Search Results (1,919)

Background: Acute transverse myelitis (ATM) can closely mimic degenerative spinal disorders, often leading to diagnostic delay or inappropriate surgical decisions. However, its epidemiologic characteristics among patients undergoing spinal surgery remain unknown. This nationwide, population-based study investigated the incidence, perioperative diagnostic trends, and risk factors of ATM in patients treated surgically for degenerative spinal disease. Methods: Data were extracted from the Korean Health Insurance Review and Assessment Service database (2014–2018). Adults (>19 years) who underwent surgery for degenerative spinal disease were identified, and those with malignancy, infection, fracture, or prior myelitis were excluded. The two-year perioperative observation period (−360 to +360 days) was divided into 24 consecutive 30-day intervals. Patients were classified by ATM occurrence, and multivariable logistic regression with bootstrap validation was used to identify independent risk factors. Incidence rates were expressed per 100,000 person-years. Results: Among 201,769 eligible patients, 269 (0.13%) developed ATM, yielding an incidence of 67 (95% CI: 59–75) per 100,000 person-years—substantially higher than in the general population. Younger age, male sex, myocardial infarction, cerebrovascular disease, rheumatologic disease, and cervical or thoracic spinal lesions were independent predictors. Notably, 28.3% of ATM cases were diagnosed within 30 days before surgery, and 50.9% within the four-month window from three months preoperatively to one month postoperatively, indicating a marked temporal clustering around surgery. Conclusions: ATM occurred far more frequently among patients undergoing surgery for degenerative spinal disease than in the general population, with diagnoses peaking immediately before surgery. This pattern likely reflects diagnostic delay rather than true perioperative onset. Because ATM can clinically and radiologically resemble degenerative myelopathy, clinicians should maintain a high index of suspicion in patients presenting with atypical or rapidly progressive neurological deterioration. Early recognition may prevent unnecessary surgery and improve neurological outcomes. Full article

Background: Acute coronary syndromes (ACSs) remain a leading cause of death and disability. Since the publication of the 2023 ESC ACS guidelines, multiple studies and an ESC/EAS dyslipidaemia update have refined how clinicians diagnose, revascularize, and treat ACS across the care continuum. Content: This state-of-the-art review synthesizes advances from 2023 to 2025 across five domains. Diagnosis: High-sensitivity troponin-based accelerated pathways remain foundational; GRACE 3.0 improves calibration for early vs. delayed angiography, while selective use of CCTA and routine use of intracoronary imaging/physiology help define the mechanism and optimize PCI. Revascularization: complete revascularization continues to underpin care in multivessel disease, with recent data favouring culprit-only PCI acutely and staged non-culprit treatment during the index stay in most STEMI presentations, particularly with heart-failure physiology. Antithrombotic therapy: Aspirin remains critical early after ACS-PCI; emerging evidence supports shorter DAPT and aspirin withdrawal after 1 month in carefully selected, low-ischaemic-risk patients, whereas day-0 aspirin-free strategies in unselected ACS are not non-inferior. Secondary prevention: A “strike early and strong” approach to LDL-cholesterol—often with combination therapy in hospital—is emphasized, alongside nuanced roles for SGLT2 inhibitors and GLP-1 receptor agonists. Special populations and implementation: Sex- and age-aware tailoring (including MINOCA/SCAD evaluation), pragmatic bleeding-risk mitigation, digitally enabled cardiac rehabilitation, and registry-driven quality improvement translate evidence into practice. Summary: Contemporary ACS care is moving from uniform protocols toward risk-stratified, mechanism-informed pathways. We offer practical algorithms and checklists to align interventional timing, antithrombotic intensity/duration, and secondary prevention with individual patient risk—bridging new evidence to bedside decisions. Full article

Background: Acute coronary syndrome (ACS) encompasses ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina. While optimal medical therapy (OMT) is central to secondary prevention, lifestyle interventions—particularly dietary modification—remain underutilised despite their potential impact on long-term outcomes. Objective: To review the current evidence regarding dietary interventions post-ACS, their implementation, adherence, and effects on cardiovascular risk factors and clinical outcomes. Methods: A narrative literature review was performed using PubMed, including studies published in English from 2000 onwards. Keywords included “acute coronary syndrome,” “diet,” “cardiovascular disease,” “outcomes,” “adherence,” “wine,” and “intermittent fasting,” combined with Boolean operators AND/OR. Animal studies were excluded. The latest search was conducted in October 2025. Results: Mediterranean-style diets, when combined with OMT and lifestyle interventions (exercise, smoking cessation, alcohol moderation), consistently improve cardiovascular risk factors and reduce recurrent ischemic events and mortality. Clinical trials and cohort studies demonstrate long-term benefits, including reductions in all-cause mortality and major adverse cardiovascular events, particularly in patients adhering to structured dietary programmes within cardiac rehabilitation. Evidence for other dietary modifications, including low-fat diets, increased fibre, antioxidant supplementation, and intermittent fasting, was more limited, often derived from small or short-term studies focusing on surrogate endpoints. Real-world adherence to dietary guidelines remains suboptimal, especially in high-risk and obese populations. Preliminary studies suggest intermittent fasting and moderate red wine consumption may confer additional cardiovascular benefits, though larger, long-term trials are needed. Conclusions: Dietary modification is a key, yet underutilised component of secondary prevention post-ACS. A Mediterranean-style, whole-food diet integrated with OMT and supported by structured cardiac rehabilitation programmes offers the most evidence-based strategy to improve risk factor control and long-term outcomes. Future research should focus on pragmatic, long-term trials assessing hard cardiovascular endpoints and implementation strategies to enhance adherence across diverse populations. Full article

Background: Coronary artery disease (CAD) is a multifactorial atherosclerotic disorder. Silicon (Si) is a trace mineral with potential antioxidant, anti-inflammatory, and lipid-modulating effects, but its clinical relevance in cardiovascular disease remains unclear. This study evaluated whether hair Si concentration—reflecting long-term exposure—is associated with CAD severity, clinical phenotype, risk factors, and systemic inflammation. Methods: A total of 130 patients with angiographically confirmed CAD (N = 36, 28% women) who met the inclusion criteria were enrolled. Disease severity was quantified using the Coronary Artery Surgery Study Score (CASSS) and SYNTAX score. Hair Si concentration was determined by inductively coupled plasma optical emission spectrometry (ICP-OES). Associations with demographic, clinical, biochemical, and inflammatory parameters were analyzed using non-parametric tests and multivariable ordinal logistic regression. Results: Median hair Si concentration was 21.3 ppm (range: 0.7–211.0). Hair Si levels showed no significant differences across CAD severity assessed by CASSS (H = 2.51; p = 0.47) or SYNTAX score (r = 0.079; p = 0.37). Similarly, no differences were observed between patients with stable angina and those presenting with acute coronary syndrome (p = 0.57) or between individuals with and without prior myocardial infarction. Hair Si concentration was unrelated to age, BMI, cardiovascular risk factors, lipid profile, or systemic inflammatory indices (all p > 0.2). Conclusions: Hair silicon concentration was not associated with CAD severity, phenotype, or systemic inflammation, suggesting that long-term Si exposure is metabolically neutral in advanced atherosclerosis. Unlike other minerals, silicon appears unlikely to serve as a diagnostic or prognostic biomarker in CAD, although its relevance may be confined to early vascular remodeling and primary prevention. Full article

Background/Objectives: The extent of myocardial scar, visualized by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR), is associated with mortality after acute myocardial infarction (MI). However, data on optimal cardiac biomarker cut-off values (e.g., high-sensitivity cardiac troponin T, hs-cTnT) for predicting LGE remain limited. This study aimed to evaluate the predictive value of cardiac biomarkers for LGE and their influence on clinical outcomes. Methods: We included 597 patients who underwent CMR a median of 3 days [interquartile range (IQR) 2–4 days] after MI (407 STEMI and 190 NSTEMI patients), with a median follow-up period of 3.0 years [IQR 1.3–3.5 years]. Results: After adjusting for key variables, maximum cardiac biomarker levels were found to have the strongest correlation with the presence and extent of LGE (p < 0.001). LGE mass and LVEF were the most robust predictors of all-cause mortality (hazard ratio [CI] 1.464 [1.050–2.040], p = 0.025, Harrell’s C 0.812; 0.697 [0.491–0.990], p = 0.044, Harrell’s C 0.810, respectively). We determined a receiver operating characteristic (ROC) area under the curve (AUC) of 0.73 and an optimal cut-off of 53 g for LGE mass and mortality, with a maximum hs-cTnT cut-off of 7270 ng/L predicting this extent of LGE. Conclusions: In this large cohort of MI patients with three-year follow-up, cardiac biomarker levels showed a strong correlation with the extent of LGE. While absolute LGE mass was associated with mortality, its predictive value was comparable to that of CMR-derived LVEF. These findings should be interpreted cautiously, given the study’s observational design, and should be considered hypothesis-generating, underscoring the need for prospective validation. Full article

Background/Objectives: This study evaluated the impact of the COVID-19 pandemic on trends of acute coronary syndrome hospitalizations, all-cause deaths, and ischemic heart disease (IHD) deaths in Allegheny County, Pennsylvania. Methods: Inpatient hospital records from two hospital systems within Allegheny County, Pennsylvania, were aggregated from January 2017 to November 2020. The primary diagnoses were acute myocardial infarction (AMI) and unstable angina. The Pennsylvania Department of Health provided all-cause and IHD death counts for the same period. We compared absolute percentage changes in admissions by year (March–November) and trends by age-specific groups (<45, 45–64, 65–74, ≥75) from the pre-pandemic (January 2017–February 2020) to pandemic (March 2020–November 2020) period using an interrupted time-series analysis. Results: There were 11,913 AMI hospitalizations pre-pandemic and 2170 AMI hospitalizations during the pandemic period. AMI hospitalizations decreased by 14.8% and unstable angina hospitalizations decreased by 30.7% during the pandemic compared to 2019, with the largest decreases occurring in those aged ≥75. Total mortality increased by 9.2%, and IHD mortality increased by 2.4%. About 80% of the increase in deaths was due to COVID-19, and approximately 75% of deaths occurred in those aged ≥75 and in long-term care facility residents. Conclusions: The COVID-19 pandemic did not markedly alter the longitudinal declining trend of AMI hospitalizations and IHD deaths in Allegheny County. Full article

Background: Cardiovascular disease is one of the leading causes of death worldwide. The presence of atherosclerotic plaques in the arteries leads to continuous growth and obstruction of blood vessels, which ultimately leads to acute myocardial infarction and sudden cardiac death. Ultrasound-triggered GVs cavitation has great potential in plaque treatment due to its noninvasive nature and safety. Methods: In this work, we constructed a Hirudin–Gas Vesicle Recombinant Plasmid to achieve gene delivery using macrophage membrane/lipid membrane fusion bio-vesicles. Results: The bio-fusion vesicles retained the macrophage membrane protein integrin α4β1 to combine with vascular adhesion molecules highly expressed by inflammatory cells to achieve delivery; the Hirudin–Gas Vesicle Recombinant Plasmid could escape lysosomes and enter the nucleus to achieve highly efficient transfection; Hirudin and Gas Vesicles are exocytosed through cleavage peptide and exocytosis peptide, respectively; their pharmacological effects are linked and complementary. Gas vesicles can break up lesion plates with the assistance of in vitro ultrasound, and Hirudin achieves fragment ablation and anti-inflammatory and lipid regulation. Conclusions: GVs-HV@MM-Lipo exerts potent anti-atherosclerotic and anti-inflammatory effects with favorable safety. GVs-HV@Lipo reduces mice aortic arch plaque area by 17%, while GVs-HV@MM-Lipo+US achieves further plaque regression and improved hemodynamics. Our work opens up a new paradigm in the treatment of atherosclerosis with Chinese medicine. Full article

Background: Oral health and cardiovascular disease share common inflammatory pathways, yet the relationship between tooth loss and post-myocardial infarction (MI) heart failure remains underexplored. Objective: To investigate the association between tooth loss and heart failure among patients with acute MI. Methods: In this cross-sectional study, 200 patients with documented MI were evaluated for tooth loss, cardiac function, and comorbidities. Heart failure was defined as an ejection fraction <40% or clinical diagnosis. Patients were categorized by tooth loss (0–8, 9–20, >20 missing teeth). Multivariate logistic regression was used to identify independent predictors of heart failure. Model performance was assessed using receiver operating characteristic (ROC) analysis. Results: The prevalence of heart failure was 38%. Mean ejection fraction declined progressively with greater tooth loss (50.1%, 44.8%, and 38.4% across the three categories; p for trend <0.001). After adjustment for age, sex, diabetes, and smoking, severe tooth loss (>20 missing teeth) remained independently associated with heart failure (adjusted OR 2.45; 95% CI, 1.15–5.23; p = 0.02). The final model demonstrated good discriminative ability (AUC = 0.78). Conclusions: Extensive tooth loss is strongly associated with heart failure among MI patients, suggesting a potential link between oral health deterioration and adverse cardiac remodeling. Integrating dental assessment into cardiovascular care may enhance risk stratification and promote holistic prevention strategies. Full article

Background: Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with a high mortality rate. Early identification of patients at risk for in-hospital CS is crucial for timely intervention. This study aimed to develop a risk prediction model for CS using admission data. Methods: This retrospective case–control study included AMI patients and classified them into case and control groups, based on the development of in-hospital CS. Clinical information at admission was obtained and 1:1 propensity score matching (PSM) was performed based on age, gender, and diagnosis of ST-elevation myocardial infarction. Factors with p < 0.10 at baseline were incorporated to identify the independent risk factors, which were further used to construct a predictive nomogram. Results: After PSM, 374 patients were finally enrolled in both groups. After relaxed least absolute shrinkage and selection operator and multivariate logistic regression, independent risk factors identified for CS in AMI patients included systolic blood pressure [odds ratio (OR): 0.866; 95% confidence interval (CI): 0.844–0.888, p < 0.001], diastolic blood pressure (OR: 1.031; 95% CI: 1.001–1.063, p = 0.046), triglycerides (OR: 0.561; 95% CI: 0.385–0.820, p = 0.003), creatinine (OR: 1.005; 95% CI: 1.000–1.010, p = 0.048), globulin (OR: 0.915; 95% CI: 0.862–0.972, p = 0.004), left ventricular ejection fraction (OR: 0.951; 95% CI: 0.928–0.975, p < 0.001), and coronary angiography (OR: 0.183; 95% CI: 0.058–0574, p = 0.004). The nomogram incorporating these variables demonstrated an area under the curve of 0.937 (95% CI: 0.952–0.967), indicating good discriminatory ability in the calibration curve and decision curve. Conclusions: Seven independent risk factors for CS in AMI patients were identified upon admission. The proposed nomogram might facilitate early risk stratification and guide clinical decision-making to improve outcomes. Full article

Cardiogenic shock (CS) is a heterogeneous pathophysiological state with high mortality, despite the development of cardiac intensive care units (CICUs) and the advanced treatments applied. The cornerstones of therapy that have been proposed in many algorithms are intravenous (i.v.) pressors and devices for mechanical circulatory support (MCS), depending on the CS profile (left, right, or biventricular involvement), etiology (acute myocardial infarction, heart failure, or other) and SCAI stage (A to E, with MCS generally recommended for Stages C–E). There are many gaps in the evidence regarding i.v. medications and devices, with the existing data being controversial. Moreover, there are differences in the devices’ availability and, as a result, a lack of experience in many centers. In this review article, an algorithm for the management of CS is proposed, and the gaps in every step are presented. Early clinical suspicion that leads to prompt diagnosis, health system organization, large-scale trials, and the configuration of national or regional shock centers could bridge the current therapeutic gaps and balance disparities in the management of CS in order to improve outcomes. Full article

Background: Inflammatory bowel disease (IBD) is associated with systemic inflammation and potential cardiovascular complications. This meta-analysis evaluates long-term cardiovascular risks in IBD. Methods: Electronic databases were searched for studies examining cardiovascular, cerebrovascular, and thromboembolic risks in IBD. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: Fifty-three studies comprising 1,406,773 patients were analyzed. IBD was linked to increased risk of ischemic heart disease (aHR 1.25; p = 0.001) myocardial infarction (aHR 1.25; p = 0.01), acute coronary syndrome (aHR 1.43; p < 0.00001), heart failure (aHR 1.24; p < 0.00001), atrial fibrillation (aHR 1.20; p < 0.00001), and stroke (aHR 1.13; p < 0.00001). Elevated risks were also observed for peripheral arterial disease (aHR 1.41; p < 0.00001), diabetes mellitus (aHR 1.40; p < 0.00001), venous thromboembolism (aHR 1.98; p < 0.00001), deep vein thrombosis (aHR 2.85; p = 0.0004), and pulmonary embolism (aHR 1.98; p = 0.03). Importantly, IBD was associated with increased cardiovascular (aHR 1.14; p = 0.03) and all-cause mortality (aHR 1.53; p < 0.00001). Conclusions: IBD patients face higher risk for adverse cardiovascular outcomes, thromboembolic disease, and mortality, necessitating early cardiovascular risk assessment and targeted interventions in this population. Full article

Background: Takotsubo syndrome (TTS) often mimics anterior ST-elevation myocardial infarction (STEMI) caused by left anterior descending (LAD) occlusion, yet the two entities differ fundamentally in pathophysiology and mechanical behavior. Two-dimensional speckle-tracking echocardiography (2D-STE) enables detailed assessment of left ventricular (LV) deformation beyond conventional ejection fraction (LVEF). This meta-analysis compared global and regional LV strain patterns in TTS versus LAD-related anterior STEMI during the acute phase. Methods: A systematic search of PubMed, Embase, and Scopus through October 2025 identified observational case–control studies directly comparing TTS and angiographically confirmed anterior STEMI, with LV mechanics assessed by 2D-STE. Random-effects models were used to pool standardized mean differences (SMDs) for LVEF; global longitudinal strain (GLS); apical, mid-ventricular, and basal longitudinal strain (ALS, MLS, BLS); and global radial strain (GRS). Heterogeneity (I²), publication bias (funnel plots, Egger’s test), meta-regression, and leave-one-out sensitivity analyses were performed. Results: Six studies comprising 221 TTS and 290 anterior STEMI patients met the inclusion criteria. TTS patients were older, predominantly female, and had fewer metabolic risk factors, while LV size was comparable. LVEF was significantly lower in TTS (SMD −1.149; 95% CI −2.20 to −0.10; p = 0.032), with stable findings across sensitivity analyses and no evidence of publication bias. GLS, ALS, MLS, and BLS showed only a non-significant trend toward greater impairment in TTS, and these comparisons were limited by marked inter-study heterogeneity. In contrast, GRS was significantly and consistently more reduced in TTS (SMD −1.284; 95% CI −1.59 to −0.98; p < 0.001), indicating more profound global radial dysfunction. Meta-regression showed no significant influence of demographic factors or vendor-specific software on LVEF or GLS differences. Conclusions: Compared with LAD-related anterior STEMI, TTS is associated with more severely depressed LVEF and markedly impaired radial strain, while longitudinal strain differences remain inconclusive and suggest only a potential trend toward greater dysfunction, reflecting the limited and heterogeneous evidence. These findings are consistent with diffuse, stress-induced myocardial stunning in TTS and suggest that 2D-STE may aid differentiation between stress cardiomyopathy and ischemic infarction in the acute setting, although longitudinal strain parameters should be interpreted cautiously and regarded as hypothesis-generating. Full article

Introduction: Sepsis-induced cardiac dysfunction (SICD) is a reversible type of cardiac disorder, with variable reported incidence and uncertain prognostic implications that may occur in patients with sepsis. This study aimed to identify patients with SICD, characterise their clinical and paraclinical features, analyse the different patterns of cardiac dysfunction, and determine prognostic implications. Methods: Patients admitted to the intensive care unit (ICU) for sepsis or septic shock who underwent echocardiography on admission were identified retrospectively. Exclusion criteria included acute myocardial infarction, preexisting severe left heart valve disease or systolic dysfunction. Clinical, paraclinical, and echocardiography data were documented. The primary outcome was a composite of in-hospital mortality, prolonged hospital stay, and prolonged ICU stay. Results: A total of 128 septic patients were included, with a median age of 72.5 years and a 55% male proportion. Alcohol abuse, vasopressor therapy and orotracheal intubation on admission were risk factors for developing SICD. More than a third developed SICD (37%). We identified four different types of cardiac dysfunction based on echocardiography. An NT-proBNP level of over 9000 pg/mL was a predictor of SICD, composite outcome and mortality. A total of 56 patients (44%) experienced in-hospital mortality. Even though the occurrence of SICD did not predict mortality, it was a significant predictor of the composite outcome. Conclusions: This study describes the incidence and spectrum of SICD in a group of septic patients admitted to a tertiary care hospital. The occurrence of any type of cardiac dysfunction associated with sepsis and high NT-proBNP levels had strong prognostic implications. Full article

Myocardial infarction (MI) triggers complex heart–brain interactions that increase the risk of stroke, cognitive decline, and mortality. Neuroinflammation and oxidative stress serve as critical mediators of these complications. We evaluated the neuroprotective effects of nebivolol, a β-blocker with nitric oxide-releasing properties, during acute MI. Male Sprague-Dawley rats were divided into sham-operated controls, MI-induced controls, and MI groups treated with oral nebivolol or intravenous loading followed by oral nebivolol. MI was induced by left anterior descending coronary artery ligation. Cardiac function was assessed by echocardiography and hemodynamic measurements. Brain tissues were analyzed for proinflammatory cytokines, oxidative stress markers, and histopathological changes. Nitric oxide synthase (NOS) isoform expression was evaluated by immunohistochemistry. MI induced significant neuroinflammation in the cerebral cortex and hippocampus, characterized by elevated cytokines, increased oxidative stress, upregulated iNOS expression, and altered histological patterns (necrosis, astrocytosis, gliosis, demyelination). Intravenous nebivolol significantly reduced these neuroinflammatory markers, normalized cytokine levels, prevented structural brain changes, and attenuated iNOS expression, while oral administration showed minimal effects. Both routes preserved cardiac function without affecting infarct size. These findings demonstrate that nebivolol, particularly via intravenous administration, provides significant NO-dependent neuroprotection during acute MI, supporting its potential as a dual-action therapeutic strategy targeting both cardiac and neurological complications. Full article

Background: Rosuvastatin and atorvastatin are indicated for cardiovascular protection in patients with type 2 diabetes (T2D) but may differ in clinical effectiveness and safety. This study compared real-world cardiovascular and safety outcomes associated with rosuvastatin versus atorvastatin in patients with T2D, with an emphasis on older adults. Methods: This retrospective cohort study used electronic health records from 10 Korean hospitals standardized to the Common Data Model. Adults (≥18 years) with T2D who were newly prescribed rosuvastatin or atorvastatin were included. After propensity score matching, primary outcomes (myocardial infarction [MI], heart failure, stroke, cardiac arrest, and in-hospital death), secondary outcomes (peripheral arterial disease [PAD] and glaucoma), and safety outcomes (acute kidney injury, cataract, and myalgia) were compared. Subgroup and sensitivity analyses were conducted among patients aged ≥65 years. Results: Among 49,034 patients (rosuvastatin, 16,123; atorvastatin, 32,911), baseline characteristics were well balanced. Across all participating hospitals, the comparative analyses showed no meaningful differences in cardiovascular or safety outcomes between the two statins. However, among patients aged ≥65 years, rosuvastatin was associated with a higher risk of PAD (hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.03–1.38), and this finding was consistent in sensitivity analysis (HR 1.31; 95% CI 1.01–1.70). Conclusions: Rosuvastatin and atorvastatin demonstrated comparable cardiovascular effectiveness and safety. Although rosuvastatin was associated with a modestly higher incidence of PAD in older adults, the difference was small. From a clinical perspective, these findings underscore the importance of individualized statin therapy tailored to patient-specific factors such as age, comorbidity, and vascular health. Overall, both statins provide overall therapeutic equivalence for cardiovascular prevention. Full article