Introduction and objectives: Guidelines recommend early initiation of the 4 pillars of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), but real-world evidence on quadruple therapy (QT) at discharge remains limited in Latin America.Methods: We conducted a retrospective cohort study of consecutive patients with HFrEF discharged from a tertiary cardiovascular center in Colombia (2022-2026). Patients were classified as receiving QT, defined as all 4 GDMT pillars, or incomplete therapy (IT, 0-3 pillars). Propensity-score optimal full matching was performed using 26 covariates. The primary endpoint was 30-day death or readmission. The robustness of the mortality findings was assessed using the primary estimator and 4 sensitivity analyses.Results: Among 3839 patients (median age, 68.2 years; 71.2% male), 2758 (71.8%) were discharged on QT. The 30-day composite endpoint occurred in 751 patients (19.6%). QT was associated with a lower risk of death or readmission (RR, 0.71; 95%CI, 0.58-0.88; P = .001). Mortality showed a consistent direction of association (RR, 0.61; 95%CI, 0.37-1.01; P = .052), with the 95%CI excluding unity in all 4 sensitivity analyses. Readmission was lower with QT (cause-specific HR, 0.73; 95%CI, 0.56-0.95; P = .017). Findings in the Chagas subgroup (n = 614) were directionally consistent with those in the overall cohort, with no significant treatment-by-subgroup interaction.Conclusions: In this Latin American HFrEF cohort, QT at discharge was associated with a lower risk of 30-day death or readmission. The magnitude of the mortality association may partly reflect residual confounding rather than a pharmacological effect. These findings support the feasibility of QT prescription in a tertiary care setting in a low- and middle-income country.
INTRODUCTION AND OBJECTIVES:Tricuspid regurgitation (TR) is closely linked to heart failure (HF). However, the burden and predictors of HF hospitalization at diagnosis and during follow-up have not been fully characterized, particularly after accounting for the competing risk of death. METHODS:We conducted a retrospective multicenter cohort study including 757 patients with significant TR. Prevalent HF was defined as HF hospitalization at the time of diagnosis. Among patients without prevalent HF, the cumulative incidence of first HF hospitalization was assessed using competing risk analysis, with all-cause mortality treated as a competing event. Multivariable models were used to identify independent predictors. RESULTS:At diagnosis, 260 patients (34.4%) were hospitalized for HF. Male sex, right-sided HF, left ventricular systolic dysfunction, and TR etiologies related to ventricular dysfunction or pulmonary hypertension were independently associated with prevalent HF. Among patients without prevalent HF (n=497), the cumulative incidence of HF hospitalization was 16.4% at 1 year and 44.3% at 7 years. Independent predictors of incident HF included prior HF hospitalization (sHR, 2.08; 95%CI, 1.50-2.87), NYHA functional class III-IV (sHR, 1.70; 95%CI, 1.24-2.35), and higher pulmonary artery systolic pressure (sHR, 1.01; 95%CI, 1.00-1.02). Tricuspid valve surgery was associated with a lower risk of HF hospitalization (sHR, 0.56; 95%CI, 0.33-0.96). CONCLUSIONS:HF hospitalization is common in patients with significant TR, both at diagnosis and during follow-up. HF hospitalization at the time of diagnosis identifies an advanced clinical phenotype, while incident hospitalization remains frequent after accounting for the competing risk of death.
INTRODUCTION AND OBJECTIVES:Cardiovascular diseases are the leading cause of mortality in Spain, yet there is no systematic population-based cardiovascular screening program. This study evaluated the feasibility of a nurse-led, single-visit cardiovascular screening program in primary care (PreveCardio), and identified the prevalence of modifiable cardiovascular risk factors, their associated socioeconomic factors, and the translation of pilot findings into regional health policy. METHODS:We conducted a cross-sectional study across 42 primary care centers in a Spanish region (January-March 2023). A random sample of 8491 individuals aged 50 to 75 years was invited to participate. Trained nurses performed a single 30-minute visit with point-of-care measurements (blood pressure, lipid profile, HbA1c) and validated questionnaires. Multivariable logistic regression models were fitted with Benjamini-Hochberg correction. RESULTS:A total of 3545 individuals participated (41.8%; mean age 61.2±7.3 years; 56.7% women). The completeness of clinical data exceeded 99%. Elevated blood pressure was identified in 40.4%, obesity in 29.5%, nonoptimal low-density lipoprotein cholesterol in 48.7%, prediabetes in 30.7%, and active smoking in 19.5%. Smoking showed the steepest socioeconomic gradient (aOR, 3.25; 95%CI, 2.09-5.03). The direct cost per participant was €11.75. CONCLUSIONS:A nurse-led, single-visit cardiovascular screening program is operationally feasible in Spanish primary care, revealing a high burden of modifiable cardiovascular risk factors and significant socioeconomic disparities. Smoking showed the steepest income-associated gradient. This pilot study led to the approval of the first systematic cardiovascular screening program in a Spanish autonomous community.
INTRODUCTION AND OBJECTIVES:To compare outcomes of ductal stenting (DS) with those of modified Blalock-Taussig shunt (mBTS) as initial palliation in neonates with functionally univentricular heart and duct-dependent pulmonary blood flow, up to bidirectional cavopulmonary connection (BCPC). METHODS:We retrospectively analyzed 192 neonates with functionally univentricular heart and duct-dependent pulmonary blood flow undergoing initial palliation with DS (n=39) or mBTS (n=153) between 2005 and 2025, using Cox proportional hazards models. RESULTS:The median follow-up was 6.3 months, including follow-up after BCPC. Low birth weight was more frequent in the DS group (28.2% vs 11.1%; P=.01). Survival after initial palliation, during the interstage period, and post-BCPC was 85.7% (95%CI, 81.9-91.5), 83.3% (95%CI, 76.9-88.1), and 79.7% (95%CI, 71.9-85.5), respectively, with no between-group differences (log-rank P >.8). Early postoperative morbidity, including neonatal intensive care unit length of stay, duration of inotropic support, and mechanical ventilation was greater after mBTS (all P=.01). Reintervention rates were similar between DS and mBTS (approximately 23% overall), with no difference in time to reintervention, even for unplanned procedures. Patients initially palliated with DS underwent BCPC earlier (5.3 [3.6-8.6] vs 7.3 [6.0-11.2] months; P=.05) and at lower body weight (5.9 [5.0-7.9] vs 6.9 [5.7-8.2] kg; P=.02). Branch pulmonary artery stenosis before BCPC was more frequent after mBTS (P=.01). After adjustment, overall mortality and reintervention before BCPC were numerically higher in the mBTS group, although these differences were not statistically significant. CONCLUSIONS:DS provided safe and effective palliation and was associated with improved early postoperative recovery. Although mortality and reintervention before BCPC were numerically lower after DS, these differences were not statistically significant.
INTRODUCTION AND OBJECTIVES:Heart failure (HF) is a growing public health concern, particularly among the elderly. Malnutrition is frequent in these patients and worsens prognosis. We aimed to determine the impact of a real-world, multidimensional nutritional program on major clinical outcomes and quality of life in older ambulatory patients with chronic HF who were malnourished or at risk of malnutrition. METHODS:This pragmatic, multicenter, prospective, randomized, open-label, blinded-endpoint trial enrolled outpatients aged> 65 years with chronic HF and a Mini Nutritional Assessment-Short Form (MNA-SF) score ≤ 11 from 14 Spanish hospitals. Participants were randomly assigned to either a structured nutritional strategy, comprising tailored dietary optimization and physical exercise recommendations, or usual care. The primary outcome was a 6-month composite of all-cause death or HF-related hospitalization. RESULTS:Recruitment was terminated early after enrolling 204 patients: 106 in the intervention group and 98 in the control group. At 6 months, no significant difference was observed in the primary composite endpoint between the intervention and control groups (17.9% vs 19.4%; HR, 0.90; 95%CI, 0.48-1.70). However, the intervention group showed significantly greater improvements in MNA-SF scores (+4.99 vs+3.65; P=.003), mid-arm muscle circumference (+0.86cm vs-1.38cm; P=.006), and quality of life as measured by the Minnesota Living with HF Questionnaire (-7.95 vs-2.44; P=.028). CONCLUSIONS:In elderly patients with chronic HF and malnutrition or at risk of malnutrition, a pragmatic nutritional intervention did not reduce major clinical outcomes. However, the intervention did improve nutritional status, biometric parameters, and quality of life. Achieving a reduction in clinical outcomes in this population may require more prolonged and individualized interventions. CLINICALTRIALS:gov number NCT05923138.
INTRODUCTION AND OBJECTIVES:Simple coarctation of the aorta (CoA) can be repaired through left lateral thoracotomy without cardiopulmonary bypass. However, late adverse events such as death, restenosis, aneurysm formation, and development of hypertension can occur, even after initial successful repair. In this study, we evaluated outcomes after surgical repair of CoA through left lateral thoracotomy and examined risk factors for adverse events. METHODS:Among 986 patients who underwent CoA repair at our institution from 2001 to 2023, we selected patients repaired through left lateral thoracotomy and excluded those with univentricular circulation. Surgical outcomes were evaluated using cumulative incidence curves, and risk factors were analyzed using Cox regression models. RESULTS:A total of 401 patients were included; 138 (34.4%) were female and 56.6% had isolated CoA. Median age at surgery was 30 days. During a median follow-up of 10.3 years (interquartile range, 3.3-17.8 years), overall survival exceeded 98% at 20 years. Reoperation was required in 4.5% of patients and catheter-based reintervention in 9.7%, both after a median of approximately 10 years. Ventricular septal defect, associated heart defects, and patch plasty were associated with increased mortality. Older age at repair, prematurity, subaortic stenosis, prosthesis implantation, and associated cardiac anomalies were associated with an increased risk of reoperation, while hypoplastic aortic arch and repair in the neonatal period increased the risk of catheter-based reintervention. CONCLUSIONS:Survival after lateral thoracotomy repair of aortic coarctation is excellent. However, late adverse events are influenced by anatomical complexity and patient-related factors, underscoring the need for structured lifelong follow-up.
The anatomical synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) score remains a cornerstone for quantifying coronary artery disease complexity and guiding decisions between percutaneous coronary intervention and coronary artery bypass grafting. Developed from the SYNTAX trial in 2009, the score uses a standard methodological approach to systematically define coronary lesion attributes and yields an overall score that allows stratification of coronary complexity. A commonly accepted stratification divides patients into low (≤ 22), intermediate (23-32), and high (≥ 33) SYNTAX score, with higher categories associated with an increased risk of adverse cardiovascular events. This review article traces the history, evolution, and integration of the SYNTAX score in ESC and ACC/AHA guidelines. We also discuss its role in clinical trials and its contribution to Heart Team deliberations in patients with complex coronary artery disease. Patient benefits include adding precision for treatment selection with a historical potential to lower mortality in high-score cases by favoring coronary artery bypass grafting. Artificial intelligence and advanced imaging, such as coronary computed tomography angiography, are advancing automated, noninvasive SYNTAX score computation with superior accuracy. Future directions involve artificial intelligence-hybrid models for real-time, personalized assessments. This review article evaluates the enduring impact of the SYNTAX score and its evolving role in precision medicine.
INTRODUCTION AND OBJECTIVES:To describe the clinical characteristics of patients with cardiac amyloidosis who have undergone heart transplantation (HT). METHODS:This retrospective multicenter study involving 14 referral centers included 113 patients with cardiac amyloidosis who underwent HT: 57 with transthyretin amyloidosis (ATTR) (22 with wild-type ATTR and 35 with variant ATTR) and 56 with light chain amyloidosis (AL). RESULTS:Compared with patients with ATTR, patients with AL amyloidosis showed more severe hemodynamic compromise before HT, with a lower cardiac index (1.7 L/min/m2 [interquartile range, 1.4-2.0 L/min/m2] vs 1.9 L/min/m2 [interquartile range, 1.6-2.4 L/min/m2]; P = .027) and higher right atrial pressure. Post-transplant infections occurred in 23 patients with ATTR (40%) and 24 with AL (43%). New-onset neuropathy occurred in 11% of patients, while neuropathy progression was more frequent in ATTR compared with AL (23% vs 7.1%; P = .044). Median follow-up was 4.6 years in ATTR and 5.4 years in AL. Five-year survival was similar in both groups (77% in AL vs 83% in ATTR). Sepsis was the leading cause of death (n = 11, 29% of deaths). Among patients with ATTR, 9 received tafamidis before HT and 7 after HT. Eight patients with ATTR received patisiran post-HT (1 pre-HT), and 3 received diflunisal post-HT. In AL, 70% received bortezomib-based therapy while 28% received daratumumab-based therapy. In AL, hematologic responses improved after HT, with the complete response rate increasing from 42% before HT to 54% after HT. CONCLUSIONS:HT is an effective treatment for carefully selected patients with cardiac amyloidosis, with comparable unadjusted survival between AL and ATTR. These findings warrant confirmation in prospective studies.
INTRODUCTION AND OBJECTIVES:Breast cancer survivors (BCS) have an elevated risk of cardiovascular disease (CVD), but standardized follow-up protocols remain limited. We aimed to describe cardiovascular comorbidities and the utilization of specialized health services, particularly cardiology services, among BCS, and to examine their association with mortality. METHODS:We conducted a retrospective cohort study of 6186 BCS diagnosed between 2000 and 2006 who survived at least 5 years after diagnosis. Participants were followed up from 2012 to 2016. Health care use and comorbidities obtained from electronic health records were analyzed. A multivariate time-dependent Cox proportional hazards model was used to assess the association between use of cardiology services and all-cause mortality. RESULTS:A total of 43.6% of long-term BCS had CVD at the beginning of follow-up. Women with CVD were older (mean age 71.8 vs 62 years; P<.001) and had a substantially higher comorbidity burden than those without CVD (5.83 vs 1.96; P <.001). During follow-up, 781 BCS (12.6%) died. Nonsurvivors were older and had a greater and more severe baseline comorbidity burden than survivors. They also had higher rates of specialist visits. Use of cardiology services was associated with lower mortality, although the association did not reach statistical significance (HR, 0.84; 95%CI, 0.67-1.05; P=.12). CONCLUSIONS:The prevalence of CVD among BCS was high, although only 18.8% used cardiology services. Nonsurvivors had a higher CVD burden and severity, and showed greater use of health care services.
INTRODUCTION AND OBJECTIVES:The use of transcatheter tricuspid edge-to-edge repair (TEER) is growing steadily due to its minimally invasive nature. The VeriSight Pro 3D intracardiac echocardiography (ICE) catheter might help to increase procedural safety and improve procedural outcomes. METHODS:In this prospective, single-center, observational study, we compared the procedural outcomes of tricuspid TEER guided by ICE plus transesophageal echocardiography (TEE) or by TEE alone. Lead-induced tricuspid regurgitation and combined mitral-tricuspid procedures were excluded. Primary events were those associated with procedural and early (30-day) safety. RESULTS:A total of 45 consecutive patients were included (25 guided by TEE and 20 by ICE+TEE). There were no significant differences in baseline clinical and echocardiographic features. No mortality, stroke, major bleeding, or major vascular events occurred. ICE significantly decreased the fluoroscopy time (ICE+TEE vs TEE: 16.2 [8.9-26.0] minutes vs 26 [18.2-32.0] minutes; P=.003), radiation dose (ICE+TEE vs TEE: 782 [390-1040] mGy vs 1413 [960-1705] mGy; P=.002), and dose-area product (ICE+TEE vs TEE: 5855 [2675-9328] cGy cm2 vs 12 120 [8670-15 080] cGy cm2; P=.004). Procedural time was also significantly decreased (ICE+TEE vs TEE: 55 [37-62] minutes vs 72 [50-80] minutes; P=.03). Optimal visualization of leaflet grasping and insertion was achieved in all ICE procedures. CONCLUSIONS:The addition of 3D ICE guidance to TEE during tricuspid TEER is associated with lower fluoroscopy time and radiation exposure compared with TEE, without any significant disadvantages regarding procedural safety. This study represents the first national experience with the novel VeriSight Pro 3D ICE catheter.
