Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association

Assessment of coronary computed tomography angiography-derived plaque features in the diagnosis of optical coherence tomography-defined vulnerable plaques

Background

Identification of vulnerable plaque is essential for pre-estimation of the risk of cardiovascular disease (CVD) and stratification of major adverse cardiac events (MACEs) risks. This study aimed to evaluate the diagnostic ability of coronary computed tomography angiography (CCTA)-derived qualitative and quantitative plaque features in detecting optical coherence tomography (OCT)-defined vulnerable plaques.

Methods

A total of 31 patients who underwent both CCTA and OCT were retrospectively included in this study. The results of OCT and CCTA were blindly analyzed on a segment-to-segment comparison. The qualitative and quantitative plaque parameters derived by CCTA were recorded. Univariate analysis and multivariate logistic regression analysis were performed to reveal the independent predictors. The diagnostic efficacy of quantitative parameters was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC).

Results

A total of 76 plaques in 31 patients were included for analysis, of which 15/76 plaques (19.7%, 10 patients) were vulnerable plaques. Low-density plaques, spotty calcification (SC), positive remodeling (PR), number of high-risk plaque signs, non-calcified fraction, and lipid fraction displayed significant differences between vulnerable and non-vulnerable plaques (P<0.05). Fibrotic plaque volume (FPV) [odds ratio (OR) =1.013; 95% confidence interval (CI): 1.003-1.024] and low attenuation plaque (LAP) (OR =23.416; 95% CI: 4.725-116.055) were shown to be independent predictors of vulnerable plaques. Compared with qualitative and quantitative models, the mixed model integrating all significant CCTA-derived plaque characteristics achieved the highest AUC and accuracy (mixed model AUC =0.87, 95% CI: 0.808-0.979; qualitative model AUC =0.80, 95% CI: 0.654-0.941; quantitative model AUC =0.64, 95% CI: 0.528-0.866).

Conclusions

The CCTA-derived plaque characteristics were able to detect the OCT-defined vulnerable plaques and show great potential as a non-invasive biomarker for early diagnosis of coronary vulnerable plaques.

Physical activity, frailty, and kinesiophobia among older adult patients with coronary heart disease in China

BACKGROUND

Physical activity (PA) offers advantages in the secondary prevention of coronary heart disease (CHD). However, in older adults, frailty and kinesiophobia may exert negative influences on PA engagement.

OBJECTIVE

To investigate PA, frailty, and kinesiophobia among older adult patients with CHD in China.

METHODS

This cross-sectional study enrolled older adult patients with CHD in the cardiac outpatient care unit of the *** University. The International Physical Activity Questionnaire, the Frailty Phenotype Scale, and the Tampa Scale of Kinesiophobia were used to evaluate PA, frailty, and kinesiophobia, respectively.

RESULTS

A total of 239 participants (mean age: 72.0 ± 7.5 years, 148 males) were enrolled. The rates of frailty and pre-frailty were 20.5 % and 46.4 %, respectively. The mean kinesiophobia score was 43.13±5.48. The median metabolic equivalent of task of PA was 2784 MET-min/week, and 25.1 % of the patients did not reach the minimum recommended by AHA (150 mins/week). Spearman rank correlation analysis showed that PA was negatively correlated with frailty (r = -0.559, P < 0.001) and kinesiophobia (r = -0.463, P < 0.001). Multivariable logistic regression analysis showed that frailty [OR = 0.412, 95 % confidence interval (CI): 0.304-0.559, P < 0.001] and kinesiophobia (OR=0.936, 95 % CI: 0.879-0.997, P = 0.040) were independently associated with PA after adjustment for age, cardiovascular adverse events, comorbidities, Barthel index, and history of dizziness.

CONCLUSIONS

Older adult patients with CHD had low levels of PA. Frailty and kinesiophobia were independently associated with PA in older adult patients with CHD. Reversing frailty and reducing kinesiophobia in older adult patients with CHD may increase PA levels.

Natural Saponins on Cholesterol-Related Diseases: Treatment and Mechanism

Saponins are compounds composed of lipophilic aglycones linked to hydrophilic sugars. Natural saponins are isolated from plants and some Marine organisms. As important cholesterol-lowering drugs, natural saponins have attracted wide attention for their therapeutic potential in a variety of cholesterol-related metabolic diseases. To review the effects of natural saponins on cholesterol-related metabolic diseases, and to deepen the understanding of the cholesterol-lowering mechanism of saponins. The literature related to saponins and cholesterol-lowering diseases was collected using keywords "saponins" and "cholesterol" from PubMed, Web of Science, and Google Scholar from January 2000 to May 2024. The total number of articles related to saponins and cholesterol-lowering diseases was 240 after excluding irrelevant articles. Natural saponins can regulate cholesterol to prevent and treat a variety of diseases, such as atherosclerosis, diabetes, liver disease, hyperlipidemia, cancer, and obesity. Mechanistically, natural saponins regulate cholesterol synthesis and uptake through the AMPK/SREBP2/3-hydroxy-3-methyl-glutaryl coenzyme A reductase pathway and PCSK9/LDLR pathway, and regulate cholesterol efflux and esterification targeting Liver X receptor/ABC pathway and ACAT family. Natural saponins have broad application prospects in regulating cholesterol metabolism, for the development of more cholesterol-lowering drugs provides a new train of thought. However, it is still necessary to further explore the molecular mechanism and expand clinical trials to provide more evidence.

Clinical state and future directions of stem cell therapy in stroke rehabilitation

Despite substantial advances in the acute management of stroke, it remains a leading cause of adult disability and mortality worldwide. Currently, the reperfusion modalities thrombolysis and thrombectomy benefit only a fraction of patients in the hyperacute phase of ischemic stroke. Thus, with the exception of vagal nerve stimulation combined with intensive physical therapy, there are no approved neuroprotective/neurorestorative therapies for stroke survivors. Stem cell therapy is a promising treatment for stroke patients and has been the focus of an increasing number of clinical trials over the past two decades. We provide a comprehensive overview of stem cell therapies available to stroke patients, focusing on the different types and doses of stem cells, timing and route of administration, patient selection, clinical outcomes, translational challenges, and future directions for the field. Information on ongoing and completed studies was retrieved from ClinicalTrials.gov, PubMed, Google Scholar, ICTRP, and Scopus. Autologous bone marrow-derived mononuclear cells (BMMNCs) are the most used, followed by autologous bone marrow stromal cells. IV therapy is typically applied in acute to subacute phases, while IT or IC routes are utilized in chronic phases. Although early-phase trials (Phase I/II) indicate strong safety and tolerability, definitive clinical effectiveness has yet to be unequivocally proven. Cochrane meta-analyses show NIH Stroke Scale improvements, though studies often have high bias and small sample sizes. Larger randomized, double-blind, placebo-controlled trials are ongoing to refine stem cell transplantation protocols, addressing cell type and source, dosage, timing, patient selection, the potential for combination therapies, and clinical efficacy.

Network Meta-Analysis on the Effects of Traditional Chinese Exercise on Stroke Patients

Background

Stroke is a common cerebrovascular disease characterized by a high incidence rate, significant disability, frequent recurrence, and elevated mortality. Exercise plays a crucial role in stroke rehabilitation, yet the relationship between traditional Chinese exercise and stroke recovery remains unclear. This study aims to evaluate the effectiveness of various conventional Chinese exercises through a systematic network meta-analysis and identify the most effective interventions for improving the rehabilitation outcomes of stroke patients.

Methods

A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and the China Science and Technology Journal Database (up to July 2024) to identify randomized controlled trials (RCTs) evaluating traditional Chinese exercises for stroke patients. Trials were included if they utilized at least one form of traditional Chinese exercise. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool (ROB 2.0). Data analysis was performed using Stata 17.0 and the Mvmeta package, employing a random-effects model.

Results

A total of 43 studies involving 2083 stroke patients were included. These studies assessed outcomes including upper limb motor function, lower limb motor function, overall motor ability, walking ability, balance ability, self-care ability, cognitive function, depression, quality of life, and sleep quality. Baduanjin, originating in the Song Dynasty and consisting of eight movements based on traditional Chinese medicine theories,was the most effective in improving upper limb motor function, overall motor ability, walking ability, self-care ability, cognitive function, quality of life, and sleep quality. Taiji, a practice integrating Chinese philosophy, martial arts, and wellness concepts, was the most effective in enhancing lower limb motor function. Wuqinxi, inspired by the dynamic movements of animals such as the tiger, deer, bear, apes, and birds, showed the best results for balance improvement. Liuzijue, a traditional exercise combining specific sound production, breathing, and movement, was most effective in alleviating depressive symptoms.

Conclusions

These findings suggest that Baduanjin may be the most effective intervention for stroke rehabilitation. However, further high-quality RCTs are required to confirm these results.

The PROSPERO registration

CRD42024566780, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024566780.

Retrospective Analysis of the Integration of Palliative Care Into the Care of Stroke Patients Admitted to a Regional Stroke Center

Background: Palliative care (PC) aims to enhance the quality of life for patients when confronted with serious illness. As stroke inflicts high morbidity and mortality, the integration of PC within acute stroke care remains an important aspect of quality inpatient care. However, there is a tendency to offer PC to stroke patients only when death appears imminent. We aim to understand why this may be by examining stroke patients admitted to a regional stroke centre who subsequently died and their provision of PC. Methods: We conducted a retrospective single-centre cohort study of patients who died during admission to the regional stroke centre at Sunnybrook Health Sciences Centre (SHSC) in Toronto, Ontario, Canada. Baseline demographics were assessed using means, standard deviations (SD), medians, interquartile ranges (IQR), and proportions. Descriptive statistics, univariate, and multivariate analyses were performed to ascertain relationships between collected variables. Results: Univariate modeling demonstrated that older age, being female, no stroke diagnosis at admission to hospital, ischemic stroke, and comorbidities of cancer or dementia were associated with a higher incidence of palliative medicine consultation (PMC), while admission from an acute care hospital and a Glasgow Coma Scale (GCS) coma classification were associated with a lower incidence of PMC. The multivariate model identified the GCS coma-related category as the only significant factor associated with a higher incidence of death but was non-significantly related to a lower incidence of PMC. Conclusion: These results highlight continued missed opportunities for PC in stroke patients and underscore the need to better optimize PMC.

Phenotypic Versus Genetic Mismatch of BMI and Type 2 Diabetes: Evidence From Two Prospective Cohort Studies

Little is known about the population-based mismatch between phenotypic and genetic BMI (BMI-PGM) and its association with type 2 diabetes. We therefore used data from the China Kadoorie Biobank and UK Biobank and calculated BMI-PGM for each participant as the difference between the percentile for adjusted BMI at baseline and the percentile for adjusted polygenic risk score for BMI. Participants were categorized into discordantly low (BMI-PGM < the first quartile), concordant (the first quartile ≤ BMI-PGM < the third quartile), and discordantly high (BMI-PGM ≥ the third quartile) groups. We calculated adjusted hazard ratios (HRs) for the association of BMI-PGM and type 2 diabetes using Cox proportional hazard models in each cohort, and combined HRs using random-effects meta-analyses. During a median follow-up of 12 years for both cohorts, BMI-PGM was associated with the risk of type 2 diabetes, with the discordantly low group showing reduced risk and the discordantly high group showing elevated risk compared with the concordant group, independent of BMI and other conventional risk factors. In addition, normal-weight individuals with discordantly high BMI-PGM faced a higher risk of type 2 diabetes than overweight individuals. These findings suggest that BMI-PGM may play a potential role in reassessing the risk of type 2 diabetes, particularly among normal-weight populations.

ARTICLE HIGHLIGHTS

Social developments have fostered an "obesogenic environment" that exacerbated phenotypic versus genetic mismatch of BMI (BMI-PGM) and the risk of type 2 diabetes. The study quantified BMI-PGM and examined its association with type 2 diabetes independent of BMI and other conventional factors. The risk of type 2 diabetes was lower in the discordantly low BMI-PGM group and higher in the discordantly high BMI-PGM group, with concordant BMI-PGM group as reference. These findings indicate the potential to reassess type 2 diabetes risk by quantifying BMI-PGM on individual levels.

A Case-Control Study on Risk Factors and Outcomes in Congestive Heart Failure

Background

Congestive heart failure (CHF) represents an important health issue characterised by considerable morbidity and mortality. This study sought to identify risk factors for CHF and to evaluate clinical outcomes between CHF patients and control subjects.

Methods

Data were obtained through interviews, physical examinations, and medical records. Risk variables encompassed hypertension, diabetes, dyslipidaemia, tobacco use, alcohol use, sedentary lifestyle, dietary practices, age, gender, and familial history of cardiovascular disease. The outcomes were all-cause mortality, cardiovascular mortality, hospitalisation, major adverse cardiovascular events (MACE), quality of life as measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and functional level according to the New York Heart Association (NYHA) classification. Statistical analyses including t-tests, Chi-square tests, logistic regression and Cox regression.

Results

The findings indicated that hypertension (71.8% vs. 38.5%, p < 0.001), diabetes (47.9% vs. 28.2%, p = 0.002), dyslipidaemia (54.7% vs. 41.0%, p = 0.04), smoking (42.7% vs. 29.1%, p = 0.03), and physical inactivity (65.8% vs. 41.9%, p < 0.001) were more prevalent in cases. Cases exhibited increased hospitalisations (1.8 ± 1.2 vs. 0.7 ± 0.9, p < 0.001), prolonged stays (10.5 ± 5.4 vs. 6.2 ± 3.8 days, p < 0.001), elevated 30-day rehospitalisation rates (21.4% vs. 8.5%, p = 0.007), and a greater incidence of intensive care units (ICU) admissions (17.1% vs. 6.0%, p = 0.01). All-cause mortality (35.9% vs. 17.1%, p = 0.001), cardiovascular mortality (25.6% vs. 10.3%, p = 0.003), and MACE (51.3% vs. 25.6%, p < 0.001) were greater in cases. Quality of life (45.8 ± 12.4 vs. 25.6 ± 10.3, p < 0.001) and functional status (55.6% vs. 23.9%, p < 0.001) were inferior in cases.

Conclusion

CHF patients had greater rates of modifiable risk variables and worse clinical outcomes than controls, underscoring the necessity for comprehensive risk management.

A New Insight on Atherosclerosis Mechanism and Lipid-Lowering Drugs

Atherosclerosis (AS) is a chronic vascular disease primarily affecting large and medium-sized arteries, involving complex pathological mechanisms such as inflammatory responses, lipid metabolism disorders and vascular plaque formation. In recent years, several emerging research hotspots have appeared in the field of atherosclerosis, including gut microbiota, pyroptosis, ferroptosis, autophagy, cuproptosis, exosomes and non-coding RNA. Traditional lipid-lowering drugs play a crucial role in the treatment of AS but are not able to significantly reverse the pathological changes. This article aims to summarize the latest research progress in the pathogenesis of AS and the diagnosis and treatment of the disease by comprehensively analyzing relevant literature mainly from the past five years. Additionally, the mechanisms of action and research advances of statins, cholesterol absorption inhibitors, fibrates and novel lipid-lowering drugs are reviewed to provide new insights into the diagnosis and treatment of AS.

Molecular and cellular role of variants of the promoter region of HAND1 gene in sporadic and isolated ventricular septal defect

Ventricular septal defect (VSD) is the most common type of congenital heart disease. HAND1 gene plays a crucial role in the development of the heart, but the role of the variants in the HAND1 gene promoter region in patients with VSD has not been explored yet. From 588 participants (300 with isolated and sporadic VSD and 288 healthy controls), DNA was extracted from blood samples. Variants at the HAND1 gene promoter region were analyzed through Sanger sequencing. Subsequently, cell functional validation was conducted through cell experiments, including dual-luciferase reporter gene analysis, electrophoretic mobility shift analysis, and bioinformatics analysis was also conducted. The promoter region of HAND1 gene had a total of 9 identified variant sites. Among them, 4 variants were exclusively found in VSD patients, and 1 variant (g.3631A>C) was newly discovered. Cell functional experiments indicated that all four variants decreased the transcriptional activity of HAND1 gene promoter with three of them reached statistical significance (p < 0.05). Subsequent analysis using JASPAR (a transcription factor binding profile database) suggests that these variants may alter the binding sites of transcription factors, potentially contributing to the formation of VSD. Our study for the first time identified variants in the promoter region of HAND1 gene in Chinese patients with isolated and sporadic VSD. These variants significantly decreased the expression of HAND1 gene, impacting transcription factor binding sites, and thereby demonstrating pathogenicity. This study offers new insights into the role of HAND1 gene promoter region, contributing to a better understanding of the genetic basis of VSD formation.

Felt stigma as a determinant of health-related quality of life among community-dwelling stroke survivors in China: A cross-sectional study

OBJECTIVES

To assess the role of felt stigma versus enacted stigma in the health-related quality of life of community--dwelling stroke survivors in China.

MATERIALS AND METHODS

A sample of 189 community--dwelling stroke survivors were investigated with the Stigma Scale for Chronic Illness (SSCI), 12-item Short Form-12 Health Survey (SF-12), modified Barthel index (MBI), Zung Self-Rating Depression Scale (ZSDS), and demographic and disease-related characteristics. Hierarchical multiple regression analysis was used to estimate the influence of felt stigma and enacted stigma on quality of life after controlling for depression, activities of daily living, and patient characteristics.

RESULTS

In total, 189 S survivors were included in the study. Overall stigma, felt stigma, and enacted stigma were moderately and strongly positively and significantly correlated with quality of life, depression, and activity in daily living (P < 0.05). Felt stigma significantly explained 2.2 % (P < 0.01) of the variance in the physical component summary (PCS). Felt stigma significantly explained 8.6 % (P < 0.01) of the variance in the mental component summary (MCS). However, enacted stigma had no effect on PCS or MCS.

CONCLUSION

Felt stigma significantly and independently contributed to the PCS and MCS quality of life of community-dwelling stroke survivors after adjustment for depression, activity of daily living and patient characteristics.

Understanding the Pain Experience and Treatment Considerations Along the Spectrum of Peripheral Artery Disease: A Scientific Statement From the American Heart Association

Peripheral artery disease (PAD) is an atherosclerotic condition that affects a growing number of individuals worldwide, with estimates exceeding 220 million. One of the central hallmarks of PAD is lower extremity pain, which may present as intermittent claudication and atypical leg pain, and, in more severe cases, ischemic rest pain, neuropathic pain, or phantom limb pain in those who underwent amputation. Although the majority of individuals with PAD may experience pain that is chronic in nature, the pathogenesis and phenomenology of pain may differ. Nociceptive, inflammatory, and neuropathic mechanisms all play a role in the generation of pain. Pain in PAD results in severe disability and can copresent with distress, sickness behaviors such as avoidance and further deconditioning, and concomitant depression, anxiety, and addiction secondary to opioid use. These factors potentially lead to chronic pain interacting with a multitude of domains of functioning, including physical, emotional, and behavioral. Whereas pain is a normal adaptive response, self-defeating behaviors and cognitions contribute to the persistence or worsening of the chronic pain experience, disability, and distress. Much remains unknown about the phenomenology of pain in PAD and its clinical subgroups and how it affects outcomes. Borrowing from other chronic pain syndromes, multimodal pain management strategies that emphasize a biopsychosocial model have generated a solid evidence base for the use of cognitive behavioral approaches to manage pain. Multimodal pain management in PAD is not the norm, but theoretical pathways and road maps for further research, assessment, and clinical implementation are presented in this scientific statement.

Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study

Background

Premorbid health traits that increase the risk of dying at the time of initial presentation of coronary heart disease (CHD) remain poorly characterized.

Methods

We followed 148,230 post-menopausal participants in the Women's Health Initiative for a median of 13.3 years. We ascertained the first occurrence of CHD and performed a joint Cox multivariate regression to identify premorbid predictors for a fatal rather than a non-fatal incident event.

Results

A total of 10,714 incident CHD events including 513 fatal events accrued during follow up. A five-year increase in age, smoking 5 to 34 cigarettes per day, and a standard deviation (SD) increase in the Cornel voltage product, an electrocardiographic measure highly correlated with left ventricular mass index on echocardiography, each independently increased the relative risk (RR) of dying from one's initial presentation of CHD by 46 % (95 % confidence interval [CI], 35 to 58 %), 30 % (8 to 51 %,), and 17 % (7 to 28 %), respectively. A high level of recreational physical activity (>1200 metabolic equivalent (MET) minutes per week) reduced one's relative risk by 32 % (12 to 49 %). A significant dose-response effect was observed for both physical activity and smoking and the reduction in absolute risk of presenting with fatal CHD associated with a healthy lifestyle was roughly equivalent to the difference in risk observed among women separated in age by approximately 10 years.

Conclusions

Modifiable factors affect a post-menopausal woman's risk of dying from her initial presentation of CHD. Our findings may reduce case-fatality risk of CHD by motivating individuals at risk to adopt and/or adhere to established primary prevention strategies.

Three-Dimensional Curvature of the Cervical Carotid Artery Predicts Long-Term Neurovascular Risk in Loeys-Dietz Syndrome

BACKGROUND

Although the relationship between cervical carotid tortuosity and cardiovascular risk in patients with Loeys-Dietz syndrome has been studied, it is unclear whether cervical carotid tortuosity influences the risk of neurovascular events.

METHODS

This is a single-institution retrospective cohort study. Cervical carotid tortuosity and morphology were assessed in patients with Loeys-Dietz syndrome who underwent baseline computed tomography/magnetic resonance imaging of the cervical and cerebral arteries from 2010 to 2022. The primary end point was a composite of adverse neurovascular events (multiple vessel cervical artery dissection, ischemic stroke, intracerebral hemorrhage, and any neurovascular intervention) at 5- and 10-year follow-ups. Independent risk factors were identified using univariate and multivariate logistic regression analyses. Single-variable predictors of 5- and 10-year outcomes were analyzed via receiver operating curve analyses. Cutoff values were determined per the Youden J index. Stratification analyses were performed for ages <60 and ≥60 years.

RESULTS

Of 105 eligible participants, 63 were included (mean age, 40±17 years; 52% female). During a mean follow-up of 8.7±4.1 years, 23 (37%) developed an adverse neurovascular event. Five-year follow-up was achieved in 86% and 10-year follow-up in 48%. Carotid total absolute curvature (TAC; P=0.008), coiling morphology (P=0.012), and TGFBR1/2 genetic variant (P=0.037) were independently associated with 5-year events. Stratification analyses revealed that the age group <60 years was more vulnerable to high TAC (unadjusted odds ratio, 7.2 [95% CI, 2.0-25.4]; P=0.002). Baseline TAC was the only independent predictor of adverse events at 5 years (area under the curve, 0.84; P<0.001) and 10 years (area under the curve, 0.75; P=0.007) in this age group. An optimal threshold for predicting neurovascular events was TAC ≥16.5. None were predictive in the age group ≥60 years.

CONCLUSIONS

Cervical carotid tortuosity is associated with a long-term increased risk of neurovascular events in Loeys-Dietz syndrome. Angiographic findings of high-risk features such as increased TAC and coiling morphology may help to identify neurovascular vulnerability noninvasively at an early stage.

Motor control complexity estimation using gait measures in individuals post-stroke

Motor control impairments post-stroke significantly limit walking ability, with residual gait impairments often persisting despite rehabilitation efforts. Integrating motor control-based assessments in post-stroke gait evaluations is essential for monitoring the underlying causes of the limited functionality and enhancing recovery outcomes. This study aimed to develop motor control-based post-stroke gait evaluation techniques using common gait measures to inform and guide rehabilitation decisions. Subject-specific, forward-dynamic simulations of eight individuals with post-stroke gait undergoing a 12-weeks FastFES gait retraining program were created pre- and post-treatment to determine muscle activation patterns for muscle module analysis. The motor control complexity index was defined by the variance not accounted for by one module (VNAF1) as a summary measure of the analysis. Twenty-eight gait measures were investigated, and the relevant measures were selected using feature selection methods and fed into a multiple linear regression model to estimate the motor control complexity index. The motor control complexity of 182 gait cycles were quantified (0.164 ± 0.047). No strong relationship (quantified using Pearson correlation coefficients) was found between gait measures and the motor control complexity index. However, a combination of four gait measures from the paretic side (maximum hip abduction and knee flexion angle during swing, knee range of motion, and maximum paretic ankle power) explained most of the variation (R2 = 0.66) in motor control complexity.

Ultrasonographic Evaluation of Optic Nerve Sheath Diameter Change Before and After Thrombolytic Treatment in Acute Ischemic Stroke

BACKGROUND

Thrombolytic therapy is the mainstay therapy for acute ischemic stroke (AIS) in the modern era. Intracranial hemorrhage (ICH) is one of the most common thrombolytic therapy complications and can cause significant problems. Non-invasive methods, such as ultrasonography (USG), are becoming prominent to detect ICH early.

OBJECTIVE

We aimed to measure the USG optic nerve sheath diameter (ONSD) in patients with AIS before and after thrombolytic therapy and to find out whether there is any correlation with the complications at 24 hours.

METHOD

Patients aged 18 years and over who were deemed suitable for thrombolytic treatment in AIS patients who presented to the emergency department of two tertiary training and research hospitals were included in the study, which was planned to be two-center, prospective observational, and cross-sectional study between March 25, 2022, and October 25, 2022. Before and after the thrombolytic treatment (0.hour, 1.hour, and 4.hour), ONSD was measured by an emergency physician at the bedside with an USG device. Patients with and without complications after thrombolytic therapy were grouped, and the ONSD measurements were compared.

RESULTS

The most common complications in 116 patients included in the study were ICH in 10.3% (n = 12), brain edema in 8.6% (n = 10), and shift in 0.9% (n = 1). We found statistically significant high values in the 4th-hour ONSD measurements in the group with complications (right, P = 0.004, left, P = 0.053). We found statistically significantly higher ONSD values in the group with complications in the 24th-hour measurements with computed tomography (CT) compared to the group without complications (P < 0.001).

CONCLUSION

We think that the follow-up of ONSD values with USG is a useful parameter in predicting the complications that may develop after thrombolytic therapy and in monitoring intracranial pressure (ICP).

Executive Functions Training Improves Language Abilities in Aphasia Rehabilitation: A Systematic Review

Background/Objectives: In recent years, the popularity of non-verbal cognitive training for aphasia has increased. Building on evidence that language abilities engage brain areas involved in executive functions (EFs) processing, this review aims to analyze the utility of EFs training alone or combined with traditional rehabilitation approaches to improve language abilities in aphasia. Methods: Systematic searches were performed in four databases evaluating studies focusing on the effects of EFs training in language rehabilitation, yielding 185 studies. After reading the full text of the selected studies and applying predefined inclusion criteria, nine studies were included based on pertinence and relevance to the topic. This systematic review has been registered in the Prospective Register of Systematic Reviews (PROSPERO 2024) with the number CRD42024519087. Results: The results of the analyzed studies indicate that various EFs training methods, such as computer-assisted executive control training, Cognitive Flexibility in Aphasia Therapy (CFAT), and the Dr. Neuronowski® program, as well as the combination of transcranial direct current stimulation (tDCS) with EFs training, can lead to improvements in language abilities in people with aphasia. Additionally, EFs training often results in specific effects on treated functions like working memory (near transfer effects) and untreated ones such as spoken sentence comprehension (far transfer effects). Conclusions: Despite the heterogeneity of the treatments and the small simple size of the studies analyzed, preliminary results are promising. Future research should further explore the effectiveness and specific contribution of EFs training to improving language functions in aphasia.

Results of an Organization-wide Physical Activity Promotion Intervention Within a Very Large Academic Health Care System

Although healthcare workers may be aware of the risks of physical inactivity, their levels of physical activity (PA) are similar to those of all US adults, with less than half engaging in sufficient PA. The purpose of this health promotion was to encourage daily PA among employees in a large academic healthcare system. We also tested whether individualized progress updates further influenced PA. This 10-week program was available to all employees of NYU Langone Health. Employees could sync their phone or accelerometer via app or web browser to count.it - the vendor chosen to monitor and manage step counts. Participants were asked to voluntarily provide basic information (age, sex, job role, work location) and complete the Physical Activity Vital Sign (minutes/week and intensity of PA) at enrollment and 10 weeks. For 10 weeks, participants were sent a message through their employee 'MyChart' portal with a link to information on the benefits of PA, and a reminder of that week's step-count challenge. Those meeting criteria for weekly challenges were included in gift card raffles. Participants were randomized 1:1 to receive the standard message ± additional emails detailing their progress. 3528 employees registered to participate (8% of all employees) although active users diminished over time (1225 at week 10). Average daily steps remained stable throughout (7319 + 4540 in week 1, 7229 + 5010 in week 10). Although there was no difference in any individual week, receipt of personalized feedback was associated with significantly higher average step counts throughout the 10-wk intervention as a whole (P = 0.01). Age and an urban work location were positively associated with steps, while female sex and a clerical job role were negatively associated with steps counts (all P < 0.005). Our findings provide important insight for workplace interventions to promote PA. They further suggest specific groups that may benefit from targeted efforts.

Critical roles of miR-21 in promotions angiogenesis: friend or foe?

MiRNAs are small RNA strands that are managed following transcription and are of substantial importance in blood vessel formation. It is essential to oversee the growth, differentiation, death, movement and construction of tubes by angiogenesis-affiliated cells. If miRNAs are not correctly regulated in regard to angiogenesis, it can deteriorate the health and lead to various illnesses, which include cancer, cardiovascular disorder, critical limb ischemia, Crohn's disease, ocular diseases, diabetic microvascular complications, and more. Consequently, it is vital to understand the crucial part that miRNAs play in the development of blood vessels, so we can develop reliable treatment plans for vascular diseases. This write-up will assess the critical role of miR-21/exosomal miR-21 in managing angiogenesis associated with bone growth, wound recovery, and other pathological conditions like tumor growth, ocular illnesses, diabetes, and other diseases connected to formation of blood vessels. Previous investigations have demonstrated that miR-21 is present at higher amounts in certain cancerous cells, and it influences a multitude of genes that moderate the increased creation of blood vessels. Furthermore, studies demonstrated that exosomal miR-21 has the capacity to interact with endothelial cells to foster tumor angiogenesis. For that reason, this review explains the critical importance of miR-21/exosomal miR-21 in managing both healthy and diseased states of angiogenesis.

Sex-Specific Risk Factors and Predictors of Major Adverse Cardiac and Cerebrovascular Events in Heart Failure with Preserved Ejection Fraction with SARS-CoV-2 Infection: A Nationwide Analysis

Background: Heart failure with preserved ejection fraction (HFpEF) is a condition with limited large-scale data on the short- and long-term effects of SARS-CoV-2 infection. This study aimed to evaluate the prevalence of major adverse cardiac and cerebrovascular events (MACCEs) in HFpEF patients hospitalized with SARS-CoV-2 and identify sex-specific risk factors and predictors of MACCEs in this population. Methods: This retrospective study analyzed HFpEF patients hospitalized with SARS-CoV-2 from the 2020 National Inpatient Sample (NIS) using ICD-10 codes. Patients hospitalized with HFpEF and SARS-CoV-2 were categorized by age (18-44, 45-64, ≥65 years). Multivariate logistic regression was used to adjust for potential confounders, with the statistical significance set at a two-tailed p-value < 0.05. Results: Among 109,750 HFpEF patients hospitalized with SARS-CoV-2, 31,960 (29.1%) experienced MACCEs. Males experienced a higher rate of MACCEs than females (31.1% vs. 27.5%, OR: 1.20, 95% CI: 1.12-1.28, p < 0.001). Adjusted analysis revealed that elderly patients (≥65 years, OR: 1.47, 95% CI: 1.33-1.62) compared with the 45-64 age group and males (OR: 1.20, 95% CI: 1.12-1.28, p < 0.001) had a higher risk of MACCEs. Key predictors included prior coronary artery bypass grafting (CABG; OR: 1.15, 95% CI: 1.02-1.30), cancer (OR: 1.24, 95% CI: 1.08-1.42), and chronic kidney disease (OR: 1.15, 95% CI: 1.08-1.23). Subgroup analysis identified additional sex-specific risk factors. In males, hyperlipidemia, obesity, tobacco use disorder, prior stroke/transient ischemic attack (TIA), prior venous thromboembolism (VTE), alcohol abuse, depression, and valvular disease were significant predictors of MACCEs. In females, hyperlipidemia, tobacco use disorder, prior stroke/TIA, prior VTE, and depression were significant predictors. Conclusions: HFpEF patients hospitalized with SARS-CoV-2 have a high risk of MACCEs, with male sex, older age, prior CABG, cancer, and chronic kidney disease as key risk factors. This study provides the first large-scale analysis of sex-specific predictors of MACCEs in HFpEF patients hospitalized with SARS-CoV-2. These findings underscore the need for focused research and clinical gender-based strategies to mitigate cardiovascular risks in this unique and high-risk population.

Exploring Potential Drug Targets in Multiple Cardiovascular Diseases: A Study Based on Proteome-Wide Mendelian Randomization and Colocalization Analysis

Background: Cardiovascular diseases (CVDs) encompass a group of diseases that affect the heart and/or blood vessels, making them the leading cause of global mortality. In our study, we performed proteome-wide Mendelian randomization (MR) and colocalization analyses to identify novel therapeutic protein targets for CVDs and evaluate the potential drug-related protein side effects. Methods: We conducted a comprehensive proteome-wide MR study to assess the causal relationship between plasma proteins and the risk of CVDs. Summary-level data for 4907 circulating protein levels were extracted from a large-scale protein quantitative trait loci (pQTL) study involving 35,559 individuals. Additionally, genome-wide association study (GWAS) data for CVDs were extracted from the UK Biobank and the Finnish database. Colocalization analysis was utilized to identify causal variants shared between plasma proteins and CVDs. Finally, we conducted a comprehensive phenome-wide association study (PheWAS) using the R10 version of the Finnish database. This study was aimed at examining the potential drug-related protein side effects in the treatment of CVDs. A total of 2408 phenotypes were included in the analysis, categorized into 44 groups. Results: The research findings indicate the following associations: (1) In coronary artery disease (CAD), the plasma proteins A4GNT, COL6A3, KLC1, CALB2, KPNA2, MSMP, and ADH1B showed a positive causal relationship (p-fdr < 0.05). LAYN and GCKR exhibited a negative causal relationship (p-fdr < 0.05). (2) In chronic heart failure (CHF), PLG demonstrated a positive causal relationship (p-fdr < 0.05), while AZGP1 displayed a negative causal relationship (p-fdr < 0.05). (3) In ischemic stroke (IS), ALDH2 exhibited a positive causal relationship (p-fdr < 0.05), while PELO showed a negative causal relationship (p-fdr < 0.05). (4) In Type 2 diabetes (T2DM), the plasma proteins MCL1, SVEP1, PIP4K2A, RFK, HEXIM2, ALDH2, RAB1A, APOE, ANGPTL4, JAG1, FGFR1, and MLN demonstrated a positive causal relationship (p-fdr < 0.05). PTPN9, SNUPN, VAT1, COMT, CCL27, BMP7, and MSMP displayed a negative causal relationship (p-fdr < 0.05). Colocalization analysis conclusively identified that AZGP1, ALDH2, APOE, JAG1, MCL1, PTPN9, PIP4K2A, SNUPN, and RAB1A share a single causal variant with CVDs (PPH3 + PPH4 > 0.8). Further phenotype-wide association studies have shown some potential side effects of these nine targets (p-fdr < 0.05). Conclusions: This study identifies plasma proteins with significant causal associations with CVDs, providing a more comprehensive understanding of potential therapeutic targets. These findings contribute to our knowledge of the underlying mechanisms and offer insights into potential avenues for treatment.

QbD-steered HPTLC approach for concurrent estimation of six co-administered COVID-19 and cardiovascular drugs in different matrices: greenness appraisal

Many COVID-19 sufferers have a history of cardiovascular illnesses, which makes them more likely to develop severe COVID-19. Such patients were advised by experts to prioritize drug therapies based on their doctor's commendations to avoid exacerbating their basic illnesses. Therefore, developing an analytical methodology for the concurrent estimation of medications prescribed for co-treating cardiovascular and COVID-19 illnesses is becoming critical in both bioavailability hubs and QC units. Herein, an inventive, rapid, and affordable HPTLC approach was developed, and its conditions were optimized employing the full factorial design approach for the concurrent estimation of aspirin, atorvastatin, atenolol, losartan, remdesivir, and favipiravir as co-administered medications, either with salicylic acid or not. Using the desirability function, the experimental design approach could forecast the best eluent system for optimal resolution results. On HPTLC-silica plates, the above-mentioned medications were separated utilizing an eluent system of ethyl acetate, methylene chloride, methanol, and ammonia (6:4:4:1 by volume), and their spots were detected at 232 nm. The proposed methodology was evaluated following ICH prerequisites and applied successfully to the medications' dosage forms, human plasma, and buffered dissolution media with superb recovery proportions and no intrusiveness from formulations' additives or plasma matrices. Five metrics were employed to appraise the suggested technique's greenness: AGREE, eco-scale, Raynie and Driver, GAPI, and NEMI. The sensitivity, large sample capacity, and short run duration (15 min) of the proposed methodology confirm its appositeness for regular estimation of the above-mentioned medications.

The association between the lifestyle risk score and metabolically healthy and unhealthy obesity phenotype in Iranian women with overweight and obesity: a cross-sectional study

Background

The evidence shows that all women with obesity do not develop metabolic complications thus, they may be metabolically healthy. The lifestyle factors in combination may influence obesity phenotypes including metabolically healthy and unhealthy obesity. While previous studies examined associations between single lifestyle factors and obesity phenotype, no previous study has examined associations between lifestyle risk score (LRS) and obesity phenotypes. This study for the first time created the LRS which is a combination of lifestyle factors and investigated the LRS in relation to various obesity phenotypes among women with overweight and obesity.

Methods

This cross-sectional study analyzed 278 women referred to health centers of the Tehran University of Medical Sciences. A multistage sampling method was used to recruit the participants. The LRS was created based on diet, physical activity (PA), sleep, obesity, and sociodemographic characteristics. A binary logistic regression analysis was used to evaluate the association between obesity phenotypes and LRS.

Results

Women with higher LRS had higher body mass index (BMI) and high-sensitivity C-reactive protein (hs-CRP) while had lower high-density lipoprotein cholesterol (HDL-C), PA, education levels, sleep quality, vegetables, grains and legumes intake. Furthermore, women with higher LRS were more likely to experience metabolically unhealthy obesity (MUO).

Conclusion

This study found significant associations between higher LRS and an increased likelihood of MUO. Further prospective studies are needed to advance our understanding of the relationship between lifestyle and obesity.

Mapping the knowledge of omics in myocardial infarction: A scientometric analysis in R Studio, VOSviewer, Citespace, and SciMAT

Many researchers nowadays choose multi-omics techniques for myocardial infarction studies. However, there's yet to be a review article integrating myocardial infarction multi-omics. Hence, this study adopts the popular bibliometrics. Based on its principles, we use software like R Studio, Vosviewer, Citespace, and SciMAT to analyze literature data of myocardial infarction omics research (1991-2022) from Web of Science. By extracting key information and calculating weights, we conduct analyses from 4 aspects: Collaboration Network Analysis, Co-word Analysis, Citing and Cited Journal Analysis, and Co-citation and Clustering Analysis, aiming to understand the field's cooperation, research topic evolution, and knowledge flow. The results show that myocardial infarction omics research is still in its early stage with limited international cooperation. In terms of knowledge flow, there's no significant difference within the discipline, but non-biomedical disciplines have joined, indicating an interdisciplinary integration trend. In the overall research field, genomics remains the main topic with many breakthroughs identifying susceptibility sites. Meanwhile, other omics fields like lipidomics and proteomics are also progressing, clarifying the pathogenesis. The cooperation details in this article enable researchers to connect with others, facilitating their research. The evolution trend of subject terms helps them set goals and directions, quickly grasp the development context, and read relevant literature. Journal analysis offers submission suggestions, and the analysis of research base and frontier provides references for the research's future development.

Bleeding Risk in Elderly Patients Undergoing Percutaneous Coronary Intervention: A Comprehensive Review

The care of elderly patients with coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCIs) presents unique challenges due to age-related physiological and functional changes. With the global population aging rapidly, this demographic change affects a growing proportion of individuals requiring PCI. However, advanced age is associated with increased susceptibility to ischemic and bleeding complications, driven by physiological changes such as altered coagulation, vascular stiffness, and declining organ function. These factors complicate the management of CAD, making the balance between reducing thrombotic events and minimizing bleeding risks particularly challenging. Antiplatelet therapy is central to post-PCI management, but its benefits and risks differ significantly in elderly patients compared to younger populations. Tools like the PRECISE-DAPT and ARC-HBR provide guidance on dual antiplatelet therapy duration and bleeding risk stratification. However, their applicability and predictive accuracy in elderly patients remain areas of active investigation. This underscores the need for improved risk assessment methods tailored to the unique needs of aging individuals. In this review, we explore the epidemiological, pathophysiological, and clinical aspects of CAD in elderly patients, emphasizing the impact of aging on disease presentation and outcomes. Furthermore, we assess current risk stratification tools and discuss their limitations in predicting adverse events in older populations. By synthesizing these insights, we aim to highlight the complexities of managing elderly CAD patients and identify opportunities for optimizing personalized care to achieve better outcomes in this vulnerable group.

Identifying pediatric hypertension in observational data: comparing clinical and claims cohorts in real-world data

We conducted retrospective public health surveillance using data from 2006 to 2016 in 7 integrated delivery systems from the US Food and Drug Administration's Sentinel System. We identified pediatric hypertensive patients by clinical and claims-based definitions and compared demographics, baseline profiles, and follow-up time profiles. Among 3 757 803 pediatric patients aged 3 to 17 years, we identified 781 722 children and 551 246 teens with at least 3 blood pressure measurements over 36 months. Of these, 70 315 children (9%) and 47 928 teens (8.7%) met the clinical definition for hypertension, and 22 465 (2.8%) children and 60 952 (11%) of teens met the clinical definition for elevated, nonhypertensive blood pressure. Of the 3.7 million patients, we identified 3246 children and 7293 teens with any claim for hypertension (claims definition). Evidence of hypertension claims among those meeting our clinical definition was poor; 2.2% and 7.3% of clinically hypertensive children and teens had corresponding claims for hypertension. Baseline profiles for patients with claims-based hypertension suggest greater severity of disease compared with clinical patients. Claims-based patients had higher rates of all-cause mortality during follow-up. Pediatric hypertension in claims-based data sources is under-captured but may serve as a marker for greater disease severity. Investigators should understand coding practices when selecting real-world data sources for pediatric hypertension work.

Left atrial strain predicts paroxysmal atrial fibrillation recurrence after catheter ablation: a 1-year study using three-dimensional speckle-tracking echocardiography

BACKGROUND

Radiofrequency catheter ablation (RFCA) is a widely employed method for restoring sinus rhythm(SR) in patients with drug-refractory paroxysmal atrial fibrillation (PAF). Three-dimensional speckle tracking echocardiography (3DSTE) is a precise and practical imaging technique for clinically assessing myocardial function in the left atrium. The objective of this study was to assess alterations in three-dimensional strains and predict recurrence in patients with PAF following RFCA.

METHODS

A total of 109 patients diagnosed with drug-refractory PAF and scheduled for RFCA were included in this study between September 2019 and June 2022. Conventional echocardiography and 3DSTE were performed prior to and one year(median period of 12.2 months) after RFCA. Global three-dimensional left atrial (LA) strain parameters, along with those of the left ventricle, were measured and analyzed statistically. The primary study endpoint was the recurrence of atrial fibrillation (AF).

RESULTS

Among the 109 patients, 78 maintained a stable SR during the one-year follow-up after RFCA, while 31 experienced a recurrence of AF. Notably, patients who sustained SR demonstrated significant improvements in various LA strain parameters, including reservoir, pump, and conduit functions, compared to both their preoperative levels and those of patients who experienced recurrence(p < 0.05). Additionally, patients with sustained SR exhibited a significant reduction in LA volume compared to those with recurrence(p = 0.003). Furthermore, left ventricular global longitudinal strain (LVGLS) and left ventricular global area strain (LVGAS) of the left ventricle showed improvement while maintaining a preserved left ventricular ejection fraction (LVEF) after RFCA(p < 0.05). Our multivariate regression analysis revealed that left atrial reservoir strain (LASr) independently predicted the recurrence of AF [odds ratio (OR), 1.19, 95% confidence interval (CI), 1.05-1.35, p = 0.005]. Receiver operating characteristic(ROC) curve showed that the area under the curve(AUC) for LASr in assessing the risk of recurrence after RFCA in patients with PAF was 0.70 ( 95% CI, 0.60-0.81, P = 0.001). The calculated cutoff value was 16.5%.

CONCLUSIONS

RFCA plays a pivotal role in preserving SR and restoring LA function in patients with PAF. 3D-STE is highly effective for post-RFCA prognostic assessment. LASr, a predictive marker for the recurrence of PAF assists in the stratification of risk and contributes to informed treatment decisions, offering valuable points of reference.

The association between the oral microbiome and hypertension: a systematic review

Background

This study systematically reviewed the available evidence regarding the potential association between oral microbiota and hypertension.

Methods

A comprehensive search of online databases was conducted by two independent investigators for all relevant articles. All observational studies that assessed the association between oral microbiota and hypertension were included. Quality appraisal was conducted using the NOS tool.

Results

A total of 17 studies comprising 6007 subjects were included. The studies varied with respect to sample type and microbial analysis method. All studies, except one, found significant differences in microbial composition between hypertensive and normotensive subjects. However, there were substantial inconsistencies regarding the specific differences identified. Still, a few taxa were repeatedly found enriched in hypertension including Aggregatibacter, Kingella, Lautropia, and Leptotrachia besides the red complex periodontal pathogens. When considering only studies that controlled for false discovery rates and confounders, Atopobium, Prevotella, and Veillonella were identified as consistently associated with hypertension.

Conclusion

There are significant differences in the oral microbiome between hypertensive and normotensive subjects. Despite the heterogeneity between the included studies, a subset of microbial taxa seems to be consistently enriched in hypertension. Further studies are highly recommended to explore this association.

Registration

PROSPERO database (ID: CRD42023495005).

[Stroke in octogenarians]

Stroke is one of the most common causes of disability in older adults. It remains a common cause of death and permanent functional limitation in individuals who are older than 80 years. Approximately 50% of all strokes occur in people over the age of 75, and 30% in those over 85. Top priorities in primary stroke prevention include the treatment of hypertension, anticoagulation for patients with atrial fibrillation, and lifestyle modifications such as smoking cessation.

Prognostic Models of Mortality Following First-Ever Acute Ischemic Stroke: A Population-Based Retrospective Cohort Study

Background and Aims

There is a lack of population-based studies focusing on guideline-based prognostic models for stroke. This study aimed to develop and validate a prognostic model that predicts mortality following a first-ever acute ischemic stroke.

Methods

The study included 899 adult patients ( ≥ 18 years) with confirmed diagnosis of first-ever acute ischemic stroke enrolled in the Malaysian National Stroke Registry (NSR) from January 2009 to December 2019. The primary outcome was mortality within 90 days post-stroke (266 events [29.6%]). The prognostic model was developed using logistic regression (75%, n = 674) and internally validated (25%, n = 225). Model performance was assessed using discrimination (area under the curve (AUC]) and calibration (Hosmer-Lemeshow test [HL]).

Results

The final model includes factors associated with increased risk of mortality, such as age (adjusted odds ratio, aOR 1.06 [95% confidence interval, CI 1.03, 1.10; p < 0.001]), National Institutes of Health Stroke Scale (NIHSS) score aOR 1.08 (95% CI 1.08, 1.13; p = 0.004), and diabetes aOR 2.29 (95% CI 1.20, 4.37; p = 0.012). The protective factors were antiplatelet within 48 h. aOR 0.40 (95% CI 0.19, 0.81; p = 0.01), dysphagia screening aOR 0.30 (95% CI 0.15, 0.61; p = 0.001), antiplatelets upon discharge aOR 0.17 (95% CI 0.08, 0.35; p < 0.001), lipid-lowering therapy aOR 0.37 (95% CI 0.17, 0.82; p = 0.01), stroke education aOR 0.02 (95% CI 0.01, 0.05; p < 0.001) and rehabilitation aOR 0.08 (95% CI 0.04, 0.16; p < 0.001). The model demonstrated excellent performance (discrimination [AUC = 0.94] and calibration [HL, X 2 p = 0.63]).

Conclusion

The study developed a validated prognostic model that excellently predicts mortality after a first-ever acute ischemic stroke with potential clinical utility in acute stroke care decision-making. The predictors could be valuable for creating risk calculators and aiding healthcare providers and patients in making well-informed clinical decisions during the stroke care process.

Plasma Ionomic Profile and Interaction Patterns in Coronary Artery Disease Patients

Humans are exposed to various chemical elements that have been associated with the development and progression of diseases such as coronary artery disease (CAD). Unlike previous research, we employed a multi-element approach to investigate CAD patients and those with comorbid conditions such as diabetes (CAD-DM2), high blood pressure (CAD-HBP), or high blood lipids (CAD-HBL). Plasma concentrations of 21 elements, including lithium (Li), boron (B), aluminum (Al), calcium (Ca), titanium (Ti), vanadium (V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), strontium (Sr), cadmium (Cd), tin (Sn), stibium (Sb), barium (Ba), and lead (Pb), were measured in CAD patients (n = 201) and healthy subjects (n = 110) using inductively coupled plasma-mass spectrometry (ICP-MS). Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) models were utilized to analyze the ionomic profiles. Spearman correlation analysis was employed to identify the interaction patterns among individual elements. We found that levels of Ba, Li, Ni, Zn and Pb were elevated in the CAD group compared to the healthy group, while Sb, Ca, Cu, Ti, Fe, and Se were lower. Furthermore, the CAD-DM2 group exhibited higher levels of Ni and Cd, while the CAD-HBP group showed lower levels of Co and Mn. In the CAD-HBL group, Ti was increased, whereas Ba, Cr, Cu, Co, Mn, and Ni were reduced. In conclusion, ionomic profiles can be utilized to differentiate CAD patients from healthy individuals, potentially providing insights for future treatment or dietary interventions.

Role of natural products in cardiovascular disease

As the world's aging population increases, cardiovascular diseases (CVDs) associated with aging deserve increasing attention. CVD in association with age is considered a major cause of morbidity and mortality worldwide. In this review, we provide an overview of the key molecular pathways, cellular processes such as autophagy, oxidative stress, inflammatory responses, myocardial remodeling and ischemia-refocused injury that accompany CVD as well as the natural products of targeting these mechanisms and some of the dietary habits that have been studied in cardiovascular-related diseases. The potential preventive and therapeutic avenues resulting from these dietary habits and natural products related to animal models and clinical studies can help us to better understand the processes involved in cardiovascular diseases and provide recommendations to reduce the cardiovascular burden associated with aging heart.

Prognostic Value of Endothelin-1 or Related Peptides in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

There is increasing evidence that endothelin-1 (ET-1) or related peptides play a prognostic value in coronary artery disease (CAD). The objective of this systematic review and meta-analysis was to evaluate the predictive role of ET-1 or related peptides in CAD patients. We comprehensively searched PubMed and Embase databases until January 15, 2023. Studies examining the association of ET-1, big ET-1, or C-terminal proendothelin-1 (CT-proET-1) level with all-cause mortality or major adverse cardiovascular events (MACEs) in CAD patients were included. Fourteen studies with 30,181 patients were identified. Comparison of the top and the lowest ET-1 level, the pooled risk ratio (RR) of all-cause mortality was 3.77 (95% confidence interval [CI] 1.59-8.94) for ET-1 and 1.65 (95% CI 1.25-2.18) for big ET-1. The pooled RR of MACEs was 2.24 (95% CI 1.85-2.72) for ET-1, 1.49 (95% CI 1.10-2.03) for big ET-1, and 3.55 (95% CI 2.12-5.96) for CT-proET-1, respectively. Subgroup analysis indicated that elevated ET-1 level was associated with 2.66-fold and 2.09-fold higher risk of in-hospital/30-day and long-term MACEs. Elevated ET-1, big ET-1, or CT-proET-1 may be independently associated with higher risk of all-cause mortality and MACEs in patients with CAD.

Lowering B-type natriuretic peptide levels and increasing cardiac function: the role of levosimendan in the treatment of heart failure

OBJECTIVE

In this study, we examined whether levosimendan could lower B-type natriuretic peptide (BNP) and improve cardiac function in patients with heart failure who have diuretic resistance and low ejection fraction.

METHODS

We conducted a cohort study among 120 participants from September 2022 to August 2023. We investigated the efficacy of treatment with levosimendan in patients with HF who exhibited diuretic resistance and had a low ejection fraction. All patients received recombinant human neuronal natriuretic peptide (rhBNP) and the treatment group additionally received levosimendan. In addition to the primary endpoints, safety measures were assessed, encompassing the monitoring of blood pressure, heart rate, and serum creatinine levels.

RESULTS

Patients in the treatment and control groups were similar in age, sickness duration, weight, and sex ratio. Medication use, New York Heart Association classification, ejection fraction percentage, and other factors were evenly distributed. The treatment group showed increased urine volume and weight loss. Both groups had similar post-treatment systolic blood pressure, heart rate, and serum creatinine levels, indicating good safety.

CONCLUSION

Levosimendan in combination with rhBNP may improve diuretic resistance in patients with HF and low ejection fraction. Further multicenter trials are needed to confirm our findings.

Right Ventricular Myocardial Infarction: Pathophysiology, Diagnosis, and Therapeutic Approaches

Right ventricular myocardial infarction (RVMI) is a significant and distinct form of acute myocardial infarction associated with considerable morbidity and mortality. It occurs most commonly due to proximal right coronary artery obstruction, often in conjunction with inferior myocardial infarction. RVMI poses unique diagnostic and therapeutic challenges due to the anatomical and functional differences between the right and left ventricles. Key clinical manifestations include symptoms of right-sided heart failure, such as hypotension, jugular venous distention, and peripheral edema. The pathophysiology of RVMI involves impaired right ventricular (RV) function, decreased cardiac output, and poor hemodynamic stability, often leading to cardiogenic shock. Diagnostic tools, including 12-lead electrocardiography, echocardiography, cardiac magnetic resonance imaging, and coronary angiography, play crucial roles in detecting RVMI and determining its severity. Treatment strategies focus on early revascularization through primary percutaneous coronary intervention or thrombolysis, maintaining adequate RV preload, and managing arrhythmias and hemodynamic instability. In severe cases, mechanical circulatory support, such as intra-aortic balloon pumps and extracorporeal membrane oxygenation, may be required. Despite advancements in imaging and therapeutic approaches, RVMI remains a complex condition that demands timely and specialized management to improve patient outcomes. Further research is needed to refine diagnostic and treatment strategies and to reduce the high mortality rates associated with this condition.

Rurality and Outcomes of Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke

Objective: To investigate differences in outcomes among patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) transferred from rural and urban hospitals to University of Maryland Medical Center (UMMC) for mechanical thrombectomy (MT). Methods: We identified patients with AIS-LVO transferred to UMMC for MT from July 2016 to June 2023. Primary outcome was good neurologic outcome, defined as 90-day modified Rankin score 0-2. Multivariable logistic regression was used to identify predictors for the primary outcome. Results: We analyzed 526 patients, 233 (44%) transferred from rural hospitals in Maryland. Median NIHSS was 17 [IQR 14-20] and was similar between groups. Patients from state-designated rural hospitals were transferred from a longer distance (difference of 57.8 km, p=0.001), but had shorter intervals from last known well time to recanalization (difference 19 min, p=0.24). They had similar odds of good neurologic outcome (OR 0.88, 95% CI 0.43-1.78, p=0.72). Conclusions: Patients transferred from rural areas for MT for AIS-LVO, at our institution, had a similar likelihood of achieving 90-day mRS 0-2 as those transferred from urban areas.

Integrative microbiomics, proteomics and lipidomics studies unraveled the preventive mechanism of Shouhui Tongbian Capsules on cerebral ischemic stroke injury

ETHNOPHARMACOLOGICAL RELEVANCE

Cerebral ischemic stroke (CIS) is one of the most important factors leading to death and disability, which seriously threaten the survival and health of patients. The intentional flora and its derived metabolites are demonstrated to play vital roles in the physiology and onset of CIS. Shouhui Tongbian Capsules (SHTB), a Traditional Chinese Medicine, could regulate gut microbiota and metabolites. Study has found that SHTB has protective effect on CIS, but the mechanism is still unclear.

AIM OF STUDY

This study was designed to evaluate the preventive effects and the mechanism of SHTB on CIS injury.

MATERIALS AND METHODS

The rats were pretreated with SHTB for 5 days, then the middle cerebral artery occlusion/reperfusion (MCAO/R) was established. Neurological deficit score, TTC staining, brain water content, H&E and Nissl staining were preformed to evaluate the preventive effects of SHTB on CIS. The Occludin and ZO-1 were analyzed to evaluate the blood-brain barrier (BBB). 16S rDNA sequencing and LC-ESI-MS/MS-based metabolomics profiling were performed to analyze the gut microbiota composition and short chain fatty acids (SCFAs) profile in gut. Serum lipopolysaccharide specific IgA antibody (LPS-SIgA) and diamine oxidase (DAO), as well as colon Claudin 5 and ZO-1 were analyzed to evaluate the intestinal barrier. Proteomics was used to evaluated the proteins profile in brain. Lipidomics were used to evaluate the brain SCFAs as well as medium and long chain fatty acids (MCFAs and LCFAs). Malondialdehyde (MDA), Total Superoxide dismutase (T-SOD), Glutathione (GSH), Glutathione peroxidase (GSH-Px), Catalase (CAT) and reactive oxygen species (ROS) were assayed to evaluate the oxidative stress in brain. Western blot was performed to evaluate the expression of PPARγ, Nrf2, SLC3A2, SCL7A11, GPX4, ACSL4 and LOX.

RESULTS

SHTB prevented rats from MCAO/R injury, which was confirmed by lower cerebral infarct rate, brain water content, neurological deficit score and nissl body loss, and improved brain pathology. Meanwhile, SHTB upregulated the expression of ZO-1 and Occludin to maintain the integrity of BBB. 16S rDNA sequencing and LC-ESI-MS/MS-based targeted metabolomics found that SHTB increased the abundance of gut microbiota, regulated the numbers of intestinal bacteria to increase the production of Acetic acid, Propionic acid, and Butyric acid, as well as decrease the production of Valeric acid and Hexanoic acid in the gut. Meanwhile, SHTB improved the intestinal barrier by upregulating the protein levels of Claudin 5 and ZO-1, which was confirmed by low concentrations of LPS-SIgA and DAO in serum. Multi omics and spearman correlation analysis indicated that SHTB regulated the abundance of Escherichia-Shigella and Lactobacillus to increase Acetic acid, Propionic acid, and Butyric acid to induce the expression of PPARγ, thereby regulating fatty acid metabolism and degradation, improving lipid metabolism disorders, downregulating lipid oxidative stress, inhibiting ferroptosis, and alleviating brain injury.

CONCLUSION

This study confirmed that SHTB improved the disturbance of fatty acid metabolism in brain tissue by regulating gut microbiota and the production of fecal SCFAs to inhibit ferroptosis caused by lipid oxidative stress and prevent CIS injury, which provided a potential candidate drug for the prevention of CIS.

Comparative phenotyping of C57BL/6J substrains reveals distinctive patterns of cardiac aging

Research in aging often refers to animal models, particularly C57BL/6J (B6J) mice, considered gold standard. However, B6J mice are distributed by different suppliers, which results in divers substrains exhibiting notable phenotypic differences. To ensure a suitable phenotype of cardiac aging, we performed heart analyses of young (5 months) and old B6J mice (24 months) from two substrains: B6JRj (Janvier) and B6JCrl mice (Charles River). In hearts of both substrains, myocardial fibrosis increased with age; however, only in old B6JRj mice cardiac hypertrophy associated with a decreased ejection fraction was observed. Gene set enrichment analysis in heart tissue using proteomic data revealed different age-associated pathway changes between the substrains, especially in oxidative phosphorylation. Functional assessment of isolated cardiomyocytes verified cardiac impairment during aging in B6JRj mice. Overall, results demonstrate that cardiac aging manifests as a moderate systolic dysfunction in B6JRj mice, while B6JCrl mice display no functional changes with age.

Dioscin pretreatment ameliorates ferroptosis in cardiomyocytes after myocardial infarction via inhibiting endoplasmic reticulum stress

BACKGROUND

Myocardial infarction (MI) remains a leading cause of mortality globally, often resulting in irreversible damage to cardiomyocytes. Ferroptosis, a recently identified form of regulated cell death driven by iron-dependent lipid peroxidation, has emerged as a significant contributor to post-MI cardiac injury. The endoplasmic reticulum (ER) stress response has been implicated in exacerbating ferroptosis.

METHODS

Here, we investigated the potential of Dioscin, a natural compound known for its diverse pharmacological properties, in mitigating ferroptosis in cardiomyocytes following MI by targeting ER stress.

RESULTS

In animal models subjected to MI, administration of Dioscin notably improved cardiac function, reduced infarct size by approximately 24%, and prevented adverse remodeling, highlighting its therapeutic potential. Through in vitro and in vivo models of MI, we demonstrated that Dioscin treatment significantly attenuates ferroptosis in cardiomyocytes, as evidenced by a decrease in lipid peroxidation by about 19% and preserved mitochondrial integrity. Moreover, Dioscin exerted its protective effects by inhibiting ER stress markers, such as the phosphorylation levels of PERK and eIF2α proteins, and the expression levels of BIP and ATF4 proteins, thus disrupting the ER stress-mediated signaling cascade associated with ferroptosis.

CONCLUSION

Overall, our findings suggested that Dioscin holds promise as a therapeutic agent against post-MI cardiac injury by mitigating ferroptosis via the suppression of ER stress. Further investigations into the precise molecular mechanisms and clinical translation of Dioscin's cardioprotective effects are warranted, offering a potential avenue for novel therapeutic interventions in MI-related cardiac complications.

Stress hyperglycemia ratio as an important predictive indicator for severe disturbance of consciousness and all-cause mortality in critically ill patients with cerebral infarction: a retrospective study using the MIMIC-IV database

BACKGROUND

Stress hyperglycemia ratio (SHR) has been linked to prognosis of cerebrovascular diseases. Nevertheless, the association between SHR and severe disturbance of consciousness (DC) and mortality among patients with cerebral infarction remains explored. This study seeks to assess the predictive potential of SHR for severe DC and mortality among patients with cerebral infarction.

METHODS

We identified individuals diagnosed with cerebral infarction within the MIMIC-IV database. We employed logistic regression to examine the correlation between the SHR index and the severity of patients' consciousness disturbance, as well as in-hospital mortality. Furthermore, we employed restricted cubic spline curves to explore potential non-linear relationships between the SHR index and outcome measures. To assess the predictive performance of the SHR index and admission blood sugar level on outcome indicators, we compared receiver operating characteristic (ROC) curves.

RESULTS

A non-linear relationship existed between SHR and the risk of severe disturbance of consciousness, while there was a linear relationship with all-cause mortality. The AUC value for predicting severe disturbance of consciousness by the SHR index is 0.5419 (95% CI: 0.5188-0.5661). The AUC value for predicting in-hospital mortality based on the SHR index is 0.6264 (95% CI: 0.5881-0.6662). It is superior to single admission blood sugar level. In addition, SHR has an incremental impact on evaluating various diseases in predicting severe disturbance of consciousness and all-cause mortality in critically ill patients with cerebral infarction.

CONCLUSIONS

SHR is an important predictive indicator for severe disturbance of consciousness and all-cause mortality of patients with cerebral infarction.

Family support and prayer are invaluable coping strategies for our recovery: Experiences of persons living with cardiovascular diseases

BACKGROUND

It is estimated that 61% of deaths caused by Cardiovascular Diseases (CVDs) globally are attributed to lifestyle-related risk factors including tobacco use, alcohol abuse, poor diet, and inadequate physical activity. Meanwhile, inadequate knowledge and misperceptions about CVDs are disproportionately increasing the prevalence of CVDs in Africa. Moreover, pre-diagnosis awareness/knowledge about CVDs among patients is essential in shaping the extent and scope of education to be provided by healthcare workers.

OBJECTIVE

Explore the experiences of patients living with CVDs (PLwCVDs) and accessing care at the Cardiothoracic Centre, Ho Teaching Hospital, regarding their knowledge of CVD-risk factors and coping strategies that work for them.

METHOD

We leveraged descriptive phenomenological design to explore the experiences of patients accessing care at the Cardiothoracic Centre at the Ho Teaching Hospital, Ghana. Using the purposive sampling technique, 17 PLwCVDs for 3yrs and above were recruited and included in the study. Thematic analysis was conducted using the qualitative computerised data software, NVivo version 14. Recruitment of participants and general conduct of the study commenced on November 1, 2023 and ended on April 30, 2024.

FINDINGS

We found that PLwCVDs and accessing care at the Cardiothoracic Centre at Ho Teaching Hospital have adequate pre-diagnosis awareness about CVD-risk factors and their knowledge of same was optimal. Moreover, past unhealthy lifestyles (such as poor dieting, abuse of alcohol, smoking, and inadequate physical activity) may have contributed to participants developing the CVDs. Furthermore, prayers and participation in church activities were the main coping strategies employed by the participants in dealing with CVDs.

CONCLUSION

The PLwCVDs and receiving treatment at the Cardiothoracic Centre at the Ho Teaching Hospital are knowledgeable in the CVD-risk factors and adopting positive coping strategies. The Cardiothoracic Centre and government must explore social media facilities to intensify public education and also correct misconceptions about CVDs.

Osteoprotegerin as an Emerging Biomarker of Carotid Artery Stenosis? A Scoping Review with Meta-Analysis

Objective: In developed countries, stroke is the fifth cause of death, with a high mortality rate, and with recovery to normal neurological function in one-third of survivors. Atherosclerotic occlusive disease of the extracranial part of the internal carotid artery and related embolic complications are common preventable causes of ischemic stroke (IS), attributable to 7-18% of all first-time cases. Osteoprotegerin (OPG), a soluble member of the tumor necrosis factor receptor (TNFR) superfamily, is considered a modulator of vascular calcification linked to vascular smooth muscle cell proliferation and collagen production in atherosclerotic plaques. Therefore, OPG emerges as a potential biomarker (BM) of calcified carotid plaques and carotid artery stenosis (CAS). Methods: We performed a literature search of PubMed on OPG in CAS and atherosclerosis published until 2024. Results: Increased levels of serum OPG were reported in both patients with symptomatic and asymptomatic CAS, and higher values were observed in those with unstable atherosclerotic plaques. Notably, increased OPG levels were observed regardless of the location of atherosclerosis, including coronary and other peripheral arteries. In addition, chronic kidney disease, the most significant confounder disturbing the association between vascular damage and circulating OPG levels, decreases the usefulness of OPG as a BM in CAS. Conclusions: Osteoprotegerin may be considered an emerging BM of global rather than cerebrovascular atherosclerosis. Its diagnostic significance in identifying patients with asymptomatic CAS and their monitoring is limited.

Exploration of the metabolomic mechanisms of postmenopausal hypertension induced by low estrogen state

Estrogen significantly impacts women's health, and postmenopausal hypertension is a common issue characterized by blood pressure fluctuations. Current control strategies for this condition are limited in efficacy, necessitating further research into the underlying mechanisms. Although metabolomics has been applied to study various diseases, its use in understanding postmenopausal hypertension is scarce. Therefore, an ovariectomized rat model was used to simulate postmenopausal conditions. Estrogen levels, blood pressure, and aortic tissue metabolomics were analyzed. Animal models were divided into Sham, OVX, and OVX +E groups. Serum estrogen levels, blood pressure measurements, and aortic tissue metabolomics analyses were performed using radioimmunoassay, UHPLC-Q-TOF, and bioinformatics techniques. Based on the above research content, we successfully established a correlation between low estrogen levels and postmenopausal hypertension in rats. Notable differences in blood pressure parameters and aortic tissue metabolites were observed across the experimental groups. Specifically, metabolites that were differentially expressed, particularly L-alpha-aminobutyric acid (L-AABA), showed potential as a biomarker for postmenopausal hypertension, potentially exerting a protective function through macrophage activation and vascular remodeling. Enrichment analysis revealed alterations in sugar metabolism pathways, such as the Warburg effect and glycolysis, indicating their involvement in postmenopausal hypertension. Overall, this current research provides insights into the metabolic changes associated with postmenopausal hypertension, highlighting the role of L-AABA and sugar metabolism reprogramming in aortic tissue. The findings suggest a potential link between low estrogen levels, macrophage function, and vascular remodeling in the pathogenesis of postmenopausal hypertension. Further investigations are needed to validate these findings and explore their clinical implications for postmenopausal women.

Global burden of cardiovascular diseases attributable to diet low in vegetables from 1990 to 2021 and forecasting the future trends: a population-based study

BACKGROUND

This investigation examines the worldwide impact of cardiovascular diseases (CVD) resulting from inadequate vegetable consumption, based on the 2021 Global Burden of Disease Study data.

METHOD

The study assessed the global, regional, and national repercussions of low vegetable intake on CVD, with a focus on variations among different age and gender demographics. It further analyzed the correlation between disease burden and the Socio-Demographic Index (SDI), and employed an ARIMA model to predict future trends in CVD associated with insufficient vegetable consumption up to 2050.

RESULT

In 2021, a diet lacking in vegetables was responsible for roughly 682,400 deaths and 16 million disability-adjusted life years (DALYs) attributed to CVD, indicating a declining pattern over recent year. Individuals aged 75 and older were predominantly affected. Future projections indicate an expected rise in CVD incidence in lower-middle SDI regions, with African nations potentially experiencing increased challenges related to low vegetable consumption by 2030 and 2050.

CONCLUSION

The findings underscore the critical necessity for preventive measures against CVD and emphasize the significance of improving dietary habits, particularly vegetable intake.

Effectiveness of shared decision making strategies for stroke prevention among patients with atrial fibrillation: cluster randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of multiple decision aid strategies in promoting high quality shared decision making for prevention of stroke in patients with non-valvular atrial fibrillation.

DESIGN

Cluster randomized controlled trial.

SETTING

Six academic medical centers in the United States.

PARTICIPANTS

Patient participants were aged ≥18 with a diagnosis of non-valvular atrial fibrillation, at risk for stroke (CHA2DS2-VASc ≥1 for men, ≥2 for women), and scheduled for a clinical appointment to discuss stroke prevention strategies. Participating clinicians were those who manage stroke prevention strategies for participating patients.

INTERVENTION

Patients were randomized to use a patient decision aid or usual care; clinicians were randomized to use an encounter decision aid or usual care with all participating patients.

MAIN OUTCOME MEASURES

Primary outcome measures were quality of shared decision making measured by OPTION12, knowledge of atrial fibrillation and its management, and decisional conflict.

RESULTS

1117 participants across six sites were included in the analysis. Compared with usual care, the combined use of both the patient decision aid and the encounter decision aid improved the quality of shared decision making (adjusted mean difference 12.1 (95% confidence interval (CI) 8.0 to 16.2; P<0.001), improved patients' knowledge (odds ratio 1.68 (95% CI 1.35 to 2.09; P<0.001), and reduced patients' decisional conflict (adjusted mean difference -6.3 (95% CI -9.6 to -3.1; P<0.001). Statistically significant improvements were also observed with the encounter decision aid alone versus usual care for all three outcomes and with the patient decision aid alone versus usual care for quality of shared decision making and knowledge. No important differences were observed in treatment choices for stroke prevention or in participants' satisfaction. No statistically significant difference in the length of visit across study groups was detected.

CONCLUSION

Patients who received any decision aid (encounter decision aid, patient decision aid, or both) had lower decisional conflict, better shared decision making, and greater knowledge than those receiving no decision aid, except for the effect of the patient decision aid on decisional conflict, which did not reach statistical significance. The study establishes that use of either pre-visit or in-visit decision aids individually or in combination is advantageous compared with usual care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04357288.

Prediction of ischemic stroke in patients with H-type hypertension based on biomarker

Hypertension combined with hyperhomocysteinemia significantly raises the risk of ischemic stroke. Our study aimed to develop and validate a biomarker-based prediction model for ischemic stroke in Hyperhomocysteinemia-type (H-type) hypertension patients. We retrospectively included 3,305 patients in the development cohort, and externally validated in 103 patients from another cohort. Logistic regression, least absolute shrinkage and selection operator regression, and best subset selection analysis were used to assess the contribution of variables to ischemic stroke, and models were derived using four machine learning algorithms. Area Under Curve (AUC), calibration plot and decision-curve analysis respectively evaluated the discrimination and calibration of four models, then external validation and visualization of the best-performing model. There were 1,415 and 42 patients with ischemic stroke in the development and validation cohorts. The final model included 8 predictors: age, antihypertensive therapy, biomarkers (serum magnesium, serum potassium, proteinuria and hypersensitive C-reactive protein), and comorbidities (atrial fibrillation and hyperlipidemia). The optimal model, named A2BC ischemic stroke model, showed good discrimination and calibration ability for ischemic stroke with AUC of 0.91 and 0.87 in the internal and external validation cohorts. The A2BC ischemic stroke model had satisfactory predictive performances to assist clinicians in accurately identifying the risk of ischemic stroke for patients with H-type hypertension.

Prognostic Impact of Preoperative Left Ventricular Systolic Dysfunction in Older Adult Patients With Gastric Cancer

BACKGROUND/AIM

The effect of left ventricular systolic dysfunction (LVSD), a risk factor for postoperative mortality, in older adult patients with gastric cancer has not been fully elucidated. This study aimed to evaluate the impact of low preoperative left ventricular ejection fraction (EF) on short- and long-term outcomes in older adult patients with gastric cancer.

PATIENTS AND METHODS

This retrospective study enrolled 237 older adult patients with gastric cancer (≥75 years old) who underwent preoperative echocardiography and curative gastrectomy. LVSD was defined as an EF <50%. Postoperative complications and prognosis were compared between patients with low- and normal-EF using the Fisher's exact or Chi-square test, log-rank test, Kaplan-Meier method, and Cox regression analysis.

RESULTS

Thirteen patients (5.4%) exhibited LVSD. The incidence of postoperative complications was not significantly different between the two groups (p=0.470), although the incidence of pneumonia was high (p=0.003) and overall survival was significantly worse in the low-EF group compared to the normal-EF group (p=0.016). Multivariate analysis revealed that decreased EF, low preoperative body mass index, and advanced pathological stage were significant prognostic factors in older adult patients with gastric cancer.

CONCLUSION

LVSD increases the risk of postoperative pneumonia and has a negative prognostic impact on older adult patients with gastric cancer.

Advancements in automated external and wearable cardiac defibrillators

PURPOSE OF REVIEW

Survival statistics for out-of-hospital cardiac arrests remain unsatisfactory. Prompt defibrillation of shockable rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia, is crucial for improving survival. Automated external defibrillators (AEDs) and wearable cardiac defibrillators (WCDs) seek to improve the survival rates following out-of-hospital cardiac arrests. We aim to review the indications, utility, advancements, and limitations of AEDs and WCDs, as well as their role in contemporary and future clinical practice.

RECENT FINDINGS

Recent advancements in these technologies, such as smartphone applications and drone delivery of AEDs and less inappropriate shocks and decreased size of WCDs, have increased their ubiquity and efficacy. However, implementation of this technology remains limited due to lack of resources and suboptimal patient adherence.

SUMMARY

Out of hospital cardiac arrests continue to pose a significant public health challenge. Advancements in AEDs and WCDs aim to facilitate prompt defibrillation of shockable rhythms with the goal of improving survival rates. However, they remain underutilized due to limited resources and suboptimal patient adherence. As these technologies continue to evolve to become smaller, lighter and more affordable, their utilization and accessibility are expected to improve.

Sex dimorphism in kidney health and disease: mechanistic insights and clinical implication

Sex is a key variable in the regulation of human physiology and pathology. Many diseases disproportionately affect one sex: autoimmune diseases, such as systemic lupus erythematosus, are more common in women but more severe in men, whereas the incidence of other disorders such as gouty arthritis and malignant cancers is higher in men. Besides the pathophysiology, sex may also influence the efficacy of therapeutics; participants in clinical trials are still predominately men, and the side effects of drugs are more common in women than in men. Sex dimorphism is a prominent feature of kidney physiology and function, and consequently affects the predisposition to many adult kidney diseases. These differences subsequently influence the response to immune stimuli, hormones, and therapies. It is highly likely that these responses differ between the sexes. Therefore, it becomes imperative to consider sex differences in translational science from basic science to preclinical research to clinical research and trials. Under-representation of one sex in preclinical animal studies or clinical trials remains an issue and key reported outcomes of such studies ought to be presented separately. Without this, it remains difficult to tailor the management of kidney disease appropriately and effectively. In this review, we provide mechanistic insights into sex differences in rodents and humans, both in kidney health and disease, highlight the importance of considering sex differences in the design of any preclinical animal or clinical study, and propose guidance on how to optimal design and conduct preclinical animal studies in future research.