Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

Longitudinal Trends in Heart Failure Mortality Linked to Coronary Artery Disease Among Adults 65 years and older

BACKGROUND

Heart failure (HF) in patients with coronary artery disease (CAD) is a leading cause of mortality among older adults in the United States. This study examines trends in HF with CAD-related mortality among adults aged 65 and older.

METHODS

A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.

RESULTS

HF associated with CAD led to 1,597,451 deaths among adults > 65, primarily occurring in medical facilities (37.1%). The AAMR for HF with CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p < 0.001), which was significant from 1999 to 2014. Men had higher AAMRs than women (227.4 vs. 137.1), with women's rates declining more significantly (AAPC: -3.23, p < 0.001). White adults had the highest AAMRs (183.0), while Asians/Pacific Islanders (81.6) recorded the lowest. Geographically, AAMRs varied, from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1) CONCLUSION: Our study reveals striking disparities in HF-related mortality among adults aged 65 years and older in the United States. While AAMRs decreased overall from 1999 to 2014, they have reached an inflection point since 2019, indicating rising mortality rates. Persistent inequalities underscore the critical need for targeted public health interventions to address these issues.

Generation and purification of iPSC-derived cardiomyocytes for clinical applications

BACKGROUND

Over the past decade, the field of cell therapy has rapidly expanded with the aim to replace and repair damaged cells and/or tissue. Depending on the disease many different cell types can be used as part of such a therapy. Here we focused on the potential treatment of myocardial infarction, where currently available treatment options are not able to regenerate the loss of healthy heart tissue.

METHOD

We generated good manufacturing practice (GMP)-compatible cardiomyocytes (iCMs) from transgene- and xenofree induced pluripotent stem cells (iPSCs) that can be seamless adapted for clinical applications. Further protocols were established for replating and freezing/thawing iCMs under xenofree conditions.

RESULTS

iCMs showed a cardiac phenotype, with the expression of specific cardiac markers and absence of pluripotency markers at RNA and protein level. To ensure a pure iCMs population for in vivo applications, we minimized risks of iPSC contamination using RNA-switch technology to ensure safety.

CONCLUSION

We describe the generation and further processing of xeno- and transgene-free iCMs. The use of GMP-compliant differentiation protocols ab initio facilitates the clinical translation of this project in later stages.

Brain-targeting biomimetic nanozyme enhances neuroprotection in ischemic stroke by remodeling the neurovascular unit

Dysfunction of the neurovascular unit significantly impacts the prognostic outcomes of ischemic stroke. However, effective strategies to comprehensively modulate the neurovascular unit have yet to be developed. In this work, we introduce a brain-targeting biomimetic nanozyme, A@HPB@THSA, designed to mitigate neurovascular unit dysfunction following ischemia/reperfusion. Specifically, aspirin is encapsulated within hollow Prussian blue nanozyme, which is subsequently modified with brain-targeting T7 peptide-conjugated human serum albumin, ultimately forming the composite A@HPB@THSA. The overexpression of transferrin receptors on cerebral vascular endothelial cells, along with compromised blood-brain barrier (BBB) permeability, facilitates the accumulation of A@HPB@THSA at cerebral ischemic lesions. The hollow Prussian blue nanozyme component effectively scavenges reactive oxygen species in ischemia/reperfusion-affected brain cells. While the aspirin component inhibits platelets aggregation and neutrophils infiltration, thereby preventing microvascular "no-reflow" and preserving the integrity of the BBB. In rat models of transient middle cerebral artery occlusion, A@HPB@THSA demonstrated comprehensive modulation of the neurovascular unit, including reduced BBB permeability, promotion of microglia polarization toward an anti-inflammatory phenotype, and enhanced neuronal survival. This work provides a promising platform to reverse dysfunctional neurovascular unit for ischemic stroke treatment.

Acetyl-CoA synthetase 2 alleviates brain injury following cardiac arrest by promoting autophagy in brain microvascular endothelial cells

INTRODUCTION

Brain injury is a common sequela following cardiac arrest (CA), with up to 70% of hospitalized patients dying from it. Brain microvascular endothelial cells (BMVECs) play a crucial role in post-cardiac arrest brain injury (PCABI). However, the effects and mechanisms of targeting BMVEC energy metabolism to mitigate brain injury remain unclear.

METHODS

We established a mouse model of cardiac arrest by injecting potassium chloride into the right internal jugular vein. Mass spectrometry detected targeted changes in short-chain fatty acids and energy metabolism metabolites in the CA/CPR group compared to the sham group. Mice with overexpressed ACSS2 in BMVECs were created using an AAV-BR1 vector, and ACSS2 knockout mice were generated using the CRE-LOXP system. The oxygen glucose deprivation/re-oxygenation (OGD/R) model was established to investigate the role and mechanisms of ACSS2 in endothelial cells in vitro.

RESULTS

Metabolomics analysis revealed disrupted cerebral energy metabolism post-CA/CPR, with decreased acetyl-CoA and amino acids. Overexpression of ACSS2 in BMVECs increased acetyl-CoA levels and improved neurological function. Vascular endothelial cell-specific ACSS2 knockout mice exhibited reduced aortic sprouting in vitro. Overexpression of ACSS2 improved endothelial dysfunction following oxygen glucose deprivation/re-oxygenation (OGD/R) and influenced autophagy by interacting with transcription factor EB (TFEB) and modulating the AMP-activated protein kinase α (AMPKα) pathway.

CONCLUSION

Our study shows that ACSS2 modulates the biological functions of BMVECs by promoting autophagy. Enhancing energy metabolism via ACSS2 may target PCABI treatment development.

Oral anticoagulant use among Medicare patients newly diagnosed with venous thromboembolism (VTE): Factors associated with treatment status

OBJECTIVE

This study aimed to describe oral anticoagulant (OAC) use among patients with venous thromboembolism (VTE).

MATERIALS AND METHODS

This study included Medicare fee-for-service beneficiaries (data from 1/1/2014-12/31/2019) newly diagnosed with VTE. Factors associated with being untreated with OACs in the first month from VTE (vs. OAC-treated), with receiving direct-acting OACs ([DOACs] vs. warfarin), and with extended OAC treatment (>3 months) were assessed using multivariable logistic regressions.

RESULTS

Overall, 169,928 patients with VTE (50.3% OAC-untreated) were included. Among the 49.7% OAC-treated patients, 74.0% used DOACs and 62.5% had extended OAC treatment. Factors associated with being untreated with OACs in the first month from VTE (odds ratio; 95% confidence interval) included Hispanic ethnicity (vs. White;1.35; 1.29-1.42), having part D low-income subsidy (1.14; 1.07, 1.20), and comorbidities such as cardiovascular diseases. Among the OAC-treated cohort, patients with index VTE diagnosis in the emergency room (vs. outpatient) setting had higher odds of receiving DOAC vs. warfarin; patients with pulmonary embolism diagnosis (vs. deep vein thrombosis) had higher odds of extended OAC treatment.

CONCLUSIONS

In this study of Medicare patients newly diagnosed with VTE, half of the patients were not treated with OAC in the first month from initial diagnosis. Factors such as Hispanic ethnicity, having low-income subsidy, and comorbidity burden were found to be associated with being untreated with OAC. Among OAC-treated patients, the majority were treated with DOAC vs. warfarin. Interestingly, more than a third of OAC-treated patients were not treated beyond 3 months, which warrants further investigation.

Cross-sectional evaluation of the metabolic vulnerability index in heart failure populations

BACKGROUND

The Metabolic Vulnerability Index (MVX) is a novel multi-marker risk score derived from nuclear magnetic resonance (NMR) measures and has shown predictive value for mortality in heart failure. Hence, we aimed to evaluate the distribution of MVX and its clinical correlates within a clinical trial population and a comparable subpopulation of patients with heart failure with reduced ejection fraction and ischemic heart disease within a community cohort.

METHODS

We studied a clinical trial (2016-2018) and a community cohort (2003-2012), matched based on ejection fraction category and presence of ischemic heart failure. NMR LipoProfile analyses of plasma from both populations provided measures of valine, leucine, isoleucine, citrate, GlycA, and small high-density lipoprotein particles used to compute sex-specific MVX scores. Univariable and multivariable regression models assessed the relationship between MVX (modeled continuously), and selected demographic and clinical covariates.

RESULTS

Clinical trial patients (N = 101, median age: 63, 93% male, median EF: 28%) were younger and predominantly male compared to the cohort (N = 288, median age: 75, 70% male, median EF: 30%). The median MVX score was lower in the clinical trial (50, 42-61) compared to the cohort (66, 58-73). Male sex and hyperlipidemia were linked to higher MVX scores in the clinical trial, while obesity and NT-proBNP were linked to lower and higher MVX scores, respectively, in the cohort (p <.05). After adjusting for significant covariates from univariable analyses and age in multivariable analyses, only the associations between male sex and MVX scores in the clinical trial, and NT-proBNP levels with MVX in the cohort remained significant.

CONCLUSION

This study highlights significant differences in MVX distribution and its clinical correlates between a clinical trial and a community cohort despite matched heart failure subtypes. These findings have important implications for interpreting and applying the score in diverse study settings.

Characteristics and Outcomes of Older Patients Undergoing Protected Percutaneous Coronary Intervention With Impella

BACKGROUND

In patients undergoing high-risk percutaneous coronary intervention, Impella has become an important adjunctive tool to support revascularization. The impact of age on the outcomes of patients undergoing high-risk percutaneous coronary intervention is limited. The aim of this study is to describe the characteristics and outcomes of patients ≥75 years of age undergoing Impella-supported high-risk percutaneous coronary intervention.

METHODS AND RESULTS

Baseline characteristics and outcomes of patients ≥75 years of age versus those of patients <75 years of age in patients enrolled in the cVAD PROTECT III (Catheter-Based Ventricular Assist Device Prospective, Multi-Center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump in Patients Undergoing Non Emergent High Risk Percutaneous Coronary Intervention) study (NCT04136392). Major adverse cardiovascular and cerebral events (composite of all-cause death, nonfatal myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) were assessed at 30 and 90 days and all-cause death at 1 year. Out of 1237 patients, 493 (39.9%) patients were ≥75 years of age. Patients ≥75 years of age had less diabetes and prior myocardial infarction, more hypertension and dyslipidemia, worse renal function, more severe valvular heart disease, but higher left ventricular ejection fraction (P<0.05 for all comparisons). Baseline Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores were similar between groups. Older patients underwent more left main percutaneous coronary intervention (58% versus 39%; P<0.0001), atherectomy (32% versus 22%; P<0.0001), and femoral access (87% versus 79%, P=0.0003) as compared with younger patients. In-hospital vascular complications did not differ, but rates of respiratory failure, pericardial tamponade, and cardiogenic shock were higher in older patients. Rates of all-cause death and major adverse cardiovascular and cerebral events did not differ between groups at 30 and 90 days. Rates of all-cause death at 1 year were higher in patients ≥75 years (adjusted hazard ratio, 1.99 [95% CI, 1.24-3.18], P=0.004).

CONCLUSIONS

Impella-supported high-risk percutaneous coronary intervention in older patients is feasible with an acceptable safety profile. However, age ≥75 years remained a statistically significant predictor for all-cause death at 1 year.

REGISTRATION

URL: https://clinicaltrials.gov; Unique Identifier: NCT04136392.

Differences in Coronary Heart Disease and Stroke Incidence Among Single-Race and Multiracial Asian and Pacific Islander Subgroups in Hawaii and California: A Retrospective Cohort Study

BACKGROUND

Little is known about clinical and sociodemographic factors affecting coronary heart disease (CHD) and stroke incidence in single-race and multiracial American Asian, Native Hawaiian, and Pacific Islander subgroups. As the US population becomes more diverse, it is important to characterize differences in risks for CHD and stroke, and their contributing factors, in these populations.

METHODS AND RESULTS

The study population included 303 958 patients from Kaiser Permanente Hawaii and Palo Alto Medical Foundation in California. Self-reported race and ethnicity were derived from electronic health records and 12 mutually exclusive single-race and multiracial groups were created for analyses. Cox proportional hazard models were used to compare CHD and stroke incidence. Unadjusted models were compared with models adjusted for age, income, education, body mass index, smoking, and comorbidities. We found up to a 4-fold variation in CHD and stroke rates among American Asian, Native Hawaiian, and Pacific Islander subgroups. Multiracial subgroups had higher rates than single-race groups. While most single-race American Asian, Native Hawaiian, and Pacific Islander groups had lower CHD and stroke risks, middle-aged Asian Indian men and Native Hawaiian women had higher stroke risks than non-Hispanic White controls. Income, education, body mass index, smoking, and comorbidities contributed significantly to risks in all groups, especially in Native Hawaiian, Pacific Islander, and multiracial groups.

CONCLUSIONS

Risks for CHD and stroke vary by racial and ethnic subgroups, demonstrating the need to unmask risks by disaggregating racial and ethnic subgroups. Multiracial American Asian, Native Hawaiian, and Pacific Islander groups had higher risks that were only partially explained by modifiable risk factors. Future studies should further explore lifestyle, psychosocial, and sociocultural factors.

Preclinical and mechanistic perspectives on adipose-derived stem cells for atherosclerotic cardiovascular disease treatment

Adipose-derived mesenchymal stem cells (AD-MSCs) are a promising therapeutic modality for cardiovascular diseases due to their immunomodulatory, anti-inflammatory, and pro-angiogenic properties. This manuscript explores the current status, challenges, and future directions of AD-MSC therapies, focusing on their application in atherosclerosis (AS), myocardial infarction (MI), and heart failure (HF). Preclinical studies highlight AD-MSC's ability to stabilise atherosclerotic plaques, reduce inflammation, and enhance myocardial repair through mechanisms such as macrophage polarisation, endothelial protection, and angiogenesis. Genetically and pharmacologically modified AD-MSCs, including those overexpressing SIRT1, IGF-1, and PD-L1 or primed with bioactive compounds, exhibit superior efficacy compared to unmodified cells. These modifications enhance cell survival, immunopotency, and reparative capacity, showcasing the potential for tailored therapies. However, clinical translation faces significant hurdles. While recent clinical trials have confirmed the safety of AD-MSC therapy, their efficacy remains inconsistent, necessitating further optimisation of patient selection, dosing strategies, and delivery methods. Donor variability, particularly in patients with co-morbidities like type 2 diabetes (T2D) or obesity, impairs AD-MSC efficacy. Emerging research on extracellular vesicles (EVs) derived from AD-MSC offers a promising cell-free alternative, retaining the therapeutic benefits while mitigating risks. Future perspectives emphasise the need for multidisciplinary approaches to overcome these limitations. Strategies include refining genetic modifications, exploring EV-based therapies, and integrating personalised medicine and advanced diagnostic tools. By addressing these challenges, AD-MSC therapies hold the potential to revolutionise the treatment of cardiovascular diseases, providing innovative solutions to improve patient outcomes.

Pulsed electromagnetic fields treatment ameliorates cardiac function after myocardial infarction in mice and pigs

INTRODUCTION

Ischemic heart disease (IHD) is a prominent contributor to mortality worldwide, with myocardial infarction (MI) representing its most severe manifestation. Pulsed electromagnetic fields (PEMF) treatment shows promise for treating IHD. Nevertheless, the therapeutic impact and underlying mechanism of PEMF in MI are not fully understood.

OBJECTIVES

To investigate the efficacy, safety, and mechanisms of PEMF for MI.

METHODS

We established MI models in both mice and pigs and performed serial echocardiography and cardiac magnetic resonance follow-up to demonstrate the benefit of PEMF treatment after MI. The pathological environment after myocardial infarction was simulated in vitro to observe changes in various cells exposed to PEMF. Gene knockout (TLR4-/-) mice and inhibitors were used to compare the differences in the efficacy of PEMF treatment relative to that of gene knockout/inhibitor treatments. Agonists were used to further explore the mechanism of PEMF treatment.

RESULTS

In post-MI mice, PEMF treatment enhanced cardiac function and reduced scar formation. PEMF reduced the macrophage inflammatory response, improved cardiomyocyte survival in an inflammatory environment, and decreased collagen secretion by fibroblasts in vitro. Importantly, in the clinically relevant porcine model, PEMF treatment inhibited the inflammatory response and alleviated adverse left ventricular remodeling. Moreover, PEMF could exert therapeutic effects similar to those of gene knockout or inhibitor treatments. In the presence of TLR4 knockout or pyrrolidine dithiocarbamate (an NF-κB inhibitor) administration, PEMF could still improve cardiac function in post-MI mice. Mechanistically, the anti-inflammatory effect of PEMF was reversed when RS09 (a TLR4 agonist) was administered, and the antifibrotic effect of PEMF was attenuated after treatment with SRI-011381 (a TGF-β signaling pathway agonist).

CONCLUSIONS

PEMF treatment exhibits considerable promise as a noninvasive physical therapy modality, warranting further investigation into its potential implications for managing patients with IHD.

Tanshinone IIA alleviate atherosclerosis and hepatic steatosis via down-regulation of MAPKs/NF-κB signaling pathway

OBJECTIVES

Tanshinone IIA (Tan IIA) exhibits therapeutic potential for atherosclerosis (AS) and hepatic steatosis (HS). The study aims to explore the mechanisms underlying the anti-atherosclerosis and anti-hepatic steatosis effects of Tan IIA.

METHODS

The LDLR-/-mice were divided into control, model, low/high Tan IIA and atorvastatin group, which fed with High-fat diet to build NAFLD-associated AS model, then administrated with 0.9 % saline, Tan IIA or atorvastatin. RAW264.7 cells divided into control, LPS, LPS plus low/high Tan IIA and LPS plus Tan IIA plus JNK activator group. The different goups' pathological changes visualized with H&E, Oil Red O and Immunofluorescence staining. The therapeutic effect of Tan IIA was reflected by lipids metabolism changes, hepatic indexes, inflammation levels. ELISA, RT-qPCR and Western blot assay were used to determine the inflammatory factors and upstream proteins. Molecular docking was used to reconfirm the importance of genes studied and locate the specific gene will study.

RESULTS

Tan IIA alleviated LDLR-/-mice AS and HS by reducing AS plaque area, lowering serum &liver lipid levels (TC, TG), improving liver function (AST, ALT). Tan IIA decreased serum inflammation levels (IL-1β, IL-6, TNF-α) and aorta & liver inflammatory-related cytokines levels (iNOS, VCAM-1, IL-6) and inhibited the phosphorylation of aorta & liver protein ERK1/2, JNK, p38 and NF-κB p65, which were validated in the LPS-stimulated macrophages supernatant and cells.

CONCLUSIONS

The study indicated that Tan IIA can alleviate atherosclerosis and hepatic steatosis via down-regulating MAPKs/NF-κB signaling pathway. This provides a potential therapeutic strategy for the co-existing situation of atherosclerosis and hepatic steatosis.

NT-proBNP in the Early Convalescent Phase after High-Risk Myocardial Infarction Is Associated with Adverse Cardiovascular Outcomes: the PARADISE-MI Trial

BACKGROUND

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with heart failure (HF) hospitalizations and death when measured during a myocardial infarction (MI). However, NT-proBNP concentrations change following the initial ischemic insult and less is known about the prognostic importance of NT-proBNP in the early convalescent phase.

METHODS

PARADISE-MI randomized 5661 patients with MI complicated by LVEF ≤40% and/or pulmonary congestion to sacubitril/valsartan or ramipril. Patients with available week 2 NT-proBNP concentrations and without incident HF between randomization and week 2 (n=1062) were analyzed. Associations of week 2 NT-proBNP with subsequent clinical outcomes were evaluated in landmark analyses using Cox models adjusted for clinical characteristics including LVEF, baseline NT-proBNP and atrial fibrillation.

RESULTS

Median 2-week NT-proBNP was 1391 [676 - 2507] ng/L. Patients in the highest NT-proBNP quartile (≥2507 ng/L) were older, had lower LVEF and eGFR, higher Killip class and more atrial fibrillation. Higher NT-proBNP concentrations were independently associated with greater risk of CV death or incident HF (adjusted HR [aHR] 1.65 per doubling of NT-proBNP; 95% CI, 1.31-2.09), HF hospitalization (aHR 1.87; 95% CI, 1.38-2.54), recurrent MI (aHR 1.46; 95% CI, 1.09-1.95) and all-cause death (aHR 1.85; 95% CI, 1.35-2.53).

CONCLUSIONS

Patients with elevated NT-proBNP concentrations approximately two weeks after a high-risk MI are at heightened risk of incident HF, recurrent coronary events and death, independent of baseline NT-proBNP concentrations and clinical characteristics. Elevations in NT-proBNP concentrations in the early convalescent phase may assist in risk stratification and identification of patients in need for more advanced preventive treatment approaches.

LAY SUMMARY

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of ventricular wall stress and in the acute phase of a myocardial infarction (MI) is strongly associated with adverse cardiovascular outcomes. NT-proBNP concentrations change dynamically after MI but they are not routinely remeasured during follow-up. In a contemporary post-MI population enrolled in the PARADISE-MI trial, NT-proBNP measured approximately two weeks following MI was independently associated with heightened risk of death, incident heart failure and recurrent MI. NT-proBNP concentrations in the early convalescent phase may help risk stratify patients following MI and identify those in need for closer follow-up and more aggressive therapies.

Air pollution, lifestyle, and cardiovascular disease risk in northwestern China: A cohort study of over 5.8 million participants

Evidence on the combined impact of air pollution and lifestyle on cardiovascular disease (CVD) risk is limited. We employed the Space-Time Extra-Trees model, an ensemble learning method for spatiotemporal data, to estimate the annual average concentrations of five air pollutants from 2017 to 2019. Cox proportional hazards models were used to assess the associations between air pollutant exposure and CVD incidence. A lifestyle score, based on body mass index, waist circumference, diet, physical activity, alcohol consumption, and smoking, was developed to examine the moderating effect of lifestyle on the air pollution-CVD relationship. Among 5,838,833 baseline participants without CVD, 414,218 developed CVD during follow-up. Long-term exposure to particulate matter (PM1, PM2.5, PM10), ozone (O3), and carbon monoxide (CO) was significantly associated with increased CVD risk. Stratified analyses revealed that exercise had the most significant impact on this association, with exercisers showing a notable reduction in risk compared to non-exercisers. An interaction between air pollution and lifestyle was observed (P-interaction < 0.001). Compared to individuals with a relatively healthy lifestyle and low air pollution exposure, those with an unhealthy lifestyle and high exposure had the highest risk of developing CVD (PM1: HR = 1.660, PM2.5: HR = 1.891, PM10: HR = 1.755, O3: HR = 1.970, CO: HR = 1.426). Further analysis revealed a synergistic additive interaction between lifestyle and air pollution, leading to relative excess risks of 0.151, 0.154, 0.137, 0.171, and 0.095 in groups with relatively unhealthy lifestyles and high exposure to PM1, PM2.5, PM10, O3, and CO, respectively. Thus, in addition to controlling major air pollutant emissions, promoting healthy lifestyle adoption is crucial.

Neighborhood Safety and Hypertension Risk: A Systematic Review

BACKGROUND

Responding to the increasing focus on residential environments, our systematic review aimed to consolidate existing empirical evidence regarding the impact of neighborhood safety on blood pressure. We also summarized the mediating and moderating mechanisms through which neighborhood safety influences blood pressure, alongside their direct effects, to offer insights for future research.

METHODS

We searched 5 electronic databases (PubMed, Ovid MEDLINE, CINAHL Complete, ProQuest Dissertations and Theses Global, and Web of Science) for the period up to and including December 27, 2022. The initial search yielded 4944 studies reviewed, of which 19 met our criteria and were reviewed.

RESULTS

Our findings consistently show that living in a safe neighborhood is associated with lower blood pressure outcomes. While most cross-sectional studies found that the association was not statistically significant (7/10 studies showed insignificant results), longitudinal studies that tracked changes in neighborhood safety over time (4/5 studies) showed significant negative associations between neighborhood safety and blood pressure. Additionally, some studies identified sex (n=3), age (n=2), and neighborhood characteristics (n=4) as significant moderators, with the strength of the association between neighborhood safety and blood pressure varying across different demographic groups and neighborhood contexts.

CONCLUSIONS

Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions. This review also highlights the importance of adopting longitudinal designs, especially those using time-varying measures of neighborhood environments.

Long-Term Prognostic Implications of Non-Culprit Lesions in Patients Presenting With an Acute Myocardial Infarction: Is It the Angiographic Stenosis Severity or the Underlying High-Risk Morphology?

BACKGROUND

Patients with acute myocardial infarction and angiographically obstructive non-culprit lesions are at high risk for recurrent major adverse cardiac events (MACEs). However, it remains largely unknown whether events are due to stenosis severity or due to the underlying high-risk lesion morphology.

METHODS

Between January 2017 and December 2021, 1312 patients with acute myocardial infarction underwent optical coherence tomography of all the 3 main epicardial arteries after successful percutaneous coronary intervention. Patients and lesions were categorized according to the presence or absence of (1) 1 or more non-culprit angiographic obstructive stenoses with a visual diameter stenosis of ≥50% and (2) 1 or more lesions with an underlying high-risk morphology defined as an optical coherence tomography thin-cap fibroatheroma (TCFA). Patients were followed for up to 5 years (median 4.1 [interquartile range: 3.0-5.0] years). MACEs comprised cardiac death, non-fatal myocardial infarction, and unplanned coronary revascularization.

RESULTS

Overall, 492 patients had at least 1 obstructive non-culprit lesion, 352 had a single lesion, and 140 had multiple obstructive non-culprit lesions. The presence and number of angiographic obstructive non-culprit lesions correlated with the proportion and number of optical coherence tomography-derived TCFAs. At the lesion level, the prevalence of TCFA was twice as high in obstructive lesions compared with nonobstructive lesions. Patients with obstructive non-culprit lesions had an increased risk of overall MACEs (17.7% versus 12.8%; hazard ratio, 1.39 [95% CI, 1.02-1.91]) and non-culprit lesion-related MACEs (8.7% versus 3.9%; HR, 2.13 [95% CI, 1.26-3.59). Results were similar when patients were categorized on the basis of the underlying TCFA. A proportionally higher rate of overall and non-culprit lesion-related MACEs was observed as the number of obstructive stenoses or TCFAs in non-culprit segments increased. The lesion-specific HRs for obstructive lesion and TCFA were 2.03 (95% CI, 1.06-3.89) and 2.39 (95% CI, 1.29-4.43), respectively. Optical coherence tomography-derived TCFA, but not angiographic obstructive stenosis, was independently predictive of recurrent MACEs in both patient-level and lesion-level multivariable models in which these 2 characteristics were introduced simultaneously.

CONCLUSIONS

The long-term prognostic implications of the presence and extent of angiographic obstructive non-culprit lesions in patients with acute myocardial infarction are primarily due to their correlation with the underlying high-risk morphology, which confers an increased risk of recurrent MACEs.

Mechanisms and consequences of myeloid adhesome dysfunction in atherogenesis

AIMS

In the context of atherosclerosis, macrophages exposed to oxidized low-density lipoproteins (oxLDLs) exhibit cellular abnormalities, specifically in adhesome functions, yet the mechanisms and implications of these adhesive dysfunctions remain largely unexplored.

METHODS AND RESULTS

This study reveals a significant depletion of Kindlin3 (K3) or Fermt3, an essential component of the adhesome regulating integrin functions, in macrophages located within atherosclerotic plaques in vivo and following oxLDL exposure in vitro. To examine the effects of K3 deficiency, the study utilized hyperlipidaemic bone marrow chimeras devoid of myeloid Kindlin3 expression. The absence of myeloid K3 increased atherosclerotic plaque burden in the aortas in vivo and enhanced lipid accumulation and lipoprotein uptake in macrophages from Kindlin3-null chimeric mice in vitro. Importantly, re-expression of K3 in macrophages ameliorated these abnormalities. RNA sequencing of bone marrow-derived macrophages (BMDM) from K3-deficient mice revealed extensive deregulation in adhesion-related pathways, echoing changes observed in wild-type cells treated with oxLDL. Notably, there was an increase in Olr1 expression [encoding the lectin-like oxidized LDL receptor-1 (LOX1)], a gene implicated in atherogenesis. The disrupted K3-integrin axis in macrophages led to a significant elevation in the LOX1 receptor, contributing to increased oxLDL uptake and foam cell formation. Inhibition of LOX1 normalized lipid uptake in Kindlin3-null macrophages. A similar proatherogenic phenotype, marked by increased macrophage LOX1 expression and foam cell formation, was observed in myeloid-specific Itgβ1-deficient mice but not in Itgβ2-deficient mice, underscoring the critical role of K3/Itgβ1 interaction.

CONCLUSION

This study shows that the loss of Kindlin3 in macrophages upon exposure to oxLDL leads to adhesome dysfunction in atherosclerosis and reveals the pivotal role of Kindlin3 in macrophage function and its contribution to the progression of atherosclerosis, providing valuable insights into the molecular mechanisms that could be targeted for therapeutic interventions.

Novel Directly Reprogrammed Smooth Muscle Cells Promote Vascular Regeneration as Microvascular Mural Cells

BACKGROUND

Although cell therapy has emerged as a promising approach to promote neovascularization, its effects are mostly limited to capillaries. To generate larger or more stable vessels, layering of mural cells such as smooth muscle cells (SMCs) or pericytes is required. Recently, direct reprogramming approaches have been developed for generating SMCs. However, such reprogrammed SMCs lack genuine features of contractile SMCs, a native SMC phenotype; thus, their therapeutic and vessel-forming potential in vivo was not explored. Therefore, we aimed to directly reprogram human dermal fibroblasts toward contractile SMCs (rSMCs) and investigated their role for generating vascular mural cells in vivo and their therapeutic effects on ischemic disease.

METHODS

We applied myocardin and all-trans retinoic acid with specific culture conditions to directly reprogram human dermal fibroblasts into rSMCs. We characterized their phenotype as contractile SMCs through quantitative reverse-transcriptase polymerase chain reaction, flow cytometry, and immunostaining. We then explored their contractility using a vasoconstrictor, carbachol, and through transmission electron microscope and bulk RNA sequencing. Next, we evaluated whether transplantation of rSMCs improves blood flow and induces vessel formation as mural cells in a mouse model of hindlimb ischemia with laser Doppler perfusion imaging and histological analysis. We also determined their paracrine effects.

RESULTS

Our novel culture conditions using myocardin and all-trans retinoic acid efficiently reprogrammed human dermal fibroblasts into SMCs. These rSMCs displayed characteristics of contractile SMCs at the mRNA, protein, and cellular levels. Transplantation of rSMCs into ischemic mouse hind limbs enhanced blood flow recovery and vascular repair and improved limb salvage. Histological examination showed that vascular density was increased and the engrafted rSMCs were incorporated into the vascular wall as pericytes and vascular SMCs, thereby contributing to formation of more stable and larger microvessels. Quantitative reverse-transcriptase polymerase chain reaction analysis revealed that these transplanted rSMCs exerted pleiotropic effects, including angiogenic, arteriogenic, vessel-stabilizing, and tissue regenerative effects, on ischemic limbs.

CONCLUSIONS

A combination of myocardin and all-trans retinoic acid in defined culture conditions efficiently reprogrammed human fibroblasts into contractile and functional SMCs. The rSMCs were shown to be effective for vascular repair and contributed to neovascularization through mural cells and various paracrine effects. These human rSMCs could represent a novel source for cell-based therapy and research.

Integration of machine learning and experimental validation reveals new lipid-lowering drug candidates

Hyperlipidemia, a major risk factor for cardiovascular diseases, is associated with limitations in clinical lipid-lowering medications. Drug repurposing strategies expedite the research process and mitigate development costs, offering an innovative approach to drug discovery. This study employed systematic literature and guidelines review to compile a training set comprising 176 lipid-lowering drugs and 3254 non-lipid-lowering drugs. Multiple machine learning models were developed to predict the lipid-lowering potential of drugs. A multi-tiered validation strategy was implemented, encompassing large-scale retrospective clinical data analysis, standardized animal studies, molecular docking simulations and dynamics analyses. Through a comprehensive screening analysis utilizing machine learning, 29 FDA-approved drugs with lipid-lowering potential were identified. Clinical data analysis confirmed that four candidate drugs, with Argatroban as the representative, demonstrated lipid-lowering effects. In animal experiments, the candidate drugs significantly improved multiple blood lipid parameters. Molecular docking and dynamics simulations elucidated the binding patterns and stability of candidate drugs in interaction with related targets. We successfully identified multiple non-lipid-lowering drugs with lipid-lowering potential by integrating state-of-the-art machine learning techniques with multi-level validation methods, thereby providing new insights into lipid-lowering drugs, establishing a paradigm for AI-based drug repositioning research, and expanding the repertoire of lipid-lowering medications available to clinicians.

Epitranscriptomics in atherosclerosis: Unraveling RNA modifications, editing and splicing and their implications in vascular disease

Atherosclerosis remains a leading cause of morbidity and mortality worldwide, driven by complex molecular mechanisms involving gene regulation and post-transcriptional processes. Emerging evidence highlights the critical role of epitranscriptomics, the study of chemical modifications occurring on RNA molecules, in atherosclerosis development. Epitranscriptomics provides a new layer of regulation in vascular health, influencing cellular functions in endothelial cells, smooth muscle cells, and macrophages, thereby shedding light on the pathogenesis of atherosclerosis and presenting new opportunities for novel therapeutic targets. This review provides a comprehensive overview of the epitranscriptomic landscape, focusing on key RNA modifications such as N6-methyladenosine (m6A), 5-methylcytosine (m5C), pseudouridine (Ψ), RNA editing mechanisms including A-to-I and C-to-U editing and RNA isoforms. The functional implications of these modifications in RNA stability, alternative splicing, and microRNA biology are discussed, with a focus on their roles in inflammatory signaling, lipid metabolism, and vascular cell adaptation within atherosclerotic plaques. We also highlight how these modifications influence the generation of RNA isoforms, potentially altering cellular phenotypes and contributing to disease progression. Despite the promise of epitranscriptomics, significant challenges remain, including the technical limitations in detecting RNA modifications in complex tissues and the need for deeper mechanistic insights into their causal roles in atherosclerotic pathogenesis. Integrating epitranscriptomics with other omics approaches, such as genomics, proteomics, and metabolomics, holds the potential to provide a more holistic understanding of the disease.

The Annual Economic Burden of Patent Foramen Ovale-Associated Stroke in the United States

BACKGROUND

Stroke is the second leading cause of death worldwide and the third leading cause of death and disability combined. Among ischemic strokes, 25% to 40% are classified as cryptogenic, with patent foramen ovale (PFO) identified as a potential underlying cause. PFO is found in 25% of the general population. Despite the significant occurrence of PFO-associated strokes, the associated costs remain largely unexplored.

AIM

This study aimed to evaluate the annual economic burden of PFO-associated stroke in the US.

METHODS

A cost-of-illness study was performed, encompassing the direct and indirect costs of PFO-associated stroke on both society and the healthcare system. The model adopted a top-down approach and a one-year, US societal perspective. A payer perspective and bottom-up costing approach were included as scenario analyses. Data was obtained by a targeted literature review.

RESULTS

The societal model, assuming 32.5% cryptogenic strokes, incurs an annual cost of over $1.3 billion in the US, with over $1.0 billion coming from new strokes and over $300 million from recurrent strokes. The majority of the costs are indirect-50% from productivity losses due to premature death and 27% from other productivity losses. Direct costs constitute 23% of the total. From the payer perspective, the annual costs for PFO-associated strokes in the US were estimated at $302 million, with hospitalization costs comprising 44%, followed by prescriptions and outpatient care at 19% and 16%, respectively.

CONCLUSION

The economic burden of PFO-associated strokes in the US is substantial, exceeding $1.3 billion per year. Different types of medical management or surgical treatments for PFO-associated stroke could lead to gains in both costs and health outcomes.

The Effect of Endocrine Disruptors on the Cardiovascular System: does sex matter?

Endocrine disruptors (EDs) are environmental chemicals that interfere with hormone function, posing significant risks to human health, including the cardiovascular system. This review comprehensively examines the impact of EDs on cardiovascular health, with a specific focus on sex differences observed in various models. Utilizing in-vitro studies, in vivo animal models, and human clinical data, we delineate how sex-specific hormonal environments influence the cardiovascular effects of ED exposure. In vitro studies highlight cellular and molecular mechanisms that differ between male and female-derived cells. In vivo models reveal distinct physiological responses and susceptibilities to EDs, influenced by sex hormones. Human studies provide epidemiological evidence and clinical observations that underscore the variability in cardiovascular outcomes between men and women. This review underscores the necessity of considering sex as a critical factor in understanding the cardiovascular implications of ED exposure, advocating for gender-specific risk assessment and therapeutic strategies. The findings aim to enhance awareness and inform future research and policy-making to mitigate the adverse cardiovascular effects of EDs across different sexes.

Long-term Antithrombotic Therapy in Patients With Chronic Coronary Syndrome: An Updated Review of Current Evidence

PURPOSE

Despite improvements in the secondary prevention of atherothrombosis in patients with coronary artery disease during the past decade, it is estimated that approximately 19 million people annually die from cardiovascular diseases worldwide. Atherothrombosis remains the core pathobiology of acute complications including myocardial infarction (MI), and therefore, antithrombotic therapy plays a pivotal role in the strategies for major adverse cardiovascular event (MACE) prevention. Unlike early antithrombotic management after acute coronary syndrome, less evidence is available on long-term antithrombotic therapy in patients with chronic coronary syndrome (CCS). In addition, greater recognition of the impact of bleeding complications of such therapies has led to a more complex and personalized approach to their application. The purpose of this article is to review the available evidence on long-term antithrombotic therapy in patients with CCS including those with high-risk characteristics such as prior MI or polyvascular disease.

METHODS

A comprehensive literature review was performed in major databases including PubMed, Embase, and the Cochrane Library. The main focus of this narrative review was on available data from guidelines, meta-analysis, randomized controlled trials, and observational studies that assessed the efficacy and safety profile of long-term antithrombotic therapy in patients with CCS.

FINDINGS

Several studies suggest that long-term antithrombotic therapy is effective in reducing the risk of recurrent MACEs in patients with CCS. Current clinical guidelines recommend single antiplatelet therapy with aspirin as a first-line long-term strategy for patients without indication for oral anticoagulation. However, novel approaches focused on P2Y12 inhibitor monotherapy are emerging. More intensive antithrombotic strategies including long-term dual antiplatelet therapy and dual pathway inhibition further reduce ischemic risk but at the cost of increased bleeding.

IMPLICATIONS

This review highlights the importance of close monitoring and regular reassessment of the risk-benefit balance of antithrombotic therapy in patients with CCS. Overall, long-term antithrombotic therapy with either single antiplatelet therapy or dual antiplatelet therapy/dual pathway inhibition is effective in reducing the risk of MACEs in patients with CCS. The choice of antithrombotic therapy should be individualized based on the patient's clinical profile, particularly for thrombohemorrhagic risk. Future research should focus on identifying the optimal antithrombotic regimen for specific subgroups of patients with prior MI particularly for those with high bleeding risk.

The impact of the number of sessions and stimulation parameters on repetitive transcranial magnetic stimulation efficacy for post-stroke upper extremity recovery: A systematic review and meta-analysis

ObjectiveTo identify the optimal number of sessions and parameters of repetitive transcranial magnetic stimulation frequency, stimulation intensity, number of pulses per session/treatment that promotes a greater effect on post-stroke upper extremity function.Data sourcesMEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, Latin American and Caribbean Health Science Literature, Scientific Electronic Library Online, and Scopus up to November 2024.Review methodsWe conducted a meta-analysis on randomized controlled trials of repetitive transcranial magnetic stimulation combined with other therapies for post-stroke upper extremity function, assessed risk-of-bias using the Physiotherapy Evidence Database scale, calculated standard mean differences (SMD) with 95% confidence intervals (CI), and determined parameter cutoff points using a receiver operating characteristic curve.ResultsThirty-five randomized clinical trials involving 897 patients were included. Compared to control groups, repetitive transcranial magnetic stimulation combined with other therapies improved upper extremity motor function with a higher effect size for: ≥ 15 sessions (SMD 0.72 95% CI, 0.37 to 1.08; p < 0.0001]), > 1 Hz frequencies (0.98 [95% CI, 0.48 to 1.48; p = 0001]), intensities of <100% of resting motor threshold (SMD 0.52 [95% CI, 0.29 to 0.75; p < 0.00001]), ≥ 1000 pulses per session (SMD 0.61 [95% CI, 0.40 to 0.82; p < 0.00001]), and ≥12,000 pulses per treatment (SMD 0.64 [95% CI, 0.36 to 0.93; p < 0.0001]).ConclusionTo enhance post-stroke upper extremity function, the optimal repetitive transcranial magnetic stimulation protocol involves at least 15 sessions, frequencies above 1 Hz, intensities below 100% of resting motor threshold, at least 1000 pulses per session, and 12,000 pulses per treatment.

Whole genome sequencing identifies pathogenic genetic variants in Han Chinese patients with familial venous thromboembolism

Genetic factors play a pivotal role in determining venous thromboembolism (VTE) risk, particularly in cases of unprovoked early-onset VTE and those with a family history. While genome-wide association studies (GWAS) has advanced our understanding, high-quality whole-genome sequencing (WGS) from family-based studies is essential to elucidate the role of rare variants. In this study, we performed WGS on 216 individuals from 35 Han Chinese VTE pedigrees and validated findings in 99 high-heritability VTE cases using whole-exome sequencing. Functional impact was assessed via qPCR and Western Blot in HEK293T cells. Classical genes explained partial familial inheritance (20/35), while non-classical genes showed comparable effects on VTE recurrence and CTEPH. From 36 rare variants, 34 pedigrees (97%) were interpreted, with 29 variants reported for the first time. Notably, three novel variants, GP6 (c.G1094A:p.R365H), TET2 (c.G3451T:p.E1151X), and JAK2 (c.G380A:p.G127D), shared in two unrelated pedigrees each and are classified as low frequency in East Asians. Functional analyses revealed significant changes in GP6 and TET2 expression compared to the wild type. These findings provide novel insights into the genetic architecture of VTE and highlight GP6, TET2, and JAK2 as potential risk factors in East Asian populations, underscoring the clinical relevance of rare variants in VTE pathogenesis.

Life-threatening risk factors contribute to the development of diseases with the highest mortality through the induction of regulated necrotic cell death

Chronic diseases affecting the cardiovascular system, diabetes mellitus, neurodegenerative diseases, and various other organ-specific conditions, involve different underlying pathological processes. However, they share common risk factors that contribute to the development and progression of these diseases, including air pollution, hypertension, obesity, high cholesterol levels, smoking and alcoholism. In this review, we aim to explore the connection between four types of diseases with different etiologies and various risk factors. We highlight that the presence of risk factors induces regulated necrotic cell death, leading to the release of damage-associated molecular patterns (DAMPs), ultimately resulting in sterile inflammation. Therefore, DAMP-mediated inflammation may be the link explaining how risk factors can lead to the development and maintenance of chronic diseases. To explore these processes, we summarize the main cell death pathways activated by the most common life-threatening risk factors, the types of released DAMPs and how these events are associated with the pathophysiology of diseases with the highest mortality. Various risk factors, such as smoking, air pollution, alcoholism, hypertension, obesity, and high cholesterol levels induce regulated necrosis. Subsequently, the release of DAMPs leads to chronic inflammation, which increases the risk of many diseases, including those with the highest mortality rates.

Dementia-related adverse events associated with direct oral anticoagulants use: a real-world, pharmacovigilance study based on the FAERS database

BACKGROUND

Direct oral anticoagulants (DOACs) are commonly used to prevent and treat thromboembolic diseases. This study aimed to assess and compare dementia related adverse events (AEs) associated with DOACs.

RESEARCH DESIGN AND METHODS

AEs related to DOACs from January 2014 to June 2023 were extracted from the FDA Adverse Event Reporting System (FAERS) database. Disproportionality analysis methods, including reporting odds ratio (ROR), proportional reporting ratio, Bayesian Confidence Propagation Neural Network, and Multi-Item Gamma Poisson Shrinker, were used to evaluate the association between DOACs and dementia-related AEs.

RESULTS

There were 12,692,968 AEs reported in FAERS after deduplication. Among these, 165, 206, 1574, and 12 dementia-related AEs that were attributed to dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. Apixaban showed the strongest association with dementia-related AEs (ROR 7.66, 95% confidence interval (CI) 7.27-8.06), while rivaroxaban had the lowest ROR (0.95, 95%CI 0.83-1.09). Women exhibited higher RORs for all DOACs, with apixaban showing the most significant correlation. Subgroup analysis indicated a significant link between apixaban and dementia, dementia Alzheimer's type and senile dementia.

CONCLUSIONS

Apixaban appears most associated with dementia-related AEs among DOACs, whereas rivaroxaban poses a lower risk. Further research is needed to validate these findings through large-scale prospective studies.

Enhancing vascular implants with heparin-polylysine-copper nanozyme coating for synergistic anticoagulation and antirestenotic activity

Re-establishing blood flow through vascular implants, such as stents, faces significant challenges, including late stent thrombosis (LST) and in-stent restenosis (ISR). Strategies to overcome these issues focus on enhancing stent surfaces with anticoagulant, pro-endothelialization, and anti-neointimal hyperplasia (NIH) properties. However, achieving all of these functionalities typically requires complex surface modifications. In this study, we developed nanozyme particles by assembling heparin, polylysine (PLL) and copper ions, which catalytically release nitric oxide (NO) in situ. A functional coating was then formed on pre-deposited polydopamine (PDA) transition layer. Our nanozyme coating not only exhibits robust anticoagulant activity but also enables sustained, in situ release of NO, a critical gas molecule for maintaining vascular health and patency. In vitro results showed that the coating significantly inhibited platelet aggregation, remarkably prolonged activated partial thromboplastin time (APTT), and selectively promoted endothelial cell growth over smooth muscle cells. Ex vivo blood circulation models confirmed its superior anti-thrombotic efficacy, while in vivo experiments further validated its ability to facilitate endothelial regeneration and suppress NIH. This technology offers significant potential for improving the safety and outcomes of cardiovascular implants.

Hydroxysafflor yellow A for ischemic heart diseases: a systematic review and meta-analysis of animal experiments

Background

Hydroxysafflor yellow A (HSYA) possesses a variety of pharmacological activities which has been demonstrated to be effective against ischemic heart disease (IHD). This study aimed to comprehensively examine the efficacy and summarize the potential mechanisms of HSYA against IHD in animal models.

Methods

We conducted electronic searches for preclinical studies on PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, Wanfang, and Chinese VIP databases from inception to 31 January 2024. The CAMARADES checklist was chosen to assess the quality of evidence. STATA 14.0 software was utilized to analyze the data. The underlying mechanisms were categorized and summarized.

Results

Twenty-eight studies involving 686 rodents were included and the mean score of methodology quality was 5.04 (range from 4 to 7). Meta-analysis observed that HSYA could decrease myocardial infarction size (SMD: -2.82, 95%CI: -3.56 to -2.08, p < 0.001) and reduce the levels of biomarkers of myocardial injury including cTnI (SMD: -3.82, 95%CI: -5.20 to -2.44, p < 0.001) and CK-MB (SMD: -2.74, 95%CI: -3.58 to -1.91, p < 0.001). HSYA displayed an improvement in cardiac function indicators including LVEF, LVSP, +dp/dt max and -dp/dt max. Furthermore, HSYA was able to reduce the levels of MDA, TNF-α and IL-6, while increasing SOD and NO levels. Mechanistically, the protective effect of HSYA in alleviating myocardial injury after ischemia may be associated with NLRP3 inflammasome, Bcl-2, Bax, caspase-3, eNOS proteins, and TLR/NF-κB, Nrf2/HO-1, JAK/STAT, PI3K/Akt, AMPK/mTOR, VEGFA pathways.

Conclusion

This study demonstrates that HSYA exerts cardioprotective effects in decreasing infarct size, reducing myocardial enzymes and improving cardiac function, which may be mediated by anti-inflammatory, antioxidant, anti-apoptotic, regulation of autophagy, improvement of microcirculation and promotion of angiogenesis. However, the absence of safety assessment, lack of animal models of co-morbidities, and inconsistency between timing of administration and clinical practice are limitations of preclinical studies.

Systematic Review Registration

clinicaltrials.gov, Identifier, CRD42023460790.

Cardiac rhythm devices in heart failure with reduced ejection fraction - role, timing, and optimal use in contemporary practice. European Journal of Heart Failure expert consensus document

Guidelines for management of heart failure with reduced ejection fraction (HFrEF) emphasize personalized care, patient engagement, and shared decision-making. Medications and cardiac rhythm management (CRM) devices are recommended with a high level of evidence. However, there are significant disparities: patients who could benefit from devices are frequently referred too late or not at all. Misconceptions about device therapy and the notion that the needs of patients (especially the prevention of sudden cardiac death) can now be met by expanding drug therapies may play a role in these disparities. This state-of-the-art review is produced by members of the DIRECT HF initiative, a patient-centred, expert-led educational programme that aims to advance guideline-directed use of CRM devices in patients with HFrEF. This review discusses the latest evidence on the role of CRM devices in reducing HFrEF mortality and morbidity, and provides practical guidance on patient referral, device selection, implant timing and patient-centred follow-up.

Understanding embolus transport and source to destination mapping of thromboemboli in hemodynamics driven by left ventricular assist device

Left Ventricular Assist Devices (LVADs) are a key treatment option for patients with advanced heart failure, but they carry a significant risk of thromboembolic complications. While improved LVAD design, and systemic anticoagulation regimen, have helped mitigate thromboembolic risks, ischemic stroke due to adverse thromboembolic events remains a major concern with current LVAD therapies. Improved understanding of embolic events, and embolus movement to the brain, is critical to develop techniques to minimize risks of occlusive embolic events such as a stroke after LVAD implantation. Here, we address this need, and devise a quantitative in silico framework to characterize thromboembolus transport and distrbution in hemodynamics driven by an operating LVAD. We conduct systematic numerical experiments to establish that our framework can quantify the source-to-destination transport patterns of thromboemboli as a function of: LVAD outflow graft anastomosis, LVAD operating pulse modulation, thromboembolus sizes, and origin locations of emboli. Additionally, we demonstrate how the resulting embolus distribution patterns compare and correlate with descriptors based solely on hemodynamic patterns such as helicity, vorticity, and wall shear stress. Using the concepts of size-dependent embolus-hemodynamics interactions, and jet impingement driven flow for hemodynamics under LVAD operation as established in our prior works, we gain valuable insights on departure of thromboembolus distribution from flow distribution, and establish that our in silico model can generate deep insights into embolus dynamics which is not otherwise available from standard of care imaging and clinical data.

USP7 promotes PINK1/Parkin-dependent mitophagy to ameliorate cerebral ischemia-reperfusion injury by deubiquitinating and stabilizing SIRT1

BACKGROUND

Cerebral ischemia-reperfusion (CI/R) injury, a major complication of ischemic stroke, is characterized by mitochondrial dysfunction and neuronal apoptosis, and understanding its underlying molecular mechanisms is essential for the development of effective therapeutic strategies. This study aimed to investigate the role of ubiquitin-specific protease 7 (USP7) in CI/R injury and elucidate its regulatory mechanisms.

METHODS

A rat model of middle cerebral artery occlusion/reperfusion (MCAO/R) and an in vitro neuronal model subjected to oxygen-glucose deprivation/reperfusion (OGD/R) were used to mimic CI/R injury. USP7 was overexpressed or knocked down, with or without co-treatment, using the autophagy inhibitor 3-methyladenine (3-MA). Neurological function was evaluated using standardized scoring systems, and cerebral infarct volume was quantified by TTC staining. Histopathological changes in the cortex and hippocampus were assessed using hematoxylin-eosin (HE) and Nissl staining. Neuronal viability and apoptosis were measured by CCK-8 assay, TUNEL staining, and flow cytometry. To assess cellular metabolism and oxidative stress, ATP and LDH levels, along with antioxidant markers (including SOD, GSH, and GSH-Px), were analyzed using commercial biochemical kits. Mitochondrial morphology and autophagosome formation were visualized using transmission electron microscopy. Gene and protein expression levels were quantified by qRT-PCR and Western blotting, respectively. Immunofluorescence microscopy was performed to evaluate the subcellular localization of target proteins and co-localization with mitochondrial membrane markers. Lastly, protein-protein interactions and ubiquitination modification were analyzed by co-immunoprecipitation assays.

RESULTS

USP7 overexpression significantly alleviated neurological deficits, reduced infarct volume, attenuated histological damage, and decreased neuronal apoptosis in the MCAO/R model. Similarly, in the OGD/R model, USP7 overexpression markedly enhanced neuronal viability, suppressed apoptosis, restored ATP production, improved antioxidant capacity (as evidenced by increased levels of SOD, GSH, and GSH-Px), and reduced LDH release. Mechanistically, USP7 stabilized SIRT1 protein expression through deubiquitination, which in turn activated the PINK1/Parkin pathway and enhanced mitophagy. This activation was demonstrated by an increased LC3II/LC3I ratio, elevated ATG5 expression, enhanced co-localization of Tomm20 and Parkin, and increased autophagosome formation. Moreover, these protective effects were abolished when either 3-MA treatment was applied or SIRT1/PINK1 expression was knocked down.

CONCLUSION

USP7 mitigates CI/R injury by promoting PINK1/Parkin-dependent mitophagy through SIRT1 deubiquitination and stabilization, suggesting USP7 as a potential therapeutic target for ischemic stroke.

Implementation considerations of aquatic therapy post-stroke: A qualitative study from Ontario, Canada

BACKGROUND AND PURPOSE

Aquatic therapy is an effective alternative approach to therapy on land in facilitating mobility and independence after a stroke. Despite the evidence reporting on the effectiveness of many aquatic interventions, there is a lack of studies elucidating essential implementation factors for aquatic therapy post-stroke.

MATERIALS AND METHODS

A purposive sample of people with lived experience of stroke and healthcare providers participated in semi-structured interviews about their experiences with aquatic therapy. A deductive content analysis approach using the Consolidated Framework for Implementation Research (CFIR) was used to identify the essential aspects of aquatic therapy implementation post-stroke.

RESULTS

Twenty-three participants (9 people with stroke experience and 14 healthcare providers) participated in the study, from across the province of Ontario in Canada. The interview data were all relevant to the five main CFIR constructs and to some of the sub-constructs. Although participants were highly favorable to aquatic therapy, several implementation considerations in terms of costs, program structure, provider qualifications, and pool access were identified at the patient, provider, and system level.

CONCLUSION

The CFIR proved valuable in identifying contextual factors relevant to implementing aquatic therapy with the stroke population. These factors included the importance of education, barriers to accessing aquatic therapy in rehabilitation and community settings, and internal and external factors influencing the application of aquatic therapy post-stroke.

Inverse association between triglyceride-glucose index and maximal oxygen uptake in US young and middle-aged population: a cross-sectional study

Background

The triglyceride-glucose (TyG) index has been linked to impaired cardiovascular fitness (CVF). However, the available evidence regarding the direct relationship between the TyG index and maximal oxygen uptake (VO2max) is limited. This study aims to investigate the association between the TyG index and VO2max.

Methods

We conducted a retrospective cross-sectional study involving 3,571 participants who completed a CVF examination as part of the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Data on triglycerides, glucose, and VO2max were collected from all participants. The TyG index was calculated using the formula: Ln[triglyceride (TG)(mg/dl) × fasting plasma glucose (FPG)(mg/dl)/2]. Linear regression analysis was utilized to substantiate the research objectives.

Results

The complex sampling design and mobile examination center sample weights were considered. In multivariable linear regression analyses, each 1 unit increase in the TyG index was associated with a decrease in VO2max [β = -1.24, 95% CI (-1.97, -0.51), p = 0.002] when expressed as a continuous variable, independent of confounders. The TyG index was converted into a categorical variable based on four quartiles. Compared with the lowest TyG quintile (Q1: 6.750-7.887), the fully adjusted β for Q4 (8.672-12.481) was -1.91 (95% CI: -3.24, -0.57, p < 0.007). A significant interaction (p = 0.007) between sex and the TyG index for VO2max was found in the population using subgroup analysis. The results of the sensitivity analysis remained stable. Mediation analysis showed the direct effect of the TyG index was -1.467 (-2.019, -0.948), with a total effect of -1.813 (-2.377, -1.286). The mediation effect of diastolic blood pressure (DBP), white blood cell count (WBC), and C-reactive protein (CRP) was -0.389 (-0.526, -0.268), -0.308 (-0.432, -0.177), and -0.252 (-0.453, -0.135), respectively. HGB was found to exert a suppressing effect on the relationship between the TyG index and VO2max, with a value of 1.469 (1.252, 1.702). The p-values for all the above effects were <0.05.

Conclusions

In the US young and middle-aged population, the TyG index was significantly adversely associated with VO2max levels. Females may exert an interaction on TyG. Evidence supported DBP, WBC, and CRP as intervening variables through which the TyG index exerts its influence on VO2max. HGB may overrule the potential inverse association between the TyG index and VO2max.NCHS IRB/ERB Protocol Number: Protocol #98-12.

In Situ H2S-Releasing Stents Optimize Vascular Healing

Stent implantation remains a cornerstone of interventional cardiology, providing a minimally invasive solution to restore blood flow in occluded vessels. However, current stents face persistent challenges in simultaneously preventing neointimal hyperplasia and promoting reendothelialization, compromising their long-term efficacy. To address these limitations, we developed an in situ H2S-releasing polymer brush-coated stent that actively modulates material-blood interactions, creating a favorable microenvironment for vascular healing. H2S enhances the stent's antithrombotic properties by inhibiting fibrinogen binding and platelet activation, while also mitigating oxidative stress and promoting macrophage polarization toward the anti-inflammatory M2 phenotype. In vivo, the H2S-releasing stents significantly improved vascular healing by accelerating endothelialization and inhibiting smooth muscle cell overproliferation, resulting in a thinner neointima with functional endothelial coverage. Transcriptomic analysis further elucidated the underlying mechanisms, revealing H2S-mediated modulation of key biological pathways that support vascular healing. These findings underscore the potential of in situ H2S release as an effective strategy for optimizing vascular implants and improving long-term outcomes.

Nrf3-Mediated Mitochondrial Superoxide Promotes Cardiomyocyte Apoptosis and Impairs Cardiac Functions by Suppressing Pitx2

BACKGROUND

Myocardial infarction (MI) elicits mitochondria reactive oxygen species (ROS) production and cardiomyocyte (CM) apoptosis. Nrf3 (nuclear factor erythroid 2-related factor 3) has an established role in regulating redox signaling and tissue homeostasis. Here, we aimed to evaluate the role and mechanism of Nrf3 in injury-induced pathological cardiac remodeling.

METHODS

Global (Nrf3-KO) and CM-specific (Nrf3△CM) Nrf3 knockout mice were subjected to MI or ischemia/reperfusion injury, followed by functional and histopathological analysis. Primary neonatal mouse and rat ventricular myocytes and CMs derived from human induced pluripotent stem cells were used to evaluate the impact of Nrf3 on CM apoptosis and mitochondrial ROS production. Chromatin immunoprecipitation sequencing and immunoprecipitation-mass spectrometry analysis were used to uncover potential targets of Nrf3. MitoParaquat administration and CM-specific adeno-associated virus vectors were used to further confirm the in vivo relevance of the identified signal pathways.

RESULTS

Nrf3 was expressed mainly in CMs in healthy human hearts, and an increased level of Nrf3 was observed in CMs within the border zone of infarcted human hearts and murine cardiac tissues after MI. Both global and CM-specific Nrf3 knockout significantly decreased injury-induced mitochondrial ROS production, CM apoptosis, and pathological cardiac remodeling, consequently improving cardiac functions. In addition, cardiac-specific Nrf3 overexpression reversed the ameliorative cardiac phenotypes observed in Nrf3-KO mice. Functional studies showed that Nrf3 promoted neonatal mouse ventricular myocyte, neonatal rat ventricular myocyte, and CMs derived from human induced pluripotent stem cell apoptosis by increasing mitochondrial ROS production. Critically, augmenting mitochondrial ROS with MitoParaquat blunted the beneficial effects of Nrf3 deletion on cardiac function and remodeling. Mechanistically, a redox regulator Pitx2 (paired-like homeodomain transcription factor 2) was identified as one of the main target genes of Nrf3. Specifically, Nrf3 binds to Pitx2 promoter, where it increases DNA methylation through recruiting heterogeneous nuclear ribonucleoprotein K and DNA-methyltransferase 1 complex, thereby inhibiting Pitx2 expression. CM-specific knockdown of Pitx2 blunted the beneficial effects of Nrf3 deletion on cardiac function and remodeling, and cardiac-specific Pitx2 overexpression attenuated MI-induced mitochondrial ROS production and CM apoptosis, as well as preserved cardiac functions after MI.

CONCLUSIONS

Nrf3 promotes injury-induced CM apoptosis and deteriorates cardiac functions by increasing mitochondrial ROS production through suppressing Pitx2 expression. Targeting the Nrf3-Pitx2-mitochondrial ROS signal axis may therefore represent a novel therapeutic approach for MI treatment.

Machine learning integration of multimodal data identifies key features of circulating NT-proBNP in people without cardiovascular diseases

N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) is important for diagnosing and predicting heart failure or many other diseases. However, few studies have comprehensively assessed the factors correlated with NT-proBNP levels in people with cardiovascular health. We used data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Machine learning was employed to assess 66 factors that associated with NT-proBNP levels, including demographic, anthropometric, lifestyle, biochemical, blood, metabolic, and disease characteristics. The predictive power of the model was assessed using five-fold cross-validation. The optimal features predicting NT-proBNP levels were identified using univariate and step-forward multivariate models. Weighted least squares regression (WLS) was applied for supplementary analysis. Finally, the relationship between the corresponding features and NT-proBNP was validated using weighted and adjusted generalized additive models (GAM). We included 12, 526 participants without cardiovascular diseases. In the univariate model, age exhibited the highest association with NT-proBNP levels (the coefficient of determination (R2) = 36.91%). The multivariate models revealed that age, gender, red blood cell count, race/ethnicity, systolic blood pressure, and total protein level were the top six predictors of NT-proBNP. GAM demonstrated a noteworthy non-linear association between NT-proBNP and age, red blood cell count, systolic blood pressure, and total protein. Our study contributes to explaining the biological mechanisms of NT-proBNP and will facilitate the design of relevant cohort studies. We underscore the significance of assessing various population subgroups when employing NT-proBNP as a biomarker, and the need for developing innovative clinical algorithms to establish personalized levels.

Predictors of white matter hyperintensities in the elderly Congolese population

Introduction

White matter hyperintensities (WMHs) are strongly linked to cardiovascular risk factors and other health conditions such as Alzheimer's disease. However, there is a dearth of research on this topic in low-income countries and underserved populations, especially in the Democratic Republic of Congo (DRC) where the population is aging rapidly with increasing cardiovascular risk factors and dementia-related diseases. This study evaluates health factors associated with WMH in the elderly Sub-Saharan Africa (SSA), specifically Congolese adults.

Methods

In a cross-sectional study of 77 people from the DRC, participants underwent neuroimaging to analyze WMHs volume and completed clinical evaluation, laboratory-based blood exams, self-reported questionnaires, and interviews. A simple linear regression model was conducted to test the association between WMHs and potential predictors (dementia, age, sex, hypertension, diabetes, tobacco abuse, stroke, high cholesterol, cardiovascular medication, and alcohol abuse). Stepwise selection and backward elimination analyses were performed to obtain the final model. Finally, a multiple linear regression model was conducted to assess the association between WMHs and variables retained in the final model (dementia, sex, and age).

Results

Of the 77 individuals, 47 (61%) had dementia, 40 (52.6%) were males, and the mean age was 73 years (± 8.0 years standard deviation). In simple linear regression models, WMHs was significantly associated with dementia (expβ1 = 1.75, 95% CI = 1.14-2.71, p-value = 0.01) though it had a weak association with age (expβ1 = 1.03, 95% CI = 1.00-1.05, p-value = 0.05) and sex (male) (expβ1 = 0.66, 95% CI = 0.43-1.01, p-value = 0.05). In multiple linear regression models, WMHs was statistically significantly associated with dementia (expβ1 = 1.97, 95% CI = 1.31-2.95, p-value =0.001), male sex (expβ2 = 0.54, 95% CI = 0.36-0.80, p-value = 0.003), and age (expβ3 = 1.03, 95% CI = 1.00-1.06, p-value = 0.03). However, WMHs was not significantly associated with common cardiovascular risk factors, such as high blood pressure, diabetes, tobacco use, obesity, and high cholesterol levels.

Discussion

WMHs is significantly associated with dementia, sex, and age in the Congolese population. Understanding these predictors may improve our ability to diagnose, assess, and develop preventative treatments for white matter disease in SSA/DRC populations, where neuroimaging is difficult to obtain.

The m7G methylation modification: An emerging player of cardiovascular diseases

Cardiovascular diseases severely endanger human health and are closely associated with epigenetic dysregulation. N7-methylguanosine (m7G), one of the common epigenetic modifications, is present in many different types of RNA molecules and has attracted significant attention due to its impact on various physiological and pathological processes. Recent studies have demonstrated that m7G methylation plays an important role in the occurrence and development of multiple cardiovascular diseases. Application of small molecule inhibitors to target m7G modification mediated by methyltransferase-like protein 1 (METTL1) has shown potentiality in the treatment of cardiovascular diseases. In this review, we summarize the basic knowledge about m7G modification and discuss its role and therapeutic potential in diverse cardiovascular diseases, aiming to provide a theoretical foundation for future research and therapeutic intervention.

HMOX1-LDHB interaction promotes ferroptosis by inducing mitochondrial dysfunction in foamy macrophages during advanced atherosclerosis

Advanced atherosclerosis is the pathological basis for acute cardiovascular events, with significant residual risk of recurrent clinical events despite contemporary treatment. The death of foamy macrophages is a main contributor to plaque progression, but the underlying mechanisms remain unclear. Bulk and single-cell RNA sequencing demonstrated that massive iron accumulation in advanced atherosclerosis promoted foamy macrophage ferroptosis, particularly in low expression of triggering receptor expressed on myeloid cells 2 (TREM2low) foamy macrophages. This cluster exhibits metabolic characteristics with low oxidative phosphorylation (OXPHOS), increasing ferroptosis sensitivity. Mechanically, upregulated heme oxygenase 1 (HMOX1)-lactate dehydrogenase B (LDHB) interaction enables Lon peptidase 1 (LONP1) to degrade mitochondrial transcription factor A (TFAM), leading to mitochondrial dysfunction and ferroptosis. Administration of the mitochondria-targeted reactive oxygen species (ROS) scavenger MitoTEMPO (mitochondrial-targeted TEMPO) or LONP1 inhibitor bortezomib restored mitochondrial homeostasis in foamy macrophages and alleviated atherosclerosis. Collectively, our study elucidates the cellular and molecular mechanism of foamy macrophage ferroptosis, offering potential therapeutic strategies for advanced atherosclerosis.

Human induced pluripotent stem cell-derived cardiomyocytes and their use in a cardiac organ-on-a-chip to assay electrophysiology, calcium and contractility

Cardiac organs-on-a-chip (OoCs) or microphysiological systems have the potential to predict cardiac effects of new drug candidates, including unanticipated cardiac outcomes, which are among the main causes for drug attrition. This protocol describes how to prepare and use a cardiac OoC containing cardiomyocytes differentiated from human induced pluripotent stem cells (hiPS cells). The use of cells derived from hiPS cells as reliable sources of human cells from diverse genetic backgrounds also holds great potential, especially when cultured in OoCs that are physiologically relevant culture platforms. To promote the broad adoption of hiPS cell-derived cardiac OoCs in the drug development field, there is a need to first ensure reproducibility in their preparation and use. This protocol aims to provide key information on how to reduce sources of variability during hiPS cell maintenance, differentiation, loading and maturation in OoCs. Variability in these procedures can lead to inconsistent purity after differentiation and variable function between batches of microtissues formed in OoCs. This protocol also focuses on describing the handling and functional assessment of cardiac microtissues using live-cell microscopy approaches to quantify parameters of cellular electrophysiology, calcium transients and contractility. The protocol consists of five stages: (1) thaw and maintain hiPS cells, (2) differentiate hiPS cell cardiomyocytes, (3) load differentiated cells into OoCs, (4) maintain and characterize loaded cells, and (5) evaluate and utilize cardiac OoCs. Execution of the entire protocol takes ~40 days. The required skills to carry out the protocol are experience with sterile techniques, mammalian cell culture and maintaining hiPS cells in a pluripotent state.

10-year trajectories of triglyceride-glucose index and progression of vertebrobasilar artery stenosis: A multicenter hospital-based prospective longitudinal cohort study

BACKGROUND

The association between the triglyceride-glucose (TyG) index and the atherosclerosis has been validated by numerous evidences. However, the prospective relationship between long-term dynamic changes in the TyG index and the progression of vertebrobasilar artery (VBA) atherosclerotic plaques remained unclear.

METHODS

This multicenter, hospital-based, prospective longitudinal cohort study included 1,336 patients with suspected stroke from January 1, 2004 to December 31, 2022. Baseline characteristics and vascular examinations were collected and performed at baseline. Patients were followed up for 10 years. The latent class trajectory modeling method was used to analyze the TyG index trajectories over the follow-up period. Cox regression was used to analyze the association of the baseline and trajectory of the TyG index with the progression of VBA plaques.

RESULTS

During the follow-up (10.80 ± 2.30 years), VBA plaque progression was found in 175 participants. Cox regression analysis indicated there was a significant positive association between the baseline TyG index and the VBA plaque progression (HR 1.886, 95 % CI 1.166-3.050, P = 0.010). Two trajectories of the TyG index were identified in a total of 1,336 participants, the low-stable group and high-increasing group. Compared with the low-stable group, the odds ratio for the high-increasing group had a 3.156-fold (95 % CI 1.629-6.112, P = 0.001) risk of VBA plaque progression.

CONCLUSIONS

Our findings suggested that higher baseline and the high-increasing trajectory of the TyG index were associated with VBA plaque progression. People with high-increasing trajectories of the TyG index predispose to develop VBA plaque progression and deserve more attention and more aggressive preventive therapies.

Outpatient worsening heart failure: innovative decongestion strategies and health equity implications

Worsening heart failure (WHF) is a major clinical and economic challenge, contributing to high rates of hospitalization and significant healthcare costs. While WHF has traditionally been managed through hospitalization, recent approaches are shifting toward outpatient care to maximize patient time spent at home and optimize allocation of hospital resources. Emerging treatments like subcutaneous furosemide and intranasal bumetanide offer promising alternatives for safe, well-tolerated, and effective diuresis outside the hospital. However, these novel strategies face several challenges, including the need for clinician/staff training, patient education, logistical difficulties, and a lack of evidence in diverse populations. To ensure equitable management, it is also essential to address healthcare disparities, particularly in socioeconomically disadvantaged and rural populations. While these new treatments have the potential to improve care delivery, additional research is necessary to assess their comparative effectiveness and overcome current limitations fully.

Motion-unrestricted dynamic electrocardiogram system utilizing imperceptible electronics

Electrocardiogram (ECG) plays a vital role in the prevention, diagnosis, and prognosis of cardiovascular diseases (CVDs). However, the lack of a user-friendly and accurate long-term dynamic electrocardiogram (DCG) device in motion has made it challenging to perform many daily cardiovascular risk screenings and assessments, such as sudden cardiac arrest, resulting in additional economic burdens on society. Here, we present a motion-unrestricted dynamic electrocardiogram (MU-DCG) system, which employs skin-conformal, imperceptible electronics for long-term, comfortable, and accurate 12-lead DCG monitoring. To facilitate assembly for use on the skin, the MU-DCG system features a pressure-activated flexible skin socket for stably soft-connecting the on-skin soft module and the off-skin stiff module during dynamic movements. Crucially, blinded cardiologist evaluations confirm minimal motion artifacts in MU-DCG-acquired ECG signals. Our results demonstrate that the MU-DCG system, with large-area, ultra-thin on-skin electrodes/leads, and an off-skin module, accomplishes anti-motion interference acquisition and in-situ analysis while retaining wearing imperceptibility.

One nanoparticle delivers two different neuroprotective amino acids into ischemic brain and protects against neuronal death in rat cerebral ischemia injury

Previous studies have proven that glycine and proline are neuroprotective but have very low permeability through the blood-brain barrier (BBB), which is a major barrier to the application of these neuroprotective amino acids in the therapy of brain injury. In this study, we aimed to develop a therapeutic strategy by which one chitosan nanoparticle could deliver two different neuroprotective amino acids, glycine and proline, into the rat ischemic brain to confer neuroprotection in a rat model of cerebral ischemia-reperfusion (I/R) injury. Using the ion cross-linking method, we developed a preparation in which one chitosan nanoparticle was simultaneously loaded with glycine and proline (AA-NPs). We evaluated the therapeutic potential of AA-NPs in both cell and animal models of cerebral ischemic stroke. We found that the levels of glycine and proline were decreased in the brain tissues of I/R rats. AA-NPs delivered both glycine and proline into the ischemic brain and reduced ischemic neuronal death in both in vitro and in vivo. These results indicated that the dual delivery of glycine and proline via AA-NPs mediated neuroprotective effects, as evidenced by the reduction of neuronal death in both cellular and animal models of ischemic stroke. AA-NPs provide an efficient and potential delivery strategy by which multiple neuroprotective amino acids can be transported into the ischemic brain simultaneously for the treatment of ischemic stroke.

Unveiling the role of GATA4 in endothelial cell senescence and atherosclerosis development

BACKGROUND AND AIMS

Cellular senescence is intimately linked to atherosclerosis development and progression. However, the mechanism is not well known. GATA4 is a classical regulator in human fibroblast senescence. This study aimed to determine the role of GATA4 in endothelial cell (EC) senescence and atherosclerosis development and the mechanisms by which it acts.

METHODS

Senescence ECs were induced using H2O2 by isolating human primary umbilical vein ECs from umbilical veins. The level of GATA4 was examined in endothelial progenitor cells (EPCs), ECs of arterial tissue from older individuals (>65 years), and aged mice (>24 months). Adeno-associated virus with EC-selective Tie1 promoter, an EC-specific gene transduction system, was used to explore the role of GATA4 in EC senescence and atherosclerosis development in ApoE-/- mice. RT-qPCR, Western blot, ChIP-PCR, and ELISA were conducted to further explore the mechanism of GATA4 in EC senescence and atherosclerosis development.

RESULTS

GATA4 protein levels are elevated in EC senescence induced by H2O2 and EPCs in older individuals. Additionally, GATA4 protein levels are increased in the ECs of arterial tissue from older individuals and aged mice and are strongly correlated with the progression of atherosclerosis plaques. Knockdown of GATA4 decreased EC senescence, dysfunction, and monocyte adhesion. Mechanistically, we found that GATA4 activates NFκB2 transcription and induces senescence-associated secretory phenotype (SASP) expression (IL-6, IL-8, CXCL1, CXCL3, ICAM-1). In vivo experiments on ApoE-/- mice demonstrated that GATA4 overexpression in ECs contributes to higher SASP expression, vascular senescence, atherosclerotic plaque formation, and impaired cardiac function.

CONCLUSIONS

Taken together, our findings indicate that elevated EC GATA4 levels contribute to the progression of atherosclerosis through the GATA4-NFκB2-SASP pathway, suggesting potential therapeutic targets for atherosclerosis-related diseases.

LT-YOLO: long-term temporal enhanced YOLO for stenosis detection on invasive coronary angiography

Coronary artery stenosis detection by invasive coronary angiography plays a pivotal role in computer-aided diagnosis and treatment. However, it faces the challenge of stenotic morphology confusion stemming from coronary-background similarity, varied morphology, and small-area stenoses. Furthermore, existing automated methods ignore long-temporal information mining. To address these limitations, this paper proposes a long-term temporal enhanced You Only Look Once (YOLO) method for automatic stenosis detection and assessment in invasive coronary angiography. Our approach integrates long-term temporal information and spatial information for stenosis detection with state-space models and YOLOv8. First, a spatial-aware backbone based on a dynamic Transformer and C2f Convolution of YOLOv8 combines the local and global feature extraction to distinguish the coronary regions from the background. Second, a spatial-temporal multi-level fusion neck integrates the long-term temporal and spatial features to handle varied stenotic morphology. Third, a detail-aware detection head leverages low-level information for accurate identification of small stenoses. Extensive experiments on 350 invasive coronary angiography (ICA) video sequences demonstrate the model's superior performance over seven state-of-the-art methods, particularly in detecting small stenoses (<50%), which were previously underexplored.

Association between post-arrest 12-lead electrocardiographic features and neurologically intact survival for patients of in-hospital cardiac arrest

Twelve-lead electrocardiogram (ECG) may provide prognostic information for in-hospital cardiac arrest (IHCA). This study aimed to identify post-arrest ECG features and their temporal changes associated with IHCA outcomes. This single-center retrospective study included patients experiencing IHCA between 2005 and 2022. Post-arrest ECGs were obtained within 48 h after an IHCA, admission ECGs upon hospital admission, and pre-arrest ECGs within 72 h before an IHCA. Multivariable logistic regression analyses were conducted to identify ECG features associated with neurologically intact survival. A total of 708 patients were included, with 131 (18.5%) achieving neurologically intact survival. The median age was 70.4 years (interquartile range: 59.2-82.6), and 362 (62.7%) patients were male. Four post-arrest ECG features were associated with survival: sinus rhythm (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.11-2.93), QRS duration between 80 and 120 ms (OR: 1.91, 95% CI 1.19-3.08), low QRS voltage (OR: 0.50, 95% CI 0.25-0.99), and prolonged QTc (OR: 1.89, 95% CI 1.08-3.28). Comparing with admission ECGs, new-onset right bundle branch block (OR: 0.39, 95% CI 0.16-0.95) and increases in the number of leads with ST depression (OR: 0.85, 95% CI 0.77-0.94) on post-arrest ECGs were inversely associated with survival. Compared with pre-arrest ECGs, increases in the number of leads with ST depression (OR: 0.91, 95% CI 0.88-0.96) on post-arrest ECGs were also inversely associated with survival. Post-arrest ECGs may serve as a valuable prognostic tool for IHCA. Further exploration is warranted to determine whether incorporating these ECG features can enhance the performance of prediction models for IHCA outcomes.