Drug-coated balloon versus drug-eluting stent for treating de novo proximal left anterior descending artery lesions: Insights from the REC-CAGEFREE I trial.

BACKGROUND Long-term low-dose aspirin (LDA) use is associated with an increased risk of peptic ulcer bleeding (PUB). Helicobacter pylori (H. pylori ) infection is a well-known risk factor for peptic ulcer disease (PUD). AIM To evaluate the prevalence of H. pylori infection in long-term LDA users, assess the impact of eradication on PUB risk, and explore its association with cardiovascular (CV) disease status and progression. METHODS A prospective observational study was conducted at Benha Teaching Hospital from January 2023 to January 2024. Four hundred adults (≥ 18 years) on daily LDA for at least one year were enrolled. All participants underwent a comprehensive evaluation, including assessment of CV comorbidities. H. pylori was diagnosed via a stool antigen test, urea breath test, and histopathology. Infected patients received levofloxacin-based triple therapy for 14 days. Eradication was assessed at six weeks, and participants were followed for six months to evaluate PUB incidence and CV outcomes, including disease progression. RESULTS The prevalence of H. pylori infection was 65.5% (262/400). H. pylori -positive patients exhibited significantly lower albumin levels (3.5 ± 0.4 g/dL vs 3.9 ± 0.6 g/dL, P < 0.001) and higher levels of urea (29.3 ± 6.4 mg/dL vs 23.5 ± 4.6 mg/dL, P < 0.001), sodium (137.8 ± 2.9 mmol/L vs 135.3 ± 3.5 mmol/L, P < 0.001), potassium (4.1 ± 0.9 mmol/L vs 3.8 ± 0.6 mmol/L, P = 0.014), and cholesterol (191.0 ± 29.7 mg/dL vs 177.0 ± 35.9 mg/dL, P = 0.004). PUB was significantly more prevalent in H. pylori -positive patients with gastric erosions (12.2% vs 0.0%, P < 0.001), peptic ulcers (23.7% vs 0.0%, P < 0.001), and gastric ulcers (10.7% vs 0.0%, P < 0.001). After eradication therapy, 51.9% (136/262) of patients tested negative for H. pylori , while 48.1% (126/262) remained positive. PUB was significantly more frequent in patients with persistent H. pylori infection (8.7% at 6 weeks, 11.9% at 6 months) compared to those with successful eradication (1.5% at 6 weeks, 3.7% at 6 months, P < 0.001), highlighting the importance of successful eradication in reducing PUB risk. Additionally, H. pylori -positive patients had a higher prevalence of ischemic heart disease (54.3% vs 33.3%, P < 0.001) and a higher burden of CV disease progression during follow-up (hazard ratio = 3.5, P < 0.001), suggesting a potential interaction between H. pylori infection and CV risk. CONCLUSION Successful screening and eradicating H. pylori in high-risk LDA users was associated with significantly reduced PUB risk and was linked to less CV disease progression in patients with persistent infection.

Novel insights into myocardial synchrony: A CMR-based approach for improving the detection of coronary artery disease at rest.

STARD4-AS1 promotes coronary artery disease and modulates endothelial dysfunction by targeting miR-204-3p/FLI1.

Trends, variation, and predictors of coronary angiography in potential cardiac organ donors.

Coronary Artery Bypass Graft as a Bridge to Kidney Transplantation.

Burden of 292 causes of death and life expectancy decomposition in Iran, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.

Noninvasive Imaging Modalities for the Evaluation of Coronary Artery Disease Among Patients With High Body Mass Index: A Focus on Coronary Computed Tomography Angiography (CCTA).

Lipoprotein(a) [Lp(a)] and diabetes mellitus (DM) are independent risk factors for worse outcomes in coronary artery disease (CAD) patients. Evidence of their joint association is limited. We aimed to investigate the combined effect of elevated Lp(a) and DM on survival outcomes in CAD patients. This study included 65 547 CAD patients (62.6 ± 10.7 years, 27.7% female) from CIN-II and RED-CARPET cohorts. Patients were stratified into four groups by Lp(a) levels (< or ≥ 30 mg/dL) and DM status. Multivariable Cox regression models estimated associations with cardiovascular and all-cause mortality, examining additive and multiplicative interactions. During a median follow-up of 5.5 years, 10 686 (16.3%) patients died from all causes and 5106 (7.8%) died from cardiovascular causes. Patients with Lp(a) ≥ 30 mg/dL and DM were independently associated with cardiovascular mortality (adjusted hazard ratio [aHR]: 1.28, 95% CI: 1.20-1.35; aHR: 1.53, 95% CI: 1.44-1.62, all p < 0.001, respectively). Compared to patients with Lp(a) < 30 mg/dL without DM, the aHRs were 1.26 (95% CI: 1.16-1.36, p < 0.001), 1.51 (95% CI: 1.40-1.62, p < 0.001) and 2.00 (95% CI: 1.83-2.18, p < 0.001) for those with Lp(a) ≥ 30 mg/dL without DM, Lp(a) < 30 mg/dL with DM and Lp(a) ≥ 30 mg/dL with DM, respectively. Significant additive interaction between elevated Lp(a) and DM on cardiovascular mortality was observed, with 12% of the excess risk attributed. Similar associations were observed in all-cause mortality. In patients with CAD, elevated Lp(a) and DM act synergistically to increase the risk of cardiovascular and all-cause mortality, suggesting that both risks should be considered to integrate management.

Contemporary cardiac rehabilitation (CR) has amoderate effect on physical activity (PA), whereas novel technologies offer promise for enhancing PA levels. Therefore, we assessed the effect of ahome-based smartphone training program in addition to center-based CR on PA levels in patients with coronary artery disease (CAD). CAD patients participating in CR were included in this randomized controlled trial (1:1, stratified for index diagnosis). The control group received usual care CR, whereas the intervention group additionally received a6-week remote smartphone program. The primary outcome was the change in accelerometer-derived moderate-to-vigorous PA (MVPA) from baseline to post-CR. Secondary outcomes included changes in light intensity PA, step count, sedentary time, functional parameters, quality of life, and cardiac anxiety. Abaseline-adjusted linear mixed model was used. Participants (16% female, intervention n = 44, control n = 49) were 63 [56-69] years old and had abaseline MVPA of1.0 (95% Confidence interval (CI):0.9;1.1) h/day. Changes in MVPA did not differ between the intervention (0.1 (95% CI: -0.0; 0.2) h/day) and control group post-CR (0.1 (95% CI: -0.0; 0.2) h/day, p-interaction = 0.75). Also, no differences between the groups were observed for light intensity PA (0.5 (95% CI: 0.2; 0.8) versus 0.4 (95% CI: 0.1; 0.8) h/day, p-interaction = 0.79). Similarly, changes in other secondary outcomes did not differ among groups. Asmartphone training program on top of the usual CR did not yield additional benefits. Amore elaborate mHealth intervention seems needed to change PA during CR in active patients with CAD.

Rising burden of MASLD and CKM syndrome in Asia: A decade of trends and future projections.

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition predominantly affecting older individuals, characterized by pain and stiffness in the shoulder and pelvic girdles. The PMR Activity Score (PMR-AS) is a composite tool for assessing disease activity, yet easily accessible inflammatory biomarkers that correlate with disease activity remain limited. The Systemic Immune-Inflammation Index (SII), derived from peripheral blood counts has emerged as a novel marker reflecting systemic inflammation. To investigate the relationship between the SII index and disease activity as measured by the PMR-AS in patients diagnosed with PMR. In this retrospective cross-sectional study, 180 patients diagnosed with PMR were included. Clinical and laboratory data at diagnosis were analyzed. PMR-AS was calculated at baseline. Pretreatment complete blood counts were used to determine the SII index. The association between SII index and PMR-AS was evaluated using Pearson correlation analysis. Patients were stratified into low disease activity and moderate-high disease activity groups based on a PMR-AS cut-off of 7. Multivariate linear regression was conducted to evaluate the independent association between SII index and PMR-AS. Among 180 patients with PMR, 86 (47.8%) had moderate-high disease activity. Coronary artery disease (CAD) was significantly more common in this group. Patients with moderate-high disease activity showed elevated WBC and neutrophil counts, reduced lymphocyte counts, and higher CRP levels. The SII index was markedly higher in the moderate-high disease activity group and demonstrated a moderate correlation with PMR-AS (r = 0.47). In multivariate analysis, CAD and SII index were independent predictors of moderate-high disease activity. ROC analysis confirmed that SII index demonstrated acceptable discriminatory performance moderate-high disease activity. The SII index may reflect disease activity in PMR and could be considered a non-invasive, cost-effective adjunct to clinical evaluation. Key Points • The SII index is a powerful predictor of disease activity in PMR. • Presence of CAD and higher SII index were independently associated with moderate-high disease activity, highlighting systemic inflammation. • Routine assessment of SII index may improve disease monitoring in PMR, supporting its integration into clinical evaluation alongside established disease activity scores.

Coronary CT angiography in master athletes: Redefining primary prevention of ischemic heart disease beyond the Italian 2023 COCIS guidelines.

Uterotonics in pregnant patients with cardiac disease: a focused review.

The Effect of Revascularization versus Amputations on Patient Mental Health in the Early Postoperative Period: A Prospective Observational Cohort Study.

Coronary CT angiography (CCTA) using retrospective helical scanning allows for cardiac function but requires high radiation exposure. This study aimed to investigate the optimal timing and feasibility of low-dose cine CT during the recirculation phase of the contrast agent. We conducted a retrospective analysis of MR perfusion examinations in 38 patients to determine the recirculation timing of the contrast agent, and, based on the findings of the MR perfusion study, a feasibility study of a low-dose cine CT during the recirculation phase was performed for 51 patients with suspected or known coronary artery disease. The MR perfusion study identified approximately 20 s after the contrast peak in the left ventricle (19.5 ± 4.3 HU) as the optimal recirculation time of contrast agent, with no significant correlation between left ventricular function and the timing. In cine CT images, CT values within the left (290.2 ± 42.1 HU) and right (264.1 ± 36.9 HU) ventricles were almost identical during the recirculation phase, with better contrast (p < 0.001) in the right atrium and ventricle compared to first-pass CCTA images. Cine CT showed high inter-rater reliability for left and right ventricular function assessment and better diagnostic performance than echocardiography for myocardial infarction assessment. The combined dose for CCTA (2.0 mSv) and cine CT (0.9 mSv) was 2.9 mSv. A brief cine CT acquisition added to CCTA, timed to contrast recirculation, provides global and regional left ventricular function at a small incremental radiation dose (approximately 1 mSv). This single-visit protocol is a valuable alternative when echocardiography or MRI access is restricted or multiple examinations are not feasible. Question This study aimed to investigate the optimal timing and feasibility of low-dose cine CT during the recirculation phase of the contrast agent. Findings A 20-s recirculation time enabled low-dose cine CT (0.9 mSv) that allowed for effective cardiac function assessment. Clinical relevance When coronary CT is already indicated, a short cine acquisition can provide complementary functional information and may reduce additional testing in selected patients.

Potential clinical application of polygenic risk scores in the estimation of cardiovascular risk in primary care; a structured narrative review

Explainable AI in Cardiology Diagnostics: A Systematic Review of Machine Learning, Meta-heuristic Optimization, and Clinical Text Mining for Coronary Artery Disease.

The increased risk of atherosclerotic diseases (stroke, coronary artery disease [CAD]) observed in depression may stem from shared pathophysiology. We examined whether: 1) major depression (MD) and atherosclerotic traits share genetic risk, and 2) altered gene expression in various tissues linked to shared genetics has a potential causal role in depression etiology. Data from the largest genome-wide association studies of MD (N = 3,887,532) and 8 atherosclerotic traits (N = 26,909-1,308,460) were used in Two-Sample Mendelian randomization and colocalization to detect cross-trait causal associations and genomic loci containing shared causal variants. In shared loci, summary data-based Mendelian randomization estimated the effects of gene expression on MD etiology using expression quantitative trait loci datasets from whole blood, brain and heart tissues and atherosclerotic plaques from the Athero-Express Biobank Study. MD genetic liability increased risk of any stroke (OR=1.15, p = 9.47 × 10-8), ischemic stroke (OR=1.16, p = 1.52 × 10-7), small vessel disease (OR=1.34, p = 4.76 × 10-5) and CAD (OR=1.2, 95 %CIs=1.13-1.26, p = 3.76 × 10-22). Eight genomic regions harbored potentially shared causal variants, including one on chromosome 7 linking MD with any stroke, ischemic stroke and CAD. Altered expression of 16 genes in blood, 10 in brain, and 6 in heart was found causal for MD etiology. In atherosclerotic plaques, one gene was linked to MD at nominal significance only. Major depression and atherosclerotic diseases share genetic risk potentially acting in depression pathophysiology through expression of genes in blood, brain and heart tissues. Involvement of atherosclerotic plaques in depression etiology was not supported. Identified pathways could guide the development of new treatments to prevent depression-heightened atherosclerotic risk.

Survival differences reported across treatment strategies for perihilar cholangiocarcinoma (pCCA) may be strongly influenced by biological patient selection rather than treatment modality itself. This study quantified how much of survival after curative-intent liver resection for pCCA can be explained by biological selection alone, using the Mayo Clinic eligibility criteria as a validated selection framework. A post-hoc analysis of consecutive patients undergoing liver resection for pCCA between January 2005 and December 2023at a tertiary referral center was performed. Patients were stratified according to whether they fulfilled adapted Mayo Clinic eligibility criteria (MC). Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier estimates and Cox regression. A total of 305 patients were included, of whom 54 (17.7%) met MC. Patients within MC were significantly younger, had lower ASA scores and significantly lower postoperative complications compared with patients outside MC (p<0.05). Median overall survival was 4.1 years within the MC versus 2.2 years in patients outside the MC (p=0.004). Similarly, median recurrence-free survival was 3.6 versus 1.5 years, respectively (p=0.005). In multivariate analysis, MC was not an independent predictor for overall survival or recurrence-free survival. Instead ASA III, renal failure, coronary artery disease, nodal involvement and positive resection margin was associated with worse survival. When applied to a surgical PCCA cohort, the Mayo eligibility criteria identify patients with markedly improved survival. The survival difference became smaller after adjusting for known prognostic factors. This suggests that the Mayo criteria reflect favorable tumor biology and patient health rather than directly determining outcomes.