SGLT2 inhibitors promote changes in the kidney that influence water and electrolyte handling. Prior studies in heart failure (HF) suggested that SGLT2 inhibitors produce a slight increase in serum sodium over time, but little is known about their impact on serum chloride and the sodium-chloride interplay. To study the serum sodium-chloride interdependence, their prognostic associations, and the impact of empagliflozin on their levels over time. EMPEROR-Pooled data (N = 9718) was used to create four mutually exclusive sodium-chloride categories based on quintiles (Q) of variable values distribution at baseline: (1) Q1Na+/Q1Cl−; (2) Q1Na+/ ≥ Q2Cl−; 3) ≥ Q2Na+/Q1Cl−; and (4) ≥ Q2Na+/ ≥ Q2Cl−. Cox models were used to study the association of these categories with outcomes. Mixed models for repeated measures were used to study the impact of empagliflozin vs placebo on sodium and chloride levels over time. Mean serum sodium levels were 140.9 ± 3.0 mmol/L and chloride 100.9 ± 3.6 mmol/L. Patients with both Na+ < 140 mmol/L and Cl− < 99 mmol/L (Q1Na+/Q1Cl−) were more frequently treated with loop diuretics and experienced 1.3 to 1.7-fold higher rates of HF events and mortality compared to patients with ≥ Q2Na+/ ≥ Q2Cl−. Patients with Q1Cl− exhibited higher mortality rates, irrespective of Na+ levels. The beneficial effects of empagliflozin were not influenced by Na+/Cl− levels; interactionP > 0.1. Compared to placebo, empagliflozin slightly increased Na+ and Cl− by + 0.1 mmol/L on average, particularly from week 32 onwards (P < 0.05), while reducing serum bicarbonate levels by −0.2 mmol/L on average (P < 0.05). In ambulatory HF, lower serum chloride levels were associated with poor outcomes independently of sodium, whereas lower sodium levels were associated with poor outcomes only in the presence of relatively low chloride. The beneficial effects of empagliflozin were not impacted by sodium or chloride.
Mitral regurgitation (MR) is commonly treated with ring-based annuloplasty. In case of recurrent MR, re-do operations are often denied due to high risk. Transcatheter valve-in-ring (V-i-R) procedures offer an alternative. This study assessed the feasibility and outcomes of using the transapical, repositionable Tendyne valve for off-label mitral V-i-R procedures, as an alternative to balloon-expandable valves like SAPIEN, which face limitations such as paravalvular leakage and LVOT obstruction. The TEND-RING registry is a retrospective, international study with prospective follow-up, including 16 high-risk patients from eight European centers who underwent Tendyne V-i-R procedures between 2017 and 2024. Procedural, 30-day, and long-term outcomes were analyzed. Patients were elderly (median age 79.5), predominantly male (81
Atrial myxoma is the most common primary cardiac neoplasm, which may cause embolisms, obstruction, and arrhythmias. Whether electrocardiographic P-wave indices carry diagnostic information for detecting atrial myxomas has not been systematically examined. We retrospectively analyzed 83 patients: 39 with histologically confirmed atrial myxoma (34 left, 5 right atrial) and 44 age- and sex-matched controls. Seven P-wave indices were derived from 12-lead ECGs: duration, morphology in V1, voltage in lead I, axis, area in lead II, morphology-voltage-P-wave duration (MVP) score and dispersion. Logistic regression was used to identify possible predictors for atrial myxoma, with adjustment for age, sex, coronary artery disease, dyslipidemia, and smoking. Patients’ median age was 60.0 [51.0–70.0] years; 77.1
Gagging during transesophageal echocardiography (TEE) can make the procedure distressing and even impossible to perform. Acupuncture is suggested to relieve the gag reflex during peroral endoscopic procedures. The aim was to test whether acupuncture is better than placebo for reducing gagging in patients undergoing elective ambulatory TEE. Sixty patients scheduled for ambulatory TEE were included according to eligibility criteria and received either fixed intradermal needles (N = 30) or placebo needles at acupuncture points CV24 and PC6 in a random order prior to TEE. Patients and practitioners, who performed TEE procedure and assessed the outcome measures were unaware of group (acupuncture or placebo) allocation. The primary outcome was the intensity of gagging, measured using verbal rating scale (VRS-11). Secondary outcomes included the use of rescue medication, the incidence of gagging, patients’ satisfaction with relief of unwanted side effects during TEE procedure, success of patients’ blinding, heart rate and oxygen saturation. Median (IQR) of patient’s reported gagging intensity in the acupuncture group was 4 (2–8) vs. 7 (5–8) in the placebo group (P = 0.13), the gagging intensity reported by TEE-examiner was 2 (1–5) among the patients from the acupuncture group vs. 4 (2–9) in the placebo group (P = 0.06). Six patients from the acupuncture group vs. 14 from the placebo group required sedative rescue medication (P = 0.03). All other measured outcomes were comparable between the study groups. Acupuncture with indwelling fixed intradermal needles may reduce the need for sedative medication in patients scheduled for elective TEE. Larger trials with improved methodology are required to verify this finding. NCT03821428; registration date: January 25, 2019.
Acoramidis, a selective transthyretin stabilizer, received EU approval in February 2025 for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM). We describe patient characteristics and comedication patterns in German routine care. Adults with ≥ 1 acoramidis dispensation between April and September 2025 were identified from the IQVIA™ Longitudinal Prescription database, which covers 82
