Sula Mazimba

Background: Vascular aging contributes to dementia risk, yet clinically interpretable markers for risk stratification remain limited. Estimated pulse wave velocity (ePWV), derived from age and mean arterial pressure, provides an accessible surrogate of arterial stiffness. We evaluated whether baseline ePWV identifies an interpretable threshold for probable dementia and distinct vascular aging phenotypes.Methods: We conducted a post-hoc analysis of SPRINT-MIND including 8,536 participants free of dementia at baseline. Baseline ePWV was calculated using age and mean arterial pressure. The primary outcome was incident probable dementia adjudicated during follow-up. Associations between ePWV and dementia risk were assessed using spline-based and quartile-based Cox proportional hazards models. Model discrimination was evaluated using Harrell’s C-index.Results: During follow-up, 323 participants developed probable dementia. Dementia risk was lowest at lower ePWV values and increased beyond approximately 10.7 m/s, identifying an interpretable risk threshold. Risk was concentrated in the highest ePWV quartile, consistent with a threshold-like pattern rather than a uniform linear gradient. In exploratory analyses, longitudinal clustering identified distinct ePWV trajectory phenotypes over 24 months.Conclusions: Baseline ePWV identified an interpretable dementia risk threshold and distinct vascular aging phenotypes in SPRINT-MIND. These findings support ePWV as a clinically interpretable marker of vascular aging that may aid dementia risk stratification.

Perioperative diastolic dysfunction has been proposed as an independent predictor of postoperative major adverse cardiac events (MACE) after noncardiac sur

BackgroundPerioperative diastolic dysfunction has been proposed as an independent predictor of postoperative major adverse cardiac events (MACE) after non-cardiac surgery. However, studies supporting this association have included patients undergoing elective procedures and employed variable echocardiographic approaches to assess diastolic function. This study aimed to evaluate the relationship between abnormal diastolic parameters in patients undergoing hip fracture surgery and postoperative MACE and mortality, utilizing a multiparametric and contemporary approach to assess diastolic function.MethodsIn this retrospective cohort study, data from adult patients with preoperative echocardiograms undergoing hip fracture repair from April 2016 to June 2021 was collected. Abnormal echocardiographic diastolic parameters were defined as E/e’ ratio > 14, TRV > 2.8 m/sec and LAVI > 34 mL/m². Patients were divided into two groups based on the number of abnormal parameters: (1) 0 or 1 abnormal and (2) 2 or 3 abnormal. MACE was defined as postoperative myocardial infarction, postoperative heart failure, postoperative pulmonary edema, or death within 30-days of procedure.ResultsOf the 148 patients included in the final analysis, postoperative MACE occurred in 15.5% (n = 23). When grouped by abnormal echocardiographic diastolic data, MACE rates were 8.6% in group 1 versus 23.9% in group 2 (P = 0.011). Similarly, 1-year and 2-year mortality was higher in group 2 compared to group 1 (31.3% vs. 13.6%; P = 0.009 and 43.3% vs. 19.8%; P = 0.002).ConclusionsA higher proportion of abnormal diastolic parameters including E/e’ ratio, TRV and LAVI is associated with an increased risk of post-operative MACE, 1-year and 2-year mortality in patients undergoing hip fracture surgery. Appraisal of these diastolic indices may help identify hip fracture patients at highest risk for MACE and open avenues for better preoperative optimization and postoperative management.

Heart failure (HF) and neurocognitive frailty (NCF) represent an increasingly recognized clinical intersection with profound implications for patient outcomes. Recent epidemiological data reveal that 40–60% of HF patients experience cognitive impairment, with prevalence increasing proportionally with disease severity. This cognitive-functional decline manifests as structural brain abnormalities, deficits in multiple cognitive domains, and reduced physical capabilities, collectively compromising self-care, increasing healthcare utilization, and elevating mortality risk by up to twofold. This comprehensive review examines the complex bidirectional relationship between HF and NCF, synthesizing current evidence on pathophysiological mechanisms, clinical assessment approaches, and management strategies. The pathophysiology involves interrelated processes, including cerebral hypoperfusion, blood–brain barrier disruption, neuroinflammation, oxidative stress, and neurohumoral dysregulation—all contributing to accelerated brain aging and functional decline. Clinical assessment requires a multidimensional approach utilizing validated cognitive and frailty tools, biomarkers, neuroimaging, and functional measures. Management necessitates integrated strategies spanning optimized pharmacotherapy, device-based interventions, cognitive rehabilitation, structured exercise, nutritional support, and coordinated multidisciplinary care. Emerging evidence suggests that early intervention may attenuate cognitive decline and improve outcomes. As the prevalence of both conditions continues to rise, future research directions should focus on standardized assessment protocols, novel therapeutic targets, and innovative care delivery models to address this challenging clinical syndrome and improve quality of life for this vulnerable population. Graphical abstract

BACKGROUND: It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E. METHODS: Using Optum’s de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year. RESULTS: Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21–0.46]; P P =0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days ( P P =0.56). CONCLUSIONS: Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery.

Introduction: Cardiac point of care ultrasound (POCUS) has been used with increasing frequency. As a result of this trend, this study sought to characterize cardiologists’ perspectives on cardiac POCUS. Methods: An 18-question survey on demographics, cardiac POCUS clinical practice, education, and infrastructure was distributed by 16 academic medical centers. Likert scale responses were categorized into three groups: 1) “strongly agree” or “agree” 2) “strongly disagree” and “disagree” and 3) “neutral.” Results: Of the 140 survey responses collected from January to September 2021, 41% of respondents used cardiac POCUS more than twice in an inpatient week. Seventy-one percent of cardiologists believed that cardiac POCUS should be integrated more regularly into clinical practice and into cardiology fellowship education. Less than half of respondents (44%) reported easy access to POCUS devices, and more than half of respondents (56%) did not think there was appropriate institutional infrastructure to easily upload and document cardiac POCUS images (56%). Conclusions: Academic cardiologists had varying opinions on the use and impact of cardiac POCUS. However, most cardiologists believed that cardiac POCUS should be more incorporated within practice despite persisting infrastructure barriers.