Search Results (1,200)

Sarcopenia, the loss of skeletal muscle mass and function, is a common and critical comorbidity in patients with conditions frequently managed by interventional radiologists, such as liver cirrhosis and hepatocellular carcinoma (HCC). Interventional radiologists are well positioned to incorporate opportunistic screening for this condition during routine preprocedural cross-sectional imaging. This review summarizes the current evidence on how sarcopenia influences patient outcomes and informs procedural planning across a spectrum of interventional radiology (IR) procedures. In transarterial embolizations for HCC, sarcopenia is a robust independent predictor of increased mortality, with meta-analyses suggesting it may also predict a lower tumor response rate. Even earlier stages of muscle loss (pre-sarcopenia) are associated with worse survival, and dynamic changes in muscle mass post-treatment can serve as a biomarker for tumor progression. For patients undergoing transjugular intrahepatic portosystemic shunt, pre-procedural sarcopenia and myosteatosis are strong, independent predictors of both mortality and the development of post-procedural hepatic encephalopathy, with the presence of both conferring the highest risk. In the context of pre-surgical portal vein embolization, sarcopenia is consistently associated with impaired volumetric liver growth, although this does not always translate to worse short-term surgical outcomes, as functional liver regeneration may be preserved. Following percutaneous liver tumor ablation, sarcopenia is a powerful predictor of overall mortality, while its role in predicting tumor recurrence remains an area of active investigation. Finally, in non-oncologic interventions for peripheral arterial disease, sarcopenia is highly prevalent and is associated with worse functional status, higher mortality, and a significantly increased risk of major amputation after endovascular therapy. In conclusion, sarcopenia is a powerful and readily available biomarker that provides crucial prognostic information—often independent of standard clinical scores—across a wide spectrum of IR procedures. The consistent evidence supports integrating sarcopenia evaluation into routine practice to enhance risk stratification, improve patient counseling, and guide multidisciplinary treatment planning. Full article

Background: Peripheral Artery Disease (PAD) of the lower extremities is a prevalent manifestation of atherosclerotic disease, significantly affecting individuals aged 55–70, with a global incidence of 4–12%. Major risk factors include smoking, diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease, all contributing to endothelial damage and subsequent plaque progression. This retrospective study examines the outcomes of endovascular treatment for TASC C and D lesions, which are complex cases that have historically required surgical intervention. Methods: From June 2022 to September 2023, 48 patients were analyzed, with a mean age of 67.48 years; 37.5% were female. Statins were administered to 64.6% of patients, and 93.8% received antiplatelet therapy. Endovascular procedures included balloon angioplasty, stenting, and the use of drug-eluting balloons (DEB), employing varying access routes, primarily via percutaneous approaches. Results: The study revealed a 12-month primary patency rate of 75.8% and a secondary patency rate of 95.5%, highlighting the effectiveness of follow-up interventions. Complications occurred in 10.4% of cases, with a perioperative mortality rate of 0%. Notably, 29.2% of patients required amputation, reflecting the severity of PAD. Conclusions: The outcomes demonstrate that endovascular treatment may be a viable alternative for managing TASC C and D lesions, offering satisfactory clinical outcomes and an acceptable safety profile. Continuous monitoring and interdisciplinary evaluations are essential for optimizing patient care and minimizing complications. As endovascular technologies advance, their role in treating severe peripheral arterial disease is likely to expand. Full article

Background: Familial hypercholesterolemia (FH) is a monogenic disorder causing markedly elevated low-density lipoprotein cholesterol (LDL-C) and premature atherosclerosis. Glucose-6-phosphate dehydrogenase (G6PD) is a key enzyme in antioxidant defense via NADPH production. G6PD deficiency, an X-linked disorder impairing redox homeostasis, may contribute to cardiovascular disease (CVD) risk. This study examined whether G6PD deficiency increases CVD risk in FH patients. Methods: We retrospectively analyzed 217 FH patients. Clinical data included demographics, lipid profiles, G6PD status, and atherosclerotic CVD outcomes (coronary, cerebrovascular, or peripheral arterial disease). In a subset, FH was confirmed by LDLR gene sequencing, and G6PD Mediterranean and Seattle variants were genotyped. Cumulative CVD prevalence was compared between G6PD-deficient and G6PD-normal FH patients. Multivariable logistic regression was adjusted for age, sex, body mass index, high blood pressure, and smoking. Results: Participants (mean age 47 years, 60% female) had markedly elevated LDL-C (mean 292 mg/dL at diagnosis). Atherosclerotic CVD was present in 119 (55%) patients. G6PD-deficient FH patients had a significantly higher CVD prevalence than those with normal G6PD activity (77.4% vs. 39.8%, p < 0.0001). LDL-C levels were higher in the G6PD-deficient group than in the non-deficient group, and this difference reached statistical significance in the univariate analysis. In the multivariable analysis, G6PD deficiency remained an independent CVD predictor (adjusted OR 3.57, 95% CI 1.30–9.83) after controlling for conventional risk factors. Conclusions: In FH, hereditary G6PD deficiency is associated with a markedly increased risk of atherosclerotic CVD. A pro-oxidative state in G6PD-deficient FH patients may play a role in premature atherogenesis. G6PD status may represent a cardiovascular risk modifier in FH, warranting further research into underlying mechanisms and targeted management. Full article

Peripheral arterial disease (PAD) is a complex, multifactorial atherosclerotic disease that primarily affects the arteries supplying the lower extremities, causing significant occlusion and reduced blood flow. Several studies have found an association between PAD and both genetic and environmental factors, which play a key role in the disease’s pathophysiology. Therefore, in this review, we describe the main genetic variants associated with plaque initiation, progression, and rupture in PAD. Furthermore, we identify different KEGG pathways involved in the pathological processes of these genes. We also describe gene expressions or transcriptomic studies, particularly in biopsies from patients with PAD. These findings could help identify the functional impact of genetic variants on the disease phenotype and, consequently, allow for the development of appropriate interventions that improve patient prognoses. Full article

Background: Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a severe complication. Surgical explantation of infected transcatheter heart valves (THV) is technically demanding and associated with high mortality. Data on risk factors for perioperative death and long-term outcomes remain limited. Aim: To identify predictors of mortality in patients undergoing surgical aortic valve replacement (SAVR) for IE after TAVR. Methods: We conducted a case–control study of patients treated with SAVR for IE after TAVR at our center between February 2008 and December 2023. Fifteen patients who died in hospital (cases) were compared with 35 perioperative survivors (controls). Hospital survivors were followed for long-term outcomes. Results: Age, sex, comorbidities (kidney disease, cerebrovascular disease, COPD, diabetes, peripheral artery disease), and anthropometrics were similar between groups. Cases had significantly lower left ventricular function and higher logistic EuroSCORE and STS-PROM before surgery. Causative microorganisms, cross-clamp time, and concomitant procedures did not differ. Postoperative pacemaker implantation, rethoracotomy, stroke, and ICU or hospital stay were comparable, while dialysis was more frequent in cases (44% vs. 25.7%). Median follow-up was 294 days (range 1–3802). Survival was 79.8% at 30 days and 67.4% at 1 year. Of 35 hospital survivors, 29 were discharged home, 6 to rehabilitation/other hospitals; 31 remain alive (1 early, 3 late deaths). Conclusions: SAVR for IE after TAVR carries high early mortality (18.1% at 30 days; 32.6% at 1 year). Higher preoperative risk scores and postoperative dialysis were associated with perioperative death. Long-term survival among hospital survivors is favorable, with most patients regaining independent living. Full article

Diabetes mellitus increases the risk of developing coronary artery disease, stroke, aortic disease, heart failure, atrial fibrillation, and peripheral arterial disease. This condition negatively impacts prognosis by increasing the risk of future cardiovascular (CV) events. Patients with type 2 diabetes mellitus need a comprehensive and personalized assessment and definition of the CV risk profile. In very high-risk individuals, special attention is required due to the high risk of adverse events despite appropriate management and treatment. Key interventions to reduce this risk include CV prevention and cardiac rehabilitation. Traditional and non-traditional CV risk factor management, dietary modifications, regular physical activity, aerobic and resistance exercise training, psychosocial and frailty management, optimal pharmacological therapy, and investigation of comorbidities are recommended to reduce the development of CV disease and mortality. Therefore, our manuscript provides updated and critical evidence on the comprehensive management of patients with type 2 diabetes mellitus in clinical practice from the perspective of CV prevention and cardiac rehabilitation, with a focus on individuals at very high risk. Further, practical guidance on individualizing exercise prescriptions based on patient-specific risk profiles and comorbid conditions is provided. Full article

Background: Aerobic and resistance training have acute effects on blood pressure (BP) in peripheral arterial disease (PAD). However, the combined effect of both exercises in a single session is still unknown. The aim of this study was to analyze the effects of a single exercise session combining walking and circuit-based training on BP in patients with PAD. Methods: Participants with PAD (n = 13; 65.0 ± 10.2 years; 76.9% male) underwent a supervised exercise therapy (SET) intervention (312 sessions, 24 sessions/patient) that included 15–30 min of walking, followed by 15 min circuit-based training. Clinic systolic (SBP) and diastolic (DBP) were recorded 5 min before and after each exercise session. Longitudinal changes were analyzed using repeated-measures analysis of variance (ANOVA) and categorical changes in blood pressure levels were evaluated with chi-square tests. Results: After each exercise session, clinic SBP decreased 4.87 mmHg (p < 0.001) and clinic DBP decreased 2.11 mmHg (p < 0.001). Furthermore, there were no differences between the initial stage of training (1–10 sessions) and late (14–24 sessions) for each time that SBD or DBP were measured. Conclusions: After an acute exercise session, both clinical SBP and DBP decreased in patients with PAD compared to pre-exercise values. However, no additional reductions in clinical BP were observed when comparing early (sessions 1–10) and late (sessions 14–24) stages of the full SET intervention. Full article

Coronary Artery Disease (CAD), mainly due to the progressive development of atherosclerotic plaques, is one of the world’s leading causes of mortality and morbidity. A significant percentage of initial events (around 30%) remain fatal to this day despite significant advances in the diagnosis and treatment of cardiovascular diseases (CVDs). Early detection and risk stratification are therefore essential. In this study, we adopted a multi-omics approach integrating transcriptomic (RNA-seq) and epigenomic (ATAC-seq) profiling of peripheral blood mononuclear cells (PBMCs) from a cohort of individuals undergoing clinically indicated cardiac computed tomography angiography (CCTA) to uncover potential novel molecular markers of CAD. We identified 39 genes consistently dysregulated across all CAD subtypes. ATAC-seq analysis revealed distinct chromatin accessibility patterns at CAD-associated loci, with a predominance of quiescent and transcriptionally active states. Validation in an independent cohort confirmed the expression patterns of key Differentially Expressed Genes (DEGs), such as Claudin 18 (CLDN18), supporting the robustness of our findings. Consequently, the integration of multi-omics data allowed us to identify a core gene signature and regulatory patterns associated with disease severity, offering potential biomarkers for clinical risk stratification in patients with CAD. Full article

Background: Inguinal wound healing disorders have been a relevant problem in the surgical treatment of peripheral arterial occlusive disease (PAD) for decades with reported rates of up to 30%. Despite the otherwise diverse innovations in vascular surgery, there are hardly any improvements in this area, on the contrary, comorbidities such as obesity, as relevant risk factors, continue to increase. The application of cold atmospheric plasma (CAP) has in turn shown promise in approaches for the treatment of chronic wounds, we therefore evaluated the potential reduction in inguinal wound healing disorders through the intraoperative application of CAP. Methods: We carried out a pilot study including 50 patients with a high risk for inguinal wound healing disorders that underwent a peripheral arterial reconstruction with inguinal access. Alternately, these patients were treated once intraoperatively with CAP (n = 25) or served as the control group (n = 25). The wound condition was then evaluated for the next fourteen days, with a follow up of three months. Results: The two groups showed no differences regarding risk factors such as smoking, obesity, PAD stage or surgery-related aspects like incision length or duration of surgery. No differences were found regarding wound-related readmission. However, the patients who had been treated intraoperatively with CAP showed a significant reduction in the need for surgical revisions due to inguinal wound healing disorders (8% vs. 32%, p = 0.034). Conclusions: This pilot study shows that the intraoperative use of CAP could be a promising approach to reduce major inguinal wound healing disorders. Full article

Background/Objectives: Exercise capacity and patient prognosis are heavily influenced by comorbidities. However, the specific impact of individual comorbid conditions on objective measures of exercise performance remains insufficiently characterized. The study aimed to identify predictors of reduced physical capacity in patients qualified for cardiac rehabilitation. Methods: A single-center retrospective analysis was conducted on 518 patients qualified for cardiac rehabilitation. After excluding 51 post-cardiac surgery patients, cardiopulmonary exercise testing data from 425 patients (316 men, median age 63 years) were analyzed. Comorbidities data, peak oxygen uptake (peak VO₂), and the ventilation-to-carbon dioxide output slope (VE/VCO₂ slope) were evaluated. Results: A significantly reduced exercise capacity (peak VO₂ < 70% of the predicted value) was observed in 29.4% of patients, while an increased VE/VCO₂ slope (≥36) was noted in 20.8% of patients. Univariate logistic regression identified sex, heart failure, valvular disease, peripheral artery disease, diabetes mellitus (T2DM), chronic kidney disease (CKD), Charlson Comorbidity Index (CCI), left ventricular ejection fraction <50%, diastolic dysfunction, and anemia as predictors of both reduced peak VO₂ and a steeper VE/VCO₂ slope. Multivariate regression analysis further identified T2DM and CKD as independent predictors of reduced peak VO₂, while sex, CKD, and CCI were independent predictors of a steeper VE/VCO₂ slope. Conclusions: Among patients qualified for cardiac rehabilitation, patient’s sex, T2DM, CKD, and the CCI emerged as key predictors of reduced exercise capacity. Reduced peak VO₂ was more commonly observed in men, while women more frequently exhibited a steeper VE/VCO₂ slope, indicating potential sex-related physiological mechanisms influencing exercise performance. Full article

Epidemiological studies have shown that the prevalence of diabetic peripheral neuropathy (DPN) will increase. Currently, DPN is treated medically. In many instances, the outcome is less than satisfactory, and the treatment is associated with side effects. We report a case of severe DPN and peripheral artery disease that are refractory to medical treatment. The patient was treated by external counterpulsation (ECP), electrical neuromuscular stimulation, a footbath in CO₂-enriched water, and hydrogen inhalation, all of which are considered off-label. The patients also took L α-lipoic acid and vitamin B12 and were advised on lifestyle modification. The combination of treatments significantly improved the patient’s pain and claudication distance, increasing it from 16 m to 300–400 m. Additionally, as a result of the decrease in nocturnal pain, the patient experienced restful sleep. The reasons for the improvement in subjective symptoms are unclear, as changes in objective vascular and neurological measurements were inconsistent with the subjective improvement. This dissociation highlights the need for further research. Given the symptomatic relief observed, however, such alternative therapies could be considered on a case-by-case basis for patients with DPN who have limited treatment options. Full article

Platelets play pivotal roles in thromboembolic diseases, such as myocardial infarction and ischemic stroke. In patients envenomed by the snake Vipera a. ammodytes (Vaa), pronounced and transient thrombocytopenia without bleeding is observed. We previously showed that Vaa-snaclec-3/2, the snake venom C-type lectin-like protein, mediates this effect ex vivo. Here, we extended our study of the antithrombotic potential of this protein in vivo using a mouse model of ferric chloride (FeCl₃)-induced carotid artery thrombosis. Prior to inducing thrombus formation, the mice received 1, 5, 10, 20, or 50 μg/kg Vaa-snaclec-3/2 intravenously. Afterward, the arterial blood flow was monitored with a perivascular Doppler probe. Additionally, the platelet count in the peripheral venous blood; tail bleeding time; and liver, lung, kidney, spleen, and heart histology were evaluated. The lowest dose of Vaa-snaclec-3/2 that we showed to cause severe thrombocytopenia and completely inhibit FeCl₃-induced thrombus formation was 20 µg/kg. This dose prolonged the median tail bleeding time from 86.5 to 153.5 s but did not induce acute spontaneous hemorrhage, as demonstrated by histological analysis. Histology revealed no signs of apoptosis, necrosis or other degenerative changes in the inspected organs of mice exposed to 20 μg/kg Vaa-snaclec-3/2. Platelet clusters were observed only in the lungs, which appear to be the primary site of platelet sequestration and the cause of thrombocytopenia. Taken together, our findings highlight the high potential of Vaa-snaclec-3/2 as a safe and effective antithrombotic agent for the transient prevention of thrombosis in acute clinical settings. Full article

Cardiovascular diseases remain the leading cause of death worldwide and are often managed through invasive surgical procedures such as heart transplantation, ventricular assist device implantation, coronary artery bypass grafting, and stent placement. However, significant unmet medical needs persist in this field. The development of pharmaceutical agents using non-invasive delivery strategies is therefore of critical importance. Current treatments often target peripheral tissues or organs—such as capillary endothelial cells, vascular smooth muscle, and renal tubules—to reduce cardiac workload by lowering blood pressure. However, effective drug delivery directly to the myocardium continues to pose a significant challenge. For conditions such as congestive heart failure (CHF) and myocardial infarction (MI), targeted delivery of therapeutic agents to the heart is essential. In this perspective review, I discuss the potential and emerging strategies for non-invasive cardiac drug delivery, focusing on receptor-mediated endocytosis and transcytosis using nanoparticle-based delivery systems that have frequently been employed for targeting the brain or cancer cells although their use for cardiac delivery remains largely unexplored. Full article

Background: The number of publications related to rivaroxaban is growing, making it difficult for scientists to review relevant materials. Objectives: This bibliometric analysis is focused on highlighting hot spots and new trends associated with rivaroxaban studies and provides references and guidance for further research. Methods: A comparison between countries, journals, authors, and organizations was performed. Microsoft Excel 2021 and VOSviewer were used to process and visualize data extracted from Web of Science. The time range was set from 1991 to late 2024. A total of 6979 articles were analyzed and bibliometric maps of co-citations of references and co-occurrences of the keywords were built. Results: Relative research interest increased until 2021, when it started to drop. The new trends in publications related to rivaroxaban are associated with a comparison of NOAC therapy outcomes with previously used vitamin K antagonists (warfarin). The research was focused also on new NOAC representatives, medical conditions treated with NOAC, and safety of the therapy. New trending topics are related to ABCB1, peripheral artery disease, direct-acting oral anticoagulants, PCI, and SARS-CoV-2. Conclusions: This bibliometric analysis showed that increasing attention is being paid to the medical conditions treated with NOACs and issues related to the safety of this therapy. Full article

Background/Objectives: The aim of this study was to determine whether incomplete follow-up and competing event risks may be associated with the clinical course after treatment and with known risk factors, such as chronic limb-threatening ischemia (CLTI), in peripheral artery disease (PAD) patients. Methods: Patients hospitalized with PAD who were treated by endovascular or open-surgical means and followed up were included in this retrospective observational study. The primary outcome was reintervention-free survival (RFS); the secondary outcomes and competing events were major amputation and death. The follow-up index (FUI), defined as the ratio between the real and the maximal follow-up interval, was determined for each patient. Results: The FUI depended significantly on the disease stage of CLTI (estimate: −0.16; p: 0.003), endovascular (0.17; p: 0.007) or open-surgical intervention (0.21; p: 0.007) and intra-hospital re-operation (−0.29; p: 0.002) and tended to decrease with age (−0.004; p: 0.09). Independent of disease stage, patients with claudication or CLTI with an FUI < 0.5 had shorter RFS than patients with a FUI ≥ 0.5 (Cox regression, p: 0.07; log-rank test, p: 0.03). When both the FUI and competing risks were considered using Fine–Gray regression analysis, CLTI was associated with RFS (p: 0.016), while FUI (p: 0.004), CLTI (p < 0.001), and the involvement of common femoral (p < 0.001) and posterior tibial arteries (p < 0.001) were associated with major amputation-free survival. Conclusions: Incomplete follow-up is associated with advanced PAD and may itself mask a worse outcome, such as reintervention, restenosis, major amputation, or death. Competing events should also be considered potential sources of bias. Therefore, the FUI and competing events should be reported, and conclusions should be drawn cautiously in both observational and randomized prospective clinical studies. Full article