OBJECTIVE:To evaluate the association between adjunctive Chinese herbal medicine (CHM) and post-percutaneous coronary intervention (PCI) adverse cardiovascular events in patients with chronic coronary syndrome (CCS), and to identify subgroups that may derive greater benefit from integrative therapy. METHODS:This study included 2274 patients with CCS after PCI: 1155 patients in the guideline-directed medical treatment (GDMT) group and 1119 patients in the integrative Chinese and Western medicine (ICWM) group. Exposure was defined as cumulative CHM treatment for > 6 months per year. The primary endpoint was a composite of repeat revascularization and in-stent restenosis (ISR). Kaplan-Meier survival analysis and multivariable Cox regression models were used to assess associations between treatment strategy and study outcomes. RESULTS:A total of 1054 patients experienced the primary endpoint, including 575 patients (49.80%) in the GDMT group and 479 patients (42.80%) in the ICWM group. Compared with the GDMT group, the ICWM group had lower cumulative incidences of the primary endpoint, repeat revascularization, and ISR (log-rank P < 0.001, P = 0.0018, and P = 0.023, respectively). After full adjustment, ICWM was associated with lower risks of the primary endpoint (adjusted HR = 0.741, 95% CI: 0.654-0.841, P < 0.001), repeat revascularization (adjusted HR = 0.781, 95% CI: 0.686-0.889, P < 0.001), and ISR (adjusted HR = 0.825, 95% CI: 0.686-0.993, P = 0.042). Subgroup analyses suggested a more pronounced association in patients with prior PCI (adjusted HR = 0.59, 95% CI: 0.48-0.73, P < 0.001) and those without multivessel coronary artery disease (adjusted HR = 0.46, 95% CI: 0.32-0.68, P < 0.001). CONCLUSIONS:In this prospective cohort study, adjunctive CHM was associated with lower risks of the composite endpoint of repeat revascularization and ISR, as well as its individual components, in patients with CCS after PCI. The observed association appeared more pronounced in patients with prior PCI and those without multivessel coronary artery disease.
Intra-aortic balloon pump (IABP) counterpulsation remains one of the most accessible forms of tempo-rary mechanical circulatory support for cardiogenic shock and high-risk coronary intervention. Its physiologic benefits,augmentation of diastolic coronary perfusion and reduction of afterload,make it a pragmatic bridge during periods of profound instability. Nonetheless,IABP ther-apy carries clinically meaningful complications,including access-site bleeding,limb ischemia,and less commonly vi-sceral ischemia. Reported vascular complication rates vary widely across contemporary series,ranging from 0.94％ to 31.1％,[1]reflecting differences in patient risk profiles,de-vice size,anticoagulation practices,and monitoring strat-egies. In routine practice,clinicians often navigate a narr-ow therapeutic margin:preventing thromboembolism wh-ile minimizing bleeding,particularly in elderly patients wi-th shock physiology and diffuse atherosclerosis.
Left atrial appendage closure (LAAC) has emerged as an effective stroke prevention strategy in non-val-vular atrial fibrillation (AF).[1]LAAC presents itself as a viable alternative for patients with AF who are at high risk for stroke and for whom anti-coagulation do not preve-nt stroke.
With the comparative evidence between tran-scatheter aortic valve replacement (TAVR)and surgical aortic valve replacement (SA-VR) now being well-established,TAVR has become an ef-fective alternative to surgery in all risk spectra. In recent ye-ars,TAVR has been increasingly adopted,with its proce-dural volume surpassing that of SAVR and is being perfor-med in progressively younger patients.[1]As the age of pa-tients undergoing TAVR decreases,the proportion of tho-se with bicuspid aortic valve (BAV) anatomy is likely to ri-se. The applications of TAVR have also expanded to BAV patients,[2]but the condition often involves complex anat-omical challenges such as heavy leaflet calcification and ao-rtopathy. Although the current recommendations for TA-VR in BAV patients remain prudent in the major guidelin-es,[3]current widespread adoption of TAVR in BAV patien-ts is of concern.
OBJECTIVE:To determine whether biological age, estimated using phenotypic age (PhenoAge) and PhenoAge acceleration, predicts in-hospital and intermediate-term outcomes after acute myocardial infarction (AMI) in older adults. METHODS:We conducted a retrospective cohort study of 192 consecutive adults [median age: 71 (62-78) years] admitted with AMI to a national tertiary center in 2022. PhenoAge metrics were derived from routine admission laboratory parameters. Patients were followed until 30 August 2025. Outcomes included in-hospital mortality and two composite endpoints: (1) all-cause mortality, non-fatal myocardial infarction, or revascularization; and (2) the above plus hospitalization for heart failure. Logistic regression models and Cox proportional hazards regression models were adjusted for baseline cardiovascular comorbidities. RESULTS:PhenoAge acceleration was independently associated with in-hospital mortality (OR = 1.051, 95% CI: 1.018-1.084, P = 0.002), whereas chronological age was not, and PhenoAge also demonstrated independent association (OR = 1.042, 95% CI: 1.013-1.072, P = 0.004). Over a median follow-up of 1285 days, all three aging metrics were independently associated with both composite endpoints and heart failure hospitalization in multivariable analyses. Receiver operating characteristic analyses demonstrated similar discriminative performance across metrics for intermediate-term outcomes [area under the curve (AUC) = 0.63-0.71]. PhenoAge demonstrated significant incremental value over chronological age [net reclassification improvement (NRI) = 0.38-0.43, integrated discrimination improvement (IDI) = 0.059-0.069, P ≤ 0.005]. CONCLUSIONS:PhenoAge acceleration independently predicted in-hospital mortality following AMI, suggesting it captures acute physiological vulnerability not reflected by chronological age. Although PhenoAge acceleration showed comparable intermediate-term discriminatory performance to chronological age, PhenoAge demonstrated significant incremental prognostic value beyond chronological age. Biological aging assessment may help identify biologically vulnerable patients at presentation and support personalized risk stratification in geriatric cardiology. These findings support further prospective evaluation of biological aging metrics in older adults with acute coronary syndromes.
An 88-year-old woman was referred to our cen-ter due to severe symptomatic aortic stenosis and heart failure in NYHA class Ⅲ. Transtho-racic echocardiography showed respectively peak and me-an gradients of 110 mmHg and 66 mmHg,and mild regurgi-tation. Following Heart Team evaluation,transcatheter aor-tic valve implantation (TAVI) was planned.
BACKGROUND:Few studies have investigated the associations between green space, the triglyceride-glucose (TyG) index, and cardiovascular health outcomes. This study aims to examine the relationships between green space and chronic cardiovascular diseases among middle-aged and older Chinese adults, while also evaluating the potential mediating effect of the TyG index. METHODS:Baseline and follow-up data were collected from the 2011 and 2015 waves, respectively, of the China Health and Retirement Longitudinal Study (CHARLS). Inverse probability of treatment weighting was used to address selection bias. City-level cluster-robust logistic regression analysis was used to assess associations between green space (2011-2014) and hypertension, heart disease, and dyslipidemia. Counterfactual exploratory mediation analysis examined the mediating role of the TyG index. Restricted cubic splines were used to explore the dose-response relationships between green space and the outcomes. RESULTS:Among 11,925 participants, each 1 standard deviation (0.0922) increment in the Normalized Difference Vegetation Index (NDVI) was associated with a 13% lower risk of hypertension (OR = 0.87, 95% CI: 0.83-0.92, P < 0.001), with a linear dose-response relationship. No significant independent associations were observed for heart disease (OR = 0.92, 95% CI: 0.82-1.03, P = 0.142) or dyslipidemia (OR = 0.96, 95% CI: 0.86-1.06, P = 0.406). Mediation analysis showed that the TyG index partially mediated the NDVI-hypertension association (indirect effect P < 0.05), the proportion mediated was 2.9% (95% CI: 1.9%-4.1%). CONCLUSIONS:Long-term residential green space exposure is significantly associated with a lower risk of hypertension in middle-aged and older Chinese adults, with the TyG index playing a modest partial mediating role. No significant independent associations were observed for heart disease or dyslipidemia. Enhancing urban greening may be an effective environmental strategy for the primary prevention of hypertension.
Interpretation of coronary physiology with fract-ional flow reserve (FFR) assumes stable relations-hips between flow,demand,and resistance,but co-nduction abnormalities such as left bundle branch block(LBBB) can disrupt myocardial activation,perfusion,and pressure-derived ischemic indices especially in aged pati-ents.[1]Heart rate related LBBB is a transient,rate-depend-ent conduction delay that induces ventricular dyssynchr-ony and impairs regional perfusion,potentially altering in-stantaneous FFR (iFFR) accuracy,particularly in the left ant-erior descending artery or the left circumflex artery disea-se.[2]Because the physiological impact of heart rate related LBBB is unknown,we investigated its influence on iFFR in aged patients with intermediate stenoses in the left coronary artery.
A 71-year-old man with a 30-year history of hypertension and a prior percutaneous coronary intervention (PCI) with two stents implanted in the left anterior descending artery 12 years ago for angina pectoris presented with a 6-month his-tory of progressive palpitations and dyspnea.
The management of severe tricuspid regurgita-tion (TR) in elderly patients has been trans-formed by transcatheter edge-to-edge repair(TEER),now a cornerstone for those at prohibitive sur-gical risk.
Background:Early cerebrovascular events (CVEs) following transcatheter aortic valve replacement (TAVR) are severe complications, but effective methods for predicting and preventing these events have not been well established. A systematic review and meta-analysis were performed to identify significant predictors of early CVEs post-TAVR. Methods:MEDLINE/Embase databases were searched for articles published between December 2015 and April 2023. Original studies evaluating predictors of CVEs within 30 days post-TAVR after adjusting for confounders were included. Two investigators independently extracted data following the PRISMA statement. Meta-analyses of multivariable data were performed using DerSimonian and Laird random-effects models, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Robustness was assessed via Harbord's test, nonparametric trim-and-fill analysis, leave-one-out sensitivity analysis, the QUIPS quality assessment tools, meta-regression, and subgroup analyses. Results:Among the 74 included studies, multivariate meta-analyses identified 11 predictors of early CVEs, including 9 patient-level predictors-a CHA2DS2-VASc ≥ 5, no prior heart failure, diabetes, isolated aortic stenosis, carotid artery stenosis, peripheral artery disease, advanced age, New York Heart Association class ≥ III, and significant left ventricular outflow tract calcification-and 2 procedure-level predictors: the absence of cerebral embolization protection and post-dilation. Additionally, 10 patient-level factors and 5 procedure-level factors were not associated with early CVEs, although significant heterogeneity was observed in most analyses. Conclusions:This study identified multiple patient-level and procedure-level factors associated or not associated with early CVEs after TAVR. These findings support the development of a comprehensive risk prediction model that can accommodate diverse patient populations and evolving procedural techniques, thereby enhancing clinical risk management strategies.
Isolated Ventricular Non-Compaction (IVNC) is characterized by prominent trabeculations and deep intertrabecular recesses in the ventricular myocardium,[1]believed to result from arrested myocar-dial compaction during embryogenesis.
Percutaneous coronary intervention (PCI) via the transradial route is now standard practice,particularly in elderly patients,owing to its lower bleeding risk and early ambulation. However,age-related vascular changes such as radial and subclavian tortuosity,elongation,and reduced arterial compliance can pose unique procedural challenges. One such chal-lenge is catheter kinking,which can impede the smooth delivery of stents.
Background:This study evaluated the impact of the Medicine IN Geriatric (MINE) application, which integrates the Integrated Medicine Management (IMM) model and STOPP/START criteria, on improving prescribing practices in elderly patients with congestive heart failure (CHF). Methods:A two-phase study was conducted: validation of the IMM model and its implementation via the MINE app. A quasi-experimental pretest-posttest control group design was used in a hospital in East Kalimantan, Indonesia. Patients aged 60-79 years were randomly assigned to the intervention or control group. The intervention group received IMM-based pharmaceutical services, including medication reconciliation, repeated medication reviews, and individualized discharge counseling. The outcomes assessed included polypharmacy rates, potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs), and health-related quality of life, using the EQ-5D-5L and EQ-VAS tools. Results:Expert validation showed high content validity, with I-CVI ≥ 0.86 and S-CVI = 0.94. During implementation, the use of antiplatelets, statins, angiotensin converting enzyme inhibitors (ACEI), and angiotensin receptor β-blockers (ARB) declined from admission to discharge. PIMs, such as beta-blockers in patients with conduction disorders and ACE-I/ARBs in those with hyperkalemia, also decreased. The intervention group's EQ-5D-5L scores improved from 0.552 to 0.664, whereas the control group's scores declined slightly. EQ-VAS scores also increased significantly in the intervention group. Conclusion:The MINE-based IMM intervention effectively reduced inappropriate prescribing and enhanced the quality of life in elderly patients with CHF. This technology-enabled multidisciplinary approach supports safer prescribing in geriatric care.
The ketogenic diet (KD), characterized by a high-fat, moderate-protein, and low-carbohydrate macronutrient composition, has gained growing interest as a potential nutritional approach to cardiometabolic diseases and aging. Emerging evidence suggests that ketone bodies, particularly β-hydroxybutyrate, act not only as alternative energy substrates but also as signaling molecules that influence vascular, metabolic, and epigenetic pathways. This review summarizes current knowledge on the cardiovascular and metabolic implications of KD, emphasizing endothelial function, cardiac energy metabolism, lipid profile, and blood pressure regulation. Experimental and clinical data indicate that KD enhances endothelial antioxidant capacity via Nrf2 activation and eNOS upregulation, reduces cellular senescence, and modulates epigenetic regulators such as histone β-hydroxybutyrylation and SIRT1. In heart failure, acute ketone supplementation improves cardiac output and energetics, while chronic adherence to KD may impair hepatic ketogenesis and lipid homeostasis, potentially offsetting its benefits. Evidence in hypertension and dyslipidemia remains controversial, with short-term improvements often contrasted by long-term elevations in LDL cholesterol and arterial stiffness. In patients with type 2 diabetes, KD promotes glycemic control and insulin sensitivity, yet the sustainability and cardiovascular safety of prolonged use are uncertain. Overall, KD represents a promising but complex therapeutic tool whose efficacy depends on individual metabolic context, diet composition, and duration. A balanced, intermittent, or cyclic ketogenic approach may offer a safer strategy to harness its cardiometabolic and anti-aging benefits.
Background Takotsubo cardiomyopathy (TCM), defined by transient left ventricular dysfunction, is commonly triggered by acute emotional/physical stress. It is recognized as a cause of acute coronary syndrome, particularly in the elderly population, as they are vulnerable due to multiple comorbidities, including frailty, a condition marked by reduced functional reserve and increased susceptibility to stressors. Methods A retrospective analysis of the National Inpatient Sample (2016-2021) was performed to identify patients aged 65 and older hospitalized with TCM using ICD-10-CM codes. Patients were classified based on frailty, defined by Johns Hopkins ACG frailty-defining diagnoses. Multivariable mixed-effects logistic regression was used to identify independent predictors of in-hospital outcomes and compare the groups. Propensity score matching was applied to 736 pairs to control for confounders and assess outcomes. Results Frail patients had significantly high in-patient mortality (5.71 vs. 1.09%, P < 0.001), cardiogenic shock (8.47 vs. 4.70%, P = 0.003), sudden cardiac arrest (3.12 vs. 1.49%, P = 0.037), sepsis (2.85 vs. 0.95%, P = 0.008), and major adverse cardiac events (22.55 vs. 18.21%, P = 0.038). There was no significant difference in acute stroke, pulmonary embolism, mechanical circulatory support utilization, cardiac arrhythmias, acute kidney injury, pacemaker insertion, and length of stay between the two groups. Conclusion Frailty is associated with an increased in-hospital mortality among elderly patients with TCM. Understanding the importance of frailty in elderly population with TCM helps us in optimizing management strategies and improving patient outcomes.
Heart failure remains a major healthcare burden in South-East Asian and Asia Pacific countries, including Malaysia. Despite strong evidence advocating for early initiation of guideline-recommended medical therapy (GRMT), current practice remains unknown regionally. Based on previously published database and registries on acute heart failure admission in the country, we explore possible barriers in achieving optimum use of GRMT among heart failure patients including challenges surrounding existing healthcare services (i.e., inpatient GRMT initiation, poor utilization of community-based services), limited data collection especially surrounding ambulatory heart failure care, and limited focus on prevention of comorbidities linked to the condition. Moving forward, three key areas of interests worth tackling would be on (1) better utilization of GRMT in the inpatient and outpatient setting, which may benefit from decentralization of care from that of tertiary, cardiac centres to district hospitals and even community-based institution u2013 possibly with specialist nurses and pharmacist at its helm, (2) improved data collection, specifically on ambulatory heart failure GRMT prescriptions u0026amp; outcomes, and cardiac rehabilitation utilization and (3) initiating nationwide efforts on early detection u0026amp; screening for heart failure, leveraging on digital health tools which has already been shown to be possible in the community setting.
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and a major risk factor for embolic stroke and heart failure (HF).[1-3]Acc-ording to the recent reports of the Global Burden of Disea-ses study,the number of patients with AF increased from 33.5 million in 2010 to 59.7 million people in 2019.[4,5]The number of attributable deaths to AF increased from 0.23 million in 2010 to 0.33 million in 2019.[4,5]One of the major problems in the management of AF is the low detection ra-te,because it is often asymptomatic and requires system-atic or opportunistic screen. Nonetheless,if detected tim-ely,it can either be reversed to sinus rhythm with various treatments or its risk can be substantially reduced with the use of anticoagulants. Screening therefore is key to impr-oving the management of AF.
The important work of Qin,et al.[1]in investigati-ng the association between oral microbiota and cardiovascular diseases using the Mendelian ra-ndomization approach is commendable,as it applies a co-ntemporary genetic epidemiological framework to address the longstanding challenges of confounding and reverse causation in microbiome research. By leveraging genome-wide association data,the authors attempted to strengthen causal inference in an area largely dominated by observati-onal evidence. Although the analysis is timely and method-ologically ambitious,several issues warrant further cons-ideration.
