Lipoprotein(a) (Lp[a]) is an established cardiovascular risk marker; however, its intraindividual variability and implications for risk stratification remain poorly understood. This study investigated the clinical and biochemical predictors of high Lp(a) levels and evaluated their potential roles in cardiovascular risk assessment to inform evidence-based public health strategies for cardiovascular disease prevention.

This retrospective multicenter observational study was conducted using data from three tertiary university hospitals in Korea. Patients with at least two Lp(a) measurements taken ≥ 90 days apart were included (n = 5,305). High Lp(a)-level variability was defined as an absolute change of > 10 mg/dL and a relative change of > 25%. Predictors of high-variability were identified through regression analyses, and risk reclassification across Lp(a) risk categories was performed.

Baseline and follow-up Lp(a) levels were strongly correlated (r = 0.89, P < 0.01); however, substantial individual variability was observed, with a median absolute change of 3.9 mg/dL and a median percentage change of 26.3%. Approximately 19.9% of the patients exhibited high Lp(a) level variability, which was associated with lower baseline Lp(a) levels and higher follow-up Lp(a) levels, lower body mass indices, higher hemoglobin levels, elevated white blood cell and platelet counts, increased serum glucose levels, lower high-density lipoprotein cholesterol levels, and use of antihypertensive medications. Notably, risk reclassification analysis revealed marked variability among patients in the intermediate "gray-zone."

The findings of this study indicate that Lp(a) level variability is associated with adverse cardiovascular risk profiles and dynamic risk reclassification. These results highlight the potential of serial Lp(a) measurements to refine cardiovascular risk stratification, particularly in intermediate-risk patients. Integrating these findings into clinical practice guidelines has the potential to improve cardiovascular risk management at the population level, reduce healthcare disparities, and inform targeted public health interventions aimed at cardiovascular prevention.

Cardio-renal syndrome (CRS), characterized by multi-organ interaction, is frequently overlooked in clinical practice. It poses significant challenges in treatment, leading to poor long-term prognosis and substantial economic burden on patients' families. This study, based on a 10-year multi-center real-world investigation, identified that hyperhomocysteinemia and hypohemoglobinemia in myocardial infarction (MI) patients are associated with an increased risk of developing CRS. Consequently, we integrated these two factors into a machine learning model to evaluate its diagnostic and prognostic value for CRS, providing novel insights for clinical and nursing practices.

A retrospective cohort study was conducted. The clinical data of 6,169 patients diagnosed with primary acute MI across four medical centers (hospitals) from January 2010 to December 2019 were collected. A combined function [f (Hcy-Hb)] was constructed based on the linear relationship between homocysteine (Hcy), hemoglobin (Hb), and eGFR. The diagnostic and prognostic performance of f (Hcy-Hb) in CRS was assessed using correlation analysis, ROC curves, and Kaplan-Meier curves of overall survival (OS) or event-free survival (EFS). Additionally, a nomogram model incorporating f (Hcy-Hb) was developed through random survival forest analysis, LASSO regression, and univariate/multifactor proportional hazard models. The prediction efficiency, net benefit, and consistency between predicted probability and actual values of this nomogram model were evaluated using ROC curves, C-index, DCA analysis, and calibration curves. Comparative analyses were conducted against two other models. Finally, Kaplan-Meier curves were utilized to assess the prognostic value of the f (Hcy-Hb)-nomogram model.

Correlation analysis revealed a significant negative correlation between f (Hcy-Hb) and eGFR in patients with post-MI treatment (r = -0.45, P < 0.05). The ROC curve demonstrated that f (Hcy-Hb) exhibited substantial diagnostic value for CRS (AUC = 0.786; 95% CI: 0.773-0.799). Patients were stratified into high and low f (Hcy-Hb) groups, revealing that elevated f (Hcy-Hb) levels were associated with adverse clinical pathophysiological indices (P < 0.05) and poorer prognosis (P < 0.05). To validate these findings, the dataset was randomly divided into a training set and a validation set at a 7:3 ratio. Random survival forest analysis within the training set identified f (Hcy-Hb) as a significant prognostic factor. Additionally, LASSO regression analysis highlighted f (Hcy-Hb) as one of the 31 key variables influencing prognosis. A nomogram model incorporating f (Hcy-Hb) was developed using univariate and multivariable Cox proportional hazards regression models. Notably, the ROC curve was utilized to assess the predictive performance of this nomogram. The AUC values for 3-, 6-, and 9-year survival predictions were 0.868, 0.866, and 0.840 in the training set, and 0.897, 0.920, and 0.818 in the validation set, respectively. The C-index was 0.86 (95% CI: 0.84-0.89) in the training set and 0.86 (95% CI: 0.82-0.90) in the validation set. Decision curve analysis (DCA) revealed comparable net benefits between the training and validation sets. Calibration curves indicated strong agreement between predicted probabilities and actual outcomes in both sets. These metrics outperformed two alternative models. Moreover, OS results from both the training and validation sets showed a significant decrease in survival rates for patients with high NomoScore (P < 0.01).

The newly constructed function [f (Hcy-Hb)], integrating Hcy and Hb levels, exhibits robust diagnostic and prognostic value in CRS. Furthermore, the f (Hcy-Hb)-nomogram model demonstrates superior predictive efficacy, net benefit, and consistency between predicted and actual outcomes.

Congenital heart defects (CHDs) are the most common major congenital anomalies, accounting for approximately one-third of all birth defects. They significantly contribute to morbidity, mortality, and healthcare costs. This study provides insights into the prevalence, characteristics, and management challenges of CHDs in The Gambia, emphasizing the need for early diagnosis, risk factor identification, and improved cardiac care infrastructure.

To determine the prevalence, management strategies, and outcomes of CHDs in children at Edward Francis Small Teaching Hospital from January 2020 to December 2022.

This retrospective descriptive cross-sectional study reviewed medical records of pediatric patients admitted to Edward Francis Small Teaching Hospital, the main referral center in The Gambia and the teaching hospital for the University of The Gambia Medical School. Patient data from January 2020 to December 2022 were analyzed.

A total of 89 patients were included, with 57.3% (n = 51) females and 42.7% (n = 38) males. The median age was 1.4 years. The most common ethnic group was Mandinka, followed by Fula. Diagnosis was confirmed by using 2D trans-thoracic echocardiography, which was performed on most of the patients (84.3%) in addition to clinical features and chest X-ray. The most prevalent CHD was ventricular septal defect (VSD) (39.3%), followed by atrial septal defect (ASD) (20.2%), tetralogy of Fallot (TOF) (16.9%), and patent ductus arteriosus (PDA) (10.1%) were also not uncommon. 15.7% of cases were unclassified. The most commonly associated clinical condition among these children with congenital heart disease was Down syndrome (18.0%), predominantly observed in children born to mothers aged over 35 years. This finding underscores the known association between advanced maternal age and chromosomal abnormalities. Maternal diabetes (2.2%) and osteogenesis imperfecta (2.2%) were also noted as less frequent but relevant associated risk factors, highlighting the multifactorial nature of congenital heart disease. Two (2.2%) had a positive family history of congenital heart disease. However, in 65(73%) of cases, there were no associated conditions or family history of CHD. The most frequently used medication in the treatment of these children was furosemide, and heart failure was the most common complication. Surgical interventions were rare: only 2.2% of these children underwent defect closure and 2.2% had pulmonary artery banding, while 95.5% of them did not receive any form of surgical treatment. Seventy-three (82.0%) were discharged and followed up in the clinic, while 6 (6.7%) died.

VSD was the most common congenital heart disease observed in this study, with a median age at diagnosis of 1.4 years (95% Confidence Interval: within 12 to 60 months). Down syndrome with maternal age > 35 years was the most frequent associated condition, and heart failure was the leading complication and primary cause of death. While both pharmacological and surgical treatment mode were used, surgical intervention for treatment of these defects remains unavailable in The Gambia, highlighting the urgent need to develop local paediatric cardiac surgery services.

Heart failure with preserved ejection fraction (HFpEF) is a common yet under-recognized complication following acute myocardial infarction (AMI), particularly after primary percutaneous coronary intervention (PCI). Early identification of at-risk patients remains a clinical challenge.

We retrospectively analyzed 458 first-episode AMI patients who underwent emergency PCI at a single center. Patients were stratified into HFpEF (n = 107) and non-heart failure (non-HF) (n = 351) groups based on the 2021 European Society of Cardiology diagnostic criteria. Clinical variables, laboratory markers, echocardiographic parameters, and coronary angiography findings were compared. Logistic regression identified independent predictors of HFpEF, and a predictive model-the Heart Failure with Preserved Ejection Fraction-Acute Myocardial Infarction Score (HFpEF-AMI Score)-was developed and evaluated.

Among 458 first-episode AMI patients undergoing emergency PCI, 107 (23.4%) developed HFpEF during hospitalization. Multivariate logistic regression identified four independent predictors of HFpEF after PCI: elevated D-dimer (>184.3 ng/mL; odds ratio [OR] 1.626, 95% confidence interval [CI] 1.466-2.771, p < 0.001), peak N-terminal pro-B-type natriuretic peptide (NT-proBNP) (>2640.11 pg/mL; OR 3.391, 95% CI 2.030-5.273, p < 0.001), increased left ventricular mass index (LVMI) (>105.91 g/m²; OR 2.057, 95% CI 1.152-3.833, p = 0.012), and involvement of the left anterior descending artery (LAD) as the infarct-related artery (IRA) (OR 4.737, 95% CI 2.363-10.545, p < 0.001). Using receiver operating characteristic (ROC) analysis, the HFpEF-AMI Score integrating these four predictors demonstrated excellent discriminatory performance, with an area under the curve (AUC) of 0.882 (95% CI: 0.849-0.910). At an optimal cut-off logit(P) ≥ 0.322, the model achieved a sensitivity of 74.8% and specificity of 86.6%. During 2-year follow-up, HFpEF patients had significantly higher rates of major adverse cardiovascular and cerebrovascular events (MACCE: 19.6% vs. 6.0%) and heart failure-related rehospitalizations (18.7% vs. 4.3%; both p < 0.001).

The HFpEF-AMI Score is a novel and clinically applicable tool for early identification of patients at risk of developing HFpEF after AMI. Incorporating routine laboratory and angiographic parameters, this score may assist in risk stratification and long-term prognostic assessment.

Fractional flow reserve (FFR) is the gold standard for assessing the physiological significance of coronary stenosis. We examined the potential correlation between digitally measured coronary cross-sectional area stenosis using coronary computed tomography (CT) angiography and FFR. We analyzed data of 32 consecutive patients with stenoses who underwent invasive FFR determination. The cross-sectional area was assessed using 128-slice coronary detector-based spectral CT angiography. Power analysis revealed that the sample size enabled the detection of an area under the receiver operating characteristic (ROC) curve (AUC) of 0.90. FFR ≤ 0.8 and > 0.8 were defined as FFR-positive and FFR-negative, respectively. Intra- and interobserver differences were negligible. Percentage cross-sectional area stenosis was calculated as 100 × (A-B)/A, where A is the cross-sectional area at non-stenotic pre-stenotic segment and B is the cross-sectional area of the most severe stenotic lesion. AUC indicated that percentage cross-sectional area stenosis effectively discriminated between FFR-positive and FFR-negative cases, yielding a sensitivity of 0.882 and specificity of 0.933 at a cutoff of 50% area reduction, with an AUC of 0.976. Lesions with less than 45% cross-sectional area stenosis on coronary CT angiography were not FFR-positive. When ROC analysis was conducted for lesion characteristics, AUC did not significantly improve. In conclusion, the percent coronary cross-sectional area stenosis measured using coronary CT angiography distinguished between FFR-positive and FFR-negative lesions with high accuracy. The severity of coronary cross-sectional area stenosis determined using CT angiography is clinically useful for predicting FFR.

Previous studies have described the association between calf circumference (CC) and chronic kidney disease (CKD). We aim to evaluate the associations between CC and cardiovascular and all-cause mortality in patients with CKD stages 3-5. Data on CKD were sourced from the National Health and Nutritional Examination Survey (NHANES) 1999-2004. The population was stratified into three groups based on their CC tertile. Kaplan-Meier method with log-rank tests for significance was used for survival analysis. Weighted Cox proportional hazards regression models were employed to estimate the hazard ratios (HRs) for cardiovascular and all-cause mortality. The potential nonlinear relationship between CC and mortality was assessed using restricted cubic spline (RCS) models. Subgroup and sensitivity analyses were conducted to strengthen the results. A total of 1166 patients were eventually included in this study. After a mean follow-up of 127.78 months, a total of 922 all-cause deaths were recorded, with 515 of them attributed to cardiovascular diseases. The Kaplan-Meier curve indicated a significant difference in overall survival between the three groups (log-rank test, P < 0.0001). Compared to the CC > 38.5 group, participants in the CC < 35.0 group had HR of 2.05 (1.44, 2.93) for all-cause mortality and 1.58 (0.75, 3.33) for cardiovascular mortality, respectively. We observed a significant nonlinear relationship between CC and cardiovascular and all-cause mortality (P-nonlinear < 0.05). Subgroup analysis further validated our results and demonstrated that the impact of CC on prognosis varies according to distinct characteristics. Sensitivity analyses yielded similar results for both all-cause and cardiovascular mortality. A reduced CC is correlated with a poorer prognosis in CKD stages 3-5 patients, suggesting its potential utility as an innovative prognostic marker.

The hemodynamics of elastic cerebral aneurysms are complicated by phenomena that affect the initiation and the progress of each aneurysm. The blood vessel deforms with pulsatile flow. In a phantom, however, it remains unclear whether the wall compliance can be neglected. In our previous study, the flow structure at another plane oriented perpendicular to the median plane was not clarified. In the approach presented here, an identical phantom is used for both the rigid and elastic wall models by adjusting the surrounding fluid when immersed in a bath. For this purpose, the full-scale phantom of an aneurysm was fabricated using a silicone elastomer. The hemodynamic factors at the orthogonal planes in the non-deformable and deformable models of the bifurcation in the middle cerebral artery were examined. Using two-dimensional particle image velocimetry, the flow velocity, the wall shear stress (WSS), the WSS gradient (WSSG), and the turbulent kinetic energy (TKE) were measured during pulsatile flow. Overall, the WSSG at the median plane is smaller than that at corresponding perpendicular plane. Additionally, the TKE in the deformable model is smaller than that in the non-deformable model. Our results have clarified the complex effects of aneurysm wall compliance on these hemodynamic factors.

Interleukins (IL) play a vital part in molecular recognition as well as immune response, and their excessive or inappropriate production can lead to inflammatory and cardiovascular diseases, etc., which are harmful to human physical and mental health. Thus, there is a pressing need to develop a strategy for the rapid and highly sensitive detection of such low concentration substances. In this study, we developed a Surface enhanced Raman spectroscopy (SERS) immunosensor for qualitative and quantitative analysis of multiple cytokines (IL-1, IL-4 and IL-6). Three Raman reporters were modified on gold nanoparticles and coupled with corresponding antibodies to form immunoprobes. The silver nanospace folded rods were prepared by tilted angle deposition technique, connected with antibodies to form an immunosensor. When the target antigen appeared on the immunosensor, it would specifically bind with the antibody to form a "sandwich" structure. Respectively, the detection limits of IL-6, IL-1 and IL-4 were 1.00 pg/mL, 0.93 pg/mL and 1.00 pg/mL. The three inflammatory factors were successfully distinguished and predicted by machine learning. In addition, we detected and calculated the recovery of IL-6 cytokines in saliva samples. The method can achieve quantitative detection and qualitative differentiation of target detectors in a wide concentration range. Meanwhile, it has the advantages of rapidity, simplicity and high specificity, which has a broad application prospect in biomedical field.

The SUMMIT trial showed that the long-acting glucose-dependent insulinotropic polypeptide receptor and glucagon-like peptide 1 receptor agonist tirzepatide decreased the risk of cardiovascular death or worsening heart failure (HF) in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Effects may differ by baseline obesity severity, distribution, or magnitude of weight loss.

In this analysis, the authors compared baseline characteristics and effects of tirzepatide on primary and other endpoints according to baseline obesity severity and distribution, and we explored relationships between degree of weight loss achieved and outcomes.

In the SUMMIT trial, 731 patients with NYHA functional class II-IV HFpEF and body mass index (BMI) ≥30 kg/m² were randomly assigned to tirzepatide (n = 364) or placebo (n = 367). The primary outcomes were time to cardiovascular death or worsening HF and change in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) at 52 weeks. Key secondary outcomes included changes in 6-minute walk distance (6MWD), C-reactive protein (CRP), and body weight (BW) at 52 weeks. In this secondary analysis, primary and secondary endpoints were analyzed based on obesity severity (BMI) and distribution (waist-height ratio [WHR]). Time-to-event endpoints were analyzed with the use of a Cox regression model, and continuous endpoints were assessed with the use of a mixed-effects model for repeated measures. Relationships between changes in BW and waist circumference (WC) on treatment with tirzepatide and changes in key endpoints also were evaluated.

Patients with obesity-related HFpEF and higher BMI were younger and more likely to be female, with more severe HF symptoms and physical limitations, greater volume expansion despite higher diuretic use and lower natriuretic peptide levels, and more severe systemic inflammation compared with patients with lower BMI. These findings were largely similar when contrasting patients by baseline WHR, but those with higher WHR also had poorer exercise capacity and more severe kidney disease. There was no evidence of heterogeneity in the effect of tirzepatide on the risk of worsening HF or cardiovascular death by BMI or WHR tertile. However, with increasing tertiles of baseline BMI, there were greater improvements in 6MWD (estimated treatment difference [ETD]: 9.9 vs 26.3 vs 37.5 m; P = 0.025), and greater decreases in BW (ETD: -10.7% vs -11.8% vs -14.4%; P = 0.006) and systolic blood pressure (ETD: -1.00 vs -6.65 vs -6.62 mm Hg; P = 0.035) with tirzepatide compared with placebo, with a trend for greater improvement in KCCQ-CSS (P = 0.097). Among those randomized to tirzepatide, greater weight loss at 52 weeks was associated with larger improvements in 6MWD, KCCQ-CSS, CRP, and blood pressure, and a greater decrease in WC was associated with larger increases in 6MWD and KCCQ-CSS. Patients with elevated WHR but lower BMI had higher NYHA functional class and N-terminal pro-B-type natriuretic peptide, poorer kidney function, and lower 6MWD compared with those with lower WHR but higher BMI.

Among patients with obesity-related HFpEF, greater BMI is associated with younger age, female sex, more volume overload and inflammation, and more severe HF, and those with greater WHR also showed greater impairment in kidney function and exercise capacity. Tirzepatide consistently reduced the risk of HF or cardiovascular death regardless of baseline BMI, but there was evidence suggesting greater improvement in 6MWD in those with higher BMI at baseline. Greater weight loss on treatment with tirzepatide was associated with greater improvements in 6MWD and KCCQ. (A Study of Tirzepatide [LY3298176] in Participants With Heart Failure With Preserved Ejection Fraction [HfpEF] and Obesity [SUMMIT]; NCT04847557).

A healthy, middle-aged man presented with acute on chronic progressive photophobia, headache and visual impairment. Clinical workup demonstrated advanced papilledema, tortuous optic nerves, flattened globes and intracranial pressure of >55 cm H₂O. Diagnostic cerebral angiogram demonstrated a Cognard IIA tentorial dural arteriovenous fistula (dAVF) associated with transverse sinus stenosis. Venous manometry demonstrated a pressure gradient of 28 mm Hg across the stenosis. Given acute symptoms of elevated intracranial pressure and significant functional gradient, venous sinus balloon angioplasty and stenting were performed, which resulted in near resolution of functional gradient, immediate improvement of symptoms and resolution of retrograde venous flow, thus downgrading his dAVF to Cognard I. At 3-month follow-up, angiographic improvement in dAVF grade was maintained, with durable improvement in papilledema and headaches.