A Combined Electrocardiographic and Imaging Predictive Risk Model for New Permanent Pacemaker After Transcatheter Aortic Valve Implantation: The RITMO Score

Currently, permanent pacemaker implantation (PPMI) is the most common complication of transcatheter aortic valve implantation (TAVI). The aim of this analysis is to develop a simple and effective risk prediction model for PPMI within 30 days of TAVI. Data from 370 patients who underwent TAVI with the self-expanding valve between February 2015 and June 2022 at our center were collected in the development cohort (DC). A risk score was developed based on baseline anatomical and electrocardiographic characteristics, including the estimation of aortic calcium load (ACL) using both the Agatston score and calcium volume. A validation cohort (VC) of 234 patients was used to test the score. Seventy-two patients (19.5%) underwent PPMI in DC. Preprocedural right bundle branch block (RBBB), membranous septum length (MSL) <5 mm, and severe ACL were significant predictors of PPMI. The Agatston score showed higher agreement with PPMI compared to calcium volume (K = 0.89; 95% CI 0.84 to 0.93 vs K = 0.71; 95% CI 0.64 to 0.79, respectively). Pre-existing RBBB, MSL, and Agatston score have been combined into a simple score, called RITMO (theoretical range from -1 to 4 points). We applied the score to the VC and find that a high score (>1) had an OR>6 to predict PPMI after TAVI. In patients undergoing TAVI with a self-expanding valve, baseline RBBB, shorter MSL, and higher ACL evaluated using the Agatston method were predictive of 30-day PPMI. In conclusion, the RITMO score represents a simple tool for risk stratification, with implications for procedural planning and patient counseling.

Prevalence of MTHFR C677T polymorphism and its association with serum homocysteine and blood pressure among different ethnic groups: insights from a cohort study of Nepal

BACKGROUND

The risk of hypertension varies based on ethnicity, environmental factors, and genetic predispositions. Studies have reported a higher risk of cardiovascular diseases (CVD) and hypertension among the Newar ethnic groups in Nepal. However, the genetic analysis for Methylenetetrahydrofolate reductase (MTHFR C677T) gene mutations, serum homocysteine, and high-sensitivity C-reactive protein (hs-CRP) levels across different ethnicities remains unexplored.

METHODS

Sociodemographic information and baseline data of 489 participants were obtained from the first phase of the Dhulikhel Heart Study. Preserved blood samples were analyzed for MTHFR C677T polymorphism using real-time polymerase chain reaction (TaqMan assay), and serum homocysteine was measured through immunoassay techniques. Descriptive analysis, the Hardy-Weinberg equilibrium test, and multinomial regression were performed.

RESULTS

The prevalence of homozygous mutation (TT) was 19.8% in the Newar group and 12.5% in the Brahmin/Chhetri ethnicity. The highest mean value of homocysteine (19.4 µmol/L) was observed in homozygous participants, followed by the heterozygous mutant group (17.4 µmol/L). A statistically significant association (P = < 0.001) was found between homocysteine levels and blood pressure.

CONCLUSIONS

The Dhulikhel Heart Study reveals a significant prevalence of the MTHFR C677T gene mutation among the Newar ethnicity compared to other groups. Elevated levels of homocysteine and high-sensitivity C-reactive protein (hs-CRP) were associated with increased blood pressure.

CLINICAL TRIAL NUMBER

Not applicable.

Relevance of Targeting Oxidative Stress, Inflammatory, and Pro-Resolution Mechanisms in the Prevention and Management of Postoperative Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF can lead to severe complications, including stroke, myocardial infarction, and sudden death. AF risk factors include pathological aging and conditions such as obesity, diabetes, and hypertension. Clinical data revealed that cardiothoracic and non-cardiothoracic surgeries are also important risk factors for AF. Post-operative AF (POAF) is associated with important public health costs caused by increased hospitalization, frequent emergency room visits, and enhanced healthcare utilization, which altogether lead to a low quality of life for the patients. Hence, POAF is a major clinical challenge, and there is an urgent need for the development of novel therapeutic strategies. Interestingly, evidence from clinical and fundamental research converges to identify cardiac oxidative stress and atrial inflammation as the common denominators of all AF risk factors. Unresolved inflammation is suspected to provoke cardiac fibrosis, which is an important contributor to cardiac arrhythmias and AF. Antioxidant, anti-inflammatory, and pro-resolution strategies may help to combat post-operative cardiac remodeling and POAF. This article aims to review the current scientific evidence supporting the role of inflammation in the pathogenesis of POAF and explore potential novel therapeutic strategies to prevent and mitigate inflammation in the management of AF.

Cardiac Remodeling and Arrhythmic Burden in Pre-Transplant Cirrhotic Patients: Pathophysiological Mechanisms and Management Strategies

Background: Chronic liver disease (CLD) and cirrhosis contribute to approximately 2 million deaths annually, with primary causes including alcohol-related liver disease (ALD), metabolic dysfunction-associated steatotic liver disease (MASLD), and chronic hepatitis B and C infections. Among these, MASLD has emerged as a significant global health concern, closely linked to metabolic disorders and a leading cause of liver failure and transplantation. Objective: This review aims to highlight the interplay between cirrhosis and cardiac dysfunction, emphasizing the pathophysiology, diagnostic criteria, and management of cirrhotic cardiomyopathy (CCM). Methods: A comprehensive literature review was conducted to evaluate the hemodynamic and structural cardiac alterations in cirrhosis. Results: Cirrhosis leads to portal hypertension and systemic inflammation, contributing to CCM, which manifests as subclinical cardiac dysfunction, impaired contractility, and electrophysiological abnormalities. Structural changes, such as increased left ventricular mass, myocardial fibrosis, and ion channel dysfunction, further impair cardiac function. Vasodilation in the splanchnic circulation reduces peripheral resistance, triggering compensatory tachycardia, while the activation of the renin-angiotensin-aldosterone system (RAAS) promotes fluid retention and increases cardiac preload. Chronic inflammation and endotoxemia exacerbate myocardial dysfunction. The 2005 World Congress of Gastroenterology (WCG) and the 2019 Cirrhotic Cardiomyopathy Consortium (CCC) criteria provide updated diagnostic frameworks that incorporate global longitudinal strain (GLS) and tissue Doppler imaging (TDI). Prolonged QT intervals and arrhythmias are frequently observed. Managing heart failure in cirrhotic patients remains complex due to intolerance to afterload-reducing agents, and beta-blockers require careful use due to potential systemic hypotension. The interaction between CCM and major interventions, such as transjugular intrahepatic portosystemic shunt (TIPS) and orthotopic liver transplantation (OLT), highlights the critical need for thorough preoperative cardiac evaluation and vigilant postoperative monitoring. Conclusions: CCM is a frequently underdiagnosed yet significant complication of cirrhosis, impacting prognosis, particularly post-liver transplantation. Early identification using echocardiography and thorough evaluations of arrhythmia risk in cirrhotic patients are critical for optimizing management strategies. Future research should focus on targeted therapeutic approaches to mitigate the cardiac burden in cirrhotic patients and improve clinical outcomes.

Patient selection, ventricular tachycardia substrate delineation, and data transfer for stereotactic arrhythmia radioablation: a clinical consensus statement of the European Heart Rhythm Association of the European Society of Cardiology and the Heart Rhythm Society

Stereotactic arrhythmia radioablation (STAR) is a novel, non-invasive, and promising treatment option for ventricular arrhythmias (VAs). It has been applied in highly selected patients mainly as bailout procedure, when (multiple) catheter ablations, together with anti-arrhythmic drugs, were unable to control the VAs. Despite the increasing clinical use, there is still limited knowledge of the acute and long-term response of normal and diseased myocardium to STAR. Acute toxicity appeared to be reasonably low, but potential late adverse effects may be underreported. Among published studies, the provided methodological information is often limited, and patient selection, target volume definition, methods for determination and transfer of target volume, and techniques for treatment planning and execution differ across studies, hampering the pooling of data and comparison across studies. In addition, STAR requires close and new collaboration between clinical electrophysiologists and radiation oncologists, which is facilitated by shared knowledge in each collaborator's area of expertise and a common language. This clinical consensus statement provides uniform definition of cardiac target volumes. It aims to provide advice in patient selection for STAR including aetiology-specific aspects and advice in optimal cardiac target volume identification based on available evidence. Safety concerns and the advice for acute and long-term monitoring including the importance of standardized reporting and follow-up are covered by this document. Areas of uncertainty are listed, which require high-quality, reliable pre-clinical and clinical evidence before the expansion of STAR beyond clinical scenarios in which proven therapies are ineffective or unavailable.

The diagnostic role of pharmacological provocation testing in cardiac electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the ESC Working Group on Cardiovascular Pharmacotherapy, the Association of European Paediatric and Congenital Cardiology (AEPC), the Paediatric & Congenital Electrophysiology Society (PACES), the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS)

The pharmacological provocation test is a pivotal tool in cardiac electrophysiology for the diagnosis of potential causes of sudden cardiac death, sudden cardiac arrest (SCA), arrhythmias, symptoms, or ECG abnormalities. The 2022 European Society of Cardiology Guidelines for the Treatment of Ventricular Arrhythmias and Prevention of Sudden Cardiac Death offered guidance on provocation testing but did not describe the indications and requirements in depth. This clinical consensus statement, led by the European Heart Rhythm Association and approved by major international stakeholders, aims to advise the general cardiologist and the arrhythmia expert who to test and when, where, and how to do it. The statement focuses on current practice for the diagnosis of subclinical arrhythmia syndromes and the causes of SCA, building upon the recommendations of the Guidelines. We address the sodium channel blocker provocation test for patients suspected of Brugada syndrome as well as the use of epinephrine, isoproterenol, adenosine, ergonovine, and acetylcholine.

Epicardial ventricular arrhythmia ablation: a clinical consensus statement of the European Heart Rhythm Association of the European Society of Cardiology and the Heart Rhythm Society, the Asian Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society

Epicardial access during electrophysiology procedures offers valuable insights and therapeutic options for managing ventricular arrhythmias (VAs). The current clinical consensus statement on epicardial VA ablation aims to provide clinicians with a comprehensive understanding of this complex clinical scenario. It offers structured advice and a systematic approach to patient management. Specific sections are devoted to anatomical considerations, criteria for epicardial access and mapping evaluation, methods of epicardial access, management of complications, training, and institutional requirements for epicardial VA ablation. This consensus is a joint effort of collaborating cardiac electrophysiology societies, including the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society.

Early and mid-term outcomes of transcatheter closure of perimembranous ventricular septal defects using double-disc occluders

Introduction

Ventricular septal defect (VSD) is a common congenital heart disease (CHD), accounting for 20-30% of all CHD cases. While surgical closure has been the gold standard for treatment, transcatheter closure has emerged as a less invasive alternative, particularly for perimembranous VSDs. This study aimed to evaluate the early and mid-term outcomes of transcatheter closure using a double-disc occluder device in a single-center Vietnamese cohort.

Method

A prospective descriptive study was conducted at Hanoi Heart Hospital, Vietnam. A total of 81 patients aged ≥1 year or weighing ≥8 kg, with perimembranous VSDs and left-to-right shunting confirmed by Doppler echocardiography, underwent transcatheter closure. Procedural success, complications, and follow-up outcomes were assessed at 1, 3, 12, and 18 months post-procedure. Data were analyzed using SPSS 20.0.

Results

The procedure achieved a success rate of 96.4%, with three failures due to large defects near the aortic valve causing significant aortic regurgitation or residual shunting. No mortality or severe complications such as device embolization or complete atrioventricular block were observed. Minor complications included transient arrhythmias (6.2%), femoral hematoma (8.6%), and mild allergic reactions to contrast agents (9.9%). At 18 months follow-up, residual shunting was minimal in 1.2% of patients, and no cases required surgical intervention.

Discussion

Transcatheter closure of perimembranous VSD using a double-disc occluder device is a feasible, safe, and effective alternative to surgery with high success rates and low complication rates. This approach offers a promising solution for select patients, especially in resource-limited settings. Further multicenter studies are recommended to validate these findings and assess long-term outcomes.

Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome in which signs and symptoms of heart failure (HF) occur despite a normal left ventricular ejection fraction. Transthoracic echocardiography (TTE) is the first-line imaging modality but disparities in patient pathways across the UK can lead to delayed diagnosis and treatment. We aimed to develop and validate a consistent, clinically appropriate and practical approach for reporting the echocardiographic suspicion of HFpEF.

METHODS

Using the Delphi method, a steering group of nine UK experts identified key domains for discussion and generated consensus statements relevant to the echocardiographic detection of HFpEF. Using a four-point Likert scale, a survey including all statements was disseminated among a wider audience of healthcare professionals to determine agreement. A consensus threshold of 75% agreement was defined as 'strong' and ≥90% as 'very strong'.

RESULTS

A total of 34 consensus statements were generated in seven domains: (1) challenges in the system approach to HFpEF; (2) enhancing referral for specialist review including echocardiography; (3) confidence in using a summary statement in an echo report; (4) identifying HFpEF and its underlying aetiology; (5) HF awareness, training and education; (6) refining multidisciplinary team roles in decision-making; (7) optimising patient experience.135 UK specialists experienced in managing HF participated in the survey, including physiologists/clinical scientists (n=43), HF specialist nurses (n=35), cardiologists (n=34), general practitioners (n=12), pharmacists (n=4) and others (n=7). 20 of 34 (59%) statements achieved very strong agreement, 10 of 34 (29%) achieved strong agreement and 4 of 34 (12%) did not meet the consensus threshold.

CONCLUSIONS

Diagnosis of HFpEF requires access to essential diagnostic tools. Establishing standardised pathways for specialist assessment and referral, including TTE reporting of HFpEF, may help eliminate diagnostic delays and geographical disparities. Further education and awareness are crucial for improving detection rates, prompt referral and patient experience.

Positive T wave in lead aVR is associated with left atrial and ventricular function and cardiac outcomes in heart failure patients with preserved ejection fraction

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) accounts for a significant proportion of heart failure cases and is associated with high morbidity and mortality. While echocardiography plays a central role in HFpEF assessment, the prognostic value of electrocardiographic (ECG) findings, particularly in lead aVR, remains underexplored. This study investigates the relationship between a positive T wave in lead aVR (TaVR) and left atrial (LA) and left ventricular (LV) function, as well as its prognostic significance in HFpEF patients.

METHODS

This retrospective study included 231 HFpEF patients diagnosed according to ESC guidelines. Patients underwent comprehensive echocardiography and 12‑lead ECG evaluation. Positive TaVR was defined as a T-wave amplitude ≥1 mm in lead aVR. LA and LV functions were assessed using LA reservoir strain (LASr) and LV global longitudinal strain (GLS), respectively. Multivariate Cox regression and Kaplan-Meier survival analyses were performed to evaluate the prognostic significance of TaVR.

RESULTS

Positive TaVR was observed in 34.6 % of patients and was associated with impaired LASr (15.02 ± 6.65 % vs. 17.78 ± 9.10 %, p = 0.023) and LV GLS (-13.66 ± 3.49 % vs. -15.19 ± 3.02 %, p = 0.001). Positive TaVR independently predicted 1-year all-cause mortality (HR = 6.02, p < 0.001) and 6-month all-cause mortality (HR = 9.67, p < 0.001). Patients with positive TaVR had higher hospitalization rates and worse clinical outcomes.

CONCLUSION

Positive TaVR is associated with LA dysfunction, LV remodeling, and poor prognosis in HFpEF. Incorporating this ECG parameter into routine clinical assessments could enhance risk stratification and guide management strategies for HFpEF patients.

MYH7 Mutations in Restrictive Cardiomyopathy

BACKGROUND

Restrictive cardiomyopathy (RCM) is a rare cardiac disease characterized by impaired ventricular filling and relaxation, with preserved systolic function. This study investigates the genetic basis of RCM and its impact on clinical outcomes, particularly heart transplantation (HTx).

OBJECTIVES

The aim of the study was to identify genetic variations associated with RCM and assess their impact on disease progression and HTx necessity.

METHODS

A retrospective analysis was conducted on 94 RCM patients from Fuwai Hospital (2003-2021), diagnosed via echocardiography or pathological examination. Whole exome sequencing screened patient samples for variants in key genes associated with RCM, validated via Sanger sequencing. Histopathological analysis of explanted hearts included systematic sampling from ventricles and interventricular septum, with Masson's trichrome staining for fibrosis quantification.

RESULTS

Genetic variants were identified in 54% of patients, with a higher prevalence in HTx patients (73%) compared to non-HTx patients (27%). Myosin heavy chain 7 (MYH7) mutations were found in 15% of cases, significantly associated with HTx (P < 0.001) and atrial fibrillation (P = 0.025). Patients with MYH7 mutations exhibited extensive fibrosis in the interventricular septum compared to nonmutation patients (P < 0.05). The mean age at diagnosis was 47.8 years, with HTx patients diagnosed at a younger age (mean 36.0 years) and transplanted at a mean age of 37.4 years, compared to non-HTx patients diagnosed at a mean age of 57.9 years. The median follow-up time was 5 years.

CONCLUSIONS

Genetic variations, particularly in the MYH7 gene, are significant risk factors for RCM progression and HTx. Genetic screening may guide early interventions, while fibrosis and MYH7 pathways offer potential therapeutic targets.

Oxidative Stress, Gut Microbiota, and Extracellular Vesicles: Interconnected Pathways and Therapeutic Potentials

Oxidative stress (OS) and gut microbiota are crucial factors influencing human health, each playing a significant role in the development and progression of chronic diseases. This review provides a comprehensive analysis of the complex interplay between these two factors, focusing on how an imbalance between reactive oxygen species (ROS) and antioxidants leads to OS, disrupting cellular homeostasis and contributing to a range of conditions, including metabolic disorders, cardiovascular diseases, neurological diseases, and cancer. The gut microbiota, a diverse community of microorganisms residing in the gastrointestinal tract, is essential for regulating immune responses, metabolic pathways, and overall health. Dysbiosis, an imbalance in the gut microbiota composition, is closely associated with chronic inflammation, metabolic dysfunction, and various diseases. This review highlights how the gut microbiota influences and is influenced by OS, complicating the pathophysiology of many conditions. Furthermore, emerging evidence has identified extracellular vesicles (EVs) as critical facilitators of cellular crosstalk between the OS and gut microbiota. EVs also play a crucial role in signaling between the gut microbiota and host tissues, modulating immune responses, inflammation, and metabolic processes. The signaling function of EVs holds promise for the development of targeted therapies aimed at restoring microbial balance and mitigating OS. Personalized therapeutic approaches, including probiotics, antioxidants, and fecal microbiota transplantation-based strategies, can be used to address OS-related diseases and improve health outcomes. Nonetheless, further research is needed to study the molecular mechanisms underlying these interactions and the potential of innovative interventions to offer novel strategies for managing OS-related diseases and enhancing overall human health.

Associations of high-density lipoprotein cholesterol, particles and subspecies with the risk of hypertension: findings from the PREVEND prospective study

OBJECTIVE

The prospective associations of high-density lipoprotein cholesterol (HDL-C), HDL particle (HDL-P) and subspecies concentrations with the risk of hypertension are uncertain. We aimed to evaluate the associations of HDL parameters with incident hypertension risk and their interplay with alcohol consumption in the PREVEND study.

METHODS

HDL parameters as measured by nuclear magnetic resonance spectroscopy and self-reported alcohol consumption were assessed in 3263 participants (mean age, 49 years; 45.8% males) without a history of hypertension at baseline. Multivariable-adjusted hazard ratios (HRs) with 95% CIs for hypertension per 1 standard deviation increment in HDL parameters were calculated.

RESULTS

During a median follow-up of 7.2 years, 825 participants developed hypertension. In analysis adjusted for several potential confounders, including alcohol consumption, there were inverse associations of HDL-C, HDL-P, medium HDL, HDL size, H3P and H4P with hypertension risk: HRs [95% confidence interval (CI) of 0.88 (0.81-0.97), 0.92 (0.86-0.99), 0.86 (0.80-0.93), 0.89 (0.82-0.98), 0.92 (0.85-0.98), and 0.87 (0.81-0.94), respectively]. Sex or alcohol consumption did not modify the associations of HDL parameters with hypertension risk. Compared with abstainers, the multivariable adjusted HRs (95% CI) of hypertension for occasional to light, moderate and heavy alcohol consumers were 0.84 (0.70-1.00), 0.83 (0.68-1.02), and 0.97 (0.69-1.37), respectively; the associations persisted on further adjustment for HDL parameters.

CONCLUSIONS

There are inverse associations of HDL-C, HDL-P, medium HDL, HDL size, H3P and H4P with hypertension risk, which are not confounded or modified by alcohol consumption. Light and moderate alcohol consumption is modestly and inversely associated with hypertension risk, independently of HDL parameters.

Reevaluating STEMI: The Utility of the Occlusive Myocardial Infarction Classification to Enhance Management of Acute Coronary Syndromes

BACKGROUND

The current classification of acute myocardial infarction (AMI) into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) has limitations in identifying patients with acute coronary occlusion (ACO) who do not exhibit classic ST-elevation. Emerging evidence suggests that a reclassification to "Occlusive Myocardial Infarction" (OMI) may enhance diagnostic accuracy and therapeutic interventions.

METHODS

A comprehensive review of the literature was conducted, focusing on the pathophysiology, electrocardiographic (EKG) patterns, and management of ACO. The utility of the OMI paradigm was evaluated against the traditional STEMI/NSTEMI framework, with a particular emphasis on atypical EKG findings and their role in guiding early intervention.

RESULTS

Traditional STEMI criteria fail to identify ACO in approximately 30% of NSTEMI patients, leading to delayed reperfusion and increased mortality. The OMI framework demonstrates improved sensitivity (78.1% vs. 43.6% for STEMI criteria) for detecting ACO by incorporating subtle EKG changes, including hyperacute T-waves, de Winter T-waves, and posterior infarction patterns. OMI-guided management facilitates timely diagnosis and intervention, potentially reducing adverse outcomes. Emerging artificial intelligence (AI) tools further enhance EKG interpretation and clinical decision-making.

CONCLUSIONS

Transitioning to the OMI paradigm addresses critical gaps in the STEMI/NSTEMI framework by emphasizing the identification of ACO irrespective of ST-segment elevation. This approach could significantly improve patient outcomes by reducing delays in reperfusion therapy. Future randomized trials are needed to validate the OMI paradigm and optimize its implementation in clinical practice.

Myocarditis and Inflammatory Cardiomyopathy in Dilated Heart Failure

Inflammatory cardiomyopathy is a condition that is characterised by the presence of inflammatory cells in the myocardium, which can lead to a significant deterioration in cardiac function. The etiology of this condition involves multiple factors, both infectious and non-infectious causes. While it is primarily associated with viral infections, other potential causes include bacterial, protozoal, or fungal infections, as well as a wide variety of toxic substances and drugs, and systemic immune-mediated pathological conditions. In spite of comprehensive investigation, the presence of inflammatory cardiomyopathy accompanied by left ventricular dysfunction, heart failure or arrhythmia is indicative of an unfavourable outcome. The reasons for the occurrence of either favourable outcomes, characterised by the absence of residual myocardial injury, or unfavourable outcomes, marked by the development of dilated cardiomyopathy, in patients afflicted by the condition remain to be elucidated. The relative contributions of pathogenic agents, genomic profiles of the host, and environmental factors in disease progression and resolution remain subjects of ongoing discourse. This includes the determination of which viruses function as active inducers and which merely play a bystander role. It remains unknown which changes in the host immune profile are critical in determining the outcome of myocarditis caused by various viruses, including coxsackievirus B3 (CVB3), adenoviruses, parvoviruses B19 and SARS-CoV-2. The objective of this review is unambiguous: to provide a concise summary and comprehensive assessment of the extant evidence on the pathogenesis, diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Its focus is exclusively on virus-induced and virus-associated myocarditis. In addition, the extant lacunae of knowledge in this field are identified and the extant experimental models are evaluated, with the aim of proposing future directions for the research domain. This includes differential gene expression that regulates iron and lipid and metabolic remodelling. Furthermore, the current state of knowledge regarding the cardiovascular implications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is also discussed, along with the open questions that remain to be addressed.

Nexilin mutations, a cause of chronic heart failure: A state-of-the-art review starting from a clinical case

Heart failure (HF) is a medical condition associated with high morbidity and mortality, despite ongoing advances in diagnosis and treatment. Among the various causes of HF, cardiomyopathies are particularly significant and must be thoroughly diagnosed and characterized from the outset. In this review, we aim to present a brief overview of cardiomyopathies as a driver of HF, with a specific focus on the genetic causes, particularly nexilin (NEXN) cardiomyopathy, illustrated by a clinical case. The case involves a 63-year-old male who presented with HF symptoms at moderate exertion. Six months prior, he had been asymptomatic, and a routine transthoracic echocardiography had shown a preserved left ventricular ejection fraction (LVEF). However, during the current evaluation, transthoracic echocardiography revealed a dilated left ventricle with a severely reduced LVEF of 30%. Subsequent coronary angiography ruled out ischemic heart disease, while cardiac magnetic resonance imaging indicated a non-inflammatory, non-infiltrative dilated cardiomyopathy with extensive LV fibrosis. Genetic testing identified a heterozygous in-frame deletion variant in the NEXN gene [c.1949_1951del, p.(Gly650del)], classified as likely pathogenic. State-of-the-art HF treatment was initiated, including cardiac resynchronization therapy with defibrillator support. Following treatment, the patient's symptoms resolved, and LVEF improved to 42%. Interestingly, this patient experienced the onset of symptoms and left ventricular dysfunction within just six months, a much faster progression compared to previously documented cases where the G650del NEXN variant is typically linked to a more gradual development of dilated cardiomyopathy. Current literature offers limited data on patients with NEXN mutations, and the connection between this gene and both dilated and hypertrophic cardiomyopathies remains an area of active research.

Evaluating inflammatory status to predict atrial fibrillation recurrence following ablation: The role of systemic immune-inflammation index

Atrial fibrillation (AF) is the most common arrhythmia in humans, affecting more than 40 million people worldwide. Radiofrequency catheter ablation (RFCA) was first introduced as a treatment for AF by Haïssaguerre M in the late 1990s. This procedure quickly became the treatment of choice, especially for symptomatic patients with AF refractory to medication. However, up to 45% of patients may experience AF recurrence within 12 months after RFCA. In this setting, AF recurrence is likely multifactorial, including atrial remodeling, local fibrosis or incomplete ablation due to failure in locating the trigger. Additionally, patients with obesity, sleep apnea, hypertension, or diabetes are at an increased risk of AF recurrence after RFCA. Inflammation is increasingly recognized as a potential key factor in AF recurrence and may arise both from the healing response of heart tissue post-ablation or from chronic low-grade inflammation, as observed in many risk factors. Here, we present an original study by Wang et al, which investigated the combination of the systemic immune-inflammation index-a marker developed to assess overall inflammatory status-and the APPLE score, designed to predict AF recurrence following RFCA. The study found that using both indicators together improved the accuracy of AF recurrence prediction. These findings underscore the significant role of inflammation in cardiovascular disease and demonstrated its impact on AF recurrence after RFCA. Further research is warranted to validate the combined use of these two scores in clinical settings for predicting AF recurrence following catheter ablation.

Clinical experience with cryopreserved mesenchymal stem cells for cardiovascular applications: A systematic review

BACKGROUND

As living biodrugs, mesenchymal stem cells (MSCs) have progressed to phase 3 clinical trials for cardiovascular applications. However, their limited immediate availability hampers their routine clinical use.

AIM

To validate our hypothesis that cryopreserved MSCs (CryoMSCs) are as safe and effective as freshly cultured MSC counterparts but carry logistical advantages.

METHODS

Four databases were systematically reviewed for relevant randomized controlled trials (RCTs) evaluating the safety and efficacy of CryoMSCs from various tissue sources in treating patients with heart disease. A subgroup analysis was performed based on MSC source and post-thaw cell viability to determine treatment effects across different CryoMSCs sources and viability status. Weighted mean differences (WMDs) and odds ratios were calculated to measure changes in the estimated treatment effects. All statistical analyses were performed using RevMan version 5.4.1 software.

RESULTS

Seven RCTs (285 patients) met the eligibility criteria for inclusion in the meta-analysis. During short-term follow-up, CryoMSCs demonstrated a significant 2.11% improvement in left ventricular ejection fraction (LVEF) [WMD (95%CI) = 2.11 (0.66-3.56), P = 0.004, I 2 = 1%], with umbilical cord-derived MSCs being the most effective cell type. However, the significant effect on LVEF was not sustained over the 12 months of follow-up. Subgroup analysis demonstrated a substantial 3.44% improvement in LVEF [WMD (95%CI) = 3.44 (1.46-5.43), P = 0.0007, I 2 = 0%] when using MSCs with post-thaw viability exceeding 80%. There was no statistically significant difference in the frequency of major cardiac adverse events observed in rehospitalization or mortality in patients treated with CryoMSCs vs the control group.

CONCLUSION

CryoMSCs are a promising option for heart failure patients, particularly considering the current treatment options for cardiovascular diseases. Our data suggest that CryoMSCs could be a viable alternative or complementary treatment to the current options, potentially improving patient outcomes.

Cardiac Contractility Modulation Improves Left Ventricular Function, Including Global Longitudinal Strain, in Patients with Chronic Heart Failure

Background: Cardiac contractility modulation (CCM) is a therapy for patients with chronic heart failure with reduced ejection fraction (HFrEF). However, so far, there is no data available as to whether the application of CCM leads to changes in left ventricular global strain (GLS). This might be of special interest because GLS is known to be a strong predictor of outcomes in patients with HFrEF. Methods: Patients over 18 years old with heart failure with impaired left ventricular function (LVEF < 45%), a QRS complex < 130 ms, and NYHA classes II-IV despite guideline-directed medical therapy who planned to receive CCM implantation within 6 months were prospectively included into this study. Every 3 months, the status regarding CCM therapy was determined, and a standardized echocardiographic examination including the determination of LV global longitudinal strain was performed. Results: Between 30.12.2021 and 10.09.2024, 22 consecutive patients were prospectively enrolled in the study. CCM implantation was performed for 19 patients at a mean time of 59 ± 65 days. Under active CCM therapy, there was an improvement in GLS, LV-EF, and the Kansas City Heart Failure Questionnaire (KCCQ; all p < 0.05). A linear regression analysis showed that the positive effect of CCM on GLS was especially pronounced in patients with a female sex, a non-ischemic etiology of heart failure, and age ≤ 69 years, respectively (all p < 0.05). Conclusions: CCM therapy is not only linked to an improvement in LV-EF but also increases the global longitudinal strain and quality of life of patients with HFrEF.

On MANTA vascular closure devices following veno arterial extracorporeal membrane oxygenation: Effectiveness and complications

MANTA vascular closure device is an alternative vascular access closure device that is predominantly designed for large bore arteriotomy procedures. Its implementation to reduce morbidity and mortality following percutaneous procedures including peripheral veno-arterial (VA)-extracorporeal membrane oxygenation (ECMO) in critically ill patients with various severe clinical conditions such as refractory cardiogenic shock remains to be under scientific discussion. The use of the MANTA vascular closure device leads to a sufficient reduction in a number of post-decannulation complications such as bleeding, vascular complications, inflammatory reactions and major amputation. Furthermore, the technical success of percutaneous decannulation of VA-ECMO with the MANTA vascular closure device appears to be safe and effective. It has been reported that MANTA vascular closure device exerted a strict similarity with other vascular surgical systems in safe profile regardless of the indication for its utilization. Overall, the immobilized patients achieved a favorable recovery outcome with MANTA including safe decannulation and low risk of vascular complications. The authors suggest the use of pulse wave distal Doppler technology for early detection of these clinically relevant complications. In conclusion, MANTA vascular closure device seems to be safe and effective technical approach to provide low-risk vascular assess for a long time for severe sick individuals.

Systemic immune inflammation index as a predictor for atrial fibrillation recurrence after catheter ablation

Atrial fibrillation (Afib) is a common arrhythmia with significant public health implications, affecting millions of individuals worldwide. Catheter ablation (CA) is an established treatment for drug-resistant Afib, yet recurrence remains a major concern, impacting quality of life in a significant portion of patients. Inflammation plays a critical role in the recurrence of Afib after ablation, with systemic inflammatory markers such as C-reactive protein being linked to higher recurrence rates. In this editorial, we discuss the study by Wang et al, published in the latest issue, which investigates the predictive role of the systemic immune inflammation index (SII) in Afib recurrence following radiofrequency CA. Elevated pre-ablation SII levels are identified as an independent predictor of recurrence, significantly enhancing the predictive power of the APPLE score. Integration of SII improved the APPLE score's predictive performance, as shown by enhanced area under the curve, net reclassification improvement, and integrated discrimination improvement. This combined model highlights the importance of both structural and inflammatory factors in Afib recurrence, offering a more personalized approach to patient management. Additionally, the affordability and accessibility of SII enhance its practicality in clinical workflows. The study by Wang et al underscores the potential of integrating SII with existing scoring systems to refine risk stratification and optimize treatment strategies. Future research should validate these findings across diverse populations, explore limitations such as the potential influence of comorbidities on SII reliability, and investigate additional biomarkers to enhance predictive accuracy.

Shedding light on the effects of sodium-glucose cotransporter 2 inhibitors in the early stages of heart failure

Heart failure (HF), which falls outside of the historical macrovascular or microvascular categorizations of diabetes complications, has been overlooked for long time in diabetic patients, despite its increasing prevalence and mortality. As originally stated in the Framingham studies, diabetes is associated with an increased risk of HF. Subsequent studies not only corroborated these findings but also identified HF as the most frequent first onset of cardiovascular involvement. The paramount role of proper management of common modifiable risk factors such as hypertension, obesity, dyslipidemia and smoking, became rapidly clear. Conversely, the impact of intensive glycemic control was more contentious. A large meta-analysis of randomized controlled trials reported a lack of effect of strict glycemic control as compared to standard care on HF-related outcomes. The considerable heterogeneity of the effect estimate and the higher risk conferred by thiazolidinediones suggested that mechanism of action of antidiabetic drugs played a key role. Furthermore, the safety concerns of pioglitazone led Food and Drug Administration to release a guidance for drug manufacturers stating that cardiovascular risk should be comprehensively evaluated during drug development. Surprisingly, in just a few years, large cardiovascular outcome trials established the beneficial cardiovascular effects of sodium-glucose cotransporter 2 inhibitors. These effects were consistent regardless diabetes and ejection fraction. Therefore, scientific community started to question the glucose-lowering and diuretic properties of sodium-glucose cotransporter 2 inhibitors as the unique mechanisms for improved outcomes. A plenty of preclinical and clinical studies identified several mechanisms besides glucose-lowering effects. However, these mechanistic studies focused on animal models and patients with established HF. If the same mechanisms account for beneficial effects in patients at risk for or with pre-HF is unknown. Grubić Rotkvić et al published an interesting work adding data in early stages HF.

Hemodynamics of Proximal Coronary Lesions in Patients Undergoing Transcatheter Aortic Valve Implantation: Patient-Specific In Silico Study

Aortic stenosis (AS) frequently coexists with coronary artery disease (CAD), complicating revascularization decisions. The use of coronary physiology indices, such as the fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and coronary flow reserve (CFR), in AS patients remains debated, particularly after transcatheter aortic valve implantation (TAVI). In this study, we employ computational fluid dynamics (CFD) to evaluate coronary hemodynamics and assess changes in the wall shear stress (WSS) before and after TAVI. Our analysis demonstrates strong agreement between CFD-derived and invasive FFR measurements, confirming CFD's reliability as a non-invasive tool for coronary physiology assessment. Furthermore, our results show no significant changes in FFR (p=0.92), iFR (p=0.67), or CFR (p=0.34) post-TAVI, suggesting that these indices remain stable following aortic valve intervention. However, a significant reduction in high WSS exposure (59% to 40.8%, p<0.001) and the oscillatory shear index (OSI: 0.32 to 0.21, p<0.001) was observed, indicating improved hemodynamic stability. These findings suggest that coronary physiology indices remain reliable for revascularization guidance post-TAVI and highlight a potential beneficial effect of aortic stenosis treatment on plaque shear stress dynamics. Our study underscores the clinical utility of CFD modeling in CAD management, paving the way for further research into its prognostic implications.

The effects of rhythmic handgrip exercise on muscle sympathetic nerve activity: A systematic review and meta-analysis

This systematic review and meta-analysis was conducted to quantify the sympathetic response to rhythmic handgrip exercise in healthy and diseased populations. Structured searches of databases were performed until June 12, 2024. We included all primary studies (other than systematic reviews and meta-analyses), and inclusion criteria were: population (all populations); intervention (rhythmic handgrip); comparator (baseline); and outcome (MSNA, BP, HR). Forty-nine studies (n = 930) were included. Burst frequency was elevated by 6.1 bursts/min during rhythmic handgrip (95 % CI, 4.52, 7.63; I2 = 53 %; p < 0.00001) across all populations. Similarly, burst incidence and total activity showed significant increases during handgrip (BI: MD, 3.0 bursts/100 hbs; 95 % CI, 0.11, 5.85; I2 = 0 %; p = 0.04; TA: MD, 49.4 a.u.; 95 % CI, 36.56, 62.20; I2 = 86 %; p < 0.00001). Subgroup analyses found greater responses in MSNA during rhythmic handgrip in healthy individuals compared to cardiovascular diseases and other conditions. Specifically, the change in burst frequency during handgrip (p = 0.0009) and total activity during handgrip (p < 0.00001) suggest a blunted sympathetic response to rhythmic handgrip in diseased populations. Meta-regression analyses in healthy populations found no relationship between the volume of handgrip applied with the associated change in sympathetic activity; however, there was a significant positive relationship between both the change in heart rate (slope = 0.131; adjusted R2 = 0.2773; p = 0.002) and the change in mean blood pressure (slope = 0.163; adjusted R2 = 0.3594; p < 0.001) with handgrip volume. An increase in MSNA is observed during rhythmic handgrip despite ranging protocols, populations, and co-interventions. These results suggest exercise is a unique stressor and challenges the understanding of general sympathetic hyperactivity in diseased populations.

Diagnostic value of neutrophil-to-lymphocyte ratio, fibrinogen-to-albumin ratio and red blood cell distribution width in tuberculosis combined with other bacterial infections

OBJECTIVE

To investigate the clinical significance of the neutrophil-to-lymphocyte ratio (NLR), fibrinogen-to-albumin ratio (FAR), and red blood cell distribution width (RDW) in pulmonary tuberculosis (PTB) associated with other bacterial lung infections.

METHODS

A total of 74 patients with PTB complicated with other bacterial lung infections, who were admitted to the Sixth People's Hospital of Nantong City (Nantong, China) from January 2021 to December 2023, were included in this study as the PTB with infection complication group. A comparison group of 96 patients with uncomplicated PTB, admitted to the same hospital during the same period, was used as the PTB without infection complication group. The NLR, FAR, and RDW values in peripheral blood were determined and compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of these indicators for early detection of PTB complicated with other bacterial infections.

RESULTS

The NLR, FAR, and RDW values were significantly higher in the PTB with infection complication group compared to the PTB without infection complication group, with differences reaching statistical significance (P < 0.05). NLR value showed a positive correlation with white blood cell count, C-reactive protein levels, and D-dimer levels. ROC curve analysis indicated that the area under the curve (AUC) values for diagnosing PTB with bacterial infection using blood NLR, FAR, and RDW were 0.861, 0.818, and 0.799, respectively. The combined AUC value of these three indicators was 0.982. The validation results showed that the diagnostic sensitivity (98.6%) and specificity (89.58%) of the combination of NLR, FAR, and RDW were higher than those of each indicator alone.

CONCLUSION

The combined assessment of blood NLR, FAR, and RDW values has high clinical diagnostic value for diagnosing PTB complicated with other bacterial infections.

The Association Between Cutaneous Wounds and Infective Endocarditis: A Nationwide Self-Controlled Case Series Study in Taiwan

BACKGROUND AND OBJECTIVES

We aim to investigate whether disruption of the skin defense in the form of cutaneous wounds may increase the incidence rate (IR) of infective endocarditis (IE) in the general population.

METHODS

We performed a retrospective population-based study using Taiwan's National Health Insurance Database from 2013 to 2022. Self-controlled case series (SCCS) was used to investigate the time-sequential association between cutaneous wounds and IE. Adult patients with both cutaneous wounds (exposure) and IE (outcome) in the database were included in the study. Conditional Poisson regression was used to calculate the adjusted IR ratios (aIRRs) of IE during the 4 weeks following wounds to that of the baseline period within the same individuals.

RESULTS

We enrolled 3,241 eligible patients for SCCS analysis. The risks of IE were elevated in the second week (aIRR, 2.16; 95% confidence interval [CI], 1.07-4.35; p value=0.032) after a treated traumatic wound. The risks of IE were elevated in the first (aIRR, 1.56; 95% CI, 1.17-2.09; p value=0.002) and second (aIRR, 1.58; 95% CI, 1.19-2.10; p value=0.002) after a treated non-traumatic wound.

CONCLUSIONS

Both traumatic and non-traumatic cutaneous wounds are associated with an increased risk of IE within the first 2 weeks after treatments among the general population in Taiwan. Clinicians should be vigilant for symptoms or signs associated with IE in these patients to avoid delays in diagnosis and treatment.

Clinical development of therapeutic mRNA applications

mRNA therapeutics are emerging as a transformative approach in modern medicine, providing innovative, highly adaptable solutions for a wide range of diseases, from viral infections to cancer. Since the approval of the first mRNA therapeutic-the coronavirus disease 2019 vaccines in 2021-we have identified more than 70 current clinical trials utilizing mRNA for various diseases. We propose classifying mRNA therapeutics into four main categories: vaccines, protein replacement therapies, antibodies, and mRNA-based cell and gene therapies. Each category can be further divided into subcategories. Vaccines include those targeting viral antigens, bacterial or parasitic antigens, general and individualized cancer antigens, and self-antigens. Protein replacement therapies include maintenance therapeutics designed to treat genetic disorders and interventional therapeutics, where delivering therapeutic proteins could improve patient outcomes, such as vascular endothelial growth factor A for ischemic heart disease or proinflammatory cytokines in cancer. Therapeutic antibodies are based on mRNA sequences encoding the heavy and light chains of clinically relevant antibodies, enabling patient cells to produce them directly, bypassing the costly and complex process of manufacturing protein-ready antibodies. Another category of mRNA-based therapeutics encompasses cell and gene therapies, including CRISPR with mRNA-mediated delivery of Cas9 and the in vivo generation of cells expressing CAR through mRNA. We discuss examples of mRNA therapeutics currently in clinical trials within each category, providing a comprehensive overview of the field's progress and highlighting key advancements as of the end of 2024.

"Unveiling the impacts of climatic cold events on the cardiovascular health in animal models"

Climate change is increasingly driving extreme weather events, leading to drastic temperature fluctuations worldwide. While overall temperatures rise, many regions are simultaneously experiencing severe cold spells that threaten the health of human populations, especially to vulnerable populations including the elderly and those with pre-existing conditions. Exposure to cold stress triggers significant physiological and biochemical disruptions. As cardiovascular diseases (CVDs) rank among the leading causes of global morbidity and mortality, the exacerbation of these conditions by cold exposure underscores critical public health challenges. The complex pathophysiological processes in cold-induced CVDs require careful analysis at an organ-system level, making animal models an ideal tool for replicating human physiological and molecular responses in a controlled environment. However, a detailed mechanism linking cold exposure and cardiovascular dysfunction remains incompletely understood, particularly in the context of animal models. Therefore, this comprehensive review aims to address and analyze from traditional rodent models to less conventional ruminants, broilers, canines, and primate animal models to understand cold stress-induced CVDs, with an extensive account of the potential molecular mechanisms and pathways such as oxidative stress, inflammation, vasomotor dysfunction, and apoptosis, along with emerging roles of cold shock proteins (CSPs), etc. We also delve into various potential therapeutic approaches and preventive measures in cold stress conditions. In conclusion, this review is the first to comprehensively address the underexplored cardiovascular complications arising from cold stress and their underlying mechanisms, particularly using animal models. Furthermore, it provides a foundation for advancing the development of more effective and targeted therapies through translational research.

Knowledge of task duration affects energetic cost during split-belt adaptation and retention of walking patterns during post-adaptation

Humans continuously adapt locomotor patterns. Whether energetic cost reduction is the primary objective or a by-product of locomotor adaptation is not known. If energetic cost is the primary objective, then manipulating energetic cost will affect the locomotor pattern. Our study aims to determine if information about task duration affects energetic cost and locomotor adaptation during split-belt walking. We hypothesize that information about a longer adaptation duration will result in lower metabolic costs and lower mechanical work. N=52 participants walked for 10 minutes with the belts moving at 1.5 and 0.5 m/s, followed by 6 minutes of walking with both belts at 1.0 m/s. Nineteen participants walked on the split-belt while we provided True information about time remaining every minute (Group T). Nineteen participants received False information that split-belt adaptation duration was around 30 minutes (Group F). Fourteen participants walked on a split-belt with accurate information about task duration, and one update at 5 minutes remaining (Group C). Participants in Groups C and F had a lower rate of change in metabolic cost from baseline (p=0.002) and generated less positive work (p=0.012) than individuals in Group T. Changes in positive work by the fast leg predicted metabolic cost reductions only in Group F (R2=0.18, p=0.040). Participants in Group F showed greater split-belt aftereffects than the C and T groups (p<0.001). We conclude that walking biomechanics are adapted to support an energetic cost reduction when maintaining an energetic reserve is needed, as is the case for Group F, but not Group T.

Programmable production of bioactive extracellular vesicles in vivo to treat myocardial infarction

Current myocardial infarction (MI) treatment strategies remain challenged in suboptimal pharmacokinetics and potential adverse effects. Here we present a bioelectronic interface capable of producing on-demand abundant bioactive extracellular vesicles (EVs) near the MI area for in-situ localized treatment. The technology, termed electroactive patch for wirelessly and controllable EV generation (ePOWER), leverages wireless bioelectronic patch to stimulate embedded electrosensitive macrophages, actively modulating the biosynthesis of EVs and enabling EV production with high programmability to be delivered directly to the MI area. ~2400% more bioactive EVs were produced per cell under our ePOWER system. When surgically implanted, we demonstrate the therapeutic potential of in-situ EV production system to alleviate MI symptoms and improve cardiac function. This programmable ePOWER technology enables in-situ production of therapeutically rich EVs, thus reducing the need for exogenous cell expansion platforms and dedicated delivery, holding promise as a therapeutic all-in-one platform to treat various diseases.

Novel Lipid-Based Formulation to Enhance Coenzyme Q10 Bioavailability: Preclinical Assessment and Phase 1 Pharmacokinetic Trial

Background: Nutraceuticals represent a strategy for maintaining health and constitute a brilliant market in Italy and across Europe. However, the absence of strict regulations regarding formulation requirements highlights a critical issue: their poor bioavailability. An example is coenzyme Q10 (CoQ10), a quinone known for its potential as a mitochondrial protective agent but characterized by low intestinal absorption. CoQ10 is a hydrophobic molecule with high molecular weight and poor water solubility, factors that significantly limit its intestinal bioaccessibility and, consequently, its oral bioavailability. Objectives: In this context, the present study describes a novel formulation designed to enhance CoQ10 bioaccessibility through in situ emulsification upon contact with gastroenteric fluids. This technology, termed Lipid-Based Auto-Emulsifying Drug Delivery System (LiBADDS), is unique because it combines a medium-chain triglyceride (MCT), a long-chain fatty acid, conjugated linoleic acid (CLA) with a high HLB solubilizer, Polysorbate 80 (PS80), and a sodium octenyl succinate starch derivative (SOS), which can create a nanometric emulsion simply by aqueous dispersion and upon contact with gastrointestinal fluids. This phenomenon promotes the prompt dispersion of CoQ10 and its rapid translocation into the serosal compartment of the intestinal epithelium. Methods: Its efficacy was evaluated in vitro through the Caco-2 cellular model and in vivo through a crossover study on healthy volunteers, measuring pharmacokinetic parameters such as AUC, Cmax, Tmax, ΔAUC, and ΔCmax. Results: Overall, LiBADDS demonstrated a significant improvement in both the bioaccessibility and bioavailability of CoQ10 compared to the unformulated substance. Conclusions: LiBADDS showed to be a promising tool to improve CoQ10 bioavailability by enhancing its bioaccessibility.

Diagnosis and treatment of lung cancer: A molecular perspective

This editorial comments on the review by Da Silva et al, published in the World Journal of Clinical Oncology which focuses on the molecular perspectives of lung cancer. With the rapid development of molecular technology, new diagnostic methods are constantly emerging, including liquid biopsy, the identification of gene mutations, and the monitoring biomarkers, thus providing precise information with which to identify the occurrence and development of lung cancer. Biomarkers, such as circulating tumor cells, circulating tumor DNA, and circulating RNA can provide helpful information for clinical application. Common types of genetic mutations and immune checkpoints include epidermal growth factor receptor, anaplastic lymphoma kinase, c-ROS proto-oncogene 1, programmed death-1 and cytotoxic T-lymphocyte-associated protein. According to specific biomarkers, targeted therapy and immunotherapy can improve survival outcomes based on the types of gene mutation and immune checkpoints. The application of molecular approaches can facilitate our ability to control the progression of disease and select appropriate therapeutic strategies for patients with lung cancer.

Cardiac Involvement in Becker Muscular Dystrophy: Insights from Echocardiographic Analysis

Becker muscular dystrophy is an infrequent genetic disorder that results from dystrophin gene mutations. Cardiac involvement is a primary manifestation. The time of onset of underlying cardiac functional abnormalities remains largely undefined. This study involved 17 pediatric patients with Becker muscular dystrophy who visited our hospital between January 1, 2002, and December 31, 2018, and underwent echocardiographic imaging analysis. Another set of 17 controls matched for age and sex to the patient cohort was chosen for comparison. Patients with Becker muscular dystrophy demonstrated a decline in echocardiographic measures, especially deformation parameters, compared with the control group. This alteration is influenced by age. Our findings suggest that early echocardiographic monitoring may help identify subclinical cardiac dysfunction, particularly in younger patients (<10 years of age).

Carbon Dioxide Digital Subtraction Angiography for Central Venous Recanalization in a Kidney Transplant Patient: A Case Report

BACKGROUND

We present the case of a kidney transplant recipient with elevated serum creatinine who developed left upper limb swelling due to left subclavian vein thrombosis. Concerned about potential hemodialysis resumption, the patient prioritized preserving their arteriovenous fistula.

METHODS

To address the swelling and maintain fistula function, central venous recanalization was necessary. Given the risk of iodine contrast-induced acute kidney injury, particularly with elevated creatinine, the patient opted for carbon dioxide (CO2) angiography. Following forearm fistula puncture, a catheter was inserted, and 50 mL of CO2 was injected. Angiography revealed a left subclavian vein filling defect and stenosis, preventing guidewire passage. The stenosis was dilated using an 8 mm × 20 mm balloon, followed by implantation of a 6 mm × 10 mm vascular stent. Postintervention CO2 angiography confirmed successful vein opening. Oral rivaroxaban was prescribed for anticoagulation.

RESULTS

The patient's limb swelling gradually resolved, and serum creatinine remained stable.

CONCLUSION

CO2-DSA represents a potentially viable alternative imaging modality for patients requiring vascular interventions who are at elevated risk of iodinated contrast-induced nephropathy.

Efficacy, safety, and complications of manta vascular closure device in VA-ECMO decannulation: A systematic review and meta-analysis

BACKGROUND

VenoArterial (VA)-ExtraCorporeal Membrane Oxygenation (ECMO) decannulation was traditionally performed surgically, often resulting in high rates of periprocedural complications such as surgical site infections, bleeding, and elevated patient mobilization costs. The advent of percutaneous techniques, particularly the MANTA® vascular closure device (MVCD), has significantly reduced these risks by enabling faster and safer decannulation. This study aimed to systematically review the success rates and complications associated with the use of percutaneous closure devices for VA-ECMO decannulation.

OBJECTIVE

Therefore, this systematic review with meta-analysis aims to evaluate the success rates and complications associated with the use of MVCD device for VA-ECMO decannulation.

MATERIALS AND METHODS

A systematic search was conducted across Pubmed, Web of Science, and Cochrane databases to identify studies evaluating postoperative outcomes in patients undergoing VA-ECMO decannulation using the MANTA® vascular closure device. The MANTA® efficacy, incidence of emergent open repair, arterial thrombosis, acute limb ischemia, pseudoaneurysms, and major bleeding were pooled by fixed-effects meta-analysis, with sources of heterogeneity being explored by meta-regression. Assessment of studies' quality was performed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool for observational cohorts and case-series studies.

RESULTS

Seven observational studies with 235 patients were included in the final analysis. Overall efficacy of MVCD in VA-ECMO decannulation was 94.8% (95% CI 91.8%-97.9%). In 235 patients, the incidence of emergency open repair after MVCD failure was 3.7% (95% CI 1.3%-6.1%), the incidence of arterial thrombosis was 7.1% (95% CI 2.9%-11.3%), the incidence of pseudoaneurysms was 3.2% (95% CI 0.9%-5.5%), the incidence of acute limb ischemia was 5.0% (95% CI 2.3%-7.8%), and the incidence of major arterial bleeding was 4.1% (95% CI 1.6%-6.7%).

CONCLUSION

This systematic review and meta-analysis highlights the safety and efficacy of the MANTA® vascular closure device in achieving hemostasis following VA-ECMO decannulation, demonstrating an acceptable success rate and a low incidence of major complications. Further studies with larger cohorts are necessary to validate these findings and to address the limitations of this preliminary experience.

The study of the association between exercise motivation and cardiorespiratory fitness in young students: a systematic review and meta-analysis

Background

In recent years, many studies have shown that exercise motivation is essential for encouraging students to engage in physical activities. Cardiorespiratory function, which is closely related to cardiorespiratory fitness, plays a crucial supportive role in sports, and its level is usually reflected by cardiorespiratory fitness measurements. This study aims to explore the correlation between exercise motivation and cardiorespiratory fitness in young students, analyze the impact of exercise motivation on cardiorespiratory fitness, and investigate the role of cardiorespiratory fitness in the formation of exercise motivation.

Methods

Following the PRISMA statement, a comprehensive literature search was carried out in six electronic databases from July 1, 2000, to December 1, 2024. The selected studies were strictly quality-assessed, and relevant data were extracted using a standardized form. Then, a meta-analysis was conducted with Stata18 software, along with heterogeneity testing and publication bias assessment.

Results

After screening, 11 studies were included. Eight directly explored the correlation between cardiorespiratory fitness and exercise motivation, while the other four investigated the link between physical activity and exercise motivation, suggesting an association between cardiorespiratory fitness and exercise motivation during physical activity. Pearson correlation analysis (11 studies) and multiple regression analysis (7 studies) were used. By combining effect sizes with a random-effects model, the average correlation coefficient was 0.24 (p < 0.001). The average standardized coefficient of exercise motivation on promoting cardiorespiratory fitness was 0.16 (p < 0.001), and that of cardiorespiratory fitness on enhancing exercise motivation was 0.18 (p < 0.001).

Discussion

The results show a significant positive correlation between exercise motivation and cardiorespiratory fitness in young students, with a moderate positive effect on each other. This provides a theoretical basis for improving young students' cardiorespiratory fitness and exercise motivation. Future research could explore more effective assessment methods to better understand the underlying mechanisms.

High-Intensity Interval Training Decreases Circulating HMGB1 in Individuals with Insulin Resistance: Plasma Lipidomics Correlate with Associated Cardiometabolic Benefits

BACKGROUND

Bodyweight high-intensity interval training (BW-HIIT) is an effective, time-efficient exercise method that reduces cardiovascular risk factors and improves muscle endurance without requiring external equipment. High mobility group box 1 (HMGB1) is a proinflammatory protein involved in insulin resistance. Previous studies revealed that HMGB1 knockout mice show improved insulin sensitivity and hyperglycemia. This study investigates whether BW-HIIT exercise can reduce proinflammatory markers, such as HMGB1, in individuals with insulin resistance.

METHODS

In total, 14 adults (2 male/12 female) aged 18 to 55 were subject to six weeks of BW-HIIT. Additionally, 10-week-old mice were subject to exercise conditioning (5 mice per group (all male)) for 4 weeks of treadmill exercise or sedentary. Human and mouse pre- and post-exercise serum/plasma samples were analyzed for lipidomics, hormonal, and cytokine multiplex assays. Cardiometabolic parameters were also performed on human subjects.

RESULTS

Post-exercise decreased systolic blood pressure (SBP), cholesterol, triglycerides, high-density lipoprotein (HDL), and cholesterol/HDL ratio in human patients with insulin resistance. Meanwhile, hormones such as amylin, glucagon, and insulin all increased post-BW-HIIT or treadmill exercise in both human and mouse models. Moreover, circulating HMBG1 levels were reduced in insulin-resistant individuals and mice after exercise. Furthermore, treadmill exercise by the animal model increased anti-inflammatory cytokines, including interleukin (IL)-10, IL-12p40, and IL-12p70, and reduced proinflammatory cytokines: eotaxin, IL-2, and macrophage inflammatory protein (MIP)-2 or CXCL2.

CONCLUSIONS

Six weeks of BW-HIIT exercise can improve cardiometabolic health, anti-inflammatory markers, hormones, and insulin sensitivity in human and mouse models undergoing exercise. Changes in circulating HMBG1 levels following BW-HIIT exercise make HMGB1 a suitable marker for cardiometabolic disease, potentiating its role beyond an alarmin. Further studies are needed to confirm these effects and to elucidate the underlying physiological mechanisms.

Sex Hormone-Binding Globulin and Cardiac Function in Men with Heart Failure: Possible Role of Diabetes

Background: The association of sex hormone-binding globulin (SHBG) with heart failure (HF) remains a topic of ongoing debate, particularly in the light of type 2 diabetes mellitus (T2DM). We aimed to assess the association of SHBG with clinical and echocardiographic parameters of HF in men according to the presence of T2DM. Methods: Data on baseline characteristics, cardiovascular risk factors and medications, laboratory findings including serum SHBG and total testosterone concentrations, and echocardiographic parameters were prospectively collected for 215 male patients consecutively hospitalized for an acute episode of HF. Results: Patients with T2DM were older (p = 0.013), had a greater body mass index (p = 0.009) and NYHA class (p = 0.001), and were more likely to have hypertension (p < 0.001) or hyperlipidemia (p = 0.032). A moderate correlation among SHBG and total testosterone with the left ventricular ejection fraction (LVEF) was observed only in T2DM patients (r = 0.456) but not among non-T2DM patients (r = 0.194). A multivariate analysis revealed the independent association of increased SHBG levels with lower LVEF values among T2DM patients (ß = -0.542, p < 0.0001), whereas in the same group higher total testosterone was an independent predictor of higher LVEF (ß = 0.531, p < 0.0001) and lower LVDD (ß = -0.442, p = 0.0002) levels. Conclusions: In men with HF and T2DM, in contrast to testosterone, SHBG may have an independent adverse impact on the LVEF, which may account for 12.5% of the variance in LVEF levels. The possible subcellular mechanisms of SHBG in men with diabetic myocardial disorder should be additionally explored.

Mortality patterns of coronary artery diseases and atrial fibrillation in adults in the United States from 1999 to 2022: An analysis using CDC WONDER

BACKGROUND

Coronary artery disease (CAD) and atrial fibrillation (AF) contribute significantly to global mortality and frequently co-exist due to shared risk factors like hypertension and diabetes. This study seeks to explore the relatively overlooked area of mortality patterns among adults who have both coronary artery disease and atrial fibrillation.

METHODS

Mortality data for individuals aged ≥25 were obtained from CDC WONDER using ICD-10 codes I20-25 (CAD) and I48 (AF). Age-adjusted mortality rates (AAMR) and crude mortality rates per 100,000 were calculated. Trends were analyzed by gender, year, race, urbanization, and state. JoinPoint regression estimated annual percent change (APC) and average annual percent change (AAPC) with 95 % confidence intervals (CI).

RESULTS

From 1999 to 2022, there were 942,461 recorded deaths among individuals with CAD and AF in the United States. The AAMR rose from 14.35 in 1999 to 24.53 in 2022, resulting in an AAPC of 2.56* (95 % CI, 2.24 - 2.85). The AAMR showed a consistent increase throughout the study period, with a significant spike from 2018 to 2022 (APC: 6.87*; 95 % CI, 4.82 - 10.66). Men consistently had higher AAMRs than women. Non-Hispanic (NH) White individuals reported the highest AAMR, followed by NH Black, Hispanic, and NH other populations. Nonmetropolitan areas exhibited higher AAMR than metropolitan regions.

CONCLUSIONS

AAMR showed a moderate rise from 1999-2018, followed by a sharp increase from 2018-2022, possibly linked to COVID-19. Further research is needed to understand contributing factors.

Vagal pathway activation links chronic stress to decline in intestinal stem cell function

Chronic stress adversely affects intestinal health, but the specific neural pathways linking the brain to intestinal tissue are not fully understood. Here, we show that chronic stress-induced activation of the central amygdala-dorsal motor nucleus of the vagus (CeA-DMV) pathway accelerates premature aging and impairs the stemness of intestinal stem cells (ISCs). This pathway influences ISC function independently of the microbiota, the hypothalamic-pituitary-adrenal (HPA) axis, the immune response, and the sympathetic nervous system (SNS). Under chronic stress, DMV-mediated vagal activation prompts cholinergic enteric neurons to release acetylcholine (ACh), which engages ISCs via the M3 muscarinic acetylcholine receptor (CHRM3). This interaction activates the p38 mitogen-activated protein kinase (MAPK) pathway, triggering growth arrest and mitochondrial fragmentation, thereby accelerating an aging-like decline in ISCs. Together, our findings provide insights into an alternative neural mechanism that links stress to intestinal dysfunction. Strategies targeting the DMV-associated vagal pathway represent potential therapeutic approaches for stress-induced intestinal diseases.

Thrombotic Thrombocytopenic Purpura-Induced Cardiomyopathy and Troponin Clearance with Plasmapheresis: True or False Reassurance?

Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathic hemolytic anemia caused by a deficiency in the von Willebrand factor-cleaving protease ADAMTS13, resulting in the formation of microthrombi. TTP is associated with severe cardiovascular complications, such as myocardial infarction, congestive heart failure, arrhythmias, and cardiogenic shock, which can lead to a poor prognosis. Although plasmapheresis is the cornerstone of TTP treatment, it complicates the interpretation of cardiac biomarkers due to the rapid clearance of these markers from the bloodstream. We present the case of a 19-year-old African American female diagnosed with TTP who had critically elevated levels of high-sensitivity troponin (HS troponin). Notably, her HS troponin levels declined rapidly with ongoing plasmapheresis, underscoring the difficulties in interpreting cardiac biomarkers in TTP and the effects of treatment on these values. This case highlights the challenges in diagnosing and managing cardiovascular complications associated with TTP and their impact on patient prognosis.

A look to the future: cyclodextrins and cyclodextrin-based drug delivery to the retina

INTRODUCTION

Retinal diseases are a leading cause of vision loss, affecting millions of people worldwide. Current treatment options are based on invasive methods such as intravitreal injections. Therefore, there is a need for alternative therapeutic strategies that are both effective and more patient-friendly.

AREAS COVERED

Topical drug delivery has gained attention as a preferred noninvasive approach, although it is hindered by several ocular barriers. Cyclodextrin (CD)-based nanoparticles have emerged as a promising strategy to overcome these limitations by enhancing drug permeability in the posterior segment of the eye. This review discusses the potential of CDs as enabling pharmaceutical excipients, their role in improving ocular drug bioavailability, and provides examples of CD-based eye drop formulations currently under development or undergoing clinical trials. Also, the role of CDs as active pharmaceutical agents in ophthalmology is discussed.

EXPERT OPINION

CD-based nanoparticle eye drops present a promising solution and have shown clinical success. CDs are approved pharmaceutical excipients for eye drop formulations and can act as active pharmaceutical ingredients for the treatment of inherent retinal diseases. Future innovations in hybrid CD-based delivery systems and integration of novel therapeutic compounds could provide more efficient and targeted treatment options for retinal diseases.

Prospective comparison of temporal changes in myocardial function in women with Takotsubo versus anterior STEMI

BACKGROUND

Takotsubo syndrome (TS) and STEMI with timely reperfusion are both characterized by reversible acute myocardial dysfunction, often referred to as myocardial stunning. The natural course of cardiac functional recovery is incompletely understood in TS and STEMI. The aim of this study was to prospectively compare changes in cardiac function over the acute and subacute phases in women with TS versus anterior STEMI.

METHODS

The Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study prospectively enrolled 61 women with TS and 41 women with STEMI. Echocardiography and blood sampling was performed within 4 h of admission and at 1, 2, 3, 7, 14, and 30 days after admission. The primary outcome was the proportion of reversible left ventricular akinesia (defined as extent of akinesia at baseline versus at 30 days) that resolved by 72 h. Secondary outcomes included LVEF, GLS, and TAPSE. Mixed effects linear regression or mixed effects tobit models with random intercepts were used to model echocardiographic parameters over time.

RESULTS

At 72 h 40.4% [95% CI 30.1%, 50.1%] of the reversible akinesia had resolved in women with TS, versus 54.7% [95% CI 38.3%, 72.0%] for STEMI (difference 14.3% [95% CI - 4.6%, 34.3%]). Time-course of recovery of LVEF and GLS was also similar in TS and STEMI. TAPSE was reduced in TS but normal in STEMI; and recovered in a similar timeframe as the left ventricular indices. In both TS and STEMI, considerable recovery of cardiac function occurred after 7 days.

CONCLUSIONS

The time course of recovery of cardiac function is similar in TS and STEMI.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT04448639, https://clinicaltrials.gov/study/NCT04448639 .

Extraction of grape seeds by different solvents affects the activities of the resultant extract

Phenolic compounds are concentrated in grape seeds; 60-70% of the extractable grape phenols are found in the seeds. The focus of this research was to isolate the phytochemicals from grape seed and to determine their ability to prevent haemolysis, their antioxidant and microbiological activities. By using the extraction procedure, three solvents were used (distilled water, ethanol and methanol). A high-performance liquid chromatographic (HPLC) test was performed to analyse the phenolic compounds and flavonoids content that were used to determine the efficiency of the various solvents used in the extraction process. All the variables under study, namely yield percentage, phenolic component concentration, and flavonoid content got significantly affected by the choice of the solvent used. The flavonoid content of the extracts was in the order methanolic extract > ethanolic extract > water extract. The methanolic extract of the grape seeds exhibited the most powerful antioxidant and hemolysis inhibitory effects among the three extracts, followed by the ethanolic and water extracts. The antibacterial activity of methanolic extract was found to be higher as compared to the ethanolic extract against Staphylococcus aureus. The antibacterial activity of the ethanolic and methanolic extracts against Salmonella enteritidis, Bacillus subtilis, Aspergillus niger and Escherichia coli were found to be equivalent. In conclusion, grape seeds contained several bioactive compounds that exerted an antioxidant, hemolysis inhibition and anti-microbial activities. These activities depends on the concentration of phenolic compounds and flavonoids in the grape seed extracts. Methanol was the superior solvent in the extraction process followed by ethanol.

Rosmarinic acid: a promising agent for male rats' renal protection against ischemia/reperfusion injury

BACKGROUND

This study investigated the potential anti-inflammatory and antioxidant renoprotective effects of rosmarinic acid, a naturally occurring phenylpropanoid, against renal damage and dysfunction following renal ischemia/reperfusion (I/R) in male rats.

METHODS

The rats were divided into four separate groups (n = 7 per group): sham (1 ml 1% DMSO, i.p.), sham + RA (rosmarinic acid, 100 mg/kg in 1 ml 1% DMSO, i.p.), I/R (bilateral renal ischemia for 45 min followed by 24 h reperfusion), I/R + RA (rosmarinic acid, 100 mg/kg in 1 ml 1% DMSO, i.p. once, 30 min prior to ischemia). After the 24-hour reperfusion period, kidney tissue samples, blood, and 24-hour urine were taken.

RESULTS

In contrast to the sham and sham + RA groups, IR injury (IRI) resulted in renal dysfunction (increased fractional excretion of sodium and decreased creatinine clearance), raised malondialdehyde levels, enhanced TLR4 (Toll-like receptor 4), NFĸB (nuclear factor-ĸB) and TNF-α (tumor necrosis factor-alpha) gene expression levels, and histological lesions in kidney tissue Administration of rosmarinic acid attenuated each change.

CONCLUSIONS

Rosmarinic acid protects the kidney against IRI by reducing inflammation and oxidative stress. Rosmarinic acid's anti-inflammatory and antioxidant properties most likely play an important role in addressing functional problems and protecting the kidney from IRI.

Trends in Antifungal Resistance Among Candida Species: An Eight-Year Retrospective Study in the Galveston-Houston Gulf Coast Region

Fungal systemic infections are a growing global health concern, particularly among immunocompromised individuals. Candida species are the leading cause of invasive fungal infections, with C. albicans historically being the most prevalent. The emergence of C. auris, known for its multidrug resistance, presents additional challenges for treatment and infection control. This study retrospectively analyzed minimal inhibitory concentration (MIC) data for common Candida species isolated from patients in the Galveston-Houston Gulf Coast region from the EPIC Laboratory Information System (LIS) between October 2016 and September 2024. Antifungal susceptibility was assessed using the SensititreTM YeastOneTM YO9 AST Plate and interpreted per Clinical and Laboratory Standard Institute (CLSI) guidelines. A total of 1206 clinical yeast isolates from over 29 species were identified, with Candida species accounting for 94.5% (1140). C. albicans (30.7%), C. glabrata (23.5%), C. parapsilosis (12.2%), and C. tropicalis (10.4%) were the most prevalent. C. auris (6.2%) emerged in late 2021 in our region, showing high MICs against fluconazole (92%) and amphotericin B (32.2%). While C. albicans, C. parapsilosis, and C. tropicalis remained susceptible to echinocandins, fluconazole resistance showed an increasing trend. C. glabrata exhibited variable susceptibility to both echinocandins and azoles. These findings highlight the urgent need for enhanced antifungal stewardship, improved diagnostics, and novel therapeutic strategies. Continued regional surveillance and targeted interventions are essential to mitigating the impact of antifungal resistance.

Prognostic significance of myocardial fibrosis in men with alcoholic cardiomyopathy: insights from cardiac MRI

OBJECTIVES

Myocardial fibrosis significantly impacts prognosis in various cardiovascular diseases, yet its role in alcoholic cardiomyopathy (ACM) remains poorly understood. This study evaluates the prognostic value of myocardial fibrosis, as detected by cardiac magnetic resonance (CMR), in ACM patients.

METHODS

We conducted a retrospective analysis of consecutive ACM patients who underwent enhanced CMR from August 2015 to October 2023. Assessment of myocardial fibrosis was performed using late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) fraction. The primary outcome was a composite of cardiac-related mortality, heart transplantation, hospitalization for heart failure, life-threatening arrhythmias, and the need for implantable cardioverter-defibrillator or cardiac resynchronization therapy.

RESULTS

A total of 141 male patients were finally enrolled with 27.7% experiencing the primary outcome over a median follow-up of 30.6 months (IQR: 18.0-44.9). LGE was found in 55.3% of patients, with a median extent of 2.9%. Compared to DCM patients who didn't consume alcohol, ACM patients showed lower LGE, native T1, and ECV values. Multivariate analysis showed LGE (HR, 1.09 [1.04, 1.15]; p < 0.001), native T1 (per 10 ms increase, 1.06 [1.02, 1.10]; p = 0.003), and ECV (per 3% increase, 1.57 [1.22, 2.01]; p < 0.001) had significant prognostic associations with adverse outcomes. Including myocardial fibrosis parameters improved predictive accuracy beyond standard assessments. A nonlinear relationship was found between lifetime ethanol consumption and myocardial fibrosis, with a plateau at low exposures and a sharp increase at higher levels.

CONCLUSION

CMR-identified myocardial fibrosis has an association with major adverse cardiac events in ACM patients, underscoring its utility in risk stratification.

KEY POINTS

Question The prognostic role of myocardial fibrosis in alcoholic cardiomyopathy remains poorly understood. Findings Fibrosis detected by cardiac MRI has good incremental value for predictive models in assessing the risk of adverse cardiovascular events in patients with alcoholic cardiomyopathy. Clinical relevance Cardiac MRI may be a potential tool to identify high-risk alcoholic cardiomyopathy patients with cardiovascular adverse event, which is helpful for early clinical treatment, and improves patients prognosis.

Developments in Extracellular Matrix-Based Angiogenesis Therapy for Ischemic Heart Disease: A Review of Current Strategies, Methodologies and Future Directions

Ischemic heart disease (IHD) is the leading cause of mortality worldwide, underscoring the urgent need for innovative therapeutic strategies. The cardiac extracellular matrix (ECM) undergoes extreme transformations during IHD, adversely influencing the heart's structure, mechanics, and cellular signaling. Researchers investigating the regenerative capacity of the diseased heart have turned their attention to exploring the modulation of ECM to improve therapeutic outcomes. In this review, we thoroughly examine the current state of knowledge regarding the cardiac ECM and its therapeutic potential in the ischemic myocardium. We begin by providing an overview of the fundamentals of cardiac ECM, focusing on the structural, functional, and regulatory mechanisms that drive its modulation. Subsequently, we examine the ECM's interactions within both chronically ischemic and acutely infarcted myocardium, emphasizing key ECM components and their roles in modulating angiogenesis. Finally, we discuss recent ECM-based approaches in biomedical engineering, focusing on different types of scaffolds as delivery tools and their compositions, and conclude with future directions for therapeutic research. By harnessing the potential of these emerging ECM-based therapies, we aim to contribute to the development of novel therapeutic modalities for IHD.

Pressure Guidewire Indicated for Coronary Fractional Flow Reserve Assessment: Structural Design, Deficiencies and Potential Solutions

Coronary heart disease (CHD) is one of the leading causes of mortality worldwide. It is primarily caused by myocardial ischemia and hypoxia resulting from atherosclerotic plaques in the coronary arteries, leading to symptoms such as angina. The severity of CHD determines the treatment approach, which may include medication or interventional therapy. Therefore, accurately assessing the severity of myocardial ischemia is crucial for effective CHD management. In recent years, fractional flow reserve (FFR), derived from the relationship between flow and pressure, has gained widespread recognition for providing valuable information to guide coronary revascularization. Pressure guidewires equipped with pressure sensors at their tips are the most commonly used tools for clinical FFR assessment. These wires measure vessel pressure to determine the severity of coronary lesions. However, during their use, issues such as signal drift, tip breakage, core wire fractures, and coating detachment may occur. This article reviews the historical development of pressure guidewires, examines the general structure of two commonly used pressure guidewires available in the market, highlights typical issues encountered during clinical use, and proposes corresponding solutions.