Matos EP, Rabito LBF, Barreto RS
… +3 more, de Souza NC, Dos Santos Oliveira JA, Sanches RCN
Int J Cardiol
· 2026 Jun · PMID 41871787
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BACKGROUND: This study examined spatiotemporal patterns and demographic determinants of mortality from diseases of the circulatory system (DCS) in Brazil, 2008-2024. METHODS: We conducted a nationwide ecological time-ser...BACKGROUND: This study examined spatiotemporal patterns and demographic determinants of mortality from diseases of the circulatory system (DCS) in Brazil, 2008-2024. METHODS: We conducted a nationwide ecological time-series study using quasi-Poisson regression with a population offset to model death counts and estimate incidence rate ratios (IRRs). Univariable and multivariable models assessed associations of macroregion, sex, age group, and ICD-10 diagnostic category with DCS mortality, adjusting for long-term time trends. RESULTS: Multivariable analysis showed a persistent annual increase of 0.62% in DCS mortality (IRR 1.0062, 95% CI 1.0047-1.0077). Marked regional disparities were observed, with the North region exhibiting substantially lower mortality rates (IRR 0.109, 95% CI 0.105-0.112) relative to the Southeast. Mortality rates were lower in females than in males (IRR 0.906, 95% CI 0.893-0.919). Age showed the strongest association with mortality: individuals aged ≥80 years had mortality rates 48 times higher (IRR 48.36, 95% CI 44.34-52.74) than those aged 20-29. CONCLUSIONS: Cardiovascular mortality in Brazil increased between 2008 and 2024, reversing prior declines. The increase occurred across demographic groups and regions, suggesting a widespread epidemiological shift. These findings underscore the need for strengthened prevention strategies integrating clinical risk reduction with action on the social determinants of cardiovascular health.
Apostolos A, Konstantinou K, Allaf M
… +13 more, Sakalidis A, Kalogeras K, Heng EL, Davies S, Duncan A, Dalby M, Mirsadraee S, Mittal T, Baltabaeva A, Smith R, Kabir T, Akhtar MM, Panoulas V
BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) is an effective therapy in patients with severe aortic stenosis presenting in acute heart failure, though whether self-expanding (SEV) or balloon-expandable valv...BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) is an effective therapy in patients with severe aortic stenosis presenting in acute heart failure, though whether self-expanding (SEV) or balloon-expandable valves (BEV) should be used in such cases is unknown. The aim of the study is to compare SEV with BEV in such patients. METHODS: Consecutive patients undergoing urgent TAVI with either SEV or BEV at two tertiary hospitals between 2012 and 2024 were studied. The primary endpoint was long-term survival over a median follow-up of 60 months. Secondary endpoints included technical and device success, in-hospital mortality, periprocedural complications, and echocardiographic valve performance. A subgroup analysis evaluated more contemporary devices (after 1/1/2017). RESULTS: A total of 587 patients underwent urgent TAVI [SEV (N = 321) and BEV (N = 266)]. BEV patients had higher rates of prior myocardial infarction and stroke. BEV achieved higher technical and device success, lower in-hospital mortality, and less post-TAVI aortic regurgitation. Although Kaplan-Meier analysis suggested better survival with BEV (log-rank p = 0.017) adjusted Cox regression revealed no significant mortality difference (HR 0.73, 95%CI 0.51-1.04). Outcomes were also comparable in the contemporary device subgroup (n = 299). CONCLUSIONS: To the best of our knowledge, this is the first analysis comparing long-term outcomes in patients presenting in acute heart failure undergoing urgent TAVI between SEV and BEV. No statistically significant difference in long-term survival was observed between SEV and BEV, supporting individualized device selection based on anatomy and operator preference.
BACKGROUND: In infective endocarditis (IE), a prompt diagnosis and therapy lead to better outcomes. Diagnostic delay seems common, but causing factors are still under-investigated, limiting actions to improve outcomes. T...BACKGROUND: In infective endocarditis (IE), a prompt diagnosis and therapy lead to better outcomes. Diagnostic delay seems common, but causing factors are still under-investigated, limiting actions to improve outcomes. This study examines variables associated with IE delayed diagnosis and mortality. METHODS: This single-centre retrospective observational study included adults diagnosed with IE according to Duke's criteria from 2009 to 2022. IE diagnoses within 5 days from hospital admission (<5d) were compared to those from day 5 onwards (≥5d). Logistic regression and Cox analyses identified factors associated with ≥5d diagnosis and in-hospital mortality. Sensitivity analyses excluding recurrent endocarditis or diagnoses before 2016, and a post-hoc analysis focused on fever at admission were performed. RESULTS: This study included 349 episodes of IE that occurred in 331 patients (females:31.2%; median age:72 years). Median time to diagnosis was 3 days (IQR:1-8), 196 (56.2%) patients received a diagnosis before and 153 (43.8%) after 5 days. Absence of fever at presentation was associated with ≥5d diagnosis (OR:2.09; 95%CI [1.23-3.56]; p = 0.011). Although mortality was not associated to a ≥ 5d diagnosis (HR:0.96; 95%CI [0.49-1.87] p = 0.905), a higher risk of mortality was found in patients with absence of fever (HR:2.03; 95%CI [1.06-3.90]; p = 0.033) and embolic events (HR:2.15; 95%CI [1.11-4.16]; p = 0.023), which were more frequent in patients without fever (46/120, 38.3%) than with fever (54/227, 23.8%, p = 0.007). CONCLUSIONS: IE patients presenting without fever have higher risk of delayed diagnosis and mortality, possibly due to a higher incidence of embolic events. In these patients, efforts to improve early diagnosis are required.
OBJECTIVE: This study aimed to delineate the cardioprotective mechanisms of low-dose Telmisartan against myocardial ischemia/reperfusion (I/R) injury, specifically by distinguishing between AMPK-dependent and AMPK-indepe...OBJECTIVE: This study aimed to delineate the cardioprotective mechanisms of low-dose Telmisartan against myocardial ischemia/reperfusion (I/R) injury, specifically by distinguishing between AMPK-dependent and AMPK-independent pathways using AMPK kinase-dead (KD) mouse models. METHODS: We subjected wild-type (WT) and AMPK KD mice to in vitro cardiomyocyte hypoxia/reoxygenation (H/R) and in vivo I/R models. The effects of Telmisartan (0.1-1 μM in vitro; 0.33 mg/kg in vivo) were assessed on contractile function, calcium transients, mitochondrial superoxide production, apoptosis (TUNEL), infarct size (TTC/Evans Blue), and key protein expression (Western blot). RESULTS: In WT mice, Telmisartan significantly improved contractile recovery, calcium handling, and reduced infarct size, oxidative stress, and apoptosis. These protective effects were largely AMPK-dependent, as they were abolished in AMPK KD mice. In contrast, the improvements in calcium handling and LKB1 phosphorylation were preserved in KD mice, indicating an AMPK-independent mechanism. Consistently, Telmisartan activated AMPK, phosphorylated cTnI(Ser150), PGC-1α, and increased the Bcl-2/Bax ratio in WT but not KD mice, whereas LKB1 activation occurred independently of AMPK. CONCLUSION: Low-dose Telmisartan confers cardioprotection against I/R injury via dual mechanisms: it primarily utilizes AMPK-dependent signaling to combat oxidative stress, apoptosis, and infarction, while independently of AMPK, it preserves calcium homeostasis and activates LKB1.
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) constitutes a heterogeneous syndrome. We examined whether systolic semilunar regurgitation-systolic aortic regurgitation (SAR) and systolic pulmonary reg...BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) constitutes a heterogeneous syndrome. We examined whether systolic semilunar regurgitation-systolic aortic regurgitation (SAR) and systolic pulmonary regurgitation (SPR)-identifies a high-risk HFpEF phenotype. METHODS: In this retrospective single-center study, 412 participants admitted with HFpEF in the past 10 years were included and echocardiographies during hospitalization were assessed. Patients were grouped by the presence of SAR and/or SPR on echocardiography. SAR and SPR were quantitatively assessed using the vena contracta width. The endpoint was the 6-year composite of heart failure rehospitalization or cardiovascular mortality. RESULTS: Of 412 patients, 248 had neither SAR nor SPR, 77 had SAR alone, 53 had SPR alone, and 34 had SAR + SPR. SAR associated with older age, larger aortic dimensions, and higher E/e'; SPR associated with higher pulmonary artery systolic pressures and reduced right ventricular function. Over 6 years, 219 heart failure rehospitalizations and 63 cardiovascular deaths occurred. The vena contracta width of SAR was an independently predictor associated with the composite endpoint (adjusted hazard ratio 1.259 per 1 mm increase, 95% confident interval 1.118-1.417, p < 0.0001), alongside atrial fibrillation and E/e'. Conversely, the vena contracta width of SPR had no significant impact on these events. CONCLUSION: SAR marks a high-risk HFpEF phenotype. Incorporating SAR into routine echocardiographic reporting may improve risk stratification and guide targeted management.
BACKGROUND: There are inequalities in mortality from acute myocardial infarction (AMI) among the regions of Spain that must be monitored in order to correct them. OBJECTIVE: To determine the evolution of AMI in terms of:...BACKGROUND: There are inequalities in mortality from acute myocardial infarction (AMI) among the regions of Spain that must be monitored in order to correct them. OBJECTIVE: To determine the evolution of AMI in terms of: patient exposure to cardiovascular risk factors, population incidence, length of stay, case fatality rate, and adjusted risk of death during hospitalization (RD). METHODS: A descriptive study of hospital admissions for AMI in Spain from 2018 to 2023, recorded in the Minimum Basic Data Set, comparing the data from this period (P2) with those previously published for the period 2007-2014 (P1). RESULTS: 414,578 patients admitted for AMI in P1 and 394,817 during P2 were studied, of whom 33,569 and 33,487 died, respectively. Between the two periods, exposure to diabetes, hypertension, dyslipidemia, renal insufficiency, and cocaine use increased significantly; only smoking decreased (p < 0.05). The incidence of AMI increased in all regions (p < 0.001). Length of stay decreased by 1 day (p < 0.001), and mortality remained stable, but with heterogeneity among regions: there were significant reductions in RD in Cantabria (44%), Murcia (19%), and Aragon (18%), as well as a significant increase in risk in Madrid (19%), Basque Country (17%) and Valencian Community (11%). CONCLUSIONS: Between P1 and P2, the incidence of AMI increased in Spain, accompanied by greater patient exposure to diabetes, hypertension, dyslipidemia, renal insufficiency, and cocaine use. The length of hospital stays decreased. RD changed heterogeneously, with significant improvements in Cantabria, Aragon, and Murcia, and a worsening in Madrid, Basque Country and Valencian Community.
Bilato C, Girardi G, Zuin M
… +7 more, Salmaso L, Schievano E, Rigatelli G, Dalla Valle C, Pasquetto G, Fedeli U, Saia M
Int J Cardiol
· 2026 Jun · PMID 41861850
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BACKGROUND: We examined 25-year population-level trends in acute myocardial infarction (AMI) in the Veneto Region (Northeastern Italy), assessing changes in incidence, patient characteristics, management strategies, and...BACKGROUND: We examined 25-year population-level trends in acute myocardial infarction (AMI) in the Veneto Region (Northeastern Italy), assessing changes in incidence, patient characteristics, management strategies, and outcomes to evaluate the performance and evolution of the regional healthcare system. METHODS: We conducted a retrospective population-based analysis of Veneto hospital discharge records (2000-2024), classifying AMI as ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) using ICD-9-CM codes. Key outcomes included same-day percutaneous coronary intervention (PCI), cardiac intensive care unit (CICU) and cardiology unit admission, and 30-day case-fatality, with analyses stratified by age and sex. Age-adjusted temporal trends were assessed using Joinpoint regression and reported as average annual percentage change (AAPC) with 95% confidence intervals. RESULTS: During the study period, 167,277 patients were hospitalized for AMI: 57.3% STEMI and 42.7% NSTEMI. Age-standardized AMI hospitalizations declined overall [AAPC -2.30%], driven by marked reductions in STEMI [AAPC -4.72%], whereas NSTEMI increased [AAPC +1.05%] and became the predominant phenotype after 2016. Thirty-day mortality decreased for both STEMI [AAPC -1.60%] and NSTEMI [AAPC -1.63%], with age-adjusted sex gaps substantially narrowing. Same-day PCI increased markedly over time [AAPC +6.41%], as did CICU admission [STEMI AAPC +0.85%; NSTEMI AAPC +0.27%], although women consistently underwent PCI less often. CONCLUSIONS: Over 25 years, AMI in the Veneto Region shifted from STEMI to NSTEMI Predominance, with greater invasive care access and lower mortality, though sex disparities persisted, highlighting the need for targeted interventions.
INTRODUCTION: Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) can potentially be reversed by early shunt closure, but its efficacy decreases over time. This study provides valuable desc...INTRODUCTION: Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) can potentially be reversed by early shunt closure, but its efficacy decreases over time. This study provides valuable descriptive data on: which factors were associated with clinical decision-making of operability and the outcomes of those decisions in infants under 1 year with PAH-CHD and an open shunt. METHODS: We retrospectively analysed 100 infants with PAH-CHD who underwent right heart catheterization for operability assessment. Acute vasodilator testing (AVT) was performed in 64 patients. RESULTS: Eleven patients (11%) were deemed non-operable and 10/11 had developmental lung disease (DLD). Positive AVT was more common among infants deemed operable, whereas developmental lung disease was more common among those deemed non-operable. In the patients who had shunt closure (89, 89%), preoperative pulmonary haemodynamic did not relate to prevalence of long-term PH. At long-term follow-up, 5 patients had PH (2 persistent PH with DLD, 1 with PAH-CHD, 2 recurrent PH after shunt closure with Down syndrome), with 4 requiring targeted pulmonary arterial hypertension treatments. CONCLUSION: In this cohort, decisions regarding operability were more closely associated with clinical features such as DLD than with PVRi. However, due to the small number of non-operable cases, these associations should be considered exploratory.
Int J Cardiol
· 2026 Jun · PMID 41861848
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BACKGROUND: Heart failure (HF) is a major health issue with high hospitalization and 30-day readmission rates. Cardiac rehabilitation (CR) is recommended for managing HF; however, its effectiveness during hospitalization...BACKGROUND: Heart failure (HF) is a major health issue with high hospitalization and 30-day readmission rates. Cardiac rehabilitation (CR) is recommended for managing HF; however, its effectiveness during hospitalization remains unclear in real-world settings. METHODS: This retrospective cohort study analyzed data from the National Hospital Organization database in Japan. We included patients with HF aged ≥40 years who were hospitalized between April 2016 and March 2019. We analyzed the relationship between inpatient CR and 30-day outcomes (primary: all-cause readmission) using logistic regression with inverse probability of treatment weighting, which creates a pseudo-population with measured baseline covariates balanced between groups. Propensity score-matched analysis was additionally performed for the primary outcome. RESULTS: Among 17,022 eligible patients, 9390 (55.2%) received inpatient CR. Inpatient CR was not significantly associated with lower risks of 30-day all-cause (odds ratio [OR]: 0.93, 95% confidence interval [CI]: 0.82-1.05), cardiovascular-related (OR: 0.97, 95%CI: 0.82-1.14), or HF-related readmissions (OR: 0.99, 95%CI: 0.82-1.19), or all-cause death (OR: 0.95, 95%CI: 0.53-1.73) in the weighted analyses. Results for all-cause readmission were consistent in the matched analysis (OR: 0.89, 95%CI: 0.78-1.01). In an exploratory subgroup analysis, inpatient CR was associated with a lower risk of 30-day all-cause readmission among patients without pre-existing kidney dysfunction. Inpatient CR was also significantly associated with improved physical function during hospitalization (OR: 1.18, 95%CI: 1.07-1.31). CONCLUSIONS: In this nationwide cohort, inpatient CR was not significantly associated with 30-day readmission risk. However, inpatient CR was associated with improvement in functional status during hospitalization.
Huang Y, Ruan M, Zhang H
… +7 more, Shen Y, Zhou M, Song H, Lu F, Gao H, Chu M, Xu L
Int J Cardiol
· 2026 Jun · PMID 41850600
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BACKGROUND: Ischemic stroke (IS) remains a major cause of death and disability. We assessed the association between cardiovascular health (CVH), quantified by Life's Essential 8 (LE8), and incident IS, and examined wheth...BACKGROUND: Ischemic stroke (IS) remains a major cause of death and disability. We assessed the association between cardiovascular health (CVH), quantified by Life's Essential 8 (LE8), and incident IS, and examined whether polygenic risk score (PRS) modifies this association. METHODS: We studied 234,991 UK Biobank participants with no history of ischemic stroke at baseline (median age 58 years [IQR, 50-64]; range, 37-73), evaluating CVH with the LE8 score, categorized as low (< 50), intermediate (50-79), or high (≥80). Genetic risk was assessed using a GWAS-derived PRS, classified into low (Q1), intermediate (Q2-Q4), or high (Q5). Cox models were used to estimate IS hazard ratios, with analyses performed for subgroups, joint effects, and interactions. RESULTS: During a median follow-up of 13.6 years, 4220 IS cases were identified. Each 10-point increase in LE8 was associated with an 18% lower risk of IS (HR = 0.82, 95% CI: 0.80-0.84). Compared with low CVH, intermediate and high CVH were linked to 37% and 51% lower IS risks, respectively. Stronger protective effects were observed among women and younger adults. Joint analyses indicated that high CVH substantially reduced the excess IS risk in participants with high PRS. CONCLUSIONS: Better CVH is linearly and inversely associated with ischemic stroke risk, with greater benefits in women and younger adults. Optimal CVH can lower the additional risk in people with a high genetic predisposition, endorsing the joint application of CVH evaluation and PRS for IS risk assessment and targeted prevention.
Oka T, Koyama Y, Tanaka N
… +20 more, Sekihara T, Ozu K, Nakano T, Masuda M, Watanabe T, Minamiguchi H, Egami Y, Miyoshi M, Okada M, Matsuda Y, Kawasaki M, Inoue K, Hikoso S, Sunaga A, Dohi T, Okada K, Nakatani D, Sotomi Y, Sakata Y, Osaka Cardiovascular Conference (OCVC)-Arrhythmia Investigators
Int J Cardiol
· 2026 Jun · PMID 41839239
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BACKGROUND: Beyond-pulmonary vein isolation (PVI) strategy after initial PVI (PVI-plus) for persistent AF (PerAF) may cause greater left atrial (LA) functional deterioration than simple PVI strategy (PVI-alone). OBJECTIV...BACKGROUND: Beyond-pulmonary vein isolation (PVI) strategy after initial PVI (PVI-plus) for persistent AF (PerAF) may cause greater left atrial (LA) functional deterioration than simple PVI strategy (PVI-alone). OBJECTIVE: We aimed to compare post-ablation LA functional decline in patients randomized to receive either PVI-alone or PVI-plus treatments and evaluate the impact of post-ablation LA function on arrhythmia recurrence. METHODS: This study is a post-hoc subanalysis of the EARNEST-PVI (NCT03514693), which randomly compared the efficacy of PVI-alone and PVI-plus strategies in patients with PerAF. Of 497 participants, we analyzed 191 patients with cardiac computed tomography-derived LA emptying fraction at three months post-ablation (LAEF). We compared LAEF between the two strategies and evaluated its association with recurrence separately in the PVI-alone and PVI-plus groups. RESULTS: PVI-alone (n = 96) and PVI-plus (n = 95) groups were well-balanced. In the PVI-plus group, 99% of the patients underwent linear ablation. Of the patients with maintained sinus rhythm, LAEF was higher in the PVI-alone than in the PVI-plus after initial session (35.7% [29.0-41.0] vs. 31.7% [26.1-37.5], P = 0.01)-a 11.2% relative reduction. AF/AT-free survival rate after final session (median follow-up: 42 [35-48] months) tended to be higher in PVI-plus (74.0% vs. 84.2%, P = 0.08). LAEF was associated with recurrence in the PVI-alone (hazard ratio [per 10% increase]: 0.60, 95% confidence interval: 0.44-0.82, P < 0.01] but not in the PVI-plus (P = 0.72). CONCLUSIONS: Beyond-PVI predominantly consisting of linear ablation resulted in an 11.2% relative reduction in LAEF, but tended to decrease recurrence, suggesting its antiarrhythmic benefits may offset the structural compromise.
Marangou J, Wirth SH, Zühlke L
… +8 more, Rwebembera J, Mwita JC, Kim J, Kraus AA, Karron R, Carapetis J, Steer A, Beaton A
Int J Cardiol
· 2026 Jun · PMID 41833866
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Rheumatic heart disease is a major cause of premature cardiovascular morbidity and mortality globally. Over the past decade, echocardiographic screening has changed our understanding of the natural history of RHD, reveal...Rheumatic heart disease is a major cause of premature cardiovascular morbidity and mortality globally. Over the past decade, echocardiographic screening has changed our understanding of the natural history of RHD, revealing a high burden of clinically silent, mild RHD among people who cannot recall a history of preceding acute rheumatic fever. This viewpoint outlines the evidence that this earliest form of rheumatic heart disease, only detectable through echocardiographic screening, is an intermediate stage that many, but not all, individuals may pass through on the pathway to advanced rheumatic heart disease. This shift in understanding has important clinical and research implications, including introducing a new and more pragmatic target for Streptococcus pyogenes vaccine trials for the indication of rheumatic heart disease prevention.
Matta MG, Dababneh E, Camuglia A
… +4 more, Niranjan S, Rahman A, Sinhal A, Singh K
Int J Cardiol
· 2026 Jun · PMID 41833865
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BACKGROUND: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is an established treatment for failed surgical bioprostheses, but sex-specific patient-reported outcomes (PROMs) are poorly characterised. ME...BACKGROUND: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is an established treatment for failed surgical bioprostheses, but sex-specific patient-reported outcomes (PROMs) are poorly characterised. METHODS: We analysed ViV-TAVI procedures in the prospective Australian Cardiac Outcomes Registry. PROMs (KCCQ-12 Overall and Clinical Summary Scores, EQ-5D-3L index and EQ-VAS) were collected at baseline, 30 days, and 12 months. Longitudinal change by sex was evaluated with linear mixed-effects models, and 12-month MACCE and valve haemodynamics were compared using regression and propensity-matched analyses. RESULTS: Among 1050 ViV-TAVI patients (359 females), PROMs improved by 30 days and were sustained to 12 months. KCCQ-12 Overall Summary Score increased by about 36 points and Clinical Summary Score by 29-30 points (both p < 0.001), with parallel trajectories in females and males. EQ-5D-3L and EQ-VAS likewise improved without sex interaction, and findings were consistent in a matched cohort. Females had higher MACCE at 30 days (5.3% vs 1.7%, p = 0.002) and 12 months (12.2% vs 5.4%, p = 0.001), driven by more strokes (4.5% vs 1.2%, p = 0.010), despite comparable 12-month valve haemodynamics. CONCLUSIONS: ViV-TAVI yields large and sustained gains in health status in both sexes, but females remain at higher risk of MACCE and stroke.
Moustafa A, Kholeif Z, Miranda WR
… +5 more, Connolly HM, Rosenbaum DN, Dearani JA, Villavicencio MT, Egbe AC
Int J Cardiol
· 2026 Jun · PMID 41833863
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BACKGROUND: Adults with congenital heart disease (CHD) with stage D heart failure (HF) have 1-year mortality risk of almost 40% without heart transplantation, and as a result, heart transplant evaluation is the logical n...BACKGROUND: Adults with congenital heart disease (CHD) with stage D heart failure (HF) have 1-year mortality risk of almost 40% without heart transplantation, and as a result, heart transplant evaluation is the logical next step in the management of these patients. The purpose of this study was to describe the clinical characteristics and outcome of adults with CHD referred for heart transplant evaluation. METHOD: Adults with CHD referred for heart transplant evaluation were divided into 3 treatment pathways after multidisciplinary transplant evaluation. (i) Transplant-listed group (patients with stage D HF and eligible for transplant); (ii) Transplant-declined group (patient with stage D HF but had contraindications for transplant); (iii) Transplant-deferred group (patients without stage D HF). RESULTS: There were 416 patients who underwent transplant evaluation (transplant-listed group [N = 159,38%]; transplant-declined group [N = 101,24%]; transplant-deferred group [N = 156;38%]). Of 159 patients in the transplant-listed group, 110 underwent heart transplant. The patients who received heart transplant had similar survival compared to patients without stage D HF. Among patients with stage D HF (N = 260), heart transplantation was associated with a 9-fold reduction in all-cause mortality. End-organ dysfunction and congestion were common among patients who were declined for transplant listing or died while waiting for transplant and were associated with all-cause mortality. CONCLUSIONS: Heart transplantation was associated with improved survival in adults with CHD presenting with stage D HF. End-organ dysfunction and congestion were associated with greater odds of being declined for transplant and waitlist mortality, suggesting need for earlier referral for transplant evaluation to improve outcomes. CONDENSED ABSTRACT: Among 416 patients referred for heart transplant evaluation, 38% (N = 159) were listed for transplant because of stage D HF of which 110 underwent transplant, 24% (N = 101) were declined for transplant listing because of contraindications to transplant, and 38% (N = 156) were deferred for transplant listing because they did not have stage D HF. Among patients with stage D HF (N = 260), heart transplantation was associated with a 9-fold reduction in all-cause mortality. End-organ dysfunction and congestion were associated with greater odds of being declined for transplant and waitlist mortality, suggesting need for earlier referral for transplant evaluation.
Burgos LM, Spaccavento A, Baro Vila RC
… +8 more, De Bortoli MA, Malano DJ, Nachman T, Meretta AH, Seia I, Elissamburu P, Diez M, Costabel JP
Int J Cardiol
· 2026 Jun · PMID 41833862
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BACKGROUND: Identifying specific aetiologies during hospitalization for acute heart failure (AHF) remains challenging, particularly conditions with important therapeutic and prognostic implications such as transthyretin...BACKGROUND: Identifying specific aetiologies during hospitalization for acute heart failure (AHF) remains challenging, particularly conditions with important therapeutic and prognostic implications such as transthyretin cardiac amyloidosis (ATTR-CM). Clinical risk scores may aid early suspicion; however, many patients are classified as intermediate risk, limiting bedside decision-making in the acute care setting. High-sensitivity cardiac troponin T (hs-TnT) may improve diagnostic stratification. METHODS: We conducted a prospective single-centre study including consecutive patients aged ≥60 years hospitalized with AHF between 2022 and 2024. All patients underwent bone-tracer scintigraphy; ATTR-CM was defined by myocardial uptake grade ≥ 2 and exclusion of plasma cell dyscrasia. The T-Amylo score was calculated blinded to diagnosis. hs-TnT was incorporated into a revised model (TnT-Amylo) using regression-derived weighting. Patients were categorized as low (0-2), intermediate (3-6), or high (7-11) risk. Diagnostic performance and reclassification were evaluated. RESULTS: Among 138 patients (63% male; mean age 80 ± 6.9 years), ATTR-CM prevalence was 15.9%. The T-Amylo score showed good discrimination (AUC 0.93). hs-TnT was significantly higher in ATTR-CM than in non-ATTR-CM patients (median 68 vs 29 ng/L; p < 0.001; AUC 0.80). In the intermediate-risk group (n = 87), hs-TnT reclassified 15.7% to high risk (72.7% ATTR-CM) and 84.3% to low risk (5% ATTR-CM). The TnT-Amylo model achieved 72.3% sensitivity and 94.9% specificity, with a net reclassification improvement of 135%. CONCLUSIONS: In AHF patients, integrating hs-TnT into a clinical risk score improves bedside diagnostic stratification, particularly among intermediate-risk patients. This approach may facilitate early aetiological identification and more efficient use of advanced imaging in the acute cardiovascular care setting. TRANSLATIONAL PERSPECTIVE: This study translates pathophysiological insights of chronic myocardial injury in transthyretin cardiac amyloidosis into a simple bedside diagnostic tool. By integrating high-sensitivity cardiac troponin T-an inexpensive and universally available biomarker-into a clinical risk score, this approach bridges mechanistic myocardial damage with pragmatic decision-making, facilitating early identification of ATTR-CM and more efficient allocation of advanced imaging resources in acute heart failure care.