The aim of this study was to investigate the associations between sleep duration, sleep disturbances and falls in different cardiovascular disease (CVD) states in a Chinese middle-aged and older adult population. This study used two waves (2011 wave1 and 2013 wave2) of data from the China Health and Retirement Longitudinal Study (CHARLS) to collect information on social, economic, and health status by tracking Chinese individuals aged 45 and above. The study used a logistic regression model to examine the association between sleep parameters and falls. Restricted cubic spline was used to analyze the association of sleep duration with falls in the overall population, and in the population with or without CVD. The overall incidence of new falls among all subjects was 18.35%. It was 24.54% in the population with CVD and 17.36% in the population without CVD. After adjusting for multiple factors, short sleep duration (less than 6 h) was significantly associated with an elevated risk of falls in total populations and with or without CVD, with OR values (95%CI) of 1.267(1.143,1.405), 1.227(1.095,1.376) and 1.442(1.130,1.841), respectively. Long sleep duration (longer than 9 h) was significantly associated with an increased risk of falls only in the CVD population, with OR values of 2.042(1.175,3.550). Sleep disturbance more than 3 days per week was significantly associated with elevated fall risk in the total population and in the population without CVD, and more than 5 days was significantly associated with elevated fall risk in the CVD population. This study reveals the association between sleep parameters and falls, particularly among patients with cardiovascular disease, where long sleep duration is associated with falls. This suggests that long sleep may be an important factor in the risk of falls in CVD patients.

Incomplete surgical left atrial appendage (LAA) closure is associated with increased thromboembolic risk in atrial fibrillation patients. We present a case of successful percutaneous closure of a significant residual leak following surgical LAA ligation. A 64-year-old female with atrial fibrillation (CHA₂DS₂-VASc score 4), prior surgical interventions including LAA ligation for thrombus formation, presented with ischemic stroke despite anticoagulation. Transesophageal echocardiography revealed a 10 mm residual communication following incomplete LAA closure. Percutaneous closure was performed using a 31 mm Amplatzer Amulet device with successful leak elimination. Percutaneous closure of residual leaks following incomplete surgical LAA closure represents a viable alternative to repeat surgery in high-risk patients. Individualized antithrombotic therapy is essential for optimal outcomes.

Epicardial fat tissue is increasingly recognized as a metabolically active adipose compartment linked to vascular inflammation and endothelial dysfunction. While links between EFT and coronary or carotid disease have been widely reported, data on its relationship with cerebrovascular hemodynamics remain limited. This study examined the association between epicardial fat thickness and vertebral artery blood flow in healthy individuals, with particular attention to potential side-specific differences. This cross-sectional study included 98 healthy adults. Epicardial fat thickness was measured using transthoracic echocardiography. Right and left vertebral artery flow volumes were assessed by color Doppler ultrasonography. Associations between EFT and vertebral artery flow were analyzed using Pearson correlation. Multivariable linear regression identified independent determinants of left vertebral artery flow volume (LVAF). ROC analysis was used to assess whether EFT could identify low LVAF. Epicardial fat thickness was not significantly associated with right vertebral artery flow volume (r = − 0.155, p = 0.127). In contrast, a significant inverse relationship was observed between EFT and LVAF (r = − 0.359, p < 0.001). In adjusted analyses accounting for age, sex, body size, smoking status, and vertebral artery diameter, EFT remained the only independent negative predictor of LVAF (β = −8.14, p = 0.001). Participants with higher EFT values (≥ 5.0 mm) exhibited significantly lower LVAF compared with those with lower EFT values. ROC analysis demonstrated modest discriminative performance for low LVAF (AUC = 0.65). Epicardial fat thickness was independently associated with reduced left vertebral artery flow. These findings suggest a potential link with altered cerebrovascular hemodynamics, although larger prospective studies are needed to confirm this association.

Chronic heart failure is a growing health concern globally, with rising prevalence and considerable social and economic impact as a leading cause of death. Although significant progress has been made in cardiovascular disease treatment over the last two decades, this condition continues to pose a significant clinical challenge. The connection between red blood cell parameters and major cardiovascular complications in patients with chronic heart failure remains poorly understood. Assessing these metrics could enhance our ability to predict long-term cardiovascular outcomes in this patient population. In this single-center, retrospective analysis of a prospective cohort, 419 chronic HF patients (mean age 63.70 ± 11.67 years) were enrolled between 2023 and 2024 and categorized into anemic (n = 251) and non-anemic (n = 168) groups based on WHO hemoglobin criteria. Baseline demographic, clinical, and hematological parameters (MCV, MCH, MCHC, RDW, Hb, HCT) were recorded. Patients were monitored over 12 months for major adverse cardiovascular events, encompassing cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, or cardiac rehospitalization. Statistical analysis was conducted using SPSS version 16, with significance defined as p < 0.05. Anemic patients had a higher prevalence of diabetes, hyperlipidemia, prior CABG, and smoking (all p < 0.05). They also exhibited significantly lower MCH, MCHC, Hb, and HCT, and higher RDW (p < 0.05). Correlation analyses revealed significant associations between various RBC indices and hematological parameters in both groups. However, in the multivariable analysis, none of the RBC indices including hemoglobin, hematocrit, MCH, and MCHC were independent predictors of rehospitalization or all-cause mortality (all p > 0.05). Hyperlipidemia showed a non-significant trend toward increased all-cause mortality (OR: 1.675; 95% CI: 0.954–2.942; p = 0.073). Although anemia and aberrant red blood cell indices correlate with an unfavorable clinical profile in heart failure patients, they did not independently predict short-term major adverse cardiovascular events in this study population. This implies that the prognostic significance of these standard hematologic parameters may be constrained in advanced heart failure.

The Pan-Immune-Inflammation Value (PIV), a novel inflammatory marker primarily studied in cancer, remains underinvestigated in elderly PCI patients. This study evaluates PIV’s prognostic value for risk stratification and personalized treatment in this population. In this study, we enrolled elderly patients undergoing PCI who were aged 75 years or older between the years 2019 and 2023. Patients were divided into low- and high-PIV groups based on the median value of the cohort. The primary endpoint was the incidence of major adverse cardiovascular events (MACE), comprising cardiac death, recurrent myocardial infarction, and target vessel revascularization. Secondary endpoints included the individual components of MACE. Cox regression and ROC analyses were employed to evaluate the independent prognostic value of PIV. Patients in the high-PIV group presented with a higher burden of comorbidities and worse cardiac function at baseline. During a median follow-up of 362 days, the high-PIV group experienced a significantly higher incidence of MACE (10.8% vs. 5.1%, P < 0.001), cardiac death (7.1% vs. 2.8%, P < 0.001), and all-cause mortality (10.8% vs. 4.5%, P < 0.001). Multivariable Cox regression confirmed PIV as an independent predictor of MACE after adjusting for confounders (Model 3: HR 1.572, 95% CI 1.040,2.377, P = 0.032). ROC analysis showed that PIV had superior predictive ability for MACE (AUC = 0.641) compared to models combining PIV with age ≥ 80 years. PIV serves as a simple, potent, and independent prognostic biomarker for MACE in elderly patients following PCI. Its integration into clinical risk stratification could help identify high-risk patients who may benefit from more intensive management.

Cardiovascular-Kidney-Metabolic (CKM) syndrome became the leading cause of death among U.S. adults in 2021. However, the relationship between different stages of CKM and the risk of all-cause mortality in the U.S. population remains unclear. Data from NHANES 2005–2018 and the Public-use Linked Mortality Files (LMF) were utilized in this study. Kaplan–Meier survival curves were generated to estimate survival probabilities across five CKM stages (stages 0 to 4) and compared using the log-rank test. Hazard ratio (HR) and 95% confidence interval (95%CI) for all-cause mortality were estimated using Cox proportional hazards regression models. Stratified analyses were conducted to explore potential effect modifications by age, sex, education, smoking status, drinking status and the Poverty Income Ratio (PIR). A total of 4,376 all-cause deaths were recorded during a median follow-up period of 7.25 years (IQR: 6.92–7.67). The risk of all-cause mortality increased progressively with higher CKM syndrome stages (P < 0.001). After multivariate adjustment, the risk of all-cause mortality for CKM stages 1 through 4 was 1.05 (95% CI: 0.81–1.44), 1.98 (95% CI: 1.54–2.56), 3.09 (95% CI: 2.36–4.06), and 4.47 (95% CI: 3.47–5.76) times higher than that for CKM stage 0, respectively. Additionally, subgroup analyses revealed that the risk of all-cause mortality in CKM stage 4 was higher among individuals under 60 years of age, females, current smokers, current drinkers, those with less than a high school education, and those with a household poverty index below1.3. Studies have found that populations with more advanced CKM staging have a higher risk of all-cause mortality. These findings underscore the need for targeted public health strategies to reduce mortality risk associated with CKM syndrome.

In-stent neoatherosclerosis (ISNA) is the leading cause of in-stent restenosis (ISR) and stent thrombosis, often signifying stent placement failure. Prior studies have demonstrated an association between uric acid (UA) levels and ISNA, while high-density lipoprotein (HDL) dysfunction may contribute to both target lesion revascularization and ISNA progression. However, no comprehensive study has evaluated the combined role of UA and HDL in ISNA. The UA to HDL ratio (UHR), an integrative metabolic-inflammatory biomarker, has been studied across various cardiovascular and metabolic disorders. This study examines the association between UHR and ISNA and assesses whether UHR predicts ISNA more accurately than UA or HDL alone. We conducted a retrospective cross-sectional study using clinical data from the Affiliated Hospital of Zunyi Medical University (2014–2025). Multivariable logistic regression models were employed to assess the association between the UHR and ISNA, with adjustments for clinically relevant confounders. Potential nonlinear relationships were examined using restricted cubic spline (RCS) regression with three knots. To validate the predictive utility of UHR, we performed subgroup analyses stratified by sex, age and comorbidities, along with ROC curve analysis to determine the optimal cutoff value and area under the curve (AUC). In multivariable regression analysis of 514 participants, each unit increase in UHR was associated with a 14.1% increased risk of ISNA (OR 1.141, 95% CI 1.113–1.170; P < 0.001). This association remained significant after adjusting for gender, age, smoking status, diabetes mellitus, hypertension, chronic kidney disease, prior stroke history, triglyceride levels, relevant medication use, as well as stent type, lesion location, and pre-dilation. RCS regression confirmed a linear relationship (P for non-linearity = 0.517). This positive correlation was consistent across most subgroups, further supporting the reliability of the findings. ROC analysis revealed that UHR had superior predictive performance for ISNA (AUC 0.793, 95% CI 0.753–0.832) compared to UA (AUC 0.760) and HDL (AUC 0.688), supporting its potential clinical utility. In OCT-diagnosed ISR patients, elevated UHR levels showed both independent association with NA development and superior predictive performance compared to UA and HDL alone.

Percutaneous closure of secundum atrial septal defects (ASDs) is a standard procedure. However, it is not without risk, and complications can be severe even in apparently straightforward cases. A 19-year-old male (80 kg, 170 cm), with a history of infantile strabismus, underwent percutaneous closure of a small (11 × 12 mm) secundum ASD with adequate rims using an 18 mm Occlutech septal occluder.The procedure was performed under general anesthesia and transesophageal echocardiography (TEE) guidance, and the device initially appeared well positioned. The following day, routine transthoracic echocardiography (TTE) failed to visualize the device, and a diagnostic error led to the device’s location being misinterpreted as a pulmonary artery on fluoroscopy. Emergency surgery was performed to remove the device and close the defect, but the device was not found. Post-operatively, real-time 3D Computed Tomography (CT) located the device in the aortic arch. It was subsequently retrieved percutaneously. During extubation, the patient developed agitation and confusion, and a cranial CT revealed a right posterior cerebral artery infarction, resulting in left homonymous hemianopsia. Follow-up neurological assessment and MRI confirmed the ischemic sequelae. Interestingly, the patient’s pre-existing strabismus completely resolved. The potential etiology of the cerebral ischemic event includes thromboembolism from the device or catheter manipulation. This case highlights that severe complications, including device embolization to unexpected systemic locations and subsequent cerebrovascular events, can occur even in low-risk ASD closures. It underscores the critical importance of meticulous, multi-view intra procedural and post-procedural imaging to prevent diagnostic errors. The unexpected resolution of strabismus following a posterior cerebral artery infarct suggests a complex neuro-ophthalmological phenomenon requiring further investigation.

Whether hepatic steatosis, as indexed by the fatty liver index (FLI), is associated with incident atrial fibrillation (AF) among adults with diabetes beyond shared cardiometabolic risk factors remains uncertain. To investigate the association between fatty liver index and incident atrial fibrillation in adults with diabetes. We analyzed 29,341 UK Biobank participants with baseline diabetes and no history of atrial fibrillation or atrial flutter, and no prior cardiovascular disease. FLI was evaluated both categorically (< 30, 30–59, 60–89, ≥ 90) and continuously using restricted cubic splines. Incident AF was identified through linked health records, with death treated as a competing risk. Cox models were sequentially adjusted for demographics, lifestyle, socioeconomic status, and metabolic factors; Fine–Gray models were also applied. Sensitivity analyses included 1:10 propensity score matching (FLI ≥ 60 vs. < 60). Among participants with FLI ≥ 30, AF risk was further stratified by the number of metabolic abnormalities (hypertension, obesity, dyslipidemia), grouped as 0, 1, 2, or ≥ 3. Over a median follow-up of 14.1 years (13.4–14.7), 2,890 incident AF events occurred. AF incidence rose across FLI categories, from 4.88 (95% CI: 4.21–5.63) to 9.92 (95% CI: 9.38–10.48) per 1,000 person-years comparing FLI < 30 with FLI ≥ 90, an absolute difference of 5.04 (95% CI: 4.15–5.92). In fully adjusted Cox models, FLI ≥ 90 was associated with a higher AF risk (HR 1.64, 95% CI: 1.40–1.92; p < 0.001), with attenuated estimates for intermediate FLI groups and a significant trend across categories (p < 0.001). Among individuals with FLI ≥ 30, AF risk increased stepwise with the number of metabolic abnormalities. Spline analyses showed a nonlinear association (p < 0.001), with AF risk increasing more noticeably at higher FLI values, particularly in the very high range. Among adults with diabetes, higher FLI was associated with a greater risk of incident AF after adjustment for measured demographic, lifestyle, and cardiometabolic factors, with the strongest association observed at very high FLI levels. These findings suggest that FLI may serve as an accessible marker for risk stratification in this high-risk population; however, residual confounding cannot be excluded and clinical utility for decision-making requires further validation.

While sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are known to lower serum uric acid (SUA) in heart failure with reduced ejection fraction (HFrEF) or diabetes, their urate-lowering effect in heart failure with preserved ejection fraction (HFpEF) remains unclear. This study aimed to evaluate this effect in HFpEF patients. HFpEF patients newly treated with SGLT-2i were retrospectively included. Changes in SUA level and gout events were analyzed during follow-up. We selected 734 patients according to propensity score matching, with the median age of 75.0(66.0–85.0) years. 31.9% were combined with chronic kidney disease(CKD) and the mean SUA was 6.4 ± 1.9 mg/dl. At 3 to 6-month follow-up, SGLT-2i treatment (79.6% dapagliflozin ) was associated with greater reduction of SUA (-0.91 ± 1.63 mg/dl vs. -0.10 ± 1.54 mg/dl; p < 0.001) and fasting glucose (-0.49(-1.59 to 0.37) vs. 0(-0.83 to 0.39) mmol/l, p = 0.002). 16 cases in SGLT-2i group had gout events and 23 cases in control group (p = 0.25). No significant difference was analyzed in estimated glomerular filtration rate (eGFR) change between groups. The control rate of SUA (< 6 mg/dl) was 72.2% and 51.2% respectively (p < 0.001). Multiple regression analysis suggested that changes of SUA were closely associated with gender, basal SUA level, eGFR and eGFR changes. Subgroup analysis showed that SGLT-2i could reduce SUA regardless of whether combined with diabetes or CKD, and the urate-lowering effect was more pronounced in those with underlying hyperuricemia. SGLT-2i (primarily dapagliflozin) could significantly reduce SUA level in HFpEF patients without increasing the risk of gout attack nor injuring renal function.