Background:The prognostic performance of biomarker-based staging systems in light chain cardiac amyloidosis (AL-CA) remains limited. In addition, the role of echocardiography in risk stratification has not been fully established in the era of contemporary therapies. This study aimed to identify echocardiographic parameters that independently predict adverse outcomes after accounting for treatment status, and to assess their incremental prognostic value beyond established biomarker-based staging systems. Methods:Clinical data and two-dimensional echocardiography were collected from patients with AL-CA, who were staged according to the 2012 revised Mayo staging system. The primary endpoint was all-cause mortality. Treatment status was defined as a time-dependent covariate and categorized as on-treatment or off-treatment. Receiver operating characteristic (ROC) analyses were performed to determine optimal cutoffs for echocardiographic parameters. Results:Among 100 patients with AL-CA, the median follow-up was 35 [15, 46] months, during which 36 deaths occurred. Patients who experienced events showed more severe structural and functional cardiac impairment than those who remained event-free. After multivariable adjustment, only left ventricular ejection fraction (LVEF) [hazard ratio (HR): 0.963, 95% confidence interval (CI): 0.930-0.998, P=0.041], mitral s' (HR: 0.737, 95% CI: 0.596-0.911, P=0.005), and mid-cavity circumferential strain (CS) (HR: 1.125, 95% CI: 1.022-1.240, P=0.016) remained independent predictors of mortality. ROC analyses identified optimal cutoff values of 5 cm/s for mitral s' and -15.9% for mid-cavity CS in discriminating between patients with and without events. Kaplan-Meier curves demonstrated progressively worse survival with increasing Mayo stage (P<0.001). Likelihood ratio tests indicated that mitral s' ≤5 cm/s and mid-cavity CS >-15.9% provided significant incremental prognostic value over the revised Mayo staging system. Incorporating mitral s' ≤5 cm/s into the Mayo staging system further improved risk reclassification, with an overall net reclassification improvement (NRI) of 31.8%. Conclusions:After adjusting for treatment status, mitral s' and mid-cavity CS remained independent prognostic markers in AL-CA, underscoring their potential to enhance current biomarker-based staging systems.

BACKGROUND:HCM-AF score is a novel risk stratification tool for atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM). N-terminal pro-brain natriuretic peptide (NT-proBNP) has shown promise in predicting AF. We aim to explore the incremental value of NT-proBNP over HCM-AF score. METHODS:In this retrospective cohort study, 778 HCM patients were included. The primary endpoint was new-onset AF. Spline curve analysis was conducted to identify the cut-off value of NT-proBNP. Harrell's C-index and likelihood ratio test were conducted to explore the incremental value. RESULTS:After a follow-up of 3.4 ± 2.3 years, AF occurred in 65 (8.4%) patients. The cut-off of NT-proBNP was 240 pg/mL. Incidence rates of AF per 1000 person-years for the low, intermediate, and high HCM-AF score groups were 8.7 (95% confidence interval [CI]: 3.5-17.7), 18.0 (95% CI: 7.7-48.8), and 59.6 (95% CI: 27.1-157.1), respectively, with the high HCM-AF score group significantly higher. For the low and high NT-proBNP groups, incidence rates were 9.2 (95% CI: 4.6-16.1) and 38.1 (95% CI: 20.3-79.4), respectively. High HCM-AF score (hazard ratio [HR]: 3.55, 95% CI: 1.33-9.48; p = 0.011) and high NT-proBNP (HR: 2.49, 95% CI: 1.21-5.10; p = 0.013) are independent predictors for AF. Addition of NT-proBNP improved models based on HCM-AF score, with C-index increasing from 0.709 to 0.768 and likelihood ratio increasing from 33.15 to 51.02. CONCLUSION:HCM-AF score is reliable and robust for Asian HCM patients. NT-proBNP demonstrated incremental value over HCM-AF score in the prediction of new-onset AF in patients with HCM. Future studies are warranted to incorporate HCM-AF score and NT-proBNP.

AIMS:Vascular complications are the leading cause of mortality, with poor glycemic control accelerating progression. This study investigated the association between multidimensional vascular ultrasound and glycemic control in type 2 diabetes mellitus (T2DM). METHODS:This study enrolled 228 patients with T2DM stratified by glycated hemoglobin (HbA1c) levels and 52 healthy controls. All participants underwent carotid ultrasound and flow-mediated dilation (FMD), multiple linear regression was used to assess the associations between arterial stiffness and hemodynamic function and HbA1c. RESULTS:As HbA1c increased, intima-media thickness, hardness coefficient (HC), and pulse wave velocity (PWV) showed the upward trend, whereas displacement, end-diastolic velocity, maximal wall shear stress (WSSmax), mean wall shear stress (WSSmean), and FMD exhibited the downward trend (all P for trend < 0.05). Multiple linear regression analysis revealed that even after adjusting for potential confounders, HC and PWV remained independently positively associated with HbA1c (B = 0.286 and 0.243, all P < 0.05), while WSSmax, WSSmean, and FMD were independently negatively associated with HbA1c (B = -0.072, -0.051, and -0.277, all P < 0.05). CONCLUSIONS:Poor glycemic control in T2DM exacerbates arterial stiffening, hemodynamic disturbance, and endothelial dysfunction. Multidimensional vascular ultrasound enables early detection of subclinical vascular damage, supporting intensive glucose management to delay cardiovascular complications.

Background: Maintenance hemodialysis is characterized by repetitive changes in fluid distribution, blood pressure, and organ perfusion. Conventional clinical examination, empirical dry-weight adjustment, and biomarkers do not fully resolve the compartment-specific nature of congestion in this population. This narrative review reframes ultrasound-based volume assessment as a multimodal diagnostic problem involving pulmonary congestion, intravascular filling, systemic venous congestion, cardiac reserve, tissue response, and perfusion vulnerability. Methods: We synthesized clinically relevant evidence indexed in PubMed and Google Scholar for studies published between January 2016 and April 2026, prioritizing dialysis-specific randomized trials, prospective cohorts, systematic reviews, consensus statements, and methodological studies related to diagnostic ultrasound, Doppler-based congestion assessment, contrast-enhanced ultrasound, elastography, artificial intelligence, point-of-care ultrasound, and remote ultrasound monitoring. Results: Lung ultrasound currently has the strongest dialysis-specific evidence for detecting and tracking pulmonary congestion. Inferior vena cava ultrasound provides adjunctive information on intravascular filling and right-sided pressure but is not a surrogate for total body water. Echocardiographic parameters help characterize filling pressure and cardiac tolerance to fluid removal, whereas venous Doppler and the Venous Excess Ultrasound Score provide an emerging approach to systemic venous congestion. Elastography and contrast-enhanced ultrasound remain investigational tools for tissue characterization and perfusion vulnerability, while AI-assisted analysis, handheld point-of-care ultrasound, and tele-ultrasound may improve standardization, automated B-line quantification, and scalability. Conclusions: Different ultrasound modalities answer different diagnostic questions in maintenance hemodialysis. A compartment-specific framework integrating congestion, perfusion, and cardiac-reserve domains may better support individualized ultrafiltration planning, hemodynamic risk assessment, and future outcome-oriented research.

H 2 FPEF and HFA-PEFF scores have demonstrated prognostic value in heart failure (HF) with preserved ejection fraction. This study aimed to explore the value of the H 2 FPEF and HFA-PEFF scores for HF risk stratification in patients with hypertrophic cardiomyopathy (HCM). In this cohort study, 1068 HCM patients were included. Then the H 2 FPEF and HFA-PEFF scores were calculated to categorize patients into low, intermediate, and high score groups. The primary endpoint was a composite of the first HF hospitalization and all-cause death. 594 (55.6%) patients were classified discordantly. After a follow-up period of 3.1 ± 2.1 years, 85 (8.0%) patients were admitted for HF for the first time, and 62 (5.8%) patients died. Rates of first HF hospitalization and all-cause death per 1000 person-years for the low, intermediate, and high H 2 FPEF score groups were 25.0 (95% confidence interval [CI]: 14.5–35.4), 52.0 (95% CI: 41.6–62.3), and 148.1 (95% CI: 77.7–218.5), respectively. For the low-intermediate and high HFA-PEFF score groups, rates were 19.3 (95% CI: 11.6–27.0) and 69.3 (95% CI: 56.4–82.1), respectively. Intermediate H 2 FPEF score (hazard ratio [HR]: 1.820, 95% CI: 1.135–2.919; P = 0.013), high H 2 FPEF score (HR: 3.464, 95% CI: 1.774–6.765; P < 0.001), and high HFA-PEFF score (HR: 2.414, 95% CI: 1.501–3.882; P < 0.001) were each independently associated with an increased risk of the primary endpoint. Intermediate-high H 2 FPEF score demonstrated an equal risk for the primary endpoint compared to the high HFA-PEFF score (HR: 0.826, 95% CI: 0.636–1.072; P > 0.05). Obesity (HR: 1.958, 95% CI: 1.140–3.363; P = 0.015), atrial fibrillation (HR: 1.686, 95% CI: 1.071–2.654; P = 0.024), pulmonary hypertension (HR: 1.613, 95% CI: 1.032–2.521; P = 0.036) of the H 2 FPEF score, and the morphological major criterion (HR: 1.601, 95% CI: 1.084–2.364; P = 0.018) and functional major criterion (HR: 2.340, 95% CI: 1.442–3.797; P < 0.001) of the HFA-PEFF score were independent predictors of the primary endpoint. A new algorithm was constructed using the independent predictors from both scores, with the functional major criterion weighted as 2 points and the others as 1 point. The H 2 FPEF score, HFA-PEFF score, and the new algorithm demonstrated C-indices of 0.594, 0.651, and 0.681, respectively. There is discordance in the classification of patients with HCM using the H 2 FPEF and HFA-PEFF scores. Both scores demonstrated prognostic value in risk stratification for HF hospitalization and all-cause death in HCM patients. Future studies should develop and validate a new algorithm integrating both scores.

BACKGROUND:Multiple studies have substantiated that repetitive transcranial magnetic stimulation (rTMS) is effective in improving the swallowing function of patients with post-stroke dysphagia (PSD). Nevertheless, the choice of stimulation methods diverges, underpinned by different recovery theories. Among the distinct stimulation approaches currently in use, which one yields the most optimal therapeutic outcomes remains unexplored. OBJECTIVE:To evaluate the rehabilitation efficacy of different rTMS methods on the swallowing function of PSD patients through network meta-analysis and traditional meta-analysis. METHODS:We searched eight databases to identify articles on rTMS treatment for PSD from inception to May 5, 2024, and screened them using EndNote 20.0. The quality of articles was evaluated by Cochrane risk bias assessment criteria, and Stata 17.0 was adopted for meta-analysis. Standardised swallowing assessment (SSA), penetration aspiration scale (PAS), and dysphagia outcome and severity scale (DOSS) served as the outcome measures of the study. RESULTS:A total of 27 articles involving 1694 patients were selected. The studies encompassed five types of stimulation methods: high-frequency rTMS on the ipsilateral hemisphere (iHF-rTMS), low-frequency rTMS on the contralateral hemisphere (cLF-rTMS), high-frequency rTMS on the contralateral hemisphere (cHF-rTMS), high-frequency rTMS on the bilateral hemispheres (biHF-rTMS), and iHF-rTMS + cLF-rTMS (iHF-cLF-rTMS). Compared with placebo, iHF-cLF-rTMS [mean difference (MD) = -11.34, 95% confidence interval (CI): -14.57 to -8.12], biHF-rTMS (MD = -6.52, 95% CI: -8.50 to -4.55), cHF-rTMS (MD = -2.84, 95% CI: -4.37 to -1.31), and iHF-rTMS (MD = -1.89, 95% CI: -2.82 to -0.96) showed significantly better effects on improving SSA of patients with PSD. According to traditional meta-analysis, for patients with post-stroke time < 1 month, iHF-rTMS (MD = -0.558, 95% CI: -0.966 to -0.150) demonstrated a superior therapeutic outcome of SSA, while for those with post-stroke time ≥ 1 month, SSA was more significantly improved in cHF-rTMS (MD = -0.760, 95% CI: -1.193 to -0.327) and iHF-rTMS (MD = -0.428, 95% CI: -0.665 to -0.129) groups, when compared with placebo. CONCLUSIONS:Bilateral stimulation protocols (biHF-rTMS and iHF-cLF-rTMS) confer superior efficacy over unilateral approaches. Early application of iHF-rTMS shows advantages. However, methodological limitations, including heterogeneity in stimulation parameters, small sample sizes in subgroup analyses, and insufficient long-term follow-up, warrant cautious interpretation. Future high-powered RCTs with standardised protocols are imperative to optimise rTMS-based precision rehabilitation.

Background:Contrast enhancement (CE) of intracranial atherosclerotic plaques is a valuable biomarker for identifying culprit plaques in ischemic stroke, but current assessment methods are limited by qualitative approaches and artifact susceptibility. Purpose:To develop and validate a semi-automated method for visualization and quantification of CE intensity and volume, and evaluate its accuracy and scan-rescan reproducibility. Study type:Retrospective. Population:Two patient groups with intracranial atherosclerotic diseases were included: Group A (n=37, 82 plaques) for developing and validating the CE map against expert review, and Group B (n=11, 23 plaques) for assessing scan-rescan reproducibility. Field Strength/Sequence:3.0 T, 3D time-of-flight gradient echo sequence and T1-weighted fast spin echo sequences, before and after Gadolinium contrast injection. Assessment:A 3D quantitative CE map was developed that incorporated dedicated multicontrast, multi-planar preprocessing, image intensity normalization, adjustment for enhancement artifacts, and derivation of a signal intensity threshold. Statistical Tests:Receiver operating characteristic curve analysis determined the optimal CE threshold. Sensitivity, specificity, and Cohen's kappa assessed agreement between the quantitative CE map and manual review. Spearman's correlation evaluated CE volume quantification. Intraclass correlation coefficient (ICC) and coefficient of variance (CV) assessed reproducibility. Results:The optimal signal intensity threshold for post-contrast maps was 0.4 plus the median plaque wall intensity on pre-contrast maps. The area under the curve for CE detection was 0.91 (95% CI: 0.87-0.94), with sensitivity and specificity of 0.83 and 0.90. CE volume measurements strongly correlated with expert measurements (Spearman's rho=0.82, p<0.001). Enhancement ratio showed high reproducibility (ICC=0.92, 95% CI: 0.82-0.96), and CE detection demonstrated robust agreement (kappa=0.82, 95% CI: 0.55-1). Data Conclusion:The proposed CE map demonstrated good accuracy compared to expert review and high scan-rescan reproducibility, enabling comprehensive assessment of CE presence, intensity, and volume for evaluating plaque vulnerability in intracranial atherosclerotic disease.

Background:The clinical manifestations of cerebrovascular disease are known to differ between the Chinese and United States (U.S.) populations as do the plaque features on imaging. Objectives:The aim of this study was to investigate and compare the histological features of excised carotid plaques from Chinese and U.S. patients. Methods:Carotid endarterectomy specimens collected from two prospective studies were included. The entire plaque was serially sectioned (10 μm thickness) at 0.5-1 mm intervals. Hematoxylin and eosin staining and Mallory's trichrome staining were performed. The morphology and components of the plaques were measured and compared between the two groups. Results:A total of 1,152 histological sections from 75 Chinese patients and 1,843 sections from 111 U.S. patients were analyzed. The Chinese group had significantly smaller minimum lumen diameters (median: 1.1 vs. 1.3 mm, p=0.046) and a larger percent wall volume (median: 74% vs. 70%, p=0.018) than the U.S. group. After adjusting for confounding factors, carotid plaques in the Chinese population were more likely to have more lipid pools (β=10.0%, 95%CI: 4.9 to 15.9%), more recent intraplaque hemorrhage (IPH; β=8.4%, 95%CI: 4.5 to 12.7%), and less late IPH (β=-8.2%, 95%CI: -11.3 to -5.4), and fewer fibrous cap disruptions (45% vs. 67%, p=0.061). Chinese plaques were more homogeneous and had a higher percentage of plaques with features of xanthomas than did U.S. plaques (20% vs 2.7%, p<0.001). Conclusions:The histology of Chinese plaques differs significantly from that of U.S. plaques, suggesting substantial differences in the pathophysiology of atherosclerotic cerebrovascular disease between Chinese and North American populations, which could enhance the gap in racial pathology comparison, indicating a need for a different management approach.

Many studies reported that glaucoma is associated with cardiovascular disease (CVD). This study aims to investigate the potential causal relationship between glaucoma and CVD using a bidirectional two-sample Mendelian randomization (MR) analysis. The genome-wide association studies (GWAS) of glaucoma and CVD were downloaded from the IEU OpenGWAS project. The CVD included unstable angina pectoris (UAP), coronary artery disease (CAD), high blood pressure (HBP), myocardial infarct (MI), heart failure (HF), ischemic stroke (IS), atrial fibrillation (AF), and pulmonary embolism (PE). The inverse variance weighting (IVW) analysis was the primary method in MR analysis. Meanwhile, sensitivity analysis and statistical power tests were performed. The random effects IVW method showed a causal relationship between glaucoma and a decreased risk of MI (Odds ratio (OR): 0.94, 95% confidence interval (CI): 0.89-0.99; P = 0.012). In the reverse MR analysis, genetic susceptibility of UAP (OR: 1.12, 95% CI: 1.02-1.23; P = 0.022), CAD (OR: 1.1, 95% CI: 1-1.21; P = 0.041), and HBP (OR: 1.83, 95% CI: 1.25-2.67; P = 0.002) was significantly linked to an increased risk of glaucoma. MR-Egger (P = 0.005) and IVW (P = 0.005) methods found that HBP presented different degrees of heterogeneity. The random effects IVW method also demonstrated that HBP is the risk factor for glaucoma (P = 0.0017). Although reverse MR initially suggested a potential association between CAD and glaucoma, MVMR showed no causal relationship after adjusting for obesity and BMI. The MR analysis found that glaucoma serves as a protective factor for MI, while UAP and HBP were risk factors for glaucoma in the European population, which may contribute to preventing and managing glaucoma and CVD.

Purpose Intraplaque haemorrhage (IPH) is a well-known risk factor for faster plaque progression (volume increase); however, its etiology is unclear. We aimed at determining what other local plaque- and systemic factors contribute to plaque progression and to the development and progression of IPH. Methods We examined 98 asymptomatic participants with carotid plaque using serial multi-contrast magnetic resonance imaging. We measured the percent of wall volume (%WV=100 x [wall volume] / [total vessel volume]) and measured IPH and calcification volumes. We used generalized estimating equations-based regression to analyze predictors of %WV change and new IPH while accounting for covariates (sex, age and statin use), and multiple non-independent observations per participant. Results Total follow-up was 1.8 ± 0.8 years on average. The presence of IPH (β: 0.6 %/y, p = 0.033) and calcification (β: 1.2 %/y, p = 0.028) were each associated with faster plaque progression. New IPH, detected on a subsequent scan in 4 % of arteries that did not initially have IPH, was associated with larger calcification (odds ratio [OR]: 2.6 per 1-SD increase, p = 0.038) and higher pulse pressure (OR: 2.3 per 1-SD increase, p = 0.016). Larger calcification was associated with greater increases in pulse pressure (β: 1.4 mm Hg/y per 1-SD increase, p = 0.040). Conclusions IPH and calcification are each independently associated with faster plaque progression. The association of carotid calcification to increased pulse pressure and new IPH development suggests a possible mechanism by which calcification drives IPH development and plaque progression.

OBJECTIVE:Anthracycline chemotherapeutic agents have significant cardiotoxicity. The present study emphasized the effect of anthracycline chemotherapy drugs on left ventricular (LV) myocardial stiffness in breast cancer patients by measuring the intrinsic wave velocity propagation (IVP), and evaluating the potential clinical value of IVP in detecting early LV diastolic function impairment.METHODS:A total of 68 newly diagnosed breast cancer patients, who were treated with anthracycline-based chemotherapy, were analyzed. Transthoracic echocardiography was performed at baseline (T0), and after 1, 2, 3, 4 and 8 chemotherapeutic cycles (T1, T2, T3, T4 and T5, respectively). Then, the IVP, LV strain parameters [global longitudinal strain (GLS), longitudinal peak strain rate at systole (LSRs), longitudinal peak strain rate at early diastole (LSRe), longitudinal peak strain rate at late diastole (LSRa), and the E/LSRe ratio], and conventional echocardiographic parameters were obtained and further analyzed. A relative reduction of >15% in GLS was considered a marker of early LV subclinical dysfunction.RESULTS:Compared to the T0 stage, IVP significantly increased at the T1 stage. However, there were no significant changes in GLS, LSRs, or LSRe between the T0 and T1 stages. These parameters significantly decreased from the T2 stage. LSRa started to significantly decrease at the T5 stage, and the E/LSRe ratio started to significantly increase at the T3 stage (all P<0.05). At the T0 stage, IVP (AUC=0.752, P<0.001) had a good predictive value for LV subclinical dysfunction after chemotherapy.CONCLUSIONS:IVP is a potentially sensitive parameter for the early clinical assessment of anthracycline-related cardiac diastolic impairment.

Recent studies report that the rate of recurrent stroke is highest in the stages immediately following cerebral infarction and decreases over time in patients with atherosclerotic carotid stenosis. The purpose of this study was to identify temporal differences in early stage carotid plaque components from acute cerebrovascular ischemic events using carotid MRI. Carotid plaque images were obtained on 3 T MRI from 128 patients enrolled in MR-CAS. Among the 128 subjects, 53 were symptomatic and 75 asymptomatic. The symptomatic patients were classified into three groups based on interval from onset of symptoms to the date of the carotid MRI (Group <14 days; 15-30 days; and > 30 days). The volume of each plaque component was identified and quantified from MR images. The presence of juxtaluminal loose matrix/inflammation (LM/I) was identified as a possible indicator of inflammation on the luminal side. Plaque components were compared between groups using the Wilcoxon rank-sum or the Chi-square test. Patient characteristics and carotid plaque morphology were similar among all four groups. The median volume of LM/I in Group >30 days was significantly lower than in other groups (0 mm3 vs 12.3 mm3 and 18.1 mm3; p = 0.003). In addition, the prevalence of juxtaluminal LM/I decreased over time (ptrend = 0.002). There were no statistically significant differences in other plaque components between the symptomatic groups. The volume of LM/I was significantly smaller in Group >30 days and prevalence of juxtaluminal LM/I in the atherosclerotic carotid plaque was high in the early stages after events. This suggests that carotid plaques undergo rapid evolution after an acute cerebrovascular ischemic event.

Background Intracranial atherosclerotic stenosis is a major cause of ischemic stroke, accounting for 30% of ischemic strokes in Asian populations. Purpose To investigate the relationship between the degree of arterial stenosis and enhancement grade of intracranial atherosclerotic disease (ICAD), the plaque characteristics in different remodeling patterns, and its potential impact. Material and Methods A total of 210 patients diagnosed with ICAD were enrolled in this retrospective study. Patients were divided into the middle cerebral artery (MCA) group (101 cases), posterior cerebral artery (PCA) group (14 cases), basilar artery (BA) group (71 cases), and intracranial segment of vertebral artery (VA) group (90 cases) according to the difference of diseased vessels. Data on presence or absence of ischemic infarction, intracranial vascular position of lesions, plaque characteristics, ICAD enhancement grade, remodeling index, and degree of arterial stenosis were collected for analysis. Results The incidence of ischemic infarction in enhancement grade 2 was significantly higher than that in enhancement grade 1 in MCA group (P = 0.019). Enhancement grade 2 of ICAD was an independent risk factor for the development of ischemic infarction (odds ratio = 4.60; 95% confidence interval: 1.91-11.03; P = 0.001). There was no significant statistical difference in infarct rate between different remodeling modalities (P>0.05). Conclusion Enhancement grade of ICAD is significantly associated with the degree of stenosis and the occurrence of ischemic stroke, which varies in different intracranial vessels. The pattern of vascular remodeling varies among different intracranial vessels, and the pattern of vascular remodeling has a significant impact on plaque characteristics.

Background: Atrial fibrillation (AF) is associated with cardiac structural and functional remodeling. We investigated the left atrial (LA) and left ventricular (LV) changes in AF subtypes by using two-dimensional echocardiography strain techniques. Methods: The study population consisted of 102 subjects with sinus rhythm (control group) and 463 patients with AF, among which 284 patients had paroxysmal AF (PAF) and 179 patients had persistent AF (PerAF). A speckle tracking automatic functional imaging software was used to perform the strain analysis. Results: Patients with AF had dilated LA maximum and minimum volume, decreased LA reservoir strain, lower LV ejection fraction (LVEF), and impaired global longitudinal strain (GLS) compared to those of the sinus rhythm control group. In patients with PerAF, the LA maximum and minimum volumes were larger, and the LA reservoir strain [PAF vs. PerAF, 28% (21,33) vs. 19% (14, 28), P < 0.05], LVEF, and absolute GLS value (PAF vs. PerAF, -16.9 +/- 3.3 vs. -14.1 +/- 3.5%) were lower than those in patients with PAF. Patients with AF regardless of LA enlargement had decreased LA reservoir strain and lower LVEF and absolute GLS value than those in the sinus rhythm control group. Conclusion: Compared with those with normal sinus rhythm, patients with AF had dilated LA volume and impaired LA function, which were further worsened in patients with PerAF than those in patients with PAF. LA functional impairment occurred before LA enlargement. Left atrioventricular remodeling happened across different stages of AF development.

Background:Hypoxia plays a vital role throughout the whole process of atherosclerotic vulnerable plaque formation, which may be induced by a reduced oxygen supply. The vasa vasorum can be affected by norepinephrine (NE) and cause a reduced oxygen supply, ultimately leading to plaque hypoxia. This study aimed to investigate the effects of norepinephrine, which can increase the tension of the vasa vasorum, on plaque hypoxia, evaluated by contrast-enhanced ultrasound imaging.Methods:Atherosclerosis (AS) was induced in New Zealand white rabbits by a combination of a cholesterol-rich diet and aortic balloon dilation. After the atherosclerotic model was well established, NE was intravenously administered three times per day for 2 weeks. Contrast-enhanced ultrasound (CEUS) and immunohistochemistry staining were performed to evaluate the expression of hypoxia-inducible factor alpha (HIF-α) and vascular endothelial growth factor (VEGF) in atherosclerotic plaques.Results:The plaque blood flow decreased after long-term norepinephrine administration. The expression of HIF-α and VEGF in atherosclerotic plaques concentrated in the outer medial layers increased, which indicated that NE might cause plaque hypoxia by contraction of the vasa vasorum.Conclusion:Apparent hypoxia of atherosclerotic plaques after long-term NE administration was mainly caused by decreased plaque blood flow due to the contraction of the vasa vasorum and high blood pressure.

Background: At present, simple reminiscence has been widely used in the field of neurocognitive disorders, life review/life review therapy has been widely used in the field of cancer, and both simple reminiscence and life review/life review therapy are suitable for psychological disorders such as depression and anxiety. However, the efficacy of reminiscence in treating cancer-related symptom has not been fully assessed. Objectives: To evaluate the effect of reminiscence therapy (RT) on relieving cancer-related symptoms such as anxiety and depression in cancer survivals. Methods: China National Knowledge Infrastructure (CNKI), VIP database, Wanfang Data Knowledge Service Platform, China Biomedical Database, PubMed, Cochrane Library, Embase, EBSCO, Scopus, and Ovid databases were searched. To collect clinical randomized controlled trials (RCT) on RT and cancer-related studies published from the establishment of the database to October 05, 2021. Two researchers independently evaluated the articles that met the inclusion criteria, meta-analysis was performed using RevMan5.4 software. Results: A total of 20 RCTs published in 2010 to 2021 were included, with a total of 1853 cancer patients. Meta-analysis results showed that the anxiety scale (HADS-A and HAMA and SAS) and depression scale (HADS-D and HAMD and SDS) scores of the RT group were significantly lower than those of the control group (HADS-A: P = .0002; HAMA: P < .00001; SAS: P = .0010; HADS-D: P = .01; HAMD: P < .00001; SDS: P = .0001). Meta-analysis results showed that RT can improve overall quality of life of cancer patients of RT group to a certain extent hope ( P < .00001). Meta-analysis results showed that the scores on the hope and dignity were significantly increased, and the difference were statistically significant ( P < .001). Conclusion: This review indicates that RT has significant efficacy on cancer-related symptoms such as anxiety and depression. RT for cancer survivals can effectively improve quality of life, self-hope, and self-esteem. The findings of this meta-analysis can provide direction for future symptom management research.

Background Progression of intracranial atherosclerotic disease (ICAD) is associated with ischemic stroke events and can be quantified with three‐dimensional (3D) intracranial vessel wall (IVW) MRI. However, longitudinal 3D IVW studies are limited and ICAD evolution remains relatively unknown. Purpose To evaluate ICAD changes longitudinally and to characterize the imaging patterns of atherosclerotic plaque evolution. Study Type Prospective. Population 37 patients (69 ± 12 years old, 12 females) with angiography confirmed ICAD. Field Strength/Sequence 3.0T/3D time‐of‐flight gradient echo sequence and T1‐ and proton density‐weighted fast spin echo sequences. Assessment Each patient underwent baseline and 1‐year follow‐up IVW. Then, IVW data from both time points were jointly preprocessed using a multitime point, multicontrast, and multiplanar viewing workflow (known as MOCHA). Lumen and outer wall of plaques were traced and measured, and plaques were then categorized into progression, stable, and regression groups based on changes in plaque wall thickness. Patient demographic and clinical data were collected. Culprit plaques were identified based on cerebral ischemic infarcts. Statistical Tests Generalized estimating equations‐based linear and logistic regressions were used to assess associations between vascular risk factors, medications, luminal stenosis, IVW plaque imaging features, and longitudinal changes. A two‐sided P ‐value<0.05 was considered statistically significant. Results Diabetes was significantly associated with ICAD progression, resulting in 6.6% decrease in lumen area and 6.7% increase in wall thickness at 1‐year follow‐up. After accounting for arterial segments, baseline contrast enhancement predicted plaque progression (odds ratio = 3.61). Culprit plaques experienced an average luminal expansion of 10.9% after 1 year. 74% of the plaques remained stable during follow‐up. The regression group (18 plaques) showed significant increase in minimum lumen area (from 7.4 to 8.3 mm 2 ), while the progression group (13 plaques) showed significant decrease in minimum lumen area (from 5.4 to 4.3 mm 2 ). Data Conclusion Longitudinal 3D IVW showed ICAD remodeling on the lumen side. Culprit plaques demonstrated longitudinal luminal expansion compared with their non‐culprit counterparts. Baseline plaque contrast enhancement and diabetes mellitus were found to be significantly associated with ICAD changes. Evidence Level 2 Technical Efficacy Stage 3

Objective: Current echocardiography evaluation of right ventricular (RV) function, which heralds the prognosis in patients with systemic lupus erythematosus (SLE), is of limited utility. The non-invasive pressure-strain loop (PSL), an emerging technique, has been found to feasible, sensitive and accurate in the diagnosis of cardiovascular diseases. The aim of this study was to quantitatively evaluate, using the non-invasive PSL, the right ventricular myocardial work (RVMW) in SLE patients.Methods: Seventy-five SLE patients were recruited and grouped by pulmonary artery systolic pressure (PASP) into normal (group A, N = 26), mild (group B, N = 22) and moderate to severe (group C, N = 27) groups. Twentyfive healthy volunteers undergoing physical examination were recruited as the control group. Right ventricular global myocardial work index (RVGWI), global constructive work (RVGCW), global wasted work (RVGWW), global work efficiency (RVGWE), global longitudinal strain (RVGLS) and other conventional parameters were measured.Discussion: There were no differences between group A and the control group with respect to RVLS, RVGLS and all RVMW parameters (all p values > 0.05). RVGWI and RVGCW significantly differed among the other groups (all p values < 0.05). RVGWE was significantly lower and RVGWW was significantly higher in group C than in the control group and groups A and B (all p values < 0.05). Compared with the control group, RVGWW was significantly increased and RVGLS was significantly decreased in group B (all p values < 0.05). All but one RVMW parameter moderately to strongly correlated with SLE disease activity index (SLEDAI) and World Health Organization Functional Class (WHO-FC). RVGWW (area under the receiver operating characteristic curve [AUC] = 0.893) and RVGWE (AUC = 0.877) were sensitive parameters in detecting earlier cardiac dysfunction in SLE patients.Conclusion: RVGWW and RVGWE serve as sensitive and promising parameters in the integrative analysis of early right ventricular dysfunction in SLE patients. To conclude, non-invasive PSL, the novel method, facilitates the quantitative assessment of RVMW in SLE patients.

Background: Patients with diabetes have accelerated atherosclerosis progression, but the underlying mechanisms are not fully understood. Dynamic contrast-enhanced magnetic resonance imaging has allowed in vivo characterization of plaque neovasculature, which plays a critical role in plaque progression. We aimed to evaluate the impact of diabetes on carotid plaque neovasculature as assessed by dynamic contrast-enhanced magnetic resonance imaging. Methods: Patients with recent ischemic stroke and ipsilateral carotid plaque underwent multicontrast magnetic resonance imaging for characterizing plaque morphology and dynamic contrast-enhanced magnetic resonance imaging for pharmacokinetic parameters of plaque neovasculature, including transfer constant ( K trans , reflecting flow, endothelial surface area, and permeability) and fractional plasma volume ( ν p ). Results: Sixty-five patients were enrolled, including 30 patients with diabetes (years since diagnosis: median 5.0 [interquartile range, [3.0–12.0]) and 35 patients without diabetes. Subjects with diabetes had a greater plaque burden and a higher prevalence of high-risk characteristics. Additionally, carotid plaques in the subjects with diabetes showed higher K trans than those in the subjects without diabetes (0.100±0.048 min -1 versus 0.067±0.042 min -1 , P =0.005) but ν p was numerically lower in the subjects with diabetes (5.2±3.7% versus 6.2±4.3%, P =0.31). The association of diabetes with high K trans (β=0.033, P =0.005) was independent of patient and plaque characteristics and remained largely intact after adjusting for serum lipids, glucose, or hs-CRP (high-sensitivity C-reactive protein). However, it became nonexistent after adjusting for hemoglobin A1c (β=−0.010, P =0.49). Conclusions: Dynamic contrast-enhanced magnetic resonance imaging of carotid plaques suggested that plaque neovasculature in patients with diabetes is leaky, indicating enhanced capability of bringing blood constituents and facilitating extravasation of inflammatory cells, erythrocytes, and plasma proteins. Leaky plaque neovasculature correlated with hemoglobin A1c and may play a role in accelerated atherosclerosis progression in diabetes.