Background: The 2023 AHA/ACC/HRS guidelines recommend against peri-procedural bridging of warfarin in patients with atrial fibrillation (AF) based solely on CHA₂DS₂-VASc score without additional thromboembolic (TE) risk factors. At our institution, decisions regarding bridging in moderate-to-high TE risk AF patients who require anticoagulation interruption incorporate patient-specific factors. Objective: To evaluate adherence to institutional peri-procedural guidelines and associated TE and bleeding events. Methods: This retrospective, single-center, observational study included AF patients receiving warfarin for stroke prevention enrolled in the anticoagulation management service. Patients had moderate-to-high TE risk (CHA₂DS₂-VASc ≥5 or other TE risk factors) and underwent moderate-to-high bleeding risk procedures between August 2023 and August 2024. Major outcomes included a composite of TE events (deep vein thrombosis, pulmonary embolism, cerebrovascular accidents, or transient ischemic attack) and a composite of International Society on Thrombosis and Haemostasis (ISTH) major and clinically relevant non-major bleeding (CRNMB) events within 30 days post-procedure. Minor outcomes included individual components of the composite outcomes and adherence to the institutional guideline. Results: Of the 145 procedures, bridging therapy was used in 87 (60%) and omitted in 58 (40%), with 92.4% compliance to institutional guidance. No TE events were observed. Of 21 bleeding events, one ISTH major bleed occurred in the bridging group and was attributed to the procedure, while 20 were CRNMB events. There were 15 (17.4%) CRNMB events in the bridging group and 5 (8.6%) in the non-bridging group. Conclusion: High adherence to institutional bridging guidelines was observed. A trend towards fewer bleeding events with no increased TE events was found in the non-bridging group in patients with moderate-to-high TE risk.
Cardiovascular disease remains the leading global cause of mortality despite advances in preventive therapies. Influenza infection is increasingly recognized as a trigger for acute cardiovascular events, prompting interest in influenza vaccination as a potential cardioprotective intervention in high-risk patients. We aimed to conduct a systematic review and meta-analysis to evaluate the effect of influenza vaccination on cardiovascular outcomes in adults with established cardiovascular disease. PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until October 2025. Seven studies were included after the final screening. Outcomes were reported as all cause mortality, myocardial infarction, major adverse cardiovascular events and heart failure related hospitalization. Interstudy heterogeneity was assessed using I² and X² statistics. Statistical calculations were performed using Review Manager 5.4.1, with a p-value of < 0.05 indicating statistical significance. Seven randomized controlled trials including 12,224 participants were analyzed. Influenza vaccination significantly reduced major adverse cardiovascular events and cardiovascular mortality. A borderline reduction was observed for myocardial infarction and all-cause mortality. No significant differences were found for stroke, coronary revascularization, or heart failure-related hospitalization. Heterogeneity was low for most primary outcomes. The routine use of influenza vaccination as an effective adjunctive strategy in secondary cardiovascular prevention is supported by the fact that it significantly lowers cardiovascular mortality and major cardiovascular events in patients with established heart disease.
BACKGROUND:Tricuspid regurgitation (TR) is a common but historically under-recognized valvular heart disease. Although mild to moderate TR was long considered benign, accumulating evidence indicates that clinically significant TR is associated with right ventricular failure, hepatic congestion, recurrent hospitalization, and increased mortality. AIMS:This review aims to provide a comprehensive overview of contemporary evaluation and management strategies for TR across its clinically relevant spectrum, with particular emphasis on severe disease and secondary mechanisms when discussing intervention. METHODS:Current literature was synthesized with a focus on TR classification, underlying mechanisms, imaging and hemodynamic assessment, risk stratification, device-related TR, and evolving therapeutic strategies, including both surgical and transcatheter approaches. RESULTS:Management paradigms have shifted toward earlier recognition and intervention, with echocardiography remaining central to diagnosis and procedural planning. While medical therapy is primarily supportive, advances in transcatheter edge-to-edge repair, annuloplasty systems, and transcatheter valve replacement have significantly expanded treatment options, particularly for patients at high surgical risk. Key determinants of therapeutic decision-making include pulmonary artery pressure, right ventricle-pulmonary artery coupling, right-sided chamber remodeling, surgical risk, and anatomic suitability. CONCLUSION:TR represents a complex and rapidly evolving area of cardiology that requires individualized assessment based on anatomy, hemodynamics, comorbidities, and the quality of available evidence. Ongoing clinical trials and emerging therapies are expected to further refine treatment algorithms and future guideline recommendations.
This study aimed to determine whether angiography-based physiological assessment yields clinical outcomes comparable to those of conventional wire-based pressure measurements in patients with coronary artery disease (CAD) undergoing evaluation of intermediate coronary stenoses. A systematic literature search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials through April 12, 2026. Randomized controlled trials comparing angiography-derived indices (such as QFR, vFFR, and angiography-based FFR) with standard wire-based methods (FFR/iFR) were included. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model, and heterogeneity was evaluated using the I² statistic. A total of three randomized trials involving 6,141 participants were included, with 3,089 patients assigned to angiography-derived assessment. At 12 months, no statistically significant difference was observed in major adverse cardiovascular events between the two strategies (RR 1.14; 95% CI 0.58-2.25; P =.48). Additionally, outcomes including all-cause mortality, myocardial infarction, target vessel failure, repeat revascularization, stent thrombosis, stroke, and cardiac mortality were comparable across groups (all P >.05). Angiography-derived physiological assessment provides similar short-term clinical outcomes to traditional wire-based techniques, supporting its use as a less invasive alternative for assessing intermediate coronary lesions. Larger studies with extended follow-up are needed to confirm these findings.
BACKGROUND:Despite the use of atrial fibrillation (AF) cutoff of 30s as the standard for success in most AF clinical trials, patients consider an AF Severity Scale (AFSS) of ≤ 5 or AF duration ≤ 1 hour as treatment success. Prevalence and factors associated with these patient-defined endpoints are unknown. METHODS:We performed a cross-sectional analysis using a single-site cohort of AF patients. We report rates of patient-defined treatment success (AFSS ≤ 5 or AF burden ≤ 1 hour) and multivariable analyses to identify factors associated with either successful outcome. RESULTS:From 2019 to 2023, 2087 patients had available AFSS symptom scores and 2305 had ambulatory ECG monitoring. Of these, 862 (41%) had AFSS scores ≤5 and 1130 (49%) had AF burden ≤1 hour. After adjusted analysis, older age (OR 1.03, 95% CI 1.02-1.04, p <0.001) was associated with AFSS ≤5. Whereas female sex (OR 0.43, 95% CI 0.35-0.52, p <0.001), CKD, COPD, depression, and CHF were less likely to meet AFSS threshold. Among the AF burden cohort, age (OR 0.98, 95% CI 0.97-0.99, p <0.001), and female sex (OR 1.24, 95% CI 1.03-1.50, p=0.025) were associated with AF burden ≤ 1 hour. Unlike the AFSS cohort, medical comorbidities such as COPD and CHF, were not significantly different for meeting AF burden goal. CONCLUSION:Less than half of AF patients had AF-symptom scores or arrhythmia burdens reflecting patient-defined treatment success. Factors associated with reaching patient reported outcome goals were distinct from those associated with arrhythmia burden goals.
