Takotsubo cardiomyopathy (TCM) is an acute form of left-ventricular systolic dysfunction triggered by emotional or physical stress, which can lead to refractory cardiogenic shock. In such cases, mechanical cardiovascular support, such as extracorporeal membrane oxygenation (ECMO), may be beneficial. However, the outcomes of ECMO in this population remain unclear.

To evaluate the association between ECMO and in-hospital outcomes in patients hospitalized with TCM and cardiogenic shock.

We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2022 to evaluate outcomes in adult patients hospitalized with TCM and cardiogenic shock. ECMO use was identified using ICD-10 procedure codes. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), total hospital charges (THCs), acute kidney injury, and bleeding complications. Propensity score matching with double adjustment using survey-weighted logistic and linear regression was used to adjust for confounders.

A total of 20 350 weighted hospitalizations were included, with 300 patients (1.5%) receiving ECMO. In the unadjusted analysis, ECMO was associated with higher in-hospital mortality (35.0 vs. 27.7%), longer LOS (19.4 vs. 12.1 days), and higher THCs ($761 206 vs. $254 690). After matching, 270 patients were identified in each group. ECMO was still associated with higher THCs ($630 317 vs. $372 195). In-hospital mortality remained higher in the ECMO group (32.5% vs. 26.7%), although not statistically significantly (P  = 0.49).

Among patients with TCM complicated by cardiogenic shock, ECMO was not associated with a significant reduction in mortality. Further studies are warranted to improve patient risk stratification and clarify the clinical value of ECMO in this population.

The optimal long-term antiplatelet monotherapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains uncertain, with limited data comparing aspirin and clopidogrel monotherapy. This meta-analysis aims to compare the safety and efficacy of clopidogrel versus aspirin in patients who have completed a standard duration (≥6 months) of event-free dual antiplatelet therapy (DAPT) following PCI with DES.

A comprehensive literature search was conducted across major electronic databases through May 2025 to identify relevant studies that compared clopidogrel monotherapy with aspirin monotherapy in adults who had undergone PCI with DES implantation. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE). Pooled estimates of relative risks (RRs) and adjusted hazard ratios (HRs) were calculated using a random-effects model.

Five studies [two randomized controlled trials, three observational studies; n = 16, 289 patients] were included. Clopidogrel monotherapy was associated with a significant 31% reduction in MACCE compared with aspirin monotherapy [RR: 0.69; 95% confidence interval (CI) 0.60-0.79; P < 0.0001]. A pooled analysis of HRs demonstrated a similar benefit (HR: 0.67; 95% CI 0.58-0.77). Incidences of major bleeding and all-cause death were comparable between the two groups (RR: 0.93; 95% CI 0.57-1.51 and RR: 0.96; 95% CI 0.74-1.25, respectively). Notably, the analysis of HRs demonstrated that clopidogrel significantly reduced the risk of stroke (HR: 0.60; 95% CI 0.45-0.82; P = 0.001) and myocardial infarction (MI) (HR: 0.65; 95% CI 0.49-0.88; P = 0.005).

Clopidogrel monotherapy is more effective than aspirin for long-term prevention of MACCE, MI, and stroke, without increasing the major bleeding risk.

CRD420251070685.

Long-term follow-up (LTFU) outpatient clinics play a primary role in screening, preventing, and addressing late effects after hematopoietic cell transplantation (HCT). Following the 2018 nationwide survey, which led to the development of standardized nationwide tools to deliver information to HCT survivors, we re-evaluated changes in the current status of LTFU clinics.

We targeted 267 HCT centers certified by the Japanese society for transplantation and cellular therapy. Several questionnaire categories were retained from the 2018 survey to compare results (e.g., LTFU clinic establishment and institutional practices for late-effect screening).

The response rate was high in both adult (90%) and pediatric HCT centers (88%), and the establishment rate of post-HCT LTFU clinics increased to 82% (adult, 90%; pediatric, 64%). Pediatric centers were more likely to continue follow-up of patients who received HCT beyond 5 years post-HCT. Regarding transitional medical care for long-term survivors at non-HCT institutions, only a few HCT centers conducted routine transitions to specific referral facilities. We observed significant changes in recommendations for secondary cancer screenings compared to 2018, with a substantial decrease in the proportions of "not routinely included as a screening issue."

In the future, it is essential to create a sustainable follow-up system, establish networks with non-HCT facilities, and educate patients to encourage behavioral changes for lifelong health screenings.

We aimed to explore the effects of applying edaravone dexborneol after intracranial vascular intervention on the levels of neuron-specific enolase (NSE), homocysteine (Hcy) and neurological function in elderly patients with acute ischemic cerebrovascular disease (AICVD).

The control group and study group were established. Serum levels of NSE, Hcy, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), and superoxide dismutase (SOD) activity were measured. Neurological function and hemorheological indices [plasma viscosity (PV), high-shear viscosity (HSV), low-shear viscosity (LSV)] were assessed. Adverse reactions and 6-month adverse outcomes were recorded.

At 14 days postoperatively, the study group exhibited lower NSE, Hcy, IL-6, TNF-α, and MDA levels and higher SOD activity than the control group (all p < 0.05). NIHSS scores, PV, HSV, and LSV decreased in both groups at 7 and 14 days postoperatively (p < 0.05), with greater improvements in the study group (p < 0.05). The study group had a lower incidence of adverse outcomes (4.00% vs. 13.33%, p < 0.05).

Edaravone dexborneol after intracranial vascular intervention significantly reduces NSE and Hcy levels, mitigates inflammation and oxidative stress, improves neurological function and hemorheology, and lowers adverse outcome rates in elderly AICVD patients without increasing adverse reactions.

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a systemic autoimmune disease where infections can trigger relapses. Dental infections, being common and associated with systemic inflammation, may play a role in AAV relapse, though their impact remains unclear. We aimed to evaluate the association between severe dental infections and early relapse in patients with AAV.

This retrospective cohort study included patients newly diagnosed with AAV between January 2011 and July 2022. Patients with severe dental infections requiring tooth extraction were placed in the dental infection group, while the remaining patients were assigned to the control group. The primary outcome was defined as either vasculitis relapse or all-cause mortality within 1 year of treatment initiation. Adjusted HRs (aHRs) and 95% CIs were estimated using Cox proportional hazards models.

A total of 93 patients were enrolled with a median age of 74 years. 41 patients (44.1%) had severe dental infections in this cohort. Over the 1-year follow-up period, 13 patients experienced a relapse and two died, resulting in a composite event rate of 20.9 per 100 person-years. Dental infection was independently associated with the composite outcome (aHR, 3.78 (95% CI 1.13 to 12.66); p=0.031). Exploratory analysis indicated that composite outcome rates were similar regardless of tooth extraction among patients with dental infections.

Severe dental infections were associated with increased risk of early relapse or mortality in AAV. These findings highlight the importance of early dental evaluation in AAV management.

Birth weight (BW) is influenced by both fetal and maternal genetic factors and is correlated with cardiometabolic outcomes later in life. Investigating these factors can clarify whether the association between BW and health risk arises from fetal, maternal, or shared genetic factors. Inflammation likely plays a key role in cardiometabolic risk related to BW. This study examined the causal effects of fetal and maternal genetically predicted BW on cardiometabolic outcomes, focusing specifically on the mediating role of inflammatory cytokines.

We used a two-sample Mendelian randomization (MR) framework to estimate the causal effects of fetal-specific and maternal-specific BW on ten cardiometabolic and autoimmune outcomes. Additionally, we conducted a two-step MR mediation analysis to assess the role of 41 core inflammatory cytokines in these effects. Exposure data for fetal-specific BW (n = 298,142) and maternal-specific BW (n = 210,267) were sourced from the EGG Consortium and UK Biobank. Outcome data were mainly obtained from GWAS consortia including FinnGen, Pan-UKBB, and DIAGRAM. Cytokine data were collected from Finnish cohorts. Genetic instruments (Single nucleotide polymorphisms, SNPs) were selected at p < 5 × 10^-8, with F-statistics > 10 ensuring robustness. Primary analyses used inverse-variance weighted MR and conducted sensitivity analyses to evaluate pleiotropy.

Fetal-specific BW was inversely associated with type 2 diabetes (T2D, OR = 0.585, 95% CI: 0.491-0.697), fasting glucose (FG, 0.918, 0.886-0.951), fasting insulin (FI, 0.907, 0.878-0.937), coronary artery disease (CAD, 0.782, 0.701-0.873), myocardial infarction (MI, 0.746, 0.650-0.855), and systemic lupus erythematosus (SLE, 0.432, 0.228-0.818), but positively associated with venous thromboembolism (VTE, 1.252, 1.108-1.416). Maternal-specific BW was inversely associated with FI (0.927, 0.889-0.966), hypertension (0.697, 0.564-0.861), CAD (0.775, 0.652-0.921), and MI (0.730, 0.593-0.897). Cytokines such as PDGF-BB, MIP-1β, SDF-1α, and IL-4 partially mediated the associations between fetal-specific BW, maternal-specific BW, and cardiometabolic outcomes, but their mediation proportions were limited.

This study provides evidence that both fetal and maternal genetically predicted BW independently influence cardiometabolic outcomes, with fetal genetic effects having a broader impact. Although inflammatory cytokines (PDGF-BB, MIP-1β, SDF-1α, IL-4) partially explain these effects, their contributions are limited, suggesting additional biological pathways underlie these lifelong associations.

People living with HIV (PLWH) face a significantly elevated risk of cardiovascular diseases (CVDs). This study aims to quantify temporal trends in HIV-attributable CVD burden at global, regional and national levels using a comparative risk assessment framework.

We systematically searched PubMed, Embase and MEDLINE for cohort studies from inception to 28 October 2024, assessing HIV infection and CVD risk. Pooled risk ratios (RRs) for total and subtype-specific CVDs were estimated using random-effects meta-analysis. Based on pooled RRs and HIV prevalence data from the Global Burden of Disease (GBD) 2021 study, we calculated population attributable fractions (PAFs) from 1990 to 2011. These PAFs were applied to GBD disability-adjusted life-years (DALYs) to estimate the age-standardised DALYs rate (ASDRs) of CVDs attributable to HIV by sex, region and year between 2000 and 2021.

35 cohort studies with 199 effect estimates were included. HIV infection was associated with increased risk of total CVDs (RR=1.38), stroke (1.90), ischaemic stroke (1.31), haemorrhagic stroke (2.04), ischaemic heart disease (1.72), myocardial infarction (1.60), heart failure (1.71), peripheral vascular disease (1.19) and cardiac arrest (2.58). Subgroup analyses showed higher ischaemic stroke risk in females and increased CVD risk among PLWH with low CD4+ or high viral load. From 1990 to 2011, the global PAF for total CVDs attributable to HIV rose from 0.0814% to 0.2244%. Global ASDR attributable to HIV nearly tripled, increasing from 3.45 to 9.26 per 100 000 population between 2000 and 2021, with stroke and ischaemic heart disease contributing most. The burden was highest in low-Sociodemographic Index regions, particularly southern Africa; in 2021, Lesotho and Eswatini had the highest ASDRs.

HIV-attributable CVD burden has risen substantially over the past two decades, with marked concentration in the African Region. Integrating CVD screening and management into HIV care is urgently needed in high-prevalence settings.

Limited studies have provided guidance on the optimal systolic blood pressure (SBP) after mechanical thrombectomy (MT) in acute ischemic stroke patients. In the Clevidipine Infusion for Blood Pressure Management After Successful Revascularization in Acute Ischemic Stroke (CLEVER) trial, our aim was to study the safety and efficacy of intensive SBP control with a Clevidipine infusion as the first-line agent.

The CLEVER trial was an investigator-initiated, single-center, open-label, randomized, controlled trial. Patients were randomized 1:1 to a SBP goal after successful MT (mTICI 2c or greater) of either 90-120mmHg (Intensive BP Management) or 90-160mmHg (Standard BP Management). The primary outcomes were time to target blood pressure and incidence of any hemorrhagic conversion at 24 hours.

Between October 2021 and December 2023, 80 eligible patients were enrolled, 40 each into the intensive BP and the standard BP management cohorts. Overall, 72% of all BP measurements in the intensive BP management group were within the target range, compared to 93% in the standard BP management group (p<0.001). The median time from the initiation of Clevidipine infusion until reaching the target SBP was significantly shorter in the standard BP management group, 10 minutes [IQR 5.0-45.0] versus 20 IQR 12.5-42.5] (95%CI:5.0-20.0, p=0.002). The incidence of hemorrhagic transformation per core lab was not significantly different in the intensive BP management group (32.5%) and the standard BP management group (35.0%); adjusted OR (0.93 [95%CI, 0.30-2.85]; p=0.89).

In the randomised CLEVER trial, intensive BP control using clevidipine after MT failed to reduce the rate of haemorrhagic conversion or sICH and resulted in a numerically lower rate of good clinical outcome compared to standard BP control. Clevidipine was well tolerated in both cohorts and demonstrated a similar safety profile. Larger studies are needed to understand the efficacy and safety of clevidipine for BP control and the optimal BP threshold after MT.

Post-stroke depression (PSD) frequently occurs after acute stroke and negatively affects rehabilitation. Dopamine has beneficial effects on motivation and emotional stability. In stroke patients, low dopamine levels are linked to PSD. This study investigated whether levodopa treatment during in-hospital rehabilitation impacts PSD compared to placebo.

ESTREL-Depression was a pre-planned analysis of the multicenter, randomized, double-blind, placebo-controlled ESTREL trial. Participants with an acute ischemic or hemorrhagic stroke were randomly assigned to receive either levodopa/carbidopa (100/25 mg) or placebo three times daily for 39 days. All ESTREL participants with (1) information about the presence or absence of depression at three months and (2) who took at least 80% of the study medication were eligible for the study. Participants with a history of depression were excluded. For the primary outcome, the presence of PSD was defined as having a T-score of ≥55 in the Patient-Reported Outcomes Measurement Information System short-form depression-4a 3 months after randomization. Binary logistic regression was performed to assess the effect of levodopa on PSD.

The study included 407 ESTREL participants (median age 72, 60% male), 209 receiving levodopa, and 198 receiving placebo. At 3 months, the frequency and odds of PSD did not differ between the levodopa group (26%) and the placebo group (28%) (OR = 0.93, 95% CI, 0.60-1.43).

In the ESTREL-Depression study, treatment with levodopa had no impact on the occurrence of PSD.

ClinicalTrials.gov: NCT03735901 (https://clinicaltrials.gov/study/NCT03735901).

Identification of factors associated with haematoma expansion (HE) in patients with primary intracerebral haemorrhage (ICH) is crucial for optimization of management and therapeutic strategies. We investigated whether such factors differed according to supratentorial ICH location, comparing deep versus lobar ICH.

Retrospective analysis of patients with primary ICH admitted at nine sites. HE was defined as growth ≥6 mL and/or ≥33% from baseline to follow-up imaging. We evaluated independent associations using multivariable logistic regression models adjusted for age, sex, baseline haematoma volume, anticoagulants and antiplatelets use and other relevant confounders identified in univariate analyses.

A total of 1768 patients were included (mean age 70 years, 56% males) of whom 1020 (58%) had deep and 748 (42%) had lobar ICH; HE occurred in 531 (30%) patients (28% deep and 33% lobar ICH). Age and baseline haematoma volume were shared predictors of HE in lobar and deep ICH. Anticoagulant use (OR = 1.61;95%, 1.04-2.50) and lower Glasgow Come Scale (OR = 0.91;95%CI, 0.85-0.96) were associated with HE only in lobar ICH, whereas the associations between systolic blood pressure >140 mmHg (OR = 1.53;95%CI, 1.03-2.29) and presentation before 3 h from onset (OR = 1.40;95%CI, 1.02-1.92) and HE were observed only in patients with deep ICH.

Some factors associated with HE were shared between deep and lobar ICH whereas others appeared to be location-specific. Our findings may reflect differences in the pathophysiology of HE according to ICH location and might improve the stratification of HE risk in clinical practice or randomized trials.