Background: With 1.4 billion people worldwide affected by elevated lipoprotein(a) [Lp(a)] concentrations, it has emerged as a critical player in the realm of cardiovascular health. Lp(a) is an established independent risk factor for coronary heart disease and became a recently recognized factor for aortic valve stenosis. This study aims to investigate the impact of elevated Lp(a) on the long-term outcomes following cardiac surgery.

Abstract Background Elevated levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) reflect cardiac status in heart failure patients and are independently associated with mortality and adverse cardiovascular outcomes in elective patients undergoing non-cardiac surgery. However, there is scarce evidence about the association between NT-proBNP and outcome after cardiac surgery in large patient populations. Purpose The aim of this study was to analyze the association of preoperative NT-pro-BNP levels with 30-day and five-year mortality after cardiac surgery. Methods A consecutive cohort of 6938 patients undergoing cardiac surgery was analyzed retrospectively. The relationship between preoperative NT-proBNP and 30-day and five-year mortality adjusted for EuroSCORE II was explored using a Cox proportional hazards model. The dynamics of preoperative NT-proBNP were analyzed by comparing the values at the time of diagnosis or assignment to surgery with the values on the day before surgery (n= 4739). Results were validated in an external cohort from the SWEDEHEART registry (n=3415). Results Median preoperative NT-proBNP was 552 ng/l. Death within 30 days occurred in 2.1% of the patients. High preoperative NT-proBNP levels were associated with a higher 30-dayand 5-yearmortality. Preoperative NT-proBNP thresholds to identify patients at high-risk (>4000 ng/l), intermediate-risk (2000-4000 ng/l) and low-risk (<2000 ng/l) for 30-day mortality were determined. Patients in the intermediate or high-risk category had a higher risk for prolonged ICU stay (OR 2.52), ultrafiltration (OR 3.68), ECMO (OR 3.63), 30-day mortality (HR 2.79), and 5-year mortality (HR 2.41) (p-value all <0.001). Patients who improved in the preoperative NT-proBNP risk had a significant 30-day and five-year survival benefit. Conclusions Preoperative NT-proBNP levels are independently associated with 30-day and five-year mortality after cardiac surgery. NT-proBNP reduction prior to surgery might decrease 30-day and five-year mortality after cardiac surgery.NTproBNP is associated with outcome

Background: We aimed to determine the relationship between postoperative high-sensitivity cardiac troponin T/creatine kinase MB and the risk of death (all-cause) within 30 days and 5 years after cardiac surgery.

Objectives: Elexacaftor/Tezacaftor/Ivacaftor (ETI) improves outcome in patients with cystic fibrosis. To evaluate possible effects of ETI specifically on Pseudomonas aeruginosa (PA) we assessed sputum cultures and PA antibodies in people with CF (PwCF). Methods: At the CF Centre Innsbruck, PwCF had routine evaluation of serum PA antibodies and sputum analysis before and during ETI. Induced sputum was collected during in-house physiotherapy. Results from sputum cultures and PA antibody status (Alkaline Protease, anti-Pseudomonas Elastase, Anti-Exotoxin A, PA Immunoglobulin G) were analysed in the local lab. PwCF with at least four sputum cultures one year before and in the first year of ETI were included. Leeds criteria were used to determine chronic, intermittent or no PA infection. PwCF with at least one PA antibody result above cut off (1:500; 2.95 EU) were counted positive. Basic therapy was not changed. Results: Of 55 PwCF starting ETI, 30 (24 female) were included. Reasons for exclusion were treatment started at another centre (8 PwCF), treatment duration of less than 4 months (9 PwCF), and low number of sputum culture results (8 PwCF) respectively. At ETI initiation, PwCF (mean age 24.6, 9–39) mostly had a moderate lung disease with mean FEV1 61.7% (18.7–108.3%) and mean Bhalla CT score of 13.8 (5–25). This preliminary data shows, that 32.8% of all sputum samples before ETI (n = 299; mean 10.0 per PwCF) were PA positive, and 32.7% of sputum cultures during ETI (n = 226; mean 7.5 per PwCF) remained PA positive. Chronic PA infection was detected in 9 before and 8 PwCF during ETI. Intermittent PA infection was detected in 8 before and 5 PwCF during ETI (4 and 3 PA antibody positive). 13 before and 17 PwCF (3 and 4 PA antibody positive) during ETI had no PA positive culture. Conclusions: Our preliminary results suggest that particularly PwCF with structural lung damage and chronic PA infection remain chronically PA culture and PA antibody positive during one year ETI.

Background: Inflammation is a major trigger for the onset of calcific aortic valve disease (CAVD). Biglycan (BGN) is a proteoglycan responsible for the stability of the valvular extracellular matrix. It is released upon mechanical stress and acts as danger-associated molecular pattern activating the innate immune system. We aimed to (1) characterize the mechanism of innate immune activation and (2) explore it as potential therapeutic target.

Aims The most appropriate definition of perioperative myocardial infarction (pMI) after coronary artery bypass grafting (CABG) and its impact on clinically relevant long-term events is controversial. We aimed to (i) analyse the incidence of pMI depending on various current definitions in a 'real-life' setting of CABG surgery and (ii) determine the long-term prognosis of patients with pMI depending on current definitions. Methods and results A consecutive cohort of 2829 coronary artery disease patients undergoing CABG from two tertiary university centres with the presence of serial perioperative cardiac biomarker measurements (cardiac troponin and creatine kinase-myocardial band) were retrospectively analysed. The incidence and prognostic impact of pMI were assessed according to (i) the 4th Universal Definition of Myocardial Infarction (4UD), (ii) the definition of the Society for Cardiovascular Angiography and Interventions (SCAI), and (iii) the Academic Research Consortium (ARC). The primary endpoint of this study was a composite of myocardial infarction, all-cause death, and repeat revascularization; secondary endpoints were mortality at 30 days and during 5-year follow-up. There was a significant difference in the occurrence of pMI (49.5% SCAI vs. 2.9% 4UD vs. 2.6% ARC). The 4th Universal Definition of Myocardial Infarction and ARC criteria remained strong independent predictors of all-cause mortality at 30 days [4UD: odds ratio (OR) 12.18; 95% confidence interval (CI) 5.00-29.67; P < 0.001; ARC: OR 13.16; 95% CI 5.41-32.00; P < 0.001] and 5 years [4UD: hazard ratio (HR) 2.13; 95% CI 1.19-3.81; P = 0.011; ARC: HR 2.23; 95% CI 1.21-4.09; P = 0.010]. Moreover, the occurrence of new perioperative electrocardiographic changes was prognostic of both primary and secondary endpoints. Conclusion Incidence and prognosis of pMI differ markedly depending on the underlying definition of myocardial infarction for patients undergoing CABG. Isolated biomarker release-based definitions (such as troponin) were not associated with pMI relevant to prognosis. Additional signs of ischaemia detected by new electrocardiographic abnormalities, regional wall motion abnormalities, or coronary angiography should result in rapid action in everyday clinical practice. Key question We aimed to (i) analyse the incidence of perioperative myocardial infarction (pMI) depending on different current definitions in a 'real-life' setting of coronary artery bypass graft surgery and (ii) determine the long-term prognosis of patients with pMI according to current definitions. Key finding There was a significant difference in the occurrence of pMI. The 4th Universal Definition of Myocardial Infarction and Academic Research Consortium criteria remained strong independent predictors for all-cause mortality at 30 days and during 5-year follow-up. Take-home message Isolated biomarker release-based definitions were not associated with pMI relevant to prognosis. Additional signs of ischaemia detected by new electrocardiogram abnormalities, regional wall motion abnormalities, or coronary angiography should result in rapid action in clinical practice.

Background: Female sex is protective against coronary artery disease (CAD). However, CAD is still underdiagnosed in women, and current data on their outcome after CABG remain controversial. The aim of this study was to (1) determine the impact of sex on outcome after CABG surgery and (2) identify responsible factors.

Background: Progressive fibrosis results in myocardial stiffening and dysfunction in patients with heart failure contributing to ventricular remodeling and impaired contractility. Despite high global burden and intensive research, there are no therapies available to remove excessive fibrosis and thus, induce reverse remodeling. The right (RV) and the left ventricle (LV) differ markedly in their embryonic development, anatomy and function. In this project we aimed to (1) elucidate mechanistic differences between RV and LV regeneration and (2) thus, reveal novel therapeutic targets for LV regeneration.