Although hydrotherapy is an alternative treatment for people with heart conditions, it is still unknown how hydrotherapy would affect these patients' quality of life and ability to exercise. The aim of this review is to investigate the impact of hydrotherapy on heart disease patients. A search of the databases PubMed, the Physiotherapy Evidence Database (PEDro), EBSCO, Scopus, and Google Scholar was conducted to identify randomized controlled trials (RCTs) examining how hydrotherapy affects people with heart conditions. The PEDro scale was used to evaluate the methodological quality of the research for bias risk. This scoping review comprised eleven studies with a total of 245 cardiac patients. Hydrotherapy reduced heart rate, mean arterial pressure, systemic vascular resistance, and cardiac index in patients with chronic heart failure and increased exercise tolerance, peak power output, and total body strength in male patients with coronary artery disease. It also improved work rate, cardiac output, stroke volume, exercise and walking capacity, and peak oxygen uptake. The risk of bias assessment revealed that one study was excellent quality, eight studies were good quality, and two were poor quality. Hydrotherapy is an effective physical therapy modality for the rehabilitation of patients with cardiac diseases. However, further, larger studies with less heterogeneity are required due to the low-quality studies and low-quality evidence to confirm the findings and elucidate the underlying mechanisms of hydrotherapy in cardiac patients.
OBJECTIVES:To investigate the relationship between body mass index (BMI) and postoperative mortality in patients undergoing aortic valve surgery, with an emphasis on exploring the presence and limits of the "obesity paradox", the phenomenon wherein overweight and mildly obese patients may experience lower mortality despite obesity's general association with adverse health outcomes. METHODS:The Nationwide Inpatient Sample (NIS) database was used to obtain data from adult patients who underwent aortic valve surgery between 2016 and 2020. BMI categories, as well as comorbidities, were identified using ICD-10 codes. Mortality rates across BMI categories were compared, and multivariate analysis was performed to adjust for comorbid conditions. This is a retrospective observational study. RESULTS:We found 301,250 adult patients who underwent aortic valve surgery. Normal weight patients (n=226,490) had a mortality rate of 3.79%. Overweight (n=2,555) and obese (n=46,320) patients demonstrated significantly lower mortality rates of 1.17% (OR=0.30, 95% CI: 0.14-0.66; P=0.003) and 2.43% (OR=0.63, 95% CI: 0.55-0.73; P<0.001), respectively. Cachectic patients (n=835) had the highest mortality rate at 14.97% (OR=4.47, 95% CI: 2.87-6.96; P<0.001). Morbidly obese patients (n=25,450) had a mortality rate of 4.13%, which was not significantly different from normal-weight patients (OR=1.09, 95% CI: 0.94-1.26; P=0.23). These trends and statistical significance remained after multivariate logistic regression, accounting for demographics and comorbidities. CONCLUSIONS:The partial obesity paradox is true in patients undergoing aortic valve surgery, with the lowest mortality occurring in overweight patients, followed by obese patients, and with cachexia having the highest mortality out of all groups.
OBJECTIVE:This study aimed to evaluate the clinical, biochemical, and functional outcomes of sacubitril/valsartan therapy in Indian patients with heart Failure (HF) with reduced ejection fraction (HFrEF) in routine practice. METHODS:We conducted a retrospective, single-centre, observational study at The Heart Clinic, New Delhi, India. Adult patients (≥18 years) with the New York Heart Association (NYHA) class II-IV HF who were newly initiated on sacubitril/valsartan and had ≥12 months of follow-up were included in the study. Clinical, echocardiographic, and biochemical data were extracted from the electronic medical records. The primary outcomes at 12 months were changes in left ventricular ejection fraction (LVEF), NYHA classification, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, estimated glomerular filtration rate (eGFR), and the number of patients receiving the maximum dose of sacubitril/valsartan. The secondary outcomes were cardiovascular and all-cause mortality. RESULTS:A total of 300 patients were analyzed (mean age, 61.3 years; 69.7% male). Hypertension (266 patients, 88.7%), diabetes (163 patients, 54.3%), and chronic kidney disease (153 patients, 51%) were the most frequent comorbidities. At 12 months, the mean LVEF increased significantly from 29.57% to 34.66% (absolute gain of 5.09%, P<0.0001). A significant improvement in functional ability was observed, with 282 patients (94%) classified as NYHA class II at 12 months compared with 22 patients (7.3%) at baseline (P<0.0001), and the NT-proBNP levels decreased from 2344.5 ± 1951.8 pg/mL to 564 ± 410.3 pg/mL (P<0.0001). Renal function remained stable (mean change in eGFR +2.01 mL/min/1.73 m2, P=0.088). Over half of the cohort (52.3%) achieved a target dose of 200 mg twice daily. No cardiovascular or all-cause deaths were observed. CONCLUSION:In this real-world Indian cohort, sacubitril/valsartan was associated with significant improvements in systolic function, functional class, and NT-proBNP levels, with preserved renal function and good tolerability. These findings support the use of sacubitril/valsartan as a cornerstone therapy for HFrEF management in routine clinical practice.
BACKGROUND:Cardiac amyloidosis is underdiagnosed. Amyloid deposits cause progressive diastolic dysfunction of a nondilated ventricle. Among the main subtypes, transthyretin amyloidosis (ATTR) affects 1 in 2,000 people, while light-chain (AL) amyloidosis is increasing in prevalence. Early identification of risk factors and prompt intervention may prevent severe complications. This study aimed to identify the risk factors for developing cardiac amyloidosis and its associated morbidity and mortality. METHODS:This retrospective cohort study used the National Inpatient Sample (2016-2020) to examine patients hospitalized with cardiac amyloidosis identified by ICD-10 codes. Over 50 risk factors, including hematologic, rheumatologic, and renal conditions, were evaluated as possible contributors. Predictors of cardiac amyloidosis and mortality were analyzed by demographic group. Inclusion required a primary or secondary diagnosis. Multiple logistic regression, adjusted for age, sex, and comorbidities, assessed associations. The primary outcome was cardiac amyloidosis; the secondary outcome was in-hospital mortality. RESULTS:There were 23,119 patients with cardiac amyloidosis. The mean age was 72.23 years, and 58% were male. Hereditary transthyretin amyloidosis (OR 215.89, 95% CI: 176.17-264.56) and familial Mediterranean fever (OR 111.99, 95% CI: 72.39-173.24) showed the strongest associations, both statistically significant (P<0.001). Additional risk factors included hematologic conditions, such as multiple myeloma (OR 15.31), Waldenström's macroglobulinemia (OR 6.99), and MGUS (OR 4.45), all P<0.001. Renal conditions such as chronic kidney disease (OR 1.83), end-stage renal disease (OR 2.76), and renal transplant (OR 2.4), and rheumatologic conditions such as Sjögren's syndrome (OR 2.04) and sarcoidosis (OR 1.69) were also significant (all P<0.001). By demographics, Black race (OR 2.52, P<0.001), Asian race (OR 1.11, P = 0.034), and older age (OR 1.05, P<0.001) were associated with increased risk. Notably, asthma, diabetes, and obesity were not linked to cardiac amyloidosis. In-hospital mortality increased with ESRD (OR 2.4), multiple myeloma (OR 1.41), and older age (OR 1.015). CONCLUSION:Hereditary transthyretin amyloidosis, familial Mediterranean fever, and Black race were the strongest risk factors, while end-stage renal disease and multiple myeloma correlated with higher in-hospital mortality. ICD-10-based diagnoses may limit accuracy. This stresses the need for improved risk stratification and targeted screening.
OBJECTIVES:The visceral adiposity index (VAI), an indicator of visceral fat accumulation and dysfunction, has been proposed as a potential marker for cardiometabolic risk. However, its association with hypertension in women of reproductive age remains unclear. Therefore, this study aims to investigate the association between VAI and the prevalence of hypertension in this specific population. METHODS:This cross-sectional study analyzed data from 2,571 women of reproductive age using the National Health and Nutrition Examination Survey (NHANES) database. Weighted multivariable logistic regression models were used to examine the relationship between VAI and hypertension, adjusting for potential confounders. Restricted cubic spline (RCS) modeling and two-piecewise linear regression were applied to evaluate the dose-response and threshold effects. Subgroup and interaction analyses were conducted across demographic and lifestyle factors. RESULTS:VAI was significantly and positively associated with the prevalence of hypertension in women of reproductive age (OR = 1.18, 95% CI: 1.08-1.29; P < 0.001). Smooth curve fitting revealed a nonlinear positive relationship (nonlinear P < 0.001), with a notable inflection point at VAI = 1.285. Below this threshold, the odds of hypertension increased sharply (OR = 4.48; 95% CI: 2.25-8.91; P < 0.001), while above it, the odds increased modestly (OR = 1.07; 95% CI: 1.02-1.13; P = 0.008). Subgroup analyses confirmed the robustness of this association across most strata. A significant interaction was found in the racial/ethnic subgroup (P for interaction = 0.017), suggesting varying strength of association among different racial groups. CONCLUSION:VAI is independently and nonlinearly associated with increased odds of hypertension in women of reproductive age, demonstrating a distinct threshold effect. These findings suggest that VAI may serve as a potential observational marker for evaluating cardiovascular risk in this population. Maintaining VAI below the 1.285 threshold could be considered in early cardiovascular prevention strategies.
BACKGROUND:Timely reperfusion remains central to the management of ST-segment elevation myocardial infarction (STEMI). In addition to limiting infarct size, delays in reperfusion may intensify systemic inflammation and contribute to impaired coronary microvascular flow, even when epicardial recanalization appears angiographically successful. This study examined whether reperfusion delay is associated with inflammatory markers at admission and impaired coronary flow measured by corrected TIMI frame count (CTFC) in patients with STEMI treated with primary PCI. METHODS:We conducted a single-center observational cohort study including 104 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PPCI).Reperfusion delay was defined as symptom-to-balloon time and was grouped into four categories (< 2, 2-4, 4-6, and > 6 hours). Inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were measured at admission and after PPCI. Coronary flow was quantitatively assessed using the corrected TIMI frame count (CTFC). Associations between reperfusion delay, inflammatory markers, and CTFC were evaluated. RESULTS:CTFC values increased progressively with longer reperfusion delay, indicating worsening coronary flow (P < 0.05). Admission ESR increased significantly with longer symptom-to-balloon time (P < 0.05), and higher CRP categories were more frequently observed among patients with delayed reperfusion (P < 0.05). Higher ESR and CRP levels at admission were also associated with increased CTFC values. Post-procedural ESR and CRP levels, however, showed no significant association with reperfusion delay or CTFC (P > 0.05). Higher ESR and CRP levels at admission were also linked with increased CTFC values. Post-procedural ESR and CRP levels, however, showed no significant association with reperfusion delay or CTFC. CONCLUSIONS:In patients with STEMI undergoing primary PCI, delayed reperfusion is associated with increased inflammatory burden at presentation and impaired coronary flow as assessed by corrected TIMI frame count. Taken together, these findings suggest that inflammatory activation during prolonged ischemia may contribute to impaired coronary flow and highlight the continued importance of minimizing reperfusion delay.
OBJECTIVES:Spontaneous Coronary Artery Dissection (SCAD) is a rare non-obstructive acute coronary syndrome. Although previously characterized by a lack of consensus on optimal management, treatment guidelines for SCAD have now been established to inform clinical practice. However, long-term follow-up data specifically for SCAD patients in China are lacking. The present study aimed to assess the clinical and angiographic outcomes of a Chinese cohort managed with initial Percutaneous Coronary Intervention (PCI) or conservative therapy. METHODS:The study enrolled 33 patients from the Northern Jiangsu People's Hospital, affiliated with Yangzhou University, whose initial diagnosis of SCAD was made from April 1, 2014 to June 30, 2020. The study recommended a follow-up coronary angiography for all patients 6 months after the initial onset. Clinical characteristics, angiographic findings, initial treatment strategies, discharge medications, and outcomes were recorded for all patients. RESULTS:Among the 33 patients with SCAD (mean age 51.9±9.7 years, 69.7% female), myocardial infarction was the predominant presentation (75.7%), with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) accounting for the majority of cases (51.5%). The left anterior descending artery (LAD) was the most frequently involved vessel (63.6%). According to the Saw classification, type 2b lesions predominated (65.7%). Compared to the conservative group, patients in the PCI group presented with a significantly higher degree of stenosis [100% (IQR, 98-100) vs. 70% (IQR, 70-80), P < 0.001] and a higher prevalence of baseline TIMI 0-1 flow (81.8% vs. 0%, P < 0.001). PCI was technically successful (TIMI 2-3 flow post-procedure) in all patients. During the initial hospitalization, the overall MACE rate was 9.1% (3/33). Over a median follow-up of 27.5 months (IQR, 15.3-51.3), the MACE rate was 9.4% (3/32), including one cardiac death. Recurrent Spontaneous Coronary Artery Dissection (R-SCAD) was confirmed in 3 patients (9.4%). No significant difference was observed in MACE-free survival between the PCI and conservative groups (59.3% vs. 85.7%, P=0.126). Follow-up coronary angiography (CAG) performed in 16 patients (50%) demonstrated angiographic healing in 15 patients (93.8%). Notably, 2 of the 3 patients who experienced late MACE had previously demonstrated complete lesion healing on 6-month follow-up CAG. Patients who underwent 6-month follow-up CAG exhibited a numerically lower MACE-free survival rate compared to those who did not, although this difference did not reach statistical significance (62.9% vs. 100.0%, P=0.10). CONCLUSION:This study reported that the outcomes of patients subjected to an initial conservative strategy were not inferior as compared to those treated with PCI. In patients who underwent follow-up CAG, healing was commonly observed. Therefore, guiding antiplatelet therapy based on angiographic findings and comorbidities appears rational.
OBJECTIVES:The purpose of this study is to assess the effects of acupuncture on glucose control, lipid metabolism, myocardial fibrosis, and the development of diabetic cardiomyopathy (DCM) in mice with type 2 diabetes. METHODS:After modelling, mice were divided into three groups: the control, model (DCM), and PC6+ST36 group. Acupuncture was applied at PC6 and ST36 acupoints for 15 min every other day, three times a week for 8 weeks during the development of diabetic cardiomyopathy. Heart function was assessed by echocardiography and electrocardiogram. Serum glucose, lipid metabolism and ANP were assessed via ELISA. The myocardium was assessed by histology, immunoblotting, RNA-seq and CUT&Tag on the day after all the treatments were finished. RESULTS:Acupuncture at Neiguan and Zusanli reduced abnormal glucose (mean difference of fed glucose decrease from 19.63 mmol/L to 12.62 mmol/L, P=0.008) and improved lipid metabolism (mean difference of TC decrease from 23.70 mmol/L to 17.81 mmol/L, P value is 0.038, TG from 27.14 mmol/L to 18.70 mmol/L, P value is 0.006, LDL from 19.36 mmol/L to 14.35 mmol/L, P value is 0.015, FFA from 578.96 mmol/L to 328.98 mmol/L, P value is 0.0001) in mice with diabetic cardiomyopathy. Both impaired systolic function (mean difference of EF increase from 52.84% to 71.10%, P value is 0.004, FS increase from 26.39% to 39.38%, P value is 0.008) and damaged diastolic function (mean difference of IVRT decrease from 26.50 ms to 16.33 ms, P value is 0.025, E/A ratio increase from 0.91 to 1.22, P value is 0.07) were observed in the DCM group, whereas acupuncture enhanced cardiac function in mice with DCM. Cardiac fibrosis was alleviated in the PC6+ST36 group, accompanied by reduced expression of fibrosis-related genes (Col1a1 family). Moreover, acupuncture inhibited cardiac apoptosis in mice with DCM to some extent. CONCLUSIONS:Acupuncture at Neiguan and Zusanli can improve heart function and myocardial hypertrophy by inhibiting cardiac apoptosis and fibrosis in mice with DCM.
Background: Mid-life hypertension is a treatable vascular risk for dementia, yet trial evidence on whether starting antihypertensives in middle age lowers late-life dementia remains mixed. This study aimed to emulate a randomized trial to estimate whether initiating antihypertensive therapy at mid-life reduces subsequent dementia risk. Methods: We emulated a randomized target trial of antihypertensive initiation using Health and Retirement Study data (2002-2020; 18-year follow-up). Eligible adults aged 45-65 with incident hypertension and dementia-free at baseline (n = 2,491) were classified in 2002 as antihypertensive treatment initiators or non-initiators. Inverse probability weights combined (I) a Firth-penalized logistic model for treatment initiation and (II) biennial censoring models; weighted Cox regression estimated hazard ratios (HRs) for incident dementia. To probe model dependence, we re-estimated treatment weights with a Super Learner ensemble and repeated all analyses. Results: Groups differed on several baseline covariates, but weighting brought every standardized mean difference to <0.10. Duringfollow-up, cumulative dementia incidence reached 15% in non-initiators and 13% in initiators. The intention-to-treat risk ratio (RR) was 0.89 (95% confidence interval [CI], 0.57-1.62); biennial RRs were likewise close to the null. Re-estimatingtreatment weights with a Super Learner ensemble yielded comparable covariate balance and a year-18 RR of 1.05 (0.74-1.70), essentially reproducingthe primary result. Analyses accountingfor competing risks of death or dropout did not materially change the estimates. Conclusions: In this nationally representative cohort, starting antihypertensive therapy in mid-life did not meaningfully change dementia risk across 18 years. Agreement between conventional and machine-learning propensity approaches makes a large protective or harmful effect unlikely and underscores the need to explore additional strategies for dementia prevention beyond routine blood pressure pharmacotherapy.
BACKGROUND:The triglyceride-glucose (TyG) index serves as a reliable surrogate marker of insulin resistance. Accumulating evidence links an elevated TyG index to increased cardiovascular risk, but its relationship with nonalcoholic fatty liver disease (NAFLD) in atrial fibrillation (AF) patients remains underexplored. This study aimed to investigate the association between the TyG index and NAFLD incidence among AF patients. METHODS:We conducted a retrospective analysis of 298 AF patients from a single tertiary care center. NAFLD was diagnosed via hepatic ultrasonography after secondary causes were excluded. TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Logistic regression models were employed to assess the independent association between the TyG index and NAFLD. RESULTS:The NAFLD prevalence was 27.9% (83/298). Patients with NAFLD presented significantly greater TyG index values (8.90 ± 0.05 vs. 8.62 ± 0.04; P < 0.001). After multivariable adjustment, each 1-unit increment in the TyG index independently predicted NAFLD (OR 2.194, 95% CI 1.149-4.190; P = 0.017). Receiver operating characteristic curve analysis demonstrated moderate discriminative ability (AUC 0.667, 95% CI 0.601-0.732). A dose-response relationship was observed (P for trend < 0.001), with NAFLD incidence increasing progressively across TyG tertiles (12.87%, 29.81%, and 40.82%). CONCLUSIONS:An elevated TyG index is an independent risk factor for NAFLD in AF patients, suggesting a shared metabolic pathophysiology between insulin resistance, hepatic steatosis, and cardiac arrhythmia. The TyG index may serve as a readily available tool for NAFLD risk stratification in this high-risk population.
Background: The role of inflammatory disease in the occurrence of atrial fibrillation/flutter (AF/AFL) is not well studied. Objective: The goal of this study was to evaluate any association between inflammatory and autoimmune disorders with the occurrences of AF/AFL using a large database. Methods: Using the Nationwide Inpatient Sample (NIS) database and ICD-10 codes for AF/AFL and several inflammatory diseases for the years 2016-2020, we evaluated the above association. Results: A total of 23,037,013 patients were identified with a diagnosis of AF/ AFL. The following diseases were independently associated with the presence of AF/AFL despite adjustment for age, demographics, and traditional risk factors: rheumatoid arthritis: OR: 1.05, CI 1.04-1.06, P<0.001, systemic sclerosis OR: 1.31, CI 1.26-1.36, P<0.001, systemic connective tissue disorders: OR: 1.07, CI 1.05-1.08, P<0.001, antiphospholipid syndrome: OR: 1.36, CI: 1.31-1.42, P<001, systemic lupus erythematosus: OR: 1.15, CI: 1.13-1.17, P<0.001 and Raynaud's syndrome: OR: 1.1, CI: 1.07-1.13, P<0.001. Ankylosing spondylitis was not found to be associated with AF/AFL. Conclusion: Using a large inpatient database, we found that some common inflammatory diseases and connective tissue disorders are independently associated with the presence of AF/AFL. Our findings are hypothesis-generating, requiring confirmation in prospective controlled trials.
BACKGROUND:Cardiac tumors are rare but clinically significant lesions requiring prompt and accurate diagnosis. While echocardiography remains the first-line imaging modality, it is limited by its inability to characterize tissue. Cardiovascular magnetic resonance imaging (CMR) and cardiac computed tomography (CT) offer superior anatomical detail but cannot reliably differentiate benign from malignant tumors. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) provides metabolic information that may overcome these limitations. METHODS:A systematic scoping review was conducted following a structured literature search covering January 2019 to September 2025. After screening 192 articles and applying predefined inclusion and exclusion criteria, 7 retrospective studies enrolling a total of 381 adult patients with newly diagnosed cardiac masses who underwent 18F-FDG PET/CT were included. RESULTS:Across all included studies, 18F-FDG PET/CT demonstrated high diagnostic accuracy in differentiating benign from malignant cardiac and pericardial masses. Key quantitative metabolic parameters consistently outperformed traditional imaging modalities. Reported sensitivity and specificity ranged from 92-100% and 88-93%, respectively. In one study, 18F-FDG PET/CT achieved a 100% decision-making rate and the highest area under the curve (AUC) of 0.94 compared to transthoracic echocardiography, CT, and CMR. SUVmax also emerged as an independent predictor of survival. CONCLUSION:18F-FDG PET/CT plays a significant diagnostic and prognostic role in evaluating cardiac tumors, offering metabolic insights that complement conventional anatomical imaging. It should be incorporated as a key adjunct in the multimodality work-up of suspected cardiac masses, particularly when malignancy is suspected or biopsy is not feasible.
Single ventricle disease (SVD) is a rare but severe form of congenital heart disease (CHD) which requires surgical palliation through the Fontan procedure. This operation, which was pioneered in 1971, has become the final part of a surgical pathway after the Norwood and Glenn procedures. The pathway aims to reduce the load on the functional ventricle whilst improving systemic blood oxygenation. Advances in surgical technique and the modern era have shifted the approach from addressing mortality concerns to offering a lifeline to patients in need. With improved survival, the Fontan population grows which requires an emphasis on the lifelong complications that these individuals face along with specific risk factors that predispose them to these issues allowing for risk stratification and systematic monitoring. This narrative review aims to summarize the recent cohort studies on Fontan patients to identify long-term outcomes of the procedure along with their associated risk factors. The literature review was conducted till December 2025 using PubMed, Scopus, and Google Scholar, the procedure itself is not curative. I has numerous morbidities including arrhythmia, heart failure, neurocognitive delays, protein-losing enteropathy, renal dysfunction, and Fontan-associated liver disease (FALD). FALD specifically may affect over half of Fontan patients within 35 years and the seriousness of FALD sequelae including cirrhosis and hepatocellular carcinoma underscores the need to prioritize early and systematic monitoring. Preoperatively, demographic, surgical, and biomarker risk factors have been shown to be predictors of postoperative complications/mortality. Overall, Fontan patients tend to have excellent survival rates over both the short and long terms compared to prior surgical eras. As postoperative concerns now shift from early mortality to long-term complications, our healthcare system must adapt to ensure lifelong follow-up and a systematic approach for early detection.
OBJECTIVES:Hypertension is a risk factor for cardiovascular diseases and is more prevalent in the elderly. Due to the aging population, it is crucial to know the risk factors of hypertension to prevent it and its complications. One potential risk factor is marital status; therefore, this study investigates the impact of marital status on hypertension risk, considering the variables of gender and age. METHODS:A comprehensive search was conducted in PubMed, Scopus, and Google Scholar until August 27, 2023. Study selection and data extraction were performed precisely. The pooled effect size for various marital status, age, and gender subgroups was calculated. RESULTS:The overall effect size of the association between marital status and HTN was 32.01 (95% CI = [38.93, 35.09]). Single, married, divorced, and widowed subgroups showed an effect size of 17.67 (95% CI = [19.23, 19.12]), 54.89 (45.05, 64,13]), 16.11 (95% CI = [14.00, 18.23]), and 27.46 (95% CI = [23.63, 31.29]), respectively. The analysis based on age revealed an effect size of 0.52 (95% CI = [0.38, 0.65]) and 0.38 (95% CI = [0.24, 0.52]). For those aged above 40 and below 40, respectively. Finally, males and females were associated with HTN, with effect sizes of 0.38 (95% CI = [0.33, 0.43]) and 0.45 (95% CI = [0.39, 0.51]), respectively. CONCLUSION:Our findings revealed that married and divorced status is associated with the highest and the lowest incidence of hypertension, respectively. In terms of gender and age, males aged < 40 were related to lower hypertension risk compared to females and those aged ≥ 40. However, more extensive cohort studies are needed to further support our findings.
Background: Severe coronary tortuosity and calcification frequently result in difficult device delivery during percutaneous coronary intervention (PCI). Conventional techniques for guide-extension (GE) insertion have reported success rates of 88-98.7% with complication rates of 1.6-5.9%. We aimed to evaluate the feasibility and safety of a novel traction balloon technique (TBT) to facilitate GE insertion to overcome these limitations and achieve reasonable procedural outcomes in complex coronary anatomy. Methods: We conducted a retrospective single-center case-series of consecutive patients who underwent GE-assisted PCI with TBT between December, 2020 and September, 2025. PCI cases in which, conventional methods of coronary device-delivery and/or GE insertion were unsuccessful were evaluated for GE-assisted PCI using TBT. The technique enables passive tracking of the GE through active traction to a large anchor-balloon inflated distally. Clinical characteristics, procedural-details, efficacy and safety endpoints were analyzed. Results: A total of 225 vessels from 214 patients (mean age 62.24 ± 9.8 years) underwent GE-assisted PCI using TBT. Clinical presentations included acute coronary syndrome (n=182, 85.05%), effort-angina (n=25, 11.68%), and heart-failure (n=7, 3.27%). Mean lesion-length was 52.15 ± 22.7 mm. All lesions were American College of Cardiology/American Heart Association type-C (n=225); and Society of Cardiovascular Angiography and Interventions type-2 (n=161, 71.56%) or type-4 (n=64, 28.44%) lesions. Median tortuosity-score was 2 (1-3) with extreme tortuosity in 75.56% of cases. Median calcification-grade was 2 (1-4) with heavy calcification in 40% of cases. Procedures were performed via upper-limb (n=194, 86.22%) or femoral (n=31, 13.78%) access. The indications for GE included distal delivery of balloons (n=195), stents (n=222) and others (n=199). The balloon-to-artery diameter ratio was 0.91 ± 0.1. The GE was inserted a median of 2 (1-6) times/vessel, achieving a mean maximum depth of 55.32 ± 17.9 mm. A total of 351 stents were deployed in 31 (12-131) minutes, with 100% procedural success. Complications included transient bradycardia and/or hypotension (n=2) and non-flow-limiting dissection (n=2). At a median follow-up of 22 (1-58) months, all patients remained asymptomatic, except for three patients who died. Conclusion: TBT-assisted GE insertion is a feasible and safe technique for device delivery during complex PCI, with high procedural success.
OBJECTIVES:The role of malnutrition in heart failure (HF) patients is unclear. We assessed the correlation between the Geriatric Nutritional Risk Index (GNRI) and all-cause mortality in HF. METHODS:PubMed, Scopus, and Web of Science were searched for observational studies reporting the correlation between GNRI and all-cause mortality in HF patients (up to January 26, 2025). Titles, abstracts, and full texts were screened. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess study quality. Data were synthesized via random-effects meta-analysis using the restricted maximum likelihood (REML) method. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS:Nineteen observational studies with 9,982 subjects were included. A low-risk GNRI group was correlated with raised all-cause mortality in HF patients (hazard ratio (HR) 1.77, 95% CI 1.38-2.16; P < 0.0001). Results were consistent across sensitivity analyses. Heterogeneity was high (I2 = 99.5%), and meta-regression explained 18.9% of the variance. Egger's test demonstrated possible publication bias (P = 0.0305). The high GNRI subgroup (5 studies, 2,193 patients) had a pooled HR of 3.15 (95% CI 0.93-5.37; P = 0.0055). The CI included 1.0, indicating some uncertainty. CONCLUSION:GNRI is a reliable nutritional tool predicting all-cause mortality in HF patients. Our study suggests GNRI should be considered for evaluating long-term prognosis in this population.
