The relationship between peripheral vascular health, including endothelia, cognitive decline, and Alzheimer's disease (AD) dementia risk is unclear.

In this study, 2844 dementia-free Framingham Offspring participants (mean age 60.6 years, 53.2% women) had baseline brachial artery flow-mediated dilation (FMD%) and reactive hyperemia (RH). Participants were then followed for a median of 17 years for incident AD and underwent plasma biomarker testing and brain magnetic resonance imaging.

FMD% (hazard ratio [HR] = 0.83, 95% confidence interval [CI] 0.76 to 0.91, p < 0.001) and RH (HR = 0.89, 95% CI 0.79 to 0.99, p = 0.049) were negatively associated with incident AD dementia after adjusting for confounders. Associations were stronger in individuals with elevated C-reactive protein. Poor vascular function correlated with higher plasma AD biomarkers, smaller brain volumes, greater white matter injury, and increased cerebral microbleeds.

Poor FMD% and RH may serve as a prognostic biomarker for cerebrovascular pathology, including endothelial dysfunction in the AD brain.

Treatment for adult IgA vasculitis (IgAV), particularly severe cases, is not well established, although recent reports have suggested potential efficacy of rituximab (RTX). Here, we report a case highlighting the effectiveness of RTX based on pathophysiological and pathological considerations of IgAV, as well as a treatment protocol that has not been previously described. A 50-year-old man receiving glucocorticoids for cutaneous IgAV developed nephrotic syndrome and acute nephritic syndrome. Renal biopsy showed marked endocapillary and extracapillary proliferation with IgA deposition, consistent with severe IgAV nephritis. Despite glucocorticoid pulse therapy and intravenous cyclophosphamide, rapidly progressive glomerulonephritis ensued, prompting RTX initiation. With reference to peripheral blood CD19^± B-cell monitoring, a single-dose RTX induction regimen was selected. Following RTX administration, the patient showed a favorable renal response. This case supports the potential efficacy of RTX in highly active IgAV with systemic symptoms. It suggests that a single-dose RTX induction approach may represent a feasible strategy to balance effective disease control with reduced infection risk in selected patients with severe adult IgAV, for which peripheral blood CD19⁺ B-cell monitoring may be helpful.

Lack of exercise or sustained low engagement in exercise represents a significant risk factor for adverse health outcomes among chronic heart failure (CHF) patients. Concurrently, family caregivers of patients with CHF often endure considerable caring burdens, leading to low quality of life (QoL) and diminished health status. Substantial evidence supports that Tai Chi has beneficial effects on cardiac function and heart failure prognosis. However, conventional Tai Chi interventions are often constrained by limitations such as site dependency and overlook the roles and needs of caregivers. Therefore, we developed a home-based, digital-assisted dyadic Tai Chi training programme aimed at improving health outcomes for both patients with CHF and their family caregivers.

This is a two-arm parallel, single-blinded randomised controlled trial. Patients with CHF and their family caregivers will be randomly assigned to (1) intervention group, participate in usual care plus a 12-week home-based digital-assisted dyadic Tai Chi training programme, comprising a 30-min online educational seminar, 1-hour online nurse-led dyadic coaching session, 1-hour preliminary Tai Chi training session and subsequent 12-week supervised dyadic Tai Chi practice; or (2) control group, only receive usual care. Outcome assessments encompass three perspectives: patients with CHF, caregivers and dyads. The primary outcome is functional capacity and cardiac function in patients with CHF. Secondary outcomes include: exercise self-efficacy of patients with CHF, sedentary behaviour, fear of activity, hospital admission and health-related QoL; care burden and QoL of caregivers; and mutuality, depression, anxiety and stress for both patients with CHF and their caregivers. Process evaluation will be implemented by assessing participation adherence and attrition. Adverse events will be recorded for safety assessment. Data will be collected at baseline (T0), 4 weeks (T1) and 12 weeks (T2) after initiation of the intervention. Intention-to-treat and sensitivity analysis (including per-protocol and subgroup analysis) will be performed using generalised estimating equations models. The minimal clinically important difference for primary outcomes will also be explored using the χ² test.

This study has been approved by the Hong Kong Polytechnic University (HSEARS20240904005) and the Affiliated Hospital of Qingdao University. The results will be published in an international peer-reviewed journal and disseminated through conference presentation to provide a novel paradigm for optimising dyadic well-being in patients with CHF and their caregivers.

NCT06876441.

Background Renal artery stenosis (RAS) can trigger the development of renal damage and poststenotic dilatation (PSD). However, the clinical relevance and mechanisms are ill-characterized. Purpose To characterize the mechanisms underlying PSD development distal to the site of RAS in humans. Materials and Methods Forty-nine individuals with RAS were prospectively consecutively recruited from October 2013 to September 2024. The characteristics of the stenosis, including the dilatation-diameter ratio (DDR), and single-kidney volumes, perfusion, and glomerular filtration rate (GFR) were measured at three-dimensional multidetector abdominal CT. Additional characteristics included stenotic kidney (STK) oxygenation (blood oxygen level-dependent MRI), cytokine levels in the STK renal vein (RV) and inferior vena cava (blood sampling), and measured GFR (iothalamate clearance). Seven participants subsequently underwent percutaneous transluminal renal angioplasty (PTRA). Data were analyzed with Spearman correlation and linear regression. Results Of 49 participants with RAS (median age, 73 years [IQR, 67-75 years]; 28 male participants), age, blood pressure, measured GFR, and STK oxygenation were comparable between participants with PSD (n = 31) and participants without PSD (n = 18), but participants with PSD had a lower median STK cortical volume. DDR positively correlated with the STK RV levels of neutrophil gelatinase-associated lipocalin, interferon-γ, and monocyte chemoattractant protein-1 (MCP-1), which were elevated in participants with PSD versus participants without PSD or in the STK RV versus the IVC (all P < .05). The regression coefficient between STK RV MCP-1 level and DDR was 0.813 (95% CI: 0.328, 1.298; P = .002) in an unadjusted model and 0.889 (95% CI: 0.246, 1.532; P = .009) after multivariable adjustment for potential confounders; that is, each 1-ng/mL increase in STK RV MCP-1 level was independently associated with a 0.889-unit DDR increase. DDR also correlated positively with urinary protein level (r = 0.33; P = .04) and negatively with estimated GFR (r = -0.51; P = .004), but there was no evidence of a correlation of DDR with renal hemodynamics, arterial morphologic features, or blood flow velocity at Doppler US. PTRA did not improve estimated GFR but did induce PSD regression, the extent of which correlated negatively with STK RV MCP-1 level. Conclusion PSD, as evaluated at abdominal CT, may be associated with STK damage and the release of MCP-1. Clinical trial registration nos. NCT02266394 and NCT04508049 © RSNA, 2026 Supplemental material is available for this article.

Aim: To evaluate the impact of adding bempedoic acid to atorvastatin therapy on cardiovascular outcomes, including major adverse cardiovascular events (MACE), cardiac arrest, all-cause hospitalization, and myopathy, in patients with established coronary artery disease.

Materials and methods: We conducted a retrospective cohort study using the TriNetX global health research network. Patients with established CAD were categorized based on their antilipemic therapy into two cohorts: atorvastatin monotherapy and atorvastatin plus bempedoic acid. Propensity score matching was employed to balance baseline characteristics between the cohorts. The primary outcome was the occurrence of MACE, while secondary outcomes included cardiac arrest events, all-cause hospitalization, and incidence of myopathy.

Results: After matching, 6,549 patients were included in each cohort. MACE occurred more frequently in the atorvastatin group (5.7%) compared to the combination therapy group (3.2%), with a hazard ratio of 1.606 (95% CI: 1.302-1.980, P<0.001). Cardiac arrest and all-cause hospitalizations were also higher in the atorvastatin group, with hazard ratios of 1.628 (95% CI: 1.041-2.544, P<0.001) and 1.418 (95% CI: 1.177-1.710, P<0.001), respectively. No significant difference in myopathy was observed (HR 0.915, 95% CI: 0.741-1.129).

Conclusions: Adding bempedoic acid to atorvastatin therapy appears to confer a protective effect in CAD patients by significantly reducing MACE, cardiac arrest, and hospitalizations without increasing myopathy risk. Prospective studies are warranted to confirm these findings.

Aim: Our study aims to compare the outcomes in patients with dilated cardiomyopathy (DCM) who have sarcoidosis and who do not have sarcoidosis.

Materials and Methods: We used data from the TriNetX US collaborative network database, including DCM patients with and without sarcoidosis between Aug 1, 2015 and Aug 1, 2025. Propensity score matching was done to minimize differences in baseline characteristics. A total of 4,514 patients in each cohort (sarcoidosis vs. non-sarcoidosis) were studied after propensity score matching. The primary outcome was ventricular assist device (VAD) placement, and the secondary outcomes were ventricular arrhythmia, hospitalization or ED visits, acute kidney injury, and stroke.

Results: The incidence of VAD insertion was more frequent in the sarcoidosis group (2.2% vs. 1.3%; OR: 1.676, 95% CI: 1.210-2.321; P<0.001). Secondary outcomes also showed significant differences, with higher rates of ventricular arrhythmia (OR: 2.082, 95% CI: 1.833-2.364; P<0.001), acute kidney injury (OR: 1.305, 95% CI: 1.157-1.473; P<0.001), and hospitalization/ED visits (OR: 1.159, 95% CI: 1.003-1.340; P<0.001) in the sarcoidosis cohort. Other arrhythmia events were more frequent (OR: 2.517, 95% CI: 2.425-2.613; P<0.001). The risk of composite stroke did not differ significantly between groups (OR: 1.132, 95% CI: 0.957-1.339; P=0.146).

Conclusions: Sarcoidosis in DCM was associated with higher risk of VAD insertion and most secondary outcomes, except stroke, indicating worse prognosis and need for closer monitoring and targeted management.

Aim: To investigate the impact of the initial choice between intravenous furosemide and torsemide on mortality outcomes and duration of hospital stay.

Materials and Methods: The prospective, open-label, comparative study included 68 adult patients hospitalized with acute heart failure (AHF). Furosemide was administered to 35 patients (51.5%) and torsemide to 33 patients (48.5%) during the first 48 hours after admission. Diuretic dosing was titrated according to urinary sodium concentration. After the initial 48 hours, further diuretic therapy was administered at the discretion of the attending physician. The primary endpoint was all-cause mortality, and the secondary endpoints were length of hospital stay and in-hospital mortality.

Results: All-cause mortality was 51.4% in patients treated with furosemide and 42.4% in those treated with torsemide (p=0.478). The median survival time was 633 days (95% CI 178-1,259) in the furosemide group and 1,093 days (95% CI 541-1,239) in the torsemide group, with no statistically significant difference in survival between the two treatment groups (p=0.44). No in-hospital deaths occurred in the torsemide group, whereas four in-hospital deaths (11.4%) were observed in the furosemide group (p=0.115). The mean length of hospital stay was 12±7 days in both groups (p=0.551).

Conclusions: Both furosemide and torsemide showed no statistically significant differences in all-cause mortality, in-hospital mortality, and length of hospital stay.

Chronic Chagas cardiomyopathy (CCC) is the most significant clinical manifestation of Chagas disease (CD) due to its impact on morbidity and mortality. Cardiac manifestations include dilated cardiomyopathy, with ventricular dysfunction, heart failure, cardiac arrhythmias and cardioembolic events. Amiodarone (AMIO) is the most commonly used antiarrhythmic drug in CCC primarily prescribed for patients with severe conduction system abnormalities. Despite preliminary evidence, no clinical study has specifically evaluated the immunomodulatory and trypanocidal effects of AMIO in patients with CCC. The main objective is to evaluate the association of AMIO therapy with serological reactivity to anti-T. cruzi and the inflammatory profile of patients with CCC.

This is a mixed (retrospective and prospective) longitudinal observational study enrolling 90 patients who will be recruited from a reference center for CD in Brazil. Patients with CCC receiving AMIO will be compared with those not receiving the drug. AMIO was prescribed at the discretion of the treating physician, independently of the present study. Eligible participants will be invited to participate during routine medical appointments. Clinical data, including electrocardiographic and echocardiographic parameters obtained during routine follow-up, will be retrospectively extracted from medical records. Blood samples will be collected at predetermined time points. The primary endpoint will be the inflammatory profile and serological reactivity to anti-T. cruzi in CCC patients. Secondary endpoints will include: (1) cardiovascular events; (2) CCC progression; (3) implantable cardioverter-defibrillator (ICD) implantation; (4) heart transplantation; (5) all-cause death and (6) a composite endpoint. The association between AMIO use and longitudinal changes in continuous variables will be determined using mixed linear models. Cox regression analysis will be used to investigate the relationship between AMIO use and selected outcomes (cardiovascular events, CCC progression, and death), adjusted for potential confounders. Hazard ratios (HRs) with 95% confidence intervals (CIs) will be reported.

Given the limited literature on the potential trypanocidal and immunomodulatory effects of AMIO in CCC, the findings of this study may provide new insights into the therapeutic potential of AMIO beyond its established antiarrhythmic properties.

Effective team communication is critical in pediatric cardiopulmonary arrest management, where delays or miscommunication can jeopardize survival. TeamScreen, a web-based interface displayed on a large screen, was developed to enhance cardiopulmonary resuscitation (CPR) by providing real-time visualization of clinical data and resuscitation steps aligned with the American Heart Association pediatric advanced life support algorithms.

This study evaluated the usability of the TeamScreen Figma prototype, evaluating how efficiently and accurately experienced emergency physicians and nurses retrieved critical information during a simulated pediatric in-hospital cardiac arrest scenario. Although no strict time constraints were imposed, participants were instructed to perform the tasks as spontaneously and as quickly as possible.

Usability testing involved 20 pediatric emergency physicians and nurses with varied CPR experience. Participants performed 21 information retrieval tasks within a simulated pediatric cardiac arrest scenario (shockable rhythm). The data collected included audio-video recordings via the think-aloud method and participant responses to the Post-Study System Usability Questionnaire (PSSUQ) version 3 and a posttest survey. Effectiveness, efficiency, and satisfaction were measured by task completion rates, time-on-task metrics, and PSSUQ scores, respectively. Think-aloud data were analyzed for usability issues using Nielsen Norman Group's rating scale and Bastien and Scapin's ergonomic criteria.

Five physicians and 15 nurses achieved a mean task success rate of 81.19% (SD 16.87%), with a mean completion time of 8.13 (SD 7.07) seconds, calculated across all 21 tasks and all participants. PSSUQ scores reflected high satisfaction (mean 2.40 [SD 1.24] of 7.00; the lower the better), notably for information clarity and system utility. Qualitative analyses identified 16 usability issues, of which 5 were deemed major, primarily involving information visibility, navigation, and density, highlighting areas for interface and workflow enhancement.

The usability evaluation confirmed TeamScreen's potential to improve real-time information access during pediatric CPR, with high task success and satisfaction scores supporting its role in aiding decision-making. Challenges with visibility, navigation, and information density require further refinement. These findings will guide improvements and inform the design of multicenter trials to assess TeamScreen's efficacy in simulation-based resuscitation settings.

Patients with or at risk for cardiovascular disease (CVD) often see many ambulatory physicians who may not communicate with each other. Care coordinators can bridge gaps in communication among physicians, but there are too few of them for all patients who might benefit.

To compare the effectiveness of 2 strategies for allocating patients with or at risk for CVD to care coordination.

This randomized clinical trial performed randomization and outreach from May 15 to November 30, 2023, and completed follow-up on May 31, 2024, in an accountable care organization in New York, New York. Participants included patients who were 65 years or older, had CVD or at least 1 CVD risk factor, had highly fragmented ambulatory care the previous year (fragmentation score ≥0.85), and had been attributed by Medicare to the accountable care organization.

Usual care assigned patients to care coordinators after any hospitalization. The intervention moved the time of care coordination earlier, offering care coordination proactively (without respect to hospitalization) to those who reported problems with care coordination on a telephone survey.

The primary outcome was emergency department (ED) visits or hospitalizations during follow-up. The main secondary outcome was acceptability of the intervention, followed by appropriateness, fidelity, and efficiency.

A total of 400 participants (202 in the intervention group and 198 in the control group) were included in the analysis. The mean (SD) age of participants was 75.8 (7.0) years; 287 (71.8%) were female. Participants had a median of 14 (IQR, 9-22) visits to 8 (IQR, 6-11) physicians during the previous year. In the intervention group, 13 participants of 49 eligible (26.5%) accepted care coordination, compared with 17 of 17 (100%) in the control group. The most common reason for declining care coordination was that participants were coordinating care themselves. There was no difference in ED visits or hospitalizations (0.25 [95% CI, 0.21-0.31] events per 100 person-days alive in the intervention group vs 0.21 [95% CI, 0.17-0.27] events per 100 person-days alive in the control group; P = .29).

In this randomized clinical trial, proactive outreach for offering care coordination in advance of hospitalization did not result in better outcomes compared with usual care offering posthospitalization coordination. Many participants declined the proactive outreach offer.

ClinicalTrials.gov Identifier: NCT05820295.