Search Results (5,672)

Background: Deep learning (DL) models using Holter-ECG may enhance risk stratification after heart failure (HF) or myocardial infarction (MI). Objective: To evaluate the prognostic performance of a Holter-based DL model for predicting major adverse cardiac events (MACE), compared with conventional noninvasive markers. Methods: In the K-REDEFINE study, 1108 patients with acute MI or HF underwent 24 h Holter monitoring. A DL model was trained using raw Holter-ECG data and tested for predicting a composite of cardiac death and ventricular arrhythmias. Its performance was compared with heart rate turbulence (HRT), T-wave alternans (TWA), and ejection fraction (EF). Results: During follow-up, 56 adjudicated cardiac deaths (1.18%/yr) and 21 ventricular arrhythmias (0.44%/yr) occurred. The DL model showed an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI, 0.70–0.77) for the composite outcome, improving to 0.77 (0.74–0.81) when combined with EF. In comparison, HRT and TWA showed lower AUROCs of 0.62 and 0.55, respectively. For cardiac death alone, the AUROC reached 0.79, further improving to 0.82 with EF. Model-derived risk stratification revealed a seven-fold increase in cardiac death risk in the high-risk group compared to the low-risk group (HR 7.47, 95% CI 2.24–24.96, p < 0.001). This stratification remained particularly effective in patients with EF > 40%. Conclusions: A DL algorithm trained on single-lead Holter-ECG data effectively predicted cardiac death and ventricular arrhythmia. Its performance surpassed conventional markers and was further enhanced when integrated with EF, supporting its potential for noninvasive, scalable risk stratification. Full article

Cardiac inflammation and hypertrophy develop as a pathologic response to an array of insults, such as myocardial infarctions, chronic systemic hypertension, and valvular defects. Due to the high prevalence of such conditions, there is an increasing need to prevent and halt cardiac hypertrophy. Because cardiac damage and subsequent remodeling can lead to arrhythmias, heart failure, and even sudden cardiac death, inhibition of cardiac hypertrophy is key to reducing cardiovascular-related mortality. The immune system is the driving force behind inflammatory reactions. All three pathways of complement system activation—classical, lectin, and alternative—are implicated in developing cardiac damage, inflammation, and hypertrophy due to infectious and non-infectious causes, autoimmune diseases, genetic polymorphisms, and forms of complement dysregulation. Of interest in this review is the role of the complement system, a collection of soluble and membrane-bound proteins that mediate inflammatory processes through interactions with signaling molecules and immune cells. This review comprehensively discusses the roles of these complement pathways in contagious, chronic inflammatory, genetic, and metabolic diseases. An overview of the completed and terminated clinical trials aimed at preventing cardiovascular mortality by targeting various aspects of the complement system and inflammatory reaction is included. Most current treatments for cardiac inflammation and remodeling primarily target the renin–angiotensin–aldosterone system (RAAS), which prevents further remodeling by reducing myocardial workload. However, moving forward, there may be a place for emerging anti-complement therapeutics, which impair the inflammatory response that generates hypertrophy itself. Full article

Cardiovascular disease (CVD) is a major cause of mortality around the world. This underscores the critical need to implement effective predictive tools to inform clinical decision-making. This study aimed to compare the predictive performance of ensemble learning algorithms, including Bagging, Random Forest, Extra Trees, Gradient Boosting, and AdaBoost, when applied to a clinical dataset comprising patients with CVD. The methodology entailed data preprocessing and cross-validation to regulate generalization. The performance of the model was evaluated using a variety of metrics, including accuracy, F1 score, precision, recall, Cohen’s Kappa, and area under the curve (AUC). Among the models evaluated, Bagging demonstrated the best overall performance (accuracy ± SD: 93.36% ± 0.22; F1 score: 0.936; AUC: 0.9686). It also reached the lowest average rank (1.0) in Friedman test and was placed, together with Extra Trees (accuracy ± SD: 90.76% ± 0.18; F1 score: 0.916; AUC: 0.9689), in the superior statistical group (group A) according to Nemenyi post hoc test. The two models demonstrated a high degree of agreement with the actual labels (Kappa: 0.87 and 0.83, respectively), thereby substantiating their reliability in authentic clinical contexts. The findings substantiated the preeminence of aggregation-based ensemble methods in terms of accuracy, stability, and concordance. This underscored the prominence of Bagging and Extra Trees as optimal candidates for cardiovascular diagnostic support systems, where reliability and generalization were paramount. Full article

Background: Rituximab is a monoclonal antibody targeting CD20, commonly used to treat autoimmune diseases such as granulomatosis with polyangiitis (GPA) and rheumatoid arthritis. While generally well-tolerated, serious adverse events, including infusion reactions and infections, are well-documented. Case Summary: We report a rare case of rituximab-induced ST-elevation myocardial infarction (STEMI) in a 26-year-old woman with no cardiovascular risk factors. She developed crushing chest pain after her first 1 g rituximab infusion, with recurrent symptoms upon re-exposure. Cardiac catheterization revealed a left circumflex artery occlusion. Additional workup showed c-ANCA positivity, cryoglobulinemia, pauci-immune glomerulonephritis, and findings consistent with GPA. Rituximab was discontinued, and she was transitioned to steroids, cyclophosphamide, and leuprolide, with no further cardiac events. Discussion: This is the first reported case in a young, previously healthy woman. Clinicians should consider rituximab-associated myocardial injury, especially in autoimmune or hypercoagulable states. Take-Home Message: Remain vigilant for cardiac events during rituximab infusions in patients with inflammatory diseases. Full article

Background: The combined impact of impaired kidney function and subclinical myocardial injury (SCMI) on cardiovascular (CV) mortality has not been well studied. We aimed to evaluate their individual and joint associations with cardiovascular mortality. Methods: We analyzed data from 6057 participants (mean age 57.0 ± 13.0 years) in the U.S. Third National Health and Nutrition Examination Survey. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Electrocardiographic SCMI was defined as a cardiac infarction/injury score ≥ 10. CV mortality was determined from the National Death Index. Multivariable logistic regression assessed baseline cross-sectional associations between eGFR and SCMI. Cox proportional hazards models were used to examine the individual and combined associations of eGFR and SCMI with CV mortality. Results: At baseline, 1297 participants (21.4%) had SCMI. In multivariable logistic regression analysis, eGFR < 45 mL/min/1.73 m² (vs. ≥45) was not associated with SCMI (OR [95% CI]: 1.10 [0.84–1.45]). Over a median follow-up of 18.4 years, 690 CV deaths occurred. In separate Cox models, both SCMI (vs. no SCMI) and eGFR < 45 (vs. ≥45) were associated with increased CV mortality risk (HR [95% CI]: 1.36 [1.16–1.60] and 1.56 [1.24–1.99], respectively). Compared with participants with eGFR ≥ 45 and no SCMI, those with both eGFR < 45 and SCMI had the highest CV mortality risk (HR [95% CI]: 2.36 [1.65–3.36]), followed by eGFR < 45 alone (1.47 [1.09–1.96]) and SCMI alone (1.33 [1.11–1.58]). Conclusions: Both reduced eGFR and SCMI were independently associated with CV mortality. Their coexistence showed the highest risk, but without statistical significance compared with each alone, possibly reflecting limited power and distinct mechanisms. Full article

Background/Objectives: Single-phase CT angiography (sCTA) is widely used to assess collateral circulation in acute ischemic stroke, but its static nature can lead to an underestimation of collateral flow. Our study aimed to develop and validate a direct, qualitative dynamic CTA (dCTA) collateral score based on CTP source images, without the need for post-processing software, to provide a more accurate prognostic tool. Methods: We retrospectively analyzed 112 patients with anterior circulation ischemic stroke from a prospective registry who underwent non-contrast CT, sCTA, and CTP within 8 h of onset. Collateral circulation was graded using a 4-point sCTA score and our novel 4-point dCTA score, which incorporates temporal filling patterns. We used linear regression to compare the association of both scores with CTP-derived core/hypoperfusion volumes, infarct growth, and final infarct volume. Results: The dCTA method frequently reclassified patients with poor collaterals on sCTA to good collaterals on dCTA (n = 23), while the reverse was rare (n = 5). A better collateral score was significantly associated with smaller core volume for both sCTA and dCTA, but the dCTA score demonstrated a superior model fit (R² = 0.36 vs. 0.32). Similar superior correlations for dCTA were observed for hypoperfusion, infarct growth, and final infarct volumes. Critically, only the dCTA score significantly modified the association between core volume and time since stroke onset (p for interaction = 0.04). Conclusions: A collateral score derived from CTP source images (dCTA) offers a more reliable prediction of infarct lesion sizes and progression than conventional sCTA. By incorporating temporal resolution without requiring extra software, dCTA provides a robust correlation with stroke temporal evolution and represents a readily implementable tool to enhance patient selection in acute stroke. Full article

Background: A thorough post-myocardial infarction (MI) evaluation is essential for prognosis and rehabilitation. While cardiopulmonary exercise testing (CPET) is the standard for assessing functional capacity, combining it with dynamic stress echocardiography (DSE) may offer a more comprehensive assessment. Aim: This study examined the role of stress echocardiography (SE) in male post-MI patients by evaluating left ventricular function with conventional indices and the change in global longitudinal strain (ΔGLS) at rest and during maximal treadmill CPET. A secondary aim was to determine whether ΔGLS could provide additional value to traditional measures in post-MI care. Methods: Eighteen men with a recent MI [15 ST-elevation MI, three non-ST-elevation MI; mean age 53.2 ± 5.9 years, mean body mass index (BMI) 27.9 ± 2.2, 44.4% with a smoking history) and 18 age-matched male controls (mean age 50.1 ± 10.8 years, mean BMI 26.5 ± 2.4, 39.0% with smoking history) were enrolled. All MI patients were under optimal medical therapy, including β-blockers, which were withheld on the test day. Most underwent percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) n = 2, or PCI for non-ST-elevation MI (NSTEMI) n = 3. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were measured at rest and at peak effort and correlated with CPET parameters. Results: Post-MI patients had lower LVEF (50.6% vs. 60.7% at rest; 55.3% vs. 67.4% at peak, both p < 0.001), impaired GLS (–14.7% vs. –20.2% at rest, p = 0.003; –15.8% vs. –22.7% at peak, p = 0.001), and reduced VO₂peak (29.2 vs. 41.9 mL/kg/min, p < 0.001) compared with controls. In the MI group, ΔGLS correlated with VO₂peak (r = –0.645, p = 0.003) and VE/VCO₂ (r = 0.539, p = 0.020), indicating its potential as a marker of functional reserve. Conclusions: Combined CPET and SE offered comprehensive insights into functional and myocardial performance, identifying ΔGLS as a useful non-invasive index for risk stratification and rehabilitation after MI, with high feasibility and safety. Full article

Atherosclerosis is common cardiovascular disease, leading to complications such as myocardial infarction and stroke. The main causes of these diseases are lipid accumulation and inflammation in large arteries. In this study, we investigated whether opioid receptor blockade impacts factors involved in atherosclerosis development. We administered naloxone to 8-week-old and 36-week-old ApoE^−/− mice, then examined the expression of Col1a1, and Col3a1 in the aorta, as well as the influence of naloxone administration on aortic collagen layer thickness and proteomic changes in the aorta. Additionally, we assessed the impact of naloxone on the splenic T-cell populations. The results showed that Col3a1 expression decreased in young mice but increased in older mice. In 36-week-old mice, naloxone administration led to an increase in aortic collagen layer thickness, but remained unchanged in young mice. Proteomic analysis identified 587 proteins that were altered following naloxone treatment. Our studies suggest that the opioid system is an important factor in atherosclerosis development. Full article

Background/Objectives: Open thoracoabdominal aortic aneurysm (TAAA) repair remains essential despite expanded endovascular options, yet the contemporary open-surgery case-mix has shifted as minimally invasive therapies became widespread. The objective was to evaluate temporal changes in patient demographics, pathology, and perioperative outcomes of open TAAA repair across two decades. Methods: Retrospective, cross border cohort of all open TAAA repairs performed at two high-volume tertiary centers (Aachen, Germany; Maastricht, Netherlands) from 2000–2024. Patients were stratified into Early Era (2004–2013) and Late Era (2014–2024). Primary endpoints were shifts in demographics and perioperative mortality/morbidity; secondary endpoints included major complications (spinal cord ischemia, acute kidney injury, pulmonary and cardiac events). Results: Among 577 open repairs, 376 (65.2%) occurred in the Early Era and 201 (34.8%) in the Late Era, with annual volumes declining to <12 cases/year after 2020. Late Era patients were younger (median 55.9 vs. 63.0 years, $p<0.001$) and had more genetic aortopathy (Marfan 26.9% vs. 11.7%, $p<0.01$) and post-dissection pathology (64.7% vs. 43.1%, $p<0.01$), alongside more prior aortic surgery (59.2% vs. 43.4%, $p<0.01$). Massive transfusion and incidental splenectomy decreased (37.8% vs. 54.5%, $p<0.01$; 5.0% vs. 14.9%, $p<0.01$). In-hospital mortality was similar (18.4% Late vs. 21.8% Early, $p=0.34$); spinal cord ischemia showed a non-significant reduction (5.5% vs. 8.0%, $p=0.26$); myocardial infarction decreased (1.0% vs. 4.3%, $p=0.03$); and ARDS increased (15.9% vs. 5.1%, $p<0.01)$. Conclusions: Despite the shift towards endovascular repair and the changing demographics of patients selected for open TAAA repair, specialized centers can maintain stable outcomes through standardized protocols and concentrated expertise. The preservation of open surgical capabilities remains crucial for specific patient populations, emphasizing the need for a balanced approach that integrates both open and endovascular techniques to provide optimal, individualized care. Full article

Background and Objectives: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard care for acute coronary syndrome (ACS). Although ticagrelor showed superiority over clopidogrel in pivotal trials, patients with advanced chronic kidney disease (CKD) or on dialysis were underrepresented and results in Asian populations have been inconsistent. Materials and Methods: We conducted a retrospective cohort study using the Taiwan Society of Cardiology Acute Coronary Syndrome-Diabetes Mellitus (TSOC ACS-DM) registry between 1 October 2013, and 30 September 2016. Eligible patients had type 2 diabetes mellitus and ACS with stage III–V CKD or were on dialysis at index hospitalization and were discharged on aspirin plus either ticagrelor or clopidogrel. The primary endpoint was a composite of cardiovascular (CV) death, CV-related readmission, and repeated revascularization. Cumulative incidence functions were compared using expectation maximization (EM) weighting and propensity score adjustment. Results: After exclusions, 451 patients were analyzed (ticagrelor n = 116; clopidogrel n = 335). Ticagrelor associated with higher myocardial infarction (HR 1.59, 95% CI 1.12–2.28, p = 0.010), CV-related readmission (HR 1.72, 95% CI 1.12–2.65, p = 0.014), repeated revascularization (HR 2.24, 95% CI 1.36–3.68, p = 0.002), and the composite endpoint (HR 1.63, 95% CI 1.06–2.48, p = 0.024) at 2 years. Conclusions: Among real-world Taiwanese patients with type 2 diabetes mellitus, ACS, and CKD, ticagrelor use was linked to increased risks of cardiovascular events compared to clopidogrel. However, these relationships might be affected by potential confounding factors. Randomized controlled trials are necessary to establish the best antiplatelet strategy for this high-risk group. Full article

Finite element analysis (FEA)-based computational fluid dynamics (CFD) simulations are essential in biomedical engineering for studying haemodynamics, yet their high computational cost limits large-scale parametric studies. This paper presents a comparative analysis of FEA and surrogate modelling techniques applied to renal artery haemodynamics. The aortic–renal bifurcation strongly influences renal perfusion, affecting conditions such as hypertension, infarction, and transplant rejection. This study evaluates GPU-accelerated voxel simulations (Ansys 2024 R2 Discovery), 2D and 3D FEA simulations (COMSOL Multiphysics 6.3), finite volume CFD (Ansys 2020 R2 Fluent), and deep neural networks (DNNs) as surrogate models. Branching angles and blood pressure were systematically varied, and their effects on velocity, pressure, and turbulent kinetic energy were assessed in a time-dependent framework. Fluent provided accurate baseline results, while COMSOL 2D gave sufficient accuracy with much lower runtimes. In contrast, COMSOL 3D required over 160 times longer, making it prohibitive. Surrogate models trained on 6500 or more FEA-derived samples achieved high predictive accuracy (R² > 0.98 for velocity and pressure), balancing training cost and result quality. Cost analysis showed surrogate models become advantageous after 76–93 simulations. Symmetry is expressed in balancing model fidelity and computational efficiency, providing a resource-effective methodology with broad potential in vascular applications. Full article

Background: Coronary artery disease (CAD) is common among liver transplantation (LT) candidates, yet whether pre-transplant percutaneous coronary intervention (PCI) improves post-LT outcomes remains uncertain. Methods: We conducted a single-center, Institutional Review Board-approved cohort study of adults undergoing LT from 2005 to 2025. Asymptomatic candidates with significant stenosis on invasive angiography were included; prior coronary artery bypass grafting was excluded. The primary endpoint was major adverse cardiovascular events (MACE: myocardial infarction [MI], stroke/transient ischemic attack, new systolic dysfunction, post-LT coronary revascularization, or all-cause death). Results: Among 111 patients (median age 65 years; 84% male), 66 (59%) underwent PCI and 45 (41%) were managed medically. Over a median 32 months of follow-up, 61 patients (55%) experienced MACE. Composite MACE did not differ between PCI and non-PCI groups (52% vs. 60%, p = 0.40; log-rank p = 0.59). Fine–Gray modeling showed no association of PCI with MACE; independent predictors were prior MI (HR 1.81, 95% CI 1.01–3.24) and pre-transplant dialysis (HR 2.13, 95% CI 1.07–4.24). Major bleeding occurred in 7%. Matched and era-stratified analyses were concordant. Conclusions: In asymptomatic LT candidates with angiographically severe CAD, pre-LT PCI was not associated with a lower incidence of post-LT MACE. Full article

Ischemia–reperfusion (I/R) injury is a complex pathological process underlying numerous acute organ failures and is a significant cause of morbidity and mortality in diseases such as myocardial infarction, stroke, thrombosis, and organ transplantation. Mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) have demonstrated considerable therapeutic potential, but their broad tropism and general repair signaling may limit their efficacy. This review addresses the emerging paradigm of using organ-specific EVs for the treatment of I/R injury in the respective organs. We summarize the existing studies performed on experimental animals showing that these native EVs could possess tissue tropism and carry a specialized cargo of proteins, miRNAs, and lipids tailored to the unique regenerative needs of their organ of origin, enabling them to precisely modulate key processes, including inflammation, apoptosis, oxidative stress, and angiogenesis. However, their clinical translation faces challenges related to scalable production, standardization, and the dualistic nature of their effects, which can be either protective or detrimental, depending on the cellular source and pathophysiological context. Future developments need to focus on overcoming these obstacles through rigorous isolation protocols, engineering strategies such as cargo enrichment and hybrid vesicle creation, and validation in large-animal models. Overall, organ-specific EVs offer a novel, cell-free therapeutic strategy with the potential to significantly improve outcomes in I/R injury. Full article

Malignant cerebral infarction (MCI) is rare but often fatal. Early identification helps guide monitoring and decompressive surgery. This study evaluated whether serum biomarkers add predictive value beyond clinical and imaging data in severe stroke patients with anterior circulation large vessel occlusion (LVO). In this prospective study, 73 acute severe LVO stroke patients underwent whole-brain CT perfusion (CTP) with rCBV-based core measurement at admission and follow-up MRI at 24 ± 12 h for infarct and edema volume assessment. Serum biomarkers (s100b, NSE, VEGF, ICAM1) were sampled a median of 20.5 h after baseline imaging. Logistic regression models predicted MCI using baseline variables (NIHSS, ASPECTS, rCBV < 30%), adding treatment data (rtPA, mTICI, NIHSS posttreatment), and adding serum biomarkers. Performance was assessed by AUC, accuracy, F1, and cross-validated R². MCI occurred in 18/73 (24%) patients. Baseline models showed an AUC of 0.72; adding treatment improved the AUC to 0.88. Biomarkers slightly increased the AUC (0.90) but did not improve F1. Higher s100b was associated with more severe injury but did not enhance the prediction of MCI. Models with baseline imaging and treatment best explained infarct (R² ≈ 0.27) and edema (R² ≈ 0.58). In conclusion, admission severity, CTP, and early treatment response are the main predictors of MCI and aid early risk stratification of patients. Despite their pathophysiologic relevance, serum biomarkers do not add substantial predictive value. Full article

The legalization of cannabis in multiple U.S. states and several other countries, along with its increasing social acceptance across diverse demographic and socioeconomic groups, has led to a growing number of patients presenting for interventional procedures with a history of cannabis use. Although anesthetic and sedation-related implications may be less pronounced than in major surgery, they remain clinically relevant and warrant careful consideration. Key factors include acute intoxication, chronic use, and cannabis use disorder. Cannabis users often require higher—and sometimes unpredictable—doses of propofol and other sedatives. Inhalational use is associated with airway hyperreactivity, increasing the risk of bronchospasm and, in severe cases, life-threatening laryngospasm. Acute intoxication may also impair the patient’s ability to provide informed consent. Cardiovascular manifestations, including tachycardia, hypertension, and an elevated risk of myocardial infarction, may occur depending on the timing and extent of recent cannabis exposure. Although these effects are unlikely to cause major complications during routine screening colonoscopy or diagnostic esophagogastroduodenoscopy, advanced therapeutic procedures may pose significant challenges for sedation providers. This narrative review summarizes the chemistry, pharmacology, and sedation-related implications of cannabis use in patients undergoing sedation requiring interventional procedures, with a specific focus on GI endoscopy. Full article