Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association

Serum Urate and Atrial Fibrillation: A Bidirectional Mendelian Randomization Study

BACKGROUND

Observational studies indicate that serum urate level is associated with atrial fibrillation (AF). However, whether this association is causal remains controversial, due to confounding factors and reverse causality. We aim to evaluate the causal relationship of genetically predicted serum urate level with AF.

METHODS

A bidirectional Mendelian randomization (MR) study was performed. Instrumental variables were obtained from the Global Urate Genetics Consortium (110347 individuals). We obtained summary statistics of AF from two genome-wide association studies (GWAS) data sets for AF. Inverse-variance-weighted method was applied to obtain MR estimates and other statistical methods were conducted in the sensitivity analyses. The reverse MR analysis was performed to evaluate the effect of AF on serum urate levels.

RESULTS

Genetically determined serum urate level was not associated with AF in two studies (OR, 1.03; 95% CI, 0.95-1.11; p = 0.47); (OR, 1.06; 95% CI, 0.99-1.12; p = 0.09). The main results kept robust in the most sensitivity analyses. Multivariable MR analyses suggested that the association pattern did not change, after adjusting for body mass index (BMI), HbA1c: hemoglobin A1c (HbA1c), hypertension, low-density lipoprotein cholesterol (LDL-C) and coronary heart disease. No causal effect of AF on serum urate levels was found in two studies (OR, 1.02; 95% CI, 0.98-1.05; p = 0.30); (OR, 1.00; 95% CI, 0.98-1.03; p = 0.95).

CONCLUSIONS

Our MR study supports no bidirectional causal effect of serum urate levels and AF. This implies that treatments aimed at lowering uric acid may not reduce the risk of AF.

Adherence to Physical Activity Recommendations Among Stroke Survivors in the United States

BACKGROUND

Physical activity is an effective modifiable behavior for preventing recurrent strokes. This study aims to determine the adherence to physical activity recommendations among stroke survivors in the United States. We further compared our findings with the adherence observed among myocardial infarction (MI) survivors and healthy adults, each assessed against distinct physical activity guidelines specific to their respective populations.

METHODS

We utilized data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, a nationally representative survey. To establish benchmarks for stroke survivors, we referenced 3 different physical activity recommendations outlined in 2011, 2014, and 2021 American Heart Association stroke prevention guidelines. Similarly, for MI survivors and healthy adults, we used the 2011 guidelines for secondary prevention of coronary vascular diseases and the 2020 World Health Organization physical activity guidelines, respectively. Adherence to recommendations was determined by the respondents' self-reported intensity, duration, and frequency of physical activity. Multivariate logistic regression compared adherence in stroke survivors, MI survivors, and healthy adults.

RESULTS

Among 48 222 stroke survivors in the United States, the overall adherence rates to 2011, 2014, and 2021 physical activity guidelines were 75.4%, 40.2%, and 69.2%. For independently mobile stroke survivors, the adherence rates increased to 78.1%, 42.1%, and 69.9%. Among MI survivors and healthy adults, the adherence rates were 42.7% and 72%. When 2021 recommendations were used as a benchmark, older (aged ≥65 years) stroke survivors were more likely to adhere to recommendations than younger survivors (71.9% versus 62.3%; P<0.0001). After adjusting for sociodemographic factors and comorbidities, non-Hispanic Black survivors were less likely to adhere to recommendations (adjusted odds ratio, 0.81 [95% CI, 0.7-0.94]), whereas older and higher educated stroke survivors were more likely to adhere to recommendations. Geographically, stroke belt and nonrural residents were less likely to adhere to recommendations ([63.5% versus 67.9%; P<0.0001]; [53.8% versus 58.7%; P<0.0001]). Stroke and MI survivors were less likely to adhere to the latest recommendations than healthy adults (adjusted odds ratio, 0.74 [95% CI, 0.69-0.8]; (adjusted odds ratio, 0.24 [95% CI, 0.22-0.26]).

CONCLUSIONS

A substantial number of stroke survivors do not meet physical activity recommendations. Tailored interventions should be designed for at-risk populations, for example, non-Hispanic Black survivors and lower educated stroke survivors.

Sini decoction alleviates inflammation injury after myocardial infarction through regulating arachidonic acid metabolism

Objective

Myocardial inflammation during myocardial infarction (MI) could be inhibited by regulating arachidonic acid (AA) metabolism. Recent studies demonstrated that Sini Decoction (SND) was identified to be an effective prescription for treating heart failure (HF) caused by MI. But the anti-inflammatory mechanism of SND remained unclear. The work was designed to investigate the anti-inflammatory mechanism of SND through the AA metabolism pathway in vitro and in vivo experiments.

Methods

An inflammatory injury model of H9c2 cells was established by lipopolysaccharide (LPS)-stimulated macrophage-conditioned medium (CM). The MI model was built by the ligation of left anterior descending (LAD) branch of coronary artery in rat. Meanwhile, the rats were divided into five groups: sham group, MI group, MI + Celecoxib group, MI + low-dose SND group (SND-L) and MI + high-dose SND group (SND-H). Cardiac function, histopathological changes and serum cytokines were examined four weeks later. Western blot analysis was conducted to verify the key enzymes levels in the AA metabolic pathway, including phospholipase A2 (PLA2), cyclooxygenases (COXs) and lipoxygenases (LOXs).

Results

These in vivo results demonstrated that SND could improve the cardiac function and pathological changes of rats with MI, and regulate the key inflammatory molecules in the AA metabolism pathway, including sPLA2, COX-1, COX-2, 5-LOX and 15-LOX. In vitro, SND could decrease the release of pro-inflammatory cytokines including TNF-α and IL-6 and inhibit cell apoptosis in CM-induced H9c2 cells. Moreover, SND could protect H9c2 cells from the damage of CM by regulating nuclear factor kappa-B (NF-κB) signal pathway and the expression of COX-2.

Conclusion

SND may be a drug candidate for anti-inflammatory treatment during MI by regulating the multiple targets in the AA metabolism pathway.

Recurrent drug eluting stent, in-stent restenosis (DES-ISR): Epidemiology, pathophysiology & treatment

Coronary artery in-stent restenosis (ISR) is driven by neointimal hyperplasia and neo-atherosclerosis in previously placed stents. Drug eluting stents (DES) have been adopted as first line therapy for the initial episode of ISR. However, recurrent ISR has limited durable salvage options. In this article we review the pathophysiology, incidence, and management options of recurrent DES- ISR.

Gender and age predict advanced heart failure in gene-negative patients with hypertrophic cardiomyopathy

BACKGROUND

Patients with hypertrophic cardiomyopathy (HCM) may develop concomitant advanced heart failure (HF). However, there is limited data on the clinical outcomes of HCM patients without sarcomere gene mutations who have advanced HF.

OBJECTIVES

To identify prognostic factors for advanced HF in gene-negative patients within a large HCM cohort.

METHODS

A total of 1529 unrelated patients with HCM were enrolled between 1999 and 2018, and followed throughout the study period. All patients underwent genotyping through whole exome or panel sequencing. From this cohort, 735 patients without mutations were studied. We assessed the effects of family history, clinical findings, and echocardiographic parameters on the development of advanced HF. Multivariable Cox proportional hazards regression analysis was conducted to identify risk factors associated with advanced HF.

RESULTS

Of the 735 gene-negative patients studied, the mean age was 52.5±13.2 years, 69.5% were male, and the mean follow-up duration was 3.2±2.3 years. During this period, 97 patients (13.2%) developed advanced HF. Using multivariable analysis, we identified significant risk factors for advanced HF: female gender (adjusted hazard ratio [HR] 2.499, 95% confidence interval [CI] 1.531-4.081, P<0.001) and older age at enrollment (adjusted HR 1.298, 95% CI 1.00-1.682, P=0.049). These findings suggest that female patients and those enrolled at an older age are at a higher risk for developing advanced HF.

CONCLUSION

Female gender and older age may predict a higher risk of advanced HF in gene-negative patients with HCM. Early detection and proactive treatment are crucial for managing and preventing complications in these patients.

A Machine Learning Model Using Cardiac CT and MRI Data Predicts Cardiovascular Events in Obstructive Coronary Artery Disease

Background Multimodality imaging is essential for personalized prognostic stratification in suspected coronary artery disease (CAD). Machine learning (ML) methods can help address this complexity by incorporating a broader spectrum of variables. Purpose To investigate the performance of an ML model that uses both stress cardiac MRI and coronary CT angiography (CCTA) data to predict major adverse cardiovascular events (MACE) in patients with newly diagnosed CAD. Materials and Methods This retrospective study included consecutive symptomatic patients without known CAD referred for CCTA between December 2008 and January 2020. Patients with obstructive CAD (at least one ≥50% stenosis at CCTA) underwent stress cardiac MRI for functional assessment. Eighteen clinical, two electrocardiogram, nine CCTA, and 12 cardiac MRI parameters were evaluated as inputs for the ML model, which involved automated feature selection with the least absolute shrinkage and selection operator algorithm and model building with an XGBoost algorithm. The primary outcome was MACE, defined as a composite of cardiovascular death and nonfatal myocardial infarction. External testing was performed using two independent datasets. Performance was compared between the ML model and existing scores and other approaches using the area under the receiver operating characteristic curve (AUC). Results Of 2210 patients who completed cardiac MRI, 2038 (mean age, 70 years ± 12 [SD]; 1091 [53.5%] female participants) completed follow-up (median duration, 7 years [IQR, 6-9 years]); 281 experienced MACE (13.8%). The ML model exhibited a higher AUC (0.86) for MACE prediction than the European Society of Cardiology score (0.55), QRISK3 score (0.60), Framingham Risk Score (0.50), segment involvement score (0.71), CCTA data alone (0.76), or stress cardiac MRI data alone (0.83) (P value range, <.001 to .004). The ML model also exhibited good performance in the two external validation datasets (AUC, 0.84 and 0.92). Conclusion An ML model including both CCTA and stress cardiac MRI data demonstrated better performance in predicting MACE than traditional methods and existing scores in patients with newly diagnosed CAD. © RSNA, 2025 Supplemental material is available for this article.

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2024

This special article is the 17th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor in chief, Dr Kaplan, and the editorial board for the opportunity to continue this series, namely, the research highlights of the past year in the specialty of cardiothoracic and vascular anesthesiology.1 The major themes selected for 2024 are outlined in this introduction, and each highlight is reviewed in detail in the main article. The literature highlights in the specialty for 2024 begin with an update on perioperative rehabilitation and enhanced recovery in cardiothoracic surgery, with a focus on novel methods to best assess our patients in the preoperative period and the impact of implementing enhanced recovery care models on outcomes. The second major theme is focused on cardiac surgery, with the authors discussing new insights into anemia, transfusions, and coronary artery bypass grafting outcomes with a focus on gender disparities. The third theme is focused on cardiothoracic transplantation, with discussions focusing on techniques related to lung transplantation, including mechanical circulatory support. The 4th theme is focused on mechanical circulatory support, with discussions exploring advancements in left ventricular assist devices highlight the evolving landscape of mechanical circulatory support and discussion of anticoagulation practices. The fifth and final theme is an update on medical cardiology, with a focus on the outcomes of transcatheter management of regurgitant pathology, device management in heart failure, and new techniques in catheter ablation. The themes selected for this article are only a few of the diverse advances in the specialty during 2024. These highlights will inform the reader of key updates on a variety of topics, leading to improvement in perioperative outcomes for patients with cardiothoracic and vascular disease.

Automated diagnosis of atherosclerosis using multi-layer ensemble models and bio-inspired optimization in intravascular ultrasound imaging

Atherosclerosis causes heart disease by forming plaques in arterial walls. IVUS imaging provides a high-resolution cross-sectional view of coronary arteries and plaque morphology. Healthcare professionals diagnose and quantify atherosclerosis physically or using VH-IVUS software. Since manual or VH-IVUS software-based diagnosis is time-consuming, automated plaque characterization tools are essential for accurate atherosclerosis detection and classification. Recently, deep learning (DL) and computer vision (CV) approaches are promising tools for automatically classifying plaques on IVUS images. With this motivation, this manuscript proposes an automated atherosclerotic plaque classification method using a hybrid Ant Lion Optimizer with Deep Learning (AAPC-HALODL) technique on IVUS images. The AAPC-HALODL technique uses the faster regional convolutional neural network (Faster RCNN)-based segmentation approach to identify diseased regions in the IVUS images. Next, the ShuffleNet-v2 model generates a useful set of feature vectors from the segmented IVUS images, and its hyperparameters can be optimally selected by using the HALO technique. Finally, an average ensemble classification process comprising a stacked autoencoder (SAE) and deep extreme learning machine (DELM) model can be utilized. The MICCAI Challenge 2011 dataset was used for AAPC-HALODL simulation analysis. A detailed comparative study showed that the AAPC-HALODL approach outperformed other DL models with a maximum accuracy of 98.33%, precision of 97.87%, sensitivity of 98.33%, and F score of 98.10%.

Projecting the economic burden of health impacts of aircraft noise: a case study of Baltimore Washington International Thurgood Marshall Airport

BACKGROUND

While the Next Generation Air Transportation System (NextGen) in the United States optimizes flight patterns, it has led to the unintended consequence of increasing aircraft noise exposure in some communities near airports. Despite the evidence that chronic exposure to high noise levels produces detrimental health effects, potential adverse health consequences due to increased noise in the affected communities have not been adequately considered in aviation policy discussions.

OBJECTIVE

We assessed the long-term health and associated economic burden of increased aircraft noise caused by NextGen near the Baltimore-Washington Thurgood Marshall International (BWI) airport in Maryland.

METHODS

A probabilistic Markov model projected the incremental health and associated economic burden over 30, 20, and 10 years, comparing post-NextGen noise exposure levels to pre-NextGen levels. Health outcomes included cardiovascular disease (CVD), anxiety disorders, noise annoyance, and low birth weight (LBW). Noise exposure was categorized into four levels (<55 dB DNL, 55-60 dB DNL, 60-65 dB DNL, >65 dB DNL). A Monte Carlo simulation with 2000 iterations was run to obtain incremental burden estimates and uncertainty intervals. One-way sensitivity analyses for noise effect parameters were conducted.

RESULTS

Increased aircraft noise exposure was estimated to produce (discounted) incremental mortality costs of $362 million, morbidity costs of $336 million, and losses of 15,326 Quality-Adjusted Life Years (QALYs) over the next 30 years. Sensitivity analyses revealed the greatest uncertainty for CVD outcomes.

IMPACT

NextGen is a system that can increase the operational efficiency of airports by optimizing flight patterns. While operational efficiency is beneficial in many ways, changes in flight patterns and volume can also produce noise pollution, a major public health concern that should be considered in policy decision-making. This study quantifies the long-term health and economic implications of increased aircraft noise exposure following the implementation of NextGen in communities near the Baltimore-Washington International Airport. Our findings underscore the importance of considering public health consequences of noise pollution.

Impact of live microbe intake on cardiovascular disease and mortality in adults with diabetes: A nationwide cohort study

OBJECTIVE

This study examines the association between dietary intake of live microbes (LM) and the risk of cardiovascular disease (CVD) and cardiovascular mortality in adults with diabetes.

METHODS

A retrospective cohort study was conducted using National Health and Nutrition Examination Survey (NHANES) data from 2001 to 2010, with follow-up mortality data through December 31, 2019. A total of 3,955 adults with diabetes were included. Dietary LM intake was categorized as low (LLM), medium (MLM), or high (HLM). Multivariate weighted logistic regression assessed the relationship between LM intake and CVD, and weighted Cox proportional hazards models were used to evaluate cardiovascular mortality.

RESULTS

Among the 3,955 participants, 1,064 had CVD. MLM consumers had a significantly lower risk of CVD (OR: 0.55; 95 % CI: 0.33, 0.92) compared to non-consumers, with no significant associations for LLM and HLM. During a median follow-up of 10.5 years, 432 cardiovascular deaths occurred. MLM intake was associated with a lower risk of cardiovascular mortality (HR: 0.65; 95 % CI: 0.49, 0.86).

CONCLUSION

Moderate consumption of dietary live microbes is associated with reduced CVD risk and cardiovascular mortality in adults with diabetes. These findings suggest potential cardiovascular benefits from including LM in the diet of diabetic patients.

Long-duration electrocardiogram classification based on Subspace Search VMD and Fourier Pooling Broad Learning System

Detecting early stages of cardiovascular disease from short-duration Electrocardiogram (ECG) signals is challenging. However, long-duration ECG data are susceptible to various types of noise during acquisition. To tackle the problem, Subspace Search Variational Mode Decomposition (SSVMD) was proposed, which determines the optimal solution by continuously narrowing the parameter subspace and implements data preprocessing by removing baseline drift noise and high-frequency noise modes. In response to the unclear spatial characteristics and excessive data dimension in long-duration ECG data, a Fourier Pooling Broad Learning System (FPBLS) is proposed. FPBLS integrates a Fourier feature layer and a broad pooling layer to express the input data with more obvious features, reducing the data dimension and maintaining effective features. The theory is verified using the MIT-BIH arrhythmia database and achieves better results compared to the latest literature method.

Characteristics and outcomes of out-of-hospital-cardiac-arrest in rural and suburban areas of Sindh, Pakistan: A cross-sectional study

Background

Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs).

Aim

To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan.

Methods

Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh. Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29.

Results

Out of 139 OHCA patients, 75.5 % were males, and 24.5 % were females, with a mean age of 52.78 ± 13.1 years. Most cardiac arrests occurred at home (54.75 %). Only 0.7 % of patients were transported by emergency medical services (EMS), while 59 % arrived via private transport, such as cars or vans. An additional 4.3 % were brought by other ambulance services, including private and philanthropic organizations, and for 36 % of patients, the mode of transportation was undocumented. Cardiac arrests were witnessed in 43.2 % of cases. CPR (either in-hospital or pre-hospital) was performed on 59 % of patients, but only 6.1 % received pre-hospital CPR (Bystander: 1.22 %, Ambulance Staff: 2.44 %, Family Member: 2.44 %). Return of spontaneous circulation (ROSC) was achieved in 14.63 % of patients, while 4.88 % were alive at hospital admission.

Conclusion

This study highlights significant gaps in the chain of survival for OHCA patients in rural and suburban Sindh, Pakistan, including inadequate EMS utilization, low bystander CPR rates, and delayed hospital care, contributing to poor outcomes. The findings may underestimate true rates due to missing and inconsistent data, emphasizing the need for improved documentation and prospective studies.

Machine Learning-Based Prediction of Unplanned Readmission Due to Major Adverse Cardiac Events Among Hospitalized Patients with Blood Cancers

BackgroundHospitalized patients with blood cancer face an elevated risk for cardiovascular diseases caused by cardiotoxic cancer therapies, which can lead to cardiovascular-related unplanned readmissions.ObjectiveWe aimed to develop a machine learning (ML) model to predict 90-day unplanned readmissions for major adverse cardiovascular events (MACE) in hospitalized patients with blood cancers.DesignA retrospective population-based cohort study.MethodsWe analyzed patients aged ≥18 with blood cancers (leukemia, lymphoma, myeloma) using the Nationwide Readmissions Database. MACE included acute myocardial infarction, ischemic heart disease, stroke, heart failure, revascularization, malignant arrhythmias, and cardiovascular-related death. Six ML algorithms (L2-Logistic regression, Support Vector Machine, Complement Naïve Bayes, Random Forest, XGBoost, and CatBoost) were trained on 2017-2018 data and tested on 2019 data. The SuperLearner algorithm was used for stacking models. Cost-sensitive learning addressed data imbalance, and hyperparameters were tuned using 5-fold cross-validation with Optuna framework. Performance metrics included the Area Under the Receiver Operating Characteristics Curve (ROCAUC), Precision-Recall AUC (PRAUC), balanced Brier score, and F2 score. SHapley Additive exPlanations (SHAP) values assessed feature importance, and clustering analysis identified high-risk subpopulations.ResultsAmong 76 957 patients, 1031 (1.34%) experienced unplanned 90-day MACE-related readmissions. CatBoost achieved the highest ROCAUC (0.737, 95% CI: 0.712-0.763) and PRAUC (0.040, 95% CI: 0.033-0.050). The SuperLearner algorithm achieved slight improvements in most performance metrics. Four leading predictive features were consistently identified across algorithms, including older age, heart failure, coronary atherosclerosis, and cardiac dysrhythmias. Twenty-three clusters were determined with the highest-risk cluster (mean log odds of 1.41) identified by nonrheumatic/unspecified valve disorders, coronary atherosclerosis, and heart failure.ConclusionsOur ML model effectively predicts MACE-related readmissions in hospitalized patients with blood cancers, highlighting key predictors. Targeted discharge strategies may help reduce readmissions and alleviate the associated healthcare burden.

Catheter Ablation of Atrial Fibrillation in Infiltrative Cardiomyopathies: A Narrative Review

Atrial and ventricular arrhythmias are common in patients with Infiltrative heart diseases. This review discusses ablative techniques for arrhythmias in amyloidosis, sarcoidosis, hemochromatosis, and glycogen storage disorders, primarily focusing on atrial fibrillation (AF). A thorough literature review was conducted on the MEDLINE database to synthesize current knowledge and propose future research directions. AF is the most common arrhythmia identified in patients with amyloidosis due to cellular infiltration and atrial dilation. While catheter ablation is associated with a significantly lower rate of all-cause mortality and admission rate, conflicting data exist regarding the higher risk of pericardial effusion, in-hospital mortality, length of stay, and cost of hospitalization. Cardiac sarcoid predisposes AF due to granulomas, atrial dilation, and scarring. Studies demonstrate encouraging outcomes and low recurrence rates in these patients who undergo ablation for AF, with no difference in complications compared to those without sarcoidosis. AF is the most common arrhythmia in hereditary hemochromatosis (HH), secondary to increased myocardial iron stores and elevated oxidative stress, and is primarily managed by chelation. Scant reports regarding ablation are described for HH and glycogen storage disorders. Catheter ablation is a safe and effective modality for the treatment of AF in infiltrative cardiomyopathy. Future large-scale trials are needed to confirm these findings.

Usefulness of empiric superior vena cava isolation in paroxysmal atrial fibrillation ablation: a meta-analysis of randomized clinical trials

BACKGROUND

The long-term success rate of pulmonary vein isolation (PVI) is suboptimal due to the presence of non-pulmonary vein (PV) foci that can trigger atrial fibrillation (AF) in up to 11%. Among non-PV triggers, the superior vena cava (SVC) is a major site of origin of ectopic beats initiating AF.

OBJECTIVE

To compare data from randomized controlled trials (RCTs) assessing PVI + empiric SVC isolation (SVCI) versus PVI alone in terms of AF recurrence, procedure-related complications, and fluoroscopic and procedural times.

METHODS

A search of online scientific libraries (from inception to April 1, 2024) was performed. Four RCTs were considered eligible for the meta-analysis totaling 600 patients of whom 287 receiving PVI + SVCI and 313 receiving PVI alone.

RESULTS

In the overall population, SVCI + PVI was associated with a non-significant reduction of AF recurrence at follow-up (0.66 [0.43;1.00], p = 0.05, I2 0%). In patients with paroxysmal AF (PAF), a significant reduction of AF recurrence was related to SVCI + PVI (11.7%) as compared to PVI alone (19.9%) (0.54 [0.32;0.92], p = 0.02, I2 0%). No statistical differences were found among the groups in terms of fluoroscopic (3.31 [- 0.8;7.41], p = 0.11, I2 = 91%), procedural times (5.69 [- 9.78;21.16], p = 0.47, I2 = 81%), and complications (1.06 [0.33;3.44], p = 0.92, I2 = 0%).

CONCLUSION

The addition of SVCI to PVI in patients in PAF is associated with a significant lower rate of AF recurrence at follow-up, without increasing complication rates and procedural and fluoroscopy times.

Improving STEMI Management Internationally: Initial Report of the American College of Cardiology-Global Heart Attack Treatment Initiative

Background

The burden of ST-segment elevation myocardial infarction (STEMI) worldwide is increasing as the leading cause of death; there are scant data on system-based initiatives and performance metrics relative to its management in low- and middle-income countries where resources are frequently limited.

Objectives

The Global Heart Attack Treatment Initiative (GHATI) ultimate aim is improving evidence-based STEMI care, adherence to guidelines, and tracking of clinical and institutional indicators in low- and middle-income countries. To achieve that goal, the process of care and outcomes of STEMI patients in those nations will be studied.

Methods

In this initial phase of GHATI (2019-2021), prospective analyses of selected STEMI metrics derived from the American College of Cardiology Chest Pain MI Registry were undertaken in 18 international hospitals, most located in developing countries unfamiliar with quality improvement metrics.

Results

Of 4,092 patients enrolled, complete data were available in 3,914 consecutive STEMIs included here: 80.5% male; 35.5% smokers; shock on arrival in 10%; and 5.1% with cardiac arrest before intervention. Overall, a 2% improvement on combined endpoints (shock; arrest before or after intervention; final ejection fraction <40%; survival at discharge) was observed over time, and survivorship also increased by 2% (P = 0.003). First medical contact to device time <90 minutes occurred in 74.8%; reperfusion therapy in 94.2%; and adherence to guidelines in 91.8%.

Conclusions

This global contemporary registry successfully enrolled STEMI patients in nations generally unfamiliar with quality improvement metrics; trends of improvement in their care were observed. GHATI may facilitate implementation of policies aimed at enhancing outcomes of cardiovascular disease worldwide, particularly in countries with evolving economies.

Hospital readmissions following catheter ablation for atrial fibrillation with THERMOCOOL™ STSF/ THERMOCOOL™ ST catheter with CARTO™ 3 system versus TactiCath™ catheter with EnSite™ system

Aim: Radiofrequency (RF) catheter ablation (CA) is a mainstay treatment for atrial fibrillation (AF). RF catheters with contact force (CF) sensing technology and electroanatomical mapping systems enable real-time assessment of catheter tip-tissue interface CF, facilitating individualized and precise CA. This study examined inpatient hospital readmissions in patients with AF treated with THERMOCOOL™ ST/ THERMOCOOL™ STSF catheter with the CARTO™ 3 System versus TactiCath™ catheter with the EnSite™ System. Materials & methods: Patients undergoing CA for AF between 1 July 2019 to 30 November 2021 were identified from the Premier Healthcare Database and grouped based on use of THERMOCOOL ST/STSF or TactiCath™. Study outcomes were all-cause, cardiovascular (CV)-, and AF-related inpatient readmission at 91-365-day post-CA. Inverse probability of treatment weighting of propensity scores balanced baseline patient, comorbidity and hospital characteristics. A weighted generalized estimating equation (GEE) model examined differences in readmission outcomes. Results: A total of 15,518 patients met inclusion criteria (THERMOCOOL ST/STSF, n = 13,001; TactiCath™, n = 2517). Patient characteristics were generally well-balanced after weighting. Patients treated with THERMOCOOL ST/STSF + CARTO 3 had a 20% lower likelihood of all-cause inpatient readmissions (7.8 vs 9.3%, chi-square p = 0.041; odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.66-0.96, GEE p = 0.019) and a 21% lower likelihood of CV-related inpatient readmission (5.2 vs 6.2%, chi-square p = 0.133, OR: 0.79, 95% CI: 0.62-0.99, GEE p = 0.043) in 91-365-days post-CA versus those treated with TactiCath™ + Ensite. No significant differences were observed for AF-related readmissions. Conclusion: Patients undergoing CA for AF treated with THERMOCOOL ST/STSF + CARTO 3 had a significantly lower risk of all-cause and CV-related inpatient hospital readmission versus those treated with TactiCath™ + Ensite.

Association Between Occupational Sitting With High Sensitivity C-Reactive Protein: The Jackson Heart Study

Modifiable, behavioral risk factors like occupational sitting may contribute to inflammation, an important cardiovascular risk factor. This study evaluated the association of self-reported occupational sitting with changes in c-reactive protein (CRP) and the role of sex. We examined occupational sitting and baseline CRP levels for 2889 African American participants in the Jackson Heart Study. Four multivariable linear regression models were estimated to determine the association of occupational sitting and CRP. Analyses were conducted in 2020. The mean age was 50.8 years and 61% were female. Participants who reported occupational sitting as "often/always" had CRP levels of 4.9±6.8 mg/L, "sometimes" had levels of 4.8±8.1 mg/L, and "never/seldom" had levels of 4.3±6.8 mg/L. In the unadjusted model, "often/always" engaging in occupational sitting was significantly associated with higher levels of CRP when compared to "never/seldom" (P < .05). This differed by sex with female participants who reported "often/always" occupational sitting had CRP levels of 6.0±7.6 mg/L compared to only 5.1±6.9 mg/L for "never/seldom." Neither the overall association nor the female-specific association remained statistically significant in the adjusted models. We found an association between occupational sitting and inflammation, measured by CRP. This association varied by sex but did not remain significant after fully adjusting for covariates.

Predicting Factors Affecting Survival Rate in Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery Using Machine Learning Methods: A Systematic Review

Background and Aim

Coronary artery bypass grafting (CABG) is a key treatment for coronary artery disease, but accurately predicting patient survival after the procedure presents significant challenges. This study aimed to systematically review articles using machine learning techniques to predict patient survival rates and identify factors affecting these rates after CABG surgery.

Methods

From January 1, 2015, to January 20, 2024, a comprehensive literature search was conducted across PubMed, Scopus, IEEE Xplore, and Web of Science. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria included studies that evaluated survival rates and predictors associated with CABG patients during the specified period.

Results

After eliminating duplicates, a total of 1330 articles were identified. Following a systematic screening, 24 studies met the inclusion criteria. Our findings revealed 43 distinct factors influencing survival rates in patients undergoing CABG. Notably, five factors-age, ejection fraction, diabetes mellitus, a history of cerebrovascular disease or accidents, and renal function-were consistently identified across multiple studies as significant predictors of postsurgical survival.

Conclusion

This systematic review identifies key factors influencing survival rates after CABG surgery and highlights the role of machine learning in improving predictive accuracy. By identifying high-risk patients through these key factors, our findings offer practical insights for healthcare providers, enhancing patient management and customizing therapeutic strategies after CABG. This study significantly enhances existing literature by combining machine learning techniques with clinical factors, thereby improving the understanding of patient outcomes in CABG surgery.

Trends in complications of cardiac and vascular prosthetic devices, implants, and grafts mortality rate in the United States (1999-2020)

To analyze mortality rates due to complications of cardiac and vascular prosthetic devices, implants, and grafts in the United States, International Classification of Diseases, Tenth Revision, codes were used on the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to retrieve death certificate data between the years 1999 and 2020 for patients aged 55 and above. Age-adjusted mortality rates (AAMRs), per 100 000 people, and annual percentage change along with their respective 95% confidence intervals were also calculated. Complications of cardiac and vascular prosthetic devices, implants, and grafts were responsible for 91 539 deaths among adults aged 55 years and older. The overall AAMR decreased from 9.2 in 1999 to 3.4 in 2020. AAMRs for men were higher than for women (overall AAMR men: 7.5; women: 4.5). Stratifying patients according to race the order of AAMRs from highest to lowest was as follows: non-Hispanic Black or African American (6.8), NH White: (5.9), NH American Indian or Alaska Native (5.7), Hispanic or Latino (4.0) and lastly NH Asian or Pacific Islander (3.2). State wise the top 90th percentile states with regard to mortality included West Virginia, South Carolina, Mississippi, North Dakota, and Alabama. In census regions the South had the highest AAMR (6.2) followed by the Midwest (6.0), the Northeast (5.4), and the West (5.1) with nonmetropolitan areas having higher AAMRs (7.0) than metropolitan areas (5.4). Further research and a more individualized pattern of treatment of older patients are necessary moving forward.

Enhancing Clinical Decision Making by Predicting Readmission Risk in Patients With Heart Failure Using Machine Learning: Predictive Model Development Study

Background

Patients with heart failure frequently face the possibility of rehospitalization following an initial hospital stay, placing a significant burden on both patients and health care systems. Accurate predictive tools are crucial for guiding clinical decision-making and optimizing patient care. However, the effectiveness of existing models tailored specifically to the Chinese population is still limited.

Objective

This study aimed to formulate a predictive model for assessing the likelihood of readmission among patients diagnosed with heart failure.

Methods

In this study, we analyzed data from 1948 patients with heart failure in a hospital in Sichuan Province between 2016 and 2019. By applying 3 variable selection strategies, 29 relevant variables were identified. Subsequently, we constructed 6 predictive models using different algorithms: logistic regression, support vector machine, gradient boosting machine, Extreme Gradient Boosting, multilayer perception, and graph convolutional networks.

Results

The graph convolutional network model showed the highest prediction accuracy with an area under the receiver operating characteristic curve of 0.831, accuracy of 75%, sensitivity of 52.12%, and specificity of 90.25%.

Conclusions

The model crafted in this study proves its effectiveness in forecasting the likelihood of readmission among patients with heart failure, thus serving as a crucial reference for clinical decision-making.

Feasibility study of 'Triple-Low' technique for coronary artery computed tomography angiography (CCTA)

This study aims to explore the feasibility of applying the "Three-Low" technique (low injection rate, low iodine contrast volume, low radiation dose) in coronary CT angiography (CCTA). We prospectively collected data from 90 patients who underwent CCTA at our hospital between 2021 and 2024. The patients were randomly assigned to either the experimental group (n = 45) or the control group (n = 45). The experimental group parameters were as follows: injection rate of 3.5-4.0 ml/s, iodine contrast volume of 35-40 ml, tube voltage of 100 kVp, and tube current of 250 mA. The control group parameters were: injection rate of 4.5-5.0 ml/s, iodine contrast volume of 45-50 ml, tube voltage of 120 kVp, and tube current of 450 mA. Both groups received a high-concentration, non-ionic, water-soluble contrast agent (Iomeprol, 40 gl/100 ml). The heart rate of all patients was ≤ 70 bpm, and breath-hold scanning was performed after breathing training. The study compared the CT values of the left anterior descending artery, left circumflex artery, right coronary artery, and aorta, as well as background noise, signal-to-noise ratio (SNR), volumetric CT dose index, dose-length product, effective radiation dose, and total iodine dose between the two groups. In the control group, no cases of contrast extravasation occurred, while 6 cases of extravasation were observed in the experimental group (p = 0.026). There was no significant difference between the groups in terms of vascular image quality (mean vascular image quality score: experimental group 4.27 ± 0.62 vs. control group 4.24 ± 0.57, p > 0.05) or vascular motion artifact score (mean vascular motion artifact score: experimental group 4.20 ± 0.59 vs. control group 4.13 ± 0.55, p > 0.05). However, significant differences were found between the experimental and control groups in the CT values of the left anterior descending artery (experimental group: 571.31 ± 49.66 HU vs. control group: 449.20 ± 36.80 HU, p < 0.05), left circumflex artery (experimental group: 570.41 ± 49.98 HU vs. control group: 450.95 ± 39.27 HU, p < 0.05), right coronary artery (experimental group: 584.52 ± 53.70 HU vs. control group: 452.66 ± 40.67 HU, p < 0.05), aorta (experimental group: 624.91 ± 48.99 HU vs. control group: 465.36 ± 34.37 HU, p < 0.05), background noise (experimental group: 24.76 ± 1.97 vs. control group: 19.09 ± 1.69, p < 0.05), SNR (experimental group: 25.30 ± 1.81 vs. control group: 24.47 ± 1.75, p < 0.05), volumetric CT dose index (experimental group: 22.97 ± 1.47 mGy vs. control group: 50.53 ± 4.89 mGy, p < 0.05), dose-length product (experimental group: 363.68 ± 21.45 mGy·cm vs. control group: 782.41 ± 58.20 mGy·cm, p < 0.05), and effective radiation dose (experimental group: 5.09 ± 0.30 mSv vs. control group: 10.95 ± 0.81 mSv, p < 0.05).The results of the Fisher test indicated that the extravasation rate was significantly higher in the high injection rate group compared to the low injection rate group (P = 0.024). The "Three-Low" technique in CCTA imaging effectively reduces the incidence of contrast extravasation caused by high injection rates and decreases the radiation dose, making it a highly feasible option for clinical application and worthy of broader adoption.

Global burden of cardiovascular disease mortality attributable to secondhand smoke, 1990-2019: Systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND

Few studies have globally assessed the cardiovascular disease (CVD) mortality burden attributable to secondhand smoke. We aimed to address this research gap.

METHODS

We used a systematic analysis design using data from the Global Burden of Disease Study 2019. Our primary outcome measures were the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) for CVD attributable to secondhand smoke. The annual average percentage change (AAPC) was utilized to describe the temporal trends of ASMR and DALYs.

RESULTS

From 1990 to 2019, global ASMR for CVD due to secondhand smoke decreased from 11.45 (95% CI: 9.47 to 13.42) to 7.43 (95% CI: 6.09 to 8.85), and DALYs decreased from 274.12 (95% CI: 225.36 to 322.20) to 176.93 (95% CI: 145.21 to 211.28). ASMR and DALYs attributable to secondhand smoke are on the rise in 47 countries, with 18 of these countries experiencing increases across both genders and all cardiovascular subtypes. Uzbekistan, Lesotho, and the Philippines have the highest AAPC for CVD due to secondhand smoke in ASMR and DALYs. Specifically, Uzbekistan's overall ASMR AAPC is 2.2 (95%CI: 2.1-2.3), Lesotho's is 1.3 (95%CI: 1.2-1.3), and the Philippines' is 1.1 (95%CI: 1.0-1.2). In terms of DALYs, the AAPC values are 1.7 for Uzbekistan (95%CI: 1.7-1.8), 1.4 for Lesotho (95%CI: 1.3-1.5), and 1.8 for the Philippines (95%CI: 1.7-1.9).

CONCLUSION

Over the past three decades, the epidemiological landscape of CVD mortality associated with secondhand smoke has undergone significant shifts. Notwithstanding global advancements, intensified interventions are paramount in regions experiencing ascending rates.

Developing a Charlson Comorbidity Index for the American Indian Population Using the Epidemiologic Data from the Strong Heart Study

BACKGROUND

The Charlson Comorbidity Index (CCI) is a frequently used mortality predictor based on a scoring system for the number and type of patient comorbidities health researchers have used since the late 1980s. The initial purpose of the CCI was to classify comorbid conditions, which could alter the risk of patient mortality within a 1-year time frame. However, the CCI may not accurately reflect risk among American Indians because they are a small proportion of the US population and possibly lack representation in the original patient cohort. A motivating factor in calibrating a CCI for American Indians is that this population, as a whole, experiences a greater burden of comorbidities, including diabetes mellitus, obesity, cancer, cardiovascular disease, and other chronic health conditions, than the rest of the US population.

METHODS

This study attempted to modify the CCI to be specific to the American Indian population utilizing the data from the still ongoing The Strong Heart Study (SHS) - a multi-center population-based longitudinal study of cardiovascular disease among American Indians. A 1-year survival analysis with mortality as the outcome was performed using the SHS morbidity and mortality surveillance data and assessing the impact of comorbidities in terms of hazard ratios with the training cohort. A Kaplan-Meier plot for a subset of the testing cohort was used to compare groups with selected mCCI-AI scores.

RESULTS

A total of 3038 Phase VI participants from the SHS comprised the study population for whom mortality and morbidity surveillance data were available through December 2019. The weights generated by the SHS participants for myocardial infarction, congestive heart failure, and high blood pressure were greater than Charlson's original weights. In addition, the weights for liver illness were equivalent to Charlson's severe form of the disease. Lung cancer had the greatest overall weight derived from a hazard ratio of 8.31.

CONCLUSIONS

The mCCI-AI was a statistically significant predictor of 1-year mortality, classifying patients into different risk strata χ2 (8, N = 1,245) = 30.56 (p = 0.0002). The mCCI-AI was able to discriminate between participants who died and those who survived 73% of the time.

Transcatheter Approaches to Atrial Functional Mitral Regurgitation: How Far Have We Come?

Functional mitral regurgitation (MR) is associated with increased cardiovascular morbidity and mortality and over the past decade, the diagnosis of atrial functional mitral regurgitation (aFMR) has been increasingly observed in the elderly, especially in those with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering distinguish the pathophysiology of aFMR from the one of ventricular origin. However, no consensus provides recommendations regarding the differential diagnosis and the subsequent management of aFMR. The advent of transcatheter mitral valve repair has paved the way for various treatments including edge-to-edge repair (TEER), mitral annuloplasty, and replacement, with optimistic results on short-medium-term outcome provided by preliminary studies. In parallel, rhythm control of AF for paroxysmal and persistent types, should be pursued to induce reverse remodeling and restoring the normal leaflet coaptation. In this setting, catheter ablation aiming for electrical isolation of the pulmonary veins is the most widely recognized and effective strategy for maintaining sinus rhythm. Nevertheless, arrhythmia-free survival is lower in patients with persistent and long-term persistent AF, leading to the adoption of hybrid strategies combining transcatheter endocardial ablation and thoracoscopic epicardial surgical ablation. This review provides an update on the diagnosis and treatment of aFMR, focusing on available transcatheter approaches that can be performed in the catheterization lab and electrophysiology lab.

Stroke in Athletes with Atrial Fibrillation: A Narrative Review

Atrial fibrillation (AF) is the most common sustained arrhythmia, linked with a significantly heightened risk of stroke. While moderate exercise reduces AF risk, high-level endurance athletes paradoxically exhibit a higher incidence. However, their stroke risk remains uncertain due to their younger age, higher cardiovascular fitness, and lower rate of comorbidities. Several key studies highlight that AF may increase the risk of stroke in endurance athletes, particularly those over 65. However, the overall risk within this population remains relatively low. Notably, older male athletes show a higher AF incidence but experience lower stroke risk than their non-athletic counterparts. Regular physical activity prior to a first stroke appears to reduce mortality, though recurrent stroke risk in athletes with AF mirrors that of non-athletes, despite an elevated AF incidence. Management of AF in athletes is complex, with limited evidence guiding anti-thrombotic strategies. In this setting, specific recommendations are sparse, particularly in sports where bleeding risk is heightened. Individualized management, emphasizing shared decision-making, is critical to balance stroke prevention with athletic performance. Rhythm control strategies, such as catheter ablation, may be a reasonable first-line treatment option for athletes, particularly in those desiring to avoid long-term medication. This review synthesizes the current literature on the incidence, predictors, and management of stroke in athletes with AF.

Interaction Effects Between COVID-19 Outbreak and Fever on Mortality Among OHCA Patients Visiting Emergency Departments

Background and Objectives: Fever in patients who have suffered an out-of-hospital cardiac arrest (OHCA) has been linked to poor clinical outcomes, as a fever can exacerbate neurological damage, increase metabolic demands, and trigger inflammatory responses. This study evaluates the impact of the COVID-19 outbreak and associated fevers on OHCA outcomes and examines how they can worsen patient prognosis. Materials and Methods: Our retrospective observational analysis used data from the National Emergency Department Information System (NEDIS), comprising adult OHCA patients at 402 EDs in Korea between 27 January and 31 December 2020 (COVID-19 pandemic period) and the corresponding period in 2019 (pre-COVID-19). The primary outcome was in-hospital mortality, with the COVID-19 outbreak as the main exposure variable and fever as an important interaction variable. We employed multilevel multivariate logistic regression with an interaction term (year of visit × fever) to examine the effects of COVID-19 and fever on mortality. Risk-adjusted mortality rates were calculated, and a difference-in-difference analysis evaluated the impact of COVID-19 on excess mortality by fever status. Results: During COVID-19, in-hospital mortality was higher among OHCA patients compared to the pre-pandemic period (adjusted OR 1.22, 95% CI 1.11-1.34), particularly among febrile patients (adjusted OR 1.40, 95% CI 1.24-1.59). Interaction analysis revealed that COVID-19 disproportionately increased mortality in febrile OHCA patients compared with non-febrile patients (difference-in-difference: 0.8%, 95% CI 0.2-1.5). Conclusions: Our study found that the COVID-19 pandemic significantly increased mortality among OHCA patients, with febrile patients experiencing disproportionately worse outcomes due to systemic delays and pandemic-related disruptions.

Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction

BACKGROUND

The incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes.

METHODS

We included first-ever stroke patients from the eICU Collaborative Research Database in 2014-2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital's ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score.

RESULTS

The primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0-68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0-77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38-2.66) and hospital (HR 1.69, 95% CI 1.32-2.16) all-cause mortality, compared with low TyG group (TyG < 9.265). TyG was also correlated with ICU length of stay (r = 0.077), hospital length of stay (r = 0.042), and Glasgow Coma Score (r = -0.132). TyG and other six features were used to construct ML models. The random forest model performed best in internal validation with AUC (0.900) and G-mean (0.443), and in external validation with AUC (0.776) and G-mean (0.399).

CONCLUSION

TyG (optimal cut-off: 9.265) was identified as an independent risk factor for ICU and hospital all-cause mortality in first-ever strokes. The ML model incorporating TyG demonstrated strong predictive performance. This emphasises the importance of insulin resistance (with TyG as a surrogate measure) in the prognostic assessment and early risk stratification of first-time stroke patients.

Association of social vulnerability and depression incidence post intracerebral haemorrhage: a cohort study

Objectives

Survivors of intracerebral haemorrhage (ICH) are at high risk of incident depression, which is modified by social determinants of health (SDOH) and associated with worse functional outcomes. We sought to determine the role of prestroke SDOH in depression incidence after ICH to better characterise post-ICH outcomes.

Study design

We analysed data from a cohort study of ICH survivors without prestroke depression, presenting at Massachusetts General Hospital between 2006 and 2017. We collected information from electronic health records (EHR), follow-up interviews and CT/MRI. The relationship between social vulnerability, air quality and post-ICH depression incidence within 12 months of acute haemorrhage was investigated using logistic regression models that also included EHR and CT/MRI information as predictors.

Results

Participants were 576 survivors, median age of 72 (IQR=61-81), 317 (55%) self-reported as male and 482 (84%) as white. 204 (35%) were diagnosed with depression within 12 months of ICH. Hospital admission longer than 1 week (OR 1.80, 95% CI 1.08 to 3.00), cerebral amyloid angiopathy (CAA) burden (OR 1.45, 95% CI 1.25 to 1.68) and social vulnerability (OR 3.03, 95% CI 1.49 to 6.19) were associated with depression incidence post-ICH.

Conclusions

In addition to CAA burden and patient location 1-week post-ICH, social vulnerability was independently associated with depression among ICH survivors. Our findings suggest that social vulnerability influences ICH outcomes. Future studies should investigate how poststroke clinical care interventions can address SDOH effects to reduce incident depression and improve outcomes among ICH survivors.

Advances in genetically modified neural stem cell therapy for central nervous system injury and neurological diseases

Neural stem cells (NSCs) have increasingly been recognized as the most promising candidates for cell-based therapies for the central nervous system (CNS) injuries, primarily due to their pluripotent differentiation capabilities, as well as their remarkable secretory and homing properties. In recent years, extensive research efforts have been initiated to explore the therapeutic potential of NSC transplantation for CNS injuries, yielding significant advancements. Nevertheless, owing to the formation of adverse microenvironment at post-injury leading to suboptimal survival, differentiation, and integration within the host neural network of transplanted NSCs, NSC-based transplantation therapies often fall short of achieving optimal therapeutic outcomes. To address this challenge, genetic modification has been developed an attractive strategy to improve the outcomes of NSC therapies. This is mainly attributed to its potential to not only enhance the differentiation capacity of NSCs but also to boost a range of biological activities, such as the secretion of bioactive factors, anti-inflammatory effects, anti-apoptotic properties, immunomodulation, antioxidative functions, and angiogenesis. Furthermore, genetic modification empowers NSCs to play a more robust neuroprotective role in the context of nerve injury. In this review, we will provide an overview of recent advances in the roles and mechanisms of NSCs genetically modified with various therapeutic genes in the treatment of neural injuries and neural disorders. Also, an update on current technical parameters suitable for NSC transplantation and functional recovery in clinical studies are summarized.

Long-Term Statin Use Is Associated With Reduced Rates of Adverse Events in Patients With Newly Diagnosed Atrial Fibrillation

BACKGROUND

The effectiveness of statin use in preventing adverse cardiovascular events in individuals with atrial fibrillation (AF) has remained uncertain. This study aimed to assess whether statin use could lead to better outcomes among individuals with AF.

METHODS AND RESULTS

We enrolled 397 787 patients with AF from January 1, 2012 to December 31, 2020. Patients with AF were divided into 2 groups (statin user and statin nonuser), and the risks of composite outcomes (including ischemic stroke, hemorrhagic stroke, and transient ischemic attack), all-cause death, and major adverse cardiovascular events (which encompassed cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization) were analyzed. We analyzed 288 958 patients with newly diagnosed AF (mean age, 73 years; 44% women; mean CHA2DS2-VASc score, 3.5). Compared with patients without statin use, statin users had lower risks of composite end points (adjusted hazard ratio [HR], 0.91 [95% CI, 0.87-0.94]; P<0.01). In regard to all-cause death, statin users exhibited a 67% risk reduction compared with statin nonusers (adjusted HR, 0.33 [95% CI, 0.32-0.33]; P<0.01). Statin use was also associated with reduced incidence of major adverse cardiovascular events (adjusted HR, 0.64 [95% CI, 0.63-0.66]; P<0.01). In the subgroups stratified by CHA2DS2-VASc score, statin therapy was particularly effective for patients with CHA2DS2-VASc scores 0 to 3 for composite end points but consistently reduced all-cause mortality and major adverse cardiovascular events across all score categories.

CONCLUSIONS

Among patients with newly diagnosed AF, statin use was associated with lower risk of ischemic stroke, hemorrhagic stroke, transient ischemic attack, all-cause mortality, and major adverse cardiovascular events.

Plasma fibroblast growth factor 21 and risk of cognitive impairment among patients with ischemic stroke

BACKGROUND AND AIMS

Previous study reported that plasma fibroblast growth factor 21 (FGF-21) was associated with poor prognosis in patients with ischemic stroke. The purpose of present study was to prospectively investigate the relationship between plasma FGF-21 and post-stroke cognitive impairment (PSCI).

METHODS

A total of 600 patients from 7 hospitals were included in this study and plasma FGF-21 levels were examined for all the participants. Cognitive impairment was evaluated using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at 3 months after ischemic stroke onset.

RESULTS

323(53.8 %) or 419(69.8 %) participants had PSCI according to MMSE or MoCA at 3 months, respectively. After adjustment for age, National Institutes of Health stroke score, education, and other covariates, the odds ratio of PSCI defined by MMSE and MoCA for the highest vs lowest quartile of plasma FGF-21 was 1.77(1.05-2.98) and 2.40(1.35-4.29), respectively. Multiple-adjusted spline regression model showed a linear association between FGF-21 levels and PSCI (all P < 0.005 for linearity). Subgroup analyses further confirmed these results.

CONCLUSION

Elevated plasma FGF-21 level was associated with PSCI at 3 months after stroke independently of established conventional risk factors, suggesting that plasma FGF-21 may have potential prognostic value in risk stratification of PSCI.

Exogenous leptin alleviates glutamate-excitotoxic injury caused by cerebral ischemia-reperfusion in mice by affecting the expression of glutamate transporters

Ischemic stroke is characterized by high morbidity and mortality and a lack of effective therapeutic interventions. Leptin plays an important role in regulating oxidative stress, angiogenesis, hematopoiesis, etc. Although recent studies have found a neuroprotective effect of leptin, little is known about its role in cerebral ischemia. This study explores the possible roles and potential preventative mechanisms of leptin in cerebral ischemia-reperfusion injury (CIRI). An in vivo middle cerebral artery occlusion/reperfusion (MCAO/R) mouse model was used to replicate the CIRI model, low (0.5 mg/kg), medium (1 mg/kg) and high (2 mg/kg) concentrations of leptin were injected intraperitoneally immediately after inserting the embolic line. After 1.5 h of ischemia and 24 h of reperfusion, we examined the neural function of the mice, collected brain tissue for histological examination, and screened for the optimal concentrations of leptin intervention. On this basis, we observed the changes of cortical apoptosis injury, intracellular calcium fluorescence intensity and astrocyte glial fibrillary acidic protein (GFAP) expression and morphological changes. In addition, we also tested the expression of transporters and metabolism-related enzymes (VGLUT-1, VGLUT-2, GLAST, GLT-1, GS, ATP1α1), the expression of inflammatory factors and the content of glutamate (Glu). Compared with the I/R group, we found that leptin improved neurological deficits, reduced the area of infarcts, maintained the normal morphology of astrocytes (AST), downregulated the expression of VGLUT-1, and upregulates the expression of GLT-1 and GLAST, thereby reducing the content of Glu in the synaptic cleft. Our studies suggest that leptin may have a neuroprotective effect by decreasing the excitotoxicity of glutamate.

Left atrial strain measured by three-dimensional echocardiography predicts atrial fibrillation in the general population

BACKGROUND

Left atrial (LA) strain by three-dimensional echocardiography (3DE), has been proposed as a more accurate measure of LA function, providing incremental prognostic benefits over traditional two-dimensional approaches.

OBJECTIVES

Our aim was to evaluate the prognostic value of LA strain by 3DE in predicting incident atrial fibrillation (AF) in the general population.

METHODS

The study included 4466 participants from a prospective longitudinal cohort study in the general population, among these 3DE LA strain was analysed in 1935 participants. The endpoint was incident AF. Adjustments were made for the CHARGE-AF clinical risk score.

RESULTS

Mean age was 54 ± 17 years, 43 % were male. During a median follow-up time of 4.8 years (interquartile range 4.3-5.5 years) 59 participants (3.0 %) developed AF. In univariable analysis, all three parameters were associated with incident AF (p value for all <0.01). After multivariable adjustments, only LA reservoir strain (LASr) and LA contractile strain (LASct) were associated with incident AF (LASr: HR 1.12 (1.07-1.17), p < 0.001, per 1 % decrease; LASct: HR 1.16 (1.09-1.24), p < 0.001, per 1 % decrease), whereas LA conduit strain (LAScd) was not (HR 1.04 (0.98-1.10), p = 0.17, per 1 % decrease). Both LASr (continuous net reclassification index 0.37 ± 0.14; p = 0.003) and LASct (continuous net reclassification index 0.41 ± 0.14; p = 0.002) provided incremental prognostic information beyond the CHARGE-AF risk score.

CONCLUSION

LASr and LASct measured by 3DE are independently associated with incident AF and provided incremental prognostic information beyond existing risk scores.

Dynamic biomarker profiles in patients with paroxysmal atrial fibrillation: Assessing the differences between sinus rhythm and acute atrial fibrillation episode

BACKGROUND

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, yet its underlying pathophysiology remains poorly understood. This study assessed whether circulating biomarker concentrations differ in paroxysmal AF patients during an acute episode compared to sinus rhythm.

METHODS

The Time of Calamity study is a prospective biomarker study within the RACE V study. Patients underwent venous blood sampling in sinus rhythm at inclusion in RACE V, as well as during a subsequent acute episode of AF for which patients reported to the hospital. Ten biomarkers were analyzed.

RESULTS

Thirty-nine patients (mean age 60 ± 9 years, 10 (25 %) women) were enrolled. During an acute AF episode, dickkopf-related protein 3 and insulin-like growth factor binding protein 7 were significantly lower, while N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitive troponin T (hsTnT), growth differentiation factor 15, and interleukin 6 were significantly higher (all p < 0.05).

CONCLUSIONS

Biomarker concentrations in paroxysmal AF patients are dynamic and differ between sinus rhythm and acute AF episodes. Notably, NT-proBNP and hsTnT, commonly used in clinical practice, were significantly elevated during an acute AF episode.

Enhancing Heart Rate-Based Estimation of Energy Expenditure and Exercise Intensity in Patients Post Stroke

BACKGROUND

Indirect calorimetry is the gold standard field-testing technique for measuring energy expenditure and exercise intensity based on the volume of oxygen consumed (VO2, mL O2/min). Although heart rate is often used as a proxy for VO2, heart rate-based estimates of VO2 may be inaccurate after stroke due to changes in the heart rate-VO2 relationship. Our objective was to evaluate in people post stroke the accuracy of using heart rate to estimate relative walking VO2 (wVO2) and classify exercise intensity. Moreover, we sought to determine if estimation accuracy could be improved by including clinical variables related to patients' function and health in the estimation.

METHODS

Sixteen individuals post stroke completed treadmill walking exercises with concurrent indirect calorimetry and heart rate monitoring. Using 70% of the data, forward selection regression with repeated k-fold cross-validation was used to build wVO2 estimation equations that use heart rate alone and together with clinical variables available at the point-of-care (i.e., BMI, age, sex, and comfortable walking speed). The remaining 30% of the data were used to evaluate accuracy by comparing (1) the estimated and actual wVO2 measurements and (2) the exercise intensity classifications based on metabolic equivalents (METs) calculated using the estimated and actual wVO2 measurements.

RESULTS

Heart rate-based wVO2 estimates were inaccurate (MAE = 3.11 mL O2/kg/min) and unreliable (ICC = 0.68). Incorporating BMI, age, and sex in the estimation resulted in improvements in accuracy (MAE Δ: -36.01%, MAE = 1.99 mL O2/kg/min) and reliability (ICC Δ: +20, ICC = 0.88). Improved exercise intensity classifications were also observed, with higher accuracy (Δ: +29.85%, from 0.67 to 0.87), kappa (Δ: +108.33%, from 0.36 to 0.75), sensitivity (Δ: +30.43%, from 0.46 to 0.60), and specificity (Δ: +17.95%, from 0.78 to 0.92).

CONCLUSIONS

In people post stroke, heart rate-based wVO2 estimations are inaccurate but can be substantially improved by incorporating clinical variables readily available at the point of care.

Direct cardiac reprogramming via combined CRISPRa-mediated endogenous Gata4 activation and exogenous Mef2c and Tbx5 expression

Direct cardiac reprogramming of fibroblasts into induced cardiomyocytes (iCMs) can be achieved by ectopic expression of cardiac transcription factors (TFs) via viral vectors. However, risks like genomic mutations, viral toxicity, and immune response limited its clinical application. Transactivation of endogenous TFs emerges as an alternative approach that may partially mitigate some of the risks. In this study, we utilized a modified CRISPRa/dCas9 strategy to transactivate endogenous reprogramming factors MEF2C, GATA4, and TBX5 (MGT) to induce iCMs from both mouse and human fibroblasts. We identified single-guide RNAs (sgRNAs) targeting promoters and enhancers of the TFs capable of activating various degrees of endogenous gene expression. CRISPRa-mediated Gata4 activation, combined with exogenous expression of Mef2c and Tbx5, successfully converted fibroblasts into iCMs. Despite extensive sgRNA screening, transactivation of Mef2c and Tbx5 via CRISPRa remained less effective, potentially due to de novo epigenetic barriers. While future work and refined technologies are needed to determine whether cardiac reprogramming could be achieved solely through CRISPRa activation of endogenous factors, our findings provide proof of concept that reliance on exogenous TFs for reprogramming can be reduced through CRISPRa-mediated activation of endogenous factors, particularly Gata4, offering a novel strategy to convert scar-forming fibroblasts into iCMs for regenerative purposes.

Buyang huanwu decoction improves synaptic plasticity of ischemic stroke by regulating the cAMP/PKA/CREB pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Ischemic stroke is an acute central nervous system disease that poses a threat to human health. It induces a series of severe pathological mechanisms, ultimately leading to neuronal cell death in the brain due to local ischemia and hypoxia. Buyang Huanwu decoction (BYHWD), as a representative formula for treating ischemic stroke, has shown good therapeutic effects in stroke patients.

AIM OF THE STUDY

This study aimed to explore the mechanism of BYHWD in promoting neural remodeling after ischemic stroke from the perspective of neuronal synaptic plasticity, based on the cAMP/PKA/CREB signaling pathway.

MATERIALS AND METHODS

A modified suture technique was employed to establish a rat model of MCAO. The rats were divided into sham, model, and BYHWD (20 g/kg) groups. After the corresponding intervention, rat brains from each group were collected. TMT quantitative proteomics technology was employed for the research. Following proteomics studies, we investigated the mechanism of BYHWD in the intervention of ischemic stroke through animal experiments and cell experiments. The experimental animals were divided into sham, model, and BYHWD (5 g/kg, 10 g/kg, and 20 g/kg) groups. Infarct volume and severity of brain injury were measured by TTC staining. HE staining was utilized to evaluate alterations in tissue morphology. The Golgi staining was used to observe changes in cell body, dendrites, and dendritic spines. Transmission electron microscopy was used to observe the ultrastructure of synapses in the cortex and hippocampus. TUNEL staining was conducted to identify apoptotic neurons. Meanwhile, a stable and reliable (OGD/R) SH-SY5Y cell model was established. The effect of BYHWD-containing serum on SH-SY5Y cell viability was measured by CCK-8 kit. The apoptosis situation of SH-SY5Y cells was determined by Annexin V-FITC/PI. Immunofluorescence was employed to measure the fluorescence intensity of synaptic-related factors Syt1, Psd95, and Syn1. Synaptic plasticity pathways were assessed by using RT-qPCR and Western blot to determine the expression levels of cAMP, Psd95, Prkacb, Creb1/p-Creb1, BDNF, Shank2, Syn1, Syt1, Bcl-2, Bcl-2/Bax mRNA and proteins.

RESULTS

After treatment with BYHWD, notable alterations were detected in the signaling pathways linked to synaptic plasticity and the cAMP signaling pathway-related targets among the intervention targets. This trend of change was also reflected in other bioinformatics analyses, indicating the important role of synaptic plasticity changes before and after modeling and drug intervention. The results of vivo and vitro experiments showed that BYHWD improved local pathological changes, and reduced cerebral infarct volume, and neurological function scores in MCAO rats. It increased dendritic spine density, improved synaptic structural plasticity, and had a certain neuroprotective effect. BYHWD increased the postsynaptic membrane thickness, synaptic interface curvature, and synaptic quantity. 10% BYHWD-containing serum was determined as the optimal concentration for treatment. 10% BYHWD-containing serum significantly reduced the overall apoptotic rate of (OGD/R) SH-SY5Y cells. Immunofluorescence experiments demonstrated that 10% BYHWD-containing serum could improve synaptic plasticity and increase the relative expression levels of synaptic-related proteins Syt1, Psd95, and Syn1. BYHWD and decoction-containing serum upregulated the mRNA and protein expression levels in (OGD/R) SH-SY5Y cells and MCAO rats, suggesting its ability to improve damaged neuronal synaptic plasticity and enhance transmission efficiency, which might be achieved through the regulation of the cAMP/PKA/CREB pathway.

CONCLUSIONS

This study may provide a basis for clinical medication by elucidating the underlying experimental evidence for the promotion of neural plasticity after ischemic stroke by BYHWD.

Expression patterns and clinical value of key m6A RNA modification regulators in smoking patients with coronary artery disease

Even though N6-methyladenosine (m6A) RNA modifications are increasingly being implicated in human disease, their mechanisms are not fully understood in smokers with coronary artery disease (CAD). Thirty m6A-related regulators' expression (MRRE) in CAD individuals (smokers and non-smokers) were analyzed from GEO. Support Vector Machine, random forest, and nomogram models were constructed to assess its clinical value. Consensus clustering, principal component analysis, and ssGSEA were used to construct a full picture of m6A-related regulators in smokers with CAD. Oxygen-glucose deprivation (OGD) and qRT-PCR were used to validate hypoxia's effect on MRRE. A comparison between smokers with CAD and controls revealed lower expression levels of RBM15B, YTHDC2, and ZC3H13. Based on three key MRREs, all models showed good clinical value, and smokers with CAD were divided into two distinct molecular subgroups. The correlations were found between key MRRE and the degree of immune infiltration. Three key MRREs in HUVECs and FMC84 mouse cardiomyocytes were reduced in the OGD group. Through hypoxia, smoking might reduce the expression levels of RBM15B, YTHDC2, and ZC3H13 in smokers with CAD. Our findings provide an important theoretical basis for the treatment of smokers with CAD.

Sex-related differences in demographics, diagnosis and management of patients with chronic coronary syndromes

AIMS

The impact of sex-related factors on current clinical management and outcomes of chronic coronary syndromes (CCS) are unclear.

METHODS

All patients belonging to the prospective, nationwide START registry were included. Their baseline characteristics, diagnostic workup, revascularization strategy, pharmacological treatment and 1-year clinical outcomes were compared with respect to sex overall and in age tertiles.

RESULTS

A total of 5070 consecutive patients were included. Most patients were males (80.1%). As expected, the prevalence of females increased with age. Distribution of risk factors and history of cardiovascular disease were different depending on sex, as well as diagnostic workup, with lower use of exercise stress testing in women (25.1% vs. 36.7%, P < 0.0001). The use of coronary angiography was similar in the two groups. Women had lower rates of multivessel coronary artery disease (CAD) (33.0% vs. 40.6% P < 0.0001) and higher rates of nonobstructive CAD (18.3% vs. 11.3%, P < 0.0001). Rates of myocardial revascularization were similar, but women were more likely to receive percutaneous coronary intervention than men (84.3% vs. 77.8%, P < 0.0001) and less likely to receive surgical/hybrid revascularization (10.0% vs. 15.1%, P < 0.0001). At 12-month follow-up, no differences were observed for the combined endpoint of all-cause mortality, re-hospitalization for myocardial infarction, heart failure, stroke or myocardial revascularization between males and females; however, a significantly worse perceived quality of life was observed in women.

CONCLUSIONS

In a large nationwide cohort of patients with CCS, clinical outcomes were not different depending on sex. However, several differences in the diagnostic work-up, treatment strategies and quality of life were found between sexes.

Advancing Myocardial Infarction Treatment: Harnessing Multi-Layered Recellularized Cardiac Patches with Fetal Myocardial Scaffolds and Acellular Amniotic Membrane

PURPOSE

Myocardial infarction (MI) is a leading cause of irreversible functional cardiac tissue loss, requiring novel regenerative strategies. This study assessed the potential therapeutic efficacy of recellularized cardiac patches, incorporating fetal myocardial scaffolds with rat fetal cardiomyocytes and acellular human amniotic membrane, in adult Wistar rat models of MI.

METHODS

Decellularized myocardial tissue was obtained from 14 to 16 week-old human fetuses that had been aborted. Chemical detergents (0.1% EDTA and 0.2% sodium dodecyl sulfate) were used to prepare the fetal extracellular matrix (ECM), which was characterized for bio-scaffold microstructure and biocompatibility via scanning electron microscopy (SEM) and MTT assay, respectively. Neonatal cardiomyocytes were extracted from the ventricles of one-day-old Wistar rats' littermates and characterized through immunostaining against Connexin-43 and α-smooth muscle actin. The isolated cells were seeded onto decellularized tissues and covered with decellularized amniotic membrane. Sixteen healthy adult Wistar rats were systematically allocated to control and MI groups. MI was induced via arterial ligation. Fourteen days post-operation, the MI group was received the engineered patches. Following a two-week post-implantation period, the animals were euthanized, and the hearts were harvested for the graft evaluation.

RESULTS

Histological analysis, DAPI staining, and ultra-structural examination corroborated the successful depletion of cellular elements, while maintaining the integrity of the fetal ECM and architecture. Subsequent histological and immunohistochemichal (IHC) evaluations confirmed effective cardiomyocyte seeding on the scaffolds. The application of these engineered patches in MI models resulted in increased angiogenesis, reduced fibrosis, and restricted scar tissue formation, with the implanted cardiomyocytes remaining viable at graft sites, indicating prospective in vivo cell viability.

CONCLUSIONS

This study suggests that multi-layered recellularized cardiac patches are a promising surgical intervention for myocardial infarction, showcasing significant potential by promoting angiogenesis, mitigating fibrosis, and minimizing scar tissue formation in MI models. These features are pivotal for enhancing the therapeutic outcomes in MI patients, focusing on the restoration of the myocardial structure and function post-infarction.

Early identification of vascular access site complications and frequent heart rate and blood pressure monitoring after cardiac catheterization: A scoping review

BACKGROUND

Nurses perform frequent heart rate (HR) and blood pressure (BP) monitoring, a widespread and longstanding practice, after cardiac catheterization (CC) to identify vascular access site complications for femoral and radial arterial approach in adult patients.

OBJECTIVE

The objective of this scoping review was to answer two questions: (1) how does the available evidence support frequent HR and BP monitoring after CC via femoral and radial approach in adult patients and (2) how does this practice prompt bedside nurses in identifying the procedure's major vascular access site complications, including bleeding, hematoma, and pseudoanurysm?

METHOD

Following the scoping review approach, literature search was conducted (PubMed, CINAHL, Google Scholar) by two co-authors and medical librarian. We reviewed, evaluated, and analyzed the evidence from twenty articles.

RESULTS

The reviewed medical and nursing literature revealed findings challenging the present practice. Out of fifteen research studies, five found frequent HR and BP monitoring after CC to be uninformative while the remaining ten did not report frequent vital signs. Two research articles reported that vascular complications after CC were discovered by RNs directly assessing the access site or by the patients themselves, unrelated to HR and BP. Five non-research articles were included, which all recommended frequent HR and BP monitoring.

CONCLUSIONS

Frequent HR and BP assessment during the recovery period is not supported by empirical research despite being consistently recommended by nursing guidelines and expert opinion articles. Current evidence supports frequent vascular access site assessments and patient education.

Percutaneous left atrial appendage closure using a modified single-operator-technician approach under deep sedation: A single-center experience

Background

Historically, percutaneous transcatheter left atrial appendage closure (LAAC) has been performed under general anesthesia (GA) with transesophageal echocardiographic images obtained by a noninvasive cardiologist and usually requires an overnight hospital stay. Alternatively, we present our single-center experience performing LAACs under deep sedation (DS), employing an echocardiographic technician instead of a noninvasive cardiologist, and expediting same-day discharge. Mid- to long-term outcomes were also evaluated with follow-up imaging at a 45-day visit.

Objective

The purpose of this study was to demonstrate the safety, feasibility, and outcomes of our single-operator-technician LAAC approach.

Methods

A total of 150 patients, with elevated CHA2DS2-VASc scores (a mean of 4 points), underwent transesophageal echocardiography-guided LAAC using the WATCHMAN FLX (Boston Scientific, Marlborough, MA) device under DS.

Results

The mean age of patients was 78 years. Seventy-six (51%) were men. One hundred forty-seven patients (98%) had the LAAC device successfully implanted, and 145 (97%) were discharged on the same day. Nine patients (6%) required conversion from DS to GA. Only 5 patients (4%) had complications during the procedure. None of the patients died or had complications from DS. During the 45-day follow-up visit, one patient had a significant peridevice leak (maximum diameter ≥ 5 mm) and another patient had device-related thrombosis.

Conclusion

Our novel single-operator-technician approach under DS is safe and feasible. Implementing protocols to simplify the traditional 2-operator approach under GA by using DS and an echocardiography technician as well as incorporating same-day discharge could make LAACs more widely available and potentially reduce procedural costs.

Simultaneously blocking ANGPTL3 and CD47 prevents the progression of atherosclerosis through regulating lipid metabolism, macrophagic efferocytosis and lipid peroxidation

Atherosclerosis (AS) ultimately cause major adverse cardiovascular events (MACEs). While traditional strategies by lipid-reducing have reduced MACEs, many patients continue to face significant risks. It might attribute to the upregulation of CD47 expression in AS lesions, that mediated anti-efferocytosis of macrophages. Therefore, we propose simultaneously blocking ANGPTL3, a vital regulator of lipid metabolism, and CD47 might be a potential approach for AS therapy. Firstly, we investigate the role of a novel anti-ANGPTL3 nanobody-Fc (FD03) in AS. We found that FD03 treatment significantly decreased circulating lipids, plaque size, and lipid deposition in apoE-/- mice compared to control Ab, but there was a twofold increase in plaque formation in comparison to baseline. However, immunofluorescence indicated the upregulation of CD47 expression in the plaques even after FD03 treatment compared to normal vascular tissue. Next, a bifunctional protein containing signal regulatory protein alpha (SIRPα) and FD03 (SIRPαD1-FD03) was constructed to block CD47 and ANGPTL3 concurrently, which had high purity, robust stability, and high affinity to CD47 and ANGPTL3 with biological activity in vitro. Furthermore, SIRPαD1-FD03 fusion protein exhibited the enhanced therapeutic effect on AS compared with SIRPαD1-Fc or FD03, regressing plaque contents and the necrotic core equal to baseline. Mechanistically, SIRPαD1-FD03 reduced serum lipids, augmented the efferocytosis rate and macrophage M2 polarization, and decreased the reactive oxygen species (ROS) and lipid peroxidation level in atherosclerotic plaques. Collectively, our project suggests an effective approach for AS by simultaneously blocking ANGPTL3 and CD47 to regulate lipid metabolism, macrophage activity and lipid peroxidation.

Implication of knowledge, lifestyle and self-efficacy in the prevention of cardiovascular diseases' risk factors among the urban elderly

Background: Cardiovascular disease (CVD) is preventable by effectively managing its risk factors. Such risk factors (smoking, unhealthy eating habits, sedentary lifestyles, etc.) are judged to reflect an individual's self-efficacy, lifestyle modification, and CVD knowledge. Objectives: To evaluate the relationship between lifestyle practices, self-efficacy, and knowledge of CVDs risk factors among the elderly. Methods: A descriptive cross-sectional study was conducted on 424 randomly individuals whose age is ≥60 years. A questionnaire-based survey was administered on the self-efficacy rate, lifestyle practices, and respondents' knowledge of CVDs risk factors. Respondents with a score of ≤50%, 51%-74.99%, and ≥75% were classified as having low, medium, or high self-efficacy. Similarly, the same score was used to classify poor, fair, or good lifestyle; and low, average, or high knowledge. Data were analysed using Statistical Package for Social Sciences, while association among variables was determined using chi-square. Results: Few respondents were involved in physical exercise (1.7%), cigarette smoking (4.5%), regular soft drinks (18.2%), and alcohol consumption (13.2%). Many respondents used excess salt during cooking (92.7%) or ate outside their homes (64.6%). 58.5%, 30.0%, and 11.6% of the respondents had fair, good, and poor lifestyle practices. 11.3%, 58.7%, and 30.0% had low, medium, and high self-efficacy scores. A total of 45.3%, 35.4%, and 19.3% had low, average, and high knowledge. Knowledge and self-efficacy scores were significantly different (P  =  0.001). Conclusion: High self-efficacy and its significant relationship with knowledge could mean that CVD risk factors can be checked if the elderly have a proper lifestyle, positive attitudes, and nutrition education.

Characterizing apparent treatment resistant hypertension in the United States: insights from the All of Us Research Program

BACKGROUND

Hypertension (HTN) remains a significant public health concern and the primary modifiable risk factor for cardiovascular disease, which is the leading cause of death in the United States. We applied our validated HTN computable phenotypes within the All of Us Research Program to uncover prevalence and characteristics of HTN and apparent treatment-resistant hypertension (aTRH) in United States.

METHODS

Within the All of Us Researcher Workbench, we built a retrospective cohort (January 1, 2008-July 1, 2023), identifying all adults with available age data, at least one blood pressure (BP) measurement, prescribed at least one antihypertensive medication, and with at least one SNOMED "Essential hypertension" diagnosis code.

RESULTS

We identified 99 461 participants with HTN who met the eligibility criteria. Following the application of our computable phenotypes, an overall population of 81 462 were further categorized to aTRH (14.4%), stable-controlled HTN (SCH) (39.5%), and Other HTN (46.1%). Compared to participants with SCH, participants with aTRH were older, more likely to be of Black or African American race, had higher levels of social deprivation, and a heightened prevalence of comorbidities such as hyperlipidemia and diabetes. Heart failure, chronic kidney disease, and diabetes were the comorbidities most strongly associated with aTRH. β-blockers were the most prescribed antihypertensive medication. At index date, the overall BP control rate was 62%.

DISCUSSION AND CONCLUSION

All of Us provides a unique opportunity to characterize HTN in the United States. Consistent findings from this study with our prior research highlight the interoperability of our computable phenotypes.

Associations between AHA's Life's Essential 8 and cognition in midlife and older adults

INTRODUCTION

This study evaluated the associations between Life's Essential 8 (LE8) and cognitive performance, and compared the strength of the relationships of Life's Simple 7 (LS7) and LE8 to cognition in midlife and older adults.

METHODS

Participants (N = 1539) were from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Cross-sectional multivariable regression examined the associations between LE8 and cognition. Secondary analyses compared model performance between LE8 and LS7 measures on cognition from the same available sample.

RESULTS

Higher LE8 scores were associated with better global cognitive performance, working memory, and attention. The LS7 model outperformed the LE8 model on global cognitive performance, but the LE8 model outperformed the LS7 model for the working memory domain.

DISCUSSION

Better cardiovascular health (CVH) was associated with better cognitive performance among US middle-aged and older adults. However, the association between CVH and specific cognitive domains varies when using LE8 versus LS7.

HIGHLIGHTS

Cardiovascular health (CVH) is associated with cognitive performance. Life's Essential 8 (LE8) is a new construct to quantify CVH. Associations between LE8 and cognition were assessed. Higher LE8 was associated with better global cognitive performance. Higher LE8 was also associated with better working memory and attention.

Advances in the study of exosomes in cardiovascular diseases

BACKGROUND

Cardiovascular disease (CVD) has been the leading cause of death worldwide for many years. In recent years, exosomes have gained extensive attention in the cardiovascular system due to their excellent biocompatibility. Studies have extensively researched miRNAs in exosomes and found that they play critical roles in various physiological and pathological processes in the cardiovascular system. These processes include promoting or inhibiting inflammatory responses, promoting angiogenesis, participating in cell proliferation and migration, and promoting pathological progression such as fibrosis.

AIM OF REVIEW

This systematic review examines the role of exosomes in various cardiovascular diseases such as atherosclerosis, myocardial infarction, ischemia-reperfusion injury, heart failure and cardiomyopathy. It also presents the latest treatment and prevention methods utilizing exosomes. The study aims to provide new insights and approaches for preventing and treating cardiovascular diseases by exploring the relationship between exosomes and these conditions. Furthermore, the review emphasizes the potential clinical use of exosomes as biomarkers for diagnosing cardiovascular diseases.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Exosomes are nanoscale vesicles surrounded by lipid bilayers that are secreted by most cells in the body. They are heterogeneous, varying in size and composition, with a diameter typically ranging from 40 to 160 nm. Exosomes serve as a means of information communication between cells, carrying various biologically active substances, including lipids, proteins, and small RNAs such as miRNAs and lncRNAs. As a result, they participate in both physiological and pathological processes within the body.

Trends and disparities in age, sex, ethnoracial background, and urbanization status in adult mortality due to thoracic aortic aneurysm: a retrospective nationwide study in the United States

INTRODUCTION

Thoracic aortic aneurysms (TAA) are a significant health concern, with the true prevalence likely underestimated due to undiagnosed cases. Outcomes in TAA are influenced by factors like age, sex, and comorbidities such as hypertension. This study examines mortality trends and disparities associated with TAA in US adults.

METHODOLOGY

This study analyzed death certificates from 1999 to 2020 using the CDC WONDER Database to identify TAA-related deaths in individuals aged 25 and older using ICD-10 codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1 000 000 and annual percent changes (APCs) were calculated and stratified by year, sex, age group, race/ethnicity, region, and urbanization status.

RESULTS

Between 1999 and 2020, 47 136 TAA-related deaths were reported among US adults. The AAMR decreased from 16.2 to 8.2 per 1 000 000, with a significant decline from 1999 to 2013 (APC: -5.00; 95% CI: -5.54 to -4.54; P<0.001). Older adults had the highest AAMRs at 44.6 per 1 000 000. Men had higher AAMRs than women (11.2 vs. 9). AAMRs were highest among non-Hispanic (NH) Black (11), followed by NH White (10.3), NH Asian or Pacific Islander (9.5), NH American Indian or Alaska Native (7.8), and Hispanic (5.2) populations. Nonmetropolitan areas had higher AAMRs than metropolitan areas (11 vs. 9.8).

CONCLUSIONS

The analysis showed a significant decline in TAA mortality since 1999, with recent stabilization. However, disparities persist, with higher AAMRs among men, older adults, NH Black adults, and nonmetropolitan residents, highlighting the need for targeted and equitable interventions.

Outcomes of extracorporeal life support in hypothermic cardiac arrest: Revisiting ELSO guidelines

AIM OF THE STUDY

Predictive factors for poor outcomes in hypothermic cardiac arrest (HCA) differ from those in normothermic out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the outcomes of extracorporeal life support (ECLS) in HCA patients who may not be considered eligible based on the guidelines set by the Extracorporeal Life Support Organization (ELSO).

METHODS

A retrospective multicentre study included 127 HCA patients, divided into two groups: those meeting the ELSO eligibility criteria for ECLS, and those with at least one of the following ELSO exclusion criteria: age over 70 years, unwitnessed cardiac arrest, or asystole.

RESULTS

Among the 62 patients who met the ELSO criteria, 38 (61 %) survived to hospital discharge, with 34 (89 %) achieving a favourable neurological outcomes. Of the 65 patients who received ECLS despite not meeting ELSO criteria, 24 (37 %) survived to discharge, with 20 (83 %) demonstrating a favourable neurological outcomes. In patients not meeting one or two ELSO criteria, survival rates were 18 of 47 (38 %) and 6 of 16 (38 %) respectively, with 83 % of survivors in both groups achieving favourable neurological outcomes. The two patients who failed to meet all three ELSO criteria did not survive.

CONCLUSION

Qualification of patients with hypothermic cardiac arrest for ECLS rewarming should not be strictly based on guidelines for normothermic cardiac arrest, as this may result in not initiating potentially life-saving treatment for patients who could have favourable prognoses for survival with good neurological outcomes.