Current expert consensus statements generally suggest cardiovascular risk assessment, including atrial fibrillation (AF) screening, on detection of covert brain infarctions (CBIs). However, evidence to guide management of CBI remains limited. In the absence of randomised clinical trials specifically targeting CBI populations, observational studies comparing individuals with and without CBI can provide insights into the prevalence and burden of cardiovascular risk factors.

We aimed to compare the burden of atherosclerosis and cardiovascular risk factors in participants with CBI to those without, and to explore the yield of AF screening in individuals with CBI.

A prospective population-based birth cohort study including men and women born in 1950 and resident in Akershus County, Norway.

The two hospitals serving the population of Akershus county, Norway.

Participants included in the Akershus Cardiac Examination (ACE) 1950 study who also underwent a subsequent MRI examination were eligible for this study.

Cardiovascular risk assessment was performed at study inclusion (2012-2015). Carotid ultrasound was used to quantify atherosclerosis through a carotid plaque score, and CHA₂DS₂-VA and Systematic COronary Risk Evaluation 2 (SCORE2) scores were calculated to estimate cardiovascular risk. Brain MRI was performed in a randomly selected, blood pressure-stratified subset of participants (2016-2024). CBI was defined as focal lesions consistent with ischaemia in the absence of clinical stroke. Participants with CBI were offered 72-hour ambulatory ECG monitoring for AF detection.

MRI was performed in 414 of 3706 (11%) participants in the ACE 1950 Study. The mean age at the time of the MRI examination was 70.2±2.3 years, and 165 (41%) were women. CBI was identified in 54 participants (13%), of whom 45 (83%) completed 72-hour ambulatory ECG monitoring. There were no differences in mean carotid plaque score, SCORE2 or CHA₂DS₂-VA score between participants with CBI compared with those with normal MRI findings. AF was detected in one (2%) participant with CBI.

In this community-based cohort of individuals in late midlife, individuals with CBI did not have an increased cardiovascular risk compared with those without, as indicated by SCORE2, CHA₂DS₂-VA score, age-appropriate carotid plaque burden and a low prevalence of AF.

URL: https://www.

gov. Unique identifier: NCT01555411.

Safety and efficacy have been well demonstrated for Micra™ leadless cardiac pacemakers (LCPs). However, the presence of sex-specific disparities remains unclear.

The aim of this single-centre observational study was to assess the sex-specific short- and long-term outcomes in patients undergoing LCP implantation.

In total, 378 LCPs were implanted in 127 women (33.6%) and 251 men (66.4%). The most frequent indications included atrial fibrillation with slow conduction (women: 31.5%, men: 44.6%), third-degree atrioventricular block (women: 31.5%, men: 33.5%) and sick sinus syndrome (women: 21.3%, men: 9.6%). Electrical performance parameters of LCPs were similar between sexes. Procedure-related complications during LCP implantation occurred more frequently in women (3.1%) compared to men (0.4%), though no difference was observed for all complications during the index stay (women: 3.9%, men: 1.6%, p = 0.18). In-hospital mortality was low for women (0.8%) and men (0.8%, p = 0.96). A multivariable logistic regression analysis adjusted for sex, age, diabetes, chronic kidney disease, coronary artery disease and transcatheter and surgical valve replacement revealed concomitant lead extraction (OR 9.153, p = 0.001) as the only predictor for complication or death during index stay. All-cause mortality was 30.7% in women (n = 39) and 27.5% in men (n = 69, p = 0.28) during a median follow-up of 41 months (IQR 22-65 months).

No sex-specific disparities were observed with respect to complications during index stay, in-hospital and all-cause mortality. Less frequent use of LCP therapy in women may relate to differing indications between sexes. Further prospective studies may help to develop sex-specific recommendations for LCP therapy.

Renal replacement therapy (RRT) is a life-saving intervention in severe acute kidney injury (AKI). After a clinician-initiated discontinuation, the likelihood of sustained liberation remains uncertain. We aimed to identify predictors of successful RRT weaning and to develop a pragmatic bedside tool (the UNDERSCORE) to support post-discontinuation management.

This post-hoc analysis of two multicenter randomized trials (AKIKI and AKIKI2) included ICU patients with KDIGO stage 3 AKI managed with a conservative initiation approach. Patients were eligible if they underwent an RRT weaning attempt, defined as discontinuation for ≥ 3 consecutive days. The primary outcome was successful weaning, i.e., no RRT resumption within seven days. Independent predictors were identified using multivariable logistic regression, and the resulting model (UNDERSCORE) was externally validated in an independent Swiss ICU cohort.

Among 554 patients who received RRT, 180 underwent a weaning attempt and 101 (56%) were successfully weaned. Six predictors were retained to construct the UNDERSCORE: RRT duration before the attempt, septic shock on admission, baseline serum creatinine, and three clinical variables assessed after the weaning attempt (use of vasopressors, invasive mechanical ventilation, and urine output). The score showed strong discrimination in the derivation cohort (AUC 0.86, 95% CI 0.80-0.91). In the external Swiss cohort (n = 415), 338 patients (81%) were successfully weaned, with fair performance across a broader case mix (AUC 0.73, 95% CI 0.66-0.80).

The UNDERSCORE, derived from a homogeneous conservative RRT initiation cohort and validated in a diverse ICU population, provides a bedside tool to estimate the probability of sustained RRT discontinuation after an initial clinician-initiated stop.

An effective automatic system for ventricular segmentation from MRI is vital for diagnosing cardiovascular diseases, yet challenges persist due to anatomical variations and artifacts.

We preprocess cardiac MRI with min-max normalization, then propose a hybrid segmentation network (ResFAU-net) integrating residual blocks, attention gates, and a Fused Accumulation Bridge module to delineate ventricle boundaries. The segmented regions are classified by the HAMC3 model, which combines cascaded capsule networks, CNNs, and hierarchical attention, with parameters optimized via the Coati Optimization Algorithm (COA).

Rigorous assessment on our CMRI dataset using metrics (Dice, IoU, accuracy, precision, etc.) demonstrates the model's high performance in segmenting and classifying the left and right ventricles achieving an IoU of 96.29 % and accuracy of 99.03 %.

The proposed ResFAU-net and HAMC3 framework offers a robust, end-to-end solution for precise ventricular cardiac analysis, demonstrating strong potential to automate and enhance the efficiency of cardiovascular diagnosis in clinical MRI workflows.

Data on pulsed-field ablation (PFA) for atrial fibrillation (AF) in patients with heart failure (HF) are limited.

To evaluate clinical outcomes of PFA in patients with AF and HF, stratified by HF subtype.

Consecutive patients undergoing first-time pentaspline PFA within the ATHENA registry were analyzed. Patients were stratified into three groups: no HF, HF with preserved ejection fraction (HFpEF, LVEF ≥50%), and HF with mildly reduced or reduced EF (HFmrEF/rEF, LVEF <50%). The primary endpoint was freedom from documented atrial arrhythmias >30 seconds after a 2-month blanking period. AAD use was left to physician discretion.

Among 1,224 patients included (68.5% with paroxysmal AF and 31.5% with persistent AF), 176 (14.4%) had HF: 40 (3.3%) with HFpEF and 136 (11.1%) with HFmrEF/rEF. The Kaplan-Meier estimated freedom from any atrial arrhythmias at 1-year follow-up was 79.9%, with higher rate in the no-HF group (81.0%) vs the HF group (73.3%, HR=1.5, 95%CI: 1.1-2.1, p=0.0133). Considering separately paroxysmal and persistent AF form, paroxysmal AF patients with no sign of HF showed significantly higher freedom from atrial arrhythmias (82.2%) than patients with HF (68.6%, 2.0, 1.3-3.1, p=0.0028), while no differences were found in patients with persistent AF (77.9% vs 76.4%, 1.1, 0.7-1.7, p=0.7065).

PFA with the pentaspline catheter appears to be an effective treatment for AF in patients with HF. Freedom from AF and atrial arrhythmias post-PFA was highest in patients with paroxysmal AF and no history of HF, with no significant differences observed in persistent AF patients.

Juvenile idiopathic arthritis (JIA) leads to significant long-term morbidity from articular and extra-articular complications, yet the burden of comorbidities in adults with long-standing disease is not well characterised. This study aimed to determine the prevalence and incidence of key comorbidities in adults with JIA and assess their association with demographic and clinical features.

We performed a national multicentre retrospective cohort study using data from adults with JIA, defined by the 2001 ILAR criteria, enrolled in the Portuguese Rheumatic Diseases Register (Reuma.pt). Demographic and clinical data, along with comorbidities, were collected. Comorbidities included cardiovascular disease, hypertension, dyslipidaemia, diabetes, thyroid disease, amyloidosis, inflammatory bowel disease, allergy and asthma, osteoporosis, psychiatric disease, and autoimmune disease. Rare conditions were grouped into broader categories. Extra-articular JIA manifestations were excluded. Incidence rates were calculated as the number of new events per 1,000 person-years (95% CI), and prevalence was assessed using frequencies.

The cohort included 748 patients, 65.6% female, with a median age of 27.7 years and a median disease duration of 20.6 years. Oligoarticular JIA was the most common subtype (29.9%). Autoimmune diseases had the highest incidence rate (7.1/1,000 person-years), followed by hypertension (5.1/1,000 person-years) and psychiatric disease (4.0/1,000 person-years). Hypertension (9%), psychiatric disease (8%), and osteoporosis (5%) were the most prevalent comorbidities. Biologic DMARD use was associated with reduced risk of psychiatric disease (OR=0.38, p=0.03), and no significant association with malignancy or infection was found.

JIA patients with long-standing disease frequently develop comorbidities, particularly hypertension. Biologic therapy seems to reduce the risk of comorbidities. Long-term monitoring of comorbidities in JIA patients is paramount.

Over the last two decades, oral small molecules that target intracellular protein kinases that mediate intracellular signaling have been found to be effective in multiple immune mediated inflammatory diseases (IMIDs). Tofacitinib was the first Janus kinase inhibitor (JAKi) approved for rheumatoid arthritis (RA) in 2012 and subsequently baricitinib, upadacitinib, and filgotinib have been approved by various regulatory agencies around the world. Substantial efficacy in RA as well as other rheumatic diseases (axial spondyloarthritis, psoriatic arthritis, giant cell arteritis) and other IMIDs (inflammatory bowel disease, atopic dermatitis) has been demonstrated. Various JAKi are in trials for lupus, inflammatory myopathies and Sjogrens with recent positive results noted in phase 2/3 clinical trials.

Although efficacy has been clearly demonstrated safety concerns have been raised based on the oral surveillance postmarketing clinical trial which demonstrated in RA patients ≥50 years old with cardiovascular risk factors treated with tofacitinib have an increase risk of venous thromboembolism and possibly major adverse cardiovascular events/malignancy compared to tumor necrosis factor inhibitor treated patients. Extensive investigations in clinical trials and real world observations over the last few years have addressed the safety issues with mixed results but have allowed for risk stratification and appropriate use of JAKi. Efforts to develop JAKi that are more selective for specific JAK isoforms are ongoing such as deucravacitinib - a TYK2 inhibitor with a different mechanism of action compared to other JAKi that might have an enhanced safety profile.

Increased use of JAKi in the management of IMIDs is ongoing and will accelerate if the positive results noted in trials for lupus, inflammatory myopathies, and psoriatic arthritis result in regulatory approval. The article highlighted in this review provide an update on the progress being made in newer rheumatic disease indications as well as efforts to better understand the adverse event profile for patients on treatment.

Delineation of the JAK-STAT pathway critical for type 1/II cytokine signaling in late 1990s resulted in the development of multiple JAKi for IMIDs. Tofacitinib was the original JAK inhibitor approved in 2012 followed by baricitinib in 2017 and upadacitinib in 2019 with filgotinib and pefecitinib approved ex-US all for rheumatoid arthritis. Since the original approval JAK inhibitors have been approved for multiple IMIDs. In this manuscript, data from clinical trials evaluating JAK inhibitors for new IMID indications will be reviewed as well as an update on safety data from real world experience.

Hidradenitis suppurativa (HS) is a chronic and debilitating skin disorder. Secukinumab, a biologic agent targeting interleukin-17, is a new therapeutic option for HS. However, data regarding its long-term outcomes are scarce.

To evaluate the long-term effectiveness, safety, and predictors of response to secukinumab in a real-world cohort of patients with moderate-to-severe HS.

Multicentre retrospective cohort study across 12 Italian tertiary referral hospitals. The primary effectiveness outcomes were the proportion of patients achieving Hidradenitis Suppurativa Clinical Response (HiSCR) and a 55% reduction in the International Hidradenitis Suppurativa Severity Score System (IHS4-55) at any time point.

A total of 77 patients (53% female; median age 38 years, interquartile range: 27-50) met the inclusion criteria. At week 52, 36.2% of patients achieved HiSCR and 55.6% achieved IHS4-55. The mean reduction from baseline to week 52 was 50.8% for skin pain Numeric Rating Scale and 55.2% for Dermatology Life Quality Index. Agreement between IHS4-55 and HiSCR was 76.6% (Cohen's kappa 0.5255; 95% CI: 0.4307-0.6202, P < .0001). Patients in Hurley stage 3 had a significantly lower hazard ratio (HR) of achieving IHS4-55 than those in Hurley stage 2 (HR 0.52; 95% CI: 0.31-0.89, P = .017), which persisted in the multivariable model (HR 0.56; 95% CI: 0.31-0.99, P = .044). No new safety concerns were identified.

This study suggests that secukinumab provides clinically meaningful long-term outcomes in HS management, even in bio-experienced patients.

Cardiovascular diseases (CVDs) remain a leading cause of global morbidity and mortality, requiring precise risk prediction models for effective prevention and management. This review maps and evaluates globally utilized and country-specific CVD risk prediction models, including the Framingham Risk Score, Pooled Cohort Equations, PREVENT, WHO/ISH Risk Charts, INTERHEART, and SCORE2. A structured literature search was conducted using PubMed and Google Scholar, from which 30 relevant studies were selected. Most of the models integrate traditional risk factors such as age, sex, blood pressure, cholesterol, and smoking status to estimate CVD risk. While these models demonstrate moderate to good discrimination (C-statistics ranging from 0.66 to 0.80) and validation, their applicability varies across populations, with concerns about overestimation or underestimation in non-original cohorts. Notably, the WHO/ISH and Globorisk models address global diversity by incorporating regional calibrations, making them suitable for low- and middle-income countries. Similarly, the country-specific risk scores outperform global models due to their incorporation of local socio-demographics. Limitations persist across existing models, including the underrepresentation of younger individuals, ethnic minorities, and the exclusion of emerging risk factors. Future efforts must prioritize the development of locally validated, population-specific models to support equitable and effective CVD risk assessment and prevention.