Women with pregnancies complicated by hypertensive disorders of pregnancy (HDP) are at significantly increased risk of cardiovascular (CVD) and metabolic diseases. Current international guidelines acknowledge this risk, however the timing, duration and method of CV screening in these high-risk women remain heterogenous. There remains a lack of an evidenced-based approach to the transition of care from hospital to community and longer-term cardiac-metabolic disease prevention.This narrative review examines the optimal timing and duration of cardiometabolic surveillance after delivery, approaches to risk stratification to identify women at greatest risk of future cardiovascular morbidity, and strategies for screening myocardial, vascular, and metabolic health. This review also explores how limited postpartum healthcare resources may be targeted most effectively, with particular emphasis on the transition from hospital to community care during the "fourth trimester" and interventions that promote sustained engagement in long-term behavioural and lifestyle modification.Current evidence supports the potential role of multidisciplinary postpartum cardiovascular clinics in delivering coordinated, risk-stratified care following HDP. These clinics facilitate early optimisation of BP through telemonitoring and patient-led medication titration, while integrating lifestyle interventions tailored to PE phenotypes and individual CV risk profiles. Future research should focus on validated risk stratification tools to identify and personalise postpartum interventions to women who are most at risk of CV morbidities. This should include risk prediction, targeted interventions based on risk profiles, and integrated care pathways in the community to optimise long-term maternal CV outcomes.

Neuropsychiatric systemic lupus erythematosus (NPSLE) is an uncommon but severe manifestation of systemic lupus with limited evidence to guide management when standard therapies fail. We report the case of a 19-year-old woman with new-onset SLE with myositis and nephritis overlap, positive for anti-Smith, anti-dsDNA, anti-PL7, and anti-Mi-2 antibodies with hypocomplementemia. Despite treatment with hydroxychloroquine and corticosteroids, she developed progressive weakness, catatonia and psychosis. MRI demonstrated diffuse cerebral volume loss. While hospitalized, she received IV methylprednisolone and mycophenolate mofetil, followed by cyclophosphamide, all with only transient improvement. Given her refractory disease, she underwent five sessions of therapeutic plasma exchange over eight days, which led to gradual resolution of catatonia and restoration of baseline mental and physical function without complications. This case underscores plasma exchange as a potential adjunctive therapy in severe, treatment-resistant NPSLE.

Pulmonary hypertension (PH) is a frequent complication of fibrotic interstitial lung diseases (ILDs), but its detection remains challenging due to overlapping clinical features. We aimed to evaluate the discriminatory power of physiological and exercise-based markers that differentiate right heart catheterization (RHC)-confirmed PH from low-probability ILD cases. In this prospective observational study of 59 patients with ILD, we evaluated pulmonary function tests (PFTs), cardiopulmonary exercise testing (CPET), and the 6-min walk test (6MWT). Patients deemed at high probability for clinically relevant PH following a multidisciplinary assessment were referred for RHC. Receiver operating characteristic (ROC) analysis was used to compare RHC-confirmed PH cases (n = 18) with a clinically low-probability ILD cohort (n = 19). Patients with RHC-confirmed PH had significantly lower diffusing capacity for carbon monoxide (DLCO) (43.44 ± 13.73% vs. 59.11 ± 13.50%, p = 0.002) and higher ventilatory inefficiency, as measured by the VE/VCO₂ slope (47.00 ± 7.90 vs. 40.71 ± 8.48, p = 0.035). DLCO showed moderate discriminatory performance (AUC 0.799; optimal cut-off 50.5% predicted; sensitivity 72%; specificity 72%), whereas VE/VCO₂ slope showed fair discrimination (AUC 0.711; cut-off ≈ 41.5; sensitivity 75%; specificity 59%). Although 6MWT distance did not differentiate the groups, post-exercise oxygen desaturation and heart rate were significant indicators. In fibrotic ILD, gas exchange and ventilatory inefficiency parameters-specifically DLCO and VE/VCO₂ slope-effectively discriminate RHC-confirmed PH from clinically low-probability cases. These markers offer a practical screening approach to identify patients who should be prioritized for further PH testing.

The blood pressure (BP) threshold at which pharmacotherapy benefit outweighs the risk of withholding treatment remains dynamic with advancing knowledge. This study explored the implications of the 2025 American Heart Association/American College of Cardiology (AHA/ACC) guideline on hypertension prevalence, treatment eligibility and BP control in Nigeria.

This was a secondary analysis of a population-based cross-sectional hypertension survey in Lagos, Nigeria. Participants were categorised as AHA/ACC 2025, Seventh Report of the Joint National Committee (JNC 7) or known hypertensives on treatment. Demographic characteristics, hypertension staging, pharmacotherapy eligibility, cardiovascular risk profile and target BP control rates were compared across categories (kidney disease-eligibility and Predicting Risk of Cardiovascular Disease Events tool-based eligibility were excluded).

Among 3030 participants aged 17-92 years, 2788 (92.0%) met AHA/ACC 2025 criteria, 1340 (44.2%) met JNC 7 criteria and 242 (8.0%) were known treated hypertensives. AHA/ACC 2025 identified a higher proportion of hypertensives aged 20-39 years. Over half of participants in both AHA/ACC 2025 and JNC 7 categories had stage 1 hypertension. Compared with JNC 7, AHA/ACC 2025 increased pharmacotherapy eligibility by 17.2% in males and 18.0% in females, with the largest increments (23.6% and 25.5%) in adults aged <20 and ≥60 years, respectively. Over a third required lifestyle modification alone under both guidelines. Among treated hypertensives, target BP control rate was 19.4% (JNC 7) and 10.7% (AHA/ACC 2025).

Application of the 2025 AHA/ACC guideline increased the burden of hypertension and pharmacotherapy eligibility in Nigeria, widening the gap between eligibility and current treatment and control rates. While this reflects earlier identification of hypertension with potential long-term cardiovascular benefit, realising this advantage in low-resource settings will require considering its implications for medicine supply, workforce capacity, and the feasibility of laboratory-based eligibility criteria in this setting.

Pulmonary hypertension caused by fibrosing mediastinitis (PH-FM) is a high-risk condition with limited validated tools for prognostic assessment. Although diffusing capacity of the lung for carbon monoxide (DLCO) predicts outcomes in several cardiopulmonary diseases, its prognostic value in PH-FM remains unclear. In this multicenter retrospective cohort study, we included 106 patients with confirmed PH-FM from 14 centers across China. The primary endpoint was all-cause mortality. Cox proportional hazards models were used to assess the association between baseline percent-predicted DLCO and mortality, with sequential adjustment for clinical, hemodynamic, and spirometric variables. The final cohort included 106 patients, of whom 60 had DLCO ≥ 60% predicted and 46 had DLCO < 60% predicted. Over a median follow-up of 36 months (interquartile range [IQR], 14.0-50.8), 27 deaths occurred. Across Cox models, each 10-percentage-point increase in percent-predicted DLCO was associated with a 30% lower risk of all-cause mortality. DLCO < 60% predicted was associated with higher all-cause mortality compared with DLCO ≥ 60% predicted, with hazard ratios ranging from 6.90 to 7.80 across models. Lower baseline percent-predicted DLCO was independently associated with a higher risk of all-cause mortality in patients with PH-FM. DLCO may provide a simple, noninvasive measure to complement current risk assessment in this population.

Cardiovascular medicine faces persistent implementation gaps driven by workforce shortages, fragmented data systems, and the cognitive burden of complex clinical decision-making-structural constraints that limit the delivery of guideline-directed care. Artificial intelligence (AI) is transitioning from isolated predictive models toward autonomous agent systems capable of perceiving, reasoning, and acting in clinical environments, offering a potential pathway to address these challenges.

This review synthesizes current evidence on AI agent systems in cardiovascular medicine across four interconnected dimensions: technical paradigms enabling agentic functionality (multi-agent systems, digital twins, multimodal integration), emerging clinical applications across the cardiovascular continuum, and governance frameworks essential for responsible translation.

We conducted a narrative review of peer-reviewed literature published between January 2020 and March 2026, drawing from PubMed, Web of Science, IEEE Xplore, and Scopus databases. Search terms included combinations of "artificial intelligence", "AI agents", "autonomous agents", "multi-agent systems", "large language models", "cardiovascular diseases", "heart failure", "digital twins", and "clinical decision support". Emphasis was placed on high-quality original research, systematic reviews, and position papers from major cardiovascular societies, with particular attention to developments from 2024 to 2026.

Agentic AI systems should function as augmented intelligence-enhancing rather than replacing clinical judgment-to close implementation gaps in cardiovascular care. Multi-agent architectures, digital cardiovascular twins, and multimodal integration are emerging as core technical paradigms. The ClinNoteAgents system demonstrates high extraction fidelity (conditional accuracy ≥90%) for clinical variables while achieving 60%-90% text reduction. Digital twin applications span therapy planning, risk prediction, and monitoring, with 69% relying on mechanistic models and 76% utilizing imaging data for personalization. Heart failure has emerged as a paradigmatic use case, driven by structural workforce gaps and the ARPA-H ADVOCATE initiative launched in January 2026. The C.A.R.D.I.O. framework (Clinical validation, Auditability, Risk stratification, Data privacy, Integration, Ongoing vigilance) and the CURACO framework (Clinical safety, Understanding, Research-informed care, Authentic patient-centred approaches, Conscientious ethics, Optimised technology) provide governance structures for responsible deployment. A rapid systematic review of 13 studies including 22,641 participants found that 85% of AI interventions improved cardiovascular outcomes, with mortality reductions of 0.8%-12% and major adverse cardiovascular event reductions of 4%-12%.

Cardiovascular medicine stands at an inflection point. The transition from assistance to autonomy requires rigorous fit-for-purpose evaluation, transparent interpretability mechanisms, and robust governance frameworks. Agentic AI systems should function as augmented intelligence-enhancing rather than replacing clinical judgment-to close implementation gaps in cardiovascular care.

The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) represents a rare and potentially life-threatening coronary anomaly. The clinical manifestations, progression, and prognosis of ALCAPA are significantly influenced by the degree of collateral circulation. Only 10%-15% of untreated individuals with ALCAPA develop extensive collateral circulation from the right coronary artery, enabling them to survive into adulthood with either no symptoms or various nonspecific symptoms, thereby presenting considerable diagnostic challenges. Furthermore, ALCAPA may occur in isolation or in conjunction with other congenital heart diseases, which can obscure its presence and complicate its management. Herein, we present a distinctive case of an adult patient with ALCAPA and coronary-pulmonary artery fistula, who exhibited facial edema and mild pericardial effusion secondary to severe hypothyroidism, without any cardiac symptoms. Given the patient's cardiomegaly, coronary artery calcification, abnormal electrocardiogram, and hyperlipidemia, coronary angiography was conducted, which incidentally revealed the presence of ALCAPA and the coronary-pulmonary artery fistula. Subsequent right heart catheterization and resting single-photon emission computed tomography myocardial perfusion scintigraphy identified pre-capillary pulmonary hypertension and regional myocardial perfusion defect in the anterior and lateral walls of the left ventricle. This case underscores the considerable difficulty in diagnosing adult ALCAPA and emphasizes the need for a thorough evaluation in patients presenting with atypical cardiac manifestations.

Axial dissections of the thoracic artery are common causes of death in people diagnosed with aortic dissection; however, decisions to intervene on ascending thoracic aortic patients are determined by the size of the ascending thoracic aorta based on its diameter. Diameter-based criteria fail to take into consideration the biomechanical properties of the aorta as well as other characteristics of the patient, and finite element analysis (in determining aortic wall stresses) would ideally address the issues associated with today's diameter-based criteria. A novel computational solution, termed BioPINN-LM, integrates 2 computational methods for the rapid real-time prediction of aortic wall stress: a physics-informed neural network (PINN) trained with mechanical simulation data to predict wall stress and a multimodal large language model that uses output data from the PINN along with image-based geometry descriptors to provide interpretable risk assessments from both ends of the aorta. Comparison of the PINN to the reference database of finite element method results demonstrates that the PINN produces an average wall stress prediction error of 8.34 kPa (6.12% relative error) for a blood pressure of 120/80 mmHg, with an average prediction time of 0.83 s per geometry compared to 38.6 min for the traditional finite element method. The conversational component of BioPINN-LM achieves 87.4% agreement with board-certified specialist recommendations on a benchmark of 200 simulated clinical scenario vignettes. As a simulation-based proof of concept, these results suggest that integrating mechanistic simulations with language-based inquiry may complement biomechanical decision-making for ascending thoracic aortic aneurysms; clinical validation on real patient cohorts with longitudinal outcomes is deferred to future work.

To investigate the mechanism of Tongdu Zhiyu acupuncture in the treatment of post-stroke depression (PSD).

A randomized controlled trial was conducted. Sixty-two PSD patients from the Department of Brain Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine were enrolled and randomly assigned in a 1∶1 ratio to a control group (n = 31) or an experimental group (n = 31). All patients received basic treatment. The control group received ordinary acupuncture, while the experimental group received ordinary acupuncture combined with Tongdu Zhiyu acupuncture. The treatment period was 8 weeks. The primary outcome was the total score on the 24-item Hamilton Depression Scale (HAMD-24). Secondary outcomes included the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index, peripheral blood mononuclear cell miR-223-3p expression, and serum levels of NLRP3, IL-1β, and IL-18.

After treatment, all indicators in the experimental group improved significantly compared with baseline (all P < 0.05), and the improvements were significantly greater than those in the control group (all P < 0.05). The HAMD-24 score decreased from 17.87 ± 3.90 to 13.04 ± 3.55; the NIHSS score decreased from 23.29 ± 6.74 to 9.97 ± 5.81; the Barthel index increased from 32.29 ± 5.37 to 87.13 ± 6.82; miR-223-3p expression increased from 0.29 ± 0.07 to 0.98 ± 0.21; serum NLRP3 decreased from (65.84 ± 7.16) ng/L to (49.56 ± 4.89) ng/L; IL-1β decreased from (43.92 ± 7.25) pg/mL to (22.24 ± 4.76) pg/mL; and IL-18 decreased from (30.70 ± 4.13) pg/mL to (15.40 ± 3.09) pg/mL.

Tongdu Zhiyu acupuncture can improve neurological function in PSD patients. Its mechanism may involve upregulating miR-223-3p expression, inhibiting NLRP3 inflammasome activation, and reducing the release of pro-inflammatory cytokines such as IL-1β and IL-18, thereby alleviating depressive symptoms.

Vulnerable atherosclerotic plaques represent a critical pathological basis of acute cardiocerebrovascular events. Previous studies indicate that atherosclerotic plaques are more vulnerable under chronic kidney disease (CKD) milieus. Emerging evidence highlights that vascular smooth muscle cells (VSMCs) play a pivotal role in maintaining plaque stability, but the underlying mechanisms remain incompletely elucidated. Here, single-cell sequencing and functional enrichment analysis of arterial tissues from patients with CKD are performed, identifying lipid metabolism disorders in VSMCs. Further utilizing spatial and targeted lipidomics, apolipoprotein-E-deficient (ApoE ^-/-) mouse with CKD (CKD/ApoE ^-/- mouse) and bioinformatics analysis, we investigate the lipidomic profile of VSMCs and find that VSMCs in CKD-associated vulnerable plaques exhibit significant accumulation of polyunsaturated fatty acids (PUFAs), which induces VSMC ferroptosis and exacerbates plaque vulnerability. Mechanistically, the deficiency of ECH1 leads to the accumulation of PUFA in VSMCs, thereby inducing ferroptosis in fibrous cap VSMCs and fibrous cap thinning. Meanwhile, low expression of mRNA binding protein human antigen R (HuR) resulting from CKD milieus mediates the lack of ECH1 in VSMCs. In contrast, VSMC-specific overexpression of ECH1, inhibition of PUFA release using giripladib or suppression of PUFA lipid peroxidation with PRGL493 significantly alleviate VSMC ferroptosis and CKD-associated plaque vulnerability. These findings reveal that ECH1-deficiency-driven PUFA accumulation is responsible for VSMC ferroptosis and atherosclerotic plaque vulnerability. Targeted regulation of ECH1-mediated PUFA metabolism may be a promising preventive and therapeutic strategy for CKD-associated plaque vulnerability.