Cardiovascular Medicine
Role of Perturbations of Epigenetic Processes in Cardiac Hypertrophy and Fibrotic Scarring
Cardiac hypertrophy and fibrotic scarring are fundamental contributors to the progression of heart failure and are associated with poor clinical outcomes. Recent advancements in cardiovascular research have emphasized the central role of epigenetic mechanisms including DNA methylation histone modifications chromatin remodeling and non-coding RNAs in regulating the gene expression changes underlying these pathological processes.
A comprehensive literature review was conducted using databases including PubMed Scopus and Web of Science. Predefined keywords and inclusion/exclusion criteria were applied to select relevant studies focusing on epigenetic regulation in cardiac hypertrophy and fibrosis. Particular attention was given to studies involving DNA methyltransferases TET enzymes histone deacetylases demethylases chromatin remodeling complexes and non-coding RNAs. Methodological transparency was ensured through a structured screening and data extraction process.
The review highlights the dynamic regulation of cardiac gene expression by epigenetic factors. DNA methylation and demethylation influence fibroblast activation and extracellular matrix deposition. Histone-modifying enzymes reshape chromatin architecture altering transcriptional accessibility. Chromatin remodeling complexes regulate nucleosome positioning during stress responses. Emerging insights into epigenetic memory and transgenerational epigenetic inheritance further reveal the heritable nature of disease susceptibility.
These epigenetic perturbations collectively orchestrate the maladaptive gene expression patterns seen in cardiac hypertrophy and fibrosis. Understanding their roles provides a mechanistic basis for identifying biomarkers and therapeutic targets. The review also discusses recent omics-based technologies that aid in the characterization of epigenetic alterations thereby expanding diagnostic and therapeutic horizons.
Epigenetic mechanisms are pivotal in the development and progression of cardiac hypertrophy and fibrosis. Advances in epigenomic profiling are facilitating the development of precise and targeted interventions. This review underscores the potential of epigenetic therapies and calls for intensified research efforts to translate these findings into clinical applications.
Heart Transplantation: Immunological Challenges Revisited
Immunologic responses to cardiac allografts initiate before transplantation during brain-dead organ procurement and might persist for years after transplantation culminating in chronic allograft dysfunction. Despite remarkable advances in post-transplant care and immunosuppressive agents acute cellular and antibody-mediated rejections as well as chronic allograft vasculopathy significantly affect cardiac allograft and patient survival.
Herein recent findings of the molecular mechanisms involved in the inflammatory responses before and after heart transplantation including brain death donor inflammation acute cellular rejection antibody-mediated rejection and chronic allograft dysfunction have been summarized along with novel therapeutic approaches for their treatment. Finally recent developments in prognostic and diagnostic biomarkers for immunological complications have been provided with an overview of the most promising biomarkers to date.
Due to the recent developments in the description of molecular mechanisms involved in the immunopathogenesis of cardiac allograft rejection some immune cells proinflammatory cytokines and adhesion molecules have been proposed as therapeutic targets for the prevention or treatment of alloimmune responses. In addition several molecules derived from graft tissue or immune cells e.g. natriuretic peptides cardiac troponins exosomal products microRNAs and donor-derived cell-free DNA have been suggested as potential biomarkers for the prediction or diagnosis of cardiac transplant rejection.
Considering the need to design non-invasive low-cost tests for early diagnosis of post-transplant complications and convenient follow-up of the cardiac transplant recipients peripheral blood biomarkers could be appropriate candidates for this purpose.
A Bibliometric Analysis of P2X7R in Cardiovascular Diseases from 2005 to 2024
The P2X7 receptor (P2X7R) which mediates inflammation is implicated in an extensive variety of diseases including cardiovascular dysfunction. Recently studies focusing on the role of P2X7R in cardiovascular disorders have garnered significant attention. However a bibliometric evaluation within this area has yet to be carried out.
A bibliometric analysis was performed by searching for research related to P2X7R and cardiovascular diseases in the Web of Science Core Collection (WoSCC) database from 2005 to 2024. The tools CiteSpace and VOSviewer were utilized to analyze data and create visual representations of various elements including countries institutions authors journals and keywords.
Over the past two decades 371 articles in English were obtained in the last 20 years. The People's Republic of China Nanchang University the journal 'Purinergic Signalling' and author Shandong Liang had the highest productivity in their respective categories. The top 4 keywords were “activation'' “p2x7 receptor'' “ATP'' and “inflammation”. Burst keyword analysis indicated that “purinergic signaling” and “oxidative stress” are emerging key areas worthy of further investigation. These topics seeing a surge in interest are predicted to remain prominent in research.
This is the first bibliometric analysis of P2X7R in cardiovascular disorders which reports the hot spots and emerging trends. The interaction between “purinergic signaling” “inflammation” and “oxidative stress” are considered to be the current research priorities suggesting that these topics are likely to remain central in future research.
This study underscores the growing importance of P2X7R in cardiovascular research and offers valuable insights to guide future investigations.
Role of eRNAs in Cardiovascular Diseases
Enhancer RNAs (eRNAs) a class of non-coding RNAs transcribed from enhancer regions have emerged as critical regulators of gene expression in cardiovascular diseases (CVDs) which are among the leading causes of morbidity and mortality in China. The pathogenesis of CVD is complex involving precise regulation of diverse biological processes. Recent advances in epigenetics have highlighted the pivotal role of eRNAs in gene regulation. This review summarizes the fundamental characteristics of eRNAs and their mechanisms of action in CVD focusing on how they regulate gene expression through enhancer-promoter looping chromatin remodeling and transcriptional control. Key eRNAs including IRENES CARMEN LINC00607 HERNA1 PSMB8-AS1 and WISPER are discussed in detail emphasizing their roles in pathological processes such as cardiac development vascular remodeling atherosclerosis and fibrosis. These eRNAs interact with transcription factors and others to influence cardiovascular gene regulatory networks. Advances in high-throughput sequencing have identified eRNAs as potential biomarkers and therapeutic targets in CVDs offering implications for diagnosis treatment and precision medicine. For instance targeting CARMEN may attenuate atherosclerosis while LEENE could address endothelial dysfunction. Despite their therapeutic potential further studies are needed to elucidate the mechanisms underlying eRNAs function and their roles in CVD pathogenesis. A deeper understanding of eRNAs may pave the way for novel therapeutic strategies in cardiovascular medicine.
Percutaneous Zero-fluoroscopy Atrial Septal Defect Closure Versus Fluoroscopy-guided Method: A Systematic Review and Meta-analysis
Percutaneous atrial septal defects (ASD) closure with fluoroscopy guidance is the standard procedure. However fluoroscopy poses stochastic and deterministic risks for small infants and children. Zero fluoroscopy ASD closure is an alternative yet its feasibility and safety compared to fluoroscopy remain unclear. Therefore this study compares outcomes using standardized fluoroscopy and zero fluoroscopy methods for transcatheter ASD closure.
Four databases (PubMed ProQuest Google Scholar Wiley) were used to search literature published before July 2023. The main results were the success rate and the complications. Outcomes were processed using the DerSimonian-Laird random-effects model of proportional meta-analysis to determine the overall proportion.
A total of 68 cohort studies (8989 patients) were included in this meta-analysis. Overall percutaneous ASD closure was successfully performed in 97% of patients (95%CI: 96-98%) based on 59 studies (8989 patients) of which fluoroscopy accounted for 97% (95%CI: 96-98%) based on 51 studies (7760 patients) and non-fluoroscopy for 98% (95%CI: 96-100%)] based on 8 studies (1229 patients). Device embolization AV block and other arrhythmias did not differ significantly between the two groups. However the percentage difference in residual leaks between the two groups was quite vast with 5% in the non-fluoroscopy group and 12% in the fluoroscopy group.
Percutaneous ASD closure with zero fluoroscopy is safe and effective as evidenced by the high success rate and is non-inferior to the standardized fluoroscopy method.
The Role of Anthocyanins in Cardiovascular Health: A Review
Anthocyanins are natural polyphenols found in various fruits and vegetables offering numerous health benefits. Clinical studies suggest that anthocyanin supplementation may regulate blood pressure improve lipid profiles reduce triglycerides (TG) thiobarbituric acid reactive substances (TBARS) cytokines and platelet aggregation while also reducing arterial stiffness. The multiple pathways including the downregulation of proinflammatory markers and suppression of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway prevention of lipoprotein oxidation enhancement of nitric oxide (NO) bioavailability improvement of endothelial function and modulation of the gut microbiota collectively contribute to managing cardiac health. However some clinical studies have found no significant positive impact of anthocyanins on cardiovascular disease possibly due to the varied form stability dosage and study duration. Therefore future research should investigate anthocyanin stability establish standardised therapeutic strategies and conduct large-scale longitudinal studies to elucidate the impact of anthocyanin consumption on cardiovascular health and quality of life.
Artificial Intelligence Tools in Myocardial Infarction Prognosis: Evaluating the Performance of Machine Learning and Deep Learning Models
In clinical practice mortality risk assessment in patients with myocardial infarction often relies on scales such as GRACE and TIMI. However these scales were developed based on cohorts assembled many years ago. Since then numerous changes have occurred ranging from shifts in MI patient profiles to the introduction of new antiplatelet medications and the adoption of more restrictive lipid therapy targets. To address this issue researchers are working to develop new stratification tools. Artificial intelligence (AI) which finds applications in nearly every area of medicine also presents solutions to this problem. This review includes sixteen papers that contain machine learning and deep learning models used to prognosticate mortality risk at different points. Machine learning (ML) models such as random forest gradient boosting and support vector machines have demonstrated good to excellent performance. However no single algorithm appears to be top-performing. Although artificial neural networks are considered one of the most promising algorithms they do not invariably outperform other ML methods. The adaptability of AI models to various scenarios and their ability to handle complex datasets reassures us of their potential in cardiology. Concerning variables that influence the risk of mortality most are well-established factors such as age left-ventricular ejection fraction lipid parameters and B-type natriuretic peptide. Additionally less apparent indicators include platelet parameters neutrophil count and blood urea nitrogen. In conclusion utilizing AI-based models in myocardial infarction risk stratification presents a significant opportunity to develop effective and tailored tools.
Comparison of Different Double-Stent Implantation Techniques on Coronary Bifurcation Lesions: A Finite Element Analysis
This study aims to investigate the impact of different double-stent methods on the structure and mechanics of coronary bifurcation lesions providing reference indicators for clinicians in selecting an appropriate interventional procedure.
Three-dimensional reconstruction of coronary Computed Tomography Angiography (CTA) image data of a patient with coronary bifurcation disease was performed. Two types of double-stent (Cullotte and Crush) procedures were simulated and their effects were evaluated using Finite element analysis. Intravascular Ultrasound (IVUS) validation and retrospective clinical analysis were performed to support computational findings.
The stress distribution following the Cullotte stent was concentrated in the SB whereas the stress after the Crush procedure was localized at the overlap with the proximal main vessel three-layer stent. Compared with the Crush procedure the Culotte approach resulted in a lower percentage of double-stent malapposition better dilation of vascular stenosis and less narrowing of the SB stent suggesting a more favorable clinical outcome. IVUS validation and retrospective clinical analysis were performed to support computational findings.
Culotte stenting resulted in better stent-vessel conformity and more favorable stress distribution. The findings support FEA as a valuable tool in procedural planning.
The findings suggest that the Culotte technique may offer mechanical advantages over the Crush technique potentially improving long-term clinical outcomes. These results emphasize the role of computational modeling in optimizing interventional strategies.
Cardiac Cancer: An Evidence-Based Study of Occurrence
From 1931 to 2025 spanning 94 years cardiac cancer has remained a rare and sporadic tumor that poses both an investigative dilemma and a therapeutic challenge. Autopsy findings indicate that the incidence of primary cardiac malignancies is approximately 0.02 percent. Surgical resection is considered a viable and often successful treatment option.
The present study aims to provide an overall assessment of cardiac cancer in Isfahan Province Iran.
To provide detailed information on specific aspects such as frequency and demographic characteristics of cardiac cancer.
The representative data of this study were drawn from the general population of Isfahan Province. SEER (Surveillance Epidemiology and End Results) data were obtained from the Deputy of Health Division of Registry of Cancer (between 2011 and 2015). With attention to subject selection (the authors followed the Sex and Gender Equity in Research (SAGER) Guidelines) and according to the ICDO topography code C38 was considered for further investigation as heart cancer or cardiac tumors.
During the study period a total of 30465 cancer patients were recorded comprising 14638 females and 15827 males. Among these 122 cases (0.4 percent) were identified as cardiac cancer including 42 females and 80 males. The patients' ages ranged from 3 to 95 years with a mean age of 46.8 ± 21.5 years. The annual distribution of reported cardiac tumors during the study period was as follows: 34 37 18 and 33 cases respectively. Based on available data from the monographic code M which does not specify subtypes the following conditions were recorded: mesothelioma (n = 25) neoplasm (n = 11) Hodgkin lymphoma nodular sclerosis NOS (n = 14) and other unspecified conditions. A total of three deaths were reported.
In the population studied the frequency of cardiac cancer in men was significantly higher than in women. Age related to cardiac cancer in 51% was between 40-70 years old. For the patient satisfaction and financial aspects of the Iranian health system further consideration is suggested regarding referral systems evidence-based pharmacotherapy and post-surgery outcome inquiries.