Inferior vena cava (IVC) aneurysms are rare clinical entities with fewer than 80 cases reported in the literature. Type I aneurysms involving the suprahepatic IVC present significant surgical challenges due to their proximity to the right atrium and the frequent necessity of cardiopulmonary bypass. We present the case of a 68-year-old female with a symptomatic, enlarging 6-cm type I IVC aneurysm. The patient underwent successful surgical resection and reconstruction using an interposition graft fashioned from a tubularized bovine pericardial patch under cardiopulmonary bypass. The postoperative course was unremarkable, and 6-month surveillance imaging confirmed graft patency without recurrence. This report highlights the feasibility of surgical intervention for symptomatic type I IVC aneurysms and describes a reconstructive technique using biologic material.

Electrocardiographic (ECG) criteria for detecting left ventricular hypertrophy (LVH) have largely been derived from non-African populations. Their diagnostic performance in Black African adults with untreated hypertension remains uncertain.

To evaluate the diagnostic performance of established ECG-LVH criteria compared with echocardiographically assessed left ventricular mass index (LVMI) in Black African adults with untreated, uncomplicated hypertension enrolled in the coArtHA trial.

In this subanalysis, we included 1,125 participants from rural Tanzania and Lesotho who underwent baseline 12-lead ECG and focused transthoracic echocardiography (fTTE). LVH was defined as LVMI > 95 g/m² in women, and >115 g/m² in men. Diagnostic performance of multiple ECG-LVH criteria was assessed using correlation analyses, sensitivity and specificity estimates, receiver-operating characteristic (ROC) analysis, including calculation of the area under the ROC curve (AUROC), and precision-recall curves (PRC).

Echocardiographic LVH was present in 56 (5%) participants. Across continuous ECG indices, Cornell voltage product adjusted by +0.8 mV in women showed the strongest association with LVMI (Spearman's rho = 0.37, p < 0.001). Among evaluated criteria, Cornell voltage product-based measures demonstrated the most consistent diagnostic performance across evaluated metrics, with an AUROC of approximately 0.76. Using established cut-off values, this criterion yielded a sensitivity of 64% and a specificity of 80%, whereas voltage-only criteria, including Multi-Ethnic Study of Atherosclerosis (MESA)- and Sokolow-Lyon-based indices, showed limited accuracy in this setting. Exploratory analyses of alternative cut-off values demonstrated the expected sensitivity-specificity trade-offs.

In this cohort of hypertensive Black African adults, ECG criteria showed a moderate association with LVMI by echocardiography. Among established ECG criteria, Cornell voltage product-based measures demonstrated the most consistent diagnostic performance. Diagnostic characteristics were strongly influenced by cut-off selection and clinical context, underscoring the need for population-specific evaluation and external validation of ECG criteria for LVH in African settings.

Clinicaltrials.gov NCT04129840. Registered on October 17, 2019 (https://www.clinicaltrials.gov/).

The comorbidity of mood disorders (MDs), represented by depression and anxiety, with chronic somatic diseases (CDs), particularly cardiometabolic conditions, poses a significant global public health challenge, markedly increasing the risk of adverse prognoses and all-cause mortality. Epidemiological studies indicate that ~36% of patients with multimorbidity exhibit psychosomatic comorbidity, with higher risk populations concentrated among females, older adults, and socioeconomically disadvantaged individuals. This review systematically analyzes the epidemiological distribution patterns of MD-CD comorbidity, with the strongest emphasis on cardiometabolic diseases-diabetes, metabolic syndrome (MetS), obesity, hypertension (HTA), and cardiovascular disease (CVD)-for which the mechanistic data are most developed, while also addressing osteoarthritis, psoriasis, inflammatory bowel disease (IBD), cancer, and neurological disorders. By integrating molecular mechanisms with clinical evidence, we highlight core pathological pathways and critically evaluate the strength of evidence supporting each: hypothalamic-pituitary-adrenal (HPA) axis dysfunction and insulin resistance (IR), substantiated by clinical data and Mendelian randomization; NLRP3 inflammasome-mediated neuroinflammation as a transdiagnostic inflammatory node; gut-brain axis dysregulation involving bile acid-GLP-1 signaling and gut-derived metabolites such as trimethylamine N-oxide (TMAO); and the kynurenine pathway (KP) as a branched metabolite axis with organ-specific consequences. Sex-specific mechanisms, particularly estrogen-regulated neuroendocrine and metabolic pathways, are identified as consistent biological modifiers of this comorbidity. A bidirectional vicious cycle underpins MD-CD comorbidity: metabolic abnormalities exacerbate limbic system dysfunction via HPA-axis hyperactivity, neuroinflammatory cascades, and disrupted gut-brain signaling, while MDs aggravate metabolic dysregulation through neuroendocrine disturbances and reduced treatment adherence.

The pathogenesis of sepsis-induced cardiomyopathy (SIC) remains unclear, and the lack of effective treatment options results in high mortality rates. There may be interactions between gut microbiota dysbiosis, serum metabolic changes, and SIC; however, research in this area is limited. This study aims to provide a theoretical basis for targeted interventions to improve the gut microbiome, thereby enhancing cardiac function and prognosis in patients with SIC.

This prospective cohort study enrolled 48 septic patients admitted to the intensive care unit (ICU) of a tertiary general hospital in Ningxia, China, between March 2024 and March 2025. Patients were stratified into SIC (n=28) and SEPSIS (n=20) groups. Age- and sex-matched healthy controls (HC, n=10) were also recruited. Fecal samples from all three groups were analyzed via 16S rRNA gene amplicon sequencing, and serum samples from the SIC and SEPSIS groups were analyzed via LC-MS-based untargeted metabolomics. Spearman's correlations linked microbial and metabolic alterations to echocardiographic parameters and myocardial injury markers.

Compared with the SEPSIS and HC groups, the SIC group presented significant differences in both the α and β diversity of the gut microbiota (all P<0.05). Compared with that in the SEPSIS group, the Bacillota/Bacteroidota ratio was significantly lower in the SIC group (P<0.05); compared with the SEPSIS and HC groups, the SIC group presented significantly increased abundances of genera such as Parabacteroides and Clostridium innocuum group and significantly decreased abundances of genera such as Oscillospiraceae_UCG-003 and Lachnospiraceae_UCG-004 (all P<0.05). Forty-nine differential metabolites were identified (VIP≥1, P<0.05): hippuric acid, estrone glucuronide, and TMAO were elevated, while 15-deoxy-Δ12,14-prostaglandin J2 was reduced in the SIC group (all P<0.05). Differential genera/metabolites correlated strongly with SIC diagnostic indicators: e.g., Parabacteroides positively correlated with estrone glucuronide, hippuric acid, and GLS, and negatively with LVEF.

Gut microbiota dysbiosis differs between patients with Sepsis-induced cardiomyopathy and healthy individuals or patients with sepsis. Additionally, the serum metabolic profile changes in SIC patients differ from those in patients with sepsis, and these characteristic changes are significantly associated with clinical indicators related to the diagnosis of SIC.

With the rapid expansion of transcatheter aortic valve implantation (TAVI), infective endocarditis (IE) involving transcatheter prostheses has emerged as a major clinical challenge associated with high morbidity and mortality. Although the overall incidence of TAVI-associated IE remains relatively low, outcomes are poor, particularly in elderly and frail patients with multiple comorbidities. Importantly, TAVI-associated IE differs from surgical prosthetic valve endocarditis in several aspects, including patient profile, microbiological characteristics, imaging findings, and therapeutic management. This contemporary review summarizes recent evidence regarding the epidemiology, microbiology, multimodality imaging, management strategies, and prognosis of IE following TAVI. Particular emphasis is placed on the prominent role of enterococci, the limitations of conventional echocardiography, and the growing importance of multimodality imaging techniques such as cardiac CT and [¹⁸F]-FDG PET/CT for diagnosis and detection of perivalvular complications. Current evidence regarding surgical versus conservative management remains limited and strongly influenced by patient selection and operative risk, making individualized Heart Team decision-making essential. Despite advances in transcatheter therapies and imaging modalities, TAVI-associated IE continues to carry very high short- and long-term mortality. Improved preventive strategies, earlier diagnosis, optimized multimodality imaging algorithms, and better selection of patients for surgical intervention are needed to improve outcomes in this high-risk population.

Pulmonary regurgitation following tetralogy of Fallot repair is a common long-term complication requiring pulmonary valve replacement. Injectable bioprosthetic valves offer a less invasive alternative to conventional surgical replacement, but comparative data in pediatric populations remain limited. This study aimed to evaluate short-term and long-term clinical outcomes of injectable pulmonary valve replacement and conventional pulmonary valve replacement in pediatric patients with severe pulmonary regurgitation following tetralogy of Fallot repair.

This retrospective study included 22 pediatric patients who underwent pulmonary valve replacement. Patients were divided into injectable (n = 9) and conventional (n = 13) groups based on anatomical criteria. Primary outcomes included early postoperative parameters and long-term valve function. The mean follow-up duration was 10.5 ± 2.5 years.

Favorable early outcomes were noted in the injectable pulmonary valve replacement cohort, including shorter intensive care unit stay (16.8 ± 6.2 vs. 37.0 ± 23.4 h, p = 0.021), reduced mechanical ventilation duration (5.2 ± 3.9 vs. 15.4 ± 11.4 h, p = 0.019), decreased chest tube drainage (206.7 ± 108.2 vs. 513.1 ± 274.1 mL, p = 0.005), and shorter hospital stay (5.4 ± 2.4 vs. 8.4 ± 3.1 days, p = 0.026). Long-term outcomes indicated similar valve function and right ventricular remodeling in the two groups, with excellent freedom from reintervention (100%) during follow-up.

Injectable pulmonary valve replacement appears to be a safe alternative, offering favorable early outcomes and long-term valve performance comparable to conventional methods. However, clinical experience and precise patient selection remain critical for achieving optimal results.

Repetitive peripheral magnetic stimulation (rPMS) is a noninvasive, painless therapy aimed at improving spasticity, with a proposed mechanism that involves neuromodulation through somatosensory and proprioceptive afferent stimulation. The present study evaluates the effectiveness of rPMS on ankle plantar flexor spasticity in participants with stroke.

Included in this prospective, double-blind, randomized, sham-controlled study were 50 participants with poststroke ankle plantar flexor spasticity graded 1-3 according to Modified Ashworth Scale (MAS). Participants were randomized into rPMS (n = 25) and sham (n = 25) groups. All participated in a conventional rehabilitation program, while the rPMS group received 10 rPMS sessions over 2 weeks and the sham group received sham rPMS. Assessments at baseline, posttreatment (2nd week), and follow-up (4th week) included MAS, Modified Tardieu Scale (MTS), Barthel Index (stair/mobility), and electrophysiological H/M ratio.

A total of 46 participants completed the study. No adverse events related to the stimulation were reported. The rPMS group showed significant improvements in MAS score, MTS angle and grade, and Barthel Index, while no significant changes were observed in the sham group. A significantly greater proportion of participants in the rPMS group (40%) demonstrated MAS score reduction compared to the sham group (4.8%) (p = 0.004). Between-group analysis favored rPMS for MAS and MTS posttreatment and at follow-up. No significant changes in H/M ratios were observed within or between the groups.

rPMS can be a valuable adjunct to a traditional rehabilitation program, potentially improving poststroke spasticity. The reductions recorded in MAS and MTS scores in the absence of electrophysiological changes suggest that rPMS may reduce the biomechanical rather than neural component of spasticity. There is a need to define optimal treatment protocols.

In Behçet's disease (BD), arterial involvement represents a significant clinical challenge associated with serious complications. The present study evaluates the characteristic features, affected vessels, lesion types, treatments, and outcomes in BD patients with nonpulmonary arterial involvement.

Included in this retrospective study were 65 BD patients whose interventions and clinical courses were accessed from medical records. The treatments administered included immunosuppressive (IS) therapies and surgical/endovascular procedures. Fisher's exact and t-test/Mann-Whitney U test were used for statistical analysis.

Fifty-nine of the patients (90.8%) were male. The median (Q1-Q3) follow-up was 4 (2-12.8) years. The most commonly affected vessels were the aorta (n = 21, 32.3%) and the femoral artery (n = 19, 29.2%). Aneurysm (n = 50, 63.2%) and thrombosis (n = 18, 22.7%) were the predominant lesions; 14 (21.5%) patients experienced arterial involvement while receiving IS therapy; and 11 (16.9%) had cardiac involvement. Cyclophosphamide and azathioprine were the most commonly used IS agents. Among the 39 (60%) patients who underwent surgical and/or interventional procedures, 32 (82%) had successful outcomes. A second arterial event was experienced by 15.3% of the sample during follow-up, and a third by 3%. Active disease was noted in nine (13.8%) patients at the time of their last visit, and of the six (9.2%) that died, most had both arterial and cardiac involvement.

Arterial involvement in BD mostly presents with aneurysms, especially in men. Surgical interventions in addition to IS therapies are required in approximately 50% of cases. As can be understood from the 15.3% relapse rate in the present study, arterial events are not uncommon, underlining the need for long-term monitoring and sustained IS treatment. Of the 9.2% of cases who died, most had both arterial and cardiac involvement.

Heart failure (HF) in older adults is frequently accompanied by geriatric syndromes that remain unrecognized in conventional cardiac evaluations. The vulnerabilities of older adults with and without HF in terms of muscle strength, physical performance, functional capacity, frailty, nutritional status, cognition, mood, anxiety, polypharmacy, and comorbidity were investigated using comprehensive geriatric assessment (CGA).

A cross-sectional study was conducted in two academic outpatient clinics, enrolling 420 adults aged ≥60 years, including 92 (21.9%) with HF. Data included sociodemographic characteristics, anthropometric measurements, and CGA parameters: handgrip strength, the Five-Times Sit-to-Stand Test (FTSST), the Short Physical Performance Battery (SPPB), activities of daily living (ADL), instrumental ADL (IADL), the FRAIL scale, the Mini Nutritional Assessment-Short Form, the Mini-Cog, the Geriatric Depression Scale-Short Form, and the Generalized Anxiety Disorder-7. Univariate and multivariate regression analyses were performed.

HF participants had slower FTSST (12.7 s versus 11.7 s; p = 0.002), and lower SPPB scores (10.0 versus 11.0; p = 0.016). IADL scores were significantly lower in the HF group (median, 7.0 versus 8.0; p < 0.001), indicating a higher prevalence of IADL impairment. Frailty (31.5% versus 18.9%; p = 0.009), malnutrition (6.5% versus 2.1%; p = 0.043), cognitive impairment (29.3% versus 14.3%; p = 0.001), and polypharmacy (88.0% versus 57.9%; p < 0.001) were significantly more prevalent in the HF group. Low lower extremity muscle strength (OR = 3.713), impaired IADL (OR = 4.974), and higher comorbidity burden (OR = 1.603) were identified as independent factors associated with HF in multivariate analysis.

Older adults with HF showed substantial deficits across multiple CGA domains, including functional capacity, frailty, nutrition, and cognition. Integration of CGA into HF management may facilitate the identification of previously unrecognized vulnerabilities and support multidisciplinary care planning.

Emerging evidence suggests that dysregulated angiogenesis may contribute to the pathogenesis of Behçet's disease (BD). This study primarily aimed to investigate serum angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) levels in Turkish patients with BD and compare them with healthy controls. The secondary aims were to compare angiopoietin levels based on clinical manifestations, disease activity, and medication use and to investigate their correlations with age, disease duration, and inflammatory markers.

This cross-sectional study included 56 consecutive patients with BD, diagnosed according to International Study Group criteria, and 56 age- and sex-matched healthy controls. Physical characteristics, clinical manifestations, time since symptom onset, time since diagnosis, medications, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were recorded. Serum Ang-1 and Ang-2 levels were measured by enzyme-linked immunosorbent assay. Comparisons between the two groups were analyzed using the Student t-test or Mann-Whitney U test, and correlations were assessed using Pearson or Spearman correlation coefficients, depending on the data distribution.

Serum Ang-1 and Ang-2 levels were significantly higher in patients with BD compared to healthy controls (p < 0.001 and p = 0.031, respectively). Patients with genital ulcers had significantly lower serum Ang-1 levels compared to those without (p = 0.029). Additionally, Ang-2 levels showed moderate positive correlations with CRP (r = 0.518, p < 0.001) and ESR (r = 0.459, p < 0.001).

The elevated expression of Ang-1 and Ang-2 in Turkish patients with BD supports the growing evidence of their possible roles in BD pathogenesis.