Aortic stenosis (AS) increases left ventricular (LV) afterload and systolic pressure (LVSP). Left ventricular myocardial work (LVMW) enables early detection of LV dysfunction. Recent evidence suggests that ID may reduce LVMW parameters, raising the question of whether ID further impairs LV systolic performance in patients with AS undergoing transcatheter aortic valve implantation (TAVI).

We evaluated 100 patients with severe AS scheduled for TAVI between March 2021 and November 2022. All underwent ID screening according to the classic and novel ID definitions and echocardiographic assessment of LVMW before TAVI and at the 1-year follow-up.

Elimination of AS was observed within the 1-year follow-up in the whole population. Despite stable ejection fraction (EF) and global longitudinal strain (GLS), LVMW indices such as global work index (GWI) and global constructive work (GCW) significantly decreased from baseline in the entire population. However, when comparing ID and non-ID patients after the procedure, a statistically significant decrease in GWI and GCW was noted at the 1-year follow-up only in the TSAT > 20% group, not in the TSAT < 20% group. We also noted a significant correlation between TSAT status and echocardiographic as well as LVMW indices. When the classic ID definition was used, all LVMW parameters changed similarly in both groups during follow-up.

TAVI significantly influenced the majority of LVMW indices in the overall study population. Using the standard ID definition, ID had no impact on differences in LVMW indices. However, when defined by TSAT < 20%, patients with ID showed no significant post-TAVI changes in LVMW indices.

Heart failure is becoming an increasingly cause of hospital admissions in the pediatric population, linked to significant morbidity and mortality. Despite advances, end-stage heart disease still causes significant symptoms, extended hospitalizations, and reduced quality of life. Pediatric palliative care (PPC), aimed at improving quality of life through symptom management, emotional support, and advanced care planning, can benefit these children. This project aimed to establish specialized PPC services for children with heart failure, regardless of their care goals, at a tertiary care and transplant center in Saudi Arabia. This project is presented with a retrospective review spanning from July 1, 2019, to June 30, 2024. The steps toward integration included (1) assessing gaps, (2) developing services, (3) setting up a referral system, (4) raising awareness, (5) implementing the program, and (6) measuring outcomes. Of the 47 children included, the average age was 10 years (SD = 4), half had a transplant, and 20 (42.6%) died during the period. The main issues were family distress (100%), children's mood issues and anxiety (59.6%), and pain (40.4%). Implementing PPC improves quality of life and ensures medical care aligns with family values. Children's emotional distress, parental anxiety over the disease's unpredictable course, and aggressive end-of-life care are key issues to address.

Growth differentiation factor-15 (GDF-15) is a stress-responsive biomarker implicated in inflammation and myocardial injury. Its prognostic value for mortality risk in acute heart failure (AHF) remains uncertain. This meta-analysis evaluated the association between elevated admission circulating GDF-15 levels and subsequent mortality in patients hospitalized with AHF.

PubMed, Embase, and Web of Science were systematically searched for prospective or retrospective cohort studies and post-hoc trial analyses enrolling adult AHF patients with blood GDF-15 measured on admission. Risk ratios (RRs) for all-cause mortality comparing high versus low GDF-15 categories were pooled using random-effects models incorporating the influence of potential heterogeneity.

Ten studies with 3724 patients with AHF were included. Overall, high admission GDF-15 levels were significantly associated with increased mortality risk during follow-up (RR = 2.82, 95% CI: 2.39-3.32; p < 0.001), with no evidence of between-study inconsistency (I² = 0%). Sensitivity analyses confirmed robustness (leave-one-out RR range: 2.73-3.00), and results remained consistent in high-quality studies (NOS ≥ 8; RR = 2.72, 95% CI: 2.26-3.27). Subgroup analyses demonstrated similar associations across Asian and Western cohorts, prospective and retrospective designs, different sampling times (at admission to within 48 h), assay methods (ELISA vs. ECLIA), cutoff definitions, follow-up duration, and adjustment for BNP/NT-proBNP (all p for subgroup differences >0.05). No significant publication bias was detected (Egger's p = 0.59).

Elevated circulating GDF-15 levels at admission are strongly associated with increased mortality risk in patients with AHF, supporting its potential role in early risk stratification.

Hypertension is more prevalent among individuals with disabilities than in the general population. This study analyzed long-term trends in disparities in hypertension care quality and the incidence of hypertensive complications among individuals with and without disabilities.

This retrospective cohort study followed 52,743 hypertensive patients aged 20 or older with disabilities newly diagnosed in 2010, along with 47,564 age- and sex-matched patients without disabilities, from 2011 to 2019. Hypertension care quality was assessed using indicators of medication adherence and the completion of three complication-monitoring tests at recommended frequency: blood test, urine test, and electrocardiogram (ECG). Hypertensive complications included major cardiovascular and cerebrovascular events, kidney diseases, and all-cause mortality. Logistic regression was repeated annually to assess hypertension care quality, and Cox-proportional model was used to estimate the risk of hypertension-related complications.

Hypertensive patients with disabilities consistently demonstrated lower medication adherence throughout the study period (adjusted odds ratio [aOR], 0.90-0.96, depending on the year), but a higher likelihood of undergoing screenings at recommended frequency (e.g., aOR for blood test, 1.31-1.39, for urine test, 1.24-1.33, and for ECG, 1.30-1.37). The risk of complications remained significantly higher among hypertensive patients with disabilities, even after adjusting for care quality indicators (e.g., adjusted hazard ratio for cardiovascular events: 1.36, 95% confidence interval: 1.31-1.41). Subgroup analyses revealed that the excess risks for complications varied across different sociodemographic groups.

These findings underscore the need for comprehensive strategies to enhance medication adherence among hypertensive patients with disabilities. Additionally, other factors beyond medication adherence and monitoring test completion that contribute to the increased risk of complications require further exploration.

Cardiac rehabilitation (CR) is a critical secondary prevention strategy for patients with acute myocardial infarction (AMI). Although CR has been covered by the National Health Insurance in Korea since 2017, real-world participation remains suboptimal. We assessed trends in CR participation over the past 5 years and identified factors associated with non-participation in treatment.

This retrospective observational study analyzed data from the National Health Insurance Service claims database between 2018 and 2022. Patients aged ≥ 40 years who were hospitalized for AMI and received acute-phase interventions, such as thrombolysis, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG), were included. CR participation was defined as having at least one claim for education, assessment, or treatment services. Multivariable logistic regression was conducted to identify factors associated with non-participation in CR treatment, focusing on patients who received care at CR-providing institutions, to minimize confounding related to institutional availability.

In total, 109,436 patients were included. Overall participation rates in CR education, assessment, and treatment increased from 2018 to 2022. However, sustained participation in outpatient treatment remained low, with only 5.7% of patients in 2022 completing ≥ 11 treatment sessions. Factors associated with lower treatment participation included the absence of prior education and assessment, lower socioeconomic status, undergoing PCI rather than CABG, and receiving care at non-tertiary hospitals. Regional disparities and inadequate institutional infrastructure further contributed to reduced access to CR services.

Although CR participation among patients with AMI in Korea has gradually increased, treatment continuity remains suboptimal. To enhance CR utilization, policy efforts should prioritize reducing patient burden, addressing provider-level barriers, and promoting equitable access through financial support mechanisms and infrastructure expansion.

Andexanet alfa is a reversal agent for factor Xa (FXa) inhibitors (rivaroxaban and apixaban) and is available for the treatment of severe FXa inhibitor-associated bleeding. However, an increase in thrombotic events after administration has been reported.

This multicenter Dutch observational study aimed to provide insights into the characteristics, usage patterns, and clinical outcomes of the Dutch patient population treated with andexanet alfa.

We included all patients treated with on- and off-label andexanet alfa from 6 of the 11 hospitals in the Netherlands that prescribed andexanet alfa between June 2019 and December 2023. Data were collected by LOGEX, a Dutch healthcare data company, using healthcare administrative data and questionnaires completed by clinicians at participating centers. Patient characteristics, details related to andexanet alfa administration, and 30-day clinical outcomes, including thrombotic events and all-cause mortality, were collected.

A total of 217 patients received andexanet alfa, including 192 treated on-label and 25 off-label. In the on-label group, the median age was 77 years (IQR, 69-82 years), and intracranial hemorrhage was the most common indication for reversal (61%). Most patients received a low dose (≤1000 mg) and were administered andexanet alfa within 4 hours of hospital admission (79%). The overall 30-day cumulative incidence of thrombotic events was 4.6%, and no thrombotic events occurred after anticoagulation was reinitiated. All-cause mortality was 34%, with similar rates between the on- and off-label groups.

Andexanet alfa was primarily prescribed for the reversal of FXa inhibitors in patients with intracerebral hemorrhage. We observed a lower incidence of thrombotic events than reported in clinical trials.

To evaluate associations between endoscopic features and hospitalization outcomes in IgA vasculitis (IgAV) with gastrointestinal (GI) involvement, focusing on endoscopic subtypes associated with prolonged hospitalization.

We analyzed 132 IgAV patients with GI involvement and complete endoscopic data at a large-volume center (January 2019 to December 2024). Clinical manifestations, endoscopic characteristics, laboratory data, and abdominal imaging findings at admission were reviewed. Prolonged length of stay (LOS) was defined as LOS exceeding the 75th percentile (>13 days). Multivariable logistic regression and gamma regression (log link) were used to examine factors associated with prolonged LOS and LOS as a continuous outcome. Sensitivity analyses additionally adjusted for treatment variables and renal involvement. Laboratory parameters were compared across endoscopic subgroups in exploratory analyses.

The median age of the patients was 18 years (IQR: 15.0-45.5), with a male-to-female ratio of 2:1. Abdominal pain was the most common presenting symptom. Bowel wall thickening was the most frequent finding on abdominal imaging. The most prevalent endoscopic finding was congestion/edema, followed by erosions, ulcers, and petechiae/ecchymosis. Endoscopic ulceration (OR 2.40, 95% CI 1.09-5.27, p=0.029) and multi-segment GI involvement (OR 2.58, 95% CI 1.20-5.58, p=0.016) were independently associated with prolonged LOS. Gamma regression showed that ulceration was associated with a 27.7% longer LOS (RR 1.277, 95% CI 1.047-1.564, p=0.018) and multi-segment involvement with a 34.7% longer LOS (RR 1.347, 95% CI 1.035-1.748, p=0.025). The association with ulceration remained significant after adjusting for treatment factors, whereas the association with multi-segment involvement was attenuated. The association of ulceration with LOS was more pronounced in patients aged ≤18 years. In sensitivity analyses, additional adjustment for renal involvement did not materially change the associations between endoscopic features and LOS.

In IgAV with GI involvement, endoscopic ulceration is the endoscopic feature most consistently associated with longer hospitalization, and the association appears stronger in patients aged ≤18 years. Multi-segment involvement shows a weaker association that attenuates after treatment adjustment. Overall, these findings support the clinical value of endoscopic phenotyping to inform clinical assessment and should be interpreted as associations rather than prognostic predictions.

Neonatal brain injury, such as hypoxic-ischemic encephalopathy (HIE), is a leading cause of infant mortality and long-term neurodevelopmental disabilities. Current clinical therapeutic strategies are limited by the blood-brain barrier (BBB), the complexity of the injury cascade, and the narrow therapeutic window. Nanomedicine has shown potential in preclinical studies for overcoming these barriers by leveraging its unique nanoscale characteristics and engineerability design to load, stabilize, and deliver vulnerable biomacromolecules across the compromised BBB to the lesion site. This review presents the first systematic horizontal comparison and critical evaluation of the major nanoplatforms employed in neonatal brain injury therapy. Based on data derived primarily from animal models, we analyze the heterogeneity across studies in model systems, administration routes, and efficacy endpoints, revealing common challenges in the field regarding long-term safety, manufacturability, and reproducibility. This review aims to provide guidance for selecting appropriate nanoplatforms to facilitate the translational advancement of this field toward clinical applications.

This study aims to examine the current status of body mass index (BMI) management capabilities among senior patients with chronic heart failure (CHF) in China, identify key influencing factors, and provide evidence-based recommendations for the development of targeted intervention strategies.

The study enrolled 550 senior patients diagnosed with CHF. Participants were assessed using three instruments: a general information questionnaire, a CHF BMI management scale, and a chronic disease self-efficacy scale. Descriptive statistics, Pearson correlation analysis, univariate analysis, and multiple linear regression analysis were employed to evaluate the level of BMI management capabilities and to identify influencing factors.

The mean score on the CHF BMI management scale was 17.43 ± 9.21, indicating an overall low level of BMI management capability. The mean score on the chronic disease self-efficacy scale was 31.95 ± 8.97. A positive correlation was observed between the scores on the chronic disease self-efficacy scale and the CHF BMI management scale (r = 0.34, p < 0.01). Multiple linear regression analysis identified family attention to patients' health status, chronic disease self-efficacy, the subtype of chronic heart failure (CHF), and the duration of the disease as significant determinants of BMI management capabilities (p < 0.01). Collectively, these variables accounted for 17.9% of the variance observed in BMI management capabilities. Notably, family attention to the patients' health status was identified as the primary determinant of BMI management capabilities in this population.

Senior patients with CHF demonstrate limited BMI management capabilities, influenced by multiple factors; with family attention to health status being the most critical influencing factor. Healthcare providers should develop and implement targeted interventions for BMI management informed by these key influencing factors to improve the clinical outcomes and the quality of life for senior CHF patients.

Antipsychotic drugs are increasingly prescribed in children and adolescents across a wide range of psychiatric conditions. Although cardiovascular adverse effects are generally considered uncommon, concerns about electrocardiographic abnormalities, particularly QTc interval prolongation, have led to ongoing debate regarding appropriate monitoring strategies. Real-world data on the frequency, persistence, and clinical relevance of ECG findings during antipsychotic treatment in youth remain limited.

This was a single-center, observational cohort study including patients younger than 18 years, treated with antipsychotics between January 2020 and December 2024. Inclusion required the availability of at least one 12-lead ECG performed during treatment and accompanied by a cardiology report. ECG parameters were extracted from all available recordings, with QTc calculated using Bazett's formula and interpreted using sex-specific reference thresholds. ECG findings were analyzed primarily at the patient level, defining abnormalities based on their occurrence at any point during follow-up. An exploratory comparison was performed between patients with and without QTc prolongation.

The study included 430 patients (79.1% males; mean age 11.3 ± 3.35 years), of whom 429 had analyzable ECG data. At the patient level, 195 of 429 patients (45.5%) exhibited at least one numeric ECG abnormality during follow-up, most commonly heart rate abnormalities. QTc prolongation above sex-specific thresholds was observed in 24 patients (5.6%) and proved to be persistent in only 5 cases (20.8%), defined as occurrence in at least 2 ECG recordings. No patient exhibited a QTc ≥500 ms, and no clinically significant ventricular arrhythmias, high-grade conduction disturbances, or sudden cardiac events were observed. QTc prolongation was not significantly associated with sex, age, antipsychotic polypharmacy, combined first- and second-generation antipsychotic exposure, or QT-relevant comedications.

In this large naturalistic pediatric cohort, ECG abnormalities during antipsychotic treatment were relatively frequent but predominantly mild, transient, and clinically benign. QTc prolongation occurred in a small minority of patients and was not associated with adverse cardiac outcomes. These findings may support a selective, risk-based approach to ECG monitoring in children and adolescents treated with antipsychotics, rather than routine universal screening.