Patients undergoing coronary angiography often experience anxiety both before and during the procedure, often treated by the administration of anti-anxiety medications. A new analysis being presented at the American College of Cardiology (ACC) Middle East 2025 Together with 16^th Emirates Cardiac Society Conference found virtual reality (VR) effectively reduced anxiety during the procedure and had more stable vital signs than patients receiving standard care.

“Virtual reality offers an innovative solution to manage and reduce the anxiety of patients undergoing an interventional cardiovascular procedure, like coronary angiography, that they are typically awake during,” said Yousef Radwan Alnomani, a clinical researcher at Benha University in Benha, Egypt, and the study’s lead author.

Coronary angiography is part of a group of cardiac tests known as cardiac catheterization, which utilizes catheters to determine blockages and/or place stents in the vessels of the heart. Coronary angiography uses X-rays during the procedure to see if the blood vessel is narrowed or blocked during the diagnosis of coronary artery disease. In coronary angiography, the standard of care is to provide anti-anxiety medications to the patient before and during the procedure.

Virtual reality is a computer simulation that enables a person to interact with computer-generated 3-D visuals or other sensory environments.

Researchers analyzed data from five randomized controlled trials comprising 451 patients comparing VR to standard of care in patients undergoing coronary angiography. Some of the VR scenarios used included nature scenes like waterfalls, mountains and valleys, designed to induce a state of relaxation that may reduce anxiety and stabilize vital signs in these patients, Alnomani said. VR during coronary angiography was found to be superior to the standard of care in reducing anxiety and was associated with significantly lower changes in heart rate and blood pressure. While VR before coronary angiography did reduce anxiety, it did not show efficacy.

“Immersing patients in a 3D simulation offers better relaxation than just watching a similar video on a screen,” Alnomani said.

Limitations of the study include its retrospective nature. Larger, randomized controlled trials are needed in the future to determine the broad use of VR in improving care of patients undergoing coronary angiography and other cardiovascular interventions.

For embargoed copies of abstracts or media registration for the conference, contact Katie Glenn at kglenn@acc.org.

The American College of Cardiology (ACC) is a global leader dedicated to transforming cardiovascular care and improving heart health for all. For more than 75 years, the ACC has empowered a community of over 60,000 cardiovascular professionals across more than 140 countries with cutting-edge education and advocacy, rigorous professional credentials, and trusted clinical guidance. From its world-class JACC Journals and NCDR registries to its Accreditation Services, global network of Chapters and Sections, and CardioSmart patient initiatives, the College is committed to creating a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at www.ACC.org or connect on social media at @ACCinTouch.

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Meeting

ACC Middle East 2025 Together with 16th Emirates Cardiac Society Conference

Infective endocarditis is an inflammation of the endothelial lining of the heart, primarily involving the heart valves, precipitated by microbial infection. Despite advances in antimicrobial therapy and cardiovascular care, mortality rates remain troublingly high, largely due to delayed diagnosis and the intricate pathogenic mechanisms that have long evaded comprehensive understanding. The research group employed a proteomic lens—essentially a large-scale study of proteins expressed in biological samples—to dissect the molecular underpinnings of IE both in the bloodstream and within the vegetations, the hallmark infectious masses on heart valves.

The key innovation here is the simultaneous analysis of plasma, the liquid component of blood containing numerous proteins, and excised vegetations, complex biofilms consisting of bacterial colonies enmeshed within host proteins and immune factors. This dual-pronged proteomic characterization enabled the identification of distinct protein signatures linked to infection severity and immune response. Unlike previous single-source analyses, this integrated strategy unveils the dynamic crosstalk between circulating proteins and the localized pathological environment of the heart, revealing a more comprehensive picture of disease progression.

Using advanced mass spectrometry techniques, the team quantified thousands of proteins, rigorously comparing their abundance and interaction patterns in samples derived from IE patients against healthy controls. Among their remarkable findings was the identification of inflammation-related proteins and immune modulators that are substantially elevated in plasma during early infection stages. These biomarkers hold immense potential not only as diagnostic tools but also as guides to the molecular pathways hijacked by pathogens, offering new therapeutic targets.

Moreover, the proteomic landscape of vegetations revealed a predominantly host-driven response interwoven with microbial proteins, underscoring the complexity of the infective nidus. The presence of specific bacterial proteins within these vegetations, in conjunction with host immune factors, provides insight into how pathogens evade immune surveillance and persist despite surgical and antibiotic intervention. This knowledge is crucial because it directly informs the development of targeted therapies aimed at disrupting these protective microbial niches.

The study also breaks new ground by demonstrating how dynamic changes in plasma proteomics can reflect the evolving state of infection. Tracking these fluctuations enables clinicians to monitor disease progression or regression in real-time, potentially improving patient stratification and optimizing therapeutic regimens. This real-time monitoring capability could revolutionize clinical management by shifting from reactive to proactive treatment paradigms.

Another intriguing aspect of the work is the integration of bioinformatics analyses to interpret the vast proteomic datasets, employing network modeling to pinpoint critical nodes and hubs in the molecular interactions governing IE pathology. These computational insights elucidate the regulatory circuits that orchestrate the host-pathogen battle, shedding light on how certain proteins may amplify or mitigate inflammation and tissue damage.

The translational implications of this research are expansive. Early and accurate diagnosis has long been the Achilles’ heel of IE management; many patients suffer irreversible cardiac damage before the infection is confirmed. Proteomic biomarkers identified in plasma might soon be developed into minimally invasive blood tests, enabling clinicians to detect IE at its inception. Such diagnostic advancements would lead to earlier intervention and improved prognosis, reducing the need for aggressive surgical procedures.

Furthermore, understanding the proteomic milieu of vegetations opens new therapeutic avenues. By targeting specific proteins crucial for biofilm formation and pathogen survival, it may be possible to disrupt these infectious aggregates, enhancing antibiotic efficacy and reducing relapse rates. This approach aligns with the broader trend in infectious disease research toward precision medicine, where treatments are tailored to the molecular characteristics of individual infections.

The authors emphasize that while these findings are highly promising, further studies involving larger, diverse patient cohorts and longitudinal sampling are essential to validate these biomarkers and translate them into clinical practice. Additionally, cross-disciplinary collaboration between proteomics experts, cardiologists, microbiologists, and bioinformaticians remains vital to harness the full potential of these integrated analyses.

Notably, this research also highlights the power of proteomics as a systems biology tool, transcending IE and potentially informing investigations into other cardiovascular infections and inflammatory disorders. By comprehensively charting protein expression and interaction networks in disease contexts, researchers can uncover hidden mechanisms and therapeutic targets that traditional genomic or transcriptomic studies might miss.

In summary, the integrated plasma and vegetation proteomic characterization pioneered by He and colleagues represents a landmark achievement in the quest to conquer infective endocarditis. Their meticulous work offers unprecedented molecular insights into the pathogenesis of IE, opening doors for earlier diagnosis, improved monitoring, and novel treatment strategies. It is a testament to the transformative power of interdisciplinary research in addressing some of the most complex challenges in medicine today.

As this research moves forward, it holds the promise not only of saving lives but also of inspiring a new generation of diagnostic and therapeutic innovations. The convergence of proteomic technologies, computational analytics, and clinical application heralds a future where infections like IE may be caught in their nascent stages and defeated before catastrophic damage ensues. This study thus stands as a beacon of progress, illuminating the path toward more precise, effective cardiovascular care.

Subject of Research: Proteomic characterization of infective endocarditis through integrated plasma and vegetation protein analysis for early diagnosis and treatment.

Article Title: Integrated plasma and vegetation proteomic characterization of infective endocarditis for early diagnosis and treatment.

Article References:
He, S., Hu, X., Zhu, J. et al. Integrated plasma and vegetation proteomic characterization of infective endocarditis for early diagnosis and treatment. Nat Commun 16, 5052 (2025). https://doi.org/10.1038/s41467-025-60184-8

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