The prognosis of nonobstructive coronary artery disease (CAD) is not well established. Comparative data between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) are limited.

To compare CCTA- and ICA-derived information in nonobstructive CAD regarding detection and clinical outcomes.

We followed 4,004 adult patients who underwent either ICA (n = 2,355) or CCTA (n = 1,649) for a median of 9 years. The primary endpoint was a composite of all-cause mortality, acute coronary syndrome/acute myocardial infarction, and stroke. Propensity score matching was performed to compare outcomes between groups. The significance level was set at 5%.

The overall event rate was 6.9%. ICA was associated with worse outcomes than CCTA (hazard ratio [HR] 0.54; 95% CI 0.42-0.68; p < 0.001). Patients with nonobstructive CAD had worse outcomes than those without CAD (HR 1.73; 95% CI 1.32-2.27; p < 0.001). Normal coronary findings on CCTA were associated with better outcomes than normal findings on ICA (HR 0.39; 95% CI 0.24-0.62; p < 0.001). Event rates increased proportionally with plaque burden. In 1,187 matched pairs, CCTA was associated with improved survival (HR 0.57; 95% CI 0.42-0.78; p < 0.001).

CCTA more closely reflects clinical outcomes than ICA. Nonobstructive CAD carries a substantial risk regardless of imaging modality.

Atrial cardiomyopathy (AC) is a condition detectable by electrocardiogram (ECG) that may play a significant role in the pathophysiology of the etiology of strokes, independently of atrial fibrillation (AF).

To evaluate the association between ECG markers of AC (prolonged P-wave duration >120 ms and P-terminal force in V1 (PTFV1) >4,000 µV·ms) as well as the occurrence of mortality and hospitalization due to stroke.

This retrospective cohort study included patients from Belo Horizonte who underwent ECGs between 2006 and 2018. Patients aged ≥40 years, in sinus rhythm, and without a previous history of stroke at baseline ECG were included. Clinical and ECG data were linked to mortality (SIM) and hospitalization (SIH) public databases. Cox regression was used to calculate hazard ratios (HRs), and incremental adjustment models for age, sex, cardiovascular risk factors, and left ventricular hypertrophy were employed. Statistical significance was set at p<0.05.

245,588 patients were included. 26.3% had prolonged P-wave duration >120 ms, and 10.1% had elevated PTFV1 >4,000 µV·ms. Mean follow-up duration was 3.5 years. AC was associated with mortality and hospitalization due to stroke (HR 1.24; 95% CI, 1.12-1.36 for P-wave duration >120 ms; p<0.001; HR 1.20; 95% CI, 1.05-1.38 for PTFV1 >4,000 µV·ms; p<0.001).

ECG markers of AC are associated with death or hospitalization due to stroke, as well as cardiovascular mortality and incident AF in a large, representative Brazilian cohort, highlighting their prognostic value.

The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score is a risk stratification tool used to predict mortality in heart failure (HF). However, potential sex-related differences in its performance and its applicability to the Brazilian population remain uncertain.

To evaluate sex-based differences in the performance of the MAGGIC score and to validate the score in a Brazilian HF cohort.

This retrospective cohort study included 866 patients followed at a HF outpatient clinic. The primary outcome was 3-year all-cause mortality. The MAGGIC score was calculated for each patient. Discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer-Lemeshow test. Analyses were performed for the overall cohort and stratified by sex. A p-value < 0.05 was considered statistically significant.

The overall 3-year mortality rate was 33.4% (36.4% in men and 27.8% in women; p = 0.010). Predicted mortality was 20.9% (mean score 18.3 ± 7), with 22.7% for men and 19.1% for women. The score demonstrated good discrimination (area under the curve = 0.72; 95% CI: 0.686-0.754), with similar performance in men (0.704 [0.661-0.747]) and women (0.733 [0.674-0.792]). Calibration showed good agreement: overall chi-square (χ2) = 1.1 (p = 0.998), men χ2 = 0.9 (p = 0.999), and women χ2 = 1.3 (p = 0.995). Observed mortality was higher in moderate-risk groups, with no significant difference between moderate- and high-risk groups (p = 0.236).

The MAGGIC score showed good performance in a Brazilian HF cohort, with no significant sex-based differences, although higher observed mortality was identified among moderate-risk patients.

A potassium-enriched salt substitute, in which part of sodium chloride is replaced with potassium chloride, has shown considerable potential as a population-level strategy to reduce sodium intake and prevent cardiovascular disease. In recent years, research has focused primarily on individuals with hypertension, demonstrating that salt substitutes can influence blood pressure (BP).

To perform a meta-analysis quantifying the magnitude of BP reduction in patients with hypertension using regular salt compared with those using a salt substitute.

PubMed, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) comparing regular salt with a salt substitute. Mean differences (MD) with 95% CIs were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic. A p-value < 0.05 was considered statistically significant.

Four RCTs involving 1,430 participants were included, of whom 725 (49.57%) received the salt substitute. The use of a salt substitute was associated with a significant reduction in systolic BP (SBP) (MD, -5.75 mmHg; 95% CI, -6.98 to -2.39 mmHg; I2 = 37%; p < 0.01) and a significant reduction in diastolic BP (DBP) (MD, -1.62 mmHg; 95% CI, -2.34 to -0.91 mmHg; I2 = 0%; p < 0.001).

In patients with hypertension, the use of a salt substitute is associated with a significant reduction in both SBP and DBP compared with regular salt.

YouTube, a video-sharing platform, aids health information sharing, and while social media's role in heart failure care remains unclear, it can enhance interaction, education, and engagement, fostering patient-centered care and encouraging treatment adherence and active health management.

The aim of the study was to evaluate the quality and usability of heart failure-related YouTube videos as a source of information for patients.

A total of 100 English-language YouTube videos on heart failure were analyzed. Videos were categorized based on uploader identity (healthcare vs. non-healthcare professionals) and assessed using quality criteria for consumer health information, Global Quality Scale, Journal of the American Medical Association criteria, and Video Power Index. Quantile regression analysis was performed to identify independent predictors of video quality.

Of the videos analyzed, 69% were uploaded by healthcare professionals. The mean quality criteria for consumer health information score was 21, Global Quality Scale was 3, and Journal of the American Medical Association was 3. Videos from professionals and longer videos had significantly higher quality scores. Quantile regression showed that video duration predicted high Global Quality Scale values at the 75th and 90th percentiles, while professional source was a consistent predictor across most quantiles.

The overall quality of YouTube videos on heart failure was found to be low to moderate, with substantial room for improvement. Videos uploaded by healthcare professionals, however, consistently demonstrated higher quality across evaluation metrics. Longer videos tend to have higher quality, but popularity does not correlate with content reliability. Efforts should be made to improve video content for better patient education.

Stroke is a global health problem that often causes physical disability and mental health issues for the survivor. While physical activity (PA) improves outcomes post stroke, it can be challenging to maintain. Barriers to maintaining PA post stroke include the setting of PA, motivation, and impairments from the stroke. There is often a desire to maintain PA after stroke, but effective interventions are currently limited.

This study aims to coproduce an intervention to support long-term PA maintenance for adults living with the effects of stroke in Northern Ireland. The objectives of this study are to understand the perspectives of key stakeholders on the components, structure, and content of an intervention to support PA maintenance and to coproduce and refine a prototype intervention to meet their specific needs and preferences.

A mixed methods study will be conducted, consisting of three stages informed by the Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer) co-production framework. Stage 1 will include a scoping review on PA maintenance in survivors of stroke and stakeholder consultation via focus groups to gain understanding from their perspective of PA. Survivors of stroke and their carers, physiotherapists, and care coordinators from community and voluntary organizations will be recruited from ongoing Post Rehabilitation Exercise Program (PREP) classes. Additional health care professionals with experience in PA and stroke will also be recruited via relevant organizations. Individuals who complete stage 1 focus groups will be invited to take part in stage 2 co-design workshops to develop a PA maintenance program for participants post PREP. Stage 3 will involve expert review of the co-production program by members of the project advisory board via a questionnaire survey. Qualitative data will be analyzed using reflexive thematic analysis from data collected in stages 1 and 2. Data from the scoping review will help shape the questions for the focus groups, and data from the focus groups will help inform questions for the three workshops. All stages will involve the stakeholders to gain feedback and suggestions for the next wave.

Five focus groups were conducted with 38 participants: three in-person (stroke survivors and their caregivers) and two online (one for PREP staff and one for other health and exercise professionals) between September and November 2025. Results from the focus groups identified two themes: shifting realities of physical activity post stroke and motivation through community. Eighteen participants subsequently consented to participate in three co-design workshops, which resulted in an intervention prototype being developed.

This study aims to co-develop an intervention to support PA maintenance in adults living with stroke after completion of community rehabilitation. To our knowledge, there is no further support for the survivors to help maintain their PA levels once they finish the 6- to 12-week community program. Engaging with survivors of stroke and their carers, PREP staff, and other exercise professionals will help shape the beginning stages of this study. Upcoming results from the pilot study will provide vital information on how to support PA maintenance in this population.

Obesity is a serious public health issue affecting children in a progressively alarming manner; thus, nutrition education and behavior change interventions during childhood are a priority. Eating and physical activity behaviors are mainly influenced by the environment; therefore, lifestyle changes are often successful when interventions are implemented in places such as the home and school. Schools are fundamental for ensuring the development of students' personalities, skills, abilities, and long-term behaviors.

This study aims to measure the effect of an intervention designed for low-income Mexican schoolchildren, focused on promoting healthy lifestyles for the prevention of obesity and cardiometabolic diseases.

The study design is a randomized clinical trial (NCT05945862), with intervention groups paired with control groups of the same grade. Four elementary schools were selected based on district socioeconomic status. The study will be carried out for 1 year in four phases: (1) initial measurements, including anthropometry, blood pressure, psychosocial diagnosis, family medical history, and behavior variables, such as nutrition knowledge, dietary intake, sleep time and quality, and physical activity; (2) intervention implementation based on social cognitive theory, the behavior change wheel with the capability, opportunity, and motivation influencing behavior theoretical framework, and the transtheoretical theory, covering topics related to nutrition and healthy eating, child health, personal and sleep hygiene, physical activity, psychosocial well-being, and motivation; (3) postintervention measurements, including initial and behavioral measurements and intervention indicators; and (4) 6-month postintervention evaluation using the same initial and behavioral measures as in phase 1. Baseline differences by age, sex, socioeconomic status, and location will be analyzed using chi-square tests (qualitative variables) and analysis of covariance (quantitative variables). Multiple linear regression will test potential baseline associations between dependent variables (anthropometrics and blood pressure) and independent variables (diet, exercise, sleep time, family interaction, psychosocial well-being, and perception of childhood obesity). For comparing changes between the intervention and control groups at postintervention and at 6-month postintervention in anthropometrics, blood pressure, and behavioral variables, we will use multilevel mixed-effects regression models, given the hierarchical structure of participants nested within schools and the repeated measurements over time. SPSS and STATA software will be used with a significance level of P<.05.

From October 2023 to August 2024, a total of 451 participants were recruited from 4 different elementary schools in Sonora, México. As of February 2026, the data collected are in the process of being captured and analyzed.

The protocol is a comprehensive program designed for schoolchildren in Mexico, intended to be an effective strategy for promoting healthy lifestyles and preventing cardiometabolic diseases. It is important to continuously adapt the intervention before implementation and to evaluate it to ensure its sustainability and expand its impact on other elementary schools, improving the health and well-being of schoolchildren.

Ischemic heart disease and related sequelae pose tremendous burdens on worldwide medical care. The excessive activation of cardiomyocytes and cardiac fibroblasts further exacerbates the prognosis after necrosis. Decades of stem cell therapy in preclinical studies suggested promising results in cardiomyocyte regeneration and tissue remodeling. However, few formulations achieved clinical translation due to the limited stem cell engraftment and insufficient arousal of resident cardiomyocytes. Here, we reported an implantable electroactive device to leverage stem cell therapy and cardiomyocyte restoration for effective heart recovery. Assisted by the piezoelectric microneedle patch with 80-cubic millimeter cavity, 1.5 × 10⁵ mesenchymal stem cells could be delivered efficiently to the infarcted site and sustained longer for continuous paracrine effects. Meanwhile, the piezoelectric stimulation generated from the poly(l-lactic) acid microneedle matrix further potentiated the stem cells and elicited more vigorous self-repair responses in cardiomyocytes. This approach was validated to effectively suppress inflammatory monocytes, reduce cardiomyocyte necrosis, and improve heart remodeling in a rat heart infarction model.

Congenital heart anomalies (CHA) significantly contribute to childhood morbidity and mortality worldwide. Understanding sex-specific differences and their association with societal development levels is crucial for formulating effective health strategies.

We extracted sex-stratified incidence, mortality, and disability-adjusted life years (DALYs) for CHA among children under five from the Global Burden of Disease Study 2021 for 204 countries and territories (1990-2021). Sex differences were quantified using male-to-female rate ratios with 95% uncertainty intervals. Temporal trends were evaluated using the estimated annual percentage change (EAPC) derived from log-linear regressions. We assessed the association between disease burden and development status using the Sociodemographic Index (SDI). To address confounding variables and geographic clustering, we fitted linear mixed-effects models with sex, SDI, and calendar year as fixed effects and GBD region as a random intercept, reporting adjusted coefficients with 95% confidence intervals.

From 1990 to 2021, the global CHA burden declined. While descriptive analysis showed higher raw point estimates for males, a multivariable mixed-effects analysis-adjusted for SDI (as a proxy for macro-level development and health-system context) and temporal trends-confirmed that male sex was significantly associated with a higher CHA burden (DALYs Adjusted Coefficient: 876.4, P < 0.001; Mortality Adjusted Coefficient: 9.7, P < 0.001). This suggests a robust male disadvantage independent of socioeconomic status. The highest CHA burdens were observed in Sub-Saharan Africa, Southeast Asia, and South Asia, while improvements in SDI were significantly associated with overall reductions in burden.

Despite overall reductions in CHA burden, profound regional disparities and observable sex differences persist, especially in resource-limited areas. Policy interventions focusing on gender-sensitive resource allocation, enhanced neonatal screening, and improved surgical access are critical to mitigating these disparities and advancing global pediatric health equity.

Currently, there are many diagnostic strategies for in-stent restenosis (ISR) used clinically, including invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), and Fractional Flow Reserve (FFR). CCTA is not recommended for post-stent implantation patients owing to suboptimal image quality caused by artifacts. The FFR application is limited by its procedural complexity. Precise evaluation may be achieved by using computed tomography-derived fractional flow reserve (CT-FFR), which combines computational fluid dynamics (CFD) with CCTA. Anatomical and functional assessments of ISR lesions could be integrated effectively as well in this way. However, the computational complexity and prolonged processing time may hinder its utility in clinical use.

This study is a multicenter, prospective, diagnostic study, aiming to establish a deep learning-based CT-FFR model for the accurate assessment of ISR and to validate its diagnostic performance using invasive FFR as the reference standard. This study will be carried out in Beijing Anzhen Hospital and 6 subcenters in China. We planned to prospectively enroll 331 post-stent implantation patients with available CCTA data since June 2022, and invasive FFR will be performed within 3 months when clinically indicated. Patient recruitment is currently ongoing. Among them, 250 patients from Beijing Anzhen Hospital will be used to adapt and extend the existing DEEPVESSEL model, a deep learning-based CT-FFR computational software designed for the non-invasive functional assessment of coronary artery disease and previously validated in de novo coronary lesions, for application in the assessment of in-stent restenosis (ISR), and 81 patients from the other 6 subcenters will be used in external validation. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value with their corresponding 95% confidence intervals (CIs) were calculated for CT-FFR. The receiver operating characteristic (ROC) curve was analyzed, and the area under the curve (AUC) was calculated. The McNemar test and Bland-Altman plot will be used to examine the diagnostic consistency between CT-FFR and invasive FFR. The correlation was analyzed by Spearman's correlation coefficient.

ChiCTR2200058822.