Frontiers in Cardiovascular Medicine最新文献

{"title":"Blood pressure changes after stair climbing in busy and quiet outpatient clinic environments among Tanzanian adults: a randomised crossover study.","authors":"Issakwisa Habakkuk Mwakyula, Oscar Mahinyila, Thobias Boniphace, Christopher Hariri Mbotwa, Anthony Ambikile Nsojo, Gloria Reginald Mbwile","doi":"10.3389/fcvm.2026.1846924","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1846924","url":null,"abstract":"<p><strong>Introduction: </strong>Blood pressure (BP) measured soon after activity may differ from later seated readings. We examined serial BP changes after stair climbing in busy and quiet outpatient settings, without assuming that a particular waiting period represents complete physiological recovery.</p><p><strong>Methods: </strong>In this randomized crossover study at Mbeya Zonal Referral Hospital, Tanzania, adults with and without a previous hypertension diagnosis drew folded numbered slips to determine environmental order. Staff recording BP were not blinded. Participants ascended and descended 19 steps before measurements immediately and every 3 min for 30 min in each environment. Mixed-effects models included period, sequence, age, sex and body mass index, with session-specific random slopes and autoregressive residual correlation. Classification was compared with each participant's environment-specific average at 24, 27 and 30 min. Exploratory laboratory analyses accounted for reporting limits and used the available observations for each marker. Clinical sensitivity analyses examined alcohol, diabetes history and medication classes.</p><p><strong>Results: </strong>The analysis included 443 participants-223 with hypertension and 220 without a previous diagnosis-contributing 9,746 measurement occasions. At 15 min, adjusted busy-minus-quiet systolic BP differences were 2.87 mmHg (95% CI 1.39-4.35) and 4.07 mmHg (2.58-5.56), respectively. Classification disagreement at that time was 10.8% (7.3%-15.5%) in quiet and 7.6% (4.8%-11.9%) in busy settings among participants with hypertension; corresponding values without a previous diagnosis were 2.3% (1.0%-5.2%) and 5.9% (3.5%-9.8%). First-period-only systolic contrasts remained positive but were larger and less precise. Evidence for differences in trajectory shape between diagnostic groups depended on the covariate-adjustment specification. No routine laboratory marker showed a clear adjusted association with the signed SBP difference from the late-session average at 12 or 15 min. Environmental systolic estimates changed little after clinical adjustment within matching samples.</p><p><strong>Conclusions: </strong>BP changed during seated observation after stair climbing, and early readings disagreed more often with the late-session average. Persistent disagreement and within-session variability do not support 12-15 min as a universally sufficient resting interval. The absence of a pre-exercise resting reference and a no-exercise comparator limits attribution of the decline to recovery from activity.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1846924"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223520","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: Angiography-guided transvenous single-chamber pacemaker implantation in mirror-image dextrocardia with congenitally corrected transposition of the great arteries.","authors":"Junda Cao, Qin Ao, Jin Ma, Ji Sun","doi":"10.3389/fcvm.2026.1956397","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1956397","url":null,"abstract":"<p><strong>Background: </strong>Mirror-image dextrocardia with situs inversus is uncommon. Transvenous permanent pacemaker implantation is technically demanding when it coexists with congenitally corrected transposition of the great arteries (ccTGA), because venous access, atrioventricular valve crossing, and fluoroscopic lead orientation may differ from usual anatomy.</p><p><strong>Case presentation: </strong>A 61-year-old man was admitted with recurrent dizziness and palpitations for 5 years; his symptoms had worsened during the preceding 2 weeks. Preoperative 12-lead electrocardiography showed atrial fibrillation with a slow ventricular response. Twenty-four-hour Holter monitoring documented 707 pauses longer than 2.0 s, with a longest R-R interval of 6.13 s. Echocardiography confirmed mirror-image dextrocardia, situs inversus, and ccTGA. A single-chamber permanent pacemaker was implanted through the right axillary vein. Posteroanterior fluoroscopy defined the right-sided cardiac silhouette; right axillary venography guided venous puncture; right atrial angiography identified the morphologic mitral annular plane; and multi-projection fluoroscopy was used to confirm the final ventricular lead position in the high mid-septal region of the morphologic left ventricle. The procedure lasted 56 min and had no acute complications. At 6-month outpatient follow-up, standard 12-lead electrocardiography, 24-hour Holter monitoring, formal device interrogation, and transthoracic echocardiography showed stable pacing, preserved ventricular performance, and no device-related complication; the paced QRS duration was 144 ms and the pacing burden was 99.8%. During telephone follow-up in June 2026, approximately 1 year after implantation, the patient reported no discomfort.</p><p><strong>Conclusion: </strong>This case describes a structured approach to conventional transvenous pacemaker implantation in mirror-image dextrocardia with ccTGA. In this patient, venography, chamber angiography, and targeted fluoroscopic views reduced procedural uncertainty, and follow-up through 1 year showed clinical stability without recognized complications.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1956397"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223575","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: Pulmonary reperfusion injury with bilateral bronchial cast thrombosis after VA-ECMO-bridged catheter-based reperfusion for cardiac arrest caused by high-risk pulmonary embolism.","authors":"Guanshuai Chen, Fanxiang Chen, Ruoyu Li","doi":"10.3389/fcvm.2026.1970263","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1970263","url":null,"abstract":"<p><p>High-risk pulmonary embolism (PE) can lead to acute right ventricular failure, obstructive shock, and cardiac arrest. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides bridging life support, buying time for imaging confirmation and reperfusion. However, reperfusion injury, pulmonary hemorrhage, and airway thrombotic obstruction may follow pulmonary artery reperfusion. Severe airway obstruction caused by bronchial cast thrombi is rare and challenging. We report a woman in her 60s awaiting surgery for a left femoral neck fracture who developed preoperative cardiac arrest due to high-risk PE. After VA-ECMO bridging and staged catheter-based pulmonary reperfusion, the patient developed reperfusion injury and bilateral bronchial cast thrombosis, managed by repeated bronchoscopy with cryoextraction. Electrical impedance tomography (EIT) monitored ventilation and perfusion. The patient was weaned from VA-ECMO and invasive ventilation but remained in a persistent vegetative state due to hypoxic-ischemic encephalopathy. This case suggests that in cardiac arrest caused by high-risk PE, VA-ECMO can buy time for diagnosis and reperfusion; however, reperfusion injury after recanalization can cause severe hemorrhage, with blood coagulating within the airways into bronchial cast thrombi and life-threatening obstruction. Bronchoscopy with cryoextraction effectively clears tenacious airway cast thrombi. EIT assists ventilation/perfusion monitoring during complex VA-ECMO support. Even when cardiopulmonary function recovers, hypoxic-ischemic brain injury may determine long-term prognosis.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1970263"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223596","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":"Combined assessment of fibrinogen-to-platelet ratio and ApoB/ApoA1 ratio for pre-angiographic risk stratification of severe multivessel coronary disease in NSTEMI.","authors":"Zongqi Zhou, Wei Wang, Haoyu Zhou, Zhiliang Chen, Mingming Jiang, Zimeng Li, Lei Li","doi":"10.3389/fcvm.2026.1931950","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1931950","url":null,"abstract":"<p><strong>Background: </strong>Residual inflammation and dysregulated lipid metabolism are closely associated with the extent of severe multivessel coronary disease (MVD) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The fibrinogen-to-platelet ratio (FPR) and the apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio reflect these two residual risk pathways, respectively, whereas the clinical value of their combined assessment for pre-angiographic identification of severe MVD remains to be evaluated.</p><p><strong>Objective: </strong>To evaluate the incremental value of combining FPR with the ApoB/ApoA1 ratio for pre-angiographic identification of severe MVD in patients with NSTEMI and to develop an adjunctive risk-stratification model.</p><p><strong>Methods: </strong>This single-center retrospective study included 580 patients with NSTEMI who underwent coronary angiography. Correlation analyses, logistic regression, and restricted cubic spline models were used to assess the associations between the two biomarkers and MVD. The area under the receiver operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the incremental value of the biomarkers. A nomogram was developed and internally validated using bootstrap resampling. Decision curve analysis (DCA) was performed to assess net clinical benefit, and subgroup analyses were conducted.</p><p><strong>Results: </strong>FPR remained independently and positively associated with severe MVD, with an approximately linear dose-response relationship; the association of the ApoB/ApoA1 ratio was attenuated after full adjustment, although it showed complementary value in patients with a very high coronary lesion burden. With the combined model, the AUC increased from 0.683 to 0.719, while the continuous NRI and IDI were 0.488 and 0.037, respectively; adding the ApoB/ApoA1 ratio to the model containing FPR did not significantly improve the AUC (<i>P</i> = 0.266) but yielded further improvements in NRI and IDI. Potential effect modification by diabetes status was observed (<i>P</i> for interaction = 0.025).</p><p><strong>Conclusion: </strong>FPR is an important adjunctive biomarker for the pre-angiographic identification of severe MVD in patients with NSTEMI, whereas the ApoB/ApoA1 ratio provides complementary reclassification information. The nomogram incorporating both biomarkers may facilitate pre-angiographic risk stratification.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1931950"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223551","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":"Living with angina: rethinking angina management in ANOCA through lived experience.","authors":"Sarena La, Sarah Brown, Cindy McCall, Annette Pompa, Rosanna Tavella, Sivabaskari Pasupathy, John F Beltrame","doi":"10.3389/fcvm.2026.1956191","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1956191","url":null,"abstract":"<p><p>Angina with non-obstructive coronary arteries (ANOCA) is an important cause of chronic angina and reduced quality of life. Despite advances in diagnostic testing and growing recognition of coronary vasomotor disorders, many of those living with ANOCA continue to experience ongoing symptoms despite treatment. The existing literature largely focuses on diagnostic methods and pharmacological management, while comparatively little attention has been paid to the lived experience of symptom control. The objective of this perspective paper, produced with the co-founders of the International Heart Spasms Alliance, is to explore angina management in ANOCA through the lens of lived experience and patient advocacy. Key challenges include the substantial impact of chronic angina on daily life, difficulties identifying effective therapies, the need to adapt to a new normal, reliance on self-management strategies, uncertainty surrounding acute symptom escalation, and the importance of support and validation. Improved angina management in ANOCA requires a holistic and individualised approach that combines mechanism-based treatment, multidisciplinary support, and meaningful incorporation of lived perspectives into clinical care and research. Successful angina management should be measured not only by symptom reduction, but also by improvements in quality of life and overall wellbeing.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1956191"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223686","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":"Single versus double transseptal puncture for atrial fibrillation radiofrequency ablation: a systematic review and meta-analysis.","authors":"Jie Xu, Wenqiang Zhang, Feilin Ye, Junning Lei, Kun Chen, Hui Li","doi":"10.3389/fcvm.2026.1907029","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1907029","url":null,"abstract":"<p><strong>Background: </strong>The single puncture technique has emerged as an alternative to conventional double transseptal puncture for radiofrequency ablation of atrial fibrillation (AF). This meta-analysis aimed to compare the efficacy and safety of these two approaches.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and the Cochrane Library up to 1st March, 2026. Prospective and retrospective cohort studies comparing single vs. double transseptal puncture during AF ablation were included. The primary outcome was the sinus rhythm maintenance. Secondary outcomes included total procedure time, fluoroscopy time, and periprocedural complications. Data were pooled using a random-effects model, and heterogeneity was assessed with the I² statistic.</p><p><strong>Results: </strong>Four studies involving 1811 patients were included. No significant difference was observed in 3-month sinus rhythm maintenance between the single- and double-puncture groups (OR 1.20, 95% CI: 0.95-1.51, <i>P</i> = 0.13). While fluoroscopy time presented similar values (MD -0.84, 95% CI: -4.80-3.11, <i>P</i> = 0.68), procedure duration was significantly longer with single transseptal puncture (MD 11.65, 95% CI: 2.62-20.69, <i>P</i> = 0.01). The incidence of periprocedural complications was similar between the two strategies (OR 0.81, 95% CI: 0.47-1.38, <i>P</i> = 0.43).</p><p><strong>Conclusions: </strong>Single transseptal puncture represents an effective and safe alternative to double puncture for atrial fibrillation ablation, with comparable rhythm outcomes, fluoroscopy exposure and complication rates, despite longer procedural duration.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/view/CRD420261300869, Identifier: CRD420261300869.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1907029"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223653","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":"Efficacy, safety, and strategy-modifying factors of pulsed field ablation for persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis.","authors":"Yuanlin Zhou, Jianhua Xie, Mingliang Fang, Shipeng Wang, Xiaohong Bin, Qingyao Liao","doi":"10.3389/fcvm.2026.1877204","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1877204","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pulsed field ablation (PFA) is increasingly applied in persistent atrial fibrillation (PerAF) and long-standing persistent atrial fibrillation (LSPAF). Previous reviews of mixed AF populations suggested potential advantages in procedural efficiency and esophageal safety, but PerAF/LSPAF-specific evidence on long-term rhythm outcomes and on the value of posterior wall or extended substrate strategies remains limited, with substantial heterogeneity in lesion sets, endpoint definitions, and comparator types.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched PubMed, Web of Science, Embase, Cochrane Library, and Scopus through April 18, 2026, with an updated verification search performed in August 2026. Because of clinical and methodological heterogeneity, formal pairwise pooling was restricted to comparisons supported by at least two clinically homogeneous head-to-head studies; single-study comparisons were synthesized narratively, and strategy-level outcomes were explored with single-arm proportion meta-analysis of exact-count cohorts. Off-antiarrhythmic drug (off-AAD) outcomes were prioritized when available. Certainty of evidence was rated using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-two studies (approximately 3,100 patients) were included. In an exploratory pooled analysis of the only two available head-to-head comparisons (380 patients, with imbalanced study weights and different lesion sets: PVI-only vs. PVI plus posterior wall isolation), PFA was associated with lower 12-month atrial arrhythmia recurrence than cryoballoon ablation [risk ratio [RR] 0.71, 95% confidence interval [CI] 0.51-0.98; GRADE certainty: very low]; this is best regarded as a preliminary signal. No statistically detectable difference in major complications was observed between PFA and cryoballoon [risk difference (RD) 0.00, 95% CI -0.02 to 0.02], reflecting absence of a demonstrable difference rather than proven equivalence. Single-study comparisons against radiofrequency ablation (RR 0.65, 95% CI 0.45-0.94) and hybrid-convergent ablation (RR 1.11, 95% CI 0.67-1.86) yielded directionally discordant results and are presented narratively. Exploratory, non-comparative single-arm analyses yielded pooled 12-month freedom from atrial arrhythmia of 66.0% (95% CI 55.5%-75.2%; I²=79.0%) for PVI plus posterior wall cohorts and 82.6% (95% CI 76.3%-87.5%; &lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 0%) for beyond-PV/extended substrate cohorts; these estimates derive from different, non-randomized cohorts and are hypothesis-generating only.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Current evidence suggests favorable efficacy and safety of PFA in PerAF/LSPAF, but certainty is low to very low for all key outcomes. The lower recurrence vs. cryoballoon ablation is an encouraging but preliminary signal requiring confirmation in adequately powered randomized trials with uniform lesion sets. Whether extended substrate strategies improve outcomes cannot be determined from ","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1877204"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223646","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":"Integration of hereditary thrombophilia data and polygenic risk scores into prognostic models improves differential diagnosis of CTEPH.","authors":"Yaroslav Kubkin, Dmitry Nikulin, Galina Okhrimenko, Larisa Minushkina, Elizaveta Dyachkova, Anna Lyzhenkova, Anna Danilova, Elena Dankovtseva, Irina Borovikova, Vladimir Zamyatin, Alexander Averyanov, Maria Poptsova, Dmitry Zateyshchikov","doi":"10.3389/fcvm.2026.1887880","DOIUrl":"10.3389/fcvm.2026.1887880","url":null,"abstract":"<p><strong>Background: </strong>Differential diagnosis between pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is crucial for treatment selection, particularly regarding surgical intervention. The prevalence of hereditary thrombophilias in Russian CTEPH patients and the utility of genetic data in differential diagnosis remain understudied.</p><p><strong>Objectives: </strong>To evaluate the prevalence of inherited thrombophilia among patients with CTEPH and PAH, to benchmark the results against published data from other cohorts, and to assess the potential utility of integrating genetic findings and polygenic risk score (PRS) parameters with clinical data for differentiating CTEPH from PAH.</p><p><strong>Methods: </strong>The study included 390 patients (252 PAH, 138 CTEPH). Whole-genome sequencing was performed to analyze classical thrombophilia genes (<i>PROC, PROS</i>1<i>, SERPINC</i>1<i>, F</i>2<i>, F</i>5<i>, ADAMTS</i>13<i>, HRG, JAK</i>2<i>, PIGA, THBD, F</i>9<i>, FGA, FGB, FGG, CALR</i>) and calculate VTE polygenic risk scores. A meta-analysis of 15 studies on hereditary thrombophilia prevalence in CTEPH was conducted. AutoML algorithm was used to construct diagnostic models.</p><p><strong>Results: </strong>Rare variants in thrombosis-associated genes were significantly more prevalent in patients with CTEPH than in those with PAH (12.3% vs. 1.2%, <i>p</i> < 0.001). Similarly, carriers of the common F5 and F2 thrombophilia variants were more frequent in the CTEPH group (15.9% vs. 6.3%, <i>p</i> = 0.002). Meta-analysis yielded pooled prevalence estimates in CTEPH of 3.0% for antithrombin deficiency, 3.6% for protein S deficiency, 4.7% for protein C deficiency, 7.9% for F5 Leiden, and 5.6% for F2 G20210A; these estimates were consistent with those reported in other populations. The clinical model yielded an ROC AUC of 0.883. The addition of PGS004854 and rare variants in thrombosis-associated genes increased the AUC to 0.951, representing an absolute increase of 0.068 (7.7%; <i>p</i> = 0.026). In the multivariable model, PGS004854 was the strongest positive genetic predictor of CTEPH (<i>β</i> = 1.869, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The genetic profile of CTEPH patients differs significantly from PAH, with a higher frequency of hereditary thrombotic risk factors. Integrating clinical data with polygenic risk scores and thrombophilia variants improves differential diagnosis accuracy and may optimize the clinical workup.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1887880"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223718","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":"Clinical characteristics and in-hospital prognostic factors in young patients with myocardial infarction.","authors":"Lin Jinxuan, Liao Yongfang, Liu Tingrong, Zhou Tao","doi":"10.3389/fcvm.2026.1864896","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1864896","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to analyze the clinical characteristics and short-term prognostic factors of young patients with acute myocardial infarction.</p><p><strong>Methods: </strong>This retrospective observational study included young patients (aged 18 to 45 years) who visited our center for AMI from January 1, 2014, to October 31, 2023. Baseline and outcome data were collected through the medical records system, with the primary endpoint being in-hospital major adverse cardiovascular events (MACE). Patients were divided into MACE and non-MACE groups based on the occurrence of in-hospital MACE. Coronary angiography was performed in 154/158 patients, all achieving post-procedural TIMI 3 flow. Multivariable logistic regression using Firth penalized likelihood with <i>a priori</i>-selected variables (LVEF, serum uric acid, age) was used to identify independent predictors of MACE.</p><p><strong>Results: </strong>Of 166 young patients initially screened, 158 were included in the final analysis after excluding 8 due to incomplete data. Among these, 27 (17.1%) experienced in-hospital MACE. Patients in the MACE group had a lower prevalence of diabetes (0.00% vs. 19.08%, <i>P</i> = 0.008), lower admission blood pressure and worse left ventricular dysfunction [lower left ventricular ejection fraction (LVEF), larger left ventricular end diastolic diameter (LVEDD)]. Single-vessel disease was the most common (38.96%), with 83.77% of patients having involvement of the left anterior descending artery. The proportion of left main disease was higher in the MACE group (15.38% vs. 3.91%, <i>P</i> = 0.045). In the Firth model, lower LVEF was the sole independent predictor of MACE (OR 0.859, 95% CI 0.794-0.917, <i>P</i> < 0.001), while serum uric acid and age were not significant.</p><p><strong>Conclusion: </strong>The clinical characteristics and coronary artery lesion features of young AMI patients are unique. Reduced LVEF is the sole independent predictor of in-hospital MACE in our cohort, underscoring the value of ventricular function assessment for short-term risk stratification.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1864896"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223628","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":"Osteoarthritis as a marker and potential contributor to cardiovascular risk: a glycocalyx-cartilage axis hypothesis.","authors":"Willem Wassenaar","doi":"10.3389/fcvm.2026.1903797","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1903797","url":null,"abstract":"<p><p>Osteoarthritis (OA) may be more than simply a reflection of aging; it could represent a symptom of underlying vascular disease processes with serious consequences for health and quality of life. The association of OA with other conditions like cardiovascular disease (CVD) suggests OA may be partially systemic and metabolic in nature. As such, this connection underscores the value of exploring the biochemical parallels between articular joints and the endothelial glycocalyx, the protective lining of blood vessels. N-acetylglucosamine may be central to this link because both articular cartilage and the endothelial glycocalyx depend on N-acetylglucosamine-containing structures. A better understanding of the pathophysiology linking OA and CVD provides the basis for the present hypothesis. Hypothesis: A reduction in available or utilized levels of N-acetylglucosamine results in a parallel degradation of articular cartilage and the endothelial glycocalyx. This would result in a shared glycan-dependent mechanism linking the pathogenesis of OA to increased cardiovascular risk. Implications: OA could serve as an early clinical marker for vascular dysfunction and potentially identify glycocalyx-targeted interventions as a new area of investigation for therapies to reduce both OA and CVD. The novelty of this research hypothesis is based on suggesting that N-acetylglucosamine-dependent glycan insufficiency is a unified mechanism connecting cartilage degeneration with vascular endothelial damage.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1903797"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223680","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}