Frontiers in Cardiovascular Medicine最新文献

{"title":"Macrophages as key modulators of calcific aortic valve disease.","authors":"Nervana Issa, Gérémy Blot, Alexandre Candellier, Cédric Boudot, Loïc Louvet, Saïd Kamel, Youssef Bennis, Lucie Hénaut","doi":"10.3389/fcvm.2025.1664067","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1664067","url":null,"abstract":"<p><p>Calcific aortic valve disease (CAVD), defined by thickening, fibrosis, and mineralization of the aortic valve (AV) leaflets, is the most common valvular heart disease worldwide. This progressive remodeling gradually impairs valve opening, obstructing blood flow. Without intervention, the resulting aortic stenosis (AS) causes hemodynamic deterioration that ultimately leads to heart failure and death. To date, therapeutic options remain limited, making valve replacement the reference treatment. While valvular endothelial and interstitial cells have traditionally been considered the primary drivers of the osteogenic program underlying AV remodeling, recent evidence highlights a central role for macrophages, whose plasticity profoundly impacts the local microenvironment. In their inflammatory state, macrophages release cytokines, generate oxidative stress, and secrete Bone Morphogenetic Protein 2 (BMP2), which promotes the osteogenic transformation of valvular cells. The resulting calcium crystal deposition further amplifies macrophage-driven inflammation, creating a vicious cycle. Conversely, immunomodulatory macrophages can protect against CAVD by releasing pyrophosphate, a calcification inhibitor. However, these macrophages also secrete pro-fibrotic factors and may undergo myeloid-to-mesenchymal transition, processes that paradoxically contribute to AV fibrosis and mineralization. In addition, macrophages within the AV can differentiate into osteoclast-like cells, suggesting that a bone-like remodeling process occurs in the cardiovascular wall. This high phenotypic plasticity complicates our understanding of CAVD pathogenesis and highlights the need for deeper insight into macrophage functions to design effective preventive and therapeutic strategies. This review summarizes the mechanisms through which different macrophage subsets promote, prevent, or reverse AV remodeling, in both native and bioprosthetic contexts, and explores the therapeutic potential of targeting macrophages or their activity to slow AS progression.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1664067"},"PeriodicalIF":2.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257787","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 of a nomogram model for predicting coronary heart disease in patients with metabolic-associated fatty liver disease.","authors":"Zhengliang Li, Xiaokai Chen, Juan Wang, Weirui Chen, Run Zhang, Lihua Cao, Shaoting Shi, Linlin Ren, Wenzhong Zhang","doi":"10.3389/fcvm.2025.1652321","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1652321","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the risk factors associated with coronary heart disease (CHD) in patients with metabolic-associated fatty liver disease (MAFLD) and develop a nomogram prediction model.</p><p><strong>Methods: </strong>This study included 394 patients with MAFLD who underwent coronary angiography at The Affiliated Hospital of Qingdao University between December 2019 and December 2024. The study cohort was divided in a 7:3 ratio into training and validation sets comprising 277 and 117 cases, respectively. The training group was further divided into the MAFLD-only (<i>n</i> = 57) and MAFLD-plus-CHD (<i>n</i> = 220) groups. LASSO and multivariable logistic regression analyses were performed to identify the risk factors of concomitant coronary heart disease in patients with MAFLD. A nomogram was constructed and validated internally to predict CHD risk in the patients. We evaluated the nomogram's predictive performance using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) in the training and validation groups.</p><p><strong>Results: </strong>Of the 394 MAFLD cases, 313 had CHD-related complications. Of the 277 patients in the training set, 220 had CHD, and of the 117 patients in the validation set, 93 had CHD. LASSO regression analysis revealed that the following variables were associated with the risk of CHD: sex, lipoprotein(a) (Lp[a]), low-density lipoprotein cholesterol, white blood cell count (WBC), glycated triglyceride-glucose index (TyG), and atherosclerosis index (AIP). Multivariate logistic regression analysis revealed that sex, Lp(a), WBC, TyG, and AIP were independent risk factors for CHD in MAFLD cases. A nomogram was constructed and an ROC curve was plotted, based on which the optimal cutoff value was determined as 0.698. The area under the curve of the nomogram in the training and validation cohorts was 0.860 (95% CI = 0.807-0.913) and 0.843 (95% CI = 0.757-0.929), respectively. Calibration curves for CHD risk probability showed good agreement between the nomogram's predicted probabilities and the observed event rates. DCA demonstrated the net clinical benefit of the constructed nomogram.</p><p><strong>Conclusion: </strong>Sex, Lp(a), WBC, TyG, and AIP emerged as independent risk factors for CHD in patients with MAFLD and the nomogram prediction model constructed using these factors could effectively predict CHD occurrence.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1652321"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250137","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":"Regulation of aquaporin-2 using traditional Chinese medicine in water balance disorders: a literature review.","authors":"Yifan Chang, Lu Liu, Xiaodong Xu, Shiqiang Zhang","doi":"10.3389/fcvm.2025.1506190","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1506190","url":null,"abstract":"<p><p>Aquaporin-2 (AQP2) is a critical protein involved in water metabolism. It is primarily located in the renal collecting duct cells' apical plasma membranes and intracellular vesicles and regulates the movement of water into and out of cells. It plays a pivotal role in maintaining fluid balance, and its dysregulation is associated with conditions such as hypertension and heart failure, which contribute to cardiovascular disease progression. AQP2 has garnered significant attention as an emerging therapeutic target. Traditional Chinese medicine (TCM) has demonstrated efficacy in treating water balance disorders, although its underlying mechanisms remain elusive. The discovery of AQP2 and its association with water metabolism provides an opportunity for TCM to explore these mechanisms more intuitively. This review integrates TCM formulas, single herbs, and active constituents, linking them to AQP2 regulation in the kidneys, heart, liver, inner ear, and uterus with an emphasis on the AVP-V2R-AQP2 axis, while distinguishing between short- and long-term regulation and highlighting cardiovascular applications. This review synthesizes the current evidence from experimental and limited clinical studies, highlights the regulatory effects of TCM on AQP2 in various organ systems, and identifies key research gaps to guide future translational and clinical investigations.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1506190"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250327","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":"Systolic pulmonary artery pressure threshold to define pulmonary and peripheral congestion in acute heart failure in absence of severe tricuspid regurgitation.","authors":"Maria Giulia Bellicini","doi":"10.3389/fcvm.2025.1678712","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1678712","url":null,"abstract":"<p><strong>Background and aims: </strong>Pulmonary and/or peripheral venous congestion defines the clinical diagnosis of acute heart failure (AHF). However, the systolic pulmonary arterial pressure (sPAP) thresholds at which pulmonary (chest x-ray) and inferior vena cava (IVC) congestion occur are not well established. This study aimed to identify a cut-off value of sPAP that reliably indicates AHF.</p><p><strong>Methods and results: </strong>We retrospectively included 380 consecutive patients hospitalized for AHF at an Italian referral centre, after excluding those with severe tricuspid regurgitation. Receiver operating characteristic (ROC) curve analysis and Youden's J statistic identified a threshold of sPAP ≥ 48.75 mmHg as the most accurate in predicting both pulmonary (sensitivity = 89.9%, specificity = 73%) and peripheral (sensitivity = 88.3%, specificity = 82.5%) fluid overload. The association between this sPAP threshold and both pulmonary and peripheral congestion was confirmed by chi-square testing (<i>p</i> < 0.001) and multivariate logistic regression (<i>p</i> < 0.001). After adjustment for confounders, sPAP ≥ 49 mmHg was independently associated with all-cause death or heart failure (HF) hospitalization (HR = 1.713; 95% CI 1.127-2.602; <i>p</i> = 0.012).</p><p><strong>Conclusions: </strong>sPAP threshold of 49 mmHg identifies congestion with clinically useful accuracy-pulmonary (chest X-ray) congestion.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1678712"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250312","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 role of gut microbiota in myocardial ischemia-reperfusion injury.","authors":"Xin Chen, Lu Ye, Xin Zou, Yuan Zhou, Chan Peng, Rui Huang","doi":"10.3389/fcvm.2025.1625299","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1625299","url":null,"abstract":"<p><p>Myocardial ischemia-reperfusion injury denotes the pathological damage resulting from the restoration of blood flow and oxygen supply following acute coronary artery occlusion. Myocardial ischemia-reperfusion injury is commonly seen in acute coronary syndromes and is an important factor in the development of ischemic cardiomyopathy, which severely affects the prognosis of coronary heart disease. The gut microbiota, a complex ecosystem with multifaceted functions, plays a crucial role in host health. Dysregulation of the gut microbiota exerts substantial effects on the onset and progression of cardiovascular diseases, including myocardial ischemia-reperfusion injury. This review elucidates the mechanisms underlying myocardial ischemia-reperfusion injury and the involvement of the gut microbiota in this process, encompassing aspects such as intestinal barrier integrity, microbial dysbiosis, inflammatory responses, oxidative stress, mitochondrial dysfunction, and metabolic alterations. Additionally, we investigate various interventions that modulate myocardial ischemia-reperfusion injury by influencing the gut microbiota. Maintaining a healthy intestinal barrier and a stable microbial ecology is paramount in preventing myocardial ischemia-reperfusion injury. High-fiber diets, probiotic consumption, short-chain fatty acids supplementation, and Traditional Chinese Medicine, can safeguard the heart against myocardial ischemia-reperfusion injury by regulating gut microbiota through diverse mechanisms. As the role of gut microbiota in myocardial ischemia-reperfusion injury continues to be investigated, it provides important therapeutic targets and drug development opportunities for the prevention and treatment of myocardial ischemia-reperfusion injury. However, further in-depth and comprehensive studies are required to fully realize these potentials.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1625299"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250342","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":"Plasma fibrinogen level and acute aortic dissection prognosis-insights from a two-center cohort study.","authors":"Jiaxin Xiao, Junshuang Tang, Zilong Fu, Kaihong Yi, Xiulian Deng, Junsi Zheng, Qingqing Ni, Shiwan Wu, Yandan Xie, Weixing Huang, Yongquan Zhang, Xiao Wang, Liang Tao, Yequn Chen, Muli Wu","doi":"10.3389/fcvm.2025.1508749","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1508749","url":null,"abstract":"<p><strong>Objective: </strong>The relationship between plasma fibrinogen level (PFL) and prognosis of acute aortic dissection (AAD) are not well defined. The present study aimed to assess the effect of PFL on AAD prognosis through a two-center study and meta-analysis.</p><p><strong>Methods: </strong>A two-center cohort study was carried out in the two hospitals from Shantou and Xi'an cities. 1981 patients with AAD, admitted from 2012 to 2021, were included and followed up by clinical interview and telephone. The primary follow-up outcomes were 30-day mortality and long-term mortality. The relationship between PFL and all-cause mortality was identified. Further, meta-analysis was performed using our data and open access data.</p><p><strong>Results: </strong>The median follow-up time for the study cohort was 21.6 months (interquartile range 8.6-45.4 months). Compared with survivors, the non-survivors had a lower PFL. Survival analysis showed that mortality was higher in those with lower PFL. After multivariate adjustment, each 1 g/L increase in PFL was associated with a 18.9% decrease in 30-day mortality rate and a 11.5% decrease in long-term mortality rate (<i>P</i> < 0.001). Meta-analysis of the included our study revealed a significant association between lower PFL and increased 30-day mortality in type A and type B AAD [OR = 3.30, 95% CI: 2.58-4.23, <i>P</i> = 0.0739; <i>I</i> ² = 47.9%]. Simultaneously, similar associations were observed in Stanford type A in for long-term mortality [OR = 3.62, 95% CI: 2.23-5.87, <i>P</i> = 0.0438; <i>I</i> ² = 56.2%].</p><p><strong>Conclusions: </strong>Low PFL is a risk factor for short and long-term all-cause mortality in patients with type A AAD and short-term all-cause mortality in patients with type B AAD.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1508749"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250213","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":"Targeting monocyte heterogeneity in aortic aneurysms: immunomodulatory strategies and therapeutic opportunities.","authors":"Rasit Dinc, Nurittin Ardic","doi":"10.3389/fcvm.2025.1670576","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1670576","url":null,"abstract":"<p><p>Aortic aneurysms (AA) remain life-threatening vascular disorders characterized by progressive dilatation and risk of rupture. Despite advances in surgical and endovascular repair, pharmacological therapies to prevent aneurysm progression are lacking. Increasing evidence implicates chronic vascular inflammation and monocyte-derived macrophages in the pathogenesis of AA via matrix degradation, smooth muscle cell apoptosis, and neovascularization. Monocytes, traditionally classified as classical (CD14++CD16-), intermediate (CD14++CD16+), and nonclassical (CD14+CD16++) subsets, exhibit diverse functions in immune surveillance, cytokine production, and tissue remodeling. This review addresses the mechanistic roles of monocyte subsets in AA progression, evaluates emerging immunomodulatory strategies including CCR2 and TREM-1 inhibition, metabolic reprogramming, nanoparticle delivery, and cell-based therapies, and explores their integration with current surgical practices. Identification of circulating monocyte phenotypes may serve as promising biomarkers for patient stratification, monitoring, and therapeutic guidance. Advances in single-cell transcriptomics may reveal dynamic monocyte-macrophage phenotypes in aneurysm tissue. Current data hold promises for providing new perspectives on therapeutic strategies targeting monocytes. However, data are largely derived from preclinical studies. Detailed clinical studies are needed. Furthermore, translating these insights into clinical practice requires multidisciplinary collaboration among experts in immunology, vascular surgery, imaging, and systems biology.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1670576"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250339","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 lactate to albumin ratio with short-term and long-term mortality in critically ill patients with heart failure complicated by sepsis: a retrospective study using the MIMIC-IV database.","authors":"Yuming Wu, Ling Wang, Qiuyan Wen","doi":"10.3389/fcvm.2025.1636375","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1636375","url":null,"abstract":"<p><strong>Background: </strong>Elevated lactate to albumin ratio (LAR) has been associated with poor prognosis in critical illnesses. However, evidence regarding LAR in patients with heart failure (HF) complicated by sepsis remains limited. This study aimed to explore the relationship between LAR and both short-term and long-term mortality in this population.</p><p><strong>Method: </strong>Patient data were extracted from the Medical Information Mart for Intensive Care (MIMIC-IV) database and stratified into quartiles based on LAR. The primary endpoints were 28-day and 365-day all-cause mortality. Kaplan-Meier survival analysis was performed to compare outcomes across the four groups. Association between LAR and mortality was assessed using restricted cubic splines (RCS) and Cox regression analysis. Additionally, subgroup and sensitivity analyses were conducted.</p><p><strong>Result: </strong>Among 4,242 participants (mean age 72.04 ± 13.50 years; 57.33% male), Kaplan-Meier analysis showed that higher LAR levels were associated with increased 28-day and 365-day all-cause mortality (log-rank <i>P</i> < 0.001). Cox regression analysis confirmed that elevated LAR was independently associated with higher 28-day and 365-day all-cause mortality (HR: 1.101, 95% CI 1.005-1.205; HR: 1.125, 95% CI 1.039-1.218). The highest LAR quartile (>0.97) remained significantly associated with both 28-day and 365-day mortality (Q4 vs. Q1: HR: 1.313, 95% CI 1.063-1.622; HR: 1.310, 95% CI 1.092-1.571). RCS analysis indicated a linear positive correlation between LAR and mortality (<i>P</i> for nonlinear > 0.05). Subgroup analysis revealed a significant interaction with hypertension (<i>P</i> for interaction = 0.033 for 28-day; <i>P</i> for interaction = 0.015 for 365-day). Sensitivity analyses confirmed the robustness of these findings.</p><p><strong>Conclusion: </strong>In critically ill patients with HF complicated by sepsis, LAR is a reliable and independent predictor of mortality. Patients in the highest LAR quartile (>0.97) have a significantly increased risk of death, providing a clinically useful reference for rapid identification of high-risk individuals. The significant interaction observed in hypertensive subgroups highlights the need for heightened clinical attention. Overall, LAR may serve as a practical biomarker for risk stratification and prognostic evaluation in this vulnerable population.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1636375"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250679","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":"Changes in central and peripheral hemodynamic parameters during blood donation.","authors":"Babak Yazdani, Gökhan Yücel, Katrin Schulz, Sabine Kayser, Behnam Shaygi, Gerhard Schumacher, Janine Poschauko, Bernhard K Krämer, Daniel Duerschmied, Anna Hohneck","doi":"10.3389/fcvm.2025.1628366","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1628366","url":null,"abstract":"<p><strong>Background: </strong>Blood donation is a common procedure, yet its acute effects on central and peripheral hemodynamics are not fully understood. This study aimed to systematically quantify immediate cardiovascular changes induced by whole blood donation in healthy adults, with a primary focus on arterial pressure and central hemodynamic parameters.</p><p><strong>Methods: </strong>Thirty healthy volunteers (12 female, 18 male; median age 34 years, IQR 24-53) underwent standardized whole blood donation. Non-invasive measurements of central and peripheral hemodynamics were performed immediately before and after donation using the VascAssist 2 device, enabling assessment of brachial and aortic blood pressures, heart rate, augmentation index (AIx), pulse wave velocity (PWV), and left ventricular ejection time (LVET).</p><p><strong>Results: </strong>Blood donation resulted in a significant reduction in brachial systolic blood pressure (SBP) [pre: 131 mmHg [IQR 121-138] vs. post: 127 mmHg [IQR 116-134]; median change -4mmHg, IQR -10 to 0; <i>p</i> = 0.002]. No statistically significant changes were observed in heart rate [pre: 72 bpm [IQR 68-80] vs. post: 74 bpm [IQR 64-81]; <i>p</i> = 0.82], diastolic blood pressure (DBP) [pre: 75 mmHg [IQR 68-81] vs. post: 74 mmHg [IQR 70-85]; <i>p</i> = 0.66], aortic SBP, or central PWV. Significant reductions were observed in augmentation index [AIx75: pre 1% [IQR -9 to 6] vs. post -5% [IQR -11 to 4]; <i>p</i> = 0.02] and LVET [pre: 244 ms [IQR 225-257] vs. post: 231 ms [IQR 215-243]; <i>p</i> = 0.0005]. No statistically significant correlations were identified between these hemodynamic responses and sex, age, body mass index, or hemoglobin concentration.</p><p><strong>Conclusion: </strong>Acute whole blood donation induces a mild but statistically significant decrease in peripheral SBP, accompanied by reductions in AIx and LVET, while central aortic blood pressure and vascular stiffness remain unchanged. These findings indicate that healthy individuals exhibit immediate adaptive mechanisms that preserve central cardiovascular stability in response to mild volume depletion. The results support the overall hemodynamic tolerability of blood donation and provide insight into the transient vascular and cardiac adaptations elicited by acute blood loss.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1628366"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250113","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":"Epicardial adipose tissue thickness on transthoracic echocardiography predicts 2-year incident atrial fibrillation in elderly hypertensive patients.","authors":"Mintao Ma, Xiaoye Zheng, Xiaojuan Wu, Qing Xie","doi":"10.3389/fcvm.2025.1650423","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1650423","url":null,"abstract":"<p><strong>Background: </strong>Epicardial adipose tissue (EAT) promotes atrial remodeling, yet prospective data on whether a single transthoracic-echocardiographic measurement of EAT can identify elderly hypertensive patients at short-term risk of atrial fibrillation (AF) are limited.</p><p><strong>Methods: </strong>In this single-center cohort study (March 2021-June 2024), 460 hypertensive adults aged ≥65 years in sinus rhythm were enrolled; epicardial adipose tissue thickness was measured on the right-ventricular free wall, and participants underwent intensive multimodal rhythm surveillance for 24 months. Cox models were adjusted for age, body mass index, systolic blood pressure, diabetes, left-atrial (LA) volume index, and β-blocker use; performance was optimism-corrected with 200 bootstraps.</p><p><strong>Results: </strong>During 902 person-years of follow-up, 55 participants (12.0%; 6.1 events per 100 person-years) developed incident AF. Baseline EAT was greater in cases than in controls (7.9 ± 1.4 vs. 5.7 ± 1.2 mm; <i>p</i> < 0.001). Each 1 mm increase in EAT independently conferred a 62% higher AF hazard [hazard ratio (HR): 1.62, 95% CI: 1.29-2.04]; the optimism-corrected HR was 1.56. The findings were consistent in those with treated obstructive sleep apnea (OSA) (HR: 1.60) and in those without OSA (HR: 1.59; interaction <i>p</i> = 0.93) and after additional adjustment for high-sensitivity C-reactive protein (HR: 1.55 in 410 participants with biomarker data). Adding continuous EAT to a clinical model improved the C-index from 0.74 to 0.79 (optimism-corrected 0.78), reduced the Akaike information criterion by 16 points, and yielded a continuous net reclassification improvement of 0.25 (95% CI: 0.09-0.39) and an integrated discrimination improvement gain of 0.05. Time-specific area under the receiver-operating-characteristic curves (AUCs) remained ≥0.76 and calibration was preserved (Grønnesby-Borgan <i>p</i> ≥ 0.60). A receiver-operating-characteristic analysis identified 6.5 mm as the optimal EAT threshold (80% sensitivity, 68% specificity); 24-month AF incidence rate was 24.7% above vs. 4.1% below this cut point (log-rank <i>p</i> < 0.001). The EAT-AF association was robust in Fine-Gray competing-risk models and consistent across sex, obesity, diabetes, and LA-size strata (all interaction <i>p</i> > 0.20).</p><p><strong>Conclusions: </strong>Echocardiographic EAT thickness is a reproducible and incrementally informative predictor of 2-year incident AF in elderly hypertensive patients. Incorporating this simple metric into routine scans could refine risk stratification and guide targeted rhythm surveillance.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1650423"},"PeriodicalIF":2.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250199","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}