Frontiers in Cardiovascular Medicine最新文献

{"title":"Pathogenicity assessment of a bicuspid aortic valve-associated <i>ELASTIN</i> variant using a zebrafish model.","authors":"Victor G Bernard, Alexis Théron, Aurélien Drouard, Jean-François Avierinos, Chris Jopling, Stéphane Zaffran, Adèle Faucherre","doi":"10.3389/fcvm.2026.1851376","DOIUrl":"10.3389/fcvm.2026.1851376","url":null,"abstract":"<p><strong>Introduction: </strong>Bicuspid aortic valve (BAV) is one of the most common congenital heart defects but its genetic basis remains incompletely defined. Extracellular matrix components play key roles in outflow tract (OFT) and valve development, but their contribution to BAV is not fully established. Following the analysis of a cohort of BAV patients, we identified a family harbouring a rare human ELASTIN (ELN) variant (p.Gln691X). Here, we investigated the pathogenicity of this variant using an in vivo zebrafish model.</p><p><strong>Methods: </strong>We generated a zebrafish elna/b double knockout (KO) using an RNAless CRISPR Cas9 strategy to avoid genetic compensation. Cardiovascular morphology and function were assessed in mutant embryos. To evaluate pathogenicity of the human ELN p.Gln691X variant, mutant and control embryos were rescued by mRNA injection encoding either WT human ELN or the p.Gln691X variant.</p><p><strong>Results: </strong>elna/b double KO zebrafish exhibited cardiovascular defects including OFT anomalies, reduced stroke volume and dysmorphic aortic valves, highlighting Elastin's critical role in cardiac development. We then used this model to test the ELN variant identified in the BAV family. We found that wild-type ELN mRNA was able to restore normal cardiac function and morphology, whereas the variant ELN mRNA failed to do so.</p><p><strong>Discussion: </strong>Our study establishes a robust in vivo model to assess ELN variant pathogenicity and provides evidence linking ELASTIN to BAV, opening new avenues for uncovering the genetic mechanisms underlying BAV.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1851376"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179995","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":"A novel morphological assessment approach for abdominal aortic aneurysms: automated segmentation and measurement using a semi-supervised deep learning algorithm.","authors":"Guangkuo Wang, Jingyi Zeng, Min Li, Fang Li, Shangqian Li, Zhigang Zhang","doi":"10.3389/fcvm.2026.1956738","DOIUrl":"10.3389/fcvm.2026.1956738","url":null,"abstract":"<p><strong>Background: </strong>Morphological assessment of abdominal aortic aneurysm (AAA) is crucial for preoperative strategy formulation, but traditional manual assessment is time-consuming and subjective.</p><p><strong>Objectives: </strong>This study aims to develop a novel semi-supervised deep learning (DL) framework for the automatic and accurate segmentation and measurement of AAA.</p><p><strong>Methods: </strong>In this study, a semi-supervised learning algorithm was developed based on computed tomography angiography scans collected retrospectively from 88 AAA patients. The algorithm employed 16 labeled cases for supervised training and incorporated 47 unlabeled cases through consistency regularization to achieve accurate segmentation of the AAA lumen, aneurysm neck, and iliac arteries. To evaluate the model's segmentation performance, the Dice similarity coefficient (DSC) and 95% Hausdorff distance (HD95) were utilized, and the agreement between automatically derived measurements and manual annotations was assessed.</p><p><strong>Results: </strong>Among the models evaluated, Swin-UNETR achieved the best segmentation performance with 97.3% accuracy. The DSC was 0.965 ± 0.025 and 0.931 ± 0.021, and HD95 was 2.01 ± 0.39 mm and 2.93 ± 0.28 mm in the internal and independent test sets, respectively. Automation and expert measurements showed generally good-to-excellent agreement based on intraclass correlation coefficient (ICC) analysis. In addition, average time per case decreased from 53.08 ± 8.17 to 4.18 ± 0.90 min, mouse movement distance from 91.62 ± 9.95 to 13.03 ± 3.12 m, and clicks from 672.62 ± 129.47 to 157.69 ± 0.90 times (all <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>The proposed Swin-UNETR algorithm enables fast, reliable, and reproducible automated segmentation and measurement of key anatomical details of AAA.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1956738"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180486","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":"Apolipoprotein B in cardiovascular risk assessment: beyond traditional lipid markers.","authors":"Lingling Li, Yixuan Feng, Xiaoya Li, Zongliang Yu, Changxin Sun, Lanqing Hu, Kaidong Zhou, Xinyi Liu, Yongfang Yuan, Liang Li, Min Wu, Longtao Liu","doi":"10.3389/fcvm.2026.1857230","DOIUrl":"10.3389/fcvm.2026.1857230","url":null,"abstract":"<p><p>Apolipoprotein B (ApoB) serves as the structural backbone of triglyceride (TG)-rich lipoproteins and low-density lipoprotein (LDL) particles and plays a key role in lipid transport. A growing body of evidence indicates that circulating ApoB levels are closely associated with the development of cardiovascular diseases such as coronary atherosclerosis, and ApoB may be one of the most accurate markers for assessing atherosclerotic cardiovascular disease (ASCVD) risk. This review discusses the limitations of conventional lipid measures, including low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TG), and systematically examines the advantages of ApoB as an alternative marker for cardiovascular risk assessment, as well as its independent predictive value. In addition, this review discusses the clinical utility, potential advantages, and challenges associated with ApoB, as well as the effects of currently available lipid-lowering therapies on ApoB and recent advances in the development of ApoB-targeted therapies, with the aim of informing more precise strategies for the prevention and treatment of cardiovascular disease.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1857230"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180493","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":"4D-Micro: a tiered, testable framework for hemodynamic-tissue perfusion mismatch in cardiac surgery.","authors":"Budanbaila La, Yanyan Bai, Yiri Du, Yi Qiu, Ling Wang","doi":"10.3389/fcvm.2026.1964275","DOIUrl":"10.3389/fcvm.2026.1964275","url":null,"abstract":"<p><p>Organ dysfunction can develop after cardiac surgery even when mean arterial pressure, cardiac output, hemoglobin, temperature, and pump flow meet conventional targets. These variables remain the safety foundation, but they do not directly establish exchange-capable capillary flow or cellular oxygen use. We propose 4D-Micro, an unvalidated conceptual framework organized around four necessary functions: barrier and conduit integrity, perfusion driving, hemorheology, and cellular oxygen use. The framework was formalized from a recurrent clinical reasoning problem through targeted evidence mapping and explicit construction rules; it was not derived from a new patient dataset or statistical latent-variable analysis. 4D-Micro separates where recovery is discordant from the provisional mechanism that might explain it, then uses a prespecified proximal response and stopping boundary to update that explanation. It is not a substitute for established cardiac surgical monitoring or a claim that all four domains can be measured directly at the bedside. A tiered implementation distinguishes a core mode based on routine variables, an enhanced mode using regional and congestion signals, and a research mode using direct microvascular or biomarker measurements. Insufficient or conflicting data remain indeterminate rather than being forced into a phenotype. We specify a staged validation pathway: content and feasibility testing, prospective assessment of classification reliability and construct validity, and only then a pragmatic comparison with protocolized usual hemodynamic care. The framework should be narrowed or rejected if it cannot be applied reliably, its predicted responses are not observed, or it fails to improve decision processes without added harm.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1964275"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180436","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":"GLP-1-Based therapies for obesity-related heart failure with preserved ejection fraction: an umbrella review incorporating broader heart failure and cardiometabolic evidence.","authors":"Qiang Li, Tianyi Yang, Guannan Jin, Yabin Zhou","doi":"10.3389/fcvm.2026.1930278","DOIUrl":"10.3389/fcvm.2026.1930278","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The cardiometabolic phenotype of obesity-related heart failure with preserved ejection fraction (HFpEF) is increasing in clinical prevalence. Existing systematic reviews and meta-analyses have primarily summarized efficacy estimates for glucagon-like peptide-1 (GLP-1)-based therapies, but the credibility and independence of these syntheses remain uncertain because methodological limitations and overlap in primary trials have not been systematically evaluated. This umbrella review therefore appraised the methodological quality, overlap, consistency, and robustness of the existing review-level evidence rather than generating another efficacy synthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted an umbrella review of systematic reviews, meta-analyses, and network meta-analyses evaluating GLP-1-based regimens in obesity-related HFpEF and adjacent cardiometabolic populations. PubMed, Embase, Web of Science, and the Cochrane Library were searched over the preceding decade. The systematic review or meta-analysis was the unit of analysis. Methodological quality was assessed with AMSTAR 2, and overlap of primary studies across reviews was quantified using the corrected covered area (CCA). No &lt;i&gt;de novo&lt;/i&gt; meta-analysis was performed; primary trials were examined only to assess overlap and calculate the CCA. Review-level findings were synthesized according to effect direction, consistency, precision, sample size, methodological quality, clinical relevance, and overlap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventeen systematic reviews underwent qualitative profiling, of which 11 reported quantitative estimates relevant to the core review-level synthesis. For heart failure hospitalization, the review by Diallo et al. reported HR 0.78 (95% CI 0.73-0.84; &lt;i&gt;n&lt;/i&gt; = 25,440). For the composite of cardiovascular death and heart failure hospitalization, Diallo et al. reported HR 0.84 (95% CI 0.78-0.89), Ahmed HM et al. reported HR 0.76 (95% CI 0.64-0.90), and Ahmed M et al. reported RR 0.73 (95% CI 0.57-0.93). Existing reviews also consistently suggested improvements in functional status. The review by Gera et al. reported OR 0.85 (95% CI 0.77-0.93; &lt;i&gt;n&lt;/i&gt; = 85,373) for stroke, whereas findings for cardiovascular and all-cause mortality remained inconsistent. Evidence for major adverse cardiovascular events was limited; the review by Gonzales-Uribe et al. reported HR 0.71 (95% CI 0.60-0.86). AMSTAR 2 classified six reviews as having low overall methodological confidence and five as having critically low overall methodological confidence. The CCA was 13.2%, indicating high overlap. All HR, RR, and OR values were estimates reported by included reviews and were not recalculated or quantitatively combined in this umbrella review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;At the level of existing evidence syntheses, GLP-1-based therapies appear most consistently associated with fewer heart failure hospitalizations and improved functional capac","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1930278"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180499","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 linear association between pulse pressure and diabetic retinopathy: a cross-sectional study.","authors":"Jinli He, Juan Ling, Xinlin Chen, Lina Zhang","doi":"10.3389/fcvm.2026.1918226","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1918226","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the relationship between pulse pressure (PP) and the prevalence of diabetic retinopathy (DR) in individuals diagnosed with type 2 diabetes mellitus.</p><p><strong>Methods: </strong>This research is a secondary analysis of a cross-sectional study conducted between April 2002 and November 2004, which included 2,001 adults with diabetes mellitus (859 men and 1,142 women, mean age 64.1 ± 11.3 years) recruited from outpatient clinics in southern Taiwan. Comprehensive demographic and clinical data were collected, defining pulse pressure as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) measured in mmHg. The association between PP and DR was assessed using multivariable logistic regression, adjusting for potential confounders, and a generalized additive model (GAM) was utilized to explore non-linear relationships.</p><p><strong>Results: </strong>Elevated PP levels were consistently associated with higher odds of prevalent DR across progressively adjusted models. When PP was modeled per 10-mmHg increment, the association remained significant in Model 1 (OR 1.16; 95% CI 1.09-1.23; <i>P</i> < 0.0001), Model 2 (OR 1.13; 95% CI 1.06-1.21; <i>P</i> = 0.0002), and Model 3 (OR 1.09; 95% CI 1.02-1.17; <i>P</i> = 0.0136). When analyzed by tertiles, the middle tertile (50-61 mmHg) showed significant associations in the unadjusted model (OR 1.31; 95% CI 1.04-1.66; <i>P</i> = 0.0218) that diminished upon full adjustment (OR 1.19; 95% CI 0.92-1.52; <i>P</i> = 0.1828). In contrast, the high tertile (62-136 mmHg) maintained a significant association after adjustments (Model 1: OR 1.82; 95% CI 1.44-2.29; <i>P</i> < 0.0001; Model 3: OR 1.47; 95% CI 1.13-1.91; <i>P</i> = 0.0039).</p><p><strong>Conclusions: </strong>This study indicates higher PP was associated with higher odds of prevalent DR in individuals with type 2 diabetes.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1918226"},"PeriodicalIF":3.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192681","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 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}