Pérez-Pisón E, Llàcer P, Croset F
… +11 more, Campos J, García M, Pérez C, Pérez A, Vergara M, Cevallos P, Rodríguez JE, Sesmero C, Fernández C, Fabregate M, Manzano L
BACKGROUND: The prognostic significance of pleural effusion in patients with acute heart failure remains insufficiently defined. Our objective was to evaluate the association between pleural effusion and long-term outcom...BACKGROUND: The prognostic significance of pleural effusion in patients with acute heart failure remains insufficiently defined. Our objective was to evaluate the association between pleural effusion and long-term outcomes, stratified by loop diuretic treatment. METHODS: This retrospective study included 656 elderly patients hospitalized for acute heart failure. Patients were stratified by the presence or absence of pleural effusion at admission. The primary endpoint was the composite of all-cause mortality and/or heart failure readmission. Multivariable Cox regression and interaction analyses between pleural effusion and loop diuretic use at discharge were performed. RESULTS: Median age was 87 (83-90) years, 65.5% were women, and 80.3% had heart failure with preserved ejection fraction. Pleural effusion was present in 40.5% of patients. After multivariable adjustment, a significant interaction was observed between pleural effusion and loop diuretic use for the combined endpoint (P for interaction = 0.043). Among patients with pleural effusion, absence of loop diuretic prescription at discharge was associated with increased risk of death and/or rehospitalization (HR 2.47, 95% CI 1.28-4.77; P = 0.007). Conversely, in patients discharged on loop diuretic, pleural effusion was not significantly associated with mortality and/or rehospitalization (HR 1.21, 95% CI 0.96-1.52; P = 0.101). CONCLUSIONS: In this elderly cohort of patients hospitalized for acute heart failure, the presence of pleural effusion was associated with a higher risk of death and/or readmission. The use of loop diuretic therapy at discharge appeared to attenuate this risk, supporting a potential role of individualized, congestion-guided treatment strategies in this population.
BACKGROUND: Contemporary real-world data describing temporal trends in optimal medical therapy (OMT) in patients with chronic coronary syndrome undergoing percutaneous coronary intervention, particularly in the context o...BACKGROUND: Contemporary real-world data describing temporal trends in optimal medical therapy (OMT) in patients with chronic coronary syndrome undergoing percutaneous coronary intervention, particularly in the context of residual risk factors, are limited. We sought to evaluate temporal trends in pre-procedural OMT, and their impact on outcomes in this patient population. METHODS: We included consecutive patients with stable angina and objective evidence of myocardial ischemia who underwent percutaneous coronary intervention at a single quaternary referral center between January 2012 and December 2023. Patients were stratified according to pre-procedural medical therapy intensity and uncontrolled cardiometabolic risk factors. The primary outcome was major adverse cardiovascular events (MACE) defined as composite of all-cause death, myocardial infarction, stroke, or target vessel revascularization assessed at 1-year follow-up. RESULTS: Among 9766 patients with chronic coronary syndrome (mean [SD] age was 67.0 [10.5] years; 27.1% female), significant trends were observed toward an increased proportion of patients presenting with more intensive medical therapy and with improved risk factor control. At 1-year, patients receiving high intensity therapy had higher rates of MACE compared with those receiving low intensity therapy (9.5% versus 6.8%; HR, 1.40; P < 0.01), but lower all-cause death (1.1% versus 1.8%; HR, 0.59; P = 0.04). Similarly, the high risk patients experienced higher MACE compared with the low risk patients (10.8% versus 7.9%; HR, 1.39; P < 0.01). No significant differences were observed in moderate intensity treatment and intermediate risk groups. CONCLUSIONS: Despite improvements in medical therapy optimization and risk factors, residual risk remained and was associated with adverse outcomes.
Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder increasingly recognized for its association with cognitive impairment and dementia. Emerging epidemiological evidence suggests that ind...Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder increasingly recognized for its association with cognitive impairment and dementia. Emerging epidemiological evidence suggests that individuals with OSA have a higher risk of developing mild cognitive impairment and accelerated cognitive decline. The pathophysiological mechanisms underlying this relationship are multifactorial, involving intermittent hypoxia, sleep fragmentation, and sympathetic activation. These disturbances contribute to oxidative stress, neuroinflammation, impaired glymphatic clearance of amyloid-β and tau proteins, and cerebrovascular dysfunction, ultimately affecting brain regions critical for memory and executive function. Despite strong mechanistic and observational evidence, the impact of OSA treatment on cognitive outcomes remains uncertain. Continuous positive airway pressure (CPAP), the first-line therapy for OSA, has shown improvements in cognitive domains in observational studies; however, randomized controlled trials have yielded inconsistent results. These findings support OSA as a modifiable contributor to neurodegeneration, although definitive evidence for cognitive benefit with treatment remains lacking. Future research should focus on early intervention, longer-term randomized trials, integration of neuroimaging and biomarker endpoints to elucidate the potential for cognitive benefit with OSA treatment.