BACKGROUND:In young adults, the risk factors (RFs) for cryptogenic ischemic stroke (CIS) remain unclear. We aimed to investigate the association between recent mechanical venous thrombosis RFs (VTRFs) and young-onset CIS in this multicenter sex- and age-matched case-control study. METHODS:Five hundred forty-six patients aged 18 to 49 years (median age, 41 [34-46] years; 47.3% women) with a recent CIS and 546 stroke-free community-based controls were included in the study across 19 European centers between October 2013 and November 2022. Mechanical VTRFs, including surgical treatment, nonsurgical intervention, injury, and immobilization occurring within 90 days prestroke, were assessed using standardized, structured interviews. Conditional logistic regression was used to assess the association of mechanical VTRFs with CIS. Age, sex, level of education, and traditional and nontraditional stroke RFs were included as confounders. RESULTS:Mechanical VTRFs within 14 days prestroke were more prevalent in cases than controls (15.4% versus 9.6%) and independently associated with CIS after adjustment for demographics and traditional stroke RFs (odds ratio [OR], 1.67 [95% CI, 1.05-2.67]). In age-stratified analysis, this association remained significant after additional adjustment for nontraditional RFs in 18- to 39-year-olds (OR, 2.36 [95% CI, 1.02-5.46]) but was not significant in the 40- to 49-year age group (OR, 1.50 [95% CI, 0.73-3.08]). In addition, mechanical VTRFs were associated with CIS in cases with clinically relevant patent foramen ovale in a fully adjusted model (OR, 2.06 [95% CI, 1.21-3.51]) but not in those without (OR, 1.29 [95% CI, 0.76-2.18]). No significant associations were observed for mechanical VTRFs occurring >14 days before stroke. Baseline blood thrombophilia markers did not differ between cases with and without mechanical VTRFs 0 to 14 or 15 to 90 days before stroke. CONCLUSIONS:Recent mechanical VTRFs occurring within 14 days preceding stroke contribute to the risk of young-onset CIS, particularly in younger individuals and those with a clinically relevant patent foramen ovale. This risk does not appear to be conveyed by thrombophilic factors assessed. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01934725.

BACKGROUND:Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal condition characterized by heart failure occurring at the end of pregnancy or within the first months after delivery in women without prior history of structural heart disease. This single-center case-control study aimed to describe the incidence, clinical profile, echocardiographic findings and outcomes of PPCM in a West-Norwegian population. METHODS:Between 2011 and 2023, a total of 15 cases of PPCM were identified at Haukeland University Hospital. The Bergen Birth Registry was used to determine the total number of births in the same period, and to recruit 30 age-matched healthy controls. Clinical characteristics, echocardiographic data, and outcomes were collected. RESULTS:The incidence rate of PPCM was 1 in 4,182 births. Risk factors included higher pre-pregnancy body mass index (BMI) (OR 1.25) and elevated systolic blood pressure at presentation (OR 1.11). The prevalence of pre-eclampsia and primiparity was significantly higher in PPCM patients compared to controls (p < 0.01). Mean left ventricular (LV) ejection fraction increased from 35% at presentation to 58% at the 6-month follow-up (p < 0.001). There were no maternal or neonatal mortalities. Three patients required ICU treatment, but none experienced major cardiovascular events. CONCLUSIONS:The incidence of PPCM in this West-Norwegian study was relatively low. Higher pre-pregnancy BMI and elevated systolic blood pressure, both important modifiable cardiovascular risk factors, were identified as predictors of PPCM. All patients experienced successful clinical and LV function recovery. Future large collaborative studies are necessary to provide a reliable description of incidence and outcomes nationwide.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are prevalent conditions with overlapping pathophysiological mechanisms. Their coexistence, termed overlap syndrome, is thought to amplify cardiometabolic risk. This study examined the 10-year risk of major adverse cardiovascular events (MACE) and all-cause mortality in individuals with COPD and OSA symptoms in a community-based cohort. Baseline data (1998–1999) from the Hordaland Health Study were linked to national registries on mortality and cardiovascular events. Of 7,456 eligible adults born 1925–1927 and 1950–1951, a random sample of 5,100 was invited, and 3,305 with valid spirometry were included. OSA symptoms were assessed by questionnaire, and chronic airway obstruction (CAO) was defined as post-bronchodilator FEV₁/FVC < 0.70. Cox regression estimated hazard ratios (HR) for MACE and all-cause mortality. CAO independently predicted both MACE (HR 1.48, 95

The impact of obstructive sleep apnea (OSA) on all-cause mortality needs further research as earlier data are inconclusive. Between 30 and 50 Obstructive sleep apnea (OSA) is linked to cardiovascular disease, but its impact on mortality, especially when combined with insomnia (COMISA), remains underexplored. This study investigated the prognostic OSA severity and COMISA in a large cohort of 2401 patients with suspected OSA. Our findings showed that moderate to severe OSA significantly predicted all-cause mortality, independent of traditional risk factors. The presence of COMISA tripled this risk, highlighting a synergistic negative effect. These results emphasize the importance of recognizing COMISA as a distinct, high-risk phenotype. Future clinical practice should include systematic screening and treatment of both OSA and insomnia to improve survival outcomes in affected patients.

Introduction International guidelines emphasise the role of heart valve centres (HVC) and specialist heart valve clinics (SHVC) to deliver optimal care to patients with heart valve disease (HVD). We sought to determine whether we could reaffirm the importance of SHVCs in our centre.Methods A total of 3731 consecutive non-SHVC (N-SHVC) patients were reviewed over 18 months. Patients (134) with a primary diagnosis of HVD were compared with 173 consecutive SHVC attendees based on international guidelines. Concordance was defined as adherence to recommended frequency of follow-up, investigations, timing of surgery and valve care advice, and discordance as any deviation from this.Results Of 134 N-SHVC patients (4.5%) with HVD, 89 (66.4%) had native valve disease and 45 (33.6%) prior heart valve surgery compared with 123 (71.1%) and 50 (28.9%) of SHVC patients, respectively, in the SHVC cohort. In symptomatic patients, the relationship to HVD was not documented in 31.5% of N-SHVC patients versus 5.7% of SHVC patients (p<0.001). Exercise testing was used infrequently in N-SHVCs compared with SHVCs (3.4% vs 32%, p<0.001) and surgical referral was lower (3.4% vs 26.8%, p<0.001). No N-SHVC patients with prior valve surgery received endocarditis prevention advice compared with 100% of SHVC patients. Overall, 34 (38.2%) of N-SHVC patients with native valve disease and 34 (84.4%) with prior cardiac surgery had discordant management compared with 4 (3.3%) and 2 (4%) of SHVC patients respectively.Conclusion Almost 5% of patients with valve disease are still seen in an N-SHVC setting despite the availability of an SHVC within the same institute and receive suboptimal care.

AIMS:We aimed to systematically evaluate standard 12‑lead electrocardiograms (ECG) in young individuals with exercise-induced laryngeal obstruction (EILO), with a special focus on the prevalence and clinical significance of T-wave inversion (TWI). METHODS AND RESULTS:235 individuals (mean age 16.7 years, 85% females) presenting to the EILO Clinic, underwent 709 high-intensity cardiopulmonary exercise treadmill testing with continuous visualization of the larynx (CLE- Continuous Laryngoscopy Exercise). There was no adverse event during exercise tests. The prevalence of TWI (negatively deflected T-wave ≥1 mm (0.1 mV amplitude) in any 2 contiguous leads excluding aVR, III, and V1) was 42.6% (18.7% isolated in the inferior wall leads, 13.2% in the inferolateral leads, 5.1% in both the inferior and anterior leads, 3% both in the inferior and anteroseptal leads, 2.1% isolated in anteroseptal leads and 0.9% isolated in anterior wall leads). Age, body height and weight, exercise duration and peak oxygen uptake did not differ between individuals with versus without TWI (all p > 0.05). There was a trend towards lower total CLE score in individuals with TWI (4.2 vs 4.5, p = 0.070). Individuals with TWI had higher resting heart rate (98 vs 95 bpm, p = 0.05), shorter PQ-interval (124 vs 129 ms, p = 0.020) and achieved higher peak heart rate (193 vs 189 bpm, p = 0.005) and metabolic equivalents during exercise (13.4 vs 12.9, p = 0.028). CONCLUSIONS:High-intensity CLE-test in individuals with EILO was not associated with any adverse cardiac findings. TWI was highly prevalent and particularly observed in the inferior or inferolateral wall leads but had no association with energetic decline or cardiac dysfunction.

Background Racial disparities in valvular heart disease are well-documented, yet evidence specific to mitral regurgitation (MR) remains fragmented. This study examined racial differences in mortality and treatment access among patients with moderate-severe MR within a universal healthcare system.Methods This retrospective cohort study utilised digital health records from a South London tertiary centre using natural language processing (NLP), including demographic, clinical, echocardiographic and socioeconomic data. Adult patients with moderate or greater MR diagnosed between 2010 and 2023 were stratified by ethnicity (White, Black, Asian). Primary outcomes were all-cause mortality and surgical/transcatheter intervention rates. Multivariable Cox regression and competing risk analyses adjusted for demographics, MR characteristics, comorbidities and socioeconomic deprivation.Results The cohort (n=6665) comprised 5331 (80.0%) White, 958 (14.4%) Black and 376 (5.6%) Asian patients with under-represented minority proportions relative to local demographics. Black patients presented younger (65.4 vs 72.2 years; p <0.001) with greater socio-economic deprivation (median IMD decile 3 vs 5), higher comorbidity burden and predominantly secondary MR (91% vs 85%; p <0.001). Crude mortality rates were 103.8, 88.1 and 80.4 per 1000 person-years for White, Black and Asian patients respectively. After adjustment, ethnicity was not independently associated with mortality (Black vs White: HR 0.90; 95% CI 0.80 to 1.00; p=0.06) or intervention (OR 0.81; 95% CI 0.59 to 1.11; p=0.18). Socioeconomic deprivation was independently associated with mortality (HR 0.97/IMD decile increase; p <0.001) and intervention rates. Crude intervention rates were lower in Black than in White patients (6.9% vs 12.7%), this difference attenuated after adjustment for MR aetiology, comorbidities and socioeconomic deprivation and did not persist as an independent association (OR 0.81; 95% CI 0.59 to 1.11; p=0.18).Conclusion MR appears under-detected among minority patients relative to local demographics and occurs at a younger age and with a greater prevalence of secondary MR and comorbidity. Once identified, clinical factors and socioeconomic deprivation rather than ethnicity itself drive outcomes and treatment access, with no statistically independent association between ethnicity and either mortality or intervention, although modest but clinically relevant differences cannot be excluded given the cohort sizes. These findings highlight the need for enhanced valve disease detection in diverse communities alongside strategies addressing socioeconomic determinants of cardiovascular health.

Aims Infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) is an uncommon but clinically devastating complication. We aimed to identify risk factors for TAVI-IE and to estimate its association with all-cause mortality.Methods and results We conducted a case-control study including patients who underwent TAVI at Haukeland University Hospital, Norway, between 2012 and 2023. Patients who developed TAVI-IE (n=71) were compared with age-matched and sex-matched controls without IE (n=213; 1:3 ratio). Death was treated as a competing event in analyses of IE, and we estimated the subdistribution HRs (SHR) for IE using Fine-Gray competing risk regression. Cox regression models with IE as a time-dependent covariate assessed the impact of infection on mortality.The incidence of TAVI-IE was 1.2% per patient-year with a median time from TAVI to infection of 13 months (IQR 4–29). In multivariable competing risk analysis, diabetes mellitus remained an independent predictor of TAVI-IE (SHR 2.08, 95% CI 1.19 to 3.65, p=0.010). Obesity (27% vs 15%, p=0.019) and balloon-expandable valve use (28% vs 13%, p=0.003) were more often observed in patients with TAVI-IE. Enterococcus faecalis was the most frequent pathogen (30%). TAVI-IE was associated with an approximately twofold increase in all-cause mortality (adjusted HR 2.13, 95% CI 1.48 to 3.07, p<0.001) with the highest risk in early infections.Conclusion TAVI-IE is an infrequent but severe complication associated with excess mortality. Diabetes mellitus was the dominant independent risk factor and E. faecalis the leading pathogen. These findings may help target monitoring and prevention in patients at the highest risk.

BACKGROUND:Previous post-mortem studies in victims of intoxication have typically focused on toxicological and biochemical analyses. This study aimed to assess the prevalence and types of cardiovascular disease in fatal intoxication cases. METHODS:We included post-mortem autopsy examinations of 865 fatal intoxication cases performed on medico-legal basis at the Gade Laboratory for Pathology at Haukeland University Hospital, Bergen between 2000 and 2013. RESULTS:The mean age at death was 42.1 years (range 13-97) and 72% were males. The cause of death was attributed to intoxication with drugs in 35% cases, combination of drugs and narcotics in 17%, narcotics in 17%, ethanol and drugs in 15%, and ethanol alone in 8% cases. More than a third (36.0%) had concomitant causes of death. The mean heart weight was 387 ± 86 g. A total of 12.3% patients had mild, 8.4% moderate and 9.7% had severe atherosclerosis, while 69.6% had no atherosclerosis or only minor changes in the coronary arteries. A total of 14.9% patients had pathological changes in the brain: cerebral oedema in 23% (n = 29) cases, old ischemic strokes in 22% (n = 28), traumatic brain injury in 13.2% (n = 17) and intracranial hemorrhage in 8.5% (n = 11), while the incidence of acute ischemic stroke was 3.1% (n = 4). Myocardial infarction (old/healed) was evident in 10.3% (n = 89) of the victims. The incidence of left ventricular hypertrophy was nearly 3-fold higher than right ventricular hypertrophy (29.2% vs 10.6%). CONCLUSIONS:In victims of intoxication, cerebrovascular disease was found in 15% and heart diseases in up to 30% of cases. It is possible that the acute toxic effects of alcohol and substance abuse are aggravated in patients with underlying cardiac and cerebrovascular diseases. The findings from the current study highlight the importance of enhanced cardiovascular risk assessment in substance use disorders, with major forensic and public health implications.

Introduction: Age, sex and family history of cardiovascular disease (CVD) are non-modifiable risk factors of CVD in offspring. Our aim was to relate parental CVD (pCVD) to artery vessel-wall measurements in offspring. Patients and methods: Offspring consisted of acute ischaemic stroke patients (15-60 years) and their partners. Young offspring was defined as ≤45 years old. Arterial wall changes were assessed as intima-media thickness of carotid and femoral arteries (cIMT/fIMT), abdominal aortic plaques (AAP), and ankle-arm index (AAI). Any offspring reported parental coronary artery disease (pCAD) and parental peripheral artery disease (pPAD). In addition, pCAD and pPAD were also verified by standardized questionnaires for living parents, or by medical records for deceased parents. Results: Reported vs. verified pCVD was present for around 90% vs. 50% of parents. Reported pCAD/pPAD was positive for 227/67 offspring and verified pCAD/pPAD was positive for 148/36 offspring, respectively. Reported and verified pCAD and pPAD were related to higher cIMT and fIMT. Reported and verified pCAD was also related to AAP and reported pPAD to AAI. The effect attenuated after adjusting for age, hypertension, dyslipidemia, diabetes mellitus and smoking. Among young offspring, reported pCAD was associated with higher cIMT and fIMT, even though the total number of young offspring was 4-fold lower compared to middle-aged offspring. Conclusions: Parental CVD is related to artery wall changes in offspring, particularly in young offspring. Regarding CVD risk assessment, extensive parental verification of CVD might not be necessary as many young patients and partners seem to be well-orientated about their parental CVD. Primary prevention from young age should get more attention.

BACKGROUND:The incidence of aortic stenosis (AS) in the older adult population in Western countries is increasing. When left untreated, AS progresses to clinical heart failure, reduced quality of life and functional capacity, and ultimately death. We aimed to assess sex differences in the long-term survival benefits of transcatheter aortic valve implantation (TAVI) in patients with severe AS. METHOD:A total of 600 consecutive patients with AS who underwent TAVI were included. Clinical and echocardiographic data were analysed. Propensity score matching was performed to assess the impact of sex on the survival benefit following TAVI, yielding 213 men and women with similar baseline characteristics. RESULTS:The mean age in the total population was 80.8±6.5 years. Women (49.3%) were older (82.2±5.3 vs 79.5±7.3 years; p<0.001), had more severe AS, higher prevalence of hypertension and basal septal hypertrophy, and higher left ventricular ejection fraction (LVEF) than men. By contrast, the prevalence of diabetes mellitus, cardiovascular disease, overall abnormal electrocardiogram, and atrial fibrillation was higher in men. During a mean follow-up of 59±24 months for men and 66±25 months for women, a total of 279 deaths occurred (125 in women and 154 in men; p=0.039). There was no difference in mortality at 1 and 2 years. The most pronounced benefit was observed at 3-year follow-up, with survival estimates of 92% for women and 84% for men (p=0.006). In a multivariable Cox regression analysis of the propensity-matched cohort, long-term event-free survival was significantly higher among women than men (hazard ratio 0.66; 95% confidence interval 0.49-0.88; p=0.004). CONCLUSIONS:At presentation, women were older, had a higher burden of hypertensive heart disease, more often exhibited concentric hypertrophy with preserved LVEF, and less frequently had atrial fibrillation compared with men. Women had better long-term survival following TAVI, with the most pronounced survival benefit observed at 3 years.

BACKGROUND:The incidence of young-onset ischemic stroke is rising, driven by cryptogenic ischemic stroke (CIS) and patients without vascular risk factors. This study examines the burden and associations of modifiable traditional, nontraditional, and female sex-specific risk factors with young-onset CIS, stratified by clinically relevant patent foramen ovale (PFO), defined by high-risk features of atrial septal aneurysm or large right-to-left shunt. METHODS:We enrolled consecutive patients aged 18 to 49 years with recent CIS and frequency-matched stroke-free controls of the same age and sex from 19 European sites. Logistic regression assessed the association of risk factor counts (12 traditional, 10 nontraditional, 5 female sex-specific) and individual risk factors, stratified by PFO. Analyses were stratified by sex and age (18-39 and 40-49 years), with computation of population-attributable risk. RESULTS:We included 523 patients (median age, 41 years; 47.3% women; 196 [37.5%] with PFO) and 523 controls. In patients with CIS without PFO, each additional traditional (odds ratio, 1.417 [95% CI, 1.282-1.568]), nontraditional (odds ratio, 1.702 [95% CI, 1.338-2.164]), and female sex-specific risk factor (odds ratio, 1.700 [95% CI, 1.107.1-2.611]) increased CIS risk. For patients with CIS with PFO, each traditional risk factor increased the risk (odds ratio, 1.185 [1.057-1.328]), but only nontraditional risk factors remained significant when fully adjusted (odds ratio, 2.656 [2.036-3.464]). Population-attributable risks for CIS without PFO were 64.7%, 26.5%, and 18.9% for traditional, nontraditional, and female sex-specific risk factors. For CIS with PFO, population-attributable risks were 33.8%, 49.4%, and 21.8%, respectively. Migraine with aura was the most significant contributor, with population-attributable risks of 45.8% for CIS with PFO and 22.7% for CIS without PFO, showing a stronger impact in women. CONCLUSIONS:Despite the initial cryptogenic label of these strokes, traditional risk factors significantly contribute to CIS without PFO, while nontraditional factors seem more critical for CIS with PFO. Migraine with aura plays a prominent role in young-onset CIS development, particularly in women. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01934725.

The risk of ablation-induced coronary artery injury is low, but may increase with the anatomic proximity and increasing frequencies of redo procedures or when catheter ablation is performed in the coronary sinus branches. We present the case of a 53-year-old woman with a history of 5 ablations over the past 12 years. Owing to recurrence of highly symptomatic atrial flutter, a repeat ablation was performed in the coronary sinus. She developed chest pain accompanied by ST-segment elevation in the inferior leads. Coronary angiography demonstrated an occluded mid-circumflex artery, which we believe was induced by direct thermal injury. This was successfully treated with a drug-eluting stent.

Background:Fatigue is a prevalent and disabling consequence of ischemic stroke in young adults, yet its multifactorial nature and impact on recovery remain underexplored. This study investigates predictors of post-stroke fatigue and association with return to work (RTW) and other variables at a one-year follow-up (1y-FU) after ischemic stroke. Methods:We analysed data from 130 patients aged 15-49 years with MRI-confirmed acute ischemic stroke enrolled in the Norwegian Stroke in Young Study II. Fatigue and cognitive symptoms were assessed using standardized self-report and clinical evaluations at 1y-FU. Multivariable logistic regression identified independent predictors of persistent fatigue, adjusting for age, sex, and stroke severity. Results:At 1y-FU, 50 % of patients reported persistent fatigue. Fatigue was independently associated with failure to RTW (OR 3.2, 95 % CI 1.8-5.6), migraine without aura (OR 2.1, 95 % CI 1.3-3.4), hearing difficulties (OR 2.0, 95 % CI 1.1-3.8), concentration problems (OR 2.4, 95 % CI 1.5-4.0), and pain (OR 2.6, 95 % CI 1.5-4.5). Patients with resolved fatigue were significantly more likely to RTW (65.9 %) compared to those with persistent symptoms (34.2 %, p < 0.001). Cognitive impairment at admission was common (45.9 %), and among these patients, 52.2 % reported persistent deficits at 1y-FU. Fatigue severity was not associated with educational attainment but increased with age and NIHSS score. Conclusions:Fatigue affects half of young ischemic stroke survivors after 1 year, substantially hindering RTW. Novel associations with migraine, hearing and cognitive deficits, and pain suggest underrecognized contributors that may be amenable to individually targeted rehabilitation. Integration of fatigue management into early stroke rehabilitation programs, with a focus on cognitive, sensory, and pain-related domains, may help optimize vocational and functional outcomes.

INTRODUCTION:Obstructive sleep apnea (OSA) - characterized by recurrent upper airway obstruction during sleep - remains underdiagnosed and undertreated. Affecting nearly one billion adults globally, OSA is especially prevalent among patients with cardiovascular comorbidities. Diagnosis may be delayed due to atypical symptoms, particularly in women, and healthcare barriers including fragmented care, limited provider training, and restricted access to specialized diagnostics. Untreated OSA contributes to an increased prevalence of resistant hypertension, recurrent arrhythmias (atrial fibrillation), stroke, and heart failure. AREAS COVERED:This review focuses on the intricate relationship between OSA and cardiovascular health, highlighting key pathophysiological mechanisms such as intermittent hypoxia, autonomic dysregulation, and systemic inflammation that drive structural and functional cardiac impairments. Further, the review highlights the importance of improved screening tools for early detection. The special report is based on systemic search of PubMed. EXPERT OPINION:Early screening and detection are crucial, given the strong association between untreated OSA and adverse health outcomes. Expert consensus recommends routine OSA screening in high-risk cardiovascular populations and emphasizes comprehensive early interventions; CPAP, lifestyle modification, and metabolic risk management. Integrating OSA assessment into cardiology practice and expanding advanced diagnostic tools may improve detection, reduce morbidity and mortality, and lessen the economic burden on healthcare systems.

CLINICAL CONDITION:We present a case of an extremely rare condition of acute stent infection in a patient with multiple previous coronary interventions who underwent a successful percutaneous coronary intervention for chronic total occlusion with stent implantation in his right coronary artery. He developed fever the day after the procedure, and blood culture showed growth of Staphylococcus aureus. Positron emission tomography-computed tomography showed fluorodeoxyglucose uptake in relation to the right coronary artery stent, and follow-up computed tomography showed the development of a pseudoaneurysm and suspicion of stent separation. KEY QUESTIONS:Is the S aureus bacteremia in his blood culture related to the procedure? What do positron emission tomography-computed tomography findings indicate? Can the devolvement of a pseudoaneurysm cause stent separation? OUTCOME:After a broad multidisciplinary discussion and fear of pseudoaneurysm rupture with lethal outcomes, a successful open-heart surgery was performed, involving the removal of the pseudoaneurysm and stents. The patient is currently doing well with only mild symptoms. TAKE-HOME MESSAGES:The current work highlights the importance of close surveillance of patients presenting with signs and symptoms of septicemia after coronary intervention. It also underscores the value of a broad and dynamic multidisciplinary discussion and action during the management of such a rare complication with mycotic coronary aneurysms.

Introduction: Obstructive sleep apnea (OSA) is more prevalent in men than women, and the exact explanation for this is unknown. The aims of the present study were to explore the prevalence and predictors of OSA in men and women with a focus on clinical characteristics, cardiovascular disease (CVD), and serum biomarkers. Methods: Between 2016 and 2018, 2,401 patients with suspected OSA underwent respiratory polygraphy and completed questionnaires on medical history (i.e., CVD). Height, weight, blood pressure, and blood samples were collected. OSA was classified according to the apnea-hypopnea index (AHI): no OSA (AHI <5), mild (5–14.9), moderate (15–29.9), and severe OSA (≥30). When dichotomized into no OSA vs. OSA, OSA was defined as AHI ≥15. Cardiometabolic risk factors included obesity, diabetes, dyslipidemia, and hypertension. Results: The prevalence of OSA was 36.2% (n = 868). There were 77.4% (n = 672) men in the OSA group. The prevalences of overall CVD, atrial fibrillation, diabetes, and chronic obstructive pulmonary disease were comparable between women and men with OSA. A dose-dependent increase in the number of cardiometabolic risk factors according to the OSA severity grade was observed both in women and men. Patients having none or 1 cardiometabolic risk factor tended to have either no OSA or mild OSA, while patients with 2 cardiometabolic risk factors were more likely to have mild to moderate OSA. Patients with ≥3 cardiometabolic risk factors (53.3%) had mainly moderate or severe OSA, equally represented between women and men. In multivariate logistic regression analyses, independent predictors of OSA were age and BMI in both sexes, smoking, hypertension, and excessive sleepiness in men, and estimated glomerular filtration rate <60 mL/min/m2 in women. Conclusions: More than half of patients with OSA had features of metabolic syndrome, evenly distributed between men and women. This requires strict control of cardiometabolic risk factors in both sexes. There were different predictors of OSA in men and women. This highlights a possible sex difference in the pathophysiology of OSA.

Objectives The primary objectives were to identify the predictors of new permanent pacemaker implantation in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The secondary objectives were to investigate the temporal changes in permanent pacemaker implantation following TAVI and its impact on long-term prognosis.Design Prospective observational cohort study of patients with AS undergoing TAVI.Setting Single-centre study conducted at a tertiary hospital in Western Norway between 2012 and 2019.Participants Among 600 consecutive patients with severe AS who were treated with TAVI, 52 patients with permanent pacemaker prior to TAVI were excluded. The remaining 548 patients were included in the present study.Baseline measures An evaluation of baseline risk factors, 12-lead ECG and echocardiography.Primary outcome measures The need for a new pacemaker implantation ≤30 days following TAVI and all-cause death.Results The mean age was 80.6±6.7 years, and 50% were males. Among the 548 eligible patients, 173 (31.6%) underwent pacemaker implantation ≤30 days following TAVI, evenly distributed between females and males (29.6% vs 33.6%, p=0.317), with higher implant rates at low-volume phase (2012–2015) and lower implant rates at high-volume phase (2016–2019) (45.8% vs 23.9%, p<0.001). On multivariable analysis, an abnormal electrocardiogram (OR 1.73; 95% CI 1.14 to 2.63, p=0.010), right bundle branch block (OR 2.23; 95% CI 1.09 to 4.59, p=0.028) and atrial fibrillation (OR 1.89; 95% CI 1.24 to 2.88, p=0.003) at baseline were strong predictors of pacemaker implantation. The type of bioprosthesis, but not size, was associated with permanent pacemaker implantation (mechanically expandable valves OR 3.48, 95% CI 2.16 to 5.59; balloon-expandable valves OR 0.07, 95% CI 0.02 to 0.29, both p<0.001)—irrespective of age and sex. During a median follow-up of 60.4 months (range 3–131 months), permanent pacemaker implantation following TAVI was not associated with all-cause mortality (HR 0.89; 95% CI 0.69 to 1.16, p=0.403).Conclusions In the current study, the rates of permanent pacemaker implantation following TAVI decreased substantially from the early low-volume phase to the late high-volume phase. An abnormal baseline ECG, right bundle branch block, atrial fibrillation and bioprosthesis selection remained important predictors of permanent pacemaker implantation. Permanent pacemaker implantation following TAVI had no impact on short or long-term survival.Ethics and dissemination The Regional Committees for Medical and Health Research Ethics (approval number: REK vest 33814/2019) and the Institutional Data Protection Services approved the study protocol. The dissemination of study findings was through peer-reviewed publication, presentation at national and international scientific meetings and conferences.Trial registration number NCT04417829.