Pub Date : 2026-01-22eCollection Date: 2025-01-01DOI: 10.3389/fcvm.2025.1740710
Darijan Ribic, Espen W Remme, Otto A Smiseth, Richard J Massey, Christian H Eek, John-Peder Escobar Kvitting, Lars Gullestad, Kaspar Broch, Kristoffer Russell
Background and aims: Conventional echocardiographic measurements like ejection fraction (EF) and global longitudinal strain (GLS) evaluate left ventricular (LV) function without considering concurrent loading conditions. A more comprehensive characterization of cardiac function and energetics can be achieved through pressure-volume analysis, but its clinical application is limited by the requirement for invasive measurements. We aimed to develop a clinically accessible, non-invasive method for pressure-volume loop analysis.
Methods: We obtained simultaneous 3-dimensional echocardiograms and invasive LV pressures with micromanometer-tipped catheters during transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Volume-time traces from the echocardiograms were combined with invasive LV pressures and non-invasive pressure estimates to construct pressure-volume loops. We used echocardiograms before and after TAVR to evaluate changes in myocardial function via non-invasive pressure-volume studies.
Results: In same-beat comparisons, stroke work calculated using non-invasive LV pressure estimations correlated well with stroke work calculated using invasive LV pressures (r = 0.95, ICC = 0.95, p < 0.0001, y = 0.90X + 1,836, mean bias -549 mmHg*mL, standard deviation 774 mmHg*mL; 95% limits of agreement: -2,006 to +967 mmHg*mL). After TAVR, stroke work fell substantially, ventricular efficiency increased, ventriculo-arterial coupling improved, and both total and resting energy consumption decreased. On the other hand, LV biplane EF and GLS remained unchanged.
Conclusions: This study confirms the validity and clinical accessibility of non-invasive pressure-volume loop analysis in patients with aortic stenosis. The method identified and characterized changes in myocardial energetics, function, and ventriculo-arterial interaction, that are not typically detected by conventional echocardiography. These findings highlight the potential of non-invasive pressure-volume analysis in clinical and research practice.
{"title":"Non-invasive pressure-volume analysis: a novel method for evaluating ventricular function in patients with aortic stenosis.","authors":"Darijan Ribic, Espen W Remme, Otto A Smiseth, Richard J Massey, Christian H Eek, John-Peder Escobar Kvitting, Lars Gullestad, Kaspar Broch, Kristoffer Russell","doi":"10.3389/fcvm.2025.1740710","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1740710","url":null,"abstract":"<p><strong>Background and aims: </strong>Conventional echocardiographic measurements like ejection fraction (EF) and global longitudinal strain (GLS) evaluate left ventricular (LV) function without considering concurrent loading conditions. A more comprehensive characterization of cardiac function and energetics can be achieved through pressure-volume analysis, but its clinical application is limited by the requirement for invasive measurements. We aimed to develop a clinically accessible, non-invasive method for pressure-volume loop analysis.</p><p><strong>Methods: </strong>We obtained simultaneous 3-dimensional echocardiograms and invasive LV pressures with micromanometer-tipped catheters during transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Volume-time traces from the echocardiograms were combined with invasive LV pressures and non-invasive pressure estimates to construct pressure-volume loops. We used echocardiograms before and after TAVR to evaluate changes in myocardial function via non-invasive pressure-volume studies.</p><p><strong>Results: </strong>In same-beat comparisons, stroke work calculated using non-invasive LV pressure estimations correlated well with stroke work calculated using invasive LV pressures (<i>r</i> = 0.95, ICC = 0.95, <i>p</i> < 0.0001, <i>y</i> = 0.90X + 1,836, mean bias -549 mmHg*mL, standard deviation 774 mmHg*mL; 95% limits of agreement: -2,006 to +967 mmHg*mL). After TAVR, stroke work fell substantially, ventricular efficiency increased, ventriculo-arterial coupling improved, and both total and resting energy consumption decreased. On the other hand, LV biplane EF and GLS remained unchanged.</p><p><strong>Conclusions: </strong>This study confirms the validity and clinical accessibility of non-invasive pressure-volume loop analysis in patients with aortic stenosis. The method identified and characterized changes in myocardial energetics, function, and ventriculo-arterial interaction, that are not typically detected by conventional echocardiography. These findings highlight the potential of non-invasive pressure-volume analysis in clinical and research practice.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1740710"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141086","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}
<p><strong>Aims: </strong>This study aims to investigate the effect of different diastolic blood pressure levels at discharge on the prognosis of patients with heart failure after acute myocardial infarction.</p><p><strong>Methods: </strong>This study included 642 patients hospitalized in the Department of Cardiology of Langfang People's Hospital who were diagnosed with heart failure after acute myocardial infarction between March 2017 and October 2022. Patients were divided according to diastolic blood pressure (DBP) at discharge into three groups: <70 mmHg (<i>n</i> = 122), 70-80 mmHg (<i>n</i> = 221), and >80 mmHg (<i>n</i> = 299) groups. The follow-up period was 12 months after discharge. The primary endpoint was a composite of all-cause mortality and all-cause readmission during follow-up. Secondary endpoints included the composite endpoint of cardiac death and cardiac readmission, as well as all-cause mortality, cardiac death, all-cause readmission, cardiac readmission, and heart failure-related readmission.</p><p><strong>Results: </strong>During the follow-up period, there were no significant differences among the three groups in the incidence of the primary endpoint (a composite of all-cause mortality and all-cause readmission) or secondary endpoints (the composite endpoint of cardiac death and cardiac readmission, all-cause mortality, cardiac death, all-cause readmission, cardiac readmission, and heart failure readmission) (<i>P</i> > 0.05). Cox regression analysis, adjusted for variables showing differences in the univariate analysis, showed that patients in the 70-80 mmHg group had a significantly higher risk of the primary endpoint than those in the <70 mmHg group (HR: 2.078, 95% CI: 1.009-4.280, <i>P</i> = 0.047). Compared with the <70 mmHg group, patients in the >80 mmHg group exhibited an increased risk of the primary endpoint (HR: 2.808, 95% CI: 1.216-6.481, <i>P</i> = 0.016), the composite endpoint of cardiac death and cardiac readmission (HR: 3.765, 95% CI: 1.393-10.176, <i>P</i> = 0.009), all-cause readmission (HR: 2.850, 95% CI: 1.197-6.789, <i>P</i> = 0.018), and cardiac readmission (HR: 3.376, 95% CI: 1.234-9.237, <i>P</i> = 0.018), with no significant differences observed for the remaining outcome measures. No significant differences in outcome indices were found between the >80 mmHg and 70-80 mmHg groups (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Different DBP levels at discharge in patients with heart failure after AMI are useful for patient prognosis evaluation. Maybe patients with heart failure after AMI with a low DBP (<70 mmHg) at discharge have a lower risk of all-cause mortality and all-cause readmission. Notably, the study population had a relatively high mean left ventricular ejection fraction, and a higher number of patients in the DBP < 70 mmHg group were treated with MRAs. Since MRAs themselves have blood pressure-lowering effects, their use may have influenced the results and prognosis. Therefore, u
{"title":"Effect of different diastolic blood pressure levels on the prognosis of patients with heart failure after acute myocardial infarction.","authors":"Xue Sun, Mengjie Lei, Xiao Wang, Jingyao Wang, Yachao Li, Cairong Li, Zhigang Zhao, Chunyan Zhang, Wanda Ma, Zengming Xue","doi":"10.3389/fcvm.2025.1703466","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1703466","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to investigate the effect of different diastolic blood pressure levels at discharge on the prognosis of patients with heart failure after acute myocardial infarction.</p><p><strong>Methods: </strong>This study included 642 patients hospitalized in the Department of Cardiology of Langfang People's Hospital who were diagnosed with heart failure after acute myocardial infarction between March 2017 and October 2022. Patients were divided according to diastolic blood pressure (DBP) at discharge into three groups: <70 mmHg (<i>n</i> = 122), 70-80 mmHg (<i>n</i> = 221), and >80 mmHg (<i>n</i> = 299) groups. The follow-up period was 12 months after discharge. The primary endpoint was a composite of all-cause mortality and all-cause readmission during follow-up. Secondary endpoints included the composite endpoint of cardiac death and cardiac readmission, as well as all-cause mortality, cardiac death, all-cause readmission, cardiac readmission, and heart failure-related readmission.</p><p><strong>Results: </strong>During the follow-up period, there were no significant differences among the three groups in the incidence of the primary endpoint (a composite of all-cause mortality and all-cause readmission) or secondary endpoints (the composite endpoint of cardiac death and cardiac readmission, all-cause mortality, cardiac death, all-cause readmission, cardiac readmission, and heart failure readmission) (<i>P</i> > 0.05). Cox regression analysis, adjusted for variables showing differences in the univariate analysis, showed that patients in the 70-80 mmHg group had a significantly higher risk of the primary endpoint than those in the <70 mmHg group (HR: 2.078, 95% CI: 1.009-4.280, <i>P</i> = 0.047). Compared with the <70 mmHg group, patients in the >80 mmHg group exhibited an increased risk of the primary endpoint (HR: 2.808, 95% CI: 1.216-6.481, <i>P</i> = 0.016), the composite endpoint of cardiac death and cardiac readmission (HR: 3.765, 95% CI: 1.393-10.176, <i>P</i> = 0.009), all-cause readmission (HR: 2.850, 95% CI: 1.197-6.789, <i>P</i> = 0.018), and cardiac readmission (HR: 3.376, 95% CI: 1.234-9.237, <i>P</i> = 0.018), with no significant differences observed for the remaining outcome measures. No significant differences in outcome indices were found between the >80 mmHg and 70-80 mmHg groups (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Different DBP levels at discharge in patients with heart failure after AMI are useful for patient prognosis evaluation. Maybe patients with heart failure after AMI with a low DBP (<70 mmHg) at discharge have a lower risk of all-cause mortality and all-cause readmission. Notably, the study population had a relatively high mean left ventricular ejection fraction, and a higher number of patients in the DBP < 70 mmHg group were treated with MRAs. Since MRAs themselves have blood pressure-lowering effects, their use may have influenced the results and prognosis. Therefore, u","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1703466"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140977","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}
Background: Research on biological age focused on the optimization and upgrading of aging clocks, which can now prospectively predict a variety of diseases. The biological age (BA) based on clinical parameters has shown predictive value for cardiovascular disease. However, evidence linking BA and its trajectories with heart failure (HF) remained limited. This study aimed to construct a clinical-parameter-based BA and to investigate its association, along with BA trajectories, with incident heart failure.
Methods: This study utilized data from the Kailuan Study, which included 76,908 Chinese adults who underwent their first health examination between 2006 and 2007. A deep neural network model was employed to estimate BA based on 32 clinical indicators. Participants were stratified into three groups-decelerated aging, accelerated aging, and normal aging-according to their baseline BA values. Six distinct aging trajectories were subsequently identified using data from the first three follow-up examinations. Cox proportional hazard models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between aging status or BA trajectories and HF incidence.
Results: Participants exhibiting accelerated aging demonstrated a 30% higher risk of HF (HR: 1.30; 95%CI: 1.19-1.43) compared to those with normal aging. Conversely, those following a high-stable trajectory demonstrated the highest risk of HF (HR: 1.79; 95%CI: 1.48-2.17). Additionally, when compared to the high-stable trajectory, the high-descending trajectory was linked to a significantly lower risk of HF (HR: 0.74; 95%CI: 0.60-0.91).
Conclusions: Accelerated biological aging significantly increased the risk of HF, whereas decelerated biological aging was linked to a reduced risk of HF. Individuals who consistently exhibited a higher level of biological aging were at the greatest risk for HF.
{"title":"The association of biological age and its trajectory with incident heart failure: a cohort study from China.","authors":"Yuhao Hu, Huayu Sun, Chenrui Zhu, Jing Hu, Jintao Tao, Bo Li, Qianxun Cai, Yutong Wu, Shuohua Chen, Shouling Wu, Yuntao Wu","doi":"10.3389/fcvm.2025.1651743","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1651743","url":null,"abstract":"<p><strong>Background: </strong>Research on biological age focused on the optimization and upgrading of aging clocks, which can now prospectively predict a variety of diseases. The biological age (BA) based on clinical parameters has shown predictive value for cardiovascular disease. However, evidence linking BA and its trajectories with heart failure (HF) remained limited. This study aimed to construct a clinical-parameter-based BA and to investigate its association, along with BA trajectories, with incident heart failure.</p><p><strong>Methods: </strong>This study utilized data from the Kailuan Study, which included 76,908 Chinese adults who underwent their first health examination between 2006 and 2007. A deep neural network model was employed to estimate BA based on 32 clinical indicators. Participants were stratified into three groups-decelerated aging, accelerated aging, and normal aging-according to their baseline BA values. Six distinct aging trajectories were subsequently identified using data from the first three follow-up examinations. Cox proportional hazard models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between aging status or BA trajectories and HF incidence.</p><p><strong>Results: </strong>Participants exhibiting accelerated aging demonstrated a 30% higher risk of HF (HR: 1.30; 95%CI: 1.19-1.43) compared to those with normal aging. Conversely, those following a high-stable trajectory demonstrated the highest risk of HF (HR: 1.79; 95%CI: 1.48-2.17). Additionally, when compared to the high-stable trajectory, the high-descending trajectory was linked to a significantly lower risk of HF (HR: 0.74; 95%CI: 0.60-0.91).</p><p><strong>Conclusions: </strong>Accelerated biological aging significantly increased the risk of HF, whereas decelerated biological aging was linked to a reduced risk of HF. Individuals who consistently exhibited a higher level of biological aging were at the greatest risk for HF.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1651743"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141475","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}
Pub Date : 2026-01-22eCollection Date: 2025-01-01DOI: 10.3389/fcvm.2025.1610295
Dongling Xu, Chi Zhang, Lin Hao, Shaojie Bi, Aiying Xue, Liangshuai Yuan, Wenke Wang
Combined methylmalonic aciduria and homocystinuria, cobalamin C (cblC) type, represents the most common inborn error of cobalamin metabolism, caused by pathogenic variants in the MMACHC gene. We report the case of a 27-year-old Chinese woman who presented with dilated cardiomyopathy and renal insufficiency. Blood amino acid and acylcarnitine profiling revealed elevated ratios of propionylcarnitine (C3) to acetylcarnitine (C2) and C3 to free carnitine (C0). Genetic testing identified compound heterozygous pathogenic variants in MMACHC-c.80A>G, p. (Gln27Arg) and c.609G>A, p. (Trp203Ter)-confirming the diagnosis of cblC-type methylmalonic aciduria with homocystinuria. Despite administration of vitamin B12 and betaine, her heart function did not improve. The patient eventually succumbed to severe COVID-19 infection, which led to metabolic acidosis, renal failure, and multi-organ failure. This case underscores the challenging clinical course of late-onset cblC disorder and contributes to its expanding phenotypic spectrum.
甲基丙二酸尿和同型半胱氨酸尿,即钴胺素C (cblC)型,是最常见的先天性钴胺素代谢错误,由MMACHC基因的致病性变异引起。我们报告一例27岁的中国妇女谁提出扩张性心肌病和肾功能不全。血液氨基酸和酰基肉碱分析显示丙酰基肉碱(C3)与乙酰肉碱(C2)和C3与游离肉碱(C0)的比值升高。基因检测鉴定出MMACHC-c的复合杂合致病变异。80A > G, p. (Gln27Arg)和c.609G > A, p. (Trp203Ter)-确认cblc型甲基丙二酸尿症合并同型半胱氨酸尿。尽管服用了维生素B12和甜菜碱,她的心脏功能并没有改善。患者最终死于严重的COVID-19感染,导致代谢性酸中毒、肾功能衰竭和多器官衰竭。该病例强调了迟发性慢性粒细胞白血病的临床过程的挑战性,并有助于扩大其表型谱。
{"title":"Case Report: Dilated cardiomyopathy as the initial presentation in an adult with late-onset CblC defect.","authors":"Dongling Xu, Chi Zhang, Lin Hao, Shaojie Bi, Aiying Xue, Liangshuai Yuan, Wenke Wang","doi":"10.3389/fcvm.2025.1610295","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1610295","url":null,"abstract":"<p><p>Combined methylmalonic aciduria and homocystinuria, cobalamin C (cblC) type, represents the most common inborn error of cobalamin metabolism, caused by pathogenic variants in the <i>MMACHC</i> gene. We report the case of a 27-year-old Chinese woman who presented with dilated cardiomyopathy and renal insufficiency. Blood amino acid and acylcarnitine profiling revealed elevated ratios of propionylcarnitine (C3) to acetylcarnitine (C2) and C3 to free carnitine (C0). Genetic testing identified compound heterozygous pathogenic variants in <i>MMACHC</i>-<i>c.80A</i> <i>></i> <i>G, p. (Gln27Arg)</i> and <i>c.609G</i> <i>></i> <i>A, p. (Trp203Ter)</i>-confirming the diagnosis of cblC-type methylmalonic aciduria with homocystinuria. Despite administration of vitamin B12 and betaine, her heart function did not improve. The patient eventually succumbed to severe COVID-19 infection, which led to metabolic acidosis, renal failure, and multi-organ failure. This case underscores the challenging clinical course of late-onset cblC disorder and contributes to its expanding phenotypic spectrum.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1610295"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141694","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}
Introduction: Telmisartan is a long-acting angiotensin II receptor blocker (ARB) with unique pharmacologic properties, including partial PPAR-γ activation. Its comparative effectiveness against other ARBs in real-world populations remains unclear.
Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including hypertensive patients aged 55-85 years without prior stroke, heart failure, or myocardial infarction. After 1:1 propensity score matching, 41,598 patients were included in each group.
Results: Telmisartan use was associated with a significantly lower risk of stroke (HR 0.805, 95% CI 0.751-0.863), heart failure (HR 0.75, 95% CI 0.672-0.836), and all-cause mortality (HR 0.59, 95% CI 0.542-0.642) compared to other ARBs. Subgroup analyses showed consistent benefits across sex, diabetes, chronic kidney disease, and hyperlipidemia.
Conclusions: In this large real-world matched cohort of over 83,000 patients, telmisartan was associated with superior cardiovascular and cerebrovascular outcomes compared to other ARBs, supporting its potential as a preferred antihypertensive agent in high-risk populations.
替米沙坦是一种长效血管紧张素II受体阻滞剂(ARB),具有独特的药理特性,包括部分PPAR-γ激活。在现实人群中,其与其他arb的比较效果尚不清楚。方法:我们使用TriNetX全球协作网络进行了一项回顾性队列研究,包括55-85岁无卒中、心力衰竭或心肌梗死的高血压患者。经1:1倾向评分匹配后,每组纳入41598例患者。结果:与其他arb相比,替米沙坦的使用与卒中(HR 0.805, 95% CI 0.751-0.863)、心力衰竭(HR 0.75, 95% CI 0.672-0.836)和全因死亡率(HR 0.59, 95% CI 0.542-0.642)的风险显著降低相关。亚组分析显示,在性别、糖尿病、慢性肾脏疾病和高脂血症中均有一致的益处。结论:在这个超过83,000名患者的大型现实匹配队列中,与其他arb相比,替米沙坦与更好的心脑血管预后相关,支持其作为高危人群首选降压药的潜力。
{"title":"Comparative effectiveness of telmisartan vs. other angiotensin receptor blockers in reducing hypertension-related cerebrovascular and cardiovascular events: a real-world retrospective study using the TriNetX network.","authors":"Tse-Yu Chen, Yi-Chun Lin, Guang-Yaw Liu, Hui-Chih Hung","doi":"10.3389/fcvm.2025.1715032","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1715032","url":null,"abstract":"<p><strong>Introduction: </strong>Telmisartan is a long-acting angiotensin II receptor blocker (ARB) with unique pharmacologic properties, including partial PPAR-γ activation. Its comparative effectiveness against other ARBs in real-world populations remains unclear.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including hypertensive patients aged 55-85 years without prior stroke, heart failure, or myocardial infarction. After 1:1 propensity score matching, 41,598 patients were included in each group.</p><p><strong>Results: </strong>Telmisartan use was associated with a significantly lower risk of stroke (HR 0.805, 95% CI 0.751-0.863), heart failure (HR 0.75, 95% CI 0.672-0.836), and all-cause mortality (HR 0.59, 95% CI 0.542-0.642) compared to other ARBs. Subgroup analyses showed consistent benefits across sex, diabetes, chronic kidney disease, and hyperlipidemia.</p><p><strong>Conclusions: </strong>In this large real-world matched cohort of over 83,000 patients, telmisartan was associated with superior cardiovascular and cerebrovascular outcomes compared to other ARBs, supporting its potential as a preferred antihypertensive agent in high-risk populations.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1715032"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141740","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}
Pub Date : 2026-01-22eCollection Date: 2026-01-01DOI: 10.3389/fcvm.2026.1728987
Thien Tan Tri Tai Truyen, Vu Ngoc Anh Pham, Huong-Dung Thi Nguyen
Sudden cardiac death (SCD) causes 180,000-360,000 annual deaths in the United States, with mortality rates exceeding 90%. Despite advances in resuscitation science, predicting SCD remains challenging due to inconsistent definitions, subtle warning signs, and temporal variability in risk factors. While traditional cardiovascular conditions are well-integrated into risk prediction models, non-cardiovascular comorbidities remain significantly underutilized despite contributing to nearly 40% of SCD cases. This review examines evidence linking various systemic conditions to SCD risk. Neurologic disorders including epilepsy (1.6-5.89-fold increased risk), depression (1.6-2.7-fold), and anxiety (1.6-fold) elevate SCD vulnerability through autonomic dysregulation and medication effects. Respiratory conditions like COPD (1.3-3.6-fold) and obstructive sleep apnea (1.6-2.6-fold) contribute through chronic hypoxemia and inflammation. Hepatic pathology, kidney disease, anemia, and endocrine disorders (particularly diabetes with 1.7-2.4-fold risk) also demonstrate significant associations. Critically, non-cardiovascular comorbidities predict not only SCD occurrence but also initial cardiac rhythm presentation-essential for determining implantable cardioverter-defibrillator candidates, as these devices only benefit shockable rhythms. Conditions like epilepsy, depression, COPD, liver cirrhosis, and chronic kidney disease correlate with predominantly non-shockable presentations. Current prediction models incorporate few non-cardiac conditions, primarily due to historical cardiac-centric approaches, sample size constraints, complex disease interactions, and overfitting concerns. Proposed solutions include multidisciplinary research collaboration, multicenter data pooling, and advanced machine learning techniques to develop more comprehensive and accurate SCD prediction algorithms.
{"title":"Beyond cardiac risk factors: non-cardiovascular comorbidities in sudden cardiac death prediction.","authors":"Thien Tan Tri Tai Truyen, Vu Ngoc Anh Pham, Huong-Dung Thi Nguyen","doi":"10.3389/fcvm.2026.1728987","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1728987","url":null,"abstract":"<p><p>Sudden cardiac death (SCD) causes 180,000-360,000 annual deaths in the United States, with mortality rates exceeding 90%. Despite advances in resuscitation science, predicting SCD remains challenging due to inconsistent definitions, subtle warning signs, and temporal variability in risk factors. While traditional cardiovascular conditions are well-integrated into risk prediction models, non-cardiovascular comorbidities remain significantly underutilized despite contributing to nearly 40% of SCD cases. This review examines evidence linking various systemic conditions to SCD risk. Neurologic disorders including epilepsy (1.6-5.89-fold increased risk), depression (1.6-2.7-fold), and anxiety (1.6-fold) elevate SCD vulnerability through autonomic dysregulation and medication effects. Respiratory conditions like COPD (1.3-3.6-fold) and obstructive sleep apnea (1.6-2.6-fold) contribute through chronic hypoxemia and inflammation. Hepatic pathology, kidney disease, anemia, and endocrine disorders (particularly diabetes with 1.7-2.4-fold risk) also demonstrate significant associations. Critically, non-cardiovascular comorbidities predict not only SCD occurrence but also initial cardiac rhythm presentation-essential for determining implantable cardioverter-defibrillator candidates, as these devices only benefit shockable rhythms. Conditions like epilepsy, depression, COPD, liver cirrhosis, and chronic kidney disease correlate with predominantly non-shockable presentations. Current prediction models incorporate few non-cardiac conditions, primarily due to historical cardiac-centric approaches, sample size constraints, complex disease interactions, and overfitting concerns. Proposed solutions include multidisciplinary research collaboration, multicenter data pooling, and advanced machine learning techniques to develop more comprehensive and accurate SCD prediction algorithms.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1728987"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141461","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}
Pub Date : 2026-01-22eCollection Date: 2026-01-01DOI: 10.3389/fcvm.2026.1737177
Mingzhuang Sun, Zhenze Yu
The management of ischemic heart disease has evolved from a narrow focus on low-density lipoprotein cholesterol (LDL-C) reduction to a comprehensive strategy targeting the regression and stabilization of coronary atherosclerotic plaque. Intravascular imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS), have been instrumental in characterizing the temporal sequence of plaque modification in response to lipid-lowering therapy. This review synthesizes evidence demonstrating that the effects on plaque are both time-dependent and agent-specific. Statins induce rapid plaque stabilization within weeks to months via mechanisms such asanti-inflammatory effects, fibrous cap thickening, and reduction of the lipid core. With prolonged treatment (months to years), statins promote plaque volume regression and facilitate a favorable shift in plaque composition towards a more stable, calcified phenotype. Non-statin agents further augment this regression. Ezetimibe, in combination with statins, provides synergistic LDL-C lowering and enhances plaque volume reduction. PCSK9 inhibitors, recognized as one of the most potent lipid-lowering agents currently available, have been shown in several studies to promote the regression of atherosclerotic plaques and reduce plaque volume. However, their effects on plaque composition-such as calcification, fibrous tissue, fibrofatty tissue, and necrotic core-remain controversial.
{"title":"Unraveling the temporal sequence of coronary atherosclerosis modification with lipid-lowering therapies through intravascular imaging: a narrative review.","authors":"Mingzhuang Sun, Zhenze Yu","doi":"10.3389/fcvm.2026.1737177","DOIUrl":"https://doi.org/10.3389/fcvm.2026.1737177","url":null,"abstract":"<p><p>The management of ischemic heart disease has evolved from a narrow focus on low-density lipoprotein cholesterol (LDL-C) reduction to a comprehensive strategy targeting the regression and stabilization of coronary atherosclerotic plaque. Intravascular imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS), have been instrumental in characterizing the temporal sequence of plaque modification in response to lipid-lowering therapy. This review synthesizes evidence demonstrating that the effects on plaque are both time-dependent and agent-specific. Statins induce rapid plaque stabilization within weeks to months via mechanisms such asanti-inflammatory effects, fibrous cap thickening, and reduction of the lipid core. With prolonged treatment (months to years), statins promote plaque volume regression and facilitate a favorable shift in plaque composition towards a more stable, calcified phenotype. Non-statin agents further augment this regression. Ezetimibe, in combination with statins, provides synergistic LDL-C lowering and enhances plaque volume reduction. PCSK9 inhibitors, recognized as one of the most potent lipid-lowering agents currently available, have been shown in several studies to promote the regression of atherosclerotic plaques and reduce plaque volume. However, their effects on plaque composition-such as calcification, fibrous tissue, fibrofatty tissue, and necrotic core-remain controversial.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"13 ","pages":"1737177"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141569","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}
Pub Date : 2026-01-22eCollection Date: 2025-01-01DOI: 10.3389/fcvm.2025.1681976
Diego Aguiar, Rafael Gonzalez-Manzanares, Manuel Raya-Cruz, Juan Carlos Romero-Vigara, Cristina Salazar Mosteiro, Alejandro J García Díaz, Victoria Gonzalez Pastor, Amaia Ugarte de Miguel, Eduard Ródenas-Alesina
Introduction: Heart failure (HF) poses a substantial global health burden due to its high prevalence and severe clinical outcomes. Early diagnosis is critical to optimize management and reduce the economic impact of HF. This scoping review consolidates existing knowledge on strategies to improve HF diagnosis, emphasizing the utility of biomarkers, imaging techniques, artificial intelligence (AI), and care pathways.
Methods: A systematic search of PubMed/Medline and Scopus databases identified 198 relevant studies published since 2010, focusing on adult populations without a prior HF diagnosis. The inclusion criteria centered on initiatives aimed at enhancing diagnostic processes.
Results: Results indicate that biomarkers, particularly natriuretic peptides such as N-terminal prohormone of BNP (NT-proBNP), are central to early HF detection, showing high sensitivity. Emerging biomarkers, like microRNAs, offer potential for improved diagnostic accuracy. Imaging techniques, including echocardiography and lung ultrasound, remain primary tools for assessing cardiac function, while AI applications in imaging and electronic health records represent a rapidly evolving field. These tools show promising potential for early identification of HF patients, although most require further validation and standardization before routine clinical implementation. Care pathways emphasizing high-resolution consultations and integrated diagnostic tools enable prompt HF diagnosis, crucial for initiating early treatments.
Discussion: By implementing these diagnostic strategies, particularly in high-risk populations such as those with comorbid conditions, there is potential to significantly advance patient outcomes and healthcare resource management. Nevertheless, it is essential to translate these advances and discoveries into clinical practice, considering healthcare context and socioeconomic limitations, and promoting international consensus to ensure their global adoption. In conclusion, ongoing research and refinement of these diagnostic tools are imperative to effectively address the growing challenge of HF.
{"title":"Improvement initiatives in the diagnostic process of heart failure: a scoping review.","authors":"Diego Aguiar, Rafael Gonzalez-Manzanares, Manuel Raya-Cruz, Juan Carlos Romero-Vigara, Cristina Salazar Mosteiro, Alejandro J García Díaz, Victoria Gonzalez Pastor, Amaia Ugarte de Miguel, Eduard Ródenas-Alesina","doi":"10.3389/fcvm.2025.1681976","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1681976","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure (HF) poses a substantial global health burden due to its high prevalence and severe clinical outcomes. Early diagnosis is critical to optimize management and reduce the economic impact of HF. This scoping review consolidates existing knowledge on strategies to improve HF diagnosis, emphasizing the utility of biomarkers, imaging techniques, artificial intelligence (AI), and care pathways.</p><p><strong>Methods: </strong>A systematic search of PubMed/Medline and Scopus databases identified 198 relevant studies published since 2010, focusing on adult populations without a prior HF diagnosis. The inclusion criteria centered on initiatives aimed at enhancing diagnostic processes.</p><p><strong>Results: </strong>Results indicate that biomarkers, particularly natriuretic peptides such as N-terminal prohormone of BNP (NT-proBNP), are central to early HF detection, showing high sensitivity. Emerging biomarkers, like microRNAs, offer potential for improved diagnostic accuracy. Imaging techniques, including echocardiography and lung ultrasound, remain primary tools for assessing cardiac function, while AI applications in imaging and electronic health records represent a rapidly evolving field. These tools show promising potential for early identification of HF patients, although most require further validation and standardization before routine clinical implementation. Care pathways emphasizing high-resolution consultations and integrated diagnostic tools enable prompt HF diagnosis, crucial for initiating early treatments.</p><p><strong>Discussion: </strong>By implementing these diagnostic strategies, particularly in high-risk populations such as those with comorbid conditions, there is potential to significantly advance patient outcomes and healthcare resource management. Nevertheless, it is essential to translate these advances and discoveries into clinical practice, considering healthcare context and socioeconomic limitations, and promoting international consensus to ensure their global adoption. In conclusion, ongoing research and refinement of these diagnostic tools are imperative to effectively address the growing challenge of HF.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1681976"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12874397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141160","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}
Background and aims: Atrial fibrillation (AF) frequently accompanies rheumatic mitral valve disease (MVD) and adversely affects postoperative outcomes. Radiofrequency ablation (RFA) and cryoablation are commonly used during mitral valve surgery, but their comparative impact on atrial remodeling in this population remains uncertain.
Methods: This retrospective cohort included 100 patients with rheumatic MVD and persistent AF who underwent mitral valve surgery with concomitant cryoablation (n = 50) or RFA (n = 50) between June 2020 and June 2024 at centers in the Almaty region, Kazakhstan. Clinical and echocardiographic parameters were assessed preoperatively, within 48 h postoperatively, and at 6 ± 2 months.
Results: Cryoablation was associated with greater left atrial (LA) volume reduction immediately and at follow-up (both p < 0.001). Multiple linear regression identified ablation modality as the only independent predictor of LA volume reduction (β = 27.9 mL, p < 0.0001), whereas duration of rheumatic disease, BMI, EuroSCORE II, and AF recurrence were not significant. At follow-up, the reduction in right atrial short-axis diameter was smaller after cryoablation (p = 0.049), and stroke volume declined less compared with RFA (-1.2 ± 17.3 mL vs. -7.3 ± 15.8 mL; p = 0.006). Cardiopulmonary bypass time, aortic cross-clamp time, and postoperative symptom improvement were comparable between groups. Freedom from AF during follow-up was also similar (log-rank p = 0.52).
Conclusions: In patients with persistent AF and rheumatic MVD undergoing mitral valve surgery, cryoablation was associated with more pronounced early atrial reverse remodeling and better preservation of stroke volume compared with RFA, without differences in operative efficiency or short-term safety. These findings should be considered hypothesis-generating, and prospective randomized studies with standardized lesion sets are required to confirm modality-specific effects.
背景和目的:房颤(AF)常伴有风湿性二尖瓣疾病(MVD),对术后预后有不利影响。射频消融(RFA)和冷冻消融是二尖瓣手术中常用的方法,但它们对该人群心房重构的比较影响仍不确定。方法:该回顾性队列包括2020年6月至2024年6月在哈萨克斯坦阿拉木图地区的中心接受二尖瓣手术并合并冷冻消融(n = 50)或RFA (n = 50)的100例风湿性MVD和持续性房颤患者。术前、术后48小时及术后6±2个月分别评估临床和超声心动图参数。结果:冷冻消融与立即和随访时更大的左心房(LA)容积减少相关(p β = 27.9 mL, p p = 0.049),与RFA相比,卒中容积下降较小(-1.2±17.3 mL vs -7.3±15.8 mL; p = 0.006)。体外循环时间、主动脉交叉夹夹时间和术后症状改善在两组间具有可比性。随访期间房颤发生率相似(log-rank p = 0.52)。结论:在接受二尖瓣手术的持续性房颤和风湿性MVD患者中,与RFA相比,冷冻消融与更明显的早期心房反向重构和更好的卒中容量保存相关,手术效率和短期安全性无差异。这些发现应该被认为是假设产生的,需要标准化病变组的前瞻性随机研究来确认模式特异性效应。
{"title":"Cryoablation and radiofrequency ablation during mitral valve surgery for rheumatic mitral valve disease: a retrospective cohort study.","authors":"Zhanar Nurbay, Auyeskhan Dzhumabekov, Roza Kuanishbekova, Rustem Tuleutayev, Nurzhan Musrepov","doi":"10.3389/fcvm.2025.1659310","DOIUrl":"https://doi.org/10.3389/fcvm.2025.1659310","url":null,"abstract":"<p><strong>Background and aims: </strong>Atrial fibrillation (AF) frequently accompanies rheumatic mitral valve disease (MVD) and adversely affects postoperative outcomes. Radiofrequency ablation (RFA) and cryoablation are commonly used during mitral valve surgery, but their comparative impact on atrial remodeling in this population remains uncertain.</p><p><strong>Methods: </strong>This retrospective cohort included 100 patients with rheumatic MVD and persistent AF who underwent mitral valve surgery with concomitant cryoablation (<i>n</i> = 50) or RFA (<i>n</i> = 50) between June 2020 and June 2024 at centers in the Almaty region, Kazakhstan. Clinical and echocardiographic parameters were assessed preoperatively, within 48 h postoperatively, and at 6 ± 2 months.</p><p><strong>Results: </strong>Cryoablation was associated with greater left atrial (LA) volume reduction immediately and at follow-up (both <i>p</i> < 0.001). Multiple linear regression identified ablation modality as the only independent predictor of LA volume reduction (<i>β</i> = 27.9 mL, <i>p</i> < 0.0001), whereas duration of rheumatic disease, BMI, EuroSCORE II, and AF recurrence were not significant. At follow-up, the reduction in right atrial short-axis diameter was smaller after cryoablation (<i>p</i> = 0.049), and stroke volume declined less compared with RFA (-1.2 ± 17.3 mL vs. -7.3 ± 15.8 mL; <i>p</i> = 0.006). Cardiopulmonary bypass time, aortic cross-clamp time, and postoperative symptom improvement were comparable between groups. Freedom from AF during follow-up was also similar (log-rank <i>p</i> = 0.52).</p><p><strong>Conclusions: </strong>In patients with persistent AF and rheumatic MVD undergoing mitral valve surgery, cryoablation was associated with more pronounced early atrial reverse remodeling and better preservation of stroke volume compared with RFA, without differences in operative efficiency or short-term safety. These findings should be considered hypothesis-generating, and prospective randomized studies with standardized lesion sets are required to confirm modality-specific effects.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1659310"},"PeriodicalIF":2.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141752","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}
Pub Date : 2026-01-21eCollection Date: 2025-01-01DOI: 10.3389/fcvm.2025.1625385
Zachary Kiernan, Gina Labate, Qun Chen, Mohammed Quader
Introduction: Two predominant pathways contribute to ischemia reperfusion injury (IRI) following donation after circulatory death (DCD): mitochondrial permeability transition pore (MPTP) opening and Calpain-1 (CPN1) activation. Each pathway has established inhibitors; Cyclosporine A (CyA) and MDL-28170 (MDL), respectively, which are effective in modulating IRI in a DCD heart with 25 min of warm ischemia time (WIT). We studied the effect of co-administering CyA and MDL during reperfusion on infarct size and graft function in DCD rat hearts with extended WIT of 35 min.
Methods: Male rats were exposed to 35 min of warm ischemia followed by 90 min of reperfusion. During reperfusion, hearts were given either 0.5 mM of CyA, 10 mM of MDL, or mixed CyA and MDL. Cardiac function and coronary flow rates were monitored throughout reperfusion and infarct size at the end of reperfusion.
Results: Infarct size in hearts treated with mixed CyA + MDL (31.59 ± 7.1%) was less than that of MDL-treated hearts (33.26 ± 4.3%) but larger than CyA-treated hearts (25.49 ± 5.9%). Graft function and coronary flow rates were variable amongst groups. CyA-treated hearts had more profound infarct size reduction when compared to MDL, and no additional synergistic effect was seen with combination treatment.
Discussion: Our results indicate that MPTP opening contributes significantly to the development of IRI in DCD hearts.
介绍:两种主要途径有助于循环死亡(DCD)捐赠后缺血再灌注损伤(IRI):线粒体通透性过渡孔(MPTP)开放和Calpain-1 (CPN1)激活。每种途径都有确定的抑制剂;环孢素A (CyA)和MDL-28170 (MDL)分别可有效调节DCD心脏25 min热缺血时间(WIT)的IRI。我们研究了再灌注时同时给予CyA和MDL对延长WIT 35 min的DCD大鼠心肌梗死面积和移植物功能的影响。方法:雄性大鼠热缺血35 min,再灌注90 min。再灌注时,心脏分别给予0.5 mM CyA、10 mM MDL或CyA和MDL混合。在再灌注过程中监测心功能和冠状动脉血流率,在再灌注结束时监测梗死面积。结果:CyA + MDL混合治疗心肌梗死面积(31.59±7.1%)小于MDL治疗心肌梗死面积(33.26±4.3%),但大于CyA治疗心肌梗死面积(25.49±5.9%)。各组间移植物功能和冠状动脉血流率不同。与MDL相比,cya治疗的心脏有更深刻的梗死面积缩小,并且与联合治疗没有额外的协同作用。讨论:我们的研究结果表明,MPTP开放对DCD心脏IRI的发展有重要作用。
{"title":"Reducing mitochondrial dysfunction through combination therapy to limit ischemia-reperfusion injury in male DCD rats.","authors":"Zachary Kiernan, Gina Labate, Qun Chen, Mohammed Quader","doi":"10.3389/fcvm.2025.1625385","DOIUrl":"10.3389/fcvm.2025.1625385","url":null,"abstract":"<p><strong>Introduction: </strong>Two predominant pathways contribute to ischemia reperfusion injury (IRI) following donation after circulatory death (DCD): mitochondrial permeability transition pore (MPTP) opening and Calpain-1 (CPN1) activation. Each pathway has established inhibitors; Cyclosporine A (CyA) and MDL-28170 (MDL), respectively, which are effective in modulating IRI in a DCD heart with 25 min of warm ischemia time (WIT). We studied the effect of co-administering CyA and MDL during reperfusion on infarct size and graft function in DCD rat hearts with extended WIT of 35 min.</p><p><strong>Methods: </strong>Male rats were exposed to 35 min of warm ischemia followed by 90 min of reperfusion. During reperfusion, hearts were given either 0.5 mM of CyA, 10 mM of MDL, or mixed CyA and MDL. Cardiac function and coronary flow rates were monitored throughout reperfusion and infarct size at the end of reperfusion.</p><p><strong>Results: </strong>Infarct size in hearts treated with mixed CyA + MDL (31.59 ± 7.1%) was less than that of MDL-treated hearts (33.26 ± 4.3%) but larger than CyA-treated hearts (25.49 ± 5.9%). Graft function and coronary flow rates were variable amongst groups. CyA-treated hearts had more profound infarct size reduction when compared to MDL, and no additional synergistic effect was seen with combination treatment.</p><p><strong>Discussion: </strong>Our results indicate that MPTP opening contributes significantly to the development of IRI in DCD hearts.</p>","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":"12 ","pages":"1625385"},"PeriodicalIF":2.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124379","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}