Search Results (4,627)

Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and long-term adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centre-based model and to support more flexible, patient-centred care. Methods: This narrative “review on a systematic backbone” synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and tele-rehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multi-component digital CR solutions. Only original studies with clinical, functional, or patient-reported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealth-enabled home-based or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centre-based CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved risk-factor profiles and quality of life to a degree comparable with face-to-face CR. Conclusions: Digital technologies can credibly support core objectives of CR in high-risk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patient-centred rehabilitation. Full article

Background and Objectives: Patients with a prior history of coronary artery bypass grafting (CABG) who present with non-ST-segment elevation myocardial infarction (NSTEMI) represent a complex, high-risk subgroup due to advanced comorbidity burden and challenging coronary anatomy. Whether an invasive strategy offers meaningful benefit over conservative management in this population remains unclear. Therefore, this study aimed to compare long-term outcomes of percutaneous coronary intervention (PCI) versus medical therapy in NSTEMI patients with previous CABG and to identify independent predictors of major adverse cardiovascular events (MACE) and all-cause mortality. Materials and Methods: This retrospective cohort study included 286 NSTEMI patients with prior CABG (PCI: 112; medical therapy: 174). Baseline demographic, clinical, laboratory, and angiographic characteristics were assessed. The primary endpoint was MACE, while the secondary endpoint was all-cause mortality. Kaplan–Meier analysis evaluated survival differences, and multivariable Cox regression identified independent predictors. Results: During follow-up, MACE rates were comparable between PCI and medical therapy (14.3% vs. 18.9%; p = 0.305). All-cause mortality was likewise similar (9.8% vs. 10.3%; p = 0.541). Kaplan–Meier analysis showed no survival benefit with PCI (log-rank p = 0.334). Hypoalbuminemia independently predicted both MACE and mortality, while CKD and HF were major determinants of long-term mortality. Conclusions: In NSTEMI patients with prior CABG, no long-term superiority of PCI over medical therapy was observed with respect to MACE or mortality. Prognosis appears more closely linked to hypoalbuminemia, CKD, and HF than to the chosen management strategy. These findings underscore the importance of individualized and risk-adapted clinical decision-making in this complex population. Full article

Background: Platelet hyperreactivity contributes to occlusive thrombus formation in vessels, precipitating acute cardiovascular events such as myocardial infarction and stroke. Traditional Chinese Medicine (TCM) has been used for centuries, and numerous TCM herbs have been reported to exert anti-inflammatory and anticoagulant effects. Objectives: We sought to identify key compounds within the TCM-derived herbal extracts that regulate platelet activity. Methods: Crude and fractioned herbal extracts were screened for their ability to inhibit platelet activation in response to multiple agonists. Platelet aggregation and flow cytometry were used to assess the potency and selectivity of the compounds within the extracts. Results: Three extracts, di gu pi (DGP), san qi (SQ), and zi cao (ZC), demonstrated inhibitory activity and were subsequently fractionated. Fractions derived from DGP, the root bark of Lycium chinense, inhibited platelet aggregation and suppressed integrin activation and granule secretion downstream of collagen receptor signaling. Further analysis identified the oxidized lipids 9(S)-hydroxy-9Z,11E-octadecadienoic acid (9-HODE), 13(S)-HODE, and 13(S)-hydroxy-9Z,11E,15Z-octadecatrienoic acid (13-HOTrE) as constituents of the bioactive fractions. Both 13-HODE and 13-HOTrE selectively inhibited collagen-mediated platelet aggregation without affecting thrombin-induced activation. Conclusions: Collectively, these findings identify oxylipins in TCM as promising candidates for the development of antiplatelet therapies targeting platelet activity and thrombosis. These oxylipins may represent novel approaches for thrombosis and have high therapeutic potential for development as next-generation antiplatelet drugs. Full article

Myocardial infarction (MI) triggers complex pathological processes, including inflammation, hypoxia, and fibrotic remodeling. MicroRNAs (miRNAs) have emerged as promising biomarkers for cardiovascular injury; however, their expression dynamics along processes remain underexplored. We used an in vivo rat model of permanent coronary occlusion to study the molecular alterations associated with MI and its resolution in a temporal mode, including five experimental groups with five animals in each: sham, PO 24 h, PO 72 h, PO 7 d, PO 1 month. Histological analysis, serum biomarkers, and miRNA/gene expression profiles were analyzed in a time-dependent manner post-occlusion. Subsequent analysis revealed early depletion of selected circulating miRNAs (PO 24 h). Transient upregulation in cardiac tissue miRNAs, inflammatory and fibrotic gene expression (Fibronectin, Collagen, Vimentin, E-Cadherin) were observed at PO 72 h. These molecular alterations correlated with histological evidence of myocardial injury and repair. Taken together, our findings delineate the molecular timeline of MI progression and resolution and identify candidate miRNAs as sensitive and time-dependent indicators of myocardial stress, including miR-107, miR-122-5p and miR-221-3p. This integrative approach supports the use of miRNA signatures for noninvasive monitoring of cardiac injury and resolution and unveils potential therapeutic targets to reduce pathological remodeling. Full article

Despite successful revascularization, patients with non-ST elevation myocardial infarction (NSTEMI) remain at higher risk of mortality and morbidity. Accurately predicting mortality risk in this cohort can improve outcomes through timely interventions. This study for the first time predicts 1-year all-cause mortality in an NSTEMI cohort using features extracted primarily from the aortic pressure (AP) signal recorded during cardiac catheterization. We analyzed data from 497 NSTEMI patients (66.3 ± 12.9 years, 187 (37.6%) females) retrospectively. We developed three survival models, the multivariate Cox proportional hazards, DeepSurv, and random survival forest, to predict mortality. Then, used Shapley additive explanations (SHAP) to interpret the decision-making process of the best survival model. Using 5-fold stratified cross-validation, DeepSurv achieved an average C-index of 0.935, an IBS of 0.028, and a mean time-dependent AUC of 0.939, outperforming the other models. Ejection systolic time, ejection systolic period, the difference between systolic blood pressure and dicrotic notch pressure (DesP), skewness, the age-modified shock index, and myocardial oxygen supply/demand ratio were identified by SHAP as the most characteristic AP features. In conclusion, AP signal features offer valuable prognostic insight for predicting 1-year all-cause mortality in the NSTEMI population, leading to enhanced risk stratification and clinical decision-making. Full article

Medication adherence following myocardial infarction (MI) is essential for effective secondary prevention, yet adherence rates remain suboptimal. Healthcare professionals (HCPs) are central to promoting adherence through clinical decision-making, patient education, and ongoing behavioural support. Understanding how HCPs perceive and experience the factors’ influencing adherence is key to developing effective, context-specific interventions. This study explored HCPs’ perspectives on medication adherence post-MI and identified behavioural determinants influencing medication management across the care pathway. A qualitative descriptive study was conducted using semi-structured interviews with HCPs in the southwest of Ireland. Participants included hospital pharmacists, community pharmacists, general practitioners (GPs), cardiologists, and nurses, recruited through purposive, convenience, and snowball sampling. Interviews were recorded, transcribed verbatim, and analysed using directed content analysis guided by the Theoretical Domains Framework (TDF). Twelve HCPs (eight female) were interviewed between December 2024 and May 2025, including four pharmacists, two GPs, three cardiologists and three nurses. Interviews lasted 30–50 min (mean 41 min). Analysis identified 15 facilitators, 13 barriers, and 7 dual-role determinants across 10 TDF domains. Novel contributions include demonstrating how HCPs’ real-world experiences contextualise adherence issues in the distinct post-MI setting characterised by abrupt care transitions, polypharmacy, and emotional vulnerability and identifying where HCPs feel most constrained and where their expertise could directly inform targeted intervention design. HCPs’ insights reveal complex, context-specific behavioural determinants influencing post-MI medication adherence and highlight the need for multidisciplinary, tailored, and system-level solutions. Enhancing collaboration, supporting patient-centred communication, and addressing resource barriers could empower HCPs to deliver more effective, personalised adherence support and inform the development of targeted intervention strategies. Full article

Background/Objectives: The Metabolic Score for Insulin Resistance (METS-IR), a non-insulin-based index of insulin resistance (IR), and subclinical myocardial injury (SCMI), identified by electrocardiogram (ECG), are each associated with cardiovascular disease (CVD). However, their joint impact on mortality remains unclear. We examined the association of the METS-IR with SCMI and evaluated the individual and combined associations of SCMI and IR with cardiovascular mortality. Methods: We analyzed adults without baseline CVD from the Third National Health and Nutrition Examination Survey (1988–1994) with mortality follow-up through 31 December 2019. The METS-IR was calculated from fasting glucose, triglycerides, high-density lipoprotein cholesterol, and body mass index and categorized as low (<75th percentile) or high (≥75th percentile). SCMI was defined as a cardiac infarction injury score ≥ 10 on ECG. Multivariable logistic regression assessed associations between the METS-IR and SCMI, and Cox regression estimated cardiovascular mortality risk across SCMI-IR combinations. Results: Among 6079 participants, 14.1% had SCMI. Higher METS-IR values were associated with greater SCMI odds (OR (95% CI): 1.58 (1.31–1.90)). Over a median of 18.8 years, 563 (9.1%) cardiovascular deaths occurred. Both SCMI and high IR were individually associated with increased cardiovascular mortality ((HR (95% CI): 1.41 (1.19–1.69) and 1.32 (1.09–1.59), respectively). Participants with both SCMI and high IR had the highest risk (HR 1.92; 95% CI 1.49–2.50) compared with those with neither condition. Conclusions: In adults without prior CVD, the METS-IR was positively associated with SCMI. The coexistence of SCMI and high IR identified a subgroup at nearly twofold higher risk of cardiovascular mortality, supporting the combined use of ECG-based injury markers and metabolic indices for cardiovascular risk stratification. Full article

Vitamin D, a fat-soluble secosteroid traditionally recognized for skeletal health, exerts pleiotropic effects on cardiovascular physiology and disease. Circulating 25-hydroxyvitamin D [25(OH)D], the principal biomarker of vitamin D status, is frequently suboptimal worldwide, particularly in older adults, individuals with darker skin pigmentation, and populations at higher latitudes. Observational studies consistently associate low 25(OH)D concentrations with increased risk of hypertension, atherosclerosis, myocardial infarction, heart failure, arrhythmias, stroke, and cardiovascular mortality. Mechanistic investigations have revealed that vitamin D modulates cardiomyocyte calcium handling, endothelial function, vascular smooth muscle proliferation, inflammation, oxidative stress, and renin–angiotensin–aldosterone system activity, establishing biologically plausible links to cardiovascular outcomes. Despite these associations, large randomized trials of vitamin D supplementation have failed to demonstrate reductions in major cardiovascular events, likely due to heterogeneity in baseline status, dosing regimens, intervention timing, genetic variability, and underlying comorbidities. Vitamin D may function more effectively as a biomarker of cardiovascular risk rather than a universal therapeutic agent, with deficiency reflecting systemic vulnerability rather than acting as a dominant causal factor. Emerging evidence supports precision approaches targeting individuals with severe deficiency, high renin activity, early endothelial dysfunction, or specific genetic profiles, potentially in combination with lifestyle or pharmacologic interventions. Future research should focus on defining optimal dosing strategies, intervention timing, and mechanistic biomarkers to identify subpopulations most likely to benefit, integrating vitamin D therapy into multifaceted cardiovascular prevention frameworks. This systematic review synthesizes molecular, observational, and clinical trial evidence, critically evaluating the current understanding of vitamin D in cardiovascular medicine and highlighting opportunities for targeted, personalized interventions. Vitamin D represents a complex, context-dependent modulator of cardiovascular health, offering both prognostic insight and potential therapeutic value when appropriately applied. Full article

Background and Clinical Significance: Left ventricular thrombus formation after acute coronary syndrome represents a severe complication. Comprehensive echocardiographic assessment of the entire ventricle is essential, as regional wall motion abnormalities predispose to thrombus development. Although vitamin K antagonists have traditionally been the cornerstone of therapy, the convenience of direct oral anticoagulants has made them increasingly popular. However, the paucity of prospective data raises concerns regarding their general interchangeability. Case Presentation: We present a case of a basal left ventricular thrombus that rapidly progressed in size despite triple antithrombotic therapy including Apixaban. Conclusions: Following ACS, regional LV dysfunction predisposes to LVT formation—even in patients with only mild to moderate systolic impairment or non-apical akinesia. Although rare, LVT may also develop in basal and mid-ventricular segments. Anticoagulant selection should remain individualized, and short-term follow-up imaging is necessary to monitor therapeutic response. Full article

This study aims to investigate the computation of the partition dimension of various anti-myocardial infarction drugs, a graph-theoretical invariant of molecular graphs representing these drugs, for understanding and computationally characterizing structural properties of molecular networks. To improve the computational modeling of this topological invariant, advanced neural network techniques, specifically graph neural networks (GNNs) and deep neural networks (DNNs), are adopted. The GNN captures topological and molecular connection features from the molecular graph structures, which are then input into the DNN model. The DNN further processes these features to estimate the partition dimension, evaluating training performance, performing regression analysis, and producing error histograms. The model’s predictions are validated against reference values. Moreover, by analyzing the role that symmetry plays in determining the calculation of partition dimension, studying how the GNN takes advantage of permutation invariance concept related to symmetry principles to provide the DNN with symmetry-invariant features, and relating the degree of molecular symmetry to the predictive model’s accuracy and performance, its structural interpretation rather than direct chemical behavior. This dual-model approach permits a comprehensive evaluation of the model’s effectiveness in apprehending the structural characteristics of molecular graphs derived from drug molecules. The results are explicated in detail, focused on prediction accuracy, error distributions, and regression results. Moreover, this graph-theoretical metric analysis of partition dimension supports structure-based drug analysis and computational modeling, rather than direct prediction of pharmacokinetic properties, by integrating artificial neural network applications into pharmaceutical research. Full article

This review examines and hypothesizes cytoprotection as a conceptual therapeutic criterion for antiarrhythmic drugs, referring to the possibility of suppressing arrhythmias while avoiding adverse electrophysiological or systemic effects. Toward a theoretically complete cytoprotective profile—preserving benefits and eliminating toxicity—the criterion was the degree of counteraction of arrhythmias (i.e., bradycardia, tachycardia, atrioventricular (AV) block, ventricular tachycardia (VT), ST-segment changes, prolonged P, PR, QRS, and QT/QTc intervals, and repolarization). Conventional and new antiarrhythmics share class I–IV ≈ partial cytoprotection/narrow range; late INa inhibitors, IKs enhancers, RyR2 stabilizers, gap junction modulators, and atrial-selective antiarrhythmics ≈ partial cytoprotection/more extended range. Still predominantly in preclinical models, stable gastric pentadecapeptide BPC 157, in the clinic, has not demonstrated adverse effects in available human trials (non-cardiac) to date. As a prominent cytoprotection mediator (LD1 not achieved in toxicology studies), it demonstrates well-matched cytoprotective–antiarrhythmic effects, BPC 157 ≈ full cytoprotection/wide-range homeostasis. In vivo, this was across models of hypo-/hyperkalemia, hypermagnesemia, ischemia–reperfusion, myocardial infarction, drug-induced arrhythmias (including local anesthetics), and vascular occlusion. BPC 157 restores sinus rhythm, normalizes P/QRS/QT intervals, prevents AV block, suppresses VT, attenuates ST-segment changes, and stabilizes heart rate, even when insults are advanced. In vitro, HEK293 studies confirm direct membrane-stabilizing actions: BPC 157 prevents hypokalemia-induced hyperpolarization, reduces hyperkalemia- and hypermagnesemia-induced depolarization, and mitigates local anesthetic-induced Na⁺/Ca²⁺ dysregulation, reflecting bidirectional homeostatic modulation of membrane potential. Thus, to confirm the hypothesis, these BPC 157 conditional, not constitutive effects, in rodent models or in vitro systems (HEK293 cells), mandate expansion of now limited clinical data and mechanisms in human investigated as a translational cytoprotective strategy for complex arrhythmias. Full article

Background: Early risk stratification in ST-elevation myocardial infarction (STEMI) remains critical, particularly for anticipating adverse outcomes such as the coronary no-reflow phenomenon (NRP) and early mortality. The Endothelial Activation and Stress Index (EASIX), calculated from routine laboratory parameters, has emerged as a potential biomarker reflecting systemic endothelial dysfunction. This study evaluated the prognostic value of admission EASIX for the NRP and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Methods: In this retrospective single-center cohort, 1931 STEMI patients treated with pPCI between January 2023 and January 2025 were included. EASIX was calculated at admission. NRP was defined as post-PCI TIMI flow ≤ 2 or TIMI 3 flow with impaired myocardial blush (TMPG ≤ 1). Multivariable logistic regression, reclassification analyses (NRI/IDI), ROC analysis, and calibration methods were used to assess predictive performance. Sensitivity and interaction analyses were conducted. Results: NRP occurred in 14.1%, and in-hospital mortality was 2.5%. EASIX was independently associated with both outcomes (NRP: adjusted OR 1.485, 95% CI 1.286–1.715; mortality: adjusted OR range 1.371–2.096 across models; all p < 0.001). EASIX significantly improved risk reclassification for both NRP and in-hospital mortality (NRI > 0.20). ROC-AUCs were 0.706 for NRP and 0.810 for mortality. Restricted cubic spline and LOWESS analyses revealed nonlinear risk escalation. Calibration plots and Brier scores confirmed model reliability. Associations persisted across ischemic time and renal function strata. Conclusions: Admission EASIX is independently associated with NRP and in-hospital mortality in STEMI. Easily accessible and integrative, EASIX may enhance early risk stratification. External validation is warranted before clinical implementation. Full article

The growing number of wearable electrocardiogram (ECG) users today, combined with the surge of artificial intelligence (AI) and machine learning (ML) in medical signal-processing, has led to a new age of wearable-enabled monitoring for cardiac conditions. With the development of advanced processing methods, wearables offer the opportunity to monitor and predict the probability of various cardiac conditions, from cardiac ischemia to arrhythmias, by collecting personalized data from the comfort of a user’s home. Although such technology has not yet entered the market, AI and ML research training specifically on wearable-based ECG data has grown significantly in the last decade. Despite this growing niche, there are few current articles reviewing the applications of these techniques in wearable ECG technology. To fill this gap, this article first primes the reader to the practical tools required to build models from ambulatory ECG, synthesizes the state of the field across major cardiac condition use-cases, and finally highlights recurring limitations in the current literature and outlines the need to improve reliability if this technology were to be widely utilized. As a result, we aim to help readers who otherwise may be unfamiliar with the specifics of these tools and their applications to form an interpretation of the current capabilities of AI/ML in wearable ECGs and identify key steps required for improvement based on the most current research. Full article

Background/Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide well-established cardiovascular and renal benefits in heart failure (HF), type 2 diabetes (T2DM), and chronic kidney disease (CKD). Although emerging trials suggest potential value after acute myocardial infarction (AMI), SGLT2 inhibitors currently have no formal indication for AMI, and real-world prescribing patterns in this setting remain uncharacterized. This study aimed to evaluate in-hospital and post-discharge prescribing patterns and clinical predictors of SGLT2 inhibitor initiation among AMI patients eligible for therapy based on guideline-supported indications. Methods: We conducted a retrospective cohort study including 244 consecutive AMI patients hospitalized between January 2023 and July 2024. A total of 180 (73.7%) met guideline-based eligibility criteria for SGLT2 inhibitors. Four multivariable logistic regression models were developed to identify independent predictors of SGLT2 inhibitor prescription. Results: A total of 117 patients (65%) received SGLT2 inhibitors and 63 (35%) remained untreated. Receivers were more frequently male (81% vs. 65%) and exhibited lower left ventricular ejection fraction (LVEF) (38.2 ± 6.7% vs. 42.4 ± 8.3%), larger ventricular volumes, and higher Killip class at presentation. HF patients with preserved ejection fraction (HFpEF) were markedly undertreated (25.9%) compared with mid-range (HFmrEF) (69.8%) or reduced (HFrEF) (73.7%). Across all models, HFpEF was a strong negative predictor of prescribing (OR 0.071–0.081, p < 0.001), while male sex and markers of clinical severity were associated with higher likelihood of initiation. Many untreated patients had T2DM or CKD despite guideline-based eligibility. No serious adverse events attributable to SGLT2 inhibitors were reported. Conclusions: In this real-world AMI cohort, SGLT2 inhibitors were prescribed primarily in relation to established indications for HF, T2DM, and CKD, yet their use remained highly variable in the absence of a dedicated recommendation for AMI. Significant therapeutic gaps were observed in HFpEF and high-risk cardiometabolic profiles, underscoring the need for clearer guidance and standardized pathways to support consistent initiation in eligible patients after MI. Full article

Background/Objectives: Low image quality reduces diagnostic accuracy. We wanted to develop a framework for assessing transthoracic echocardiography (TTE) image quality in apical 2-, 3-, and 4-chamber views, and to use this framework to characterise segment-level visualisation patterns in patients with heart failure (HF). Methods: In this cross-sectional study, 268 TTE examinations from 230 patients qualified for ICD/CRT implantation in primary prevention of sudden cardiac death were analysed. Patient demographic, electrocardiographic, echocardiographic, and clinical characteristics were collected, and apical 2-, 3-, and 4-chamber views were extracted for image quality evaluation. Mean scores for each segment were calculated. The proportion of well-visualised segments per view was also evaluated. Risk factors for poor image quality were assessed. Results: We internally assessed the reliability of the framework (intra-class correlation coefficient > 0.9). The anterior and anterolateral walls consistently demonstrated the poorest quality, and the inferior segments the best. Clear inner-edge-to-outer-edge delineation of ≥5 segmental borders was achieved in only 30% of studies, while ≥5 endocardial border segments were visualised in 65% of cases. Reduced quality was frequently observed in patients with higher BMI and BSA, presence of HF risk factors (diabetes, prior myocardial infarction, and atrial fibrillation), and heart abnormalities (increased left ventricular end-diastolic value and hypokinesis). Conclusions: The prevalence of imaging challenges in TTE examinations performed in patients qualified for CRT-D/ICD implantation is high. These findings underscore the need for thorough training of echocardiographers and for sustained attention to technical details affecting image quality to achieve consistently high-quality images in routine practice. Full article