In advanced heart failure patients, limited exercise capacity often prevents significant increases in core temperature. Due to reduced muscle mass and minimal blood flow in inactive muscles, their limb temperatures tend to be lower. This study investigates whether core-hand temperature difference can serve as a distinguishing criterion between New York Heart Association (NYHA) Class III and IV heart failure. This study included 80 patients with NYHA Class IV (median age: 68 years) and 82 with NYHA Class III (median age: 65 years) heart failure with reduced ejection fraction. Core body temperature was measured using an infrared thermometer, while hand temperature was recorded with a forward looking infrared C5 thermal camera after a 15-minute acclimatization at room temperature. The core-mean hand temperature difference (Tc-Mht) was 8.7 °C ± 1.5 °C in the Class IV group and 7.1 °C ± 1.7 °C in the Class III group (p < 0.001). The difference in hand temperature (highest-lowest) was 3 °C (2-4 °C) in the Class IV group and 1 °C (0-2 °C) in the Class III group (p < 0.001). A Tc-Mht > 7.7 °C showed 76% sensitivity (95% confidence interval: 66-84%) for detecting NYHA Class IV in thermoneutral environments. Tc-Mht may serve as a prognostic marker in heart failure patients.

This study aimed to compare access and target lesion patency rates between undersized and apposed/oversized lateral-edge covered stents in patients with hemodialysis access-related central venous occlusive disease (CVOD). A retrospective analysis of 76 hemodialysis patients undergoing endovascular treatment for CVOD was conducted. All of the patients received undersized covered stents at the medial edge. Based on lateral-edge sizing, the patients were divided into undersized (n = 14) and apposed/oversized (n = 62) groups. Patency outcomes were compared using the log-rank test, and multivariable analysis was used to identify risk factors associated with the primary outcome. The 12-month access primary patency rate was significantly higher in the undersized group than in the apposed/oversized group (76.4% vs. 25.9%, p = 0.047). The 12-month target lesion primary patency rate was also higher in the undersized group; however, the difference was not statistically significant (76.4% vs. 52.1%, p = 0.186). Factors associated with the primary outcome included older age (odds ratio [OR] = 1.03, p = 0.011), coronary artery disease (OR = 2.03, p = 0.041), stenting to central veins for access thrombosis (OR = 3.53, p = 0.001), more stents (OR = 3.11, p = 0.002), apposed/oversized lateral stent edge (OR = 2.73, p = 0.044), and higher stent-to-vessel ratio (OR = 1.19, p = 0.022). The 12-month primary patency rate was better in the undersized group than in the apposed/oversized group. Endovascular treatment with undersized covered stents may be a feasible approach for hemodialysis access-related CVOD. Larger randomized studies are required to confirm these findings.

The Taiwan Registry of Hypertrophic Cardiomyopathy (THIC) is a multicenter national registry containing the clinical and imaging data of patients with hypertrophic cardiomyopathy (HCM) in Taiwan. The aim of the registry is to systematically evaluate the clinical, genetic and biochemical features, possible natural course, and outcomes of HCM and relevant rare diseases that mimic HCM such as Fabry disease (FD) and transthyretin amyloid cardiomyopathy in Taiwan, and to identify their specific "red-flag" signs, which are especially valuable from the perspective of unique genetic mutations or clinical manifestations in Taiwanese patients. Herein, we present the design and initial baseline data from the registry. The THIC is an observational program that aims to collect prospective and/or retrospective data of patients with HCM in Taiwan. The registry plans to recruit 800 individuals with unexplained left ventricular hypertrophy, including 200 with FD, with a follow-up period of at least 12 months, and the project is expected to run for 5 years. Data on baseline characteristics, laboratory and imaging results, deaths, major adverse cardiovascular, cerebrovascular and renal events are collected. The THIC has been in the enrollment phase since December 2022, and has enrolled 534 patients (age 62.37 ± 13.41 years, male 65.6%) as of March 15, 2025 from 13 centers. At enrollment, 284 of these patients had HCM, 227 had FD, and 23 had ATTR-CM. Family history was found to be an important diagnostic clue; however, common echocardiographic and laboratory data including N-terminal pro-brain natriuretic peptide were not significantly different between the three groups. The THIC will contain comprehensive clinical and imaging data of patients with HCM, FD and ATTR-CM in Taiwan, and provide an opportunity to extend our knowledge on the clinical presentations and long-term consequences of these disease entities. It will aid in understanding patients with unexplained LVH in the context of the genetic background of Taiwanese patients, and in identifying predictors of LVH and important clinical events.

This study aimed to evaluate the prognostic implications and optimal timing for assessing left ventricular ejection fraction (LVEF) trajectory in patients with heart failure (HF) and an LVEF < 50%. The Taiwan Society of Cardiology HF Registry 2020 is a prospective, multicenter registry of hospitalized HF patients in Taiwan. This study included patients with an LVEF < 50% during their index HF hospitalization, and at least one follow-up echocardiogram within 2 years. HF with improved EF (HFimpEF) was defined as an absolute increase in LVEF > 10% from baseline. The primary endpoints were all-cause mortality and HF hospitalization at 2 years. Predictors of an improvement in LVEF trajectory were also evaluated. A total of 1478 patients were enrolled, with 873 in the HFimpEF group and 605 in the non-HFimpEF group. HFimpEF was associated with a lower risk of mortality (hazard ratio: 0.41 [0.27-0.62], p < 0.001) and reduced HF hospitalizations (8.6% vs. 24.4%, p < 0.001) at 2 years follow-up. Subgroup analysis showed that survival benefits diverged at an LVEF improvement > 10%, emerging as early as 6 months and persisting beyond 12 months. Lower baseline LVEF was paradoxically associated with better survival. Neither maximal guideline-directed medical therapy (GDMT) score nor revascularization correlated with LVEF trajectory. However, HFimpEF patients received higher doses of renin-angiotensin system inhibitors and beta-blockers in the first year. LVEF trajectory at 6 months appears to be a valuable prognostic tool, and higher-dose fundamental HF therapy was more important than achieving a higher overall GDMT score.

The Coronavirus disease 2019 (COVID-19) pandemic necessitated rapid advances in treatment, with Paxlovid emerging as an effective oral antiviral. Despite its efficacy in reducing hospitalizations and mortality among high-risk patients, the impact of Paxlovid on cardiovascular outcomes remains unclear, especially given the increased cardiovascular risks associated with COVID-19. We conducted a retrospective cohort study using data from the Chang Gung Memorial Hospital System in Taiwan of patients admitted with COVID-19 from January 1, 2022 to December 31, 2022. Propensity score matching was used to create comparable cohorts of patients treated with Paxlovid and those not treated with Paxlovid. The primary outcomes were cardiovascular events and all-cause mortality within a 12-month follow-up period. The study analyzed 606 patients treated with Paxlovid and 1,809 matched patients who were not. Paxlovid significantly reduced all-cause mortality at 3 months (relative risk [RR] 0.75, p = 0.0216) and 6 months (RR 0.81, p = 0.0492), but this effect was not sustained at 12 months (p = 0.2069). Notably, venous thromboembolism rates were significantly higher in the Paxlovid group at 6 months (RR 4.78, p = 0.0057) and 12 months (RR 2.65, p = 0.0477). While Paxlovid treatment resulted in significant short-term survival improvements among COVID-19 patients, it was also associated with a higher incidence of venous thromboembolic complications. These findings highlight the need for careful patient selection and monitoring, particularly for those with preexisting cardiovascular conditions.

The prevalence of cardiovascular disease (CVD) is increasing globally. Hypertension and dyslipidemia are well-established risk factors, and their co-existence significantly increases the risk of CVD. Epidemiological studies consistently report a high prevalence of their co-existence, ranging from 15% to 31%. The combined impact of hypertension and dyslipidemia on the vascular endothelium is more detrimental than their individual effects, potentially accelerating atherosclerosis and increasing the overall risk of CVD. This review highlights the benefits of concurrently treating dyslipidemia and hypertension to prevent CVD, drawing insights from the Anglo-Scandinavian Cardiac Outcomes Trial study and recent clinical studies conducted in Asia. Notably, the single-pill combination of amlodipine and atorvastatin has been shown to enhance adherence while providing a synergistic effect in protecting the vascular endothelium and preventing CVD. By aggressively managing both conditions, healthcare providers can significantly reduce the risk of future cardiovascular events across diverse patient populations and ethnicities.

Myocardial infarction (MI) remains a leading cause of mortality and morbidity worldwide. Cardiac rehabilitation (CR) is an evidence-based intervention that improves cardiovascular outcomes; however, the optimal timing and contents of CR remain unclear. This study aimed to investigate the effects of an early-phase, exercise-based supervised comprehensive CR program on functional exercise capacity, grip strength, fatigue, sleep quality, and health-related quality of life (HRQOL) in patients with MI. A randomized controlled trial was conducted involving 32 medically stable MI patients allocated to either an intervention or control group. The intervention group received a two-phase supervised CR program initiated within the first week post-MI, including inpatient and outpatient aerobic, calisthenic, and strengthening exercises for eight weeks. The control group received usual care. Primary and secondary outcomes included the 6-minute walk distance (6MWD), 30-second sit-to-stand test (30-sec STS), grip strength, fatigue (functional assessment of chronic illness therapy [FACIT]-fatigue), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and HRQOL (12-Item Short-Form Questionnaire and MacNew Heart Disease Health-Related Quality of Life Questionnaire). Compared to the control group, the intervention group showed significant improvements in 6MWD (mean difference [MD] = 97.3 m, p < 0.001), 30-sec STS (MD = 3.1 repetitions, p = 0.001), grip strength (MD = 5.7 kg, p = 0.04), FACIT-Fatigue score (MD = 8.8 points, p < 0.001), PSQI score (MD = -2.7 points, p < 0.001), and HRQOL subdomains (p < 0.05). No adverse events were reported. Early-phase supervised CR significantly enhanced physical capacity, fatigue, sleep quality, and HRQOL in this cohort of MI patients. Early initiation of structured CR should be considered in clinical practice to promote faster recovery and improve long-term outcomes following MI.

Transeptal puncture (TSP) is an important technique in catheter ablation and structural interventions. Several novel techniques and equipment have been developed, however they are limited by availability and cost. To evaluate the efficacy and safety of a modified TSP technique guided by a 0.014″ angioplasty wire and an electrified Brockenbrough (BRK) stylet. One hundred consecutive patients who received the modified TSP technique and another 100 undergoing conventional TSP for pulmonary vein isolation for non-valvular atrial fibrillation from January 2019 to January 2023 were retrospectively analyzed. A historical comparison with three associated studies was performed. Age, gender, left atrial diameter, left ventricular ejection fraction, acute complications, and BRK needle jump distances during TSP were analyzed. Both groups demonstrated comparable characteristics, including age (conventional TSP vs. modified TSP; 65.8 ± 9.6 vs. 63.63 ± 10.3 years; p = 0.077), sex (conventional TSP vs. modified TSP; males, 75% vs. 67%; p = 0.213), and left atrial diameter (conventional TSP vs. modified TSP; 40.55 ± 7.7 vs. 42.60 ± 8.2 mm; p = 0.069). All received continuous periprocedural nonvitamin K oral anticoagulants and underwent TSP with a BRK needle. There was no acute pericardial effusion or tamponade immediately after TSP or at the end of catheter ablation. Inadvertent jump of the BRK needle was significantly attenuated in the modified TSP group (conventional TSP vs. modified TSP; 0.766 ± 0.19 vs. 1.455 ± 0.48 cm; p < 0.001). No TSP-related complications were observed. The modified TSP technique using readily available equipment with an electrified stylet and a 0.014″ angioplasty wire is a simple, safe, and cost-effective alternative. This method reduces the built-up tension by mechanical force during tenting and minimizes the risk of inadvertent jumping.

MicroRNAs (miRs) are involved in cardiac remodeling, and tachyarrhythmia can regulate miR expression. While microRNA-1 (miR-1) is essential for genes involved in atrial tachyarrhythmia, the effect of rapid electrical stimulation (RES) on fibroblast-derived exosomal miR-1 is unknown. This study investigated the molecular regulation of exosomal miR-1 and its therapeutic potential in human atrial fibroblasts (HCF-aa) using RES. HCF-aa were cultured in a pacer dish and exposed to RES (0.5 V/cm and 10 Hz). We then investigated whether miR-1 expression could be regulated in HCF-aa under RES, and examined the effects on T-box transcription factor 18 (Tbx18) and connexin 43 (Cx43) protein levels. RES initially upregulated and subsequently downregulated exosomal miR-1 expression. Overexpression of miR-1 reduced Tbx18 levels but increased Cx43 expression in HCF-aa after 64 hours of RES. Conversely, mutant miR-1 and miR-1 antagomir significantly reduced Cx43 expression. Luciferase reporter assays indicated that miR-1 antagomir pretreatment suppressed the transcriptional activity of Tbx18 on the Cx43 promoter, an effect reversed by mutating the Tbx18 binding site. RES for 24 hours increased exosomal miR-1 and led to a reduction in Tbx18 3'-UTR luciferase activity; this effect was mitigated by mutating the hsa-miR-1-3p binding site. Immunohistochemical staining confirmed that miR-1 antagomir downregulated Cx43, while Tbx18 siRNA upregulated Cx43 in RES-exposed HCF-aa. In HCF-aa under RES, miR-1 and Tbx18 regulated Cx43 expression, with miR-1 modulating Cx43 through Tbx18. These findings provide insights into the molecular mechanisms of cardiac remodeling and offer potential therapeutic targets for treating tachyarrhythmia.

The aim of this study was to assess the prognostic significance of the longitudinal tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio as a surrogate marker of right ventricular (RV) to pulmonary arterial (PA) coupling in patients with pulmonary arterial hypertension (PAH). A retrospective cohort study was conducted on patients with PAH. The TAPSE/PASP ratio at baseline and at 3 to 6 months of follow-up was evaluated along with other echocardiographic and clinical parameters. The study included 68 patients with PAH, 75% of whom were female, with a mean age of 46 years and a mean follow-up duration of 64 months. At baseline, non-survivors had higher brain natriuretic peptide levels, shorter 6-minute walk distance (6MWD), and worse hemodynamic profiles compared with survivors. A TAPSE/PASP ratio > 0.22 mm/mmHg at baseline and > 0.23 mm/mmHg at 3 to 6 months of follow-up was associated with improved survival. Compared with baseline, survivors had lower pulmonary vascular resistance, lower PASP, and reduced left ventricular eccentricity indexat follow-up. In addition, better outcomes were observed in patients with World Health Organization functional class (WHO FC) I/II and 6MWD > 390 m compared with those in WHO FC III/IV and 6MWD ≤ 390 m. The TAPSE/PASP ratio is a noninvasive marker of RV-PA coupling that can provide dynamic prognostic insights in patients with PAH. It may assist in guiding treatment escalation and individualized therapy. Further studies are needed to verify its role and integration into comprehensive PAH risk assessment frameworks.