Transfemoral transcatheter aortic valve implantation (TAVI) is the treatment of choice for severe aortic stenosis in patients with elevated surgical risk. However, vascular complications remain a major source of morbidity and mortality. The protection wire technique was introduced to prevent major access-related complications, but its role in contemporary TAVI practice is uncertain. To evaluate whether routine protection wire use reduces vascular complications in contemporary transfemoral TAVI. We performed a retrospective, single-centre analysis of 1476 consecutive patients undergoing transfemoral TAVI between January 2020 and August 2023. Until November 2021, protection wire placement was standard-of-care (Group 1, n = 801); thereafter procedures were performed without routine protection wire use (Group 2, n = 675). Vascular complications were defined according to VARC-3 criteria. Multivariable logistic regression was used to identify independent predictors of minor and major vascular complications. The composite of minor and major vascular complications occurred more frequently in Group 1 than in Group 2 (18.6
Real-world evidence on lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) control in patients at high cardiovascular (CV) risk without prior myocardial infarction (MI) or stroke remains limited. We evaluated LLT use, treatment intensification, LDL-C monitoring, and LDL-C goal attainment across North America, Europe, and Asia-Pacific. VESALIUS-REAL is a retrospective observational study using a common protocol across 11 databases between 2017 and 2022. Eligible patients (aged ≥ 50 years) had coronary artery disease, atherosclerotic cerebrovascular disease, peripheral artery disease, or high-risk diabetes, together with elevated lipids, and additional CV risk factors, but no history of MI or stroke or end-stage renal disease. The earliest date when all criteria were met was defined as the index date. LLT patterns and local guideline-recommended LDL-C goal achievement were summarised. Among 1,126,756 patients (51
Cardiovascular-kidney-metabolic (CKM) syndrome is associated with increased risks of cardiovascular disease (CVD) and all-cause mortality, but its relationship with body composition phenotypes remains unclear. This population-based cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2007–2018, linked to the National Death Index through December 31, 2019. Participants were stratified on body mass index (BMI) and waist-to-height ratio (WHtR): (1) obesity with central adiposity (high BMI, high WHtR), (2) obesity without central adiposity (high BMI, low WHtR), (3) normal weight with central adiposity (normal BMI, high WHtR), and (4) normal weight without central adiposity (normal BMI, low WHtR). CKM multimorbidity was defined as ≥ 2 of hypertension, hyperlipidemia, diabetes, chronic kidney disease, and/or CVD. Primary and secondary outcomes were all-cause and cardiovascular mortality. Associations were assessed using survey-weighted Cox proportional hazards models. The weighted cohort represented 106.9 million US adults (mean age 47.2). Majority were normal weight without central adiposity (53.3
Accurate pre-procedural computed tomography (CT) analysis is essential for optimal valve sizing and clinical outcomes in transcatheter aortic valve implantation (TAVI). Recently, fully automated, artificial intelligence (AI)-based CT analysis platforms have been developed to simplify and standardize this process. The aim of the study was to investigate the clinical impact of this new analysis method on the selection of valve prosthesis size. Overall, 247 patients with symptomatic severe aortic stenosis were enrolled. Patients underwent TAVI procedures at two different heart centres. The pre-procedural datasets were analysed by a standard TAVI CT-analysis software (3M, Pie Medical Imaging BV, The Netherlands) and a fully-automated CT-analysis-platform employing a deep-learning based algorithm. Key annular measurements and simulated prosthesis size selection were compared between both methods. The mean aortic annulus diameter was 24.5 ± 2.3 mm (3mensio) and 24.4 ± 2.4 mm (AI), respectively, with a mean absolute error (MAE) of 0.6 mm and mean absolute percentage error (MAPE) of 2.6
Elevated plasma ketone bodies (KBs) are linked to poor outcomes in heart failure (HF), yet the prognostic value of repeated KB measurements is uncertain. To study temporal changes in plasma KBs in HF patients in relation to prognosis. Plasma KBs were measured by nuclear magnetic resonance spectroscopy in 467 patients from the TRIUMPH study. Blood was obtained up to seven times during 1-year follow-up after HF hospitalization. Associations between serial KB measurements and the endpoint of death and HF rehospitalization were investigated by joint modeling. Similar analyses were conducted in the Bio-SHiFT study, including 397 chronic HF patients with up to 10 repeated blood samples during a median follow-up of 2.1 years. The endpoint in Bio-SHiFT was a composite of cardiovascular death, HF hospitalization, left ventricular device implantation and heart transplantation. In TRIUMPH, median age was 74 years, 37
BACKGROUND AND AIMS:Up to 30% of patients fail to respond after cardiac resynchronization therapy (CRT). While echocardiographic predictors of response are well described in de novo CRT, evidence in CRT upgrade populations remains limited. We investigated predictors of echocardiographic response in the BUDAPEST-CRT Upgrade trial cohort. METHODS:In this randomized trial, 360 patients with heart failure and reduced ejection fraction (HFrEF) with priorly implanted pacemaker or ICD, ≥ 20% right ventricular (RV) pacing burden, and wide-paced QRS (≥ 150 ms) were randomized to CRT-D upgrade (n = 215) or ICD upgrade (n = 145). Echocardiographic response was defined as ≥ 15% reduction in left ventricular end-systolic volume (LVESV) at 12 months. RESULTS:Among 275 patients with paired echocardiographic data, 161 (59%) were responders. Responders had fewer HF hospitalizations (0.6% vs. 7.0%, p = 0.003), more often received mineralocorticoid receptor antagonists (71% vs. 59%, p = 0.038), and showed a higher baseline RV pacing burden (88.9% vs. 83.4%, p = 0.025) than non-responders. Independent predictors of echocardiographic response were randomization to CRT-D (OR 5.57, 95% CI 2.56-12.12, p < 0.0001), greater RV pacing burden (OR 1.02 per %, 95% CI 1.00-1.04, p = 0.024), non-ischemic cardiomyopathy (OR 2.50, 95% CI 1.15-5.26, p = 0.021), and a lateral LV lead position (OR 8.79, 95% CI 1.28-60.39, p = 0.027). CONCLUSIONS:In patients with pacing-induced cardiomyopathy, CRT-D upgrade significantly improved echocardiographic outcomes. Non-ischemic etiology, higher RV pacing burden, and lateral LV lead positioning were associated with greater benefit. These results underscore the importance of tailored patient selection and lead placement strategies to optimize CRT-D upgrade outcomes.
Although diabetes is a recognized risk factor for atrial fibrillation (AF) and heart failure (HF), the cardiovascular consequences of prediabetes remain unclear, particularly regarding AF subtypes and HF development. This study aimed to evaluate the association of prediabetes with new-onset AF, including subtype specificity, and its association with HF development using an international, real-world cohort. We analyzed de-identified electronic health records from the TriNetX network, including adults aged 18-79 years without prior AF or atrial flutter. Prediabetes was defined as hemoglobin A1c (HbA1c) 5.7-6.4
Cardiac involvement is the major determinant of mortality in variant TTR amyloidosis (ATTRv). Treatment options have recently become available, which make early diagnosis important. Several imaging modalities for screening are proposed including bone scintigraphy, conventional, and strain echocardiography but data on their relative value is limited in this population. To investigate the value of left ventricular global longitudinal strain (LV-GLS) for screening for cardiac involvement in a population of transthyretin (TTR) pathogenic variant carriers. Fifty-three TTR pathogenic variant carriers from two Dutch academic hospitals underwent transthoracic echocardiography (TTE) and bone scintigraphy as part of routine out-patient care to assess cardiac involvement. LV-GLS was measured by two blinded reviewers. Abnormalities in LV-GLS (cut-off − 21.5
Fabry disease (FD) is a progressive X-linked lysosomal storage disorder characterized by the accumulation of pathological glycosphingolipids in a wide range of cells, leading, among others, to vascular endothelial dysfunction. Advanced atherosclerosis, indicated by increased intima-media thickness (IMT), and endothelial injury, characterized by impaired arterial flow-mediated dilatation (FMD), are associated with a higher cardiovascular risk seen in these patients. Next, echocardiography may provide non-invasive insight into cardiac changes that may also correlate with endothelial dysfunction in FD. However, evidence on that relationship is scarce, especially regarding sex differences. Therefore, we aimed to evaluate endothelial function together with echocardiographic changes in a cohort of Polish FD patients. We assessed brachial artery FMD, measured common carotid artery IMT, and performed transthoracic echocardiography to evaluate cardiac involvement in 31 FD patients without cardiovascular events in medical history (17 male and 14 female patients) and 31 controls matched by age, sex, and body mass index (BMI). FD patients exhibited a 54.8
In patients with chronic coronary syndrome, risk factors for ischaemic events and bleeding tend to overlap. However, the combined effects of these factors have scarcely been studied in contemporary real-world settings. All patients in Sweden undergoing elective PCI for chronic coronary syndrome between 2006 and 2014 enrolled in the SWEDEHEART registry were included. Six risk factors (age ≥ 65 years, chronic kidney disease, diabetes, multivessel disease (MVD), prior bleeding, and prior acute myocardial infarction (AMI)) were assessed in relation to the risk of ischaemic (cardiovascular death/AMI/stroke) and major bleeding events. We studied 24,051 patients, of whom 59
Concomitant mitral (MR) and/or tricuspid regurgitation (TR) in patients with aortic stenosis (AS) is often regarded as a late-stage disease manifestation, resulting from left ventricular damage, pulmonary hypertension, and right heart dysfunction. However, we assume that atrioventricular valve regurgitation in the context of severe AS may often develop as an independent entity, but knowledge regarding these patients and their risk factors is scarce. The aim of this study was to characterize patients who develop atrioventricular valve regurgitation after transcatheter aortic valve replacement (TAVR) and its impact on mortality. We analyzed patients with severe AS but without concomitant atrioventricular valve disease undergoing TAVR between January 2016 and December 2021. Novel MR and/or TR ≥ grade 2 and its impact on 3-year all-cause and cardiovascular mortality were evaluated. A total of 1034 TAVR patients without preexisting atrioventricular valve regurgitation were included in the study. Of these, 114 patients (11.0
Early detection of atrial fibrillation (AF) may reduce the risk of complications such as stroke. This study evaluated the diagnostic performance of a toilet seat-integrated electrocardiogram (TS-ECG) for AF detection under controlled clinical conditions. This prospective multicentre feasibility study included 83 participants (mean age 64 years, 55
Fractional flow reserve (FFR) is the gold standard for evaluating the functional significance of coronary stenosis. With advances in methods based on computational fluid dynamics and three-dimensional vessel reconstructions, non-invasive assessment using indices such as vessel FFR (vFFR) has become feasible. To evaluate the association between vFFR and optical coherence tomography (OCT)-derived parameters in patients with chronic coronary syndromes (CCS). In this single-center, prospective, observational study, patients with CCS and intermediate coronary stenoses (40–80
Sirolimus-coated balloons (SCB) may offer improved antiproliferative efficacy over paclitaxel-coated balloons; however, data regarding their performance in de novo coronary lesions are limited. The GINGER study aimed to evaluate the angiographic efficacy and clinical safety of a SCB (Magic Touch®) in the treatment of long (≥ 25 mm) de novo coronary artery lesions. This observational, prospective, multicenter, single-arm cohort study enrolled patients with at least one long de novo lesion treated with SCB. Co-primary endpoints were late lumen loss (LLL) and net lumen gain at 9 months. Secondary endpoints included: procedural success, periprocedural myocardial infarction, binary restenosis and a device-oriented composite endpoint (DOCE), defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI) and clinically-driven target lesion revascularization (CD-TLR). The study was registered at ClinicalTrials.gov (NCT05471245). A total of 104 patients was enrolled at 8 centers. Mean lesion length was 28.9 ± 16.0 mm and reference vessel diameter was 2.3 ± 0.6 mm. Procedural success was achieved in all cases. At 9-month angiographic follow-up, LLL was 0.28 ± 0.68 mm, net lumen gain 0.62 ± 0.63 mm, and binary restenosis was observed in 33.3
Systemic inflammation is increasingly linked to atrial arrhythmogenesis, yet arrhythmic risk and downstream cardiovascular complications remain poorly quantified for inflammatory diseases managed outside cardiology, including neutrophilic dermatoses such as pyoderma gangrenosum (PG). We performed a global, large retrospective cohort study, including 147 healthcare organizations. Adults were included in three separate 1:1 propensity score–matched cohorts: (1) PG vs non-PG to assess incident AF and relevant arrhythmogenic heart disease; (2) PG with vs without AF to examine AF-related outcomes within PG; and (3) AF with vs without PG to examine the impact of PG within AF. Patients were followed for up to 5 years. Cox proportional hazards models, 90-day sensitivity analyses, and negative control outcomes enhance robustness. Among 11,351 adults with PG and 2,132,938 without PG, matching yielded 11,216 well-balanced in each cohort. PG was associated with higher 5-year AF incidence (HR 1.61, p < 0.001). Among 1286 PG patients with AF and 10,834 without AF, 1133 pairs were matched. In the PG population, AF was associated with higher risks of systemic thromboembolism (HR 2.26, p < 0.001), heart failure (HR 4.19, p < 0.001), and all-cause mortality (HR 1.59, p < 0.001). In the AF population (1286 AF patients with PG; 2,400,413 without PG), PSM yielded 1265 pairs. PG was associated with increased systemic embolism (HR 2.03, p < 0.001), heart failure (HR 2.17, p < 0.001), and mortality (HR 1.53, p < 0.001). Negative control outcomes were consistently null; Cox proportional hazards models and sensitivity analyses showed similar patterns. PG was associated with increased incident AF and, among patients with AF, identified a high-risk phenotype with substantially higher thromboembolic events, heart failure, and mortality.
Data on left atrial appendage closure (LAAC) in valvular patients remain limited. This study aimed to evaluate procedural safety and outcomes of LAAC in patients with and without prior mitral valve interventions (PMVI). Patients who underwent transcatheter LAAC between 2016 and 2023 across high-volume centers in Europe and North America were included. Patients were stratified according to the presence or absence of PMVI (surgical or transcatheter). The primary endpoint was a composite of all-cause mortality and ischemic events (ischemic stroke or systemic embolism) at 2 years. Among 1,213 consecutive patients, 142 had PMVI. Patients with PMVI had higher rates of chronic heart failure, permanent AF, and lower left ventricular ejection fraction. Disc-lobe devices and combined procedures were more frequently used in the PMVI group. Procedural success was very high in both groups (99.3
Coronary computed tomography angiography (CCTA) as first-line diagnostic tool for suspected coronary artery disease (CAD) offers detailed assessment of coronary plaque, yet data on non-calcified components remain limited. This study aims to analyze total coronary plaque burden as well as non-calcified plaque characteristics in an ESC-guideline-selected cohort and to establish age- and sex-specific percentile distributions and benchmark values for quantitative plaque assessment. All patients undergoing CCTA for a clinical indication at a German outpatient institution between July 2017 and June 2020 were included. Plaque analysis using validated semi-automated software was performed on all coronary arteries; plaque burden was measured with differentiation among total, calcified, non-calcified, and low-attenuation components. Of 5412 patients, coronary plaques were present in 67.1
The Endothelial Activation and Stress Index (EASIX) is a routinely available marker of endothelial activation and systemic stress. Although baseline EASIX predicts mortality in chronic heart failure, its long-term longitudinal behavior and prognostic relevance during follow-up remain insufficiently characterized. To assess whether serial EASIX measurements identify clinically relevant risk trajectories and improve dynamic mortality risk stratification in chronic heart failure. We analyzed 1924 patients with chronic heart failure from the Heidelberg chronic heart failure outpatient registry with at least two available EASIX measurements. The main landmark transition analysis included 1789 patients with valid first-to-second transition assignment, follow-up after the second EASIX measurement, and complete covariate data for the adjusted Cox model. Patients were categorized into early EASIX transition groups using the median baseline log2(EASIX) threshold applied to the first and second measurements. Survival analyses were landmarked at the second EASIX measurement. Associations with all-cause mortality were assessed using multivariable Cox regression, patient-specific EASIX slopes derived from linear mixed-effects models, and time-updated Cox models. In the full longitudinal cohort, 330 deaths occurred. In the adjusted landmark transition cohort, patients rising from low to high EASIX had markedly increased subsequent mortality compared with stable low patients (adjusted HR 2.33, 95
Percutaneous pericardiocentesis is the standard diagnostic and therapeutic procedure for severe pericardial effusion (PE). While its procedural safety has improved over time, data on long-term outcomes in cancer patients remain limited. We aim to evaluate clinical outcomes after pericardiocentesis, with a specific focus on neoplastic-related PE. We collected data of patients who underwent percutaneous pericardiocentesis at the University Hospital of Modena, between December 2006 and September 2025. Patients were stratified into three groups: neoplastic, idiopathic, and other specific etiologies. The primary endpoint was all-cause mortality, while the secondary endpoint was a composite of in-hospital adverse events. A total of 179 patients were included (median age 72, 39.7
