Frontiers in Cardiovascular Medicine最新文献

{"title":"Long-term outcomes of left atrial appendage closure techniques on stroke prevention of recurrent atrial fibrillation patients: epicardial excision versus percutaneous occlusion.","authors":"Adnan Abibe Goia, Meng Xu, Hu Qiuming","doi":"10.3389/fcvm.2025.1601303","DOIUrl":"10.3389/fcvm.2025.1601303","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the efficacy of left atrial appendage closure performed by excision (LAAC-EE) vs. occlusion (LAAC-PO) for stroke prevention in patients with recurrent atrial fibrillation undergoing radiofrequency ablation.</p><p><strong>Methods: </strong>In this retrospective analysis, 160 consecutive patients (109 undergoing LAAC-EE and 51 undergoing LAAC-PO) were evaluated. To adjust for baseline differences, stabilized inverse probability of treatment weighting (IPTW) was applied using a logistic regression model with age, sex, and CHA₂DS₂-VASc score as predictors. Weighted Kaplan-Meier survival analyses were conducted to assess stroke-free survival over a 5-year follow-up period, and weighted Cox proportional hazards regression was used to evaluate the association between LAAC modality and stroke occurrence, adjusting for age, sex, diabetes, CHA₂DS₂-VASc score, HAS-BLED score, and left atrium size.</p><p><strong>Results: </strong>Overall, the weighted mean CHA2DS2-VASc score was 3.1 ± 0.1 (3.0 ± 0.2 in LAAC-EE vs. 3.3 ± 0.2 in LAAC-PO; <i>p</i> = 0.159), indicating moderate baseline stroke risk. When stratified, 39.2% of LAAC-EE and 18.9% of LAAC-PO patients were in the low-risk category (CHA2DS2-VASc ≤2), 48.2% vs. 69.6% in the medium-risk group (score 3-4), and 12.6% vs. 11.5% in the high-risk group (score ≥5) (<i>p</i> = 0.093). Over 5 years, stroke occurred in 64 patients-29.4% in the LAAC-EE group vs. 62.7% in LAAC-PO-and weighted Kaplan-Meier analysis showed significantly greater stroke-free survival with excision (log-rank <i>p</i> < 0.001). In the weighted multivariate Cox model, LAAC-EE was associated with a non-significant 51.6% reduction in stroke risk (HR 0.48; 95% CI 0.13-1.74; <i>p</i> = 0.27). Age (HR 1.09 per year; <i>p</i> = 0.008) and HAS-BLED score (HR 10.54; <i>p</i> < 0.001) remained significant predictors, whereas sex, diabetes, and CHA₂DS₂-VASc score did not.</p><p><strong>Conclusion: </strong>Although the multivariate analysis did not achieve statistical significance for the treatment modality, the observed hazard ratio indicates that LAAC-EE may reduce stroke risk by approximately 51.6% compared to LAAC-PO. The significant impact of age and HAS-BLED score on stroke risk underscores the importance of individualized patient selection. These findings suggest a potential clinical benefit of LAAC-EE, particularly among lower-risk patients, and warrant further investigation in larger prospective studies.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1601303"},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324958","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":"Comparing endovascular techniques for left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair for type B acute aortic syndromes: a retrospective cohort study.","authors":"Zizhong Zhang, Guangkun Sun, Jiacheng Ye, Bin Liu, Yongzheng Wang, Yuliang Li, Haiyang Chang","doi":"10.3389/fcvm.2025.1566798","DOIUrl":"10.3389/fcvm.2025.1566798","url":null,"abstract":"<p><strong>Background: </strong>Castor-branched stent-graft, chimney stent, and fenestration techniques have been employed for left subclavian artery (LSA) revascularization during zone 2 thoracic endovascular aortic repair (TEVAR), but not recommended routinely. This study aimed to compare the safety and efficacy of these techniques.</p><p><strong>Methods: </strong>From February 2017 to June 2020, 133 patients with type B acute aortic syndromes undergoing LSA revascularization during zone 2 TEVAR were retrospectively enrolled. The primary outcomes include technical success, mortality, stroke and spinal cord ischemia. The secondary outcomes include aortic remodeling, LSA patency, freedom from aorta-related reintervention.</p><p><strong>Results: </strong>Fifty patients were treated with the Castor-branched stent-graft (Group A), 42 with the chimney technique (Group B), and 41 with the fenestration technique (Group C). The groups demonstrated a similar technical success rate, with 96% in Group A, 97.62% in Group B, and 95.12% in Group C. Despite a more predominant bird-beak configuration in group A (<i>p</i> = 0.003), no significant difference was observed in perioperative complications. Two TEVAR-related deaths occurred in Groups B and C, while none was reported in Group A. During the first two years of follow-up, favorable aortic remodeling was confirmed in all groups. Each group exhibited two cases of LSA occlusions. Aorta-related reintervention and mortality did not significantly differ among the groups.</p><p><strong>Conclusion: </strong>Endovascular techniques are feasible for LSA revascularization during zone 2 TEVAR, with favorable aortic remodeling. However, the durability of these procedures requires careful evaluation, given the potential concern of LSA occlusion.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1566798"},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324950","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":"Predicting prognosis of sepsis in patients based on right ventricular strain imaging development and validation of a nomogram model.","authors":"Qinxin Wang, Hongmin Chen, Bingyi Zhang, Chang Zhou, Boyuan Xing, Chang Li, Shijin Xu, Yun Liu","doi":"10.3389/fcvm.2025.1532674","DOIUrl":"10.3389/fcvm.2025.1532674","url":null,"abstract":"<p><strong>Background: </strong>The right ventricle (RV) plays a significant role in septic myocardial injury and associated organ dysfunction. Hence, identifying right ventricular systolic dysfunction (RVSD) early is crucial for improving outcomes in septic patients, yet current research on RVSD in sepsis remains limited.</p><p><strong>Objective: </strong>The study aims to identify risk factors for adverse outcomes in septic patients and construct a nomogram prediction model incorporating right ventricular strain and right ventricle-pulmonary artery coupling parameters.</p><p><strong>Methods: </strong>This single-center prospective study included 156 sepsis patients admitted from September 2021 to October 2024. General clinical, laboratory, and echocardiographic data were collected within 72 h of sepsis diagnosis. Prognosis was used to divide patients into two groups. Lasso regression was used to examine the baseline features of both groups. Multivariable logistic regression analysis and a nomogram were used to predict sepsis prognosis. The relationship between RVSD and 28-day mortality was examined.</p><p><strong>Results: </strong>Within 28 days, 52 of 141 sepsis patients died. Univariate analysis showed that the non-survivor cohort was older and had higher APACHE II and Sequential Organ Failure Assessment (SOFA) ratings and procalcitonin, B-type natriuretic peptide, cTnI, and lactate. RV-free wall strain (-18.9% ± 1.6% vs. -20.1% ± 1.5%, <i>p</i> < 0.001) and RV global strain (-18.6% ± 1.4% vs. -17.6% ± 1.0%, <i>p</i> < 0.001) were lower in the non-survivor group compared to the survivor cohort. PASP and RV-GS/PASP ratio significantly differed between the two groups (<i>p</i> < 0.05). Multivariable logistic regression analysis identified age >67 years, SOFA score ≥7.5, procalcitonin ≥5.7 ng/ml, lactate ≥3.5 mmol/L, RV-FWS ≥-19.4%, and RV-GS/PASP ≥-0.55 as independent risk factors for poor sepsis outcomes. The prognostic model using these six risk factors had an area under the curve (AUC) of 0.907 (95% CI: 0.858-0.954). Internal validation showed strong nomogram calibration with a C-index of 0.88.</p><p><strong>Conclusion: </strong>The RV-GS/PASP ratio demonstrated significant prognostic utility for predicting clinical outcomes in sepsis patients. Furthermore, the nomogram model incorporating age, SOFA score, procalcitonin, lactate, and RV-FWS exhibited excellent discriminative ability, with an AUC of 0.907.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1532674"},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324960","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 after transcatheter aortic valve replacement in young multimorbid patients as compared to an age-, gender- and comorbidity-matched background population.","authors":"Pernille Steen Bække, Vilhelmas Bajoras, Jawad Butt, Thomas Pilgrim, Nicholas Joseph Montarello, Maurizio Taramasso, Didier Tchetche, Liesbeth Rosseel, Ričardas Kundelis, Kristijonas Česas, Alexander Sedaghat, Jan-Malte Sinning, Rik Adrichem, Mizuki Miura, Magdalena Erlebach, Stephan Windecker, Darren Mylotte, Raj Makkar, Emil Fosbøl, Nicolas Van Mieghem, Ole De Backer","doi":"10.3389/fcvm.2025.1600790","DOIUrl":"10.3389/fcvm.2025.1600790","url":null,"abstract":"<p><strong>Introduction: </strong>Contrary to the current guidelines patients with symptomatic severe aortic stenosis and ≤65 years of age are often referred for transcatheter aortic valve replacement (TAVR). However, the outcome after TAVR in this patient cohort remains unclear.</p><p><strong>Objectives: </strong>This study aimed to assess the rationale for denial of surgical aortic valve replacement (SAVR) in young multimorbid patients referred for TAVR, to evaluate 3-year all-cause mortality and to compare outcomes with a matched control cohort.</p><p><strong>Patients and methods: </strong>Retrospective data were collected on all consecutive patients ≤65 years of age with severe aortic stenosis treated with TAVR at 9 centres between 2010 and 2019. The TAVR-population was compared with a 1:4 age-, gender-, and comorbidity-matched population obtained from the Danish National Registries.</p><p><strong>Results: </strong>The study population consisted of 459 TAVR-recipients and 1,836 matched registry-controls. The main reasons for SAVR denial were prior cardiac surgery (35%), lung disease (30%) and frailty (23%). The 3-year all-cause mortality was 34% in the TAVR-group compared with 8% in the age-, gender- and comorbidity-matched controls with a hazard ratio (HR) of 6.5 (95% CI 4.5-9.6; <i>P</i> < 0.001). Patients undergoing TAVR with an active chronic disease (heart failure, lung disease, dialysis) had a 3-year all-cause mortality HR of 1.8-2.4 compared with controls. Overall, 3-year mortality rates in these distinct TAVR-subgroups were high (30%-50%) irrespective of the underlying condition.</p><p><strong>Conclusions: </strong>Young, multimorbid aortic stenosis patients aged ≤65 years and treated with TAVR between 2010 and 2019 have increased medium-term all-cause mortality compared with an age-, gender- and comorbidity-matched background population.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1600790"},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324959","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":"Case Report: Stepwise noninvasive diagnosis of Takotsubo cardiomyopathy in an elderly patient-From ECG clues to echocardiographic and CTA confirmation.","authors":"Yanling Teng, Xingxing Sun, Minglang Wang, Ziyang Wang, Yilian Wang","doi":"10.3389/fcvm.2025.1608992","DOIUrl":"10.3389/fcvm.2025.1608992","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo cardiomyopathy (TTC) is frequently misdiagnosed as acute coronary syndrome in elderly patients. This case demonstrates how ECG findings facilitate a noninvasive diagnostic algorithm for TTC, validated by echocardiography and coronary computed tomography angiography (CCTA).</p><p><strong>Case summary: </strong>An 88-year-old woman presented with chest tightness and dyspnea after emotional stress (bereavement). Initial ECGs showed the concurrent appearance of ST-segment elevations in anterior (V3-V5) and inferior leads (II, III, aVF), suggesting apical injury and the diagnosis of TTC. Bedside echocardiography revealed apical akinesis with preserved basal contraction (LVEF 35%), while CCTA ruled out obstructive disease. Supportive therapy led to symptom resolution. At 1-year follow-up, LVEF recovered to 61% with normalized ECG.</p><p><strong>Conclusion: </strong>This case highlights ECG's pivotal role in suspecting TTC, enabling a Noninvasive diagnostic approach (echocardiography + CCTA) for elderly patients.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1608992"},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324949","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":"Takotsubo cardiomyopathy associated with <i>Protobothrops mucrosquamatus</i> envenomation: a case report.","authors":"HanDong Wu, KeChun Zhou, XiaoTong Ma","doi":"10.3389/fcvm.2025.1598373","DOIUrl":"10.3389/fcvm.2025.1598373","url":null,"abstract":"<p><strong>Background: </strong><i>Protobothrops mucrosquamatus</i>, commonly known as the Taiwan habu, is a highly venomous snake species. Its venom is rich in haemotoxins and neurotoxins, capable of inducing severe coagulopathy, tissue necrosis, and multi-organ damage. However, to date, there have been no reported cases of Takotsubo cardiomyopathy (TTS) triggered by envenomation from <i>P. mucrosquamatus</i>. TTS is characterised by transient left ventricular dysfunction precipitated by acute stress events and is typified by abnormalities in left ventricular wall motion, often mimicking the clinical presentation of coronary artery disease.</p><p><strong>Case introduction: </strong>This report presents a rare case of Takotsubo cardiomyopathy (TTS) triggered by envenomation from <i>P. mucrosquamatus</i>. Following the snakebite, the patient rapidly developed severe pain and bleeding at the bite site, and subsequently experienced acute chest tightness and chest pain during hospitalisation. To elucidate the aetiology, the patient underwent a series of investigations, including electrocardiography, transthoracic echocardiography, and coronary angiography, which ultimately confirmed the diagnosis of TTS. The patient received comprehensive treatment comprising administration of anti-venom serum to neutralise the venom, fluid resuscitation, and antiplatelet therapy. The clinical condition gradually stabilised, and the patient was eventually discharged in good health.</p><p><strong>Conclusion: </strong><i>Protobothrops mucrosquamatus</i> envenomation may precipitate Takotsubo cardiomyopathy (TTS). Given the considerable overlap in early clinical presentation between TTS and acute myocardial infarction (AMI), early utilisation of echocardiography, coronary angiography, and fractional flow reserve (FFR) assessment is crucial for accurate diagnosis. The cornerstone of treatment lies in the prompt and adequate administration of anti-venom serum, combined with fluid resuscitation and supportive symptomatic care. The judicious use of antiplatelet agents after restoration of coagulation function is generally considered safe and does not significantly increase the risk of bleeding.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1598373"},"PeriodicalIF":2.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Contemporary applications of machine learning and artificial intelligence for the management of heart failure.","authors":"Andre Rodrigues Duraes, Mansueto Gomes-Neto, Edimar Alcides Bocchi","doi":"10.3389/fcvm.2025.1611859","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1611859","url":null,"abstract":"<p><p>Heart failure (HF) is a complex syndrome with substantial clinical and economic impact. This editorial highlights four original articles published in <i>Frontiers in Cardiovascular Medicine</i> that showcase contemporary applications of machine learning and artificial intelligence (AI) in HF management. These studies address early diagnosis through novel biomarkers, disease stratification based on transcriptomics, mechanistic insight into apoptotic pathways, and predictive telemonitoring using real-time AI models. Collectively, these contributions exemplify the transformative potential of data-driven technologies in personalizing care and preventing decompensation in HF. We discuss both the promise and challenges of integrating these tools into routine.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1611859"},"PeriodicalIF":2.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316313","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":"Real-world sex differences in healthcare utilization after cryoballoon ablation: 2-year outcomes from the Cryo Global Registry.","authors":"Surinder Kaur Khelae, Kyoung Ryul Julian Chun, Christian Drephal, Fernando Scazzuso, Fred J Kueffer, Kelly A van Bragt, Thorsten Lawrenz, Derick Todd, Paweł Ptaszyński, Csaba Földesi","doi":"10.3389/fcvm.2025.1549002","DOIUrl":"10.3389/fcvm.2025.1549002","url":null,"abstract":"<p><strong>Introduction: </strong>Cryoballoon ablation (CBA) is a well-established treatment for atrial fibrillation (AF). However, evidence on the impact of sex on outcome is sparse. This real-world analysis aims to describe outcome after CBA in both sexes.</p><p><strong>Methods: </strong>This registry is an ongoing, global evaluation of CBA procedures in standard-of-care practice. Females undergoing CBA were compared to males at baseline and 12-, and 24-months post-ablation. Serious procedure-related adverse event rate, rate of atrial arrhythmia (AA) recurrence, repeat ablation, hospitalization, cardioversion, and quality-of-life (QoL; EQ-5D-3l) were compared.</p><p><strong>Results: </strong>Of 3,089 patients with 12-month follow-up, 1,136 (36.8%) were female; and a subset of 1,099 patients (400 female) were followed through 24 months. Females presented with different comorbidities at baseline. The complication rate was low overall in females (3.9%) and males (2.7%, <i>p</i> = 0.07). At 24-month follow-up, the rate of AA recurrence was 25.0% in females and 22.1% in males and female sex was a predictor of AA recurrence (HR adj = 1.21, <i>p</i> = 0.047) and rehospitalizations (HR adj = 1.25, <i>p</i> = 0.03) in a propensity score adjusted analysis. In addition, females stayed in the hospital longer compared to males during the index ablation procedure (47.9% with 2 or more days in hospital vs. 39.3% in males, <i>p</i> < 0.01), as well as during the first hospital stay post-ablation (78.2% with 2 or more days in hospital vs. 60.2% in males, <i>p</i> < 0.01). QoL improved from baseline to 12 months in females (0.85 ± 0.15-0.90 ± 0.13) and males (0.91 ± 0.13-0.94 ± 0.11) and remained high at 24 months.</p><p><strong>Discussion: </strong>CBA performed according to standard-of-care practice was safe in both sexes. The efficacy of CBA is marginally lower in females, but 75% of females remained free from AA recurrence at 24-months and reported a meaningful improvement in QoL post ablation.</p><p><strong>Systematic review registration: </strong>https://clinicaltrials.gov/ct2/show/NCT02752737, The Cryo Global Registry (NCT02752737).</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1549002"},"PeriodicalIF":2.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316316","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":"Baseline atrial volume indices and major adverse cardiac events following thoracic radiotherapy.","authors":"Edmund M Qiao, John He, Katrina D Silos, Jordan O Gasho, Patrick Belen, Danielle S Bitterman, Elizabeth McKenzie, Jennifer Steers, Christian Guthier, Anju Nohria, Michael T Lu, Hugo J W L Aerts, Andriana P Nikolova, Raymond H Mak, Katelyn M Atkins","doi":"10.3389/fcvm.2025.1560922","DOIUrl":"10.3389/fcvm.2025.1560922","url":null,"abstract":"<p><strong>Introduction: </strong>Patients receiving thoracic radiotherapy (RT) have an increased risk of major adverse cardiac events (MACE) posttreatment. We utilized machine learning (ML) to discover novel predictors of MACE and validated them on an external cohort.</p><p><strong>Methods: </strong>This multi-institutional retrospective study included 984 patients [<i>n</i> = 803 non-small cell lung cancer (NSCLC), <i>n</i> = 181 breast cancer] treated with radiotherapy. Extreme gradient boosting was utilized to discover novel clinical, dosimetric, and anatomical features (CT-based cardiac substructure segmentations) associated with MACE in a cohort of locally advanced NSCLC patients. Fine-Gray regression was performed with non-cardiac death as a competing risk. External validation was performed utilizing independent cohorts of NSCLC or breast cancer patients.</p><p><strong>Results: </strong>In the discovery dataset (<i>n</i> = 701), 70 patients experienced MACE. ML modeling (training AUC, 0.68; testing AUC, 0.71) identified right and left atrial volume indices (RAVI and LAVI, respectively) as top predictors. After adjusting for baseline cardiovascular risk and known radiotherapy predictive factors, RAVI was associated with an increased risk of MACE [subdistribution hazard ratio (sHR) 1.02/unit, 95% confidence interval (CI): 1.00-1.04; <i>p</i> = 0.03]. In the validation cohorts (<i>n</i> = 102 NSCLC; <i>n</i> = 181 breast cancer), RAVI was associated with an increased risk of MACE (NSCLC: sHR 1.05, 95% CI: 1.001-1.106, <i>p</i> = 0.04; breast cancer: sHR 1.06, 95% CI: 1.01-1.11, <i>p</i> = 0.03). Similar findings were found for LAVI.</p><p><strong>Discussion: </strong>ML modeling identified right and left atrial enlargement as novel radiographic predictors for increased risk of MACE following chest radiotherapy, which was validated in independent breast and lung cancer datasets. Given that echocardiography studies have demonstrated the prognostic utility of atrial volume indices across cardiovascular risk groups, these findings warrant further study to identify additional strategies for upfront cardiovascular risk profiling.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1560922"},"PeriodicalIF":2.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316310","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":"An immunostaining-based approach for assessing myocardial viability in the infarcted mouse hearts.","authors":"Weili Ouyang, Xueqing Liu, Zheheng Ding, Yanan Ji, Jianfeng Zhao, Hongtao Zhu, Weidong Wu, Zhaoping Ding","doi":"10.3389/fcvm.2025.1598314","DOIUrl":"10.3389/fcvm.2025.1598314","url":null,"abstract":"<p><strong>Introduction: </strong>With the growing need for reliable and precise detection of cell viability in spatial biology, we introduce an antibody-based staining of cardiac troponin I (cTnI) as a simple yet valuable tool for delineating cardiomyocyte viability in the early stages of myocardial infarction (MI).</p><p><strong>Methods & results: </strong>In circulation, cTnI was found to be the most abundantly released biomarker within the first 24 h after MI. In heart sections, partial depletion of cTnI staining was observed within dying cardiomyocytes as early as 6 h, with almost absence by 24 h despite of preserved membrane integrity. In contrast, staining for other sarcomeric proteins, such as troponin T and <i>α</i>-actinin, remained detectable for several days until immune cells infiltration occurred. We further validated the rapid loss of cTnI staining by cross-verifying <i>in-vivo</i> and <i>ex-vivo</i> measurements. Notably, cTnI-stained sections showed precise overlap with TTC-stained images at the cellular level and showed a highly consistent pattern of cardiomyocyte distribution and infarct area (<i>r</i>² = 0.96) when compared to <i>in-vivo</i> measurements using manganese-enhanced magnetic resonance imaging (MEMRI).</p><p><strong>Conclusion: </strong>These findings highlight the coordinated, stepwise breakdown of sarcomeric proteins following ischemic injury in the mouse heart and underscore the utility of antibody-based cTnI staining as a valuable tool for early myocardial viability assessment and infarct area detection with high spatial resolution.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1598314"},"PeriodicalIF":2.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316309","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}