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Kern A, Stompór T, Bojko K, Sienkiewicz E, Pawlak S, Pawlak K, Pawlak D, Poskrobko G, Andrasz E, Gromadziński L, Jalali R, Onichimowski D, Piwko G, Zalewski A, Bil J. Kynurenine as a Predictor of Long-Term Mortality: A 10-Year Follow-Up from the KORONEF Registry. Biomedicines 2025; 13:1123. [PMID: 40426950 PMCID: PMC12109461 DOI: 10.3390/biomedicines13051123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Revised: 04/25/2025] [Accepted: 05/02/2025] [Indexed: 05/29/2025] Open
Abstract
Background: The kynurenine (KYN) pathway of tryptophan metabolism has been linked to inflammation and cardiovascular risk, but its long-term prognostic value remains unclear. Methods: We analyzed 492 patients from the KORONEF registry who underwent coronary and renal angiography and were followed for a median of 10.2 years. Plasma levels of tryptophan (TRP), KYN, and downstream metabolites were measured. The primary endpoint was all-cause mortality. Results: The mean age was 64.4 ± 9.9 years, and 37.2% of patients were female. Common comorbidities included hypertension (74.8%), dyslipidemia (46.0%), and diabetes (25.8%). Overall mortality reached 29.5% and increased across KYN tertiles: 17.6% (T1), 28.2% (T2), and 42.9% (T3) (p < 0.001). In a multivariable Cox analysis, KYN independently predicted mortality (HR: 1.79; 95% CI: 1.15-2.44; p < 0.001), alongside age, diabetes, prior myocardial infarction, chronic kidney disease, and left ventricular ejection fraction. Other kynurenine pathway metabolites were not independently associated with outcomes. Conclusions: Elevated kynurenine levels independently predict 10-year all-cause mortality in patients undergoing coronary angiography. KYN may represent a useful prognostic biomarker beyond traditional clinical and angiographic variables.
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Affiliation(s)
- Adam Kern
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.); (S.P.); (L.G.)
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Tomasz Stompór
- Department of Nephrology, Hypertension and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland;
| | - Krystian Bojko
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.); (S.P.); (L.G.)
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Ewa Sienkiewicz
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Sebastian Pawlak
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.); (S.P.); (L.G.)
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Krystyna Pawlak
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Dariusz Pawlak
- Department of Pharmacodynamics, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Grzegorz Poskrobko
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Ewa Andrasz
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.); (S.P.); (L.G.)
| | - Rakesh Jalali
- Department of Emergency Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (R.J.); (D.O.)
- Clinical Emergency Department, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland
| | - Dariusz Onichimowski
- Department of Emergency Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (R.J.); (D.O.)
- Clinical Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, 10-727 Olsztyn, Poland
| | - Grażyna Piwko
- Department of Cardiology, University of Warmia and Mazury in Olsztyn, Branch in Ełk, 19-300 Ełk, Poland;
- Scanmed Cardiology Center in Ełk, 19-300 Ełk, Poland;
| | | | - Jacek Bil
- National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
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Scarica V, Rinaldi R, Animati FM, Manzato M, Montone RA. Coronary microvascular dysfunction: pathophysiology, diagnosis, and therapeutic strategies across cardiovascular diseases. EXCLI JOURNAL 2025; 24:454-478. [PMID: 40376434 PMCID: PMC12078779 DOI: 10.17179/excli2025-8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Accepted: 03/13/2025] [Indexed: 05/18/2025]
Abstract
Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, presenting with acute and chronic coronary syndromes. Although coronary atherosclerosis is a major cause of IHD, many patients with angina or myocardial ischemia do not have obstructive coronary heart disease and impairment of the coronary microcirculation has been increasingly implicated as a relevant cause of IHD. Therefore, coronary microvascular dysfunction (CMD) refers to a term covering a wide spectrum of structural and functional alterations which affect the coronary microcirculation leading to myocardial ischemia and angina. The advent of non-invasive and invasive functional tests has exponentially broadened the ability to recognize CMD and delineate related clinical and biochemical features. Despite major advances in diagnosing and stratifying this condition, therapeutic strategies remain limited and poorly defined. In this review, we will provide an overview of the pathophysiology and the diagnostic evaluation of CMD across the spectrum of cardiovascular diseases. Furthermore, we will discuss the novel therapeutic strategies available for these patients in the perspective of a personalized medicine approach.
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Affiliation(s)
- Vincenzo Scarica
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Cardiology Unit, Infermi Hospital, Rimini, Italy
| | - Francesco Maria Animati
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Manzato
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco A. Montone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Rinaldi R, Kunadian V, Crea F, Montone RA. Management of angina pectoris. Trends Cardiovasc Med 2025:S1050-1738(25)00033-7. [PMID: 40086653 DOI: 10.1016/j.tcm.2025.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2025] [Revised: 03/04/2025] [Accepted: 03/08/2025] [Indexed: 03/16/2025]
Abstract
Angina pectoris, a primary manifestation of ischemic heart disease, imposes a significant clinical and economic burden globally. This review highlights recent advancements in the management of angina, emphasizing a patient-centred approach that integrates pharmacological, interventional, and lifestyle strategies to reduce cardiovascular risk and improve patient outcomes. For obstructive coronary artery disease, optimal medical therapy represents the cornerstone of treatment. Individualized regimens should be tailored to clinical factors such as blood pressure, heart rate, left ventricular function, comorbidities like heart failure and diabetes, concomitant medications, patient preferences, and drug availability. Myocardial revascularization is reserved for select cases to alleviate symptoms or improve prognosis. For angina or ischemia with non-obstructive coronary arteries (ANOCA/INOCA), precise endotype classification, differentiating microvascular angina, vasospastic angina, mixed type and non-coronary chest pain, enables personalized treatment strategies. Lifestyle interventions, including smoking cessation, weight management, adherence to Mediterranean diet, and exercise therapy, are essential components of care, promoting improved cardiovascular outcomes and quality of life. Structured exercise programs, particularly within cardiac rehabilitation settings, have demonstrated efficacy in enhancing functional capacity and reducing adverse events. Emerging therapies, including pharmacological agents and novel interventional approaches such as the coronary sinus reducer, hold promise for addressing unmet needs in refractory angina and challenging ANOCA/INOCA cases. Future directions should prioritize the integration of precision medicine, digital health technologies, and multidisciplinary care to optimize outcomes and advance personalized angina management.
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Affiliation(s)
- Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Cardiology Unit, Infermi Hospital, Rimini, Italy
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle-upon-Tyne NE2 4HH, United Kingdom; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Center of Excellence of Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Bäck M, Hofmann R. Myocardial infarction and low ambient temperature: does presence or absence of stenoses make a difference? Eur Heart J 2025; 46:451-453. [PMID: 39607783 DOI: 10.1093/eurheartj/ehae820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2024] Open
Affiliation(s)
- Magnus Bäck
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm 171 76, Sweden
- Translational Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Nancy University Hospital, University of Lorraine and INSERM U1116, Nancy, France
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Aasim M, Aziz R, Mohsin AU, Khan R, Zahid A, Awais M, Marquez Roa LA, Shaukat N, Ikram J. Outcomes of Coronary Artery Bypass Grafting in Patients With Impaired Left Ventricular Function and the Role of Preoperative Myocardial Viability. Cureus 2024; 16:e76198. [PMID: 39840188 PMCID: PMC11750051 DOI: 10.7759/cureus.76198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2024] [Indexed: 01/23/2025] Open
Abstract
Background Coronary artery bypass grafting (CABG) improves outcomes in patients with ischemic left ventricular (LV) dysfunction, but accurate patient selection remains critical. Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging aids in assessing myocardial viability, a key predictor of surgical outcomes. This study aimed to evaluate the impact of myocardial viability on postoperative outcomes in patients undergoing CABG. Methods This was a single-center prospective analysis of clinical outcomes in 37 patients with impaired LV function (mean ejection fraction: 35.59%); myocardial viability was assessed using LGE-CMR prior to CABG. Patient demographics, perioperative details, and short-term outcomes, including in-hospital mortality and recovery metrics, were analyzed. Results Patients exhibited high myocardial viability (mean: 88.16%), with an average of 2.35 non-viable segments. In-hospital mortality was 5.4% (n=2), and the mean hospital stay was six days. Patients with greater viability demonstrated better recovery and fewer complications. Multivessel coronary artery disease was prevalent (94.6%, n=35), with tailored graft configurations addressing individual anatomical and disease complexities. Conclusion LGE-CMR is a valuable tool for predicting outcomes in ischemic LV dysfunction. Myocardial viability strongly correlates with improved surgical recovery, highlighting the importance of integrating LGE-CMR into preoperative decision-making. Further studies are required to explore the long-term impact of myocardial viability on treatment outcomes and quality of life.
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Affiliation(s)
- Muhammad Aasim
- Cardiac Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Raheela Aziz
- Cardiovascular Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Atta Ul Mohsin
- Cardiac Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Raheel Khan
- Cardiac Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Ayesha Zahid
- Cardiovascular Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Muhammad Awais
- Cardiovascular Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | | | - Nauman Shaukat
- Cardiovascular Medicine, Royal Cornwall Hospitals NHS Trust, Truro, GBR
| | - Jibran Ikram
- Cardiovascular Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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Russo F, Palma A, Cacciatore S, Tomarelli E, Spadafora L. Rethinking Beta-Blockers After ST-Segment Elevation Myocardial Infarction: Essential for Some, Questionable for Others. J Cardiovasc Pharmacol 2024; 84:578-580. [PMID: 39259302 DOI: 10.1097/fjc.0000000000001632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Affiliation(s)
- Federico Russo
- Department of Clinical and Molecular Medicine, Unit of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital-University Company, Rome, Italy
| | | | - Stefano Cacciatore
- Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, Italy ; and
| | | | - Luigi Spadafora
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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Di Vito L, Di Giusto F, Mazzotta S, Scalone G, Bruscoli F, Silenzi S, Selimi A, Angelini M, Galieni P, Grossi P. Management of vulnerable patient phenotypes and acute coronary syndrome mechanisms. Int J Cardiol 2024; 415:132365. [PMID: 39029561 DOI: 10.1016/j.ijcard.2024.132365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/07/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
Atherosclerosis is a chronic vascular disease. Its prevalence increases with aging. However, atherosclerosis may also affect young subjects without significant exposure to the classical risk factors. Recent evidence indicates clonal hematopoiesis of indeterminate potential (CHIP) as a novel cardiovascular risk factor that should be suspected in young patients. CHIP represents a link between impaired bone marrow and atherosclerosis. Atherosclerosis may present with an acute symptomatic manifestation or subclinical events that favor plaque growth. The outcome of a plaque relies on a balance of innate and environmental factors. These factors can influence the processes that initiate and propagate acute plaque destabilization leading to intraluminal thrombus formation or subclinical vessel healing. Thirty years ago, the first autopsy study revealed that coronary plaques can undergo rupture even in subjects without a known cardiovascular history. Nowadays, cardiac magnetic resonance studies demonstrate that this phenomenon is not rare. Myocardial infarction is mainly due to plaque rupture and plaque erosion that have different pathophysiological mechanisms. Plaque erosion carries a better prognosis as compared to plaque rupture. Thus, a tailored conservative treatment has been proposed and some studies demonstrated it to be safe. On the contrary, plaque rupture is typically associated with inflammation and anti-inflammatory treatments have been proposed in response to persistently elevate biomarkers of systemic inflammation. In conclusion, atherosclerosis may present in different forms or phenotypes. Vulnerable patient phenotypes, identified by using intravascular imaging techniques, biomarkers, or even genetic analyses, are characterized by distinctive pathophysiological mechanisms. These different phenotypes merit tailored management.
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Affiliation(s)
- Luca Di Vito
- Cardiology Unit, C. and G, Mazzoni Hospital, AST Ascoli Piceno, Italy.
| | | | - Serena Mazzotta
- Department of Haematology and Stem Cell Transplantation Unit C. e G, Mazzoni Hospital, Ascoli Piceno, Italy
| | - Giancarla Scalone
- Cardiology Unit, C. and G, Mazzoni Hospital, AST Ascoli Piceno, Italy
| | - Filippo Bruscoli
- Cardiology Unit, C. and G, Mazzoni Hospital, AST Ascoli Piceno, Italy
| | - Simona Silenzi
- Cardiology Unit, C. and G, Mazzoni Hospital, AST Ascoli Piceno, Italy
| | - Adelina Selimi
- University Hospital "Umberto I-Lancisi-Salesi", Ancona, Italy
| | - Mario Angelini
- Department of Haematology and Stem Cell Transplantation Unit C. e G, Mazzoni Hospital, Ascoli Piceno, Italy
| | - Piero Galieni
- Department of Haematology and Stem Cell Transplantation Unit C. e G, Mazzoni Hospital, Ascoli Piceno, Italy
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