Pulmonary arterial hypertension (PAH) is a rare, progressive disease characterised by elevated pulmonary vascular resistance that can lead to right ventricular failure and premature death. Ralinepag is an oral, once-daily, selective prostacyclin IP receptor agonist developed to treat PAH. We aimed to evaluate the efficacy and safety of ralinepag in patients with PAH. ADVANCE OUTCOMES was a randomised, double-blind, placebo-controlled, event-driven, phase 3 trial of ralinepag in patients with PAH. Eligible patients were aged 18 years or older and PAH was diagnosed on the basis of the 2022 European Society of Cardiology and European Respiratory Society guidelines (mean pulmonary artery pressure >20 mm Hg, pulmonary artery wedge pressure ≤15 mm Hg, and pulmonary vascular resistance of >2 Wood units). Patients were randomly assigned (1:1) to ralinepag or placebo, initiated at a dose of 50 μg once daily and titrated weekly until the highest tolerated individualised dose was reached. Randomisation was stratified by baseline 6-minute walk distance (6MWD), PAH aetiology, and oral background therapy. A block size of four was used within each combination of stratification factors. The sponsor, patients, and all personnel directly involved with the conduct of the study were masked to study drug identity and randomisation assignments. The primary outcome was time to first clinical worsening event, a composite of death from any cause, admission to hospital due to worsening PAH or right heart failure, initiation of parenteral or inhaled prostacyclin-pathway therapy, disease progression, or unsatisfactory long-term clinical response. Efficacy analyses were done in the full analysis set and safety analyses in the safety set; both sets comprised 687 patients after exclusion of 41 randomly assigned and treated patients from sites in China (exclusions due to regulatory challenges and data integrity concerns). This study is registered with ClinicalTrials.gov (NCT03626688) and euclinicaltrials.eu (2023-509304-16-00) and is complete. Patients were enrolled between Jan 24, 2019, and June 20, 2025. Of 1037 patients screened for eligibility, 728 were randomly assigned and received at least one dose of ralinepag or placebo; 687 were included in the full analysis and safety sets, of whom 350 received ralinepag and 337 received placebo. Median follow-up from randomisation to clinical worsening event, censoring, or study closure was 85·0 weeks (IQR 27·6-160·9) in the ralinepag group and 78·4 weeks (34·6-137) in the placebo group. At baseline, patients had a mean 6MWD of 438·9 m (SD 104·8) and 548 (80%) of 687 patients were receiving dual background PAH therapy. Overall, 64 (18%) of 350 patients in the ralinepag group and 121 (36%) of 337 patients in the placebo group had a first clinical worsening event (hazard ratio 0·45 [95% CI 0·33-0·62]; p<0·0001). The largest numerical between-group differences in components of the composite outcome were observed for disease progression, initiation of parenteral or inhaled prostacyclin-pathway therapy, and unsatisfactory long-term clinical response. Adverse event was the primary reason for treatment discontinuation in 65 (19%) of 350 patients in the ralinepag group and ten (3%) of 337 patients in the placebo group. Serious adverse events occurred in 98 (28%) patients in the ralinepag group and 104 (31%) patients in the placebo group. Adverse events leading to death occurred in 15 (4%) and 14 (4%) patients, respectively. In patients with PAH receiving contemporary background therapy, ralinepag significantly reduced the risk of first clinical worsening compared with placebo, but was associated with more adverse-event-related treatment discontinuations. These results support the use of ralinepag as an oral, once-daily prostacyclin-pathway treatment option for PAH. United Therapeutics Corporation.
To investigate the value of three-dimensional speckle-tracking echocardiography (3D-STE) in evaluating early left ventricular (LV) systolic function in patients with different types of dyslipidemia. A total of 109 patients with dyslipidemia treated at our hospital were selected and divided into high total cholesterol (TC) group, high triglyceride (TG) group, low high-density lipoprotein cholesterol (HDL-C) group and mixed dyslipidemia group, according to the variety of dyslipidemia for further analysis.A total of 100 healthy volunteers approximately matched for age and gender were selected as the control group. The basic clinical data and conventional echocardiographic parameters were obtained, and the global longitudinal peak strain (GLPS), circumferential peak strain (GCPS) and radial peak strain (GRPS) of the left ventricle were obtained by 3D-STI technology for further analysis. (1)The GLPS and GCPS of the high TC group, high TG group and low HDL-C group were lower than those of the control group, and the GLPS, GCPS and GRPS of the mixed dyslipidemia group were lower than those of the other groups. (2) The ROC curve analysis showed that the area under the curve (AUC) of GLPS for detecting dyslipidemia patients was the largest. (3) Linear regression analysis showed that GLPS was independently correlated with TC, LDL-C, TG, and HDL-C. The independent effect of LDL-C on GLPS (standardizedβ = -0.368) was stronger than that of TC (standardizedβ = -0.356), suggesting LDL-C has a greater impact on left ventricular longitudinal strain. (4)The Bland-Altman analysis showed that 3D-STE parameters had good intra-observer and inter-observer consistency. Dyslipidemia had adverse effects on left ventricular strain parameters, especially in patients with mixed dyslipidemia. 3D-STE effectively evaluated the global systolic function of LV in patients with different types of dyslipidemia, and LDL-C shows the strongest independent effect correlating with worse systolic function.
Complete revascularization is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, whether the non-culprit lesions should be evaluated using angiography or fractional flow reserve (FFR) remains uncertain. The aim of this study was to evaluate the long-term outcome of patients with STEMI and multivessel disease who had non-culprit FFR-values>0.80 and thus deferred PCI. Of the 627 patients included in the DANAMI-3-PRIMULTI trial, 314 patients were randomized to FFR-guided complete revascularization and 280 were included in this substudy. Patients were divided into a PCI-deferral group who had no PCI of non-culprit lesions (FFR > 0.80) (n = 106) and a PCI group encompassing patients treated with PCI of at least one non-culprit lesion (FFR ≤ 0.80 or an angiographical diameter stenosis of ≥90%) (n = 174). The combined endpoint included all-cause mortality, myocardial infarction, or urgent revascularization. During a median follow-up of 10.5 years (IQR 9.8-11.4), the composite outcome occurred in 62 (36%) patients in the PCI group and in 50 (47%) patients in the PCI-deferral group (adjusted HR 0.64, 95% CI: 0.44-0.95, p = 0.025). PCI-deferral was associated with a significantly higher risk of cardiovascular mortality (adjusted HR 0.48, CI 95% 0.24-0.97, p = 0.040) compared to the PCI group. In patients with STEMI and multivessel disease, deferring PCI of non-culprit lesions based on FFR > 0.80 was associated with an increased risk of the combination of all-cause mortality, myocardial infarction, or urgent revascularization as well as cardiovascular mortality compared to patients treated with PCI of FFR-positive non-culprit lesions.
Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) have shown to improve cardiovascular and renal outcomes in patients with heart failure, diabetes mellitus and chronic kidney disease. However, despite these conditions being consistently associated with an increased risk of contrast-associated acute kidney injury (CA-AKI), the role of SGLT2-I in the prevention of post-contrast nephropathy remains unclear. The aim of the present study was to evaluate the impact of chronic therapy with SGLT2-I on the occurrence of CA-AKI in patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Patients undergoing coronary procedures and chronically (≥ 7 days) treated with SGLT2-I were retrospectively identified and paired 1:1 with those not receiving gliflozins, via propensity score matching. The primary endpoint was the occurrence of CA-AKI within 72 h after contrast media exposure (KDIGO definition). A total of 724 patients were included (362 treated with SGLT2-I and 362 controls), of whom 20.6% were females, 73.2% had diabetes mellitus and 22.9% presented with acute coronary syndrome. CA-AKI occurred in 70 patients (9.7%) overall, with a significantly lower rate of events in the SGLT2-I treated patients (6.4% vs 13.0%, OR = 0.46 95%CI 0.27-0.77, p = 0.003). This association with SGLT2-I remained significant at multivariable analysis (adjusted OR = 0.50, 95%CI 0.29-0.87, p = 0.014), after correction for residual baseline differences and according to the RIFLE and AKIN criteria. This study shows that among unselected patients undergoing coronary angiography and/or PCI, the chronic use of SGLT2-I is associated with a significant reduction in the rate of CA-AKI, as compared with untreated patients.
A careful preoperative evaluation of patients with mitral regurgitation (MR) is pivotal to optimize the timing of intervention and clinical outcome. The aim of this study was to evaluate preoperative prognostic parameters, among basic and speckle tracking echocardiography (STE), in patients undergoing MR surgery. We prospectively enrolled patients with severe MR who underwent preoperative clinical, biohumoral and echocardiographic evaluation, before mitral valve surgery. After surgery, patients were followed to investigate clinical outcome. The primary endpoint was a composite of heart failure hospitalizations and all cause-mortality, the secondary endpoint was to identify the best predictors of postoperative functional capacity assessed by New York heart association (NYHA) class. The final study cohort consisted of 110 patients with a mean age of 64 ± 13 years, 59% male. All strain parameters were reduced, while myocardial work (MW) showed normal values. Median follow-up was 17 (10-29) months. The primary endpoint occurred in 10 patients. Two echocardiographic predictors for the primary endpoint were global peak atrial longitudinal strain (PALS) ≤ 21.5% and free wall right ventricular longitudinal strain (fwRVLS) ≥ -22% with ROC curves. The study population was then divided into 3 groups (Group 1, n = 32: PALS>21.5% and fw-RVLS < -22%, Group 2, n = 46: either global PALS or fwRVLS reduced, Group 3, n = 32: PALS ≤ 21.5% and fwRVLS ≥ -22%). Kaplan-Meier curves showed good risk stratification of the composite endpoint across the three groups. Global wasted work(GWW) was an independent predictor of symptoms persistence (NYHA class > II) at follow-up. STE, particularly with the combination of left atrial and right ventricular strain analysis, can provide additional prognostic value for the preoperative evaluation of patients with MR referred for surgery.
Decision to perform a fenestrated Fontan remains difficult to standardize, and criteria vary widely across centres. To evaluate, in a cohort of pediatric patients undergoing total cavo-pulmonary connection (TCPC), the prognostic implications of fenestration at baseline and medium-term follow-up. This retrospective study included children who underwent extracardiac TCPC between 2012 and 2024. Patients were stratified by fenestration status at last follow-up. Primary endpoint was a composite of cardiovascular death, heart failure hospitalization, functional limitation, symptomatic desaturation, listing for heart transplantation, or Fontan failure. Predictors of adverse outcomes were analysed using Cox proportional hazards models and Random Survival Forest (RSF). Among 109 patients, 61 (55.9%) underwent fenestrated TCPC. Of these, 29 (48%) had persistently patent fenestration, 16 (26%) had spontaneous closure, and 16 (26%) underwent transcatheter closure. Percutaneous closures occurred at a median of 3.8 years after TCPC (IQR 2.2-5.1), whereas spontaneous closure occurred earlier (0.3 years; IQR 0.2-0.9). Patients with persistent fenestration had worse pre-Fontan haemodynamical profile. Over a median follow-up of 7.54 years, 10 patients reached the primary outcome. At univariate time-dependent Cox analysis, HLHS, >moderate AV regurgitation, and persistent fenestration were associated with the primary outcome. In exploratory multivariable analysis, HLHS remained independently associated, while persistent fenestration showed borderline association. RSF analysis confirmed fenestration status as a major predictor, followed by HLHS, TPG, and AV valve regurgitation. A persistently patent fenestration may be a marker of high risk in the Fontan population. Pre-Fontan haemodynamic characteristics influence the likelihood of fenestration closure.
Non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, account for a substantial proportion of global mortality and morbidity and represent a major challenge for the health system worldwide. Effective prevention and mitigation of NCDs requires coordinated strategies that combine health system interventions with population-level policies targeting key risk factors such as tobacco use, harmful alcohol consumption, unhealthy diets and physical inactivity. Evidence on actionable strategies implemented across diverse health systems and policy contexts remains fragmented. This scoping review aims to map the range, nature and implementation contexts of actionable health system and policy strategies for the prevention and mitigation of NCDs. The review will follow the methodology outlined by the Joanna Briggs Institute for scoping reviews and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search will be conducted across MEDLINE (via PubMed), Scopus, Web of Science, Embase, CINAHL, PsycINFO and Global Health. Grey literature sources such as government reports, national NCD strategies and documents from international organisations will also be searched to capture policy and implementation evidence. Studies involving populations at risk of or living with NCDs and describing health system or policy interventions aimed at prevention or mitigation will be eligible. Study selection will be conducted in two stages-title and abstract screening followed by full-text review-by two independent reviewers using predefined criteria based on the Population-Concept-Context framework. Data will be extracted using a standardised charting form capturing bibliographic information, study characteristics, intervention types, implementation contexts and outcomes, then summarised by geographical region, study design and intervention type. A thematic synthesis will categorise interventions into major domains such as health system-based strategies and population-level policy interventions. Findings will be presented through narrative summaries, tables and evidence maps. This scoping review involves only secondary analysis of published and publicly available literature, and does not involve primary data collection, so no ethical approval is required. The findings will be disseminated through peer-reviewed journal publications and conference presentations.
The extension of transcatheter aortic valve replacement (TAVR) to younger patients with longer life expectancy has driven a shift in focus toward procedural optimization, with the goals of maximal clinical improvement, durable outcomes, maintained coronary access, and avoidance of permanent pacemaker implantation. A TAVR CODE framework including 4 key fluoroscopic parameters-coaxiality, orientation, depth, and expansion-has recently been proposed to standardize the intraprocedural evaluation of optimal transcatheter heart valve (THV) implantation. Systematic implementation of these concepts during TAVR is expected to improve valve performance and durability. This is hypothesized to improve afterload reduction, enhance left ventricular reverse remodeling, and confer increased and longer lasting clinical benefits. To date, procedural strategies to optimize TAVR outcomes have been largely based upon expert opinion, supported predominantly by mechanistic and retrospective studies. Ongoing randomized trials are evaluating the effects of systematic pre- and postdilatation during TAVR, the impact of same-volume double-tap techniques with balloon-expandable valves, and the effectiveness of different commissural alignment techniques. Meanwhile, intravascular ultrasound is under investigation as a tool to evaluate THV expansion to guide postdilatation, while technical consistency may be improved by innovative THV designs that promote symmetrical expansion, better fluoroscopic visualization, and robotic insertion systems using artificial intelligence. In this article, we detail the possible impact of implementing the TAVR CODE framework on THV function, durability, and clinical outcomes, and provide an expert perspective on procedural strategies to achieve optimal index TAVR outcomes, including management frameworks and position statements according to contemporary best practices.
Aortic stiffness is a proxy for cardiovascular risk, but the methods are technically demanding. Ultrasound-based assessment of aortic wall strain patterns is established in abdominal aortic aneurysms but has never been described in the non-aneurysmal aorta. This study aimed to describe a workflow for ultrasound-derived strain mapping of the non-aneurysmal abdominal aorta and assess technical applicability, acquisition reproducibility, and age-related strain patterns. In this cross-sectional proof-of-concept study, healthy volunteers underwent ultrasound scanning of their non-aneurysmal abdominal aortas with standard equipment. Three independent operators scanned each participant. The ultrasound acquisitions were saved as short videos, or cine-loops, and were analysed off-line with prototype software to extract mean strain, strain heterogeneity, and circumferential strain patterns. Acquisition reproducibility was assessed with extended Bland-Altman statistics, and associations with age group and sex were analysed using regression models and functional data analysis. Fifty-seven volunteers were included, generating 171 cineloops; all were suitable for strain analysis. Mean strain decreased with age from 8.70% in participants aged <30 years to 3.90% in those aged >50 years (P < .001), and strain heterogeneity was associated with age (P = .01). Mean strain and heterogeneity were not associated with sex. Inter-operator limits of agreement were ±1.5 mm for diameter, ±1.64 percentage points for mean strain, and ±0.18 for heterogeneity index. Ultrasound-derived strain mapping of the non-aneurysmal abdominal aorta is applicable and shows acceptable acquisition reproducibility. The method describes age-related differences in aortic strain, supporting validation as a future tool for assessing aortic stiffness and cardiovascular risk.
To explore temporal patterns of serially measured cardiovascular-related biomarkers in patients with chronic heart failure (CHF), with the objective of identifying biomarker pathophysiological trajectories associated with clinical outcomes. These explorative analyses can generate hypotheses regarding underlying pathophysiological processes and the potential role of multi-biomarker approaches in chronic HF. The BioMEMS-study involved 334 patients with moderate to severe chronic HF in NYHA class III who received either standard of care or remote hemodynamic monitoring. Serial blood samples were collected at baseline, 3, 6, and 12 months, and biomarker levels were assessed using the Olink Cardiovascular-III panel. Joint modelling analyses were performed, integrating longitudinal biomarker trajectories and risk of the composite endpoint of all-cause mortality or HF hospitalization. In multivariable-adjusted models, 15 biomarkers were consistently and significantly associated with the composite endpoint after adjustment for confounders and multiple testing. MMP-2, ST2, IGFBP-1, IGFBP-7, and NT-proBNP exhibited the strongest associations with the composite endpoint, with hazard ratios (95% CI) of 2.72 (1.87-4.03), 2.71 (2.00-3.80), 2.70 (1.81-4.27), 2.48 (1.81-3.45), and 2.28 (1.72-3.03), respectively. These findings were robust across sensitivity analyses correcting for clinical confounders and treatment groups. Temporal trajectories revealed higher biomarker levels in patients who experienced incident events, with biomarkers showing corresponding changes in levels preceding events. Serial biomarker measurements could provide additional insights in the pathophysiology of worsening HF. Specific biomarkers reflecting myocardial stress, cardiac remodelling and fibrosis show changes in levels over time as worsening HF approaches, which highlights possible involvement of these pathophysiological pathways.
Angina with nonobstructive coronary arteries (ANOCA) is a heterogeneous condition encompassing distinct endotypes representing different underlying pathophysiological mechanisms. Endothelial dysfunction is considered a central hallmark of ANOCA. However, studying patient-derived endothelial cells (ECs) remains challenging due to the limited availability of disease-specific endothelial samples. We therefore aimed to assess the feasibility of isolating and culturing ECs from catheterization material obtained during routine coronary function testing in ANOCA patients. Catheterization material was collected from 79 ANOCA patients (84% female, age 58 ± 10 years) undergoing coronary function testing. ECs were isolated, expanded and characterized using immunostaining, flow cytometry, gene expression profiling and functional assays. EC isolation was successful in 43% of cases and resulted in 34 primary EC cultures that were expanded up to passage 10. Isolation success was independent of clinical or procedural characteristics. Isolated cells exhibited typical EC morphology and expressed EC markers confirmed by immunostaining, flow cytometry and gene expression analyses. EC marker gene expression remained largely stable over passages. However, stress- and defense-related gene expression programs increased over time, while proliferation-related processes decreased. Functional assays demonstrated that the coronary catheterization-derived ECs showed typical properties of wound healing, angiogenesis, activation responses upon stimuli and monocyte adhesion. This study demonstrates the feasibility of isolating and expanding ECs directly from catheterization material collected during routine coronary function testing in ANOCA patients. These patient-derived ECs retain characteristic endothelial features and functionality. This approach offers primary EC cultures to study the mechanisms underlying endothelial dysfunction in ANOCA.
The inflammasome pathway has been implicated in the progression of heart failure (HF). Preclinical studies suggest that angiotensin receptor-neprilysin inhibitor (ARNi) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapies may attenuate inflammasome activation, yet evidence in the failing human myocardium remains sparse. Hence, we evaluated the associations between ARNi and SGLT2i therapies and myocardial priming of inflammasome pathway components in explanted hearts from heart transplantation (HTX) recipients. Biobank samples from the left ventricular myocardium of 104 HTX recipients were analyzed. The mRNA and protein expression of inflammasome-related targets (absent in melanoma 2 [AIM2], NLR family pyrin domain containing 3 [NLRP3], caspase-1, gasdermin D, and nuclear factor kappa-light-chain-enhancer of activated B cells [NF-κB]) were quantified using qRT-PCR and Western blotting. Multivariable linear regression models were applied to assess the relationships between inflammasome component expression and clinical variables, including treatment with ARNi and SGLT2i. ARNi and SGLT2i therapies were associated with lower mRNA expression of AIM2, NLRP3, caspase-1, and NF-κB in univariate analyses. However, after adjustment for clinical covariates, these associations with inflammasome-related transcripts were no longer statistically significant. In multivariable models, only female sex, diabetes, time since heart transplantation, and serum potassium concentration remained associated with myocardial inflammasome pathway expression. In myocardial samples from patients with advanced HF, no clear differences in the expression of selected inflammasome priming-related targets were observed between treatment eras before and after the introduction of ARNi and SGLT2i therapies, despite their experimentally suggested anti-inflammatory effects, warranting further investigation.
Among high-bleeding risk (HBR) patients undergoing coronary stenting, abbreviated dual antiplatelet therapy (DAPT) reduces bleeding without ischemic risk trade-off; whether these benefits persist across the entire spectrum of bleeding risk has not been investigated. The aim of this study is to explore the value of the novel PRECISE-HBR score as a risk stratification tool to guide DAPT duration in patients at high bleeding risk. The XIENCE Short DAPT program combined 3 international single-arm studies of HBR patients treated with cobalt-chromium everolimus-eluting stents who discontinued DAPT at 1 month (XIENCE 28 USA/Global) or 3 months (XIENCE 90), if event free and treatment adherent. Bleeding risk was classified as nonhigh (PRECISE-HBR score ≤22), high (score 23-26), or very high (score ≥27). Clinical outcomes were assessed between 1 and 12 months using propensity score stratification. Among 3,364 patients, the PRECISE-HBR score was ≤22, 23-26, and ≥27 in 359 (10.7%), 744 (22.1%), and 2,261 (67.2%), respectively. Rates of BARC (Bleeding Academic Research Consortium) type 3-5 bleeding (0.3%, 2.5%, 5.6%) and death or myocardial infarction (2.9%, 4.6%, 9.8%) increased progressively across risk categories. One- versus 3-month DAPT was associated with a significant reduction in BARC type 3-5 bleeding in patients with a score ≥27 (HR: 0.59, 95% CI: 0.39-0.88) but not in those <27 (HR: 2.31, 95% CI: 0.89-5.99; P-interaction = 0.012). Ischemic risk was similar between 1- and 3-month DAPT, irrespective of the PRECISE-HBR score (P-interaction = 0.40). The PRECISE-HBR score identified patients at increased risk for both bleeding and ischemic events who seemed to derive greater benefit from 1-month DAPT after stent implantation.
The E-wave propagation index (EPI) has been proposed as a simple risk marker of left ventricular (LV) thrombus (LVT) formation. We sought to investigate the association between EPI and LVT in patients with heart failure with reduced ejection fraction (HFrEF). This was a retrospective cohort study on 768 patients with HFrEF. The EPI was measured as the velocity time integral of the transmitral E-wave divided by the LV length. The endpoint was LVT formation. Logistic regression was applied to investigate the association between EPI and LVT. Multivariable adjustments were made for age, mitral regurgitation, apical aneurysm, prior myocardial infarction, and LV ejection fraction (LVEF). Area under receiver operating characteristic curves was used to assess the optimal cut-off value for EPI. Of 768 HFrEF patients, 24 (3%) had developed LVT. The mean age was 66 years, 73% were men, and the mean LVEF was 28%. EPI was lower among those who had developed LVT (1.1 vs 1.3, p = 0.018), and EPI was significantly associated with LVT formation in univariable logistic regression (OR = 1.16 (1.0-1.3), per 0.1 decrease). This finding was unchanged after multivariable adjustments. The EPI provided an area under the curve of 0.68 with an optimal cutoff of 1.2. This cutoff had a sensitivity of 75%, specificity of 60%, positive predictive value of 6%, and negative predictive value of 99%. Patients with an EPI <1.2 had a four-fold increased risk of LVT (OR = 4.42 (1.73-11.25), p = 0.002). In patients with HFrEF, the EPI was independently associated with LVT formation. Additionally, an EPI > 1.2 indicates a low likelihood of developing LVT.
Logistic regression was performed to estimate the association between D-dimer level 、the main pulmonary artery-to-ascending aorta diameter ratio, the right-to-left ventricular (RV/LV) diameter ratio, the pulmonary embolism (PE) index, and the perfusion defect index and PE risk stratification. And to evaluate the predictive value of these parameters for identifying severe PE. A retrospective analysis was conducted on the clinical data of 52 patients diagnosed with PE by dual-source CT pulmonary angiography in the author's hospital. Based on clinical manifestations, patients were classified into a severe group and a non-severe group. Statistical analyses were performed using professional software to assess D-dimer, the main pulmonary artery-to-ascending aorta diameter ratio, RV/LV diameter ratio, PE index, perfusion defect index, and PE risk stratification. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of these parameters for severe PE. Levels of RV/LV diameter ratio, PE index, and perfusion defect index were significantly higher in the severe group than in the non-severe group (P < 0.05). ROC curve analysis showed that pulmonary embolism index (AUC = 0.850, 95%CI: 0.724-0.934) and perfusion defect index (AUC = 0.840, 95%CI: 0.712-0.927) had good differentiation efficiency for the severe group. D-dimer levels were not correlated with the risk stratification of PE. The RV/LV diameter ratio can serve as reference indicators for identifying severe PE patients. Both the perfusion defect index and the PE index demonstrated good predictive value for severe cases. These findings offer valuable insights for optimizing the clinical management and treatment strategies for PE patients.
Distinguishing possible from definite infective endocarditis (IE) is challenging and may affect clinical decisions. A better understanding of how possible and definite IE differ, according to the ESC Duke criteria, may clarify the clinical relevance of this distinction. To compare clinical characteristics and outcomes in patients with possible and definite IE. We included all patients with a first episode of possible or definite left-sided IE from the NatIonal Danish endocarditis stUdieS (NIDUS) registry (2016-2021), classified according to the 2015 ESC modified Duke criteria. We assessed baseline characteristics and management, as well as six-month rates of IE-related outcomes and all-cause mortality. Among 3,017 patients, 587 (19.5%) had possible IE and 2,430 (80.5%) definite IE. Patients with possible IE were older and more often had left-sided prosthetic valves (35.4% vs. 25.8%) and culture-negative IE (30.0% vs. 2.2%), but less often vegetations >10 mm (13.6% vs. 32.8%) (all p < 0.001). Complications and cardiac surgery (10.9% vs. 24.6%) were less frequent in the possible IE group. Antibiotic treatment was shorter in possible IE (median days 37 vs. 40; p = 0.01). Six-month all-cause mortality was similar: 27.4% [95% CI: 23.8-31.1] vs. 28.1% [95% CI: 26.3-29.9], as were IE-related outcomes. Patients with possible IE more often had left-sided prosthetic valves and culture-negative IE, but less often vegetations >10 mm, complications or cardiac surgery, and received shorter antibiotic treatment. Clinical outcomes were similar. These findings highlight diagnostic challenges and the need for tailored diagnostic and treatment strategies.
Adults with congenital heart disease (ACHD) have a rising prevalence of atrial fibrillation/flutter (AF) and elevated thrombotic and bleeding risk. Although direct oral anticoagulants (DOACs) are established in non-ACHD AF, comparative effectiveness in ACHD is not well defined. In a propensity score-matched retrospective cohort study using the TriNetX database, adults (age ≥ 18 ) with ACHD and AF receiving oral anticoagulation were identified, excluding those with mechanical valves, LVAD, antiphospholipid syndrome, or rheumatic mitral stenosis. Patients were matched 1:1 to DOAC or warfarin. The primary outcomes were composite embolic events, composite bleeding events, and net clinical outcome (embolism, bleeding, or all-cause mortality). Secondary outcomes included gastrointestinal bleeding, nontraumatic intracranial hemorrhage (ICH), cardioembolic stroke, systemic arterial embolization, cerebral infarction, and all-cause mortality. Associations were estimated using hazard ratios (HRs). Sensitivity analysis was performed to confirm the robustness of magnitude and direction of outcomes. After matching, 27,166 patients were included (13,583 per group). DOAC use was associated with lower hazard of net clinical outcome (HR 0.87, 95% CI 0.81-0.93), driven by reduced composite bleeding (HR 0.82, 95% CI 0.75-0.90) and all-cause mortality (HR 0.68, 95% CI 0.64-0.72). Hazard of composite embolic events did not differ (HR 0.94, 95% CI 0.87-1.03). DOACs were associated with lower hazard of systemic arterial embolization (HR 0.62, 95% CI 0.52-0.73), nontraumatic ICH (HR 0.74, 95% CI 0.61-0.90), and gastrointestinal bleeding (HR 0.84, 95% CI 0.76-0.93). No significant differences were observed for cerebral infarction or cardioembolic stroke. In a large propensity-matched cohort of patients with ACHD and AF, DOAC therapy was associated with lower hazard of net clinical outcome, all bleeding events, and all-cause mortality compared with warfarin, without increased embolic risk.
Coronary sinus reducer (CSR) is an emerging therapeutic invasive treatment option that can improve refractory angina symptoms. However, access to this service in the UK remains largely restricted to tertiary centres. To assess patient outcomes, procedural safety and feasibility of establishing a CSR service in a UK district general hospital (DGH) without on-site surgical back-up. A total of 27 consecutive patients with refractory angina underwent CSR implantation between October 2023 and March 2025. Angina severity and functional status were assessed using the Seattle Angina Questionnaire (SAQ) or Canadian Cardiovascular Society (CCS) class, prior to and 6-months after CSR implantation. The primary endpoint was improvement of SAQ score by at least 10 points or CCS class by ≥1 at 6-months follow-up. Secondary endpoints were procedural success, periprocedural and in-hospital MACE, and major bleeding. Procedural success was achieved in 96.4% of the patients. No major peri-procedural complications were reported. The mean SAQ score improved significantly from 53.2±15.8 at baseline to 62.0±15.8 at 6-month follow-up (p=0.005). The median CCS class decreased from 3 (IQR 3-3) at baseline to 2 (IQR 1-2) (p<0.001), with 75.0% of evaluable patients improving by at least one CCS class. Significant improvement was most pronounced in Angina Frequency (57.8±21.7 vs. 72.2±21.4 at 6-month, p<0.001), and Angina Stability (39.6±27.7 vs. 60.4±28.2 at 6-month, p=0.005), which subsequently led to improvement in Physical Limitation (43.9±18.8 vs. 52.2±21.3 at 6-month, p=0.020), CONCLUSION: CSR implantation led to improvement of quality-of-life at 6-months follow-up. This service can be delivered safely and effectively within a DGH setting, with outcomes comparable to tertiary centres. Our data supports that post-CSR implantation same-day discharge is both safe and cost-effective.
Acute myocardial infarction (AMI) remains a leading cause of death worldwide and in Colombia. Beyond survival, AMI can markedly impair health-related quality of life (HRQoL), yet the prognostic value of HRQoL measured during the index hospitalization remains insufficiently explored, particularly in middle-income countries. We conducted a prospective cohort study of 1093 adults with type 1 myocardial infarction admitted to a tertiary referral center in Colombia between 2023 and 2025. HRQoL was assessed within 24 h of admission using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument and the EuroQol Visual Analogue Scale (EQ-VAS). Multivariable Poisson regression with robust variance was used to estimate adjusted risk ratios (RRs) for one-year mortality and rehospitalization. At 12 months, all-cause mortality was 4.3% and rehospitalization was 2.6%. Impairment in the mobility domain was independently associated with higher risks of mortality (RR = 1.80; p = 0.045) and rehospitalization (RR = 2.22; p = 0.031). Percutaneous coronary intervention (RR = 0.28; p < 0.001) and male sex (RR = 0.54; p = 0.034) were associated with lower mortality risk. Baseline HRQoL assessed during hospitalization for AMI was associated with one-year mortality and rehospitalization. Mobility limitations identified patients at higher risk and may complement conventional clinical risk stratification.
Coronary heart disease (CHD) remains a leading cause of mortality worldwide, with individuals with diabetes mellitus (DM) facing markedly elevated risk due to complex inflammatory and metabolic disturbances. Emerging composite inflammatory and metabolic indices have demonstrated promise in enhancing cardiovascular risk stratification, yet research quantifying and comparing their respective predictive performance and assessing their relative contributions remains limited. This study aimed to develop a clinically applicable model for early CHD risk prediction in diabetic patients using novel composite inflammatory and metabolic indices. This study utilized data from 3379 diabetic participants in the NHANES 1999-2018 survey cycles. Additionally, an independent external set of 902 patients from Qilu Hospital of Shandong University served as the validation cohort. Novel inflammatory and metabolic indices were calculated. Feature selection was performed via LASSO regression, the univariate logistic regression, and the Boruta algorithm. Nine machine learning (ML) models were developed using selected predictors. Model performance was evaluated using the receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis. SHapley Additive exPlanations (SHAP) values were used to interpret model predictions and identify key contributing features. Five composite indices UHR (uric acid-to-HDL ratio), MHR (monocyte-to-HDL ratio), NPAR (neutrophil-to-albumin ratio), NLR (neutrophil-to-lymphocyte ratio), and AIP (atherogenic index of plasma) were identified as robust predictors of CHD. The random forest (RF) algorithm achieved the highest performance, with an AUC of 0.852 in the internal validation set and 0.713 in the external cohort. Calibration plots, Brier scores, and decision curve analysis further confirmed the RF model's predictive reliability and clinical utility. SHapley Additive exPlanations (SHAP) value analysis revealed that UHR, MHR, NLR, age, and hypertension were the key features driving CHD prediction. We developed and externally validated an ML model incorporating five composite inflammatory and metabolic indices (UHR, MHR, NLR, NPAR, AIP), which demonstrated promising performance in predicting CHD risk in diabetic patients.