Perioperative myocardial injury (PMI) is associated with a higher mortality after noncardiac surgery. Ischemic symptoms are uncommon postoperatively due to analgesics used perioperatively, necessitating nonsymptomatic surveillance. Although ST-segment deviation indicates myocardial ischemia, its association with PMI remains poorly understood. This study explored the association between continuous perioperative ST-segment monitoring and PMI in patients undergoing intermediate- to high-risk vascular surgery.

This was a prospective, single-center cohort study. In addition to standard monitoring, all patients were monitored using a six-lead continuous electrocardiography (ECG) with ST-segment analysis perioperatively. ST events were analyzed according to the fourth universal myocardial infarction definition and as individualized deviations from lead-specific baseline values. The primary outcome was PMI, defined by an increase in high-sensitivity cardiac troponin T measured preoperatively and at 4 to 6, 24, and 48 hours postoperatively. Multivariable Poisson regression was used for primary analysis.

In total, 498 patients were included, and 46 (9%) incurred PMI. ST-elevation was seen in 89 (18%) and not significantly associated with PMI (adjusted relative risk [RR], 1.75; 95% confidence interval [CI], 0.87-3.53; P = .12), whereas ST-depression was seen in 38 (8%) and showed a significant association with PMI (adjusted RR, 3.85; 95% CI, 1.86-7.94; P < .001). Absolute ST-segment deviation >1 mm from individualized lead baseline was also associated with PMI (RR, 2.03; 95% CI, 1.01-4.06; P = .046). When ST-depression was added to the baseline model, including age and the American Society of Anesthesiologists (ASA) physical status classification system, overall net risk classification improved (NRI, 0.50; 95% CI, 0.16-0.86).

ST-depression meeting universal myocardial infarction criteria and ST deviations >1 mm from individualized baseline were associated with PMI. Intra- and postoperative ST-segment monitoring may facilitate detection of PMI.

Postoperative atrial fibrillation (POAF) is the most common complication of myocardial revascularization surgery, associated with predisposing factors and outcomes such as increased hospital stay, higher stroke and mortality rates. The objective of this study is to estimate the incidence of POAF and associated factors and outcomes, with emphasis on peripheral arterial disease.

A retrospective cohort study was carried out involving adult patients admitted to admitted to the intensive care unit in the immediate postoperative period of myocardial revascularization surgery in a private hospital in South Brazil. Sociodemographic data, comorbidities, hospital and intensive care unit stay, occurrence of stroke and death were collected. Multivariate analyses were performed to identify independent relationships between variables using Poisson Regression with a robust estimator. Relative risks and 95% confidence intervals were estimated.

A total of 421 patients were included. The incidence of POAF was 23.8% (100 patients), statistically and independently associated with patient's older age (p<0.001), with systemic arterial hypertension (p<0.001) and with peripheral arterial disease (p<0.001). Increased incidence of POAF was also associated with increased hospital and intensive care unit length of stay.

A higher incidence of POAF after myocardial revascularization was associated with peripheral arterial disease, older age, and systemic arterial hypertension.

Cardiac arrhythmias are heterogeneous conditions that may limit physical activity (PA) and impair quality of life (QoL). To describe levels of PA and perceived barriers as well as to assess their associations with arrhythmia phenotype and QoL in tertiary care outpatients with preserved left ventricular (LV) function. This pilot cross-sectional study enrolled adults with documented arrhythmias and LV ejection fraction (LVEF) ≥ 50%. PA was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and QoL using the 12- Item Short Form Survey (SF-12). Arrhythmias were classified as supraventricular tachycardia (SVT), atrial fibrillation (AF) and/or atrial tachycardia (AT) (including atrial flutter when applicable), ventricular, inherited, or multiple. Associations were analyzed using chi-square tests, multinomial regression, and linear regression models. Among 202 participants (mean age 50.5 ± 15.3 years; 58.9% men), 20.3% were sedentary and 45.6% were active or very active. The prevalence of sedentary behavior was higher among patients with ventricular arrhythmias (25.9%), inherited arrhythmias (35.1%), and multiple arrhythmias (25.0%) compared with those with SVT (3.8%) and AF/AT (8.0%) (p = 0.043). In adjusted models, active or very active PA showed a trend toward higher SF-12 physical component scores (p = 0.08), whereas mental component scores were primarily influenced by symptom status and sex. In this tertiary outpatient cohort with arrhythmias and preserved LVEF, physical inactivity clustered among higher-risk phenotypes and was frequently associated with potentially modifiable barriers, including medical advice and lack of time. Higher levels of PA tended to be associated with better physical health status, supporting individualized, risk-based counseling and supervised strategies to safely promote PA in patients with arrhythmias.

Chagas disease affects millions worldwide and remains a leading cause of cardiomyopathy in Latin America. Early diagnosis remains challenging in endemic regions. Artificial intelligence (AI)-based electrocardiography (ECG) analysis may offer a low-cost strategy for large-scale screening in resource-limited settings.

To evaluate the performance of an AI-ECG algorithm combined with clinical data for detecting Chagas disease in a community-based screening program conducted in a highly endemic region in Northeastern Brazil.

In August 2024, 1,115 adults underwent standardized 12-lead ECG acquisition during a field campaign in Feira de Santana, Bahia, Northeast Brazil. A previously trained AI model analyzed ECG tracings and incorporated three clinical variables: i) prior residence in triatomine-infested areas, ii) poor housing conditions, and iii) family history of Chagas disease. Individuals flagged as AI-positive were classified as suspected cases. Suspected cases and matched controls (2:1) underwent point-of-care serological testing.

The algorithm flagged 121 individuals (10.9%), corresponding to an estimated AI-based prevalence of Chagas disease of 7.8% (95%CI: 6.2-9.6). Among the 112 individuals who completed serological testing, 13 tested positive, all within the AI-positive suspected group; no seropositive cases were identified among controls. Sensitivity was 100% (95%CI: 69-100), specificity 40% (95%CI: 30-50), negative predictive value 100% (95%CI: 91-100), and positive predictive value 12% (95%CI: 11-14), with a diagnostic odds ratio of 6.6.

An AI-ECG algorithm combined with simple clinical variables demonstrated excellent sensitivity for the detection of Chagas disease and may represent a valuable triage tool in endemic, resource-constrained settings.

Patients with Wolff-Parkinson-White (WPW) syndrome frequently develop atrial fibrillation (AF); however, the factors associated with the occurrence of AF remain incompletely defined.

To evaluate the prevalence and associated factors of clinical AF and electrophysiological study (EPS)-induced AF in a large consecutive cohort of patients with WPW undergoing accessory pathway (AP) ablation.

This retrospective analysis included 845 consecutive patients with WPW who underwent AP ablation at a single tertiary referral center. A standardized EPS protocol was applied throughout the study period. Study outcomes included clinical AF (documented by medical history or monitoring before EPS), EPS-induced AF, and any AF (composite outcome). Multivariable logistic regression models were used to estimate adjusted odds ratio (ORa) with 95% CIs. Statistical significance was set at p < 0.05.

Mean age was 33.2 ± 15.9 years, and 486 of 845 patients (57.5%) were male. Multiple APs were identified in 31 patients (3.7%). The most common AP locations were left lateral (327/845, 38.7%) and posterior (323/845, 38.2%). Clinical AF was present in 109 patients (12.9%), EPS-induced AF in 77 (9.1%), and any AF in 168 (19.9%). In multivariable analyses, a left lateral AP was independently associated with clinical AF (ORa, 2.31; 95% CI, 1.53-3.49; p < 0.001), whereas a posterior AP was associated with EPS-induced AF (ORa, 1.78; 95% CI, 1.07-2.91; p = 0.025). Female sex was associated with lower odds of EPS-induced AF (ORa, 0.56; 95% CI, 0.34-0.93; p = 0.025). Increasing age was independently associated with clinical AF (per-year ORa, 1.018; p = 0.007) and any AF (per-year ORa, 1.014; p = 0.009).

In this large cohort of patients with WPW undergoing AP ablation, left lateral AP location and older age were independently associated with a higher prevalence of clinical AF. In contrast, posterior AP location and male sex were associated with a greater likelihood of EPS-induced AF.

The prognostic value of coronary artery calcium (CAC) score in nonobstructive coronary artery disease (NObCAD; stenosis < 50%) remains insufficiently characterized.

To investigate the association between CAC score, cardiovascular risk factors, and clinical outcomes in patients with NObCAD.

A total of 2,509 patients underwent coronary computed tomography angiography (CTA) and were followed for 8.9 ± 2.6 years. Plaque burden was classified according to CAD-RADS™ 2.0 into none, mild, moderate, and high/highest. The primary endpoint (PEP) was a composite of all-cause mortality, acute coronary syndrome/acute myocardial infarction, and stroke. Statistical significance was set at 5%.

CAC score was 0 in 45.4% of patients, 1-99 in 36.6%, and ≥ 100 in 18.0%. Correspondingly, 38.3% of patients had no coronary lesions, 38.5% had mild lesions, 14.1% had moderate lesions, and 9.2% had high/highest lesions. Among patients with CAC = 0, the absence of coronary lesions predominated (81.2%), whereas it was rare among those with CAC ≥ 100. The PEP occurred in 4.9% of patients, predominantly driven by all-cause mortality. Among the 396 patients with serial coronary CTA (mean interval: 6.5 ± 2.6 years), CAC progression (> 2.5 increase based on the square root method) was observed in 41.9%. Plaque burden increased in parallel. CAC score showed a positive association with plaque burden and cardiovascular risk factors.

In NObCAD, CAC is present in more than half of patients and is associated with both plaque burden and cardiovascular risk factors. The incidence of PEP increases in proportion to risk factor burden and CAC levels. CAC and plaque burden progress concurrently over time, supporting the role of CAC as a surrogate marker of subclinical atherosclerosis progression.

Permanent pacemaker implantation is an established treatment for both sick sinus syndrome (SSS) and atrioventricular block (AVB), yet limited data exist comparing long-term clinical outcomes and cardiac remodeling patterns between these distinct bradyarrhythmic etiologies.

To compare three-year clinical outcomes and cardiac structural changes between SSS and AVB patients following permanent pacemaker implantation.

This retrospective observational study enrolled 192 adult patients (65 SSS, 127 AVB) who underwent pacemaker implantation between January 2018 and December 2020. Demographic data, echocardiographic parameters, pacemaker-recorded data, and clinical outcomes were assessed at baseline, one month, six months, one year, and three years. Primary outcomes included changes in cardiac structure and function, symptomatic improvement, new-onset atrial fibrillation, rehospitalization, and all-cause mortality.

Both groups demonstrated significant declines in left ventricular ejection fraction over three years (SSS: 57.2±6.0% to 54.3±8.3%, p<0.001; AVB: 55.5±7.0% to 53.0±6.8%, p<0.001). Despite similar ventricular dysfunction progression, distinct remodeling patterns emerged: SSS patients exhibited significant increases in left atrial diameter (31.3 to 38.8 mm, p=0.040), left ventricular end-diastolic diameter (45.2 to 51.0 mm, p<0.001), and mitral regurgitation prevalence (26.2% to 64.6%), while AVB patients maintained stable chamber dimensions despite high ventricular pacing burden (>90%). Symptomatic improvement was comparable (SSS: 85.6% vs. AVB: 83.5%, p=0.84), as were new-onset atrial fibrillation (41.5% vs. 37.0%, p=0.54), rehospitalization (50.8% vs. 58.3%, p=0.38), and all-cause mortality (13.8% vs. 11.8%, p=0.69). Mortality predictors differed: mitral regurgitation severity in SSS versus coronary artery disease, beta-blocker therapy, and left atrial volume in AVB patients.

Despite similar symptomatic benefits and clinical outcomes, SSS and AVB patients demonstrate distinct cardiac remodeling patterns and different mortality predictors, supporting the need for etiology-specific follow-up strategies in pacemaker recipients.

to analyze caregivers' and health professionals' perceptions of interventions that promote self-care in stroke survivors.

qualitative study within an interpretivist paradigm; we conducted nine interviews with family caregivers and three focus groups with health professionals. Data were collected in Angola (December 2024-January 2025), audio-recorded, transcribed, and analyzed using content analysis in webQDA®.

central concerns include planning and continuity of individualized rehabilitation programs to ensure ongoing support, communication, and access to resources; training stroke survivors and their families for self-care management through information and education, prevention of self-neglect, and support for therapeutic regimen management; and training family caregivers to promote self-care and transition into the caregiver role.

the findings clarify caregivers' and health professionals' perceptions of how self care is promoted among stroke survivors and yield recommendations for clinical practice and research.

Aphasia following stroke is primarily characterized by language impairment; however, accumulating evidence suggests that deficits in auditory and cognitive processing may also contribute to impaired language function. Auditory evoked potentials provide objective markers of neural processing across subcortical, cortical, and cognitive levels and may help clarify the neurophysiological mechanisms underlying post-stroke aphasia.

To investigate multilevel auditory processing and its relationship with language performance in individuals with post-stroke aphasia using Auditory Brainstem Responses (ABR), Late Latency Responses (LLR), and P300 potentials.

Cross-sectional observational study conducted at a university hospital in Türkiye.

Twenty-nine individuals with post-stroke aphasia and 33 age-matched healthy controls were included. Language performance was assessed using the Aphasia Language Assessment Test and a standardized naming task. Auditory processing was evaluated using ABR, LLR (P1, N1, P2, N2), and P300 potentials recorded according to standard electrophysiological protocols. Group comparisons were performed for latency and amplitude measures, and correlation analyses were conducted to examine associations between electrophysiological parameters and language performance.

Compared with healthy controls, individuals with aphasia demonstrated significantly prolonged latencies in ABR waves and interpeak intervals, as well as in all LLR and P300 components (p < 0.05). No significant group differences were observed in amplitude measures. Naming performance was significantly lower in the aphasia group. Although correlations between language performance and electrophysiological measures did not reach statistical significance, moderate negative trends were observed between naming scores and N2 and P300 latencies.

Post-stroke aphasia is associated with delayed auditory processing across subcortical, cortical, and cognitive levels, reflecting generalized slowing rather than reduced neural recruitment. Latency-based auditory evoked potential measures may complement behavioral language assessments and support a multilevel auditory-cognitive framework for aphasia evaluation and rehabilitation.

The prognostic utility of the Hata angiographic classification for long-term outcomes in Takayasu arteritis (TAK) remains unclear.

To evaluate the prognostic value of the Hata classification for predicting major adverse cardiovascular events (MACE) and the need for vascular interventions in patients with TAK.

This single-center, retrospective cohort study included patients diagnosed with TAK between 2000 and 2025. Multivariate logistic regression analyses were performed to identify independent predictors, with statistical significance defined as p < 0.05.

Of 203 patients initially identified, 18 were excluded. The final cohort included 185 patients, of whom 80.0% were women, with a median age at diagnosis of 29 years. Type V was the predominant angiographic pattern (64.9%). During a median follow-up of 10.8 years, MACE occurred in 35.7% of patients, while 37.3% required vascular intervention. The Hata classification was not associated with MACE occurrence. Independent predictors of MACE included female sex, which was protective (odds ratio [OR], 0.38; 95% CI, 0.17-0.86; p = 0.021), and longer symptom onset-to-diagnosis time, which increased risk (OR, 1.10; 95% CI, 1.03-1.18; p = 0.006). In contrast, the Hata classification independently predicted the need for vascular intervention. Hata Type I showed a strong protective association compared with Type V (OR, 0.10; 95% CI, 0.01-0.53; p = 0.029). Baseline aortic insufficiency was also independently associated with a higher likelihood of intervention (OR, 2.54; 95% CI, 1.18-5.60; p = 0.018) (Central Illustration).

The Hata classification appears to be a robust predictor of vascular intervention but not MACE in TAK. Greater anatomical disease extension (Type V) and baseline aortic insufficiency were associated with increased procedural risk, whereas MACE risk was associated with diagnostic delay and male sex. The observed long-term dissociation between high rates of clinical remission (92.4%) and continued disease progression underscores the importance of imaging-based surveillance and highlights the need for prospective multicenter studies to validate these findings.