AIMS: Evidence regarding statin adherence among patients with hypertension in primary care is limited. We assessed statin adherence in Swedish primary care and examined associations between patient characteristics and ad...AIMS: Evidence regarding statin adherence among patients with hypertension in primary care is limited. We assessed statin adherence in Swedish primary care and examined associations between patient characteristics and adherence. METHODS AND RESULTS: In this retrospective register-based cohort study from a large Swedish region, data from all primary health care centres were linked to data on comorbidities, dispensed drugs, and socioeconomic factors. Patients with hypertension who initiated statin therapy in 2012-2015 were included. Adherence during two years after initiation was measured using the proportion of days covered (PDC). Explainable machine learning with XGBoost and SHAP values identified baseline characteristics associated with adherence. Associations were estimated using adjusted multilevel regression and presented as odds ratios (ORs) and median odds ratio (MOR).Among 30 497 patients (mean age 66 years; 48% women), the mean two-year PDC was 73.2%, while 60.2% achieved adequate adherence (PDC >80%). Adequate adherence differed by indication (P <0.001): 54.0% in primary prevention, 61.3% in diabetes without cardiovascular disease, and 65.5% in secondary prevention. The five most important characteristics associated with adequate adherence according to SHAP values were dispensed antithrombotic therapy (OR 1.38, 95% CI 1.26-1.50), primary health care centre (MOR 1.16, 95% CI 1.12-1.20), 10-year increase in age (OR 1.14, 95% CI 1.12-1.17), initiation with atorvastatin (OR 1.33, 95% CI 1.24-1.44), and countries of birth outside Sweden (OR range 0.73-0.78). CONCLUSION: Only 60% of patients achieved adequate statin adherence, which varied substantially by indication. Patient- and provider-level factors identified could guide targeted interventions to optimize preventive cardiovascular care.
AIMS: Prognosis in tricuspid regurgitation (TR) is shaped by complex clinical and hemodynamic interactions, complicating risk stratification. We aimed to use explainable artificial intelligence (EAI) to model these relat...AIMS: Prognosis in tricuspid regurgitation (TR) is shaped by complex clinical and hemodynamic interactions, complicating risk stratification. We aimed to use explainable artificial intelligence (EAI) to model these relationships and identify key predictors of outcomes. METHODS AND RESULTS: We analyzed long-term all-cause mortality in a large prospective registry of patients with native TR across the full severity spectrum. Patients underwent detailed clinical evaluation and quantitative Doppler-echocardiography. Supervised-EAI models were applied to identify and rank predictors of mortality under medical therapy, capturing non-linear associations and interactions among baseline characteristics.Among 9,761 patients (mean age 73 ± 15 years; 56.9% women; EROA 40[30-56]mm2; RVol 39[29-53]mL/beat; 42% severe TR), 2,676 deaths occurred during 3.8 ± 4.6 years of follow-up. EAI identified and ranked 20 prognostic determinants of survival. Hemodynamic measures, led by elevated pulmonary-artery systolic and right-atrial pressures, were strongest, followed by age and comorbidity. TR-related variables ranked next, led by right-ventricular dysfunction and EROA, which outperformed integrative TR grade and TRIScore. Left-ventricular parameters were less influential. Non-linear effects, including those involving ejection fraction, and interactions such as higher EROA-related risk with elevated pulmonary-pressures or lower TRIScore (both p < 0.03) were observed. Proportional-hazards models confirmed EROA as the strongest TR severity marker (p < 0.0001), with excess mortality beginning at 40mm2 and increasing further at 60mm2. CONCLUSIONS: EAI ranked mortality predictors in TR, highlighting patient factors, hemodynamics, TR-specific measures, and left-ventricular function. Among TR-specific measures, EROA and TRIScore were most prognostic. Recognizing their impact can refine risk stratification, guide intervention timing, and inform long-term management.
BACKGROUND: The API-CAT trial demonstrated that reduced-dose apixaban (2.5 mg twice daily) was noninferior to full-dose apixaban (5 mg twice daily) for the prevention of recurrent venous thromboembolism in patients with...BACKGROUND: The API-CAT trial demonstrated that reduced-dose apixaban (2.5 mg twice daily) was noninferior to full-dose apixaban (5 mg twice daily) for the prevention of recurrent venous thromboembolism in patients with cancer, while resulting in fewer clinically relevant bleeding events. Although these findings are expected to influence clinical practice, real-world data on physicians' anticoagulation decisions in this setting remain limited. OBJECTIVES: To describe investigators' anticoagulant treatment decisions for patients enrolled in the API-CAT trial after discontinuation of blinded study treatment and prior to trial unblinding and dissemination of results. METHODS: This descriptive analysis included patients from the prospective, multicenter, randomized, double-blind API-CAT trial who received at least one dose of study medication. Investigators prospectively documented anticoagulation management following either premature or planned discontinuation of blinded apixaban. Decisions were categorized as treatment discontinuation, continuation at a reduced dose, or continuation at a full dose. Descriptive analyses examined treatment choices according to patient characteristics, cancer features, and contextual factors. RESULTS: Of 1,766 randomized patients, 1,458 (82.6%) were included in the analysis. After discontinuation of study treatment, anticoagulation was stopped in 198 patients (13.6%) and continued in 1,260 (86.4%). Among those continuing therapy, 790 patients (62.7%) received full-dose anticoagulation, 465 (36.9%) received a reduced dose, 5 unknown. Direct oral anticoagulants (DOACs) were prescribed in 89.6% of cases, and low-molecular-weight heparin in 9.9%. Treatment decisions were generally consistent across patient and cancer characteristics but varied according to timing of treatment discontinuation, physician specialty, and country. CONCLUSIONS: Prior to unblinding of the API-CAT trial, treatment decisions appeared poorly driven by clinical characteristics, reflecting a "therapeutic grey zone" where anticoagulation was continued in most patients but with highly variable dosing. This exploratory snapshot provides a baseline to monitor the anticipated shift toward wider adoption of reduced-dose apixaban for extended anticoagulation following publication of the API-CAT results. The substantial proportion of treatment discontinuation highlights the need for further studies to identify patients who may safely stop therapy.
Barletta V, Bartalucci M, Starace F
… +2 more, Ripoli A, Ceccarelli R
Eur Heart J Imaging Methods Pract
· 2026 Jan · PMID 42358628
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Wearable electrocardiogram (ECG) technologies have emerged as promising tools for continuous cardiac monitoring during physical activity. However, evidence regarding the accuracy of single-lead wearable ECG systems under...Wearable electrocardiogram (ECG) technologies have emerged as promising tools for continuous cardiac monitoring during physical activity. However, evidence regarding the accuracy of single-lead wearable ECG systems under dynamic exercise conditions remains limited. We evaluated the performance of a wearable chest-band ECG device by comparing simultaneous recordings with a conventional multi-lead exercise ECG system during rest and graded cycle ergometer exercise in healthy volunteers. Agreement was assessed using RR interval measurements, heart-rate metrics, and complementary agreement analyses, including participant-level correlation and Bland-Altman evaluation.
Eur Heart J Case Rep
· 2026 Jun · PMID 42358611
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BACKGROUND: Mitral valve surgery in patients with chronic severe heart failure carries a high perioperative risk. Life-threatening complications such as intraoperative left ventricular rupture, severe postoperative ventr...BACKGROUND: Mitral valve surgery in patients with chronic severe heart failure carries a high perioperative risk. Life-threatening complications such as intraoperative left ventricular rupture, severe postoperative ventricular dysfunction, and subsequent mechanical valve thrombosis remain challenging and require urgent multidisciplinary management. CASE SUMMARY: A 57-year-old woman with severe rheumatic mitral stenosis, atrial fibrillation, and New York Heart Association class III heart failure underwent mitral valve replacement, tricuspid annuloplasty, left atrial thrombectomy, and left atrial appendage closure. Intraoperative acute left ventricular rupture was successfully repaired urgently. Postoperatively, she developed severe left ventricular dysfunction (left ventricular ejection fraction [LVEF], 22%) requiring intra-aortic balloon pump support on postoperative day 1 (POD 1), followed by successful extubation (POD 11), stress-induced gastrointestinal bleeding (POD 13), device removal (POD 14), and prosthetic valve thrombosis (POD 20) managed by intensified anticoagulation. Ventricular and valve function improved markedly by POD 29 (LVEF 43%; effective orifice area, 1.7 cm). At 3- and 5-month follow-ups, optimized medical therapy maintained stable cardiac function, and the patient remained asymptomatic. DISCUSSION: This case highlights critical surgical and postoperative challenges associated with long-standing rheumatic mitral stenosis. Despite preserved preoperative LVEF, the patient developed profound haemodynamic instability requiring mechanical circulatory support. Additionally, the coexistence of gastrointestinal bleeding and prosthetic valve thrombosis required a carefully balanced and individualized anticoagulation strategy. This study emphasizes the importance of early recognition of risk factors for ventricular rupture, prompt surgical intervention, and multidisciplinary collaboration in managing complex cardiac cases. Furthermore, it underscores the role of conservative management with intensified anticoagulation when reoperation or thrombolysis is not feasible.
Schwarzkopf D, Hinkov H, Lee CB
… +2 more, Klein C, Unbehaun A
Eur Heart J Case Rep
· 2026 Jun · PMID 42358610
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BACKGROUND: Severe functional mitral valve regurgitation due to acute myocardial infarction in the setting of profound cardiogenic shock presents a challenging treatment scenario. Persistent mitral regurgitation despite...BACKGROUND: Severe functional mitral valve regurgitation due to acute myocardial infarction in the setting of profound cardiogenic shock presents a challenging treatment scenario. Persistent mitral regurgitation despite successful myocardial revascularization requires a careful and effective treatment approach. CASE SUMMARY: A 54-year-old male was admitted to our cardiac arrest centre due to severe cardiogenic shock. The patient underwent percutaneous coronary intervention with stenting of the left main coronary artery, left anterior descending, and ostial left circumflex artery in the setting of a ST-elevation myocardial infarction. After successful revascularization, cardiogenic shock persisted and advanced temporary mechanical circulatory support (tempMCS) with extracorporeal membrane oxygenation and a micro-axial flow pump was required. Further diagnostic evaluation revealed severe functional mitral regurgitation despite sufficient left-ventricular unloading. We present a case in which tempMCS stabilized the patient and mitral regurgitation was successfully eliminated using a transcatheter edge-to-edge repair flexible nitinol device. DISCUSSION: While mitral valve transcatheter edge-to-edge repair in cardiogenic shock on mechanical circulatory support is rare, it has shown feasibility and positive outcomes in limited reports. This is the first case using a nitinol edge-to-edge repair device in this context. Our report emphasizes the need for further discussion on device selection and comparative studies to optimize treatment in this high-risk group.
Kashiki K, Matsumoto K, Yamada A
… +2 more, Kawasaki S, Nishisaki H
Eur Heart J Case Rep
· 2026 Jun · PMID 42358609
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BACKGROUND: Coronary artery aneurysms are rare, and mycotic coronary aneurysms arising secondary to bacterial infection are even rarer. CASE SUMMARY: A 77-year-old woman with end-stage renal disease presented with a 1-we...BACKGROUND: Coronary artery aneurysms are rare, and mycotic coronary aneurysms arising secondary to bacterial infection are even rarer. CASE SUMMARY: A 77-year-old woman with end-stage renal disease presented with a 1-week history of persistent fever following arteriovenous fistula creation. Transthoracic echocardiography revealed a mild pericardial effusion. On the day after admission, a blood culture yielded methicillin-sensitive Transoesophageal echocardiography revealed a well-demarcated hypoechoic lesion encasing the right coronary artery and moderate pericardial effusion. Owing to further accumulation of pericardial effusion, urgent pericardial drainage was performed, and purulent bloody pericardial fluid was evacuated, from which was isolated. Computed tomography revealed a saccular right coronary aneurysm, suggestive of a diagnosis of a 'mycotic coronary aneurysm' concomitant with purulent pericarditis. Despite the urgent transfer, the aneurysm ruptured before the planned surgery, and the patient subsequently died after surgical repair. DISCUSSION: Autopsy studies have revealed that most mycotic coronary aneurysms represent 'pseudoaneurysms', characterized by thinning of the arterial wall with outward bulging due to disruption of the elastic tissue layers. Thus, rapid dilation of the aneurysm and eventual rupture into the pericardial cavity may be key characteristics of this pathological condition. Clinicians should maintain a high index of suspicion for mycotic coronary aneurysms in patients with persistent bacteraemia and pursue prompt multimodal imaging for early detection, particularly when the standard evaluations for infective endocarditis are unknown. Furthermore, in the presence of haemorrhagic pericardial effusion, timely surgical intervention is imperative, because it indicates aneurysmal rupture.
Chen ZW, Cheng JF, Huang CY
… +8 more, Lin TT, Wang TC, Yang YY, Chuang SL, Tsai CT, Lin LY, Hung CL, Wu CK
Eur Heart J Digit Health
· 2026 Jul · PMID 42358229
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AIMS: Diabetes mellitus (DM) is a major contributor to adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). We aim to develop and externally validate a machine learning-based model us...AIMS: Diabetes mellitus (DM) is a major contributor to adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). We aim to develop and externally validate a machine learning-based model using a random survival forest (RSF) approach for predicting the composite outcome of hospitalization for heart failure (HHF) and cardiovascular (CV) death in patients with DM and HFpEF. METHODS AND RESULTS: This retrospective cohort study included 1450 adult patients with coexisting DM and HFpEF identified from the National Taiwan University Hospital-Integrated Medical Database. An initial RSF model was trained using 27 clinical variables, and the top 9 predictors were selected to construct a parsimonious final model. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC), and external validation was conducted in an independent cohort ( = 729) from MacKay Memorial Hospital. Over a mean follow-up of 3.6 ± 3.0 years, 327 patients (22.6%) experienced the composite outcome. The final RSF model achieved an AUC of 88.2% in the training cohort and 79.8% in the validation cohort. The nine selected predictors were age, N-terminal pro-brain natriuretic peptide, serum albumin, fasting glucose, estimated glomerular filtration rate, uric acid, left atrial diameter, peripheral artery disease, and left ventricular ejection fraction. Risk increased progressively with the number of risk factors present. CONCLUSION: The RSF-based model incorporating nine routinely available variables accurately predicts HHF and CV death in patients with DM and HFpEF. This tool may support personalized risk assessment and guide clinical decision-making.