搜索结果：Journal of interventional cardiology

The reduction of the annual equivalent dose limit to the lens of the eye from 150 to 20 mSv has increased the need for reliable assessment of occupational eye lens exposure, particularly in interventional radiology. Lens absorbed dose is commonly evaluated either using a dosimeter near the eye or indirectly using chest dosimeter readings. Although the indirect approach is well established in interventional cardiology, its validity for procedures with different exposure geometries remains uncertain. This study evaluated the agreement between direct and indirect estimates of lens equivalent dose in haemodynamic, electrophysiological and gastroenterological procedures. Forty-one physicians were monitored using thermoluminescent dosimeters placed close to the eye and on the chest above the lead apron. Direct lens doses were compared with indirect estimates derived from chest dosimeter. Agreement was assessed using linear fitting, Pearson's correlation coefficients and analysis of variance. A total of 449 valid dosimetric pairs were analysed. A statistically significant correlation between direct and indirect lens dose estimates was observed for haemodynamic and electrophysiological procedures. The indirect lens dose estimates provided conservative estimates in approximately 80% of cases and never resulted in exceedance of the 20 mSv annual dose limit. In contrast, no significant correlation was found for endoscopic retrograde cholangiopancreatography procedures, where indirect estimates frequently underestimated lens dose due to non-frontal exposure geometry. These findings confirm that reliable and conservative assessment of eye lens dose estimates in interventional cardiology is possible when chest doses are well below regulatory limits. However, caution is required when extending its use to non-cardiac procedures, where procedure-specific exposure conditions may compromise the reliability of lens dose estimates.

Neurologic injury is a significant cause of morbidity and mortality in pediatric extracorporeal membrane oxygenation (ECMO). Noninvasive neurologic monitoring is important for early detection and management of neurologic injury. Automated infrared pupillometry (AP) provides accurate and repeatable bedside quantitative measurements of pupil reactivity via the Neurological Pupil Index (NPi&#xae;). We evaluated if any abnormal NPi (defined as an NPi&#x2009;<&#x2009;3) during the first 72&#xa0;h of ECMO support could identify patients at risk for death or disability at discharge. An observational cohort of pediatric patients who required ECMO support was analyzed. NPis were measured during the first 72&#xa0;h after ECMO cannulation using the NPi&#xae;-200 automated pupillometer, and the lowest value (NPi-min) was identified. The primary outcome was death prior to hospital discharge. The secondary outcome was discharge Functional Status Scale (FSS) score&#x2009;>&#x2009;10, indicating at least moderate disability. A total of 75 patients were included in the study, of whom 26 (35%) died and 49 (65%) survived. Seventeen patients had an NPi-min&#x2009;<&#x2009;3 during the first 72&#xa0;h of their ECMO course. Patients who died had significantly lower median NPi-min values compared with patients who survived (2.6 vs. 4.3, p&#x2009;=&#x2009;0.0008). An NPi-min&#x2009;<&#x2009;3 was associated with increased mortality; in adjusted analysis, higher NPi-min was associated with lower odds of death (OR 0.57 per 0.5-unit increase, 95% CI 0.40-0.81, p&#x2009;=&#x2009;0.0015); independent of age category (neonate versus non-neonate); ECMO type (venoarterial (VA), versus venovenous (VV)); electroencephalogram (EEG) severity; and pre-ECMO Pediatric Sequential Organ Failure Assessment (pSOFA) score. This model had a good discriminatory capacity for death with an area under the receiver operating curve (AUROC) of 0.82. In contrast, NPi-min was not significantly associated with at least moderate disability (FSS&#x2009;>&#x2009;10) in adjusted analysis (OR 0.83 per 0.5-unit increase, 95% CI 0.60-1.15, p&#x2009;=&#x2009;0.26; AUROC 0.70). In children undergoing ECMO support, any NPi measurement of less than 3 during the first 72&#xa0;h of ECMO initiation is associated with hospital mortality, but associations with at least moderate discharge disability are less clear. Automated pupillometry can be a useful tool for the early prognostication of pediatric patients requiring ECMO. &#x2022; Children supported on extracorporeal membrane oxygenation are at a disproprotionally higher risk for death and&#xa0;neurological morbidity compared with the broader critically ill pediatric population. &#x2022;&#xa0;Automated pupillometry provides objective bedside assessment of pupillary reactivity, but its prognostic value in&#xa0;pediatric ECMO remains poorly defined. &#x2022; In this single-center study of pediatric patients supported on extracorporeal membrane oxygenation, a minimum&#xa0;Neurological Pupil Index less than 3 within the first 72 hours of ECMO support was independently associated with in hospital mortality, but its association with discharge functional disability was less consistent.

The benefit of percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTOs) to improve clinical symptoms and quality of life (QoL) as compared with optimal medical therapy (OMT) is still under debate because of the scarcity of available randomized trials (RCTs). We evaluated the effect of PCI vs OMT in patients with a CTO and no concomitant coronary lesions in a post-hoc pooled analysis of 2 RCTs. A total of 518 patients with a single CTO and no other significant coronary lesion were extracted from 2 RCTs, EUROCTO and DECISION-CTO, which had compared PCI vs OMT. Randomization to PCI or OMT was 1:1 in DECISION and 2:1 in EUROCTO. The clinical status was assessed by the Seattle Angina Questionnaire (SAQ) at baseline and after 12 months, and clinical events were monitored for 3 years. PCI was successful in 92.2%. On an intention-to-treat analysis, PCI appeared to be superior to OMT for the change of angina frequency scores between baseline and follow-up (12.2 vs 8.6; P = 0.009), QoL (19.5 vs 11.3; P < 0.001), and the SAQ summary score (13.8 vs 8.5; P < 0.001). For physical limitation, the difference was just at the level of the Bonferroni correction for multiple tests (P = 0.01). There was a wide variability of changes in SAQ scores. For QoL, the major determinant for a significant improvement was a low baseline score and the assignment to PCI, whereas gender, diabetes, or lesion complexity had no influence. During a mean follow-up of 3.1 years, the clinical endpoints of cardiac death or nonfatal myocardial infarction were similar in both groups (OMT vs PCI: 2.7% vs 5.1%; P = 0.17). The rates of stroke or hospitalization for bleeding were similar, and only target lesion revascularizations were more frequent with OMT (18.8% vs 10.6%; P = 0.005). In this post-hoc analysis from 2 RCTs of patients with a single CTO and no significant concomitant lesion, PCI achieved better improvement in QoL, angina frequency, and the SAQ summary score than OMT with no signal of excess harm regarding clinical endpoints. (EUROCTO [Evaluate the Utilization of Revascularization or Optimal Medical Therapy for the Treatment of Chronic Total Coronary Occlusions; NCT01760083] and DECISION-CTO [Drug-Eluting Stent Implantation Versus Optimal Medical Treatment in Patients With Chronic Total Occlusion; NCT01078051]).

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1&#xb7;3 billion (95% uncertainty interval [UI] 1&#xb7;2 to 1&#xb7;4) individuals were estimated to be living with MASLD (ie, 16&#xb7;1% of the global population), with an age-standardised prevalence rate of 14&#x2009;429&#xb7;3 (95% UI 13&#x2009;268&#xb7;3 to 15&#x2009;990&#xb7;6) per 100&#x2009;000 population, representing a percentage increase of 142&#xb7;7% (95% UI 139&#xb7;2 to 146&#xb7;7) in crude numbers from 1990 (0&#xb7;5 billion [0&#xb7;5 to 0&#xb7;6]) and of 28&#xb7;6% (27&#xb7;8 to 29&#xb7;5) in the rate (11&#x2009;217&#xb7;2 [10&#x2009;276&#xb7;8 to 12&#x2009;467&#xb7;0] per 100&#x2009;000 in 1990). An estimated 3&#xb7;6 million (2&#xb7;8 to 4&#xb7;5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39&#xb7;6 (31&#xb7;2 to 49&#xb7;9) per 100&#x2009;000 population. Despite a 116&#xb7;3% (93&#xb7;3 to 139&#xb7;4) increase in crude DALYs (from 1&#xb7;7 million [1&#xb7;3 to 2&#xb7;1] in 1990), its age-standardised estimate remained consistent (1&#xb7;8% [-8&#xb7;6 to 12&#xb7;8]) from 1990 (38&#xb7;9 [30&#xb7;1 to 49&#xb7;8] per 100&#x2009;000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29&#x2009;246&#xb7;1 [26&#x2009;848&#xb7;3 to 32&#x2009;048&#xb7;7] per 100&#x2009;000) and Andean Latin America showed the highest DALY rate (152&#xb7;3 [114&#xb7;1 to 194&#xb7;7] per 100&#x2009;000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653&#xb7;5 [7923&#xb7;7 to 9592&#xb7;8] per 100&#x2009;000) and east Asia had the lowest DALY rate (16&#xb7;3 [13&#xb7;5 to 19&#xb7;9] per 100&#x2009;000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15&#x2009;616&#xb7;4 [14&#x2009;349&#xb7;2 to 17&#x2009;263&#xb7;3] per 100&#x2009;000 people in 2023) than in females (13&#x2009;245&#xb7;2 [12&#x2009;132&#xb7;0 to 14&#x2009;692&#xb7;6] per 100&#x2009;000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2&#xb7;2 [95% UI 1&#xb7;6 to 3&#xb7;1] per 100&#x2009;000 people), followed by high BMI (1&#xb7;4 [0&#xb7;6 to 2&#xb7;4] per 100&#x2009;000 people) and smoking (1&#xb7;0 [0&#xb7;3 to 1&#xb7;8] per 100&#x2009;000 people). Our forecasting model estimates that 1&#xb7;8 billion (95% UI 1&#xb7;6 to 2&#xb7;0) individuals are likely to have MASLD by 2050, representing a 42&#xb7;0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15&#x2009;774&#xb7;9 (95% UI 14&#x2009;613&#xb7;9 to 17&#x2009;336&#xb7;2) per 100&#x2009;000 people in 2050, representing an average annual percentage change of 0&#xb7;3% (95% UI 0&#xb7;3-0&#xb7;3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16&#xb7;1% and approximately 1&#xb7;3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.

Percutaneous coronary intervention for coronary chronic total occlusion (CTO PCI) is offered for symptom and quality of life improvement, despite the absence of blinded randomized evidence. The aim of this study was to assess the efficacy of CTO PCI in the first randomized, placebo-controlled trial of CTO PCI. ORBITA-CTO is a multicenter, randomized, blinded trial comparing CTO PCI with a placebo procedure. Patients had angina attributable to a single-vessel CTO, without bystander coronary disease. Angina symptoms were recorded daily using the ORBITA app. After dual-injection coronary angiography, patients were randomized to either CTO PCI or placebo. Blinding was maintained using auditory isolation and deep conscious sedation. Antianginal medications were stopped at randomization and reintroduced on a patient-initiated protocol. At the 6-month follow-up, assessments were repeated. The primary efficacy outcome was the angina symptom score, an ordinal scale combining the daily symptom burden assessed by the ORBITA app, antianginal use, and over-ride events. Secondary outcomes were symptom and quality of life questionnaires and blinding fidelity. Between October 19, 2021 and October 21, 2025, 50 patients were randomly assigned to CTO PCI (n = 25) or placebo (n = 25). One patient randomized to PCI was withdrawn during the procedure because of a complication. All 50 patients were included in the primary analysis. Compared with placebo, CTO PCI resulted in an immediate and sustained improvement in the angina symptom score (OR: 4.38; 95% credible interval [CrI]: 1.57-12.69; probability of benefit [Pr{Benefit}] = 0.996), arising from a clear reduction in the number of episodes of angina (OR: 4.38; 95% CrI: 1.55-11.78; Pr[Benefit] = 0.997). This resulted in an additional 30.6 days free of angina (95% CrI: 11.1-50.7; Pr[Benefit] >0.999). Improvements were also observed with the Seattle Angina Questionnaire in angina frequency (+10.7; 95% CrI: 1.4-20.2; Pr[Benefit] = 0.988), physical limitation, quality of life, and summary score and Canadian Cardiovascular Society class. Blinding of patients, staff, and researchers was maintained. In patients with symptomatic single-vessel CTO, CTO PCI improves angina beyond placebo. (A Placebo-controlled Trial of Chronic Total Occlusion Percutaneous Coronary Intervention for the Relief of Stable Angina [ORBITA-CTO]; NCT05142215).

Intracardiac echocardiography (ICE) is an imaging technique that provides real-time, detailed visualization of intracardiac structures during various interventional procedures performed in the electrophysiology laboratory. Over the past decades, ICE has evolved beyond simply assisting with transseptal puncture, becoming an auxiliary tool in numerous aspects of cardiac interventions. This scientific statement offers a comprehensive, systematic overview of current applications of ICE across different clinical scenarios. The existing evidence regarding the benefits of ICE is primarily derived from observational studies, which complicates the formulation of definitive advice for its clinical use. Thus, this document aims to serve as a practical roadmap, emphasizing the key benefits of the technique. The document covers fundamental principles of ICE imaging, standardized views, its role in transseptal puncture, ablation of supraventricular and ventricular arrhythmias, reduction of procedural radiation, early detection and management of periprocedural complications, identification of infective endocarditis, and the role of ICE for endomyocardial biopsy and left atrial appendage occlusion procedures.

Predicting the progression/regression of coronary plaque burden is challenging. We aimed to develop a deep learning model to forecast changes in percent atheroma volume (&#x394;PAV) using intravascular ultrasound (IVUS). We analysed data from IBIS-4 and PACMAN-AMI. Core lab measurements of plaque burden were available from IVUS pullbacks. Each model consists of a bidirectional Long Short-Term Memory (biLSTM) layer followed by two fully connected layers with one neuron each, resulting in both a classification for input progression/regression and an estimation of the &#x394;PAV. For the derivation and validation, a total of 1,960 regions of interest (ROIs) from the IBIS-4 dataset were used. The mean&#xb1;standard deviation of the model accuracy was 0.85&#xb1;0.02, the Matthews correlation coefficient was 0.70&#xb1;0.04, and the F1 score was 0.85&#xb1;0.02 for both progression and regression classes. In the testing (external validation) process with the PACMAN-AMI dataset, 5,283 ROIs were utilised. The mean &#x394;PAV was -0.31&#xb1;5.63, for which 2,665 featured regression with a mean &#x394;PAV of -4.57&#xb1;3.73, and 2,618 presented progression with a mean &#x394;PAV of 4.02&#xb1;3.55, representing 49.6% of plaque progression prevalence. The predictive performance across the 100 trained models in the testing dataset showed an accuracy of 0.84, a Matthews correlation coefficient of 0.68, and an F1 score for the progression and regression classes of 0.84. This is the first deep learning model capable of detecting changes in plaque progression by analysing the rate of plaque burden change between adjacent frames.

Coronary obstruction (CO) during transcatheter aortic valve replacement (TAVR) is rare but potentially fatal. Computed tomography (CT)-based risk assessment algorithms aim to identify high-risk patients, but their utility remains underexplored. The aim of this study was to examine the clinical utility of a CT-derived algorithm for predicting CO during TAVR and identify predictors of CO despite coronary protection (CP). In this prospective study, 164 patients at risk for CO during TAVR were enrolled. Preprocedural CT was used to classify risk using a published algorithm. A novel volumetric parameter, valve-to-coronary volume (VTCV), was calculated in high-risk cases using sinus width and valve-to-coronary (VTC) distance. The decision to use CP was left to the heart team. Clinical endpoints followed Valve Academic Research Consortium 3 definitions. According to the CT-based algorithm, 58.5% of patients (96 of 164) were at low risk, 24.4% (40 of 164) at intermediate risk, and 17.1% (28 of 164) at high risk. CP was performed in 12.8% of low-risk patients (16 of 125), 52.8% of intermediate-risk patients (28 of 53), and 93.9% of high-risk patients (31 of 33). All CO events (n = 7) occurred in the high-risk group. VTC distance and VTCV were significantly lower in patients with CO (P = 0.006 and P = 0.005, respectively). VTCV independently predicted CO (area under the curve, 0.841; 95% CI: 0.702-0.979; P < 0.001), outperforming VTC distance alone. The predictive value of VTCV was validated in an external cohort including 11 European centers. A CT-based algorithm stratifies patients into 3 CO risk categories, though the decision for CP in clinical practice seems to incorporate additional clinical and procedural variables. Although CP reduces CO risk, its efficacy is limited in patients with very small VTCV, which can be predicted preprocedurally via CT. (Leipzig TAVR Registry; NCT05015452).

The identification of abnormal ventricular potentials (AVPs) in intracardiac electrograms of post-ischemic ventricular tachycardia patients is challenging, and the development of automated tools is hampered by the lack of annotated benchmarking datasets. This work presents the ARGO dataset, the first open-access collection of manually annotated left-ventricle post-ischemic ventricular tachycardia electrograms. The dataset includes 1962 signals from nine patients, including unipolar and bipolar electrograms, 12-lead surface ECGs, and the local activation time and voltage maps, with annotations of the bipolar EGMs in terms of their nature (i.e., Physiological, AVP, or Unknown) and the delineation of the onset/end of the AVPs. The annotation is the result of three independent annotations by as many expert electrophysiologists, including a final consensus, for enhanced reliability and accuracy of the dataset. Leveraging good inter-rater and intra-rater reliability, the proposed validation analysis also provides quantitative estimates of the tolerance associated with AVP delineation error. Even considering the limitations of the proposed dataset affecting generalizability, ARGO provides a unique resource to support the development and validation of computational tools for AVP identification and characterization.

Transcatheter Aortic Valve Implantation (TAVI) has emerged as a less invasive alternative to surgical aortic valve replacement, especially for high-risk patients. While TAVI is expected to improve symptoms and functional status, clinical recovery is often heterogeneous, and subjective assessments may not fully capture the degree of improvement. To our knowledge, the changes in functional capacity following TAVI have not been well explored using cardiopulmonary exercise testing (CPET).The study aims to characterise mid-term changes in exercise tolerance after TAVI and identify clinical and functional predictors of improvement in exercise capacity and complications after TAVI. A total of 161 patients with severe aortic stenosis scheduled for TAVI will be prospectively enrolled across three expert centres. Each will undergo clinical assessment and incremental CPET within two weeks before and four to six weeks after the procedure. The primary outcome is a change in VO&#x2082; peak and VO&#x2082; at the anaerobic threshold. Secondary outcomes include exploratory associations between baseline characteristics and observed changes in functional capacity, quality of life and complications. The bioethics committee of the Hospital Cl&#xed;nic de Barcelona, Spain, approved this protocol (HCB/2024/0782). All the participating centres obtained local approval prior to patient recruitment. The findings will be published in a peer-reviewed journal and submitted to relevant conferences. ClinicalTrials.gov NCT06833762 (registered 10th of March 2025).

In nonischemic dilated cardiomyopathy (NICM), the severity of secondary mitral regurgitation (SMR) is dynamic, depending on loading conditions and the effect of guideline-directed medical therapy (GDMT). However, the longitudinal trajectories of SMR and their prognostic implications remain insufficiently explored. We aimed to define the long-term trajectories of SMR and their prognostic impact in NICM. We retrospectively analyzed 764 NICM patients who underwent serial echocardiographic evaluations over a median follow-up of 9 (4-15) years. The longitudinal trajectories of SMR were identified using a latent class mixed model. Phenotypic characteristics and cardiovascular outcomes (all-cause death [D], heart transplant [HT], left ventricular assist device implantation [LVAD]) associated with SMR trajectories were investigated. Secondary mitral regurgitation trajectories identified for patients with baseline no to mild SMR (n = 440) were no progression (76.2%), mild worsening (10.2%), and severe worsening (13.6%). In patients with baseline moderate to severe SMR (n = 324), trajectories included persistent moderate to severe SMR (24%), mild improvement (8%), and strong improvement (68%). Smaller left atrium was associated with both mild and strong SMR improvement, while absence of left bundle branch block and New York Heart Association functional class <III were, respectively, associated with strong and mild SMR improvement. No independent factors related to SMR worsening were identified. In patients with baseline moderate to severe SMR, any improvement of SMR was linked with a lower risk of D/HT/LVAD, whereas in patients with none to mild baseline SMR, only severe worsening was associated with higher risk of D/HT/LVAD. Identification and characterization of longitudinal SMR trajectories may predict the outcome of individual patients with NICM and guide early therapeutic or interventional strategies to improve prognosis.

Atherosclerotic plaque rupture is largely acknowledged as the main mechanism of acute coronary syndrome. However, the prognostic significance of plaque rupture detected in nonculprit coronary sites remains largely unknown. We investigated the long-term clinical outcomes of nonculprit plaque rupture detected by optical coherence tomography in the prospective CLIMA study. The primary composite endpoint was cardiac death or target-segment myocardial infarction (TS-MI) through 5-year follow-up. Among 1003 patients (age 64.8y; 24.6% women), nonculprit plaque rupture was observed in 7.3% of patients. Three-vessel disease, total plaque length, thin-cap fibroatheroma and large lipid arc were independently associated with nonculprit plaque rupture. The presence of nonculprit plaque rupture was associated with the primary endpoint at univariable (HR 2.09, 95%CI 1.07-4.08, p&#xa0;=&#xa0;0.030) but not clinical (adjusted HR 1.70, 95%CI 0.83-3.48, p&#xa0;=&#xa0;0.145) and morphological (adjusted HR 1.63, 95%CI 0.83-3.21, p&#xa0;=&#xa0;0.156) multivariable analysis. The individual rates of cardiac death (HR 1.64, 95%CI 0.70-3.85, p&#xa0;=&#xa0;0.252) and TS-MI (HR 2.87, 95%CI 0.97-8.47, p&#xa0;=&#xa0;0.057) did not significantly differ between patients with vs without nonculprit plaque rupture. At the Kaplan-meier analysis, the presence of nonculprit plaque rupture was significantly associated with the primary endpoint only in presence of a thin-cap fibroatheroma (TCFA). The presence of nonculprit plaque rupture did not improve the predictive accuracy of any TCFA in multiple prediction models. Nonculprit plaque rupture was associated with cardiac events at univariable but not multivariable analysis. Identification of nonculprit PR did not improve the predictive value of established high-risk morphological features such as TCFA; however, future ad hoc studies are needed to further clarify its potential independent clinical relevance. URL: https://www. gov; Unique identifier: NCT02883088.

Despite long-standing research on the relationship between coronary artery disease complexity and metabolic and hormonal parameters, the number of studies focusing on non-diabetic patients, a key subgroup of this disease, has remained limited. This study aims to investigate the relationship between specific metabolic and hormonal markers and disease complexity in non-diabetic patients with coronary artery disease. This work is intended to contribute to a growing body of literature, supporting the accelerating trend in research rather than the previously observed plateau. In this single-center observational study, between January 2021 and December 2024, patients hospitalized with acute coronary syndrome and undergoing coronary angiography were retrospectively screened based on their medical records and laboratory data (blood tests obtained after fasting for at least 12 hours). Patients were categorized into two groups: those with a diagnosis of diabetes and those without. A relationship analysis was performed between the two groups based on HbA1c levels (HbA1c &#x2265; 6.5% and HbA1c < 6.5%) and hospital Information Management System data, information on whether or not the patient has been previously diagnosed with diabetes.Additionally, an analysis of the SYNTAX score and its components was conducted to investigate the association between coronary artery disease complexity and various metabolic and hormonal parameters in non-diabetic patients with acute coronary syndrome by identifying correlations differing from those observed in the diabetic group. Among the 636 study participants, the mean HbA1c level was 6.34 &#xb1; 1.38. Of these patients, 65.4% (n = 416) had HbA1c levels of 6.4% or below, while 34.6% (n = 220) had levels of 6.5% or above. Spearman correlation analysis was used to evaluate the relationships between non-normal distributions of the SYNTAX score and clinical and biochemical variables. The SYNTAX score demonstrated a positive and statistically significant correlation with HbA1c (r = 0.242, p < 0.05), age (&#x3c1; = 0.215, p < 0.05), and serum uric acid (SUA) (&#x3c1; = 0.139, p < 0.05). In the group with HbA1c levels < 6.5%, there was a positive correlation between the SYNTAX score and HbA1c, age, and serum uric acid. In contrast, in the group with HbA1c levels &#x2265; 6.5%, the SYNTAX score showed a positive correlation only with age (&#x3c1; = 0.164, p < 0.05), and negative correlation with GGT (&#x3c1; = -0.152, p < 0.05) and BMI (&#x3c1; = -0.144, p < 0.05). TSH and serum uric acid (SUA) levels were independently associated with the severity of coronary artery disease, particularly in the non-diabetic subgroup of patients with obstructive coronary artery disease. These findings may support more accurate risk stratification in clinical practice and facilitate the development of tailored approaches for each coronary artery disease subgroup by identifying potential new target parameters.

Against the backdrop of rapidly rising healthcare expenditures and ongoing reforms in medical insurance payment systems, rigorous evaluation of payment policies and their impacts on medical behavior and outcomes is of critical importance. Using 32,313 inpatient records from the cardiology and cardiothoracic surgery departments of a tertiary hospital in Shanghai between 2007 and 2015, this study constructs a quasi-experimental difference-in-differences (DiD) framework to assess the effects of the Shanghai global budget prepayment policy on hospital cost structures and healthcare quality. The results indicate that the DiD estimator of the policy significantly reduced total inpatient expenditures, suggesting a more streamlined and rationalized cost structure. However, the implementation of the policy was also associated with a significant increase in in-hospital mortality, raising concerns about potential unintended consequences for patient outcomes. The 30-day readmission rate did not change significantly following the reform. To strengthen causal inference, propensity score matching was employed to balance patient characteristics across pre-and post-policy periods. The findings remain robust across multiple sensitivity analyses. Overall, this study highlights the complex trade-offs between cost containment and care quality under payment reform and provides quantitative evidence to inform the optimization of global budget prepayment policies and the advancement of value-based healthcare.

According to the 2025 ESC/EACTS guidelines for the management of valvular heart disease, transcatheter tricuspid valve interventions (TTVI) have received a Class IIa recommendation (Level of Evidence: A) for the treatment of patients with severe symptomatic tricuspid regurgitation. However, in patients with severe left ventricular dysfunction (LVD) or right ventricular dysfunction (RVD) or precapillary pulmonary hypertension (pcPH), optimal medical therapy (OMT) is preferred because of the potential risk for futility. The aim of this study was to evaluate clinical and symptomatic outcomes in such "OMT candidate" patients. Using data from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), guideline-based thresholds for LVD, RVD, and pcPH were applied to patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER). Patients meeting &#x2265;1 exclusion criterion ("OMT candidates") were compared with those meeting current recommendations ("TTVI appropriate") regarding NYHA functional class improvement and 2-year survival free from heart failure hospitalization (HFH). Among 1,626 T-TEER patients, 213 (13.1%) met &#x2265;1 exclusion criterion (4.2% of those with LVD, 6.8% of those with RVD, and 3.6% of those with pcPH). Severe LVD, RVD, and pcPH were each associated with significantly lower 1-year HFH-free survival (LVD, 54.6% vs 72.9% [P < 0.001]; RVD, 59.0% vs 73.2% [P = 0.003]; pcPH, 56.2% vs 73.4% [P = 0.021]; median survival follow-up 446 days [Q1-Q3: 192-805 days]). Despite higher NYHA functional class at baseline and follow-up, the rate of &#x2265;1-class improvement was comparable across subgroups (LVD, 51.1% vs 59.4% [P = 0.25]; RVD, 59.7% vs 59.0% [P = 0.90]; pcPH, 51.3% vs 59.4% [P = 0.31]). Overall, "OMT candidates" had lower HFH-free survival than "TTVI-appropriate" patients (58.7% vs 74.3%; P < 0.001) but showed comparable symptomatic relief (&#x2265;1 NYHA functional class in 56.2% vs 59.5%; P = 0.68). T-TEER may provide symptomatic benefit in selected high-risk patients with severe LVD, RVD, or pcPH. In the absence of randomized evidence, multidisciplinary evaluation at experienced heart valve centers remains essential to balance potential benefit against procedural futility. Further studies are warranted to refine patient selection and optimize outcomes in this challenging cohort.

After resuscitation from out of hospital cardiac arrest (OHCA), mechanical ventilation (MV) and respiratory management are fundamental to support patients in the intensive care unit (ICU) and to minimise secondary brain injury. Best practices for MV and association with clinical outcomes in patients with OHCA remain unclear. This protocol describes a pre-planned respiratory-focused series of sub-analyses within the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) trial, an ongoing interventional study evaluating 6-month mortality after randomisation in patients admitted to ICUs following OHCA. The primary aim is to describe real-world ventilator settings and gas-exchange targets during the first 72 hours after ICU admission in patients receiving invasive mechanical ventilation after OHCA. Secondary aims include to estimate the incidence of respiratory complications during ICU stay (eg, ventilator-associated pneumonia, acute respiratory distress syndrome, barotrauma); and to explore the association between early ventilator settings/gas-exchange parameters and 6-month outcomes (mortality and neurological status). Exploratory aim is to characterise weaning and extubation practices, including timing and failure rates.Eligible patients will include adult STEPCARE participants receiving invasive MV after return of spontaneous circulation with available respiratory data recorded within the STEPCARE database.Data collected in the STEPCARE trial that will be analysed include patients' prehospital characteristics; clinical examination at hospital admission and at ICU admission; ventilator settings and arterial blood gases recorded at predefined time points during ICU stay. In particular: MV setting (mode, tidal volume, positive end-expiratory pressure, fraction of inspired oxygen, tidal volume, mechanical power, plateau/driving pressures), gas-exchange values (arterial partial pressure of oxygen and carbon dioxide, pH, arterial saturation of oxygen), timing of measurements and the occurrence/timing of respiratory complications and weaning outcomes. The STEPCARE study has been approved by the regional ethics committee at Lund University (Dnr 2022-02425-01, Approved IRB on 2022-06-18) and by all ethics boards in the participating countries. No additional ethical approval is required for this predefined secondary analysis, as no further data collection or interventions will be performed. Findings will be disseminated through publication in peer-reviewed journals and, where appropriate, conference abstracts and presentations. Patients and the public were not involved. NCT05564754.

A key challenge in pulmonary arterial hypertension (PAH) research is assessing the specific impact of this condition on health-related quality of life (HRQoL), also considering the patient's subjective experience and caregiving burden. The prospective, observational, multicentre Non-INterventional Study on Pulmonary arterial hypertension patients treated with macitentan and/or selexipag: ExperienCe from an ITalIan cOhort (INSPECTIO) study integrated narratives with patient-reported outcomes (PROs) and clinical data to gain deeper insight into patients' experiences of PAH, also involving caregivers' perspectives. The study was conducted across 29 Italian hospital-based centres and enrolled adult patients with PAH already on treatment with macitentan and/or selexipag as part of combination therapy. A dedicated narrative collection was carried out within the larger study. Patient and caregiver narratives were collected at enrolment (visit 1; V1) and at 12 months (visit 3; V3), then analysed through MAXQDA software and correlated with emPHasis-10 questionnaire scores and clinical data. Out of the 186 patients enrolled in the overall INSPECTIO study, 96/186 (52%) completed the narrative at V1 and 58/186 (31%) at V3; 29/54 (54%) caregivers completed the narrative at V1 and 16/54 (30%) at V3. The analysis revealed an alignment between patient narratives and emPHasis-10 scores. Specifically, at V3, emPHasis-10 scores were higher for patients who did not mention their domestic life in narratives, reported feelings of shame or isolation, limitations or breathlessness also in daily activities and reported ongoing treatment-related issues. Nonetheless, at V3, 36/58 (62%) of patients described living with PAH as manageable. The care pathway showed a positive impact on caregivers: their narratives indicated a shift from V1 to V3, with improved perceptions of the care relationship and PAH therapies. INSPECTIO is the first study to integrate narratives, PROs and clinical data in PAH research. Findings suggested that appropriate support and therapeutic management are crucial to help patients cope with the condition. Narratives have proven to be a valuable tool for understanding the impact of PAH and improving its management, providing insights that can inform a more patient-centred approach. NCT04567602.

Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377&#x2008;000 incident childhood cancer cases (95% UI 288&#x2008;000-489&#x2008;000), 144&#x2008;000 deaths (131&#x2008;000-162&#x2008;000), and 11&#xb7;7 million (10&#xb7;7-13&#xb7;2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27&#xb7;0% (15&#xb7;5-36&#xb7;1) globally, from 197&#x2008;000 (173&#x2008;000-218&#x2008;000) in 1990, but increased in the WHO African region by 55&#xb7;6% (25&#xb7;5-92&#xb7;4), from 31&#x2008;500 (24&#x2008;900-38&#x2008;500) to 49&#x2008;000 (42&#x2008;600-58&#x2008;200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26&#xb7;5% (26&#xb7;5-26&#xb7;5) in GBD 2017 to 10&#xb7;5% (8&#xb7;1-13&#xb7;1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47&#xb7;3% (42&#xb7;2-52&#xb7;0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.

Early identification of stroke aetiology, hemodynamic monitoring and detection of complications represent key challenges for vascular neurologists. Stroke-point-of-care ultrasound (Stroke-POCUS) has emerged as a structured framework for integrating multimodal bedside ultrasound into stroke management. Stroke-POCUS involves the comprehensive bedside use of various ultrasound modalities, including cervical and transcranial ultrasound, orbital ultrasound, echocardiography, venous system ultrasound, lung ultrasound, abdominal ultrasound and interventional ultrasound. These modalities are applied in an integrated manner to assess stroke patients in the acute setting, aiming to support diagnosis, etiological investigation, detection of complications and monitoring of treatment response, as an adjunct, not a substitution for computed tomography, magnetic resonance imaging, or standard comprehensive ultrasound examination. The integration of multiple ultrasound modalities within Stroke-POCUS enables clinicians to obtain rapid, noninvasive answers to well-defined clinical questions at the patient's bedside and in real time. This capability is particularly critical for patients requiring expedited diagnostics prior to urgent treatment initiation, for clinically unstable patients in whom intrahospital transport carries an increased risk of complications, as well as for assessing potential underlying causes, identifying secondary complications and monitoring treatment efficacy. Stroke-POCUS represents a comprehensive bedside imaging strategy that enhances the evaluation and management of stroke patients. By integrating multiple ultrasound techniques, it provides a more holistic view of stroke pathophysiology, complications and treatment monitoring, potentially improving clinical decision-making and individualised patient care.