BACKGROUND:Cardiovascular disease (CVD) and light chain (AL) amyloidosis are important causes of morbidity and mortality in patients with multiple myeloma (MM). Additionally, MM therapies can have cardiovascular effects. However, the extent to which phase III MM trials account for underlying CVD and amyloidosis through eligibility criteria, screening and reporting remains uncertain. These elements of trial design and reporting are essential for accurate interpretation of cardiovascular safety signals. OBJECTIVES:To examine practice-changing MM trials with respect to amyloidosis and CVD eligibility criteria, assessment for cardiac amyloidosis, reporting of baseline cardiovascular characteristics and cardiovascular adverse events (CVAE). METHODS:Systematic review of phase III randomised controlled trials of MM drug therapies published in English between 2015 and 2025, identified by searching MEDLINE, Embase and Cochrane Library. Eligible trials enrolled adults aged ≥18 years with MM and included ≥100 patients per treatment group; non-randomised, subgroup and abstract-only reports were excluded. RESULTS:41 trials enrolling 20 144 participants were included. Amyloidosis was an exclusion criterion in 30 trials typically using non-specific definitions. No trial reported active screening for amyloidosis or assessment of cardiac involvement. Baseline cardiovascular investigations were common but were not used to identify cardiac amyloidosis. At least one cardiovascular exclusion criterion was present in 98% of trials, most commonly heart failure and recent myocardial infarction. Baseline cardiovascular characteristics were reported in only one trial. CVAEs were investigator-reported, inconsistently defined and not centrally adjudicated. CONCLUSIONS:Phase III MM trials frequently incorporate amyloidosis and CVD exclusion criteria. However, the prevalence of cardiac amyloidosis and other CVD within these practice-changing MM trials remains poorly defined and CVAE reporting remains suboptimal. These limitations may bias safety and efficacy outcomes and reduce trial generalisability. PROSPERO REGISTRATION NUMBER:CRD420251125097.
RATIONALE:Higher blood pressure variability (BPV) has been associated with adverse cardiovascular events in various clinical settings, but its effects during critical illness remain unclear. There have been observed disparities in risk-adjusted mortality between females and males in the intensive care unit (ICU) and it is possible that BPV contributes to the underlying mechanistic physiology. OBJECTIVES:We aimed to examine whether BPV differs between females and males in the ICU and whether sex modifies the association between BPV and clinical outcomes. METHODS:This retrospective study included all adult patients admitted to the ICU between January 2013 and December 2023. Exposure was the biologically-assigned sex. Main outcomes were BPV measured by normalised average real variability (ARV) and coefficient of variation during the first 7 days of ICU admission. Exploratory outcomes included ICU mortality. Multivariable regression models were used to adjust for patient characteristics. MAIN RESULTS:A total of 11 153 admissions were included, of which 4390 (39.4%) were females. Females had increased variability in mean arterial pressure (MAP) and diastolic blood pressure (DBP) compared with males (normalised ARV of MAP: 8.2% vs 8.2%, adjusted coefficient 0.15, 95% CI 0.03 to 0.26 and normalised ARV of DBP: 9.3% vs 9.1%, adjusted coefficient 0.41, 95% CI 0.27 to 0.55). In the separate multivariable logistic regression analysis, BPV was associated with increased ICU mortality in a dose dependent manner (p<0.001). Each percentage increase in MAP variability was associated with 12% higher odds of ICU mortality, an effect that was modified by sex (p for interaction=0.024). CONCLUSIONS:Females have higher variability in MAP and DBP compared to males during critical illness, which results in association with higher risks of short-term mortality. A thorough understanding of physiological differences, risk stratification and potential treatment strategies are crucial for mitigating sex-related disparities in the ICU.
Objective This study aimed to evaluate the safety and efficacy of transapical epicardial temporary pacemaker lead implantation compared with the conventional transvenous approach in patients undergoing transapical transcatheter aortic valve implantation (TAVI).Methods In this single-centre retrospective study, 399 patients who underwent transapical TAVI between December 2018 and August 2024 were included. Of these, 298 received transapical epicardial temporary pacing leads and 101 received transvenous leads. Primary outcomes included pacemaker-related cardiac tamponade, valve displacement and mortality. Secondary outcomes encompassed perioperative complications, permanent pacemaker implantation and postoperative adverse events.Results No cases of cardiac tamponade, valve displacement or mortality related to temporary pacing were observed in either group. Poor lead contact occurred in one patient (0.3%) in the transapical group versus three patients (3.0%) in the transvenous group (p=0.05). Postoperative permanent pacemaker implantation was required in 12 transapical patients (4.0%) and three transvenous patients (3.0%, p=0.86).Conclusion Transapical epicardial temporary pacing is a safe and effective alternative to transvenous pacing during transapical TAVI, with comparable complication rates and potential technical benefits. Further randomised studies are warranted to validate these findings and explore long-term outcomes.
Background NT-proBNP is a key biomarker in heart failure (HF). Patients with markedly elevated levels are at high risk of adverse outcomes but experience delays in specialist care. Evidence on the impact of an automated, high-threshold NT-proBNP referral pathway embedded in electronic patient records is limited.Methods All NT-proBNP results >5000 pg/mL over a 12-month period triggered automatic HF team referral. Referrals were categorised as inpatients, outpatients with known HF, outpatients not suitable for follow-up or new outpatients without a diagnosis of HF who were eligible for enrolment. Eligible patients were offered echocardiography and review within 48 hours, with treatment and outcome data collected prospectively. A retrospective comparator cohort included all outpatient NT-proBNP results >5000 pg/mL from patients not known to the HF service in the 12 months before implementation.Results Over 12 months, 889 referrals were generated: 417 (47%) inpatients, 370 (42%) known outpatients, 59 (7%) not appropriate and 43 (5%) enrolled. Median time to review was 2 days, with 70% meeting the 48-hour target. Among enrolled patients (mean age 81, 56% male, median NT-proBNP 7480 pg/mL), HF with reduced ejection fraction (HFrEF) was diagnosed in 21 (49%), HF with mildly reduced ejection fraction in seven (16%), HF with preserved ejection fraction in 10 (23%) and severe aortic stenosis or new atrial fibrillation in four each (10%). At 12 weeks, 62% of patients had improved by at least one New York Heart Association class, and mean left ventricular ejection fraction increased from 27% to 45% in those with HFrEF. At 12 weeks, admission and mortality were 36% and 8%, respectively, compared with 35% and 12% in the retrospective cohort (n=60).Conclusion An automated high-threshold NT-proBNP pathway is feasible and identifies very high-risk patients. Enrolled patients had rapid therapy optimisation, with observed improvements in symptoms and cardiac function.
Background Diagnosing heart failure with preserved ejection fraction (HFpEF) can be challenging because natriuretic peptide (NP) plasma levels and diastolic function parameters during rest echocardiography may be normal or marginally abnormal in patients displaying exercise-induced symptoms suggestive of HF. In these patients exercise echocardiography is recommended.We wanted to assess whether directly measured NP levels post-exercise had added diagnostic value beyond rest plasma N-terminal pro-brain NP (NT-proBNP) levels for diagnosing HFpEF.Methods Participants with left ventricular diastolic dysfunction (LVDD), who could not be classified as HFpEF by a panel of experts more than 4 years ago, were prospectively enrolled in the HELPFulUP observational study from August 2021 to October 2022. All participants in the HELPFulUP study underwent clinical assessment, rest and exercise-echocardiography and measurements of plasma NT-proBNP before and directly after exercise. An expert panel, blinded to exercise NT-proBNP results, but with knowledge of signs, symptoms and all other diagnostic parameters including baseline values of NT-proBNP adjudicated HFpEF status. We calculated the area under the receiver operating characteristic curve (area under the curve (AUC)) for HFpEF for rest and post-exercise NT-proBNP levels and the delta NT-proBNP.Results Of the 112 LVDD participants (59 women), 11 were diagnosed with HFpEF by the expert panel based on the additional information retrieved from exercise echocardiography, and 101 remained classified as LVDD. Rest (AUC=0.78 (95% CI 0.66 to 0.90) and exercise values of NT-proBNP (AUC=0.77 (95% CI 0.65 to 0.90) had similar discriminatory value. The delta NT-proBNP AUC was 0.53 (95% CI 0.31 to 0.75).Conclusions In this pilot study, the diagnostic performance of the change with exercise in NP levels to detect incident HFpEF, beyond measurements in rest, did not point to a strong diagnostic value.
BACKGROUND:Cardiovascular (CV) disease remains the second leading cause of mortality in Japan, yet real-world estimates of recurrent CV risk across acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) phenotypes are limited. We quantified recurrent CV risk and characterised high-risk subgroups in Japanese patients with ACS and CCS. METHODS AND RESULTS:This retrospective cohort study used the Medical Data Vision claims database. Patients with ACS or CCS were followed from cohort entry to the first composite CV endpoint or end of data. The primary composite endpoint included all-cause death, myocardial infarction or stroke. The secondary composite endpoint included the primary endpoint plus hospitalisation for unstable angina, hospitalisation for heart failure or emergent or elective coronary revascularisation. Baseline clinical characteristics were evaluated as predictors. Time-to-event analyses were conducted.26 656 and 16 172 patients were included in the ACS and CCS cohorts, respectively. Median follow-up was 3.0 years in the ACS cohort and 3.2 years in the CCS cohort. The 1-year risk of the primary endpoint was 17.7% in first-time ACS, 8.0% in prior ACS and 5.3% in CCS; corresponding 5-year risks were 24.0%, 13.8% and 12.0%, respectively. In CCS, elderly men with prior ACS, heart failure, diabetes mellitus and chronic kidney disease had a 23.0% 1-year risk of the primary endpoint. CONCLUSIONS:Recurrent CV risk was highest after a first ACS event and was heterogenous in CCS, with substantially higher risk in comorbidity-burdened subgroups. These findings provide contemporary real-world estimates of recurrent CV risk and support further refinement and validation of risk-stratification approaches for secondary prevention.
Background Electrical cardioversion (ECV) is widely used for restoring sinus rhythm in atrial fibrillation (AF). However, population-level trends in use of ECV in individuals with AF remain poorly characterised.Aim We examined nationwide temporal trends in ECV utilisation between 2010 and 2022 in Denmark.Methods We conducted a registry-based cohort study using Danish nationwide health data. Two cohorts were defined: (1) individuals with prevalent or newly diagnosed AF were used to quantify annual ECV volume. (2) Individuals with newly diagnosed AF were used to calculate unadjusted and age-adjusted and sex-adjusted ECV rates per 1000 person-years during the first year after diagnosis.Results The total number of ECVs per year increased almost fourfold between 2010 and 2022 (from 2204 to 8300). The 1-year age-adjusted and sex-adjusted rate of ECVs decreased from 449.5 per 1000 person-years in 2010 to 316.6 per 1000 person-years in 2021. Rates increased among individuals aged ≥75 years but declined among younger patients. When restricted to the first ECV procedure, analyses showed a twofold increase in first-time ECVs.Conclusions The increasing volume of ECVs reflects growing demand for rhythm control, while declining rates may suggest more targeted use of ECV. The findings highlight the need for resource planning and monitoring of procedural burden to support guideline implementation and equitable rhythm control delivery.
BACKGROUND:Catheter-directed thrombolysis (CDT) has emerged as a reperfusion strategy for intermediate-risk and high-risk pulmonary embolism (PE), potentially improving thrombus resolution while reducing bleeding risk compared with systemic thrombolysis. However, evidence comparing CDT with anticoagulation alone remains inconsistent. OBJECTIVE:To evaluate the efficacy and safety of CDT compared with anticoagulation alone in intermediate-risk and high-risk PE. METHODS:A systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Cochrane Library, Epistemonikos and ProQuest were searched through 8 May 2026. Randomised and observational studies comparing CDT with anticoagulation alone were included. Primary outcomes were all-cause mortality and major bleeding. Random-effects models were used to calculate pooled risk ratios (RRs) and mean differences with 95% CIs. RESULTS:18 studies involving 16 126 patients were included. CDT was associated with a lower risk of all-cause mortality compared with anticoagulation alone (RR 0.41, 95% CI 0.32 to 0.54; p<0.0001; I²=0%). No statistically significant difference was observed in major bleeding (RR 1.78, 95% CI 0.85 to 3.71; p=0.1259; I²=51.3%), and trim-and-fill analysis yielded a similarly non-significant result (adjusted RR 0.84, 95% CI 0.39 to 1.79). CDT and anticoagulation alone showed comparable outcomes for PE-related mortality, intracranial haemorrhage, delta right ventricle (RV)/left ventricle (LV) ratio, delta Thrombus Burden Score or systolic pulmonary artery pressure. Meta-regression identified that a greater baseline RV/LV ratio was associated with attenuation of the observed mortality benefit. CONCLUSIONS:CDT was associated with lower all-cause mortality compared with anticoagulant alone in intermediate-risk and high-risk PE without a statistically significant increase in intracranial haemorrhage. Larger adequately powered randomised trials are needed to define the role of CDT in acute PE. PROSPERO REGISTRATION NUMBER:CRD420261373193.
Cardiovascular disease (CVD) is the most common cause of death in women. Early identification of CVD risk factors in women is often overlooked by physicians leading to delays in diagnosis and treatment of CVD with subsequent morbidity and mortality. There may be a correlation between declining hormone levels during menopause and the prevalence of CVD during midlife. Alterations in the CVD risk profile of women throughout the menopause transition (MT) are multifactorial and include changes to arterial stiffness, endothelial function, lipid metabolism, insulin resistance and adipose fat distribution. Menopausal Hormonal Therapy (THM) is a potential therapy to reduce CVD risk, though clinical trials have shown conflicting results, with some trials reporting an increase in CVD events with THM. A holistic approach to care for women going through the MT could be beneficial to improve their CVD risk profile and quality of life. This would include early identification of risk factors in individual patients and raising public and professional awareness of CVD risk burden in this patient population. Improving the knowledge of healthcare professionals and the public that women going through the MT are at an increased risk of CVD is a key target area to improve cardiovascular health in women. Current risk assessment scores for CVD do not include sex-specific risk factors. Guidelines and National Health Systems are beginning to recognise the importance of reproductive history in women’s cardiovascular health. In this review, we aim to discuss traditional and sex specific risk factors for CVD in menopausal women, current guidelines on THM, gaps in knowledge and strategies to reduce CVD in women.
BACKGROUND:This study aimed to explore the association of long-term left ventricular assist device (LVAD) support with changes in inflammation and cardiac remodelling in subjects with advanced heart failure (HF). METHODS:A single-centre prospective observational trial was conducted in 16 consecutive subjects with advanced HF who were indicated for implantation of HeartMate 3 LVAD. Blood samples were collected both during the procedure (V1) and 12 months postoperatively (V2) for comprehensive analysis. Additionally, in a subgroup of seven LVAD subjects listed for heart transplantation (HTx), a histological examination was performed on myocardial samples obtained during LVAD implantation and from the explanted heart following HTx. RESULTS:LVAD implantation was associated with reductions in brain natriuretic peptide (324.7±47.0 vs 124.6±50.3 pg/mL) and C reactive protein (15.2±3.8 vs 6.0±1.3 mg/L) levels. Decreased inflammation markers coincided with reduced levels of lymphocyte- and macrophage-derived cytokines and their stimulating factors. LVAD implantation was associated with modulation of circulating biomarkers related to negative cardiac remodelling processes, including reductions in fibrosis- and remodelling-associated mediators (Extracellular Matrix Metalloproteinase Inducer, fibroblast growth factor (FGF)-2, FGF-19, receptor for advanced glycation endproducts, suppression of tumourigenicity 2, interleukin 27) and angiogenesis-related factors (stromal cell-derived factor-1α, growth differentiation factor (GDF)-15, somatotropin, vascular endothelial growth factor, angiopoietin 1, hepatocyte growth factor). In parallel, markers of metabolism and systemic catabolic state were significantly modulated, with decreases in GDF-15, somatotropin, trefoil factor 3 and resistin and increases in leptin levels. Histological analysis of myocardial samples available from a subgroup of subjects showed reduced macrophage infiltration following LVAD implantation. CONCLUSIONS:Long-term LVAD support was associated with improved biochemical and haematological profiles and with coordinated changes in circulating markers of inflammation, metabolism and cardiac remodelling. These exploratory findings provide further insight into the biological changes associated with durable mechanical unloading in subjects with advanced HF.
Background The optimal revascularisation strategy for patients undergoing percutaneous coronary intervention (PCI) after transcatheter aortic valve implantation (TAVI) remains undefined. In particular, the prognostic impact of complete revascularisation (CR) versus incomplete revascularisation (ICR) in this setting is unknown. Aims To evaluate the long-term clinical outcomes of CR versus ICR in patients undergoing PCI after TAVI. Methods We analysed 447 patients from the multicentre, international Revascularization After Transcatheter Aortic Valve Implantation (REVIVAL) registry who underwent PCI after TAVI between 2008 and 2023. Patients were classified as CR or ICR according to the presence of residual significant stenosis following PCI. The primary endpoint was the 4-year incidence of major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction or stroke. The Kaplan-Meier method was used to estimate cumulative event rates, and a weighted Cox regression model employing an entropy balance approach was used to adjust for possible confounders. Results ICR was achieved in 132 patients (29.5%) and CR in 315 patients (70.5%). The mean follow-up after PCI was 1065±904 days (1213±938 in the ICR group; 1002±883 in the CR group). The crude 4-year incidence of MACE was 35.0% with ICR and 34.7% with CR (HR 0.93, 95% CI 0.62 to 1.39, p=0.710). Adjusted analysis confirmed no significant difference (32.5% vs 34.1%; HR 1.01, 95% CI 0.62 to 1.64, p=0.971). Conclusion In this registry, CR after TAVI was common but not associated with improved outcomes compared with ICR. These results support a selective rather than systematic pursuit of CR in elderly, high-risk post-TAVI patients.
Background Evidence supporting dietary interventions for heart failure (HF) prevention remains limited. The Dietary Approaches to Stop Hypertension (DASH) diet has been proposed as a cardioprotective dietary pattern, but population-level evidence linking DASH adherence to HF risk is sparse. Aim To examine the association between adherence to the DASH diet—characterised by high intake of vegetables, fruits and whole grains, and lower consumption of sodium and red and processed meat—with combined risk of HF incidence and death due to HF, as well as its risk factors, namely hypertension and type 2 diabetes mellitus (T2DM). Methods A prospective cohort analysis was conducted using UK Biobank participants free of HF at baseline (2006–2010), with follow-up to 2024. Dietary intake was assessed using ≥2 instances of 24-hour recall. DASH scores were derived and categorised into quintiles. Fine-Gray competing risks Cox models estimated adjusted HRs (aHRs) and 95% CIs for a primary composite outcome of incident HF or HF-related death, adjusting for sociodemographic factors, deprivation, obesity, smoking, hypertension and T2DM and accounting for all-cause mortality. Secondary outcomes were incident hypertension and T2DM. Results Among 124 777 participants (mean age 56.1±7.8 years; 56% female; 7% with diabetes; 36% with hypertension), followed for a mean of 12 years, 2931 HF events and 441 HF-related deaths occurred. Compared with the lowest DASH adherence quintile, the highest quintile had a lower risk of HF after adjustment for sociodemographic factors (aHR 0.79, 95% CI 0.70 to 0.89, p<0.001) and comorbidities (aHR 0.89, 95% CI 0.79 to 1.00, p<0.05). Greater DASH adherence was associated with reduced risk of hypertension (aHR 0.91, 95% CI 0.86 to 0.96, p<0.001) and T2DM (aHR 0.82, 95% CI 0.75 to 0.90, p<0.001). Conclusions Greater adherence to the DASH diet was associated with lower combined risk of HF and death due to HF, as well as hypertension and T2DM, supporting the role of a DASH diet in HF prevention.
Background Quality of life (QoL) measures are commonly used in randomised trials assessing therapies for stable angina. As these outcomes rely on patient reporting, they are susceptible to placebo and expectation effects when blinding is absent. It remains unclear whether trials investigating QoL outcomes in stable angina routinely incorporate blinded designs. Methods We performed a meta-epidemiological analysis of randomised controlled trials evaluating therapeutic interventions for stable angina, examining the association between QoL endpoint use and trial blinding. Trials were identified through systematic searches of MEDLINE from inception to February 2026. Trial characteristics including intervention type, QoL endpoint use and blinding status were extracted. QoL endpoint use was defined according to the primary endpoint where specified or any reported endpoint otherwise. Associations between QoL endpoint use and trial blinding were evaluated using Poisson regression to estimate adjusted prevalence ratios. Results A total of 381 randomised trials were included, of which 58 (15%) incorporated QoL endpoints. QoL endpoint use increased over time. Blinding status was available for 355 trials; 308 (87%) trials reported participant blinding. Trials using QoL endpoints were less frequently blinded than those without QoL endpoints (54% vs 92%). In adjusted analyses, QoL endpoint use was associated with a lower likelihood of blinding (adjusted prevalence ratio 0.70, 95% CI 0.57 to 0.87, p=0.001). Findings remained consistent in a sensitivity analysis restricted to trials with explicitly stated primary endpoints. This pattern was observed across pharmacological, interventional and other therapies. Conclusion In randomised trials of therapies for stable angina, QoL endpoints are increasingly used but are less frequently accompanied by blinded trial designs. Given the vulnerability of subjective outcomes to bias, these findings highlight a potential blinding paradox in angina trials, whereby outcomes most prone to bias are often evaluated in studies that are less likely to incorporate blinding. PROSPERO registration number CRD420261336319.
OBJECTIVE:Prolonged length of stay (LOS) contributes substantially to the healthcare burden in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), yet large-scale evidence from Chinese populations remains limited. This study aimed to identify factors associated with prolonged LOS among AMI patients undergoing PCI. METHODS:Data were derived from the nationwide CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) registry (November 2014 to December 2020). A total of 70 209 AMI patients aged 18-80 years undergoing PCI were included. Prolonged LOS was defined as >75th percentile. Multivariable logistic regression was used to identify independent predictors. Temporal trends in LOS from 2015 to 2020 were also assessed. Patients were further stratified by five pre-admission risk factors to assess dose-response relationships. RESULTS:LOS decreased in ST-segment elevation myocardial infarction from 2015 to 2017 but remained stable thereafter, with no significant change in non-ST-segment elevation myocardial infarction. Female sex (OR=0.823), prior PCI (OR=0.745) and hyperlipidaemia (OR=0.917) were associated with a lower risk of prolonged LOS, whereas older age (OR=1.013), prior heart failure (OR=2.230), diabetes (OR=1.140) and transient ischaemic attack (OR=1.341) were independently associated with an increased risk of prolonged LOS (all p<0.05). A significant dose-response relationship was observed, with higher risk associated with increasing numbers of risk factors. CONCLUSION:Prolonged LOS among AMI patients undergoing PCI was associated with both baseline characteristics and in-hospital factors, with a clear cumulative effect, which may aid risk stratification and optimisation of in-hospital management. TRIAL REGISTRATION NUMBER:NCT02306616.
Background Racial and ethnic differences in diabetic cardiomyopathy (DbCM) exist, with black and Hispanic participants showing poorer health status. It remains unclear whether these differences affect the natural progression of the disease. We aimed to evaluate disease progression in individuals with DbCM, as well as racial differences in the response to AT-001. Methods A total of 625 participants with DbCM were randomised to either placebo or AT-001 and followed for 15 months. The primary outcome was change in peak oxygen uptake (peak VO 2 ) and secondary outcomes included Kansas City Cardiomyopathy Questionnaire (KCCQ) and Physical Activity Scale for the Elderly scores. Analyses were stratified by race and ethnicity (black, Hispanic, white). Results Black and Hispanic participants who received placebo experienced greater declines in peak VO 2 (−0.74 and −1.67 mL/kg/min, respectively) compared with white participants (−0.23 mL/kg/min, p=0.005). AT-001 demonstrated a non-statistically significant trend towards slower declines in peak VO 2 in black and Hispanic participants (−0.31 and −0.62 mL/kg/min, p=0.29, respectively). Black participants who received placebo had the largest declines in most KCCQ scores. Conclusion Black and Hispanic participants with DbCM experienced faster disease progression, with black participants showing the most pronounced functional and quality of life declines. The effect of AT-001 on peak VO 2 changes was not statistically significant with similar effects between racial and ethnic groups ( NCT04083339 ). Trial registration number NCT04083339 .
AIM:Low adherence to a healthy lifestyle constitutes a major barrier to effective prevention of cardiovascular disease. We aimed to investigate the effect of pictorial-based information about subclinical atherosclerosis on adherence to health-promoting lifestyle recommendations. METHODS:Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) is a pragmatic, open-label randomised controlled trial within the Västerbotten Intervention Programme (VIP) in Sweden. In the VIP, residents of Västerbotten county are invited to a health survey and a health-promoting dialogue at the ages of 40, 50 and 60.A total of 3532 VIP participants were included in VIPVIZA during 2013-2016. They underwent a carotid ultrasound examination in addition to the usual VIP process and were randomised 1:1 to intervention group (receiving graphical colour-coded and age-related information about carotid intima-media thickness and plaques, written information about atherosclerosis and a motivational dialogue) or control group (no information or dialogue).We developed a lifestyle index based on self-reported physical activity, smoking habits, diet and alcohol consumption, ranging from 4 to 12, with higher levels indicating healthier lifestyles. We used ordinal regression to compare the lifestyle index in the intervention and control groups at the 3-year follow-up, with adjustments for baseline levels of lifestyle index, age, sex and education. RESULTS:The OR for having a healthier lifestyle index after 3 years was 1.20 (95% CI 1.01 to 1.42, p=0.03), comparing the intervention group to the control group. We found no interactions for age, sex or education. CONCLUSION:Our findings provide some evidence for the contributory role of pictorial-based information about subclinical atherosclerosis in promoting sustained healthy lifestyle habits. TRIAL REGISTRATION NUMBER:NCT01849575.
Background For patients with a high risk of sudden cardiac death, despite the benefits of an implantable cardioverter defibrillator (ICD), some patients are still at high risk of death.Aim The purpose of this study was to develop and validate a nomogram predicting all-cause mortality for patients with an ICD.Methods We retrospectively analysed the data of multicentre ICD registration study from 2010 to 2014 in China. A total of 617 ICD patients formed a development cohort. The physical activity monitored by ICD and clinical data was collected. Univariate and multivariate Cox regression analyses were used to screen mortality predictors and construct the nomogram. The performance of the nomogram was evaluated by the consistency index (C-index) and the calibration curve. Additionally, extensive subgroup and sensitivity analyses were conducted to evaluate the model’s robustness. A total of 196 ICD patients formed a validation cohort.Results In the development cohort, physical activity, diabetes and left ventricular end-diastolic diameter were selected as independent prognostic factors. The nomogram was constructed by these three factors. The C-index of the nomogram was 0.80 (95% CI 0.75 to 0.84). The calibration curve showed that the predicted survival probability of the nomogram was in good agreement with the actual survival probability. In the validation cohort, the C-index of the nomogram was 0.74 (95% CI 0.64 to 0.84), and the calibration curve still maintained good consistency. Crucially, the nomogram maintained stable and excellent discriminative capacity across primary and secondary prevention subgroups, as well as for predicting specific cardiac and sudden cardiac death.Conclusions Our study develops and validates a nomogram predicting all-cause mortality for patients with an ICD by integrating the physical activity monitored by ICD and clinical data. The nomogram performs well and can provide personalised death risk assessment for ICD patients.Trial registration number ChiCTR-ONRC-13003695.
Background Circulatory collapse at hospital arrival represents one of the most severe clinical presentations of ST-segment elevation myocardial infarction (STEMI) and is associated with poor prognosis. Statins exert pleiotropic effects beyond lipid-lowering, including anti-inflammatory, endothelial, microvascular and plaque-stabilising actions which may influence early clinical severity in myocardial infarction. We investigated the association between pre-admission statin therapy and circulatory collapse at hospital arrival in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).Methods This retrospective single-centre study included 551 consecutive patients with STEMI undergoing primary PCI. Pre-admission statin therapy was defined as continuous statin use for ≥30 days before admission. The primary outcome was circulatory collapse at hospital arrival, defined using an operational definition of advanced haemodynamic compromise before primary PCI. Multivariable logistic regression and sensitivity analyses including propensity score adjustment and inverse probability of treatment weighting were performed.Results Circulatory collapse occurred in 77 patients (14.0%) and was less frequent among patients receiving statins than among those not receiving statins (7.5% vs 16.6%, p=0.005). In the primary multivariable model, pre-admission statin therapy was associated with a lower risk of circulatory collapse (adjusted OR 0.23; 95% CI 0.10 to 0.50; p<0.001). This association remained consistent across sensitivity analyses, including exclusion of lactate-based classification without pre-PCI cardiopulmonary arrest or pharmacological/mechanical circulatory support, propensity score adjustment, inverse probability of treatment weighting and additional adjustment for background preventive medications. 30-day mortality did not differ significantly according to pre-admission statin therapy status.Conclusions Pre-admission statin therapy was associated with a lower risk of circulatory collapse at hospital arrival in patients with STEMI undergoing primary PCI. These findings suggest that chronic statin therapy may be associated with a less severe early haemodynamic phenotype at STEMI presentation, although residual confounding cannot be excluded.
BACKGROUND:Clinical benefit of percutaneous coronary intervention (PCI) in chronic coronary syndromes (CCS) remains controversial. Coronary wave intensity analysis (WIA) provides mechanistic insights into cardiac-coronary coupling. OBJECTIVES:To assess peri-PCI WIA changes at rest and during hyperaemia, and to identify features associated with improvements in epicardial and microvascular resistance. METHODS:Intracoronary Doppler and pressure measurements were analysed in 27 CCS patients undergoing elective PCI. Haemodynamics (fractional flow reserve (FFR), basal and hyperaemic stenosis resistance (bSR, hSR), coronary flow reserve (CFR), basal and hyperaemic microvascular resistance (bMR, hMR)) and WIA metrics (forward compression wave (FCW), backward compression wave (BCW), forward expansion wave (FEW), backward expansion wave (BEW), wave speed) were quantified at rest and hyperaemia. RESULTS:PCI reduced bSR and hSR (p<0.001), increased FFR (0.58±0.18 to 0.87±0.09; p<0.001) and CFR (1.68±0.47 to 2.79±0.62; p<0.001), and lowered hMR (2.22 (1.67-3.10) to 1.49 (1.18-1.74); p<0.001). At rest, PCI increased FCW (40.3±48.9 to 89.3±64.8; p=0.022), FEW (24.5 (7.2-42.8) to 58.8 (24.0-93.1); p=0.001) and BEW (57.6±70.6 to 82.1±51.8; p=0.017). Hyperaemic backward wave peaks augmented significantly (BCW: 77.8±53.3 to 172.8±112.3; BEW: 60.5±47.5 to 126.7±66.2; both p<0.001). WIA time-to-peaks occurred earlier post-PCI. Reduced resting wave speed (41±21 to 25±10 m/s; p<0.001) correlated with hMR decreases (r=0.77; p<0.001). Increased resting BEW correlated with total vascular resistance reductions (hSR+hMR; r=-0.76; p<0.001). CONCLUSIONS:Elective PCI restores phasic cardiac-coronary coupling. Resting BEW and coronary wave speed provide complementary physiological endpoints reflecting microvascular and epicardial recovery, warranting larger prospective evaluation.
Background This study assessed cardiac performance in response to maximal physiological stress in recreational long-distance runners.Methods In this cross-sectional observational study, 44 male recreational long-distance runners (age 32.6±8.8 years; body mass index 23.4±2.2 kg/m²) and 41 age-matched and sex-matched untrained controls performed a maximal cardiopulmonary exercise test on a cycle ergometer. Gas exchange and haemodynamic (bioreactance) measurements were assessed simultaneously. Cardiac power output (CPO), an integrative index of cardiac performance, was calculated from cardiac output and mean arterial pressure. Oxygen extraction was expressed as the arterial-venous oxygen difference (a–vO₂ diff).Results Runners achieved significantly higher maximal oxygen consumption than controls (53.2±6.8 vs 38.7±8.2 mL·kg⁻¹·min⁻¹, p<0.01) and higher peak work rate (276±31 vs 231±60 W, p<0.01). Despite superior aerobic capacity, runners demonstrated lower indices of cardiac performance at maximal exercise, including CPO (5.01±1.00 vs 5.64±1.46 W, p=0.03), cardiac output (18.7±3.0 vs 22.6±4.4 L·min⁻¹, p<0.01) and stroke volume (109±21 vs 126±28 mL·beat⁻¹, p=0.04). In contrast, a–vO₂ diff was approximately 30% higher in runners (21.6±3.7 vs 15.9±4.5 mL O₂·100 mL⁻¹ blood, p<0.01).Conclusions Long-distance runners demonstrate higher oxygen consumption and oxygen extraction but lower haemodynamic response to maximal exercise stress test. These findings may suggest a potential cardioprotective role of endurance training characterised by reduced cardiac workload during maximal physiological stress.
