Maxo L, Digne F, Darmon A
… +7 more, Landon V, Laveau F, Stratiev V, Abdellaoui M, Acheampong A, Nappi F, Nejjari M
Am J Cardiol
· 2026 May · PMID 42214579
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Conduction disturbances remain a major barrier to early discharge after transcatheter aortic valve replacement (TAVR), leading to prolonged monitoring and increased hospital length of stay. The ECG-based conduction-manag...Conduction disturbances remain a major barrier to early discharge after transcatheter aortic valve replacement (TAVR), leading to prolonged monitoring and increased hospital length of stay. The ECG-based conduction-management algorithm proposed by Rodés-Cabau stratifies the risk of conduction disturbances after TAVR; however, its impact on hospital length of stay remains insufficiently studied. We aimed to evaluate whether systematic implementation of this algorithm is associated with reduced hospital length of stay after transfemoral TAVR. We conducted a single-center, nonrandomized before-after comparative study including consecutive patients undergoing transfemoral TAVR. Outcomes were compared between a historical control cohort managed without a standardized conduction algorithm and a prospective cohort managed according to the Rodés-Cabau criteria. The primary endpoint was postprocedural hospital length of stay. Multivariable linear regression was used to adjust for baseline characteristics, procedural factors, and postprocedural complications. Propensity score-based sensitivity analyses were performed. A total of 496 patients were included (124 in the control cohort and 372 in the intervention cohort). Mean postprocedural hospital length of stay was significantly shorter in the intervention cohort compared with controls (5.2 ± 2.7 vs 7.6 ± 3.2 days; p <0.001). Implementation of the Rodés-Cabau algorithm remained independently associated with reduced length of stay (adjusted β -1.90 days; 95% CI -2.54 to -1.27). Despite greater use of self-expandable valves, rates of high-grade conduction disturbances and permanent pacemaker implantation were lower in the intervention cohort. In conclusion, systematic ECG-guided conduction management after transfemoral TAVR is associated with a clinically meaningful reduction in hospital length of stay and improved discharge efficiency in real-world practice; however, given the nonrandomized before-after design, temporal confounding cannot be excluded.
Liu R, Zheng W, Qin H
… +16 more, Zhou Y, Li X, Li Y, Wang H, Wei X, Ren W, Hu X, Zhang H, Zhang Z, Jiang M, Peng Y, Shu X, Zhang J, Wang P, Zou X, Jing T
Am J Cardiol
· 2026 May · PMID 42208718
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Coronary no-reflow (NR) after percutaneous coronary intervention (PCI) predicts adverse prognosis in patients with acute coronary syndrome (ACS). This study aimed to establish a machine learning-based risk prediction mod...Coronary no-reflow (NR) after percutaneous coronary intervention (PCI) predicts adverse prognosis in patients with acute coronary syndrome (ACS). This study aimed to establish a machine learning-based risk prediction model for periprocedural NR in ACS patients undergoing PCI. We conducted a single-center, prospective, observational cohort study enrolling consecutive ACS patients undergoing PCI between January 2023 and March 2024. Patients were allocated to a training set (n = 692) and a test set (n = 297) based on admission order. Key predictive features were screened using Lasso regression and the Boruta algorithm, and the overlapping variables were utilized to construct 5 models: Logistic regression, support vector machine, random forest, extreme gradient boosting, and light gradient boosting machine (LightGBM). Model performance was validated in the test set. Among 989 included patients, 145 (14.7%) developed NR. The final predictors included cardiac troponin, aspartate aminotransferase, pre-PCI Thrombolysis in Myocardial Infarction flow grade, number of stents implanted, intraoperative hypotension, and ACS subtypes. The logistic regression model showed the optimal discriminative capacity, with an area under the receiver operating characteristic curve of 0.8799 (95% confidence interval: 0.8151 to 0.9447), as well as favorable accuracy (0.8822), F1-score (0.6316), G-mean (0.7983), and precision-recall curve-area under the curve (PR-AUC) (0.6249). Restricted cubic spline analysis confirmed a nonlinear relationship between aspartate aminotransferase levels and NR risk (p-nonlinear <0.001). In conclusion, we established a concise machine learning-based model for post-PCI NR risk stratification; the nomogram and online calculator support efficient periprocedural risk assessment in ACS patients.
Josey GC, Cohen J, Scheinuk JE
… +5 more, Hasnie UA, Saleh A, McElwee SK, Parcha V, Clarkson SA
Am J Cardiol
· 2026 May · PMID 42208717
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Myocarditis-associated cardiogenic shock is associated with significant morbidity and mortality, yet sex-based differences in outcomes remain poorly characterized. We conducted a retrospective cohort study using the TriN...Myocarditis-associated cardiogenic shock is associated with significant morbidity and mortality, yet sex-based differences in outcomes remain poorly characterized. We conducted a retrospective cohort study using the TriNetX Research Network, a federated electronic health records platform aggregating de-identified data from 99 US health care organizations. Adult patients with concurrent diagnosis of myocarditis and cardiogenic shock from January 1, 2012 to December 31, 2024, were included. After 1:1 propensity score matching, 1,452 men and 1,452 women were identified with balanced baseline characteristics. The risk of all-cause mortality within 6 months of the index date was lower among men compared with women (20.1% vs. 24.0%; HR: 0.82 [95% CI: 0.70 to 0.96]; p = 0.01). Men had higher rates of acute kidney injury (44.0% vs. 38.8%; HR: 1.18 [95% CI: 1.05 to 1.67]; p = 0.004), while rates of new-onset atrial fibrillation/flutter, ventricular tachyarrhythmias, cardiac arrest, and mechanical circulatory support use were similar between sexes. In conclusion, in this large real-world cohort of patients with Myocarditis-associated cardiogenic shock, women sex was associated with higher 6-month mortality despite lower acute kidney injury rates and similar arrhythmia burden and mechanical circulatory support (MCS) use, suggesting that patient sex may be an important prognostic variable warranting further prospective investigation.
Mahajan A, Hussain M, Farina J
… +4 more, Elsayed A, Baxter C, Athmakuri K, Chaliki H
Am J Cardiol
· 2026 May · PMID 42208716
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The coexistence of atrial fibrillation (AF) and aortic stenosis (AS) complicates echocardiographic assessment, as AF-related beat-to-beat variability attenuates flow-dependent Doppler parameters like transvalvular mean g...The coexistence of atrial fibrillation (AF) and aortic stenosis (AS) complicates echocardiographic assessment, as AF-related beat-to-beat variability attenuates flow-dependent Doppler parameters like transvalvular mean gradient (MG) and Peak Velocity. Current guidelines recommend averaging these measurements over 5 consecutive cycles in AF; however, this may underestimate true AS severity. In this retrospective study of 35 patients with AS and preserved (left ventricular ejection fraction ≥50%) undergoing echocardiography in both AF and sinus rhythm (SR) within a 3-month interval, averaged MG during AF was significantly lower than SR (19 vs 21 mm Hg; p <0.001) with lower agreement (ICC = 0.866), whereas the highest single-cycle MG closely approximated SR values (21 vs 20 mm Hg; p = 0.741) with excellent agreement (ICC = 0.953). A similar pattern was observed for peak velocity. These findings suggest that averaged AF gradients and velocities may underrecognize significant AS severity, and that the highest technically adequate AF values may better reflect true hemodynamic burden, warranting prospective validation.
Akoum A, Shabrawi MNE, Ramadan A
… +8 more, Mohamed K, Elbahloul MA, Wehbeh BED, Ateeq M, Kamel I, Khalil I, Wahba A, Elgendy IY
Am J Cardiol
· 2026 May · PMID 42208715
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Lifelong anticoagulation is essential in durable left ventricular assist device (LVAD) recipients to mitigate thrombotic complications, but the optimal anticoagulant strategy remains undefined. Direct oral anticoagulants...Lifelong anticoagulation is essential in durable left ventricular assist device (LVAD) recipients to mitigate thrombotic complications, but the optimal anticoagulant strategy remains undefined. Direct oral anticoagulants offer pharmacological advantages over warfarin, yet large-scale outcomes data in the LVAD population, particularly among patients without atrial fibrillation, are limited. Using the TriNetX Research Network, we conducted a retrospective cohort study of adult LVAD recipients without atrial fibrillation or atrial flutter who received either a direct oral anticoagulant (n = 1,150) or warfarin (n = 3,052). After 1:1 propensity score matching, 955 patients per group were included. Time-to-event analyses over 12 months used Kaplan-Meier methods and Cox proportional hazards regression. The primary outcome was major bleeding, defined as gastrointestinal hemorrhage or intracranial hemorrhage. Secondary outcomes included thrombotic complications, all-cause mortality, and all-cause hospitalization. Direct oral anticoagulant use was associated with a significantly lower risk of major bleeding (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.36 to 0.58; p <0.001), but a significantly higher risk of thrombotic complications (HR 2.22, 95% CI 1.88 to 2.61; p <0.001), compared with warfarin. All-cause mortality did not differ between groups (HR 0.90, 95% CI 0.70 to 1.15; p = 0.389). In conclusion, among LVAD recipients without atrial fibrillation, direct oral anticoagulant therapy was associated with a lower incidence of major bleeding, but a higher risk of thrombotic events compared with warfarin, suggesting the need for prospective trials to define the optimal anticoagulation strategy in this population.
Ru L, Gong Z, Zhao Y
… +10 more, Song X, Ma Y, Liu X, Li Z, Zhang C, Geng X, Mi J, Kong L, Li P, Zhang Q
Am J Cardiol
· 2026 May · PMID 42167712
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Anterograde wiring is fundamental to Chronic total occlusions percutaneous coronary intervention (CTO) percutaneous coronary intervention but often limited by guidewire crossing difficulty. We introduce a novel Titrated...Anterograde wiring is fundamental to Chronic total occlusions percutaneous coronary intervention (CTO) percutaneous coronary intervention but often limited by guidewire crossing difficulty. We introduce a novel Titrated Contrast Recanalization (TCR) technique to facilitate anterograde crossing. Consecutive patients undergoing CTO percutaneous coronary intervention using TCR as the primary strategy between August and December 2025 were enrolled. TCR used an automated microinjector to deliver 0.1 to 0.5 ml contrast into CTOs with real-time pressure monitoring, enhancing CTO architecture visualization for wire guidance. Lesions were classified by contrast penetration patterns: type 1, localized patchy confined within the occlusion; type 2, linear microchannels through the occlusion; or type 3, patchy staining extending beyond the vessel contour or tracking longitudinally along the vessel wall. Polymer-jacketed wires were used for linear microchannels; anterograde wire escalation or the parallel-wire techniques were applied to types 1 and 3, while retrograde or anterograde dissection re-entry serving as a last resort. The primary endpoint was successful anterograde crossing; secondary endpoints were TCR-related complications. Among 71 CTOs (mean lesion length >20 mm in 76.1%; moderate/heavy calcification in 64.8%), successful anterograde crossing was achieved in 70 cases (98.6%) with no TCR-related complications. Anterograde crossing with polymer-jacketed wires succeeded in 40 lesions; anterograde wire escalation and parallel-wire techniques were successful in 8 and 15, respectively; the remaining 7 were recanalized by intravascular ultrasound guidance, retrograde, or anterograde dissection re-entry. Median crossing time was 8 minutes (IQR, 6 to 13) and median microinjected contrast per TCR was 0.37 ml (IQR, 0.29 to 0.40). In conclusion, TCR is a feasible anterograde-first technique with promising efficacy and safety outcomes.
Am J Cardiol
· 2026 May · PMID 42162649
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This study aimed to assess differences in left ventricular ejection fraction (LVEF) measurements between cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) and identify determinants influencing cli...This study aimed to assess differences in left ventricular ejection fraction (LVEF) measurements between cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) and identify determinants influencing clinical classification discordance. We retrospectively enrolled patients who underwent both CMR and TTE imaging within a 1-week interval. The study endpoint was a comparative analysis of LVEF measurements between 2 modalities. We also assessed the impact of these measurements on clinical decisions, referencing the European Society of Cardiology's heart failure and specific threshold (50%, 35%) classification. Logistic regression was used to explore the association of imaging characteristics with LVEF classification differences. 1,213 patients were included. The median LVEF values were 58% for TTE and 49% for CMR. The modalities demonstrated moderately strong agreement in LVEF measurements (intraclass correlation coefficient = 0.64). Using the heart failure classification, LVEF categories were determined by both modalities in 65.0% of patients, whereas 33.5% of patients were downward reclassified by CMR. Analysis using thresholds of 50% and 35% indicated inconsistent LVEF classification in 2.7%, 73.4%, and 63.4% of patients, respectively. Multivariate regression analysis showed that septal (odds ratio = 2.02; 95% confidence interval: 1.55 to 2.62) and lateral (odds ratio = 1.82; 95% confidence interval: 1.40 to 2.37) motion abnormalities were associated with LVEF classification differences. In conclusion, septal and lateral wall motion abnormalities detected on TTE are strong predictors of reclassification. CMR should be prioritized in such cases to guide clinical management and mitigate TTE-related misclassification risks.
Sara JDS, Carvalho PEP, Seto A
… +7 more, Shlofmitz E, Strepkos D, Alexandrou M, Williford N, Burke MN, Brilakis ES, Sandoval Y
Am J Cardiol
· 2026 May · PMID 42144125
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Intracoronary imaging (ICI) is an important adjunct to invasive coronary angiography for the assessment of lesion morphology and guidance of percutaneous coronary intervention. Extensive data, including several randomize...Intracoronary imaging (ICI) is an important adjunct to invasive coronary angiography for the assessment of lesion morphology and guidance of percutaneous coronary intervention. Extensive data, including several randomized clinical trials and meta-analyses, support the use of ICI to improve clinical outcomes. Despite a modest increase in utilization, adoption remains limited, even in the setting of a robust evidence base and guideline recommendations. In this review, we provide a comprehensive overview of contemporary ICI modalities, including clinical indications, comparative advantages and limitations, and key supportive evidence. We also offer practical guidance on their use, procedural considerations, and address common pitfalls, as well as address the identification and clinical implications of high-risk "vulnerable" plaque features.
Vanhentenrijk S, Chaikijurajai T, Engelman T
… +5 more, Grodin JL, Finet JE, Smedira NG, Desai MY, Tang WHW
Am J Cardiol
· 2026 May · PMID 42144124
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Hemodynamic gain index (HGI) is a novel, simple parameter calculated from resting and peak systolic blood pressure and heart rate (HR) during exercise, however, its prognostic value in patients with hypertrophic cardiomy...Hemodynamic gain index (HGI) is a novel, simple parameter calculated from resting and peak systolic blood pressure and heart rate (HR) during exercise, however, its prognostic value in patients with hypertrophic cardiomyopathy (HCM) is unknown. We investigate the prognostic value of alternative nonmetabolic exercise testing parameters in a contemporary HCM cohort. HGI was calculated from systolic blood pressure at rest and peak /HR data from consecutive HCM patients who underwent cardiopulmonary exercise testing for symptom evaluation. Multivariable Cox regression analysis was performed with the primary outcome of all-cause mortality and/or heart transplantation. Logistic regression models were used for HGI to predict the need for future myectomy or alcohol septal ablation. In our cohort of 905 patients with HCM, HGI correlated well with circulatory power (CP, r = 0.71, p <0.001) and peak VO (r = 0.64, p <0.001). HGI (Area Under Curve (AUC) 0.87, 95% CI 0.81-0.92) demonstrated comparable accuracies to CP (AUC 0.88, 95% CI 0.83-0.92) and peak VO (AUC 0.81, 95% CI 0.75-0.87) in predicting transplant-free survival. Higher HGI was independently associated with a lower risk of primary endpoint (adjusted HR 0.25, 95% CI 0.15-0.42, p <0.001), all-cause mortality (adjusted HR 0.31,95% CI 0.17-0.56, p <0.001), and was associated with lower risk for future myectomy or alcohol septal ablation (OR 0.78, 95% CI 0.67-0.91, p = 0.002). HGI may serve as an independent predictor for adverse outcomes in patients with HCM with comparable prognostic value to peak VO and CP. In addition, HGI may identify those who would likely need myectomy or alcohol septal ablation, independent of pVO evaluation.
Taha A, Mondal A, Sandhyavenu H
… +8 more, Atti L, Alhajji M, Thangjui S, Shaik BF, Thyagaturu H, Caccamo M, Fonarow GC, Balla S
Am J Cardiol
· 2026 May · PMID 42144123
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Pharmacologic management after Takotsubo syndrome (TTS) remains empirical. We evaluated whether early sodium-glucose cotransporter-2 inhibitor initiation after TTS was associated with clinical outcomes in a large real-wo...Pharmacologic management after Takotsubo syndrome (TTS) remains empirical. We evaluated whether early sodium-glucose cotransporter-2 inhibitor initiation after TTS was associated with clinical outcomes in a large real-world cohort. Using the TriNetX US Collaborative Network, we identified adults with incident TTS from 2015 to 2025. Patients initiated on a sodium-glucose cotransporter-2 inhibitor within 14 days were propensity-matched 1:1 to patients without early sodium-glucose cotransporter-2 inhibitor use. Follow-up for time-to-event analyses began on day 14. The primary outcome was all-cause mortality. Secondary outcomes were heart failure hospitalization, cardiogenic shock, cardiac arrest, and major adverse cardiovascular events. A total of 54,701 patients with TTS, 1,803 matched pairs were analyzed. Early sodium-glucose cotransporter-2 inhibitor use was associated with lower all-cause mortality (8.1% vs 13.6%; hazard ratio 0.71; 95% confidence interval 0.58 to 0.87; p = 0.001). Associations were not significant for heart failure hospitalization, cardiogenic shock, cardiac arrest, or major adverse cardiovascular events. Mortality findings were directionally consistent in sensitivity analyses excluding patients with COVID-19 and, separately, diabetes mellitus. In this observational landmark analysis, early sodium-glucose cotransporter-2 inhibitor use after TTS was associated with lower all-cause mortality but not lower cardiovascular event rates.
Cumitini L, Giubertoni A, Mennuni M
… +2 more, Degiovanni A, Patti G
Am J Cardiol
· 2026 May · PMID 42134615
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Transcatheter tricuspid valve interventions have recently emerged as effective therapeutic options for patients with severe tricuspid regurgitation (TR) and heart failure at high surgical risk. Despite evidence of post-p...Transcatheter tricuspid valve interventions have recently emerged as effective therapeutic options for patients with severe tricuspid regurgitation (TR) and heart failure at high surgical risk. Despite evidence of post-procedural clinical improvement, data regarding changes in functional capacity remain limited. In this prospective, observational study, we enrolled high-risk patients with at least severe TR and heart failure undergoing transcatheter tricuspid valve repair by the PASCAL device or replacement with the EVOQUE system. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET), in addition to clinical, laboratory, and echocardiographic parameters, at baseline and 3 months postprocedure. The primary endpoint was the change in peak oxygen consumption (VO₂) by CPET at 3 months versus baseline. Secondary endpoints included changes in other CPET parameters, TR severity by transthoracic echocardiography, New York Heart Association (NYHA) class, daily furosemide dose, and pro-brain natriuretic peptide (pro-BNP) levels. A total of 10 patients were enrolled, with successful device implantation obtained in all cases. Peak VO₂ improved significantly from 14.7 ± 3.7 at baseline to 16.4 ± 2.9 ml/kg/min at 3 months (p = 0.009). Peak oxygen pulse increased from 85.1 ± 20.2% to 103.7 ± 23.3% (p = 0.022), and ventilation maximum rose from 39.9 ± 10.3 L/min to 45.7 ± 10.9 L/min (p = 0.035). TR severity was reduced (p = 0.002), NYHA class improved (p = 0.016), and daily furosemide dose decreased (p = 0.016). Although pro-BNP levels declined, this reduction was not statistically significant. No adverse event occurred during follow-up. In conclusion, among patients with severe TR and heart failure, TR reduction by transcatheter tricuspid valve interventions was associated with improved CPET-derived functional capacity, better functional class, and reduced diuretic requirement during short-term follow-up.
Nathan S, Tosun S, Al-Rameni D
… +13 more, Jezovnik MK, Wang J, Devineni H, Belletti A, Landoni G, Janowiak L, Kutilek K, Patel J, Salas de Armas I, Patel M, Gregoric ID, Nascimbene A, Kar B
Am J Cardiol
· 2026 May · PMID 42134614
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While veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has become central in the management of patients in advanced stages of cardiogenic shock due to its relative ease of deployment, there is no standardized...While veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has become central in the management of patients in advanced stages of cardiogenic shock due to its relative ease of deployment, there is no standardized practice for left ventricular venting. This study evaluated the relative impact of distinct left ventricular venting strategies-no venting (control), unloading (intra-aortic balloon pump or Impella CP), and offloading (Impella 5.0/5.5)-on successful device weaning and overall hospital survival. A retrospective analysis of 232 patients (2018 to 2021) with refractory cardiogenic shock was conducted, with patients matched using propensity scores based on initial Survival After Veno-artErial ECMO (SAVE) scores. Overall survival to discharge was 39% (92 of 232), with 72% of survivors achieving full neurologic recovery. Univariate analysis identified age, SAVE score, extracorporeal cardiopulmonary resuscitation status, initial lactate levels, and arterial pulsatility as primary survival predictors. After propensity matching for baseline SAVE score, the OFFLOAD configuration (Impella 5.0/5.5) significantly outperformed V-A ECMO alone. This strategy was associated with a marked increase in survival days until device removal, yielding a hazard ratio of 9.57 (95% CI 2.80 to 32.7; p <0.001). In patients with refractory cardiogenic shock, active left ventricular offloading via Impella 5.0/5.5 may facilitate more successful V-A ECMO weaning. These findings suggest that an offloading strategy provides a distinct early survival advantage compared to alternative venting configurations.
Am J Cardiol
· 2026 May · PMID 42128260
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Transcatheter aortic valve replacement (TAVR) is increasingly considered as an alternative to surgical aortic valve replacement (SAVR) for low-risk patients with aortic stenosis. However, its long-term efficacy remains u...Transcatheter aortic valve replacement (TAVR) is increasingly considered as an alternative to surgical aortic valve replacement (SAVR) for low-risk patients with aortic stenosis. However, its long-term efficacy remains uncertain. This study aimed to compare clinical outcomes and procedural complications of TAVR versus SAVR in low-risk patients with aortic stenosis. We updated our 2019 systematic review by searching MEDLINE, EMBASE, and Cochrane Central (May 2019-April 2025) for randomized controlled trials (RCTs) comparing TAVR and SAVR in low-risk patients with aortic stenosis. We extracted outcomes at 30 days, 12 months, and ≥5 year follow-up. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2 tool. Five RCTs (n = 4,532) were included. TAVR reduced 30-day all-cause mortality (RR: 0.45, 95% CI: 0.37-0.55), cardiovascular mortality (RR: 0.45, 95% CI: 0.38-0.54), atrial fibrillation (RR: 0.21, 95% CI: 0.10-0.41), and life-threatening bleeding (RR: 0.28, 95% CI: 0.13-0.58), but increased pacemaker implantation (RR: 3.10, 95% CI: 1.23-7.82). Mortality benefits persisted at 12 months. At ≥5 years, results were inconclusive due to wide CIs across outcomes, including all-cause death (RR: 0.99, 95% CI: 0.72-1.35), cardiovascular death (RR: 0.93, 95% CI: 0.64-1.35), atrial fibrillation (RR: 0.44, 95% CI: 0.16-1.22), endocarditis (RR: 0.70, 95% CI: 0.33-1.45) and aortic reintervention (RR: 1.21, 95% CI: 0.59-2.49). TAVR shows early clinical benefits in low-risk patients with aortic stenosis, but long-term outcomes compared to SAVR remain uncertain. Individualized heart team decision-making remains essential.
Gnanaraj JP, Steaphen AP, Jeemon P
… +19 more, Sivasubramanian R, Sivadasanpillai H, Wander GS, Sikka P, Yadav A, Ghosh AK, Choudhary D, Rai D, Singh G, Viegas M, Tyagi S, Marwah S, Srivatsava S, Sathyendra S, Isukapalli V, Dadhwal V, Joshi V, Anish K, NPAC India Investigators
Am J Cardiol
· 2026 May · PMID 42128258
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Cardiovascular disease (CVD) is a leading and preventable cause of maternal mortality in low and middle-income countries (LMICs), yet most management guidelines rely on data from high-income countries. Robust, nationally...Cardiovascular disease (CVD) is a leading and preventable cause of maternal mortality in low and middle-income countries (LMICs), yet most management guidelines rely on data from high-income countries. Robust, nationally representative data on pregnant women with heart disease (PWHD) are limited in India, underscoring the need for locally relevant evidence to guide clinical practice and policy. The National Pregnancy and Cardiac Disease Study in India (NPAC-India) is a multiphase national initiative, and this paper describes the protocol for Phase 1, a prospective multicenter observational study initiated at 56 sites across India. All consecutive pregnant women presenting for antenatal care with known or newly diagnosed cardiovascular diseases, including congenital or acquired structural heart disease, cardiac arrhythmia, ischemic heart disease, aortopathies, or pulmonary vascular disease, will be enrolled from July 2024. Clinical details related to antenatal, intranatal, and postnatal care will be systematically documented. All study participants will be followed up for 6 months after the end of their pregnancy. The primary outcome is a composite of maternal cardiac events during pregnancy and up to 6 weeks postpartum. The secondary outcomes cover obstetric and fetal parameters. The study will evaluate the predictive accuracy of widely used general and lesion-specific risk assessment tools in the Indian population and explore the development and validation of a population-specific risk stratification model. The NPAC-India study is expected to facilitate the development of evidence-based, locally tailored guidelines for managing heart disease in pregnancy, thereby reducing maternal and fetal risks in India. The generation of national data may strengthen clinical care, improve resource allocation, and inform public health policy.
Knezevic-Maragh M, Gilani F, Nandakumar NA
… +7 more, Hudli ARM, Puhachova M, Zafar W, Esther P, AlGhaithi A, Salman N, Bengherbia L
Am J Cardiol
· 2026 May · PMID 42128257
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Heart failure with preserved ejection fraction (HFpEF) is highly prevalent and associated with substantial morbidity and mortality. The clinical benefit of mineralocorticoid receptor antagonist (MRA) therapy in this popu...Heart failure with preserved ejection fraction (HFpEF) is highly prevalent and associated with substantial morbidity and mortality. The clinical benefit of mineralocorticoid receptor antagonist (MRA) therapy in this population remains uncertain. A meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, searching PubMed, Embase, and Scopus from inception through the most recent available data to identify randomized controlled trials and observational cohort studies comparing MRAs with placebo or no MRA therapy in adults with HFpEF. Primary outcomes were all-cause mortality, cardiovascular mortality and HF hospitalization, while secondary outcomes included hyperkalemia. Random-effects models were used to pool risk ratios (RRs) or hazard ratios with 95% confidence intervals (CLs). Twenty-one reports representing 11 unique studies comprising 50,983 patients met the inclusion criteria; 8,976 received MRA therapy, and 28,999 served as controls. MRA use was not associated with a statistically significant reduction in all-cause mortality (RR 0.91, 95% CI 0.81 to 1.02) or cardiovascular mortality (RR 0.84, 95% CI 0.66-1.05; p = 0.13). MRA therapy, however, was associated with a significant reduction in HF hospitalization (RR 0.81, 95% CI 0.73 to 0.90; p <0.0001). MRA use was also associated with an increased risk of hyperkalemia (RR 2.04, 95% CI 1.55 to 2.68; p <0.00001). In conclusion, MRA therapy in HFpEF reduces HF hospitalization without a significant mortality benefit and is associated with increased hyperkalemia risk.
Andrews T, Coombe V, McBride P
… +10 more, Gonzalez PE, Lee J, Dawdy J, Zweig B, Frisoli TM, Villablanca P, Golwala H, Amoroso NS, Zahr F, O'Neill BP
Am J Cardiol
· 2026 May · PMID 42114631
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Transcatheter tricuspid valve replacement (TTVR) has emerged as a nonsurgical approach for patients with severe tricuspid regurgitation. However, clinical variables which may impact the overall patient response to TTVR r...Transcatheter tricuspid valve replacement (TTVR) has emerged as a nonsurgical approach for patients with severe tricuspid regurgitation. However, clinical variables which may impact the overall patient response to TTVR remain elusive. B-type natriuretic peptide (BNP) may reflect disease severity, which in turn may help predict response to TTVR and identify patients at increased risk of adverse outcomes. We evaluated the association between baseline BNP and clinical outcomes (all-cause hospitalization or death) and Kansas City Cardiomyopathy Questionnaire at 30-days and 1-year among 148 patients undergoing TTVR. BNP was analyzed as both a continuous variable and stratified by tertiles. Baseline BNP tertile was not associated with improvement in health status measured by change in Kansas City Cardiomyopathy Questionnaire score at 30-days (p = 0.48) or 1-year (p = 0.57). Sixteen patients (10.8%) experienced a 30-day event and 34 (23%) experienced a 1-year event. Baseline BNP was higher among patients experiencing 1-year events compared with those without events (median 668 vs 375 pg/ml, p = 0.004). One-year event rates increased stepwise across BNP tertiles (10.2%, 22.5%, and 36.0%; p = 0.0095) at 1-year. In a multivariable Cox regression analysis adjusting for age, body mass index, and serum creatinine, higher baseline BNP was independently associated with the composite endpoint of death or rehospitalization (hazard ratio 1.74, 95% confidence interval 1.15 to 2.64, p = 0.00912). Higher baseline BNP was associated with increased risk of adverse clinical outcomes following TTVR but was not associated with improvement in patient-reported health status. BNP may serve as a marker of disease severity and risk stratification in patients undergoing TTVR.