Early vascular aging (EVA) reflects accelerated arterial aging and is increasingly recognized as an important precursor of cardiovascular disease (CVD). Insulin resistance (IR) has been implicated in the pathogenesis of vascular aging. The triglyceride-glucose-body mass index (TyG-BMI), a surrogate marker of IR, has demonstrated predictive value for several cardiometabolic disorders. However, evidence regarding its association with EVA remains limited.

This cross-sectional study enrolled 1,272 Chinese adults aged 30 ~ 59 years who completed brachial-ankle pulse wave velocity (baPWV) measurement. EVA was defined as a baPWV value above the 90th percentile in the corresponding 10-year age group. Multivariable logistic regression models were applied to assess the association between TyG-BMI and EVA. Restricted cubic spline (RCS) analysis was conducted to explore the potential nonlinear relationship. Additional analyses further examined the associations of TyG-BMI with baPWV and Framingham risk score (FRS)-derived indicators. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive ability of TyG-BMI for EVA.

After full adjustment, each 10-unit increase in TyG-BMI was associated with a 14.9% increased risk of EVA (odds ratio [OR] 1.149, 95% confidence interval [CI] 1.083~1.231). RCS analysis revealed a nonlinear association between TyG-BMI and EVA, with a turning point at a TyG-BMI value of 210.98. TyG-BMI also showed a nonlinear association with baPWV and FRS-derived indicators (predicted vascular age, age gap, and predicted 10-year CVD risk). In the fully adjusted model incorporating TyG-BMI, the area under the curve (AUC) for identifying EVA was 0.8533.

This cross-sectional study demonstrated that TyG-BMI was independently and nonlinearly associated with EVA among young and middle-aged Chinese adults. The observed turning point suggests a potential reference point for this association. These findings suggest that TyG-BMI may serve as a simple, readily accessible indicator for assessing EVA risk in this population, pending external validation.

To develop and internally validate a preliminary clinical prediction model for incident gastrointestinal hemorrhage (GH) occurring after admission in children with IgA vasculitis (IgAV), with continuous laboratory predictors retained in original scale to maximize predictive information.

Single-center retrospective cohort including 662 pediatric IgAV patients (2016-2022). The primary derivation cohort comprised 599 patients without overt bleeding on admission, among whom 126 (21.0%) developed delayed-onset GH ≥ 24 h post-admission. Eight admission-based predictors were selected for the Primary Continuous Model (PCM): abdominal pain, vomiting, neutrophil count, eosinophil count, mean platelet volume, albumin, complement C3, and IgA. D-dimer was excluded from the PCM because restricted cubic spline analysis demonstrated a significant non-linear, threshold-dependent relationship rather than a linear association with GH risk (P for non-linearity = 0.032); it was subsequently incorporated into the Simplified Bedside Score (SBS) via its clinically established dichotomous cutoff of 210 µg/L. Multivariable logistic regression with Enter method was performed. Internal validation included 1000-bootstrap resampling, Hosmer-Lemeshow calibration assessment, and decision curve analysis. A simplified dichotomized nine-point bedside scoring system was derived post hoc for clinical triage.

The primary eight-variable continuous model achieved an apparent AUC of 0.790 (95% CI: 0.748-0.832) and a bootstrap optimism-corrected AUC of 0.763. Calibration was excellent (Hosmer-Lemeshow P = 0.917). Five predictors demonstrated independent association with delayed-onset GH (P < 0.05): abdominal pain, vomiting, neutrophil count, MPV, and C3. The simplified dichotomized bedside scoring system yielded a corrected AUC of 0.779, with sensitivity of 77.0% and specificity of 70.2%. Restricted to clinically significant overt severe GH (n = 102), the corrected AUC increased to 0.801.

This admission-based preliminary prediction model achieves moderate discrimination for post-admission GH in pediatric IgAV. The primary continuous model preserves predictive information, while a simplified dichotomized scoring system facilitates bedside triage. In conclusion, this admission-based model preserves substantial predictive information and provides a validated baseline framework; we now propose and open this simplified dichotomized scoring system for external validation across international multicenter pediatric cohorts.

Situs inversus totalis with mirror-image dextrocardia is a rare anatomical condition that creates specific challenges for minimally invasive mitral valve surgery. In totally endoscopic procedures, the reversed cardiac orientation may affect thoracic access, peripheral cannulation, left atrial exposure and accurate identification of mitral valve segments. We report a case of left-sided three-dimensional totally endoscopic mitral valve repair in this setting, with emphasis on operative planning and intraoperative segment orientation.

A 39-year-old woman presented with progressive exertional dyspnea and New York Heart Association class II to III symptoms. Echocardiography showed severe mitral regurgitation caused by posterior leaflet prolapse involving P2 and extending toward P3. Computed tomography angiography confirmed situs inversus totalis, mirror-image dextrocardia, a right-sided aortic arch, bilateral superior vena cavae and an uninterrupted inferior vena cava. A left-sided three-dimensional totally endoscopic approach was used with peripheral cardiopulmonary bypass through the left femoral vessels and supplemental left internal jugular venous drainage. Intraoperative segment orientation was deliberately re-established using the left atrial appendage as a fixed landmark to identify the A1/P1 side and distinguish it from A3/P3. Valve repair consisted of neochordal implantation to the prolapsing posterior leaflet and ring annuloplasty. Intraoperative transesophageal echocardiography, predischarge transthoracic echocardiography and 1-month follow-up transthoracic echocardiography showed no residual or recurrent mitral regurgitation, with preserved left ventricular systolic function at follow-up.

This case illustrates that valve-preserving, totally endoscopic mitral repair can be feasible in situs inversus totalis with mirror-image dextrocardia when imaging, cannulation, access and segment orientation are planned as a single operative strategy. The main educational message is that, in this case, the left atrial appendage served as a practical anatomical reference for maintaining segmental orientation during mitral repair in mirror-image anatomy.

Although transcatheter aortic valve implantation (TAVI) has been demonstrated to be a successful treatment for aortic stenosis, it remains associated with complications, such as paravalvular leakage (PVL). To address these, TAVI devices continue to undergo iterative development. Integration of in silico trials into the regulatory validation pathway offers a promising approach to accelerate the development and clinical implementation of novel TAVI devices. This study addresses the feasibility of conducting large-scale in silico TAVI trials using a virtual cohort generator (VCG) combined with a fast-to-evaluate model. The objective is to investigate anatomical and procedural predictors of PVL in silico, as was done in an earlier clinical study. A virtual cohort of 500 synthetic aortic stenosis patients was generated, that matched anatomical and demographic characteristics of the clinical population. Using a novel fast-to-evaluate TAVI deployment model, nearly 29,000 simulations were performed across multiple model parameter combinations per patient. Shape and demographic distributions in the in silico trial, remained within the bounds of the clinical study. Among the investigated anatomical parameters, a higher angle between left ventricular outflow tract and ascending aorta was found in patients with significant PLV, in both clinical and virtual cohorts. Additionally, the relationship between PVL and implantation depth appeared highly patient-specific, which is in line with findings in clinical studies. The ability to systematically test multiple TAVI deployments scenarios per patient, which is unfeasible in clinical practice, provides valuable insights for procedure design and optimisation. Overall, the results support the feasibility of implementing large-scale in silico TAVI trials, using the VCG and a fast-to-evaluate model, into the regulatory validation chain.

Diagnosis of left ventricular diastolic dysfunction (LVDD) in the context of septic shock is challenging. We aimed to compare different algorithms applied to septic patients.

Secondary analysis of a prospective, single-center study of 98 consecutive adult septic shock patients undergoing comprehensive speckle-tracking echocardiography within 24 h of ICU admission. We studied the prevalence and the prognostic value of five LVDD diagnostic algorithms:2016-American Society of Echocardiography (ASE)/European Association CardioVascular Imaging(EACVI), 2024-British Society of Echocardiography(BSE), 2025-ASE, Lanspa-simplified criteria, and a further Lanspa-modified version hereby proposed (adding LVDD diagnosis when LV ejection fraction< 50%, as in 2016-ASE-EACVI guidelines). Logistic regression and Kaplan-Meier curves were used to explore the association between algorithms and 30-day mortality.

The prevalence of LVDD on day 1 varied widely, ranging from 32.7%(Lanspa) to 72.4%(2024-BSE). Concordance between the three cardiology guidelines ranged from slight to moderate: the lowest agreement among them was observed between the 2016-ASE/EACVI and the 2025-ASE criteria(55.1%, Kappa 0.10), whereas the highest agreement across all five algorithms was seen between the 2016-ASE/EACVI and the Lanspa-modified criteria(88.8%, Kappa 0.77). When correcting for severity score, need for invasive ventilation, and norepinephrine dose, independent prognostic values for 30-day mortality were observed only for the 2025-ASE, the Lanspa and the Lanspa-modified algorithms, but all algorithms had similar predictive performances.

The prevalence of LVDD in septic shock is highly dependent on the diagnostic algorithm utilized. Although only the 2025-ASE, Lanspa, and Lanspa-modified algorithms demonstrated independent prognostic value after multivariable adjustment, prognostic discrimination for 30-day mortality was moderate and comparable across all approaches.

The potential role of structured clinical pretest probability assessment in the diagnostic workup of giant cell arteritis (GCA) is not well defined.

We applied four clinical prediction rules to patients enrolled in the ongoing prospective PREDICT GCA study. All patients underwent temporal artery biopsy in addition to the detailed clinical and sonographic workup. The final diagnosis was based on the 6 months follow-up and ambiguous cases were judged by an independent expert panel. The diagnostic accuracy of the four models was determined using 2×2 contingency tables and receiver operating characteristic analysis. Patients with and without discordant results in different scoring systems were compared using univariate significance tests.

Seventy patients were analysed. The highest diagnostic accuracy (area under the curve (AUC) 0.84) and the highest negative predictive value (NPV, 86.7%) were provided by the Ing et al model. The other scores performed worse, with AUC/NPV of 0.74/78.6% (Southend GCA Probability Score), 0.75/73.7% (Bhavsar-Khalidi Score) and 0.70/77.8% (PREDICT score). In 37.5% of patients, clinically significant discordances in categorisation (classification as both low and non-low risk by different scoring systems) were evident. These patients less frequently presented with clinical symptoms and signs of cranial GCA (all p<0.01), but the rate of visual impairment did not differ from that in patients with consistent risk estimation results.

Clinical prediction models for the diagnosis of GCA differ in their diagnostic accuracy. Clinically relevant discordances of individual risk prediction are common.

DRKS00031293.

In Denmark, hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) are primarily diagnosed and managed in specialised inherited cardiac disease clinics, making them suitable for registry-based studies of diagnostic patterns. Both conditions are associated with substantial morbidity, yet nationwide data on prevalence and geographic variation remain limited. We aimed to describe the prevalence and regional distribution of HCM and ARVC in Denmark.

In this nationwide registry-based study, we included individuals with a diagnosis of HCM or ARVC in Denmark as of 1 July 2024, matched 1:10 to the general population by age and sex. Data on comorbidities, socioeconomic factors and geographic distribution were obtained from national registries. Municipalities were classified by degree of urbanisation.

A total of 4705 individuals were identified, of whom 90% had HCM and 10% had ARVC. The prevalence of HCM was 71 per 100 000 individuals, while ARVC prevalence was 8.1 per 100 000. Compared with the Capital Region, all other regions had significantly higher prevalence of HCM, ranging from 61.4 per 100 000 in the Capital Region to 80.3 per 100 000 in Zealand and was significantly higher in thinly populated than densely populated areas. In contrast, ARVC prevalence showed no significant regional variation and no significant urban-rural differences. Socioeconomic characteristics were broadly similar to the general population.

In Denmark, HCM shows significant geographic and urban-rural variation in diagnosed prevalence, whereas ARVC is more uniformly distributed. These findings suggest that healthcare organisation and referral patterns may contribute to variation in disease detection.

Heart failure with preserved ejection fraction (HFpEF) phenotypes have been characterised as static entities in trial populations yet their temporal dynamics remain unexplored in routine clinical practice. We aimed to identify HFpEF phenogroups from real-world electronic health records (EHRs), characterise their longitudinal stability and determine whether phenogroup trajectories were associated with differences in mortality.

A natural language processing (NLP) pipeline identified HFpEF cases from multisite EHRs (2010-2022). Latent class analysis (LCA) defined baseline phenogroups and annual supervised random forest (RF) classification using time-updated values of the same baseline LCA variables tracked individual transitions over five years. Competing risks regression quantified transition versus death probabilities. Time-varying Cox models assessed mortality risk associated with current (vs baseline) phenogroup status. Phenogroups were independently re-derived by LCA in an external cohort and compared with RF predictions.

Among 2223 patients (60% female, median age 75 years (IQR 63-83); left ventricular ejection fraction (LVEF) 60.1%; follow-up 4.0 years (IQR 2.2-6.1), we identified four phenogroups: young-low comorbidity (22%), obesity-predominant (24%), elderly atrial dysfunction (32%) and cardiovascular-kidney-metabolic (23%). Young-low comorbidity had the highest transition probability (47.7%), while cardiovascular-kidney-metabolic and elderly-atrial dysfunction were highly stable (3.2% and 12.1% transitioned, respectively). Within young-low comorbidity, those who transitioned had greater baseline cardiac abnormalities, including higher E/e', left ventricle mass and wall thickness. Adjusted mortality risk was highest in cardiovascular-kidney-metabolic (HR 1.53, 95% CI 1.22 to 1.92, p<0.001); current phenogroup status discriminated mortality risk modestly better than baseline classification alone (C-index 0.659 vs 0.648). In an independent external cohort (n=3349), RF predictions agreed strongly with independently derived LCA phenogroup labels (C-statistics 0.891-0.953).

Longitudinal NLP-based phenotyping of real-world EHRs identified four reproducible HFpEF phenogroups with distinct trajectories, distinguishing an early progressive disease state from stable advanced phenotypes. Earlier HFpEF detection using artificial intelligence-driven EHR tools could facilitate phenotype-targeted treatment of patients at potentially modifiable stages.

To identify, through structured co-creation with patients across the thoracic aortic disease (TAD) spectrum, which domains of between-visit monitoring patients themselves consider meaningful and to translate these into a patient-driven digital monitoring agenda.

Qualitative co-creation study in four sequential phases: secondary analysis of existing patient engagement material (A), targeted focus groups addressing under-represented perspectives (B), a mixed-stakeholder co-design workshop (C) and a member-check validation session (D). Analysis used reflexive thematic analysis and framework synthesis. Reported following Consolidated Criteria for Reporting Qualitative Research (COREQ).

A single Dutch tertiary referral centre for TAD, 2024-2025.

Adults (≥18 years) with TAD, purposively sampled across three trajectories: surgically managed acute dissection, elective aortic surgery and aneurysm or bicuspid aortic valve under surveillance. Phase A, 45 participants in six sessions; phase B, 13 in two focus groups; phase C, 9 (6 patients, 3 healthcare professionals); phase D, 9 participants from earlier phases.

Patient-derived domains considered relevant to digital monitoring and their translation into components of a monitoring agenda, together with the conditions participants regarded as necessary for such monitoring to be acceptable.

Five domains recurred across trajectories: managing uncertainty and fear of recurrence, interpreting symptoms and bodily signals, blood pressure self-monitoring and variability, life participation including activity and reproductive decisions and accessibility and proportionality. These were translated into an agenda comprising symptom contextualisation, longitudinal blood pressure trends, patient-reported outcomes, contextual activity feedback, educational decision support and transparent escalation pathways. Participants framed monitoring as an adjunct to imaging surveillance, not a replacement, emphasising interpretability and restrained alerting.

Structured patient engagement and iterative co-design produced a patient-driven digital monitoring agenda for TAD integrating biomedical and psychosocial dimensions, describing priorities articulated by these participants rather than their distribution and providing a foundation for developing and evaluating hybrid digital surveillance models in aortic care.

We wanted, as part of a wider study, to elicit perspectives of patients with congenital heart disease (CHD) and/or their parents/carers about which outcomes of CHD and/or cardiac surgery matter and what should be measured and reported.

Qualitative, closed, asynchronous, online discussion forums underpinned by an interpretivist framework.

Three patient charities in the UK set up and moderated separate online forums for adult patients with CHD/carers, adolescent patients with CHD and parents/carers of children and young people with CHD.

Thematic analysis using a codebook approach.

There were five forums in total; 343 participants signed up, two-thirds of whom were adult patients (n=235; 69%). Four themes reflecting different types of outcomes were identified: clinical outcomes related to surgery (eg, diagnosis-based survival, complications, readmission and reintervention rates); other clinical outcomes (eg, long-term survival, use of medications, pregnancy risks and outcomes); outcomes related to service provision (eg, availability of support services, cancellations, delayed follow-up); and patient-reported outcomes (eg, quality of life, mental health outcomes).

Participants identified a range of outcomes about which they wanted more information but within the context of an individualised approach to how much, when and what information is provided. The importance of achieving a balance between knowing so much that it has a detrimental impact on mental health and not knowing enough so that patients/carers are unable to make informed decisions was emphasised.