGP did not show a significant difference between groups, but GDF-15 and sCD14 were correlated to LDLc levels.

Conclusions

Lp(a) and the new markers FABP3 e FABP4 are associated with FH, their levels are modulated by the use of statins, and they could be potential markers to assess the disease when genetic testing is not available.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01537-w.

Passivated hydrogel interface: Armor against foreign body response and inflammation in small-diameter vascular grafts

The development of small-diameter vascular grafts (SDVGs) still faces significant challenges, particularly in overcoming blockages within vessels. A key issue is the foreign-body response (FBR) triggered by the implants, which impairs the integration between grafts and native vessels. In this study, we applied an interfacial infiltration strategy to create a stable, hydrophilic, and passivated hydrogel coating on SDVGs. This coating effectively resisted FBR and improved integration between the grafts and host tissue. We also incorporated anthocyanins, an antioxidant, into the hydrogel network to mitigate oxidative stress and promote endothelialization. The hydrogel coating exhibited excellent stability, retaining its integrity during continuous flushing over 15 days. Anthocyanins were released in response to reactive oxygen species (ROS), reducing inflammation and enhancing vascularization in a mouse subcutaneous implantation model. In a rabbit carotid artery replacement model, the SDVGs exhibited rapid endothelialization, guided vascular remodeling, and inhibited calcification, showing strong potential for clinical application. This study presents a straightforward and effective approach to improve the patency rate, endothelialization, and anti-calcification properties of SDVGs by equipping them with a protective anti-FBR and anti-inflammation hydrogel layer.

Current and future diagnostics of congenital heart disease (CHD)

Congenital heart defects (CHD) are one of the most common anomalies found among live births and represent a complex multifactorial condition. Given that more than 90 % of cases survive due to improved early treatment options (e.g., catheter intervention, surgical procedure, and improved intensive care), genotype-informed patient follow-up should consider lifelong treatment considering different types of comorbidities. Unfortunately, a thorough genetic workup is only offered to a minority of CHD patients. However, a comprehensive understanding of the genetic underpinnings combined with in-depth phenotyping would strengthen our knowledge regarding the impact of environmental (e.g., pre-gestational diabetes) and genetic causes ranging from aneuploidies to single variants and more complex inheritance patterns on early heart development. Therefore, comprehensive genetic analysis in these patients is an essential way of predicting the prognosis and recurrence risk in families and ultimately improving patients' quality of life due to better therapeutic options. In this review, we examine the different types of variants and genes of different molecular genetics techniques to assess the diagnostic yield in different CHD sub-phenotypes. Given the complex inheritance pattern observed in CHD, we also consider possible future methods and frameworks to improve diagnostics and allow for better genotype-phenotype correlation in this patient group. Predicting recurrence risk and prognosis in CHD patients will ultimately allow for better treatment and lifelong therapeutic outcomes for CHD patients.

Hyperbaric oxygen therapy for cardiovascular surgery

Common cardiovascular surgeries include coronary artery bypass grafting, cardiac valve replacement, radiofrequency ablation, and cardiac intervention surgery. Multiple postoperative complications, such as hypoxic encephalopathy, air embolism, retained intracardiac air, cognitive dysfunction and major adverse cardiovascular events, including heart failure, ischemic stroke, and myocardial infarction, may occur after these cardiovascular surgeries. Hyperbaric oxygen can be used in preconditioning to lower the morbidity of adverse complications. It is also effective for the treatment of numerous postoperative complications. We provide evidence from the current literature highlighting the use of hyperbaric oxygen therapy for preconditioning and managing postoperative complications.

Sex differences in adenosine deaminase activity associate with disparities in SARS-CoV-2 innate immunity

Females demonstrate elevated type-I interferon production and a stronger antiviral immune response; however, the mechanisms underlying sex-based differences in antiviral immunity are incompletely understood. We previously reported that low adenosine deaminase (ADA) activity perturbs the methylation-based transcriptional silencing of endogenous retroviral elements (hERV), which stimulates IFN-Stimulated Genes (ISG) and primes antiviral immunity. Here we demonstrate lower ADA activity in females compared to their male counterparts, which correlated with higher hERV and ISG expression in female lungs. Sex differences in ADA2 were linked to the number and expression profiles of blood and lung-derived monocyte populations. Single-cell RNA sequencing of respiratory cells from patients with COVID-19 showed a significant female bias in hERV-ISG signatures, and implicated IL-18 as a driver of sex-specific ADA2 expression. Observations in healthy and COVID-19 cohorts indicate that higher ADA activity is associated with suppressed antiviral innate immunity in the male respiratory tract, which may drive adverse COVID-19 outcomes.

Genomic analysis of progenitors in viral infection implicates glucocorticoids as suppressors of plasmacytoid dendritic cell generation

Plasmacytoid Dendritic cells (pDCs) are the most potent producers of interferons, which are critical antiviral cytokines. pDC development is, however, compromised following a viral infection, and this phenomenon, as well as its relationship to conventional (c)DC development is still incompletely understood. By using lymphocytic choriomeningitis virus (LCMV) infection in mice as a model system, we observed that DC progenitors skewed away from pDC and toward cDC development during in vivo viral infection. Subsequent characterization of the transcriptional and epigenetic landscape of fms-like tyrosine kinase 3+ (Flt3+) DC progenitors and follow-up studies revealed increased apoptosis and reduced proliferation in different individual DC-progenitors as well as a profound type I interferon (IFN-I)-dependent ablation of pre-pDCs, but not pre-DC precursors, after both acute and chronic LCMV infections. In addition, integrated genomic analysis identified altered activity of 34 transcription factors in Flt3+ DC progenitors from infected mice, including two regulators of Glucocorticoid (GC) responses. Subsequent studies demonstrated that addition of GCs to DC progenitors led to downregulated pDC-primed-genes while upregulating cDC-primed-genes, and that endogenous GCs selectively decreased pDC, but not cDC, numbers upon in vivo LCMV infection. These findings demonstrate a significant ablation of pre-pDCs in infected mice and identify GCs as suppressors of pDC generation from early progenitors. This provides a potential explanation for the impaired pDC development following viral infection and links pDC numbers to the hypothalamic-pituitary-adrenal axis.

Role and Relationship Between Homocysteine and H2S in Ischemic Stroke

Homocysteine (Hcy), a sulfur-containing amino acid, is an important intermediate product of methionine metabolism. Hcy can be either metabolized to cysteine, a precursor for glutathione synthesis and hydrogen sulfide (H2S) production, or regenerated back to methionine. Besides, the Hcy metabolism is central to supply methyl groups, which are essential for DNA methylation. In the transsulfuration pathway of Hcy metabolism, Hcy is metabolized to form cysteine and H2S by catalytic enzymes, containing cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE). Hcy metabolism-related enzymes and coenzymes, such as vitamin B6, vitamin B12, and folic acid, are closely related to hyperhomocysteinemia (HHcy), which is frequently accompanied by reduced H2S content. An accumulating study has revealed that HHcy is a risk factor for ischemic stroke, while H2S, served as a gaseous mediator at the physiological level, has protective effects against ischemic stroke. This review outlined the literature data from recent research related to Hcy metabolism and H2S production and described the roles and relationship among Hcy metabolism and H2S in ischemic stroke.

Comparison of immunological and immunogenetic markers in recent-onset type 1 diabetes among children and adults

This study aimed to compare the immunological and immunogenetic profiles over a spectrum of childhood- and adulthood-onset T1D at diagnosis. The cross-sectional study involved participants with recently diagnosed T1D (n = 168), aged 2.9-68.2 years. HLA-II alleles, single nucleotide polymorphisms (SNP) (rs2476601, rs3087243, rs1990760, rs13266634), thyroid and coeliac disease-related autoantibodies and anti-enterovirus antibodies (anti-EV) were analysed regarding the diabetes-associated autoantibodies' (DAA) status and the age of participants. In the longitudinal study, 19 immune checkpoint gene expression levels in children (n = 25) aged 3.6-14.5 years were measured at diagnosis and 1 year after diagnosis. The duration of symptoms before diagnosis was age-dependent. Older age increased the odds of being single DAA-positive (OR 1.05; 95% CI 1.02-1.09), while anti-EV IgG positivity increased the odds of being multiple DAA-positive (adjusted OR 4.42; 95% CI 1.62-12.04). The DAA-negative T1D participants were older than the DAA-positive individuals. The checkpoint gene expression levels between the two time points were similar, but exhibited more pronounced variability at the time of diagnosis. These results confirm immunological variability in recent-onset T1D cases between children and adults and stress the importance of further research to define the comprehensive immunological profile of the disease age-related subgroups.

Current knowledge on the mechanisms underpinning vasculogenic mimicry in triple negative breast cancer and the emerging role of nitric oxide

Vasculogenic mimicry (VM) is the process by which cancer cells form vascular-like channels to support their growth and dissemination. These channels lack endothelial cells and are instead lined by the tumour cells themselves. VM was first reported in uveal melanomas but has since been associated with other aggressive solid tumours, such as triple-negative breast cancer (TNBC). In TNBC patients, VM is associated with tumour aggressiveness, drug resistance, metastatic burden, and poor prognosis. The lack of effective targeted therapies for TNBC has stimulated research on the mechanisms underpinning VM in order to identify novel druggable targets. In recent years, studies have highlighted the role of nitric oxide (NO), the NO synthesis inhibitor, asymmetric dimethylarginine (ADMA), and dimethylarginine dimethylaminohydrolase 1 (DDAH1), the key enzyme responsible for ADMA metabolism, in regulating VM. Specifically, NO inhibition through downregulation of DDAH1 and consequent accumulation of ADMA appears to be a promising strategy to suppress VM in TNBC. This review discusses the current knowledge regarding the molecular pathways underpinning VM in TNBC, anti-VM therapies under investigation, and the emerging role of NO regulation in VM.

Impact of Genetic Mutations in Hyperhomocysteinemia and Metabolic Syndrome on Physiological Parameters and Quality of Life in Healthy Individuals

BACKGROUND/AIM

Hyperhomocysteinemia (HH) is a metabolic condition linked to cardiovascular and cognitive health risks. This study investigated the prevalence of HH and cardiovascular metabolic syndrome (MS) among patients with symptoms such as fatigue, joint pain, muscle weakness, vertigo, paresthesia, and aphthous stomatitis. The objective was to explore the associations between HH, MS, and quality of life, emphasizing the role of personalized dietary interventions.

PATIENTS AND METHODS

A prospective study was conducted between 2019 and 2023, including 86 patients aged 18 years or older who underwent nutrigenetic testing and provided anthropometric data. Participants were divided into three groups: those with HH (45.3%), those without HH or MS (31.4%), and those with MS but without HH (23.3%). Nutrigenetic analyses assessed genetic predispositions related to nutrient metabolism.

RESULTS

Patients with HH exhibited reduced quality of life, with lower Short Form-12 Health Survey (SF-12) scores compared to other groups. Sex-specific nutrient needs and age-related changes in dietary requirements were identified. Metabolic conditions, including obesity, hypertension, and hypercholesterolemia, inversely impacted nutrient utilization. Physical activity positively correlated with higher demands for folic acid, vitamin B12, zinc, and magnesium.

CONCLUSION

Nutritional interventions targeting these needs effectively improved metabolic health and alleviated symptoms. HH significantly impacts quality of life and metabolic health. Personalized dietary and lifestyle modifications tailored to genetic predispositions, sex, and age are critical for mitigating cardiometabolic risks. These findings lay the groundwork for targeted interventions aimed at improving health outcomes in individuals with HH and MS.

Protein post-translational modification crotonylation of TXN and GLO1 in artery and vein grafts for coronary artery surgery

A key problem in coronary artery bypass grafting (CABG) is the lower long-term patency of the saphenous vein (SV) compared to internal thoracic artery (ITA). The potential strategies to improve the long-term patency of the vein graft include developing drugs to block unfavorable pathways in the vein and even to change the protein structure of the vein towards arterial structure. It is therefore important to understand the differences of the protein structure between arterial and venous grafts. Using post-translational modification (PTM) proteomics, we systematically investigated differences between ITA and SV with regard to a vascular stenosis-related PTM crotonylation. Crotonylome and PTM crotonylation in paired ITA and SV segments (n = 150) from patients undergoing CABG surgery were performed by proteomics analysis with further validation. To elucidate the underlying mechanisms, we focused on three crotonylated enzymatic proteins with anti-oxidative effects-thioredoxin (TXN), glyoxalase 1 (GLO1), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) - whose crotonylation patterns were systematically investigated. The functional validation was performed using both site-mutation experiments in HEK293 cells and pharmacological inhibitors in ex vivo cultured ITA/SV tissue specimens. Comprehensive crotonyl-proteomics demonstrated 3652 proteins are differentially-expressed and 411 proteins are differentially-crotonylated in ITA/SV segments. In the identified crotonylated proteins, SV demonstrated significantly higher levels compared to ITA. Notably, SV showed higher crotonylation levels on TXN-K3, GLO1-K157, and GAPDH-K61, which were associated with decreased enzymatic activity, elevated methylglyoxal (MGO) accumulation, and increased oxidative stress. Inhibition of CREB-binding protein (CBP) reversed oxidative stress in SV by suppressing crotonylation of the three enzymes. In Hek293 cells, both site-specific and comprehensive crotonylation decreased the activities of TXN/GLO1/GAPDH, which in turn triggered the accumulation of MGO. Overexpression of histone deacetylases HDAC1 and HDAC3 showed the opposite effect, restoring enzyme function. This study is the first to reveal significant differences in PTM crotonylation between human ITA and SV, shedding light on the biological mechanisms underlying the functional disparities between these grafts. These differences impact the enzymatic activity of key proteins involved in oxidative stress, providing insights into the molecular basis of graft performance. Importantly, these findings form a scientific basis for developing specific methods including new anti-oxidative drugs and gene therapy to target on crotonylation in the vein graft in order to improve the long-term graft patency.

Gamma-glutamyl transferase to high-density lipoprotein cholesterol ratio: A valuable predictor of coronary heart disease incidence

BACKGROUND AND AIM

Existing studies have found that serological markers for predicting coronary heart disease (CHD) have relatively low predictive value for the severity of coronary arteries and the types of CHD. GGT to HDL-C ratio (GHR) has been shown to be associated with T2DM and non-alcoholic fatty liver disease. Therefore, we explore the relationship among GHR, CHD and its subgroups.

METHODS AND RESULTS

The study retrospectively analyzed 2703 participants from August 2022 to August 2023. The patients were divided into CHD group (N = 1911) and control group (N = 792) according to the diagnostic criteria of CHD. Adjustments for all covariates found that GHR was an independent risk factor for CHD (OR: 1.025, 95 % CI 1.016-1.033) and had the highest AUC of 0.767 (95 % CI 0.744-0.790) in identifying CHD. Additionally, GHR was significantly associated with multi-vessel CHD (OR: 1.018, 95 % CI 1.012-1.023) and showed excellent diagnostic capability for patients with multi-vessel CHD (AUC: 0.638). Moreover, compared with chronic coronary syndromes (CCS) and unstable angina (UA) groups, the level of GHR was significantly increased in acute myocardial infarction (AMI) (ST elevation myocardial infarction and Non-ST elevation myocardial infarction) group (P < 0.05). GHR had the higher AUC in STMETI [0.819 (95 % CI 0.796-0.854)] and NASTEMI [0.792 (95 % CI 0.766-0.816)] than the CCS and UA groups.

CONCLUSIONS

Our study analyses found that GHR is an independent risk factor for CHD and can predict the severity of coronary artery stenosis. Moreover, GHR has a high predictive value for AMI than CCS and UA in CHD patients.

Challenges in coronary angiography through radial artery access due to anatomic variations: A single-center experience

BACKGROUND

Radial artery (RA) access has become common in cardiac catheterization due to fewer vascular complications and MACE compared to transfemoral approach (TFA). However, anatomic variations are more common in the upper-extremity.

METHODS

We performed a single-center retrospective analysis of 926 patients from January 2010 to January 2023 who underwent coronary angiography through transradial approach (TRA) via the right upper-extremity where RA angiogram was performed. Outcomes included anatomic variations, sociodemographic and health characteristics, adverse outcomes, and procedural challenges. Multivariate logistic regression was utilized to estimate the odds ratio of the association between anatomic variations and adverse outcomes and procedural challenges.

RESULTS

Our analysis included 926 patients with a mean age of 59.9 years. Approximately 32.3 % of patients had at least one anatomic variation. Individual variations included 14.4 % radial tortuosity, 12 % high bifurcation, 11.9 % M-sign, and 1 % RA loops. These patients were older (P < 0.001) and more likely to have hyperlipidemia (P = 0.049). They had high odds of high contrast dose (>73.7 mL) (OR = 1.73, P < 0.001), long fluoroscopy time (>10.7 mins) (OR = 2.02, P < 0.001), high radiation exposure (>1120 mGy) (OR = 2.47, P < 0.001), difficulty engaging coronary arteries (OR = 2.70, P < 0.001), and transfer to TFA (OR = 4.89, P < 0.001). Females (OR = 2.89, P < 0.001) and smaller RA size (OR = 2.61, P < 0.001) were associated with spasm. Major complications were not significant.

CONCLUSIONS

We found a high prevalence of anatomic variations in the upper-extremity vasculature. They were associated with high odds of high contrast dose, long fluoroscopy time, high radiation exposure, and procedural challenges during TRA coronary angiography. The rate of major complications was not significant in these patients.

Bexarotene regulates zebrafish embryonic development by activating Wnt signaling pathway

Bexarotene (Bex) is a selective retinoid X receptor (RXR) agonist and is commonly used as an anti-tumor drug in the clinic to treat patients with cutaneous T-cell lymphoma (CTCL). With the widespread use of this drug, people are increasingly concerned about its side effects and safety of use. At present, the effects of bexarotene drugs on the health of organisms remain uncertain, but retinoid drugs are generally biologically active and may pose potential risks to them. Therefore, in this study, we used a zebrafish model to evaluate the effects of Bex on embryonic development. Six hours after fertilization, we exposed zebrafish embryos to 3 μg/L, 6 μg/L, and 9 μg/L bexarotene. At 96 hpf, compared with the control group, zebrafish embryos exposed to bexarotene showed obvious heart and liver development defects, including reduced hatching rate, pericardial enlargement, heart rate disorder, yolk sac edema, small liver area and abnormal photo-optical motor responses. Transcriptome and qPCR results showed abnormal expression of genes related to heart and liver development was induced by Bexarotene. Mechanistically, bexarotene induced a significant upregulation of the transcriptional expression levels of genes related to the Wnt signaling pathway, and IWR-1 was able to effectively rescue the heart and liver developmental defects of zebrafish caused by bexarotene. Therefore, our study showed that bexarotene may cause zebrafish embryonic developmental defects by upregulating the Wnt signaling pathway, revealing the side effects and associated novel mechanisms of bexarotene, and providing a theoretical basis for its safe and effective use in the treatment of clinically related diseases.

Surveying the Therapeutic Potentials of Isoliquiritigenin (ISL): A Comprehensive Review

Isoliquiritigenin (ISL), a major chalcone-type flavonoid produced predominantly from liquorice roots (Glycyrrhiza species), has exceptional therapeutic potential across a wide range of pharmacological activities. ISL has numerous benefits including antioxidant, anti-inflammatory, antidiabetic, cardioprotective, hepatoprotective, neuroprotective, and anticancer activities. This review gathers the pharmacological effects of ISL remarking into its mechanism of actions such as how it modulates oxidative stress, inflammatory pathways, glucose metabolism, and cancer growth, demonstrating its pharmacological versatility. The review emphasizes new advances in the field, allowing for more rational development and clinical use of ISL in medicine. However, further research is required to confirm the target-organ toxicity or side-effect investigations.

Relationship between endothelial activation and stress index and all-cause mortality in rheumatoid arthritis patients: a moderating effect of gamma-glutamyl transferase

Aim

This study aimed to explore the relationship between endothelial activation and stress index (EASIX) and all-cause mortality in patients with rheumatoid arthritis (RA), and to further examine whether gamma-glutamyl transferase (GGT) influences this association.

Methods

We included 2,543 participants with RA from the National Health and Nutrition Examination Survey (NHANES) in this retrospective cohort study. The study outcome was considered to be all-cause mortality. EASIX and GGT levels were measured at baseline (study enrollment) using laboratory data from NHANES. EASIX was divided into two groups based on its median: ≥0.476 and <0.476, while GGT was divided into two groups based on its median: ≥23 U/L and <23 U/L. EASIX was calculated using the formula, lactate dehydrogenase (LDH, U/L) × creatinine (mg/dL)/platelet count (109/L), based on the baseline laboratory measurements. Weighted multivariate Cox regression models were used to assess the associations between EASIX and GGT with the risk of all-cause mortality. Importantly, a moderated analysis of GGT (moderator) was conducted to examine the relationship between EASIX and all-cause mortality among patients with RA. Additionally, subgroup analysis was performed based on age, duration of arthritis, diabetes, and hypertension.

Results

A total of 867 individuals developed all-cause mortality over a mean follow-up period of 122.86 ± 3.29 months. After fully adjusting for potential confounding factors, higher EASIX (≥0.476) was positively associated with all-cause mortality (hazard ratio [HR] = 1.42; 95% confidence interval [CI]: 1.18-1.73). However, the association between GGT and all-cause mortality was not significant (p > 0.05). Moderated analysis revealed that higher GGT levels strengthened the correlation between EASIX and all-cause mortality among patients with RA (p = 0.013). The association between EASIX and the risk of all-cause mortality varied depending on GGT levels. The subgroup analysis revealed that GGT moderated the relationship between EASIX and all-cause mortality among RA patients aged 60 years or older (p = 0.007), with a history of arthritis lasting more than 5 years (p = 0.040), or diagnosed with diabetes (p = 0.009) or hypertension (p = 0.016). Competing risks analysis accounting for cardiovascular mortality yielded consistent results (subdistribution hazard ratio [sHR] = 1.39; 95% CI: 1.15-1.69), further supporting the primary findings.

Conclusion

High EASIX was positively associated with all-cause mortality in patients with RA, and this association was significantly enhanced by higher GGT levels.

Progressive Protocols for Pediatric Acute Lower Extremity Ischemia Postcatheterization Pediatric Lower Extremity Ischemia Protocol Postcatheterization

BACKGROUND

Pediatric acute lower extremity ischemia postcatheterization (PALIC) represents a significant clinical challenge. Effective management protocols that minimize aggressive interventions and complications are essential for improving patient outcomes. This investigation assesses the effectiveness of the FAST protocol (Fasudil infusion combined with Anticoagulation based on oxygen Saturation monitoring backup with Thrombolytic) series in treating pediatric acute lower extremity ischemia after catheterization (PALIC), with a particular emphasis on minimizing aggressive interventions and complications.

METHODS

A retrospective study of 1,380 pediatric catheterization cases from January 2009 to December 2022 was conducted. The research encompassed 3 stages: before FAST implementation (stage 1), during initial FAST adoption (stage 2), and subsequent FAST+ upgrade (stage 3).

RESULTS

Acute lower extremity ischemia (ALI) was observed in 7.1% (98/1,380) of pediatric cases postcatheterization. The PALIC detection rates in stages 2 and 3 were 4.2% and 12.1%, respectively, showing a statistically significant reduction in aggressive interventions from 100% to 0% and complications from 100% to 1.2% in later stages (P < 0.05).

CONCLUSION

The safety and effectiveness of both the FAST and FAST+ protocols in managing PALIC have been demonstrated. The enhanced FAST+ protocol notably improve early detection, thereby augmenting the effectiveness of treatment.

Cardiac protection of wogonin in mice with pulmonary fibrosis by regulating Sirt1/ γ-H2AX pathway

Background

Clinical evidence suggests that pulmonary fibrosis (PF) and heart failure (HF) often co-exist; however, the specific impact of PF on HF remains underexplored. This gap in understanding complicates the management and treatment of HF in patients with PF.

Objectives

To investigate the effects of PF on cardiac function and myocardial fibrosis using a mouse PF model and evaluate the therapeutic potential of wogonin, a flavonoid compound known for its anti-PF properties.

Methods

A PF mouse model was established via intratracheal administration of bleomycin (BLM). Starting on day 8 post-BLM treatment, wogonin (50 mg/kg) was intraperitoneally administered every 2 days for 2 weeks. Cardiac function was assessed using echocardiography, while myocardial fibrosis was evaluated through Masson staining. In vitro, H9C2 cardiomyocytes were exposed to CoCl2 or H2O2 for 24 h with or without wogonin (20 μM) treatment. Apoptosis and DNA damage markers were analysed using immunofluorescence, immunoblotting, and the Comet assay. The interaction between wogonin and Sirt1 was examined using biotin-affinity pulldown assays and molecular docking simulations.

Results

Mice with PF exhibited significant cardiac dysfunction and myocardial fibrosis. Wogonin treatment markedly improved ejection fraction and attenuated myocardial fibrosis in PF mice. Mechanistic studies revealed that wogonin alleviated DNA damage and cardiomyocyte apoptosis by upregulating Sirt1 and downregulating γ-H2AX expression. Docking simulations predicted that wogonin forms a stable complex with Sirt1 through hydrogen-bonding and hydrophobic interactions, which was further validated by biotin-affinity pulldown assays.

Conclusion

Wogonin exerts protective effects against cardiac dysfunction and fibrosis in PF mice by modulating Sirt1/γ-H2AX-mediated pathways to reduce DNA damage and apoptosis. These findings suggest the potential of wogonin as a therapeutic agent for managing HF associated with PF.

Post-translational acylation of proteins in cardiac hypertrophy

Acylations are post-translational modifications in which functional groups are attached to amino acids on proteins. Most acylations (acetylation, butyrylation, crotonylation, lactylation, malonylation, propionylation and succinylation) involve lysine but cysteine (palmitoylation) and glycine (myristoylation) residues can also be altered. Acylations have important roles in physiological and pathophysiological processes, including cardiac hypertrophy and related cardiovascular diseases. These post-translational modifications influence chromatin architecture, transcriptional regulation and metabolic pathways, thereby affecting cardiomyocyte function and pathology. The dynamic interaction between these acylations and their regulatory enzymes, such as histone acetyltransferases, histone deacetylases and sirtuins, underscores the complexity of cellular homeostasis and pathological processes. Emerging evidence highlights the therapeutic potential of targeting acylations to modulate enzyme activity and metabolite levels, offering promising avenues for novel treatments. In this Review, we explore the diverse mechanisms through which acylations contribute to cardiac hypertrophy, highlighting the complexity and potential therapeutic targets in this regulatory network.

Homocysteine, Nutrition, and Gut Microbiota: A Comprehensive Review of Current Evidence and Insights

Homocysteine, a sulfur-containing amino acid, is an intermediate product during the metabolism of methionine, a vital amino acid. An elevated concentration of homocysteine in the plasma, named hyperhomocysteinemia, has been significantly related to the onset of several diseases, including diabetes, multiple sclerosis, osteoporosis, cancer, and neurodegenerative disorders such as dementia, Alzheimer's and Parkinson's diseases. An interaction between metabolic pathways of homocysteine and gut microbiota has been reported, and specific microbial signatures have been found in individuals experiencing hyperhomocysteinemia. Furthermore, some evidence suggests that gut microbial modulation may exert an influence on homocysteine levels and related disease progression. Conventional approaches for managing hyperhomocysteinemia typically involve dietary interventions alongside the administration of supplements such as B vitamins and betaine. The present review aims to synthesize recent advancements in understanding interventions targeted at mitigating hyperhomocysteinemia, with a particular emphasis on the role of gut microbiota in these strategies. The emerging therapeutic potential of gut microbiota has been reported for several diseases. Indeed, a better understanding of the complex interaction between microbial species and homocysteine metabolism may help in finding novel therapeutic strategies to counteract hyperhomocysteinemia.

Urinary metabolomics analysis based on LC-MS for the diagnosis and monitoring of acute coronary syndrome

Background

Acute coronary syndrome (ACS) is a cardiovascular disease caused by acute myocardial ischemia. The aim of this study was to use urine metabolomics to explore potential biomarkers for the diagnosis of ACS and the changes in metabolites during the development of this disease.

Methods

Urine samples were collected from 81 healthy controls and 130 ACS patients (103 UA and 27 AMI). Metabolomics based on liquid chromatography-mass spectrometry (LC-MS) was used to analyze urine samples. Statistical analysis and functional annotation were applied to identify potential metabolite panels and altered metabolic pathways between ACS patients and healthy controls, unstable angina (UA), and acute myocardial infarction (AMI) patients.

Results

There were significant differences in metabolic profiles among the UA, AMI and control groups. A total of 512 differential metabolites were identified in this study. Functional annotation revealed that changes in arginine biosynthesis, cysteine and methionine metabolism, galactose metabolism, sulfur metabolism and steroid hormone biosynthesis pathways occur in ACS. In addition, a panel composed of guanidineacetic acid, S-adenosylmethionine, oxindole was able to distinguish ACS patients from healthy controls. The AUC values were 0.8339 (UA VS HCs) and 0.8617 (AMI VS HCs). Moreover, DL-homocystine has the ability to distinguish between UA and AMI, and the area under the ROC curve is 0.8789. The metabolites whose levels increased with disease severity the disease were involved mainly in cysteine and methionine metabolism and the galactose metabolism pathway. Metabolites that decrease with disease severity are related mainly to tryptophan metabolism.

Conclusion

The results of this study suggest that urinary metabolomics studies can reveal differences between ACS patients and healthy controls, which may help in understanding its mechanisms and the discovery of related biomarkers.

Role of cystathionine-β-synthase and hydrogen sulfide in down syndrome

Down syndrome (DS) is a genetic condition where the person affected by it is born with an additional - full or partial - copy of chromosome 21. DS presents with characteristic morphological features and is associated with a wide range of biochemical alterations and maladaptations. Cystathionine-β-synthase (CBS) - one of the key mammalian enzymes responsible for the biogenesis of the gaseous transmitter hydrogen sulfide (H2S) - is located on chromosome 21, and people with DS exhibit a significant upregulation of this enzyme in their brain and other organs. Even though 3-mercaptopyruvate sulfurtransferase - another key mammalian enzyme responsible for the biogenesis of H2S and of reactive polysulfides - is not located on chromosome 21, there is also evidence for the upregulation of this enzyme in DS cells. The hypothesis that excess H2S in DS impairs mitochondrial function and cellular bioenergetics was first proposed in the 1990s and has been substantiated and expanded upon over the past 25 years. DS cells are in a state of metabolic suppression due to H2S-induced, reversible inhibition of mitochondrial Complex IV activity. The impairment of aerobic ATP generation in DS cells is partially compensated by an upregulation of glycolysis. The DS-associated metabolic impairment can be reversed by pharmacological CBS inhibition or CBS silencing. In rodent models of DS, CBS upregulation and H2S overproduction contribute to the development of cognitive dysfunction, alter brain electrical activity, and promote reactive gliosis: pharmacological inhibition or genetic correction of CBS overactivation reverses these alterations. CBS can be considered a preclinically validated drug target for the experimental therapy of DS.

Key Concepts in Cardiovascular Secondary Prevention: A Case-Based Review

Atherosclerotic cardiovascular disease (ASCVD) continues to be a growing global health concern with ischemic heart disease and stroke as leading causes of years of life lost. While aging is a major ASCVD risk factor, recent trends show a concerning rise in its incidence among younger adults driven, in part, by increased rates of risk factors such as hypertension and diabetes. These individuals with ASCVD are at elevated risk of recurrence years following their initial event, further underscoring the need for aggressive implementation of secondary prevention strategies to reduce morbidity and mortality. This case-based review discusses evidence-based pharmacological approaches to ASCVD secondary prevention-focusing on the roles of antiplatelets, lipid lowering therapies, antihypertensive medications, and glucose lowering treatments, in practical clinical settings.

Different Effects of Riociguat and Vericiguat on Pulmonary Vessels and Airways

Background/Objectives: Pulmonary hypertension is a progressive disease leading to right heart failure. One treatment strategy is to induce vasodilation via the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate (NO-sGC-cGMP) signaling pathway. There are currently two soluble guanylate cyclase stimulators on the market: Riociguat and vericiguat, with vericiguat having a longer half-life and needing to be taken only once a day. This study investigated whether the pharmacological differences between the drugs affect pulmonary vessels and airways. Methods: The effects of vericiguat and riociguat on pulmonary arteries, veins, and airways were studied using rat precision-cut lung slices (PCLS). Vessels were pretreated with endothelin-1 and airways with serotonin. In isolated perfused lungs (IPL), the effects of sGC stimulation on pulmonary artery pressure (PAP), airway resistance, inflammatory cytokine, and chemokine release were quantified. Results: Riociguat and vericiguat caused pulmonary artery dilation in PCLS. During IPL, riociguat was more effective than vericiguat in reducing PAP with a statistically significant reduction of 10%. Both drugs were potent bronchodilators in preconstricted airways (p < 0.001). Only vericiguat reduced airway resistance during IPL, as shown here for the first time. Both drugs significantly reduced IL-6 and IL-1ß levels, while riociguat also reduced VEGF-A and KC-GRO levels. Conclusions: Riociguat and vericiguat had three main effects in the two rat ex-vivo models: They dilated the pulmonary arteries, induced bronchodilation, and reduced inflammation. These properties could make sGC stimulators useful for treating diseases associated with endothelial dysfunction. In the future, vericiguat may provide an alternative treatment to induce bronchodilation in respiratory diseases.

Diagnostic value of combined detection of serum neuron-specific enolase and homocysteine in patients with coronary atherosclerosis

BACKGROUND

The aim of this paper was to investigate the diagnostic significance and severity assessment of serum neuron-specific enolase (NSE) combined with homocysteine (Hcy) for patients with coronary atherosclerosis (coronary artery disease, CAD).

METHODS

Two hundred sixty-three patients with coronary artery disease were selected as the research group, and 400 healthy individuals who underwent physical examination during the same period were taken as the control group. Electrochemiluminescence immunoassay and biochemical analyzer were employed to detect the serum NSE and Hcy levels of all subjects. The diagnostic value of combined and individual serum NSE and Hcy detection for the combined group was analyzed using the ROC curve.

RESULTS

The serum NSE (19.91±9.98 vs. 11.17±2.35) and Hcy levels (15.76±5.37 vs. 10.17±3.71) in the research group were significantly higher than those in the control group, with a statistically significant difference (P<0.05). The serum NSE (16.67±4.02 vs. 18.63±5.49 vs. 20.29±5.87) and Hcy levels (13.28±2.49 vs. 15.56±2.67 vs. 16.66±3.94) gradually increased across groups A, B, and C, and inter-group comparisons showed statistically significant differences (P<0.05). The AUC value of combined serum NSE and Hcy detection for CAD patients was higher (0.879 vs. 0.724 vs. 0.827) than individual NSE and Hcy testing. The specificity of Hcy for the diagnosis of CAD was the highest, reaching 90.3%. The sensitivity of combined NSE and Hcy (82.9%) was higher than the individual testing sensitivity of the two groups.

CONCLUSIONS

The combined detection of serum NSE and Hcy has high diagnostic efficacy for CAD and provides reference value in assessing the severity of the disease.

Predictive value of pericoronary fat attenuation index for graft occlusion after coronary artery bypass grafting

PURPOSE

Based on coronary computed tomography angiography (CCTA), this study aimed to evaluate the predictive value of pericoronary fat attenuation index (FAI) for graft occlusion in patients following coronary artery bypass grafting (CABG).

MATERIALS AND METHODS

The clinical and imaging data of 100 patients with coronary artery disease (CAD) who underwent CCTA and subsequently received successful CABG between December 2012 and March 2024 were retrospectively collected. According to the subsequent CCTA evaluation of grafts, they were categorized into occlusion group (n = 27) and patency group (n = 73). Based on CCTA images, FAI of the proximal segment of the three coronary arteries and epicardial adipose tissue (EAT) parameters were measured and compared between the two groups. The Cox regression model was employed to screen the independent predictors of graft occlusion. The predictive model was constructed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic performance of the model.

RESULTS

Among the 100 cases, 74 were males, with a mean age was 62.42 ± 7.57 years. During the 15.50 (5.00, 36.75) months follow-up period, grafting vessel occlusion occurred in 27 patients (27.0%). The right coronary artery (RCA) in occlusion group was -73.36 ± 7.24HU, which was notably higher compared to patency group (-79.93 ± 9.75HU) (P < 0.05). Multivariable Cox regression analysis indicated that RCA FAI (HR = 5.205, 95% CI 1.938-13.979; P = 0.001) was independently correlated with graft occlusion, with an optimal cutoff value of -79.39 HU.RCA FAI added incremental prognostic value beyond clinical characteristics for patients following CABG (AUC 0.784 vs. 0.677, P = 0.027).

CONCLUSIONS

The RCA FAI can serve as a crucial predictor for graft occlusion in patients following CABG, enabling early identification of high-risk individuals and facilitating timely and effective intervention measures to enhance patient prognosis.

A Simple Modification Results in a Significant Improvement in Measuring the Size of Extracellular Vesicles

OBJECTIVE

Size distribution is an important biophysical property of extracellular vesicles (EVs). EVs include small EVs (s-EVs) and large EVs (l-EVs) by size. Differential ultracentrifugation (dUC) is widely used to separate EVs from biofluids, but it can precipitate large impurity particles. Dynamic light scattering (DLS) is a simple and fast method for analyzing the size distribution of EVs. However, this approach is nonideal for heterogeneous and polydisperse samples since a small quantity of large impurity particles can markedly disturb the DLS results. Here, we developed a simple method to improve the reliability of DLS measurements.

METHODS

Plasma was obtained from 13 volunteers. The plasma was first processed by dUC to obtain crude l-EVs. The crude l-EVs were filtered with syringe filters (pore size of 1 μm and membrane material of hydrophilic polyvinylidene fluoride (PVDF)) to remove large impurity particles from l-EVs. The size distributions of the crude l-EVs and filtered l-EVs were measured via DLS.

RESULTS

After the samples were filtered, the coefficients of variation of the hydrodynamic radius and Peak 1 intensity of the filtered l-EVs decreased from 20.39% (12.76-28.96%) and 20.44% (14.58-28.32%) to 3.05% (1.79-4.72%) and 3.43% (1.76-5.88%), respectively, compared with those of the crude l-EVs.

CONCLUSION

These findings suggest that filtration can effectively separate circulating l-EVs in plasma to remove large impurity particles and make samples suitable for characterization by DLS. Our findings provide a simple method to improve precision via DLS to measure the size distribution of EVs.

Impact of gender differences on optimal oxygen delivery thresholds to prevent acute kidney injury in cardiac surgeries with cardiopulmonary bypass

Background

The nadir oxygen delivery index (DO2i) during cardiopulmonary bypass (CPB) is reportedly associated with acute kidney injury (AKI) in patients undergoing cardiac surgery. However, there are few reports on the relationship between patient sex and the nadir DO2i threshold to prevent AKI. The aim of this study was to seek and evaluate the optimal DO2i threshold differences between males and females to avoid AKI during on-pump cardiac surgery.

Methods

We retrospectively analyzed a total of 430 patients who underwent cardiac surgery between March 2017 and February 2023. A receiver operating characteristic analysis and univariable and multivariable regression analyses were performed to evaluate the association between perioperative variables, including the nadir DO2i and incidence of AKI, in males and females.

Results

The nadir DO2i was significantly lower (median, 294 [interquartile range (IQR), 272-317] mL/min/m2 versus 277 [IQR, 262-295] mL/min/m2; P < .001) and cumulative time below the DO2i of 270 mL/min/m2 was longer (0.3 [IQR, 0-4.2] minutes vs 3.0 [IQR, 0-11.7] minutes; P < .001) in the female patients. However, the incidence rate of AKI was similar in males and females (15.2% [n = 39/256] vs 16.7% [n = 29/174]; P = .68). The best cut-off values of nadir DO2i for AKI were <301 mL/min/m2 (sensitivity, 82.1%; specificity, 39.5%) in males and <273 mL/min/m2 (sensitivity, 69.0%; specificity, 61.4%) in females.

Conclusions

The optimal DO2i to prevent AKI during cardiac surgery differs between males and females. Therefore, CPB management should be adjusted by sex based on the different cut-off values of nadir DO2i.

Effects of Nicorandil, Isosorbide Mononitrate, or Diltiazem on Radial Artery Grafts After CABG: The Randomized ASRAB-Pilot Trial

BACKGROUND

The optimal antispastic treatment after coronary artery bypass grafting using radial artery (RA) grafts is controversial. This clinical trial aimed to generate pilot comparative data on the effects of nicorandil, isosorbide mononitrate, or diltiazem on RA grafts.

METHODS

This was a single-center, randomized, open-label, parallel-group pilot trial. Eligible patients who underwent coronary artery bypass grafting using RA grafts were randomized in a 1:1:1 ratio to receive oral nicorandil (15 mg daily), isosorbide mononitrate (50 mg daily), or diltiazem (180 mg daily) for 24 weeks post-coronary artery bypass grafting. The primary outcome was RA graft failure (modified Fitzgibbon grade B, S, or O) at 1 and 24 weeks, assessed by coronary computed tomography angiography.

RESULTS

Among 150 randomized participants, 149 (mean age, 56.8 years; 13.4% women) with 177 RA grafts were assessed at least once by coronary computed tomography angiography, including 50 participants with 64 RA grafts in the nicorandil group, 50 participants with 57 RA grafts in the isosorbide mononitrate group, and 49 participants with 56 RA grafts in the diltiazem group, respectively. At 1 week post-coronary artery bypass grafting, the RA graft failure rates were lower with nicorandil versus diltiazem (19.4% versus 25.0%; difference, -5.6% [95% CI, -20.6% to 9.3%]) and isosorbide mononitrate versus diltiazem (18.2% versus 25.0%; difference, -6.8% [95% CI, -21.8% to 8.6%]). The RA graft failure rates were slightly higher with nicorandil versus isosorbide mononitrate (19.4% versus 18.2%; difference, 1.2% [95% CI, -13.3% to 15.2%]). At 24 weeks, RA graft failure rates were lower with nicorandil versus diltiazem (16.1% versus 27.8%; difference, -11.7% [95% CI, -26.6% to 3.4%]), and isosorbide mononitrate versus diltiazem (12.5% versus 27.8%; difference, -15.3% [95% CI, -29.8% to -0.2%]), and slightly higher with nicorandil versus isosorbide mononitrate (16.1% versus 12.5%; difference, 3.6% [95% CI, -9.6% to 16.4%]).

CONCLUSIONS

In this pilot trial, treatment with nicorandil or isosorbide mononitrate was associated with a lower RA graft failure rate compared with diltiazem. Larger hypothesis-testing trials are warranted.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT04310995.

Asymmetric Dimethylaminohydrolase Gene Polymorphisms Associated with Preeclampsia Comorbid with HIV Infection in Pregnant Women of African Ancestry

Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase (NOS) inhibitor associated with vascular disease, which is prevalent in human plasma. Two isoforms of the enzyme dimethylarginine dimethylaminohydrolase (DDAH), DDAH 1 and 2, degrade ADMA. This study investigates the association of DDAH 1 (rs669173, rs7521189) and DDAH 2 gene polymorphisms (rs805305, rs3131383) with the risk of preeclampsia (PE) comorbidity with human immunodeficiency virus (HIV) infection in pregnant women of African ancestry. A total of 405 women were enrolled in this study: 204 were PE, 201 were normotensive pregnant, and 202 were HIV positive. DNA was extracted from whole blood, and SNPs (rs669173, rs7521189, rs805305, and rs3131383) were amplified to detect single-nucleotide polymorphisms (SNPs). After PCR amplification, allelic discrimination was examined. Comparisons were conducted utilizing the Chi-squared test. Our findings indicated that preeclamptic women displayed a greater prevalence of the three variants compared to those with both PE and HIV infection. There is an association between the rs669173 and rs7521189 SNPs of the DDAH 1 gene and rs3131383 of the DDAH 2 gene, which could play a role in reducing the bioavailability of nitric oxide (NO), which affects endothelial function, leading to the development of PE in pregnant women of African ancestry. In contrast, the rs805305 variant of the DDAH 2 gene was not significantly associated with PE development. Interestingly, none of the SNPs investigated correlated with HIV infection or could be attributed to the human allelic variant influence on HIV infection outcome.

Sequential Grafting of the Left Internal Thoracic Artery to the Left Anterior Descending Artery and Graft Failure

BACKGROUND

There is concern that left internal thoracic artery (LITA)-to diagonal (D)-to left anterior descending artery (LAD) grafts may be more susceptible to failure compared with single LITA-LAD grafts.

METHODS

Pooled individual patient data from 8 clinical trials with systematic graft imaging were analyzed to assess the incidence of sequential LITA-D-LAD vs single LITA-LAD grafts. Mixed-effects multivariable logistic regression, adjusting for patient characteristics and clustering within trials, was used.

RESULTS

Of 3969 patients with LITA-LAD grafts, 283 patients (7.1%) received sequential LITA-D-LAD grafts. Patients with sequential LITA-D-LAD grafts were older (66 vs 65 years, P = .009) and more often men (88% vs 83%, P = .03). Overall, graft failure occurred in 9.3% of patients with LITA-LAD grafts, with more graft failure occurring in single (9.5%) than in sequential LITA-D-LAD grafts (6.4%, P = .08) at a median time to imaging of 1.0 years (interquartile range, 1.0-1.1 years). After multivariable adjustment, sequential LITA-D-LAD grafting was not associated with graft failure (adjusted odds ratio, 1.22; 95% CI, 0.68-2.18; P = .55). There was no difference between groups in mortality (2.8% vs 5.3%, P = .06), myocardial infarction (1.4% vs 1.6%, P = .90), revascularization (4.5% vs 7.3%, P = .08), or stroke (1.7% vs 1.2%, P = .40).

CONCLUSIONS

In selected patients, LITA-D-LAD grafting was not associated with higher risk of graft failure or adverse clinical events at 1 year.

Surgical Revascularization Decisions in Ischemia and Heart Failure

Coronary artery bypass grafting is the major modality of coronary revascularization in patients with ischemic cardiomyopathy as it provides surgical collateralization of the coronary bed protecting the functional myocardium. Myocardial viability testing does not have an established role in the surgical evaluation. Concomitant surgical ventricular restoration does not improve symptoms or survival, though patients with large aneurysms and significant reduction in ventricular size could benefit. Correction of functional mitral regurgitation does not improve survival, and severe functional mitral regurgitation should be addressed via mitral valve replacement. Temporary mechanical circulatory support can be used as a bridge to recovery.

Nanomedicine-based strategies for the treatment of vein graft disease

Autologous saphenous veins are the most frequently used conduits for coronary and peripheral artery bypass grafting. However, vein graft failure rates of 40-50% within 10 years of the implantation lead to poor long-term outcomes after bypass surgery. Currently, only a few therapeutic approaches for vein graft disease have been successfully translated into clinical practice. Building on the past two decades of advanced understanding of vein graft biology and the pathophysiological mechanisms underlying vein graft disease, nanomedicine-based strategies offer promising opportunities to address this important unmet clinical need. In this Review, we provide deep insight into the latest developments in the rational design and applications of nanoparticles that have the potential to target specific cells during various pathophysiological stages of vein graft disease, including early endothelial dysfunction, intermediate intimal hyperplasia and late-stage accelerated atherosclerosis. Additionally, we underscore the convergence of nanofabricated biomaterials, with a particular focus on hydrogels, external graft support devices and cell-based therapies, alongside bypass surgery to improve local delivery efficiency and therapeutic efficacy. Finally, we provide a specific discussion on the considerations, challenges and novel perspectives for the future clinical translation of nanomedicine for the treatment of vein graft disease.

Contributing role and molecular basis of Vitamin D/Vitamin D receptor deficiency in hyperhomocysteinemia-induced cardiac hypertrophy

Hyperhomocysteinemia and vitamin D deficiency are known to promote cardiac hypertrophy, however, whether vitamin D signaling is involved in hyperhomocysteinemia-induced cardiac hypertrophy remains unexplored. This study aimed to address this question by clarifying the effect of homocysteine on vitamin D and vitamin D receptor (VDR), with further elucidation of the regulatory mechanisms. Methionine diet-induced hyperhomocysteinemic (HHcy) rats and homocysteine-incubated cardiomyocytes were used as in vivo and in vitro models of cardiac hypertrophy. Gain-and-loss-of function of VDR and miR-125b-5p were achieved by plasmid transfection and AAV9-mediated delivery. HHcy rats showed lowered serum and cardiac 1,25(OH)2D3 levels and increased 24-hydroxylase (CYP24A1) expression in kidney and myocardium. VDR expression was downregulated and miR-125b-5p was upregulated in the myocardium of HHcy rats and in homocysteine-incubated cardiomyocytes as well. Knockdown of VDR facilitated while overexpression mitigated homocysteine-induced cardiomyocyte hypertrophy, accompanied by activation and inhibition of calcineurin/nuclear factor of activated T cells 4 (NFATc4) respectively. Dual-luciferase reporter gene assay and gain-and-loss-of function of miR-125b-5p in cardiomyocytes indicated the targeting and repressing of VDR by miR-125b-5p and its pro-hypertrophic effect. The role of miR-125b-5p-mediated VDR downregulation in homocysteine-induced cardiac hypertrophy was further demonstrated in vivo. Treatment with VDR agonist inhibited hypertrophic growth both in vivo and in vitro, resulting from VDR upregulation and consequent calcineurin/NFATc4 inhibition. These findings demonstrated that homocysteine reduces 1,25(OH)2D3 level in both plasma and myocardium via upregulating CYP24A1 and represses myocardial VDR expression via the mediation of miR-125b-5p. Vitamin D/VDR deficiency contributes to hyperhomocysteinemia-induced cardiac hypertrophy via activating calcineurin/NFATc4 pathway.

Hypoxia and ischemic stroke modify cerebrovascular tone by upregulating endothelial BK(Ca) channels-Lessons from rat, pig, mouse, and human

AIM

In animal models and human cerebral arteries, the changes in endothelial cell (EC)-large conductance calcium-activated potassium channel (BKCa) distribution, expression, and function were determined in hypoxia and ischemic stroke. The hypothesis that hypoxia and ischemic stroke induce EC-BKCa in cerebral arteries was examined.

METHODS

Immunohistochemistry analyzed BKCa expression in EC and smooth muscle (SM) of the middle-cerebral artery (MCA) from rat, piglet, and mouse, and pial arteriole of human. Pressure myography with pharmacological intervention characterized EC-BKCa and TRPV4 function in rat MCA. Electron microscopy determined caveolae density and vessel properties in rat and mouse MCA.

RESULTS

In rat, pig, and human cerebral vessels, EC-BKCa was absent in normoxia; present after chronic (rat) and acute hypoxia (pig), post-ischemic stroke in human vessels, and after endothelin-1-induced stroke in rats. Mouse MCA EC-BKCa expression increased after acute hypoxia. In rat MCA post-hypoxia and stroke, EC and SMC caveolae density increased, with reduced medial thickness, and unchanged diameter. Caveolae and BKCa did not colocalize. In rat MCA, iberiotoxin (IbTx) potentiated pressure-induced tone in hypoxia/stroke, but not in normoxia. In normoxia, overall MCA tone was unaffected by endothelial removal, but was increased in hypoxia/stroke, where there was no additive effect of endothelial removal and IbTx on tone. Functional TRPV4 was expressed in EC of rat MCA post-stroke.

CONCLUSIONS

In post-hypoxia/stroke, but not in normoxia, EC-BKCa contribute to the regulation of MCA tone. Identifying unique up- and downstream signaling mechanisms associated with EC-BKCa is a potential therapeutic target to control blood flow post-hypoxia/stroke.

Ligusticum chuanxiong: a chemical, pharmacological and clinical review

Ethnopharmacological Relevance

The dried rhizome of Ligusticum chuanxiong S.H.Qiu, Y.Q.Zeng, K.Y.Pan, Y.C.Tang and J.M.Xu (Apiaceae; including the horticultural variety Ligusticum chuanxiong Hort.) [synonym: Conioselinum anthriscoides (H.Boissieu) Pimenov and Kljuykov (The taxonomic classification has been adopted by the World Checklist of Vascular Plants)] is a traditional Chinese botanical drug renowned for its anti-inflammatory and antioxidant properties. It has been widely used to treatment various diseases, particularly cardio-cerebral vascular diseases (CCVDs).

Aim of the review

This review aims to summarize recent advances in Ligusticum chuanxiong (CX) research, including its chemical composition and pharmacological effects, and modern clinical applications.

Materials and methods

A systematic literature search was conducted using keywords such as "Chuanxiong," "traditional Chinese medicine," "chemical components," "metabolites," "CCVDs," and "pharmacological effects" to identify relevant literature published between 2014 and 2025. Databases including PubMed, Web of Science, Google Scholar, and CNKI were utilized. Chemical structures in SMILES format were retrieved from the PubChem, and two-dimensional chemical structures were generated using ChemDraw Ultra 8.0. Classical prescriptions of chuanxiong were obtained from authoritative traditional Chinese medicine databases.

Results

Over 100 metabolites have been isolated and identified from CX, classified into nine major classes. Key bioactive compounds include senkyunolide A, ligustilide, tetramethylpyrazine (TMP), and ligusticum CX polysaccharides (LCP). CX demonstrates significant pharmacological effects in treating CCVDs, such as atherosclerosis (AS), myocardial and cerebral ischemia-reperfusion injury, and hypertension. Its therapeutic mechanisms include antiplatelet activity, endothelial cell protection, anti-inflammatory, antioxidant, and anti-apoptotic properties. CX can be administered alone or in combination with other traditional Chinese medicines (TCMs) or chemical drugs, showing efficacy in cardiovascular, nervous system, digestive system disorders, as well as analgesia and anticancer activities.

Conclusion

CX holds substantial clinical value for treating multi-system diseases, with extensive evidence supporting its use in CCVDs. Further research and clinical exploration of CX are warranted to fully harness its therapeutic potential.

Metabolites-mediated posttranslational modifications in cardiac metabolic remodeling: Implications for disease pathology and therapeutic potential

The nonenergy - producing functions of metabolism are attracting increasing attention, as metabolic changes are involved in discrete pathways modulating enzyme activity and gene expression. Substantial evidence suggests that myocardial metabolic remodeling occurring during diabetic cardiomyopathy, heart failure, and cardiac pathological stress (e.g., myocardial ischemia, pressure overload) contributes to the progression of pathology. Within the rewired metabolic network, metabolic intermediates and end-products can directly alter protein function and/or regulate epigenetic modifications by providing acyl groups for posttranslational modifications, thereby affecting the overall cardiac stress response and providing a direct link between cellular metabolism and cardiac pathology. This review provides a comprehensive overview of the functional diversity and mechanistic roles of several types of metabolite-mediated histone and nonhistone acylation, namely O-GlcNAcylation, lactylation, crotonylation, β-hydroxybutyrylation, and succinylation, as well as fatty acid-mediated modifications, in regulating physiological processes and contributing to the progression of heart disease. Furthermore, it explores the potential of these modifications as therapeutic targets for disease intervention.

Lipid metabolism-associated metabolites on cardiovascular diseases: a two-sample Mendelian randomized study

Background

There is a growing body of evidence indicating that metabolites are associated with an increased risk of cardiovascular diseases (CVDs), the underlying causality of these associations remains largely unchallenged. Given the inherent difficulty in establishing causality using epidemiological data, we employed the technique of Mendelian randomization to investigate the potential role of plasma metabolite factors in influencing the risk of CVDs.

Methods

The exposure was based on 1,400 plasma metabolites, and outcomes involved four CVD datasets from public databases. Initial causality was assessed by inverse variance weighting (IVW), followed by sensitivity analyses using MR-Egger regression, weighted median, and Multiple Effectiveness Residual Sums and Outliers (MR-PRESSO) method. Potential heterogeneity and multivalence were assessed using the MR-Egger intercept and Cochran's Q statistic. After Bonferroni correction, causal associations were found to be significant with p-values less than 0.05. All statistical analyses were rigorously executed in R software.

Results

Our findings identified causal relationships between 15 metabolites and cardiovascular disease. Of these, 4 were associated with AA (aortic aneurysm), 7 with atrial fibrillation and flutter, 2 with HF (heart failure), and 3 with stroke.

Conclusion

This is the first systematic mendelian randomization analysis using genome-wide data to assess the causal relationship between serum metabolites and different cardiovascular diseases, providing preliminary evidence for the impact of lipid metabolism disorders on cardiovascular disease risk.

Genetic test results and one-year developmental outcomes of fetuses with congenital heart disease

Objective

This study evaluated the utility of single nucleotide polymorphism (SNP) microarray analysis in prenatal genetic assessment of fetuses diagnosed with congenital heart disease (CHD), retrospectively analyzing pregnancy outcomes and their association with physical and intellectual development within the first year of life.

Patients and methods

It included 105 fetuses diagnosed with CHD via prenatal echocardiography from January 2016 to June 2020, categorized into two groups: isolated cardiac structural abnormalities (76 cases) and additional extracardiac structural abnormalities (29 cases). All fetuses underwent chromosome karyotype and SNP array testing, with retrospective analysis of pregnancy outcomes, postnatal physical and intellectual development at one year of age.

Results

Chromosomal abnormalities were identified in 15.2% (16/105) of the fetuses. A significantly higher incidence of chromosomal abnormalities was observed in the group with combined extra-cardiac structural abnormalities compared to the group with isolated cardiac abnormalities (P < 0.05). The detection rates of pathogenic Copy Number Variations (CNV), variants of uncertain significance (VOUS), and benign CNV showed no significant differences between the groups (P > 0.05). The detection rate of CNV was significantly lower in fetuses with isolated cardiac abnormalities (P < 0.05). The delivery rate was 61.0%, significantly higher in fetuses with only cardiac abnormalities. Of these, 38.5% of ventricular septal defects closed naturally within the first year. Only a small proportion of the children displayed developmental delays at one year of age.

Conclusion

SNP array analysis enhances the detection of genetic etiologies in CHD, assisting in the precise localization of chromosomal anomalies and candidate gene screening. It is effective for prenatal diagnosis in CHD fetuses. Fetuses with isolated cardiac structural abnormalities show lower rates of chromosomal anomalies and CNVs and generally have favorable one-year developmental outcomes, underlining the importance of SNP array analysis in managing CHD outcomes.

Hematological parameters and major adverse cardiovascular events: a prospective study in a Chinese population involving 2,970 participants

Hematological parameters are among the most accessible and routinely performed clinical tests. Recent studies have gradually revealed their potential for risk prediction. This study aimed to assess the association between hematological parameters and major adverse cardiovascular events (MACEs) in patients with coronary artery disease. This prospective study included 2,970 Chinese participants who underwent coronary angiography, with hematological and biochemical indicators measured at baseline. MACEs, comprising myocardial infarction, stroke, revascularization, and all-cause mortality, were recorded during follow-up. Univariate and multivariate analyses were conducted to evaluate the relationship between the hematological parameters and MACEs. Over a median follow-up period of 79 months, 474 MACEs were documented. Kaplan-Meier analysis indicated that the participants with lower levels of RBC, PLT, PCT, LYMPH% and BASO%, as well as higher RDW-CV, RDW-SD, MONO% and NEUT%, exhibited reduced survival probability. Multivariate Cox regression analysis identified elevated RDW-CV as a significant risk factor for MACE (T3 HR, 1.292; 95% CI, 1.013-1.647; P=0.039), while lower BASO% demonstrated a protective effect (T3 HR, 0.750, 95 % CI: 0.591-0.953; P=0.018). LYMPH% also showed a significant association with MACEs. Additionally, nonlinear correlations were observed between PLT and PCT and MACEs. In conclusion, RDW-CV, BASO%, PLT, PCT and LYMPH% were closely associated with MACEs and may serve as potential predictors for cardiovascular risk in patients with coronary artery disease.

Long-Chain Polysaturated Fatty Acid in Atrial Fibrillation-Associated Stroke: Lipidomic-GWAS Study

This study aimed to explore the relationship between lipidomic domains, particularly free fatty acids (FFAs), and the presence of atrial fibrillation (AF) in patients with acute stroke, and to identify mechanisms of AF-associated stroke through genetic studies.A total of 483 stroke patients without AF (n = 391) and with AF (n = 92) were selected from a prospectively collected stroke registry. Lipidomic profiling was conducted, and the lipid components associated with AF were explored using fold-change analyses and clustering. Genotyping was conducted through trait comparison. Colocalization was also performed.Among the lipidomic domains, the free fatty acid (FFA) class was positively associated with AF. Long-chain fatty acids with 14 to 24 carbons and unsaturated FFAs distinguished AF. Clustering analysis based on FFAs revealed differences in AF proportion across groups. Genome-wide association study (GWAS) identified two loci associated with clustered groups of FFA metabolites: near MIR548F3 associated with FFA 20:1, FFA 20:2, FFA 22:5, and FFA 22:6; and near RPL37A associated with FFA 22:5 and FFA 22:6. These loci were associated with increased fibrinogen levels. In the GWAS for the FFA metabolite, quantitative trial locus analysis, loci near rs28456 and rs3770088, and FFA 20:4-QTLs were co-localized with the eQTLs of FADS2, a gene involved in the peroxisome proliferator-activated receptor gamma-related signaling pathway, in the whole blood, left ventricle, and atrial appendage tissue.Elevated FFA levels, especially those of long-chain unsaturated FFAs, are strongly associated with AF-associated stroke. This relationship is regulated by the peroxisome proliferator-activated receptor (PPAR) gamma-related signaling pathway.

High-throughput untargeted metabolomic profiling of urinary biomarkers in acute myocarditis patients: a cross-sectional study

Acute myocarditis, characterized by inflammatory myocardial injury, significantly risks heart failure and sudden death. Despite its severity, specific biomarkers are lacking. This study applied metabolomic analysis to urine samples from 21 acute myocarditis patients and 21 controls using UPLC-MS/MS, revealing 728 increased and 820 decreased metabolites in patients. The affected pathways were predominantly related to the amino acid metabolism, lipid metabolism, carbohydrate metabolism, nucleotide metabolism, and others. We have validated 19 metabolites with an area under the receiver operating characteristic curve (AUC-ROC) greater than 0.7 and a high level of identification confidence. Potential biomarkers upregulated in acute myocarditis patients included phytosphingosine, N-acetylneuraminic acid, indolelactic acid, L-glutamic acid, 4-pyridoxic acid, N1-methyl-2-pyridone-5-carboxamide, palmitic acid, hydroxyphenyllactic acid, riboflavin, nicotinic acid, choline, N-formylkynurenine, guanine, and hypoxanthine. Conversely, sebacic acid, 4-vinylphenol sulfate, capryloylglycine, 4-ethylphenylsulfate, and azelaic acid were found to be decreased. Collectively, the metabolomic profiling has uncovered distinct metabolic signatures in patients with acute myocarditis. The amino acid metabolism appears to play a pivotal role in the pathogenesis of acute myocarditis, offering potential avenues for diagnostic and therapeutic development.

A Comprehensive Review of Canine and Feline Ventricular Septal Defects-From Pathogenesis to Long-Term Follow-Up

Congenital heart defects (CHDs) in dogs and cats represent a definite minority of cardiac patients. One of the most commonly diagnosed is ventricular septal defects (VSDs). These are associated with abnormal ventricular septation during the prenatal period; however, the mutations of the genes responsible for this phenomenon are not fully understood. VSDs pose a significant diagnostic challenge due to the multitude of locations in the ventricular septum where they are likely to occur. Therefore, there are many phenotypes of the defect causing many problems in terms of a common nomenclature. Among the various classifications, the latest terminology issued by The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD) considers both electrical conduction pathways and adjacent structures to standardize nomenclature. Further, defects located at different sites can alter both prognosis and subsequent management for the patient; thus, taking accurate measurements is crucial. Among these, the Qp:Qs and VSD:Ao ratios, the direction of blood flow through the defect, its location, the diameter and maximum flow velocity, and the pressure difference between the RV and LV are indicated. Emerging technologies such as 3D echocardiography and cardiac magnetic resonance may provide additional diagnostic value. Altogether, along with clinical symptoms, we should determine further management, involving the monitoring of the patient, the implementation of pharmacological treatment, or referral for surgical closure of the VSD. This review summarizes current knowledge on VSD, where the pathogenesis of the condition, diagnosis, and management, including conventional and surgical methods as well as long-term follow-up, are described, providing a complete overview of the issue.

Arterial conduits for coronary bypass grafting: the set-point concept

Endothelial cells control the vascular tone of arterial grafts used for coronary artery bypass surgery and react to changes in local shear stress. The vascular adaptations induced by endothelial cell activation affect the outcome of surgical grafts and can be predicted based on the set-point theory. In this Hypothesis piece, it is proposed that the set-point concept should inform surgical decision making for coronary artery bypass surgery.