Sleep disturbances before stroke have been associated with stroke risk and severity, but the relationships between habitual pre-stroke sleep symptoms and subsequent neurological and functional outcomes remain unclear. We examined associations between self-reported pre-stroke sleep symptoms and stroke outcomes at admission and follow-up.

This exploratory secondary analysis included data from two prospective stroke cohorts conducted at Copenhagen University Hospital Rigshospitalet, Denmark. Adults with ischaemic stroke or intracerebral haemorrhage who completed a 16-item sleep questionnaire at admission and follow-up were included. Regression models were adjusted for age, sex, previous stroke or transient ischaemic attack, and depression; follow-up models were additionally adjusted for the corresponding admission outcome.

Among 133 participants, the median age was 70 years, 36.8% were women, and 90.2% had ischaemic stroke. Median follow-up was 167 days. Pre-stroke unintended leg movements during sleep, sleep-maintenance insomnia, and nocturia were associated with higher follow-up NIHSS (adjusted β 1.27, 95% confidence interval [CI] 0.41-2.12; β 0.93, 95% CI 0.21-1.66; and β 0.98, 95% CI 0.25-1.72, respectively). Hypnagogic hallucinations were associated with higher admission NIHSS (adjusted β 2.22, 95% CI 0.61-3.83), lower admission BI (adjusted β -17.83, 95% CI -27.98 to -7.69), NIHSS > 4 (adjusted odds ratio 3.06, 95% CI 1.40-6.67), and BI < 80 (adjusted odds ratio 2.18, 95% CI 1.03-4.65).

Several self-reported pre-stroke sleep symptoms were associated with neurological and functional outcomes after stroke. These pre-stroke symptoms may identify vulnerability phenotypes warranting further investigation.

Hypertension has significant socioeconomic consequences and adversely affects the health-related quality of life (HRQOL) of people living with hypertension. In Cameroon, although one-third of adults have hypertension, no study has previously examined its impact on the HRQoL of individuals. This study aimed to assess the effect of hypertension on the HRQoL of people living with hypertension followed up in three health facilities in the Dschang Health District.

We carried out a comparative analytical cross-sectional study to compare people with a confirmed diagnosis of hypertension (exposed group) with age-, sex-, and location-matched participants without hypertension (unexposed group). Data were collected through face-to-face interviews via a standardized questionnaire including the Health Utilities Index Mark 3 (HUI3) to assess HRQoL. Data were analysed using SPSS software, and the significance threshold was set at 5%. Comparisons between the two groups were performed using multivariable linear regression for continuous HUI3 scores and logistic regression for binary HRQoL outcomes.

A total of 196 participants were enrolled in this study, with 98 in each group. The median age of the subjects was 66 years (IQR: 60-73.25), and most of the participants were females (62.2%). Among chronic comorbidities, diabetes was significantly more common among participants with hypertension (OR = 30.961 [6.87-139.51], p value = 0.001). Compared with those without hypertension, people with hypertension had significantly poorer HRQoL (a difference of 0.2017 in the overall mean HUI score, p < 0.001), and this difference was more than 6 times greater than the clinically important difference of 0.03. Neither a longer duration of hypertension since diagnosis nor the overall burden of comorbidities was associated with a reduction in HRQoL.

These findings underscore the importance of integrating routine HRQoL assessment and comprehensive management of hypertension into hypertension care programs. They also support continued investment in health promotion and primary prevention strategies aimed at reducing the burden of hypertension and diabetes in Cameroon and other low- and middle-income settings.

Cerebral edema (CED) is a common complication of acute ischemic stroke, associated with increased mortality and poor functional outcomes. While infarct size is a known predictor, the role of sodium homeostasis remains unclear. This study evaluated risk factors for CED and its impact on outcomes.

We prospectively enrolled 178 patients with acute non-lacunar ischemic stroke. Cerebral edema was assessed and graded using the SITS-MOST edema scale over the first seven days. Sodium concentration and variability were monitored daily. Risk factors for CED were identified through multivariate logistic regression, and the impact of CED on mortality, functional outcomes, hemorrhagic transformation, and seizures was analyzed.

CED occurred in 38.2% of patients and was associated with larger infarcts (> 3 cm), higher NIHSS, lower ASPECTS, lack of reperfusion, and multi-territory involvement. No differences were observed in demographics or cardiovascular risk factors. Sodium levels were higher on days 3 and 5 in CED patients, with greater variability, while baseline levels were not predictive. Infarct size and day 3 sodium were independent predictors. CED was linked to worse outcomes, including higher 1-month mortality (23.5% vs. 1.8%), increased hemorrhagic transformation, and reduced functional independence. No association with seizures was found.

Infarct size remains the strongest risk factor for cerebral edema after ischemic stroke. Baseline sodium levels were not determining CED development. CED worsens outcomes but is not linked to seizure risk. These findings underscore the importance of early imaging and suggest a potential role for targeted anti-edema therapies in patients with larger strokes.

This study aimed to assess the association between grandparental age and the risk of Down syndrome and evaluate the relationship between paternal age and congenital heart disease (CHD) among affected children in Peru. A retrospective case-control study was conducted at a national pediatric referral center in Peru, including 290 participants (145 cases with free trisomy 21 and 145 controls without genetic disorders). Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Parental ages were higher in cases than in controls, but there were no significant differences in grandparental ages. Maternal age was the strongest risk factor for Down syndrome (OR = 1.16 per additional year; 95% CI: 1.09-1.23). No significant association was found between maternal grandmother's age and Down syndrome (OR = 0.96 per additional year; 95% CI: 0.91-1.02). Paternal age ≥ 32.6 years (categorical analysis based on the Liu-derived cut-off) was associated with an increased risk of congenital heart disease in the presence of FT21, compared with a reference group combining FT21 without CHD and healthy controls (aOR = 3.64; 95% CI: 1.96-6.77).

In this Latin American cohort, maternal age remains the primary risk factor for Down syndrome, with no evidence supporting an effect of maternal grandmother's age at the birth of the mother. Notably, advanced paternal age was independently associated with higher odds of congenital heart disease among children with Down syndrome. These findings warrant confirmation in independent populations before being considered for clinical application.

• Advanced maternal age is the main established risk factor for Down syndrome. • The maternal grandmother's age at the birth of the mother remains uncertain, with inconsistent evidence. The contribution of paternal age to congenital heart disease in affected individuals has been insufficiently studied.

• In this case-control study from a Latin American population, the maternal grandmother's age at the birth of the mother was not associated with DS • Advanced paternal age was independently associated with higher odds of congenital heart disease among children with Down syndrome.

Associations between plasma proteomic profiles and left atrial strain (LAS) may provide insights into biological processes that underly variations in atrial function in adults without overt cardiovascular disease (CVD).

We aimed to assess the associations between circulating proteins and phasic LAS, and explore the potential influence of cardiometabolic factors on these relationships.

Study participants included individuals from the population of the Bialystok PLUS (Bialystok Polish Longitudinal University Study), examined between 2018 and 2024, including adults aged 35-70 years who had complete echocardiographic data and plasma samples available for proteomic profiling. Individuals with overt cardiovascular, inflammatory, neoplastic, or neurodegenerative disease were excluded. LA reservoir (LASr), conduit (LAScd), and contraction (LASct) strains were assessed on speckle‑tracking echocardiography. Plasma proteomic profiling was performed using the Olink Reveal platform. The associations between 1034 proteins and LAS parameters were analyzed using age‑adjusted linear models with false discovery rate (FDR) correction (q ≤0.1). Additional analyses evaluated the influence of cardiometabolic risk factors and overlap with conventional echocardiographic parameters.

The study included 414 adults at a median (interquartile range) age of 51 (43-61) years; 47.3% were men. After age adjustment, significant associations were observed exclusively for LAScd, with 30 proteins meeting the FDR threshold, whereas no proteins showed associations with LASr or LASct. The proteins linked to LAScd were mainly involved in metabolic regulation, inflammation, cellular stress responses, and tissue remodeling. The proteomic signature of LAScd showed only partial overlap with conventional echocardiographic phenotypes. After further adjustment for cardiometabolic risk factors, no associations remained significant after FDR correction.

In adults without overt CVD, LAScd was the only component of LAS associated with a distinct age‑adjusted plasma proteomic profile. The observed associations were substantially influenced by cardiometabolic risk factors, suggesting that the identified proteomic patterns primarily reflect underlying cardiometabolic processes. Further longitudinal studies are needed to determine the clinical significance of these findings.

Many inequities exist in the global access of heart and lung transplantation. Few studies have identified global strategies to implement equitable access to heart or lung transplantation.

Members of the International Society for Heart and Lung Transplantation (ISHLT) developed a consortium to identify strategic priorities to improve global access to heart and lung transplantation according to the Capability, Opportunity, Motivation- Behavior Change Wheel Model (COM-B/ BCW), an implementation science framework. Initial workshops were held at the ISHLT Scientific Sessions and refined with follow-up focus group meetings of consortium members from 2025 through 2026.

Focus 1 was to improve quality of transplant data for access and outcomes; prioritized behavior included: 1) improving collection of social determinants of health, race, and ethnicity data, and 2) collecting data on patients referred but not listed. Focus 2 was to improve transplant access to diverse racial and ethnic populations; prioritized behavior included: 1) increasing transparency regarding candidacy and allocation, and 2) improving awareness regarding diverse patient and community needs for transplant consideration. Focus 3 was to improve access with patient-centered approaches; prioritized behavior included: individualizing a comprehensive patient assessment and plan. Focus 4 was to develop transplant programs in under-resourced countries; prioritized behaviors included: 1) developing a national or regional heart and lung transplant infrastructure and workforce plan, and 2) identifying and designating transplant capable centers as pilot hubs or consortium nodes.

An ISHLT consortium developed and prioritized strategies for behavior change to improve global access to heart and lung transplantation. These strategies may form the basis of global quality improvement and implementation research studies for transplantation equity.

Bartonella infective endocarditis (IE) is a rare cause of initially blood culture-negative IE, classically associated with cat flea exposure in Bartonella henselae infection or body lice infestation among individuals experiencing homelessness or alcoholism in Bartonella quintana infection. We report the case of an 84-year-old man with severe calcific aortic stenosis who was undergoing evaluation for pre-transcatheter aortic valve implantation (TAVI). Cardiac computed tomography (CT) unexpectedly revealed a peri-annular cavity consistent with a drained or healed peri-annular abscess, despite the absence of fever or other clinical features of IE. Initial blood cultures were negative, and TAVI was planned following multidisciplinary discussion, pending serological results. However, a subsequently reported high-titer Bartonella serology prompted readmission, and TAVI was ultimately deferred after the diagnosis was confirmed. Prolonged incubation of blood cultures subsequently identified B. quintana, while brain magnetic resonance imaging (MRI) revealed a lesion suspicious for an intracranial infectious aneurysm. Definite IE was established according to the 2023 Duke-International Society for Cardiovascular Infectious Diseases (Duke-ISCVID) criteria based on two major criteria: high-titer Bartonella serology and imaging evidence of a peri-annular abscess. No classical epidemiological risk factors for Bartonella infection were identified. Despite targeted antimicrobial therapy, the patient experienced progressive clinical deterioration, and multiple comorbidities precluded surgical intervention. He ultimately died of multiorgan failure. This case highlights the diagnostic challenge of occult B. quintana IE incidentally identified during pre-TAVI evaluation, including in patients without classical epidemiological risk factors or overt manifestations of infection. It also emphasizes that unexpected peri-annular abnormalities detected during pre-TAVI evaluation should prompt a thorough investigation for IE, even in clinically unsuspected cases, with direct implications for procedural planning.

Pulmonary arterial hypertension (PAH) is a severe cardiopulmonary disease associated with substantial morbidity and mortality. However, the global burden, future trajectory, and potentially modifiable risk factors for PAH among older adults remain insufficiently characterized. This study aimed to quantify the global burden and projected trends of PAH among adults aged ≥ 60 years and investigate the causal association between body mass index (BMI) and PAH risk using Mendelian randomization (MR). We extracted PAH burden estimates from the Global Burden of Disease (GBD) 2021 study across 204 countries and territories, 21 GBD regions, and five socio-demographic index (SDI) strata. Temporal trends were assessed using age-standardized rates and average annual percent changes (AAPCs), while demographic decomposition and Bayesian age-period-cohort (BAPC) models were applied to evaluate drivers of burden changes and future trajectories. Two-sample MR analyses were performed using genome-wide significant BMI-associated genetic variants as instrumental variables and PAH genome-wide association study summary statistics from FinnGen. Between 1990 and 2021, global incident cases of PAH among adults aged ≥ 60 years increased from 6771.01 (95% uncertainty interval [UI]: 4577.81-9656.55) to 15,622.29 (95% UI: 10,546.44-22,296.65), and deaths increased from 6812.93 (95% UI: 5305.00-8473.04) to 15,443.42 (95% UI: 11,746.25-18,388.02). Although the age-standardized mortality, prevalence, and disability-adjusted life year (DALY) rates declined, the age-standardized incidence rate showed a slight increase (AAPC = 0.07%, 95% CI: 0.05-0.09). Marked geographic and SDI-related disparities were observed, with population growth and aging identified as the predominant contributors to the rising absolute burden. BAPC modeling projected continued increases in absolute PAH cases through 2050 despite declining age-standardized mortality and DALY rates. In addition, MR analyses provided suggestive evidence for a positive association between genetically predicted higher BMI and increased PAH risk (inverse-variance weighted odds ratio [IVW OR] = 1.84, 95% CI: 1.11-3.05, p = 0.018). Among older adults, the global absolute burden of PAH has increased substantially over the past three decades and is expected to continue rising, largely driven by population aging and growth. Genetic evidence further suggests that elevated BMI may represent a potentially modifiable risk factor for PAH. These findings highlight the need for enhanced surveillance, improved diagnostic strategies, equitable healthcare access, and targeted metabolic risk management to address the growing burden of PAH in aging populations.

To evaluate the association between an Intelligent Hypertension Excellence Centers (iHEC)-integrated teaching model and multidimensional educational outcomes in standardized residency training, and to explore whether self-directed learning (SDL) mediates the association between digital health-enhanced training and educational performance.

A retrospective sequential cohort study was conducted among 245 resident physicians who completed a standardized 4-week hypertension rotation in the Department of Geriatric Cardiology between September 2022 and August 2024. Residents were assigned to a conventional ward-based teaching cohort (n = 118) or an iHEC-integrated teaching cohort (n = 127) according to rotation period. Both cohorts received identical curriculum requirements, faculty supervision, and assessment procedures. Educational outcomes included objective structured clinical examination (OSCE) performance, knowledge acquisition, SDL readiness, critical thinking disposition, and educational satisfaction. Structural equation modeling (SEM) with bias-corrected bootstrapping was performed to evaluate direct and indirect associations.

Baseline characteristics and educational assessments were comparable between cohorts. After adjustment for baseline performance, specialty, and calendar time, the iHEC cohort demonstrated higher post-rotation OSCE scores [adjusted mean difference (AMD) 6.85, 95% CI 5.12-8.58, p < 0.001], knowledge scores (AMD 5.42, 95% CI 3.84-7.00, p < 0.001), SDL scores (AMD 9.86, 95% CI 7.21-12.51, p < 0.001), and critical thinking scores (AMD 12.45, 95% CI 9.15-15.75, p < 0.001). The respecified SEM demonstrated good model fit (CFI = 0.962, TLI = 0.951, RMSEA = 0.052, SRMR = 0.038). The iHEC teaching model was positively associated with SDL (β = 0.68, p < 0.001) and educational performance (direct effect β = 0.36, p < 0.001). SDL showed a significant indirect association with educational performance (β = 0.38, 95% bootstrap CI 0.21-0.55), accounting for 51.4% of the total association.

The iHEC hypertension teaching model was associated with improved resident educational outcomes, with enhanced self-directed learning representing a potential explanatory pathway underlying these observed associations; prospective multicenter studies are needed to further evaluate causal relationships, long-term retention, and implementation feasibility.

Moyamoya disease is known to be associated with the Ring Finger 213 gene variant (RNF213 p.R4810K) in East Asians; however, it remains less studied in South Asians. This study aims to identify the RNF213 p.R4810K and non- p.R4810K variants and to investigate their phenotypic correlation in an Indian cohort of Moyamoya patients.

The study prospectively enrolled 100 patients with unilateral or bilateral Moyamoya disease (June 2023 to June 2024). Whole exome sequencing was performed to identify all the RNF213 exonic variants. The patients were grouped based on the single-nucleotide variants detected (RNF213 p.R4810K and non- p.R4810K variants) and their pathogenicity. The RNF213 p.R4810K variants were further categorized as homozygous and heterozygous. The demographic, clinical, and angiographic characteristics were collected. Statistical correlations of RNF213 polymorphisms with phenotypic features were assessed by Kruskall-Wallis tests and Fisher's Exact tests.

Seventy-four (74%) patients carried no RNF213 variants, while 26 (26%) carried RNF213 variants. The founder variant p.R4810K was detected in 9 (9%) patients, and non- p.R4810K variants in 19 (19%) patients. Five missense variants were reported as novel variants (p.Gln681Glu, p.Pro2875Ser, p.Leu4117Pro, p.Gln4029Arg, p.Asp4003Val). Among these, p.Leu4117Pro and p.Asp4003Val, located within the RING domain, were predicted to destabilize the protein structure. The genotype-phenotype correlation showed that the domicile state (p = 0.006), family history of Moyamoya disease (p = 0.001), and periventricular anastomosis (p = 0.026) were significantly different among patients with p.R4810K and non- p.R4810K variants than those without. There was no significant difference observed in clinical presentation or severity of the disease between homozygous and heterozygous carriers.

The study confirmed that both RNF213 p.R4810K and non- p.R4810K variants increase the risk of Moyamoya disease with variable phenotypic expression. Further functional studies in a large cohort would help in delineating the role of these variants in disease pathophysiology as well as in better genotype- phenotype correlations.