Frontiers in Cardiovascular Medicine最新文献

{"title":"The roles of neutrophils in cardiovascular diseases.","authors":"Yanjie Lian, Xiaolei Lai, Cong Wu, Li Wang, JuJu Shang, Heyi Zhang, Sihan Jia, Wenlong Xing, Hongxu Liu","doi":"10.3389/fcvm.2025.1526170","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1526170","url":null,"abstract":"<p><p>The immune response plays a vital role in the development of cardiovascular diseases (CVDs). As a crucial component of the innate immune system, neutrophils are involved in the initial inflammatory response following cardiovascular injury, thereby inducing subsequent damage and promoting recovery. Neutrophils exert their functional effects in tissues through various mechanisms, including activation and the formation of neutrophil extracellular traps (NETs). Once activated, neutrophils are recruited to the site of injury, where they release inflammatory mediators and cytokines. This study discusses the main mechanisms associated with neutrophil activity and proposes potential new therapeutic targets. In this review, we systematically summarize the diverse phenotypes of neutrophils in disease regulatory mechanisms, different modes of cell death, and focus on the relevance of neutrophils to various CVDs, including atherosclerosis, acute coronary syndrome, myocardial ischemia/reperfusion injury, hypertension, atrial fibrillation, heart failure, and viral myocarditis. Finally, we also emphasize the preclinical/clinical translational significance of neutrophil-targeted strategies.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1526170"},"PeriodicalIF":2.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771919","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 and safety of distal transradial access for coronary angiography and percutaneous coronary intervention: a meta-analysis.","authors":"Qinyan Yang, Xianli Wei, Jianyu Wu, Chunlan Li, Yuechen Qin, Haijian Zeng, Mengtian Qin, Yue Zou, Shiming Zhang, Weiming Liang, Jie Li","doi":"10.3389/fcvm.2025.1530995","DOIUrl":"10.3389/fcvm.2025.1530995","url":null,"abstract":"<p><strong>Introduction: </strong>This meta-analysis aims to evaluate the efficacy and safety of dTRA for coronary angiography (CAG) and percutaneous coronary intervention (PCI) in comparison to cTRA.</p><p><strong>Materials and methods: </strong>Four databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched from their inception to 13 April 2024 for studies comparing dTRA and cTRA in coronary diagnostic or interventional catheterization. The meta-analysis evaluated radial artery occlusion (RAO), procedure success, the success rate of catheter puncture, the success rate of a single attempt, hematoma occurrence, radial artery spasms, puncture site bleeding, puncture time, procedural time, the dosage of contrast medium, and hemostasis time.</p><p><strong>Results: </strong>A total of 31 studies were included in the meta-analysis. Compared with cTRA, dTRA significantly reduced the incidence of RAO [odds ratio (OR) = 0.41, 95% CI: 0.34-0.50, <i>P</i> < 0.05], hematoma (OR = 0.67, 95% CI:0.56-0.80, <i>P</i> < 0.05), and shorter hemostasis time [weighted mean difference (WMD) = -0.43, 95% CI:-0.65 to -0.20, <i>P</i> < 0.05] but had a significantly lower procedure success rate (OR = 0.41, 95% CI: 0.30-0.56, <i>P</i> < 0.05), a lower catheter puncture success rate (OR = 0.44, 95% CI: 0.27-0.71, <i>P</i> < 0.05), and a longer puncture time (WMD = 0.60, 95% CI: 0.44-0.75, <i>P</i> < 0.05). No significant differences were observed between dTRA and cTRA in terms of the success rate of a single attempt, radial artery spasms, puncture site bleeding, procedural time, and dosage of contrast medium.</p><p><strong>Conclusions: </strong>Our results revealed that dTRA is a workable and safe method for cardiovascular interventional diagnostics and treatment. It significantly reduces the incidence of RAO and hematoma, as well as shortens hemostasis time following surgery.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024596238, PROSPERO (CRD42024596238).</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1530995"},"PeriodicalIF":2.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763435","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":"Association of myocardial and liver T2* iron measurements with systolic and diastolic function by CMR feature tracking strain analysis.","authors":"Hugo G Quezada-Pinedo, Benedikt Bernhard, Jan C Zurkirchen, Anselm W Stark, Noushin Sadat Ahanchi, Catherine Gebhard, Daniel Ott, Alan A Peters, Hendrik von Tengg-Kobligk, Jonathan Schütze, Adam Bakula, Andreas Wahl, Kim N Cajachagua-Torres, Taulant Muka, Christoph Gräni","doi":"10.3389/fcvm.2025.1547161","DOIUrl":"10.3389/fcvm.2025.1547161","url":null,"abstract":"<p><strong>Background/objectives: </strong>Myocardial and liver iron overload can be assessed through T2* in magnetic resonance imaging (MRI). It is unclear, how T2* measurements are associated with systolic and diastolic left ventricular function assessed by novel feature tracking (FT) strain.</p><p><strong>Methods: </strong>Consecutive patients with suspected iron overload undergoing MRI T2* were retrospectively included. T2* was studied continuously and in categories: normal myocardial iron status (T2* ≥ 20 ms), myocardial iron overload (T2* < 20 ms), normal liver iron status (T2* ≥ 15.4 ms) and liver iron overload (T2* < 15.4 ms). Multivariable regression models were used to assess associations between T2* and FT strain.</p><p><strong>Results: </strong>Among 172 participants, longitudinal e/a ratio [-0.17 (-0.27, -0.08), <i>p</i> = 0.001], longitudinal early diastolic strain rate [-0.13 (-0.23, -0.03), <i>p</i> = 0.014], circumferential late diastolic strain rate [0.18 (0.03, 0.32), <i>p</i> = 0.016], longitudinal late diastolic strain rate [0.20 (0.03, 0.36), <i>p</i> = 0.019] were associated with higher T2*. Liver iron overload was associated with circumferential systolic strain rate [-0.42 (-0.74, -0.09), <i>p</i> = 0.014] and longitudinal early diastolic strain rate [0.27 (0.04, 0.49), <i>p</i> = 0.023]. Combined liver and myocardial iron overload were associated with longitudinal e/a ratio [0.72 (0.19, 1.24), <i>p</i> = 0.008]. No associations of T2* values with systolic function were found.</p><p><strong>Conclusion: </strong>Liver and a combination of myocardial and liver iron overload were associated with increased early diastolic filling and increased e/a ratio respectively, which may serve as markers of diastolic dysfunction. Impaired diastolic function, even in the absence of myocardial iron overload was associated with liver iron metabolism and may indicate early cardiac involvement, while left ventricular systolic function is still preserved.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1547161"},"PeriodicalIF":2.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11958997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763429","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":"Cardiac preservation using <i>ex vivo</i> organ perfusion: new therapies for the treatment of heart failure by harnessing the power of growth factors using BMP mimetics like THR-184.","authors":"William D Carlson, Dattatreyamurty Bosukonda, Peter C Keck, Philippe Bey, Shannon N Tessier, Frederic R Carlson","doi":"10.3389/fcvm.2025.1535778","DOIUrl":"10.3389/fcvm.2025.1535778","url":null,"abstract":"<p><p>As heart transplantation continues to be the gold standard therapy for end-stage heart failure, the imbalance between the supply of hearts, and the demand for them, continues to get worse. In the US alone, with less than 4,000 hearts suitable for transplant and over 100,000 potential recipients, this therapy is only available to a very few. The use of hearts Donated after Circulatory Death (DCD) and Donation after Brain Death (DBD) using <i>ex vivo</i> machine perfusion (EVMP) is a promising approach that has already increased the availability of suitable organs for heart transplantation. EVMP offers the promise of enabling the expansion of the overall number of heart transplants and lower rates of early graft dysfunction. These are realized through (1) safe extension of the time between procurement and transplantation and (2) <i>ex vivo</i> assessment of preserved hearts. Notably, <i>ex vivo</i> perfusion has facilitated the donation of DCD hearts and improved the success of transplantation. Nevertheless, DCD hearts suffer from serious preharvest ischemia/reperfusion injury (IRI). Despite these developments, only 40% of hearts offered for transplantation can be utilized. These devices do offer an opportunity to evaluate donor hearts for transplantation, resuscitate organs previously deemed unsuitable for transplantation, and provide a platform for the development of novel therapeutics to limit cardiac injury. Bone Morphogenetic Protein (BMP) signaling is a new target which holds the potential for ameliorating myocardial IRI. Recent studies have demonstrated that BMP signaling has a significant role in blocking the deleterious effects of injury to the heart. We have designed novel small peptide BMP mimetics that act via activin receptor-like kinase (ALK3), a type I BMP receptor. They are capable of (1) inhibiting inflammation and apoptosis, (2) blocking/reversing the epithelial-mesenchymal transition (EMT) and fibrosis, and (3) promoting tissue regeneration. In this review, we explore the promise that novel therapeutics, including these BMP mimetics, offer for the protection of hearts against myocardial injury during <i>ex vivo</i> transportation for cardiac transplantation. This protection represents a significant advance and a promising <i>ex vivo</i> therapeutic approach to expanding the donor pool by increasing the number of transplantable hearts.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1535778"},"PeriodicalIF":2.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763432","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":"Successful pharmaco-mechanical treatment of a subtotally occluded venous bypass graft in a patient presenting with acute coronary syndrome: a case report and review of the current literature on the role of local thrombolysis.","authors":"Matthias Renker, Samuel Sossalla, Christoph Schoefthaler, Grigorios Korosoglou","doi":"10.3389/fcvm.2025.1471462","DOIUrl":"10.3389/fcvm.2025.1471462","url":null,"abstract":"<p><p>Coronary artery bypass grafting (CABG) is a common and effective treatment for patients with complex coronary artery disease. This case report discusses a 75-year-old male patient who presented with angina and shortness of breath due to thrombus formation in a venous graft 20 years after CABG. Initial diagnostics indicated non-ST-elevation myocardial infarction, leading to immediate intervention. Cardiac catheterization revealed thrombus in the vein graft to the large first diagonal branch, necessitating percutaneous coronary intervention. Despite initial efforts, thrombus aspiration and further catheter advancement were unsuccessful. A combination of balloon angioplasty, stent implantation, and intra-arterial thrombolysis with recombinant tissue plasminogen activator (rt-PA) was employed, resulting in significant thrombus reduction and improved coronary flow. Follow-up coronary CT angiography (CCTA) confirmed complete thrombus resolution and patent graft. The patient was discharged with dual antiplatelet therapy and showed favorable outcomes. This case emphasizes the challenges of managing thrombotic complications in venous bypass grafts and highlights the effectiveness of a multifaceted interventional approach combined with CCTA for non-invasive patient follow-up and assessment of treatment success. Furthermore, a review of the current literature on the role of local thrombolysis for occluded coronary artery bypass grafts is provided.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1471462"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751871","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":"Mitochondria associated membranes in dilated cardiomyopathy: connecting pathogenesis and cellular dysfunction.","authors":"Pingge He, Hongbo Chang, Yueqing Qiu, Zhentao Wang","doi":"10.3389/fcvm.2025.1571998","DOIUrl":"10.3389/fcvm.2025.1571998","url":null,"abstract":"<p><p>Dilated cardiomyopathy (DCM) is a leading cause of heart failure, yet therapeutic options remain limited. While traditional research has focused on mechanisms such as energy deficits and calcium dysregulation, increasing evidence suggests that mitochondria-associated membranes (MAMs) could provide new insights into understanding and treating DCM. In this narrative review, we summarize the key role of MAMs, crucial endoplasmic reticulum (ER)-mitochondria interfaces, in regulating cellular processes such as calcium homeostasis, lipid metabolism, and mitochondrial dynamics. Disruption of MAMs function may initiate pathological cascades, including ER stress, inflammation, and cell death. These disruptions in MAM function lead to further destabilization of cellular homeostasis. Identifying MAMs as key modulators of cardiac health may provide novel insights for early diagnosis and targeted therapies in DCM.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1571998"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751759","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":"Multiple coronary artery perforation as a fatal complication during the management of an undeflatable stent balloon: a case report.","authors":"Seok Hyun Kim, Sang Hyun Lee, Jeongsu Kim, Kook Jin Chun","doi":"10.3389/fcvm.2025.1565014","DOIUrl":"10.3389/fcvm.2025.1565014","url":null,"abstract":"<p><strong>Background: </strong>An undeflatable stent balloon following its inflation during percutaneous coronary intervention (PCI) is a rare and unpredictable complication that can lead to serious consequences. Currently, there is no standardized protocol for managing this issue.</p><p><strong>Case presentation: </strong>An 83-year-old man presented with chest pain. Coronary angiography showed a chronic total occlusion (CTO)-like lesion in the proximal left anterior descending coronary artery (LAD). Following stent deployment, the balloon failed to deflate and remained inflated within the LAD. Despite multiple retrieval attempts, the issue remained unresolved. As an alternative to surgical removal, we inflated the balloon beyond its rated burst pressure within the coronary artery. The balloon eventually ruptured and was successfully retrieved; However, this resulted in multiple severe coronary perforations, which were effectively sealed using covered stents.</p><p><strong>Conclusion: </strong>Balloon deflation failure is an exceptionally rare, unpredictable, and critical complication of PCI. While various troubleshooting strategies exist, inflating an undeflatable balloon beyond its burst pressure should be considered only as a last resort, with thorough preparation for potential complications.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1565014"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751761","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 machine learning model for online predicting the risk of in heart failure: based on the routine blood test and their derived parameters.","authors":"Jianchen Pu, Yimin Yao, Xiaochun Wang","doi":"10.3389/fcvm.2025.1539966","DOIUrl":"10.3389/fcvm.2025.1539966","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF), a core component of cardiovascular diseases, is characterized by high morbidity and mortality worldwide. By collecting and analyzing routine blood data, machine learning models were built to identify the patterns of changes in blood indicators related to HF.</p><p><strong>Methods: </strong>We conducted a statistical analysis of routine blood data from 226 patients who visited Zhejiang Provincial Hospital of Traditional Chinese Medicine (Hubin) between May 1, 2024, and June 30, 2024. The patients were divided into an experimental group (HF patients) and a normal control group. Additionally, 211 patients from the Qiantang and Xixi centers formed an independent external validation cohort. This study used both univariate and multivariate analyses to identify the risk factors associated with HF. Variables associated with HF were selected using LASSO regression analysis. In addition, eight different machine learning algorithms were applied for prediction, and the prediction performances of these algorithms were comprehensively evaluated using the receiver operating characteristic curve, area under the curve (AUC), calibration curve analysis, and decision curve analysis and confusion matrix.</p><p><strong>Conclusions: </strong>Using LASSO regression analysis, leukocyte, neutrophil, red blood cell, hemoglobin, platelet, and monocyte-to-lymphocyte ratios were identified as risk factors for HF. Among the evaluated models, the random forest model exhibited the best performance. In the validation cohort, the area under the curve (AUC) of the model was 0.948, while that of the test cohort was 1.000. The calibration curve revealed good agreement between the actual and predicted probabilities, whereas the decision curve showed the significant clinical application of the model. Additionally, the AUC of the model in the external independent test cohort was 0.945.</p><p><strong>Discussion: </strong>We used an online predictive tool to develop a predictive machine-learning model. The main purpose of this model was to predict the probability of developing HF in the future. This prediction can provide strong support and references for clinicians when making decisions. This online forecasting tool not only processes a large amount of data but also continuously optimizes and adjusts the accuracy of the model according to the latest medical research and clinical data. We hope to identify high-risk patients for early intervention to reduce the incidence of HF and improve their quality of life.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1539966"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751639","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":"Evaluating cystatin-C and monocyte-to-high-density lipoprotein cholesterol ratio as indicators of obstructive sleep apnea severity in male patients.","authors":"Run-Tian Meng, Qiao-Wen Chen, Chih-Yuan Ko","doi":"10.3389/fcvm.2025.1545100","DOIUrl":"10.3389/fcvm.2025.1545100","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the association between blood cystatin-C (Cys-C) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR), both established inflammatory markers, with the severity of obstructive sleep apnea (OSA) in male patients.</p><p><strong>Methods: </strong>A total of 117 male participants who underwent overnight polysomnography (PSG) between February 2019 and December 2022 were included. Based on the apnea-hypopnea index (AHI), participants were categorized into three groups: G1 (AHI < 5 events/hour, <i>n</i> = 9; control group), G2 (5 ≤ AHI < 30 events/hour, <i>n</i> = 32), and G3 (AHI ≥ 30 events/hour, <i>n</i> = 76). Serum Cys-C and MHR levels were measured and analyzed for their correlation with OSA severity. Multivariate logistic regression and receiver operating characteristic (ROC) analyses assessed their diagnostic value, while restricted cubic spline (RCS) analysis examined potential nonlinear relationships.</p><p><strong>Results: </strong>Cys-C and MHR levels increased with OSA severity and showed significant positive correlations with AHI (Cys-C: <i>r</i> = 0.084, <i>P</i> < 0.05; MHR: <i>r</i> = 0.1286, <i>P</i> < 0.05). In multivariate regression, MHR remained an independent correlate of OSA severity (adjusted OR = 47.130, 95% CI: 1.014-6.692, <i>P</i> = 0.008), whereas Cys-C lost statistical significance after adjusting for confounders. RCS analysis found no significant nonlinear relationship (<i>P</i> > 0.05). ROC analysis showed that combining Cys-C and MHR modestly improved diagnostic accuracy (AUC = 0.6622, 95% CI: 0.554-0.77). Subgroup analysis indicated that severe OSA patients with hypertension had higher Cys-C and MHR levels compared to those without hypertension, though the differences were not statistically significant (<i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>Cys-C and MHR are positively associated with OSA severity, with MHR emerging as a stronger independent biomarker. Incorporating these markers into OSA risk stratification may enhance clinical assessment and targeted interventions. Future large-scale prospective studies are needed to validate their prognostic value and clinical utility.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1545100"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751654","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":"Dapagliflozin effects on exercise, cardiac remodeling, biomarkers, and renal and pulmonary function in heart failure patients: not as good as expected?","authors":"Massimo Mapelli, Irene Mattavelli, Elisabetta Salvioni, Nicolò Capra, Valentina Mantegazza, Anna Garlaschè, Jeness Campodonico, Filippo Maria Rubbo, Chiara Paganin, Teresa Maria Capovilla, Alessandro Alberto Nepitella, Rebecca Caputo, Paola Gugliandolo, Carlo Vignati, Beatrice Pezzuto, Fabiana De Martino, Giulia Grilli, Marco Scatigna, Alice Bonomi, Gianfranco Sinagra, Manuela Muratori, Piergiuseppe Agostoni","doi":"10.3389/fcvm.2025.1542870","DOIUrl":"10.3389/fcvm.2025.1542870","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are standard therapy for heart failure (HF). We performed a holistic evaluation of dapagliflozin, including its effects on exercise performance, left ventricle (LV) reverse remodeling, cardiac biomarkers, fluid retention, and renal and pulmonary function.</p><p><strong>Methods: </strong>We enrolled HF reduced ejection fraction (LVEF) outpatients (EF <40%) eligible for SGLT2-i and performed cardiopulmonary exercise tests (CPET), pulmonary function tests, bioelectrical impedance vector analysis, and laboratory and echocardiographic assessments at baseline (<i>T</i> = 0), after 2-4 weeks (T1), and after 6 months of treatment (T2).</p><p><strong>Results: </strong>None of the patients interrupted SGLT2-i for adverse events albeit follow-up was completed by 67 of 75 enrolled patients. At T2, mean LVEF increased (from 34.6 ± 7.8 to 37.5 ± 9.2%; <i>p</i> < 0.001) while end-diastolic (EDV) and end-systolic (ESV) volumes decreased [EDV: 186 (145-232) vs. 177 (129-225) mL, ESV: 113 (87-163) vs. 110 (76-145) mL; <i>p</i> < 0.001]. Peak oxygen intake was unchanged [peakVO₂: 16.2 (13.4-18.7) vs. 16.0 (13.3-18.9) mL/kg/min; <i>p</i> = 0.297], while exercise ventilatory efficiency (VE/VCO₂ slope) improved [from 34.2 (31.1-39.2) to 33.7 (30.2-37.6); <i>p</i> = 0.006]. Mean hemoglobin increased (from 13.8 ± 1.5 to 14.6 ± 1.7 g/dL; <i>p</i> < 0.001), while renal function did not change after a transient worsening at T1. NT-proBNP, ST-2, and hs-TNI did not change as overall body fluids and quality of life assessed by KCCQ. NYHA class improved (<i>p</i>=0.002), paralleled by a decrease of MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score, from 3.3% (1.9-8.0) to 2.8% (1.2-5.7), suggestive of a positive impact on 2 years prognosis (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Dapagliflozin induced positive LV remodeling, improvement of exercise ventilatory efficiency, and NYHA class but without peakVO₂ fluid status and cardiac biomarkers changes.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1542870"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751686","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}