Frontiers in Physiology

Background: Pressure volume (PV) loop analysis remains the gold standard for assessing the intrinsic global diastolic properties of the left ventricle (LV). Traditional fitting techniques rely on local, phase-constrained fittings and are limited due to their sensitivity to noise, landmark selection, violation of assumptions, and non-convergence. Objective: To develop and validate DIAPINN, a physics-informed neural network (PINN) framework capable of calculating intrinsic diastolic properties of ...

Background and AimsAccurate classification of mitral stenosis (MS) remains a significant clinical challenge. This study aimed to develop an artificial intelligence (AI) framework to automatically detect clinically significant MS from echocardiography. MethodsWe developed EchoNet-MS, an open-source end-to-end integrated approach combining video based convolutional neural networks to assess MS severity and differentiate rheumatic etiology from echocardiography and validated its performance across...

BackgroundKetone bodies have shown potential to improve cardiac metabolism and function in patients with heart failure (HF). ObjectiveTo evaluate the effects of exogenous ketone-based interventions on cardiac function in patients with HF or related cardiometabolic risk factors. MethodsWe conducted a systematic review based on a search of MEDLINE, EMBASE, CINAHL, Cochrane Library, and Scopus from inception to January 2025. Eligible studies included randomized controlled trials evaluating exogen...

Nocturnal glucose regulation is modulated by autonomic and circadian mechanisms, yet their dynamic interplay in apparently healthy, free-living populations remains poorly studied. Here, we assessed 227,860 nights of concurrent sleep data from Ultrahuman AIR ring and M1 continuous glucose monitoring (CGM) system across 5849 adults globally to examine nocturnal cardio-metabolic coupling. We found that higher sleep consistency was inversely associated with glucose variability, and vice versa. Unsup...

RationaleAutonomic dysfunction is a hallmark of sepsis pathophysiology, yet its quantification remains challenging. Multiscale entropy (MSE) derived from heart rate variability (HRV) offers a dynamic measure of physiological complexity and may serve as a biomarker of early deterioration associated with subsequent organ failure, vasopressor escalation, or mortality. ObjectiveTo determine whether MSE computed across multiple temporal scales during the first 24 hours of Intensive Care Unit (ICU) a...

BackgroundAcute myocarditis is typically self-limiting and resolves spontaneously in most cases. However, ventricular arrhythmias (VA) complications, which may be life-threatening are associated with higher rates of in-hospital complications and mortality. Catheter ablation is occasionally required for acute myocarditis associated ventricular tachycardia (VT), but data on its procedural use and outcomes, in this setting, remain limited. We aimed to determine the prevalence of VA among patients h...

Background: Acute heart failure (AHF) exhibits marked heterogeneity in diastolic hemodynamics, yet comprehensive echocardiographic assessment of diastolic function (DF) and filling pressure (FP) is often infeasible. We evaluated whether artificial intelligence-enabled electrocardiography (AI-ECG) could provide scalable DF grading and FP estimation in hospitalized AHF patients. Methods: We retrospectively studied adults hospitalized for AHF across Mayo Clinic sites (2013-2023) who received 1 dose...

BACKGROUNDPeak oxygen uptake (pVO2) is a strong, independent predictor of adverse cardiovascular outcomes, supporting cardiopulmonary exercise testing as a primary end point assessing efficacy of novel drug therapies in obstructive hypertrophic cardiomyopathy (oHCM) clinical trials. However, characterizing changes in pVO2 that patients perceive as beneficial or meaningful (ie, minimal important difference [MID]) has not been determined. METHODSData from patients with symptomatic oHCM enrolled i...

BACKGROUNDVisit-to-visit blood pressure variability (VVV BPV) is an important yet underutilised risk factor for cardiovascular disease (CVD) risk prediction. Incorporating VVV BPV in the model predicting CVD could improve its performance. This study aims to incorporate VVV BPV into a CVD risk prediction model and to evaluate its performance by comparing the discrimination and calibration of models using a single BP measurement versus those incorporating VVV BPV METHODSThis prospective cohort st...

BackgroundInhaled combusted cannabis and co-use of combusted cannabis and nicotine electronic cigarettes (nECIGs) are on the rise, yet their long-term cardiovascular risk is unclear due to the high prevalence of confounders in observational human studies. Using primary plasma and monocytes and a novel ex vivo mechanistic model of two early steps in atherogenesis, this study examined whether chronic combusted cannabis use is associated with atherogenic changes, as estimated by 1) monocyte transen...

Background and AimsDespite advances in reperfusion and medical therapy, survivors of acute myocardial infarction (AMI) remain at risk for adverse left ventricular remodeling (LVR), a precursor to heart failure. Building on prior work outlining 12-month biomarker trajectories linked to early ventricular dysfunction, we aimed to assess whether these circulating biomarkers predict long-term adverse LVR. MethodsWe prospectively enrolled 155 patients experiencing their first AMI. Clinical, biochemic...

BackgroundCardiac surgery significantly improves clinical endpoints but imposes challenges in postoperative recovery. Assessing patient-reported outcome is crucial for optimal care. However, no cardiac surgery-specific tools currently exist to adequately capture postoperative recovery experience. ObjectivesTo develop and validate a recovery scale after cardiac surgery (Fuwai-CRS). MethodsThis study was conducted from May 2023 to December 2024, comprising: (1) a qualitative study (Cohort 1) enr...

ObjectivesTo identify unique echocardiographic signatures associated with TTR+ carrier status preceding onset of cardiac amyloidosis. BackgroundCarrier status for the most common pathogenic TTR variant in the United States, Val142Ile (V142I), found in 4% of African Americans (AA) and 1% of Hispanic/Latino (H/L) individuals, confers a 40-60% lifetime risk of developing variant transthyretin amyloidosis (ATTRv), including cardiac amyloidosis (CA) and heart failure (HF). Myocardial amyloid deposit...

PurposeDespite strong evidence, real-world adoption of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains suboptimal. The Get With The Guidelines-Heart Failure (GWTG-HF) program was designed to close gaps in care. We evaluated whether hospital participation in GWTG-HF is associated with greater GDMT intensity and improved outcomes. MethodsWe conducted a retrospective analysis (2013-2021) of Medicare beneficiaries with Part A and Part D hos...

As of early 2026, over 115 million US adults (more than 1 in 3) have prediabetes, a condition with an annual conversion rate of 5%-10% to type 2 diabetes. Total diabetes (diagnosed and undiagnosed) affects approximately 40.1 million Americans, or 12% of the population, with roughly 1.5 million new cases diagnosed annually. Continuous Glucose Monitoring (CGM) provides real-time, 24/7 insights into glycemic variability, detecting dangerous highs, lows, and trends that HbA1c (a 3-month average) mis...

BackgroundHypertension affects over 30% of adults and is the leading risk factor for cardiovascular disease. It often presents without obvious symptoms, meaning that, although effective therapies exist, hypertension remains widely undiagnosed and insufficiently treated. Genomics-based prediction methods have shown only modest benefits for these disorders, but proteomic markers have demonstrated potential for greater predictive and clinical value. MethodsWe applied a novel machine-learning based...

Background and aims Iron deficiency (ID) and myocardial iron depletion (MID) are causally linked to heart failure (HF) in the general population and in preclinical models. ID is common amongst pregnant women, but its impact on cardiac adaptations to pregnancy is unknown. This study examines that impact, and its potential relevance to peripartum cardiomyopathy (PPCM). Methods. We provided female mice with iron-replete or iron-deficient diets, and monitored cardiac function and morphology longitud...

ObjectivesVisit-to-visit blood pressure variability (VVV BPV) is an underutilised risk factor for cardiovascular disease (CVD). This study aims to determine the minimum number of BP measurements needed and to identify cut-off values for the standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of systolic and diastolic VVV BPV to predict CVD risk in primary care. MethodsWe analysed data from the electronic practice-based research network (ePBRN) in Southwest...

BackgroundEvolocumab promotes coronary plaque regression in patients with coronary artery disease, but little is known regarding carotid plaques (CP). This study aimed to evaluate the impact of evolocumab on top of lipid-lowering therapy (ELLT) on carotid morphological stabilization (MS) and plaque regression (PR) compared to lipid-lowering therapy (LLT) alone. MethodsAsymptomatic patients with internal carotid stenosis[≥]50% and LDL-C[≥]100 mg/dL were randomized to ELLT or LLT and monito...

BackgroundAnthracyclines are central to childhood cancer therapy but predispose patients to cardiotoxicity leading to long-term cardiovascular risk. Endothelial injury and impaired repair contribute to this, yet pediatric data remain limited. ObjectiveTo longitudinally assess endothelial injury and repair in childhood cancer patients treated with anthracyclines by quantifying circulating endothelial cells (CECs) and endothelial progenitor cells (EPCs). MethodsIn a single-centre retrospective c...