In-stent restenosis (ISR) remains a major obstacle in percutaneous coronary intervention (PCI) in patients with coronary heart disease. Although previous studies suggest that remnant cholesterol (RC) may play a significant role in ISR, the exact relationship remains underexplored. This study aims to investigate the predictive value of RC levels for the risk of ISR following PCI and drug-eluting stent (DES) implantation. A retrospective study was conducted on 548 CHD patients who underwent PCI at the First Affiliated Hospital, Sun Yat-sen University, between January 2018 and December 2023. The primary outcome was the presence of ISR, defined as ≥50% in-segment diameter stenosis. Patients were divided into 2 groups: ISR (n = 56) and non-ISR (n = 492). The ISR group exhibited significantly higher RC levels compared to the non-ISR group (P = .004). Multivariable logistic regression analyses revealed that RC (odds ratio [OR] = 2.873, 95% CI: 1.121-7.364, P = .028), diabetes (OR = 2.656, 95% CI: 1.474-4.786, P = .001), and alcohol consumption (OR = 2.988, 95%CI: 1.082-8.251, P = .035) were independent predictors of ISR. The predictive logistic model combining RC with 6 clinically relevant factors (age, gender, smoking status, alcohol consumption, hypertension, and diabetes) for ISR showed a higher area under the curve of 0.721 (95% CI: 0.654-0.789), compared to the model with only RC, which had an area under the curve of 0.618 (95% CI: 0.547-0.690). Increased RC levels were significantly associated with ISR in CHD patients following PCI. This study suggests that RC could be a potential risk factor and predictive marker for the development of ISR after DES implantation.

The association between the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and lacunar infarction (LI) remains inconclusive.

The literature retrieval encompassed PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang (inception - March 2026). Case-control studies that reported genotype frequencies of MTHFR C677T (CC, CT, and TT) in LI patients and controls were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) for 5 genetic models were calculated using random/fixed-effects models in Stata 13.0. Prespecified exploratory subgroup analyses were conducted by ethnicity and symptom status. Four methodological sensitivity analyses assessed the robustness of findings by restricting analyses to studies with magnetic resonance imaging (MRI) only versus CT/MRI, Trial of Org 10172 in Acute Stroke Treatment classification versus radiological criteria, Hardy-Weinberg equilibrium-compliant controls, and Newcastle-Ottawa Scale score ≥ 7. Meta‑regression, heterogeneity (I2), and publication bias (Begg/Egger tests with trim‑and‑fill) were also performed.

Twelve studies comprising 5097 participants (1598 cases/3499 controls) were included. Significant associations were observed in 4 genetic models: recessive (TT vs CT + CC): OR = 1.36, 95% CI = 1.05 to 1.77; dominant (TT + CT vs CC): OR = 1.22, 95% CI = 1.05 to 1.41; allelic model (T vs C): OR = 1.19, 95% CI = 1.07 to 1.33; and homozygous contrast (TT vs CC): OR = 1.45, 95% CI = 1.11 to 1.89. Exploratory subgroup analyses, limited by small numbers of studies in several strata, suggested stronger associations in Asian populations and symptomatic lacunar stroke; these findings are underpowered and should be interpreted with caution. Sensitivity analyses restricting to MRI‑only studies, Trial of Org 10172 in Acute Stroke Treatment‑defined cases, Hardy-Weinberg equilibrium‑compliant controls, or higher‑quality studies (Newcastle-Ottawa Scale ≥ 7) produced results broadly consistent with the primary findings. However, significant publication bias was detected, and all pooled ORs decreased and lost statistical significance after trim‑and‑fill adjustment.

The initially observed association between MTHFR C677T and LI was no longer significant after trim‑and‑fill adjustment for publication bias. All analyses used unadjusted crude genotype data, so residual confounding by vascular and nutritional factors cannot be excluded, and the pooled estimate combined distinct lacunar phenotypes. A formal assessment using the Grading of Recommendations Assessment, Development and Evaluation framework showed very low certainty of evidence. Routine MTHFR genotyping for LI risk assessment is therefore not currently supported, and further rigorous studies are warranted.

Insulin resistance is closely associated with various cardiovascular and metabolic diseases. The estimated glucose disposal rate (eGDR), as a convenient assessment indicator of insulin resistance, has been increasingly utilized in recent years for cardiovascular risk prediction. However, studies on the relationship between eGDR and chest pain risk remain relatively scarce. Based on the 2 major databases of National Health and Nutrition Examination Survey (NHANES) and China Health and Retirement Longitudinal Study (CHARLS), this study systematically analyzed the association between eGDR levels and the risk of chest pain and compared the similarities and differences in the results between the 2 populations. We utilized databases from 2 prospective cohorts, NHANES and CHARLS. The eGDR calculation formula was: eGDR = 21.158 - (0.09 × WC) - (3.407 × HTN) - (0.551 × HbA1c). Here, WC represents waist circumference (cm), HTN indicates a history of hypertension (yes = 1, no = 0), and HbA1c denotes glycated hemoglobin (%). Participants were stratified according to eGDR levels into quartiles. A multivariate logistic regression model was employed to assess the association between eGDR and chest pain, with dose-response curves analyzed using restricted cubic spline analysis. In the fully adjusted model, the highest quartile of eGDR in CHARLS showed a trend of reduced risk for chest pain compared to the lowest quartile (odds ratio = 0.86, 95% confidence interval: 0.73-1.01, P = .066), whereas a significant negative correlation was observed in NHANES (odds ratio = 0.54, 95% confidence interval: 0.45-0.65, P < .001). Elevated eGDR (reduced insulin resistance) was significantly associated with a decreased risk of chest pain, suggesting that insulin resistance may be an important potential risk factor for chest pain. This association was consistent in both China and the United States, though the magnitude of the effect varied. This study supports the use of eGDR as a potential biomarker for identifying chest pain risk.

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide, and endothelial cell senescence (EC senescence) is increasingly recognized as a key driver of vascular dysfunction and age-related cardiovascular pathology. Although recent studies have clarified the molecular mechanisms and therapeutic potential of EC senescence in CVDs, a dedicated bibliometric analysis of this field is still lacking. This study aimed to map the global research landscape, identify major contributors and influential sources, and reveal evolving hotspots and emerging frontiers from 2001 to 2024.

Publications on EC senescence in CVDs were retrieved from the Web of Science Core Collection (WoSCC) using a topic-based search strategy. Bibliometric analyses and visualizations were performed using CiteSpace, VOSviewer, and the R package Bibliometrix.

A total of 1679 papers were analyzed, with China and the United States collectively accounting for nearly half of the global output. Zoltan Ungvari was the most prolific author and one of the most influential co-cited researchers in this field. The journals publishing the largest number of articles in this field were the International Journal of Molecular Sciences, Aging Cell, and PLOS ONE. The 5 most productive institutions were Sun Yat-sen University, the University of Oklahoma, Huazhong University of Science and Technology, Semmelweis University, and Southern Medical University. High-frequency keywords identified "oxidative stress" and "inflammation" as the primary mechanistic themes. Temporal trends indicated a progressive shift in research emphasis from fundamental mechanisms to translational applications.

This study shows that research in this field has grown rapidly, although a substantial translational gap remains. In the future, the integration of single-cell multi-omics and artificial intelligence may help accelerate the clinical translation of senolytics and extracellular vesicle-based therapies.

Infections are frequent precipitants of acute decompensated heart failure (ADHF) and may alter decongestive trajectories in patients with cardiorenal syndrome type 1 (CRS1), it may reduce diuretic efficacy and increase the risk of kidney injury. However, the impact of infection on decongestion and kidney outcomes in CRS1 remains unclear.

We conducted a prospective cohort study including 256 patients with CRS1 hospitalized at a tertiary center (2022-2024). Patients were stratified by the presence of infection, defined as clinical suspicion plus antibiotic therapy. The primary outcome was successful decongestion, assessed by symptoms, biomarkers (BNP/CA-125), and POCUS findings. Secondary outcomes included major adverse kidney events at 10 and 30 days (MAKE: death, kidney replacement therapy [KRT], or ≥25% eGFR decline).

Seventy-two patients (28.1%) had infection, presenting with higher BNP (13,405 vs. 25,264 pg/mL, p = 0.012) and lower PaO2 (45 vs. 65.5 mmHg, p = 0.019). Furosemide exposure was comparable (600 vs. 580 mg, p = 0.62). Successful decongestion occurred in 61.4% of patients with infection vs. 59.8% without infection (p = 0.83). Infection was not independently associated with decongestion (aOR 1.28, 95% CI 0.65-2.51) or MAKE-30 (aOR 1.26, 95% CI 0.57-2.79).

In CRS1, infection was associated with more severe baseline congestion but did not compromise decongestion rates or increase short-term MAKE. These findings support the notion that achieving decongestion is feasible in patients with ADHF due to infection without an incremental risk of MAKE.

Chronic carotid artery occlusive disease is associated with a high risk of ischemic events and long-term neurological deficits. Optimising surgical revascularisation outcomes requires an integrated understanding of anatomical, hemodynamic, and functional factors. This study aims to assess the neuro-radiological, clinical, and cognitive outcomes following cerebral revascularisation in patients with chronic internal carotid artery occlusion.

This single-centre, prospective, open-label interventional longitudinal study includes 60 patients with chronic internal carotid artery occlusion undergoing superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass at National Centre for Neurosurgery in Kazakhstan. The primary endpoint of the study is the incidence of ischemic stroke during the 6-month follow-up period after surgery. Pre- and postoperative evaluations include detailed angiographic assessment of collateral circulation and donor vessel diameter, as well as cerebral perfusion imaging using arterial spin labelling MRI. Neurological and cognitive function are assessed using standardized clinical and neuropsychological tests. Early and six-month follow-up evaluations focus on bypass patency, perfusion changes, and clinical outcomes.

By integrating anatomical, hemodynamic, and functional data, this study aims to identify predictors of successful revascularisation and favorable clinical outcomes. Correlation of postoperative angiographic and perfusion findings with cognitive and neurological recovery may refine surgical decision-making, enhance risk stratification, and optimize individualized patient care. Ultimately, this comprehensive approach seeks to improve the overall efficacy and safety of STA-MCA bypass in patients with chronic carotid artery occlusive disease.

ClinicalTrials.gov NCT07396025. Registered on February 5, 2026.

Patients with rare vascular liver diseases (VLDs), including non-cirrhotic portal vein thrombosis and Budd-Chiari syndrome, may develop severe complications from an early age. Yet, little is known about their healthcare experience and unmet needs. This study aimed to identify key challenges in the care of these patients across 4 European countries.

Semi-structured interviews were conducted with patients, members of patient advocacy organizations (PAOs), and health care providers (HCPs) from France, Spain, Switzerland, and the Netherlands. A standardized interview guide explored challenges and unmet needs in healthcare. Using thematic framework analysis, themes were first identified nationally, then synthesized internationally.

Thirty-seven individuals participated: 13 patients, 7 PAO representatives, and 17 HCPs. Across countries, VLDs were seen as difficult to diagnose, communicate, and manage, given the uncertainty about their etiology, progression, and treatment. Four core challenges were identified: (1) diagnostic wandering, sometimes due to insufficiently targeted imaging requests and limited radiologic experience; (2) challenges in communicating the diagnosis given the complexity and severity of the disease; (3) scientific uncertainty regarding the etiology, progression, and treatment of VLDs, leading to difficulties for HCPs in risk interpretation and for patients in understanding and managing their condition; (4) challenges in care coordination, particularly for patients with associated diseases or comorbidities. In addition, supportive care, particularly in addressing mental health issues and fatigue, was considered insufficient, and management of reproductive and sexual health was considered to require tailored communication strategies.

This study highlights perceived cross-country challenges in the care of patients with rare VLDs, underscoring the need for targeted interventions in communication and care coordination to improve their healthcare experience and outcomes.

Echocardiography is central to the diagnosis of infective endocarditis (IE). Although guidelines recommend repeating echocardiography when clinical suspicion persists despite negative or inconclusive findings, the diagnostic value of repeating transthoracic echocardiography (TTE) remains uncertain. The aim was to evaluate the diagnostic performance of repeat TTE in the diagnosis of IE among patients with suspected IE.

This retrospective study conducted at Lausanne University Hospital (2015-2024) including adult patients with suspected IE who underwent 2 TTEs within 21 days. IE was classified according to the 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria.

A total of 503 episodes were included, of which 254 (50%) were diagnosed as IE. The second TTE was performed within 8 days from first TTE (interquartile range, 5-13 days). The second TTE identified new vegetations in 34 (7%) episodes and new paravalvular complications in 17 (3%) episodes. Sensitivity for detecting vegetations increased from 47% (95% CI, 39%-56%) for the first TTE to 57% (95% CI, 48%-65%) for the second. By excluding the results of cardiac imaging modalities other than TTE, the sensitivity of the second TTE for diagnosing IE was higher (45% [95% CI, 38%-51%]), compared with 34% (95% CI, 28%-41%) for the first TTE; the second TTE led to reclassification from possible to definite IE in 7 (1%) of cases.

Repeat TTE modestly improved typical IE lesion detection; however, within a multimodality imaging strategy, its incremental diagnostic contribution was limited. These results suggest that repeated TTE alone is unlikely to substantially alter diagnosis in most patients, supporting the use of complementary imaging when suspicion of IE remains high.

Prognostic staging systems in transthyretin amyloid (ATTR) cardiomyopathy were developed before the introduction of disease-modifying treatment. We therefore evaluated contemporary risk stratification according to different staging systems in patients with ATTR cardiomyopathy.

All patients with newly diagnosed ATTR cardiomyopathy and baseline biomarker measurements from 2019 to 2023 were included from Mayo Clinic, Rochester, MN. Prognostic outcomes were calculated with Kaplan-Meier analysis for 3e staging systems in the main analysis: the National Amyloidosis Centre (NAC) staging system; a modified Mayo staging system using hsTNT (high-sensitivity troponin T) cutoff >65 ng/L; the extended NAC model with a fourth stage (NT-proBNP [N-terminal pro-B-type natriuretic peptide] >10 000 ng/L).

The study population consisted of 441 patients with a median age of 76 years, 93% were men, 85% were initiated on tafamidis, and 94% had wild-type ATTR. Median follow-up was 3.4 years, and 109 deaths occurred during follow-up. The 3-year survival for the Mayo stages were 92.3% (88.7-95.9) for stage I, 71.6% (63.0-81.3) for stage II, and 43.5% (32.4-58.5) for stage III. For the NAC system, 3-year survival were 92.0% (89.0-95.7), 67.5% (59.0-77.3), and 47.0% (34.7-63.5) for stages I, II, and III, respectively. The 3-year survival by the extended NAC system was 92.0 (69.0-79.2), 69.0% (60.1-79.2), 53.2% (39.9-70.8) and 34.4% (17.4-68.0) for stages I, II, III, and IV, respectively.

In a contemporary cohort of patients with ATTR cardiomyopathy, the NAC and modified Mayo staging systems remained equally effective in delineating clinically meaningful prognostic groups, whereas the extended NAC system identified a stage IV subgroup with high mortality.

The optimal strategy and timing for percutaneous cervicocerebral artery revascularization (PCAR) combined with coronary artery bypass grafting (CABG) remain uncertain in patients with severe carotid or vertebral artery stenosis.

We retrospectively analyzed adults undergoing concomitant or staged PCAR-CABG at Beijing Anzhen Hospital from January 2011 to December 2025. The primary endpoint was perioperative death or stroke. Strategies were compared using Firth penalized logistic regression. In the staged cohort, restricted cubic splines and interval-based analyses assessed the association between interprocedural interval and outcomes.

Among 801 patients, 57 (7.1%) underwent concomitant and 744 (92.9%) underwent staged intervention; the median interprocedural interval was 30 days (interquartile range, 9-46). PCAR was performed for severe vertebral stenosis in 221 (27.6%), severe carotid stenosis in 474 (59.2%), and both in 106 (13.2%). Perioperative death or stroke occurred in one patient (1.8%) in the concomitant group and 37 patients (5.0%) in the staged group. Concomitant intervention was not significantly associated with the primary endpoint after adjustment (adjusted odds ratio (OR) 0.43; 95% confidence interval (CI), 0.05-1.76; P = 0.280). Exploratory analyses suggested decreasing risk with longer intervals, although no significant nonlinear association was identified. The 1-7-day staged group had the highest estimated odds relative to the concomitant group (adjusted OR, 4.89; 95% CI, 1.04-48.30; P = 0.044).

Perioperative death or stroke did not differ significantly between concomitant and staged PCAR-CABG. However, the limited number of events precludes conclusions regarding equivalence. Interval-specific findings were exploratory and require confirmation in adequately powered prospective multicenter studies.