Search Results (576)

Background: There is limited contemporary evidence on predictors of adverse outcomes in ST-elevation myocardial infarction (STEMI) involving the right coronary artery (RCA). We examined this in a single-centre retrospective cohort study, focusing on 30-day outcomes. Methods: Consecutive patients presenting to an Australian tertiary hospital between May 2022 and April 2024 with acute STEMI who underwent primary percutaneous coronary intervention (PCI) or rescue PCI were eligible. Patients were divided into STEMI due to RCA and non-RCA culprit lesions, and their characteristics were compared. The primary outcome was a composite of 30-day all-cause mortality and cardiogenic shock. Results: Among 320 included patients, the primary composite outcome was similar between the RCA and non-RCA groups (12% vs. 15%, p = 0.44), although 30-day mortality was lower in the RCA-STEMI group (2% vs. 8%, p = 0.01). In the RCA-STEMI cohort, right ventricular (RV) longitudinal dysfunction on echocardiogram, defined as a tricuspid annular plane systolic excursion (TAPSE) < 17 mm or RV tissue doppler lateral annular systolic velocity (RV S′) < 10 cm/s (p = 0.04), and Thrombolysis in Myocardial Infarction (TIMI) flow < 3 in the RV marginal branch post-PCI (p = 0.04) were independently associated with the primary outcome. The latter was also associated with a higher risk of intensive care unit admission for cardiogenic shock (p < 0.01) and heart failure requiring inpatient diuresis (p = 0.02). Conclusions: In patients with RCA-STEMI, compromised RV marginal branch flow post-PCI and impaired RV function were independently associated with the composite primary outcome of 30-day all-cause mortality and cardiogenic shock. These characteristics may assist early identification of at-risk individuals who could benefit from pro-active monitoring and early implementation of therapies for cardiogenic shock. Full article

With the considerable number of low-dose CT examinations performed in lung cancer screening, variations in participant positioning, scan direction, or localiser angle are likely to occur in practice. These variations are known to affect automatic tube current modulation (ATCM) operation, yet organ-specific dose implications across CT models remain unknown. Therefore, this simulation study systematically characterised the effect of the aforementioned variations. Using the Alderson RANDO phantom, ATCM profiles were established on CT scanners from four major vendors (GE, Siemens, Canon, Philips) after introducing vertical and lateral mispositioning, craniocaudal and caudocranial scan directions, and varying localiser projection angles. Additionally, off-centre positioning and scan direction changes preceded by either a single posteroanterior (PA) or dual (PA+lateral) localiser were evaluated. Doses to the lungs, heart, thyroid, liver, and breasts were calculated from Monte Carlo simulations of each setup for 32 patient-specific voxel models. The results demonstrate statistically significant and scanner-dependent dose variations. PA localisers generally produced the highest organ doses. However, on the Philips system, organ dose increases of at least 50% were observed after the lateral projection angle. GE and Siemens scanners showed pronounced dose increases following downward mispositioning with a single PA localiser (18–50% and 5–25%, respectively), an effect largely mitigated by adding a lateral localiser. Canon and Philips scanners exhibited generally stable ATCM behaviour after vertical off-centring, although Canon showed notable dose increases upon lateral mispositioning, with dose increases up to 37.5% and 34% after a single PA or dual localiser, respectively. Variations in scan direction displayed highly model- and organ-dependent effects. Dose deviations were largely mitigated after dual localisers for the GE, Canon, and Philips scanner types. Here, organ dose differences were within an absolute range of 10%, indicating that a change in scan direction preceded by a dual localiser can reduce extreme dose deviations. Remarkably, no significant difference was observed solely for the Siemens scanner when combined with a dual localiser, as lung, heart, breast, and liver doses remained significantly (between 20 and 35%) lower when scanning craniocaudally, whereas the thyroid dose in this setup remained considerably higher (up to 20% mean increase). Ultimately, findings indicate that seemingly minor protocol deviations can lead to significant underestimation of anticipated organ-specific doses associated with lung cancer screening. Scanner-specific optimisation, supported by medical physics expertise, is therefore essential. Full article

Background: Rickettsial diseases are endemic in southeastern Mexico, yet their potential subclinical cardiac effects remain poorly understood. Although severe spotted fever and typhus group infections may cause myocarditis and arrhythmias, limited evidence exists regarding cardiac alterations in individuals previously diagnosed with rickettsiosis who later show Rickettsia spp. IgG seropositivity. Methods: This follow-up observational study was conducted at a tertiary referral hospital in the Yucatan Peninsula. From an initial cohort of 390 patients evaluated for suspected rickettsial disease, 284 were confirmed as IgG-positive during follow-up. Among them, 18 adults who were asymptomatic for acute rickettsiosis at reassessment, but reported mild or nonspecific cardiac symptoms, underwent standardized cardiological evaluation. Procedures included a 12-lead electrocardiogram (ECG), transthoracic echocardiography, and 24 h Holter monitoring. All studies were reviewed independently by two blinded cardiologists with senior adjudication. Results: Global systolic function was preserved in all participants. However, subclinical abnormalities were identified, including right ventricular dilation in 16.7%, clinically relevant QTc prolongation in 22.2%, sinus pauses in 11.1%, reduced heart rate variability in 11.1%, atrial flutter in one patient, and complete left bundle branch block in one patient. QTc prolongation was detected exclusively through Holter monitoring. Conclusions: Adults previously diagnosed with rickettsiosis may exhibit subclinical cardiac involvement despite apparent recovery. Holter monitoring appears more sensitive than ECG for identifying electrical disturbances, warranting larger prospective studies. Full article

Background/Objectives: Entelon150^® (Vitis vinifera seed extract), losartan, and rosuvastatin have been shown to be effective in reducing calcification and inflammation of bovine pericardium implants. However, no study has compared the effects of the drugs on bioprosthetic heart valve (BHV). This study aimed to compare the anti-calcification and anti-inflammatory effects of each drug in a rat model. Methods: Twenty-eight female Sprague-Dawley rats (two weeks old) were implanted with BHV leaflets in the dorsal subcutis. They were divided into control, losartan (10.3 mg/kg/day), rosuvastatin (2 mg/kg/day), and Entelon150^® (30.8 mg/kg/day) groups. Eight weeks later, the calcium level and inflammatory cell infiltration in the BHV leaflets as well as the expression levels of IL-6, osteopontin, and BMP-2 in the surrounding tissues were measured. Results: Losartan-, Entelon150^®-, and rosuvastatin-treated groups showed a decrease in the calcium content as compared to the control group in the order. A reduction in the inflammatory cell infiltration was observed in the treatment groups (losartan > Entelon150^® > rosuvastatin) as compared to that in the control group. The treatment groups showed a decrease in IL-6, OPN, and BMP-2 expression levels as compared to the control group in the following order: Entelon150^® > losartan > rosuvastatin. Conclusions: The calcification of the BHV leaflets and inflammation of the surrounding tissues in treatment groups were lower than those in the control group and were comparable to each other. Entelon150^® showed comparable anti-inflammatory and anti-calcification effects and may represent a potential therapeutic candidate for prolonging BHV durability, although further validation is required. Full article

Heart and respiratory rate monitoring during sleep enables the detection of physiological irregularities through contact or contactless methods. Traditional approaches like polysomnography are accurate but costly, ergonomically limited, and often poorly accepted by patients. Smart Bedding^® is a novel, flexible bedsheet equipped with a high-resolution sensor network that records movement, pressure, sound, temperature, and humidity throughout the night. This study aimed to estimate cardiorespiratory parameters using the Smart Bedding^® IMU. Data from 30 participants sleeping on Smart Bedding^® while undergoing simultaneous polysomnography were analyzed. A robust and low-cost preprocessing pipeline was developed; estimation was performed using zero-crossing, peak detection, and Burg’s method for comparison, and validation was conducted using polysomnography as the gold-standard reference. Respiratory and heart rates were accurately estimated, achieving overall accuracies of 93.9% and 88.7% using zero-crossing and peak detection, respectively. Respiratory rate estimation showed no significant limitations across the frequency spectrum or among sleeping positions. However, heart rate estimation accuracy decreased when the frequency was below 55 BPM or when participants slept in a lateral sleep position, likely due to reduced cardiac signal power. Overall, the proposed methodology accurately tracked respiratory and cardiac patterns throughout the night, supporting Smart Bedding^® as a promising tool for future sleep tracking applications. Full article

Cantrell syndrome (CS) is a rare congenital disorder involving defects in the thoraco-abdominal midline, the diaphragm, the pericardium, the sternum and the heart. Since the initial description of the syndrome, 165 well-documented cases in humans have been reported, demonstrating substantial heterogeneity ranging from complete pentalogy to partial or atypical variants. A systematic review classified body wall defects and associated anomalies into nine categories, which are fully described in the manuscript. The categories include midline defects (UThAb, SUThAb, UAb, SUAb, SUICD, and UH), lateral defects (ThLAb and StLAb), and special cases. Each case was reassessed for umbilical cord status, body wall morphology, cardiac anomalies and additional malformations. Midline defects predominated (153 out of 165 cases, 92.7%), with supraumbilical variants being the most frequent. Umbilical hernias formed a distinct subgroup of ten cases. Lateral defects were uncommon (9 cases, 5.5%) and typically presented as thoracogastroschisis or lateral thoracoabdominoschisis. These defects were often associated with normal umbilical cords. Cardiac anomalies were universal, with ventricular and atrial septal defects being the most common findings. Reclassification revealed that many cases originally labeled as ‘classic pentalogy of Cantrell’ were more accurately classified as partial or atypical forms. This unified framework improves epidemiological understanding and diagnostic precision. From a One Health perspective, it underscores CS as a shared developmental vulnerability across mammalian species. Full article

Because CKMS was only proposed by the American Heart Association in 2023, there has been a paucity of information about the distribution and determinants of the syndrome across population groups. We reviewed published studies of the prevalence of CKMS in the U.S. and other countries and obtained new estimates of the prevalence of this syndrome among U.S. adults by birth decade and sociodemographic attributes using 2019, 2021, and 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. The results of this study indicate that CKMS is widespread in the general U.S. population, especially among older cohorts born before 1940 and during the 1940s, 1950s, and 1960s. Except for the three younger cohorts, born in the 1980s, 1990s, and 2000 or later, the prevalence of CKMS stage 4 was significantly higher among males than in females. Among those born between the 1950s and 1990s, the prevalence was significantly higher among non-Hispanic Blacks compared to their non-Hispanic white counterparts. Across all birth decades, prevalence of CKMS stage 4 was generally higher among those without a college degree, from a low-income household, and residing in rural areas. These prevalence rate estimates will further our understanding of the burden and unique needs of different population groups in improving cardiovascular–kidney–metabolic health across the life course. Full article

What does “Big Bang” mean? What was the actual origin of these two words? There are many aspects hidden under this name, which are seldom explained. They are discussed here. To frame the analysis, help will be sought from the highly authoritative voices of two exceptional writers: William Shakespeare and Umberto Eco. Both have explored the tension existing between words and the realities they name. And this includes names given to outstanding theorems and spectacular discoveries, too. Stigler’s law of eponymy is recalled in this context. These points will be at the heart of the quest here, concerning the concept of “Big Bang”, which only a few people know what it means, actually. Fred Hoyle was the first to pronounce these words, in a BBC radio program, with a meaning that was later called inflation. But listeners were left with the image he was trying to destroy: the explosion of Lemaître’s primeval atom (an absolutely wrong concept). Hoyle’s Steady State will be carefully compared with inflation cosmology. They are quite different, and yet, in both cases, the possibility of creating matter/energy out of expanding space is rooted in the same fundamental principles: those of General Relativity. As is also, the possibility of having a universe with zero total energy, anticipated by R.C. Tolman, in 1934 already. It will be shown, how to obtain accelerated expansion from negative pressure; how to reconcile energy conservation with matter creation in an expanding universe; and a curious relation between de Sitter spacetime and Steady State cosmology. Concerning the naming issue, it will be remarked that, today, the same label “Big Bang” is used in very different contexts: (a) the Big Bang Singularity; (b) as the equivalent of cosmic inflation; (c) speaking of the Big Bang cosmological model; (d) to name a very popular TV program; and more. Full article

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease and affects male patients more often than women. Prior studies, however, suggested that women are diagnosed later and at advanced stages of the disease, present with more pronounced symptoms, and experience worse outcomes. Objectives: To investigate sex-specific differences in clinical, laboratory, and comprehensive imaging characteristics in a contemporary cohort of HCM patients from a tertiary referral center in Austria. Methods: We retrospectively analyzed 321 HCM patients enrolled in a prospective registry (2018–2024). All patients underwent a comprehensive baseline evaluation, including medical history, laboratory assessment, transthoracic echocardiography, and cardiac magnetic resonance imaging. Results: At diagnosis, women were significantly older (62 vs. 53 years, p < 0.001) and presented with more advanced functional class (NYHA ≥ II: 80% vs. 49%, p < 0.001). Six-minute walking distance was lower and obstructive HCM was more prevalent in women (425 vs. 505 m, p < 0.001, and 55% vs. 32%, p < 0.001, respectively). Echocardiographic assessment revealed higher diastolic filling pressures (E/E′ 18 vs. 10, p < 0.001), larger indexed atrial volumes (29.5 vs. 26.6 mL/m², p < 0.001), a higher left ventricular ejection fraction (70% vs. 62%, p < 0.001), and a larger indexed interventricular septal thickness in women (10.2 vs. 9.3 mm/m², p = 0.004). Moreover, serum levels of NT-proBNP were significantly higher in women (760 vs. 338 pg/L, p < 0.001). Conclusions: Female patients with HCM were diagnosed at an older age, presented with more advanced symptoms, had higher rates of obstructive physiology, and a phenotype characterized by diastolic dysfunction and elevated biomarkers, closely resembling heart failure with preserved ejection fraction. Recognizing these sex-specific disparities is crucial in improving diagnostic awareness and individualized therapeutic management. Full article

Background/Objectives: The long-term impact of intubation during infancy or early childhood on later childhood or adolescence remains unclear. This study investigates the association between early-life intubation and subsequent mental health outcomes. Methods: We conducted a retrospective cohort study using nationwide data on children born in Korea between 2002 and 2005. Those who underwent intubation (exposed cohort) were compared with 1:10 matched unexposed controls who did not undergo intubation. Results: The exposed cohort (n = 18,799) had a significantly higher incidence rate of mental health disorders than controls (28.2 vs. 13.9 per 1000 person-years; HR 1.82, 95% CI 1.74–1.93). Autism spectrum disorder (HR 3.09) and attention-deficit/hyperactivity disorder (HR 1.61) increased in early childhood, while bipolar disorders (HR 2.36), schizophrenia spectrum disorders (HR 2.27), depressive disorders (HR 1.94) and anxiety disorders (HR 1.84) increased in adolescence. Higher incidence was noted in females, children not admitted to intensive care units, and those without congenital heart disease or bronchopulmonary dysplasia (p < 0.05). Hospitalization length correlated with mental health outcomes (p < 0.001), but ventilator duration did not (p = 0.694). Conclusions: Early-life intubation is associated with an increased risk of mental health disorders, highlighting the need for long-term follow-up and support for these children. In particular, increased clinical awareness is needed during follow-up care for patients at higher risk, such as females, children without congenital heart disease or bronchopulmonary dysplasia, those intubated at an older age, and those with longer hospitalizations. Full article

Background: Obesity, defined as an abnormal accumulation of body fat, is becoming a global epidemic. Individuals with obesity may present with increased abdominal fat, which is associated with hypertension, altered respiratory mechanics, higher resting heart rate, and may contribute to an increased cardiovascular risk. Physiological parameters, such as heart rate, blood pressure, respiratory rate, and oxygen saturation, can change hours before the occurrence of a clinically relevant adverse event. Thus, physiological parameters can be considered good predictors of clinical deterioration. Obesity is also associated with physical dysfunctions that can impair physical performance. The non-pharmacological therapeutic strategy for the treatment of obesity involves lifestyle modifications, including a healthy diet and regular physical exercise. Whole-body vibration (WBV) exercise, a type of physical activity, has demonstrated benefits in several specific populations, including obese individuals. Objectives: The objective of this study was to evaluate the immediate effects of a single whole-body vibration (WBV) exercise session, consisting of 15 sets, using a vibration platform (VP) with alternating vertical or lateral displacement, on physiological parameters, perceived exertion, strength, and functionality in obese adults. Methods: Seventy-two obese adult participants were randomly divided into three groups (vertical group, alternating lateral group, and placebo group). Physiological parameters were assessed before, during, and after the intervention, in addition to perceived exertion, functionality, and muscle strength. Results: When comparing the results before and after the intervention, the heart rate–pressure product increased significantly in the alternating lateral group (p = 0.005), and heart rate increased significantly (p = 0.0001) and then decreased significantly (p = 0.030) only in the alternating lateral group. Post hoc analysis revealed a significant increase in perceived exertion in the lateral alternation group, from the period before the intervention to the 10th set (p = 0.006) and from the period before to the period after the intervention (p = 0.011). In the vertical group, a significant increase was observed from the period before the intervention to the 10th set (p = 0.020). Conclusions: In conclusion, considering all the findings of this study, whole-body vibration (WBV) exercise promoted some immediate changes in physiological parameters and perception of effort in obese adults. WBV exercise with the alternating vibration platform induced significant fluctuations in heart rate and increased the heart rate–blood pressure product, although with values within the normal range. Perception of effort increased in all groups. Considering the absence of discrepant changes in physiological parameters, impact on the cardiovascular system, and fatigue, the WBV exercise intervention in side-alternating or vertical vibration vibratory platforms can be considered a viable non-conventional exercise option for the obese population. Full article

Background: Sex-based disparities in the presentation, management, and outcomes of infective endocarditis (IE) remain insufficiently characterized despite their growing recognition. This study systematically evaluates current evidence on sex differences in the presentation, treatment, and outcomes of IE. Methods: A systematic review and meta-analysis were conducted according to PRISMA and Cochrane guidelines. EMBASE, MEDLINE, PubMed, the Cochrane Library, and Google Scholar were searched up to October 2024. Twenty-four studies including 139,952 patients (79,698 men and 60,254 women) were analyzed. Primary outcomes were mortality (in-hospital, 30-day, and 1-year), stroke, and treatment modality (medical vs. surgical). Secondary outcomes included complications, procedural characteristics, and hospital course. Results: Men were younger at diagnosis and had higher rates of substance abuse and coronary artery disease, while women more often had hypertension, diabetes, chronic lung disease, and prior valvular pathology. Men more frequently had aortic and prosthetic valve IE, whereas women had mitral and tricuspid involvement. Men were about 65% more likely to undergo surgery for infective endocarditis than women, while women were predominantly managed medically. Men had lower in-hospital (OR 0.81, 95% CI 0.72–0.92) and 1-year mortality (OR 0.76, 95% CI 0.61–0.94), though 30-day mortality did not differ significantly. Women experienced shorter hospital stays but longer ICU admissions and more heart failure, whereas men had more recurrent IE. Conclusions: Men underwent surgery more often and had better short- and long-term survival. Women presented later, with greater comorbidity and higher complication rates. Enhanced recognition of sex-specific risk and equitable surgical referral may improve IE outcomes. Full article

Cocaine-related deaths present significant diagnostic challenges due to the nonspecific nature of cardiac histopathology and the limited reliability of postmortem toxicology, often affected by redistribution phenomena. This study investigated the postmortem heart expression and distribution of an anti-cocaine monoclonal antibody, aiming to evaluate immunohistochemistry (IHC) as a potential complementary tool for diagnosing cocaine-related fatalities. Fifteen cases of acute cocaine-related death, with toxicological data exclusively positive for cocaine, were examined and compared to ten cases negative for drug abuse. Cardiac samples from the lateral left ventricular wall and interventricular septum underwent IHC using an experimentally optimized protocol. All cocaine-related cases demonstrated clear and widespread immunopositivity, with varying staining intensities across a semi-quantitative scale. Immunostaining localized consistently to nuclear and myofibrillar compartments and showed no association with postmortem interval (mean PMI 72.33 h; range 30–144). Control samples exhibited no staining. Positive immunostaining also highlighted cardiomyocyte alterations related to cocaine toxicity, particularly hypercontracted fibers with myofibrillar rhexis and contraction band necrosis. While these findings align with the established cocaine-induced myocardial injury, the intense nuclear staining observed may further reflect oxidative DNA damage associated with cocaine exposure. This study provides novel evidence supporting the applicability of anti-cocaine IHC in postmortem investigations. The technique may serve as a valuable adjunct in detecting cocaine distribution within cardiac tissue, particularly when toxicological data are inconclusive or unavailable. Full article

Background/Objectives: The first 1000 days of life represent a critical window for growth and neurodevelopment, during which nutrition strongly influences brain development and metabolic programming. In phenylketonuria (PKU), dietary management is essential to prevent neurological impairment and later-life risk of non-communicable diseases (NCDs). This review examines current evidence on PKU from pregnancy through complementary feeding, highlighting the impact of nutritional strategies on neurodevelopmental and metabolic outcomes. Methods: This narrative review, following PRISMA guidelines, used a systematic search of PubMed and Scopus with defined PICO questions. Original research, reviews, and guidelines on PKU nutrition during the first 1000 days were included, emphasizing neurological and metabolic outcomes. Results: Articles addressed prenatal and postnatal factors in PKU. Optimised metabolic control in women with PKU is critical to prevent maternal PKU syndrome, reducing risks of miscarriage, congenital heart defects, microcephaly, and neurocognitive impairment. Pre-conception dietary management, frequent blood Phe monitoring, supplementation with Phe-free protein substitutes (PSs), micronutrients, and emerging pharmacological therapies support maternal and foetal health. Following newborn screening, early dietary treatment in infants with PKU maintains plasma Phe within safe ranges, promoting growth and neurodevelopment. Breastfeeding, combined with Phe-free infant PSs, is feasible, and complementary feeding should be introduced carefully. Frequent monitoring and tailored dietary adjustments, including second-stage PSs, support metabolic control, while data on gut microbiota remain limited. Conclusions: Early multidisciplinary interventions are crucial to optimise metabolic and neurodevelopmental outcomes during this window of opportunity. Further research is needed to address remaining gaps and optimise PKU management across the first 1000 days. Full article

Background/Objectives: The majority of chromosome 22q11.2 deletions are de novo, resulting from meiotic non-allelic homologous recombination (NAHR). While 22q11.2 deletion syndrome (22q11.2DS)-associated phenotypes are well characterized, risk factors leading to NAHR are poorly understood, including the possible relationship with assisted reproductive technology (ART). Here we examined the prevalence of ART conceptions and medical comorbidities in patients with 22q11.2DS vs. spontaneously conceived (SC) patients with 22q11.2DS. Methods: Retrospective analysis, under IRB approval, of medical records on 1184 patients with laboratory-confirmed de novo chromosome 22q11.2 deletions was performed. ART conceptions included IVF with and without ICSI. Deletion size and obstetric, family, and medical histories were examined. Results: We identified 30 pregnancies conceived using ART (2.57%) compared with the U.S. general population rate of 2.3% (p-value = 0.6603). ART and SC sub-cohorts demonstrated no significant differences in deletion size or perinatal outcomes, including preterm birth, multiples, polyhydramnios, or congenital heart disease. Controlling for these factors, neonates conceived via ART were more likely to be admitted to the ICU (aOR = 6.3). Conclusions: Pregnancies conceived via ART, and later found to have 22q11.2DS, demonstrated no significant differences in prevalence or perinatal outcomes compared with the U.S. general population. Moreover, NAHR is unrelated to ART in this population. Likewise, associated phenotypic features are unrelated. These data will be reassuring to those families where ART was employed to conceive children who were later found to have 22q11.2DS. Full article