Cardiovascular diseases have been the primary contributor to deaths worldwide, and hence, the need to detect arrhythmia from Electrocardiogram signals in a precise and efficient manner is a critical problem in the medical community. This work presents a lightweight and computationally efficient framework that integrates Discrete Wavelet Transform (DWT)-based statistical features, ECG morphological descriptors, and Artificial Bee Colony (ABC)-optimized eXtreme Gradient Boosting Machine (XGBM) classification for ECG beat analysis. This work has been implemented using the popular MIT-BIH Arrhythmia Database, which has 100,674 instances of ECG beats, divided into five AAMI classes, with a severe level of class imbalance, where 89.4% instances belong to the Normal class. ECG signals have been pre-processed using a seven-stage algorithm, including Butterworth high-pass filtering, notch filtering, Pan-Tompkins R-peak detection, beat segmentation, and normalisation. Then, a three-level Haar transform is implemented, and 32 statistical features have been extracted from the DWT decomposition, along with 32 morphological features, forming a 64-dimensional vector. The proposed ABC algorithm with 8 bees and 8 iterations optimizes the six XGBM model hyperparameters using a balanced fitness function of accuracy and macro F1-score and converges at the optimal fitness value of 0.8211. The proposed ABC-XGBM model has a classification accuracy of 95.14%, a macro F1-score of 0.948, a macro AUC of 0.983, Matthews Correlation Coefficient of 0.925, and G-Mean of 0.932 with class-wise AUC values > 0.94. An ablation study has shown that the proposed DWT adds +3.7% and the proposed ABC optimization adds +1.14% in accuracy improvement. Five-fold cross-validation has shown a stable performance with a mean accuracy of 0.952 ± 0.001 at a time complexity of 1.0 ms per sample without the dependency of the GPU. The proposed framework is better than the other deep learning models such as CardioAttentionNet with a classification accuracy of 91.20% and the proposed transformer-based classifier with a classification accuracy of 90.50%.

BACKGROUND: The prevalence of valvular disease in the US is approximately 2.5%. Given that over 5 million Americans are affected, it is crucial to find those at higher risk of progression. The goal of this paper is to uncover which patients are more likely to have valvular disease progression using demographic factors, EKG and echocardiogram (ECHO) findings. METHODS: This paper utilized the EchoNext Database, which pairs 100,000 electrocardiograms and echocardiograms based on specific structural heart disease labels. Univariate and multivariate logistic regression were used to find risk factors for progression for aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), tricuspid regurgitation (TR) and pulmonary insufficiency (PI). Progression was defined as worsened valvular disease on follow up ECHOs. RESULTS: There were 100,000 encounters of EKGs/ECHOs included in the study, and 36,286 individual patients. Independent risk factors of AS progression were age and QRS duration. Age, QRS duration, AS, AR, MR and pericardial effusion were independent risk factors for AR progression. MR progression was independently associated with PR, QRS and QTc durations, MR and left ventricular ejection fraction. QRS duration, MR, TR and right ventricular function were independent factors for TR progression. Lastly, for PI progression, male sex and AS were found to be independent risk factors. CONCLUSIONS: The combination of demographic, electrocardiographic and echocardiographic findings can help better assess the progression of valvular disease.

PURPOSE: Whether de novo organized left atrial tachyarrhythmia (LAT) shows preserved left atrial appendage (LAA) mechanics has not been adequately characterized. We compared LAA peak emptying velocity across atrial fibrillation (AF) phenotypes and de novo LAT. METHODS: Multicenter retrospective cohort of 634 consecutive first-ablation candidates undergoing pre-ablation transesophageal echocardiography (TEE) at five centers: paroxysmal AF (PAF, n = 146), persistent AF (PeAF, n = 310), long-standing persistent AF (LsPeAF, n = 86), and LAT (n = 92). Markedly reduced LAA function was peak emptying velocity <25 cm/s. Multivariable regression adjusted for rhythm during TEE, CHADS-VASc, body mass index (BMI), left ventricular ejection fraction (LVEF), and left atrial (LA) diameter. RESULTS: Mean LAA velocity was 55.7 ± 19.4 (PAF), 44.3 ± 18.5 (PeAF), 31.0 ± 12.5 (LsPeAF), and 36.6 ± 13.5 cm/s (LAT); p < 0.001. LAT lay closer to LsPeAF than to PAF and did not differ from LsPeAF (Tukey p = 0.140). Prevalence of velocity <25 cm/s: 2.7%, 11.9%, 32.6% and 18.5% (p < 0.001). After adjustment, larger LA diameter (β = -0.53/mm, p < 0.001) and higher CHADS-VASc (β = -1.93/point, p < 0.001) were independently associated with lower velocity. Compared with LAT, PAF had lower odds of velocity <25 cm/s (OR 0.19, 95% CI 0.06-0.62). CONCLUSION: De novo organized LAT exhibits LAA mechanical dysfunction comparable to long-standing persistent AF rather than to PAF. Organized rhythm does not imply preserved appendage function. LAA peak emptying velocity may serve as a functional remodeling marker for pre-ablation phenotyping.

Hemopexin (Hpx) is an acute phase plasma protein that is responsible for sequestration and removal of cell-free heme with very high affinity (K < 1 pM). Hpx expression in liver cells is induced following an inflammatory event such as severe hemolysis. Therefore, plasma Hpx has potential clinical relevance due to its' ability to bind free heme, thus reducing lipid peroxidation and activation of inflammatory pathways in genetic anemias, such as sickle cell disease (SCD). This provides the rationale for purifying Hpx at high purity and at large scale. Starting from human Cohn fraction IV, we purified a protein cocktail using tangential flow filtration for use in this study as the starting material for purification of Hpx. Hpx was purified from the protein cocktail using immobilized metal ion affinity chromatography. SDS-PAGE and densitometric analysis showed that Hpx was purified to homogeneity and was approximately 99% pure. To gain further insight into Hpx activity and its' ligand binding properties, we employed comparative biophysical techniques such as UV-visible, circular dichroism, electron paramagnetic resonance and stopped flow spectroscopy. Finally we evaluated Hpx in a mouse model of SCD to test the ability of the novel material to attenuate tissue iron accumulation.

Children/adolescents with sickle cell disease (SCD) experience muscle-related impairments and declines in physical function. These deficits result from chronic anemia and impaired oxygen delivery, limiting the development of safe and effective exercise-based interventions. To better understand the effects of SCD on sustained activity, this study aimed to compare the physical function of children/adolescents with SCD to normative values and evaluate changes in neuromuscular function and muscle oxygenation during the 6-min walk test (6MWT). Each child/adolescent underwent a standardized 6MWT while measuring vastus lateralis muscle activity and oxygenation using surface electromyography (EMG) and Near-infrared spectroscopy. Heart rate was also continuously monitored. Compared to age- and sex-matched norms (625.9 ± 55.1 m), children/adolescents with SCD had a higher resting heart rate (108.5 ± 11.7 vs. 90.3 ± 5.0 bpm;  = 0.023), covered less distance (482.7 ± 91.9 m;  = 0.002), but no difference in heart rate at the End of the 6MWT ( = 1.0). Heart rate rose steadily throughout the 6MWT, 121.3 ± 11.1 bpm at the Start ( = 0.17), 139.0 ± 20.3 bpm at Mid ( = 0.009), and 142.1 ± 24.2 bpm at the End ( 0.009). EMG median frequency decreased significantly from pre-start (82.7 ± 11.7 Hz) to the Start of walking (68.5 ± 21.7 Hz;  = 0.028), and remained low at Mid (68.0 ± 22.4 Hz;  = 0.047) and End (65.7 ± 21.5 Hz;  = 0.047). Children/adolescents with SCD had reduced functional walking capacity, with an elevated resting heart rate and expected increases, sustained changes in neuromuscular activation during submaximal, sustained activities. This suggests that routine activities may place greater physiologic demands on children/adolescents with SCD, and that clinical assessments may require more than just walking distance.

Two novel triterpenoids, named congmuyenoside F-G (), and twelve known compounds (), including three compounds (, , ) isolated from var. (Franch. & Sav.) Pojark. for the first time, were identified from the total saponin fraction of leaves. Using AB-8 macroporous adsorption resin, reversed-phase ODS column chromatography, preparative HPLC and other separation techniques, triterpenoid saponins were obtained. The structures of two novel compounds were identified using extensive spectral data. In addition, the inhibitory effects of total saponin fraction and compounds on the growth of 4T1, Hep G2, RKO, and H1299 tumour cell lines were tested by MTT assay, and the results showed that compounds and exhibited no inhibitory effect on the growth of the four tumour cell lines, whereas compound exhibited inhibitory effects on all four cell lines with IC values of 23.69 ± 0.75, 68.00 ± 12.86, 27.96 ± 1.62, and 26.12 ± 1.67 μM, respectively.

Prolonged sitting is a key risk factor for cardiovascular disease, partly due to its cumulative endothelial dysfunction. Although physical activity may mitigate the deleterious effects of sitting time, the relationship between habitual physical activity levels and sitting-induced endothelial impairment remains unclear. Thus, we aimed to examine the association between sitting-induced endothelial dysfunction and habitual physical activity in healthy adults. This quasi-experimental pre-post study evaluated 15 healthy adults exposed to 3 hours of uninterrupted sitting. Baseline and post-intervention measurements of calf circumference (CC) and flow-mediated dilation (FMD) of the superficial femoral artery were taken. Physical activity was assessed via the long International Physical Activity Questionnaire (IPAQ). Endothelial function significantly decreased after sitting (ΔFMD = -2.15%, d=1.56), and CC significantly increased (ΔCC = +1.24 cm, d=0.74). An inverse correlation was found between total moderate-to-vigorous physical activity (MVPA) and ΔFMD (ρ = -0.57, p < 0.05). The linear mixed model showed that prolonged sitting effects on ΔFMD were significantly moderated by baseline MVPA level (Time×MVPA interaction: F(1,12) = 7.69, p = 0.017). Prolonged sitting acutely impairs endothelial function and promotes lower-limb fluid accumulation. Habitual MVPA may attenuate the adverse vascular impact of acute sitting, reinforcing its importance for vascular health.

The flow of blood through stenotic arteries is considered one of the most significant areas of investigation in the world of mathematical fluid mechanics. This significance arises from the topic's application to the field of biomedicine. Within an arterial system of blood that has been stenosed, the goal of this research initiative is to investigate the effect that nanoparticles have on the characteristics that define the human circulatory system. The current investigation analyzes blood flow behavior in a controlled, permeable artery employing the Casson hybrid nanofluid model and, additionally, gold, Cu, and silver nanoparticles. The current study examines the investigation of magnetohydrodynamics (MHD) Casson hybrid nanofluid Darcy-Forchheimer flow (DFF) over a stenotic artery with a heat source/sink. By transforming the partial differential equations (PDEs) into ordinary differential equations (ODEs) by utilizing suitable similarity variables. After that, the mathematical solution of these equations used the BVP4c method in the MATLAB solver and analysis for skin and Nusselt number table values for hybrid nanofluid cases. The statistical analysis is used to solve for different physical factors. During a study in which values of both variables are subject to essentially unknown oversights, the task is utilizing statistical techniques to discover the best possible linear equations. In this concept, two different hybrid nanomaterials are used for analyzing heat transfer characteristics. According to these graphical results, the present model concludes that case-2 has better performance than case-1. Rising values of the magnetic parameter improve heat transfer owing to Joule heating impacts and control flow via the Lorentz force, which in turn affects the distribution of shear stresses close to the artery wall. The current work highlights the role of nanoparticles and magnetic fields in enhancing flexibility near arteries' surfaces. This work has substantial repercussions for the treatment of cancer and the treatments that are used to avoid cardiovascular disease, as it suggests that improved heat transfer and shear stress distribution can enhance the effectiveness of therapies targeting tumor cells and improve blood flow in cardiovascular interventions.

Type 2 diabetes mellitus and peripheral artery disease are pathophysiologically interlinked through shared mechanisms such as chronic inflammation and endothelial dysfunction, highlighting the imperative to identify common biomarkers for enhancing early detection and risk stratification. A review of PubMed through December 2025 was performed, culminating in the inclusion of 55 original studies. The synthesis revealed significant dysregulation of inflammatory markers including IL-6 and ICAM-1, endothelial and oxidative stress mediators such as TET3 and the PRDX family, along with coagulation markers such as von Willebrand factor and fibrinogen, all correlating with disease severity in comorbid patients. Multi-marker panels, exemplified by the HART PAD score and combined neutrophil-to-HDL ratio with systemic inflammation response index, demonstrated superior predictive accuracy compared to individual biomarkers. Subsequent investigations should prioritise prospective validation and clinical standardisation of these candidate markers. This scoping review offers a novel structured integration of biomarkers across fluid, cellular and functional domains, advocating for an integrated multi-marker strategy to facilitate personalised management in this high-risk population.

BACKGROUND: The prevalence of untreated, uncontrolled and resistant hypertension and their specific prognosis among American adults with prediabetes remain unclear. We aimed to explore the prevalence of hypertension treatment and control and their associated risks of all-cause and cardiovascular disease (CVD) mortality among this population. METHODS: We analyzed data from 12,321 participants in the NHANES survey (1999-2016). Prediabetes was defined as fasting plasma glucose 5.6-7.0 mmol/L, hemoglobin A1c 5.7%-6.4%, 2-hour glucose 7.8-11.1 mmol/L, or self-reported diagnosis. Hypertension was defined as blood pressure ≥140/90 mmHg, a self-reported history of hypertension, or current antihypertensive medication use, and categorized into untreated, controlled, uncontrolled, and resistant hypertension. Cox regression assessed associations between hypertension categories and CVD and all-cause mortality. RESULTS: The study included 12,321 adults with prediabetes, representing an estimated 53.3 million individuals. Age- and sex-standardized hypertension prevalence was 43%. Among those with hypertension, 62% were receiving treatment. Among treated individuals, 66% had controlled hypertension, 26.5% had uncontrolled hypertension, and 7.5% had resistant hypertension. Mortality risk increased progressively from non-hypertensive to untreated, controlled, uncontrolled, and resistant hypertension stages. Compared to non-hypertensive individuals, hazard ratios (HRs) for CVD mortality were 1.17 (95% CI: 0.80-1.71), 1.52 (1.04-2.21), 2.03 (1.35-3.05), and 1.83 (1.07-3.13), respectively (P trend <0.001). For all-cause mortality, HRs were 1.01 (0.86-1.20), 1.05 (0.87-1.26), 1.16 (0.95-1.41), and 1.42 (1.09-1.85), respectively (P trend = 0.022). CONCLUSIONS: Hypertension was highly prevalent among American adults with prediabetes, and mortality risk increased with advancing hypertension stages.

BACKGROUND The coexistence of cardiac myxoma and hypertrophic cardiomyopathy is exceedingly rare and poses diagnostic and therapeutic challenges. While atrial myxomas may cause acute hemodynamic compromise, concomitant left ventricular outflow tract obstruction (LVOTO) due to hypertrophic cardiomyopathy can remain clinically underestimated, raising uncertainty regarding the optimal timing of septal reduction therapy. CASE REPORT A 38-year-old man was admitted with acute dyspnea and hypoxemia. Imaging revealed pulmonary congestion and a large left atrial mass causing functional mitral stenosis. Transthoracic echocardiography demonstrated asymmetric septal hypertrophy (maximum thickness 25 mm) with dynamic LVOTO and a mobile left atrial mass consistent with myxoma. The patient underwent surgical resection of the tumor with concomitant septal myectomy. Histopathology confirmed atrial myxoma and myocardial hyperplasia. Postoperatively, complete atrioventricular block required permanent dual-chamber pacemaker implantation. At short-term follow-up, the patient was asymptomatic with mild residual LVOTO. CONCLUSIONS This case underscores the importance of comprehensive structural and functional assessment in patients with intracardiac tumors. In young patients with favorable prognostic features and significant left atrial dilatation, early septal myectomy performed concomitantly with tumor resection may be justified, even when resting LVOT gradients are below conventional thresholds. This strategy aligns with the latest American and European guidelines on cardiomyopathies and may prevent delayed intervention and disease progression. The case also highlights atrioventricular block as a relevant complication of surgical myectomy, reinforcing the need for careful perioperative planning. Overall, this report provides an instructive example of individualized surgical decision-making in complex cardiomyopathy presentations.

BACKGROUND: Physical activity (PA) is a key modifiable factor for elevated blood pressure (EBP). We aimed to clarify the evolving relationships between PA and EBP in childhood or adolescence by examining multilevel factors within an ecological model. METHODS: National data were extracted from 2010, 2014, and 2019 cycles of the Chinese National Survey on Students' Constitution and Health, using a multistage stratified cluster sampling design. We defined EBP by the updated Chinese reference standards and obesity by sex- and age-specific body mass index (BMI) cutoffs. Inadequate PA was defined as <1 h/day; ecological factors at society-, school-, and individual-level were collected through a questionnaire. Multilevel logistic regression, interaction analyses, and population-attributable fractions were used to evaluate associations between multilevel ecological factors related to PA and EBP. RESULTS: We included 642,386 participants (7-18 years). The EBP prevalence increased from 13.6% to 17.9% alongside increasing obesity, while inadequate PA decreased in prevalence. Inadequate PA was associated with EBP in 2010, with the odds ratio (OR) of 1.17 (95% confidence interval [CI]: 1.04, 1.21) but attenuated during 2010-2019. The multilevel factors related to PA displayed interactions to reduce EBP risk (P for interaction <0.05). At the societal-level, urban residence was protective against EBP, whereas a lack of exercise facilities increases the odds. At the school-level, inadequate physical education and sports competitions, coupled with unhealthy dietary lifestyles at the individual-level, contributed to EBP (P <0.05). The contributions of individual-level ecological factors related to PA decreased but of societal- and school-level increased on EBP, independent of obesity. CONCLUSIONS: A rise in EBP burdens during 2010-2019 contrasted with an increase in PA. PA-related ecological factors across society-, school-, and individual-level exhibited complex interactions on EBP. Although the impact of individual-level lifestyles on EBP was waning and obesity remained a primary concern, there was increased recognition of societal- and school-level's ecological factors related to PA during 2010-2019. Promoting PA requires a comprehensive approach that addresses both facilitating and inhibiting factors, which is crucial for healthy blood pressure (BP).

BACKGROUND: The roles of Contactin-2 (CNTN2) and ferroptosis in heart failure and cardiac remodeling remain incompletely understood. RESULTS: CNTN2 was significantly upregulated in hypertrophic cardiomyopathy patients and heart failure mice. In cardiomyocyte specific CNTN2 conditional knockout (CNTN2 cKO) mice, transverse aortic constriction (TAC) induced markedly exacerbated heart failure, cardiac remodeling and ferroptosis compared to control mice. Ferroptosis inhibition substantially attenuated heart failure in CNTN2 cKO mice subjected to TAC, indicating that enhanced ferroptosis contributes to the detrimental effects of CNTN2 deficiency. RNA sequencing identified NUPR1, a ferroptosis repressor, as a downstream molecule of CNTN2. Mechanistically, CNTN2 activated the Lyn/eIF2α/ATF4 pathway to regulate NUPR1. CNTN2 overexpression attenuated Angiotensin II-induced cardiomyocyte ferroptosis and pathological remodeling, whereas these protective effects were abolished by Lyn or NUPR1 inhibitors. We further revealed CNTN2 and Lyn interacted with each other, and that CNTN2 interacted with Lyn through its 1-328aa domain. In vivo NUPR1 overexpression via AAV9 significantly mitigated TAC-induced heart failure and cardiac remodeling in CNTN2 cKO mice. CONCLUSIONS: Our study demonstrates that CNTN2 protects against pressure overload induced heart failure and cardiac remodeling by regulating ferroptosis through the Lyn/eIF2α/ATF4/NUPR1 pathway, suggesting CNTN2 as a potential therapeutic target.

BACKGROUND: Standing sedation is frequently required in donkeys for minor surgical and diagnostic procedures, yet information on the cardiac safety of α2-adrenoceptor agonists and opioid combinations in this species is limited. This study evaluated the echocardiographic effects of intravenous medetomidine, butorphanol, and their combination in clinically healthy donkeys. MATERIALS AND METHODS: Sixty donkeys were randomly assigned to four groups (n = 15/group) to receive intravenous saline (control group, CG), medetomidine group (10 µg/kg, MG), butorphanol group (50 µg/kg, BG), or medetomidine-butorphanol group (10 µg/kg + 50 µg/kg, MBG). Butorphanol was administered 5 min after medetomidine in the MBG. M-mode echocardiography was performed from a right parasternal short-axis view at baseline and at 5, 15, 30, 45, 60, 90, and 120 min after treatment. Left ventricular internal diameter (LVID), interventricular septal thickness (IVST), and left ventricular posterior wall thickness (LVPW) were measured at end-diastole (d) and end-systole (s). Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), stroke volume (SV), ejection fraction (EF%), and fractional shortening (FS%) were calculated. Data were analyzed using a repeated-measures general linear model. RESULTS: Medetomidine alone was associated with significant reductions in EF% and FS%, together with significant changes in LVIDs and LVIDd. SV was also significantly lower in the medetomidine group than in the control group during the main post-treatment period; however, SV and the calculated LV volumes were interpreted cautiously because they are load-dependent variables derived from linear M-mode measurements. These changes were accompanied by an increase in LVIDs and a reduction in IVSs, indicating transient depression of conventional left ventricular systolic indices and altered loading conditions. Butorphanol alone produced only minor, parameter-specific changes in LVID, IVST, and most echocardiographic indices, with no consistent clinically relevant deterioration compared with baseline or the CG. In contrast, the MBG showed marked changes in ventricular dimensions and calculated indices from 15 to 60 min; however, these findings were interpreted cautiously because the calculated systolic indices are load-dependent. CONCLUSIONS: Intravenous medetomidine, butorphanol, and their combination exert distinct and protocol-dependent effects on left ventricular dimensions and systolic function in donkeys. Medetomidine alone substantially and transiently depresses systolic performance, whereas butorphanol alone is comparatively cardiovascular-sparing. The medetomidine-butorphanol combination may be considered for standing sedation in clinically healthy donkeys; however, its echocardiographic effects should be interpreted cautiously as load-dependent changes, and cardiovascular monitoring remains advisable.

BACKGROUND AND OBJECTIVE: Systemic residual inflammation plays a pivotal role in the pathophysiology of coronary artery disease (CAD). Cardiovascular protection by SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1Ra) is associated with reduced inflammatory burden but underlying cellular mechanisms remain incompletely defined. We investigated whether SGLT2i and GLP-1Ra synergistically suppress monocyte activation and prevent both systemic inflammatory mediator-induced and monocyte-driven endothelial dysfunction in CAD. METHODS AND RESULTS: Plasma and circulating monocytes were analyzed in healthy individuals (n = 20), patients with cardiovascular disease without CAD (n = 20), and patients with stable CAD (n = 55), and their effects on endothelial cell responses were assessed. CAD plasma showed increased IL-1β, IL-6, TNF-α, MCP-1, soluble ICAM-1, and VCAM-1, and a proteomic profile enriched in complement, innate immune, and extracellular matrix remodeling pathways. CAD plasma induced oxidative stress in endothelial cells, reduced nitric oxide, increased leukocyte and platelet adhesion, and enhanced procoagulant activity, correlating with circulating TNF-α and sICAM-1. CAD monocytes exhibited a metabolically activated phenotype with increased oxidative stress, mitochondrial activity, glucose and cholesterol uptake, calcium signaling, procoagulant activity, and adhesion to endothelial cells. These changes correlated with circulating TNF-α, sICAM-1, and plasma-induced endothelial dysfunction. CAD monocytes showed increased NF-κB, NOX2, and NLRP3 signaling with reduced CREB/NRF2 pathways, produced elevated levels of pro-inflammatory cytokines, while CAD monocytes-conditioned medium induced endothelial oxidative stress and blunted nitric oxide production. GLP-1Ra or SGLT2i attenuated these effects, while combined treatment provided synergistic protection, reducing CAD plasma-induced endothelial oxidative stress (~ 80%) and restoring endothelial function, reducing CAD monocytes oxidative stress (~ 82%), metabolic activation and pro-thrombotic activity, reprogramming monocytes toward anti-inflammatory phenotype and preventing CAD monocytes-induced endothelial dysfunction. CONCLUSION: CAD features systemic inflammation that drives monocyte activation and endothelial dysfunction. Combined SGLT2i and GLP-1Ra synergistically suppress monocyte pro-inflammatory and pro-thrombotic activity and subsequently driven endothelial dysfunction.

BACKGROUND: The demand for home healthcare services for chronic conditions has increased due to the transition of care from hospitals to the home. This study aimed to adapt a Clinical Practice Guideline (CPG) for home-based nursing care of adult patients with heart failure in the healthcare system of Iran. METHODS: This study was conducted using a multi-method design within the 10-step framework of the Practice Guidelines Evaluation and Adaptation Cycle (PGEAC). A systematic review was conducted in PubMed, Scopus, Web of Science, and nine publicly accessible CPG databases to find relevant guidelines. Subsequently, a robust CPG was selected based on the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) checklist. After translating the guideline, a search for supporting evidence was conducted in databases for each guideline recommendation, and the results were classified based on the level of evidence. Next, a qualitative study was conducted to strengthen recommendations with a weak evidence level and uncover additional recommendations and domains. The preliminary draft of the CPG was then evaluated in an expert panel meeting. In the final phase, the adapted CPG was validated through three Delphi rounds. RESULTS: "Adapting Heart Failure Guidelines for Nursing Care in Home Health Settings," was selected as an appropriate CPG with 145 recommendations within five domains. Following translation and evaluation of the evidence level, 26 recommendations were categorized in the weak level of evidence. In the qualitative phase, these recommendations were further examined, and also 26 new recommendations were developed; 12 under the domain of the "Generic care in heart failure" and 14 within two newly identified domains. Twenty-one recommendations were removed during the expert panel meeting, as well as 33 ones in the first Delphi round, due to duplication or not being applicable the Iranian healthcare system. The final adapted CPG included 117 recommendations within six domains. CONCLUSIONS: This adapted CPG provides a robust framework for nurses and other healthcare professionals to deliver home healthcare services for Iranian heart failure patients and their families. It can enhance the quality of home-based care, reduce hospital readmissions, improve patients' outcomes, and the cost-effectiveness of home-based care programs.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) and non-alcoholic fatty liver disease (NAFLD) are closely linked to insulin resistance and elevated cardiovascular risk, triglyceride-glucose (TyG)-related indices, the atherogenic index of plasma (AIP), and the cardiometabolic index (CMI) have emerged as practical surrogate markers for cardiometabolic risk assessment in these populations. However, it remains unclear whether the associations of these indices with adverse cardiovascular events remain consistent when transitioning from the NAFLD to the newly defined MASLD framework, and a comprehensive comparison of these indices across both diagnostic criteria is lacking. METHODS: This study included 4693/3266, 74,173/67,864, and 7823/10,576 individuals with MASLD/NAFLD from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKB), and China Pudong cohort, respectively. Multivariate Cox proportional hazards models, restricted cubic spline analyses, and time-dependent receiver operating characteristic curves were employed to assess associations. Linear regression models evaluated relationships between TyG-related indices and cortical/subcortical structural volumes. Mediation analyses examined the role of oxidative stress, phenotypic aging, and inflammatory markers. RESULTS: Most IR-related indices demonstrated nonlinear, predominantly J-shaped associations with cardiovascular disease (CVD) and related mortality, especially within the UKB. TyG-WC optimally predicted 3-year CVD mortality in MASLD/NAFLD across UKB and NHANES, as well as ischemic stroke (IS) in UKB-MASLD. TyG-WHTR was the strongest predictor for CVD mortality in the Pudong cohort and myocardial infarction (MI) in UKB-MASLD. Notably, elevated TyG-WHTR was consistently associated with heightened risks across all endpoints: CVD mortality (NAFLD: UKB: HR 1.60, 95%CI 1.38-1.84, NHANES: 1.90, 1.34-2.70, Pudong: 1.24, 1.10-1.40; MASLD: UKB: 1.59, 1.38-1.82, NHANES: 1.86, 1.36-2.54, Pudong: 1.70, 1.43-2.03), MI (NAFLD: 1.20, 1.09-1.33; MASLD: 1.22, 1.11-1.34), and IS (NAFLD: 1.41, 1.24-1.61; MASLD: 1.39, 1.23-1.57). Structural neuroimaging analyses revealed significant negative correlations between TyG-WC/TyG-WHTR and subcortical volumes (P < 1 × 10). Mediation analyses indicated that oxidative stress, phenotypic aging, and inflammatory markers collectively accounted for 1.4-27% of the observed associations. CONCLUSIONS: Insulin Resistance-Related Indices demonstrate robust clinical utility in predicting CVD and mortality in NAFLD/MASLD across three distinct cohorts, with oxidative stress, inflammatory activation, and accelerated aging serving as potential mechanistic pathways.

BACKGROUND: Hypertension is the leading risk factor for cardiovascular diseases, with the greatest burden in low- and middle-income countries where access to care and infrastructure for prevention and management is limited. In Rwanda, community health workers (CHWs) have long played a critical role in improving access to health services. In 2023, the Turambe ('Live Longer') program integrated digitally enabled hypertension screening into Rwanda's community health program across three districts, equipping CHWs with blood pressure monitors and mobile devices loaded with the mUzima mobile application. This study aimed to assess the CHW-led screening process, evaluate the screening cascade from CHW identification to diagnosis confirmation, and determine the factors associated with hypertension diagnosis. METHODS: Data was extracted and socio-demographic and clinical characteristics were analyzed using frequencies and percentages. Chi-square tests assessed associations between diagnosis and patient characteristics, and logistic regression identified factors associated with hypertension diagnosis following referral. RESULTS: The program supported the screening of 499,475 community members representing 55.9% of the population aged 15 years and above. The majority of those screened were female (54.5%) and most were aged 35-44 years (29.6%). Of those screened, 63,291 (12.7%) individuals were found to have elevated blood pressure and were referred to health facilities. Among these referrals, 4,537 (7.2%) completed the referral by visiting a health facility and 2,873 (63.3%) of them were confirmed to have hypertension; 2,218 (48.9%) were newly diagnosed and 655 (14.4%) with a prior diagnosis. Among those who completed referral to health facilities, the proportion of those confirmed to have hypertension increased with age, reaching 71.0% among individuals aged above 65 years. Multivariable analysis showed that increasing age was strongly associated with a hypertension diagnosis, with those aged ≥ 65 years having 3.91 times higher odds (aOR: 3.91; 95% CI: 2.06-7.43) compared to those aged 25-34 years. Male sex was associated with 15% reduced odds (aOR: 0.85; 95% CI: 0.75-0.98) compared to females. CONCLUSION: This digital community-based hypertension screening program achieved substantial population coverage and a relatively high diagnostic yield among those who completed referral, demonstrating the potential of leveraging CHW networks and mobile technology for large-scale NCD detection and monitoring. However, low referral-to-care linkage limits inference on CHW diagnostic accuracy at the population level. Strengthened referral systems and further research into barriers to linkage are needed to translate community screening into timely diagnosis and management.

BACKGROUND: Coronary artery disease (CAD) is a prevalent cardiovascular condition worldwide. Trimethylamine N-oxide (TMAO), a metabolite produced by gut microbiota, plays a crucial role in the pathogenesis and progression of CAD. However, the association between plasma TMAO and all‑cause mortality in Chinese CAD patients remains to be fully explored. METHODS: In this observational cohort study, 389 hospitalized CAD patients, confirmed via coronary angiography at Xiangya Hospital in 2022, were enrolled. Plasma TMAO levels were measured using liquid chromatography-tandem mass spectrometry. All-cause mortality events were identified through telephone interviews, hospital outpatient visits, and official hospital records, conducted semi-annually. Kaplan-Meier analysis and Cox regression analysis were employed to investigate the relationship between TMAO levels and all-cause mortality. RESULTS: Among 364 CAD patients who completed the median follow-up period of 39 months (IQR: 37-42 months), 40 patients (11.0%) experienced all-cause mortality. Patients with elevated TMAO levels, based on the optimal cutoff value of 317.62 ng/mL, had a significantly higher mortality rate compared to those with lower levels (P < 0.0001). After adjusting for conventional risk factors, including diabetes, elevated TMAO levels showed a significant association of all-cause mortality (hazard ratio [HR] 2.657; 95% CI: 1.389 to 5.084; P = 0.003). CONCLUSIONS: Elevated plasma TMAO levels are significantly associated with increased all-cause mortality over a median follow-up of 39 months in CAD patients from South China.

BACKGROUND: Intraoperative circulatory decompensation during lung transplantation is a life-threatening event that often necessitates a challenging transition from veno-venous (VV) to veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). This study evaluated perioperative variables associated with decompensation under an explicitly exploratory observational framework. METHODS: A retrospective analysis was conducted on 97 patients with end-stage lung disease undergoing lung transplantation with initial VV-ECMO support from January 2020 to December 2022. Intraoperative circulatory decompensation was redefined using objective hemodynamic and echocardiographic criteria; VV-to-VA conversion was recorded as a management consequence rather than as a defining criterion. Propensity score matching (PSM) was applied to balance confounding factors, resulting in 75 analyzed patients. Candidate models were revised as exploratory penalized models and internally assessed by repeated fivefold cross-validation and bootstrap optimism correction. RESULTS: In the matched descriptive comparison, pH and lactate remained robustly different after FDR correction, while highest intraoperative PASP, pulmonary valve VMAX, aortic valve VMAX, and heart rate were interpreted as exploratory signals. To reduce temporal bias, we separated a preoperative/peri-induction model from a secondary intraoperative monitoring model. In internal validation, the preoperative/peri-induction model achieved a repeated fivefold cross-validation AUC of 0.803 and a bootstrap optimism-corrected AUC of 0.813, with a Brier score of 0.151. The intraoperative monitoring model, which included highest intraoperative PASP, achieved a repeated fivefold cross-validation AUC of 0.853 and a bootstrap optimism-corrected AUC of 0.865, with a Brier score of 0.121. CONCLUSIONS: Lower preoperative arterial pH, higher lactate, and dynamic intraoperative pulmonary pressure changes were associated with clinically documented circulatory decompensation in this exploratory single-center cohort. These internally assessed findings require external validation before clinical implementation.

BACKGROUND: Critical aortic valve stenosis in neonates and infants is a life-threatening congenital heart disease characterized by severe left ventricular outflow tract obstruction and compromised systemic perfusion. Balloon aortic valvuloplasty (BAV) has become an established initial treatment option; however, data on early outcomes in this vulnerable population remain relatively limited. METHODS: This retrospective single-center study included 30 neonates and infants (≤ 12 months) with critical aortic valve stenosis who underwent balloon aortic valvuloplasty between 2016 and 2024. Clinical, echocardiographic, and hemodynamic parameters were analyzed before and after the procedure. Early procedural success, complications, and short-term outcomes were assessed. RESULTS: Balloon aortic valvuloplasty resulted in a significant immediate reduction in transaortic pressure gradients (p < 0.05), indicating effective relief of left ventricular outflow tract obstruction. Left ventricular systolic function improved or remained stable in the majority of patients. New-onset or increased aortic regurgitation occurred in some cases, predominantly mild to moderate in severity, while severe regurgitation was uncommon. Early mortality was low, and most patients demonstrated favorable early clinical stabilization. Some patients required reintervention or surgical referral because of residual stenosis or progressive aortic regurgitation. CONCLUSIONS: Balloon aortic valvuloplasty is a safe and effective first-line treatment for critical aortic valve stenosis in neonates and infants, providing rapid hemodynamic improvement with acceptable early outcomes. The procedure represents an important therapeutic strategy in the initial management of this high-risk pediatric population.

OBJECTIVE: End-stage kidney disease continues to disproportionally impact the lives of First Nations(FN) peoples. This paper examines the trajectory of chronic kidney disease (CKD) care in FN individuals who started dialysis. METHODS: We used health administrative data held at the Manitoba Centre for Health Policy (MCHP) for the period of 2000-2019, which was linked to the Manitoba First Nations Research File to identify Registered FN. Data we used included: Diagnostic Services Manitoba Laboratory Data, Medical Claims, Hospital Discharge Abstracts, Drug Program Information Network Data, Public Canadian Census Files, Manitoba Health Insurance Registry, and Physician Resource File. All records are de-identified. Our primary outcome was to assess the frequency of uninformed dialysis starts among FN. LESSONS LEARNED: We identified 1,686 FN people who started dialysis during the study period. Of those, 396 (23.5%) started dialysis within three months of their first nephrology visit. We compared those initiating dialysis within 3 month to other FN with longer nephrology follow-up: as a group, FN initiating dialysis within 3 month of their first nephrology visit were more unwell as evidenced by a significantly higher Elixhauser co-morbidity index (5 vs. 3 P < 0.001), hypertension (70.7% vs. 57.1% p < 0.001) and congestive heart failure (31.1 vs17.4% P < 0.001). Primary care visits in all FN groups with CKD occurred in over 95% and CKD screening was similar in all groups at over 40% a year prior to the first nephrology visit. Less than 70% of FN with CKD were on appropriate preventative medications (69 vs. 68% p = NS)) IMPLICATIONS: Improvements in primary prevention at the primary care level are needed to avoid late nephrology referrals and improve overall care of FN with CKD.

BACKGROUND: Acute heart failure (AHF) is a major cause of emergency department (ED) visits and is associated with significant morbidity and mortality. In Thailand, real-world data on AHF presentations and outcomes in the ED remain limited, particularly in resource-constrained settings. This study aimed to describe the clinical characteristics, treatment, and outcomes of AHF patients in a tertiary care ED in Northeastern Thailand and identify factors associated with in-hospital mortality. METHODS: We conducted a retrospective cohort study of adult patients (≥ 18 years) diagnosed with AHF at the ED of Srinagarind Hospital between October 2021 and March 2023. Patients transferred from other hospitals or who were pregnant were excluded. Clinical data were extracted from electronic health records. The primary outcome was in-hospital mortality. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with in-hospital mortality. RESULTS: Of 902 eligible AHF patients, the median age was 71 years (IQR: 60-80), and 52.0% were male. The in-hospital mortality rate was 6.0%. Non-survivors were more likely to have a history of congestive heart failure, chronic kidney disease, or cerebrovascular accident, and presented with lower diastolic blood pressure and oxygen saturation. They were also more likely to be triaged as Emergency Severity Index (ESI) level 1 and require ICU admission, ventilatory support, and inotropic support. In multivariable analysis, the need for inotropic support was the only variable independently associated with in-hospital mortality (adjusted OR 3.97; 95% CI 1.91-8.40; p < 0.001). CONCLUSION: In this ED-based cohort, the in-hospital mortality of patients with acute heart failure was comparable to international reports. The need for inotropic support was strongly associated with hospital mortality, likely reflecting severe hemodynamic compromise.

BACKGROUND: Direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, real-world prescribing patterns and dosing appropriateness in low- and middle-income countries remain poorly characterized. This study evaluated patterns of oral anticoagulant use and identified clinical determinants of suboptimal prescribing in a tertiary cardiovascular center in Vietnam. METHODS: We conducted a retrospective observational study of 209 patients with NVAF who received oral anticoagulation at a tertiary cardiovascular center between 2023 and 2024. Data were extracted from electronic medical records, including demographics, comorbidities, renal function, bleeding history, and prescribed anticoagulants. Multivariable logistic regression was used to identify factors associated with anticoagulant selection, defined as DOAC versus VKA use. DOAC dosing appropriateness was assessed according to the 2021 European Heart Rhythm Association Practical Guide, and predictors of potentially inappropriate dose reduction were evaluated. RESULTS: DOACs were prescribed in 77.0% of patients, most commonly rivaroxaban, which accounted for 55.3% of all anticoagulant prescriptions. VKAs were prescribed in 23.0% of patients. Among VKA users, 85.4% had INR values outside the therapeutic range at admission, largely due to subtherapeutic international normalized ratio values. Reduced DOAC doses were prescribed in 88 of 161 DOAC users (54.7%). Among 85 assessable reduced-dose DOAC users, 42 (49.4%) were classified as having potentially inappropriate dose reduction. In the parsimonious multivariable model, age ≥ 75 years was associated with higher odds of DOAC use (odds ratio [OR] 5.08; 95% confidence interval [CI] 1.95-13.23; p = 0.001), whereas female sex (OR 0.43; 95% CI 0.21-0.91; p = 0.027), heart failure (OR 0.23; 95% CI 0.09-0.59; p = 0.002), and prior bleeding (OR 0.20; 95% CI 0.05-0.87; p = 0.031) were associated with lower odds of DOAC use. CONCLUSION: In this single-center retrospective study from Vietnam, oral anticoagulant prescribing in patients with NVAF showed several areas for optimization, including frequent INR values outside the therapeutic range at admission among VKA users and frequent potentially inappropriate DOAC dose reduction. These findings support the need for improved dose optimization, and monitoring strategies, but should be interpreted cautiously give the observational design and inpatients data source.