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Tag: Cardiovascular Medicine

  • IL1R2 tracks vascular endothelial changes in Kawasaki disease

    What the study found

    The study found that IL1R2, a gene involved in immune signaling, was downregulated in acute Kawasaki disease and elevated in convalescence. It also found that Kawasaki disease peripheral blood mononuclear cells were associated with impaired human umbilical vein endothelial cell viability and migration.

    Why the authors say this matters

    The authors conclude that these findings may improve understanding of peripheral blood mononuclear cells and peripheral blood mononuclear cell–endothelial cell co-cultures in Kawasaki disease. They present IL1R2 as a key hub gene related to vascular endothelial function in this condition.

    What the researchers tested

    The researchers analyzed RNA sequencing data from peripheral blood mononuclear cells in 12 acute Kawasaki disease patients and 12 healthy controls to identify differentially expressed mRNAs and hub genes. They then validated selected genes in 20 Kawasaki disease patients with coronary artery lesions, 20 without coronary artery lesions, and 40 healthy controls, and used co-cultures of peripheral blood mononuclear cells with human umbilical vein endothelial cells followed by real-time PCR, ELISA, and functional assays.

    What worked and what didn't

    The RNA sequencing analysis identified 6,039 differentially expressed mRNAs, including 2,267 upregulated and 3,772 downregulated. Thirty hub genes were selected, and IL1R2, FCGR1A, and CD177 showed the reported expression changes across acute Kawasaki disease, Kawasaki disease with coronary artery lesions, and convalescence. The study also reported that Kawasaki disease peripheral blood mononuclear cells significantly impaired endothelial cell viability and migration.

    What to keep in mind

    The abstract does not describe long-term follow-up or clinical outcomes beyond the groups tested. It also does not provide detailed limitations of the study in the available summary.

    • IL1R2 was downregulated in acute Kawasaki disease and elevated in convalescence.
    • FCGR1A and CD177 showed opposite expression patterns across disease stages and coronary artery lesion status.
    • Peripheral blood mononuclear cells from Kawasaki disease were linked to reduced endothelial cell viability and migration.
    • The RNA sequencing screen found 6,039 differentially expressed mRNAs.
    • Thirty hub genes were selected from the sequencing analysis.

  • Dipyridamole with immunoglobulin and aspirin showed better outcomes in Kawasaki disease

    What the study found

    The meta-analysis found that dipyridamole combined with immunoglobulin and aspirin was associated with better clinical outcomes than immunoglobulin combined with aspirin alone in children with Kawasaki disease. The safety of the two approaches appeared comparable.

    Why the authors say this matters

    The authors conclude that the findings suggest a more effective treatment option for Kawasaki disease in children. They also indicate that this approach has comparable safety to the comparison treatment.

    What the researchers tested

    The researchers systematically reviewed randomized controlled trials comparing dipyridamole plus immunoglobulin and aspirin versus immunoglobulin plus aspirin in children with Kawasaki disease. They searched PubMed and several Chinese databases, then pooled the data with RevMan 5.3.

    What worked and what didn't

    Eighteen randomized controlled trials involving 1,594 patients were included. The observation group had a higher total effective rate and lower time to clinical symptom improvement, C-reactive protein, erythrocyte sedimentation rate, platelet count, coronary artery lesion rate, and fibrinogen levels; there was no significant difference in adverse reactions.

    What to keep in mind

    The summary does not provide details on the individual trial quality beyond noting that quality assessment was performed. The conclusions are based on the included randomized controlled trials and the outcomes reported in the abstract.

    • 18 randomized controlled trials with 1,594 patients were included.
    • Dipyridamole plus immunoglobulin and aspirin had a higher total effective rate than the comparison treatment.
    • Several clinical and laboratory measures were lower in the dipyridamole group, including CRP, ESR, platelet count, coronary artery lesion rate, and fibrinogen.
    • No significant difference in adverse reactions was reported between groups.
    • The authors conclude the combination treatment was superior in efficacy with comparable safety.

  • Pregnant women with autoimmune disease showed altered left ventricular myocardial work

    What the study found

    The study found signs of subclinical left ventricular dysfunction in pregnant women with autoimmune diseases. Apical constructive work was consistently reduced in this group.

    Why the authors say this matters

    The authors conclude that myocardial work, especially apical constructive work, provides incremental value over global longitudinal strain, a standard measure of how the heart muscle shortens, in autoimmune pregnancies.

    What the researchers tested

    The researchers evaluated left ventricular myocardial work using left ventricular pressure-strain loops, which combine heart pressure and strain measurements. They studied 96 participants: pregnant women with autoimmune diseases, non-pregnant patients with autoimmune diseases, and healthy pregnant women, using echocardiography, two-dimensional speckle-tracking, and myocardial work analysis.

    What worked and what didn't

    After adjustment, the pregnant autoimmune group had increased left ventricular volume and lower apical constructive work than the non-pregnant autoimmune group, while global myocardial work indices were similar. Compared with healthy pregnant women, they had lower E/A, increased left ventricular volumes, higher E/e', and higher peak strain dispersion; after adjustment, they also had lower global work index, global constructive work, global work efficiency, and apical constructive work, with peak strain dispersion still higher.

    What to keep in mind

    The abstract does not describe longer-term outcomes or clinical follow-up. The study was conducted at one hospital and included 96 participants, so the available summary does not show how broadly the findings apply.

    • Pregnant women with autoimmune diseases showed subclinical left ventricular dysfunction.
    • Apical constructive work was consistently lower in the pregnant autoimmune group.
    • Compared with healthy pregnant women, the group had worse several myocardial work and echocardiographic measures.
    • Global myocardial work indices were similar between pregnant and non-pregnant autoimmune patients before adjustment.
    • The authors say myocardial work may add value beyond global longitudinal strain.

  • Offspring of mothers with CHD had higher CHD incidence

    What the study found

    The study found that 16 of 198 infants, or 8.1%, were diagnosed with congenital heart disease (CHD, a heart defect present from birth). Most of the detected defects were non-critical, and the most common diagnosis was ventricular septal defect.

    Why the authors say this matters

    The authors conclude that these findings provide context for prenatal counselling and for tailored fetal and neonatal echocardiography screening (ultrasound imaging of the heart before and after birth) in this high-risk population.

    What the researchers tested

    The researchers did a single-centre retrospective review of patients with CHD who received prenatal care at a multidisciplinary Cardio-Obstetrics clinic at a southeastern U.S. academic medical centre from 2015 to 2023. They excluded patients with acquired heart disease, syndromic or inherited CHD, and deliveries at outside hospitals with missing delivery data. The main outcome was infant CHD confirmed by postnatal echocardiography.

    What worked and what didn't

    CHD was confirmed in 16 infants. Among the affected infants, none needed early in-hospital cardiac surgery, and one died in hospital; that infant also had severe extracardiac anomalies concerning an underlying genetic syndrome. Secondary outcomes included neonatal intensive care unit admission, early in-hospital cardiac surgery, and in-hospital infant mortality.

    What to keep in mind

    This was a retrospective, single-centre study, so the findings reflect one clinical setting. The abstract does not provide additional limitations beyond the exclusions described in the methods.

    • CHD was diagnosed in 16 of 198 infants born to mothers with CHD.
    • The CHD incidence in this cohort was 8.1%.
    • The most common defect reported was ventricular septal defect.
    • No affected infants required early in-hospital cardiac surgery.
    • One infant died in hospital, and that infant had severe extracardiac anomalies concerning a genetic syndrome.

  • Non-obstetric SCAD showed mortality and treatment disparities

    What the study found

    Non-obstetric spontaneous coronary artery dissection, or SCAD, was associated with low but clinically significant in-hospital mortality in this U.S. hospital cohort. The study also found differences in treatment and outcomes by sex and race.

    Why the authors say this matters

    The authors conclude that the findings underscore the need for standardized management strategies and equitable cardiovascular care delivery. The study suggests that persistent sex- and race-based disparities remain important in non-pregnancy-associated SCAD.

    What the researchers tested

    The researchers conducted a retrospective cohort study using the 2022 National Inpatient Sample, a U.S. database of hospitalizations, and identified adult admissions with a primary diagnosis of SCAD using ICD-10-CM codes. They excluded pregnancy-related admissions, peripartum cardiomyopathy, obstetric complications, and patients under 18 years old, and then used weighted analyses and multivariable logistic regression in STATA 18.0.

    What worked and what didn't

    A total of 4,563 hospitalizations met the criteria, and 72.6% were female, with a mean age of 52.4 years. In-hospital mortality was 3.2%, women were less likely than men to undergo percutaneous coronary intervention (PCI, a procedure to open a narrowed coronary artery), and Black patients had higher adjusted odds of death than White patients. Cardiogenic shock, chronic kidney disease, and older age were independent predictors of mortality, while PCI was not independently associated with lower in-hospital mortality.

    What to keep in mind

    This was an observational study based on administrative hospital data, so it describes associations rather than proving causes. The abstract does not describe longer-term outcomes, and the findings apply to hospitalized adults with non-pregnancy-associated SCAD in the 2022 National Inpatient Sample.

    • The study examined 4,563 U.S. hospitalizations for non-obstetric SCAD.
    • Overall in-hospital mortality was 3.2%.
    • Women underwent PCI less often than men despite similar cardiogenic shock rates.
    • Black patients had higher adjusted odds of mortality than White patients.
    • Cardiogenic shock, chronic kidney disease, and older age predicted mortality.
    • PCI was not independently linked to lower in-hospital mortality.

  • Isolated coronary ectasia was linked to more recurrent heart attacks

    What the study found

    Patients whose first myocardial infarction was caused by isolated coronary artery ectasia, a widening of the coronary arteries, had more recurrent heart attacks and more stent thrombosis than patients without ectasia. The study also found a higher combined rate of death or recurrent myocardial infarction in the ectasia group.

    Why the authors say this matters

    The authors conclude that isolated coronary artery ectasia may be clinically important in patients with myocardial infarction. The findings indicate that these patients had worse long-term outcomes than similar patients without ectasia.

    What the researchers tested

    The researchers retrospectively studied patients who had coronary angiography after a first myocardial infarction caused by isolated coronary artery ectasia. They compared them with a control group of patients with myocardial infarction without coronary artery ectasia, excluding people with more than 20% narrowing in vessels other than the infarct-related lesion.

    What worked and what didn't

    A total of 404 patients were included, and 63.9% of the infarctions were ST-elevation myocardial infarctions. Death or recurrent myocardial infarction occurred in 26.7% of patients in the isolated ectasia group versus 16.3% in the control group, and recurrent myocardial infarction was 22.8% versus 13.4%, respectively. Stent thrombosis was also more common in the ectasia group, while death alone was similar between groups.

    What to keep in mind

    This was a retrospective study, so the available summary does not show randomized comparison. The abstract does not describe all potential limitations, and the results apply to patients with first myocardial infarction and isolated coronary artery ectasia as defined in this study.

    • Patients with myocardial infarction caused by isolated coronary artery ectasia had more recurrent myocardial infarction than controls.
    • The combined outcome of death or recurrent myocardial infarction was higher in the ectasia group.
    • Stent thrombosis occurred more often in patients with isolated coronary artery ectasia.
    • In multiple variable analysis, coronary artery ectasia was associated with death/recurrent myocardial infarction and with recurrent myocardial infarction.
    • Most ectasia cases were multivessel diffuse ectasia, classified mainly as Markis I or Markis II.

  • Pregnancy-associated SCAD showed a higher-risk clinical pattern

    What the study found

    Women with pregnancy-associated spontaneous coronary artery dissection, or P-SCAD, had several reproductive and clinical differences compared with women whose SCAD was not associated with pregnancy. The study found higher use of assisted reproductive technology, more preeclampsia, and a more severe heart event pattern in the P-SCAD group.

    Why the authors say this matters

    The authors conclude that women with P-SCAD represent a higher-risk phenotype and that these findings add reproductive health information to a condition where such data have been limited. They also note that the results are relevant because the cohort had high rates of vascular imaging and showed differences in heart recovery after the event.

    What the researchers tested

    The researchers used data from the iSCAD Registry, a large multicenter registry, and compared women with P-SCAD to women with non-pregnancy-associated SCAD, or NP-SCAD, from 2019 to 2024. They analyzed survey-based clinical and reproductive history, along with investigator-confirmed clinical and imaging data, and compared groups using Kruskal-Wallis and chi-square tests.

    What worked and what didn't

    Among 907 women with SCAD and at least one pregnancy, 98 had P-SCAD. Compared with NP-SCAD, the P-SCAD group had lower fibromuscular dysplasia, similar rates of extracoronary abnormalities, more assisted reproductive technology use, more multigravida with more than five gestations, and more preeclampsia. They also had more severe SCAD features, including more STEMI, more multivessel segment involvement, lower left ventricular ejection fraction, and less recovery of left ventricular ejection fraction by one year; most women in both groups were managed medically.

    What to keep in mind

    This summary is based on a registry cohort and comparisons with both NP-SCAD and general U.S. reproductive-aged population rates. The abstract does not describe all potential limitations, and some comparisons involved smaller numbers within subgroups, such as the left ventricular ejection fraction analyses.

    • 98 of 907 women with prior pregnancies had pregnancy-associated SCAD.
    • P-SCAD was linked with higher use of assisted reproductive technology and more preeclampsia.
    • Women with P-SCAD had lower rates of fibromuscular dysplasia than women with NP-SCAD.
    • P-SCAD was associated with more severe heart-event features, including STEMI and multivessel involvement.
    • Left ventricular ejection fraction recovery by 1 year was less in the P-SCAD group.

  • Placental abruption linked to higher cardiovascular risk in twins

    What the study found

    The study found that placental abruption, a pregnancy complication in which the placenta separates from the uterine wall too early, was associated with higher cardiovascular disease risk in twin offspring through early adulthood. The authors report that part of this association was explained by preterm delivery, meaning birth before 37 weeks of gestation.

    Why the authors say this matters

    The authors conclude that efforts to optimize obstetric care for people carrying twins to reduce the risk of placental abruption may be worth considering. They also suggest this may have public health benefits by reducing cardiovascular disease in twin offspring.

    What the researchers tested

    The researchers used the PACER offspring cohort, which linked twin births in New Jersey from 1993 to 2020 with hospitalization and mortality records over 28 years of follow-up. They analyzed the association between placental abruption and nonfatal incident cardiovascular disease, and used a Cox model to estimate how much of the association was mediated through preterm delivery.

    What worked and what didn't

    Among 116,796 twin births, 2,597 were complicated by placental abruption. Incident cardiovascular disease occurred at a higher rate in abruption births than in nonabruption births, and abruption was associated with a 2.47-fold increased risk of cardiovascular disease in twin offspring. The findings were similar for heart disease and stroke, and about 40% of the total effect was mediated through preterm delivery before 37 weeks; the mediated proportion was greater at earlier delivery ages.

    What to keep in mind

    The abstract does not describe detailed study limitations. The analysis was restricted to twin offspring in New Jersey, so the summary does not establish whether the same pattern applies outside this setting.

    • Placental abruption was associated with higher cardiovascular disease risk in twin offspring.
    • The reported risk increase was 2.47-fold overall.
    • About 40% of the association was mediated through preterm delivery before 37 weeks.
    • Similar risk patterns were reported for heart disease and stroke.
    • The study used linked birth, hospitalization, and mortality records from New Jersey with 28 years of follow-up.

  • West-Norwegian study finds low PPCM incidence and recovery

    What the study found

    The study found that peripartum cardiomyopathy, a form of heart failure that occurs near the end of pregnancy or soon after delivery, was relatively uncommon in this West-Norwegian population. It also found that patients generally recovered clinically and in left ventricular function over follow-up.

    Why the authors say this matters

    The authors conclude that higher pre-pregnancy body mass index and elevated systolic blood pressure are important modifiable cardiovascular risk factors linked to peripartum cardiomyopathy. They also say that larger collaborative studies are needed to describe incidence and outcomes more reliably across the country.

    What the researchers tested

    This was a single-center case-control study at Haukeland University Hospital in West Norway. The researchers identified 15 cases of peripartum cardiomyopathy from 2011 to 2023, used the Bergen Birth Registry to determine the number of births, and recruited 30 age-matched healthy controls. They collected clinical characteristics, echocardiographic data, and outcomes.

    What worked and what didn't

    The incidence rate was reported as 1 in 4,182 births. Higher pre-pregnancy body mass index and elevated systolic blood pressure at presentation were associated with PPCM, and the prevalence of pre-eclampsia and primiparity was higher in patients than in controls. Mean left ventricular ejection fraction improved from 35% at presentation to 58% at 6 months, there were no maternal or neonatal deaths, three patients needed ICU treatment, and no major cardiovascular events were reported.

    What to keep in mind

    The study was small and single-center, with only 15 PPCM cases, so the findings are limited to this setting. The abstract does not describe other limitations beyond the need for larger collaborative studies.

    • Peripartum cardiomyopathy incidence was reported as 1 in 4,182 births in West Norway.
    • Higher pre-pregnancy body mass index and elevated systolic blood pressure were linked to PPCM.
    • Pre-eclampsia and primiparity were more common in PPCM patients than in controls.
    • Left ventricular ejection fraction improved from 35% to 58% by 6 months.
    • No maternal or neonatal deaths and no major cardiovascular events were reported.

  • Coronary vessel wall abnormalities were found in adults long after Kawasaki disease

    What the study found

    Adults many years after severe Kawasaki disease often had coronary vessel wall abnormalities on optical coherence tomography, a high-resolution imaging test. These abnormalities were seen even in some regressed aneurysms, which are widened coronary arteries that had later become smaller.

    Why the authors say this matters

    The authors conclude that these findings suggest a need to improve screening and monitoring of adult coronary problems related to Kawasaki disease. They also say the results may help identify substrates for acute coronary syndrome, a sudden reduction in blood flow to the heart.

    What the researchers tested

    The researchers used optical coherence tomography (OCT), a high-resolution imaging method, in 11 adults who had been followed for at least 15 years after acute Kawasaki disease with coronary artery aneurysms of 6 mm or more. They compared OCT findings across 51 coronary segments and also considered prior coronary angiography and cardiac multi-detector computed tomography findings.

    What worked and what didn't

    Among 51 coronary segments, OCT found fibrocalcific plaque, fibroatheroma, superficial signal-rich regions with attenuation, microvessels, luminal thrombi, and ruptured plaque in varying numbers of segments. Nearly all normal segments showed no OCT-detected abnormalities, while coronary artery lesions, including regressed aneurysms, showed these abnormalities; advanced lesions on angiography and calcified plaques on computed tomography were associated with OCT-detected vessel wall abnormalities. The abstract does not report a treatment or intervention, only imaging findings.

    What to keep in mind

    The study involved only 11 patients, all with severe coronary involvement after Kawasaki disease, so the authors say the findings may not generalize to milder cases. The abstract also states that the results do not show causality.

    • Eleven adults were studied a median of 22.6 years after acute Kawasaki disease.
    • OCT found vessel wall abnormalities in many coronary artery lesion segments, including regressed aneurysms.
    • Normal coronary segments were mostly free of OCT-detected abnormalities.
    • Advanced angiography lesions and CT-detected calcified plaques were associated with OCT abnormalities.
    • The authors say the findings warrant further study for screening and monitoring.