Objective: To explore the diagnostic value of fractional flow reserve (FFR) based on optical coherence tomography (OCT) for coronary functional ischemia, and to investigate the feasibility of synchronously obtaining Doppler blood flow velocity information with the help of OCT technology. Methods: This study was a single-center, prospective, self-controlled clinical study on coronary heart disease patients who underwent OCT and FFR assessment at Department of Cardiology, the Second Hospital of Jilin University from January 2024 to February 2025. Linear regression analysis was used to evaluate the correlation and consistency between OCT-FFR and FFR. With FFR≤0.80 as the gold standard for judging whether the target vessel was ischemic, the diagnostic performance of OCT-FFR was evaluated, and the diagnostic value of OCT-FFR for significant coronary artery ischemia was assessed using subject operating characteristic curves. Blood flow OCT data were analyzed by Doppler processing algorithm to obtain information on coronary blood flow velocity. Results: A total of 31 vessels from 28 patients were analyzed, the correlation coefficient r between OCT-FFR and FFR of the 31 vessels was 0.84 (P<0.001). With FFR as the gold standard to determine whether a coronary artery is ischemic, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for OCT-FFR was 93.55%, 75.00%, 100.00%, 1.00, 0.92. In clinical practice, Doppler OCT was used for the first time to obtain information on coronary blood flow velocity. Conclusion: OCT-FFR had an excellent correlation and consistency with FFR in judging whether there is coronary artery ischemia. The feasibility of the simultaneous acquisition of OCT-FFR and Doppler flow velocity information in coronary stenosis was preliminarily verified.

Objective: To explore the value of cardiac magnetic resonance imaging (CMR) derived left ventricular late gadolinium enhancement (LV LGE) for the primary prevention of malignant ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. Methods: This was a single-center retrospective study. Consecutive ARVC patients who underwent CMR at Fuwai Hospital between January 2016 and September 2020, with no history of malignant ventricular arrhythmias at diagnosis, were enrolled. Clinical data and CMR characteristics were collected. The primary endpoint was defined as new-onset malignant ventricular arrhythmias related events, including sustained ventricular tachycardia, ventricular fibrillation/flutter, sudden cardiac death, cardiac arrest, and appropriate implantable cardioverter-defibrillator discharge. Follow-up via telephone interviews and medical records was conducted to confirm endpoint occurrences, and patients were categorized into event-free and event groups based on endpoint status. Univariable and multivariable Cox regression analysis were performed to identify independent risk factors for malignant ventricular arrhythmias in ARVC patients. Subgroup analyses were conducted based on the ARVC 5-year risk score (cutoff: 25%) and the median value of LV LGE percentage (cutoff: 13%). Kaplan-Meier curves were plotted, and log-rank tests were used to compare the difference in the incidence of primary endpoint events between subgroups. Receiver operating characteristic curves and likelihood ratio test were used to evaluate the incremental prognostic value of LV LGE percentage beyond the ARVC 5-year risk score. Results: A total of 172 ARVC patients were enrolled, aged (39.0±16.6) years, including 73 females (42.4%). During a follow-up of 53.1 (25.4, 76.9) months, 51 patients (29.7%) experienced malignant ventricular arrhythmias related events, including 3 cases of sudden cardiac death, 1 cardiac arrest, 33 sustained ventricular tachycardia and 14 appropriate implantable cardioverter-defibrillator discharges. Multivariable Cox regression analysis indicated that the ARVC 5-year risk score (HR=1.028, 95%CI 1.015-1.041, P<0.001) and LV LGE percentage (HR=1.059, 95%CI 1.032-1.087, P<0.001) were independent risk factors of the primary endpoint events. Kaplan-Meier analysis using composite stratification (ARVC 5-year risk score cutoff: 25%; LV LGE percentage cutoff: 13%) demonstrated that patients with both high risk scores (≥25%) and extensive LV LGE (≥13%) had the highest risk of primary endpoint events. Notably, among patients with ARVC 5-year risk scores <25%, those with LV LGE≥13% had a higher incidence of primary endpoint events than those without (log-rank P=0.037). The composite prediction model combining the 5-year risk score and left ventricular LGE percentage demonstrated significantly improved predictive performance (area under the curve (AUC)=0.82, 95%CI 0.75-0.90; likelihood ratio test all P<0.001) compared to single-variable models (left ventricular LGE percentage alone: AUC=0.71, 95%CI 0.63-0.82, P=0.01; 5-year risk score alone: AUC=0.71, 95%CI 0.62-0.81, P=0.02). Conclusion: LV LGE percentage independently predict new-onset malignant ventricular arrhythmias in ARVC patients and provided incremental prognostic value based on the existing ARVC 5-year risk score.

Objective: To summarize and analyze the clinical characteristics and treatment outcomes of patients with recurrent pericarditis. Methods: This observational study consecutively recruited patients with recurrent pericarditis who were hospitalized at Peking University People's Hospital between January 2017 and February 2024. Clinical characteristics and treatment outcomes were collected and summarized during follow-up. Results: A total of 8 recurrent pericarditis patients including 3 males were included, with an age of 34.0 (22.0, 39.5) years. In terms of clinical features, all patients presented with acute-onset severe chest pain, accompanied by fever in 7 and an audible pericardial friction rub in 2 patients. Electrocardiogram showed no diffuse ST-segment elevation or PR-segment depression in any patient. Echocardiography revealed pericardial effusion in all cases, with extensive fibrinous exudate and transient pericardial thickening observed in 6 patients. CT identified concurrent pleural and/or peritoneal effusions in 6 patients. All patients exhibited marked elevations in C-reactive protein, erythrocyte sedimentation rate and D-dimer levels. Whole-exome sequencing identified MEFV gene mutations associated with familial Mediterranean fever in 3 cases. Two patients developed cardiac tamponade requiring pericardiocentesis, which revealed hemorrhagic effusion. In the aspect of treatment outcomes, the time from recurrence to first confirmed diagnosis of recurrent pericarditis of this cohort was 14.5 (13.3, 19.5) d. Upon diagnosis, all patients promptly received standard anti-inflammatory therapy with ibuprofen and colchicine, achieving rapid relief. However, during a follow-up of 12.0 (6.0, 25.3) months, 3 patients experienced recurrence, and 2 developed transient constrictive pericarditis. Conclusion: Patients with recurrent pericarditis typically exhibit characteristic clinical presentations, laboratory abnormalities, imaging findings and potential genetic associations. Although standard anti-inflammatory therapy demonstrates favorable short-term efficacy, long-term management remains challenging due to the risks of recurrence and progression to constrictive pericarditis.

European cardiovascular guidelines recommend systematic atrial fibrillation (AF) screening in community-dwelling high-risk patients. However, little is known about the impact of abnormal screening findings, including AF and non-AF incidental findings on the target population. This gap highlights the need to assess both the benefits and potential harms from patients' perspectives to fully understand the impact of AF screening. Therefore, the aim of this study is to explore patients' experiences with AF screening among those who received abnormal findings from ambulatory ECG monitoring.

We conducted a qualitative study using semistructured interviews, analysed thematically. Participants in the PATCH-AF trial, based in Amsterdam primary care, were purposively sampled based on their screening results (AF or non-AF incidental findings), sex and socioeconomic status.

We achieved data saturation after conducting 16 interviews (6 with interviewees diagnosed with AF and 10 with non-AF incidental findings). Participants had a median age of 76 (73-79) years, and 56% were male. Their experiences, whether positive or negative, fluctuated throughout the screening process and depended on their initial motivations for participation in AF screening (seeking extra health checks, finding explanations for pre-existing symptoms or contributing to medical research), expectations and perceived benefits from clarification, diagnostic workup or treatment. Influencing factors included the type of finding (AF or non-AF incidental finding), healthcare provider communication and individual characteristics such as age, socioeconomic status and medical history.

This qualitative study highlights both positive and negative AF screening experiences from the patients' perspective. It underscores how patients' motivations and expectations for participation, the type of ambulatory ECG finding and communication and follow-up by healthcare providers shape their overall experiences. Healthcare providers should be aware of these factors to optimise screening consultations. Clear guidelines on communicating abnormal ambulatory ECG findings, especially incidental findings, are warranted.

The Netherlands Trial Register (NTR) number NL9656.

Atrial fibrillation (AF) requires comprehensive management due to its complex nature. The Atrial Fibrillation Better Care (ABC) pathway, introduced in the 2020 European Society of Cardiology Guidelines, has demonstrated clinical benefits, yet adherence remains suboptimal. This study evaluates the impact of establishing an Atrial Fibrillation Centre (AFC) on ABC pathway adherence in a Chinese teaching hospital.

This study employed an interrupted time series analysis to assess monthly ABC pathway adherence rates before and after AFC construction. The analysis focused on anticoagulation (A), better symptom control (B) and comorbidity management (C).

Following AFC establishment, the hospital-wide ABC adherence rate increased by 11.82%, with a sustained monthly increase of 0.27%. Improvements were primarily observed in cardiology and internal medicine departments, whereas surgical departments showed minimal change. Anticoagulation and symptom control adherence improved significantly, while comorbidity management remained unchanged.

The AFC improved ABC pathway adherence through standardised, multidisciplinary AF management. Significant gains in anticoagulation and symptom control were observed, but rhythm control and comorbidity management remained suboptimal. Barriers include limited ablation access and fragmented care. Future efforts should enhance interdisciplinary collaboration, expand procedural accessibility and integrate long-term cardiovascular risk management to optimise AF care.

Establishing an AFC significantly improved ABC pathway adherence, which proved effective in both stroke prevention and symptom management, particularly in cardiology and internal medicine departments. Future efforts should focus on enhancing rhythm control strategies and optimising comorbidity management to further improve integrated AF care.

MR-50-24-014759.

Despite guideline warnings and concerns for increased mortality, acute ischemic stroke (AIS) survivors older than 66 years of age still receive benzodiazepines (BZDs). We examined the BZD-associated effect on mortality within 30 days post-discharge on survival among older Medicare beneficiaries after an AIS.

We analyzed a sample of Medicare beneficiaries enrolled for at least 12 months before hospitalization for AIS. Our primary exposure was BZD initiation within 30 days post-discharge, and its primary outcome was 90 days mortality risk differences (RDs) from discharge using trial emulation with methods to address confounding (i.e., cloning, weighting, censoring, and inverse-probability-of-censoring weighting).

Of 47 421 beneficiaries, 826 (1.74%) initiated BZD 30 days post-discharge, and 6392 (13.48%) died within 90 days. The median age was 79 (IQR: 12), with 55.3% female, 82.9% White, 10.1% Black, 1.7% Hispanic, 2.2% Asian, and 0.4% American Native. After standardization (based on age, sex, race/ethnicity, length of stay, and baseline dementia), the 90-day mortality risk revealed an RD of 26 events per 1000 (95% CI: 22, 33). Subgroup analyses revealed higher RDs in older age groups, particularly those aged 86 or older, with an RD of 84 events per 1000 (95% CI: 73, 106), and for patients with baseline dementia, with an RD of 87 events per 1000 (95% CI: 63, 112).

Initiating BZDs within 30 days post-AIS discharge was associated with increased 90 days mortality risk, especially in older adults 76 years and older and those with baseline dementia, highlighting their vulnerability to BZD adverse effects.

This study looked at how starting to take benzodiazepines (BZDs) affects survival in older adults after a stroke. BZDs are medications typically used for anxiety, insomnia, and seizures. The study focused on patients 66 years old and older on Medicare and determined whether taking BZDs within 30 days after leaving the hospital increased their risk of dying within 90 days. The study analyzed over 47,000 patients, selecting those with more favorable outcomes, and found that 1.74% began taking BZDs after their stroke. After adjusting for factors like age, gender, race, hospital stay, and dementia, we found that starting BZDs was associated with a higher risk of death. The risk was particularly high in patients 86 years and older and those with dementia. The study concluded that prescribing BZDs to older stroke survivors could substantially raise the risk of death, especially in the oldest and most vulnerable patients.

Ventricular assist devices have been widely accepted as an alternative treatment for advanced heart failure, while heart transplantation is a limited procedure because of the shortage of donors. In face of a scarce availability of these devices, many centers around the world have developed their own technologies. We describe historical and general features of the main ventricular assist devices developed at the Instituto Dante Pazzanese de Cardiologia. The auxiliary total artificial heart is an electromechanical pulsatile blood pump with left and right chambers, being originally designed to work as a heterotopic artificial heart. The spiral pump is a disposable device and currently available for clinical use in cardiopulmonary bypass. It works through a combination of centrifugal and axial pumping principles coming from a conically shaped impeller. The implantable centrifugal blood pump was conceived for long-term circulatory assistance with a unique impeller design concept producing a mixed flow. The apico-aortic blood pump consists of a miniaturized centrifugal pump originally conceived for bridge to transplantation strategy. The temporary circulatory support device is a new centrifugal blood pump for temporary ventricular assistance developed with the purpose of bridge-to-decision or recovery strategies. Additionally, the hybrid cardiovascular simulator was developed as a tool to test blood pumps as they minimize the need for animal experiments. Brazil represents an important reference with a few academic groups with a considerable output in ventricular assist devices research and development. Notable devices produced at Instituto Dante Pazzanese de Cardiologia have demonstrated excellent results for clinical application.

While MRI is known to be crucial for TIA workup, the benefit of perfusion-weighted imaging (PWI) is underexplored. We aimed to assess the association between focal hypoperfusion on baseline PWI MRI and the long-term incidence of subsequent acute ischemic stroke (AIS) after TIA.

Consecutive patients with TIA who underwent baseline PWI MRI as part of their emergency consultation between January 2015 and December 2019 were retrospectively identified. For study inclusion, both a time-based (symptom duration <24 hours) and an imaging-based (no signs of ischemia on diffusion-weighted imaging) TIA definition were applied. Long-term incidences of AIS after TIA were identified based on follow-up reports. Associations between focal hypoperfusion and subsequent AIS were assessed using Cox regression models adjusted for predefined predictors of stroke occurrence including symptomatic extracranial or intracranial stenosis. In subgroup analyses, we aimed to determine effects of focal hypoperfusion within vs outside the expected TIA territory, defined as a brain region potentially correlating with TIA symptoms.

Of 1,359 eligible patients with TIA, 1,075 with PWI MRI (79%) were included (median age 70 years, 46% female). Focal hypoperfusion was identified in 211 patients (20%); in 116 of 211 (55%), hypoperfusion occurred within the expected TIA territory. The median time from symptom onset to imaging was 233 minutes (interquartile range [IQR] 131-632) for patients with focal hypoperfusion vs 229 minutes [IQR 140-441] for patients without (p = 0.42). Focal hypoperfusion was associated with a higher incidence of AIS (adjusted hazard ratio [aHR] 2.13; 95% CI 1.19-3.80). While this was observed for focal hypoperfusion within the expected TIA territory (aHR 3.95; 95% CI 2.05-7.60), there was no such association in case of focal hypoperfusion outside the expected TIA territory (aHR 0.72; 95% CI 0.25-2.03).

Focal hypoperfusion on acute PWI MRI was found in 1 in 5 patients with TIA. It was associated with a higher incidence of AIS during long-term follow-up, especially when within the expected TIA territory. Further research is needed to clarify the predictive value of focal hypoperfusion in relation to the incidence of AIS after TIA and to explore potential therapeutic implications.

Previous studies suggest that the location of coronary artery disease cannot independently predict atrial fibrillation after coronary artery bypass grafting, but with little information, it has also been thought that simultaneous right coronary endarterectomy may cause this rhythm problem.

In this study, we aimed to evaluate the effect of right coronary artery bypass grafting on early postoperative atrial fibrillation.

Patients who underwent elective on-pump coronary artery bypass grafting operations in our hospital were included in the study, and patients who underwent a different open-heart surgery or those who had previously undergone open-heart surgery were not included. Patients included in the study were divided into Group 1 (patients who developed postoperative atrial fibrillation) and Group 2 (patients who did not develop postoperative atrial fibrillation) and compared in terms of right coronary artery bypass grafting and other follow-up parameters.

The mean age of a total of 158 patients included in the study was determined as 63.25 ± 10.07 years (range 44 - 85 years), 120 were male, and 96% of them had hypertension. Postoperative atrial fibrillation developed in 43 patients, and right coronary artery bypass grafting was performed in 123 patients.

We think that the frequency of postoperative atrial fibrillation development may be higher in cases where right coronary artery bypass grafting is performed, as it may play a role in processes related to the conduction system and right ventricular dysfunction, and multicenter studies with a large number of patients would be beneficial on this subject.