Cardiology Research And Practice[JOURNAL]
Sun
200 papers
Impact of Mildly Elevated Alanine Transaminase on In-Hospital Outcomes and Statin Intolerance in Elderly Patients With Acute Myocardial Infarction: A Retrospective Cohort Study.
Liang Y, Li M, Huang J … +4 more , Wang R, Mo Y, He X, Xue L
Cardiol Res Pract · 2025 · PMID 41476865 · Full text
BACKGROUND: Mild alanine transaminase (ALT) elevation is common in older patients with acute myocardial infarction (AMI), but its prognostic value and implications for statin therapy remain unclear. METHODS: This retrosp...
BACKGROUND: Mild alanine transaminase (ALT) elevation is common in older patients with acute myocardial infarction (AMI), but its prognostic value and implications for statin therapy remain unclear. METHODS: This retrospective cohort study included 321 AMI patients aged ≥ 75 years admitted from 2014 to 2019 at Guangdong Provincial People's Hospital. Mild ALT elevation was defined as ALT between the upper limit of normal (ULN) and 3 × ULN, and significant elevation as ALT > 3 × ULN. Patients were grouped by admission ALT into normal (N, = 201), mildly elevated (ME, = 104), and significantly elevated (SE, = 16). Logistic regression analyses in SPSS 26.0 and R 3.4.3 assessed the association between ALT levels and in-hospital mortality, adjusting for cardiac function, infarct size, renal function, and treatment factors. RESULTS: Among survivors with elevated ALT, 87.4% achieved normalization before discharge. Statin intolerance was identified in 58 patients (18.9%) at admission and persisted in 6.7% at discharge. The ALT-ME group had significantly higher statin intolerance (36.5% vs. 2.0%, < 0.001) and higher in-hospital mortality (18.3% vs. 6.0%, = 0.001) compared with the ALT-N group. Logistic regression analysis demonstrated that ALT elevation was independently associated with higher in-hospital mortality (per 10 U/L ALT elevation, odds ratio 1.164, p = 0.010). CONCLUSION: In older patients with AMI, mild elevation in ALT levels upon admission is associated with worse in-hospital outcomes, and statin intolerance is common and mostly reversible. Short-term substitutes for statins should be considered in these patients.
TBL1XR1 Promotes Coronary Artery Disease by Regulating Triglyceride Metabolism via the PPAR Pathway.
Yang L, Tang L, Gao W … +4 more , Zhu S, Liu J, He Y, Meng F
Cardiol Res Pract · 2025 · PMID 41476864 · Full text
INTRODUCTION: Transducin beta-like 1 X-linked receptor 1 (TBL1XR1) is significantly upregulated in the peripheral blood of patients with coronary artery disease (CAD). This study aimed to validate the differential expres...
INTRODUCTION: Transducin beta-like 1 X-linked receptor 1 (TBL1XR1) is significantly upregulated in the peripheral blood of patients with coronary artery disease (CAD). This study aimed to validate the differential expression of TBL1XR1 in CAD and investigate its role in CAD progression using RNA interference. METHODS: The expression of TBL1XR1 at the mRNA and protein levels was detected in patients with CAD and controls using reverse transcription-polymerase chain reaction (RT-PCR) and western blotting. Additionally, the effects of gene silencing in human liver cells through RNA interference on PPARα expression and intracellular triglyceride (TG) levels were determined. RESULTS: TBL1XR1 expression was significantly higher in the peripheral blood of CAD patients compared to controls at both mRNA (1.71 ± 0.96 vs. 1.00 ± 0.34, < 0.01) and protein levels (0.41 ± 0.19 vs. 0.13 ± 0.07, = 0.038). Logistic regression analysis revealed that high TBL1XR1 expression is an independent risk factor for CAD. Relative TBL1XR1 expression positively correlated with serum TG levels (rs = 0.56, < 0.01) and Gensini score (rs = 0.53, < 0.01), indicating an association with CAD severity. In human liver cells, TBL1XR1 silencing significantly increased peroxisome proliferator-activated receptor alpha (PPARα) expression at both mRNA ( < 0.05) and protein levels ( < 0.01) while reducing intracellular TG levels (0.24 ± 0.16 vs. 0.51 ± 0.09, < 0.01). CONCLUSION: is a key factor for risk assessment, diagnosis, and evaluating coronary lesion severity in patients with CAD. Its role in promoting atherosclerosis initiation and development may be associated with regulation of TG metabolism via the PPARα pathway.
Dementia is associated with higher mortality and worse patient-centered outcomes after complex and high-risk coronary artery stenting.
Shah KB, Xiang L, Shah SK … +2 more , Adler RR, Weissman JS
Am Heart J Plus · 2026 Jan · PMID 41459320 · Full text
OBJECTIVES: The aims of this study were to assess whether dementia status influences outcomes of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI). BACKGROUND: CHIP-PCI is a type of coronary arter...
OBJECTIVES: The aims of this study were to assess whether dementia status influences outcomes of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI). BACKGROUND: CHIP-PCI is a type of coronary artery stenting procedure for patients with anatomically complex coronary artery disease and significant medical comorbidities. As the population ages, more patients will require CHIP-PCI including those with Alzheimer's dementia and related dementias (ADRD). Outcomes of CHIP-PCI in patients with ADRD are underexplored. METHODS: We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with and without ADRD who underwent CHIP-PCI from July 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were complications and readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care. RESULTS: 8884 patients undergoing CHIP-PCI met study criteria, and 766 (8.6 %) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be older (81.2 vs 77.5, < 0.001) and frail (52.1 % vs. 27.3 %, p < 0.001). 1-year mortality was higher among patients with ADRD (OR 1.34, 95 % CI 1.14-1.57) as was 90-day major complications (OR 1.22, 95 % CI 1.03-1.43) and readmissions (OR 1.27, 95 % CI 1.07-1.50). Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.81, 95 % CI 1.48-2.22) and have lower time-at-home ratios (Mean Difference -5.48, 95 % CI -9.24 to -2.45). CONCLUSIONS: Patients with ADRD demonstrate higher 1-year mortality as well as major complications. They demonstrate especially poor time-at-home ratio and risk for discharge to a higher level of care. These data should be used by patients, their families, and physicians to facilitate goal-concordant care.
Cardiac troponin T elevation predicts mortality in hospitalized COVID-19 patients.
Bruno KA, Wright RS, Culberson J … +16 more , Wieczorek MA, Hodge DO, Johnson PW, Jimenez YA, Whelan ER, Malavet JM, Larson KF, Senefeld JW, Wiggins CC, Klassen SA, Ricci J, Sher T, Carter RE, Joyner MJ, Fairweather D, Jaffe AS
Am Heart J Plus · 2026 Jan · PMID 41446701 · Full text
OBJECTIVE: To evaluate if cardiac troponin values predict poor outcomes in COVID-19 patients across the range of patients of different sex and age. METHODS: We examined high-sensitivity cardiac troponin T (hs-cTnT) level...
OBJECTIVE: To evaluate if cardiac troponin values predict poor outcomes in COVID-19 patients across the range of patients of different sex and age. METHODS: We examined high-sensitivity cardiac troponin T (hs-cTnT) levels in 1050 severely ill hospitalized COVID-19 patients who had hs-cTnT data available and participated in the Expanded Access Program for convalescent plasma study during the first wave (April-August 2020) of the COVID-19 pandemic. RESULTS: We observed a continuous relationship between hs-cTnT levels and mortality in hospitalized males and females with COVID-19. This finding was present regardless of sex or age. CONCLUSION: These data indicate the prognostic ability of hs-cTnT to predict mortality in hospitalized COVID-19 patients across all relevant patient groups.Clinical Trials registration number: NCT04338360.
Oxidized low-density lipoprotein cholesterol and plaque vulnerability.
Goto J, Kinoshita D, Otaki Y … +9 more , Ra S, Ono H, Mito T, Shikama T, Tachibana S, Kato S, Watanabe T, Jang IK, Watanabe M
Am Heart J Plus · 2026 Jan · PMID 41446700 · Full text
BACKGROUND: The oxidation of low-density lipoprotein cholesterol (LDL-C) plays a critical role in plaque inflammation and the subsequent high-risk plaque formation. However, the relationship between LDL-C oxidation and p...
BACKGROUND: The oxidation of low-density lipoprotein cholesterol (LDL-C) plays a critical role in plaque inflammation and the subsequent high-risk plaque formation. However, the relationship between LDL-C oxidation and plaque morphology in patients with diabetes mellitus (DM) has not been systematically studied. The study aimed to investigate the association between LDL-C oxidation and plaque morphology assessed using optical coherence tomography (OCT). METHODS: A total of 138 patients with chronic coronary syndrome who underwent OCT were analyzed. Malondialdehyde-modified LDL-C (MDA-LDL), a representative form of oxidized LDL-C, was measured. Levels of LDL-C oxidation were assessed using the ratio of MDA-LDL to LDL-C ratio. Plaque morphology was assessed by OCT at the target lesions. RESULTS: Patients were divided into three groups according to the tertiles of LDL-C oxidation levels. Lipid index and macrophage grade were significantly higher in patients with higher levels of LDL-C oxidation in patients with DM (low vs. moderate vs. high; lipid index: 714 vs. 1226 vs. 2217, for trend = 0.040; macrophage grade: 2 vs. 7 vs. 13, for trend = 0.009). In contrast, no association was found in patients without DM (low vs. moderate vs. high; lipid index: 1109 vs. 1181 vs. 1436, for trend = 0.633; macrophage grade: 8 vs. 5 vs. 8, for trend = 0.748). Those associations remained significant even after adjusting for confounders in patients with DM but not in those without. CONCLUSIONS: The levels of LDL-C oxidation were associated with plaque vulnerability, especially in patients with DM.
Patterns and predictors of palliative care use in acute heart failure hospitalizations.
Shafiq A, Salman A, Akram S … +12 more , Farooq MR, Ghaffar QBA, Ijaz A, Imtiaz A, Irshad H, Kumar A, Riaz MF, Rauf S, Sarwar U, Fatima K, Hasan A, Ahmed R
Am Heart J Plus · 2026 Jan · PMID 41439271 · Full text
BACKGROUND: Palliative care consultation (PCC) in acute decompensated heart failure (ADHF) may enhance care quality and align treatment with patient goals. However, national trends and predictors of PCC in ADHF remain po...
BACKGROUND: Palliative care consultation (PCC) in acute decompensated heart failure (ADHF) may enhance care quality and align treatment with patient goals. However, national trends and predictors of PCC in ADHF remain poorly defined. METHODS: We used the National Inpatient Sample (2018-2020) to identify hospitalizations for adults (≥18 years) with a primary diagnosis of ADHF using ICD-10-CM codes. PCC was defined by ICD-10-CM code Z51.5. Multivariable survey-weighted logistic regression identified predictors of PCC use, adjusting for demographics, socioeconomic status, comorbidities, and hospital factors. RESULTS: Among 3,655,265 hospitalizations, older age was associated with higher odds of PCC (aOR 1.05 per year; 95 % CI, 1.05-1.05). Compared to White individuals, odds of PCC were lower for Asian or Pacific Islander (aOR 0.74), Black (aOR 0.83), and Hispanic individuals (aOR 0.76). Medicare patients had lower odds than those with Medicaid (aOR 0.72). The highest income quartile was associated with greater PCC use (aOR 1.18). PCC was less common in the Northeast (aOR 0.88), South (aOR 0.93), and West (aOR 0.91) compared to the Midwest. Urban teaching hospitals had higher PCC rates than rural hospitals (aOR 1.48). Patients with greater comorbidity and higher mortality risk were more likely to receive PCC. CONCLUSION: PCC use in ADHF is influenced by demographic, socioeconomic, clinical, and institutional factors. Racial, regional, and hospital-level disparities suggest a need for interventions to promote equitable access to palliative care for patients with ADHF.
The impact of diabetes on giant negative T-wave amplitude in apical hypertrophic cardiomyopathy patients.
Song S, Xu M, Gao J … +3 more , Feng X, Huang H, Wang L
Am Heart J Plus · 2026 Jan · PMID 41439270 · Full text
Clinical observations indicate an attenuation of giant negative T-waves (GNTWs) in some patients with apical hypertrophic cardiomyopathy (ApHCM), a condition frequently comorbid with type 2 diabetes mellitus (T2DM). The...
Clinical observations indicate an attenuation of giant negative T-waves (GNTWs) in some patients with apical hypertrophic cardiomyopathy (ApHCM), a condition frequently comorbid with type 2 diabetes mellitus (T2DM). The objective of this study was to examine the effect of T2DM on the GNTWs amplitude in ApHCM. A retrospective cohort of 124 ApHCM patients from Changzhou First People's Hospital (2021-2024) was categorized into T2DM ( = 30) and non-T2DM ( = 94) groups per American Diabetes Association criteria. A comparative analysis of baseline characteristics was conducted using Kruskal-Wallis and χ tests. The association between T2DM and maximal negative T-wave voltage (Tmax) was assessed via multivariable linear regression, while nonlinear relationships were explored with generalized additive models (GAM). The T2DM subgroup exhibited a higher prevalence of hypertension (83.3 % vs. 60.6 %, = 0.022) and coronary artery disease (44.8 % vs. 19.4 %, = 0.006). The T2DM group demonstrated significantly lower absolute magnitude of both R-waves [3.000 (2.118, 3.775) mV vs. 3.625 (2.615, 4.400) mV, = 0.045] and GNTWs (Tmax) [- 0.600 (-0.700, 0.400) mV vs. -0.750 (-1.100, 0.500) mV, = 0.016]. Multivariable analysis identified T2DM as an independent predictor of attenuated GNTWs ( = 0.272, = 0.016). GAM confirmed a significant nonlinear inverse correlation between T2DM and T-wave amplitude ( < 0.05). In conclusion, T2DM is independently associated with lower absolute magnitude of GNTWs in ApHCM, potentially obscuring characteristic electrocardiographic features. It is incumbent upon clinicians to take these diabetes-related confounding effects into account during diagnostic evaluation.
Triglyceride-glucose index predicts early, short-term, and long-term mortality after transcatheter aortic valve replacement.
Abu Khadija H, Najajra D, Masu'd M … +12 more , Abu Hamdeh N, Ayyad O, Mahamid A, Bagan M, Abdullah A, Alkrinawi J, Zayed A, Darwish A, Enairat ALE, Kirzhner A, Schiller T, Alnees M
Am Heart J Plus · 2026 Jan · PMID 41439269 · Full text
BACKGROUND: Despite transforming care for severe aortic stenosis, TAVR is still followed by early and late mortality. The triglyceride-glucose (TyG) index, an insulin-resistance marker from routine triglyceride and gluco...
BACKGROUND: Despite transforming care for severe aortic stenosis, TAVR is still followed by early and late mortality. The triglyceride-glucose (TyG) index, an insulin-resistance marker from routine triglyceride and glucose levels, may flag high-risk patients in Ashkenazi-Jewish and Mediterranean individuals. We examined whether baseline TyG predicts all-cause mortality at 30 days, 1 year, and 3 years post-TAVR. METHODS: We retrospectively studied patients with severe symptomatic aortic stenosis who underwent TAVR at a single tertiary center between 2010 and 2024. The TyG index was calculated from baseline triglyceride and glucose values. The primary endpoint was all-cause mortality at 1 year, with secondary endpoints of all-cause mortality at 30 days and 3 years. Cox proportional hazards models evaluated the association between TyG (per 1-unit increase) and mortality, adjusting for major clinical risk factors. Additionally, ROC curves were used to derive cohort-specific TyG thresholds for short-term and long-term mortality. RESULTS: Results: A total of 821 TAVR patients were included. All-cause mortality was 3.4 % at 30 days, 10.9 % at 1 year, and 19.7 % at 3 years. Higher baseline TyG was associated with significantly increased mortality risk at all time points. After multivariable adjustment, each 1-unit increase in TyG index conferred a higher hazard of 1-year death (adjusted HR 1.62, 95 % CI 1.21-2.16) and remained predictive of mortality at 30 days (HR 1.92, 95 % CI 1.08-3.42) and 3 years (HR 1.42, 95 % CI 1.14-1.77). ROC analysis identified distinct TyG thresholds for short-term and long-term outcomes, with an optimal cut-point of 9.012 for 30-day mortality, 9.15 for 1-year mortality, and 8.700 for 3-year mortality. CONCLUSIONS: Baseline TyG index is an independent predictor of early, short-term, and long-term mortality after TAVR. The identification of cohort-specific TyG cut-points highlights population-specific metabolic risk calibration and supports the use of TyG as a simple and informative biomarker for refining risk stratification and follow-up intensity in TAVR recipients.
Obesity burden among heart failure patients in an urban safety net hospital: Implications for GLP-1 agonist therapy.
Yee T, Gajjar P, Gopal DM … +1 more , Nayor M
Am Heart J Plus · 2026 Jan · PMID 41439268 · Full text
INTRODUCTION: Novel obesity medications (glucagon-like peptide-1 [GLP-1] agonists) show promise for treatment of patients with obesity and heart failure (HF), especially with preserved ejection fraction (HFpEF). However,...
INTRODUCTION: Novel obesity medications (glucagon-like peptide-1 [GLP-1] agonists) show promise for treatment of patients with obesity and heart failure (HF), especially with preserved ejection fraction (HFpEF). However, data are limited regarding the burden of obesity among HF patients in real-world samples. METHODS: We conducted a retrospective electronic medical record-based query of HF patients at a single urban safety net hospital system. RESULTS: In 1373 patients (mean age 67 ± 14 years, 59 % women) admitted for acute HF (563 [41 %] with HFpEF, 649 [47 %] with reduced ejection fraction, and 161 [12 %] without ejection fraction assessment), up to 64 % met eligibility criteria GLP-1 agonists compared with 42 % of control patients admitted for non-HF diagnoses. This was primarily driven by higher obesity prevalence. DISCUSSION: The majority of HF patients at an urban safety net hospital are eligible for GLP-1 agonist medications; allocation of these medications to a large patient population represents a major public health challenge.
BUN-albumin ratio as a prognostic marker in decompensated heart failure with reduced ejection fraction.
Abofrekha B, Shadi M, Jdaidani J … +7 more , Agarwal A, Sanayeh EB, Zayed A, Itani H, Jung LU, El-Sayegh S, Rojas-Marte GR
Am Heart J Plus · 2026 Jan · PMID 41431464 · Full text
BACKGROUND: Decompensated heart failure with reduced ejection fraction (D-HFrEF) is a prevalent cause of hospitalization and mortality. Early risk stratification is crucial for targeted interventions. The blood urea nitr...
BACKGROUND: Decompensated heart failure with reduced ejection fraction (D-HFrEF) is a prevalent cause of hospitalization and mortality. Early risk stratification is crucial for targeted interventions. The blood urea nitrogen to serum albumin ratio (BAR) has shown prognostic value in critical illness, but its role in D-HFrEF is understudied. OBJECTIVES: This study aimed to evaluate the association of BAR calculated within 24 h of admission with length of hospital stay (LOS), in-hospital mortality, and 30-day readmissions in patients hospitalized with D-HFrEF and identify an optimal cut-off value for each outcome. METHODS AND RESULTS: This was a multicenter retrospective cohort analysis of 2286 patients hospitalized in 2022 with D-HFrEF. The population's median age was 72.00 years, with 59.8 % being male. In the fully adjusted model, each one-unit increase in baseline BAR was associated with a 2.85 % increase in the length of hospital stay in days (IRR: 1.027, 95 % CI: 1.021-1.033, < 0.001) and significantly higher odds of in-hospital mortality (OR: 1.107, 95 % CI: 1.076-1.139, < 0.001) and prolonged LOS (≥30 days) (OR: 1.065, 95 % CI: 1.034-1.097, p < 0.001). BAR was not significantly associated with 30-day readmission ( = 0.06). Receiver operating characteristic analysis identified optimal BAR cut-off points of 6.82 for mortality. CONCLUSIONS: Our data show that an elevated BAR on admission is associated with increased in-hospital mortality and LOS > 30 days in patients hospitalized for D-HFrEF. This readily available marker can aid in identifying patients at higher risk for adverse events. Prospective studies are needed to validate our findings.
Increasing burden of lower extremity peripheral arterial disease in Sub-Saharan Africa, 1990-2021 - results from the global burden of disease study 2021.
Nadjingar N, Martin VT, Zhang P
Am Heart J Plus · 2026 Jan · PMID 41399779 · Full text
OBJECTIVE: Lower extremity peripheral artery disease (PAD) is a growing public health challenge in sub-Saharan Africa (SSA), yet epidemiological data remain scarce compared to high-income regions. This study addresses th...
OBJECTIVE: Lower extremity peripheral artery disease (PAD) is a growing public health challenge in sub-Saharan Africa (SSA), yet epidemiological data remain scarce compared to high-income regions. This study addresses this gap by analyzing trends in PAD burden across SSA from 1990 to 2021, leveraging the Global Burden of Disease (GBD) dataset to inform targeted interventions. METHODS: Using GBD 2021 data, we assessed PAD incidence, prevalence, disability-adjusted life years (DALYs), mortality, and associated risk factors across 46 SSA countries. Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were calculated, stratified by sex, age, and Socio-Demographic Index (SDI). RESULTS: From 1990 to 2021, SSA experienced sharp increases in PAD burden: incidence (≥132.7 %), prevalence (≥132.8 %), DALYs (≥202.9 %), and mortality (≥231.5 %), contrasting with global declines. These trends oppose global declines reported in recent studies, underscoring SSA's unique vulnerability to a diabetes-driven PAD burden. Age-standardized rates rose significantly (EAPCs: 0.12-2.24), with the highest DALY rates in Gabon (57.2/100,000) and Southern SSA. Diabetes accounted for 30.8 % of PAD-related DALYs (male-to-female ratio: 1.8:1), while aging (≥80 years) contributed to 33.9 % of deaths. CONCLUSIONS: The divergent rise of PAD in SSA, which contrasts with global trends, demands region-specific solutions: (1) integrating PAD screening into diabetes programs, (2) aging-focused care, and (3) improved local data to address disparities in Gabon (highest DALYs) and conflict zones.
Higher hemoglobin is associated with better survival in coronary artery disease, heart failure with reduced ejection fraction, and chronic kidney disease.
Hung CY, Lee WL, Sheu WH … +1 more , Liang KW
Am Heart J Plus · 2026 Jan · PMID 41399778 · Full text
BACKGROUND: Anemia is a common comorbidity in patients with heart failure (HF) or chronic kidney disease (CKD) and could be associated with worse clinical outcomes. However, to date, the impact of anemia on survival in a...
BACKGROUND: Anemia is a common comorbidity in patients with heart failure (HF) or chronic kidney disease (CKD) and could be associated with worse clinical outcomes. However, to date, the impact of anemia on survival in a complex triple-comorbidity of coronary artery disease (CAD), HF with reduced ejection fraction (HFrEF), and CKD remains inconclusive. METHODS: We retrospectively analyzed data for subjects with significant CAD, HFrEF (defined as left ventricular ejection fraction (EF) <40 %) and CKD (defined as estimated glomerular filtration rate (eGFR) ≦60 ml/min/1.73m) from our cardiac catheterization laboratory between January 2010 and September 2019. Clinical and laboratory variables were recorded from traceable chart records from our hospital. All-cause and cardiovascular mortality were counted until December 2019 and served as study outcomes. RESULTS: A total of 128 subjects with CAD, HFrEF and CKD were analyzed. Anemia was prevalent (81/128 = 63.3 %) in this complex disease combination. The median follow-up duration was 36 months and 77 subjects (60.1 %) died. Cox survival analysis revealed that higher baseline hemoglobin (hazard ratio 0.864, 95 % CI 0.753-0.992, per 1 g/dl increase), higher eGFR, better EF, and the use of beta-blockers were associated with lower all-cause mortality. CONCLUSIONS: A higher baseline admission hemoglobin value was associated with lower all-cause mortality in subjects with significant CAD, HFrEF, and CKD.
Sudden cardiac death in stable coronary artery disease: A literature review.
Tabbah R, Saliba W, Abi-Saleh B
Am Heart J Plus · 2026 Jan · PMID 41399777 · Full text
Sudden cardiac death (SCD) remains a leading cause of mortality in patients with stable coronary artery disease (CAD), despite advances in diagnosis, risk stratification, and therapy. This review synthesises current evid...
Sudden cardiac death (SCD) remains a leading cause of mortality in patients with stable coronary artery disease (CAD), despite advances in diagnosis, risk stratification, and therapy. This review synthesises current evidence on epidemiology, pathophysiology, clinical predictors, and preventive strategies for SCD in chronic coronary syndromes. Historical perspectives, including early autopsy observations, highlight the longstanding recognition of SCD as a complication of CAD. Contemporary data reveal that SCD often represents the first clinical manifestation of coronary heart disease, with a substantial proportion of cases occurring in individuals classified as low risk. Mechanistically, SCD is frequently triggered by acute ischemia or arrhythmogenic substrates in the context of structural and electrical remodeling. Key predictors include left ventricular dysfunction, ventricular arrhythmias, and specific electrocardiographic markers, though their predictive value in stable CAD remains limited. Preventive strategies range from optimal medical therapy and lifestyle interventions to device-based approaches, such as implantable cardioverter-defibrillators, in selected high-risk subgroups. Despite these measures, risk stratification tools lack sufficient sensitivity and specificity to guide widespread prophylactic interventions. Future research should focus on refining predictive models by integrating clinical, imaging, and biomarker data to enable more targeted prevention of SCD in stable CAD populations.
Single centre experience of rotablation-assisted left main percutaneous coronary intervention.
Sohil MM, Masood I, Goyal D … +1 more , Rashid H
Am Heart J Plus · 2026 Jan · PMID 41377036 · Full text
BACKGROUND: CABG has limitations as a treatment modality in patients with Left main disease and high synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Some patients are uns...
BACKGROUND: CABG has limitations as a treatment modality in patients with Left main disease and high synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Some patients are unsuitable for surgery owing to high surgical risk. Importantly, limited centers are offering CABG, particularly in our part of the world. Limited data exist on long-term outcomes in Indian patients undergoing rotablation-assisted PCI for such lesions. Our objective was to assess in-hospital and two-year clinical outcomes of patients undergoing rotablation-assisted left main PCI at our center. METHODS: This prospective observational study included 45 consecutive patients undergoing rotablation-assisted left main PCI from January 2020 to January 2023. Baseline characteristics, procedure-related factors, in-hospital, and two-year outcomes were assessed. Subgroup analysis was done to assess the predictors of adverse outcomes. RESULTS: Our cohort had anatomically complex coronary artery disease with a SYNTAX score of 40.1 ± 8.2. 86.7 % ( = 39) of patients had severe angiographic calcification. Intravascular ultrasound (IVUS) was done in 75.6 % of patients ( = 34). 71.1 % ( = 32) of patients had a true bifurcation lesion. Rotablation was performed using Rotablator RA system. The target burr-artery ratio was 0.7. Burrs used were sized from 1.25 mm to 2 mm and were operated at speeds of 140,000 to 180,000 rpm. Multiple burrs were used when clinically necessary. 75.6 % ( = 34) of patients were done by the two-stent technique. Double kissing CRUSH (DK CRUSH) was the most common two-stent technique used in 71.1 % ( = 32) patients. Angiographic success was 100 %, while procedural success was 97.8 %. In-hospital mortality was 2.2 %. At two years, major adverse cardiovascular events (MACE) free survival was 93.3 %. CONCLUSION: Rotablation-assisted PCI in severely calcified left main lesions is safe and effective, offering good procedural success and favourable mid-term clinical outcomes.
A Pragmatic Trial Evaluating the Impact of the Anumana Clinical Decision Support Tool for Guideline-Directed Management of Heart Failure (ACT-HF): Clinical trial design and methods.
Lopez-Jimenez F, Alger HM, Hackett SP … +18 more , Gundurao V, Mehta K, Jain P, Kumar-M P, Padhye C, Puranik A, Vassor K, Ravi SK, Barry B, Chatterjee R, Chow C, Dolor R, Greene SJ, Lin G, Rushlow D, Stampehl M, Zhu X, Awasthi S
Am Heart J Plus · 2026 Jan · PMID 41377035 · Full text
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is progressive and pervasive. Guidelines provide evidence-based recommendations to manage HFrEF, yet adherence to Guideline Directed Medical Therapy (GDMT)...
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is progressive and pervasive. Guidelines provide evidence-based recommendations to manage HFrEF, yet adherence to Guideline Directed Medical Therapy (GDMT) is low. An opportunity exists to improve adherence by delivering actionable data, reducing clinician information overload, and enhancing patient care. A Pragmatic Trial Evaluating the Impact of the Anumana Clinical Decision Support Tool for Guideline-Directed Management of Heart Failure (ACT-HF) will evaluate a clinical decision support software (CDSS) that integrates in electronic health records (EHR), automates chart review, and identifies care gaps. METHODS: Anumana's Guideline Navigator is an innovative, multi-module AI-enabled CDSS with automated chart review to rapidly analyze EHR data, detect care gaps, and provide alerts for eligible patients not receiving optimal GDMT. ACT-HF, a multi-center cluster pragmatic trial, will recruit and randomize clinician participants (≤250) from 2 health systems to receive intervention software or provide usual care. The trial will evaluate outpatient care for adults with documented HFrEF and not on optimal GDMT (>2148). Outcomes will be evaluated at 90 days. Clinician participants may discuss results with patients, but patients will not have access to the CDSS. RESULTS: Primary outcome is change in GDMT medications; exploratory endpoints include clinical outcomes, resource utilization, and usability. Subgroup analyses include health system, clinician, and patient-level characteristics associated with outcomes. CONCLUSION: Building on efforts to improve GDMT adherence, ACT-HF will test Anumana's Guideline Navigator in a multicenter study to evaluate outcomes and further refine the CDSS EHR integration EHR for improved clinical utility, workflow integration, and patient outcomes.
Exploring the interaction between klotho and TyG index in cardiovascular risk stratification: A metabolic-inflammatory network analysis with mediation and machine learning insights.
Min J, Yang Y
Am Heart J Plus · 2026 Jan · PMID 41362380 · Full text
BACKGROUND: This study explores the relationship of metabolic-inflammatory network and cardiovascular disease (CVD), offering new insights into the roles of Klotho and the Triglyceride-Glucose (TyG) index in CVD pathogen...
BACKGROUND: This study explores the relationship of metabolic-inflammatory network and cardiovascular disease (CVD), offering new insights into the roles of Klotho and the Triglyceride-Glucose (TyG) index in CVD pathogenesis. METHODS: Data from 5402 adults (mean age: 58.04 ± 10.83 years; 50.96 % female) from the NHANES in 2007-2016 database were analyzed. We proposed a prediction model for CVD risk incorporating Klotho protein, TyG index, and their interaction. The predictive value of these factors was evaluated using machine learning techniques, including random forest analysis and CHAID decision tree modeling. RESULTS: The study found no association between serum alpha-Klotho levels and CVD risk. However, the TyG index was demonstrated to be a significant predictor of CVD risk, particularly when lifestyle and socio-economic factors were not accounted for. TyG values were associated with an increased risk of metabolic syndrome and CVD (Model 1 : 1.234; Model 2 : 1.268). There was a significant interaction between Klotho-TyG was observed (coefficient - 2.608 × 10). In addition, the random forest model achieved an accuracy of 66.63 % with high specificity and precision, and in the CHAID model an error of 27 %. CONCLUSIONS: This study underscores the TyG index as a key biomarker for CVD risk, with the Klotho-TyG interaction improving risk stratification, and supporting early screening, treatment, and personalized interventions for more effective CVD management.
The association of epicardial adipose tissue thickness and human neutrophil lipocalin with mitral annular calcification.
Xue Y, Wang X, Liu X … +4 more , Zhang Q, Liu Z, Leng B, Li X
Am Heart J Plus · 2026 Jan · PMID 41362379 · Full text
STUDY OBJECTIVE: Mitral annular calcification (MAC) is significantly associated with coronary artery stenosis and valvular dysfunction. And epicardial adipose tissue (EAT) can secrete inflammatory factors and human neutr...
STUDY OBJECTIVE: Mitral annular calcification (MAC) is significantly associated with coronary artery stenosis and valvular dysfunction. And epicardial adipose tissue (EAT) can secrete inflammatory factors and human neutrophil lipocalin (HNL) are widely used as indicators of inflammation. There is now increasing evidence of a strong link between MAC and the inflammatory response. This study aims to investigate the effects of EAT thickness and HNL in MAC. DESIGN: A cross-sectional approach was used in this study. SETTING: The Second Affiliated Hospital of Shandong First Medical University. PARTICIPANTS: The included patients was classified into a calcification group (MAC group) and a control group based on the presence or absence of MAC on echocardiography. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The clinical data, HNL, EAT thickness of the two groups were measured, collected and analyzed. Logistic regression analysis was used to assess the independent risk factors for MAC and the receiver operating characteristic (ROC) curve was plotted to evaluate the effectiveness of EAT thickness and HNL in diagnosing MAC. RESULTS: Patients in the MAC group had significantly higher basal and apical EAT thickness and HNL level than those in the control group. Basal EAT thickness was independently associated with MAC (OR = 2.003, 95 % CI = 1.474-2.721, < 0.001). The AUC for basal EAT thickness to predict MAC was 0.880. CONCLUSION: Our data suggest EAT thickness and HNL were significantly associated with MAC, and basal EAT thickness near the right coronary artery was independently associated with MAC and had a high predictive value for MAC.
Integration of BNP and blood glucose for identifying coronary flow reserve impairment: A cardiovascular-kidney-metabolic perspective.
Matsumoto K, Otsuka K, Kagawa S … +14 more , Yamaura H, Miura T, Sugioka K, Saitoh W, Okamoto A, Kajio G, Fujisawa N, Yamaguchi T, Shimada T, Hayashi Y, Shibata A, Ito A, Yamazaki T, Fukuda D
Am Heart J Plus · 2026 Jan · PMID 41362378 · Full text
Cardiovascular-kidney-metabolic (CKM) syndrome may predispose patients to coronary microvascular dysfunction (CMD) through systemic microvascular injury. We investigated the association between CKM risk factors and CMD,...
Cardiovascular-kidney-metabolic (CKM) syndrome may predispose patients to coronary microvascular dysfunction (CMD) through systemic microvascular injury. We investigated the association between CKM risk factors and CMD, focusing on the diagnostic performance of accessible biomarkers. In this exploratory analysis, we retrospectively analyzed 65 patients who underwent invasive coronary physiological assessment with thermodilution-derived coronary flow reserve (CFR) and index of microcirculatory resistance (IMR). Clinical variables included casual blood glucose, B-type natriuretic peptide (BNP), and the urine albumin-to-creatinine ratio (ACR), along with echocardiographic indices of diastolic function. Among the 65 patients, 20 (31 %) had impaired CFR. BNP (AUC = 0.74; 95 % confidence interval, CI, 0.60-0.88) and casual blood glucose (area under the curve, AUC = 0.64; 95 % CI, 0.49-0.80) showed diagnostic accuracy for impaired CFR of <2.0, while ACR improved model performance when combined with BNP or E/e'. The combination of BNP and casual glucose significantly improved diagnostic performance compared with either marker alone (AUC = 0.83 vs. 0.75; 95 % CI, 0.73-0.93; = 0.03). The elevated BNP (AUC = 0.77, 95 % CI: 0.59-0.95) and higher ACR (AUC = 0.71, 95 % CI: 0.52-0.90) were significantly associated with structural CMD defined as CFR < 2.0 and IMR ≥ 25, whereas casual blood glucose was not. From a CKM perspective, BNP and casual blood glucose were associated with impairment of CFR and may serve as simple, accessible biomarkers for its early detection and risk stratification.
Nationwide trends and disparities in deaths from second- or third-degree atrioventricular block (1999-2022): A 24-year retrospective analysis of CDC WONDER data.
Saeed H, Sulaiman SA, Abdullah … +8 more , Goyal P, Thakkar K, Sultan W, Mayo JZ, Arshad MK, Singh A, Daoud M, Jain H
Am Heart J Plus · 2026 Jan · PMID 41362377 · Full text
BACKGROUND: AV block prevalence increases with age: first-degree affects 6 % of adults over 60 with low mortality, second-degree is more serious, and third-degree, though rare (0.02 % in the U.S.), has a 37 % five-year s...
BACKGROUND: AV block prevalence increases with age: first-degree affects 6 % of adults over 60 with low mortality, second-degree is more serious, and third-degree, though rare (0.02 % in the U.S.), has a 37 % five-year survival rate if untreated. Analyzing mortality trends in second- or third-degree AV blocks in the U.S. is vital for treatment and identifying at-risk populations. METHODOLOGY: We analyzed death certificates from the CDC WONDER database (1999-2022) for second- and third-degree AV Block (ICD-10 codes I44.1 and I44.2) in individuals aged 25 and older. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age, race/ethnicity and geographics. RESULTS: Between 1999 and 2022, 54,420 deaths were reported in patients with second- or third-degree AV block. The AAMR increased from 12.8 to 14.9, with a significant rise from 2013 to 2022 (APC: 7.26; 95 % CI: 6.13 to 9.96; < 0.001). Older adults had higher AAMRs (45.0) compared to middle-aged (2.1) and young adults (0.3). Men had higher AAMRs than women (11.3 vs. 8.6). Ethnoracial disparities showed the highest AAMRs in NH American Indian individuals (13.3), followed by NH Black (10.5), NH White (9.8), Hispanic (7.3), and NH Asian individuals (5.9). Non-metropolitan areas had higher AAMRs than metropolitan areas (11.7 vs. 9.2). CONCLUSIONS: Mortality from second- and third-degree AV block has increased since 1999, particularly in the last decade, with higher rates in men, older adults, NH American Indian or Alaska Native individuals, and non-metropolitan areas, highlighting the need for further research to address these disparities.
Sex-based differences in outcomes of mitral valve surgery: A meta-analysis of propensity score-matched studies with reconstructed time-to-event data.
Consoli L, Majeed MW, Cetinel E … +5 more , Lajczak P, Koziakas IG, Kirov H, Doenst T, Caldonazo T
Am Heart J Plus · 2026 Jan · PMID 41362376 · Full text
BACKGROUND: Studies indicate worse outcomes for women undergoing mitral valve surgery, but this can be biased in the context of differences in risk profiles between sexes. We aimed to assess short- and long-term outcomes...
BACKGROUND: Studies indicate worse outcomes for women undergoing mitral valve surgery, but this can be biased in the context of differences in risk profiles between sexes. We aimed to assess short- and long-term outcomes of mitral valve surgery in men and women using confounder-adjusted data. METHODS: We searched PubMed, Embase, and the Cochrane Library for eligible propensity-score-matched studies. Analysis was performed for short-term (<30 days mortality and procedural complications) and long-term (>1 year mortality, reoperation, and mitral regurgitation) endpoints. A pairwise random-effects meta-analysis was done for short-term outcomes, pooling risk ratios (RR) with 95 % confidence intervals (CIs). A meta-analysis of Kaplan-Meier derived individual patient data was conducted for long-term endpoints. Cox frailty regression analysis was used to obtain hazard ratios (HR). RESULTS: We included 12 studies (n = 55,616). No significant differences were observed in the short-term risks of death (RR 1.02; 95 % CI: 0.91-1.15; p = 0.72), stroke (RR 1.04; 95 % CI: 0.87-1.26; p = 0.65), kidney injury (RR 0.97; 95 % CI: 0.71-1.32; p = 0.85), atrial fibrillation (RR 0.96; 95 % CI: 0.81-1.14; p = 0.61), or pacemaker implantation (RR 0.93; 95 % CI: 0.84-1.02; p = 0.1). The hazards of long-term mortality (HR 0.97; 95 % CI: 0.91-1.03; p = 0.3) and reoperation (HR 1.65; 95 % CI: 0.39-6.91; p = 0.5) were similar between sexes. However, women had a higher hazard of recurrent mitral regurgitation (HR 1.61; 95 % CI: 1.08-2.37; p = 0.018). CONCLUSIONS: This meta-analysis found no sex-based differences in short- or long-term mortality, reoperation rates, or procedural complications following mitral valve surgery. A higher hazard of recurrent mitral regurgitation was observed in women.
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