Background Sex-related differences are well recognized in heart failure with preserved ejection fraction (HFpEF), but real-world data describing clinical outcomes by sex among patients with obesity and HFpEF treated with tirzepatide remain limited. Objectives To compare observed hospitalization, cardiovascular, and gastrointestinal outcomes between male and female patients with obesity and HFpEF treated with tirzepatide. Design Retrospective, propensity score-matched, within-treatment cohort study. Methods A retrospective study was conducted using TriNetX database which included 110 healthcare organizations. Adults with obesity, HFpEF, and taking tirzepatide between June 1, 2022 and January 1, 2025 were identified. Males and females were balanced using 1:1 propensity score matching (n=1,654 per group). Primary outcome assessed included all-cause hospitalization. Secondary outcomes were all-cause mortality, HF exacerbation, major adverse cardiovascular events (MACE), incident atrial fibrillation, nausea/vomiting and diarrhea. Two prespecified falsification endpoints were used. Results During 1-year follow-up, males had a lower hazard of all-cause hospitalization compared with females (HR 0.87, 95% CI 0.77–0.98). No significant differences were observed for all-cause mortality (HR 1.73, 95% CI 0.95–3.18), HF exacerbation (HR 1.14, 95% CI 0.90–1.44), MACE (HR 1.28, 95% CI 0.99–1.65), or incident atrial fibrillation (HR 1.21, 95% CI 0.61–2.43). Males experienced lower rates of nausea and vomiting (HR 0.50, 95% CI 0.37–0.67), while diarrhea was similar (HR 0.84, 95% CI 0.59–1.19). Falsification endpoints showed no significant associations. Conclusion Among tirzepatide-treated patients with obesity and HFpEF, no statistically significant sex-associated differences were detected in major cardiovascular outcomes. Males had a modestly lower observed hazard of hospitalization and fewer coded nausea and vomiting events. Because this was a within-treatment observational comparison without an external comparator, these findings should not be interpreted as evidence of differential tirzepatide effectiveness by sex.
Background Despite the increasing adoption of minimally invasive approaches for valvular heart disease, the learning trajectory for complex thoracoscopic double valve replacement (DVR) remains largely uncharacterized. Objectives To evaluate the learning curve of two-incision thoracoscopic DVR, determine the case threshold for procedural proficiency, and identify independent predictors of major adverse surgical events (MASE). Design Retrospective cohort study. Methods We evaluated 252 consecutive thoracoscopic DVR procedures performed at a single high-volume center between March 2017 and December 2024. Cumulative sum (CUSUM) analysis of cardiopulmonary bypass (CPB) time was utilized to define distinct learning phases. MASE, a composite of mortality, conversion to sternotomy, and reoperation for bleeding, served as the primary clinical outcome. Multivariate logistic regression was performed to identify independent predictors of MASE. Results CUSUM analysis revealed three distinct learning phases: Acquisition (cases 1–67), Acceleration (cases 68–139), and Mastery (cases 140–252). Mean CPB time decreased progressively from 187.5±34.2 to 156.3±27.6 and 138.4±18.9 minutes across the three phases (p<0.001). Concurrently, MASE rates declined significantly from 16.4% in the Acquisition phase to 4.2% in the Acceleration phase, stabilizing at 4.4% during the Mastery phase (p=0.006). A small aortic annulus emerged as the strongest independent predictor of complications (OR 467.483, p<0.001), followed by operations performed during the Acquisition phase (OR 14.564, p=0.007). Conclusion Thoracoscopic DVR demonstrates a three-phase learning curve, with technical proficiency achieved after approximately 139 cases. Early procedural implementation requires risk-adapted case selection, specifically avoiding small aortic annuli during the initial experience. Because standard risk models may significantly underestimate mortality in this context, procedure-specific considerations and learning curve position are essential when evaluating candidates for this advanced minimally invasive approach.
Background: Endovascular aneurysm repair (EVAR) is used to treat patients with abdominal aortic aneurysm (AAA) who have suitable anatomy, while complex AAAs often require fenestrated and branched stent grafts, necessitating further refinement of the technique. Objective: To evaluate the safety and efficacy of fenestrated/branched EVAR (F/B-EVAR) assisted by three-dimensional (3D) printing for treating complex AAA. Design: Retrospective cohort study. Methods: This multicenter retrospective cohort study collected baseline data and clinical outcomes from patients treated with F/B-EVAR between January 2012 and June 2025. The population was divided into the 3D simulation group and the conventional measurement group. The 3D simulation group underwent a simulation to assess fenestration and branch positioning strategies. Study endpoints included procedural success rate, incidence of periprocedural complications and major adverse events, as well as procedural duration and radiation dose. Results: The mean age of patients was 70.2 ± 8.8 years, with 68.9% being male. Compared to the conventional measurement group, the 3D simulation group had a significantly higher procedural success rate (98.8% vs 91.6%, p < 0.001), shorter procedural duration ((115.2 ± 35.0) min vs (138.7 ± 43.7) min, p < 0.001), and lower radiation dose ((107.2 ± 43.9) mGy vs (144.5 ± 56.3) mGy, p < 0.001). Furthermore, although no significant differences were observed in the incidence of all-cause mortality and major cardiovascular adverse events during the 30-day follow-up between the two groups, the incidence of life-threatening major bleeding, major vascular complications, and acute kidney injury stage ⩾3 was significantly lower in the 3D simulation group. Conclusion: F/B-EVAR guided by 3D simulation may allow for accurate planning of fenestration and branch positioning, potentially improving procedural success rate and suggesting a potential to enhance the quality of outcomes.
Background: Coronary microvascular disease (CMVD) is an important contributor to ischemic heart disease. Symptomatic patients without obstructive coronary lesions may still have microvascular ischemia, which is associated with an increased risk of major adverse cardiovascular events. The diagnosis of CMVD relies on coronary function testing or noninvasive imaging techniques, which are not universally available and may limit routine clinical implementation. Objectives: Growing evidence supports the notion that biological processes such as inflammation and oxidative stress drive vascular aging and contribute to microvascular dysfunction. The systemic immune-inflammation index (SII) is a marker used to assess immune-inflammatory and thrombotic status and has shown prognostic value in chronic heart failure, and acute myocardial infarction. However, its role in CMVD remains underexplored. Design: To address this gap, we retrospectively analyzed 180 patients with angina who underwent myocardial contrast stress echocardiography between January and November 2022 at the First Affiliated Hospital of Harbin Medical University. Methods: Based on coronary microcirculatory function, patients were divided into two groups: 91 with normal function and 89 with microcirculatory disorders. Clinical data and lab indicators were compared. Results: SII was significantly higher in the CMVD group (722.96 ± 354.10 vs 618.51 ± 324.50; p < 0.05). Logistic regression identified SII, LDL cholesterol as independent CMVD predictors. Pearson correlation demonstrated an inverse relationship between SII and coronary flow reserve, supporting its link with impaired microvascular function. Receiver operating characteristic analysis further showed that the combined SII and LDL model provided improved discriminatory performance compared with either marker alone, achieving an area under the curve of 0.76 with a sensitivity of 77.5% and specificity of 69.2%. Conclusion: SII is independently associated with CMVD and improved discriminatory performance when combined with LDL.
Background: Drug-coated balloons (DCBs) represent a “leave-nothing-behind” strategy in percutaneous coronary intervention (PCI), particularly for small vessel disease and in-stent restenosis. However, long-term comparative real-world data between paclitaxel- and sirolimus-coated balloons remain limited, and the impact of lesion characteristics on outcomes is not fully understood. Objectives: This study aimed to evaluate the 2-year clinical outcomes of coronary DCB therapy and compare the performance of sirolimus- and paclitaxel-coated balloons in a real-world cohort. Design: Single-center retrospective cohort study. Methods: A total of 92 consecutive patients who underwent DCB-based PCI between January 2020 and December 2022 were retrospectively analyzed. Patients were grouped according to DCB type (sirolimus vs paclitaxel). The primary endpoints were restenosis, target lesion revascularization (TLR), and major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and TLR. Secondary outcomes included changes in angina frequency and severity, and selected laboratory parameters. Outcomes were assessed over 24-month follow-up period. Results: The overall 2-year restenosis rate was 13.0%, with TLR occurring in 7.6% of patients, and MACE in 9.8%. Significant improvements in angina frequency and severity were observed at 3 months (both p < 0.001). C-reactive protein (CRP) levels decreased during follow-up ( p = 0.01). Patients with diabetes had numerically higher rates of restenosis (15.0% vs 11.0%) and MACE (12.5% vs 9.6%) compared with nondiabetic patients, although differences were not statistically significant. Similarly, sirolimus-coated balloons were associated with lower rates of restenosis (11.7% vs 15.6%) and TLR (6.7% vs 9.4%) compared with paclitaxel-coated balloons, without statistical significance. Larger vessel diameter was associated with an increased risk of restenosis ( p = 0.004). Conclusion: In this real-world cohort, coronary DCB therapy was associated with acceptable 2-year clinical outcomes and significant symptom improvement. Although sirolimus-coated balloons showed numerically favorable results, no definitive conclusions regarding superiority can be drawn. Larger prospective studies are needed to confirm these findings and to better define optimal patient and lesion selection. Trial registration: Not applicable.
Background: Current guidelines lack instruction on fluid administration for patients with critically ill heart failure (HF) in the intensive care unit. Objectives: This study aims to compare the risk of mortality and acute kidney injury (AKI) outcomes among unlimited intake, restrictive intake, and negative balance. Design: Retrospective cohort study. Methods: A total of 3267 patients with HF not receiving renal replacement therapy were included from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and were grouped into restrictive fluid intake (the first 24-h fluid intake from 1500 to 2000 mL), negative fluid balance management (the first 24-h net output >1000 mL), and unlimited fluid control groups. The primary endpoint was 28-day mortality, and the secondary endpoints were morbidity of 48-h AKI, 7-day AKI, and AKI progression from 48 h to 7 days. The odds ratio (OR) and the 95% confidence interval (CI) were estimated by multivariable logistic regression, and mediation analyses were performed. Results: Negative fluid balance, not restrictive fluid intake, was correlated to a lower risk of 28-day mortality (OR: 0.750 (0.570–0.987), p = 0.040), 48-h AKI (OR: 0.207 (0.169–0.255), p < 0.001), and 7-day AKI (OR: 0.261 (0.207–0.330), p < 0.001) but was correlated to a higher risk of AKI progression (OR: 2.284 (1.835–2.843), p < 0.001) compared to unlimited fluid control after multivariable adjustment. The 24-h net output mediated AKI incidence and progression. Conclusion: Negative fluid balance was related to lower risk of 28-day mortality, 48-h AKI, and 7-day AKI but a higher risk of AKI progression, which requires further clinical trials for validation.
This case report describes a rare case of a giant right atrial aneurysm (RAA) in a 7-month-old male infant admitted to Children’s Hospital Affiliated to Zhengzhou University in July 2025. A RAA was detected during a physical examination at 2 months of age with no clinical symptoms present. Follow-up reexamination at 7 months of age revealed progressive enlargement of the RAA, and the infant thus underwent aneurysm resection plus atrial septal defect repair under cardiopulmonary bypass. Postoperative histopathological examination confirmed the diagnosis of RAA. On the second postoperative day, the infant developed neurological complications including lethargy, skew deviation, mild hemiplegia, and focal epilepsy. The hospital immediately implemented a multimodal intervention strategy involving mannitol for dehydration, glucocorticoids for anti-inflammation, antiepileptic medication, and strict fluid management. The infant achieved near-complete recovery of neurological function at discharge on the 21st postoperative day, with significant improvement in brain abnormalities on follow-up at 1 month postoperatively. This case highlights cytotoxic cerebral edema, a rare postoperative neurological complication following RAA resection in children, and emphasizes the importance of early identification and multimodal treatment for such complications, providing valuable clinical evidence for the perioperative management of pediatric cardiac surgery.
Transthyretin (TTR) amyloid cardiomyopathy occurs when stable TTR, normally a 4-protein tetramer, becomes misfolded and aggregates to form amyloid fibrils that accumulate in the heart. Progressive accumulation causes cardiomyopathy, leading to arrhythmia and heart failure. Acoramidis is a high-affinity TTR stabilizer (⩾90%) evaluated in the ATTRibute-CM clinical trial. In this podcast discussion, Dr Mathew Maurer and Dr Adam Castaño provide insights into their recent analysis of prognostic implications of acoramidis-mediated changes to serum TTR (sTTR) in 557 patients and the associated implications for all-cause mortality. For the patients included in this analysis, acoramidis fully mediated a sharp and significant early rise in sTTR levels (mean 9.1 mg/dL) by day 28, sustained through month 30. Incremental changes (+5 mg/dL) in sTTR were associated with a 31.6% lower odds of mortality through month 30. This evidence strongly supports a direct association between early, sustained sTTR increases with acoramidis treatment and survival.
BACKGROUND:Heart failure (HF) remains a major public health challenge in India, with a need for effective and well-tolerated therapeutic strategies. OBJECTIVE:The RESTORE-HF study evaluated the real-world effectiveness and safety of torsemide-spironolactone fixed-dose combination (FDC) in Indian patients with HF. DESIGN:Prospective, multicenter, observational study. METHODS:This study was conducted across 101 sites in India. Patients aged 18-75 years with HF with reduced ejection fraction and signs of congestion were enrolled and initiated on the torsemide-spironolactone FDC. Participants were followed over 3 weeks from baseline. The primary objective was the change in body weight. Secondary endpoints included changes in New York Heart Association (NYHA) functional class, edema, occurrence of adverse events (AEs), and physician and patient assessments of efficacy and tolerability. RESULTS:Of the 1841 patients screened, 1752 were enrolled, and 1520 completed the study. The mean (SD) age of participants was 58.61 (9.45) years, of whom 61.05% were male. The study showed a significant reduction in mean body weight was observed from 75.54 kg at baseline to 73.13 kg at week 3 (mean difference: 2.41 kg; p < 0.0001). Additionally, an improvement in NYHA functional class and edema was observed over 3 weeks from baseline. Overall, 22.11% patients achieved no-edema stage. Only three mild AEs related to loose stools were reported, and no serious AEs or deaths occurred. Over 98% of physicians and patients rated the therapy favorably. CONCLUSION:The RESTORE-HF study demonstrated that the torsemide-spironolactone FDC may be associated with a mean body weight reduction of 2.41 kg and may be generally well-tolerated in Indian heart failure patients. Furthermore, the FDC may be linked to significant symptomatic improvement over 3 weeks in real-world clinical practice.
Artificial intelligence (AI) and machine learning are rapidly transforming cardiac electrophysiology, offering new avenues for diagnosing, managing, and treating cardiac arrhythmias. These technologies leverage diverse data sources, including clinical records, imaging, and electrical waveforms, to support decision-making and optimize outcomes, particularly in procedures such as cardiac ablation. This scoping review explores the evolving role of AI in cardiology, emphasizing its applications in diagnostics, predictive analytics, and procedural innovations. It also examines the collaborative dynamics of interdisciplinary teams, highlighting how professionals, such as electrophysiologists, computer scientists, clinicians, nurses, perfusionists, and technologists, contribute to identifying and solving key challenges in the field. The integration of AI into cardiology is not only enhancing diagnostic precision and patient outcomes but also streamlining healthcare delivery. As technological capabilities expand, AI is poised to play an increasingly central role in preventive cardiology, enabling more accurate risk assessments, earlier interventions, and the promotion of healthier lifestyles. However, the successful implementation of AI requires thoughtful coordination across disciplines and a clear understanding of its limitations and ethical considerations. This review underscores the importance of fostering interdisciplinary collaboration and aligning AI innovations with clinical needs. It also identifies barriers to adoption and proposes strategies for integrating AI tools into routine practice. Ultimately, the findings aim to guide stakeholders, including researchers, clinicians, and policymakers, in advancing the development and application of AI systems in cardiology. By doing so, the healthcare community can move toward reducing the global burden of cardiovascular disease and improving population health. The insights presented here, after a review of 142 studies, offer a roadmap for future research and clinical integration, ensuring that AI continues to serve as a catalyst for innovation and excellence in cardiac care.
BACKGROUND:Despite continuous advances in management over the last two decades for pulmonary embolism (PE), treating intermediate- to high-risk PE remains challenging. There is a critical need to expand our understanding of the clinical spectrum beyond systolic blood pressure (SBP) to inform the intricate decision-making process for initiating advanced treatment in patients with intermediate- to high-risk PE. OBJECTIVES:We aimed to characterize the range of SBP values in patients with intermediate- to high-risk PE undergoing advanced therapy across different clinical settings. The secondary objective included the incidence of bleeding complications (intracranial, major, and minor). DESIGN:We conducted a systematic review in alignment with PRISMA guidelines. The review involves a comprehensive, structured search of multiple electronic databases. DATA SOURCES AND METHODS:We created two groups: Group 1, case reports and series, and Group 2, randomized control trials and cohorts with intermediate-risk PE who underwent advanced treatment. In addition, we performed an exploratory analysis in Group 1, created solely for descriptive purposes, to determine the frequency of the previously mentioned impending deterioration factors in the literature and further clarify their potential role in initiating advanced treatment. RESULTS:We identified 1871 intermediate-high risk PE patients who received advanced therapy, divided into two groups: Group 1 for case reports and series, and Group 2 for randomized controlled trials and cohorts. In total, 77.1% reported SBP; the weighted average was 125.8 and 129.2 mmHg for Groups 1 and 2, respectively. The most common initial clinical presentations were dyspnea, syncope, and chest pain. In the exploratory analysis, we found that borderline SBP (110-120 mmHg), right ventricular dysfunction, and heart rate (⩾120 bpm) were the most frequent impending clinical deterioration factors. CONCLUSION:This systematic review shows that the SBP range for advanced treatment (129.2 and 125.8 mmHg) aligns with previous clinical models. However, it is important to recognize that while these SBP ranges may suggest practice variation, causality or definitive clinical instability cannot be inferred from aggregate data without patient-level outcomes. Outside of randomized controlled trials, clinical decision-making regarding advanced treatment may not fully align with international recommendations in real-world scenarios. TRIAL REGISTRATION:Research Registry number: 2065.
Severe burn injuries result in a massive systemic inflammatory and hypermetabolic response, often disrupting multiple organ systems, including the cardiovascular system. Cardiac troponins are frequently elevated in burn patients, but the interpretation of these elevations is hardly straightforward. Sometimes, elevated troponin means type 1 myocardial infarction (MI) due to an acute coronary event, but it might also reflect type 2 MI due to an imbalance between body oxygen demand and supply, or even non-ischemic myocardial injury from things like overwhelming inflammation, sepsis, or direct thermal effects on the heart itself. This narrative review explores the prevalence, underlying pathophysiological mechanisms, diagnostic challenges, and prognostic implications of troponin elevation in burn patients. We discussed the limitations of applying conventional MI diagnostic criteria in this unique population. The role of electrocardiographic and echocardiographic assessment, as well as the potential utility of high-sensitivity troponin assays, is also discussed. Understanding of how burn pathophysiology relates to myocardial injury is essential for accurate diagnosis, improved management, and better outcomes in this highly vulnerable group of patients.
Pulmonary artery aneurysms (PAAs) are a rare pathology with potentially devastating consequences. In this case series, we describe two cases of clinically isolated pulmonary arteritis and concisely review the literature surrounding this new clinical entity. Two Caucasian women, aged 65 and 73, were referred to our cardiovascular surgery center with incidental PAAs, both growing to over 65 mm in main pulmonary artery diameter. Both participants underwent serial thoracic CT-angiograms to monitor the pulmonary artery aneurysms. Both pulmonary artery aneurysms showed an interval increase in diameter, so they were repaired surgically. The main pulmonary artery was excised in both cases and replaced with a synthetic graft. No pre- or postoperative corticosteroids were administered. Neither of our patients had systemic symptoms of giant cell arteritis or elevated inflammatory markers. In both cases, only the main pulmonary artery was replaced to minimize surgical complexity and risk; however, the left pulmonary artery of one patient began to further dilate 5 years postoperatively. Currently, no reintervention is planned. These cases represent mounting evidence for the existence of clinically isolated pulmonary arteritis leading to a pulmonary artery aneurysm. This entity is analogous to clinically isolated aortitis and may represent a subclinical smoldering vasculitis. These rare aneurysms can progress over time and require surgical intervention. In the absence of guidelines for pulmonary artery aneurysm intervention, the present cases will serve to guide further management of this rare disease.
BACKGROUND:Guideline-directed medical therapy (GDMT) prolongs survival in patients with heart failure with reduced ejection fraction (HFrEF). However, different countries implement GDMT differently, and many patients are still undertreated. Therefore, this study aimed to assess GDMT utilization in patients with chronic HFrEF at the adult cardiac clinics of three selected hospitals in Addis Ababa, Ethiopia. METHODS:An explanatory sequential mixed-methods (quantitative cross-sectional followed by qualitative phenomenological) study design was used to assess GDMT usage in patients with HFrEF at the study settings from September 25 to November 25, 2022. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. Adherence level was defined as good (adherence score = 1), moderate (0.5 < score <1), and poor (score ⩽0.5). Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Logistic regression model was used to determine the association. Statistical significance was declared at p < 0.05. Qualitative data were analyzed with MAXQDA 2020. RESULTS:Three hundred forty-one patients were included in the quantitative study. Adherence to GDMT was good in 128 (37.5%) of the patients. Patient parameters, including female gender (adjusted odds ratio (AOR) = 0.55, 95% CI: 0.32-0.93), unable to read and write (AOR = 0.31, 95% CI: 0.11-0.86), primary education (AOR = 0.27, 95% CI: 0.12-0.63), were negatively associated with Physicians' good adherence. Hypertension was associated with lower odds of physicians' good adherence (AOR = 0.41, 95% CI: 0.21-0.78). Absence of comorbidities (other than hypertension; AOR = 2.65, 95% CI: 1.36-5.15) were positive predictors. System, patient, and physician-related factors were reported as barriers to intensifying GDMT. CONCLUSION:Nearly one-fourth of eligible patients were on ⩽50% of guidelines-recommended drugs. Female gender, educational level, and comorbidities were the factors associated with adherence to GDMT. System, patient, and physician-related reasons for poor adherence were identified. Multipronged interventions are required to address those adherence barriers.
Background: Inflammation significantly impacts disease progression and prognosis in acute pulmonary embolism (APE); however, the optimal method to quantify this inflammation for prognostic purposes remains unclear. Objectives: We aimed to identify the most effective blood-based inflammatory marker for predicting short-term mortality in patients with APE. Methods: We retrospectively analyzed 301 patients with APE. We compared the predictive performance of nine inflammatory markers for 30-day mortality, focusing on the inflammatory burden index (IBI), and contrasted it with the standard clinical score (sPESI). Results: After adjusting for potential confounders, a higher IBI was strongly and independently associated with an increased risk of 30-day mortality. IBI demonstrated superior predictive ability compared with all other inflammatory markers and the sPESI score. The relationship between IBI and mortality risk was linear; higher IBI values corresponded to greater mortality risk. Conclusion: IBI is a robust and independent predictor of short-term survival in patients with APE. Calculated from routine blood tests (C-reactive protein, neutrophil, and lymphocyte counts), it offers a simple, rapid, and cost-effective tool that may enhance early risk stratification and guide personalized treatment decisions in clinical practice. Further validation in independent cohorts is required to confirm its prognostic utility.
Background: Rapid interpretation of electrocardiography (ECGs) is essential for reducing patient mortality and morbidity associated with heart conditions. Despite its significance, many healthcare providers struggle to achieve proficiency in ECG interpretation. Objective: This study assessed nurses’ knowledge, practices, and associated factors regarding ECG interpretation in the emergency and intensive care units of selected public hospitals in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted to evaluate nurses’ knowledge, practices, and factors related to ECG interpretation in selected public hospitals of emergency and intensive care units in Addis Ababa, Ethiopia. Data were collected using structured, self-administered questionnaires and analyzed using SPSS version 26. Binary logistic regression models were employed to identify associations between the dependent and independent variables. Results: Among 255 of the study participants, only 60 (23.5%) and 69 (27.1%) of them demonstrated good knowledge and practice in ECG strip interpretation, respectively. The most frequently recognized ECG strip was asystole. Factors associated with good knowledge and practice encompassed holding a master’s degree, receiving ECG training, and working in intensive care units. Conclusion: This study identified the lack of knowledge and practice among nurses in ECG interpretation. The findings highlight the need for training programs and experience-sharing initiatives to enhance nurses’ proficiency in ECG interpretation which might ultimately improve patient outcomes.
BACKGROUND:Hereditary transthyretin amyloidosis (hATTR) is caused by mutations in the transthyretin (TTR) gene, which lead to the aggregation of misfolded TTR protein and amyloid accumulation in the peripheral nerves, heart, and gastrointestinal tract. Recently, RNA therapeutics, including small interfering RNAs (siRNAs) and antisense oligonucleotides (ASOs), have been approved for treating patients with hATTR. OBJECTIVES:To assess the neurological efficacy and safety of RNA therapeutics in hATTR patients. DESIGN:Systematic review and meta-analysis. DATA SOURCES AND METHODS:A systematic literature search was conducted on PubMed, Cochrane, and ClinicalTrials.gov from inception to August 14, 2024. Outcomes included changes from baseline in the Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) score and the modified Neuropathy Impairment Score +7 (mNIS + 7), modified body mass index (mBMI), adverse effects, serious adverse events, and all-cause mortality. RESULTS:Our study included four RCTs with 842 patients (568 in the RNA therapeutics group and 274 in the placebo group). RNA therapeutics significantly improved Norfolk QoL-DN (mean difference (MD), -18.79; 95% CI, -22.32 to -15.25; p < 0.00001; I2 = 28%) and mNIS + 7 scores (MD, -26.90; 95% CI, -31.67 to -22.13; p < 0.00001; I2 = 61%), with significant preservation of mBMI (MD, 114.98; 95% CI, 90.64-139.32; p < 0.00001; I2 = 59%) compared to placebo. There were no significant differences between the two groups regarding the risk of adverse effects (risk ratio (RR), 0.89; 95% CI, 0.69-1.15; p = 0.36; I2 = 34%), serious adverse effects (RR, 0.70; 95% CI, 0.31-1.58; p = 0.39; I2 = 20%), and all-cause mortality (RR, 0.70; 95% CI, 0.31 to 1.58; p = 0.39; I2 = 20%). CONCLUSION:RNA therapeutics are effective and well-tolerated in patients with hATTR, significantly improving quality of life and the progression of neurological impairment. siRNAs demonstrate better outcomes compared to ASOs. TRIAL REGISTRATION:PROSPERO (CRD42024568346).
BACKGROUND:Different accessible and low-cost biomarkers have been investigated to stratify patients with acute heart failure (AHF). One of them is the red cell distribution width (RDW), which proved to be a greater prognostic marker of mortality than other conventional markers. OBJECTIVE:Therefore, the objective of our study is to determine whether the anemic status modifies the magnitude of association between high RDW and 1-year mortality in patients with AHF. DESIGN:Observational, analytical, retrospective cohort study. METHODS:We included participants ⩾18 years old hospitalized with a diagnosis of AHF. As an association measure, a crude and adjusted generalized linear model of the Poisson family calculated the risk ratio (RR) with a 95% confidence interval (95% CI). RESULTS:In all, 709 participants with an average age of 73.48 years were included. At 1 year, the risk of dying was three times higher with high RDW (RR = 3.05, 95% CI: 1.39-6.66; p < 0.01). In anemic participants, the risk of dying at 1 year is two times greater with high RDW (RR = 2.18, 95% CI: 0.91-5.22; p = 0.07), while in non-anemic participants, the risk of dying increased almost seven times (RR = 6.95, 95% CI: 1.65-29.23; p < 0.01). CONCLUSION:High RDW is a risk factor for mortality at 1 year in patients with AHF. A greater magnitude of association was found in non-anemic patients.
Carotid blowout syndrome (CBS) is a potentially fatal condition requiring prompt diagnosis and intervention. CBS primarily affects patients with a history of surgery or irradiation for head and neck malignancies. In this report, we describe a case of CBS in which the carotid artery ruptured 2 months after carotid artery stenting in a patient with a previous history of surgery and irradiation for pharyngeal cancer. Although the distance between the orifice of the common carotid artery and the ruptured site was short, the “no-touch” technique —using the Newton-shaped stiff inner catheter (Newton-T ® , Medikit) during the guiding catheter navigation—and snare fixation enabled a stable procedure. Two self-expanding covered stents (GORE ® VIABAHN ® , Gore) covered the ruptured site. Despite adverse conditions, the combination of these techniques led to effective management of impending CBS, a potentially fatal disease. This case report highlights the feasibility of covered stents for CBS and the techniques used for guiding catheter navigation and stabilization throughout the procedure.
