Cardiovascular disease (CVD) risk assessment based on single-time-point measurements may inadequately capture the dynamic interplay of obesity, metabolic dysfunction, and chronic inflammation. Understanding their long-term co-evolution may improve CVD risk stratification.

We conducted a prospective cohort study using data from the China Health and Retirement Longitudinal Study. Participants aged ≥ 45 years with repeated measurements of body mass index (BMI), triglyceride-glucose (TyG) index, and high-sensitivity C-reactive protein (hsCRP) between 2011 and 2015 were included. Joint trajectories of these obesity-metabolic-inflammatory markers were identified using the KmL3D clustering algorithm. Incident CVD (heart disease or stroke) was ascertained during follow-up from 2015 to 2020. Cox proportional hazards models were applied to evaluate associations between trajectory groups and CVD risk after adjustment for demographic, lifestyle, and clinical covariates.

Among 4483 participants (mean age 57.8 years; 52.6% women), four distinct joint trajectory patterns were identified: a sustained low-risk profile (46.8%), an obesity-predominant profile (26.7%), a metabolic-obesity-driven profile (17.1%), and an inflammation-dominant profile (9.4%). During a median follow-up of 5.0 years, 592 incident CVD events occurred. Compared with the low-risk profile, all adverse trajectory groups were associated with significantly higher CVD risk, with hazard ratios ranging from 1.35 to 1.46 after full adjustment. Associations were more pronounced for stroke, particularly among individuals with a metabolic-obesity-driven trajectory. Findings were robust across sensitivity analyses.

Distinct dynamic co-evolution patterns of obesity, metabolic dysfunction, and inflammation identify population subgroups with substantially different risks of incident CVD.

Acute coronary syndromes (ACS) represent one of the leading causes of cardiovascular mortality and morbidity, with a substantial clinical, organizational, and economic impact on the Italian National Health Service (NHS). On behalf of the National Center for Clinical Excellence, Quality and Safety of Care of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), the Italian Association of Hospital Cardiologists (ANMCO) promoted the development of consensus-based recommendations for good clinical practice (RBPCA) for the diagnosis and management of ACS, with the aim of integrating and contextualizing the most recent European Society of Cardiology guidelines within the Italian healthcare setting. The recommendations were developed through a multidisciplinary Consensus Conference, according to the ISS methodological framework, addressing 16 clinical and organizational issues of major relevance related to the diagnostic and therapeutic pathway of ACS. The RBPCA aim to reduce variability in clinical management, promote appropriateness and uniformity of care, and improve clinical outcomes for patients with ACS within the context of the Italian NHS.

Cardiogenic shock is a critical condition with a short-term mortality rate of around 40-50%, which has remained unchanged over the years despite therapeutic advances in acute cardiac diseases. In this context, the use of microaxial flow pumps is increasing and in the DanGer Shock trial it reduced the 6-month mortality in patients with cardiogenic shock due to acute myocardial infarction compared to standard therapy. The aim of this study was to evaluate how the use of microaxial flow pump in our population of patients with cardiogenic shock impacted survival and short- and mid-term outcomes.

We retrospectively collected data from 78 patients with cardiogenic shock treated with microaxial flow pump and admitted to the Cardiac Intensive Care Unit of Ospedali Riuniti of Ancona, Italy, between April 2014 and December 2024. The primary end-point was the assessment of independent predictors of in-hospital mortality, while the secondary end-point was a composite end-point (all-cause death, rehospitalization for heart failure, acute coronary syndrome, arrhythmias, heart transplantation, or ventricular assist device implantation at 12-month follow-up).

Mean age of the population was 59.3 years, predominantly of male sex. The mean left ventricular ejection fraction at admission was 24.2%, mean serum lactate level at admission was 5.8 mmol/l. In 17 patients, Impella mechanical circulatory support represented an escalation therapy from intra-aortic balloon pump. In-hospital mortality was 32.1%, and variables such as age, left ventricular ejection fraction at intensive care unit admission, and the presence of right ventricular dysfunction were associated with higher in-hospital mortality. The secondary end-point occurred in 7 patients (8.9%): 3 patients died and 4 patients were rehospitalized for cardiovascular causes within 12 months after discharge.

Impella circulatory support is a device capable of "resting" the ventricular myocardium while ensuring adequate cardiac output. In our observational evaluation, the use of Impella was associated with a reduction in in-hospital mortality. However, optimal timing of implantation remains to be clarified to maximize its benefit and avoid futile use.

In recent years, catheter ablation for atrial fibrillation (AF), particularly pulmonary vein isolation, has become an increasingly used and evidence-based treatment aimed primarily at improving symptoms and quality of life. In this context, the management of oral anticoagulation (OAC) after the procedure has become a major topic of discussion within the scientific community. Current guidelines recommend continuing OAC based on the thromboembolic risk profile assessed by the CHA2DS2-VA score, regardless of the apparent success of the ablation. However, in recent years several research groups have explored the possibility of discontinuing anticoagulation after successful ablation in patients without documented arrhythmia recurrence. In particular, two recent randomized trials, ALONE-AF and OCEAN, have investigated strategies of anticoagulation discontinuation or de-escalation in the post-ablation setting, contributing to renewed debate regarding the necessity of long-term anticoagulation in selected patients. In parallel, the OPTION trial evaluated an alternative strategy based on left atrial appendage occlusion as a means to avoid long-term anticoagulant therapy. The aim of this review is to summarize and critically discuss the most recent evidence regarding antithrombotic management after AF ablation, focusing on clinical implications, methodological limitations, and potential future directions toward more individualized therapeutic strategies.

There are no data on the implementation of shock teams (ST) or their impact on cardiogenic shock (CS) in Spain.

We conducted a retrospective observational study including episodes of CS (2016-2022) from hospitals within the Spanish National Health System with availability of an Interventional Cardiology Unit. The population was divided into a) patients hospitalized in centers with ST (CS-ST) and b) patients hospitalized in centers without ST (CSNST). Furthermore, the availability of a cardiac intensive care unit (CICU), cardiac surgery, heart transplant program, and volume of CS cases at each center were recorded. The outcome variable was the in-hospital mortality rate.

A total of 15,879 episodes were analyzed, 32% (5,095) of which corresponded to the CS-ST group. The proportion of  enters with ST availability increased progressively from 7% in 2016 to 39% in 2022. Patients from the CS-ST group were younger (68 vs 71 years, P < .001) and more frequently underwent mechanical ventilation, renal replacement therapy, and circulatory support (P < .001), showing a higher rate of acute kidney failure and stroke and longer lengths of stay (12 days vs 9 days, P < .001). Care in centers with ST (OR, 0.86; 95% CI, 0.77-0.96; P = .005) and CICU (OR, 0.82; 95% CI, 0.69-0.98; P < .033) was significantly associated with a lower mortality rate.

The availability of ST has expanded in our setting. Patients admitted to centers with ST are managed more invasively, with a lower in-hospital mortality rate despite a higher rate of complications.

Hypertension and dyslipidaemia are key modifiable risk factors of dementia, and the combined use of statins and antihypertensive medications (AHMs) may offer protective benefits. However, evidence on specific combinations remains limited. This study examined associations between dementia risk and the use of statins with angiotensin-II (Ang-II) promoting AHMs (drugs that increase Ang-II formation) compared with statins combined with Ang-II suppressing AHMs (drugs that decrease Ang-II formation).

This was a prospective study using data from the 45 and Up Study cohort, a large population-based cohort in New South Wales, Australia. Participants aged ≥ 45 years with hypertension and dyslipidaemia were included if they had concurrent statin and AHM use. Exposure groups were defined as either users of statins and Ang-II promoting AHMs (angiotensin II receptor blockers [ARBs], thiazides, and dihydropyridine calcium channel blockers [DHP CCBs]) or statins and Ang-II suppressing AHMs (angiotensin-converting enzyme inhibitors [ACEIs], beta-blockers [BBs], and non-DHP CCBs). Medication exposure was determined based on a proportion of days covered (PDC ≥ 80%). Baseline characteristics of the two groups were balanced using 1:1 pair propensity score matching. The Cox proportional hazards model was used to estimate hazard ratios (HRs) adjusted for diet, physical activity, comorbidities, and concomitant medications.

Among 34,610 matched participants (17,305 per group; a mean age [standard deviation (SD)] of 65.8 (8.8) years; a mean follow-up (SD) of 12.4 (5.1) years), use of a statin plus Ang-II promoting AHM was associated with a 12% lower dementia risk (HR, 0.88; 95% CI, 0.79-0.98) and 13% lower all-cause mortality (HR, 0.87; 95% CI, 0.82-0.93) compared to statin plus Ang-II suppressing AHM combinations. Combinations of rosuvastatin or atorvastatin with Ang-II promoting AHMs (HR, 0.43; 95% CI, 0.36-0.50 and HR, 0.74; 95% CI, 0.64-0.84, respectively) conferred greater benefit compared with simvastatin combined with Ang-II promoting AHMs. The effects were consistent across both sexes, with the protective association observed only in the 65-74-year age group, and combinations involving ARBs demonstrated superior benefit compared to those with ACEIs. Findings were robust across sensitivity analyses, including applying a competing-risks model for death.

Combined therapy with a statin plus Ang-II promoting AHMs, particularly rosuvastatin or atorvastatin with an ARB, was associated with lower dementia risk, suggesting cognitive benefits may inform therapy selection. Future randomised trials should confirm these findings and explore underlying mechanisms.

Hemiplegic shoulder pain (HSP) is a major cause of disability that is still challenging to manage in clinical practices. Both pulsed radiofrequency (PRF) and repetitive transcranial magnetic stimulation (rTMS) could reduce poststroke HSP to certain extents. However, it remains unknown whether combined PRF and rTMS treatment could increase analgesic efficacy for poststroke HSP.

To evaluate the therapeutic efficacy of combined PRF and transcranial magnetic stimulation in treating HSP.

This was a randomized, assessor-blinded pilot study.

The rehabilitation department of a single hospital.

In this pilot study, a 3-arm study design was utilized to compare the treatment efficacy of combined PRF and rTMS treatment with a single PRF or rTMS strategy. Patients were randomly assigned to receive PRF, rTMS, or combined treatment. Outcomes assessments included pain intensity, motor activity, and neurophysiological activities.

Our data indicated that rTMS acted more efficiently to reduce pain than PRF treatment. Combined treatment had a larger long-term efficacy than rTMS treatment alone. Both combined and single treatment improved motor recovery and neural transmissions, such as suprascapular nerve amplitude and somatosensory N20.

As we designed a pilot study, the sample size was small in each treatment arm. Our findings thus need to be validated in future large studies.

These novel findings provide a safe and effective treatment strategy for poststroke HSP by combining PRF with rTMS treatment.

Chinese Clinical Trial Registry: ChiCTR2500100181.

Chronic post-stroke aphasia is heterogeneous, and focal lesion models do not fully explain persistent language impairment. We tested whether accelerated brain aging and regional white matter hyperintensity (WMH) burden provide complementary MRI markers of residual brain vulnerability in chronic post-stroke aphasia.

We analyzed Western Aphasia Battery Aphasia Quotient (WAB-AQ), brain-predicted age difference (Brain-PAD), aphasia subtype, fluency phenotype, regional WMH burden, and lesion-volume/site measures in 137 participants from the Aphasia Recovery Cohort using covariate-adjusted regression, mixed-effects modeling, lesion-aware sensitivity analyses, and internal validation.

Higher Brain-PAD was associated with lower WAB-AQ in the full cohort (β = -3.38, p < 0.001) and remained significant after accounting for subtype and fluency structure. Non-fluent participants had higher Brain-PAD than fluent participants (β = 2.19, p < 0.001). Among candidate WMH measures, anterior WMH was the most consistently supported vascular feature. In the final WMH-complete model, Brain-PAD (β = -3.11, p < 0.001) and anterior WMH burden (β = -8.20, p = 0.001) were independently associated with lower WAB-AQ and improved model fit beyond Brain-PAD alone (ΔR² = 0.077). In lesion-aware sensitivity analyses, total lesion volume was strongly associated with WAB-AQ, but Brain-PAD and anterior WMH remained associated with WAB-AQ after lesion-volume adjustment.

Chronic post-stroke aphasia severity was better characterized by a lesion-aware dual-vulnerability model in which accelerated brain aging indexed global structural vulnerability and anterior WMH burden captured complementary lobar vascular white matter injury beyond total lesion volume.

This multicenter retrospective study aimed to describe temporal trends in clinical indications for plasma exchange (PE) in adult patients at four quaternary-care hospitals in Bogotá (2008-2024) and to examine their distribution across successive ASFA guideline editions. Adults ≥ 18 years who received ≥ 1 PE session were included; indications were coded using ICD-10, and outcomes were classified as complete improvement, partial improvement, no change, or death. Descriptive statistics were performed using RStudio. Of 970 patients screened, 758 met eligibility criteria. Median age was 47 years (IQR 33-60); 62.4% were women. Neurological and rheumatological indications predominated (n = 634, 83.6%), particularly neuromyelitis optica spectrum disorders and ANCA-associated vasculitis. A total of 3954 sessions were performed (median: 5 per patient; IQR: 5-6). Hypocalcemia was the most frequent complication. Overall, 74.0% achieved complete or partial improvement, with higher rates in neurological conditions. Sixty-nine deaths occurred (9.1%), mostly attributed to systemic autoimmune diseases. Over the study period, neuroimmunological indications increased markedly, while use of PE for ANCA-associated vasculitis declined following its reclassification to ASFA category III in 2023. ASFA categories I and II accounted for 92.7% of indications; Category I representation declined from 66.7% (2008-2010) to 40.6% (2023-2024), while case volume grew from 21 to 266 patients per triennium. Over 16 years, PE indications shifted substantially toward immune-mediated neurological disorders, driven by expanded diagnostic availability for AQP4-IgG and MOG-IgG and evolving ASFA recommendations. These findings underscore the need for prospective studies and a national PE registry in Colombia.

Inpatient care for venous leg ulcers is often inconsistent, with delays in vascular assessment and compression therapy contributing to prolonged healing and fragmented treatment. This evaluation examined a front-door Tissue Viability Nurse-led service providing specialist assessment at hospital admission. A descriptive service improvement evaluation was conducted. From 2022, patients in the Assessment Ward admitted with leg wounds received Tissue Viability assessment within one working day, including Doppler-based vascular evaluation, wound bed preparation, peri-wound skin optimisation and early initiation of compression therapy. Compression bandaging became a core clinical skill for registered nurses, supported by a rationalised product formulary. This observational evaluation and qualitative review suggested that early specialist involvement supported the timely initiation of compression therapy, reduced variation in inpatient wound care and minimised duplicate referrals through clear Tissue Viability-led care plans. Staff confidence in applying compression was perceived to improve, collaboration with vascular, dermatology and community services strengthened and patients informally reported clearer information and greater continuity of care, supporting a timelier approach to care delivery. Positioning Tissue Viability expertise at the Assessment Ward appeared to support improvements in the consistency and safety of care processes in leg ulcer management. This front-door specialist model, rarely described in acute care literature, enhanced timeliness and coordination and provides a scalable approach to addressing international gaps in acute wound care pathways.