Interrelation of Oxidative Stress and Genetics in Pathophysiology of Obesity and Obesity-Related Conditions

Obesity is a medical condition influenced by many factors and manifested by the excessive accumulation of fat. It is well documented that oxidative stress plays a significant role in the development of obesity and its related diseases. The antioxidant system's enzymes, such as catalase, superoxide dismutase, glutathione peroxidase, paroxonase, etc., play a significant role in maintaining the oxidant-antioxidant balance in living organisms. Genetic variants of antioxidant system genes may affect the antioxidant system and its efficacy, which can lead to increased oxidative stress and higher risk for the development of obesity and its comorbidities. This review is focused on genetic variants such as single nucleotide polymorphisms of some antioxidant enzymes, ROS generators and transcription factors, and their impact on increased oxidative stress and the development of obesity and medical conditions related to obesity, like insulin resistance and metabolic syndrome.

A Systematic Review of Transcarotid Approach for Endovascular Aortic Repair in Treating Aortic Disease

PurposeThe purpose of this study is to evaluate the feasibility, efficacy, and safety of transcarotid approach endovascular aortic repair (EVAR) in patients where conventional femoral access is not possible.Materials and MethodsA systematic review of all articles discussing transcarotid approach EVAR published in the PubMed, Embase, Ovid, Web of Science, and Cochrane Library databases were conducted. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsIn accordance with the inclusion criteria, 17 articles discussing transcarotid approach EVAR were retrieved, encompassing 18 patients. Among these patients, 6 patients were related to ascending aortic disease, including 4 cases of pseudoaneurysms, 1 case of penetrating ulcer, and 1 case of dissection. 9 patients had descending aortic disease, comprising 6 aneurysms, 2 penetrating ulcers, and 1 pseudoaneurysm. There were 3 cases of abdominal aortic disease, including 2 aneurysms and 1 endoleak. Among these patients, 10 cases had access through the left common carotid artery, and 8 cases had access through the right common carotid artery. One patient experienced spinal cord ischemia and subsequently died of multi-organ failure caused by acute pancreatitis. Additionally, there was one case of minor embolization in the nonsurgical carotid supply area. No cerebral infarctions were observed in the vascular territory of the ipsilateral carotid artery at the surgical approach site.ConclusionsResearch on transcarotid approach EVAR is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This systematic review suggests that transcarotid approach EVAR may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. These findings indicate that this method is associated with a relatively manageable perioperative complications and mortality rates.

Contemporary Perspectives on Congestion in Heart Failure: Bridging Classic Signs with Evolving Diagnostic and Therapeutic Strategies

Congestion represents a defining hallmark of heart failure (HF) leading to increased morbidity and mortality in HF patients. While it was traditionally viewed as a simple and uniform state of volume overload, contemporary understanding has emphasized its complexity, distinguishing between intravascular, interstitial, and tissue congestion. Congestion contributes to overt clinical manifestation of HF. However, subclinical congestion often goes undetected, increasing the risk of adverse outcomes. Residual congestion, in particular, remains a frequent and challenging issue, with its persistence at discharge being strongly linked to rehospitalization and poor prognosis. Clinical evaluation often fails to reliably identify the resolution of congestion, highlighting the need for supplementary diagnostic methods. Improvement in imaging modalities, including lung ultrasound, venous Doppler, and echocardiography, have significantly enhanced the detection of congestion. Moreover, biomarkers such as natriuretic peptides, bioactive adrenomedullin, soluble CD146, and carbohydrate antigen 125 offer valuable, complementary insights into fluid distribution and the severity of HF congestion. Therefore, a comprehensive, multimodal strategy that integrates clinical evaluation with imaging and biomarker data is crucial for optimizing the management of congestion in HF. Future approaches should prioritize personalized decongestive therapy, addressing both intravascular and tissue congestion, while aiming to preserve renal function and limit neurohormonal activation. Refinement of these strategies holds promise for improving long-term outcomes, reducing rehospitalizations, and enhancing overall patient prognosis.

Exploring the prognostic value of the novel nutritional index for in-hospital mortality in acute coronary syndrome: a sex-specific analysis

Background

Emerging evidence suggests that nutritional status plays a pivotal role in determining the prognosis of patients with acute coronary syndrome (ACS). This study aimed to investigate the relationship between a novel nutritional index, Triglycerides × Total Cholesterol × Body Weight Index (TCBI), and short-term prognosis in patients with ACS.

Methods

A retrospective study was conducted using data from 5,277 ACS patients admitted to intensive care units of 208 United States hospitals in the eICU Collaborative Research Database (eICU-CRD) in 2014 and 2015. Patients were divided into three groups based on TCBI tertiles: Group 1 (< 1017.97), Group 2 (1017.97-2069.02), and Group 3 (> 2069.02).

Results

Multivariate logistic regression analysis showed that after adjusting for 17 confounding variables, higher TCBI had significantly lower in-hospital mortality [Tertile 3 vs Tertile 1: OR (95% CI): 0.67 (0.48, 0.94), p = 0.019]. This relationship was significant in the male subgroup but not in the female subgroup. The association between TCBI and in-hospital mortality was more pronounced in male patients and those with blood pressure > 140 mmHg. Subgroup analysis revealed a significant interaction between sex and the predictive value of TCBI (p for interaction < 0.05).

Conclusion

Higher TCBI was independently associated with decreased in-hospital mortality in ACS patients, particularly in male patients. TCBI, as a novel nutritional index, may serve as a practical tool for risk stratification and personalized management of ACS patients.

Beyond Pulmonary Vein Reconnection: Exploring the Dynamic Pathophysiology of Atrial Fibrillation Recurrence After Catheter Ablation

Atrial fibrillation (Afib) recurrence after catheter ablation (CA) remains a significant clinical challenge, driven by a complex and dynamic interplay of structural, electrical, and autonomic mechanisms. While pulmonary vein isolation (PVI) is the cornerstone of CA, recurrence rates remain substantial, highlighting the need to understand the evolving pathophysiology beyond PV reconnection. Post-ablation changes, including inflammation, edema, oxidative stress, and ischemia, create a transient proarrhythmic state that may contribute to early recurrence. Over time, atrial remodeling, fibrosis, and residual autonomic activity further sustain arrhythmogenicity. Additionally, epicardial adipose tissue promotes atrial myopathy, accelerating disease progression, particularly in patients with risk factors such as older age, female sex, obesity, hypertension, obstructive sleep apnea, and heart failure. The multifactorial nature of Afib recurrence underscores the limitations of a "one-size-fits-all" ablation strategy. Instead, a patient-specific approach integrating advanced mapping techniques, multimodal imaging, and computational modeling is essential. Artificial intelligence (AI) and digital twin models hold promise for predicting recurrence by simulating individualized disease progression and optimizing ablation strategies. However, challenges remain regarding the standardization and validation of these novel approaches. A deeper understanding of the dynamic interconnections between the mechanisms driving recurrence is crucial for improving long-term CA outcomes. This review explores the evolving nature of Afib recurrence, emphasizing the need for a precision medicine approach that accounts for the continuous interaction of pathophysiological processes in order to refine patient selection, ablation strategies, and post-procedural management.

Efficacy and safety of antidepressant in post-myocardial infarction associated depression: a meta-analysis and systematic review

OBJECTIVE

This study aimed to summarize the available data and assess whether antidepressants are effective and well-tolerated in the treatment of post-myocardial infarction (MI)-associated depression.

MATERIALS AND METHODS

A comprehensive search of public databases (PubMed, Embase, Web of Science, Ovid, EBSCO, and the Cochrane Library) was conducted for publications on interventions for post-MI depression before October 2024. Keywords included post-myocardial infarction depression, antidepressants, myocardial infarction, and depression. Pooled data were analyzed using Stata software.

RESULTS

A total of twelve studies were included. At baseline, no significant difference was observed in depression severity between the antidepressant treatment and control groups (pooled SMD = -0.022, 95% CI: -0.087-0.044). Antidepressant treatment significantly reduced depression scores after long-term follow-up (pooled SMD = -1.023, 95% CI: -1.671- -0.375). The incidence of adverse cardiac events was not significantly higher in the treatment group compared to the control group (pooled HR = 0.893, 95% CI: 0.793-1.005). Antidepressants did not increase the risk of all-cause mortality (pooled HR = 0.957, 95% CI: 0.699-1.311), and there was no significant difference in the risk of rehospitalization for heart disease (pooled HR = 1.070, 95% CI: 0.820-1.398). Antidepressant treatment was associated with a reduced risk of MI recurrence (pooled HR = 0.787, 95% CI: 0.693-0.894) and revascularization procedures (pooled HR = 0.858, 95% CI: 0.755-0.975). Moderate-certainty evidence (GRADE assessment) supports antidepressant efficacy in improving depressive symptoms, while low-certainty evidence suggests potential cardiac risk reduction.

CONCLUSION

This meta-analysis demonstrates that antidepressants are effective and well-tolerated in the treatment of post-MI depression. Antidepressants can improve depressive symptoms without adversely affecting long-term prognosis. The clinical application of these findings should consider the moderate certainty for symptom improvement and low certainty for MI recurrence benefits.

Ante-mortem diagnosis of unilateral pulmonary vein stenosis in a cat: a case report

BACKGROUND

Pulmonary hypertension (PH) detection in cats may be challenging. Pulmonary venous stenosis (PVS) is rare in cats and can lead to PH. The only reported PVS case received a post-mortem diagnosis. Imaging during the cat's lifetime established the diagnosis in this case.

CASE PRESENTATION

A 2 year-old Norwegian Forest cat was diagnosed with pulmonary oedema and PH secondary to cor triatriatum sinister (CTS) and showed improved breathing following two subcutaneous furosemide treatments, 1 and 2 mg/kg, during an overnight stay at the referral veterinary hospital. Sildenafil alone (0.69 mg/kg, PO, BID) was prescribed post-discharge to address PH without diuretics. Post-discharge from the referral veterinary hospital, collapse and pre-syncope were suspected to be due to PH. Consequently, sildenafil was titrated weekly, starting at 1.09 mg/kg BID and increasing to 1.63 mg/kg BID. Pre-syncope and collapse resolved, and pulmonary opacities reduced considerably, although concerns remained that increased pulmonary blood flow to suspected CTS from sildenafil might worsen cardiogenic pulmonary oedema. The patient was also treated with rivaroxaban (2.5 mg/head, SID), considering the increased risk of thrombus formation due to blood flow stasis and endothelial damage. Thirty-eight days later, the cat presented for the first time to our hosipital (Azabu University Veterinary Teaching Hospital) for examination. On echocardiography, a continuous mosaic blood flow (maximum and minimum velocity, 3.14 m/s; estimated pressure gradient, 39.4 mmHg) was observed in two enlarged pulmonary veins. Pulmonary artery enlargement (main pulmonary artery to thoracic aorta ratio: 1.90), pulmonary vein stenosis (PVS), and diffuse bilateral ground-glass lung opacities were observed using computed tomography. PH with unilateral PVS involving two out of the three right pulmonary veins, specifically the right cranial and right middle pulmonary veins, along with pulmonary parenchymal disease, was diagnosed. The cat was further treated with furosemide (1 mg/kg, BID, PO) with no clinical signs but succumbed to acute dyspnoea 51 days after the first visit.

CONCLUSIONS

Unilateral PVS should be considered in young cats with a localised alveolar pattern and no left atrial enlargement, because the prognosis may be poor. Severe PH with PVS may coexist with lung disease. If sildenafil is used, it should be started at a low dose and monitored closely.

Sex hormones correlate with heart rate variability in healthy women and this correlation is conserved in women with well-controlled type 2 diabetes mellitus

SUBJECTS AND METHODS

In this study, four groups of women were designated according to their health status (control or T2DM) and fertility status (premenopausal or postmenopausal). Five serum sex hormones were measured (estradiol, progesterone, testosterone, LH and FSH), and time-domain and frequency-domain HRV indices were determined during three conditions: supine position, active standing, and rhythmic breathing. For the complete sample (n=118), bivariate Pearson correlations and linear multiple regressions were used to analyze the relationship between sex hormones, HRV indices, and other independent variables, such as glycemia and age. A p-value <0.05 was considered as significant.

RESULTS

There were no differences in sex hormones or HRV indices when comparing the healthy and T2DM groups. All bivariate Pearson correlations were significant between sex hormones and HRV indices; estradiol, progesterone, and testosterone have positive correlations; meanwhile, LH and FSH were negative in the time-domain (SDNN, RMSSD, pNN20) and frequency domain (PLF and PHF) indices. Regression models adjusted for mean heartbeat intervals confirmed an association between all sex hormones and HRV indices. Estradiol maintained significance in the regression models for specific HRV indices during supine and active standing conditions even after adjusting for age and glucose levels.

CONCLUSIONS

All sex hormones correlate with HRV indices. Regression analysis confirms that this correlation is independent from the mean heartbeat interval. However, in regression models adjusted for age and glucose levels, only estradiol was found to be significant, and should be considered an important variable related to cardiovascular and autonomic balance in T2DM women and may provide crucial information to improve cardiovascular risk algorithms.

Association of Angiotensin Receptor-Neprilysin Inhibitors Use and Better Cardiorenal Outcomes in Patients With Heart Failure and Acute Kidney Disease

PURPOSE

Angiotensin receptor-neprilysin inhibitors (ARNi) have been shown to improve cardiovascular outcomes in heart failure (HF) patients. However, their impact on HF patients with concurrent acute kidney disease (AKD) remains underexplored. This study investigated the outcomes of ARNi compared to angiotensin-converting enzyme inhibitors (ACEi) in HF patients with AKD.

METHODS

The study included 20,009 hospitalized HF and AKD patients who underwent dialysis during hospitalization, recovered from dialysis within 90 days after discharge, and were followed until November 30, 2022, using data from TriNetX. The study period began in July 2015, coinciding with the availability of ARNi in the market. Propensity score matching (1:1) was applied to balance ARNi and ACEi groups. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were calculated to assess the risks of mortality, major adverse kidney events (MAKE), readmission and major adverse cardiac events (MACE). The follow-up period was conducted with a maximum duration of 5 years.

RESULTS

A total of 20,009 AKD patients (mean [SD] age, 59.1 [12.2] years) were enrolled, of whom 21.9% received ARNi, with a median follow-up of 2.3 years. After matching, 4391 patients (mean age, 58.6 years; male, 67.9%) were identified in both the ARNi and control groups. ARNi users exhibited a significantly lower risk of mortality (aHR, 0.32, 95% CI 0.13-0.80, p = 0.01), MAKE (aHR, 0.58, 95% CI 0.51-0.66, p < 0.01 ), and readmission (aHR, 0.61, 95% CI 0.55-0.68, p <0.01) versus controls. However, no significant difference in the risk of MACE was observed between the two groups (aHR, 0.94, 95% CI 0.82-1.09, p = 0.78). Subgroup analysis revealed ARNi users, when concomitantly treated with mineralocorticoids, diuretics, or beta-blockers had significantly lower risks of mortality, readmission, and MAKE than the control group. In addition, ARNi significantly reduced mortality and MAKE in patients with GFR 30-60 mL/min/1.73 m2, irrespective of proteinuria status. However, no significant benefit was observed in patients with GFR <30 mL/min/1.73 m2.

CONCLUSIONS

In HF patients with AKD, ARNi was associated with reduced all-cause mortality, MAKE, and readmission risks compared to ACEi, particularly with concurrent mineralocorticoids, diuretics, or beta-blockers. Future research is necessary to further investigate the impact of ARNi on outcomes in patients with HF and AKD.

The combined effects of high-intensity interval training and time-restricted feeding on the AKT/FOXO1/PEPCK pathway in diabetic rats

High-intensity interval training (HIIT) and time-restricted feeding (TRF) have shown promise for improving glucose regulation by increasing insulin sensitivity, enhancing glucose uptake, reducing glucose production. Therefore, this study investigates the combined effects of HIIT and TRF on the AKT/FOXO1/PEPCK signaling pathway in the liver tissue of type 2 diabetic rats. 42 male Wistar rats (4-5 weeks of age) were included in the study. The animals were randomly divided into two groups: (1) Standard diet (SD, non-Diabetic (Non-D, n = 7) (2) High-fat diet (HFD, n = 35) for 4 weeks. To induce diabetes, 35 mg/kg of streptozotocin (STZ) was injected intraperitoneally (IP). Animals with blood glucose levels of > 250 mg/dL were considered as diabetic. Diabetic rats were randomly divided into 5 groups (n = 7): (1) Diabetes-exercise (D-EX), (2) Diabetes-TRF (D-TRF), (3) Diabetes-combined TRF and exercise (D-TRF&EX), (4) Diabetes no treatment (D-NT), (5) Diabetes with metformin (D-MET). Interventions (HIIT and TRF) were performed for 10 weeks. Rats in the Non-D group did not exercise and did not receive metformin or TRF. Periodic Acid-Schiff (PAS) staining was used to histologically analyze the liver tissue. Levels of blood glucose, insulin resistance (IR), FOXO1 protein, PEPCK, and area under the curve (AUC) following the IPGTT test, were significantly decreased in treatment groups compared to the D-NT group (p < 0.05). The AKT protein levels (p < 0.01), glycogen content (p < 0.05), and insulin sensitivity (p < 0.001) increased in the treatment groups as compared with the D-NT group. Microscopic examination of the liver tissue in general showed a better tissue arrangement in both treatment groups than in the D-NT group. Combining HIIT and TRF may be effective for improving blood glucose regulation, insulin sensitivity, in type 2 diabetes, as compared to TRF or HIIT interventions alone.

Cardioprotective effect of 19,20-epoxydocosapentaenoic acid (19,20-EDP) in ischaemic injury involves direct activation of mitochondrial sirtuin 3

AIMS

Although current clinical therapies following myocardial infarction (MI) have improved patient outcomes, morbidity, and mortality rates, secondary to ischaemic and ischaemia reperfusion (IR) injury remains high. Maintaining mitochondrial quality is essential to limit myocardial damage following cardiac ischaemia and IR injury. The mitochondrial deacetylase sirtuin 3 (SIRT3) plays a pivotal role in regulating mitochondrial function and cardiac energy metabolism. In the current study, we hypothesize that 19,20-epoxydocosapentaenoic acid (19,20-EDP) attenuates cardiac IR injury via stimulating mitochondrial SIRT3.

METHODS AND RESULTS

Ex vivo models of isolated heart perfusions were performed in C57BL/6 mice to assess the effect of 19,20-EDP on cardiac function and energy metabolism following IR injury. In vivo permanent occlusion of the left anterior descending coronary artery was performed to induce MI; mice were administered 19,20-EDP with or without the SIRT3 selective inhibitor 3-TYP. Mitochondrial SIRT3 targets and respiration were assessed in human left ventricular tissues obtained from individuals with ischaemic heart disease (IHD) and compared to non-failing controls (NFCs). Binding affinity of 19,20-EDP to human SIRT3 was assessed using molecular modelling and fluorescence thermal shift assay. Results demonstrated that hearts treated with 19,20-EDP had improved post-ischaemic cardiac function, better glucose oxidation rates, and enhanced cardiac efficiency. The cardioprotective effects were associated with enhanced mitochondrial SIRT3 activity. Interestingly, treatment with 19,20-EDP markedly improved mitochondrial respiration and SIRT3 activity in human left ventricle (LV) fibres with IHD compared to NFC. Moreover, 19,20-EDP was found to bind to the human SIRT3 protein enhancing the NAD+-complex stabilization leading to improved SIRT3 activity. Importantly, the beneficial effects of 19,20-EDP were abolished by SIRT3 inhibition or using the S149A mutant SIRT3.

CONCLUSION

These data demonstrate that 19,20-EDP-mediated cardioprotective mechanisms against ischaemia and IR injury involve mitochondrial SIRT3, resulting in improved cardiac efficiency.

The burden and trend prediction of ischemic heart disease associated with lead exposure: Insights from the Global Burden of Disease study 2021

AIM

The purpose of this study was to quantify the global burden of ischemic heart disease associated with lead exposure, utilizing data from the Global Burden of Disease (GBD) Study, 2021.

METHODS

Data on the burden of ischemic heart disease (IHD) associated with lead exposure were compiled globally from 1990 to 2021. These data were further stratified by dimensions including gender, age, GBD regions, and countries. Utilizing the Joinpoint regression model, we analyzed long-term trends in the burden of IHD disease associated with lead exposure and derived estimated annual percentage changes (EAPC). For future projections, we used an ARIMA model to predict potential trends in the burden of IHD disease associated with lead exposure over the next decade.

RESULTS

The study's findings reveal that in 2021, there were 590,370 deaths attributed to IHD (95% UI (Uncertainty interval (UI) is derived from the Bayesian school of statistical analysis used in the GBD studies. Unlike the frequency school of thought, which constructs confidence intervals (CI), the Bayesian school of thought views probability as a measure of confidence in an event, and in this approach the actual mean is viewed as a random variable dependent on the data and prior knowledge, with UI indicating that there is a specific probability (e.g., 95%) that the actual mean will fall within the interval.): -83,778 to 1,233,628) and 11,854,661 disability-adjusted life years (DALYs) (95% UI: -1,668,553 to 24,791,275) globally due to lead exposure, reflecting an increasing and then stabilizing trend from 1990 to 2021. Comparative analysis across study regions indicated a higher disease burden for IHD in regions with lower Socio-Demographic Index (SDI) values, contrasting with the lower burden in regions with higher SDI values. Furthermore, IHD mortality and DALYs peak in the 70-80 age cohort, with males exhibiting higher rates compared to females. Decadal projections indicate a downward trend in IHD mortality and DALYs for regions with higher SDI, in contrast to an anticipated upward trend in regions with lower SDI.

CONCLUSION

The global burden of ischemic heart disease associated with lead exposure is increasing, particularly in regions with low SDI values and within the elderly population. Considering the profound threat posed by lead exposure to the global burden of IHD, there is an imperative to consistently reinforce and execute robust prevention strategies to mitigate environmental lead exposure.

Effects of different exercise habits on mitigating physical frailty in older adults: A cross-sectional study

Encouraging regular exercise is essential for promoting health among older adults. This study aimed to examine the effects of exercise on frailty and aging, considering demographic and economic factors. Between August to December 2022, individuals aged 65 and older were recruited from 12 districts in Taipei. A self-administered questionnaire was used to collect data on exercise frequency, duration, and type. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria. A total of 2,545 participants were analyzed using logistic regression. The results indicated that 23.4% of participants were pre-frail and 8.7% were frail. Regular exercise was significantly associated with a reduced risk of frailty. Specifically, exercise duration exhibited a significant inverse relationship with frailty risk. Participants that exercised 31-60 minutes daily had a 59% lower risk of frailty compared to those who exercised less than 15 minutes daily. Those participants who exercised more than 60 minutes daily had a 69% lower risk. Additionally, participants who did not engaging in aerobic exercise had a 34% higher risk of pre-frailty. Thus, these findings underscore the importance of promoting regular exercise, particularly aerobic exercise, as key strategies to reduce frailty and improve overall health in older adults.

A multi-trait genome-wide association study of coronary artery disease and subclinical atherosclerosis traits

Measures of subclinical atherosclerosis, such as coronary artery calcification (CAC) and carotid intima-media thickness (CIMT), reflect the underlying pathophysiology of coronary artery disease (CAD) and are genetically correlated with CAD and related risk factors. Leveraging summary statistics from genome-wide association studies of CAD, CIMT, CAC, type 2 diabetes, low-density lipoprotein cholesterol, and systolic blood pressure, we performed 15 separate multi-trait GWAS to identify shared susceptibility loci and elucidate the pleiotropic architecture underlying atherosclerosis. We identified 442 shared risk loci across all analyses that met an experiment-wide Bonferroni threshold of 3.3 × 10-9, uncovering 195 novel atherosclerosis loci. Multi-trait colocalization confirmed a shared causal signal in 25 shared novel loci for atherosclerosis. Trait-eQTL colocalization identified evidence of a shared causal signal in arterial, subcutaneous adipose, and cardiac tissues, implicating genes such as PRRX2, BNC2, CLIC4, SCAI, and PPP6C, and pathways related to vascular remodeling, inflammation, and metabolic regulation.

Drug Design in the Age of Network Medicine and Systems Biology: Transcriptomics Identifies Potential Drug Targets Shared by Sarcoidosis and Pulmonary Hypertension

Network medicine considers the interconnectedness of human diseases and their underlying molecular substrates. In this context, sarcoidosis and pulmonary hypertension (PH) have long been thought of as distinct diseases, but there is growing evidence of shared molecular mechanisms. This study reports on common differentially expressed genes (DEGs), regulatory elements, and pathways between the two diseases. Publicly available transcriptomic datasets for sarcoidosis (GSE157671) and PH (GSE236251) were retrieved from the Gene Expression Omnibus database. DEGs were identified using GEO2R, followed by pathway enrichment and gene interaction analyses via GeneMANIA and STRING. Importantly, a total of 13 common DEGs were identified between sarcoidosis and PH, with 7 upregulated and 6 downregulated genes. The SMAD2/3 nuclear pathway was a shared enriched pathway, suggesting a role in fibrosis and immune regulation. There were also divergences between sarcoidosis and PH. For example, gene set enrichment analysis indicated significant associations of the IFN-gamma signaling pathway with sarcoidosis and the TNF-alpha signaling with PH. miRNA network analysis identified hsa-miR-34a-5p, hsa-let-7g-5p, and hsa-miR-19a-3p as key shared regulators linked to common genes in both sarcoidosis and PH. Finally, DGIdb analysis revealed potential therapeutic candidates targeting these genes in both diseases. This study contributes to the field of drug design and discovery from a network medicine standpoint. The shared molecular links uncovered between sarcoidosis and PH in this study point to several potential biomarkers and therapeutic targets. Further experimental validation and translational medical research are called for diagnostics and drugs, which can effectively and safely help the clinical management of both diseases.

Cardiac and Digestive Forms of Chagas Disease: An Update on Pathogenesis, Genetics, and Therapeutic Targets

Chagas disease, caused by the protozoan parasite Trypanosoma cruzi (T. cruzi), is a neglected disease affecting around 6 million people, with no effective antiparasitic drugs or vaccines. About 40% of Chagas disease patients develop symptomatic forms in the chronic phase of infection, chronic Chagas cardiomyopathy (CCC) or digestive forms like megaoesophagus and megacolon, while most infected patients (60%) remain asymptomatic (ASY) in the so-called indeterminate form (IF). CCC is an inflammatory cardiomyopathy that occurs decades after the initial infection. Death results from heart failure or arrhythmia in a subset of CCC patients. Myocardial fibrosis, inflammation, and mitochondrial dysfunction are involved in heart failure and arrhythmia. Survival in CCC is worse than in other cardiomyopathies. Distinct from other cardiomyopathies, CCC displays a helper T-cell type 1 (Th1-T) cell-rich myocarditis with abundant interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) and selectively lower levels of mitochondrial energy metabolism enzymes and high-energy phosphates in the heart. A CD8+ T cell-rich inflammatory infiltrate has also been found in the Chagasic megaesophagus, which is associated with denervation of myoenteric plexi. IFN-γ and TNF-α signaling, which are constitutively upregulated in Chagas disease patients, negatively affect mitochondrial function and adenosine 5'-triphosphate (ATP) production-cytokine-induced mitochondrial dysfunction. In addition, the differential susceptibility to developing CCC has prompted many studies over the past 25 years on the association of genetic polymorphisms with disease outcomes. A comprehensive understanding of Chagas disease pathogenesis is crucial for identifying potential therapeutic targets. Genetic studies may offer valuable insights into factors with prognostic significance. In this review, we present an updated perspective on the pathogenesis and genetic factors associated with Chagas disease, emphasizing key studies that elucidate the differential progression of patients to CCC and other symptomatic forms. Furthermore, we explore the interplay between genetic susceptibility, inflammatory cytokines, mitochondrial dysfunction and discuss emerging therapeutic targets.

Cell-Permeable Microprotein from Panax Ginseng Protects Against Doxorubicin-Induced Oxidative Stress and Cardiotoxicity

(1) Background: Doxorubicin (DOX) is a frontline chemotherapeutic, but its side-effects from oxidative stress, leading to cardiotoxicity, pose significant challenges to its clinical use. We recently discovered a novel family of proteolysis-resistant, cystine-dense, and cell-penetrating microproteins from Panax ginseng that we term ginsentides. Ginsentides, such as the 31-residue TP1, coordinate multiple biological systems to prevent vascular dysfunction and endoplasmic reticulum stress induced by internal and external stressors. (2) Methods: We assessed the protective effects of ginsentide TP1 on DOX-induced cardiotoxicity using both in vitro functional studies on H9c2 cardiomyocytes and in vivo animal models by zebrafish and ICR mouse models. In these models, we examined oxidative stress, apoptosis, intracellular calcium levels, mitochondrial function, inflammatory responses, and cardiac function. (3) Results: We show that ginsentide TP1 protects against DOX-induced cytotoxicity in the mitochondria-rich H9c2 cardiomyocytes and reduces myocardial injury in zebrafish and mice by mitigating oxidative stress, inflammation, calcium, and mitochondrial dysfunction, as well as apoptosis-mediated cell death. Importantly, TP1 preserves cellular homeostasis without compromising the anticancer potency of DOX in breast cancer cells. (4) Conclusions: our findings highlight a specific antioxidative function of ginsentide TP1 in managing DOX-induced cardiotoxicity during cancer treatment and provide a promising lead for developing cardioprotective peptides and microproteins against oxidative stress.

The Relevance of Endothelial Dysfunction Biomarkers in Thalassemia Patients and Healthy Individuals: A Systematic Review and Meta-Analysis

Cardiovascular complications are a major concern in thalassemia patients, primarily driven by endothelial dysfunction. This systematic review and meta-analysis evaluated endothelial biomarkers as indicators of cardiovascular disease risk in thalassemia. A systematic search of PubMed, Scopus, and Embase identified 41 studies comparing biomarkers in thalassemia patients and healthy individuals. The biomarkers analyzed included ICAM-1, VCAM-1, E-selectin, P-selectin, von Willebrand factor (vWF), endothelial microparticles (EMPs), nitric oxide (NO), nitric oxide synthase (NOS), asymmetric dimethylarginine (ADMA), and endothelin-1 (ET-1). Using random effects modeling, pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. The results showed significantly elevated levels of ICAM-1 (SMD 2.15, 95% CI: 1.09-3.22), VCAM-1 (SMD 2.50, 95% CI: 1.35-3.66), E-selectin (SMD 1.21, 95% CI: 0.92-1.50), P-selectin (SMD 1.62, 95% CI: 0.83-2.42), and ET-1 (SMD 1.23, 95% CI: 0.03-2.42) in thalassemia patients. However, NO, ADMA, and vWF showed no significant differences. No studies on NOS were identified, while only one study found significantly elevated EMPs in thalassemia patients. This review highlights ICAM-1, VCAM-1, E-selectin, P-selectin, and ET-1 as key biomarkers for cardiovascular complications in thalassemia. Further research on EMPs and NOS is essential to enhance the understanding of endothelial dysfunction in this population.

Elevated serum amylase concentrations are associated with worse in-hospital outcomes among patients with acute myocardial infarction

BACKGROUND

In light of the well-established connection between sympathetic overactivity and early adverse events in myocardial infarction (MI) patients, this study aims to explore the potential association between serum amylase levels and in-hospital outcomes in patients with acute MI.

METHODS

Patients aged ≥ 18 years that were hospitalized due to acute MI were prospectively included in the present study. All patients underwent clinical and laboratory examination, transthoracic echocardiography and were referred for invasive cardiology work-up as needed. Blood sample for serum amylase measurement were obtained at the time of admission, using the spectrophotometric method. A composite outcome, comprising death, ventricular tachycardia, 3rd degree atrioventricular block, instances requiring cardiopulmonary resuscitation, and transfer for cardiac surgery, was formulated for the present analysis and was the principal outcome of interest.

RESULTS

A total of 202 patients were included in the present analysis. Patients who met the composite outcome exhibited significantly higher serum amylase levels than the counterparts who have not (55 (41-75) U/L vs. 87 (53-122) U/L, p < 0.001). Multivariate analysis revealed that amylase levels predicted the composite outcome independent of age, sex, acute MI type, serum creatinine, and cardiac troponin (adjusted odds ratio [aOR] 1.021, 95% confidence interval [CI] 1.008-1.034, p = 0.001). Additionally, a weak but significant association was observed between serum amylase levels and GRACE score (r = 0.25, p < 0.001).

CONCLUSION

The findings suggest that serum amylase concentration at admission might be used as a simple, non-invasive indicator of increased sympathetic activity and adverse in-hospital outcomes in patients with acute MI.

Oxidative Stress-related Gene Signature: A Prognostic Tool for Predicting Survival in ST-elevation MI

Background

This study aimed to identify differentially expressed oxidative stress-related genes (DEOSRGs) in ST-elevation MI (STEMI) patients and examine their connection to clinical outcomes.

Methods

We conducted a systematic review of Gene Expression Omnibus datasets, selecting GSE49925, GSE60993 and GSE61144 for analysis. DEOSRGs were identified using GEO2R2, overlapping across the selected datasets. Functional enrichment analysis was performed to understand the biological roles of the DEOSRGs. An optimal model was constructed using Least Absolute Shrinkage and Selection Operator penalised Cox proportional hazards regression. The clinical utility of the signature was assessed through survival analysis, receiver operating characteristic (ROC) curve and decision curve analysis. A prognostic nomogram was developed to predict survival risk, with the signature being externally validated using our own plasma samples.

Results

A prognostic signature was formulated, incorporating three upregulated DEOSRGs (matrix metalloproteinase-9, arginase 1, interleukin 18 receptor accessory protein) and three clinical variables (age, serum creatinine level, Gensini score). This signature successfully stratified patients into low- and high-risk groups. Survival analysis, ROC curve analysis and decision curve analysis demonstrated the signature's robust predictive performance and clinical utility within 2 years post-disease onset. External validation confirmed significant outcome differences between the risk groups.

Conclusion

This study identified DEOSRGs in STEMI patients and developed a prognostic signature integrating gene expression levels and clinical variables. While the signature showed promising predictive performance and clinical utility, the findings should be interpreted considering the limitations of small sample size and control group selection.

The role of resistance exercise-induced local metabolic stress in mediating systemic health and functional adaptations: could condensed training volume unlock greater benefits beyond time efficiency?

The majority of "specialised" exercise configurations (e.g., supersets, drop sets, blood flow restriction) are being assessed as "shortcuts" to hypertrophy and strength improvements. However, these advanced training techniques may also offer significant benefits for systemic health and functional outcomes across recreational and clinical populations via locally induced metabolic responses. Stress-regulating mechanisms are known to enhance the body's resilience by facilitating allostasis, the process of coordinating adaptive processes in reaction to stressors such as physical training. Yet, the role of the local metabolic stress provoked by resistance exercise has not gained much research attention despite its wide potential. Positive effects are not only linked to improved muscular endurance, hypertrophy and strength via primary and secondary mechanisms, but also to the release of myokines, hormones, microRNAs, immune factors, inflammatory substances and other endocrine molecules that initiate numerous health-promoting modifications on a systemic level. Resistance exercise strategies that maximise the local accumulation of metabolites are not well defined, although high volume, close proximity to failure and shorter rests seem to be a necessity. Additionally, blood flow restriction training provides a potent alternative for inducing local acidosis, thereby triggering several pathways associated with improved immunity and physical function even in remote muscle tissues. Future research is warranted to further explore advanced resistance training techniques, as these approaches may offer comparable benefits for physical and mental health to those seen with other forms of exercise such as high-intensity interval training and heavy resistance training.

Bidirectional Interaction Between Chronic Kidney Disease and Porphyromonas gingivalis Infection Drives Inflammation and Immune Dysfunction

Introduction: Chronic kidney disease (CKD) is characterized by a decline in renal function, increased mortality, and significant impairments in the immune system and function of immune cells. These alterations are often derived by uremic toxins, which, in turn, modify the immune system's response to infections. Our research investigates the progression of Porphyromonas gingivalis (P. gingivalis) infection during CKD and its subsequent impact on kidney failure. Methods: We utilized two infectious models, a chamber model representing short-term local inflammation and alveolar bone loss that mimic chronic infection of periodontium, both in conjunction with a CKD model. Additionally, our in vitro studies employed primary macrophages, osteoclasts, and lymphocytes to characterize the immune responses to P. gingivalis and pathogen-associated molecular patterns (PAMPs) in the presence of uremic toxins. Results and Conclusion: Our findings demonstrate that uremic toxins, such as indoxyl sulfate (IS), alter responses of macrophages and lymphocytes to P. gingivalis. In vivo, CKD significantly enhanced P. gingivalis survival and infection-induced alveolar bone loss. The increased distribution of pathogen within peripheral tissues was associated with altered inflammatory responses, indicating that CKD promotes infection. Moreover, P. gingivalis-infected mice exhibited a marked increase in renal inflammation, suggesting that the relationship between uremia and infection is bidirectional, with infection exacerbating kidney dysfunction. Furthermore, we observed that infected CKD mice exhibit decreased serum immunoglobulin G (IgG) levels compared to infected mice without CKD, implying that uremia is associated with immune dysfunction characterized by immunodepression and impaired B lymphocyte function.

Role of a Multidisciplinary Program (Amyloidosis Program of Calgary) on Recognition and Intervention for AL and ATTR Amyloidosis

BACKGROUND

The diagnosis and management of amyloidosis requires strong coordination among various teams and a multidisciplinary approach which is essential for providing the diagnostic tools needed for patients with organ amyloid deposition.

METHODS

In this study, we reviewed the referral patterns to the cardiac and hematology amyloid clinics since the inception of the Amyloidosis Program of Calgary (APC) in 2019. The APC was established to facilitate the diagnosis and treatment of amyloidosis. Additionally, a central referral system was created to expedite the triage of cases with potential amyloid-related symptoms.

RESULTS

The cardiac amyloid clinic saw an increase in referrals from 41 in 2018 to 105 in 2022, although there was a temporary decrease from 67 in 2019 to 56 in 2020 during the first year of the pandemic. Most referrals came from nonamyloid cardiology clinics, followed by hematology referrals. Fifty percent of the cases referred were patients with ATTR and 18% represented AL cases. Moreover, amyloid clinic at our cancer center also began receiving referrals via the central triage system in 2019, with AL amyloidosis cases increasing from 16 to 25 between 2018 and 2023. Therefore, we report here the significant impact of the APC on increasing referrals for patients with ATTR, with the program facilitating diagnostic pathways for these rare conditions.

IN SUMMARY

Since 2022, the establishment of an amyloid screening clinic has furthered these efforts, aiming to enhance early recognition and improve clinical outcomes.

Mitochondrial DNA in atherosclerosis: Mechanisms, biomarker potential, and therapeutic perspectives

Atherosclerosis is a chronic inflammatory disease in which mitochondrial DNA (mtDNA) has emerged as a key contributor to its pathogenesis. We synthesized evidence from experimental and clinical studies showing that mtDNA damage, release, and mutation profoundly affect endothelial cells, macrophages, and vascular smooth muscle cells, thereby driving plaque initiation and progression. By activating immune signaling pathways-including cGAS-STING, NLRP3 inflammasome, and TLR9-mtDNA amplifies inflammation and oxidative stress, exacerbating atherosclerotic lesion development. We further highlight that mtDNA copy number variations and specific mtDNA mutations may serve as biomarkers for early atherosclerosis detection and risk stratification. In reviewing these data, we also discuss promising therapeutic interventions aimed at mitigating mtDNA damage, such as mitochondria-targeted antioxidants and enhanced mitophagy, which have shown preliminary efficacy in delaying plaque progression. Overall, this review underscores mtDNA's dual role as both a driver of atherosclerosis and a potential diagnostic and therapeutic target.

Recent Progress in Thiazole, Thiosemicarbazone, and Semicarbazone Derivatives as Antiparasitic Agents Against Trypanosomatids and Plasmodium spp

Neglected tropical diseases (NTDs), including Chagas disease, human African trypanosomiasis (HAT), leishmaniasis, and malaria, remain a major global health challenge, disproportionately affecting low-income populations. Current therapies for these diseases suffer from significant limitations, such as reduced efficacy, high toxicity, and emerging parasite resistance, highlighting the urgent need for new therapeutic strategies. In response, substantial efforts have been directed toward the synthesis of new molecules with improved potency, selectivity, and pharmacokinetic profiles. However, despite many of these compounds exhibiting favorable ADMET (absorption, distribution, metabolism, excretion, and toxicity) profiles and strong in vitro activity, their translation into in vivo models remains limited. Key challenges include the lack of investment, the absence of fully representative experimental models, and difficulties in extrapolating cell-based assay results to more complex biological systems. In this review, we analyzed the latest advancements (2019-2024) in the development of these compound classes, correlating predictive parameters with their observed biological activity. Among these parameters, we highlighted the partition coefficient (LogP), which measures a compound's lipophilicity and influences its ability to cross biological membranes, and Caco-2 cell permeability, an in vitro model widely used to predict intestinal drug absorption. Additionally, we prioritized the most promising molecules and structural classes for pharmaceutical development, discussing structure-activity relationships (SARs) and the remaining challenges that must be overcome to enable the clinical application of these compounds in the treatment of NTDs.

Multi-Organ Denervation: The Past, Present and Future

The sympathetic division of the autonomic nervous system plays a crucial role in maintaining homeostasis, but its overactivity is implicated in various pathological conditions, including hypertension, hyperglycaemia, heart failure, and rheumatoid arthritis. Traditional pharmacotherapies often face limitations such as side effects and poor patient adherence, thus prompting the exploration of device-based multi-organ denervation as a therapeutic strategy. Crucially, this procedure can potentially offer therapeutic benefits throughout the 24 h circadian cycle, described as an "always-on" effect independent of medication compliance and pharmacokinetics. In this comprehensive review, we evaluate the evidence behind targeted multi-organ sympathetic denervation by considering the anatomy and function of the autonomic nervous system, examining the evidence linking sympathetic nervous system overactivity to various cardiometabolic and inflammatory conditions and exploring denervation studies within the literature. So far, renal denervation, developed in 2010, has shown promise in reducing blood pressure and may have broader applications for conditions including arrhythmias, glucose metabolism disorders, heart failure, chronic kidney disease and obstructive sleep apnoea. We review the existing literature surrounding the denervation of other organ systems including the hepatic and splenic arteries, as well as the pulmonary artery and carotid body, which may provide additional physiological benefits and enhance therapeutic effects if carried out simultaneously. Furthermore, we highlight the challenges and future directions for implementing multi-organ sympathetic ablation, emphasising the need for further clinical trials to establish optimal procedural technique, efficacy and safety.

Biomechanical and histomorphometric characterization of the melatonin treatment effect in the carotid artery subjected to hypobaric hypoxia

This study aims to assess the efficacy of melatonin in mitigating the adverse effects of hypobaric hypoxia on the cardiovascular system of neonatal lambs (30 days old). Two groups were considered for this purpose: (i) Melatonin-treated group (N = 5) and (ii) Control group (N = 6) without treatment. All subjects were exposed to hypobaric hypoxia during gestation and perinatal periods, with melatonin administered after birth. The study focused on the carotid artery, a known predictor of cardiovascular risk. Biomechanical tests, morphometric, and histological measurements were conducted, and a numerical model was developed based on the biomechanical data. Key findings showed remodeling effects: Firstly, a realignment of collagen fibers towards a longitudinal direction was observed with melatonin treatment, similar to non-hypoxic arteries. Second, changes in residual stress and ex-vivo luminal radius were noted, aiming to reduce wall stress and increase vascular resistance. These changes indicate an antihypertensive response, reducing the effects of increased blood pressure and flow due to hypobaric hypoxia. This study demonstrates that biomechanical and histomorphometric methodologies effectively assess the beneficial effects of melatonin treatment under hypobaric hypoxia exposure.

The ABO Blood System and Associated Implications for Hemostasis and Thrombosis

The relationship between non-O blood groups and thromboembolic events has been suggested by several studies, although the exact underlying mechanisms are not fully elucidated. However, the correlation between ABO blood groups with the opposite pole of hemostasis, hemorrhage, has been investigated less thoroughly. Non-O blood groups confer an overall increased risk of single, recurrent, and provoked thromboembolic episodes. On the other hand, blood group O has been associated with more severe bleeding events and less favorable manifestations in individuals with hemorrhagic disorders. Therefore, ABO blood group screening may have a role in both thrombotic and hemorrhagic risk assessment and could potentially be added to available clinical prediction systems. This strong belief is supported by the ongoing research. Nevertheless, up to date, the majority of studies represent important heterogeneity, and given the frequency of non-O blood groups, a natural reluctance to incorporate blood groups in risk assessment models arises. Therefore, a more targeted approach should be considered to provide safe outcomes. The in vitro estimation of the thrombotic and hemorrhagic profile of each blood group separately, the quantitative estimation of VWF, FVIII, and platelet function in several disease settings and in well-organized studies, could be useful to establish a clear relationship of ABO blood types with hemostatic and thrombotic disorders. This may ensure a safe approach to categorizing a patient's risk, managing treatment, and influencing prognosis.

Giant Coronary Aneurysms

We report the case of a woman in her 20s presenting with 1 year of intermittent chest pain and exertional dyspnea found to have multiple giant coronary aneurysms. The largest aneurysm was found to be 7.2 × 5.2 cm in the left anterior descending artery. Because of the size and location of the aneurysms, surgical intervention was pursued and involved resection of the coronary aneurysms with reconstruction and bypass grafting.

Untargeted metabolomic profiling for identifying systemic signatures of helicobacter pylori infection in a guinea pig model

Infections caused by the Gram-negative bacterium Helicobacter pylori (H. pylori) can lead to gastritis, gastric or duodenal ulcers, and even gastric cancer in humans. Investigating quantitative changes in soluble biomarkers associated with H. pylori infection offers a promising method for monitoring the progression of the infection, inflammatory response and potentially systemic consequences. This study aimed to identify, using an experimental model of H. pylori infection in guinea pigs, the specific metabolomic biomarkers in the serum of H. pylori-infected (32) versus uninfected (32) animals. The H. pylori status was confirmed through histological, molecular, and serological examinations. Metabolomic profiling was conducted using UPLC-QTOF/MS methods. The metabolomic biomarkers significantly associated with H. pylori infection were selected based on volcano plots and traditional univariate receiver operating characteristics (ROC). This study identified 12 unique metabolites significantly differentiating H. pylori-infected guinea pigs from uninfected ones. In summary, the metabolomic profiling of serum samples, in combination with ROC characteristics of the data, enhances the monitoring of H. pylori infection and related inflammatory responses in guinea pigs experimentally infected with these bacteria, with potential applications in humans for prediction the infection course and its systemic effects.

Unraveling the Genetic Blueprint of Doxorubicin-Induced Cardiotoxicity Through Systems Genetics Approaches

Background

Anthracycline-induced cardiotoxicity (ACT) is a significant concern for cancer survivors. The genetic basis of ACT remains unclear because of the impact of lifestyle and environmental factors in human studies. This study employs a murine genetic reference population (GRP) of BXD recombinant inbred strains, derived from DBA/2J (D2) and C57BL/6J (B6) crosses, to map quantitative trait loci (QTLs) linked to doxorubicin (DOX)-induced cardiotoxic phenotypes through systems genetics approaches.

Methods

To model variability in ACT, 58 BXD strains and parental B6 and D2 mice (N ≥ 4 mice/sex, 3-4 months old) underwent an intraperitoneal injection of DOX (20 mg/kg). Survival and body weight (BW) were monitored for 10 days. Echocardiography was performed before treatment and on Day 5 post-treatment. Genetic mapping and Mendelian randomization (MR) analyses were used for identifying QTLs and candidate genes associated with DOX-induced traits and severity.

Results

Parental B6 strain had 60% survival, whereas only 24% of D2 mice survived on Day 10. Among BXD strains, median survival varied, with BXD77 showing the lowest at four days. Echocardiography revealed restrictive dysfunction and a small-heart phenotype resembling "Grinch syndrome" observed in ACT patients. Significant QTLs on Chromosome 10 (86-94 Mb), Chromosome 19 (52.5-54.2 Mb) and on Chromosome 14 (103-120 Mb) were associated with the survival, mean BW loss, and left ventricular (LV) volumes and ejection fraction (EF%), respectively. MR analysis identified significant causal associations between the genes implicated in BW loss (ADD3, HSPA12A, SLC18A2, PDZD8, DUSP5, CASP7) as well as EF% and LV volumes (GPC6, UGGT2, SLAIN1, POU4F1, MBNL2) in BXD mice post-DOX and heart failure (HF) outcomes in humans.

Conclusions

Survival, BW loss, and echocardiography parameters considerably varied among DOX-treated BXDs, suggesting significant influence of genetic background on expression of those traits. Several candidate genes that may modulate ACT susceptibility and HF were identified, providing a foundation for genetic-based risk stratification and therapeutics in cardio-oncology.

Invasive Strategy With Intended Percutaneous Coronary Intervention Versus Conservative Treatment in Older People With ST-Segment-Elevation Myocardial Infarction: A Meta-Analysis

BACKGROUND

Patients ≥80 years old were underrepresented or excluded from landmark trials demonstrating the superiority of primary percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction. The current meta-analysis assessed the effects of an invasive strategy with intended PCI compared with conservative treatment in older people (≥80 years) with ST-segment-elevation myocardial infarction.

METHODS

A structured literature search was performed. The primary outcome was overall survival. Secondary outcome analyses included but were not limited to 30-day and 1-year mortality.

RESULTS

Thirteen studies reporting on 102 158 older adults were included. Of these, 31 629 (31%) were assigned to PCI and 70 529 (69%) were treated conservatively. The overall survival was 76.5% in PCI and 67.2% in conservative treatment at the time of longest available follow-up (odds ratio [OR], 2.18 [95% CI, 1.79-2.66], P<0.001, I2=88%, favoring PCI). The follow-up period ranged from 30 days to 26.5 months. The 30-day. (OR, 0.39 [95% CI, 0.31-0.50], P<0.001, I2=0%) and 1-year mortality (OR, 0·34 [95% CI, 0.25-0.46], P<0.001, I2=0%), were lower in the PCI group.

CONCLUSIONS

This meta-analysis indicates a potential underuse of PCI in older adults with ST-segment-elevation myocardial infarction. PCI was advantageous in short- and long-term survival, but these results were affected by confounding. Nonetheless, every second patient not referred for invasive treatment survived at least 1 year. These findings have hypothesis generating implications, but they indicate ageism and emphasize that PCI should not be automatically withheld in older patients.

Mitochondrial Dysfunction and Atherosclerosis: The Problem and the Search for Its Solution

Background/Objectives: This review has been prepared to promote interest in the interdisciplinary study of mitochondrial dysfunction (MD) and atherosclerosis. This review aims to describe the state of this problem and indicate the direction for further implementation of this knowledge in clinical medicine. Methods: Extensive research of the literature was implemented to elucidate the role of the molecular mechanisms of MD in the pathogenesis of atherosclerosis. Results: A view on the pathogenesis of atherosclerosis through the prism of knowledge about MD is presented. MD is the cause and primary mechanism of the onset and progression of atherosclerosis. It is proposed that this problem be considered in the context of a continuum. Conclusions: MD and atherosclerosis are united by common molecular mechanisms of pathogenesis. Knowledge of MD should be used to argue for a healthy lifestyle as the primary way to prevent atherosclerosis. The development of new approaches to diagnosing and treating MD in atherosclerosis is an urgent task and challenge for modern science.

Thiazolidinedione Use and Cardiovascular Outcomes in Patients With Type 2 Diabetes Who Underwent Carotid Artery Revascularization

BACKGROUND

Thiazolidinediones are oral antidiabetic agents known for their wide-ranging pleiotropic effects, potentially offering cardiovascular protection. Using a nationwide health claims database in Korea, we evaluated whether thiazolidinedione treatment was associated with long-term cardiovascular prognosis after carotid revascularization.

METHODS AND RESULTS

This retrospective cohort study included patients with type 2 diabetes who underwent carotid endarterectomy or stent insertion in Korea between 2009 and 2020. The use of medications, including thiazolidinediones, was determined from prescription records, identifying exposure to medications within 30 days following carotid revascularization. The primary outcome was the composite occurrence of stroke, myocardial infarction, and all-cause death following carotid revascularization. A multivariate Cox regression analysis was conducted to assess the primary outcomes. The cohort included 14 220 patients with type 2 diabetes who underwent carotid revascularization (2669 via carotid endarterectomy and 11 551 via carotid stent insertion). Among them, 1034 patients received thiazolidinedione treatment. Over a mean follow-up period of 4.13±3.14 years, 4087 patients experienced a primary outcome. Thiazolidinedione treatment was significantly associated with a reduced risk of primary outcomes (adjusted hazard ratio [HR], 0.81 [95% CI, 0.71-0.93]; P=0.002). The protective effect of thiazolidinediones was supported in a propensity score-matched analysis comparing thiazolidinedione users with nonusers (HR, 0.81 [95% CI, 0.68-0.95]; P=0.013).

CONCLUSIONS

Thiazolidinedione treatment following carotid revascularization was associated with favorable cardiovascular outcomes in patients with type 2 diabetes. Further research is needed to explore the cardioprotective roles of thiazolidinediones in this high-risk group.

Tpeak-Tend interval predicts arrhythmia recurrence in idiopathic ventricular fibrillation and early repolarization syndrome

BACKGROUND

In about 8% of survivors of sudden cardiac death, no structural or electrical heart disease can be identified. Some of these patients with idiopathic ventricular fibrillation (IVF) present ECG markers of early repolarization (Early Repolarization Syndrome, ERS). The Tpeak-Tend interval has been linked to increased arrhythmic risk in different clinical settings, such as Brugada syndrome or hypertrophic cardiomyopathy. As there is limited data about the relationship of Tpeak-Tend and arrhythmogenesis in IVF, respectively, its significance in risk stratification in ERS, the aim of this study was to investigate a possible correlation between sustained ventricular arrhythmia (VA) recurrences in these patients and the Tpeak-Tend interval.

METHODS AND RESULTS

We retrospectively investigated 56 consecutive IVF patients (64.3% male, mean age 37.8 ± 12.9 years) who received an implantable cardioverter-defibrillator for secondary prevention. Markers of early repolarization were present in 32.1% of cases. During a mean follow-up of 41.2 ± 35.8 months, 11 patients (19.6%) received in total 18 adequate ICD-therapies. Patients with VA recurrence showed longer Tpeak-Tend compared to arrhythmia-free patients (105 ± 14 ms vs. 91 ± 14 ms, p = 0.03). The combination of prolonged Tpeak-Tend (> 90 ms) and an early repolarization pattern was associated with a 12-fold increased risk of recurrent VA (p = 0.002).

CONCLUSION

Prolonged Tpeak-Tend was associated with VA recurrence in patients with survived IVF. This correlation was even more pronounced in IVF patients with early repolarization pattern. The Tpeak-Tend interval might play a future role in risk stratification of patients with ERS.

Current hotspot and study trend of transcatheter aortic valve replacement, a bibliometric analysis from 2009 to 2023

Introduction

Transcatheter aortic valve replacement (TAVR), alternatively termed transcatheter aortic valve implantation (TAVI), represents a seminal advancement in cardiovascular interventions by obviating the necessity for open-heart surgery traditionally associated with surgical aortic valve replacement (SAVR). This technique entails percutaneous delivery of a bioprosthetic valve. Despite the surfeit of literature on TAVR over the past fifteen years, a bibliometric analysis is conspicuously absent.

Method

A query executed on the Web of Science Core Collection (WoSCC) on September 1, 2022, returned 8,359 articles and reviews pertinent to TAVR. Data interpretation leveraged Microsoft Excel, CiteSpace, and VOSviewer to illustrate trends and delineate focal points within the corpus of TAVR research.

Result

The analysis incorporated 8,359 articles and reviews on TAVR from January 1, 2009, to August 1, 2023. Publication volume expanded from 35 in 2009 to a pinnacle in 2020, reflecting a near thirty folds increase, with citations escalating from 56 in 2009 to 27,354 in 2021. The United States prevailed in scholarly output (Np = 3,015), citation frequency (Nc = 70,991, excluding self-citations), and academic impact (H-index = 120). Columbia University was distinguished by the highest number of publications (Np = 380), citations (Nc = 41,051), and H-index (84). Within the author community, Rodes-Cabau J was preeminent, with 260 publications and an equivalent citation index and H-index. Keywords such as "balloon-expandable valve," "coronary access," "next-day discharge," "conducti on disturbances," and "coronary obstruction" have surfaced as the lexicon of burgeoning research themes.

Conclusion

Investigation into TAVR has emerged as a major area of scholarly focus. The United States stands at the forefront of this research. Columbia University ranks as the preeminent institution in terms of publication output. Key research themes such as "balloon-expandable valve," "coronary access," and "coronary obstruction" are shaping up as current and prospective research hotspots, signaling potential areas for future study and innovation.

Dietary vitamin intake and its association with hypertension (HPT) among Malaysian adults

This study aims to investigate the association between dietary vitamin (A, B6, B9, B12, C, E, and K) intake and hypertension (HPT) among Malaysian adult population. This is a cross-sectional analysis of baseline data from a population-based cohort of 10,031 participants from the Malaysia arm of the Prospective Urban and Rural Epidemiology (PURE) study. Participants were classified as having HPT if they reported a diagnosis of high blood pressure (systolic blood pressure (SBP)/diastolic blood pressure (DBP) > 140/90). Participants' usual dietary intake was assessed using a validated food frequency questionnaire. Vitamin (A, B6, B9, B12, C, E, and K) intake was calculated using nutrient databases. The Mann-Whitney U test was used to assess differences in vitamin intake between the HPT groups. This study found that the prevalence of HPT among 10,031 respondents was 43.5%. The overall dietary intake of vitamins A and C was adequate, but the intake of vitamins B6, B9, B12, E, and K was inadequate compared to Malaysia's Recommended Nutrient Intakes (RNI). The intake of vitamins A, B6, B9, B12, E, and K was significantly lower among patients with HPT compared to those without HPT (p-value < 0.001). This study found that the Malaysian adult population is not receiving sufficient intake of vitamins B6, B9, B12, E, and K from their diet. Improving vitamin intake can be achieved through nutrition education, a diet that includes a variety of healthy foods, and food fortification and supplementation.

Assessing the effect of hypertension on the severity of coronary artery lesions in young female with acute coronary syndrome

BACKGROUND

The fact that hypertension is associated with atherosclerotic cardiovascular disease in the elderly has been confirmed. However, very little is known about its impact on the severity of coronary artery lesions in young people, especially in young women.

OBJECTIVE

To evaluate the effect of essential hypertension (EH) on the severity of coronary artery lesions in young women with acute coronary syndrome (ACS), and to provide a reference for clinical prevention and treatment.

METHODS

From January 2003 to January 2022, 5220 young women (aged ≤ 44 years) who underwent coronary angiography (CAG) due to chest pain symptoms were retrospectively analyzed, of whom 2684 were diagnosed with ACS. After patients with diabetes, hypercholesterolemia, and smoking were excluded, 1772 patients were enrolled. According to whether the patient has EH or not, they were divided into EH combined with ACS group (EH-ASC group; n = 824) and non-hypertension ACS group (control group; n = 948). The severity of coronary artery lesions and the follow-up results after percutaneous coronary intervention (PCI) were compared between the groups.

RESULTS

There was no significant difference in the type of ACS and the number of lesion vessels between the two groups (P > 0.05). The proportion of type B2 (17.11%) and type C (31.55%) lesions in the EH-ACS group was significantly higher than that (11.39% and 20.68%) in the control group (P < 0.05). The number of stents implanted (1.55 ± 0.95) and the length of stents (23.99 ± 6.77 mm) in the EH-ACS group were significantly greater than those (1.36 ± 0.75 and 22.34 ± 6.91 mm) the in control group (P < 0.05). During a follow-up period of 11-138 months, the cumulative rate of major adverse cardiac events (MACE) and target vessel revascularization (TVR) in the EH-ACS group (22.09% and 20.26%) was significantly higher than that (9.28% and 8.65%) in the control group (P < 0.05).

CONCLUSION

Hypertension exacerbates the severity of coronary artery lesions in young women with ACS. It is suggested that attention should be paid to the prevention and treatment of hypertension in young women, a special population, to reduce the prevalence of ACS, and a focus on improving hypertension awareness and management among young women could be beneficial in reducing the risk and severity of ACS.

The inconclusive superiority debate of allogeneic versus autologous MSCs in treating patients with HFrEF: a systematic review and meta-analysis of RCTs

BACKGROUND

Recent randomized controlled trials have consistently demonstrated the safety and potential efficacy of MSC therapy for heart failure patients. This study delves into mesenchymal stem cells' promising potential, offering a beacon of hope for the future of heart failure treatment with reduced ejection fraction (HFrEF).

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for this systematic review and meta-analysis. We searched four databases and registers for RCTs, including PubMed, EBSCO, clinicaltrials.gov, ICTRP, and other relevant websites. We then selected thirteen RCTs with 1184 participants based on our pre-defined inclusion/exclusion criteria. Two independent assessors extracted the data and performed a quality assessment. The data were then plotted for various outcomes, including death, hospitalization, major adverse cardiac events, pump function parameters, and 6-min walk distance.

RESULTS

The safety of MSC-based treatment has been consistently demonstrated with MSCs from autologous (AutoMSCs) and allogeneic (AlloMSCs) sources. This reassuring finding underscores the reliability of MSC-based therapy irrespective of their source. However, AutoMSCs showed a trend toward greater protective benefits. Subgroup analysis revealed no significant differences between AutoMSCs and AlloMSCs in improving LVEF; 0.86% (95% CI - 1.21-2.94%) for AlloMSCs versus 2.17% (- 0.48%; 95% CI - 1.33-5.67%) for AutoMSCs. AlloMSCs significantly reduced end-diastolic volume (LVEDV) by - 2.08 mL (95% CI - 3.52-0.64 mL). Only AlloMSCs significantly improved 6-min walking distance (6-MWD); 31.88 m (95% CI 5.03-58.74 m) for AlloMSCs versus 31.71 m (95% CI - 8.91-71.25 m) for AutoMSCs. The exclusion of studies using adipose-derived cells resulted in even better safety and a significant improvement in LVEF for AlloMSCs treatment.

CONCLUSION

Our findings suggest that AlloMSCs are at par with AutoMSCs in improving functional outcomes in heart failure patients. This underscores the need for future investigations in a larger patient cohort, emphasizing the urgency and importance of further research to fully understand the potential of MSCs in treating heart failure.

Pathways and Molecular Mechanisms Governing LDL Receptor Regulation

Clearance of circulating plasma LDL (low-density lipoprotein) cholesterol by the liver requires hepatic LDLR (low-density lipoprotein receptor). Complete absence of functional LDLR manifests in severe hypercholesterolemia and premature atherosclerotic cardiovascular disease. Since the discovery of the LDLR 50 years ago by Brown and Goldstein, all approved lipid-lowering medications have been aimed at increasing the abundance and availability of LDLR on the surface of hepatocytes to promote the removal of LDL particles from the circulation. As such a critical regulator of circulating and cellular cholesterol, it is not surprising that LDLR activity is tightly regulated. Despite over half a century's worth of study, there are still many facets of LDLR biology that remain unexplored. This review will focus on pathways that regulate the LDLR and emerging concepts of LDLR biology.

Prognostic Role of Electrocardiographic Alternans in Ischemic Heart Disease

Background/Objectives: Noninvasive arrhythmic risk stratification in patients with ischemic heart disease is poor nowadays, and further investigations are needed. The most correct approach is based on the use of electrocardiogram (ECG) with the extraction of indices such as ECG alternans (ECGA). The aim of this study is to monitor the ECG evidence of ischemic coronary artery occlusion by the ECGA and to verify its ability to monitor the time course of balloon inflation, with the final goal of contributing to the exploration of the prognostic role of ECGA in ischemic heart disease. Methods: The ECGA amplitude and magnitude were computed by the correlation method (CM) on the STAFF III database, where ischemic coronary artery occlusion was induced in a controlled manner through coronary artery blockage by balloon inflation. ECGA computed during balloon inflation was also compared with periods before and after the inflation. Results: ECGA values became statistically higher during inflation than in the pre-inflation period and increased as inflation time increased, although not always in a statistically significant manner. ECGA went from values in the range 4-7 µV and 169-396 µV·beat before inflation to values in the range 5-9 µV and 208-573 µV·beat during 5 min of inflation (resulting statistically higher than before inflation), returning towards values in the range 4-8 µV and 182-360 µV·beat after inflation for amplitude and magnitude, respectively. Conclusions: CM-based ECGA detection was able to track the balloon inflation period. Our ECGA investigation represents a contribution in the field of research exploring its prognostic role as a noninvasive electrical risk index in ischemic heart disease.

Effect of Tadalafil on cardiac function and left ventricular dimensions in Duchenne muscular dystrophy: safety and cardiac MRI substudy results from a randomized, placebo-controlled trial

BACKGROUND

Inhibition of phosphodiesterase 5 (PDE5) was hypothesized to slow disease progression in Duchenne muscular dystrophy (DMD). Tadalafil, a once-daily PDE5 inhibitor, did not slow loss of ambulation in a phase 3 placebo-controlled trial. This report details the cardiac findings from this study.

METHODS

Patients with DMD (N = 331) aged 7 to 14 years on stable glucocorticoids were randomized to tadalafil 0.3 mg/kg/day, 0.6 mg/kg/day, or placebo. Ejection fraction (EF), fractional shortening, and M-mode ventricular dimensions were measured on echocardiograms. 12-lead ECGs were centrally evaluated for heart rate and intervals, and qualitative diagnoses. Vital signs and unsolicited adverse events were collected throughout the study. Cardiac MRI (CMR) was collected in a subset of 27 patients. Z-scores for ventricular dimensions and volumes were calculated based on published age-normative reference values. Treatment differences for change in continuous ECG parameters and vital signs were compared using Wilcoxon rank-sum tests. Echocardiogram and CMR parameters were analyzed with an ANCOVA model.

RESULTS

Tadalafil had no adverse effects on echocardiographic left ventricular (LV) EF or fractional shortening, ECG findings, or vital signs. Mean diastolic LV internal dimension (LVIDd) was increased in the tadalafil 0.6 mg/kg group versus placebo at Week 24 (+ 0.13 cm, p =.019) and Week 48 (+ 0.18 cm, p =.008), with a similar pattern observed for LV systolic dimensions (LVIDs). Mean LV end diastolic volume (EDV) measured by CMR also increased at Week 48 in the tadalafil 0.3 mg/kg (+ 13.0 ml, p =.047 vs. placebo) and 0.6 mg/kg (+ 12.0 ml, p =.08 vs. placebo) groups, with numerically smaller increases in LV EDV and commensurate increases in stroke volume and cardiac output. Z-scores for LVIDd and LV EDV were generally below the normal range at baseline and increased toward or within the normal range in the tadalafil groups but not in the placebo group.

CONCLUSIONS

No adverse effects of tadalafil on cardiovascular function were evident based on adverse events, echocardiograms, ECG, or vital sign measurements through 48 weeks in patients with DMD. The small mean increases in LVID and LV volume observed with tadalafil are consistent with PDE5 inhibitor pharmacology, but their clinical relevance in the context of LV tonic contraction in DMD is unknown and deserve further study.

CLINICALTRIALS

GOV IDENTIFIER

NCT01865084 (first registration date: 24-May-2013).

Associations of alcohol with the human gut microbiome and prospective health outcomes in the FINRISK 2002 cohort

BACKGROUND AND AIMS

Alcohol remains a global risk factor for non-communicable diseases with the gut microbiome emerging as a novel elucidator. We investigated how gut microbiome associates with alcohol on population level, if there is mediation reflected in health outcomes, and how functional potential is related.

METHODS

Our sample consisted of 4575 shallow-shotgun sequenced fecal samples from the FINRISK 2002 cohort (25-74yrs., 52.5% women). Alcohol (g 100% alcohol/week) use was self-reported. Diversity and differential species abundances were analyzed using multiple linear regression. Compositional differences were analyzed using PERMANOVA, and prospective associations with Cox-regression. Connections between alcohol, microbiome, inflammatory markers, and outcomes were assessed using serial mediation. Functional associations were assessed using KEGG-orthologies and multiple linear regression.

RESULTS

High-risk alcohol consumers had significantly lower bacterial diversity when compared to low-risk consumers (mean±SD:4.04±0.41 vs. 4.11±0.43, p = 9.56 × 10- 4). Alcohol also associated with significant shifts in overall composition (PERMANOVA; p ≤ 1.00 × 10- 4) and differential abundances of 344 species (ANCOM-BC2; q ≤ 0.05). These shifts were characterized by an increase in relative abundances of Gram-negative bacteria, the top genera of which were Bacteroides and Prevotella, and a decrease in putatively beneficial species in genera such as Lactobacillus, Bifidobacterium, and Akkermansia. Prospective associations with all-cause mortality (HR:1.12 [1.02-1.23]), and liver disease (HR:1.53 [1.22-1.92]) were observed. The association between alcohol and liver disease had a mediating link via a proinflammatory beta-diversity principal coordinate (OR:1.04 [1.001-1.10]). Functional associations were observed with 1643 KO-groups (q < 0.05, npositive=431, nnegative=1212). Antioxidative and gut integrity maintaining functions were diminished and lipopolysaccharide synthesis enriched.

CONCLUSIONS

Alcohol use is associated with community-level shifts in composition towards enriched Gram-negative bacteria, and diminished levels of putatively beneficial bacteria. Alcohol use associates with a proinflammatory gut microbiome profile that mediates alcohol's effect on incident liver disease risk, possibly via increased proliferation of endotoxins through the gut epithelial lining.

Less Is More: Management of Left Atrial Appendage Perforation With Impending Cardiac Tamponade Following Watchman Device Placement

By 2030, the United States will have over 12 million people with atrial fibrillation, which carries a five-fold increase in risk of stroke. Watchman device is an alternative in patients who are poor candidates for anticoagulation. Here, we present a rare case of Watchman device implantation related to left atrial appendage (LAA) perforation noted intraoperatively with portion of the device in the pericardial space. A 93-year-old female with high fall risk and on Coumadin presented for Watchman device placement. During implantation, LAA perforation was noted with exudation of contract in the pericardium during deployment, and decision to deploy the device was made, hoping it would help seal the leak. Retrieving the device was thought to put the patient at risk of bigger perforation. Following which successful pericardial window with temporary drain placement avoided sternotomy and overall had a good outcome. A Watchman device with self-expanding frame covering the left atrial facing surface was deployed, after which a rare but potential complication of perforation was noted during delivery. The device left in place sealed the leak and prevented potential worsening incase device was retrieved. Eventually, this decision improved the outcome of the patient.

Diagnostic and prognostic significance of miRNA-15a-5p, 16-5p, and 92a-3p in arrhythmogenic right ventricular cardiomyopathy

BACKGROUND

Arrhythmogenic right ventricular cardiomyopathy (ARVC) presents diagnostic challenges and significant clinical burden because of life-threatening ventricular arrhythmias, compounded by the limited ability to predict patient prognosis using current clinical parameters. MicroRNAs (miRNAs) offer potential as markers in cardiac diseases, including ARVC, providing insights into disease pathogenesis, identification, and prognosis. However, current diagnostic criteria lack sensitivity and specificity, highlighting the need for novel markers such as miRNAs to better understand ARVC's complex pathophysiologic mechanisms.

OBJECTIVE

This multisite study assessed circulating miRNA expression in ARVC patients, stratified by 5-year event-free survival risk, to explore their potential as a marker for improving ARVC diagnosis and prognosis.

METHODS

Blood samples from 102 ARVC patients, 24 Brugada syndrome (BrS) patients, and 22 healthy controls were analyzed for the expression of 20 miRNAs using TaqMan quantitative real-time polymerase chain reaction (PCR), ARVC patients were stratified by 5-year event-free survival risk. Six candidate miRNAs were selected for further analysis, and machine learning algorithms were applied for classification and risk stratification based on miRNA profiles. Additionally, genotyping and functional annotation of miRNA targets were performed.

RESULTS

Six miRNAs exhibited differential expression between high- and low-risk ARVC patients. MiR-15a-5p, miR-16-5p, and miR-92a-3p demonstrated the best performance in risk stratification. MiR-15a-5p also displayed higher expression in patients with adverse cardiac events. Comparative analysis with BrS patients and healthy controls consistently demonstrated increased expression of these miRNAs in ARVC.

CONCLUSION

This study highlights miRNAs' potential to enhance the diagnosis, disease progression, and clinical outcomes of ARVC, supporting further research to improve patient care.

Life-threatening risk factors contribute to the development of diseases with the highest mortality through the induction of regulated necrotic cell death

Chronic diseases affecting the cardiovascular system, diabetes mellitus, neurodegenerative diseases, and various other organ-specific conditions, involve different underlying pathological processes. However, they share common risk factors that contribute to the development and progression of these diseases, including air pollution, hypertension, obesity, high cholesterol levels, smoking and alcoholism. In this review, we aim to explore the connection between four types of diseases with different etiologies and various risk factors. We highlight that the presence of risk factors induces regulated necrotic cell death, leading to the release of damage-associated molecular patterns (DAMPs), ultimately resulting in sterile inflammation. Therefore, DAMP-mediated inflammation may be the link explaining how risk factors can lead to the development and maintenance of chronic diseases. To explore these processes, we summarize the main cell death pathways activated by the most common life-threatening risk factors, the types of released DAMPs and how these events are associated with the pathophysiology of diseases with the highest mortality. Various risk factors, such as smoking, air pollution, alcoholism, hypertension, obesity, and high cholesterol levels induce regulated necrosis. Subsequently, the release of DAMPs leads to chronic inflammation, which increases the risk of many diseases, including those with the highest mortality rates.

Effects of exercise intervention on exercise capacity and cardiopulmonary function in patients with atrial fibrillation: A randomized controlled trial systematic review and meta-analysis

BACKGROUND

Atrial fibrillation (AF) is a common cardiac arrhythmia that significantly impacts the cardiopulmonary function and quality of life of patients. Despite various treatment strategies, non-pharmacological interventions, particularly exercise interventions, have gained attention in recent years.

OBJECTIVE

Through systematic review and meta-analysis, this study explores the impact of physical activity on the exercise capacity and quality of life of AF patients. It assesses the safety, clinical outcomes, and physiological mechanisms of exercise intervention in the treatment of AF.

METHODS

The systematic review and individual patient data (IPD) meta-analysis method were employed, following the PRISMA-IPD guidelines, for literature selection, data extraction, and quality assessment. The analysis focused on the impact of exercise on the cardiopulmonary function and quality of life of AF patients in randomized controlled trials.

RESULTS

A total of 12 randomized controlled trials involving 287 AF patients were included. Meta-analysis demonstrated a significant improvement in the 6-minute walk test capacity (SMD=87.87, 95% CI [42.23, 133.51]), static heart rate improvement (SMD=-7.63, 95% CI [-11.42, -3.85]), and cardiopulmonary function enhancement (SMD=2.37, 95% CI [0.96, 3.77]) due to exercise. There was also a significant improvement in the quality of life (SMD=0.720, 95% CI [0.038, 1.402]).

CONCLUSION

Exercise has a significant effect on improving exercise capacity and cardiopulmonary function in patients with atrial fibrillation. Particularly, high-intensity exercise training has a more significant impact on improving cardiopulmonary function and exercise capacity, emphasizing the importance of personalized exercise plans in enhancing the cardiopulmonary health of AF patients. Further research is needed to explore the effects of exercise on improving the quality of life in the future.

PROSPERO ID

CRD2023493917.

Corneal endothelial and retinal microvascular changes in pseudoexfoliation syndrome: insights from specular microscopy and OCT angiography

PURPOSE

To investigate the correlation between corneal specular microscopy (SM) and macular optical coherence tomography angiography (OCTA) data in patients with pseudoexfoliation syndrome (PXS).

METHODS

This was a cross-sectional, prospective study. Consecutive patients aged > 45 years with PXS or normal examination results were included. We examined cell density (CD), average cell area (AVG), coefficient of variation (CV), and hexagonality values from the SM. We collected 6 × 6 mm macular OCTA data with a quality score of 6/10 or higher.

RESULTS

Thirty-five eyes with PXS and 32 healthy eyes were evaluated. The CD, AVG, CV, and hexagonality for the PXS group were 2388.5 ± 368.8 cell/mm2, 435.0 ± 117.6 µm2, 28.9 ± 4.8%, and 67.6 ± 4.8%, respectively. The control group had the following values for CD, AVG, CV, and hexagonality: 2654.5 ± 269.8 cell/mm2, 380.4 ± 38.8 µm2, 29.8 ± 5.1%, and 67.1 ± 4.9%, respectively. No correlation was observed between OCTA and SM findings in the PXS group. We found a slight but significant link between CD and OCTA outer and total field estimations in the control group (p = 0.03 r = -0.25 and p = 0.02, r = 0.27, respectively). AVG and OCTA data in the control group indicated an association in the outer- and full-field analyses (p = 0.03 r = 0.25, p = 0.02, r = 0.27, respectively).

CONCLUSION

Highlighting the observed lack of correlation between SM and macular OCTA findings in PXS patients in this study emphasizes the necessity of prioritizing early detection of anterior segment changes. The results indicate that immediate monitoring and intervention could reduce undesired consequences and maintain visual function in those affected.