Frontiers in Cardiovascular Medicine最新文献

{"title":"Clinical and epidemiological characterization of heart failure patients in a high-altitude setting: a retrospective study at a tertiary hospital in Quito, Ecuador.","authors":"Vladimir Ullauri, Marlon Patricio Aguirre Espinosa, Tanya María Padilla Molina, Diana Moreira-Vera, Henry Oswaldo Jaramillo Prado, Ana Gabriela Finke Barriga, John Fabricio Salto González, Liliana Elizabeth Flores Rodríguez, Marisol Elizabeth Cárdenas Calderón, Giuseppe Paul Ayala Abarca, Juan S Izquierdo-Condoy, Jorge Vasconez-Gonzalez, Esteban Ortiz-Prado","doi":"10.3389/fcvm.2026.1776502","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1776502","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a major global health problem and a leading cause of morbidity and mortality. In Latin America, evidence remains limited, and HF characterization in high-altitude care settings is underreported. Quito (-2,800 m a.s.l.) provides a unique clinical context, although retrospective hospital-based data without standardized hypoxia phenotyping or sea-level comparators cannot support altitude-specific causal inference.</p><p><strong>Objective: </strong>This study aims to describe the clinical and epidemiological characteristics of patients diagnosed with HF at the Metropolitan Hospital of Quito, a tertiary care facility located at an altitude of approximately 2,800 meters, from January 2021 to December 2023.</p><p><strong>Methods: </strong>A retrospective observational study was conducted using anonymized medical records of 122 patients diagnosed with HF (ICD-10 codes I500, I501, I509). Data on demographic, clinical, and outcome variables were collected. Exploratory comparisons were performed by discharge survival status (alive vs. deceased) using chi-square or Fisher's exact tests for categorical variables and two-sample Student's <i>t</i>-tests for continuous variables (two-sided <i>p</i> < 0.05).</p><p><strong>Results: </strong>Most patients (88.5%) were aged over 65 years, with men comprising 55.7% of the cohort. Hypertension (59.8%), dyslipidemia (18.9%), and atrial fibrillation (44.3%) were the most prevalent comorbidities. Hypertensive heart disease was the most frequent documented etiology of HF (14.8%), although etiology was unavailable in a substantial proportion of records. In-hospital mortality was low (3.3%). Exploratory univariate analyses identified unadjusted associations between in-hospital mortality and dialysis dependency, immunologic diseases, and other vascular diseases.</p><p><strong>Conclusions: </strong>This study provides a contemporary clinical and epidemiological profile of HF patients managed at a high-altitude tertiary hospital in Quito and identifies exploratory factors associated with in-hospital mortality in this care setting. Future multicenter studies incorporating standardized hypoxia-related measurements and appropriate comparator cohorts are needed to better understand HF phenotypes and outcomes in Andean populations.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1776502"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835922","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":"Bidirectional Mendelian randomization analysis of hypertension, coronary artery disease, and gastric cancer with supplementary clinical data.","authors":"Qian Ma, Ya-Fei Kong, Ai-Li Li, Li-Na Song, Yun-Meng Tian","doi":"10.3389/fcvm.2026.1803696","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1803696","url":null,"abstract":"<p><strong>Background: </strong>The relationship between gastric cancer and cardiovascular traits, including hypertension and coronary artery disease (CAD), remains incompletely understood. Observational studies are prone to confounding and reverse causation, and genetic evidence may help clarify the nature of these associations.</p><p><strong>Methods: </strong>We conducted a bidirectional two-sample Mendelian randomization (MR) analysis using publicly available genome-wide association study (GWAS) summary statistics to investigate the relationships between gastric cancer, hypertension, and CAD. Multiple MR methods and sensitivity analyses were applied to assess robustness. To provide supplementary clinical context, we additionally conducted a small retrospective clinical analysis of 45 individuals, including gastric cancer cases and non-cancer controls, using logistic regression adjusted for age and sex.</p><p><strong>Results: </strong>MR analyses showed no evidence that genetic liability to gastric cancer was associated with the risk of hypertension or CAD. In contrast, genetic predisposition to hypertension was inversely associated with gastric cancer risk. These findings were consistent across sensitivity analyses. In the retrospective cohort, hypertension was not significantly associated with gastric cancer risk.</p><p><strong>Conclusions: </strong>This study provides genetic evidence supporting an inverse association between hypertension liability and gastric cancer risk. However, the supplementary retrospective clinical analysis was limited by its small sample size and did not provide independent validation of the MR findings. Larger observational studies are needed. Further studies are warranted to clarify the underlying biological mechanisms.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1803696"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835943","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 risk prediction model for myocardial hypoperfusion after primary PCI in ST-segment elevation myocardial infarction.","authors":"Yan Zhao, Xiaoxia Fang, Huilin Li, Minglei Han, Fucheng Zhang, Mingming Qiao","doi":"10.3389/fcvm.2026.1806053","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1806053","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the determinants of myocardial hypoperfusion following primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) and to develop a risk prediction model.</p><p><strong>Methods: </strong>Clinical data from 434 patients with STEMI who underwent primary PCI at our hospital between January 2023 and June 2025 were retrospectively collected. Patients were randomly assigned to a training cohort (<i>n</i> = 304) and a validation cohort (<i>n</i> = 130) at a 7:3 ratio. Based on postprocedural myocardial perfusion, the training cohort was further divided into a hypoperfusion group (<i>n</i> = 103) and a normal perfusion group (<i>n</i> = 201). Candidate variables were screened using Boruta and least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression to identify independent predictors. A risk prediction model was constructed using R software and visualized as a nomogram. Model performance and clinical utility were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Multivariable logistic regression identified time from onset to primary PCI, atorvastatin dose before PCI, balloon deflation method during PCI, red cell distribution width (RDW), and monoamine oxidase (MAO) levels as independent predictors of myocardial hypoperfusion (all <i>P</i> < 0.05). The nomogram demonstrated good discrimination, with area under the curve (AUC) values of 0.855 (95% CI: 0.811-0.900) in the training cohort and 0.838 (95% CI: 0.764-0.912) in the validation cohort. Calibration curves indicated good agreement between predicted and observed outcomes. Decision curve analysis showed that the model provided greater net benefit than both treat-all and treat-none strategies across threshold probabilities of 0.01-0.99 in the training cohort and 0.07-0.99 in the validation cohort.</p><p><strong>Conclusion: </strong>Time from onset to primary PCI, atorvastatin dose before PCI, balloon deflation method during PCI, RDW, and MAO levels are important determinants of myocardial hypoperfusion following primary PCI in patients with STEMI. The proposed prediction model demonstrated favorable predictive performance and clinical utility, suggesting its potential value for early risk stratification.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1806053"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical effects of sodium-glucose cotransporter 2 inhibitors combined with conventional therapy in myocardial infarction: a systematic review and meta-analysis of randomized controlled trials.","authors":"Zhipeng Xu, Xinjun Dai, Tianhang Jia, Xi Li, Xiaoyan Zhang, Pengfei Zhang, Huimin Niu, Jie Li","doi":"10.3389/fcvm.2026.1797628","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1797628","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve clinical outcomes in patients with heart failure; however, their efficacy and safety in patients with myocardial infarction, particularly when used in addition to conventional therapy, remain controversial. Therefore, this study aims to evaluate the effects of adding SGLT2i to conventional therapy on clinical outcomes in patients with myocardial infarction through a systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis to compare the effects of conventional therapy with or without SGLT2i on clinical outcomes in patients with myocardial infarction. PubMed, Web of Science, the Cochrane Library, and Embase were systematically searched.The primary outcome was the incidence of hospitalization for heart failure. Secondary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), left ventricular ejection fraction (LVEF), N-terminal pro-B type natriuretic peptide (NT-proBNP), and low-density lipoprotein cholesterol (LDL-C). Safety outcomes comprised renal dysfunction, hepatic dysfunction, urinary tract infection, and glycemia-related adverse events. All analyses were conducted using a random-effects model. Prespecified subgroup analyses for the primary outcome were performed according to the presence or absence of type 2 diabetes mellitus, timing of SGLT2i initiation, and specific SGLT2i agent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This meta-analysis included 13 randomized controlled trials involving 22,238 patients with myocardial infarction. Compared with conventional therapy alone, treatment with SGLT-2i significantly reduced the incidence of hospitalization for heart failure (RR = 0.76, 95% CI 0.68-0.84, &lt;i&gt;p&lt;/i&gt; &lt; 0.00001). For key secondary outcomes, the use of SGLT2i was not associated with all-cause mortality (RR = 0.87, 95% CI 0.75-1.01, &lt;i&gt;p&lt;/i&gt; = 0.06), but was associated with a significant reduction in the risk of major adverse cardiovascular events (MACE) (RR = 0.84, 95% CI 0.73-0.98, &lt;i&gt;p&lt;/i&gt; = 0.03). However, no significant difference was observed between the two groups in cardiovascular mortality (RR = 0.87, 95% CI 0.61-1.24, &lt;i&gt;p&lt;/i&gt; = 0.44). In addition, SGLT2i combined with conventional therapy significantly improved left ventricular ejection fraction (MD = 3.45, 95% CI 0.67-6.24, &lt;i&gt;p&lt;/i&gt; = 0.02) and significantly reduced NT-proBNP levels (MD = -311.99, 95% CI -666.00-15.23, &lt;i&gt;p&lt;/i&gt; = 0.04). In terms of safety outcomes, the use of SGLT2i was associated with a reduced risk of renal dysfunction (RR = 0.77, 95% CI 0.66-0.89, &lt;i&gt;p&lt;/i&gt; = 0.0006) and glycemia-related adverse events (RR = 0.56, 95% CI 0.40-0.80, &lt;i&gt;p&lt;/i&gt; = 0. 001). No significant increase was observed in the risk of urinary tract infection (RR = 1.73, 95% CI 0.76-3.97, &lt;i&gt;p&lt;/i&gt; = 0.12; &lt;i&gt;P&lt;/i&gt; = 0.19) or hepatic dysfunction (RR = 2.46, 95% CI 0.86-6.98, &lt;i&gt;p&lt;/i&gt; = 0.09; &lt;i&gt;P&lt;/i&gt; =","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1797628"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835886","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":"Cardiopulmonary parameters in patients with Tetralogy of Fallot: the reference values for treadmill and cycle ergometer.","authors":"Benedetta Leonardi, Federica Gentili, Eliana Tranchita, Claudia Montanaro, Gianfranco Butera, Rosalinda Palmieri, Giulia Di Già, Aurelio Secinaro, Giovanni Antonelli, Michele Lioncino, Ugo Giordano","doi":"10.3389/fcvm.2026.1673478","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1673478","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to establish sex- and age-specific reference values for ramp cycle-ergometer and treadmill cardiopulmonary exercise testing (CPET) in patients with Tetralogy of Fallot (ToF). Despite successful surgical repair, residual pulmonary regurgitation remains common in repaired ToF (rToF), often leading to right or left ventricular dysfunction and reduced exercise capacity. CPET is a reliable tool for evaluating cardiopulmonary function. Although both treadmill and cycle ergometer protocols are used interchangeably, reference value ranges for each method in this population remain unclear.</p><p><strong>Method: </strong>CPET data were collected from asymptomatic rToF patients who had undergone cardiac magnetic resonance imaging (CMR) and performed CPET on a treadmill or cycle ergometer between 2020 and 2024. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ).</p><p><strong>Results: </strong>Among 290 patients, median age at CPET was 21.6 years (15.9-29.3), and median BMI was 22.5 kg/m² (20.0-24.9). Nearly all participants (99%) were in NYHA class I. Physical activity was classified as sedentary in 29%, moderate in 61%, and high in 9%. Median VO₂ peak was 26.4 mL/min/kg (23.0-31.5), corresponding to 72.9% predicted (62.4-83.2). Median oxygen pulse at peak was 9.9 mL/beat (8.2-12.0), with 76.9% predicted (68.0-87.5). Median VE/VCO₂ slope at the respiratory compensation point was 29.0 (26.0-32.6), and median oxygen uptake efficiency slope (OUES) was 1,792.5 mL/min/log(L/min) (1,535.0-2,181.5). VO₂ peak and percent-predicted VO₂ were significantly higher with treadmill testing in both sexes (<i>p</i> < 0.05); oxygen pulse was higher only in females. VE/VCO₂ slope and OUES were unaffected by modality. When stratified by age (<18 vs. ≥18 years), treadmill-related differences in VO₂ peak and percent-predicted VO₂ remained significant in both sexes ≥18 years, and in females <18 years. Oxygen pulse was significantly higher with treadmill only in females ≥18 years. VE/VCO₂ slope and OUES remained unchanged across modalities and age groups.</p><p><strong>Conclusion: </strong>This study provides CPET values stratified by modality and sex in a large cohort of asymptomatic rToF patients, offering valuable reference data for clinical assessment. Future studies should validate pediatric normative CPET values through prospective, inclusive, statistically powered cohorts using standardized protocols and cross-center comparability.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1673478"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-center clinical analysis of hybrid aortic arch repair for aortic arch lesions.","authors":"Yang Gao, Yilingrui Wang, Quanhua Pan, Chuanzhang Xu, Lijuan Zhang, Zhiwei Xu","doi":"10.3389/fcvm.2026.1797260","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1797260","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and short-to-mid-term efficacy of hybrid aortic arch repair (HAR) within a structured, anatomy- and risk-based decision-making framework for heterogeneous aortic arch lesions.</p><p><strong>Methods: </strong>Forty-five consecutive patients with aortic arch lesions who underwent HAR between January 2019 and January 2024 were retrospectively included. Lesions comprised degenerative arch aneurysm (46.7%), non-A non-B aortic dissection (33.3%), residual arch disease after Type A repair (13.3%), and penetrating ulcers (6.7%). Preoperative computed tomography angiography and EuroSCORE II were used for anatomical assessment and risk stratification. Based on a two-dimensional principle of anatomical suitability and comorbidity risk, patients were assigned to Type I HAR (<i>n</i> = 2), Type II HAR (<i>n</i> = 16), or Type IV HAR (<i>n</i> = 27). Type I involved debranching with staged Zone 0 thoracic endovascular aortic repair (TEVAR), Type II consisted of total arch replacement with stented elephant trunk followed by TEVAR, and Type IV used cervical bypass with one-stage Zone 2 TEVAR. All decisions were confirmed by a multidisciplinary team.</p><p><strong>Results: </strong>All procedures were technically successful, with no intraoperative or 30-day mortality. Type I HAR showed the shortest operative time and least blood loss, whereas Type II had the highest surgical complexity and longest recovery. Postoperative complications were minor, and no stroke, renal failure, or permanent organ injury occurred. During a median follow-up of 18 months (range, 6-36 months), no aortic-related death, endoleak, reintervention, or branch vessel occlusion occurred. Aorta-related survival and freedom from reintervention were both 100%.</p><p><strong>Conclusion: </strong>Individualized HAR guided by anatomical features and patient risk provides a safe and effective treatment for complex aortic arch lesions, particularly in high-risk patients unsuitable for open surgery.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1797260"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835861","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":"Prognostic significance of the TyG index combined with the NLR for heart failure: a retrospective study.","authors":"Sirui Yang, Hongxing Zhang, Yanqing Liu, Lusha Gao, Yun Song, Ping Xia, Tao Shi, Fazhi Yang, Lixing Chen","doi":"10.3389/fcvm.2026.1712467","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1712467","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index and the neutrophil-lymphocyte ratio (NLR) are independent prognostic factors in patients with heart failure, but no studies have explored the predictive value of the TyG index combined with the NLR (TyG-NLR) for all-cause mortality in patients with heart failure.</p><p><strong>Methods: </strong>A total of 1,063 patients with HF admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2021 were enrolled in the study. Based on the median of TyG-NLR, patients were divided into a low TyG-NLR group (TyG-NLR < 5.93) and a high TyG-NLR group (TyG-NLR ≥ 5.93) and 4 subgroups according to the median TyG and NLR (Group 1: TyG <1.79 + NLR < 3.31; Group 2: TyG < 1.79 + NLR ≥ 3.31; Group 3: TyG ≥ 1.79 + NLR < 3.31; Group 4: TyG ≥ 1.79 + NLR ≥ 3.31). We used Kaplan-Meier curves, Cox survival analyses, ROC curves, NRI, IDI, and DCA to explore the predictive value of the TyG-NLR for all-cause mortality in HF patients.</p><p><strong>Results: </strong>According to the Kaplan-Meier analysis, those with higher TyG indices and NLRs (TyG ≥ 1.79 and NLR ≥ 3.31) had significantly higher mortality rates than the other patients. By univariate and multivariate Cox proportional hazards analyses, we identified the TyG-NLR as an independent predictor of all-cause mortality in patients with CHF. In the subgroup analysis, the risk of death and all-cause mortality rates were 2.033 times higher in Group 2 (<i>p</i> < 0.001), 1.486 times higher in Group 3 (<i>p</i> = 0.018), and 2.984 times higher in Group 4 (<i>p</i> < 0.001), with Group 1 being the reference group. In addition, the receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) analysis revealed that the model with the TyG-NLR is superior to the traditional model in predicting all-cause mortality in patients with HF.</p><p><strong>Conclusions: </strong>Our findings demonstrate that an increased TyG-NLR is an independent predictor of increased mortality in patients with HF.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1712467"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835938","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":"Can development alone save lives? trends and forecasts of congenital heart anomalies-attributable premature mortality in ASEAN.","authors":"Muhammad Iqhrammullah, Derren D C H Rampengan, Starry H Rampengan, Radityo Prakoso, Teuku Andi Syahputra, Iqbal Farhan Sayudo, Shakira Amirah, Ayers Gilberth Ivano Kalaij, Puan Faiza Nurianada, Muhammad Habiburrahman","doi":"10.3389/fcvm.2026.1698307","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1698307","url":null,"abstract":"<p><strong>Background: </strong>Congenital heart anomalies (CHAs) are a leading cause of premature childhood mortality and contribute substantially to years of life lost (YLL). Despite overall improvements in child survival in Southeast Asia, progress in reducing CHA-attributed mortality has been uneven. Examining how trends in CHA-related YLL align with socioeconomic development is critical for informing targeted health system investments. This study assesses trends and projections of CHA-attributed premature mortality in ASEAN countries from 2000 to 2030 in relation to development levels.</p><p><strong>Methods: </strong>Data from the Global Burden of Disease Study 2021 were used to extract CHA-attributed YLL rates, including all-age and age-stratified estimates (<5, 5-9, and 10-19 years), alongside Socio-demographic Index (SDI) values from 2000 to 2021. Estimated Annual Percentage Change (EAPC) for YLL and SDI was calculated using log-linear regression, and an efficiency ratio quantified YLL reduction per unit SDI gain. Forecasts up to 2030 were generated using ARIMA and ARIMAX models applied to the natural logarithm-transformed outcome values, with SDI trajectories stratified by recent growth patterns.</p><p><strong>Results: </strong>From 2000 to 2021, all ASEAN countries showed declining CHA-attributed YLL. Singapore achieved the steepest decline (from 104.27 to 26.09 per 100,000) and highest efficiency relative to SDI gains. Children under five consistently bore the greatest burden, with 2021 YLLs ranging from 319 per 100,000 in Singapore to 7,435 per 100,000 in Lao PDR, a more than 23-fold disparity. Under SDI-adjusted projections to 2030, Cambodia, Lao PDR, Myanmar, and Timor Leste were projected to achieve moderate reductions of approximately 16-29% compared with 2021, although their absolute YLL levels remained high (YLLs > 600 per 100,000). The estimated trends in Singapore and Brunei Darussalam exceeded those expected under the SDI-adjusted projections, with projected YLLs of 17.35 and 131.67 per 100,000 population, respectively.</p><p><strong>Conclusion: </strong>CHA-attributed premature mortality is largely preventable but not assured by development alone. Greater YLL reductions occur when investment in pediatric cardiac care keep pace with socioeconomic progress, highlighting the need for targeted interventions in countries with rising SDI but limited mortality reduction.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1698307"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835941","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":"Associations of AI-derived coronary CT angiography features with CZT-SPECT coronary flow reserve and FFR-CT.","authors":"Jing Ni, Zekun Pang, Haoran Guo, Ajay Kumar Chaudhary, Fukai Zhao, Yue Chen, Jiao Wang, Jianming Li","doi":"10.3389/fcvm.2026.1803774","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1803774","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the associations of artificial intelligence (AI)-derived coronary CT angiography (CCTA) features with coronary flow reserve (CFR) measured by cardiac-cadmium zinc-telluride single-photon emission computed tomography (CZT-SPECT) and CT-derived fractional flow reserve (FFR-CT), and to investigate their intrinsic relationships.</p><p><strong>Methods: </strong>This retrospective study included 251 patients (753 vessels) with suspected or known coronary artery disease (CAD), who underwent CZT-SPECT and concurrent CCTA. Myocardial ischemia was defined as CFR <2.0 or FFR-CT ≤0.8. Generalized estimating equations (GEE) were used to analyze the associations between CCTA coronary parameters and the two ischemia definitions.</p><p><strong>Results: </strong>Among the 753 vessels, the agreement analysis between CFR and FFR-CT for ischemia was poor (Kappa = 0.084). Multivariate analysis demonstrated that CFR <2.0 was only associated with perivascular fat attenuation index (FAI) and calcified plaque burden, whereas FFR-CT ≤0.8 was additionally predicted by low attenuation plaque and lipid plaque burden (all <i>p</i> < 0.05). Subgroup analysis revealed distinct plaque feature patterns among discordant CFR/FFR-CT statuses. The same set of coronary features achieved an adjusted AUC of 0.892 for FFR-CT-defined ischemia and 0.615 for CFR-defined ischemia.</p><p><strong>Conclusions: </strong>CFR and FFR-CT reflect different pathophysiological dimensions: CFR reduction is more associated with microvascular dysfunction in the context of inflammation and diffuse lesions, whereas FFR-CT mainly reflects focal, obstructive ischemia caused by high-risk plaques (such as low attenuation plaque). CCTA is an important tool for assessing obstructive coronary lesions, but coronary features alone are insufficient to predict whether CFR is abnormal or not. However, in the absence of invasive reference standards (invasive FFR and index of microcirculatory resistance), these findings should be considered hypothesis-generating and require confirmation in future studies incorporating invasive physiological assessment.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1803774"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835864","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 and cardiac dysfunction in long COVID With cardiovascular symptoms is associated with imbalance in the ADMA-DDAH-NOx pathway.","authors":"Mohamed Saad Rakab, Imaduddin Mirza, Mohamed M Ali, Ammar Khan, Dawood Darbar, Abeer M Mahmoud","doi":"10.3389/fcvm.2026.1802359","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1802359","url":null,"abstract":"<p><strong>Background: </strong>Post-acute sequelae of COVID-19 (PASC) commonly feature lingering symptoms of persistent cardiovascular pathology, yet the mechanisms remain incompletely defined. The ADMA-DDAH-NO<i>x</i> axis is a central regulator of endothelial function: ADMA inhibits endothelial NOx synthase, while DDAH clears most circulating ADMA. Although ADMA is linked to acute COVID-19 severity, its regulation in PASC remains largely unknown.</p><p><strong>Methods: </strong>We performed integrated vascular and cardiac phenotyping in 49 RECOVER participants: never-infected controls (<i>n</i> = 10), recovered COVID-19 without persistent symptoms (PASC-, <i>n</i> = 20), and PASC with persistent cardiovascular-related symptoms lasting ≥12 weeks post-infection (PASC+, <i>n</i> = 19). We measured ADMA, DDAH, NO, inflammatory/coagulation markers, endothelial function [brachial and microvascular flow-mediated dilation (FMD)], and cardiac structure and function using comprehensive echocardiography with speckle-tracking strain.</p><p><strong>Results: </strong>PASC+ exhibited the highest inflammatory and thrombotic markers, with D-dimer being > 3-fold higher than controls, and hs-CRP nearly threefold higher. PASC+ demonstrated lower NOx and substantially higher ADMA than the other two groups, accompanied by only modest DDAH upregulation, suggesting insufficient counter-regulation. Endothelial function was significantly impaired in the PASC+ group compared to the control and PASC- groups, as evidenced by lower brachial and microvascular FMD. PASC+ individuals exhibited worse longitudinal mechanics and higher levels of hs-troponin and NT-proBNP. Ejection fraction was lower in PASC+ compared with Controls and PASC-.</p><p><strong>Conclusions: </strong>These findings identify an imbalance in the ADMA-DDAH-NO<i>x</i> axis that is associated with endothelial dysfunction and cardiac involvement in cardiovascular-symptom PASC, supporting a potentially targetable pathway for risk stratification and therapeutic investigation.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1802359"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835492","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}