BACKGROUND: Inflammation is associated with atrial fibrillation (AF) recurrence after catheter ablation. This study aimed to create machine learning models of inflammatory biomarkers and clinical parameters to predict early recurrence of atrial fibrillation (ERAF) and late recurrence of atrial fibrillation (LRAF) after catheter ablation. METHODS: The study included 114 patients with abnormal body weight, defined as body mass index (BMI) > 25 kg/m², and paroxysmal, persistent, or long-standing persistent AF. Blood samples were collected at baseline and 24 hours after ablation. Almost 120 clinical and laboratory parameters were selected to develop machine learning models of ERAF and LRAF. Shapley additive explanations (SHAP) were derived to explain the obtained predictions. The models were trained and tuned for hyperparameters by five-fold cross-validation and subsequently evaluated on independent test sets using stratified sampling. RESULTS: ERAF was observed in 20.3% of patients. LRAF was diagnosed in 26.3% of patients. The ERAF model with 5 variables — monocyte count, platelet-to-lymphocyte ratio (PLR), fibrinogen, and parameters measured before ablation, such as glomerular filtration rate (GFR) and left atrial volume — performed well in the studied cohort (mean AUC, 0.70 ± 0.06). The LRAF model with parameters such as neutrophil-to-lymphocyte ratio (NLR), soluble vascular cell adhesion molecule-1 (sVCAM-1), troponin, monocyte-to-HDL-C ratio (MHR), adiponectin, and ERAF also showed valuable performance (mean AUC, 0.77 ± 0.11). CONCLUSIONS: The machine learning model based on inflammatory biomarkers is a valuable tool for predicting ERAF. The combination of ERAF and inflammatory biomarkers significantly improves LRAF prediction.
BACKGROUND: Chronic total occlusion (CTO) is a common finding on coronary angiograms of patients diagnosed with coronary artery disease, with an incidence ranging from 15 to 25%. Despite its high incidence, this type of coronary lesion is rarely treated with percutaneous coronary intervention. The key to success appears to be appropriate qualification for revascularization. Asymptomatic patients should be assessed for inducible ischemia within the occluded vessel territory to detect patients with a high ischemic burden, defined as inducible ischemia involving > 10% of the myocardium. Single-photon emission computed tomography (SPECT) is a well-established method of myocardial perfusion assessment; however, it is not widely available, especially in less developed regions. The aim of the study was to evaluate CTO patients to identify clinical parameters that could predict the presence of relevant inducible ischemia measured by SPECT. METHODS: The study included 50 patients with a single-vessel CTO and without any other significant coronary artery stenosis. Patients underwent clinical examination, laboratory tests, echocardiography, 6-minute walk test, cardiopulmonary exercise testing, exercise impedance cardiography, and SPECT. RESULTS: The only parameters associated with a high ischemic burden were CTO location (in the left anterior descending artery and circumflex artery) and one echocardiographic parameter: myocardial lateral wall longitudinal strain. CONCLUSIONS: Given the high incidence of CTO, there is an increasing need to define non-invasive markers that could predict the presence of a high ischemic burden and good clinical outcome after revascularization. Echocardiographic longitudinal strains are worth further research in terms of their utility in predicting inducible ischemia.
BACKGROUND:The EkoSonic Endovascular System (EKOS™) is an ultrasound-assisted catheter-directed thrombolysis (UACDT) device, which is becoming more popular for treatment of pulmonary embolism (PE) in patients with intermediate-high and high risk. Ultrasound waves help clot fragmentation and dissolution, therefore requiring less thrombolytic agent. With lower doses of thrombolysis, the bleeding risk is reduced but not eliminated. We aimed to evaluate the safety of this therapy in intermediate-high-risk central PE with intermediate and high bleeding risk. METHODS:We retrospectively analyzed the database of a rural hospital between March 2021 and July 2024 for UACDT with EKOS™ in patients with intermediate-high-risk central PE and Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) score ≥ 1. We evaluated procedure-related complications, bleeding events within the first 7 days, the need for further intervention, and all-cause in-hospital mortality. RESULTS:Thirty patients underwent UACDT with EKOS™. Their mean age was 68 ± 15.6 years (30% ≥ 80 years). Deep vein thrombosis was present in 16 patients (53.3%). Access was via the brachial vein (23.3%) or the common femoral vein (76.7%). One patient had major bleeding from the access site. There were no other procedure-related major complications. Two patients had minor bleeding events. All bleeding events were managed conservatively without the need for blood transfusion. One patient (3.3%) died in-hospital due to multiple organ failure, and 86% of the patients (26/30) had no complications. CONCLUSIONS:Our analysis suggests that UACDT with EKOS™ is safe for the management of intermediate-high-risk central PE in patients with intermediate and high bleeding risk even in a rural hospital setting.
BACKGROUND: Paroxysmal atrial fibrillation (PAF) increases the risk of ischemic stroke. The CHA₂DS₂-VASc score is commonly used for stroke risk assessment but has some limitations in low-risk individuals. The MAPH score has been suggested as a simple predictor of thrombotic events in patients with myocardial infarction, although its effectiveness in patients with PAF remains uncertain. This study aimed to compare the predictive performance of the MAPH score and the CHA₂DS₂-VASc-M score for ischemic stroke in patients with PAF. METHODS: This retrospective study included 474 patients (253 with ischemic stroke and 221 without stroke) between January 2023 and July 2025. The MAPH score was calculated using mean platelet volume (MPV), age, total protein, and hematocrit (HCT). Age was excluded from the MAPH score when creating CHA₂DS₂-VASc-M to avoid redundancy. Receiver operating characteristic (ROC) analysis and logistic regression were used to evaluate predictive performance. RESULTS: MPV, total protein, HCT, and MAPH scores were significantly higher in patients with stroke (p < 0.001 for all). ROC analysis showed that the MAPH score had an area under the curve (AUC) of 0.706, CHA₂DS₂-VASc 0.595, and CHA₂DS₂-VASc-M 0.667. In low-risk patients (CHA₂DS₂-VASc ≤1), MAPH (AUC 0.719) and CHA₂DS₂-VASc-M (AUC 0.711) performed better than CHA₂DS₂-VASc alone (AUC 0.510). Multivariate logistic regression identified MAPH, CHA₂DS₂-VASc-M, MPV, total protein, and HCT as independent predictors of ischemic stroke. CONCLUSIONS: The MAPH score, whether used independently or alongside CHA₂DS₂-VASc, enhances the prediction of ischemic stroke among patients with PAF, especially in low-risk groups. Including MAPH in standard risk evaluations could improve decisions regarding anticoagulant therapy.
BACKGROUND: The Fontan procedure revolutionized the management of univentricular heart physiology but is associated with long-term complications. Although pulmonary vascular disease, atrioventricular valve regurgitation, and ventricular dysfunction are well-recognized risks, aortic dilation and aortic regurgitation (AR) are emerging concerns. This study aimed to assess the prevalence and risk factors for aortic dilation and AR in adult post-Fontan patients. METHODS: We retrospectively analyzed 101 single-ventricle patients who underwent Fontan palliation and were hospitalized at NIKARD between 2013 and 2022. Echocardiographic data were reviewed for aortic dimensions and AR severity using Doppler techniques and quantitative parameters. Statistical analyses included parametric and nonparametric tests (p < 0.05). RESULTS: Of 101 patients (52 male), 13.8% had moderate/severe AR. Aortic root dilation (≥ 45 mm) was observed in 12 patients; 17 had an ascending aortic diameter > 36 mm. The mean aortic root and ascending aortic diameters were 36.9 mm and 32.4 mm, respectively. Older age at Fontan palliation was an independent risk factor for AR and aortic dilation. Patients with a lateral tunnel Fontan had a threefold higher risk of AR (OR 3.19, p = 0.020), while prior Blalock-Taussig shunt and diagnoses such as double-inlet left ventricle (DILV), double-outlet right ventricle (DORV), or hypoplastic right heart syndrome (HRHS) also increased risk. Single-ventricle morphology showed no significant association. CONCLUSION: Aortic dilation and AR are notable late complications after Fontan palliation. Regular long-term imaging follow-up is recommended to monitor aortic pathology.
BACKGROUND:Cardiogenic shock (CS) often complicates out-of-hospital cardiac arrest (OHCA), contributing to high mortality despite therapeutic advances. METHODS:This study retrospectively analysed patients admitted to a tertiary centre between 2021-2024. The cohort of patients with CS was divided into two groups: OHCA with return of spontaneous circulation and non-OHCA. RESULTS:The study included 280 patients with a median age of 69 (60-76) years, of whom 197 (70%) males. There were 46 (16%) patients in the OHCA group and 234 (84%) in non-OHCA. Acute coronary syndrome (ACS) was a more frequent cause of CS in the OHCA group: 36 (78%) vs. 113 (48%), p < 0.01. The OHCA patients were less likely to have hypertension (41% vs. 63%, p < 0.01), chronic heart failure (CHF) (41% vs. 62%, p < 0.01), and a history of percutaneous coronary intervention (11% vs. 29%, p < 0.01). The OHCA patients exhibited lower C-reactive protein) levels and higher levels of white blood cells. Despite distinct profiles, there was no significant difference in mortality between the study groups. CONCLUSIONS:Patients with OHCA and non-OHCA CS exhibited distinct clinical profiles, with ACS as the leading cause of OHCA and chronic conditions were more often diagnosed in non-OHCA cases. Similar mortality rates suggest improved OHCA management, emphasizing the need for extensive data collection to assess shock risk.
BACKGROUND: Aortic stenosis (AS) increases left ventricular (LV) afterload and systolic pressure (LVSP). Left ventricular myocardial work (LVMW) enables early detection of LV dysfunction. Recent evidence suggests that ID may reduce LVMW parameters, raising the question of whether ID further impairs LV systolic performance in patients with AS undergoing transcatheter aortic valve implantation (TAVI). METHODS: We evaluated 100 patients with severe AS scheduled for TAVI between March 2021 and November 2022. All underwent ID screening according to the classic and novel ID definitions and echocardiographic assessment of LVMW before TAVI and at the 1-year follow-up. RESULTS: Elimination of AS was observed within the 1-year follow-up in the whole population. Despite stable ejection fraction (EF) and global longitudinal strain (GLS), LVMW indices such as global work index (GWI) and global constructive work (GCW) significantly decreased from baseline in the entire population. However, when comparing ID and non-ID patients after the procedure, a statistically significant decrease in GWI and GCW was noted at the 1-year follow-up only in the TSAT > 20% group, not in the TSAT < 20% group. We also noted a significant correlation between TSAT status and echocardiographic as well as LVMW indices. When the classic ID definition was used, all LVMW parameters changed similarly in both groups during follow-up. CONCLUSIONS: TAVI significantly influenced the majority of LVMW indices in the overall study population. Using the standard ID definition, ID had no impact on differences in LVMW indices. However, when defined by TSAT < 20%, patients with ID showed no significant post-TAVI changes in LVMW indices.
BACKGROUND: Intravascular lithotripsy (IVL) utilizes high-energy sonic waves to create controlled fractures in calcified plaques, facilitating vessel preparation and improving stent apposition. METHODS: The study was designed to evaluate the safety and efficacy of IVL in a patient population that included individuals with acute myocardial infarction (MI). A total of 201 consecutive patients who underwent percutaneous coronary intervention (PCI) using IVL [Shockwave C2 or C2+ (Shockwave Medical Inc, Santa Clara, CA, US)] from April 2020 onward were included in this single-center registry. The study population comprised 76 patients with acute MI (Group 1) and 125 patients with non-MI (Group 2). RESULTS: Left ventricular ejection fraction was lower (46.0% ± 13.1% vs. 50.9% ± 10.5%; p = 0.022), while SYNTAX Score was significantly higher (20.0 ± 11.3 vs. 16.5 ± 10.2; p = 0.059) in Group 1 than in Group 2 (46.0% ± 13.1% vs. 50.9% ± 10.5%; p = 0.022). The overall IVL success rate and procedure success rate were very high (97.5% and 99.5%, respectively). A mean increase in lumen area was observed in Group 1 and Group 2: 5.9 ± 3.7 mm2 vs. 4.5 ± 2.2 mm2 and 237% vs. 239%, respectively. In the long-term follow-up there was no difference in all-cause mortality between Group 1 and Group 2 (9.0% vs. 8.1%; p = 0.997), cardiac death (p = 0.340), repeat MI (p = 0.986) and major adverse cardiovascular events [MACE; cardiac death, myocardial infarction, stroke] (16.8% vs. 9.8%; p = 0.501). Prior chronic kidney disease (CKD), post rota-atherectomy debulking, prior coronary artery bypass graft (CABG) and longer lesions were independent predictors of long-term all-cause mortality. CONCLUSIONS: Intravascular lithotripsy is an effective treatment for the modification of calcified atherosclerotic lesions, with a high success rate and few periprocedural complications. The long-term outcomes achieved in this complex population are satisfactory.
BACKGROUND:In patients with embolic stroke of undetermined source (ESUS), detecting new-onset atrial fibrillation (AF) is crucial because it leads to treatment change and reduces stroke recurrence and mortality. However, the high cost and relatively low AF detection rate of implantable cardiac monitors (ICM) necessitate the identification of predictive factors to better select candidates. This study aimed to identify AF predictors in ESUS patients with left atrial enlargement (LAE) to improve ICM selection. METHODS:We conducted a retrospective observational study with consecutive patients with ESUS and LAE admitted to a tertiary hospital. Echocardiographic, electrocardiographic, and 24-hour Holter electrocardiogram (ECG) findings were collected and analyzed using multivariate logistic regression and cross-validation techniques. Independent predictors were incorporated into a risk model classifying patients into low-, moderate-, and high-risk categories for new-onset AF. RESULTS:A total of 100 patients were included. After an 18-month follow-up period, new-onset AF was detected in 19 patients (20%). Independent predictors included severe LAE (odds ratio [OR] 4.80, 95% confidence interval [CI] 1.32-17.37; p = 0.017), interatrial block (OR 6.22, 95% CI 1.27-30.47; p = 0.024), and atrial tachycardia ≥ 20 beats on 24-hour Holter-ECG (OR 7.62, 95% CI 1.21-47.74; p = 0.03). A predictive risk score (area under the curve [AUC] 0.733; p < 0.001) was developed, classifying patients into low (9.67% risk), moderate (36.6%), and high (100%) risk categories. CONCLUSIONS:Interatrial block (IAB), atrial tachycardia (AT) ≥ 20 beats, and severe LAE are strong new-onset AF predictors in ESUS patients with LAE. A new scoring system effectively stratifies AF risk, optimizing ICM selection.
BACKGROUND: Timely identification of hypertrophic cardiomyopathy (HCM) patients who may require a heart transplant (HT) in the future is crucial. Our study aimed to identify predictive factors associated with the need for HT in HCM patients. METHODS: All patients undergoing HT due to HCM in a tertiary HT hospital from 2003 to 2020 were included and compared — matched 1:4 for similar follow-up time since diagnosis — to a control HCM cohort. Patients’ clinical and imaging characteristics at HCM diagnosis and longitudinal data were assessed. RESULTS: 85 patients, 17 who required a HT and 68 HCM control patients from the HCM clinic, were included. At HCM diagnosis, patients who would later require HT had higher NT-proBNP levels (880.5 vs. 86.2 pg/mL), larger left atrium (LA) dimensions (49 vs. 40 mm), and slightly reduced left ventricle (LV) ejection fraction (50 vs. 60%), and showed higher prevalence of atrial fibrillation (AF) (47 vs. 22%). During a median follow-up of 11.6 years, patients subsequently requiring HT developed further worsening functional class and higher incidence of hospital admission for HF and incidence of sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator (ICD) ther-apy (log-rank p < 0.001 in both). This was accompanied by significant LA dilatation (8 vs. 1 mm, p = 0.037) and worsening LV diastolic function. CONCLUSIONS: Left atrium dilatation, AF, elevated NT-proBNP levels, and lower LV ejection fraction at HCM diagnosis should alert about the potential future need for HT. Progressive LA enlargement and worsening diastolic function during follow-up are warning signs that should prompt referral to a HT center.
