Abstract The study sought to evaluate the association between blood group status, including the ABO and Rhesus (Rh) blood group systems, and atrial fibrillation (AFib) in a cohort of patients undergoing cardiac catheterization or intervention. The final study cohort consisted of 909 patients. The demographic variables, characteristics, comorbidities, and medications of the patients were retrieved from the hospital electronic medical record system, patient charts, and/or records from the national health system database. The patients were categorized according to the presence or absence of AFib. Propensity score matching (PSM) analysis was performed to adjust for the influence of differences in the patients' baseline features, comorbid situations, and drug usage on AFib. AFib was present in 9.0% (n = 82) of the study population. Non-O blood group (standardized mean difference [SMD] = 0.170, p = 0.331) and RhD− phenotype (SMD = −0.054, p = 0.629) were numerically more prevalent in patients with AFib than in those without AFib before PSM, with no statistical significance. PSM yielded 78 patients in each group. Non-O blood group (SMD = −0.055, p = 0.980) and RhD− phenotype (SMD = −0.036, p = 0.821) were numerically more prevalent in patients with AFib than in those without AFib after PSM, with no statistical significance. Multivariable logistic regression analysis performed after PSM revealed that ABO blood type (overall p = 0.986) and RhD+ blood phenotype (odds ratio = 0.907, 95% confidence interval: 0.356–2.313, p = 0.838) were not associated with AFib. The study did not demonstrate a significant association between AFib and blood group status, including the ABO and Rh systems.
Abstract Pampiniform plexus thrombosis is a rare manifestation of superficial venous thrombosis that can mimic inguinal or scrotal pathology and lacks location-specific management guidance. A 28-year-old man presented with progressive left scrotal pain and swelling. Duplex ultrasound showed a noncompressible thrombus within the pampiniform plexus with absent venous flow and preserved testicular perfusion. Magnetic resonance imaging confirmed an 8-cm thrombus extending toward the deep inguinal ring. Because of the thrombus extent, progressive symptoms, and uncertain propagation risk, an evidence-informed off-label strategy with rivaroxaban 10 mg once daily was chosen after shared decision-making. Symptoms improved rapidly, and follow-up duplex ultrasound on day 45 demonstrated complete recanalization. The patient remained asymptomatic. This case highlights extensive pampiniform plexus thrombosis as a rare vascular–urological entity and suggests that individualized off-label anticoagulation with rivaroxaban may be a feasible therapeutic option when the extent of thrombus and symptom progression raises concern for further propagation.
The increasing global burden of vascular disease and multimorbidity has highlighted the limitations of single-specialty care, necessitating a shift toward integrated multidisciplinary models. This narrative review synthesizes international guidelines and evidence to frame multidisciplinary vascular care as a formal governance model rather than an ad hoc clinical collaboration. By institutionalizing decision-making through structured boards, standardized pathways, and shared accountability, multidisciplinary teams (MDTs) effectively decouple treatment selection from procedural execution. This separation functions as a governance safeguard, reducing operator-driven bias and ensuring that care remains aligned with long-term, patient-centered goals. The review emphasizes that effective MDT function is enabled by shared competency, which allows diverse specialists to maintain consistent standards across diagnostics, medical therapy, and longitudinal follow-up. Evidence across arterial and venous domains demonstrates that structured MDT frameworks are consistently associated with improved clinical outcomes, including enhanced limb salvage and reduced mortality. Furthermore, the manuscript proposes extending these governance principles "upstream" to prevention-oriented services, such as venous outpatient clinics, to identify cardiovascular risk earlier in the disease trajectory. This governance-based approach is particularly relevant for middle-income health systems, such as Indonesia, providing a scalable framework to standardize care and improve access to appropriate interventions.
Abstract Chronic venous insufficiency is one of the most common vascular disorders worldwide and is taking a considerable socioeconomic toll. Still, the disease remains underdiagnosed and undertreated, often dismissed as a benign condition, though its progression can result in debilitating pain, venous ulceration, and significantly diminished quality of life. The present article aims to give a concise overview of pathophysiology as well as disease management with a focus on conservative therapy, as well as a brief overview of surgical treatment options.
Abstract Thoracic aortic aneurysm (TAA) is a common, clinically silent, and potentially fatal condition that is often not identified until catastrophic complications such as dissection or rupture occur. Although the increasing use of advanced imaging modalities has improved detection, early diagnosis remains challenging. TAA development reflects a complex interplay of genetic predisposition, extracellular matrix remodeling, and hemodynamic stress that progressively weakens the aortic wall. Heritable connective tissue disorders and bicuspid aortic valve disease are key contributors to ascending aortic pathology, whereas chronic hypertension and atherosclerotic degeneration are more commonly associated with descending aneurysms. Most patients remain asymptomatic, with symptoms typically arising only in advanced stages or when complications develop; when present, they are often nonspecific and may relate to aneurysm size, rate of expansion, or compression of adjacent mediastinal structures. Diagnosis is primarily imaging-based, with computed tomography angiography serving as the standard for comprehensive evaluation, while echocardiography and magnetic resonance imaging play complementary roles in screening and surveillance. Overall, TAA represents a progressive disease process, and early identification through appropriate imaging and risk-based surveillance is essential to prevent life-threatening complications and guide timely clinical intervention.
Abstract Mitral regurgitation affects 2% of the world population. Given its potential for severe clinical consequences, reliable assessment is essential for guiding treatment. While advancements in echocardiographic imaging have expanded available diagnostic techniques, no single method has become the gold standard. Current guidelines emphasize a multimodal approach assessing qualitative and quantitative parameters for comprehensive evaluation. This review examines the techniques utilized for mitral valve regurgitation (MR) assessment, discusses their advantages and limitations, and highlights the enduring need for an integrative approach. Despite continued progress, MR evaluation remains fundamentally reliant on the integration of multiple methods to achieve an accurate diagnosis and assessment.
Abstract Thoracic aortic aneurysm (TAA) is broadly classified into ascending thoracic aneurysm, aortic arch aneurysm, and descending thoracic aneurysm based on the location of the aneurysms. TAAs frequently also have abdominal aortic extension, namely, thoracoabdominal aortic aneurysm (TAAA). The majority of TAAs are sporadic in nature and primarily affect older adults, but there are certain genetic predispositions for TAA. There are also infectious and inflammatory conditions that are associated with TAAs. Today, aortic dissection and hypertension are the common etiologies of TAA. Clinical presentation of TAA is frequently related to the etiology and location of aneurysms.
Abstract Cross-sectional imaging (CSI) is the standard for diagnosis and surveillance of ascending thoracic aortic aneurysm (ATAA), the principal phenotype of heritable thoracic aortic disease (HTAD). However, CSI-based screening is limited by cost and availability. Posteroanterior and lateral chest radiography (CXR) is ubiquitous and inexpensive, yet its role in ATAA screening is underemphasized in contemporary training. A scoping review was conducted in accordance with PRISMA-ScR guidelines to synthesize literature describing CXR findings of ATAA. PubMed (1896–January 2026) was searched and supplemented by review of seminal radiology textbooks and reference lists. Sources with explicit descriptions of radiographic findings were synthesized qualitatively. The search identified 7,160 unique records; 192 underwent full-text review and 15 sources informed the synthesis. Historical CXR signs of ATAA were identified, including mediastinal widening, convex right mediastinal contour, enlargement of the aortic knob, and loss of the retrosternal clear space. Individually, these findings are anatomically grounded but diagnostically limited. Although gestalt-based signs have been described, none were logically articulated or integrated. To address this gap, we propose the CXR “Liberty Hat” sign, a perceptual heuristic integrating four anatomically linked features into a recognizable pattern. We hypothesize that this sign may improve CXR-based recognition of ATAA in younger (<50 years) relatives of patients with HTAD. Historical CXR signs of ATAA remain fragmented when applied individually. The proposed “Liberty Hat” sign integrates established findings into a unified perceptual framework suitable for teaching and future validation, potentially supporting renewed use of CXR as a low-cost screening tool for at-risk individuals.
Abstract Thoracic aortic aneurysms (TAAs) are potentially life-threatening and historically managed with open surgical repair. Thoracic endovascular aortic repair (TEVAR) offers a significantly less invasive method to exclude the aneurysm from systemic blood flow, thereby reducing the risks associated with the pre- and postoperative periods. Today, TEVAR is generally accepted as the first choice for most patients with degenerative descending TAAs, and it is being used increasingly for more complex aortic pathologies. Proper patient selection (anatomically suitable) is crucial, particularly for suitable landing zones and vascular access. Improvements in stent-graft design (flexible nitinol-based stents and branched/fenestrated configurations) have made the aortic arch and even the ascending aorta amenable for safe placement of a stent-graft. TEVAR offers improved survival rates, fewer complications, and shorter hospitalizations compared with open surgery. Nonetheless, there remain concerns regarding the long-term durability, particularly in younger patients who may require reinterventions. In addition to the complications typically seen with any form of endovascular repair (endoleaks, device migration, retrograde dissection, spinal cord ischemia), TEVAR also presents unique complications such as stroke. As with any form of endovascular repair, lifelong surveillance using computed tomography scans is required to monitor for late complications, determine the sac behavior of the aneurysm, etc. Regardless of the limitations presented by TEVAR, it has emerged as a major player in the treatment of TAAs. Ongoing refinements in stent-grafts, imaging modalities, and procedural techniques will continue to expand the applications of TEVAR and improve outcomes for an increasing number of patients with thoracic aortic diseases.
Peripheral artery disease (PAD) significantly limits walking capacity and impairs quality of life. Although structured exercise therapy is recommended for symptomatic PAD, its clinical benefit appears paradoxical, as exercise does not reduce plaque burden or reverse large-vessel arterial obstruction and is often limited by exertional leg pain. Instead, repeated skeletal muscle contraction induces microvascular dilation, collateral recruitment, and improved muscle oxygen utilization, providing functional benefits independent of changes in arterial stenosis. Preclinical and translational evidence indicates that contracting skeletal muscle acts as an endocrine organ, releasing myokines that mediate muscle-vascular communication. Among these mediators, follistatin-like 1 (FSTL1) has been implicated in endothelial repair, nitric oxide signaling, and vascular adaptation. Through this muscle-vascular crosstalk, exercise produces improvements in functional performance despite persistent vascular stenosis. This review synthesizes mechanistic and clinical evidence to address the gap between exercise as a behavioral recommendation and exercise as a biologically active, disease-modifying intervention in PAD. By integrating myokine signaling, microcirculatory adaptation, and functional outcomes, we link mechanistic insights to evidence-based exercise prescriptions aligned with contemporary guideline recommendations, and identify directions for future translational and clinical research.
Abstract Thoracic aortic aneurysms of the ascending aorta carry a high risk of dissection and rupture with increasing size and patient age. Successful surgical outcomes require comprehensive preoperative optimization and rigorous surgical planning. Selection of cardiopulmonary bypass strategies, cannulation sites, and neuroprotective methods are all critical to prevent complications.
Abstract Aortic root pathologies were once considered untreatable, and though significant innovations have been made, this area continues to represent a complex clinical challenge. Aortic root surgery has experienced significant innovations over the past several decades. Cardiopulmonary bypass allowed for the first successful repairs of thoracic aortic aneurysms. Following this, there were many developments of composite valve–graft replacement, such as the Bentall procedure. Several technical refinements occurred to address challenges related to coronary reimplantation, bleeding concerns, and pseudoaneurysm formation. Also, valve-sparing aortic root replacement techniques emerged for patients to preserve native valve leaflets, most notably the remodeling (Yacoub) and reimplantation (David) approaches. Among these, the reimplantation technique has demonstrated superior durability with lower rates of late aortic insufficiency and reintervention and is now the most widely adopted valve-sparing strategy. Along with these techniques, methods for aortic annular and root enlargement were developed to address hypoplastic annuli and to reduce patient–prosthesis mismatch, which evolved early from the Nicks and Manougian procedures to the more recent Y-incision technique, which allows for the implantation of larger prosthetic valves with improved hemodynamic profiles and early data revealing promising results. Indications for aortic root intervention are guided by aneurysm size, growth rate, valve dysfunction, genetic aortopathies, and associated complications such as dissection or endocarditis. These guidelines also recognize the importance of utilizing a heart team approach for these patients. Outcome data have demonstrated improved operative mortality and comparable long-term survival between composite graft and valve-sparing approaches, with technique selection influenced by valve morphology, patient comorbidities, and long-term anticoagulation considerations. This review summarizes the historical evolution, operative strategies, indications, and outcomes of aortic root surgery.
Abstract Heart failure (HF) is a heterogeneous clinical syndrome that remains a leading cause of morbidity, mortality, and health care utilization worldwide. Contemporary efforts to standardize HF terminology have culminated in updated consensus definitions that integrate clinical symptoms and signs with objective corroboration by natriuretic peptide elevation and/or evidence of cardiogenic congestion from imaging, diagnostic modalities, or hemodynamic assessment. In parallel, modern classification frameworks emphasize complementary domains that capture disease trajectory and phenotype, including stage of disease (risk through advanced HF), functional limitation, and left ventricular ejection fraction–based categories. This review summarizes the evolution and current state of HF definitions and classification systems and highlights their implications for clinical care, research design, and trial generalizability. We then synthesize the major etiologic pathways leading to HF, spanning ischemic heart disease, hypertensive and valvular remodeling, genetic and nonischemic cardiomyopathies, inflammatory and infectious causes, toxic/metabolic/endocrine injury, infiltrative and storage disorders, and peripartum cardiomyopathy. Finally, we outline shared pathophysiologic mechanisms that link diverse causes to a common final phenotype, including maladaptive ventricular remodeling, neurohormonal and autonomic activation, inflammation and endothelial dysfunction, microvascular and mitochondrial derangements, cardiorenal and cardiohepatic interactions, and systemic consequences such as skeletal muscle dysfunction and frailty. By integrating definition, classification, etiology, and pathophysiology, this review provides a pragmatic framework to improve diagnostic precision, refine phenotyping, and support mechanism-based prevention and therapy across the HF spectrum.
Abstract Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) are prevalent clinical syndromes associated with significant morbidity and mortality. Although both diagnoses are part of the same spectrum, the underlying pathophysiology and responsiveness to medical therapies differ. HFrEF is characterized by a maladaptive neurohormonal response that results in ventricular remodeling, forming the basis of guideline-directed medical therapy (GDMT) centered traditionally on the four pillars: renin–angiotensin–aldosterone system inhibition, β-blockade, mineralocorticoid receptor antagonism (MRA), and sodium-glucose transporter 2 (SGLT2) inhibition. GDMTs confer robust mortality benefit and heart failure hospitalizations and should be initiated early and in combination, when hemodynamics and end organ function permits. In contrast, HFpEF is driven largely by comorbid associated inflammation, diastolic dysfunction, and elevated ventricular filling pressures, with fewer therapies demonstrating clear mortality benefits. Recent research has established SGLT2 inhibitors as the most consistently effective therapy for HFpEF, with some emerging research on selective use of MRAs and glucagon-like peptide-1 receptor agonists. This literature review summarizes the current evidence-based pharmacological management strategies for both HFrEF and HFpEF, highlighting differences in guideline recommendations, exploring the therapeutic overlap and ongoing uncertainty. As newer clinical trial data emerge, future guidelines may further refine optimal treatment strategies for the heterogeneity of the heart failure population.
To summarize current evidence on sex-related differences in peripheral arterial disease (PAD) with respect to risk factors, disease distribution, response to endovascular therapy, and surgical outcomes. This review synthesizes data from observational studies, registries, and randomized trials evaluating sex-based differences in PAD epidemiology, anatomy, treatment patterns, and clinical outcomes. Women with PAD typically present at an older age and have a higher prevalence of comorbidities, including diabetes, chronic kidney disease, anemia, and frailty. They are less likely to receive guideline-directed medical therapy and more frequently present with atypical symptoms, contributing to delayed diagnosis and higher rates of chronic limb-threatening ischemia. Anatomically, women exhibit smaller vessel diameters, more diffuse and distal disease, and greater lesion complexity. Endovascular therapy yields similar or lower rates of major amputation in women compared with men; however, women experience higher rates of repeat revascularization and periprocedural complications, likely related to vessel size and comorbidity burden. In surgical revascularization, historical disparities in outcomes have diminished, with contemporary data demonstrating comparable limb salvage rates, although women may still experience longer hospital stays and higher wound complication rates. Sex differences in PAD significantly impact clinical presentation, anatomical patterns, and treatment outcomes. Women present later with more advanced disease yet achieve similar or improved limb salvage compared with men. These findings underscore the need for earlier diagnosis, equitable medical therapy, and individualized treatment strategies. Future studies should incorporate sex-specific analyses to optimize PAD management and improve outcomes across populations.
Abstract Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography reflects coronary inflammation and predicts cardiovascular outcomes. Statins possess anti-inflammatory properties beyond lipid-lowering effects. We conducted a systematic review and meta-analysis to evaluate whether statin therapy reduces PCAT attenuation, thereby mitigating pericoronary inflammation. We systematically searched PubMed, Cochrane Library, Scopus, and ScienceDirect databases for studies published between January 2020 and September 2025 examining PCAT attenuation changes with statin therapy. Eligible studies included randomized controlled trials and cohort studies involving patients undergoing serial coronary computed tomography angiography with identical scan parameters at least 12 months apart. Quality assessment utilized the Newcastle-Ottawa Scale. Meta-analysis employed fixed-effects modeling, calculating mean differences with 95% confidence intervals. Statistical heterogeneity was assessed using I2 statistics. Three studies comprising 162 patients met inclusion criteria. Meta-analysis demonstrated statistically significant PCAT attenuation reduction following statin treatment (mean difference −3.02 HU; 95% CI: −4.69 to −1.35; p = 0.0004). Heterogeneity among studies was minimal (I2 = 4%, p = 0.35). All included studies achieved excellent methodological quality (8 stars on Newcastle-Ottawa Scale), with adequate follow-up duration exceeding 12 months and follow-up rates above 90%. Statin therapy significantly reduces pericoronary adipose tissue attenuation, indicating measurable anti-inflammatory effects on coronary vasculature. These findings support PCAT attenuation as a potential noninvasive biomarker for monitoring statin therapeutic response and coronary inflammation and provide quantitative evidence supporting the anti-inflammatory effects of statins on coronary vasculature. The magnitude of this effect may vary according to statin intensity, with more consistent reductions observed in high-intensity regimens.
Abstract Heart failure (HF) is a diverse clinical syndrome resulting from structural or functional cardiac abnormalities, leading to impaired cardiac output and increased filling pressures. Early and accurate diagnosis is crucial to guide therapy, improve prognosis, and reduce morbidity and mortality. This review outlines a contemporary stepwise diagnostic framework that reflects a real-world approach, integrating clinical evaluation, laboratory testing, imaging, and hemodynamic assessment. Particular emphasis is placed on biomarkers, including B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), and echocardiography, which remain the backbone of HF diagnosis, while advanced imaging, genetic testing, and cardiopulmonary exercise testing are used to resolve diagnostic uncertainty in select complex cases. Rather than treating HF as a single entity, this review highlights specific etiologies, including ischemic, genetic, inflammatory, infiltrative, endocrine, and arrhythmogenic causes, and their specific diagnostic considerations. Novel biomarkers, implanted pressure monitoring, and artificial intelligence are examples of emerging techniques that are beginning to complement traditional testing and offer opportunities for early detection, individualized treatment, and preventive measures. By combining traditional and innovative diagnostic tools, clinicians can identify HF promptly, tailor therapy to underlying causes, and ultimately improve patient outcomes and quality of life.
Peripheral artery disease (PAD) affects more than 230 million people worldwide, with a disproportionate burden in low- and middle-income countries. PAD is more common in the elderly population; prevalence increases significantly from about 10% in individuals aged 55 to 59 years to 60% among people aged ≥ 85 years. Racial and ethnic disparities are evident in PAD, as Black individuals have nearly double the prevalence of PAD compared with non-Hispanic White individuals. Chronic limb-threatening ischemia, the most advanced clinical manifestation of PAD that affects approximately 1.3% of adults aged ≥40 years is associated with an annual risk of 20% for both mortality and amputation. Conventional modifiable risk factors, including smoking, diabetes mellitus, hypertension, and dyslipidemia, account for roughly 75% of PAD cases, with the most common association being tobacco use and diabetes. The PAD prevalence has almost doubled between 1990 and 2021 globally. Despite its high prevalence, PAD remains underdiagnosed, as only about half of physicians establish the diagnosis despite symptoms suggestive of PAD. This underrecognition contributes to inadequate risk factor management and increases the risk of major adverse cardiovascular and limb events. Therefore, the early diagnosis of PAD remains essential. Emerging artificial intelligence-based approaches are promising for earlier detection of high-risk patients; however, traditional strategies, such as focusing on modifiable risk factor controls, are still the most important step to reduce cardiovascular and limb complications associated with PAD.
