Background:Sleeve gastrectomy (SG) improves obesity-related metabolic abnormalities, including dyslipidemia. However, postoperative changes in individual lipoprotein fractions and lipoprotein-associated antioxidants remain incompletely understood. This exploratory study aimed to characterize changes in serum lipoprotein fraction profiles after SG in Japanese patients with severe obesity using anion-exchange high-performance liquid chromatography (AEX-HPLC). Methods:Patients who underwent SG at Ohama Daiichi Hospital between July and December 2020 were enrolled. Clinical data and serum samples were obtained before and after surgery. Serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs) were measured by enzymatic assays, and small dense LDL-C (sdLDL-C) was estimated using Sampson's equation. Lipoprotein fractions were evaluated by AEX-HPLC. α-tocopherol concentrations in HDL, LDL, and very low-density lipoprotein (VLDL) fractions were measured by reverse-phase high-performance liquid chromatography. Overall changes over time were assessed using the Friedman test, followed by post hoc Wilcoxon signed-rank tests with Benjamini-Hochberg false discovery rate adjustment. Results:Of 20 patients who underwent SG, 12 were analyzed after excluding eight with inadequate stored serum quality. Mean age and body mass index were 45.3 ± 10.5 years and 43.4 ± 5.9 kg/m2, respectively. SG significantly reduced body weight, hemoglobin A1c, and enzymatically measured TG, while HDL-C increased significantly. No significant changes were observed in LDL-C or non-HDL-C. Estimated sdLDL-C levels and the sdLDL-C/LDL-C ratio decreased significantly after SG. AEX-HPLC revealed significant increases in HDL and LDL fractions and a significant decrease in the VLDL fraction. α-Tocopherol content in HDL and LDL fractions increased significantly after SG, whereas no significant changes were observed in α-tocopherol-LDL/LDL or α-tocopherol-HDL/HDL. In contrast, α-tocopherol-VLDL/VLDL increased significantly after SG. Conclusions:SG was associated with improvements in body weight and conventional lipid parameters, including reduced TG and increased HDL-C, together with a reduction in estimated sdLDL-C, in Japanese patients with severe obesity. AEX-HPLC revealed complex postoperative changes in lipoprotein fractions, including reduced VLDL and increased HDL and LDL fractions. Lipoprotein-associated α-tocopherol distribution also changed after SG; however, the clinical significance of these changes requires further investigation.
Cardiovascular autonomic dysfunction is an underrecognized manifestation of cancer therapy-related cardiotoxicity with important clinical implications. Disruption of autonomic regulation during chemotherapy most commonly manifests as orthostatic hypotension, inappropriate sinus tachycardia, and reduced heart rate variability, often occurring in the absence of overt structural heart disease. These abnormalities may contribute to symptom burden, impaired functional capacity, and increased cardiovascular risk in patients undergoing cancer treatment. Emerging data indicate that autonomic dysfunction in this setting may be modifiable. Among available interventions, structured exercise programs demonstrate the strongest and most consistent improvements in autonomic indices, alongside established benefits in functional capacity, fatigue, and quality of life. Relaxation and mindfulness-based interventions, including yoga, offer low-risk adjunctive benefits, whereas cryotherapy remains exploratory. Pharmacologic therapies play a symptom-directed role, particularly for orthostatic hypotension, but are often constrained by comorbid cardiovascular disease and limited oncology-specific evidence. This review evaluates current evidence on the clinical manifestations and therapeutic strategies for chemotherapy-associated cardiovascular autonomic dysfunction, highlighting opportunities to improve patient-centered outcomes in cardio-oncology care.
Background:Racial disparities have been documented across multiple domains of cardiovascular care, yet data on mitral valve intervention remain limited. We examined racial differences in procedural selection and outcomes following transcatheter edge-to-edge repair (TEER) and open mitral valve surgery. Methods:Using the National Inpatient Sample (NIS, 2016-2022), we identified 26,456 adults undergoing mitral valve intervention. Multivariable regression models were used to assess racial differences in mortality, procedure type, length of stay, and charges, adjusting for demographics, comorbidities, hospital characteristics, and illness severity. Results:TEER comprised 89% of procedures. Black patients were younger (mean 62 vs 70 years) but presented with higher illness severity. After adjustment, Black patients had greater odds of receiving TEER (odds ratio (OR) = 1.36; 95% confidence interval (CI), 1.15-1.61). Mortality disparities persisted after adjustment: Black patients (OR = 1.49; 95% CI, 1.01-2.19; P = 0.045) and Asian/Pacific Islander patients OR = 2.20; 95% CI, 1.30-3.72; P = 0.003). Late presentation was more common among Black (24%) and Hispanic (27%) compared with White patients (13%). Conclusions:Black and Asian/Pacific Islander patients experience elevated inpatient mortality following mitral valve intervention that is not fully explained by covariates available in NIS. Late referral patterns are consistent with barriers to timely specialized care in minority populations.
Background:Simple bedside scores may support risk stratification after acute heart failure hospitalization, particularly during post-discharge follow-up when biomarker testing or complete registry-derived variables may be unavailable. We evaluated non-biomarker bedside risk scores for 1-year all-cause mortality after acute heart failure hospitalization in Vietnam. Methods:We conducted a retrospective cohort study of 497 adults hospitalized for acute heart failure at Cho Ray Hospital, Vietnam, between January and August 2021, with post-discharge outpatient follow-up and 1-year vital status ascertainment. This was a pragmatic evaluation of simplified bedside/domain scores constructed from routine clinical variables, not a formal external validation of the original GWTG-HF (Get With The Guidelines-Heart Failure) or OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) equations. The primary score was an a priori-expanded eight-item, non-biomarker score including age, New York Heart Association class, systolic blood pressure, heart rate, serum sodium, serum creatinine, left ventricular ejection fraction, and hemoglobin. Natriuretic peptides and the AHEAD (atrial fibrillation, anemia, age, renal dysfunction and diabetes mellitus) score were not included. Discrimination was assessed using area under the receiver operating characteristic curve with bootstrap 95% confidence intervals, threshold characteristics and observed mortality across score groups. Results:Among 497 patients, 57 died within 1 year (11.5%). Point-score areas under the curve ranged from 0.525 to 0.590. The expanded eight-item score had an area under the curve of 0.590 (95% confidence interval, 0.509-0.660). At 4 or more points, sensitivity was 0.491, specificity was 0.655, positive likelihood ratio was 1.42, and negative likelihood ratio was 0.78. Observed mortality increased from 7.1% (95% confidence interval, 4.3-11.6) in the low-score group to 12.4% (7.7-19.4) in the intermediate-score group, and 15.6% (11.0-21.6) in the high-score group. A cross-validated clinical model using the same non-biomarker information achieved an area under the curve of 0.671. Conclusions:In this Vietnamese cohort after acute heart failure hospitalization, characterized by predominantly reduced or mildly reduced left ventricular ejection fraction, simple non-biomarker point scores provided modest prognostic information for 1-year mortality. Their role is broad orientation rather than definitive individual prognostication, and external validation is needed before implementation.
Polypharmacy lacks a consistent definition in the literature and studies use varying numeric thresholds, ranging from the use of four to as many as 15 medications with the most frequent cutoff being five or more medications. It is highly prevalent and particularly relevant in patients with atrial fibrillation (AF) and atrial flutter (AFL) who have multiple comorbidities and often require multi-agent therapy. As a result, these patients face increased risk of bleeding, falls, drug-drug interactions, adverse drug-related events, and medication non-adherence. This scoping review aims to identify how polypharmacy is defined in AF and AFL, to examine the clinical consequences of these definitions, and summarize considerations to prevent polypharmacy. A comprehensive literature search was completed across five databases to identify articles that address and define polypharmacy in AF and AFL. A protocol was prospectively registered on PROSPERO (CRD420251135482) before data extraction began. Included articles defined polypharmacy in adult patients with a diagnosis of AF or AFL. Of the 109 articles identified, 96% (n = 105) discussed AF only, 4% (n = 4) discussed AF and AFL together without differentiation, and none focused solely on AFL. Most articles (96%, n = 105) used a quantitative definition, while 4% (n = 4) used a qualitative definition. The most common definition of polypharmacy, reported in 51% (n = 56) of articles, was the use of five or more medications. This definition is not clinically meaningful as most patients with AF or AFL are already on five or more medications. There is ongoing debate on the definition of polypharmacy in this population. If a numeric cutoff is utilized, we propose increasing it to 10 or more medications as has been suggested in other cardiovascular conditions such as heart failure. More importantly, regardless of how we define polypharmacy in AF or AFL, it is crucial that providers continually assess each medication to ensure that the benefits outweigh the risks.
Background:Growing evidence links oral microbial dysbiosis to atherosclerotic cardiovascular disease (ASCVD), yet its role in acute myocardial infarction (AMI) and the transition from stable coronary artery disease (CAD) to acute events remains unclear. We aimed to characterize taxonomic and functional alterations of the oral plaque microbiome across cardiovascular health states and explore their clinical relevance. Methods:We enrolled 60 age- and sex-matched adults, 20 in each group. Supragingival plaque underwent 16S rRNA sequencing and functional inference. Alpha and beta diversity were assessed, and differential features were identified by Linear Discriminant Analysis Effect Size (LEfSe). The metabolic pathway predictions were using Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. Results:Alpha and beta diversity showed no significant differences in overall microbial richness, evenness, or global community structure among groups. However, marked taxonomic shifts were observed. AMI patients exhibited enrichment of pro-inflammatory genera (Veillonella, Porphyromonas, Dialister, Megasphaera, and Acidaminococcus) and depletion of commensal taxa (Haemophilus and Lautropia). LEfSe identified disease-specific microbial signatures distinguishing healthy control, CAD, and AMI. Functional prediction revealed enrichment of arachidonic acid, pyrimidine, and D-glutamine/D-glutamate metabolism in CAD, with further increases in necroptosis-, proteasome-, and inflammation-related pathways in AMI, whereas two-component signaling systems were enriched in healthy controls. Conclusions:The oral microbiome exhibits progressive taxonomic and functional shifts from health to CAD and AMI, supporting an oral-cardiovascular axis and highlighting oral microbial profiles as potential noninvasive biomarkers for ASCVD risk stratification.
Background:Drug-eluting stents (DESs) are key to percutaneous coronary intervention (PCI), with outcomes shaped by device, patient, and operator factors. The everolimus-eluting stent (EES, Espalier) was assessed in a multicenter, real-world study for safety and efficacy. The study evaluated the clinical outcomes, safety, and procedural success of the indigenous Espalier EES (Cognitive Technologies Pvt. Ltd.) in patients undergoing coronary revascularization at tertiary care centers in India. Methods:This retrospective, multicenter study enrolled 402 adults (≥ 18 years) with native coronary lesions suitable for PCI. The primary endpoint was 12-month target lesion failure (TLF: cardiac death, target vessel myocardial infarction (MI), emergent coronary artery bypass grafting (CABG), or clinically driven target lesion revascularization (TLR)). Secondary endpoints included 6-month TLF, target vessel revascularization (TVR), stent thrombosis, and device/procedural success. Subgroup analyses were performed by age, sex, body mass index (BMI), vessel size, and clinical presentation. Results:At 6 months, adverse events were minimal (0.50%), with no MI or stent thrombosis, one death (0.25%), and one TLF (0.25%). At 12 months, mortality remained 0.25%, with no MI or stent thrombosis, while TVR occurred in 1.49% and TLF in 1.74% of patients. Subgroup analyses revealed higher event rates in older patients (≥ 70 years), those with unstable angina, abnormal electrocardiogram (ECG)/echocardiographic findings, and patients with two comorbidities. Device and procedural success were achieved in all cases (100%), with no failures recorded. Conclusions:The Espalier EES demonstrated high procedural success and low adverse event rates at 12 months, with slightly higher risks observed in elderly and high-risk patients.
Background: Despite advances in contemporary stent technology and procedural techniques, in-stent restenosis (ISR) remains a clinically significant cause of repeat revascularization. Coronary angiography, although the standard diagnostic modality, has limited ability to identify the underlying mechanism of ISR. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) may improve mechanism-based decision-making and procedural optimization. This study aimed to evaluate the impact of intracoronary imaging on ISR mechanism identification and treatment strategy during ISR percutaneous coronary intervention (PCI). Methods: This prospective observational study included 34 patients with 40 ISR lesions (60 previously implanted stents) undergoing IVUSor OCT-guided PCI at a tertiary care center. Patients underwent detailed assessment of cardiovascular risk factors, angiographic classification of ISR, and systematic intracoronary imaging analysis. ISR lesions were classified as mechanically driven or tissue-proliferative based on imaging findings. The primary objective was to assess the impact of imaging on lesion preparation and definitive treatment strategy. Results: The mean age was 63 years, and 82.4% were male. Diffuse ISR was present in 57.5% of lesions. Intracoronary imaging identified mechanical and tissue-proliferative ISR in equal proportions (50% each). Mechanical ISR was more frequently associated with earlier presentation and structural complexity, including multisegment involvement and stent overlap zones. Intravascular imaging led to escalation of lesion modification strategies in 50% of lesions. Before imaging, drug-eluting balloon (DEB) therapy was planned in 55% and drug-eluting stent (DES) implantation in 15% of cases. Following imaging, DES implantation was performed in 50% of lesions, representing a significant shift in treatment strategy (McNemar test, P = 0.021). Conclusion: Both mechanical and tissue-proliferative mechanisms contributed substantially to ISR. Intracoronary imaging clarified the dominant ISR mechanism, guided lesion preparation, and modified definitive treatment strategy. These findings suggest a mechanism-based role for IVUS/OCT in lesion assessment and procedural planning during ISR PCI. Larger comparative studies with longer follow-up are required to determine whether imaging-guided ISR PCI improves clinical outcomes.
Background:There is growing interest in developing risk assessment tools/metrics to improve treatment, management, and outcomes for pulmonary arterial hypertension (PAH). This study investigated the association of the pulmonary artery pulsatility index (PAPi) with patient characteristics, hospitalization, and mortality. Methods:Data collected from the US-based Registry to Evaluate Early and Long-Term PAH Disease Management were stratified/analyzed according to baseline PAPi quartiles (36-month follow-up). Results:In total, 2,711 patients were included. Baseline demographic/clinical characteristics were similar; however, the lowest quartiles (< 3.55; ≥ 3.55 to < 5.5) had higher New York Heart Association/World Health Organization functional class, while those in the highest quartiles (≥ 5.5 to < 9.0; ≥ 9.0) had longer 6-min walk distance. Of 2,414 patients assessed for hospitalization, 1,326 (54.9%) were hospitalized. Lower PAPi correlated with increasing hospitalization probability (≥ 9.0 quartile, n = 291 (48.0%); ≥ 5.5 to < 9.0 quartile, n = 333 (54.8%); ≥ 3.55 to < 5.5 quartile, n = 340 (57.2%); and < 3.55 quartile, n = 362 (59.7%)). Of 681 (28.1%) patients who died, 150 (24.1%) were in the ≥ 9.0 quartile, 154 (25.5%) the ≥ 5.5 to < 9.0 quartile, 157 (26.7%) the ≥ 3.55 to < 5.5 quartile, and 220 (35.9%) the < 3.55 quartile (P < 0.001). Compared with the < 3.55 quartile, there was a 35.6%, 25.8%, and 23.3% reduction in mortality in the ≥ 9.0, ≥ 5.5 to < 9.0, and ≥ 3.55 to < 5.5 quartiles, respectively. Conclusions:PAPi may be a useful prognostic tool and long-term predictor of clinical events in PAH.
Background: The cardiovascular intensive care unit (CICU) has evolved into a multidisciplinary unit managing critically ill patients with high mortality rates. In 2022, the Sardjito Cardiovascular Intensive Care (SCIENCE) score introduced seven simple parameters assessed within the first 24 h to predict CICU mortality. The Mayo Cardiac Admission Risk Score (M-CARS) is a well-established tool for predicting CICU mortality but requires specialized laboratory tests. This study compared the predictive performance of the SCIENCE score and M-CARS and validated SCIENCE at its development site. Methods: This retrospective cohort study was conducted between February 2022 and September 2024 and included CICU patients at Sardjito Hospital. Outcomes assessed were CICU and in-hospital mortality. Predictive performance was evaluated by accuracy, discrimination, and calibration (Hosmer-Lemeshow test). Results: Over 50% of the initial participants were excluded due to missing M-CARS data (particularly the anion gap), leaving 1,503 eligible patients. M-CARS showed good predictive performance for CICU mortality (accuracy 70.9%, area under the curve (AUC) 0.804, P = 0.685) and in-hospital mortality (accuracy 72.2%, AUC 0.797, P = 0.303). The SCIENCE score also showed good predictive performance for CICU mortality (accuracy 63.7%, AUC 0.775, P = 0.059) and in-hospital mortality (accuracy 65.8%, AUC 0.767, P = 0.352). Acute stroke (hemorrhagic and non-hemorrhagic) was associated with higher CICU and in-hospital mortality (P < 0.05). Conclusion: Both the SCIENCE score and M-CARS provide acceptable predictive performance for CICU patients. However, as M-CARS has limited applicability in some settings, the SCIENCE score may serve as a more practical alternative.
Background:Previous studies have reported low circulating brain-derived neurotrophic factor (BDNF) concentrations in patients with coronary artery disease (CAD), but findings have been inconsistent and may be influenced by platelet-related factors. This study evaluated the association between plasma BDNF and CAD in patients undergoing coronary computed tomography angiography (CCTA). Methods:We prospectively enrolled 402 consecutive patients who underwent CCTA for CAD screening at Fukuoka University Hospital and who were either clinically suspected of having CAD or had at least one cardiovascular risk factor. CAD was defined as coronary artery stenosis of 50% or greater. Plasma BDNF was measured and its association with CAD and clinical variables was examined using multivariate linear regression and logistic regression. The effect of covariate adjustment on the association between BDNF and CAD was assessed using the change-in-estimate method. Results:Patients with CAD (n = 186) had lower plasma BDNF levels compared with patients without CAD (n = 216) (5.73 ± 3.16 vs. 6.41 ± 3.42 ng/mL, P = 0.039). Multivariate linear regression analysis revealed that platelet count was the strongest determinant of plasma BDNF levels (β = 0.027, P < 0.001). Unadjusted logistic regression analysis showed that higher BDNF levels were associated with a lower prevalence of CAD (odds ratio (OR) 0.94, 95% confidence interval (CI) 0.88-1.00, P = 0.039). However, after adjusting for platelet count, this association weakened and became non-significant (OR 0.976, 95% CI 0.909-1.05, P = 0.49). Further adjustment for age and coronary artery calcification score did not significantly alter the results. Conclusions:In a cohort undergoing CCTA with a relatively intermediate pre-test probability of CAD, plasma BDNF levels were lower in patients with CAD, but this crude correlation was primarily explained by platelet-related confounding factors. Platelet count should be considered when evaluating BDNF as a cardiovascular biomarker in patients with intermediate cardiovascular risks.
Background:Heart failure is a frequent complication of diabetes, highlighting the importance of integrated cardiometabolic assessment. Glycated hemoglobin (HbA1c) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) represent complementary biomarkers reflecting glycemic control and myocardial stress. Point-of-care testing (POCT) platforms may facilitate decentralized diagnostics and shorten analytical turnaround time. The aim of this study was to evaluate the analytical performance of the AFIAS-3 point-of-care fluorescence immunoassay platform for HbA1c and NT-proBNP measurements in comparison with established central laboratory methods. Methods:This single-center verification study included 50 patient samples for each analyte. HbA1c measurements obtained using AFIAS-3 were compared with Tosoh G8 high-performance liquid chromatography (HPLC), while NT-proBNP measurements were compared with the cobas 8000 electrochemiluminescence immunoassay. Analytical precision and accuracy were assessed using manufacturer quality control materials. Method comparison was performed using Passing-Bablok regression, Bland-Altman analysis, and Spearman correlation. Agreement at clinical thresholds was evaluated using Cohen's kappa statistics. Results:For HbA1c, analytical precision was excellent, with coefficients of variation of 1.9% and 1.8%. Correlation with the reference method was strong (r = 0.98), and the mean bias was minimal (-0.03%). Agreement at the diagnostic threshold of 6.5% was excellent (κ = 0.92). For NT-proBNP, coefficients of variation were 5.3% and 15.4%. Correlation with the central laboratory method was very high (r = 0.99), although proportional bias was observed at higher concentrations (slope 1.24). Agreement at clinically relevant thresholds remained substantial. Conclusions:The AFIAS-3 POCT platform demonstrated excellent analytical agreement for HbA1c and acceptable agreement for NT-proBNP at clinically relevant thresholds. Dual biomarker POCT may support decentralized cardiometabolic diagnostics, although NT-proBNP values at higher concentrations should be interpreted cautiously.
Background:The study aimed to compare the efficacy and safety of simplified single-freezing protocol with achieving -40 °C within 60 s of freezing as the observation index and the conventional time-to-isolation (TTI)-guided double-freezing protocol using second-generation cryoballoon in the treatment of atrial fibrillation (AF). Methods:A retrospective analysis was performed. After propensity score matching, 146 patients who underwent conventional TTI-guided protocol freezing (conventional group) and 146 patients who underwent single-freezing temperature-guided protocol freezing (simplified group) using second-generation cryoballoon were included. Procedure time, X-ray time and dose, complications, success rate, and recurrence rate during follow-up were analyzed. Results:Compared with the conventional group, the simplified group showed a significant reduction in procedure time (98.8 ± 16.3 vs. 79.4 ± 12.7 min, P < 0.001), and X-ray time (24.3 ± 6.8 vs. 17.8 ± 4.9 min, P < 0.001) and dose (681.1 ± 337.8 vs. 540.1 ± 343.7 mGy, P < 0.001). There was no significant difference in the success rate of acute pulmonary vein isolation between the two groups of patients (145/146 vs. 146/146, P = 0.975) and the proportion of maintaining sinus rhythm during follow-up (114/146 vs. 109/146, P = 0.842). Cox regression analysis showed that simplified protocol is not a predictive factor for recurrence in AF cryoablation. Conclusions:In summary, the single-freezing temperature-guided protocol demonstrates comparable efficacy and safety to conventional TTI-guided protocol of second-generation cryoballoon in the AF ablation with the advantages of reducing procedure time and radiation exposure.
Background:Heart rate (HR) is a key marker of autonomic and hemodynamic stress in acute heart failure (AHF). Whether 24-h Holter-derived mean HR provides incremental prognostic value for short-term clinical outcomes during hospitalization remains unclear. This study evaluated the association between Holter-derived mean HR and short-term clinical outcomes in patients hospitalized with AHF. Methods:The study enrolled consecutive adults hospitalized with AHF at a tertiary hospital between October 2020 and June 2021. All participants underwent 24-h Holter monitoring during early hospitalization. Mean HR was categorized as < 70, 70-100, or > 100 beats per minute (bpm). Outcomes included in-hospital mortality, and all-cause mortality and readmission at 30, 60, and 90 days post-discharge. Two cardiologists blinded to outcomes interpreted Holter data. Statistical analyses were conducted to evaluate associations between mean HR categories and short-term clinical outcomes. Results:Ninety-four patients were included (mean age 66 ± 16.2 years; 56.4% female). In-hospital mortality was strongly associated with mean HR (4.8% for < 70 bpm vs. 31.3% for > 100 bpm; P = 0.023). A HR threshold > 100 bpm significantly increased in-hospital mortality (P = 0.012). In contrast, admission HR alone did not predict mortality (P = 0.573). Post-discharge mortality (1.1-4.3%) and readmission rates (5.3-13.8%) did not differ across HR categories. Conclusions:Holter-derived mean HR was a robust predictor of in-hospital mortality in patients hospitalized with AHF, outperforming single-time HR measurements. These findings may have potential relevance to perioperative risk assessment in patients with AHF, although prospective studies including surgical cohorts are required.
Background:Atrial fibrillation (AF) is associated with a substantially increased risk of ischemic stroke and systemic embolism particularly in elderly patients. Understanding real-world patterns of anticoagulation (AC) use in elderly population is critical. Methods:This is a retrospective, single-center, chart review study that included patients who had nonvalvular AF between 2021 and 2024. Patients were divided into two groups according to age: 50-75 years old and 76-89 years old. Primary endpoint was AC underutilization, which was defined by the presence of all the following conditions: 1) CHA2DS2-VASc score > 2; 2) Outcomes Registry for Better Informed Treatment (ORBIT) score ≥ 3; 3) without AC. Secondary endpoint was AC appropriateness, which is defined by the presence of all the following conditions: 1) CHA2DS2-VASc > 2; 2) ORBIT < 3; 3) with AC. Results:A total of 6,386 patients were included. Among them, 3,306 patients were 50-75 years old, and 3,080 patients were 76-89 years old. Patients in age group 76-89 had a 4.547-fold higher odds ratio (OR = 4.547; 95% confidence interval (CI), 3.827-5.403) to have AC underutilization than those in age group 50-75. Patients in age group 76-89 were 108% (OR = 2.077; 95% CI, 1.818-2.374) more likely to have AC appropriateness than those in age group 50-75. History of bleeding (OR = 10.582; 95% CI, 6.467-17.315; P < 0.001) and glomerular filtration rate (GFR) (OR = 0.985; 95% CI, 0.982-0.988; P < 0.001) were independent predictors of appropriateness. Similar, history of bleeding (OR = 2.402; 95% CI, 1.666-3.462; P < 0.001) and GFR (OR = 1.006; 95% CI, 1.001-1.010; P = 0.0185) were also independent predictors of underutilization. Conclusions:Patients in age group 76-89 were more likely to have AC underutilization than patients in age group 50-75. History of bleeding and GFR were independent predictors of appropriateness and underutilization. These findings highlight the ongoing challenge of balancing stroke prevention and bleeding risk in elderly AF patients and underscore the importance of guideline-directed, individualized AC strategies.
Background:It has remained unclear about the factors that are involved in the pericardial fibrotic process and the occurrence of postoperative low cardiac output syndrome (LCOS) in constrictive pericarditis. This study aimed to analyze the role of toll-like receptor 4 (TLR4) and high-mobility group box 1 (HMGB1) in pericardial fibrosis, and their impact on the development of postoperative LCOS in patients with constrictive pericarditis. Methods:This retrospective study enrolled 24 constrictive pericarditis patients who underwent isolated pericardiectomy at our department from May 2023 to April 2025. Pericardial tissues were subjected to immunohistochemistry to detect the expression of TLR4, HMGB1, α-smooth muscle actin (α-SMA) and collagen III. Mean optical density (MOD) was used for quantitative analysis of immunohistochemical staining. Pearson correlation analysis was performed to assess associations between TLR4, HMGB1 and fibrotic markers, while receiver operating characteristic (ROC) curves were used to evaluate their potential predictive value for postoperative LCOS. Results:Of the 24 patients, seven (29.2%) patients developed postoperative LCOS. TLR4 was expressed in 21 (87.5%) specimens, and HMGB1 was expressed in all specimens. Pearson correlation analysis showed positive correlations between TLR4 and α-SMA (r = 0.529, P = 0.008), HMGB1 and α-SMA (r = 0.516, P = 0.010), and TLR4 and HMGB1 (r = 0.844, P < 0.001). MOD values of TLR4 and HMGB1 were significantly higher in patients with postoperative LCOS (P = 0.028 and P < 0.001, respectively). ROC curve suggested that TLR4 (area under the curve (AUC) = 0.790, 95% confidence interval (CI), 0.516-1.000) and HMGB1 (AUC = 0.941, 95% CI, 0.853-1.000) had potential predictive value for postoperative LCOS. Conclusions:TLR4 and HMGB1 were involved in the pericardial fibrosis and were significantly associated with the occurrence of postoperative LCOS in constrictive pericarditis.
Background: Exercise-based cardiac rehabilitation (CR) programs are recommended in outpatients at least three times a week, but high-frequency visits can be difficult due to patients' work schedules. The association between the frequency of exercise-based CR and the increase in exercise tolerance is not well known. We evaluated the effect of CR once a week or more for improving exercise tolerance. Methods: This is a retrospective observational study. From February 2011 to January 2020, 110 outpatients who participated in CR and performed a cardiopulmonary exercise test (CPET) two times (initially and within 6 months) were registered. We divided the patients into those who participated in CR once a week or more (n = 75) and less than once a week (n = 35) and compared the changes in the results of CPET. Results: Overall, the median patient age was 68.5 (59-74) years, 69.1% were males, and the body mass index was 23.8 (20.2-27.4) kg/m2. The average frequency of CR was 1.54 (0.93-1.89) times per week. While patients who participated in CR once a week or more showed improvements in oxygen uptake, ventilatory equivalent, ventilatory efficiency, and oxygen uptake per heart rate, those who participated in CR less than once a week showed only small improvements. The ratio of oxygen uptake to work rate in patients who participated in CR once a week or more also improved significantly. Conclusions: Patients who participated in a CR program once a week or more showed improved exercise tolerance.
Background: Recent trial data demonstrates improved outcomes for the treatment of ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS) with percutaneous coronary intervention (PCI) supported by mechanical circulatory support (MCS). Clinical outcomes in patients with Alzheimer's disease and related dementias (ADRD), however, remain unknown, as these patients were excluded from relevant trials. Physicians and caregivers struggle to navigate time-sensitive decision making for patients with ADRD presenting with STEMI or CS. The aims of this study were to assess the association of ADRD with outcomes of PCI with MCS in the setting of STEMI or CS. Methods: We compared outcomes among Medicare fee-for-service (FFS) beneficiaries aged 66 years or older, with and without ADRD, who underwent PCI with MCS for STEMI or CS from July 1, 2017 to December 31, 2019. The primary clinical outcome was inpatient mortality, and secondary clinical outcomes were 1-year mortality, complications, and readmissions. Patient-centered outcomes were time-at-home ratio and discharge to a higher level of care. Results: A total of 13,110 patients undergoing PCI with MCS for STEMI or CS met study criteria, and 988 (7.5%) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be older (81.1 vs. 75.5, P < 0.001) and frail (47.0% vs. 22.0%, P < 0.001). In- patient mortality was similar between groups (odds ratio (OR), 1.05; 95% confidence interval (CI), 0.92-1.21), but 1-year mortality was higher among patients with ADRD (OR, 1.41; 95% CI, 1.21-1.64). Major complications and readmissions were similar between groups. Patients with ADRD were more likely to be discharged to a higher level of care (OR, 1.46; 95% CI, 1.16-1.82) than those without ADRD but demonstrated a similar time-at-home ratio. Conclusions: Patients with ADRD demonstrate similar rates of inpatient mortality and major complications but have higher rates of 1-year mortality and discharge to higher levels of care.
Background: Congestive heart failure (CHF) remains a major global health issue, affecting millions of adults worldwide, contributing to significant hospitalizations and mortality. While randomized controlled trials (RCTs) are essential for improving CHF care, their external validity remains uncertain. This study evaluates the external validity of CHF RCTs published between 2014 and 2024 using the criteria developed by van 't Hooft et al. Methods: A systematic appraisal of CHF RCTs was performed using MEDLINE and Embase on April 1, 2025. Included studies were full-text, English-language, human trials focused on CHF interventions. Trials were assessed with a 13-criterion guideline covering pragmatic principles, context, information gain, feasibility, transparency, value, and patient-centeredness. Two reviewers independently screened and extracted data, resolving discrepancies by consensus. Trial characteristics and predictors of usefulness were analyzed via linear regression and descriptive statistics. Results: Among 659 records screened, 44 met inclusion criteria. Of these, 15.9% demonstrated information gain, 36.4% provided context placement, and 4.5% avoided violations of pragmatic principles. Patientcenteredness was fully addressed in 54.5% of trials and 38.6% demonstrated feasibility. A majority of studies disclosed funding at 77.3% and conflict of interest statements at 68.2%. Transparency and usefulness values showed a modest upward trend over time (r = 0.42, P < 0.05). Conclusions: Although CHF RCTs are the gold standard for evaluat ing new interventions, many fall short in pragmatism, information value, power analysis, and data transparency. Future trials may benefit from prioritizing pragmatic principles, adequate power calculations, cost analysis, and data sharing.
Background:Cardiac diseases caused by various factors eventually lead to heart failure (HF) as the condition progresses, during which inflammation and pyroptosis are markedly enhanced. Nuclear respiratory factor-1 (NRF-1) is a transcriptional regulator involved in multiple physiological functions; however, its role in pyroptosis during HF remains unclear. Methods:Serum samples from patients with HF were collected to evaluate the levels of NRF-1. An HF rat model was established to assess the expression of NRF-1 in serum and cardiac tissue and to investigate its association with HF and the expression of inflammatory markers gasdermin D (GSDMD), caspase-1, interleukin (IL)-8, and IL-1β. NRF-1-overexpressing and NRF-1-silenced H9C2 cell lines were constructed, and myocardial injury was induced by hypoxia and doxorubicin (DOX) to evaluate the effects of NRF-1 on pyroptosis-related molecules GSDMD and caspase-1, as well as inflammatory cytokines IL-8 and IL-1β. Finally, the expression of NRF-1 in the serum of HF patients was analyzed based on New York Heart Association (NYHA) functional classification to validate the dynamic changes of NRF-1 during pyroptosis in HF. Results:Although previous studies have reported inconsistent findings regarding serum NRF-1 expression levels among different HF patient cohorts, our current results demonstrate that serum NRF-1 expression is significantly reduced in HF patients compared to those with normal cardiac function (NF), while the expression of pyroptosis-related molecules GSDMD and caspase-1, as well as pro-inflammatory cytokines IL-8 and IL-1β, is markedly increased. These findings were further validated in an HF rat model. In vitro experiments revealed that NRF-1 attenuates hypoxia and DOX-induced pyroptosis in H9C2 cardiomyocytes, highlighting its protective role in the pathogenesis of HF. Finally, serum NRF-1 levels assessed according to NYHA functional classification suggest that the differential expression of NRF-1 observed across samples may be attributed to variations in the stages of HF among patients. Conclusions:NRF-1 is a dynamically expressed molecule with cardioprotective properties that ameliorates HF and attenuates pyroptosis by inhibiting the caspase-1/GSDMD signaling pathway.
