Cardiovascular diagnosis and therapy最新文献

{"title":"Comprehensive analysis for the role of macrophage-driven genes in abdominal aortic aneurysm.","authors":"Lei Yang, Qian Zhou, Gang Zhao, Shan Chen, Wei Gou, Zhipeng Hu","doi":"10.21037/cdt-2025-365","DOIUrl":"10.21037/cdt-2025-365","url":null,"abstract":"<p><strong>Background: </strong>Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease characterized by chronic inflammation and immune dysregulation, with macrophages playing a critical pathogenic role. However, the molecular determinants underlying macrophage involvement in AAA remain incompletely defined. This study aimed to identify macrophage-related diagnostic biomarkers for AAA through an integrated retrospective analysis of public transcriptomic datasets and experimental validation.</p><p><strong>Methods: </strong>Single-cell RNA sequencing (scRNA-seq) was applied to AAA samples to identify macrophage-enriched cell clusters and extract cell-type-specific gene signatures. Differentially expressed genes (DEGs) were derived from bulk RNA sequencing (RNA-seq) datasets that were retrospectively retrieved from public databases, and intersected with macrophage-specific genes to identify macrophage-related DEGs. A least absolute shrinkage and selection operator (LASSO)-based diagnostic model was constructed and validated with independent cohorts. Gene set variation analysis (GSVA), immune infiltration analysis, and Mendelian randomization (MR) were used to investigate pathway activity, immune contexture, and genetic associations between hub genes and AAA risk. Finally, reverse transcription quantitative polymerase chain reaction (RT-qPCR) was performed in human AAA tissues (n=3) and normal abdominal aortic specimens (n=3) obtained from patients undergoing vascular surgery who met predefined clinical eligibility criteria (no prior aortic surgery, no active infection or systemic inflammatory disease), and these specimens were collected at Ningxia Medical University General Hospital to validate the expression of hub genes.</p><p><strong>Results: </strong>Nineteen distinct cell clusters were identified in the scRNA-seq dataset (AAA =6, normal =0), with macrophages as the dominant population. A total of 59 macrophage-related DEGs were obtained, with functional enrichment implicating lipid metabolism and immune response pathways. A five-gene diagnostic model (<i>ARG2, S100A6, VASH1, PI3</i>, and <i>SMU1</i>) was constructed using the bulk RNA-seq training dataset GSE47472 (AAA =14, normal =8) and validated in an independent cohort GSE57691 (AAA =49, normal =10), achieved excellent performance {area under curve (AUC) =0.981 [95% confidence interval (CI): 0.951-0.993] in the training set and 0.935 (95% CI: 0.903-0.998) in the validation set}. Among them, <i>SMU1</i> was notably upregulated in macrophages and positively correlated with inflammatory response, PI3K-AKT-mTOR, and apoptosis pathways. <i>SMU1</i> expression was negatively correlated with M2 macrophage infiltration. MR analysis suggested a potential genetic association between spliceosome-related genes and AAA risk. Clinical validation further showed that <i>SMU1</i> was significantly downregulated in AAA tissues.</p><p><strong>Conclusions: </strong><i>SMU1</i> is a novel macrop","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"3"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431019","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 cross-sectional observational study: assessment of cardiovascular damage in mucopolysaccharidoses mutation carriers.","authors":"Thanh Luan Nguyen, Alla Nikolaevna Semyachkina, Victoria Yurievna Voinova, Maria Alexandrovna Shkolnikova, Tuan Anh Luong, Huu Khanh Le, Elena Vladimirovna Reznik","doi":"10.21037/cdt-24-469","DOIUrl":"10.21037/cdt-24-469","url":null,"abstract":"<p><strong>Background: </strong>Mucopolysaccharidoses (MPS) are a group of lysosomal storage diseases. Cardiovascular pathology occurs in all types of MPS, represented by valvular defects, myocardial hypertrophy, and coronary artery disease. Cardiovascular abnormalities in parents of patients with MPS are poorly understood, which is the purpose of our work.</p><p><strong>Methods: </strong>During January 2022 to October 2023, a cross-sectional observational study of MPS mutation carriers was conducted in the City Clinical Hospital No. 31, practice base of the Department of Propaedeutics of Internal Disease, Pirogov Russian National Research Medical University, Moscow, Russian Federation. There were 21 consecutive parents of children with MPS examined. All MPS carriers-parents underwent a standard clinical and laboratory examination, electrocardiography (ECG), echocardiography, 24-hour Holter ECG monitoring. Distributions of all parametric characteristics of the patients were not normal, non-parametric criteria were used in statistical calculations. Differences between nominal variables were compared using a Chi-squared test. Fisher's exact test was used when more than 20% of cells with expected frequencies less than 5. P value <0.05 was considered statistically significant. The analysis was performed by a biostatistician using the statistical software SPSS (version 26.0; SPSS Institute, USA) and STATISTICA (version 12.0; StatSoft, USA).</p><p><strong>Results: </strong>The median (25th and 75th percentiles) of age was 36 [33; 37] years. There were no confirmed myocardial and brain infarctions, nor diabetes mellitus in the examined carriers (81% female). A decrease in left ventricular (LV) ejection fraction <40% was found in 1 (4.8%), up to 40-50% in 2 (9.5%) carriers. LV wall thickness ≥1.5 cm was detected in 14 (66.7%) carriers, asymmetric LV hypertrophy in 18 (85.7%). Thickening of the mitral valve leaflets was detected in 16 (76.2%) carriers. Hydropericardium was detected in 5 (23.8%) carriers. Atrial flutter was registered in 1 (4.8%), paroxysmal supraventricular tachycardia in 7 (33.3%), sinus bradycardia in 3 (14.3%); conduction disorders in 15 (71.4%) carriers. A short PR interval was detected on the ECG in 2 (9.5%) carriers. A prolonged QT interval was registered in 3 (14.3%) of carriers, transient ST-segment depression in 10 (47.6%), ST-segment elevation in 3 (14.3%) carriers.</p><p><strong>Conclusions: </strong>Our results suggested the possibility of clinical manifestations of cardiac involvement in MPS carriers. Further comparative studies are required in larger populations to assess the rate of progression of the identified abnormalities and the effectiveness of drug therapy in these patients.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"5"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430906","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":"Effectiveness of radiofrequency catheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy: long-term outcomes and predictors of recurrence.","authors":"Zhipeng Zhang, Shijun Li, Liang Ma, Chengming Ma, Shiyu Dai, Yuanjun Sun, Rongfeng Zhang, Xianjie Xiao, Haochen Sun, Shulong Zhang, Xiaohong Yu, Lianjun Gao, Yunlong Xia, Jinqiu Liu, Xiaomeng Yin","doi":"10.21037/cdt-2025-196","DOIUrl":"10.21037/cdt-2025-196","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Atrial fibrillation (AF) is the most common type of arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and may worsen their prognosis considerably. However, the effectiveness of radiofrequency catheter ablation (RFCA) for this population is unclear due to the unique pathological features of HCM. The aim of this study was to assess the long-term effectiveness of RFCA, identify independent predictors of AF recurrence, and examine their predictive value for AF recurrence in patients with HCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective observational study of patients with HCM and AF who underwent their first session of RFCA between January 2013 and January 2020. Initially, 153 patients were screened, among whom 129 had follow-up data. The patients were divided into two groups based on the presence or absence of arrhythmic recurrence after RFCA: a sinus rhythm (SR) group and a recurrence group. Univariate and multivariate Cox regression models were used to identify the independent predictors of AF recurrence. Receiver operating characteristic curve analysis was applied to establish the value of the comorbidities, age, persistent/permanent AF, procedure type, CAAP-AF score (coronary artery disease, age, sex, atrial diameter, type of AF, and prior antiarrhythmic drug failure), AF duration, age, creatinine level, persistent AF, left atrial diameter (LAD), and APPLE score (age &gt;65 years, persistent AF, impaired estimated glomerular filtration rate, LAD, and ejection fraction) in predicting AF recurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 129 patients, 58 were placed in the SR group and 71 in the recurrence group. Independent predictors of AF recurrence identified by multivariate analysis were female sex (P=0.01), a large LAD (P&lt;0.001), and moderate-to-severe mitral regurgitation (MR) (P=0.008). The CAAP-AF score demonstrated high value for predicting AF recurrence (concordance statistic =0.768; 95% CI: 0.685-0.850; P&lt;0.001), with a sensitivity of 84.5% and a specificity of 56.9% for a score ≥5. RFCA significantly reduced AF-related symptoms in patients with HCM. The mean modified European Heart Rhythm Association (mEHRA) symptom classification was improved from 2.9±0.7 at baseline to 1.9±1.0 at follow-up (P&lt;0.001). The SR group also had a better New York Heart Association (NYHA) class at follow-up than at baseline (2.2±0.9 &lt;i&gt;vs.&lt;/i&gt; 1.8±0.7, P=0.006) and also had a higher NYHA functional status at follow-up than did the recurrence group (1.8±0.7 &lt;i&gt;vs.&lt;/i&gt; 2.3±0.9, P=0.04). The SR group also experienced fewer embolic events and fewer hospitalizations due to heart failure (HF) exacerbation (P&lt;0.001) and lower HCM-related mortality as compared to the recurrence group (5.6% &lt;i&gt;vs.&lt;/i&gt; 0%, P=0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;RFCA may be an effective rhythm control strategy for patients with HCM accompanied by AF, with significant improvement in symptoms and mEHRA and NYHA class. The CAAP-AF score","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430977","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":"Artificial intelligence in cardiology: a narrative review with focus on patient outcomes.","authors":"Michaella Alexandrou, Ippokratis Konstantinidis, Jose Manuel Orenday, Dimitrios Strepkos, Pedro E P Carvalho, Eleni Kladou, Bavana V Rangan, Olga C Mastrodemos, Harmanpreet Kaur, Yader Sandoval, Emmanouil S Brilakis","doi":"10.21037/cdt-2025-479","DOIUrl":"10.21037/cdt-2025-479","url":null,"abstract":"<p><strong>Background and objective: </strong>Artificial intelligence (AI) is rapidly transforming cardiology through advancements in diagnostic accuracy, prognostication, and treatment personalization. While evidence for algorithmic performance is robust, its true impact on patient-centered outcomes remains unclear. This review aims to evaluate how AI applications influence patient outcomes in cardiology and identify current limitations and future directions.</p><p><strong>Methods: </strong>A targeted literature search was conducted in PubMed, Scopus, Embase, and Cochrane databases on May 9 and 23, 2025, using a combination of terms related to AI, cardiology, and patient outcomes. Filters were applied to include human studies, English language, and studies published between January 2015 and May 2025. Two reviewers independently screened articles, and three reviewers reached consensus for final inclusion. A total of 11 studies met inclusion criteria.</p><p><strong>Key content and findings: </strong>AI tools have demonstrated potential benefits across multiple domains, including clinical decision support, cardiac imaging, remote patient monitoring, and patient engagement. Evidence suggests AI can enhance diagnostic accuracy, procedural efficiency, and patient self-management. However, most studies report surrogate or process-related endpoints rather than hard clinical outcomes. Large-scale randomized trials remain scarce, and improvements in mortality, hospitalization, and quality of life (QoL) are inconsistently demonstrated. Ethical considerations, implementation challenges, and cost-effectiveness concerns persist.</p><p><strong>Conclusions: </strong>AI in cardiology shows promise for improving patient care, but robust evidence linking its adoption to improved clinical outcomes is limited. By synthesizing available findings, this review highlights critical evidence gaps and provides guidance for future research, which should prioritize prospective trials focused on patient-centered endpoints and address barriers to implementation, transparency, and equity.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"8"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430965","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":"Complications of catheter-directed interventions in acute pulmonary embolism: a narrative expert review with guidance on management.","authors":"Gonzalo García-Martí, Maite Velázquez Martín, Nicolás Maneiro Melón, Pablo Salinas","doi":"10.21037/cdt-2025-aw-538","DOIUrl":"10.21037/cdt-2025-aw-538","url":null,"abstract":"<p><strong>Background and objective: </strong>Catheter-directed interventions (CDI) for pulmonary embolism (PE) have emerged as alternatives to systemic thrombolysis for patients requiring reperfusion, enabling thrombus burden reduction through low-dose local thrombolysis or mechanical thrombectomy. Despite encouraging hemodynamic and clinical outcomes, procedure-specific complications are poorly characterized in the literature. This narrative review aims to synthesize the reported complications of CDI in acute PE and provide practical management strategies.</p><p><strong>Methods: </strong>A PubMed search covering 2014-2025, limited to articles published in English or Spanish, complemented by reference screening, identified randomized clinical trials and prospective or retrospective registries of CDI in acute PE reporting safety outcomes. These studies were used to construct a comprehensive overview of CDI-related complications, while additional registries, case reports, and case series were examined to describe rare events not captured by primary studies, as well as expert insights when evidence was insufficient or unavailable.</p><p><strong>Key content and findings: </strong>Complications of CDI in acute PE encompass a broad and heterogeneous spectrum including access-site complications, right-heart injury, pulmonary arterial lesions, catheter malfunction and mechanical complications, and hemodynamic deterioration. Their incidence varies considerably across studies, and the absence of standardized definitions or classifications limits accurate assessment of the true frequency and clinical impact of those adverse events.</p><p><strong>Conclusions: </strong>Based on the available evidence, this narrative expert review examines the spectrum of CDI-related complications in acute PE. It seeks to bridge the gap between innovation and safety by equipping clinicians and interventionalists with practical guidance for the recognition, prevention, and management of these adverse events.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"9"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430936","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":"Recommendations regarding artificial intelligence for manuscript writing.","authors":"Todd A Laffaye, Brian H Carlson, William K Freeman, Chadi Ayoub","doi":"10.21037/cdt-2025-1-658","DOIUrl":"10.21037/cdt-2025-1-658","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"13"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430948","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":"Safety and clinical outcomes of micro-axial intravascular flow pump compared to intra-aortic balloon pump in cardiogenic shock.","authors":"Mana Makino, Daisuke Shishikura, Hirofumi Kusumoto, Yohei Yamauchi, Kazushi Sakane, Tomohiro Fujisaka, Ryosuke Zushi, Yumiko Kanzaki, Masaaki Hoshiga, Hideaki Morita","doi":"10.21037/cdt-2025-302","DOIUrl":"10.21037/cdt-2025-302","url":null,"abstract":"<p><strong>Background: </strong>The micro-axial intravascular flow pump (mAFP) may potentially improve the prognosis of cardiogenic shock (CS). Despite its advanced hemodynamic profile, efficacy remains undetermined. Safety and mid-term outcomes were compared between the mAFP and intra-aortic balloon pump (IABP).</p><p><strong>Methods: </strong>This single-center, cross-sectional study retrospectively evaluated 205 consecutive patients treated using the IABP or mAFP at Osaka Medical and Pharmaceutical University from January 2017 to June 2023. After exclusion of those with CS who were treated with only extracorporeal membrane oxygenation (ECMO), patients who required IABP or mAFP were enrolled in the current study. The primary outcome was 180-day mortality. Secondary outcomes were major [major bleeding (Bleeding Academic Research Consortium criteria 3-5), limb ischemia and stroke] and other complications (hemolysis, thrombocytopenia, acute kidney impairment and requirement of renal replacement therapy). Those outcomes were compared between IABP and mAFP.</p><p><strong>Results: </strong>Of all patients, 62 (30.2%) received the mAFP and 143 (69.8%) the IABP. There were no significant differences in 180-day mortality between the devices (P=0.86). Further investigation according to the Society for Cardiovascular Angiography and Intervention (SCAI) shock stage classification demonstrated that the mortality rate for SCAI C was significantly lower in the mAFP group (P=0.02), while mortality was not significantly different for SCAI D/E (P=0.71). The major and other complications were more frequent in the mAFP group (61.3% <i>vs.</i> 46.0%, P=0.02 and 90.3% <i>vs.</i> 68.8%, P<0.001, respectively). In multivariate analysis, age ≥75 years [hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.42-3.97], out-of-hospital cardiopulmonary arrest (OHCPA) (HR: 2.05, 95% CI: 1.04-4.08), ECMO use (HR: 5.05, 95% CI: 2.85-8.95) and major complications (HR: 2.11, 95% CI: 1.07-4.17) were independently associated with mortality. Moreover, age ≥75 years (HR: 2.06, 95% CI: 1.08-3.92) and ECMO use (HR: 6.67, 95% CI: 3.32-13.42) were independent predictors of major complications, whereas mAFP (<i>vs</i>. IABP) (HR: 5.27, 95% CI: 1.71-16.30), age ≥75 years (HR: 2.80, 95% CI: 1.28-6.11) and ECMO use (HR: 8.34, 95% CI: 2.33-29.9) were independent predictors of other complications.</p><p><strong>Conclusions: </strong>Classical CS attained benefit from the mAFP, whereas it is still challenging for patients with severe CS, particularly OHCPA and requirement for ECMO. The use of mAFP was associated with more complications and its true impact on clinical outcomes remains to be determined.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"2"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430972","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":"Calcific aortic valve disease: can targeting endothelial-mesenchymal transition be a new alternative to surgery?-a narrative review.","authors":"Chao Song, Tumin Sha, Chaoliang Liu, Jianqiang Li","doi":"10.21037/cdt-2025-373","DOIUrl":"10.21037/cdt-2025-373","url":null,"abstract":"<p><strong>Background and objective: </strong>Calcific aortic valve disease (CAVD) is a prevalent and progressive cardiovascular condition, particularly found in the elderly population, characterized by the thickening, calcification, and increased stiffness of the aortic valve leaflets. These structural changes lead to impaired valve function and ultimately contribute to heart failure and increased cardiovascular mortality. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) remain the only effective treatments but are associated with significant risks, high costs, and limited suitability for early-stage or asymptomatic patients. Therefore, the development of non-invasive, disease-modifying therapies is of critical importance. This review aims to summarize current evidence on the role of endothelial-mesenchymal transition (EndMT) in the pathogenesis of CAVD and to explore its potential as a therapeutic target for future non-surgical interventions.</p><p><strong>Methods: </strong>A comprehensive literature search was performed in PubMed, Web of Science, and Embase. Studies related to aortic valve stenosis published between January 1, 2019 and December 20, 2024, as well as all available reports on EndMT published prior to the search date, were included. Only English-language publications were considered, and relevant findings were synthesized to support this review.</p><p><strong>Key content and findings: </strong>Recent studies have highlighted the pivotal role of EndMT in the pathogenesis of CAVD. EndMT contributes to valvular fibrosis, inflammation, and osteogenic differentiation, all of which drive disease progression. Targeting key EndMT-related pathways-such as transforming growth factor-β (TGF-β), Notch, and Wnt-offers promising therapeutic potential. Moreover, combining EndMT-targeted strategies with anti-inflammatory and anti-calcification interventions may enable early-stage intervention, thereby slowing disease progression and reducing reliance on surgical treatments. This review summarizes current understanding of EndMT mechanisms in CAVD and explores emerging therapeutic strategies beyond current surgical options.</p><p><strong>Conclusions: </strong>CAVD progresses through complex mechanisms involving inflammation, lipid deposition, and osteoblastic differentiation. EndMT has emerged as a key driver of fibrosis and osteogenesis in valve mesenchymal cells, thereby accelerating calcification. However, its regulatory networks and pathway interactions remain incompletely understood. Further research is needed to clarify these mechanisms and develop EndMT-targeted interventions, which may offer new avenues for early diagnosis and treatment of CAVD.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"7"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430963","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":"Early diagnosis of acute experimental autoimmune myocarditis in mice with preserved left ventricular ejection fraction: a feasibility study based on 9.4 T magnetic resonance.","authors":"Wenjing Zhao, Qinfang Miao, Yan Chen, Chuangwei Wei, Nan Zhang, Jiayi Liu, Lei Xu, Haikun Qi, Zhaoying Wen","doi":"10.21037/cdt-2025-500","DOIUrl":"10.21037/cdt-2025-500","url":null,"abstract":"<p><strong>Background: </strong>The application of ultrahigh-field cardiac magnetic resonance imaging (MRI), such as 9.4 T imaging, in mouse models remains challenging, especially under rapid heart rates (500-600 beats per minute), and its feasibility and reproducibility have yet to be thoroughly studied. Therefore, this study aimed to evaluate the feasibility and reproducibility of combining cardiac magnetic resonance feature tracking (CMR-FT)-derived strain parameters and conventional cardiac MRI parameters to image an acute experimental autoimmune myocarditis (EAM) mouse model under a 9.4 T ultrahigh field system and to assess its potential for the early diagnosis of acute EAM.</p><p><strong>Methods: </strong>This retrospective study (conducted from December 2023 to December 2024) included 45 male BALB/c mice (30 EAM mice and 15 controls). EAM mice were injected with Complete Freund's Adjuvant (CFA; Sigma-Aldrich) to induce myocarditis. The control mice were treated with equal amounts of normal saline at the same time and position as those in experimental mice. CMR was performed with a 9.4 T scanner (Biospec 94/30; Bruker BioSpin) at 7 days, which included precontrast T1, postcontrast T1 and T2, and extracellular volume fraction (ECV) mapping. Left ventricular (LV) strain was evaluated via feature tracking. The diagnostic performance of CMR was evaluated through receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>A total of 45 mice (30 EAM mice and 15 controls) were included. All parameters were feasible in the mice that underwent CMR, and there was excellent reliability, as indicated by intraclass correlation coefficients greater than 0.9 for both intra- and interobserver agreement across all parameters. Intra- and interobserver agreement was analyzed by intraclass correlation coefficients (ICC). EAM mice demonstrated significantly impaired strain parameters compared to healthy controls [global radial strain (GRS): 34.07%±2.49% <i>vs.</i> 38.20%±2.76%, P<0.001; global circumferential strain: -19.44%±1.40% <i>vs.</i> -21.4%±2.37%, P=0.001; global longitudinal strain: -17.03%±1.64% <i>vs.</i> -19.04%±2.03%; P=0.001]. In ROC analyses, combining GRS with T2 generated the best parameter for identifying acute myocarditis (area under the curve, 0.882; sensitivity, 88.7%; specificity, 82.0%) and provided incremental diagnostic value.</p><p><strong>Conclusions: </strong>The feasibility of LV strain parameters combined with CMR conventional sequences in identifying EAM in mice at 9.4 T CMR has good reproducibility. For mice with preserved LV ejection fraction, the combination of T2 and GRS can significantly increase the ability to predict EAM within 7 days and provides incremental value as compared to conventional CMR parameters.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"16 1","pages":"6"},"PeriodicalIF":2.2,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430991","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":"Antigen carbohydrate 125 as a prognostic biomarker in patients with stable chronic heart failure.","authors":"Paula Guedes Ramallo, Marina Martínez Moreno, Andrea Romero Valero, Nuria Vicente Ibarra, Antonio García Honrubia, Manuel Jesús Gomez Martínez, Jesús Castillo Castillo, Alejandro Martínez-Rodríguez, Julio Núñez Villota, Pedro Morillas Blasco","doi":"10.21037/cdt-2025-244","DOIUrl":"10.21037/cdt-2025-244","url":null,"abstract":"<p><strong>Background: </strong>Carbohydrate antigen 125 (CA125) has been associated with a higher risk of mortality and readmission after an acute heart failure (HF) episode. However, the utility of CA125 in evaluating prognosis in chronic and stable HF is not yet established. The aim of this prospective study was to assess whether there is prognostic value of plasma CA125 in chronic HF population with reduced ejection fraction (HFrEF) after a long period of clinical stability.</p><p><strong>Methods: </strong>Prospective cohort study that included consecutive patients with stable HFrEF who were followed in the outpatient HF clinic of the General University Hospital of Elche (Alicante, Spain) between July 2018 and January 2019. Stability was defined as the absence of hospital admissions due to HF symptoms or use of intravenous diuretics for at least six months before the inclusion date. The primary outcome was all-cause mortality related to CA125. The secondary endpoints were HF admissions and total cardiovascular (CV) admissions. The association between CA125 and recurrent hospitalizations was evaluated by the Famoye bivariate Poisson regression model.</p><p><strong>Results: </strong>The study included 116 patients [69±12 years, 71.6% males, left ventricular ejection fraction 33.4%±7.1%; 52.6% in New York Heart Association class I (indicating long-term stability)]. The median CA125 value was 9.15 U/mL [interquartile range (IQR), 6.15-14.08 U/mL]. During a median follow-up of 18 months (IQR, 13-19 months), there were 13 deaths, 47 HF admissions, and 60 CV admissions. After multivariate adjustment, patients with CA125 >9.15 U/mL had higher rates of HF admissions [incidence rate ratio (IRR) 2.49; 95% confidence interval (CI): 1.14-5.44; P=0.02] and CV admissions (IRR 1.88; 95% CI: 1.01-3.52; P=0.04) compared with those with lower levels. Higher CA125 values were also associated with an increased risk of mortality in a non-linear fashion (P=0.02). Additionally, CA125 levels correlated with serum sodium (P<0.001), inferior vena cava diameter (P=0.03), and inflammatory status (P=0.01).</p><p><strong>Conclusions: </strong>In patients with stable chronic HFrEF, higher plasma CA125 was associated with an increase in the burden of mid-term morbidity and mortality. CA125 could be a surrogate marker of residual congestion and inflammatory activity in this particular scenario.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 6","pages":"1161-1173"},"PeriodicalIF":2.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12775155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932296","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}