Objectives The study evaluated the association between body roundness index (BRI) and predicted 10-year cardiovascular disease (CVD) risk, using the 2019 World Health Organization risk score, and compared the predictive performance of BRI with body mass index (BMI) for assessing CVD risk. Methods A cross-sectional study of Royal Thai Army (RTA) personnel aged 40–60 years, using 2022 health examination data, was conducted. Multivariable logistic regression assessed the association between BRI and moderate-to-very-high risk (≥10%) of CVD, estimating the adjusted prevalence ratio (APR) with a 95% confidence interval (CI). Receiver operating characteristic (ROC) analysis compared the predictive performance of BRI and BMI for CVD risk. Results A total of 34,610 participants were included. Higher BRI was positively associated with a predicted 10-year moderate-to-very-high risk of CVD, with an APR of 1.17 (95% CI: 1.11–1.23). In BRI quartiles, APR was 1.25 (95% CI: 1.13–1.38), 1.36 (95% CI: 1.23–1.52), and 1.57 (95% CI: 1.39–1.78), respectively, in quartiles 2, 3, and 4 compared with quartile 1 ( p -trend <0.001). For a BRI threshold ≥3.25, the APR was 1.26 (95% CI: 1.16–1.36). The ROC for predicting 10-year moderate-to-very-high risk of CVD was 0.60 (95% CI: 0.59–0.61) for BRI, compared to 0.56 (95% CI: 0.55–0.58) for BMI ( p -value <0.001). Conclusion An association between a high BRI and increased 10-year CVD risk among RTA personnel was observed. Our study also highlighted that BRI performed better than BMI at predicting 10-year CVD risk.
Objectives To compare Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) and Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) for predicting clinically significant in-hospital bleeding among patients with acute myocardial infarction managed in a non-percutaneous coronary intervention secondary-care setting. Design Retrospective cohort study. Setting A Malaysian secondary public hospital without on-site percutaneous coronary intervention facilities. Participants Adults with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction admitted during 2024. Main outcome measures Clinically significant in-hospital bleeding; inter-score agreement, discrimination, calibration, threshold-based sensitivity and specificity, category-based net reclassification improvement (NRI) and exploratory simultaneous logistic regression. Results Among 842 patients, 143 (17.0%) experienced bleeding. Agreement between ACUITY and CRUSADE risk categories was fair (κ = 0.270; 95% confidence interval (CI) 0.228–0.313). ACUITY and CRUSADE showed modest discrimination (C-statistics 0.632 and 0.615, respectively; DeLong p = 0.76). Hosmer–Lemeshow p-values were 0.070 for ACUITY and 0.050 for CRUSADE. At cut-offs of ACUITY ≥ 14 and CRUSADE ≥ 40, sensitivity was 76.2% versus 56.6%, and specificity was 46.2% versus 63.4%, respectively; separate paired McNemar tests were significant for both comparisons (both p < 0.001). Global NRI was 0.024 (95% CI −0.061 to 0.108; p = 0.586), indicating no statistically significant overall reclassification improvement. In exploratory simultaneous logistic regression, ACUITY remained associated with bleeding (p = 0.012), whereas CRUSADE did not (p = 0.264). Conclusions Both scores showed modest discrimination. At ACUITY ≥ 14 and CRUSADE ≥ 40, ACUITY was more sensitive and CRUSADE more specific, without evidence of a clear overall advantage. Neither score should be used alone to guide management decisions.
Objective To assess the demographic, clinical, and echocardiographic characteristics of adults with congenital heart disease (CHD). Methods A descriptive cross-sectional study was performed at the department of pediatric cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan, from November 2022 to October 2023. Inclusion criteria were adult patients (≥18 years of age) diagnosed with CHDs (both already diagnosed and newly diagnosed). Results Of 184 patients, 100 (54.3%) were male. Mean age and BMI were 25.66 ± 9.19 years and 17.75 ± 4.32 kg/m 2 . Seventeen (9.2%) adult CHD patients were newly diagnosed. Shortness of breath, cyanosis, palpitation, and chest pain, were reported in 158 (85.9%), 65 (35.3%), 52 (28.3%), and 51 (27.7%) patients. Tetralogy of Fallot (TOF), atrial septal defect (ASD), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) were the most common CHD types, noted in 46 (25.0%), 35 (19.0%), 32 (17.4%), and 12 (6.5%) patients respectively. ASD was significantly more prevalent in females than in males (82.9% vs. 17.1%, p < . 001), and it was significantly more frequent in 18–30 age group ( p < . 001). TOF was more common in 18–30 age group ( p = . 013). VSD was significantly more prevalent in males ( p = . 028). Conclusions TOF, ASD, VSD, and PDA were the most frequent types of adult CHDs. Notably, 9.2% of patients were newly diagnosed, suggesting potential underdiagnosis or late detection. With a substantial portion of the population experiencing CHD-related symptoms with some diagnosed only in adulthood, demand for dedicated centers equipped with expertise in managing adult CHD becomes evident.
Background Prior meta-analyses of aldosterone synthase inhibitors (ASIs) for hypertension were limited by heterogeneous evidence and incomplete safety assessment. New randomised controlled trials (RCTs), including BaxHTN, required an updated synthesis. Methods MEDLINE, PubMed, Embase, and Cochrane CENTRAL were searched through January 2026 for placebo-controlled RCTs of ASIs for hypertension. Random-effects models pooled mean differences in systolic and diastolic blood pressure (BP) and risk ratios (RRs) for safety, with 95% confidence intervals (CIs). Principal systolic BP combined office and 24-h ambulatory measurements; office-only analysis was post hoc. Results Nine RCTs (10 independently randomised cohorts; 3595 participants) were included. ASIs reduced systolic BP (mean difference (MD) −6.84 mmHg; 95% CI −8.76 to −4.93) and diastolic BP (MD −2.99 mmHg; 95% CI −4.22 to −1.76). Office-only systolic BP results were similar (MD −6.64 mmHg; 95% CI −8.97 to −4.32). Intermediate- and high-dose estimates were numerically greater than the low-dose estimate, but interaction was nonsignificant ( P = 0.25). ASIs increased hyperkalaemia (RR 2.74; 95% CI 1.59–4.71), hyponatraemia (RR 1.81; 95% CI 1.11–2.95), hypotension (RR 2.76; 95% CI 1.29–5.93), and at least one adverse event (RR 1.22; 95% CI 1.05–1.42). Serious adverse events did not differ significantly (RR 0.98; 95% CI 0.59–1.62). Certainty was high for BP and at least one adverse event and moderate for other safety outcomes. Conclusion ASIs provide clinically meaningful short-term BP reduction in uncontrolled or resistant hypertension but increase electrolyte abnormalities, hypotension, and adverse events. Monitoring is warranted; long-term cardiovascular, renal, and safety outcomes remain uncertain.
Objectives Although recent advancements in imaging technologies and computational power have significantly enhanced our ability to investigate intracardiac flow dynamics of the right heart (RH), inadequate imaging spatial and temporal resolution and reliance on experimentally derived constitutive relations pose challenges in creating patient-specific models capable of quantifying important flow parameters, particularly in pediatric cases. Image-driven computational models with prescribed kinematics offer a feasible and cost-efficient solution; however, accurate modeling of intricate structures including the tricuspid valve (TV) remains hindered by the resolution constraints of current imaging techniques. Methods We present a novel, image-driven, patient-specific direct numerical simulation (DNS) framework that integrates TV kinematics with RH motion. The prescribed TV kinematics are informed by the 4D-flow MRI velocity field. This approach avoids reliance on fully resolved valve imaging while preserving essential valve dynamics. The results are validated through direct comparison with the 4D-MRI measurements for both healthy control and repaired tetralogy of fallot (rToF) cases. Results The proposed framework successfully reproduced physiologically relevant RH flow features. Simulated velocity fields showed good qualitative agreement with 4D-MRI measurements, demonstrating the ability of the workflow to accurately capture RH hemodynamics. Volume-averaged total kinetic energy and vorticity magnitude also showed good quantitative agreement with the 4D-MRI data. Conclusion This study introduces an image-driven, patient-specific modeling of TV driven by 4D-flow data. By integrating TV kinematics with RH, the proposed approach strengthens the link between medical imaging and high-fidelity simulation, enabling accurate characterization of RH flow dynamics without relying on structural property data.
