Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

Associations of triglyceride glucose-body mass index with short-term mortality in critically ill patients with ischemic stroke

BACKGROUND

The triglyceride glucose-body mass index (TyG-BMI) has been established as a convenient and reliable marker for assessing insulin resistance (IR) and has been shown to be significantly correlated with stroke. However, only a few studies have been conducted in this field, with conflicting conclusions.

METHODS

This study based on the eICU database, investigated the association between TyG-BMI and 28-day mortality in critically ill ischemic stroke (IS) patients. Multivariate Cox regression models were employed to analyze the impacts of the TyG-BMI on 28-day hospital and ICU mortality. Restricted cubic splines (RCS) were applied to explore the nonlinear relationship between the TyG-BMI and 28-day mortality. K‒M curves were utilized for outcome comparisons among different TyG-BMI groups. Additionally, interaction and subgroup analyses were performed to validate the robustness of the results.

RESULTS

A total of 1,362 critically ill patients with IS were enrolled, with a mean age of 68.41 ± 14.16 years; 47.50% were male. Multivariate Cox regression analysis revealed that, the high TyG-BMI group had significantly higher 28-day hospital mortality(HR = 1.734, P = 0.032) and ICU mortality (HR = 2.337, p = 0.048). RCS analysis showed a nonlinear positive correlation between the TyG-BMI and 28-day hospital mortality. Below the inflection point of the TyG-BMI = 380.37, each increase of 1 standard deviation (SD) (approximately 25.5 units) in the TyG-BMI was associated with a 37.3% increase in 28-day hospital mortality (HR = 1.373, P = 0.015), and above 380.376, each 1-SD increase in the TyG-BMI resulted in an 87.9% decrease in 28-day hospital mortality (HR = 0.121, P = 0.057). The log-likelihood ratio test P value = 0.004. For 28-day ICU mortality, the TyG-BMI exhibited a significant positive linear correlation in RCS.

CONCLUSIONS

Elevated TyG-BMI is significantly associated with an increased risk of short-term all-cause mortality in patients with critically ill IS in the United States. This result provides compelling evidence to address the existing discrepancies in this research domain, indicating that the TyG-BMI could serve as a straightforward and efficient biomarker for identifying critically ill IS patients at high risk of mortality.

Risk of Coronary Artery Disease in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis

Background and Aims

Coronary artery disease (CAD) is increasingly observed in patients with liver cirrhosis. However, data on the incidence and prevalence of CAD in cirrhotic patients are heterogeneous, and the association remains uncertain. In this study, we aimed to conduct a systematic review and meta-analysis to address these issues.

Methods

PubMed, EMBASE, and Cochrane Library databases were searched. Incidence, prevalence, and factors associated with CAD were pooled using a random-effects model. Risk ratio (RR) and odds ratio (OR), with their 95% confidence interval (CI), were calculated to evaluate differences in CAD incidence and prevalence between patients with and without liver cirrhosis.

Results

Fifty-one studies were included. The pooled incidences of CAD, acute coronary syndromes, and myocardial infarction (MI) were 2.28%, 2.02%, and 1.80%, respectively. Liver cirrhosis was not significantly associated with CAD incidence (RR = 0.77; 95% CI = 0.46-1.28) or MI (RR = 0.87; 95% CI = 0.49-1.57). The pooled prevalence of CAD, acute coronary syndromes, and MI was 18.87%, 12.54%, and 6.12%, respectively. Liver cirrhosis was not significantly associated with CAD prevalence (OR = 1.29; 95% CI = 0.83-2.01) or MI (OR = 0.58; 95% CI = 0.28-1.22). Non-alcoholic steatohepatitis, hepatitis C virus, advanced age, male sex, diabetes mellitus, hypertension, hyperlipidemia, smoking history, and family history of CAD were significantly associated with CAD in cirrhotic patients.

Conclusions

CAD is common in cirrhotic patients, but cirrhosis itself may not be associated with an increased CAD risk. In addition to traditional risk factors, non-alcoholic steatohepatitis and hepatitis C virus infection are also associated with CAD presence in cirrhotic patients.

Exploring Discharge Preparedness of Patients With Stroke: A Qualitative Descriptive Study

Aim: This study aimed to explore the experiences and perceptions of patients in a rehabilitation center who had experienced a stroke, regarding their concerns about discharge and life after stroke. Methods: A qualitative descriptive design was used and unstructured interviews were conducted with 100 patients with stroke. Reflexive thematic analysis was employed to identify recurring patterns and themes in the data, ensuring an in-depth understanding of the participants' experiences. Results: Three themes were generated from the analysis: (a) general post-hospitalization concerns, (b) concerns regarding the ability to handle activities of daily living, and (c) post-discharge aspirations and goals. Conclusions: This study sheds light on the diverse perspectives of patients with stroke regarding discharge from rehabilitation centers. A person-centered approach for patients with stroke is an important step for coordinating discharge planning. Developing a personalized care plan for meeting patients' needs is critical to address fundamental care issues.

Hemodynamics Indicates Differences Between Patients With And Without A Stroke Outcome After Left Ventricular Assist Device Implantation

Stroke remains a leading cause of complications and mortality in heart failure patients treated with a Left Ventricular Assist Device (LVAD). Hemodynamics plays a central role underlying post-LVAD stroke risk and etiology. Yet, detailed quantitative assessment of hemodynamic variables and their relation to stroke outcomes in patients on LVAD support remains a challenge. Modalities for pre-implantation assessment of post-implantation hemodynamics can help address this challenge. We present an in silico hemodynamics analysis for a digital twin cohort 12 patients on LVAD support; 6 with reported stroke outcomes and 6 without. For each patient we created a post-implant twin with the LVAD outflow graft reconstructed from cardiac-gated CT images; and a pre-implant twin of an estimated baseline flow by removing the LVAD outflow graft and driving flow from the aortic valve opening. Hemodynamics was characterized using descriptors for helical flow, vortex generation, and wall shear stress. We observed higher average values for descriptors of positive helical flow, vortex generation, and wall shear stress, across the 6 cases with stroke outcomes when compared with cases without stroke. When the descriptors for LVAD-driven flow were compared against estimated pre-implantation flow, extent of positive helicity was higher, and vorticity and wall shear were lower in cases with stroke compared to those without. Our study suggests that quantitative analysis of hemodynamics after LVAD implantation; and hemodynamic alterations from a pre-implant flow scenario, can potentially reveal hidden information linked to stroke outcomes during LVAD support. This has broad implications on understanding stroke etiology; and using patient digital twins for LVAD treatment planning, surgical optimization, and efficacy assessment.

Using Virtual Reality to Improve Outcomes Related to Quality of Life Among Older Adults With Serious Illnesses: Systematic Review of Randomized Controlled Trials

BACKGROUND

Virtual reality (VR) has promise as an innovative nonpharmacologic treatment for improving a patient's quality of life. VR can be used as an adjunct or treatment for many acute and chronic conditions, including serious illnesses.

OBJECTIVE

This systematic review aims to assess the current state of the literature of randomized controlled trials that use VR in patients with serious illnesses. Two secondary aims include assessing intervention components associated with improved quality of life and functional outcomes among older adults, as well as evaluating how well the randomized controlled trials adhere to consensus standards for VR research.

METHODS

We searched PubMed, Embase, and CINAHL for randomized controlled studies published at any time. We screened and accepted studies that reported outcomes related to patients' quality of life, provided an immersive VR intervention, and included patients with serious illness. We narratively summarized key attributes of publications that shed light on study efficacy, generalizability, replicability, and clinical utility. All studies were assessed for study quality with the Cochrane Risk of Bias tool and for concordance with 8 recent consensus standards for VR research.

RESULTS

From the 12,621 articles searched in May 2024, a total of 24 (0.19%) studies met the inclusion criteria, and of these, 88% (21/24) reported an improvement in at least 1 patient quality of life outcome and 67% (16/24) had a high risk of bias. In 7 (n=24, 29%) studies, VR was used to provide distraction therapy to reduce pain. In total, 5 (n=24, 21%) studies included training, supervision, and assistance in VR use, which demonstrated improvements in patient quality of life-related outcomes. Of 24 studies, 9 (38%) included patients with stroke, 9 (38%) included patients with cancer, 4 (17%) included patients with cardiovascular disease, 1 (4%) included patients with chronic obstructive pulmonary disease, and 1 (4%) included patients who reported pain in hospital. In all 9 studies that included patients with stroke, the main purpose of VR was to improve mobility and strength; these studies had higher frequency and longer durations of VR use, ranging from 2 to 9 weeks, as compared to a VR use duration of <2 weeks for studies aiming to reduce pain or anxiety. Regarding consensus standards for VR research, 29% (7/24) of the studies adhered to all 8 criteria, and all studies (24/24, 100%) adhered to ≥5 criteria.

CONCLUSIONS

Nascent evidence suggests VR's potential in mitigating pain, anxiety, and depression and improving mobility among persons with serious illnesses. Most studies did not provide detailed information about unassisted or assisted use, suggesting that VR for older adults is currently most appropriate for observed settings with assistance available.

TRIAL REGISTRATION

PROSPERO CRD42022346178; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346178.

From surgery to recovery: Measuring success through quality of life and functional improvements after cardiac surgery

Coronary artery disease and aortic valve stenosis are highly prevalent cardiovascular diseases worldwide, resulting in substantial morbidity and mortality. Surgical interventions, such as coronary artery bypass grafting and surgical aortic valve replacement, offer significant therapeutic benefits, including enhanced postoperative quality of life (QoL) and functional capacity, which are key indicators of surgical success. This editorial reviews recent studies on postoperative QoL and functional outcomes in patients undergoing cardiac surgery. Factors such as preoperative health, age, intensive care unit stay duration, surgical risk, and perioperative complications could influence these outcomes. Cardiac rehabilitation is pivotal in enhancing patient function, reducing frailty and improving long-term QoL.

Assessing the uptake of the core outcome set in randomized controlled trials for coronary artery disease: a trial registry analysis

BACKGROUND

Coronary artery disease (CAD) is a global health crisis, responsible for nearly 20 million deaths annually worldwide and 12.6% of all deaths in the United States. Randomized controlled trials (RCTs) are critical for developing evidence-based clinical guidelines, but inconsistent outcome reporting across RCTs hinders evidence synthesis and comparability. In 2015, McNamara et al. introduced a CAD core outcome set (COS) to promote standardization in CAD trial outcomes. This study evaluates the uptake of the CAD COS in RCTs registered at ClinicalTrials.gov since its publication.

METHODS

This trial registry analysis evaluated the uptake of the CAD COS in phase III/IV RCTs registered on ClinicalTrials.gov from May 2010 to June 2023. Trials were included if they assessed CAD interventions and excluded if the trials were non-randomized, focused on diagnostic tests, or were categorized as "not applicable" (e.g., behavioral interventions). COS adherence was measured as the proportion of reported outcomes among the 23 defined in the CAD COS. We analyzed changes in adherence over time, including pre- and post-COS publication periods, with secondary analyses examining continent, sponsor type, recruitment status, and enrollment number.

RESULTS

Among 433 trials, procedural interventions (45.0%) and all-cause mortality (40.9%) were the most reported outcomes, while acute renal failure (2.1%) and dyspnea (2.8%) were the least. Pre-2015, trials reported an average of 11.5% of the COS-defined outcomes. Post-2015, trials initiated after the CAD COS publication reported a slightly higher proportion of COS-defined outcomes compared to earlier trials, reflecting a modest increase in the number of items reported. However, this increase was not statistically significant (p = 0.012). Recruitment status significantly influenced adherence (p < 0.001), while continent and sponsor type did not. A weak positive correlation was observed between enrollment number and adherence (r = 0.27, p < 0.001).

CONCLUSIONS

Despite its publication in 2015, CAD COS uptake remains limited, with no significant changes in adherence over time. Barriers such as limited dissemination, lack of trialist awareness, and preferences for custom outcomes likely contribute to these findings. Greater emphasis on education, patient-centered outcomes, and COS tailored to specific CAD indications is needed to enhance uptake and comparability in CAD trials.

Bystander interventions and clinical outcomes among adult out-of-hospital cardiac arrest victims in South Korea over a decade: Sex-based disparities

OBJECTIVE

Delivering bystander interventions is key to improving out-of-hospital cardiac arrest (OHCA) outcomes. Despite reports on sex disparities in bystander interventions and clinical outcomes, comprehensive national-scale assessments in South Korea remain insufficient. Therefore, this study aimed to evaluate nationwide trends over a decade and examine sex disparities in bystander interventions among adult victims of OHCA in South Korea.

STUDY DESIGN

Population-based cohort study.

METHODS

We analysed bystander interventions and clinical outcomes among adult OHCA using data from the government's Out-of-Hospital Cardiac Arrest Surveillance between January 2009 and December 2019. We further assessed sex-based differences according to the arrest location, bystander type, and age group.

RESULTS

This study included a total of 209,901 victims of OHCA. The rate of bystander cardiopulmonary resuscitation (BCPR) improved from 3 % in 2009 to 25 % in 2019. Over the past decade, the usage rate of automated external defibrillators (AEDs) has consistently remained below 1 %. Compared to males, females received BCPR at an odds ratio (OR) of 1·05. However, in public locations, when the bystander was a non-family member, and for those over the age of 65 years, the ORs were 0·80, 0·88, and 0·96, respectively. A gap in sex disparity was observed annually when cardiac arrests occurred in public locations and the bystander was not a family member.

CONCLUSIONS

Sex disparities in BCPR are pronounced based on arrest location and bystander type. BCPR education programmes should be designed to address OHCA cases across sexes, and improvements in AED usage should be made.

Sacubitril/Valsartan partially alleviates myocardial infarction injury by activating the FGF21 signaling pathway via PPARs

The recent discovery of clinically significant data, alongside novel physiological and pathological occurrences surrounding sacubitril/valsartan (Sac/Val) beyond its approved indications, necessitates an urgent reevaluation of its underlying mechanism of action. In the present investigation, we observed a substantial elevation in the serum levels of fibroblast growth factor 21 (FGF21) among patients with acute myocardial infarction (AMI) who were administered Sac/Val, compared to those who were not, utilizing ELISA-based measurements. Furthermore, through the utilization of a mouse model of myocardial infarction induced by ligation of the left anterior descending branch, we confirmed that FGF21 mediates the cardioprotective effect of Sac/Val, employing both loss-of-function and gain-of-function approaches. Molecular docking and SPR experiments validated that Sac/Val can regulate FGF21 via its interaction with PPARs, and verified the role of PPARs in mediating Sac/Val regulation of FGF21 by inhibiting PPARs. In conclusion, we found that Sac/Val can act as an agonist of FGF21, which provides a new idea for the development of FGF21 drugs, and FGF21 as a new target of Sac/Val to ameliorate myocardial infarction, which provides a basis for new indications for Sac/Val.

Triglyceride-glucose index as a superior marker of insulin resistance for predicting long-term major adverse cardiovascular events following coronary artery bypass grafting in China

Insulin resistance (IR) has emerged as a risk factor for coronary artery disease (CAD), but there are currently insufficient data on the association of non-insulin-based IR indexes [triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose (TyG) index, and metabolic score for IR (METS-IR)] with the postoperative prognosis in patients undergoing coronary artery bypass grafting (CABG). Therefore, the present study aimed to examine the predictive power of the above non-insulin-based IR indexes for postoperative prognosis of CABG patients, and to further compare the predictive power of the three indexes. This study included 1472 consecutive CABG patients from June 2014 to January 2019. These patients were divided into two groups based on major adverse cardiovascular events (MACE): without MACE (n = 1136) and with MACE (n = 336). Formulas were used to calculate TyG index, TG/HDL-C, and METS-IR. The Cox regression was done. The study examined how TyG index, TG/HDL-C, and METS-IR improved model performance. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate this. The evaluation of model goodness-of-fit was conducted by employing the Akaike information criterion (AIC), Bayesian information criterion (BIC), and χ2 likelihood ratio test. During follow-up, 336 patients experienced the MACE. The associations of TyG index, TG/HDL-C, and METS-IR with MACE were significant. Patients with higher TyG index were at higher risk of MACE (Kaplan-Meier analysis: log-rank P < 0.001; Cox regression: HR = 2.077; 95% CI 1.549-2.784, P < 0.001). The TyG index had the highest area under the curve (AUC) value of 0.593 (95% confidence interval [CI]: 0.557-0.629). The addition of the TyG index yielded a significant improvement in prognostic prediction and model fit [continuous NRI (95% CI): 0.274 (0.1533-0.395), P < 0.001; IDI (95% CI): 0.01(0.0042-0.0159), P < 0.001; AIC: 4662.01; BIC: 4738.35; likelihood ratio test: P < 0.001). The study highlights the prognostic significance of the TyG index, TG/HDL-C, and METS-IR in individuals with CABG. Among these markers, the TyG index had the most robust capacity for predicting MACE. It resulted to be a valuable marker for risk classification and long-term outcome prediction.

Study on the use of black phosphorus quantum dots in the treatment of atherosclerosis

Atherosclerosis is the pathological basis of cardiovascular disease, and there are no clinical drugs that can safely and efficiently remove atherosclerotic plaques. In this study, black phosphorus quantum dots (BPQDs) were applied to the treatment of atherosclerosis in high fat diet ApoE-/- model mice that BPQDs were given every other day for 3 weeks without changing the high-fat diet. 45.3% atherosclerotic plaque was cleared efficiently within 3 weeks in BPQDs intravenous administration way every other day. The treatment was more effective than traditional statins. The findings suggest that BPQDs have great potential to be applied for clinical prevention and treatment of AS that does not require dietary changes.

Paeoniflorin Attenuates Limb Ischemia by Promoting Angiogenesis Through ERα/ROCK-2 Pathway

Background: Peripheral artery disease (PAD) is a high-risk vascular condition, and vascular remodeling has become a promising therapeutic approach. Paeoniflorin (PF) is the main bioactive compound in the roots of Paeonia lactiflora Pall, which is commonly used to treat a range of cardiovascular disorders. However, the mechanisms underlying the ameliorating effects of PF on PAD remain unclear. Therefore, the purpose of this study was to explore the therapeutic efficiency of PF on PAD and determine its mechanisms. Methods: The blood flow of mice was detected with a laser Doppler dot scanning imaging system. HE staining was used to observe the morphological changes of ischemic muscle. The changes in the serologic indexes were detected with an automatic biochemical assay, and the capillary density of ischemic gastrocnemius was detected with a Lectin immunofluorescence assay. The expression of angiogenesis-related proteins in ischemic gastrocnemius was detected with Western blotting, and the proportion of macrophages and neutrophils in total cells was detected with flow cytometry. Results: PF significantly increased blood flow, capillary density and protein expressions of vascular endothelial growth factor A (VEGFA), matrix metalloproteinase 2 (MMP2), matrix metalloproteinase 2 (MMP9), and estrogen receptor α (ERα) in mouse ischemic tissue in a PAD model. PF enhances the migration of endothelial cells and promotes the formation of tubular structures, involving the ERα/ROCK2 signaling pathway. Furthermore, PF was found to promote the phenotypic transformation of macrophages and alleviated grave inflammatory responses during vascular remodeling. Conclusions: We determined that PF as a potent compound in promoting angiogenesis and mitigating inflammatory responses during revascularization.

Feasibility of Smartphone-Based Exercise Training Integrated with Functional Electrical Stimulation After Stroke (SETS): A Preliminary Study

One emerging method in home stroke rehabilitation is digital technology. However, existing approaches typically target one domain (e.g., upper limb). Moreover, existing interventions do not cater to older adults with stroke (OAwS), especially those with high motor impairment, who require adjunct therapeutic agents to independently perform challenging exercises. We examined the feasibility of Smartphone-based Exercise Training after Stroke (SETS) with Functional Electrical Stimulation (FES). A total of 12 participants (67 ± 5 years) with stroke (onset > 6 months) exhibiting moderate-to-high motor impairment (Chedoke McMaster Leg ≤ 4/7) underwent 6 weeks of multicomponent (gait, functional strength, dynamic balance) training integrated with FES to paretic lower limb muscles. Primary measures included safety and adherence. Secondary measures included motivation, acceptability and attitude, usability, and clinical measures of gait and balance function like the 10-Meter Walk Test and Mini-BESTest. Participants reported no adverse events and moderate-to-high adherence (84.17 ± 11.24%) and improvement (up to 40%) in motivation, acceptability, and attitude and system usability. Participants also showed pre-post improvements in all measures of gait and balance function (p < 0.05). Integrating SETS and FES is feasible and yields short-term gains in gait and balance function among OAwS. Future studies could validate our findings by examining its efficacy with control groups to identify the differential effects of SETS and FES.

Trends in Ischemic Stroke Hospitalization and Outcomes in the United States Pre- and Peri-COVID-19 Pandemic: A National Inpatient Sample Study

Background/Objectives: The COVID-19 pandemic impacted healthcare systems globally, disrupting the management and treatment of acute ischemic stroke (AIS). Understanding how AIS admissions, treatments, and outcomes were affected is critical for improving stroke care in future crises. The objective of this work was to assess the COVID-19 pandemic's impact on AIS admissions, treatment patterns, complications, and patient outcomes in the U.S. from 2016 to 2021, focusing on differences between pre-pandemic (2016-2019) and peri-pandemic (2020-2021) periods. Methods: This is a retrospective cohort study using the National Inpatient Sample (NIS) database, analyzing weighted discharge records of AIS patients over six years. Data encompass U.S. hospitals, including urban, rural, teaching, and non-teaching facilities. The study included AIS patients aged 18 and older (N = 3,154,154). The cohort's mean age was 70.0 years, with an average hospital stay of 5.1 days and an adjusted mean cost of $16,765. Men comprised 50.5% of the cohort. We analyzed temporal trends in AIS hospitalizations from 2016 to 2021, comparing pre- and peri-COVID-19 periods. The primary outcome was the AIS admissions trend over time, with secondary outcomes including reperfusion therapy utilization, intubation rates, discharge disposition, and complications. Trends in risk factors and NIH Stroke Scale (NIHSS) severity were also evaluated. Results: AIS admissions rose from 507,920 in 2016 to 535,694 in 2021. Age and sex distribution shifted, with a growing proportion of male AIS cases (from 49.8% to 51.4%) and a decrease in mean age from 70.3 to 69.7 years. Although not statistically significant, White patients were the majority (68.0%), though their proportion declined as Black, Hispanic, and Asian/Pacific Islander cases increased. Reperfusion therapy, especially mechanical thrombectomy, rose from 2.2% to 5.6% over the study period. Intubation rates increased from 4.8% pre-COVID-19 to 5.5% peri-COVID, with higher rates among COVID-positive patients. NIHSS severity declined over time, with severe strokes (NIHSS ≥ 16) decreasing from 14.5% in 2017 to 12.6% in 2021. Conclusions: The COVID-19 pandemic brought significant shifts in AIS patterns, with younger, more diverse patients, increased reperfusion therapy use, and rising complication rates. These changes underscore the importance of resilient healthcare strategies and resource allocation to maintain stroke care amid future public health emergencies.

Zero Background Visualizing Phosphorescence Lateral Flow Immunoassay of Cardiac Troponin I for Rapid and Accurate Diagnosis of Myocardial Infarction

Fluorescence lateral flow immunoassays (FL-LFIA) have attracted considerable attention in clinical diagnosis due to their outstanding merits of affordable, sensitive, on-site, and quick detection. However, they are still plagued by significant signal interference, such as autofluorescence and scattered light. The development of high-performance and robust phosphors, i.e., label probes featuring with the character of low/no optical background, remains a great challenge. Herein, we report a novel visualized phosphorescence LFIA (Phos-LFIA), where the composite microspheres, i.e., carbon dots (CDs) covalently embedded in dendritic mesoporous silicon nanoparticles (DMSNs), were designed and selected as the report probes. The obtained CDs@DMSNs revealed uniform morphologies and particle sizes, as well as ultralong (lifetime: 1.14 s, visible for over 8 s to naked eyes) room temperature phosphorescence (RTP) in aqueous solution. As competitive nanotags, CDs@DMSNs were designed for an ultralong phosphorescence-based time-gated LFIA for cardiac troponin I (cTnI) without optical interference. The fabricated Phos-LFIA test strips demonstrated zero-background signal and were applied for highly sensitive cTnI detection in both buffer and a complex serum matrix, with corresponding limits of detection (LODs) of 0.19 and 0.21 ng/mL, respectively. For a clinical validation, the proposed Phos-LFIA revealed an excellent clinical analytical performance (sensitivity: 95.45%, specificity: 88.9%, κ value: 0.85), demonstrating its potential for rapid and accurate diagnosis of myocardial infarction. This work provided a promising background-free probe for FL-LFIA, and it would also open an opportunity for developing highly sensitive screening platforms for other targets through modifying different recognition ligands onto CDs@DMSNs.

Molecular mechanism underlying stress response and adaptation

Stress, a common life experience, impacts both mental and physical health, contributing to conditions such as anxiety and cardiovascular disease. It triggers physiological and psychological responses, primarily through the Hypothalamic-Pituitary-Adrenal (HPA) and Sympathetic-Adrenal-Medullary (SAM) axes, which are coordinated by the autonomic nervous system. Dysregulation of the glucocorticoid system, mediated by mineralocorticoid and glucocorticoid receptors, plays a critical role in neurodegenerative disorders like Alzheimer's disease. Cellular pathways like PI3K/Akt, NF-κB, and AP-1 transcription factors maintain homeostasis during stress and are targets for therapeutic research. Epigenetic influences and genomic modifications highlight the long-lasting effects of stress on gene expression. Adaptive responses, such as allostasis, allow the body to maintain stability amid stress. However, excessive stress leads to allostatic load, negatively impacting the immune, endocrine, and nervous systems. Current treatments include pharmacological and lifestyle interventions, with emerging approaches such as psychobiotics and precision medicine offering future potential.

Factorial Mendelian randomization of lipoprotein (a) lowering, low-density lipoprotein cholesterol lowering, and lifestyle improvements: joint associations with cardiovascular risk

BACKGROUND

High levels of lipoprotein(a) [Lp(a)] have been associated with an increased risk of cardiovascular disease (CVD); however, the effects of Lp(a)-lowering therapy in combination with low-density lipoprotein cholesterol (LDL-C)-lowering treatment or lifestyle improvements on CVD risk remain unexplored.

METHODS

We conducted a factorial Mendelian randomization study among 385 917 participants in the UK Biobank. Separate genetic scores were constructed to proxy the effects of Lp(a) lowering, LDL-C lowering through different targets [HMG-CoA reductase, NPC1-like intracellular cholesterol transporter 1, proprotein convertase subtilisin/kexin Type 9, and low-density lipoprotein receptor (LDLR)], as well as improvements in body mass index (BMI), systolic blood pressure (SBP), and lifestyle factors (cigarette smoking, alcohol consumption, and physical activity).

RESULTS

Genetically predicted lower Lp(a) levels were associated with a decreased risk of CVD and CVD-specific mortality. Per 50-mg/dl, the hazard ratio ranged from 0.73 [95% confidence interval (CI): 0.73, 0.73] for peripheral artery disease (PAD) to 0.95 (95% CI: 0.92, 0.99) for venous thromboembolism. In factorial analyses exploring combined exposure to low-level Lp(a) and low-level LDL-C, there was no consistent evidence for departure from an additive model for any outcome (Pinteraction > .05), with the exception of the analysis using the LDLR score and PAD (Pinteraction = .006). In factorial analyses exploring combination therapies integrating Lp(a) lowering with interventions on BMI, SBP, and lifestyle factors, there was no evidence for departure from an additive model in any analysis (Pinteraction > .05).

CONCLUSIONS

Our study suggests that Lp(a) lowering will have a similar magnitude for reducing cardiovascular events whether it is considered alone, or in conjunction with LDL-C reduction or lifestyle improvements.

Identification and regulation of a novel leptin receptor-linked enhancer during zebrafish ventricle regeneration

AIMS

Vertebrates vary greatly in their abilities to regenerate injured hearts. Zebrafish possess a remarkable capacity for cardiac regeneration, making them an excellent model for regeneration research. Recent studies have reported the activation and underlying regulatory mechanisms of leptin b (lepb) and the leptin b-linked enhancer (LEN) in injured hearts. However, the regenerative response activity of the leptin receptor (lepr) and its regulatory mechanisms still warrant further exploration.

MATERIALS AND METHODS

We identified a novel lepr-linked enhancer (leprEnh) and generated a stable transgenic zebrafish line for validation. We also employed a genetic ventricle ablation system to elucidate the mechanisms governing its activation. Immunofluorescence, in situ hybridization and confocal imaging of larvae treated with various inhibitors during ventricle regeneration were performed.

KEY FINDINGS

Our results revealed that both lepr expression and leprEnh-directed EGFP fluorescence were weakly expressed in the ventricle during early heart development but displayed a sharp increase after ventricle ablation. Strong injury response activity was also observed in the atrium. Furthermore, the regeneration-responsive activity was attenuated by hemodynamic force alteration and was modulated by Notch, ErbB2 and BMP signaling pathways.

SIGNIFICANCE

Our study sheds light on the regulation of lepr and leprEnh during heart regeneration and provide a basis for screening for novel therapeutic targets for myocardial infarction.

Abducens nerve palsy in patients with spontaneous intraventricular hemorrhage: A case report

RATIONALE

The purpose of this case report is to describe the process of the patient developing abductor nerve paralysis, analyze the causes of this symptom, provide new diagnostic and treatment ideas for patients with spontaneous intraventricular hemorrhage who develop abductor nerve paralysis, and be alert to the occurrence of abductor nerve paralysis in such patients.

PATIENT CONCERNS

A 49-year-old man was admitted to our hospital with a spontaneous intraventricular hemorrhage. After performing digital subtraction angiography of the whole brain under local anesthesia, his eyes were limited in abduction, accompanied by hemorrhage and exudation of the optic papilla. Edema is an extremely rare condition.

DIAGNOSES

Transient intracranial hypertension was considered after reexamination with computed tomography.

INTERVENTIONS

The application of mannitol and the release of cerebrospinal fluid were used to reduce intracranial pressure and provide patient-related symptomatic treatment.

OUTCOMES

After 1 month, the patient's eyes had no abduction limitation and showed good activity.

LESSONS

Abducens nerve palsy is a common condition. Owing to its complex etiology, a careful and comprehensive examination is necessary. In particular, patients with spontaneous cerebral hemorrhage who undergo digital subtraction angiography should pay more attention to the abducens nerve.

Current usage of inclisiran for cardiovascular diseases: overview of current clinical trials

Background

Cardiovascular diseases are predominant health conditions across the world due to their rising prevalence and association with several disorders. Inclisiran, a small interfering RNA (siRNA) therapy, lowers low density lipoproteins cholesterol (LDL-C) by targeting proprotein convertase subtilisin/kexin type 9 (PCSK9). Its exact role in cardiovascular diseases is not fully understood.

Aim

This review examines current usage of Inclisran for cardiovascular diseases.

Method

A detailed search of Clinicaltrials.gov was conducted to identify relevant studies that investigated heart diseases using Inclisran. Data on study design, sample size, intervention details, and outcomes related to Inclisran were extracted and analyzed.

Results

As of 30 December 2024, there were 92 clinical trials on involving inclisiran found at clinicaltrials.gov. The investigation focused on studies that used inclisiran for cardiovascular diseases and found that limited clinical trials were identified with limited interventional measures. The final number of analyzed trials was 11. The follow-up duration ranged from 270 to 1,695 days with a total of 214,176 participants with a favorable safety profile and twice-yearly dosing after initial loading dose. The collective findings from these trials demonstrated effective LDL-C and PCSK9 lowering compared to baseline measurements. Most studies focused on LDL-C lowering rather than measuring cardiovascular outcomes.

Conclusion

Although the studies showed inclisiran to lower LDL-C effectively, the evidence is still limited with regards to cardiovascular outcomes data. There is a need for real world studies addressing long-term safety, adherence and cost-effectiveness and therapeutic outcomes of combination therapy.

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.

Time in the United States and walking for physical activity among Black Californians: Findings from the California Health Interview Survey (2012-2017)

Background

No studies examine associations between acculturation and physical activity (PA) in California's foreign-born Black population, even though rates of PA are lower in Black populations, lower PA rates are a risk for cardiovascular disease, and this population is growing. Further, despite differences in CVD and PA by sex and mental health status; no studies have examined whether these factors modify associations between acculturation and PA.

Methods

We used the California Health Interview Survey (2012-2017) and fully adjusted, survey-weighted regression models to examine associations between time in the US as a proxy for acculturation (i.e., foreign-born <10 years in the US, foreign-born ≥10 years in the US) and walking for PA [leisure time (LTPA) and transportation-related (TRPA)] among Black Californians (n = 5,952). We also tested effect modification by sex and mental health status.

Results

About 7 % in the sample were foreign-born. In the adjusted model of TRPA, the odds of walking for PA were significantly higher in the foreign-born group living <10 years in the US (OR = 8.63; 95 %CI: 2.49, 29.86; p < 0.01) and no different in the foreign-born group living ≥10 years in the US (OR = 1.05; 95 % CI: 0.62, 1.75; p = 0.85), compared to US-born Black Californians. We found no effect modification of the associations by sex or mental health, except by frequency of feeling depressed.

Conclusion

Some foreign-born Black Californians have higher odds of walking for PA related to transportation than their US-born counterparts. Future research is needed to examine the role of mental health status on PA levels of this immigrant group.

Nanomaterials: Promising Tools for the Diagnosis and Treatment of Myocardial Infarction

Myocardial infarction (MI) is the leading cause of mortality from cardiovascular diseases. Rapid diagnosis and effective treatment are critical for improving patient prognosis. Although current diagnostic and therapeutic approaches have made significant progress, they still face challenges such as ischemia-reperfusion injury, microcirculatory disorders, adverse cardiac remodeling, and inflammatory responses. These issues highlight the urgent need for innovative solutions. Nanomaterials, with their diverse types, excellent physicochemical properties, biocompatibility, and targeting capabilities, offer promising potential in addressing these challenges. Advances in nanotechnology have increasingly drawn attention to the application of nanomaterials in both diagnosing and treating myocardial infarction. We summarize the pathophysiological mechanisms and staging of myocardial infarction. We systematically review the applications of nanomaterials in MI diagnosis, including the detection of biomarkers and imaging techniques, as well as in MI treatment, encompassing anti-inflammatory effects, antioxidant stress, inhibition of fibrosis, promotion of angiogenesis, and cardiac conduction repair. We analyze the existing challenges and provide insights into future research directions and potential solutions. Specifically, we discuss the need for rigorous safety assessments, long-term efficacy studies, and the development of robust strategies for translating laboratory findings into clinical practice. In conclusion, nanotechnology holds significant promise as a new strategy for diagnosing and treating myocardial infarction. Its potential to enhance clinical outcomes and revolutionize patient care makes it an exciting area of research with practical applications in real-world clinical settings.

Acute Kidney Injury in Patients After Cardiac Arrest: Effects of Targeted Temperature Management

BACKGROUND

Cardiac arrest (CA) is a leading cause of mortality and morbidity, with survivors often developing post-cardiac arrest syndrome (PCAS), characterized by systemic inflammation, ischemia-reperfusion injury (IRI), and multiorgan dysfunction. Acute kidney injury (AKI), a frequent complication, is associated with increased mortality and prolonged intensive care unit (ICU) stays. This study evaluates AKI incidence and progression in cardiac arrest patients managed with different temperature protocols and explores urinary biomarkers' predictive value for AKI risk.

METHODS

A prospective, single-center observational study was conducted, including patients with Return of Spontaneous Circulation (ROSC) post-cardiac arrest. Patients were stratified into three groups: therapeutic hypothermia (TH) at 33 °C, Targeted Temperature Management (TTM) at 35 °C, and no temperature management (No TTM). AKI was defined using KDIGO criteria, with serum creatinine and urinary biomarkers (TIMP-2 and IGFBP7) measured at regular intervals during ICU stay.

RESULTS

AKI incidence at 72 h was 31%, varying across protocols. It was higher in the No TTM group at 24 h and in the TH and TTM groups during rewarming. Persistent serum creatinine elevation and fluid imbalance were notable in the TH group. Biomarkers indicated moderate tubular stress in the TTM and No TTM groups.

CONCLUSIONS

AKI is a frequent complication post-cardiac arrest, with the rewarming phase identified as critical for renal vulnerability. Tailored renal monitoring, biomarker-guided risk assessment, and precise temperature protocols are essential to improve outcomes.

The 9p21.3 coronary artery disease risk locus drives vascular smooth muscle cells to an osteochondrogenic state

Background

Genome-wide association studies have identified common genetic variants at ~300 human genomic loci linked to coronary artery disease (CAD) susceptibility. Among these genomic regions, the most impactful is the 9p21.3 CAD risk locus, which spans a 60 kb gene desert and encompasses ~80 SNPs in high linkage disequilibrium. Despite nearly two decades since its discovery, the role of the 9p21.3 locus in cells of the vasculature remains incompletely resolved.

Methods

We differentiated induced pluripotent stem cells (iPSCs) from risk and non-risk donors at 9p21.3 into vascular smooth muscle cells. We performed single-cell transcriptomic profiling, including co-embedding and comparison with publicly available human arterial datasets. We conducted functional characterization using migration and calcification assays and confirmed our findings on iPSC-VSMCs derived from additional donors. Finally, we used overexpression of ANRIL followed by gene expression analysis.

Results

We demonstrated that iPSC-VSMCs harboring the 9p21.3 risk haplotype preferentially adopt an osteochondrogenic state and show remarkable similarity to fibrochondrocytes from human artery tissue. The transcriptional profile and functional assessment of migration and calcification capacity across iPSC-VSMCs lines from multiple donors concordantly resemble an osteochondrogenic state. Importantly, we identified numerous transcription factors driving different VSMC state trajectories. Additionally, we prioritized LIMCH1 and CRABP1 as signature genes critical for defining the risk transcriptional program. Finally, overexpression of a short isoform of ANRIL in non-risk cells was sufficient to induce the osteochondrogenic transcriptional signature.

Conclusions

Our study provides new insights into the mechanism of the 9p21.3 risk locus and defines its previously undescribed role in driving a disease-prone transcriptional and functional state in VSMCs concordant with an osteochondrogenic-like state. Our data suggest that the 9p21.3 risk haplotype likely promotes arterial calcification, through altered expression of ANRIL, in a cell-type specific and cell-autonomous manner, providing insight into potential risk assessment and treatment for carriers.

Loss of white matter tracts and persistent microglial activation in the chronic phase of ischemic stroke in female rats and the effect of miR-20a-3p treatment

Our previous studies showed that intravenous injections of the small non-coding RNA mir-20a-3p is neuroprotective for stroke in the acute phase and attenuates long-term cognitive impairment in middle-aged female rats. In this study, we evaluated postmortem brain pathology at 100+d after stroke in a set of behaviorally characterized animals. This included Sham (no stroke) controls or stroke animals that received either mir20a-3p at 4h, 24h and 70d iv post stroke (MCAo+mir20a-3p) or a scrambled oligo (MCAo+Scr). Brain volumetric features were analyzed with T2 weighted and Diffusion Tensor magnetic resonance imaging (MRI) followed by histological analysis. Principal component analysis of Fractional Anisotropy (FA)-diffusion tensor MRI measures showed that MCAo+Scr and MCAo+mir20a-3p groups differed significantly in the volume of white matter but not gray matter. Weil myelin-stained sections confirmed decreased volume of the corpus callosum, internal capsule and the anterior commissure in the ischemic hemisphere of MCAo+Scr animals compared to the non-ischemic hemisphere, while sham and MCAo+Mir-20a-3p showed no hemispheric asymmetries. The MCAo+Scr group also exhibited asymmetry in hemisphere and lateral ventricle volumes, with ventricular enlargement in the ischemic hemisphere as compared to the non-ischemic hemisphere. The numbers of microglia were significantly elevated in white matter tracts in the MCAo+Scr group, with a trend towards increased myelin phagocytic microglia in these tracts. Regression analysis indicated that performance on an episodic memory test (novel object recognition test; NORT) was associated with decreased white matter volume and increased microglial numbers. These data support the hypothesis that stroke-induced cognitive impairment is accompanied by white matter attrition and persistent microglial activation and is consistent with reports that cognitive deterioration resulting from vascular diseases, such as stroke, is associated with secondary neurodegeneration in regions distal from the initial infarction.

Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems

BACKGROUND

Health system disruptions since onset of the COVID-19 pandemic may have adversely impacted adherence to medications for common cardiovascular risk factors.

METHODS

We examined adherence to and discontinuation of incident prescriptions for medications treating hypertension, dyslipidemia, diabetes, and atrial fibrillation in Ontario, Alberta, and Nova Scotia, Canada. We compared the recent period (April 1, 2020 through most recently available follow-up: September 30, 2021 for Ontario; March 31, 2021 for Alberta; and March 31, 2022 for Nova Scotia) to the baseline, pre-pandemic period (April 1, 2014 through March 31, 2019). In each province, people aged ≥66 years with a valid health number and corresponding incident prescription were included. For each medication class, adherence in the recent period, defined as ≥ 0.80 proportion-of-days-covered (PDC), was compared to the pre-pandemic period using modified Poisson regression with robust error variance, adjusted for patient characteristics. Similarly adjusted Cox proportional hazards models compared hazard of discontinuation over one year of follow-up between the two time periods.

RESULTS

In the recent period, PDC ranged from 48.9% for dyslipidemia medications in Alberta to 82.2% for anticoagulants in Nova Scotia. Adherence was not different between periods, with the following exceptions: higher adherence in the recent period for antihypertensives (adjusted risk ratios [aRR] 1.08, 95% CI 1.06-1.10) and dyslipidemics (aRR 1.07, 95% CI 1.04-1.09) in Nova Scotia, and for antihyperglycemics (aRR 1.10, 95% CI 1.08-1.14) and anticoagulants (1.15, 95% CI 1.12, 1.18) in Alberta. Adherence was lower in the recent period only for antihypertensives in Alberta (aRR 0.95, 95% CI 0.93, 0.97). One-year rates of discontinuation ranged from 20.9% for anticoagulants in the Alberta recent period to 56.7% for antihypertensives in the Ontario baseline period. The adjusted hazard of discontinuation was lower or unchanged in the recent period for all medication classes.

CONCLUSIONS

Despite significant health system disruptions since 2020, recent adherence to incident cardiovascular prescriptions was similar or better than before and rates of medication discontinuation were lower. However, interventions are still needed to improve existing, suboptimal adherence.

The Association of Hospital-Cardiologist Integration With Patient Outcomes, Care Quality, and Utilization

BACKGROUND

Cardiologists are increasingly moving from independent practice to direct employment by hospitals. Hospital employment has the potential to improve care coordination and delivery, but little is known about its effect on care quality and outcomes.

OBJECTIVES

In this study, we sought to assess the association between hospital employment of cardiologists and patient outcomes, care quality, and utilization among patients hospitalized with incident acute myocardial infarction (AMI) or heart failure (HF).

METHODS

We used a sample of Medicare fee-for-service beneficiaries hospitalized with incident AMI or HF from 2008 to 2019. We identified the accountable cardiologists that cared for these patients and determined their employment status by means of tax identification numbers. We used difference-in-differences methods to compare clinical outcomes, quality measures, and utilization for patients treated by hospital-employed cardiologists after switching from independent to hospital-employed practice, to outcomes for patients treated by cardiologists who remained independent. Models were adjusted for time trends and patient, hospital, and cardiologist characteristics. Patient outcomes were in-hospital mortality, 30-day mortality, and 30-day readmission. Quality measures were receipt of: 1) a guideline-recommended test to assess cardiac function; and 2) a 30-day follow-up clinic visit. Utilization measures were length of stay and, for AMI patients, the proportion receiving coronary revascularization.

RESULTS

The proportion of U.S. cardiologists employed by hospitals increased from 26% in 2008 to 63% in 2019. We identified 186,052 AMI and 259,849 HF patients cared for by cardiologists who switched to hospital employment and 168,052 AMI and 245,769 HF patients cared for by independent cardiologists. Patient characteristics were similar (mean age 80.8 years; 47% men). We found no significant differences in outcomes (eg, adjusted difference in 30-day mortality 0.03% [95% CI: -0.39% to 0.45%] for AMI patients and -0.05% [95% CI: -0.37% to 0.27%] for HF patients); no differences in most quality metrics except a small increase in the proportion of HF patients with 30-day follow-up (adjusted difference: 1.04%; 95% CI: 0.46%-1.62%); and no differences in utilization between patients treated by hospital-employed cardiologists (postswitch) vs independent cardiologists.

CONCLUSIONS

Among U.S. cardiologists, there has been a large shift from independent practice to direct employment by hospitals. We found minimal evidence that cardiologist employment by hospitals improves care quality or outcomes.

Amyloid-β and heart failure in Alzheimer's disease: the new vistas

Alzheimer's disease (AD) is the most common cause of dementia and represents 75% of all dementia types. AD neuropathology is due to the progressive deposition of extracellular amyloid-beta (Aβ) peptide and intracellular hyperphosphorylated tau protein. The accumulated Aβ forms amyloid plaques, while the hyperphosphorylated tau protein forms neurofibrillary tangles (NFTs). Both amyloid plaques and NFTs are hallmarks of AD neuropathology. The fundamental mechanism involved in the pathogenesis of AD is still elusive, although Aβ is the more conceivable theory. Aβ-induced neurodegeneration and associated neuroinflammation, oxidative stress, endoplasmic reticulum stress (ER), and mitochondrial dysfunction contribute to the development of cognitive impairment and dementia. Of note, Aβ is not only originated from the brain but also produced peripherally and, via the blood-brain barrier (BBB), can accumulate in the brain and result in the development of AD. It has been shown that cardiometabolic conditions such as obesity, type 2 diabetes (T2D), and heart failure (HF) are regarded as possible risk factors for the development of AD and other types of dementia, such as vascular dementia. HF-induced chronic cerebral hypoperfusion, oxidative stress, and inflammation can induce the development and progression of AD. Interestingly, AD is regarded as a systemic disease that causes systemic inflammation and oxidative stress, which in turn affects peripheral organs, including the heart. Aβ through deranged BBB can be transported into the systemic circulation from the brain and accumulated in the heart, leading to the development of HF. These findings suggest a close relationship between AD and HF. However, the exact mechanism of AD-induced HF is not fully elucidated. Therefore, this review aims to discuss the link between AD and the risk of HF regarding the potential role of Aβ in the pathogenesis of HF.

Association Between Cardiometabolic Comorbidity Burden and Outcomes in Heart Failure

BACKGROUND

Cardiometabolic comorbidities such as obesity, diabetes, and hypertension are highly prevalent in heart failure (HF). We aimed to examine the association between severity of cardiometabolic comorbidities and hospitalization in patients with HF.

METHODS

In a retrospective electronic health record-based cohort of adults ≥ $$ \ge $$ 18 with HF, we categorized individuals based on the number of severe cardiometabolic comorbidities, including hypertension, diabetes, and obesity. Severely uncontrolled comorbidities were defined as systolic blood pressure ≥160 mm Hg, hemoglobin A1c ≥8%, and body mass index ≥35 kg/m2. Cox regression models were used to assess the association between cardiometabolic comorbidity burden and time to all-cause and HF hospitalization at 1 year, adjusting for age, sex, race or ethnicity, and insurance status, smoking, prior hospitalization, and Elixhauser comorbidity index. Stratified analyses were conducted for HF with preserved and reduced ejection fraction.

RESULTS

A total of 26 800 individuals with HF (mean age 75± $$ \pm $$ 13.7, 46% women, 69% White) experienced 4284 (16%) hospitalizations over a 1-year period. Compared with individuals with absent comorbidities, those with 1 or 2 to 3 severely uncontrolled comorbidities had a significantly higher risk of all-cause hospitalization (hazard ratio [HR], 1.23 [95% CI, 1.09-1.39] and HR, 1.57 [95% CI, 1.35-1.83], respectively). We found similar associations for HF hospitalization. These associations were similar among individuals with HF with preserved ejection fraction compared with HF with reduced ejection fraction.

CONCLUSIONS

Greater cardiometabolic comorbidity burden was associated with increased risk of all-cause hospitalization in HF. This reinforces the role for targeting severely uncontrolled cardiometabolic comorbidities to reduce morbidity in HF.

Estimation of total mediation effect for a binary trait in a case-control study for high-dimensional omics mediators

Mediation analysis helps uncover how exposures impact outcomes through intermediate variables. Traditional mean-based total mediation effect measures can suffer from the cancellation of opposite component-wise effects and existing methods often lack the power to capture weak effects in high-dimensional mediators. Additionally, most existing work has focused on continuous outcomes, with limited attention to binary outcomes, particularly in case-control studies. To fill in this gap, we propose anR 2 total mediation effect measure under the liability framework, providing a causal interpretation and applicable to various high-dimensional mediation models. We develop a cross-fitted, modified Haseman-Elston regression-based estimation procedure tailored for case-control studies, which can also be applied to cohort studies with reduced efficiency. Our estimator remains consistent with non-mediators and weak effect sizes in extensive simulations. Theoretical justification on consistency is provided under mild conditions. In the Women's Health Initiative of 2150 individuals, we found that 89% (CI: 73% - 91%) of the variation in the underlying liability for coronary heart disease associated with BMI can be explained by metabolomics.

Cost-effectiveness of continuous real-time intracardiac recurrent event detection and alerting in high-risk acute coronary syndrome patients

BACKGROUND

ALERTS was a pivotal randomized clinical trial (RCT) evaluating an intracardiac monitor with real-time alerting in high-risk acute coronary syndrome patients. The cost-effectiveness however is unknown.

METHOD

A decision model estimated health effects and costs of implanting a Guardian device in a target patient population, compared to current standard-of-care (SOC). Health and economic outcomes were modeled using ALERTS trial results and relevant literature.

RESULTS

Base-case analysis indicated an incremental lifetime cost of $21,988 with Guardian as compared to SOC (increase of 0.18 life years or 0.37 quality-adjusted life years (QALY)). The incremental cost-effectiveness ratio (ICER) was $121,056/LY or $58,668/QALY.

CONCLUSION

Real-time intracardiac monitoring with patient alerting was cost-effective using conventional thresholds in acute coronary syndrome (ACS) patients at high-risk for recurrent events.

Sex-Specific Analysis of Carotid Artery Through Bilateral 3D Modeling via MRI and DICOM Processing

The present study explores the anatomical differences between sexes of the carotid artery using non-invasive magnetic resonance imaging (MRI) and a DICOM processing protocol. Bilateral three-dimensional models of the carotid artery were constructed for 20 healthy young adults, 10 males and 10 females, in order to evaluate key anatomical landmarks; these include the bifurcation diameter and angle, as well as the internal and external carotid arteries (ICA and ECA) for both sides (left and right). The results show that males exhibit larger bifurcation and ECA diameters, which could indicate reduced endothelial shear stress (ESS). However, as there is no previously observed sex difference in ESS between sexes, compensatory factors might be in play, such as blood pressure. This underscores the interaction between vascular geometry and stroke risk disparities; future research is encouraged to analyze diverse demographics and employ flow modeling techniques to further asses the connection between anatomical differences within a given population and vascular outcomes.

The Intersection of Menopause, Lack of Physical Activity, and Cardiovascular Risk

Cardiovascular disease (CVD) is the leading cause of mortality in women in the United States, and the physiologic changes that occur during perimenopause and menopause can increase women's risk of CVD. Physical activity levels decrease with age, but physical activity can effectively reduce both menopausal symptoms and CVD risk in women. Interventions to increase physical activity and reduce menopausal symptoms and CVD risks in women are often not comprehensive and are unsustainable due to individual contextual barriers. Furthermore, there is a lack of counseling, education, and support for women related to both the menopause transition and prevention of CVD. Theory-based, collaborative interventions addressing physical, social, contextual, individual, and other socioecological factors seem to be the most effective and sustainable and are needed to increase physical activity, reduce CVD risks, and enhance quality of life in menopausal women.

Related factors and safety of reaching the therapeutic target of warfarin after heart valve surgery in hospitalized patients: A retrospective cohort study

Warfarin is a commonly employed anticoagulant drug aimed at rapidly reaching the optimal international normalized ratio (INR), potentially reducing the hospitalization time in clinical settings. However, limited research has been conducted on the influencing factors and the safety implications of promptly reaching the target INR range in patients with valvular heart disease who have undergone valve replacement or repair. The present study aimed to assess the factors related to the safety considerations of rapidly reaching the target INR range in patients treated with warfarin. A retrospective cohort investigation was performed on hospitalized patients treated with warfarin between July 2022 and June 2023. Patient data were gathered from patient documentation. A total of 175 patients were included in the current study. The mean time to reach an effective INR threshold was 9.8 days (median, 3-28 days). Age >65 years, body mass index <24 kg/m2, no smoking history and warfarin starting dose ≥3 mg/day were separate factors linked to rapidly reaching the effective INR threshold for warfarin management. The occurrence of INR levels ≥4 was significantly elevated among patients who reached the effective INR threshold more rapidly, while bleeding incidents were not significantly different. Inpatients aged >65 years, those with a body mass index <24 kg/m², no smoking history or prescribed a starting warfarin dosage ≥3 mg/day had a higher likelihood of rapidly reaching the effective INR threshold with warfarin. To enhance safety for these patients, enhanced INR tracking and suitable warfarin dosage adjustments are suggested following the initiation of oral warfarin therapy.

Isolation, identification, and challenges of extracellular vesicles: emerging players in clinical applications

Extracellular vesicles (EVs) serve as critical mediators of intercellular communication, encompassing exosomes, microvesicles, and apoptotic vesicles that play significant roles in diverse physiological and pathological contexts. Numerous studies have demonstrated that EVs derived from mesenchymal stem cells (MSC-EVs) play a pivotal role in facilitating tissue and organ repair, alleviating inflammation and apoptosis, enhancing the proliferation of endogenous stem cells within tissues and organs, and modulating immune function-these functions have been extensively utilized in clinical applications. The precise classification, isolation, and identification of MSC-EVs are essential for their clinical applications. This article provides a comprehensive overview of the biological properties of EVs, emphasizing both their advantages and limitations in isolation and identification methodologies. Additionally, we summarize the protein markers associated with MSC-EVs, emphasizing their significance in the treatment of various diseases. Finally, this article addresses the current challenges and dilemmas in developing clinical applications for MSC-EVs, aiming to offer valuable insights for future research.

Tracking of blood pressure levels from childhood

The overall goal of this review is to summarize what is currently known regarding the tracking of blood pressure levels from early childhood into later adulthood and to describe the factors contributing to increased hypertension prevalence across the lifespan. This review describes 4 theoretical constructs of blood pressure trajectory across the lifespan: forward development, forward tracking, forward reversal, and maintenance of normal blood pressure levels.

The effects of nordic walking on the cardiovascular risk factors in older adults: A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the effects of Nordic walking on cardiovascular risk factors in the elderly population through a systematic review and meta-analysis of randomized controlled trials.

METHODS

Literature searches were conducted in PubMed, Embase, Cochrane Library, and Web of Science through November 2023. Two authors independently assessed heterogeneity in subgroups, performed sensitivity and meta-regression analyses, and extracted data. Outcomes were measured using mean difference (MD) or standardized mean difference (SMD), each with a corresponding 95 % confidence interval (CI).

RESULTS

A total of 22 studies comprising 1,271 subjects, with an average age of 62.21±7.76 years were included in the meta-analysis. Nordic walking significantly reduced body mass index (MD = -0.67, 95 % CI [-1.12; -0.23], p < 0.01), body weight (MD = -1.76, 95 % CI [-2.91; -0.62], p < 0.01), waist circumference (MD = -2.21, 95 % CI [-4.13; -0.29], p = 0.02), and body fat percentage (MD = -1.54, 95 % CI [-2.61; -0.48], p < 0.01). It also significantly enhanced maximal oxygen consumption (SMD = 0.60, 95 % CI [0.11; 1.10], p < 0.01), and reduced systolic blood pressure (MD = -2.92, 95 % CI [-5.23; -0.60], p < 0.01), low-density lipoprotein (SMD = -0.27, 95 % CI [-0.43; -0.12], p < 0.01), total cholesterol (SMD = -0.20, 95 % CI [-0.35; -0.05], p < 0.01), triglycerides (SMD = -0.30, 95 % CI [-0.47; -0.13], p < 0.01) in older adults, while also improving diastolic blood pressure in people over 65 years of age (MD =-5.26, [-8.79,-1.72], p < 0.01).

CONCLUSIONS

Nordic walking mitigates cardiovascular risk factors in older adults and is particularly effective in improving diastolic blood pressure in individuals over 65 years of age.

A Prospective Multicenter Analysis of Mobile Stroke Unit Cost-Effectiveness

OBJECTIVE

Given the high disease and cost burden of ischemic stroke, evaluating the clinical efficacy and cost-effectiveness of new approaches to prevent and treat ischemic stroke is critical. Effective ischemic stroke management depends on timely administration of thrombolytics after stroke onset. This study evaluates the cost-effectiveness associated with the use of mobile stroke units (MSUs) to expedite tissue plasminogen activator (tPA) administration, as compared with standard management through emergency medical services (EMS).

METHODS

This study is a prospective, multicenter, alternating-week, cluster-controlled trial of MSU versus EMS. One-year and life-time cost-effectiveness analyses, using the incremental cost-effectiveness ratio (ICER) method, were performed from the perspective of CMS's Medicare. Quality-adjusted life years (QALYs) estimated using patient-reported EQ-5D-5L data were used as the effectiveness measure. Health care utilizations were converted to costs using average national Medicare reimbursements. ICERs excluding patients with pre-existing disability, and limited to stroke-related costs were also calculated.

RESULTS

The first-year ICER for all tPA-eligible patients using total cost differences between MSU and EMS groups was $238,873/QALY; for patients without pre-existing disability was $61,199/QALY. The lifetime ICERs for all tPA-eligible patients and for those without pre-existing disability were $94,710 and $31,259/QALY, respectively. All ICERs were lower when restricted to stroke-related costs and were highly dependent on the number of patients treated per year in an MSU.

INTERPRETATION

MSUs' cost-effectiveness is borderline if we consider total first-year costs and outcomes in all tPA-eligible patients. MSUs are cost-effective to highly cost-effective when calculations are based on patients without pre-existing disability, patients' lifetime horizon, stroke-related costs, and more patients treated per year in an MSU. ANN NEUROL 2025;97:209-221.

Associations of Social, Behavioral, and Clinical Factors With Sex Differences in Stroke Recurrence and Poststroke Mortality

BACKGROUND

Few population-based studies have assessed sex differences in stroke recurrence. In addition, contributors to sex differences in recurrence and poststroke mortality, including social factors, are unclear. We investigated sex differences in these outcomes and the contribution of social, clinical, and behavioral factors to the sex differences.

METHODS

First-ever ischemic stroke cases identified from 2008 to 2019 from the population-based Brain Attack Surveillance in Corpus Christi Project in Texas were included and followed for recurrence and all-cause mortality through 2020. Sex differences in outcomes with and without adjustment for potential confounding factors, including social, behavioral, and clinical factors, were examined using Cox proportional hazard models. Factors that changed the log hazard ratio (HR) for sex by at least 10% after adjustment were identified as confounders/contributors. Final models were adjusted for all identified confounders.

RESULTS

Of 2326 participants (mean age, 68 years; 48% women; 57% Mexican American), over median follow-ups of 5.4 years for recurrence and 3.7 years for mortality, 274 recurrences and 965 deaths occurred. No significant sex differences in recurrence were noted in unadjusted (HR, 0.89 [95% CI, 0.70-1.13]), age-adjusted (HR, 0.92 [95% CI, 0.72-1.18]), or fully adjusted models (HR, 0.88 [95% CI, 0.67-1.16]). Although women had a higher crude mortality rate than men (HR, 1.22 [95% CI, 1.08-1.38]), this sex difference disappeared after age adjustment (HR, 0.91 [95% CI, 0.80-1.03]). Other factors contributing to the sex difference included education, marital status, prestroke depression, health behaviors, initial stroke severity, prestroke disability, comorbidities, atrial fibrillation, and coronary artery disease. After simultaneously adjusting for all identified confounders, women had lower poststroke mortality (HR, 0.79 [95% CI, 0.68-0.91]).

CONCLUSIONS

Sex differences in stroke recurrence were not apparent. Women had a higher unadjusted poststroke mortality rate but lower adjusted mortality than men. Social and psychosocial factors, alongside clinical factors, primarily explained the sex disparity in poststroke mortality.

The Association Between Hemoglobin Glycation Index and Carotid Artery Plaque in Patients With Coronary Heart Disease

This study aimed to examine the association between the hemoglobin glycation index (HGI) and carotid artery plaque (CAP) in patients with coronary heart disease (CHD). We conducted a cross-sectional analysis of 10,778 patients with CHD. The participants were divided into three groups by HGI tertiles (T1 HGI<-0.44, T2 -0.44 ≤ HGI ≤ 0.15, T3 HGI>0.15). The presence of CAP was used to diagnose by carotid ultrasonography. Logistic regression analysis was used to analyze the association between the HGI and CAP. The association between HGI and CAP was also assessed according to sex, age, smoking status, and drinking status. We further assessed the association between HGI and the ultrasound characteristics of CAP. The baseline analysis showed substantial differences in relevant parameters between the three groups of patients with CHD according to the tertiles of the HGI. Multivariate logistic regression analysis showed that HGI was significantly associated with CAP (odds ratio [OR] 1.32; 95% confidence interval [CI] 1.26-1.39). The association between HGI and CAP exists among different sex, age, smoking, and drinking status. Furthermore, there was a significant and positive association between HGI and all four different echogenicities of the CAP.

Hospital-physician integration and Medicare spending: Evidence from stable angina

OBJECTIVE

To examine the association between hospital-cardiologist integration and Medicare spending for stable angina patients.

DATA SOURCES AND STUDY SETTING

This study used Medicare Standard Analytic Files from 2013 to 2020 and the Centers for Medicare and Medicaid Services National Downloadable File for accompanying physician data.

STUDY DESIGN

This was a retrospective cohort study of Medicare beneficiaries with a new diagnosis of stable angina between 2013 and 2020.

DATA COLLECTION/EXTRACTION METHODS

Patients with a new diagnosis of stable angina were categorized by whether they received care from an independent or a hospital-integrated cardiologist.

PRINCIPAL FINDINGS

Total spending for this sample was high: an average of $103,946 per patient over 12 months. Adjusted for covariates, patients of integrated cardiologists did not spend significantly more or less than clinically comparable patients of independent cardiologists (-$3856, 95% CI: -$8631 to 920, p = 0.11). This was true for overall inpatient (-$2622, 95% CI: -6069 to 825, p = 0.14) and outpatient (-1162, 95% CI: -$3510 to 1185, p = 0.33) spending as well as cardiology-specific inpatient and outpatient spending. Among high-risk patients, overall spending between the integrated and independent groups was comparable, though patients of integrated cardiologists incurred lower spending than those of their independent counterparts in inpatient care (-$13,589; 95% CI: -24,432 to -2746, p = 0.01). In a supplemental analysis, findings suggested that site-neutral payments would have resulted in lower spending among patients of integrated physicians.

CONCLUSIONS

Specific clinical settings may lend themselves to efficiencies created by integration for certain complex patients, though we do not test a causal mechanism here. Adoption of site-neutral payment policy may also lead to lower spending among patients of integrated physicians.

WHAT IS KNOWN ON THIS TOPIC

Hospital-physician integration has increased significantly in the United States. Policymakers and health policy experts have expressed concerns that hospital-physician integration leads to increased health spending and may threaten healthcare affordability. While some studies link integration to greater spending, many use incomplete measures of spending, do not consider the potential benefits of care coordination, or rely on outdated data.

WHAT THIS STUDY ADDS

Spending among patients with stable angina, a common cardiovascular condition, was nearly equal, on average, across patients of integrated and independent cardiologists. Inpatient spending on high-risk patients was somewhat lower for those under the care of integrated cardiologists. Overall, patients of integrated cardiologists incurred largely comparable spending relative to patients of independent cardiologists, indicating that the impact of hospital-physician integration may depend on the clinical context.

Motivation in veterans with an acute/subacute ischemic stroke did not improve cognition and functional motor recovery but reduced deaths

BACKGROUND

The role of motivation per se in the presence or absence of depression in stroke-related cognitive and functional motor recovery has not been studied.

AIM

This study aimed to determine the role of motivation on cognition and functional motor recovery in patients after an acute and subacute ischemic stroke.

DESIGN

Prospective, observational, single-center study.

SETTING

Enrollment was undertaken in an inpatient neurorehabilitation facility.

POPULATION

A total of 125 veterans with stroke were admitted to an inpatient neurorehabilitation facility.

METHODS

Recovery locus of control (RLOC) measured the degree of motivation. The primary outcome measures were changes from baseline in the Action Research Arm Test (ARAT), total and sub-scores of Functional Independence Measures (TFIM), and the 2-minute walk test (2-MWT) on discharge from the IRF.

RESULTS

The mean age of the study sample was 65±9.3 years, they were mainly non-Hispanic white (N.=92, 74%) men (N.=119, 95%) admitted 9±11 days after acute stroke. When the sample was divided into less motivated (score 0-25, N.=32) and motivated (score ≥ 26, N.=93) as measured by the total RLOC for a statistical median of 26, the two groups had similar baseline characteristics including admission depression, TFIM, ARAT, and 2-MWT scores. The change in the primary outcome measure scores from baseline was similar between the two groups. Motivated group veterans had a lower all-cause mortality rate at 12 months than less motivated veterans (P=0.001).

CONCLUSIONS

A higher level of motivation irrespective of the degree of depression did not improve cognitive or functional motor recovery scores. However, motivated veterans had a lower all-cause mortality at 12 months.

CLINICAL REHABILITATION IMPACT

The result of this study has important implications in clinical practice highlighting that motivated patients are more likely to be discharged home and have a lower all-cause mortality.

The stroke seesaw: unveiling the enigma of stuttering acute ischemic stroke

Introduction

Beyond the familiar face of the acute ischemic stroke, lies the unexpected display of symptoms challenging our preconceptions and beckoning us to explore the intriguing nuances that lie beneath the surface.

Presentation of case

We introduce an unusual case of an older adult who presented to our institution with repetitive focal neurologic deficits (FND). Initial investigation was negative for any brain hemorrhage or infarcts. Repeat investigation during readmission showed findings of brain infarct for which appropriate treatment was provided. The fluctuating pattern of FND is what we refer to as a stuttering presentation of stroke.

Discussion

Our case brings attention to stuttering, an atypical presentation of ischemic stroke, not previously well described in medical literature. Our case demonstrates that stuttering stroke presentations may imitate more short-lived neurologic events such as transient ischemic attacks.

Conclusion

All the patient events throughout the entirety of their time course should be thoroughly reviewed so that thrombolytics can then be considered in the earliest window of opportunity for patients with stuttering stroke presentations to prevent disability due to ischemic stroke.

Occult Ventricular Fibrillation Visualized by Echocardiogram During Cardiac Arrest: A Retrospective Observational Study From the Real-Time Evaluation and Assessment for Sonography-Outcomes Network (REASON)

Objectives

Cardiac arrest patients with a shockable rhythm are more likely to survive an out-of-hospital cardiac arrest (OHCA) compared with a nonshockable rhythm. An electrocardiogram (ECG) is the most common way to identify a shockable rhythm, but it can miss patients with clinically significant ventricular fibrillation (vfib). We sought to determine the percentage of nonshockable OHCA patients that demonstrated vfib on echo.

Methods

Secondary analysis of echo images recorded from a prior study from our group, Real-Time Evaluation and Assessment for Sonography-Outcomes Network (REASON), a multicenter, observational study of OHCA patients presenting to the emergency department with nonshockable rhythms. Using ECG and echocardiogram images recorded during the initial cardiopulmonary resuscitation (CPR) pause, 2 independent emergency physicians determined the presence of vfib. Two experienced emergency physicians (R.G. and T.G.) reviewed echo images with adjudication by a third if necessary. ECG interpretation was unblinded to patient information. The primary outcome was the proportion of patients in occult vfib.

Results

During the first CPR pause, reviewers noted occult vfib in 22/685 (3.2%; 95% CI, 2.1%-4.8%) subjects. Patients with ECG vfib (n = 55) were defibrillated immediately during the first pause in CPR, but no patients with occult vfib during the first pause in CPR were defibrillated. Subsequently, 50% (11 of 22) of occult vfib patients were defibrillated when ECG vfib was recognized during an ensuing pause in CPR.

Conclusion

One in 33 OHCAs with a nonshockable ECG rhythm exhibits VF on echocardiogram. Patients presenting to the emergency department in a presumed nonshockable rhythm following OHCA may benefit from prompt defibrillation if personnel recognize occult vfib on echo.

Mid-life anti-inflammatory metabolites are inversely associated with long-term cardiovascular disease events

BACKGROUND

Preclinical data have shown that low levels of metabolites with anti-inflammatory properties may impact metabolic disease processes. However, the association between mid-life levels of such metabolites and long-term ASCVD risk is not known.

METHODS

We characterised the plasma metabolomic profile (1228 metabolites) of 1852 participants (58.1 ± 7.5 years old, 69.6% female, 43.6% self-identified as Black) enrolled in the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study. Logistic regression was used to assess the impact of metabolite levels on ASCVD risk (nonfatal MI, revascularisation, and cardiac mortality). We additionally explored the effect of genetic variants neighbouring ASCVD-related genes on the levels of metabolites predictive of ASCVD events. The Atherosclerosis Risk in Communities (ARIC) study (n = 4790; 75.5 ± 5.1 years old, 57.4% female, 19.5% self-identified as Black) was used as an independent validation cohort.

FINDINGS

In fully adjusted models, alpha-ketobutyrate [AKB] (OR 0.62 [95% CI, 0.49-0.80]; p < 0.001), and 1-palmitoyl-2-linoleoyl-GPI [OR, 0.62, 95% CI, 0.47-0.83; p < 0.001], two metabolites in amino acid and phosphatidylinositol lipid pathways, respectively, showed a significant protective association with incident ASCVD risk in both Heart SCORE and ARIC cohorts. Three plasmalogens and a bilirubin derivative, whose levels were regulated by genetic variants neighbouring FADS1 and UGT1A1, respectively, exhibited a significant protective association with ASCVD risk in the Heart SCORE only.

INTERPRETATION

Higher mid-life levels of AKB and 1-palmitoyl-2-linoleoyl-GPI metabolites may be associated with lower risk late-life ASCVD events. Further research can determine the causality and therapeutic potential of these metabolites in ASCVD.

FUNDING

This study was funded by the Pennsylvania Department of Health (ME-02-384). The department specifically disclaims responsibility for any analyses, interpretations, or conclusions. Additional funding was provided by National Institutes of Health (NIH) grant R01HL089292 and UL1 TR001857 (Steven Reis). Further, NIH funded R01HL141824 and R01HL168683 were used for the ARIC study validation (Bing Yu).

Evaluation of a machine learning-based metabolic marker for coronary artery disease in the UK Biobank

BACKGROUND AND AIMS

An in silico quantitative score of coronary artery disease (ISCAD), built using machine learning and clinical data from electronic health records, has been shown to result in gradations of risk of subclinical atherosclerosis, coronary artery disease (CAD) sequelae, and mortality. Large-scale metabolite biomarker profiling provides increased portability and objectivity in machine learning for disease prediction and gradation. However, these models have not been fully leveraged. We evaluated a quantitative score of CAD derived from probabilities of a machine learning model trained on metabolomic data.

METHODS

We developed a CAD-predictive learning model using metabolic data from 93,642 individuals from the UK Biobank (median [IQR] age, 57 [14] years; 39,796 [42 %] male; 5640 [6 %] with diagnosed CAD), and assessed its probabilities as a quantitative metabolic risk score for CAD (M-CAD; range 0 [lowest probability] to 1 [highest probability]) in participants of the UK Biobank. The relationship of M-CAD with arterial stiffness index, ejection fraction, CAD sequelae, and mortality was assessed.

RESULTS

The model predicted CAD with an area under the receiver-operating-characteristic curve of 0.712. Arterial Stiffness Index increased by 0.19 and ejection fraction decreased by 0.2 % per 0.1 increase in M-CAD. Both incident and recurrent myocardial infarction increased stepwise over M-CAD quartiles (odds ratio (OR) 15.3 [4.2 %] and 12.5 [0.2 %]) in top quartiles as compared to the first quartile of incident and recurrent MI respectively). Likewise, the hazard ratio and prevalence of all-cause mortality, CVD-associated mortality, and CAD-associated mortality increased stepwise over M-CAD deciles (2.98 [14 %], 9.34 [4.3 %], 26.7 [2.7 %] in the top deciles as compared to the first decile of all-cause, CVD, and CAD mortality respectively).

CONCLUSIONS

Metabolic-based machine learning can be used to build a quantitative risk score for CAD that is associated with atherosclerotic burden, CAD sequelae and mortality.

Evaluation of sex differences in the receipt of concomitant atrial fibrillation procedures during nonmitral cardiac surgery

OBJECTIVE

Women are less likely to receive guideline-recommended cardiovascular care, but evaluation of sex-based disparities in cardiac surgical procedures is limited. Receipt of concomitant atrial fibrillation (AF) procedures during nonmitral cardiac surgery was compared by sex for patients with preoperative AF.

METHODS

Patients with preoperative AF undergoing coronary artery bypass grafting and/or aortic valve replacement at any of the 33 hospitals in Michigan from 2014 to 2022 were included. Patients with prior cardiac surgery, transcatheter AF procedure, or emergency/salvage status were excluded. Hierarchical logistic regression identified predictors of concomitant AF procedures, account for hospital and surgeon as random effects.

RESULTS

Of 5460 patients with preoperative AF undergoing nonmitral cardiac surgery, 24% (n = 1291) were women with a mean age of 71 years. Women were more likely to have paroxysmal (vs persistent) AF than men (80% vs 72%; P < .001) and had a higher mean predicted risk of mortality (5% vs 3%; P < .001). The unadjusted rate of concomitant AF procedure was 59% for women and 67% for men (P < .001). After risk adjustment, women had 26% lower adjusted odds of concomitant AF procedure than men (adjusted odds ratio, 0.74; 95% CI, 0.64-0.86; P < .001). Female sex was the risk factor associated with the lowest odds of concomitant AF procedure.

CONCLUSIONS

Women are less likely to receive guideline recommended concomitant AF procedure during nonmitral surgery. Identification of barriers to concomitant AF procedure in women may improve treatment of AF.

Real world experience in effect of torsemide vs. furosemide after discharge in patients with HFpEF

AIMS

Few studies have focused on the effect of torsemide versus furosemide after discharge on prognosis in patients with heart failure with preserved ejection fraction (HFpEF). This single-centre retrospective real-world study was conducted to evaluate the effect of torsemide versus furosemide after discharge on all-cause mortality and rehospitalization for heart failure in patients with HFpEF.

METHODS

Consecutive patients who were diagnosis with HFpEF after discharge between January 2015 and April 2018 at the First Affiliated Hospital of Dalian Medical University and who had been treated with torsemide or furosemide were included in this study. The primary outcome was all-cause mortality. The second outcome was rehospitalization for heart failure.

RESULTS

A total of 445 patients (mean age 68.56 ± 8.07, female 55%) were divided into the torsemide group (N = 258) or furosemide group (N = 187) based on the treatment course at discharge from the hospital. During a mean follow-up of 87.67 ± 11.15 months, death occurred in 68 of 258 patients (26.36%) in the torsemide group and 60 of 187 patients (30.09%) in the furosemide group [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.57-1.15, P = 0.239]. Rehospitalization for heart failure occurred in 111 of 258 patients (43.02%) in the torsemide groups and 110 of 187 patients (58.82%) in the furosemide group (HR 0.64, 95% CI 0.49-0.85, P = 0.002).

CONCLUSIONS

Compared with furosemide, torsemide did not significantly reduce all-cause mortality, but there was association between torsemide and reduced rehospitalization for heart failure in patients with HFpEF.