Hasil untuk "Diseases of the circulatory (Cardiovascular) system"

Mudassir Hasan Khan, Ahmad Nayfeh, Mudassir Masood et al.

Electrocardiogram (ECG) foundation models represent a paradigm shift from task-specific pipelines to generalizable architectures pre-trained on large-scale unlabeled waveform data. This survey presents a unified and deployment-aware review of foundation models and medical large language models (LLMs) for ECG intelligence in cardiovascular disease (CVD) diagnosis, monitoring, and clinical decision support. The central thesis of this survey paper is that next-generation cardiovascular AI systems will be inherently agentic, requiring the synergistic integration of two complementary model classes: (i) ECG foundation models that act as signal-level interpreters, learning rich electrophysiological representations via self-supervised and multimodal pretraining, and (ii) medical LLMs, trained on biomedical text corpora, that function as knowledge-based reasoning backbones for contextual inference, guideline alignment, and clinical decision support. Thus, the survey systematically reviews existing pool of generalist medical LLMs, as well as ECG foundation models that utilize techniques such as self-supervised learning, multimodal ECG-language alignment, vision transformer architectures, and possess capabilities such as zero-shot classification, automated report generation, and longitudinal risk modeling. Recognizing the constraints of consumer-grade wearable edge devices, we further examine model optimization techniques such as quantization, pruning, knowledge distillation, as well as the role of small language models in enabling low-latency, energy-efficient, and privacy-preserving ECG intelligence on edge platforms such as smartwatches. Finally, we outline future directions in multimodal ECG foundation models, agent-driven monitoring, and explainable, secure edge intelligence, with particular emphasis on real-time, on-device cardiovascular analytics in consumer electronics ecosystems.

Wafa A. Nawwab, Sultan A. Alqasim, Nada N. Alghamdi et al.

Sickle cell disease (SCD) is a genetic disorder characterized by rigid, sickle-shaped red blood cells, leading to complications such as vaso-occlusive crises (VOCs). These acute pain episodes are the most common reason for emergency visits and hospitalizations in adults with SCD. his narrative review evaluated the efficacy of pharmacological and non-pharmacological treatments for acute pain crises in adults with SCD, with secondary attention to safety outcomes, including side effects, treatment duration, hospital stay, and readmission rates. Materials and Methods: A literature search was conducted in PubMed, Cochrane Library, and Google Scholar up to August 20, 2024, focusing on randomized controlled trials (RCTs) in English involving adult patients. Relevant studies were reviewed, and findings were synthesized narratively. The result Twelve RCTs involving 576 adults were included. Most studies were of good quality, though two had high risk and two had unclear risk of bias. Interventions included L-glutamine, pregabalin, regadenoson, ketorolac, individualized opioid protocols, progressive muscle relaxation, and music therapy. L-glutamine and individualized opioid protocols consistently reduced pain intensity. Pregabalin and ketorolac showed mixed results, while non-pharmacological interventions provided modest pain relief or improved mood. Overall, individualized treatment approaches appeared more effective than uniform protocols, though variability in study design and outcomes limits generalizability. IIn conclusion Twelve RCTs involving 576 adults were included. Most studies were of good quality, though two had high risk and two had unclear risk of bias. Interventions included L-glutamine, pregabalin, regadenoson, ketorolac, individualized opioid protocols, progressive muscle relaxation, and music therapy. L-glutamine and individualized opioid protocols consistently reduced pain intensity. Pregabalin and ketorolac showed mixed results, while non-pharmacological interventions provided modest pain relief or improved mood. Overall, individualized treatment approaches appeared more effective than uniform protocols, though variability in study design and outcomes limits generalizability. TEK therapy and L-glutamine were most effective for pain reduction, while pregabalin and regadenoson were safe and promising. Non-pharmacological interventions may support standard care, but further high-quality RCTs are recommended to confirm efficacy and safety.

Lehan Wang, Hualiang Wang, Chubin Ou et al.

Cardiovascular disease (CVD) remains the leading cause of death worldwide, requiring urgent development of effective risk assessment methods for timely intervention. While current research has introduced non-invasive and efficient approaches to predict CVD risk from retinal imaging with deep learning models, the commonly used fundus photographs and Optical Coherence Tomography (OCT) fail to capture detailed vascular features critical for CVD assessment compared with OCT angiography (OCTA) images. Moreover, existing methods typically classify CVD risk only as high or low, without providing a deeper analysis on CVD-related blood factor conditions, thus limiting prediction accuracy and clinical utility. As a result, we propose a novel multi-purpose paradigm of CVD risk assessment that jointly performs CVD risk and CVD-related condition prediction, aligning with clinical experiences. Based on this core idea, we introduce OCTA-CVD, the first OCTA dataset for CVD risk assessment, and a Vessel-Aware Mamba-based Prediction model with Informative Enhancement (VAMPIRE) based on OCTA enface images. Our proposed model aims to extract crucial vascular characteristics through two key components: (1) a Mamba-Based Directional (MBD) Module that captures fine-grained vascular trajectory features and (2) an Information-Enhanced Morphological (IEM) Module that incorporates comprehensive vessel morphology knowledge. Experimental results demonstrate that our method can surpass standard classification backbones, OCTA-based detection methods, and ophthalmologic foundation models. Our codes and the collected OCTA-CVD dataset are available at https://github.com/xmed-lab/VAMPIRE.

Seyed Ali Sadegh-Zadeh, Alireza Soleimani Mamalo, Mahsa Behnemoon et al.

This study investigates long-term cardiovascular complications in COVID-19 patients using advanced clustering techniques. The objective was to analyse ECG parameters, demographic data, comorbidities, and hospitalization details to identify patterns in cardiovascular health outcomes. We applied K-means clustering and identified three distinct clusters: Cluster 0 with moderate heart rate variability and ICU admissions, Cluster 1 with lower heart rate variability and ICU admissions, and Cluster 2 with higher heart rate variability and ICU admissions, indicating higher risk profiles.

Alessandro Fontana

The evolutionary origins of ageing and age-associated diseases continue to pose a fundamental question in biology. This study is concerned with a recently proposed framework, which conceptualises development and ageing as a continuous process, driven by genetically encoded epigenetic changes in target sets of cells. According to the Evolvable Soma Theory of Ageing (ESTA), ageing reflects the cumulative manifestation of epigenetic changes that are predominantly expressed during the post-reproductive phase. These late-acting modifications are not yet evolutionarily optimised but are instead subject to ongoing selection, functioning as somatic "experiments" through which evolution explores novel phenotypic variation. These experiments are often detrimental, leading to progressive physical decline and eventual death, while a small subset may produce beneficial adaptations, that evolution can exploit to shape future developmental trajectories. According to ESTA, ageing can be understood as evolution in action, yet old age is also the strongest risk factor for major diseases such as cardiovascular diseases, cancer, neurodegenerative disorders, and metabolic syndrome. We argue that this association is not merely correlational but causal: the same epigenetic process that drive development and ageing also underlie age-associated diseases. Growing evidence points to epigenetic regulation as a central factor in these pathologies, since no consistent patterns of genetic mutations have been identified, whereas widespread regulatory and epigenetic disruptions are observed. From this perspective, evolution is not only the driver of ageing but also the ultimate source of the diseases that accompany it, making it the root cause of most age-related pathologies.

Fanwen Wang, Zi Wang, Yan Li et al.

Cardiovascular health is vital to human well-being, and cardiac magnetic resonance (CMR) imaging is considered the {clinical reference standard} for diagnosing cardiovascular disease. However, its adoption is hindered by long scan times, complex contrasts, and inconsistent quality. While deep learning methods perform well on specific CMR imaging {sequences}, they often fail to generalize across modalities and sampling schemes. The lack of benchmarks for high-quality, fast CMR image reconstruction further limits technology comparison and adoption. The CMRxRecon2024 challenge, attracting over 200 teams from 18 countries, addressed these issues with two tasks: generalization to unseen {modalities} and robustness to diverse undersampling patterns. We introduced the largest public multi-{modality} CMR raw dataset, an open benchmarking platform, and shared code. Analysis of the best-performing solutions revealed that prompt-based adaptation and enhanced physics-driven consistency enabled strong cross-scenario performance. These findings establish principles for generalizable reconstruction models and advance clinically translatable AI in cardiovascular imaging.

M. S. Mah, Enyuan Cao, Dovile Anderson et al.

Consumption of a diet rich in saturated fat increases lipid absorption from the intestine, assembly into chylomicrons, and delivery to metabolic tissues via the lymphatic and circulatory systems. Accumulation of ceramide lipids, composed of sphingosine and a fatty acid, in metabolic tissues contributes to the pathogenesis of cardiovascular diseases, type 2 diabetes mellitus and cancer. Using a mesenteric lymph duct cannulated rat model, we showed that ceramides are generated by the intestine and assembled into chylomicrons, which are transported via the mesenteric lymphatic system. A lipidomic screen of intestinal-derived chylomicrons identified a diverse range of fatty acid, sphingolipid, and glycerolipid species that have not been previously detected in chylomicrons, including the metabolically deleterious C16:0 ceramide that increased in response to high-fat feeding in rats and human high-lipid meal replacement enteral feeding. In conclusion, high-fat feeding increases the export of intestinal-derived C16:0 ceramide in chylomicrons, identifying a potentially unknown mechanism through which ceramides are transported systemically to contribute to metabolic dysfunction.

Ming Yang, Tiepeng Li, Shujing Guo et al.

With the increase of aging population and prevalence of obesity, the incidence of cardiovascular disease (CVD) and cancer has also presented an increasing tendency. These two different diseases, which share some common risk factors. Relevant studies in the field of reversing Cardio-Oncology have shown that the phenotype of CVD has a significant adverse effect on tumor prognosis, which is mainly manifested by a positive correlation between CVD and malignant progression of concomitant tumors. This distal crosstalk and the link between different diseases makes us aware of the importance of diagnosis, prediction, management and personalized treatment of systemic diseases. The circulatory system bridges the interaction between CVD and cancer, which suggests that we need to fully consider the systemic and holistic characteristics of these two diseases in the process of clinical treatment. The circulating exosome-miRNAs has been intrinsically associated with CVD -related regulation, which has become one of the focuses on clinical and basic research (as biomarker). The changes in the expression profiles of cardiovascular disease-associated miRNAs (Cardio-miRNAs) may adversely affect concomitant tumors. In this article, we sorted and screened CVD and tumor-related miRNA data based on literature, then summarized their commonalities and characteristics (several important pathways), and further discussed the conclusions of Cardio-Oncology related experimental studies. We take a holistic approach to considering CVD as a risk factor for tumor malignancy, which provides an in-depth analysis of the various regulatory mechanisms or pathways involved in the dual attribute miRNAs (Cardio-/Onco-miRNAs). These mechanisms will be key to revealing the systemic effects of CVD on tumors and highlight the holistic nature of different diseases. Therefore, the Cardio-miRNAs should be given great attention from researchers in the field of CVD and tumors, which might become new targets for tumor treatment. Meanwhile, based on the principles of precision medicine (such as the predictive preventive personalized medicine, 3PM) and reverse Cardio-oncology to better improve individual outcomes, we should consider developing personalized medicine and systemic therapy for cancer from the perspective of protecting cardiovascular function.

Dawei Lu, Qian Luo, Rui Chen et al.

Ambient particulate matter pollution is one of the leading causes of global disease burden. Epidemiological studies have revealed the connections between particulate exposure and cardiovascular and respiratory diseases. However, until now, the real species of ambient ultrafine particles (UFPs) in humans are still scarcely known. Here we report the discovery and characterization of exogenous nanoparticles (NPs) in human serum and pleural effusion (PE) samples collected from non-occupational subjects in a typical polluted region. We show the wide presence of NPs in human serum and PE samples with extreme diversity in chemical species, concentration, and morphology. Through chemical multi-fingerprinting (including elemental fingerprints, high-resolution structural fingerprints, and stable iron isotopic fingerprints) of NPs, we identify the sources of the NPs to be abiogenic, particularly, combustion-derived particulate emission. Our results provide evidence for the translocation of ambient UFPs into the human circulatory system, and also provide information for understanding their systemic health effects. Exposure to ambient particulate matter is one of the leading global health risks. Here, the authors reveal, by means of chemical multi-fingerprinting, the presence of exogenous ultrafine particles with diverse species and morphology in non-occupational human serum and pleural effusion.

Shreya Meda, Joyce Gyamfi, Kahini Patel et al.

BackgroundHypertension (HTN) currently affects over 120 million Americans, in the United States (US). Thus, the implementation of evidence-based interventions (EBI) for blood pressure (BP) reduction is pivotal in minimizing this burden. We sought to evaluate evidence from published literature on the effectiveness of musical interventions for BP reduction within the US.MethodsA systematic review of studies that utilize music interventions to manage BP was conducted in October of 2022. An extensive search of several databases utilizing MeSH terms and relevant keywords was conducted for articles published through October 2022. An updated search was conducted in October 2023 to identify additional studies.Results2,381 studies were screened for title/abstract relevancy. 1,885 studies were deemed irrelevant, and 495 studies were examined for full-text review; of which 384 were excluded due to being non-US-based. Overall, 25 studies were found where BP was the primary outcome and discussed musical interventions within the US. Of the 25 studies, 72% reported a significant decrease in BP after the administration of a musical intervention and only 28% reported the race and ethnicity of participants.ConclusionThere are limited studies that examine the effect of music interventions on BP reduction in the US, as a primary outcome. However, based on the evidence, musical interventions are effective for BP reduction. Moreover, the studies that were conducted in the US include a low percentage of high-risk racial and ethnic minority populations. Future EBI should target this underserved/high-burden group to improve disparity gaps within BP reduction via non-pharmacological means. Systematic Review RegistrationOpen Science Framework, doi: 10.17605/OSF.IO/4G3EB.

Sophie Greutert, Tatiana Schlomer, Marc Righini

Transient perivascular inflammation of the carotid artery (TIPIC) syndrome, historically named idiopathic carotidynia or Fay syndrome, is a rare condition characterized by inflammation and pain in the carotid artery. The diagnosis requires a specific clinical–radiological presentation. We describe a 37-year-old female who presented with headaches and left neck pain and was diagnosed with TIPIC syndrome with temporary perivascular infiltration.

Tingyu Wang, You Yu, Yinglong Ding et al.

BackgroundThoracic Aortic Dissection (TAD) is a life-threatening disease without effective drug treatments. The disruption of HASMCs homeostasis is one direct histopathologic alteration in TAD pathological process. Several miRNAs have been shown abnormally expressed in TAD and to regulate HASMCs homeostasis. The primary goal of this study is to identify the miRNAs and the specific mechanisms that lead to HASMCs homeostasis disruption.MethodsBulk miRNA sequencing was performed to explore the aberrantly expressed miRNA profile in TAD, and differentially expressed miRNAs were verified with qRT-PCR. To explore the role of the key miRNAs (miR-3529) in HASMCs homeostasis, we overexpressed this miRNA with lentivirus in HASMCs. Integrative transcriptomics and metabolomics analysis were used to uncover the functional roles of this miRNA in regulating HASMCs homeostasis. Further, the target gene of miR-3529 was predicted by bioinformatics and verified through a dual-luciferase reporter assay.ResultsBulk miRNA sequencing showed miR-3529 was elevated in TAD tissues and confirmed by qRT-PCR. Further experimental assay revealed miR-3529 upregulation induced HASMCs homeostasis disruption, accompanied by reducing contractile markers and increasing pro-inflammatory cytokines. Integrative transcriptomics and metabolomics analysis showed that miR-3529 overexpression altered the metabolic profile of HASMC, particularly lipid metabolism. ABCA1 was found to be a direct target of miR-3529. Mechanistically, the miR-3529/ABCA1 axis disrupted HASMCs homeostasis through the JAK2/STAT3 signaling pathway.ConclusionsmiR-3529 is elevated in TAD patients and disrupts HASMCs homeostasis by reprogramming metabolism through the JAK2/STAT3 signaling pathway. These findings favor a role for miR-3529 as a novel target for TAD therapy.

Hong‐Bin Lin, Pu Hong, Meng‐Yu Yin et al.

Background Cardiac damage induced by ischemic stroke, such as arrhythmia, cardiac dysfunction, and even cardiac arrest, is referred to as cerebral‐cardiac syndrome (CCS). Cardiac macrophages are reported to be closely associated with stroke‐induced cardiac damage. However, the role of macrophage subsets in CCS is still unclear due to their heterogeneity. Sympathetic nerves play a significant role in regulating macrophages in cardiovascular disease. However, the role of macrophage subsets and sympathetic nerves in CCS is still unclear. Methods and Results In this study, a middle cerebral artery occlusion mouse model was used to simulate ischemic stroke. ECG and echocardiography were used to assess cardiac function. We used Cx3cr1GFPCcr2RFP mice and NLRP3‐deficient mice in combination with Smart‐seq2 RNA sequencing to confirm the role of macrophage subsets in CCS. We demonstrated that ischemic stroke‐induced cardiac damage is characterized by severe cardiac dysfunction and robust infiltration of monocyte‐derived macrophages into the heart. Subsequently, we identified that cardiac monocyte‐derived macrophages displayed a proinflammatory profile. We also observed that cardiac dysfunction was rescued in ischemic stroke mice by blocking macrophage infiltration using a CCR2 antagonist and NLRP3‐deficient mice. In addition, a cardiac sympathetic nerve retrograde tracer and a sympathectomy method were used to explore the relationship between sympathetic nerves and cardiac macrophages. We found that cardiac sympathetic nerves are significantly activated after ischemic stroke, which contributes to the infiltration of monocyte‐derived macrophages and subsequent cardiac dysfunction. Conclusions Our findings suggest a potential pathogenesis of CCS involving the cardiac sympathetic nerve–monocyte‐derived macrophage axis.

Mohamed E. M. K. Abdelaziz, Libaihe Tian, Thomas Lottner et al.

Cardiovascular diseases (CVDs) and congenital heart diseases (CHD) pose significant global health challenges. Fluoroscopy-guided endovascular interventions, though effective, are accompanied by ionizing radiation concerns, especially in pediatric cases. Magnetic resonance imaging (MRI) emerges as a radiation-free alternative, offering superior soft tissue visualization and functional insights. However, the lack of compatible instruments remains a hurdle. We present two novel catheter systems, a tendon-driven steerable catheter and an active tracking Tiger-shaped catheter, fabricated using a unique fiber drawing technique. These catheters, showcasing mechanical properties similar to commercial counterparts, have undergone rigorous in-vitro and in-vivo testing, yielding promising outcomes. This innovative approach has the potential to streamline medical device development, thus enhancing patient care in MR-guided interventions.

Li Zhang, Ge Zhang, Yongzhen Lu et al.

As one of the most prevalent heritable cardiovascular diseases, dilated cardiomyopathy (DCM) induces cardiac insufficiency and dysfunction. Although genetic mutation has been identified one of the causes of DCM, the usage of genetic biomarkers such as RNAs for DCM early diagnosis is still being overlooked. In addition, the alternation of RNAs could reflect the progression of the diseases, as an indicator for the prognosis of patients. Therefore, it is beneficial to develop genetic based diagnostic tool for DCM. RNAs are often unstable within circulatory system, leading to the infeasibility for clinical application. Recently discovered exosomal miRNAs have the stability that is then need for diagnostic purpose. Hence, fully understanding of the exosomal miRNA within DCM patients is vital for clinical translation. In this study, we employed the next generation sequencing based on the plasma exosomal miRNAs to comprehensively characterize the miRNAs expression in plasma exosomes from DCM patients exhibiting chronic heart failure (CHF) compared to healthy individuals. A complex landscape of differential miRNAs and target genes in DCM with CHF patients were identified. More importantly, we discovered that 92 differentially expressed miRNAs in DCM patients undergoing CHF were correlated with several enriched pathways, including oxytocin signalling pathway, circadian entrainment, hippo signalling pathway‐multiple species, ras signalling pathway and morphine addiction. This study reveals the miRNA expression profiles in plasma exosomes in DCM patients with CHF, and further reveal their potential roles in the pathogenesis of it, presenting a new direction for clinical diagnosis and management of DCM patients with CHF.

M. Ufnal, A. Żądło, R. Ostaszewski

Chi-Tang Ho, Ming Wu, S. Panyod et al.

Gut microbiota refers to the microorganisms that inhabit the human gastrointestinal tract. It is a complex community of microorganisms that reside in the digestive system and play an important role in health. When the gut microbiota is balanced, it is beneficial to the host and when it is imbalanced or dysbiotic, it can lead to the development of diseases.1 The gut microbiota is responsible for several functions, including digestion and metabolism of dietary nutrients into several metabolites, such as short-chain fatty acids, vitamins, and other compounds.2 Additionally, the gut microbiota interacts with the intestinal cells to regulate the immune system and protect against pathogens.3 Certain microbiota can enhance the gut barrier function, maintain intestinal integrity, and prevent harmful bacterial metabolites from entering the circulatory system.4 Dysbiosis of the gut microbiota has been implicated as a causative factor of several diseases, including inflammatory bowel disease, cardiovascular disease, obesity, and diabetes.5 Some gut microbiota metabolites require the host enzyme to convert their metabolites to affect the body; for instance, trimethylamine (TMA) requires hepatic flavin monooxygenase 3 (FMO3) to form

Rahul Mallick, A. Duttaroy

The endothelium acts as the barrier that prevents circulating lipids such as lipoproteins and fatty acids into the arterial wall; it also regulates normal functioning in the circulatory system by balancing vasodilation and vasoconstriction, modulating the several responses and signals. Plasma lipids can interact with endothelium via different mechanisms and produce different phenotypes. Increased plasma-free fatty acids (FFAs) levels are associated with the pathogenesis of atherosclerosis and cardiovascular diseases (CVD). Because of the multi-dimensional roles of plasma FFAs in mediating endothelial dysfunction, increased FFA level is now considered an essential link in the onset of endothelial dysfunction in CVD. FFA-mediated endothelial dysfunction involves several mechanisms, including dysregulated production of nitric oxide and cytokines, metaflammation, oxidative stress, inflammation, activation of the renin-angiotensin system, and apoptosis. Therefore, modulation of FFA-mediated pathways involved in endothelial dysfunction may prevent the complications associated with CVD risk. This review presents details as to how endothelium is affected by FFAs involving several metabolic pathways.

Eman M. Mansory, Lotus Alphonsus, Janine R. Hutson et al.

Background: Venous thromboembolism (VTE) remains one of the leading causes of morbidity and mortality during pregnancy and the postpartum period. Despite that, the prevention and management of VTEs in pregnant patients is an area of great debate. Objectives: The aim of this systematic review was to evaluate the risk of VTE recurrence during pregnancy for pregnant patients with prior personal history of VTE and the effect of LMWH on such risk. Methods: MEDLINE and EMBASE were searched between January 2000 to December 2022. We included studies that evaluated pregnant patients with previous personal history of VTE and assessed VTE recurrence with or without thromboprophylaxis. A meta-analysis of proportions was done through a Freeman–Tukey transformation using random effect models. Results: 30 studies were included in this systematic review. The studies included 5075 pregnant patients with a previous history of DVT or PE. We found a wide variability in thromboprophylaxis strategies. The estimated pooled proportions of VTE recurrence were 2.5% (95% CI 1.8–3.3) in patients who were consistently on anticoagulation during pregnancy (pre- and post-partum), 4.7% (95% CI 1.8–8.8) in patients who received anticoagulation in the postpartum period only, and 13.6% (95% CI 6.5 to 22.8) in patients who were not on anticoagulation. Conclusions: In patients with a previous VTE history receiving prophylactic anticoagulation (either both pre- and post-partum or post-partum only), the estimates of VTE recurrence were lower than for patients who did not receive prophylaxis, however, a direct comparison was not possible. The optimal thromboprophylaxis strategy remains unknown.