Association between serum α-klotho levels and the incidence of diabetic kidney disease and mortality in type 2 diabetes: evidence from a Chinese cohort and the NHANES database

BACKGROUND

The α-klotho is crucial in diabetes and its related complications. This study seeks to explore the link between α-klotho levels and the risk of diabetic kidney disease (DKD) as well as all-cause and cardiovascular mortality among individuals with type 2 diabetes mellitus (T2DM).

METHODS

The investigation involved 126 Chinese T2DM patients and 4,451 individuals from the National Health and Nutrition Examination Survey (NHANES) database. To evaluate the relationship between α-klotho levels and DKD risk, multivariate logistic regression was utilized. Additionally, restricted cubic spline (RCS) regression analysis was conducted to examine the nonlinear relationship between α-klotho levels and DKD incidence. RCS analysis was employed to explore the correlation between α-klotho and both all-cause and cardiovascular mortality.

RESULTS

In the Chinese cohort, α-klotho levels were notably elevated in T2DM group compared to DKD group. The NHANES data revealed a significant inverse relationship between α-klotho levels and DKD risk. Nonlinear analysis further illustrated a substantial nonlinear connection between α-klotho levels and DKD risk. Serum α-klotho levels below 880.78 pg/mL were linked to increased DKD risk in T2DM patients. When compared to the T2DM group, the DKD group had markedly higher all-cause and cardiovascular mortality rates, with the α-klotho low group (e.g., Q1) exhibiting lower survival compared to other groups. Cox regression findings indicated that elevated α-klotho levels could mitigate all-cause mortality in T2DM patients. The relationship between α-klotho levels and all-cause mortality was also nonlinear, with the minimal risk found at α-klotho levels between 776.95 pg/mL and 812.69 pg/mL, varying by gender.

CONCLUSION

There exists a notable association between α-klotho levels and DKD risk, along with mortality in T2DM patients, with varying effects based on gender. These results highlight the potential importance of α-klotho as both a biomarker and a therapeutic target.

Patterns of malnutrition in infants and children with congenital heart diseases, an experience of a large tertiary hospital

Background: Congenital heart disease (CHD) is the most prevalent congenital abnormality in children. Infants and children with CHD are at a higher risk of malnutrition. Aim: The purpose of this research was to investigate the frequency of anthropometric malnutrition, for example, underweight, wasting, and stunting, among infants and children with CHD attending the emergency room of a large tertiary hospital. Methods: Between January 2022 and August 2022, a cross-sectional study was carried out on 96 infants and children presenting with heart failure at Children's Hospital Cairo University. All enrolled participants had anthropometric and biochemical nutritional assessments. Anthropometric z-scores were calculated for each infant or child using WHO reference ranges. Biochemical and nutritional assessments were carried out through screening for iron deficiency anemia and electrolyte imbalances. Results: Ninety-six infants and children were enrolled in our study, with males representing 54.8%. Seventy percent of the patients were anthropometrically malnourished, with underweight being the most prevalent (59.4%). Some children had more than one type of malnutrition. Electrolyte imbalance was a major biochemical malnutrition indicator, with hypophosphatemia present in 39.6% of the enrolled children. Conclusion: Malnutrition poses a significant health problem in infants and children with CHDs. To improve outcomes, it is essential to integrate systematic measures for identifying and managing malnutrition into the care of these patients. Both anthropometric and biochemical malnutrition should be routinely screened in all clinical settings to ensure comprehensive management and support.

Predictors of vasovagal symptoms or syncope during outpatient diagnostic hysteroscopy: A prospective observational study

OBJECTIVE

To analyze factors conditioning the apparition of vasovagal prodromic symptoms or vagal syncope during or immediately after a diagnostic hysteroscopy performed in an outpatient setting.

STUDY DESIGN

Prospective observational study including 1255 patients who received an outpatient diagnostic hysteroscopy in the Hysteroscopy Unit of Quirón Dexeus University Hospital, Barcelona, Spain since April 2019 until December 2021. Data such as fasting, smoking, analgesic or anxiolytic treatment intake, parity and menopausal status were collected. Patients with pathologies or treatments that could modify pain tolerance were excluded.

RESULTS

Mean age was 42.7 ± 9.03 years. An 84.3 % of patients were premenopausal, while 15.7 % were smokers and 59 % of them had smoked 30 min before the procedure. Thirty-three point three percent of patients were fasting and 56.5 % had taken analgesic or anxiolytic pre-medication. A total of 79 patients (6.3 %) developed symptoms of vasovagal reaction. Pain was reported as 7.56 ± 1.97 in the Visual Analogic Scale (VAS) in patients with vagal symptoms versus 4.95 ± 2.66 in patients without vagal symptoms (p < 0.001). In the multivariate logistic model only a higher VAS score and a previous history of vasovagal symptoms during medical procedures were associated to a higher probability of developing vagal symptoms after adjusted by covariates [Odds Ratio (OR): 1.67 (95 % confidence interval (CI):1.45;1.93), OR:3.44 (95 % CI: 2.04;5.79) respectively].

CONCLUSIONS

When performing an outpatient hysteroscopy, patients should be asked about their previous history of vagal symptoms during medical procedures. Painful procedures should be immediately stopped in order to prevent discomfort, avoid the apparition of vagal prodromes or syncope and improve satisfaction with the procedure.

Right atrial myxoma excision with pulmonary thrombectomy

Myxomas are the most common primary tumors of the heart. Myxomas that are smooth and large usually present with obstructive symptoms whereas the ones that are villous and friable embolize. Due to the risk of mechanical obstruction and embolization, they require immediate surgical intervention. We present a case of a young female with multiple right atrial (RA) myxomas and embolic occlusion of the right pulmonary artery (RPA) managed successfully with surgical excision and pulmonary thrombectomy.

Takotsubo cardiomyopathy following liver transplantation: A multicenter cohort study

Takotsubo cardiomyopathy (TCM) is an acute, stress-mediated, reversible cardiomyopathy that occurs in the absence of hemodynamically significant coronary artery disease. We aimed to investigate the characteristics and outcomes of patients who developed TCM following liver transplantation (LT) in a multicenter study. Adult patients from 6 centers across the United States who developed TCM according to Mayo Clinic criteria following LT between 2008 and 2023 were included. Demographics, perioperative and long-term outcomes, and treatment modalities were assessed. Fifty-five patients were included. The center incidence of TCM ranged from 0.1% to 0.5%. The majority were female (54.5%) and Caucasian (87.2%), and the median age at transplant was 59 years. The primary etiologies for LT were alcohol-associated cirrhosis (49.1%) and metabolic dysfunction-associated steatotic liver disease cirrhosis (21.8%). The median time from LT to TCM diagnosis was 4 days. TCM was associated with a 60.9% reduction in left ventricular ejection fraction (LVEF) from a pretransplant median LVEF of 64.0%-25.0%. The most common treatment for TCM was diuretics (67.3%) and afterload reduction (54.5%), with only 27.3% of patients requiring vasopressor support. At a median follow-up of 31.5 months, 1-year and 3-year overall survivals (OSs) were 86.3% and 69.4%, respectively. A repeat echocardiogram performed at a median of 84 days demonstrated that 45/55 patients (81.8%) had recovered LVEF ≥50%. Patients with LVEF recovery to ≥50% had significantly improved OS compared to those without LVEF recovery >50% (106.4 vs. 12.2 mo, p = 0.001). TCM following LT is associated with a significant reduction in LVEF; however, the majority of patients recover LVEF to >50% with minimal perioperative mortality. Importantly, follow-up assessment of LVEF has significant implications as lack of recovery is associated with worse OS.

Treatments for weight gain in schizophrenia

PURPOSE OF REVIEW

Obesity and related metabolic disorders are extremely common in psychiatric patients, particularly in those with schizophrenia. Elucidating this link's neurobiology may inform clinicians and researchers of rational therapeutic approaches necessary to optimize clinical outcomes.

RECENT FINDINGS

Current literature highlights the pivotal role of the inflammation-oxidative stress-insulin resistance loop in the pathophysiology of both metabolic and neuropsychiatric disorders. The concept of 'diabetophrenia' is put forward to highlight the overlapping neurobiological mechanisms underlying metabolic dysfunction and schizophrenia symptoms. Innovative treatments, including the combination of xanomeline with trospium and incretin-based medicines, demonstrate encouraging potential in addressing such complex health challenges.

SUMMARY

The nuanced dynamics of chronic inflammation and psychiatric symptomatology underscore the significance of addressing both metabolic and mental health factors in a cohesive fashion while considering unique psychosocial contexts, dietary preferences, and lifestyle choices. A multidisciplinary strategy is essential for incorporating counseling, dietary interventions, behavioral therapies, and pharmacotherapy into the management of schizophrenia. The ensuing enhanced collaboration among healthcare professionals may render obsolete the prevailing siloed conceptualizations of mental disorders, opening new vistas for generating synergistic insights into the mind-body systems and leading to improved health and quality of life for patients with schizophrenia and other psychiatric conditions.

Risk of acute myocardial infarction in patients with non-typhoidal Salmonella infection: A nationwide matched population-based cohort study

OBJECTIVES

We used a nationwide cohort to explore the association of non-typhoidal Salmonella (NTS) with risk of incident acute myocardial infarction (AMI).

STUDY DESIGN

Nationwide matched population-based cohort study.

METHODS

We retrospectively analyzed a national insurance database, in which the NTS cohort (N = 15,152) and non-NTS cohort (N = 60,608) were individually-matched at 1:4 ratio by the index date, age, gender, and propensity score of comorbidities. Participants were identified by International Classification of Diseases, 9th Revision (ICD-9) codes from January 1, 2000 to December 31, 2014 and follow-up to Dec 31, 2017. Cox proportional hazard-models taking competing risk of death into account were adopted to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) of AMI. Multiple sensitivity analyses were conducted focusing on gender and comorbidities.

RESULTS

The sub-distribution HR (sHR) of new-onset AMI was 1.63 (95 % CI, 1.32-2.01; p < 0.0001). Our findings were consistent across gender (female, sHR = 1.42; 0.98-2.07 and male, sHR = 1.72; 1.34-2.22). While a positive association between NTS infection and AMI risk was noted in individuals without comorbidities, the correlation persisted in those with diabetes (sHR = 1.85; 1.34-2.55), moderate to severe kidney disease (sHR = 3.02; 1.49-6.13), acquired immunodeficiency syndrome (sHR = 1.64; 1.33-2.02), gastroenteritis (sHR = 2.75; 1.32-5.74) and hypertension (sHR = 1.66; 1.28-2.15) CONCLUSIONS: The risk of AMI was significantly higher in the NTS cohort than that in the non-NTS cohort, indicating that NTS infection may be a potentially modifiable risk factor for AMI that warrants further studies for verification.

The impact of cardiovascular drugs on hyperglycemia and diabetes: a review of 'unspoken' side effects

AIMS

The increasing prevalence of cardiovascular diseases has led to the widespread use of cardiovascular drugs that can adversely impact glucose metabolism. This review focuses on the latest evidence on the potential of cardiovascular drugs to induce adverse glycemic effects but also the underlying mechanisms, prevention, and management strategies.

MATERIALS AND METHODS

A comprehensive literature search was conducted across scientific databases until May 25th, 2024.

RESULTS

Certain cardiovascular drugs can induce hyperglycemia through multiple mechanisms, including altered the secretion and sensitivity of insulin through direct cytotoxic effects toward pancreatic beta cells and increased glucose secretion. Notably, diuretics, beta-blockers, calcium channel blockers, and statins have been associated with significant glycemic disturbances. The risk of hyperglycemia varies based on individual factors, drug dosages, and concurrent medications. These drug-induced hyperglycemic effects may sometimes reverse upon discontinuation of related medication. Effective management should include lifestyle modifications, the use of glucose-lowering medications, and opting for lower-risk cardiovascular drugs. Monitoring for hyperglycemia involves educating affected individuals and conducting regular blood glucose tests. Identifying at-risk individuals and implementing preventive measures are crucial for improving both cardiovascular and metabolic outcomes.

CONCLUSIONS

Certain cardiovascular drugs significantly contribute to hyperglycemia and diabetes mellitus through various mechanisms. Effective management includes identifying at-risk individuals, choosing lower-risk medications, and implementing monitoring and preventive strategies. Further research is needed to fully understand these mechanisms and develop targeted interventions to prevent and manage cardiovascular drug-induced hyperglycemia, thereby improving clinical outcomes.

Randomized comparison of sheath size for coronary intervention: time to hemostasis and risk of radial artery occlusion

BACKGROUND

Transradial access is the preferred approach for coronary procedures due to lower complication rates compared to femoral access. However, minimizing equipment for radial access may further reduce bleeding and radial artery occlusion (RAO).

AIMS

This study assessed whether the use of 5F sheaths, compared to 6F sheaths, reduces time to hemostasis and the risk of RAO in patients undergoing diagnostic coronary angiography and/or coronary intervention.

METHODS

3600 patients were randomized to 5F or 6F sheaths, except when operators preferred 6F sheaths. TR-band deflation and removal times were recorded, and radial artery patency was assessed at discharge using the reverse Barbeau test, with Types C and D indicating RAO.

RESULTS

942 patients were randomized to 5F and 945 to 6F sheath. In 1713 patients, 6F sheaths were chosen up front by the operator. In intention-to-treat analysis no significant differences were observed between the randomized groups in time to TR-band removal (101 vs. 105 min, p = 0.07), or RAO (1.6 % vs. 2.1 %, p = 0.44). A significant crossover to 6F sheaths occurred in the 5F group. In as-treated analyses, TR-band removal times were shorter with 5F compared to 6F and operator-preferred 6F sheaths (98.5 min, 105 min, 111 min, P < 0.01). No significant differences in RAO risk were observed between groups (1.8 %, 1.9 %, 1.2 %, P = 0.34).

CONCLUSIONS

Although 5F sheaths reduced time to TR-band deflation and removal compared to 6F sheaths, no significant reduction in RAO was observed. High crossover rates suggest operator preference remains a key factor in sheath selection.

Unraveling the Serum Protein Landscape in Celiac Disease: Current Evidence and Future Directions

BACKGROUND

Celiac disease (CD) is a chronic autoimmune disorder characterized by an abnormal immune response to gluten, leading to intestinal inflammation and various clinical manifestations. Serum proteins are increasingly recognized as potential biomarkers in CD, reflecting inflammation, malabsorption, and immune activation.

OBJECTIVE

This review aims to elucidate the role of serum proteins in the pathogenesis, diagnosis, and management of CD, emphasizing their potential as noninvasive biomarkers and therapeutic targets.

METHODS

A comprehensive review of current literature was conducted, focusing on key serum proteins such as albumin, transthyretin (TTR), transferrin, β2-microglobulin (β2M), C-reactive protein (CRP), and immunoglobulins. Their alterations in CD and their relevance to disease activity, nutritional status, and treatment response were examined.

RESULTS

CD-related inflammation leads to increased acute-phase proteins (e.g., CRP) and decreased transport proteins (e.g., albumin, TTR, transferrin), contributing to malnutrition and anemia. TTR serves as a sensitive marker of nutritional status, while transferrin levels correlate with iron deficiency, a common CD complication. Immunoglobulin profiles reflect immune responses to gluten. These proteins provide insights into CD pathophysiology and offer potential utility for diagnosis and monitoring.

CONCLUSION

Serum proteins represent promising biomarkers for CD diagnosis and management, with potential for integration into clinical practice. Further research is necessary to validate their utility in routine patient care and explore their role in personalized therapeutic strategies.

Unsupervised clustering of single-lead electrocardiograms associates with prevalent and incident heart failure in coronary artery disease

Aims

Clinical consequences of coronary artery disease (CAD) are varied [e.g. atrial fibrillation (AF) and heart failure (HF)], and current risk stratification tools are ineffective. We aimed to identify clusters of individuals with CAD exhibiting unique patterns on the electrocardiogram (ECG) in an unsupervised manner and assess their association with cardiovascular risk.

Methods and results

Twenty-one ECG markers were derived from single-lead median-beat ECGs of 1928 individuals with CAD without a previous diagnosis of AF, HF, or ventricular arrhythmia (VA) from the imaging study in UK Biobank (CAD-IMG-UKB). An unsupervised clustering algorithm was used to group these markers into distinct clusters. We characterized each cluster according to their demographic and ECG characteristics, as well as their prevalent and incident risk of AF, HF, and VA (4-year median follow-up). Validation and association with prevalent diagnoses were performed in an independent cohort of 1644 individuals. The model identified two clusters within the CAD-IMG-UKB cohort. Cluster 1 (n = 359) exhibited prolonged QRS duration and QT intervals, along with greater morphological variations in QRS and T-waves, compared with Cluster 2 (n = 1569). Cluster 1, relative to Cluster 2, had a significantly higher risk of incident HF [hazard ratio (HR): 2.40, 95% confidence interval (CI): 1.51-3.83], confirmed by independent validation (HR: 1.77, CI: 1.31-2.41). It also showed a higher association with prevalent HF (odds ratio: 4.10, CI: 2.02-8.29), independent of clinical risk factors.

Conclusion

Our approach identified a cluster of individuals with CAD sharing ECG characteristics indicating HF risk, holding significant implications for targeted treatment and prevention enabling accessible large-scale screening.

Deep Learning-based Aligned Strain from Cine Cardiac MRI for Detection of Fibrotic Myocardial Tissue in Patients with Duchenne Muscular Dystrophy

Purpose To develop a deep learning (DL) model that derives aligned strain values from cine (noncontrast) cardiac MRI and evaluate performance of these values to predict myocardial fibrosis in patients with Duchenne muscular dystrophy (DMD). Materials and Methods This retrospective study included 139 male patients with DMD who underwent cardiac MRI at a single center between February 2018 and April 2023. A DL pipeline was developed to detect five key frames throughout the cardiac cycle and respective dense deformation fields, allowing for phase-specific strain analysis across patients and from one key frame to the next. Effectiveness of these strain values in identifying abnormal deformations associated with fibrotic segments was evaluated in 57 patients (mean age [± SD], 15.2 years ± 3.1), and reproducibility was assessed in 82 patients by comparing the study method with existing feature-tracking and DL-based methods. Statistical analysis compared strain values using t tests, mixed models, and more than 2000 machine learning models; accuracy, F1 score, sensitivity, and specificity are reported. Results DL-based aligned strain identified five times more differences (29 vs five; P < .01) between fibrotic and nonfibrotic segments compared with traditional strain values and identified abnormal diastolic deformation patterns often missed with traditional methods. In addition, aligned strain values enhanced performance of predictive models for myocardial fibrosis detection, improving specificity by 40%, overall accuracy by 17%, and accuracy in patients with preserved ejection fraction by 61%. Conclusion The proposed aligned strain technique enables motion-based detection of myocardial dysfunction at noncontrast cardiac MRI, facilitating detailed interpatient strain analysis and allowing precise tracking of disease progression in DMD. Keywords: Pediatrics, Image Postprocessing, Heart, Cardiac, Convolutional Neural Network (CNN) Duchenne Muscular Dystrophy Supplemental material is available for this article. © RSNA, 2025.

Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

BACKGROUND

Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity.

METHODS

This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions.

RESULTS

Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR.

CONCLUSIONS

Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

Exercise-based cardiac rehabilitation for heart failure: effects on echocardiographic parameters and functional capacity: a randomized clinical trial

Introduction

Multiple comorbidities and physiological changes play a role in a range of heart failure (HF) conditions and influence the most effective approach to exercise-based rehabilitation. This research aimed to examine and compare the outcomes of concurrent exercise training, focusing on echocardiographic parameters and functional capacity of patients with heart failure with reduced ejection fraction (HFrEF).

Methods

In this randomized control trial, a total of 76 patients (average age: 68.2 ± 4.8 years) with HFrEF were randomly allocated into two groups: intervention group (IG, N = 38) and control group (CG, N = 38) that IG performed an 8-week concurrent exercise training (three aerobic and two resistance exercise sessions/week) and daily breathing exercises. Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, and functional capacity (6-minute walking test) were assessed before and the end of the study.

Results

The comparison of CG and IG showed that 6-min walking test (204.2 ± 28.72 vs. 273 ± 38.37) and ejection fraction (EF) (28.28 ± 4.39 vs. 37.23 ± 6.54) had increased, and left ventricle end-diastolic dimension (53.89 ± 4.73 vs. 46.71 ± 5.35) and left ventricle end-systolic dimension (45.55 ± 4.8 vs. 39 ± 5.26) had decreased after 8 weeks, respectively (P < 0/05).

Conclusion

In summary, this study provides compelling evidence that exercise-based cardiac rehabilitation can lead to meaningful improvements in echocardiographic parameters and functional capacity among older adults with HF, advocating for its broader implementation in clinical settings.

Propionic Acidemia-Induced Proarrhythmic Electrophysiological Alterations in Human iPSC-Derived Cardiomyocytes

Propionic acidemia (PA) is a metabolic disorder caused by a deficiency of the mitochondrial enzyme propionyl-CoA carboxylase (PCC) due to mutations in the PCCA or PCCB genes, which encode the two PCC subunits. PA may lead to several types of cardiomyopathy and has been linked to cardiac electrical abnormalities such as QT interval prolongation, life-threatening arrhythmias, and sudden cardiac death. To gain insights into the mechanisms underlying PA-induced proarrhythmia, we recorded action potentials (APs) and ion currents using whole-cell patch-clamp in ventricular-like induced pluripotent stem cells-derived cardiomyocytes (hiPSC-CMs) from a PA patient carrying two pathogenic mutations in the PCCA gene (p.Cys616_Val633del and p.Gly477Glufs*9) (PCCA cells) and from a healthy subject (healthy cells). In cells driven at 1 Hz, PCC deficiency increased the latency and prolonged the AP duration (APD) measured at 20% of repolarization, without modifying resting membrane potential or AP amplitude. Moreover, delayed afterdepolarizations appeared at the end of the repolarization phase in unstimulated and paced PCCA cells. PCC deficiency significantly reduced peak sodium current (INa) but increased the late INa (INaL) component. In addition, L-type Ca2+ current (ICaL) density was reduced, while the inward and outward density of the Na+/Ca2+ exchanger current (INCX) was increased in PCCA cells compared to healthy ones. In conclusion, our results demonstrate that at the cellular level, PCC deficiency can modify the ion currents controlling cardiac excitability, APD, and intracellular Ca2+ handling, increasing the risk of arrhythmias independently of the progressive late-onset cardiomyopathy induced by PA disease.

Are sarcopenia and its individual components linked to all-cause mortality in heart failure? A systematic review and meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis was to assess sarcopenia and its components as prognostic factors in patients with heart failure (HF).

METHODS

From inception to December 2022, a systematic literature search was carried out utilizing PubMed, Web of Science, Scopus, and Cochrane Library databases. A meta-analysis employing a random-effects model was performed to assess the pooled effects.

RESULTS

The systematic review and meta-analysis included 32 and 18 longitudinal studies, respectively. The prediction of 1- to 2-year all-cause mortality in sarcopenia was not statistically significant (hazard ratio (HR): 1.35, 95% CI 0.76-2.38, I2 = 54%, P = 0.31). The lowest combined quartile and quantile of the population were used to define low handgrip strength that showed identical results (HR: 1.24, 95% CI 0.94-1.62, I2 = 0%, P = 0.13). Low L3-L4 psoas muscle mass (HR: 2.20, 95% CI 1.26-3.83, I2 = 87%, P < 0.01) and slow gait speed (HR: 1.45, 95% CI 1.20-1.74, I2 = 0%, P < 0.01) were significant contributors to all-cause mortality risk. Additionally, a 0.1 m/s increase in gait speed demonstrated a significant reduction of all-cause mortality (HR: 0.77, 95% CI 0.66-0.90, I2 = 60%, P < 0.01). Our narrative synthesis also described appendicular lean mass (ALM) and short physical performance battery (SPPB) scores as significant prognostic factors.

CONCLUSIONS

Compared to patients with higher overall functional performance, those with HF and low ALM, low psoas muscle mass, low SPPB, and slow gait speed are at an increased risk of all-cause mortality. Early prevention and/or treatment of lower limb physical function deterioration may be an essential strategy to reduce the risk of premature death in HF.

Predictive Value of MHR, PLR Combined With NLRP1 for Severity and Long-Term Prognosis in Premature Coronary Artery Disease

OBJECTIVE

To investigate the predictive value of platelet to lymphocyte ratio (PLR), monocyte to high-density lipoprotein ratio (MHR) combined with nucleotide binding oligomeric domain like receptor protein 1 (NLRP1) for the severity of premature coronary heart disease (PCHD) and its 2-year long-term prognosis.

METHOD

A total of 132 patients with PCHD examined in our hospital from February 2020 to January 2022 were retrospectively selected as the research objects. All patients who met the criteria were divided into mild group, moderate group, and severe group according to the severity of PCHD. The patients were followed up for 2 years. Patients were then divided into good prognosis group (without adverse cardiovascular events, n = 96) and poor prognosis group (with adverse cardiovascular events, n = 36). The predictive value was evaluated by ROC curve and multivariate logistic regression analysis.

RESULTS

Compared with the mild group, the levels of MHR, PLR, and NLRP1 in the moderate group and the severe group were significantly increased (p < 0.05). The levels of MHR, PLR, and NLRP1 in the poor prognosis group were higher than the good prognosis group (p < 0.05). The area under the curve (AUC) of MHR, PLR, and NLRP1 alone and in combination for predicting the 2-year long-term prognosis of patients was 0.787, 0.653, 0.869, and 0.926, respectively. Combined markers showed superior predictive accuracy (p < 0.05). After adjusting for confounding factors such as treatment, comorbidities, weight, gender, and smoking, MHR, PLR, and NLRP1 were independent risk factors for severe progression and poor prognosis of PCHD (p < 0.05).

CONCLUSION

MHR, PLR, and NLRP1 were increased in patients with higher severity of PCHD and poor prognosis. The combined detection has certain clinical guiding value for PCHD. However, this study was a single-center retrospective study with a small sample size. Thus, the results need to be further verified.

Alterations in the Plasma Metabolome Associated With Maternal Smoking During the First Trimester and Foetal Growth

Tobacco smoking during pregnancy has been associated with an increased risk of adverse outcomes like low birth weight. This study determined changes in the circulating metabolome linked to maternal smoking in the first trimester and correlated these changes to the growth of the foetus. The circulating metabolome was examined from first trimester plasma samples by non-targeted (global) liquid chromatography mass spectrometry-based metabolite profiling of 227 pregnant women (99 smokers and 117 non-smokers) from the Kuopio Birth Cohort Study. Tobacco smoking was self-reported through a questionnaire and verified with cotinine measurements from plasma samples. In summary, 64 significant differences were observed between the groups after correction for multiple testing e.g. in metabolites indicating endocrine disruption (e.g. dehydroepiandrosterone sulphate [DHEA-S], VIP = 2.70, d = 0.68, p < 0.0001), metabolites associated with oxidative stress (e.g. bilirubin, VIP = 2.00, d = 0.50, p < 0.0001) and lipid metabolism (e.g. LysoPC 16:1, VIP = 2.07, d = 0.51, p < 0.0001). Some of these metabolites, e.g. DHEA-S and bilirubin, correlated with low birth weight, and some, e.g. LysoPC 16:1, correlated with small head circumference at birth. In conclusion, maternal smoking during the first trimester of pregnancy was associated with an altered metabolite profile linked to endocrine disruption and increased oxidative stress.

A Confirmatory Factory Analysis of the Exercise Sensitivity Questionnaire (ESQ)

PURPOSE

The Exercise Sensitivity Questionnaire (ESQ) is a self-report measure used to assess the extent to which different physical sensations of exercise elicit anxiety (ie, exercise sensitivity). The ESQ was developed for individuals with cardiovascular conditions and initially validated in a non-clinical sample. This study evaluates the factor structure and measurement invariance in a clinical sample of adults with various cardiovascular conditions.

METHODS

This was a cross-sectional study with retrospective chart review. Patients (N = 265; 73% male, mean age 67.8 ± 10.5 years) were attending an orientation for outpatient medically supervised exercise-based cardiac rehabilitation. The factor structure was examined using Confirmatory Factor Analysis, and tests of measurement invariance were evaluated by sex and advanced age (<65 years, >65 years). Internal consistency, descriptive characteristics, and correlates of ESQ scores and its factors were evaluated. Concurrent validity was evaluated in a subset of patients (N = 57) with elevated exercise sensitivity.

RESULTS

The Confirmatory Factor Analysis supported a 2-factor model, which was invariant, but not a 1-factor model, and reflected anxiety about (1) cardiopulmonary and (2) pain/weakness exercise sensations. Internal consistency of ESQ items was high. ESQ scores were associated with higher body mass index and shorter 6-Minute Walk Test distance, particularly the pain/weakness factor. ESQ scores evidenced preliminary concurrent validity with anxiety sensitivity and general anxiety but discriminant validity with depressive symptoms.

CONCLUSIONS

There is support for the validity and reliability of ESQ scores as a 2-dimensional index of exercise sensitivity. The ESQ taps a psychological phenotype with relevance to exercise tolerance, and potentially cardiac rehabilitation participation, that warrants continued investigation.

Insights from autopsy-initiated pathological studies of the pathogenesis and clinical manifestations of atherosclerosis and ischemic heart disease: Part II. Ischemic heart disease

CONTEXT

Ischemic heart disease (IHD) due to coronary atherosclerosis constitutes the leading cause of morbidity and mortality worldwide. This review was undertaken to retrospectively analyze the lines of research that generated the evidence for our contemporary understanding of atherosclerosis-based coronary artery disease and to provide a rationale for continued support for autopsy-based research in order to make further progress in reduction of the morbidity and mortaility from IHD.

OBJECTIVES

To analyze the contributions of the autopsy to complement and validate other lines of investigation in determining the complex interactions between coronary artery alterations linked to the major manifestations of coronary atherosclerosis, namely, coronary thrombosis, acute myocardial infarction, and sudden cardiac death.

DATA SOURCES

Systematic search on PubMed to gather relevant studies concerning autopsy studies and reviews of the pathology and pathogenesis of atherosclerosis, ischemic heart disease, coronary atherosclerosis, coronary thrombosis, myocardial infarction and sudden cardiac death.

CONCLUSIONS

An extensive search of the published literature has confirmed the continuing importance of the autopsy as a powerful tool to understand the pathogenesis, clinical features, and therapeutic options for the treatment of atherosclerosis and its major manifestation, ischemic heart disease. This has been described in the Part I companion of the present review. Autopsy-initiated studies have documented the prevalence and clinicopathological significance of atherosclerosis in different human populations and its relationship to risk factors. It has been shown that the clinically silent phase of ischemic heart disease (IHD) begins in the first decades of life. Pathological studies have clarified the complex relationship between coronary atherosclerosis, coronary thrombosis, and myocardial ischemic events. These studies also have elucidated the pathological basis of sudden cardiac death. Insights from these studies also have been important in developing and evaluating strategies for continued progress in reducing the morbidity and mortality attributed to atherosclerosis and IHD.

Machine-learning approaches for risk prediction in transcatheter aortic valve implantation: Systematic review and meta-analysis

OBJECTIVES

With the expanding integration of artificial intelligence (AI) and machine learning (ML) into the structural heart domain, numerous ML models have emerged for the prediction of adverse outcomes after transcatheter aortic valve implantation (TAVI). We aim to identify, describe, and critically appraise ML prediction models for adverse outcomes after TAVI. Key objectives consisted in summarizing model performance, evaluating adherence to reporting guidelines, and transparency.

METHODS

We searched PubMed, SCOPUS, and Embase through August 2023. We selected published machine learning models predicting TAVI outcomes. Two reviewers independently screened articles, extracted data, and assessed the study quality according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcomes included summary C-statistics and model risk of bias assessed with the Prediction Model Risk of Bias Assessment Tool. C-statistics were pooled using a random-effects model.

RESULTS

Twenty-one studies (118,153 patients) employing various ML algorithms (76 models) were included in the systematic review. Predictive ability of models varied: 11.8% inadequate (C-statistic <0.60), 26.3% adequate (C-statistic 0.60-0.70), 31.6% acceptable (C-statistic 0.70-0.80), and 30.3% demonstrated excellent (C-statistic >0.80) performance. Meta-analyses revealed excellent predictive performance for early mortality (C-statistic: 0.81; 95% confidence interval [CI], 0.65-0.91), acceptable performance for 1-year mortality (C-statistic: 0.76; 95% CI, 0.67-0.84), and acceptable performance for predicting permanent pacemaker implantation (C-statistic: 0.75; 95% CI, 0.51-0.90).

CONCLUSIONS

ML models for TAVI outcomes exhibit adequate-to-excellent performance, suggesting potential clinical utility. We identified concerns in methodology and transparency, emphasizing the need for improved scientific reporting standards.

26-Week Repeated-Dose Toxicity Study of a Novel Antiarrhythmic Drug Sulcardine Sulfate in Sprague-Dawley Rats

Sulcardine sulfate (Sul) is a novel antiarrhythmic agent blocking multiple channels and exhibits unique pharmacological properties such as lower APD-dependent prolongation and reduced arrhythmia risk. Sul is currently in Phase III clinical trials, yet studies on its long-term toxicological profile and potential target organs remain unexplored. This study investigated the related toxicity of Sul in Sprague Dawley (SD) rats through repeated oral administration for 26 weeks, followed by a 4-week recovery period. Consistent with the clinical intended mode of administration, Sul was administered via oral gavage at daily doses of 0, 175, 350, and 700/525 mg/kg in rats. On account of clinically observed body weight loss of male and female rats in the high-dose group compared with the control group, with one female rat in the high-dose group dying after 8 weeks of administration, the high dose was adjusted to 525 mg/kg. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in male rats significantly increased in the medium- and high-dose groups, whereas female rats in these groups showed a significant rise in alkaline phosphatase (ALP) levels, accompanied by varying degrees of weight gain in the liver and lungs. Additionally, brownish-red pigment deposition was observed in hepatocytes and Kupffer cells across all dosing groups, along with foam cell deposition in the alveolar cavities. Concomitant toxicokinetics showed that the drug accumulated to some extent in the animals. Consequently, the liver and lungs were identified as potential target organs, and the no observed adverse effect level (NOAEL) was determined to be 175 mg/kg.

Elevated blood pressure, stroke volume, and vascular tone in young women who use oral contraception

Use of hormonal contraception is important to consider as a risk or protective factor in the development of cardiovascular disease. Prior reports of short and long-term effects of hormonal contraception on cardiovascular disease allude to its potential for immediate and delayed cardiovascular effects, but the nature of direct early cardiovascular changes as the result of hormonal contraception use remains understudied. This cross-sectional data analysis add-on study compared differences in cardiovascular function of naturally cycling women (n = 90) and women using oral contraceptive pills (n = 35) at rest and in response to physiological breathing challenges that activated the sympathetic (paced sighing) or parasympathetic (slow paced breathing) nervous systems. Results showed women using oral contraception had elevated resting systolic blood pressure as well as increased stroke volume and shortened pulse transit time (i.e., vasoconstriction) relative to naturally cycling women. Despite resting differences, both groups responded similarly to breathing challenges. Elevated resting blood pressure and altered sympathetic control, even at preclinical levels, may increase physiological wear-and-tear, particularly if hormonal contraceptive use continues over long periods of time. These findings are particularly compelling considering the youth and health of the current sample.

Comparative Accuracy of Semiconductor Single-Photon Emission Computed Tomography (SPECT) Versus Cardiac Magnetic Resonance (CMR) for Myocardial Viability Assessment

Background Evaluating myocardial viability is critical for developing optimal strategies for ischemic cardiomyopathy. While semiconductor single-photon emission computed tomography (D-SPECT) demonstrated higher image quality than conventional Anger cameras for assessing myocardial viability, its accuracy compared to cardiac magnetic resonance (CMR) in the same patient cohort is still unknown. Methods We conducted a retrospective study on patients with known or suspected coronary artery disease who underwent D-SPECT and CMR within 100 days. Rest deficit score on D-SPECT and depth of contrast enhancement on late gadolinium enhancement (LGE) in CMR were classified and compared using a 16-segment analysis. Follow-up echocardiography was performed about a year after the initial examinations, detecting whether the optimal medical therapy (OMT) was followed by invasive therapy (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]). The five-year survival rates were also compared. Results The study comprised 336 segments from 21 consecutive patients collected between January 2015 and December 2017. Using LGE as a viability criterion, a D-SPECT score of three had the highest diagnostic accuracy (area under the curve: 0.97). Follow-up echocardiography showed significant improvements in left ventricular ejection fraction in patients receiving OMT + PCI/CABG compared to OMT alone (OMT vs. OMT + PCI/CABG; 1.5% ± 3.4% vs. 7.1% ± 5.0%, p = 0.008); five-year survival rate did not significantly differ between the groups. Conclusions Deficits observed at rest on D-SPECT and LGE extent on CMR showed a strong correlation in evaluating myocardial viability, implying that D-SPECT is a viable alternative to CMR for this purpose.

Chiari Network-Induced Tricuspid Valve Obstruction

We present a case of a 5-day-old neonate exhibiting lip cyanosis and hypoxemia, with a percutaneous oxygen saturation of 74%, as the primary clinical manifestations. Echocardiography and intraoperative examination revealed an abnormally elongated Chiari network obstructing the tricuspid valve orifice. This case highlights the clinical importance of anatomical variations in the Chiari network, which, although generally a benign embryological remnant, can lead to hemodynamic disturbances necessitating prompt identification in neonatal cardiology assessments.

The heart of the matter: How gut microbiota-targeted interventions influence cardiovascular diseases

The human body is habitat to a wide spectrum of microbial populations known as microbiota, which play an important role in overall health. The considerable research has mostly focused on the gut microbiota due to its potential to impact numerous physiological functions and its correlation with a variety of disorders, such as cardiovascular diseases (CVDs). Imbalances in the gut microbiota, known as dysbiosis, have been linked to the development and progression of CVDs through various processes, including the generation of metabolites like trimethylamine-N-oxide and short-chain fatty acids. Studies have also looked at the idea of using therapeutic interventions, like changing your diet, taking probiotics or prebiotics, or even fecal microbiota transplantation (FMT), to change the gut microbiota's make-up and how it works in order to prevent or treat CVDs. Exploring the cause-and-effect connection between the gut microbiota and CVDs offers a hopeful path for creating innovative microbiome-centered strategies to prevent and cure CVDs. This review presents an in-depth review of the correlation between the gut microbiota and CVDs, as well as potential therapeutic approaches for manipulating the gut microbiota to enhance cardiovascular health.

Cardiac Rehabilitation for Women with Heart Disease

Cardiovascular disease is the leading cause of morbidity and mortality in women globally. Cardiac rehabilitation (CR)-a comprehensive program including supervised progressive exercise, education, support, behavior modification, and nutritional guidance over 36 individual sessions-positively impacts morbidity, mortality, function, and quality of life. Overall, less than 30% of those who qualify are referred and participate in CR-referral and completion rates are significantly less in women compared with men despite evidence supporting equal benefit. Barriers contributing to these disparities have been identified, and CR programs can be modified to enhance the participation of women.

Characteristics and outcomes of patients with acute coronary syndrome who present with atypical symptoms: a systematic review, pooled analysis and meta-analysis

How frequent and whether outcomes are worse for patients with atypical presentation in acute coronary syndrome (ACS) across the literature is not known. We conducted a systematic review of the literature on patients with ACS or acute myocardial infarction who reported whether their symptoms were atypical or typical. We determined the proportion of patients with atypical or no chest pain and used meta-analysis to evaluate predictors of atypical presentation and mortality associated with atypical presentation. A total of 43 studies were included with 1 691 401 patients (mean age: 65.4 years, 63.8% male). The proportion of patients with atypical presentation ranged from 4.6 to 74.2% while for those with no chest pain it ranged from 1.4 to 35.5%. Atypical presentation occurred in 11.6% of patients (28 studies) and no chest pain occurred in 33.6% of patients (16 studies). The three strongest factors associated with increased odds of atypical presentation or no chest pain presentation were non-ST-elevation myocardial infarction [odds ratio (OR): 2.38, 95% confidence interval (CI): 1.55-3.64], greater Killip class (OR: 2.22, 95% CI: 1.84-2.67), and prior heart failure (OR: 1.79, 95% CI: 1.76-1.82). There is a two-fold increase in odds of mortality with atypical or no chest pain presentation in ACS compared with the typical presentation (OR: 2.07, 95% CI: 1.71-2.50, I2  = 99%). Atypical presentation occurs in approximately 1 in 10 patients with ACS but can be as high as 1 in 3 in some populations. Patients who present atypically are at two-fold increased risk of mortality.

KCNQ1 Polymorphism in the Context of Ischemic Cardiomyopathy: A Potential Key to Decision-Making for Device Implantation

BACKGROUND

Ventricular tachyarrhythmia (VTA) in ischemic cardiomyopathy (ICM) is a life-threatening condition influenced by genetic factors and electrical remodeling. This study investigated the association between KCNQ1 gene polymorphisms (rs2237892 and rs2237895) and the development of VTA in ICM patients to improve risk stratification and guide device implantation decisions.

METHODS

This single-center study included 213 ICM patients with implantable cardioverter-defibrillators (ICD) for primary prevention of VTA. Patients were divided into arrhythmia and control groups based on device interrogation findings. Genetic analysis for rs2237892 and rs2237895 polymorphisms was performed using real-time polymerase chain reaction (PCR). Clinical, electrocardiographic, and laboratory parameters were analyzed. Correlation and logistic regression analyses evaluated the association between KCNQ1 polymorphisms and VTA risk.

RESULTS

The arrhythmia group demonstrated significantly higher QT dispersion, frontal QRS-T angle, and T-wave peak-to-end interval compared to the control group. The TT genotype of rs2237892 and the AC genotype of rs2237895 were significantly associated with increased VTA risk (p < 0.001). Multivariate analysis confirmed these genotypes as independent predictors of VTA. No significant differences in other clinical or laboratory risk factors were observed.

CONCLUSIONS

KCNQ1 gene polymorphisms (rs2237892 and rs2237895) are strongly associated with VTA in ICM patients, suggesting a potential role as biomarkers for risk stratification. These findings may assist in tailoring ICD implantation decisions and improving patient outcomes.

Exploring the links between polyphenols, Nrf2, and diabetes: A review

Diabetes mellitus, a complex metabolic disorder, is marked by chronic hyperglycemia that drives oxidative stress and inflammation, leading to complications such as neuropathy, retinopathy, and cardiovascular disease. The Nrf2 pathway, a key regulator of cellular antioxidant defenses, plays a vital role in mitigating oxidative damage and maintaining glucose homeostasis. Dysfunction of Nrf2 has been implicated in the progression of diabetes and its related complications. Polyphenols, a class of plant-derived bioactive compounds, have shown potential in modulating the Nrf2 pathway. Numerous compounds have been found to activate Nrf2 through mechanisms including Keap1 interaction, transcriptional regulation, and epigenetic modification. Preclinical studies indicate their ability to reduce reactive oxygen species (ROS), improve insulin sensitivity, and attenuate inflammation in diabetic models. Clinical trials with certain polyphenols, such as resveratrol, have demonstrated improvements in glycemic parameters, though results remain inconsistent. While polyphenols show promise as a component of non-pharmacological approaches to diabetes management, challenges such as bioavailability, individual variability in response, and limited clinical evidence highlight the need for further investigation. Continued research could enhance understanding of their mechanisms and improve their practical application in mitigating diabetes-related complications.

Regulation of Cardiac Function by the Autonomic Nervous System

The autonomic nervous system is critical for regulating cardiovascular physiology. The neurocardiac axis encompasses multiple levels of control, including the motor circuits of the sympathetic and parasympathetic nervous systems, sensory neurons that contribute to cardiac reflexes, and the intrinsic cardiac nervous system that provides localized sensing and regulation of the heart. Disruption of these systems can lead to significant clinical conditions. Recent advances have enhanced our understanding of the autonomic control of the heart, detailing the specific neuronal populations involved and their physiologic roles. In this review, we discuss this research at each level of the neurocardiac axis. We conclude by discussing the clinical field of neurocardiology and attempts to translate this new understanding of neurocardiac physiology to the clinic. We highlight the contributions of autonomic dysfunction in prevalent cardiovascular diseases and assess the current status of novel neuroscience-based treatment approaches.

Use of CPR feedback devices in resuscitation training: A systematic review and meta-analysis of randomized controlled trials

Objectives

The use of cardiopulmonary resuscitation (CPR) feedback devices during training is increasing. This review evaluates whether incorporating CPR feedback devices in training improves patient survival, CPR quality in actual resuscitation, skill acquisition and retention after training.

Methods

This systematic review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR). We searched MEDLINE, EMBASE, and SCOPUS databases from inception to September 30, 2024, including randomized controlled trials (RCTs) in all languages (with an English abstract) comparing CPR training with and without feedback devices. Outcome included patient survival, quality of clinical performance in resuscitation, and CPR skill acquisition and retention. Non-RCT studies, unpublished work without peer review or animal studies were excluded. Risk of bias was assessed using Cochrane tools, and certainty of evidence was graded using the Grading of Recommendations Assessment, development and Evaluation (GRADE) approach. Standardized mean difference (SMD) were calculated and pooled effects were analyzed using random-effects models. PROSPERO CRD42023488130.

Results

We identified 20 RCTs with 4579 participants. Risks of bias ranged from low to critical (low: 8, moderate: 9, and critical: 3). No studies evaluated the patient survival, clinical performance in resuscitation or cost-effectiveness. Compared to no feedback, using CPR feedback devices during training significantly improved key quality metrics. Pooled effect sizes were 0.76 (95%CI 0.02 - 1.50) for mean compression depth (15 studies), 0.98 (95%CI: 0.10 - 1.87) for depth compliance (16 studies), 0.29 (95%CI: 0.10 - 0.48) for mean rate (17 studies), 0.44 (95%CI: 0.23 - 0.66) for rate compliance (9 studies), and 0.53 (95%CI: 0.31 - 0.75) for recoil compliance (10 studies) in favour of using feedback devices during training. Heterogeneity was large (I2 > 50%) in all analyses. Planned subgroup analyses revealed no statistically significant interaction between healthcare professionals and laypersons. Using the GRADE approach, the certainty of evidence was downgraded for certain outcomes due to critical risk of bias for 3 studies and inconsistency but upgraded for strong association.

Conclusion

The use of CPR feedback devices during resuscitation training improves key quality metrics of CPR performance, with moderate to high certainty of evidence. However, further studies are needed to evaluate the impact on cost-effectiveness, clinical performance and patient outcomes.

The triad of physical activity: An optimal combination for cardiovascular health

The combination of moderate to vigorous physical activity with muscle-strengthening physical activity is increasingly recognized for its significant impact on cardiovascular health. This narrative review synthesizes current evidence to compare the cardiovascular benefits of combined physical activity versus singular forms, especially in primary prevention. The main focus is on hormonal, nervous, genetic, and molecular adaptations, critical mechanisms underlying the body's response to physical activity. Our findings endorse superior benefits for combined moderate to vigorous and muscle-strengthening physical activity for preventing cardiovascular disease (CVD). This combined approach synergistically enhances cardiovascular function and more effectively reduces risk factors than either activity alone. While more research is needed to distinguish between moderate and vigorous activity levels in combination with muscle-strengthening physical activity, current evidence supports comprehensive physical activity guidelines that maximize cardiovascular health. These findings highlight the importance of integrated physical activity regimens in public health strategies and clinical practice to mitigate the global CVD burden.

Exploring the complex interplay between alcohol consumption and cardiovascular health: Mechanisms, evidence, and future directions

This review article explores the intricate relationship between alcohol consumption and cardiovascular health, underscoring on both clinical outcomes and underlying pathophysiological mechanisms. It examines the complex dose-response relationships for various cardiovascular disease (CVD) subtypes, including coronary heart disease, stroke, and atrial fibrillation, while categorizing pathophysiological mechanisms into three conceptual areas: primary initiating factors, secondary transmission pathways, and end-organ effects. Although mild-to-moderate alcohol consumption may confer some benefits for cardiovascular health and certain CVD subtypes, growing evidence highlights the importance of lifestyle modifications to reduce alcohol intake, particularly among heavy drinkers. This review provides a comprehensive overview of current knowledge, emphasizes the need for future research with robust methodologies, and advocates for incorporating updated scientific evidence into personalized approaches within international cardiovascular and national guidelines.

Feedback Attention to Enhance Unsupervised Deep Learning Image Registration in 3D Echocardiography

Cardiac motion estimation is important for assessing the contractile health of the heart, and performing this in 3D can provide advantages due to the complex 3D geometry and motions of the heart. Deep learning image registration (DLIR) is a robust way to achieve cardiac motion estimation in echocardiography, providing speed and precision benefits, but DLIR in 3D echo remains challenging. Successful unsupervised 2D DLIR strategies are often not effective in 3D, and there have been few 3D echo DLIR implementations. Here, we propose a new spatial feedback attention (FBA) module to enhance unsupervised 3D DLIR and enable it. The module uses the results of initial registration to generate a co-attention map that describes remaining registration errors spatially and feeds this back to the DLIR to minimize such errors and improve self-supervision. We show that FBA improves a range of promising 3D DLIR designs, including networks with and without transformer enhancements, and that it can be applied to both fetal and adult 3D echo, suggesting that it can be widely and flexibly applied. We further find that the optimal 3D DLIR configuration is when FBA is combined with a spatial transformer and a DLIR backbone modified with spatial and channel attention, which outperforms existing 3D DLIR approaches. FBA's good performance suggests that spatial attention is a good way to enable scaling up from 2D DLIR to 3D and that a focus on the quality of the image after registration warping is a good way to enhance DLIR performance. Codes and data are available at: https://github.com/kamruleee51/Feedback_DLIR.

Patent foramen ovale: A variant of normal or a true congenital heart disease?

Foramen ovale plays a key role in foetal circulation, however it may remain patent after birth throughout the life. Its patency is so frequent in healthy people (27-35 %), such as to be considered a variant of normal. It is at risk of complications, like paradoxical embolism by right to left shunt with stroke, migraine, temporary blindness, as well as aneurysm, thrombosis and endocarditis of the fossa ovalis. There is no doubt that it should be considered a congenital heart disease at all effects. Invasive cardiology closure with umbrella and even with stiches is nowadays feasible and indicated in specific clinical scenarios. Further research is needed to determine whether cardiac echo-doppler screening for identifing affected patients as a primary prevention measure is advisable.

Palliative Intermittent Drainage of Neoplastic Pericardial Effusions with a Permanent Subcutaneous Pleural Access Port

Recurrent pericardial effusion (PE) with cardiac tamponade due to a cardiac mass was identified in two dogs. Cytology of the masses was consistent with a malignant epithelial tumor with a neuroendocrine appearance in both cases. Given the location and description, an ectopic thyroid carcinoma was considered the most likely cytological diagnosis. Pericardiectomy and chemotherapy were proposed in both cases, but the owners declined to perform any invasive surgical treatment, and an alternative option was offered to palliate the symptoms associated with PE. Placement of a subcutaneous pleural access port in the pericardial cavity was achieved to drain the PE and avoid the need to perform serial percutaneous pericardiocentesis. The placement of a subcutaneous access port appeared to be safe and well tolerated in two patients for whom more invasive treatment was declined and may be considered for future similar cases.

Predictors of Incident Heart Failure in Patients With Chronic Chagas Disease Cardiomyopathy

PURPOSE

Patients with chronic Chagas cardiomyopathy (CCC) have a high mortality due to heart failure (HF). The aim of this study was to investigate clinical and echocardiographic predictors of incident HF in patients with CCC.

METHODS

Single-center retrospective longitudinal observational study which included 176 adult patients (59.1% women; 53.9 ± 10 years old; mean left ventricular [LV] ejection fraction 62% ± 10%) at an early stage of CCC (electrocardiogram and/or wall motion changes but no HF). The primary outcome was incident HF. The association between studied parameters with incident HF was performed by competing-risk survival regression models using the Fine and Gray method.

RESULTS

After a mean follow-up of 8.8 ± 3.6 years, 42 patients progressed to HF (27.04 cases/1000 patient-years). A model 0 adjusted for clinical and 2D-Doppler echocardiographic parameters and for all-cause mortality revealed diabetes mellitus (HR 4.91, 95% CI 1.67-14.4, p = 0.004), LV ejection fraction (HR 0.96, 95% CI 0.93-0.99, p = 0.022), and E' velocity (HR 0.79, 95% CI 0.67-0.95, p = 0.01) as independently associated with incident HF. The addition of strain-derived parameters to model 0 revealed that LV global circumferential strain (HR 0.83, 95% CI 0.78-0.89, p < 0.001) and left atrial booster contraction strain (HR 1.14, 95% CI 1.02-1.28, p = 0.022) were associated with incident HF.

CONCLUSION

While most clinical parameters were not associated with incident HF in patients with CCC, echocardiographic parameters, including LV systolic and diastolic function and strain-derived parameters, were associated with incident HF in patients with CCC. This knowledge can be very useful for planning the care and follow-up of these patients.

ANMCO position paper: diagnosis and treatment of heart failure with preserved systolic function

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure. Therefore, diagnosing those patients early is crucial to provide the best treatment. Moreover, the diagnosis is influenced by the patient's comorbidities, and some HFpEF patients have symptoms common to other rare diseases that, if unrecognized, develop an unfavourable prognosis. This position paper aims to provide the clinician with a useful tool for diagnosing and treating patients with HFpEF, guiding the clinician towards the most appropriate diagnostic and therapeutic pathway.

Takotsubo Cardiomyopathy With an Unusually High Troponin Level Post-laparotomy for Small Bowel Obstruction Secondary to Adhesions in a Patient Presenting With Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) triggering adhesion-related small bowel obstruction (SBO) is rare. The occurrence of Takotsubo cardiomyopathy (TCM) with an unusually high level of troponin I in the clinical course presents a unique diagnostic challenge. We report the case of a female patient in her 40s who had repeatedly presented to the hospital with abdominal pain and initially showed signs of PID, which later developed to SBO due to adhesions requiring laparotomy. Six days post-laparotomy, she experienced chest pain with ST-segment elevation on electrocardiogram (ECG) and high troponin I level at 16,804 ng/L (reference range: 0-39 ng/L), and bedside echocardiography showed apical ballooning with severely impaired left ventricular ejection fraction. Her cardiac biomarkers and echocardiogram features improved over the next few days making TCM the likely cause, with ST-segment elevation myocardial infarction (STEMI) being the main differential diagnosis. Besides the unique series of events that created the level of complexity, this case highlighted the importance of considering PID as a potential trigger for SBO, the cautious evaluation of troponin in acute coronary syndrome (ACS)-mimicking presentation, and, above all, the necessity of timely multidisciplinary team involvement in dealing with complex cases.

A Retrospective Analysis Assessing Paravalvular Leak and Pacemaker Implantation Using TEE and Non-Contrast CT for CKD Patients Compared With CT Angiography for Annular Sizing Pre-TAVR

Background and Aims

Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for many patients with severe aortic stenosis. Proper pre-procedure sizing of the aortic annulus is crucial in preventing post-TAVR complications. This is typically performed with CT angiography, but the use of contrast is controversial in patients with chronic kidney disease (CKD).

Methods

This study of 557 patients from 2016 to 2021 sought to evaluate a contrast-sparing protocol for balloon expandable TAVR evaluation in patients with CKD, in which patients with glomerular filtration rate of less than 40 would undergo transesophageal echocardiogram (TEE) and CT without contrast (83 patients) for aortic annular sizing instead of CT angiography (445 patients).

Results

We found that there was no significant difference in rates of greater than trace or greater than mild paravalvular leak between the two groups at hospital discharge, 30 days, or 1-year post-TAVR. We also found no difference in rates of permanent pacemaker implantation at these same time points.

Conclusions

This suggests that TEE and non-contrast CT could be a viable alternative to CTA in patients with CKD, although more research into other variables such as mortality and other post-procedural complications is necessary.

Acute Effect of High-Intensity Interval Exercise on Blood Pressure in Females Living with Type 2 Diabetes and Hypertension

BACKGROUND

The acute effects of high-intensity interval training (HIIT) on blood pressure (BP) may depend on the exercise protocol performed.

PURPOSE

To compare the acute effect of high- and low-volume HIIT on post-exercise and ambulatory BP in untrained older females diagnosed with both type 2 diabetes and hypertension.

METHODS

Fifteen females (69 (65-74) yr) completed a crossover study with three experimental conditions: 1) REST (35 min in sitting position); 2) HIIT10 (10 × 1 min at 90% heart rate max (HRmax)), and 3) HIIT4 (4 × 4 min at 90% HRmax). After each experimental condition, BP was measured under controlled (4 h) and in subsequent free-living conditions (20 h).

RESULTS

In the controlled post-condition 4-h period, no significant interaction (time-condition) was observed for all BP parameters ( P ≥ 0.082). Similarly, during the subsequent 20-h free-living ambulatory monitoring (diurnal and nocturnal), no differences between conditions were detected ( P ≥ 0.094). A significant reduction in nighttime pulse pressure was observed in both HIIT4 and HIIT10 compared with REST (46 (44-50), 45 (42-53) vs 50 (45-57) mm Hg, respectively; P ≤ 0.018) with no differences between HIIT conditions ( P = 0.316). Changes in nocturnal systolic BP approached but did not reach statistical significance ( P = 0.068).

CONCLUSIONS

This study suggests that in untrained older females living with type 2 diabetes and hypertension, the HIIT10 and HIIT4 protocols have very limited to no acute effect on post-exercise and ambulatory BP. The fact that the vast majority of participants had well-controlled office and ambulatory BP values as well as low cardiorespiratory fitness could explain these findings.

Novel and established biomarkers to complement risk scores in patients with acute decompensated heart failure - a pilot study

Study Objective

There are several risk scores for mortality in patients with acute decompensated heart failure (ADHF) such as the European Collaboration on Acute Decompensated Heart Failure Score (ELAN-HF Score), the ADHF/NT-proBNP-Score or A2B-Score (age, anemia, BNP). The aim of this study was to evaluate the predictive value of such risk scores with and without addition of novel cardiorenal biomarkers.

Design & Setting

Single-center, exploratory prospective cohort study at the University Hospital Heart Centre Brandenburg.

Participants

Forty-four adult patients hospitalized for ADHF.

Interventions

Measurement of established and novel biomarkers at hospital admission including N-terminal-pro brain natriuretic peptide (NT-pro-BNP), troponin T, creatinine, cystatin C, soluble suppression of tumorigenicity 2 (sST2), Neprilysin, Dickkopf-3 (DKK3), interleukin-6 (IL-6), growth differentiation factor-15 (GDF-15), Galectin-3, Progranulin and urine neutrophil gelatinase-associated lipocalin (uNGAL).

Main Outcome Measures

Analysis of predictive indices of ELAN-HF, ADHF/NT-proBNP and A2B-Scores for 90-day mortality with and without adding biomarkers. AUC <0.8 was considered as fair, ≥0.8 as good and > 0.9 as excellent predictive value.

Results

Median age was 78.0 (25th-75th percentiles 69.3-83.8) years, 50 % (22/44) were female. Twelve patients (27.3 %) died within 90 days after discharge. All three risk scores were higher in non-survivors and showed fair AUC for 90-day mortality (ELAN-HF: 0.792 [0.639-0.901], p = 0.003; ADHF-NT-proBNP score: 0.749 [0.559-0.938], p = 0.012; A2B score: 0.734 [0.541-0.927], p = 0.017). Adding troponin T, cystatin C-based estimated glomerular filtration rate (eGFR) or uNGAL to risk scores was associated with an area under the curve (AUC) >0.80 for all models. Combination of troponin T, cystatin C-based eGFR and uNGAL increased risk scores to AUC >0.91.

Conclusion

These findings imply that further evaluation of the addition of a panel of cardiorenal biomarkers to ADHF risk scores is warranted.

Transcatheter aortic valve implantation for a patient with both severe aortic stenosis and membranous ventricular septal aneurysm: a case report

Background

There have been few reports on transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) and a membranous ventricular septal aneurysm (MSA).

Case summary

A 77-year-old female complaining of dyspnoea was transferred to our hospital. Transthoracic echocardiography (TTE) showed progressive very severe AS with reduced left ventricular (LV) systolic function. The patient was scheduled for TAVI due to high surgical risk. Preoperative computed tomography showed a MSA located between the right coronary cusp and the non-coronary cusp, therefore a part of the annulus rim was lacking. We draw a virtual annulus line to assess her true annulus size and selected a 29 mm size of Evolut Pro Plus. Since the bottom end of the valve was positioned into the MSA, the valve was begun to expand with a lack of coaxiality and massive paravalvular leak (PVL) occurred. Therefore, we decided to retrieve the 29 mm valve. An up-sized 34 mm Evolut was tried, but it was too large and caused the phenomenon of stent-frame infolding. We had to retrieve the 34 mm valve again, and tried to deploy another 29 mm valve at a position as high as possible and pushed the delivery system during the final release to maintain good coaxiality. Postoperative TTE showed significant recovery of LV systolic function, and the PVL was mild.

Discussion

In patients with both MSA and severe AS, it is difficult to measure the precise annulus size for ensuring stability of the self-expanding valve and preventing PVL.

Late onset epilepsy and stroke: Diagnosis, pathogenesis and prevention

The association of stroke and late-onset epilepsy (LOE) is discussed with special regard to its diagnosis, pathogenesis, and prevention. In addition to epidemiological data, including those from different age groups, the mechanisms for the development of acute symptomatic and remote symptomatic seizures are reviewed. The risk factors associated with seizures and post-stroke epilepsy (PSE) are considered, along with the methodological limitations of the study. For future research, the distinction between acute and remote symptomatic seizure before or after seven days from stroke onset should be reviewed because different acute symptomatic seizures (ASSs) themselves can entail a variable PSE risk. The definition of LOE by age is hitherto inconsistent. Comparing adult lifespan epochs, it is evident that stroke and seizures exhibit similar prevalence profiles. Young adulthood, old adulthood, and elderly epochs may be relevant for the differentiation of LOE subtype by age, vascular comorbidity, and other characteristics. A step-scheme strategy as a possible contribution to cerebrovascular prevention approaches is proposed.

Cardioprotective Glucose-Lowering Agents and Dementia Risk: A Systematic Review and Meta-Analysis

Importance

Although diabetes is a risk factor for dementia, the effect of glucose-lowering therapy for prevention of incident dementia is uncertain.

Objective

To determine whether cardioprotective glucose-lowering therapy (sodium-glucose cotransporter-2 inhibitors [SGLT2is], glucagon-like peptide-1 receptor agonists [GLP-1RAs], metformin, and pioglitazone), compared with controls, was associated with a reduction in risk of dementia or cognitive impairment, and among primary dementia subtypes.

Data Sources

The PubMed and Embase databases were searched for studies published from inception of the database to July 11, 2024.

Study Selection

Randomized clinical trials comparing cardioprotective glucose-lowering therapy with controls that reported dementia or change in cognitive scores. Cardioprotective glucose-lowering therapies were defined as drug classes recommended by guidelines for reduction of cardiovascular events, based on evidence from phase III randomized clinical trials. Inclusion criteria were assessed independently and inconsistencies were resolved by consensus.

Data Extraction and Synthesis

Data were screened and extracted independently by 2 authors adhering to the PRISMA guidelines in August 2024. Random-effects meta-analysis models were used to estimate a pooled treatment effect.

Main Outcomes and Measures

The primary outcome measure was dementia or cognitive impairment. The secondary outcomes were primary dementia subtypes, including vascular and Alzheimer dementia, and change in cognitive scores.

Results

Twenty-six randomized clinical trials were eligible for inclusion (N = 164 531 participants), of which 23 trials (n = 160 191 participants) reported the incidence of dementia or cognitive impairment, including 12 trials evaluating SGLT2is, 10 trials evaluating GLP-1RAs, and 1 trial evaluating pioglitazone (no trials of metformin were identified). The mean (SD) age of trial participants was 64.4 (3.5) years and 57 470 (34.9%) were women. Overall, cardioprotective glucose-lowering therapy was not significantly associated with a reduction in cognitive impairment or dementia (odds ratio [OR], 0.83 [95% CI, 0.60-1.14]). Among drug classes, GLP-1RAs were associated with a statistically significant reduction in dementia (OR, 0.55 [95% CI, 0.35-0.86]), but not SGLT2is (OR, 1.20 [95% CI, 0.67-2.17]; P value for heterogeneity = .04).

Conclusions and Relevance

While cardioprotective glucose-lowering therapies were not associated with an overall reduction in all-cause dementia, this meta-analysis of randomized clinical trials found that glucose lowering with GLP-1RAs was associated with a statistically significant reduction in all-cause dementia.

Adrenal Anatomy and Physiology

The adrenal glands are paired endocrine organs that play a vital role in maintaining homeostasis by regulating blood pressure, metabolism, electrolyte balance, and the body's response to stress. Each gland comprises the adrenal cortex, which produces steroid hormones, and the adrenal medulla, responsible for catecholamine synthesis. The cortex is further divided into three functional zones, the zona glomerulosa (mineralocorticoids), zona fasciculata (glucocorticoids), and zona reticularis (androgens), while the medulla secretes adrenaline, noradrenaline, and dopamine under sympathetic control. This article aims to provide a comprehensive overview of the adrenal glands, including their anatomical structure, embryological development, vascular supply, microscopic architecture, and physiological function. Additionally, the historical evolution of adrenal research and the impact of modern molecular advancements are discussed. Understanding the anatomy and function of adrenal gland is crucial for diagnosing and managing adrenal disorders, including hormonal deficiencies, hypersecretion syndromes, and adrenal neoplasms.

Association of APOB (rs515135) and PCSK9 (rs505151) gene polymorphisms with CAD in the Indian population

INTRODUCTION

Coronary artery disease (CAD) is a multifactorial disorder influenced by both genetic and clinical risk factors. Lipid metabolism genes such as apolipoprotein B(APOB) (rs515135) and proprotein convertase subtilisin/kexin type 9 (PCSK9)(rs505151), have been associated with susceptibility to CAD. Study investigates the potential role of these genetic polymorphisms with risk of CAD in the Indian population.

MATERIALS AND METHODS

A case-control study including 150 CAD cases and 150 controls. Angiographically proven Cases were recruited from the Cardiology Unit, Department of Medicine, Era's Lucknow Medical College. Genotyping was done using specific primers and restriction digestion; statistical analysis included t-tests, odds ratios, and haplotype analysis.

RESULTS

CAD cases(mean age 49.93   ±   9.13 years) had higher serum cholesterol and VLDL but lower systolic and diastolic BP compared to controls (mean age 56.47   ±   9.39 years). The APOB G allele showed a significant protective effect against CAD (OR: 0.431,p = 0.001).

CONCLUSION

The APOB G allele may serve as a protective factor against CAD, highlighting its potential role in genetic screening for lower disease risk. Further large-scale studies are required to confirm these findings.