ABSTRACT Background De novo heart failure (HF) during the first ST‐segment elevation myocardial infarction (STEMI) hospitalization significantly increases mortality and readmission. While nutritional and inflammatory indicators like the advanced lung cancer inflammation index (ALI) and modified Controlling Nutritional Status (mCONUT) score are gaining attention, their exact association with post‐STEMI de novo HF remains unclear. Methods This retrospective study (January 2016 to June 2025) included 1598 first‐time STEMI patients undergoing percutaneous coronary intervention. Patients were categorized into de novo HF and non‐HF groups to evaluate the association of ALI and mCONUT scores with HF development. Results The HF group exhibited significantly lower ALI and higher mCONUT scores compared to the non‐HF group. Multivariate logistic regression identified lower ALI and higher mCONUT scores as independent predictors of HF risk. Receiver operating characteristic analysis demonstrated that mCONUT possessed better predictive performance than ALI, with effects remaining highly consistent across subgroups. Sensitivity analyses and NRI/IDI results confirmed that mCONUT provides independent incremental predictive value beyond traditional risk models (optimism‐corrected C ‐statistic 0.785 vs. 0.751). These associations were independent of admission hemodynamic status (Killip class) and treatment era. Conclusion Both ALI and mCONUT scores are independently associated with in‐hospital de novo HF in STEMI patients. The mCONUT score demonstrates superior predictive performance, serving as a promising indicator for early risk stratification.
ABSTRACT Aims and Background Transthyretin amyloid cardiomyopathy (ATTR‐CM) is the most common form of cardiac amyloidosis leading to restrictive cardiomyopathy and progressive heart failure. The prognostic relevance of inflammatory biomarkers is unknown so far. This study aims to evaluate an association of white blood cell (WBC) count and clinical outcome in form of hospitalisation for heart failure in ATTR‐CM patients. Methods and Results WBC count was assessed in 150 patients (median age 80 [76−82] years; 13.3% female) with ATTR‐CM from the West German Amyloidosis Center. Most patients (95.3%) received transthyretin stabilizer therapy. The cohort was divided into patients with low and high WBC count by median split. Hospitalisation for heart failure was defined as primary endpoint. The median follow‐up time was 825 (728−932) days. ATTR‐CM patients with high WBC count showed higher prevalence of heart failure with reduced ejection fraction (HFrEF) at baseline assessment. High WBC count was mainly driven by a relative increase in neutrophils. During follow‐up incidence of hospitalisation for heart failure was higher in patients with high WBC count (log‐rank p = 0.035). Cox regression confirmed an association between WBC count and occurrence of hospitalisation due to heart failure (hazard ratio [HR]: 1.130; 95% confidence interval [CI]: 1.015−1.257; p = 0.025), which was unaffected after adjustment for further confounders. Conclusions Increased WBC count was associated with incidence of hospitalisation for heart failure in ATTR‐CM patients, indicating a potential for inflammatory biomarkers in disease monitoring.
ABSTRACT Background Right ventricular (RV) adaptation to increased pulmonary afterload is a major determinant of prognosis in pulmonary hypertension (PH), yet comprehensive validation of simple noninvasive markers against invasive hemodynamic parameters remains limited. We investigated whether the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio reflects the clinical, echocardiographic, and invasive hemodynamic spectrum of PH. Methods We retrospectively analyzed 209 consecutive patients with right heart catheterization‐confirmed PH who underwent comprehensive clinical assessment, transthoracic echocardiography, and invasive hemodynamic evaluation between 2016 and 2024. Patients were stratified into quartiles according to the TAPSE/sPAP ratio, and clinical, laboratory, echocardiographic, and hemodynamic characteristics were compared. Results The mean age was 58.8 ± 16.5 years, and 61% of patients were female. Lower TAPSE/sPAP ratios were associated with older age, higher NT‐proBNP and serum uric acid levels, and lower estimated glomerular filtration rate (all p < 0.05). Decreasing TAPSE/sPAP ratios were also associated with larger right atrial and right ventricular dimensions, lower TAPSE, and higher tricuspid regurgitation velocity and estimated sPAP (all p < 0.001). Invasive hemodynamic assessment demonstrated progressively higher right ventricular systolic pressure, mean pulmonary artery pressure, and pulmonary vascular resistance (all p < 0.001), whereas mixed venous oxygen saturation increased across quartiles ( p = 0.036). Conclusions The TAPSE/sPAP ratio is a practical, noninvasive marker that closely reflects right ventricular remodeling and invasive hemodynamic impairment in pulmonary hypertension. Lower TAPSE/sPAP ratios identify patients with more advanced RV–pulmonary arterial uncoupling and may improve bedside hemodynamic risk stratification.
ABSTRACT Background The prognostic and functional significance of chronotropic incompetence (CI) across different heart failure (HF) phenotypes remains unclear in previous studies. Hypothesis This study compared survival and exercise performance in HF patients with and without CI. Methods We systematically searched PubMed, Embase, Scopus, and Cochrane Library until October 2025. Prognosis outcomes were assessed using Cox proportional hazards models based on reconstructed individual patient data. Exercise performance metrics were analyzed as mean differences (MD) using a random‐effects model. Restricted mean survival time analyses quantified differences in life expectancy. Results Twenty‐one studies were included. CI was associated with a higher risk of composite cardiovascular events (hazard ratio: 2.75; 95% CI: 2.18–3.48; p < 0.001) and all‐cause mortality (hazard ratio: 1.97; 95% CI: 1.64–2.36; p < 0.001). Over 2500‐days, patients with CI experienced 410 and 176 fewer event‐free days for composite cardiovascular events and all‐cause mortality, respectively. Patients with CI had significantly lower resting heart rate (HR) (MD: −6.25 bpm; p < 0.001), peak HR (MD: −35.12 bpm; p < 0.001), and HR reserve (MD: −28.84 bpm; p < 0.001). Moreover, the CI subgroup experienced lower exercise duration (MD: −77.68 s; p : 0.021), peak workload (MD: −19.15 watts; p < 0.001), and peak VO 2 (MD: −3.34 mL·kg −1 ·min −1 ; p < 0.001); with a higher VE/VCO 2 slope (MD: 2.20; p < 0.001). The results remained robust in both reduced and preserved HF phenotypes. Conclusion CI is associated with poorer survival and impaired functional capacity. These findings underscore the clinical importance of recognizing and addressing CI in the management of HF patients.
ABSTRACT Background Atherosclerotic cardiovascular disease (ASCVD) remains a major global cause of morbidity and mortality, with obesity as a critical contributor. Traditional measures like body mass index (BMI) do not fully capture fat distribution or composition. Anthropometric and fat indices such as body fat (BF), may offer greater precision in ASCVD risk assessment. Methods We analyzed data from 1106 university individuals (26−72 years). The primary analysis included adults 40−70 years ( n = 761), for whom 10‐year ASCVD risk was estimated using the 2019 ACC/AHA Pooled Cohort Equations (PCE). We modeled continuous risk using sex‐adjusted linear regression with each index entered separately and We tested Index × Sex interactions. Discrimination for elevated risk (≥7.5%) was assessed with ROC/AUC. A secondary analysis in participants <40 years assessed discrimination for a composite high risk‐factor burden endpoint (≥2 abnormalities among BP, lipids, smoking, diabetes, BMI). Results The median (IQR) of ASCVD risk score was 1.33 (0.55−3.77), significantly higher in men than women (2.67 vs. 0.65; p < 0.001). Most participants (73.1%) were classified as low‐risk, though men had greater representation in higher‐risk categories. Furthermore, BF, Waist‐to‐height ratio (WHtR), and Waist‐to‐hip ratio (WHR) showed the strongest positive associations with continuous PCE risk, whereas Fat‐free mass (FFM) was inversely associated ( p < 0.001). For discriminating ≥7.5% risk, WHR performed best, BF and WC were modest and WHtR and BMI provided little to no discriminative ability. Conclusion Anthropometric indices such as WC, WHR, and BF are valuable discriminators of ASCVD risk, surpassing BMI in risk assessment and stratification.
