Background: Transcatheter aortic valve replacement (TAVR) is currently the most commonly utilized management strategy for severe aortic stenosis. The short-term outcomes of TAVR in patients who experienced a recent acute myocardial infarction (AMI) remain unclear. Methods: Using data from the National Readmissions Database years 2016 to 2020, we identified patients who underwent TAVR and had a recent AMI (either ST-elevation [STEMI] or non-ST-elevation myocardial infarction [NSTEMI]) and underwent percutaneous coronary intervention (PCI) within 90 days prior to the TAVR. The primary outcome assessed was in-hospital mortality. A multivariable logistic regression model adjusting for patient and hospital level characteristics was conducted. Results: Among 113,300 patients who underwent TAVR, 2,033 (1.8%) had an AMI within 90 days prior to the TAVR. Compared with those who did not have a recent AMI, there was no significant difference in in-hospital mortality (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 0.62 - 1.99, P=0.72), stroke (aOR 1.22, CI 0.48 - 3.08, P=0.68), and valvular complications (aOR 0.98, CI 0.49 - 1.97, P=0.95). However, there was a higher incidence of major bleeding (aOR 1.97, CI 1.26 - 3.07, P=0.003) and acute kidney injury (aOR 1.86, CI 1.52 - 2.27, P<0.001). There was no difference in the outcomes based on the initial presentation (STEMI vs NSTEMI). Conclusions: Among patients who are undergoing TAVR and had an AMI within 90 days, TAVR appears to be safe, and not associated with higher short-term mortality. However, these patients had a higher incidence of AKI and major bleeding.
Introduction: Higher left ventricular filling pressure (LVFP) is often associated with non-fluid responsiveness in heart failure patients, particularly those with reduced ejection fraction. This hemodynamic state has been linked to adverse outcomes, including higher rates of rehospitalization and mortality. However, the prognostic implications of fluid responsiveness assessed after decongestion remain uncertain. Aims: To explore the relationship between fluid responsiveness and short-term outcomes in patients with heart failure and reduced ejection fraction, by assessing changes in the Velocity Time Integral (VTI), measured at LVOT using apical 5-chamber view via echocardiography during the passive leg raising (PLR) maneuver. Methods: This prospective observational analytical cohort study enrolled patients with acute heart failure reduced ejection fraction who were hospitalized for decongestion at Adam Malik Hospital between December 2024 and March 2025. Fluid responsiveness was defined as an increase in VTI of ≥10% before and after performing the PLR. The relationship between fluid responsiveness and the outcomes of rehospitalization and mortality at 30 days and 3 months was analyzed using the Chi-square test. Results: Among 65 enrolled patients, 37 (57%) were classified as non-fluid responders (NFR). Within 30-day after discharge, 4 (10.8%) patients were rehospitalized, and 2 (5.4%) patients died. Within 3-months after discharge, 8 (21.6%) patients were rehospitalized, and 7 (18.5%) patients died. Twenty-eight (43%) were classified as fluid responders (FR). Within 30-day after discharge, 4 (14.3%) patients were rehospitalized and 3 (10.7%) patients died. Within 3-months after discharge, 2 (7.1%) patients were rehospitalized, and 5 (17.9%) patients died. No statistically significant differences in rehospitalization or mortality rates at either 30 days or 3 months between two groups. Event rates showed overlapping patterns across fluid responsiveness categories. Conclusions: In this exploratory analysis, fluid responsiveness assessed by PLR was not associated with short-term rehospitalization or mortality in decongested patients with HFrEF. Given the limited statistical power, these findings should be interpreted as hypothesis-generating rather than confirmatory, and further adequately powered studies are warranted to clarify the prognostic role of PLR-derived fluid responsiveness in this population.
Earlier Am J Cardiol papers reported that a composite measure of marital quality predicted heart failure (HF) survival over follow-up intervals of 3 and 8 years after adjusting for baseline illness severity (NYHA class). The strongest single predictor in the composite was reported frequency of the couple’s useful discussions about the patient’s HF, a finding reminiscent of communal coping, wherein partners come to construe a stressful health problem as “ours,” rather than “yours” or “mine,” and take collaborative actions to deal with it. Additional studies of partners’ first-person plural pronoun use (we-talk) have bolstered the communal coping evidence base and prompted interest in helping patients and their partners achieve the health benefits communal coping appears to confer. In this commentary I note that routine clinical interactions can either reinforce an individualistic framing (“your disease, your responsibility”) or foster communal coping by inviting shared appraisal and joint problem-solving. Specifically, simple shifts in clinical language (e.g., addressing both partners, externalizing the illness, asking how couples manage heart failure together) can help construct a sense of we-ness that reduces conflict, supports collaboration, and offers a plausible pathway linking relationship processes to survival. Communal coping thus offers a mechanism, a clinical target, and a practical bridge between cardiology and relational science that does not require asking physicians to become therapists.
Calcific aortic valve disease (CAVD) is a prevalent and progressive disorder marked by fibrocalcific remodeling of the aortic valve, for which no effective pharmacological therapies currently exist. While CAVD is recognized as an active, cell-driven process, the intercellular communication networks that govern pathological valve remodeling are not fully understood. Extracellular vesicles (EVs) have emerged as key mediators of such communication in cardiovascular disease, transferring bioactive molecules like microRNAs (miRNAs) between cells to influence disease progression. This review synthesizes the current understanding of EV-mediated miRNA signaling in cardiovascular calcification, with a specific focus on its emerging role in CAVD. We discuss the established functions of EV-miRNAs in vascular disease and calcification and then examine recent paradigm-shifting evidence regarding miR-145-5p in the valvular context. Contrary to its well-established protective role in vascular smooth muscle cell homeostasis, recent work demonstrates that endothelial-derived EVs enriched in miR-145-5p are taken up by valvular interstitial cells (VICs), where they promote osteogenic reprogramming under calcifying conditions. This finding challenges the generalized view of miR-145-5p as a universally anti-calcific agent and highlights a critical dependence on cellular context and mode of intercellular transfer. By positioning EV-associated miR-145-5p as an active signaling molecule in valve calcification, this review underscores the complexity of miRNA function in different cardiovascular compartments and emphasizes the need to consider the specific cellular origin and delivery mechanisms when investigating the pathophysiology of CAVD.
Introduction: Plasma donation is generally considered a safe procedure, and most reported adverse events are related to venipuncture or transient volume loss. Arterial thrombotic events, including acute myocardial infarction, are exceedingly rare but have been described after source plasma donation performed by plasmapheresis. We report a young man without traditional cardiovascular risk factors who presented with acute ST-elevation myocardial infarction after plasma donation. Case presentation: A 27-year-old man with eczema and intermittent cannabis use presented with chest pain approximately 12 hours after plasma donation. Electrocardiography demonstrated anterolateral ST-segment elevation, and coronary angiography showed a large proximal left anterior descending (LAD) artery thrombus with TIMI 1 flow. Aspiration thrombectomy restored TIMI 3 flow, although residual stenosis persisted. A repeat angiogram performed two days later showed persistent proximal LAD thrombus. When the patient returned several days later for completion of the evaluation, repeat angiography demonstrated a contained proximal LAD dissection without residual thrombus; based on the initial angiographic appearance and interval development after thrombectomy, this finding was considered most consistent with a procedural complication rather than the primary cause of presentation. Transthoracic echocardiography showed new severe left ventricular systolic dysfunction with an ejection fraction of 20%–25% and extensive apical akinesis. Conclusion: Plasma donation may rarely be followed by arterial thrombosis, including ST-elevation myocardial infarction. In this case, plasma donation was considered a plausible trigger for coronary thrombosis, while cannabis use represented a potential additional contributing factor. Persistent ischemic symptoms after donation warrant prompt evaluation for acute coronary syndrome.
Introduction and Objective: Semi-compliant (SC) balloons are essential in PCI for lesion preparation before stent deployment. The Optima SC PTCA balloon catheter, a next-generation device, was evaluated in this post-marketing, multicenter study to assess its real-world performance and safety. Methods: This was a retrospective, observational study conducted across four interventional cardiology centers in India. A total of 183 adult patients with coronary artery disease who underwent PCI with Optima SC balloon pre-dilatation were included. Procedural and device success, adverse events, and operator-assessed device performance were evaluated. Patients were followed up to 3 months, as the time frame was adequate to establish procedural safety and performance of this PTCA catheter. Results: Device and procedural success were achieved in 179 out of 183 patients (97.8%); failure in 2.2% was reported in complex lesions. No major adverse cardiac events (MACE), serious adverse events (SAE), or device-related complications were reported during hospital stay, though two clinical events (angina and target lesion failure) were reported in two patients during follow-up. Operator assessment rated performance satisfactory or better in >90% of cases across all parameters. Conclusion: The Optima SC semi-compliant PTCA balloon catheter demonstrated a high procedural success rate and an excellent short-term safety profile in a real-world clinical setting. These findings support its use as a reliable and effective tool for coronary lesion pre-dilatation during PCI.
Background: Subretinal drusenoid deposits (SDDs), a hallmark of age-related macular degeneration (AMD), have been linked to cardiovascular disease, but the underlying mechanism remains unclear. We investigated the association between SDDs and severe aortic stenosis (AS). Methods: A total of 96 patients with low-flow (LF) severe AS underwent ophthalmologic evaluation to determine SDD status. All patients underwent transthoracic echocardiography and were classified into classical low-flow low-gradient (cLFLG), paradoxical low-flow low-gradient (pLFLG), or high-gradient low-flow (HGLF) AS. Echocardiographic measurements included peak aortic jet velocity (Vmax), mean aortic gradient (MG), cardiac index (CI), and Society of Thoracic Surgeons (STS) score. Group comparisons were performed using ANOVA, t-tests, and Fisher’s exact test. Results: Among 96 patients with severe AS who underwent comprehensive ophthalmologic evaluation, SDDs were present in 54 (56%). Compared with patients without SDD, those with SDD were older (P=0.04), had a higher prevalence of AMD (P<0.001), and had higher STS scores (P=0.04). Patients with SDD demonstrated lower peak aortic velocity, peak and mean transvalvular gradients, and cardiac index (all P≤0.04). The distribution of AS hemodynamic subtypes did not differ between groups. Conclusions: In patients with severe AS, SDDs were associated with lower transvalvular flow and gradient indices, supporting low-flow physiology as a potential mechanism underlying SDD development.
Ratio variables, such as body mass index (BMI) and left ventricular ejection fraction (LVEF), are deeply ingrained in cardiovascular research and practice, yet the use of ratios in regression models can confuse associations and obscure underlying mechanisms. Drawing on examples from genome-wide association studies of adiposity traits and echocardiographic studies of cardiotoxicity, we illustrate how spurious correlation, mathematical coupling, and collider bias can arise when ratios are analyzed without attention to their component variables. Associations with ratio traits like BMI or LVEF are not unique to the ratio; instead, they intermix signals for the numerator and denominator. Regressing ratios on their components can generate tautological findings that are difficult to translate or interpret clinically. We propose a practical decision framework to guide analysis that begins with separate regressions of the numerator and denominator on the exposure, uses adjusted models when the exposure is independent of the denominator, and otherwise favors multivariate approaches, adopting a ratio outcome as a fallback. We encourage cardiovascular investigators to view ratios as one of several competing representations rather than default endpoints, and to choose modeling strategies that promote interpretability and clinical utility. In highlighting limitations of ratios for mechanistic and etiologic research, we do not challenge their use in evidence-based and guideline-supported clinical practice.
Background: Currently, newer strategies are being implemented regarding WATCHMAN placement in the community hospital, such as same-day discharge (SDD). The safety of this protocol needs to be further assessed. Objective: The study aimed to evaluate the outcomes of SDD versus non-SDD in patients with nonvalvular atrial fibrillation who underwent WATCHMAN placement by comparing baseline demographics and post-procedure outcomes. Methods: We retrospectively reviewed four hundred thirty patients who underwent the WATCHMAN procedure in a community hospital between July 2019 and September 2024. Outcomes studied included readmission and mortality rates within thirty days following WATCHMAN placement. Results: From the 430 patients that were reviewed, 284 patients had non-SDD and 146 had SDD. All-cause readmissions within 30 days of discharge were significantly lower in the SDD group compared to that of the non-SDD (15.8% vs 25.7%, p = 0.02). Additionally, there was a statistically significant difference between the percentage of SDD versus non-SDD patients with thirty-day readmissions due to infectious etiologies (1.37% vs 5.99%; p=0.03). Conclusion: The all-cause readmission rates of SDD vs non-SDD patients suggests that SDD is a safe and acceptable approach amongst patients undergoing LAAC in the community hospital setting with limited resources.
Background: Myocardial infarction (MI) leads to progressive left ventricular (LV) remodeling, significantly affecting patient outcomes and prognosis. Objective: This paper provides a critical overview of the current standard of care and emerging pharmacological and regenerative therapies for prevention of cardiac remodeling post-MI. Methods: We examined the effectiveness of conventional neurohormonal blockers, such as ACE inhibitors, ARBs, beta-blockers, and aldosterone antagonists, and their limitations, together with the evidence for new drug classes (ARNIs, SGLT2 inhibitors) and cell-based approaches. In particular, we focused on the progress in stem cell treatments, including mesenchymal stem cells (MSCs) and induced pluripotent stem cells (iPSCs), as well as the influence of bioengineering and biomaterials on the enhancement of drug delivery and retention. Results: The current standard treatments reliably interact with the neurohormonal system but have barriers such as the incomplete blockade effect and side effects that limit their dosages. New drugs like ARNIs and SGLT2 inhibitors demonstrate superior outcomes due to their multimodal pathway targeting and improved heart metabolic function. In the field of regenerative medicine, there is a shift from the previously inconsistent approach of whole-cell implantation towards the widely accepted mechanism of using the paracrine effect of MSCs along with the application of highly advanced bioengineering techniques (cardiac patches, hydrogels, synthetic stem cells) to improve cell survival and targeted drug delivery, thus overcoming the problems of immunogenicity and poor engraftment. Additionally, the use of TGF-β inhibitors as one of the anti-fibrotic agents shows potential for the precision modulation of the extracellular matrix through research into anti-inflammatory and specific anti-fibrotic agents. Conclusion: The future of attenuating adverse cardiac remodeling lies in a multimodal therapy paradigm. This therapeutic paradigm utilizes not only the optimized neurohormonal blockade together with the targeted anti-inflammatory, anti-fibrotic, and advanced engineered regenerative interventions, but also the complete and long-lasting preservation of LV structure and function after MI.
Background: In-stent restenosis (ISR) remains a significant concern in coronary artery disease management. This study aims to evaluate the efficacy of coronary computed tomography angiography (CCTA) in detecting ISR and to identify stent-related factors in a real-world patient population. Methods: This single-center study was conducted over a six-month period in 2024. Patients with a history of PCI who underwent CCTA due to suspected ISR were included, with subsequent invasive coronary angiography (ICA) performed for confirmation. One randomly experienced radiologist evaluated CCTA images for stent characteristics and ISR severity, while two interventional cardiologists assessed ICA results. The association between CCTA findings related to stents and ISR confirmation via ICA was analyzed, and the positive predictive value (PPV) for CCTA in identifying significant ISR was calculated. Results: A total of 22 patients were included in the study, with a mean age of 62.5 ± 7.3 years. A total of 34 stents were evaluated by CCTA, revealing that 7 stents (20.6%) exhibited ISR with <50% stenosis, while 27 stents (79.4%) had >50% stenosis. The presence of >50% stenosis was statistically significant (p=0.026) associated with ICA findings, with a PPV of 51.8%. Notable variations in PPV were observed based on stent location: proximal left anterior descending artery (LAD) placements had a PPV of 60%, while mid-LAD placements had a PPV of 57.1%. Stents longer than 30 mm demonstrated a higher likelihood of >50% ISR (p=0.011), with a PPV of 76.9%, compared to those measuring 10-20 mm (40%). Additionally, stent diameter was significantly associated with ISR on ICA findings (p=0.024), where larger diameters (>3.5 mm) exhibited an 85.7% PPV for >50% ISR. Conclusion: Coronary CT angiography serves as an important method for evaluating in-stent restenosis, though its predictive accuracy can differ based on several factors. As a result, is essential to take into account the stent's location within the coronary vessels, as well as its length and diameter. This consideration may assist healthcare professionals in making informed clinical decisions and developing follow-up plans for managing coronary artery disease.
Guidelines-driven diagnostic investigations for suspicion of functionally relevant coronary artery disease (fCAD) are complex and expensive. Therefore, we evaluated whether a previously validated proteomic residual cardiovascular risk (RCVR) model could complement existing fCAD detection strategies by accurately identifying patients at high risk for an event and safely ruling out fCAD in low-risk patients. Clinical assessments, single-photon emission computed tomography myocardial perfusion imaging, and RCVR proteomic predictions were available in 4106 BASEL VIII study participants previously evaluated for suspicion of fCAD. The ability of each measure to predict the occurrence of major adverse cardiovascular (CV) events were compared separately in participants without (primary) and with (secondary) a history of CV disease. Primary participants with a negative fCAD diagnosis had an unstratified 4-year CV event rate of 9.4%, comparable to the overall event rate of 10.7%, however, the event rate dropped to only 2.3% (p<0.001) when using the RCVR model to identify “low” risk individuals. Similarly, in secondary participants the event rate in “low” risk individuals was only 9.9% (p<0.001) compared to 20.5% in fCAD negative participants and a 26.4% overall event rate. These results suggest RCVR could be used to rule out low risk individuals and potentially eliminate unnecessary testing in 42.2% of primary and 27.6% of secondary participants. RCVR was also able to identify individuals with a negative fCAD diagnosis that were still at high risk of a CV event. Within primary and secondary participants respectively, 7.1% and 14.6% of participants were identified as “high” risk with an observed event rate of 39.9% and 52.0%. Together these results suggest prognostic protein testing in combination with cardiac imaging or clinical diagnostic assessments may provide a more comprehensive assessment of patient risk and aid in medical management and monitoring.
Ticagrelor is an oral, third-generation reversible P2Y12 receptor antagonist used in the treatment of patients with atherosclerotic cardiovascular disease. Dyspnea is a well-recognized side effect of ticagrelor, typically occurring within hours to days after initiation. In most cases, the dyspnea is mild and resolves spontaneously without intervention. However, dyspnea can be significant and intolerable in some patients necessitating discontinuation of ticagrelor. Less commonly recognized is the association of ticagrelor with central sleep apnea. Here, we present a case of a patient who developed dyspnea shortly after starting ticagrelor but also exhibited evidence of central sleep apnea, both of which markedly improved upon discontinuation of the drug. The exact pathophysiologic mechanism underlying ticagrelor-associated dyspnea and central sleep apnea remains unclear. However, one hypothesis suggests that stimulation of pulmonary vagal C-fibers leads to increased levels of extracellular adenosine, which may heighten chemosensitivity to hypercapnia and thus contribute to these respiratory effects.
Background: Infective endocarditis (IE) refers to inflammation of the endocardium, which is the inner layer of the heart. One of the most significant risk factors for developing IE is bioprosthetic valves within the heart. IE can lead to formation of vegetations on the surfaces of heart valves, making treatment difficult with antibiotics alone, often requiring surgery. Although IE can be treated with surgery or antibiotics, the presence of bioprosthetic valves can lead to recurrence of infection. Recurrence can cause several different complications including pseudoaneurysms of the mitral-aortic intervalvular fibrosa (MAIVF). Case presentation: A 73-year-old male with a history of bicuspid aortic valve requiring several aortic valve replacements for IE presented to a university hospital with altered mental status and hypotension to 79/50. The patient developed severe sepsis with blood cultures growing Streptococcus dysgalactiae. Given the patient’s extensive history of IE, transesophageal echocardiogram (TEE) was done to rule out recurrence of infection. TEE showed pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF). Cardiothoracic surgery was consulted for possible surgical intervention given this finding in the setting of recurrent prosthetic valve endocarditis (PVE) but ultimately decided that the patient was a poor surgical candidate given his extensive history of cardiac surgeries. The patient was stabilized with antibiotics and fluid resuscitation and was discharged with a course of antibiotics followed by lifelong prophylactic antibiotic therapy. Conclusion: This case highlights the life-threatening sequelae of PVE. Pseudoaneurysm of the MAIVF is a rare complication of PVE that occurs from PVE itself or surgery to the aortic or mitral valves. Providers should be aware of the importance of early detection of these findings with close follow up and imaging with modalities like TEE or cardiac computed tomography angiography (CTA) to see if surgical interventions can be pursued before further complications arise.
The COVID-19 pandemic strained healthcare delivery, but its lasting impact on acute and chronic cardiovascular and cerebrovascular mortality remains unclear. We compared in-hospital mortality for ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), ischemic stroke, and congestive heart failure (CHF) across pre-pandemic, pandemic, and post-pandemic eras. We performed a retrospective cohort study of 38,735 U.S. hospital admissions (Jan 1, 2019–May 31, 2024) classified as pre-pandemic (Jan 2019–Mar 2020), pandemic (Mar 2020– May 2023), or post-pandemic (May 2023–May 2024). Cases were identified using ICD-10 codes. Multivariable logistic regression—adjusted for age, sex, race, diabetes, hypertension, chronic kidney disease, end-stage renal disease, COPD, and acute COVID-19 infection— assessed mortality odds across eras for each condition. STEMI (n=6,798) and stroke (n=18,142) mortality did not differ significantly across eras. NSTEMI (n=11,684) and CHF (n=8,775) mortality peaked during the pandemic (NSTEMI OR 1.47; CHF OR 1.53 vs post-pandemic; p<0.05) and declined markedly afterward. Chronic kidney disease (OR 1.41–1.75), end-stage renal disease (OR 2.28–3.40), and acute COVID-19 infection (OR 2.18–2.71) were independent predictors of higher mortality. STEMI and stroke mortality remained stable across all three eras—likely due to established “code STEMI” and “code stroke” protocols. NSTEMI and CHF mortality peaked during the pandemic and improved post-pandemic, potentially reflecting better resourcing, enhanced care delivery, and widespread implementation of guideline-directed medical therapy. Sustained chronic disease management and emergency protocols are essential to optimize outcomes during and after healthcare crises.
Background: Heart failure (HF) stands out as a major reason for hospital admissions. Vitamin D deficiency is also associated with a higher risk of cardiovascular diseases. Due to recent conflicting findings, this study aimed to investigate clinical outcomes based on serum vitamin D levels in hospitalized patients with HF. Methods: In this cross-sectional study, 258 hospitalized patients with acute decompensated heart failure (ADHF) were investigated during 2022–2023. Demographic, clinical and laboratory parameters of patients were recorded. They were divided into two groups based on 25-hydroxyvitamin D ([25-OH] D) levels: sufficient ≥30 ng/ml and insufficient <30 ng/ml. Finally, the studied variables were compared between the groups. All data analysis was performed by SPSS version 16.0. Results: In this study, the mean age of the patients in sufficient and insufficient vitamin D groups was 66.91±14.38 and 63.88±13.74 years, respectively. There was no significant difference in terms of age, underlying diseases, smoking status among the groups (P>0.05). The ejection fraction (EF) was lower in patients with insufficient vitamin D (20.66±10.91% vs. 23.98±11.82%). Moreover, vitamin D deficiency was associated with history of hospitalization (P<0.05). The incidence of edema and arrhythmia was higher in patients with insufficient vitamin D (P<0.05) and it was not related to mortality rate during hospitalization in the studied population (P>0.05). Conclusions: Our findings indicate that vitamin D deficiency in patients with ADHF is associated with lower EF, recurrent hospitalizations, edema, and arrhythmia. Consequently, regular monitoring and appropriate treatment of vitamin D levels in these individuals may help mitigate its associated complications to some extent, as much as possible.
Background: Atrial fibrillation (AF) is a major risk factor for ischemic stroke, with the left atrial appendage (LAA) being the predominant source of thrombi. Surgical LAA occlusion (LAAO) with devices like the AtriClip offers a mechanical alternative to long-term oral anticoagulation (OAC), particularly for patients at high bleeding risk or with OAC contraindications. Purpose: Despite the increasing use of surgical LAAO, optimal post-procedural management—specifically regarding the necessity and duration of anticoagulation and the role of surveillance imaging—remains a subject of debate and practice variability. This comprehensive review examines current anticoagulation strategies, risk stratification tools (CHA2DS2-VASc, HAS-BLED), the efficacy and challenges associated with AtriClip LAAO, and the critical role of postoperative imaging modalities (transesophageal echocardiography [TEE] and cardiac computed tomography angiography [CTA]). Findings: Current guidelines offer divergent recommendations on anticoagulation following surgical LAAO. While LAAO significantly reduces thromboembolic risk, a residual risk persists due to potential incomplete LAA exclusion, thrombus formation on remnant stumps, or non-LAA embolic sources. The CHA2DS2-VASc score remains crucial for risk assessment guiding anticoagulation decisions. Postoperative imaging is vital for confirming complete LAA occlusion, detecting device-related thrombus or residual leaks, and guiding individualized antithrombotic therapy. However, robust long-term data on thromboembolic events post-AtriClip and direct comparisons with contemporary DOAC therapy are limited. Conclusion: Management following surgical LAAO with AtriClip requires a personalized approach, integrating baseline thromboembolic and bleeding risks with imaging-confirmed procedural success. Routine postoperative imaging is essential. Further research, including randomized controlled trials, is needed to standardize post-LAAO anticoagulation protocols, define optimal imaging surveillance strategies, and clarify the management of incomplete LAA occlusion to improve long-term outcomes in AF patients.
Background: Contrast-induced acute kidney injury (CI-AKI) is a potential complication following percutaneous coronary intervention (PCI), particularly in patients with pre-existing kidney conditions. Previous research has identified hyperuricemia as a predictor for CI-AKI. Allopurinol, a medication commonly used to manage hyperuricemia, also possesses anti-inflammatory properties. This study aims to assess the impact of adding allopurinol to hydration therapy on CI-AKI incidence in patients undergoing PCI. Results: We enrolled 107 patients undergoing PCI with moderate to high Mehran risk scores; Participants were randomly assigned to either an allopurinol group (n=52) or a control group (n=55). The allopurinol group received 300 mg of allopurinol 24 hours before and one hour before PCI, along with intravenous normal saline at 1 ml/kg/hour. The control group received conventional hydration only. Serum creatinine and urea levels were measured before and 48 hours after the procedure. An increase in serum creatinine by ≥25% or ≥0.5 mg/dL 48 hours after PCI was used to detect contrast-induced acute kidney injury (CI-AKI). The mean age of the patients was 59.8±8.9 years, with 63% being male. The baseline Mehran risk score was 9.5±3.0. Baseline characteristics, including age, gender, risk factors, kidney function, and uric acid levels, were similar between the two groups. CI-AKI occurred in 5 patients (9.6%) in the allopurinol group and 15 patients (27.3%) in the control group (P=0.017). No significant difference was found in serum uric acid levels between patients with and without CI-AKI (7.2±2.8 mg/dL vs. 6.8±2.0 mg/dL, p-value: 0.49). Conclusion: Our results suggest that allopurinol may reduce CI-AKI incidence beyond its hypouricemic effect following elective PCI in patients with moderate to high Mehran risk score. However, further large-scale, multi-center studies are needed to confirm these findings.
Background: CT coronary angiography (CTCA) and invasive coronary angiography (ICA) are widely used to evaluate coronary artery disease (CAD). Both involve iodinated contrast, which may cause contrast-induced acute kidney injury (CI-AKI), particularly in high-risk patients. This study compared the incidence of AKI following CTCA versus ICA in hospitalized patients with symptomatic CAD. Methods: We conducted a retrospective cohort study using the TriNetX electronic health record network (2010–2025). Patients were identified using ICD-10 and CPT codes. Inclusion criteria were hospitalized adults with CAD and angina who underwent CTCA or diagnostic cardiac catheterization. Patients with myocardial infarction, prior revascularization, or end-stage renal disease were excluded. Patients were placed into mutually exclusive cohorts based on the procedure performed. The primary outcome was AKI within 1–4 days post-procedure. Propensity score matching (1:1) was used to balance baseline characteristics. Results: A total of 160,111 patients underwent CTCA and 88,081 underwent cardiac catheterization. After matching, 72,946 patients per group were analyzed. AKI occurred in 0.64% of CTCA patients vs. 1.29% of ICA patients. CTCA was associated with significantly lower odds of AKI (OR 0.496; 95% CI, 0.440–0.556) and an absolute risk reduction of 0.64% (p<0.001). Conclusion: Among hospitalized patients with angina and Coronary artery disease, CT Coronary Angiography was associated with a significantly lower risk of Acute kidney injury compared to diagnostic catheterization. While absolute rates were low, the difference may reflect reduced invasiveness and contrast exposure with CT Coronary Angiography. These findings suggest CT Coronary Angiography may be a safer initial diagnostic option in coronary artery disease patients at increased risk for renal complications.
Background: Acute myocardial infarction (AMI) with heart failure (HF), is the main cause of increased mortality. Early risk stratification by Killip classification is essential for its management. Today, non-invasive diagnostic methods such as lung ultrasound (LUS) are on the rise due to their ability to provide valuable insights without invasive methods. In this study we aimed to evaluate diagnostic value of LUS in comparison with Killip classes after angiography in AMI patients. Methods: In this cross-sectional study, 60 patients referred to Ghaem hospital in Mashhad, Iran during 2022-2023 with AMI were participated. LUS and echocardiography were performed for all patients before and after angiography and the results were compared with Killip classes. In order to perform LUS, the 8-zone method was used, and the number of B-lines in each zone was counted. All data were analyzed by SPSS software version 22. Results: Of all the patients, 56.7% were male and the mean age was 59.11 ± 14.82 years. There was statistically significant difference in terms of TIMI score, B-lines in LUS, ejection fraction, E/EM, E/A, Killip class before and after angiography (P<0.05). There was a moderate agreement between the results of Killip class and LUS before and after angiography (Cohen's kappa coefficient was 0.410 and 0.556, respectively). Conclusion: Based on our findings, Killip Class and LUS can predict the mortality of AMI patients in the future and the results of LUS had a moderate agreement with the Killip class.
