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

Machine learning-based radiomic features of perivascular adipose tissue in coronary computed tomography angiography predicting inflammation status around atherosclerotic plaque: a retrospective cohort study

OBJECTIVES

This study expolored the relationship between perivascular adipose tissue (PVAT) radiomic features derived from coronary computed tomography angiography (CCTA) and the presence of coronary artery plaques. It aimed to determine whether PVAT radiomic could non-invasively assess vascular inflammation associated with plaque presence.

METHODS

In this retrospective cohort study, data from patients undergoing coronary artery examination between May 2021 and December 2022 were analyzed. Demographics, clinical data, plaque location and stenosis severity were recorded. PVAT radiomic features were extracted using PyRadiomics with key features selected using Least Absolute Shrinkage and Selection Operator (LASSO) and recursive feature elimination (RFE) to create a radiomics signature (RadScore).Stepwise logistic regression identified clinical predictors. Predictive models (clinical, radiomics-based and combined) were constructed to differentiate plaque-containing segments from normal ones. The final model was presented as a nomogram and evaluated using calibration curves, ROC analysis and decision curve analysis.

RESULTS

Analysis included 208 coronary segments from 102 patients. The RadScore achieved an Area Under the Curve (AUC) of 0.897 (95% CI: 0.88-0.92) in the training set and 0.717 (95% CI: 0.63-0.81) in the validation set. The combined model (RadScore + Clinic) demonstrated improved performance with an AUC of 0.783 (95% CI: 0.69-0.87) in the validation set and 0.903 (95% CI: 0.83-0.98) in an independent test set. Both RadScore and combined models significantly outperformed the clinical model (p < .001). The nomogram integrating clinical and radiomics features showed robust calibration and discrimination (c-index: 0.825 in training, 0.907 in testing).

CONCLUSION

CCTA-based PVAT radiomics effectively distinguished coronary artery segments with and without plaques. The combined model and nomogram demostrated clinical utility, offering a novel approach for early diagnosis and risk stratification in coronary heart disease.

LASF: a local adaptive segmentation framework for coronary angiogram segments

Coronary artery disease (CAD) remains the leading cause of death globally, highlighting the critical need for accurate diagnostic tools in medical imaging. Traditional segmentation methods for coronary angiograms often struggle with vessel discontinuity and inaccuracies, impeding effective diagnosis and treatment planning. To address these challenges, we developed the Local Adaptive Segmentation Framework (LASF), enhancing the YOLOv8 architecture with dilation and erosion algorithms to improve the continuity and precision of vascular image segmentation. We further enriched the ARCADE dataset by meticulously annotating both proximal and distal vascular segments, thus broadening the dataset's applicability for training robust segmentation models. Our comparative analyses reveal that LASF outperforms well-known models such as UNet and DeepLabV3Plus, demonstrating superior metrics in precision, recall, and F1-score across various testing scenarios. These enhancements ensure more reliable and accurate segmentation, critical for clinical applications. LASF represents a significant advancement in the segmentation of vascular images within coronary angiograms. By effectively addressing the common issues of vessel discontinuity and segmentation accuracy, LASF stands to improve the clinical management of CAD, offering a promising tool for enhancing diagnostic accuracy and patient outcomes in medical settings.

Development of an electroconductive Heart-on-a-chip model to investigate cellular and molecular response of human cardiac tissue to gold nanomaterials

To date, various strategies have been developed to construct biomimetic and functional in vitro cardiac tissue models utilizing human induced pluripotent stem cells (hiPSCs). Among these approaches, microfluidic-based Heart-on-a-chip (HOC) models are promising, as they enable the engineering of miniaturized, physiologically relevant in vitro cardiac tissues with precise control over cellular constituents and tissue architecture. Despite significant advancements, previously reported HOC models often lack the electroconductivity features of the native human myocardium. In this study, we developed a 3D electroconductive HOC (referred to as eHOC) model through the co-culture of isogenic hiPSC-derived cardiomyocytes (hiCMs) and cardiac fibroblasts (hiCFs), embedded within an electroconductive hydrogel scaffold in a microfluidic-based chip system. Functional and gene expression analyses demonstrated that, compared to non-conductive HOC, the eHOC model exhibited enhanced contractile functionality, improved calcium transients, and increased expression of structural and calcium handling genes. The eHOC model was further leveraged to investigate the underlying electroconduction-induced pathway(s) associated with cardiac tissue development through single-cell RNA sequencing (scRNA-seq). Notably, scRNA-seq analyses revealed a significant downregulation of a set of cardiac genes, associated with the fetal stage of heart development, as well as upregulation of sarcomere- and conduction-related genes within the eHOC model. Additionally, upregulation of the cardiac muscle contraction and motor protein pathways were observed in the eHOC model, consistent with enhanced contractile functionality of the engineered cardiac tissues. Comparison of scRNA-seq data from the 3D eHOC model with published datasets of adult human hearts demonstrated a similar expression pattern of fetal- and adult-like cardiac genes. Overall, this study provides a unique eHOC model with improved biomimcry and organotypic features, which could be potentially used for drug testing and discovery, as well as disease modeling applications.

A review: Carrier-based hydrogels containing bioactive molecules and stem cells for ischemic stroke therapy

Ischemic stroke (IS), a cerebrovascular disease, is the leading cause of physical disability and death worldwide. Tissue plasminogen activator (tPA) and thrombectomy are limited by a narrow therapeutic time window. Although strategies such as drug therapies and cellular therapies have been used in preclinical trials, some important issues in clinical translation have not been addressed: low stem cell survival and drug delivery limited by the blood-brain barrier (BBB). Among the therapeutic options currently sought, carrier-based hydrogels hold great promise for the repair and regeneration of neural tissue in the treatment of ischemic stroke. The advantage lies in the ability to deliver drugs and cells to designated parts of the brain in an injectable manner to enhance therapeutic efficacy. Here, this article provides an overview of the use of carrier-based hydrogels in ischemic stroke therapy and focuses on the use of hydrogel scaffolds containing bioactive molecules and stem cells. In addition to this, we provide a more in-depth summary of the composition, physicochemical properties and physiological functions of the materials themselves. Finally, we also outline the prospects and challenges for clinical translation of hydrogel therapy for IS.

Self-healing and cell-free vascular grafts

We developed an innovative self-healing tissue engineering vessel (SH-TEV) that heals fast after repeated needle punctures, while maintaining artery like mechanical strength and toughness even under wet conditions. The SH-TEV is designed as a bilayer tube engineered by electrospinning an autonomous self-healing polyurethane, PU-DAA, around a tube of a native biomaterial, small intestinal submucosa (SIS), that can be functionalized with biomolecules to recruit host cells and promote endothelialization. The self-healing PU-DAA was designed to incorporate multi-strength H-bonds and reversible hydrazone bonds and exhibited high strength (3.95 ± 0.16 MPa), toughness (23.01 ± 2.37 MJ/m3), and fast autonomous self-healing (86.44 ± 6.65 % after 12 h) under physiological conditions. The self-healing layer supported attachment, spreading and proliferation of fibroblasts, indicating biocompatibility. When SH-TEVs were implanted as interpositional grafts into the rat aorta for 4 weeks, they remained patent without any thrombosis (100 % animal survival and 100 % graft patency), were endothelialized and developed a smooth muscle cell containing vascular wall. In addition, they showed excellent self-healing ability following needle puncture (hemostatic time <40 s) immediately after implantation and four weeks later. Collectively, these results demonstrate the potential of SH-TEVs as vascular access conduits for hemodialysis applications.

Systemic coagulation-inflammation index in the prediction of ISR in patients undergoing drug-eluting stents implant: A retrospective study based on multiple machine learning methods

BACKGROUND

The Systemic Coagulation-Inflammation index (SCI) is an innovative hematological metric that accurately reflects both coagulopathic and inflammatory dynamics. In this paper, the objective of this paper is to explain the prognostic impact of SCI on ISR in patients with coronary heart disease (CAD).

METHODS

This retrospective study analyzed clinical data from 724 CAD patients who underwent PCI with DES between September 2017 and June 2023. The study compared preoperative clinical data between patients who developed ISR and non-ISR groups. To avoid overfitting, we implemented 5 folds of resampling prior to model development. We then divided the dataset into training and validation sets in a 7:3 ratio. We constructed eight different machine-learning models to predict the occurrence of ISR. We selected the optimal model based on its performance metrics and clinical net benefit, and further validated its predictive power using an independent external dataset. To interpret the results, we applied the Shapley Additive Explanation (SHAP) method to the final model, XgBoost, enabling a visual analysis of key predictors influencing ISR. Additionally, this paper externally validated the optimal model using data from Zhongnan Hospital of Wuhan University and plotted the corresponding working curves of the subjects. This approach offered robust and interpretable insights into factors related to ISR.

RESULTS

Significant differences in clinical characteristics were observed between the non-ISR and ISR groups. The internal validation results identified the Xgboost model as the optimal model due to its best performance (AUC = 0.971, 95 % CI 0.9569-0.9851) and favorable goodness-of-fit. Among the 10 predictive variables, sex, age, and SCI were strong predictors of ISR. Specifically, being male, increasing age, having a low SCI, a high Gensini score, and smoking habits were positively correlated with an increased risk of ISR. We validated the optimal model using external data from the Zhongnan Hospital of Wuhan University, which produced an excellent subject-worker curve with an area under the curve of 0.92.

CONCLUSION

In this paper, we have identified the Xgboost model as the optimal model for predicting ISR. In addition, sex, age, Gensini score, and smoking habits were strong predictors of ISR.

Phytochemical and biological studies on rare and endangered plants endemic to China. Part XLIV. Integrated NMR/EI-MS/LC-PDA-ESIMS approach for dereplication and targeted isolation of fortunefuroic acids from Keteleeria fortunei across diverse geographical origins

Secondary metabolites in plants of the same species, though originating from distinct geographical regions, frequently display both similarities and notable variations. A prior study on the vulnerable Chinese endemic conifer Keteleeria fortunei, collected from Yunnan province (KFYN), led to the isolation of fortunefuroic acids (FFAs) A-I. These compounds represent a unique class of triterpenoids characterized by a rare furoic acid moiety within the lateral chain. The distinct 23,27-epoxy-23,25(27)-dien-26-oic acid unit present in FFAs can be readily identified by characteristic proton NMR signals (δH-24: ca 6.36 ppm; δH-27: ca 7.97 ppm), a prominent ion fragment at m/z 125 in the EI-MS, and typical UV absorption peak around λmax 245 nm. In this study, an integrated approach was employed to dereplicate and isolate FFA-type compounds from K. fortunei collected from Fujian Province (KFFJ). This approach combined NMR, EI-MS, and LC-PDA-ESIMS data to detect and analyze compounds with molecular weights in the range of 464-468 Da, a distinguishing feature of FFA-type compounds. Consequently, six previously undescribed FFAs K-P (1-6) were obtained, alongside the re-isolation of FFAs A-D and H. Compound 1 exhibits a rare 17,14-friedo-cyclaorane type skeleton, while compound 2 is characterized as a 3,4-seco-cyclaorane-3,26-dioic acid. Compounds 3-6 are identified as derivatives of 9βH-lanost-26-oic FFAs. Additionally, a previously unreported lanost-26-oic acid derivative (7) was also identified, exhibiting an inhibitory effect on ATP-citrate lyase. Their chemical structures and absolute configurations were determined through spectroscopic analysis, GIAO NMR calculations combined with DP4+ probability analyses, and electronic circular dichroism calculations. The isolated FFAs have the potential to serve as chemotaxonomic markers for the genus Keteleeria within the Pinaceae family. This study marks the first application of integrated NMR/EI-MS/LC-PDA-ESIMS methods for both dereplication and the discovery of new natural products. Notably, the KFFJ samples were collected from a location approximately 1500 km away from that of KFYN. Understanding the impact of geographical origins on specialized metabolites may provide valuable insights into the sustainable utilization and conservation of endangered plant species.

Fusion of multi-scale feature extraction and adaptive multi-channel graph neural network for 12-lead ECG classification

BACKGROUND AND OBJECTIVE

The 12-lead electrocardiography (ECG) is a widely used diagnostic method in clinical practice for cardiovascular diseases. The potential correlation between interlead signals is an important reference for clinical diagnosis but is often overlooked by most deep learning methods. Although graph neural networks can capture the associations between leads through edge topology, the complex correlations inherent in 12-lead ECG may involve edge topology, node features, or their combination.

METHODS

In this study, we propose a multi-scale adaptive graph fusion network (MSAGFN) model, which fuses multi-scale feature extraction and adaptive multi-channel graph neural network (AMGNN) for 12-lead ECG classification. The proposed MSAGFN model first extracts multi-scale features individually from 12 leads and then utilizes these features as nodes to construct feature graphs and topology graphs. To efficiently capture the most correlated information from the feature graphs and topology graphs, AMGNN iteratively performs a series of graph operations to learn the final graph-level representations for prediction. Moreover, we incorporate consistency and disparity constraints into our model to further refine the learned features.

RESULTS

Our model was validated on the PTB-XL dataset, achieving an area under the receiver operating characteristic curve score of 0.937, mean accuracy of 0.894, and maximum F1 score of 0.815. These results surpass the corresponding metrics of state-of-the-art methods. Additionally, we conducted ablation studies to further demonstrate the effectiveness of our model.

CONCLUSIONS

Our study demonstrates that, in 12-lead ECG classification, by constructing topology graphs based on physiological relationships and feature graphs based on lead feature relationships, and effectively integrating them, we can fully explore and utilize the complementary characteristics of the two graph structures. By combining these structures, we construct a comprehensive data view, significantly enhancing the feature representation and classification accuracy.

Enhancing atrial fibrillation detection in PPG analysis with sparse labels through contrastive learning

BACKGROUND

With the advancements in wearable technology, photoplethysmography (PPG) has emerged as a promising technique for detecting atrial fibrillation (AF) due to its ability to capture cardiovascular information. However, current deep learning-based methods has strict requirements on the quantity of labeled data. To overcome this limitation, we explore the performance of self-supervised contrastive learning in PPG-based AF detection.

METHODS

Our method initially utilizes 1,209 h of unlabeled PPG data from the VitalDB database, conducting self-supervised pretraining using two contrastive learning frameworks, SimCLR and BYOL. Subsequently, the weights of the encoder are transferred and fine-tuned on a small amount of labeled PPG data to complete the AF detection task, including the selected MIMIC III, UMass, and DeepBeat datasets. In the realm of contrastive learning, we investigated seven data augmentation operations to explore their composite and preferred combinations, as well as the effects of double-sided and single-sided transformations.

RESULTS

Our research ultimately demonstrated that the preferred combination, incorporating single-sided transformation with the Drift operation, is most suitable for PPG data. Notably, even with only 1 %, 20 %, and 1 % of the training data from the three datasets used for fine-tuning, our approach achieves better F1 scores compared to supervised learning on the respective complete training sets. Additionally, on the 0.01 % DeepBeat training set, fine-tuning still showed a clear advantage over supervised learning.

CONCLUSION

Appropriate self-supervised contrastive pretraining effectively leverages a substantial amount of existing unlabeled PPG data, thus reducing the reliance on labeled data for AF detection, and offering a possible solution to address the limitations posed by the scarcity of labels.

The effect of colchicine on coagulation in patients with chronic coronary disease who use vitamin K antagonists

BACKGROUND

Low-dose (0.5 mg/day) colchicine improves cardiovascular outcomes in patients with stable coronary disease. Around 10-15% of these patients simultaneously use anticoagulant therapy, including vitamin-K antagonists (VKAs). In vitro studies and case reports have described a possible interaction between colchicine and VKAs leading to increased INR, but controlled studies are lacking.

OBJECTIVE

The aim of this study was to investigate if there is a drug-drug interaction between low-dose colchicine and VKAs in patients with chronic coronary disease.

METHODS

This study was a sub-analysis of the randomized low-dose colchicine for secondary prevention of cardiovascular disease 2 (LoDoCo2) trial. This placebo-controlled trial investigated efficacy of colchicine 0.5 mg once daily in patients with chronic coronary disease. For the current study, we included a selection of Dutch patients who concomitantly used a VKA. Following a 30 days open-label colchicine run-in phase, patients were randomized to colchicine or placebo. The primary outcome was the intra-patient difference in international normalized ratio (INR) during the first month after starting or stopping colchicine as compared to the preceding month. Secondary outcomes included changes in VKA daily dosage, assessed in the same pattern and before and after randomization, and time in therapeutic range (TTR), assessed before and after randomization to reflect long-term effects. INR measurements were part of routine clinical care.

RESULTS

In total, 73 patients were included (35 colchicine and 38 in the placebo group). No significant intra-patient change in INR was observed after starting colchicine during the open-label run-in phase (mean INR: 2.60 before vs. 2.67 during run-in, difference 0.07, 95% CI - 0.13 to 0.26; p = 0.50). Similarly, stopping colchicine treatment (i.e., randomization to placebo) did not significantly alter INR levels (mean INR: 2.70 during run-in vs. 2.81 after randomization, difference 0.11, 95% CI - 0.12 to 0.33; p = 0.34). The change in mean VKA daily dosage was - 0.01 mg (95% CI - 0.03 to 0.01; p = 0.35) when starting colchicine and - 0.01 mg (95% CI - 0.03 to 0.01; p = 0.41) when switching to placebo. TTR in patients allocated to active treatment was 65.8% in the year prior to the start of colchicine and 73.4% in the year after randomization to colchicine (change in TTR 7.56%, 95% CI - 0.14 to 15.26%; p = 0.05). Mean VKA dosage remained similar (change in VKA dosage of 0.01 mg; 95% CI - 0.11 to 0.13 mg; p = 0.84).

CONCLUSION

No significant changes in INR, VKA dosage, or TTR in patients using VKAs after starting or stopping colchicine were observed. These results suggest that there is no need for additional INR monitoring beyond the standard of care when using low-dose colchicine, though further studies in larger populations would help to confirm this conclusion.

Identification of the crucial roles of BAXhigh NK cells in human derived mesenchymal stem cell therapy for chronic heart failure patients

Mesenchymal stem cells (MSCs) have demonstrated significant potential in heart failure (HF) treatment, but the exact mechanisms are still not fully understood. This research utilized single-cell RNA sequencing to examine alterations in peripheral blood mononuclear cells from heart failure patients pre- and post-MSC therapy. Moreover, we utilized Mendelian randomization (MR) analysis to identify causal genes linked to HF. Specifically, through scRNA-seq, we observed a progressive increase in Natural Killer (NK) cells within peripheral blood mononuclear cells (PBMCs) following MSC treatment. Furthermore, MR analysis identified the differentially expressed gene (DEG) BAX as a potential target gene for HF. Notably, the expression of BAX was significantly downregulated after MSC treatment, suggesting its potential as a therapeutic response biomarker. Cell-cell communication analysis revealed that BAXhigh NK cells displayed reduced cell-cell communication and increased apoptotic activity. Enrichment analysis indicated an association between BAXhigh NK cells and the "coagulant" pathway. Taken together, our findings suggest that BAX may contribute to the pathogenesis of HF by promoting coagulation and apoptotic pathways. In contrast, MSCs appear to suppress BAX expression, thereby inhibiting these pathways. MSC treatment increases the proportion of NK cells and reduces BAXhigh NK cells, ultimately improving NK cell function, and ameliorating HF.

"I can't unsee him lying in my kitchen": Understanding the trauma of family members who witness a loved one's cardiac arrest

Background

While there is a growing body of research in the field of post-cardiac arrest outcomes and survivorship, the lived experience of close family members who witness the arrest itself and who may have performed CPR, has not been specifically explored.

Methods

We employed qualitative interpretive descriptive methodology using key informant interviews for data collection. Participants were recruited internationally, and interviews were conducted virtually following a semi-structured format. Thematic data analysis was conducted using a constant comparative approach.

Results

Interviews were conducted with 33 family members who were present at the time of their loved ones cardiac arrest. Across the participant stories, we identified the core concept of 'base trauma' that centres around what family member witnesses initially experience at the time of the arrest itself. We postulate that this core theme influences six significant patterns of experience including: 1) feelings of responsibility, 2) fear of recurrence without them, 3) the impact of reliving the event, 4) the inability to escape triggers, 5) the delayed realization of their own trauma, and lastly 6) dealing with psychologic disconnect.

Conclusions

There is increasing research evidence that family members of cardiac arrest survivors have their own challenges as part of the recovery journey. We introduce novel concept of the compounded impact of the initial base trauma those that witness and respond to a loved ones cardiac arrest have. The nuanced experiences of this group point to the need to normalize their experience as a 'trauma' and suggest that support pathways need to recognize this.

Influence of Neighborhood Disadvantage and Individual Sociodemographic Conditions on Heart Failure Self-care

BACKGROUND

Residence in socioeconomically disadvantaged neighborhoods and individual sociodemographic conditions contribute to worse heart failure (HF) outcomes and may influence HF self-care. However, associations between neighborhood disadvantage, socioeconomic conditions, and HF self-care are unclear.

OBJECTIVE

The purpose of this secondary analysis was to investigate whether neighborhood disadvantage and individual socioeconomic conditions predicted worse HF self-care.

METHODS

This study was a secondary analysis of baseline data from a mixed-method study of 82 adults with HF. Participant zip codes were assigned a degree of neighborhood disadvantage using the Area Deprivation Index. Those in the top 20% most disadvantaged neighborhoods (Area Deprivation Index ≥ 80) were compared with those in the least disadvantaged neighborhoods. The Self-Care of Heart Failure Index was used to measure self-care maintenance and monitoring. Multiple linear regression was conducted.

RESULTS

Of all participants, 59.8% were male, 59.8% were persons of color, and the mean age was 64.87 years. Residing in a disadvantaged neighborhood and living alone predicted worse HF self-care maintenance and monitoring. Having no college education was also a predictor of worse HF self-care maintenance. Although persons of color were more likely to reside in disadvantaged neighborhoods, race was not associated with HF self-care.

CONCLUSION

Residing in a disadvantaged neighborhood and living alone may be important risk factors for worse HF self-care. Differences in self-care cannot be attributed solely to the individual sociodemographic determinants of race, gender, age, annual household income, or marital status. More research is needed to understand the connection between neighborhood disadvantage and HF self-care.

Hemodynamics indicates differences between patients with and without a stroke outcome after left ventricular assist device implantation

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

Vascular Quality Initiative assessment of compliance with Society for Vascular Surgery Practice Guidelines for the endovascular management of claudication

OBJECTIVE

In 2015, Society for Vascular Surgery (SVS) guidelines on claudication management were released, spanning optimal medical management, procedural, and post-procedure recommendations. Uptake of guidelines and changes to clinical practice over time remain unknown. This study hypothesized that guideline-aligned practice increased after guideline release.

METHODS

The Vascular Quality Initiative Peripheral Vascular Intervention (VQI PVI) dataset was queried for years 2010 to 2021 for cases of claudication from occlusive disease. Only the initial procedure was considered, and subsequent interventions were excluded. The primary endpoint was care aligned with the 2015 SVS claudication treatment guidelines that were possible to evaluate in the VQI PVI dataset. Guideline-aligned practice before 2016 was compared with that after 2016. A hierarchical regression was used to control for hospital-level variation introduced by changing VQI membership during the study timeframe.

RESULTS

A majority of the 2015 SVS guideline GRADE 1-A recommendations can be assessed using the VQI PVI dataset. Overall, 93,654 cases were included, 30.9% before 2016 and 69.1% after guideline release. After controlling for hospital-level variation, guideline-aligned care improved for preoperative smoking cessation, aspirin, clopidogrel, and statin use, and postoperative medical therapy with antiplatelet, dual antiplatelet, and statin therapy. Guideline aligned care did not change over time for aorto-iliac stent use, covered stent use in calcified aortoiliac disease, or superficial femoral artery stenting for 5- to 15-cm lesions. Guideline-aligned care worsened for isolated infrapopliteal treatments and use of bare metal stents for 5- to 15-cm superficial femoral artery occlusions. Secondary analysis identified an association between area deprivation index and increased odds of smoking and decreased odds of meeting post-discharge optimal medical therapy.

CONCLUSIONS

Although guideline-aligned care improved after guideline release for medical management of claudication, procedural elements did not improve. Those with social deprivation were less likely to receive guideline-aligned care for medical management, representing a future area of study and improvement. High-grade recommendations can be tracked using the VQI PVI dataset and should be monitored to help improve care.

Sevoflurane Preconditioning Protects Against Myocardial Ischemia Reperfusion Injury in Mice via PI3K/AKT/GSK3β-mediated Upregulation of Syntaxin1a

Preconditioning with volatile anesthetics, such as isoflurane and sevoflurane, can protect the myocardium against ischemia/reperfusion injury (IRI). Syntaxin1A (Stx1A) is cardioprotective and regulated by volatile anesthetics. However, is the mechanism by which sevoflurane preconditioning (SPC) induces Stx1A to exert myocardial protection remains unclear. The study investigates whether SPC induces upregulation of Stx1A through the thymoma viral proto-oncogene (AKT)/Glycogen synthase kinase 3 β (GSK3β) signaling pathway. Myocardial IRI model in mice was established by surgically ligating the left anterior descending coronary followed by loosening of the occlusion. Regulation of signaling pathway by intraperitoneal administration of the phosphatidylinositol 3-kinase (PI3K) inhibitor, Ly294002 (30 mg/kg), and GSK3β inhibitor, TWS119 (30 mg/kg). The triphenyl tetrazolium chloride (TTC) staining method was used to measure the myocardial infarction area. Serum creatine kinase MB (CK-MB) and lactic dehydrogenase (LDH) concentration were measured by enzyme-linked immunosorbent assay (ELISA). Western blot was employed to examine AKT/GSK3β pathway activity, as well as expressions of Stx1A, small ubiquitin-like modifier 1 (SUMO1), growth hormone-releasing hormone (GHRH), or calcitonin gene-related peptide (CGRP), and brain natriuretic peptide (BNP). Both IRI and SPC induced upregulation of Stx1A in mice. However, the upregulation was abolished by treatment with Ly294002, while TWS119 further increased its expression (p < 0.05). Myocardial infarct area, serum CK-MB, and LDH were elevated in the IRI group but were inhibited by SPC-induced (p < 0.05); however, this inhibition by SPC was eliminated by Ly294002 (p < 0.05). TWS119 causes the opposite effect (p < 0.05). These findings demonstrated that SPC activated the AKT/GSK3β signaling pathway to upregulate Stx1A expression and provide protection to the myocardium.

Current and future clinical trials for the use of neuromodulation in the treatment of stroke: A review of the clinical Trials.gov database

Neuromodulation is a rapidly growing field in neurosurgery and has shown promise in the treatment of stroke. The aim of this study is to review current clinical trials assessing the role of neuromodulation in the treatment of stroke and post-stroke impairments. Clinical trials were found using the search terms "stroke" and "stimulation." A total of 996 clinical trials were included in this study with 386 excluded before analysis. Overall, the number of published clinical trials significantly increased over time (p < 0.001; r = 0.927). Of these, 452 (63.7 %) clinical trials were completed, 242 (34.1 %) were in the recruitment stage, and 16 (2.3 %) in the active and not recruiting stage. Of these trials, 77 were completed with published results. By treatment modality, 35 of the published trials evaluated the use of tDCS or TMS. An additional 28 of the published trials evaluated neuromuscular stimulation. Finally, three evaluated VNS, two evaluated medication treatment and nine were found evaluating a wide variety of other modalities. Other interventions included electrical stimulation of various peripheral nerves or muscles, vagal nerve stimulation, deep brain stimulation, and thermoneuromodulation. A majority of trials studied the effects of stroke on motor function (47). The remaining studies assessed outcomes including aphasia (10), pain (6), coordination and gait (5), imaging outcomes (5), swallowing (2), sensation (1) and cognition (1). There has been strong interest in studying the effect of neuromodulation on recovery after stroke with majority of the current clinical trials studying the use of tDCS or TMS to improve motor function.

Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle

PURPOSE

Hospital readmissions have been a long-standing problem in the American health care system. Despite many efforts, programs, papers, and interventions identified and studied, 14% of all adult admissions result in a readmission. Readmissions are mostly considered preventable and are considered an indicator of care quality for a hospital. Due to unexpected readmissions, patients are at an increased risk for illness or injury, increased stress, financial strain, and diminished quality of life. Readmissions also negatively impact hospital systems related to decreased bed availability, stretched resources, and potential financial penalties and payment reductions. Patients with an admission related to heart failure are at an increased risk of readmission, with a national readmission rate of 23%.

PRIMARY PRACTICE SETTING

The quality improvement project was implemented on two telemetry units at an acute care hospital.

METHODOLOGY AND SAMPLE

A gap analysis identified procedural and organizational reasons for readmission in the heart failure population at an acute care hospital. Using evidence-based best practice guidelines established by the American Heart Association, American College of Cardiology, and the Heart Failure Society of America, a four-pronged proactive discharge bundle was implemented using the plan-do-study-act framework for continuous improvement. All patients admitted to the telemetry units with a primary or secondary diagnosis of heart failure received the discharge planning bundle: (1) an early assessment by the case management department, (2) patient-centered specialty heart failure education, (3) predischarge medication delivery, and (4) predischarge physician follow-up appointment scheduling within 7 days of discharge. A total of 133 patients were evaluated for inclusion in the heart failure cohort. Of those, 52 patients received the evidence-based intervention.

RESULTS

The evidence-based project was implemented over 7 weeks, September through October of 2023 on the medical telemetry units. Of the 52 patients receiving the evidence-based sample, two of the patients experienced a readmission due to heart failure (3.85%). Incidentally, it was found that patients without a readmission had an average of 2.3 completed interventions, while those with readmissions had an average of 1.5 interventions.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Case managers are an integral part of the care transition from the acute care setting back to the community. Often, it is the case manager leading this effort through various interventions. Findings from this quality improvement project suggest the use of the evidence-based, four-pronged approach to discharge planning for the heart failure patient population reduced the risk and rate of heart failure-related readmissions for the involved nursing units. These findings also surmise that there is a correlation between the number of interventions and the rate of readmission.

Sex-Based Differences in Cardiovascular Outcomes Associated With COVID-19: A Systematic Review and Meta-Analysis

COVID-19 has emerged as a global health crisis with significant consequences, not only for respiratory health but also for the cardiovascular system. This study aimed to investigate potential sex-based disparities in cardiovascular outcomes among individuals diagnosed with COVID-19 A systematic search was performed in PUBMED/MEDLINE, SCOPUS, and EMBASE, up until January 2024 to identify studies measuring the sex-based differences in cardiovascular outcomes associated with COVID-19. The outcomes of interest included (myocardial infarction, venous thromboembolism, ischemic stroke, major bleeding, mortality, heart failure and hospitalization length). The meta-analysis was performed using the 'Stata' software, version 18. We identified 11 studies involving 31,044 males and 25,917 females in our review. A slightly lower risk of myocardial infarction in females (RR: 1.24; 95% CI [1.03, 1.49]; p = 0.02) contrasted with a substantially increased risk of venous thromboembolic events (RR: 1.43; 95% CI [1.19, 1.71]; p = 0.00) in males. Additionally, males displayed a slightly higher risk of major bleeding (RR: 1.22; 95% CI [1.06, 1.40]; p = 0.00). This trend continued with significantly higher rates of extracorporeal membrane oxygenation (ECMO) utilization (RR: 2.14; 95% CI [1.11, 4.13]; p = 0.02) in males. Moreover, stroke outcomes and overall mortality were demonstrably worse for males (RR: 1.46; p = 0.05 and RR: 1.21; p = 0.00, respectively). Males with COVID-19 face higher risks of myocardial infarction, venous thromboembolism, ischemic stroke, major bleeding, and mortality. Heart failure and hospitalization length show no gender disparity. These findings highlight the crucial role of gender in COVID-19's cardiovascular complications.

Adherence Trends to Physical Activity Guidelines in Adults With Cardiovascular Diseases and the Impact of Wearables on Adherence: Findings From a National Representative Sample

BACKGROUND

Physical activity (PA) is crucial for primary and secondary prevention of cardiovascular diseases (CVDs); however, adherence to PA guidelines remains challenging.

OBJECTIVES

We examined adherence trends to PA guidelines among adults with CVD and the effects of engagement with wearables on adherence.

METHODS

We used data from 3 cycles of the Health Information National Trends Survey collected in 2019, 2020, and 2022. Adults 18 years or older with a self-reported history of CVD were included in the study. Adherence to PA guidelines was measured as self-reported engagement in at least 150 min/wk of moderate-intensity aerobic PA and a minimum of 2 d/wk of muscle-strengthening activity. Engagement with wearables was assessed as the use of wearables within the past 12 months and the frequency of use in the past month. Weighted multivariate logistic regression was used to examine the effect of engagement on adherence to the PA guidelines.

RESULTS

The sample comprised 1540 respondents. The estimated proportions of adults with CVD who adhered to aerobic PA guidelines were 22.9% (95% confidence interval [CI], 16.8-27.8), 29.6% (95% CI, 21.8-35.4), and 27.2% (95% CI, 21.8-30.0) in 2019, 2020, and 2022, respectively. In addition, 24.0% (95% CI, 18.4-29.7), 25.6% (95% CI, 18.9-32.3), and 26.8% (95% CI, 21.1-32.4) adhered to muscle-strengthening activity guidelines in 2019, 2020, and 2022, respectively. There were no significant changes in adherence trends for either aerobic (odds ratio [OR], 1.12; P = .228) or muscle-strengthening (OR, 1.07; P = .508) activities in the included years. The use of wearables was positively associated with adherence to aerobic PA (OR, 2.72; P = .023) and muscle-strengthening activity (OR, 2.85; P = .020) in the cumulative years.

CONCLUSIONS

Adherence to PA guidelines among adults with CVD remains consistently low. However, the use of wearables may be beneficial for promoting adherence.

The Prevalence of Atherosclerotic Cardiovascular Disease in Patients with Type 2 Diabetes in Jordan: The PACT-MEA Study

INTRODUCTION

This study investigated the prevalence and clinical management of atherosclerotic cardiovascular disease (ASCVD) and ASCVD risk in patients with type 2 diabetes (T2D) in Jordan.

METHODS

PACT-MEA (NCT05317845) was a non-interventional, cross-sectional, observational study of adults with T2D recruited in seven countries across the Middle East and Africa. In Jordan, assessments were conducted at ten sites, three in primary care and seven in secondary care settings.

RESULTS

The Jordan cohort included 576 individuals (27.8% primary care, 72.2% secondary care settings), similarly represented by male and female patients, with a mean age of 59.7 ± 11.7 years and a median duration of diabetes of 10.0 years. The prevalence of established ASCVD (eASCVD) was 26.2% overall (95% CI: 22.8-30.0) and 21.9% and 27.9% in primary care and secondary care settings, respectively (95% CI: 16.1-28.9, 23.8-32.4), higher than that observed in the regional PACT-MEA analysis. By the European Society of Cardiology 2021 criteria, 66.0% of patients were classified as high risk and 33.3% as very high risk (which included eASCVD). Use of renin-angiotensin system inhibitors, statins, and cardioprotective antidiabetic medication was higher in secondary care settings. None of the participants achieved all guideline recommendations with respect to risk factor control, body mass index, exercise, and pharmacotherapy.

CONCLUSIONS

More than one-quarter of patients with T2D in Jordan had ASCVD, and nearly all were at high/very high ASCVD risk. These findings suggest a need for multifactorial approaches to risk reduction in this population within Jordan in both primary and secondary care settings.

TRIAL REGISTRATION

URL: https://www.

CLINICALTRIALS

gov ; Unique identifier: NCT05317845.

Physical Activity Habits and Incident First-Ever Stroke in Middle-Aged Adults-A Prospective Cohort Study

BACKGROUND

Lifestyle affects the risk of cardiovascular events such as myocardial infarction and stroke. Several lifestyle factors, such as physical activity (PA), are modifiable, and in this study, we examined the association between leisure-time PA habits and the risk of a first-ever stroke.

METHODS

This prospective study included residents in Västerbotten, Sweden, who participated in the Västerbotten Intervention Programme at 40, 50, and 60 years of age. Altogether, 31,855 individuals (50.5% women, mean age: 42.6 [6.9] y at baseline) participated between 1989 and 2016. Leisure-time PA was categorized as irregular (never/now and then) or regular (once a week/2 or 3 times a week/more than 3 times a week). Changes in PA were compared between examinations (10 y apart). Cases of stroke were validated according to World Health Organization MONICA (Monitoring Trends and Determinants of Cardiovascular Disease) criteria. The risk related to changes in leisure-time PA was estimated using a multivariable Cox regression model.

RESULTS

During an average follow-up of 9.8 years (4.4), 609 incident first-ever stroke cases occurred (1.9%). A multivariable model showed that, compared with individuals with irregular PA at both examinations, those reporting regular PA over time had a lower risk of stroke (hazard ratio: 0.78, 95% CI, 0.61-0.99).

CONCLUSION

Middle-aged adults who maintained regular PA during their leisure time over 10 years had a lower risk of a first-ever stroke. This association is probably partly mediated by lower body mass index and a reduced risk of hypertension and diabetes.

Incidence of new onset arterial hypertension after metabolic bariatric surgery: an 8-year prospective follow-up with matched controls

BACKGROUND

Metabolic bariatric surgery (MBS) reduces the risk of new-onset hypertension; however, it is unclear whether this effect varies according to patient sex, age, or socioeconomic background. This study aimed to assess the risk of new-onset arterial hypertension after MBS, with a special focus on these patient characteristics.

METHODS

This follow-up study with matched controls was nested in a large employee cohort, the Finnish Public Sector study, consisting of individuals with no hypertension at baseline. For each patient who underwent laparoscopic MBS between 2008 and 2016, two propensity-score matched controls were selected from individuals hospitalized with a diagnosis of obesity or individuals with self-reported severe obesity [body mass index (BMI) ≥ 35 kg/m 2 ] but no recorded history of MBS. Cases of new-onset hypertension were identified via linked electronic health records from the national health registries until December 31, 2016.

RESULTS

The study included 912 patients and 1780 matched controls. The rate of new-onset hypertension per 1000 person-years was 2.8 in the surgery group and 9.6 in the control group, with a rate ratio of 0.29 (95% confidence intervals 0.15-0.57) and a rate difference of -6.8 (95% confidence intervals -9.6 to -4.0) per 1000 person-years. No significant differences in rate reduction after MBS were observed to be associated with patient sex, age, or socioeconomic status.

CONCLUSION

Metabolic bariatric surgery reduces the risk of new-onset arterial hypertension across all age-, sex-, and socioeconomic subgroups.

Emerging risk factors for heart failure in younger populations: A growing public health concern

Heart failure (HF) is a growing public health concern, with an increasing incidence among younger populations. Traditionally, HF was considered a condition primarily affecting the elderly, but of late, emerging evidence hints at a rapidly rising HF incidence in youth in the past 2 decades. HF in youth has been linked to a complex interaction between emerging risk factors, such as metabolic syndrome, environmental exposures, genetic predispositions, and lifestyle behaviors. This review examines these evolving determinants, including substance abuse, autoimmune diseases, and the long-term cardiovascular effects of coronavirus disease 2019, which disproportionately affect younger individuals. Through a comprehensive analysis, the study highlights the importance of early detection, targeted prevention strategies, and multidisciplinary management approaches to address this alarming trend. Promoting awareness and integrating age-specific interventions could significantly reduce the burden of HF and improve long-term outcomes among younger populations.

Novel approaches in antihypertensive pharmacotherapeutics

PURPOSE OF REVIEW

The management of hypertension remains suboptimal despite the widespread use of multiple antihypertensive medication groups. We hereby aim to evaluate the novel therapeutic approaches for the management of hypertension.

RECENT FINDINGS

As the decline in SBP and/or DBP is associated with a significant decline in major adverse cardiovascular events and all-cause mortality, the optimal management of hypertension is at most importance. The high prevalence of resistant hypertension, approximately 10% of hypertensive population, remains a major concern associated with high morbidity and mortality. Recently, multiple novel pharmacotherapeutic approaches have been implicated in the management of hypertension on various pathophysiological mechanisms, including aldosterone synthetase inhibitors, RNA-based therapies such as antisense oligonucleotides and small-interfering RNA, atrial natriuretic peptide analogs, dual endothelin antagonists, intestinal sodium-hydrogen exchanger-3 inhibitors, compound 17b and nonsteroidal mineralocorticoid receptor antagonists.

SUMMARY

Pharmacotherapeutic management options for hypertension is a growing field of research with potential clinical implications for multiple agents in upcoming years. Such novel approaches have the potential to improve clinical outcomes of hypertension management.

E3 ubiquitin ligase CHIP alleviates H/R-induced myocardial injury by inhibiting pyroptosis

BACKGROUND

Hypoxia/Reoxygenation (H/R) injury to cardiomyocytes has adverse effects on the function, structure and prognosis of the heart. Studies have shown that H/R injury is closely related to pyroptosis. The inflammatory response induced by pyroptosis, leading to the death of cardiomyocytes. However, the specific mechanism of pyroptosis in myocardial H/R injury is not fully understood. In recent years, the important role of CHIP proteins in cardiovascular diseases has gradually attracted attention. Studies have found that CHIP protein can play an important role in the regulation of pyroptosis. However, its role in ameliorating H/R injury in cardiomyocytes has not been fully studied.

METHODS

An in vitro H/R model was constructed, and CHIP was knockdown and overexpression interfered simultaneously. The effect of CHIP on pyroptosis and its reduction of H/R-induced myocardial injury were verified by detection of cell viability, LDH, cell membrane integrity, ROS production, inflammatory factors (NLRP3, Caspase-1, ASC, IL-1β) and β-catenin/HSF1 signaling pathway.

RESULTS

In our study, we verified that the occurrence of oxidative stress and pyroptosis as well as cell damage was significantly increased in cardiomyocytes after H/R stimulation in vitro. After CHIP knockdown, pyroptosis of cardiomyocytes was further aggravated, accompanied by the down-regulation of HSF1/β-catenin signaling axis. These adverse changes were ameliorated after CHIP overexpression.

CONCLUSION

Our study confirmed that CHIP can alleviate H/R-induced myocardial injury by mediating pyroptosis, which may be achieved by regulating HSF1/β-catenin signaling pathway.

Migrasomes as intercellular messengers: potential in the pathological mechanism, diagnosis and treatment of clinical diseases

Migrasomes are newly identified organelles that were first discovered in 2015. Since then, their biological structure, formation process, and physiological functions have been gradually elucidated. Research in recent years has expanded our understanding of these aspects, highlighting their significance in various physiological and pathological processes. Migrasomes have been found to play crucial roles in normal physiological functions, including embryonic development, vascular homeostasis, material transport, and mitochondrial quality control. Additionally, emerging evidence suggests their involvement in various diseases; however, clinical research on their roles remains limited. Current studies indicate that migrasomes may contribute to disease pathogenesis and hold potential for diagnostic and therapeutic applications. This review consolidates existing clinical research on migrasomes, focusing on their role in disease mechanisms and their use in medical applications. By examining their biological structure and function, this review aims to generate insights that encourage further research, ultimately contributing to advancements in disease prevention and treatment.

Prevalence, Characteristics, and Prognostic Associations of Cachexia Diagnosed Using Asian Working Group for Cachexia 2023 Criteria in Older Adults With Heart Failure

BACKGROUND

Few studies have examined the characteristics of heart failure (HF) patients with cachexia using the Asian Working Group for Cachexia (AWGC) 2023 criteria. This study assessed the characteristics and clinical impact of cachexia in older adults with HF.

METHODS AND RESULTS

Results of laboratory measurements, echocardiography, physical function, depression, nutritional status, and the prevalence of cachexia, frailty, and sarcopenia were assessed in older adults (≥65 years) with HF in a stable condition just before discharge. After discharge, all participants were prospectively followed for adverse clinical events. Patients were classified based on the presence or absence of cachexia, and their frailty, sarcopenia, and clinical outcomes were compared. The prevalence of cachexia diagnosed by AWGC 2023 and Evans criteria was 24.7% and 12.9%, respectively. Among HF patients with cachexia, 71.6% had frailty and 86.7% had sarcopenia. Patients with cachexia had significantly poorer physical function and nutrition than those without. Cox proportional hazards analysis identified cachexia as an independent predictor of all-cause and cardiovascular death.

CONCLUSIONS

Cachexia in older adults with HF is strongly associated with poor physical function, malnutrition, and adverse clinical outcomes. Early identification and management of cachexia may help improve the prognosis in this population.

Longitudinal Trends in Heart Failure Mortality Linked to Coronary Artery Disease Among Adults 65 years and older

BACKGROUND

Heart failure (HF) in patients with coronary artery disease (CAD) is a leading cause of mortality among older adults in the United States. This study examines trends in HF with CAD-related mortality among adults aged 65 and older.

METHODS

A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.

RESULTS

HF associated with CAD led to 1,597,451 deaths among adults > 65, primarily occurring in medical facilities (37.1%). The AAMR for HF with CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p < 0.001), which was significant from 1999 to 2014. Men had higher AAMRs than women (227.4 vs. 137.1), with women's rates declining more significantly (AAPC: -3.23, p < 0.001). White adults had the highest AAMRs (183.0), while Asians/Pacific Islanders (81.6) recorded the lowest. Geographically, AAMRs varied, from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1) CONCLUSION: Our study reveals striking disparities in HF-related mortality among adults aged 65 years and older in the United States. While AAMRs decreased overall from 1999 to 2014, they have reached an inflection point since 2019, indicating rising mortality rates. Persistent inequalities underscore the critical need for targeted public health interventions to address these issues.

Automated comprehensive evaluation of coronary artery plaque in IVOCT using deep learning

The process of manually characterizing and quantifying coronary artery plaque tissue in intravascular optical coherence tomography (IVOCT) images is both time-consuming and subjective. We have developed a deep learning-based semantic segmentation model (EDA-UNet) designed specifically for characterizing and quantifying coronary artery plaque tissue in IVOCT images. IVOCT images from two centers were utilized as the internal dataset for model training and internal testing. Images from another independent center employing IVOCT were used for external testing. The Dice coefficients for fibrous plaque, calcified plaque, and lipid plaque in external tests were 0.8282, 0.7408, and 0.7052 respectively. The model demonstrated strong correlation and consistency with the ground truth in the quantitative analysis of calcification scores and the identification of thin-cap fibroatheroma (TCFA). The median duration for each callback analysis was 18 s. EDA-UNet model serves as an efficient and accurate technological tool for plaque characterization and quantification.

Factors Related to Self-Care Behaviors' in Chronic Heart Failure Patients: A Cross-Sectional Study in Western Iran

PurposeSelf-care is recognized as an important element in the comprehensive management of patients with heart failure. The study aimed to explore the correlations of self-care behaviors in chronic heart failure patients in Kermanshah, West Iran.DesignDescriptive and analytical cross-sectional.SettingHospital.SampleThe research population included 597 (246 female and 351 male) patients with chronic heart failure visiting Imam Ali Cardiovascular Hospital in Kermanshah in 2022.MeasuresDemographic information, European Heart Failure Self-care Behavior Scale.AnalysisIndependent-sample t test, ANOVA, and Kruskal-Wallis in SPSS-24. The significance level was set at 5%.ResultsThe participants' age was 63.04 ± 14.1 years. The mean and standard deviation of the participants' self-care behaviors was 2.91 ± 31.00, and only 20.60% of the patients reported engaging in satisfactory self-care behaviors. Self-care behaviors were significantly related to Income level, ethnicity, family history of background disease, history of co-morbidity, history of addiction, access to medical centers, and not with any other variables.ConclusionBased on the study's results, most participants exhibited moderate self-care behaviors, suggesting that these patients may need preventive educational interventions to acquire the knowledge, skills, and attitudes necessary for effective self-care behaviors. Therefore, it is essential to design and implement a health promotion educational intervention aimed at convincing these patients to make lifestyle changes and adhere to their dietary and medication regimens to improve self-care behaviors.

Unraveling the Role of NeuroD2 in Ischemic Pathophysiology: Insight into Neuroprotection Mechanisms Associated with AKT Survival Kinase

NeuroD2 (ND2), a neuron-specific transcription factor, is essential in neural differentiation and neuroplasticity, yet its regulation under neuronal injury is barely uncovered. Effective treatment strategies for ischemic conditions require extensive knowledge of the signaling pathways and mechanisms underlying ischemic pathophysiology. This study aims to uncover the neuroprotective role of ND2 in ischemia and its interactions with critical signaling pathways implicated in recovery. An in vitro ischemic stroke model oxygen-glucose deprivation (OGD) method was applied to neuro-2A (N2a) cells with lentiviral ND2 (LvND2) overexpression. DNA fragmentation and cell survival assays indicated ND2's neuroprotective and anti-apoptotic effects under OGD conditions. Proteomic profiling and interaction analyses showed that LvND2 regulated the synthesis of cellular signaling, proliferation and cell adhesion-related proteins, such as MAPK3, Mki67, and NCAM. Additionally, a positive correlation was observed between ND2 expression and phosphorylated AKT levels. To investigate the interaction between ND2 and the PI3K/AKT signaling pathway, the pathway was pharmacologically inhibited with Wortmannin 30 min before OGD induction. After 8 h of OGD followed by 16 h of reperfusion, cell survival, DNA fragmentation, and Western blot analyses were performed. LvND2 administration alone increased cellular survival, whereas its combination with Wortmannin resulted in decreased cell survival. Additionally, LvND2 alone reduced the number of TUNEL-positive cells, while its combination with Wortmannin remains non-significant. These findings suggest that ND2 and AKT function in a coordinated manner within the PI3K/AKT survival pathway. ND2 may modulate AKT activity, highlighting its potential as a therapeutic target for addressing ischemic pathophysiology through molecular therapies.

Association between household sleep environment and sleep health characteristics in middle-aged adults: The CARDIA sleep study

OBJECTIVES

Household environmental factors and sleep hygiene may contribute to poor sleep health. We identified associations between household sleep environment (HHSE) and sleep health characteristics in White and Black adults.

METHODS

This study included cross-sectional data from the CARDIA sleep ancillary study at Year 35 (n=711). HHSE was assessed in two domains (sleep disruptors and sleep hygiene) using a questionnaire, and higher scores indicated more sleep disruptors or poorer sleep hygiene. Sleep outcomes included (1) self-reported sleep quality and daytime sleepiness and (2) actigraphy-measured sleep duration, sleep percentage, sleep timing (midpoint sleep time), and sleep regularity. We used robust regression to estimate differences in sleep outcomes corresponding to each 1-point increment in HHSE. Racial differences in associations of interest were examined by testing for interaction.

RESULTS

Participants' mean age was 61.5 (SD=3.6) years, 63% were women, and 36.7% were Black. After multivariable adjustment (β [95% CI]), more sleep disruptors (0.145 [0.04, 0.24]) and poor sleep hygiene (0.170 [0.10, 0.23]) were associated with self-reported poor sleep quality. Poor sleep hygiene was associated with actigraphy-measured shorter sleep duration (-1.397 [-2.73, -0.01]) and sleep irregularity (0.017 [0.01, 0.02]). In stratified analysis, more sleep disruptors were associated with poor sleep quality (0.320 [0.10, 0.53]) and greater daytime sleepiness (0.330 [0.11, 0.54]) only in Black participants.

CONCLUSIONS

Poor HHSE was related to self-reported poor sleep quality and to objective shorter sleep duration and sleep irregularity. Targeted interventions to mitigate sleep disruptors and promote good sleep hygiene may help to improve sleep health.

MS4A6A regulates ox-LDL-induced endothelial dysfunction and monocyte adhesion in atherosclerosis via the IKK/NF-kappaB pathway

Atherosclerosis (AS) is characterized by chronic inflammation, which is a significant pathogenic factor of cardiovascular diseases (CVDs). Alleviating endothelial dysfunction and monocyte adhesion are effective ways to halt the development of AS. Membrane Spanning 4-Domains A6A (MS4A6A) is associated with inflammation and primarily regulates immunity and cell signaling. These processes are closely related to the occurrence of AS. However, the specific mechanism remains unclear. In this study, bioinformatics analysis revealed that MS4A6A expression was elevated in human atherosclerotic plaques. Western blot, enzyme-linked immunosorbent assay, immunohistochemistry, and immunofluorescence analyses confirmed that MS4A6A expression correlated with the severity of AS and was significantly expressed in endothelial cells. We determined that MS4A6A was upregulated in atherosclerotic lesions of high-cholesterol diet (HFD) ApoE-/- mice. In a cellular model using human umbilical vein endothelial cells (HUVECs) stimulated with oxidized low-density lipoprotein (ox-LDL), MS4A6A expression exhibited a temporal and concentration-dependent upregulation. Silencing MS4A6A reduced endothelial dysfunction and monocyte adhesion, decreasing the expression of inflammatory factors, adhesion molecules, and reactive oxygen species (ROS). The pathway inhibitor Bay 11-7085 (irreversible inhibitor of IxBalpha phosphorylation) using IκB kinase (IKK) silencing showed that MS4A6A promotes endothelial dysfunction and monocyte adhesion by regulating the IKK/NF-kappaB pathway. This study demonstrated for the first time that MS4A6A facilitates endothelial dysfunction and monocyte adhesion by modulating the IKK/NF-κB signaling pathway, thereby promoting the progression of AS. This study provides a theoretical foundation for utilizing MS4A6A as a biomarker and potential therapeutic target for the prevention and treatment of AS.

Neighborhood Safety and Hypertension Risk: A Systematic Review

BACKGROUND

Responding to the increasing focus on residential environments, our systematic review aimed to consolidate existing empirical evidence regarding the impact of neighborhood safety on blood pressure. We also summarized the mediating and moderating mechanisms through which neighborhood safety influences blood pressure, alongside their direct effects, to offer insights for future research.

METHODS

We searched 5 electronic databases (PubMed, Ovid MEDLINE, CINAHL Complete, ProQuest Dissertations and Theses Global, and Web of Science) for the period up to and including December 27, 2022. The initial search yielded 4944 studies reviewed, of which 19 met our criteria and were reviewed.

RESULTS

Our findings consistently show that living in a safe neighborhood is associated with lower blood pressure outcomes. While most cross-sectional studies found that the association was not statistically significant (7/10 studies showed insignificant results), longitudinal studies that tracked changes in neighborhood safety over time (4/5 studies) showed significant negative associations between neighborhood safety and blood pressure. Additionally, some studies identified sex (n=3), age (n=2), and neighborhood characteristics (n=4) as significant moderators, with the strength of the association between neighborhood safety and blood pressure varying across different demographic groups and neighborhood contexts.

CONCLUSIONS

Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions. This review also highlights the importance of adopting longitudinal designs, especially those using time-varying measures of neighborhood environments.

Biomechanical insights into the development and optimization of small-diameter vascular grafts

Small-diameter vascular grafts (SDVGs; inner diameter ≤6 mm) offer transformative potential for treating cardiovascular diseases, yet their clinical application remains limited due to high rates of complications such as acute thrombosis and intimal hyperplasia (IH), which compromise long-term patency. While advancements in biological and material science have driven progress, the critical role of biomechanical factors-such as hemodynamic forces and mechanical mismatch-in graft failure is often overlooked. This review presents insights from recent clinical trials of SDVG products and summarizes biomechanical contributors to failure, including disturbed flow patterns, mechanical mismatch, and insufficient mechanical strength. We outline essential mechanical performance criteria (e.g., compliance, burst pressure) and evaluation methodologies to assess SDVG performance. Furthermore, we present optimization strategies based on biomechanical principles: (1) graft morphological design optimization to improve hemodynamic stability, (2) structural, material, and fabrication innovations to achieve compliance matching with native arteries, and (3) biomimetic approaches to mimic vascular tissue and promote endothelialization. By systematically addressing these biomechanical challenges, next-generation SDVGs may achieve superior patency, accelerating their clinical translation. This review highlights the necessity of considering biomechanical compatibility in SDVG development, thereby providing initial insights for the clinical translation of SDVG. STATEMENT OF SIGNIFICANCE: Small-diameter vascular grafts (SDVGs) offer transformative potential for cardiovascular disease treatment but face clinical limitations. While significant progress has been made in biological and material innovations, the critical role of biomechanical factors in graft failure has often been underestimated. This review highlights the importance of biomechanical compatibility in SDVG design and performance, emphasizing the need to address disturbed flow patterns, mechanical mismatch, and inadequate mechanical strength. By proposing optimization strategies based on biomechanical principles, such as graft morphological design, compliance matching, and biomimetic approaches, this work provides a roadmap for developing next-generation SDVGs with improved patency. These advancements have the potential to overcome current limitations, accelerate clinical translation, ultimately benefiting patients worldwide.

Co-administration of atorvastatin with piperine induces reproductive toxicity in male Wistar rats through oxidative stress induction and downregulation of StAR, CYP11a1, 3βHSD and 17βHSD genes

Atorvastatin is a statin group of medicine that inhibits biosynthesis of cholesterol and mainly prescribed for treating cardiovascular diseases. Black pepper is a one of the mostly used spices that contains an alkaloid called piperine in its fruits which is known to cause male reproductive toxicity. Both atorvastatin and black pepper (piperine) are randomly consumed by the patients of chronic hyperlipidemia and it is important to know the synergistic effects of atorvastatin and piperine on male fertility parameters. Twenty rats were taken for the study and divided into four groups each containing five rats. Group I served as a control, group II animals are treated with atorvastatin (ATR) (8mg/kg BW), group III animals received piperine (PIP) (10mg/kg BW) and group IV animals were co-administered with piperine (10mg/kg BW) and atorvastatin (8mg/kg BW). All treatments were done by using water suspension of atorvastatin and piperine and using oral gavage for consecutive 28 days and thereafter assessed for gravimetric and histomorphometry analysis, sperm motility and morphology, ROS generation, anti-oxidant enzymes, serum testosterone quantification, qRTPCR (StAR, CYP11a1, 3βHSD and 17βHSD genes) and toluidine blue staining for analyzing chromatin integrity of spermatozoa. The results showed that co-administration of ATR+PIP significantly reduced body weight, changed in GSI also found. Activities of major two antioxidant enzymes (SOD and Catalase) were found to reduce whereas levels of TBARS and ROS in testicular tissues increased significantly. The study found that combined administration of atorvastatin and piperine negatively impacted male fertility potential, causing reproductive toxicity.

Biodegradable Microneedle Patch Confers Crocin with Outstanding Effects in the Treatment of Myocardial Infarction

Crocin (CRO), the main active component of Crocus sativus (saffron), exhibits significant therapeutic potential for the treatment of myocardial infarction (MI). However, its clinical application is hindered by poor oral administration due to the intestinal barrier. To overcome this limitation, a CRO-incorporated biodegradable microneedle (CRO-DMN) patch was developed to transdermally deliver CRO into the bloodstream, enhancing its therapeutic effect against MI. The microneedle patch, fabricated from sodium hyaluronate (HA), demonstrated excellent mechanical strength, effectively penetrating the stratum corneum and facilitating CRO infiltration to a depth exceeding 300 μm successfully. Studies revealed that CRO was fully released within 30 min postapplication, and the skin self-healed within 90 min after patch removal. Importantly, administration of CRO-DMNs to MI mice resulted in significant improvements in cardiac function and reductions in infarct size compared with CRO treatment alone. Additionally, CRO-DMNs also provided superior protective effects on the myocardium and mitochondria and significantly increased angiogenesis in the infarction border area. In conclusion, CRO-DMNs represent a promising transdermal drug delivery system that effectively improves the therapeutic efficacy of CRO in the treatment of MI.

Assessing the effect of hypertension on the severity of coronary artery lesions in young female with acute coronary syndrome

BACKGROUND

The fact that hypertension is associated with atherosclerotic cardiovascular disease in the elderly has been confirmed. However, very little is known about its impact on the severity of coronary artery lesions in young people, especially in young women.

OBJECTIVE

To evaluate the effect of essential hypertension (EH) on the severity of coronary artery lesions in young women with acute coronary syndrome (ACS), and to provide a reference for clinical prevention and treatment.

METHODS

From January 2003 to January 2022, 5220 young women (aged ≤ 44 years) who underwent coronary angiography (CAG) due to chest pain symptoms were retrospectively analyzed, of whom 2684 were diagnosed with ACS. After patients with diabetes, hypercholesterolemia, and smoking were excluded, 1772 patients were enrolled. According to whether the patient has EH or not, they were divided into EH combined with ACS group (EH-ASC group; n = 824) and non-hypertension ACS group (control group; n = 948). The severity of coronary artery lesions and the follow-up results after percutaneous coronary intervention (PCI) were compared between the groups.

RESULTS

There was no significant difference in the type of ACS and the number of lesion vessels between the two groups (P > 0.05). The proportion of type B2 (17.11%) and type C (31.55%) lesions in the EH-ACS group was significantly higher than that (11.39% and 20.68%) in the control group (P < 0.05). The number of stents implanted (1.55 ± 0.95) and the length of stents (23.99 ± 6.77 mm) in the EH-ACS group were significantly greater than those (1.36 ± 0.75 and 22.34 ± 6.91 mm) the in control group (P < 0.05). During a follow-up period of 11-138 months, the cumulative rate of major adverse cardiac events (MACE) and target vessel revascularization (TVR) in the EH-ACS group (22.09% and 20.26%) was significantly higher than that (9.28% and 8.65%) in the control group (P < 0.05).

CONCLUSION

Hypertension exacerbates the severity of coronary artery lesions in young women with ACS. It is suggested that attention should be paid to the prevention and treatment of hypertension in young women, a special population, to reduce the prevalence of ACS, and a focus on improving hypertension awareness and management among young women could be beneficial in reducing the risk and severity of ACS.

Causal analysis of the National Chronic Disease Management Program on intracerebral hemorrhage mortality

Intracerebral hemorrhage (ICH) significantly contributes to mortality and long-term disability, particularly in low- and middle-income countries (LMICs) like Vietnam. ICH prevalence is higher in individuals with chronic diseases, particularly with poor treatment adherence. This study aims to evaluate the impact of the outpatient treatment strategy with the National Chronic Disease Management Program (NCDMP), implemented in Vietnam, on the intracerebral hemorrhage mortality rate per 100,000 individuals (IHMR100k) from 2010 to 2019. National IHMR100k data were analyzed over the period, employing the 'CausalImpact' method to assess the causal effect of the NCDMP intervention, with data from the end of 2016 serving as the baseline for comparison. Analysis of the national mortality data over the period (2010-2019) revealed significant changes in mortality rates due to ICH, with the IHMR100k showing a gradual decline over time, reaching a low of 0.44 in 2019, although it remained among the top 10 causes of death. The implementation of the NCDMP strategy contributed to a decline in IHMR100k from 0.88 in 2010 to 0.44 in 2019. The Causal Impact analysis indicated that the actual average mortality rate was 0.54, lower than the predicted mean of 0.75. The absolute effect of the intervention was -0.21 (95% CI: -0.34 to -0.08), signifying a substantial reduction in mortality rates associated with ICH. The findings indicate that the NCDMP effectively reduced ICH mortality rates in Vietnam. This underscores the importance of sustainable outpatient care strategies for managing chronic diseases, enhancing medication access, and improving health outcomes in LMICs.

Construction and evaluation of a 180-day readmission prediction model for chronic heart failure patients based on sCD40L

The high readmission rate of patients with chronic heart failure (HF) can cause waste of medical resources and economic losses. Establishing an effective HF readmission model can effectively alleviate medical pressure and improve the quality of treatment. In this study, we conducted a comprehensive analysis of clinical and laboratory data from 248 patients with chronic HF who received treatment at our medical center between January 2021 to January 2022. We also measured soluble CD40 ligand (sCD40L) levels to determine their association with readmission due to HF during follow-up. To analyze the data, we employed various statistical methods including one-way ANOVA, correlation analysis, univariate COX regression, and Least Absolute Shrinkage and Selection Operator COX regression. Using these techniques, we organized the data and constructed a predictive model that was both trained and validated. We developed a nomogram to assess the likelihood of readmission within 180 days for patients with chronic HF. Our findings revealed that monocytes, creatinine, sCD40L, and hypertension history were all independent risk factors for 180-day HF readmissions. Additionally, our model's AUC was 0.731 in the training dataset and 0.704 in the validation dataset. This study provides new insights for predicting readmission within 180 days for patients with chronic HF. And sCD40L is an important predictive indicator for readmission of HF patients within 180 days, and clinical doctors can develop appropriate treatment plans based on sCD40L.

Predicting response to non-invasive brain stimulation in post-stroke upper extremity motor impairment: the importance of neurophysiological and clinical biomarkers

BACKGROUND

Non-invasive brain stimulation (NIBS) is a promising approach to enhance upper extremity motor impairment (UEMI) recovery in post-stroke individuals. However, variability in treatment response poses a significant challenge. Identifying neurophysiological and clinical biomarkers that predict NIBS response could improve personalization and treatment efficacy.

OBJECTIVES

This study aims to determine the predictive relevance of neurophysiological and clinical biomarkers for responses to NIBS in post-stroke UEMI using a machine learning model.

METHODS

This secondary analysis involved 63 post-stroke individuals with UEMI (age 56.9 ± 11.1 years). A support vector machine model was used to assess the importance of two neurophysiological biomarkers-brain activity in the lesioned hemisphere quantified using quantitative electroencephalography (power ratio index, PRI) and corticospinal tract (CST) integrity assessed via transcranial magnetic stimulation-and one clinical biomarker-the level of UEMI assessed with Fugl-Meyer upper extremity (FMA-UE)-in predicting responders (ΔFMA-UE ≥ 5 points) and those with excellent response (ΔFMA-UE ≥ 10 points) to NIBS based on the change of FMA-UE before and after treatment.

RESULTS

Of the 63 participants, 42 (65%) were classified as responders, and 14 (22%) demonstrated excellent responses. Predictive importance for responders was 0.78 for PRI-LH, 0.21 for UEMI level, and 0.01 for CST integrity. For predicting excellent responses, PRI-LH had an importance of 0.39, UEMI level 0.37, and CST integrity 0.24.

CONCLUSIONS

The study highlights the importance of electrical brain activity in the LH and UEMI level in predicting NIBS responders and excellent responses, with CST integrity being particularly valuable for excellent outcomes.

Exploring trade-offs in equitable stroke risk prediction with parity-constrained and race-free models

A recent analysis of common stroke risk prediction models showed that performance differs between Black and White subgroups, and that applying standard machine learning methods does not reduce these disparities. There have been calls in the clinical literature to correct such disparities by removing race as a predictor (i.e., race-free models). Alternatively, a variety of machine learning methods have been proposed to constrain differences in model predictions between racial groups. In this work, we compare these approaches for equitable stroke risk prediction. We begin by proposing a discrete-time, neural network-based time-to-event model that incorporates a parity constraint designed to make predictions more similar between groups. Using harmonized data from Framingham Offspring, MESA, and ARIC studies, we develop both parity-constrained and unconstrained stroke risk prediction models, then compare their performance with race-free models in a held-out test set and a secondary validation set (REGARDS). Our evaluation includes both intra-group and inter-group performance metrics for right-censored time to event outcomes. Results illustrate a fundamental trade-off in which parity-constrained models must sacrifice intra-group calibration to improve inter-group discrimination performance, while the race-free models strike a balance between the two. Consequently, the choice of model must depend on the potential benefits and harms associated with the intended clinical use. All models as well as code implementing our approach are available in a public repository. More broadly, these results provide a roadmap for development of equitable clinical risk prediction models and illustrate both merits and limitations of a race-free approach.

Fish Swim Bladder-Derived ECM Hydrogels Effectively Treat Myocardial Ischemic Injury through Immunomodulation and Angiogenesis

Injectable hydrogel implants represent a promising therapeutic approach for ischemic heart failure; but their efficacy is often limited by low bioactivity, poor durability, and inadequate injection techniques. Herein, a unique hydrogel incorporating extracellular matrix from fish swim bladder (FSB-ECM), which has distinct advantages over mammalian derived ECM, such as low antigenicity, bioactivity, and source safety, is developed. It consists of collagen, glycoproteins, and proteoglycans, including 13 proteins common in the myocardial matrix and three specific proteins: HSPG, Col12a1, and vWF. This hydrogel enhances cardiac cell adhesion and stretching while promoting angiogenesis and M2 macrophage polarization. In addition, its storage modulus (G') increases over time, reaching about 1000 Pa after 5 min, which facilitates transcatheter delivery and in situ gelling. Furthermore, this hydrogel provides sustained support for cardiac contractions, exhibiting superior longevity. In a rat model of ischemic heart failure, the ejection fraction significantly improves with FSB-ECM treatment, accompanied by increased angiogenesis, reduced inflammation, and decreased infarct size. Finally, RNA sequencing combined with in vitro assays identifies ANGPTL4 as a key protein involved in mediating the effects of FSB-ECM treatment. Overall, this new injectable hydrogel based on FSB-ECM is suitable for transcatheter delivery and possesses remarkable reparative capabilities for treating heart failure.

Hypercoagulable state and gut microbiota dysbiosis as predictors of poor functional outcomes in acute ischemic stroke patients

Stroke is the second leading cause of death worldwide. Acute ischemic stroke (AIS) patients often exhibit hypercoagulable state and gut microbiota dysbiosis. However, the association between coagulation abnormalities and gut microbiota dysbiosis in AIS patients and their predictive value for poor functional outcomes in AIS has not been investigated. Our study enrolled 95 AIS patients and 81 healthy controls, using 16S rRNA sequencing to analyze gut microbiota composition. Baseline fibrinogen level was found to be an independent risk factor for poor functional outcomes at 90-day follow-up (odds ratio = 2.16, 95% confidence interval: 1.02-4.59, P = 0.044). AIS patients showed significant gut microbiota dysbiosis, with significantly increased Parabacteroides and Alistipes, and decreased Prevotella and Roseburia, associated with coagulation indices. Furthermore, compared with AIS patients with normal coagulation function, those in a hypercoagulable state exhibited a significant increase in Alistipes and a decrease in Prevotella. We identified gut microbial biomarkers consisting of 15 bacteria that predicted poor functional outcome in AIS patients at 90-day follow-up. Coagulation indices improved the predictive performance of these biomarkers. In training and validation cohorts, area under the curve (AUC) values were 0.930 and 0.890 for microbial biomarkers alone, 0.691 and 0.751 for coagulation indices alone, and 0.943 and 0.944 for coagulation indices combined with gut microbial biomarkers. Our study showed that AIS patients with hypercoagulable state had gut microbiota dysbiosis, with Alistipes and Prevotella significantly associated with coagulation indices. A classification model based on coagulation indices and gut microbial biomarkers accurately predicted poor functional outcome in AIS patients at 90-day follow-up.

IMPORTANCE

Acute ischemic stroke (AIS) patients often exhibit hypercoagulable state and gut microbiota dysbiosis. However, the relationship between hypercoagulable state and gut microbiota dysbiosis in AIS patients and their predictive value for poor functional outcomes has not been fully explored. Our study of 95 AIS patients showed that baseline fibrinogen level was an independent risk factor for poor functional outcome at 90-day follow-up in AIS patients. Hypercoagulable state in AIS patients correlates with gut microbiota dysbiosis. AIS patients with hypercoagulable state had increased Alistipes abundance and decreased Prevotella abundance. A classification model based on coagulation indices and gut microbial biomarkers accurately predicted poor functional outcome in AIS patients at 90-day follow-up.

Investigating the impact of glycated hemoglobin levels on stroke severity in patients with acute ischemic stroke

Stroke is a sudden neurological decline caused by cerebrovascular diseases or impaired blood circulation. Research investigating the connection between glycated hemoglobin A1c (HbA1c) levels and stroke severity is limited. This study examined the connection between HbA1c levels and stroke severity in patients with acute ischemic stroke. A retrospective cross-sectional analysis of the medical records of 1103 patients with acute ischemic stroke from January 2020 to January 2024 was conducted. Patients were divided into seven groups on the basis of their HbA1c levels. Stroke severity within these groups was assessed via the National Institutes of Health Stroke Scale (NIHSS), with the aim of identifying correlations between stroke severity and glycemic status. This study examined the impact of various HbA1c levels on a range of demographic and clinical characteristics in stroke patients. The patients were grouped into seven categories on the basis of their HbA1c levels, and characteristics such as age; body mass index (BMI); LDL, HDL, and creatinine levels; and NIHSS scores at hospital admission were compared across these groups. Significant differences were observed in age, LDL levels (F = 3.999, P < 0.001), and creatinine levels (F = 1.303, P = 0.253) among the HbA1c categories. However, there were no significant differences in BMI, HDL levels, or length of hospital stay. A positive correlation was found between HbA1c levels and NIHSS scores, indicating that higher HbA1c levels are associated with greater stroke severity. This study revealed that the risk of severe stroke increases significantly when HbA1c levels exceed 6.5%. In contrast, maintaining HbA1c levels below 6.5% is linked to a reduced risk of severe stroke and lower mortality. Additionally, older adults are at greater risk and tend to experience more severe strokes.

Obesity is associated with impaired long-term prognosis in patients undergoing coronary angiography: Results from a large-scaled single centre registry

BACKGROUND

The study investigates the prognostic value of body mass index (BMI) in a large cohort of unselected patients undergoing invasive coronary angiography (CA). More than one third of the world population is overweight or obese with increasing prevalence. Obesity is an established risk factor for the development of coronary artery disease (CAD), but its impact on outcomes in patients undergoing CA remains controversial.

METHODS

Consecutive patients undergoing invasive CA were included at one institution from 2016 to 2022. Patients were stratified by BMI on admission according to the current WHO definition into the following subgroups: BMI 18.5- < 25 kg/m2, 25- < 30 kg/m2, 30- < 35 kg/m2 and ≥ 35 kg/m2. The prognostic value of BMI was investigated with regard to the primary endpoint rehospitalization for heart failure (HF) at 36 months and the secondary endpoints acute myocardial infarction (AMI) and coronary revascularization at 36 months.

RESULTS

From 2016 to 2022, 6583 patients undergoing CA were included with a median BMI of 27.5 kg/m2 (mean: 28.3 kg/m2). Patients with a BMI of 25- < 30 kg/m2 had the highest prevalence of CAD (71.1 %) and 3-vessel CAD (30.5 %), whereas patients with a BMI ≥ 35 kg/m2 had the lowest prevalence (61.4 % and 20.1 %, respectively). After multivariable adjustment, patients with a BMI ≥ 35 kg/m2 had the highest risk of HF-related rehospitalization at 36 months compared to those with a BMI in the normal range (adjusted HR = 1.210; 95 % CI: 1.011-1.448; p = 0.038).

CONCLUSION

In patients undergoing CA, a BMI ≥35 kg/m2 was associated with the highest risk of HF-related rehospitalization at 36 months.

Evaluation of machine learning methods for prediction of heart failure mortality and readmission: meta-analysis

BACKGROUND

Heart failure (HF) impacts nearly 6 million individuals in the U.S., with a projected 46% increase by 2030, is creating significant healthcare burdens. Predictive models, particularly machine learning (ML)-based models, offer promising solutions to identify patients at greater risk of adverse outcomes, such as mortality and hospital readmission. This review aims to assess the effectiveness of ML models in predicting HF-related outcomes, with a focus on their potential to improve patient care and clinical decision-making. We aim to assess how effectively machine learning models predict mortality and readmission in heart failure patients to improve clinical outcomes.

METHOD

The study followed PRISMA 2020 guidelines and was registered in the PROSPERO database (CRD42023481167). We conducted a systematic search in PubMed, Scopus, and Web of Science databases using specific keywords related to heart failure, machine learning, mortality and readmission. Extracted data focused on study characteristics, machine learning details, and outcomes, with AUC or c-index used as the primary outcomes for pooling analysis. The PROBAST tool was used to assess bias risk, evaluating models based on participants, predictors, outcomes, and statistical analysis. The meta-analysis pooled AUCs for different machine learning models predicting mortality and readmission. Prediction accuracy data was categorized by timeframes, with high heterogeneity determined by an I² value above 50%, leading to a random-effects model when applicable. Publication bias was assessed using Egger's and Begg's tests, with a p-value below 0.05 considered significant RESULT: A total of 4,505 studies were identified, and after screening, 64 were included in the final analysis, covering 943,941 patients. Of these, 40 studies focused on mortality, 17 on readmission, and 7 on both outcomes. In total, 346 machine learning models were evaluated, with the most common algorithms being random forest, logistic regression, and gradient boosting. The neural network model achieved the highest overall AUC for mortality prediction (0.808), while the support vector machine performed best for readmission prediction (AUC 0.733). The analysis revealed a significant risk of bias, primarily due to reliance on retrospective data and inadequate sample size justification.

CONCLUSION

In conclusion, this review emphasizes the strong potential of ML models in predicting HF readmission and mortality. ML algorithms show promise in improving prognostic accuracy and enabling personalized patient care. However, challenges like model interpretability, generalizability, and clinical integration persist. Overcoming these requires refined ML techniques and a robust regulatory framework to enhance HF outcomes.

Risk factors and clinical outcome of postoperative hyperglycemia after cardiac surgery with cardiopulmonary bypass

Background

There is a high incidence of postoperative hyperglycemia (PHG) in cardiac surgery with cardiopulmonary bypass (CPB), as well as increased morbidity and mortality. The purpose of this study was to evaluate the incidence of PHG after cardiac surgery with CPB, the independent risk factors, and its association with clinical outcomes.

Methods

This was a retrospective, observational study of patients who underwent cardiac surgery with CPB between January 2023 and March 2024 in West China Hospital of Sichuan University. A total of 1,008 consecutive postoperative cardiac surgery patients admitted to the cardiac surgery intensive care unit (ICU) were divided into a non-PHG group and a PHG group. Patients' blood glucose levels were evaluated immediately after cardiac surgery and every 3-4 h daily for 10days, until discharge from the ICU. For patients with PHG, intravenous insulin infusion was performed according to the institution's protocol, and perioperative risk factors for hyperglycemia and clinical outcomes were assessed.

Results

PHG, defined as random blood glucose ≥10.0 mmol/L (180 mg/dl) on two occasions within 24 h, occurred in 65.28% of cardiac surgery patients. Multivariable logistic regression analysis identified that age [odds ratio (OR) 1.054, 95% confidence interval (CI) 1.040-1.069; p < 0.001], female sex (OR 1.380, 95% CI 1.023-1.864; p = 0.035), diabetes (OR 13.101, 95% CI 4.057-42.310; p < 0.001), pulmonary infection (OR 1.918, 95% CI 1.129-3.258; p = 0.016), aortic cross-clamp time (OR 1.007, 95% CI 1.003-1.010; p < 0.001), and intraoperative highest glucose (OR 1.515, 95% CI 1.370-1.675; p < 0.001) emerged as independent risk factors for PHG. Moreover, PHG had higher rates of acute kidney injury (12.61% vs. 4.00%; p < 0.001), delirium (9.57% vs. 3.43%; p < 0.001), pulmonary infection (12.01% vs. 5.14%; p < 0.001), longer duration of mechanical ventilation (19 vs. 14 h; p < 0.001), length of ICU stay (74 vs. 58 h; p < 0.001), length of hospitalization (13 vs. 11 days; p < 0.001), and higher rate of self-discharge or death (3.95% vs. 0.57%; p = 0.002) compared with patients with non-PHG.

Conclusions

PHG occurs frequently in patients after cardiac surgery. Age, female, diabetes, pulmonary infection, aortic cross-clamp time, and intraoperative highest glucose were independent risk factors for PHG. PHG is associated with worse clinical outcomes, including a higher rate of acute kidney injury, delirium, and pulmonary infection, greater duration of mechanical ventilation, length of ICU stay, length of hospitalization, and higher rate of automatic discharge or death.

Genetic and Lifestyle Risks for Coronary Artery Disease and Long-Term Risk of Incident Dementia Subtypes

BACKGROUND

Shared genetic and lifestyle risk factors may underlie the development of both coronary artery disease (CAD) and dementia. We examined whether an increased genetic risk for CAD is associated with long-term risk of developing all-cause, Alzheimer's, or vascular dementia, and investigated whether differences in potentially modifiable lifestyle factors in the mid- to late-life period may attenuate this risk.

METHODS

A prospective cohort study of 365 782 participants free from dementia for at least 5 years after baseline assessment was conducted within the UK Biobank cohort. Genetic risk was assessed using a genomewide polygenic risk score (PRS) for CAD and lifestyle risk using a modified version of the American Heart Association's Life's Essential 8 Lifestyle Risk Score (LRS). Higher values for both scores were deemed to represent increased risk. Primary outcomes were incident all-cause, Alzheimer's, and vascular dementia diagnoses obtained from electronic health records. Secondary outcomes were neuroimaging phenotypes measured in 32 028 participants recalled for magnetic resonance imaging. Sensitivity analyses were conducted to test the extent by which biological and behavioral risk factors contributed to observed associations.

RESULTS

A total of 8870 cases of all-cause dementia were observed over a median 13.9-year follow-up. Both genetic (PRS) and lifestyle (LRS) risk scores for CAD were associated with a modestly elevated risk of all-cause dementia (subhazard ratio per SD increase, 1.10 [1.08, 1.12], P<0.001, for PRS and 1.04 [1.02, 1.06], P=0.006, for LRS). This risk appeared largely attributable to underlying vascular dementia diagnoses (subhazard ratio, 1.16 [1.11, 1.21], P<0.001 for PRS and 1.15 [1.09, 1.22], P<0.001, for LRS), because Alzheimer's disease was found to demonstrate moderate associations with PRS alone (subhazard ratio, 1.09 [1.06, 1.13]; P<0.001). LRS was found to have an additive rather than interactive effect with PRS, with individuals in the highest tertiles for both genetic and lifestyle risk for CAD ≈70% more likely to develop vascular dementia during follow-up compared with those in the lowest tertiles for both (subhazard ratio, 1.71 [1.39, 2.11]; P<0.001). This was substantially attenuated in those with a low LRS at baseline, however, regardless of underlying genetic risk (40% to 50% reduction for low versus high LRS tertile regardless of PRS tertile; P<0.001 for all). In a subset of individuals recalled for neuroimaging assessments, those in the highest tertiles for genetic and lifestyle risk for CAD demonstrated a ≈25% greater volume of white matter hyperintensities than those in the lowest risk tertiles, but showed little difference in gray matter or hippocampal volumes. Sensitivity analyses identified associations between both biological and behavioral risk scores with white matter hyperintensity burden and vascular dementia, whereas some Alzheimer's dementia associations showed seemingly paradoxical relationships.

CONCLUSIONS

Individuals who are genetically predisposed to developing CAD also face an increased risk of developing dementia in old age. This risk is reduced in those demonstrating healthy lifestyle profiles earlier in the lifespan, particularly in those who may be at an increased risk of developing dementia caused by an underlying vascular pathology.