Gene expression profiling is an emerging noninvasive method for rejection surveillance in heart transplants. Tricuspid regurgitation prevalence increases over time after heart transplant, and many prior studies have implicated invasive endomyocardial biopsy. The relationship between the use of gene expression profiling (AlloMap molecular expression test; CareDx ) versus endomyocardial biopsy with regard to prevalence of tricuspid damage has never been studied.

Among 158 heart transplant patients with history of gene expression profiling and mean follow -up duration of 10.3 years that we reviewed, 114 patients were included in this study. Patients were divided into 4 groups based on mean endomyocardial biopsy and mean gene expression profiling sampling times. Tricuspid regurgitation grade change was compared between the group with less gene expression profiling and more endomyocardial biopsy versus the group with more gene expression profiling and less endomyocardial biopsy.

Results from this single -center study showed that no statistically significant difference in tricuspid regurgitation for cardiac transplant patients who were monitored for rejection by endomyocardial biopsy versus gene expression profiling.

Preference of gene expression profiling instead of endomyocardial biopsy for rejection surveillance does not have a significant effect on tricuspid valve regurgitation.

Stroke incidence and mortality are higher among adults in northern and western China, commonly referred to as the "Stroke Belt." However, few studies have compared stroke action awareness between Stroke Belt and non-Stroke Belt regions at the national level. This study aimed to evaluate stroke action awareness-including recognition of symptoms and appropriate emergency responses-among community residents in China, with comparisons between Stroke Belt and non-Stroke Belt regions.

We conducted a cross-sectional, questionnaire-based survey of community residents across China to assess knowledge of stroke symptoms and appropriate responses to suspected stroke events.

A total of 6181 residents were included in the final analysis, with 2037 living in Stroke Belt regions and 4144 in non-Stroke Belt regions. Overall, 19.07% (n = 1179) were unaware of any stroke symptoms, 17.96% (n = 1110) recognized one symptom, 11.97% (n = 740) recognized two symptoms, and 50.99% (n = 3152) recognized all three. Additionally, 77.59% (n = 4796) identified calling emergency medical services (EMS) as the correct response. Multivariable logistic regression showed that residents of the Stroke Belt had significantly lower odds of recognizing all three symptoms (adjusted odds ratio [aOR]: 0.50; 95% CI: 0.44-0.56; p < 0.001), calling EMS (aOR: 0.62; 95% CI: 0.54-0.70; p < 0.001), and both recognizing all three symptoms and calling EMS (aOR: 0.51; 95% CI: 0.45-0.58; p < 0.001).

Stroke action awareness remains notably low among community residents in China, with the lowest levels observed in the Stroke Belt. Targeted public health interventions are urgently needed to improve symptom recognition and promote timely action for emergency stroke care, especially in high-risk regions such as the Stroke Belt.

Substance use disorder (SUD)-related emergencies are increasing globally, with cardiotoxicity contributing substantially to morbidity and mortality. This study evaluated cardiotoxicity patterns and factors associated with in-hospital mortality among adults with SUD presenting to the emergency department (ED).

This retrospective observational study was conducted from January 2014 to December 2024 at Sultan Qaboos University Hospital, University Medical City, Muscat, Oman. Adults aged ≥18 years with SUD and positive urine drug screening (UDS) were included if they had elevated troponin (>14 ng/L), electrocardiographic abnormalities or echocardiographic structural dysfunction. Clinical, laboratory, imaging, management and outcome data were analysed.

A total of 4,400 ED medical records were reviewed; 478 patients had SUD and 78 (16.3%) met the inclusion criteria (mean age = 40.8 ± 12.3 years, 92.3% male). Opiate-class positivity on UDS was the most frequent finding (62.8%), followed by methamphetamine (29.5%). Sinus tachycardia (41.0%) and ST-T changes (15.4%) were the most common electrocardiographic abnormalities. Elevated troponin was present in 87.2%. Overall, in-hospital mortality was 15.4%. Hypokinesia (odds ratio [OR] = 5.12, 95% confidence interval [CI]: 1.08-24.22; P = 0.040) and left ventricular impairment (OR = 6.14, 95% CI: 0.95-39.88; P = 0.057) showed the strongest mortality associations.

Among ED patients with SUD, positive UDS and cardiotoxicity, structural cardiac dysfunction was associated with higher in-hospital mortality. These findings support early cardiovascular assessment, including electrocardiography, troponin testing and selective echocardiography, in high-risk patients with substance-related toxicity.

The East African immigrant community in San Diego has proactively sought multi-generational, nutrition-focused strategies for the prevention and management of cardiometabolic disease. Existing studies on Somali immigrants in the U.S. Midwest document elevated rates of diabetes (4.5-21.1%), overweight/obesity, and dyslipidemia, while qualitative evidence indicates that dietary acculturation, particularly within the first decade of migration, is associated with decreased consumption of traditional foods and increased exposure to sodium- and sugar-dense processed foods. This community case study describes the long-standing community-academic partnership between United Women of East Africa Support Team (UWEAST) and the University of California, San Diego Herbert Wertheim School of Public Health Anderson Lab, operationalized through the Healthy Eating with Spices and Herbs to Manage Hypertension (HAWAASH) research project series and formative phase of HAWAASH2. Guided by Community Based Participatory Research (CBPR) and community-driven research principles, the partnership prioritized social participation, empowerment, and capacity building through shared governance, community-led recruitment, multilingual engagement strategies, and culturally responsive implementation practices. Using a convenience sampling approach with an iterative mixed-methods formative design, 60 community members and seven key informants contributed to shaping the design of a future culturally tailored nutrition intervention. Activities were conducted at the UWEAST community hub in City Heights, San Diego. Grounded theory-guided thematic analysis identified five themes from community member interviews and four themes from key informant interviews, encompassing cultural food identity, structural barriers to healthy eating, dietary acculturation experiences, community social assets, and readiness for nutrition programming. This case study highlights practical strategies, lessons learned, and contextual constraints relevant to advancing equitable, community-driven nutrition initiatives among underrepresented immigrant populations. Detailed findings on measurement tool acceptability and proof-of-concept intervention plausibility are reported in companion manuscripts.

Venous thromboembolism (VTE) is the third most common cause of cardiovascular death. Primary Antiphospholipid Syndrome (P-APS) is a chronic systemic autoimmune disorder characterized by thrombotic events and/or obstetric complications in patients carrying antiphospholipid antibodies (aPL) without autoimmune pathology. The prevalence of primary antiphospholipid syndrome (P-APS) in patients with VTE is approximately 9%. However, few studies have evaluated non-criteria antiphospholipid antibodies in the acute phase of VTE.

To assess the role of criteria and non-criteria antiphospholipid antibodies in patients with acute VTE.

A cohort of 181 patients with VTE was followed for 2 years. An age-matched control group of 181 healthy individuals was included for comparison.

Criteria aPL were detected in 8.8% of patients, whereas non-criteria aPL were present in 23.8%. Criteria aPL were independently associated with overall VTE (OR 7.09, p=0.021) and unprovoked VTE (OR 4.61, p=0.021). IgA anti-Beta2 Glycoprotein-1 antibodies (aB2GP1), detected in 16% of patients, were independently associated with VTE (OR 4.31, p=0.014) and unprovoked VTE (OR 3.78, p=0.006). Furthermore, IgA aB2GP1 positivity was also associated with more severe clinical presentation, defined by a Pulmonary Embolism Severity Index scale ≥3 (OR 3.13; p=0.048), and with the development of chronic thromboembolic pulmonary hypertension (OR 5.7; p=0.008).

IgA aB2GP1 antibodies are independently associated with VTE, particularly unprovoked VTE, and with both severe pulmonary embolism, and subsequent chronic thromboembolic pulmonary hypertension.

Venous thromboembolism (VTE) frequently complicates septic shock, yet precise, individualized risk stratification tools remain scarce. This study aimed to develop and externally validate an explainable machine learning (ML) framework to predict VTE in this critically ill population.

A retrospective cohort study was conducted including adult septic shock patients admitted between January 2020 and December 2025. The study population was partitioned into an internal development cohort (n=733) and an independent external validation cohort from a separate tertiary hospital (n=257, Xi'an No. 3 Hospital). We utilized the Boruta algorithm alongside recursive feature elimination to isolate optimal predictors. Six ML algorithms were trained and evaluated using metrics including the area under the receiver operating characteristic curve (AUC) and F1 score. Shapley Additive Explanations (SHAP) were integrated to establish model transparency.

The VTE incidence within the development cohort was 17.74% (130/733). The feature selection pipeline distilled six robust predictors: fibrin degradation products (FDP), prothrombin time (PT), white blood cells (WBC), activated partial thromboplastin time (APTT), D-dimer, and C-reactive protein (CRP). Among the evaluated models, the Random Forest (RF) algorithm exhibited superior discriminative capacity and promising performance in an independent external validation cohort, achieving an AUC of 0.9718 and an F1 score of 0.7917 in the independent external validation cohort, with a sensitivity of 0.7037. SHAP analysis revealed that heightened thrombo-inflammatory markers combined with abbreviated coagulation intervals fundamentally drove VTE risk, offering personalized predictive insights via individual force plots.

We successfully established a highly accurate and interpretable RF-based predictive model for VTE in septic shock patients. By leveraging six routine clinical biomarkers and SHAP-derived transparency, this tool bridges complex algorithmic forecasting with clinical intuition, providing a transparent risk assessment framework that may assist in risk stratification for thromboprophylaxis after prospective validation. Future implementation studies are needed to assess its real-world clinical utility and impact on patient outcomes.

While diastolic dysfunction (DD) is a critical heart failure precursor linked to metabolic stress, the specific association between the promising triglyceride-glucose waist circumference (TyG-WC) index and DD remains insufficiently characterized under contemporary diagnostic standards. This study aimed to evaluate the association between the TyG-WC index and the risk of DD in a community-based population of middle-aged and older adults.

In this cross-sectional study of 1,413 participants, DD was adjudicated according to the age-stratified echocardiographic criteria. Multivariable logistic regression and restricted cubic splines (RCS) were employed to assess independent associations and dose-response relationships. Furthermore, machine learning techniques, including LASSO regression for feature selection and Random Forest models interpreted by Shapley Additive exPlanations (SHAP), were utilized to quantify the predictive contribution of TyG-WC.

After full adjustment for demographics, blood pressure, and clinical comorbidities, TyG-WC was independently associated with an increased risk of DD (OR = 1.002, 95% CI: 1.001-1.004, P < 0.001). Individuals in the high TyG-WC group (≥776.5) faced a significantly higher risk of DD compared to the low group (OR = 1.656, 95% CI: 1.266-2.166, P < 0.001). RCS analysis confirmed a significant linear dose-response relationship (P _overall<0.001), indicating that the probability of DD escalates with increasing TyG-WC. The full predictive model achieved an AUC of 0.687, demonstrating incremental value beyond traditional risk factors. Subgroup analyses demonstrated the robustness of these findings, with significant interactions observed for hypertension and diabetes status. Machine learning identified TyG-WC as an independent contributor for DD, with SHAP values consistently linking higher index levels to increased risk.

Elevated TyG-WC is independently associated with an increased risk of DD. As a cost-effective and easily accessible marker of cardiometabolic stress, TyG-WC may serve as a practical screening tool for the early identification and risk stratification of subclinical heart failure.

Lower socioeconomic status (SES), reflected by greater socioeconomic deprivation, lower household income, and lower educational attainment (EA), has been associated with atrial fibrillation (AF). This study aimed to examine the causal influence of SES on AF risk.

Single-nucleotide polymorphisms (SNPs) associated with Townsend deprivation index (TDI) or household income from the UK Biobank (N = 462,464 and N = 397,751, respectively) and EA from the Social Science Genetic Association Consortium (N = 3,037,499) were selected as instrumental variables. AF-associated SNPs were extracted from FinnGen data freeze 8 (N = 208,594) and a meta-analysis (N = 1,030,836) by Nielsen et al. Two-sample Mendelian randomization (MR) was used to estimate causal relationships, with validity assessed via sensitivity analyses.

TDI showed no association with AF risk in either FinnGen (odds ratio (OR) = 0.972, 95% confidence interval (CI): 0.607-1.556, p = 9.00E-01) or Nielsen et al. (OR = 0.805, 95% CI: 0.470-1.381, p = 4.30E-01). Similarly, genetically proxied household income was not associated with AF risk (OR = 1.233, 95% CI: 0.808-1.881, p = 3.30E-01; OR = 0.941, 95% CI: 0.755-1.173, p = 5.90E-01). However, higher genetically proxied EA was associated with lower AF risk in FinnGen (OR = 0.745, 95% CI: 0.653-0.849, p = 1.00E-05) and Nielsen et al. (OR = 0.849, 95% CI: 0.784-0.920, p = 5.90E-05).

Our MR study found that higher genetically proxied EA was associated with lower AF risk, whereas no evidence of association was found for genetically proxied TDI or household income.

Risk stratification after transcatheter tricuspid edge-to-edge repair (T-TEER) remains challenging, particularly in patients with advanced right-sided heart failure and systemic disease burden. Biomarkers reflecting inflammation, stress response and multiorgan dysfunction may provide additional prognostic information in this setting.

This prospective single-centre cohort study included 84 consecutive patients undergoing T-TEER for severe tricuspid regurgitation using the TriClip or PASCAL system. Baseline concentrations of growth differentiation factor-15 (GDF-15), soluble urokinase plasminogen activator receptor (suPAR), and NT-proBNP were measured prior to intervention. The primary endpoint was all-cause mortality at 12 months. Secondary endpoints included cardiovascular rehospitalisation and a combined cardiovascular endpoint. Prognostic performance was assessed using receiver operating characteristic and tertile-based Kaplan-Meier analyses. Owing to the limited number of events, all analyses were considered exploratory.

During 12-month follow-up, all-cause mortality occurred in 10 patients (11.9%), while cardiovascular rehospitalisation was observed in 29 patients (34.5%). GDF-15 demonstrated good discriminative performance for all-cause mortality (AUC 0.823, 95% CI 0.714-0.932, p = 0.001), whereas suPAR showed moderate prognostic discrimination (AUC 0.742, 95% CI 0.605-0.878, p = 0.013). In contrast, NT-proBNP showed no significant discrimination for all-cause mortality (AUC 0.535, 95% CI 0.362-0.709, p = 0.720). Higher tertiles of both GDF-15 and suPAR were associated with reduced overall and rehospitalisation-free survival.

Baseline GDF-15 and suPAR were associated with adverse outcomes after T-TEER and demonstrated greater prognostic discrimination than NT-proBNP in this exploratory cohort. These exploratory findings support further investigation of systemic stress and inflammation biomarkers for risk stratification in patients with severe tricuspid regurgitation.

Lower limb venous diseases are prevalent chronic conditions that require standardized, efficient, and patient-centered clinical assessment across diverse healthcare settings. Despite increasing digitalization of healthcare, scalable multilingual digital infrastructures capable of supporting standardized pre-consultation data collection and physician-validated real-world evidence generation remain limited. We conducted a global, cross-sectional observational study, using an innovative physician-invited/patient-completed digital registry, designed to enable pre-clinical engagement. The registry was conceived as a modular, multilingual digital infrastructure, allowing individuals to include clinical data prior to any physician encounter who will then validate the already acquired information, while also completing the healthcare professional part· We assessed geographic reach, usability, engagement in data completion, and cross-sectional associations between demographic, clinical factors and disease stage, defined as CEAP clinical class and Venous Clinical Severity Score (VCSS). 6457 patients from 59 countries from Africa, Asia, Europe, North and South America enrolled in the registry before their first specialist consultation. Completion of all the required data was achieved by 1355 patients from 12 countries. Among participating physicians, the platform usability was rated as easy in 94.2% of responses, while its overall usefulness was rated as high or very high in 76.6% of responses. Privacy concerns were expressed in 17% of cases. Cross-sectional analyses identified risk factor profiles associated with CEAP class ≥ 4 and VCSS ≥ 8·5. These stage-associated profiles differed from those previously reported, reflecting the need for a detailed integration of appropriately collected real-world data in venous disease investigations. A global, multilingual, physician-invited/patient-completed digital registry may facilitate earlier patient engagement and has the potential to support more efficient care pathway, moreover across linguistic contexts, with more timely data capture. This registry provides a scalable digital infrastructure for standardized patient- and physician-validated data collection across multiple countries, with potential applicability to multidisciplinary clinical practice and research. Such infrastructure may facilitate earlier and broader diagnostic insights, including for conditions beyond the initial reason for care seeking, and provide a robust foundation for machine learning, reducing reliance on synthetic datasets and supporting scalable, equitable digital health innovation across medical specialties.