It is increasingly recognized that many cardiovascular diseases have a genetic basis. Advancements in genome sequencing have allowed for dramatically higher rates of genetic testing with improved availability at a reduced cost. Technologic innovations-catalyzed by clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 (Cas9)-related approaches-have enabled the ability to edit an individual patient's genome in a precise and targeted manner. Delivery of these genetic interventions to desired cells specifically, safely, and efficiently has been a challenge, but the development of lipid nanoparticles offers a promising approach in cardiovascular diseases with hepatocyte-expressed treatment targets. Progress in genetic therapies have been exponential such that curative treatments for some cardiovascular diseases are imminent. Given such rapid advancement and the potential scope of impact, this scientific statement provides an overview of gene editing therapies for the practicing clinician. This includes descriptions of: 1) the basic science that supports gene editing therapy; 2) the cardiovascular diseases that are currently most amenable for initial application of gene editing-diseases that are typically monogenic, that are modifiable by knockdown of protein production, and whose protein synthesis errors occur in the liver (certain variants of hypercholesterolemia and amyloidosis); and 3) the inherent challenges of gene editing including the societal and ethical implications of high-cost, single-treatment cures. As gene editing technology in the treatment of cardiovascular diseases continues to expand and evolve, cardiovascular clinicians are key stakeholders in ensuring that these interventions are applied with the proper clinical indications and with guardrails to promote ethical and equitable treatment.

The optimal timing for initiating antiplatelet therapy (APT) after intravenous alteplase in acute ischemic stroke (AIS) remains unclear, due to concerns about intracranial hemorrhage. This study evaluated the safety and efficacy of early APT (≤24 h post-alteplase) versus standard APT (>24 h) in AIS patients.

We conducted a retrospective analysis of 154 AIS patients treated with intravenous alteplase between May 2019 and December 2022. Patients were stratified into early APT (E-APT, n = 77) and standard APT (S-APT, n = 77) groups. Neurological and functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at discharge and at 3 months. Coagulation parameters and hemorrhagic events were monitored to evaluate safety.

Baseline characteristics were comparable between groups. At 3 months, the E-APT group demonstrated significantly greater neurological improvement (ΔNIHSS: 4.31 ± 3.45 vs. 3.25 ± 3.49; p = 0.041) and better functional outcomes (mRS: 0.98 ± 1.12 vs. 1.35 ± 1.24; p = 0.030) than the S-APT group. Early APT was not associated with increased cerebral hemorrhage (0% vs. 2.6%, p = 0.155) or mortality (2.6% vs. 5.2%, p = 0.405). Spearman correlation confirmed that shorter intervals from alteplase to APT were associated with improved outcomes (ΔNIHSS: ρ = -0.28, p = 0.001; mRS: ρ = 0.24, p = 0.003). Subgroup analyses indicated that aspirin was the primary contributor to the observed benefits.

Initiating APT within 24 h after alteplase improves neurological and functional recovery in AIS without increasing hemorrhagic risk. These findings suggest that earlier APT may be considered in post-thrombolysis management, potentially informing revisions to current guideline recommendations.

Purpose To evaluate the feasibility of retrospective electrocardiographically (ECG) gated single-shot cine using deep learning-enhanced compressed sensing (AI-CS) versus conventional balanced steady-state free precession (bSSFP) cine, focusing on left ventricular (LV) structure and function. Materials and Methods Between September 1, 2023, and September 28, 2024, participants (including those with suspected arrhythmias) were prospectively recruited to undergo short-axis cine imaging with both bSSFP and AI-CS single-shot sequences on a 1.5-T scanner. LV volumetric parameters (LV end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, and mass) and strain parameters (peak strain in the radial, longitudinal, and circumferential directions and the time to peak strain SD) were measured and compared using Wilcoxon signed rank tests. Results Among 25 healthy volunteers (mean age, 37.88 years ± 16.76 [SD]; 18 female) and 45 participants with suspected arrhythmia (mean age, 53.21 years ± 15.45; 20 female), the AI-CS single-shot cine had better image quality compared with bSSFP cine, particularly in participants with arrhythmia (European Cardiovascular Magnetic Resonance Registry score: 0.32 ± 0.68 for bSSFP cine vs 0.05 ± 0.22 for AI-CS single-shot cine; P < .001), with fewer mistrigger events and cardiac motion artifacts. AI-CS showed good to excellent agreement with bSSFP for biventricular volume and LV mass measurements and provided comparable ejection fraction values to those at echocardiography in cases in which bSSFP failed (37.50% ± 5.28 vs 31.70% ± 6.43; z = -1.864; P = .06). Scan time was significantly reduced with AI-CS (10 seconds ± 2 vs 132 seconds ± 8; P < .001). Conclusion AI-CS single-shot cine demonstrated greater image quality and clinical feasibility compared with bFFSP cine in healthy participants and participants with suspected arrhythmias. Keywords: Artificial Intelligence-assisted Compressed SENSE, Arrhythmias, Left Ventricular Structure, Left Ventricular Function, Cardiac MRI, Balanced Steady-State Free Precession Cine Sequences Supplemental material is available for this article. © RSNA, 2026.

Purpose To evaluate the effect of section thickness on aortic valve calcification quantification via photon-counting detector (PCD) CT. Materials and Methods This retrospective study included patients who underwent electrocardiography-gated PCD CT from March 2023 to October 2024. The aortic valve Agatston score (AVAS), aortic valve calcium volume (AVCV), and aortic valve calcium mass (AVCM) were measured at 3-mm, 1-mm, and 0.4-mm sections. Linear mixed model and regression analyses were performed. Sex-specific AVAS thresholds were used for aortic stenosis (AS) severity classification (≥2000 for male patients, ≥1300 for female patients). Results Eighty-four patients (median age: 84 years [IQR: 80-88 years], 58 female) were included. AVAS at 70 keV decreased with thinner sections: 3-mm section, 2141 (95% CI: 1931, 2351); 1-mm section, 1900 (95% CI: 1690, 2110), and 0.4-mm section, 1791 (95% CI: 1581, 2001) (P < .001). AVCV decreased similarly: 1806 mm³ (95% CI: 1640, 1972), 1496 mm³ (95% CI: 1330, 1661), and 1373 mm³ (95% CI: 1207, 1538) (P < .001). AVCM differed minimally: 518 mg (95% CI: 452, 585), 525 mg (95% CI: 459, 592), and 527 mg (95% CI: 461, 594) (P < .001 except for 1 mm vs 0.4 mm, P = .24). Compared with 3-mm sections, seven of 84 (8.3%) and eight of 84 (9.5%) patients were reclassified from CT-severe to CT-nonsevere with 1- and 0.4-mm sections, respectively (P < .001). Regression-based equivalent thresholds were 1770 (male patients) and 1154 (female patients) at 1 mm and 1675 (male patients) and 1087 (female patients) at 0.4 mm. Conclusion Thin-section PCD CT decreased AVAS and AVCV, resulting in AS severity reclassification in 8%-9% of patients. Keywords: Applications-CT, CT-Photon Counting, Cardiac, Aortic Valve, Calcifications/Calculi Supplemental material is available for this article. © RSNA, 2026.

There is limited data on perioperative management of patients with prior stroke undergoing total hip arthroplasty (THA). This study evaluates timing for THA following stroke. We assessed (1) complications at 90 days, 1 year, and 2 years; (2) timing of stroke and THA; and (3) risk factors for periprosthetic joint infection (PJI).

We retrospectively analyzed a national database to identify 35,496 THA patients. Cohorts were stratified by time from stroke to surgery: no stroke (n = 20,000), stroke within 6 months (n = 5,535), 12 months (n = 3,165), 18 months (n = 2,614), 24 months (n = 2,168), and 30 months (n = 2,014). Complication rates were compared at 90 days, 1 year, and 2 years, and multivariate analysis identified risk for PJI.

Stroke within 6 months of THA was associated with higher PJI revision rates at 90 days and 2 years (all P < .046). Stroke within 18 months increased PJI revision risk across all time points (all P < .047). Several risk factors were associated with this complication, including hypertension, obesity, and tobacco use. Stroke 6 to 18 months before THA was associated with higher rates of 90-day complications, including deep vein thrombosis, cardiac arrest, and surgical site infections. Patients with stroke prior to THA had significant risks of revision for PJI and aseptic revisions at 1 and 2 years, with risks depending on time between stroke and THA (all P < .002).

A history of stroke increases postoperative complications after THA, particularly PJI. We recommend patients defer THA for at least 18 months following a stroke to minimize risks.

This study explores the experiences of pregnant women with HDP in Eastern Indonesia, focusing on how they perceive the condition, access care, and manage the emotional and practical challenges during pregnancy.

A qualitative phenomenological design was used, involving in-depth interviews with 15 pregnant women diagnosed with HDP across three primary healthcare centers in Eastern Indonesia. Data were collected using semi-structured interviews, transcribed verbatim, and analysed thematically.

Four themes emerged: (1) Emotional distress and psychological burden following HDP diagnosis; (2) Uncertainty in knowledge and care, exacerbated by inconsistent medical information and limited provider communication; (3) Diverse coping strategies, ranging from active information seeking to avoidance and reliance on social support; and (4) Self-management combining medical advice, lifestyle changes, and traditional practices. These findings reveal critical gaps in health education, communication, and culturally appropriate care delivery.

This study highlights the need for context-specific, culturally sensitive approaches to HDP management. Interventions should strengthen patient-provider communication, standardise care practices, and integrate health education at the primary level. Understanding women's lived experiences is essential to improving maternal outcomes in low-resource settings and reducing Indonesia's maternal mortality rate.

In patients with atrial fibrillation (AF), the impact of liver disease (LD) on oral anticoagulant (OAC) prescription and outcomes remains unclear, as well as possible differences between European and Asian populations.

To examine the impact of LD on OAC prescriptions and risks of adverse outcomes in a large cohort of European and Asian AF patients.

AF patients were derived from two large observational registries held in Europe and Asia. OAC prescription and risk of outcomes were analysed according to LD at baseline. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Logistic regression assessed associations with OAC prescription, and Cox regression analyses evaluated risks of outcomes. Interaction analyses were performed between European and Asian patients.

Among 15,681 patients (mean age 68.4 ± 10.7 years; 37.1% female), 517 (3.3%) had LD. The OAC prescription rate was similar among European and Asian individuals (6.8% vs. 82.9%, p = .113). After adjustments, LD was associated with lower OAC prescription (OR .67, 95% CI .53-.84), with a greater reduction in European than in Asian patients (p_int = .015). LD was associated with a higher risk of the composite outcome (HR 1.42, 95% CI 1.11-1.81) and MACEs (HR 1.47, 95% CI 1.07-2.02), with no significant European versus Asian differences (p_int = .631). Among LD patients, those not prescribed OAC had a higher MACE risk compared with those prescribed OAC (p_int = .050), with no differences in major bleeding.

In AF, LD is associated with reduced OAC prescription, especially in Europe, and a higher risk of adverse outcomes, particularly in patients not receiving OAC, with no significant differences between European and Asian cohorts.

Ambient temperature is a key environmental driver of cardiovascular health. With rising global temperatures and increasing frequency, intensity, and duration of extreme temperature events, understanding the cardiovascular impacts of nonoptimal temperature is more urgent than ever. Short-term exposures to both heat and cold increase the risk of cardiovascular events, including myocardial infarction, stroke, heart failure decompensation, arrhythmias, and sudden cardiac death. Climate, built environment, socioeconomic variables, physiological vulnerability, and systemic inequities exacerbate these risks. There is also a growing appreciation of the importance of contextual factors such as geographic location, housing, occupation, and individual-level exposure. A range of biological mechanisms, including autonomic and neurohormonal activation, endothelial dysfunction, inflammation, hemoconcentration, and impaired thermoregulation, mediate temperature-related cardiovascular risk. Nonoptimal temperatures affect not only the incidence of cardiovascular disease but also health care access and delivery. They can increase demand for emergency care, disrupt operations, and pose challenges to the resilience and sustainability of health systems. Meanwhile, cardiovascular care contributes significantly to health care-related greenhouse gas emissions, highlighting a paradox in which efforts to protect cardiovascular health can indirectly contribute to climate-driven risks. This scientific statement synthesizes current knowledge of the relationship between nonoptimal temperature and cardiovascular health, highlights inequalities in exposure and outcomes, and identifies actionable strategies at the individual, community, health system, and public policy levels. Last, this scientific statement outlines significant research gaps and future priorities, including the need for improved exposure assessment, better understanding and measurement of the impact of long-term exposures, interactions with medications and coexposures, and identification of risk modifiers. Coordinated action is needed in research, clinical practice, and policy to mitigate the rising risks of nonoptimal temperatures on cardiovascular health in a changing climate.

Healthcare-associated infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP) are a global public health threat with rising hospital morbidity and mortality. We conducted a meta-analysis to systematically identify CRKP infection risk factors.

We searched Medline, Embase, Web of Science, and Cochrane Library for studies published January 1991-December 2024. Pooled odds ratio (OR)/95% confidence intervals (CIs) were used to assess risk factors; publication bias was evaluated via funnel plots and Egger's test, and robustness via leave-one-out sensitivity analysis.

Fifty-one studies (13,860 patients: 4,711 CRKP cases, 9,149 carbapenem-susceptible K. pneumoniae controls) were included, with 43 reported risk factors. Thirty-one were significant: demographic/underlying diseases [male sex (OR = 1.31), kidney diseases (OR = 1.47), respiratory system diseases (OR = 2.69), cardiovascular diseases (OR = 1.34)]; invasive procedures [endoscopy (OR = 4.08), tracheal cannula (OR = 3.72), mechanical ventilation (OR = 3.61)]; medical environment [ICU admission (OR = 4.27), pre-infection hospital stay (mean difference=14.98 days)]; antibiotics [tigecycline (OR = 5.97), carbapenems (OR = 4.79), which may reflect disease severity, prior colonization]. Subgroup analysis showed regional heterogeneity: Western populations had higher risks with cephalosporins (OR = 2.68 vs. Eastern 1.55) and fluoroquinolones (OR = 3.58 vs. Eastern 1.89), while Eastern populations had higher risks with invasive procedures (dialysis: OR = 4.47 vs. Western 2.03). Sensitivity analysis confirmed robust results.

This meta-analysis reports endoscopy and surgical drainage as distinct subtypes of invasive procedural factors associated with hospital-acquired CRKP infection and describes regional differences in associated factors between Eastern and Western populations. These findings, based on observational evidence, provide preliminary insights for targeted prevention strategies.

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024628428.

The growing use of nanomaterials (NMs) in consumer, medical and industrial products raises significant concerns about human exposure and the risk of cardiovascular toxicity. This narrative review synthesizes three critical and interconnected aspects of nanomaterial-induced cardiotoxicity-risk assessment models, mechanisms, and mitigation strategies-with the overarching goal of advancing fundamental knowledge and supporting the development of safer NMs. A variety of assessment models are explored, ranging from traditional in vitro and in vivo systems to emerging organ-on-a-chip platforms. A tiered, decision-driven strategy for model selection is based on risk-stage, objective-orientation, evidence complementarity, and ethical optimization, with emphasis on the critical need to assess toxicity under pathological conditions. Key mechanisms include oxidative stress, mitochondrial dysfunction, inflammatory responses, disruption of ion homeostasis, and induction of cell death. The specific pathway is often dictated by the physicochemical properties of nanoparticle. Potential mitigation strategies include surface engineering, elemental substitution/doping, morphological design, the use of chelating agents/antioxidants, and adopting Safe-by-Design principles. Interdisciplinary collaboration is crucial during the developmental phase to balance the immense application potential of NMs with the imperative to address their associated toxicity challenges.