Atrial fibrillation (AF) is linked to tricuspid annulus (TA) and right heart (RH) remodeling. Despite advances in catheter ablation, data regarding its structural impact on the TA and RH chambers remain limited. Therefore, the impact of radiofrequency ablation (RFA) on TA and RH remodeling in persistent AF patients is less clear. Furthermore, the potential of three-dimensional echocardiography (3DE) for evaluating TA and RH remodeling following RFA requires further exploration. This study aimed to characterize TA and RH geometry and function in persistent AF patients before and after RFA via 3DE.

The 90 subjects included in this study were divided into three groups: the persistent AF group (n = 30); persistent AF patients who underwent successful RFA with sinus rhythm maintenance at the 3-month follow-up were assigned to the RFA group (n = 30); and the control group (n = 30). 3DE datasets were analyzed to measure TA and RH geometry and function via Tomtec 3D echocardiography analysis software.

Compared with the AF group, the RFA group presented shorter linear dimensions of the right atrium (RA) (p < 0.05). The right atrial ejection fraction (EF) and right ventricular (RV) EF were significantly greater in the RFA group than in the AF group (RAEF: 45.56% vs. 28.57%, p = 0.003; RVEF: 45.94% vs. 38.45%, p < 0.001). However, there was no significant difference in the RV fractional area change (FAC) index (p > 0.05). The TA area, anteroposterior diameter, and circumference were significantly smaller in the RFA group than in the control group in all phases (all p < 0.05). After 3 months, RFA intervention (B = -0.440, p < 0.001) demonstrated significant inverse associations with the TA perimeter. Moreover, the non-planar angle and tricuspid leaflet tenting height were smaller in the RFA group than in the control group in the systolic phase (p < 0.05).

This study suggests that RFA may contribute to favorable TA and RH remodeling in patients with persistent AF, and that 3DE may provide more comprehensive and sensitive assessments with excellent feasibility, facilitating readily accessible evaluations for AF patients undergoing RFA.

Hypertension is a major cause of cardiovascular event-related mortality, and its association with aortic aneurysm and dissection is being extensively studied.

To assess mortality trends and demographic disparities in hypertensive diseases with aortic dissection and aneurysm as a contributing cause.

A retrospective observational study was conducted using the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death (MCD) database to assess mortality trends among individuals aged over 25 years in the United States from 1999 to 2020. Hypertension (ICD-10: I10-I15) was considered the underlying cause of death, with aortic dissection and aneurysm (ICD-10: I71.0) recorded as contributing causes. Data were stratified by gender, race, geographic region, and place of death. Age-adjusted mortality rates (AAMR) and annual percentage change (APC) were calculated.

A total of 20,782 deaths were recorded, with a crude rate of 4.6 per million. The AAMR initially declined (-2.12% APC from 1999 to 2006) but increased significantly from 2006 to 2009 (+56.82% APC). It then decreased slightly from 2009 to 2020 (-0.42% APC). The highest mortality was observed in males (10,902, 52.5%), White individuals (16,551, 79.6%), metropolitan regions (17,426, 83.9%), and medical facilities (13,328, 64.13%). Temporal trends showed an increasing AAMR in both males (+57.22% APC from 2006 to 2009) and females (+56.32% APC from 2006 to 2009). A similar trend was observed during those years in African American individuals (APC +52.45%) and White individuals (APC +57.22%), indicating evolving disparities.

Mortality trends in hypertension with aortic dissection and aneurysm have shifted, with rising disparities in gender, race, geographic areas, and place of death. These findings underscore the need for targeted prevention strategies and improved healthcare access.

This study aimed to explore the mediating effect of serum cortisol on the relationship between stigma and post-stroke depression (PSD) in patients with acute ischemic stroke. To enhance early screening for post-stroke depression and prevent its development.

A total of 367 patients admitted to the Department of Neurology and Neurosurgery at Xuzhou Central Hospital between January and December 2024 were selected using a convenience sampling method. Participants completed a general information questionnaire and the 8-item Stigma Scale for Chronic Illness, and their serum cortisol levels were measured at 8:00 a.m. the day after admission. Spearman correlation was used to analyze the correlation between serum cortisol, stigma level and depression degree in patients with acute ischemic stroke. The mediating effect Model was tested by Model 4 model in the PROCESS plug-in.

Among the participants, 182 were in the PSD group and 185 in the non-PSD group, with significant differences in income, education, serum cortisol, and stigma levels between the groups (p < 0.05). Spearman correlation analysis showed a significant positive correlation between stigma and depression severity (r = 0.715, p < 0.001), stigma and serum cortisol (r = 0.193, p < 0.001), and serum cortisol and depression severity (r = 0.261, p < 0.001). Mediation analysis using Model 4 of the PROCESS macro indicated that serum cortisol partially mediated the relationship between stigma and depression, with a mediating effect size of 0.019 (95%CI: 0.004-0.046), accounting for 2.5% of the total effect.

These findings suggest that serum cortisol plays a partial mediating role between stigma and PSD in patients with acute ischemic stroke, highlighting a potential biological mechanism linking psychosocial stress to mental health outcomes in this population.

Long RP supraventricular tachycardia poses a significant diagnostic challenge because of overlapping electrophysiological features among differential diagnoses. Detailed evaluation with an electrophysiological study is essential for accurate diagnosis and effective management, particularly when initial ablation attempts fail to eliminate inducibility.

A 40-year-old Southeast Asian male with a 5-year history of recurrent palpitations was referred for evaluation. Baseline echocardiography was normal. During symptomatic episodes, electrocardiography demonstrated long RP tachycardia. Electrophysiology study revealed eccentric atrial activation with decremental conduction, with the earliest A recorded at DD 9-10 (coronary sinus ostium/left posteroseptal region). Tachycardia cycle length was 410 ms, with a VA interval of 215 ms, AH interval of 93 ms, HA interval of 332 ms (AH/HA < 1), a VAV response during ventricular entrainment, PPI-TCL of 225 ms, and SA-VA of 194 ms. Ventricular reset did not terminate the arrhythmia and showed no atrial delay or advancement. Ablation at the coronary sinus ostium terminated the tachycardia but did not prevent reinduction. A subsequent slow pathway ablation was performed, during which slow junctional rhythm was observed. Post-ablation testing demonstrated crossover at 320 ms, while supraventricular tachycardia remained easily inducible with atrial S1 pacing at 400 ms. Given persistent inducibility, medical therapy was optimized and the patient was scheduled for advanced three-dimensional mapping and ablation. The leading differential diagnoses were atypical atrioventricular nodal reentrant tachycardia (fast-slow variant) with a bystander accessory pathway and permanent junctional reciprocating tachycardia with coexisting dual AV nodal physiology.

This case illustrates the diagnostic complexity and management challenges of long RP supraventricular tachycardia, particularly in distinguishing atypical atrioventricular nodal reentrant tachycardia from permanent junctional reciprocating tachycardia. When initial ablation does not achieve full arrhythmia control, a stepwise strategy involving detailed electrophysiological evaluation, cautious ablation, and advanced mapping may be required to guide definitive therapy.

Falls are an important patient safety concern and stroke patient are at high risk. Artificial intelligence (AI) could be leveraged to reduce patient falls in the hospital but there is scarcity of data. Therefore, the aim of this study is to evaluate the effectiveness of the SMART AI Patient Sitter system-an AI-powered motion-sensing and alert system designed for fall detection and prevention in a real-world hospital setting.

Conducted from January to December 2024 at the Acute Stroke Unit of Hospital Seberang Jaya (ASUHSJ), the study involved 30 stroke patients who consented to AI monitoring. The SMART AI patient sitter system comprised an optical sensor, alert panel, and control panel monitored by AI, which detected patient movement and triggered alerts to the observation counter. Blurred, non-identifiable images maintained patient privacy, and investigators were identified through uniform recognition. Data on mobility and fall events were recorded continuously.

The integration of this system led to an 83.33% reduction in fall incidents and the generation of 1,439 alerts with a 95.34% accuracy rate. Enrolled patients had a mean age of 61 years(SD ± 12.8) years; 63.3% were male; 56.7% were of Malay ethnicity and 83.3% were classified as high fall risk. The median duration of monitoring was 3 days (IQR: 1.0-6.0), with a median of 19 bed exits(IQR: 1.0-85.0) bed exits. The first bed exit attempt occurred at a median of 150 minutes (IQR: 20.0-2103.0) minutes post-admission. Response time to movement alerts was prompt, with a median of 21  seconds (IQR: 4.0-75.0). Only one fall (3.3%) was recorded during the study. The incident involved a moderate-risk patient who attempted to stand abruptly. Staff responded within 29 seconds, and the patient recovered without severe injury.

These findings suggest the system's potential in early detection and timely intervention. Study data demonstrated wide variability in patient mobility patterns, highlighting the need for individualized monitoring. The SMART AI patient sitter system's ability to deliver real-time alerts, ensure patient privacy, and reduce fall incidence demonstrates its value in improving stroke patient safety. Overall, this study supports the integration of AI-based monitoring tools in clinical settings to enhance patient care and reduce preventable incidents like falls.

Off-pump coronary artery bypass grafting (CABG) remains technically demanding, especially in low-income settings. Understanding the surgical learning curve is crucial for optimizing outcomes, training, and resource utilization.

This study aimed to evaluate the surgical learning curve for off-pump coronary artery bypass grafting (CABG) using cumulative sum (CUSUM) analysis. We conducted a retrospective analysis of 49 patients who underwent isolated CABG. Key performance indicators, including operation time, number of anastomoses, ventilation duration, ICU stay, and postoperative hospitalization, were assessed to identify performance trends and a transition point reflecting surgical proficiency.

A transition point in the cumulative sum (CUSUM) chart was observed in Case 28. The mean operation time decreased from 267.1 min pre-transition to 180.7 min post-transition. Other improvements included ventilation time (from 10.66 to 6.52 h), ICU time (from 42.34 to 22.57 h), and postoperative hospitalization (from 12.44 to 9.24 days). The number of anastomoses remained consistent throughout the study period.

CUSUM analysis effectively identified the performance improvement phases. The operation time and perioperative parameters improved after the transition point, reflecting a positive learning curve.

Takayasu arteritis (TA) is a granulomatous inflammatory disease of unknown etiology that affects the aorta and its branches, including the coronary and pulmonary arteries. Diagnosis in pediatric age is late because the initial manifestations are nonspecific.

Objective: Describe demographic, epidemiological, clinical characteristics, aortic and cardiovascular damage of patients with TA in pediatric age, and status in adult life. Retrospective study between 1988 and 2023. All children met the EULAR/PRINTO/PRES criteria for pediatric TAK. The records of symptom onset, type of angiographic lesion, surgical or interventional procedures, evolution, and status were reviewed.

The median was 12 years, with Q1-Q3 (8-15). Predominant symptoms were fatigue 29%, angina in 12%, Arterial hypertension in 53%, congestive heart failure in 12%, and stroke in 12%. The most common angiographic classification of Hata was type V, associated with a pulmonary artery lesion (V + P) in 6 (12%) and a coronary artery lesion (V + C) in 4 (8%). Forty-one patients (84%) reached adulthood; 5 (10%) discontinued care in childhood, so their prognosis is unknown.

The timely identification of TA in children is a challenge that requires clinical art. Timely medical and interventional management allows a better prognosis and long-term survival.

Global khat (Catha edulis) consumption currently affects approximately 20 million individuals, despite originating primarily in East Africa and the Arabian Peninsula. While traditionally viewed as a regional practice with limited relevance to Western societies, modern distribution networks and diaspora communities have facilitated its international spread, transforming khat into a global substance of concern. This study builds upon existing evidence by synthesizing data from fifteen studies which is significantly more than previous reviews to firmly establish khat (Catha edulis) use as a risk factor for elevated blood pressure and tachycardia, both of which are key precursors to hypertension.

This systematic review and meta-analysis aimed to aimed to systematically evaluate, and synthesize the available evidence on the epidemiological association between khat (Catha edulis) chewing as an exposure and hypertension as an outcome, 2024.

The comprehensive search of this systematic review and meta-analysis included cross-sectional and case-control studies published in English from inception up to December 30, 2024 on association between khat (Catha edulis) and hypertension. Excluded were conference proceedings, qualitative research, commentaries, editorial letters, case reports, case series, and monthly and annual police reports. The search covered full-text publications written in English and databases such as PubMed/MEDLINE, African Journals Online (AJOL), and Google Scholar. A checklist from the Joanna Briggs Institute (JBI) was used to evaluate the quality of the studies. Two independent reviewers performed data extraction, critical appraisal, and article screening. Assessment of the certainty evidences was done by applying the GRADE method. The statistical analysis was done using the software packages STATA-17 and RevMan 5.4. The Cochrane Q statistic with I² was used to assess between study heterogeneity. A weighted inverse variance random effects model was used to calculate the pooled odds ratio with 95% confidence interval.

Fifteen studies were included in this systematic review and meta-analysis. From meta-analysis, a total of 12,409 participants were involved. Of the 3986 Khat chewers, 1278 were found to have hypertension. On contrary, out of the 8423 of non-chewers, 1341 were found to have hypertension. Pooled analysis showed that khat chewer were 2.4 times more likely to have hypertension as compared to non-khat chewer (OR 2.4, 95%CI 1.48-3.88) at p = 0.0004, I² = 93% (95% CI: 88-96%). The findings of the Egger's test (P = 0.655) and funnel plot revealed that no evidence of publication bias.

This systematic review suggests khat chewing as a significant modifiable risk factor for hypertension, urging targeted public health interventions, policy regulation, and integration of cessation counseling into healthcare programs. Future research should employ rigorous designs, standardized measurements, and broader literature inclusion to strengthen causal evidence, while collaboration with endemic regions and objective biomarker use could enhance data reliability and generalizability. Addressing khat use may substantially reduce hypertension-related cardiovascular burdens in affected populations.

This systematic review and meta-analysis was registered in PROSPERO with the registration ID and link as follows: CRD42024555322: Available from: https://www.crd.york.ac.uk/prospero/display_record.php .

Postoperative atrial fibrillation (POAF) is a common complication following off-pump coronary artery bypass grafting (CABG). This study aims to assess whether elevated preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) levels can effectively stratify patients based on their risk of developing POAF.

Utilizing a retrospective database of 512 patients who underwent off-pump CABG, we compared preoperative clinical data, including NT-proBNP levels, between patients experiencing POAF lasting longer than 30 s during hospitalization and those who did not.

POAF manifested in 23.6% of patients (121 out of 512). After off-pump CABG, 39% of patients (100 out of 256) with NT-proBNP levels greater than the median (388 pg/mL) developed POAF, in contrast to only 8% of patients (21 out of 256) with levels below 388 pg/mL (P < 0.0001). NT-proBNP levels were significantly higher in patients with POAF compared to those without (median, 1149 vs. 278 pg/mL; P < 0.0001). Multivariate logistic regression analysis revealed that in patients undergoing off-pump CABG, a NT-proBNP level of 388 pg/mL or greater (OR, 5.72; 95% CI, 3.24-10.48; P < 0.0001) was the only independent risk factor for POAF.

For patients undergoing off-pump CABG, increased age, preoperative left ventricular ejection fraction (LVEF) and left atrial diameter (LAD), creatinine levels, and a preoperative NT-proBNP level of 388 pg/mL or greater emerged as significant risk factors for POAF. Identifying individuals predisposed to POAF enables the design of trials evaluating preventive strategies to mitigate this complication.

The aim of this study is to establish and validate an optimal explainable prediction model based on a machine learning (ML) approach to predict the short-term prognosis in high on-treatment platelet reactivity (HTPR) individuals with acute ischaemic stroke (AIS). Using individual basic characteristics, blood test indices, and the CYP2C19 genotype, a model to predict a poor functional prognosis (modified Rankin scale score ≥ 3) was constructed based on ML models, including logistic regression, support vector machine, decision tree, random forest (RF), extreme gradient boosting, and light gradient boosting machine. On this basis, global and local interpretability techniques were used to interpret selected ML models and explore the risk factors affecting the short-term prognosis of AIS in patients with HTPR. In this study, the performance of the model was futher evaluated through sensitivity analysis and subgroup analysis. A total of 515 AIS patients with HTPR were retrospectively enrolled, and approximately 129 (25%) had a poor outcome in the short term. Among the 6 ML models, RF performed best in discriminative ability in terms of area under the curve (0.84 [0.71-0.97]), accuracy (0.80 [0.71-0.89]), and precision (0.71 [0.61-0.81], which are far superior to the other models. Interpretability techniques showed that high levels of diastolic blood pressure, blood urea nitrogen, homocysteine, C-reactive protein, white blood cells, and CYP2C19 poor metabolizers were significant predictors of a poor prognosis of AIS in patients with HTPR. The risk prediction model for AIS patients with HTPR based on RF algorithms has high predictive power. By applying interpretability methods, the model's transparency and clinical usability were enhanced, offering a reference for the clinical prevention and treatment of HTPR.