Background Although cardiac ultrasound is frequently performed in patients with chest pain, the probability of obstructive coronary artery disease (CAD) cannot be quantified. We investigated the potential of cardiac ultrasound radiomics (ultrasomics) to identify obstructive CAD using limited echocardiography frames, suitable for cardiac point-of-care ultrasound evaluation. Methods In total, 333 patients who were either healthy controls (n=30), undergoing invasive coronary procedures (n=113), or coronary CT angiography (n=190) were divided into two temporally distinct training (n=271) and testing (n=62) cohorts. Machine learning models were developed using ultrasomics for predicting severe CAD (stenosis >70%) and compared with regional LV wall motion abnormalities (RWMA). Results In total, 94 (28.2%) patients had severe CAD with 50 (15.0%) having high-risk CAD defined as left main stenosis >50% (n=11), multivessel CAD (n=43), or 100% occlusion (n=20). The ultrasomics model was superior to RWMA for predicting severe CAD [area under the receiver operating curve (AUC) of 0.80 (95% confidence interval [CI]: 0.74 to 0.86) vs. 0.67 (95% CI: 0.61-0.72), p=0.0014] in the training set and [0.77 (95% CI: 0.64-0.90) vs. 0.70 (95% CI: 0.56-0.81), p=0.24] in the test set, respectively. The model also predicted high-risk CAD with an AUC of 0.84 (95% CI: 0.77-0.90) in the training set and 0.70 (95% CI: 0.48-0.88) in the test set. A combination of ultrasomics with RWMA showed incremental value over RWMA alone for predicting severe CAD. Conclusions Cardiac ultrasomic features extracted from limited echocardiography views can aid the development of machine learning models to predict the presence of severe obstructive CAD.

Neurocysticercosis (NCC) is the most common parasitic infection of the nervous system and acquired epilepsy in low-resource settings due to the pork tapeworm, Taenia solium. Humans contract the intestinal infection of the adult tapeworm (taeniasis) through the fecal-oral route after consuming undercooked food, particularly pork or water, contaminated with tapeworm eggs. When the larvae invades the central nervous system (CNS), the infection causes NCC, which often manifests as late-onset seizures, chronic headaches, and intracranial hypertension. We describe a 31-year-old Hispanic multigravida woman from Guatemala, at 33 weeks of gestation, who presented with multiple syncopal and hypotensive episodes prompting a Computed tomography (CT) image of the head revealing multiple small cerebral calcifications indicating NCC. In this article, we highlight the significance of early symptom recognition and diagnostic workup for NCC in areas with diverse immigrant populations. We also discuss the epidemiology, clinical manifestations, and current treatment modalities available for NCC.

Background: Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) usually coexist and are related to increased morbidity and mortality. Cardiovascular benefits have been demonstrated by drugs such as sodium-glucose cotransporter-2 inhibitors (SGLT2i) and GLP-1 receptor agonists including the dual GIP/GLP-1 receptor agonist tirzepatide (collectively, incretin-based therapies); however, their relative effectiveness in patients with concomitant AF and HFpEF remains undefined. Methods: We conducted a retrospective, propensity score-matched cohort study utilizing the TriNetX Global Collaborative Network. Adults with AF or atrial flutter with a diagnosis of HFpEF who initiated incretin-based therapies (GLP-1 receptor agonists or dual GLP-1/GIP receptor agonists) or SGLT2i were included; index medication was required to be initiated within 30 days of a qualifying AF/HFpEF diagnosis. 1:1 matching was performed based on baseline medications, demographics, and comorbidities. Co-primary outcomes were all-cause mortality, inpatient visits, and emergency department (ED) visits at 1 year. Secondary outcomes included myocardial infarction, ischemic stroke, acute kidney injury, transient ischemic attack, major adverse cardiovascular events (MACE; all-cause mortality/MI/stroke composite), and AF-related procedures. Agent-specific subgroup analyses were performed for semaglutide and tirzepatide separately. Sensitivity analyses were conducted at 6 months and 2 years. Results: 7624 patients were included in each cohort after matching (mean age: 70.8 years; 52% women). At 1 year, incretin-based therapy was associated with lower all-cause mortality (5.3% vs. 7.3%, HR 0.721, 95% CI 0.634–0.820; p < 0.001), fewer inpatient visits (30.0% vs. 37.4%, HR 0.743, 95% CI 0.702–0.787; p < 0.001), and no statistically significant difference in ED visits (27.0% vs. 28.0%; HR 0.946, 95% CI 0.888–1.007; p = 0.081) compared with SGLT2i. Incretin-based therapy was also associated with lower risk of MACE (HR 0.709), acute kidney injury (HR 0.751), myocardial infarction (HR 0.583), catheter ablation (HR 0.685), and electrical cardioversion (HR 0.472). No significant differences were observed in ischemic stroke or transient ischemic attack. These findings were broadly consistent at 6-month and 2-year follow-up, and directionally consistent in agent-specific subgroup analyses of semaglutide and tirzepatide. Conclusions: In this large propensity-matched cohort of patients with AF and HFpEF, initiation of incretin-based therapy (GLP-1 receptor agonists or dual GLP-1/GIP receptor agonists) was associated with lower all-cause mortality, fewer inpatient visits, and reduced cardiovascular events compared with SGLT2i. These findings, while subject to observational limitations, suggest potential benefits of incretin-based therapy in this high-risk population and support the need for prospective comparative trials.