Cardiology Research最新文献

{"title":"Progressive Shifts in Oral Plaque Microbiota From Health to Coronary Artery Disease and Acute Myocardial Infarction.","authors":"Han-Lin Tsai, Yung-Ping Chen, Jia-Ying Tsai, Chih-Yen Yep, Chao-Wen Tan, Chi-Pin Lee, Chun-Yu Wu, Tzu-Hsien Tsai","doi":"10.14740/cr2232","DOIUrl":"10.14740/cr2232","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence links oral microbial dysbiosis to atherosclerotic cardiovascular disease (ASCVD), yet its role in acute myocardial infarction (AMI) and the transition from stable coronary artery disease (CAD) to acute events remains unclear. We aimed to characterize taxonomic and functional alterations of the oral plaque microbiome across cardiovascular health states and explore their clinical relevance.</p><p><strong>Methods: </strong>We enrolled 60 age- and sex-matched adults, 20 in each group. Supragingival plaque underwent 16S rRNA sequencing and functional inference. Alpha and beta diversity were assessed, and differential features were identified by Linear Discriminant Analysis Effect Size (LEfSe). The metabolic pathway predictions were using Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway.</p><p><strong>Results: </strong>Alpha and beta diversity showed no significant differences in overall microbial richness, evenness, or global community structure among groups. However, marked taxonomic shifts were observed. AMI patients exhibited enrichment of pro-inflammatory genera (<i>Veillonella</i>, <i>Porphyromonas</i>, <i>Dialister</i>, <i>Megasphaera</i>, and <i>Acidaminococcus</i>) and depletion of commensal taxa (<i>Haemophilus</i> and <i>Lautropia</i>). LEfSe identified disease-specific microbial signatures distinguishing healthy control, CAD, and AMI. Functional prediction revealed enrichment of arachidonic acid, pyrimidine, and D-glutamine/D-glutamate metabolism in CAD, with further increases in necroptosis-, proteasome-, and inflammation-related pathways in AMI, whereas two-component signaling systems were enriched in healthy controls.</p><p><strong>Conclusions: </strong>The oral microbiome exhibits progressive taxonomic and functional shifts from health to CAD and AMI, supporting an oral-cardiovascular axis and highlighting oral microbial profiles as potential noninvasive biomarkers for ASCVD risk stratification.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"288-299"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Autonomic Dysfunction in Cancer Therapy: Clinical Manifestations and Management.","authors":"Tyler Abram Kilgore, Sruthi Vellanki, Sravya Vellanki, Jeffrey Curran Henson, Srikanth Vallurupalli","doi":"10.14740/cr2242","DOIUrl":"10.14740/cr2242","url":null,"abstract":"<p><p>Cardiovascular autonomic dysfunction is an underrecognized manifestation of cancer therapy-related cardiotoxicity with important clinical implications. Disruption of autonomic regulation during chemotherapy most commonly manifests as orthostatic hypotension, inappropriate sinus tachycardia, and reduced heart rate variability, often occurring in the absence of overt structural heart disease. These abnormalities may contribute to symptom burden, impaired functional capacity, and increased cardiovascular risk in patients undergoing cancer treatment. Emerging data indicate that autonomic dysfunction in this setting may be modifiable. Among available interventions, structured exercise programs demonstrate the strongest and most consistent improvements in autonomic indices, alongside established benefits in functional capacity, fatigue, and quality of life. Relaxation and mindfulness-based interventions, including yoga, offer low-risk adjunctive benefits, whereas cryotherapy remains exploratory. Pharmacologic therapies play a symptom-directed role, particularly for orthostatic hypotension, but are often constrained by comorbid cardiovascular disease and limited oncology-specific evidence. This review evaluates current evidence on the clinical manifestations and therapeutic strategies for chemotherapy-associated cardiovascular autonomic dysfunction, highlighting opportunities to improve patient-centered outcomes in cardio-oncology care.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"267-276"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Biomarker Bedside Risk Scores for One-Year Mortality After Acute Heart Failure Hospitalization.","authors":"Duc Khanh Nguyen, Thanh Tuan Tran, Cao Cuong Tran","doi":"10.14740/cr2241","DOIUrl":"10.14740/cr2241","url":null,"abstract":"<p><strong>Background: </strong>Simple bedside scores may support risk stratification after acute heart failure hospitalization, particularly during post-discharge follow-up when biomarker testing or complete registry-derived variables may be unavailable. We evaluated non-biomarker bedside risk scores for 1-year all-cause mortality after acute heart failure hospitalization in Vietnam.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 497 adults hospitalized for acute heart failure at Cho Ray Hospital, Vietnam, between January and August 2021, with post-discharge outpatient follow-up and 1-year vital status ascertainment. This was a pragmatic evaluation of simplified bedside/domain scores constructed from routine clinical variables, not a formal external validation of the original GWTG-HF (Get With The Guidelines-Heart Failure) or OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) equations. The primary score was an a priori-expanded eight-item, non-biomarker score including age, New York Heart Association class, systolic blood pressure, heart rate, serum sodium, serum creatinine, left ventricular ejection fraction, and hemoglobin. Natriuretic peptides and the AHEAD (atrial fibrillation, anemia, age, renal dysfunction and diabetes mellitus) score were not included. Discrimination was assessed using area under the receiver operating characteristic curve with bootstrap 95% confidence intervals, threshold characteristics and observed mortality across score groups.</p><p><strong>Results: </strong>Among 497 patients, 57 died within 1 year (11.5%). Point-score areas under the curve ranged from 0.525 to 0.590. The expanded eight-item score had an area under the curve of 0.590 (95% confidence interval, 0.509-0.660). At 4 or more points, sensitivity was 0.491, specificity was 0.655, positive likelihood ratio was 1.42, and negative likelihood ratio was 0.78. Observed mortality increased from 7.1% (95% confidence interval, 4.3-11.6) in the low-score group to 12.4% (7.7-19.4) in the intermediate-score group, and 15.6% (11.0-21.6) in the high-score group. A cross-validated clinical model using the same non-biomarker information achieved an area under the curve of 0.671.</p><p><strong>Conclusions: </strong>In this Vietnamese cohort after acute heart failure hospitalization, characterized by predominantly reduced or mildly reduced left ventricular ejection fraction, simple non-biomarker point scores provided modest prognostic information for 1-year mortality. Their role is broad orientation rather than definitive individual prognostication, and external validation is needed before implementation.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"321-329"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Disparities in Transcatheter Edge-to-Edge Repair Versus Open Mitral Valve Surgery: A Nationwide Analysis.","authors":"Ali Awad, Qusai Al Qudah, Joud Fahed, Mariam Chalhoub, M Chadi Alraies","doi":"10.14740/cr2226","DOIUrl":"10.14740/cr2226","url":null,"abstract":"<p><strong>Background: </strong>Racial disparities have been documented across multiple domains of cardiovascular care, yet data on mitral valve intervention remain limited. We examined racial differences in procedural selection and outcomes following transcatheter edge-to-edge repair (TEER) and open mitral valve surgery.</p><p><strong>Methods: </strong>Using the National Inpatient Sample (NIS, 2016-2022), we identified 26,456 adults undergoing mitral valve intervention. Multivariable regression models were used to assess racial differences in mortality, procedure type, length of stay, and charges, adjusting for demographics, comorbidities, hospital characteristics, and illness severity.</p><p><strong>Results: </strong>TEER comprised 89% of procedures. Black patients were younger (mean 62 vs 70 years) but presented with higher illness severity. After adjustment, Black patients had greater odds of receiving TEER (odds ratio (OR) = 1.36; 95% confidence interval (CI), 1.15-1.61). Mortality disparities persisted after adjustment: Black patients (OR = 1.49; 95% CI, 1.01-2.19; P = 0.045) and Asian/Pacific Islander patients OR = 2.20; 95% CI, 1.30-3.72; P = 0.003). Late presentation was more common among Black (24%) and Hispanic (27%) compared with White patients (13%).</p><p><strong>Conclusions: </strong>Black and Asian/Pacific Islander patients experience elevated inpatient mortality following mitral valve intervention that is not fully explained by covariates available in NIS. Late referral patterns are consistent with barriers to timely specialized care in minority populations.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"277-287"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Valve and Left Ventricular Outflow Tract Calcification as Predictors of Early Complications After Transcatheter Aortic Valve Implantation: A Prospective Single-Center Study.","authors":"Abubakr Muhamed Bakr, Mansour Mohamed Mostafa, Mohamed Adel Attia, Ahmad E Mostafa, Diaa Kamal, Ayman Ahmed Gad, Waseem Omar Ahmed, Sariya Khan, Muhammad Saad Reihan","doi":"10.14740/cr2247","DOIUrl":"10.14740/cr2247","url":null,"abstract":"<p><strong>Background: </strong>The prognostic implications of aortic valve and left ventricular outflow tract (LVOT) calcification following transcatheter aortic valve implantation (TAVI) are uncertain. The aim of the study was to assess the influence of aortic valve and LVOT calcification on early TAVI outcomes.</p><p><strong>Methods: </strong>From October 2021 to May 2024, in this single-center prospective cohort study, preoperative aortic valve calcium score via the Agatston method was determined by multidetector computed tomography (MDCT), and LVOT calcification was semi-quantitatively assessed in 95 consecutive symptomatic severe aortic stenosis patients who underwent TAVI. Primary endpoints assessed within 30 days after TAVI were paravalvular leak (PVL > grade 2), permanent pacemaker implantation (PPM) for high-grade atrioventricular (AV) block, and requirement for postimplantation balloon dilatation.</p><p><strong>Results: </strong>The mean calcium score was 2,658 ± 1,799. Five patients (5.2%) required PPM, and 14 (14.7%) developed transient PVL > grade 2, all of which improved after dilatation. The aortic valve calcium score was associated with PVL (area under the curve (AUC) = 0.70; P < 0.01), high-grade AV block (AUC = 0.66; P = 0.02), and postimplantation dilatation (AUC = 0.64; P = 0.03). LVOT calcification predicted high-grade AV block (P = 0.027).</p><p><strong>Conclusions: </strong>Quantitative LVOT and aortic valve calcification grading is a reliable predictor of early conduction and valvular dysfunction complications after TAVI and demonstrates the value of comprehensive preprocedural computed tomography (CT) imaging for procedural planning and risk stratification.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"338-346"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Lipoprotein Fractions and Lipoprotein-Associated Alpha-Tocopherol After Sleeve Gastrectomy in Patients With Severe Obesity.","authors":"Hisayuki Katsuyama, Yuji Hirowatari, Daisuke Manita, Tatsuya Iwasaki, Sachiyo Yoshio, Susumu Inamine, Mariko Hakoshima, Takumi Kawaguchi, Hidekatsu Yanai","doi":"10.14740/cr2244","DOIUrl":"10.14740/cr2244","url":null,"abstract":"<p><strong>Background: </strong>Sleeve gastrectomy (SG) improves obesity-related metabolic abnormalities, including dyslipidemia. However, postoperative changes in individual lipoprotein fractions and lipoprotein-associated antioxidants remain incompletely understood. This exploratory study aimed to characterize changes in serum lipoprotein fraction profiles after SG in Japanese patients with severe obesity using anion-exchange high-performance liquid chromatography (AEX-HPLC).</p><p><strong>Methods: </strong>Patients who underwent SG at Ohama Daiichi Hospital between July and December 2020 were enrolled. Clinical data and serum samples were obtained before and after surgery. Serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs) were measured by enzymatic assays, and small dense LDL-C (sdLDL-C) was estimated using Sampson's equation. Lipoprotein fractions were evaluated by AEX-HPLC. α-tocopherol concentrations in HDL, LDL, and very low-density lipoprotein (VLDL) fractions were measured by reverse-phase high-performance liquid chromatography. Overall changes over time were assessed using the Friedman test, followed by <i>post hoc</i> Wilcoxon signed-rank tests with Benjamini-Hochberg false discovery rate adjustment.</p><p><strong>Results: </strong>Of 20 patients who underwent SG, 12 were analyzed after excluding eight with inadequate stored serum quality. Mean age and body mass index were 45.3 ± 10.5 years and 43.4 ± 5.9 kg/m², respectively. SG significantly reduced body weight, hemoglobin A1c, and enzymatically measured TG, while HDL-C increased significantly. No significant changes were observed in LDL-C or non-HDL-C. Estimated sdLDL-C levels and the sdLDL-C/LDL-C ratio decreased significantly after SG. AEX-HPLC revealed significant increases in HDL and LDL fractions and a significant decrease in the VLDL fraction. α-Tocopherol content in HDL and LDL fractions increased significantly after SG, whereas no significant changes were observed in α-tocopherol-LDL/LDL or α-tocopherol-HDL/HDL. In contrast, α-tocopherol-VLDL/VLDL increased significantly after SG.</p><p><strong>Conclusions: </strong>SG was associated with improvements in body weight and conventional lipid parameters, including reduced TG and increased HDL-C, together with a reduction in estimated sdLDL-C, in Japanese patients with severe obesity. AEX-HPLC revealed complex postoperative changes in lipoprotein fractions, including reduced VLDL and increased HDL and LDL fractions. Lipoprotein-associated α-tocopherol distribution also changed after SG; however, the clinical significance of these changes requires further investigation.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"330-337"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pristine+™ Everolimus-Eluting Cobalt-Chromium Coronary Stent System: A Prospective, Multicenter Registry.","authors":"Rishi Sethi, Akshyaya Pradhan, Pravesh Vishwakarma, Prakash Kumar Hazra, Sumanta Chatterjee, Supratip Kundu, Pradip Bhowmik, Parijat Deb Choudhury, Pranav Shamraj, Monika Bhandari, Sridhar Kasturi, Shanivaram Vijay Kumar Reddy, Sheeba George, Yash Paul Sharma, Prashant Kumar Panda, Anil Potdar, Ravi Kumar Patnaik","doi":"10.14740/cr2230","DOIUrl":"10.14740/cr2230","url":null,"abstract":"<p><strong>Background: </strong>Recent advances in percutaneous coronary interventions (PCIs) have substantially improved clinical outcomes. Generating real-world evidence on the 1-year outcomes of ultrathin-strut drug-eluting stents (DES) remains important, particularly in healthcare settings where cost and accessibility may influence stent selection.</p><p><strong>Methods: </strong>A prospective, single-arm, multicenter registry was conducted to evaluate the 1-year safety and efficacy of an indigenous everolimus-eluting cobalt-chromium stent (EES) (Pristine+™ - Make: Relisys Medical Devices Limited, India) featuring an ultrathin strut (60-µm) design. The primary endpoint was the 1-year incidence of major adverse cardiac event (MACE) defined as a composite of cardiac death (CD), myocardial infarction (MI), and stent thrombosis (ST).</p><p><strong>Results: </strong>The study enrolled 1,088 patients, predominantly male (78.9%). High prevalence of diabetes mellitus (34.7%), hypertension (63.9%), and smoking history (25.7%) was noted. The mean age was 58.6 ± 10.6 years, with 69.9% between 36 and 65 years. A total of 95.9% completed the 1-year follow-up. At 1-year, the Kaplan-Meier incidence of MACE was 2.89% (40 events), comprising 18 CD (1.65%), 13 MI (1.19%), and nine ST (0.83%). All-cause mortality was 2.3% (25 events). One target-vessel myocardial infarction (TV-MI; 0.09%) was reported and no clinically indicated target-lesion revascularization (CI-TLR) events occurred.</p><p><strong>Conclusion: </strong>This study demonstrated favorable 1-year clinical outcomes with Pristine+™, reflected by low rates of MACE and no CI-TLR during the 1-year follow-up. A total of 1,386 Pristine+ EES were implanted in this study.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"308-320"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Definition of Polypharmacy in Atrial Fibrillation and Atrial Flutter: A Scoping Review.","authors":"Ali Murra, Akhil Mahant, Lorraine Porcello, Burr Hall, Keshav Patel","doi":"10.14740/cr2236","DOIUrl":"10.14740/cr2236","url":null,"abstract":"<p><p>Polypharmacy lacks a consistent definition in the literature and studies use varying numeric thresholds, ranging from the use of four to as many as 15 medications with the most frequent cutoff being five or more medications. It is highly prevalent and particularly relevant in patients with atrial fibrillation (AF) and atrial flutter (AFL) who have multiple comorbidities and often require multi-agent therapy. As a result, these patients face increased risk of bleeding, falls, drug-drug interactions, adverse drug-related events, and medication non-adherence. This scoping review aims to identify how polypharmacy is defined in AF and AFL, to examine the clinical consequences of these definitions, and summarize considerations to prevent polypharmacy. A comprehensive literature search was completed across five databases to identify articles that address and define polypharmacy in AF and AFL. A protocol was prospectively registered on PROSPERO (CRD420251135482) before data extraction began. Included articles defined polypharmacy in adult patients with a diagnosis of AF or AFL. Of the 109 articles identified, 96% (n = 105) discussed AF only, 4% (n = 4) discussed AF and AFL together without differentiation, and none focused solely on AFL. Most articles (96%, n = 105) used a quantitative definition, while 4% (n = 4) used a qualitative definition. The most common definition of polypharmacy, reported in 51% (n = 56) of articles, was the use of five or more medications. This definition is not clinically meaningful as most patients with AF or AFL are already on five or more medications. There is ongoing debate on the definition of polypharmacy in this population. If a numeric cutoff is utilized, we propose increasing it to 10 or more medications as has been suggested in other cardiovascular conditions such as heart failure. More importantly, regardless of how we define polypharmacy in AF or AFL, it is crucial that providers continually assess each medication to ensure that the benefits outweigh the risks.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"249-266"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sugammadex: Safety Profile and Adverse Effects in Infants Less Than Two Years of Age With Congenital Heart Disease.","authors":"Zachary Holtz, Stephania Paredes Padilla, Sibelle Aurelie Yemele Kitio, Julie Rice-Weimer, Joseph D Tobias","doi":"10.14740/cr2243","DOIUrl":"10.14740/cr2243","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite widespread clinical use and Food and Drug Administration (FDA) approval for use in patients from birth to &lt; 2 years old in 2024, data regarding the safety and monitoring practices of sugammadex in infants with congenital heart disease (CHD) remains limited. While its efficacy has been demonstrated, adverse effects have been documented including bradycardia and allergic reactions, including anaphylaxis. These effects may be of particular concern in infants with CHD, who may be at a higher risk for hemodynamic instability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The current study retrospectively evaluated a random sample of patients over a 10-year period to determine the efficacy, perioperative adverse effects, and neuromuscular monitoring practices associated with the administration of reversal agents for neuromuscular blocking agents in patients less than 2 years of age with CHD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study cohort included 497 encounters across 375 unique patients with a median age of 7 months who received either sugammadex or neostigmine, which served as a historical comparator. Bradycardia occurred at a low and comparable rate in both groups (1.4%), and no cases of anaphylaxis were documented. Additional adverse events were heterogeneous and were likely attributable to the underlying CHD, associated comorbidities, and the hemodynamic complexity of the surgical procedures rather than to the reversal agent alone. Successful tracheal extubation was achieved in over 90% of encounters, with a similar rate between groups. Rate of residual neuromuscular blockade was also comparable between groups, though quantitative train-of-four (TOF) monitoring was inconsistently documented. Furthermore, wide variability in sugammadex dosing was observed, highlighting an opportunity for standardization in this high-risk pediatric population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In the current cohort of infants with CHD, sugammadex was associated with a low incidence of perioperative adverse effects and rates of successful tracheal extubation similar to neostigmine. These patterns held despite higher ASA status among patients receiving sugammadex, which suggests greater baseline illness severity. Observed adverse events were heterogeneous and likely reflect the underlying clinical context in addition to any reversal agent effects. This study also highlights practice variability, including inconsistent documentation of quantitative TOF monitoring, which limits the ability to assess residual blockade and may contribute to variable dosing of sugammadex. In this physiologically vulnerable population, standardized monitoring and prospective data would help clarify how to best dose sugammadex. Taken together, these findings support the continued use of sugammadex in infants with CHD while highlighting the limits of current evidence. Larger, prospective studies with consistent monitoring are needed to better define the safe use ","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"300-307"},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy and Safety of P2Y12 Inhibitors in Patients With Diabetes Mellitus and Coronary Artery Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Abdullah Ghazi Aljohani, Osamah Omar Alturki, Ghaida Yahya Alahmari, Abdulrahman Thumayl Al-Shammari, Muqrin Abdullah Alharbi, Asmaa Esam Saeed Ali, Ali Saleh AlYounis, Abdulkarim Abdurrahman Mohammed Alshehri, Fahad Ali Hussain Alqahtani, Nourhan Sulaiman Basyouni, Khalid Noor Almutairi, Refal Hamad Jamjoom, Mansour Mohammed Abdullah Alahmari, Ahmed Sobhy","doi":"10.14740/cr2254","DOIUrl":"10.14740/cr2254","url":null,"abstract":"<p><strong>Background: </strong>Patients with diabetes mellitus (DM) and coronary artery disease (CAD) are at high risk of thrombotic events and exhibit reduced responsiveness to conventional antiplatelet therapy. While newer P2Y12 inhibitors such as ticagrelor and prasugrel provide more potent platelet inhibition, the optimal therapeutic strategy in this population remains uncertain.</p><p><strong>Methods: </strong>A systematic review and network meta-analysis of randomized controlled trials (RCTs) was conducted in accordance with PRISMA guidelines. Electronic databases were searched through April 2026 to identify RCTs comparing clopidogrel, prasugrel, ticagrelor, and placebo in patients with DM and CAD receiving background aspirin therapy. Random-effects models were used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs). The primary efficacy outcome was major adverse cardiovascular events (MACEs), while safety outcomes included major bleeding.</p><p><strong>Results: </strong>Seventeen RCTs, including 40,919 patients, were identified, with 15 trials included in the quantitative synthesis. Compared with placebo, prasugrel and ticagrelor were associated with significant reductions in MACEs, whereas clopidogrel showed no significant benefit. No significant differences were observed in cardiovascular or all-cause mortality across treatment strategies. Prasugrel was associated with a lower risk of myocardial infarction, while ticagrelor was associated with a lower risk of stroke. Both agents increased major bleeding versus placebo, and ticagrelor was also associated with a higher risk of dyspnea. Ranking analysis suggested that prasugrel was the most effective strategy for ischemic outcomes, whereas placebo was the safest strategy overall.</p><p><strong>Conclusions: </strong>In patients with DM and CAD, prasugrel and ticagrelor provide superior protection against ischemic events compared with clopidogrel but are associated with an increased bleeding risk compared with placebo. Prasugrel appears to offer the greatest overall efficacy, while ticagrelor shows a distinct benefit in stroke prevention. These findings support individualized antiplatelet strategies that balance ischemic and bleeding risks in this high-risk population.</p>","PeriodicalId":9424,"journal":{"name":"Cardiology Research","volume":"17 4","pages":"347-359"},"PeriodicalIF":1.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}