Search Results (4,764)

Background: Heart failure (HF) is highly prevalent among patients on maintenance hemodialysis (HD) and contributes substantially to morbidity and mortality. This study aimed to evaluate the prevalence, clinical characteristics, and prognostic impact of HF in a chronic HD population. Methods: A single-center observational study was conducted on 271 HD patients (January 2022–September 2024). HF was defined and classified according to 2021 ESC criteria using echocardiography and NT-proBNP. Clinical, laboratory, and dialysis parameters were compared between HF and non-HF patients. Predictors of HF were assessed using multivariable logistic regression, and survival analyses were performed using Cox regression and Kaplan–Meier curves. Results: HF was identified in 75% of patients: 45% had a preserved EF, 31% had a mildly reduced EF, and 24% had a reduced EF. HF patients were older, had higher NT-proBNP, lower EF, more atrial fibrillation, CAD, and increased interdialytic weight gain. In the multivariable analysis, a reduced EF (OR = 0.77, p = 0.001), older age (OR = 1.12, p = 0.001), and UF rate (OR = 1.31, p = 0.02) were found to independently predict HF. During the 34-month follow-up, HF was found to be associated with significantly higher all-cause and cardiac mortality and more frequent HF-related hospitalizations (log-rank p < 0.001). In the multivariable Cox regression, two variables were found to independently predict all-cause death, NT-proBNP (per 1000 pg/mL) (HR 1.030, p = 0.029) and a lower EF: (HR 0.97, p = 0.019). For cardiac death, a higher NT-proBNP (HR 1.038, p = 0.033) and a lower EF (HR 0.933, p = 0.001) together with a lower BMI (HR = 0.929, p = 0.028) persisted as independent predictors. Conclusions: HF is extremely common in HD patients and identifies a subgroup with distinct clinical characteristics and poor prognosis. NT-proBNP and left ventricular ejection fraction are key independent predictors of mortality, underscoring the importance of early cardiac evaluation and integrated volume and dialysis management to improve outcomes. Full article

ST-segment elevation myocardial infarction (STEMI) represents a time-critical medical emergency where complete coronary artery occlusion initiates progressive myocardial necrosis. The fundamental principle of modern STEMI care—“Time is Muscle”—establishes that ischemic duration directly determines infarct size and clinical outcomes. Each minute of delay correlates with increased mortality, larger infarcts, and a higher risk of heart failure development. Total ischemic time encompasses both patient-mediated delays (often the largest component) and system-related delays, each influenced by distinct factors requiring targeted interventions. This comprehensive review analyzes the components of total ischemic time, quantifies the clinical consequences of delay, and evaluates evidence-based mitigation strategies. We examine the evolution from fibrinolysis to primary percutaneous coronary intervention and the resulting logistical challenges. System-level interventions—including public awareness campaigns, regionalized STEMI networks, pre-hospital ECG acquisition, and standardized hospital protocols—have dramatically reduced treatment times. However, persistent disparities based on geography, presentation timing, sex, race, and age remain problematic. Emerging technologies, particularly artificial intelligence for ECG interpretation, offer promise for further time reduction. Full article

Cardiac computed tomography (CT) has long evolved as a highly accurate screening tool for coronary artery disease. New technologies such as multi-detector rows and artifact reduction by a new motion correction algorithm have made it possible to evaluate coronary artery stenosis with higher diagnostic accuracy and lower radiation exposure. In addition to the anatomical evaluation of coronary arteries, the introduction of fluid dynamic analysis enables the measurement of coronary fractional flow reserve (FFR) for each stenotic lesion, which can only be achieved through invasive catheter evaluation. Myocardial ischemia can now also be detected using myocardial stress perfusion CT imaging. In addition, with the advent of dual-energy imaging or new image reconstruction technology, the addition of late contrast phase imaging enables myocardial late enhancement and left ventricular (LV) extracellular volume (ECV) analysis, which was previously possible only with cardiac magnetic resonance imaging (MRI). It has also been reported that LV ECV may be useful in predicting prognosis in cases with cardiomyopathies. In addition, retrospective imaging of the entire heart in a single cardiac cycle is now possible with lower radiation exposure, enabling not only morphological evaluation of the heart and valves but also myocardial strain analysis, which has conventionally been evaluated mainly by echocardiography and is expected to be applied in clinical practice in the future. Cardiac CT, which overcomes the weaknesses of other modalities while demonstrating greater usefulness through the latest technological development, is expected to expand its field of application to the entire heart analysis. The purpose of this review is to provide an overview of the technological development of cardiac CT, which has seen remarkable development in recent years, along with its clinical utility, with the aim of enabling clinicians to fully utilize it in daily practice. Full article

Background/Objectives: Calcific aortic valve disease (CAVD) is a progressive condition marked by thickening and calcification of the valve leaflets, leading to impaired cardiac function and increased cardiovascular risk. As disease progression is strongly influenced by hemodynamics and lipid accumulation, computational modeling provides a powerful tool for understanding the biomechanical drivers of calcification. Methods: This study investigates the effects of coronary artery flow and varying left ventricular outflow tract (LVOT) velocity profiles on low density lipoprotein (LDL) accumulation and associated aortic valve calcification using a partitioned fluid–structure interaction framework coupled with scalar transport modeling, with a focus on understanding the differential behaviors of the three valve leaflets: the non-coronary cusp (NCC), right coronary cusp (RCC), and left coronary cusp (LCC). Four distinct LVOT flow velocity profiles (anterior, lateral, posterior, and medial) and coronary flow are simulated to determine their effects on the distribution of LDL accumulation and associated calcification across the valve leaflets. Results/Conclusions: Our results indicate that the RCC experiences greatest excursion and lowest calcification. The LCC shows lowest excursion and slightly higher susceptibility for calcification. Finally, the NCC experiences intermediate excursion, but is most prone to calcification. Full article

Background: Dilated cardiomyopathy (DCM) is a myocardial disorder characterized by structural and functional abnormalities, in particular left or biventricular chamber dilatation and systolic dysfunction, occurring without evidence of coronary artery disease, hypertension, valvular disease, or congenital heart defects. It is a significant cause of sudden cardiac death, particularly in young individuals, often remaining undiagnosed until autopsy. Methods: A systematic review of the literature was conducted following PRISMA guidelines to revisit the main postmortem findings (gross, microscopic, and genetic) useful to perform the postmortem diagnosis of DCM. Scientific databases (PubMed and Scopus) were searched for articles published up to February 2025 describing postmortem findings in individuals diagnosed with DCM. Inclusion criteria were focused on studies reporting macroscopic cardiac findings, and microscopic and genetic variants identified postmortem or in related familial studies. Data were extracted and categorized to identify consistent diagnostic markers and to assess the frequency and relevance of genetic findings in autopsy-confirmed DCM cases. From 2081 initial records, 30 studies met inclusion criteria. Two reviewers independently performed study selection and data extraction, and methodological limitations of the included studies were considered qualitatively to inform the synthesis. Results: Common macroscopic features included increased heart weight (often > 350 g), dilated left or biventricular chambers, and thinning of the ventricular walls. Histologically, the most consistent findings were diffuse interstitial fibrosis, myocyte hypertrophy, and nuclear atypia. Particular attention was given to morphological features essential to distinguish between genetic and nongenetic forms of DCM and, thus, useful to perform a differential diagnosis with disease having a DCM-like pattern. Notably, truncating variants in genes such as TTN, FLNC, DSP, PKP2, and MYH7 were frequently reported, particularly in young decedents with no significant history of cardiac disease. However, only about half of reviewed studies included any form of genetic analysis, reflecting a significant gap in current practice for forensic pathologists. Conclusions: DCM may cause sudden death without prior symptoms, making genetic testing essential to uncover the diagnosis, especially in cases with a negative phenotype. Therefore, molecular autopsy combined with careful macroscopic and microscopic analysis can strengthen the forensic assessment. Full article

Background: Human papillomavirus (HPV) is a serious disease caused by a viral infection that can lead to various types of cancers in both women and men. Nearly all cases of cervical cancer (99.7%) develop as a result of an HPV infection, ranging from low to high grade, with a 5-year mortality rate ranging from 8 to 81% depending on the timeliness of diagnosis. Recent studies have further shown that HPV significantly increases the risk of cardiovascular disease, including coronary artery disease (CAD). However, the mechanism and impact of HPV on CVD from a proteomics and transcriptomics perspective are not well understood. Objectives: The purpose of this work is to provide the evidence framework for using machine learning to further advance knowledge on the interplay of HPV and CVD in relation to proteomic and transcriptomic changes. Key findings: In addition to existing known relationships between HPV and atherosclerosis and CAD, dilated cardiomyopathy (DCM) is identified as an important cardiovascular disease modified by HPV infections. A more comprehensive understanding of the cholesterol-modifying mechanisms underpinning HPV’s influence on CVD has been identified. Downstream ML has been used to selectively identify key proteins for subsequent bioinformatic mining across a range of public and in-house curated databases. Implications: By further understanding the mechanisms underlying HPV-induced cardiovascular pathogenesis, machine learning models can be developed in a more targeted manner, stratifying patients that will have an optimal response to emerging probiotic-based therapies. Full article

Background/Objectives: A significant proportion of patients with angina undergoing invasive coronary angiography have no obstructive coronary artery disease (ANOCA), often due to coronary microvascular dysfunction (CMD). Coronary function testing (CFT) enables the physiological endotyping of these patients during angiography. This meta-analysis aimed to evaluate whether CFT-guided therapy improves angina symptoms and quality of life compared with standard angiography-guided care. Methods: Major databases were systematically searched for randomised controlled trials (RCTs) up to September 2025. The primary endpoint was angina severity; secondary endpoints included angina limitation, stability, frequency, treatment satisfaction, and quality of life. Pooled analyses were performed using a random-effects model with inverse-variance weighting to derive the weighted mean difference (95% confidence interval, CI). Results: Three RCTs involving 535 patients (mean age 60 years, 64% female) met inclusion criteria. The disclosure of CFT results did not significantly improve overall angina severity (mean difference: 6.00, 95% CI −2.32 to 14.33; p = 0.16), with considerate heterogeneity (I² = 92%). No difference was observed for angina frequency or quality of life. In contrast, angina limitation, stability, and treatment satisfaction all favoured the CFT-disclosed group, although the results were heterogeneous. Conclusions: Invasive CFT appears feasible and clinically relevant in patients with ANOCA. Although several SAQ domains improved following physiology-guided management, these findings require cautious interpretation given the modest sample size and considerable heterogeneity. Larger, methodologically robust trials are warranted to clarify whether a CFT-guided strategy should be routinely integrated into the diagnostic and therapeutic pathway for ANOCA. Full article

Cardiovascular health is essential for human survival, yet it remains threatened by injuries associated with metabolic disorders, myocardial infarction, ischemia–reperfusion, and even general anesthesia. The development of a safe and effective cardioprotective agent would be of considerable value in diverse clinical settings. Epigallocatechin gallate (EGCG), the principal constituent of catechins, has garnered considerable attention owing to its diverse health benefits. As a natural antioxidant and anti-inflammatory agent, it has been shown in numerous studies to exert pronounced cardioprotective effects. In preclinical studies, EGCG not only protects the coronary arteries but also attenuates adverse cardiac remodeling, prevents regulated cell death of cardiomyocytes, and enhances cardiac function. In addition, clinical studies have confirmed its beneficial effects on metabolic disorders, endothelial dysfunction, and adverse cardiac remodeling. Full article

Background: The aim of this study was to investigate the effect of preoperative statin use on postoperative bleeding and related complications in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: Between 2023 and 2025, 627 patients who underwent isolated CABG were evaluated. The patients were divided into two groups: Group A (n = 241, received preoperative statins) and Group B (n = 386, did not receive preoperative statins). All preoperative, intraoperative parameters, and postoperative outcomes were compared. Results: Patient demographics, comorbidities, laboratory parameters, EuroSCORE II, echocardiographic findings, operative data, cross-clamp times, and cardiopulmonary bypass times were similar. Intraoperative and postoperative blood product use were comparable between the groups. Postoperative total bleeding was higher in Group A than in Group B, but no statistical difference was found. The postoperative exploration rate was higher in Group A than in Group B, but no statistically significant difference was found. There were no significant differences between the groups in terms of gastrointestinal bleeding. Postoperative atrial fibrillation (POAF) was significantly lower in Group A than in Group B (21 (8.7%)–74 (19.2%), p < 0.001). Mortality was higher in Group B than in Group A, but no statistically significant difference was found (3 (1.2%)–14 (3.6%), p = 0.07). Intensive care unit stay was longer in Group B than in Group A. A significant negative association was found between statin usage and POAF (p = 0.001, OR = 0.418). Conclusions: We found no statistically significant increase in postoperative bleeding or blood product use with preoperative statin therapy in isolated CABG patients. However, we found that preoperative statin therapy was protective against POAF. Full article

Background: Despite the increasing adoption of minimally invasive direct coronary artery bypass (MIDCAB), data on its long-term outcomes—particularly regarding sex-based differences—remain limited. This study presents a robust 20-year analysis comparing males and females, assessing perioperative outcomes, long-term survival, and independent predictors of mortality to inform sex-sensitive clinical decision-making. Methods: A retrospective cohort analysis of 676 patients (138 females, 538 males) undergoing MIDCAB was performed. Propensity score matching (PSM) generated balanced female and male cohorts (n = 129 each). Preoperative demographics, short-term outcomes, and long-term survival were assessed using Kaplan–Meier analysis and Cox regression modelling. Results: In unmatched cohorts, females exhibited significantly lower NYHA class distribution (p = 0.011) and higher atrial fibrillation prevalence (p = 0.038), with otherwise comparable comorbidities. Propensity score matching achieved cohort balance, and short-term outcomes—including 30-day mortality, stroke/TIA, and reoperation—were similar across sexes. Kaplan–Meier analysis of matched cohorts revealed no significant survival difference (log-rank p = 0.3370), though females demonstrated greater 20-year survival than males (77.6% versus 55.8%). In females, age 70–79 (HR 2.66; 95% CI: 1.02–6.95; p = 0.046) and cerebrovascular disease (HR 5.33; 95% CI: 1.49–19.03; p = 0.010) were independently associated with mortality. In males, significant predictors included diabetes (HR 1.86; 95% CI: 1.02–3.38; p = 0.042), chronic kidney disease (HR 4.92; 95% CI: 1.21–20.02; p = 0.026), pulmonary disease (HR 2.35; 95% CI: 1.20–4.60; p = 0.013), cerebrovascular disease (HR 4.77; 95% CI: 1.97–11.56; p < 0.001), and reduced left ventricular ejection fraction (HR 0.17; 95% CI: 0.06–0.43; p < 0.001). Conclusions: This 20-year study, the longest to date, demonstrates that MIDCAB achieves durable and equivalent long-term survival in males and females. It highlights sex-specific predictors of mortality, emphasizing the necessity for personalized preoperative risk assessment and postoperative management. Full article

Background: Intraoperative high-volume diuresis is a frequent but underrecognized complication in cardiac surgery, potentially leading to hypovolemia, electrolyte imbalances, and hemodynamic instability. Its mechanisms remain poorly defined. This study investigated the hormonal and biochemical regulation of urine output during off-pump coronary artery bypass grafting (OPCABG). Methods: For this single-center observational cohort study, 70 patients undergoing OPCABG were enrolled (diuresis: urine output > 5 mL/kg/h, n = 38; normal, n = 32). Hormonal markers and osmolality parameters were measured perioperatively. Logistic regression was used to identify independent predictors, and receiver operating characteristic (ROC) curves was used to assess model performance. Results: Intraoperative high-volume diuresis occurred in 54.2% of patients. Logistic regression identified a low Body Mass Index (BMI) (OR 0.72, p = 0.002), reduced albumin (OR 0.75, p = 0.014), and lower copeptin (OR 0.43, p = 0.037) as independent predictors (AUC 0.855). Perioperatively, NT-proBNPT0 rose in both groups, aldosterone increased only in the diuresis group, and copeptin showed a slight nonsignificant rise. Plasma sodium was higher in cases of diuresis at the end of surgery (148.4 vs. 144.9 mmol/L, p < 0.001). Despite greater urine output and fluid infusion, the rates of intensive care unit (ICU) admission and hospital stays were similar. Conclusions: Intraoperative high-volume diuresis in OPCABG is strongly associated with reduced antidiuretic hormone activity, suggesting a partial central diabetes insipidus-like mechanism. Although not affecting short-term outcomes, it posed challenges for intraoperative fluid and electrolyte management. Larger multicenter studies are needed for validation. Full article

Background: Vascular calcification is a strong predictor of cardiovascular morbidity and mortality. Oxidative stress plays a key role in promoting vascular calcification. Glutathione (GSH), as a major cellular antioxidant, is produced in response to oxidative stress and is regulated by the enzyme glutamate-cysteine ligase (GCL). In this study, we examined the role of the GCL modifier subunit (GCLm) in regulating vascular smooth muscle cell (VSMC) calcification. Methods: Human coronary artery VSMCs were exposed to phosphate-rich media to induce calcification. Results: Calcification led to a decrease in the GSH:GSSG ratio (reduced glutathione to oxidized glutathione), and elevated GCLm expression, coincident with mobilization of osteogenic genes and loss of contractile phenotype. KEGG pathway analysis of human unstable atherosclerotic plaques similarly showed increased GCLm expression and activation of reactive oxygen species (ROS)-related pathways. Notably, forced overexpression of GCLm in murine VSMCs (MOVAS cells) significantly accelerated calcification. These findings implicate GCLm upregulation in promoting VSMC calcification, potentially by disrupting redox homeostasis and driving phenotypic switching. Further mechanistic studies are warranted to evaluate GCLm as a potential therapeutic target in vascular calcification. Full article

Background: Empagliflozin and dapagliflozin are the most widely prescribed sodium–glucose cotransporter-2 inhibitors (SGLT2i) with established cardioprotective benefits across the spectrum of heart failure (HF). However, direct comparative data remain limited, particularly in patients with a history of coronary revascularization—a population at persistently high cardiovascular (CV) risk. This study aimed to compare the long-term cardiovascular outcomes of empagliflozin versus dapagliflozin in revascularized HF patients who had undergone coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods: This retrospective cohort study included 631 HF patients who had undergone coronary revascularization (CABG or PCI) and were treated with an SGLT2 inhibitor (353 dapagliflozin, 278 empagliflozin) between 2014 and 2022 at a tertiary cardiovascular center. Patients were stratified by left ventricular ejection fraction (LVEF ≥ 50%: HFpEF; LVEF < 50%: HFrEF/HFmrEF). The primary outcomes were all-cause mortality, cardiac mortality, major adverse cardiovascular events (MACE), cardiac MACE, and HF-related hospitalization. Cox regression analyses—including time-dependent covariates—were performed to identify independent predictors of cardiac MACE. Results: Baseline demographic, clinical, and biochemical characteristics were comparable between groups. During a mean follow-up of 19.6 ± 1.5 months, there were no significant differences between dapagliflozin and empagliflozin in all-cause mortality (19.3% vs. 19.8%), cardiac mortality (11.0% vs. 12.2%), MACE (25.8% vs. 26.3%), cardiac MACE (23.8% vs. 21.9%), or hospitalization (23.8% vs. 23.7%) (all p > 0.05). Subgroup analyses by LVEF yielded consistent findings. In time-adjusted Cox modeling, age (HR = 2.089; 95% CI: 1.723–2.533; p < 0.001) and atrial fibrillation (AF) (log-rank p = 0.030) were identified as significant predictors of cardiac MACE, while creatinine and NT-proBNP lost significance after adjustment. Both age and AF showed time-varying hazard effects, with risk attenuation over time. Conclusions: In this real-world cohort of revascularized HF patients, empagliflozin and dapagliflozin demonstrated comparable long-term cardiovascular outcomes, supporting a class effect of SGLT2 inhibitors in this high-risk population. Beyond pharmacologic comparison, age and AF emerged as dynamic predictors of cardiac MACE, highlighting the importance of longitudinal, time-dependent risk assessment in heart failure management following coronary revascularization. Full article

Even when people with diabetes mellitus (DM) meet their cholesterol goals, they still face a higher risk of heart and blood vessel problems. One major reason is a particle called lipoprotein(a), or Lp(a), which is similar to LDL cholesterol. Raised levels of Lp(a) are inherited rather than caused by lifestyle. Lp(a) can build up in the body and make it easier for blood clots to form because it closely resembles a protein called plasminogen, reducing its ability to form plasmin that dissolves blood clots. At the same time, chemical changes like oxidation and glycation can make blood vessels more inflamed, adding to the risk. Elevated concentrations of Lp(a) (>30 mg/dL; 75 nmol/L), and particularly >50 mg/dL (125 nmol/L), are independently associated with coronary artery disease, ischemic stroke, diabetic nephropathy, retinopathy, and neuropathy. Conventional lipid-lowering therapies exert neutral or modest effects on Lp(a), in contrast to RNA-based targeted agents (antisense oligonucleotides and siRNA [Small Interfering RNA]), which achieve reductions of 70–95% and show consistent results in Phase 2 clinical trials. In this review, we bring together findings from laboratory research and clinical studies, and highlight why it is important to measure Lp(a) levels—at least once in a person’s life, and especially in those with diabetes—to help doctors better assess risk and plan more effective treatments. In diabetic populations, the adaptation of Lp(a)-targeted therapies could redefine the management of residual risk and improve both cardiovascular and microvascular outcomes. Full article

Background/Objectives: Coronary artery disease (CAD) remains the leading cause of death primarily in patients over 65 years old, with an increasing incidence, especially in Eastern European countries. Primary and secondary prevention protocols are based on a large number of cardiovascular (CV) risk factors, but low-density lipoprotein cholesterol (LDL-C) remains the main treatment target and one of the central determinants of CV risk. Apolipoprotein B (apoB) is the main structural protein in all atherogenic lipoproteins, and, unlike LDL-C, which only reflects the cholesterol content of LDL, apoB directly quantifies the total number of all circulating atherogenic particles. Over the past decade, a growing amount of data has supported the utility of apoB for CV risk assessment; however, its superiority over LDL-C remains unclear. Our study aimed to investigate the predictive value of apoB for both the presence and the severity of CAD in a statin-treated cohort from an Eastern European hospital and to compare it with standard lipid biomarkers. Methods: A total of 121 statin-treated patients, who were evaluated using coronary angiography, were consecutively enrolled and subdivided into three groups: 52 patients with significant coronary artery disease (S-CAD), 36 patients with non-significant coronary artery disease (NS-CAD), and 33 patients without coronary atherosclerosis (N-CAD). Apolipoprotein B was measured at the moment of enrollment using the immunoturbidimetric assay. Results: The mean values of LDL-C, TC, non-HDL-C, and apoB increased progressively across the three studied groups. Unlike traditional lipid biomarkers, apoB levels differed significantly not only between N-CAD and S-CAD, but also between N-CAD and NS-CAD. The diagnostic superiority of apoB extended beyond group mean differences, as it also demonstrated the strongest correlation with CAD severity. ApoB showed a moderate correlation with the Gensini score (r = 0.43, p < 0.001), which was markedly higher compared to LDL-C, TC, or non-HDL-C, all of which presented only a weak correlation (r = 0.26, r = 0.23, and r = 0.28, respectively). Additionally, in a logistic regression analysis, apoB demonstrated the highest predictive power for the presence of significant CAD (per SD increase: OR 2.386, 95% CI 1.52–3.75, p = 0.000), and it was the only biomarker able to predict left main disease (per SD increase: OR 2.433, 95% CI 1.38–4.30, p = 0.002) and three vessel disease (per SD increase: OR 1.639, 95% CI 1.012–2.654, p = 0.044). Residual apoB was also calculated and remained significantly associated with the presence of coronary atherosclerosis. Conclusions: ApoB proved to be a reliable predictor for CAD, independent of LDL-C. Compared to standard lipid biomarkers, apoB was superior in detecting NS-CAD and showed a better correlation with the severity of CAD. Additionally, in our study, only apoB was significantly correlated with left main disease and three vessel disease. Full article