Growing evidence associates patent foramen ovale right-to-left shunt (PFO-RLS) with conditions including migraine, cryptogenic stroke (CS), and transient ischemic attack (TIA). However, the potential role of pulmonary right-to-left shunt (P-RLS) remains unclear. This study aimed to characterize PFO-RLS and P-RLS using contrast transesophageal echocardiography (cTEE) and analyze their distinct features and intrinsic associations with migraine and CS/TIA.

302 patients with clinically suspected right-to-left shunt (RLS) contrast transesophageal echocardiography (cTEE) between October 2019 and January 2025 were retrospectively analyzed. Target Symptom Group included patients presenting with migraine, cryptogenic stroke (CS), and/or transient ischemic attack (TIA); all other patients comprised the Comparison Group. cTEE was performed to detect and quantitatively evaluate both patent foramen ovale right-to-left shunt (PFO-RLS) and pulmonary right-to-left shunt (P-RLS). We conducted stratified analyses to assess the relationships of PFO-RLS and P-RLS individually with the presence of target symptoms. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with the Target Symptom Group.

All 302 patients were successfully examined using TTE and cTEE. cTEE revealed 165 cases of PFO-RLS and 217 cases of P-RLS. Stratified analyses showed no statistical significance of P-RLS among patients with varying degrees of PFO-RLS between the positive symptom and other symptoms group. PFO-RLS was statistically significant between the two groups in patients with varying degrees of P-RLS. Pulmonary vein shunt and PFO shunt were significantly associated with positive symptoms (p < 0.05) in the univariate analysis; however, only PFO shunt was an independent risk factor in the multivariate analysis (OR 1.363, p < 0.05). Patients with moderate-to-severe dual shunts had the highest proportion(76.5%) of positive symptoms. Further analysis showed no significant interaction (p > 0.05).

cTEE has a good diagnostic value for determining the source of RLS microvesicles. PFO-RLS causes migraine and CS/TIA; the more shunts there are, the more severe the symptoms. Current grading system for right-to-left shunt does not take microbubble size into consideration, although P-RLS is more common, it does not cause severe symptoms. A PFO shunt alone is an independent risk factor for migraine and CS/TIA.

This study aimed to evaluate the all-cause mortality predictive value of left atrioventricular coupling indexes in patients with chronic Chagas disease (CD).

This single-center retrospective longitudinal study included 382 patients with chronic CD. The left atrioventricular coupling index (LACI) was defined as the ratio of left atrial (LA) over left ventricular (LV) end-diastolic volumes. LA volumetric/mechanical coupling index (LAVI/A') was the ratio of maximum LA volume index over late diastolic mitral annulus velocity. The endpoint was a composite of all-cause mortality or heart transplant. The associations between LACI or LAVI/A' and the endpoint independent from clinical, electrocardiographic, and 2D echocardiographic parameters (Model I) or from Model I adjusting variables plus LV and LA strain parameters (Model II) were tested by multivariate Cox-proportional-hazards regression.

After a mean follow-up of 6.6 ± 2.7 years, 80 patients died and two underwent a heart transplant. LACI was associated with the endpoint in Models I (HR 1.03, 95% CI 1.01-1.05, p = 0.01) and II (HR 1.03, 95% CI 1.01-1.05, p = 0.0008). LAVI/A' was also associated with the endpoint in Models I (HR 1.08, 95% CI 1.05-1.12, P < 0.0001) and II (HR 1.09, 95% CI 1.05-1.12, P < 0.0001). The area under the ROC curve was larger for LAVI/A' than LACI (0.87 vs. 0.65, P < 0.0001). The optimal cutoff value for LAVI/A' was 3.3 mL × s/cm^-1 per m² (sensitivity 81.7%, specificity 83.7%). Patients with LAVI/A' ≥ 3.3 at baseline had a 19-fold higher risk for all-cause mortality.

New echocardiographic LA coupling indexes are promising predictors of dismal clinical outcomes in CD.

Current ASE/EACVI echocardiography guidelines recommend estimating central venous pressure from inferior vena cava (IVC) diameter and collapsibility in biventricular circulations. Because altered blood volume, venous capacitance, and venous tone may weaken the relationship between IVC morphology and systemic venous pressure, it is uncertain whether these criteria apply in the Fontan circulation.

In 101 adults with a Fontan circulation (median age 27.8 years), echocardiographic IVC and resting peripheral venous pressure (PVP) were measured simultaneously. ASE/EACVI guidelines were applied directly, estimating central venous pressure based on IVC diameter > 21 mm and collapsibility < 50%. Agreement with measured PVP categories was assessed using weighted κ. As a secondary post hoc analysis, IVC diameter and collapsibility thresholds were optimized within the same cohort to assess whether simple recalibration could materially improve agreement.

Median resting PVP was 10.6 (8.6-13.1) mmHg, and 21% had PVP ≥ 15 mmHg. IVC collapsibility was < 50% in 99%, whereas only 17% had IVC diameter > 21 mm. IVC diameter (r = 0.14, p = 0.163) and IVC collapsibility (r = -0.06, p = 0.527) did not correlate with PVP. Conventional criteria assigned no patient to the low pressure category and showed poor agreement with measured PVP (weighted κ 0.02, 95% confidence interval -0.12 to 0.16). Post hoc within-cohort recalibration (using IVC diameter ≥ 20 mm and collapsibility ≤ 10% as cut-offs) only modestly improved agreement (weighted κ 0.24, 95% confidence interval 0.05 to 0.42).

IVC-based pressure estimation is unreliable in adults with a Fontan circulation. Validated peripheral or invasive pressure measurements should be preferred for accurate Fontan pressure assessment.

Levodopa did not enhance early motor recovery at 3 months after stroke in the Enhancement of Stroke Rehabilitation with Levodopa (ESTREL) trial. However, whether levodopa modifies the time course of recovery, leading to a delayed benefit remains unclear. Here, we examined levodopa's effects on the trajectories of motor recovery up to 6 months after stroke.

The ESTREL trial, a double-blind, randomised controlled clinical trial, compared a 39-day regimen of levodopa/carbidopa (100 mg/25 mg, 3×/day) to placebo alongside standardised task-oriented training. We longitudinally analysed Fugl-Meyer Motor Assessment (FMA) total scores (primary outcome), mRS and NIHSS (secondary outcomes) at baseline (0-7 days post stroke), 5 weeks, 3 and 6 months using linear mixed-effects models including timepoint, treatment allocation and their interaction.

In total, 576 of 610 (94%) participants (median age 73 years; 40% female) were analysed. FMA scores improved over time in both groups (P < .001), with no overall levodopa effect across visits (estimate 0.65 points, 95% CI, -3.3 to 4.6; P = .75). There was no indication that levodopa modified the recovery trajectory (χ2 = 0.52, df = 3, P = .91), and estimated levodopa-placebo differences in FMA changes across visit intervals were small, ranging from -0.7 to +0.8 points, with confidence intervals crossing zero. Secondary outcomes showed similar longitudinal improvement, without evidence of a treatment effect.

In this post hoc analysis of ESTREL participants with repeated FMA assessments, motor impairment improved from the first days after stroke up to 6 months. Levodopa added to task-oriented inpatient rehabilitation did not improve motor recovery or alter its trajectory over this period.

NCT03735901, available at ClinicalTrials.gov: https://clinicaltrials.gov/study/NCT03735901?cond=NCT03735901&rank=1.

This study aims to evaluate cognitive function in patients with Cerebral Small Vessel Disease (CSVD) and investigate its association with variables such as serum Insulin-like Growth Factor-1 (IGF-1). Artificial intelligence algorithms, specifically eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP), were utilized for analysis and interpretation.

A total of 216 patients diagnosed with CSVD were enrolled from the Department of Neurology, Third Affiliated Hospital of Soochow University, between November 2019 and August 2020. Clinical and biochemical data-including triglycerides, total cholesterol, low-density lipoprotein cholesterol, fasting blood glucose, glycosylated hemoglobin (HbA1c), fasting insulin, C-peptide, anti-human insulin antibodies, and IGF-1-were obtained under standardized laboratory protocols. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Based on cognitive performance, patients were categorized into CSVD with cognitive impairment and CSVD without cognitive impairment.

The original cohort included 216 patients with CSVD, comprising 50 patients with MCI and 166 patients without MCI. To address class imbalance during model development, SMOTE-NC was applied within the development dataset. The XGBoost model achieved a precision of 0.790, recall of 0.901, F1 score of 0.820, accuracy of 0.833, and Cohen's kappa coefficient of 0.667 in the validation cohort. Feature importance analysis identified key predictors, while SHAP values enabled intuitive visualization of each feature's impact. Decision Curve Analysis (DCA) confirmed the model's clinical utility and net benefit, underscoring its potential for early MCI detection and targeted intervention to improve patient outcomes.

Combining XGBoost and SHAP enhances model interpretability, facilitating the identification of critical risk factors such as reduced IGF-1 levels in MoCA-defined MCI in patients with CSVD. This AI-driven approach offers a valuable tool for informing treatment decisions and optimizing healthcare resource allocation.

Atrial fibrillation or flutter (AFl) frequently coexists with chronic heart failure (CHF), yet its impact on in-hospital outcomes in large, unselected populations remains insufficiently defined.

We analyzed all hospitalizations for CHF (ICD-10-GM I50*) in Germany from 2014 to 2022 using nationwide administrative data. Patients were stratified by rhythm status (AFl vs. non-AFl). Outcomes included in-hospital mortality, complications, length of stay, and health care costs. Multivariable logistic regression was used to identify independent predictors of mortality.

Among 4,057,291 hospitalizations, 56.9% had AFl. These patients were older (median 82 vs. 79 years), more often female, and showed a higher comorbidity burden, particularly CKD, hypertension, and stroke. AFl was associated with higher rates of complications such as AKI (11.9% vs. 9.7%; p < 0.001) and cardiogenic shock (1.15% vs. 1.03%; p < 0.001), but lower use of mechanical ventilation and assist devices. Despite this, in-hospital mortality was slightly lower in AFl (8.30% vs. 8.66%). AFl patients had longer median hospital stays (8 vs. 7 days), while costs were comparable. Ventilated AFl patients had longer ventilation times (28 vs. 21 hours). In multivariable analysis, AFl was independently associated with higher mortality in most age groups, except for patients aged 40-49, 80-89, and > 90 years.

In this nationwide cohort, AFl was common among CHF patients and linked to more advanced disease. Its impact on in-hospital mortality was age-dependent and complex, highlighting the need for tailored clinical management.

Hypertension (HTN) is a common and complex disorder influenced by multiple genetic and environmental factor, where the underlying mechanisms of its etiology remain incompletely understood although the identification of several contributing elements. This research sought to evaluate the possible relationship between genetic polymorphisms in methylenetetrahydrofolate reductase (MTHFR) and With-No-Lysine Kinase 1 (WNK1) genes and susceptibility to hypertension.

Genomic DNA was extracted from blood samples collected from 220 individuals with hypertension and 220 normotensive controls. Genotyping of MTHFR (rs1801133 and rs1801131) and WNK1 (AluYb8) polymorphisms was performed using direct PCR and PCR-RFLP techniques. The resulting data were subjected to appropriate statistical analyses.

A statistically significant association was identified between the rs1801131 polymorphism of the MTHFR gene and susceptibility to hypertension (p = 0.0006). This association remained significant under the codominant, dominant, and recessive genetic models, with all p-values < 0.016. Furthermore, the CC haplotype of the MTHFR gene showed a significant association with hypertension (OR = 2.02, p = 1e-04).

These findings indicate that the MTHFR rs1801131 polymorphism is significantly associated with hypertension susceptibility and may represent a potential genetic marker. This highlights its relevance for future studies exploring genotype-driven risk assessment and personalized approaches to hypertension management.

The relationship between Neuromyelitis optica spectrum disorder (NMOSD) and specific cardiovascular outcomes, particularly macrovascular events such as peripheral artery disease (PAD) and venous thromboembolism (VTE), has not been examined in a population-based study. The current study investigated the association between NMOSD and the risks of PAD and VTE.

This retrospective cohort study used data from the Taiwan National Health Insurance Research Database. Patients with new-onset NMOSD between 2003 and 2020. Patients with previous PAD or VTE were excluded. Each patient was matched to five general patients for comparison using propensity score matching. In total, the study included 2,027 patients with NMOSD and 10,135 matched general population controls. A Cox proportional hazards model was used to investigate PAD and VTE risk, with relevant variables controlled for. NMOSD was stratified by severity to further verify the association between disease severity and macrovascular event risk. The control variables considered in this study were sex, age, insured salary, urbanization, Charlson comorbidity index (CCI), and related comorbidities.

The average follow-up of all participants was 7.01 person-years. After adjustments for relevant variables, patients with NMOSD had significantly higher risks of PAD (adjusted hazard ratio [aHR] = 1.40; 95% confidence interval [CI]: 1.02-1.92) and VTE (aHR = 4.81; 95% CI: 3.08-7.52). The risk of vascular events was strongly associated with disease severity. Severe NMOSD was associated with markedly increased risks of PAD (aHR = 2.26; 95% CI: 1.41-3.61) and VTE (aHR = 11.69; 95% CI: 6.86-19.90), whereas mild and moderate disease did not significantly increase PAD risk.

NMOSD is a significant risk factor for PAD and VTE. These findings highlight the importance of proactive vascular risk assessment and preventive management in patients with NMOSD.

Transgender individuals represent a marginalised population, often exposed to unique psychosocial stressors, limited healthcare access, and social exclusion, all of which may contribute to an increased risk of cardiovascular disease (CVD). However, evidence focusing exclusively on the cardiovascular outcomes in this group remains limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of major cardiovascular morbidities among transgender adults.

A systematic search of five databases (PubMed, PubMed Central, Embase, Scopus, and Google Scholar) was conducted to identify observational studies reporting cardiovascular outcomes in transgender individuals aged ≥18 years. The study protocol was registered with PROSPERO (CRD42022383213). The inclusion criteria were cross-sectional, cohort, and case-control studies published in English. Data extraction and quality assessment were independently performed by two reviewers using standardised tools. A meta-analysis was conducted using a random-effects model, and publication bias was assessed using funnel plots and Egger's test.

10 eligible studies that focused on transgender individuals were included in the final analysis. The pooled prevalence rates were hypertension 21% (95% CI: 12-36; I ² = 99.0%), stroke/CVA 5% (95% CI: 3-8; I ² = 84.3%), coronary artery disease (CAD) 3% (95% CI: 1-19; I ² = 98.8%), and myocardial infarction (MI) 7% (95% CI: 6-9; I ² = 75.5%). Funnel plots indicated a symmetrical distribution for hypertension and stroke, suggesting low publication bias, whereas asymmetry was noted for CAD and MI.

This review revealed a substantial burden of cardiovascular morbidity among transgender individuals, warranting routine screening and targeted preventive strategies in this population. Policymakers and healthcare providers should consider inclusive approaches to reduce cardiovascular risk. Further longitudinal studies and comparative analyses of cisgender populations are essential for guiding evidence-based interventions.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022383213, identifier: CRD42022383213.

While prolonged sedentary behavior is an established contributor to hemorrhoidal disease, the precise quantitative impact of dietary fiber within sedentary occupational cohorts remains to be fully elucidated. This study aimed to characterize the dose-response relationship between fiber consumption and hemorrhoid prevalence among professionals in sedentary roles.

In this cross-sectional investigation of 421 sedentary professionals, dietary patterns were evaluated via validated instruments, and hemorrhoid status was determined through a combination of clinical assessment and symptom-based screening. We utilized multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Furthermore, restricted cubic spline (RCS) analysis, adjusted for age, BMI, exercise habits, and sedentary duration, was employed to model the dose-response landscape.

The cohort exhibited a hemorrhoid prevalence of 38.95%. Multivariable-adjusted models revealed a significant inverse correlation between total fiber intake and hemorrhoid risk (P for trend < 0.001). Compared with the lowest energy-adjusted intake group (< 13.1 g/d), participants in the highest quartile (>18.5 g/d) had lower odds of hemorrhoids (adjusted OR: 0.56; 95% CI: 0.32-0.98). RCS regression identified a non-linear "L-shaped" association (P for non-linearity = 0.024). The curve showed visual flattening near 25 g/d, which should be interpreted as a descriptive pattern rather than a statistically validated threshold.

Higher dietary fiber intake was independently associated with lower hemorrhoid prevalence among sedentary workers. Because of the cross-sectional design, these findings should not be interpreted as evidence of causality. Prospective studies are needed to clarify temporality and to determine whether increasing dietary fiber intake can reduce future hemorrhoid occurrence.