Search Results (1,962)

Cardiac and hemodynamic conditions such as myocardial infarct, cardiomyopathy, hypertension, and aortic valve disease can impair conduction within the Purkinje fiber network and compromise left ventricular (LV) pump function. We developed a computational framework that couples electrical propagation in a structurally organized Purkinje fiber network with LV electromechanics to analyze the impact of conduction abnormalities on cardiac performance. A baseline simulation reproduced physiological activation patterns and pump indices consistent with healthy human data. Conduction block was then introduced at different locations within the Purkinje fiber network. LV pump function was strongly dependent on block location: left bundle branch block (LBBB) produced the largest reduction in ejection fraction (EF) (59% to 46%) and peak pressure (119 to 97 mmHg), whereas left anterior fascicle block caused smaller functional changes. Across simulations, myocardial activation delay and systolic dyssynchrony index (SDI) exhibited a nonlinear relationship with EF and myocardial strain. A threshold behavior was identified at a simulated LV activation duration of approximately 240 ms and an SDI of 8.4%, beyond which EF and strain decreased by about 5% relative to baseline. These findings provide a mechanistic framework to investigate how Purkinje fiber network conduction abnormalities influence LV pump dysfunction. Full article

Background and Objectives: This study investigated the prognostic value of the C-reactive protein–albumin–lymphocyte (CALLY) index in predicting all-cause mortality among patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. Materials and methods: This retrospective single-center study included 303 patients who underwent TAVI. The CALLY index and other established prognostic scores were calculated at baseline. Patients were followed for a median of 21 months. The primary endpoint was all-cause mortality. Results: A total of 60 patients (19.8%) died during follow-up. The CALLY index demonstrated the highest predictive performance for all-cause mortality, with an AUC of 0.698 (95% CI: 0.628–0.768, p < 0.001). In multivariate Cox regression, a low CALLY index remained an independent predictor of mortality (HR: 3.80, 95% CI: 2.03–7.11, p < 0.001), along with reduced LVEF, chronic kidney disease, and diabetes mellitus. Kaplan–Meier analysis further confirmed markedly worse survival in the high-risk group (log-rank p < 0.001). Conclusions: The CALLY index was independently associated with mortality after TAVI and may represent a complementary biomarker for risk stratification in this population. Full article

Background: Alcohol-related liver disease is frequently associated with systemic vascular dysfunction and increased arterial stiffness. This may contribute to adverse clinical outcomes. Modulation of the gut microbiota through fecal microbiota transplantation (FMT) has emerged as a potential therapeutic strategy in liver cirrhosis, but its influence on vascular stiffness in humans remains insufficiently characterized. Methods: This prospective study evaluated arterial stiffness in patients with alcohol-related liver cirrhosis undergoing FMT. A control group received standard care. Vascular stiffness was assessed non-invasively using an oscillometric arteriograph based on pulse wave analysis. Measurements were performed at baseline and at one and three months after FMT under standardized conditions. The main indices assessed included aortic pulse wave velocity, augmentation index, ejection duration and return time. Direct microbiome sequencing and metabolomic profiling were not performed. Results: At baseline, the study and control groups had comparable vascular stiffness profiles. Only minor differences in selected hemodynamic parameters were observed. At one month after intervention, no statistically significant differences in arterial stiffness indices were observed between groups. Longitudinal analysis within the FMT group also showed no significant changes in direct markers of arterial stiffness across the three-month follow-up period. A non-significant tendency toward reduced ejection duration was noted. Conclusions: In patients with advanced alcohol-related liver cirrhosis, FMT did not produce measurable short-term improvements in arterial stiffness. These findings suggest that short-term vascular effects of microbiota modulation may be difficult to detect in patients with advanced alcohol-related liver cirrhosis. Larger studies including earlier-stage patients, longer follow-up and direct microbiome and metabolomic assessment are needed to clarify potential vascular effects of FMT. Full article

Background: An aortic disease diagnosis can be perceived by patients as a stressful and often life-altering event. In addition, an acute event, such as aortic rupture or dissection—and the surgical intervention that will be required to address it—can be viewed as potentially life-threatening and traumatic. Serious health conditions, including stroke and acute coronary syndromes, have been described in the literature to correlate with trauma-like symptoms. Post-traumatic stress disorder (PTSD) is well described in connection with external traumatic events, such as war, assault and similarly catastrophic events. A key element of this type of PTSD is that its occurrence arises secondary to an external traumatizer. However, recent work has suggested that internal events—such as a catastrophic medical event (e.g., acute cardiovascular event and/or surgery)—can trigger PTSD symptoms. An important question is whether medical event-initiated PTSD can (or should) be treated similarly to traditionally defined PTSD, when the triggering threat may persist rather than having been confined to a past event. This systematic review will summarize the literature on the occurrence of PTSD as a consequence of an acute cardiovascular event and attempt to identify effective treatments using meta-analysis, if the literature quantity and quality support it. Methods: The search strategy will include publicly available electronic databases, including MEDLINE via PubMed and OVID, EMBASE via Elsevier, Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost, SCOPUS, PsychInfo, and the Cochrane Library, to identify publications that report the development and/or treatment of PTSD as a consequence of an acute cardiovascular event, which include cardiac arrest, acute coronary syndromes, and acute aortic syndromes. Identification of publications, article classification, methodological review/quality assessment, and data extraction will be performed by two trained experts in cardiovascular epidemiology, with the resolution of disagreements carried out by a third independent reviewer. The review conduct and meta-analysis will follow PRISMA and MOOSE guidelines. Data will be aggregated using random effects models when quantitative data are reliable and heterogeneity is reasonable. If a quantitative synthesis is not possible due to data quality, a narrative synthesis will be conducted. Statistical heterogeneity will be assessed by I² statistics. The quality of evidence will be assessed using the GRADE criteria. Ethics and Dissemination: This study did not require an institutional review board or human subjects protection committee approval given the nature of the study design. The results will be published in a peer-reviewed journal, along with recommendations for future research. Full article

Background: Infective endocarditis (IE) affects both native and prosthetic heart valves, the endocardial surface, as well as cardiac implantable electronic devices. Identifying specific IE biomarkers for its early risk stratification remains crucial, particularly in cases with blood culture-negative endocarditis. Methods: Eleven native heart valves obtained from IE and calcific aortic valve disease (CAVD) patients were analyzed. Immunohistochemical analysis of a pan-leukocyte marker (CD45), macrophage marker (CD68), T-lymphocyte marker (CD3), B-lymphocyte marker (CD19), neutrophil myeloperoxidase (MPO), and marker of vascular endothelial cells (CD31) was performed. Differentially expressed genes (DEGs) were identified by whole-transcriptome sequencing; proteomic profiling was performed by dot-blotting. Results: The immunophenotyping demonstrates the infiltration of macrophages and neutrophils, as well as occasional T-lymphocytes in the IE-affected aortic valves, and the CAVD-affected heart valves were characterized by the absence of neutrophils. For the whole-transcriptome sequencing, 157 DEGs were identified: 124 DEGs were upregulated, and 33 genes were downregulated in the IE-affected heart valves compared to the CAVD-affected ones. According to the dot-blotting, 35 cytokines were identified in the studied heart valves, but only 21 molecules were expressed in both IE and CAVD-affected heart valves. Analysis of proteases and their inhibitors allowed the identification of 13 protease molecules and 18 enzyme inhibitor molecules in all examined heart valves. Conclusions: The results of the present study can help to improve our understanding of the IE pathogenesis. In addition, we identified the candidate cellular and molecular-genetic features of IE-affected native heart valves. Full article

Background: Chronic kidney disease (CKD) associated vascular calcification (VC) is a leading cause of cardiovascular mortality, partially driven by osteogenic transdifferentiation of vascular smooth muscle cells (VSMCs). Chaperone-mediated autophagy (CMA) is a selective lysosomal degradation cellular process. However, the precise role and mechanism of CMA in CKD-associated vascular calcification remain unknown. Methods: We studied calcified arteries from CKD patients and rats fed on a high-phosphate diet using histological and ultrastructural methods. VSMCs' calcification was induced by a calcification medium containing high phosphate and calcium. CMA activity was measured by a KFERQ reporter and lysosomal staining. The expression of LAMP2a and HSP90AA1 was knocked down by siRNA, overexpressed by plasmid, and activated by QX77.1. Bioinformatic analysis, protein interaction studies, immunofluorescence and co-immunoprecipitation were performed to investigate the potential mechanism of CMA in VC. Results: The expression of LAMP2a was increased in human calcified radial artery tissues (n = 3, p < 0.05) and rats' calcified aortic tissues (n = 3, p < 0.01), accompanied by lysosomal abnormalities. The activity of CMA was increased during the osteogenic transdifferentiation of VSMCs, as indicated by increased expression of RUNX2 and reduced expression of SM22α (p < 0.05). LAMP2a knockdown attenuated VSMCs’ calcification (p < 0.05), whereas pharmacological activation of CMA aggravated calcification in VSMCs (p < 0.01). Bioinformatic screening identified HSP90AA1 as a candidate involved in CMA in vascular calcification. Elevated HSP90AA1 expression was observed in human calcified radial artery tissues (n = 3, p < 0.01) and rat calcified aortic tissues (n = 3, p < 0.01), which promoted osteogenic transdifferentiation of VSMCs (p < 0.05). HSP90AA1 interacted with LAMP2a and positively regulated its expression (p < 0.01). Conclusions: These findings support an association between CMA activation and CKD vascular calcification. It suggests that HSP90AA1 facilitates vascular calcification in chronic kidney disease involving chaperone-mediated autophagy. Full article

Myocardial calcification is an uncommon complication associated with end-stage chronic kidney disease (CKD) in feline patients. This report describes the clinical and multimodal imaging features of metastatic calcification in a 10-year-old castrated male mixed-breed cat. The patient presented with dyspnea and anorexia, and was diagnosed with IRIS Stage 4 CKD. Laboratory findings revealed severe hyperphosphatemia and an elevated calcium–phosphorus product (CPP) of 135 mg²/dL², based on total calcium. This value significantly exceeds 70 mg²/dL², a threshold associated with a high probability of inducing soft tissue mineralization. Echocardiography revealed extensive hyperechoic foci with posterior acoustic shadowing in the interventricular septum and left ventricular wall. Functional assessment demonstrated a restrictive diastolic filling pattern, suggesting increased myocardial stiffness and congestive heart failure. Computed tomography (CT) further visualized systemic involvement, showing diffuse, amorphous calcifications (400–900 HU) in the myocardium, multifocal aortic wall, and extracardiac tissues. Despite intensive treatment with diuretics and renal support, the patient was euthanized eight days later due to progressive renal failure. This case illustrates that the interaction between metastatic calcification and uremic cardiomyopathy (UC) can result in refractory heart failure, underscoring the value of combined echocardiography and CT in evaluating end-stage renal disease. Full article

Background/Objectives: Totally endoscopic mitral valve repair reduces surgical trauma and accelerates recovery but can be technically challenging, particularly for precise annuloplasty suturing. The VirtuoSEW^® (LSI Solutions, Victor, NY 14564m, USA) automated annular suturing system was developed to standardize and simplify suture placement. This study was an early evaluation of this technology’s safety, efficacy, and feasibility in totally endoscopic microInvasive mitral valve repair (µMVr). Methods: We conducted a retrospective observational study of 20 patients with severe mitral valve disease of various etiologies. All patients underwent mitral valve repair using the VirtuoSEW^® system for automated placement of annuloplasty sutures, combined with leaflet resection or chordal management as appropriate. Postoperative outcomes were assessed at one month using echocardiography and clinical evaluation. Perioperative and postoperative complications and early mortality were systematically recorded. Results: VirtuoSEW^®-assisted mitral valve repair was safe and effective, achieving complete elimination of severe mitral regurgitation in all patients (N = 20, 100%). Annuloplasty rings included Physio-ring (N = 12, 60%), Memo 3D (N = 4, 20%), and Memo 4D (N = 4, 20%), combined with leaflet repair techniques: leaflet plication (N = 5, 25%), neochordae implantation (N = 7, 35%), sliding plasty (N = 2, 10%), commissural repair (N = 1, 5%), and hemibutterfly repair (N = 1, 5%). Concomitant procedures included: tricuspid valve repair (N = 1, 5%) and atrial septal defect closure (N = 1, 5%). Mitral annulus diameter decreased from 42.0 ± 5.3 mm to 34.2 ± 2.2 mm (p = 0.001). Mean total surgery, cardiopulmonary bypass, and aortic cross-clamp times were 170.3 ± 21.3, 143.4 ± 21.5, and 80.4 ± 7.9 min, respectively. ICU stay was 1.0 ± 0.2 days, with a hospital stay of 8.0 ± 1.9 days. No perioperative complications—including bleeding (N = 0, 0%), stroke (N = 0, 0%), infections (N = 0, 0%), or 30-day mortality (N = 0, 0%)—occurred. Conclusions: µMVR invasive mitral valve repair using the VirtuoSEW^® system is safe, effective, and reproducible, as well as compatible with almost all repair techniques, providing complete restoration of valve competence with no early device-related complications. To our knowledge, this is the first clinical study reporting outcomes with this device, supporting its potential to streamline mitral repair and improve procedural efficiency. Full article

Background: The genus Brucella has expanded considerably in the 21st century. With the advent of advanced phylogenetic analyses, a close genetic relationship between Brucella and Ochrobactrum has been identified, leading to reclassification of Ochrobactrum species within the genus Brucella. Among these, Brucella anthropi (formerly Ochrobactrum anthropi) is increasingly recognized as a rare cause of invasive human infection. We report a clinically significant case of B. anthropi infective endocarditis and review the available literature. Methods: We report a case of B. anthropi infective endocarditis and conducted a narrative review of the English-language medical literature through 2025. Cases were analyzed for demographics, clinical presentation, antimicrobial susceptibility, and outcomes. Results: A 75-year-old man with a prosthetic aortic valve and prior endocarditis presented with fever of unknown origin, weight loss, and prior transient ischemic attacks. Blood cultures grew B. anthropi after prolonged incubation. Transesophageal echocardiography demonstrated vegetations involving both the aortic and tricuspid valves, and the patient required targeted combination antimicrobial therapy due to persistent bacteremia. Seven additional cases of B. anthropi infective endocarditis were identified on review of the literature. Most patients had underlying valvular disease or prosthetic material. Reported lethality approached 25%. Antimicrobial susceptibility patterns were variable, underscoring the importance of targeted individualized therapy. Conclusion: Consistent with other Gram-negative bacilli, B. anthropi is a rare but established cause of acute bacterial endocarditis. Despite its rarity, it may represent an under-recognized cause of invasive disease. This case highlights the importance of prolonged culture incubation, careful microbiologic interpretation, and susceptibility-guided therapy. Full article

Background: Neonatal and infant aortic arch reconstruction remains a high-risk cardiovascular procedure requiring effective cerebral and myocardial protection. Variability in perfusion strategies may influence early hemodynamic stability and postoperative recovery. This study aimed to evaluate the early and short-term cardiovascular outcomes of a standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous antegrade selective cerebral and continuous coronary perfusion. Methods: In this retrospective single-center cohort study, 31 consecutive neonates and infants undergoing aortic arch reconstruction between November 2022 and December 2025 were analyzed. A standardized surgical protocol was applied, consisting of extensive ductal tissue resection, interdigitating posterior end-to-end anastomosis, anterior autologous pericardial patch augmentation, and moderate hypothermic antegrade selective cerebral perfusion combined with continuous coronary perfusion via innominate artery cannulation. Early postoperative outcomes and short-term echocardiographic follow-up results were assessed. Results: The cohort included 31 patients, 22.6% of whom had complex associated cardiac anomalies requiring concomitant procedures. Median cardiopulmonary bypass and aortic cross-clamp times were 119 and 64 min, respectively. There was no in-hospital mortality. Major complications were infrequent, and median intensive care unit stay was 5 days. During a median follow-up of 6.8 months, one patient (3.2%) developed recoarctation requiring reintervention. No late mortality was observed. Conclusions: A fully standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous cerebral and coronary perfusion demonstrated favorable early cardiovascular and short-term outcomes, even in anatomically complex cases. Preservation of continuous coronary perfusion may be associated with improved myocardial stability and early postoperative recovery; however, these findings should be interpreted as observational and hypothesis-generating given the absence of a control group. Larger multicenter studies with longer follow-up are warranted to confirm these findings. Full article

Background: The prevalence of severe aortic stenosis (AS) is increasing, in accordance with a longer life expectancy. Aortic valve calcification is a multifactorial pathological process involving a complex interplay between different types of regenerative cellular and genetic factors. Among these cells, endothelial progenitor cells (EPCs) and their osteoblastic phenotype subpopulation (EPC-OCNs) have been implicated in vascular remodeling and disease progression. Objectives: To assess longitudinal changes in EPC and EPC-OCN levels in patients with severe symptomatic AS undergoing transcatheter aortic valve implantation (TAVI). Methods: In this prospective observational study, 65 patients with severe AS undergoing TAVI were enrolled. Circulating EPC and EPC-OCN levels were quantified by flow cytometry before the procedure, at 4 ± 1 days, and at 90 ± 29 days after TAVI. EPCs were defined by expression of CD133, CD34, and VEGFR-2. Results: Circulating EPC levels remained unchanged throughout the follow-up. In contrast, circulating EPC-OCNs increased significantly over time. Specifically, CD133+/VEGFR-2+/OCN+ cells rose from 2.50% to 6.25%, CD34+/VEGFR-2+/OCN+ from 2.04% to 4.05%, and VEGFR-2+/OCN+ from 1.46% to 3.01% (all p < 0.01). This suggests an osteogenic response to TAVI, while classical endothelial repair mechanisms were not systemically activated. Conclusions: EPC-OCNs increased significantly following TAVI, possibly reflecting ongoing tissue remodeling or calcification processes. In contrast, the stability of classical EPCs levels suggests limited systemic endothelial regeneration. These observations underscore the potential role of EPC-OCNs as markers or modulators of pre- and post-TAVI vascular remodeling. Full article

Background and Objectives: Patients with porcelain aorta (PA) pose major surgical challenges during aortic valve replacement, making transcatheter aortic valve replacement (TAVR) the preferred alternative. However, data on the prognostic significance of PA among TAVR recipients are limited. This study sought to evaluate whether PA is associated with adverse short-term outcomes following TAVR. Materials and Methods: Consecutive, surgery-naïve patients who underwent TAVR between 2012 and 2020 at a single institution were retrospectively analyzed. Based on preoperative CT scans, patients were categorized as having either porcelain aorta (PA) or non-calcific aorta (NC). Inverse probability of treatment weighting (IPTW) was used to minimize baseline differences, with standardized mean differences (SMD) < 0.1 indicating adequate covariate balance. Logistic regression addressed residual post-IPTW imbalances. Results: A total of 2037 patients with severe symptomatic aortic stenosis were identified, of whom 40 (2%) had PA. Compared to the NC population, PA patients were more likely to be younger (p = 0.002), had a higher prevalence of heart failure symptoms (p = 0.041) and peripheral artery disease (p = 0.006). After adjustment for preoperative characteristics, no significant differences were observed between groups in post-TAVR mortality (p = 0.498), stroke (p = 0.606), or postoperative creatinine levels (p = 0.827). However, PA patients experienced significantly longer in-hospital (p < 0.001) and ICU (p < 0.001) lengths of stay. Conclusions: In this single-center cohort, PA did not appear to confer additional risk of mortality, stroke or renal failure, although it remained associated with longer postoperative in-hospital and ICU lengths of stays. TAVR appears to be a safe and effective method of AVR when significant circumferential atherosclerotic aortic calcification precludes aortic cross-clamping. Full article

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency characterized by important sex-related differences in presentation, management, and outcomes. Although women account for a smaller proportion of cases, they typically present at older ages and more frequently exhibit atypical symptoms, hemodynamic instability, and complications such as pericardial effusion or tamponade, contributing to diagnostic delays and higher pre-hospital mortality. Beyond clinical factors, biological differences may influence disease expression in women. Menopause-associated vascular aging, hormonal modulation of extracellular matrix remodeling, and pregnancy-related hemodynamic and connective tissue changes may alter aortic wall integrity and susceptibility to dissection. Notably, women often experience dissection at smaller absolute aortic diameters, highlighting the potential importance of body-size indexing in risk stratification and surgical thresholds. In type A AAD, women are less likely to undergo extensive surgical repair in some cohorts, and although contemporary in-hospital mortality differences are narrowing, long-term survival disparities may persist. In type B AAD, women are more frequently managed conservatively, while outcomes following thoracic endovascular aortic repair appear broadly comparable between sexes. Pregnancy and the postpartum period represent particularly vulnerable windows, especially among patients with underlying heritable aortopathies. Greater awareness of sex-specific biological and clinical characteristics, incorporation of indexed aortic dimensions, and improved multidisciplinary management strategies are essential to optimize outcomes for women with acute aortic dissection. Full article

Transcatheter aortic valve implantation (TAVI) has become the predominant treatment strategy for severe aortic stenosis across all surgical risk categories. The coexistence of coronary artery disease (CAD) in 40–75% of TAVI candidates has traditionally mandated pre-procedural invasive coronary angiography (ICA). However, computed tomography coronary angiography (CTCA), which is already integral to TAVI planning for annular sizing and access route evaluation, offers the potential to assess coronary anatomy simultaneously. Accumulating evidence demonstrates that CTCA possesses excellent sensitivity (90–97%) and high negative predictive value (94–99%) for excluding significant proximal CAD, potentially serving as a reliable gatekeeper to avoid unnecessary ICA in a substantial proportion of patients. This approach is particularly attractive given the questionable benefit of routine pre-emptive coronary revascularization in stable TAVI candidates, as demonstrated by the ACTIVATION and NOTION-3 trials. This review synthesizes the current evidence on the diagnostic performance of CTCA, clinical outcomes with CT-guided strategies, technical considerations and limitations, and the evolving paradigm of coronary assessment in the contemporary TAVI era. We propose a practical algorithm integrating CTCA as a first-line screening tool, reserving ICA for patients with suspected significant proximal disease, thereby optimizing resource utilization while maintaining patient safety. Full article

Background and Objectives: The optimal management of dilated ascending aorta during aortic valve replacement (AVR) in older or high-risk patients remains debated. While graft replacement is the standard procedure, reductive ascending aortoplasty (RAA) may offer a less invasive, tissue-preserving alternative. This study evaluated long-term RAA outcomes and identified the optimal patient profile. Materials and Methods: In a single-center cohort, 64 patients underwent AVR with unwrapped RAA (2005–2025). Patients were stratified by valve phenotype (tricuspid [TAV], n = 45; bicuspid [BAV], n = 19) and age (<70 years, n = 52; ≥70 years, n = 12). Endpoints were early safety, long-term survival, and aortic redilatation (≥50 mm). Results: Outcomes diverged markedly by subgroup. Patients aged ≥70 years demonstrated excellent 10-year freedom from redilatation (83.3%) with no reinterventions. In contrast, BAV patients had higher redilatation rates (31.6% vs. 8.9%; p = 0.053) and a trend toward more reexploration for bleeding (15.8% vs. 6.7%; p = 0.109). Redilatation and reintervention were concentrated in patients <70 years. Conclusions: RAA with AVR offers favorable long-term durability, but success is highly age-dependent. The procedure is a safe, effective tissue-preserving strategy for selected older patients (≥70 years), particularly those with TAV. However, high redilatation rates in BAV patients suggest that RAA should be avoided in this population, reinforcing graft replacement as preferred for younger patients. Full article