搜索结果：Journal of cardiac failure

During the initial workup of a patient with chronic heart failure, increased left ventricular (LV) filling pressures at rest or during exercise, and a LV ejection fraction ≥50%, physicians are expected to exclude the presence of established diseases that masquerade as heart failure with preserved ejection fraction (HFpEF), referred to as "HFpEF mimics". These diseases include (1) cardiac amyloidosis; (2) hypertrophic cardiomyopathy; (3) infiltrative, restrictive and inflammatory cardiomyopathies (sarcoidosis, hemochromatosis, Fabry's disease, and radiation- and chemotherapy induced restrictive disorders); (4) hemodynamically significant valvular heart disease; (5) pericardial diseases (particularly constrictive pericarditis); (6) high-output heart failure; and (7) end-stage kidney disease. These diseases were recognized long before HFpEF was defined as a disorder, have specific targeted treatments, and have generally been excluded from randomized controlled trials of new drugs for HFpEF. Interestingly, following the exclusion of HFpEF mimics, patients demonstrate the typical clinical and pathophysiological features of cardiometabolic HFpEF, with an exceptionally high prevalence of central adiposity, dysglycemia, hypertension and systemic inflammation - even though large-scale trials did not require participants to have any feature of a cardiometabolic disorder. The homogeneity of the phenotypic presentations of these patients is consistent with the lack of observed heterogeneity in the responses to broad-based treatments (i.e., sodium-glucose cotransporter 2 inhibitors, finerenone and incretins). Importantly, many patients with adiposity-related HFpEF were not permitted to participate in large-scale trials, which excluded patients with severe obesity, lower natriuretic peptides and without manifest echocardiographic diastolic filling abnormalities. In conclusion, the exclusion of HFpEF mimics from the broad population of patients with left-sided heart failure and an ejection fraction ≥50% yields a relatively homogeneous patient population with the features of adiposity-related HFpEF.

Background Accurate prediction of heart failure (HF) risk is crucial for early intervention and prevention. Traditional models rely on clinical risk factors, whereas cardiac MRI parameters may offer additional predictive value. Purpose To evaluate whether integrating multidimensional cardiac MRI parameters with the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations improves HF risk prediction. Materials and Methods This secondary analysis of a prospective study included participants from the UK Biobank who underwent cardiac MRI. Participants were randomly divided into 70% for a training set and 30% for an internal test set. Eighty-two representative cardiac MRI variables were log-transformed and standardized. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression combined with bootstrap resampling. Sex-specific Fine-Gray competing risk models were constructed based on the PREVENT equations. Model performance was evaluated using the C-index and calibration charts. Results This study included 39&#x2009;069 participants (mean age, 55 years &#xb1; 7.5 [SD]; 20&#x2009;520 women). Sixteen cardiac MRI parameters identified by LASSO enhanced HF risk prediction. In the training set (n = 27&#x2009;531), the C-index increased from 0.753 (95% CI: 0.728, 0.777) to 0.812 (95% CI: 0.787, 0.837) (&#x394;C-index = 0.059; P < .001); in the internal test set (n = 11&#x2009;538), it increased from 0.760 (95% CI: 0.719, 0.801) to 0.821 (95% CI: 0.779, 0.862) (&#x394;C-index = 0.061; P = .007). In men, left atrial (LA) functional parameters contributed most to the improvement in C-index, including LA ejection fraction (&#x394;C-index = 0.022), whereas in women, the gain was primarily driven by left ventricular (LV) ejection fraction (&#x394;C-index = 0.011) and myocardial strain (LV circumferential strain: &#x394;C-index = 0.008; LV radial strain: &#x394;C-index = 0.006). Conclusion Integrating cardiac MRI parameters into the PREVENT equations improved HF risk prediction and highlighted sex-specific pathophysiologic differences. &#xa9; RSNA, 2026 Supplemental material is available for this article. See also the editorial by Hanneman and Moayedi in this issue.

Prior studies have shown that a supranormal range of left ventricular ejection fraction (LVEF) is associated with adverse cardiovascular outcomes. However, the prognostic value of stress perfusion cardiac magnetic resonance (CMR) in patients with supranormal LVEF is not well defined. This study aimed to assess the prognostic significance of stress perfusion CMR in patients with known or suspected coronary artery disease and supranormal LVEF. This cohort study included patients aged &#x2265;18 years who underwent clinical stress perfusion CMR at an academic hospital in Thailand between 2011 and 2022 and had an LVEF &#x2265;65% on CMR. Patients were divided into two groups based on the presence of myocardial ischaemia on CMR and were followed for major adverse cardiovascular events (MACE), defined as a composite of all-cause death, acute coronary syndrome (ACS) or hospitalisation for heart failure. A total of 531 patients were included (mean age 68.7&#xb1;11.0 years; 42.6% male; mean LVEF 75.1%&#xb1;6.2%). Myocardial ischaemia was detected in 124 patients. During a median follow-up of 5.4 years (IQR, 2.1-9.5), 63 MACE occurred. Patients with myocardial ischaemia had a significantly higher rate of MACE than those without ischaemia (3.71 vs 1.74 per 100 patient-years; HR 2.13; 95%&#x2009;CI 1.28 to 3.54; p=0.004). In multivariable Cox regression analysis, myocardial ischaemia remained independently associated with MACE (HR 1.81; 95%&#x2009;CI 1.08 to 3.05; p=0.02). The prognostic value of myocardial ischaemia was consistent across LVEF tertiles (p for interaction=0.79). Other independent predictors included age (HR 1.03; 95%&#x2009;CI 1.001 to 1.05; p=0.03), a history of heart failure (HR 2.65; 95%&#x2009;CI 1.57 to 4.46; p<0.001) and LV mass index (HR 1.03; 95%&#x2009;CI 1.02 to 1.04; p<0.001). In patients undergoing stress perfusion CMR with supranormal LVEF, myocardial ischaemia detected by CMR provided significant prognostic value for predicting a composite of all-cause death, ACS or hospitalisation for heart failure.

After resuscitation from out of hospital cardiac arrest (OHCA), mechanical ventilation (MV) and respiratory management are fundamental to support patients in the intensive care unit (ICU) and to minimise secondary brain injury. Best practices for MV and association with clinical outcomes in patients with OHCA remain unclear. This protocol describes a pre-planned respiratory-focused series of sub-analyses within the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) trial, an ongoing interventional study evaluating 6-month mortality after randomisation in patients admitted to ICUs following OHCA. The primary aim is to describe real-world ventilator settings and gas-exchange targets during the first 72 hours after ICU admission in patients receiving invasive mechanical ventilation after OHCA. Secondary aims include to estimate the incidence of respiratory complications during ICU stay (eg, ventilator-associated pneumonia, acute respiratory distress syndrome, barotrauma); and to explore the association between early ventilator settings/gas-exchange parameters and 6-month outcomes (mortality and neurological status). Exploratory aim is to characterise weaning and extubation practices, including timing and failure rates.Eligible patients will include adult STEPCARE participants receiving invasive MV after return of spontaneous circulation with available respiratory data recorded within the STEPCARE database.Data collected in the STEPCARE trial that will be analysed include patients' prehospital characteristics; clinical examination at hospital admission and at ICU admission; ventilator settings and arterial blood gases recorded at predefined time points during ICU stay. In particular: MV setting (mode, tidal volume, positive end-expiratory pressure, fraction of inspired oxygen, tidal volume, mechanical power, plateau/driving pressures), gas-exchange values (arterial partial pressure of oxygen and carbon dioxide, pH, arterial saturation of oxygen), timing of measurements and the occurrence/timing of respiratory complications and weaning outcomes. The STEPCARE study has been approved by the regional ethics committee at Lund University (Dnr 2022-02425-01, Approved IRB on 2022-06-18) and by all ethics boards in the participating countries. No additional ethical approval is required for this predefined secondary analysis, as no further data collection or interventions will be performed. Findings will be disseminated through publication in peer-reviewed journals and, where appropriate, conference abstracts and presentations. Patients and the public were not involved. NCT05564754.

Assessing left ventricular end diastolic pressure (LVEDP) is critical in managing patients with heart failure. This study aims to explore the utility of left atrial speckle tracking echo (STE) and tissue Doppler derived indices (TDI) in predicting LVEDP in patients with heart failure in India. This prospective study included 210 hemodynamically stable patients admitted with heart failure who underwent left heart catheterization. Echocardiography (TDI and STE indices) and Invasive LVEDP were recorded. Elevated LVEDP was associated with significantly higher ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') and lower LA strains in reservoir (LAS-r) values. In Bivariate analysis LAS-r showed inverse correlation with LVEDP (-0.74, 95% CI -0.78 to -0.68; p <0.0001). Multivariate regression identified Biplane LAS-r as an independent predictor of LVEDP (0.42; 95% CI 0.31-0.55; p < 0.0001).Receiver operating characteristic(ROC) analysis showed that LAS-r (cut-off &#x2264;17)had superior diagnostic accuracy (AUC 0.97; sensitivity 88.4%, specificity 93.1%) compared to E/e' (0.71), LAS-ct, and LAVi (0.81, 0.64). E/e' though an independent predictor (1.09, 95% CI 1.02-1.14; p 0.008), had markedly lower sensitivity(57.2%) than that of LAS-r. Conventional markers like LA volume index (LAVi) and LVEF were not significant in the multivariate model. Diastolic dysfunction 2016 guidelines showed 64.29% accuracy in diagnosing patients with raised LVEDP. In patients with heart failure, parameters like mean E/e' ratio, LAVi, E wave DT are useful indices to estimate LVEDP; however, peak LAS-r (cut-off &#x2264;17) provides a better prediction of LVEDP and could be considered a promising noninvasive index to assess LVEDP in patients of heart failure.

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is a challenging chronic disease to manage. Patients' daily self-care decisions are associated with improved AF outcomes, quality of life, and decreased hospital use and cost. However, many patients find these real-world or naturalistic decisions difficult, often because of their inherent complexity and ambiguity, coupled with the uncertainty of AF. Intervention research using technology to support AF self-care has largely emphasized making decisions with clinicians. Patients with AF are increasingly using consumer technology; yet, little is known about the use of technology by patients with AF in independent self-care decision-making. Addressing this gap will facilitate developing interventions that better leverage technology to enhance patients' naturalistic decision-making. This study aimed to explore the experiences of older adult patients in using technology to support self-care decision-making. Following an interpretive descriptive qualitative approach, older adult patients with AF were recruited from 3 specialty heart function clinics in a Western Canadian province to participate in 1 of 6 facilitated virtual focus groups for 1.5 hours. Patients were asked about their self-care decision-making since AF diagnosis, their AF-specific technology use and its use in making self-care decisions, their technology motivations, benefits, constraints, and other possibilities for use. Inductive thematic analysis was used to code the transcribed data, moving from open coding to clustering of common codes into categories, looking for patterns of meaning between and across categories to iteratively arrive at main themes and subthemes. Thirty patients (n=15, 50% women) with AF (mean age, 73, SD 5.7 years; range 63-85 years) participated in the focus groups. Participants' experiences of using technology to make daily self-care decisions were highly variable but centered on its personalized use to meet their individualized needs, preferences, and life context. The personalizing process of technology use in decision-making was characterized by three themes: (1) beginning technology use in their own times and ways, during their AF trajectory-pre-, at the time, at some point AF post diagnosis, and could be either self-initiated and/or provider recommended or influenced; (2) developing patterns of AF self-care decision-making using technology, including establishing their personal baseline, keeping out of the danger zone, watchful waiting, and seeking decision-making support; and (3) finding the place for technology in normalizing daily life, either settling on or limiting its use to normalize life. Findings expand understandings of naturalistic decision-making by elucidating the personalized process of technology use in AF self-care.

In asymptomatic severe degenerative mitral regurgitation (MR), indications for surgery mainly rely on 2D echocardiographic criteria. Preoperative peak atrial longitudinal strain (PALS) has prognostic value for predicting clinical outcome after surgery for MR while Bernard demonstrated the prognostic value of an echocardiographic staging assessment of extra-valvular cardiac damage in patients with at least moderate MR.The primary aim was to assess the additive prognostic value of PALS to Bernard's staging classification in patients undergoing surgery for degenerative MR. Ambispective multicenter cohort study of patients with severe degenerative MR undergoing surgery. Patients were assigned to Bernard's stages based on pre-operative echocardiographic data, from which PALS values were obtained. Follow-up assessed the composite primary endpoint: all-cause mortality, hospitalization for heart failure, acute myocardial infarction, stroke, life-threatening bleeding or wound infections requiring re-intervention, failure requiring re-intervention. Three hundred patients (mean age 63 &#xb1; 13&#x200a;years; 65% men) were enrolled with a median follow-up of 24&#x200a;months. Bernard's staging predicted outcomes in our population, as demonstrated by survival analysis with Kaplan-Meier curves (log-rank 13.3; P&#x200a;=&#x200a;0.01) and Cox model (hazard ratio of 1.51; P < 0.001). Adding PALS improved prognostic performance (&#x3c7;2&#x200a;=&#x200a;20.96 vs. 16.15), with an area under the curve of 0.70 vs. 0.64 at 24&#x200a;months, a net reclassification improvement of 0.18 (P&#x200a;=&#x200a;0.031), an integrated discrimination improvement of 0.02 (P&#x200a;=&#x200a;0.020). We identified an optimal PALS cutoff of 18% associated with the primary endpoint. PALS has a potential additive role in estimating the prognosis of patients undergoing surgery for severe degenerative MR.

The coexistence of preeclampsia and uncontrolled thyrotoxicosis leading to acute respiratory failure is rare and poses significant diagnostic and therapeutic challenges, particularly with respect to safe fluid management in the obstetric intensive care setting. We report the case of a 35-year-old woman at 37-week gestation who presented with progressive dyspnea, acute pulmonary edema, and fetal distress, necessitating emergency cesarean section and subsequent intensive care admission. Point-of-care ultrasound (POCUS) demonstrated impaired left ventricular systolic function (ejection fraction 40%), reduced left ventricular outflow tract velocity time integral (LVOT VTI 10-11 cm), a dilated inferior vena cava, and diffuse pulmonary B-lines, consistent with volume overload and compromised forward cardiac output. Serial POCUS-guided assessments were used to titrate diuretic therapy and optimize mechanical ventilation, resulting in progressive improvement in LVOT VTI (up to 20 cm), resolution of pulmonary edema, achievement of negative fluid balance, and clinical recovery. The patient was successfully extubated on day 5 and discharged home on day 7. This case demonstrates the clinical utility of POCUS, particularly serial LVOT VTI measurements, in providing actionable, dynamic bedside data to safely guide fluid management when static hemodynamic indices are unreliable, highlighting the value of POCUS in complex high-risk obstetric critical care.

Purpose To evaluate whether the artificial intelligence (AI)-quantified mean thoracic skeletal muscle (TSM) attenuation from coronary artery calcium (CAC) scans predicts incident cardiovascular disease (CVD), with a focus on atrial fibrillation (AF) and heart failure (HF). Materials and Methods Data from the Multi-Ethnic Study of Atherosclerosis, including participants without baseline CVD who underwent CAC scanning, were retrospectively analyzed. Myosteatosis was defined by sex-specific, AI-quantified mean TSM attenuation cutoffs. The Cox proportional hazards model was used to compare total CVD, AF, and HF risks between the bottom and top quartiles of TSM attenuation after adjusting for CVD risk factors, inflammatory markers, insulin resistance, Agatston score, TSM volume, and social determinants of health. Results Among 5739 participants (mean age, 62.1 years &#xb1; 10.3 [SD]; 3002 [52.3%] female), 1826 CVD events occurred over 19 years, including 1139 AF and 359 HF events. Myosteatosis was independently associated with increased risks of total CVD (hazard ratio [HR], 1.48 [95% CI: 1.25, 1.75]; P = .001), AF (HR, 1.68 [95% CI: 1.37, 2.07]; P < .001), and HF (HR, 1.61 [95% CI: 1.18, 2.19]; P < .002). Participants with both myosteatosis and high Agatston scores had markedly higher cumulative incidences compared with those with high Agatston scores alone (total CVD: 84.6% vs 68.6%; AF: 52.9% vs 42.4%; HF: 22.6% vs 16.1%). Adding myosteatosis to the Agatston score significantly improved prediction (time-dependent area under the receiver operating characteristic curve, total CVD: 0.74 vs 0.80, P < .001; AF: 0.68 vs 0.76, P < .001; HF: 0.73 vs 0.78, P = .007). Conclusion AI-quantified mean TSM attenuation on CAC scans independently predicted AF and HF and enhanced the Agatston score's predictive value. Keywords: Myosteatosis, Coronary Artery Calcium Scan, Atrial Fibrillation, Heart Failure, Artificial Intelligence, Applications-CT, Cardiac, Thorax, Muscular, Heart ClinicalTrials.gov NCT00005487 Supplemental material is available for this article. &#xa9; RSNA, 2026.

Take Home Illustration. Heart Failure Pharmacotherapy Across the TAVR Continuum. GDMT recommendations across the pre-, peri-, and post-procedural phases of TAVR. The recommendations are based on available evidence for each drug class regarding safety, efficacy, and impact on clinical outcomes. BB&#x202f;=&#x202f;beta blocker; HF&#x202f;=&#x202f;heart failure; GDMT&#x202f;=&#x202f;guideline directed medical therapy; HFpEF&#x202f;=&#x202f;heart failure with preserved ejection fraction; HFrEF&#x202f;=&#x202f;heart failure with reduced ejection fraction; MRA&#x202f;=&#x202f;mineralocorticoid receptor antagonist; RASi&#x202f;=&#x202f;renin angiotensin system inhibitor; SGLT2i&#x202f;=&#x202f;sodium glucose transporter 2 inhibitor; TAVR&#x202f;=&#x202f;transcatheter aortic valve replacement. Transcatheter aortic valve replacement (TAVR) is an increasingly common treatment option for severe symptomatic aortic stenosis. However, heart failure often persists because of incomplete reversal of myocardial remodeling, fibrosis, and diastolic dysfunction. TAVR corrects valvular afterload but does not resolve the underlying myocardial disease. Guideline-directed medical therapy (GDMT), including renin-angiotensin system inhibitors (RASi), sodium-glucose cotransporter-2 inhibitors (SGLT2i), mineralocorticoid receptor antagonists (MRAs), and beta-blockers (BBs), has a strong mechanistic rationale and potential clinical benefit, although evidence in TAVR populations remains heterogeneous and is largely observational. Nonetheless, accumulating data support continuation and early optimization of GDMT in the pre-, peri-, and post-TAVR periods, with the most consistent benefit observed for RASi and SGLT2i. Key uncertainties remain regarding optimal timing, patient selection, and class-specific effects. This State-of-the-Art Review integrates current evidence and proposes a framework to guide GDMT use across the TAVR continuum while defining priorities for future randomized trials Condensed Abstract: Post-TAVR heart failure frequently persists because of residual myocardial disease. GDMT, including RASi, SGLT2i, MRAs, and BBs, may improve outcomes but remains underutilized and inconsistently addressed in current guidelines. GDMT should ideally be continued when tolerated and optimized early across the TAVR continuum, particularly RASi and SGLT2i. Therapy should be tailored to heart failure phenotype across the TAVR continuum. Randomized trials are needed to define optimal implementation strategies.

Deploying cardiac segmentation models as remote inference services creates a black-box setting in which robustness under out-of-distribution shift is critical. We evaluated two candidate configurations for biventricular segmentation of short-axis cine cardiac magnetic resonance images trained on the same public benchmark dataset: a nnU-Net ensemble and nnSAM. Both were assessed within the same deployment-oriented framework on two external cohorts, a multi-site, multi-vendor adult dataset and a single-site, multi-scanner pediatric congenital heart disease dataset. Performance was evaluated using geometric metrics and biomarker-based endpoints, including clinically relevant ejection fraction (EF) failure rates. While performance was similar in the adult cohort, the nnU-Net ensemble was more robust in the pediatric cohort, with better geometric preservation and lower EF failure rates. These findings indicate that deployment-oriented validation of remote cardiac segmentation services should assess biomarker reliability alongside geometric accuracy.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally. The co-occurrence of COPD exacerbation and cirrhosis may compound clinical complexity and elevate adverse outcome risks. This study aimed to evaluate the impact of cirrhosis on outcomes among patients admitted with acute exacerbations of COPD. Data were extracted from the Nationwide Inpatient Sample database for the period of 2019 to 2021. Patients hospitalized with acute exacerbations of COPD were identified using ICD-10 codes. The study population was stratified into patients with cirrhosis and those without. The primary outcome was in-hospital mortality. Secondary outcomes included sepsis, hepatic encephalopathy, respiratory failure, cardiac arrest, cardiac arrhythmias, pneumothorax, pulmonary embolism, acute kidney injury, and hospital length of stay. Among 914,498 patients hospitalized with COPD exacerbations, 4.2% had cirrhosis. Cirrhotic patients were younger and had higher in-hospital mortality, longer length of stay, and higher hospital charges compared to noncirrhotics. Cirrhosis was independently associated with increased mortality and a higher risk of sepsis, acute kidney injury, encephalopathy, shock, and prolonged hospitalization. Associations with arrhythmia and cardiac arrest were not statistically significant. Cirrhosis is associated with higher in-hospital mortality and increased risk of complications in patients admitted for COPD exacerbations, contributing to longer hospital stays and higher healthcare costs. Clinical monitoring and tailored management are warranted in this group.

Left ventricular (LV) reverse remodelling (LVRR) is a key therapeutic objective in heart failure (HF) with reduced ejection fraction (HFrEF), yet only a subset of patients exhibit meaningful recovery despite guideline-directed medical therapy (GDMT). End-systolic wall stress (ESWS) and global longitudinal strain (GLS) reflect complementary aspects of myocardial mechanics. This study evaluated whether their integrated assessment predicts LVRR, therapeutic responsiveness, and clinical outcomes. A total of 196 consecutive HFrEF patients (LV ejection fraction < 40%) were prospectively enrolled and underwent clinical and echocardiographic evaluation at baseline and after 6.5&#xa0;&#xb1;&#xa0;2.0&#xa0;months. LVRR was defined as an absolute increase in LV ejection fraction > 10% to &#x2265; 35% plus a&#xa0;&#x2265; 15% reduction in end-systolic volume. ESWS was calculated using a validated meridional formula integrating brachial systolic pressure, end-systolic internal diameter, and posterior wall thickness, and GLS was derived by speckle-tracking echocardiography. Predictors of LVRR were assessed using multivariable logistic regression and receiver-operating characteristic analysis. Patients were stratified into four phenotypes based on ESWS and GLS thresholds. LVRR occurred in 38% of patients. GLS and ESWS were independent predictors of LVRR (area under the curve 0.82 and 0.78, respectively), with optimal cut-offs of -12.1% and 160&#xa0;kdyne/cm2. Patients with low ESWS and preserved GLS showed the highest probability of LVRR, the greatest improvement in haemodynamic profile, and the lowest incidence of appropriate implantable cardioverter-defibrillator shocks. Conversely, high ESWS combined with impaired GLS identified patients with a low occurrence of LVRR, persistently elevated filling pressures, reduced LV efficiency, and the poorest survival. Integrated stress-strain phenotyping using ESWS and GLS improves prediction of LVRR, therapeutic responsiveness, and prognosis in HFrEF, and may help identify patients with limited recovery potential who warrant earlier evaluation for advanced HF therapies.

Disrupted cerebral blood flow is suggested to contribute to secondary brain injury after cardiac arrest (CA). This study aimed to investigate cerebral microcirculation after return of spontaneous circulation (ROSC) following asphyxial CA. We hypothesized that contraction of pericytes after ROSC compromises cerebral capillary blood flow. Transgenic C57BL/6NRj mice (n=19) of both sexes were studied. Mice were expressing tdTomato as a fluorescent reporter under the control of the platelet-derived growth factor receptor &#x3b2; promoter to label pericytes. Chronic cranial windows were implanted 3&#x2009;weeks before the experiment. Four minutes of asphyxial CA was followed by cardiopulmonary resuscitation. Two-photon microscopy assessed cerebral hemodynamics in the same cohort of mice at both 3 and 24&#x2009;hours after ROSC. Of 13 mice in the CA group, 9 achieved ROSC; 6 and 5 mice survived to 3 and 24&#x2009;hours after ROSC, respectively. Arterial blood pressure was similar between groups 3 and 24&#x2009;hours after ROSC. At 3&#x2009;hours after ROSC, pial arteries and penetrating arterioles were constricted in the CA group compared with sham (arteriole diameter, 12.2&#x2009;&#x3bc;m [95% CI, 10.9-13.4] versus 15.6&#x2009;&#x3bc;m [95% CI, 13.8-17.5] in CA and sham; P=0.003). Similarly, first- and second- to third-order capillaries showed reduced diameters 3&#x2009;hours after ROSC (first-order diameter, 3.9&#x2009;&#x3bc;m [95% CI, 3.5-4.2] versus 5.3&#x2009;&#x3bc;m [95% CI, 4.8-5.9] in CA and sham; P=0.002). The vasoconstriction was associated with slower red blood cell velocities throughout the capillary network (for second- to third-order capillaries upstream from venule; 0.78&#x2009;mm/s [95% CI, 0.46-1.09] versus 2.14&#x2009;mm/s [95% CI, 1.73-2.55]; P<0.001) and increased capillary flow stalling. Artery-to-vein mean transit time was increased and relative transit-time heterogeneity was decreased 3&#x2009;hours after ROSC. By 24&#x2009;hours after ROSC, vessel diameters, blood flow velocity, transit time, and capillary stalling were not different compared with sham. Cerebrovascular vasospasm 3&#x2009;hours after ROSC was associated with impaired cerebral microcirculation and increased capillary flow stalling.

Predicting successful heart donation after circulatory death (DCD) remains a challenge. We developed a model to predict progression to circulatory death after withdrawal of care in potential DCD heart donors. Adult DCD heart offers at a single institution over a six-month period were retrospectively reviewed. Univariate logistic regression was used to assess associations between pre-withdrawal-of-care variables and a binary outcome of circulatory death. The discriminatory performance of multivariate logistic regression and four supervised machine-learning models in predicting circulatory death was assessed by stratified cross validation. The top-performing model type was developed using the full dataset and externally validated in a cohort of potential donors at a distant center. Of 234 included offers, 150 (64.1%) progressed to circulatory death. Factors associated with circulatory death included Glasgow Coma Scale, brainstem reflexes; mean arterial pressure, vasoactive inotropic score, ventilator triggering, positive end-expiratory pressure, PaO2/FiO2 ratio, and serum sodium. A multivariate logistic regression model demonstrated sensitivity of 0.85, specificity of 0.52, and AUC of 0.77 in the development cohort, and sensitivity of 1.00, specificity of 0.50, and AUC of 0.88 in external validation. We present a novel model to predict progression to circulatory death among potential DCD heart donors.

Applying platelet rich plasma (PRP) to the sternum immediately prior to approximation has been shown to enhance wound healing, lower the incidence of sternal wound infections, reduce costs associated with treating these infections and decrease post-operative pain scores. Multiple investigations have reported device specific outcomes regarding PRP preparation yields from healthy volunteer blood donors, all with initial platelet counts in the normal range. What is missing from the literature is how accurately PRP preparations reflect device-specific yield target values, particularly under the clinical conditions encountered routinely in the cardiac surgery arena. The Magellan&#xae; group (30 cases) and the Angel&#xae; group (30 cases) comprised the two study groups (2 groups, 60 total cases, 120 samples total). Pre and post processing blood samples from each group were analyzed for platelet counts. Platelet count increases were assessed for accuracy when compared to a specific target. Individual yields from each tested device demonstrated some degree of limited variability. However, both groups mean values achieved and slightly exceeded the target value of a six-fold increase; Magellan group (M&#xa0;=&#xa0;6.58, SD&#xa0;=&#xa0;1.33), Angel group (M&#xa0;=&#xa0;6.31, SD = 0.93). Both devices, on average, appear capable of accurately preparing PRP to meet the specific target value of a six-fold increase over baseline under conditions routinely encountered in cardiac surgery.

Obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF). Incretin-based therapies are associated with a reduction in worsening heart failure (HF) events for patients with HF with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), although the time to clinical benefit from these therapies is unknown. PubMed, Embase, and CENTRAL were searched until July 12, 2025 for randomized controlled trials studying incretin-based therapies (semaglutide, tirzepatide) in adults with overweight/obesity and HF with ejection fraction >40%, and &#x2265;52-week follow-up. We extracted study-level data, from which individual participant data (IPD) was reconstructed. To estimate the time to benefit, we iteratively calculated hazard ratios (HR) and 95% confidence intervals (CI) with the dataset truncated for each day of follow-up. We pooled overall results with reconstructed IPD and study-level random-effects meta-analyses. Risk of bias was assessed with RoB 2, and certainty of evidence with GRADE. Four trials, encompassing 4149 participants and a weighted average median follow-up of 2.47 years, were included. Risk of bias was low. Compared to placebo, incretin-based therapies reduced worsening HF or cardiovascular death (HR 0.59, 95% CI 0.45-0.78; moderate certainty). The nominal time to first statistical significance was 126 days (4.1 months), and statistical significance was sustained after day 162 (5.3 months). Incretin-based therapies reduced worsening HF events (HR 0.33, 95% CI 0.20-0.54; high certainty), with sustained significance after day 183 (6.0 months). Incretin-based therapies are associated with reduced HF events in patients with overweight/obesity and HFmrEF/HFpEF, with sustained statistically significant outcome benefits observed from approximately 6 months onwards.

Hydroxychloroquine (HCQ) is a cornerstone in treating autoimmune diseases and is generally well-tolerated. Cardiotoxicity is a rare but serious adverse effect of prolonged HCQ therapy. The progression of cardiac dysfunction may evade early detection with standard noninvasive investigations. This case report was prepared in accordance with the CABARET guidelines from the EQUATOR Network. The patient underwent comprehensive clinical evaluation for diagnostic clarification. A 57-year-old woman with Sjogren's disease (SjD) who was treated with HCQ 400&#xa0;mg daily for nearly 21 years (cumulative dose&#x2009;~&#x2009;3,000&#xa0;g). The patient started to develop symptoms of syncope, shortness of breath and lower extremity edema. Noninvasive evaluation including echocardiography, coronary angiography, and cardiac magnetic resonance imaging failed to identify a clear etiology, demonstrating preserved ventricular size and systolic function without evidence of infiltrative or inflammatory cardiomyopathy. Continued decline in the patient's clinical status in addition to lack of response to medical therapy, an endomyocardial biopsy (EMB) was performed and revealed findings consistent with HCQ induced cardiotoxicity. HCQ was stopped; however, the damage was beyond reversal, so the patient ended up having an orthotopic heart transplantation. This case sheds light on an irreversible HCQ-induced cardiotoxicity that ended up with a heart transplantation. Despite extensive cardiac workup this adverse effect remained undetected until advanced disease. Delayed diagnosis can lead to irreversible cardiac damage and EMB should be considered in patients on prolonged HCQ therapy with unexplained cardiac symptoms and nondiagnostic workup. This can prompt early discontinuation of HCQ with potentially reversible damage and more favorable outcomes.

Heart failure (HF) is often diagnosed during acute decompensation, but earlier diagnosis in community settings may improve outcomes. We examined differences in patient characteristics, care models, and clinical outcomes by diagnosis setting. We conducted a population-based cohort study of 597,025 Ontarians aged &#x2265;40 with incident HF between 2010-2022. Patients were classified by diagnosis setting (community vs. acute care). We compared baseline characteristics, primary care models, and outcomes, including all-cause mortality and HF-related healthcare use. Of the cohort, 36.9% were diagnosed in acute care settings. This was more common among older adults (46.4% among patients >85 years vs. 28% in 40-61 years, p<0.0001), women (38.2% vs. 35.8% in men; p< 0.0001), individuals in the lowest income quintile (40.4% vs. 33.3% in the highest; p< 0.0001), and people without a primary care provider (57.2% vs [36.1%] for those with a PCP; p< 0.0001).. After adjusting for age, sex and comorbidities, acute care diagnosis was associated with increased risk of 1-year all-cause mortality (hazard ratio [HR] at 1 year 1.81, 95% CI: 1.80-1.83), HF-related hospitalizations (rate ratio [RR] 2.78, 95% CI 2.74-2.83), and emergency department visits (RR 2.58, 95% CI 2.51-2.65). More than one-third of patients are diagnosed with HF in acute care with disproportionately higher rates among older adults, women, low-income individuals, and those with no primary care provider. Acute care diagnosis was also associated with higher mortality and greater HF-related acute care use, underscoring missed opportunities for earlier community diagnosis and treatment.