The aerodynamic noise produced by the annular axial cooling fan significantly impacts the NVH performance of automobiles. In response to this challenge, the paper proposes a low-noise annular axial cooling fan design, which based on the principle of small-hole jet flow. To balance the aerodynamic performance and the benefits of noise reduction, an L16 orthogonal array was utilized to optimize the perforated blade parameters at the fan rated operating condition (rotational speed of 2400 rpm and a static pressure rise of ΔPs =120 Pa). Numerical simulations reveal that micro-jets ejected from the perforations effectively optimize the blade surface pressure distribution, diminishing negative pressure backflow zones and significantly reducing vorticity at the guide ring and blade trailing edge. The comprehensive optimal configuration was identified as: radial spacing divided into 15 equal segments, 1 circumferential locating line, 3 radial locating lines, and a 2 mm perforation diameter. Under the identical 120 Pa aerodynamic loading, the optimized model successfully maintained the required mass flow rate while achieving a 1.92 dBA experimental reduction in the A-weighted Total Sound Pressure Level (TSPL) compared to the original model. While discrete tonal noise is significantly suppressed at high speeds, an inherent acoustic tradeoff was observed, characterized by a slight increase in broadband high-frequency noise at lower speeds. The results confirm that this perforation-based method is a viable noise reduction strategy. It provided new insights and references for the low-noise design of annular axial cooling fans.
Catheter ablation (CA) improves outcomes in atrial fibrillation (AF) with left ventricular systolic dysfunction (LVSD), but the influence of LV fibrosis remains unclear. This study sought to compare outcomes of CA in patients with AF and LVSD stratified by the presence or absence of LV late gadolinium enhancement (LGE) on cardiac magnetic resonance. Patients from the CAMERA-MRI II (Catheter Ablation Versus Medical Rate Control of the Atrial Fibrillation With Systolic Heart Failure and Myocardial Fibrosis-an MRI Guided Multi-Centre Randomised Controlled Clinical Trial) randomized study were classified as LGE positive (LV LGE burden ≥5%) or LGE negative (<5%) and all underwent CA. Outcomes at 12 months included change in left ventricular ejection fraction (LVEF), LVEF normalization, AF burden, functional capacity, and heart failure hospitalization. Eighty patients underwent CA (40 LGE positive and 40 LGE negative). Both groups demonstrated substantial improvement in LVEF (LGE positive: ΔLVEF +20.3 ± 11.0%; LGE negative: +21.7 ± 11.8%; P = 0.578 for between-group difference in change). Unadjusted 12-month LVEF was lower in LGE-positive patients (49.1 ± 11.3% vs 54.5 ± 9.0%; P = 0.019); however, after adjustment for baseline cardiac magnetic resonance and markers of baseline disease severity, LGE status was not independently associated with 12-month LVEF (P = 0.849). Fewer LGE-positive patients achieved LVEF normalization (LVEF ≥50% in 52% vs 82% in LGE negative; P = 0.004), whereas arrhythmia-free survival and AF burden reduction were comparable. Improvements in biomarkers, functional status, and quality of life occurred in both groups. Higher LGE burden (>20%) was associated with attenuated LVEF recovery. In AF with LVSD, CA is associated with substantial improvement in LV systolic function and clinical status regardless of LGE status. Absolute 12-month LVEF and normalization rates are lower in LGE-positive patients, consistent with greater baseline disease severity, whereas higher scar burden appears to modulate the magnitude of recovery and may inform expectations regarding outcomes.
High-loading rate events such as automotive collisions, aircraft ejection, and underbody blast can result in severe spinal injuries. Computational models aim to predict injuries to enable future safety improvements but require a detailed understanding of the high-rate mechanical response of the spine's structures, particularly the intervertebral discs. This study aimed to characterise the compressive and flexion stiffness properties of human intervertebral discs across all levels of the spine, using an inverse modelling approach. Vertebral body-disc-vertebral body segments from each level of four human cadaveric spines were subjected to increasing rates of loading in both compression and flexion using a servo-hydraulic machine for lower rates, and a drop tower for higher rates. A multibody model was developed for each segment (two degree-of-freedom spring), and an inverse method was used to calculate the non-linear disc response that matched the one measured experimentally. Compressive loads were applied at mean strain rates of 0.82, 4.54, 6.71 and 30.35/s and flexion loads were applied at mean rates of 0.28, 1.92, 4.19 and 12.46 rad/s. Differences were observed between spinal regions (lumbar vs thoracic vs cervical), with inferior thoracic spine segments demonstrating higher compressive and flexion stiffnesses compared to other levels. An increase in compressive and flexion stiffnesses were seen with loading rate, with greater variations in stiffness at higher loading rates, and increased degeneration grades. The 3rd order polynomial disc stiffnesses under high-rate axial compression and flexion, calculated according to spinal region and loading rate, can be used to inform physical and computational surrogate spinal models that aim to improve strategies to prevent spinal injuries.
Cardiovascular disease (CVD) is the leading cause of death among women globally. Recognition of sex-specific risk factors, pathophysiology, and clinical presentations has established women's cardiovascular health as a research and clinical priority. Pregnancy complications, premature menopause, and autoimmune disease, are now identified as long-term contributors to cardiovascular risk, while female-predominant syndromes such as ischemia with non-obstructive coronary arteries and heart failure with preserved ejection fraction are increasingly acknowledged. Novel therapies and updated guidelines emphasize psychosocial determinants, reproductive history, and postpartum risk assessment in prevention and management. Despite these advances, women remain underdiagnosed, undertreated, and underrepresented in clinical trials. Diagnostic delays and limited access to therapies and rehabilitation persist globally, with disparities pronounced in Saudi Arabia, where obesity, diabetes, and hypertension are highly prevalent. Closing these gaps requires sustained investment in sex-specific research, equitable access to evidence-based care, and integration of women's cardiovascular health into national strategies under Saudi Vision 2030.
Chronic heart failure (CHF) remains a leading cause of mortality globally, with limited therapeutic options targeting its underlying pathological mechanisms. Guizhi Gancao Decoction (GGD), a classic traditional Chinese medicine formula, has been used for centuries to treat cardiovascular diseases, but its molecular mechanisms in CHF remain elusive. This study aimed to investigate the therapeutic effects of GGD on isoproterenol (ISO)-induced CHF in mice and explore its underlying mechanisms, focusing on the cAMP/PKA signaling pathway, ubiquitin-proteasome system (UPS), and calcium handling. A CHF model was established by subcutaneous injection of ISO in C57BL/6 mice. Cardiac function and structural remodeling were evaluated using echocardiography, histopathology (hematoxylin-eosin staining, Masson staining), and molecular markers (ANP, BNP). Serum metabolomics combined with western blotting was used to identify key signaling pathways. Co-immunoprecipitation (Co-IP) and mass spectrometry (MS) were employed to explore protein-protein interactions. Molecular docking and in vitro calcium transient assays validated the functional relevance of key targets. GGD treatment significantly improved ISO-induced cardiac dysfunction, as evidenced by increased ejection fraction (EF), fractional shortening (FS), and reduced left ventricular internal diameters (LVIDs/d). Pathological hypertrophy and fibrosis were attenuated by GGD, particularly at low doses, with downregulated ANP/BNP expression. Metabolomic profiling identified the cAMP/PKA pathway as a critical target, where GGD normalized ISO-induced upregulation of PKA regulatory (RI-α/β) and catalytic (α/β/γ) subunits. Five active ingredients in GGD (e.g., 4-hydroxy cinnamic acid, 18α-glycyrrhetinic acid) exhibited strong binding affinity to PKA. Co-IP-MS revealed PKA interaction with proteasome-related proteins (Psma2, Psmb5, Ube2d3), and GGD inhibited ISO-enhanced PKA-proteasome binding, restoring UPS homeostasis. Importantly, GGD reduced ubiquitin-mediated degradation of SERCA2a, preserved calcium transient dynamics, and improved cardiomyocyte contractility, an effect mimicked by the proteasome inhibitor MG132. GGD alleviates ISO-induced CHF by modulating the cAMP/PKA pathway, inhibiting PKA-proteasome interactions, and preserving SERCA2a-dependent calcium cycling. These findings highlight GGD as a promising therapeutic agent for CHF via targeting UPS-mediated SERCA2a degradation. However, because the present study was conducted using a single batch of GGD, the findings should be considered preliminary and require further validation across multiple batches of herbal materials.
This Medical News article discusses a new study that found weakened heart muscle cell contractions in patients with heart failure with preserved ejection fraction and very high body mass index.
Heart failure (HF) is a major public health issue globally, requiring early risk stratification to improve patient outcomes. Despite numerous machine learning (ML) applications in HF prediction, critical gaps persist: lack of systematic algorithm benchmarking under standardized conditions, reliance on single explainable AI (XAI) methods, and insufficient attention to class imbalance. We provide the first comprehensive benchmark of 10 ML algorithms for HF risk stratification and establish a validated dual-XAI framework for clinical deployment. We analyzed a publicly available dataset of 2,169 patients with 15 clinical features. Ten ML algorithms (five traditional: Logistic Regression, Decision Tree, Support Vector Machine, K-Nearest Neighbors, Naive Bayes; five ensemble: Random Forest, Gradient Boosting, XGBoost, LightGBM, CatBoost) were compared under rigorously standardized conditions, including an 80:20 stratified train-test split, identical preprocessing, and a fixed random seed. Performance was evaluated using six complementary metrics: Receiver Operating Characteristic-Area Under Curve (ROC-AUC), accuracy, precision, recall, F1-score, and Precision-Recall AUC (PR-AUC). SHapley Additive exPlanations (SHAP) and Local Interpretable Model-agnostic Explanations (LIME) were applied to interpret the best model, with quantitative cross-method concordance analysis. Logistic Regression achieved optimal performance (ROC-AUC = 0.9451, accuracy = 88.25%, F1-score = 0.8294, PR-AUC = 0.9113), outperforming complex ensemble methods. Left Ventricular Ejection Fraction (LVEF) was the dominant predictor (SHAP normalized importance = 1.0; LIME weight = 0.2917), followed by diabetes, age, hypertension, and serum creatinine, with 100% SHAP-LIME concordance in top-3 rankings. The false-negative rate on the test set was 18.42% (28/152), supporting the model's clinical utility for high-risk patient identification. Key contributions include: (1) the first systematic comparison of 10 algorithms under identical experimental conditions; (2) a novel dual-XAI framework (SHAP + LIME) with quantified cross-validation, addressing single-method biases; (3) demonstration that simple, interpretable models outperform complex ensembles on moderate-sized datasets (n = 2,169), offering practical guidance for resource-limited settings; and (4) quantitative validation of LVEF dominance across interpretation methods. The validated framework shows potential for clinical risk stratification systems, though prospective validation against independent clinical outcomes is required.
This post hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial examined whether estimated plasma volume status (ePVS) modifies the association between estimated glomerular filtration rate (eGFR) and incident atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF). A total of 2,202 HFpEF patients without baseline AF were included. ePVS was calculated using the Duarte formula, and participants were stratified into low and high ePVS groups based on the cohort median. Multivariable Cox proportional hazards models were used to assess the association between eGFR and incident AF, with stratified analyses by spironolactone treatment. During follow-up, 4.9% of patients developed incident AF. No significant association between eGFR and AF was observed in the low ePVS group. In contrast, among patients with high ePVS, higher eGFR was associated with a reduced risk of incident AF after multivariable adjustment, with a significant nonlinear relationship (P for nonlinearity <0.001) and a statistically significant eGFR × ePVS interaction (P for interaction = 0.010). The association was consistent regardless of spironolactone use. This exploratory post hoc analysis suggested that ePVS may modify the association between eGFR and incident AF in HFpEF, with lower eGFR linked to higher AF risk primarily in patients with elevated ePVS. These hypothesis-generating findings should be interpreted cautiously given the limited number of events. Prospective studies are warranted to validate this potential interaction and its clinical implications.
Background Cardiac sarcoidosis (CS) may present with conduction abnormalities, ventricular arrhythmias, and heart failure. The delay in recognizing cardiac involvement in systemic sarcoidosis leads to disease progression, resulting in major morbidity and mortality. We studied the clinical, electrocardiographic, and imaging features of cardiac sarcoidosis and its mortality predictors. Methods The clinical data of patients with CS who presented to the Sree Chitra Tirunal Institute for Medical Sciences and Technology between 2005 and 2021 were retrospectively analysed. The diagnosis of CS was based on the 2014 Heart Rhythm Society Expert Consensus recommendations and the 2016 Japanese Circulation Society clinical diagnosis criteria. Patients with obstructive coronary artery disease and possible myocarditis were excluded from the study. Results Forty-three patients of CS (31 males), aged 49 (8.8) years, were followed up for a mean duration of 4.3 (range 1.87-6.5) years. The presenting clinical manifestations were ventricular tachycardia (VT) 14/43 (33%), acute heart failure 14/43 (33%), complete heart block 10/43 (23%), and non-sustained VT/symptomatic ventricular premature complexes 2/43 (5%). Systemic manifestations included lymphadenopathy 28/43 (65%), pulmonary parenchymal involvement 26/43 (60%), and neurological involvement 8/43 (19%). The mean basal left ventricular ejection fraction at presentation was 41.1% (standard deviation 16.1%), and 31/33 (94%) of the patients had late gadolinium enhance-ment in cardiac MRI, with the predominant pattern being sub-epicardial 18/33 (58%) or mid-myocardial 17/33 (54%). Eighteen (42%) patients received implantable cardioverter defibrillator (ICD); nearly half had appropriate ICD shocks. On follow-up, 11 (25%) patients died, 10 (23%) had recurrent heart failure admissions, and 5 (29%) had recurrent ICD shocks. Multivariate analysis revealed higher New York Heart Association (NYHA) class/clinical heart failure at presentation, elevated erythrocyte sedimentation rate at diagnosis, and persistent low ejection fraction during follow-up to be predictors of mortality, not VT. Survival analysis showed that recurrent heart failure admissions predict early mortality. Conclusion Although arrhythmia was the most common manifestation, clinical heart failure was seen in nearly half of the patients with a diagnosis of CS. A high prevalence of heart failure, along with 25% mortality in our study, may indicate a delayed recognition of cardiac involvement in these patients' natural history. Recurrent heart failure admissions predicted early mortality.
In advanced heart failure (AdHF), repeated levosimendan infusions between 0.1 and 0.2 μg/kg/min for 6-24 h every 2-4 weeks were associated with inconsistent outcomes and trends towards worse prognosis. Treatment effect with lower dosing is however unknown. The aims of this retrospective study were to assess the impact of 24-h levosimendan cycles at 0.05 μg/kg/min every 4 weeks on HF therapy, outcomes, and safety and to identify predictors of treatment efficacy. Among 286 AdHF patients, 39 levosimendan-treated subjects (4.19 ± 2.6 infusions) and 39 standard-of-care (SOC) subjects matched 1:1 based on a propensity score accounting for age, sex, ischemic heart disease, left ventricular (LV) ejection fraction, creatinine, heart rhythm, and heart transplantation (HTx) listing underwent comparison of their outcome. Efficacy was defined as 1-year survival without LV-assist-device, urgent HTx and urgent hospitalization for HF. Adverse events (AE) included permanent levosimendan interruption, sustained arrhythmias, or hypotension occasioning permanent infusion hold. Beta-blocker (BB) dose increased with levosimendan [34.7% (18.4-50%) of target-dose at 6-months vs. 21.9% (6.25-25%) at baseline (P = 0.022)]. At 1 year, 26 patients reached the efficacy endpoint in the levosimendan group vs. 14 in the SOC group (HR = 0.42; 95% CI = 0.22-0.83; P = 0.01). The benefit of levosimendan was essentially driven by the reduction of HF hospitalization (HR = 0.367; 95% CI = 0.16-0.85; P = 0.014), with no difference in the reduction of death, LVAD or SU-HTx (HR = 0.8; 95% CI = 0.3-21.4; P = 0.65). No AE occurred. We found no prognostic factor at baseline but BB therapy (95.6% vs. 50%; P = 0.005), higher BB dosing (33 ± 20% vs. 9 ± 20% of target-dose; P = 0.036), and lower heart rate (71 ± 10.4 vs. 81 ± 14 bpm; P = 0.039) at 3 months were associated with treatment efficacy. Our findings raise the hypotheses that low-dose levosimendan is safe, enables BB up-titration, and is associated with improved outcomes. Heart rate, BB therapy, and BB dosing at 3 months may predict event-free survival.
Primary Hyperparathyroidism (PHPT) is associated with increased cardiovascular risk, partly driven by elevated calcium and parathyroid hormone levels that contribute to structural cardiac changes, including left ventricular hypertrophy. Parathyroidectomy is the definitive treatment for symptomatic PHPT, yet evidence on postoperative cardiac improvement remains inconsistent. This study aims to evaluate echocardiographic changes following parathyroidectomy to clarify its impact on cardiac structure and function. We followed the PRISMA guidelines and searched through electronic databases including Medline, Embase and Cochrane. We identified a total of 24 studies encompassing data from 881 patients with PTHP undergoing parathyroidectomy with measurements of echocardiographic parameters. Echocardiographic parameters included strain, ejection fraction, relaxation time, chamber diameters and flow velocities. Although the pooled standardized mean difference demonstrated that left ventricular ejection fraction did not undergo a statistically significant change (SMD: 0.15, 95% CI: -0.12 to 0.49, p = 0.40), global longitudinal strain exhibited a significant post‑parathyroidectomy improvement (SMD: 0.60, 95% CI: 0.37 to 0.83, p < 0.00001). Furthermore, we identified a reduction in the E/A ratio and an increase in left ventricular mass, collectively suggesting the presence of ongoing cardiac remodeling after parathyroidectomy. Global longitudinal strain may represent a more sensitive marker of subtle improvements in left ventricular function following parathyroidectomy in patients with PHPT. Further studies are needed to determine whether this parameter confers additional prognostic value in individuals with cardiovascular disease.
Symptoms related to gastrointestinal autonomic neuropathy, which can involve gallbladder, are prevalent in patients with diabetes. We hypothesize that diabetes duration may impact gallbladder volume and motility. This study aims to explore relationships between gallbladder volume parameters and diabetes duration in individuals with type 2 diabetes compared with non-diabetic controls. Autonomic neuropathy will also be explored. In this cross-sectional observational case-control study, matched individuals with longstanding type 2 diabetes, early type 2 diabetes, and non-diabetic controls were included. Gallbladder motility was investigated by gallbladder volume changes measured by three-dimensional ultrasound. Gallbladder volumes were collected at predefined time intervals before and after intake of a standardized high-fat meal. Autonomic neuropathy was evaluated by cardiovascular (Vagus) and sudomotor (Sudoscan) testing. Sixty-one adults were included in the final analysis, of which 18 had longstanding type 2 diabetes, 15 had early type 2 diabetes, and 28 were non-diabetic controls. Subjects with longstanding type 2 diabetes had significantly higher fasting gallbladder volume and ejection volume compared to the controls (p = 0.020 and p = 0.019, respectively). No other significant differences in gallbladder motility were observed. Only five participants had autonomic neuropathy. Specific gallbladder volume and motility parameters were associated with diabetes duration. Associations between gallbladder motility and autonomic neuropathy could not be analyzed.
The nonsteroidal mineralocorticoid receptor antagonist finerenone has been shown to improve cardiovascular and kidney outcomes in patients with cardio-kidney-metabolic (CKM) syndrome, but its effects on sudden death (SD) are uncertain. We investigated independent predictors of SD and treatment effects of finerenone on SD. In this prespecified FINE-HEART analysis, we pooled participant-level data from 3 placebo-controlled trials of finerenone in CKM syndrome, including 2 trials of chronic kidney disease with type 2 diabetes (FIDELIO-DKD [Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease] and FIGARO-DKD [Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease]) and a trial of heart failure with mildly reduced ejection fraction/heart failure with preserved ejection fraction (FINEARTS-HF [FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure]). SD in each trial was centrally adjudicated by a blinded clinical endpoint committee. We identified clinical predictors of SD in multivariable Cox regression models and examined treatment effects of finerenone on SD in Cox models stratified by region and trial. Of the 18,991 participants, 418 (2.2%) (0.77 per 100 patient-years) experienced SD during a median follow-up of 2.9 years. Overall, rates of SD were higher in FINEARTS-HF than in the chronic kidney disease trials (1.5 vs 0.5 per 100 patient-years). For the pooled population, higher risk of SD was associated with older age, history of heart failure, atrial fibrillation, prior myocardial infarction, higher urine albumin-to-creatinine ratio, and lower baseline systolic blood pressure. Randomization to finerenone reduced the risk of SD compared with placebo (HR: 0.81; 95% CI: 0.67-0.98; P = 0.034). Relative risk reductions were consistent across subgroups defined by number of baseline CKM conditions (Pinteraction = 0.93) and trial (Pinteraction = 0.71). The nonsteroidal mineralocorticoid receptor antagonist finerenone was associated with a lower risk of SD across the CKM spectrum. (FINE-HEART: An Integrated Pooled Analysis of Finerenone across 3 Phase III Trials of Heart Failure and Chronic Kidney Disease and Type 2 Diabetes; CRD42024570467).
Hereditary spastic paraplegia (HSP) is primarily an inherited neurodegenerative disorder, although reports suggest possible systemic involvement. Cardiac manifestations in SPG4-HSP remain poorly understood, and dilated cardiomyopathy (DCM) has not previously been documented. A 54-year-old woman with genetically confirmed SPG4-HSP presented with progressive dyspnea and a new left bundle branch block. Echocardiography and cardiac magnetic resonance revealed nonischemic DCM with reduced ejection fraction and dyssynchrony. Alternative causes were excluded, and extended cardiomyopathy gene testing was negative. Guideline-directed medical therapy was initiated with symptomatic improvement at outpatient follow up, and she subsequently received cardiac resynchronization therapy with defibrillator given persistent low ejection fraction and dyssynchrony. To the best of our knowledge, this is the first reported experience of coexisting SPG4-HSP and idiopathic DCM. While causality remains uncertain, the case highlights a potential cardiac phenotype in SPG4 and underscores the importance of targeted cardiac evaluation in HSP patients presenting with exertional symptoms. Cardiac symptoms in SPG4-HSP warrant structured cardiac assessment. Standard heart-failure therapy and device management remain applicable.
Atrial fibrillation (AF) is a common electrical complication in patients with acute myocardial infarction. The HAVOC score was originally proposed as a clinical tool for predicting AF in patients with cryptogenic stroke or transient ischemic attack. This study evaluated the predictive value of the HAVOC score for new-onset AF (NOAF) in patients with ST-segment elevation myocardial infarction (STEMI). Between August 2019 and December 2024, the data of 1640 patients (mean age: 56.3 ± 11.2 years, male: 1134, 69.1%) with STEMI were retrospectively analyzed. Patients were divided into two groups: those with and those without NOAF. All patients underwent electrocardiographic monitoring and echocardiographic evaluation following primary percutaneous coronary intervention. Overall, NOAF was observed in 115 patients. A comparison of the clinical and demographic characteristics between the groups showed that age, hypertension frequency, chronic obstructive pulmonary disease, and history of stroke were higher in the NOAF group. Left ventricular ejection fraction was significantly lower (38.2 ± 10.8 vs. 47.9 ± 10.1%, p < 0.001) and left atrial diameter (42.2 ± 4.5 vs. 37.5 ± 4.1 mm, p = 0.001) was significantly higher in these patients. Furthermore, the incidence of unsuccessful intervention, contrast-induced nephropathy, and in-hospital mortality as well as the HAVOC score were significantly higher in patients with NOAF. A high HAVOC score (odds ratio [OR] = 1.078; 95% confidence interval [CI]: 1.022-1.258; p = 0.001) was identified as an independent predictor of NOAF in patients with STEMI. The HAVOC score appears to be a useful tool for predicting NOAF in patients with STEMI. Identifying individuals with high HAVOC scores may enable early recognition and prevention of AF-related complications. HINTERGRUND: Vorhofflimmern (VF) ist eine häufige elektrische Komplikation bei Patienten mit akutem Herzinfarkt. Der HAVOC-Score wurde ursprünglich als klinisches Instrument zur Vorhersage von VF bei Patienten mit kryptogenem Schlaganfall oder transienten ischämischen Attacken vorgeschlagen. Ziel der vorliegenden Studie war es, den prädiktiven Wert des HAVOC-Scores für neu aufgetretenes VF („new-onset atrial fibrillation“, NOAF) bei Patienten mit ST-Strecken-Hebungs-Infarkt (STEMI) zu untersuchen. Zwischen August 2019 und Dezember 2024 wurden die Daten von 1640 Patienten (Durchschnittsalter: 56,3 ± 11,2 Jahre, davon männlich: 1134; 69,1%) mit STEMI retrospektiv analysiert. Die Patienten wurden in 2 Gruppen aufgeteilt: eine mit und eine ohne NOAF. Bei allen Patienten wurden ein EKG-Monitoring und eine echokardiographische Untersuchung nach der primären perkutanen Koronarintervention durchgeführt. Bei 115 Patienten wurde ein NOAF festgestellt. Der Vergleich klinischer und demografischer Merkmale zwischen den Gruppen zeigte, dass das Alter, die Häufigkeit von Hypertonie, chronisch obstruktiver Lungenerkrankung und Schlaganfall in der Anamnese in der NOAF-Gruppe höher waren. Die linksventrikuläre Ejektionsfraktion war signifikant niedriger (38,2 ± 10,8 vs. 47,9 ± 10,1%; p < 0,001), und der linksatriale Durchmesser (42,2 ± 4,5 vs 37,5 ± 4,1 mm; p = 0,001) war signifikant höher bei diesen Patienten. Außerdem waren bei Patienten mit NOAF die Inzidenz erfolgloser Interventionen, kontrastmittelinduzierter Nephropathien und die Krankenhausmortalität sowie der HAVOC-Score signifikant höher. Ein hoher HAVOC-Score (Odds Ratio [OR] = 1,078; 95%-Konfidenzintervall [95%-KI]: 1,022–1,258; p = 0,001) stellte sich als unabhängiger Prädiktor von NOAF bei Patienten mit STEMI heraus. Der HAVOC-Score scheint ein nützliches Instrument zur Vorhersage von NOAF bei Patienten mit STEMI zu sein. Die Identifizierung von Personen mit hohen HAVOC-Scores kann eine Früherkennung und Prävention von VF-bedingten Komplikationen ermöglichen.
Left-ventricular filling pressure estimated using cardiovascular magnetic resonance (LVFPcmr) provides a noninvasive measure of diastolic function and has demonstrated prognostic value comparable to invasive assessment in heart failure populations. However, data on LVFPcmr in patients following acute ST-segment elevation myocardial infarction (ASTEMI) are limited. Thus, this study aimed to evaluate the diagnostic and prognostic implications of LVFPcmr in a cohort of patients with ASTEMI. This study included 296 patients with ASTEMI who underwent cardiovascular magnetic resonance (CMR) after percutaneous coronary intervention (PCI). The primary clinical endpoint was major adverse cardiac events (MACEs), defined as a composite of death, reinfarction, and heart failure. Univariable and multivariable Cox regression analyses were used to determine the association between LVFPcmr and MACEs. Receiver operating characteristic curve and Kaplan-Meier analyses were performed to evaluate the prognostic value of LVFPcmr in patients with ASTEMI. During a median follow-up of 1563 days (interquartile range: 1442-1714 days), 38 patients (12.84%) experienced MACEs. These patients exhibited significantly higher CMR-derived LVFPcmr values than those without MACEs (14.57 [13.17-15.99] vs. 13.30 [12.05-14.51] mmHg; p < 0.001). Moreover, the Youden index identified an optimal LVFPcmr cutoff of 14.30 mmHg for high-risk classification (p < 0.001). In univariable Cox regression analysis, each 1 mmHg increase in LVFPcmr was associated with a significantly higher risk of MACEs (hazard ratio [HR]: 1.31; 95% confidence interval [CI]: 1.14-1.51; p < 0.001). This association remained robust in multivariable models after adjustment for baseline covariates, left-ventricular ejection fraction, and infarct size (% of LV mass) (HR: 1.25 per 1 mmHg increase; 95% CI, 1.07-1.46; p < 0.01). The multivariable regression model yielded a Harrell C-index of 0.77, indicating strong discriminative ability for predicting MACEs. LVFPcmr independently predicts long-term MACEs after ASTEMI, supporting the use of this approach in post-PCI risk stratification.
To determine the feasibility of using natural language processing (NLP) to extract ejection fraction (EF) and related cardiac imaging parameters for cancer survivors, across multiple imaging modalities, over a 20-year period. Retrospective observational study applying NLP to multi-modality cardiovascular imaging reports. Large academic medical center with electronic health records spanning 2000-2020. More than 4000 patients with multi-modality cardiac imaging reports, including echocardiography, nuclear cardiology, and cardiac magnetic resonance (CMR). Application of NLP algorithms to extract EF and related measurements from free-text cardiac imaging reports. Manual review was performed to assess and resolve discrepancies. Applicability of NLP for extracting EF across echocardiography, nuclear cardiology, and CMR reports. NLP successfully extracted EF values across all imaging modalities. The method demonstrated comparable performance in echocardiography, nuclear cardiology, and CMR reports. Discrepancies identified through manual review highlighted the importance of algorithm training to accommodate modality-specific terminology and improve sensitivity. NLP offers a scalable approach for extracting EF and related parameters from large volumes of unstructured imaging reports across multiple modalities. While NLP is modality-agnostic, algorithm training and manual review are essential. This approach can facilitate longitudinal analyses of cardiac function in cancer survivors and other patient populations.
Infective endocarditis carries high mortality in hemodialysis patients, particularly when caused by methicillin‑resistant Staphylococcus aureus. Concomitant fungemia further worsens prognosis but remains rare. A 52‑year‑old woman with type 2 diabetes mellitus and stage V chronic kidney disease on thrice‑weekly hemodialysis presented with atypical chest pain, fatigue, night sweats, and splinter hemorrhages. She was afebrile. Transthoracic echocardiography showed preserved left‑ventricular ejection fraction and grade II mitral/tricuspid regurgitation; transesophageal echocardiography revealed a 0.7 × 2.1 cm pedunculated vegetation on the septal leaflet of the tricuspid valve. Three sets of peripheral and catheter blood cultures were drawn, and empiric renally adjusted daptomycin plus gentamicin were started. On day 3, C‑reactive protein had fallen. Cultures grew methicillin‑resistant Staphylococcus aureus in two peripheral sets and in the tunneled catheter, and Candida tropicalis in one peripheral set. The infected catheter was removed and a brachio‑axillary graft was placed. Gentamicin was discontinued; daptomycin was continued for six weeks. Voriconazole was administered for 21 days, ending 14 days after negative fungal cultures. Follow‑up echocardiography at week 6 showed complete resolution of the vegetation. The patient remained asymptomatic at three‑month follow‑up. In immunocompromised hemodialysis patients, dual bacterial‑fungal bloodstream infections can occur, yet not every positive fungal culture indicates endocardial involvement. Serial cultures, prompt removal of infected hardware, and targeted antimicrobial therapy can achieve cure without surgery even in the presence of sizable vegetations.
Heart failure management in skilled nursing facilities (SNFs) is complicated by limited access to specialists, incomplete clinical documentation, and patients with complex comorbidities. Artificial intelligence clinical decision support systems have been developed mostly for acute hospital settings but not for SNF settings. We present ForeSight-HF, an artificial intelligence clinical decision support tool designed specifically for SNF heart failure management. Built on a large language model with HIPAA-compliant infrastructure, ForeSight-HF synthesizes unstructured clinical documentation to generate heart failure likelihood scores, exacerbation risk scores, and individualized management recommendations. We illustrate its utility through 2 contrasting cases: a Warm/Wet (congested, well-perfused) patient for whom the system recommended intensified diuresis, and a Cold/Dry (hypovolemic, hypoperfused) patient for whom it recommended diuretic de-escalation to prevent harm. ForeSight-HF may help close a persistent care gap in postacute heart failure management.
The T-wave peak-end (TpTe) interval and its ratio to the QT interval (TpTe:QT) are ECG markers of myocardial repolarization dispersion. We hypothesized that these markers are associated with echocardiographic indices reflecting structural remodeling in dogs with the dilated cardiomyopathy (DCM) phenotype and are minimally influenced by heart rate (HR). A cross-sectional study was conducted in dogs with an echocardiographic subtype of DCM, excluding sighthound breeds, between July 2021 and June 2023. Dogs receiving antiarrhythmic drugs prior to the diagnostic ECG were excluded. Repolarization markers (QT interval, corrected QT interval using the Fridericia formula [QTc], TpTe interval, and TpTe:QT) were retrospectively evaluated from in-clinic ECGs and correlated with echocardiographic variables (left ventricular end-diastolic diameter normalized to body weight [LVEDDN], left ventricular end-systolic diameter normalized to body weight [LVESDN], end-diastolic volume, end-systolic volume [ESV], end-diastolic volume normalized to body surface area, ESV normalized to body surface area, fractional shortening, and ejection fraction). Correlation analysis between repolarization markers and HR showed a significant moderate negative correlation for the QT interval, whereas QTc exhibited a weak positive correlation. The TpTe interval showed a weak negative correlation, and TpTe:QT demonstrated a negligible correlation with HR; however, neither association was statistically significant. The TpTe interval showed significant weak correlations with LVEDDN and LVESDN, whereas TpTe:QT showed significant weak to moderate correlations with LVEDDN, LVESDN, ESV, and ESV normalized to body surface area, even after adjustment for HR. In contrast, QT and QTc were not significantly associated with any echocardiographic variable. The TpTe interval and TpTe:QT might have been independent of HR and correlated with left ventricular diameter and volume. The TpTe interval and TpTe:QT may serve as ECG repolarization markers reflecting myocardial structural remodeling in dogs with DCM.