Introduction: The 2018 revision of the United Network for Organ Sharing (UNOS) heart allocation system has shifted clinical practice toward increased use of temporary mechanical circulatory support (tMCS) as a bridge to transplantation (BTT). However, comparative outcomes between temporary and durable MCS strategies remain incompletely defined, particularly from a strategy-level perspective. We aim to compare clinical and peri-transplant outcomes between temporary and durable mechanical circulatory support strategies in patients undergoing heart transplantation. Methods: We conducted a single-center retrospective cohort study of consecutive adult patients who underwent orthotopic heart transplantation between October 2018 and October 2020. Patients were categorized according to MCS strategy as temporary (Impella 5.5 or axillary intra-aortic balloon pump) or durable left ventricular assist device (LVAD). Primary outcomes included device-to-transplant time, cardiopulmonary bypass time, and post-transplant ICU length of stay (LOS). Kaplan–Meier analysis and multivariable linear regression were used to evaluate outcomes and predictors. Results: A total of 26 patients were included, of whom 17 (65.4%) received tMCS and 9 (34.6%) durable LVAD support. Temporary MCS was associated with significantly shorter waitlist time (median 27.5–34 vs. 606 days, p = 0.002) and device-to-transplant time (7–13 vs. 572 days, p = 0.001). Kaplan–Meier analysis demonstrated significantly shorter time to transplantation with tMCS (log-rank χ2 = 18.98, p < 0.001). In multivariable analysis, tMCS remained independently associated with shorter device-to-transplant time (B = −495.23; 95% CI −714.38 to −276.08; p = 0.001) and shorter cardiopulmonary bypass time (B = −88.85; 95% CI −126.32 to −51.38; p = 0.001). No statistically significant differences in post-transplant ICU LOS or other early post-transplant outcomes were detected between groups. Conclusions: In this single-center cohort, temporary MCS was associated with significantly shorter time to transplantation and shorter cardiopulmonary bypass times compared with durable LVAD support, while no statistically significant differences in early post-transplant outcomes were detected between groups.
Background: Left ventricular remodeling after myocardial infarction is heterogeneous, and conventional baseline measures of systolic function only partly anticipate its course. Left ventricular ejection fraction (LVEF) and myocardial work reflect different aspects of systolic performance. We examined whether deviation of global work index (GWI) from the value expected for LVEF is associated with reverse remodeling after reperfused ST-elevation myocardial infarction (STEMI). Methods: In 101 prospectively enrolled patients with single-vessel STEMI, echocardiography was performed 12–24 h after reperfusion and at 12 ± 2 months. Residual GWI (GWIr) was calculated as observed GWI minus regression-predicted GWI for the corresponding LVEF. The primary outcome was follow-up 3D end-systolic volume (3D-ESV), adjusted for baseline. Results: Of 60 patients with paired imaging, 58 had baseline GWI; 18 showed reverse remodeling (≥15% 3D-ESV reduction). Each 1-SD higher GWIr was associated with 3.74 mL lower follow-up 3D-ESV (95% CI −6.70 to −0.77; p = 0.015) and higher odds of reverse remodeling (odds ratio 2.38, 95% CI 1.28–5.01; p = 0.005). For the continuous outcome, absolute GWI had a comparable point estimate with a wider confidence interval. Conclusions: Higher GWIr, indicating myocardial work higher than expected for LVEF, was associated with lower follow-up 3D-ESV and higher odds of reverse remodeling after adjustment for baseline 3D-ESV. These exploratory findings require external validation.
Background: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have bidirectional pathophysiological interactions. Although HFpEF has been associated with arrhythmia recurrence after radiofrequency catheter ablation (RFCA), whether its impact differs across AF subtypes remains incompletely understood. Objective: This study aims to evaluate the prognostic impact of HFpEF on AF recurrence following RFCA in paroxysmal versus persistent AF. Methods: A total of 509 patients who underwent RFCA for AF were enrolled in our retrospective study. These patients were categorized into two groups: the normal group and the HFpEF group. The primary endpoint was freedom from atrial tachyarrhythmias (≥30 s) after the initial 3-month blanking period post-index ablation, without any antiarrhythmic drugs. Results: HFpEF was present in 15.9% of the cohort. At the 12-month follow-up visit, sinus rhythm maintenance was recorded in 62.7% of the patients in the HFpEF group versus 82.0% in the normal group (p < 0.001). A multivariable analysis identified HFpEF as an independent predictor of AF recurrence (hazard ratio [HR]: 2.06, 95% confidence interval [CI]: 1.26–3.38, p = 0.004). After 1:1 propensity score matching, HFpEF remained an independent predictor of AF recurrence (HR 1.93, 95% CI: 1.06–3.50, p = 0.03). A subgroup analysis showed a robust association in paroxysmal AF (HR = 6.00, 95% CI: 3.07–11.73, p < 0.001) but not in persistent AF (HR = 1.43, 95%CI: 0.80–2.55, p = 0.231), with a significant interaction (p for interaction = 0.022). During the 12-month follow-up visit, an improvement in the New York Heart Association (NYHA) classification could be seen in 82.7% of the cohort, with all Class III patients showing a functional improvement. Conclusions: There is an increased risk of recurrence in patients with HFpEF post-ablation, particularly among patients with paroxysmal AF. Notably, catheter ablation remains effective at improving the NYHA functional class, even in HFpEF patients. These findings support the utilization of HFpEF as a key indicator for pre-procedural risk stratification.
We examined associations between preoperative anxiety and postoperative pain and kinesiophobia. This single-center study included 120 patients (coronary-artery bypass grafting [CABG], n = 85; valve surgery, n = 35). State and trait anxiety were assessed preoperatively. Pain-related outcomes and kinesiophobia were assessed at three perioperative time points. Surgery-specific correlations underwent false discovery rate adjustment. In the full cohort, state anxiety (rho = −0.134, p = 0.145) and trait anxiety (rho = 0.017, p = 0.856) were not significantly correlated with the postoperative pain-related composite; corresponding postoperative kinesiophobia correlations were rho = 0.025 (p = 0.783) and rho = −0.063 (p = 0.495). The nine-item pain-related composite increased postoperatively (4.57 ± 0.40 to 7.50 ± 0.30) and declined predischarge (4.53 ± 0.37; Friedman p < 0.001; Kendall W = 0.766, reported as the effect-size measure for the Friedman test); kinesiophobia remained stable (p = 0.796). In exploratory analyses, state anxiety correlated with postoperative composite scores in valve surgery (rho = −0.409, p = 0.015) and predischarge kinesiophobia in CABG patients (rho = 0.230, p = 0.034); neither survived multiplicity adjustment (q = 0.234 and 0.276). Overall associations were not statistically significant; exploratory subgroup signals require confirmation in adequately powered, procedure-specific studies.
Background: Hepatic dysfunction is associated with adverse outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the clinical significance of ischemic hepatitis (IH) identified before versus during ECMO support remains uncertain. We investigated the association between IH categories and in-hospital outcomes in patients receiving VA-ECMO. Methods: We retrospectively analyzed 182 adult patients receiving VA-ECMO between 2019 and 2025, including 159 surgical and 23 nonsurgical patients. Patients were classified as having no IH (n = 71), pre-ECMO IH (n = 47), or on-ECMO IH (n = 64). The primary outcome was in-hospital mortality. Results: In-hospital mortality was 71.8%, 85.1%, and 89.1% in the no IH, pre-ECMO IH, and on-ECMO IH groups, respectively (overall p = 0.028). ECMO weaning success rates were 57.7%, 27.7%, and 34.4%, respectively (p = 0.002). In multivariable logistic regression adjusted for age, hypertension, baseline left ventricular ejection fraction, and estimated glomerular filtration rate, on-ECMO IH was associated with higher odds of in-hospital mortality compared with no IH (adjusted OR 4.019, 95% CI 1.453–11.112; p = 0.007). The corresponding association for pre-ECMO IH was not statistically significant (adjusted OR 2.213, 95% CI 0.785–6.241; p = 0.133). However, the direct adjusted comparison between on-ECMO IH and pre-ECMO IH was not statistically significant (adjusted OR 1.816, 95% CI 0.543–6.072; p = 0.333). Conclusions: Ischemic hepatitis identified during VA-ECMO support was associated with increased in-hospital mortality compared with the absence of IH. However, no statistically significant difference was demonstrated between pre-ECMO and on-ECMO IH. These findings should be interpreted cautiously given the retrospective classification of IH and potential temporal bias.
