Lili Wang, Linlin Gao, Qin Chen, Li Chen, Hui Xu, Ling Sun, Youbin Hu
{"title":"Effect of ticagrelor combined with metoprolol extended-release tablets on cardiac function and clinical prognosis in elderly patients with acute coronary syndrome after percutaneous coronary intervention.","authors":"Lili Wang, Linlin Gao, Qin Chen, Li Chen, Hui Xu, Ling Sun, Youbin Hu","doi":"10.3389/fcvm.2025.1492569","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1492569","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndrome (ACS) poses significant risks to older individuals. This study sought to assess the impact of combining ticagrelor and metoprolol extended-release tablets on clinical prognosis and cardiac function in elderly ACS patients following percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>From February 2022 to February 2023, 90 elderly ACS patients who underwent PCI at our institution were retrospectively enrolled and divided into two groups: an observation group (OG) and a control group (CG), with 45 patients in each group. The CG received oral metoprolol extended-release tablets, while the OG received both oral metoprolol extended-release tablets and ticagrelor. Prognostic indicators and cardiac function were evaluated before and after treatment.</p><p><strong>Results: </strong>The treatment effectiveness rate in the OG was 97.78%, significantly higher than the CG's rate of 77.78% (<i>P</i> < 0.05). Post-treatment, the OG displayed notable improvements in cardiac function, including significantly higher left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), and cardiac index (CI) compared to the CG (<i>P</i> < 0.05). Both groups experienced enhanced exercise capacity, as evidenced by longer exercise duration (ED) and improved 6-min walking test (6MWT) results, with the OG showing superior gains (<i>P</i> < 0.05). Additionally, the OG had significantly higher serum levels of cardiac troponin T (cTnT) and creatine kinase isoenzyme (CK-MB) than the CG (<i>P</i> < 0.05). Decreases in serum levels of sICAM-1, MMP-9, and hs-CRP were observed in both groups, with more pronounced improvements in the OG (<i>P</i> < 0.05). The incidence of adverse prognostic events in the OG was significantly lower at 8.89%, compared to 37.78% in the CG (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Ticagrelor combined with metoprolol extended-release tablets can significantly improve cardiac function, motor performance, and quality of life in ACS patients after PCI. Additionally, it effectively increases myocardial injury markers and reduces serum inflammatory factor levels.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1492569"},"PeriodicalIF":2.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397991","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":"Endothelial protease-activated receptor 4: impotent or important?","authors":"Rahul Rajala, Courtney T Griffin","doi":"10.3389/fcvm.2025.1541879","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1541879","url":null,"abstract":"<p><p>The protease thrombin, which increases its levels with various pathologies, can signal through the G protein-coupled receptors protease-activated receptors 1 and 4 (PAR1/PAR4). PAR1 is a high-affinity receptor for thrombin, whereas PAR4 is a low-affinity receptor. Finding functions for PAR4 in endothelial cells (ECs) has been an elusive goal over the last two decades. Several studies have demonstrated a lack of functionality for PAR4 in ECs, with many claiming that PAR4 function is confined mostly to platelets. A recent study from our lab identified low expressing but functional PAR4 in hepatic ECs <i>in vivo.</i> We also found that PAR4 likely has a higher signaling potency than PAR1. Given this potency, ECs seem to limit PAR4 signaling except for extreme cases. As a result, we claim PAR4 is not an impotent receptor because it is low expressing, but rather PAR4 is low expressing because it is a very potent receptor. Since we have finally shown PAR4 to be present and functional on ECs <i>in vivo</i>, it is important to outline why such controversy arose over the last two decades and, more importantly, why the receptor was undervalued on ECs. This timely review aims to inspire investigators in the field of vascular biology to study the regulatory aspect of endothelial PAR4 and its relationship with the more highly expressed PAR1.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1541879"},"PeriodicalIF":2.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398247","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":"Severe reversible cardiomyopathy associated with adrenal crisis caused by isolated adrenocorticotropin deficiency: a case report.","authors":"Li Wang, Fangfang Bu, Lanjie He, Guihua Yao","doi":"10.3389/fcvm.2025.1451635","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1451635","url":null,"abstract":"<p><p>Adrenal crisis, also known as acute adrenal insufficiency, is an endocrine emergency that is associated with high mortality rates. Reversible cardiomyopathy with severe heart failure is a rare complication of adrenal crisis. Isolated adrenocorticotropin deficiency (IAD) is a rare condition of pituitary adrenal insufficiency. In this case report, we describe a 74-year-old male patient who was in good physical health and was admitted to our hospital with a sudden onset of fever and confusion that was complicated by hyponatremia and hypotension. Cardiac ultrasound showed significantly reduced left ventricular ejection fraction (LVEF; 10%). The patients was initially diagnosed with \"septic shock\" because of elevated inflammatory indicators and treated with mechanical circulatory support, antibiotics, fluid resuscitation, and intravenous administration of 50 mg hydrocortisone every 6 h for 2 days (400 mg in total). The symptoms of the patient improved significantly by this treatment in 6 days. The LVEF improved from 10% to 40%. However, the initial treatment did not alleviate hypotension and confusion. Therefore, the status of adrenal function was analyzed using blood and urine cortisol tests. Blood and urinary cortisol levels were significantly reduced, but concurrent increase in the ACTH levels were not observed. This indicated adrenal crisis. Subsequently, the patient was initially administered intravenous injection of hydrocortisone (50-150 mg/day) for 5 days, and then transitioned to a physiological supplement dose orally. The LVEF value improved further to 52%. Finally, the patient was diagnosed with adult isolated ACTH deficiency. The patient was prescribed regular oral hydrocortisone. The patient has not shown any signs of heart failure during follow up for more than half a year. In summary, we described a rare and severe case of adrenal crisis complicated with reversible cardiomyopathy that was caused by isolated ACTH deficiency. In such a case, conventional guideline directed medical therapy (GDMT) for heart failure was not considered suitable because of the underlying hypotension, hypoglycemia, and hyponatremia. Our study showed that timely supplementation of glucocorticoids achieved better therapeutic effects in patients with adrenal crises complicated by severe cardiomyopathy.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1451635"},"PeriodicalIF":2.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398349","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":"Development and validation of a prediction model of hospital mortality for patients with cardiac arrest survived 24 hours after cardiopulmonary resuscitation.","authors":"Renwei Zhang, Zhenxing Liu, Yumin Liu, Li Peng","doi":"10.3389/fcvm.2025.1510710","DOIUrl":"10.3389/fcvm.2025.1510710","url":null,"abstract":"<p><strong>Objective: </strong>Research on predictive models for hospital mortality in patients who have survived 24 h following cardiopulmonary resuscitation (CPR) is limited. We aim to explore the factors associated with hospital mortality in these patients and develop a predictive model to aid clinical decision-making and enhance the survival rates of patients post-resuscitation.</p><p><strong>Methods: </strong>We sourced the data from a retrospective study within the Dryad dataset, dividing patients who suffered cardiac arrest following CPR into a training set and a validation set at a 7:3 ratio. We identified variables linked to hospital mortality in the training set using Least Absolute Shrinkage and Selection Operator (LASSO) regression, as well as univariate and multivariate logistic analyses. Utilizing these variables, we developed a prognostic nomogram for predicting mortality post-CPR. Calibration curves, the area under receiver operating curves (ROC), decision curve analysis (DCA), and clinical impact curve were used to assess the discriminability, accuracy, and clinical utility of the nomogram.</p><p><strong>Results: </strong>The study population comprised 374 patients, with 262 allocated to the training group and 112 to the validation group. Of these, 213 patients were dead in the hospital. Multivariate logistic analysis revealed age (OR 1.05, 95% CI: 1.03-1.08), witnessed arrest (OR 0.28, 95% CI: 0.11-0.73), time to return of spontaneous circulation (ROSC) (OR 1.05, 95% CI: 1.02-1.08), non-shockable rhythm (OR 3.41, 95% CI: 1.61-7.18), alkaline phosphatase (OR 1.01, 95% CI: 1-1.01), and sequential organ failure assessment (SOFA) (OR 1.27, 95% CI: 1.15-1.4) were independent risk factors for hospital mortality for patients who survived 24 h after CPR. ROC of the nomogram showed the AUC in the training and validation group was 0.827 and 0.817, respectively. Calibration curves, DCA, and clinical impact curve demonstrated the nomogram with good accuracy and clinical utility.</p><p><strong>Conclusion: </strong>Our prediction model had accurate predictive value for hospital mortality in patients who survived 24 h after CPR, which will be beneficial for assisting in identifying high-risk patients and intervention. Further confirmation of the model's accuracy required external validation data.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1510710"},"PeriodicalIF":2.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390497","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}
Djawid Hashemi, Karl Jakob Weiß, Patrick Doeblin, Moritz Blum, Radu Tanacli, Hana Camdzic, Hans-Dirk Düngen, Frank Edelmann, Titus Kuehne, Marcus Kelm, Sebastian Kelle
{"title":"Exploring the association between tissue sodium content, heart failure subtypes, and symptom burden: insights from magnetic resonance imaging.","authors":"Djawid Hashemi, Karl Jakob Weiß, Patrick Doeblin, Moritz Blum, Radu Tanacli, Hana Camdzic, Hans-Dirk Düngen, Frank Edelmann, Titus Kuehne, Marcus Kelm, Sebastian Kelle","doi":"10.3389/fcvm.2025.1458152","DOIUrl":"10.3389/fcvm.2025.1458152","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) is a complex clinical syndrome with high morbidity and mortality, influenced significantly by sodium balance. Recently, magnetic resonance imaging (MRI) has emerged as a non-invasive method to evaluate tissue sodium load in HF patients. This proof-of-principle study investigates the association between tissue sodium content, assessed by MRI, and HF-related baseline parameters in an outpatient cohort of patients with chronic heart failure, including those with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF).</p><p><strong>Methods and results: </strong>This prospective study included 29 HF patients (10 HFpEF, 12 HFmrEF, and 7 HFrEF) recruited from two centers in Berlin, Germany. Patients underwent MRI to assess tissue sodium content in the lower extremity. Tissue sodium content was analyzed in relation to baseline HF parameters, including renal function, natriuretic peptide levels, clinical signs of congestion, diuretic use, and New York Heart Association (NYHA) functional class. No significant differences in tissue sodium content were observed between the three HF entities. Sodium values did not differ significantly with clinical signs of congestion or diuretic use. No significant correlations were found between tissue sodium content and renal function (eGFR) or natriuretic peptide levels (NT-proBNP) in any HF group overall. However, explorative analyses showed a positive correlation between free (<i>r</i> = 0.79, <i>p</i> = 0.036) and total (<i>r</i> = 0.79, <i>p</i> = 0.036) tissue sodium content in the skin and NT-proBNP levels in HFrEF patients, but not in HFmrEF and HFpEF. Similarly, there was a correlation between kidney function and both free (<i>r</i> = -0.64, <i>p</i> = 0.025) and total (r = -0.61, <i>p</i> = 0.035) skin sodium in patients with edema and no prior use of loop diuretics, but no correlation for kidney function and both free and total skin sodium in symptomatic patients with established diuretic therapy or asymptomatic patients with no diuretic therapy.</p><p><strong>Conclusion: </strong>Our findings provide exploratory insights into the potential diagnostic value of tissue sodium content in HF, particularly in HFrEF patients. With findings showing an association of tissue sodium content with NT-proBNP levels in HFrEF patients and with kidney function in edema patients without prior loop diuretic use, further research is needed to understand the role of tissue sodium content in HF pathophysiology and its potential diagnostic and prognostic implications.</p><p><strong>Trial registration: </strong>German Clinical Trials Register (DRKS), registration number (DRKS00015615).</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1458152"},"PeriodicalIF":2.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390499","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":"Amphetamine use as a predictor of cardiovascular and cerebrovascular mortality and morbidity: a longitudinal cohort study of criminal justice clients.","authors":"Ada Åhman, Jonas Berge, Anders Håkansson","doi":"10.3389/fcvm.2025.1378833","DOIUrl":"10.3389/fcvm.2025.1378833","url":null,"abstract":"<p><strong>Introduction: </strong>Amphetamine use is an increasing problem, and studies suggest a connection between amphetamine use and cardiovascular and cerebrovascular pathology. However, few long-term studies examine amphetamine users' risk of cardiovascular and cerebrovascular pathology, in comparison to users of other drugs. In addition, in a criminal justice system, illicit drug use and psychiatric comorbidity is common, whereas structured treatment and follow-up is uncommon, and stimulant use is common in this setting. The aim of this study was to investigate the risk of cardiovascular and cerebrovascular morbidity and mortality for intravenous drug users with different drugs as the primary drug, using data from the criminal justice system.</p><p><strong>Methods: </strong>A cohort of injecting substance users (<i>N</i> = 2,422) was identified in the Swedish criminal justice system through interviews with the Addiction Severity Index (ASI) between January 2001 and August 2006. Data on age, sex, self-reported injection drug, tobacco use, and time in prison or custody were retrieved from the ASI database. The clients were followed in national registers up to 2014 with respect to cardiovascular and cerebrovascular morbidity and mortality. Potential predictors of cardiovascular and cerebrovascular events were investigated.</p><p><strong>Result: </strong>Self-reported main drug was amphetamine in 51.5% (<i>n</i> = 1,247), polysubstance use in 33% (<i>n</i> = 799), and heroin in 15.5% (<i>n</i> = 376) of the cohort. Total observational time for the entire cohort was 23,911 person-years [median 10.3 years (IQR 9.3-11.2 years)]. The highest incidence rates of both cardiovascular and cerebrovascular events were found among amphetamine users. Bivariate analyses showed a significantly higher percentage of cardiovascular events in amphetamine users compared to other substance users (<i>p</i> < 0.044). Amphetamine was not significantly associated with cardiovascular or cerebrovascular events, compared to the main drug heroin or polysubstance use.</p><p><strong>Conclusion: </strong>In this study on substance-using criminal justice clients, while the highest incidence rates of both cardiovascular and cerebrovascular events were found among amphetamine-using individuals, the study did not provide evidence of an independent association. The study highlights the need to take co-factors into account, such as comorbidities and socio-economic factors. More studies are needed to distinguish substance-specific pathology from the impact of other unhealthy lifestyle factors among substance-using individuals.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1378833"},"PeriodicalIF":2.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382092","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}
Nathan Angelo Lecaros Yap, Zahid Khan, Xingwei He, Jae-Geun Lee, Soe Maung, Kimberley R Morgan, Tingquan Zhou, Helle Precht, Patrick W Serruys, Hector M Garcia-Garcia, Yoshinobu Onuma, Sean Hynes, Sebastian Kelle, Anthony Mathur, Andreas Baumbach, Christos V Bourantas
{"title":"What have we learnt from histology about the efficacy of coronary imaging modalities in assessing plaque composition?","authors":"Nathan Angelo Lecaros Yap, Zahid Khan, Xingwei He, Jae-Geun Lee, Soe Maung, Kimberley R Morgan, Tingquan Zhou, Helle Precht, Patrick W Serruys, Hector M Garcia-Garcia, Yoshinobu Onuma, Sean Hynes, Sebastian Kelle, Anthony Mathur, Andreas Baumbach, Christos V Bourantas","doi":"10.3389/fcvm.2025.1507892","DOIUrl":"10.3389/fcvm.2025.1507892","url":null,"abstract":"<p><p>Accurate evaluation of coronary artery pathology is essential for risk stratification and tailoring appropriate treatment. Intravascular imaging was introduced for this purpose 40 years ago enabling for the first time <i>in vivo</i> plaque characterization. Since then, several studies have evaluated the efficacy of the existing intravascular imaging modalities in assessing plaque pathology and composition and their potential in guiding intervention and predicting vulnerable plaques. Today it is known that intravascular imaging is an indispensable tool in percutaneous coronary intervention planning, but the existing modalities have a limited efficacy in predicting lesion vulnerability; a fact that should be attributed to their advantages and limitations in accurately assessing morpho-pathological features that are common in advanced atherosclerotic plaques. This review aims to provide a comprehensive evaluation of the performance of intravascular imaging in characterizing plaque phenotypes using histology as a reference standard; it summarizes the studies comparing the available invasive imaging techniques against histology, discusses the findings and limitations of these studies and highlights the potential of novel intravascular imaging approaches that were introduced for a more complete and comprehensive evaluation of plaque pathobiology.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1507892"},"PeriodicalIF":2.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382086","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":"\"Pharmacological\" analysis of atrial fibrillation maintenance mechanism: reentry, wavelets, or focal?","authors":"Alexander Burashnikov","doi":"10.3389/fcvm.2025.1447542","DOIUrl":"10.3389/fcvm.2025.1447542","url":null,"abstract":"<p><p>The primary electrophysiological mechanism of atrial fibrillation (AF) maintenance is poorly defined. AF mapping studies readily record focal activations (defining them as focal sources or breakthroughs) and \"incomplete reentries\" (defining them as reentries or would-be-reentries) but do not or rarely detect complete circular activations. Electrophysiological alterations induced by anti-AF drugs before AF cardioversion may help delineate the mechanism of AF maintenance. Cardioversion of AF by antiarrhythmic drugs is associated with prolongation of the AF cycle length and temporal excitable gap (t-EG), resulting in improvement in AF organization (AF-org), and with or without alterations in the refractory period, conduction velocity and wavelength. Such electrophysiological pattern is conceivable with termination of a single focal source but not a single reentry (Class III agents do not increase reentrant t-EG). Yet, a single focal source and multiple focal sources are plausible as the primary mechanism of AF maintenance prior drug administration. Improvement in AF-org caused by anti-AF agents before AF cardioversion is coherent with simultaneous multiple random reentries and wavelets. However, simultaneous multiple reentries are unlikely to occur regularly (most of the contemporary AF mapping studies report either a single reentry at a time or no reentry at all), and the ability of random wavelets to maintain AF is speculative. The conducted analysis inclines toward the focal source as the primary mechanism of AF maintenance.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1447542"},"PeriodicalIF":2.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382091","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}
Changyu Sun, Neha Goyal, Yu Wang, Darla L Tharp, Senthil Kumar, Talissa A Altes
{"title":"Conditional diffusion-generated super-resolution for myocardial perfusion MRI.","authors":"Changyu Sun, Neha Goyal, Yu Wang, Darla L Tharp, Senthil Kumar, Talissa A Altes","doi":"10.3389/fcvm.2025.1499593","DOIUrl":"10.3389/fcvm.2025.1499593","url":null,"abstract":"<p><strong>Introduction: </strong>Myocardial perfusion MRI is important for diagnosing coronary artery disease, but current clinical methods face challenges in balancing spatial resolution, temporal resolution, and slice coverage. Achieving broader slice coverage and higher temporal resolution is essential for accurately detecting abnormalities across different slice locations but remains difficult due to constraints in acquisition speed and heart rate variability. While techniques like parallel imaging and compressed sensing have significantly advanced perfusion imaging, they still suffer from noise amplification, residual artifacts, and potential temporal blurring due to the rapid transit of dynamic contrast vs. the temporal constraints of the reconstruction.</p><p><strong>Methods: </strong>This study introduces a conditional diffusion-based generative model for myocardial perfusion MRI super resolution, addressing the trade-offs between spatiotemporal resolution and slice coverage. We adapted Denoising Diffusion Probabilistic Models (DDPM) to enhance low-resolution perfusion images into high-resolution outputs without requiring temporal regularization. The forward diffusion process introduces Gaussian noise incrementally, while the reverse process employs a U-Net architecture to progressively denoise the images, conditioned on the low-resolution input image.</p><p><strong>Results: </strong>We trained and validated the model on a retrospective dataset of dynamic contrast-enhanced (DCE) perfusion MRI, consisting of both stress and rest images from 47 patients with heart disease. Our results showed significant image quality improvements, with a 5.1% reduction in nRMSE, a 1.1% increase in PSNR, and a 2.2% boost in SSIM compared to GAN-based super-resolution method (<i>P</i> < 0.05 for all metrics using paired <i>t</i>-test) in retrospective study. For the 9 prospective subjects, we achieved a total nominal acceleration of 8.5-fold across 5-6 slices through a combination of low-resolution acquisition and GRAPPA. PerfGen outperformed GAN-based approach in sharpness (4.36 ± 0.38 vs. 4.89 ± 0.22) and overall image quality (4.14 ± 0.28 vs. 4.89 ± 0.22), as assessed by two experts in a blinded evaluation (<i>P</i> < 0.05) in prospective study.</p><p><strong>Discussion: </strong>This work demonstrates the capability of diffusion-based generative models in generating high-resolution myocardial perfusion MRI from conditional low-resolution images. This approach has shown the potentials to accelerate myocardial perfusion MRI while enhancing slice coverage and temporal resolution, offering a promising alternative to existing methods.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1499593"},"PeriodicalIF":2.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382096","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 impact of type 2 diabetes on left ventricular function in hypertensive patients: a three-dimensional speckle-tracking imaging study.","authors":"Yang Qingmei, Chen Xiaoyan, Fang Jianxiu","doi":"10.3389/fcvm.2024.1453809","DOIUrl":"10.3389/fcvm.2024.1453809","url":null,"abstract":"<p><strong>Objectives: </strong>The study aimed to evaluate the impact of the co-occurrence of hypertension and type 2 diabetes mellitus (T2DM) on the deterioration of left ventricular (LV) structure and function using three-dimensional speckle-tracking imaging (3D-STI), compared to patients with only hypertension.</p><p><strong>Methods: </strong>Data from 272 hypertensive patients, including 85 with T2DM and 187 without, along with 45 normal controls, were analyzed. Participant characteristics were assessed before and after propensity score matching (PSM). 3D-STI-derived parameters, including LV function and global strain parameters, were compared among controls and different patient groups. Multivariable linear regression analyses were conducted to determine the impacts of T2DM on LV function and global strain. Additionally, linear mixed-effects regression models were used to evaluate the associations between 3D-STI-derived parameters and T2DM over time in hypertensive patients.</p><p><strong>Results: </strong>Significant increases in the E/e' ratio and declines in the LV global radial strain (GRS) were observed across the control group, HTN (T2DM-) group, and HTN (T2DM+) group. After adjusting for various factors using PSM analysis, LV global circumferential strain (GCS) and global area strain (GAS) were also found to be significantly decreased in the HTN (T2DM+) group compared to the HTN (T2DM-) group. Multivariable regression analyses, accounting for various covariates, indicated that T2DM was independently linked to LV strains (LV GAS: <i>β</i> = 0.95, 95% CI: 0.90-1.00, <i>p</i> = 0.029; LV GRS: <i>β</i> = 1.03, 95% CI: 1.01-1.06, <i>p</i> = 0.014) in hypertensive patients. Furthermore, linear mixed-model analysis revealed that LV GCS (<i>β</i> = 1.20, 95% CI: 0.38-2.01, <i>p</i> = 0.004) and GRS (<i>β</i> = -2.82, 95% CI: -4.97-0.68, <i>p</i> = 0.010) deteriorated over the 12-month period.</p><p><strong>Conclusions: </strong>T2DM exacerbates the decline in LV global and regional strains in patients with hypertension, and 3D-STI may be a valuable tool for detecting these asymptomatic preclinical abnormalities.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"11 ","pages":"1453809"},"PeriodicalIF":2.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382022","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}