Search Results (857)

Objectives: The purpose of this study was to determine whether concomitant tricuspid valve repair (TVr) at the time of left ventricular assist device (LVAD) implantation improves outcomes in patients with ≥moderate tricuspid regurgitation (TR) and to evaluate the prognostic value of preoperative right ventricular (RV) strain. Methods: In a retrospective analysis of 100 LVAD recipients (44 TVr; 56 No-TVr), preoperative (preop) and postoperative (postop) clinical, echocardiographic, and hemodynamic variables, including pulmonary vascular resistance (PVR) and pulmonary artery pulsatility index (PAPI), were analyzed. RV free wall strain (RV-FWS) and RV fractional area change (RV-FAC) were measured by speckle tracking. Early right heart failure (RHF) was modeled with multivariable logistic regression, and 2-year mortality was assessed with Fine–Gray competing risk regression. Preoperative and three-month measurements were compared within each of the 100 patients. Results: Baseline invasive hemodynamics, RV-FWS, and RV-FAC were similar between the TVr and No-TVr groups. TVr at the time of LVAD implantation reduced postoperative TR grade, but it did not improve RV-FWS or RV-FAC at 3 months. The No-TVr patients were more often discharged home and had lower 30-day readmissions. PVR was comparable preoperatively and at 3 months postoperatively. In adjusted analyses, preop PVR, PAPI, and TVr were not independently associated with early RHF, whereas decreased preoperative RV-FWS and lower preop RV-FAC independently predicted higher 2-year mortality. Conclusions: In LVAD recipients with ≥moderate TR, concomitant TVr lowers postoperative TR severity but does not improve early RHF, RV strain-based remodeling, or 2-year mortality. Preoperative RV deformation metrics, rather than preoperative PVR or PAPI, independently predict survival following LVAD implantation with or without TVr. Full article

Background/Objectives: Cannabis sativa (CS) exerts its effects through the endocannabinoid system. Although studies have shown limited evidence regarding the plant’s therapeutic efficacy, little is known about the standardization of doses and their corresponding effects. This study aims to analyze changes in muscle electrical activity and cardiovascular hemodynamics before, during, and after administering doses of full-spectrum cannabis and tetrahydrocannabinol (THC) oils. Methods: Participants will be assigned to a single group that will undergo five different interventions: CBD + THC at 12.50 mg, CBD + THC at 18.75 mg, THC intervention at 12.50 mg, THC at 18.75 mg, and placebo intervention (PI). The study will enroll healthy, self-reported men and women aged 18 to 50, with no mental health disorders and no exposure to CS in the past six months. Interventions will occur on five randomized days, following three phases: (1) pre-intervention (PRE-IN); (2) intervention (IN)—1 h after oral oil ingestion; and (3) post-intervention (POST-IN)—2 h 30 min after ingestion. At each stage, 2 min of quiet breathing (QB); 2 min with an inspiratory resistance valve (30% of maximal inspiratory pressure—PImax) and expiratory valve (10% of maximal expiratory pressure—PEmax) (VAL); and 4 min of recovery without the valve (REC) were evaluated. Register: RBR-3jsvtbr. Conclusions: This study will enhance the understanding of the dose–response effects of full-spectrum cannabis and THC oils and may serve as a model for future research in this field. Full article

Background: Despite advances in temporary mechanical circulatory support (tMCS), patients with cardiogenic shock (CS) who are treated with a microaxial flow pump (mAFP; Impella^®, Abiomed) still have a high mortality rate. A dysregulated systemic inflammatory response significantly contributes to multiorgan failure in this population. CytoSorb^® hemadsorption has emerged as a potential adjunctive therapy for modulating inflammation, but data on its use in CS are limited. Methods: This retrospective, single-center study used propensity score matching analysis (1:1 matching; n = 15 per group) to compare the outcomes of patients receiving mAFP support with and without concomitant CytoSorb therapy. Baseline data (T0), including comorbidities and clinical status at ICU admission, were collected for all patients. In the CytoSorb group, data were collected at two additional time points: 24 h before the start of CytoSorb therapy (T1), and 24 h after its completion (T2). At these time points, laboratory values and parameters on respiratory, hemodynamic, and organ function were assessed. Corresponding data were also collected for matched patients in the non-CytoSorb group at equivalent time points relative to their matched counterparts. Results: In the propensity score-matched cohort, patients treated with CytoSorb exhibited significant improvements between T1 and T2. Specifically, reductions were observed in the vasoactive-inotropic score (p = 0.035), procalcitonin levels (p = 0.041), peak inspiratory pressure (p = 0.036), and positive end-expiratory pressure (p = 0.016). Flow rates through the mAFP declined significantly (p = 0.014), suggesting stabilization of hemodynamics. These changes were not observed in the non-CytoSorb group, where most parameters remained unchanged or exhibited less pronounced trends. We observed a lower in-hospital mortality rate in the CytoSorb group (33.3% versus 46.7%), though the difference was not significant, potentially due to limited statistical power. Conclusions: CytoSorb hemadsorption in mAFP-supported CS was associated with improved hemodynamic stability and reduced inflammatory burden. These findings suggest a potential therapeutic benefit of adjunctive hemadsorption in this high-risk population. Full article

During pregnancy, a series of physiological changes occur in women, particularly affecting the cardiovascular system with significant hemodynamic alterations. Subsequently, this leads to renal adaptations manifesting through variations in glomerular filtration rate. This close interconnection between the heart and kidneys implies that issues arising in one organ will disrupt this fundamental balance, inevitably involving all associated organs. The purpose of this review is to gather all possible nephrological conditions that may arise during pregnancy, as well as pre-existing conditions that may become apparent or worsen during this period. This review describes the natural history, treatment, and impact of these conditions on pregnancy itself. Among the most common conditions are preeclampsia and HELLP syndrome, severe complications characterized by hypertension, proteinuria, and multiorgan damage that require immediate clinical attention. Additionally, women with chronic kidney disease are at higher risk of developing maternal–fetal complications, such as preterm birth and intrauterine growth restriction. Common causes of acute renal failure are also analyzed, including thrombotic microangiopathy, acute fatty liver of pregnancy, acute onset or flare of systemic lupus erythematosus, and catastrophic antiphospholipid antibody syndrome. Given the importance of proper renal function during pregnancy, it is essential to have a thorough understanding of nephrological diseases that may affect this phase of women’s lives. This knowledge is crucial for managing these conditions effectively to avoid risks to the survival of both the mother and the newborn. Full article

Background: Patent ductus arteriosus (PDA) in dogs causes persistent left-to-right shunting, leading to pulmonary overcirculation, left heart volume overload, and potential congestive heart failure. Accurate assessment of fluid imbalance is essential but challenging with conventional echocardiography or biomarkers. Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), may serve as a non-invasive marker of extracellular fluid distribution and cellular integrity. Objectives: This study aimed to evaluate PhA as an indicator of thoracic fluid imbalance in dogs with PDAby analyzing its correlation with pulmonary velocity (PV) and end-diastolic volume (eV), as well as its responsiveness to surgical correction. In addition, we assessed the relationships between PhA and echocardiographic structural indices (LA/Ao, TDI Sep E/Em, TDI Lat E/Em) and examined the influence of the measurement region. Methods: PhA was measured at 5, 50, and 250 kHz in 30 PDA-affected and 15 healthy dogs, with electrode placement across thorax, trunk, and abdomen. Echocardiography evaluated PV, eV, and PDA-specific structural parameters. Results: Thoracic PhA at 5 kHz was significantly reduced in PDAdogs, strongly correlated with PV and moderately with eV. Postoperative measurements showed progressive PhA recovery. Only TDI Lat E/Em correlated with mid-frequency PhA, while other structural indices showed minimal association. Thoracic PhA was lower than trunk or abdominal values, indicating that thoracic measurements may better capture localized extracellular fluid changes in PDAcompared with other regions. Conclusion: Thoracic PhA at 5 kHz effectively reflects extracellular fluid changes in PDA, complements structural echocardiography, and tracks postoperative fluid normalization. Its non-invasive nature supports clinical utility for monitoring hemodynamic burden and therapeutic response. Full article

Bypass graft is widely used, especially in cardiovascular diseases, to detour clogged blood vessels, alleviating and correcting the manifestation of the symptoms of damaged blood vessels. Bypass grafting is also used in hemodialysis treatment, specifically an arteriovenous bypass graft, considering the repeated withdrawal of blood, for the dialysis machine to filter the blood and return it to the body to circulate. Nonetheless, bypass grafts are susceptible to failure due to the abnormal hemodynamic performance of the blood flowing to the graft, leading to complications such as thrombosis, intimal hyperplasia, and atherosclerosis. Multiple bypass graft designs are continuously developed to optimize the desirable hemodynamics of the blood, which is essential to avoid complications. This study examines helical arteriovenous bypass graft (AVG) hemodynamic performance using Computational Fluid Dynamics (CFD) simulations to identify enhanced blood flow characteristics. The analysis concentrated on area-weighted average wall shear stress (AWA-WSS), helicity, pressure drop, time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT) from twenty-seven graft models changing anastomosis angles, helical diameters, and helical pitches. Model 25-13-30 (25-degree anastomosis angle, 13 mm helical diameter, 30 mm helical pitch) demonstrated the most favorable overall hemodynamic performance based on the variables considered. The results indicate that integrating helical shape into bypass grafts improves hemodynamic performance, reduces intimal hyperplasia risk, and may prolong graft durability. These findings provide valuable insights and suggestions for enhancing AVG designs to support patient outcomes. Full article

Functional Near-Infrared Spectroscopy is (fNIRS) a non-invasive neuroimaging technique that monitors cerebral hemodynamic responses by measuring near-infrared (NIR) light absorption caused by changes in oxygenated and deoxygenated hemoglobin concentrations. While fNIRS has been widely used in cognitive and clinical neuroscience, a key challenge persists: the lack of practical tools required for calibrating source-detector separation (SDS) to maximize sensitivity at depth (SAD) for monitoring specific cortical regions of interest to neuroscience and neuroimaging studies. This study presents DrSVision version 1.0, a standalone software developed to address this limitation. Monte Carlo (MC) simulations were performed using segmented magnetic resonance imaging (MRI) data from eight cadaveric heads to realistically model light attenuation across anatomical layers. SAD of 10–20 mm with SDS of 19–39 mm was computed. The dataset was used to train a Gaussian Process Regression (GPR)-based machine learning (ML) model that recommends optimal SDS for achieving maximal sensitivity at targeted depths. The software operates independently of any third-party platforms and provides users with region-specific calibration outputs tailored for experimental goals, supporting more precise application of fNIRS. Future developments aim to incorporate subject-specific calibration using anatomical data and broaden support for diverse and personalized experimental setups. DrSVision represents a step forward in fNIRS experimentation. Full article

Background: Hypertrophic cardiomyopathy (HCM) is a heterogeneous myocardial disease in which conventional prognostic models, primarily focused on sudden cardiac death, often fail to identify patients at risk of clinically relevant events such as heart failure progression or rehospitalization. Cardiopulmonary exercise testing (CPET) quantifies functional capacity, while stress echocardiography (SE) provides mechanistic insights into exercise-induced hemodynamic changes. Their combined application (CPET–SE) may enhance risk stratification in patients with HCM. Methods: In this retrospective study, 388 patients with obstructive and non-obstructive HCM (mean age 48 ± 15 years, 63.1% male) underwent baseline CPET–SE between 2010 and 2022 and were followed for a median of 7.4 years [IQR 4.3–10.2]. Echocardiographic parameters were assessed at rest and peak exercise, and CPET indices included peak oxygen consumption (pVO₂), ventilatory efficiency, and anaerobic threshold. The primary outcome was a composite of heart failure hospitalization or progression to end-stage HCM. Results: Over a median follow-up of 7.4 years, 63 patients (16.2%) experienced an event of the primary outcome. Patients who developed a primary outcome had greater left atrial diameter (45.0 vs. 41.0 mm, p < 0.001) and indexed volume at rest (36.4 vs. 29.0 mL/m², p < 0.001), with further dilation during stress (p = 0.046); increased LV wall thickness (p = 0.001); higher average E/e′ at rest and during stress (p ≤ 0.004); and higher pulmonary artery systolic pressure at rest (p = 0.027) and during stress (p = 0.044). CPET findings included lower pVO₂ (16.0 vs. 19.5 mL/kg/min, p = 0.001), reduced % predicted pVO₂ (p = 0.006), earlier anaerobic threshold (p = 0.032), impaired ventilatory efficiency (p = 0.048), and chronotropic incompetence (p < 0.001) in patients who experienced a primary outcome. Multivariable analysis identified dyslipidemia (OR 2.58), higher E/e′ (OR 1.06), and lower pVO₂ (OR 0.92) as independently associated with the primary outcome. Conclusions: CPET–SE provided a comprehensive evaluation of patients with HCM, associating aerobic capacity to its hemodynamic determinants. Reduced pVO₂ showed the strongest association with adverse outcomes, while exercise-induced diastolic dysfunction and elevated pulmonary pressures identified a high-risk phenotype. Incorporating CPET–SE into longitudinal management of patients with HCM may enable earlier detection of physiological decompensation and guide personalized therapeutic strategies. Full article

Microcirculation in cutaneous tissue is essential to balance oxygen delivery and maintain the health of the skin. Senescence contributes to microcirculatory dysfunction through mechanisms involving chronic inflammation, structural remodeling of microvessels, and disturbances in hemodynamics. In this study we investigated the promoting effect of escin on blood flow through topical application. To elucidate the molecular mechanisms of escin, kinase phosphorylation changes in human umbilical vein endothelial cells (HUVECs) were examined. Escin stimulates the Wnt/β-Catenin and c-Jun N-terminal kinase (JNK) signaling pathway in cultured HUVECs. To clarify the target of escin in the Wnt/β-Catenin signaling pathway, gene expression in response to escin treatment was evaluated, and escin-mediated signaling activation was accompanied by glycogen synthase kinase-3 beta (Gsk3β), according to inhibitor studies performed with IWR1 (tankyrase inhibitor). In addition, the expression level of the Gsk3β were down-regulated by escin treatment in cultured HUEVCs. Escin also enhanced vascular remodeling, and, when applied topically, led to a sustained increase in cutaneous blood flow. Escin-mediated Wnt signaling activation could enhance blood vessel networks via Gsk3β down-regulation. In conclusion, our data demonstrate that escin promotes angiogenic behavior and enhances adenosine-induced perfusion in humans, thereby supporting its potential role in modulating cutaneous microcirculation. Full article

Background: Isometric handgrip (IHG) exercise reduces blood pressure (BP) in both normotensive and hypertensive individuals. However, there are few studies specifically addressing its effects in hypertensive patients with ischemic heart disease (IHD). This research aimed to compare acute hemodynamic responses and post-exercise hypotension to single bouts of IHG handgrip performed at two different intensities in patients with IHD. Methods: Fifty-four sedentary patients were enrolled and randomly assigned to one of three groups: (1) high-intensity isometric handgrip performed at 70% of maximal voluntary contraction (MVC) (IHG-70%); (2) low-intensity isometric handgrip performed at 30% of MVC (IHG-30%); (3) control group (no exercise). Heart rate and BP were measured, and transthoracic echocardiography was performed at baseline, during exercise (lasting 3 min), and after 15 min post-exercise. BP was also measured at 30, 45, and 60 min of recovery. Results: No significant changes in systolic BP occurred during the exercise phase between the three study groups. Systolic BP decreased significantly in IHG-70% compared to the control at 30 (−7.7 ± 1.9; p = 0.035) and 45 min (−8.1 ± 2.3; p = 0.021) post-exercise, while there were no significant differences between IHG-70% and IHG-30% at different time-points. There were no significant changes in diastolic BP between the two active groups and between IHG-70 and IHG-30 versus control at different time-points (repeated-measures ANOVA p = 0.257). Global work efficiency was unchanged in IHG-70% (−4%) and IHG-30% (+1%) compared to control (ANOVA p = 0.154). Conclusions: High-intensity and low-intensity isometric handgrip exercises did not cause hemodynamic impairment in IHD. High-intensity exercise was more effective than low-intensity in reducing post-exercise systolic BP. Full article

The common iliac artery supplies blood to the lower extremities, and stenosis in this region severely impacts hemodynamics. This study investigates the effects of 25%, 50%, and 75% iliac artery stenosis on key hemodynamic parameters using a fluid–structure interaction (FSI) approach. Semi-idealized geometries reconstructed from patient-specific data modeled realistic arterial behavior. Parameters such as wall displacement, time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), high oscillatory low shear magnitude (HOLMES) index, and endothelial cell activation potential (ECAP) were evaluated. Results showed peak wall displacement of 2.85 mm in the bifurcation zone under 75% stenosis. TAWSS increased with stenosis severity, peaking in stenotic regions and decreasing significantly downstream. OSI was highest in non-stenosed right branches and bifurcation areas, indicating multidirectional shear forces. HOLMES values were lowest downstream of stenoses, indicating disturbed flow. ECAP exceeded the thrombosis risk threshold (1.4 Pa⁻¹) in post-stenotic zones under 75% stenosis, suggesting a higher risk of clot formation. These results demonstrate that stenosis disrupts local flow and causes hemodynamic changes downstream, emphasizing the need for comprehensive clinical assessment beyond the stenotic site. Regions with elevated ECAP and low HOLMES downstream may be prone to thrombosis, highlighting the importance of careful hemodynamic monitoring for treatment strategies. Full article

Acute pulmonary embolism (APE) remains a significant cause of mortality and morbidity despite increasing prophylaxis for deep venous thrombosis (DVT). The IVC filter is a temporary or permanent intravascular device that traps migrating thrombi from their origin in the pelvis or a lower limb into the pulmonary vasculature, thereby preventing significant APE. The current and longstanding indications for placing an IVC filter are in patients with documented lower extremity DVT and acute APE who also have absolute contraindications to anticoagulation or have experienced an acute, hemodynamically unstable APE requiring ventilatory and vasoactive support, with limited cardiovascular reserve. Updated guidelines have led to a significant rise in IVC filter placements for specific therapeutic indications of venous thromboembolism compared to prophylactic use. Meta-analyses show that IVC filter placement is associated with a lower risk of subsequent APE but an increased risk of DVT. However, there appears to be no significant reduction in APE-related mortality and no change in all-cause mortality. Early complications after IVC filter placement typically relate to procedural issues and include bleeding or infection at the venous access site, development of arteriovenous fistulas, accidental arterial puncture, and post-procedural access site hematoma or thrombosis. Additional early complications include IVC filter malposition, incomplete expansion, IVC penetration, or guidewire entrapment. Delayed complications may involve DVT below the filter, IVC occlusion due to the filter, IVC filter migration, fracture of one of the IVC filter components, IVC rupture, or IVC thrombosis. Retrieval of IVC filters by simple, advanced, or open techniques should be considered after weighing the risk-to-benefit for the individual patient. Deployment of the IVC filter remains an important component of interventional APE management within the narrow indications currently proposed. Current guidance recommends that an untethered temporary IVC filter should be placed and retrieved once the contraindication to anticoagulation is resolved. Full article

Background: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of noncompressible torso hemorrhage remains controversial. We aimed to utilize a novel and transparent/interpretable artificial intelligence (AI) method called Optimal Policy Trees (OPTs) to improve the appropriate use and decrease the misuse of REBOA in hemodynamically unstable blunt trauma patients. Methods: We trained and then validated OPTs that “prescribe” REBOA in a 50:50 split on all hemorrhagic shock blunt trauma patients in the 2010–2019 ACS-TQIP database based on rates of survival. Hemorrhagic shock was defined as a systolic blood pressure ≤90 on arrival or a transfusion requirement of ≥4 units of blood in the first 4 h of presentation. The expected 24 h mortality rate following OPT prescription was compared to the observed 24 h mortality rate in patients who were or were not treated with REBOA. Results: Out of 4.5 million patients, 100,615 were included, and 803 underwent REBOA. REBOA patients had a higher rate of pelvic fracture, femur fracture, hemothorax, pneumothorax, and thoracic aorta injury (p < 0.001). The 24 h mortality rate for the REBOA vs. non-REBOA group was 47% vs. 21%, respectively (p < 0.001). OPTs resulted in an 18% reduction in 24 h mortality for REBOA and a 0.8% reduction in non-REBOA patients. We specifically divert the misuse of REBOA by recommending against REBOA in cases where it leads to worse outcomes. Conclusions: This proof-of-concept study shows that interpretable AI models can improve mortality in unstable blunt trauma patients by optimizing the use and decreasing the misuse of REBOA. To date, these models have been used to predict outcomes, but their groundbreaking use will be in prescribing interventions and changing outcomes. Full article

Background: Dibutyl phthalate (DBP) is a prevalent environmental pollutant that can accumulate in organisms, becoming amplified after the food cycle and ultimately affecting human health. Recent studies have provided evidence suggesting a potential association between exposure to DBP and cardiovascular diseases (CVDs). Objectives: This study’s objective is to investigate the toxic cardiovascular effects of long-term exposure to DBP, particularly its impact on the heart and blood vessels. To be specific, we hypothesized and verified the potential mechanisms underlying DBP-induced cardiac and vascular injuries, focusing on oxidative stress, pyroptosis, inflammatory responses, and metabolic pathways. Methods: The rats were divided into 5 groups: Control group, DBP-Low group, DBP-Medium group, DBP-High group, and DBP-High + Vitamin E group. The entire experimental period lasted 12 weeks. We conducted examinations on echocardiography, histopathology, oxidative stress biomarkers, pyroptosis-related biomarkers, and inflammatory cytokine biomarkers. Additionally, we carried out serum metabolomics analysis. Result: Our research findings indicate that long-term exposure to DBP can cause significant toxic effects on the cardiovascular system. Specifically, DBP leads to changes in oxidative stress indicators (ROS and an increase in MDA levels, alongside a decrease in GSH levels) and protein levels related to pyroptosis (NLRP3, Caspase-1 and GSDMD levels increase) in cardiac and vascular tissues, triggering oxidative inflammatory responses (IL-1β and IL-18 levels increase), damaging the heart and blood vessels (organizational structure deformation and collagen fiber infiltration) and ultimately affecting their functions (abnormalities in cardiac function and hemodynamics). Additionally, the results of metabolomics studies suggest that metabolic pathways (Biotin metabolism, TCA cycle, Vitamin B6 metabolism, Pantothenate and CoA biosynthesis, and Riboflavin metabolism) and metabolites may also be of great significance. Conclusion: Long-term exposure to DBP can induce cardiovascular toxicity in rats, manifesting as cardiac and vascular damage, as well as alterations in organ function. This process is characterized by oxidative stress, activation of the pyroptosis pathway, inflammatory responses, and modifications to metabolic pathways. Full article

Current fractional flow reserve computed tomography (FFR_CT) methods use static imaging, potentially missing critical hemodynamic changes during the cardiac cycle. We developed a novel dynamic FFR_CT framework using 4D-CTA data to capture temporal coronary dynamics throughout the complete cardiac cycle. Our automated pipeline integrates 4D-CTA processing, temporally weighted geometric modeling, and patient-specific boundary conditions derived from actual flow measurements. Preliminary validation in three patients (four vessels) showed that dynamic FFRCT values (0.720, 0.797, 0.811, and 0.952) closely matched invasive FFR measurements (0.70, 0.78, 0.78, and 0.94) with improved accuracy compared to conventional static methods. The dynamic approach successfully captured physiologically relevant hemodynamic variations, addressing inter-patient variability limitations of standardized approaches. This study establishes the clinical feasibility of dynamic FFR_CT computation, potentially improving non-invasive coronary stenosis assessment for clinical decision-making and treatment planning. Full article