Vascular Health and Risk Management

Purpose Aquaporin 1 (AQP1), a transmembrane water channel protein, has been implicated in the regulation of necroptosis. However, its specific role in atherosclerotic plaque stability through the modulation of necroptosis remains unclear. Therefore, in this study, we aim to investigate whether AQP1 influences necroptosis in atherosclerosis by binding to receptor-interacting serine/threonine-protein kinase 1 (RIPK1) and decreasing the expression of receptor-interacting serine/threonine-protein kinase 3 (RIPK3) and mixed lineage kinase domain-like pseudokinase (MLKL). Patients and Methods The gene expression of AQP1 and necroptosis-associated genes significantly differ between atherosclerosis and normal groups. Genes linked to necroptosis were screened to influence the AS identified by weighted gene coexpression network analysis (WGCNA). Then we collected femoral atherosclerosis and normal aortic samples, further conducted single-cell sequencing and spatial transcriptomic methods to confirm the potential function and pathway of AQP1 in endothelial cells. Meanwhile, we overexpressed AQP1 in ox-LDL-treated endothelial cells in vitro. Results Firstly, via single-sample Gene Set Enrichment Analysis (ssGSEA) scores, we found that necroptosis plays the most important role among all ways of programmed cell death in two kinds of atherosclerosis. AQP1, RIPK1, RIPK3 and MLKL express differently in normal and atherosclerosis tissue by differentially expressed gene (DEG) analysis and Western Blot (WB). WGCNA analysis indicates that AQP1, MLKL and RIPK3 were significantly related to the AS. The area under the curve of the above hub genes was greater than 0.8 (AQP1 0.946, RIPK1 0.908, RIPK3 0.988, MLKL 0.863). We found AQP1 highly enriched in endothelial cells (ECs) by single-cell analysis. We sequenced the samples by spatial transcriptome and found that AQP1 was also mainly enriched in ECs both in expression and spatial location. With AQP1 overexpression in ECs, it significantly inhibited the expression of MLKL and RIPK3 and stimulated EC proliferation. Conclusion Our study identified that AQP1 suppresses atherosclerotic necroptosis by inhibiting the expression of RIPK3 and MLKL in ECs which might indicates that AQP1 plays a role in atherosclerosis. This new mechanism contributes to improving the diagnostic, prognostic, and therapeutic outcomes of atherosclerosis.

Background Aerobic training has been considered beneficial for determining the detrimental alterations in blood vessels caused by aging. Objective Evaluate the relationship between the preventive effects of aerobic exercise and time of practice on cardiovascular health, in aged Wistar rats. Methods Wistar rats (16 months) were divided into 3 groups: (1) sedentary (AGED); (2) long-term trained\61 weeks (LTT); and (3) short-term trained\final 8 weeks of life (STT). Body weight, maximum physical capacity, systolic blood pressure (SBP), pulse wave velocity (PWV), plasma nitrite (NO), oxidative stress (TBARS), wall thickness, the wall-to-lumen ratio, and collagen of the thoracic aorta, carotid, and femoral arteries were measured. Results Both trained groups showed an increase in physical capacity when compared to the AGED group (p=<0.001 for LTT and p=0.011 for STT), and the LTT group demonstrated higher values when compared to the STT group (p= 0.004). The LTT group presented attenuation of PWV (p= 0.002) and a reduction in the wall thickness and wall-to-lumen ratio of the thoracic aorta (p=0.032 and 0.008, respectively) and carotid arteries (p=0.019 and 0.012, respectively) when compared to the AGED group. The STT group presented a reduction in TBARS compared to the AGED group (p=0.046). Additionally, both trained groups (LTT and STT) presented a reduction in the percentage of arterial collagen compared to the AGED group in the thoracic aorta (p=<0.001 and p=0.001 respectively) and carotid arteries (p= <0.008 and p= 0.041 respectively). Conclusion This study demonstrated that long-term training decreased the level of collagen, PWV values, wall thickness, and the wall-to-lumen ratio of the aorta and carotid arteries compared to the AGED group. Moreover, short-term training reduced TBARS and collagen percentage in the aorta and carotid arteries compared to the AGED group.

Background Hypertension (HT) is a major risk factor for adult morbidity and mortality in low- and middle-income countries and little is known regarding the distribution of HT risk and treatment access within urban areas. Patients and methods We used data from the Vientiane Multi-Generational Birth Cohort in urban Lao PDR to assess the prevalence of loss and retention across five stages of HT care for 40+ year old adults: i) prevalence of hypertension, ii) hypertensives who ever had their BP measured by a health care professional, iii) hypertensives ever diagnosed with HT by a professional, iv) patients currently treated with HT medication, and v) patients with currently controlled BP. We estimated associations between sociodemographic and lifestyle predictors and the proportion of participants who reached each care cascade step using mutually adjusted Poisson regression modeling. Results Among the 3196 participants aged 40 to 99 years, the overall prevalence of HT was 16.3%, with higher rates for women, people over 60 years, peripheral district residents, low educated, widowed, and obese. Among people with HT, 90.2% ever had their BP measured by a health care professional, 69.3% ever received a HT diagnosis, 60.9% HT were currently on (drug) treatment, and 39.5% had currently controlled BP. The largest cascade of care losses occurred at the diagnosis and control stages with better outcomes for women. While central districts showed higher rates of diagnosis, control levels were lower than in peripheral districts, but there these differences appeared to be explained by adjusting for sociodemographic and lifestyle factors. Conclusion While HT prevalence in Lao PDR is lower than reported for other LMICs, more than 16% over the age of 40 years suffer from HT, and 60% of these cases are currently not controlled. Major policy efforts are needed to support this population and to prevent HT-driven excess mortality.

Background Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is a systemic immune vasculitis with an unclear etiology. It is often complicated by coronary artery disease. This study uses bidirectional Mendelian randomization (MR) to investigate the interaction between KD and circulating inflammatory factors, providing insights into their causal relationships. Methods We conducted a two-way pooled MR analysis to examine the causal links between 41 circulating inflammatory regulators and the risk of KD. Genetic data related to inflammation were sourced from three genome-wide association studies (GWASs) involving CRP, PCT, and cytokines, while KD data were derived from other studies. Inverse-variance weighting (IVW) was the primary MR method, with sensitivity analyses performed using MR‒Egger, weighted median, weighted mode, and MR–PRESSO to ensure robustness. Results Forward MR analyses showed no significant relationship between inflammatory factors and KD outcomes. In contrast, reverse MR, with KD as the exposure factor, revealed that interleukin-2 (IL-2) and interleukin-8 (IL-8) were significantly associated with KD (IL-2: OR=1.0085, P=0.037; IL-8: OR=1.0099, P=0.014). Borderline significant associations were observed for factors such as B_NGF, EOTAXIN, HGF, and IL_12_P70 in MR‒Egger and weighted median analyses. Conclusion This bidirectional MR study highlights the role of circulating inflammatory modulators in KD risk, offering insights into KD pathogenesis and potential therapeutic targets.

Introduction The association between depressive symptoms and cardiovascular disease (CVD) is widely acknowledged. However, there is a lack of relevant evidence among the middle-aged population in developing countries where depressive symptoms often go undetected and untreated. The objectives of this study were to assess the association between depressive symptoms and CVD in Indonesia and to compare the association between the middle-aged and elderly population. Methods This national cross-sectional population-based survey used secondary data from the publicly available Indonesian Family Life Survey (IFLS-5). Depressive symptoms were assessed using a modified Center for Epidemiologic Studies Depression (CESD-R-10) scale, and data on CVD and sociodemographic variables were self-reported. Binary logistic regression was performed to determine the association between depressive symptom and self-reported CVD after adjusting for confounding factors, with an adjusted odds ratio (AOR) and 95% confidence interval (CI) reported. Subgroup analysis was performed based on the age group. Results The study included 9049 respondents, predominantly the middle-aged (71.1%), female (52.6%), elementary school graduates (50.7%), non-smokers (59.0%), non-obese (77.3%), without depressive symptoms (82.2%), and without self-reported CVD (96.7%). Respondents with depressive symptoms were more likely to experience self-reported CVD (AOR = 1.56; 95% CI = 1.18–2.05; p-value = 0.002), after adjusting for potential confounders. A significant association was observed between depressive symptoms and self-reported CVD in elderly respondents (AOR = 1.89; 95% CI = 1.22–2.94; p-value = 0.005), whereas no significant association was observed in the middle-aged group (AOR = 1.39; 95% CI = 0.98–1.98; p-value = 0.063) after adjusting for confounders. Conclusion Respondents with depressive symptoms were associated with an increased risk of self-reported CVD, highlighting the urgent need for targeted prevention strategies, especially for those struggling with depressive symptoms.

Background Scientific societies universally recommend evaluating the accuracy of electronic devices designed for blood pressure (BP) measurement using established validation protocols. Objective This study aimed to assess the accuracy of the Combei BP880W wrist device for BP measurement in the general population, according to the ISO 81060–2:2018/AMD 1:2020 Universal Standard. Methods The Combei BP880W is an oscillometric device designed to measure BP at the wrist. This study adhered to the ISO 81060–2:2018/AMD 1:2020 protocol and employed the same-arm sequential BP measurement method. A total of 85 participants, meeting protocol-specified age, gender, BP, and cuff distribution criteria, were included. The accuracy analysis utilized Criterion 1 (differences and standard deviations between reference and test device measurements) and Criterion 2 (intra-individual standard deviation of BP differences). Results Eighty-five participants were included. Mean BP differences between the simultaneous observer measurements were −0.2 ± 1.9 mmHg for systolic BP (SBP) and 0.1 ± 1.9 mmHg for diastolic BP (DBP). For Criterion 1, the mean difference ± standard deviation (SD) between the reference and test device measurements were −2.7 ± 5.9 mmHg (SBP) and −2.0 ± 3.9 mmHg (DBP), meeting the required threshold (≤ 5 ± 8 mmHg). For Criterion 2, intra-individual SDs were 4.6 mmHg (SBP) and 3.4 mmHg (DBP), both below the respective limits (≤ 6.39 mmHg for SBP and ≤ 6.65 mmHg for DBP). Conclusion The Combei BP880W wrist device meets the accuracy requirements of the ISO 81060–2:2018/AMD 1:2020 protocol, supporting its use for home BP monitoring in the general population.

Introduction Previous studies with visible light spectroscopy (VLS) and laser Doppler flowmetry (LDF) have shown reduced mucosal circulation of the stomach and duodenal wall in patients with median arcuate ligament syndrome (MALS) and chronic mesenteric ischemia (CMI). However, transserosal microcirculatory assessment during the operative treatment of patients with these conditions has not yet been performed. We aimed to investigate if laparoscopic decompression for MALS and aortomesenteric bypass in CMI can result in immediate measurable increase in the microcirculation in stomach and duodenum. Patients and Methods In a single center, prospective comparative cohort study, twenty-eight patients suspected of MALS, and eleven with CMI underwent assessment of transserosal microcirculation of stomach and duodenum with Visible Light Spectroscopy (VLS) and Laser Doppler flowmetry (LDF), during surgery. Patients with computed tomography angiography (CTA) verified stenosis grade ≥50% in MALS and ≥70% in CMI were included in the study. Duplex ultrasound (DUS) was performed before and after the surgical treatment. The changes in the pre- and postoperative microcirculation were calculated with paired sample t-test. Results VLS showed significant increase in the transserosal relative hemoglobin concentration (rHb) after laparoscopic decompression in patients with MALS (Stomach, before: 58AU±13, after: 62AU±14, p = 0.017) and (Duodenum, before: 62AU±15, after:70AU±15, p = 0.004). Furthermore, a significantly increased blood flow was found in duodenum (Before: 276AU±89, After: 315AU±93, p = 0.015). However, the SaO2 was decreased significantly in the stomach (Before: 86AU±10, After: 82AU±14, p = 0.015), but remained unchanged in the duodenal serosa.The study did not find any increase in the microcirculation of the CMI patients after revascularization. The baseline transserosal microcirculation was indifferent between the groups. Conclusion Laparoscopic decompression leads to enhanced transserosal microcirculation in stomach and duodenum in the patients with MALS. The baseline transserosal microcirculation in stomach and duodenum is indifferent in the MALS and CMI.

Background A growing number of individuals develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of the standard modifiable risk factors (hypertension, diabetes, dyslipidemia, and cigarette smoking) (SMuRF-less patients). Prevalence of SMuRF-less patients in the Middle East has not been studied. This study investigates the prevalence, clinical profiles and outcomes of SMuRF-less patients compared with those who have SMuRFs. Methods We analyzed data from 6 published registries and from the Jordan SMuRF-less patients study, including baseline demographic features, cardiovascular risk factors, comorbid diseases, utilization of secondary prevention pharmacotherapy and one year outcome in SMuRF-less patients, those with 1–2 SMuRFs and with 3–4 SMuRFs. Results. A total of f 5540 ASCVD patients were enrolled. Mean age was 57.5 ± 11.6 years, and 1333 (24.1%) were women. Of the whole group, 214 (3.9%) were SMuRF-less, 3014 (54.4%) had 1–2 SMuRFs and 2312 (41.7%) had 3–4 SMuRFs. Compared with the SMuRFs groups, SMuRF-less group were younger, more likely to be men, and had lower prevalence of obesity, physical inactivity, metabolic syndrome, heart failure and chronic kidney disease. SMuRF-less patients were less likely to receive secondary prevention cardiovascular medications (antiplatelet agents, statins, renin angiotensin blockers and beta blockers); all p < 0.001. One year survival in the SMuRF-less patients was significantly lower than that in the SMuRFs groups (97.7% vs.98.4% vs.98.3%, respectively, p = 0.01). Multivariate analysis showed that young age, absence of heart failure and utilization of secondary preventive medications were associated with better one year outcome. Conclusion In this cohort of ME patients with ASCVD, nearly four in 100 were SMuRF-less. This rate is lower than that reported by most of published studies, mainly due to the high prevalence of the 4 SMuRFs. SMuRF-less patients were younger, had less comorbid disease, received less secondary prevention pharmacotherapy and had higher rate of one year mortality than those with SMuRFs. Clinical Trials The study is registered with ClinicalTrials.gov, unique identifier number NCT06199869.

Regular sexual activity is comparable to moderate exercise and may be safe for patients with cardiovascular disease (CVD). According to the recommendations of the Princeton III Conference (P3), people with a low risk of adverse cardiac events can undertake sexual activity safely, while other patients must first stabilise their cardiovascular status. Exercise testing is recommended to assess the safety of sexual activity in people with questionable or uncertain cardiac risk (P3). Patients after successful and uncomplicated treatment of myocardial infarction (MI) can return to sexual activity after 3 weeks if the stress test is negative. The 4th Princeton Conference (P4) recommends the use of the 2019 regimen developed by the American College of Cardiology (ACC) and American Heart Association (AHA) to assess the risk of atherosclerotic cardiovascular disease (ASCVD) in men with ED (ACC/AHA ASCVD 2019). Sexual health education plays an important role in the successful return to safe sexual activity, which should include post-MI patients and their relatives. The responsibility for counselling lies with cardiologists, general practitioner (GP) and nursing staff. Sexual rehabilitation should be an integral part of cardiac rehabilitation, and lifestyle modification and optimal treatment of underlying medical conditions are key to maintaining psychophysical well-being and a successful sex life.

Objective An association between white blood cell count (WBC-C) before percutaneous coronary intervention (PCI) and prognosis has been established in patients undergoing PCI. However, the effect of WBC-C after PCI on the long-term prognosis of patients with unstable angina pectoris (UA) is unclear. Methods A retrospective cohort study was conducted in 1811 consecutive patients with UA. The changes of WBC and subgroup counts before and in the early postoperative stages after PCI were observed by paired Wilcoxon signed-rank test. The Kaplan–Meier method and COX proportional regression model were used to evaluate the association between the incidence of 5-year endpoint events and post-PCI leukocytosis. Results Leukocytosis and neutrocytosis within 24 hours after PCI were observed in majority of patients with UA, while lymphocyte count significantly decreased after PCI in those patients. There were no significant differences in 5-year all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE) between patients in the post-PCI leukocytosis and the control group. However, the 5-year incidence of major adverse cardiovascular events (MACE) was significantly increased in the post-PCI leukocytosis group (p = 0.017, Log rank test). Leukocytosis after PCI was independently associated with the occurrence of MACE (hazard ratio: 1.36; 95% confidence interval: 1.06–1.75; p = 0.015). Conclusion Peripheral WBC and neutrophil counts within 24 hours after PCI significantly increased in response to PCI in patients with UA, while lymphocyte count significantly decreased after PCI in those patients. The post-PCI leukocytosis offered predictive value for an increased risk of MACE for up to 5 years in patients with UA.

Background Adequate self-care behavior is an important factor in controlling hypertension to reduce the number of complications. A patient’s knowledge about hypertension can influence their self-care behavior in practice. Purpose The aim of this study was to identify self-care behaviors among hypertension patients based on their knowledge. Patients and Methods This descriptive correlational study was conducted on patients with hypertension in primary care. The sample was selected using purposive sampling, with a one-month data collection period yielding 115 samples. The Hypertension Self-Care Profile instrument was used to assess self-care behavior while the Knowledge on Hypertension instrument was utilized to evaluate knowledge. The characteristics variable was analyzed using descriptive statistics, while the correlation between self-care behavior and knowledge was evaluated using spearman rank correlation. Results Most participants had favorable attitudes towards self-care (53%), and they had adequate knowledge about hypertension (53.9%). Patients with favorable behavior and adequate knowledge were 52.5%, while patients with unfavorable behavior and inadequate knowledge were 63.0%. This study found no significant association between self-care behavior and knowledge (p = 0.099, r = 0.155). Conclusion Despite most participants demonstrated favorable attitudes and adequate knowledge regarding hypertension self-care, a significant association between these variables was not identified. This suggests that knowledge alone may not be a sufficient predictor of self-care behavior in this population and further research is required to understand the complex factors influencing self-care adherence and develop effective interventions to improve patient outcomes.

Background Delayed extubation (DE) after cardiac surgery is associated with high morbidity, mortality, increased length of stay in the intensive care unit, and hospital costs. Various studies have identified factors that influence the occurrence of DE in patients after cardiac surgery, but no review has systematically synthesized the results. Purpose This review aimed to identify the influencing factors and the leading causes of DE in patients after cardiac surgery. Methods This scoping review uses the framework developed by Arksey and O’Malley (2005). Literature was searched through four databases: PubMed, Scopus, Science Direct, and CINAHL, and two search engines, Sage and Google Scholar, accessed on October 20, 2024. The articles analyzed met the inclusion criteria, such as full-text articles in English, published from 2014–2024, with case-control, cross-sectional, longitudinal, and cohort study designs and had good quality as assessed using the Joanna Briggs Institute critical appraisal checklist. Data was synthesized using thematic analysis. Results Eight articles with a total of 13801 participants were included in this review. The prevalence of DE after cardiac surgery ranged from 13.6% to 91.9%. The factors affecting DE were categorized into preoperative, intraoperative and postoperative. The factors most commonly reported to influence ED include preoperative factors (age ≥ 60 and EF < 50%), intraoperative factors (duration of surgery ≥7 hours, use of IABP and sedatives), and postoperative factors (BNP≥806 pg/mL). The leading causes of DE after cardiac surgery are hemodynamic instability requiring increased inotropes (33.51%), reduced level of consciousness or drowsiness (31.91%), and postoperative bleeding (20.74%). Conclusion The process of extubation is a crucial phase in postoperative care. By comprehending the elements that impact DE, healthcare providers can effectively allocate medical resources to enhance the success of weaning, extubation, and recovery following cardiac surgery. Consequently, further research focusing on DE is essential, particularly in patients who have undergone cardiac surgery.

Background Atrial fibrillation (AF) accounts for the majority of arrhythmias affecting adults. It is associated with an increased mortality and various complications. Obesity being a major risk factor of cardiovascular and metabolic diseases including AF has always been connected to the overall burden of AF, but its role in the development of AF complications remains unclear. Our study aims to evaluate the impact of obesity on the complications of AF in Jordanian patients to establish a proper prognosis since studies regarding this topic in the Middle East are scant. Methods This study analyzed data from the Jordanian AF study (JoFib), which enrolled Jordanians with AF. Clinical characteristics were compared among patients who developed complications and those who did not. A binary logistic regression analysis was conducted to identify factors associated with AF complications development. Results 1857 patients were enrolled. There was no significant difference in BMI value between patients who developed complications and those who did not. Male sex, old age, hypertension, diabetes mellitus, and higher risk scores were associated with increased odds of developing complications. The oral anticoagulant use was found to be protective. Smoking had no significant effect on odds of complications. Conclusion The study concludes that increased BMI is not significantly associated with a reduced risk of developing AF complications. Further research with longer follow-up and larger sample sizes is needed to confirm these results.

Background and purpose Body mass index (BMI), as a straightforward measure, is widely used in clinical practice, and its results are linked to HT and patient prognosis. This study aimed to ascertain if sex differences exist in the prognostic significance of BMI at the time of admission to the cardiology unit, and how this impacts the LOHS for patients suffering from hypertension. Patients and methods A retrospective analysis of the medical records of 486 patients admitted urgently with a diagnosis of HT to the Cardiology Department at University Hospital in Wroclaw (Poland) between January 2017 and June 2021 was conducted. Results Women accounted for 53% of the study group and were older than men (64.7±12.8 vs 60.5±11.8, p=0.466). The mean BMI in women was 28.49±5.39 and in men 29.14±4.88. In an unadjusted linear regression model BMI results were not independent predictors of LOHS in either sex. After adjusting the model for comorbidities and blood test results, significant independent predictors of LOHS in women were LDL (B=−0.02, p<0.001), HDL (B=−0.043, p=0.012), TC (B=0.015, p=0.007), and hsCRP (B=0.02, p=0.013), while in men they were LDL (B= −0.026, p<0.001), HDL (B= −0.058, p=0.003), and TC (B=0.022, p=0.002). Conclusions The result of BMI assessed at the time of a patient’s admission to the cardiology department is not a significant predictor of LOHS in both men and women with hypertension.

Objective To explore the clinical characteristics and treatment outcomes of intracerebral hemorrhage in eosinophilic granulomatosis with polyangiitis (EGPA). Methods and Patient Presentation We report an 18-year-old student of EGPA complicated with intracerebral hemorrhage. The laboratory tests showed a continuous increase in eosinophils. The CT of head and chest showed cerebral hemorrhage and pulmonary infiltration. Interventions The patient received an intravenous infusion of methylprednisolone 1g/(kg·d) and cyclophosphamide for 3 days, followed by oral prednisone 1 mg/(kg·d). Outcomes At discharge, the patient’s head and chest CT showed obvious absorption of intracranial hematoma and improvement of pulmonary infiltration. We reviewed 40 previously published cases of EGPA with intracerebral hemorrhage focusing on the clinical features and treatment of intracerebral hemorrhage caused by EGPA. Conclusion For the cases of EGPA complicated with intracerebral hemorrhage, we should timely differentiate diagnosis and recognition. Early diagnosis with aggressive immunosuppressive therapy can help improve the prognosis of patients EGPA with intracerebral hemorrhage. When a patient is affected by EGPA, it is essential to remain vigilant for signs of Central Nervous System involvement. The treatment with glucocorticoids and cyclophosphamide is effective in managing EGPA.

Purpose Hemoglobin (Hb) levels and red cell distribution width (RDW) are standard and widely used parameters that predict clinical outcomes in patients with chronic heart failure (CHF). The Hb to RDW ratio (HRR) provides an incremental clinical prediction, as it reflects the various clinical characteristics of patients. No published data exists in the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) databases on HRR and its association with in-hospital mortality among patients with CHF. The aim of this study was to evaluate the relationship between the HRR and in-hospital mortality in two large real-world cohorts of patients with chronic CHF. Patients and Methods Data from the MIMIC-IV and eICU-CRD databases were used to explore the association between HRR and in-hospital mortality. Multivariate logistic regression, stratified analysis with interaction, and restricted cubic splines were used to investigate the association between HRR and in-hospital mortality. Results A total of 30,411 patients with CHF were enrolled based on the MIMIC-IV and multicenter eICU-CRD databases (15,983 and 14,428, respectively), including 16,295 men and 14,116 women with a median age of 73 years. The mean HRR was 0.69 ± 0.20. The overall in-hospital mortality rate was 12.63%. Increasing quantiles of HRR were associated with reduced in-hospital mortality rates. After adjusting for significant predictors, multivariate logistic regression analysis demonstrated that a low HRR was a significant predictor of in-hospital mortality, with a graded reduction in risk as HRR increased. Sensitivity analysis using restricted cubic splines demonstrated a continuous increase in in-hospital mortality risk with decreasing HRR (P = 0.262 for the non-linear model). Conclusion A linear relationship was observed between baseline HRR levels and in-hospital mortality. Lower HRR levels were associated with higher in-hospital mortality in patients with CHF. HRR could be a reliable clinical metric for assessing in-hospital mortality risk.

Purpose Studies consistently show abnormally high levels of lactate acid in cardiovascular disease patients, suggested that targeting lactate production may serve as potential strategies for the treatment in the future. However, observational results may be subject to residual confounding and bias. Methods This study used the dataset from GWAS database to examine confounding in epidemiologic associations between lactate and cardiovascular diseases. A genome-wide genetic association study using Mendelian randomization (MR) was performed from December 02, 2023 to January 15, 2024 to reduce confounding and enhance causal inference. Primary analysis was conducted using inverse-variance-weighted MR. All studies included patients predominantly of European ancestry. Results The association between lactate and cardiovascular diseases, including 60801 cases from coronary heart disease, 7018 cases from myocardial infarction, 14334 cases from coronary atherosclerosis, 60620 cases from atrial fibrillation, 54358 cases from hypertension, 71 cases from hypertrophic cardiomyopathy, 47309 cases from heart failure, 7055 cases from stroke, 7193 cases from cardioembolic ischemic stroke, 4373 cases from ischemic stroke caused by large vascular atherosclerosis, 2118 cases from pulmonary embolism, 1230 cases from peripheral artery disease, and 4620 cases from venous thromboembolism. Genetically predicted coronary atherosclerosis was associated with a higher risk of lactate level (OR = 1.950; 95% CI (0.087, 1.249); P = 0.024); this association was also evident for peripheral artery disease (OR = 1.003; 95% CI (0.000, 0.005); P = 0.021). No genetically predicted associations were noted for the other cardiovascular diseases. Conclusion The findings of this study provide genetic evidence supporting a higher risk of lactate level only in coronary atherosclerosis and peripheral artery disease. However, no genetic association between lactate level and the other cardiovascular diseases.

Background While general anesthesia has been widely used in endovascular thrombectomy for acute ischemic stroke (AIS), the optimal anesthesia medication for hemodynamic management remains unclear. Purpose To compare the effects of remimazolam and propofol on endovascular thrombectomy for AIS. Methods This study is a single-center, double-blind and randomized controlled trial. Eligible patients will be randomly allocated into the remimazolam group and propofol group. Remimazolam and propofol will be administered to induce and maintain anesthesia respectively. The primary outcome is the incidence of intraoperative hypotension. The secondary outcomes include frequency of hypotension, the largest difference value of mean arterial pressure (MAP), dosage of vasopressors, extubation time, operation time, modified thrombolysis in cerebral infarction (mTICI) level, National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin scale (mRS) score. Conclusion This study evaluates the influences of remimazolam versus propofol on endovascular therapy for AIS patients. Results of this study are expected to provide more evidence of the choice of anesthetics in this kind of operation. Trial Registration This study has been registered at the Chinese Clinical Trial Registry (ChiCTR2300076880).

Ischemic stroke is the second leading cause of mortality and morbidity worldwide. Due to the urgency of implementing immediate therapy, acute stroke necessitates prompt diagnosis. The current gold standards for vascular imaging in stroke include computed tomography angiography (CTA), digital subtraction angiography (DSA) and magnetic resonance angiography (MRA). However, the contrast agents used in these methods can be costly and pose risks for patients with renal impairment or allergies. The aim of this paper is to provide a comprehensive overview of current MRI techniques and sequences for evaluating ischemic stroke, emphasizing the importance of non-contrast options and their clinical implications for radiologists in the diagnosis and management of ischemic stroke. Standard MRI sequences—such as T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), DWI-FLAIR mismatch, and apparent diffusion coefficient (ADC)—are essential for determining infarct location, volume, and age. Additionally, incorporating susceptibility-weighted imaging (SWI) sequence aids in identifying signs of hemorrhagic transformation within the infarcted region. Advanced techniques like arterial spin labeling (ASL) can serve as a non-contrast alternative for mapping cerebral blood flow (CBF) and allowing for comparison between infarcted and healthy brain areas. Adding ASL to the routine sequence allows ASL-DWI mismatch analysis that is useful for quantifying salvageable tissue volume and facilitate timely recanalization, while time-of-flight (TOF) MRA and magnetic resonance venography (MRV) help assess venous thrombosis, stenosis, or arterial occlusions. Finally, MR spectroscopy can provide insights into critical brain metabolites, including N-acetylaspartate (NAA), and lactate (Lac) to determine patient prognosis. Current MRI technology provides a myriad of sequence options for the comprehensive evaluation of ischemic stroke without the need for contrast material. A thorough understanding of the advantages and limitations of each sequence is crucial for its optimal implementation in diagnosis and treatment.

Background Anthropometric measures such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) are associated with elevated blood pressure and hypertension in adolescents. We aimed to assess these anthropometric measures (BMI, WC, and WHtR) and examine their association with hypertension in adolescents. Methods Adolescents’ BMI, mid-upper arm circumference (MUAC), WC, body roundness index (BRI), waist-to-hip ratio (WHR), WHtR, and a body shape index(ABSI) values were measured and calculated. Receiver operating characteristic curves (ROCs) were created to determine the discriminatory capacities of these anthropometric parameters for hypertension. The cutoff points for these parameters were identified using Youden’s index. Results A total of 401 adolescents [186(46.4%) were females and 215 (53.6%) were males] were included. The median (interquartile range, IQR) age was 14.0 (12.1‒16.2) years. Thirty-six adolescents were found to have hypertension. Among the anthropometric parameters, MUAC (area under the curve (AUC] = 0.76, at the cutoff 26.1 cm, sensitivity = 61.0, specificity = 83.0), WC (AUC= 0.74, at the cutoff 70.3 cm, sensitivity = 66.7, specificity = 77.0), BMI (AUC= 0.73, at the cutoff 17.4 kg/m², sensitivity = 83.3, specificity = 59.0), and hip circumference (HC) (AUC= 0.72, at the cutoff 91.0 cm, sensitivity = 55.6, specificity = 83.0) performed fairly in detecting hypertension in adolescents, whereas WHR, WHtR, ABSI, and BRI performed poorly. A univariate analysis showed that, except for WHR, all anthropometric parameters (BMI, MUAC, WC, HC, WHtR, BRI, and ABSI) were associated with hypertension. However, in a multivariate analysis, only increased MUAC (adjusted odds ratio [AOR]= 1.24, 95% CI= 1.03‒1.50) was associated with hypertension. Conclusion This study showed that MUAC, WC, BMI, and HC could be used to detect hypertension in adolescents. Other parameters,namelyWHR, WHtR, ABSI, and BRI, perform poorly in this regard. Larger studies are needed in the future.

Objective We conducted a study titled for Investigation on the characteristics of 24-hour blood pressure (BP) dipping patterns in hypertensive stroke patients. Methods Descriptive research, analysis, and comparison, the research was conducted from July 2019 to September 2020 at the Vietnam Heart Institute - Bach Mai Hospital. There are 100 patients diagnosed with idiopathic hypertension who were divided into two groups (without stroke complications and another group with chronic stroke complications > 6 weeks), both groups were similar in age (45–64 years old). Results The daytime systolic BP (SBP) indices, 24-hour BP including SBP, diastolic BP (DBP), and mean arterial pressure (MAP), and particularly night-time BP indices were elevated in the stroke group compared with those without stroke complications (p < 0.05); there were no significant differences observed in daytime DBP and MAP between the two groups. SBP indices were higher in those with hemorrhage stroke compared with those with ischemic stroke, albeit without statistical significance. The prevalence of non-dipper was significantly higher in the stroke group compared with the non-stroke group (p < 0.001). Conclusion The daytime SBP indices, 24-hour BP (SBP, DBP, MAP), and particularly night-time BP indices were elevated in the stroke group compared with those without stroke complications. The prevalence of non-dipper was significantly higher in the stroke group compared with the non-stroke group.

Non-valvular atrial fibrillation (NVAF) is the most common sustained arrhythmia worldwide, and is associated with significant morbidity and mortality. Increasing life expectancy, coupled with a surge in comorbidity burden, has resulted in a sharp increase in NVAF prevalence over the last three decades. Coronary artery disease (CAD) is an important and clinically relevant risk factor of AF. Concomitant CAD has significant implications for AF management and is a major determinant of the overall outcomes. Shared risk factors, a common pathophysiological basis, and heightened thrombogenesis culminating in cardiovascular adverse events, highlight the close association between the two. The clinical course of AF is worse when associated with CAD, resulting in poor heart rate control, increased propensity to develop stroke and myocardial infarction, increased likelihood of acute presentation with hemodynamic collapse and pulmonary edema, increased bleeding tendencies, and poor response to ablation therapies. Emerging research highlighting the significant role of underlying CAD as an independent predictor of thromboembolic risk has paved the way for the adoption of CAD beyond prior myocardial infarction into the symbol “V” of the CHA2DS2-VASc score. In our opinion, elderly patients aged >65 years with AF, with a history of one or more cardiovascular comorbidities, or evidence of atherosclerosis in other vascular beds should warrant a closer look and a dedicated effort to look for associated CAD. This would allow for a more holistic and comprehensive approach to patients with AF and ultimately help reduce the disease burden and improve the overall outcomes.

The coexistence of heart failure (HF) and type 2 diabetes mellitus (T2DM) is common and poses a serious threat to human health because these diseases have a high degree of commonality at the vascular level. However, the diagnosis of HF in primary care can be challenging, leading to the risk of inadequate management of both conditions. Using two case reports as examples, we attempt to shed light on the issues involved in this challenge. In the first case presentation, a 62-year-old male patient with T2DM and dyspnea was initially diagnosed with HF during primary care. However, further workup revealed that the actual cause of the patient’s breathlessness was the exacerbation of chronic obstructive pulmonary disease. In the second case, a 59-year-old woman with T2DM and obesity complained of leg swelling that was attributed to chronic venous insufficiency by a primary care physician. A correct diagnosis of HF with preserved ejection fraction (HFpEF) was made using N-terminal pro-B-type natriuretic peptide and echocardiography. Due to diabetic vasculopathy HF is more likely to progress with a preserved ejection fraction. In addition, symptoms of COPD or obesity may overlap with or mask symptoms of HFpEF. The issues of over- and misdiagnosis of HFpEF in primary care are discussed in our review, which emphasizes the nonspecific nature of symptoms, such as breathlessness and leg edema in patients with type 2 diabetes mellitus. It is of utmost importance for healthcare providers to be aware of unusual manifestations of heart failure and, vice versa, of diseases that masquerade as heart failure. This will enable them to manage risks in these patients with greater consistency.