Heart transplantation (HT) remains the gold-standard therapy for selected patients with advanced heart failure. Increasing recipient complexity and donor organ scarcity have led to the increased use of short-term mechanical circulatory support (ST-MCS) as a bridge to HT. The prognostic impact of ST-MCS on primary graft dysfunction (PGD) and other early outcomes remains limited.

We analyzed data from the Primary Graft Dysfunction Consortium, a retrospective registry including 3800 adult HTs at 14 centers in the United States, Canada, and Europe between 2010 and 2020. Primary outcomes were severe PGD (according to International Society for Heart and Lung Transplantation criteria) and 1-year mortality. Multivariable logistic regression and Cox models were used, with multiple imputation for missingness.

Overall, 669 patients (17.6%) received pre-HT ST-MCS. Among them, 16.9% were supported with extracorporeal membrane oxygenation (ECMO), 60.4% with an intra-aortic balloon pump, 9.1% with a percutaneous left ventricular assist device, 9.1% with surgical ventricular assist devices, and 4.5% with other devices. ST-MCS use increased over time and varied by region, with the intra-aortic balloon pump predominating in the United States and ECMO more frequently used in Canada and Europe. Overall, ST-MCS was not associated with severe PGD after adjustment; however, ECMO was independently associated with greater PGD risk (adjusted odds ratio 3.28, 95% confidence interval 1.90-5.66). One-year mortality was 11.0% and did not differ significantly according to ST-MCS use after multivariable adjustment.

In this large contemporary multinational cohort, pretransplant ST-MCS use has increased, with geographic heterogeneity observed. Although ECMO is associated with a greater risk of severe PGD, ST-MCS does not independently increase 1-year mortality after HT, supporting its use as a bridge in high-risk patients.

Donation after circulatory death (DCD) heart transplantation has expanded rapidly in the United States, but whether outcomes have evolved during national dissemination remains uncertain. Given the increasing complexity of candidates with advanced heart failure, understanding the stability of outcomes during expansion is clinically important. We evaluated temporal changes by comparing early adoption with later expansion.

Adult DCD heart transplant recipients in the United Network for Organ Sharing registry (January 2019 to June 2024) were stratified into an early era (2019-2021) and a late era (2022-2024). The primary endpoint was 1-year graft failure. Secondary endpoints included 1-year all-cause mortality, renal-replacement therapy before discharge, and length of stay. A secondary exploratory analysis assessed overall survival up to 2 years. Inverse probability of treatment weighting was applied to adjust for baseline differences. Prespecified subgroup analyses were performed in high-risk recipients, including those with impaired functional status, pulmonary hypertension, and preoperative mechanical circulatory support.

Among 1489 recipients (303 early, 1186 late), DCD use increased substantially over time and expanded across a greater number of transplant centers. Unadjusted and inverse probability of treatment weighting-adjusted analyses showed no significant differences between eras in length of stay, renal-replacement therapy, 1-year mortality, retransplantation, or graft failure. Exploratory analyses of overall survival up to 2 years showed no significant difference between groups. Outcomes were consistent across high-risk subgroups.

Early outcomes after DCD heart transplantation remained stable during rapid national expansion despite broader recipient risk profiles, supporting the scalability of this strategy without evidence of outcome deterioration.

Cardiac magnetic resonance and cardiac computed tomography have become essential imaging modalities in the evaluation of patients with a wide spectrum of cardiovascular diseases, providing valuable anatomical and functional information for clinical decision-making, prognostic stratification, and therapeutic planning. Their indications and clinical applications have expanded considerably in recent years; however, accessibility and implementation remain uneven among health care settings. To facilitate and promote access to these techniques, the Cardiovascular Imaging Association of the Spanish Society of Cardiology has prepared this position statement, which brings together, in a structured format, the main recommendations of the European Society of Cardiology regarding their use. The document promotes the implementation of these modalities through specialized training for health care professionals, the use of well-established indications, and the prioritization of applications with high clinical impact in cardiovascular medicine.

To investigate whether antihypertensive medications modify the risk of heat-related illness during heatwaves among adults with hypertension in Japan.

We identified adults with hypertension in Tsukuba City administrative claims data between April 2014 and March 2019. Average daily temperature was derived from Japan Meteorological Agency data. We used a self-controlled case series (SCCS) design to estimate incidence rate ratios (IRRs) for heat-related illness during 5-day pre-heatwave, heatwave and 5-day post-heatwave periods compared to baseline within individuals. The main analysis was stratified by person-time prescribed antihypertensives (angiotensin-converting enzyme [ACE] inhibitors/angiotensin II receptor blockers [ARBs], calcium channel blockers [CCBs] or non-loop diuretics) and person-time not prescribed antihypertensives, with drug-temperature interaction assessed. Subgroup analyses were conducted for each antihypertensive class. All models were adjusted for age and season.

We observed a greater increase in the rate of heat-related illness during heatwaves versus baseline among person-time prescribed antihypertensives (IRR: 1.64, 95% CI: 1.53-1.75) than among person-time not prescribed antihypertensives (IRR: 1.42, 95% CI: 1.27-1.58), with evidence of drug-temperature interaction (p < 0.01). When examining individual drug classes, ACE inhibitors/ARBs and CCBs were associated with an increased risk of heat-related illness during heatwaves, whereas there was no evidence of an effect with diuretics.

Our findings indicate that people taking antihypertensives are more vulnerable to heat-related illnesses during heatwaves. More research is required to explore whether this is a causal effect of the medication or due to differences between those who are treated and untreated with antihypertensives that are related to the outcome.

Affecting hundreds of millions of women worldwide, polyendocrine metabolic ovarian syndrome (PMOS, formerly polycystic ovary syndrome) carries a significantly higher risk of cardiovascular and metabolic diseases. Here we discuss how renaming this disease reframes a profoundly misunderstood condition for which basic metabolic research remains critically underfunded and fragmented.

The poor materials stability, sluggish adsorption kinetics, and limited selectivity present major challenges for uranium recovery from tantalum-niobium ore leachate. Herein, by leveraging spatial constraints imposed by cyano groups and the structural robustness of irreversible olefin linkages, a highly crystalline olefin-linked covalent organic framework (COF), TP-BPDAN, featuring a brick-wall-like topology, was successfully constructed through the condensation of top-truncated [1,1':3',1''-terphenyl]-3,3'',5,5''-tetracarbaldehyde (TPTCA) with C₂-symmetrical 4,4'-biphenyldiacetonitrile (BPDAN). This alternating mesoporous/microporous architecture was specifically engineered to minimize diffusion barriers and accelerate mass transport compared to conventional homoporous COFs. Subsequently, the adjacent cyano groups were converted into cyclic imidedioxime functionalities, yielding TP-BPDAN-IDO, a material engineered with high-density, optimized coordination sites for uranium binding. As a result, the heteroporous TP-BPDAN-IDO exhibits remarkable improvements in adsorption kinetics, achieving 92% of its maximum adsorption capacity within 10 min, significantly outperforming homoporous COFs. Notably, TP-BPDAN-IDO demonstrates an outstanding uranium uptake capacity from strongly acidic leachate derived from a tantalum-niobium mine, along with exceptional selectivity for U(VI) over V(V), which effectively avoids vanadium interference faced by traditional amidoxime-based materials. This work not only expands the structural diversity of olefin-linked COFs but also provides a promising strategy for designing functional porous materials aimed at advancing energy sustainability.

The auditory-cardiac interplay enables sound perception to modulate cardiac rhythm and homeostasis. However, its underlying regulatory mechanism and therapeutic potential remain largely underexplored, due to fundamental limitations in acoustic stimulation precision. Here we present an opto-mechano-cardiac coupling strategy that bypasses the propagation constraints of sound wave to enable precise acoustic modulation of cardiac function. Utilizing dynamically reconfigurable optical traps (1064 nm, 100 kHz refresh rate), we translated musical rhythms into programmable otolith oscillation patterns, thus establishing deterministic input-output relationships between mechanical stimulation and cardiac responses. We found that hindbrain areas, primarily the vagal motor area, mediate this opto-mechano-cardiac modulation, through adrenergic activation and a shift in the balance between sympathetic and parasympathetic activity. Leveraging real-time rhythm transcoding, we precisely quantified the modulation capabilities of auditory stimuli with distinct spectral composition on cardiac rhythm, and successfully rescued the drug-induced pathological cardiac rhythm disorders. By bridging optical physics and autonomic cardiac physiology via optomechanical otolith oscillation, this work establishes a mechanistic framework to explore sensory-cardiac modulation and personalized arrhythmia management, paving the way for advancing music therapy from empirical practice to quantitative biomedicine.

To analyze the concordance between the stratification offered by the tool included in the adaptation of the capability-motivation-opportunity model for patients with cardiovascular diseases developed by De Dios et al. 2025 and that obtained when applying it in clinical practice.

Observational, cross-sectional, single-center study (January-March 2025) which included patients undergoing active treatment with proprotein convertase subtilisin/kexin type 9 inhibitors or inclisiran who attended outpatient hospital pharmacy consultations. The variables collected for stratification were demographic, clinical, pharmacotherapeutic, and socio-health variables. The adapted capacity-motivation-opportunity model in patients with cardiovascular diseases was used for stratification. The Chi-square method for a single sample was used to analyze concordance. The data were processed using the IBM-SPSS v.30 statistical program.

A total of 126 patients were included (median age 63.2 years (IQR = 58.9-72.5); 69.2% men). The percentages obtained were 6.3% (95% CI: 2.1-10.6%) in priority 1, 33.3% (95% CI: 25.1-41.6%) in priority 2, and 60.3% (95% CI: 51.8-68.8%) in priority 3, with theoretical distribution being 10, 30, and 60%, respectively (p = 0.342).

There is agreement between both distributions, which supports the applicability of the tool in healthcare practice, and it can be used to prioritize resources in outpatient consultations.

This review aimed to summarize the biological rationale for the protective effects of estrogen, the robust evidence supporting the benefits of menopausal hormone therapy (MHT), and the evolving regulatory and historical context shaped by the reinterpretation of the Women's Health Initiative data. This study outlines the risk-benefit profile of contemporary MHT regimens and presented a modern clinical framework for the use of MHT as a preventive strategy to support metabolic, cardiovascular, and skeletal health across and beyond the menopausal transition. Moreover, this review emphasized that menopausal symptoms should be recognized as a critical biological inflection point necessitating proactive intervention. Furthermore, the 2025 FDA regulatory shift reinforces the safety and efficacy of individualized MHT when initiated within the "window of opportunity," providing a definitive strategy for long-term prevention of chronic diseases in healthy women.

Heart transplantation has historically been defined by the scarcity of donor organs and the uncertainties surrounding them. Over the past 50 years, advances in immunosuppression, surgical techniques, and posttransplant surveillance have improved outcomes, yet the fundamental paradigm remains unchanged: the replacement of a failing heart still depends on the death of another person. In this Perspective, we argue that this paradigm is beginning to shift, with early evidence emerging from molecular diagnostics that enable noninvasive detection of graft injury. Over the coming decades, regenerative therapies, immune engineering, and advances in organ preservation are poised to shift the trajectory of advanced heart failure, reducing progression to end-stage disease, whereas evolving mechanical circulatory support technologies may provide durable alternatives or bridges. As biologic restoration becomes feasible, artificial intelligence may integrate molecular, physiologic, and clinical data into adaptive systems of care. By 2076, heart transplantation will be characterized by a spectrum of cardiac-restoration strategies, including regeneration, engineered tissues, xenografts, and targeted immune therapies to promote graft tolerance. In this evolving model of care, equity will be strengthened through integration of data, decision-making, and care delivery. Collectively, these advances mark a shift from the incremental progress of the past 50 years toward an accelerating pace of scientific and clinical innovation that will redefine heart failure care, moving beyond donor-dependent transplantation.