This study aimed to report the 5-year outcomes of patients with newly diagnosed branch retinal vein occlusion (BRVO).

A retrospective review of patient charts was conducted. Data on central macular thickness (CMT), best-corrected visual acuity (BCVA), photoreceptor integrity, number of intravitreal (IV) antivascular endothelial growth factor (anti-VEGF) injections administered, and treatment regimen were assessed.

Ninety-seven eyes from individual patients with a mean age of 70.90 ± 11.49 (38-92) were included. The mean BCVA improved, and the mean CMT decreased at all follow-up visits following treatment (p < 0.05). Thirty-two eyes (33%) gained 3 lines of BCVA at the five-year follow-up. The mean number of total IV anti-VEGF injections administered was 19 ± 13.35 (1-49) during the five-year period, and 27.83% of patients received rescue laser treatment. Fifty-four percent of eyes received three consecutive monthly loading doses of IV anti-VEGF injections. The mean change in BCVA in the loading dose (+) group was significantly greater than in the loading dose (-) group at 1-year and subsequent visits. The loading dose (+) group showed a significantly greater reduction in CMT compared to the loading dose (-) group. The mean estimated time for BCVA to decline by ≥3 lines was 117 ± 8.74 months (95% CI = 100.21-134.51).

Anti-VEGF treatment was effective in improving anatomical and functional outcomes in BRVO patients during long-term follow-up. Initial treatment with three loading doses of anti-VEGF resulted in greater vision gain and more pronounced anatomical improvement.

Elevated low-density lipoprotein cholesterol (LDL-C) levels are a leading risk factor for atherosclerotic cardiovascular disease (ASCVD), a major global cause of illness and death. Patients' qualitative insights about experiences, priorities, and needs are essential for creating more targeted, patient-centered quality improvement interventions.

To document the experiences of people with high levels of low-density LDL-C in three countries.

Qualitative study of 60-min in-depth interviews with 50 adult patients from Australia, Brazil, and the United States. The study was overseen by a Steering Committee comprising patients, patient advocates, researchers, and cardiologists. The interviews explored pathways and barriers to high LDL-C diagnosis; the burden of managing high LDL-C and the awareness of the association between high LDL-C and cardiovascular risks. The data were analyzed by applying a structured, team-based approach to coding qualitative data.

There were three main pathways to diagnosing high cholesterol: routine physical exams conducted by primary care providers; symptomatic presentations or incidental findings during emergency visits and through a healthcare visit for another condition, frequently diabetes. Healthcare providers' communication styles influenced patients' perceptions of their conditions. Two-thirds of participants (n = 33) attempted lifestyle changes after their high cholesterol diagnosis, but work schedules and daily routines posed barriers to maintaining healthy habits. Some participants who experienced ASCVD events waited hours or days before seeking care, assuming their symptoms were not serious. After diagnosis of an ASCVD event, many patients feared death and worried about their families' futures. When asked about potential improvements to their current therapy, 21 patients mentioned reduced administration frequency.

This pilot study provides insights into patients' experiences living with and managing elevated LDL-C. It describes opportunities for policymakers and healthcare providers to improve the detection of elevated LDL-C and support patients in understanding risks and strategies for reducing the risk of ASCVD events.

The high burden of blood pressure-related cardiovascular diseases in Bangladesh is potentially caused by excessive dietary sodium and insufficient potassium intake. Our objective is to estimate dietary salt and potassium intake among Bangladesh rural and urban adults from urinary excretion of sodium and potassium.

We conducted a cross-sectional study between December 2017 and June 2018, including participants aged 30-59 years from three urban and three rural sites in Bangladesh. Data included urinary excretion of sodium and potassium estimated from one 24-hr urine collection and blood pressure measurements.

Among 840 enrolled participants, complete data was available in 509 individuals. Mean age was 43.0 (SD ±7.9) years; 20.9% had hypertension, 50.9% were women, and 50.9% resided in urban areas. Mean systolic and diastolic blood pressure were 118.6 (SD ± 16.6) mmHg and 76.3 (SD ± 11.3) mmHg, respectively. Overall, the mean urinary sodium excretion was 3.9 g/day (95% CI = 3.8 to 4.0), corresponding to a mean salt intake of 9.7 g/day (95% CI = 9.4-10.1). Mean urinary potassium excretion was 1.4 g/day (95% CI = 1.3-1.4), corresponding to an estimated mean dietary potassium intake of 2.0 g/day. Men and urban residents had slightly but non-significantly higher sodium and potassium excretion than women and rural residents.

In Bangladesh, salt intake exceeded WHO's recommended <5g/day limit, while potassium intake was substantially lower than the recommended intake of ≥ 3.5g/day for adults. Promoting low-sodium and potassium-rich diets through nationwide campaigns and policies, including advocating for accessible low-sodium and potassium-enriched salt substitutes, is recommended to mitigate cardiovascular disease risks.

ObjectivesCardiac syndrome Y (CSY) phenomenon is characterized by the gradual opacification of the coronary vasculature at the distal level. The leuko-glycemic index (LGI) is a blood glucose and white blood cell count index. This study investigates the relationship between CSY and the leuko-glycemic index.MethodsA case-control, retrospective study was conducted. Consecutively selected individuals with complaints of angina were included in the study. Subjects with normal coronary flow (n = 132) and coronary slow flow (n = 136) were classified, after confirmation of coronary angiography results.ResultsThe age ranges were recorded as 57 (48-64) for the NCF group vs. 52 (46-58) for the CSY group, P = .010. The mean hematocrit (Hct), Hemoglobin (Hg), White blood cells (WBC), and LGI were significantly higher in the CSY group than in the normal coronary flow group (P < .001). Accordingly, CSY was positively correlated with Hct, Hg, and WBC (P < .001). ROC curve analysis indicated that a cut-off value of ≥9.28 for the LGI predicted CSF with a sensitivity of 78% and a specificity of 78.1% [Area under the curve (AUC): 0.626 and 95% CI: 0.559-0.693].ConclusionsIn this study, we show for the first time that elevated LGI levels can independently predict CSF formation in the subclinical process.

Acute myocardial infarction (AMI) is a serious heart disease with high fatality rates. The progress of AMI involves immune cell infiltration. However, suitable clinical diagnostic biomarkers and the roles of immune cells in AMI remain unknown. Three datasets (GSE61145, GSE34198, and GSE66360) were used from Gene Expression Omnibus. Dysregulated expression of genes was screened and functionally analyzed. Weighted Gene Co-expression Network Analysis (WGCNA) was used to identify significant module genes associated with AMI. Machine learning algorithms (Support Vector Machine (SVM), Random Forest (RF) and Least Absolute Shrinkage and Selection Operator (LASSO)) were applied to identify hub genes. Subsequently, receiver operating characteristic curves (ROC) were generated to evaluate the risk of AMI patients. Finally, immune cell infiltration were assessed by CIBERSORT, correlation analysis and immunohistochemistry. A total of 134 upregulated and 25 downregulated genes were identified. Functional analysis showed that the dysregulated genes were involved in cytokine- and immune-related signaling. Ten hub genes were used to establish a diagnostic model. Immune cell infiltration analysis showed that ten genes were correlated with activation of various immune cells; specifically, naive B cells, activated CD4 memory T cells, and resting mast cells were significantly associated with AMI. Immunohistochemical staining indicated that FOS and IL18RAP were significantly upregulated in AMI, CD4 naive T and neutrophils were significantly infiltrated in the microenvironment of AMI. The hub genes involved in activating immune cell infiltration and developing AMI could act as promising diagnostic biomarkers and targets for clinical treatment of AMI.

Dilated Cardiomyopathy (DCM) is an important cause of significant cardiac functional impairment in pediatric patients. There is to date debate on which echocardiographic variable correlates better with the functional status of the patient.

28 DCM patients (NYHA class II and III), and 30 controls were enrolled in the study, where advanced echocardiographic examination was used to assess LV (Left ventricular) function. Tissue Doppler, 2D speckle tracking for PSI (post-systolic strain index calculation), and blood speckle tracking for the timing of LV vortex formation were implemented.

Intriguingly, none of LV GLS and GAS (Global longitudinal and area strain), or EF (Ejection fraction, were able to differentiate NYHA II and III subgroups of cases. In contrast, PSI, and systolic vortex formation were significantly different between subgroups of cases; systolic vortex was seen in 33% of NYHA II patients compared to 77% of NYHA III patients, a PSI median value of 5% was seen in NYHA III cases, and a cut-off >4% was 92% sensitive in predicting worse manifestations.

Dyssynchrony; seems to play a significant role in orchestrating symptoms of heart failure. In this context, blood speckle tracking study seems a promising bedside method, in its assessment. A large room for improvement and systemization of its assessment is still needed to objectivize its use.

Coronary embolism (CE) is rare and is an unusual cause of acute myocardial infarction (AMI). Japan NCVC criteria of CE were the first criteria that did not be verified and accepted.

We collected all the CE patients in our hospital between 2015 and 2021, analyzed the characters, diagnosis, and treatment, and confirmed the value of Japan NCVC criteria.

Eighteen AMI patients diagnosed with CE were enrolled. Seventeen patients (94.4%) were given PCI treatments. Six patients (33.3%) had artificial heart valves, and three (16.7%) had mechanical valves. Eleven patients (61.1%) had atrial fibrillation (AF), one (5.6%) had hypertrophic cardiomyopathy, and two (11.1%) had hypercoagulable state. 68.8% of patients had insufficient anticoagulation in this study. Seven patients (38.9%) fulfilled the criteria for definite CE, and nine (50%) were classified as probable CE. The other two patients (11.1%) did not fulfill the criteria of CE with distal coronary artery embolism and one criterion of Japan NCVC criteria. The diagnosis accuracy rate of Japan NCVC criteria was 88.9%. Thrombus aspiration was the first-line treatment used in 14 patients (77.8%) and performed in 9 vessels (47.4%) as the only treatment method.

CE is rare in AMI, and AF is the most critical cause which should draw our attention. The Japan NCVC criteria were a helpful diagnostic tool for CE with high accuracy, but the distal coronary artery embolism with moderate atherosclerosis might be overlooked. Thrombus aspiration was the preferred treatment to remove thrombus and restore coronary flow to improve prognosis.

The cardiovascular-kidney-metabolic (CKM) syndrome is a systemic condition defined by multifaceted interactions among metabolic risk factors, chronic kidney disorder, and cardiovascular diseases. Inflammation is essential in the pathogenesis and progression of CKM syndrome. Inflammatory markers, including the systemic immune inflammation index (SII) and the systemic inflammation response index (SIRI), function as composite indicators for assessing immune-related inflammatory status. This study seeks to address the associations between SII/SIRI and death outcomes in individuals with CKM syndrome using outcomes from the National Health and Nutrition Examination Survey (NHANES, 1999-2018).

This cross-sectional investigation comprised 18,452 individuals (≥ 20 years) with CKM syndrome, utilizing outcomes from ten cycles of NHANES (1999-2018). Participants were divided into higher and lower SII and SIRI groups according to cut-off values established by the optimally chosen rank statistics approach. Kaplan-Meier analysis and Cox proportional hazards and Fine-Gray competing risk regression models were utilized to evaluate the links between SII/SIRI and death outcomes in CKM individuals. Stratified and subgroup analyses were performed to further corroborate the results. Restricted cubic spline (RCS) analysis was utilized to examine potential non-linear links between SII/SIRI and death outcomes in this cohort. Ultimately, time-dependent receiver operating characteristic (ROC) analysis was employed to evaluate the prediction precision of SII and SIRI regarding death outcomes in short- and long-term follow-ups.

Upon controlling for potential confounders, higher SII levels (≥ 898.21) correlated with a 1.42-fold elevation in the risk of all-cause mortality (ACM) (HR: 1.42, 95% CI 1.23-1.56, P < 0.001) and a 1.50-fold elevation in cardiovascular mortality (CVM) (HR: 1.50, 95% CI 1.15-1.96, P = 0.002). Increased SIRI levels (≥ 1.23) correlated with a 1.28-fold escalation in the risk of ACM (HR: 1.28, 95% CI 1.14-1.43, P < 0.001) and a 1.38-fold escalation in the risk of CVM (HR: 1.38, 95% CI 1.12-1.70, P = 0.003). RCS analysis demonstrated a U-shaped, non-linear correlation between SII/SIRI concentrations and ACM (both P_non-linear < 0.001), whereas a linear link was identified between SII/SIRI levels and CVM (both P_non-linear > 0.05). Time-dependent ROC analysis revealed that SII and SIRI illustrated moderate to excellent and constant prognostic efficacy for short-term and long-term mortality outcomes in individuals with CKM syndrome, with SIRI consistently outperforming SII at all assessed time intervals.

Higher values of SII and SIRI are related to an elevated risk of ACM and CVM in U.S. adults with CKM syndrome. SIRI had moderate, stable predictive capacities for ACM and CVM, whereas SII exhibited moderate to poor predictive capacity for both outcomes, with SIRI consistently outperforming SII across all evaluated time points. These outcomes highlight these inflammatory markers' potential in forecasting adverse mortality outcomes in this population.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is an autoimmune necrotizing small vessel vasculitis, frequently resulting in severe renal manifestations such as rapidly progressive glomerulonephritis (AAV-GN). Monitoring disease activity and determining ongoing renal involvement remain significant clinical challenges due to the limitations associated with traditional biomarkers. This study focused on the potential of circulating microRNA (miRNA) as supplementary noninvasive biomarkers for disease activity in AAV-GN.

This prospective follow-up study involved serum samples from 60 patients with biopsy-proven AAV-GN, collected at renal biopsy and at 3-, 6-, 12-, and 24-month intervals post-biopsy. Nine miRNAs (miR-21-3p, miR-30b/d/e-5p, miR-142-5p, miR-150-5p, miR-181a-5p, miR-181b-5p, and let-7a-5p) were selected based on the differential expressions in renal tissue and corresponding serum samples identified in the previous research phases. Expression analysis was performed using quantitative real-time polymerase chain reaction and correlated with disease activity based on the Birmingham Vasculitis Activity Score and other clinical parameters.

A significant correlation was identified between disease activity and the expression levels of the miR-30 family members and let-7a. Specifically, these miRNAs demonstrated consistent correlation patterns across follow-up samples independent of the time elapsed post-biopsy, with down-regulation correlating with the presence of active disease. Notably, the miRNA expression profile in partial remission appeared analogous to that of complete remission, suggesting that many patients categorized as having partial remission may, in fact, be considered in true clinical remission.

This study supports serum miRNA profiling as an adjunct noninvasive biomarker for assessing disease activity in AAV-GN. Such an approach could provide complementary information alongside traditional biomarkers and refine the future management of AAV-GN. However, it is important to acknowledge that our actual study cohort was small due to challenging technical aspects of miRNA expression analysis in the serum. Therefore, further research with larger cohorts is required to validate these results and assess their clinical applicability.

The integration of artificial intelligence (AI) into medical diagnostics has significantly impacted cardiology by enhancing diagnostic precision and therapeutic strategies. Coronary artery disease continues to be a leading cause of global morbidity and mortality, with coronary angiography being the diagnostic gold standard. However, the subjective nature of angiographic interpretation can lead to inconsistent assessment. AI aims to provide automated, objective assessments to mitigate these challenges.

This study evaluated ChatGPT with Generative Pre-trained Transformer (GPT)-4o (OpenAI, USA), for automated coronary angiogram interpretation. Due to its inability to process video data, we extracted maximum contrast frames from diagnostic angiogram views. These anonymised images were analysed by GPT-4o. Its diagnostic findings and stent recommendations were compared with expert cardiologist assessments.

We included 100 patients who underwent coronary interventions between January and April 2024. GPT-4o accurately identified coronary vessels in 98% of images. The overall sensitivity for detecting lesions requiring intervention was 71.6%, with a specificity of 57.2% (F1 score 0.652). Performance varied by vessel with best results for left anterior descending artery (sensitivity 81.0%; specificity 69.3%) and right coronary artery (sensitivity 86.5%; specificity 61.4%). Identification of the target vessel based solely on imaging was 47%, which improved to 87% with additional clinical information.

GPT-4o shows potential as a supportive tool in coronary angiography interpretation. Its diagnostic performance improves significantly when contextual clinical information is included. However, its accuracy based on static images alone remains below the threshold required for reliable diagnostic and therapeutic support. The lack of cine-loop data as an essential element in real-world angiographic interpretation is a key limitation. Future developments should focus on enhancing AI capabilities for analysing complex anatomical structures and integrating dynamic imaging data to augment clinical utility.