Background: Silent cranial embolism due to carotid artery stenting has been demonstrated to cause dementia, cognitive decline, and even ischemic stroke. The purpose of this study was to compare the periprocedural asymptomatic cranial embolism rates of different stent designs used for extracranial carotid stenosis with diffusion-weighted magnetic resonance imaging. Methods: A total of 507 consecutive patients who underwent carotid artery stenting at our center from December 2010 to June 2020 (mean age, 66.4 +/- 9.5) were analyzed retrospectively. The patients were divided into 3 groups as open-cell stent (334 patients), closed-cell stent (102 patients), and hybrid-cell stent (71 patients) groups. Diffusion-weighted magnetic resonance imaging was performed for the patients before and after carotid artery stenting and compared. The diffusion limitations of 3 stent groups on cranial diffusion-weighted magnetic resonance imaging were compared with one another. Results: Periprocedural asymptomatic same-side microembolism, which was the primary endpoint of our study, was detected in 58 (17.4%) patients in the open-cell stent group, 6 (5.9%) patients in the closed-cell group, and 8 (11.3%) patients in the hybrid cell group, and overall in 72 (14.2%) patients. On diffusion-weighted magnetic resonance imaging, periprocedural asymptomatic same-side cranial embolism was found to be statistically significantly higher in the open-cell group compared to the other two groups (P = .011). Conclusions: The result of this study showed us that the rate of same-side cranial embolism detected on cranial diffusion-weighted magnetic resonance imaging after carotid artery stenting performed with open-cell stent was higher than those of the carotid artery stenting procedure performed with closed-cell and hybrid-cell stents.

Background: In heart failure with reduced ejection fraction (HFrEF), implantable cardioverter-defibrillators (ICDs) are used for the primary prevention of sudden cardiac death, yet many patients never receive appropriate therapy, and left ventricular ejection fraction (LVEF) alone poorly discriminates who will. We investigated whether a cumulative electrical risk score (ERS) derived from the surface electrocardiogram is associated with appropriate ICD therapy. Methods: In this single-center, retrospective study, 205 patients with HFrEF who underwent ICD implantation for primary prevention were classified according to whether they had received appropriate ICD therapy. A modified eight-parameter ERS was calculated from the baseline electrocardiogram. Associations were assessed using receiver operating characteristic (ROC) analysis and logistic regression. Results: The ERS showed moderate-to-good discrimination (AUC 0.795; p < 0.001); a cut-off of 3.5 yielded 91% sensitivity and 71.4% specificity. After adjustment for age, sex, LVEF, cardiomyopathy etiology, BNP and device duration, the ERS remained independently associated with appropriate ICD therapy (adjusted OR 2.189; 95% CI 1.246–3.845; p = 0.006). Conclusions: A cumulative electrical risk score from the standard electrocardiogram was independently associated with appropriate ICD therapy and may add risk information beyond LVEF. These retrospective findings warrant prospective, multicenter validation.

Background: Transcatheter aortic valve implantation (TAVI) is increasingly performed for severe aortic stenosis with improving procedural success rates; however, post-procedural complications remain a significant clinical challenge. Growing evidence suggests that sarcopenia may adversely affect morbidity and mortality in this patient population. Methods: This retrospective, single-center cohort study included 171 patients undergoing elective TAVI (January 2018-February 2024). Muscle area (MA), visceral, subcutaneous (SATA), and total adipose tissue area (TATA) were measured at the L3 vertebral level from pre-procedural computed tomography angiography (CTA). Primary endpoints were all-cause and cardiac mortality; secondary endpoints were permanent cardiac conduction defect, permanent pacemaker implantation (PPI), and hospital stay. Results: The cohort comprised 95 women (55.5%) and 76 men (44.5%), median age 78.9 years, society of thoracic surgeons score 6.30 (IQR = 4.37-9.33). Over 21.8 ± 17.9 months, 43 patients (25.1%) died, including 12 cardiac deaths (7.0%). Lower MA and MA/body mass index (BMI) ratio were independently associated with cardiac mortality in men (adjusted odds ratio [OR] = 0.935, P = .016 and OR = 0.983, P = .042). Permanent cardiac conduction defect occurred in 44 patients (27.7%); lower SATA and TATA were independent predictors in women (OR = 0.990, P = .031 and OR = 0.994, P = .024). Permanent pacemaker implantation was required in 30 patients (18.6%); adipose tissue parameters were associated with PPI in women on univariate analysis but did not retain significance after multiple adjustment. Conclusion: Pre-procedural CTA-derived body composition assessment may contribute to the prediction of mortality and morbidity in TAVI patients without additional cost or radiation exposure. The association of lower MA with cardiac mortality in men, and of reduced adipose tissue with conduction disturbances in women, suggests that sex-specific body composition parameters may provide prognostic value beyond conventional risk scores.

Objective: Patients with a prior history of coronary artery bypass grafting (CABG) presenting with non–ST-elevation acute coronary syndrome (NSTE-ACS) represent a high-risk population in whom revascularization decisions are frequently individualized in real-world practice. Objective biomarkers capable of supporting treatment selection in this setting remain limited. The Naples Prognostic Score (NPS), a composite index integrating inflammatory and nutritional parameters, may reflect overall clinical vulnerability. Methods: In this retrospective, single-center observational cohort study, the association between NPS and treatment strategy selection was evaluated in 367 patients with prior CABG presenting with NSTE-ACS between January 2019 and October 2025. NPS was calculated at admission prior to coronary angiography using total cholesterol, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and serum albumin levels. Patients were categorized into low (0–2) and high (3–4) NPS groups. Treatment strategies were determined through routine multidisciplinary clinical assessment and were not influenced by study investigators. Multivariable logistic regression and prespecified stratified sensitivity analyses were performed. Results: Revascularization was selected in 169 patients (46.0%), including 164 percutaneous coronary interventions and 5 redo CABG procedures. Patients undergoing revascularization had significantly lower NPS values. High NPS was independently associated with a lower likelihood of being selected for revascularization (OR 0.28, 95% CI 0.17–0.48; p < 0.001). Procedural success rates following PCI were similar between NPS groups (89.0% overall; p = 0.161). Results remained consistent across stratified sensitivity analyses according to clinical presentation, chronic kidney disease status, and age categories. Conclusions: Higher NPS values were associated with a lower likelihood of revascularization without affecting procedural success. NPS appears to reflect disease burden and clinical vulnerability rather than treatment benefit. It may also capture acute inflammatory status and should be considered a complementary, not decisive, clinical marker.

Objective: To evaluate the safety outcomes associated with short-term low-dose dobutamine initiation in a monitored ward setting compared with initiation in the intensive care unit (ICU) in patients with advanced heart failure.Material and Methods: This retrospective single-center study included 121 patients who received low-dose dobutamine (2.5–5 µg/kg/min for 72 hours) between 2015 and 2025. Patients were classified as ward (n=37) or ICU (n=84). The primary endpoint was life-threatening arrhythmia. Secondary endpoints included new-onset supraventricular arrhythmia and post-treatment hypotension.Results: Life-threatening arrhythmia occurred in 12 patients (9.9%) overall. No events were observed in the ward group (0/37), whereas 12 occurred in the ICU group (12/84, 14.3%) (absolute risk difference −14.3%, 95% CI −23.3 to −3.2; p = 0.017). Supraventricular arrhythmia rates were similar (5.4% vs. 2.4%; p = 0.585). Post-treatment hypotension was more frequent in the ICU group (20.2% vs. 2.7%; p = 0.012).Conclusion: Given the retrospective design, triage-based patient selection, and substantial baseline differences between groups, the findings should be interpreted descriptively and do not establish comparative safety between the ward and ICU groups. In carefully selected patients who do not meet ICU admission criteria, short-term low-dose dobutamine initiation under structured ward monitoring may be feasible, but prospective studies are required to establish its safety.