Frontiers in Cardiovascular Medicine最新文献

{"title":"Maintenance of atrial fibrillation by reciprocal triggering of competitive focal sources: a hypothesis.","authors":"Alexander Burashnikov","doi":"10.3389/fcvm.2026.1910201","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1910201","url":null,"abstract":"<p><p>The primary mechanism of atrial fibrillation (AF) maintenance remains debatable. However, contemporary atrial surface AF mapping studies readily detect multifocal activity, less readily \"incomplete reentries\" (defining them as reentries or false reentries) and never or rarely full-circuit reentries. Most of the surface multifocal waves during AF are short-lasting (1-3 waves) and they appear to be largely breakthroughs. Some of the multifocal activities during AF, particularly repetitive/sustained, can be explained with reciprocal triggering of delayed afterdepolarization (DAD) activities. Indeed, the condition that causes DAD activity (i.e., intracellular calcium abnormalities plus rapid activation) is continuously present during AF throughout the atria, that may provide a sufficient \"arrhythmogenic reserve\" for the generation of multiple competitive focal sources sustaining AF. In such scenario, there should be commonly one dominant source at a time along with subsidiary active and/or latent/overridden sources (the currently fastest sustained source acts to override all the others, covering all, most, or a large part of the atrium at a time). This may account for a spatiotemporal periodicity usually recorded during AF. Sustained focal sources should self-terminate/decelerate sooner or later and/or be overridden by currently faster sources, entailing a periodical switching of dominant sources (the currently \"fittest\" dominates). Anti-AF success of the Cox-Maze and pulmonary vein isolation procedures, separating the main atrial arrhythmogenic regions, can be generally explained with the interruption of mutual triggering of multiple DAD sources. Thus, reciprocal triggering of competitive DAD sources may broadly account for the maintenance and spatiotemporal periodicity of AF as well as for the anti-AF success of the Cox-Maze and pulmonary vein isolation procedures.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1910201"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223731","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":"Circulating musclin as a potential prognostic biomarker for major adverse cardiovascular events in surgically treated acute aortic dissection: a retrospective cohort study.","authors":"Jia Liu, Zhihui Liu, Liang Guo, Zhiyuan Wang, Jinfang Wu, Xiaobing Li, Huijun Zhang, Huining Liu","doi":"10.3389/fcvm.2026.1953235","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1953235","url":null,"abstract":"<p><strong>Background: </strong>Musclin is a skeletal muscle-derived myokine with reported cardioprotective effects; however, its prognostic relevance in acute aortic dissection (AAD) remains uncertain. This study examined whether admission Musclin levels were associated with postoperative major adverse cardiovascular events (MACE) and whether they added prognostic information beyond conventional clinical indicators.</p><p><strong>Methods: </strong>We retrospectively enrolled 108 surgically treated AAD patients from 2022 to 2023. Musclin levels were measured by ELISA in residual serum samples collected at admission. The primary endpoint was composite MACE. Kaplan-Meier survival analysis, multivariate Cox regression, time-dependent ROC, IDI and NRI were used to evaluate the predictive and incremental value of Musclin.</p><p><strong>Results: </strong>During 400-day follow-up, 36 patients (33.3%) developed MACE. The CART-derived optimal Musclin cutoff was 4.815 ng/mL. Kaplan-Meier analysis showed that low Musclin group had significantly higher MACE cumulative incidence than high Musclin group (48.2% vs. 17.3%, log-rank <i>P</i> < 0.001). Multivariate Cox regression confirmed circulating Musclin associated with a lower risk of MACE (HR = 0.314, 95%CI: 0.104-0.943, <i>P</i> = 0.039). Time-dependent AUC analysis demonstrated that the combined model incorporating Musclin (model 2) achieved superior AUC compared with the clinical model (model 1). Even at the 250-day time point, where the incremental gain (<i>Δ</i>AUC) was minimal, the combined model still exhibited significantly better discriminative performance (0.876 vs. 0.837, DeLong <i>P</i> = 0.013). At the 250-day landmark, IDI was 0.153 (95%CI: 0.018-0.286, <i>P</i> = 0.012) and overall NRI was 0.167 (95%CI: 0.003-0.336, <i>P</i> = 0.044), with event-specific NRI reaching 0.361 (<i>P</i> = 0.012). Sensitivity analyses yielded directionally consistent associations when Musclin was analyzed using the cohort median or as a continuous variable.</p><p><strong>Conclusions: </strong>In this single-center retrospective cohort, lower admission Musclin was associated with a higher risk of postoperative MACE. Musclin may be a severity-related biomarker that could complement conventional risk indicators, but its independent clinical utility, optimal threshold, and role in risk stratification require prospective multicenter validation with comprehensive perioperative adjustment before clinical use.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1953235"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223583","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":"Angiographic prevalence of occlusion myocardial infarction and the limited value of serial troponin in patients with non-ST-segment elevation acute coronary syndrome.","authors":"Sajid Kadir, Sandeep Sasidharan, Sandipan Shringi, Mahati Dasari, Pramukh Arun Kumar","doi":"10.3389/fcvm.2026.1903711","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1903711","url":null,"abstract":"<p><strong>Background: </strong>An estimated 25%-34% of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are diagnosed with an occluded culprit artery during catheterization. Whether early serial troponin kinetics discriminate angiographically defined occlusion myocardial infarction (OMI) in catheterized patients with NSTE-ACS remains uncertain.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of 481 patients with NSTE-ACS who underwent coronary catheterization between 2017 and 2023. OMI was defined by a purely angiographic criterion: >90% culprit-vessel stenosis with Thrombolysis in Myocardial Infarction flow grade 0, 1, or 2. Seven contemporary sensitivity troponin I metrics (absolute values at 0, 3, and 6 h; deltas; and ratios) were evaluated by receiver operating characteristic analysis. Operating characteristics are reported with 95% confidence intervals (CIs) and likelihood ratios.</p><p><strong>Results: </strong>Ninety-eight patients (20.4%) met the angiographic definition of OMI. These patients were younger (median, 65.5 vs. 70.0 years; <i>p</i> = 0.025), had fewer comorbidities, and more often presented with chest pain (92.9% vs. 82.8%; <i>p</i> = 0.013). The left circumflex artery was the most common culprit in OMI (36.7%). Twenty-nine patients with OMI (29.6%) had a presentation ECG classified as normal (no ST-T change or bundle branch block. No troponin metric reliably discriminated OMI from non-occlusion MI. The prespecified primary predictor, the 0-6-h change in troponin concentration, had an area under the curve (AUC) of 0.623 (95% CI, 0.544-0.703) and the best single metric, the 6-h value, of 0.654 (0.580-0.727); all seven unadjusted troponin-metric AUCs were under 0.66. At its Youden cutoff (≥0.379 ng/mL), the 6-h troponin had a sensitivity of 69.4%, a specificity of 57.7%, a positive predictive value of 27.2%, and a negative predictive value of 89.3%. The highest positive predictive value of any metric was 41.3%, the first troponin (at 0 h) identified fewer than 40% of patients with OMI at its optimal threshold, and likelihood ratios produced only limited shifts in post-test probability.</p><p><strong>Conclusion: </strong>Among analyzable patients with NSTE-ACS undergoing catheterization, approximately one in five met the study-defined angiographic criteria for OMI. Early serial troponin kinetics showed only modest discrimination, and upper confidence bounds fell below levels expected of a standalone triage biomarker. Complementary strategies for identifying these patients, including expert ECG interpretation, warrant further study.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1903711"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223476","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":"Serum 25-hydroxyvitamin D, systemic immune-inflammation index, and atherogenic index of plasma in statin-untreated type 2 diabetes: a cross-sectional mediation analysis.","authors":"Hüseyin Avni Fındıklı, Vehbi Şirikçi","doi":"10.3389/fcvm.2026.1884708","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1884708","url":null,"abstract":"<p><p>This cross-sectional study investigated the associations between serum 25-hydroxyvitamin D [25(OH)D] levels, systemic inflammatory burden, and atherogenic lipid profile in statin-untreated adults with type 2 diabetes, with particular emphasis on the contribution of the systemic immune-inflammation index (SII). A total of 619 statin-untreated patients with type 2 diabetes were included. Participants were stratified according to serum 25(OH)D concentrations into deficient (<20 ng/mL), insufficient (20-29.9 ng/mL), and sufficient (≥30 ng/mL) groups. Multivariable linear regression, BCa bootstrap mediation analysis with 5,000 resamples, and restricted cubic spline models were used. In fully adjusted models, each 10 ng/mL decrease in serum 25(OH)D was independently associated with higher SII (β=0.064, 95% CI 0.023-0.105; <i>p</i> = 0.002) and higher atherogenic index of plasma (AIP; β=0.031, 95% CI 0.009-0.053; <i>p</i> = 0.006). The indirect association through SII accounted for 26.5% of the total association between 25(OH)D and AIP (bootstrap 95% CI 12.8-43.1). Indirect associations were weaker for the neutrophil-to-lymphocyte ratio and non-significant for the monocyte-to-lymphocyte and platelet-to-lymphocyte ratios. Restricted cubic spline analyses demonstrated significant non-linearity for both SII and AIP, with points of maximal curvature at 18.7 ng/mL and 19.6 ng/mL, respectively. Estimates were similar in overlapping laboratory subgroups, but the indirect association was not significant in men (19.2%, 95% CI -7.6 to 39.4) or after exclusion of patients with severe deficiency (<10 ng/mL), although formal testing showed no significant interaction with sex. In a sensitivity analysis for unmeasured mediator-outcome confounding, the indirect association was reduced to zero at a residual correlation of only <i>ρ</i>=0.20, indicating limited robustness. The findings are compatible with a statistical indirect relationship involving systemic inflammation between vitamin D status and atherogenic dyslipidaemia, but the cross-sectional design precludes causal inference. The non-linear pattern near 20 ng/mL suggests that the inflammatory-atherogenic phenotype may become more pronounced below this threshold.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1884708"},"PeriodicalIF":3.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223651","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":"Definitions and determinants of success in left bundle branch area pacing: a systematic review.","authors":"Jie He, Jianhui Tang, Changjiu Huang, Chuan Zhang, Xiaofen Liu, Fei Wang, Zhuoyuan Yu","doi":"10.3389/fcvm.2026.1957797","DOIUrl":"10.3389/fcvm.2026.1957797","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) achieves more physiological ventricular activation by advancing the lead deep into the interventricular septum and recruiting the left conduction system. Although alternative pacing is usually available when LBBAP is unsuccessful, difficult cases may undergo repeated nonproductive septal deployments before crossover, with longer procedure and fluoroscopy times and greater myocardial injury. Preprocedural prediction may therefore improve implantation and backup planning and reduce unnecessary procedural burden.</p><p><strong>Methods: </strong>PubMed and Embase were searched from inception through July 16, 2026. Two reviewers independently screened the literature. Ninety analytic full-text reports were included; preprocedural determinants formed the primary review question, while later-stage evidence was retained to contextualize endpoint definitions and clinical translation.</p><p><strong>Results: </strong>Among 90 analytic full-text reports, evidence was concentrated on capture verification, whereas only 10 evaluated preprocedural determinants. Recurrent candidate signals included left ventricular enlargement, nonclassical conduction phenotypes, and septal scar; no clinically validated threshold was identified. Septal scar was the most anatomically direct preprocedural marker of mechanical deployment difficulty, with scar location and burden linked to the intended lead path in two observational CMR cohorts. Only one multivariable prediction model was identified and it lacked external validation. Acute procedural outcomes varied by endpoint definition and clinical indication and were not directly comparable.</p><p><strong>Conclusion: </strong>Left ventricular enlargement, nonclassical conduction phenotypes, and septal scar may serve as candidate risk indicators for LBBAP procedural difficulty, although no clinically validated thresholds are currently available. When CMR is already available or clinically indicated, septal scar distribution may add information to substrate assessment and estimation of mechanical difficulty; whether dedicated CMR acquisition and CMR-informed planning improve implantation efficiency or outcomes remains untested. Routine CMR screening is unsupported. For preprocedural studies specifically targeting successful left conduction-system recruitment, confirmed capture may serve as a preferred mechanistic anchor endpoint. Mechanical deployment, indication-specific electrical correction, procedural complexity, crossover, and long-term benefit should be reported separately. Future models should incorporate operator and implant-system factors and demonstrate calibration, external validation, and clinical impact.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261452030, PROSPERO CRD420261452030.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1957797"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215389","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":"Thrombus burden-stratified catheter-directed thrombolysis combined with percutaneous transluminal angioplasty for acute arteriovenous graft thrombosis in hemodialysis patients: a comparison of single-session versus extended infusion protocols.","authors":"Bin Chen, Keyu Tang, Xiaoyuan Lin, Guiyuan Zhang, Run Lin, Haitao Dai, Yonghui Huang","doi":"10.3389/fcvm.2026.1919383","DOIUrl":"10.3389/fcvm.2026.1919383","url":null,"abstract":"<p><strong>Purpose: </strong>To compare single session (SS) versus extended infusion (EI) catheter-directed thrombolysis (CDT) combined with PTA for acute AVG thrombosis, with allocation based on thrombus burden and lesion morphology.</p><p><strong>Methods: </strong>This study included hemodialysis patients with acute AVG thrombosis treated between April 2020 and September 2023. All patients underwent angiographic classification of AVG stenosis/occlusion into two morphological types: Type I (isolated venous anastomotic stenosis/occlusion) and Type II (complex, multi-segment occlusion involving the arterial anastomosis, graft lumen, and/or venous anastomosis). Based on this classification and thrombus burden assessment, patients with Type I lesions or low thrombus burden received SS-CDT + PTA, while those with Type II lesions or high thrombus burden received EI-CDT + PTA. The primary endpoint was primary patency. Secondary endpoints included technical success rate, procedure-related complications, and secondary patency. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression were performed. A shared-frailty model and patient-level sensitivity analysis were used to account for within-patient clustering.</p><p><strong>Results: </strong>A total of 105 procedures in 89 patients were analyzed (SS-CDT, <i>n</i> = 73; EI-CDT, <i>n</i> = 32). Median primary patency was comparable: SS-CDT 183 days vs. EI-CDT 183 days (log-rank <i>p</i> = 0.867). The proportion of Type II lesions was 80.8% (59/73) in the SS-CDT group and 90.6% (29/32) in the EI-CDT group (<i>p</i> = 0.261). On multivariate Cox regression, graft age >24 months was associated with improved patency (HR 0.59, <i>p</i> = 0.023), while Type II morphology (HR 0.80, <i>p</i> = 0.428) and CDT protocol (HR 0.91, <i>p</i> = 0.79). Technical success was 100% in both groups (excluding 7 crossover procedures). One major complication (septic shock) occurred in the EI-CDT group. Minor complications were comparable, except puncture-site bleeding (EI-CDT: 18.8% vs. SS-CDT: 0%, <i>p</i> < 0.001). Urokinase infusion was interrupted in 2 EI-CDT procedures due to bleeding.</p><p><strong>Conclusions: </strong>Patency outcomes were not significantly influenced by CDT protocol duration or lesion morphology, suggesting that the stratified treatment approach effectively equalized outcomes across clinical contexts; notably, graft age >24 months was independently associated with improved primary patency (HR 0.59, <i>p</i> = 0.023), a finding most plausibly reflecting survivor-graft bias rather than a true treatment effect.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1919383"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215446","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":"Subclavian-to-internal carotid artery bypass with carotid endarterectomy for total occlusion of the common carotid artery under awake neurologic monitoring: a case series.","authors":"Yerbol Dogalbayev, Kuralay Ilbekova, Ruslan Tukinov, Gulnar Mustafinova, Nurlan Azimzhanov, Seilbek Beketov, Didar Kadyrbek, Tokan Sultanaliyev, Irlan Sagandykov, Alexandr Fursov","doi":"10.3389/fcvm.2026.1959220","DOIUrl":"10.3389/fcvm.2026.1959220","url":null,"abstract":"<p><strong>Background: </strong>Total occlusion of the common carotid artery (CCA) from its origin is rare, occurring in less than 1% of brachiocephalic stenoses. Surgical revascularization is technically demanding, especially with tandem severe ipsilateral internal carotid artery (ICA) stenosis. Procedures under regional anesthesia with continuous neurologic monitoring are rarely described.</p><p><strong>Objective: </strong>To evaluate outcomes of subclavian-to-internal carotid artery bypass with carotid endarterectomy (CEA) in symptomatic patients with total CCA occlusion and severe ipsilateral ICA stenosis under regional anesthesia with awake neurologic monitoring.</p><p><strong>Methods: </strong>This retrospective single-center case series included 4 symptomatic male patients (mean age 68.0 years, range 59-75) with total CCA occlusion (Riles type 1A) and severe ipsilateral ICA stenosis (80%-95% by NASCET), who underwent subclavian-to-internal carotid bypass with ICA endarterectomy under cervical plexus and supraclavicular brachial plexus block with 0.5% ropivacaine between December 2021 and June 2026. Neurologic status was monitored continuously in awake patients during carotid cross-clamping. Systolic blood pressure was maintained approximately 20 mmHg above preoperative baseline to optimize collateral perfusion.</p><p><strong>Results: </strong>Primary technical success was 100%. Mean carotid cross-clamping time was 19.3 min (range, 17-21 min). Retrograde ICA stump pressure was ≥40 mmHg in all patients. No intraoperative neurologic deficits, perioperative strokes, transient ischemic attacks, cranial nerve injuries, graft thromboses, or deaths occurred. At the latest available follow-up, all grafts remained patent and no recurrent neurologic events were recorded. Twelve-month follow-up was available for Patients A, C, and D, whereas Patient B had 3 months of follow-up. One patient with contralateral 98% ICA stenosis underwent staged contralateral CEA one month later.</p><p><strong>Conclusion: </strong>In this small case series, subclavian-to-internal carotid artery bypass combined with ICA endarterectomy under regional anesthesia with awake neurologic monitoring was technically feasible and was associated with favorable observed perioperative and available follow-up outcomes. Larger comparative studies are warranted.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1959220"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215411","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":"Editorial: Investigating the role of extracellular vesicles in cardiovascular disease mechanisms.","authors":"Jona Benjamin Krohn, Elena Aikawa","doi":"10.3389/fcvm.2026.1994562","DOIUrl":"10.3389/fcvm.2026.1994562","url":null,"abstract":"","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1994562"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215408","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":"Perivascular fat attenuation index improves the identification of functional myocardial ischemia beyond traditional risk factors: a coronary CT angiography-derived fractional flow reserve study.","authors":"Zhihong Gao, Lingmei Jia, Min Jia","doi":"10.3389/fcvm.2026.1950032","DOIUrl":"10.3389/fcvm.2026.1950032","url":null,"abstract":"<p><strong>Background: </strong>Perivascular fat attenuation index (FAI) derived from coronary computed tomography angiography (CCTA) is a novel imaging biomarker of coronary inflammation. However, its incremental value in predicting functional myocardial ischemia, defined by CT-derived fractional flow reserve (CT-FFR), beyond traditional cardiovascular risk factors and epicardial adipose tissue (EAT) volume remains unclear.</p><p><strong>Methods: </strong>A total of 380 consecutive patients who underwent clinically indicated CCTA with CT-FFR evaluation were retrospectively analyzed. Functional ischemia was defined as CT-FFR ≤0.80. Patients were stratified into low and high FAI groups based on the optimal cutoff value of -81.32 Hounsfield Units (HU). Multivariate logistic regression analysis was performed to identify independent predictors of ischemia. The incremental diagnostic performance of adding FAI to a baseline clinical model was assessed using area under the receiver operating characteristic curve (AUC), continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).</p><p><strong>Results: </strong>Despite comparable baseline profiles for low-density lipoprotein cholesterol, body mass index, and glycemic status (<i>P</i> > 0.05), patients in the high FAI group exhibited significantly lower CT-FFR values (0.75 ± 0.13 vs. 0.79 ± 0.12, <i>P</i> = 0.0017). After adjusting for age, gender, traditional cardiovascular risk factors, and EAT volume, average FAI remained a robust independent predictor of functional ischemia [Adjusted Odds Ratio [OR]: 1.056 per 1 HU increase; 95% Confidence Interval [CI]: 1.019-1.096; <i>P</i> = 0.004]. Notably, EAT volume did not reach statistical significance in the multivariate model (<i>P</i> = 0.584). The addition of FAI to the clinical model resulted in a modest, non-significant improvement in AUC (0.731 vs. 0.707, <i>P</i> = 0.087), but yielded significant improvement in risk reclassification (continuous NRI: 0.339, <i>P</i> = 0.001; IDI: 0.024, <i>P</i> = 0.002). Subgroup analysis demonstrated a consistent risk trend across varying degrees of stenosis, age, and body mass index categories (OR range: 1.03-1.07). DCA confirmed superior net clinical benefit for the FAI-integrated model across a wide threshold probability range (25%-75%).</p><p><strong>Conclusions: </strong>Coronary perivascular FAI is an independent imaging marker for CT-FFR-defined functional ischemia and provides incremental value beyond traditional risk factors and EAT volume. These findings support FAI as a non-invasive marker of coronary inflammation that may refine risk stratification for functionally significant coronary artery disease. However, as CT-FFR mainly reflects epicardial physiology, the association between FAI and microvascular dysfunction remains to be determined.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1950032"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215437","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":"Femoral artery pseudoaneurysm in Behçet's syndrome: long-term outcomes and associated factors.","authors":"Yanfei Yang, Yuexin Chen","doi":"10.3389/fcvm.2026.1942219","DOIUrl":"10.3389/fcvm.2026.1942219","url":null,"abstract":"<p><strong>Background: </strong>Behçet's syndrome with femoral artery pseudoaneurysm (BS-FAP) is exceedingly rare, and its long-term postoperative recurrence profile remains undefined. We aimed to ascertain event-free survival (EFS) and examine associations of immunosuppressive adherence and five inflammatory biomarkers (<i>N</i>LR, PLR, SII, SIRI, IBI) with relapse. External validation was performed via systematic review and individual patient data (IPD) meta-analysis.</p><p><strong>Methods: </strong>This retrospective study included 13 BS-FAP patients who underwent femoral artery surgery at Peking Union Medical College Hospital (2002-2022). The primary endpoint was EFS, a composite of same-site recurrence, <i>de novo</i> aneurysm, re-intervention, death, or amputation. Five inflammatory indices were derived from preoperative blood counts. EFS was estimated using Kaplan-Meier with log-rank comparisons. A systematic literature search was conducted for descriptive IPD meta-analysis.</p><p><strong>Results: </strong>The cohort (median age 34 years, 85% male) underwent endovascular (<i>n</i> = 6), open (<i>n</i> = 6), or hybrid (<i>n</i> = 1) repair. Median follow-up was 60 months (all ≥36 months). Five-year EFS was 69.2% in primary analysis and 76.9% in sensitivity analysis. Endovascular and open approaches showed comparable EFS (<i>p</i> = 0.992). Elevated NLR, PLR, SIRI, and IBI were associated with lower 5-year EFS (50.0% vs. 85.7%), with SIRI showing the strongest trend (<i>p</i> = 0.131); SII (<i>p</i> = 0.787) and ESR (<i>p</i> = 0.994) showed no trend. Three patients (23.1%) developed <i>de novo</i> aneurysms beyond 5 years, all after immunosuppressive discontinuation. In a supplementary four-level adherence analysis, no patient was fully adherent perioperatively; preoperative-only use (<i>n</i> = 2) showed the highest disease-specific 5-year EFS (100%). The cohort showed mucocutaneous predominance (oral ulcers 92.3%) and venous involvement in 38.5%. IPD meta-analysis (40 individual cases + 12 series) confirmed a temporal mortality decline from 26%-40% (early open) to 0%-5.8% (contemporary endovascular). Published case reports (median follow-up 6 months) reported 11% recurrence, vs. 31% in our 60-month cohort, confirming systematic underestimation.</p><p><strong>Conclusion: </strong>The recurrence burden after BS-FAP surgery is systematically underestimated in short-follow-up literature; surveillance should extend beyond 5 years. Immunosuppressive adherence is a modifiable target for recurrence control. SIRI emerges as the most promising biomarker for risk stratification. Endovascular and open repair offer comparable long-term EFS. This exploratory study supports a comprehensive pathway of \"surgical intervention-uninterrupted immunosuppression-extended surveillance,\" with adherence incorporated into quality metrics.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1942219"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215441","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}