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

LifeAPP: self-monitoring of blood pressure after preterm preeclampsia: a randomized controlled feasibility trial

OBJECTIVE

This was a pilot study to investigate the feasibility of developing a low-cost mobile technology-based intervention to encourage blood pressure (BP) monitoring and adoption of healthy lifestyle habits.

METHODS

This was a prospective, controlled, randomized, non-blinding feasibility study that involved the use of electronic BP monitor and smartphone. Eligible participants in the intervention group were instructed to send the BP measurements to members of the LifeAPP team digitally from an application for smartphones linked to the BP device by Bluetooth and also via WhatsApp. The LifeAPP team sent feedback containing information as follows: a) safety of the BP levels; b) motivational messages aiming at maintaining self-monitoring; c) motivational messages aiming at the importance of developing healthy lifestyle habits. The primary outcome was feasibility: recruitment capacity, retention, and compliance with follow-up rates.

RESULTS

Between 1 June 2020 and 24 January 2021, 48 participants were randomized to the intervention group, and 48 participants were randomized to the control group. The recruitment capacity of the participating centers proved to be adequate. Among the participants recruited for intervention group, 21 (43.7%) attended predefined visits at 3 months and only 12 (25%) attended predefined visits at 6 months. Similar loss to follow-up was observed in the control group.

CONCLUSION

Despite successful recruitment of a cohort of women following preterm preeclampsia, there was no sufficient retention of participants. Therefore, new strategies for long-term follow-up of women who developed preeclampsia are needed before a further study in this group of patients can be contemplated.

Dyslipidemia and cerebral atrophy among health check-up individuals: A cross-sectional study

Objective

To examine the association between dyslipidemia and cerebral atrophy in Chinese health check-up population.

Methods

67,526 participants underwent routine health check-ups at the health management center of the First Affiliated Hospital of Sun Yat-Sen University (FAH-SYSU) in Guangzhou for two years (2022-2023) in this cross-sectional study. Cerebral atrophy was determined by expert physicians based on non-contrast scans of Head Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA) and/or Head Computed Tomography (CT). The levels of Total Cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were measured and classified by quartiles into four categories, respectively. The multivariable logistic regression model was used to obtain the odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 1,661 participants were included with ages from 18 to 93 years. Among 1,661 participants, 121 (7.28%) had cerebral atrophy. On multivariate analysis, TC and LDL-C were not associated with cerebral atrophy, although TC and LDL-C were lower in the subgroup with cerebral atrophy.

Conclusions

This cross-sectional study conducted in China is the first to identify that health check-up examinees with cerebral atrophy had lower levels of TC and LDL-C raising the possible association between lower levels of TC and LDL-C with cerebral atrophy, and possible cognitive dysfunction. Future study is planned to overcome the existing limitation and address the lack of statistically significant association between TC and LDL-C levels with cerebral atrophy and possible dementia.

FP receptor inhibits autophagy to aggravate aging-related cardiac fibrosis through PI3K/AKT/mTOR signaling pathway

BACKGROUND

F-prostanoid receptor (FP receptor), a receptor for Prostaglandin F2α(PGF2α), is involved in the process of tissue fibrosis, but its exact role in the aging heart remains unclear.

METHODS

We investigated cardiac function, myocardial fibrosis levels, autophagy levels and related mechanistic pathways in different groups of mice using gene silencing. At the cellular level, we simulated the senescence process of cardiac fibroblasts and investigated the related mechanisms using relevant inhibitors.

RESULTS

In aging mice, FP receptor and PI3K/AKT/mTOR pathways are increased and autophagy levels are decreased, ultimately leading to cardiac fibrosis. FP receptor gene silencing slows down the above process. We found similar changes at the cellular level.

CONCLUSION

FP receptor could activate PI3K/AKT/mTOR pathway and inhibit cardiac autophagy, which resulted in aging-related cardiac fibrosis. Thus, the inhibition of FP receptor could improve aging-related cardiac remodeling, implicating its potential therapeutic application to treat cardiovascular diseases associated with aging.

Positive childhood experiences and adult cardiovascular health

OBJECTIVE

To test whether positive childhood experiences (PCEs) assessed prospectively in adolescence predict ideal cardiovascular health in adulthood, even after controlling for experiences of childhood maltreatment. We also tested whether PCEs would moderate the association between childhood maltreatment and adult cardiovascular health and whether sex moderated the association between PCEs and cardiovascular health.

METHOD

Data originated from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative longitudinal study in the United States (n = 2,916). Using data from the Wave 1 adolescent assessment (Mage = 15.70 years, 1994-1995), a 12-item index of cumulative self-reported PCEs (e.g., stable caregiver, adult mentor, one good friend, enjoyed school, good neighbors) was created. Childhood maltreatment experiences were self-reported at Wave 3 (Mage = 22.06 years, 2001-2002) and Wave 4 (Mage = 28.53 years, 2008). An ideal cardiovascular health score was calculated in Wave 5 (Mage = 37.47 years, 2016-2018) using the American Heart Association's Life's Essential 8 cardiovascular health index.

RESULTS

Greater PCEs predicted more ideal cardiovascular health (β = .13, p < .001), and greater childhood maltreatment predicted less ideal cardiovascular health in adulthood (β = -.12, p < .001). PCEs did not moderate the association between childhood maltreatment and adult cardiovascular health. Sex moderated the association between PCEs and adult cardiovascular health (β = .09, p = .042), such that the association was stronger for female (β = .20, p < .001) than male (β = .08, p = .073).

CONCLUSION

The finding that PCEs prospectively predict more ideal cardiovascular health in adulthood beyond the effect of childhood maltreatment suggests that promoting PCEs should be tested as part of interventions to prevent adult cardiovascular disease. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Undetected language deficits in left or right hemisphere post-stroke patients

Previous studies have reported that widely used tests for aphasia identification are unable to detect the subtle language deficits of left hemisphere brain damaged (LHBD) individuals. Similarly, the language disorders of individuals with right hemisphere brain damage (RHBD) usually remain undetected, due to the lack of any specialized test for the evaluation of their language processing skills. The aim of the present study was to evaluate the language deficits of 80 individuals suffering from the effects of either a LHBD or RHBD stroke, who were diagnosed as having no aphasia or language deficits based on the application of Boston Diagnostic Aphasia Examination. Their language abilities were examined with the use of the Adults' Language Abilities Test, which explores morpho-syntactic and semantic phenomena of the Greek language in both the comprehension and production modalities. Results revealed that both groups of stroke survivors performed significantly worse compared to the group of healthy participants. Thus, it appears that the latent aphasia of LHBD and the language deficits of RHBD patients are likely to remain undetected and that patients are at risk of not receiving appropriate treatment if their language abilities are not evaluated by an effective and efficient battery of language tests.

Effect of geriatric care on health outcomes in older patients with cardiac disease: A systematic review

BACKGROUND

As patients with cardiac disease age and become frail, their care needs become more complex. Therefore geriatric care might benefit these patients. This review summarizes current research investigating the impact of geriatric care on clinical outcomes in older cardiac patients.

METHODS

The MEDLINE, Embase, and Cochrane databases were searched on 11 May 2023 for randomized controlled trials (RCTs) and observational studies comparing additional geriatric care to usual care in older (+70) cardiac patients. The Cochrane risk of bias tool and Robbins-E tool were used for quality assessment of RCTs and observational studies respectively. Data on mortality rates, readmissions, length of stay, complications, discharge destinations, functional outcomes, and quality of life (QoL) were extracted. Two authors independently selected studies, extracted data and assess study quality.

RESULTS

Twelve articles involving 3531 patients (average age 73-85 years; 44-59 % male) were identified, mainly focussing on heart failure or patients requiring cardiothoracic surgery. The studies had a moderate to high risk of bias. Two out of three studies (n = 771) showed reduced complication rates (e.g. delirium incidence) when comparing geriatric assessment to usual care. Additionally, two out of three studies (n = 449), indicated improved QoL scores for patients who received a geriatric care. No significant effects were found for other outcomes.

CONCLUSION

Low-quality evidence suggests that geriatric care may be associated with lower complication rates and an improved quality of life in older cardiac patients. However, more research is needed to clarify the effect of a geriatric care in this patient population.

REGISTRATION

The study protocol was registered in the international prospective register of systematic reviews (PROSPERO 2022 CRD42022337353).

Computed tomography-based coronary lumen volume to myocardial mass ratio in patients undergoing transcatheter aortic valve replacement: a novel method for risk assessment

BACKGROUND

The coronary lumen volume to myocardial mass (V/M) ratio has been suggested as a quantitative metric of potential imbalance between coronary blood supply and myocardial oxygen demand. This study was designed to assess the prognostic value of the V/M ratio for predicting major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR).

METHODS

This study enrolled patients who received a standard planning computed tomography (CT) scan before TAVR and dichotomized at the median of 33.31 mm³/g of V/M ratio into groups with low V/M ratio and high V/M ratio. The V/M ratio was calculated by coronary computed tomography angiography (CTA). The endpoint was a composite of all-cause mortality, stroke, and hospitalization for heart failure. The cumulative incidence of the MACE was compared using Kaplan-Meyer plots and uni- and multivariate Cox proportional hazards regression analysis.

RESULTS

In total, 139 patients were enrolled in this study finally (mean age 71.7 ± 6.7 years, 41.7% female). The mean V/M ratio was considerably lower in patients with MACE than in those without MACE (26.5 ± 4.9mm3/g vs. 34.0 ± 3.8mm3/g, P<0.001). Multivariate Cox proportional hazards regression showed that the low V/M ratio group (≤ 33.31 mm³/g) had a higher risk of MACE after TAVR (HR: 6.14, 95%CI: 1.37-27.54; P = 0.018).

CONCLUSIONS

The lower V/M ratio could serve as an independent predictor of MACE in patients undergoing TAVR.

CLINICAL TRIAL NUMBER

Not applicable.

Atrial Fibrillation and Dementia: A Comprehensive Literature Review

Atrial fibrillation (AF) and dementia commonly co-occur and pose significant challenges to public health, particularly in aging populations. While the heightened risk of stroke in AF undoubtedly contributes to neurocognitive injury, accumulating evidence suggests that stroke alone does not explain the full extent of cognitive decline in individuals with AF. Shared risk factors such as advancing age, hypertension, and diabetes, as well as pathophysiological mechanisms that include silent cerebral infarcts, chronic hypoperfusion, inflammatory pathways, and cerebral microbleeds, appear to drive this multifaceted relationship. Increasing data from observational cohorts, randomized trials, and meta-analyses underscore the potential benefits of anticoagulation, rhythm control, and lifestyle interventions in mitigating these neurocognitive risks, though notable gaps in research remain. This review provides a comprehensive examination of the epidemiology, pathophysiological mechanisms, and current therapeutic strategies for AF-related cognitive impairment. By evaluating emerging evidence-including data on anticoagulation timing, AF ablation, and cognitive screening-we highlight critical areas in need of further investigation to inform clinical practice and improve outcomes for this vulnerable population.

Mode of locomotion and other determinants of navigation ability post-stroke

ABSTRACTMaintaining the ability to navigate through one's environment is an important component of quality of life after cerebrovascular accidents (CVA). Yet, navigation ability is not commonly assessed in post-CVA rehabilitation, and when it is, assessment methods are quite varied. Here, we assessed navigation impairment in thirty-four individuals with left and right CVA compared to sixteen neurotypical controls. We had three primary aims, (1) to confirm the presence of route and survey learning impairment post-stroke as assessed by a real-world task, (2) to assess whether navigation impairments are more likely to be detected when assessment is performed in certain locomotion conditions (walking, wheelchair, and video), and (3) to evaluate potential underlying causes of navigation impairment. Results reveal an impairment for individuals with CVA relative to controls on the route memory task. We also observed a benefit of real-world navigation, as individuals with CVA were particularly impaired in the video condition. Heading sensitivity and, to a lesser degree, lateralized attention were two underlying abilities contributing to route memory when walking. Together these results are consistent with the importance of real-world methods of assessing navigation in stroke, and suggest the possibility that treatment of deficits in heading sensitivity may improve spatial navigation.

Sirtuin3 attenuates pressure overload-induced pathological myocardial remodeling by inhibiting cardiomyocyte cuproptosis

Pathological myocardial remodelling is the initiation of pressure overload-induced heart failure, and its involvement in the associated molecular mechanisms remains to be fully elucidated. The aim of this study was to investigate whether Sirtuin3 (SIRT3) can affect pathological myocardial remodeling by regulating cellular cuproptosis and its potential mechanisms. In this study, we found that pressure overload induced pathologic myocardial remodeling in which cardiomyocytes showed a distinct cuproptosis signature accompanied by downregulation of SIRT3 expression. In vitro experiments demonstrated that copper ions reduced SIRT3 expression by 40 % (p < 0.01) via lysosomal degradation. In vivo validation showed that pressure overload reduced SIRT3 expression by 35 % (p < 0.01) in myocardial tissue. And SIRT3 knockdown increased pressure overload-induced pathological myocardial remodeling and cardiomyocyte cuproptosis. In contrast, cardiomyocytes-specific overexpression of SIRT3 by adeno-associated virus vectors attenuated pressure overload-induced pathologic myocardial remodeling and was unaffected by circulating levels of copper ions and hepatic and renal impairment. Mechanistically, the reduction of SIRT3 induced cardiomyocytes to become copper ion-sensitive state cells by affecting the binding of copper ion transporter proteins to microtubule-associated protein 1 light chain 3 beta(LC3B) in cardiomyocytes. Disturbance of copper ion homeostasis in cardiomyocytes leads to accumulation of copper ions in cardiomyocytes and the development of cuproptosis. These findings elucidate a novel mechanism by which SIRT3 affects cardiomyocyte death in pressure overload-induced pathologic myocardial remodeling and suggest the great potential of SIRT3-regulated cuproptosis of cardiomyocytes in the prevention or treatment of pathologic myocardial remodeling.

Association of Accelerometer-Derived Physical Activity Pattern With the Risks of All-Cause, Cardiovascular Disease, and Cancer Death

BACKGROUND

Current guidelines suggest engaging in a minimum of 150 minutes of moderate to vigorous physical activity (MVPA) each week to support overall health. However, the effect of concentrated versus evenly distributed physical activity (PA) on health outcomes remains uncertain. This study aims to investigate the associations of "weekend warrior" pattern, where most MVPA is completed in 1 to 2 days, and a more evenly spread MVPA pattern with mortality risk.

METHODS

Data from the UK Biobank were used, with participants having a full week of device-measured PA data from 2013 to 2015. Three MVPA patterns were defined: inactive, active weekend warrior, and active regular. The relationships between PA patterns and mortality risk were investigated using the Cox proportional hazards model.

RESULTS

During an 8.1-year median follow-up, 3965 adults died from all causes, including 667 from cardiovascular disease and 1780 from cancer. Both the active weekend warrior group (all-cause death: hazard ratio [HR], 0.68 [95% CI, 0.64-0.74]; cardiovascular disease death: HR, 0.69 [95% CI, 0.58-0.83]; cancer death: HR, 0.79 [95% CI, 0.71-0.89]) and the active regular group (all-cause death: HR, 0.74 [95% CI, 0.68-0.81]; cardiovascular disease death: HR, 0.76 [95% CI, 0.61-0.94]; cancer death: HR, 0.87 [95% CI, 0.76-0.99]) demonstrated a lower mortality risk compared with the inactive group after following the recommended 150 minutes of MVPA per week. Furthermore, there was no discernible difference in the mortality risk between the active regular group and the active weekend warrior group.

CONCLUSIONS

Engaging in PA concentrated within 1 to 2 days was related with a similar reduction in mortality risk as more evenly spread activity. Our findings are particularly significant for individuals who find it challenging to engage in regular PA due to time constraints.

Expanding the horizons of bicyclol in multiple diseases: Mechanisms, therapeutic implications and challenges

Bicyclol, a drug stemmed from the traditional Chinese medicine Schisandra chinensis, has been widely utilized in clinical practice due to its efficacy and safety to manage hepatopathy. Its diverse biological properties-including antiviral, anti-inflammatory, antifibrotic, immunomodulatory, antioxidative, antisteatotic, and antitumor effects-underscore its significant medicinal effects in versatile hepatic disorders, incorporating viral hepatitis, non-alcoholic fatty liver disease, hepatocellular carcinoma, acute hepatic failure, hepatic fibrosis as well as drug-induced liver injury. Furthermore, ongoing researches into the molecular mechanisms, biological activities and mode of actions concerning bicyclol have uncovered its potential therapeutic implications in other multiple diseases/conditions. Studies have indicated promising efficacy pertaining to bicyclol to treat idiopathic pulmonary fibrosis, acute lung injury, cerebral ischemia/reperfusion injury, renal dysfunction, renal cell carcinoma, and cardiovascular diseases. Accordingly, this narrative review article summarizes the current understanding of diverse biological activities and underpinning mechanisms of bicyclol across a range of diseases, as well as its pharmacokinetics, toxicity profile and shed light on future perspectives.

Bryostatin-1 improves function in arteries with suppressed endothelial cell autophagy

We have previously reported that when autophagy is suppressed in endothelial cells (ECs), a glycolytic defect limits shear-stress -induced ATP production to an extent that purinergic 2Y1 receptor (P2Y1R)-mediated activation of EC nitric oxide (NO) synthase (eNOS) is compromised. Subsequently we demonstrated the functional relevance of this finding in arteries from mice with genetic, pharmacological, and age-associated EC autophagy impairment. Using gain and loss of function approaches in vitro, we further revealed that p-PKCδT505 serves as a signaling link between P2Y1R activation and NO generation. Here we sought to discern the functional relevance of this observation. First, shear-stress- induced activating phosphorylation of eNOS (p-eNOSS1177) that is otherwise prevented by knockdown of autophagy-related gene 3 (Atg3) in ECs was restored by the PKC agonist bryostatin-1. Next, in murine models of genetic and age-associated EC autophagy compromise, depressed vasodilation displayed by femoral and cerebral arteries was reversed by bryostatin-1 in a manner that could be prevented by concurrent NO synthase inhibition. Finally, the bryostatin-1-mediated normalization of intraluminal flow-induced vasodilation observed in femoral arteries from both models of EC autophagy disruption was mitigated by inhibiting downstream targets of p-PKCδT505 i.e., p-PKDS744/S748 and p-PKDS916. These findings provide evidence that stimulating PKC/PKD has strategic potential to restore compromised endothelial function in pathologies associated with suppressed EC autophagy e.g., aging.

Troponin I biomarker sensing from clinical patient samples using molecularly imprinted polymer nanoparticles for advancing healthcare approaches in cardiovascular disease

Cardiac troponin I (cTnI) is a critical protein biomarker for heart attack diagnosis. This study presents a thorough analysis of a novel biosensing device utilizing molecularly imprinted polymer nanoparticles (nanoMIPs) for detecting cTnI in clinical patient serum samples post myocardial infarction. The methodology, based on the heat-transfer method approach, offers faster measurements times than the current gold standard and sample volumes equivalent to a single blood drop. Biomarker binding shows performance comparable to a high-sensitivity ELISA, accurately identifying patients with elevated cTnI levels (R2 = 0.893). The cTnI peak concentration time variations are attributed to heterogeneous serum complexes, with different troponin complex sizes potentially generating differing thermal insulation levels. Comparison with an established patient database demonstrates robust correlations between our cTnI concentrations and clinical parameters (R2 = 0.855). This underscores the potential of nanoMIP sensors for sensitive cTnI detection, providing insights into post-heart attack biomarker levels. Furthermore, our methodology presents the additional benefits of being low cost and portable enabling measurements at time and place of patients. Consequently, it holds the potential to become a vital part of the diagnostic pathway for heart attack treatment, ultimately reducing healthcare costs and improving patient outcomes.

Evaluating Acute Stroke Diagnosis Using Simulation Scenarios

STUDY OBJECTIVE

This study sought to explore the clinical and process factors that, alone or in combination, influence the accuracy of stroke diagnosis in the emergency department (ED) by applying a novel design of experiments methodology.

METHODS

We used design of experiments, a branch of applied statistics, to create a screening experiment comprised of patient simulation scenarios in which purposeful changes are made to prespecified factors thought to potentially influence the outcome of interest. We used 4 base case scenarios (typical and atypical acute ischemic stroke, intracerebral hemorrhage, and complex migraine [a stroke mimic]) and 12 prespecified clinical factors thought to influence stroke diagnosis (eg, patient age, history of seizure, and interruption occurring during patient assessment that the physician must attend to [distraction]) based on literature review and expert opinion. Experimental runs were designed using a modified fractional factorial design approach. Physicians, including postgraduate trainees from 3 health systems, were invited to participate. After each run, participants were asked to provide a diagnosis and their confidence in that diagnosis; both inperson and virtual assessments were conducted. We used multivariate regression to explore factor(s) influencing physician confidence in stroke diagnosis. Confidence was signed, with positive confidence corresponding to a stroke diagnosis and negative confidence to a nonstroke diagnosis, allowing confidence levels from the regression model to be translated to misdiagnosis.

RESULTS

A total of 27 physicians (12 neurology and 15 emergency medicine) completed 100 experimental runs. The typical ischemic stroke base case presentation was accurately diagnosed in every run, whereas the other 3 base cases were less accurately diagnosed. Stroke overdiagnosis occurred in the complex migraine case (83% false positive) and stroke underdiagnosis in the intracerebral hemorrhage case (36% false negative). Distraction during patient evaluation and the availability of a witness from whom relevant information could be obtained exhibited significant, independent effects on diagnostic confidence. Distractions of the physician had an even stronger influence on stroke diagnostic confidence when no witness was present.

CONCLUSIONS

Applying the design of experiments methods to simulated scenarios, we found that distraction and presence of a witness significantly influenced diagnostic confidence and thus, stroke diagnostic accuracy. These findings should inform future studies to understand the underlying mechanisms of ED misdiagnosis and in the design of future interventions to improve stroke diagnostic formulation.

Association between accelerometer-measured irregular sleep duration and longitudinal changes in body mass index in older adults

BACKGROUND

Irregular sleep duration may disrupt circadian rhythms and contribute to metabolic, behavioral, and mood changes, potentially increasing the risk for obesity. However, quantitative data on the relationship between sleep duration irregularity and weight change are lacking.

METHODS

In this prospective study, we analyzed data from 10,572 participants (mean age: 63 years) in the UK Biobank who wore accelerometers for a week between 2013 and 2015 and had two body mass index (BMI; kg/m²) measurements on average 2.5 years apart. Irregular sleep duration was assessed by the within-person standard deviation (SD) of 7-night accelerometer-measured sleep duration.

RESULTS

Participants with sleep duration SD > 60 min versus ≤30 min had 0.24 kg/m2 (95% CI: 0.08, 0.40) higher BMI change (kg/m2), standardized to three-year intervals, and 80% (95% CI: 1.28, 2.52) higher risk for incident obesity, after adjusting for sociodemographic factors, shift work, and baseline BMI or follow-up period (p-nonlinearity <0.02 for both). These associations remained consistent after adjusting for lifestyle, comorbidities, and other sleep factors, including sleep duration. Age, sex, baseline BMI, and genetic predisposition to higher BMI (measured with a polygenic risk score) did not appear to modify the association.

CONCLUSIONS

Since irregular sleep duration is common, trials of interventions targeting sleep irregularity might lead to new public health strategies that tackle obesity.

Follicle-stimulating hormone promotes EndMT in endothelial cells by upregulating ALKBH5 expression

BACKGROUND

The incidence of atherosclerosis markedly rises following menopause. Our previous findings demonstrated that elevated follicle-stimulating hormone (FSH) levels in postmenopausal women accelerate atherosclerosis progression. Plaque instability, the fundamental pathological factor in acute coronary syndrome, primarily results from vascular embolism due to plaque rupture. Recent evidence highlights that endothelial-to-mesenchymal transition (EndMT) exacerbates plaque instability, although the link between FSH and EndMT has not been fully established. This investigation sought to explore the possible influence of FSH in modulating EndMT.

METHODS

In this study, apolipoprotein E-deficient (ApoE-/-) mice served as an atherosclerosis model, while human umbilical vascular endothelial cells (HUVECs) were used as cellular models. Protein levels were assessed through immunochemical techniques, gene expression was quantified via RT-qPCR, and nucleic acid-protein interactions were evaluated using immunoprecipitation. The m6A modification status was determined by MeRIP, and cellular behaviors were analyzed through standard biochemical assays.

RESULTS

Our results indicate that FSH induces EndMT both in vitro and in vivo. Additional investigation suggested that FSH upregulates the transcription factor Forkhead box protein M1 (FOXM1) at both protein and mRNA levels by enhancing the expression of AlkB homolog 5, RNA demethylase (ALKBH5). FSH reduces m6A modifications on FOXM1 through ALKBH5, leading to increased nascent transcript levels and mRNA stability of FOXM1. Dual-luciferase reporter assays highlighted cAMP-response element binding protein (CREB)'s essential function in facilitating the FSH-induced upregulation of ALKBH5.

CONCLUSIONS

These findings suggest that FSH promotes ALKBH5 expression, facilitates N6-methyladenosine (m6A) demethylation on FOXM1, and consequently, induces EndMT. This study elucidates the impact of FSH on plaque instability and provides insights into potential strategies to prevent acute coronary syndrome in postmenopausal women.

Association of microRNA-210-3p with NT-proBNP, sST2, and Galectin-3 in heart failure patients with preserved and reduced ejection fraction: A cross-sectional study

BACKGROUND

Heart failure (HF) is a growing health problem and around two percent are affected in the general population. Accurate diagnostic markers that have the potential for early diagnosis of HF are lacking. This study aimed to compare the expression levels of microRNA-210-3p with biomarkers NT-proBNP, sST2, and galectin-3, in heart failure patients with preserved and reduced ejection fractions.

MATERIALS AND METHODS

The cross-sectional study was conducted on 270 hypertensive heart failure patients in the age group of 30 to 75 years of both genders. The participants with evidence of HF were recruited from the Department of Cardiology in a tertiary care hospital in Chennai, India. MicroRNA-210-3p was analyzed by qRT-PCR in a stratified sample of 80 HF patients and 20 apparently healthy individuals. Biomarkers were analyzed by ELISA. Institutional ethics committee approval and written informed consent were obtained. Statistical analysis was performed using R software (4.2.1). Based on the type of distribution of data, appropriate statistical tools were used. p-value ≤  0.05 was considered to be statistically significant.

RESULTS

All the biomarkers including microRNA-210-3p were significantly higher in HFrEF than in HFpEF. MAGGIC score showed a positive correlation with all the biomarkers. The cut-off of microRNA-210-3p was 5.03.

CONCLUSION

All the biomarkers were significantly elevated in HFrEF compared to HFpEF. However, microRNA-210-3p could be an early marker in the diagnosis of heart failure. The strategy of employing a multi-marker approach could help in the early diagnosis as well as in stratifying the HF patients.

Does hospitalisation improve oral anticoagulant optimisation in patients with atrial fibrillation?

BACKGROUND

Hospitalisation offers an opportunity for medication review and correction, yet it has received little attention. We aimed to evaluate oral anticoagulant (OAC) use in patients with atrial fibrillation at hospital admission and discharge and determine whether hospitalisation improves care.

METHODS

We conducted an observational study at the Royal Hobart Hospital, Australia, in patients with atrial fibrillation. The appropriateness of stroke-prevention therapy at admission and discharge was evaluated using Australian guidelines. Factors associated with correcting inappropriate OAC therapy were identified using multiple logistic regression.

RESULTS

Among 902 patients, 47.1% (n = 425) were receiving inappropriate OAC therapy at admission. The most common errors included lack of OAC therapy (58.6%, n = 249) and underdosing of direct-acting OACs (15.5%, n = 66). OAC therapy appropriateness at discharge was assessed for 844 patients; 73.8% were receiving appropriate therapy (versus 53.8% at admission (p < .001)). Specifically, 49.0% (n = 191) of the admission therapy errors were corrected. Correction was more likely in patients admitted to the stroke (adjusted odds ratio [aOR]: 16.93, 95% CI: 1.31-218.48) or cardiology wards (aOR: 4.10, 95% CI: 1.94-8.64), and if bleeding occurred during hospitalisation (aOR: 4.01, 95% CI: 1.07-14.99). Conversely, receiving rivaroxaban at admission (aOR: .23, 95% CI: .11-.51) and having a medium or high bleeding risk (ORBIT score ≥3) (aOR: .46, 95% CI: .25-.84) decreased the likelihood of correction.

CONCLUSION

Hospitalisation improved OAC therapy appropriateness; however, 51.0% of patients admitted with inappropriate therapy continued without correction. An intervention that enhances the hospital care team correcting inappropriate OAC therapy is warranted.

Influence of estradiol deficiency on the mineralocorticoid receptor response in postmenopausal women: a cross-sectional study

OBJECTIVE

Premenopausal women (PreM) have a cardioprotective advantage over postmenopausal women (PostM) due to estrogen. The interaction of estrogen with the mineralocorticoid receptor (MR) pathway remains unexplored. This study aimed to identify changes in aldosterone, renin and sexual steroid levels and MR surrogate biomarkers in PostM that may explain changes in blood pressure and renal damage.

METHODS

A cross-sectional study was carried out with 47 normotensive and hypertensive Chilean women distributed between PreM and PostM. Clinical, anthropometric and biochemical parameters, including aldosterone, plasma renin activity (PRA) and surrogate markers of MR activity, were assessed.

RESULTS

PostM had greater systolic blood pressure (SBP) (p < 0.001) than PreM. A negative correlation was observed between estradiol and fractional excretion of potassium (FEK) (ρ = -0.29; p = 0.023), adjusted for age and SBP. Compared with hypertensive PreM, hypertensive PostM (PostM-HT) showed reduced PRA (p = 0.045) and greater FEK (p = 0.04). Normotensive PostM (Post-NT) exhibited greater SBP (p = 0.03), neutrophil gelatinase-associated lipocalin (NGAL) levels (p = 0.04) and FEK (p = 0.03) than normotensive PreM.

CONCLUSION

Our results suggest enhanced MR sensitivity not only in PostM-HT, as evidenced by lower PRA and elevated FEK, but also in PostM-NT, who exhibited greater FEK and NGAL levels, surrogate markers of MR activation. These results support a novel role of MR activation and cardiovascular risk in PostM women.

Cost-Effectiveness of Team-Based Coaching With Surveillance for Prevention of Acute Kidney Injuries

Importance

More than 10% of US patients undergoing endovascular procedures experience contrast-associated acute kidney injuries (AKIs), resulting in increased costs and health deficits. Prevention protocols reduce AKIs, but uptake and adherence vary greatly, and the cost-effectiveness of these interventions is unknown.

Objective

To analyze the cost-effectiveness of 4 implementation interventions for AKI prevention in patients undergoing cardiac catheterizations.

Design, Setting, and Participants

This economic evaluation used a Markov decision model with 3-year horizon was constructed to simulate quality-adjusted life years (QALYs) and costs after AKI prevention protocol implementation for patients undergoing cardiac catheterization. Data from the IMPROVE AKI trial, a cluster-randomized trial conducted across 20 US Department of Veterans Affairs medical centers from 2019 to 2021, were used for probabilities, with economic and utility data derived from literature. Patients aged 18 years or older, who underwent cardiac coronary angiography for diagnostic or treatment of pathology were included. Patients with a history of dialysis (hemodialysis or peritoneal dialysis) were excluded. Data were analyzed from January to June 2024.

Exposure

Interventions compared were assistance, assistance with surveillance, collaborative, and collaborative with surveillance.

Main Outcomes and Measures

QALYs and cost in dollars discounted at 3% per year and incremental cost-effectiveness ratio (ICER) using willingness-to-pay threshold of $100 000 per QALY. One-way and probabilistic sensitivity analyses were performed.

Results

Among 122 803 patients, 13 047 experienced AKIs (10.6%). Patient characteristics were balanced across 4 groups with an overall median (IQR) age of 70 (65-74) years, 119 119 males (97%), 25 789 Black patients (21%), 88 418 White patients (72%), and 8596 for all other racial and ethnic groups (7%). AKI incidences were 13.3% (95% CI, 11.0%-15.6%) in assistance, 11.4% (95% CI, 9.5%-13.3%) in assistance with surveillance, 12.7% (95% CI, 11.1%-14.4%) in collaborative, and 7.9% (95% CI, 6.4%-9.5%) in collaborative with surveillance. Intervention costs per patient were $12.74 (IQR, $9.56-$15.93) for collaborative with surveillance, $3.97 (IQR, $2.98-$4.96) for collaborative, $3.36 for assistance with surveillance, and $2.69 for assistance. Drivers for total cost of interventions were costs of AKI and subsequent permanent kidney disease. ICERs revealed collaborative with surveillance as economically dominant. Compared with assistance, collaborative with surveillance saved $742.75 while improving cost-effectiveness by 0.02 QALYs per person. Results were robust to sensitivity analyses.

Conclusions and Relevance

In this economic evaluation of implementation strategies for AKI prevention, virtual learning collaborative with automated surveillance reporting was the economically preferred intervention and was estimated to decrease AKI likelihood, permanent kidney disease, and their associated costs after undergoing cardiac catheterization. These results may be generalizable to other endovascular procedures and practice-changing protocols or checklists implementation efforts.

Association of Sleep Traits With Venous Thromboembolism: Prospective Cohort and Mendelian Randomization Studies

Previous research indicates an association between sleep traits and venous thromboembolism (VTE) risk, though causal relationships remain uncertain. This study evaluated combined and independent associations between sleep traits and VTE risk using UK Biobank data and explored the causal associations between sleep traits and VTE through two-sample Mendelian randomization (MR) analyses. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations between the healthy sleep score, as well as individual sleep traits (including sleep duration, insomnia, daytime sleepiness, snoring, and chronotype), and VTE risk were calculated using Cox proportional hazards regression models. Additionally, the two-sample MR analyses used the inverse-variance weighted method to determine odds ratios (ORs) and 95% CIs for causal associations. In the cohort analysis, 314 077 VTE-free participants were followed for a median of 12.3 years, during which 7176 VTE cases occurred. In comparison to those with a sleep score of 0-1, participants with a score of 5 were associated with a 30% lower risk of VTE (HR: 0.70; 95% CI: 0.61-0.80). A U-shaped association was noted between sleep duration and VTE risk. Both short (≤ 6 h) and long (≥ 9 h) sleep durations increased VTE risk. Excessive daytime sleepiness, snoring, and evening chronotype also elevated VTE risk. MR analyses supported a causal relationship for short sleep duration (OR: 1.24; 95% CI: 1.04-1.47) with VTE risk, while other sleep traits showed no causal association. These findings underscore the importance of optimal sleep in reducing VTE risk.

The effect of brief, repetitive balance training on balance and fall risk in older people with stroke: A randomized controlled trial

ObjectiveTo evaluate the effect of integrating a specific balance-training program focused on static balance to the conventional rehabilitation program on dynamic balance, risk of falls, and activities of daily living (ADLs) in older adults post-stroke.DesignA single-blinded randomized controlled trial.SettingInstitutional Intermediate Care Hospital.SubjectsPost-stroke older adults in a subacute phase without cognitive impairment, aged 65 years and older, exhibiting trunk control in a seated position for 30 seconds without supporting the arms.InterventionThe control group underwent the usual treatment, consisting of 60-minute physiotherapy sessions, 5 days per week, for 30 days. The experimental group integrated into the usual treatment 15 minutes of the balance-training program (45 min + 15 min).Main measuresBalance impairment (Mini-BESTest and Berg Balance Scale (BBS), risk of falls (BBS), and independence for ADLs (Barthel Index)) were assessed at baseline, 15 and 30 days after the start of interventions.ResultsSeventy-one post-stroke patients (77.7 ± 9.0 years, 49.2% women) were randomized into the experimental (n = 35) or control (n = 36) groups. The experimental group showed improved dynamic balance at day 15 (Mini-BESTest: 2.90 [1.05-4.77], p = 0.003; BBS: 4.31 [1.41-7.23], p = 0.004) and day 30 (Mini-BESTest: 6.06 [2.85-9.27], p < 0.001; BBS: 8.24 [2.96-13.53], p = 0.003), as well as greater independence levels (11 [2.75-19.23], p = 0.010) compared to the control group. The control group showed higher risk of falls on day 15 (p = 0.035) and day 30 (p = 0.003) than the experimental group.ConclusionsA simple, easily reproducible approach designed by and for the older adult to rehabilitate post-stroke impairments effectively improved balance, functional gait, risk of falls, and ADLs.

Evaluating Patient and Provider Experiences of Enrolling in a Remote Cardiovascular Health Program: A Qualitative Interview Study

BACKGROUND

Remote health management programs utilizing evidence-based algorithm-driven virtual care solutions for chronic disease management offer a novel approach to addressing implementation gaps for conditions such as hypertension. However, little is known about how to optimize patient enrollment.

METHODS

Through structured interviews, we conducted a qualitative analysis of patient and primary care physician attitudes toward enrollment in a remote hypertension management program at Mass General Brigham (Boston, MA). We selectively recruited a sampling of patients who had enrolled, declined, or were eligible for Mass General Brigham's remote hypertension management program, which utilized interdisciplinary teams to implement clinical guideline-based algorithmic management of hypertension. We analyzed the data using thematic analysis to identify common themes related to enrollment and engagement.

RESULTS

Between July and August 2022, we performed 20 patient interviews and 6 provider interviews. Most patient participants were male (n=12) and identified their race and ethnicity as White (n=15). Most provider participants were female (n=4), and all were medical doctors. Six themes related to hypertension care and remote hypertension management programs were identified: (1) strong connections between patients and care teams drive engagement; (2) there is widespread comfort with hybrid care delivery; (3) provider guidance facilitates home blood pressure monitoring; (4) the decision to enroll hinges on provider endorsement; (5) a clearly articulated program structure; and (6) working with trained nonlicensed navigators is an acceptable element of remote hypertension management programs.

CONCLUSIONS

Enrollment in remote hypertension management programs depends on several key factors. As in traditional care settings, providers significantly influence patient engagement with remote hypertension programs. Key challenges include nonlicensed navigator training and communication clarity about program structure. Building upon facilitators and addressing core challenges are essential for expansion of innovative hypertension care delivery programs to improve patient outcomes at scale.

Accelerometer-derived physical activity patterns and incident type 2 diabetes: a prospective cohort study

BACKGROUND

Emerging evidence suggests a significant relationship between the duration of physical activity (PA) and the incidence of type 2 diabetes (T2D). However, the association between the "weekend warrior" (WW) pattern-characterized by concentrated moderate-to-vigorous PA (MVPA) over one to two days-and T2D remains unclear.

METHODS

This prospective cohort study aims to utilize device-measured PA data to investigate the associations between PA patterns and T2D. Individuals were divided into three MVPA patterns on the basis of WHO guidelines: inactive (< 150 min), active WW (≥ 150 min with ≥ 50% of total MVPA achieved in one to two days), and active regular (≥ 150 min but not active WW). These patterns were also evaluated using sample percentile thresholds. The relationships between PA patterns and the risk of T2D were analysed employing Cox proportional hazards models.

RESULTS

A total of 1972 participants developed T2D over a 7.9-year median follow-up period. In the fully adjusted model, both active patterns demonstrated comparable reductions in the risk of developing T2D (active WW: hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.58-0.71; active regular: 0.56, 0.49-0.64). Moreover, the risk of T2D exhibited a progressive decline as the duration of MVPA increased across both active patterns.

CONCLUSIONS

Engaging in MVPA for one or two days per week provides comparable protective benefits against the incidence of T2D as more evenly distributed PA. Additionally, exceeding the current guidelines may confer even greater advantages.

Analysis and assessment of ferroptosis-related gene signatures and prognostic risk models in skin cutaneous melanoma

Background

The occurrence and development of skin cutaneous melanoma (SKCM) are significantly influenced by ferroptosis, a sort of regulated cell death characterized by iron deposition and lipid peroxidation. Although positive strides have been achieved in the present management of SKCM, it is still unknown exactly how ferroptosis occurs in this condition. We aimed to determine the role of prognostically relevant ferroptosis-related genes (PR-FRGs) in SKCM development and prognosis.

Methods

The training group was created using combined transcriptomic RNA data acquired from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases. The dataset GSE19234 was acquired from the Gene Expression Omnibus (GEO) database as a validation group. Differentially expressed ferroptosis-related genes (DE-FRGs) were obtained from the training group, of which 103 showed up-regulation and 77 showed down-regulation. Then, 12 PR-FRGs were identified by the protein-protein interaction (PPI) network and Cox regression analysis, and prognostic risk models and nomograms were constructed. The risk model was validated using a validation group, and the prognostic value of the risk model was analyzed. Finally, immunohistochemical data were obtained from the Human Protein Atlas (HPA) website to validate the PR-FRGs.

Results

Twelve PR-FRGs were identified. A prognostic risk model was built using PR-FRGs, and patients in the training and validation groups were classified as high or low risk based on the risk model. The outcomes demonstrated that the prognosis was better for the low-risk group. Prognostic value analysis showed that the prognostic risk model could accurately predict the patients' overall survival (OS), was superior to clinical traits such as age, gender, and tumor stage in predicting ability, and could be used as an independent predictor. Meanwhile, the nomogram constructed based on PR-FRGs can effectively predict the prognosis of SKCM patients. Finally, PR-FRGs were validated in the HPA database.

Conclusions

Ferroptosis affects the prognosis of SKCM patients. Prognostic risk model and nomogram constructed based on 12 PR-FRGs demonstrated significant advantages in predicting the prognosis of SKCM patients. This will help in the identification and prognostic prediction of SKCM and in the discovery of new individualized treatment modalities.

Ambulatory Blood Pressure in Tourists at Low Versus High Altitude: Colorado High Altitude Monitoring Pressure Study

IntroductionLimited evidence exists to guide travelers about blood pressure (BP) changes at high altitude (HA). Our primary objective compared 24-h ambulatory BP at low altitude (LA) vs HA in a cohort of tourists. Exploratory analyses compared results by sex and history of underlying hypertension.MethodsThis prospective observational cohort study measured ambulatory BP with Welch-Allyn ABPM 6100 monitors at LA (<1000 m) and HA (median 2751 m). Measurements included heart rate/BP every 30 min while awake and hourly overnight, BP≥180/100 mm Hg, sleep quality, and Lake Louise score (acute mountain sickness).ResultsAmong 33 participants (median age 61 y, 17 with hypertension, 12 on BP medication), 25 completed LA and HA measurements. Average 24-h mean arterial pressure (MAP) increased at HA by 6 mm Hg (95% CI, 2-10 mm Hg; P=0.04). When analyzed by the presence of preexisting hypertension, 24-h MAP was similar between LA and HA in those with underlying hypertension (mean difference, 4 mm Hg; 95% CI, -4 to 11 mm Hg; P=0.3) but rose at HA in those without (mean difference, 9 mm Hg; 95% CI, 5-14 mm Hg; P=0.001). At HA, 24-h MAP was similar in both groups (mean difference, 9 mm Hg; 95% CI, 0-19 mm Hg; P=0.05). Results did not differ by sex. Severe-range BP was common in all groups and asymptomatic.ConclusionsAmong this tourist cohort, we observed an increase in average 24-h MAP at HA. Altitude-related changes in BP varied greatly between individuals. This variation was related in part to underlying hypertension but not sex. Our data suggest that BP changes are not of clinical concern in HA travelers.

Association between uric acid to high-density lipoprotein cholesterol ratio and peripheral arterial disease in hypertensive patients: A cohort study

BACKGROUND AND AIMS

Uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) is a new indicator of inflammation and metabolism proposed by recent researches. Previous researches have confirmed a positive association between UHR and the risk of cardiovascular death. However, it is undetermined that the association between UHR and peripheral arterial disease (PAD).

METHODS AND RESULTS

The research is a prospective cohort study that included a total of 6,867 participants from the Chinese Hypertension Registry Study. 328 participants were identified with PAD during a median follow-up period of 48 months. Multiple logistic regression analysis and smooth curve fitting were applied to explore the association between UHR and PAD among men and women. After adjusting for potential confounders, UHR was positively associated with PAD both in men (HR: 1.27, 95 % CI: 1.07-1.51) and women (HR: 1.45, 95 % CI: 1.19-1.77). Subgroup analyses showed that the association between UHR and PAD remained stable across subgroups of men and women (all P for interaction >0.05).

CONCLUSIONS

There is a significant positive association between UHR and new-onset PAD in the Chinese hypertensive population both in men and women. An elevated UHR predicted increased risk of PAD.

Validation of the Malta Gait Scale: A Time-Efficient Tool for Poststroke Assessment

Over 80% of stroke survivors experience walking dysfunction, impacting quality of life. Rehabilitation is crucial for gait recovery, and accurate assessments facilitate tailored programs. While computerized gait analysis is the gold standard, it is costly and requires specialized training, making observational gait analysis (OGA) more common. However, OGA can also be time-consuming. This study validates the Malta Gait Scale (MGS), a concise, illustrated 7-item observational tool using video recordings for gait measurements. The aim is to provide an effective, time-efficient method for gait evaluations by comparing the MGS with the established Wisconsin Gait Scale (WGS) and Gait Assessment Intervention Tool (GAIT), which have 14 and 31 items, respectively. Forty-nine participants were included in a retrospective study to validate the MGS. We evaluated its reliability using weighted Cohen's kappa (κ) for intrarater and interrater reliability. Concurrent validity was assessed by comparing the MGS with the WGS and GAIT scales using Spearman's rho (ρ). The Wilcoxon test assessed the efficacy of the MGS in detecting rehabilitation-induced changes, differentiating healthy from stroke participants, and evaluating time efficiency. The MGS demonstrated almost perfect agreement, with interrater and intrarater κ values of 0.952 and 0.977, respectively. It showed high positive correlations with the WGS and GAIT, with ρ values of 0.898 and 0.877. MGS required an average administration time of 7 min and 29 s, significantly less than the WGS (27 min and 46 s) and GAIT (50 min and 6 s) (p < 0.001). Following rehabilitation, significant improvements were observed in patients using both the MGS and WGS scales (p = 0.018), and the MGS effectively distinguished between healthy individuals and stroke patients (p < 0.001). The MGS is a valid, reliable, and efficient tool for gait assessment in stroke survivors, supporting smartphone use and facilitating rapid measurements in clinical settings where time is critical.

Serum CA125: a prognostic biomarker for mortality in chronic heart failure

OBJECTIVE

To examine the relationship between serum Carbohydrate Antigen 125 (CA125) levels and long-term mortality in Chronic Heart Failure (CHF) patients and to assess its predictive value as a biomarker.

METHODS

This was a retrospective cohort study. We reviewed the medical records of 4,442 consecutive patients admitted to the First Affiliated Hospital of Xinjiang Medical University with a diagnosis of CHF since July 2012. After applying inclusion and exclusion criteria, 1,413 patients with available CA125 level measurements were included. The patients were categorized into three groups based on ejection fraction: HFrEF, HFmrEF, and HFpEF. Demographic details, comorbidities, and laboratory parameters were collected. CA125 levels were measured using an automated chemiluminescent immunoassay. Survival analysis was performed using the Kaplan-Meier method and Cox proportional hazards regression.

RESULTS

The median follow-up was 22.75 months. Elevated CA125 levels were significantly associated with increased all-cause mortality (ACM) across all CHF subtypes (HR = 2.05, 95% CI: 1.60-2.64, P < 0.001), especially in the HFpEF group (HR = 2.32, 95% CI: 1.59-3.40, P < 0.001). The area under the ROC curve for CA125 was 0.655, indicating moderate predictive accuracy. Multivariate analysis revealed that patients with CA125 levels ≥ 20.8 U/mL had a significantly higher risk of ACM (HR = 2.05). Adjustments for confounding factors did not alter these findings.

CONCLUSION

Our findings suggest that serum CA125 levels may serve as a potential prognostic biomarker for mortality in CHF patients, particularly in the HFpEF subgroup. However, further research is needed to confirm these findings and elucidate the underlying mechanisms.

Evidence-based medicine and the cardiac troponin 99th percentile for the diagnosis of acute myocardial infarction

The 99th percentile of cardiac troponin assays for determining the presence of acute myocardial infarction (AMI) was set when assay analytical performance was much less precise than currently and was chosen, in part, to reduce the frequency of 'false-positive' results. A result greater than 99th percentile criterion has been a requirement of each version of the universal definition of MI. It also became used as a dichotomous decision-making threshold in diagnostic strategies for investigating AMI in acute care settings. There are numerous difficulties in deriving the 99th percentile which undermine its reliability as a standalone test threshold. It is important for patient safety that all users are aware of the challenges and pitfalls of using the 99th percentile for decision-making. We present a focused review of the 99th percentile, highlighting some difficulties with its use as a decision threshold as well as possible adjunctive strategies and alternative approaches.

Dodecafluoropentane improves neuro-behavioral outcomes and return of spontaneous circulation rate in a swine model of cardiac arrest

INTRODUCTION

Dodecafluoropentane emulsion (DDFPe) administration has previously demonstrated improved gas exchange in single-organ perfusion models. This could translate to prevention of brain injury in cardiac arrest.

METHODS

We induced cardiac arrest in 12 pigs, performing CPR after 5-minute downtime. Pigs were randomly assigned to DDFPe (n = 7) or saline placebo (n = 5) groups. Neurologic injury biomarkers were measured at baseline, after return of spontaneous circulation (ROSC), and every 24 hours in survivors. Blinded Neurological Alertness Score, Neurological Dysfunction Score, and Overall Performance Score was performed in addition to histopathological scoring of parietal and hippocampal sections.

RESULTS

One placebo and four DDFPe pigs survived the 96-hour observation period. The odds ratio for ROSC was 7.2 (p = 0.22). Survival odds ratio was 4.6 (p = 0.29). All surviving animals had impaired motor responses that recovered by 72 hours. DDFPe animals showed better neuro-behavioral scores than placebo.

CONCLUSION

The findings of this novel study provide a proof of concept and early signal toward efficacy of intravenous DDFPe in cardiac arrest. The trend toward improved ROSC and functional survival may reflect improved microcirculatory gas exchange in DDFPe animals. Improving gas exchange in brain microcirculation during resuscitation from cardiac arrest may provide a significant therapeutic benefit.

Impact of plant-derived antioxidants on heart aging: a mechanistic outlook

Heart aging involves a complex interplay of genetic and environmental influences, leading to a gradual deterioration of cardiovascular integrity and function. Age-related physiological changes, including ventricular hypertrophy, diastolic dysfunction, myocardial fibrosis, increased arterial stiffness, and endothelial dysfunction, are influenced by key mechanisms like autophagy, inflammation, and oxidative stress. This review aims to explore the therapeutic potential of plant-derived bioactive antioxidants in mitigating heart aging. These compounds, often rich in polyphenols, flavonoids, and other phytochemicals, exhibit notable antioxidant, anti-inflammatory, and cardioprotective properties. These substances have intricate cardioprotective properties, including the ability to scavenge ROS, enhance endogenous antioxidant defenses, regulate signaling pathways, and impede fibrosis and inflammation-promoting processes. By focusing on key molecular mechanisms linked to cardiac aging, antioxidants produced from plants provide significant promise to reduce age-related cardiovascular decline and improve general heart health. Through a comprehensive analysis of preclinical and clinical studies, this work highlights the mechanisms associated with heart aging and the promising effects of plant-derived antioxidants. The findings may helpful for researchers in identifying specific molecules with therapeutic and preventive potential for aging heart.

The Prognostic Yield of Admission Shock Index in Patients with ST-Segment Elevation Myocardial Infarction: SEMI-CI Study

Background

Early identification of high-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) helps prevent complications. The shock index (SI) is a bedside risk-stratification tool used in emergency departments. In this study, we aimed to assess the SI's predictive value for prognosticating in-hospital and one-year mortality, as well as one-year major cardiovascular events (MACEs). As secondary endpoints, we assessed the age SI's performance and the influence of prehospital transport factors on SI's predictive value.

Methods

This prospective cohort study is named SEMI-CI and enrolled patients with STEMI who were referred to a cardiology hospital in Isfahan. We analyzed data on 867 patients with STEMI. Systolic blood pressure (SBP) and heart rate (HR) upon admission were used to calculate SI. Patients were divided into two groups based on SI, and 277 patients had SI > 0.7.

Results

In-hospital death, one-year mortality, and MACE were more prevalent in those patients presenting with SI ≥ 0.7. However, after multivariate adjustment, SI was an independent predictor of in-hospital mortality and MACE, but it was not associated with one-year mortality. Furthermore, mortality rates increased from lower to higher age groups. Among patients transferred by emergency medical services to our hospital, SI showed prognostic implications for in-hospital mortality but not for one-year mortality.

Conclusions

The current study showed that a positive SI and age SI are valuable risk-stratification tools to identify high-risk patients presenting with STEMI.

The PREVASC study: Prospective REgistry of Valve disease in Asymptomatic Italian elderly SubjeCts

AIMS

Valvular heart disease (VHD) is the third leading cause of cardiovascular morbidity, with its incidence and public health impact projected to increase significantly. This study adopts a novel perspective, focusing on elderly individuals residing in rural areas, highlighting the unique dynamics of small-town settings.

METHODS

This multicenter, observational study was conducted from May 2022 to September 2023, under the coordination of the AOU Careggi Echo Core-Lab, which managed the entire screening program. In 10 small Italian villages, each municipality facilitated the enrollment of asymptomatic individuals aged ≥ 65 years, with no prior VHD history, through voluntary participation. Participants were grouped into three age categories (65-69, 70-74, and ≥ 75 years) and underwent a thorough evaluation, including a Quality of Life (QoL) questionnaire and comprehensive echocardiographic assessment focusing on VHD detection and grading.

RESULTS

Among 1,113 participants, the prevalence and severity of VHD showed a significant increase with age (p < 0.0001). Remarkably, 94% of individuals aged ≥ 75 years had at least one valvular defect, with 22.5% presenting moderate or severe valvulopathy, including a prevalence of 4.8% for moderate or severe aortic valve stenosis and 7.5% for mitral regurgitation. Right-sided valvulopathies followed a similar trend, affecting 71.9% of elderly participants. QoL evaluations revealed a generally positive perceived health status, with a mean score of 77 ± 16.

CONCLUSIONS

Our registry highlights that the prevalence of VHD in asymptomatic individuals over 65 years living in small Italian communities is substantial, increases with age, and is predominantly degenerative in etiology. Notably, most individuals with undiagnosed VHD perceived themselves as healthy.

Sexual Dimorphism in Cardiometabolic Diseases: From Development to Senescence and Therapeutic Approaches

The global incidence and prevalence of cardiometabolic disorders have risen significantly in recent years. Although lifestyle choices in adulthood play a crucial role in the development of these conditions, it is well established that events occurring early in life can have an important effect. Recent research on cardiometabolic diseases has highlighted the influence of sexual dimorphism on risk factors, underlying mechanisms, and response to therapies. In this narrative review, we summarize the current understanding of sexual dimorphism in cardiovascular and metabolic diseases in the general population and within the framework of the Developmental Origins of Health and Disease (DOHaD) concept. We explore key risk factors and mechanisms, including the influence of genetic and epigenetic factors, placental and embryonic development, maternal nutrition, sex hormones, energy metabolism, microbiota, oxidative stress, cell death, inflammation, endothelial dysfunction, circadian rhythm, and lifestyle factors. Finally, we discuss some of the main therapeutic approaches, responses to which may be influenced by sexual dimorphism, such as antihypertensive and cardiovascular treatments, oxidative stress management, nutrition, cell therapies, and hormone replacement therapy.

Burden of Coronary Artery Disease as a Predictor of New Vascular Events and Mortality in Patients With Ischemic Stroke: Insights From the Norwegian Stroke in the Young Study

BACKGROUND

Studies in young patients with stroke identified coronary artery disease (CAD) as a main contributor to mortality. In the present NOR-SYS (Norwegian Stroke in the Young Study), we aimed to investigate the prevalence of CAD, and the impact on new vascular events and mortality.

METHODS

A total of 385 patients with ischemic stroke, aged ≤60 years, were included. CAD was defined as a history of CAD or positive coronary imaging (computed tomography or coronary angiography).

RESULTS

Mean age was 49.6 years, and 68.1% were men. The prevalence of CAD was 25.2% (n=97) (nonobstructive, 9.6% [n=37]; and obstructive, 15.6% [n=60]). In the subsample of patients without clinical CAD but with femoral plaque on ultrasound (n=58) who underwent cardiac computed tomography, 46% (n=27) had nonobstructive CAD and 28% (n=16) had obstructive CAD. During a median follow-up of 10.1 years, 36 patients (9.4%) died, 84 (21.8%) reached a composite end point of new stroke, myocardial infarction, or death, whereas 64 (16.6%) had a composite end point of new stroke or death. Event-free survival was significantly lower in patients with obstructive CAD versus no CAD or nonobstructive CAD (log-rank P<0.001). In the multivariable Cox regression models, CAD was a strong and independent predictor of all-cause mortality (hazard ratio [HR], 2.20 [95% CI, 1.05-4.60]; P=0.037) and the composite end point of death or recurrent ischemic stroke (HR, 3.24 [95% CI, 1.46-7.20]; P=0.004).

CONCLUSIONS

In young and middle-aged ischemic stroke survivors, a quarter of patients had CAD. CAD was an independent predictor of recurrent stroke and mortality. In patients without previous CAD, but femoral plaque on ultrasound, nearly a half had nonobstructive and one-fourth had obstructive CAD. Systematic screening with cardiac computed tomography may identify high-risk patients after ischemic stroke.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01597453.

Association between the haemoglobin glycation index and 30-day and 365-day mortality in patients with heart failure admitted to the intensive care unit

BACKGROUND

The hemoglobin glycation index (HGI) represents the difference between the observed and predicted values of haemoglobin A1c (HbA1c). However, the association between HGI and prognosis of heart failure (HF) is not completely clarified yet and requires more investigation. This study aimed to explore the connection between HGI and mortality in HF patients.

METHODS

The data for the study were derived from the MIMIC-IV database from 2008 to 2019, a publicly available clinical database in intensive care. A linear regression equation between HbA1c and fasting blood glucose (FBG) was established to calculate predicted HbA1c. The endpoints were 30-day and 365-day all-cause mortality. Kaplan-Meier analysis was utilized to compare survival rates across groups differentiated by their HGI levels. The Cox regression models and restricted cubic spline (RCS) analysis were utilized to analyze the association between HGI and mortality.

RESULTS

The study collected a total of 2846 patients with HF (40.1% male), of whom 305 patients (10.7%) died within 30 days and 954 patients (33.5%) died within 365 days. Kaplan-Meier curves revealed patients with higher HGI had significantly higher mortality risks (log-rank P < 0.001). A high HGI was significantly associated with 30-day mortality (adjusted HR [aHR]: 2.36, 95% CI: 1.74-3.20, P < 0.001) and 365-day mortality (aHR: 1.40, 95% CI: 1.16-1.68, P < 0.001) after adjustment for potential confounders. Likewise, each unit increase in the HGI correlated with a 1.42-fold higher risk of 30-day mortality (aHR: 1.42, 95% CI: 1.28-1.57, P < 0.001) and 1.19-fold higher risk of 365-day mortality (aHR: 1.19, 95% CI: 1.11-1.68, P < 0.001). RCS analysis suggested an L-shaped nonlinear association between HGI and clinical endpoints (P for nonlinearity < 0.001), with an inflection point value of - 1.295. Subgroup analysis and sensitivity analysis revealed that the correlation between HGI and 30-day and 365-day all-cause mortality remained consistent.

CONCLUSIONS

In ICU-admitted HF patients, HGI was independently associated with increased risks of 30-day and 365-day mortality and the identification of high HGI (> 0.709) provided a valuable tool for clinicians to detect high-risk populations. Integrating HGI into routine clinical practice might strengthen the prognosis-based decision making improve HF patient outcomes.

Systolic Blood Pressure Modifies the Effect of Endovascular Thrombectomy in Acute Ischemic Stroke: A Mediation Analysis

BACKGROUND

Systolic blood pressure (BP) is a key factor in the outcomes of patients with acute ischemic stroke (AIS) receiving endovascular thrombectomy (EVT). However, the factors that mediate the association between BP and clinical outcome are unclear.

METHODS

Consecutive patients with AIS in the anterior circulation underwent continuous BP monitoring for 24 hours. The 3-month modified Rankin scale (mRS) score was defined as the clinical functional outcome. The systolic BPI indices (BPIs) were successive variation, standard deviation, variability independent of mean BP (VIM), and 24-hour mean BP. Regression analysis was used to assess the correlation between different BPIs and functional outcomes, whereas mediation analysis was employed to assess the potential mediating effects of baseline risk factors through BP on functional outcomes.

RESULTS

A total of 140 of 292 patients (47.9%) achieved functional independence, and 87 (29.8%) experienced hemorrhagic transformation (HT). A history of stroke or hypertension and NIHSS score at onset were associated with SD and VIM (P < 0.05). BP variation (BPV) was still strongly associated with functional outcomes after adjustment for different risk factors. Mediation analysis revealed that stroke affected functional outcomes by affecting BPV, while the hypertension history affected functional prognosis by impacting the 24-hour mean BP and BPV. In addition, higher National Institute of Health stroke scale (NIHSS) scores were associated with increased BPV, whereas increased BPV was correlated with a greater proportion of unfavorable outcomes.

CONCLUSIONS

To our knowledge, this study is the first to explore the mediating effects of different BPIs on the relationships between risk factors and functional outcomes and may provide new insights and potential mechanisms for improving AIS prognosis.

Endogenous Estrogen Exposure and Hypertension Risk; A Population-based Cohort Study With About 2 Decades of Follow-up

CONTENT

The impact of endogenous estrogen exposure (EEE) on hypertension (HTN) incidence has not been investigated yet.

OBJECTIVE

This study aimed to evaluate HTN incidence in women with different endogenous estrogen durations.

METHODS

Information was gathered from the Tehran Lipid and Glucose Study to conduct current research. At the initiation of the study, 4463 postmenarche normotensive women, including 3599 premenopausal and 864 menopausal women, were included. EEE was calculated for each woman, and they were followed up for the HTN event. According to the EEE, the hazard ratios and 95% confidence intervals (CI) for the HTN event were presented using Cox proportional hazards regression models (unadjusted and adjusted).

RESULTS

The median (interquartile range) of follow-up (between menarche and the date of HTN incidence or last follow-up) was 33.2 (25.1, 42.3) years. The event of menopause occurred in 31.8% of participants. The unadjusted model's findings illustrated that the EEE z-score was inversely associated with HTN incidence in postmenarcheal women [unadjusted hazard ratio (HR) .47, 95% CI .44-.50], meaning that the risk of HTN decreased by 53% for every 1-SD rise in the EEE z-score. After adjusting for potential confounders, the results showed no statistically significant changes (adjusted HR .46, 95% CI .43-.49). In participants with prehypertension at baseline, the hazard of HTN decreased by 56% per 1-SD rise in the EEE z-score.

CONCLUSION

This longitudinal study demonstrated the protective effect of a longer EEE duration on HTN risk, even among those with prehypertension status.

Interactive effect between Selenium and Vitamin C levels on risk of hypertension among adult women in the United States: evidence from NHANES 2011 to 2020

Background

Hypertension poses an imperative global health risk, affecting over 1 billion people and contributing to cardiovascular disease, especially for women. While previous studies suggest micronutrients such as Vitamin C or Selenium can help reduce blood pressure, research on their interactive effects remains limited.

Methods

This cross-sectional study analyzed data from 9,343 women aged 20 years and older in NHANES (2011-2020). Logistic regression analysis was conducted to evaluate the effect of each micronutrient on hypertension. To account for potential interactions between micronutrients, we calculated the relative excess risk due to interaction, which assessed their combined effect on hypertension.

Results

We confirmed the individual associations of Vitamin C and Selenium with hypertension, showing significant negative correlations (p < 0.05). Participants were then divided into four groups, and those with high intakes of both Vitamin C and Selenium had a significantly lower risk of hypertension (p < 0.05), supporting the association between the combined intake of these nutrients and lower hypertension risk, though no synergistic effect was observed.

Conclusion

The findings support the combined intake of Vitamin C and Selenium in hypertension prevention, broadening thoughts on the level of nutrition for the treatment of hypertension. These results suggest a potential association between adequate supplementation of Vitamin C and Selenium and lower blood pressure. However, further rigorous clinical studies are essential to validate and strengthen these findings.

Vortioxetine alleviates motor, cognitive and emotional disorders in post-stroke rats by regulating the TLR-2/NF-κB pathway

Cognitive impairments following post-stroke significantly hinder neurological recovery and exacerbate patient morbidity, underscoring urgent need for effective therapeutic strategies. Vortioxetine (VTX), a prominent Selective Serotonin Reuptake Inhibitor (SSRI), boasts notable antidepressant, cognition-enhancing, and anti-inflammatory properties. This investigation delves into VTX's influence on motor skills, spatial learning-memory capabilities, and depressive behaviors in Middle Cerebral Artery Occlusion (MCAO) rats, alongside its underlying mechanisms. Our findings reveal that while VTX fails to entirely reverse ischemic-reperfusion damage, it substantially ameliorates spontaneous locomotor functions, augments post-stroke learning-memory capacities, and exhibits potent antidepressant and anxiety-like efficacy. Preliminary data propose that these beneficial effects may stem from inflammation modulation via the Toll-Like Receptor 2 (TLR-2)/Nuclear Factor-Kappa B (NF-κB) signaling pathway. Collectively, our work underscores VTX's promising role in enhancing motor, cognitive functions, and mitigating depressive symptoms following cerebrovascular accidents, potentially through inflammation regulation. These insights pave the way for novel interventions addressing post-stroke complications, warranting further exploration.

Can cardiovascular health and its modifiable healthy lifestyle offset the increased risk of all-cause and cardiovascular deaths associated with insulin resistance?

BACKGROUND

Insulin resistance(IR) is associated with an increased risk of all-cause and cardiovascular death, and modifiable healthy lifestyles play an active role in the improvement of IR and the reduction of all-cause and cardiovascular death. Whether cardiovascular health (CVH) and modifiable healthy lifestyles within it can attenuate or even offset the heightened perils of both all-cause and cardiovascular deaths associated with insulin resistance remains unclear.

METHODS

The study encompassed 14,172 healthy participants from the 2005-2018 NHANES programme. Insulin resistance was evaluated using the TyG index, TyG-WC, and TyG-WHtR, while CVH was assessed employing the LE8 score, in addition to the LE4 index redefined according to four health behaviours. Weighted multifactor Cox regression models were used to assess the association of IR and CVH with all-cause and cardiovascular mortality, and dose-response relationships were assessed using restricted cubic spline. Furthermore, subjects were grouped according to IR and CVH scores, and generalised linear models were used to estimate the weighted mortality and risk of death for each group and to calculate the absolute risk difference. Finally, the predicted probability of all-cause and cardiovascular mortality risk as a function of IR was computed, and the complex relationship between the three was visualised using two-dimensional grouped scatter plots and three-dimensional surface plots.

RESULTS

Among the 14,172 healthy participants included in the study, 1534 deaths occurred over a mean follow-up period of 7.6 years (382 of these deaths were due to cardiovascular causes). The weighted Cox regression analysis indicated that elevated TyG-WC and TyG-WHtR correlated with a greater likelihood of mortality from all causes and cardiovascular events, whereas cardiovascular health was inversely associated with these risks. Additional stratification revealed a notable reduction in the likelihood of mortality from all causes and cardiovascular events as cardiovascular health improved, irrespective of the presence of insulin resistance. Additionally, participants with high insulin resistance but moderate or high cardiovascular health did not have significantly increased risks compared with those with low insulin resistance. Stratified scatter plots and 3D surface plots revealed that cardiovascular health and modifiable healthy lifestyles significantly reduced the risk of insulin resistance-related death, with greater reductions observed at higher insulin resistance levels.

CONCLUSIONS

In this cohort study, improving cardiovascular health and modifiable health behaviors significantly reduced the risk of insulin resistance-related all-cause and cardiovascular deaths. Maintaining cardiovascular health at moderate or high levels (LE8 ≥ 50) could offset the increased risks caused by insulin resistance.

Case Report: Complete AV block in two patients with a congenital absence of the right coronary artery: an unusual correlation

Background

Congenital absence of the right coronary artery (RCA) is an extremely rare coronary anomaly with a very low incidence in the general population. The prevalence of complete atrioventricular (AV) block also appears to be low. No previous reports have documented the coexistence of congenital absence of the RCA and complete AV block in the same patient.

Case summaries

Case 1 was a 52-year-old man with no significant past medical history who experienced syncope. The initial ECG revealed complete AV block with a non-specific ST-T segment. Coronary angiography showed mild, non-obstructive atherosclerosis in the dominant left circumflex artery (LCx), which continued along the anatomical course of the RCA. The patient underwent a dual-chamber pacemaker implantation for complete AV block. Case 2 was a 79-year-old man with a history of hypertension and coronary heart disease who presented with gradually worsening fatigue lasting 6 h. ECG showed complete AV block with a non-specific ST-T segment. Coronary angiography revealed an abnormal origin of the RCA arising from the distal portion of a dominant LCx, which retrogradely followed the course of a normal RCA to the base of the heart. The patient also underwent a dual-chamber pacemaker implantation for complete AV block.

Conclusion

These two cases represent the first reported instances of complete AV block coexisting with congenital absence of the RCA, where the LCx supplied the territory of the RCA without evidence of myocardial infarction.

Predictors of significant tricuspid regurgitation in atrial fibrillation: a meta-analysis

Aims

Significant tricuspid regurgitation (TR) in atrial fibrillation (AF) patients is becoming a global issue, as it can lead to progressive right ventricular enlargement and heart failure, thereby increasing morbidity and mortality. This study aimed to evaluate potential predictors of significant TR in AF patients using open databases.

Methods

PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for relevant studies from inception to September 2023. Using STATA 14.0 statistical software, hazard ratios (HRs) were calculated for data synthesis. The potential predictors included clinical characteristics, echocardiography parameters, and prior comorbidities. Evidence certainty was evaluated based on the GRADE system.

Results

In total, 12 studies involving almost 16,000 patients were included in this review. Female sex (HR = 2.14; 95% CI: 1.84-2.49; I2 = 0.0%; p = 0.430), persistent atrial fibrillation (HR = 2.99; 95% CI: 2.47-3.61; I2 = 0.0%; p = 0.896), left ventricular ejection fraction [standard mean difference (SMD) = -0.16; 95% CI:-0.30 to -0.03; I2 = 69.8%; p < 0.000], age (HR = 1.07; 95% CI: 1.04-1.09; I2 = 72.3%; p = 0.013), heart failure (HR = 1.86; 95% CI: 1.45-2.39; I2 = 9.0%; p = 0.348), age ≥65 years (HR = 2.30; 95% CI: 1.63-3.25; I2 = 55.1%; p = 0.108), chronic lung disease (HR = 1.33; 95% CI: 1.02-1.74; I2 = 0.0%; p = 0.882), right ventricle fractional area change (SMD = 0.18; 95% CI: 0.01-0.36; I2 = 0.0%; p = 0.440), systolic pulmonary arterial pressure (SMD = 0.97; 95% CI: 0.76-1.19; I2 = 41.5%; p = 0.181), and proper ventricular systolic pressure (SMD = 1.07; 95% CI: 0.54-1.59; I2 = 92.4%; p < 0.000) may negatively influence significant TR.

Conclusions

This meta-analysis identified a potential negative influence of several clinical characteristics, echocardiography parameters, and previous comorbidities on significant TR. However, due to the low level of certainty of evidence, our analysis can only provide some guidance to practitioners and researchers. Caution is advised, and further validation is needed.

Explaining the Variance in Cardiovascular Health Indicators among Asian Americans: A Comparison of Demographic, Socioeconomic, and Ethnicity

The Asian American (AA) population is the fastest-growing major racial group in the U.S. Typically treated as a monolith in research, disaggregated data show disproportionate cardiovascular disease (CVD) burden among certain AA ethnic groups. This analysis aimed to identify which factors explain variance in cardiovascular health among AA ethnic groups. We analyzed pooled 2010-2018 National Health Interview Survey data from Chinese, Asian Indian, Filipino, and Other Asian adults in the U.S. CVD outcomes of interest were coronary heart disease, heart attack, and stroke. Covariates included sociodemographic characteristics, CVD-related health conditions, and behaviors. Variance explained by sociodemographic, health behaviors, and health conditions were calculated based on the adjusted R-squared from a series of five models for each CVD health outcome. Of the 10,353 AA adults in the sample, 53% identified as female. Compared to the aggregate AA sample and the other ethnic groups, Filipinos had a higher burden of any CVD outcome (5.9%), particularly for coronary heart disease (4.0%). The combination of all predictors explained at most 13% of variance, with sociodemographic characteristics accounting for at least half of the variance explained among all participants. Health behaviors explained a greater amount of additional variance for all CVD outcomes among Asian Indians, including an additional 3.1% for stroke. Inversely, existing health conditions were significant predictors of CVD for all AA ethnic groups compared to Asian Indians. There is heterogeneity in CVD outcomes and related risk factors in AA ethnic groups, emphasizing the need for culturally tailored prevention and intervention strategies.

Ghrelin promotes neurologic recovery and neurogenesis in the chronic phase after experimental stroke

BACKGROUND

The neuroprotective and proangiogenic potential of ghrelin in acute ischemic stroke has been demonstrated in experimental studies. However, the transferability of these results is limited as ghrelin was administered either before or very early after stroke onset and follow-up was limited to the first days after stroke. The aim of this study was therefore to close and extend this knowledge gap. To this end, we investigated the effect of ghrelin in two different translational animal models, one investigating acute and one investigating long-term structural and functional recovery after experimental stroke.

METHODS

Middle cerebral artery occlusion (MCAO) or photothrombotic stroke was induced in 65 adult male Wistar rats. Eleven sham-operated animals served as controls. The rats were treated with either ghrelin, the ghrelin receptor antagonist [D-Lys]-GHRP-6 or a control substance. Up to four weeks after ischemia, behavioral tests such as the cylinder test, the tape removal test, and the rotarod test were performed to examine sensorimotor deficits, and the Morris water maze was performed to examine effects on the acquisition and consolidation of new memories. The structural outcome was determined by a differential analysis of neurogenesis in relation to survival and proliferation of newborn neurons in the post-ischemic brain, angiogenesis and determination of infarct size.

RESULTS

Ghrelin treatment improved motor and somatosensory functions and preserved the consolidation of new memories after photothrombotic stroke. As a structural correlate, long-term survival and sustained proliferation of neuronal cells after stroke was significantly increased in ghrelin-treated rats, while angiogenesis remained unaffected. In contrast to these neuroregenerative mechanisms, ghrelin did not induce immediate neuroprotective effects after MCAO.

CONCLUSIONS

Our results suggest that ghrelin has a significant pro-neuroregenerative effect by enhancing long-term survival and sustained proliferation of neurons in the dentate gyrus and peri-infarct area, thus promoting functional recovery. Overall, ghrelin represents a promising target in the subacute and chronic phase after ischemic stroke.

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

Background

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

Methods

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

Results

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

Conclusions

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