Search Results (310)

Pulmonary hypertension (PH) can be defined as a mean pulmonary artery pressure (mPAP) greater than 20 mm Hg at rest during right heart catheterization (RHC). The reported prevalence of PH throughout the globe has been estimated to impact approximately 1% of the total population, with a majority of those afflicted being women more than men. Numerous etiologies give rise to the pathophysiology of PH, including heart disease (i.e., left-sided heart failure), lung diseases, and other unclear causes related to chronic stages and complications surrounding long-standing pulmonary thromboembolisms, side effects of certain medications, and genetic and environmental factors. Untreated PH can lead to severe morbidities such as cardio-renal syndrome and congestive hepatopathy (cardiac cirrhosis). Management of PH focuses on decreasing pulmonary pressures by using vasodilators such as prostanoids, and phosphodiesterase type 5 (PDE-5) inhibitors, as well as newer treatments such as sotatercept, which inhibits activin signaling, thereby inhibiting excessive cell growth in the pulmonary artery vasculature and down-regulating the pro-proliferative pathways. Full article

Cardiac arrest is a way of demise of patients who are affected by heart failure (HF), being more frequent in those with HF with a reduced left ventricular ejection fraction (HFrEF), and is, as such, responsible for 30–50% of cardiac death. Specific data on the risk of sudden cardiac death (SCD) related to HF with a preserved ejection fraction (HFpEF) and HF with a mildly reduced ejection fraction (HFmrEF) are lacking, as well as data regarding ventricular arrhythmias in this population. Considering the 0.3% person/year incidence rate of investigator-reported ventricular tachycardia (VT) and ventricular fibrillation (VF), the rate of SCD in the analyzed population seems to be 1.3% per year. Age, gender, history of diabetes and myocardial infarction, left bundle branch block (LBBB) on electrocardiogram (ECG), and a natural logarithm of N-terminal pro B-type natriuretic peptide (NT-proBNP), identified a subgroup of HFpEF patients with a higher risk (5-year cumulative incidence of 11%) of sudden death (SD). In HFpEF patients, both glifozins and finerenone did not demonstrate a beneficial effect on SCD incidence in comparison to placebo. A significantly lower rate of SCD emerged in patients who were treated with dapaglifozin (10 vs. 26 pts) among patients with HF with an improved ejection fraction (HFimpEF), who were defined as patients with a previous left ventricular ejection fraction (LVEF) < 40%. Promising methods discussed include cardiac magnetic resonance, myocardial scintigraphy, genetic assessment, and electrophysiologic studies for predicting SCD in those patients. In conclusion, arrhythmic SCD in HFpEF patients should not be considered merely as an effect of VT/VF; bradyarrhythmia is probably more frequent and dangerous. The effects of drugs in preventing SCD in HFpEF have not been demonstrated yet. Full article

Peripartum cardiomyopathy (PPCM) is a distinct condition that presents as heart failure (HF) in a woman who was previously healthy and has no prior cardiovascular issues. It results from idiopathic left ventricular (LV) dysfunction, characterized by a reduced LV ejection fraction below 45%. PPCM is a life-threatening condition with a high mortality rate (MR) that demands urgent treatment. Methods: This narrative review aims to define PPCM and its pathophysiology and conduct a scoping review of the latest data on the management of patients with peripartum cardiomyopathy during pregnancy and the postpartum period. Results: Currently, treatment follows standard HF protocols for reduced ejection fraction, with the possible addition of bromocriptine, and during pregnancy, medications that do not harm the fetus. Conclusions: Early, aggressive therapy is essential for a better prognosis, but managing PPCM can be challenging. Treatment of PPCM patients should be led by a team of highly qualified specialists, known as the Obstetric and Cardiac Care Team, comprising an obstetrician-perinatologist, an anesthesiologist, a cardiologist, and a cardiac intensive care specialist. Baseline left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) are the main prognostic factors. LVEF less than 30%, significant LV dilatation, LVEDD ≥ 6.0 cm, and right ventricular involvement are factors indicative of a poor prognosis. While pregnancy after PPCM is possible, it should be discouraged due to the significant risk of complications and even death. The most common causes of death in patients with PPCM are thromboembolic complications, severe HF, serious ventricular arrhythmias, cardiogenic shock, and sudden cardiac arrest. Full article

Background: Determining the optimal duration of extracorporeal cardiopulmonary resuscitation (ECPR) remains challenging, as patient outcomes may vary significantly based on individual characteristics. We aimed to establish critical time thresholds for achieving favorable neurological outcomes with ECPR across different risk groups, potentially providing more tailored guidance for clinical decision-making. Methods: This single-center retrospective study screened 279 adult patients who received ECPR between 2013 and 2020. Through multivariate analysis of various clinical parameters, we developed a pragmatic bedside risk stratification framework to identify groups with different prognostic profiles. The primary outcome was neurological status at discharge, assessed by the Cerebral Performance Categories scale. Results: In multivariate analysis, age greater than 50 years with asystole (adjusted odds ratio [OR]: 4.89, 95% confidence interval [CI]: 1.41–17.00) or pulseless electrical activity (adjusted OR: 9.70, 95% CI: 2.80–33.60), aspartate transaminase (adjusted OR: 1.52, 95% CI: 1.15–1.99), creatinine (adjusted OR: 2.08, 95% CI: 1.30–3.34), initial lactate (adjusted OR: 1.88, 95% CI: 1.27–3.45), and low-flow time (adjusted OR: 3.50, 95% CI: 2.02–6.06) were associated with poor neurological outcomes. Based on these findings, we identified three distinct risk groups showing different acceptable low-flow time thresholds: low-risk (38 min), moderate-risk (27 min), and high-risk (20 min). Notably, no favorable neurological outcomes were observed beyond 70 min in the low-risk group and 90 min in moderate/high-risk groups. Risk group stratification effectively predicted neurological outcomes across different low-flow time intervals. Conclusions: Risk-stratified evaluation of low-flow time (cardiac arrest to ECMO pump-on) provides clinically relevant thresholds for different patient groups, suggesting that continuation of ECPR may be warranted in low-risk patients even with extended low-flow times. This approach may enable more personalized decision-making in ECPR implementation. Full article

Background/Objectives: The “weekend effect,” characterized by increased mortality and complication rates for weekend hospital admissions, is well documented in myocardial infarction and stroke but has been less thoroughly investigated in acute decompensated heart failure (ADHF). This study evaluates the weekend effect in ADHF using a national cohort. Methods: A retrospective cohort study was conducted using the 2016–2020 Nationwide Inpatient Sample (NIS). Adult ADHF admissions were identified by ICD-10 codes and classified as weekend or weekday admissions. Over 30 variables, including age, sex, and comorbidities, were analyzed. Propensity score matching (1:1) yielded 489,204 patients per group. Univariate and multivariate logistic regression models were used to assess outcomes, adjusting for key covariates. Results: Of 2,131,915 ADHF hospitalizations, 501,076 (23.5%) occurred on weekends. The cohort was 48% female, with a mean age of 72 years (SD ± 12.3). After 1:1 matching, weekend admissions had higher odds of cardiac arrest (aOR: 1.10; 95% CI: 1.06–1.13, p < 0.001), inpatient mortality (aOR: 1.07; 95% CI: 1.05–1.09, p < 0.001), acute kidney injury (AKI; aOR: 1.07; 95% CI: 1.06–1.08, p < 0.001), and acute respiratory failure (ARF; aOR: 1.28; 95% CI: 1.27–1.30, p < 0.001). No significant differences were observed in mechanical circulatory support (MCS) use or length of stay. Conclusions: Weekend ADHF admissions were associated with a higher risk of mortality and complications, which may be attributable to reduced specialist availability or delayed diagnostics. These findings underscore the need for standardized ADHF protocols to ensure equitable care throughout the week. Full article

Background: The ISCHEMIA trial demonstrated no overall prognostic benefit of an initial invasive strategy over optimal medical therapy (OMT) in patients with chronic coronary syndrome (CCS) and moderate-to-severe ischemia. However, managing patients with stable angina and low systolic blood pressure (SBP) remains challenging due to limited tolerance to vasodilatory anti-anginal drugs and the uncertain role of revascularization in improving long-term outcomes for this subgroup. Objectives: This study aimed to estimate the treatment effect of an initial invasive strategy (INV) compared with conservative medical therapy (CON) on long-term clinical outcomes and quality of life in patients with stable angina, particularly those with low baseline systolic blood pressure (≤120 mmHg). Methods: We conducted a post hoc analysis of 3544 patients with stable angina from the ISCHEMIA trial, divided into an initial invasive strategy or a conservative approach. The primary endpoint was a 3-year composite of cardiovascular death, myocardial infarction, hospitalization for unstable angina or heart failure, or resuscitated cardiac arrest. Health-related quality of life was assessed using the Seattle Angina Questionnaire (SAQ). In the subgroup, patients were stratified by baseline SBP, diastolic blood pressure (DBP) and heart rate; the Cox model was adjusted for the covariates. Results: Baseline characteristics were generally comparable between the two groups. Over 3 years of follow-up, no significant difference in primary endpoint events was observed between the INV and CON group in the overall cohort (HR = 0.94, 95%CI 0.77–1.14, p = 0.53), and the INV group had the higher SAQ score. Among patients with low baseline SBP (≤120 mmHg), after adjusting for clinical factors using Cox regression, randomized treatment assignment to the INV approach significantly reduced adverse cardiovascular events compared with conservative therapy (HR = 0.58, 95%CI 0.38 to 0.89). Conclusions: In patients with stable angina, an invasive strategy improved long-term quality of life. Among those with low baseline SBP (≤120 mmHg) and limited tolerance to vasodilatory anti-anginal drugs, invasive management reduced 3-year adverse events, supporting tailored revascularization strategies for these patients; a larger cohort is needed for validation. However, this subgroup-specific causal contrast derives from a post hoc exploratory analysis and should be interpreted cautiously; prospective randomized studies are needed to further validate these findings. Full article

Left-ventricular non-compaction (LVNC) is a recently classified cardiomyopathy that involves abnormal trabeculations inside the left ventricle, most commonly located in the ventricular apex. There are 9 distinct types of non-compaction cardiomyopathy that can impact both the left and right ventricles with subtypes involving mostly pediatric patients with concurrent congenital heart disease (CHD), to individuals in late adult-staged ages. LVNC affects the population with an estimated range of incidence from 0.014% to 1.3% and the disease can be diagnosed with the utilization of imaging studies such as transthoracic echocardiography (TTE). LVNC can also impact and lead patients to develop heart failure with estimated prevalence that can reach to 3–4% during their lifetime. LVNC often leads to complications such as heart failure, arrhythmias, and thromboembolic events and without adequate medical management and pharmacological therapies this can progress and lead to worsening cardiac function, sudden cardiac arrest, and even death. There are no strict guidelines organized for screening and monitoring for LVNC in patients except with the inclusion of having a high suspicion in patients without other cardiac abnormalities. Thus, more advanced clinical research and the establishment of diagnostic protocols needs to be standardized in order to further investigate the causes, prognostic factors and therapeutic modalities of patients with LVNC. The field of LVNC cardiomyopathy is expanding but better understanding of the pathophysiology and genetic influence of this cardiac disease is vital for the precision treatment and personalized care of LVNC. Full article

Introduction: Selective brain hypothermia has been investigated to improve neurological outcomes in patients with cardiac arrest; however, an optimal clinical method has not yet been established. This study aimed to evaluate the feasibility of a technique combining transnasal evaporative cooling with simultaneous endovascular temperature management to achieve selective brain hypothermia while preventing systemic hypothermia. Methods: Three adult male Göttingen swine were anesthetized and mechanically ventilated. Transnasal cooling was initiated at maximum output while endovascular warming preserved systemic temperature. Brain parenchymal and rectal temperatures, mean arterial pressure (MAP), heart rate (HR), and cardiac output (CO) were continuously monitored for 60 min. Temperature differences between brain and rectum at 60 min were analyzed. Results: A brain–rectal gradient ≥1.0 °C was achieved in all swine at 25, 40, and 30 min, respectively, and maintained at 1.0–1.5 °C thereafter. Brain temperature (34.5 ± 0.34 °C) was significantly lower than rectal temperature (35.8 ± 0.35 °C) at 60 min after initiation of the selective cooling procedure (p = 0.0048). MAP, HR, and CO showed no deviations from baseline. Conclusions: The combination of transnasal cooling and endovascular warming reliably induced selective brain hypothermia of 1–1.5 °C without adverse effects on hemodynamic parameters in swine. Full article

Background: Traditionally, wild jujube (Ziziphus jujuba Mill. var. spinosa (Bunge) Hu ex H. F. Chou) has been used to nourish the heart, calm the spirit, and arrest spontaneous sweating. Modern research confirms its broad pharmacological activities, including antioxidant, anti-inflammatory, neuroprotective, and cognitive-enhancing effects. This study aims to isolate and characterize the structure of jujube polysaccharides and evaluate their protective effects against oxidative stress damage in neural stem cells (NSCs). Methods: We successfully isolated and purified a novel pectin polysaccharide (ZJP-2) from wild jujube. Its structure was characterized in detail using high-performance liquid chromatography coupled with multi-angle laser light scattering and refractive index detection (HPLC-MALS-RI), high-performance anion exchange chromatography (HPAEC), gas chromatography–mass spectrometry (GC-MS), and nuclear magnetic resonance (NMR) spectroscopy. Results: Structural analysis revealed that ZJP-2 is a pectin heteropolysaccharide with a molecular weight of approximately 67.93 kDa. Its monosaccharide composition primarily includes galac-turonic acid (GalA), arabinose (Ara), rhamnose (Rha), galactose (Gal), and glucose (Glc). The backbone consists of α-GalA and rhamnose-galacturonic acid-I (RG-I) domains linked by (1→4)-glycosidic bonds. NMR spectroscopy further confirmed its glycosidic bond types. In activity assessment, our study demonstrated that ZJP-2 significantly alleviated DMNQ-induced oxidative stress damage in C17.2 neural stem cells. Its protective effect was achieved by reducing intracellular reactive oxygen species (ROS) levels and upregulating the mRNA expression of antioxidant genes associated with the signaling axis (p < 0.05). Moreover, ZJP-2 suppressed DMNQ-induced overexpression of Nestin and NeuN (p < 0.05), contributing to the maintenance of NSCs’ undifferentiated state and functional homeostasis. Conclusions: In conclusion, ZJP-2 possesses distinct structural characteristics and significant neuroprotective potential, supporting its development as a natural functional food or dietary supplement for preventing oxidative stress-related neural damage. Full article

Cardiovascular disease (CVD) persists as the leading cause of global mortality, with adult mammalian hearts exhibiting limited regenerative capacity. Although cardiomyocytes (CMs) can re-enter the cell cycle and undergo DNA synthesis in response to injury, they fail to complete mitosis and cytokinesis, resulting in a functional blockade of productive proliferation following ischemic or aging-related injury. Reactive oxygen species (ROS) exhibit a context-dependent duality in cardiac regeneration: while maintaining redox homeostasis and supporting developmental signaling at physiological concentrations, pathological ROS accumulation exacerbates myocardial decline by inducing DNA damage response (DDR)-mediated cell cycle arrest at G2/M phase, along with structural and functional impairments. This review examines the mechanisms of ROS generation—from its cellular origins to its molecular drivers—in ischemic heart disease, and explores the modulation of regenerative signaling by oxidative stress. We further critically assess emerging therapeutic interventions targeting ROS-mediated myocardial regeneration. By delineating the functional roles of ROS in cardiac injury and repair, this review provides a mechanistic and translational framework for developing redox-based therapies aimed at promoting cardiomyocyte proliferation and myocardial regeneration after ischemic injury. Full article

Background/Objectives: Cardiopulmonary bypass (CPB) facilitates complex cardiac surgery but can damage erythrocyte membranes, impairing microcirculation and oxygen transport. Standard rheological tests assess overall blood properties but fail to define specific cellular mechanisms. In this study, atomic force microscopy (AFM) was employed to characterize morphological, nanostructural, and mechanical changes in erythrocytes following CPB and CPB combined with hypothermic circulatory arrest (HCA). Methods: The study included 14 patients who underwent cardiac surgery with CPB. Patients were divided into two groups. Group 1 underwent heart valve surgery with normothermic CPB (n = 7), and Group 2 underwent aortic arch surgery with CPB combined with HCA and moderate hypothermia (28 °C) (n = 7). Arterial blood samples were collected before the induction of anesthesia and immediately after CPB. The morphology and surface roughness (Rtm) of the erythrocyte membrane were evaluated on air-dried blood smears. Young’s modulus (E) was estimated from force-distance curves on living cells; measurements were performed at 24 °C in PBS. Results: Following CPB, both groups exhibited a decrease in the proportion of discocytes and an increase in echinocytes. In the CPB+HCA group, discocytes were absent after surgery. The mean Rtm increased 1.4-fold in Group 1 and 1.6-fold in Group 2, indicating greater nanostructural membrane damage in the latter. In Group 1, Young’s modulus increased by an average of 1.6 times, indicating increased cell stiffness. In Group 2, the increase was smaller (mean: 1.1 times) and was not statistically significant in some patients. Conclusions: Normothermic CPB primarily affects the nanomechanical properties of erythrocytes, whereas CPB+HCA induces more severe morphological and membrane surface damage while relatively preserving cytoskeletal elasticity. AFM-derived parameters of membrane roughness and cell elasticity may serve as sensitive indicators of erythrocyte biophysical integrity. Full article

Background: In-hospital cardiac arrest (IHCA) constitutes a high-impact clinical event, associated with substantial mortality, frequent neurological and functional impairment. There is a pressing need for primary IHCA studies that evaluate risk predictors, given the inherent challenges of IHCA data collection, previously unharmonized reporting frameworks, and the predominant focus of prior investigations on other domains. Among potential contributors, the “off-hours effect” has consistently been linked to poorer IHCA outcomes. Accordingly, we sought to examine whether in-hospital mortality after IHCA varies according to the time and day of occurrence within a tertiary academic center in Northern Greece. Methods: We conducted a single-center observational cohort study using a prospectively maintained in-hospital resuscitation registry at AHEPA University General Hospital, Thessaloniki. All adults with an index IHCA between 2017 and 2019 were included, and definitions followed Utstein-style recommendations. Results: Multivariable logistic regression adjusted for organizational, patient, and process-of-care factors demonstrated that afternoon/night arrests, weekend arrests, heart failure comorbidity, and need for mechanical ventilation were independent predictors of higher in-hospital mortality. Conversely, arrhythmia as the cause of IHCA and arrests occurring in the intensive care unit or operating room were associated with improved survival. Subgroup analyses confirmed consistent off-hours differences, with weekend events showing reduced 30-day and 6-month survival and worse functional status at discharge. Afternoon/night arrests were more frequent, characterized by longer response intervals and lower survival at both time points. Conclusions: Organizational factors during nights and weekends, rather than patient case mix, drive poorer IHCA outcomes, underscoring the need for targeted system-level improvements. Full article

Background/Objectives: In the present study, we hypothesized that cardiac surgery in pediatric patients with congenital heart disease (CHD) leads to profound endothelial glycocalyx degradation, measured as the increase in plasma syndecan-1 concentration, and that this endothelial damage is more pronounced in patients with cyanotic CHD. Methods: A total of 40 infants (24 with acyanotic and 16 with cyanotic CHD) were enrolled in this prospective study. A total of 39 cardiac surgeries were performed with cardiopulmonary bypass (CPB), 38 with CPB and aortic clamping, and 3 with CPB, aortic clamping, and deep hypothermic circulatory arrest. Results: Syndecan-1 concentrations increased significantly post-surgery compared to the baseline in both groups (cyanotic: 24.4 to 48.0 ng/mL, p < 0.0001; acyanotic: 28.8 to 59.8 ng/mL, p < 0.0001). However, there was no significant difference in syndecan-1 concentrations at any timepoint between children with cyanotic and those with acyanotic CHD. Baseline syndecan-1 showed no correlation with preoperative arterial oxygen saturation (r = 0.26, p = 0.102), hemoglobin (r = −0.3, p = 0.06), age (r = 0.15, p = 0.36), and weight (r = 0.13, p = 0.42). Of note, CPB time (r = 0.08, p = 0.63) and AC time (r = 0.03, p = 0.86) were not related to syndecan-1 concentrations at the end of surgery. Conclusions: Cardiac surgery leads to profound glycocalyx degradation in children with CHD detected by increased plasma syndecan-1 concentrations. Regardless of major pathophysiological differences, children with cyanotic and acyanotic CHD presented similar plasma syndecan-1 values throughout the study. Full article

Background: Sodium–glucose cotransporter 2 inhibitors (SGLT2 inhibitors), initially developed for glycemic control in type 2 diabetes, have demonstrated robust cardiovascular and renal benefits. Emerging evidence suggests that these agents may also affect valvular pathobiology, particularly in degenerative aortic stenosis (AS), through anti-inflammatory and antifibrotic mechanisms. Objectives: This study evaluated whether SGLT2 inhibitor use is associated with improved clinical outcomes in degenerative AS, including all-cause mortality and the need for SAVR or TAVR, recognizing that these endpoints represent surrogate rather than direct measures of valve hemodynamic progression. Methods: A retrospective cohort analysis was conducted using TriNetX, a federated electronic medical record-based research network. Diagnoses are captured using ICD-9/ICD-10-CM codes and medications using ATC codes. Adults with non-rheumatic AS were stratified by SGLT2 inhibitors use. Propensity score matching (1:1) was performed to balance baseline characteristics between treated and untreated groups (n = 10,912 per group). Primary outcomes included all-cause mortality, TAVR, and SAVR during follow-up. Echocardiographic parameters (AVA, Vmax, mean gradient) were not systematically available. Results: After adjustment for comorbidities, SGLT2 inhibitor use was independently associated with lower all-cause mortality (6.15% vs. 9.34% HR 0.595; 95% CI 0.552–0.641; p < 0.001), TAVR (2.81% vs. 2.89% HR 0.835; 95% CI 0.746–0.934; p = 0.002), SAVR (1.28% vs. 1.90% HR 0.514; 95% CI 0.442–0.599; p < 0.001), cardiac arrest (0.82% vs. 1.21% HR 0.71; 95% CI 0.582–0.867; p < 0.001), and end-stage kidney disease (0.40% vs. 1.0% HR 0.292; 95% CI 0.222–0.384; p < 0.001). Although these associations may suggest slower disease progression, interpretation is limited by the lack of systematic echocardiographic follow-up. Conclusions: In addition to their established benefits in heart failure and renal protection, SGLT2 inhibitors may have valve-preserving effects in degenerative AS. Because true hemodynamic progression could not be evaluated, these results should be viewed as associations with surrogate clinical endpoints. Prospective studies with standardized imaging are required to determine whether SGLT2 inhibition can directly alter the course of this currently untreatable disease Full article

Total Coronary Revascularization via left Anterior Thoracotomy (TCRAT) represents a modern evolution of sternum-sparing, on-pump multivessel coronary artery bypass grafting. In this review, we will summarize the historical development, detail the surgical principles, and provide a comprehensive overview of the clinical outcomes of TCRAT. The technique combines cardiopulmonary bypass using peripheral arterial as well as venous cannulation and cardioplegic cardiac arrest using transthoracic aortic cross-clamping with surgical access through a left anterior minithoracotomy. By applying special slinging and rotational maneuvers, both a stable exposition of all coronary territories—in particular those of the right and the circumflex coronary artery—and a quiet, bloodless operating field enable complete anatomical revascularization and complex coronary surgery procedures, including all variations in multiarterial grafting in unselected patients. Data from all published clinical series were integrated, and a weighted analysis of a total of 2282 patients was performed. TCRAT proved to be very effective with regard to complete anatomical revascularization and modern grafting strategies, and it showed excellent perioperative safety in an all-comers population. Both the 30-day mortality and perioperative stroke incidence were distinctly below 1.0%. Data from mid-term follow-up, although rare so far, are promising and compare well to those of the important RCTs. The TCRAT approach eliminates sternal complications completely and accelerates recovery. As an on-pump arrested-heart surgery, TCRAT inherently permits the combination of minimally invasive multivessel CABG with a variety of other cardiac operations, mainly the combination with valve procedures. The integration of robotic and endoscopic assistance represents the next evolutionary step. With its reproducibility and broad applicability, TCRAT holds strong potential to become a standard routine technique in the field of minimally invasive cardiac surgery. Full article