Liu HY, Guo MM, Pu SJ
… +6 more, Jiang JR, Yi H, Chen HW, Zeng HY, Lin WD, Xue YM
Cardiol Res Pract
· 2025 · PMID 41357950
·
Full text
OBJECTIVE: To explore the feasibility of continuous low-dose isoproterenol (ISP) in identifying atrial fibrillation (AF) triggers under conscious sedation and to investigate the association between unmappable triggers an...OBJECTIVE: To explore the feasibility of continuous low-dose isoproterenol (ISP) in identifying atrial fibrillation (AF) triggers under conscious sedation and to investigate the association between unmappable triggers and postablation recurrence. METHODS: In 50 PAF patients (Group 1), standardized ISP infusion (2-4 μg/min) was administered to provoke triggers, followed by adenosine triphosphate (ATP) challenge (30-40 mg) if no arrhythmia was induced. A matched control cohort ( = 96, Group 2) was selected based on baseline characteristics. Pulmonary vein isolation (PVI) was performed in all patients. Those with mappable triggers underwent additional ablation based on triggers. Additional ablation for other patient was guided by operators' discretion. RESULTS: In Group 1, provocative testing identified mappable triggers in 35 patients (Group 1A: 34 PV triggers and 10 non-PV triggers) and unmappable triggers in 5 (Group 1B), with 10 patients showing no inducible arrhythmia (Group 1C). After 12-month follow-up, Group 1B showed significantly higher recurrence than all other groups (60.0% vs. Group 1A: 5.7%, Group 1C: 0%, and Group 2: 14.6%; < 0.05). CONCLUSIONS: Continuous low-dose ISP challenge provides a pragmatic approach for intraprocedural AF trigger identification, particularly under conscious sedation. The high recurrence rate in patients with unmappable triggers underscores the imperative for advanced mapping modalities to precisely localize arrhythmogenic foci origins.
Karisa P, Sylviana N, Goenawan H
… +2 more, Fitrianti HP, Setiawan
Cardiol Res Pract
· 2025 · PMID 41357949
·
Full text
INTRODUCTION: Angiogenesis is a critical adaptation to regular physical exercise, primarily driven by hypoxia-inducible factor-1 alpha (HIF-1). However, prolonged exercise has been associated with the downregulation of H...INTRODUCTION: Angiogenesis is a critical adaptation to regular physical exercise, primarily driven by hypoxia-inducible factor-1 alpha (HIF-1). However, prolonged exercise has been associated with the downregulation of HIF-1, potentially mediated by increased expression of its negative regulators, prolyl hydroxylase domain (PHD) and factor-inhibiting HIF-1 (FIH). OBJECTIVES: This study aimed to investigate the effects of short-term (acute) and long-term (chronic) moderate-intensity exercise on HIF-1, PHD, and FIH mRNA expression in Wistar rat hearts. METHODS: Twenty Wistar rats (age: 8 weeks, body weight: 200-250 g) were divided into four groups: acute control (AC) (15 days) ( = 5), acute exercise (AE) (15 days) ( = 5), chronic control (CC) (8 weeks) ( = 5), and chronic exercise (CE) (8 weeks) ( = 5). The exercise groups underwent moderate-intensity treadmill exercise with 20 m/min for 30 min each day for 5 times a week. At the end of the experiment, rats were sacrificed 1 h (acute group) and 24 h (chronic group) after exercise using isoflurane anesthesia, followed by cervical dislocation. Left ventricular heart muscle samples were collected for mRNA expression analysis of HIF-1, PHD, and FIH using real-time PCR. RESULTS: Exercise significantly altered the expression of HIF-1, PHD, and FIH. HIF-1 mRNA was significantly higher in the AE group versus AC (AC vs AE, =0.006) and in the CE group versus CC (CC vs CE, =0.004). PHD expression likewise increased with exercise (AE vs AC, =0.001; CE vs CC, ≤ 0.001). In contrast, FIH showed no significant differences (acute =0.472; chronic =0.095). Exploratory one-way analyses confirmed overall group effects for HIF-1 ( ≤ 0.001) and PHD (=0.016), but not for FIH (=0.105). CONCLUSION: Chronic moderate-intensity exercise upregulates the expression of HIF-1 negative regulators (PHD and FIH) in the myocardium, suggesting a shift from acute hypoxia-driven responses to oxygen-dependent regulation. These findings offer insight into the molecular adaptations of cardiac tissue to prolonged exercise and their potential role in angiogenesis regulation.
Shaikh Y, Shahnoor S, Fahim MAA
… +4 more, Khan AM, Shaikh T, Moeed A, Asghar MS
Am Heart J Plus
· 2025 Dec · PMID 41333297
·
Full text
INTRODUCTION: Alzheimer's disease is one of the leading causes of death among the elderly in the United States with heart failure sharing similar risk factors. This study investigated trends and disparities in Alzheimer'...INTRODUCTION: Alzheimer's disease is one of the leading causes of death among the elderly in the United States with heart failure sharing similar risk factors. This study investigated trends and disparities in Alzheimer's disease mortality among older adults with heart failure from 1999 to 2020 in the United States. METHODS: Making use of ICD-10 codes death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research database was retrieved for patients aged ≥65 years between 1999 and 2020. Age-adjusted mortality rates (AAMRs), per 100,000 people, and Annual Percentage Change (APCs) with their respective 95 % Confidence Intervals (CI) were also calculated. Data was stratified by year, gender, race and geographical distribution. RESULTS: Alzheimer's disease with coexisting heart failure was responsible for 192,459 deaths between 1999 and 2020. Overall the AAMR increased from 21.32 in 1999 to 24.56 in 2005 (APC: 1.9760*; 95 % CI: 0.6001 to 3.9507) after which a significant decrease to 16.52 by 2013 was observed (APC: -4.9301*; 95 % CI: -6.5209 to -4.0119). AAMRs decreased from this point forward reaching 22.21 in 2020 (APC: 4.1573*; 95 % CI: 3.0373 to 5.7232). Women had higher AAMRs than men (21.57 vs 18.41). Among racial groups, the Non-Hispanic (NH) White (21.62) population had the highest AAMRs followed by NH Black/African American (17.87), Hispanic/Latino (14.3) and NH Asian/Pacific Islander (8.96). Furthermore, AAMRs also varied by census region (West: 24.05; Midwest: 22.83; South: 21.1; Northeast: 13.38). Moreover, nonmetropolitan areas had higher AAMRs compared to metropolitan areas (27.23 vs 19.09). States in the top 90th percentile such as Kentucky, Oklahoma, Washington, North Dakota and Mississippi had AAMRs that were three times higher relative to states in the lower 10th percentile including Nevada, Florida, New York, District of Columbia and Hawaii. CONCLUSION: Alzheimer's disease mortality with associated heart failure has shown considerable variation in adults ≥65 years. AAMRs were highest in women, NH Whites, residents of the West and nonmetropolitan patient populations. Targeted interventions and a more holistic approach to patient management are essential in achieving favorable outcomes for vulnerable groups moving forward.
Naing P, Scalia GM, Murdoch D
… +4 more, Ranasinghe I, Forrester DL, Strange G, Playford D
Am Heart J Plus
· 2025 Dec · PMID 41323513
·
Full text
All-cause pulmonary hypertension (PH) is associated with increased mortality and an enormous public health concern. However, given its complexity, multiple potential etiologies and inherent diagnostic challenges, PH diag...All-cause pulmonary hypertension (PH) is associated with increased mortality and an enormous public health concern. However, given its complexity, multiple potential etiologies and inherent diagnostic challenges, PH diagnosis may be delayed or missed entirely. Artificial Intelligence (AI) shows potential to provide a simple but multifaceted, personalized approach for early identification of PH. AI-assisted patient triage may help highlight individuals requiring further investigation. Echocardiography may improve the identification of PH due to left heart disease and PH from other causes using a combination of AI systems such as image guidance, auto-measurement, deep phenotyping and smart reporting. Multi-level AI integrating clinical and echocardiographic data has the potential to democratize access to medical care and assist in selecting those most at risk for thorough evaluation at expert centers. In this state-of-the-art review, we discuss how new technology including AI can assist in improving the diagnosis and management of PH.
Siano M, Makhija R, Patel N
… +20 more, Sartori S, Farhan S, Power D, Feng Y, Chang W, Camaj A, Kalaba F, Dhulipala V, Yasumura K, Thapi R, Vijay P, Gurung N, Vinayak M, Hooda A, Krishnamoorthy P, Sweeny J, Dangas G, Mehran R, Kini A, Sharma S
Am Heart J Plus
· 2025 Dec · PMID 41323512
·
Full text
BACKGROUND: Patients with diabetes mellitus (DM) have worse outcomes after percutaneous coronary intervention (PCI), even with everolimus-eluting stents (EES). Limited data are available comparing outcomes in DM versus n...BACKGROUND: Patients with diabetes mellitus (DM) have worse outcomes after percutaneous coronary intervention (PCI), even with everolimus-eluting stents (EES). Limited data are available comparing outcomes in DM versus non-DM receiving various bioresorbable polymer (BP) or durable polymer (DP) EES after rotational atherectomy (RA). We aimed to study the impact of DM on outcomes in patients undergoing PCI with BP-EES and DP-EES after RA. METHODS: Consecutive patients undergoing PCI with RA between 2014 and 2021 were included. The primary outcome was major adverse cardiac events (MACE), a composite of death, myocardial infarction (MI), or stroke at 1 year, which was stratified according to DM status. Regression analysis was performed to adjust for confounders. RESULTS: Among 2376 patients (mean age 70.3 ± 10.7, 49.5 % DM) that underwent RA, 552 received BP-EES and 1824 received DP-EES. Both groups had similar number of stents implanted and stent diameters; however, the BP-EES group had a higher SYNTAX score and was more likely to have multi-vessel disease and undergo PCI to the left anterior descending, circumflex, and right coronary artery. In both BP-EES and DP-EES groups, there was no significant difference in adjusted risk of MACE (BP-EES: 7.3 % vs. 7.1 %, HR 0.78, 95 % CI 0.35-1.78, = 0.562 & DP-EES: 7.5 % vs. 3.7 %, HR 1.49, 95 % CI 0.89-2.50, = 0.130) between diabetics and non-diabetics. CONCLUSIONS: Despite differences in baseline characteristics, DM was not associated with worse MACE at one year in patients with complex coronary artery disease undergoing RA and PCI with contemporary BP-EES or DP-EES.
Am Heart J Plus
· 2025 Dec · PMID 41323511
·
Full text
Pulmonary hypertension (PH) is a severe cardiovascular disorder characterized by pulmonary arterial smooth muscle cells (PASMCs) proliferation and vascular remodeling. The nuclear factor-kappa B (NF-κB) family of transcr...Pulmonary hypertension (PH) is a severe cardiovascular disorder characterized by pulmonary arterial smooth muscle cells (PASMCs) proliferation and vascular remodeling. The nuclear factor-kappa B (NF-κB) family of transcription factors serves as a central mediator of inflammatory responses and plays a critical role in both innate and adaptive immunity. In recent years, the involvement of NF-κB signaling in PH pathogenesis has attracted growing interest. Accumulating evidence indicates that NF-κB contributes to pulmonary vascular remodeling and right ventricular (RV) dysfunction by modulating inflammatory processes, cell proliferation, and apoptosis. This review systematically summarizes the molecular mechanisms by which NF-κB contributes to PH, emphasizing its cell-specific roles in PASMCs and pulmonary arterial endothelial cells (PAECs), and evaluates the therapeutic potential of NF-κB as a target in PH.
Vignarajah A, Oro P, El Dahdah J
… +3 more, Vigneswaramoorthy N, Vest AR, Shah G
Am Heart J Plus
· 2025 Dec · PMID 41323510
·
Full text
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a popular first-line treatment option in managing Type 2 Diabetes Mellitus (T2DM) with cardiovascular co morbidities. Studies have established the ben...BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a popular first-line treatment option in managing Type 2 Diabetes Mellitus (T2DM) with cardiovascular co morbidities. Studies have established the benefit of GLP-1 RAs in improving cardiovascular (CV) outcomes in patients with T2DM. However, the impact of GLP-1 RAs on mortality and cardiovascular outcomes in patients with T2DM and Heart failure with reduced ejection fraction (HFrEF) remains uncertain. METHODS: This retrospective cohort study employed an active-comparator new-user design using the TriNetX Research Network database. Patients aged 18 years or older with T2DM and left ventricular ejection fraction of ≤40 % were identified for inclusion. Patients were classified into two groups: GLP-1 RAs users versus dipeptidyl peptidase 4 inhibitor (DPP4i) users. Propensity score matching (1:1) was conducted based on demographics, body mass index, comorbidities, glycated hemoglobin levels, medications and socioeconomic factors resulting in a matched cohort of 26,196 patients. Outcomes analyzed included all-cause mortality, acute myocardial infarction, cerebrovascular accident, and all-cause hospitalization. RESULTS: The GLP-1 RA user group demonstrated a reduced hazard ratio (HR, 95 % confidence interval) over 5 years compared with the DPP4i user group for all-cause mortality (0.62, 0.59-0.66, < 0.001), all-cause hospitalization (0.71, 0.69-0.73, < 0.001), acute myocardial infarction (0.87, 0.82-0.92, < 0.001), heart failure exacerbation (0.83, 0.81-0.86, < 0.001) and cerebrovascular accidents (0.85, 0.80-0.92, P < 0.001). CONCLUSION: In patients with T2DM and HFrEF, GLP-1 RA therapy shows potential beneficial effects in reducing CV events over 5 years compared to control (DPP4i) group.
Am Heart J Plus
· 2025 Dec · PMID 41323509
·
Full text
BACKGROUND: Hypertensive heart disease (HHD) and ischemic heart disease (IHD) are major global burdens. High body mass index (BMI) is a key modifiable risk factor, but the global burden, trends, and inequalities of HHD a...BACKGROUND: Hypertensive heart disease (HHD) and ischemic heart disease (IHD) are major global burdens. High body mass index (BMI) is a key modifiable risk factor, but the global burden, trends, and inequalities of HHD and IHD attributable to high BMI remain poorly defined. METHODS: We analyzed Global Burden of Disease data from 1990 to 2021 across 204 countries, estimating age-standardized mortality rates (ASMRs), disability-adjusted life-year rates (ASDRs), and annual average percentage changes (AAPCs). Additional analyses included age- and sex-specific distributions, socio-demographic index (SDI) patterns, frontier and decomposition analyses, inequality metrics, and projections to 2035 using Bayesian age-period-cohort and ARIMA models. RESULTS: From 1990 to 2021, global ASMR and ASDR for HHD attributable to high BMI slightly increased (AAPC: 0.014 and 0.099), whereas those for IHD declined (AAPC: -0.067 and -0.751). The highest HHD burden occurred in Southern Sub-Saharan Africa, and the greatest IHD burden in Eastern Europe. Elderly females had higher HHD mortality and DALYs, while middle-aged males bore greater IHD burden. HHD inversely correlated with SDI ( = -0.5524, < 0.001), whereas IHD showed a unimodal relationship. Decomposition highlighted aging and population growth as major contributors. Inequalities worsened for HHD but improved for IHD. Forecasts suggest continued rises in HHD and declines in IHD by 2035. CONCLUSIONS: HHD and IHD attributable to high BMI show divergent global trends and inequality patterns, underscoring the urgent need for targeted weight management and cardiovascular risk reduction, particularly in low- and middle-SDI regions.
Igata S, Bibby D, Fang Q
… +4 more, Rasmussen W, Abraham T, Olgin J, Schiller NB
Am Heart J Plus
· 2025 Dec · PMID 41323508
·
Full text
BACKGROUND: Left atrial end-diastolic volume index (LAEDVI), the smallest achieved diastolic volume, strongly predicts cardiovascular events. We hypothesize that echocardiographic left atrial reservoir strain (LASr) para...BACKGROUND: Left atrial end-diastolic volume index (LAEDVI), the smallest achieved diastolic volume, strongly predicts cardiovascular events. We hypothesize that echocardiographic left atrial reservoir strain (LASr) parallels LAEDVI, providing an additional measurement of LA function. METHODS: We analyzed 133 subjects from the BEAT-AFib study. All subjects were in sinus rhythm when studied and were either deemed at risk for atrial fibrillation (Afib) (At-risk, = 73) or had a history of Afib (Afib, = 60). The at-risk group had two or more of the following: age > 65 years, hypertension, diabetes, sleep apnea, BMI ≥ 30 kg/m, stable heart failure, and chronic kidney disease without dialysis. We included 83 normal subjects from our laboratory database. LA volumes were measured from 3-dimensional images. LASr was obtained by 2-dimensional speckle tracking R-R gating method from apical 4- and 2- chamber views. RESULTS: LASr was 38 % in normal, 31 % in at-risk, and 23 % in Afib, ( < 0.01). LAEDVI was 11 mL/m in normal, 15 mL/m in at-risk, and 21 mL/m in Afib ( < 0.01). LASr was associated with LAEDVI ( = -0.684), LAESVI ( = -0.528), LA ejection fraction ( = 0.661), E/e' ratio medial ( = -0.571) (all < 0.01). CONCLUSIONS: LAEDVI are significantly different among normal subjects, those at-risk for Afib development and sinus rhythm with Afib history. LASr paralleled with LAEDVI in its ability to distinguish among these groups indicating that LASr is an additional useful component in evaluating LA function.
Mirza UB, Mansoor F, Fnu U
… +4 more, Riaz S, Zaka M, Raza AA, Samadi A
Am Heart J Plus
· 2025 Dec · PMID 41312412
·
Full text
Neurocognitive dysfunction is a common but often overlooked complication in patients with Acute Coronary Syndrome (ACS). This narrative review aims to provide a comprehensive synthesis of current evidence on the prevalen...Neurocognitive dysfunction is a common but often overlooked complication in patients with Acute Coronary Syndrome (ACS). This narrative review aims to provide a comprehensive synthesis of current evidence on the prevalence, mechanisms, clinical assessment, and management strategies of cognitive impairment in ACS patients. We highlight how neurocognitive deficits including memory loss, reduced attention, and executive dysfunction arise from cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. These deficits arise from mechanisms including cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. Such impairments are associated with poorer clinical outcomes, decreased treatment adherence, and increased mortality. Routine cognitive assessment remains absent from standard ACS management, despite the availability of effective tools such as the Montreal Cognitive Assessment (MoCA), which can detect subtle cognitive deficits early in hospitalization. Integrating cognitive screening into clinical protocols enables timely interventions and better patient stratification. Management strategies should combine pharmacological treatment of cardiovascular risk factors with non-pharmacological interventions such as cognitive rehabilitation, mental health support, and lifestyle modification. Multidisciplinary collaboration between cardiology, neurology, psychology, and rehabilitation specialists is essential to address both cardiac and cognitive recovery. By integrating findings from clinical and epidemiological studies, this review underscores the need for routine cognitive screening, multidisciplinary care, and innovative interventions such as telemedicine to improve patient outcomes. Recognizing cognitive health as an integral part of ACS management offers a more holistic, patient-centered approach to recovery.
Labounek R, Matheson MJ, Petersen AJ
… +13 more, Hansen A, Block AD, Strong C, Hill A, Kremer M, Robertson AJ, Maharaj V, Lakshminaryan K, Li D, Henderson JN, Nestrasil I, Lenglet C, Mantyh WG
Am Heart J Plus
· 2025 Dec · PMID 41282305
·
Full text
OBJECTIVE: American Indian/Indigenous (AI) populations have the highest rate of ischemic heart disease (IHD) of any racial or ethnic group in the United States. While modifiable cardiovascular risk factors represent a we...OBJECTIVE: American Indian/Indigenous (AI) populations have the highest rate of ischemic heart disease (IHD) of any racial or ethnic group in the United States. While modifiable cardiovascular risk factors represent a well-established source of elevated IHD in AI, little is known regarding genetic IHD influences, in particular , which has an ancestry-dependent prevalence and effect on human disease. We sought to quantify the prevalence and association between and IHD in AI communities. METHODS: We performed a cross-sectional, community-based study including tribal Elders (ages >54 years) at the Bois Forte Band of Chippewa in the state of Minnesota. We collected data pertaining to demographics, cardiovascular risk factors, genotype, and ischemic heart disease (defined as history of myocardial infarction, coronary artery bypass graft, angiogram showing coronary artery disease, percutaneous transluminal coronary angioplasty, or thrombolytic therapy). FINDINGS: One-hundred-eighty-one participants were included. Their median age and interquartile range were 67 (61, 73) years, AI ancestry was 75 % (50 %, 100 %), 126 (70 %) were females, 46 (25 %) were heterozygous, and 5 (2.8 %) were homozygous. Each allele increased the odds of IHD in AI tribal Elders 2.38-fold (95 % CI: 0.94-6.89; = 0.06), which is comparable to a two-point rise in hemoglobin A1C. CONCLUSIONS: appears to play an important role in the risk of IHD in AI populations, given its high prevalence and strong association with IHD.
Am Heart J Plus
· 2025 Dec · PMID 41282304
·
Full text
Rapid atrial fibrillation (rapid AF) often induces or exacerbates acute heart failure (HF). However, there is controversy regarding whether β-blockers should be used to control the ventricular rate in patients during the...Rapid atrial fibrillation (rapid AF) often induces or exacerbates acute heart failure (HF). However, there is controversy regarding whether β-blockers should be used to control the ventricular rate in patients during the acute HF phase. AF management guidelines generally recommend considering the addition of β-blockers when digoxin-like drugs (such as cedilanid) fail to effectively control the ventricular rate. Nevertheless, HF guidelines clearly state that β-blockers should be used with caution during the acute decompensation phase to avoid the negative inotropic effect that may exacerbate the condition. This article systematically reviews the clinical management strategies under this guideline contradiction, including: (1) Different recommendations on ventricular rate control and the use of β-blockers in domestic and international guidelines for AF and HF; (2) A pooled analysis of relevant research evidence; (3) Application strategies of β-blockers (especially short-acting agents esmolol and landiolol) in the acute phase. We focus on discussing the latest research progress and clinical application strategies of esmolol and landiolol in HF induced by rapid AF, evaluate their effectiveness and safety. Although some studies and consensus articles have focused on the management of rapid AF complicated by HF, there is currently a lack of systematic reviews on this issue. Therefore, the writing of this review has important academic value and clinical guiding significance, providing a reference for treatment decisions in this special population.
Am Heart J Plus
· 2025 Dec · PMID 41282303
·
Full text
OBJECTIVES: To determine the incidence and predictors of unplanned 30-day readmission and in-hospital mortality among adults hospitalized with AHF in Ethiopia. METHODS: A multicenter prospective observational study was c...OBJECTIVES: To determine the incidence and predictors of unplanned 30-day readmission and in-hospital mortality among adults hospitalized with AHF in Ethiopia. METHODS: A multicenter prospective observational study was conducted in six referral hospitals in the Amhara region between December 2023 and April 2024. Adults (≥18 years) with AHF were consecutively enrolled and followed up until discharge and 30 days post-discharge. Kaplan-Meier survival analysis and Cox regression were used to estimate outcomes and predictors. RESULTS: Of the 1131 patients, 275 (24.4 %) were readmitted within 30 days and 121 (10.7 %) died in the hospital. Independent predictors of readmission included hyponatremia (AHR = 10.5; 95 % CI: 3.1-36.2), thrombocytopenia (AHR = 16.7; 95 % CI: 4.8-58.3), ischemic heart disease (AHR = 6.9; 95 % CI: 1.8-27.0), Charlson Comorbidity Index ≥4 (AHR = 6.5; 95 % CI: 1.7-24.6), poor physician adherence to guideline-directed therapy (AHR = 8.2; 95 % CI: 2.3-30.1), and low patient adherence (AHR = 4.8; 95 % CI: 1.6-14.5). Prescription of ACE inhibitors, beta-blockers, and SGLT2 inhibitors at discharge significantly reduced the readmission risk (AHR range: 0.09-0.30). The predictors of in-hospital mortality included reduced ejection fraction, tachycardia, hypoxemia, left bundle branch block, pulmonary hypertension, elevated creatinine, severe hypertension, and pneumonia. CONCLUSION: AHF patients in Ethiopia experience high short-term readmission and mortality. Correcting electrolyte imbalances, improving comorbidity management, strengthening physician adherence to guideline-directed therapy, and promoting patient adherence are essential for improving outcomes.
Kang J, El-Andari R, Fialka N
… +4 more, Hong Y, McMurtry MS, Nagendran J, Nagendran J
Am Heart J Plus
· 2025 Dec · PMID 41282302
·
Full text
OBJECTIVE: The optimal revascularization strategy for patients with three-vessel coronary artery disease (3VD) and heart failure (HF) remains uncertain due to the absence of randomized trials directly comparing coronary...OBJECTIVE: The optimal revascularization strategy for patients with three-vessel coronary artery disease (3VD) and heart failure (HF) remains uncertain due to the absence of randomized trials directly comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). With few observational studies providing long-term follow-up, clinical equipoise persists. We therefore evaluated 10-year outcomes between CABG and PCI in patients with HF and 3VD. METHODS: This retrospective population-based cohort study included adults with 3VD and HF undergoing isolated CABG or PCI in Edmonton, Alberta, Canada (2009-2018). Patients with STEMI, prior CABG, or concomitant procedures were excluded. The primary endpoint was all-cause mortality. Secondary endpoints included readmission for myocardial infarction (MI), stroke, repeat revascularization, and all-cause rehospitalization. Multivariable Cox regression was used to adjust for baseline characteristics. RESULTS: Of 1774 screened patients, 632 met inclusion criteria (CABG: n = 97; PCI: n = 535). At 10 years, all-cause mortality was significantly lower in the CABG group (62.4 %) compared to PCI (71.8 %) (adjusted hazard ratio [aHR] 0.65, 95 % CI 0.47-0.92; = 0.014). CABG was also associated with markedly lower rates of MI readmission (3.2 % vs. 23.7 %; aHR 0.11, 95 % CI 0.03-0.38; < 0.001) and repeat revascularization (6.4 % vs. 21.6 %; aHR 0.22, 95 % CI 0.09-0.53; = 0.001). Rates of stroke ( = 0.757) and all-cause rehospitalization ( = 0.157) were not significantly different. CONCLUSIONS: In patients with 3VD and HF, CABG is associated with significantly improved long-term survival, reduced MI readmissions, and fewer repeat revascularizations compared to PCI. These findings reinforce the need for a multidisciplinary Heart Team review to ensure the optimal intervention strategy.
Ngoc TN, Nhat LNT, Van AP
… +15 more, Thu SH, Minh NN, Tien TV, Bich HLT, Viet HT, Thu HPT, Do Phuong N, Thuy LTT, Phuong LD, Cao CD, Nguyen L, Minh NN, Kim CDT, Thu HN, Thu HNT
Am Heart J Plus
· 2025 Dec · PMID 41282301
·
Full text
STUDY OBJECTIVE: To establish sex-specific electrocardiographic (ECG) reference values in healthy Vietnamese late adolescents and characterize sex-based differences in repolarization patterns. DESIGN: Cross-sectional obs...STUDY OBJECTIVE: To establish sex-specific electrocardiographic (ECG) reference values in healthy Vietnamese late adolescents and characterize sex-based differences in repolarization patterns. DESIGN: Cross-sectional observational study. SETTING: University health screening program in Vietnam. PARTICIPANTS: A total of 5127 first-year university students (58.6 % female; age 17-29 years), all asymptomatic and without known cardiovascular or metabolic disease. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Standard ECG parameters (heart rate, PR interval, QRS duration, QTc, QRST angle), J-point elevation, ST-segment amplitude, and T-wave morphology in leads V1-V6, stratified by sex. RESULTS: Significant sex differences were observed in all ECG parameters ( < 0.001). Females had higher heart rates (83 vs. 80 bpm), shorter PR intervals (138 vs. 140 ms), and longer QTc intervals (423 vs. 406 ms), while males showed longer QRS durations (90 vs. 80 ms) and narrower QRST angles. In precordial leads, males exhibited higher J-point and ST-segment amplitudes, especially in V2-V3, with the 98th percentile of ST60V2 reaching 0.40 mV. Anterior T-wave inversion (TWI) was more common in females, notably in V1 (71.3 % vs. 48.1 %) and V2 (2.5 % vs. 0.9 %). TWI beyond V2 was rare in both sexes. CONCLUSION: This is the first large-scale study to define sex-specific ECG reference values in a Vietnamese cohort. Marked differences in repolarization patterns emphasize the importance of ethnicity- and sex-specific criteria to enhance diagnostic accuracy and avoid misinterpretation in Southeast Asian populations.
Nemov VC, Dunham A, Giugni CS
… +5 more, De Assis V, Coughlin E, Cain MA, Louis JM, Crousillat DR
Am Heart J Plus
· 2025 Nov · PMID 41262182
·
Full text
INTRODUCTION: We investigated associations between pre-conception cardiovascular risk factor burden and adverse pregnancy outcomes (APOs) in women with cardiovascular disease (CVD). METHODS: We created a patient registry...INTRODUCTION: We investigated associations between pre-conception cardiovascular risk factor burden and adverse pregnancy outcomes (APOs) in women with cardiovascular disease (CVD). METHODS: We created a patient registry from our cardio-obstetrics program. APOs were defined as intrauterine growth restriction (IUGR), hypertensive disorder of pregnancy (HDP), and pre-term birth. RESULTS: Analysis included 63 women. 42 (66.7 %) experienced no APOs, while 21 (33.3 %) did; 18 (28.6 %), 3 (4.8 %), and 12 (19.0 %) developed an HDP, IUGR, or delivered pre-term, respectively. Pre-conception risk burden was not a significant predictor of APO development ( 0.139). However, patients with pre-term delivery had a significantly higher number of risk factors ( < 0.001), as did patients with chronic hypertension with superimposed HDP ( < 0.001). DISCUSSION: Women delivering pre-term have higher risk factor burdens. Since pre-term birth is associated with future CVD in women independent of cause, optimization of preconception cardiovascular health could help mitigate these risks in an already vulnerable population.
Mousavi A, Shojaei S, Dastjerdi P
… +13 more, Rahmati S, Izadpanahi K, Pishraft-Sabet H, Afshar EJ, Salehi K, Sabri M, Arbatan MN, Fallahtafti P, Wilbert A, Ambrosy AP, Syed MA, Iskander M, Hosseini K
Am Heart J Plus
· 2025 Nov · PMID 41262181
·
Full text
BACKGROUND: Post-operative venous thromboembolism (VTE) remains a concern following cancer-related surgeries. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of direct oral anticoagulan...BACKGROUND: Post-operative venous thromboembolism (VTE) remains a concern following cancer-related surgeries. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) compared to low molecular weight heparin (LMWH) for thromboprophylaxis after cancer-related surgeries. METHODS: We systematically searched databases for studies comparing DOACs to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries. Primary outcomes were VTE incidence and bleeding events. Secondary outcomes included all-cause mortality and hospitalization rates. Subgroup analyses examined DOAC type, cancer type, and follow-up duration. A random-effects model calculated pooled risk ratios (RRs) with 95 % confidence intervals (CIs). RESULTS: Analysis included 16 studies with 6400 participants in the DOAC group (mean age 62.05 years, 28.15 % male) and 5801 participants in the LMWH group (mean age 60.78 years, 34.65 % male). DOACs were non-inferior to LMWH for VTE prevention (RR = 0.81, 95 % CI 0.56 to 1.16) with no significant difference in bleeding rates (RR = 0.70, 95 % CI 0.70 to 1.18). Mortality and hospitalization rates were similar between groups. Subgroup analyses suggested possible VTE reduction with DOACs in urological cancer surgeries (RR = 0.52, 95 % CI 0.44 to 0.61) and lower bleeding trends with Apixaban (RR = 0.64, 95 % CI 0.44 to 0.94). CONCLUSIONS: DOACs appear non-inferior to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries, with comparable safety. The superior VTE prevention in urological cancer surgeries and Apixaban's favorable safety profile warrant further investigation. Moreover, additional research is necessary to clarify the roles of specific DOACs and optimal prophylaxis strategies across various cancer types and surgical procedures.