Patent foramen ovale (PFO), present in 20 - 30% of the population, is often asymptomatic but may allow right-to-left blood shunting that bypasses pulmonary filtration. This phenomenon has been implicated in cryptogenic stroke and migraine with aura, where microemboli or vasoactive substances may trigger cortical spreading depression. This work, through a clinical case, evaluates the role of percutaneous PFO closure in managing refractory migraine with aura by reviewing current evidence and pathophysiological mechanisms. Initially used for stroke prevention, PFO closure has been proposed as a compassionate treatment for refractory migraines. Although observational studies reported reductions in migraine frequency and severity, randomized trials have been inconsistent. Meta-analyses suggest benefits in specific subgroups, such as patients with aura, but heterogeneity limits conclusions. This case report presents the case of a 22-year-old patient with refractory migraine and a confirmed PFO who underwent successful percutaneous closure, achieving complete migraine remission, improved quality of life, and no evidence of residual shunting. Larger trials are needed to refine patient selection and validate guidelines.

Heart failure with reduced ejection fraction (HFrEF) represents a significant global health burden, affecting more than 60 million individuals worldwide and contributing substantially to morbidity, hospitalization, and pre-mature mortality. Despite advances in evidence-based therapies, managing HFrEF remains complex. Contemporary treatment strategies are anchored in four foundational drug classes - angiotensin-converting enzyme inhibitors or angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors; beta-blockers; mineralocorticoid receptor antagonists; and sodium-glucose cotransporter-2 inhibitors. These “four pillars” of HFrEF treatment have proven benefits in improving survival and quality of life. However, effective treatment involves not only prescribing these medications, but also timely initiation, thoughtful combination, and careful uptitration to target doses shown to be effective in clinical trials. Real-world data reveal that many patients do not receive these therapies optimally, often due to inappropriate doses or delays in initiation, which limits their clinical benefits. Early initiation of all four drug classes - ideally within 30 days of diagnosis or a decompensated event - can significantly reduce hospitalizations, disease progression, and all-cause mortality. In selected patients, additional treatments, such as vericiguat, ivabradine, and iron supplementation may provide further benefit, particularly for those with persistent symptoms or iron deficiency. Thus, managing HFrEF requires a comprehensive, individualized approach that aligns clinical practice with evidence-based protocols to maximize outcomes and reduce the health burden of patients.

Atrial fibrillation (AF) is associated with an increased burden of cardiovascular complications. Early rhythm control has demonstrated promising benefits in this context. Oral anticoagulation has significantly improved overall survival in AF patients by reducing thromboembolic events. However, several comorbidities are linked to an elevated risk of hemorrhagic complications. Left atrial percutaneous appendage closure (LAPAC) is emerging as a promising therapeutic strategy in this subgroup of patients. Interventional cardiologists are increasingly exploring a combined approach involving simultaneous AF ablation and LAPAC to harness the benefits of both procedures and potentially reduce the length of in-hospital stay. According to current literature, the periprocedural safety of combined procedures appears comparable to that of each procedure performed separately, although it is associated with increased hospitalization costs. Notably, the appropriate anticoagulation/antiaggregant therapy regimen following combined procedures remains a subject of ongoing debate. A minimum of 8 weeks of oral anticoagulation is mandatory following AF ablation, irrespective of the patient’s stroke risk or the energy modality used. Conversely, LAPAC should be offered only to patients with contraindications to long-term oral anticoagulation. In the early post-discharge period, no significant differences are observed between combined and isolated procedures. Over long-term follow-up, device thrombosis may occur, with its incidence seemingly unaffected by combined procedures. However, peri-device leaks tend to increase over time in patients undergoing combined procedures, with ridge edema related to radiofrequency delivery considered the primary cause of this phenomenon. New emerging energies (such as pulsed-field ablation) require further evaluation to determine long-term outcomes. According to published position papers, the combined strategy of AF ablation and LAPAC may be a reasonable therapeutic option in selected patients.

Takotsubo syndrome (TTS), also known as the “broken heart syndrome” or “stress cardiomyopathy,” is characterized by transient left ventricular systolic dysfunction, usually in the absence of significant obstructive coronary artery disease. The pathophysiology of TTS remains incompletely understood, though commonly proposed mechanisms include catecholamine surge, estrogen deficiency, and coronary circulation dysfunction. TTS was initially regarded as benign and reversible; however, studies indicate that it may have severe short- and long-term complications. There are several prognostic factors associated with TTS that may influence patient outcomes. In this review, we aim to explore these prognostic factors in relation to various clinical variables, including age, gender, trigger type, atrial arrhythmias, rate-corrected QT interval, baseline left ventricular systolic function, and comorbidities. While many factors are thought to influence TTS, current research findings remain inconsistent. To improve prognosis, there is an urgent need to develop better risk-assessment tools. This can be achieved through large-scale, multicenter studies and analysis of existing research. By understanding these prognostic factors, better prevention and intervention strategies can be developed for TTS, reinforcing its recognition as a serious cardiovascular condition.

The Map3k3^I441M knock-in mouse model reveals an age-dependent mechanism in cerebral cavernous malformation (CCM) pathogenesis, wherein PI3K pathway activation is required for lesion formation in adults but not juveniles. Notably, rapamycin treatment effectively inhibited lesions across age groups, underscoring mammalian target of rapamycin (mTOR) inhibition as a potential therapy. This commentary highlights mechanistic insights from the Map3k3^I441M knock-in mouse model, emphasizing the age-dependent role of PI3K signaling in CCM formation. It discusses the potential synergy between MAP3K3 and PIK3CA mutations, explores the therapeutic potential of mTOR inhibition, and considers the potential influence of pre-conceptional environmental exposures on CCM susceptibility.

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that severely impacts memory and cognitive functions. Early diagnosis remains crucial for timely intervention and care. This research aims to explore the use of artificial intelligence, specifically deep learning, for the early prediction and classification of AD using structural magnetic resonance imaging (MRI) images. A dataset comprising approximately 44,000 brain MRI images with four diagnostic classes (mild, moderate, severe, and very severe dementia) was used to train and evaluate multiple convolutional neural network (CNN) architectures. Three deep learning models were developed and tested: a custom CNN built from scratch, a spatial-channel convolutional attention network (SCCAN), and a pre-trained Visual Geometry Group VGG16 model using transfer learning. The methodology included extensive preprocessing, data augmentation, normalization, and a train-validation-test split to ensure robust performance. Evaluation metrics such as accuracy, precision, recall, F1-score, and confusion matrices were used to assess classification efficacy. Among the models tested, the Visual Geometry Group VGG16 model achieved the highest classification accuracy, closely followed by the SCCAN, while the custom CNN demonstrated competitive performance with fewer layers. Grad-CAM visualizations were integrated to provide insight into model decision-making, enhancing interpretability. The results confirm the effectiveness of deep learning in classifying early AD stages with high accuracy and support its integration into clinical diagnostic tools. However, the study also identifies limitations, including dataset diversity, class imbalance, and generalizability across diverse populations. Future research should consider using larger, multi-center datasets (including PET and EEG modalities). This project demonstrates that deep learning can offer reliable, scalable, and interpretable solutions for the early detection of AD, potentially transforming the diagnostic pathway and enabling earlier therapeutic interventions.

Vascular cognitive impairment (VCI) is a cognitive dysfunction syndrome caused by various vascular-related risk factors, with hypertension regarded as one of the main pathogenic factors. Chronic hypertension can promote cognitive decline through abnormal microcirculation structure, white matter fiber injury, blood-brain barrier destruction, oxidative stress, and neuroinflammatory reaction, increasing the incidence of vascular dementia. To fully grasp the research status in this field, this study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for literature identification. A controlled vocabulary-based search strategy was employed to screen PubMed, Embase, Web of Science, and Cochrane Library for human studies published from January 2000 to March 2025, focusing on hypertension, VCI, dementia, antihypertensive treatment, and aerobic exercise intervention. Analysis of literature shows that angiotensin converting enzyme inhibitors and calcium channel blockers may play a neuroprotective role by increasing cerebral blood flow, reducing oxidative stress, and delaying amyloid deposition. However, these mechanisms and their clinical results are still controversial. Aerobic exercise, particularly moderate and high-intensity exercise, can continuously improve cerebral blood flow, promote neuroplasticity development, and enhance cognitive performance. However, significant limitations remain in the existing research. Thus, it is essential to conduct a systematic, integrated analysis and further strengthen standardized experimental design and personalization.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome in which patients have clear signs of heart muscle injury but show <50% stenosis on coronary angiography. We recognize it as a distinct condition that demands its own diagnostic and treatment approaches. Recent studies were reviewed to elucidate the pathophysiology, diagnostic criteria, and management strategies for MINOCA. PubMed, Scopus, and Google Scholar were searched for full-text, peer-reviewed articles on MINOCA’s pathophysiology and diagnostics. Keywords such as “non-obstructive coronary artery,” “ischemic heart diseases,” and “myocardial infarction” were used. Following the screening and synthesis of the selected papers, we found that MINOCA can result from ischemic causes—plaque disruption, vasospasm, microvascular dysfunction, spontaneous coronary artery dissection, and coronary embolism—as well as from non-ischemic causes, such as myocarditis and Takotsubo cardiomyopathy. The diagnostic evaluation of MINOCA relies on high-sensitivity troponin assays, coronary angiography, cardiac magnetic resonance (CMR) imaging, optical coherence tomography, and functional testing for vasomotor disorders. There are emerging biomarkers, including microRNAs, copeptin, and soluble suppression of tumorigenicity-2, that help refine the risk assessment. We concluded that MINOCA requires a stepwise diagnostic algorithm and personalized treatment methods tailored to the underlying cause, while advocating for early use of CMR imaging, targeted imaging or functional tests, and long-term follow-up. Future randomized trials are warranted to validate etiology-specific therapies and imaging-guided management strategies.

Cardiovascular diseases (CVDs) are a major contributor to global morbidity and mortality, highlighting the need for early detection and prevention. This study introduces CardioPredict AI, a cloud-based system using advanced machine learning (ML) for CVD prediction. It offers scalable, accessible, and real-time diagnosis. The system leverages a comprehensive patient dataset that integrates multiple clinical features, including age, cholesterol levels, and blood pressure. Data preprocessing involved imputation, normalization, one-hot encoding, and the selection of 12 key features. The random forest model achieved an accuracy of 90.21%, a recall of 94.75%, and an F1-score of 91.31%, meeting the medical standards for heart disease prediction (recall >90%; false negatives <20). Cross-validation yielded a recall of 0.8940 ± 0.0889. Key features include personalized recommendations, real-time risk assessment through a Streamlit application, SHapley Additive exPlanation-based interpretability, and a dashboard for patient metrics. This study highlights the potential of ML and cloud computing to reduce the burden of CVDs through early detection.

Orthostatic hypotension (OH) is a common but underrecognized disorder defined by an abnormal fall in blood pressure on standing. It reflects impaired autonomic and cardiovascular adaptation to postural change, leading to transient cerebral hypoperfusion. Beyond immediate symptoms such as dizziness and syncope, OH is associated with long-term risks including falls, fractures, cognitive decline, and cardiovascular morbidity. This review synthesizes current evidence on epidemiology, definitions, pathophysiology, diagnostic approaches, management strategies, and future directions. Four phenotypes, including initial, classical, delayed, and delayed recovery, represent a clinical continuum from transient to sustained autonomic failure. Diagnosis relies primarily on the active standing test, with tilt-table and beat-to-beat monitoring enhancing detection of atypical forms. Home and ambulatory blood pressure monitoring provide additional insight into supine hypertension and postprandial patterns. Management prioritizes symptom control and prevention of complications through stepwise strategies: Lifestyle modification, volume and salt expansion, compression therapy, and pharmacological agents such as midodrine, droxidopa, and fludrocortisone. Drug selection and dosing must account for comorbid hypertension and supine hypertension risk. Recent research highlights phenotype-specific prognostic differences and emerging options, including pyridostigmine, atomoxetine, and device-based abdominal compression. Digital phenotyping through home or beat-to-beat monitoring may enable personalized management. The evolving understanding of OH underscores the importance of individualized, evidence-based care aimed at functional improvement and reduction of adverse outcomes rather than strict normalization of blood pressure.