Frontiers in Cardiovascular Medicine最新文献

{"title":"Editorial: Cardiovascular Imaging Case Reports 2025: Emphasizing Uncommon Clinical Scenarios.","authors":"Antonios Karanasos, Grigorios Korosoglou","doi":"10.3389/fcvm.2026.2003404","DOIUrl":"10.3389/fcvm.2026.2003404","url":null,"abstract":"","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"2003404"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215386","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":"Incremental value of dedicated [²⁰¹Tl] cadmium-zinc-telluride thallium SPECT over rest/stress [^99mTc] technetium sestamibi SPECT MPI: a comparative analysis of fixed perfusion defects.","authors":"Phattaraphorn Teungsang, Methawee Laohamethanee, Napat Kitkhuandee, Thanapol Kliteneam, Daris Theerakulpisut","doi":"10.3389/fcvm.2026.1901315","DOIUrl":"10.3389/fcvm.2026.1901315","url":null,"abstract":"<p><strong>Background: </strong>Rest/stress [^99mTc]technetium sestamibi single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is a mainstay for evaluating coronary artery disease. However, fixed defects on standard MPI present a well-documented clinical challenge, as they can represent either non-viable scars or viable hibernating myocardium. We aimed to examine the incremental value and rate of diagnostic reclassification provided by performing subsequent dedicated cadmium-zinc-telluride (CZT) [²⁰¹Tl]thallium myocardial SPECT in patients presenting with fixed defects on standard sestamibi MPI.</p><p><strong>Methods: </strong>In this retrospective study, we analyzed 174 patients-totaling 2,958 myocardial segments-who underwent both protocols. Intermodality correlation was assessed, and the rates of segmental and patient-level reclassification (segments converting from <50% maximum uptake on sestamibi to ≥50% maximum uptake on thallium) were quantified.</p><p><strong>Results: </strong>While a moderately high correlation was observed between the baseline uptake scores of the two modalities (Spearman's r = 0.817 for rest sestamibi vs. thallium), thallium imaging provided substantial additional information, with 48.0% of segments classified as fixed defects on sestamibi SPECT demonstrating improved uptake on thallium SPECT. At the patient level, 78.9% of individuals who had fixed defects on the initial sestamibi SPECT had at least one segment reclassified. Receiver operating characteristic analysis showed that a rest sestamibi uptake score of <20% predicted a lack of reclassification with 99% specificity, although with low sensitivity (12%).</p><p><strong>Conclusion: </strong>In a selected cohort of patients presenting with fixed defects on standard rest/stress sestamibi SPECT MPI, supplementary imaging with thallium myocardial CZT SPECT provided incremental data, altering the clinical interpretation in nearly 80% of patients. However, in the absence of an independent viability reference standard, this finding represents intertracer diagnostic reclassification rather than proven functional recovery. A rest sestamibi uptake of <20% demonstrated high specificity for non-reclassification; however, this cutoff should be interpreted cautiously as a potential gatekeeping finding when considering downstream testing rather than a rigid rule for omitting further myocardial viability evaluation.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1901315"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215415","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":"Open surgical repair of complex non-Type A and non-Type B aortic dissection in a right aortic arch-case report.","authors":"Tailuan Peng, Mingkun Xu, Chaohu Xiang, Jun Xiang, Yong Liu","doi":"10.3389/fcvm.2026.1784447","DOIUrl":"10.3389/fcvm.2026.1784447","url":null,"abstract":"<p><strong>Objective: </strong>To report the diagnostic and treatment process of a patient with complex non-Type A and non-Type B aortic dissection, and to discuss its clinical characteristics and surgical strategy.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of a patient with complex non-Type A and non-Type B aortic dissection.</p><p><strong>Results: </strong>After admission, the patient was diagnosed with complex non-Type A and non-Type B aortic dissection through computed tomography angiography (CTA). The aorta exhibited a right-sided arch, with the left common carotid artery originating from the ascending aorta and the aberrant left subclavian artery arising from the distal aortic arch. The right vertebral artery originated from the right-sided aortic arch. The dissection tear was located at the distal part of the aortic isthmus, approximately 2 cm in width. The dissection flap extended proximally to the distal aspect of the right subclavian artery origin and distally to the proximal aspect of the left renal artery origin. Due to the high difficulty of endovascular repair and the increased risk of long-term complications, an open surgical approach was chosen. This involved deep hypothermic circulatory arrest with elephant trunk stenting, left common carotid to left subclavian artery bypass. The patient was discharged one week after surgery in good health.</p><p><strong>Conclusion: </strong>This case illustrates that open surgical repair can be a feasible and effective option for selected patients with non-A non-B aortic dissection and complex arch anatomy that limits endovascular repair. Treatment should be individualized according to entry-tear location, arch-branch anatomy, landing-zone feasibility, malperfusion risk, and institutional expertise. Due to the special anatomical structure and high surgical difficulty, a personalized treatment plan must be developed. Open surgery still offers irreplaceable advantages in certain cases.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1784447"},"PeriodicalIF":3.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215451","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":"Early blood pressure outcomes after SPYRAL™ renal denervation: an exploratory small cohort analysis.","authors":"Sasho Stanisavljevikj, Ali Anwar, Ahmed Abu Rumman, Hristijan Alagjozovski, Vladyslav Kavalerchyk, Ivica Bojovski, Davor Vukadinović, Joachim Weil, Alexander Staudt","doi":"10.3389/fcvm.2026.1934448","DOIUrl":"10.3389/fcvm.2026.1934448","url":null,"abstract":"<p><strong>Background: </strong>Catheter-based renal denervation (RDN) is an interventional therapy for patients with resistant or uncontrolled arterial hypertension after the exclusion of secondary causes. This study aimed to evaluate the effects of the SPYRAL™ catheter system on systolic (SBP) and diastolic blood pressure (DBP) in a real-world clinical setting. Additionally, we explored whether the number of ablation points was associated with the magnitude of blood pressure (BP) reduction.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study including patients aged ≥18 years with predominantly resistant hypertension with preserved renal function (eGFR ≥40 mL/min/1.73 m2) and no evidence of secondary hypertension. Ambulatory blood pressure monitoring (ABPM) and renal function were assessed at baseline and three months after RDN. Patients were stratified into subgroups based on the number of ablation points (≤20 vs. >20). A two-tailed <i>p</i>-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Data from eleven patients (mean age 64.4 ± 8.1, 45.5% were male) were analyzed. At three months, eGFR remained stable (mean decrease -4.6 mL/min/1.73 m², CI 95% -15.8-6.6, <i>p</i> = 0.37). Mean ambulatory SBP and DBP decreased significantly following RDN (<i>Δ</i> -19.4mmHg, CI 95% -9.2 to -29.7, <i>p</i> = 0.002; <i>Δ</i> -8.6 mmHg, CI 95% -3.9 to -13.3, <i>p</i> = 0.002; for SBP and DBP respectively). Subgroup analysis revealed that patients with more ablation points experienced a greater reduction in SBP (<i>Δ</i> -17.7 mmHg, CI 95% 0.1-35.3, <i>p</i> = 0.04) and a numerically greater reduction in DBP (<i>Δ</i> -4.8 mmHg, CI 95% 4.5-12, <i>p</i> = 0.27) than those with fewer abation points.</p><p><strong>Conclusion: </strong>In this small retrospective cohort, reductions in SBP and DBP were observed following RDN using the SPYRAL™ multi-electrode system, with no excess of adverse renal events. These preliminary findings require confirmation in larger, adequately powered patient cohorts before firm conclusions can be established.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1934448"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215418","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":"Mortality trends in deaths attributed to adverse drug reactions with cardiovascular disease listed among multiple causes in the United States, 1999-2020.","authors":"Xing Guo, Kun Zheng, Lingying Su, Hong Zhu","doi":"10.3389/fcvm.2026.1857514","DOIUrl":"10.3389/fcvm.2026.1857514","url":null,"abstract":"<p><strong>Background: </strong>Adverse drug reactions (ADRs) represent a significant cause of preventable mortality and continue to pose a major challenge to medication safety. However, national temporal and demographic patterns of deaths in which an ADR was assigned as the underlying cause and cardiovascular disease (CVD) was also listed on the death certificate remain poorly characterized.</p><p><strong>Methods: </strong>We conducted a death certificate-based descriptive study using the CDC WONDER Multiple Cause of Death database from 1999 to 2020. Included records were deaths in which an ADR-related ICD-10 code (Y40-Y59) was assigned as the underlying cause of death and a CVD code (I00-I99) was listed among the multiple causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Temporal trends were assessed with Joinpoint regression, estimating annual percent change (APC) and average APC (AAPC). Mortality patterns were further analyzed by age, sex, race, region, and urbanization level, and drug categories recorded on the included death certificates were summarized descriptively.</p><p><strong>Results: </strong>From 1999 to 2020, 3,976 CVD-listed ADR deaths were identified, corresponding to an overall AAMR of 0.057 per 100,000 U.S. population. The AAMR of these deaths increased significantly over the study period (AAPC = 4.755%, 95% CI: 3.513-6.428; <i>P</i> < 0.001). Mortality burden increased with age, particularly among individuals aged 75 years and older. Males exhibited higher mortality rates than females, and significant disparities were evident by race and geography, with the highest burden observed in Black individuals and rural populations. Drug-specific analysis showed that unspecified drugs were recorded in 1,398 deaths (35.2%). Anticoagulants were the most frequently recorded specified drug category (<i>n</i> = 948; 23.8% of all included deaths), particularly among decedents with cerebrovascular disease.</p><p><strong>Conclusion: </strong>CVD-listed ADR mortality in the United States rose significantly from 1999 to 2020. The burden was most pronounced in older adults and disproportionately high among males, Black individuals, and rural residents. Anticoagulants were the most frequently recorded specified drug category. These descriptive findings identify population-level patterns that warrant confirmation through studies incorporating medical records, prescribing data, and case-level clinical adjudication.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1857514"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215421","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":"Trends in mortality due to acute myocardial infarction and pneumonia among older adults in the U.S.: a CDC wonder analysis (1999-2023).","authors":"Shuai Feng, Lianghao Zhang, Lin Quan, Nannan Jiang, Ziyi Zhao, Hongxiang Ji, Chuanshen Xu, Jinquan Liu","doi":"10.3389/fcvm.2026.1913867","DOIUrl":"10.3389/fcvm.2026.1913867","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the comprehensive national trends in deaths related to pneumonia and AMI in the US from 1999 to 2023.</p><p><strong>Methods: </strong>CDC wonder multiple cause of death database was used to extract data of elderly (≥65 years) with pneumonia and AMI as main or contributing cause of death. Age-Adjusted Mortality Rates (AAMRs) per 100,000 population were calculated. Trends were stratified by sex, race/ethnicity, state, urban-rural classification, census region, ten-year age group, and place of death.</p><p><strong>Results: </strong>A total of 186,411 deaths associated with pneumonia and AMI during 1999-2023 were identified. The cumulative AAMR was 17.76 during 1999-2020, and 14.2 during 2021-2023. A significant decline in AAMR was found through the study period (AAPC:-4.26, 95% CI -6.71 to -1.74). The AAMR of men was higher than women, and the decrease of AAMR was steeper in women (AAPC:-4.38, 95% CI -6.78 to -1.92 among women vs. -4.07, 95% CI -5.68 to -2.43 among men). NH American Indian or Alaska Native has the highest AAMR, while NH Asian or Pacific Islander had the lowest AAPC (-5.03, 95% CI -7.95 to -2.02). Non-metropolitan had higher AAMR (22.93 vs. 16.59) and AAPC (-1.69 vs. -3.51) than metropolitan. South region showed the highest AAMR and AAPC compared to other census regions.</p><p><strong>Conclusions: </strong>The AAMR per 100,000 of pneumonia and AMI decreased among older adults in the US during 1999-2023, with higher mortality burden among men, NH American Indian or Alaska Native, rural area, and South region.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1913867"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180244","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 discrimination of SOFA-2 vs. SOFA-1 and incremental information from cardiovascular scoring and vasoactive support intensity in patients with sepsis receiving early vasoactive therapy.","authors":"Tianci Huang, Mingyuan Pan, Lifan Pan, Peng Liang, Chenglin Mou, Junyu Lu","doi":"10.3389/fcvm.2026.1918792","DOIUrl":"10.3389/fcvm.2026.1918792","url":null,"abstract":"<p><strong>Background: </strong>Patients with sepsis who require vasoactive support during the first 24 h of intensive care represent a heterogeneous population. It is uncertain whether the Sequential Organ Failure Assessment (SOFA)-2 score improves mortality discrimination compared with the SOFA-1 score and whether observed circulatory support intensity provides complementary prognostic information.</p><p><strong>Methods: </strong>This multicohort observational study used Medical Information Mart for Intensive Care IV (MIMIC-IV) for a 24-h conditional landmark analysis. Patients alive and still in the ICU beyond 24 h were followed from ICU admission +24 h through ICU day 28 for reconstructed all-cause mortality. We compared SOFA-1 and SOFA-2, evaluated SOFA-2 total and cardiovascular scores, analyzed first-24-h five-agent norepinephrine-equivalent peak burden (norepinephrine, epinephrine, dopamine, phenylephrine, and vasopressin), and internally evaluated an exploratory drug-composition model. Fixed strata were assessed directionally in eICU Collaborative Research Database and an independent-center high-risk stress test cohort with cohort-specific endpoints.</p><p><strong>Results: </strong>The MIMIC-IV 24-h landmark cohort included 11,892 patients and 2,687 post-landmark deaths. SOFA-2 showed no observed discrimination advantage over SOFA-1 (area under the receiver operating characteristic curve, AUROC, 0.731 vs. 0.732; difference, -0.0005; 95% confidence interval, -0.0086 to 0.0076; <i>P</i> = 0.908). The SOFA-2 cardiovascular score had lower discrimination than the SOFA-1 cardiovascular score (0.663 vs. 0.676; <i>P</i> = 0.006). Mortality was 51.94% for the exploratory SOFA-2 ≥12 group and 17.09% below 12, and increased from 11.30% to 47.45% across four study-defined peak burden categories. The SOFA-2-plus-drug-composition model had an apparent AUROC of 0.768 and a bootstrap-corrected AUROC of 0.767, but it was not externally validated. Fixed strata preserved the direction of risk ranking in both external cohorts, whereas absolute risk and calibration differed.</p><p><strong>Conclusion: </strong>SOFA-2 did not show an observed overall mortality discrimination advantage over SOFA-1 in this population. SOFA-2 total and cardiovascular scores, together with observed vasoactive support intensity, provided complementary prognostic description at 24 h. The ≥12 rule is exploratory, and drug-related associations do not establish causal treatment effects or clinical decision utility.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1918792"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179980","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":"Pak1 overexpression is associated with mild concentric cardiac remodeling and favorable systolic and diastolic functional indices in transgenic mice.","authors":"Johnathan Yarbro, Tamayo Kobayashi, Youhua Zhang, Elizabeth Levy, Yuan Huang, Satoru Kobayashi, Qiangrong Liang","doi":"10.3389/fcvm.2026.1858786","DOIUrl":"10.3389/fcvm.2026.1858786","url":null,"abstract":"<p><strong>Background: </strong>p21-activated kinase 1 (Pak1) is a serine/threonine kinase implicated in cardioprotection, calcium handling, and excitation-contraction coupling. However, the effects of Pak1 gain- and loss-of-function on cardiac performance remain incompletely understood. Here, we characterized baseline overall cardiac performance in cardiac-specific Pak1 transgenic (TG) and knockout (KO) mice using advanced echocardiography and invasive hemodynamic assessments.</p><p><strong>Methods: </strong>Adult wild type (WT), Pak1 TG, and Pak1 KO mice, aged 7-11 months, underwent comprehensive phenotyping, including M-mode echocardiography, pulsed-wave and tissue Doppler imaging, speckle-tracking echocardiography (STE)-based strain analysis, invasive left ventricular pressure measurements, Western blot analysis, and histological evaluation using hematoxylin and eosin and Masson's trichrome staining. In addition, WT and Pak1 TG mice aged 20-22 months were studied to assess persistence of the TG phenotype with aging.</p><p><strong>Results: </strong>M-mode echocardiography showed that Pak1 TG mice exhibited concentric LV remodeling, characterized by increased wall thickness and reduced chamber dimensions compared with KO and WT controls. Histological analysis revealed greater cardiomyocyte cross-sectional area and width in TG mice than in KO mice, whereas WT values were intermediate and did not differ significantly from TG. Masson's trichrome staining detected no significant difference in myocardial fibrosis between TG and WT hearts under the present sampling conditions. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) expression was not elevated in TG hearts. TG hearts exhibited higher fractional shortening and increased global longitudinal, radial, and circumferential strain, indicating increased echocardiographic indices of systolic function. Invasive hemodynamics showed higher +<i>dP</i>/<i>dt</i> _max without a significant difference in aortic blood pressure, although these findings do not establish load-independent intrinsic contractility. Diastolic indices also differed, including increased diastolic strain rates, shorter IVRT, lower Tau, and reduced myocardial performance index, whereas <i>E</i>/<i>e</i>' was unchanged. Similar remodeling and functional indices were observed in aged TG mice, although the cross-sectional design does not establish preservation with aging. Pak1 KO mice showed modestly reduced systolic indices with preserved diastolic indices.</p><p><strong>Conclusions: </strong>Pak1 overexpression is associated with concentric LV remodeling and favorable systolic and diastolic functional indices. These findings support further investigation of Pak1-dependent mechanisms and its role in cardiac disease.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1858786"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192608","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":"Machine learning prediction of deep vein thrombosis before staged surgery in lower-leg and ankle fractures treated with temporary external fixation.","authors":"Ximing Lin, Hongpeng Gao, Weizhang Lin, Shijie Wang, Zepeng Lin, Yue Yang, Peiyi Zhuang, Chenxing Cai, Rongyuan Yang","doi":"10.3389/fcvm.2026.1963261","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1963261","url":null,"abstract":"<p><strong>Background: </strong>Deep vein thrombosis (DVT) detected between temporary external fixation and staged definitive surgery can complicate perioperative management of lower-leg and ankle fractures. We developed machine-learning models to estimate DVT probability during this interval.</p><p><strong>Methods: </strong>This retrospective cohort included adults admitted during 2015-2025 who underwent staged fixation and bilateral lower-extremity venous ultrasonography. A stratified 70:30 split defined development and validation sets. Development-set imputation, Boruta feature selection, and five-fold cross-validation were used to develop 12 classifiers. Algorithms were compared in the validation set. The selected Naive Bayes pipeline underwent 500 development-cohort bootstrap replications for optimism correction. Discrimination, precision-recall performance, calibration, and decision curves were evaluated. SHapley additive explanations (SHAP) and a bilingual research prototype web application supported interpretation.</p><p><strong>Results: </strong>Among 356 patients, 55 (15.4%) had DVT, including 40 with calf muscular vein thrombosis. The development and validation sets comprised 250 patients (39 events) and 106 patients (16 events). Boruta retained nine predictors. Naive Bayes had the highest validation receiver operating characteristic area under the curve (AUC), 0.807 (95% confidence interval, 0.705-0.909). Precision-recall AUC was 0.343, sensitivity was 0.875, and specificity was 0.589. Beta calibration reduced the Brier score from 0.135 to 0.116 without changing discrimination. The apparent AUC was 0.858, mean bootstrap optimism was 0.084, and optimism-corrected AUC was 0.773. Injury-to-admission time, calcium, age, platelet count, fibrinogen, and hemoglobin had the largest mean absolute SHAP values.</p><p><strong>Conclusion: </strong>The model may support risk stratification for an ultrasound-detected composite DVT endpoint in this staged-treatment population. Its proposed use is to inform surveillance timing and intensity while retaining routine bilateral ultrasonography. Prospective validation is required before clinical implementation.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1963261"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192679","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":"Effect of an artificial intelligence health education accurately linking system on self-management in young and middle-aged patients after percutaneous coronary intervention: a protocol.","authors":"Yueli Li, Mengke Shan, Machao Liu, Yannan Zhang, Meiqi Zhang, Pingping Qin, Xia Zhao, Yunhua Li","doi":"10.3389/fcvm.2026.1879287","DOIUrl":"10.3389/fcvm.2026.1879287","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease is a common heart disease worldwide, and the morbidity and mortality rates among Chinese residents continue to rise. Percutaneous coronary intervention (PCI) can improve survival rates, but long-term management is required after the procedure. Traditional interventions have shortcomings such as dependence on medical institutions and the lack of personalized treatment plans. This study aims to evaluate the effectiveness of the Artificial Intelligence-based Health Education Precision Linkage System (AI-HEALS) in improving self-health management among young and middle-aged patients after PCI.</p><p><strong>Methods and analysis: </strong>This is a single-center, randomized, single-blind, parallel-group controlled trial. Eligible patients aged 18-59 years from Xuanwu Hospital, Capital Medical University, will be randomly allocated at a 1:1 ratio to receive either standard care plus the AI-HEALS intervention (intervention group) or standard care alone (control group). The primary outcome is the change in self-management ability from baseline to the 3-month intervention endpoint, assessed using the Coronary Heart Disease Self-Management Behavior Scale (CSMS). Secondary outcomes include medication adherence, dietary behavior, exercise frequency, and psychological indicators. Assuming an effect size of <i>d</i> = 0.69, 80% statistical power, and a two-sided significance level of <i>α</i> = 0.05, with an anticipated 20% dropout rate, the required sample size was calculated as 86 participants (43 per group). Primary analyses will follow the intention-to-treat principle. Generalized linear mixed models will be used for repeated measures outcomes, and multiple imputation by chained equations will handle missing data. Quantitative findings will be integrated with qualitative data from structured interviews conducted among intervention group participants.</p><p><strong>Ethics and dissemination: </strong>This study has been approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University (Approval No.[2024] 409-002). Written informed consent will be obtained from all participants. Results will be disseminated through peer-reviewed publications and academic conferences.<b>Clinical Trial Registration</b>: http://www.chictr.org.cn/, identifier ChiCTR2500100519.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1879287"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180491","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}