Residual inflammatory risk after acute myocardial infarction (AMI) remains an important determinant of long-term outcomes despite optimal lipid-lowering therapy. The prognostic significance of serial high-sensitivity C-reactive protein (hs-CRP) measurements beyond the acute phase remains unclear. This study compared baseline and 1-year hs-CRP for predicting 3-year major adverse cardiovascular events in patients with AMI undergoing percutaneous coronary intervention.

We analyzed a large prospective AMI registry in which hs-CRP was measured at baseline and 1 year, classifying patients at each time point using a ≥ 2 mg/L threshold. The primary endpoint was 3-year MACE, including cardiovascular death, recurrent myocardial infarction, stroke, repeat revascularization, and stent thrombosis.

Among 16,371 patients, 9,618 (58.8%) had elevated hs-CRP at baseline. Of the 5,389 patients with 1-year data, 28.9% had elevated hs-CRP. Baseline hs-CRP predicted MACE within the first year (hazard ratio [HR] 1.38, 95% CI 1.21-1.57); however, this association was no longer significant beyond 1 year. One year hs-CRP independently predicted subsequent 2-year MACE (HR 1.33, 95% CI 1.01-1.77). Patients with persistently high hs-CRP (≥ 2 mg/L at both time points) had the highest 3-year MACE risk (HR 1.49, 95% CI 1.08-2.06, p = 0.015 vs. persistently low group) than patients with recovered, worsening, and persistently low hs-CRP.

In patients with AMI, hs-CRP measured at 1-year provides stronger long-term prognostic information than that at baseline beyond 1 year. Routine assessment of hs-CRP may improve risk stratification and guide targeted anti-inflammatory strategies in secondary prevention.

Distal radial access (DRA) has been associated with fewer access-site complications, but evidence in acute coronary syndrome (ACS) remains limited. This study evaluated the feasibility and safety of DRA in ACS patients with good arterial pulsation.

Patients with good arterial pulsation from the prospective, multicenter KODRA registry were analyzed, comparing those with ACS (n = 1,618) and non-ACS (n = 2,588). The primary efficacy endpoint was successful coronary angiography (CAG) without access-site crossover. The primary safety endpoint was DRA-related bleeding, and the secondary safety endpoint was radial artery occlusion (RAO). Multivariable logistic regression was performed to assess the association between ACS and study endpoints.

The mean age was 66.3 ± 11.9 years, and 69.6% were male. The rate of successful CAG without access-site crossover was comparable between ACS and non-ACS patients (94.2% vs. 94.9%, p = 0.094). DRA-related bleeding occurred more frequently in ACS (4.3% vs. 2.6%, p = 0.002). RAO rates were similar before discharge (0.1% vs. 0.2%, p = 0.396), but lower at one-month in ACS patients (0.3% vs. 1.0%, p = 0.010). ACS was not independently associated with either primary efficacy (OR 0.871, 95% CI 0.664-1.144) or primary safety endpoint (OR 0.817, 95% CI 0.538-1.240).

In patients with good arterial pulsation, DRA was feasible in ACS, with higher bleeding but lower RAO compared with non-ACS. ACS was not independently associated with procedural failure or DRA-related bleeding. DRA may be considered a reasonable access strategy in selected ACS patients.

BACKGROUND Bifascicular block is typically asymptomatic and incidentally diagnosed, yet it may progress to advanced conduction disturbances. In patients with unexplained syncope and conduction abnormalities, exercise stress testing can diagnose transient conduction disease. While not routinely indicated for known atrioventricular block, stress testing may clarify etiology in patients without resting high-grade block. We present a case of syncope in a patient with bifascicular block, in whom exercise stress testing revealed complete atrioventricular block and sinoatrial exit block. CASE REPORT A 72-year-old man with chronic right bundle branch block and left anterior fascicular block presented with recurrent exertional syncope. Baseline electrocardiogram revealed bifascicular block, prompting exercise stress testing. During transition from Stage 1 to Stage 2 of the Bruce protocol, he developed transient complete atrioventricular block and near-syncope, followed by Mobitz II atrioventricular block and repetitive sinoatrial Wenckebach block during recovery. Computed tomography coronary angiography showed no obstructive lesions. A dual-chamber permanent pacemaker was subsequently implanted. Follow-up showed minimal pacing, and resolution of symptoms. CONCLUSIONS This case highlights the diagnostic utility of exercise stress testing in patients with conduction abnormalities and unexplained syncope. The concurrent occurrence of atrioventricular block and sinoatrial exit block during stress testing is rare. This directly guided our management. Stress testing reproduced transient high-grade atrioventricular block and sinoatrial exit block, and preceded progressive conduction deterioration over 4 years, to near-continuous ventricular pacing. Stress testing provides symptom-electrocardiogram correlation; the provoked atrioventricular block may indicate advanced conduction-system disease progression, and documentation of syncope with high-grade block supports timely pacing.

Hypertension (HT) is a common chronic condition linked to increased cardiovascular risk, reduced functional capacity, altered muscle properties, and impaired psychosocial well-being. Therefore, this study aimed to compare the 12-week effects of chair-based yoga and manual therapy on cardiovascular, functional, musculoskeletal, and psychosocial outcomes in individuals with HT. This single-blinded, randomized controlled trial included 75 participants (48 females) who were randomly allocated to three groups: Group I (Patient Education-PE), Group II (PE+Chair Yoga), and Group III (PE+Manual Therapy). Interventions were conducted twice weekly for 45 min over 12 weeks. Outcome measures included systolic and diastolic blood pressure (SBP/DBP), heart rate (HR), the 6-Minute Walk Test, muscle tone and stiffness (Myoton PRO), anxiety and depression, and mental well-being. Both Group II and Group III led to significant within-group reductions in SBP (p = 0.02 and p = 0.03, respectively) and HR (p = 0.04 and p = 0.02, respectively), with significant group-by-time interactions favoring Groups II and III over Group I. Functional capacity improved significantly in Groups II and III compared to Group I (p = 0.04). Group III specifically demonstrated significant reductions in muscle tone (p = 0.03) and stiffness (p = 0.04). Group II showed superior improvements in anxiety scores (p = 0.04) and mental well-being compared to other groups. Chair-based yoga and manual therapy are effective non-pharmacological strategies for enhancing autonomic regulation and reducing blood pressure in hypertensive patients. While both interventions improve cardiovascular and functional parameters, manual therapy is more effective for modulating muscle viscoelastic properties. In contrast, chair yoga provides greater benefits for psychosocial well-being and anxiety reduction.

Biological age captures inter-individual heterogeneity in aging process arising from genetic and environmental influences. Metabolites, as the end-products of metabolism, integrate these factors and are therefore well suited for biological age estimation. Urinary metabolomics, in particular, provides a non-invasive and information-rich matrix for assessing systemic metabolic states. We applied different machine learning techniques to develop a biological age score from high-resolution 1H nuclear magnetic resonance (NMR) metabolites measured in urine samples from a large population-based cohort. The derived metabolic age score was applied to evaluate longitudinal trajectories over more than a decade. Cross-sectional associations with age-related clinical phenotypes were examined, and prospective analyses assessed associations with incident diseases and all-cause mortality. Metabolic age progression over time varied between individuals, underscoring inter-individual heterogeneity in metabolic aging. In cross-sectional analyses, the metabolic age score showed biologically plausible associations with a range of age-related clinical phenotypes. Furthermore, metabolic age was predictive of multiple diseases and all-cause mortality independent of chronological age. Our findings highlight the utility of urinary metabolomics as a robust, non-invasive approach for biological age assessment. The characterization of long-term metabolic age trajectories provides novel insight into inter-individual differences in aging and establishes urinary metabolic age as a promising tool for risk stratification and aging research.

Tenecteplase is an alternative to alteplase for intravenous thrombolysis in acute ischemic stroke given its simplified administration and comparable safety and efficacy. However, its impact on workflow metrics that may affect clinical outcomes, such as door-to-needle and door-in-door-out times, has not been well-characterized.

To compare door-to-needle and door-in-door-out times between tenecteplase-treated and alteplase-treated patients with acute ischemic stroke in US hospitals.

This cohort study used data from the American Heart Association's Get With The Guidelines-Stroke registry between July 1, 2020, and June 30, 2022. The analysis included adult patients with ischemic stroke who received intravenous thrombolysis. Data analysis was conducted from August to November 2023.

Tenecteplase or alteplase treatment in a consecutive series of patients with ischemic stroke.

Primary outcomes were door-to-needle time among patients who arrived directly to the reporting hospital and door-in-door-out time among those transferred after thrombolytic administration. Secondary outcomes were door-to-puncture and other endovascular workflow metrics among patients treated with thrombectomy after thrombolysis. Generalized linear mixed models were used to assess the association between thrombolytic treatment and workflow time intervals outcomes.

Of 133 228 thrombolysis-treated patients (mean [SD] age, 68.3 [14.8] years; 64 173 female [48.2%]; median [IQR] National Institutes of Health Stroke Scale score, 7 [3-14]), 13 988 (10.5%) received tenecteplase, and 119 240 (89.5%) received alteplase. The mean (SD) door-to-needle time was significantly shorter with tenecteplase vs alteplase (47.0 [26.8] vs 52.7 [28.0] minutes; adjusted mean difference, -3.13 minutes; 95% CI, -3.84 to -2.42 minutes). Door-to-needle time 30 minutes or less occurred more frequently with tenecteplase than with alteplase (2955 of 9893 patients [29.9%] vs 14 781 of 72 539 patients [20.4%]; adjusted odds ratio [aOR], 1.34; 95% CI, 1.25 to 1.44), as did door-to-needle time 45 minutes or less (5766 of 9893 patients [58.3%] vs 35 238 of 72 539 patients [48.6%]; aOR, 1.24; 95% CI, 1.17 to 1.32) and 60 minutes or less (7670 of 9893 patients [77.5%] vs 51 282 of 72 539 patients [70.7%]; aOR, 1.25; 95% CI, 1.17 to 1.33). Among transferred patients likely eligible for mechanical thrombectomy, mean (SD) door-in-door-out times were shorter for tenecteplase vs alteplase (108.3 [31.6] vs 114.1 [32.0] minutes; adjusted mean difference, -5.94 minutes; 95% CI, -9.10 to -2.77 minutes). Among patients receiving thrombectomy, shorter times were observed in the tenecteplase group for door-to-arterial puncture, door-to-device deployment, and door-to-reperfusion. Hospitals that transitioned to tenecteplase during the study period had faster door-to-needle time times after vs before the switch (mean [SD], 51.1 [12.1] vs 52.7 [10.8] minutes; adjusted mean difference, -1.52 minutes; 95% CI, -2.88 to -0.15 minutes).

In this analysis of a large nationwide registry, tenecteplase was associated with faster door-to-needle and door-in-door-out times than alteplase. These workflow advantages provide support for broader use of tenecteplase for stroke thrombolysis.

Cardiac shear wave elastography (SWE) is an emerging ultrasound-based technique that enables noninvasive assessment of myocardial mechanical properties beyond conventional motion- and deformation-based indices. By tracking the propagation of shear waves within the myocardium using ultrafast imaging, SWE provides stiffness-related information that may complement standard echocardiographic parameters in selected clinical settings. In this narrative review, we summarize the methodological principles of cardiac SWE, including acoustic radiation force-induced techniques, natural shear wave imaging approaches, and emerging three-dimensional SWE. We discuss current clinical evidence in key disease states characterized by altered myocardial stiffness, such as hypertrophic cardiomyopathy, cardiac amyloidosis, heart failure with preserved ejection fraction, and post-transplant or diffuse myocardial injury. Importantly, SWE measurements are highly context-dependent and influenced by cardiac phase, loading conditions, myocardial anisotropy, imaging plane, and acquisition methodology. Therefore, reported values should be interpreted as reflecting stiffness-related myocardial behavior rather than direct measures of fibrosis or specific histopathologic substrates. At present, cardiac SWE remains primarily a research-stage technique, with potential roles in phenotypic characterization, disease burden assessment in selected populations, longitudinal monitoring, and future integration into multiparametric echocardiographic and artificial intelligence-assisted workflows. Further standardization, definition of normal reference ranges, technical validation, and multicenter clinical studies are required before broader clinical adoption. In conclusion, cardiac SWE represents a promising extension of echocardiographic assessment of myocardial mechanics, but its clinical interpretation requires careful consideration of methodological, physiological, and disease-specific determinants.

Heart failure (HF) is closely linked to mitochondrial dysfunction, featured by abnormal energy metabolism, excessive reactive oxygen species (ROS), and imbalanced mitochondrial dynamics. Clinically, effective targeted therapies for mitochondrial dysfunction are still lacking, which aggravates HF and multi-organ injury. Mitochondrial non-coding RNAs (mt-ncRNAs) form a regulatory network critical for mitochondrial function. Among them, mitochondrial-encoded circular RNAs (mecciRNAs) and mitochondrial double-stranded RNAs (mt-dsRNAs) are research hotspots. mecciRNAs protect the heart by assisting protein import and regulating mitochondrial pores and ROS; their degradation worsens HF, while exogenous supplementation alleviates injury. mt-dsRNAs arise from aberrant mitochondrial transcription and contribute to myocardial injury and remodeling via MAVS, cGAS-STING, and PNPT1 pathways. Gene therapy targeting mecciRNAs and mt-dsRNAs combined with mitochondrial delivery represents a promising strategy for HF treatment.

In the World Health Organization (WHO) 2022 classification of chronic myelomonocytic leukemia (CMML), the cutoff for absolute monocyte values was lowered from 1.0 × G/L (2016) to 0.5 × G/L to incorporate cases formerly referred to as oligomonocytic CMML. The prevalence of this criterion in the general population and its potential association with demographic parameters and comorbidities is unclear. In order to answer these questions, we used the previously published LEAD (lung, heart, social, body) cohort (ClinicalTrials.gov; NCT01727518), which is a longitudinal, observational, population-based Austrian cohort aiming to investigate the impact of genetic, environmental, social, developmental, and ageing factors on respiratory health and associated comorbidities through life. The prevalence of the 2022 criterion was 11.976% in the general population, as compared to 0.747% of the 2016 criterion. In the descriptive analysis, individuals with the 2022 criterion as compared to those without this criterion were more often males, had a greater height and bodyweight, more frequently suffered from cardiovascular (CVD) and chronic obstructive pulmonary disease (COPD), and had higher C‑reactive protein (CRP) values. In the multivariable logistic regression, higher CRP, COPD, and CVD were significantly associated with the 2022 criterion. Our results show that in the general population, the 2022 CMML blood diagnostic criterion is 16 times more common than the 2016 criterion. The 2022 criterion is associated with CVD, COPD, and inflammation, which should be considered in the interpretation of this criterion in clinical practice.

Titanium fastener technology is increasingly adopted for use in minimally invasive valve surgery and open procedures to facilitate faster operative times and reproducible fastening of sutures. The objective of this study was to evaluate the technical feasibility and short-term safety of automated titanium fastener technology for securing sutures in heart valve repair and/or heart valve replacement procedures.

The CRIMP study is a multicenter, prospective study that enrolled patients undergoing heart valve repair or replacement via open or minimally invasive approaches at three centers (n = 120). The primary endpoints were device success and prosthesis implantation time.

Mean age was 62.5 (SD 11.1) years, 33.3% of patients was female and the cohort was characterized as low surgical risk (EuroSCORE II 1.6%; SD 2.3%). Predominant valve disease was mitral regurgitation. Median procedure time was 178 (IQR 145-210) min. Median aortic cross-clamp time was 82 (IQR 59-107) min. The majority of procedures was minimally invasive (76.7%). In aortic valve procedures, median prosthesis implantation time (first stitch until last COR-KNOT placement) was 25 (IQR 18-46) min and in mitral valve procedures median implantation time was 50 (IQR 48-52) min. Device success was 100%, since no automated titanium fastener failed to grip or crimp appropriately. Median number of COR-KNOTS used was 14 (IQR 12-16) per valve. In-hospital mortality was 0.8%. All observed adverse events were considered unrelated to the device and there was no valve prosthesis dehiscence at 30-days of follow-up.

The use of automated titanium fastener technology for suture fixation in heart valve surgery was technically feasible and showed short-term safety in all patients, with no obvious device-related adverse events observed. Graphical abstract available for this article.  Clinical trial registration number: DRKS00038956.