Frontiers in Cardiovascular Medicine最新文献

{"title":"Association between lesion-specific fat attenuation index and high-risk plaque on coronary computed tomography angiography.","authors":"Zhikun Chen, Junmei Zhao, Yayun Liu, Ya Ma, Shitong Yin, Chunlan Bai, Yazhao Sun, Meiyu Zhang","doi":"10.3389/fcvm.2026.1979906","DOIUrl":"10.3389/fcvm.2026.1979906","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between lesion-specific fat attenuation index (FAI) derived from coronary computed tomography angiography (CCTA) and CCTA-defined high-risk plaque (HRP).</p><p><strong>Methods: </strong>A total of 560 patients undergoing CCTA for the first time who had at least one evaluable coronary atherosclerotic lesion were consecutively included. One target lesion was selected for each patient. Four CCTA-derived high-risk plaque features were assessed, including low-attenuation plaque, positive remodeling, spotty calcification, and the napkin-ring sign. Lesions exhibiting at least two of these features were classified as CCTA-defined HRP, and lesion-specific FAI was quantified from the pericoronary adipose tissue surrounding the target lesion and expressed in Hounsfield units (HU). Binary logistic regression was used to evaluate the association between lesion-specific FAI and CCTA-defined HRP. Restricted cubic spline analysis was performed to characterize the shape of the association, and subgroup and sensitivity analyses were conducted to evaluate the robustness of the findings.</p><p><strong>Results: </strong>Lesion-specific FAI was significantly higher in patients with CCTA-defined HRP than in those without HRP (-76.5 ± 4.8 HU vs. -81.0 ± 4.8 HU), with a mean difference of 4.47 HU [95% confidence interval (CI), 3.54-5.41 HU, <i>P</i> < 0.001] and a Cohen's <i>d</i> of 0.93. In the fully adjusted model, each 5-HU increase in lesion-specific FAI was associated with higher odds of CCTA-defined HRP [odds ratio (OR), 2.03; 95% CI, 1.52-2.69; <i>P</i> < 0.001]. Restricted cubic spline analysis demonstrated a significant overall association between lesion-specific FAI and CCTA-defined HRP (<i>P</i> for overall <0.001), with no significant evidence of nonlinearity (<i>P</i> for nonlinearity = 0.702). The association remained consistent across the examined subgroups, with no significant interactions, and the findings remained robust in sensitivity analyses.</p><p><strong>Conclusions: </strong>Higher lesion-specific FAI was independently associated with CCTA-defined HRP, with higher odds of HRP across increasing FAI values. The association remained consistent across subgroup and sensitivity analyses. Lesion-specific FAI may provide complementary information for characterizing CCTA-defined high-risk plaque and assessing the local perilesional environment. Further prospective studies with invasive imaging or longitudinal clinical outcomes are needed to determine its potential incremental value.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1979906"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180477","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":"Reading discordant bedside indices in sepsis-induced cardiomyopathy: an evidence-mapping framework for diagnosis and trial design.","authors":"Lulu Zhang, Siye Zhang","doi":"10.3389/fcvm.2026.1918976","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1918976","url":null,"abstract":"<p><p>Sepsis-induced cardiomyopathy (SICM) affects 20%-30% of patients with septic shock and independently predicts mortality, yet it lacks a consensus definition or validated reference standard. Bedside diagnostic indices-left ventricular ejection fraction (LVEF), global longitudinal strain, E/e', troponin level, and cardiac index-are frequently discordant, and no principled framework exists for interpreting this discordance. In parallel, every major pharmacological intervention targeting SICM, including levosimendan, corticosteroids, and beta-blockers, has failed to demonstrate consistent mortality benefit across randomised trials. Herein, we propose that both impasses may share a single root cause: a construct validity failure in which bedside indices used for diagnosis and trial enrolment do not reliably identify the specific pathophysiological processes that they are assumed to represent. We present a structured evidence-mapping framework that organises six bedside diagnostic methods against seven pathophysiological trait dimensions of SICM, grading the evidence for each combination against explicit criteria and identifying structural blind spots. The framework explains why index discordance is a diagnostic signal rather than a measurement error, identifies two dimensions-metabolic dysfunction and cardiac-specific inflammatory signalling-that are structurally invisible to all current bedside diagnostics and whose invisibility offers a testable explanation for repeated trial failures, and translates these insights into a three-step bedside reasoning framework. When LVEF is depressed but longitudinal function is preserved, the framework directs assessment towards ventriculo-arterial uncoupling rather than inotrope escalation; when right ventricular dysfunction predominates, it directs assessment towards reverse resuscitation. The framework reframes index discordance from a source of diagnostic paralysis into a source of clinical precision and defines the enrolment biomarker agenda required to make future SICM trials mechanistically interpretable.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1918976"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180009","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":"Closing the diagnostic gap in transthyretin cardiac amyloidosis: red flags, modern imaging, and emerging therapies.","authors":"Zhengjun Yi, Peng Li, Xueqian Wang","doi":"10.3389/fcvm.2026.1935800","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1935800","url":null,"abstract":"<p><p>Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized, treatable, and still underdiagnosed cause of heart failure with preserved ejection fraction (HFpEF) and unexplained left ventricular hypertrophy in older adults, with a typical diagnostic delay of several years. We conducted a narrative review with a systematic literature search of PubMed and Embase (January 2000 to June 2026) using database-specific controlled vocabulary and free-text terms related to ATTR cardiomyopathy, clinical red flags, bone scintigraphy, monoclonal protein testing, cardiac magnetic resonance, tafamidis, acoramidis, vutrisiran, and emerging TTR-directed therapies. Two authors screened titles and abstracts, resolved disagreements by consensus, and prioritized multicenter cohorts, clinical trials, meta-analyses, systematic reviews, and guideline or consensus documents. Sixty-two references were included. Three practice points emerge from the literature. First, suspicion should be triggered by red flags such as bilateral carpal tunnel syndrome, lumbar spinal stenosis, spontaneous distal biceps tendon rupture, and the combination of increased ventricular wall thickness with low or normal QRS voltage. Second, the contemporary diagnostic pathway requires parallel bone scintigraphy and complete monoclonal protein screening; grade 2-3 myocardial uptake supports non-biopsy diagnosis of ATTR-CM only when monoclonal screening is negative and myocardial uptake is confirmed, preferably by SPECT or SPECT/CT. Third, treatment options now extend beyond tafamidis to acoramidis and vutrisiran, with amyloid-depleting antibodies under active investigation. We propose a pragmatic, resource-stratified diagnostic framework for targeted case-finding rather than population-level screening.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1935800"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180418","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":"Effects of different exercise types on visceral adipose tissue and glycemic parameters in adults with stage 1 cardiovascular-kidney-metabolic syndrome: a systematic review and network meta-analysis of randomized controlled trials.","authors":"Xinda Wei, Hanyu Zhao, Shuang Yue, Tao Ren, Yuhang Yang, Jiazhen Wang, Ruihua Cao, Ji Fang, Fan Su, Fei Zhong","doi":"10.3389/fcvm.2026.1873140","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1873140","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome, particularly at stage 1, is increasingly prevalent worldwide. Although exercise interventions are recognized as effective in reducing visceral adipose tissue (VAT) and improving glucose metabolism, their effects in adults with stage 1 CKM syndrome remain unclear. This study aimed to systematically analyze the effects of different exercise types on VAT, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) in adults with stage 1 CKM syndrome.</p><p><strong>Methods: </strong>We searched six bibliographic databases-China National Knowledge Infrastructure (CNKI), WanFang Database, VIP Database, Web of Science, Embase, and PubMed-from inception to 15 April 2026, using the PICOS framework. A frequentist random-effects Network Meta-Analyses was conducted using STATA 18.0 software to evaluate the effects of interventions on VAT, FBG and HbA1c. The effectiveness of various exercise intervention types was ranked by calculating the surface under the cumulative ranking curve (SUCRA), and the risk of bias was evaluated using the Cochrane Risk of Bias (ROB 2.0) tool. This study protocol was registered in PROSPERO (CRD420261304633).</p><p><strong>Results: </strong>Thirty-seven randomized controlled trials involving 3483 participants were included. Compared with the control group, aerobic training significantly decreased VAT [standardized mean difference = -0.44, 95% confidence interval (CI): (-0.62, -0.26)], while mind-body exercise (MBE) significantly improved FBG [mean difference (MD) = -1.16 mmol/L, 95% CI: (-1.57, -0.75)] and HbA1c [MD = -0.35%, 95% CI: (-0.62, -0.07)]. Subgroup analysis revealed that high-intensity interval training with an intervention duration of ≤ 12 weeks (SUCRA = 67%) and aerobic training with a duration of >12 weeks (SUCRA = 94.9%) had the highest probability of being the most effective intervention for reducing VAT in included studies. In addition, mind-body exercise ranked highest for FBG improvement, though with limited certainty.</p><p><strong>Conclusions: </strong>These findings provide evidence that different exercise types exert distinct benefits on metabolic health in adults with stage 1 CKM syndrome. In particular, aerobic training may be more effective than other exercise types in reducing VAT, while MBE may contribute to more benefits in improving FBG and HbA1c.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261304633, Identifier CRD420261304633.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1873140"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180516","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":"Comparison of hybrid coronary revascularization and minimally invasive multivessel CABG for multivessel coronary artery disease.","authors":"Ting Ren, Haoyi Yao, Zhaohui Cheng, Zibo Lin, Jiapei Qiu, Qiang Zhao","doi":"10.3389/fcvm.2026.1887132","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1887132","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the perioperative and early-to-mid-term outcomes of hybrid coronary revascularization (HCR) and minimally invasive multivessel coronary artery bypass grafting (MICS-CABG) for treating multivessel coronary artery disease (MVCAD).</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study including MVCAD patients who underwent HCR or MICS-CABG at Ruijin Hospital between January 2019 and December 2024. The primary endpoint was the incidence of major perioperative complications within 30 days after surgery, including all-cause mortality, myocardial infarction (MI), and stroke. Secondary endpoints included 1-year all-cause survival and 1-year graft or target-vessel patency. Propensity score matching (PSM) was performed to reduce baseline imbalance between the two groups. Kaplan-Meier analyses were used to evaluate 1-year survival.</p><p><strong>Results: </strong>A total of 169 patients were included, of whom 91 underwent HCR and 78 underwent MICS-CABG. After 1:1 PSM, 132 patients remained, with 66 patients in each group. Major perioperative complications within 30 days after surgery were comparable. In the HCR group, MI occurred in 1 patient (1.52% vs. 0.00%; <i>P</i> = 1.000), stroke in 2 patients (3.03% vs. 0.00%; <i>P</i> = 0.476), and death in 1 patient (1.52% vs. 0.00%; <i>P</i> = 1.000), whereas no such events occurred in the MICS-CABG group. The MICS-CABG group had significantly longer operative time (250 vs. 160 min, <i>P</i> < 0.001) and greater 24-hour postoperative drainage (420 vs. 185 mL, <i>P</i> < 0.001). Postoperative respiratory complications were numerically more frequent after MICS-CABG. The 1-year survival rate was comparable between the HCR and MICS-CABG groups after PSM (98.5% vs. 98.4%; log-rank <i>P</i> = 0.996). The 1-year left anterior descending artery (LAD) revascularization patency rate was comparable between the HCR and MICS-CABG groups (94.6% vs. 90.0%; <i>P</i> = 0.366), as was non-LAD target-vessel patency (86.5% vs. 87.0%; <i>P</i> = 0.922).</p><p><strong>Conclusions: </strong>HCR and MICS-CABG provided comparable perioperative safety, early-to-mid-term survival, and 1-year revascularization patency in selected patients with MVCAD. Treatment strategy may be individualized according to coronary lesion characteristics and cardiopulmonary function.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1887132"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180465","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":"Simulation-guided outlet valve repair: early integration of computationally-derived principles of free-edge length in bicuspidization repair.","authors":"Perry Seo Choi, Alexander D Kaiser, Riya Nilkant, Amit Sharir, Umar Siddiqi, Hannah L McMullen, Alison L Marsden, Michael R Ma","doi":"10.3389/fcvm.2026.1957668","DOIUrl":"10.3389/fcvm.2026.1957668","url":null,"abstract":"<p><strong>Background: </strong>Symmetric bicuspidization repair for outlet valve pathologies relies on the surgeon's subjective assessment. Recent computational and ex-vivo work suggests sizing free-edge length to 1.57 times aortic diameter is optimal. This principle was applied clinically at our institution, and this study compares post-implementation outcomes with historical results.</p><p><strong>Methods: </strong>All patients with attempted bicuspidization from 2011 to 2025 were queried. Primary outcome was freedom from valve-related reoperation or valve replacement. Secondary outcomes were cross-clamp time, number of bypass runs, mean transvalvular gradient, and regurgitation grade. Kaplan-Meier curves were generated for primary outcome with log-rank comparison. Secondary outcomes were compared with Wilcoxon rank-sum test.</p><p><strong>Results: </strong>At median age 5.9 years, fourteen patients underwent symmetric bicuspidization (9 historical, 5 simulation-guided). Valve configuration included unicuspid (<i>n</i> = 2), bicuspid (<i>n</i> = 6), tricuspid (<i>n</i> = 4), and quadricuspid (<i>n</i> = 2). Repair indication was predominantly regurgitation (<i>n</i> = 13/14, 93%). Five (56%) historical patients underwent reoperation compared with zero simulation-guided patients (median follow-up 948 vs. 455 days). Three (33%) historical patients required repeat bypass run, compared to zero simulation-guided. Cross-clamp time was not different between groups (72 vs. 89, <i>p</i> = 0.74). Acute and latest postoperative mean gradients were also not significantly different (acute: 13.5 vs. 9.6, <i>p</i> = 0.14; latest: 12.4 vs. 3.3, <i>p</i> = 0.08), though gradient variability was two to four times lower in the simulation-guided group.</p><p><strong>Conclusions: </strong>This exploratory study presents promising early outcomes after prespecified, standardized sizing of the free-edge length in symmetric bicuspidization repair. Simulation-guided design can be applied in complex valve repair and may enhance early outcomes.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1957668"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between insulin resistance-related indices and cardiovascular disease in patients with atopic dermatitis: mutual validation using real-world and NHANES data.","authors":"Yu An, Han Zhou, Liangjuan Ma","doi":"10.3389/fcvm.2026.1903179","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1903179","url":null,"abstract":"<p><strong>Background: </strong>The number of patients with atopic dermatitis (AD) who develop cardiovascular disease (CVD) has been increasing year by year. However, reliable biomarkers for identifying AD patients with a higher burden of prevalent CVD remain lacking.</p><p><strong>Methods: </strong>This study included patient data from the First Affiliated Hospital of Harbin Medical University from 2014 to 2023 and data from the U.S. National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression analyses were performed to evaluate the associations of triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), C-reactive protein-triglyceride-glucose index (CTI), and CTI-body mass index (CTI-BMI) with prevalent CVD in patients with AD. Restricted cubic spline (RCS) analyses, subgroup analyses, and sensitivity analyses were conducted to evaluate the robustness of the findings. Seven machine learning (ML) models and SHAP analysis were applied to assess the discriminative performance of these indices for prevalent CVD status.</p><p><strong>Results: </strong>In the real-world dataset, 145 patients had prevalent CVD, whereas 75 participants had prevalent CVD in the NHANES dataset. Multivariable logistic regression analyses showed that, after adjustment for clinical covariates, all four indices were significantly and positively associated with prevalent CVD among patients with AD. These associations remained consistent across most subgroup analyses. Restricted cubic spline analyses showed no evidence of nonlinear associations, and sensitivity analyses supported the robustness of the findings. Among the evaluated ML models, CTI-BMI demonstrated the highest discriminative performance for prevalent CVD status in both datasets and contributed most substantially to model discrimination.</p><p><strong>Conclusion: </strong>This study demonstrated that TyG, TyG-BMI, CTI, and CTI-BMI were significantly associated with prevalent CVD among patients with AD. CTI-BMI showed the strongest discriminative performance among the evaluated indices and provided modest incremental discrimination when incorporated into machine learning models. These findings suggest that these indices may serve as potential adjunctive markers for cardiovascular burden assessment in patients with AD; however, further prospective studies are required to determine their value for predicting future cardiovascular events.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1903179"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180427","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":"Cardiovascular outcomes of oral incretin-based drugs in type 2 diabetes: a GRADE-assessed meta-analysis of 67,679 patients.","authors":"Muhammad Faizan Ali, Omer Farooq Mohammed, Amina Suhail, Faisal Naseer, Nimra Shafi, Muhammad Usman Arshad, Omar Shazly, Muneeb Shad Mohmand, Husnain Ahmad, Noof K Binashikhbubkr, Muhammad Maaz, Muhammad Khan, Sivaram Neppala, Mustafa Al-Jarshawi, Mohamed Fawzi Hemida","doi":"10.3389/fcvm.2026.1884895","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1884895","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;While injectable GLP-1 receptor agonists like semaglutide have demonstrated clear cardiovascular benefits in type 2 diabetes mellitus (T2DM), the role of oral incretin-based therapies, including oral semaglutide and DPP-4 inhibitors-remains less well defined. Comprehensive evaluation of their cardiovascular efficacy is warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research question: &lt;/strong&gt;What are the cardiovascular outcomes associated with oral incretin-based therapies, specifically oral semaglutide and DPP-4 inhibitors, in patients with T2DM compared to placebo or standard care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched electronic databases for randomized controlled trials (RCTs). Meta-analysis was conducted in R version 4.4.3 using the \"meta\" and \"metasens\" packages. Statistical analysis was performed using R software and RStudio (version 4.4.2). We calculated pooled estimates using risk ratios (RR) with 95% confidence intervals (CIs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 9 studies comprising 67,679 patients were included, of which two evaluated oral semaglutide and the remaining seven assessed DPP-4 inhibitors. There was no significant reduction in all-cause mortality (RR 0.97, 95% CI 0.90-1.04, &lt;i&gt;p&lt;/i&gt; = 0.35) or cardiovascular death (RR 0.98, 95% CI 0.91-1.05, &lt;i&gt;p&lt;/i&gt; = 0.48). Major adverse cardiovascular events (MACE) showed a non-significant reduction overall (RR 0.95, 95% CI 0.91-1.00, &lt;i&gt;p&lt;/i&gt; = 0.06), with oral semaglutide demonstrating a significant benefit (RR 0.86, 95% CI 0.78-0.95, &lt;i&gt;p&lt;/i&gt; = 0.003). Non-fatal myocardial infarction (MI) (RR 0.98, 95% CI 0.88-1.09) and non-fatal stroke (RR 0.93, 95% CI 0.83-1.03) were not significantly affected. Hospitalizations due to heart failure (RR 0.98, 95% CI 0.84-1.13) and unstable angina (RR 1.00, 95% CI 0.87-1.15) remained unchanged. Coronary revascularization was slightly reduced with oral semaglutide (RR 0.76, 95% CI 0.64-0.91). Adverse events leading to discontinuation were higher with oral semaglutide (RR 1.51, 95% CI 1.15-1.98), while serious adverse events were significantly reduced (RR 0.96, 95% CI 0.94-0.99, &lt;i&gt;p&lt;/i&gt; = 0.003). Sensitivity analyses were conducted due to significant heterogeneity in key outcomes. While omitting certain studies reduced heterogeneity, the overall results remained consistent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Oral incretin-based therapies were not associated with significant reductions in all-cause mortality, cardiovascular death, or MACE overall, though oral semaglutide showed a significant MACE benefit and reduced coronary revascularization on subgroup analysis. Non-fatal MI, fatal or non-fatal MI, non-fatal stroke, fatal or non-fatal stroke and hospitalization due to heart failure or unstable angina were unaffected, and oral semaglutide carried a higher risk of treatment discontinuation. These findings suggest no clear class-wide cardiovascular benefit of oral incretins, with signals specific to oral semaglutide warranting co","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1884895"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180429","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":"Pantoprazole-induced anaphylactic asthma and Type I Kounis syndrome: a case report and literature review.","authors":"Ailing Huang, Songyun Li, Haseeb Sattar, Yalu Qin, Kaixin Tian, Qian Nie","doi":"10.3389/fcvm.2026.1883834","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1883834","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPIs) are among the most frequently prescribed medications and are generally considered to have a favourable safety profile. Nevertheless, immediate hypersensitivity reactions may occur and, in exceptional circumstances, can precipitate Kounis syndrome (KS), an acute coronary syndrome resulting from the activation of inflammatory pathways. We describe an elderly patient who developed severe anaphylaxis with Type I KS shortly after intravenous pantoprazole administration in the presence of an unsuspected myocardial bridge, and discuss the potential clinical implications.</p><p><strong>Case summary: </strong>An 85-year-old woman with a 30-year history of well-controlled bronchial asthma was admitted with community-acquired pneumonia. During hospitalization, she received intravenous pantoprazole (40 mg) for acid reflux. Within five minutes of the infusion, she developed a widespread erythematous rash, severe bronchospasm, profound hypotension (74/56 mmHg), and ST-segment elevation of approximately 0.3 mV in leads I, aVL, and V₁ to V₄. Emergency coronary angiography demonstrated no obstructive coronary artery disease but identified a myocardial bridge involving the mid-left anterior descending artery, producing nearly 90% systolic compression. Serial cardiac troponin and NT-proBNP concentrations remained within the normal range. Assessment using the Naranjo Adverse Drug Reaction Probability Scale yielded a score of six, indicating a probable causal relationship between pantoprazole and the adverse event. The patient was treated with methylprednisolone (80 mg). The recovery occurred within 2 h.</p><p><strong>Conclusion: </strong>This case highlights that intravenous pantoprazole may rarely trigger life-threatening Type I Kounis syndrome. It also raises the possibility that a pre-existing myocardial bridge can accentuate coronary vasospasm during severe allergic reactions, thereby contributing to the clinical presentation. Based on this experience and the available literature, we propose a practical management algorithm to facilitate timely diagnosis and treatment in similar clinical settings.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1883834"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179785","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":"Mechanical circulatory support devices in heart failure: a narrative review of current evidence, clinical applications, complications, and future directions.","authors":"Ruirui Zhu, Fangyuan Zhang, Yudong Peng, Yucheng Zhong","doi":"10.3389/fcvm.2026.1859170","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1859170","url":null,"abstract":"<p><p>Mechanical circulatory support devices (MCSDs) have evolved from rescue therapy for refractory cardiogenic shock (CS) to an essential component of advanced heart failure management, spanning temporary support, bridge strategies, durable left ventricular assist device (LVAD), and total artificial heart (TAH). This structured narrative review summarizes the historical evolution, current indications, device classification, major short-term and long-term platforms, adverse events, and future directions of MCSDs. Literature was selected in a structured narrative manner with emphasis on contemporary guidelines, randomized or comparative studies, major registries, and representative Chinese experience. Available evidence shows that MCSDs can improve hemodynamics and, in selected populations, survival and quality of life; however, these benefits must be balanced against bleeding, stroke, infection, right heart failure, device malfunction, cost, and major ethical and access constraints. Current practice thus necessitates careful patient selection, stage-based therapeutic escalation, and rigorous evaluation of mixed evidence pertaining to temporary MCSDs, LVAD and TAH, instead of merely describing individual devices.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1859170"},"PeriodicalIF":3.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179796","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}