Search Results (226)

Background/Objectives: Platelet activity contributes to myocardial infarction; inadequate inhibition is a risk factor for stent thrombosis and mortality. Inadequate platelet inhibition during treatment is an important risk factor for stent thrombosis and may be associated with increased mortality. This study assessed platelet and coagulation activity in post-MI patients, identifying parameters associated with adverse ST-elevation myocardial infarction (STEMI) outcomes over 3 years, to identify patients needing intensive secondary prevention. Methods: From 57 admitted patients, 19 STEMI patients were analyzed. Thromboelastography (TEG) and Total Thrombus Formation Analysis System (T-TAS) were used to assess hemostasis and coagulation. Selected laboratory parameters were measured for correlations. Major adverse cardiovascular events (MACEs) were defined as ischemic stroke, myocardial infarction, ischemic heart disease, thrombosis, and death from cardiovascular causes. Results: The group with MACEs was characterized by a faster time to initial clot formation and greater reflection of clot strength. T-TAS parameters, such as area under the curve at 10 min (T-TAS AUC10), showed lower values in the same group of patients. A moderate positive correlation suggested that as white blood cell count increases, T-TAS AUC10 values also tend to increase. A strong negative correlation (rho = −1.000, p < 0.01) was observed between low-density lipoprotein and kinetics in the TEG using the kaolin test at baseline in patients with MACEs. Conclusions: Some of the parameters suggest they are associated with adverse outcomes of STEMI, indicate the existence of an inflammatory state, and may contribute to risk stratification of STEMI patients and identify who will require ongoing monitoring. Full article

Background/Objectives: Anatomical and functional damage of the mitral valve (MV) apparatus in patients with dilated cardiomyopathy (DCM) is secondary to left ventricular (LV) injury, leading to functional mitral regurgitation (FMR). Real-time four-dimensional echocardiography (RT 4DE) is a useful imaging technique in different pathologies, including DCM. Left atrial (LA) strain, as measured by left atrium quantification software, is an accurate technique for evaluating increased filling pressure. The MV has a complex three-dimensional morphology and motion. Four-dimensional echocardiography (4DE) has revolutionized clinical imaging of the mitral valve apparatus. This study aims (1) to characterize the mitral annulus (MA) parameters in patients with DCM and advanced-stage heart failure (HF) according to etiology and (2) to find correlations between left atrial function and MA remodeling in this group of patients, using 4DE quantification software. Methods: A total of 82 patients with DCM and an LV ejection fraction ≤ 40% were recruited. Conventional 2DE and RT 4DE were conducted in DCM patients with a compensated phase of HF before discharge. The measured parameters were left atrial reservoir strain (LASr), annular area (AA), annular perimeter (AP), anteroposterior diameter (A-Pd), posteromedial to anterolateral diameter (PM-ALd), commissural distance (CD), interregional distance (ITD), annular height (AH), nonplanar angle (NPA), tenting height (TH), tenting area (TA), and tenting volume (TV). Results: Measured parameters revealed more advanced damage of LA and MA parameters in ischemic compared to nonischemic etiology. Univariate analysis identified AA, AP, A-Pd, PM-ALd, CD, ITD, TH, TA, and TV (p < 0.0001) as determinants of LASr. Including these parameters in a stepwise multivariate logistic regression, PM-ALd (p = 0.03), TH (p = 0.043), and TV (p = 0.0001) were the best predictors of LAsr in these patients. Conclusions: The results of this study revealed the correlation between LA function depression and MA remodeling in patients with DCM. Full article

This study aimed to investigate the differences in proprioceptive changes at different time points (Pre vs. Post vs. 90 min vs. 24 h) before and after ischemic preconditioning. It followed a within-subject, self-controlled design, and a total of 21 trained male participants were assessed using two-point discrimination threshold tests on thigh and knee joint position sense testing. The results demonstrated that ischemic preconditioning effectively improved proprioceptive accuracy (two-point discrimination, right lower limb, p < 0.001; two-point discrimination, left lower limb, p < 0.001; knee position sense, right lower limb, p = 0.001; knee position sense, left lower limb, p = 0.014) and stability (two-point discrimination, right lower limb, p < 0.001; two-point discrimination, left lower limb, p = 0.002; knee position sense, right lower limb, p < 0.001; knee position sense, left lower limb, p = 0.003), with the optimal time point for enhancement identified at 90 min. This research suggests administering IPC 90 min before warm-up or competition to enhance athletic performance. Full article

Background: Ischemic preconditioning (IPC) is a non-invasive, time-efficient strategy that has been shown to acutely enhance athletic performance. The present study examined the effects of 5 min of IPC on vertical and horizontal jump performance. A secondary aim was to explore the associations between outcomes of the 5-Hop (5-H) test and drop jump performance, in order to provide further evidence supporting the validity of the 5-H test for assessing reactive strength characteristics in trained jumpers. Methods: Twelve trained track and field jumpers (nine males, three females, age: 23.2 ± 2.9 years; height: 1.76 ± 0.07 m; body mass: 71.5 ± 8.0 kg) completed two conditions: an IPC condition applied to one leg and a control condition applied to the contralateral leg. In the first week, one leg was assigned to IPC and the other to the control condition, while in the second week, the conditions for each leg were reversed. Vertical single-leg performance was evaluated by drop jump (DJ) height, ground contact time, and reactive strength index (RSI). Horizontal jump performance was assessed by a five-hop (5-H) test during which total distance (TD), total time (TT), and reactive hopping index (RHI) were obtained. Results: Compared to the control condition, IPC enhanced DJ height (+ 3.6%) and RSI (+ 7.8%) (p < 0.05, g = 0.16 and 0.32, respectively) and reduced contact time (−4.4% p < 0.05, g = 0.41). Also, IPC resulted in significant improvements in TD (+ 4.1%) and RHI (+ 3.9%) during the 5-H test (p < 0.05, g = 0.32 and 0.42, respectively), while TT remained unchanged. Conclusions: A single cycle of IPC acutely improved vertical and horizontal jump performance and reactive strength indices in trained jumpers. These findings support the use of IPC as a practical, time-efficient method to enhance neuromuscular performance in explosive tasks. Full article

Background and Objectives: International guidelines differ on short-term (4-week) oral anticoagulation (OAC) indication after acute cardioversion for recent-onset atrial fibrillation (AF < 12–48 h) in low-risk patients (CHA₂DS₂-VA = 0). While Canadian and Chinese guidelines recommend OAC for all, European, Australian and New Zealand, and American guidelines state that such treatment is optional due to the absence of high-quality evidence supporting its indication in this specific scenario. This study aimed to assess physicians’ management of a simple clinical case at an international level, focusing on how they balance ischemic and bleeding risks in a setting lacking any strong evidence-based recommendations. Materials and Methods: Six different AF guidelines were evaluated regarding the recommendation for and scientific evidence justifying short-term OAC in this specific setting. Following review, an international questionnaire was developed with Google Forms 2024 (Mountain View, CA, USA) and circulated among physicians working in the fields of cardiology, internal medicine, intensive care unit, geriatrics, and emergency medicine at 17 centres in Italy, France, and Canada. Results: A total of 78 responses were obtained. Younger physicians and cardiologists appeared to administer OAC more frequently compared to older physicians or those working in other specialties (95% CI Fisher’s Exact Test p = 0.049 and 0.029, respectively). Significant differences were observed in the use of periprocedural imaging, with transoesophageal echocardiogram (TOE) prior to cardioversion being performed more often in Europe vs. Canada (p = 0.006) and in long-term rhythm control, with first-line pulmonary vein isolation (PVI) being offered more frequently by European cardiologists (p = 0.013). No statistically significant association was found regarding guideline adherence for OAC administration (p = 0.120). Conclusions: The real-world antithrombotic management of low-risk (CHA₂DS₂-VA = 0), acutely cardioverted AF patients varies significantly among different healthcare systems. Particularly in cardiology departments, reducing the time limit for safely not prescribing OAC to < 12 h, ensuring local access to direct oral anticoagulants (DOACs) and considering regional stroke risk profiles, as well as actively preventing haemorrhage in patients receiving short-term OAC could all limit cardioversion-related complications in this low-risk population. Full article

Background/objectives: Nutritional status is increasingly acknowledged as a pivotal determinant of clinical course and recovery in patients with acute ischemic stroke (AIS). Malnutrition can compromise immune competence, delay neurological recovery, and exacerbate adverse outcomes, particularly in those undergoing intensive interventions such as mechanical thrombectomy (MT). To objectively assess nutritional status, indices such as the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score have been utilized in various clinical populations. These indices incorporate routinely available laboratory parameters, reflecting both nutritional and inflammatory states. This study explores whether PNI and CONUT scores are associated with 90-day clinical outcomes in AIS patients treated with MT, aiming to evaluate their potential utility as prognostic biomarkers in acute stroke care. Methods: A total of 404 patients with AIS who underwent MT between 2023 and 2024 were retrospectively evaluated. Demographic, clinical, and laboratory data were collected, and nutritional status was assessed using PNI and CONUT scores. Clinical outcomes were stratified as favorable (modified Rankin Scale [mRS] 0–2) or unfavorable (mRS 3–6) at 90 days post-stroke. Results: Among the 404 patients included in the study, 50.5% had favorable and 49.5% had unfavorable clinical outcomes. Patients with favorable outcomes were younger (71 vs. 78 years, p = 0.001), had lower National Institutes of Health Stroke Scale (NIHSS) scores, and higher Alberta Stroke Program Early CT Scores (ASPECTS) (p = 0.001). The puncture-to-recanalization time was significantly longer in the unfavorable outcome group (47.5 min vs. 30.0 min, p = 0.003). Laboratory findings revealed higher glucose levels (p = 0.029), and lower serum albumin (p = 0.003) and lymphocyte levels (p = 0.001) in the unfavorable outcome group. Among nutritional indices, the CONUT score was significantly higher in the unfavorable outcome group (p = 0.001), whereas the PNI score was higher in the favorable outcome group (p = 0.001). ROC analysis showed that the CONUT score had significant prognostic performance (AUC = 0.721, p < 0.001), while the PNI had poor discriminatory power (AUC = 0.274, p < 0.001). Multivariate logistic regression identified age, baseline NIHSS, ASPECT score, and CONUT score as independent predictors of clinical outcome (p < 0.05). Conclusions: Among the two nutritional indices evaluated, the CONUT score demonstrated significant prognostic value in predicting 90-day clinical outcomes after MT. In contrast, the PNI showed limited discriminatory power, highlighting the superiority of CONUT as a reliable biomarker in acute stroke care. Full article

Introduction: Endovascular thrombectomy (EVT) is highly effective for ischemic stroke patients with a large vessel occlusion. EVT is typically only offered at urban hospitals; therefore, patients are transferred for EVT from hospitals that solely offer thrombolysis. There is uncertainly around patient selection for transfer, which results in a large number of futile transfers. Machine learning (ML) may be able to provide a model that better predicts patients to transfer for EVT. Objective: The objective of the study is to determine if ML can provide decision support to more accurately select patients to transfer for EVT. Methods: This is a retrospective study. Data from Nova Scotia, Canada from 1 January 2018 to 31 December 2022 was used. Four supervised binary classification ML algorithms were applied, as follows: logistic regression, decision tree, random forest, and support vector machine. We also applied an ensemble method using the results of these four classification algorithms. The data was split into 80% training and 20% testing, and five-fold cross-validation was employed. Missing data was accounted for by the k-nearest neighbour’s algorithm. Model performance was assessed using accuracy, the futile transfer rate, and the false negative rate. Results: A total of 5156 ischemic stroke patients were identified during the time period. After exclusions, a final dataset of 93 patients was obtained. The accuracy of logistic regression, decision tree, random forest, support vector machine, and ensemble models was 68%, 79%, 74%, 63%, and 68%, respectively. The futile transfer rate with random forest and decision tree was 0% and 18.9%, respectively, and the false negative rate was 5.37 and 4.3%, respectively Conclusions: ML models can potentially reduce futile transfer rates, but future studies with larger datasets are needed to validate this finding and generalize it to other systems. Full article

Background/Objectives: Cognitive impairment is a frequent and underrecognized comorbidity in elderly patients with heart failure with preserved ejection fraction (HFpEF), contributing to poor outcomes and complicating disease management. This study aimed to identify risk factors associated with cognitive impairment in elderly HFpEF patients from Western Romania and to develop a point-based risk score for clinical use. Methods: We conducted a cross-sectional analysis of HFpEF patients aged ≥65 years. Cognitive status was assessed using the Mini-Mental State Examination-2 (MMSE-2), with significant impairment defined as a score <24. Multivariable logistic regression analysis was performed to identify independent predictors of cognitive dysfunction. Results: A total of 326 HFpEF patients were included. Diabetes mellitus, prior stroke or transient ischemic attack (TIA), carotid artery disease, elevated N-terminal pro–B-type natriuretic peptide (NT-proBNP), and reduced estimated glomerular filtration rate (eGFR) were independently associated with cognitive impairment. Higher Kansas City Cardiomyopathy Questionnaire (12-KCCQ) scores and anticoagulant therapy for atrial fibrillation were associated with a lower risk. Based on these variables, a simple point-based cognitive risk score was developed, demonstrating strong discriminatory ability (area under the curve = 0.84). A threshold of ≥2 points identified cognitive impairment with 75% sensitivity and 83% specificity. Conclusions: Our findings underscore the importance of integrated cardiovascular and cognitive assessment in elderly HFpEF patients. The developed risk score offers a pragmatic tool for the early identification of cognitive dysfunction, potentially informing timely interventions and preventive strategies. Full article

Background: Early studies indicated that the high content of tanshinone IIA (T−IIA) and rosmarinic acid (RA) in Salvia castanea Diels f. Tomentosa Stib (SCT) gives them significant potential for development as therapeutic agents for ischemic stroke (IS). However, the extraction process and quality of the active ingredients from SCT are still big challenges, with present processes providing insufficient pharmacological effects. This study aims to identify the optimal extraction process and perform a quality characterization of the total tanshinones and phenolic acids extracted from SCT, as well as to elucidate the neuroprotective effect of these extracts. Methods: The extraction process was optimized using an orthogonal experimental design (OED), and quality characterization was performed using HPLC, UV, and LC-MS. The neuroprotective effect of the extracted tanshinones and phenolic acids was studied using the middle cerebral artery occlusion (MCAO) paradigm, and its underlying mechanism was revealed through RNA-seq analysis combined with network pharmacology. Results: The optimal extraction pressure of total tanshinones was 60 MPa, while the extraction temperature and time for total phenolic acids were 4 °C and 25 min, respectively. In these extracts, the total tanshinone and phenolic acid contents increased to 369.43 and 189.10 mg/g, respectively; 23 of the 19 tanshinones and 23 phenolic acids identified in this study have not been observed in previous studies. It was demonstrated that the combined extract had a promising neuroprotective effect against IS; RNA-seq combined with network pharmacology analysis indicated that the active compounds may regulate a series of core genes associated with signaling pathways to protect against IS. Conclusions: The combined SCT extract studied in this research exerted neuroprotective effects on IS. In general, these findings improve our preliminary understanding of the chemical composition and bioactivity of SCT. Full article

Background and Objectives: Despite the latest advancements in interventional procedures and pharmacological therapy, the incidence of heart failure and death rate following an acute myocardial remain unacceptably high. This study was designed in response to the limited and conflicting literature data regarding the diagnostic and prognostic role of modern inflammatory biomarkers in patients with coronary artery disease. Materials and Methods: We conducted a case–control, prospective observational study. A total of 145 patients were analyzed, of whom 105 patients had an acute coronary syndrome diagnosis and represented the study group, while 40 patients with a chronic coronary syndrome diagnosis represented the control group. This study investigates the diagnostic and prognostic role of the interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), Growth differentiation factor 15 (GDF-15), and classic biomarkers in patients with ischemic coronary heart disease. Results: IL-1β exhibited a prognostic role, being significantly correlated with a left ventricular ejection fraction below 30%. GDF-15 plays a dual role, as a cardio-inflammatory biomarker, being significantly correlated with both N-terminal pro-brain natriuretic peptide (NT-proBNP), and IL-1β, IL-6, and CRP. At the same time, GDF-15 represents a surrogate marker for renal dysfunction. According to the ROC analysis, patients at high mortality risk can be identified with adequate accuracy by cardiac troponin, GDF-15, and IL-10, in addition to NT-proBNP. Logistic regression models confirmed NT-proBNP and IL-10 as mortality predictors. Conclusions: IL-1β stands out for its significant prognostic role, while IL-6 did not demonstrate a diagnostic or prognostic role in acute myocardial infarction patients. IL-10 demonstrated superior predictive value in terms of fatal prognosis compared with the other modern biomarkers. GDF-15 is representative of a multivalent biomarker involved in inflammation, heart failure, and renal dysfunction. Full article

Background: Chronic kidney disease–mineral and bone disorder (CKD-MBD) is a key contributor to complications, including ischemic heart disease (IHD), which significantly elevates mortality in patients with chronic kidney disease (CKD). This study aims to identify factors associated with IHD risk in pre-dialysis CKD and establish the minimum parathyroid hormone (PTH) threshold necessary to mitigate this risk. Methods: We retrospectively analyzed data from CKD stage 3–5ND patients aged over 18 years, followed from 2018 to 2022. IHD was identified using ICD-10 codes. An adjusted Cox regression model and joint modeling analysis were used to assess the association between risk factors and IHD. Results: A total of 1210 CKD patients were included in the analysis, with a median follow-up duration of 513.5 days (IQR 189–979). The incidence of IHD was 7.5%. PTH levels ≥166 ng/L (HR 1.87, 95% CI 1.05–3.35, p = 0.03) and age ≥65 years (HR 1.68, 95% CI 1.003–2.81, p = 0.04) were significantly associated with an increased risk of IHD. In joint modeling analysis, time-varying PTH, age ≥65 years, and diabetes mellitus (DM) were significantly associated with an increased risk of IHD, whereas ARB and statin use were associated with a reduced risk. Calcium and phosphate levels did not demonstrate significant associations with IHD risk. Conclusions: Baseline PTH levels ≥166 ng/L and time-varying PTH were independently and significantly associated with an increased risk of IHD. In contrast, calcium and phosphate levels showed no significant association with IHD risk. Full article

Background/Objectives: Patients hospitalized for de novo heart failure with reduced ejection fraction (HFrEF) may experience improvement in left ventricular function, a phenomenon associated with improved morbidity and mortality outcomes. However, the factors influencing this improvement remain unclear. This study aimed to investigate the association between clinical and therapeutic factors and short-term improvement or recovery of left ventricular ejection fraction (LVEF) in patients hospitalized with newly diagnosed heart failure with reduced ejection fraction (HFrEF). Methods: This was a prospective observational study conducted in two referral centers in Spain. All patients admitted with de novo HFrEF between March 2021 and December 2023 were included. Improved myocardial function (HFimpEF) was defined as an initial LVEF ≤ 40% and a follow-up echocardiogram showing LVEF > 40%, with an increase of ≥10 points from baseline. Results: In total, 157 patients (63.3%) met the criteria for HFimpEF. Among the various etiologies of heart failure, significant differences were found between groups for tachycardiomyopathy (HFimpEF: 29.3% vs. non-HFimpEF: 13.1%, p = 0.006), valvular (HFimpEF: 7.6% vs. non-HFimpEF: 1.1%, p = 0.05), and ischemic (HFimpEF: 17.2% vs. non-HFimpEF: 43.9%, p < 0.0001) etiologies. Multivariate analysis showed that non-ischemic etiologies significantly favored myocardial improvement compared to ischemic cardiomyopathy. NT-proBNP values were consistently higher in the non-HFimpEF group at all time points measured with statistically significant differences, except at admission. Event-free survival curves (hospitalization for HF, worsening HF, and all-cause mortality) diverged early, showing statistically significant differences between groups. Conclusions: Overall, 63% of patients hospitalized for de novo HFrEF achieved myocardial improvement within an average of 3–4 months, with improvement favored by valvular and tachycardiomyopathy etiologies. This improvement has a significant prognostic impact. Full article

Objectives: Stroke is a leading cause of disability worldwide, requiring timely intervention with intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT). This study evaluates real-world stroke management in a regional stroke unit, focusing on IVT administration and EVT transfer logistics. Design: A sub-analysis was performed using prospectively collected data from an observational study. Setting: This study took place at a regional, non-university stroke unit in Germany, serving approximately 253,000 inhabitants. Participants: A total of 2436 patients were admitted for suspected stroke between May 2019 and June 2021. Outcome Measures: Outcome measures included IVT administration rates, reasons for IVT non-administration, and EVT transfer logistics for acute ischemic stroke (AIS) patients. Results: Of 952 stroke cases, 14.8% received IVT, with a mean door-to-needle time (DNT) of 41 ± 36 min. The most common reasons for IVT non-administration were unclear or elapsed symptom onset (51.8%), anticoagulation (7.9%), resolving symptoms (18.4%), and intracranial hemorrhage (7.1%). EVT transfers occurred in 6.7% of AIS patients, with a mean door-in-door-out (DIDO) time of 81 ± 36 min. Conclusions: This study highlights the low IVT rate, primarily due to delayed hospital presentation, and the limited number of EVT transfers. The prolonged DIDO times emphasize the urgent need for streamlined transfer protocols to optimize stroke care delivery. Full article

Background: CT perfusion (CTP) overestimation of core volume >10 mL compared to the final infarct volume (FIV) size is the current definition of the ghost infarct core (GIC) phenomenon. However, subsequent infarct growth might influence FIV. We aimed to report a more reliable assessment of GIC occurrence, defined as no evidence of infarct at 24 h follow-up imaging, compared to CTP core volume at admission. This phenomenon was named absolute GIC (aGIC), and we investigated its prevalence and predictors. Methods: A total of 652 consecutive stroke patients with large vessel occlusion who achieved successful recanalization (mTICI 2b-3) after endovascular treatment (EVT) and non-contrast CT (NCCT) follow-up imaging at 24 h were retrospectively analyzed. Ischemic core volume was automatically generated from CTP, and FIV was manually determined on follow-up NCCT. Multivariable logistic regression was used to explore aGIC predictors. Results: We included 652 patients (53.3% female, median age 75 years), of whom 35 (5.3%) had an aGIC. The aGIC group showed higher ASPECTS (p < 0.001), shorter (<3 h) onset-to-imaging time (p < 0.016), poorer collaterals (p < 0.001), and higher hypoperfusion intensity ratio (p < 0.001) compared to the non-aGIC group. In multivariate analysis, ASPECTS (odds ratio (OR), 2.37; p <0.001), onset-to-imaging time (OR, 0.99; p = 0.034), collateral score (OR, 0.24; p < 0.001), and hypoperfusion intensity ratio (OR, 23.2; p < 0.001) were independently associated with aGIC. Conclusions: aGIC is a more reliable evaluation of infarct core volume overestimation assessed on admission CTP and represents a rare phenomenon, associated with ultra-early presentation and poor collaterals. Full article

Background and purpose: Perforator stroke (PS) is a subtype of perinatal arterial ischemic stroke (PAIS), in which injuries occur in the territory of the perforator branches of the main cerebral arteries. This study aims to explore the incidence, timing, risk factors, and clinical presentation of PS in both preterm and full-term neonates. Material and methods: We retrospectively analyzed data about all the neonatal brain MRIs carried out in our hospital from March 2012 to March 2023. Criterium of inclusion was the radiologically confirmed diagnosis of perforator stroke involving one or more arterial districts. Results: A total of 1928 patients underwent brain MRIs during the period considered. PAIS was present in 50 patients, of which 19 had PS (38%). Among the patients with PS, nine were preterm babies (47%), and six suffered from perinatal asphyxia (31.5%). PS cUS diagnosis preceded MRI diagnosis in 88% of preterm babies. The mean age at cUS diagnosis was 20 ± 7 days. Preterm babies were often asymptomatic, whereas term babies showed neurological symptoms (mainly seizures). The outcome was favorable as long as PS was isolated. Conclusions: PS is surprisingly frequent among PAIS. It represents the most common form of PAIS in preterm babies and in babies suffering from birth asphyxia. Prenatal and perinatal factors suggesting a possible thromboembolic etiology leading to PAIS are rare in our population of preterm babies, in which the diagnosis was always preceded by negative cUS. These assumptions suggest a postnatal development of PS in premature babies more than a perinatal one. Full article