Background/Objectives: Hereditary transthyretin amyloidosis (ATTRv) is a heterogeneous multisystem disease caused by pathogenic transthyretin gene (TTR) variants. Increased awareness and availability of disease-modifying therapies have resulted in increased diagnoses, even in previously nonendemic regions. The aim of this study was to update the nationwide Austrian ATTRv registry by characterizing the clinical, genetic, and regional distribution of TTR variants. Methods: This multicenter, observational analysis examined ATTRv cases diagnosed in Austria between 2014 and 2025. Individuals were included according to the presence of pathogenic or likely pathogenic variants or variants of uncertain significance (VUSs) in TTR. Results: In total, 100 individuals were identified, including symptomatic and asymptomatic carriers. Compared with our previously presented data, the number of genetically confirmed ATTRv cases has more than doubled. Twenty-three TTR variants were identified. The most frequent pathologic variants were p.His108Arg (26%), p.Ile127Phe (11%), and p.Thr69Ile (9%), while p.Val113Leu (9%) represented the most frequent VUS. Significant regional clustering of p.His108Arg was documented in Vienna and Lower Austria. Other findings included a rising number of p.Val142Ile carriers and phenotypically relevant VUSs in 20 patients. Conclusions: Our findings revealed an increasing detection rate of ATTRv in a nonendemic European region. These data underscore the importance of multidisciplinary evaluation, cascade testing, and long-term monitoring to improve early diagnosis and timely management in hereditary amyloidosis.

Background Cardiac transthyretin amyloidosis (ATTR‐CA) is frequently underdiagnosed and commonly presents as heart failure with preserved ejection fraction (HFpEF). Early identification enables disease‐modifying therapy but remains challenging in routine practice, so simple, widely available screening tools are needed. Methods In this multicenter validation study, 885 patients with HF from 2 European centers were included. The internal validation cohort comprised 560 patients with preserved ejection fraction and analyzable ECGs: 149 with ATTR‐CA, 318 with HFpEF, and 93 with hypertrophic cardiomyopathy. External validation used an independent cohort of 107 patients (72 ATTR‐CA, 31 HFpEF, 4 hypertrophic cardiomyopathy). Standard 12‐lead ECGs were analyzed blindly by 3 independent observers using a previously developed, 2‐step, artificial intelligence–derived, visually interpretable ECG algorithm. Results The ECG pattern was present in 82.6% of patients with ATTR‐CA, versus 10.2% with HFpEF and 6.5% with hypertrophic cardiomyopathy ( P <0.001). Internal‐cohort accuracy was high: area under the curve 0.87 (95% CI, 0.84–0.90), sensitivity 83% (95% CI, 76%–88%), specificity 91% (95% CI, 88%–93%), and negative predictive value 93% (95% CI, 91%–96%). In the external cohort, the area under the curve was 0.84 (95% CI, 0.76–0.92), with sensitivity 89% (95% CI, 78%–94%) and specificity 79% (95% CI, 63%–90%). The pattern was strongly associated with ATTR‐CA (odds ratio, 46 [95% CI, 27–80]; P <0.001) and with reduced 3‐year survival (log‐rank P =0.007). Conclusions A visually interpretable, artificial intelligence–derived ECG algorithm enables effective screening for ATTR‐CA among patients with HFpEF. Its simplicity and compatibility with standard ECG systems support broad clinical implementation.

The diagnosis and management of hypertrophic cardiomyopathy (HCM) is increasingly complex, and systematic evidence remains sparse. The Austrian HCM registry aims to provide representative real-world data addressing gaps in evidence. Here, we report design, methods and results after one year enrolment. The Austrian HCM Registry is an ongoing prospective, multicenter registry including University and community hospitals across Austria. Patients with written informed consent undergo a structured assessment of symptoms, past medical history, family history and the presence of HCM-specific red flags. Clinical data derived from electrocardiogram, echocardiography, laboratory analysis, and genetic testing are collected and entered into a web-based, responsive electronic case report form. Bilateral data transfer agreements ensure legal protection of each site. Between March 2024 and May 2025, 7 University centers and 7 community hospitals from 6 out of 9 Austrian federal states were initiated. Overall, recruitment rate was 2.5 patients per site and month, with University centers and community hospitals contributing 92

AIMS:The aim of this study was to assess symptoms and long-term cardiopulmonary impairments over a period of up to 30 months following severe COVID-19 infection. METHODS AND RESULTS:This prospective multicenter cohort study included 200 patients hospitalized between February 2020 and October 2021 with a PCR-confirmed COVID-19 infection. Follow-up examinations 6, 18, and 30 months post-discharge included electrocardiogram, transthoracic echocardiography, cardiac magnetic resonance imaging, chest computed tomography (CT) scan, pulmonary function test (PFT), 6-min walk test, and a laboratory panel. 200 patients completed their 6-month follow-up after discharge and those with pathological findings on cardiopulmonary imaging received additional follow-ups at 18 and 30 months (170 and 139 patients, respectively).At 30 months, most of the cardiopulmonary imaging abnormalities had resolved. Only two patients with previously reduced left ventricular function had persistent mild impairment at 30 months [6 months: n = 15 (8%)]. Pericardial effusion resolved in all patients but one [6 months: n = 28 (17%)]. Signs of pericarditis and myocarditis had already regressed at the 18-month follow-up [6 months: n = 7 (5%)].Chest CT scans showed partial improvement: only one patient had complete resolution at 30 months, while the remaining patients [30 months: n = 17 (94%)] developed minor fibrotic and scarred tissue [6 months: n = 41 (24%)].Long COVID incidence was high with 73% at 6 months and still 49% at 30 months, with no clear predictors identified. CONCLUSION:Even though cardiopulmonary functional and structural abnormalities regressed over time, almost half of the patients still suffered from Long COVID at 30 months. The disconnect between pathological cardiopulmonary findings and reported symptoms, continues to pose a persistent clinical challenge in the understanding and managing Long COVID.

Sudden cardiac death (SCD) remains a predominant mode of death in cardiovascular mortality. Despite advancements in guideline-recommended medical therapy and risk stratification, accurately identifying patients who would benefit most from implantable cardioverter-defibrillator (ICD) therapy over the long term remains a significant challenge. The wearable cardioverter-defibrillator (WCD) has emerged as a non-invasive bridge to either ICD implantation or recovery of left ventricular function. This expert review presents a comprehensive and up-to-date summary of clinical evidence on WCD use for SCD prevention and heart failure (HF) management. Specifically, it will address: (i) the concept and mechanism of the WCD; (ii) evidence from randomized and observational studies regarding efficacy, safety, and cost-effectiveness; (iii) integration of the WCD into HF management; and (iv) knowledge gaps and priorities for future research.

BACKGROUND:Despite favorable hemodynamic and neurohormonal effects, endothelin receptor antagonists have not improved outcomes in patients with heart failure (HF), possibly because they cause fluid retention. METHODS:In this randomized, double-blind, multicenter trial (SERENADE [Macitentan in Heart Failure With Preserved Ejection Fraction and Pulmonary Vascular Disease]), we evaluated the effects of an endothelin receptor antagonist, macitentan, in patients with HF, left ventricular ejection fraction ≥40%, and pulmonary vascular disease. After a 4-week placebo run-in (to ensure clinical stability), followed by a 5-week single-blind macitentan run-in, patients who did not exhibit fluid retention were randomized to macitentan or placebo. The primary end point was change in NT-proBNP (N-terminal pro-B-type natriuretic peptide; baseline to 24 weeks); secondary end points included change in KCCQ (Kansas City Cardiomyopathy Questionnaire) clinical summary score (baseline to 24 weeks) and time to worsening HF by 52 weeks. RESULTS:Of 230 patients enrolled, 28 were excluded during the placebo run-in, 60 excluded during the macitentan run-in, and 142 were randomized. Macitentan had no effect on change in NT-proBNP (geometric mean ratio [macitentan/placebo], 1.02 [90% CI, 0.88-1.19]; P=0.79) or on secondary end points (placebo-corrected change in KCCQ clinical summary score, -3.5 [90% CI, -8.2 to +1.2]; P=0.22). Worsening HF occurred in 20 (28%) patients assigned to macitentan and 13 (18%) assigned to placebo (hazard ratio, 1.48 [90% CI, 0.83-2.67]; P=0.24). More macitentan-treated patients developed fluid retention (16 [23%] versus 10 [14%]) and cardiac adverse events (33 [46%] versus 22 [31%]) versus placebo. CONCLUSIONS:Despite a novel enrichment trial design to target pulmonary vascular disease and exclude treatment-related fluid retention in patients with HF and preserved/mildly reduced left ventricular ejection fraction, macitentan neither lowered NT-proBNP nor improved HF outcomes. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03153111 and NCT03714815.

BACKGROUND Heart failure (HF) guidelines recommend titration of beta-blockers (BBs) to improve survival; however, women are less optimized with BBs, and there are no studies that have assessed the utility of remote heart rate (HR) monitoring to optimize treatment. OBJECTIVE We aimed to assess the utility of HR data and HR alerts from the wearable cardioverter-defibrillator (WCD) to optimize BB/ ivabradine dosage in women with newly diagnosed cardiomyopathy with reduced ejection fraction, prescribed the WCD as standard of care. METHODS The Optimizing Beta-Blocker Dosage in Women Using the Wearable Cardioverter Defibrillator study is a multi-center, prospective pilot study that will enroll up to 300 patients at 20 sites in Europe and the United States, with a 2-week run-in phase to assess WCD compliance and HR data completion. Those with at least 105 hours per week WCD wear will be advanced into the 3-month study. In the study phase, we will provide biweekly HR trend reports and HR alerts (first month: >90 bpm, second month: >80 bpm, third month: >70 bpm) to the enrolling sites, to facilitate titration of BBs and ivabradine. A total of 95 subjects with a full dataset will provide sufficient power to detect an improvement of effective HR control in 70% of the subjects (as compared to 56% in a historical cohort). Secondary end points include HR reported as nighttime median value and HR control alerts. Tertiary end points include median nighttime HR, quality of life scores, and physical activity. CONCLUSION This female-only study will provide clinically actionable information on the impact of remote monitoring of HR during the early post-discharge period in women with HF who achieve adequate BB/ivabradine dosage.

AbstractAimsDespite receiving guideline‐directed medical heart failure (HF) therapy, patients with pulmonary hypertension associated with left heart disease (PH‐LHD) experience higher mortality and hospitalization rates than the general HF population. AZD3427 is a functionally selective, long‐acting mimetic of relaxin, a hormone that has the potential to induce vasodilation and prevent fibrosis. In a phase 1b study conducted in patients with HF, AZD3427 demonstrated a favourable safety and pharmacokinetic profile. To address the unmet medical need in patients with PH‐LHD in the context of HF, AZD3427 is currently under development as a potential treatment option.Methods and resultsThe Re‐PHIRE study is a phase 2b, randomized, double‐blind, placebo‐controlled, multicentre, dose‐ranging study to evaluate the effect of AZD3427 on a broad range of PH‐LHD phenotypes. In total, 220 patients will be randomized to four treatment groups to receive a subcutaneous injection of AZD3427 or placebo every 2 weeks for 24 weeks. The primary endpoint of the study is the change in pulmonary vascular resistance in patients treated with AZD3427 versus placebo after 24 weeks of treatment. Key secondary endpoints include changes in mean pulmonary arterial pressure, pulmonary artery wedge pressure, systemic vascular resistance, 6‐min walking distance, N‐terminal pro B‐type natriuretic peptide levels, echocardiographic parameters, and health‐related quality of life (assessed by the Kansas City Cardiomyopathy Questionnaire).ConclusionsRe‐PHIRE is the first study of a relaxin mimetic in patients with PH‐LHD. The insights gained from the Re‐PHIRE study are expected to inform the further development of AZD3427 in the PH‐LHD population, including identifying the most suitable pulmonary hypertension and HF phenotypes for treatment.

Imaging data support the clinical effects of RNA interference agent vutrisiran in patients with transthyretin amyloidosis with cardiomyopathy — and point to a potential new role for echocardiographic parameters in monitoring individual treatment responses.

Background Despite known clinical benefits, guideline-recommended heart rate (HR) control is not achieved for a significant proportion of patients with HF with reduced ejection fraction. The wearable cardioverter-defibrillator (WCD) provides continuous HR monitoring and alerts that could aid medication titration. Objective This study sought to evaluate sex differences in achieving guideline-recommended HR control during a period of WCD use. Methods Data from patients fitted with a WCD from 2015 to 2018 were obtained from the manufacturer's database (ZOLL). The proportion of patients with adequate nighttime resting HR control at the beginning of use (BOU) and at the end of use (EOU) were compared by sex. Adequate HR control was defined as having a nighttime median HR <70 beats/min. Results A total of 21,440 women and a comparative sample of 17,328 men (median 90 [IQR 59-116] days of WCD wear) were included in the final dataset. Among patients who did not receive a shock, over half had insufficient HR control at BOU (59% of women, 53% of men). Although the proportion of patients with resting HR >= 70 beats/min improved by EOU, 43% of women and 36% of men did not achieve guideline-recommended HR control. Conclusion A significant proportion of women and men did not achieve adequate HR control during a period of medical therapy optimization. Compared with men, a greater proportion of women receiving WCD shocks had insufficiently controlled HR in the week preceding ventricular tachyarrhythmia/ventricular fibrillation and 43% of nonshocked women, compared with 36% of men, did not reach adequate HR control during the study period. The WCD can be utilized as a remote monitoring tool to record HR and inform adequate uptitration of beta-blockers, with particular focus on reducing the treatment gap in women.

Background: SARS-CoV-2 infection affects the cardiopulmonary system in both the acute and long-term phase. This study aimed to comprehensively assess symptoms and potential long-term impairments 6, 18 and 30 months in patients previously hospitalized for severe Covid-19 infection. Methods: This prospective registry included patients hospitalized for PCR-confirmed Covid-19 infection. Approximately 6 months post-discharge, follow-up examination included patient history, clinical examination, echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a comprehensive laboratory panel. Patients with pathologic findings during the first visit underwent a second (at 18 months) and third (at 30 months) follow-up examination. Those without pathologic findings or who refused further medical examinations were contacted via phone to inquire about symptoms. Results: Between July 2020 and April 2022, 200 patients (91% general ward, 9% intensive care unit) were recruited. Due to dropouts, the second visit was conducted in 170 patients, and the third visit in 139 (74 in person, 65 via telephone). Long Covid criteria were fulfilled by 73% at 6 months, 52% at 18 months and 49% at 30 months post-discharge, with fatigue being the most common symptom (Figure 1). Echocardiography at 6 months showed impaired left ventricular function in 15 patients, with normalization in 80% at 18 months and further 66% at 30 months (Figure 2). cMRI revealed pericardial effusions in 28 patients at 6 months, which resolved in 47% at 18 months and in further 60% at 30 months. Signs of peri- or myocarditis were present in 7 patients at 6 months and were resolved in all 4 patients who attended control studies at 18 months. Chest CT scans at 6 months identified post-infectious residues in 41 patients, with full recovery in 20% at 18 months without further normalization after 30 months. The length of in-hospital stay was identified as a significant predictor for persisting Long Covid 6 months after discharge (95% CI: 1.005 - 1.12, p=0.03). Conclusion: While the prevalence of Long Covid decreased over time, a significant symptom burden persisted at 6, 18 and even 30 months after severe Covid-19 infection. Structural and functional abnormalities were less frequent compared to reported symptoms, posing a challenge in substantiating the causes of these symptoms.

Background: Intracardiac thrombosis is common in transthyretin amyloid cardiomyopathy (ATTR-CM), and patients are at risk for thromboembolic events. However, silent cerebral infarcts and the extent of cerebral small vessel disease in patients with cardiac amyloidosis are unknown. Methods: Thirty-two consecutively selected ATTR-CM patients were prospectively studied by cerebral magnetic resonance imaging (cMRI) and compared with 43 CHA2DS2-VASc-matched controls (Co). Structural clinical standard cMRI sequences and features of cerebral vessel involvement were included and quantified by two board certified neuroradiologists in consensus blinded to clinical status. Group differences were estimated using generalized (logistic) linear regression models adjusting for vascular risk factors based on the CHA2DS2-VASc score. Results: The median CHA2DS2-VASc score was 4 for ATTR-CM and Co (p = 0.905). There were no differences between groups in the frequency of current or former smokers (p = 0.755), body-mass-index > 30 (p = 0.106), and hyperlipidemia (p = 0.869). The number of territorial infarcts (4 vs. 0, p = 0.018) was higher in ATTR-CM compared to Co, as was the mean number of cerebral microbleeds (1.4 vs. 0.3, p ≤ 0.001) and the number of Virchow–Robin spaces (43.8 vs. 20.6, p ≤ 0.001). Lacunar lesion presence was higher in ATTR-CM (6 vs. 2, p = 0.054). CHA2DS2-VASc score, atrial fibrillation, anticoagulation, and the interaction term of CHA2DS2-VASc score and atrial fibrillation did not affect the probability of a territorial ischemic lesion or lacunar lesion in logistic regression modeling. Conclusions: In patients with ATTR-CM free from clinically apparent neurological symptoms, cMRI revealed unreported significant small cerebral vessel disease and territorial ischemia. Our findings may support low thresholds for anticoagulation and cMRI in patients with ATTR-CM.

OBJECTIVE:The evidence-based DETECT pulmonary arterial hypertension (PAH) algorithm is frequently used in patients with systemic sclerosis (SSc) to help clinicians screen for PAH by using noninvasive data to recommend patient referral to echocardiography and, if applicable, for a diagnostic right-sided heart catheterization. However, the hemodynamic definition of PAH was recently updated in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines. The performance of DETECT PAH in identifying patients with a high risk of PAH according to this new definition was assessed.METHODS:In this post hoc analysis of DETECT, which comprised 466 patients with SSc, the performance of the DETECT PAH algorithm in identifying patients with a high risk of PAH as defined in the 2022 ESC/ERS guidelines (mean pulmonary arterial pressure [mPAP] >20 mm Hg, pulmonary capillary wedge pressure [PCWP] ≤15 mm Hg, and pulmonary vascular resistance >2 Wood units) was assessed using summary statistics and was descriptively compared to the known performance of DETECT PAH as defined in 2014, when it was developed (mPAP ≥25 mm Hg and PCWP ≤15 mm Hg).RESULTS:The sensitivity of DETECT PAH in identifying patients with a high risk of PAH according to the 2022 ESC/ERS definition was lower (88.2%) compared to the 2014 definition (95.8%). Specificity improved from 47.8% to 50.8%.CONCLUSION:The performance of the DETECT algorithm to screen for PAH in patients with SSc is maintained when PAH is defined according to the 2022 ESC/ERS hemodynamic definition, indicating that DETECT remains applicable to screen for PAH in patients with SSc.

Aims Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) experience reduced functional capacity. We evaluated changes in functional capacity over extensive follow-up using cardiopulmonary exercise testing (CPX). Methods ATTR-CM patients underwent CPX and blood testing at baseline, first [V1, 8 (6–10) months] and second follow-up (V2) at 35 (26–41) months after start of disease-specific therapy. Results We included 34 ATTR-CM patients, aged 77 (±6) years (88.2% men). CPX showed two patterns with functional capacity improvement at V1 and deterioration at V2. Peak work capacity ( P = 0.005) and peak oxygen consumption (VO 2 , P = 0.012) increased at V1 compared with baseline and decreased at V2. The ventilation to carbon dioxide relationship slope (VE/VCO 2 ) increased at V2 compared with baseline and V1 ( P = 0.044). A cut-off for peak VO 2 at 14 ml/kg·min showed more events (composite of death and heart failure hospitalization): less than 14 vs. greater than 14 ml/kg·min ( P = 0.013). Cut-offs for VE/VCO 2 slope at 40 showed more events greater than 40 vs. less than 40 ( P = 0.009). Conclusion ATTR-CM patients showed an improvement and deterioration in the short-term and long-term follow-up, respectively, with a better prognosis for those with peak VO 2 above 14 ml/kg·min and for a VE/VCO 2 slope below 40.

AbstractAimsTransthyretin ‘wild‐type’ amyloid cardiomyopathy (ATTRwt‐CM) is a differential diagnosis of heart failure with preserved ejection fraction (HFpEF). The clinical work‐up for ATTRwt‐CM is challenging. Considering a combination of clinical variables specific for ATTRwt‐CM might aid in identifying patients at risk.Methods and resultsSixty patients (78 ± 6 years, 8% female) were diagnosed with ATTRwt‐CM by endomyocardial biopsy. Preserved ejection fraction (LVEF >45%) was present in 41 of the patients. Those were 1:1 propensity score age‐ and sex‐matched to a cohort of patients with HFpEF. ATTRwt‐CM patients had less obesity (P = 0.01) and higher septal thickness (IVSd, P < 0.01) as well as more diastolic dysfunction (E/e′, P < 0.01). On multivariable regression IVSd > 14 mm, E/e′ > 14 and absence of obesity (P > 0.01 for all) were identified as predictors for ATTRwt‐CM. A weighted point‐based score was derived with IVSd > 14 mm = 1 point; absence of obesity = 2 points; and E/e′ > 14 = 3 points. Area under the curve (AUC) for the summation score was 0.91 (0.84–0.97, P < 0.01) and a score of more than 3 points predicted ATTRwt‐CM with good sensitivity (78%) and specificity (90%). The score was validated in an external cohort of 142 patients with ATTRwt‐CM and 419 HFpEF patients showing sufficient accuracy (AUC 0.91, 0.88–0.94, P < 0.01). A value greater than 3 points demonstrated a high sensitivity (93%) and a negative predictive value of 97%.ConclusionsA score based on basic clinical and echocardiographic features helps to distinguish ATTRwt‐CM from typical HFpEF. This could facilitate the diagnostic work‐up for these patients and enable earlier disease screening on a large scale.

BACKGROUND:There is an unmet need for early detection of heart failure decompensation, allowing patients to be managed remotely and avoid hospitalization. OBJECTIVES:The purpose of this study was to compare a strategy utilizing data from a wearable HF sensor for management following a HF hospitalization to usual care. METHODS:Eligible subjects were discharged from the hospital within the previous 10 days and had a HF event in the previous 6 months. The concurrent control study was divided into 2 arms; a control arm, BMAD-HF and an open-label intervention arm, BMAD-TX. The HFMS (Heart Failure Monitoring System) was worn by subjects for up to 90 days. Device data was blinded to investigators and subjects in the BMAD-HF control arm but provided proactively in the BMAD-TX intervention arm. The impact of HF management with the HFMS was evaluated by Kaplan-Meier analysis of time to first HF hospitalization. RESULTS:A total of 522 subjects were enrolled in the study at 93 sites. A total of 245 subjects in BMAD-HF and 249 in BMAD-TX were eligible for intention-to-treat analysis. There were 276 hospitalizations in 189 subjects at 90 days, of which 108 events were determined to be heart failure related in 82 subjects. The subjects in the arm managed using HFMS data to direct HF therapy had a 38% lower HF hospitalization rate during the 90 days following a HF hospitalization compared to subjects in the control arm (HR: 0.62; P = 0.03). CONCLUSIONS:In patients with a recent HF hospitalization, a strategy of using HFMS data for HF management is associated with a 38% relative risk reduction in 90-day HF rehospitalization. (Benefits of Microcor in Ambulatory Decompensated Heart Failure [BMAD-TX]; NCT04096040; Benefits of Microcor in Ambulatory Decompensated Heart Failure [BMAD-HF]; NCT03476187).

Patients with established atherosclerotic cardiovascular disease (ASCVD) or those with type-2 diabetes mellitus (T2D) and additional risk factors need a careful control of their cardiovascular risk profile to prevent ischemic complications. Despite thorough treatment of these factors, the risk of ischemic events remains high due to the residual cardiovascular risk. Hypertriglyceridemia may be an important contributor and might help to identify patients who could benefit from additional riskreducing therapy beyond the control of low-density lipoprotein-cholesterol, antidiabetic medication, and blood- pressure management. The randomized, double -blind REDUCE-IT study investigated the potential benefit of Icosapent-ethyl (IPE) treatment in patients at high cardiovascular risk (ASCVD or T2D and additional risk factor) with elevated triglycerides (135-499 mg/dL) under statin-treatment. After a median follow-up of 4.9 years, the primary endpoint (cardiovascular death, non -fatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina or coronary revascularisation) was significantly reduced. In addition, a significant reduction of cardiovascular mortality, myo cardial infarctions and strokes were observed. This positive treatment effect was independent from the plasma levels of triglycerides before and after treatment initiation. Regarding adverse events, a higher risk of atrial fibrillation and an associated increased hospitalization rate was observed under IPE treatment. Severe bleeding complications tended to be higher in the IPE group (not statistically significant) but were not associated with fatal bleeding complications or an increased risk of hemorrhagic strokes. On the basis of this data, the treatment option with IPE was already included in the guidelines of international societies (European Society of Cardiology, American Stroke Association). J Kardiol 2024; 31 (3-4): 64-7.

IntroductionSARS-CoV-2 infection affects the cardiopulmonary system in the acute as well as long-term phase. The aim of the present study was to comprehensively assess symptoms and possible long-term impairments 6 and 18 months after hospitalization for severe COVID-19 infection.MethodsThis prospective registry included patients with PCR-confirmed COVID-19 infection requiring hospitalization. Follow-up approximately 6 months post discharge comprised a detailed patient history, clinical examination, transthoracic echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a laboratory panel. At the time of the second follow-up visit at 18 months, patients without pathologic findings during the first study visit were contacted by phone to inquire about the course of their symptoms. In all other patients all initial examinations were repeated.ResultsTwo hundred Patients, who were hospitalized for COVID-19, were contacted by phone and were recruited for the study. Due to dropouts the second study visit was performed in 170 patients. A comparison between the two study visits at 6 and 18 months post discharge showed the following results: Six months after discharge, 73% and 18 months after discharge 52% fulfilled the criteria for Long COVID with fatigue being the most common symptom (49%). Echocardiography at 6 months post discharge showed an impaired left ventricular function in 8% of which 80% returned to normal. Six months post discharge, cMRI revealed pericardial effusion in 17% which resolved in 47% of the 15 patients who underwent a control cMRI. Signs of peri- or myocarditis were present in 5% of the patients and were resolved in all 4 patients who attended control studies. At 6 months, chest CT scans identified post-infectious residues in 24%. In the 25 repeated chest CT scans 20% showed full recovery. Length of in-hospital stay was identified as a significant predictor for persisting Long COVID (95% CI: 1.005–1.12, p = 0.03).ConclusionComparing 6 to 18 months, the prevalence of Long COVID decreased over time, but a high symptom burden remained. Structural and functional abnormalities were less frequent than the portrayed symptoms, and it thus remains a challenge to substantiate the symptoms.