Frontiers in Cardiovascular Medicine最新文献

{"title":"Mitochondria associated membranes in dilated cardiomyopathy: connecting pathogenesis and cellular dysfunction.","authors":"Pingge He, Hongbo Chang, Yueqing Qiu, Zhentao Wang","doi":"10.3389/fcvm.2025.1571998","DOIUrl":"10.3389/fcvm.2025.1571998","url":null,"abstract":"<p><p>Dilated cardiomyopathy (DCM) is a leading cause of heart failure, yet therapeutic options remain limited. While traditional research has focused on mechanisms such as energy deficits and calcium dysregulation, increasing evidence suggests that mitochondria-associated membranes (MAMs) could provide new insights into understanding and treating DCM. In this narrative review, we summarize the key role of MAMs, crucial endoplasmic reticulum (ER)-mitochondria interfaces, in regulating cellular processes such as calcium homeostasis, lipid metabolism, and mitochondrial dynamics. Disruption of MAMs function may initiate pathological cascades, including ER stress, inflammation, and cell death. These disruptions in MAM function lead to further destabilization of cellular homeostasis. Identifying MAMs as key modulators of cardiac health may provide novel insights for early diagnosis and targeted therapies in DCM.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1571998"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple coronary artery perforation as a fatal complication during the management of an undeflatable stent balloon: a case report.","authors":"Seok Hyun Kim, Sang Hyun Lee, Jeongsu Kim, Kook Jin Chun","doi":"10.3389/fcvm.2025.1565014","DOIUrl":"10.3389/fcvm.2025.1565014","url":null,"abstract":"<p><strong>Background: </strong>An undeflatable stent balloon following its inflation during percutaneous coronary intervention (PCI) is a rare and unpredictable complication that can lead to serious consequences. Currently, there is no standardized protocol for managing this issue.</p><p><strong>Case presentation: </strong>An 83-year-old man presented with chest pain. Coronary angiography showed a chronic total occlusion (CTO)-like lesion in the proximal left anterior descending coronary artery (LAD). Following stent deployment, the balloon failed to deflate and remained inflated within the LAD. Despite multiple retrieval attempts, the issue remained unresolved. As an alternative to surgical removal, we inflated the balloon beyond its rated burst pressure within the coronary artery. The balloon eventually ruptured and was successfully retrieved; However, this resulted in multiple severe coronary perforations, which were effectively sealed using covered stents.</p><p><strong>Conclusion: </strong>Balloon deflation failure is an exceptionally rare, unpredictable, and critical complication of PCI. While various troubleshooting strategies exist, inflating an undeflatable balloon beyond its burst pressure should be considered only as a last resort, with thorough preparation for potential complications.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1565014"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a machine learning model for online predicting the risk of in heart failure: based on the routine blood test and their derived parameters.","authors":"Jianchen Pu, Yimin Yao, Xiaochun Wang","doi":"10.3389/fcvm.2025.1539966","DOIUrl":"10.3389/fcvm.2025.1539966","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF), a core component of cardiovascular diseases, is characterized by high morbidity and mortality worldwide. By collecting and analyzing routine blood data, machine learning models were built to identify the patterns of changes in blood indicators related to HF.</p><p><strong>Methods: </strong>We conducted a statistical analysis of routine blood data from 226 patients who visited Zhejiang Provincial Hospital of Traditional Chinese Medicine (Hubin) between May 1, 2024, and June 30, 2024. The patients were divided into an experimental group (HF patients) and a normal control group. Additionally, 211 patients from the Qiantang and Xixi centers formed an independent external validation cohort. This study used both univariate and multivariate analyses to identify the risk factors associated with HF. Variables associated with HF were selected using LASSO regression analysis. In addition, eight different machine learning algorithms were applied for prediction, and the prediction performances of these algorithms were comprehensively evaluated using the receiver operating characteristic curve, area under the curve (AUC), calibration curve analysis, and decision curve analysis and confusion matrix.</p><p><strong>Conclusions: </strong>Using LASSO regression analysis, leukocyte, neutrophil, red blood cell, hemoglobin, platelet, and monocyte-to-lymphocyte ratios were identified as risk factors for HF. Among the evaluated models, the random forest model exhibited the best performance. In the validation cohort, the area under the curve (AUC) of the model was 0.948, while that of the test cohort was 1.000. The calibration curve revealed good agreement between the actual and predicted probabilities, whereas the decision curve showed the significant clinical application of the model. Additionally, the AUC of the model in the external independent test cohort was 0.945.</p><p><strong>Discussion: </strong>We used an online predictive tool to develop a predictive machine-learning model. The main purpose of this model was to predict the probability of developing HF in the future. This prediction can provide strong support and references for clinicians when making decisions. This online forecasting tool not only processes a large amount of data but also continuously optimizes and adjusts the accuracy of the model according to the latest medical research and clinical data. We hope to identify high-risk patients for early intervention to reduce the incidence of HF and improve their quality of life.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1539966"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating cystatin-C and monocyte-to-high-density lipoprotein cholesterol ratio as indicators of obstructive sleep apnea severity in male patients.","authors":"Run-Tian Meng, Qiao-Wen Chen, Chih-Yuan Ko","doi":"10.3389/fcvm.2025.1545100","DOIUrl":"10.3389/fcvm.2025.1545100","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the association between blood cystatin-C (Cys-C) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR), both established inflammatory markers, with the severity of obstructive sleep apnea (OSA) in male patients.</p><p><strong>Methods: </strong>A total of 117 male participants who underwent overnight polysomnography (PSG) between February 2019 and December 2022 were included. Based on the apnea-hypopnea index (AHI), participants were categorized into three groups: G1 (AHI < 5 events/hour, <i>n</i> = 9; control group), G2 (5 ≤ AHI < 30 events/hour, <i>n</i> = 32), and G3 (AHI ≥ 30 events/hour, <i>n</i> = 76). Serum Cys-C and MHR levels were measured and analyzed for their correlation with OSA severity. Multivariate logistic regression and receiver operating characteristic (ROC) analyses assessed their diagnostic value, while restricted cubic spline (RCS) analysis examined potential nonlinear relationships.</p><p><strong>Results: </strong>Cys-C and MHR levels increased with OSA severity and showed significant positive correlations with AHI (Cys-C: <i>r</i> = 0.084, <i>P</i> < 0.05; MHR: <i>r</i> = 0.1286, <i>P</i> < 0.05). In multivariate regression, MHR remained an independent correlate of OSA severity (adjusted OR = 47.130, 95% CI: 1.014-6.692, <i>P</i> = 0.008), whereas Cys-C lost statistical significance after adjusting for confounders. RCS analysis found no significant nonlinear relationship (<i>P</i> > 0.05). ROC analysis showed that combining Cys-C and MHR modestly improved diagnostic accuracy (AUC = 0.6622, 95% CI: 0.554-0.77). Subgroup analysis indicated that severe OSA patients with hypertension had higher Cys-C and MHR levels compared to those without hypertension, though the differences were not statistically significant (<i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>Cys-C and MHR are positively associated with OSA severity, with MHR emerging as a stronger independent biomarker. Incorporating these markers into OSA risk stratification may enhance clinical assessment and targeted interventions. Future large-scale prospective studies are needed to validate their prognostic value and clinical utility.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1545100"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dapagliflozin effects on exercise, cardiac remodeling, biomarkers, and renal and pulmonary function in heart failure patients: not as good as expected?","authors":"Massimo Mapelli, Irene Mattavelli, Elisabetta Salvioni, Nicolò Capra, Valentina Mantegazza, Anna Garlaschè, Jeness Campodonico, Filippo Maria Rubbo, Chiara Paganin, Teresa Maria Capovilla, Alessandro Alberto Nepitella, Rebecca Caputo, Paola Gugliandolo, Carlo Vignati, Beatrice Pezzuto, Fabiana De Martino, Giulia Grilli, Marco Scatigna, Alice Bonomi, Gianfranco Sinagra, Manuela Muratori, Piergiuseppe Agostoni","doi":"10.3389/fcvm.2025.1542870","DOIUrl":"10.3389/fcvm.2025.1542870","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are standard therapy for heart failure (HF). We performed a holistic evaluation of dapagliflozin, including its effects on exercise performance, left ventricle (LV) reverse remodeling, cardiac biomarkers, fluid retention, and renal and pulmonary function.</p><p><strong>Methods: </strong>We enrolled HF reduced ejection fraction (LVEF) outpatients (EF <40%) eligible for SGLT2-i and performed cardiopulmonary exercise tests (CPET), pulmonary function tests, bioelectrical impedance vector analysis, and laboratory and echocardiographic assessments at baseline (<i>T</i> = 0), after 2-4 weeks (T1), and after 6 months of treatment (T2).</p><p><strong>Results: </strong>None of the patients interrupted SGLT2-i for adverse events albeit follow-up was completed by 67 of 75 enrolled patients. At T2, mean LVEF increased (from 34.6 ± 7.8 to 37.5 ± 9.2%; <i>p</i> < 0.001) while end-diastolic (EDV) and end-systolic (ESV) volumes decreased [EDV: 186 (145-232) vs. 177 (129-225) mL, ESV: 113 (87-163) vs. 110 (76-145) mL; <i>p</i> < 0.001]. Peak oxygen intake was unchanged [peakVO₂: 16.2 (13.4-18.7) vs. 16.0 (13.3-18.9) mL/kg/min; <i>p</i> = 0.297], while exercise ventilatory efficiency (VE/VCO₂ slope) improved [from 34.2 (31.1-39.2) to 33.7 (30.2-37.6); <i>p</i> = 0.006]. Mean hemoglobin increased (from 13.8 ± 1.5 to 14.6 ± 1.7 g/dL; <i>p</i> < 0.001), while renal function did not change after a transient worsening at T1. NT-proBNP, ST-2, and hs-TNI did not change as overall body fluids and quality of life assessed by KCCQ. NYHA class improved (<i>p</i>=0.002), paralleled by a decrease of MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score, from 3.3% (1.9-8.0) to 2.8% (1.2-5.7), suggestive of a positive impact on 2 years prognosis (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Dapagliflozin induced positive LV remodeling, improvement of exercise ventilatory efficiency, and NYHA class but without peakVO₂ fluid status and cardiac biomarkers changes.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1542870"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of heart rate variability, oxygen saturation, and anthropometric data with machine learning to predict the presence and severity of obstructive sleep apnea.","authors":"Rafael Rodrigues Dos Santos, Matheo Bellini Marumo, Alan Luiz Eckeli, Helio Cesar Salgado, Luiz Eduardo Virgílio Silva, Renato Tinós, Rubens Fazan","doi":"10.3389/fcvm.2025.1389402","DOIUrl":"10.3389/fcvm.2025.1389402","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) is a prevalent sleep disorder with a high rate of undiagnosed patients, primarily due to the complexity of its diagnosis made by polysomnography (PSG). Considering the severe comorbidities associated with OSA, especially in the cardiovascular system, the development of early screening tools for this disease is imperative. Heart rate variability (HRV) is a simple and non-invasive approach used as a probe to evaluate cardiac autonomic modulation, with a variety of newly developed indices lacking studies with OSA patients.</p><p><strong>Objectives: </strong>We aimed to evaluate numerous HRV indices, derived from linear but mainly nonlinear indices, combined or not with oxygen saturation indices, for detecting the presence and severity of OSA using machine learning models.</p><p><strong>Methods: </strong>ECG waveforms were collected from 291 PSG recordings to calculate 34 HRV indices. Minimum oxygen saturation value during sleep (SatMin), the percentage of total sleep time the patient spent with oxygen saturation below 90% (T90), and patient anthropometric data were also considered as inputs to the models. The Apnea-Hypopnea Index (AHI) was used to categorize into severity classes of OSA (normal, mild, moderate, severe) to train multiclass or binary (normal-to-mild and moderate-to-severe) classification models, using the Random Forest (RF) algorithm. Since the OSA severity groups were unbalanced, we used the Synthetic Minority Over-sampling Technique (SMOTE) to oversample the minority classes.</p><p><strong>Results: </strong>Multiclass models achieved a mean area under the ROC curve (AUROC) of 0.92 and 0.86 in classifying normal individuals and severe OSA patients, respectively, when using all attributes. When the groups were dichotomized into normal-to-mild OSA vs. moderate-to-severe OSA, an AUROC of 0.83 was obtained. As revealed by RF, the importance of features indicates that all feature modalities (HRV, SpO₂, and anthropometric variables) contribute to the top 10 ranks.</p><p><strong>Conclusion: </strong>The present study demonstrates the feasibility of using classification models to detect the presence and severity of OSA using these indices. Our findings have the potential to contribute to the development of rapid screening tools aimed at assisting individuals affected by this condition, to expedite diagnosis and initiate timely treatment.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1389402"},"PeriodicalIF":2.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751873","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":"Correlation between pulmonary to systemic flow ratio and N-terminal Pro-B-type natriuretic peptide level in children with atrial septal defect.","authors":"Li-Chin Liao, Yun-Yu Chen, Yun-Ching Fu, Hui-Chih Hung","doi":"10.3389/fcvm.2025.1522603","DOIUrl":"10.3389/fcvm.2025.1522603","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial septal defect (ASD) increases pulmonary to systemic flow ratio (<i>Q</i> _p/<i>Q</i> _s) which is an important determinant factor for treatment. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are correlated with volume overloading of the heart. This study aims to explore the relationship between <i>Q</i> _p/<i>Q</i> _s and NT-proBNP levels in children with ASD.</p><p><strong>Materials and methods: </strong>Between January 2010 and December 2023, 464 patients under 20 years old with ASD who underwent cardiac catheterization and received NT-proBNP test were enrolled retrospectively. Baseline characteristics such as sex, body weight, and age were recorded. <i>Q</i> _p/<i>Q</i> _s was measured during standardized right heart catheterization according to Fick principle.</p><p><strong>Results: </strong>A significant positive correlation existed between NT-proBNP and <i>Q</i> _p/<i>Q</i> _s (R = 0.507, <i>P</i> < 0.001), with an <i>R</i> ² of 0.258. The linear regression model indicates that a one-unit (pg/ml) increase in NT-proBNP corresponded to a 0.003-unit increase in <i>Q</i> _p/<i>Q</i> _s (<i>P</i> < 0.001). Patients with a <i>Q</i> _p/<i>Q</i> _s ratio ≥ 2 had significantly higher NT-proBNP levels than those with a ratio <2 (<i>P</i> < 0.001).</p><p><strong>Conclustion: </strong>This study, the largest cohort to date, reveals the correlation between non-invasive NT-proBNP level and invasive <i>Q</i> _p/<i>Q</i> _s measurement in children with ASD.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1522603"},"PeriodicalIF":2.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751678","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":"Cross-Sectional analysis of demographic and clinical characteristics of patients in the United States using icosapent ethyl.","authors":"Peter P Toth, John R Nelson, Handrean Soran, Om P Ganda, Nathan D Wong, Hakima Hannachi, David Abrahamson, Josh Hartman, Sierra Luciano, Sephy Philip","doi":"10.3389/fcvm.2025.1411233","DOIUrl":"10.3389/fcvm.2025.1411233","url":null,"abstract":"<p><strong>Introduction: </strong>Icosapent ethyl (IPE) is indicated for the treatment of severe hypertriglyceridemia (triglycerides ≥500 mg/dl) and for reducing the risk of cardiovascular (CV) events in statin-treated adults with moderately elevated triglycerides (150-499 mg/dl) and established CV disease [secondary prevention (SP)] or diabetes with CV risk factors [primary prevention (PP)]. We describe real-world characteristics of US patients taking IPE.</p><p><strong>Methods: </strong>Patients with ≥2 IPE prescriptions were identified in the TriNetX database. PP criteria were: ≥50 years with diabetes mellitus, ≥1 additional CV risk factor, and triglycerides 150-499 mg/dl. SP criteria were established CV disease and triglycerides 150-499 mg/dl.</p><p><strong>Results: </strong>Among patients with ≥2 IPE prescriptions and triglyceride data, 56.2% (18,897/33,645) met PP or SP criteria, 28.0% (9,431/33,645) had severe hypertriglyceridemia. In the PP and SP cohorts, mean (SD) ages were 62.7 (8.0) and 64.0 (10.7) years, respectively. In the SP cohort, coronary artery disease was the most common pre-existing CV disease (85.8%) and many had diabetes (63.1%). In the PP and SP cohorts, 81.7% and 90.4%, respectively, received statin treatment. Before IPE initiation, mean (SD; median) triglyceride levels were 305 (150; 253) and 279 (142; 230) mg/dl in the PP and SP cohorts, respectively, and mean/median LDL-C levels were <100 mg/dl in both.</p><p><strong>Discussion: </strong>Patients taking IPE had characteristics consistent with its indication, including well-controlled LDL-C levels with statin use. The higher triglyceride levels before IPE initiation suggest that IPE may be underutilized in patients at high risk for CV events; however, future studies are needed.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1411233"},"PeriodicalIF":2.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751683","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":"Short-term recurrent coronary artery thrombosis with acute myocardial infarction in a patient with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome: a case report.","authors":"Xue-Guo Fu, Yan-Hua Guo, Shi-Chao Wang, Wen-Quan Zhang","doi":"10.3389/fcvm.2025.1532842","DOIUrl":"10.3389/fcvm.2025.1532842","url":null,"abstract":"<p><strong>Background: </strong>Acute myocardial infarction commonly occurs in patients with coronary artery disease, but rarely, it can develop under a hypercoagulable state. Aplastic anemia can be accompanied by paroxysmal nocturnal hemoglobinuria clones or transform into paroxysmal nocturnal hemoglobinuria with a significantly elevated prothrombotic state. These thrombotic complications predominantly arise in veins rather than in arteries. Coronary artery thrombosis in these patients, especially with short-term recurrent arterial thrombosis after initial successful treatment, is exceedingly rare.</p><p><strong>Case presentation: </strong>A 39-year-old man with a history of aplastic anemia with paroxysmal nocturnal hemoglobinuria clones for 8 years presented with chest pain, and was diagnosed with acute inferior wall myocardial infarction on November 21, 2022. Despite standardized coronary intervention and anticoagulant/antiplatelet therapy, the patient reported intermittent chest discomfort with persistently elevated cardiac troponin and d-dimer levels 20 days after initial treatment. Repeat coronary angiography confirmed recurrent thrombosis in the right coronary artery. He underwent repeated balloon dilation and thrombus aspiration with intensified anticoagulation, which alleviated his clinical symptoms and normalized his cardiac troponin and d-dimer levels. The patient was finally confirmed to have aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome.</p><p><strong>Conclusion: </strong>Patients with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome can have thrombosis in arteries, such as coronary arteries, leading to acute myocardial infarction. Recurrent coronary artery thrombosis can occur after initial successful revascularization and anticoagulant/antiplatelet therapy. Close monitoring of clinical symptoms, repeated electrocardiogram and laboratory tests, coronary angiography, strengthened anticoagulation, and precautions for bleeding risks should be considered in patients with aplastic anemia-paroxysmal nocturnal hemoglobinuria syndrome.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1532842"},"PeriodicalIF":2.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751868","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":"Detection of arterial remodeling using epicardial adipose tissue assessment from CT calcium scoring scan.","authors":"Juhwan Lee, Tao Hu, Michelle C Williams, Ammar Hoori, Hao Wu, Justin N Kim, David E Newby, Robert Gilkeson, Sanjay Rajagopalan, David L Wilson","doi":"10.3389/fcvm.2025.1543816","DOIUrl":"10.3389/fcvm.2025.1543816","url":null,"abstract":"<p><strong>Introduction: </strong>Non-contrast CT calcium scoring (CTCS) exams have been widely used to assess coronary artery disease. However, their clinical applications in predicting coronary arterial remodeling remain unknown. This study aimed to develop a novel machine learning model to predict positive remodeling (PR) from CTCS scans and evaluate its clinical value in predicting major adverse cardiovascular events (MACE).</p><p><strong>Methods: </strong>We analyzed data from 1,324 patients who underwent both CTCS and CT angiography. PR was defined as an outer vessel diameter at least 10% greater than the average diameter of the segments immediately proximal and distal to the plaque. We utilized a total of 246 features, including 23 clinical features, 12 Agatston score-derived features, and 211 epicardial fat-omics features to predict PR. Feature selection was performed using Elastic Net logistic regression, and the selected features were used to train a CatBoost machine learning model. Classification performance was evaluated using 1,000 repetitions of five-fold cross-validation and survival analyses, comparing actual and predicted PR in the context of predicting MACE.</p><p><strong>Results: </strong>PR was identified in 429 patients (32.4%). Using Elastic Net, we identified the top 13 features, including four clinical features, three Agatston score-derived features, and six fat-omics features. Our method demonstrated excellent classification performance for predicting PR, achieving a sensitivity of 80.3 ± 1.7%, a specificity of 89.7 ± 1.7%, and accuracy of 81.9 ± 2.5%. The Agatston-score-derived and fat-omics features provided additional benefits, improving classification performance. Furthermore, our model effectively predicted MACE, with a hazard ratio (HR) of 4.5 [95% confidence interval (CI): 3.2-6.4; C-index: 0.578; <i>p</i> < 0.00001] in the training set and an HR of 3.2 (95% CI: 2.5-4.0; C-index: 0.647; <i>p</i> < 0.00001) in the external validation set.</p><p><strong>Conclusion: </strong>We developed an innovative machine learning model to predict coronary arterial remodeling from epicardial fat and calcification features from low-cost/no-cost screening CTCS scans. Our results suggest that vast number of CTCS scans can support more informed clinical decision-making and potentially reduce the need for invasive and costly testing for low-risk patients.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1543816"},"PeriodicalIF":2.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751690","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}