Background:Injectable proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are an established strategy to lower low-density lipoprotein cholesterol (LDL-C) and reduce atherosclerotic cardiovascular disease risk. Recently developed oral PCSK9 inhibitors may be a user-friendly alternative. Methods:A systematic search from inception through March 6, 2026, identified randomized controlled trials comparing oral PCSK9 inhibitors with placebo in adults with established atherosclerotic cardiovascular disease or at high risk of atherosclerotic cardiovascular disease, receiving background lipid-lowering therapy, or with statin intolerance. The efficacy endpoint was percentage change in lipid levels including LDL-C, apolipoprotein-B, lipoprotein(a), triglycerides, and non-HDL-C. Safety outcomes included any adverse event, serious adverse events, discontinuation due to adverse events, and new-onset or worsening of diabetes attributed to intervention. Random-effects meta-analysis was performed using restricted-maximum-likelihood estimation with Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity was assessed using I² statistic. Results:Across five randomized phase 2 and 3 trials (n = 4226), oral PCSK9 inhibitors were associated with a significant reduction in LDL-C versus placebo (mean difference -49.92%; 95% CI -56.41 to -43.43; I² = 86%; PI, -72.30 to -27.54). Significant reductions were also observed in ApoB, Lp(a), triglycerides, and non-HDL-C. Safety outcomes were similar between both groups. In dose-matched analyses of MK-0616 at comparable dosing across trials, reductions in lipid markers remained significant with minimal heterogeneity. Conclusions:Oral PCSK9 inhibitors were associated with reductions in LDL-C, ApoB, non-HDL-C, and lipoprotein(a), with safety profile comparable to placebo. Longer-term studies evaluating cardiovascular outcomes and comparisons with injectable PCSK9 inhibitors are required to define their clinical role.

BACKGROUND:Whether mineralocorticoid receptor antagonists (MRAs) confer incremental clinical benefit in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) treated with disease-modifying therapy remains uncertain. We aimed to assess the effectiveness and safety of MRAs in patients with ATTR-CM receiving disease-modifying therapy. METHODS:This retrospective cohort study used data from the TriNetX US database to identify adult patients with ATTR-CM who initiated disease-modifying therapy (tafamidis or vutrisiran) within 1 year of incident heart failure (HF) diagnosis between 1 September 2019 and 10 December 2025. Patients were categorised as MRA users or non-users and were matched based on 1:1 propensity-score matching. The primary effectiveness endpoint was a composite of all-cause mortality or HF hospitalisation (HFH). Secondary effectiveness endpoints were all-cause mortality, HFH and ventricular arrhythmia (VA). The safety endpoint was hyperkalaemia. RESULTS:Among 4598 patients with ATTR-CM (mean (SD) age, 77.6 (8.4) years; 3726 (81.0%) men) treated with tafamidis (n=4386) or vutrisiran (n=377), 505 MRA users were matched to 505 non-users. MRA use was not associated with significant reductions in all-cause mortality or HFH (HR 1.04; 95% CI 0.82 to 1.32; p=0.73). There was no significant difference in all-cause mortality (HR 1.00; 95% CI 0.70 to 1.46; p=0.96), HFH (HR 1.09; 95% CI 0.84 to 1.43; p=0.48) and VA (HR 1.07; 95% CI 0.77 to 1.48; p=0.67). Hyperkalaemia was not significantly higher in MRA users (HR 1.13; 95% CI 0.89 to 1.44; p=0.29) compared with non-users. CONCLUSIONS:In a contemporary cohort of patients with ATTR-CM treated with disease-modifying therapy, MRA use was associated with limited incremental clinical benefits.

RATIONALE: In patients with human immunodeficiency virus (HIV) infection, pulmonary hypertension (PH) and heart failure (HF) are common comorbidities. Despite the marked improvements in treatment of these conditions, HIV+ patients are frequently faced with social adversities (SA) that significantly impact access to care and negatively influence clinical outcomes. In this study, we aimed to evaluate the impact of SA on all-cause mortality in patients with HIV. METHODS: In this retrospective/prospective study, adult patients in the New York City-Health+Hospitals system who had a diagnosis of HIV and a clinic/inpatient visit for heart failure between 07/2017 and 06/2022 were included. A PH diagnosis was determined by either echocardiography or right heart catheterization when available. The presence of SA was determined by review of assessments by licensed medical social workers. Logistic regression was employed to evaluate relationships between various predictors and outcomes. After adjusting for clinical covariates, a Cox's proportional hazards model was used to assess the association between socioeconomic disadvantage and all-cause mortality. RESULTS: In total, 1044 patients with HIV and HF were enrolled, of whom 131 had echocardiographic evidence of PH (12.5%, PH group). When compared with the non-PH group, PH was strongly associated with hypertension (HTN, p<0.01), HF with preserved ejection fraction (HFpEF, p<0.001), atrial fibrillation (p<0.001), history of venous thromboembolism (p<0.01), chronic obstructive pulmonary disease (p < 0.001), history of cancer (p<0.05) and end stage renal disease (p< 0.001). In a regression model, PH was independently associated with increased mortality (Odds ratio [OR] 1.76, 95% confidence interval [CI] 1.22-2.56, p<0.01). Other factors independently associated with mortality were history of malignancy (OR 1.75, 95%CI 1.28-2.39, p<0.01) and ESRD (OR 2.13, 95%CI 1.57-2.89, p<0.01). To determine the impact of SA and PH on mortality, an adjusted proportional hazards model was developed. After correcting for confounding variables, patients with PH and SA had hazard ratios (HR) of 7.14 (95%CI 3.34-7.21) for all-cause mortality when compared to patients without PH or SA (noPH/noSA group). In comparison, patients with PH that did not face SA (PH/noSA group) had HR of 2.83 (95%CI 1.39-5.75, p<0.01) for all-cause mortality. CONCLUSIONS: In patients with HIV and HF, the development of PH significantly worsens all-cause mortality. Importantly, patients living with HIV often encounter barriers to healthcare access that negatively affect clinical outcomes. In this study, the presence of SA was independently associated with increased mortality. Prognosis was even poorer in patients with PH and co-occurring SA.

BACKGROUND:Obesity is a recognized risk factor for heart failure (HF) in people living with HIV. However, among patients with HF, being overweight or having mild to moderate obesity has been associated with significantly improved survival rates compared with those at normal weight-a phenomenon known as the obesity paradox. This paradox has not yet been evaluated in patients with both HIV and HF in the era of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is). Our study aimed to assess the mortality risk associated with body mass index (BMI) in patients with both HIV and HF and evaluate the impact of GLP-1 RAs and SGLT-2is on mortality across different weight categories. METHOD:This study analyzed data from the New York City Health + Hospitals Corporation (NYC HHC) cohort (NYC 4H), which included records from 11 major New York City Health + Hospitals facilities. The dataset combined retrospective baseline data with ongoing prospective follow-up. The cohort consisted of adults with confirmed HIV and HF who had inpatient or clinic visits between July 2017 and June 2022. HIV infection and HF were initially identified using relevant International Classification of Diseases and Related Health Problems, 10th Revision codes and were further confirmed through laboratory results and echocardiograms. Medication data were verified through electronic health records and cross-referenced with pharmacy records. The primary outcome was the hazard ratio (HR) of overall mortality across different BMI categories in patients with both HIV and HF, assessed using proportional hazard regression models adjusted for age, sex, race, comorbidities, smoking status, and functional status. Secondary analyses included re-hospitalization within 6 months of discharge and the association between GLP-1 RAs/SGLT-2is and overall mortality in patients with HIV and HF. Additional analyses were conducted to assess the efficacy of these medications within different BMI categories. RESULTS:A total of 1044 patients were analyzed, including 657 males (62.9%) and 387 females (37.1%), with an average age of 61.6 years at baseline and an average follow-up of 3.8 years. A low BMI (<18.5) was associated with a 57% increase in mortality (HR 1.57; 95% confidence interval [CI] 1.03-2.39; p = 0.04), whereas class I obesity (BMI 30.0-35.9) was associated with a 35% reduction in mortality (HR 0.65; 95% CI 0.42-0.99; p = 0.04) compared with normal BMI, after adjusting for covariates. Class II obesity was associated with a lower rate of re-hospitalization within 6 months of discharge. No significant differences were observed in cardiovascular mortality across different BMI categories. The use of GLP-1 RAs was associated with a 46% reduction in overall mortality risk (HR 0.54; 95% CI 0.30-0.97; p = 0.04), and SGLT-2is were associated with a 77% reduction in overall mortality risk (HR 0.23; 95% CI 0.11-0.46; p < 0.001) after adjusting for BMI and comorbidities. For both medications, the greatest mortality benefit was observed in patients with the highest BMI categories. CONCLUSION:Our study found that overall mortality was higher among underweight individuals with both HIV and HF. Among patients with both conditions, GLP-1 RAs and SGLT-2is significantly reduced mortality, with the greatest survival benefit observed in users within the highest BMI categories.

Abdominal surgeries make up a significant portion of all surgical procedures performed worldwide. Despite advances in surgical techniques, there is significant morbidity and mortality associated with abdominal surgeries. Cardiopulmonary complications in the postoperative period play an important part in the elevated risk associated with these surgeries. Preoperative medical assessments have therefore become the standard of care to evaluate the risk of surgery, optimize a patient’s medical conditions, and mitigate the perioperative risk. While there has been increasing utilization of lung point of care ultrasound (POCUS) in the immediate preoperative setting, the use of lung POCUS at the preoperative medical assessment clinic visit has not been studied. While using risk stratification tools is common in current practice, the role of adjunctive office-based techniques like lung POCUS have not been studied in this setting. We conducted an observational prospective pilot study to evaluate the association of lung POCUS findings in the preoperative visit on the risk of adverse cardiopulmonary outcomes in the 30-day postoperative period after major abdominal surgery. A standardized scoring system called integrated lung ultrasound score (iLUS) is used for objective assessment. Our study attempted to determine whether the addition of lung POCUS can be used to better stratify the risk for postoperative complications.

Pulmonary embolism (PE) remains a critical condition with significant mortality and morbidity, necessitating timely detection and intervention to improve patient outcomes. This review examines the evolving role of artificial intelligence (AI) in PE management. Two primary AI-driven models that are currently being explored are deep convolutional neural networks (DCNNs) for enhanced image-based detection and natural language processing (NLP) for improved risk stratification using electronic health records. A major advancement in this field was the FDA approval of the Aidoc© AI model, which has demonstrated high specificity and negative predictive value in PE diagnosis from imaging scans. Additionally, AI is being explored for optimizing anticoagulation strategies and predicting PE recurrence risk. While further large-scale studies are needed to fully establish AI’s role in clinical practice, its integration holds significant potential to enhance diagnostic accuracy and overall patient management.

Background: Right ventricular (RV) dysfunction is associated with poor clinical outcomes in critically ill sepsis patients, but its pathophysiology and predictors are incompletely characterized. We aimed to investigate the predictors of RV dysfunction and its outcomes in sepsis patients admitted to the intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of adult patients admitted to the ICU for sepsis who had echocardiography within 72 h of diagnosis. Patients with acute coronary syndrome, acute decompensated heart failure, or significant valvular dysfunction were excluded. RV dysfunction was defined as the presence of RV dilation, hypokinesis, or both. Demographics and clinical outcomes were obtained from electronic medical records. Results: A total of 361 patients were included in our study-47 with and 314 without RV dysfunction. The mean age of the population was 66.8 years and 54.6% were females. Compared to those without RV dysfunction, patients with RV dysfunction were more likely to require mechanical ventilation (63.8% vs. 43.9%, p = 0.01) and vasopressor support (61.7% vs. 36.6%, p < 0.01). On multivariate logistic regression analysis, increasing age (OR 1.03, 95% C.I. 1.00-1.06), a history of HIV infection (OR 5.88, 95% C.I. 1.57-22.11) and atrial fibrillation (OR 4.34, 95% C.I. 1.83-10.29), and presence of LV systolic dysfunction (OR 14.40, 95% C.I. 5.63-36.84) were independently associated with RV dysfunction. Patients with RV dysfunction had significantly worse 30-day survival (Log-Rank p = 0.023). On multivariate Cox regression analysis, older age (HR 1.02, 95% C.I. 1.00-1.04) and peak lactate (HR 1.16, 95% C.I. 1.11-1.21) were independent predictors of 30-day mortality. Conclusions: Among other findings, our data suggests a possible association between a history of HIV infection and RV dysfunction in critically ill sepsis patients, and this should be investigated further in future studies. Patients with evidence of RV dysfunction had poorer survival in this population; however this was not an independent predictor of mortality in the multivariate analysis. A larger cohort with a longer follow-up period may provide further insights.