Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide. Early prediction and timely intervention are critical to reducing the burden of heart disease. This study proposes SmartHeart, a conceptual framework that integrates structured clinical data with a proposed real-time data acquisition pipeline for interpretable cardiovascular risk prediction. A publicly available heart disease dataset - aggregated from multiple clinical sources and shared in a merged, cleaned form on Kaggle, containing 11 clinical variables and 1190 patient records, was used to train and evaluate six supervised machine learning models: Support Vector Classifier (SVC), Random Forest, XGBoost, CatBoost, AdaBoost, and Extra Trees Classifier. Following rigorous preprocessing, model performance was assessed using a stratified nested 5-fold cross-validation framework, where an inner loop optimized hyperparameters and an outer loop provided robust internal performance estimation, followed by final evaluation on an independent held-out test set. Among all models, Random Forest achieved the highest performance, with an accuracy of 92.86 % and an AUC of 97.14 %, supported by 95 % confidence intervals and pairwise t-tests confirming its statistical superiority. To enhance interpretability, SHAP (SHapley Additive exPlanations) and LIME (Local Interpretable Model-agnostic Explanations) were applied to explain individual predictions, identifying features such as chest pain type, ST slope, and maximum heart rate as key contributors. While the real-time component remains at the architectural and conceptual stage, the proposed SmartHeart framework lays the foundation for future integration into cloud-based healthcare systems, enabling explainable and proactive cardiovascular risk assessment.

Atrial fibrillation (AF) is frequently complicated by heart failure (HF), leading to increased morbidity and mortality. Catheter ablation (CA) has been shown in randomized controlled trials (RCTs) to improve outcomes in selected patients with AF and heart failure with reduced ejection fraction (HFrEF). However, the efficacy of CA compared with antiarrhythmic drug (AAD) therapy in patients with heart failure with preserved ejection fraction (HFpEF) has not been conclusively established. Consequently, real-world evidence is needed to further clarify the potential benefits of CA across the broader spectrum of HF populations.

Our research will investigate the impact of CA on the clinical prognosis of patients with AF and HF, compared to a pharmacological treatment approach.

Patients with AF and HF were prospectively enrolled from August 2011 to December 2020 in the China-AF Registry. The efficacy of CA versus pharmacological treatment was evaluated in propensity score matched (PSM) cohorts using Cox proportional hazards analysis. The primary endpoint was all-cause mortality, with secondary endpoints including thromboembolism and cardiovascular death.

From a cohort of 3072 AF and HF patients, 2529 were analyzed (678 underwent CA and 1851 received pharmacological treatment). Propensity score matching resulted in 604 patients per group, well-balanced (mean age 62.6 ± 10.5 years, 38.3% female), with 53.3% having persistent AF. Ablation patients underwent an average of 1.16 ± 0.41 procedures. Over a mean 4.16-year follow-up, CA group saw significantly fewer deaths (4.8% vs. 14.1%; adjusted HR 0.54, 95% CI 0.32-0.91; p < 0.001) compared to the pharmacological group after adjusting potential confounders. CA was also associated with a reduced risk of cardiovascular death (adjusted HR 0.35, 95% CI 0.17-0.74; p = 0.005) and thromboembolism (adjusted HR 0.48, 95% CI 0.26-0.88; p = 0.020), after adjusting medication use.

In patients with AF and HF, CA was associated with improved clinical outcomes compared to pharmacological treatment in this real-world cohort. Nevertheless, residual confounding cannot be excluded, and the findings should be interpreted with caution pending confirmation from prospective randomized studies.

www.chictr.org.cn. Identifier: ChiCTR-OCH-13003729.

We appraise recent clinical trials, cohort studies, and meta-analyses on dietary and physical activity interventions for prevention and management of high blood pressure.

We identified several notable new findings. Using a new statistical model for estimation of treatment dose-response patterns, potassium supplementation demonstrated a U-curve relationship, in contrast to the linear association for other exposures studied. Recent salt substitute reports document substantial BP lowering and prevention of cardiovascular and all-cause mortality. A large and statistically powerful alcohol dose-response meta-analysis of prospective cohort studies suggests there is no beneficial or safe level for alcohol consumption. Finally, large meta-analyses suggest isometric resistance exercise has substantial capacity to lower BP. A major area of uncertainty remains how best to implement the desired dietary and physical activity interventions. In addition to confirming and expanding core knowledge for the role of diet and physical activity in the etiology, prevention and management of high blood pressure, reports during the last 5 years have added to our understanding of dose-response relationships for sodium, potassium, physical activity, and alcohol consumption with high blood pressure, have detailed the efficacy of new treatment options, and have ighlighted areas of continuing uncertainty.

Calcium scoring from noncontrast computed tomography (CT) is used clinically to adjudicate aortic stenosis severity in patients with discordant echocardiography.

The aim of this study was to investigate whether quantification of aortic valve calcium volume from computed tomography angiography (CTA) can provide robust diagnostic discrimination of disease severity and inform risk stratification of patients with aortic stenosis.

Patients with mild to severe aortic stenosis who underwent concurrent CTA and echocardiography were included in a retrospective international multicenter observational cohort study. Accuracy of aortic valve calcium volume to diagnose severe aortic stenosis in patients with concordant disease on echocardiography was assessed. Association of aortic valve calcium volume with the incidence of aortic valve replacement or all-cause death was investigated.

The study included 1,521 patients (mean age: 74 ± 10 years; 44% female; median peak aortic jet velocity: 3.8 m/s [Q1-Q3: 3.1-4.5 m/s]). Indexed aortic valve calcium volume correlated with peak aortic jet velocity (ρ = 0.723; P < 0.001) and noncontrast CT calcium score (ρ = 0.896; P < 0.001). In the derivation cohort (n = 689), sex-specific thresholds for indexed calcium volume (men: 122 mm³/cm²; women: 61 mm³/cm²) provided excellent diagnostic discrimination for severe aortic stenosis (C-statistic: 0.900 for men; 0.926 for women). Similar diagnostic discrimination was observed in the validation cohort (n = 459; C-statistic: 0.933 for men; 0.944 for women). Clinical outcomes were available in 711 patients (25% with discordant echocardiography), with 249 reaching the primary endpoint after 26 months (Q1-Q3: 12-53 months). Indexed calcium volume thresholds were independently associated with aortic valve replacement or all-cause mortality in both the cohort as a whole (HR: 2.01 [95% CI: 1.30-3.10]; P < 0.01) and those with discordant echocardiography (HR: 1.58 [95% CI: 1.01-2.44]).

In patients with aortic stenosis, indexed aortic valve calcium volume from CTA provides accurate discrimination of disease severity and additive prognostic information. This technique can be easily applied to patients undergoing CTA for transcatheter aortic valve replacement or coronary artery evaluation without the need for a separate noncontrast CT scan.

Iron deficiency (ID) is common in patients with heart failure (HF), but optimal use of circulating iron indices as diagnostic criteria and for defining treatment targets remain uncertain.

This study sought how to determine how individual iron studies, and different definitions of iron deficiency, relate to functional capacity, hemoglobin levels, and outcomes in the largest study to date of iron repletion in HF.

The HEART-FID (Ferric Carboxymaltose in Heart Failure with Iron Deficiency) trial evaluated ferric carboxymaltose vs placebo in patients with HF with a left ventricular ejection fraction ≤40% and ID defined as ferritin <100 ng/mL or <300 ng/mL with transferrin saturation (Tsat) <20%. We assessed ferritin levels and alternative definitions of ID (serum iron level <13 μM, Tsat <20% in isolation), and continuous measures of iron indices, in relation to functional capacity, hemoglobin levels, and prognosis by multivariable regression.

By trial design, all patients with complete iron studies at baseline (N = 2,951) had ferritin levels <100 or <300 ng/mL with Tsat <20%. Although 89.8% of participants had ferritin <100 ng/mL, only 59.8% had iron <13 μM, 40.5% had Tsat <20%, and 31.1% had ferritin <30 ng/mL. Tsat <20% and iron <13 μM were associated with lower baseline levels of hemoglobin, worse NYHA functional class, shorter 6-minute walk distance (6MWD), and worse outcomes. In contrast, these measures differed minimally within ferritin strata. Tsat and iron levels remained associated with hemoglobin levels and 6MWD after multivariable adjustment and changes in Tsat and iron levels over 6 months related to changes in hemoglobin level and 6MWD.

Patients with HF demonstrate wide variability in fulfillment of various diagnostic criteria for ID. Despite ferritin <100 ng/mL being the most common ID criteria met in HEART-FID, Tsat and iron and their changes over time, more than ferritin, were related to functional capacity, hemoglobin levels, and prognosis. Our results support prioritization of Tsat and iron levels in defining iron deficiency in HF (Randomized Placebo-controlled Trial of FCM as Treatment for Heart Failure With Iron Deficiency and Sub-Study [HEART-FID]; NCT03037931).

Dilated cardiomyopathy (DCM) is a progressive myocardial disorder lacking reliable molecular biomarkers for early diagnosis. Given the emerging role of protein lactylation in cardiovascular disease, we investigated lactylation-related genes (LRGs) in DCM using transcriptomic data from the GEO database. Differential gene expression and lactylation databases were integrated to identify 18 dysregulated LRGs. Using ensemble machine learning algorithms, six core LRGs (G6PD, PPP1CC, MBP, LSP1, HMGN1, HMGN2) were selected to construct a diagnostic model, which showed robust performance across five external cohorts. Unsupervised clustering revealed two molecular DCM subtypes. Immune infiltration and ssGSEA analyses suggested that core LRGs modulate immunometabolic remodeling. Single-cell RNA-seq analysis confirmed their cell-type-specific distribution, with fibroblasts identified as dominant signaling sources via CellChat analysis. Ferrostatin-1 and Resveratrol were predicted as potential therapeutic compounds targeting core genes. Validation in human and mouse myocardial tissues confirmed differential gene and protein expression. This study uncovers lactylation-driven molecular signatures in DCM and establishes a robust diagnostic model with promising translational potential. By linking lactate metabolism to immune regulation and cardiac remodeling, our findings highlight novel diagnostic markers and potential therapeutic targets for precision intervention in DCM.

Driveline infection remains a major complication of long-term ventricular assist device therapy. Previous studies have associated the risk of infection with driveline design and physical properties. The CH-VAD is a fully magnetically levitated pump with an ultrathin (diameter 3.3 mm), highly flexible driveline designed to reduce infection risk. This study was conducted to assess the incidence, risk factors, approaches to prevention and management of driveline infection in CH-VAD patients (NCT06878456).

All patients who underwent CH-VAD implantation between June 2017 and October 2024 at nine centers were retrospectively analyzed. Data related to clinical characteristics, surgical procedures, driveline infection prevention and management details were collected, and risk factors were analyzed.

A total of 181 consecutive patients were included, with a median age of 56 years and 86% male. During a median support duration of 1.6 years, driveline infections occurred in 20 out of 181 patients (11.0%). Twenty-six events were observed, corresponding to a rate of 0.07 events per patient-year. Cumulative incidence of the first driveline infection was 2.8% at 6 months, 5.6% at 12 months and 8.5% at 24 months. Frequent dressing changes were found to be significantly associated with increased driveline infection risk (HR 3.773, p = 0.022).

Patients treated with CH-VADs experienced an encouraging low rate of driveline infection, considered among the lowest reported for durable ventricular assist devices. These findings have implications for both clinical management and driveline design.

The interaction between the immune and cardiovascular systems is a growing field of investigation with bidirectional aspects. B cells are modulators of the adaptive and the innate immunity and they orchestrate bone marrow and spleen immune responses beyond infectious diseases. B cell regulation contributes to the pathophysiology of myocardial damage in several conditions including myocardial infarction, heart failure and atherosclerosis. In parallel, B cell-derived hematological disorders are interlinked to cardiovascular complications, including thrombosis and immunoglobulin-related cardiotoxicity. The scope of this review is to summarize the function and role of B cells as important players in myocardial and vascular adaptations to injury and as mediators of cardiovascular adverse events in hematological disorders. The primary focus is to highlight the clinical and preclinical findings regarding B cell-targeted therapies and their positive or negative impact on the cardiovascular system. A deeper understanding of B cell subpopulations, functions, and secretome could lead to targeted therapeutic interventions for cardiovascular and hematologic diseases.

Idiopathic macular telangiectasia type 1 (MacTel 1) almost always occurs unilaterally, bilateral MacTel 1 in female is unusual and has only been described rarely in literature. This study reviews the literature on clinical and imaging presentations of bilateral MacTel 1 and treatment options. This report aims to raise awareness among clinicians regarding such rare clinical scenarios.

A 76-year-old female patient presented with blurred vision in both eyes for over 5 years. She had a history of well-controlled hypertension for more than 6 years, her best-corrected visual acuity was 0.06 in the right eye and 0.25 in the left eye.

Fundus examination, ultra-widefield fluorescein angiography and optical coherence tomography/optical coherence tomography angiography images supported the diagnosis of bilateral MacTel 1.

She received intravitreal anti-vascular endothelial growth factor therapy in oculus uterque, and the left eye was treated with a dexamethasone intravitreal implant.

The patient's condition was characterized by cystoid macular edema and hard exudate, without response to anti-vascular endothelial growth factor drug. However, a dexamethasone implant showed improvement of the cystoid macular edema, but her best-corrected visual acuity remained unchanged.

This case of bilateral MacTel 1 in a female provides valuable insights into multimodal imaging studies and interventions for this uncommon condition.