Cardiovascular diagnosis and therapy最新文献

{"title":"Symptoms of post-traumatic distress and quality of life in adults with aortopathy and congenital heart defects or hereditary connective tissue diseases.","authors":"Helena Dreher, Oliver Dewald, Annika Freiberger, Sebastian Freilinger, Frank Harig, Nicole Nagdyman, Nina Theresa Strueven, Mathieu Suleiman, Fritz Mellert, Niko Kohls, Ann-Sophie Kaemmerer-Suleiman","doi":"10.21037/cdt-2025-224","DOIUrl":"10.21037/cdt-2025-224","url":null,"abstract":"<p><strong>Background: </strong>Aortopathies do not only occur in acquired heart disease but are often associated with congenital heart defects (CHD) or hereditary connective tissue disease (HCTD). Individuals diagnosed with these conditions have an increased risk of life-threatening events, such as aortic dissection or rupture. The diagnosis of an aortopathy or the occurrence of complications are life-changing and psychologically stressful events, possibly inducing post-traumatic stress symptoms (PTSS) and a reduced quality of life (QoL). This study aimed to estimate the prevalence of PTSS and QoL related to cardiological parameters in adults with aortopathies and CHD or HCTD.</p><p><strong>Methods: </strong>This retrospective epidemiological cross-sectional study enrolled 137 adults with aortopathies and CHD or HCTD between May 2024 and October 2024. PTSS and QoL were assessed using the Posttraumatic Diagnostic Scale, the Impact of Event Scale-Revised, the Short Form-36, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The reasons for PTSS were explored using free-text responses. Descriptive analyses were performed to assess measures of central tendency and distribution. To examine differences and associations, non-parametric tests and Spearman's rank correlation were applied, and logistic regression models were used to further investigate medical and psychological associations.</p><p><strong>Results: </strong>Overall, 5.8% (n=8) to 7.3% (n=10) of the enrolled patients [mean age: 41.1±10.8 (18 to 63) years; 54% women] showed elevated PTSS indicative of clinical concern related to their aortopathy. Between pre-existing psychological disorders and PTSS, a significant association could be observed (odds ratio: 9.71, P=0.007). Cardiac parameters were not significantly associated with developing PTSS. Free-text responses showed a wide range of distressing events, ranging from anxiety, pain or shock to physical limitations. Overall QoL was good, although patients with PTSS showed a lower QoL (MLHFQ: 12.30 <i>vs</i>. 21.90, P=0.004).</p><p><strong>Conclusions: </strong>Despite the low prevalence of PTSS and generally good QoL, our findings underscore the importance of incorporating psychological screening into standard care for patients with CHD or HCTD with aortopathies. A holistic approach that goes beyond the medical management of aortopathies and includes comprehensive psychological support is essential in optimizing patient outcomes.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"781-791"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063456","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 statins on major adverse cardiovascular events, metabolic and inflammatory parameters in patients with hepatitis B virus comorbid with cardiovascular disease.","authors":"Qian Wu, Xiaoxuan He, Xiaoning Tong, Ying Li, Carolina Dagli-Hernandez, Patrick M Honore, Xiaoqin Wang","doi":"10.21037/cdt-2025-63","DOIUrl":"10.21037/cdt-2025-63","url":null,"abstract":"<p><strong>Background: </strong>The association between hepatitis B virus (HBV) infection and cardiovascular disease (CVD) remains uncertain. This study aimed to investigate the impact of HBV infection on 13 major adverse cardiovascular events (MACEs) among patients with CVD with or without statin use.</p><p><strong>Methods: </strong>A prospective cohort study was conducted to examine the cardiovascular, metabolic [atherogenic index (AI) and atherogenic index of plasma (AIP)], hepatic [albumin-bilirubin index (ALBI) score and fibrosis 4 index (FIB-4)] and inflammatory parameters [complete blood count-derived inflammation indices (CBCIIs)] in patients with HBV-cardiovascular comorbidity. In total, 45,013 individuals participated in the baseline survey between June 2020 and August 2023 at The First Affiliated Hospital of Xi'an Jiaotong University. The patients were categorized into two groups according to their surface antigen status. Finally, a sample size of 496 participants was included in the study: patients with coexisting CVD and HBV (n=271) and patients with CVD alone (n=225). In hierarchical analyses, the Breslow-Day test assessed model conformance, while the Mantel-Haenszel test performed stratified Chi-squared testing. To control for potential confounders, logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for MACEs.</p><p><strong>Results: </strong>HBV infection served as a protective factor of coronary heart disease (CHD) (OR =0.27; 95% CI: 0.12-0.60; P=0.001) and angina pectoris (AP) (OR =0.56; 95% CI: 0.36-0.86; P=0.008). Conversely, HBV infection elevated the risk of acute myocardial infarction (AMI) (OR =2.24, 95% CI: 1.40-3.57; P=0.001). Our study also suggests that statin therapy can lead to a dose-dependent decrease in liver fibrosis, and an increase in the atherogenicity index and systemic inflammatory response among patients with CVD.</p><p><strong>Conclusions: </strong>Our findings suggest that patients with CVD who also have HBV infection may experience a reduction in MACEs when treated with statins. The observed improvements in hepatic function, atherosclerotic burden, and systemic inflammation associated with statin therapy may contribute to the favorable cardiovascular outcomes among individuals with CVD. This study demonstrates that in CVD patients infected with HBV, concurrent monitoring of metabolic and inflammatory parameters can help reduce the risk of MACEs. Future studies will focus on determining quantitative relationships between individual metabolic or inflammatory indicators and MACEs in larger cohorts.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"738-754"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063504","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":"Cardiac magnetic resonance imaging assessment of myocardial disease in children and adolescents.","authors":"Aswathy Vaikom House, Lars Grosse-Wortmann","doi":"10.21037/cdt-24-502","DOIUrl":"10.21037/cdt-24-502","url":null,"abstract":"<p><p>Cardiac magnetic resonance (CMR) imaging has become a crucial diagnostic and prognostic tool for assessing myocardial health, especially in pediatric patients with congenital heart disease. This review focuses on the role of CMR in myocardial tissue characterization, particularly its ability to detect and quantify fibrosis using techniques such as late gadolinium enhancement (LGE), T1 and T2 mapping, and extra-cellular volume (ECV) measurements. CMR offers superior anatomical and functional information, complementing traditional imaging modalities by enabling detailed visualization of native myocardial edema, interstitial fibrosis, and other tissue changes. These advanced imaging techniques are particularly useful in diagnosing conditions such as myocarditis, cardiac allograft rejection, Kawasaki disease (KD), and other cardiomyopathic processes. In pediatric myocarditis, CMR has demonstrated strong diagnostic utility, with T1 and ECV values helping to differentiate between healthy controls and patients with acute myocarditis, while also predicting disease severity and outcomes. In the context of cardiac transplant, T1 mapping, shows promise in detecting early signs of rejection, providing a less invasive alternative to endomyocardial biopsy. Additionally, CMR has been employed to monitor myocardial damage in KD, where it detects increased ECV in both coronary-affected and remote myocardial areas. The review also discusses CMR's application in tracking myocardial fibrosis in pediatric cardiomyopathies, highlighting its potential as a prognostic marker for heart failure progression. Despite its advantages, challenges remain in standardizing imaging protocols across disease states and establishing comprehensive guidelines for routine use. The future of CMR in pediatric cardiology lies in its ability to improve early diagnosis, guide personalized treatment, and enhance long-term monitoring of heart conditions, ultimately improving patient outcomes.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"888-897"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063528","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":"Automated cardiac magnetic resonance interpretation derived from prompted large language models.","authors":"Lujing Wang, Liang Peng, Yixuan Wan, Xingyu Li, Yixin Chen, Li Wang, Xiuxian Gong, Xiaoying Zhao, Lequan Yu, Shihua Zhao, Xinxiang Zhao","doi":"10.21037/cdt-2025-112","DOIUrl":"10.21037/cdt-2025-112","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The versatility of cardiac magnetic resonance (CMR) leads to complex and time-consuming interpretation. Large language models (LLMs) present transformative potential for automated CMR interpretations. We explored the ability of LLMs in the automated classification and diagnosis of CMR reports for three common cardiac diseases: myocardial infarction (MI), dilated cardiomyopathy (DCM), and hypertrophic cardiomyopathy (HCM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study enrolled CMR reports of consecutive patients from January 2015 to July 2024, including reports from three types of cardiac diseases: MI, DCM, and HCM. Six LLMs, including GPT-3.5, GPT-4.0, Gemini-1.0, Gemini-1.5, PaLM, and LLaMA, were used to classify and diagnose the CMR reports. The results of the LLMs, with minimal or informative prompts, were compared with those of radiologists. Accuracy (ACC) and balanced accuracy (BAC) were used to evaluate the classification performance of the different LLMs. The consistency between radiologists and LLMs in classifying heart disease categories was evaluated using Gwet's Agreement Coefficient (AC1 value). Diagnostic performance was analyzed through receiver operating characteristic (ROC) curves. Cohen's kappa was used to assess the reproducibility of the LLMs' diagnostic results obtained at different time intervals (a 30-day interval).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study enrolled 543 CMR cases, including 275 MI, 120 DCM, and 148 HCM cases. The overall BAC of the minimal prompted LLMs, from highest to lowest, were GPT-4.0, LLaMA, PaLM, GPT-3.5, Gemini-1.5, and Gemini-1.0. The informative prompted models of GPT-3.5 (P&lt;0.001), GPT-4.0 (P&lt;0.001), Gemini-1.0 (P&lt;0.001), Gemini-1.5 (P=0.02), and PaLM (P&lt;0.001) showed significant improvements in overall ACC compared to their minimal prompted models, whereas the informative prompted model of LLaMA did not show a significant improvement in overall ACC compared to the minimal prompted model (P=0.06). GPT-4.0 performed best in both the minimal prompted (ACC =88.6%, BAC =91.7%) and informative prompted (ACC =95.8%, BAC =97.1%) models. GPT-4.0 demonstrated the highest agreement with radiologists [AC1=0.82, 95% confidence interval (CI): 0.78-0.86], significantly outperforming others (P&lt;0.001). For the informative prompted models of LLMs, GPT-4.0 + informative prompt (AC1=0.93, 95% CI: 0.90-0.96), GPT-3.5 + informative prompt (AC1=0.93, 95% CI: 0.90-0.95), Gemini-1.0 + informative prompt (AC1=0.90, 95% CI: 0.87-0.93), PaLM + informative prompt (AC1=0.86, 95% CI: 0.82-0.90), LLaMA + informative prompt (AC1=0.82, 95% CI: 0.78-0.86), and Gemini-1.5 + informative prompt (AC1=0.80, 95% CI: 0.76-0.84) all showed almost perfect agreement with radiologists' diagnoses. Diagnostic performance was excellent for GPT-4.0 [area under the curve (AUC)=0.93, 95% CI: 0.92-0.95] and LLaMA (AUC =0.92, 95% CI: 0.90-0.94) in minimal prompted models, while informative prompted models","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"726-737"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063562","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":"Head in the clouds.","authors":"Lin Abigail Tan","doi":"10.21037/cdt-2025-390","DOIUrl":"10.21037/cdt-2025-390","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"934-936"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063155","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":"Myocardial contrast echocardiography predicts major adverse cardiovascular and cerebrovascular events in the population after percutaneous coronary intervention-a systematic review and meta-analysis.","authors":"Xun Wu, Libo Chen, Yuqi Yang","doi":"10.21037/cdt-2024-664","DOIUrl":"10.21037/cdt-2024-664","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Existing studies demonstrated that myocardial contrast echocardiography (MCE), which provides residual myocardial viability (MV) information, is an effective long-term prognostic tool. However, the specific prognostic value of microvascular perfusion (MVP) parameters detected by contemporary intravenous MCE (IV-MCE) remains to be fully elucidated. Moreover, there is ongoing debate regarding the optimal quantitative diagnostic indicator measured by IV-MCE, including A, β, and myocardial blood flow (MBF), for major adverse cardiovascular and cerebrovascular events (MACCEs). This study aims to identify the most effective IV-MCE parameter for predicting MACCEs through a comprehensive meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a comprehensive search for retrospective or prospective cohort studies written in English and Chinese that evaluated the prognostic value of IV-MCE in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). PubMed, Embase, Web of Science, Cochrane, SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (CSTJ), and Wanfang were searched until March 20, 2025. The primary outcome was the diagnostic efficacy of myocardial perfusion score index (MPSI), A, β, and MBF for MACCEs. Secondary outcomes included associations between abnormal MVP, microvascular obstruction (MVO), MPSI, β, MBF and MACCEs occurrence. Summary receiver operating characteristic (SROC) curves and hazard ratios (HRs) were used to assess diagnostic performance and analyze associations by Stata 15.0. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The study protocol was prospectively registered in the PROSPERO database (CRD42024524641).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixteen studies involving 1,942 patients were included. The overall study quality was deemed high. Abnormal MVP [HR: 2.61, 95% confidence interval (CI): 1.42-4.79, P=0.002], MVO (HR: 4.51, 95% CI: 2.30-8.83, P&lt;0.001), MPSI (HR: 5.74, 95% CI: 1.41-23.34, P=0.02), β (HR: 7.18, 95% CI: 1.01-51.24, P=0.049), and MBF (HR: 4.62, 95% CI: 2.42-8.83, P&lt;0.001) were found to be linked with MACCEs occurrence. Significant heterogeneity (&lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt;=69.5%, 83.9%, and 95.0%) was observed in abnormal MVP, MPSI, and β across studies, and publication bias was identified in all five studies. The area under the curve (AUC) (95% CI) for MPSI, A, β, and MBF in diagnosing MACCEs was 0.84 (0.80-0.87), 0.83 (0.80-0.86), 0.84 (0.80-0.87), and 0.73 (0.69-0.77), respectively. Deeks' funnel plots further confirmed that there was no significant publication bias in the results for these four studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The evidence supported that both qualitative and quantitative parameters of IV-MCE can provide moderate predictive power for MACCEs occurrence after PCI, with MPSI and β s","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"802-819"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063383","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":"Gender-specific differences in body mass index and cardiovascular risk adversely impact survival after aortic valve replacement.","authors":"Suvitesh Luthra, Hannah Masraf, Davorin Sef, David Thirukumaran, Szabolcs Miskolczi, Theodore Velissaris","doi":"10.21037/cdt-2025-113","DOIUrl":"10.21037/cdt-2025-113","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of evidence on association between gender specific differences in obesity and cardiovascular risk after isolated surgical aortic valve replacement (AVR) and its impact on outcomes and long-term survival. The aim of this study was to assess the impact of obesity on perioperative outcomes and long-term survival after isolated AVR.</p><p><strong>Methods: </strong>In this retrospective, single-centre study, we included all patients who underwent isolated AVR between April 2000 and December 2019 from the cardiac surgery database of the Southampton General Hospital (Patient Administration System, e-CAMIS, Yeadon, Leeds, UK). Patients with infective endocarditis, re-sternotomy, other concomitant cardiac procedures, homografts, autografts and emergency operations were excluded. Univariable regression analysis was performed to identify predictors of in-hospital mortality. Hazard ratios were calculated using a Cox proportional hazards model.</p><p><strong>Results: </strong>Total of 2,398 patients were included in the study and two groups of patients were compared: body mass index (BMI) 25-34.9 kg/m² (n=2,000) and BMI ≥35 kg/m² (n=398) based on sensitivity modelling. Actuarial survival was comparable across BMI groups at 12.5and 12.7 years for BMI 25-34.9 kg/m² and BMI ≥35 kg/m², respectively (P=0.75 log-rank). Long-term survival was specifically worse for patients with high BMI and composite cardiovascular risk of hypertension, diabetes mellitus, and current smoking [hazard ratio (HR) 1.93, 95% confidence interval (CI): 1.45-2.58, P<0.001] and patients with moderate-to-severe patient prosthesis mismatch (PPM) (effective orifice areas index ≤0.85 cm²/m²) (HR 1.17 95% CI: 0.98-1.39, P=0.08). Median survival time for females was 11.5 years [interquartile range (IQR): 10.3-12.3 years] versus 14.2 years (IQR: 12.7-15.7 years) for males (log-rank P=0.006), although gender was not a significant predictor of long-term survival after adjusting for covariates. Moderate-severe PPM was associated with significantly worse survival in females (log-rank P<0.01), compared to males for whom this difference was not significant (log-rank P=0.21).</p><p><strong>Conclusions: </strong>Obesity with composite risk factors (hypertension, diabetes mellitus and active smoking) is associated with adverse survival. We did not observe gender-specific differences in long-term survival among specific BMI groups of patients.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"770-780"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063617","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":"ChronoSynthNet: a dual-task deep learning model development and validation study for predicting real-time norepinephrine dosage and the early detection of hypotension in patients with septic shock.","authors":"Zeyu Jiang, Shixuan Zhang, Yana Yuan, Jiucun Wang, Zixin Hu","doi":"10.21037/cdt-2025-265","DOIUrl":"10.21037/cdt-2025-265","url":null,"abstract":"<p><strong>Background: </strong>In intensive care units (ICUs), managing septic shock requires maintaining adequate tissue perfusion with vasopressors, most commonly norepinephrine, while avoiding under or over-dosing that can worsen hypotension, organ injury, and adverse effects. Bedside vasopressor titration often depends on clinician judgment and simple rules, with limited tools providing individualized, time-aware guidance or early warning of impending hypotension. ChronoSynthNet aimed to create a data-driven model that learns from routine electronic health record (EHR) time-series data to personalize vasopressor therapy and anticipate deterioration. To develop and validate a dual-task deep learning model that predicts real-time norepinephrine requirements and detects hypotension early in adults with septic shock.</p><p><strong>Methods: </strong>We performed a retrospective cohort analysis using the Medical Information Mart for Intensive Care [MIMIC-IV (2008-2019)] database. Eligible adult ICU stays met Sepsis-3 criteria, received norepinephrine, and had adequate time-series data. ChronoSynthNet integrates a shared Transformer encoder, long short-term memory (LSTM) layers, and a dynamic feature-weighting network to learn cross-variable and temporal relationships. The dataset was split 80/20 into training and internal test sets, with five-fold cross-validation on training data. Classification performance for early hypotension detection was assessed using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), precision, recall, and specificity; norepinephrine rate prediction performance was assessed using mean squared error (MSE). Ninety-five percent confidence intervals (95% CIs) were calculated for AUROC, recall, and specificity on the internal test set using bootstrap and Wilson methods.</p><p><strong>Results: </strong>ChronoSynthNet achieved AUROC of 0.89 (95% CI: 0.836-0.938) for hypotension classification and MSE of 0.0213 (95% CI: 0.0192-0.0234) for predicting the norepinephrine infusion rate. The model demonstrated high specificity (97%, 95% CI: 96.3-98.3%) and precision (92%, 95% CI: 90.3-93.7%), with a recall of 74% (95% CI: 71.3-76.7%). Hypotension events were predicted a median of 3.5 hours in advance.</p><p><strong>Conclusions: </strong>ChronoSynthNet demonstrated strong performance in early hypotension detection and norepinephrine dose forecasting in ICU patients with septic shock. These findings support its potential role in aiding real-time vasopressor titration and early recognition of hemodynamic instability; prospective multicenter validation is needed before clinical deployment.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"833-846"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063516","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":"BK channel agonists may affect matrix vesicle secretion and ameliorate vascular calcification via autophagy.","authors":"Jue Sun, Youwei Lu, Zixuan Li, Junhao Dai, Parveen K Garg, Hong Xin, Qianhong Yang","doi":"10.21037/cdt-2025-86","DOIUrl":"10.21037/cdt-2025-86","url":null,"abstract":"<p><strong>Background: </strong>Vascular calcification (VC) is a common high-risk factor for cardiovascular disease and is mainly caused by the deposition of calcium (Ca²⁺), phosphorus, and other minerals on the walls of arteries and veins; however, its specific pathogenic mechanism is still unclear. The aim of the present study was to explore the effect of large-conductance calcium and voltage-activated potassium (BK) channels in regulating VC.</p><p><strong>Methods: </strong>In this study, primary vascular smooth muscle cells (VSMCs) isolated from the rat or murine thoracic aorta were treated with calcifying media and NS1619 and 3-methyladenine (3-MA) and divided into the following five groups: (I) the control group; (II) the control + NS1619 group; (III) the calcify group; (IV) the calcify + NS1619 group; (V) the calcify + NS1619+3-MA group. Twelve male C57BL/6 mice (20-25 g) were treated with vitamin D and NS1619 and divided into the following four groups: (I) the control group; (II) the vitamin D model group; (III) the vitamin D +5 mg/kg NS1619 group; and (IV) the vitamin D +10 mg/kg NS1619 group. Gene expression, protein expression and the size and concentration of MVs were tested by quantitative polymerase chain reaction (qPCR), Western blot (WB), immunohistochemistry and nanoparticle tracking analysis (NTA), respectively.</p><p><strong>Results: </strong>We found that BK channels regulate VC. BK channel downregulation was observed in samples from animal and cell models of VC. Both the application of the BK channel agonist NS1619 and BK overexpression modulated the expression of Runt-related transcription factor 2 (Runx2) and alpha-smooth muscle actin (α-SMA) by suppressing matrix vesicles (MVs) formation and secretion, consequently improving VC in VSMCs. However, intervention with the autophagy inhibitor 3-MA appeared to regulate the secretion of MVs and simultaneously weakened the therapeutic effect of NS1619 on calcification.</p><p><strong>Conclusions: </strong>Although our experimental sample size is small, we still speculate that BK channel agonists might inhibit the secretion of MVs by activating autophagy, thereby alleviating VC. BK channels may be applied in clinical practice and become a potential target for treating VC.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"820-832"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063565","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":"Digital clinical teaching of cardiovascular surgery supported by precision imaging and 3D printing technology: a randomized parallel-controlled trial.","authors":"Tengyue Zhao, Yuanyuan Wang, Bingjie Wang, Yu Liu, Ziying Chen, Yuming Wu","doi":"10.21037/cdt-2025-98","DOIUrl":"10.21037/cdt-2025-98","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiovascular surgery demands deep knowledge of the heart's intricate three-dimensional (3D) anatomy, but current teaching methods do not adequately develop students' spatial skills. Advances in precise imaging and 3D printing offer transformative potential for clinical education. In this study, taking the teaching of cardiovascular surgery as an example, we aimed to integrate precision imaging and 3D printing technologies with case-based learning (CBL), problem-based learning (PBL), and team-based learning (TBL). Our objective was to explore digital teaching approaches in clinical surgery and address the limitations of current learning models in spatial visualization training.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study employed a parallel design randomized controlled trial (RCT) methodology. A total of 80 clinical medicine students from the 2020 cohort, currently undertaking their practicum in the Department of Cardiac Great Vascular Surgery at The Second Hospital of Hebei Medical University, were randomly assigned into two groups: a digital teaching group and a case-, problem-, and team-based learning (C-P-TBL) teaching group, each comprising 40 students. The digital teaching group utilized an innovative digital teaching approach, enhanced by precision imaging and 3D printing technology. In contrast, the C-P-TBL teaching group employed an integrated teaching model combining CBL, PBL, and TBL. The two groups were compared via theoretical and skills assessment, along with the analysis of teaching quality questionnaires and teaching satisfaction metrics, so as to evaluate the incremental benefits conferred by digital tools within the existing teaching framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The digital teaching group demonstrated superior performance compared to the C-P-TBL teaching group, as evidenced by higher scores in theoretical knowledge (86.28±10.756 &lt;i&gt;vs.&lt;/i&gt; 80.25±9.440), clinical skills (87.90±7.530 &lt;i&gt;vs.&lt;/i&gt; 83.05±7.473), and overall assessment (86.93±8.131 &lt;i&gt;vs.&lt;/i&gt; 81.37±7.716). Based on the results of the teaching quality questionnaires, the digital teaching group demonstrated a statistically significant superiority over the C-P-TBL teaching group in several areas: self-learning ability, comprehension and application of theoretical knowledge, problem discovery and analysis skills, spatial imagination capability, and overall self-comprehensive ability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The integration of digital technologies, exemplified by precision imaging and 3D printing, with CBL, PBL, and TBL methodologies, has been shown to significantly enhance the spatial visualization skills of medical students. This approach not only improves their theoretical understanding and technical proficiency, but also leads to higher self-assessment of abilities and increased satisfaction with the teaching process. Consequently, this pedagogical strategy merits consideration for widespread implementation in th","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 4","pages":"714-725"},"PeriodicalIF":2.1,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063531","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}