Journal of Cardiovascular Development and Disease

Background: Previous studies identified epicardial adipose tissue (EAT) as a metabolic risk factor for atrial remodeling. However, given the distinct physiological changes associated with aging, findings from the general population may not translate directly to older adults. This study aims to clarify the relationship between EAT and left atrial (LA) diameter in older adults specifically. Methods: This retrospective cross-sectional study was conducted among in an older adult cohort (aged ≥ 65 years) at Peking Union Medical College Hospital. The association between EAT and LA diameter was evaluated using multivariable linear regression, a generalized additive model, and restricted cubic spline (RCS) modeling. Results: Among 353 participants (median age 75 years), EAT was independently associated with LA diameter (β = 0.286, p < 0.001) after adjusting for confounders including age, BMI, and LDL-C. Notably, RCS analysis revealed a J-shaped relationship between EAT volume and LA dimensions. Specifically, when EAT exceeded 110.7 cm³, the LA diameter increased significantly by 0.22 mm per 10 cm³ increase in EAT (p = 0.004). Conclusions: EAT accumulation shows a non-linear association with left atrial remodeling in older adults, with an identifiable threshold at 110.7 cm³. EAT may be a valuable biomarker for cardiovascular risk stratification, suggesting that EAT burden monitoring could be beneficial in older populations.

Background. Cor triatriatum dexter (CTD) is a rare congenital heart defect where a membrane divides the right atrium into two chambers, resulting from the incomplete regression of the right valve of the sinus venosus. Due to its rarity, only individual case reports and a limited number of case series have been published to date. This study constitutes the most extensive comprehensive review conducted in this area. Eight factors were evaluated: age at diagnosis, sex, clinical presentation, electrocardiographic findings, imaging (ultrasound, CT, or MRI), associated cardiac anomalies, and patient outcomes. Methods. The electronic databases PubMed and Scopus were searched from their inception until 30 October 2025. Only case reports and case series were considered for inclusion. Studies involving foetuses, autopsies, and animals were excluded. The collected data were primarily presented as percentages. Results. One hundred fourteen studies were found encompassing 124 patients. The mean age at diagnosis was 33.3 ± 9.4 years The most common clinical presentations were dyspnoea (44.3%) and cyanosis (29.5%). The most commonly encountered ECG changes were supraventricular tachycardia/atrial flutter/atrial fibrillation (33.3%) and right bundle branch block (22.6%). On chest X-ray, cardiomegaly was noted in 46.5%. CTD was suspected or diagnosed by echocardiography in 95.2% of cases. The diagnosis was confirmed by CT and/or MRI in 34.1% of cases. A concomitant congenital heart defect was found in 67.7%, especially in the form of all kinds of atrial septal defect (38.1%) and of right valvular and right ventricular involvement (20.1%). An outcome was reported in 97/124. Surgical correction was the treatment of choice in 51.6%. Since 1991, a percutaneous approach has been employed in selected cases (5.1%). Conservative management was the treatment of choice in 43.3%. The mortality rate was 8.2%. Discussion. The principal limitation of this systematic review lies in its reliance solely on case reports and small case series, reflecting the absence of large-scale studies on CTD. Nonetheless, it constitutes the most comprehensive analysis available to date.

The limited capacity for cardiomyocyte proliferation in the adult human heart restricts its ability to recover from injury. Building on discoveries in regenerative model systems, such as zebrafish and neonatal mice, reactivation of a latent potential for cardiomyocyte proliferation is a strategy to promote therapeutic heart regeneration. Although cardiomyocyte proliferation remains modest even with the most effective mitogenic stimuli identified to date, evidence for a potential functional benefit in pre-clinical model systems has led to the initiation of several early-phase clinical programs. Here, we review insights from model organisms that inform the potential efficacy and limitations of therapeutic cardiomyocyte proliferation, systems to study human cardiomyocyte proliferation, and the natural history of cardiomyocyte proliferation in the human heart. We also examine the translational trajectory of selected discoveries, including therapeutic delivery modalities, and attendant safety concerns. Finally, we discuss critical challenges that will need to be addressed to enable successful clinical translation.