Cardiovascular-kidney-metabolic (CKM) syndrome represents a composite disease state driven by glucose and lipid metabolic dysregulation. The Cholesterol, High-density lipoprotein, and Glucose (CHG) index reflects the composite burden of these metabolic factors. However, its impact on the onset, stage-wise progression, and prognosis of CKM syndrome remains unclear. This study utilized data from two large-scale prospective cohorts. In the UK Biobank (UKB) cohort, Fine-Gray proportional subdistribution hazards models were employed to investigate associations between CHG levels and the risk of incident cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM), as well as the risk of progression from CKM Stage 0–1 to 2–3 and Stage 1–3 to 4. In the Beijing Anzhen Hospital cohort, Cox regression models assessed the impact of CHG on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with CKM Stage 4 (established coronary artery disease). A causal forest algorithm was used to identify high-value subpopulations, and restricted cubic splines (RCS) characterized dose-response relationships. Sensitivity analyses were conducted to verify result robustness. The study included 370,916 participants free of CKM diseases from UKB (median follow-up: 16.5 years) and 8,494 patients with CKM Stage 4 from Beijing Anzhen Hospital (median follow-up: 645 days). In the general population, each 1-SD increase in the CHG index was significantly associated with an increased risk of incident T2DM (HR: 1.47; 95

Atherosclerosis (AS) is a chronic inflammatory disease that underlies major cardiovascular disorders and necessitates early intervention. Central to its pathogenesis is reactive oxygen species-driven inflammation, which exacerbates plaque formation and progression. An ideal therapeutic strategy should simultaneously resolve lipid accumulation and suppress inflammatory pathways to restore homeostasis in the lesional microenvironment. Recently, the proliferation-inducing ligand (APRIL) has emerged as a promising therapeutic target for attenuating atherosclerotic plaque development. Here, we report a cyclodextrin-based, low-toxicity polyhydroxyl cationic vector (cyclodextrin-based ethanolamine-modified poly(glycidyl methacrylate), CD-PGEA-CD), engineered for efficient lipid scavenging and delivery of an APRIL-encoding plasmid (pAPRIL). This integrated nanoplatform (CD-PGEA-CD/pAPRIL) mediates robust APRIL overexpression in vitro concomitant with suppression of key pro-inflammatory cytokines (TNF-alpha and IL-6). In vivo, the system significantly reduced plasma low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels by 40% and 46%, respectively, and achieved near-complete regression of advanced plaques. All-atom molecular dynamics simulations elucidated the strong cholesterol-binding affinity of the platform, demonstrating its superior lipid-clearing efficiency through selective cholesterol sequestration and enhanced membrane interaction dynamics. Together, these findings establish a molecular-to-tissue therapeutic paradigm offering a safe and effective strategy for the treatment of AS.

BACKGROUND:The optimal long-term antithrombotic strategy in patients with atrial fibrillation (AF) and coronary artery disease (CAD) after successful catheter ablation (CA) remains uncertain. OBJECTIVE:This study aimed to compare the effectiveness and safety of single antiplatelet therapy (SAPT) vs oral anticoagulation (OAC) monotherapy in this population. METHODS:This cohort study used a target trial emulation framework based on data from the China Atrial Fibrillation Registry. Patients with nonvalvular AF and CAD who underwent index CA were screened. Those free from AF recurrence, thromboembolism, or bleeding 12 months after ablation were included and categorized according to antithrombotic regimen at the 12-month landmark. The primary effectiveness outcome was thromboembolism (ischemic stroke or systemic embolism), and the primary safety outcome was bleeding (International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding). Secondary outcomes included all-cause mortality and net clinical benefit. Inverse probability of treatment weighting was used for confounding adjustment. RESULTS:Among 998 patients (mean age 66.8 years; 26.5% women), 706 received SAPT and 292 OAC monotherapy. Over a mean follow-up of 3.0 years, 19 thromboembolic and 29 bleeding events occurred. After weighting, no statistically significant difference in thromboembolism was observed (hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.18-1.61), whereas SAPT was associated with lower bleeding risk (HR, 0.40; 95% CI, 0.18-0.91). No significant differences were observed in mortality (HR, 0.77; 95% CI, 0.35-1.72) or net clinical benefit (HR, 0.66; 95% CI, 0.36-1.20). CONCLUSION:In this stable postablation population with AF and CAD, SAPT was associated with lower bleeding risk vs OAC monotherapy, whereas no statistically significant difference in thromboembolism was observed.

BACKGROUND:The RIGHT trial was designed to assess the efficacy and safety of postprocedural anticoagulation (PPA) in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). OBJECTIVES:The authors aimed to report the prespecified 1-year outcomes. METHODS:RIGHT is an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled, superiority trial conducted in 53 sites across China. Patients with ST-segment elevation myocardial infarction were randomly assigned (1:1) after primary PCI to receive low-dose PPA (enoxaparin, unfractionated heparin, or bivalirudin) or matching placebo for at least 48 hours. Major adverse cardiac events (MACEs) including all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis (definite), and urgent revascularization (any vessel), were assessed during a 1-year follow-up. RESULTS:Over a median follow-up of 1.0 year (IQR: 1.0-1.0), MACE data were available for 99.2% of participants. MACEs occurred in 4.2% (63/1,494) of the PPA group and 4.9% (73/1,495) of the placebo group (HR: 0.86; 95% CI: 0.61-1.21), with no between-group difference in major bleeding (1.3% vs 1.5%; HR: 0.87; 95% CI: 0.47-1.62). In the group of enoxaparin vs placebo, we observed reduction of MACEs with enoxaparin (HR: 0.53; 95% CI: 0.30-0.97) with no excess bleeding. Meta-analyses also showed an advantage of enoxaparin over no anticoagulation in reducing MACEs at 30 days (risk ratio: 0.635; 95% CI: 0.399-0.997). CONCLUSIONS:Low-dose PPA after primary PCI was safe but did not reduce ischemic events at the 1-year follow-up. If clinically indicated, our results suggest that enoxaparin may be beneficial and warrants confirmation in future studies. (Comparison of Anticoagulation Prolongation vs. no Anticoagulation in STEMI Patients After Primary PCI [RIGHT]; NCT03664180).

Identifying the underlying cause of cardiac dysfunction is essential for determining the appropriate treatment and prognosis. The current management paradigm for heart failure (HF) and cardiomyopathies predominantly emphasizes structural and ischemic etiologies, often overlooking the substantial role of electrical dyssynchrony in cardiac dysfunction and remodeling. This work introduces a novel conceptual framework that integrates existing evidence illustrating how electrical dyssynchrony induces mechanical dyssynchrony, culminating in regional cardiac impairment and structural remodeling. The myocardial area that activated early lacks proper afterload, impairing its ability to perform work effectively. Consequently, disuse atrophy gradually manifests in the early activation area over time. We propose the concept of early-excitation segment atrophy (EESA) syndrome to address the HF caused by asynchronous conduction. For the left ventricle, whichever part contracts first will become disused and may contribute to or exacerbate HF. The conduction abnormalities known to induce EESA include left bundle branch block (LBBB), right ventricular pacing (RVP), bilateral bundle branch block (BBBB), Wolff-Parkinson-White (WPW) syndrome, and premature ventricular contractions (PVCs). Appropriate diagnosis and treatment will lead to improved left ventricular ejection fraction and reduced mortality. By integrating EESA into clinical practice, we aim to improve the recognition and management of dyssynchrony-induced cardiomyopathies, ultimately enhancing patient outcomes. This review presents an update of the mechanisms, prevalence, incidence, and risk factors, as well as their diagnosis and management, while highlighting current gaps of knowledge.

INTRODUCTION:The cryoballoon catheter is a gold-standard single-shot device for pulmonary vein isolation (PVI). Pulsed-field ablation (PFA) is a tissue-selective, nonthermal cardiac ablation modality. We assessed the preclinical safety and durability of a novel conformal, balloon-shaped, single-shot PFA catheter for PVI and circular atrial lesions. METHODS:A 13 Fr balloon-shaped PFA catheter (PFBalloonTM, 20 electrodes, 24 mm diameter, EnChannel Medical) was applied using a biphasic waveform of microsecond scale (± 750 V, 4.9 s per application). In 10 swine, superior vena cava (SVC), left superior PV (LSPV), right superior PV (RSPV) and right atrial appendage (RAA) were targeted for isolation. Localization of PFBalloon was evaluated by fluoroscopy and intracardiac echocardiography (ICE). PFA was delivered in a novel tailored configuration (small ring, large ring, or global pulse) to minimize diaphragm stimulation and optimize pulse efficiency. Five swine were assessed at 30 days post-procedure for lesion durability, gross pathology, and histologic examination, while the remaining five swine were evaluated at 90 days to assess longer term outcomes. RESULTS:In all 10 swine, PFA resulted in 100% successful acute isolation of the SVC, RSPV, and LSPV using 4.2 ± 0.6, 5.0 ± 1.1, and 4.4 ± 1.8 applications per vein, respectively, and acute isolation of RAA in 9/10 swine using 5.3 ± 2.0 applications. At 30 days post-procedure, 14 out of 20 targeted sites (70.0%) remained isolated in five pigs. At 90 days, 19 out of 20 sites (95.0%) remained isolated in the remaining five pigs. The overall pulse configurations were 9.0% small ring, 25.4% large ring, and 65.6% global. PFA did not affect phrenic nerve function, with very few microbubbles recorded on ICE. No major complications were observed. CONCLUSIONS:In this preclinical study, a novel conformal, balloon-shaped catheter designed for single-shot PVI can create durable isolation without complications.

BackgroundLeft ventricular (LV) geometric remodeling is a key pathophysiological feature in heart failure with preserved ejection fraction (HFpEF), yet its prognostic implications among patients with concomitant atrial fibrillation (AF) remain unclear.MethodsIn this prospective multicenter China-AF cohort study, we categorized baseline LV geometry as normal, eccentric hypertrophy, concentric remodeling, or concentric hypertrophy based on left ventricular mass index (LVMI) and relative wall thickness (RWT). The primary endpoint was a composite of cardiovascular death, thromboembolism, and major bleeding. Secondary outcomes included all-cause death and individual components. Associations were assessed using multivariable Cox regression.ResultsA total of 1,691 patients were included, with a median follow-up of 4.8 years. Abnormal LV geometry was present in 50.9% of patients. Concentric remodeling (adjusted HR [aHR] 1.53, 1.17–2.01) and concentric hypertrophy (aHR 1.48, 1.10–1.99) were independently associated with higher primary endpoint risk, with concentric hypertrophy also associated with increased cardiovascular mortality and thromboembolism. Catheter ablation was associated with a lower risk of the primary outcome, with the lowest point estimate observed in the concentric remodeling subgroup (aHR 0.29, 95% CI 0.12–0.74); however, no significant interaction by LV geometry was detected (P for interaction = 0.147). Neither renin-angiotensin-aldosterone system inhibitors (RAASi) nor beta-blockers demonstrated benefit across geometry subtypes.ConclusionLV geometric patterns provide meaningful prognostic stratification in patients with concomitant AF and HFpEF. Concentric remodeling and concentric hypertrophy were associated with higher risks of the primary outcome and cardiovascular mortality, whereas thromboembolic risk was most evident in concentric hypertrophy. The association between catheter ablation and a lower risk of the primary outcome in the concentric remodeling subgroup should be interpreted cautiously, given the observational design and the absence of a significant interaction by LV geometry. Further studies are warranted to validate potential phenotype-guided treatment strategies in this population.Clinical trial registrationURL: clinicaltrials.gov/study/NCT06987825, Identifier NCT06987825.

QuestionIs discontinuation of guideline-directed medical therapy (GDMT) after catheter ablation feasible and safe in patients with atrial fibrillation (AF) with improved cardiac function?FindingsIn this randomized clinical trial of 50 patients with AF and heart failure (HF) with improved ejection fraction (suspected with AF-mediated cardiomyopathy), phased GDMT withdrawal in those with normalized left ventricular ejection fraction and sinus rhythm resulted in HF deterioration in 3 of 23 patients (13%) compared with none in the continuation group. This was not a statistically significant difference.MeaningAlthough this study did not find significantly more HF deterioration in patients who discontinued GDMT vs those who continued, further studies are needed to determine whether GDMT can be safely discontinued in this population. This pilot randomized clinical trial assesses whether phased withdrawal of heart failure medication in patients who have undergone catheter ablation for atrial fibrillation (AF) and experienced improvements in cardiac function is feasible and safe. ImportanceWithdrawal of guideline-directed medical therapy (GDMT) for heart failure (HF) is common after atrial fibrillation (AF) catheter ablation and recovery of cardiac function, but safety remains uncertain.ObjectiveTo assess the feasibility and safety of phased GDMT withdrawal in patients with AF with highly suspected AF-mediated cardiomyopathy after catheter ablation.Design, Setting, and ParticipantsThis open-label pilot randomized clinical trial included adult patients who were enrolled and randomized from April 13, 2023, to September 19, 2024, at Beijing Anzhen Hospital, China, with a 6-month follow-up. Eligible patients were those with suspected AF-mediated cardiomyopathy at 3 months after ablation, defined by sinus rhythm at 3 months after ablation, absence of other suspected cardiomyopathies, improvement of left ventricular ejection fraction (LVEF) from 45% or less to 55% or more, normalized LV end-diastolic diameter (LVEDD), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels less than 250 ng/L, and no HF symptoms or signs.InterventionsPatients were randomly assigned in a 1:1 ratio to phased GDMT withdrawal or GDMT continuation.Main Outcomes and MeasuresThe primary end point was HF deterioration, defined as LVEF decline more than 10% to less than 55%, LVEDD increase more than 10% and beyond normal, NT-proBNP levels doubling to more than 400 ng/L, or worsening HF signs or symptoms. Secondary outcomes included cardiovascular events, changes in echocardiographic and cardiac magnetic resonance (CMR) parameters, NT-proBNP levels, Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) scores, atrial arrhythmia recurrence, and adverse drug events.ResultsAmong 50 patients enrolled and randomized, 47 completed follow-up (median [IQR] age, 56.0 [48.0-60.5] years; 37 males [78.7%]), including 23 (48.9%) in the GDMT withdrawal group and 24 (51.1%) in the continuation group. HF deterioration occurred in 3 patients with GDMT withdrawal (13.0%) and 0 with GDMT continuation (0%) (P = .11). Early GDMT reinitiation in 3 patients with HF deterioration showed recovery of LVEF or NT-proBNP. No cardiovascular events occurred. Median (IQR) echocardiographic (LVEF: 0% [-3.0% to 3.5%] vs 1.5% [-5.0% to 5.0%]), CMR (LVEF: -2.1% [-7.2% to 4.6%] vs 2.9% [-2.6% to 7.4%]), and KCCQ-12 score (0 [0 to 0.5] vs 0) changes were similar between groups. Median (IQR) NT-proBNP levels declined more in the GDMT continuation group than the withdrawal group (-25.7 [-33.6 to -6.7] pg/mL vs 2.7 [-21.4 to 24.2] pg/mL; P = .03). Adverse drug events were more frequent in the GDMT continuation group than the withdrawal group (5 [20.8%] vs 0 [0%]; P = .050). Arrhythmia recurrence rates were comparable (GDMT withdrawal: 3 [13.0%] vs continuation: 3 [12.5%]).Conclusions and RelevanceIn this pilot randomized clinical trial of carefully selected patients with AF with normalized cardiac function and sinus rhythm after catheter ablation, 13% of patients with GDMT withdrawal experienced HF deterioration, whereas drug-related complications were more common in the continuation group, suggesting that further studies are needed to determine whether GDMT can be safely discontinued in this population.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2300077439

To evaluate the efficacy and safety of sitokiren (SPH3127) tablet in patients with mild-to-moderate essential hypertension in comparison to valsartan capsule. This multicentre, randomised, double-blind, parallel Phase III trial was designed in 2 stages. In the 1st stage, eligible patients were randomised to receive 50 mg, 100 mg or 200 mg of SPH3127 tablet or 80 mg of valsartan capsule once daily (QD) for 12 consecutive weeks. In the 2nd stage, eligible patients were randomised to receive assigned dose of SPH3127 tablet based on the results from the 1st stage or valsartan 80 mg QD for 12 consecutive weeks. Primary outcome was the change from baseline in mean sitting diastolic blood pressure (msDBP) at Week 12. Safety outcome measures included any adverse events. Exploratory outcomes included plasma concentration of SPH3127, as well as the assessment of the correlation between SPH3127 exposure with the level of renin inhibition, clinical efficacy and occurrence of adverse events. The 1st stage enrolled 189 patients, of which 129 eligible patients were randomised. High plasma renin activity (PRA) inhibitory effect (83

Hypertension is a significant risk factor for cognitive impairment (CI), yet the corresponding neural network abnormalities remain underexplored. In this study, we examined the associations among global and domain-specific cognitive dysfunction, neuroimaging measures, and blood pressure in a subgroup of hypertensive patients with CI (N = 41) from a randomized controlled trial who underwent ultra-high-field 7 T MRI. Structural atrophy related to CI was localized to regions overlapping the attention networks. Both whole-brain and within-network dysfunction of the attention networks were associated with worse global cognitive performance. Notably, hyperconnectivity within key attention network hubs, including the right anterior insula and posterior intraparietal sulcus, was associated with declined processing speed in hypertensive patients, mediating the association between pulse pressure and processing speed. These findings provide new insights into the neural pathophysiology of hypertension-related CI and suggest potential network-based targets for intervention.

The role of prophylactic cavotricuspid isthmus (CTI) ablation remains controversial in atrial fibrillation (AF) patients without atrial flutter (AFL). Given the strong association between AF, AFL, and age, this study aimed to evaluate the impact of additional CTI ablation on recurrence-free survival, with a focus on age-stratified outcomes. Between June 2020 and June 2022, 1226 paroxysmal AF patients without AFL who underwent first AF catheter ablation at Beijing Anzhen Hospital were enrolled. 899 patients underwent pulmonary vein isolation (PVI) alone (PVI group) and remaining 327 patients underwent additional CTI ablation (PVI + CTI group). Both groups were stratified into four age quartiles to assess age-related recurrence risk. Over a median 36.6-month follow-up, prophylactic CTI ablation did not have a better outcome in overall population. In the PVI + CTI group, the oldest age quartile (> 70 years) was independently associated with a lower risk of recurrence compared with the youngest quartile (≤ 56 years; adjusted HR 0.41, 95

This study investigated the association between serum uric acid (UA) levels and atrial fibrillation (AF) burden in Chinese patients with AF. In this cross-sectional study, AF burden was defined as the proportion of AF duration to total monitoring time, recorded by a patch device over ≥24 hours. Serum UA levels were measured at the start of monitoring. Multivariate logistic regression was used to assess associations. A total of 952 patients with AF (66.4% women; median age 64 years) were included. A 1-SD increase in UA (91.4 μmol/L) was associated with elevated risk of persistent AF (adjusted OR: 1.32; 95% CI: 1.12–1.55; P < 0.001). The highest UA quintile had a greater risk of persistent AF than the lowest quintile of patients (adjusted OR: 2.43; 95% CI: 1.49–3.98; P for trend < 0.001). Serum UA levels are positively associated with AF burden in a dose-dependent manner. UA might serve as an accessible biomarker and potential therapeutic target for AF burden assessment.

Objectives: Real-world data on oral anticoagulant (OAC) use patterns and dosing appropriateness in patients with nonvalvular atrial fibrillation (AF) remain limited in China. This study aims to characterize trends in OAC prescribing and assess the dosing appropriateness of direct oral anticoagulants (DOAC) in nonvalvular AF. Methods: This is a retrospective secondary analysis of the prospective China-AF Registry (ChiCTR-OCH-13003729, registered on October 22, 2013), using data from patients with nonvalvular AF who were discharged on OAC between 2011 and 2022. Real-world trends in warfarin versus DOAC use and dosing appropriateness were evaluated. Predictors of inappropriate DOAC dosing were identified. Results: Among the included patients, 10,205 received warfarin and 15,084 received DOAC. The proportion of DOAC prescriptions increased from 0% in 2011 to 98% after 2020, whereas warfarin use declined from 99.74% to 1.99%. The shift accelerated after 2017, coinciding with the inclusion of dabigatran and rivaroxaban into the National Reimbursement Drug List. DOAC were less frequently prescribed to high-risk patients, including those with higher CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age [≥75 years earns 2 points, 65–74 years earns 1 point], diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism [2 points], vascular disease [e.g., prior myocardial infarction, peripheral artery disease], and female sex category) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly (>65 years), drugs/alcohol use (HAS-BLED) scores, older age, and lower creatinine clearance (all P for trend < 0.05). Inappropriate dosing was more prevalent in these higher-risk groups ( P for trend < 0.001). Older age was independently associated with inappropriate dosing (per 10 years, odds ratio [OR] = 1.39; 95% confidence interval [CI], 1.29–1.51; P < 0.001). In contrast, male (OR = 0.77; 95% CI, 0.65–0.91; P = 0.002), prescriptions post-2017 (OR = 0.12; 95% CI, 0.07–0.20; P < 0.001), persistent AF (OR = 0.78; 95% CI, 0.67–0.92; P = 0.002), and dabigatran use (OR = 0.020; 95% CI, 0.020–0.028; P < 0.001) were associated with lower odds of inappropriate dosing. Conclusions: From 2011 to 2022, OAC prescribing in China shifted dramatically from warfarin to DOAC, with more rapid DOAC adoption after the 2017 National Reimbursement Drug List update. Although DOAC dosing appropriateness improved over time, inappropriate dosing remained common in higher-risk patients, particularly older adults.

Background Serum magnesium (Mg) plays an important role in cardiac electrophysiology, but its association with atrial arrhythmia recurrence after catheter ablation remains unclear. Objective To investigate the association between preprocedural serum Mg levels and atrial arrhythmia recurrence after AF ablation. Methods We included 5,789 patients undergoing AF ablation from the prospective China-AF registry. Patients were categorized into tertiles according to baseline serum Mg levels: low (<0.84 mmol/L), intermediate (0.84–0.90 mmol/L), and high (>0.90 mmol/L). The primary outcome was atrial arrhythmia recurrence. Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between serum Mg levels and recurrence risk. Results During a median follow-up of 372 days, recurrence occurred in 40.5%, 36.5%, and 41.1% of patients in the low, intermediate, and high Mg groups, respectively. Compared with the intermediate group, both low and high Mg levels were associated with increased recurrence risk (low versus intermediate: hazard ratio [HR], 1.09 [95% CI, 1.01–1.21]; high versus intermediate: HR, 1.12 [95% CI, 1.01–1.25]). Restricted cubic spline analysis demonstrated a significant nonlinear association between serum Mg levels and recurrence risk (P for nonlinearity = 0.003), with the lowest estimated risk observed within the intermediate range of serum Mg values. Findings were consistent across subgroup, sensitivity, and competing-risk analyses. Conclusions Preprocedural serum Mg levels were nonlinearly associated with atrial arrhythmia recurrence after AF ablation. Serum Mg may serve as a readily available marker of recurrence risk and warrant further investigation into the mechanisms linking Mg homeostasis and post-ablation outcomes.

BACKGROUND:The impact of body mass index (BMI) on the outcomes of radiofrequency catheter ablation (RFCA), including atrial fibrillation (AF) recurrence rate, cardiac remodelling, and quality of life (QoL), remains uncertain. METHODS:We analysed 12 104 first-time RFCA patients from the China-AF registry, stratified by BMI: under/normal weight (< 25 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). The primary outcome was AF recurrence. Exploratory outcomes included 12-month echocardiographic parameters and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores. Multivariable Cox regression, median regression, restricted cubic splines (RCS), and subgroup analyses were performed. RESULTS:In this cohort (median age 61.55 years, 32.6% female), obese patients were significantly younger with higher comorbidities burdens. Over a median follow-up of 47.5 months, 4932 (40.8%) patients experienced AF recurrence. BMI exhibited a linear, dose-dependent association with recurrence risk (fully adjusted HR 1.01, 95% CI, 1.00-1.02; obese HR 1.16, 95% CI: 1.05-1.28), consistent across primary analyses, sensitivity analyses using Chinese BMI classification standards, and subgroups (with stronger associations in males, < 65 years, persistent AF), without significant interactions across these subgroups (all pinteraction > 0.05). Exploratory analyses suggested obesity was linked to nonlinearly higher 12-month left ventricular end-diastolic diameter (LVEDD; 2.17 mm, 95% CI: 0.79-3.55) and left ventricular wall thickness (LVWT; 0.81 mm, 95% CI: 0.45-1.17) versus under/normal-weight, with nonlinear association in primary analysis (both pnonlinear < 0.05). CONCLUSION:Higher BMI exhibits a linear association with AF recurrence post-RFCA. Obesity is linked to nonlinear adverse remodelling (LVEDD and LVWT).

Background: Rising evidence indicates that several autoimmune rheumatic diseases (ARDs) are associated with higher risk of heart failure (HF), however large-scale comparative studies across multiple ARDs are scarce. Methods: In this cohort study, participants from the UK Biobank without prevalent HF were included. The relation between ARDs and the incidence of HF and mortality were analyzed using Cox proportional hazards models. Results: Of 499,525 participants included in this study ( n = 10,198 with ARDs, n = 489,327 without ARDs), 18,686 HF cases occurred over a median follow-up of 13.8 years. Significantly elevated risks for HF were observed among all patients with ARDs ( P < 0.05), with the highest relative risk of HF in patients with systemic sclerosis (HR: 4.38; 95% CI: 2.98–6.43; P < 0.001). Of patients who developed HF, those with ARDs exhibited a higher prevalence of rheumatic valvular disease (16.6% vs. 14.0%), non-rheumatic aortic valve disease (12.6% vs. 9.6%), and pulmonary heart disease (7.0% vs. 4.6%) prior to the diagnosis of HF ( P < 0.05), while the prevalence of coronary artery disease, atrial fibrillation/atrial flutter, and hypertensive heart disease were similar. A history of ARDs was associated with increased all-cause mortality after diagnosis of HF (HR: 1.32; 95% CI: 1.23–1.42; p < 0.001), especially for non-cardiovascular mortality (HR: 1.42; 95% CI: 1.30–1.56; p < 0.001). Conclusions: Various ARDs were associated with a higher risk of HF. Patients with HF and ARDs had a higher prevalence of valvular disease and pulmonary heart disease before HF diagnosis compared to other patients with HF. A history of ARDs was associated with higher mortality after diagnosis of HF.