Frontiers in Cardiovascular Medicine最新文献

{"title":"The association of non-exercise estimated cardiorespiratory fitness with hypertension and all-cause mortality in American and Chinese populations: evidence from NHANES and CHARLS.","authors":"Mo-Yao Tan, Ping Zhang, Si-Xuan Zhu, Shan Wu, Ming Gao","doi":"10.3389/fcvm.2025.1497292","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1497292","url":null,"abstract":"<p><strong>Background: </strong>The Non-Exercise Estimated Cardiorespiratory Fitness (NEE-CRF) method has gained attention in recent years due to its simplicity and effectiveness. Hypertension and all-cause mortality are significant public health issues worldwide, highlighting the importance of exploring the association between NEE-CRF and these two conditions.</p><p><strong>Methods: </strong>The data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS) were utilized to validate the association between NEE-CRF and hypertension as well as all-cause mortality. NEE-CRF was calculated using a sex-specific longitudinal non-exercise equation. To investigate the relationship between hypertension and all-cause mortality, multivariable regression analysis, generalized additive models, smooth curve fittings, and threshold effect analysis were employed. Logistic regression was used for hypertension analysis, while Cox proportional hazards regression was applied for all-cause mortality. Additionally, we conducted stratified analyses and interaction tests among different groups.</p><p><strong>Results: </strong>In the NHANES, after fully adjusting for covariates, each unit increase in NEE-CRF was associated with a 24% reduction in the risk of hypertension (OR: 0.76, 95% CI: 0.74-0.78) and a 12% reduction in the risk of all-cause mortality (HR: 0.88, 95% CI: 0.79-0.86). Subgroup analyses showed that the relationship between NEE-CRF and both hypertension and all-cause mortality remained negatively correlated across different subgroups. The negative association was also validated in the CHARLS.</p><p><strong>Conclusions: </strong>Higher NEE-CRF levels may reduce the risk of developing hypertension and all-cause mortality.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1497292"},"PeriodicalIF":2.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976577","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 ADO-II percutaneous occlusion and traditional surgery in the treatment of doubly committed subarterial ventricular septal defects in children.","authors":"Bei Tan, Mi Li, Kaijun Zhang, Xue Zhou, Qiuyue Ao, Dan Yin, Zhenli Cheng, Ping Xiang","doi":"10.3389/fcvm.2025.1541796","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1541796","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to evaluate the efficacy and safety of ADO-II percutaneous occlusion and traditional open-chest surgery for treating doubly committed subarterial ventricular septal defect (dcVSD) in children.</p><p><strong>Methods: </strong>The clinical data of 151 children with dcVSD treated at Chongqing Medical University Affiliated Children's Hospital between July 2019 and May 2024 were retrospectively analyzed. Patients were divided into a transcatheter group (percutaneous occlusion) and a surgical group (open-chest repair) on the basis of the treatment method used. Key evaluation metrics included procedural success rates, complication rates, and perioperative management parameters.</p><p><strong>Results: </strong>Occlusion technical success was 94.9% (37/39) in the interventional sample of 39 patients. The 112 surgical patients had a 100% technical success rate. Three interventional patients had sinus rhythm before discharge, and 2 of 18 surgical patients had residual right bundle branch block at the last follow-up. The mild aortic valve prolapse of 115 individuals (76.2%) improved to varied degrees postoperatively. Of 96 individuals with preoperative aortic regurgitation, 83 exhibited no change, 49 improved, 17 developed new regurgitation, and two worsened. The two groups differed significantly in postoperative hospital stay, time to independent ambulation, operative time, mechanical ventilation, blooding amount, Blood transfusion volume, Fever within 72 h after operation, pulmonary infections, intravenous nutrition, antibiotic use, and hospitalization cost (all <i>p</i> < 0.05). There no serious problems were recorded the transcatheter group, including device dislodgement, cardiac or vascular perforation, death, or hemolysis. In the surgical group, one patient had residual shunting reoperation and another had infective endocarditis.</p><p><strong>Conclusion: </strong>Children with dcVSD can recover faster and safer using ADO-II percutaneous occlusion, which is minimally invasive and inexpensive. It can be the first-line treatment for selected patients.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1541796"},"PeriodicalIF":2.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990752","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":"Coronary microcirculation dysfunction causing ischemia with non-obstructive coronary arteries: a case report.","authors":"Wei Qi, Yazheng Zhang, Le Wang, Kai Hou, Ting Li, Jiachun Lang, Hongliang Cong","doi":"10.3389/fcvm.2025.1556064","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1556064","url":null,"abstract":"<p><p>The study presents a case of INOCA attributed to CMVD in a 53-year-old male patient experiencing exertional angina, despite the absence of significant coronary artery stenosis on angiography. The patient presented with reversible myocardial ischemia detected by myocardial perfusion imaging, with an ischemic area accounting for 12% of the left ventricular wall. Diagnostic tests revealed an elevated index of microcirculatory resistance (IMR = 46.3) and a quantitative flow ratio (QFR = 0.94), confirming CMVD. Genetic testing identified a NOTCH1 c.3862G>A variant in the proband and some family members, suggesting a potential contribution to CMVD pathogenesis through impaired vascular remodeling and microcirculatory regulation. After six months of targeted treatment with nicorandil, coenzyme Q10, trimetazidine, and rosuvastatin, the patient's symptoms resolved, and myocardial ischemia reversed. While an MYH7 variant was also detected, its clinical relevance was ruled out due to the family's absence of associated cardiomyopathy phenotypes. The NOTCH1 gene may play a potential role in INOCA caused by CMVD, however, further research is needed to elucidate its underlying regulatory mechanisms. The findings provide a foundation for precise diagnosis and personalized management of INOCA.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1556064"},"PeriodicalIF":2.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991085","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":"Influence of Zhigancao decoction on chronic heart failure combined with depression.","authors":"Ying Wang, Jun Wang, Wang Lv, Hu Chen, Yang Zhang, Qian Yang, Xiaoli Ma, Run Guo, Qianyu Zhang","doi":"10.3389/fcvm.2025.1538940","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1538940","url":null,"abstract":"<p><p>Chronic heart failure (CHF) combined with depression represents a significant clinical challenge due to the mutual exacerbation of physical and psychological symptoms. This study investigated the therapeutic effects of Zhigancao decoction, a traditional Chinese medicine, in combination with conventional Western treatments in patients with CHF and depression. A total of 122 patients were enrolled and divided into two groups: a control group receiving standard Western treatment, and an observation group receiving Zhigancao decoction in addition to conventional therapy. Outcomes were assessed by evaluating the clinical efficacy, cardiac function, inflammatory markers, depressive symptoms, and quality of life. The Zhigancao decoction group exhibited significantly higher efficacy rates, improved left ventricular ejection fraction (LVEF), reduced levels of inflammatory markers [N-terminal pro-brain natriuretic peptide (NT-proBNP), matrix metalloproteinase-9 (MMP-9), and high-sensitivity C-reactive protein (hs-CRP)], and lower scores on depression scales, compared to the control group. Furthermore, the quality of life significantly improved in the Zhigancao decoction group. These findings underscore the potential of Zhigancao decoction as an effective adjunct to conventional treatments for managing CHF combined with depression, offering a holistic approach that integrates physical and mental health improvements.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1538940"},"PeriodicalIF":2.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002924","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":"Identification of signature genes and subtypes for heart failure diagnosis based on machine learning.","authors":"Yanlong Zhang, Yanming Fan, Fei Cheng, Dan Chen, Hualong Zhang","doi":"10.3389/fcvm.2025.1492192","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1492192","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a multifaceted clinical condition, and our comprehension of its genetic pathogenesis continues to be significantly limited. Consequently, identifying specific genes for HF at the transcriptomic level may enhance early detection and allow for more targeted therapies for these individuals.</p><p><strong>Methods: </strong>HF datasets were acquired from the Gene Expression Omnibus (GEO) database (GSE57338), and through the application of bioinformatics and machine-learning algorithms. We identified four candidate genes (<i>FCN3</i>, <i>MNS1</i>, <i>SMOC2</i>, and <i>FREM1</i>) that may serve as potential diagnostics for HF. Furthermore, we validated the diagnostic value of these genes on additional GEO datasets (GSE21610 and GSE76701). In addition, we assessed the different subtypes of heart failure through unsupervised clustering, and investigations were conducted on the differences in the immunological microenvironment, improved functions, and pathways among these subtypes. Finally, a comprehensive analysis of the expression profile, prognostic value, and genetic and epigenetic alterations of four potential diagnostic candidate genes was performed based on The Cancer Genome Atlas pan-cancer database.</p><p><strong>Results: </strong>A total of 295 differential genes were identified in the HF dataset, and intersected with the blue module gene with the highest correlation to HF identified by weighted correlation network analysis (<i>r</i> = 0.72, <i>p</i> = 1.3 × 10^-43), resulting in a total of 114 key HF genes. Furthermore, based on random forest, least absolute shrinkage and selection operator, and support vector machine algorithms, we finally identified four hub genes (<i>FCN3</i>, <i>FREM1</i>, <i>MNS1,</i> and <i>SMOC2</i>) that had good potential for diagnosis in HF (area under the curve > 0.7). Meanwhile, three subgroups for patients with HF were identified (C1, C2, and C3). Compared with the C1 and C2 groups, we eventually identified C3 as an immune subtype. Moreover, the pan-cancer study revealed that these four genes are closely associated with tumor development.</p><p><strong>Conclusions: </strong>Our research identified four unique genes (<i>FCN3</i>, <i>FREM1</i>, <i>MNS1</i>, and <i>SMOC2</i>), enhancing our comprehension of the causes of HF. This provides new diagnostic insights and potentially establishes a tailored approach for individualized HF treatment.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1492192"},"PeriodicalIF":2.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991092","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":"Current hotspot and study trend of transcatheter aortic valve replacement, a bibliometric analysis from 2009 to 2023.","authors":"Ping Lai, Dekuan Zhang, Jin-Hua Xue, Shuquan Xu, Kejun Tian, Hong-Zhou Zhang, Bei Wang, Yi-Ming Zhong, Yong-Ling Liao","doi":"10.3389/fcvm.2025.1411561","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1411561","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter aortic valve replacement (TAVR), alternatively termed transcatheter aortic valve implantation (TAVI), represents a seminal advancement in cardiovascular interventions by obviating the necessity for open-heart surgery traditionally associated with surgical aortic valve replacement (SAVR). This technique entails percutaneous delivery of a bioprosthetic valve. Despite the surfeit of literature on TAVR over the past fifteen years, a bibliometric analysis is conspicuously absent.</p><p><strong>Method: </strong>A query executed on the Web of Science Core Collection (WoSCC) on September 1, 2022, returned 8,359 articles and reviews pertinent to TAVR. Data interpretation leveraged Microsoft Excel, CiteSpace, and VOSviewer to illustrate trends and delineate focal points within the corpus of TAVR research.</p><p><strong>Result: </strong>The analysis incorporated 8,359 articles and reviews on TAVR from January 1, 2009, to August 1, 2023. Publication volume expanded from 35 in 2009 to a pinnacle in 2020, reflecting a near thirty folds increase, with citations escalating from 56 in 2009 to 27,354 in 2021. The United States prevailed in scholarly output (Np = 3,015), citation frequency (Nc = 70,991, excluding self-citations), and academic impact (H-index = 120). Columbia University was distinguished by the highest number of publications (Np = 380), citations (Nc = 41,051), and H-index (84). Within the author community, Rodes-Cabau J was preeminent, with 260 publications and an equivalent citation index and H-index. Keywords such as \"balloon-expandable valve,\" \"coronary access,\" \"next-day discharge,\" \"conducti on disturbances,\" and \"coronary obstruction\" have surfaced as the lexicon of burgeoning research themes.</p><p><strong>Conclusion: </strong>Investigation into TAVR has emerged as a major area of scholarly focus. The United States stands at the forefront of this research. Columbia University ranks as the preeminent institution in terms of publication output. Key research themes such as \"balloon-expandable valve,\" \"coronary access,\" and \"coronary obstruction\" are shaping up as current and prospective research hotspots, signaling potential areas for future study and innovation.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1411561"},"PeriodicalIF":2.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992099","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":"Related factors affecting misdiagnosis of aortic dissection: a single-center retrospective study.","authors":"Sheng Wang, Liu Yang, Tao Hu, Hui Deng, Weiling Tu, Yijie Wu, Linfeng Li","doi":"10.3389/fcvm.2025.1561225","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1561225","url":null,"abstract":"<p><strong>Objective: </strong>Aortic dissection (AD) is a life-threatening cardiovascular emergency. Delayed diagnosis frequently leads to treatment delays, elevated mortality, and complications. This study investigates the factors contributing to the misdiagnosis of AD and proposes strategies for improving its early diagnosis.</p><p><strong>Methods: </strong>A retrospective analysis of 801 patients with AD identified 219 cases for inclusion, which were split into a training set (131 cases) and a validation set (88 cases). A binary logistic regression model was used to identify factors influencing misdiagnosis, while a Nomogram prediction model was developed.</p><p><strong>Results: </strong>The analysis revealed that factors such as the timing and suddenness of symptom onset, typical back pain, walk-in clinic visits, and laboratory results (D-dimer, fibrinogen, and white blood count) were significant in predicting misdiagnosis. The Nomogram model showed high predictive accuracy with an Area under the ROC curve (AUC) of 0.924 in the training set and 0.912 in the validation set, demonstrating good sensitivity and specificity.</p><p><strong>Conclusion: </strong>The model offers potential for improving diagnostic accuracy and clinical outcomes in AD cases.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1561225"},"PeriodicalIF":2.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995903","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":"Surgical and transcatheter aortic valve replacement align survival with general population expectations: insights from standardized mortality ratios.","authors":"Marin Boute, David De Azevedo, Christophe de Terwangne, Anne-Catherine Pouleur, Agnès Pasquet, Bernhard L Gerber, Laurent de Kerchove, Christophe Beauloye, Joëlle Kefer, Frédéric Maes, Sophie Pierard, David Vancraeynest","doi":"10.3389/fcvm.2025.1547456","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1547456","url":null,"abstract":"<p><strong>Background: </strong>Comparative long-term survival outcomes between transcatheter (TAVR) and surgical (SAVR) aortic valve replacement remain debated. While randomized controlled trials support TAVR's non-inferiority, real-world data indicate the opposite. Comparing SAVR and TAVR patients with matched reference populations may reduce bias from direct comparisons. We compared the 5-year overall survival rates of SAVR, non-frail TAVR, and frail TAVR patients with those of matched general population standards.</p><p><strong>Methods: </strong>All patients who underwent bioprosthetic SAVR or TAVR at a tertiary hospital from 2012 to 2021 were included. Based on intervention type and Clinical Frailty Scale, patients were divided into three groups: SAVR, non-frail TAVR, and frail TAVR. Survival was compared to individual-level age- and sex-matched general population data using standardized mortality ratios (SMRs).</p><p><strong>Results: </strong>The cohort included 939 SAVR, 328 non-frail TAVR, and 121 frail TAVR patients, with mean ages of 73.6, 85.3, and 85.6 years, and median EuroSCORE II values of 1.9%, 4.0%, and 5.2%, respectively. SAVR and non-frail TAVR patients had survival rates comparable to those of the reference population [SMR = 0.93 [0.76-1.14]; <i>p</i> = 0.437 and SMR = 0.94 [0.76-1.15]; <i>p</i> = 0.468]. Conversely, frail TAVR patients faced a 40% increased mortality risk compared with their reference population [SMR = 1.40 (1.04-1.88); <i>p</i> = 0.012].</p><p><strong>Conclusions: </strong>In non-frail patients, TAVR and SAVR both restore life expectancy to general population standards. For frail TAVR patients, the lower survival rate highlights frailty's important prognostic impact and underlines the ongoing challenge of refining patient selection to avoid futility.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1547456"},"PeriodicalIF":2.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008811","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 image quality of coronary CT angiography with and without ECG-gating in wide-detector CT.","authors":"Kun Wang, Yueqiao Zhang, Bin Chen, Hong Ren","doi":"10.3389/fcvm.2025.1570743","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1570743","url":null,"abstract":"<p><strong>Objective: </strong>To compare the image quality, radiation dose, and examination time between non-electrocardiogram (ECG)-gated coronary CT angiography (ECG-less CCTA) and conventional ECG-gated CCTA using wide-detector CT, and validate its clinical applicability.</p><p><strong>Methods: </strong>In this prospective study, 109 patients with suspected coronary artery disease were divided into ECG-less (Group A, <i>n</i> = 59) and ECG-gated (Group B, <i>n</i> = 50) groups. Objective metrics (CT attenuation, noise, SNR, CNR), subjective image quality (4-point scale), and examination time were analyzed. Diagnostic performance (sensitivity, specificity) was evaluated against invasive coronary angiography (ICA). A modified ECG-less protocol (Group A2, <i>n</i> = 30) was implemented to optimize radiation dose. Plaque characterization agreement was assessed using Cohen's <i>κ</i>.</p><p><strong>Results: </strong>The ECG-less group demonstrated higher radiation dose (2.83 ± 0.93 vs. 1.90 ± 1.41 mSv, <i>p</i> < 0.001) but significantly shorter examination time (225.03 ± 33.37 vs. 330.06 ± 56.35 s, <i>p</i> < 0.001). The modified ECG-less protocol reduced the effective dose by 28% (2.03 ± 0.75 mSv, <i>p</i> < 0.001 vs. Group A), achieving statistical comparability to the conventional group (<i>p</i> = 0.62). Subjective image scores (4-point scale) and SNR/CNR showed no significant differences between groups (<i>p</i> > 0.05). ECG-less CCTA achieved per-segment sensitivity/specificity of 93.3%/97.5% and per-patient 94.4%/50% for detecting ≥50% stenosis. Plaque characterization exhibited high agreement (calcified: <i>κ</i> = 0.82; non-calcified: <i>κ</i> = 0.78; mixed: <i>κ</i> = 0.75).</p><p><strong>Conclusion: </strong>ECG-less CCTA provides comparable image quality and diagnostic accuracy to conventional ECG-gated CCTA while significantly reducing examination time. This technique is applicable in emergency scenarios where ECG lead placement is unfeasible (e.g., severe trauma, unreliable ECG signals).</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1570743"},"PeriodicalIF":2.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999564","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":"Synthetic fibrosis distributions for data augmentation in predicting atrial fibrillation ablation outcomes: an <i>in silico</i> study.","authors":"Alexander M Zolotarev, Kiane Johnson, Yusuf Mohammad, Omnia Alwazzan, Gregory Slabaugh, Caroline H Roney","doi":"10.3389/fcvm.2025.1512356","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1512356","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac fibrosis influences atrial fibrillation (AF) progression and ablation outcomes, with late gadolinium enhancement (LGE) MRI providing a non-invasive tool to measure fibrosis distributions. While deep learning (DL) has shown promise in predicting ablation success, training such pipelines is limited by the availability of real patient data.</p><p><strong>Methods: </strong>In this study, we generated synthetic fibrosis distributions using a denoising diffusion probabilistic model trained on a collection of 100 real LGE-MRI distributions. We incorporated them into 1,000 bi-atrial meshes derived from a statistical shape model and simulated AF episodes on them before and after various ablation strategies to expand the training dataset for DL-based outcome prediction. Our approach aims to improve the predictive performance of the DL pipeline by enhancing dataset diversity and better-capturing patient variability.</p><p><strong>Results: </strong>We showed that the fibrosis distributions generated by the diffusion model closely resemble real LGE-MRI distributions, based on metrics such as mean intensities ( <math><mn>1.1</mn> <mo>±</mo> <mn>0.2</mn></math> vs. <math><mn>1.1</mn> <mo>±</mo> <mn>0.3</mn></math> ) and average Shannon entropy ( <math><mn>0.77</mn> <mo>±</mo> <mn>0.06</mn></math> and <math><mn>0.81</mn> <mo>±</mo> <mn>0.03</mn></math> ). AF biophysical simulations can be effectively conducted on bi-atrial meshes incorporating these synthetic distributions. Training the deep learning pipeline on these simulations produces performance metrics comparable to those achieved with real LGE-MRI distributions (ROC-AUC <math><mo>=</mo></math> 0.952 vs. 0.943).</p><p><strong>Conclusion: </strong>We have shown the ability of synthetic fibrosis distributions to be a data augmentation tool for deep learning classification of outcomes of various ablation strategies, which may enable rapid and precise assessment of atrial fibrillation treatment strategies.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1512356"},"PeriodicalIF":2.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976587","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}