BACKGROUND:Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but carry a risk of immune-related adverse events, reported in 15% to 90% of the patients. ICI-associated pericardial and myocardial disease has been increasingly recognized, yet data on outcomes remain limited. We aimed to use a large real-world database to investigate the short- and long-term outcomes of ICI-associated pericarditis, myocarditis, and myopericarditis versus the non-ICI cases. METHODS:We conducted a retrospective analysis using the TriNetX database to identify patients >18 years old on ICI and diagnosed with pericarditis, myocarditis, or myopericarditis within 1 year of initiation of therapy. The primary outcome assessed was all-cause mortality, tamponade, constrictive pericarditis, and need for pericardiocentesis at 90-day, 1-year, and 5-year follow-up. RESULTS:A total of 3661, 226, and 46 patients were identified in matched cohorts of ICI-induced pericarditis, myocarditis, and myopericarditis, respectively. One- and 5-year mortality was greater for pericarditis (44.3% versus 37.3%; 54.3% versus 46.9%), myocarditis (38.9% versus 20.8%; 47.8% versus 34.3%), and myopericarditis (56.5% versus 28.3%; 63.0% versus 28.3%; all P≤0.002). A multivariable Cox model showed increased ICI-related mortality for pericarditis 1-year hazard ratio [HR], 1.20 (95% CI, 1.12-1.29), 5-year HR, 1.26 (95% CI, 1.18-1.35), myocarditis 90-day HR, 1.82 (95% CI, 1.21-2.73), 1-year HR, 2.04 (95% CI, 1.43-2.91), 5-year HR, 1.64 (95% CI, 1.26-2.61), and myopericarditis 1-year HR, 2.24 (95% CI, 1.15-4.37), and 5-year HR, 2.78 (95% CI, 1.44-5.36), all with P<0.001. CONCLUSION:Among 3661, 226, and 46 patients with ICI-associated pericarditis, myocarditis, and myopericarditis, respectively, we demonstrated an increased risk of all-cause mortality as compared with the respective non-ICI population.

Introduction Despite the growing use of immune checkpoint inhibitors (ICI) in cancer treatment, data regarding ICI-associated pericardial disease are primarily derived from case reports and case series. ICI related pericardial disease can be difficult to diagnose and is associated with significant morbidity. We conducted a systematic review to further characterize the epidemiology, clinical presentation, and outcomes of this patient population. Methods A search of four databases resulted in 31 studies meeting inclusion criteria. Patients > 18 years old who presented with ICI mediated pericardial disease were included. Intervention was medical + surgical therapy and outcomes were development of cardiac tamponade, morbidity, and mortality. Results Thirty- eight patients across 31 cases were included. Patients were majority male (72%) with a median age of 63. Common symptoms included dyspnea (59%) and chest pain (32%), with 41% presenting with cardiac tamponade. Lung cancer (81%) was the most prevalent, and nivolumab (61%) and pembrolizumab (34%) were the most used ICIs. Pericardiocentesis was performed in 68% of patients, and 92% experienced symptom improvement upon ICI cessation. Overall mortality was 16%. Discussion This study provides the most comprehensive analysis of ICI-mediated pericardial disease to date. Patients affected were most commonly male with lung cancer treated with either Nivolumab or Pembrolizumab. Diagnosis may be challenging in the setting of occult presentation with normal EKG and physical exam as well as delayed onset from therapy initiation. ICI-associated pericardial disease demonstrates high morbidity and mortality, as evidenced by a majority of patients requiring pericardiocentesis.

Objective Coronary artery bypass grafting (CABG) is an established revascularisation strategy for multivessel and left main coronary artery disease. Although aspirin is routinely recommended for patients with CABG, the optimal antiplatelet regimen after CABG remains unclear. We evaluated the efficacies and risks of different antiplatelet regimens (dual (DAPT) versus single (SAPT), and dual with clopidogrel (DAPT-C) versus dual with ticagrelor or prasugrel (DAPT-T/P)) after CABG. Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and performed a comprehensive literature search using PubMed, Ovid Medline, Ovid Embase and Cochrane Central Register of Controlled Trials. Data were extracted and pooled using random-effects models and Review Manager (V.5.4). Results Among the 2970 article abstracts screened, 215 full-text articles were reviewed and 38 studies totaling 77 447 CABG patients were included for analyses. DAPT compared with SAPT was associated with significantly lower all-cause mortality (OR 0.65 with 95% CI 0.50 to 0.86; p=0.002), cardiovascular mortality (OR 0.53, 95% CI 0.33 to 0.84; p=0.008), and major adverse cardiac and cerebrovascular events (MACCE) (OR 0.68, 95% CI 0.51 to 0.91; p=0.01), but higher rates of major (OR 1.30, 95% CI 1.08 to 1.56; p=0.007) and minor bleeding (OR 1.87, 95% CI 1.28 to 2.74; p=0.001) after CABG. DAPT-T/P compared with DAPT-C was associated with significantly lower all-cause (OR 0.43, 95% CI 0.29 to 0.65; p≤0.0001) and cardiovascular mortality (OR 0.44, 95% CI 0.24 to 0.80; p=0.008), and no differences on other cardiovascular or bleeding outcomes after CABG. Conclusion In patients with CABG, DAPT compared with SAPT and DAPT-T/P compared with DAPT-C were associated with reduction in all-cause and cardiovascular mortality, especially in patients with acute coronary syndrome. Additionally, DAPT was associated with reduction in MACCE, but higher rates of major and minor bleeding. An individualised approach to choosing antiplatelet regimen is necessary for patients with CABG based on ischaemic and bleeding risks.

Background:Malignant pericardial effusion (Eff) is often asymptomatic and has an unknown prevalence, due to its occult presentation. The condition often is identified postmortem on autopsy, and it is associated with a poor prognosis. Given the late presentation of malignant pericardial Effs, a minimal volume of literature has examined the epidemiology, clinical characteristics, and outcomes of these complex patients. We conducted a systematic review to advance present understanding of this condition. Methods:A search of 4 databases resulted in 41 case reports meeting criteria. Inclusion criteria were being a patient aged > 18 years who presented with pericardial Eff in the setting of malignancy. Intervention was medical and/or surgical therapy, and the outcome was mortality. Results:For the 41 patients included, the median age was 54 years, and the majority were male patients (58%). Dyspnea was the leading symptom (90%), and cardiac tamponade was present in 78% of cases. Common cancers included lung, gastrointestinal, and renal neoplasms (59%). Pericardiocentesis occurred in 98% of cases, with a median fluid extraction volume of 1000 mL. Death occurred in 44%, primarily due to disease progression and/or metastasis. Conclusions:This study presents the largest systematic review on malignancy-induced pericardial Effs to date. Notably, solid tumours, and specifically lung adenocarcinomas, are common culprits. Malignant pericardial Effs are often severe, with a majority of patients presenting with cardiac tamponade. Overall, treatment options are limited, and the associated mortality rate is high.

In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.

Recurrent pericarditis (RP) poses a significant burden on individuals' quality of life. The psychosocial effects of RP are not well understood. It cannot be overlooked, because it can affect the psychosocial well-being of the patients because of the chronicity of the symptoms and multiple flare-ups. Addressing the multifaceted challenges posed by RP requires a comprehensive approach that not only focuses on symptom control but also emphasizes patient education, psychological support, and shared decisionmaking to optimize physical and emotional well-being. Therefore, we aim to share our perspective on the effect of RP on the quality of life of the patients.

Recurrent pericarditis (RP) poses a significant burden on individuals' quality of life. The psychosocial impact of RP is not well understood. It cannot be overlooked, as it can impact the psychosocial well-being of the patients due to the chronicity of the symptoms and multiple flare-ups. Addressing the multifaceted challenges posed by RP requires a comprehensive approach that not only focuses on symptom control but also emphasizes patient education, psychological support, and shared decision-making to optimize both physical and emotional well-being. Therefore, we aim to share our perspective on the effect of RP on the quality of life of the patients.

Background Recurrent pericarditis (RP) is a complex condition associated with significant morbidity. Prior studies have evaluated which variables are associated with clinical remission. However, there is currently no established risk-stratification model for predicting outcomes in these patients. Objectives We developed a risk stratification model that can predict long-term outcomes in patients with RP and enable identification of patients with characteristics that portend poor outcomes. Methods We retrospectively studied a total of 365 consecutive patients with RP from 2012 to 2019. The primary outcome was clinical remission (CR), defined as cessation of all anti-inflammatory therapy with complete resolution of symptoms. Five machine learning survival models were used to calculate the likelihood of CR within 5 years and stratify patients into high-risk, intermediate-risk, and low-risk groups. Results Among the cohort, the mean age was 46 ± 15 years, and 205 (56%) were women. CR was achieved in 118 (32%) patients. The final model included steroid dependency, total number of recurrences, pericardial late gadolinium enhancement, age, etiology, sex, ejection fraction, and heart rate as the most important parameters. The model predicted the outcome with a C-index of 0.800 on the test set and exhibited a significant ability in stratification of patients into low-risk, intermediate-risk, and high-risk groups (log-rank test; P < 0.0001). Conclusions We developed a novel risk-stratification model for predicting CR in RP. Our model can also aid in stratifying patients, with high discriminative ability. The use of an explainable machine learning model can aid physicians in making individualized treatment decision in RP patients.

Background Obesity leads to an increased risk of cardiovascular disease morbidity and death, including heart failure. Bariatric surgery has been proven to be the most effective long‐term weight management treatment. This study investigated the changes in cardiac structure and function after bariatric surgery, including left ventricular global longitudinal strain. Methods and Results There were 398 consecutive patients who underwent bariatric surgery with pre‐ and postoperative transthoracic echocardiographic imaging at a US health system between 2004 and 2019. We compared cardiovascular risk factors and echocardiographic parameters between baseline and follow‐up at least 6 months postoperatively. Along with decreases in weight postoperatively, there were significant improvements in cardiovascular risk factors, including reduction in systolic blood pressure levels from 132 mm Hg (25th–75th percentile: 120–148 mm Hg) to 127 mm Hg (115–140 mm Hg; P=0.003), glycated hemoglobin levels from 6.5% (5.9%–7.6%) to 5.7% (5.4%–6.3%; P<0.001), and low‐density lipoprotein levels from 97 mg/dL (74–121 mg/dL) to 86 mg/dL (63–106 mg/dL; P<0.001). Left ventricular mass decreased from 205 g (165–261 g) to 190 g (151–236 g; P<0.001), left ventricular ejection fraction increased from 58% (55%–61%) to 60% (55%–64%; P<0.001), and left ventricular global longitudinal strain improved from −15.7% (−14.3% to −17.5%) to −18.6% (−16.0% to −20.3%; P<0.001) postoperatively. Conclusions This study has shown the long‐term impact of bariatric surgery on cardiac structure and function, with reductions in left ventricular mass and improvement in left ventricular global longitudinal strain. These findings support the cardiovascular benefits of bariatric surgery.