Cardiac imaging and in particular transthoracic echocardiography and computed tomography play a major role in the selection of the patients for surgical or transcatheter aortic valve replacement, for the assessment or procedural success and early prosthetic valve hemodynamics following aortic valve replacement, and for the evaluation and follow-up of the prosthetic valve structure and function in the longer-term, which is key to demonstrate the valve durability. The purpose of this review article is thus to present the role of cardiac imaging, and particularly transthoracic echocardiography and computed tomography, in: (1) patient selection for intervention; (2) assessment of procedural and device success, and of intended performance of the valve; and (3) assessment of the long-term success, valve durability, and prognosis, for clinical trials of intervention in patients with aortic stenosis. Transthoracic echocardiography is the primary imaging modality to detect and stage bioprosthetic valve dysfunction. However, multimodality imaging, including transesophageal echocardiography and computed tomography, is often necessary to determine the cause of bioprosthetic valve dysfunction and make the differential diagnosis between prosthesis-patient mismatch, structural valve deterioration, thrombosis, pannus, or endocarditis. The clinical trials in the field of structural heart disease, and particularly in the field of aortic valve intervention, include imaging end points as part of the primary or key secondary end points. Standardized methods and definitions should be applied to adjudicate these imaging end points, and ideally, these trial end points should be analyzed by independent imaging core labs.
In addition to aortic manifestations, Marfan syndrome can affect retinal vessels. Our aim was to evaluate retinal circulation, and its correlation with genotype and cardiovascular manifestation identifying predictors of aortic involvement (dilation and/or dissection). In the retrospective, cross-sectional study, 39 Marfan syndrome patients with optical coherence tomography angiography records were included. Retinal thickness, superficial and deep vessel density in total retina, fovea, parafovea, perifovea, area and perimeter of foveal avascular zone, fractal dimension were measured. Two groups were created by mutation type: haploinsufficient, dominant negative. Latter were divided into two subgroups according to whether mutation resulted in cysteine elimination. Subjects were assigned into cardiovascular risk based on previous aortic surgery. Retina of haploinsufficient patients was thinner in total, foveal, parafoveal, perifoveal areas compared to dominant negative subjects (p ≤ 0.047). Retinal thickness of haploinsufficient individuals was thinner in total, parafoveal areas compared to dominant negative without (LSD p = 0.038, Bonferroni p = 0.027, respectively) and with cysteine elimination variants (LSD p = 0.032, Bonferroni p = 0.002, respectively). In fovea and perifovea, retinal thickness was decreased in haploinsufficient patients in comparison to dominant negative with cysteine elimination group (Bonferroni p ≤ 0.029). Total, parafoveal, perifoveal superficial and total, parafoveal deep vessel density of subjects who underwent aortic surgery were lower compared to non-operated patients (p ≤ 0.043). To the best of our knowledge, our study is the first to describe a relationship between genotype and optical coherence tomography angiography parameters in Marfan syndrome. These findings along with correlations between genetics and cardiovascular manifestations reported previously, suggest that these parameters may be indirect predictors of increased cardiovascular risk. Here we demonstrated associations between these parameters and aortic involvement.
Cardiovascular diseases remain important causes of morbidity and potential premature mortality in children. Although clinical imaging and electrophysiologic testing have advanced, early, minimally invasive biomarkers that can both detect myocardial injury and help differentiate among overlapping pediatric phenotypes are still limited. Circulating microRNAs (miRNAs; miRs) are becoming attractive biomarker candidates because many are abundant in the heart, actively released into the circulation, and remarkably stable in plasma. The study aimed to assess the expression of miR-1-3p, miR-let-7b-5p, miR-21-5p, and miR-26b-5p in children with cardiovascular disease. Children aged 10-18 years with cardiac arrhythmias, myocarditis, or cardio-myopathies were recruited. The control group consisted of healthy age- and sex-matched children. For each participant, peripheral venous blood was collected for plasma isolation and miRNA profiling. The expression of miR-1-3p, miR-let-7b-5p, miR-21-5p, miR-26b-5p, and UniSp6 molecules was analyzed using the comparative cycle threshold delta Ct (ΔCt) method. A p-value ≤ 0.05 was considered statistically significant. miR-26b-5p was significantly downregulated in patients with cardiac disease compared with healthy controls. miR-21-5p and miR-26b-5p were downregulated in patients with ventricular arrhythmia. Moreover, miR-26b-5p was downregulated in arrhythmia in general. We found no significant difference in the expression of miR-1-3p, miR-let-7b-5p, miR-21b-5p, and miR-26b-5p between patients with and without myocarditis, as well as with and without hypertrophic cardiomyopathy. miR-26b-5p may distinguish young patients with cardiovascular disease and those with arrhythmias from healthy individuals. miR-21-5p and miR-26b-5p may also be seen as potential biomarkers of ventricular arrhythmia. Further studies involving a larger sample size are required to obtain sufficient data and validate these findings.
Climate change represents an escalating global health crisis that profoundly influences the risk factors for cardiovascular disease (CVD). Human-driven alterations in climate - including rising ambient temperatures, more frequent and severe heatwaves, air pollution, and extreme weather events - directly and indirectly exacerbate hypertension, diabetes, hyperlipidemia, and physical inactivity. Exposure to high temperatures and pollution promotes vascular dysfunction, inflammation, and oxidative stress, leading to worsened blood pressure control, dysglycemia, and disrupted lipid metabolism. Extreme weather events, floods, and wildfires trigger acute spikes in cardiovascular events through dehydration, myocardial ischemia, and arrhythmias, while also disrupting healthcare delivery and medication adherence. Moreover, climate-driven changes in food systems and nutritional quality exacerbate unhealthy dietary behaviors, further amplifying cardiometabolic risk. Vulnerable populations - including older adults, racial and ethnic minorities, and those of lower socioeconomic status - bear a disproportionate burden of these effects. Mitigating the cardiovascular consequences of climate change requires integrated approaches that incorporate climate-sensitive risk stratification, targeted education of patients and clinicians, and adaptive health system responses. Primary care physicians play a central role in delivering anticipatory guidance and equitable care to at-risk individuals. This review synthesizes evidence linking climate change with CVD risk profiles. It outlines clinical and public health strategies to strengthen climate resilience in cardiovascular medicine.
Myocarditis is an inflammatory disease involving the heart muscle and potentially the pericardium. While there are many potential causative agents, commonly grouped into infectious (viral, bacterial, parasitic) or noninfectious (autoimmune, systemic disorders, drugs, cancer related), the main pathological pathways ultimately lead to an inflammatory process of the myocardium resulting in necrosis and edema. As there are specific therapies available for patients with myocarditis, reliable and early diagnosis is crucial. Multimodality imaging, especially cardiovascular magnetic resonance, has made a noninvasive diagnosis feasible. Cardiovascular magnetic resonance can not only provide a diagnosis based on the updated Lake Louise criteria, but it also functions as a diagnostic gateway, leading to other imaging modalities, for example, positron emission tomography or computed tomography. Finally, imaging results can help to initiate treatment options as well as determine when a patient can return to work or exercise. This review will cover multimodal imaging in patients with myocarditis with a focus on cardiovascular magnetic resonance, providing case examples of how imaging can guide care and treatment in these patients. In addition, the review focuses on the recent European Society for Cardiology guideline on the management of myocarditis and pericarditis comparing the recommendation to the American College of Cardiology expert consensus statements and the Japanese Circulation Society guidelines.
Technetium-labeled bone-avid tracers have been repurposed to diagnose transthyretin cardiac amyloidosis without rigorous kinetic studies. Supply shortages have necessitated the use of hydroxymethylene diphosphonate (HMDP) as an alternative to technetium-99m pyrophosphate, though comparative data remain limited. This study characterizes tracer kinetics using quantitative single-photon emission computed tomography with computed tomography. Twenty-four subjects undergoing evaluation for transthyretin cardiac amyloidosis underwent serial single-photon emission computed tomography with computed tomography imaging with pyrophosphate (n=11) or HMDP (n=13) on a cadmium zinc telluride system (SpectrumDynamics Veriton). Single-photon emission computed tomography acquisitions were obtained at intervals from 5 minutes to 3 hours post-injection. Quantitative parameters included standardized uptake values (SUVs), target-to-background ratios, and total cardiac activity derived from 3-dimensional volumes of interest for myocardium, blood pool, and bone. Mixed-effects models with splines compared time-activity trends between tracers. All 16 subjects with positive imaging demonstrated visual myocardial uptake above the blood pool within 10 minutes post-injection. Myocardial SUVs were similar between tracers and decreased linearly over time, whereas blood pool SUVs declined biexponentially and bone SUVs increased exponentially. HMDP exhibited faster blood pool clearance and higher bone uptake than pyrophosphate, resulting in higher heart-to-blood pool target-to-background ratios across all time points. Bone activity exceeded myocardial activity earlier with HMDP (mean ≈90 versus 130 minutes; P<0.001), resulting in a visual reduction of myocardial intensity with HMDP due to scaling. No association was observed between quantitative indices and clinical disease severity markers. Both pyrophosphate and HMDP provide diagnostic myocardial visualization within 10 minutes of injection, with similar myocardial SUVs that decline linearly over time. HMDP demonstrates more rapid blood pool clearance and greater bone uptake, resulting in earlier skeletal dominance and often requiring upward adjustment of image intensity to visualize myocardial uptake on delayed images. The results provide kinetic data that can inform future protocol optimization and quantitative standardization.
Chronic diseases are the largest contributor to overall morbidity and mortality. The workplace lifestyle interventions have shown improvements in anthropometric, and cardiometabolic parameters. However, data related to workplace wellness programs in the United Arab Emirates (UAE) are scarce. The aim of this study was to evaluate the effectiveness of a workplace wellness intervention on anthropometric measures, functional capacity and cardiovascular fitness. We conducted a 12-week workplace wellness intervention among employees of a leading UAE healthcare organization. The program included physical activity challenges targeting step count and calorie expenditure, with assessments conducted at baseline, day 45, and day 90. We used adjusted linear mixed-effects models to analyse the data. A total of 116 participants were included in the analysis [mean age 39.2 (SD 8.4) years, female sex 49.1%]. Compared with baseline values, we observed a significant improvement in weight, body mass index, and waist circumference both at day 45 [-0.52 (95% CI, -0.96 to -0.08) kg, -0.18 (-0.32 to -0.03) kg/m2, -2.53 (-3.93 to -1.14) cm, respectively], and at day 90 [-1.16 (-1.81 to -0.51) kg, -0.40 (-0.62 to -0.18) kg/m2, -3.73 (-5.84 to -1.59) cm, respectively]. The total functional movement score increased by 2.76 (2.23-3.30) and 4.99 (4.50-5.49) at day 45 and day 90, respectively. The systolic blood pressure was decreased by -2.58 (-5.09 to -0.07) mmHg and -4.76 (-7.09 to -2.43) mmHg, and Rockport 1-mile walking time was decreased by -2.06 (-2.57 to -1.55) minutes and -2.46 (-3.11 to -1.82) minutes at day 45 and day 90, respectively, compared with the baseline values. The predicted cardiorespiratory fitness (VO2) increased by 9.00 (7.28-10.73) mL·kg-1·min-1 at day 45, and by 7.24 (5.34-9.13) mL·kg-1·min-1 at day 90. Compared with week-1 levels, the activity wearable parameters of steps and calories per day showed reductions mid-intervention [-1,392 steps/day, (-2,233 to -550); -248 calories/day, (-404 to -92)], and by day 90 [-1,008 steps/day (-2,164 to 148); -157 calories/day (-310 to -5). The wearable-derived resting heart rate showed a modest decline with mean reductions of -1.41 bpm (-2.52 to -0.30) at mid-intervention, and -0.57 bpm (-1.79 to 0.66) by day 90. Our findings show significant improvements in anthropometry, functional movement scores, and selected parameters of cardiovascular fitness associated with workplace wellness program. These results contribute important preliminary data for the UAE healthcare workforce, and suggest that incorporating workplace interventions into organizational health policies could play a crucial role in improving employee health.
Although extracorporeal circulation (ECC) is routinely used in invasive cardiovascular medicine and can cause severe complications, the impact of ECC on arterial blood flow is not yet fully understood. This study aims to reveal actual bloodflow profiles during different ECC scenarios. Twenty-three New Zealand White rabbits underwent ECC by ante- (n = 7) or retro-grade (n = 9) or physiological perfusion (n = 7). Arterial blood flow profiles were assessed with a focus on cerebral and visceral perfusion. Numerical simulation models were tuned and validated based on magnetic resonance imaging (MRI). Ante- and retrograde ECC resulted in completely divergent aortic blood flow patterns. Supraaortic and visceral perfusions were not impaired during ante- or retro grade ECC. Excellent correlation of volume flow rates was achieved between MRI and simulations (r = 0.98). Intima damage was observed in regions of high wall shear stress (WSS). This is the first study assessing arterial blood flow during different ECC scenarios in a living organism, and additionally validating precise blood flow simulations by in vivo measurements. Retrograde ECC does not a priori impair cerebral perfusion. Individualized simulations may guide cannulation strategies aiming at minimization of ECC-related complications.
To present sex-specific reference data for peak oxygen uptake (V̇O2peak) in Norwegian patients with coronary artery disease (CAD) undergoing cardiac rehabilitation and examine its association with major adverse cardiovascular events (MACE). We retrospectively analysed treadmill cardiopulmonary exercise test (CPET) data from 1,651 CAD patients (21% women; mean (SD) age 61 (9) years) attending inpatient cardiac rehabilitation (2004-2022). Patients were categorized by index event: myocardial infarction (MI), coronary artery bypass grafting, or percutaneous coronary intervention/pharmacologically treated CAD. Age-, sex-, and diagnosis-specific V̇O2peak reference data were generated. Associations between V̇O2peak and a combined MACE endpoint (all-cause mortality, acute coronary syndrome, stroke, or heart failure) were assessed using Cox proportional hazards models including natural cubic splines for assessing non-linear patterns. Men had higher V̇O2peak than women (mean (SD) 26.9 (6.7) vs. 23.2 (5.3) mL·kg-1·min-1; p < 0.001). V̇O2peak was on average 2.5 and 1.7 mL·kg-1·min-1 lower per decade of age in men and women, respectively. Patients with a previous MI had the highest V̇O2peak, followed by CABG and PCI/CAD (p <0.001). During 7,880 person-years, 510 patients (36%) experienced MACE. Each 1 mL·kg-1·min-1 higher V̇O2peak was associated with a 7% lower MACE risk (HR [95 % CI]; 0.93 [0.92-0.95]) in men and 5% (HR [95 % CI]; 0.95 [0.91-0.99]) in women. Patients in the highest cardiorespiratory fitness quartile had a 55% lower risk compared to the lowest quartile. Associations were consistent across CAD subcategories. Sex-specific natural cubic spline models revealed inverse, non-linear associations. This study provides novel sex- and diagnosis-specific V̇O2peak reference values for Norwegian CAD patients and confirms V̇O2peak as a strong prognostic marker, supporting its integration into routine secondary prevention and individualized care. This study provides new normative values for exercise capacity in Norwegian patients with coronary artery disease and shows that better fitness strongly reduces the risk of death and future heart problems. Key findings:Patients with the best fitness levels had about half the risk of major heart problems compared with those who were least fit.Men with coronary artery disease had higher fitness than women, and fitness was lower with increased age and varied by specific coronary artery disease diagnosis.
Although global myocardial flow reserve (MFR) is a powerful prognostic factor, it may overlook segmental abnormalities and does not differentiate focal from diffuse perfusion impairments. Therefore, we sought to assess whether integrated MFR provides incremental prognostic value beyond global MFR. Consecutive patients undergoing positron emission tomography myocardial perfusion imaging between 2019 and 2025 were included. For each patient, global MFR and the proportion of the myocardium with diffuse and focal integrated MFR impairment were quantified. The primary outcome was the total burden of death, myocardial infarction, and heart failure hospitalization. Multivariable Andersen-Gill Cox models with robust variance estimators were used to estimate hazard ratios (HRs). Restricted cubic splines were used to account for potential nonlinearity. Over a median follow-up of 550 days (interquartile range, 203-1017 days), 1511 primary outcome events occurred in 8500 patients. In a multivariable model adjusted for both parameters, diffusely impaired integrated MFR (HR per interquartile range, 2.02 [95% CI, 1.33-3.05]), but not global MFR (HR per interquartile range, 1.10 [95% CI, 0.82-1.47]), was associated with poorer outcomes. Diffuse perfusion impairment was more strongly associated with the primary outcome (HR per interquartile range, 2.20 [95% CI, 1.72-2.82]) than focal impairment (HR, 1.25 [95% CI, 1.07-1.46]). Diffusely impaired integrated MFR was more prognostic in patients with a preserved left ventricular ejection fraction (P for interaction <0.001). At ejection fractions of 40%, 50%, 60%, and 70%, the HRs per interquartile range for greater diffuse impairment were 1.43, 1.97, 2.49, and 3.02, respectively. Diffuse impairments in myocardial perfusion are associated with poorer outcomes compared with focal impairments and are more informative than global MFR. Diffuse impairments may be more prognostic in patients with a preserved ejection fraction.
We developed an automatic self-enhancement-based perfusion mapping (SEPM) method to relatively map the microvascular perfusion level in contrast-enhanced magnetic resonance imaging (CE-MRI) into four categories: hyper-enhanced, isoenhanced, hypo-enhanced, and non-enhanced. These regions are identified based on the relative enhancement from the local pre-contrast arrival frame. We hypothesized that the signal intensity and change in signal intensity of skeletal calf muscles over a course of approximately 10 min of dynamic CE-MRI are measures of perfusion abnormalities that are of importance in patients with peripheral artery disease (PAD). Impairments of the microvascular circulation of the skeletal calf muscles in PAD patients can be quantified by analyzing signal enhancement patterns in CE-MRI. We assessed hypoperfusion in 52 study participants including 35 PAD patients and 17 matched controls. We also investigated PAD subgroups with a known higher risk of adverse outcomes including those with concomitant diabetes mellitus and those who did not complete a graded 6-min treadmill walking test. Our findings show that PAD patients demonstrate a consistently higher rate of hypoperfusion percentages compared to matched controls. Our findings further indicate that each calf muscle group exhibits varying levels of heterogeneity, reflecting non-uniform perfusion dynamics. In five distinct calf muscle groups and averaged over all calf muscle compartments, the average percentage of the hypoperfused regions was lowest in the control group and highest in the more severe PAD groups including treadmill non-completers and those with concomitant diabetes. The quantification of the microcirculation is of importance to assess PAD patients.
Excess adiposity has been associated with Hodgkin lymphoma (HL) development, but its implications remain unclear. Bone marrow (BM), a frequent extranodal involvement site, contains both red and fatty yellow marrow. We investigated whether obesity influences HL outcomes and characterized the BM and cytokine profiles. In this retrospective study, HL patients were analyzed to assess the association between obesity with relapse and mortality. Yellow and red marrow composition were evaluated using CT imaging and correlated with HL outcomes. A nested study analyzed cytokines in the interstitial marrow fluid (IMF) and in circulation of HL patients, in comparison to a control group of healthy blood donors. Further, in vitro functional analyses were performed. Overweight/obesity in HL patients was associated with lower rates of BM involvement, disease relapse, and mortality. Moreover, dense yellow marrow was related to increased risk of death. HL subjects had elevated levels of adiponectin in IMF compared to marrow donors, whereas higher insulin, interleukin 8, and osteoprotegerin levels in IMF were associated with shorter time to relapse. At the molecular level in BM, HL patients had overexpression of LEPR and IGFBP3 in adipocytes, while stromal cells overexpressed IGF-axis receptors. In in vitro studies, human recombinant IGF-1 significantly induced the L428 HL cell line proliferation, which when combined with IGFBP-3 modified apoptosis. The current findings suggest that obesity is associated with a lower incidence of BM involvement and mortality in patients with HL. The obesity together with HL mechanistically influences systemic and local BM cytokine production, thereby impacting HL fate.
This document presents the Guidelines for the Appropriate Use of Renal Denervation (RDN) Systems in Japan, jointly endorsed by the Japanese Society of Hypertension (JSH), the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), and the Japanese Circulation Society (JCS). Based on the final consensus statement of the Joint Committee on RDN, these guidelines identify resistant hypertension as the principal indication for RDN treatment in Japan. Indicated resistant hypertension is strictly defined as uncontrolled blood pressure, confirmed by both office and out-of-office measurements (ambulatory blood pressure monitoring or home blood pressure monitoring), despite lifestyle modification and appropriate antihypertensive therapy with three or more drug classes, including a diuretic. RDN procedures should be performed by a multidisciplinary Hypertension Renal Denervation Treatment (HRT) team, composed of JSH-, CVIT-, and JCS-certified specialists, nurses, pharmacists, and registered dietitians, within accredited centers providing accessible outpatient care. Using standardized checklists and procedural manuals, the HRT team thoroughly evaluates lifestyle factors, pharmacological therapy, and patient background, and determines the indication for RDN based on a shared decision-making process with each patient. The Japanese Society of Hypertension Guidelines for the Management of Elevated Blood Pressure and Hypertension 2025 (JSH2025) explicitly state that RDN may serve as a novel adjunctive treatment option for resistant hypertension (recommendation strength: 2, evidence strength: B, consensus rate: 100%). This recognition represents a pivotal step toward integrating RDN into clinical practice in Japan. Moving forward, the Joint RDN Committee will revise and update indications and implementation guidance as appropriate, informed by real-world clinical evidence.
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Partial anomalous pulmonary venous return (PAPVR) is a congenital cardiovascular malformation in which one or more pulmonary veins drain abnormally into the right atrium or systemic venous circulation, producing a pretricuspid left-to-right shunt. In anatomic terms, this condition is more precisely described as a partial anomalous pulmonary venous connection, whereas PAPVR refers to the physiological consequence of anomalous venous drainage. Historically, these anomalies were most often diagnosed during childhood; however, with increasing use of cross-sectional imaging modalities such as cardiac computed tomography and cardiovascular magnetic resonance, the condition is increasingly identified in adults. Adult presentations are heterogeneous, ranging from incidental imaging findings to clinically significant disease characterized by right ventricular volume overload, atrial arrhythmias, and pulmonary arterial hypertension. Recognition of PAPVR/partial anomalous pulmonary venous connection in adults remains clinically important, as delayed diagnosis may allow progressive right-sided cardiac remodeling and pulmonary vascular changes. This narrative review aims to move beyond classic anatomical descriptions and provide a clinically oriented overview of PAPVR in adults. We summarize the embryologic basis, anatomic variants, epidemiology, clinical manifestations, and hemodynamic consequences of this condition. Particular emphasis is placed on multimodality imaging-including transthoracic echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance-for accurate diagnosis and procedural planning. The review also discusses hemodynamic evaluation with right-heart catheterization, risk assessment for pulmonary hypertension, and indications for intervention. Management strategies are reviewed in detail, including surgical techniques such as intracardiac baffling, single-patch and 2-patch repairs, and the Warden procedure, as well as the evolving role of transcatheter and hybrid approaches in carefully selected adult patients. Special clinical scenarios-including late presentation, pregnancy, and coexisting pulmonary hypertension-are also addressed. By integrating diagnostic, therapeutic, and longitudinal follow-up perspectives, this review provides a practical framework for the evaluation and management of adults with PAPVR in modern cardiology practice.
The hybrid stage 1 procedure (HS1P) has been proposed as an alternative to the Norwood operation. We utilized a multicenter database to compare both strategies. The Fontan Outcomes Registry using Clinical Examinations was queried for patients who underwent HS1P or Norwood. Propensity score matching was performed. Composite outcome (death, transplant listing, protein losing enteropathy, plastic bronchitis, atrial/ventricular tachyarrhythmia, or pulmonary artery (PA) reintervention) and cardiac magnetic resonance (CMR) variables were compared. Secondary analyses compared between HS1P and shunt type (Sano versus Blalock-Thomas-Taussig (BTTS)). 228 patients were analyzed (76 HS1P, 152 Norwood) after exclusion and matching. Median follow-up after Fontan was 14 years (95% CI: 13.0-15.1) using the reverse Kaplan-Meier method. The freedom from composite outcome was 82.3/74.5/61.2% for HS1P patients compared to 81.4/69.5/54.7% for Norwood patients at 5/10/15-year follow-ups, respectively (HR=1.02, 95% CI: 0.62-1.70, p=0.9305). Individual components of the composite outcome were also similar between HS1P and Norwood in the matched cohort including PA reintervention. CMR and echocardiographic parameters did not differ between groups. In a three group analysis of the unmatched cohort (n=954) using BTTS as the reference, HS1P was not associated with differences in adjusted hazard for the composite outcome or its individual components compared with BTTS. HS1P in those who survived to Fontan completion had comparable Fontan era outcomes and CMR findings to Norwood in a propensity matched multicenter cohort. Further longitudinal work is essential to refine patient selection and to optimize long-term outcomes.
The digital transformation of healthcare is creating new opportunities to enhance access, engagement, and outcomes in exercise, fitness, cardiovascular disease (CVD) prevention, and rehabilitation. This review synthesizes current evidence on digital health technologies across the cardiovascular care continuum, emphasizing their role in promoting physical activity in both primary and secondary prevention. A narrative review was conducted examining mobile health applications, wearable devices, artificial intelligence, remote monitoring platforms, and emerging technologies including virtual reality, 5G connectivity, and large language models. Applications were evaluated in the context of CVD prevention, rehabilitation, and behavior change. Digital tools can personalize exercise prescriptions, monitor physiologic metrics, and support remote supervision in clinical and community settings. Wearables and mobile platforms demonstrate utility in improving adherence, fitness, and CVD risk. AI-driven systems enable adaptive programming, patient monitoring, and predictive modeling, while virtual and augmented reality offer immersive options for home-based rehabilitation. Persistent barriers include digital literacy, inequitable access, and data privacy concerns. Digital health technologies are reshaping exercise-based cardiovascular care. When coupled with behavior change strategies and ethical implementation, they can extend the reach and impact of physical activity interventions. Further research is needed to guide clinical integration, long-term evaluation, and equitable adoption.
Background: In end-stage liver disease (ESLD), cardiovascular changes are frequent and relate to the presence of hyperdynamic circulation. In 2019, diagnostic criteria for cirrhotic cardiomyopathy (CCM) were updated to include tissue Doppler and speckle tracking imaging in defining left ventricle (LV) systolic and diastolic dysfunction. Evaluation of diastolic function remains challenging, with frequent indeterminate cases and emerging evidence of worse prognosis. The aim of the present study was to evaluate the prevalence of LV systolic and diastolic dysfunction in cirrhosis, in correlation with liver disease severity and potential prognostic implications. Methods: We performed an observational, retrospective, non-randomized, single-center study that included 99 cirrhotic patients evaluated for liver transplant (LT) in a tertiary center. Liver disease severity and complications were analyzed with survival and echocardiography data to determine potential correlations with prognosis. For statistical analysis, IBM® SPSS® Statistics version 20 (Chicago, IL, USA) was utilized. A two-sided p-value < 0.05 was considered statistically significant. Results: Left atrial (LA) volume index (r = 0.230, p = 0.022), LA reservoir strain (r = 0.291, p = 0.003), and LA contraction strain absolute value (r = 0.223, p = 0.027) positively correlated with the severity of liver disease expressed by MELD Na score. LA dilation (≥34 mL/m2) was the most common echocardiographic finding. It was present in 69.7% of patients, with one third having severe LA dilation (>45 mL/m2), which was associated with worse survival (log rank p = 0.019). LA contraction strain with an absolute value higher than 16% was also associated with worse survival (log rank p = 0.024). In multivariable Cox analysis, only MELD-Na and LA volume index remained independently associated with mortality. Diastolic dysfunction appeared more prevalent among the non-surviving patients irrespective of the diagnostic criteria used (p = 0.023 for American Society of Echocardiography 2016 criteria; p = 0.032 for CCM 2019 criteria). On binomial logistic regression, the presence of significant diastolic dysfunction (>grade 1) was associated with an increased probability of composite end-point of death or LT in the presence of liver disease severity confounders. The use of the LA stiffness index in discerning diastolic function in patients with standard inconclusive evaluation may warrant further investigation. Conclusions: Echocardiographic alterations, particularly LA enlargement, are associated with liver disease severity and clinical outcomes in ESLD. These findings are hypothesis-generating and suggest a potential role for echocardiography in risk stratification, warranting validation in larger prospective studies.
Antibody-conjugated microbubbles have gained significant attention in biomedical imaging and therapy due to their unique acoustic properties and molecular targeting capabilities. These gas-filled microbubbles, already adopted in modern clinical workflows as ultrasound contrast agents, can be functionalized with specific antibodies to target disease biomarkers. Such targeted microbubbles enable ultrasound-based molecular imaging of tumors, cardiovascular lesions, and inflammation by binding to sites of interest. They can also serve as platforms for targeted drug and gene delivery. This review summarizes the core principles of contrast-enhanced ultrasound (CEUS); details current microbubble composition, acoustic response (harmonic generation, cavitation thresholds), and in vivo kinetics (stability, circulation time); and provides an overview of antibody-based targeting strategies. We compare noncovalent methods such as avidin-streptavidin to covalent approaches including NHS ester, maleimide-thiol, and click chemistry, evaluating their relative stability, conjugating efficiency, and translation potential. Practical considerations such as immunogenicity, orientation, and retention of antibodies are discussed in the context of conjugation chemistry. This review offers a mechanistic and translational perspective on antibody-conjugated microbubbles and underscores the current limitations of conjugation chemistries, while outlining the hurdles that must be addressed to enable future clinical translation.