1,2,4-Trimethoxybenzene ameliorates depression-like behaviors by inhibiting the activation of NLRP3 inflammasome

Our previous works identified that 1,2,4-Trimethoxybenzene (1,2,4-TTB) is an NOD-like receptor (NLR) family pyrin domain-containing-3 (NLRP3) inflammasome-specific inhibitor and ameliorates the severity of experimental autoimmune encephalomyelitis. This study explored whether 1,2,4-TTB has an antidepressive-like role, which depends on suppressing NLRP3 inflammasome. In the current study, the depression-like behaviors induced by lipopolysaccharide (LPS) or fear conditioning were used to determine the antidepressive-like role of 1,2,4-TTB. The results showed that NLRP3 inflammasome is activated in the hippocampus by repetitive injection of LPS. 1,2,4-TTB attenuates the depression-like behaviors and suppresses hippocampal NLRP3 inflammasome activation in LPS-induced depression model mice. In addition, we proved that 1,2,4-TTB enhances the fear memory extinction and alleviates anxiety- and depression-like behavior in mice stimulated by fear conditioning. Consistently,1,2,4-TTB inhibited the activation of hippocampal NLRP3 inflammasome in mice subjected to fear conditioning. Therefore, our study demonstrates that 1,2,4-TTB mitigates depression-like behaviors, depending on its inhibitory role in NLRP3 inflammasome activation.

Oral microbiome dysbiosis in cryptogenic ischemic stroke patients with high-risk patent foramen ovale

Patent foramen ovale (PFO) is the most common congenital heart abnormality of foetal origin and has been associated with cryptogenic ischemic stroke (CIS) through several mechanisms, with most theories supporting paradoxical embolism. Other possible but unknown contributing factors, such as the role of the microbiome in PFO-associated strokes, remain unclear. We analysed saliva metagenomes to study the differences in the oral microbiome between young-onset CIS patients with clinically relevant high-risk PFO (n = 52) and those without PFO (n = 52). Age- and sex-matched stroke-free controls (n = 16) with high-risk PFO were included for the comparison. Beta diversity was significantly different between patients and controls with high-risk PFO, but not between patients with and without high-risk PFO. The phylum Ascomycota and class Saccharomycetes were significantly more abundant in patients with high-risk PFO than in those without high-risk PFO. Additionally, the abundance of Lactococcus, including Lactococcus raffinolactis and L. cremoris, was higher in controls with high-risk PFO than in patients with high-risk PFO. These findings highlight that oral dysbiosis and high-risk PFO may form a critical but under-recognized combination in the aetiology of CIS. Future research should focus on elucidating the precise mechanisms of these interactions and developing targeted interventions.

Targeting gut-immune-heart modulate cardiac remodeling after acute myocardial infarction

The gut microbiota interacts with the host to regulate disease and health status. An increasing number of studies have recognized the bidirectional regulation between gut microbiota and immune cells, which plays a significant role in the etiology and prognosis of diseases. Gut microbiota is also a crucial regulatory factor in cardiovascular diseases. After acute myocardial infarction, myocardial and endothelial damage rapidly triggers an inflammatory response, activating the immune system and disrupting the gut microbiota ecology, thereby affecting cardiac remodeling after acute myocardial infarction and potentially leading to heart failure. We have elucidated the regulatory mechanisms of complex intercellular networks in the immune system during cardiac remodeling after acute myocardial infarction. Furthermore, this research examines the roles and mechanisms of gut microbiota, immune cells, and gut metabolites in relation to cardiac remodeling and heart failure after myocardial infarction. Finally, we discuss the potential of targeting gut immune cells as an effective approach to prevent and treat heart failure after acute myocardial infarction in the future, through methods such as dietary regulation, probiotic supplementation, and microbiota transplantation.

Particles, Liquids, and Antiplatelets: Restarting Antiplatelets on Postintervention Day 3 or Later is Associated with Improved Outcomes After Particle Embolization

BACKGROUND AND OBJECTIVES

Timing of restarting antiplatelet agents after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) is a topic of controversy. The aim of this study was to determine whether the timing of antiplatelet restart after MMAE for cSDH affects long-term radiographic and clinical outcomes.

METHODS

A multi-institutional, retrospective cohort study was performed using data from 4 academic medical centers that performed MMAE for cSDH from 2018 to 2023. Patients were prescribed an antiplatelet agent before MMAE were included. Variables included demographics, comorbidities, timing of the procedure and antiplatelet restart, baseline modified Rankin Scale, initial size of SDH, and embolic material used. Outcomes were thickness of SDH at short-term (2 weeks) and long-term (6 weeks) follow-ups, need for unplanned surgical evacuation, and modified Rankin Scale at 90 days.

RESULTS

Of 128 patients (78% male, median age 76 years [IQR 70-83]), 67 patients (52%) had their antiplatelet agent restarted postintervention. Patients who did not have their antiplatelet agent restarted experienced higher mortality (20% vs 5%, P = .038). Among patients with antiplatelet agent restarted postintervention, there was a significant correlation (R = -0.43, P = .025) between timing of antiplatelet restart and long-term SDH size change. Antiplatelet restart on postintervention day 3 or later was associated with improvement in long-term SDH thickness (β = -5.7 mm, s.e. 2.5, P = .034). This effect was observed in the particle-embolization subgroup (β = -8.3 mm, s.e. 3.2, P = .021), but not the liquid-embolization subgroup (β = 1.7 mm, s.e. 5.5, P = .773).

CONCLUSION

There was a higher rate of mortality and decreased functional independence among patients who did not have their antiplatelet agent restarted after MMAE for cSDH. Among patients who did have their antiplatelet restarted, a restart date of postintervention day 3 or later was associated with a significant decrease in long-term SDH size.

A mendelian randomization study on the association between 731 types of immune cells and 91 types of blood cells with venous thromboembolism

BACKGROUND

Venous thromboembolism (VTE) is a grave medical condition characterized by the blockage of distant blood vessels due to blood clots or detached vessel wall fragments, leading to ischemia or necrosis of the affected tissues. With the recent introduction of immunothrombosis, the significance of immune cells in the process of thrombus formation has gained prominent attention. Complex cross-talk occurs between immune cells and blood cells during infection or inflammation, with immune cells actively participating in blood clot formation by promoting platelet recruitment and thrombin activation. Nevertheless, comprehensive studies on the genetic association between immune cells phenotypes and VTE remain scarce. This article employed Mendelian randomization (MR) to investigate the association between the incidence of VTE and a range of 731 immune cell types, along with 91 blood cell perturbation phenotypes, utilizing single nucleotide polymorphisms as instrumental variables.

METHODS

Through the utilization of publicly available genetic data, a two-sample bi-directional MR analysis was conducted. Sensitivity analyses included Cochran's Q test, MR-Egger intercept test, MR-pleiotropy residual sum and outlier (MR-PRESSO) and leave-one-out analysis. For significant associations, replication analysis was conducted using GWAS data from deep vein thrombosis (DVT) and pulmonary embolism (PE).

RESULTS

We firstly investigated the causal relationship between 731 immune cells and VTE risk. All the GWAS data were obtained from European populations and from men and women. The IVW analysis revealed that CD20 on naive-mature B cell, CD20 on IgD- CD38dim B cell, and CD20 on unswitched memory B cell may increase the risk of VTE (P < 0.05). CD28- CD8dim T cell %T cell, CD64 on monocyte and CD64 on CD14 + CD16- monocyte may be protective factors against DVT (P < 0.05). Then disturbed blood cells types as exposure were analyzed to examine its association with occurrence of VTE. Initial and replication analysis both revealed that environmental KCl-impacted red blood cells and butyric acid-impacted platelet accelerated incidence of VTE (P < 0.05), while colchicine -impacted eosinophil, KCl-impacted reticulocyte and Lipopolysaccharide (LPS) -impacted neutrophil reduced VTE risk (P < 0.05). Sensitivity analyses confirmed the robustness and reliability of these positive findings.

CONCLUSIONS

Our study presents evidence of a causal link between six immune cell phenotypes and VTE. Additionally, we have identified two types of blood cells that are associated with both VTE and DVT, and three types of blood cells that are relevant to both VTE and PE.

CLINICAL TRIAL NUMBER

Not applicable.

Independent risk factors and outcomes for ventilator-associated pneumonia due to multidrug-resistant organisms after cardiac valvular surgery

Background

Although numerous studies have documented the risk factors for ventilator-associated pneumonia (VAP) after cardiac surgery, most of these studies included heterogeneous patient populations. This study aimed to explore the risk factors for VAP caused by multidrug-resistant organisms (MDRO) in patients admitted to the cardiosurgery intensive care unit (CSICU) following cardiac valvular surgery.

Methods

This was a single-center, retrospective study. The clinical data of adult VAP patients following cardiac valvular surgery from January 2021 to December 2023 were analyzed. Patients were divided into MDRO VAP and non-MDRO VAP groups. Perioperative clinical data and postoperative follow-up results were collected for both groups. Univariable and multivariable logistic regression analyses were performed to identify risk factors for MDRO VAP, and the outcomes of MDRO VAP patients were analyzed. The species of pathogens isolated from the VAP patients were also investigated.

Results

A total of 109 VAP patients were included in this study, including 47 patients with MDRO VAP and 62 patients with non-MDRO VAP. Multivariable logistic regression analysis identified that independent risk factors for MDRO VAP included preoperative hypoalbuminemia (OR, 0.838; CI, 0.733-0.957; p = 0.009), prolonged mechanical ventilation (OR, 1.173; CI, 1.005-1.369; p = 0.043), and extended broad-spectrum antibiotic therapy (OR, 1.112; CI, 1.019-1.213; p = 0.018). Patients with MDRO VAP had significantly longer ICU stays, total hospital stays, and higher hospitalization costs than non-MDRO VAP patients. The in-hospital mortality rate of the MDRO VAP group was significantly higher than that of the non-MDRO VAP group (29.79% vs. 1.61%, p < 0.001). Gram-negative bacilli were the predominant pathogens in MDRO VAP patients (97.87%), with the highest rate of Pseudomonas aeruginosa (29.79%).

Conclusion

Postoperative MDRO VAP in patients undergoing cardiac valvular surgery is linked to severe clinical outcomes. Greater attention should be given to patients with prolonged mechanical ventilation, extended broad-spectrum antibiotic therapy, and preoperative hypoalbuminemia to prevent MDRO VAP infections.

LT-YOLO: long-term temporal enhanced YOLO for stenosis detection on invasive coronary angiography

Coronary artery stenosis detection by invasive coronary angiography plays a pivotal role in computer-aided diagnosis and treatment. However, it faces the challenge of stenotic morphology confusion stemming from coronary-background similarity, varied morphology, and small-area stenoses. Furthermore, existing automated methods ignore long-temporal information mining. To address these limitations, this paper proposes a long-term temporal enhanced You Only Look Once (YOLO) method for automatic stenosis detection and assessment in invasive coronary angiography. Our approach integrates long-term temporal information and spatial information for stenosis detection with state-space models and YOLOv8. First, a spatial-aware backbone based on a dynamic Transformer and C2f Convolution of YOLOv8 combines the local and global feature extraction to distinguish the coronary regions from the background. Second, a spatial-temporal multi-level fusion neck integrates the long-term temporal and spatial features to handle varied stenotic morphology. Third, a detail-aware detection head leverages low-level information for accurate identification of small stenoses. Extensive experiments on 350 invasive coronary angiography (ICA) video sequences demonstrate the model's superior performance over seven state-of-the-art methods, particularly in detecting small stenoses (<50%), which were previously underexplored.

Associations of Gla-rich protein and interleukin-1β with coronary artery calcification risk in patients with suspected coronary artery disease

Background

Gla-rich protein (GRP) and interleukin-1β (IL-1β) are recognized as reliable biomarkers for evaluating inflammation and are effective predictors of cardiovascular disease. However, the relationship between GRP, IL-1β, and coronary artery calcification (CAC) in patients with suspected coronary artery disease (CAD) remains unclear. Therefore, we investigated the association between these inflammatory biomarkers (GRP and IL-1β) and CAC in patients with suspected CAD.

Methods

This prospective study included patients with suspected CAD who underwent coronary computed tomography angiography (CTA). Fasting venous blood samples were collected at admission, and GRP and IL-1β levels were quantified using enzyme-linked immunosorbent assays (ELISA). The Agatston score was calculated to assess coronary artery calcification (CAC) based on coronary CTA findings.

Results

A total of 120 patients were included in this study. Multivariate logistic regression analysis revealed that GRP [odds ratio (OR), 1.202; 95% confidence interval (CI), 1.065-1.356; p = 0.003] and IL-1β (OR, 1.011; 95% CI, 1.002-1.020; p = 0.015) were independent risk factors for CAC severity. Receiver operating characteristic (ROC) curve analysis demonstrated that GRP had a predictive ability for CAC, with an area under the curve (AUC) of 0.830 [95% CI (0.755, 0.904)]. IL-1β exhibited an AUC of 0.753 [95% CI (0.660, 0.847)]. The combination of GRP and IL-1β in a predictive model improved the AUC to 0.835. Additionally, GRP and IL-1β levels showed a strong positive correlation (r = 0.6861, p < 0.05), and GRP was significantly associated with CAC severity (r = 0.5018, p < 0.05).

Conclusions

Elevated levels of GRP and IL-1β, as inflammatory biomarkers, were associated with CAC in patients with suspected CAD. These biomarkers may provide valuable insights into the pathophysiology of coronary artery calcification and contribute to improved risk stratification in this patient population.

The role of NLRP3 inflammasome in multiple sclerosis: pathogenesis and pharmacological application

Multiple sclerosis (MS) is widely acknowledged as a chronic inflammatory autoimmune disorder characterized by central nervous system (CNS) demyelination and neurodegeneration. The hyperactivation of immune and inflammatory responses is recognized as a pivotal factor contributing to the pathogenesis and progression of MS. Among various immune and inflammatory reactions, researchers have increasingly focused on the inflammasome, a complex of proteins. The initiation and activation of the inflammasome are intricately involved in the onset of MS. Notably, the NLRP3 inflammasome, the most extensively studied member of the inflammasome complex, is closely linked with MS. This review will delve into the roles of the NLRP3 inflammasome in the pathogenesis and progression of MS. Additionally, therapeutic strategies targeting the NLRP3 inflammasome for the treatment of MS, including natural compounds, autophagy regulators, and other small molecular compounds, will be detailed in this review.

Relationship between β-receptor blocker and atrial fibrillation in patients with heart failure: an observational study based on MIMIC IV database

BACKGROUND

The β-receptor blocker is used to treat heart failure (HF), and its role in the occurrence of atrial fibrillation (AF) is unclear in patients with HF. This study aimed to investigate the relationship between β-receptor blocker use and AF in patients with HF.

METHODS

All data was collected from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The relationship between β-receptor blocker and AF was analyzed by univariate logistic regression, multivariate logistic regression, and subgroup analysis. The machine learning algorithm including logistic and Random forest was used to analyze the importance of variables in AF. The interaction analysis was conducted to determine whether other factors influence the relationship between β-receptor blocker and AF.

RESULTS

A total of 953 participants were involved. We found that the use of beta-blockers increased the risk of AF this result was not affected by confounding factors (OR (95%CI): 2.821[2.014,3.951], p < 0.01). The interaction analysis showed that myocardial infarction (MI) and β-receptor blocker had an interaction on AF (p for interaction < 0.001). The results of additive and multiplicative interaction analysis indicated that β-receptor-blocker use and infarction are antagonistic in the development of AF in patients with HF ((S (95% CI): 0.283[0.142, 0.563]; AP (95% CI): -1.187[-2.020, -0.354]; RERI (95% CI): -2.237[-3.722, -0.752], OR (95% CI):0.374[0.184, 0.772]).

CONCLUSION

This study found that β-receptor blocker use was an important risk factor for AF in patients with HF. β-receptor blocker use was antagonistic to MI in AF in patients with HF.

CLINICAL TRIAL

Not applicable.

Explainable machine learning model for assessing health status in patients with comorbid coronary heart disease and depression: Development and validation study

BACKGROUND

Coronary heart disease (CHD) and depression frequently co-occur, significantly impacting patient outcomes. However, comprehensive health status assessment tools for this complex population are lacking. This study aimed to develop and validate an explainable machine learning model to evaluate overall health status in patients with comorbid CHD and depression.

METHODS

Utilizing data from the 2021-2022 Behavioral Risk Factor Surveillance System, we developed and externally validated machine learning models to predict overall health status, defined as having both poor physical and mental health for ≥ 14 days in the past 30 days. Eleven machine learning algorithms were evaluated, including artificial neural networks, support vector machines, and ensemble methods. The SHapley Additive exPlanations (SHAP) method was employed to enhance model interpretability. Model performance was assessed using discrimination, calibration, and decision curve analysis.

RESULTS

The study included 9,747 participants in the derivation cohort and 8,394 in the external validation cohort. Among the eleven algorithms evaluated, an optimized XGBoost model with eight key features demonstrated balanced performance. SHAP analysis revealed that employment status, physical activity, income, and age were the most influential predictors. The model maintained good discrimination (AUC 0.712, 95% CI 0.703-0.721 in derivation; AUC 0.711, 95% CI 0.701-0.721 in validation), calibration and clinical utility across both cohorts.

CONCLUSION

Our explainable machine learning model provides a novel, comprehensive approach to assessing health status in patients with comorbid CHD and depression, offering valuable insights for personalized management strategies.

Colchicine in Coronary Artery Disease: Where Do We Stand?

ABSTRACT

Colchicine is an anti-inflammatory drug for different inflammatory conditions and is approved for secondary prevention of cardiovascular events in patients with coronary artery disease, mainly based on the results of the LODOCO2 and COLCOT trials. The recently published CLEAR SYNERGY trial reported neutral results for colchicine in patients with acute myocardial infarction undergoing percutaneous coronary intervention, challenging the previous reported benefits of colchicine. While colchicine appeared rather safe across the different studies, the variation in efficacy may suggest that the one-size-fits-all for the treatment of acute and chronic forms of coronary artery disease may not be appropriate, and that low-dose colchicine may be beneficial as an add-on therapy in patients who are stable or recovering from acute event, and not so helpful in patients with acute myocardial infarction already receiving intensive pharmaco-invasive therapies.

Early clinical outcomes of transcatheter aortic valve implantation using the NAVITOR system

Transcatheter aortic valve implantation (TAVI) using the NAVITOR system has been relatively underreported due to its recent introduction in Japan. This study aimed to assess the short-term outcomes of TAVI with the NAVITOR in real-world clinical practice. Patients with severe aortic stenosis who underwent TAVI using the NAVITOR system at our institution between December 2022 and December 2023 were prospectively enrolled. We evaluated the 30-day post-TAVI outcomes using the Valve Academic Research Consortium 3 (VARC-3). Among 32 consecutive patients (mean age, 84 years; 19% female), technical success was achieved in 31 (96.8%). One patient developed a subclavian artery vascular dissection, requiring balloon angioplasty during the TAVI procedure, and another received a permanent pacemaker due to persistent advanced atrioventricular block. At the 30-day follow-up, device success was achieved in 31 (96.8%) patients, with early safety observed in 27 (84.3%). One patient experienced sudden unexplained death after discharge. None of the patients experienced myocardial infarction, valve embolisation, life-threatening bleeding, or acute kidney injury within 30 days after the procedure. Echocardiographic follow-up showed a median effective orifice area index of 1.26 ± 0.27. Contrast-enhanced computed tomography was performed in 19 patients 30 days after the procedure, revealing hypo-attenuated leaflet thickening (HALT) in 10 (52.6%). Although the 30-day outcomes of TAVI using the NAVITOR system appeared promising, a relatively high incidence of HALT was observed.

Emergency medicine updates: Management of sepsis and septic shock

INTRODUCTION

Sepsis is a common condition associated with significant morbidity and mortality. Emergency physicians play a key role in the diagnosis and management of this condition.

OBJECTIVE

This paper evaluates key evidence-based updates concerning the management of sepsis and septic shock for the emergency clinician.

DISCUSSION

Sepsis is a life-threatening syndrome, and rapid diagnosis and management are essential. Antimicrobials should be administered as soon as possible, as delays are associated with increased mortality. Resuscitation targets include mean arterial pressure ≥ 65 mmHg, mental status, capillary refill time, lactate, and urine output. Intravenous fluid resuscitation plays an integral role in those who are fluid responsive. Balanced crystalloids and normal saline are both reasonable options for resuscitation. Early vasopressors should be initiated in those who are not fluid-responsive. Norepinephrine is the recommended first-line vasopressor, and if hypotension persists, vasopressin should be considered, followed by epinephrine. Administration of vasopressors through a peripheral 20-gauge or larger intravenous line is safe and effective. Steroids such as hydrocortisone and fludrocortisone should be considered in those with refractory septic shock.

CONCLUSION

An understanding of the recent updates in the literature concerning sepsis and septic shock can assist emergency clinicians and improve the care of these patients.

Large-volume single-institution experience with transradial versus transfemoral mechanical thrombectomy in acute ischemic stroke: a retrospective cohort study

BACKGROUND

Transradial access (TRA) is increasingly common in cerebrovascular intervention, but its safety and efficacy in mechanical thrombectomy (MT) in acute ischemic stroke remain unclear.

METHODS

We reviewed a prospectively maintained single-institution stroke database including consecutive cases between January 1, 2016 and December 31, 2023. Patients were categorized by initial access site, TRA or transfemoral access (TFA). Access site complications (ASCs) were tabulated and classified by Clavien-Dindo (CD) grade.

RESULTS

1121 patients were included (862 TFA, 259 TRA). TRA was associated with a mean 7.7 (95% CI 5.9 to 9.6) additional minutes from puncture-to-first-pass, and 7.7 (95% CI 4.8 to 10.6) additional minutes from puncture-to-recanalization. Among anterior circulation occlusions, TRA was associated with a 47% increase in the puncture-to-first-pass interval and a 27% increase in puncture-to-recanalization interval (P<0.001). Among posterior circulation occlusions, procedural times were not significantly different between TFA and TRA approaches. There were no significant differences in mean number of passes (1.7 vs 1.8, P=0.58), first pass successful recanalization rates (42.4% vs 45.6%, P=0.37), and post-procedural successful recanalization rates (67.2% vs 68.2%, P=0.76). Crossover rates were higher among the TRA group (5.8% vs 2.6%, P=0.01); ASCs and ASCs of CD grade >1 presented less frequently in the TRA group (12 (4.8%) vs 53 (6.1%), P=0.36; 4 (1.5%) vs 30 (3.5%), P=0.11, respectively), though both failed the predetermined threshold of statistical significance.

CONCLUSION

TRA MT was associated with similar posterior circulation but longer anterior circulation procedural times, overall similar rates of Thrombolysis In Cerebral Infarction (TICI) 2c/3 reperfusion, and similar neurologic outcomes when compared against TFA procedures.

Transcatheter versus surgical aortic valve replacement for severe aortic valve stenosis: Meta-analysis with trial sequential analysis

OBJECTIVES

Randomized controlled trials comparing transcatheter aortic valve implantation with surgical aortic valve replacement demonstrate conflicting evidence, particularly in low-risk patients. We aim to reevaluate the evidence using trial sequential analysis, balancing type I and II errors, and compare with conventional meta-analysis.

METHODS

Databases were searched for randomized controlled trials, which were divided into higher-risk and lower-risk randomized controlled trials according to a pragmatic risk classification. Primary outcomes were death and a composite end point of death or disabling stroke assessed at 1 year and maximum follow-up. Conventional meta-analysis and trial sequential analysis were performed, and the required information size was calculated considering a type I error of 5% and a power of 90%.

RESULTS

Eight randomized controlled trials (n = 5274 higher-risk and 3661 lower-risk patients) were included. Higher-risk trials showed no significant reduction in death at 1 year with transcatheter aortic valve implantation (relative risk, 0.93, 95% CI, 0.81-1.08, P = .345). Lower-risk trials suggested lower death risk on conventional meta-analysis (relative risk, 0.67, 95% CI, 0.47-0.96, P = .031), but trial sequential analysis indicated potential spurious evidence (P = .116), necessitating more data for conclusive benefit (required information size = 5944 [59.8%]). For death or disabling stroke at 1 year, higher-risk trials lacked evidence (relative risk, 0.90, 95% CI, 0.79-1.02, P = .108). In lower-risk trials, transcatheter aortic valve implantation indicated lower risk in conventional meta-analysis (relative risk, 0.68, 95% CI, 0.50-0.93, P = .014), but trial sequential analysis suggested potential spurious evidence (P = .053), necessitating more data for conclusive benefit (required information size = 5122 [69.4%]). Follow-up results provided inconclusive evidence for both primary outcomes across risk categories.

CONCLUSIONS

Conventional meta-analysis methods may have prematurely declared an early reduction of negative outcomes after transcatheter aortic valve implantation when compared with surgical aortic valve replacement.

Rationale and Design of the CREATE Trial: A Multicenter, Randomized Comparison of Continuation or Cessation of Single Antithrombotic Therapy at 1 Year After Transcatheter Aortic Valve Replacement

BACKGROUND

Current guidelines and expert consensus recommend lifelong single antiplatelet therapy for patients undergoing transcatheter aortic valve replacement who have no indication for anticoagulation or dual antiplatelet therapy. However, there is no direct evidence from randomized controlled trials supporting this practice. Furthermore, the optimal duration of antiplatelet therapy in this population has not been adequately investigated.

METHODS AND RESULTS

CREATE (A Multicenter Randomized Controlled Study to Evaluate Cessation of Antithrombotic Therapy at 1 Year in TAVR Patients-The CREATE Study) is a prospective, multicenter, open-label, randomized controlled trial for patients who have undergone successful transcatheter aortic valve replacement and have no indication for long-term oral anticoagulation or antiplatelet therapy. Eligible patients are free from major bleeding and ischemic events for 1 year postprocedure before being randomized 1:1 to single antiplatelet therapy (control group) or no antiplatelet therapy (experimental group). The primary efficacy end point is the incidence of bleeding events, defined by the VARC-3 (Valve Academic Research Consortium-3) criteria, at 1-year postrandomization. The primary safety end point is a composite of cardiac death, myocardial infarction, and ischemic stroke at 1 year. The trial is powered for both superiority in efficiency and noninferiority in safety. Accordingly, a total of 3380 patients will be enrolled.

CONCLUSIONS

The CREATE trial aims to assess if stopping antiplatelet therapy at 1-year after transcatheter aortic valve replacement reduces bleeding risk without increasing ischemic events in patients not requiring chronic antithrombotic therapy.

REGISTRATION

URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2400087454.

The role of TyG index in predicting low left ventricular ejection fraction after acute coronary syndrome

AIMS

This study aimed to investigate whether triglyceride-glucose (TyG) index and other clinical and demographic parameters are associated with left ventricular ejection fraction (LVEF) following an acute coronary syndrome (ACS) event.

METHODS & RESULTS

This retrospective cohort study included patients hospitalized with a diagnosis of ACS. The TyG index was calculated using the formula: TyG = ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. A total of 2,135 patients were included in the study (mean age: 57.49 ± 11.45 years, 78.64% male). Multivariable logistic regression revealed that mildly reduced or reduced LVEF was associated with immigrant population (p = 0.004), diabetes mellitus (p = 0.017), previous coronary artery disease (CAD) (p < 0.001), ST-elevation myocardial infarction (STEMI) (p < 0.001) and high (≥4.95) TyG index (p < 0.001). Reduced LVEF (≤40%) was independently associated with an immigrant status (p = 0.031), previous CAD (p = 0.001), peripheral artery disease (p = 0.038), renal diseases (p = 0.011), STEMI (p < 0.001) and high (≥5.10) TyG index (p < 0.001).

CONCLUSIONS

The TyG index shows potential as an independent risk factor for low LVEF after ACS.However, its relatively low sensitivity and specificity suggest that it may have a supportive role in risk stratification. Further research is needed to confirm its utility as a reliable prognostic marker for heart failure in ACS patients.

Awake Venovenous Extracorporeal Membrane Oxygenation in the Intensive Care Unit: Challenges and Emerging Concepts

Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. Avoidance of sedation and invasive ventilation during ECMO (commonly referred to as "awake ECMO") may have potential advantages, including a lower rate of delirium, shorter mechanical ventilation time, and the possibility of undergoing early rehabilitation and/or physiotherapy. However, awake ECMO is also associated with several risks, such as self-inflicted lung injury and cannula displacement or self-removal. Accordingly, invasive ventilation before ECMO, as well as weaning from ECMO before weaning from mechanical ventilation, remain the most common approaches. In this review, the authors describe indications, contraindications, advantages, disadvantages, and current evidence on the use of ECMO without invasive ventilation in patients with respiratory failure.

Commonalities of platelet dysfunction in heart failure with preserved ejection fraction and underlying comorbidities

Heart failure with preserved ejection fraction (HFpEF) is characterized by a lack of a specific targeted treatment and a complex, partially unexplored pathophysiology. Common comorbidities associated with HFpEF are hypertension, atrial fibrillation, obesity and diabetes. These comorbidities, combined with advanced age, play a crucial role in the initiation and development of the disease through the promotion of systemic inflammation and consequent changes in cardiac phenotype. In this context, we suggest platelets as important players due to their emerging role in vascular inflammation. This review provides an overview of the role of platelets in HFpEF and its associated comorbidities, including hypertension, atrial fibrillation, obesity and diabetes mellitus, as well as the impact of age and sex on platelet function. These major HFpEF-associated comorbidities present alterations in platelet behaviour and in features linked to platelet size, content and reactivity. The resulting dysfunctional platelets can contribute to further increase inflammation, oxidative stress and endothelial dysfunction, suggesting an active role of these cells in the initiation and progression of HFpEF. Recent evidence shows that reduced platelet count and elevated mean platelet volume are associated with worsening heart failure in HFpEF patients. However, the specific mechanisms by which platelets contribute to HFpEF development and progression are still largely unexplored, with only a few studies investigating platelet function in HFpEF. We discuss the limited yet significant body of research investigating platelet function in HFpEF, emphasizing the need for more comprehensive studies. Additionally, we explore the potential mechanisms through which platelets may influence HFpEF, such as their interactions with the vascular endothelium and the secretion of bioactive molecules like cytokines, chemokines and RNA molecules. These interactions and secretions may play a role in modulating vascular inflammation and contributing to the pathophysiological landscape of HFpEF. The review underscores the necessity for future research to elucidate the precise contributions of platelets to HFpEF, aiming to potentially identify novel therapeutic targets and improve patient outcomes. The evidence presented herein supports the hypothesis that platelets are not merely passive bystanders but active participants in the pathophysiology of HFpEF and its comorbidities.

Quantitative serum proteomic analysis for biomarker discovery in post-COVID-19 postural orthostatic tachycardia syndrome (PC-POTS) patients

Postural orthostatic tachycardia syndrome (POTS) is a chronic, debilitating condition that is characterized by an excessive increase in heart rate upon orthostatic challenge. Before the COVID-19 pandemic, POTS affected 0.5 % to 1 % of the U.S. population. Since the pandemic, the incidence has risen sharply, adding an estimated 6-7 million new cases in the U.S. Despite its importance, there is currently no reliable biomarker for POTS, leading to significant diagnostic delays. A major hurdle in identifying biomarkers is the heterogeneous nature of the syndrome. To address this, we focused on a homogeneous subgroup of post-COVID-19 POTS (PC-POTS) patients. We conducted quantitative proteomics on sera from 9 PC-POTS patients and 9 healthy controls, identifying 31 proteins with significantly different abundances in PC-POTS patients. Most elevated proteins were linked to actin filaments or immune functions/inflammation. Weighted Gene Co-Expression Network Analysis revealed module 7 (M7) correlated strongly with PC-POTS diagnosis and related traits. The key proteins in M7 included MTPN, TAGLN2, ADP-ribosylation factor 1, PDLIM1, PPIA, CNN2, LGALSL, TXN, TLN1, TUBA4A, IL4, TREML1, GP1BA, and, all highly correlated with these traits. Cell-type enrichment analysis revealed that M7 was highly associated with immune and neuronal cells. The main pathways identified in M7 included the integrin signaling pathway, blood coagulation, and glycolysis. These findings suggest that the key proteins in M7 could serve as biomarkers for PC-POTS. This study uses quantitative proteomics to identify potential biomarkers that differentiate PC-POTS patients from healthy controls, establishing a foundation for further research and validation.

Post-Mortem imaging biobanks: Building data for reproducibility, standardization, and AI integration

In recent years, post-mortem imaging has advanced with techniques such as Post-Mortem Computed Tomography (PMCT) and Post-Mortem Magnetic Resonance imaging (PMMR). PMCT is particularly useful for assessing skeletal injuries, vascular lesions, and estimating post-mortem intervals. These analyses are based on radiomics principles, a growing field that requires specialized expertise, which is still limited. To support this field, post-mortem imaging biobanks are proposed as valuable tools, especially when enhanced with Artificial Intelligence (AI). However, complexities in this field require caution and adherence to guidelines, especially regarding consent for image storage, participant information, international cooperation, and nonprofit operations.

Work Disability Prevention and Management

OBJECTIVE

This abbreviated version of the American College of Occupational and Environmental Medicine's (ACOEM) Work Disability Prevention and Management Guideline reviews the available evidence and provides recommendations to clinicians regarding interventions to help patients remain at or return to work.

METHODS

Systematic literature reviews were conducted. Studies were graded and evidence tables were created, with involvement of a multidisciplinary expert panel that evaluated the evidence and finalized recommendations for all clinical questions. Extensive peer review was performed. Consensus recommendations were formulated when evidence was lacking.

RESULTS

Evidence-based recommendations have been developed to guide work disability prevention and management.

CONCLUSIONS

Clinicians should utilize quality evidence in determining treatment methods to prevent and alleviate work disability for workers. This guideline offers an evidence-based framework for preventing and mitigating work disability for individual adults in the active workforce. It is designed for use by healthcare clinicians who desire to minimize the negative impact of health conditions on working people's lives and livelihoods.

Academic Productivity in Ophthalmology and Its Correlation to National Economic Indicators Among the OECD Countries: A Bibliometric Analysis

PURPOSE

Prompted by the clinical concern that limited healthcare resources allocation affects physicians' research productivity, this study examines the association between bibliometric indices of ophthalmologic research and national economic indicators in Organisation for Economic Co-operation and Development (OECD) countries.

METHODS

The Scimago Journal and Country rank source was searched for research productivity data in ophthalmology among OECD countries between 1996 and 2019. Bibliometric indices included: documents number, number and percent of citable documents, citations number, citations per document, and H-index. The updated economic indicators of each country (gross domestic product [GDP] per capita, health spending as percent of GDP (health expenditure), gross domestic expenditure on research, and development as percent of GDP [GERD]) were collected from the World Bank and the OECD websites. Correlation between economic and bibliometric metrics and multivariate linear regression analyses were performed.

RESULTS

Among 267,444 documents analyzed, correlation analysis found a strong correlation between health expenditure and H index (r = 0.711, p < 0.001); a moderate correlation between health expenditure and documents number (r = 0.589, p < 0.001), number of citable document (r = 0.593, p < 0.001) and citations number (r = 0.673, p < 0.001); and a moderate correlation between GERD and H index (r = 0.564, p < 0.001). Multivariate regression analysis controlling for economic factors, population and language showed the independent association of these parameters with bibliometric indices.

CONCLUSIONS

This study demonstrates a positive correlation between bibliometric indicators of ophthalmology research and economic factors, particularly health expenditure, among the OECD countries. Our results suggest an advantage of domestic investment in health to expand academic productivity in the field of ophthalmology.

E3 Ubiquitin Ligase TRIM7 Alleviates Lipopolysaccharide-Induced Acute Lung Injury via Inhibiting NLRP3 Inflammasome Activation

Acute lung injury (ALI) is a common clinical disease with high mortality, characterized by tissue damage caused by excessive activation of inflammation. TRIM7 is an E3 ligase that plays an important role in regulating viral infection, tumor progression, and innate immune response. However, its function in ALI is unclear. In this study, lipopolysaccharide (LPS) was used to stimulate C57BL/6j mice and HULEC-5a cells to establish ALI models in vivo and in vitro. TRIM7 expression was down-regulated during ALI. Furthermore, overexpressing TRIM7 in HULEC-5a cells relieved cell damage and inflammatory activation induced by LPS stimulation. TRIM7 knockdown had the opposite effect. Trim7-overexpressing mice were established by endotracheal injection of adeno-associated virus 6-Trim7 virus in vivo; the ALI model was then induced by LPS stimulation. Overexpression of TRIM7 could alleviate lung tissue injury, pulmonary interstitial hemorrhage, increased alveolar and vascular permeability, inflammatory cell infiltration, and secretion of inflammatory factors induced by LPS stimulation. Mechanistically, TRIM7 inhibited the expression of NOD-, LRR- and pyrin domain-containing 3 (NLRP3) and the activation of the NLRP3 inflammasome. The regulatory effect of TRIM7 on ALI depended on the NLRP3 inflammasome. This investigation, for the first time, showed the inhibitory effect of TRIM7 on ALI and activation of the NLRP3 inflammasome, providing new targets and ideas for the research on the mechanism and treatment of ALI.

Patient-Reported Outcome Measures in Cardiovascular Research and Care: PRO(M)s and CONS

ABSTRACT

Patient-reported outcome measures (PROMs) are vital tools in cardiovascular disease research and care, providing insights that complement traditional clinical outcomes such as mortality and morbidity. PROMs capture patient experiences with cardiovascular disease, such as quality of life, functional capacity, and emotional well-being, allowing clinicians to assess how interventions affect daily life. PROMs are integral to cardiovascular investigations and management, especially in chronic conditions and rehabilitation, where they inform on the impact of personalized care plans by tracking symptom progression and patient adherence. Selecting and applying to cardiovascular research and practice effective PROMs involves evaluating their validity, reliability, and sensitivity to change, with instruments such as the Kansas City Cardiomyopathy Questionnaire and the Seattle Angina Questionnaire widely used for heart failure and coronary artery disease, respectively. Implementing PROMs in real-world practice requires addressing challenges related to workflow integration and patient adherence, emphasizing their value in patient-centered care. As digital health advances, remote PROM data collection through mobile applications and wearable devices will enhance access to and extent of PROMs, and artificial intelligence-driven analytical tools will provide real-time, automated and plausible more poignant insights for personalized treatment. Future efforts should focus on culturally adapting PROMs for diverse populations to ensure global applicability. PROMs should also be established as essential components of innovative research and responsive, patient-centered cardiovascular care.

[Septic cardiomyopathy-diagnosis and estimation of disease severity]

BACKGROUND

The relevance of septic cardiomyopathy is frequently underestimated due to the complexity of the pattern of cardiac injury and the corresponding difficulties in quantifying the degree of functional impairment.

AIM

Account of the methods for diagnosis and severity classification of septic cardiomyopathy.

METHODS

Literature review and analysis of the main findings.

RESULTS

Septic cardiomyopathy is characterized by both systolic and diastolic impairment of not only the left, but also the right ventricle, as well as by sinus-tachycardiomyopathy (≥ 90-95 beats/min) of variable degree. Sepsis-related organ failure assessment (SOFA) score, left ventricular ejection fraction (LVEF), ECG and cardiac biomarkers do not help in grading severity of septic cardiomyopathy. For that purpose either a sophisticated echocardiography diagnosis is mandatory, or the measurement of those global heart function parameters which take into account the dependency of cardiac output on afterload, in view of the pronounced vasodilatation in sepsis and septic shock, is needed. A suitable parameter on the basis of cardiac output measurement is afterload-related cardiac performance (ACP), which gives the percentage of cardiac output in a septic patient related to the cardiac output a healthy heart pumps when challenged by a fall in systemic vascular resistance to the same extent. The calculation of ACP shows that at least one in two septic patients suffers from impaired heart function and that mortality increases as severity increases.

CONCLUSION

Simple parameters like LVEF are not apt for diagnosis nor for disease severity classification of septic cardiomyopathy. For that purpose either sophisticated echocardiography techniques or load-independent parameters-best validated-ACP measurements are appropriate.

Clinical and subclinical acute brain injury caused by invasive cardiovascular procedures

Over the past 50 years, the number and invasiveness of percutaneous cardiovascular procedures globally have increased substantially. However, cardiovascular interventions are inherently associated with a risk of acute brain injury, both periprocedurally and postprocedurally, which impairs medical outcomes and increases health-care costs. Current international clinical guidelines generally do not cover the area of acute brain injury related to cardiovascular invasive procedures. In this international Consensus Statement, we compile the available knowledge (including data on prevalence, pathophysiology, risk factors, clinical presentation and management) to formulate consensus recommendations on the prevention, diagnosis and treatment of acute brain injury caused by cardiovascular interventions. We also identify knowledge gaps and possible future directions in clinical research into acute brain injury related to cardiovascular interventions.

The Effect of Prior Use of Statins on the Severity of COVID-19 Disease: A Retrospective Study

It has been suggested that the use of statin pills beforehand could potentially influence the outcomes when individuals are hospitalized with COVID-19. In this study, we investigated how the prior use of statin medication could influence the COVID-19 severity parameters. In this retrospective cohort study, we categorized COVID-19 patients into 2 groups: statin users and non-users. Then, various data including age, gender, the patient's need for ventilation support, the lowest oxygen blood saturation level, the length of hospitalization, receiving remdesivir treatment, and their COVID-19 vaccination status were collected. Out of 168 patients, 62 had taken statin medication before being admitted. Using statins decreased the patient's need for ventilation support, length of hospitalization, ventilation duration, and oxygen saturation level (P < .001). Interaction effect analysis showed that receiving remdesivir statically affected the length of hospitalization, ventilation duration, and oxygen saturation level but did not significantly affect the association between statins and needing to ventilator. The use of statin pills before COVID-19 admission reduced the requirement for ventilator support.

Microglial pyroptosis drives neuropathic pain and targeting NLRP3 alleviates pain and neuroinflammation

Neuropathic pain is triggered by nerve damage or disease and involves chronic neuroinflammation driven by activated microglia releasing pro-inflammatory cytokines. PANoptosis, a complex cell death program encompassing apoptosis, pyroptosis, and necroptosis, has emerged as a key player in neuroinflammation. While individual PANoptosis pathway have been linked to pain, its systemic role in neuropathic pain remains unclear. This study explored the involvement of PANoptosis in microglia under neuropathic pain and its potential therapeutic targeting. After spinal nerve ligation (SNL), robust microglia activation and pro-inflammatory cytokines were increased in spinal dorsal horn. To figure out the major PANoptosis under neuropathic pain, bioinformatic analysis and protein analysis were explored by using spinal dorsal horn on 14 days of post injury. The results supported that pyroptosis was the dominant pathway after injury, and we further investigated pyroptosis-related markers on microglia specifically. Notably, pyroptosis marker (caspase-1) was elevated in microglia compared to apoptosis (cleaved caspase-3) and necroptosis (p-RIPK3) markers. This finding highlights microglia pyroptosis as a key driver of neuropathic pain development. To harness this knowledge therapeutically, we employed intrathecal injection of NLRP3 siRNA nanoparticles. NLRP3, a crucial component of the inflammasome complex triggering pyroptosis, served as our target. Strikingly, this intervention effectively alleviated mechanical allodynia, a hallmark of neuropathic pain, alongside reducing microgliosis and dampening microglial pyroptosis. Our findings reveal that microglia pyroptosis plays a key role in neuropathic pain and suggest NLRP3 siRNA nanoparticles as a promising therapeutic avenue for pain management.

Reevaluating Normal-Flow Low-Gradient Severe Aortic Stenosis: Clinical Phenotypes and Outcomes in Severe Aortic Stenosis Among Transcatheter Aortic Valve Replacement Patients

BACKGROUND

Aortic stenosis (AS) is a complex condition with various hemodynamic subtypes, each with distinct clinical profiles and outcomes. The aim of this study was to assess the characteristics and outcomes of different AS phenotypes on the basis of flow and gradient patterns.

METHODS

In this retrospective cohort study, 930 patients who underwent transcatheter aortic valve replacement for severe symptomatic AS at Mayo Clinic sites from 2012-2017 were included. Patients were classified into three groups: high gradient (HG), low-flow low-gradient (LFLG), and normal-flow low-gradient (NFLG). Baseline clinical, echocardiographic, and computed tomographic characteristics, including aortic valve area, aortic valve calcium score, left ventricular ejection fraction, and the prevalence of tricuspid regurgitation, and atrial fibrillation were analyzed. One- and 5-year all-cause mortality outcomes were compared using Kaplan-Meier analysis and Cox proportional-hazards models.

RESULTS

The final cohort included 273 patients in the NFLG group (29.4%), 563 in the HG group (60.5%), and 94 in the LFLG group (10.1%). After reevaluation and careful review of the echocardiograms, 41 patients with NFLG AS were reclassified into the LFLG group. Patients with LFLG AS had the highest prevalence of atrial fibrillation or flutter (60%) and tricuspid regurgitation (17%). Aortic valve calcium score was significantly lower in the NFLG group compared with the HG and LFLG groups. One-year mortality was highest in the LFLG group (17.4%), followed by the HG (13.9%) and NFLG (10.9%) groups, but the difference was not statistically significant (P = .20). The 5-year mortality rate was higher in the LFLG group (55.6%) compared with the NFLG (47.2%) and HG (47.9%) groups but did not reach statistical significance (P = .20).

CONCLUSIONS

LFLG AS was associated with more comorbidities and higher mortality compared with HG and NFLG AS, though differences in mortality were not statistically significant. The NFLG group, after close review and reclassification, showed the least significant AS. Randomized trials are needed to clarify the prognosis and management of NFLG AS.

Expanding indications for drug-coated balloons in coronary artery disease

INTRODUCTION

Despite technical advances in percutaneous coronary intervention (PCI) and new iterations of drug-eluting stents (DES), complications still occur, including stent thrombosis and in-stent restenosis (ISR). Drug-coated balloons (DCBs) provide a promising option for the treatment of coronary lesions - particularly when DES are undesirable or contraindicated - allowing for PCI without the implantation of metallic devices, thus adhering to the 'leave nothing behind' principle.

AREAS COVERED

A comprehensive literature search has been performed on PubMed, Web of Science and Cochrane, up to November 2024, with no significant restrictions. This article provides an overview of available DCB and summarizes the evidence supporting their use in different settings, including ISR, small-vessel disease, de novo large-vessel disease, and bifurcations.

EXPERT OPINION

Trials of DCB are heterogeneous with respect to population, sample size, follow-up, anatomical pattern, and device used. Furthermore, they usually have limited statistical power for clinical endpoints. Based on current knowledge, DES may be preferrable for DES-ISR, de novo lesions in large vessels and for the treatment of the main branch in true bifurcations, with DCB approved for small-vessel disease and selected ISR lesions. Ongoing trials are expected to provide definitive insights into the efficacy and safety of DCB in different scenarios.

The potential role of cardiac CT in ischemic stroke: bridging cardiovascular and cerebrovascular health

Ischemic stroke, accounting for approximately 80% of all stroke cases, remains a leading cause of death and disability worldwide. Effective management of ischemic stroke is heavily influenced by its etiology, which can range from large-artery atherosclerosis and cardiac embolism to cerebral small-vessel occlusions and cryptogenic strokes. Cardioembolic stroke, which makes up about 30% of ischemic strokes, often leads to more severe symptoms and worse outcomes, necessitating anticoagulation therapy for prevention. Cryptogenic strokes, comprising over 25% of ischemic strokes, pose significant challenges for treatment and prevention due to their elusive nature. Thorough investigation of cardioembolic sources during the acute phase of stroke is crucial. While transthoracic and transesophageal echocardiography are traditional methods for detecting intracardiac thrombi and patent foramen ovale (PFO), cardiac CT has emerged as a non-invasive, efficient alternative. Cardiac CT can effectively visualize intracardiac thrombi, PFO, valvular abnormalities, tumors, and complex aortic plaques. This review discusses the potential applications of cardiac CT in ischemic stroke, emphasizing its role in identifying stroke etiology, predicting stroke risk, and assessing patient prognosis. The integration of advanced imaging technologies and artificial intelligence further enhances its diagnostic accuracy and clinical utility, promising to improve outcomes and reduce the healthcare burden associated with ischemic stroke.

Ethnic variations in neutrophil count as predictors of prognosis following acute myocardial infarction

AIMS

Elevated neutrophils are associated with a poor prognosis after acute myocardial infarction (AMI) but it is not known if ethnicity influences the association between neutrophil count and outcome. We aimed to describe the temporal dynamics of neutrophils after AMI, and assess the interaction between ethnicity, neutrophil count, and outcomes after AMI.

METHODS

Consecutive patients presenting with AMI between 2016 and 2023 were divided into two groups according to their median neutrophil count. Ethnicity was dichotomised as white and other ethnic groups combined (referred to as 'ethnic minorities'). The primary outcome was in-hospital mortality, with a secondary outcome of 60-day mortality.

RESULTS

In our study of 3062 AMI patients (76 % white, 24 % from ethnic minority groups), we found that neutrophil counts rose early post AMI, which coincided with a nadir of the other cell groups. We identified a relative baseline neutropenia in ethnic minority individuals, compared to white individuals (6.85 vs 8.42 × 109/L). We observed a significant, independent association between elevated neutrophils at baseline and the primary outcome of in-hospital mortality (OR 2.06, p < 0.001) and secondary outcome of 60-day all-cause mortality (HR 1.08, p = 0.002). Sub-group analysis revealed a significant interaction between ethnicity and elevated neutrophils (p = 0.004), indicating that a comparable neutrophil count conferred an increased risk for ethnic minority patients for both outcomes.

CONCLUSIONS

We report ethnicity-specific leucocyte dynamics after AMI. Furthermore, neutrophil count is associated with a disproportionate risk in ethnic minority compared with white individuals. Understanding post-AMI inflammation and its interaction with ethnicity is essential in providing personalised prognostication and patient management.

Impact of gender on in-hospital and long-term outcomes after transcatheter aortic valve implantation: an analysis of the Spanish TAVI registry

INTRODUCTION AND OBJECTIVES

Impact of gender on long-term outcomes after transcatheter aortic valve implantation (TAVI) remains uncertain. We aimed to investigate gender-specific differences in TAVI and its impact on outcomes.

METHODS

This analysis used data from the prospective Spanish TAVI registry, which included consecutive TAVI patients treated in 46 Spanish centers from 2009 to 2021. The primary endpoint was all-cause mortality at 12 months. Secondary endpoints included in-hospital and 30-day mortality and TAVI-related complications. Adjusted logistic and Cox regression analyses were performed.

RESULTS

The study included 12 253 consecutive TAVI patients with a mean age of 81.2±6.4 years. Women (53.9%) were older, and had a higher STS-PROM score (7.0±7.0 vs 6.2±6.7; P < .001) than men. Overall, the TAVI-related complication rate was similar between women and men, with specific gender-related complications. While women more frequently developed in-hospital vascular complications (13.6% vs 9.8%; P <.001) and cardiac tamponade (1.5% vs 0.6%; P=.009), men showed a higher incidence of permanent pacemaker implantation (14.5% vs 17.4%; P=.009). There was no difference in all-cause mortality either in hospital (3.6% vs 3.6%, adjusted OR, 1.01; 95%CI, 0.83-1.23; P=.902), at 30 days (4.2% vs 4.2%, adjusted OR, 0.90; 95%CI, 0.65-1.25; P=.564) or at 1 year (11% vs 13%, adjusted HR, 0.94; 95%CI, 0.80-1.11; P=.60).

CONCLUSIONS

Women treated with TAVI are older and have more comorbidities than men, leading to distinct complications between genders. Nevertheless, all-cause mortality in the short-term and at 1-year was similar between men and women.

The Prognostic Value of Circulating Cytokines and Complete Blood Count-Based Inflammatory Markers in COVID-19 Patients With Atrial Fibrillation

Background

Atrial fibrillation (AF) is associated with a high burden of cardiovascular disease, which has been worsened during the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to assess the association between clinical markers, especially interleukin-6 (IL-6) and other inflammatory biomarkers, and the severity of COVID-19 in patients with AF.

Methods

This retrospective cohort study categorized patients based on clinical presentations and laboratory results to investigate the prognostic significance of inflammatory markers in COVID-19 outcomes among those with AF. The study included 100 hospitalized COVID-19 patients aged between 40 to 80 years and was conducted at the Chapidze Hospital in Tbilisi, Georgia. Patients were then grouped by disease severity according to computed tomography (CT) scores, clinical symptoms, respiratory rate and oxygen saturation. Levels of IL-6 were obtained at three time points during hospitalization. A broad range of laboratory tests, including C-reactive protein (CRP), ferritin, and D-dimer, were also conducted.

Results

Patients with AF demonstrated significantly elevated levels of IL-6 (P = 0.024), CRP (P = 0.001), and ferritin (P < 0.001), suggesting a severe inflammatory response. D-dimer levels were also notably higher in the AF group (P < 0.005), indicating an increased risk of thrombotic complications. Oxygen saturation levels were significantly lower (P = 0.004) and CT scores higher in patients with AF. Furthermore, the length of hospitalization was longer among patients with AF (median duration significantly higher, P = 0.032), indicating a more severe disease course.

Conclusions

The proinflammatory markers such as IL-6 are independent predictive markers of COVID-19 severity in AF patients. Overall, it highlights urgent treatment approaches, such as available anti-inflammatory drugs, for COVID-19 patients with arrhythmias. Combining these biomarkers into clinical routines helps us better identify patients at risk and how to treat them.

Advances in Pathophysiological Mechanisms of Degenerative Aortic Valve Disease

Degenerative aortic valve disease (DAVD) represents the most prevalent valvular ailment among the elderly population, which significantly impacts their physical well-being and potentially poses a lethal risk. Currently, the underlying mechanisms of DAVD remain incompletely understood. While the progression of this disease has traditionally been attributed to degenerative processes associated with aging, numerous recent studies have revealed that heart valve calcification may represent a response of valve tissue to a specific initiating factor, involving the interaction of various genes and signaling pathways. This calcification process is further influenced by a range of factors, including genetic predispositions, environmental exposures, metabolic factors, and hemodynamic considerations. Based on the identification of its biomarkers, potential innovative therapeutic targets are proposed for the treatment of this complex condition. The present article primarily delves into the underlying pathophysiological mechanisms and advancements in diagnostic and therapeutic modalities pertaining to this malady.

Tailored hydration for the prevention of contrast-induced acute kidney injury after coronary angiogram or PCI: A systematic review and meta-analysis

BACKGROUND

Contrast-induced acute kidney injury (CI-AKI) is a frequent complication of coronary interventions associated with an increased risk of mortality and morbidity. The optimal intravenous hydration strategy to prevent CI-AKI is not well-established. The primary objective is to determine if a tailored hydration strategy reduces the risk of CI-AKI and of major adverse cardiovascular events (MACE) in patients undergoing coronary angiography compared with a nontailored hydration strategy.

METHODS

A study-level meta-analysis of randomized controlled trials comparing tailored versus nontailored hydration strategies for the prevention of CI-AKI (primary outcome) and of MACE (main secondary outcome) in patients undergoing coronary angiography for any indication was performed. Tailored hydration was defined as the administration of intravenous fluids based on patient-specific parameters other than weight only.

RESULTS

A total of 13 studies were included (n = 4,458 participants). The overall risk of bias was moderate. A tailored strategy was associated with a significant reduction in the risk of CI-AKI (RR = 0.56, 95% CI, [0.46-0.69], P < .00001; I2 = 26%), and of MACE (RR = 0.57, 95% CI, [0.42-0.78], P = .0005; I2 = 12%). A tailored hydration strategy was not associated with a significant reduction in the other prespecified secondary outcomes, except for all-cause mortality (RR = 0.57, 95% CI, [0.35, 0.94], P = .03; I2 = 0%). The impact of a tailored strategy on the primary outcome was consistent in sensitivity analyses.

CONCLUSION

These results suggest that tailored hydration is superior to nontailored hydration in reducing the risk of CI-AKI and MACE in patients undergoing coronary angiography. Future trials are required to identify the optimal tailored hydration strategy.

Urinary dickkopf-3 as a predictor for postoperative acute kidney injury in the intensive care unit

BACKGROUND

As a life-threatening complication in patients undergoing surgery, acute kidney injury (AKI) is strongly associated with a worse prognosis. Urinary dickkopf-related protein 3 (DKK3) has been identified as a biomarker for predicting postoperative AKI in patients undergoing cardiac surgery.

OBJECTIVE

To investigate the predictive value of urinary DKK3 on postoperative AKI and develop a clinical model based on the predictor for predicting the development of AKI within seven days for patients undergoing noncardiac surgery.

METHODS

All patients who were admitted to the Intensive Care Unit (ICU) after noncardiac surgery from March 2023 to June 2023 were included in this study. The patients' baseline data on demographic characteristics, lifestyle risk factors, medical history, clinical features, and laboratory tests before surgery were collected at the time of admission. Besides, the blood samples for cystatin C and routine laboratory tests and the urine samples for DKK3 tests were simultaneously collected at the time of admission to the ICU. In addition, the independent predictors of postoperative AKI were identified by univariate, multivariate, and LASSO analyses. Moreover, a nomogram for predicting postoperative AKI was developed based on these independent predictors. Finally, the nomogram was evaluated through calibration and decision curve analyses.

RESULTS

A total of 166 patients with a median age of 67 years old were included in this study, including 94 (56.63 %) males. Among these patients, 47 patients (28.3 %) developed postoperative AKI. Additionally, 7 independent risk factors, including preoperative serum creatinine, preoperative eGFR, preoperative serum albumin, preoperative serum potassium ion, cystatin C, uDKK3/uCr, and SOFA score, were selected by univariate and multivariate regression analyses. Eventually, 4 independent risk factors (including preoperative eGFR, cystatin C, uDKK3/uCr, and SOFA score) identified in this study by LASSO analyses were used to establish the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model was 0.868. The calibration curve and decision curve analysis results demonstrated that the nomogram had good prediction performance.

CONCLUSIONS

Urinary DKK3/creatinine was independently associated with postoperative AKI for patients in the ICU after noncardiac surgery. The nomogram constructed based on uDKK3/uCr, preoperative eGFR, cystatin C, and SOFA score showed a higher accuracy in predicting postoperative AKI.

Outcomes following additional drainage during veno-venous extracorporeal membrane oxygenation: A single-center retrospective study

Refractory hypoxemia during veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) may require an additional cannula (VV-V ECMO) to improve oxygenation. This intervention includes risk of recirculation and other various adverse events (AEs) such as injury to the lung, cannula malpositioning, bleeding, circuit or cannula thrombosis requiring intervention (i.e., clot), or cerebral injury. During the study period, 23 of 142 V-V ECMO patients were converted to VV-V utilizing two separate cannulas for bi-caval drainage with an additional upper extremity cannula placed for return. Of those, 21 had COVID-19. In the first 24 h after conversion, ECMO flow rates were higher (5.96 vs 5.24 L/min, p = .002) with no significant change in pump speed (3764 vs 3630 revolutions per minute [RPMs], p = .42). Arterial oxygenation (PaO2) increased (87 vs 64 mmHg, p < .0001) with comparable pre-oxygenator venous saturation (61 vs 53.3, p = .12). By day 5, flows were similar to pre-conversion values at lower pump speed but with improved PaO2. Unadjusted survival was similar in those converted to VV-V ECMO compared to V-V ECMO alone (70% [16/23] vs 66.4% [79/119], p = .77). In a mixed effect regression model, any incidence of AEs, demonstrated a negative impact on PaO2 in the first 48 h but not at day 5. VV-V ECMO improved oxygenation with increasing flows without a significant difference in AEs or pump speed. AEs transiently impacted oxygenation. VV-V ECMO is effective and feasible strategy for refractory hypoxemia on VV-ECMO allowing for higher flow rate and unchanged pump speed.

Use of Social Media to Source Medical Information Among Parents of Pediatric Otolaryngology Clinic Patients: A Survey Study

OBJECTIVE

The reach and impact of social media as it pertains to medical information among the parents and guardians of pediatric otolaryngology patients is unknown. This survey-based study investigates the use of social media as a source of medical knowledge in this population.

METHODS

Parents and guardians visiting a pediatric Otolaryngology clinic located at a tertiary care children's hospital in southern California from September 2022 to May 2023 were approached for study inclusion. Decision tree and logistic regression analysis was conducted to identify patterns of social media usage in association with factors of interest.

RESULTS

Of the 400 parents included in the study, most were female (80.0%); 49.5% were 30 to 40 years of age, and 18.8% were <30 years old. Most (90.0%) used social media, and 44.5% actively used it to obtain health information related to care for their children. A large proportion of parents (73.0%) were interested in social media content to better understand their child's condition, particularly the opportunity to view videos and images of a surgery planned for their child (75.0%). About half (50.5%) would permit their child's doctor to post about their child on social media, and 53.8% stated they would be more inclined to choose a surgeon who uses social media to educate families about their child's condition.

CONCLUSION

Most parents/guardians were interested in and had obtained critical medical information on social media, especially content pertaining to their child's medical condition(s). Analysis of survey responses identified the social media content most valued by parents/guardians of children undergoing otolaryngological surgery. These findings can be used by pediatric otolaryngologists to better understand their patients' preferences and improve access to health information for their patients on social media, as well as to grow their practices.

Interventional therapies for chronic heart failure: An overview of recent developments

Heart failure (HF), the final manifestation of most cardiovascular diseases, has become a major global health concern, affecting millions of individuals. Despite basic drug treatments, patients present with high morbidity and mortality rates. However, recent advancements in interventional therapy have shown promising results in improving the prognosis of patients with HF. These advancements include transcatheter aortic valve replacement for severe aortic stenosis, transcatheter mitral valve repair for chronic mitral regurgitation, neuromodulation therapy for multiple targets and measures in the treatment of chronic HF and left ventricular assist device implantation for advanced HF (Figure 1). In this review, we aimed to provide an overview of the current progress in interventional therapies for chronic HF.

Impact on mortality at 90 days of acute kidney injuries in endovascularly treated stroke: A systematic review, meta-analysis, and meta-regression

AimTo investigate the prognostic implication (mortality at 3 months) of acute kidney injury (AKI) in acute ischemic stroke treated with mechanical thrombectomy (MT).Material and MethodsA literature search was performed using PubMed/OVID/Cochran's CENTRAL database (time frame: inception to January 2023). Study characteristics, patient status, clinical outcomes, AKI incidence, and sample size were recorded. The exclusion criteria were non-English literature, no human subjects, and <10 patients as the sample size. Studies were assessed using the MINORS/GRADE system. Meta-analysis and meta-regression with a random-effects model were performed.Results3314 studies were retrieved. After applying the exclusion criteria, the final population included of 18/3314 studies (0.5%). Among them, only 6/18 (33.3%) studies reported results in two separate groups (AKI vs non-AKI), allowing for inference statistics for a total population of 3229 (538.6 ± 403.7). The I^2 was 34.6 and Q's Cochrane was 7.80. The pooled odds ratio (OR) for mortality at 3 months in patients with AKI was 5.8 (95% confidence interval [95% CI] 95% CI 3.62 to 9.52). Leave-one-out meta-analysis showed no significant sources of heterogeneity. In the meta-regression, diabetes prevalence was associated with a higher mortality rate (OR 1.14, 95% CI 1.03 to 1.28), and lower age and a small amount of contrast media were negatively correlated (0.91 [95% CI 0.83 to 0.99] and OR 0.97 [95% CI 0.94 to 1.00], respectively).ConclusionAKI was significantly associated with the mortality rate in MT-treated stroke patients (OR 5.8 [95% CI 3.62 to 9.36]).

Age-related variations in heart rate variability profiles among patients with schizophrenia and major depressive disorder

Patients with psychiatric disorders exhibit general autonomic dysregulation and elevated cardiovascular risks, which could be indexed by heart rate variability (HRV). However, HRV is susceptible to age and other patient-specific factors. This study aimed to investigate the HRV profile and age-related variations, as well as the potential influence of sex, BMI, and HR on HRV in psychiatric populations. There were 571 consecutive patients diagnosed with schizophrenia (SZ) (N = 282) or major depressive disorder (MDD) (N = 289) recruited and classified as adolescent (11-21 years) and adult (> 21 years) groups. HRV indices were measured with 3-minute resting ECG recordings. Compared to adolescent subjects, all time-domain and nonlinear HRV indices were notably reduced in adults, while frequency-domain HRV was comparable. Between SZ and MDD groups, only HTI differed significantly. Age and psychiatric disorders exhibited complex interaction effects on HRV. Stratified by age stage, MDD patients exhibited slightly higher HRV in adolescence but slightly lower HRV in adulthood. In logistic regression analysis, HTI and SD2 were significantly distinctive between adolescents and adults in MDD group, while pNN50 was distinctive in SZ group. Moreover, female subjects demonstrated lower time-domain HRV, LF/HF and SD2 than males. HR exhibited inverse relationship with three domain HRV. No significant effect of BMI was observed. In psychiatric populations, compared to adolescents, adults decreased in time-domain and nonlinear HRV, but not in frequency-domain HRV. Age and psychotic disorders exhibited complex interaction effects on HRV. Sex and HR also emerged as important influencing factors of HRV.

New-onset headache after transcatheter atrial septal defect closure: a systematic review

Background

Migraine is a complex neurological disorder marked by severe headache and associated with various systemic symptoms. Atrial septal defect (ASD) closure, a common cardiac procedure, has been linked to the onset of new migraine episodes. This systematic review explores the incidence and management of migraine following transcatheter ASD closure.

Methods

A comprehensive literature search was conducted in PubMed, Scopus, and CINAHL Ultimate, covering studies from inception to August 2024. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024578609). Data extraction and risk of bias assessment were systematically performed by independent reviewers.

Results

A total of 831 studies were identified out of which 13 were included for the final analysis. The studies encompassed diverse populations globally, revealing varying onset times for migraine post-ASD closure, ranging from as early as 1 day to up to a year. Migraine incidence varied significantly, with several studies noting a higher prevalence in females and some cases showing a familial predisposition typically in the maternal side. The typical methods for ASD closure involved transcatheter approaches. Treatment modalities included non-steroidal anti-inflammatory drugs, calcium channel blockers, and anticoagulants, with some cases experiencing spontaneous resolution of symptoms. Modifications to anti-platelet therapy post-procedure, such as the introduction of clopidogrel along with aspirin, showed significant efficacy in treating and preventing migraine.

Conclusion

This review highlights a significant correlation between ASD closure and the onset of migraine, underlining the need for further investigation into preventive strategies and management. These findings suggest a complex interaction between structural heart alterations and migraine pathophysiology.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12055-025-01906-x.

Heart failure with reduced ejection fraction developed from valvular surgery: Risk factors and therapeutic effects of sacubitril valsartan

Objective

To investigate the risk factors for heart failure developed from cardiac valvular surgery and the efficacy of sacubitril valsartan (ARNI).

Methods

Clinical data from patients with left ventricular ejection fraction (LVEF) ≥ 50 % who consecutively underwent cardiac valvular (mitral/aortic valve) surgery in 2021 were collected. Pre - and intra - operative variables were analyzed to explore risk factors for HFrEF (LVEF ≤ 40 %). Post - operative HFrEF patients were split into ARNI - treated (n = 15) and non-ARNI - treated (n = 15) groups. Follow - up echocardiography data were compared to assess ARNI's efficacy.

Results

Among 420 patients undergoing valve surgery (117 aortic, 133 mitral, 170 double-valve), 34 (8.1 %) developed HFrEF, showing significantly higher in-hospital mortality than non-HFrEF patients (8.82 % vs 0.52 %). Multivariate analysis identified preoperative left ventricular diameter as an independent HFrEF risk factor. During follow-up, 70 % of HFrEF patients achieved LVEF > 50 % within 6 months, Repeated-measures F test demonstrated significantly greater LVEF improvement (P = 0.036) and LVEDD reduction (P = 0.014) in the ARNI group versus non-ARNI group.

Conclusions

About 8 % of patients with LVEF ≥ 50 % developed HFrEF after cardiac valvular surgery, and large left ventricular diameter was an independent risk factor. Sacubitril valsartan is very effective in improving left ventricular remodeling and LVEF in such cohort.