Effect of a Nurse-Led Support Program Using Mobile Application Versus Nurse Phone Advice on Patients at Risk of Coronary Artery Disease: A Randomized Controlled Trial

BACKGROUND

Coronary artery disease (CAD) is a major health problem of atherosclerotic cardiovascular (CV) disease and early intervention is regarded important. Given the proven effect of a lifestyle intervention with nursing telephone counselling and mHealth use in health care, yet the comparisons of both support are lacking, this study is proposed.

OBJECTIVES

This study aimed to compare the effects of a coronary artery disease (CAD) support program using a mobile application versus nurse phone advice on exercise amount and physical and psychological outcomes for clients at risk of CAD.

METHODS

A prospective randomized controlled trial was conducted. Ethical approval was obtained. Two-hundred and twenty-six clients were screened, and a total of 168 clients who were at risk of CAD and routinely used smartphones were randomized into the app support group (App group) or the nurse phone advice (NPA) group. Although all participants received the same health talk delivered by a cardiac nurse at the community center, the App group received additional CAD app support, whereas the NPA group received nurse phone advice for 20 min monthly. The app content comprised (1) CAD knowledge in 10 modules, (2) individual exercise records with their own goals and health measures, and (3) a chest pain action list. The intervention lasted for 3 months. Health outcome data were collected at baseline (T0) and after 1 (T1) and 3 (T2) months. The outcomes were the total amount of exercise (primary outcome), self-efficacy in illness management, perceived stress, and CAD risk profile (body weight, body mass index, and lipid concentration). Generalized estimating equation models were used to assess differential changes in all outcomes within 3 months.

RESULTS

The attrition rates at 3 months were 3.49% and 9.30% for the App and NPA groups, respectively. The App support group was superior to the NPA group in significantly increasing total exercise amount and reducing body weight, waist circumference, triglycerides, and increased self-efficacy in illness management.

LINKING EVIDENCE TO ACTION

The result provides further insights of app development to support health promotion programs for community-dwelling adults at risk of CAD.

High-sensitivity cardiac troponin-T concentrations and their prognostic implications in patients with paroxysmal supraventricular tachycardia

AIMS

To examine whether elevated high-sensitivity troponin-T (hs-TnT) concentrations in patients with paroxysmal supraventricular tachycardia (PSVT) without known cardiovascular disease (CVD) are associated with an increased risk of death.

METHODS

Patients with de novo PSVT and ≥ 1 measured hs-TnT level from 2013 to 2020 during hospitalization without known CVD were retrospectively identified in the Danish nationwide registries. Elevated hs-TnT was defined as ≥14 ng/l. The primary outcome was all-cause mortality assessed at 0-30 days and 31-365 days, using multivariable Cox regression with average treatment effect, rendering standardized absolute and relative risks. The secondary outcome was a composite endpoint of myocardial infarction, coronary revascularization, stroke, or heart failure-related contact.

RESULTS

A total of 1203 patients were included, with 792 (65.8 %) patients having elevated hs-TnT levels. The standardized mortality risk within 30 days was significantly higher in patients with elevated hs-TnT compared with those with normal concentrations [2.38 %, 95 % confidence interval (CI): 1.38 to 3.37 versus <0.01 %, 95 % CI: <0.01 to <0.01; p = 0.001]. At 31-365 days, the standardized risk of death was 1.51 % (95 % CI: 0 to 3.28) in individuals with a normal hs-TnT and 4.23 % (95 % CI: 2.81 to 5.66) in those with an elevated hs-TnT (p = 0.31). The risk of the composite secondary outcome did not significantly differ between the groups.

CONCLUSION

In patients with de novo PSVT and without known CVD, elevated hs-TnT concentrations were associated with increased short-term mortality. Long-term mortality was not significantly affected by elevated hs-TnT, likely due to study limitations, and requires further investigation.

Giant right coronary artery aneurysm presenting with recurrent syncope: A diagnostic challenge

Coronary artery aneurysm (CAA) is a rare form of coronary artery disease characterized by abnormal dilation of a coronary artery segment. While CAAs can present with various symptoms, syncope is notably uncommon, with limited documented cases. We present the case of a 24-year-old woman with a 2-month history of recurrent syncope, occurring in the absence of other symptoms. Initial evaluations, including MRI and cardiac examinations, revealed no abnormalities. However, a transthoracic echocardiogram identified a ring-like structure adjacent to the tricuspid valve, and subsequent computed tomography angiography confirmed a large right coronary artery aneurysm. This case highlights the rare presentation of recurrent syncope as a manifestation of CAA, emphasizing the need for timely diagnosis and intervention in similar cases.

Twenty-Five Years of Evolution and Hurdles in Electronic Health Records and Interoperability in Medical Research: Comprehensive Review

BACKGROUND

Electronic health records (EHRs) facilitate the accessibility and sharing of patient data among various health care providers, contributing to more coordinated and efficient care.

OBJECTIVE

This study aimed to summarize the evolution of secondary use of EHRs and their interoperability in medical research over the past 25 years.

METHODS

We conducted an extensive literature search in the PubMed, Scopus, and Web of Science databases using the keywords Electronic health record and Electronic medical record in the title or abstract and Medical research in all fields from 2000 to 2024. Specific terms were applied to different time periods.

RESULTS

The review yielded 2212 studies, all of which were then screened and processed in a structured manner. Of these 2212 studies, 2102 (93.03%) were included in the review analysis, of which 1079 (51.33%) studies were from 2000 to 2009, 582 (27.69%) were from 2010 to 2019, 251 (11.94%) were from 2020 to 2023, and 190 (9.04%) were from 2024.

CONCLUSIONS

The evolution of EHRs marks an important milestone in health care's journey toward integrating technology and medicine. From early documentation practices to the sophisticated use of artificial intelligence and big data analytics today, EHRs have become central to improving patient care, enhancing public health surveillance, and advancing medical research.

Complications of percutaneous coronary intervention

Complications of percutaneous coronary intervention (PCI) can lead to significant morbidity and mortality. In-depth understanding of the mechanisms and management options of these complications as well as timely recognition and action can sometimes be lifesaving. In this review we discuss the mechanisms, prevention methods, diagnosis, and management of three major PCI complications: a) perforation b) acute vessel closure, and c) equipment loss.

Allostatic Load in Parents and Offspring: Sex Differences and Intergenerational Effects on Cardiovascular Disease-Free Survival

BACKGROUND

Allostatic load (AL), a measure of cumulative stress-related physiological dysregulation, predicts the onset of chronic diseases. We investigated the relationship between AL and cardiovascular disease (CVD)-free survival in parents and offspring, including sex-specific differences.

METHODS

The analysis consisted of 6145 offspring-mother-father trios derived from the Framingham Heart Study. Clinically defined cutoffs from 9 physiological biomarkers across biological systems were used to generate composite AL score. Assessments of the associations of AL with CVD-free survival were conducted using Kaplan-Meier plots, Irwin's restricted means, and Cox proportional hazards regression models.

RESULTS

Over a 47-year period, parents and offspring experienced 1832 and 1060 incident CVD events, respectively. Parents exhibited a notably higher prevalence of high AL (29.5%) and CVD incidence rate (17.2 per 1000 person-years) compared with offspring (13.2% and 8.9, respectively, both P < .001). High parental AL was associated with 30% higher incident CVD risk in offspring, with maternal AL biomarkers being more predictive of offspring CVD risk than paternal. Parents and offspring with low AL lived 12.5 and 13.4 years longer without CVD, respectively, compared with those with high AL. The hazards of incident CVD were highest in daughters with high AL, up to 2.8 times (hazard ratio, 2.83; 95% confidence interval, 1.71-4.67), with similar risk observed in sons and parents.

CONCLUSION

Parental AL is associated with offspring CVD risk, with maternal AL biomarkers having a stronger association. This highlights the critical role of parental and, more importantly, maternal health in CVD risk management and broader public health strategies.

Increased Risk of End-Stage Kidney Disease After Traumatic Amputation: Nationwide Cohort Study

BACKGROUND

Amputation confers disabilities upon patients and is associated with substantial cardiovascular and metabolic morbidity and mortality. We aimed to compare the incidence of end-stage kidney disease (ESKD) between individuals with amputation and the general population.

METHODS

A population-based retrospective cohort study was performed using the Nationwide Health Insurance Service database for the period between 2010 and 2018. A total of 24,925 individuals with amputation were included with a ratio of 1:3 age- and sex-matched controls. A Cox proportional hazards regression analysis was used to calculate the risk of ESKD among amputees.

RESULTS

During a mean follow-up period of 4.3 years, there were 40 incident ESKD cases (0.4 per 1000 person-years) among individuals with amputation. Individuals with amputation showed a higher risk of ESKD (adjusted HR [aHR] of 1.75, 95% confidence interval [CI] of 1.20-2.54) compared with matched controls. The risk was further increased in those with mild disability (aHR of 1.41, 95% CI of 0.51-3.87) and severe disability (aHR of 8.22, 95% CI of 2.99-22.61). When considering the levels of amputation, the association was apparently more prominent in proximal than distal amputation, in particular for proximal upper limb amputation (aHR of 17.90, 95% CI of 4.37-73.40).

CONCLUSIONS

Individuals with amputation were at a significantly greater risk of ESKD than the general population, particularly subjects with severe disability and proximal amputation. Our data suggest that amputations should be added to the list of risk factors for the development of chronic kidney disease.

The jalap roots: A herbal legacy from the neotropics to the world

ETNOPHARMACOLOGICAL RELEVANCE

The Convolvulaceae or morning glory family, with about 2000 species in the world's Tropics and subtropics, stands out among the plants used in traditional medicine. Medicinal plant complexes with important purgative properties have been developed in Mexico and Brazil from members of the genera Ipomoea and Operculina with storage roots. Popularly known as the jalap roots, their resin glycosides cause purgative and laxative activities that facilitate bowel movements.

AIM OF THE STUDY

This article reviews the importance of the Convolvulaceae family in herbal medicine with a holistic approach that includes a historical perspective, as well as descriptions of crude drugs, phytopharmaceuticals, and chemical constituents. It further considers the family's distribution and biological properties, such as documented purging and cytotoxic activities of the Mexican and Brazilian jalap roots. The main aim of this review is to afford insights into the use and management of medicinal jalap roots for their potential development as herbal medicines.

MATERIALS AND METHODS

A search for available information on the genera and species that constitute the jalap roots was conducted using scientific databases, including PubMed, Google Scholar, ScienceDirect, and the International Plant Names Index. Also, numerous historical European herbals, botanical books, and pharmacopeias were reviewed using the Biodiversity Heritage Library and Internet Archive.

RESULTS

The review establishes that from the initial introduction of the medicinal jalap roots to Europe in the 16th century, various types of Neotropical purging roots were confused. The misunderstanding resulted from similar traditional uses of several species with common morphological features, organoleptic characteristics, and vernacular names. Subordinate species were also frequently used as substitutes for the signature or officinal crude drug. A compendium of contemporary uses of Mexican and Brazilian jalaps in herbal medicine is also presented.

CONCLUSIONS

Mexican and Brazilian jalap roots, still in use in traditional medicine, offer great potential as sources of biologically active principles. Research should prioritize the investigation on their chemical markers, toxicity, mechanisms of action, ecological requirements, and ecological networks. An integrated ethnopharmacological approach, which has not been adequately explored, would promote their proper management as novel phytopharmaceuticals.

Prognostic Value of Advanced Echocardiography in Patients with Ischemic Heart Disease: A Comprehensive Review

Cardiovascular (CV) diseases caused 20.5 million deaths in 2021, making up nearly one-third of global mortality. This highlights the need for practical prognostic markers to better classify patients and guide treatment, especially in ischemic heart disease (IHD), which represents one of the leading causes of CV mortality. Transthoracic echocardiography (TTE) is a key, non-invasive imaging tool widely used in cardiology for diagnosing and managing a range of CV conditions. It is the first choice for diagnosing and monitoring patients with acute coronary syndrome (ACS). Alongside well-established echocardiographic measures, new techniques have proven useful for predicting adverse events in IHD patients, such as three-dimensional (3D) and tissue Doppler imaging (TDI), and speckle tracking technology. This review aims to explore the latest echocardiographic tools that could provide new prognostic markers for patients in the acute phase and during follow-up after an acute myocardial infarction (AMI). We focus on new imaging methods like TDI, myocardial work index (MWI), speckle-tracking strain, and 3D technologies using TTE, which are easy to use and widely available at all stages of coronary artery disease (CAD).

Discovery platforms for RNA therapeutics

RNA therapeutics are emerging as a unique opportunity to drug currently "undruggable" molecules and diseases. While their advantages over conventional, small molecule drugs, their therapeutic implications and the tools for their effective in vivo delivery have been extensively reviewed, little attention has been so far paid to the technological platforms exploited for the discovery of RNA therapeutics. Here, we provide an overview of the existing platforms and ex vivo assays for RNA discovery, their advantages and disadvantages, as well as their main fields of application, with specific focus on RNA therapies that have reached either phase 3 or market approval. LINKED ARTICLES: This article is part of a themed issue Non-coding RNA Therapeutics. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v182.2/issuetoc.

Influence of Right and Left Bundle Branch Block in Patients With Cardiogenic Shock and Cardiac Arrest

OBJECTIVES

The study investigates the prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in patients with cardiogenic shock (CS) compared with no bundle branch block (BBB). In patients with heart failure, existence of RBBB and LBBB has influence on prognosis.

DESIGN

Prospective registry-study.

SETTING

ICU of a tertiary academic hospital in Germany.

PATIENTS

Adult patients with CS.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Consecutive patients with CS were included. The prognostic impact of RBBB and LBBB on 30-day all-cause mortality was tested within the entire cohort and in the subgroup of CS patients with cardiac arrest at admission. The final study cohort comprised 248 patients. Patients with RBBB showed the highest 30-day all-cause mortality followed by LBBB and no BBB (72.5% vs. 52.9% vs. 50.0%; log-rank p = 0.015). These findings were consistent even after solely including CS patients with cardiac arrest (90.0% vs. 73.3% vs. 62.2%; log-rank p = 0.008). After adjustment for lactate, norepinephrine, troponin I, Acute Physiology Score, Society of Cardiovascular Angiography & Interventions shock stage, and heart rate in a multivariable Cox regression analysis, RBBB still revealed a negative impact on 30-day all-cause mortality (hazard ratio [HR], 1.807; 95% CI, 1.107-2.947; p = 0.018), whereas LBBB was not associated with 30-day all-cause mortality. In this multivariable Cox regression model lactate (HR, 1.065; 95% CI, 1.018-1.115; p = 0.006), troponin I (HR, 1.003; 95% CI, 1.001-1.005; p = 0.001), and Acute Physiology Score (HR, 1.033; 95% CI, 1.001-1.066; p = 0.041) were as well associated with 30-day all-cause mortality. Finally, no association of RBBB was found with the incidence of liver or severe renal failure.

CONCLUSIONS

Besides the Acute Physiology Score, lactate, and troponin levels, RBBB was associated with an increased 30-day all-cause mortality in consecutive CS patients with and without cardiac arrest, whereas LBBB showed no prognostic impact.

Interdisciplinary perspectives on the co-management of metabolic dysfunction-associated steatotic liver disease and coronary artery disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a public health threat as it affects approximately 38% of the adult population worldwide, with its prevalence rising in step with that of obesity and type 2 diabetes. Beyond the implications of MASLD for liver health, it is also associated with cardiovascular and vascular dysfunction. Although the many shared risk factors and common metabolic milieu might indicate that cardiovascular disease and MASLD are discrete outcomes from common systemic pathogeneses, a growing body of evidence has identified a potential causal relationship between MASLD and coronary artery disease, which is the leading cause of morbidity and mortality in people with MASLD and all-cause mortality worldwide. This Review takes an interdisciplinary approach, drawing on hepatology, cardiology, endocrinology, and metabolic and internal medicine specialists to help to delineate the intricate interplay between MASLD and coronary artery disease. It sheds light on novel opportunities for targeted interventions and personalised management strategies.

Respiratory Pathology and Cardiovascular Diseases: A Scoping Review

Respiratory diseases and cardiovascular diseases (CVDs) have high prevalence and share common risk factors. In some respiratory diseases such as sleep apnoea and COPD, the evidence of their negative impact on the prognosis of CVDs seems clear. However, in other diseases it is less evident whether there is any direct relationship. With this in mind, our objective was to provide information that may be helpful to better understand the relationship between respiratory pathology and CVDs. There are different reasons for this relationship, such as shared risk factors, common pathophysiological mechanisms, side effects of treatment and the direct effect in the heart and great vessels of respiratory diseases. Indeed, aging and smoking are risk factors for CVDs and also for respiratory diseases such as obstructive sleep apnea (OSA), COPD and interstitial lung diseases (ILD). Furthermore, there are common pathophysiological mechanisms that affect both respiratory diseases and CVDs, such as accelerated atherosclerosis, microvascular dysfunction, endothelial dysfunction, inflammation, hypoxemia and oxidative stress. Besides that, it is well known that lung cancer, sarcoidosis and amyloidosis may directly affect the heart and great vessels. Finally, side effects of drugs for respiratory diseases and the discontinuation of treatments that are necessary for CVDs, such as β-blockers and aspirin, may have a deleterious impact on the cardiovascular system. In conclusion, the coexistence of respiratory diseases and CVDs is very common. It makes modifying diagnostic and therapeutic management necessary and is also a relevant prognostic factor.

Unveiling an insidious diagnosis and its implications for clinical practice: Individual patient data systematic review of pregnancy-associated spontaneous coronary artery dissection

BACKGROUND

Pregnancy-Associated Spontaneous Coronary Artery Dissection (P-SCAD) is the most common cause of myocardial infarction in pregnancy and postpartum. Aim of this systematic review is to provide a descriptive picture of P-SCAD presentation, clinical course, management and outcomes.

METHODS

International databases were systematically screened up to November 2023 and all published P-SCAD case reports/series identified; additionally, we gathered four original cases, establishing a new database for the derived cohort.

RESULTS

253 studies (215 case reports, 38 case series) were included for the analysis, enrolling 316 patients admitted between 1952 and 2023. Median age was 34 (SD 5) years old, 64 (20.4 %) were prepartum, 249 (79.6 %) postpartum. Most common presentation was ST-elevation myocardial infarction (72.6 %). Cardiac arrest and cardiogenic shock occurred in 18.4 % and 16.1 %, respectively. Multivessel dissection was present in 45.2 % of cases, with left anterior descending artery being most frequently affected (74.4 %). Initial therapeutic strategy was medical therapy in 54.8 % while upfront revascularization was performed in 45.2 % of cases. Excluding autoptic studies, mortality rate was 4.1 %, without significant differences between pre and postpartum SCAD (p-value 0.6) or according to initial therapeutic approach (p-value 0.5). Recurrences after index event were registered in 74 patients (23.4 %), being more common after medical treatment than in case of immediate revascularization (30.8 versus 18.3 %, p-value 0.02).

CONCLUSIONS

P-SCAD is a complex clinical scenario: timely diagnosis is difficult, therapeutic management not well-defined, rate of recurrences not negligible. Additional observational studies and dedicated registries are necessary to enhance the management of this rare but severe condition.

An In Vitro Study of 355-nm Laser Ablation of Atherosclerotic Lesions Model

A study of 355 nm laser with high pulse energy across various types of atherosclerotic lesion models is presented. The 355 nm laser pulses (10 ns) are delivered via a single fiber (600 μm diameter), and the ablation of calcified tissue, lipid tissue, and thrombus-like tissue are studied under varied laser fluence (40-70 mJ/mm2) and repetition rate (5-30 Hz). The contact and noncontact ablation processes of chicken tibia samples (calcified tissue) are compared at 60 mJ/mm2 and 30 Hz, and the size of ablation particles is in the range of 0.1-1 μm. At the same repetition rate, the advancement rate of tricalcium phosphate samples reaches 150 μm/s at 70 mJ/mm2. Calcified and lipid models demonstrate predictable increases in ablation with higher laser fluence and repetition rate. The fresh porcine blood clot samples exhibit high-quality ablation with good channel effect at 50 mJ/mm2 and 30 Hz.

From apoplexy in antiquities to cerebrovascular stroke in modernity: a narrative timeline and tale

Background

Stroke is one of the commonest encountered brain and neurological disorders worldwide. Stroke management has had a major shift in the last 50 years and precisely since the discovery and approval of thrombolysis as an acute management followed by multiple trials on mechanical thrombectomy and its approval. Yet, Stroke is as old as the history of mankind. Historically stroke symptoms’ description is older than the descriptions of the Greco-Roman civilization (500 BC – 800 AD). Before Stroke, the term apoplexy was described in ancient civilizations and evidence of suffering and managing it is preserved within the mummies, inscriptions, and papyri of the Egyptian civilization, clay tablets of the Mesopotamian civilization, medical books of the Chinese civilization, and although physicians and scientists consider the Greco-Roman civilization the base for modern medicine, yet the golden age of Islam (800 – 1200 AD) might have shared more in identifying bases of stroke. The European Renaissance beginning from 1400 AD with its famous anatomists and physicians greatly contributed too to stroke localization and vascular supply.

Conclusions

As medicine and science are in a continuous chain from the past to the future through the present, the current comprehensive review highlights the major important and documented shifts in the history of stroke over more than 4500 years starting from ancient civilizations BC up to 2024 AD.

Evolution in electrophysiology 100 years after Einthoven: translational and computational innovations in rhythm control of atrial fibrillation

In 1924, the Dutch physiologist Willem Einthoven received the Nobel Prize in Physiology or Medicine for his discovery of the mechanism of the electrocardiogram (ECG). Anno 2024, the ECG is commonly used as a diagnostic tool in cardiology. In the paper 'Le Télécardiogramme', Einthoven described the first recording of the now most common cardiac arrhythmia: atrial fibrillation (AF). The treatment of AF includes rhythm control, aiming to alleviate symptoms and improve quality of life. Recent studies found that early rhythm control might additionally improve clinical outcomes. However, current therapeutic options have suboptimal efficacy and safety, highlighting a need for better rhythm-control strategies. In this review, we address the challenges related to antiarrhythmic drugs (AADs) and catheter ablation for rhythm control of AF, including significant recurrence rates and adverse side effects such as pro-arrhythmia. Furthermore, we discuss potential solutions to these challenges including novel tools, such as atrial-specific AADs and digital-twin-guided AF ablation. In particular, digital twins are a promising method to integrate a wide range of clinical data to address the heterogeneity in AF mechanisms. This may enable a more mechanism-based tailored approach that may overcome the limitations of previous precision medicine approaches based on individual biomarkers. However, several translational challenges need to be addressed before digital twins can be routinely applied in clinical practice, which we discuss at the end of this narrative review. Ultimately, the significant advances in the detection, understanding, and treatment of AF since its first ECG documentation are expected to help reduce the burden of this troublesome condition.

Effectiveness of the repeated 3-time-balloon-inflation method in reducing coronary stent edge dissection

The optimal procedural protocol for coronary stent deployment remains undetermined. Post-dilation with a high-pressure balloon is often performed to optimize the stent expansion. However, high-pressure dilation also carries the potential risk of coronary artery injury. A previous in vitro study reported that multiple-times balloon inflation at the same pressure resulted in better stent expansion compared to one-time balloon inflation. In our facility, we frequently perform the repeated 3-time-balloon-inflation method, wherein the stent delivery balloon was inflated 3 times at nominal pressure to deploy the stent, to improve stent expansion without high-pressure balloon inflation. Although this method seems effective in avoiding excessive high-pressure dilation, its clinical data are insufficient. In this study, we investigated the clinical outcomes of the repeated 3-time-balloon-inflation method. This retrospective study included 370 patients with 467 stented coronary lesions. These subjects were divided into two groups: one with standard balloon inflation and the other with repeated 3-time balloon inflation, and treatment outcomes were compared. The repeated 3-time-balloon-inflation group had 254 lesions, and the standard-balloon-inflation group had 213 lesions. Stent edge dissection occurred in 6 lesions (2.8%) in the standard-balloon-inflation group, whereas did not occur in the repeated 3-time-balloon-inflation group. A statistically significant difference remained even after propensity score matching (p = 0.040). The final minimum stent area and long-term clinical outcomes were not significantly different between the two groups. The repeated 3-time-balloon-inflation method may reduce stent edge dissection while demonstrating comparable minimal stent area and long-term outcomes to the standard-balloon-inflation method.

Development of myopia in scuba diving and hyperbaric oxygen treatment: a case report and systematic review

Introduction

A 54-year-old, previously healthy Caucasian male diver was on a 22-day liveaboard diving holiday. During this time, he performed 75 open-circuit dives, of which 72 were with enriched air nitrox. All dives were within recreational length and depth. After the trip he noticed a worsening of vision and his refraction had changed from the previous -3.75/-5.75 to -5.5/-7.75 dioptres. Hyperoxic myopia is a well-known phenomenon after hyperbaric oxygen treatment (HBOT), but related literature in recreational divers is scarce.

Methods

A systematic literature review on the effect of a hyperoxic environment on the development of myopia was done according to the PRISMA guidelines. Three databases were searched: Ovid MEDLINE, Scopus, and the Cochrane Library. A risk of bias analysis was done on all articles, and the GRADE approach was used to evaluate the quality of evidence. Articles that had sufficient data were used to synthesise a visualisation of oxygen exposure and changes in refraction.

Results

Twenty-two articles were included in this review. These included five case reports, two case series, nine cohort studies, one randomised controlled trial and five reviews, of which one was systematic. Most articles described HBOT patients' ocular complications, although four articles were diver centric. The synthesis of results suggests that divers tend to get a greater myopic shift with a smaller exposure. However, the data were too heterogeneous to perform meaningful statistical analyses. This review is the first to focus on divers instead of HBOT patients.

Conclusions

The case presented led to a systematic literature review on the effects of hyperbaric oxygen on refractive changes in both HBOT patients and divers. The data were too heterogeneous to make meaningful suggestions on a safety limit to prevent myopisation in diving.

Actions Taken by Bystanders During Sudden Cardiac Arrest: Analysis of Emergency Medical Service Documentation in Poland

Background/Objectives: Sudden cardiac arrest (SCA) is a severe medical condition involving the cessation of the heart's mechanical activity. Following the chain of survival, which includes early recognition and calling for help, early initiation of cardiopulmonary resuscitation (CPR), early defibrillation, and post-resuscitation care, offers the greatest chances of saving a person who has experienced SCA. The aim of this study was to analyze cases of out-of-hospital cardiac arrest (OHCA) and assess the actions taken by bystanders. Methods: The input for analysis consisted of 49,649 dispatch records from the emergency medical team (EMT) at the Voivodeship Emergency Medical Station in Bialystok in 2018-2019. Results: Among the patients where bystanders performed CPR, the return of spontaneous circulation (ROSC) occurred in 30.53% of cases, whereas in the cases where the bystander did not perform CPR, ROSC occurred in 2.35% of cases. When cardiac arrest rhythm was ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), ROSC occurred in 58.62% of cases, while there was asystole or pulseless electrical activity (PEA) present, ROSC occurred in 26.56% of cases. In patients who experienced OHCA in a VF/pVT rhythm and who underwent intubation, ROSC occurred in 58.73% of cases, whereas in patients who underwent alternative procedures for airway management, ROSC occurred in 83.33% of cases. Conclusions: The most significant factor influencing the occurrence of ROSC in patients is CPR initiation by bystanders. The presence of a rhythm that requires defibrillation increases the likelihood of achieving ROSC in the patient. Alternative methods for airway management appear to be more beneficial in VF/pVT rhythms.

Awareness and knowledge of cardiopulmonary resuscitation (CPR) among the general public in West-Bank in Palestine

BACKGROUND

Sudden cardiac death (SCD) is a leading cause of cardiovascular-related deaths, often occurring outside hospitals in undiagnosed individuals. Our study aims to assess the baseline awareness and skills in performing CPR among the population in Palestine.

METHODS

A cross-sectional study was conducted using an online questionnaire to assess CPR knowledge among residents of the West Bank, Palestine. Convenience sampling targeted 300 participants via social media. Data were analyzed using descriptive statistics and chi-square tests to examine associations.

RESULTS

The study surveyed 555 participants, revealing that 58.2% lacked CPR training. Awareness of cardiac arrest signs varied, with chest pain being the most recognized 19%. CPR training significantly improved participants' recognition and response to cardiac emergencies.

CONCLUSION

Addressing the fear of legal consequences is crucial to encourage bystander assistance. We recommend increasing first aid awareness through scientific conferences, free training courses, media campaigns, and incentivized competitions.

Epigenome-wide mediation analysis of the relationship between psychosocial stress and cardiometabolic risk factors in the Health and Retirement Study (HRS)

BACKGROUND

Exposure to psychosocial stress is linked to a variety of negative health outcomes, including cardiovascular disease and its cardiometabolic risk factors. DNA methylation has been associated with both psychosocial stress and cardiometabolic disease; however, little is known about the mediating role of DNA methylation on the association between stress and cardiometabolic risk. Thus, using the high-dimensional mediation testing method, we conducted an epigenome-wide mediation analysis of the relationship between psychosocial stress and ten cardiometabolic risk factors in a multi-racial/ethnic population of older adults (n = 2668) from the Health and Retirement Study (mean age = 70.4 years).

RESULTS

A total of 50, 46, 7, and 12 CpG sites across the epigenome mediated the total effects of stress on body mass index, waist circumference, high-density lipoprotein cholesterol, and C-reactive protein, respectively. When reducing the dimensionality of the CpG mediators to their top 10 uncorrelated principal components (PC), the cumulative effect of the PCs explained between 35.8 and 46.3% of these associations.

CONCLUSIONS

A subset of the mediating CpG sites were associated with the expression of genes enriched in pathways related to cytokine binding and receptor activity, as well as neuron development. Findings from this study help to elucidate the underlying mechanisms through which DNA methylation partially mediates the relationship between psychosocial stress and cardiometabolic risk factors.

Coronary Artery Disease and Severe Aortic Stenosis: Contemporary Treatment Options for Patients Undergoing Transcatheter Aortic Valve Implantation

Approximately 50% of individuals eligible for transcatheter aortic valve implantation (TAVI) have coronary artery disease (CAD). The influence of CAD, both its prevalence and severity, on post-TAVI clinical results has yielded conflicting findings. Recent research has shown positive results for the use of computed tomography angiography and functional percutaneous evaluation of coronary lesions in the pre-TAVI assessment, besides the classic coronary angiography. As we anticipate the outcomes of current randomized studies, it has become common practice to perform invasive revascularization on TAVI patients with obstructive CAD. Furthermore, there is a lack of comprehensive data about the occurrence, features, and treatment of coronary incidents after TAVI. There is also growing concern about the possible difficulties in accessing the coronary arteries in patients who need coronary angiography with or without intervention after TAVI. This review presents a comprehensive analysis of the contemporary treatment options of CAD in patients undergoing TAVI. In this context, it examines the incidence of CAD in TAVI candidates; its clinical significance; the assessment and management of CAD before, concomitant, and after the procedure, including patients’ unresolved concerns; and possible future aspects.

Construction and validation of coronary heart disease risk prediction model for general hospitals in Tacheng Prefecture, Xinjiang, China

Objective

To analyze the risk factors for coronary heart disease (CHD) in patients hospitalized in general hospitals in the Tacheng Prefecture, Xinjiang, and to construct and verify the nomogram prediction model for the risk of CHD.

Methods

From June 2022 to June 2023, 489 CHD patients (CHD group) and 520 non-CHD individuals (control group) in Tacheng, Xinjiang, were retrospectively selected. Using a 7:3 ratio, patients were divided into a training group (706 cases) and a validation group (303 cases). General clinical data were compared, and key variables were screened using logistic regression (AIC). A CHD risk nomogram for Tacheng was constructed. Model performance was assessed using ROC AUC, calibration curves, and DCA.

Results

In the training group, non-Han Chinese (OR = 2.93, 95% CI: 2.0-4.3), male (OR = 1.65, 95% CI: 1.0-2.7), alcohol consumption (OR = 1.82, 95% CI: 1.2-2.9), hyperlipidemia (OR = 2.41, 95% CI: 1.7-3.5), smoking (OR = 1.61, 95% CI: 1.0-2.6), diabetes mellitus (OR = 1.62, 95% CI: 1.1-2.4), stroke (OR = 2.39, 95% CI: 1.6-3.7), older age (OR = 1.08, 95% CI: 1.1-1.2), and larger waist circumference (OR = 1.04, 95% CI: 1.0-1.1) were the risk factors for coronary heart disease (all P < 0.05). The area under the curve (AUC) of the work characteristics of the subjects in the training group and the validation group were 0.80 (95% CI: 0.8-0.8) and 0.82 (95% CI: 0.8-0.9), respectively. The Hosmer-Lemeshow test indicated P = 0.325 for the training group and P = 0.130 for the validation group, with calibration curves closely fitting the ideal curve. The predicted values aligned well with actual values, and decision curve analysis results suggest that the model offers a net clinical benefit.

Conclusion

The CHD risk prediction model developed in this study for general hospitals in Tacheng Prefecture, Xinjiang, demonstrates strong predictive performance and serves as a simple, user-friendly, cost-effective tool for medical personnel to identify high-risk groups for CHD.

Exercise Interventions in the Management of Postural Orthostatic Tachycardia Syndrome: A Scoping Review

Objective

This review aims to identify the exercise rehabilitation approaches used for patients with POTS (Postural Orthostatic Tachycardia Syndrome).

Methods

An electronic literature search was conducted using the PubMed database, covering January 2005 to October 2023. Studies were included if they reported an exercise rehabilitation intervention for POTS patients and resulting clinical outcomes. Eligible study designs included randomized and non-randomized clinical trials and case reports.

Results

Initially, 34 publications were identified, but only 14 met the criteria for inclusion. After a thorough analysis, 7 studies were included in this scoping review. The majority of the studies stated aerobic exercise training significantly improves symptoms in most of the patients with orthostatic intolerance, reduces the frequency of syncope, enhances patient quality of life, and improves autonomic balance as assessed by heart rate variability analysis and cardiorespiratory endurance. Short-term exercise training was found to boost physical fitness and cardiorespiratory responses in patients with POTS. Therefore, exercise training can serve as an effective non-pharmacological therapy for managing POTS.

Conclusion

This scoping review identified different approaches used for exercise rehabilitation in POTS patients. However, more research is needed to identify the optimal exercise rehabilitation program for this patient population.

Association Between Sleep Quality and Cirrhotic Cardiomyopathy: A Prospective Case-Control Study

Objective

The main purpose of this study is to evaluate the changes in sleep quality among patients with cirrhotic cardiomyopathy (CCM).

Methods

The study included liver cirrhosis patients aged 18-75 from Northern Jiangsu People's Hospital Affiliated to Yangzhou University and collected their clinical examination results to assess the clinical characteristics and related risk factors of patients with CCM.

Results

The study found that the onset of CCM was not related to the etiology of inducing cirrhosis. Pittsburgh Sleep Quality Index (PSQI) score (odds ratio (OR) = 13.476, 95% confidence interval (CI) = 1.514-119.923, P = 0.020), absolute GLS (OR = 0.328, 95% CI = 0.210-0.510, P < 0.001), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR = 1.050, 95% CI = 1.025-1.076, P < 0.001) were identified as independent risk factors for inducing CCM.

Conclusion

In patients with CCM, a decrease in sleep quality often occurs. When cirrhotic patients also have poor sleep quality, along with a decrease in absolute Global Left Ventricular Strain (GLS) levels and an increase in NT-proBNP levels, these factors may pose a higher risk for CCM development. However, further validation of these research findings is required in larger sample sizes.

Incremental Cardiovascular Risk of Menopause in Women with Psoriasis, Psoriatic Arthritis or Spondyloarthritis?

PURPOSE OF THE REVIEW

This narrative review aims to discuss the most recent studies regarding the risk of cardiovascular disease (CVD) in women with psoriasis, psoriatic arthritis (PsA) and spondyloarthritis (SpA). In addition, the potential of menopause to modulate/increase CVD risk in women with these diseases will also be explored. It is of major interest to gain more understanding into this topic because it can have meaningful implications for screening and treatment of CVD risk in these women.

RECENT FINDINGS

Literature shows that psoriasis, PsA, SpA and menopause itself cause higher CVD risks and higher CVD prevalence. This is predominantly explained by the increase of chronic systemic inflammation. No existing literature conclusively demonstrates or studies specifically whether the menopause amplifies this effect caused by psoriasis, PsA, or SpA.

CONCLUSION

Differences in pathophysiology of psoriasis, SpA and PsA versus the menopausal transition could suggest that menopause may increase the risk of CVD. However, the hypothesis that menopause represents an additional CV risk factor in women with psoriasis, PsA and SpA still needs to be thoroughly investigated and more clinical studies are required for further understanding and conclusions.

Cardiac Tumor Within the Left Ventricle: Thrombus or Something Else?

Papillary fibroelastoma is a benign cardiac tumor that most commonly arises from the valvular endocardium and is typically resected because of its predisposition to cause embolic complications. In this clinical vignette, we describe the case of a patient who presented with a round, mobile 1.3 × 1.1-cm sessile mass attached to the left ventricular apex discovered on transthoracic echocardiography at an outside institution. A multidisciplinary team and multimodality imaging approach were taken to treat a diagnostically challenging presentation of a papillary fibroelastoma due to lack of visualization on higher-resolution imaging studies.

Exploring risk factors for Raynaud's phenomenon post COVID-19 vaccination

BACKGROUND

Raynaud's phenomenon (RP) has recently been observed in recipients of the COVID-19 vaccine. It is unclear whether RP is directly caused by the COVID-19 vaccine. This study aims to investigate the potential causation between RP and COVID-19 vaccination.

METHODS

In this study, we searched PubMed, EMBASE, and Web of Science from January 1, 2020, to March 19, 2024. We included the articles with clinical related findings, specifically case reports and case series. Conference abstracts, editorial publications, preprint, and those not specifically related to COVID-19 vaccination are excluded. The refined selection process aimed to ensure a focused and clinically relevant analysis of the association between RP and COVID-19 vaccination.

RESULTS

A total of six articles were ultimately included in this study, comprising five case reports and one case series involving 24 patients with RP after vaccination. Baseline characteristics of the studies showed the RP post COVID-19 vaccination frequently occurred with females compared to males (70.83 vs. 29.17 %). Of the patients with RP post COVID-19 vaccination, 87.5 % (21/24) had either a history or possible predisposing factors of RP. Among the patients with detailed information of vaccination (n = 20), the number of vaccine doses was not related to RP development (45 % (1st) vs. 30 % (2nd) vs. 25 % 3rd dose). For types of vaccine, 75 % of RP were found to have received the administration of mRNA vaccine (15/20).

CONCLUSION

The risk of bias was increased due to the uncontrolled study designs and small sample size, making it impossible to attribute causation between RP and COVID-19 vaccination. These few cases may have occurred independently of vaccination. However, physicians should still remain vigilant for RP following COVID-19 vaccination, particularly as the number of vaccinated individuals continues to rise.

Predictors, prevalence and prognostic role of pulmonary hypertension in patients with chronic kidney disease: a systematic review and meta-analysis

BACKGROUND

To estimate the predictors, prevalence and prognostic role of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) using meta-analysis.

METHODS

The PubMed, EmBase, and the Cochrane library were systematically searched for eligible studies from inception till May 2024. All of pooled analyses were performed using the random-effects model.

RESULTS

Fifty observational studies involving 17,558 CKD patients were selected. The prevalence of PH in CKD patients was 38% (95% confidence interval [CI]: 33%-43%), and the prevalence according to CKD status were 31% (95% CI: 20%-42%) for CKD (I-V), 39% (95% CI: 25%-54%) for end stage kidney disease (ESKD) (predialysis), 42% (95% CI: 35%-50%) for ESKD (hemodialysis), and 26% (95% CI: 19%-34%) for renal transplant. We noted the risk factors for PH in CKD included Black individuals (relative risk [RR]: 1.39; 95% CI: 1.18-1.63; p < 0.001), chronic obstructive pulmonary disease (RR: 1.48; 95% CI: 1.21-1.82; p < 0.001), cardiovascular disease history (RR: 1.62; 95% CI: 1.05-2.51; p = 0.030), longer dialysis (RR: 1.70; 95% CI: 1.18-2.46; p = 0.005), diastolic dysfunction (RR: 1.88; 95% CI: 1.38-2.55; p < 0.001), systolic dysfunction (RR: 3.75; 95% CI: 2.88-4.87; p < 0.001), and grade 5 CKD (RR: 5.64; 95% CI: 3.18-9.98; p < 0.001). Moreover, PH in CKD patients is also associated with poor prognosis, including all-cause mortality, major cardiovascular events, and cardiac death.

CONCLUSION

This study systematically identified risk factors for PH in CKD patients, and PH were associated with poor prognosis. Therefore, patients with high prevalence of PH should be identified for treatment.

Perforation of the Septal Perforators: A Case Series and Proposed Management Paradigm

Septal artery perforations are an uncommon complication of percutaneous coronary intervention. Unlike epicardial vessels, septal perforations do not result in pericardial effusions but rather produce septal haematomas. While most can be managed expectantly, a small proportion requires active management to prevent rapid haematoma expansion resulting in compromise of right ventricular filling and 'dry tamponade'. We present two cases of septal artery perforation during percutaneous coronary intervention and propose a management approach that takes into account the unique haemodynamic consequences of this complication.

Comparing network structures of depressive and anxiety symptoms between demographically-matched heart disease and heart disease free samples using propensity score matching: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BACKGROUND

Older adults with heart disease often experience higher rates of comorbid anxiety and depression. This study examined depression and anxiety network structures among older adults with heart disease and their heart disease free peers.

METHODS

Network analyses of secondary cross-sectional data from the 2017 to 2018 wave of CLHLS were used to construct groups of older adults with and without heart disease using propensity score matching. Depression and anxiety symptoms were assessed using Center for Epidemiological Studies Depression Scale and Generalized Anxiety Disorder Scale, respectively. Central symptoms and bridge symptoms were identified using expected influence.

RESULTS

1689 older adults with heart disease and matched control sample of 1689 older adults without heart disease were included. The prevalence and severity of depression and anxiety were significantly higher in older adults with heart disease compared to the control group. There was no significant difference in overall structures of depression and anxiety network models between two the groups. Key central symptoms and bridge symptoms within these groups were highly similar; GAD 2 "Uncontrollable worrying" and GAD 4 "Trouble relaxing" were identified as the most central symptoms, while GAD 1 "Nervousness" and CESD 1 "Feeling bothered" were identified as key bridge symptoms across both network models.

CONCLUSION

Depression and anxiety are more prevalent in older adults with heart disease than demographically-matched heart disease free controls. However, network structures of these symptoms do not differ between two groups. Accordingly, depression and anxiety psychosocial interventions developed for older adults without heart disease may also benefit older adults with heart disease.

Efficacy and safety of lipid-lowering therapies in combination with or without statin to reduce the cardiovascular risk: A systematic review of randomised controlled trials

Background and aims

Cardiovascular diseases (CVD) pose a significant global health burden. Lowering low-density lipoprotein-cholesterol is the primary therapeutic aim for preventing primary and secondary CVD events. While statins are the standard treatments, their limitations, such as side effects and intolerance in certain patient groups, necessitate exploration of alternative lipid-lowering therapies (LLTs). We systematically reviewed randomised controlled trials (RCTs) evaluating cardiovascular outcomes associated with non-statin LLTs (bempedoic acid, alirocumab, evolocumab, ezetimibe, and inclisiran) in adults with CVD or high cardiovascular risk.

Methods

EMBASE, Medline, Cochrane Library, and clinical trial registries were systematically searched for eligible studies, from inception until February 08, 2023. Two reviewers independently screened the studies, with discrepancies resolved by a third reviewer. Data extraction and validation were conducted, and the risk of bias was assessed using the Cochrane Risk-of-Bias tool-2 for RCTs.

Results

The search strategy yielded 2104 citations. Post screening for eligibility, nine unique trials/studies (84 publications) were identified. Among these, one trial each was identified for bempedoic acid and alirocumab, three for evolocumab, and four for ezetimibe. No published literature documenting the cardiovascular outcomes of inclisiran was identified. Only one trial (CLEAR Outcomes) included statin-intolerant patients at baseline. Most studies evaluated a 3-component, 4-component, or 5-component major adverse cardiovascular events composite as an outcome along with individual components. The quality of the included trials was found to be fair-to-good.

Conclusions

The systematic review findings emphasise the significance of considering non-statin LLTs as viable treatment options for individuals with CVD or high cardiovascular risk who cannot tolerate or achieve optimal lipid control with statin therapy alone.

Left Ventricular False Tendons: A Morphological Study by Echocardiography

PURPOSE

This is a prospective study aimed to investigate the morphology of left ventricular false tendons (LVFTs) using echocardiography and explore its associations with age, sex, body mass index (BMI), congenital heart structural abnormalities, and premature ventricular contractions (PVCs).

METHODS AND RESULTS

We analyzed data from 889 individuals who underwent consecutive echocardiograms at our ultrasound department between December 2023 and February 2024. Routine echocardiograms were performed to detect congenital structural abnormalities, with a focus on identifying LVFT. We examined the prevalence, number, and distribution of LVFTs, as well as their correlation with age, sex, BMI, and congenital heart structural abnormalities. LVFTs were detected in 460 of 889 cases (51.74%), totaling 672 LVFTs. LVFT prevalence significantly differed not only between sexes but also between ages. LVFT prevalence was higher in individuals with lower BMI. There was no significant difference in congenital heart structural abnormalities between the groups, but the composition of distinct types of structural abnormalities differed between the groups. The incidence of PVCs in the LVFT-positive group was significantly higher than in the LVFT-negative group.

CONCLUSIONS

The prevalence of LVFTs is notably higher in males than females and tends to decrease with advancing age and increasing BMI. LVFTs display diverse morphological features and may interact synergistically with certain congenital heart structural abnormalities. LVFTs can easily lead to PVCs in healthy people, but the risk of leading to malignant PVCs does not seem to be high. Correctly recognizing the morphological characteristics of LVFTs helps to distinguish similar ultrasonic images of different diseases, thus avoiding missed diagnoses and misdiagnoses in ultrasound work and clinical practice.

Cost-effectiveness of lowering systolic blood pressure in reducing cardiovascular disease burden in Australia

AIM

Cardiovascular diseases (CVD) remain a leading global cause of death. This research examines the impact of lowering systolic blood pressure (SBP) on reducing CVD prevalence. It also assesses the cost-effectiveness of such interventions from a healthcare perspective.

METHODS

A synthesis matrix was created to analyse CVD risk factors (SBP, smoking, diabetes, and cholesterol), identifying SBP as the most impactful modifiable risk factor. We utilised validated health economic model which incorporates pooled cohort risk equations to predict the 10-year risk of the first CVD event, factoring in participants' gender, age, SBP, cholesterol levels, diabetes, and smoking status. The primary outcome was the incremental cost-effectiveness ratio (ICER), measured in costs per quality-adjusted life years (QALYs) and years of life lived. In a hypothetical scenario, we reduced SBP by 20 % in participants with levels ≥140 mmHg, based on the 2016 Hypertension Management Guide (National Heart Foundation of Australia). A 5 % discount rate was applied to all costs and outcomes.

RESULTS

After reducing SBP by 20 % in participants with levels ≥140 mmHg, we observed a decrease in CVD deaths by 4756 cases (1.21 %) and non-fatal CVD events by 7877 cases (0.77 %). Post-intervention, there was an increase in years of life lived and QALYs experienced by 26,252 years (0.03 %) and 23,928 years (0.03 %), respectively. Acute and chronic costs also decreased, with acute event costs reduced by AUD 24,437,625 (0.28 %) and chronic costs by AUD 18,544,776 (0.71 %). Hypothetical scenario was found to be dominant (cost-saving).

CONCLUSIONS

Our results demonstrate that reducing SBP at the population level is cost-saving and has a significant positive impact on cardiovascular outcomes and related costs for those at risk of CVD.

The relationship between dyslipidemia and menopausal symptoms in Chinese menopausal women: a cross-sectional study

OBJECTIVE

To investigate the relationship of dyslipidemia and menopausal symptoms in Chinese menopausal women.

MATERIAL AND METHODS

A total of 989 eligible participants with menopausal syndrome were recruited from outpatient clinics in several cities in China. Menopausal symptoms were assessed using the Chinese Menopause Rating Scale (CMRS), the Self-rating Depression Scale (SDS), and the Self-rating Anxiety Scale (SAS). Serum lipid profile was measured using enzyme colorimetry. The relationship between lipid profile and menopausal symptoms was assessed using Student's t test/nonparametric Mann-Whitney U test, Spearman's correlation test, and binary logistic regression analysis.

RESULTS

Among the 989 patients, 527 had dyslipidemia while 462 did not. Patients with dyslipidemia had significantly higher Self-rating Anxiety Scale (SAS) scores than those without (p < 0.001), while there was no significant difference in Self-rating Depression Scale (SDS) scores. Patients without dyslipidemia had higher scores on the Chinese Menopause Rating Scale (CMRS) vascular dimension compared to those with dyslipidemia (p = 0.003). The correlation test revealed that variables associated with dyslipidemia included age (p = 0.031), CMRS hot flashes dimension score (P = 0.003), and SAS score (p < 0.001). Regression analysis demonstrated that BMI (OR: 1.08, 95% CI: 1.01-1.16, p = 0.027), SAS scores (OR = 1.10, 95% CI = 1.07-1.13), vasomotor dimension (OR = 0.89, 95% CI = 0.83-0.95), physical dimension (OR = 0.96, 95% CI = 0.93-1.00), and social dimension (OR = 0.84, 95% CI = 0.74-0.95) were independently associated with an increased risk of dyslipidemia.

CONCLUSIONS

This study showed that anxiety was associated with an unfavorable lipid profile, and menopausal depression seemed to have no relationship with lipid profile, while vasomotor symptoms appeared to be a favorable factor for dyslipidemia in Chinese menopausal women.

Invasive group A Streptococcus infection (Streptococcus pyogenes): Current situation in Spain

Group A ß-hemolytic Streptococcus (S. pyogenes), also known as GAS, is a Gram-positive bacterium. It can be easily identified in the microbiology laboratory by its ability to hemolyse blood in culture media. This bacterium is highly virulent due to its production of enzymes and toxins, and its ability to cause immunologically mediated diseases such as rheumatic fever and post-streptococcal glomerulonephritis. GAS is the primary cause of bacterial pharyngotonsillitis, although it is typically a benign and non-invasive disease. However, it also has the potential to cause severe skin and soft tissue infections, necrotising fasciitis, bacteraemia and endocarditis, pneumonia and empyema, and streptococcal toxic shock syndrome, without any age or predisposition limits. The term invasive GAS disease (iGAS) is used to refer to this group of conditions. In more developed countries, iGAS disease has declined thanks to improved hygiene and the availability of antibiotics. For example, rheumatic fever has practically disappeared in countries such as Spain. However, recent data suggests a potential increase in some iGAS diseases, although the accuracy of this data is not consistent. Because of this, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has posed several questions about invasive GAS infection, especially its current situation in Spain. The committee has enlisted the help of several experts in the field to answer these questions. The following lines contain the answers that we have collaboratively produced, aiming to assist not only the members of ICOMEM but also anyone interested in this topic.

New and future heart failure drugs

In the past decade, our understanding of heart failure pathophysiology has advanced significantly, resulting in the development of new medications such as angiotensin-neprilysin inhibitors, sodium-glucose cotransporter-2 inhibitors and oral soluble guanylate cyclase stimulators. Backed by positive findings from large randomized controlled trials, recommendations for their use were recently included in the 2022 AHA/ACC/HFSA guidelines and 2023 ESC guidelines for management of heart failure. Promising drugs for future heart failure treatment include agents that modulate the neurohormonal system, vasodilators, anti-inflammatory drugs, mitotropes, which improve deranged energy metabolism of the failing heart, and myotropes, which increase cardiac contractility by affecting cardiac sarcomere function. Here, we discuss these new and future heart failure drugs. We explain their mechanisms of action, critically evaluate their performance in clinical trials and summarize the clinical scenarios in which the latest guidelines recommend their use. This Review aims to offer clinicians and researchers a comprehensive overview of novel therapeutic classes in heart failure treatment.

Cerebral Autoregulation: A Target for Improving Neurological Outcomes in Extracorporeal Life Support

Despite improvements in survival after illnesses requiring extracorporeal life support, cerebral injury continues to hinder successful outcomes. Cerebral autoregulation (CA) is an innate protective mechanism that maintains constant cerebral blood flow in the face of varying systemic blood pressure. However, it is impaired in certain disease states and, potentially, following initiation of extracorporeal circulatory support. In this review, we first discuss patient-related factors pertaining to venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and their potential role in CA impairment. Next, we examine factors intrinsic to ECMO that may affect CA, such as cannulation, changes in pulsatility, the inflammatory and adaptive immune response, intracranial hemorrhage, and ischemic stroke, in addition to ECMO management factors, such as oxygenation, ventilation, flow rates, and blood pressure management. We highlight potential mechanisms that lead to disruption of CA in both pediatric and adult populations, the challenges of measuring CA in these patients, and potential associations with neurological outcome. Altogether, we discuss individualized CA monitoring as a potential target for improving neurological outcomes in extracorporeal life support.

Advances in, and prospects of, 3D preclinical models for skin drug discovery

The skin has an important role in regulating homeostasis and protecting the body from endogenous and exogenous microenvironments. Although 3D models for drug discovery have been extensively studied, there is a growing demand for more advanced 3D skin models to enhance skin research. The use of these advanced skin models holds promise across domains such as cosmetics, skin disease treatments, and toxicity testing of new therapeutics. Recent advances include the development of skin-on-a-chip, spheroids, reconstructed skin, organoids, and computational approaches, including quantitative structure-activity relationship (QSAR) and quantitative structure-property relationship (QSPR) research. These innovations are bridging the gap between traditional 2D and advanced 3D models, moving progress from research to clinical applications. In this review, we highlight in vitro and computational skin models with advanced drug discovery for skin-related applications.

Multiple Treatment Strategies of Accessory Renal Artery Related Hypertension: Report of Two Cases and Literature Review

Renovascular hypertension (RVH) is a primary cause of secondary hypertension, primarily driven by the activation of the renin-angiotensin-aldosterone system activation. Recently, growing studies suggested accessory renal artery (ARA) might also contribute to RVH. However, the treatment of ARA-related hypertension and whether to take interventional treatment lack consensus. Herein, we report two cases of ARA-related hypertension in our hospital. Imaging studies of both patients showed ARA stenosis. One patient had ARA occlusion well-compensated through tortuous collateral branches, achieving normal blood pressure by medical treatment alone. The other patient had ARA stenosis coexisted with main renal artery stenosis, and revascularization of both arteries led to a significant postoperative reduction in blood pressure. A literature review was conducted to summarize overall treatment strategies for ARA-related hypertension and clarify the relationship between ARA and hypertension. Recent research supported an association between ARA and hypertension. While medical therapy remains the first-line treatment for ARA-related hypertension, interventional procedures should be considered for patients whose blood pressure remains uncontrolled despite conservative management.

Cardiac implantable electronic devices in pregnancy: A position statement

The aim of this document is to provide guidance for the management of women and birthing people with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). Cardiac devices are becoming more common in obstetric practice and a reference document for contemporary evidence-based practice is required. Where evidence is limited, expert consensus has established recommendations. The purpose is to improve safety and reduce the risk of adverse events relating to implanted cardiac devices during pregnancy, birth and the postnatal period.

Treating adult patients of severe psoriasis with methotrexate leads to reduction in biomarkers of atherosclerosis: A prospective study

Background

Psoriasis is a common skin disorder; affecting 0.4-2% of general population and is associated with increased risk of cardiovascular diseases. We conducted this prospective study to determine change in biomarkers of atherosclerosis in plaque psoriasis in patients treated with methotrexate.

Methods

The study was carried out at a tertiary care centre over a period of 1 year after institutional ethical clearance. The study included 50 patients. Adults with severe psoriasis not receiving any systemic treatment for last 3 months were included in the study. Clinical parameters including psoriasis area and severity index (PASI), dermatology quality of life index (DLQI) and estimation of IL-6, hsCRP, and HDL levels and LDL: HDL ratio were done at baseline and at 12 weeks.

Results

A total of 50 patients were included and 42 completed the study. The mean age and mean duration of disease was 44.4 (±13.2) years and 10.8 (±9.9) years, respectively. Pre- and post-treatment mean PASI was 16.3 (±8.3) and 7.43 (±4.9), respectively (p = 0.001). The level of VEGF, IL-6, and hsCRP was 127 (±158) pg/ml, 5.3 (±2.5) pg/ml, and 4.2 (±4.1) mg/L, respectively. The levels of VEGF, IL-6, and hsCRP after 12 weeks of treatment were found to be 59.3 (±61) pg/ml (p=0.006), 3.6 (±2.1) pg/ml (p < 0.001), and 2.6 (±3.1) mg/L (p = 0.012), respectively.

Conclusion

Methotrexate use in patients with chronic plaque psoriasis reduces the level of biomarkers of atherosclerosis at 12 weeks. Early treatment with methotrexate may help in reduction of cardiovascular risk in psoriasis patients.

Interventional Applications for an Ostial Protection Guidewire-The WALPO Technique

Coronary atherosclerotic lesions at the ostium and proximal coronary arteries pose significant challenges in percutaneous coronary interventions (PCI), especially in the left main coronary artery (LMCA). Guide catheter-induced damage can lead to severe complications such as vessel dissection or myocardial infarction. Ostial stent placement with drug-eluting stents offers mechanical support and reduces restenosis but is technically challenging due to the anatomical complexity of the ostium. Complications like longitudinal stent deformation and hydraulic dissection from contrast media are specific concerns. The aortic free-floating wire technique, expanded in this article to Wire in Aorta for Localization and Protection of the Ostium (WALPO), provides a method for safely locating and protecting the ostium during PCI, aiming to improve the safety and efficacy of PCI at this location.

MINOCA as the result of coronary artery aneurysm thrombosis

Myocardial infarction (MI) can be caused by many factors. In addition to the typical obstruction or stenosis of the coronary arteries, there is heterogenic MI with non-obstructive coronary arteries (MINOCA). A rare cause of MINOCA is the thrombosis of a coronary artery aneurysm (CAA). This current case report describes a male patient with CAA thrombosis as the cause of MINOCA following surgery for a mucoepidermoid carcinoma. The patient underwent angiography that identified three CAAs that were located as follows: (i) in the proximal part of the left anterior descending artery (5.55 mm); (ii) in the distal part of the circumflex artery (8.05 mm); and (iii) in the distal part of the right coronary artery (6.61 mm). Thrombotic masses were identified within all three structures. The patient received balloon angioplasties without stent implanting and recovered well. The patient was also notable for the presence of two brain artery aneurysms that were the cause of the previous strokes that he had experienced. This case report also reviews the literature in order to: (i) summarize the aetiological factors and clinical manifestations of CAA; (ii) discuss the diagnostic methods for CAA; (iii) describe the medical and surgical management of CAA; and (iv) assess the prognosis of this rare clinical event.

Diabetes Mellitus and Cardiovascular Disease: Exploring Epidemiology, Pathophysiology, and Treatment Strategies

Diabetes mellitus (DM) affects 537 million people as of 2021, and is projected to rise to 783 million by 2045. This positions DM as the ninth leading cause of death globally. Among DM patients, cardiovascular disease (CVD) is the primary cause of morbidity and mortality. Notably, the prevalence rates of CVD is alarmingly high among diabetic individuals, particularly in North America and the Caribbean (46.0%), and Southeast Asia (42.5%). The predominant form of CVD among diabetic patients is coronary artery disease (CAD), accounting for 29.4% of cases. The pathophysiology of DM is complex, involving insulin resistance, β-cell dysfunction, and associated cardiovascular complications including diabetic cardiomyopathy (DCM) and cardiovascular autonomic neuropathy (CAN). These conditions exacerbate CVD risks underscoring the importance of managing key risk factors including hypertension, dyslipidemia, obesity, and genetic predisposition. Understanding the genetic networks and molecular processes that link diabetes and cardiovascular disease can lead to new diagnostics and therapeutic interventions. Imeglimin, a novel mitochondrial bioenergetic enhancer, represents a promising medication for diabetes with the potential to address both insulin resistance and secretion difficulties. Effective diabetes management through oral hypoglycemic agents (OHAs) can protect the cardiovascular system. Additionally, certain antihypertensive medications can significantly reduce the risk of diabetes-related CVD. Additionally, lifestyle changes, including diet and exercise are vital in managing diabesity and reducing CVD risks. These interventions, along with emerging therapeutic agents and ongoing clinical trials, offer hope for improved patient outcomes and long-term DM remission. This study highlights the urgent need for management strategies to address the overlapping epidemics of DM and CVD. By elucidating the underlying mechanisms and risk factors, this study aims to guide future perspectives and enhance understanding of the pathogenesis of CVD complications in patients with DM, thereby guiding more effective treatment strategies.

Daytime variation of in-hospital mortality and low cardiac output syndrome after pediatric cardiac surgery-a retrospective cohort study

OBJECTIVE

Recent studies suggest that adult cardiac surgery performed in the morning increases the risk of major adverse cardiac events, but it is unclear whether this association exists in pediatric cardiac surgery. This study aimed to determine whether the composite outcome of in-hospital mortality and low cardiac output syndrome (LCOS) differs between morning and afternoon pediatric cardiac surgeries.

METHODS

This retrospective cohort study enrolled 23,433 consecutive pediatric patients who underwent cardiac surgery between August 2014 and December 2021. Pediatric patients who had surgery start time between 8 AM and 11 AM (morning surgery) versus between 2 PM and 5 PM (afternoon surgery) were compared in the risk of the composite outcome. The Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STAT) score was used to indicate the surgical complexity. The adjusted odds radio (aOR) for the composite outcome was calculated using multivariate logistic regression. The restricted cubic spline (RCS) was performed to characterize the continuous relationship between the surgery start time and risk of the composite outcome.

RESULTS

Of 16,534 included pediatric patients, 1.2% died after morning surgery and 0.6% died after afternoon surgery. The composite outcome of in-hospital mortality and LCOS occurred in 14.2% (1,507 of 10,591) of morning surgeries and 8.6% (514 of 5,943) of afternoon surgeries: morning versus afternoon aOR, 1.186 (95% CI, 1.046 to 1.344; p = 0.008). The association was also determined in children aged 3 to 18 years (aOR = 1.598, p = 0.003), weighted between 6.1 to 8.7 kg (aOR = 1.453, p = 0.006), or more than 13 kg (aOR = 1.488, p = 0.019), and with STAT category 4-5 (aOR = 1.367, p = 0.014) subgroups. The RCS plot showed that the aOR of the composite outcome decreased with a delay in the start time of surgery.

CONCLUSION

Our study supports the selective afternoon scheduling of specific pediatric cardiac surgeries, but further investigation is needed in a multicenter cohort.KEY MESSAGESThis study reviewed 23,433 consecutive pediatric patients who underwent cardiac surgery between August 2014 and December 2021.This study suggested that afternoon surgery was associated with a lower risk of the composite outcomes of in-hospital mortality and low cardiac output syndrome.The above association was also determined in children aged 3 to 18 years, weighted between 6.1 and 8.7 kg, or more than 13 kg, and with STAT category 4-5 subgroups.The restricted cubic spline plot showed that the adjusted risk of the composite outcome decreased with a delay in the start time of surgery.Our findings support selective afternoon scheduling for specific pediatric cardiac surgery.