Cardiology Updates

Disability in activities of daily living before hospitalisation and clinical outcomes following acute-phase rehabilitation in older individuals with cardiovascular disease
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2974/7837264?rss=1

AbstractBackgroundOlder individuals with cardiovascular disease (CVD) frequently complicate disability in activities of daily living (ADLs), defined as needing assistance performing ADLs, which is at risk for further functional decline and higher mortality. Although acute-phase physical rehabilitation has been recently highlighted for its effectiveness on functional outcomes in older individuals with CVD, the effectiveness in those with pre-hospitalization ADLs disability is uncertain.PurposeTo investigate the association between the ADLs disability before hospitalisation and outcomes after acute-phase rehabilitation, including physical function changes during hospitalisation and clinical events after hospital discharge in older individuals with CVD.MethodsWe studied 2792 individuals aged ≥65 admitted to a university hospital for CVD treatment and received inpatient physical rehabilitation tailored for each patient. The information on disability in ADLs before admission was obtained through interviews about difficulty performing basic ADLs, including feeding, bathing, toileting, dressing, and ambulating. The primary outcome was the Short Physical Performance Battery (SPPB), measured at the initiation of inpatient rehabilitation as a baseline and at hospital discharge to assess the changes in physical function during hospitalisation. We also investigated the five-year composite events of all-cause death and/or rehospitalisation due to heart failure after discharge. The repeated analysis of covariance adjusted for clinical characteristics was used to examine the change in SPPB between ADLs status. We also analysed the association between SPPB change after acute-phase rehabilitation and incidences of composite events in individuals with or without ADLs disability.ResultsIndividuals with ADLs disability before hospitalisation were observed in 163 (5.8%) patients, who showed older age, higher prevalence of heart failure and comorbidities, and lower SPPB at baseline than those with ADLs independent. Conversely, SPPB was significantly higher at hospital discharge than at baseline, even in patients with pre-hospitalization ADLs disability and without interaction between the ADL status (P=0.091, Figure 1). The negative change in SPPB was observed only in 240 (8.6%), and its rate was higher in individuals with ADLs disability than those without (14.2% vs 7.8%, P=0.007). During the median follow-up of 2.6years, the composite events occurred in 760 patients (27.2%), and the combination of negative change in SPPB with ADLs disability was only associated with higher incidences of composite events against preserved SPPB with ADLs independent as reference (adjusted hazard ratio: 2.57, 95% confidence intervals: 1.11–5.97, Figure 2).ConclusionsAcute-phase rehabilitation may contribute to better changes in physical function, which is associated with a lower risk of clinical events in older individuals with CVD and pre-hospitalisation ADLs disability.Figure 2

Hyperlipidemia interferes with the behavior of variant NKT cells
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.3827/7839159?rss=1

AbstractBackgroundNKT cells significantly influence atherosclerosis development. However, inconsistent findings on the function of the NKT cells and the invariant subset in atherosclerosis remains a challenge. Moreover, there is no clarity on the role and phenotype of the variant (vNKT) subset in atherosclerosis.PurposeTo understand the role of the vNKT subsets in HFD-induced atherosclerosis.MethodsWe extracted the data for meta-analysis to understand the role of the whole NKT and iNKT cells in atherosclerosis. PRISMA guidelines were followed for the meta-analysis. In addition, C57BL/6 mice (WT) were fed with HFD for 20 weeks from 6-8 weeks of age. vNKTs were identified as CD3+NK1.1+CD1d-tetramer- within the CD3+NK1.1+ NKT cell population in both liver and spleen by flow cytometry. Intracellular cyotkines staining was performed. Statistical differences inthe means of two groups are calculated by two-tailed Student’s t-test with nonparametric Mann-Whitney tests. P-valueResultsThe NKT cell numbers increased significantly in the spleen, lymph nodes, blood, and liver in the HFD-fed mice fed from 1.5 to 24 weeks in Apoe-/-, Ldlr-/- in comparison to wild-type mice (SMD, 2.51 [95% CI, 1.42, 3.61]). Contrary to this, the iNKT cell numbers and the iNKT TCR gene expression levels, decreased significantly in the HFD-fed mice (SMD, -2.04 [95% CI, -3.34, -0.75]). The reduction in iNKT cell numbers is also supported by the clinical data from the AMI patients when compared to healthy controls [SMD = -1.81, 95% CI = -2.89, -0.74] (Figure 1). In HFD-fed C57BL/6 hyperlipidemic mice, significantly increased levels of total cholesterol (HFD vs Chow; 226.5±29.66 vs 118.5±10.56 mg/dL, n=4) and LDLc (44.56±11.96 vs 16.69±1.13 mg%, n=4) was observed. The number of vNKTs in the liver was significantly increased by 46% (HFD vs Chow 28.35±2.28 vs 19.41±1.36, n=6-7) (Figure 2A). However, the CD8+ vNKTs were significantly decreased by 68.6% in the liver (4.72±0.99 vs 15.06±0.96) and the CD4+ vNKTs decreased more than two times in the HFD-fed WT liver (7.39±0.76 vs 18.28±0.36) (Figure 2B). Also, the intracellular IFN-γ+ vNKT cells doubled in their numbers in the HFD-fed spleen (14.31±1.39 vs 6.367±0.87) compared to the chow-fed mice (Figure 2C).Conclusion(s)Meta-analysis revealed dual nature of the NKT cells and its invariant subsets in atherosclerosis, since the whole NKTs increase whereas the iNKTs decrease in number. The vNKT subset actively participates in immune modulation in the HFD-induced hyperlipidemia by increasing their number, as well as by differentially regulating CD8 and CD4 co-receptors between chow and HFD. HFD induced a pro-inflammatory nature in the splenic vNKTs but not in liver vNKTs, that in turn may aggravate other immune cells. This data confirms the dual nature of the NKT subsets and reveals a crucial systemic involvement of vNKT cells in the progression of dyslipidemia.

LDL-C target attainment and statin use in patients with ASCVD, familial hypercholesterolaemia, and those otherwise at moderate/high-risk of ASCVD in australian general practice (SCOPE-GP)
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.3013/7837261?rss=1

AbstractBackgroundThe proportion of Australian general practice patients not attaining low-density lipoprotein cholesterol (LDL-C) goals is not well described. The SCOPE-GP study evaluated duration of LDL-C exceeding treatment goals, statin use and discontinuation rates in patients with atherosclerotic cardiovascular disease (ASCVD), without ASCVD events but at moderate/high-risk, and familial hypercholesterolemia (FH).MethodsThis population-based retrospective cohort study used de-identified medical records of adult patients captured in the IQVIA GP-EMR database. Patients were indexed at the earliest date of ASCVD, FH, or hyperlipidemia diagnosis from January 1, 2010 to June 30, 2022, with a variable follow-up period from index to June 30, 2022. Ascertainment of study cohort was based on the 2021 ESC/EAS guidelines and Framingham Risk Equation. LDL-C test result levels were extracted per patient, summarised and analysed. Patients were stratified based on their test results at latest results/closest to censor date.Average time above target levels is the proportion of number of days above LDL-C target levels over total number of follow-up days for each patient. A Poisson distribution was fitted to estimate 95% confidence interval. Lipid lowering therapies (LLT) were stratified by (ASCVD, FH and moderate/high risk of CVD) at last visit/censor date. Combination of LLT were defined as prescriptions for fixed dose combinations or ≥2 separate scripts of LLT from different classes within 180 days from last visit/censor date (look back period).Discontinuation is defined as no statins were prescribed again after the last script for 270 days or more, limited to the first occurrence.ResultsThe average time with LDL-C levels above target was 1077.5 days in ASCVD patients (n=2,688), 938.6 days in moderate-risk ASCVD (n=37,003), 980.9 days in high-risk ASCVD (n=85,199), and 900.8 days in FH (n=279). The proportion of days above target level for all four cohorts is described in Figure 1.Among 107,552 patients with recorded LDL-C levels ≥1.8mmol/L at their last visit/censor date, 30.9% were on statin monotherapy and 1.0% were on statin+ezetimibe. Statin use was highest in ASCVD patients (65.4%), followed by FH (49.5%), high risk (40.0%) and moderate risk subjects (29.5%) (Table 1).Statin discontinuation rates were 60.3%, 76.3, 66.1%, and 65.8% in these groups, respectively.The predominant reason for statin discontinuation was non-specific adverse drug reactions (12.2% ASCVD, 11.7% moderate-risk, 13.2% high-risk and 17.9% FH). The proportion of subjects contraindicated to statins was highest in moderate risk subjects (0.05%).ConclusionsProlonged periods of elevated LDL-C and high statin discontinuation rates were prevalent among at-risk individuals in Australian primary care. This underscores a significant ASCVD burden that could be prevented with more active lipid management.

Elderly patients with decompensated heart failure: prospective analysis from the LECRA-HF registry
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.897/7835727?rss=1

AbstractBackground/IntroductionHeart failure (HF) presents as a clinical syndrome associated with an adverse prognosis, increased mortality risk, and recurrent hospitalizations for HF (HHF). In Poland, there has been a persistent increase in the overall prevalence and hospitalizations of HF among patients. Each subsequent HHF is associated with progressively worsening prognosis. In Europe, HF is most prevalent in elderly individuals, rendering this patient group particularly susceptible to HF exacerbations.PurposeThe aim of this study was to conduct a comprehensive analysis of the oldest patients (≥80 years) hospitalized due to HF decompensation, compared to the rest of the evaluated cohort, including overall mortality after median 46 months of observation.MethodsThe prospective registry of patients with HF decompensation (LECRA-HF) is an ongoing registry conducted at a tertiary cardiology center specializing in HF treatment. Patients enrolled in the registry (n=1394) were evaluated for the presence of cardiovascular risk factors, HF phenotype, laboratory, and echocardiographic findings, as well as overall mortality. Due to the frequent occurrence of HF in elderly patients, we arbitrarily chose to compare two cohorts of patients: those above (n=306) vs. below 80 years of age (n=1088).ResultsMedian age of elderly patients was 84 [82-86] years, of which only 7.8% were >90 years of age. HFrEF was the most common HF phenotype, which, occurred less frequently in the elderly (54.4 vs 74.4%, P4497 pg/mL (PConclusion(s)Patients aged ≥80 years were characterized by a higher burden of comorbidities. They were more often qualified to cardiac pacemakers, but less often to implantable cardioverter-defibrillators and invasive coronary procedures. The most common HF phenotype was HFrEF, however with a significant increase in HFpEF. They exhibited significantly higher overall mortality compared to those

Assessment of surgical revascularization completeness with quantitative myocardial blood flow distribution derived from CCTA in severe coronary artery disease
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.1352/7837996?rss=1

AbstractBackgroundComplete revascularization remained the "holy grail" in the treatment of patients with severe coronary artery disease (CAD). However, there is no universally accepted definition of complete revascularization after coronary bypass graft surgery (CABG). The current assessment methods are visual, categorical, and biased by the operator's intention. Moreover, no method to date provides an individualized quantification of residual ischemia burden.PurposeWe aim to provide an individualized method to assess the completeness of surgical revascularization through quantitative myocardial blood flow distribution derived from coronary computed tomography angiography (CCTA) that could reflect the actual functional ischemia burden after CABG.MethodsPatients with 3VD and/or left main CAD were enrolled in the first-in-human FAST TRACK CABG trial for surgical revascularization guided solely by CCTA and fractional flow reserve derived from CCTA (FFRCT). Following CABG, the study protocol mandated a 30-day follow-up CCTA, which provides graft patency and topographical adequacy of the bypass graft anastomoses. The pre- and post-CABG CCTA were analyzed. The FFRCT value and percent myocardial blood flow distribution (%MBF) were computed for all 16 SYNTAX score segments using the validated method of Keulards et al(1). On pre-CABG CCTA, the myocardium located distal to the site where the FFRCT value dropped below 0.80 on the vessel centerline was considered ischemic, and the %MBF of the subtended myocardium was summed into the total percent ischemic myocardium (Figure 1). Following CABG, the segment was considered adequately revascularized when a non-narrowed graft was anastomosed distally to the site of FFRCT≤0.8 on the pre-operative CCTA. The change in percent ischemic myocardium and the residual ischemic burden were calculated for each patient (Figure 2).ResultsCCTA, FFRCT, and %MBF were obtained pre- and post-CABG in 96 patients, and the percent ischemic myocardium was computed per patient. At baseline, the average percent ischemic myocardium was 72.0(19.1)%. Post-CABG, the residual percent ischemic myocardium was 13.6(15.1)%. Residual percent ischemic myocardium ConclusionPercent ischemic myocardium and the completeness of surgical revascularization can be assessed with CCTA-derived %MBF. This novel method allows clinicians to assess the individualized ischemia burden and the completeness of revascularization that could be incorporated into personalized CABG planning.Figure 1Figure 2

Delays in diagnosis and treatment initiation of ATTR cardiac amyloidosis: a real-world data analysis
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.774/7839158?rss=1

AbstractIntroductionCardiac amyloidosis (CA) is a serious condition characterized by the accumulation of abnormal protein deposits in the heart muscle, leading to functional impairments and, ultimately, heart failure. Transthyretin amyloid cardiomyopathy (ATTR-CM) is the most common form encountered in CA diagnosis with previously underestimated prevalence. ATTR-CM poses a diagnostic challenge, with a substantial number of cases diagnosed late and at advanced stages. The availability of specific pharmacological treatment using the transthyretin-stabilizer tafamidis further emphasizes the need for timely diagnosis. Here, we aim to assess delays in diagnosis and initiation of therapy in a real-world collective of patients with ATTR-CM.MethodsAll individuals diagnosed from 01/2018 to 05/2023 with ATTR-CM at our university hospital, Germany, were systematically assessed for eligibility in this study. Specifically, we enrolled patients who were undergoing transthyretin stabilizer therapy. The investigation aimed to determine the duration, in days, from the initial suspicion of heart disease to the definitive diagnosis of ATTR-CM. It was also investigated whether the diagnosis of ATTR-CM was made more quickly over time as awareness increased. Additionally, the study assessed the time elapsed until patients received pharmacological therapy following the confirmed diagnosis. The study was approved by the local ethics committee (23-11500-BO).ResultsAfter screening of 194 consecutive patients, 154 were included in the analysis, while 40 patients were excluded due to insufficient records. The results of this study reveal that a median of 300 (113-962) days elapsed from the initial suspicion of amyloidosis to the final confirmation. Initial indications of CA often presented as nonspecific symptoms such as unclear dyspnea (16.2% n=25), abnormal echocardiography (75.3% n=116), or, in rare cases, incidental findings (8.4% n=13). Following the diagnosis, an additional median of 84 (46-163.5) days passed before the first prescription of a transthyretin stabilizer. To assess an improvement of ATTR-CM diagnosis over time, we stratified the data into tertiles by date of first diagnosis. The results showed a gradually decrease in medium time to diagnosis of 466 (181-1035) days in the earliest tertile (2018-2019) to 389 (141-1508) days in the most recent tertile (2022-2023) (pConclusionThis study shows a major healthcare deficit and underscores the medical need for improved screening procedures and diagnostic modalities to expedite the timely diagnosis of CA, as early identification of the condition is crucial for enhancing the quality of life for patients and preventing life-threatening complications.

Development of a predictive model for adherence to pharmacological treatment in ischemic heart disease: consideration of psychosociocultural, neuropsychological, and mental health variables
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2952/7837252?rss=1

AbstractIntroductionAdherence to pharmacological treatment recommendations is the main preventable cause of rehospitalization and premature mortality in patients diagnosed with ischemic heart disease, which in turn, is permeated by modifiable psychosocial risk factors such as anxiety, depression, stress, type A behavior pattern, inhibitory control, attitudes and behavioral beliefs towards the disease and treatment. The objective of this study was to develop and test a model to predict adherence to pharmacological treatment in patients with ischemic heart disease undergoing coronary revascularization surgery based on psychosocial, neuropsychological and mental health variables.Material and MethodsCross-sectional study with a sample of 691 patients between 45 and 82 years of age (M= 52 years, SD= 12.15), 46% women and 54% men, diagnosed with ischemic heart disease and undergoing coronary revascularization surgery. Anthropometric, cardiovascular and psychosocial risk factors were evaluated. The scales were designed and validated to assess adherence to pharmacological treatment in ischemic heart disease by means of EFA and CFA, which showed adequate internal consistency indicators and psychometric properties.ResultsUsing the AMOS v.24 statistical package, a path analysis was performed for the variable of adherence to pharmacological treatment, with attitudes toward the disease and treatment, behavioral beliefs, and inhibitory control (executive function) as direct predictors, explaining 54% of the variance in adherence to pharmacological treatment in ischemic heart disease, and the model fit indices were: χ2(33) =261. 19; CMIN/DF= 7.91; TLI= .893; NFI= .815; IFI= .901; CFI= .900; AGFI= .822, SRMR= 2.727; RMSEA=.053.ConclusionsThe findings of this research contribute to the understanding of adherence to pharmacological treatment in ischemic heart disease as a process and not only as an isolated construct, in which mental health intervenes interacting with psychosocial and cultural aspects of the patient with respect to their disease and pharmacological treatment and in turn provides evidence that inhibitory control as an executive function. This provides evidence that inhibitory control as an executive function is useful for understanding adherence to pharmacological treatment, which shows the need to incorporate in the hospital setting comprehensive psychological evaluations and interventions that allow us to predict adherence to pharmacological treatment of ischemic heart disease in order to intervene in the processes involved, which could contribute to the prevention of rehospitalization and premature mortality.

Association of Vascular endothelial factor D with pulmonary hypertension in heart failure: the PREHOSP-CHF Study
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.983/7835715?rss=1

AbstractBackgroundPulmonary hypertension (PH) complicated with heart failure (HF) is associated with increased morbidity and mortality. Vascular endothelial growth factor D (VEGF-D), one of key regulators of lymphangiogenesis, was reported to be higher in HF patients with pulmonary congestion on chest X-ray. Furthermore, we previously reported that HF patients with high VEGF-D had higher incidence of major adverse cardiovascular events (MACE), defined as cardiovascular death or heart failure hospitalization.PurposeTo investigate the association of VEGF-D with pulmonary hypertension in patients with HF.MethodsThe PREHOSP-CHF study is a multicenter prospective cohort study to determine the predictive value of angiogenesis-related biomarkers in HF. A total of 1,024 patients (mean age 75.5±12.6 years; 58.7% male) admitted to acute decompensated HF were included in the analyses. Serum levels of VEGF-D, as well as N-terminal pro B-type natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin-I (hs-cTnI), high sensitivity C reactive protein (hs-CRP), were measured at the time of discharge. PH was assessed by tricuspid regurgitation velocity (TRV) in echocardiography. Patients were followed-up over two years.ResultsData on PH was obtained in 932 patients. Of these, 44 (4.7%) and 223 (23.9%) patients showed PH (TRV>3.4 m/s) and borderline PH (TRV>2.8 m/s), respectively. Patients with PH/borderline PH were significantly older and had lower body mass index. Prevalence of prior HF hospitalization, HF with preserved ejection fraction, atrial fibrillation, anemia, and chronic kidney disease were higher in patients with PH/borderline PH. Levels of NT-proBNP and VEGF-D, but not hs-cTnI or hs-CRP, were higher in patients with PH/borderline PH (Figure). Levels of NT-proBNP and VEGF-D had weak but significant correlation with TRV (NT-proBNP, R2=0.04, PConclusionsVEGF-D levels were independently associated with PH in patients with HF, and might serve as a predictive biomarker for PH, as well as prognostic biomarker for MACE among patients with HF.

Relation between wearable heart rate monitor derived training load and cardiac adaption in endurance athletes
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2999/7837249?rss=1

AbstractBackgroundNo studies have effectively measured training load (TL) from wearable heart rate (HR) monitors and determined its relation to exercise induced left and right ventricular (LV, RV) remodeling. A better insight into drivers of exercise induced cardiac remodeling is of clinical relevance to guide training advice in athletes at risk of adverse remodeling.PurposeWe determined the TL, based on HR monitoring by commercial wearables[1]. The number and duration of training sessions was quantified during a period of 3 months. Training-intensity was calculated as Edwards TRIMP (eTRIMP) based on the product of training duration in one of 5 HR zones (1=light, 5=very vigorous) and the coefficient related to the respective HR zone.MethodsTraining data was collected in 2 prospective multicenter studies. Master@Heart comprises endurance trained middle-aged men aged 45 to 70years[2]. Pro@Heart consists of elite athletes aged 16 to 23years[3]. For this analysis, all male athletes with complete training data recorded using a chest-worn HR monitor for 3 months were included. Using an in-house developed pipeline, maximal HR and TL were calculated from raw training data. Cardiac magnetic resonance imaging was performed to measure indexed LV/RV end-diastolic volume (LVEDVi, RVEDVi), end-systolic volume (LVESVi, RVESVi), ejection fraction (LVEF, RVEF) and LV mass (LVMi).ResultsPro@Heart athletes (n=69; age 21.9 ± 4.2 years) trained more than Master@Heart athletes (n=82; age 55.2 ± 6.5 years) and their total 3-month TL (eTRIMP) was also higher (9718 ± 3190 vs. 5499 ± 3775min; PConclusionWe prospectively quantified TL in comparison to CMR-derived measures of cardiac remodeling and demonstrated that training duration in low intensity training zones is most predictive for cardiac volumes and mass, whereas LVEF and RVEF are more closely associated to time in zone 3. Very vigorous intensity exercise was not predictive, likely due to limited time training in zone 4 and 5.

Patient engagement in pulmonary embolism research: Insights form the Attend-PE study
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.3391/7839157?rss=1

AbstractBackgroundThere is growing recognition of the significance of a close collaboration between patients, clinicians, and researchers to ensure that research and health service delivery effectively meets the needs of end users [1-3]. However, there is limited understanding of best practices for patient engagement in research among patients with venous thromboembolism, and there is sparse knowledge about challenges to and facilitators of this process [4, 5].PurposeTo describe and explore the process and evaluate the impact of patient engagement in the development of a structured nurse-led post pulmonary embolism care model (the Attend-PE model).MethodThis prospective embedded case study of patient engagement was conducted within the research project - A structured Integrated post Pulmonary Embolism care model (Attend-PE). The study was based on documents from patient journey mapping (PJM), documents and field notes from workshops, and semi-structured interviews with two patients with pulmonary embolism, two clinicians working with pulmonary embolism patients and the Attend-PE researchers. Data were analyzed based on research questions guided by the United Kingdom six Standards for Public Involvement; Inclusive opportunities, Working together, Support & learning, Governance, Communications and Impact [6].ResultPatients played a crucial role throughout the entire Attend-PE study, contributing to research questions, design, execution, and dissemination, as illustrated in Figure 1. The patients were involved at a higher engagement level in the co-creation of the Attend-PE model and co-creation of patient education and information material. Comparatively the engagement level was lower in decisions regarding outcomes, feasibility testing and implementation of the Attend-PE model, as shown in Figure 2. Notably, despite lower engagement level, the continuous involvement in the research process was invaluable to the patients. This ensured that they maintained insight in the research process, even though their contributions varied in the different phases.Important facilitators of patient engagement within the Attend-PE were related to "Inclusive opportunities" and "Support and learning". Patients highlighted the importance of being a part of the process, working together as a team, and being prepared for the work. Important challenges to patient involvement related to "Communication" and "Governance", including lack of expectation alignment and communication regarding clinical elements where clinicians often dominated the discussions.ConclusionPatient involvement has been invaluable in the development of a structured nurse-led post pulmonary embolism care model. Further, patients will be involved in evaluation of the national implementation process and dissemination of study results.Figure 1Figure 2

Biomarkers of cardiohepatic syndrome in the cardiac intensive care unit
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.1742/7837988?rss=1

AbstractIntroductionNon-cardiovascular end-organ dysfunction is an important determinant of outcomes in cardiac intensive care unit (CICU) patients. We examined the association between in-hospital mortality with the severity and extent of admission liver function test (LFT) abnormalities in a heterogeneous CICU population.PurposeWe hypothesized that a greater severity or extent of LFT abnormalities would be associated with higher in-hospital mortality.MethodsWe included consecutive unique adult CICU patients with available data for one or more of the admission LFT values of interest. Admission laboratory values were defined as those closest to CICU admission. We used the NIH Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 to categorize the severity of each LFT abnormality from Grade 0 (normal) to Grade 4 (life-threatening). We defined the extent of LFT abnormality as the number of individual LFTs meeting criteria for CTCAE Grade 1 or greater. The primary outcome of interest was all-cause in-hospital mortality. Odds ratio (OR) and 95% confidence interval (CI) values for in-hospital mortality were estimated using logistic regression, before and after multivariable adjustment.ResultsOf 12,428 unique CICU patients, 5,144 were excluded due to a lack of available data for any admission LFT values. The remaining 7,284 patients comprised the final study population. Among patients with available data for each individual LFT, abnormal values were present in: AST, 2,743/5,733 (47.8%); ALT 1,576/5,512 (28.6%); ALK 611/3,684 (16.6%); and TB 898/5,155 (17.4%). A total of 864 (11.9%) patients died during hospitalization. In-hospital mortality was higher for patients with one or more LFTs meeting criteria for CTCAE Grade 1 or greater (17.9% vs. 6.4%, adjusted OR 1.54 [1.27-1.86], p ConclusionCardiohepatic syndrome is an important predictor of prognosis in CICU patients, as the extent and severity of LFT abnormalities are strongly associated with in-hospital mortality. This is the first large-scale study to examine the association between the magnitude of hepatic biomarker derangement with in-hospital mortality in unselected CICU patients. Patients with markedly elevated LFT values exhibited the highest risk of in-hospital mortality. This analysis advocates for the inclusion of commonly obtained LFTs in future risk-prediction tools for enhanced prognostication.

Cardiopulmonary exercise testing predicts risk of progressive heart failure and long term mortality in ambulatory patients awaiting isolated heart transplant
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.916/7835703?rss=1

AbstractIntroductionCardiopulmonary exercise testing (CPET) parameters such as peak VO2 ≤ 14ml/kg/min, percentage predicted peak VO2 (ppVO2) ≤ 50% and ventilation equivalent of carbon dioxide (Ve/VCO2) >35 l/min/l/min are recommended thresholds to list for isolated heart transplant. There is minimal data on clinical events after listing to guide clinical management or priority in organ allocation.PurposeTo assess the effect of peak VO2, ppVO2, Ve/VCO2 on clinical events after listing for isolated heart transplant.MethodsIn a single centre retrospective study, we identified patients who were status 6 or status 2 prior to 2018 at time of listing for isolated heart transplant between 2007 and 2021. Clinical data were collected by chart review. Primary outcome of progressive heart failure was defined as death or upgrade in transplant priority status (new inotropes or mechanical circulatory support). Comparison was made between peak VO2 strata (> 14 vs ≤ 14 ml/kg/min), ppVO2 strata (> 50% vs 40-50% vs 35 l/min/l/min). Secondary outcome was time dependent survival after listing for heart transplant.ResultsWe identified 141 patients of which 133 underwent CPET and follow up was available for 130 who were included in the analysis. Median age was 53 years (interquartile range 41-59 years), 29.1% of patients were female. Median peak VO2 was 14.0 ml/kg/min (11.2-15.7), ppVO2 was 44% (36-52), Ve/VCO2 slope was 34.0 (31.0-37.0) and RER was 1.1 (1.1-1.2).87 patients had progressive heart failure consisting of 34 deaths and 83 patients having upgrade in priority status. There was a significant difference in risk of progressive heart failure comparing peak VO2 strata (Figure 1) (freedom from event at one year 71.4% with peak VO2 > 14 vs 46.5% with peak VO2 ≤ 14, p=0.00061) and ppVO2 strata (Figure 2) (freedom from event at one year 75.0% with ppVO2 >50% vs 61.2% with ppVO2 40-50% vs 42.6% with ppVO2 34, p=0.52).There were 34 deaths before transplant and 23 deaths after transplant. 87 patients underwent transplant. In a time dependent survival analysis, age, gender and ppVO2 1 year after listing, HR 0.16 (0.08-0.32)) were significant predictors of lower mortality whilst Ve/VCO2>35 (HR 2.09 (1.19-3.68)) was a significant predictor of higher mortality.ConclusionsPeak VO2 and ppVO2 stratify risk of progressive heart failure in ambulatory patients awaiting isolated heart transplant. However, Ve/VCO2 is a predictor of significantly higher mortality. These findings should affect clinical management and transplant priority status; and influence revision of future guidelines.Freedom from event by peak VO2 strataFreedom from event by ppVO2 strata

Combined mammographic breast density and breast arterial calcification is incrementally predictive of coronary artery disease beyond traditional risk factors
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.3087/7837239?rss=1

AbstractBackgroundCoronary artery disease (CAD) risk is underestimated in women using current risk stratification tools. The mammographic finding of breast arterial calcification (BAC) associates with CAD. Furthermore, breast adipose tissue, measured through breast density (BD) on mammography (low breast density indicates high adiposity) has shown potential to act as a pro-inflammatory, pro-atherogenic fat deposit. Given its uptake in screening programs, mammography may therefore represent a novel risk stratification tool for cardiovascular disease in women.PurposeTo evaluate the association between the combined mammographic features of BD and BAC, with CAD.MethodsSingle-centre, retrospective, cross-sectional study, including 153 women, mean age 62±10, who had both clinically indicated mammography, and coronary computed tomography angiogram (CCTA) for suspected CAD. CAD risk was identified by the CAD Consortium Score, with a 15% threshold for low and high risk. BD was visually assessed and categorised by 4-level BI-RADS grade with grade A-B representing low density, and C-D representing high density (Figure 1). BAC was visually assessed and categorised as present/absent (Figure 1). CAD was categorised as presence/absence of coronary artery plaque on CCTA. Logistic regression was performed with results presented as Odds Ratio (OR) and [95% Confidence Intervals]. Receiver operator characteristic area under the curve (AUC) was used for model discrimination.ResultsLow BD (n=103 (67%)) was associated with CAD (OR 3.20 [1.58-6.53], p=0.001, as was BAC presence (n=37 (24%), OR 4.36 [1.58-12], p=0.004). There were 51 (33%) with elevated CAD risk. Participants were categorised into 4 subgroups based on low/high BD and presence/absence of BAC: 29 (19%) had low BD and BAC, 74 (48%) had low BD and no BAC, 8 (5%) had high BD and BAC and 42 (27%) had high BD and no BAC. Significantly higher proportions of CAD were noted with low BD and BAC alone, as well as combined low BD and BAC (Figure 2). Compared with high BD/BAC negative, the presence of low BD and BAC independently associated with CAD (OR 5.27 [1.19-23.3], p=0.03). Significant incremental benefit was seen after adding BD/BAC status to CAD Consortium Score (AUC 0.65 vs. 0.72, p=0.004).ConclusionsCombined, and individual mammographic features of low BD and BAC presence are associated with CAD and improve risk prediction beyond standard coronary risk probabilities. Standardised reporting of these features to inform risk identification may be of further benefit and should be tested in prospective screening studies.

Biomarkers for monitoring patients with cardiac amyloidosis during transthyretin-stabilizer therapy
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.775/7839156?rss=1

AbstractIntroductionCardiac amyloidosis is characterized by deposition of amyloid fibrils in the heart, leading to structural abnormalities and functional impairments resulting in heart failure. Amyloid transthyretin amyloidosis cardiomyopathy (ATTR-CM) is the most common form with increasing incidence due to growing awareness and improved diagnosis. The ATTR stabilizer tafamidis serves as the first specific therapy approved for ATTR-CM, and many promising substances are in late-stage clinical trials. With growing numbers of patients receiving stabilizer therapy, valid tools for monitoring treatment response and detecting disease progression are currently lacking. Here, we aim to assess systemic and cardiac biomarkers in patients receiving stabilizer therapy.MethodAll individuals diagnosed with ATTR-CM at our university hospital, were systematically assessed for eligibility in this study. We enrolled patients who were undergoing therapy with tafamidis. Biomarkers including Hemoglobin (Hb), Creatinine, estimated glomerular filtration rate (eGFR), International Normalized Ratio (INR), C-reactive protein (CRP), Troponin and NT-proBNP were examined at baseline and during 6 and 12 months follow-up. Wilcoxon signed rank test was used for statistical analysis. The study was approved by the local ethics committee (23-11500-BO).Results194 patients were included in the analysis with median age of 80 (76-83) years (86,6% male). Results showed an impaired renal function at baseline (all mean ± SD) with creatinine 1.24 ± 0.46 mg/dl and eGFR 58.64 ± 18.24 ml/min/kg with statistically significant increase after 6 months in creatinine (1.31 ± 0.51 mg/dl, pConclusionAlthough troponin and BNP are routinely used and recommended as biomarker for monitoring patients with ATTR-CM, the diagnostic value may be insufficient to assess therapy response. Results emphasize the need to identify new biomarkers to adequately reflect the specific aspects of ATTR-CM disease progression. This study reveals significant alterations in creatinine and eGFR due to a worsening of kidney function, but an increase of Hb, suggesting a potential indicator for treatment response. Future research should explore innovative approaches like proteomic analysis as promising approach for both diagnostic and prognostic biomarkers.

Trajectories of weight and their impact on cardiac remodeling and function 16 years after bariatric surgery
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2887/7837236?rss=1

AbstractIntroductionObesity is a major risk factor for heart failure, particularly heart failure with preserved left ventricular (LV) ejection fraction. Surgical treatment of obesity have significant beneficial short-term effects on weight loss and on cardiac function; its long-term impact on cardiac remodeling and function remains largely unknown.PurposeWe examine the long-term effect of bariatric surgery on cardiac remodeling and function in adults with preserved LV ejection fraction.MethodsForty-four individuals with severe obesity [body mass index (BMI) ≥35kg/m2] and preserved LV ejection fraction (≥50%) who underwent bariatric surgery (biliopancreatic diversion with duodenal switch [BPD-DS]) were included. Anthropometric measurements and echocardiography were obtained at baseline, 12 months and 16 years follow-up.ResultsMean age of participants (71% female) was 44 ± 8 years and body mass index (BMI) 49.6 ± 6.1 kg/m2. Bariatric surgery led to marked weight reduction and significant improvements in obesity-related metabolic conditions/comorbidities (hypertension, dyslipidemia, type 2 diabetes). Mean percentage of weight loss at 12 months was 37.1 ± 7.0 %. Percentage of weight regain at 16 years averaged 8.9 ± 35.0 %. Bariatric surgery was associated with a significant reduction in indexed LV mass and LV hypertrophy (p 10% of weight lost; n=25; 57%) was not found to be associated with a worsening in cardiac remodeling compared to those who maintained weight loss, except for indexed LV mass (-9.3 ± 10.6 vs. -5.5 ± 7.8 g/m2.7; p=0.04) and LV end-diastolic diameter (-5.4 ± 4.0 vs. -3.5 ± 3.3 cm; p=0.01).ConclusionBariatric surgery (BPD-DS) leads to durable long-term weight loss. Weight regain following bariatric surgery does not appear to have adverse effect on cardiac remodeling and function. Surgical treatment of obesity may be an effective and safe way to prevent clinical cardiac dysfunction and heart failure related to obesity.

Explainable machine learning and multi-modal data for predicting readmission in patients with heart failure
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.931/7835691?rss=1

AbstractBackgroundCardiovascular diseases (CVDs) are among the leading causes of mortality and morbidity globally, with an estimated 1 million hospital admissions for CVD in England in 2019/20, leading to 5.5 million bed days. In addition, patients with CVDs have a notably high rate of hospital readmission, with approximately one in four patients experiencing heart failure (HF) being readmitted within one month of discharge. We explored whether machine learning models trained on electrocardiogram (ECG) and patient electronic health records (EHRs) can support decision-making and risk management and ultimately improve health outcomes for HF patients.PurposeThe project aims to develop a machine learning model to predict health outcomes for HF patients. To test the hypothesis, we trained and tested an explainable machine learning model to predict the risk of mortality and hospital readmission rate for HF patients.MethodsWe used EHR data and tabulated ECG records to train an XGBoost model to predict the risk of 30-day mortality and 30-day hospital readmission for HF patients. EHR data from a cohort of 2,868 patients with their ECG records were used for model development. We extracted a total of 78 features from the ECG data, such as heart rate variability (HRV), P-wave durations, and QT intervals. These ECG features were combined with coded and free-text EHR data (e.g., demographic information, diagnosis, medication history, and lab results) and used as tabular inputs to the XGBoost model. Of the 2,868 patients, an internal set of 574 patients stratified by age, sex, and health outcomes (30-day mortality and 30-day hospital readmission) were held out for testing.ResultsAmong 2,868 HF patients with 10-year follow-up, 1065 patients were reported for mortality or hospital readmission within 30 days of discharge. When the machine learning model was trained on ECG data in addition to EHR data, the model was able to predict patient mortality and hospital readmission rate in the test set with an area under the curve (AUC) of 0.91 and 0.70, respectively. For mortality prediction, the model achieved a sensitivity and specificity of 0.81 and 0.82, respectively, when employing an operating point with minimum difference between the sensitivity and specificity. When the threshold was adjusted to favor sensitivity at 0.91, the model specificity decreased to 0.74. The machine learning model also identified high sensitive troponin levels, QT dispersion, and lactate dehydrogenase levels as features of high importance for predicting the outcomes for HF patients.ConclusionsOur developed machine learning model was able to predict mortality and readmission risks in HF patients using multi-modal data. Upon further validation, the machine learning model has the potential to be tested for supporting clinical decision-making and risk management for HF patients.ROC CurveFeature Importance

Sex-specific prediction of cardiogenic shock complicating acute coronary syndromes: the SEX-SHOCK score
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.1761/7837978?rss=1

AbstractBackgroundMortality of cardiogenic shock (CS) complicating acute coronary syndromes (ACS) remained nearly unchanged over the last two decades. Female CS patients are less likely to receive guideline recommended care, while having worse in-hospital outcomes as compared to males.1 Presently available tools to assess the risk of developing CS in the setting of ACS, such as the ORBI risk score, were developed in predominantly male patient populations, while not considering inflammatory mediators or proxies of cardiorenal function.PurposeThe present study aimed (i) to test the sex-specific performance of the ORBI model to predict in-hospital CS in patients presenting with ACS, and (ii) to develop and externally validate a better performing risk prediction model for both, women and men.MethodsAmong 44’220 ACS patients recruited in the Swiss AMIS-Plus study, the sex-specific performance of the ORBI risk score to estimate the probability for the development of CS was tested. By harnessing regression- and machine-learning based modelling approaches (ie, random forest [RF], multiple layer perceptron [MLR], and logistic regression [LR]), independent predictors of in-hospital CS were identified in sex-disaggregated data. Best performing models and variables were then used to develop SEX-SHOCK, a novel risk prediction model that accounts for sex-specific disease characteristics. External validation was done in 4’787 ACS patients recruited in the SPUM-ACS study.ResultsThe ORBI risk prediction model demonstrated lower discriminatory performance in female patients relative to males (AUC [95%CI]: 0.76 (0.74-0.78) vs. 0.81(0.80-0.83); pConclusionOur study highlights important sex differences in the performance of available tools for risk prediction of developing in-hospital CS among patients presenting with ACS. By harnessing regression- and machine-learning-based approaches, the SEX-SHOCK risk score was developed, outperforming existing risk prediction models in internal and external validation cohorts.

Effect of the longitudinal change in anemia status on clinical outcomes for patients with nonvalvular atrial fibrillation: analysis from the Hokuriku-Plus AF registry
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.485/7839155?rss=1

AbstractBackgroundAnemia is a common comorbidity in older patients with heart failure (HF)1 and atrial fibrillation (AF)2, associated with an increased risk of adverse events. This study evaluated the prognostic effects of longitudinal changes in anemia status on clinical outcomes in patients with AF, as limited data are available on this aspect.Methods and ResultsWe prospectively evaluated data of 1,388 patients with AF obtained from the Hokuriku-Plus AF registry (1,010 men, 72.3±9.7 years) and recorded the incidence of cardiovascular death (CVD), HF, thromboembolism, and major bleeding. Finally, 1,233 patients with AF with baseline and first year of follow up hemoglobin levels were evaluated. Patients were categorized into 3 groups based on the longitudinal changes in 1-year anemia status: AF without anemia (group 1), AF with improved anemia (group 2), and AF with sustained or new-onset anemia (group 3). During 1–5-year follow up, the incidences of CVD, HF, thromboembolism, and major bleeding were significantly higher in patients with AF and anemia than in those without (Figure1). Additionally, the incidence of CVD or HF was significantly higher in group 3 than in groups 1 and 2 (Figure 2). Multivariate analysis revealed no anemia or improvement from anemia in 1 year as an independent predictor for reducing CVD and HF.ConclusionsRecovery from anemia may be associated with a favorable clinical course in AF.

Environmental noise exposure is associated with one-year survival after a first myocardial infarction
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2940/7837227?rss=1

AbstractIntroductionAlthough several studies have shown a link between environmental noise exposure and risk of acute Myocardial Infarction (MI), only few studies have investigated its association with prognosis after MI. We aimed was to analyze the relationship between residential environmental noise exposure and one-year prognosis after a first MI.MethodsThis observational, longitudinal study was conducted from data collected by a French observatory (RICO) from 2004 to 2009. The outcome was defined by Major Adverse Cardiovascular Events (MACE). Medical data were collected from patients hospitalized for an acute MI from patients registered in the database between January 1st, 2004, and December 31st, 2008, with the following criteria: first MI, aged 18 years or older, with a valid home address and residing in a French urban unit, and who survived at least 28 days after the acute MI were included in the present study. Environmental noise and air pollutants exposure were considered at the residence of the patients. Noise exposure was quantified for two time periods: daily (LAeq,24h) and at night (Lnight) with an annual average. Two outdoor air pollutants were considered: nitrogen dioxide (NO2) and particulate matter with an aerodynamic diameter ≤ 10 µm (PM10). Air pollution exposure levels within the 30 days preceding a major cardiac event (MACE) were estimated. MACE were defined as cardiac death, re-hospitalisation for heart failure, recurrent MI, emergency revascularization, stroke, angina and or unstable anginaResultsAmong the 864 subjects included, most were male (64%), the median age was at 69 y. Nineteen percent (N = 164) presented a MACE during the one year follow-up, and the most frequent were cardiac death (32%). For each 10 dB(A) increase during Lnight , the hazard ratio (HR) of MACE was 1.25 (95% IC 1.09 to 1.43), independently of air pollutants and other confounding. This effect was modified by age and gender. Conclusion and relevance: Our findings suggest for the first time a strong association between noise exposure, in particular during the night, and prognosis at one year after a first MI. If confirmed by larger prospective studies, our study could help to identify original opportunities for environment-based secondary prevention strategies.

Resting heart rate and outcomes in patients with heart failure: impact of AF from the Thai-Heat Failure Registry (THFR - HRAF study)
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.936/7835679?rss=1

AbstractIntroductionHeart rate (HR) is a significant prognosis factor and target of the treatment in patients with heart failure (HF) but this relationship in heart failure patients with atrial fibrillation (AF) is uncertain.MethodsA total of 2,996 patients with HF were enroll in the Thai-Heart Failure registry between 2023 to 2024, from 37 heart failure clinics in Thailand. Patients were classified by resting HR and whether having AF or not. The primary outcomes are all-cause death and/or HF. The continuous prognostic relationship and interaction were determined by Cubic-spline model.ResultsTotal of 2,932 patients with available resting heart rate and AF status were analyzed (mean age 59.3±14.5 years, 67.9% male, mean LVEF 31.9%, 12.4% having AF). There were 273, 1,497, 895 and 267 patients have HR 100 bpm, respectively. From the lowest HR to the highest group, the all-cause death and/or HF were 16.5%, 10.4% 13.7% and 14.0%. Interestingly, the patients in the lowest, high and highest HR group were associated with poorer outcomes when compared to patients with normal HR (60-80 bpm). (p 40% (p= 0.37, 0.48 and 0.41, respectively). The hazard ratio is lowest between 64 to 91 bpm. The relationship is the same in patient with AF (p for interaction 0.071) but higher hazard ratio at any giving heart rate.ConclusionThe normal heart rate (between 60-80 bpm) is associated with the best outcomes, not lower is better. HR is a significant prognosis factor whether having AF or not. The relationship is mainly in patient with HFrEF.Figure

Subgroup results from KARDIA-2: impact of demographic and baseline disease characteristics on zilebesiran response in patients with hypertension uncontrolled by a standard oral antihypertensive
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2593/7835765?rss=1

AbstractBackgroundZilebesiran is an investigational RNA interference therapeutic targeting hepatic angiotensinogen synthesis. In KARDIA-1, a single subcutaneous (SC) dose of zilebesiran monotherapy significantly reduced 24-hr mean ambulatory and office systolic blood pressure (SBP) from baseline to Months 3 and 6 versus placebo. The Phase 2 KARDIA-2 study assessed efficacy and safety of zilebesiran with a standard oral antihypertensive in patients with uncontrolled hypertension.PurposeUncontrolled hypertension is a leading cause of cardiovascular morbidity and mortality, and medication non-adherence affects blood pressure control. Developing effective, long-lasting treatments is crucial for patients with hypertension uncontrolled by standard therapy.MethodsKARDIA-2 enrolled adults with mild-to-moderate hypertension who were untreated or receiving stable therapy with ≤2 antihypertensives. Patients discontinued prior antihypertensive medication and were randomized 10:7:4 to open-label, once-daily oral treatment with 40 mg olmesartan, 5 mg amlodipine, or 2.5 mg indapamide. After ≥4 weeks on protocol-specified medication, patients with a 24-hr mean ambulatory SBP of 130–160 mmHg were randomized 1:1 in a double-blind manner to a single SC dose of zilebesiran 600 mg or placebo as add-on therapy. The primary endpoint was change from baseline to Month 3 in 24-hr mean ambulatory SBP versus placebo for each group. Efficacy and safety were also assessed in pre-specified subgroups: age (ResultsThe primary analysis included 667 patients (median age [range] 59 [27–75] years; 57% male, 28% Black). At Month 3, least-squares mean differences (LSMD) (95% confidence interval [CI]) between zilebesiran and placebo for the olmesartan, amlodipine, and indapamide groups were −4.0 (−7.6, −0.3), −9.7 (−12.9, −6.6), and −12.1 (−16.5, −7.6) mmHg, respectively, for 24-hr mean ambulatory SBP (all pConclusionIn KARDIA-2, a single dose of zilebesiran significantly reduced SBP versus placebo at Month 3 on top of a standard oral antihypertensive, with encouraging safety data. SBP reduction was consistent across most subgroups. Treatment with zilebesiran combined with standard antihypertensives may be effective for a broad population of patients with hypertension uncontrolled on monotherapy.

First in-human study of 64Cu-DOTATATE positron emission tomography/computed tomography(PET/CT) in infective endocarditis: a prospective head-to-head comparison with 18-FDG PET/CT
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.1814/7838013?rss=1

AbstractBackgroundInfective endocarditis (IE) is a severe and potentially fatal condition, which can be challenging to diagnose. Positron emission tomography/computed tomography (PET/CT) with [18F]fluorodeoxyglucose ([18F]FDG) is proposed as a diagnostic tool in the ESC endocarditis guidelines, but holds limitations.PurposeTo compare the tracer uptake between [64Cu]Cu-DOTATATE and [18F]FDG in patients with IE, and to examine sensitivity and specificity in patients with prosthetic valve endocarditis (PVE) or native valve endocarditis (NVE).MethodsThe CuDOS-study was a prospective study including 20 cases with IE (10 with PVE and 10 with NVE) and 20 controls. [64Cu]Cu-DOTATATE and [18F]FDG PET/CT were performed in all participants. Scans were read blinded to clinical data. Tracer uptakes were measured as maximum standardized uptake values (SUVmax) in each heart valve. A visual interpretation of the presence or absence of IE was recorded for [64Cu]Cu-DOTATATE and [18F]FDG, respectively.ResultsThe median age of the cases and controls was 68 years [IQR 53-71] and 61 years [IQR 56-67], respectively. In cases and controls, 85% and 70% were men, respectively. [64Cu]Cu-DOTATATE uptake (median SUVmax [IQR]) in patients with IE was higher than in controls (2.38 [1.87-2.90] vs. 1.43 [1.30-1.56], pConclusion[64Cu]Cu-DOTATATE PET/CT showed relevant uptake in the infected valve in patients with infective endocarditis. [64Cu]Cu-DOTATATE had a numerically higher specificity than [18F]FDG in prosthetic valve endocarditis, although the difference was not statistically significant. Both tracers were limited in the detection of native valve endocarditis.Figure 1 [64Cu]Cu-DOTATATE and [18F]FDG

Antithrombotic therapy decision making in advanced cancer: Patients and clinicians' views, perspectives, and experiences
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.3384/7838897?rss=1

AbstractBackgroundDecision-making regarding antithrombotic therapy (ATT) for patients with advanced cancer is highly challenging, given the competing risks and benefits of this treatment near the end of life. SERENITY is a Pan-European study aiming to develop and evaluate a shared decision-making support tool (SDMST), to facilitate ATT management with patients with advanced cancer, at the end of life (1).PurposeTo explore patients’ and clinicians’ views, perspectives and experiences of ATT treatment and decision making. These data will form part of the evidence base to develop and evaluate a SDMST to support decision-making with patients with advanced cancer receiving ATT.MethodsSemi-structured interviews were conducted with patients and clinicians involved in ATT treatment and management in the UK, Denmark, France and Spain. Data were analysed using Framework Analysis; the thematic framework was informed by concomitant SERENITY work packages, interview transcripts/summaries and patient and public representatives.ResultsFifty-nine patients and 77 clinicians were interviewed across the four countries. Some patients expressed a preference not to be involved or informed, while others felt they should have the ultimate authority over ATT prescribing decisions. For many, there was little distinction between being informed about the decision and being involved in the decision regarding ATT; ultimately, many patients expressed the doctor should make the final decision. However, many patients did not perceive there to be a decision to make, either due to the complexities of the choice to be made, or that there are circumstances in which they should discontinue ATT. Similarly, while patients relied heavily on the doctors’ expertise, clinicians described significant reliance upon the patient perspective, due to the complexity of competing risks and benefits, and the context of advanced cancer/multi-comorbidities. Some patients reported being highly concerned about the risks of ATT deprescription, while others did not have a strong opinion on this treatment, deferring to their clinicians’ expertise. Thus, a discordance in decision-making perceptions between patients and clinicians was evident. Moreover, the decision is multifaceted in nature; the context of advanced cancer, coupled with the possibility that the clinician prescribing ATT may not serve as the primary clinician during the time when ATT decisions must be made, further complicated both the decision-making process and the opportunity for shared decision making.ConclusionThere appears to be discordance in decision-making perceptions between patients and clinicians, which could negatively influence the co-decision making regarding ATT, contributing to prescribing inertia, and potentially impacting patient outcomes.A SDMST may help support the complexity around the decision, ensuring informed choices are made, and patients’ wishes and values are incorporated into the decision.

Prevalence of cardiovascular complications and factors associated with higher case-fatality rate among hospitalized patients with sarcoidosis
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.3030/7837280?rss=1

AbstractBackgroundCardiovascular (CV) involvement is a serious complication of sarcoidosis with exaggerated morbidity and mortality. However, the prevalence of CV comorbidities and their case-fatality rate have not been established among hospitalized patients with sarcoidosis.MethodsUsing the National Inpatient Sample (NIS) database, hospitalized patients with a diagnosis of sarcoidosis were identified. The prevalence of each CV comorbidity and the associated case-fatality rate was determined among this population of patients.ResultsData of 406,315 admission cases with a diagnosis of sarcoidosis was analyzed from 2016 to 2020. Of this, 13,950 patients (3.4%) had AMI (STEMI: 0.3% and NSTEMI: 2.3%), 121,515 patients (30%) had HF (HFrEF: 8% and HFpEF: 13%), 7,470 patients (1.8%) had CVA, 8,825 patients had sarcoid myocarditis (2.2%), 8,965 patients (5.6%) had PVD, 71,815 patients had Afib (17.7%), 46,775 patients (11.5%) had cardiorenal syndrome, and 3,905 patients (1%) developed cardiac arrest. Case-Fatality rate was the highest for sarcoidosis patients who developed cardiac arrest (61.4%), followed by STEMI (11.6%), NSTEMI (7.7%), and cardiac tamponade (7.8%). Increasing age (2% for each year), male gender (14% more than females), and black race (25%) but not economic status was associated with increased odds of death among patients with sarcoidosis. While PCI was associated with a lower mortality rate (aOR: 0.4, 95%CI:0.2-0.7, P=0.005), revascularization with CABG (aOR: 0.3, 95% CI: 0.1-1.2, P=0.08) did not reduce the mortality rate.ConclusionAtrial fibrillation, heart failure (HFpEF > HFrEF), and cardiorenal syndrome are the most common cardiovascular complications among hospitalized patents with sarcoidosis. However, case-fatality rate is significantly higher for other less prevalent cardiovascular comorbidities of sarcoidosis, which include cardiac arrest, acute myocardial infarction (STEMI > NSTEMI), and cardiac tamponade.

The impact of pre-myocardial infarction exercise frequency on prognosis in acute myocardial infarction patients
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2663/7835759?rss=1

AbstractBackgroundAcute myocardial infarction (AMI) is a critical cardiovascular event often associated with significant morbidity and mortality. Despite the acknowledgment of regular physical activity as vital for cardiovascular health, its influence on post-AMI prognosis in patients with varying pre-AMI exercise frequencies remains to be fully explored.PurposeThis study aimed to investigate the outcomes of AMI patients based on their exercise frequency prior to the occurrence of AMI, comparing those with regular exercise (once or more per week) versus those with infrequent or no exercise.MethodsThis study included acute myocardial infarction cohorts from 71 secondary or tertiary hospitals between January 1, 2010 and June 30, 2023. Inclusion criteria comprised AMI patients evaluated for exercise frequency using the Community Health Questionnaire before hospitalization. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), net adverse clinical events (NACE), and all-cause mortality, with secondary outcomes comprising the individual components of MACCE and NACE. Propensity score matching (PSM) was employed to adjust for differences in clinical characteristics between the two groups. Multivariable Cox regression and robust multivariable Cox regression were conducted before and after PSM to evaluate the impact of exercise frequency on outcomes.ResultsThe final study population consisted of 77,427 participants (42.1% in the High-frequency exercise group). The median follow-up duration was 1595 days, the mean age was 66.03±11.82 years, 65.6% were male. Compared to individuals with infrequent exercise before AMI, those with regular exercise exhibited significantly lower risks of MACCE [aHR 0.93 (0.91-0.96), pConclusionsThis study underscores the protective role of regular physical activity prior to AMI in reducing adverse post-AMI outcomes. Promoting pre-AMI physical activity can be a key element in preventive cardiology, potentially improving prognosis and decreasing the likelihood of cardiovascular events post-AMI.Figure 1

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.1346/7838010?rss=1

AbstractBackgroundTo the best of our knowledge there is no evidence of the association between microalbuminuria, measured as single spot urine albumin to creatinine ratio (ACR), with very long-term mortality in patients with non-ST segment Elevation Acute Coronary Syndromes.AimTo evaluate the association between admission ACR and very long-term all-cause mortality in an unselected cohort of non-ST-segment elevation acute coronary syndromes patients.MethodsA prospective cohort study was conducted, including patients with non-ST-segment elevation acute coronary syndromes admitted in the Intensive Care Unit. The ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. The primary endpoint was all-cause mortality during the follow-up. Actuarial survival curves were compared by log rank test and a logistical Cox regression analysis was performed to identify variables independently associated with mortality in the follow-up. Statistics were calculated using the IBM Statistics program SPSS version 26.Results600 patients were analyzed. The overall average ACR value was 7 mg/gr (95% CI 4-26). 76% had normoalbuminuria (ACR 0-30 mg/gr), 22% had microalbuminuria (ACR 30-300 mg/gr), and 1.5% had macroalbuminuria (ACR > 300 mg/gr). The median and interquartile range of follow-up was 12 years (95% IC 11-14). The average ACR among those who met the primary endpoint was 59.15 mg/gr (95% CI 52-66) and among the survivors, 27.66 mg/gr (95 % CI 63-77), p > 0,003. ACR terciles were defined by 33th and 66th percentiles: tercile 1: patients with ACR of 0 to 4 mg/gr, tercile 2: ACR from 4 to 17 mg/g and tercile 3 values greater than 17mg/gr. Strong associations were observed between ACR with age, hypertension, stroke and history of COPD, previous use of angiotensin II converter/blocking enzyme inhibitors, systolic blood pressure at admission, ST segment deviation, left ventricle ejection fraction and elevation of serum Troponin T and CPK MB. All cause-mortality during the follow-up was 14% (CI 95% 11-17). Elevation of ACR was significantly associated with long term mortality risk: log rank test chi square: 133.936, p = 0.0001. By multivariate Cox regression analysis adjusted by age, gender, diabetes, hypertension, serum creatinine, troponin T elevation, ST segment deviation, previous AMI, prior use of aspirin, statins and percutaneous coronary intervention after hospitalization, the ACR was independently associated with a 12-year follow-up mortality: OR 13 (95% IC 5-35; p < 0.0001).ConclusionSingle spot urine ACR at admission is a strong predictor of 12-year follow-up mortality in an unselected cohort of patients with non-ST-segment elevation acute coronary syndromes.Baselines characteristics of cohortsMultivariable COX regression analysis

A sane approach to the high volume of alert transmissions in remote monitoring- turning of clinically non-relevant alerts decreases substantially workload
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.733/7838896?rss=1

AbstractBackgroundRemote monitoring (RM) offers a safe and effective method of monitoring patients with cardiac implantable electronic devices (CIEDs). The downside of RM is the data deluge of various transmissions, the majority of which are non-actionable. It has been suggested that optimizing alert transmissions could partly overcome this problem.PurposeThe purpose of this study is to evaluate how the workload in RM can be safely decreased by thoroughly assessing the clinical relevance of each alert and deactivating non-relevant alerts.MethodsData on the number of alerts, scheduled and patient-initiated transmissions, as well as the causes and actions initiated by the transmissions, were systematically collected from the year 2023, during which the approach of actively deactivating clinically non-relevant alerts was conducted (A sane approach, Figure 1). The trend of alert transmissions and the proportion of actionable scheduled transmissions are presented.ResultsOverall, during the study period, 8182 transmissions were generated from 3732 followed CIEDs. Of these, 2306 were alert transmissions, and the rate of alerts decreased by 56% during the follow-up, from 0.07 to 0.04 per device per month. Additionally, our data shows that new alerts that have not occurred in the previous six months occurred on average at a rate of 0.03 per CIED per month, and this trend remained unchanged during the follow-up. Of the 3335 scheduled transmissions, 11% (364) were actionable, and both the number and proportion of actionable scheduled transmissions remained unchanged during the follow-up period. Interestingly, no alerts were triggered from 1124 (70%) of all patients but 88 (2%) of all CIEDs generated 30% of all alerts.ConclusionsIn this study, we demonstrate that RM workload can be decreased by actively evaluating the clinical relevance of each alert transmission. Our approach, where non-relevant alerts are turned off, likely does not impair patient safety and thus this practise enhance the RM.

Prognostic impact of mitral valve geometry in patients with secondary mitral regurgitation: a secondary analysis of the MITRA-FR trial
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.1916/7838009?rss=1

AbstractBackgroundMitral valve (MV) transcatheter edge-to-edge repair (TEER) has emerged as a second line therapy on top of guidelines-directed medical treatment (GDMT) in heart failure (HF) patients with severe secondary mitral regurgitation (SMR). Following the disparate results of the COAPT and MITRA-FR pivotal trials, echocardiographic markers of LV remodeling and MR severity have been proposed to select patients most likely to benefit from MV-TEER.The characterization of MV geometry arises as a potential tool to stratify risk of outcomes in SMR patients, who underwent classical surgery or MV-TEER intervention.However, it remains unknown whether MV geometry parameters were associated with prognosis in MITRA-FR patients and whether MV-TEER could modulate their impact on outcomes.PurposeTo evaluate the association between MV geometry and outcomes of HF patients with SMR in the MITRA-FR trial, as well as the impact of SMR treatment modality.MethodsThirteen MV geometry parameters were assessed from baseline transthoracic echocardiograms in patients from the MITRA-FR trial. The prognostic impact of MV geometry parameters was studied on top of the baseline clinical variables used in the primary analysis of MITRA-FR (i.e. age, atrial fibrillation [AF], ischemic cardiomyopathy, myocardial infarction, left ventricular ejection fraction [LVEF] and effective regurgitant orifice area [EROA]). The primary endpoint was the composite of all-cause mortality or HF hospitalization (HFH) within 2 years. The effect of treatment arms (MV-TEER plus GDMT vs. GDMT alone) on this association was also evaluated.ResultsAmong the 307 patients included in the pivotal trial, 272 were analyzed in the present study (i.e. 135 from the GDMT group and 137 from the GDMT + MV-TEER group). Mean age was 70±10, 74% male. 50% had ischemic cardiomyopathy and 34% AF. LVEF was 33±7% and EROA was 31±11 mm².MV geometry parameters were presented for the whole population and according to the randomization group in the Table. Among these parameters, only MV tenting area remained independently associated with the primary endpoint (Hazard Ratio (HR) = 1.22 per 1 cm², Confidence Interval (CI) = 1.01-1.47; p=0.041) after multivariate analysis (Figure). Tenting height was independently associated with the risk of HFH (HR=1.07 per 1 mm, CI=1.00-1.14, p=0.037), but no MV geometry variable was associated with all-cause death. These findings remained consistent in both treatment arms (p>0.20 for interaction).ConclusionIn HF patients with SMR included in the MITRA-FR trial, MV tenting area and MV tenting height were independently associated with the risk of HFH or all-cause mortality and HFH respectively, without any difference according to treatment arms. These data suggest that MV tethering provides an incremental prognostic value beyond classical echocardiographic variables, including EROA, and then should be considered in the risk stratification of patients with HF and SMR.Table of MV geometry parameters featuresMultivariate analysis (Forrest-plots)

Association between lipoprotein particle concentration and size and progression of coronary plaque: the MACS Longitudinal Coronary CT angiography study
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2746/7835753?rss=1

AbstractBackgroundPeople living with HIV have greater risk of cardiovascular diseases (CVD) than people without HIV and tend to have different risk profiles, including higher serum triglycerides and lower LDL cholesterol levels. Nuclear magnetic resonance (NMR) provides a detailed phenotype of lipoproteins.PurposeTo examine the associations between lipoprotein particle concentrations and size and progression of coronary artery plaque among people living with and without HIV, and whether these associations differ by HIV serostatus.MethodsMen with no clinical CVD in the Multicenter AIDS Cohort Study (MACS) who underwent a coronary CT angiography at baseline (2010-13) and follow-up (2015-17) were included. NMR spectroscopy was completed on fasting serum samples at baseline. Logistic regression models for the change in total coronary plaque volume (in tertiles) were estimated with NMR-derived lipoproteins as predictors. Levels were log-transformed and standardized to make results comparable. Models were adjusted for demographics, statin use and HIV serostatus (model 1) with addition of CVD risk factors (model 2). Interactions by HIV serostatus were also tested.ResultsA total of 549 men (314 with HIV; 235 without HIV) were included. Mean age was 53 ±7 years; 58% were White, 30% Black, and 12% Hispanic. Coronary plaque was present in 70% and plaque volume progressed in 79% of the cohort. Among men with HIV, 81% had undetectable HIV RNA and 12% had a diagnosis of AIDS at baseline. Men with HIV had significantly higher levels of small LDL-P, and total, medium and large VLDL-P levels compared to men without HIV, and lower levels of total, small and large HDL-P (Table 1). Men with HIV had significantly greater progression of plaque volume (37 mm3) compared to men without HIV (31 mm3, pConclusionAssociations between lipid particle concentrations and coronary plaque progression differed between men with and without HIV, with stronger associations seen in men without HIV for total and small LDL-P. Despite having higher VLDL and lower HDL particle concentrations at baseline, these particle concentrations were only associated with plaque progression in men without HIV. Further research is needed to elucidate HIV specific factors for plaque progression to tailor risk reduction strategies.

Recent cardiac rehabilitation and its impact on cardiopulmonary exercise test variables in Brazilian cardiac transplant recipients
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2987/7837274?rss=1

AbstractIntroductionHeart transplantation (HTx) is an option for restoring the functional capacity of individuals with end-stage heart failure (HF). Cardiac rehabilitation (CR) plays an important role in improving variables related to cardiopulmonary exercise testing (CPET) in post-HTx patients.PurposeTo evaluate whether CR is effective in improving CPET variables in Brazilian patients post-recent HTx compared to a Control Group (CG).MethodsRetrospective comparative study composed of two groups: CR group (CRG) and CG. These recent HTx patients (aged 14 to 73 years) initiated CR within 150 days and were recruited from an HTx outpatient clinic at a south Brazilian public university hospital between 2014 and 2023. CPET was performed at three different times: pre-HTx (Time 01), post-recent HTx (Time 02), and post-CR or post-follow-up for CG (Time 03). This study was approved by the Institutional Review Board (protocol No. 20180651). Statistical analysis used Generalized Estimating Equations with alpha ≤ 0.05, and the mean difference (MD) data were presented along with 95% confidence interval (CI).ResultsCRG (n=18) had a mean age of 47.3±15.6 years and CG (n=11) 48.6±12.5 years (P=0.81). The mean time to start CRG was 62.2±9.6 days (minimum: 21; maximum: 147). There was an interaction for the Group*Time factor for the following CPET variables: VO2peak (P=0.039); VEmax (P=0.009); VO2 on second ventilatory threshold (PConclusionEarly CR after very recent HTx significantly increase peak VO2peak, VEmax, T½ and VO2 and HR at the VT2 compared to the control group (CG).

Prospective screening and proposed treatment algorithm for immune checkpoint inhibitor induced myositis in neoadjuvant-treated rectal cancer patients: data from the phase II CHINOREC trial
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.3209/7838895?rss=1

AbstractBackgroundMyositis is an infrequent (MethodsThe CHINOREC study is an ongoing prospective, randomized, open-label, multicenter, phase II investigator-initiated trial (IIT). Patients with intermediate to locally advanced rectal cancer (LARC) receive either neoadjuvant CRT alone or in combination with a single dose of IPI and 3 cycles of NIVO, following surgical resection. Patients are monitored at baseline and throughout the whole study period for myotoxicity biomarkers, including cardiac troponin T (cTnT) and cardiac troponin I (cTnI).FindingsFrom 06/2020 to 11/2023, 80 patients have been enrolled of whom 50 patients were randomized to the CRT+IPI/NIVO arm. Six patients (12%) developed biopsy-verified myositis. Myositis treatment was promptly implemented using a pragmatic step-up approach. Patients received glucocorticoids (GC) with concomitant intravenous immunoglobulin (IVIG). If myotoxicity biomarkers did not improve, patients received infliximab (INFLIXI) and/or plasma exchange (PLEX). Although all patients had strikingly elevated cTnT (median peak 284 ng/L, 95% CI 39-3097), cTnI levels remained largely normal, correlating with a negative cardiac magnetic resonance (CMR). All patients underwent successful tumor surgery without any major surgical complication. As of today, all patients' creatine kinase (CK) and myoglobin (MB) levels have normalized and they are tumor free without any major sequela.InterpretationLongitudinal biomarker screening (cTnT/cTnI) for ICI-induced myotoxicities is pivotal in curative neoadjuvant-treated cancer patients to initiate an early counter treatment in a holistic step-up approach, without compromising oncological principles.

Validation of the MIDA mortality risk score in a surgical cohort of patients with primary mitral regurgitation
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.1917/7838006?rss=1

AbstractBackground and aimThe MIDA scale is a prognostic tool for stratification of short- and long-term mortality risk in patients with primary mitral regurgitation (PMR).The aim of this study is to validate the MIDA (1) score in our population of PMR treated with surgery.MethodsRetrospective analysis of a prospective cohort of patients with PMR who underwent mitral valve surgery in a tertiary care center from 2014 to 2022.The necessary parameters for calculating the MIDA Score (age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure (RVSP), left ventricular end-systolic diameter (LVESD), and LV ejection fraction (LVEF)) were collected, and the MIDA score for each patient was calculated. Thereafter, patients were classified into seven different risk groups. One year and long-term mortality during follow-up were recorded.A logistic regression analysis was performed to evaluate the association of each parameter with outcomes. Finally, curves for the cumulative incidence of all-cause mortality according to the MIDA score were generated with the Kaplan–Meier method.ResultsA total of 349 patients were included. Mean age was 68.5 [12.4] years, 55.8% were male, and the median LVEF was 60% (55-65). Mean follow up was 3.28 (2) years.One year mortality occurred in 29 (8.3%) patients, and long-term mortality in 59 (16.9%).According to the MIDA score, the distribution of patients in each subgroup was as follows: score 0 (n=28), score 1-2 (n=35), score 3-4 (n=60), score 5-6 (n=99), score 7-8 (n=81), score 9-10 (n=35), score > 11 (n=11). Most of our cohort was classified as intermediate-risk patients, with a median score of 6 (3-8).In the univariable logistic regression analysis, age, symptoms before surgery and RVSP were the only MIDA parameters significantly associated with mortality (Table-Figure 1).In our population, the discriminatory capacity of the MIDA score, was moderate, with an area under the ROC curve of 0.676 CI (0.624-0.725) for one year mortality, and 0.702 (0.651-0.749) for long term mortality. The best cut-off point for predicting one-year and long-term mortality was a MIDA score of 7.Kaplan-Meier curves for mortality during follow-up are shown in Figure 2.ConclusionsThe MIDA score showed a fair discriminatory capacity in our surgical cohort of patients with PMR. Variables included in the score that had a significant association with mortality were age, presence of symptoms and elevated RVSP.LV parameters included in the MIDA, which are the current class I indication for surgery, did not show a significant association with outcomes.Different echocardiographic variables to evaluate cardiac damage in PMR are needed to achieve better stratification.Table-Figure 1Figure 2

Assessment of experimental circulating biomarkers in volume and pressure overload: insights from a cohort study
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2749/7835747?rss=1

AbstractIntroductionExperimental biomarkers including Angiopoietin-2 (ANG2), bone morphogenetic protein 10 (BMP10), fibroblast growth factor 23 (FGF23), and insulin-like growth factor-binding protein 7 (IGFBP7) are hypothesized to reflect cardiac pathophysiological processes that are potentially present in adverse cardiac remodeling in volume or pressure overload. This study aims to elucidate the relationship between these circulating biomarkers and the presence of hemodynamically significant pressure or volume overload and adverse outcomes and compare it to N-terminal pro B-type natriuretic peptide (NT-proBNP).MethodsWe studied the association between the four experimental circulating biomarkers in patients with pressure or volume overload with reference to none/mild valvular disease in N=1302 of an observational outpatient cardiology cohort. The median age was 63.0 (25th/75th quartile 51.5, 71.4) years, 445 (34.2%) were women. Circulating biomarkers were quantified using a novel antibody-based method. Logistic regression models with cox regression plots were employed to assess the association of each biomarker with the severity of valve disease concerning volume or pressure overload, adjusted for age and sex.ResultsIn the overall population, elevated levels of ANG2, BMP10, FGF23 and IGFB7 were positively associated with the presence of significant volume overload (ANG2: Odds ratio (OR) 1.26 (95% confidence interval (CI) 1.17-1.35), pConclusionsThis study demonstrates that circulating biomarkers involved in distinct pathophysiological pathways of inflammation, fibrosis and calcification are elevated in patients with hemodynamically significant volume overload. Since they are also related to mortality, their clinical role needs to be explored further, also in context with the routine biomarker NT-proBNP.

Electrocardiogram-based artificial intelligence to identify prevalent coronary artery disease
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.1348/7838005?rss=1

AbstractBackgroundCoronary artery disease (CAD) often goes undetected for years before it manifests and results in substantial morbidity and mortality. Some patients have neither typical risk factors nor symptomatic angina despite progressive disease.PurposeDevelop a deep-learning model to detect prevalent CAD and identify people at risk for adverse events using electrocardiograms (ECG) in a primary care setting.MethodsWe developed a convolutional neural network using 12-lead ECG waveforms to discriminate the presence of CAD defined using diagnostic codes ("ECG2CAD"). ECG2CAD was trained on 764,670 ECGs from 137,199 individuals at the Massachusetts General Hospital (MGH). Model performance for discrimination of prevalent CAD was measured using AUROC and AUPRC, and compared against a model comprising age and sex, as well as the Pooled Cohort Equations (PCE), in three test sets independent of model training: MGH, Brigham and Women’s Hospital (BWH) and UK Biobank. ECG2CAD was assessed across subgroups of age, sex and self-reported ethnicity and for incident CAD-related events in the BWH primary care subset.ResultsECG2CAD was evaluated in MGH (N=18,706 [N=6,051 cases], age 57±16 years), BWH (N=88,270 [N=27,898 cases], age 57±16 years), and UK Biobank (N=42,147 [N=1,509 cases], age 65±8 years). ECG2CAD consistently discriminated prevalent CAD (MGH: AUROC 0.782, AUPRC 0.639; BWH: AUROC 0.747, AUPRC 0.588; UK Biobank: AUROC 0.760, AUPRC 0.155) and incrementally improved upon both a model based on age and sex (pConclusionsArtificial intelligence-enabled analysis of the 12-lead ECG may facilitate efficient identification of individuals with possible undiagnosed CAD and inform downstream testing and preventive measures.

ND15, subunit of the electron transport chain protein-complex I, age-dependently worsens cardiac performance in Drosophila melanogaster
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.3682/7838894?rss=1

AbstractIntroductionIn the natural aging process of the heart, aside others, mitochondrial dysfunction is an essential driver for the development of reduced cardiac performance. Previous analysis of protein expression levels in cardiomyocytes of aged mice and have found aberrancies in subunits of the mitochondrial Complexes I – IV of the electron transport chain. Especially, the complex I subunit ND15 was highly downregulated. To elucidate the functional effects of this gene on the cardiac performance, we generated cardiomyocyte specific ND15 knock-downs in Drosophila melanogaster.MethodsWe generated Drosophila with heart-specific (+/+; Hand4.2-GAL4/UAS-ND15; tdtK/+) (ND15-KD)knockdown of ND15 using the UAS/GAL4 system. The flies' cardiomyocytes endogenously express tdTomato, facilitating fluorescence-based live imaging of the heart by high-resolution video fluorescence microscopy. The recorded data was processed using a R-Script, resulting inResultsWe compared wild type (WT) flies to ND15-KD flies at age 3 weeks(young) and 7 weeks(old).Knockdown of ND15 resulted in impaired cardiac function. Most parameters deteriorated in aged flies in comparison to young flies. The heart frequency was significantly reduced (WT:6 beats/s – KD:4 beats/s – pConclusionThis study demonstrates that heart-specific deletion of ND15 results in a marked impairment of systolic and diastolic cardiac function in Drosophila accompanied by pro-arrhythmogenic actions. We could identify ND15 as a new mitochondrial molecular target for the maintenance of regular cardiac function and rhythmicity, especially with increasing age. Further mechanistic studies and translation to mammalian organisms are ongoing.

Speckle tracking echocardiography as a predictor of location of ablation sites in candidates to catheter ablation for recurrent ventricular tachycardia
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.304/7837268?rss=1

AbstractBackgroundPreoperative imaging is essential before a ventricular tachycardia (VT) ablation procedure, to improve operative outcomes and reduce procedural times. Although MRI is the gold standard, it has several limitations, including patient compliance, possible presence of non-MRI-compatible devices, and long acquisition time. Speckle tracking echocardiography (STE) is a reliable and appealing technique that quantifies regional and global myocardial deformation, as well as layer-specific (endo-, mid- and epicardial) longitudinal strain, without MRI limitations.PurposeThis study aimed to evaluate the efficacy of STE in predicting VT ablation sites.MethodsIn this study, we compared the bull’s eye segmentation of the left ventricle, global and layer-specific, obtained with STE (TomTec Arena), to investigate whether echocardiography can predict the areas of scar and late potential, as identified by electroanatomic mapping (EnSite X mapping, HD Grid mapping catheter, Abbott). Strain analysis and electroanatomic mapping data were matched segment-by-segment to obtain pairs of endocardial strain and bipolar substrate maps, as well as pairs of midmyocardial/epicardial strain and unipolar substrate maps.ResultsTwenty-three consecutive patients with an indication for catheter ablation for recurrent VT were enrolled. All patients were being treated with beta-blockers, 52% were taking amiodarone, and only 2 patients were on mexiletine. A total of 1170 pairs of bull’s eye segments were available for analysis. A binary logistic mixed-effects model was used to predict the presence of electroanatomical scar based on strain echocardiography data, to account for interpatient variability. The study findings highlighted a close correlation between the bipolar map and endocardial strain values, and between the unipolar map and midmyocardial strain values. Progressively higher (less negative) values of endocardial strain proved predictive of bipolar electroanatomical scar, with an increase in the odds ratio of bipolar electroanatomical scar equal to 6.2% (95% confidence interval 2.5%-10%) for each unit increase in strain values. Similarly, progressively higher values of midmyocardial strain were predictive of unipolar electroanatomical scar, with an increase in the odds ratio of unipolar electroanatomical scar equal to 6.2% (95% confidence interval 1.2%-11.4%) for each unit increase in strain values.ConclusionsThe data from our study showed an anatomical correspondence between the areas of low potential identified by electroanatomical mapping and the areas of anomalous longitudinal strain. In particular, the endocardial strain correlates with the bipolar map, and the meso-epicardial strain correlates with the unipolar map. These data may prove useful in the appropriate planning of the procedure in patients with an indication for catheter ablation in the context of recurrent VT.

Invasive validation of central blood pressure measurements using a suprasystolic monitor
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.2574/7835741?rss=1

Abstract Interest in the assessment of Central Blood Pressure (cBP) is steadily growing since it is a better predictor of myocardial infarction, stroke, or death than Peripheral Blood Pressure (pBP). However, pBP remains the first line for the diagnosis of hypertension (HTN) due to the ease and speed of the measurement.We sought to validate a new method to estimate cBP from brachial sphygmomanometer measurements.We estimated cBP using a sphygmomanometer that can record, after conventional pBP measurements, the pressure in the cuff maintained at a constant suprasystolic pressure. cBP is calculated using a method based on applying a physics-based model of the left subclavian artery to the brachial arterial branch to the suprasystolic brachial artery pressure waveforms. We compared this noninvasive estimated cBP to an invasive gold-standard measurement during cardiac catheterization. After clinically indicated cardiac catheterization requiring a haemodynamic assessment of a moderate coronary artery stenosis by Fractional Flow Reserve (FFR), the wire that incorporates a high fidelity electronic pressure transducer was positioned into the guiding catheter left in the ascending aorta. Simultaneous measurements were performed with a cuff placed on the patient's left arm. The output signals were recorded in a custom-based acquisition system. The comparison was obtained on the same 10 seconds recorded by the cuff and the pressure wire. The goal will be to reach 85 patients as recommended by the ARTERY Society Task Force. It recommends as an accuracy criterion to achieve a mean difference ≤ 5 mmHg with a standard deviation (SD) ≤ 8 mmHg, which are the standards adopted for this study. Patients with aortic stenosis, atrial fibrillation, or frequent (supra)ventricular extrasystoles were excluded.A total of 197 pairs of measured-estimated cBP were analysed in 78 patients with a mean age of 63 ± 8 yo, 75% of whom were men, 70% had hypertension, 26% fdiabetes, 93% dyslipidemia, 41% were tobacco users and 14% suffered from clinical peripheral artery diseases without history of revascularization. The median (InterQuartiles 25-75%) pBP was 123 [112 134] / 70 [64 77] mmHg. Measured cBP was 102 [92 11] / 78 [70 84] mmHg with a central augmentation index of 34 [23 44] %. The mean difference between estimated and measured systolic cBP was 4.9 ± 6.5 mmHg, while it was -3.9 ± 5.8 mmHg for diastolic cBP, meeting the prespecified accuracy criteria.In conclusion, our approach based on an exact matching and comparison of non-invasive suprasystolic arm cuff measurements and high-fidelity aortic BP validates that an estimation of central aortic blood pressure that can be easily carried out in daily practice and might improve HTN management. It remains to be demonstrated that more cardiovascular complications will be avoided by guiding the antihypertensive therapy with cBP instead of pBP measurements.Bland-Altman of estimated - measured cBP

Echocardiographic evaluation of right ventricle to pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.135/7838002?rss=1

AbstractBackgroundRight Ventricle to Pulmonary Artery (RV/PA) uncoupling, which depicts the inability of RV contractility to match the increasing RV afterload, has recently gained recognition as a simple echocardiography parameter to aid prognosis judgment in patients with RV dysfunction. In Aortic Stenosis (AS) patients, the extent of RV dysfunction and Pulmonary Hypertension (PH) has been linked with poor outcomes, but the prognostic value of RV/PA uncoupling in AS patients undergoing TAVI has not been well-defined.PurposeTo investigate the prognostic value of RV/PA uncoupling and its association with echocardiographic parameters in AS patients undergoing TAVI.MethodsWe conducted a systematic search through Pubmed and Embase to include studies up to February 2024. Studies were eligible if they evaluated the prognostic performance of RV/PA uncoupling in AS patients undergoing TAVI. Random-effects model were employed to pool the adjusted Hazard Ratio (aHR) with inverse-variance weighting method or Relative Risk (RR) with 95% Confidence Interval (95% CI) using Mantel-Haenszel test for categorical outcomes or Weighted Mean Difference (WMD) for numerical outcomes. Risk of bias assessment was conducted using the Newcastle Ottawa Scale (NOS).ResultsThirteen studies were included. Out of 4,146 patients, 55.21% were reported to have RV-PA uncoupling prior to TAVI. RV/PA uncoupling was customarily assessed with TAPSE/PASP ratio, with threshold for uncoupling ranging between ConclusionPre-procedural RV/PA uncoupling emerges as an independent predictor of worse prognosis in AS patients undergoing TAVI, contributing to a better understanding of the impact of this parameter on patient outcomes.Pooled aHR for poor outcomesMD for baseline difference

Catheter ablation vs medical management for atrial fibrillation in patients with heart failure: a systematic review and metanalysis
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.405/7838893?rss=1

AbstractBackgroundCurrent guidelines recommend a class IIa recommendation for catheter ablation in Atrial Fibrillation [AFIB]. Traditionally, catheter ablation has been known to be more effective in maintaining sinus rhythm than pharmacological management. However, there is sparse evidence to suggest that this translates to improved clinical outcomes in patients with heart failure. We did a systematic review and meta-analysis of randomized trials to compare the efficacy of ablation vs medical management for AFIB in heart failure.MethodsA systematic search was conducted for randomized trials from inception to Jan 2024 for studies comparing the outcomes of catheter ablation vs medical management for AFIB in heart failure. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular (CV) mortality, heart failure hospitalizations, change in LV ejection fraction (LVEF), AF recurrence rate, 6-minute walk test (6MWT), change in MLHFQ scores and cerebrovascular events. Random-effects models were used to calculate the pooled incidence, mean difference (MD), and risk ratios (RRs) with 95% confidence intervals (CIs).ResultsA total of 10 RCTs with 2,348 patients were included in this study. Pulmonary vein isolation was the mainstay ablation strategy used. Compared with medical management, Ablation was associated with a significant reduction in all-cause mortality (RR- 0.61; 95% CI, 0.48-0.78; PConclusionRandomized trials have shown clear benefits with catheter ablation compared to medical management for AFIB in heart failure. Ablation has demonstrated significantly lower all-cause mortality, reduced CV mortality, HF hospitalizations, AFIB recurrence rate, and improvement in LVEF. Patients who underwent catheter ablation showed improvement in functional outcomes like 6MWT and MLHFQ scores. There was no difference in the incidence of cerebrovascular events compared to medical management. This study adds to the growing evidence in the literature for ablation therapy; however, more trials are needed to identify patients for optimal benefits across the spectrum of heart failure patients.Forest PlotsForest Plots

Impact of epicardial adipose tissue and atrial functional impairment in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehae666.246/7838001?rss=1

AbstractBackgroundRecent studies outlined the additional prognostic value of atrial function in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). At the same time, increased epicardial adipose tissue (EAT) volumes have proven impact on atrial functional impairment in cardiovascular disease by nurturing adverse atrial remodelling.PurposeTo explore the impact of increased EAT volumes as a potential pathomechanistic factor of atrial functional impairment in patients with severe AS undergoing TAVR.Methods146 patients with severe AS underwent cardiac magnetic resonance (CMR) within 48h prior to TAVR between January 2017 and June 2021. Image analyses included myocardial volume quantification as well as CMR-feature-tracking derived strain. EAT volumes were manually delineated on short axis stacks in end-diastolic cardiac phases and indexed to body surface area. Functional and morphological parameters were compared between patients with high and low EAT volumes. Associations between morphological and functional parameters and EAT were tested using a multivariable linear regression model including patient specific parameters.ResultsAfter dichotomization at the median of 46.5ml/m2 total EAT volume, patients were assigned to high- and low-EAT groups accordingly. There was comparable age and body mass index and similar rates of co-morbidities such as hypertension, diabetes and atrial fibrillation in both groups. We observed a higher number of male patients in the high-EAT group (36 [53%] vs. 50 [72%], p=0.018). Regarding left and right ventricular dimensions and function, no differences could be shown. Left atrial (LA) end-systolic volumes were significantly higher in the high-EAT group (29.4ml/ml² [19.7-39.4] vs. 40.9ml/ml² [30.2-59.3], p=0.008), while there were no significant differences in end-diastolic volumes. Furthermore, LA reservoir strain was significantly lower in the high-EAT group compared to the low-EAT group (18.0% [11.7-21.0] vs. 11.8% [7.7-16.4], p=0.008) and was independently associated with higher EAT volumes (p=0.018) irrespective of cardiovascular risk factors and left ventricular (LV) systolic function in a multivariable regression model.ConclusionIn patients with severe AS undergoing TAVR, increased EAT volumes are associated with both, morphological and functional changes of the atria. As impaired atrial function was previously shown to be an important predictor of mortality in TAVR patients, those results potentially render EAT as an additional pathomechanistic link between atrial remodelling and worse outcome in TAVR patients.

🔗 Full Guidelines

Environmental sustainability in cardiovascular practice: current challenges and future directions
https://www.nature.com/articles/s41569-024-01077-z

Nature Reviews Cardiology, Published online: 25 October 2024; doi:10.1038/s41569-024-01077-z (https://www.nature.com/articles/s41569-024-01077-z)In this Review, Rajagopalan and colleagues summarize the sources of greenhouse gas emissions related to the provision of cardiovascular health care and suggest strategies to reduce carbon emissions and costs, including the use of renewable energy, waste reduction and disease prevention.

⚫️ Finerenone in Heart Failure with Preserved or Mildly Reduced Ejection Fraction
Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2407107

HFpEF and HFrEFhas limited treatments with proven mortality benefits. But finerenone is changing that! 🌟

📚 Background: Finerenone’s efficacy in heart failure with mildly reduced or preserved ejection fraction was uncertain.

🩺 Methods: Patients were randomly assigned to receive finerenone or placebo in a double-blind trial.

📊 Results: Finerenone significantly reduced total worsening heart failure events and cardiovascular deaths compared to placebo.

▪️Conclusions: Finerenone is effective in reducing heart failure worsening and cardiovascular deaths in patients with mildly reduced or preserved ejection fraction.

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🧠 2024 Stroke Prevention Guidelines from AHA / ASA

Full Guidelines here - https://t.me/Updates_in_Medicine/2269

Key updates from AHA/ASA :

 1. 💊 Aspirin Use: Recommended only for high-risk cardiovascular patients. Routine use is discouraged due to bleeding risks.

 2. 🥗 Lifestyle Changes: Focus on Mediterranean or DASH diets, regular physical activity, and smoking cessation.

 3. 💉 Blood Pressure Management: Aim for a target of <130/80 mm Hg to lower stroke risk.

 4. 🩸 Diabetes Control: Maintain HbA1c <7% for those with Type 2 diabetes to prevent stroke.

 5. ⚕️ Lipid Management: Statins are recommended for patients at high risk of cardiovascular events.

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Conduction Disturbances and Outcome After Surgical Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Stenosis

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.070753?af=R

OpenEP and EP Workbench for electrophysiology data analysis
https://www.nature.com/articles/s41569-024-01092-0

Nature Reviews Cardiology, Published online: 23 October 2024; doi:10.1038/s41569-024-01092-0 (https://www.nature.com/articles/s41569-024-01092-0)In this Tools of the Trade article, Bodagh and Williams highlight the utility of OpenEP, an open-source platform that offers standardized solutions for storage and analysis of electroanatomic mapping data.

Progressive Understanding of Aortic Disease

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.070477?af=R

Partial Heart Transplantation

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.071498?af=R

Evolution of Coronary Surgery

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.070918?af=R

Introduction to the 2024 Cardiovascular Surgery–Themed Issue of Circulation

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.072090?af=R

Caffeine and Chronic Disease: Benefits and Risks (Original Article)
🔗 https://www.medscape.com/viewarticle/ready-jolt-caffeine-brings-benefits-and-risks-2024a1000ilx?src=rss


📊 Key Insights for Medical Professionals

• Caffeine temporarily raises BP, but regular coffee may lower hypertension risk.

• Unfiltered coffee raises cholesterol; filtered coffee has minimal impact.

• Coffee may reduce atrial fibrillation risk, no strong evidence of increased heart risks.

• For diabetics, coffee consumption linked to lower mortality risk.

• Caution with high caffeine doses (>400 mg/day) due to toxicity risk, especially with energy drinks.


💡 Conclusion: Moderate coffee may benefit health, but dose and patient factors are key.

@Updates_in_Medicine

Cardiac Monitoring Is Crucial in Neuromuscular Disorder Care
https://www.medscape.com/viewarticle/cardiac-monitoring-crucial-neuromuscular-disorder-care-2024a1000j5i?src=rss

Heart dysfunction is common, and maternal carriers may be affected too.

Innovative approaches to the management of recurrent atrial fibrillation, aortic dilation, and Brugada syndrome
https://academic.oup.com/eurheartj/article/45/40/4245/7828271?rss=1

Combo of Gout Genetics and Poor Lifestyle Can Up CVD Risk
https://www.medscape.com/viewarticle/combination-genetic-risk-gout-and-poor-lifestyle-choices-2024a1000it2?src=rss

Individuals at a high genetic risk for gout faced a significantly higher risk for cardiovascular disease than those at a lower genetic risk and would benefit from adhering to a healthy lifestyle.

[Review] Clinical update on acute cholecystitis and biliary pancreatitis: between certainties and grey areas

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00459-0/fulltext?rss=yes

Lower your cholesterol early, and stick with it!
https://www.nature.com/articles/s41569-024-01095-x

Nature Reviews Cardiology, Published online: 18 October 2024; doi:10.1038/s41569-024-01095-x (https://www.nature.com/articles/s41569-024-01095-x)Consumption of a high-fat diet leads to the progressive growth of atherosclerotic lesions. Two new studies document that, despite similar overall exposure to high-fat diet over a lifetime, an intermittent consumption of high-fat diet early in life accelerates atherosclerosis compared with continuous consumption of a high-fat diet. The mechanisms for accelerated atherosclerosis include reprogramming of macrophages and neutrophils.

AF Linked to Severe AEs After UACDT for Thrombolysis
https://www.medscape.com/viewarticle/afib-linked-severe-adverse-events-after-uacdt-thrombolysis-2024a1000ijp?src=rss

Patients with AF had threefold higher risk for shock, bleeding complications, and all-cause mortality when undergoing ultrasound-assisted catheter-directed thrombolysis.

Extracellular RIPK3 Acts as a Danger-Associated Molecular Pattern to Exaggerate Cardiac Ischemia/Reperfusion Injury

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.123.068595?af=R

New Evidence That Plaque Buildup Shouldn't Be Ignored
https://www.medscape.com/viewarticle/new-evidence-plaque-buildup-shouldnt-be-ignored-2024a1000ihw?src=rss

There is no question that subclinical disease on imaging predicts death, report investigators who say their new screening could be started on younger people.

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SGLT2 Inhibitors Associated With Better Survival in PAH (Original Article)

🫀 Study from CHEST 2024 shows that SGLT2 inhibitors (dapagliflozin, empagliflozin) are linked with reduced mortality in pulmonary arterial hypertension (PAH).

📉 1-year mortality dropped from 15.5% to 8.1%
📉 5-year mortality dropped from 25% to 14.6%

💡 Potential mechanisms include anti-inflammatory effects and vascular remodeling, but more trials are needed before these findings can change clinical practice.

https://www.medscape.com/viewarticle/sglt2-inhibitors-associated-better-survival-pah-2024a1000idi?ecd=a2a

#MedicalResearch


@Updates_in_Medicine

Muscle Mass and Glucagon-Like Peptide-1 Receptor Agonists: Adaptive or Maladaptive Response to Weight Loss?

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.067676?af=R

Optical Spectroscopic Detection and Typing of Cardiac Amyloidosis

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.069554?af=R

Letter by Jha Regarding Article, “mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis”

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.070147?af=R

💊 Beta-Blocker After Myocardial Infarction: Continue or Stop?

🔹 Study: Multicenter trial with 3,698 patients across France.

🔹 Objective: To assess the safety of stopping beta-blockers after a heart attack to improve quality of life.

🔹 Methods:
• Patients randomized into two groups: one continued beta-blockers, the other stopped.
• Focused on patients with a left ventricular ejection fraction of at least 40%.

🔹 Results:
• Cardiovascular events occurred in 23.8% of patients who stopped beta-blockers vs. 21.1% who continued.
• Risk difference: 2.8%.
• No improvement in quality of life for those who stopped beta-blockers.

🔸 Conclusion: Stopping beta-blockers wasn’t as safe as continuing them.

Original Article - https://www.nejm.org/doi/full/10.1056/NEJMoa2404204

#medicalresearch

@Updates_in_Medicine

Focus on ischaemic heart disease: secondary prevention, cardiogenic shock, and novel therapeutic targets
https://academic.oup.com/eurheartj/article/45/39/4141/7821015?rss=1

🫀 SCAI Expert Consensus: STEMI Management in Primary PCI (Expert Consensus Statement)

• STEMI is a critical emergency; primary PCI is the gold standard for reperfusion.

• This article provides best practices for cardiac catheterization lab readiness and arterial access.

• Detailed review of managing large thrombus burden and various anatomical/clinical situations 🧬.

• Focuses on procedural and technical aspects not covered in ACC/AHA guidelines.

For full guidelines : https://t.me/Updates_in_Medicine/2242



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YAP Overcomes Mechanical Barriers to Induce Mitotic Rounding and Adult Cardiomyocyte Division

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.123.066004?af=R

Associations of Circulating ANGPTL3, C-Terminal Domain–Containing ANGPTL4, and ANGPTL3/8 and ANGPTL4/8 Complexes with LPL Activity, Diabetes, Inflammation, and Cardiovascular Mortality

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.069272?af=R

A Rare Noncoding Enhancer Variant in SCN5A Contributes to the High Prevalence of Brugada Syndrome in Thailand

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.124.069041?af=R

Clinical and subclinical acute brain injury caused by invasive cardiovascular procedures
https://www.nature.com/articles/s41569-024-01076-0

Nature Reviews Cardiology, Published online: 11 October 2024; doi:10.1038/s41569-024-01076-0 (https://www.nature.com/articles/s41569-024-01076-0)Invasive cardiovascular procedures are inherently associated with a risk of acute brain injury, both during and after the intervention. In this international Consensus Statement, the authors provide consensus recommendations on the prevention, diagnosis and treatment of acute brain injury caused by cardiovascular interventions.