Background: Patients with chronic coronary syndrome (CCS) are frequently complicated by reduced exercise tolerance. Previous studies exploring the relationship between body mass index (BMI) and cardiopulmonary function among CCS patients have reported conflicting results, and the definite association between the two indicators remains unclear. Accordingly, we performed this study to characterize their actual correlation.Methods: This retrospective study examined the association between BMI and Cardiopulmonary Exercise Testing (CPET) indices and the modifying effect of sex in 405 CCS patients recruited from the Cardiovascular Disease Center of Taizhou People's Hospital. Patients were divided into three groups based on BMI tertiles, and CPET parameters were compared. Multiple linear regression and sex-stratified analyses were conducted.Results: In patients with CCS, BMI exerted a bidirectional linear differential effect on cardiopulmonary exercise capacity without nonlinear inflection points: higher BMI correlated with greater PeakVO₂ (B = 22.851, 95%CI: 16.180-29.522, β = 0.270, p < 0.001), yet lower Peak VO₂/kg (B=-0.214, 95%CI: -0.310--0.117, β=-0.212, p < 0.001). This association was modified by sex. The positive association between BMI and PeakVO₂ was stronger in males (B = 31.708, 95%CI: 21.609-41.806, β = 0.377, p < 0.001), whereas the negative inhibitory effect of BMI on Peak VO₂/kg was more pronounced in females (B=-0.242, 95%CI: -0.370--0.115, β=-0.271, p < 0.001). Moreover, other determinants of cardiopulmonary function exhibited sex disparities.Conclusion: In patients with CCS, higher BMI was positively correlated with absolute peak exercise capacity but negatively correlated with peak VO₂/kg, and this correlation showed sex heterogeneity.

BackgroundOcclusive pulmonary arterial lesions represent a major technical challenge for balloon pulmonary angioplasty (BPA) in patients with Takayasu arteritis-associated pulmonary artery involvement. However, evidence and procedural guidance regarding BPA for occlusive lesions in this population remain limited.ObjectivesThis study aimed to summarize our center experience with BPA for occlusive pulmonary arterial lesions in patients with Takayasu arteritis and to identify potential risk factors associated with restenosis after BPA.DesignRetrospective cohort.MethodsWe retrospectively enrolled patients with Takayasu arteritis who had occlusive pulmonary arterial lesions. Lesions were morphologically categorized as subtotal or total occlusions. Total occlusions were further subclassified as cone-shaped, pouch-like, or ostial occlusions.ResultsWe included 66 patients with Takayasu arteritis, in whom 182 occlusive lesions were identified. In terms of locations, most ostial occlusions (56.52%) located lobar, while other kinds of lesions more common located segmentally. Total occlusions more frequently required guide-extension catheter support than subtotal occlusions (70.21% vs. 40.63%, P<0.001). Hard-tip guidewires were required for revascularization in 53.85% of ostial occlusions, compared with only 3.13% of subtotal occlusions. Lesion-level technical success rates among attempted lesions decreased with increasing lesion complexity: 100% for subtotal occlusions, 96.0% for cone-shaped occlusions, 68.4% for pouch-like occlusions, and 43.8% for ostial occlusions. The corresponding recanalization rates among all identified lesions were 78.69%, 88.9%, 52.04%, and 10.14%, respectively. In exploratory univariable Firth penalized logistic regression, irregular anticoagulation was associated with a higher likelihood of restenosis (OR 8.51, 95% CI 1.39-60.91; P=0.021), whereas baseline hemodynamics were not associated with restenosis.ConclusionThe techniques and devices illustrated in this study might guide the BPA performance in addressing occlusive lesions.

The ankle-brachial index (ABI) is an important indicator for assessing the severity of peripheral arterial disease (PAD), but the limitations of single measurements are increasingly recognized. This study aimed to explore the predictive value of diurnal ABI variability for PAD symptom progression and to develop a prediction model incorporating ABI variability.

This prospective cohort study enrolled patients diagnosed with PAD, stratified by Fontaine staging. All patients underwent ABI measurements at three time points (8:00, 12:00, 18:00) at baseline, with calculation of ABI mean, range, and coefficient of variation. The primary endpoint was symptom progression during follow-up. Generalized additive models (GAM) were used to evaluate the relationship between ABI variability and symptom progression, with comparison to restricted cubic splines (RCS) and linear models.

The final analysis included 680 PAD patients followed for 40 months, with 225 (33.1%) experiencing symptom progression. Diurnal ABI variability (range, standard deviation, and coefficient of variation) showed differences between progression and non-progression groups, but these were not statistically significant (P=0.079). GAM modeling revealed that age (P<0.001) and mean ABI (P=0.032) were significant predictors of symptom progression, while ABI range alone was not significant as a predictor (P=0.214). The model demonstrated good calibration (Hosmer-Lemeshow Test P=0.1327) and moderate discrimination (AUC=0.688, 95%CI: 0.643-0.733). Patients were stratified into three risk groups based on predicted risk: low-risk (≤18%), medium-risk (19-29%), and high-risk (≥30%), with actual event rates of 13.2%, 23.7%, and 36.8%, respectively, showing good agreement with predicted risks. Kaplan-Meier analysis revealed significant differences in progression-free survival when stratified by ABI severity (P=0.013), but not when stratified by ABI variability (P=0.79).

Mean ABI and age are the primary predictors of PAD symptom progression, while diurnal ABI variability may provide additional predictive value in specific patient subgroups. Prediction models incorporating multiple time-point ABI measurements facilitate risk stratification and individualized management of PAD patients.

Coronary artery aneurysm is a rare condition commonly treated with conventional surgery under cardiopulmonary bypass because of its complexity. Here, we present a patient who underwent minimally invasive off-pump coronary surgery via left mini-thoracotomy for a left anterior descending artery saccular aneurysm. A Japanese woman in her late 40s, who had been treated with beta-blocker therapy for hypertrophic cardiomyopathy, and steroid and immunosuppressive therapies after renal transplantation, developed chest discomfort on effort recently. Digital Holter electrocardiography showed ST-segment depression associated with exertional dyspnea, suggesting ischemic heart disease. Coronary angiography revealed a saccular aneurysm of the left anterior descending artery that had caused ischemia due to turbulence. This patient was diagnosed with a left coronary artery aneurysm causing ischemic symptoms, which indicated surgical intervention, whereas we judged that the mild to moderate mitral valve regurgitation and mild left ventricular outflow stenosis, caused by hypertrophic cardiomyopathy, did not require surgical interventions. Then, we performed aneurysmal plication after bypass grafting to the left anterior descending by the left internal thoracic artery via left mini-thoracotomy under off-pump guidance. The patient recovered well, and the symptoms disappeared. Postoperative computed tomography angiography showed good patency of the internal thoracic artery and complete disappearance of the aneurysm. This case demonstrates the potential utility of minimally invasive off-pump coronary surgery via left mini-thoracotomy as a useful alternative for patients with simple left coronary artery aneurysms.

Pericarditis remains a common and clinically relevant cardiovascular condition whose diagnosis and management have evolved substantially over time. Understanding this historical progression provides important context for contemporary practice and emerging therapeutic strategies. Early descriptions, dating back to Hippocrates, framed pericarditis as a clinical observation, with more precise diagnostic characterization emerging in the 19th century through the work of Laennec and later refined by clinicians such as Spodick and Hatle. Initial treatment approaches were largely symptomatic or surgical, including pericardiectomy for advanced constrictive disease. The mid-twentieth century marked a shift toward medical therapy with the introduction of nonsteroidal anti-inflammatory drugs and corticosteroids, which improved symptom control but were limited by high recurrence rates. The advent of echocardiography transformed pericardial disease evaluation by enabling noninvasive diagnosis, hemodynamic assessment, and safer pericardiocentesis. More recently, cardiac magnetic resonance imaging has further advanced care by allowing detailed tissue characterization and improved risk stratification. Randomized trials established colchicine as a cornerstone therapy for both acute and recurrent pericarditis. A major paradigm shift has occurred with the recognition of autoinflammatory mechanisms underlying recurrent disease and the introduction of targeted interleukin-1 inhibition, including anakinra and rilonacept, particularly for refractory cases. Together, these advances reflect a transition from empirical management toward mechanism-based, personalized care. Ongoing progress in imaging, biomarker integration, and targeted immunomodulation is expected to further refine diagnosis, treatment, and long-term outcomes for patients with pericardial disease.

The "2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery.

A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.

This study aimed to investigate the effects of blood flow restriction training (BFRT) combined with visual feedback training (VFT) on lower limb function and serum levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) in patients with stroke.

Forty patients with stroke who were hospitalized at the Rehabilitation Hospital of Chongqing Medical University between July 2025 and May 2026 were enrolled and randomly assigned to either the VFT group (control group) or the BFRT combined with VFT group (experimental group). The control group received VFT in addition to conventional rehabilitation, whereas the experimental group received BFRT combined with VFT on the basis of conventional rehabilitation. After 4 weeks of treatment, manual muscle testing (MMT), the Fugl-Meyer Assessment-Lower Extremity (FMA-LE), the Timed Up and Go Test (TUGT), the Modified Barthel Index (MBI), the Functional Ambulation Category (FAC), the Pro-Kin balance test, and serum levels of BDNF and VEGF were compared between the two groups.

Compared with baseline, MMT, FMA-LE, MBI, and FAC scores significantly increased in both groups after 4 weeks of treatment (P < 0.05), with greater improvements observed in the experimental group than in the control group (P < 0.05). TUGT performance also improved significantly in both groups compared with baseline (P < 0.05), with the experimental group demonstrating significantly greater improvement than the control group (P < 0.05). Following treatment, Pro-Kin balance test performance improved significantly in both groups (P < 0.05), and the experimental group achieved better results than the control group (P < 0.05). Serum levels of BDNF and VEGF increased significantly in both groups after the intervention (P < 0.05), with significantly greater increases observed in the experimental group (P < 0.05).

BFRT combined with VFT can significantly improve balance, lower limb function, and activities of daily living in patients with stroke. It also effectively increases serum levels of BDNF and VEGF, thereby promoting neurovascular plasticity.

Metabolic remodeling, defined as changes in the energy substrate preferences and energy production efficiency of the myocardium, is one of the pathogenic characteristics of failing hearts, though its molecular mechanisms remain incompletely understood. Through untargeted metabolomics coupled with targeted mass spectrometry, we report that plasma succinate levels are significantly elevated in patients with impaired cardiac function (ejection fraction, EF<50%) compared to those with preserved EF (EF⩾50%). Succinate is a key metabolite intermediate in the tricarboxylic acid cycle. Mechanistically, we demonstrate that β-adrenergic receptor activation upregulates synoviolin 1 (SYVN1), which promotes the ubiquitination and degradation of nuclear respiratory factor 1 (NRF1). In turn, this downregulates the expression of succinate dehydrogenase complex iron sulfur subunit B (SDHB), leading to intracellular succinate accumulation and subsequent release. Furthermore, we show that the sodium-glucose cotransporter 2 inhibitor empagliflozin binds to NRF1, restores SDHB expression, normalizes succinate levels, and ameliorates cardiac dysfunction in a pressure-overload model. Our findings delineate a novel SYVN1/NRF1/SDHB-succinate axis that drives mitochondrial dysfunction in heart failure, and identify its potential as a therapeutic target for metabolic modulation.

To evaluate the association between thyroid hormone alterations and mortality in critically ill and cardiovascular patients, and to compare the prognostic performance of non-thyroidal illness syndrome and isolated low triiodothyronine.

PubMed/MEDLINE, Scopus, and Web of Science were systematically searched for studies published between 2014 and 2026 evaluating thyroid dysfunction and mortality in acute or critical illness. Studies assessing non-thyroidal illness syndrome or isolated low triiodothyronine were included. Random-effects meta-analyses were performed using odds ratios (ORs) with 95% confidence intervals (CIs).

Twenty-two studies were included. Fifteen studies evaluating non-thyroidal illness syndrome (5,230 patients) showed a significant association with mortality (OR 3.19, 95% CI 2.10-4.85), although heterogeneity was substantial (I²=67.5%, p<0.0001). Nine studies evaluating isolated low triiodothyronine (6,282 patients) also demonstrated a significant association with mortality (OR 2.93, 95% CI: 2.04-4.20), with substantial heterogeneity (I²=63.8%, p = 0.0048). Subgroup comparison and exploratory meta-regression showed no significant differences in effect size between the two definitions of thyroid dysfunction.

Both non-thyroidal illness syndrome and isolated low triiodothyronine are associated with increased mortality in critically ill and cardiovascular patients. Although current aggregate data do not demonstrate a clear quantitative superiority of one definition over the other, non-thyroidal illness syndrome may provide a more integrated biological framework for interpreting thyroid dysfunction during acute illness.

Alternative splicing (AS) and alternative polyadenylation (APA) are crucial post-transcriptional mechanisms enhancing transcriptomic and proteomic diversity. Dysregulation of AS and APA is pivotal in cardiovascular disease pathogenesis. This review focuses on RNA-binding proteins (RBPs) orchestrating AS and APA interplay in cardiovascular gene expression, particularly in cardiovascular diseases (CVDs) like atherosclerosis, heart failure, myocardial fibrosis, and ventricular remodeling. AS and APA exhibit intricate crosstalk, with RBPs influencing both processes. Key RBPs play mechanistic roles in immune regulation, calcium handling, and fibrotic signaling in CVDs. Additional regulatory factors such as non-coding RNAs, microbial influences, and redox signaling further modulate RBP activity and AS/APA outcomes. Targeting RBP-mediated AS and APA presents a promising therapeutic approach for CVDs, despite challenges related to specificity, regulatory complexity, and validation in human models. Future research should delve into cell-type-specific profiles and preclinical efficacy to advance precision treatments.