BMC Cardiovascular Disorders

This study aims to investigate the cardioprotective effects of 4-Hydroxybenzaldehyde (4-HBA) against isoproterenol (ISO)-induced cardiac fibrosis and to elucidate the underlying mechanisms. In vivo, cardiac fibrosis was induced in C57BL/6 mice by subcutaneous injection of ISO, and the mice were treated with 4-HBA or a TGF-{beta} inhibitor. Assessments using echocardiography, histopathology, and Western blotting demonstrated that 4-HBA significantly alleviated ISO-induced cardiac dysfunction, reduced collagen deposition, and attenuated apoptosis in mice. Mechanistically, 4-HBA inhibited TGF-{beta} expression and Smad2/3 phosphorylation. In vitro, ISO was applied to cardiomyocytes (HL-1) and cardiac fibroblasts (MCFs), with or without 4-HBA or TGF-{beta} inhibitor intervention. The results showed that 4-HBA suppressed HL-1 apoptosis and fibroblast proliferation, and significantly reduced the expression of extracellular matrix genes, TGF-{beta} levels, and Smad2/3 phosphorylation in MCFs. These findings indicate that 4-HBA reduces myocardial injury while targeting the TGF-{beta}/Smad2/3 pathway to attenuate cardiac fibrosis, highlighting its potential as a therapeutic agent for fibrotic cardiomyopathy.This study aims to investigate the cardioprotective effects of 4-Hydroxybenzaldehyde (4-HBA) against isoproterenol (ISO)-induced cardiac fibrosis and to elucidate the underlying mechanisms. In vivo, cardiac fibrosis was induced in C57BL/6 mice by subcutaneous injection of ISO, and the mice were treated with 4-HBA or a TGF-{beta} inhibitor. Assessments using echocardiography, histopathology, and Western blotting demonstrated that 4-HBA significantly alleviated ISO-induced cardiac dysfunction, reduced collagen deposition, and attenuated apoptosis in mice. Mechanistically, 4-HBA inhibited TGF-{beta} expression and Smad2/3 phosphorylation. In vitro, ISO was applied to cardiomyocytes (HL-1) and cardiac fibroblasts (MCFs), with or without 4-HBA or TGF-{beta} inhibitor intervention. The results showed that 4-HBA suppressed HL-1 apoptosis and fibroblast proliferation, and significantly reduced the expression of extracellular matrix genes, TGF-{beta} levels, and Smad2/3 phosphorylation in MCFs. These findings indicate that 4-HBA reduces myocardial injury while targeting the TGF-{beta}/Smad2/3 pathway to attenuate cardiac fibrosis, highlighting its potential as a therapeutic agent for fibrotic cardiomyopathy.

Background Atrial fibrillation (AF) is associated with declines in physical function. While physical activity is linked to better physical function in the general population, its long-term impact in people with AF remains unclear. Investigating this relationship could provide insights and inform interventions for this population. Methods 624 participants with AF from the Atherosclerosis Risk in Communities (ARIC) cohort assessed in 2011-2013 were studied. Physical activity was assessed using the modified Baecke Physical Activity Questionnaire. Physical function was measured using the Short Physical Performance Battery (SPPB), grip strength, and 4-meter walk time up to 3 times over an 8-year period, with 4-meter walk speed as a secondary outcome evaluated in supplemental analyses. Confounder-adjusted linear mixed models were used to assess associations between physical activity and change in physical function trajectories over time. Results Participants had a mean age of 78.5 {+/-} 5.4 years, with 52.6% males and 13.8% Black. Median follow-up was 6.6 years. At baseline, greater sport-related leisure time, non-sport leisure time, and total moderate-to-vigorous physical activity (MVPA) were cross-sectionally associated with better physical function. However, physical activity measures were not significantly associated with temporal trajectories in physical function over time. Conclusions In participants with AF, greater habitual physical activity was significantly associated with better baseline physical function but not with future trajectories. Randomized trials are needed to examine whether interventions that improve habitual physical activity or MVPA can improve physical functioning in individuals with AF.

Postoperative atrial fibrillation (POAF) is a frequent complication following cardiac surgery and has been associated with an increased risk of thromboembolic events. However, cardiac surgical populations are heterogeneous, and the long-term thromboembolic implications of POAF may differ according to the index surgical procedure. This systematic review and meta-analysis evaluated the procedure-specific association between POAF and long-term thromboembolic outcomes after adult cardiac surgery, with particular emphasis on coronary artery bypass grafting (CABG) and isolated valve surgery. PubMed and Scopus were searched from database inception through August 3, 2026. Studies reporting long-term thromboembolic outcomes in patients with new-onset POAF compared with patients without POAF were evaluated, with eligible evidence classified according to the index surgical procedure. Four observational studies were included in the primary quantitative synthesis, with two studies contributing to the CABG analysis and two to the isolated valve-surgery analysis. Adjusted hazard ratios (HRs) were pooled separately by procedure using inverse-variance methods, and a formal between-subgroup interaction test was performed. Following CABG, POAF was associated with an increased long-term thromboembolic hazard (pooled HR 1.147, 95% CI 1.053-1.249; I^2=0%). A stronger association was observed following isolated valve surgery (pooled HR 1.362, 95% CI 1.181-1.573; I^2=0%). The between-subgroup interaction was statistically significant ({chi}^2=4.10, P=0.043), providing exploratory evidence that the magnitude of the association may differ according to surgical procedure. These findings suggest that the long-term thromboembolic implications of POAF may not be uniform across cardiac surgical populations. However, because only two studies contributed to each procedure subgroup and the available evidence was observational, the interaction should be considered hypothesis-generating. Further adequately powered studies with standardized outcome definitions and procedure-specific reporting are required to confirm these findings and determine their implications for long-term risk stratification and anticoagulation strategies.

BackgroundCardiovascular disease risk is higher in men than in women. Although sex differences in aortic wall adaptation following antihypertensive treatment have been reported in acute hypertension models, the response after gradually developing hypertension, which mimics human essential hypertension, remains unclear. This study investigated sex differences in aortic wall adaptation following acute blood pressure reduction after gradually developing hypertension. MethodSeventeen-week-old spontaneously hypertensive rats (SHRs) were assigned to the Hypertensive group or the antihypertensive (Reversal) group (N = 5/sex each). The Reversal group received the antihypertensive drug captopril for 4 weeks to maintain systolic blood pressure below 130 mmHg. Age-matched Wistar Kyoto rats (N = 3/sex) served as normotensive (Normal) group. After the experimental period, arterial wall thickness, circumferential wall stress, smooth muscle cell phenotype, and histological changes were evaluated. ResultsAntihypertensive treatment significantly reduced systolic blood pressure in both sexes. Both male and female SHRs exhibited elevated circumferential wall stress during the gradual development of hypertension. In females, antihypertensive treatment significantly reduced medial thickness compared with the Hypertensive group, whereas males showed no reduction. Circumferential wall stress in female Reversal group did not differ significantly from either the Hypertensive or Normal group, whereas males exhibited a significant reduction in circumferential wall stress compared with the Hypertensive group. Furthermore, the reduced collagen area fraction in the Hypertensive group returned to the normotensive levels only in females following antihypertensive treatment. ConclusionThese findings indicate that vascular remodeling induced by gradually developing hypertension is more effectively reversed by antihypertensive treatment in females than in males.

Abstract Background: Most animal models of HCM are mouse-based, but the thin interventricular septum in mice makes it difficult to clearly distinguish pathological hypertrophy, which introduces substantial errors and constrains basic HCM research. Cats develop HCM spontaneously, and the common MYBPC3-A31P variant in cats is homologous to human mutations in both genetics and pathology, with a larger body size that makes them suitable as large-animal models. This study examines how heterozygosity or homozygosity for the p.A31P mutation (c.91G>C) in the MYBPC3 gene affects the phenotype and severity of HCM in affected cats, with the aim of establishing an ideal large-animal model for clinical risk stratification and precision diagnosis and treatment of human HCM. Methods: Forty-nine Maine Coon cats were enrolled and stratified into homozygous mutant (HOM, n=8), heterozygous mutant (HET, n=26), and wild-type (WT, n=15) groups. All cats underwent echocardiography, blood pressure measurement, physiological assessment, hematological and biochemical analyses, and cross-species sequence conservation analysis. Results: No significant differences in baseline characteristics including age and body weight were observed among groups (P>0.05). HOM cats exhibited significantly higher left ventricular outflow tract pressure gradients and greater basal septal thickness compared to WT cats (P<0.05), with HET cats showing intermediate values. Analysis of hematological and serum biochemical parameters revealed no evidence of systemic inflammation or hepatic injury. Sequence conservation analysis confirmed that the A31 residue is highly conserved across mammalian species. Conclusions: This study provides a phenotypic characterization of Maine Coon cats carrying the MYBPC3-A31P mutation, revealing marked gene-dose effects on cardiac structure and function, with homozygous individuals exhibiting more severe phenotypic features. This model serves as a large-animal translational platform that not only clarifies genotype-phenotype correlations but also supports risk stratification and precision therapeutic strategies in human HCM. Its spontaneous nature and genetic homology to human disease make it particularly valuable for bridging preclinical findings to clinical application.

Background: Pulmonary arterial hypertension (PAH) is a serious disease with poor prognosis, especially in infants or preterm babies and there is still no optimal treatment for this disease. Noradrenalin (NE) is a vasoactive mediator which is released by sympathetic ganglion. According to previous studies, NE/1-adrenoreceptors is not only in regulating normal physiologic responses, but also in the pathogenesis of PAH. However, the mechanisms of NE in PAH are not fully understood. Methods: Human PASMC (PASMC) was used in this study. Cell viability assay and Wound healing assay were used to evaluate the proliferation and migration of PASMC. Immunoprecipitation and western blots analysis were used to investigate the mechanisms which involved in NE-induced PASMC proliferation. Results: We investigated that NE could induce human PASMC proliferation and migration. Furthermore, we first find that endothelin 1 (ET-1) signaling pathway plays an important role in NE-induced PASMC proliferation. ET1 is a critical molecular which is known for regulating cell growth and migration. We investigated that NE could increase NE-1 secretion, further enhancing ET-1 bind to its receptors. For further clarifying the downstream signals in NE/ET-1 induced PASMC proliferation, we detected the phosphorylation and expression levels of ERK and JNK. Conclusions: By combining the results from ours and previous studies, we believed that JNK/c-jun pathway may play an important role in NE-induced PASMC proliferation. Key Words: Noradrenaline; Pulmonary Arterial Hypertension; Pulmonary Artery Smooth Muscle Cells; Endothelin-1; JNK/c-Jun Signaling.

Background: Electrocardiographic (ECG) markers of atrial cardiopathy (AC) are associated with stroke mortality, but whether this association is modified by blood pressure (BP) is unknown. Methods: We analyzed 7,191 adults free of cardiovascular disease from the Third National Health and Nutrition Examination Survey who underwent baseline ECG. AC was defined by three ECG markers: prolonged P-wave duration 120 ms), abnormal P-wave axis (<0{degrees} or >75{degrees}), and deep terminal negativity of the P wave in V1 (<100 V). AC burden (per additional AC marker) and AC presence (1 vs. 0 markers) were examined in relation to stroke mortality using Cox proportional hazards models. Participants were stratified by BP as normal/elevated (<130/80 mmHg), stage 1-2 hypertension (130-159/80-99 mmHg), or severe hypertension (160/100 mmHg). Interaction by BP category was assessed. Results: During a median follow-up of 13.8 years, 183 stroke deaths occurred. In multivariable adjusted model, AC burden was associated with a 41% higher risk of stroke mortality (HR (95%CI): 1.41 (1.13-1.77)). This association was significantly modified by BP (interaction P=0.003). The HRs (95% CIs) per additional AC marker were 0.88 (0.52-1.49), 1.39 (1.03-1.88), and 2.94 (1.82-4.75) for normal/elevated BP, stage 1-2 hypertension, and severe hypertension, respectively. A similar pattern of associations was observed for AC presence, although the interaction with BP was not statistically significant. Conclusions: ECG-defined AC burden was independently associated with stroke mortality, with substantially stronger associations among individuals with severe hypertension, supporting BP as an important modifier of its prognostic significance.

Background: Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTCA) has emerged as a novel non-invasive biomarker of coronary inflammation and cardiovascular risk. The degree to which PCAT reflects local or systemic inflammation remains uncertain. We hypothesized that the presence, location and extent of PCAT would be associated with transcoronary or transcardiac cytokine gradient. Methods: This prospective cohort study involved 31 adults with stable coronary artery disease who underwent clinically indicated CTCA within 90 days of invasive coronary angiography. Patients with acute coronary syndromes or unstable angina were excluded. Blood samples were obtained from peripheral vein, coronary sinus, aortic root, and right coronary artery at time of cardiac catheterization. Plasma interleukin-6 (IL-6) and interleukin-1{beta} (IL-1{beta}) concentrations from each site were used to calculate transcardiac and transcoronary cytokine gradients. PCAT attenuation was measured using semi-automatic software by readers blinded to clinical and biochemical endpoints. Results: Participants were predominantly male (76%), aged 66.6 {+/-} 9.4 years, with a high prevalence of hypercholesterolemia (76%), hypertension (73%), and diabetes (36%). Mean PCAT attenuation was -74.8 HU (RCA), -70.3 HU (LCx), and -73.6 HU (LAD). Regression analyses showed no significant associations between PCAT attenuation and IL-6 gradients across any coronary territory (all p >0.40; R2 {approx} 0), including in plaque-free subgroup analyses. IL-1{beta} was below the assay detection limit in 81% of participants; analyses using non-parametric testing and logistic no association with PCAT attenuation. RCA (OR 0.96, 95% CI 0.88-1.06, p=0.46), LCx (OR 1.00, 95% CI 0.91-1.09, p=0.94), LAD (OR 0.99, 95% CI 0.90-1.08, p=0.81). Conclusion: In a cohort with predominantly stable coronary disease, PCAT attenuation was not associated with intracardiac or intracoronary IL-6 or IL-1{beta} gradients, including in plaque-free vessels. These findings suggest that PCAT attenuation may not reflect active cytokine-mediated coronary inflammation in stable disease.

Background: Sex-related disparities in acute coronary syndrome (ACS) recognition and management remain a global health concern. We examined sex-based differences in clinical presentation, management, and outcomes among patients with chest pain attended by emergency medical services (EMS) across Brazil. Methods: We conducted a retrospective study using a registry from 14 Brazilian states between January 2020 and June 2024 within a private hospital network. Patients with chest pain were classified by cardiologists as unstable angina (UA), ST-elevation myocardial infarction (STEMI), or non-ST-elevation myocardial infarction (NSTEMI). Multivariable regression evaluated sex differences in diagnosis, treatment, and outcomes. Sensitivity analyses included state-clustered standard errors and E-values for unmeasured confounding. Results: Among 7,171 patients with confirmed ACS (68.2% male), median age was 63.0 years [IQR 20.0]; women were older than men (67.0 [20.0] vs 61.0 [19.0] years). Diagnoses were UA in 46.7%, STEMI in 18.8%, and NSTEMI in 34.6%. Overall, 91.7% received aspirin and 89.6% at least one additional antiplatelet agent. After adjustment, women had higher odds of chest pain classified as probably or possibly ischemic versus definitely ischemic (adjusted OR 1.51 [95% CI 1.33-1.72] and 1.60 [1.37-1.86], respectively) and lower odds of STEMI and NSTEMI relative to UA (adjusted OR 0.59 [0.51-0.68] and 0.74 [0.66-0.83], respectively). Door-to-ECG time was longer in women unadjusted ({beta}=1.53 minutes [0.24-2.82]) but not after adjustment ({beta}=1.04 [-0.27 to 2.36]). In-hospital mortality did not differ between sexes, with no evidence of excess short-term mortality in women. Conclusions: Within a private hospital network in Brazil, women with confirmed ACS were more often classified with less definitely ischemic chest pain and less frequently with STEMI or NSTEMI than men. Door-to-ECG differences did not persist after adjustment, and mortality did not differ by sex. These findings support sex-sensitive triage and diagnostic protocols to reduce inequities in ACS recognition and treatment.

Background: Obstructive hypertrophic cardiomyopathy (oHCM) causes substantial symptom burden and impaired functional capacity. Mavacamten has emerged as a targeted pharmacologic treatment, whereas alcohol septal ablation (ASA) is an established septal reduction therapy (SRT). Direct comparative real-world data remain limited. Methods: In this propensity-controlled observational study, longitudinal registry data from Heidelberg University Hospital were analyzed. Consecutive adults with oHCM, NYHA class ?II symptoms, and a maximum LVOT gradient ?50 mmHg treated with mavacamten or ASA were included. The cohort comprised 107 ASA- and 113 mavacamten-treated patients. Follow-up was performed at 6 and 12 months. The primary endpoint was a composite adverse clinical outcome including cardiovascular death, heart failure hospitalization, SRT, heart transplantation, ventricular assist device implantation, permanent pacemaker implantation for third-degree atrioventricular block, or decline in left ventricular ejection fraction to <40%. Results: Both treatments showed significant improvement in NYHA class and LVOT gradient reduction over 12 months. Mean LVOT gradient decreased from 100.3 to 44.2 mmHg after ASA and from 85.7 to 18.4 mmHg with mavacamten at 12 months (both p<0.001). Between-group differences were not significant at 6 months, whereas residual LVOT gradient was lower with mavacamten at 12 months (p=0.004). NT-proBNP declined in both groups and was lower with mavacamten at both follow-up visits (both p<0.001). Third-degree atrioventricular block occurred more frequently after ASA (6.5% vs 0%, p=0.002). The composite endpoint occurred in 13 ASA- (12.1%) and 4 mavacamten-treated patients (3.5%) (p=0.003), with higher 1-year event-free survival in the mavacamten group (HR 0.19; 95%-CI 0.06-0.60; p=0.001). Conclusions: In this real-world comparative study, both ASA and mavacamten improved symptoms and LVOT obstruction in oHCM. Mavacamten was associated with a more favorable short-term hemodynamic and safety profile at 12 months.

Background: Adults aged [&ge;]75 years represent a rapidly growing population at risk of acute myocardial infarction (AMI), yet they remain markedly underrepresented in statin trials for primary prevention. The limited evidence base, together with multimorbidity, functional heterogeneity, and competing mortality risks, has contributed to uncertainty regarding the potential role of statins in very old adults. This study evaluated the association between baseline statin exposure and incident AMI among community-dwelling adults aged [&ge;]75 years without prior cardiovascular disease. Methods: We conducted a retrospective population-based cohort study using linked primary-care, hospital, laboratory, and pharmacy dispensing data from the Community of Madrid. Statin exposure was ascertained during a 24-month exposure-assessment period from 1 January 2018 to 31 December 2019 and classified at a landmark date of 1 January 2020, when outcome follow-up began. Participants were classified as exposed if they had received at least two statin dispensations during the exposure-assessment period and had no record of prior lipid-lowering therapy before 2018. Individuals with prior cardiovascular disease, type 1 diabetes, cancer, dementia, or advanced chronic kidney disease were excluded. Missing data were addressed using multiple imputation. The association between baseline statin exposure and incident AMI was estimated using multivariable Cox proportional hazards regression. Propensity-score matching and Fine-Gray competing-risk regression, with all-cause mortality as the competing event, were performed as sensitivity analyses. Results: Among 174,014 individuals included in the final cohort, 32,698 (18.8%) met the criteria for baseline statin exposure. The mean age was 82.5 years. During a median follow-up of 5 years, AMI occurred in 533 (1.63%) statin-exposed individuals and 2722 (1.93%) non-exposed individuals (p=0.0003). The observed absolute risk difference was 0.30 percentage points (95% CI, 0.14-0.45), corresponding to an estimated observational number needed to treat of 338 over 5 years (95% CI, 222-708). In the fully adjusted Cox model, baseline statin exposure was associated with a lower risk of incident AMI (HR, 0.805; 95% CI, 0.731-0.887). In the full-cohort Fine-Gray model accounting for competing mortality, baseline statin exposure remained associated with a lower cumulative incidence of AMI (sHR, 0.823; 95% CI, 0.748-0.905). After propensity-score matching, the association remained in the competing-risk analysis (subdistribution HR, 0.852; 95% CI, 0.738-0.983). Conclusions: In this large population-based cohort of adults aged [&ge;]75 years without prior cardiovascular disease, baseline statin exposure was associated with a lower incidence of AMI across several analytical approaches. The observed absolute risk difference was modest, and the findings should be interpreted in light of the observational design, residual confounding, and the potential for selection related to survival to the landmark date. Further randomized evidence is needed to determine whether this association reflects a causal effect of statin therapy in very old adults. Keywords: Statins; primary prevention; acute myocardial infarction; aged [&ge;]75 years; landmark analysis; competing risks; propensity-score matching; real-world data.

BACKGROUND The optimal antiplatelet regimen in patients with acute coronary syndrome (ACS) and multivessel disease undergoing drug-coated balloon (DCB) angioplasty remains unclear. METHODS This was a prespecified subgroup analysis of the REC-CAGEFREE II trial, which was conducted at 41 sites in China and randomized 1948 exclusively DCB-treated participants with ACS to stepwise dual antiplatelet therapy (DAPT) de-escalation or standard DAPT. The primary endpoint was net adverse clinical events (NACE; including all-cause death, stroke, myocardial infarction, revascularization, and BARC type 3 or 5 bleeding) at 12 months. Participants were stratified into multivessel and single-vessel subgroups according to angiographic characteristics. RESULTS Overall, 720/1948 (37.0%) patients had multivessel disease. The multivessel subgroup was associated with a significantly higher risk of NACE compared with the single-vessel subgroup (12.5% versus 6.7%, HR IPTW:1.84, 95%CI:1.35-2.51, P<0.001). No significant interaction was observed between vessel status (multivessel or single-vessel) and treatment allocation with respect to NACE (Pinteraction=0.542). In the multivessel subgroup, NACE occurred in 44/368 (12.1%) and 45/352 (12.9%) in the stepwise de-escalation and standard DAPT groups (HR IPTW:0.95, 95%CI:0.62-1.75, P=0.818), respectively. In the single-vessel subgroup, NACE occurred in 43/607 (7.1%) and 39/621 (6.3%) in the stepwise de-escalation and standard groups (HR IPTW:1.12, 95%CI:0.72-1.70, P=0.611), respectively. For the prespecified hierarchical secondary endpoint, win ratio analyses yielded more wins for stepwise de-escalation in both subgroups. CONCLUSIONS Among patients with ACS undergoing DCB-only angioplasty, those with multivessel disease were associated with a higher risk of NACE than those with single-vessel disease. Stepwise DAPT de-escalation and standard DAPT exhibited similar risk-benefit profiles in both subgroups.

Aims: Arrhythmogenic cardiomyopathy (ACM) is a genetic disease defined by arrhythmias and myocardial fibrosis with impaired cardiac function and increased risk of sudden cardiac death. Pathogenic variants are mostly identified in desmosomal genes such as desmoglein-2 (DSG2). We identified a novel disease phenotype in patients homozygous for the DSG2 variant c.523+2T>C (splice site of exon 5/intron 5), characterized by cardioembolic events in addition to classical ACM features. Here, we evaluate this new thromboembolic phenotype by comparing the clinical data to specific murine disease models. Methods and Results: We describe three unrelated patients presenting with an embolic event and/or left ventricular thrombus. Clinical evaluation revealed a shared right ventricular ACM phenotype characterized by arrhythmias, impaired function, and fibrotic remodeling. In addition, patients exhibited localized fibrotic changes of the left ventricular apex with formation of an aneurysm and predisposition to thrombus formation. Genetic analysis identified the DSG2 variant c.523+2T>C as a founder variant from the "Bernese Oberland". To elucidate the variant's functional impact, a mouse model deficient for Dsg2 exon 5 (Dsg2{Delta}ex5) was established and compared to a model carrying the adhesion-deficient Dsg2-W2A variant. Echocardiography, ECG, and histology in Dsg2{Delta}ex5 mice revealed similar disease patterns to patients and a loss of DSG2 expression. Importantly, these animals exhibited left apical fibrosis with aneurysm formation and left ventricular thrombus formation. In contrast, the Dsg2-W2A model presented with a biventricular ACM-phenotype but without left ventricular thrombi. Conclusions: We identified a novel ACM phenotype in patients homozygous for the DSG2 founder variant c.523+2T>C characterized by left ventricular apical fibrosis. Dsg2{Delta}ex5 mice recapitulate the patients' phenotype suggesting a causative link between left ventricular aneurysm due to DSG2 deficiency and thrombus formation with subsequent embolism. This highlights a novel pathological feature of ACM and the need for variant and phenotype-specific therapy.

Left ventricular hypertrophy, common in cardiometabolic and renal disease, is a major risk factor for cardiovascular morbidity and mortality. Left ventricular mass is a highly heritable, polygenic trait. Linkage studies in WKY and SHRSP rats have identified a quantitative trait locus for left ventricular mass index on chromosome 14. Congenic strains, where trait-associated genetic loci are introduced into a control strain, can identify causal genetic mediators relevant to human disease. Chromosome 14 congenic (WKY.SPGla14a), WKY, and SHRSP strains underwent cardiac phenotyping and transcriptome profiling at; 1-3 days (neonate), 5 weeks, and 16-weeks. Compared to WKY, LVMI was significantly increased in SHRSP and WKY.SPGla14a at 5 weeks (LVMISHRSP-WKY=0.26g/kg, LVMIWKY.SPGla14a-WKY=0.30g/kg), prior to measured hypertension in this model. SHRSP blood pressure was significantly greater than WKY.SPGla14a, and WKY from 12-20 weeks (AUCdiff=497 vs WKY, AUCdiff=412 vs WKY.SPGla14a). Cardiac transcriptome analysis of neonate, 5-week, and 16-week hearts identified significantly increased expression of secreted phosphoprotein 1 (Spp1/osteopontin) in SHRSP and WKY.SPGla14a compared to WKY, which is positioned within the transferred congenic region. Overexpression of Spp1 mRNA significantly increased H9c2 cell size and was shown to be transferred in small extracellular vesicles (sEV). Overexpression of Spp1 in neonatal chromosome 14 congenic and SHRSP strains preceded development of increased cardiac mass and onset of hypertension. The congenic strategy identified Spp1 as a positional and functional candidate gene determining increased LVMI in the SHRSP model of human cardiovascular disease.

Background: A dose finding trial evaluated safety and adherence for pre-cardiac surgery administration of sodium valproate. Integrated multi-omics analyses of myocardium were used to characterise mechanisms underlying the treatment effects. Methods: Adults undergoing cardiac surgery were randomised 1:1:1:1 with concealed allocation to no treatment (Controls), sodium valproate 15mg/kg/day for 1-2 weeks, 15mg/kg/day for 4-6 weeks, or 25mg/kg/day for 4-6 weeks pre-surgery. The primary analysis evaluated adherence and toxicity. Myocardial injury was defined by high sensitivity serum troponin at 24 hours post-surgery. Single-nucleus Assay for Transposase-Accessible Chromatin with sequencing (snATACseq) and single nuclei RNA sequencing (snRNAseq) of myocardial biopsies collected at surgery assessed treatment effects on chromatin accessibility and gene expression. Candidate mechanisms were validated in in vitro. Results: The analysis cohort included 42 participants enrolled between January 2020 and August 2024. Non-compliance (38%) was highest with longer and higher dosing. Sodium valproate 15mg/kg/day for 1-2 weeks had the highest levels of complete treatment adherence (70%), with 20% experiencing moderate/severe drug related adverse effects. An as-treated analyses demonstrated reductions in troponin release in participants receiving Valproate[&le;]14 days. Myocardial biopsies from trial participants demonstrated activation of hormetic p53 and Akt-GSK-3{beta} ferroptosis protection pathways. Treatment effects were not attributable to chromatin accessibility. Treatment >14 days resulted in a heart failure phenotype with suppression of ferroptosis protection pathways, endothelial mesenchymal transition, and increased myocardial injury. Conclusions: Sodium valproate 15mg/kg/day for [&le;]14 days pre-surgery is well tolerated in adults awaiting cardiac surgery. This treatment was associated with upregulation of ferroptosis protection pathways and reductions in myocardial injury.

Background: High-sensitivity cardiac troponin (hs-cTn) assays enable safe early discharge of patients at very low risk for myocardial infarction. We previously developed a single-sample rule-out pathway using the ARCHITECT hs-cTnI assay to risk stratify patients with suspected acute coronary syndrome. In a secondary analysis of the POC-ET (Point of Care Evaluation of High-sensitivity Cardiac Troponin) study, we evaluated performance of risk stratification with the Alinity hs-cTnI assay. Methods: Patients presenting with possible myocardial infarction in the POC-ET (NCT05665127) study were included. The primary outcome was type 1, 4b or 4c myocardial infarction or cardiac death at 30 days. Cardiac troponin I (cTnI) was measured in stored materials using the ARCHITECT and Alinity hs-cTnI assays. The sex-specific 99th percentile upper reference limit (URL) are 34 ng/L in men and 16 ng/L in women for both assays. Agreement was assessed with Bland-and-Altman limit of agreement method, Passing Bablok regression, and Pearson's correlation coefficient. Distributions of presentation measurements were compared with Kolmogorov-Smirnov test. Performance was evaluated in the overall population and prespecified subgroups. The negative predictive value (NPV) and sensitivity were determined and proportion of patients identified as low, intermediate, and high risk were calculated and modelled using ordinal logistic regression. Results: In 986 patients (60 [51-70] years, 38% female), 78 (7.9%) had a primary outcome. Strong agreement was found in the raw cTnI measurements (99% samples within the Bland-Altman limit of agreement; correlation coefficient r: 0.967 (95% CI 0.964-0.969, P<0.001); Passing Bablok regression: slope 1.12 [1.11-1.13], intercept -0.16 [-0.18 to -0.13]). At presentation, distributions of cTnI measurements by the two assays were similar (P=0.810). Both assays showed comparable diagnostic performance using a risk stratification threshold of <5 ng/L and the sex-specific diagnostic threshold, with the same NPV (Alinity 100 [99.7-100]% versus ARCHITECT 100 [99.7-100]%) and sensitivity (Alinity 100 [97.3-100]% versus ARCHITECT 100 [97.3-100]%). Similar proportions of patients stratified as low- (Alinity 67% versus ARCHITECT 67%), intermediate-risk (23% versus 24%) and high-risk (10% versus 9%) at presentation with minor reclassification. Similar efficacy was observed across subgroups stratified by sex, age, history of myocardial infarction, renal function, and symptom duration. Conclusions: The Alinity hs-cTnI and the ARCHITECT hs-cTnI assays can be used interchangeably in the assessment of suspected myocardial infarction with comparable safety and efficacy.

Background: Preoperative risk assessment in vascular surgery relies on clinical scores and lipids that do not capture atherosclerotic disease activity. Circulating fatty acid synthase (cFAS) is a liver-derived enzyme whose concentration correlates with arterial plaque FAS content independent of LDL. The 5-item modified frailty index (mFI-5) is a validated predictor of postoperative mortality. Whether cFAS predicts outcomes after vascular surgery, and whether combining it with the mFI-5 improves risk discrimination, have not been examined. Methods: We studied 657 patients undergoing elective vascular surgery at a single center (2014 to 2023). cFAS was classified as non-detectable (n = 306) or, among detectable values, by tertiles (n = 117 each). Multivariable Cox models assessed associations with major adverse events (MAE), major adverse cardiovascular events (MACE), major adverse limb events (MALE), reintervention, and mortality, and Harrell's C-statistic quantified the incremental discrimination gained by adding cFAS and the mFI-5 to standard clinical covariates. Results: High serum cFAS was independently associated with 5-year MAE (adjusted hazard ratio [aHR] 1.94; 95% CI 1.31- 2.85), mortality (aHR 1.77; 1.05 to 3.00), MALE (aHR 4.53; 2.04 to 10.05), and reintervention (aHR 2.50; 1.37 to 4.57), but not MACE. Severe frailty (mFI-5 of 3 or higher) was associated with MACE (aHR 2.69; 1.29 to 5.58) and MAE (aHR 2.46; 1.30 to 4.65) but not limb endpoints at 1 year. Adding cFAS raised the 1-year MALE C-statistic from 0.649 to 0.764; the combined model yielded the highest discrimination. Conclusions: cFAS and mFI-5 were independently and additively associated with adverse outcomes after elective vascular surgery. cFAS was associated with limb events and mortality, the mFI-5 with cardiovascular events. Combining them improved discrimination over standard covariates.

Background: Spontaneous coronary artery dissection (SCAD) causes acute coronary syndrome that predominantly affects women. It is not known why SCAD occurs in specific coronary artery segments. We aimed to identify anatomical and hemodynamic factors that lead to SCAD. Methods: We studied 36 women with angiographically-confirmed SCAD from more than 20 hospital sites and 75 sex- and ethnicity-matched control participants with normal coronary anatomy. Coronary arteries were reconstructed from computed tomography coronary angiography (CTCA) to quantify vessel geometry (curvature, diameter, torsion) and flow-derived metrics (time-averaged endothelial shear stress [TAESS], topological shear variation index [TSVI], oscillatory shear index [OSI], and relative residence time [RRT]) at the tree (left/right), territory (LAD, LCx, RCA), and lesion levels. Results: Compared with controls, SCAD-affected coronary arteries had greater curvature and higher TAESS and TSVI at the whole-tree level (all p?0.007). At the vessel (territory) level, SCAD-affected arteries were smaller in average diameter and showed higher curvature, TAESS, and TSVI than matched control vessels (all p?0.047). Within the same patient, SCAD lesion segments were characterized by smaller diameter, lower torsion, and higher TAESS and TSVI than non-affected segments from the same coronary tree (all p?0.001; curvature borderline). A model combining curvature, TAESS, and TSVI discriminated SCAD from controls with AUC 0.95 (left tree) and 0.97 (right tree); adding diameter yielded AUCs >0.91 at the territory level. Conclusions: SCAD was associated with a reproducible multi-scale signature of smaller vessel caliber and higher, more variable endothelial shear stress supporting a hemodynamic contribution to SCAD clustering in specific coronary arteries and segments.

Purpose: Comorbid restless legs syndrome (RLS) and obstructive sleep apnea (OSA) -(COROSA)- is poorly characterized in African populations. We estimated its prevalence and correlates in a population-based sample in Benin. Methods: This was a cross-sectional analysis of 1,810 adults aged [&ge;]25 years from the Benin Society and Sleep (BeSAS) study. RLS was defined by International RLS Study Group criteria and OSA by an apnea-hypopnea index [&ge;]5 events/h on home respiratory polygraphy; COROSA required both. Correlates were assessed by multivariable logistic regression; multinomial models compared COROSA with OSA only, RLS only, and neither disorder. An exploratory analysis examined hypertension across eight mutually exclusive sleep-disorder groups, including comorbid insomnia, RLS and OSA (COMIROSA). Results: COROSA prevalence was 3.5% (95% CI 2.7-4.4). Independent correlates were age 40-59 years (aOR 2.91, 95% CI 1.38-6.73), age [&ge;]60 years (aOR 3.76, 1.61-9.35), rural residence (aOR 10.54, 4.94-25.43), overweight (aOR 2.29, 95% CI: 1.16-4.49), obesity (aOR 3.83, 95% CI: 1.75-8.31), and insomnia (aOR 2.49, 1.37-4.50). Relative to OSA only, COROSA was associated with hypertension and insomnia; relative to RLS only, obesity was the main distinguishing factor. Hypertension was associated with COROSA and COMIROSA, with a larger estimate for COMIROSA (aOR 4.03 vs 2.64). Conclusion: COROSA affected 3.5% of adults in Benin and co-occurred with obesity, hypertension and insomnia. Screening for overlapping sleep disorders may improve identification of high-risk individuals. COMIROSA remains a hypothesis requiring validation in larger longitudinal studies.

Background: Ticagrelor and prasugrel are recommended P2Y12 inhibitors for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), yet uncertainty persists regarding their direct comparative evidence and guideline recommendations differ. Methods: We conducted a multinational retrospective new-user cohort study across 7 claims and electronic health record databases. Adults with ACS undergoing first PCI who initiated ticagrelor or prasugrel were included; patients with prior major ischemic or hemorrhagic events or oral anticoagulant use were excluded. The primary outcome was 1-year major adverse cardiovascular events (MACE: all-cause mortality, acute myocardial infarction, or stroke). Secondary outcomes included net adverse clinical events (NACE) and individual components. Propensity scores were estimated using large-scale L1-regularized logistic regression and applied through stratification. Prespecified diagnostics (covariate balance, empirical equipoise, and systematic error) determined eligibility of each database for inclusion in meta-analysis. Database-specific hazard ratios (HRs) were combined using Bayesian random-effects meta-analysis. Results: Among 7 participating databases, 3 met prespecified diagnostic criteria and were included in the primary meta-analysis, comprising 133,718 patients from one nationwide Korean claims database and two U.S. commercial claims databases (ticagrelor, 109,639; prasugrel, 24,079). For 1-year MACE, the pooled HR for ticagrelor versus prasugrel was 1.28 (95% credible interval [CrI], 0.89-1.88), with substantial between-database heterogeneity. Sensitivity analyses across alternative time-at-risk definitions and propensity score matching were consistent. No statistically credible differences were observed for NACE (HR 1.23, CrI 0.88-1.75), all-cause mortality (HR 1.17, CrI 0.78-1.77), cardiovascular mortality (HR 1.23, CrI 0.81-1.87), ischemic events (HR 1.28, CrI 0.88-1.90), hemorrhagic events (HR 1.01, CrI 0.72-1.39), acute myocardial infarction (HR 1.30, CrI 0.88-1.94), stroke (HR 1.09, CrI 0.73-1.58), or gastrointestinal bleeding (HR 1.04, CrI 0.77-1.41). In a post hoc meta-analysis restricted to the two U.S. databases, the pooled HR for 1-year MACE was 1.49 (95% CrI 1.05-2.10). Conclusions: In this pre-specified multinational observational study, no statistically credible difference in 1-year MACE was observed between ticagrelor and prasugrel in patients with ACS undergoing PCI. However, substantial cross-database heterogeneity warrants further investigation into context-specific comparative effectiveness and safety.