Cardiovascular (CV) disease is a leading cause of morbidity and mortality after liver transplantation (LT). Coronary computed tomography angiography (CCTA) has increasingly replaced stress testing (ST) for CV risk assessment in LT candidates with intermediate-to-high CV risk, although comparative evidence remains limited. The primary endpoint was the incidence of post-LT major adverse cardiovascular events (MACE) by CV screening modality; the secondary endpoint was to identify predictors of MACE.

This single-center retrospective study included 506 patients who underwent LT between 2018 and 2023. According to CV screening modality, patients were stratified into three groups: no test (low CV risk), ST, or CCTA.

Among 506 LT recipients, 358 (70.8%) presented low CV risk, 57 (11.3%) underwent ST, and 91 (18.0%) CCTA. Compared with ST, CCTA led to higher rates of coronary angiography (14% vs. 31.9%, p = 0.011) and revascularization (0% vs. 15.4%, p < 0.0001). After a median follow-up of 2.5 years [IQR 1.5-3.9], MACE occurred more frequently in CCTA (18.4%) and ST (14%) groups than in low-risk group (9%) (p = 0.041), while no significant difference was observed between CCTA and ST groups (14% vs. 18.4%, p = 0.501). In univariate and multivariate Cox-regression analysis, only age and family history of coronary artery disease were independent predictors of MACE.

CCTA and ST resulted in comparable post-LT CV outcomes. Although CCTA was associated with a higher number of pre-LT coronary interventions, it was not associated with a lower incidence of MACE, underscoring the need to refine CV risk stratification protocols in LT candidates.

Currently, there are no international guidelines for cardiovascular screening procedures in LT candidates, leading to variability in practice across different centers and countries. Coronary computed tomography angiography (CCTA) has emerged as a more accurate method than stress testing (ST) in detecting coronary artery disease (CAD) in patients with end-stage liver disease. In the present study, all pre-transplant coronary revascularizations were performed in patients screened with CCTA, while none occurred in the ST group. Despite this, the incidence of post-LT major adverse cardiovascular events (MACE) was similar between groups. In our cohort, revascularizations prompted by CCTA did not significantly reduce post-LT MACE rate. Age and family history of CAD were the only independent predictors of MACE. Our results underscore the need to refine cardiovascular risk stratification protocols for LT candidates.

This study presents the development and validation of a multimodal framework that incorporates CT-based radiomics, machine learning algorithms, and clinico-radiologic features to enhance the detection accuracy of symptomatic carotid plaques. Clinically applicable nomograms were established for personalized risk stratification and management in asymptomatic patients.

This retrospective study analyzed computed tomography angiography (CTA) data from 206 head and neck patients at Ordos Central Hospital (January 2020-June 2024), including 157 symptomatic and 49 asymptomatic individuals. Patients were randomly allocated into training/validation cohorts (7:3 ratio), with an additional prospectively enrolled cohort of 44 carotid plaque cases from Jining First People's Hospital serving as an independent test set. Following radiomics feature extraction from CTA images, machine learning models were constructed using tree-based algorithms (Random Forest, XGBoost, LightGBM). An integrated multimodal model combining clinical variables, radiological characteristics, and radiomics signatures was developed. Performance was assessed via receiver operating characteristic (ROC) analysis, reporting area under the curve (AUC), sensitivity, and specificity metrics.

Multivariable analysis identified high-density lipoprotein cholesterol (HDL-C) levels and a history of diabetes as independent predictors of symptomatic carotid plaques. Radiomics models utilizing machine learning demonstrated moderate to strong diagnostic capability, yielding AUCs of 0.625-0.814 in the validation cohort and 0.743-0.802 in the test cohort. The multimodal integrated framework consistently surpassed standalone models, attaining AUCs of 0.836 in the validation set and 0.845 in the test set, which were significantly higher than both clinical and radiomics predictors alone.

The CT radiomics-based machine learning model developed in this study demonstrated favorable diagnostic efficacy in discriminating symptomatic carotid plaques. The multimodal framework integrating clinical indicators with radiomic signatures significantly enhanced the model's discriminative power and generalizability. This work confirms the clinical potential of radiomics analysis derived from routine CTA for precision risk assessment in cardiovascular disease, providing a novel supportive tool for individualized risk stratification of carotid atherosclerosis.

CT imaging-based radiomics and machine learning models can effectively support clinical decision-making, enhance risk stratification for carotid plaque patients, and facilitate personalized treatment strategies.

Venous leg ulcers are a common manifestation of chronic venous disease and are associated with substantial morbidity and impaired health-related quality of life (HRQoL). Patient-reported outcome measures are essential for capturing the patient perspective of disease burden and treatment outcomes in wound care management. The Sheffield Preference-based Venous Ulcer questionnaire (SPVU-5D) is a concise preference-based instrument designed to assess the quality of life in individuals with venous leg ulcers and to support health-economic evaluation. However, its measurement properties have not been extensively examined in different linguistic contexts. This study aimed to evaluate the psychometric properties of the Spanish version of the SPVU-5D in patients with venous leg ulcers. A methodological validation study was conducted involving 132 patients (264 observations from pre- and post-treatment assessments) with a mean age of 63.76 ± 10.02 years. Cross-cultural adaptation followed the established guidelines for translation and cultural equivalence. Content validity was assessed using Aiken's V coefficient. Structural validity and reliability were examined using multilevel confirmatory factor analysis and measurement performance was further evaluated using a multilevel graded response model based on item response theory. Floor and ceiling effects, minimum detectable change and convergent validity with the RESVECH 2.0 clinical scale were also evaluated. Confirmatory factor analysis supported a unidimensional structure with excellent fit indices and satisfactory internal consistency. Item response theory analyses showed high item discrimination and well-distributed difficulty thresholds for the items. The floor and ceiling effects were minimal, indicating adequate sensitivity across the latent trait continuum. The Spanish version of the SPVU-5D demonstrates satisfactory validity, reliability and measurement precision and represents a useful instrument for assessing the health-related quality of life in patients with venous leg ulcers.

Iron is an essential trace element for life, playing critical roles in oxygen transport, electron transfer, and DNA synthesis. Recently, it has been increasingly linked to cardiovascular diseases. To investigate this connection, our study analyzed two major clinical databases, MIMIC and eICU, to assess the short-term (28-day) prognostic value of iron metabolism biomarkers-including serum iron, ferritin, transferrin, and total iron-binding capacity (TIBC)-in patients with acute coronary syndrome (ACS). We conducted a retrospective cohort study using data from patients with ACS in the Medical Information Mart for Intensive Care (MIMIC-IV v2.2) database as the internal cohort. For external validation, we utilized the eICU Collaborative Research Database (v2.0). To examine the association between iron biomarkers (serum iron, ferritin, transferrin, and TIBC) and short-term adverse outcomes in ACS patients, we employed multivariate Cox regression, restricted cubic spline (RCS) analysis, and Kaplan-Meier (KM) survival curves. Subsequently, we randomly split the internal cohort into a training set (70%) and a testing set (30%). Univariate logistic regression was applied to identify common prognostic variables across the training set, testing set, and the external validation cohort. Using these shared variables, we developed a multivariate logistic regression model for risk prediction. Finally, the performance of this predictive model was evaluated using receiver operating characteristic (ROC) curve analysis. The study ultimately included 1,652 ACS patients from the MIMIC cohort and 701 from the eICU cohort, with 28-day mortality rates of 10.90% and 20.40%, respectively. In the fully adjusted multivariable model, iron biomarkers showed significant associations with 28-day mortality. Elevated ferritin predicted higher mortality risk (per-unit increase: HR 1.001, 95% CI 1.001-1.002, P = 0.001; Q4 vs. Q1: HR 1.983, 95% CI 1.143-3.440, P = 0.015), while higher transferrin and TIBC were protective. The quartile-based analysis revealed clinically meaningful risk gradients. In contrast, higher levels of transferrin (per-unit increase: HR 0.996, 95% CI 0.993-0.999, P = 0.001; Q4 vs. Q1: HR 0.448, 95% CI 0.265-0.756, P = 0.003) and TIBC (per-unit increase: HR 0.995, 95% CI 0.993-0.998, P = 0.001; Q4 vs. Q1: HR 0.437, 95% CI 0.260-0.734, P = 0.002) were associated with a protective effect. RCS analysis revealed a linear relationship between transferrin, TIBC, and the risk of short-term adverse outcomes, while the relationship for ferritin was nonlinear. Finally, ROC analysis demonstrated that the risk prediction model, which integrated iron biomarkers with eight other independent predictors, outperformed traditional critical illness scoring systems in identifying high-risk ACS patients. The AUC values were 0.70 for the training set, 0.75 for the testing set, and 0.69 for the external eICU validation set. All findings were consistently validated in the external eICU cohort. This study confirms that iron metabolism biomarkers-specifically ferritin, transferrin, and TIBC-serve as independent predictors of 28-day mortality risk in patients with acute coronary syndrome, whereas serum iron showed no significant association with short-term mortality. The risk prediction model developed from these markers demonstrated superior discriminative performance (AUC: 0.69-0.75) compared to conventional scoring systems during both internal and external validation. These biomarkers not only showed statistically significant continuous associations but also enabled clear risk stratification, with extreme quartiles demonstrating markedly different mortality risks. These findings suggest that assessing the iron metabolic profile could aid in the early identification of high-risk patients and provides a valuable foundation for future research into targeted therapeutic strategies.

Allogenic blood product transfusion has well-documented risks and adverse outcomes. To limit perioperative transfusions for neonates and infants undergoing cardiac surgery, our institution launched a blood conservation program in May, 2021. Over the past several years, our standard has changed from blood priming the cardiopulmonary bypass (CPB) circuit for most patients ≤12 kilograms (kg) to administering an asanguinous prime to all patients with an adequate baseline hematocrit (HCT), regardless of weight. For those requiring transfusion, the technique of modified blood priming (MBP), introduced herein, presents an intermediate solution between a clear and standard blood prime, with the goal of administering the minimum amount of packed red blood cells (PRBC) to maintain safe oxygen-carrying capacity while on CPB.

The crystalloid prime in the core of the CPB circuit (venous reservoir, arterial pump boot, and oxygenator) is displaced with a pre-calculated amount of PRBC to maintain an on-bypass HCT of ≥24%. In addition, the crystalloid in the arterial and venous lines is replaced with patient blood volume via retrograde and venous autologous priming (RAP and VAP). Once CPB is established, the remaining crystalloid in the ultrafiltration (UF) and cardioplegia (CPG) circuits is displaced into a syringe with circulating blood to minimize any further hemodilution.

We have applied MBP to 26 patients weighing less than 7 kg. The mean amount of PRBC these patients received during CPB, including in the prime, was half the amount when compared to the initial amount of PRBC we include in our institution's standard blood prime alone.

The MBP technique allows safe initiation of CPB in the subset of neonates and infants with a post-dilutional hematocrit (PDHCT) calculated at less than 24% while avoiding excessive transfusion of exogenous blood products.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare yet life-threatening congenital cardiac anomaly in which the left coronary artery originates from the pulmonary trunk, leading to severe myocardial ischemia, infarction, and progressive heart failure if untreated. Definitive management requires surgical reimplantation of the anomalous artery into the aorta, supported by meticulously tailored cardioplegia to protect the vulnerable pediatric myocardium, whose perfusion is further complicated by right-to-left coronary collaterals. This manuscript reports the findings of a targeted narrative review of operative videos, technical tutorials, and institutional protocols, synthesising practical knowledge on myocardial protection strategies for ALCAPA repair. Three techniques emerged as the most widely adopted and technically distinct: (1) simultaneous aortic and pulmonary-root administration of cold Custodiol^®, providing prolonged single-dose crystalloid protection; (2) antegrade cold-blood cardioplegia supplemented by direct left-coronary ostial perfusion after main pulmonary artery transection, allowing staged protection during extended cross-clamp times; and (3) a classical normothermic blood protocol with repeated root doses and routine half-dose ostial delivery, offering dynamic electrolyte control and familiarity to most congenital teams. For each strategy, we summarise precise indications, operative setup, perfusion pressures, dosing schedules, and practical tips for managing collateral-driven early electrical activity. By distilling evidence and expert practice into a concise technical comparison, this narrative review provides congenital cardiac surgeons with an up-to-date, step-by-step reference for safe, effective myocardial protection in ALCAPA repair.

Although the literature on extracorporeal cardiopulmonary resuscitation (ECPR) has grown substantially, coherent integrative paradigms remain limited. This study synthesizes two decades of research to elucidate knowledge gaps and orient future inquiry.

A mapping review of studies from 2004 to 2024 was performed via PubMed and EMBASE. Only studies comparing ECPR to conventional cardiopulmonary resuscitation were included. Data were extracted and synthesized thematically.

A total of twenty studies were included, the majority being retrospective and observational design, including three interventional studies. Mortality rates following ECPR remain high and more or less constant, up to 86%. To improve chances of survival, several factors need to be considered. First is patient selection: age limit, initial cardiac rhythm, bystander resuscitation with sufficient efficacy, and maximum low-flow time are common criteria, although inconsistently applied. Some studies suggest higher ECPR survival rates in specific clinical scenarios, but none of the previous studies have yet succeeded in formulating an algorithm that facilitates the identification of the most suitable candidates. The second factor affecting outcomes is the pathophysiologic processes during ECPR. This is largely unexplored territory, with current knowledge limited to observational studies of low-flow injury. Most studies do not report on factors including temperature management during support, pump flow, target mean arterial pressures, and oxygenation strategies. Lastly, and potentially most significantly, is the timing of ECPR initiation. Timely restoration and maintenance of circulation and oxygenation halt the accumulation of oxygen debt and commence oxygen debt repayment. To date, data on optimal initiation timing thresholds remains undetermined.

Current ECPR literature lacks knowledge across three interdependent domains that require an integrated approach: validated selection criteria, a mechanistic understanding of ischemia-reperfusion injury, and precise initiation-timing strategies. A multidisciplinary research agenda is needed to unlock the true value of ECPR in cardiac arrest care.

Acute decompensated heart failure is a clinical syndrome characterized by upregulation of neurohormonal compensatory mechanisms that, while intended to preserve organ perfusion as a response to reduced cardiac output, progressively exacerbate systemic congestion. Perfusion, defined by adequate oxygen delivery to the tissues, is more complex than simple cardiac output and arterial inflow, and is also significantly influenced by venous backpressure, as well as microcirculatory autoregulation. Therefore, as venous pressures continue to rise, these may ultimately contribute to hypoperfusion and, therefore, cardiogenic shock (CS). Other mechanisms, such as inflammation and increased organ capsular pressure, can contribute to further impairments in tissue oxygenation. This gradual and often clinically unrecognized deterioration from acute decompensated heart failure to heart failure-related CS (HF-CS) contrasts with acute myocardial infarction-related CS, where underlying compensatory mechanisms are more limited. Furthermore, prolonged and unrecognized hypoperfusion may further worsen HF-CS through progressive microcirculatory dysfunction with subsequent uncoupling of macrocirculation and microcirculation. At this point, normalization of macrocirculatory parameters may no longer restore tissue oxygenation. Early identification of hypoperfusion is, therefore, critical so that interventions targeting systemic hemodynamics may still improve tissue perfusion and reverse circulatory collapse. This review (1) outlines the pathophysiology of hypoperfusion in HF-CS; (2) summarizes invasive, biochemical, and imaging parameters to detect hypoperfusion; (3) phenotypes HF-CS profiles; and (4) proposes a monitoring framework for hypoperfusion in HF-CS.

The Fontan procedure constitutes the definitive surgical strategy for complex congenital heart disease, establishing a circulation in which systemic venous blood is directed to the pulmonary arteries through a staged reconstruction that separates systemic and pulmonary venous return in the absence of a subpulmonary ventricle. This uniquely altered haemodynamic state exerts deleterious effects on endothelial function, thereby promoting progressive end-organ dysfunction and contributing substantially to the long-term morbidity observed in patients with Fontan circulation. ΜETHODS/RESULTS: Over recent decades, clinical research has employed a range of functional methods to assess macro- and microvascular function, as well as arterial stiffness. This review summarizes the available functional non-invasive techniques for evaluating vascular function in the Fontan circulation and discusses the existing evidence linking these vascular parameters to cardiac dysfunction, associated comorbidities, and clinical outcomes in this population.

Functional non-invasive vascular assessment may provide valuable information for monitoring disease progression and risk stratification in Fontan circulation; however, further longitudinal studies are required to clarify its prognostic significance and potential clinical utility.

Children with congenital heart disease (CHD) are at high risk of malnutrition, feeding difficulties and altered body composition beyond infancy. Nutritional decisions are often based on cardiac anatomy. Although anatomy alone does not capture differences in metabolic demand, mesenteric perfusion and feeding intolerance. This review presents physiology-based framework to guide nutritional support in pediatric CHD care pathway.

Recent evidence favors early enteral feeding when hemodynamically appropriate, prioritizing human milk in high-risk infants, standardizing perioperative feeding protocols, assessment beyond weight alone and early attention to oral feeding skills. Long term concern includes micronutrition deficiency, protein losing enteropathy, sarcopenia, obesity and feeding difficulties. Some evidence remains unclear in several areas including exact calorie and protein goal, hemodynamic feeding threshold, weight loss medications in pediatric CHD. Five hemodynamic categories (systemic hypoperfusion, global hypoxia, pulmonary over circulation, mixing lesions, and single-ventricle physiology) may providea practical way to guide nutrition decisions than anatomic diagnosis alone. Matching feeding strategy to mesenteric perfusion, metabolic demand, and complication risk may improve consistency of care but pediatric-specific prospective studies stratified by hemodynamic physiology with patient-centered endpoints are needed.