Not too much, not too little. Titrating flow rate to minimise inspiratory effort during helmet CPAP: A bench study

BACKGROUND

Non-invasive helmet respiratory support is suitable for several clinical conditions. Continuous-flow helmet CPAP systems equipped with HEPA filters have become popular during the recent Coronavirus pandemic. However, HEPA filters generate an overpressure above the set PEEP.

METHODS

A lung simulator was used to mimic patient respiratory mechanics and effort. Compared to room air spontaneous breathing, the additional inspiratory effort attributable to helmet CPAP (ΔPmusHelmet) was recorded at different continuous-flow rates (30-150 L/min), PEEP levels (5, 10, 12.5 cmH2O) and respiratory rates (15, 20, 25, 30 breaths/minute), both with and without a HEPA filter at the outlet port.

RESULTS

Helmet pressure swings during inspiration largely explained ΔPmusHelmet variations (p<0.001, Spearman's Rho=0.964). The lowest ΔPmusHelmet levels (0.2 [0; 0.4] cmH2O) were frequently recorded (>70%) at a 90 L/min flow rate. Higher ΔPmusHelmet levels were recorded when the continuous-flow was lower than the peak inspiratory flow (3.7 [3.1; 5.6] cmH2O, p<0.001) or when a HEPA filter was used (2.7 [2.2; 3.5], p<0.001). Increasing the flow rate resulted in higher overpressure levels, particularly with a HEPA filter (p<0.001). Overpressure levels correlated with ΔPmusHelmet (p<0.001, Spearman's Rho=0.598).

CONCLUSIONS

Helmet pressure swings below PEEP lead to additional inspiratory efforts. The HEPA filter acts as a flow resistor, generating an overpressure leading to increased respiratory effort. The continuous-flow rate should be titrated high enough to slightly exceed the peak inspiratory flow; however, further flow increase is not recommended as it leads to an increase in overpressure and helmet pressure swings below PEEP.

Prophylactic effects of nutrition, dietary strategies, exercise, lifestyle and environment on nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and its prevalence has risen sharply. However, whether nutrition, dietary strategies, exercise, lifestyle and environment have preventive value for NAFLD remains unclear.

METHODS

Through searching 4 databases (PubMed, Web of Science, Embase and the Cochrane Library) from inception to January 2025, we selected studies about nutrition, dietary strategies, exercise, lifestyle and environment in the prevention of NAFLD and conducted a narrative review on this topic.

RESULTS

Reasonable nutrient intake encompassing macronutrients and micronutrients have an independent protective relationship with NAFLD. Besides, proper dietary strategies including mediterranean diet, intermittent fasting diet, ketogenic diet, and dietary approaches to stop hypertension diet have their inhibitory effects on the developmental process of NAFLD. Moreover, right exercises including walking, jogging, bicycling, and swimming are recommended for the prevention of NAFLD because they could effectively reduce weight, which is an important risk factor for NAFLD, and improve liver function. In addition, embracing a healthy lifestyle including reducing sedentary behavior, not smoking, sleeping well and brushing teeth regularly is integral since it not only could reduce the risk of NAFLD but also significantly contribute to overall prevention and control. Finally, the environment, including the social and natural environments, plays a potential role in NAFLD prevention.

CONCLUSION

Nutrition, dietary strategies, exercise, lifestyle and environment play an important role in the prevention of NAFLD. Moreover, this review offers comprehensive prevention recommendations for people at high risk of NAFLD.

Effect of aspirin dosage on oxidative stress and platelet reactivity in patients undergoing coronary artery bypass grafting (APRICOT): randomized controlled trial

Coronary artery bypass grafting (CABG) triggers oxidative stress and platelet activation. High acetylsalicylic acid (ASA) dose might mitigate the transient proinflammatory state. We compared the effect of three ASA dosages on post-CABG platelet reactivity, oxidative stress, and serum CD39 and CD73 levels. Thirty-six consecutive patients undergoing elective off-pump CABG, pre-treated with ASA 1 × 75 mg for ≥7 days, were randomized to continue the prior treatment regimen, switch to ASA 1 × 150 mg, or ASA 2 × 75 mg. Blood was collected on admission, 7 days, 1 month, and 3 months after CABG. Platelet reactivity was assessed using impedance aggregometry. Platelet oxidative stress was measured as platelet mitochondria extracellular oxygen consumption rate and oxidatively damaged whole-blood DNA cleavage. Serum CD39 and CD73 levels were determined using ELISA. Platelet reactivity and oxidative stress parameters were comparable in all groups. Patients treated with ASA 2 × 75 mg had higher CD39 levels at 7 days and 1 month (p = .049, p = .033), compared to the control group. ASA 2 × 75 mg was associated a beneficial effect on serum CD39 levels after off-pump CABG, without a significant effect on oxidative stress parameters.

Ventricular-arterial coupling: changes with ageing and implications across cardiovascular conditions

PURPOSE

Ventricular-arterial coupling (VAC) is a crucial concept in cardiovascular physiology, representing the dynamic interaction between the left ventricle and the arterial system. This comprehensive literature review explores the changes in VAC with ageing and various cardiovascular diseases (CVDs).

MATERIALS AND METHODS

This literature review covers studies on changes in VAC with age and common CVDs, such as arterial hypertension, atrial fibrillation (AF) and heart failure with preserved and reduced ejection fraction and aortic stenosis (AS). The review discusses traditional measures of VAC, including arterial elastance (Ea) and ventricular elastance (Ees), as well as emerging parameters, such as global longitudinal strain (GLS) and pulse wave velocity (PWV). The review introduces the PWV/GLS ratio as a novel method for assessing VAC.

RESULTS

With ageing, both Ea and Ees increase, while the Ea/Ees ratio remains relatively stable, reflecting balanced arterial and ventricular adaptations. Novel measures, such as PWV/GLS ratio, show greater impairment in older adults and provide a comprehensive evaluation of VAC.

CONCLUSIONS

Ageing disrupts VAC through arterial stiffening and reduced heart function, often exacerbated by CVDs. Novel metrics like PWV/GLS may improve VAC assessment, helping clinicians manage age-related cardiovascular issues by identifying risks earlier and guiding treatment to support efficient heart-artery interaction.

Learning to swim with back pain: a qualitative study of swimmers with chronic low back pain

PURPOSE

Swimming is one form of exercise advised to people with chronic low back pain (CLBP), there is limited research, however, supporting this recommendation and describing the experience and use of swimming in this population. The aim of this study was to explore the experience of people who use swimming to manage CLBP.

METHODS

Semi-structure interviews were conducted with 14 swimmers who were using swimming to manage CLBP. Thematic analysis was used to analyse the interview data, and the themes were mapped onto the capability, opportunity, motivation and behaviour (COM-B) model to understand the behavioural factors.

RESULTS

Five common themes were developed during the analysis: (1) My back pain journey; (2) Learning to swim with back pain; (3) How swimming looks for me; (4) What I gain from swimming; and (5) Keep calm and carry-on swimming. The themes mapped onto all three COM-B domains.

CONCLUSIONS

The participants found that swimming was a valuable self-management tool for CLBP. The findings from the thematic and COM-B analysis indicate that learning to swim with CLBP can be a complex journey, influenced by several interrelated behavioural factors. In the absence of multi-professional support, inclusive swimming communities and accessible swimming venues, swimming participation rates may be affected.

"If you ask me … ": experienced cardiac rehabilitation patients' perspectives on maintaining regular heart-healthy physical activity

PURPOSE

Despite the proven benefits of regular exercise and physical activity (PA), engagement of cardiac patients and adherence to recommended PA remain challenging. This study aimed to interview cardiac patients who are experienced in maintaining a physically active lifestyle to gain insight into how regular PA can become part of one's life after a cardiac event.

METHODS

Twenty-five cardiac patients (18 men and 7 women; age range 39-83 years) participated in audio-recorded, semi-structured qualitative interviews. Patients were recruited from a clinical site in Salzburg, Austria, which offers ongoing weekly exercise classes under medical supervision for cardiac patients. Interview transcripts were analysed against the background of the Reasoned Action Approach and coded inductively.

RESULTS

Eight themes were generated that elucidated patients' long-term engagement with PA: well-being and physical benefits; health literacy; community, groups, and partners; attitude, expectation and mindset; professional supervision; digital technology; nice distractions; and possibility of personalized tailoring. These themes are linked to several elements of the Reasoned Action Approach, including attitude, norm, behavioural control, skills, and environment.

CONCLUSION

This study highlights important aspects with respect to shaping a positive attitude towards PA and the significance of the social environment in establishing regular PA in cardiac patients.

Smoking as a causative factor in chronic kidney disease: a two-sample Mendelian randomization study

Smoking is widely acknowledged for its harmful effects on multiple organs. However, its specific causal relationship with chronic kidney disease (CKD) remains uncertain. This study applied bivariate causal analysis and two-sample Mendelian randomization (MR) methods to examine the association between various smoking behaviors - initiation, cessation, age at initiation, cigarettes smoked per day, and lifetime smoking - and CKD, using genome-wide data. The inverse variance weighted (IVW) method was the primary analytical tool, supported by sensitivity analyses, pleiotropy assessments, and mediation analyses. External validation was conducted using independent datasets. The results revealed positive associations between CKD and smoking initiation (Pivw = 1.8 × 10-2, OR = 1.192), earlier age at initiation (Pivw = 2.3 × 10-3, OR = 1.481), cigarettes smoked per day (Pivw = 8.8 × 10-3, OR = 1.216), and lifetime smoking (Pivw = 2.3 × 10-7, OR = 2.445). In contrast, smoking cessation demonstrated a protective effect against CKD (Pivw = 4.0 × 10-12, OR = 0.791). External validation results aligned with the primary findings, and the absence of significant heterogeneity confirmed the robustness of the MR analysis. Additionally, the effect of smoking on CKD was mediated by factors such as body mass index, cardiovascular disease, hypertension, and type 2 diabetes. These findings identify smoking as a contributing factor to CKD and suggest that reducing smoking prevalence could significantly lower the incidence of CKD in the population.

Rationale and design of the anticoagulant therapy after left atrial appendage closure (ATLAAC) trial

INTRODUCTION

Left atrial appendage closure (LAAC) has become a recommended addition to oral anticoagulation for patients with atrial fibrillation, who undergo cardiac surgery. The procedure significantly reduces the risk of stroke and systemic arterial embolism, potentially making oral anticoagulation (OAC) unnecessary or even harmful, when considering the associated increased risk of bleeding. This publication describes the rationale and design of a randomized trial, testing the hypothesis that stopping OAC is noninferior to continuing OAC after surgical LAAC in terms of the primary endpoint.

METHODS

The ATLAAC trial is a multicenter, randomized, controlled trial, aiming to enroll 1,220 patients with atrial fibrillation, who have undergone surgical LAAC and remain on OAC. A cardiac CT scan is performed to confirm success of the LAAC. Patients with successful closure are randomized to stop or continue OAC. The primary endpoint is the first occurrence of ischemic stroke, systemic arterial embolism, or major bleeding over an expected mean follow-up of 4 years. Secondary endpoints include all-cause mortality, cardiovascular mortality, any bleeding leading to hospitalization, blood transfusion, venous thromboembolism, myocardial infarction, and quality of life measures.

TRIAL STATUS

Enrollment for the ATLAAC trial began in March 2024. As of January 18th, 2025, 554 patients have been enrolled in the study and 319 patients have been randomized. Recruitment is expected to continue for approximately 12 months. Follow-up will be stopped once 128 primary endpoints have occurred.

CONCLUSIONS

The ATLAAC trial will evaluate the safety of stopping OAC after surgical LAAC.

TRIAL REGISTRATION NUMBER

EU-CT: 2022-502986-92-00, clinicaltrials.gov ID: NCT06401616.

Targeted delivery of engineered adipose-derived stem cell secretome to promote cardiac repair after myocardial infarction

Stem cell secretome offers a promising alternative to stem cell transplantation for treating myocardial infarction (MI). However, its clinical application faces two major challenges: how to enhance the levels of growth factors within the secretome to promote cardiac cell survival and vascularization, and how to efficiently deliver the secretome to the infarcted heart during the acute MI phase without risking rupture of the weakened myocardium. To address these challenges, we upregulated angiogenic growth factors in the secretome from adipose-derived stem cells (ADSC-secretome) by conditioning the cells under hypoxia and with insulin-like growth factor 1 (IGF-1). Our results show that exposure to 1 % O₂ condition significantly increased the expression of VEGF, bFGF, and PDGF-BB compared to 5 % O₂ condition. Co-treatment with IGF-1 further elevated the levels of these growth factors and, notably, reduced the secretion of pro-inflammatory cytokines such as TNFα, IL-1β, and IL-6 from the ADSCs. To rapidly and specifically deliver the secretome to the infarcted heart during acute MI, we encapsulated it within ischemia-targeting nanoparticles. These nanoparticles, designed for intravenous injection, preferentially accumulated in the infarcted region. The treatment significantly improved cardiac cell survival, tissue vascularization, and cardiac function. These findings suggest that ADSC secretome, enriched with angiogenic growth factors, holds strong potential for facilitating cardiac repair following MI.

Potential role of large language models and personalized medicine to innovate cardiac rehabilitation

Cardiac rehabilitation is a crucial multidisciplinary approach to improve patient outcomes. There is a growing body of evidence that suggests that these programs contribute towards reducing cardiovascular mortality and recurrence. Despite this, cardiac rehabilitation is underutilized and adherence to these programs has been a demonstrated barrier in achieving these outcomes. As a result, there is a growing focus on innovating these programs, especially from the standpoint of digital health and personalized medicine. This editorial discusses the possible roles of large language models, such as their role in ChatGPT, in further personalizing cardiac rehabilitation programs through simplifying medical jargon and employing motivational interviewing techniques, thus boosting patient engagement and adherence. However, these possibilities must be further investigated in the clinical literature. Likewise, the integration of large language models in cardiac rehabilitation will be challenging in its nascent stages to ensure accurate and ethical information delivery.

Pathophysiology of heart failure with preserved ejection fraction in overweight and obesity - Clinical and treatment implications

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with vast prevalence worldwide. Despite recent advances in understanding its pathophysiology, HFpEF remains under-diagnosed in clinical practice. Obesity-related HFpEF is a distinct and frequent phenotype with an additionally challenging diagnosis. We address the importance of overweight and obesity in HFpEF, focusing on the influence of adipose tissue in inflammation and neurohormonal activity. We also discuss atrial and ventricular remodelling in obesity-related HFpEF and potential clinical implications. Obesity is an independent risk factor for HFpEF. Adipose tissue synthesizes aldosterone, causing lower levels of natriuretic peptide. Adipocytes dysfunction promotes a pro-inflammatory state and leads to extracellular matrix remodelling and consequently stiffening of the heart and vessels. Thus, the quantity, distribution and quality of the excess fat influences cardiovascular risk. Visceral and epicardial adipose tissue are often associated with an increased likelihood of developing HFpEF. Obesity-related HFpEF presents higher risk of left ventricular concentric remodelling and inadequate accommodation of the expanded volume due to the obesity, resulting in higher left ventricular filling pressure. Nevertheless, microvascular endothelium inflammation modifies cardiomyocyte elasticity and increases collagen deposition, which enhances myocardial fibrosis and results in HFpEF. Furthermore, neurohormonal activation may also contribute to cardiac remodelling by inducing plasma volume expansion. In turn, leptin also stimulates aldosterone synthesis and enhances renin-angiotensin-aldosterone system. Obesity-related HFpEF presents worse overall prognosis, with increased risk of heart failure hospitalization and all-cause mortality. Intentional weight loss through caloric restriction, physical activity, pharmacological intervention and/or bariatric surgery are promising strategies.

Ethanol-induced dysfunction of the mesenteric perivascular adipose tissue is driven by mineralocorticoid receptors

The renin-angiotensin-aldosterone system (RAAS) is critical in ethanol-induced vascular dysfunction. Mineralocorticoid receptors (MR) trigger ethanol-induced vascular hypercontractility through pro-oxidative and pro-inflammatory effects. However, the contribution of MR to ethanol-induced perivascular adipose tissue (PVAT) dysfunction is unknown. Appreciating the importance of MR to PVAT dysfunction in distinctive pathological conditions, we investigated whether MR would play a role in ethanol-induced PVAT dysfunction. With this purpose, male Wistar Hannover rats were treated with ethanol 20% (in volume ratio) and/or potassium canrenoate [a MR antagonist (MRA); 30 mg/kg/day, gavage] for 5 weeks. Ethanol increased the circulating levels of aldosterone and impaired acetylcholine-induced relaxation of mesenteric arteries with, but not without PVAT. Antagonism of MR prevented ethanol-induced impairment in acetylcholine relaxation as well as the reduction of leptin levels and reactive oxygen species (ROS) overproduction in the mesenteric PVAT (mPVAT) from ethanol-treated rats. Ethanol promoted neutrophil accumulation and augmented the concentration of tumor necrosis factor (TNF)-α in the mPVAT and these responses were prevented by the MRA. Functional assays showed that tiron [a scavenger of superoxide (O2•-)] and etanercept (an antibody anti-TNF-α) failed to reverse the impairment of acetylcholine-induced relaxation promoted by ethanol. In mesenteric arteries, antagonism of MR prevented ROS generation, lipoperoxidation, and increased TNF-α levels induced by ethanol. In conclusion, our findings suggest that MR is involved in ethanol-induced dysfunction of mPVAT. This study enhances our understanding of how ethanol exerts harmful effects on the cardiovascular system, highlighting PVAT as a target for these detrimental effects.

Vasoplegic Syndrome in Cardiac Surgery: A Narrative Review of Etiologic Mechanisms and Therapeutic Options

Vasoplegic syndrome, a form of distributive shock that may manifest during or after cardiopulmonary bypass, is a serious complication that increases morbidity and mortality after cardiac surgery. No consensus definition exists, but vasoplegic syndrome is generally described as a state of pathologic vasodilation causing hypotension refractory to fluid resuscitation and vasopressor therapy, and resulting in organ malperfusion despite a normal or increased cardiac output. Diagnosis can be complex as there is a broad differential diagnosis for low systemic vascular resistance in the cardiac surgical patient. Interpretation of hemodynamic data can also be challenging in the setting of mixed shock states and mechanical support. This narrative review summarizes the pathophysiology of vasoplegic syndrome, the literature concerning its incidence and risk factors, the hemodynamic parameters important to the diagnosis of vasoplegic syndrome, a consensus definition of the syndrome, and a proposed goal-directed treatment framework.

Advancing emergency upper extremity care: A pilot study of ChatGPT's potential role in diagnosing and managing hand and wrist trauma

Purpose

Hand and wrist trauma is a frequent cause of emergency room (ER) visits. However, hospitals often lack immediate hand specialist coverage. This study aims to evaluate the efficacy of Artificial Intelligence (AI) platforms like ChatGPT in aiding in the diagnosis and patient management of upper extremity trauma.

Methods

Ten clinical vignettes depicting common hand and wrist emergency clinical situations were created by the senior author to represent a broad range of common upper extremity injuries. These were presented to plastic surgery residents and ChatGPT (version 4.0). The responder was tasked to provide a diagnosis, ER management, and definitive treatment plans for each vignette. Responses were collected and scored by two attending plastic surgeons, blinded to the source, on a scale of 0 (poor) to 30 (excellent). Univariate and linear regression models were utilized for analysis.

Results

A total of 16 resident responses (9 junior and 7 senior) and 16 ChatGPT responses were collected for each of the 10 clinical scenarios. ChatGPT had significantly higher total average scores (mean = 26.6 vs. 22.7, p < 0.05) and ER management scores (mean = 9.9 vs. 6.7, p < 0.05) when compared to residents. We did not find any notable differences in diagnosis or definitive treatment scores between residents and ChatGPT responses. However, the study was not sufficiently powered to detect smaller effect sizes in these areas. No apparent correlations between scores and resident year of training were observed.

Conclusions

ChatGPT provided clinically accurate diagnosis and management plans for upper extremity trauma. Implementing AI in trauma management has the potential to improve the management of hand and wrist trauma in emergency settings by serving as a diagnostic and clinical reference tool for emergency medical providers. However, their integration into clinical practice should be carefully evaluated and focused on complementing, and not replacing, traditional consults. Ultimately, these tools could alleviate the burden placed on ERs and limit reliance on hand consults.

Machine learning risk-prediction model for in-hospital mortality in Takotsubo cardiomyopathy

BACKGROUND

Takotsubo cardiomyopathy (TC) is an acute heart failure syndrome characterized by transient left ventricular dysfunction, often triggered by stress. Data on risk scores predicting mortality in TC is sparse. We developed a machine-learning risk score model to predict in-hospital mortality in patients with TC.

METHODS

The National Inpatient Sample (NIS) database 2016-2020 was queried to identify adult patients (≥18 years) with TC using ICD-10 code I51.81. The primary outcome was in-hospital mortality. The dataset was randomly split into training (70 %), validation (20 %), and testing (10 %) dataset. Model performance was assessed using the area under the curve (AUC) with 95 % confidence intervals (95 % CI).

RESULTS

Amongst 38,662 TC patients identified [mean age 67.15 ± 14.17 years, female 32,089 (83 %)], 2499 (6.5 %) died. A novel risk score (0-127) was developed on age, race, Elixhauser comorbidity burden, history of hypertension, history of cardiac arrhythmia, presentation of cardiac arrest, cardiogenic shock, and acute kidney injury. Model AUCs (95 % CI) in the training, validation, and testing datasets were 0.809 (0.781-0.838), 0.809 (0.780-0.837), and 0.838 (0.820-0.856), respectively.

CONCLUSION

TC carries high morbidity and mortality. Our novel machine learning-based risk score is an important tool for risk stratification. External validation is needed to confirm these findings.

TagGen: Diffusion-based generative model for cardiac MR tagging super resolution

PURPOSE

The aim of the work is to develop a cascaded diffusion-based super-resolution model for low-resolution (LR) MR tagging acquisitions, which is integrated with parallel imaging to achieve highly accelerated MR tagging while enhancing the tag grid quality of low-resolution images.

METHODS

We introduced TagGen, a diffusion-based conditional generative model that uses low-resolution MR tagging images as guidance to generate corresponding high-resolution tagging images. The model was developed on 50 patients with long-axis-view, high-resolution tagging acquisitions. During training, we retrospectively synthesized LR tagging images using an undersampling rate (R) of 3.3 with truncated outer phase-encoding lines. During inference, we evaluated the performance of TagGen and compared it with REGAIN, a generative adversarial network-based super-resolution model that was previously applied to MR tagging. In addition, we prospectively acquired data from 6 subjects with three heartbeats per slice using 10-fold acceleration achieved by combining low-resolution R = 3.3 with GRAPPA-3 (generalized autocalibrating partially parallel acquisitions 3).

RESULTS

For synthetic data (R = 3.3), TagGen outperformed REGAIN in terms of normalized root mean square error, peak signal-to-noise ratio, and structural similarity index (p < 0.05 for all). For prospectively 10-fold accelerated data, TagGen provided better tag grid quality, signal-to-noise ratio, and overall image quality than REGAIN, as scored by two (blinded) radiologists (p < 0.05 for all).

CONCLUSIONS

We developed a diffusion-based generative super-resolution model for MR tagging images and demonstrated its potential to integrate with parallel imaging to reconstruct highly accelerated cine MR tagging images acquired in three heartbeats with enhanced tag grid quality.

Bioactive equivalent combinatorial components of Xiao-Xu-Ming decoction inhibit the calmodulin-mediated MLCK/MLC axis to attenuate coronary artery spasm

BACKGROUND

Coronary artery spasm (CAS) is a severe pathological disorder with limited treatment options. Inhibiting vascular smooth muscle cell (VSMC) proliferation has emerged as a promising therapeutic strategy for CAS.

PURPOSE

This study aims to investigate the potential function of Xiao-Xu-Ming decoction (XXMD) in the attenuation of CAS in rats.

METHODS

The involvement of bioactive equivalent combinatorial components (BECCs) of XXMD in CAS was predicted using network pharmacological analysis. A CAS rat model was established using pituitrin (Pit), and an Ang II-induced cell model was developed to assess the effects of BECCs on VSMC contraction. The expression of contractile phenotype markers was analyzed using RT-qPCR and Western blotting. Additionally, MTT assay, flow cytometry, Annexin V/PI staining, and Transwell assay were performed to evaluate cell proliferation, cell cycle progression, apoptosis, and migration. A collagen gel contraction assay was conducted to assess VSMC contraction.

RESULTS

Network pharmacological analysis suggested that BECCs in XXMD may influence CAS development through the Calmodulin (CaM)-MLCK/MLC axis. The drug-containing XXMD serum significantly inhibited VSMC proliferation and migration by reducing the expression of MLCK, α-SMA, Calponin, and SMHHC. Furthermore, it suppressed VSMC proliferation by downregulating MLCK expression via CaM inhibition. Importantly, BECCs of XXMD promoted anti-inflammatory responses, vasorelaxation, and oxidative stress reduction in Pit-induced CAS rats.

CONCLUSION

These findings suggest that BECCs in XXMD may counteract CAS by modulating the CaM-mediated MLCK/MLC pathway in VSMCs. This mechanism may offer a foundation for novel and effective therapeutic strategies to treat CAS and prevent associated cardiac events, such as myocardial infarction and sudden cardiac death.

NOVELTY

This study identifies a novel mechanism by which the "active ingredient cluster" of XXMD alleviates CAS through modulation of the MLCK/MLC signaling pathway via CaM. These insights enhance our understanding of XXMD's therapeutic potential in CAS treatment.

Experimental evidence on colchicine's mode of action in human carotid artery plaques

BACKGROUND AND AIMS

Atherosclerosis, driven by inflammation, is a leading cause of cardiovascular events. Recent clinical trials have highlighted the therapeutic potential of anti-inflammatory treatments. Consequently, colchicine is being recommended for secondary prevention in current guidelines, although the drug's mechanistic actions are not fully understood.

METHODS

To this end, we conducted a multiomic investigation of colchicine's effect on human carotid plaques. Sections from endarterectomy specimens were exposed to colchicine at concentrations of 2 ng/ml and 10 ng/ml ex vivo for 24 h and compared to untreated segments of the same plaque. Gene expression changes were analyzed by bulk RNA sequencing, and plaque secretomes underwent mass spectrometry for proteomic analysis. In situ cell proliferation was assessed by histology.

RESULTS

Our data indicate, that colchicine suppresses neutrophil and platelet degranulation and activation, collagen degradation and atheromatous plaque macrophage proliferation in a dose-dependent manner in human plaques, while stimulating myofibroblast activation. Unexpectedly, interleukine (IL)-1beta release from colchicine treated plaques was not reduced. These results indicate that the inflammasome may not be the predominant target of low-dose colchicine in human carotid artery plaques.

CONCLUSION

Our study identifies multifactorial pathways through which colchicine, the first cardiovascular guideline-recommended anti-inflammatory drug, predominantly acts on human atherosclerotic lesions beyond the inflammasome. Targeting neutrophil and platelet degranulation, collagen degradation and macrophage proliferation, selectively, may provide substantial therapeutic benefit in atherosclerotic cardiovascular disease without colchicine's undesired side effects.

The passability of delivery catheter system during self-expanding transcatheter aortic valve replacement: A CT-based prediction model

OBJECTIVE

Aortic anatomy may pose challenges to the advancement of the delivery catheter system (DCS) and affect the outcome of self-expanding transcatheter aortic valve replacement (SE-TAVR). This study aimed to develop a preprocedural CT-based nomogram to predict the passability of DCS and clinical SE-TAVR outcomes.

METHODS AND RESULTS

Data of 348 patients who underwent transfemoral SE-TAVR were retrospectively collected from May 2018 to December 2023. A number of 118 patients received snare catheter, indicating poor DCS passaibility. All patients were randomized to development (n = 244) and validation (n = 104) sets. A predictive model was constructed by logistic regression and presented as a nomogram, which indicated that larger aortic angle, severe calcification, larger ascending aorta diameter, coronary ostial height of ≤10 mm, and bicuspid aortic valve were independent anatomical risk factors for poor DCS passability during SE-TAVR. Subsequently, the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were depicted to assess the performance of the nomogram, revealing its good accuracy and concordance. This model also showed that patients with poor DCS passability were more likely to develop significant postprocedural paravalvular leak (PVL).

CONCLUSIONS

The model adequately predicts the DCS passability during SE-TAVR, which provides a comprehensive profile of risk factors for poor DCS passability and indicates coronary ostial height of ≤10 mm as a novel anatomical risk factor, in addition to the larger aortic angle, severe calcification, larger ascending aorta diameter, and bicuspid aortic valve. Patients with poor DCS passability are more likely to develop significant PVL.

Sex-specific differences of advanced glycation end products in diabetes

Advanced glycation end products (AGEs) are formed through non-enzymatic glycation reactions and accumulate in tissues, particularly under pathological conditions such as diabetes mellitus. These compounds are linked to the progression of diabetic complications, including nephropathy, retinopathy, and cardiovascular disease, through mechanisms such as oxidative stress and chronic inflammation. Emerging evidence suggests significant sex-specific differences in AGE formation, accumulation, and their biological effects, influenced by hormonal variations, dietary patterns, and metabolic differences. While the underlying biochemistry of AGE formation, such as the Maillard reaction and dicarbonyl compound activity, is well-characterized, the implications of these processes for clinical outcomes remain underexplored. This mini-review highlights the interplay between molecular mechanisms and sex-specific factors in AGE-related pathophysiology. It further discusses potential therapeutic approaches targeting AGE formation and receptor-mediated pathways, emphasizing the importance of integrating sex-specific considerations into diabetes management. Bridging molecular insights with clinical practice could advance personalized treatment strategies for diabetic complications.

Venous Excess Ultrasound (VExUS) score and short-term outcomes in ambulatory patients with heart failure with reduced ejection fraction: an exploratory study

BACKGROUND

Venous congestion significantly contributes to morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). The Venous Excess Ultrasound (VExUS) score, a multi-parameter sonographic assessment of systemic venous congestion, has shown prognostic utility in hospitalized HFrEF. However, its role in risk-stratifying ambulatory HFrEF patients remains unclear. This prospective exploratory study investigated the prognostic value of elevated VExUS scores in ambulatory HFrEF patients.

RESULTS

Of 109 enrolled patients, 23 (21%) had a high VExUS score (≥ 2). Patients with high VExUS scores had significantly higher rates of the primary composite endpoint of all-cause mortality or HF hospitalization within 90 days (87% vs. 19.8%, p < 0.001), worsening renal function (47.8% vs. 17.3%, p < 0.001), and unplanned visits (82.6% vs. 14.8%, p < 0.001). While dilated IVC had higher sensitivity for the primary outcome, VExUS demonstrated greater specificity, especially in patients with moderate to severe tricuspid regurgitation (TR).

CONCLUSIONS

An elevated VExUS score was associated with adverse short-term outcomes in this exploratory analysis. VExUS score may provide a more specific assessment of congestion than IVC diameter alone, particularly in the presence of significant TR, potentially improving risk stratification in this population.

Ecological risks of trace elements in sediments and Thalassia testudinum from Cartagena Bay

This study assesses the ecological risks from trace elements in sediments and Thalassia testudinum in two contrasting areas of the Colombian Caribbean: Cartagena Bay (CTG Bay), an industrialized zone, and the Rosario and San Bernardo Corals National Natural Park (RSBC-NNP), a reference site. A total of 47 trace elements were quantified using inductively coupled plasma mass spectrometry (ICP-MS). Sediment contamination was quantified through pollution indices, and bioconcentration factors (BCFs) were calculated to evaluate trace element accumulation in T. testudinum. Concentrations of most trace elements in sediments from CTG Bay exceeded those found in RSBC-NNP, with the greatest fold differences observed for Cd (16.7), Ni (3.9) and Cr (3.8). At RSBC-NNP, the highest levels were found for Sr (4.333±0.412 mg/kg), B (0.109±0.032 mg/kg) and Zn (0.040±0.006 mg/kg), whereas CTG Bay recorded the maximum values for the same elements, Sr (0.988±0.512 mg/kg), B (0.178±0.05 mg/kg), and Zn (0.081±0.016 mg/kg). T. testudinum exhibited bioaccumulation capacity for most trace elements. BCFs exceeded 1 for 41 elements analyzed in CTG Bay, with Ge, Hf, Ba, Th and Ta leading the list, compared to 15 in RSBC-NNP, headed by Mo. The Pollution factors, Geoaccumulation indexes, Enrichment factors. and the Nemerow Pollution Index confirmed the degraded state of CTG Bay sediments. These findings validate T. testudinum as a bioindicator of marine quality, and emphasize the need for continuous monitoring and mitigation strategies to protect this key species and its ecosystem.

The Impacts of Housing Conditions on the Cardiopulmonary and Neurobehavioral Responses of Mice to High Temperature and Wildfire Smoke

Climate change is a serious global public health concern that is associated with increased cardiovascular morbidity and mortality and adverse neurobehavioral outcomes. Moreover, it is contributing to increased wildfires, which pose a distinct threat to cardiovascular and respiratory health, especially in the presence of other stressors. Living conditions can be a significant nonchemical stressor that alters physiology and impacts wildfire smoke responsiveness, especially when combined with ambient heat. To determine the combined impact of housing and temperature on behavioral health and the cardiopulmonary response to wildfire smoke (WS), female mice were split into enriched (EH) and depleted housing (DH) at normal (NT) and high temperatures (HT) for 20 weeks and assessed at baseline and after a single filtered air (FA) or WS exposure. Separate radiotelemetered mice were similarly housed for 4 weeks and then exposed to FA sham and then WS. EH mice had higher activity and body temperature and lower heart rate at NT, and these effects were blocked at HT. HT-DH mice had an increased heart rate variability following WS and increased arrhythmias. Interestingly, HT-EH caused increased anxiety-like behavior. Thus, although EH likely protects cardiopulmonary health, it might also negatively impact the behavior at HT in mice. As such, the living temperature and housing conditions should be carefully considered when assessing susceptibility to disease and environmental exposures.

Leptin promoter G2548A variant, elevated plasma leptin levels, and increased risk of Type 2 diabetes with CAD in Iranian patients: A genetic association study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a significant risk factor for coronary artery disease (CAD). Leptin polymorphism is known to be associated with obesity and Type 2 diabetes mellitus. This study aimed to investigate the possible links between a specific leptin polymorphism (LEP 2548G/A) and plasma leptin level with the risk of Type 2 diabetes mellitus patients with CAD in the Iranian population for the first time.

METHODS AND RESULTS

A total of 150 patients with Type 2 diabetes mellitus and CAD were included in the study, along with 150 nondiabetic controls. Blood samples were collected from participants. Biochemical analysis and genotyping were done using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The plasma leptin level was higher in females in the case group. There was a positive correlation between females and obese diabetic subjects (P < 0.001). Regarding the single-nucleotide polymorphism in the leptin gene promoter, we found that the variant genotypes AA and GG were associated with a twofold (OR = 2.09, P = 0.006) and fourfold (OR = 4.2, P = 0.017) increased risk of Type 2 diabetes mellitus patients with CAD, respectively. The GG genotype was also associated with obesity and higher plasma leptin level in the case group (OR = 4.92, P < 0.001).

CONCLUSIONS

Leptin G2548A and plasma leptin levels may contribute to Type 2 diabetes with CAD in the Iranian population.

Platelets in preeclampsia: an observational study of indices associated with aspirin nonresponsiveness, activation and transcriptional landscape

BACKGROUND

Platelets play critical roles in the pathogenesis of preeclampsia, including thrombosis, endothelial dysfunction and inflammation. However, preeclampsia-associated changes in platelet gene expression and activation at the maternal-foetal interface remain unknown. Moreover, aspirin nonresponsiveness in high-risk pregnancies underscores the need for low-cost biomarkers to identify nonresponders. Nevertheless, the changes of platelet indices in women who develop preeclampsia despite aspirin prophylaxis have not yet been evaluated. In this study, we aimed to investigate the changes in platelet indices associated with aspirin nonresponsiveness, activation state and transcriptional landscape in preeclampsia.

METHODS

Platelet indices were compared between aspirin-responsive and nonresponsive women. Logistic regression analysis was performed to determine the associations between platelet indices and aspirin nonresponsiveness. Opal immunofluorescence staining was performed to evaluate the expression of platelet-specific (CD42b) and activation (CD62P) markers in placental villous and decidual tissues. RNA sequencing (RNA-seq) was performed to investigate the transcriptomic profile of platelets.

RESULTS

A decrease in platelet count (PC) during the second trimester as well as an increase in mean platelet volume (MPV) and a lower PC/MPV ratio in the third trimester were significantly associated with the subsequent development of aspirin nonresponsiveness. We observed significantly greater expression of CD62P in the placental villous and CD42b in the decidua of the preeclamptic group than in those of the nonpreeclamptic group. Colocalization analysis of CD42b and CD62P revealed that the preeclamptic placenta and decidua presented significant platelet activation. RNA-seq analysis revealed a total of 20, 618 and 1819 transcripts in the peripheral blood, placental villous and decidua of preeclamptic women, respectively. Functional analysis revealed that the PI3K-Akt and Wnt signalling pathways were significantly enriched in the placental villous and decidua of preeclamptic patients, respectively. RT‒qPCR analysis confirmed the upregulation of FKBP5, LAMA5, FZD5 and FGG mRNA expression in preeclampsia.

CONCLUSIONS

Our findings suggest that PC in the second trimester and PC, MPV and PC/MPV ratio in the third trimester may be useful for assessing aspirin nonresponsiveness in women at high risk of preeclampsia. Furthermore, our findings demonstrate that preeclampsia is associated with increased platelet activation and significant enrichment of signalling pathways involved in platelet activation.

Characterisation of a large, single-centre cohort of patients with Becker muscular dystrophy to inform standardised care guidelines

AIMS

This retrospective, cross-sectional study aimed to characterise a large cohort of paediatric and adult patients with Becker muscular dystrophy (BMD) to inform clinical care.

RESULTS

The analysis included data from 163 male patients with genetically confirmed BMD followed up at a highly specialised neuromuscular centre between 1982 and 2023. The mean age at last neuromuscular assessment was 33.2 years (range 1.4-86.3). Large deletions in the DMD gene were the most common variants (78% of cases), followed by large duplications and small variants, each accounting for 11% of cases. BMD diagnosis was prompted by skeletal muscle symptoms in 52.2% of cases, a positive family history in 27.6%, neuropsychiatric issues or diagnoses in 9.7%, incidental findings in 6.7%, and cardiomyopathy in 3.8%. Twenty-three percent of patients were non-ambulant at last evaluation, with a mean age at loss of ambulation (LoA) of 42.2 years (range 11.2-77.6 years). Disease duration correlated with the severity of motor impairment (expressed as fully ambulant, ambulant with limitation, ambulant with aids, non-ambulant) at last assessment. Cardiac involvement was observed in 52.3% of patients. Severe respiratory impairment was rare and more prevalent in non-ambulant patients. Neuropsychiatric issues were common (44.2%), but only 18.4% of patients had a formal diagnosis.

CONCLUSIONS

Retrospective analyses of clinical case records contribute to improved understanding of the variability of phenotypes of BMD. Combined with data from other large cohorts, these findings can contribute to the development of standard of care guidelines for BMD and inform the design of clinical trials of novel therapies.

Plasma-Supplemented Red Cell Concentrates as Alternatives to Whole Blood in Porcine Ex Vivo Heart Perfusion

BACKGROUND

Normothermic ex vivo organ perfusion holds promise for increasing the organ donor pool, however standard use of autologous whole blood (WB) presents logistical and functional challenges. This study compared red cell concentrate (RCC)-, rejuvenated RCC-, and WB-based perfusates over a 4-hour ex vivo heart perfusion (EVHP) to assess blood quality and its impact on myocardial function.

METHODS

Porcine WB was leukodepleted and hypothermically stored until perfusion. RCCs were divided into five perfusate groups (n=3, unless otherwise indicated): (A) WB with 14-day-stored RCCs (n=2), (B) 14-day-stored RCCs alone, (C) 14-day-stored RCCs with plasma, (D) day-14 rejuvenated RCCs, perfused on day 14 of storage with plasma, (E) day-14 rejuvenated RCCs, perfused on day 21 of storage with plasma. All groups were compared to WB (n=5). At the start, and after 4 hours of perfusion, measurements of coronary flow, cardiac index, oxygen extraction, oxygen consumption, metabolites, RBC indices, hemolysis, extracellular potassium, methemoglobin, p50, morphology, osmotic fragility, and deformability were collected.

RESULTS

Plasma-containing perfusates showed increased coronary flow, cardiac index, and initial oxygen consumption. After four hours, glucose concentrations in RCC-based solutions decreased, while hemolysis increased in most groups. Both rejuvenated RCC groups had lower extracellular potassium concentrations and improved oxygen affinity. WB-based perfusates demonstrated better RBC deformability and reduced fragility.

CONCLUSIONS

Plasma is crucial for maintaining perfusate and myocardial quality in porcine EVHP models. RCC-based perfusates alongside plasma offer comparable quality to WB, potentially addressing some of the logistical challenges faced by EVHP, though this remains to be translated to humans.

Cardiac cephalalgia-headache as an atypical presentation of ST-segment elevation myocardial infarction: a case report

BACKGROUND

Ischaemic heart disease commonly presents with chest pain and autonomic symptoms; however, atypical manifestations can occur. Cardiac cephalalgia is a rare presentation of acute coronary syndrome, characterised by a migraine-like headache triggered by myocardial ischaemia. Diagnosis requires a high index of suspicion.

CASE PRESENTATION

We describe a 47-year-old man with diabetes and a history of smoking who presented with an acute, severe frontotemporal headache accompanied by nausea and vomiting. Electrocardiography revealed ST-segment elevation in the inferior leads. Coronary angiography demonstrated multivessel coronary artery disease involving the right coronary artery and the left anterior descending artery. A subsequent measurement of serum troponin I confirmed myocardial injury. Both arteries were successfully stented, leading to clinical improvement and resolution of the headache.

CONCLUSIONS

This case highlights the importance of considering cardiac causes in patients presenting with severe headaches particularly in those with cardiovascular risk factors.

Unraveling the genetic blueprint of doxorubicin-induced cardiotoxicity through systems genetics approaches

BACKGROUND

Anthracycline-induced cardiotoxicity (ACT) is a significant concern for cancer survivors, while genetic basis of ACT remains unclear. This study employs a murine genetic reference population (GRP) of BXD recombinant inbred strains, derived from DBA/2J (D2) and C57BL/6J (B6) crosses, to map quantitative trait loci (QTLs) linked to doxorubicin (DOX)-induced phenotypes through systems genetics approaches.

METHODS

To model variability in ACT, 58 BXD strains and parental B6 and D2 mice (n ≥ 4 mice/sex/strain, 3-4-month-old) underwent an intraperitoneal injection of DOX (20 mg/kg). Survival and body weight (BW) were monitored for 10 days. Echocardiography was performed before treatment and on Day 5 post-treatment, followed by genetic mapping and Mendelian randomization analyses for identifying QTLs and candidate genes associated with DOX-induced traits and severity.

RESULTS

Parental B6 strain had 60% survival, whereas 24% of D2 mice survived on Day 10. Among BXD strains, median survival varied, with BXD77 showing the lowest at Day 4. Echocardiography revealed cardiac dysfunction and a small-heart phenotype resembling ACT patients. Significant QTLs on Chromosome 10 (86-94 Mb), Chromosome 19 (52.5-54.2 Mb) and on Chromosome 14 (103-120 Mb) were associated with the survival, mean BW loss, and left ventricular (LV) volumes and ejection fraction (EF%), respectively. MR analysis identified significant causal associations between the genes implicated in BW loss (ADD3, HSPA12 A, SLC18 A2, PDZD8, DUSP5, CASP7) as well as EF% and LV volumes (GPC6, UGGT2, SLAIN1, POU4 F1, MBNL2) in BXD mice post-DOX and heart failure outcomes in humans. Most of the top candidates showed cardiomyocyte specific expression based on scRNA-seq data.

CONCLUSIONS

Survival, BW loss, and echocardiography parameters considerably varied among DOX-treated BXDs, suggesting significant influence of genetic background on expression of those traits. Several candidate genes that may modulate ACT susceptibility and heart failure were identified, providing a foundation for genetic-based risk stratification and therapeutics in cardio-oncology.

Coronary microvascular dysfunction and its role in heart failure with preserved ejection fraction for future prevention and treatment

Ischemic heart disease has long been established as the leading cause of heart failure, typically as a result of hemodynamically significant and obstructive coronary anatomy. Since, the role of dysfunctional coronary microvascular pathophysiologic mechanisms have also been associated with the development of congestive heart failure (CHF), most notably heart failure with preserved ejection fraction (HFpEF) although with limited clinical evidence. Conventional cardiometabolic and behavioral risk factors common to HFpEF such as diabetes mellitus (DM), obesity, hypertension, dyslipidemia, smoking, and chronic kidney disease foster a pro-inflammatory environment conducive to endothelial dysfunction and improper regulation of vasoactive substances. The impaired relaxation and increased vasoconstriction of damaged endothelium gives rise to impaired coronary blood flow and episodes of transient ischemia. Such coronary microvascular dysfunction (CMD) has its own implication on cardiovascular pathophysiologic mechanisms beyond symptomatic coronary and myocardial ischemia, and thus its own potential prevention goals and treatment targets for patients with HFpEF, where previous management had been limited. As such, we conducted a literature review to address the current landscape of data which links CMD to HFpEF. Furthermore, we considered the implications of biopsychosocial elements such as race, ethnicity, sex, gender, and the social determinants of health as they relate to the disparate health outcomes of those most at risk for CMD and HFpEF.

A rare case of biatrial myxoma in an 11-year-old girl patient with thromboembolic stroke: A case report

INTRODUCTION

Cardiac myxomas (CM) are benign primary tumors typically found in the left atrium, but biatrial myxomas are exceptionally rare, comprising only 3-5 % of cases. This report highlights the rarity of biatrial myxomas in a young patient, the importance of early recognition due to the risk of thromboembolic events, which can lead to stroke. Excellent surgical intervention is needed to prevent CM recurrences.

CASE PRESENTATION

An 11-year-old girl presented with sudden onset of left-sided hemiparesis, aphasia, right-sided facial drooping, cephalgia, palpitations, nausea, and intermittent chest pain over the past two months. Laboratory examination revealed anemia and elevated D-Dimer. Echocardiography and cardiac CT demonstrated large masses in the right and left atrium, suggesting myxomas. The patient was diagnosed with biatrial myxomas complicated by thromboembolic stroke.

CLINICAL DISCUSSION

Complete mass evacuation was performed through median sternotomy. Histopathology examination confirmed CM.

CONCLUSION

This case emphasizes the importance of early detection, detailed examination and surgical intervention of biatrial myxomas, especially in young patients, to prevent and manage life-threatening thromboembolic complications and recurrence of CM. Timely intervention is crucial for ensuring favorable outcomes.

Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF

AIMS

Inter-atrial block (IAB), a marker of electrical atrial dysfunction, is associated with an increased risk of atrial fibrillation (AF) and adverse events in various populations. The prognostic impact of IAB in heart failure (HF) with preserved ejection fraction (HFpEF) remains unknown. The aim of this study is to determine the prevalence of IAB and the association of IAB and AF with adverse events in HFpEF across different healthcare settings.

METHODS AND RESULTS

To identify electrical atrial dysfunction, baseline ECG's and medical history were analysed in HFpEF patients in an ambulatory setting and after recent HF hospitalisation. Patients were categorised into (i) HFpEFNo IAB, (ii) HFpEFIAB, or (iii) HFpEFAF. Adverse events included HF hospitalisation, cardiac/sudden death and a composite of both. The ambulatory cohort included 372 patients [mean age 75 ± 7 years, 252 (68%) females]. The recently hospitalised cohort included 132 patients [mean age 81 ± 10 years, 80 (61%) females]. Ambulatory patients included 17 (4%) HFpEFnoIAB, 114 (31%) HFpEFIAB and 241 (65%) HFpEFAF, while recently hospitalised patients included 31 (23%), 73 (55%) and 28 (21%), respectively. After 33 months of follow-up of ambulatory patients, composite endpoints occurred in 0 (0%) HFpEFnoIAB, 12 (11%) HFpEFIAB [HR 4.1 (95% CI 0.5-522.6)] and 59 (24%) HFpEFAF patients [HR 10.1 (95% CI 1.5-1270.4), P < 0.001]. Recently hospitalised patients showed a similar trend, with composite endpoints in 10 (32%) HFpEFnoIAB, 31 (42%) HFpEFIAB (HR 1.5 [95% CI 0.7-3.1]) and 22 (79%) HFpEFAF (HR 3.8 [95% CI 1.8-8.1], P < 0.001).

CONCLUSIONS

Progressive stages of electrical atrial dysfunction appeared to be prognostic markers of adverse outcomes in ambulatory and recently hospitalised patients with HFpEF. Ambulatory patients with HFpEF and no early stages of electrical atrial dysfunction showed to be at very low risk for adverse outcomes. Whether such patients benefit less strict management remains to be investigated.

Bone mechanical loading reduces heart rate and increases heart rate variability in mice

Cardiovascular disease and osteoporosis are clinically associated. Bone adapts to mechanical forces by altering its overall structure and mass. In response to mechanical strain bone cells release signaling molecules and activate the nervous system. Bone also exhibits endocrine functions that modulate a number of tissues including the heart. We hypothesized that bone mechanical loading acutely alters cardiac function via neural and/or endocrine mechanisms. To test this hypothesis, we performed in vivo tibia mechanical loading in anesthetized mice while monitoring heart parameters using electrocardiogram (ECG). An immediate, transient reduction in resting heart rate was observed during tibial loading in both adult male and female mice (p < 0.01) with concurrent increases in heart rate variability (HRV) (p < 0.01). ECG intervals, PR, QRS and QTc were unaffected with loading. In further studies, we found that at least 3 N of load was necessary to elicit this heart response in adult mice. With aging to 11-12 months the responsiveness of the heart to loading was blunted, suggesting this bone-heart connection may weaken with age. Administration of lidocaine around the tibia significantly diminished the heart rate response to bone loading (p < 0.05). Moreover, pre-treatment with sympathetic antagonist propranolol inhibited this heart rate response to loading (p < 0.05), while parasympathetic antagonist atropine did not (p > 0.05). This suggests that a neuronal afferent pathway in the hindlimb and reduction in efferent sympathetic tone mediate this bone-neuro-heart reflex. In conclusion, the findings that tibia bone loading age-dependently modulates heart function support the concept of physiological coupling of the skeletal and cardiovascular systems.

Sodium-glucose cotransporter 2 inhibitors in the treatment of heart failure patients: A systematic review and meta-analysis of cost-utility studies

AIMS

Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have shown promise in reducing cardiovascular mortality and hospitalization due to heart failure (HF), a significant global health issue. This study aims to evaluate the incremental net benefit (INB) of SGLT-2i in HF patients through a systematic review and meta-analysis of cost-utility studies.

METHODS

We searched five databases from their inception until Aug 30, 2024, economic evolution studies reporting cost-effectiveness and cost-utility analyses comparing SGLT-2i combined with standard triple-therapy versus standard triple-therapy alone in HF patients were selected. INB as the primary outcome was calculated in monetary units adjusted for purchasing power parity in 2022 US dollars.

RESULTS

This review included 46 studies, with 41 studies (55 comparisons) pooled into meta-analysis. Adding SGLT2is was cost-effective compared to standard triple-therapy alone, from both healthcare system perspective (INB, $4042.08; 95 % CI, $1758.70-$6325.46) and payer perspective (INB, $12,972.84; 95 % CI, $4711.5-$21,234.22). However, subgroup analyses showed non-significant economic benefit in HF patients with preserved ejection fraction (HFpEF) both from the healthcare system perspective (INB, -$639.32; 95 % CI, -$1850.09-$571.44) and the payer perspective (INB, $3611.07; 95 % CI, -$208.49-$7430.64). Additionally, HF patients from low- and middle-income countries did not show significant economic benefit from the payer perspective (INB, $55,645.70; 95 % CI, -$51,000.00-$160,000.00).

CONCLUSIONS

The findings suggest that adding SGLT-2i is cost-effective compared to conventional standard triple-therapy alone, from both healthcare system and payer perspectives. Nevertheless, the economic benefits are limited in HFpEF and those from low- and middle-income countries. Further research is needed to explore the cost-effectiveness from a broader societal perspective.

Balancing privacy and health integrity: A novel framework for ECG signal analysis in immersive environments

The widespread use of immersive technologies such as Virtual Reality, Mixed Reality, and Augmented Reality has led to the continuous collection and streaming of vast amounts of sensitive biometric data. Among the biometric signals collected, ECG (electrocardiogram) stands out given its critical role in healthcare, particularly for the diagnosis and management of cardiovascular diseases. Numerous studies have demonstrated that ECG contains traits to distinctively identify a person. As a result, the need for anonymization methods is becoming increasingly crucial to protect personal privacy while ensuring the integrity of health data for effective clinical utility. Although many anonymization methods have been proposed in the literature, there has been limited exploration into their ability to preserve data integrity while complying with stringent data protection regulations. More specifically, the utility of anonymized signal and the privacy level achieved often present a trade-off that has not been thoroughly addressed. This paper analyzes the trade-off between balancing privacy protection with the preservation of health data integrity in ECG signals focusing on memory-efficient anonymization techniques that are suitable for real-time or streaming applications and do not require heavy memory computation. Moreover, we introduce an analytical framework to evaluate the privacy preservation methods alongside health integrity, incorporating state-of-the-art disease and person identifiers. We also propose a novel metric that assists users in selecting an anonymization method based on their desired trade-off between health insights and privacy protection. The experimental results demonstrate the impact of the de-identification techniques on critical downstream tasks, such as Arrhythmia detection and Myocardial Infarction detection along with identification performance, while statistical analysis reveals the biometric nature of ECG signals. The findings highlight the limitations of using such anonymization methods and models, emphasizing the need for approaches that maintain the clinical relevance of ECG data in real-time and streaming applications, particularly in memory-constrained environments.

Validation of a biomarker-based mortality score for cardiogenic shock patients: Comparison with a clinical risk score

AIMS

Cardiogenic shock (CS) is the deadliest manifestation of acute heart failure, with persistently high mortality rates and a lack of recent therapeutic breakthroughs. Accurate risk prediction is crucial in clinical decision-making and the design of future clinical trials. We aimed to validate the CLIP score, a biomarker-based risk score comprising cystatin C, lactate, interleukin-6 and NT-proBNP, for predicting mortality in acute coronary syndrome (ACS) related CS, and to compare its predictive value with the previously published CardShock risk score.

METHODS AND RESULTS

The study is a post hoc analysis of the CardShock Study, a prospective, observational European multicentre study on CS. The CLIP score was calculated 12 h after hospital admission, and its ability to predict 90-day mortality was assessed using are under the curve (AUC) of the receiver-operating characteristics (ROC) curve analysis. The discriminative ability of the CLIP score was compared with the CardShock risk score by comparing the AUC's. The cohort was dichotomized into low and high risk groups by the optimal cut-off value derived from the ROC analysis of the CLIP score. Kaplan-Meier curves were constructed to evaluate risk stratification when combining the CLIP and CardShock risk scores. The cohort (n = 121) comprised 77% (n = 93) men and the median age was 67 years (IQR 61-76). A total of 21% (n = 25) of the patients had non-ACS related CS. The CLIP score demonstrated appropriate predictive accuracy for 90-day mortality (AUC 0.84, 95% CI 0.77-0.91), comparable with the CardShock risk score (AUC 0.77 [95% CI 0.69-0.85]; P = 0.064 for comparison). A CLIP score cut-off of 0.28 stratified patients into high risk (65% mortality) and low risk (16% mortality) groups. In addition, incorporating the CLIP score enhanced risk stratification in all CardShock risk score categories.

CONCLUSIONS

The CLIP score, calculated within 12 h of hospital admission, accurately predicted 90-day mortality in CS and complemented the CardShock risk score. The biomarker-based score has potential utility in dynamic mortality risk assessment and could inform clinical management and trial design.

Fluid-structure interaction simulations in patient-specific coronary arteries with aneurysms: Viscoelastic or shear-thinning property of blood

BACKGROUND AND OBJECTIVE

Coronary artery aneurysm is a progressive and often asymptomatic condition with a prevalence ranging from 0.3 % to 5 %. This condition can lead to severe and potentially fatal complications. Given the challenges of conducting experiments on real patients, numerical simulations have emerged as a valuable alternative. This study aims to enhance the accuracy of hemodynamic analysis and fluid-structure interaction assessments by incorporating the viscoelastic properties of blood, which are often overlooked, in simulations of the right coronary artery with various aneurysm morphologies.

METHODS

This research employs numerical simulations to analyse the hemodynamics and assess the one-way coupled fluid-structure interaction within the right coronary artery. The study utilised the simplified Phan-Thien/Tanner model to represent the viscoelastic properties of blood. Different aneurysm morphologies were simulated, and the results were compared with those obtained using the widely recognised Carreau model. The analysis focused on the time-average wall-shear stress, as well as the stress and deformation experienced by the aneurysm wall.

RESULTS

The hemodynamic analysis demonstrated that the simplified Phan-Thien/Tanner model produced similar flow patterns to the Carreau model but resulted in a significant reduction of approximately 50 % in the time-average wall-shear stress. This reduction aligns with previous findings. Additionally, the study revealed substantial differences in the stress and deformation of the aneurysm wall, with the simplified Phan-Thien/Tanner model proving more accuracy. The largest deformations were observed in aneurysms with incipient and fusiform shapes, particularly in the divergent section of the proximal region. In the case of saccular aneurysms, the most compromised area was identified not within the aneurysm sac itself, but in the region of the artery just upstream.

CONCLUSIONS

Incorporating the viscoelastic properties of blood into fluid-structure interaction simulations significantly improves the accuracy of hemodynamic and structural assessments of coronary artery aneurysms. This study underscores the importance of considering these properties when evaluating aneurysm behaviour, which could have important implications for understanding the progression and potential rupture of aneurysms, thereby guiding more effective clinical interventions.

From lipids to glucose: Investigating the role of dyslipidemia in the risk of insulin resistance

Dyslipidemia is recognized as one of the most prevalent metabolic disorders and is frequently associated with other prevalent conditions, particularly diabetes mellitus. There appears to be a bidirectional connection between these two metabolic disorders. While considerable research has focused on how insulin resistance can lead to lipid abnormalities, the reverse relationship specifically, how dyslipidemia could assist in developing insulin resistance and diabetes mellitus has received relatively less attention. This review aims to comprehensively evaluate the mechanisms through which dyslipidemia can induce insulin resistance. Dyslipidemia is primarily classified into three main categories: hypercholesterolemia, hypertriglyceridemia, and low levels of HDL. These conditions may promote insulin resistance across multiple pathways, including the accumulation of lipid metabolites, dysfunction of pancreatic β-cells, increased reactive oxygen species, endoplasmic reticulum stress and inflammation, endothelial dysfunction, alterations in adiponectin levels, changes in bile acid composition and concentration, and dysbiosis of gut microbiota. However, further investigation is required to fully elucidate the cellular and molecular mechanisms underlying the relationship between lipid disorders and insulin resistance. Emphasizing such research could facilitate the development of therapeutic strategies targeting both conditions simultaneously.

[Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year]

BACKGROUND

Heart failure (HF) is a severe condition associated with high rates of hospitalization and mortality. Early outpatient detection of symptoms and weight gain through remote medical monitoring of HF (HF-RM) could improve patient prognosis.

OBJECTIVES

To evaluate the effectiveness of HF-RM in managing congestion in HF outpatients and to analyze event rates over 12 months (HF-related hospitalizations and all-cause mortality), as well as associated costs.

METHODS

We included patients enrolled in the HF-RM at our hospital from July 2020 to December 2022. For each patient, HF-RM relied on daily transmission of weight and symptoms via a connected scale. Any alerts related to weight gain or the onset of new symptoms were managed within 48 hours by the specialized HF team, including a telephone contact, NT-proBNP testing, and treatment adjustment if necessary. Data on HF-related hospitalizations and vital status were collected over a 12-month period before and after the implementation of HF-RM. Event rates were compared to expected values at the onset of HF-RM, based on patient profiles and data from the ESC-HF-LT registry. Cost analysis included costs associated with HF-RM, the specialized HF nurse, biological tests, and HF hospitalizations.

RESULTS

Among the 147 patients included, the average age was 60 ± 12 years, and 75% were male. The average ejection fraction (EF) was 33 ± 11%, with 76% of patients presenting with reduced EF. During the HF-RM period, 85 alerts (54% of patients) led to a significant reduction in weight and symptoms within 30 days. The hospitalization rate decreased from 44.9% before the initiation of HF-RM to 11.6% afterward (p < 0.0001). The 12-month event rate was 15%, significantly lower than the expected 24.5% (p = 0.0002). The absence of transmitted alerts was strongly correlated with the absence of events (negative predictive value of 95.2%). The number of days spent at home increased, and costs significantly decreased.

CONCLUSION

HF-RM is associated with improved outpatient congestion control, reduced hospitalizations, and decreased healthcare costs. Further prospective, randomized studies are needed to better assess the impact of HF-RM on the progression of HF and its costs.

Prospective ultrasonographic evaluation of femoral and vastus intermedius muscles as predictors of ICU-acquired weakness in critically ill patients

PURPOSE

Intensive care unit-acquired weakness (ICU-AW) is associated with poor functional outcomes and increased healthcare costs. This study aimed to evaluate the diagnostic performance of muscular ultrasound (MUS) measurements in predicting ICU-AW and identify potential predictors.

METHODS

Forty-three surgical and medical ICU patients underwent serial MUS measurements of the femoral cross-sectional area (Fcsa) and femoral + vastus intermedius thickness (F + VIth) on days 1, 3 and 5 post-ICU admission. Patients were categorized as having ICU-AW (Medical Research Council (MRC) sum score < 48 at discharge) or not. Univariate and multivariate logistic regression analyses were performed to identify predictors of ICU-AW. The diagnostic performance of MUS measurements was assessed via receiver operating characteristic (ROC) curves. Clinical outcomes (ICU length of stay, ventilator days, extubation failure) were compared between the groups.

RESULTS

Patients with ICU-AW (n = 12, 28%) showed a significant reduction in the Fcsa from Day 1 to Day 5 (p < 0.001). Univariate analysis revealed significant associations between ICU-AW and the Apache II score (OR 1.12, p = 0.03), SOFA score (OR 1.32, p = 0.008), and Day 1 F + VIth score (OR 0.23, p = 0.05). Multivariate analysis confirmed a significant association with the SOFA score (OR 1.35, p = 0.04) and a trend toward an F + VIth score of Day 1 (OR 0.12, p = 0.09). The day 1 Fcsa and F + VIth demonstrated moderate predictive capabilities for ICU-AW (ROC-AUC values of 0.72 and 0.82, respectively). ICU-AW patients experienced longer ICU stays, more ventilator days, and higher extubation failure rates.

CONCLUSION

Preexisting low muscle mass, combined with a high SOFA score, may be a stronger predictor of ICU-acquired weakness than the degree of subsequent muscle loss.

Unveiling the therapeutic journey of snail mucus in diabetic wound care

A diabetic wound (DW) is an alteration in the highly orchestrated physiological sequence of wound healing especially, the inflammatory phase. These alterations result in the generation of oxidative stress and inflammation at the injury site. This further leads to the impairment in the angiogenesis, extracellular matrix, collagen deposition, and re-epithelialization. Additionally, in DW there is the presence of microbial load which makes the wound worse and impedes the wound healing cycle. There are several treatment strategies which have been employed by the researchers to mitigate the aforementioned challenges. However, they failed to address the multifactorial pathogenic nature of the disease. Looking at the severity of the disease researchers have explored snail mucus and its components such as achacin, allantoin, elastin, collagen, and glycosaminoglycan due to its multiple therapeutic potentials; however, glycosaminoglycan (GAGs) is very important among all because they accelerate the wound-healing process by promoting reepithelialization, vascularization, granulation, and angiogenesis at the site of injury. Despite its varied applications, the field of snail mucus in wound healing is still underexplored. The present review aims to highlight the role of snail mucus in diabetic wound healing, the advantages of snail mucus over conventional treatments, the therapeutic potential of snail mucus, and the application of snail mucus in DW. Additionally, clinical trials, patents, structural variations, and advancements in snail mucus characterization have been covered in the article.

Pump-Induced Hemolysis of Speed Modulated Axial-Flow Left Ventricular Assist Devices

BACKGROUND

Reduced arterial pulsatility during continuous-flow left ventricular assist device (LVAD) support is associated with certain adverse events. An approach to increase arterial pulsatility is pump speed modulation. Therefore, this in vitro study compares the pump-induced hemolysis of constant speed and modulated speed modes for two different axial-flow LVADs. Furthermore, the hemolytic performance of both LVADs is compared.

METHODS

Two Sputnik1 and two HeartMate2 (HM2) axial-flow LVADs were operated simultaneously for 6 h in automated hemolysis test benches (n = 7 for each mode). Rectangular speed patterns with modulation rates of 70 and 140 bpm were investigated. Speed modulation amplitudes provided head pressures between 80 and 120 mmHg. To quantify hemolysis, plasma-free hemoglobin was determined every hour and the modified index of hemolysis (MIH) was calculated.

RESULTS

Speed modulation increased all MIH values of the Sputnik1 LVADs, but decreased most MIH values of the HM2 LVADs compared to the constant speed mode. However, significant differences were only observed for one Sputnik1. Furthermore, the Sputnik1 pumps induced lower MIH levels compared to the HM2 pumps using constant speed mode.

CONCLUSIONS

It seems that the HM2 can be operated in speed modulation mode without an increased risk of hemolysis. However, for the Sputnik1, the potential benefits of speed modulation must be balanced against the risk of increased hemolysis. The underlying causes need to be investigated in future studies using computational fluid dynamics. Furthermore, using the clinically established constant speed mode, it appears that the Sputnik1 will cause fewer hemolytic issues than the HM2.

A Systematic Review and Meta-analysis on Stenting for Aortic Coarctation Management in Adults

PURPOSE

Endovascular treatment of aortic coarctation (CoA) constitutes a valuable alternative with low morbidity and mortality. The aim of this systematic review and meta-analysis was to assess the technical success, re-intervention, and mortality after stenting for CoA in adults.

MATERIALS AND METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis statement and PICO (patient, intervention, comparison, outcome) model were followed. An English literature data search was conducted, using PubMed, EMBASE, and CENTRAL, until December 30, 2021. Only studies reporting on stenting, for native or recurrent CoA, in adults were included. The risk of bias was assessed using the Newcastle-Ottawa Scale. A proportional meta-analysis was performed to assess the outcomes. Primary outcomes were technical success, intra-operative pressure gradient and complications, and 30-day mortality.

RESULTS

Twenty-seven articles (705 patients) were included (64.0% males, 34.0±13.6 years). Native CoA was present in 65.7%. Technical success was 97% (95% confidence interval [CI], 0.96%-0.99%; p<0.001, I2=9.49%). Six (odds ratio [OR]: 1%; 95% CI, 0.00%-0.02%; p=0.002, I2=0%) ruptures and 10 dissections (OR: 2%; 95% CI, 0.001%-0.02%; p<0.001, I2=0%) were reported. The intra-operative and 30-day mortality were 1% (95% CI, 0.00%-0.02%; p=0.003, I2=0%) and 1% (95% CI, 0.00%-0.02%; p=0.004, I2=0%), respectively. The median follow-up was 29 months. Sixty-eight re-interventions (OR: 8%; 95% CI, 0.05%-0.10%; p<0.001, I2=35.99%) were performed; 95.5% were endovascular. Seven deaths were reported (OR: 2%; 95% CI, 0.00%-0.03%; p=0.008, I2=0%).

CONCLUSION

Stenting for CoA in adults presents high technical success and the intra-operative and 30-day mortality rates were acceptable. During the midterm follow-up, the re-intervention rate was acceptable, and mortality was low.Clinical ImpactAortic coarctation is a quite common heart defect that may be diagnosed in adult patients, as a first diagnosis in native cases or as a recurrent after previous repair. Endovascular management using plain angioplasty has been associated to a high intra-operative complication and re-intervention rate. Stenting in this analysis seems to be safe and effective as is related a high technical success rate, exceeding 95%, with a low intra-operative complication and death rate. During the mid-term follow-up, the re-interventions rate is estimated at less than 10% while most cases are managed using endovascular means. Further analyses are needed on the impact of stent type on endovascular repair outcomes.

The theatrics of collagens in the myocardium: the supreme architect of the fibrotic heart

Heart failure (HF) mediated by cardiac fibrosis (CF) is characterized by an excessive accumulation of collagen-based extracellular matrix (ECM) in the myocardium. CF is a common pathophysiological condition in many heart diseases and can be distinctly categorized into two types: replacement and interstitial. In ischemic heart diseases, sudden loss of cardiomyocytes leads to the replacement of CF to prevent ventricular rupture. In contrast, excessive collagen deposition in the interstitial space between cardiomyocytes (often in response to pressure overload, chronic cardiac stress, hypertension, etc.) is termed interstitial CF. The progression of HF due to cardiac fibrosis is mainly driven by compromised diastolic function, resulting from increased stiffness of the heart wall muscle due to collagen-based scar formation. Increased myocardial stiffness is primarily catalyzed by the differential cross linking of deposited collagens forming the scar in the fibrotic heart. Although collagen deposition remained a hallmark of fibrosis, the pathophysiological progression due to biochemical alterations and mechanistic discrepancy of collagens across cardiac fibrosis subtypes remains elusive. With the advent of next-generation RNA sequencing and high-resolution mass spectrometry, mechanistic insights into collagen-mediated scar maturation have gained impetus. A deeper understanding of the spatiocellular transcriptional heterogeneity and site-specific collagen posttranslational modifications (PTMs) in maneuvering ECM remodeling is gaining attention. The unexplored mechanisms of posttranslational modifications and subsequent collagen cross linking in various cardiac fibrosis may provide the prime target for therapeutic interventions. This review comprehensively summarizes the detailed pattern, role, signaling, and mechanical contributions of different collagens and their PTMs, including cross-linking patterns as newer therapeutic regimens during cardiac fibrosis.

Feasibility and Clinical Value of Intraprocedural Doppler Ultrasonography Blood Flow Parameters During Peripheral Endovascular Procedures for Limb Salvage: A Pilot Study

PURPOSE

To investigate whether Doppler ultrasound (DUS) blood flow parameters could serve as quantifiable functional endpoints of peripheral endovascular arterial procedures for chronic limb-threatening ischemia (CLTI), influencing wound healing.

METHODS

This is a prospective single-center study investigating intraprocedural DUS parameters (pulsatility index [PI] and pedal acceleration time [PAT]) in quantifying immediate hemodynamic alterations in consecutive CLTI patients with wound, ischemia, and foot infection wound class ≥1 undergoing endovascular interventions. Primary endpoints were feasibility of preendovascular and postendovascular treatment measurements of PI/PAT, quantification of immediate PI/PAT modifications of the posterior and anterior foot circulation following revascularization, the correlation between PI and PAT, and 6-month complete wound healing. Secondary endpoints included the 6-month limb salvage (no major amputation) and complete and partial wound healing rates.

RESULTS

A total of 28 patients (75.0% male) were enrolled, and 68 vessels were treated. The overall mean PAT values significantly decreased from 154.15±70.35 ms preprocedural to 107.21±49.6 ms postprocedural (p<0.01), and the mean PI values significantly increased from 0.93±0.99 to 1.92±1.96 (p<0.01). Postprocedural PAT at the anterior tibial (r2=0.804; p=0.346) and the posterior tibial arteries (r2=0.784; p=0.322) had a strong correlation and postprocedural PI at the anterior tibial (r2=0.704; p=0.301) and the posterior tibial arteries (r2=0.707; p=0.369) had a good correlation with 6-month complete wound healing. The 6-month complete and partial wound healing rates were 38.1% and 47.6%, respectively. Limb salvage was 96.4% and 92.4% at 6 and 12 months of follow-up, respectively.

CONCLUSIONS

Pedal acceleration time and PI accurately detected immediate hemodynamic changes of foot perfusion following revascularization and could serve as prognostic factors of wound healing in patients with CLTI.Clinical ImpactIntraprocedural measurement of simple Doppler ultrasound blood flow parameters, Pulsatility Index (PI) and Pedal Acceleration Time (PAT), accurately detected immediate hemodynamic changes of foot perfusion following endovascular revascularization and could therefore serve as intraprocedural prognostic factors of wound healing in patients with chronic limb-threatening ischemia. This is the first time that PI has been proposed as a hemodynamic index of successful angioplasty outcome. The optimization of intraprocedural PAT and PI could be used to guide angioplasty and predict clinical success.

Associations of high-density lipoprotein cholesterol, particles and subspecies with the risk of hypertension: findings from the PREVEND prospective study

OBJECTIVE

The prospective associations of high-density lipoprotein cholesterol (HDL-C), HDL particle (HDL-P) and subspecies concentrations with the risk of hypertension are uncertain. We aimed to evaluate the associations of HDL parameters with incident hypertension risk and their interplay with alcohol consumption in the PREVEND study.

METHODS

HDL parameters as measured by nuclear magnetic resonance spectroscopy and self-reported alcohol consumption were assessed in 3263 participants (mean age, 49 years; 45.8% males) without a history of hypertension at baseline. Multivariable-adjusted hazard ratios (HRs) with 95% CIs for hypertension per 1 standard deviation increment in HDL parameters were calculated.

RESULTS

During a median follow-up of 7.2 years, 825 participants developed hypertension. In analysis adjusted for several potential confounders, including alcohol consumption, there were inverse associations of HDL-C, HDL-P, medium HDL, HDL size, H3P and H4P with hypertension risk: HRs [95% confidence interval (CI) of 0.88 (0.81-0.97), 0.92 (0.86-0.99), 0.86 (0.80-0.93), 0.89 (0.82-0.98), 0.92 (0.85-0.98), and 0.87 (0.81-0.94), respectively]. Sex or alcohol consumption did not modify the associations of HDL parameters with hypertension risk. Compared with abstainers, the multivariable adjusted HRs (95% CI) of hypertension for occasional to light, moderate and heavy alcohol consumers were 0.84 (0.70-1.00), 0.83 (0.68-1.02), and 0.97 (0.69-1.37), respectively; the associations persisted on further adjustment for HDL parameters.

CONCLUSIONS

There are inverse associations of HDL-C, HDL-P, medium HDL, HDL size, H3P and H4P with hypertension risk, which are not confounded or modified by alcohol consumption. Light and moderate alcohol consumption is modestly and inversely associated with hypertension risk, independently of HDL parameters.

Sex Specific Outcomes With Cardiac Resynchronization Therapy in Patients With Symptomatic Heart Failure Having Reduced Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis

Cardiac resynchronization therapy (CRT) has emerged instrumental in managing heart failure. Notably, there is a lack of evidence of CRT efficacy among both sexes. Thus, this meta-analysis focuses on the long-term benefits of CRT in both sexes. PubMed, The Cochrane Library and clinicaltrials.gov were searched for articles from 2010 to 2024. ROB2 was used to assess risk of bias of RCTs. Newcastle Ottawa Scale was used for quality appraisal of cohorts. Meta-analysis was conducted on Revman 5.4. Out of 2722 articles, only 9 RCTs and 18 cohorts were included. Our results demonstrated that females had a significantly lower risk of composite outcomes compared to males in both RCTs (RR 0.80; 95% CI [0.68, 0.94], P = .006) and cohorts (RR 0.76; 95% CI [0.63, 0.92], P = .004). Results were similar for all-cause mortality. For heart failure hospitalization, only cohorts showed a significant lesser risk in females (RR 0.78; 95% CI [0.65, 0.93], P = .006). Left ventricular ejection fraction improved significantly in females but no differences were observed for NYHA class improvement. Males showed a 31% lower survival rate. However future trials are needed to highlight this variation.

Pituitary apoplexy in a patient on antiplatelet therapy: A case report

Pituitary apoplexy is a rare but life-threatening neurosurgical emergency, typically caused by acute hemorrhage or infarction of a pituitary adenoma within the sella turcica. It presents clinically with the sudden onset of severe headache, visual impairment and ophthalmoplegia. The present study reported the case of a 45-year-old male who experienced intermittent headaches and progressive right-sided visual deterioration over two months, with acute worsening in the preceding 6 h. The patient's medical history included coronary stent implantation and the patient had been on enteric-coated aspirin therapy for ~4 months. Magnetic resonance imaging and computed tomography of the head confirmed the diagnosis of pituitary apoplexy. The patient underwent emergency endoscopic transsphenoidal surgery, leading to significant improvement in right-sided vision. At the 6-month follow-up, the patient exhibited complete recovery with no evidence of tumor recurrence on imaging. This case highlights the importance of timely diagnosis and surgical intervention in achieving favorable outcomes in pituitary apoplexy and serves as a reminder for clinicians to consider the risk of hemorrhage in patients on long-term antiplatelet therapy.

Diabetes Mellitus and Associated Vascular Disease: Pathogenesis, Complications, and Evolving Treatments

Diabetes mellitus is a metabolic disorder, characterized by elevated blood sugar levels (hyperglycemia) and insulin dysregulation. This disease is associated with morbidity and mortality, including significant potential vascular complications. High levels of hyperglycemia lead to not only elevated levels of reactive oxygen species but also advanced glycation end products, which are detrimental to the vascular endothelium and reduce protective compounds such as nitric oxide and prostacyclin. This damage contributes to the development of both macrovascular and microvascular complications. The present investigation explores the pathophysiological mechanisms of diabetic vascular complications and evaluates current management strategies, including lifestyle modifications, pharmacological treatments, and emerging therapies. The review underscores the importance of ongoing progress in diabetes management and patient education to lead to optimal patient-health outcomes and quality of life for individuals with diabetes mellitus.