To evaluate the feasibility, safety, and short-term outcomes of transcatheter closure of sinus venosus atrial septal defect (SVASD) using covered stents. We conducted an institutional retrospective analysis of 24 consecutive patients aged 15-70 years with superior SVASD and significant left-to-right shunting (QP/QS ≥ 1.5), who underwent percutaneous closure using covered stents between June 2021 and December 2023. Pre-procedural imaging included transesophageal echocardiography and cardiac Computed Tomography angiography (CTA). Procedural details, technical success, and echocardiographic parameters were recorded. Post-procedural outcomes were assessed with transthoracic echocardiography and/or CTA. The Patients' median age was 38 years (IQR: 28-53), and 50% were female. Median Atrial Septal Defect (ASD) size was 15 mm (IQR: 11-19), and median QP/QS ratio decreased from 1.8 (IQR: 1.7-1.95) to 1.1 (IQR: 1.0-1.25) after closure (p < 0.001). Covered stents were used in all cases, and 13 patients (54.1%) required additional non-covered stent support. Technical success was achieved in 96% of patients, with one case of device embolization requiring surgical intervention. Minor complications occurred in 7 patients (29.1%), including hematoma and asymptomatic thrombosis. No mortality was observed. At 3 months, right ventricular dysfunction and enlargement significantly improved (p = 0.004 and p = 0.001, respectively), while right atrial size remained unchanged (p = 0.317). Catheter-based repair of SVASD is feasible, safe, and effective with a low rate of complications. This approach may offer a minimally invasive alternative to surgery in anatomically suitable patients.

To examine whether exposure to sugar rationing during early life is associated with a reduction in the risk of cardiovascular outcomes in adulthood.

Natural experiment study.

UK population based cohort.

63 433 UK Biobank participants born between October 1951 and March 1956 without prevalent cardiovascular disease, multiple births, adoption, or birth outside the UK. Exposure was quasi-experimentally assigned on the basis of birth date relative to the end of sugar rationing in 1953. External validation cohorts from the Health and Retirement Study and the English Longitudinal Study of Ageing were used.

Primary outcomes were incident cardiovascular disease, myocardial infarction, heart failure, atrial fibrillation, stroke, and cardiovascular disease mortality, ascertained through linked health records. Hazard ratios were estimated using Cox and parametric hazard models adjusted for demographic, socioeconomic, lifestyle, parental health, and genetic factors and geographical controls. Multiple cardiac parameters were measured in a subset undergoing cardiac magnetic resonance imaging.

Longer exposure to sugar rationing was associated with progressively lower cardiovascular risks in adulthood. Compared with people never exposed to rationing, those exposed in utero plus 1-2 years had hazard ratios of 0.80 (95% confidence interval (CI) 0.73 to 0.90) for cardiovascular disease, 0.75 (0.63 to 0.90) for myocardial infarction, 0.74 (0.59 to 0.95) for heart failure, 0.76 (0.66 to 0.92) for atrial fibrillation, 0.69 (0.53 to 0.89) for stroke, and 0.73 (0.54 to 0.98) for cardiovascular disease mortality. Incident diabetes and hypertension jointly mediated 31.1% of the sugar rationing-cardiovascular disease association, whereas birth weight contributed only 2.2%. Sugar rationing was also associated with a modest increase in left ventricular stroke volume index (0.73 (95% CI 0.05 to 1.41) mL/m²) and ejection fraction (0.84%, 95% CI 0.40% to 1.28%).

Exposure to sugar rationing during the first 1000 days of life was associated with lower cardiovascular risks in adulthood and slightly more favourable cardiac indices, suggesting long term cardiovascular benefits of early life sugar restriction.

Chronic respiratory diseases, such COPD and asthma, increase the risk of atherosclerotic cardiovascular disease (ASCVD) through shared pathophysiological mechanisms and modifiable risk factors. There are a number of methods to assess ASCVD, and limited systematic information about how these may be applied to chronic respiratory diseases.

To systematically report existing methods of estimating ASCVD risk in chronic respiratory disease populations, highlighting strengths, limitations and clinical applicability.

A systematic search of MEDLINE, Embase, Scopus, and CINAHL was conducted up to June 2025 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (www.crd.york.ac.uk/PROSPERO identifier CRD42024543335). An extended search was also performed. To assess search sensitivity, a random sample of 30 studies from the extended search were reviewed. Key international clinical guidelines were examined for recommended tools. Studies assessing ASCVD risk in chronic respiratory disease populations were included. A narrative synthesis was employed.

63 studies from 26 countries identified 68 ASCVD risk assessment tools and biomarkers in chronic respiratory disease. Imaging techniques such as coronary artery calcium scoring, and carotid intima-media thickness provide detailed anatomical information, but require equipment and expertise. Risk scores (Framingham Risk Score; Systematic Coronary Risk Evaluation) are practical, although they lack precision at the individual level. Biomarkers and functional tests provide holistic measurements yet are often resource-demanding. Arterial stiffness measurement directly assesses vascular pathology and requires specialist equipment.

Multiple ASCVD risk assessment methods exist for chronic respiratory diseases, highlighting the need to understand the strengths and weaknesses of tools for tailored solutions. Future studies should address validation, accessibility and improved personalised risk stratification.

The minimally important difference (MID) for frailty variation associated with adverse outcomes remains unknown in patients with heart failure and preserved ejection fraction (HFpEF), and whether spironolactone can ameliorate frailty progression in this population remains unclear.

We analysed data from 1767 participants in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. The MID for frailty was calculated using an anchor-based approach, with the EuroQol-Visual Analogue Scale (EQ-VAS) as the anchor. Frailty index (FI), defined as a 35-item cumulative deficit score, and EQ-VAS were assessed at baseline and 1-year follow-up. The primary composite outcome (cardiovascular death, aborted cardiac arrest or heart failure hospitalisation) was assessed from the 1-year follow-up visit. Adjusted Cox proportional hazards models evaluated the link between FI changes (ΔFI≥MID) and the primary outcome. Longitudinal FI changes were analysed using linear mixed-effects models to evaluate spironolactone's effect.

The MID for the FI was 0.03 points. An FI reduction ≥MID was associated with a lower risk of the primary composite outcome (aHR, 0.63; 95% CI 0.48 to 0.82), all-cause mortality (aHR, 0.57; 95% CI 0.42 to 0.76) and heart failure hospitalisation (aHR, 0.55; 95% CI 0.40 to 0.75) after adjusting for baseline FI, age, sex, New York Heart Association class, smoking status and treatment assignment. No between-group difference in FI change was observed with spironolactone versus placebo (aOR, 0.85; 95% CI 0.67 to 1.09).

Frailty improvement exceeding the 0.03 FI threshold predicts better prognosis in HFpEF, underscoring the value of routine assessment. Spironolactone use was associated with neutral effects on frailty progression in our analysis, suggesting potential safety in this vulnerable population.

NCT00094302.

Both air pollution and temperature variability (with cold wave as an extreme form) may influence the incidence of ischaemic stroke (IS). This study aimed to examine the association between winter air pollution-cold wave sequential events (persistent air pollution followed by cold waves) and IS incidence among adults aged>=60 years.

Clinical data were sourced from the Tianjin Medical and Health Big Data Platform (covering 81 secondary/tertiary hospitals), and meteorological/air quality data were sourced from the National Meteorological Science Data Centre. Spearman rank correlation analysis was used to assess the relationships between meteorological variables (eg, 24-hour temperature decrease), atmospheric pollutants (including Air Quality Index (AQI)) and elderly IS incidence. A distributed lag nonlinear model (DLNM) was applied to analyse lagged effects of winter air pollution and cold wave sequential events on IS incidence, while a generalised additive model (GAM) was used to evaluate additive interactions between air pollution and cold waves on IS incidence.

The study included 109 513 adults aged >=60 years with first-onset IS from 2016 to 2019. Eight winter air pollution-cold wave sequential events were identified over 4 years, with higher daily IS incidence during event periods (67 new cases/day), lag periods (68 new cases/day) than non-event periods (60 new cases/day). Subgroup analysis showed that among adults aged ≥80 years, proportional incidence during both events (80 to 85 years old: 1.89, 95% CI 0.52 to 3.26; 85 to 90 years old: 1.96, 95% CI 0.59 to 3.33) and lag period (80 to 85 years old: 0.90, 95% CI 0.02 to 1.78; 85 to 90 years old: 1.52, 95% CI 0.64 to 2.40) increased compared with the non-event period. Daily IS incidence was positively correlated with 24-hour temperature decreases, AQI and other air pollutants. DLNM showed that lag effects emerged 4 days post-exposure, with the highest IS risk at a 9-day lag (RR=1.122, 95% CI 0.443 to 2.838). GAM confirmed positive additive interactions between air pollution and cold waves on IS incidence (p<0.001).

Winter air pollution-cold wave sequential events exert a synergistic, lagged effect on IS incidence in the elderly, with adults >=80 years being the most vulnerable. The observed risk patterns and underlying mechanisms underscore the importance of integrated environmental and public health strategies to reduce IS burden in this high-risk population.

To develop a CERT SCORE utilising both odd-chain and even-chain ceramide species, and to evaluate its association with short-term and lifetime cardiovascular risk in patients with coronary atherosclerotic heart disease (CAD).

Prospective cohort study.

A patients-based cohort in the Beijing Anzhen Hospital, Capital Medical University.

CAD patients were defined as having at least one coronary artery stenosis of ≥50% as assessed by coronary angiography or CT angiography.

Major adverse cardiac events (MACE) including all-cause death, myocardial infarction, heart failure, cerebral infarction and readmission.

We quantified 13 ceramide species and calculated the ratios of Cer(d18:1/14:0) and Cer(d18:1/24:0). Based on these measurements, Cer(d18:1/19:0), Cer(d18:1/19:0)/Cer(d18:1/14:0), Cer(d18:1/19:0)/Cer(d18:1/24:0) and Cer(d18:1/21:0)/Cer(d18:1/24:0) were selected to construct the CERT SCORE. Using this score, patients were classified into two distinct risk categories for MACE: low-risk (score 0-6) and high-risk (score 7-12). The high-risk group exhibited a significantly higher short-term risk of MACE (HR 2.10; 95% CI 1.50 to 2.94) compared with the low-risk group. The cumulative MACE risk in the low- and high-risk groups during the 1000-day follow-up was 25.45% and 44%, respectively. Subgroup analyses revealed that the presence of multivessel coronary artery lesions did not significantly modify the association between the CERT SCORE and short-term MACE risk (p value for interaction=0.967). Furthermore, in the age groups of 41-50 years, 51-60 years and 61-70 years, lifetime risk was significantly elevated in the high-risk group compared with the low-risk group.

We have developed a ceramide-based risk stratification tool (CERT SCORE) that demonstrates robust predictive value for identifying high-risk MACE patients among CAD patients. This tool offers considerable clinical utility for guiding patient management and informing therapeutic decisions.

To present the cardiovascular risk strata based on the Global HEARTS Initiative calculator and analyze statin prescription among users of Primary Health Care in São Leopoldo, Rio Grande do Sul.

This was a cross-sectional observational study including users aged 18 years or older listed in the Cardiovascular Risk Operational Report. Categorical data were presented as absolute and relative frequencies and 95% confidence intervals (95%CI). Associations between categorical variables were analyzed using the chi-square test or Fisher's exact test, with statistical significance defined as p-value≤0.050.

It was possible to calculate the cardiovascular risk of 2,199 users. Most users presented low (41.4%; 95%CI 39.3; 43.5) or moderate risk (38.0%; 95%CI 36.0; 40.1), while 19.6% (95%CI 18.0; 21.3) had high risk and 1.0% (95%CI 0.6; 1.4) had very high risk. Statin prescription was recorded in 29.5% (95%CI 27.6; 31.4) of the medical records. There was a statistically significant association (p-value<0.001) between cardiovascular risk and statin prescription, with higher prescription frequency among high-risk users (41.2%).

Most Primary Health Care users in São Leopoldo had low to moderate cardiovascular risk. The prescription of statins was consistent with clinical guidelines, considering cardiovascular risk in decision-making; however, it was reached by less than one-third of the overall sample.

Fractal analysis (FA) of neutrophils has demonstrated potential in identifying changes in chromatin associated with clinical parameters in individuals with chronic diseases. Therefore, this study aimed to investigate FA of neutrophils' nuclei from patients with Trypanosoma cruzi and/or HIV. Fifty-three individuals were recruited and divided into four groups: T. cruzi-infected patients with chronic chagasic cardiomyopathy (CCC) (n=18), seropositive HIV individuals (SPHIV) (n=14), T. cruzi-HIV coinfected patients (n=9), and healthy individuals (n=12). Micrographs of neutrophils underwent FA using a box-counting method in the ImageJ software. Clinical parameters obtained from patients' medical records, such as left ventricle mass index (LVMI), left ventricle ejection fraction (LVEF), risk of ischemic stroke (IS), and sudden death were analyzed. FA was lower in patients compared to the control group (P<0.0001). Chagas disease (CD) patients showed higher FA when the LVEF was higher (r=0.53), which increased the risk of sudden death (r=-0.62). In SPHIV, when FA was higher, T CD4+ lymphocyte count was also higher (r=0.66) and the T CD8+ lymphocyte count was lower (r=-0.54). Coinfected individuals showed higher FA, when LVEF (r=0.60), neutrophil to lymphocyte ratio (r=0.80), total lymphocytes (r=0.70), and T CD4+ lymphocyte count (r=0.70) were increased, and T CD8+ lymphocyte count was decreased (r=-0.70). FA was an independent marker of changes in neutrophil chromatin and has proven to be a prognostic tool and a method for risk stratification for adverse events, survival, and mortality in individuals infected with T. cruzi and/or HIV.

A prolonged QT interval (QTc) is associated with the development of atrial fibrillation. However, reports linking QTc variability and atrial fibrillation are limited.

To investigate the relationship linking prolongation and variability of QTc with new-onset atrial fibrillation in Japanese adults.

This retrospective study analyzed the annual health screening data of 103,304 adults (50,438 males; mean age, 54 years) who did not exhibit atrial fibrillation at baseline between April 2005 and October 2018. The majority of the study population underwent annual health examinations according to Japan's health welfare policy. We calculated QTc times using the Bazett formula (QTc = QT/√RR). QTc variability is indicated by the gap between the maximum and minimum QTc values. Atrial fibrillation was diagnosed by 12-lead surface electrocardiography. The association between QT prolongation and variability in new-onset atrial fibrillation was ascertained by logistic regression analysis. The strength of the association was further analyzed using multivariable analyses adjusted for sex, age, dyslipidemia, diabetes, hypertension, obesity, estimated glomerular filtration rate, and alcohol consumption.

During the follow-up (median six years), we recorded 341 (0.3%) new atrial fibrillation cases. Univariable analysis showed a significant association between QTc prolongation and variability with new-onset atrial fibrillation (odds ratio [OR] per 10 ms, 1.08 and 1.15; 95% confidence interval [CI], 1.03-1.13 and 1.07-1.23, respectively; P < 0.001). Multivariable analysis suggested increased risk of new-onset atrial fibrillation with QTc prolongation and QT variability (OR per 10 ms, 1.09 and 1.16; 95% CI, 1.04-1.14 and 1.09-1.24, respectively; P < 0.001).

In the general Japanese population, QTc prolongation and large QT variability are risk factors for new-onset atrial fibrillation. QT prolongation and large QT variability during sinus rhythm may be good markers for predicting not only ventricular but also atrial arrhythmias such as atrial fibrillation.

Rheumatic heart disease (RHD) shows significant sex differences in disease burden. This study assesses these differences using data from the Global Burden of Disease Study 2021 (GBD 2021).

We extracted sex-specific indicators for RHD from the GBD database, including disability-adjusted life years (DALYs), mortality, and prevalence. Trends were analyzed using estimated annual percentage change (EAPC), and sex differences were assessed via female-by-male ratios.

From 1990 to 2021, females consistently had higher age-standardized DALYs (ASDR), mortality (ASMR), and prevalence rates (ASPR) than males. These differences were particularly pronounced in specific regions and age groups. In 2021, female ASDR and ASMR in Andorra were over three times higher than males, while in the Cook Islands, they were less than half of males' rates. In the United States Virgin Islands, females aged 10-19 had an ASMR only 0.01 times that of males, whereas in the United Arab Emirates, females aged 70-89 had ASDR and ASMR five times higher than males. Overall, the female-by-male ratios in ASDR, ASMR, and ASPR have shown a yearly decline. However, these ratios are positively correlated with the Sociodemographic Index (SDI), with correlation coefficients of 0.1 for ASDR, 0.22 for ASMR, and 0.47 for ASPR.

Our study reveals a persistent global sex disparity in RHD burden from 1990 to 2021, with females generally experiencing a heavier burden. These findings underscore the need for sex-specific approaches in RHD prevention and treatment and further research into the underlying factors driving these disparities.