Cell-free mitochondrial DNA and microRNA-137 for early diagnosis of preeclampsia

Frontiers in Cardiovascular Medicine · 2026-04-01

Background: Biomarkers for predicting preeclampsia are not routinely available. Currently, preeclampsia is diagnosed with the development of clinical manifestations and proteinuria when widespread endothelial dysfunction and end-organ dysfunction have occurred. Objectives: This study aimed to (1) compare the serial changes in circulating mitochondrial cell-free DNA (ccf-mtDNA) levels between pregnant women who developed preeclampsia and healthy pregnant controls and (2) to determine if circulating microRNAs (miRNAs) previously linked to placenta development and/or preeclampsia could be detected. Methods: This single-center, nested case-control study involved singleton pregnancies less than 16 weeks of gestation at increased risk for preeclampsia, with at least one high-risk factor or two moderate-risk factors, and healthy pregnant controls. Patients were followed throughout their pregnancy, with blood collected at three time points to quantify plasma levels of ccf-mtDNA and five microRNAs (miRNAs). All patients received 81 mg aspirin daily initiated before 16 weeks of gestation. Results: The mean and standard deviation (SD) of age in years was 31.1 ± 7.5 for the preeclampsia group and 31.9 ± 5.7 for the control group. Gestational age at delivery in weeks was 36.3 ± 3.2 for the preeclampsia group and 36.9 ± 4.3 for the healthy control group. The gestational age at diagnosis of preeclampsia was 34.8 ± 3.4 weeks. Participants who developed preeclampsia had a significantly reduced amount of ccf-mtDNA in the maternal circulation compared to that in healthy pregnant controls. The reduction in ccf-mtDNA reached significance at Visit 1 (1.688 ± 1.254 copies for the preeclampsia group versus 4.014 ± 2.381 copies for 1 µL of plasma for the healthy control group), corresponding to the second trimester. ccf-mtDNA levels in the exosomal fraction remained unchanged throughout pregnancy. The plasma levels of miRNA-137 were significantly decreased in patients with preeclampsia compared to healthy pregnant controls at all time points. Conclusions: Plasma levels of miRNA-137 and ccf-mtDNA are decreased as early as the first and second trimester, respectively before the clinical diagnosis of preeclampsia in the third trimester. Early detection of changes in plasma levels of miRNAs and ccf-mtDNA could be used for early prediction of preeclampsia.

Veno-pulmonary extracorporeal membrane oxygenation for concomitant right ventricular and respiratory support: A systematic review of utilization patterns and outcomes

Perfusion · 2025-10-15

BackgroundVeno-pulmonary artery extracorporeal membrane oxygenation (V-P ECMO) is a configuration of extracorporeal life support (ECLS) for patients with isolated or predominantly right ventricular (RV) failure and inadequate gas exchange due to severe respiratory failure. We aimed to systematically review the existing literature to better understand its utilization patterns and associated outcomes.MethodsThe electronic search identified all studies reporting the characteristics and outcomes of V-P ECMO use in adult patients. Patient-level data for 110 patients from 60 case reports and case series were extracted and analyzed.ResultsThe median patient age was 45 [IQR, 32-56] years, and 63% were male. Patients most commonly presented with moderate to severe RV dysfunction (90%), along with acute hypoxic respiratory failure (64%) and severe pulmonary hypertension (23%). On presentation, 85% of patients were placed on ventilatory support for a median duration of 13 [5-32] days. V-P ECMO was initiated in the setting of a primary cardiorespiratory pathology in 75% of cases, and major chest surgery in 25% of cases. A percutaneous dual-lumen cannula was used in 64% of cases, of which 29% required an additional cannula. The median duration of V-P ECMO support was 12 [7-31] days. Overall, 42% of patients recovered, 26% underwent lung transplantation, and 9% underwent heart transplantation. In-hospital mortality was 22%. At a median follow-up time of 81 [44-181] days, overall survival was 75%.ConclusionV-P ECMO can be utilized in place of traditional ECLS strategies with favorable outcomes across various settings.

Effectiveness of Right Heart Catheterization in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock

The Journal of Heart and Lung Transplantation · 2025-04-01

HeartMate 3 left ventricular assist device infection−related left ventricular pseudoaneurysm: Extirpation in the setting of left ventricular recovery

JTCVS Techniques · 2025-01-25

Durable mechanical circulatory support (MCS) via continuous-flow (CF) left ventricular (LV) assist device (LVAD) implantation is widely applied to treat end-stage heart failure (HF).However, important drawbacks and limitations exist.Hemocompatibility-and infection-related complications remain, which are (1) contributors to longterm mortality and (2) reasons to urgently undertake heart transplantation (HT). 1 Yet, although HT is the "gold standard" therapy for end-stage HF, it is not without drawbacks/limitations.Consequently, increased attention has been focused upon achieving left ventricular (LV) functional recovery with device explantation.This case report highlights the morbidity of infectious LVAD complications, with a satisfactory outcome achieved via LVAD explantation.This is a single patient-based case report.The patient provided informed consent for publication; institutional review board approval was not required.

Heart Allograft Utilization Rates Following Donation After Circulatory Death Compared to Donation After Brain Death in the Ideal Heart Donor

Clinical Transplantation · 2025-08-01

BACKGROUND: The number of heart allografts obtained from donation after circulatory death (DCD) remains low, especially compared to donation after brain death (DBD). Our study aimed to identify factors associated with the underutilization of hearts in ideal donors. METHODS: Patient-level data were obtained from the United Network for Organ Sharing (UNOS) database for all adult deceased donors who underwent organ procurement and subsequent transplantation between January 2020 and December 2023. "Ideal" DCD donors were analyzed as a separate subset and compared with ideal DBD donors. Transplantation rates, along with associated factors, were assessed. RESULTS: The rate of heart allograft utilization was 6.9% in DCD donors compared to 35.4% among DBD donors (p < 0.001). Subgroup analysis of ideal donors demonstrated that 41% of DCD donors were utilized for heart transplantation compared to 85% of DBD donors (p < 0.001). Multivariable logistic regression analysis for heart utilization demonstrated that interventions, including extracorporeal life support (odds ratio [OR] 7.48, 95% CI 4.72-12.35) and coronary angiography (OR 2.77, 95% CI 1.76-4.39), were independent predictors of utilization. There was no significant association with hypertension (OR 0.75, 95% CI 0.52-1.06), tobacco use (OR 0.71, 95% CI 0.47-1.06), or BMI (OR 0.99, 95% CI 0.97-1.01) in the ideal DCD donor. Regional variation in donor heart utilization rates was observed. CONCLUSION: There remains a significant portion of ideal DCD donors whose hearts remain unutilized. Identifying and addressing factors related to underutilization may improve organ yield.

Incidence, risk factors and clinical outcomes of pericardial effusion in left ventricular assist device patients

World Journal of Cardiology · 2025-06-20

BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices (LVADs) can be detrimental to health outcomes. This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs. AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion. The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion. METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018. Statistical analysis was performed using Pearson χ 2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients, respectively. RESULTS The prevalence of LVAD was 9850 (0.01%) among total study patients (n = 98112095). The incidence of pericardial effusion among LVAD patients was 640 (6.5%). The prevalence of liver disease (26.6% vs 17.4%), chronic kidney disease (CKD; 54.6% vs 49.4%), hypothyroidism (21.9% vs 18.1%), congestive heart failure (98.4% vs 96.5%), atrial fibrillation (Afib; 58.59% vs 50.5%), coronary artery disease (CAD; 11.7% vs 4.4%), dyslipidemia (31.3% vs 39.3%), and having undergone percutaneous coronary intervention (PCI; 1.6% vs 0.7%) was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort. Multivariate regression analysis demonstrated that CAD (OR = 2.89) and PCI (OR = 2.2) had the greatest association with pericardial effusion in patients with LVADs. These were followed by liver disease (OR = 1.72), hypothyroidism (OR = 1.2), electrolyte derangement (OR = 1.2), Afib (OR = 1.1), and CKD (OR = 1.05). Among patients with LVADs, the median length of stay (33 days vs 27 days) and hospitalization cost (847525 USD vs 792616 USD) were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort. There was no significant difference in mortality between cohorts. The prevalence of cardiac tamponade was 109 (17.9% of LVAD patients with pericardial effusion). Ten (9.2% of LVAD patients with cardiac tamponade) patients underwent pericardiocentesis and 44 (40.3%) received a pericardial window. CONCLUSION This study shows that liver disease, CKD, PCI, hypothyroidism, electrolyte derangement, Afib, and CAD had a significant association with pericardial effusion in LVAD patients. Hospitalization cost and length of stay were higher in the pericardial effusion group, but mortality was the same.

Cardio-Microcurrent Device Treatment for Heart Failure with Reduced Ejection Fraction: Results from the C-MIC II Open-Label Randomized Controlled Trial

European Journal of Heart Failure · 2025-07-15 · 3 citations

AIMS: In patients with heart failure, alterations in electrical fields generated within the myocardium have been associated with myocardial oedema which can act as a substrate for left ventricular dysfunction. Safety and efficacy of a direct microcurrent therapy using an implanted generator (C-MIC) remain uncertain. METHODS AND RESULTS: Ambulatory patients with non-ischaemic dilated cardiomyopathy with left ventricular ejection fraction (LVEF) of 25% to 35% and New York Heart Association (NYHA) class III-IV were randomized to C-MIC (device) or control group in addition to guideline-directed medical therapy. The primary endpoint was change in LVEF at 6 months. Pre-specified secondary endpoints included 6-min walk distance (6MWD), Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS), and NYHA functional class. Of 70 patients randomized, 65 were included in modified intention-to-treat analysis (C-MIC device: n = 32; control: n = 33). At 6 months, treatment with C-MIC versus control improved LVEF (mean difference: 5.1%; 95% confidence interval [CI] 3.1-7.1%, p < 0.001). The proportions of patients with improvement in at least one NYHA class (risk difference: 68.9%; 95% CI 50.6-87.2, p < 0.001), an increase of ≥5 points in KCCQ-OSS (risk difference: 60.0%; 95% CI 42.3-77.6, p < 0.001), and an increase of ≥30% in 6MWD (risk difference: 38.3%; 95% CI 14.4-62.2) were substantially higher in the device versus control group (p < 0.002). CONCLUSIONS: In patients with non-ischaemic chronic heart failure with reduced ejection fraction, the C-MIC device compared with control improved LVEF, symptoms, functional capacity and quality of life.

Outcomes following isolated right ventricular assist device as durable support for primary right heart failure: An INTERMACS analysis

JHLT Open · 2025-04-02

Outcomes with isolated right ventricular assist devices (iRVAD) using pumps designed for the left ventricle are not well described. This study compares the clinical characteristics and outcomes of iRVAD patients to those patients treated with left ventricular assist device (LVAD) and biventricular assist devices (BiVAD). This study consisted of patients who received iRVAD from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry (2006-2017). The primary outcome was 2-year survival. Of 20,789 patients, 26 (0.13%) received iRVAD, 17 with pulsatile flow and 9 with continuous-flow devices. Device strategy was bridge to recovery/rescue therapy in 9 (35%), bridge to transplant/decision in 14 (52%), and destination therapy in 3 (12%). Twelve (46%) patients were INTERMACS profile 1, 5 patients (19%) required extracorporeal membrane oxygenation, and 13 (50%) needed mechanical ventilation. Two-year survival for patients with iRVAD (41.3%) was similar to BiVAD (45.2%) and significantly lower than LVAD (69.0%). In patients with isolated right-sided failure, long-term iRVAD support is feasible.

Ideal Body Weight Ratio for Donor‐to‐Recipient Size Matching in Heart Transplantation

Clinical Transplantation · 2025-10-25

BACKGROUND: While various models are useful for donor-recipient size matching, the optimal approach for predicting the correct match remains unclear. We sought to determine the association between ideal body weight (IBW) ratio and post-transplant survival. METHODS: The United Network for Organ Sharing (UNOS) database was queried for all patients who underwent isolated heart transplantation between July 2000 and July 2023. Donor-recipient size matching was assessed using predicted heart mass (PHM), ideal predicted heart mass (IPHM), and IBW. Ratios were stratified as undersized (≤0.8), properly sized (>0.8 to <1.2), and oversized (≥1.2). Stratified Kaplan-Meier analysis was conducted using the log-rank test. Restricted cubic splines (RCS) were constructed to evaluate the association with mortality. RESULTS: A total of 46 721 donor-recipient matches were identified. PHM demonstrated higher survival for properly sized and oversized patients compared to undersized (p < 0.01). For IPHM, survival was highest in the properly sized patients, lower in the oversized, and lowest in the undersized patients (p < 0.01). For IBW, survival was superior in properly sized group compared to undersized and oversized patients (p < 0.03). Non-linear analysis of PHM showed increased mortality risk with undersizing and decreased risk with oversizing (p < 0.01). IPHM demonstrated higher mortality risk with undersizing but no notable risk with oversizing (p < 0.01), whereas IBW showed increased risk with both undersizing and oversizing (p < 0.01). CONCLUSION: The IBW model appears to be non-inferior to PHM. IBW penalized equally for both undersizing and oversizing, making it potentially an additional useful metric in the evaluation of donor-recipient size matching.

Precise monitoring of transpulmonic resistance in bridge-to-transplant patients supported by the Aeson total artificial heart

The Journal of Heart and Lung Transplantation · 2025-02-06 · 2 citations

The Aeson total artificial heart (TAH) features embedded pressure sensors for flow autoregulation, which can also be used to estimate pressure gradients. In this bridge-to-transplant study, right and left ventricular pressure data and pump output from the TAH were analyzed to estimate transpulmonic resistance (eTPR) every 30 days. Three patients (aged 60, 35, and 54) with preimplant pulmonary vascular resistance of 7.0, 3.2, and 7.1 Wood Units, respectively, were supported by the TAH at pump outputs of 4.5 to 6.5 liter/min. All showed significant eTPR reductions (1.4-1.5 Wood Units) and received donor hearts after 243, 155, and 109 days of support. Two patients underwent successful transplants without complications; one died post transplant from pneumonia and multiorgan failure. The Aeson TAH's eTPR monitoring system offers a promising, noninvasive approach to managing pulmonary hypertension and assessing transplant eligibility in real time.