Frontiers in Cardiovascular Medicine最新文献

{"title":"Trends in prescribing optimal medical therapy at discharge following percutaneous coronary intervention in a tertiary care hospital in the UAE.","authors":"Maryam Charehjoo, Seeba Zachariah, Karim Ghannem, Firas Alani, Kimberly McKeirnan","doi":"10.3389/fcvm.2025.1522216","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1522216","url":null,"abstract":"<p><strong>Background: </strong>Optimal medical therapy (OMT) is recommended in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) to enhance the clinical outcomes and support secondary prevention. However, real-world data on OMT prescription practices in the United Arab Emirates (UAE) remain limited. This study aimed to evaluate the prevalence and determinants of OMT prescription at hospital discharge in a UAE tertiary care setting.</p><p><strong>Methods: </strong>This retrospective observational study included 103 consecutive patients who underwent PCI between January 2021 and June 2023 at a tertiary academic hospital in the UAE. Demographic and clinical data, including comorbidities and discharge medications, were collected from electronic medical records. OMT was defined as the concurrent prescription of aspirin, a P2Y12 inhibitor, statin, <i>β</i>-blocker, and either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). Patients were stratified into OMT and non-OMT groups. Categorical variables were compared using the chi-square test or Fisher's exact test, as appropriate, while non-normally distributed continuous variables were analyzed using the Mann-Whitney <i>U</i>-test. Multivariate logistic regression was used to identify factors independently associated with OMT prescription at discharge.</p><p><strong>Results: </strong>Among the 103 patients, the median age was 49.0 years [interquartile range (IQR): 44.3-54.1], with a predominance of males (93.2%) and non-Arabs (74.8%). OMT was prescribed at discharge in 39 patients (37.9%). Multivariate analysis revealed that diabetes (adjusted odds ratio [aOR] = 3.86, 95% confidence interval [CI]: 1.42-10.52, <i>p</i> = 0.01), and hypertension (aOR = 5.99, 95% CI: 2.04-17.60, <i>p</i> = 0.001) were significantly associated with higher odds of OMT prescription. In contrast, age >50 years (aOR = 0.23, 95% CI: 0.08-0.65, <i>p</i> = 0.01) and the presence of acute heart failure (aOR = 0.06, 95% CI: 0.01-0.60, <i>p</i> = 0.02) were associated with lower odds.</p><p><strong>Conclusion: </strong>The rate of OMT prescriptions at discharge was comparable to international studies, though suboptimal. Diabetes and hypertension were positive predictors, while advanced age, and acute heart failure were negative predictors of OMT prescription. Multicenter studies with larger sample size would be needed to get more details. These findings suggest a need for targeted interventions to improve adherence to guideline-directed therapy. Future multicenter studies with larger sample sizes are warranted to validate these observations.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1522216"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: rescue thrombolysis after failed primary percutaneous coronary intervention in coronary artery ectasia with ST-elevation myocardial infarction.","authors":"Jiejun Sun, Muyun Tang, Zhiyu Zhang, Ming Yang, Zhujun Shen, Ran Tian, Zhenyu Liu","doi":"10.3389/fcvm.2025.1595445","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1595445","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery ectasia (CAE) is a rare disease characterized by pathological ectasia of the coronary artery. In the setting of ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) of the ectatic culprit vessel is less likely to succeed due to significant thrombus burden and tortuous ectatic coronary anatomy. However, there are currently no clinical guidelines for subsequent treatment when primary PCI fails. We present a case of successful revascularization by rescue thrombolysis after failed primary PCI in a CAE patient presenting with STEMI.</p><p><strong>Case presentation: </strong>A 63-year-old male presented with a four-hour history of typical rest angina and electrocardiographic findings of inferior ST-segment elevation was diagnosed with acute inferior STEMI. Emergency coronary angiography revealed a complete mid-segment occlusion of the right coronary artery (RCA) and abnormal ectasia of the three main coronary arteries. Multiple attempts to cross the lesion with a guidewire were unsuccessful, leading to the termination of primary PCI. Subsequently, rescue thrombolysis was administered, and repeat angiography confirmed recanalization of the RCA.</p><p><strong>Discussion: </strong>This case is the first to highlight the potential benefit of timely rescue thrombolysis in CAE patients with STEMI when primary PCI fails. It provides useful clinical insight into the management of this high-risk subset of STEMI patients.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1595445"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving landscape of restrictive cardiomyopathy treatment: clinical trial trends and future directions.","authors":"Bin Deng, Wenhua Liu","doi":"10.3389/fcvm.2025.1561917","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1561917","url":null,"abstract":"<p><p>Restrictive cardiomyopathy (RCM) is a rare form of heart muscle disease characterized predominantly by diastolic dysfunction and restrictive filling, for which no guideline-supported pharmacological treatment currently exists. We reviewed the clinical trial landscape for RCM to identify emerging therapeutic strategies and trends. Using the TrialTrove database, we identified 63 RCM-related clinical trials (2007-2024) after excluding studies of standard therapies or unrelated conditions. Our analysis shows that research interest in RCM has remained modest but steady, with many trials in early (Phase I) and late (Phase III/IV) stages. Transthyretin stabilizers, particularly tafamidis, accounted for a significant portion of these trials and have demonstrated improved cardiac function and outcomes in transthyretin amyloid cardiomyopathy (ATTR-CM). In addition, novel disease-modifying approaches - including antisense oligonucleotides, RNA interference therapies, and gene-editing strategies - are being explored in clinical trials, reflecting a shift towards targeted treatment of underlying causes. Approximately half of the identified trials have been completed, though a few were terminated early due to insufficient efficacy. These findings highlight a dynamic and evolving therapeutic landscape in RCM. While tafamidis has substantially advanced ATTR-CM management, emerging RNA-silencing and gene therapy techniques hold promise to address the unmet needs in RCM, warranting further large-scale studies to validate their safety and efficacy.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1561917"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and prognostic value of circulating biomarkers in heart failure.","authors":"Artur Kovenskiy, Zhussipbek Mukhatayev, Aliya Sailybayeva, Makhabbat Bekbossynova, Almagul Kushugulova","doi":"10.3389/fcvm.2025.1633164","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1633164","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) represents a global health burden with distinct phenotypes characterized by varying left ventricular ejection fraction (LVEF). Despite shared endothelial dysfunction, heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) exhibit fundamentally different pathophysiological mechanisms, comorbidity profiles, and treatment responses.</p><p><strong>Methods: </strong>This systematic review and meta-analysis examine inflammatory, cardiac remodelling and congestion, and myocardial injury biomarkers across HF phenotypes, integrating data from 78 studies encompassing 58,076 subjects.</p><p><strong>Results: </strong>Our analysis reveals a significant elevation of IL-6, TNF-alpha, and hs-CRP in HF compared to controls, with distinct biomarker profiles emerging between phenotypes. While inflammatory markers universally increase with disease severity, their utility in phenotypic differentiation remains limited due to substantial overlap. Comorbidity burden significantly influences inflammatory profiles, creating diagnostic challenges that multi-biomarker approaches may address. NT-proBNP, sST2, GDF-15, and cardiac troponins demonstrate complementary value when combined with inflammatory markers, potentially enabling more precise phenotypic classification.</p><p><strong>Conclusion: </strong>Our findings highlight the central role of inflammation in HF pathophysiology while identifying critical knowledge gaps, particularly regarding HFpEF-specific inflammatory signatures. This comprehensive analysis provides a foundation for developing targeted immunomodulatory therapies and personalized diagnostic approaches in heart failure management.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42025639405, PROSPERO CRD42025639405.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1633164"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transthoracic echocardiography-guided subaortic ventricular septal defect closure in infants: a case report.","authors":"Radityo Prakoso, Rina Ariani, Yovi Kurniawati, Brian Mendel, Oktavia Lilyasari","doi":"10.3389/fcvm.2025.1647073","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1647073","url":null,"abstract":"<p><strong>Introduction: </strong>Subaortic VSD, while similar to perimembranous defects, pose a higher risk for aortic valve insufficiency and AV block. This case aims to assess the safety and efficacy of percutaneous subaortic VSD closure in infants under 10 kg using transthoracic echocardiography-only guidance.</p><p><strong>Case presentation: </strong>A one-year-old infant, 8.9 kg, was scheduled for subaortic VSD closure due to concerns of failure to thrive. Percutaneous closure was performed using a retrograde transarterial approach with a 7/5 mm Konar-MF VSD Occluder (Lifetech) under TTE guidance. Apical 5-chamber view showed smallest VSD diameter 3.8 mm. 3.5/5F Guiding JR catheter with soft hydrophilic wire were then maneuvered to descending aorta in subxiphoid 12 o'clock view, suprasternal short axis view and positioned just above the aortic valve. Catheter was then entered to the LV shown by parasternal long axis view. 3.5/5F Guiding JR catheter was then crossed the subaortic VSD in parasternal short axis view. The Konar-MF VSD Occluder (Lifetech) No. 7/5 mm was deployed assisted by apical 5-chamber view. Device detachment was then evaluated in parasternal short axis view showing no residual shunt. At six-month follow-up, the device was well seated, and the symptoms subsided.</p><p><strong>Conclusions: </strong>Our case underscores that zero-fluoroscopy TTE-only percutaneous subaortic VSD closure is feasible in selected patients under 10 kg with no major complications.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1647073"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of cardiac function before LVAD implantation in patients with and without early, acute right heart failure: insights from cardiac magnetic resonance.","authors":"Carl-Thaddäus Braun, Hermann Körperich, Michiel Morshuis, Sabina P W Guenther, Lech Paluszkiewicz, Nikolai Hulde, Henrik Fox, Sebastian V Rojas, Jan Gummert, René Schramm","doi":"10.3389/fcvm.2025.1629252","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1629252","url":null,"abstract":"<p><strong>Background: </strong>Early acute right heart failure (eaRHF) during left ventricular assist device (LVAD) implantation significantly impacts patient survival and complicates perioperative management. Although numerous clinical, echocardiographic, and hemodynamic risk factors have been identified, accurately predicting eaRHF remains challenging. Cardiac magnetic resonance (CMR) provides a precise, non-invasive evaluation of cardiac structure and function and may enhance risk stratification eaRHF. This study aims to assess the predictive value of preoperative CMR-derived parameters, comparing their utility to established echocardiographic and right heart catheterization (RHC) markers for identifying eaRHF.</p><p><strong>Methods: </strong>This retrospective analysis was conducted on 55 patients who received CMR before LVAD implantation at our center between 2018 and 2024. Of these 55 patients, 40 had image quality sufficient for offline analysis. Patients receiving a temporary right ventricular assist device (tRVAD) intraoperatively were defined as having eaRHF. Receiver Operating Characteristic (ROC) analysis was used to evaluate the predictive capability of CMR, echocardiographic, and RHC parameters.</p><p><strong>Results: </strong>Ten patients (25%) developed eaRHF. Preoperative bilirubin levels were significantly higher in the eaRHF group (1.6 mg/dl vs. 1.1 mg/dl, <i>p</i> = 0.010). Echocardiographic Tricuspid Annular Plane Systolic Excursion (TAPSE) tended to be lower in eaRHF patients (12 mm vs. 18 mm, <i>p</i> = 0.080). RHC parameters, specifically right ventricular stroke work index (RV-SWI; <i>p</i> < 0.001), cardiac output (CO; <i>p</i> = 0.003), and cardiac index (CI; <i>p</i> = 0.004), were significantly lower in eaRHF patients. CMR showed significantly higher RV end-diastolic volumes (RV-EDV, 288.4 ml vs. 216.7 ml, <i>p</i> = 0.046) and indexed RV-EDV (RV-EDVi, 135.4 ml/m² vs. 104.7 ml/m², <i>p</i> = 0.033) in the eaRHF group. ROC analysis identified CO (AUC = 0.90, sensitivity = 100%, specificity = 72%, <i>p</i> < 0.001), CI (AUC = 0.88, sensitivity = 83%, specificity = 83%, <i>p</i> < 0.001), and RV-SWI (AUC = 0.86, sensitivity = 83%, specificity = 86%, <i>p</i> < 0.001) as strong predictors. Moderate predictive values were observed for RV-EDVi (AUC = 0.73, <i>p</i> = 0.040) and RV global radial strain (RV-GRS; AUC = 0.70, <i>p</i> = 0.044).</p><p><strong>Conclusion: </strong>Hemodynamic parameters from RHC demonstrated the strongest predictive capability for eaRHF. However, selected CMR-derived parameters, especially indexed RV-EDV and RV GRS, offer moderate predictive value and may serve as adjunctive tools in preoperative risk stratification for LVAD candidates.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1629252"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericoronary adipose tissue inflammation mediates the atherogenic effects of lipids on multivessel coronary artery disease: a CCTA-based radiomics analysis.","authors":"Haimei Du, Junchen Zheng, Yaxin Yao, Qin Zhou, Linjuan Li","doi":"10.3389/fcvm.2025.1629984","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1629984","url":null,"abstract":"<p><strong>Objective: </strong>The atherogenic index of plasma (AIP) is a robust predictor of cardiovascular risk. However, its mechanism of action in the severity of coronary artery disease (CAD) remains unknown. We investigated whether pericoronary adipose tissue inflammation [assessed using the fat attenuation index (FAI)] mediates the association between AIP and CAD in middle-aged and older adults.</p><p><strong>Methods: </strong>A total of 450 patients who underwent coronary computed tomography angiography at Yan'an University Affiliated Hospital (2022-2024) were enrolled in this study. Coronary atherosclerotic disease (CAD) severity was defined as multivessel CAD (MVCAD; ≥50% stenosis in ≥2 arteries). The fat attenuation index (FAI) was measured around the right coronary artery (RCA-FAI) using a standardized radiomics protocol. Logistic regression and mediation analyses (PROCESS macro, 1,000 bootstrap samples) were used to quantify these associations.</p><p><strong>Results: </strong>The atherogenic index of plasma (AIP) independently predicted MVCAD (OR = 2.35, 95% CI: 1.96-5.10, <i>P</i> < 0.01). The RCA-FAI showed a dose-dependent CAD risk (OR = 1.33 per one-unit increase, <i>P</i> < 0.01), with a 33% higher risk per FAI increment. Mediation analysis revealed that the RCA-FAI explained 27.9% of the AIP-MVCAD association (<i>P</i> < 0.05). Stratification by glucose metabolism status confirmed the consistent role of the RCA-FAI across subgroups, whereas the AIP-CAD association was significant only in normoglycemic individuals.</p><p><strong>Conclusion: </strong>This is the first study to demonstrate that coronary arterial inflammation (RCA-FAI) partially mediates the atherogenic effects of AIP on MVCAD, suggesting a dual pathway of lipid-driven inflammation and metabolic dysregulation. Our findings highlight RCA-FAI as a promising imaging biomarker for CAD risk stratification, irrespective of glucose metabolism status.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1629984"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bendopnea as an independent prognostic marker for adverse events in hospitalized heart failure patients: insights from a multicenter prospective cohort study.","authors":"Yang Wu, Yuanting Zhu, Shuaiye Liu, Yanqing Hu, Shan Ma","doi":"10.3389/fcvm.2025.1659830","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1659830","url":null,"abstract":"<p><p>Heart failure (HF) remains a leading cause of cardiovascular morbidity and mortality globally, affecting over 64 million individuals ( 1). Despite advancements in therapeutic strategies, the heterogeneity of HF symptoms complicates risk stratification and personalized management. Bendopnea, defined as dyspnea occurring within 30 s of forward trunk flexion, has emerged as a potential marker of hemodynamic compromise, yet its clinical significance in large multicenter cohorts remains underexplored. This prospective study enrolled 482 hospitalized HF patients from 2 tertiary care centers, stratifying them into bendopnea (<i>n</i> = 208) and non-bendopnea (<i>n</i> = 274) groups. Our results demonstrated that bendopnea was associated with more severe cardiac dysfunction, including lower left ventricular ejection fraction (LVEF: 38.9% ± 7.6% vs. 42.7% ± 8.1%, <i>P</i> < 0.001), larger left ventricular end-diastolic diameter (LVEDD: 63.8 ± 5.9 mm vs. 59.2 ± 5.6 mm, <i>P</i> < 0.001), and higher NT-proBNP levels (median 1,320.5 ng/L vs. 985.2 ng/L, <i>P</i> < 0.001). Over 1.5 years of follow-up, patients with bendopnea exhibited a significantly higher cumulative incidence of adverse events: HF rehospitalization (35.1% vs. 22.3%, <i>P</i> < 0.001), all-cause mortality (19.7% vs. 12.4%, <i>P</i> = 0.003), and arrhythmias requiring intervention (20.7% vs. 11.7%, <i>P</i> = 0.001). Multivariable Cox regression confirmed bendopnea as an independent predictor of adverse outcomes (<i>HR</i> = 1.6, 95% CI 1.3-2.0, <i>P</i> < 0.001). These findings highlight bendopnea as a clinically actionable marker for risk stratification in HF, supporting its integration into routine clinical practice.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1659830"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early left heart decompression protects the lungs in a canine model of acute left heart failure being treated with venoarterial extracorporeal membrane oxygenation.","authors":"Yali Chen, Tiewei Xu, Qin Zhen, Changping Gan, Yan Kang, Peng Ji","doi":"10.3389/fcvm.2025.1545903","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1545903","url":null,"abstract":"<p><strong>Background: </strong>Nearly 30% of patients who undergo venoarterial extracorporeal membrane oxygenation (VA-ECMO) suffer pulmonary edema, which increases mortality risk. Left heart decompression is widely considered an effective way to counter left ventricular dilatation during VA-ECMO, but whether decompression can protect the lung or improve prognosis is unclear. We investigated this question using a canine model of acute left heart failure being treated through VA-ECMO.</p><p><strong>Methods: </strong>The left anterior descending artery was ligated in 12 beagles to induce acute heart failure, and starting 1 h later, animals were treated using femoral-femoral VA-ECMO for 3 h. In half the animals, left heart decompression was initiated concurrently with VA-ECMO. In the other half, decompression was initiated 1 h after VA-ECMO began. The \"early decompression\" and \"late decompression\" groups were compared in terms of pulmonary function, cardiac function, hemodynamics, histopathology and inflammatory responses.</p><p><strong>Results: </strong>Early initiation of decompression led to significantly higher PaO₂ (63.27 ± 3.35 vs. 24.70 ± 4.44 mmHg, <i>P</i> = 0.030), lower PaCO₂ (31.65 ± 2.87 vs. 41.02 ± 4.88 mmHg, <i>P</i> = 0.014), smaller alveolar-arterial oxygen pressure difference, weaker transpulmonary pressure gradient (3.67 ± 3.14 vs. 13.35 ± 4.26 mmHg, <i>P</i> = 0.017), milder pulmonary edema, lower levels of pro-inflammatory cytokines TNF-α and IL-6 in lungs, lower left atrial pressure, lower left ventricular end diastolic pressure, lower mean pulmonary artery pressure, and higher mean arterial pressure. Earlier decompression also led to milder pulmonary blood congestion and pulmonary histopathology.</p><p><strong>Conclusion: </strong>Left heart decompression, when initiated as soon as possible during VA-ECMO, can protect pulmonary function by alleviating inflammatory responses in the lung, improving hemodynamics and lowering ventricular filling pressure.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1545903"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic relationship between Sjögren's syndrome and abdominal aortic aneurysm: insights from a European population's genome-wide association analysis.","authors":"Yunanji Zhou, Hao Xiong, Qinghua Luo, Zhaohui Ding, Jun He, Lihua Wang","doi":"10.3389/fcvm.2025.1554991","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1554991","url":null,"abstract":"<p><strong>Background: </strong>Abdominal aortic aneurysm (AAA) and Sjögren's syndrome (SS) frequently coexist, suggesting shared pathogenesis, but their genetic-immunological links are unclear.</p><p><strong>Objective: </strong>Investigate the shared genetic architecture and immune pathways between SS and AAA.</p><p><strong>Methods: </strong>Using European GWAS summary statistics (SS: 585 cases/1,546 controls; AAA: 4,083 cases/420,324 controls), we applied complementary genomics approaches: LDSC (genetic correlation), S-LDSC (tissue heritability), PLACO/FUMA (pleiotropic loci), MAGMA/Metascape (pathways), SMR (druggable targets), and HyPrColoc (immune cells).</p><p><strong>Key results: </strong>A significant positive genetic correlation exists (rg = 0.32, PFDR = 0.021). We identified 8 shared risk SNPs and 6 pleiotropic genes (e.g., HLA-B, HLA-DQB2, LSM2) within loci 6p22.2-21.32. Pathway analyses revealed significant enrichment for MHC class II antigen presentation (<i>P</i> = 3.1 × 10^-12) and U6 snRNA binding/spliceosome (<i>P</i> = 2.8 × 10^-7). Tissue-specific heritability enrichment occurred in artery/aorta, kidney, and secretory tissues (all pS-LDSC < 9.3 × 10^-4). Immune co-localization implicated myeloid dendritic cells expressing HLA-DR (rs9272318) in convergent dysregulation. HLA-B emerged as a prioritised druggable target (pSMR = 1.65 × 10^-8).</p><p><strong>Conclusion: </strong>This study establishes a shared genetic and immunological basis for SS and AAA, driven primarily by dysregulated HLA-mediated antigen presentation (HLA-B/HLA-DR), spliceosome dysfunction, and NK cell impairment. These findings provide mechanistic insights for early AAA detection in SS patients and support developing immunotherapies targeting HLA pathways.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1554991"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}