Targeting Immune Cell Metabolism: A Promising Therapeutic Approach for Cardiovascular Disease

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality globally. Recent groundbreaking preclinical and clinical research underscores the pivotal role of metabolite remodelling in the pathology of CVD. This metabolic transformation not only directly fuels the progression of CVD but also profoundly influences the immune response within the cardiovascular system. In this review, we focused on the complex interactions between cardiovascular metabolic alterations and immune responses during the course of CVD. Furthermore, we explore the potential therapeutic interventions that could be developed based on the understanding of metabolic alterations and immune dysregulation in CVD. By targeting these metabolic and immunological pathways, novel strategies for the prevention and treatment of CVDs might be developed to improve patient outcomes and reduce the global burden of this disease.

Sex Specific Outcomes With Cardiac Resynchronization Therapy in Patients With Symptomatic Heart Failure Having Reduced Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis

Cardiac resynchronization therapy (CRT) has emerged instrumental in managing heart failure. Notably, there is a lack of evidence of CRT efficacy among both sexes. Thus, this meta-analysis focuses on the long-term benefits of CRT in both sexes. PubMed, The Cochrane Library and clinicaltrials.gov were searched for articles from 2010 to 2024. ROB2 was used to assess risk of bias of RCTs. Newcastle Ottawa Scale was used for quality appraisal of cohorts. Meta-analysis was conducted on Revman 5.4. Out of 2722 articles, only 9 RCTs and 18 cohorts were included. Our results demonstrated that females had a significantly lower risk of composite outcomes compared to males in both RCTs (RR 0.80; 95% CI [0.68, 0.94], P = .006) and cohorts (RR 0.76; 95% CI [0.63, 0.92], P = .004). Results were similar for all-cause mortality. For heart failure hospitalization, only cohorts showed a significant lesser risk in females (RR 0.78; 95% CI [0.65, 0.93], P = .006). Left ventricular ejection fraction improved significantly in females but no differences were observed for NYHA class improvement. Males showed a 31% lower survival rate. However future trials are needed to highlight this variation.

How does the addition of antiplatelet therapy to antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease affect outcomes? A meta-analysis of randomized controlled trials

Atrial fibrillation (AF) and stable coronary artery disease (CAD) often coexist, creating a significant burden. The efficacy of adding antiplatelet therapy to oral anticoagulant (OAC) therapy in treating these patients remains unclear, prompting this meta-analysis. A comprehensive search across databases was conducted for relevant studies. Outcomes of interest included net adverse clinical event (NACE), all-cause mortality, cardiovascular disease (CVD) mortality, major bleeding, any bleeding, hemorrhagic stroke, and ischemic stroke. A hazard ratio (HR) with 95% confidence intervals (CI) was pooled. Three randomized controlled trials (3945 patients) were analyzed. OAC monotherapy (MT) significantly reduced major bleeding (HR: 0.57; 95% CI: 0.40-0.83; P = 0.003) and any bleeding (HR: 0.55; 95% CI: 0.46-0.65; P < 0.0001) compared to combination therapy. No significant findings were observed for NACE, all-cause mortality, CVD mortality, hemorrhagic and ischemic strokes. Our meta-analysis revealed that OAC MT significantly reduced bleeding events while the number of stroke events and mortality remained similar compared to combination therapy in patients with AF and stable CAD.

Left Atrial Size and Left Atrial Volume Index as Predictors of Atrial High-Rate Episodes

BACKGROUND

Recent studies have shown that atrial high-rate episodes (AHREs) are associated with adverse cardiovascular outcomes, including an increased risk of stroke, cardiovascular mortality, and future atrial fibrillation. Despite efforts to identify predictors for AHRE, the relationship between left atrial morphology and AHRE remains unclear.

METHODS

We systematically reviewed MEDLINE and EMBASE from inception to May 2024 to assess the association between left atrial morphology, measured as left atrial diameter (mm) and left atrial volume index (LAVI, mL/m2) via transthoracic echocardiography, and the occurrence of AHRE in patients without a prior history of atrial fibrillation at device implantation. Means and standard deviations of LAD and LAVI were extracted to calculate pooled mean differences using the generic inverse variance method.

RESULTS

A total of 18 cohort studies were included in the meta-analysis. The results showed that patients with AHRE had significantly higher left atrial diameter and LAVI compared to those without AHRE. The pooled mean difference for left atrial diameter was 2.19 mm (95% CI: 1.11-3.28; I2 = 80%, p < 0.001), while for LAVI, it was 4.88 mL/m2 (95% CI: 2.55-7.21; I2 = 55%, p < 0.001).

CONCLUSIONS

Our study demonstrated that patients with AHRE had greater left atrial diameter and LAVI than those without AHRE. Further research is needed to clarify the underlying mechanism.

Association of glucagon-like peptide-1 receptor agonists with atrial fibrillation, cardiac arrest, and ventricular fibrillation: Casual evidence from a drug target Mendelian randomization

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown benefits for cardiorenal outcomes in patients with type 2 diabetes mellitus. Although some observational studies suggest that GLP-1RAs protect against arrhythmias, the evidence remains inconclusive.

METHODS

This study aimed to assess the causal relationship between GLP-1RAs and arrhythmias, including atrial fibrillation (AF), cardiac arrest, and ventricular fibrillation. We performed a two-sample Mendelian randomization (MR) analysis to examine the associations between genetically proxied GLP-1RAs and the risk of arrhythmias. Genetic instruments for GLP-1RAs were obtained from the cis-expression quantitative trait loci of the GLP1R gene, on the basis of data from the eQTLGen Consortium. Genome-wide association study (GWAS) data for AF were sourced from FinnGen10, whereas data for cardiac arrest and ventricular fibrillation came from the GWAS Catalog. Bayesian colocalization and multivariable Mendelian randomization (MVMR) analyses were conducted as supplementary analyses.

RESULTS

Twelve independent single nucleotide polymorphisms were identified as genetic instruments for GLP-1RAs. MR analysis indicated that genetically proxied GLP-1RAs were associated with a reduced risk of AF (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.71-0.85, p = 4.45E-08, posterior probability of hypothesis 4 [PP.H4] = 0.007) and a lower risk of cardiac arrest and ventricular fibrillation (OR = 0.60, 95% CI = 0.42-0.85, p = 0.0039, PP.H4 = 0.018). Bayesian colocalization analysis revealed that genetically proxied GLP-1RAs did not share genetic variation with arrhythmias. MVMR analysis revealed that, after adjusting for body mass index and type 2 diabetes mellitus, genetically proxied GLP-1RAs did not have a significant effect on the risk of arrhythmias.

CONCLUSIONS

Our findings suggest that genetically proxied GLP-1RAs are causally associated with a reduced risk of AF, cardiac arrest, and ventricular fibrillation. Further randomized controlled trials are needed to confirm these results.

Treatment outcome and associated factors of patients with atrial fibrillation in adult emergency rooms of selected hospitals of Addis Ababa, Ethiopia: A one-year cross-sectional study

BACKGROUND

Atrial fibrillation is the most common sustained cardiac rhythm disorder with substantial mortality and morbidity from stroke, thromboembolism, heart failure, and impaired quality of life. This study aimed to investigate the emergency presentation, treatment outcome and associated risk factors of atrial fibrillation patients admitted to three tertiary hospitals in Addis Ababa.

METHODS

A cross-sectional study was conducted in the adult emergency room of three tertiary hospitals in Addis Ababa. All atrial fibrillation patients admitted to these hospitals from August 15, 2021, to August 15, 2022, fulfilling inclusion criteria were included in the study. Data was collected by reviewing medical records in the form of a structured data abstraction form and analyzed by SPSS.

RESULT

A total of 133 chart records were reviewed and the mean (±SD) age of study participants was 54.82 ± 20.49 years and ranged between 18-85 years of age. The majority of the patients, 47 (35.3%) were aged between 18-40 years. Nearly more than half of the patients 69 (51.9%) were females and two third [91 (68.4%)] of the patients were from Addis Ababa. Patients of the age group 40-59 with atrial fibrillation have an 82% lower chance of developing stroke than those in the age group >60 years and patients with underlying cardiovascular diseases have seven times higher odds of having a stroke compared to those without underlying cardiac diseases. Male patients with atrial fibrillation had 2.15 times higher odds of staying for > 24 hours at the emergency department compared to female patients. The odds of a > 24-hour stay in the ER significantly increased by 2.7 times as the patient became unstable compared to stable patients.

CONCLUSION

Males and those with unstable atrial fibrillation have a higher chance of staying more than 24 hours in the emergency room. According to the study, patients who were more than 60 years of age with underlying cardiovascular diseases had a higher likelihood of developing ischemic stroke.

Prognostic value of hemoglobin to serum creatinine ratio in ST-elevation myocardial infarction: a secondary analysis based on a cohort study

INTRODUCTION

The long-term relationship between hemoglobin to serum creatinine (HB/SCr) ratio and clinical outcomes in ST-elevation myocardial infarction (STEMI) remains uncertain. This study aimed to determine the predictive value of the HB/SCr ratio for long-term major adverse cardiovascular events (MACE) in patients with STEMI.

METHODS

This study was based on a prospective cohort conducted in China, which included 460 STEMI patients who successfully underwent primary percutaneous coronary intervention. Cox proportional hazards models were utilized to explore the relationship between the HB/SCr ratio and MACE in STEMI patients over a 30-month follow-up period. The predictive value of the HB/SCr ratio for MACE was assessed using the receiver operating characteristic curve.

RESULTS

A total of 118 patients (26%) developed MACE during the follow-up period. After adjusting for confounding factors, a lower HB/SCr ratio emerged as a significant predictor of MACE in STEMI patients. Subgroup analyses indicated that the HB/SCr ratio was inversely associated with MACE in patients aged ≥ 60 years, males, those with a history of hypertension, individuals experiencing anterior wall myocardial infarction, patients classified as Killip grade I, and those receiving single stent implantation. Sensitivity analysis revealed that the inverse association between the HB/SCr ratio and MACE occurrence persisted in patients with normal hemoglobin levels. The area under the curve for the HB/SCr ratio in predicting MACE was 0.611.

CONCLUSIONS

The baseline HB/SCr ratio was inversely associated with MACE, suggesting that it may serve as a useful biomarker for identifying high-risk STEMI patients at an early stage.

Correlation Between PhenoAgeAccel and Clinical Outcomes in Atrial Fibrillation Patients Undergoing Radiofrequency Catheter Ablation

Purpose

To investigate the relationship between phenotypic age (PhenoAge) and accelerated phenotypic age (PhenoAgeAccel) and recurrence of atrial fibrillation (AF) in patients after radiofrequency catheter ablation (RFCA).

Patients and Methods

Preoperative PhenoAge and PhenoAgeAccel were determined in AF patients undergoing RFCA. We used logistic regression models and subgroup analysis to study the relationship between PhenoAge and PhenoAgeAccel and the risk of AF recurrence. As for revealing the value of PhenoAgeAccel in predicting AF recurrence, the ROC curve analysis was performed. To further detect the enhancement role of in PhenoAgeAccel in the APPLE score and a model of established risk factors in predicting AF recurrence, C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was conducted.

Results

A total of 322 patients with AF who underwent RFCA in our hospital were included in the present study. The mean follow-up period was 21 months. The frequency of AF recurrence increased gradually as the PhenoAgeAccel index rose. The optimal cut-off value of the PhenoAgeAccel index was -0.338. Patients with PhenoAgeAccel ≥ -0.338 had a significantly greater likelihood of experiencing recurrent AF than those with PhenoAgeAccel <-0.338 (OR 3.989, 95% CI 2.006-7.933, p < 0.001). The association was also reflected in each subgroup. Incorporating the PhenoAgeAccel into the APPLE score and the existing model of established risk factors for recurrence may result in enhancements to the C-statistics, NRI and IDI (p<0.05), respectively.

Conclusion

PhenoAgeAccel was positively and independently associated with AF recurrence following RFCA.

Inflammatory Burden Index Associated with Recurrence of Atrial Fibrillation After Radiofrequency Catheter Ablation

Background

Recurrence rates of atrial fibrillation (AF) remain high after radiofrequency catheter ablation (RFCA), and inflammation plays an important role in the process. Inflammatory burden index (IBI) as a new inflammatory marker has been found to be associated with worse prognosis in cardiovascular disease. But there are no studies on its role in predicting AF recurrence. The aim of this study was to assess the value of IBI in predicting recurrence of AF after RFCA.

Methods

This was a single-center retrospective observational study. Consecutive enrolment of PersAF who underwent first-time radiofrequency ablation between January 2021 and June 2024. Inflammatory Burden Index (IBI) was calculated as C-reactive protein (CRP) × neutrophil/lymphocyte (NLR).

Results

A total of 142 (27.2%) patients experienced recurrence after RFCA. Multivariate analysis showed that PersAF (OR = 1.599; 95% CI: 1.028 ~ 2.486, p = 0.018), CHA2DS2-VASc score≥2 (OR = 1.769; 95% CI: 1.142 ~ 2.741, p = 0.011), LAD (OR = 1.098; 95% CI: 1.054 ~ 1.145, p < 0.001) and IBI (OR = 1.028; 95% CI: 1.007 ~ 1.050, p = 0.009), were independent predictors of recurrence. ROC analysis shows superiority of IBI (AUC=0.695, 95% CI: 0.647 ~ 0.743, p < 0.001) over CRP and NLR in predicting AF recurrence. When IBI was integrated into the traditional model (including PersAF, LAD and CHA2DS2-VASc Score), the discrimination and reclassification accuracy for the recurrence were significantly improved.

Conclusion

Inflammatory load index associated with the recurrence of AF after RFCA. Integration of IBI can improve the model about the recurrence of AF after RFCA.

Delayed diagnosis of the full triad autoimmune polyendocrine syndrome type 2 with adrenal crisis: a case report and literature review

Background

Autoimmune polyendocrine syndrome type 2 (APS-2) is a rare disorder characterized by autoimmune damage to multiple endocrine glands and typically involves primary adrenal insufficiency (PAI), autoimmune thyroid disease (AITD), and type 1 diabetes mellitus (T1DM). Clinical presentations that feature the full triad alongside adrenal crisis (AC) are rare, with only four such cases reported globally. While AC is the most life-threatening acute complication of APS-2, its pathogenesis is complex and incompletely understood. While there are multiple potential triggers, the role of exogenous substances such as traditional Chinese medicine [TCM] has not been systematically examined.

Case presentation

A 69-year-old female was hospitalized with a 9-year history of increasing fatigue, which had recently worsened due to high fever, anorexia, and vomiting lasting 2 days. She has previously been diagnosed with T1DM (nine years prior) and AITD (five years prior). Four years earlier, she underwent thymoma resection. Three years before admission, she self-administered an unknown TCM remedy that coincided with increased fatigue and mucocutaneous hyperpigmentation. On admission, she was in hypovolemic shock and severe hyponatremia (118.0 mmol/L). Laboratory tests revealed low basal cortisol (2.38 μg/dL) and markedly elevated adrenocorticotropic hormone (>1250 pg/mL). An adrenocorticotropic hormone stimulation test confirmed non-responsive adrenal function, indicating PAI. Together with her medical history and positive antibody profile, APS-2 with AC was diagnosed. She responded well to high-dose intravenous glucocorticoid therapy, sodium supplementation, and symptomatic management. Although persistent hyponatremia recurred following discharge, it resolved following fludrocortisone acetate supplementation, and her condition remained stable at the last follow-up.

Conclusion

We report the fifth case of full-triad APS-2 with AC and document a 9-year diagnostic delay due to non-specific symptoms with asynchronous multi-glandular involvement. Thyroxine replacement therapy and potential TCM-induced changes may have aggravated cortisol metabolism and immune imbalances, hastening adrenal failure. Clinicians should implement stepwise organ-function monitoring in patients with any single-gland autoimmune disease, maintain vigilance for exogenous medication use, and implement multidisciplinary management strategies to mitigate the risk of AC. This case provides critical insights into both the pathogenesis and clinical management of APS-2.

Association between urinary albumin-to-creatinine ratio and all-cause and cardiovascular-cause mortality among MASLD: NHANES 2001-2018

Background

Urinary albumin-to-creatinine ratio (UACR) is an established biomarker for assessing kidney damage, but recent studies suggest it may also reflect broader health risks. This study aimed to investigate the association between UACR and all-cause and cardiovascular disease (CVD)-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods

In this prospective cohort study, we included sample of 3,412 MASLD enrolled in the National Health and Nutrition Examination Survey 2001-2018. The study population was divided into three different risk categories based on urinary UACR: low level (<4.67 mg/g), intermediate level (4.67-7.67 mg/g), and high level (7.68-30 mg/g). Cox proportional hazards models were used to estimate the hazard ratios (HR) for the association between UACR level and both all-cause and CVD-cause mortality. Restricted cubic spline (RCS) curve analysis was employed to assess the non-linear association between UACR and mortality. Kaplan-Meier (KM) survival curves were used to evaluate survival rates across UACR groups.

Results

The study found that higher UACR levels, even within the normal range, were independently associated with increased risks of both all-cause and CVD-cause mortality. Each 1 mg/g increase in UACR was associated with a 4% higher risk of all-cause mortality (HR 1.04, 95% CI 1.03-1.05) and a 5% higher risk of cardiovascular mortality (HR 1.05, 95% CI 1.02-1.08). Compared with the low UACR group, high UACR both showed an increased all-cause mortality risk [HR, 2.69 (95% CI, 2.07-3.50)] and CVD-cause mortality risk [HR, 2.97 (95% CI, 1.76-4.99)]. RCS curve analysis revealed a non-linear positive correlation between UACR and both all-cause and CVD-cause mortality, identifying UACR thresholds of 7.467 mg/g for all-cause mortality and 7.195 mg/g for CVD-cause mortality. The KM survival curves confirmed that participants with lower UACR levels had higher survival rates.

Conclusion

Elevated UACR levels within the normal range, are associated with increased all-cause and cardiovascular mortality in patients with MASLD. UACR may serve as a useful early biomarker for identifying individuals at higher risk of mortality, supporting more proactive clinical interventions to manage MASLD-related risks.

Unsupervised clustering of single-lead electrocardiograms associates with prevalent and incident heart failure in coronary artery disease

Aims

Clinical consequences of coronary artery disease (CAD) are varied [e.g. atrial fibrillation (AF) and heart failure (HF)], and current risk stratification tools are ineffective. We aimed to identify clusters of individuals with CAD exhibiting unique patterns on the electrocardiogram (ECG) in an unsupervised manner and assess their association with cardiovascular risk.

Methods and results

Twenty-one ECG markers were derived from single-lead median-beat ECGs of 1928 individuals with CAD without a previous diagnosis of AF, HF, or ventricular arrhythmia (VA) from the imaging study in UK Biobank (CAD-IMG-UKB). An unsupervised clustering algorithm was used to group these markers into distinct clusters. We characterized each cluster according to their demographic and ECG characteristics, as well as their prevalent and incident risk of AF, HF, and VA (4-year median follow-up). Validation and association with prevalent diagnoses were performed in an independent cohort of 1644 individuals. The model identified two clusters within the CAD-IMG-UKB cohort. Cluster 1 (n = 359) exhibited prolonged QRS duration and QT intervals, along with greater morphological variations in QRS and T-waves, compared with Cluster 2 (n = 1569). Cluster 1, relative to Cluster 2, had a significantly higher risk of incident HF [hazard ratio (HR): 2.40, 95% confidence interval (CI): 1.51-3.83], confirmed by independent validation (HR: 1.77, CI: 1.31-2.41). It also showed a higher association with prevalent HF (odds ratio: 4.10, CI: 2.02-8.29), independent of clinical risk factors.

Conclusion

Our approach identified a cluster of individuals with CAD sharing ECG characteristics indicating HF risk, holding significant implications for targeted treatment and prevention enabling accessible large-scale screening.

Predictive Value of MHR, PLR Combined With NLRP1 for Severity and Long-Term Prognosis in Premature Coronary Artery Disease

OBJECTIVE

To investigate the predictive value of platelet to lymphocyte ratio (PLR), monocyte to high-density lipoprotein ratio (MHR) combined with nucleotide binding oligomeric domain like receptor protein 1 (NLRP1) for the severity of premature coronary heart disease (PCHD) and its 2-year long-term prognosis.

METHOD

A total of 132 patients with PCHD examined in our hospital from February 2020 to January 2022 were retrospectively selected as the research objects. All patients who met the criteria were divided into mild group, moderate group, and severe group according to the severity of PCHD. The patients were followed up for 2 years. Patients were then divided into good prognosis group (without adverse cardiovascular events, n = 96) and poor prognosis group (with adverse cardiovascular events, n = 36). The predictive value was evaluated by ROC curve and multivariate logistic regression analysis.

RESULTS

Compared with the mild group, the levels of MHR, PLR, and NLRP1 in the moderate group and the severe group were significantly increased (p < 0.05). The levels of MHR, PLR, and NLRP1 in the poor prognosis group were higher than the good prognosis group (p < 0.05). The area under the curve (AUC) of MHR, PLR, and NLRP1 alone and in combination for predicting the 2-year long-term prognosis of patients was 0.787, 0.653, 0.869, and 0.926, respectively. Combined markers showed superior predictive accuracy (p < 0.05). After adjusting for confounding factors such as treatment, comorbidities, weight, gender, and smoking, MHR, PLR, and NLRP1 were independent risk factors for severe progression and poor prognosis of PCHD (p < 0.05).

CONCLUSION

MHR, PLR, and NLRP1 were increased in patients with higher severity of PCHD and poor prognosis. The combined detection has certain clinical guiding value for PCHD. However, this study was a single-center retrospective study with a small sample size. Thus, the results need to be further verified.

A Retrospective Analysis Assessing Paravalvular Leak and Pacemaker Implantation Using TEE and Non-Contrast CT for CKD Patients Compared With CT Angiography for Annular Sizing Pre-TAVR

Background and Aims

Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for many patients with severe aortic stenosis. Proper pre-procedure sizing of the aortic annulus is crucial in preventing post-TAVR complications. This is typically performed with CT angiography, but the use of contrast is controversial in patients with chronic kidney disease (CKD).

Methods

This study of 557 patients from 2016 to 2021 sought to evaluate a contrast-sparing protocol for balloon expandable TAVR evaluation in patients with CKD, in which patients with glomerular filtration rate of less than 40 would undergo transesophageal echocardiogram (TEE) and CT without contrast (83 patients) for aortic annular sizing instead of CT angiography (445 patients).

Results

We found that there was no significant difference in rates of greater than trace or greater than mild paravalvular leak between the two groups at hospital discharge, 30 days, or 1-year post-TAVR. We also found no difference in rates of permanent pacemaker implantation at these same time points.

Conclusions

This suggests that TEE and non-contrast CT could be a viable alternative to CTA in patients with CKD, although more research into other variables such as mortality and other post-procedural complications is necessary.

Assessing level of awareness of atrial fibrillation among general public: a cross-sectional study

BACKGROUND

Patients with atrial fibrillation (AF) are at increased risk of stroke. Poor knowledge of AF in general population contributes to under-detection and treatment delay. Therefore, this study aimed to assess level of awareness of AF among general public in Dhulikhel municipality, Nepal.

METHODS

This was a cross sectional study involving quantitative approach using self-administered questionnaire. Participants of age ≥ 50 years from wards 4, 5, 6 and 7 of Dhulikhel municipality were enrolled. English version of AFKAT (Atrial Fibrillation Knowledge Assessment Tool) was translated and validated which was then used to assess the level of awareness of AF.

RESULTS

In total 355 respondents were recruited. The mean age group was found to be 65.57 ± 9.99 years. Mean percentage score of level of awareness of AF was found to be only 2.61%, which was very poor. Only 2.54% (n = 9) had good level of knowledge about AF. 95.77% (n = 340) had very poor level of awareness. Significant difference of mean awareness level was found between group with AF and without AF. Respondent with AF had 58.70% score compared with just 2.29% score of non-AF group. Knowledge deficits were more in older participants. The knowledge score of AF was found to be 3.55%, 4.21%, 0.05%, 1.21% and 0% among age groups 50-59 years, 60-69 years, 70-79 years, 80-89 years and ≥ 90 years respectively. Only 2.54% (9 out of 355) correctly identified that AF can lead to blood clot and stroke. Just 2.82% (10 out of 355) respondents recognized that anticoagulants are used to prevent stroke in AF patients.

CONCLUSIONS

The level of awareness of AF among general public of Dhulikhel was found to be very poor. Appropriate interventions need to be applied to educate risk groups about AF to reduce future risk of stroke and minimize public health burden.

CLINICAL TRIAL NUMBER

Not applicable.

Trends of Cardiac Complaints in Pediatric and Young Adult Populations During the COVID-19 Pandemic

The COVID-19 pandemic had a significant impact on the physical and mental health of all age groups. While many studies have evaluated the serious cardiac manifestation associated with multisystem inflammatory syndrome of children, there are less studies evaluating how the COVID-19 pandemic impacted the presentation of less severe symptomatic cardiac manifestations. This large retrospective cross-sectional study examined the impact of the COVID-19 pandemic on the cardiovascular health of patients 1 to 24 years of age by assessing care presentation trends for chest pain, palpitations, and syncope for patients in the military health system. Overall, chest pain had the highest rate of presentation when compared to syncope and palpitations. There was a significant decrease in the rate of incidence for all three cardiac symptoms during the first year of the COVID-19 pandemic compared to the pre-COVID-19 period. When comparing the second year of the COVID-19 pandemic to the pre-COVID-19 period, there was a significant decrease in chest pain and syncope but a slight increase in palpitations. Overall, our results showed that these common cardiac presentations did not greatly increase during the COVID-19 pandemic.

KLK8: charting new territories in left ventricular hypertrophy biomarker research

OBJECTIVE

This study investigates the diagnostic potential of serum Kallikrein-related peptidase 8 (KLK8) in detecting left ventricular hypertrophy (LVH).

METHODS

A total of 62 hypertensive patients with LVH, 60 without LVH, and 60 healthy controls were analyzed. LVH was defined by echocardiography using LVMI thresholds (>95 g/m2 for females, >115 g/m2 for males). Serum KLK8 levels were measured via ELISA, and receiver operating characteristic (ROC) curve analysis assessed its diagnostic performance.

RESULTS

KLK8 levels were significantly higher in hypertensive patients with LVH (8.59 ± 1.59 ng/mL) than in those without LVH (5.80 ± 1.35 ng/mL) and healthy controls (3.68 ± 0.82 ng/mL). KLK8 positively correlated with blood pressure and cardiac structural parameters, including IVST, LVPWT, and LVEDD. ROC analysis revealed high sensitivity and specificity, indicating KLK8's potential as a biomarker for early LVH detection in hypertension.

CONCLUSION

In hypertensive patients, KLK8 demonstrates good diagnostic value in predicting LVH.

Description of Atrial Fibrillation in a Cardiology Department in Mahajanga, Madagascar

Introduction Despite the increasing development of research on atrial fibrillation (AF), epidemiologic data remain limited in certain regions, particularly Madagascar. Madagascar is a country with limited resources and data on the cardiovascular health of the population. Our objectives were to report the prevalence of AF and to describe patient characteristics. Materials and methods This was a retrospective descriptive study that included 103 patients with AF during their hospitalization at the cardiology department of the Mahavoky Atsimo University Hospital in Mahajanga between January 2015 and July 2023. Results The prevalence of AF was 5.27%. The mean age of the patients was 59.53 years (±17.88), and the sex ratio was 1.10. All patients were symptomatic, and dyspnea (53.40%; n = 55) was the main symptom. Signs of heart failure (HF) were observed in 70.87% of cases (n = 73). The majority of patients (87.38%; n = 90) had a CHA2DS2-VASc (congestive HF, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, sex category) score ≥ 2, and of these, 10 patients were not anticoagulated. Vitamin K antagonists and direct oral anticoagulants were prescribed in 71.84% (n = 74) and 9.71% (n = 10) of cases, respectively. Rate control was the most commonly used therapeutic strategy. Spontaneous return to sinus rhythm occurred in 14 patients (13.59%). Twelve patients (11.65%) had a stroke, and one patient (0.97%) died during a mean hospital stay of 6.92 days (±4.7). Conclusions This study provides an overview of the situation in Madagascar. Management is far from meeting current recommendations for good practice, which is a major challenge.

Associations between fibrinogen levels and the risk of all-cause mortality: a long-term cohort study

Although prior research has investigated the link between fibrinogen and mortality risk, there is a notable lack of long-term cohort studies. This study seeks to examine the relationship between plasma fibrinogen levels and all-cause mortality. Fibrinogen levels were divided into low and high groups based on the median and further categorized into quartiles. Kaplan-Meier analysis was employed for survival analysis, and hazard ratios (HRs) were calculated using the Cox proportional hazards model. Our study included 5,690 participants, divided into a lower fibrinogen group (fibrinogen ≤ 370 mg/dL, N = 2,851) and a higher fibrinogen group (fibrinogen > 370 mg/dL, N = 2,839). The survival probability of the lower fibrinogen group was higher than that of the higher group (70.98% vs. 47.98%, P < 0.0001). All-cause mortality was higher in the higher fibrinogen group compared to the low fibrinogen group (HR 1.26, 95% CI 1.09-1.45, P = 0.002). Compared to Q1, mortality risk increased in Q2 (HR 1.26, 95% CI 1.00-1.59, P = 0.05), Q3 (HR 1.39, 95% CI 1.15-1.69, P < 0.001), and Q4 (HR 1.51, 95% CI 1.23-1.87, P < 0.001). Higher fibrinogen levels correlate with an elevated risk of all-cause mortality, suggesting fibrinogen is a potential biomarker for mortality risk.

Medical management of acute severe ulcerative colitis in the hospitalized patient

INTRODUCTION

Approximately one in every four patients with ulcerative colitis will develop acute severe ulcerative colitis (ASUC). Historically, this was managed with intravenous steroids and surgery when steroids failed. The use of rescue therapy.

AREAS COVERED

This review summarizes the latest research in the management of hospitalized patients with ASUC. Covering the historical data and success of rescue therapy with cyclosporine and then with infliximab changed outcomes and reduced the risk of colectomy during the hospitalization and at 1 year. More recently, more biologics and small molecules have been approved and more patients present to the hospital with ASUC already failing anti-tumor necrosis factor antagonists. More recent studies have shown some efficacy of rescue therapy with other classes of biologics (e.g. interleukins and anti-integrins). The more recently approved small molecules (i.e. tofacitinib and Upadacitinib) have shown a rapid onset in therapeutic efficacy in as little as 1 day with sustained response at 1 year in reducing the risk of colectomy following ASUC.

EXPERT OPINION

In the expert opinion, we discuss the challenges in the treatment of patients with ASUC. We summarize the data of current biologics and new small molecules and their emerging roles in the management of ASUC.

Diagnostic value of neutrophil-to-lymphocyte ratio, fibrinogen-to-albumin ratio and red blood cell distribution width in tuberculosis combined with other bacterial infections

OBJECTIVE

To investigate the clinical significance of the neutrophil-to-lymphocyte ratio (NLR), fibrinogen-to-albumin ratio (FAR), and red blood cell distribution width (RDW) in pulmonary tuberculosis (PTB) associated with other bacterial lung infections.

METHODS

A total of 74 patients with PTB complicated with other bacterial lung infections, who were admitted to the Sixth People's Hospital of Nantong City (Nantong, China) from January 2021 to December 2023, were included in this study as the PTB with infection complication group. A comparison group of 96 patients with uncomplicated PTB, admitted to the same hospital during the same period, was used as the PTB without infection complication group. The NLR, FAR, and RDW values in peripheral blood were determined and compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of these indicators for early detection of PTB complicated with other bacterial infections.

RESULTS

The NLR, FAR, and RDW values were significantly higher in the PTB with infection complication group compared to the PTB without infection complication group, with differences reaching statistical significance (P < 0.05). NLR value showed a positive correlation with white blood cell count, C-reactive protein levels, and D-dimer levels. ROC curve analysis indicated that the area under the curve (AUC) values for diagnosing PTB with bacterial infection using blood NLR, FAR, and RDW were 0.861, 0.818, and 0.799, respectively. The combined AUC value of these three indicators was 0.982. The validation results showed that the diagnostic sensitivity (98.6%) and specificity (89.58%) of the combination of NLR, FAR, and RDW were higher than those of each indicator alone.

CONCLUSION

The combined assessment of blood NLR, FAR, and RDW values has high clinical diagnostic value for diagnosing PTB complicated with other bacterial infections.

Effect of atrial fibrosis on clot burden score and physicochemical properties of thrombus in patients with ischaemic stroke occurring in non-valvular atrial fibrillation

Background

To investigate the effect of the degree of atrial fibrosis on the clot burden score (CBS) and physicochemical properties in patients with acute ischaemic stroke (AIS) due to non-valvular atrial fibrillation (NVAF).

Methods

A total of 117 patients with AIS in NVAF attending the Department of Cardiovascular Medicine and the Cerebrovascular Diagnostic and Treatment Centre between August 2021 and May 2024 were included in the study. Baseline clinical data, biochemical indexes, and imaging data of the patients were collected, and the patients were divided into 93 cases of the CBS (score of 0-6) group and 24 cases of the CBS (score of 7-10) group according to the CBS. CBS (score of 0-6) signifies higher clot burden. The enzyme-linked immunosorbent assay was used to measure the concentration of galactaglutinin-3 (gal-3) and transforming growth factor (TGF-β1) in the serum of the patients, and the PTFV1 were collected by 12-lead electrocardiogram, and the differences in the degree of atrial fibrosis between different groups and the risk factors of CBS (score of 0-6) were analysed. To analyse the effect of atrial fibrosis on the collateral circulation of stroke, the patients were divided into 31 cases with good collateral circulation (grade 3-4) and 86 cases with poor collateral circulation (grade 0-2) according to the digital subtraction angiography (DSA) images. The cerebral thrombus was collected from 60 AIS patients who underwent mechanical thrombectomy. The content of erythrocyte, fibrin/platelets and leukocytes in the thrombus was analysed by Mathew's scarlet blue staining, and the density of thrombus was measured by computed tomography (CT).

Results

A total of 117 patients were included in this study, and the proportion of hypertensive patients, proportion of chronic atrial fibrillation (CAF), B-type natriuretic peptide (BNP), neutrophil/lymphocyte ratio (NLR), D-dimer, uric acid concentration, proportion of patients with PTFV1 < -0.03 mm s, gal-3, and TGF-β1 were higher in the CBS (score of 0-6) group as compared to the CBS (score of 7-10) group (P-value < 0.05). Hypertension, proportion of CAF, homocysteine, NLR, D-dimer, uric acid, PTFV1 < -0.03 mm s, gal-3, and TGF-β1, were risk factors for the development of high CBS in atrial fibrillation (AF), and hypertension and CAF were the most important factors for the occurrence of AF in the independent risk factors for stroke combined with high clot burden. gal-3 and TGF-β1 were risk factors for poor collateral circulation, atrial fibrosis indexes were not associated with thrombus pathological composition and thrombus density.

Conclusions

Atrial fibrosis increases clot burden in patients with AIS due to NVAF but does not significantly correlate with the physicochemical properties and density of the thrombus.

Mortality patterns of coronary artery diseases and atrial fibrillation in adults in the United States from 1999 to 2022: An analysis using CDC WONDER

BACKGROUND

Coronary artery disease (CAD) and atrial fibrillation (AF) contribute significantly to global mortality and frequently co-exist due to shared risk factors like hypertension and diabetes. This study seeks to explore the relatively overlooked area of mortality patterns among adults who have both coronary artery disease and atrial fibrillation.

METHODS

Mortality data for individuals aged ≥25 were obtained from CDC WONDER using ICD-10 codes I20-25 (CAD) and I48 (AF). Age-adjusted mortality rates (AAMR) and crude mortality rates per 100,000 were calculated. Trends were analyzed by gender, year, race, urbanization, and state. JoinPoint regression estimated annual percent change (APC) and average annual percent change (AAPC) with 95 % confidence intervals (CI).

RESULTS

From 1999 to 2022, there were 942,461 recorded deaths among individuals with CAD and AF in the United States. The AAMR rose from 14.35 in 1999 to 24.53 in 2022, resulting in an AAPC of 2.56* (95 % CI, 2.24 - 2.85). The AAMR showed a consistent increase throughout the study period, with a significant spike from 2018 to 2022 (APC: 6.87*; 95 % CI, 4.82 - 10.66). Men consistently had higher AAMRs than women. Non-Hispanic (NH) White individuals reported the highest AAMR, followed by NH Black, Hispanic, and NH other populations. Nonmetropolitan areas exhibited higher AAMR than metropolitan regions.

CONCLUSIONS

AAMR showed a moderate rise from 1999-2018, followed by a sharp increase from 2018-2022, possibly linked to COVID-19. Further research is needed to understand contributing factors.

Optimizing dialysis modalities for diabetic end-stage kidney disease: A focus on personalized care and resource-limited settings

Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide. While both haemodialysis (HD) and peritoneal dialysis (PD) are commonly used treatment options for ESKD, the choice of dialysis modality in diabetic ESKD patients remains a critical decision influenced by various patient-related, healthcare system, and socio-economic factors. This article examines the factors influencing the selection of dialysis modalities for diabetic patients, with a focus on the challenges and opportunities in low-resource settings. Key considerations include the impact of comorbidities such as peripheral arterial disease and CKD-related mineral bone disorder (MBD), as well as patient preferences, caregiver burden, and the availability of healthcare infrastructure. The article highlights the need for personalized approaches to dialysis selection, considering both clinical outcomes and quality of life. It also emphasizes the potential benefits of home dialysis, including home HD and PD, in improving patient autonomy and long-term survival. The article advocates for better government policies, increased awareness, and improved support systems to enhance the accessibility and efficacy of dialysis treatments, particularly in underserved populations. Further research comparing the outcomes of different dialysis modalities across diverse settings is essential to guide global treatment strategies for diabetic ESKD patients.

Transcutaneous delivery of disease-specific PI3K/Akt/mTOR inhibitor-based hybrid nanoparticles in hydrogel system for the management of psoriasis: Insights from in vivo studies

Psoriasis is a chronic autoimmune skin disorder characterized by excessive epidermis thickening, keratinocyte proliferation, and angiogenesis, driven by the PI3K/Akt/mTORC1, one of the key signalling axis of psoriasis. Corticosteroids used for treatment have limited efficacy and numerous side effects, thereby necessitating the development of safer, targeted therapeutic options for improved disease management and patient outcomes. Here we address this problem by encapsulating the PI3K/Akt/mTORC1 inhibitor Rapamycin in lipid-polymeric conjugated hybrid nanoparticles (RPMN) and incorporating these particles in a carbopol-based hydrogel system (RPMNGel), with enhanced release kinetics, long-term stability, better spreadability over reported literature for the treatment of psoriasis, and skin residence time. Using an in-vivo imiquimod-induced psoriatic model, in comparison to free drug-loaded gels, RPMNGel showed increased accumulation and deeper epidermal penetration, and slower diffusion within the psoriatic skin without causing any side effects to normal skin. The cumulative psoriasis area severity index score reduced from 10.5 to 5. 1 at day 7 in the group treated with RPMNGel. Overall, our studies establish the efficacy of RPMNGel for improved psoriasis treatment and management through enhanced drug penetration, prolonged drug release and reduced systemic toxicity.

Association of atrial cardiopathy and residual shunt after patent foramen ovale closure in patients experiencing migraine

AIMS

Migraine is a prevalent and incapacitating condition. The association between patent foramen ovale (PFO) and migraine-type headaches has been extensively documented. In clinical practice, patients may observe residual shunting after PFO closure. Nevertheless, the underlying mechanisms affecting residual shunting after PFO closure remain unclear. Recent studies have identified left atrial abnormalities, specifically atrial cardiopathy, as an independent risk factor for the development of atrial fibrillation (AF), left atrial thrombosis, and subsequent stroke. To that end, the present study aims to investigate the relationship between residual shunt occurrence after PFO closure and atrial cardiopathy.

METHODS

A retrospective analysis comparing postoperative residual shunts in patients with and without atrial cardiopathy was conducted. The study cohort consisted of 174 patients with severe migraine and confirmed right-to-left shunt (RLS) (grades II-IV) who voluntarily opted for PFO closure between April 1, 2021, and December 31, 2022. Enrolled patients were categorized into two groups: PFO with or without atrial cardiopathy.

RESULTS

A total of 174 migraineurs who underwent PFO closure (PFO with atrial cardiopathy group, n = 20; PFO without atrial cardiopathy group, n = 154) were included. Compared to patients without atrial cardiopathy, those with atrial cardiopathy were older (54.85 ± 11.86 vs. 43.03 ± 13.78 years, p = 0.0003), had a higher prevalence of hypertension (30.00% vs. 11.69%, p = 0.0255), and a higher prevalence of diabetes mellitus (10.00% vs. 1.30%, p = 0.0146). Following fully adjusted multivariate logistic analysis, atrial cardiopathy (OR = 0.119; P = 0.046), BMI (OR = 0.875; P = 0.025) and atrial septal aneurysm (OR = 5.465; P = 0.028) were identified as independent predictors for residual right-to-left shunt.

CONCLUSIONS

The presence of atrial cardiopathy in patients with severe migraine and PFO was inversely associated with residual shunting following PFO closure.

The impact of clinical phenotypes of coronary artery disease on outcomes in patients with atrial fibrillation: A post-hoc analysis of GLORIA-AF registry

BACKGROUND

Coronary artery disease (CAD) and atrial fibrillation (AF) often coexist, but the impact of clinical phenotypes of CAD on outcomes in AF patients in the non-vitamin K antagonist oral anticoagulant drugs (NOACs) era is less well understood.

METHODS

This was a post-hoc of the GLORIA-AF registry, a global, multicenter, prospective AF registry study. Patients were divided into three groups: prior history of myocardial infarction (MI)/unstable angina group (Group 1); stable angina group (Group 2); and a control group without stable angina or history of MI/unstable angina. The primary endpoint was the composite of all-cause death or stroke, and the safety endpoint was major bleeding.

RESULTS

A total of 24,827 patients were included in this analysis (median age was 71 (IQR, 64-78) years; 55% male) and 5394 (21.7%) had CAD. During a follow-up of 2 years, the incidence of the primary endpoint was 5.99 (95% CI, 5.33, 6.71) per 100 patient-years in Group 1, 4.04 (95% CI, 3.55, 4.70) per 100 patient-years in Group 2, and 2.79 (95% CI, 2.62, 2.96) per 100 patient-years in the control group (p < .001). Compared the control group, the adjusted hazard ratio of the primary composite endpoint in Groups 1 and 2 were 1.58 (95% CI, 1.37, 1.83, p < .001) and 1.22 (95% CI, 1.04, 1.43, p = .012), respectively. Among anticoagulated patients with AF and CAD, NOACs were associated with a reduced risk of the primary composite endpoint and major bleeding, compared with vitamin K antagonists (VKA).

CONCLUSIONS

CAD was prevalent in patients with AF, and clinical phenotypes of CAD influenced outcomes in patients with AF, with a history of MI/unstable angina being associated with a significantly increased risk of CV events, compared to stable angina. NOACs were superior to VKA in terms of the effectiveness and safety outcomes in patients with AF and concomitant CAD.

Relationship Between Epicardial Adipose Tissue and Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

INTRODUCTION AND AIM

Heart failure with preserved ejection fraction (HFpEF) is a significant clinical challenge, often coexisting with atrial fibrillation (AF), which exacerbates patient outcomes by increasing risks of stroke, hospitalizations, and mortality. Recent studies suggest that epicardial adipose tissue (EAT), a metabolically active fat depot, may contribute to AF pathogenesis by promoting atrial remodeling and fibrosis. This study aimed to evaluate the relationship between EAT thickness and AF in HFpEF patients.

MATERIALS AND METHODS

A total of 110 HFpEF patients were included, with 20 (18.2%) having documented AF. EAT thickness was measured using transthoracic echocardiography, and AF was confirmed via electrocardiography.

RESULTS

Patients with AF had significantly greater EAT thickness compared to those without AF (8.3 ± 0.9 mm vs. 7.1 ± 0.8 mm, p < 0.001). Receiver operating characteristic (ROC) analysis demonstrated that EAT thickness was a strong predictor of AF (AUC = 0.87, p < 0.001), with a cut-off value of 7.5 mm achieving 89% sensitivity and 75% specificity.

CONCLUSION

These findings indicate that increased EAT thickness is independently associated with AF in HFpEF patients, highlighting its potential as a biomarker for AF risk stratification. Future studies should explore whether targeting EAT could improve clinical outcomes in this high-risk population.

Robotic-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting with Concomitant Left Atrial Appendage Exclusion

Off-pump robotic-assisted minimally invasive direct coronary artery bypass (MIDCAB) achieves revascularization without conventional sternotomy and provides benefit to patients that otherwise may not be ideal surgical candidates. For patients with comorbid atrial fibrillation, left atrial appendage exclusion may reduce stroke risk and is achievable via mini thoracotomy during concomitant MIDCAB. Here, we report four patients who underwent off-pump robotic-assisted MIDCAB and concurrent epicardial left atrial appendage exclusion. Intraoperative transesophageal echocardiography confirmed complete left atrial appendage exclusion in all cases. The concomitant robotic approach proved to be feasible, efficacious, and safe, with no postoperative mortality or stroke events during follow-up.

Atrial Fibrillation as an Independent Predictor of Myocardial Ischemia

Background and Objectives: Atrial fibrillation (AF) and coronary artery disease (CAD) are highly prevalent cardiovascular conditions. This study investigated the role of AF in myocardial ischemia, as assessed with myocardial perfusion imaging (MPI), in patients with suspected stable CAD. Materials and Methods: Our retrospective study included 259 individuals with a negative medical history of CAD who underwent 99mTc tetrofosmin MPI-single-photon emission computed tomography (SPECT)-for nonspecific symptoms to rule out stable CAD. Results: Of the enrolled patients, 90 MPIs were from patients with AF and 169 MPIs were from patients without AF. Semi-quantitative assessments of the extent and severity of perfusion abnormalities according to the summed stress score (SSS) and summed difference score (SDS) were conducted. It was found that patients with a history of AF, compared to patients without AF, were older (p < 0.001), of the male gender (p < 0.001), and had dyslipidemia (p = 0.019). History of AF was associated with increased SSS ≥ 4 (OR 5.12, p < 0.001) and SDS ≥ 2 (OR 2.66, p < 0.001). After adjustment for other risk factors, AF remained an independent predictor of myocardial ischemia on MPI-SPECT. Conclusions: In the current study, an association of AF with extensive perfusion defects in MPI-SPECT studies was found in patients with clinically suspected CAD independently of common cardiovascular risk factors.

CITE-Seq Analysis Reveals a Differential Natural Killer Cell SPON2 Expression in Cardiovascular Disease Patients Impacted by Human-Cytomegalovirus Serostatus and Diabetes

Coronary artery disease (CAD) is linked to atherosclerosis plaque formation. In pro-inflammatory conditions, human Natural Killer (NK) cell frequencies in blood or plaque decrease; however, NK cells are underexplored in CAD pathogenesis, inflammatory mechanisms, and CAD comorbidities, such as human cytomegalovirus (HCMV) infection and diabetes. Analysis of PBMC CITE-seq data from sixty-one CAD patients revealed higher blood NK cell SPON2 expression in CAD patients with higher stenosis severity. Conversely, NK cell SPON2 expression was lower in pro-inflammatory atherosclerosis plaque tissue with an enriched adaptive NK cell gene signature. In CAD patients with higher stenosis severity, peripheral blood NK cell SPON2 expression was lower in patients with high HCMV-induced adaptive NK cell frequencies and corresponded to lower PBMC TGFβ transcript expression with dependency on diabetes status. These results suggest that high NK cell SPON2 expression is linked to atherosclerosis pro-homeostatic status and may have diagnostic and prognostic implications in cardiovascular disease.

Left atrial appendage velocity, association with inflammatory indices in non-valvular atrial fibrillation patients

INTRODUCTION

Decreased left atrial appendage emptying velocity (LAAV) is a marker for thrombus formation. This study evaluates the association between LAAV and inflammatory indices in non-valvular atrial fibrillation (AF) patients.

METHODS

The study population was 1428 patients with AF, 875 of whom enrolled. Based on the LAAV, patients were divided into three groups of 262 patients with a velocity of <25 cm/s, 360 patients with a velocity of 25 to 55 cm/s, and 253 patients with a velocity of >55 cm/s to assess and compare in terms of inflammatory indices, including the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, systemic immune inflammation index, neutrophil - to - platelet ratio and white blood cell-to-platelet ratio (WPR).

RESULTS

There was no statistical difference in the level of inflammatory indices between the three groups, and none of them were related to LAAV (p > .05) except WPR with a weak negative correlation (p = 0.01, r = -0.10). Patients with lower LAAV were found to have a higher age (p = 0.001), decreased left ventricular ejection fraction (p = 0.001) and greater left atrial volume index (p = 0.001).

CONCLUSION

This study did not show any association between inflammatory indices and LAAV in non-valvular AF patients except for the WPR.

Inflammatory Bowel Disease and Stroke: Exploring Hidden Vascular Risks

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is primarily known for its gastrointestinal manifestations. However, emerging evidence suggests a potential link between IBD and an increased risk of stroke, likely mediated by chronic systemic inflammation, endothelial dysfunction, and a prothrombotic state. Despite this growing recognition, the exact mechanisms and extent of this association remain unclear, highlighting a critical knowledge gap. This review aims to systematically analyze the association between IBD and stroke, exploring the underlying vascular mechanisms and identifying potential risk factors contributing to cerebrovascular events in IBD patients. A comprehensive literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across PubMed, Scopus, and Google Scholar using keywords such as "IBD," "Stroke," "Chronic inflammation," "Cerebrovascular risk," and "Gut-brain axis." After screening 150 studies and applying inclusion and exclusion criteria, six studies were included in the final synthesis. The findings suggest that chronic inflammation in IBD plays a key role in increasing stroke risk through endothelial dysfunction and a heightened prothrombotic state, with additional risk factors such as atrial fibrillation during active IBD flares further contributing to cerebrovascular events. While biologic therapies, including tumor necrosis factor (TNF)-alpha inhibitors, are effective in reducing systemic inflammation, their impact on mitigating stroke risk remains inconclusive. Given the potential role of IBD as an independent risk factor for stroke, a multidisciplinary approach to management is crucial. Addressing modifiable risk factors through pharmacologic interventions such as biologics, statins, and antiplatelet agents, alongside lifestyle modifications, could help reduce cerebrovascular complications in IBD patients. Further research is needed to explore personalized therapeutic strategies and establish clearer preventive guidelines for this at-risk population.

The Role of Artificial Intelligence in the Detection of Cardiac Amyloidosis: A Systematic Review

Cardiac amyloidosis (CA) is an underdiagnosed condition that occurs when misfolded amyloid proteins deposit in cardiac tissue causing progressive myocardial dysfunction. Artificial intelligence (AI) technology demonstrates strong potential to enhance the identification of various cardiovascular diseases, including CA. This systematic review examines how AI systems identify CA. This study explores AI's application as a diagnostic tool for CA. We searched five databases (PubMed/MEDLINE, Scopus, Web of Science, Embase, and IEEE Xplore) for relevant studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ten of the 629 studies we discovered were determined to be suitable for the current systematic review. We used the PICOS (P: population, I: intervention or exposure, C: comparison, O: outcome, S: study type) framework to collect relevant data from the included studies. The screening procedure was blinded and used predefined inclusion and exclusion criteria. It was undertaken in two phases. Whenever disagreements emerged, the reviewers deliberated and concluded. After the screening procedure, 10 studies in all were judged suitable for this review. Through the analysis of standard laboratory data, transthoracic echocardiography, electrocardiogram, medical records, cardiac magnetic resonance, and whole-body scintigraphy, these studies assessed the potential usefulness of AI models in diagnosing CA. AI models have been useful as a CA diagnostic tool, outperforming professional cardiologists in one instance or being on par with them in others.

Identifying Risk Factors of Major Adverse Cardiac Events in Patients With Ulcerative Colitis: A Retrospective Japanese Claims Data Analysis

BACKGROUND AND AIM

We conducted a retrospective study to identify incidence rates and potential risk factors of major adverse cardiac events (MACE) in Japanese patients with ulcerative colitis (UC), as existing data are scarce, inconsistent, and provide limited representation of the real-world situation of MACE in Japan.

METHODS

We utilized administrative claims data, collected between January 2013 and December 2022, from Medical Data Vision, Japan. Patients (aged ≥ 20 years) diagnosed with UC within ± 1 month of the prescription date during the study period were included in the incident cohort. Exclusions comprised patients diagnosed with UC in the first 365 days or with myocardial infarction, heart failure, stroke, or other ischemic heart diseases within 30 days pre-index. The cumulative incidence rate of MACE was calculated using the Kaplan-Meier method. Multivariate Cox regression models were used to calculate hazard ratios (HRs) for all relevant potential risk factors.

RESULTS

Of 11 407 patients in the incident cohort, 91 (0.8%) experienced incident MACE. Over 120 months, the cumulative incidence rate of MACE was 2.86% (95% confidence interval [CI]: 1.89-4.32). Significant HRs (95% CI) were found for age category (≥ 65 years) (4.557 [2.786-7.452]), diabetes (1.709 [1.030-2.835]), and atrial fibrillation (AF) (2.759 [1.188-6.405]) (all p < 0.05). Patients with a history of stroke showed numerically increased risk (1.871 [0.508-6.886]) of MACE.

CONCLUSIONS

The cumulative incidence rate of MACE was 2.86% over 120 months. Age, comorbidities of diabetes and AF, and history of stroke were the major risk factors for MACE in Japanese UC patients.

Oral anticoagulant (OAC) monotherapy vs. dual-antithrombotic therapy (DAT) in patients with atrial fibrillation and coronary artery disease; a meta-analysis of four randomized controlled trials

Background

Dual-antithrombotic therapy (DAT) is recommended for patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) but carries an increased risk of bleeding. Recent trials suggest oral anticoagulant (OAC) monotherapy as a safer alternative, but data remains limited. We conducted a meta-analysis to compare OAC monotherapy with DAT in this population.

Methods

A comprehensive literature search was conducted using PubMed, Embase, and Cochrane Central Library to identify randomized controlled trials (RCTs) that compared OAC monotherapy with DAT in patients with AF and stable CAD. A bivariate random-effects model was used to perform meta-analyses. Statistical analyses were conducted using R Software 4.4.1, with a significance level of P < 0.05. Heterogeneity was assessed using I 2 statistics, and the quality of studies was evaluated using the revised Cochrane risk-of-bias tool.

Results

Four RCTs with a total of 4123 patients (20.2% females) were included. The mean age of the participants was 74 years. The results showed a significant reduction in major or clinically relevant nonmajor bleeding (risk ratio [RR]: 0.52; 95% confidence interval [CI]: 0.34-0.80; P = 0.003) in the OAC monotherapy group compared to the DAT group. However, net adverse clinical events (NACE) (RR: 0.67; 95% CI: 0.45-1.01; P = 0.054), major ischemic events (RR: 0.98; 95% CI: 0.62-1.53; P = 0.91) and all-cause mortality (RR: 0.94; 95% CI: 0.49-1.83; P = 0.87) were comparable between the two groups.

Conclusions

In patients with AF and stable CAD, OAC monotherapy reduced the risk of major bleeding, with no significant differences in NACE, major ischemic events, or all-cause mortality as compared to DAT.

Recent Advances in Cardiac Resynchronization Therapy: Current Treatment and Future Direction

Cardiac Resynchronization Therapy (CRT) has been established as a major component of heart failure management, resulting in a significant reduction in patient morbidity and death for patients with increased QRS duration, low left ventricular ejection fraction (LVEF), and high risk of arrhythmias. The ability to synchronize both ventricles, lower heart failure hospitalizations, and optimize clinical outcomes are some of the attractive characteristics of biventricular pacing, or CRT. However, the high rate of CRT non-responders has led to the development of new modalities including leadless CRT pacemakers (CRT-P) and devices focused on conduction system pacing (CSP). This comprehensive review aims to present recent findings from CRT clinical trials and systematic reviews that have been published that will likely guide future directions in patient care.

Known yet underdiagnosed: Invasive assessment of coronary microvascular disease and its implications

Coronary microvascular disease (CMD) is one of the commonest causes of cardiac chest pain. The condition is more prevalent in women, and incidence is known to increase with age, hypertension, and diabetes. The pathophysiological pathways are heterogenous and related to intrinsic vascular and endothelial dysfunction. Furthermore, this entity is known to be associated with adverse cardiovascular outcomes. Despite this, there is inertia amongst cardiologists to further evaluate patients with non-critical coronary artery disease and suspected CMD. With refinement in technology, we have now better understanding of CMD and invasive testing in the catheterization laboratory is a viable option for confirming the diagnosis of CMD. However, despite advances in diagnosing and stratifying this entity, therapeutic options remain limited and poorly defined. In this editorial, we will briefly focus on the pathophysiology and invasive assessment and therapeutic options available for CMD.

Drug Advances in NAFLD: Individual and Combination Treatment Strategies of Natural Products and Small-Synthetic-Molecule Drugs

Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease and is closely associated with metabolic diseases such as obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome. However, effective treatment strategies for NAFLD are still lacking. In recent years, progress has been made in understanding the pathogenesis of NAFLD, identifying multiple therapeutic targets and providing new directions for drug development. This review summarizes the recent advances in the treatment of NAFLD, focusing on the mechanisms of action of natural products, small-synthetic-molecule drugs, and combination therapy strategies. This review aims to provide new insights and strategies in treating NAFLD.

Prediabetes and atrial fibrillation risk stratification, phenotyping, and possible reversal to normoglycemia

Patients admitted with prediabetes and atrial fibrillation are at high risk for major adverse cardiac or cerebrovascular events independent of confounding variables. The shared pathophysiology between these three serious but common diseases and their association with atherosclerotic cardiovascular risk factors establish a vicious circle culminating in high atherogenicity. Because of that, it is of paramount importance to perform risk stratification of patients with prediabetes to define phenotypes that benefit from various interventions. Furthermore, stress hyperglycemia assessment of hospitalized patients and consensus on the definition of prediabetes is vital. The roles lifestyle and metformin play in prediabetes are well established. However, the role of glucagon-like peptide agonists and metabolic surgery is less clear. Prediabetes is considered an intermediate between normoglycemia and diabetes along the blood glucose continuum. One billion people are expected to suffer from prediabetes by the year 2045. Therefore, real-world randomized controlled trials to assess major adverse cardiac or cerebrovascular event risk reduction and reversal/prevention of type 2 diabetes among patients are needed to determine the proper interventions.

Mesalazine-Induced Myocarditis in Inflammatory Bowel Disease: A Systematic Review

Crohn's disease (CD) and ulcerative colitis (UC) are two forms of inflammatory bowel disease (IBD). This chronic, immune-mediated disorder leads to inflammation in specific gastrointestinal tract regions. Myocarditis is a rare but significant IBD complication that affects roughly 0.3% of cases. Mesalazine-induced myocarditis is a rare side effect of mesalazine therapy, which is considered a standard treatment for IBD. Increased mortality and cardiogenic shock are possible outcomes of this adverse response. The objectives of this study are to characterize the clinical features of mesalazine-induced myocarditis in patients with IBD, to conduct a comprehensive analysis of mesalazine-related myocarditis cases in IBD patients, to review the existing literature, to elucidate the pathophysiological mechanisms of myocarditis in IBD, and to determine whether myocarditis represents an extraintestinal manifestation of IBD or an adverse drug reaction to mesalazine. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Relevant literature was retrieved from Cochrane, ScienceDirect, Google Scholar, PubMed, and PubMed Central (PMC). Only articles published in English or with a full English translation available within the last 10 years (2014-2024) were included. A rigorous quality assessment tool was applied to ensure the quality of evidence-based medicine that will be utilized to construct a conclusion and direct future reviews. Among 43 patients analyzed, 29 (67%) developed myocarditis attributable to mesalazine treatment, while 14 (33%) exhibited myocarditis unrelated to the medication. Our findings indicate that myocarditis in IBD is more likely to be a severe drug reaction than an extraintestinal manifestation of IBD progression. In drug-induced myocarditis cases, mesalazine derivatives, including sulfasalazine, mesalamine, and balsalazide, were most frequently implicated. Potential mechanisms underlying mesalazine-associated myocarditis include IgE-mediated hypersensitivity reactions, direct cardiotoxicity, cell-mediated hypersensitivity, or humoral antibody responses to drug metabolites. When treating myocarditis in IBD, whether due to medication or as an extraintestinal manifestation, discontinuing the offending drug and initiating immunosuppressive therapy appear to be the most effective approach.

Association between menopause, body composition, and nonalcoholic fatty liver disease: A prospective cohort in northern China

BACKGROUND

The association between menopause, changes in body composition, and nonalcoholic fatty liver disease is not clear, and there is a lack of weight management strategies for perimenopausal women from the perspective of preventing nonalcoholic fatty liver disease.

METHODS

A total of 1316 postmenopausal and 3049 premenopausal women in the Kailuan cohort in China between 2006 and 2017 were enrolled and followed up till 2021. Cox regression models, including the causal mediation analyses, were used to estimate the association between menopause and nonalcoholic fatty liver disease and the potential mediation effect of changes in body composition. We also explored the impact of weight changes on the correlation between menopause and nonalcoholic fatty liver disease.

RESULTS

Women who experienced menopause had a higher risk of nonalcoholic fatty liver disease than premenopausal women (9-year cumulative incidence: 56.87 % vs. 48.80 %, adjusted hazard ratio = 1.219, 95 % confidence interval: 1.088-1.365). The nine-year cumulative incidence of nonalcoholic fatty liver disease was higher among overweight/obese postmenopausal women (67.24 % vs. 45.74 %, P < 0.001) and those with abdominal obesity (63.36 % vs. 49.69 %, P < 0.001); however, the hazard ratio of menopause for nonalcoholic fatty liver disease was more evident in women with a body mass index under 23.0 kg/m2 (hazard ratio = 1.434, 95 % confidence interval: 1.168-1.759) and those with normal waist circumference (hazard ratio = 1.362, 95 % confidence interval: 1.129-1.643), which could partially be explained by the visceral fat index (7.09 % and 7.35 % mediation, respectively). Weight loss of 3 % or more or reduction in waist circumference by 5 % or more was associated with a 31.1 % reduction (95 % confidence interval, 20.8 %-40.0 %) or a 14.2 % reduction (95 % confidence interval, 1.1 %-25.6 %) in the risk of nonalcoholic fatty liver disease among the premenopausal women. For postmenopausal women, weight gain of 3 % or more was associated with an increased risk of nonalcoholic fatty liver disease, especially in individuals with a body mass index under 23.0 kg/m2.

CONCLUSION

Menopause was associated with a higher risk of nonalcoholic fatty liver disease, partially by increasing visceral fat. Controlling weight in perimenopausal women may reduce the risk.

Factors associated with cognitive impairment in patients with atrial fibrillation: A systematic review and meta-analysis

BACKGROUND

Atrial fibrillation (AF) is associated with an increased risk of cognitive impairment. Therefore, exploring factors which may be associated with cognitive impairment is important. Correspondingly, this study aimed to systematically evaluate factors associated with cognitive impairment in AF patients by synthesizing relevant evidence.

METHODS

A database search of the PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, Wanfang, and VIP databases was conducted from inception until December 21, 2023. The effect size was expressed as a combined odds ratio (OR) and 95 % confidence interval (95 % CI). The heterogeneity was qualitatively analyzed by Cochran's Q test and quantified by the I2 statistic.

RESULTS

A total of 7,128 studies were identified from the 8 databases, and 39 studies of 3,491,423 participants were included. A meta-analysis was performed on 19 influencing factors. Advanced age (OR=1.38, 95 % CI: 1.11-1.71), female sex (OR=2.19, 95 % CI: 1.18-4.06), smoking (OR=2.44, 95 % CI: 1.24-4.80), hypertension (OR=1.61, 95 % CI: 1.27-2.03), diabetes (OR=1.42, 95 % CI: 1.20-1.67), and hearing impairment (OR=1.37, 95 % CI: 1.05-1.81) were risk factors for cognitive impairment. A higher education level (OR=0.57, 95 % CI: 0.46-0.72), oral anticoagulants (OR=0.61, 95 % CI: 0.48-0.78), novel oral anticoagulants (OR=0.63, 95 % CI: 0.54-0.73), warfarin (OR=0.55, 95 % CI: 0.39-0.79), novel oral anticoagulants relative to warfarin (OR=0.88, 95 % CI: 0.81-0.97), catheter ablation (OR=0.74, 95 % CI: 0.58-0.94) and exercise (OR=0.66, 95 % CI: 0.61-0.72) were protective factors for cognitive impairment.

CONCLUSIONS

Age, sex, education level, smoking, exercise, hypertension, diabetes, hearing impairment, anticoagulation therapy, and catheter ablation were associated with cognitive impairment in AF patients.

Prognostic Value of Transvalvular Flow Rate in Aortic Stenosis: Implications for Risk Stratification

BACKGROUND

Timing of treatment of aortic stenosis (AS) is of key importance. AS severity is currently determined by transthoracic echocardiography (TTE) with a main focus on mean trans-aortic gradients. However, echocardiography has its limitations. The transvalvular flow rate (Q), is defined as the ratio of stroke volume (SV) to ejection time (ET): Q = SV/ET.

PURPOSE

To examine the prognostic value of aortic transvalvular flow rate (Q), in patients with moderate or severe AS.

METHODS

Clinical data from 824 patients diagnosed with AS between 2017 and 2020, and followed up until 2022 for four clinical outcomes: mortality, congestive heart failure (CHF), transcatheter aortic valve implantation (TAVI), and surgical aortic valve replacement (SAVR) was used for this retrospective study. Univariate and multivariate regression analyses were performed for the whole cohort and for the moderate AS subgroup, to identify prognostic markers. Kaplan-Meier survival analysis was conducted for different transvalvular flow rates and AS severities.

RESULTS

Findings demonstrate that lower Q is a significant risk factor for all-cause mortality even when adjusted for other echocardiographic and clinical variables. Survival analysis for the composite outcome occurrence (TAVI, SAVR, CHF, or mortality) and mortality showed significant differences between groups stratified by AS severity and Q (p value <0.0001). Specifically, Q was more substantial in the moderate AS group.

CONCLUSION

Transvalvular flow rate (Q) is independently prognostic for all-cause mortality. Furthermore, patients with moderate AS and lower Q should be closely monitored. Flow rate assessment should be integrated into the diagnosis, classification, and prognosis framework for AS.

A retrospective study of reported adverse events associated with cardiac stents in Indian population

BACKGROUND

Cardiac stents are utilized to treat coronary artery diseases, a leading cause of death worldwide including in India. We investigated frequency and nature of adverse events (AEs) associated with cardiac stents in the Indian population.

METHODS

The source data was systematically collected by National Coordination Centre-Materiovigilance programme of India (NCC-MvPI), anonymized from 2020 to 2022. The database contained 10,542 reports of medical devices adverse events, with cardiac stents accounting for 2,075 of these events. These reports were meticulously collected, cleaned, segregated, and analyzed.

RESULTS

We observed that 93% AEs associated with cardiac stents were serious, with the most common being dissection followed by chest pain, thrombosis, and breathing difficulties. However, only 5% of reports resulted in death. Additionally, male patients experienced more AEs than female and elderly patients had a higher incidence of AEs after stent placement.

CONCLUSION

The study highlights the need for continued research in this area to identify the root cause of AEs associated with cardiac stents and develop effective measures to reduce these incidences. Future studies can also focus on evaluating the long-term outcomes of patients with cardiac stents to gauge safety and effectiveness of different stent types.

A Shocking Outcome: Cardioversion-Induced Flash Pulmonary Edema

Atrial fibrillation (AF) is the most common major cardiac rhythm disorder in adults and causes considerable morbidity and mortality, particularly in elderly patients. We present the case of a 75-year-old female admitted for acute heart failure with a history of AF and recurrent heart failure exacerbations. Despite aggressive medical management with amiodarone and diuretics, the patient continued to deteriorate. The cardiology team recommended electrical cardioversion to re-establish a normal sinus rhythm. By doing so, the patient developed flash pulmonary edema after the procedure and required immediate intubation with mechanical ventilation. There was a need for tracheostomy to facilitate prolonged ventilatory support after some time. Over time, they were weaned off the ventilator and discharged home after full recovery. This case illustrates the challenges of managing AF in an elderly patient and the possible risks of flash pulmonary edema due to cardioversion.

Prognostic value of the fibrinogen-to-albumin ratio (FAR) in patients with chronic heart failure across the different ejection fraction spectrum

The ratio of fibrinogen to albumin (FAR) is considered a new inflammatory biomarker and a predictor of cardiovascular disease risk. However, its prognostic value for patients with chronic heart failure (CHF) with different ejection fractions (EFs) remains unclear. A total of 916 hospitalized patients with CHF from January 2017 to October 2021 in the First Affiliated Hospital of Kunming Medical University were included in the study. Death occurred in 417 (45.5%) patients out of 916 patients during a median follow-up time of 750 days. Among these patients, 381 patients suffered from HFrEF (LVEF <40%) and 535 patients suffered from HFpEF or HFmrEF (HFpEF plus HFmrEF, LVEF ≥ 40%). Patients were categorized into high-level FAR (FAR-H) and low-level FAR (FAR-L) groups based on the optimal cut-off value of FAR (9.06) obtained from receiver operating characteristic (ROC) curve analysis. Upon analysing the Kaplan - Meier plots, the incidence of death was significantly higher in all patients with FAR-H and patients in both HF subgroups (p < 0.001). The multivariate Cox proportional hazard analyses indicated that the FAR was an independent predictor of all-cause mortality, regardless of heart failure subtype. (HR 1.115, 95% CI 1.089-1.142, p < 0.001; HFpEF plus HFmrEF, HR 1.109, 95% CI 1.074-1.146, p < 0.0001; HFrEF, HR 1.138, 95% CI 1.094-1.183, p < 0.0001) The optimal cut-off value of FAR in predicting all-cause mortality was 9.06 with an area under the curve value of 0.720 (95% CI: 0.687-0.753, p < 0.001), a sensitivity of 68.8% and a specificity of 65.6%. After adjusting for the traditional indicators (LVEF, Lg BNP, etc.), the new model with the FAR had better prediction ability in patients with CHF. Elevated FAR is an independent predictor of death in CHF and is not related to the HF subtype.

GLP-1, GIP/GLP-1, and GCGR/GLP-1 receptor agonists: Novel therapeutic agents for metabolic dysfunction-associated steatohepatitis

The global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is estimated at 32.4%, reflecting its growing clinical significance. MASLD, which includes MASLD and metabolic dysfunction-associated steatohepatitis (MASH) has been linked to increased metabolic, cardiovascular, and malignant morbidity. Progression into fibrotic stages of MASLD is also strongly associated with liver-related mortality. The past few years have seen a heightened focus on creating innovative therapeutic strategies for MASH management. GLP-1 receptor agonists (RA) have also emerged as a potential treatment option. Studies on GLP-1 agonists, such as liraglutide and semaglutide, have demonstrated efficacy in MASH management, albeit with limited histological improvement of fibrosis. However, recent investigations into GLP-1/GIP RA (tirzepatide) and Glucagon/GLP-1 RA (survodutide) have shown even more encouraging results, with higher rates of MASH resolution and fibrosis improvement. The tolerability of these medications due to their gastrointestinal side effects remains a major concern. Future research should focus on optimizing drug regimens, identifying patients most likely to benefit, and balancing efficacy with tolerability. The evolving landscape of MASH therapeutics suggests a bright future, with the potential for combination therapies to further enhance patient outcomes.

Relationship between predictive factors and atrial high-rate episodes in heart failure with reduced ejection fraction patients with cardiac implantable electronic devices

OBJECTIVE

Atrial high-rate episodes (AHRE) are atrial tachyarrhythmia episodes detected by implanted cardiac devices, characterised by an atrial rate exceeding 180-190 beats per minute. Recent studies have linked AHRE to the development of atrial fibrillation (AF) and increased stroke risk, especially when episodes last longer than 5-6 min. This study aimed to evaluate the relationship between predictive factors and the occurrence of AHRE in heart failure with reduced ejection fraction (HFrEF) patients with cardiac implantable electronic devices (CIEDs).

METHODS

This single-centre, retrospective study included a cohort of 155 consecutive HFrEF patients with CIEDs, but without a diagnosis of AF, enrolled between January 2023 and December 2023. Patients were stratified based on the presence of AHRE detected during device interrogation.

RESULTS

The average age of the patients was 54 ± 14 years, and 83.2% of the study population were male. Patients with AHRE had a reduced left ventricular ejection fraction (LVEF) (p = 0.026) and an increased left atrial diameter (p < 0.001) compared to the group without AHRE. Patients with AHRE had elevated levels of creatinine, uric acid, and TSH compared to those without AHRE (p = 0.006, p = 0.021, p = 0.009, respectively). In the univariable logistic regression analysis, LVEF (HR = 0.690, 95% CI = 0.610-0.913, p = 0.013), left atrial diameter (HR = 8.215, 95% CI = 1.557-43.34, p < 0.001), creatinine (HR = 7.369, 95% CI = 1.749-31.05, p = 0.006), uric acid (HR = 1.073, 95% CI = 1.062-1.196, p = 0.020), total cholesterol (HR = 0.989, 95% CI = 0.979-0.999, p = 0.031), and C-reactive protein levels (HR = 1.146, 95% CI = 1.002-1.131, p = 0.047) were identified as independent predictors of AHRE. In multivariable logistic regression analysis, left ventricular ejection fraction (HR = 0.890, 95% CI = 0.795-0.998, p = 0.046), left atrial diameter (HR = 8.215, 95% CI = 1.557-43.34, p < 0.001), and uric acid concentration (HR = 1.650, 95% CI = 1.063-2.561, p = 0.025) were identified as predictors of atrial high-rate events.

CONCLUSION

LVEF, left atrial diameter, and uric acid level were found to be independent predictors of AHRE in patients with HFrEF. Identifying AHRE is crucial for risk stratification and guiding therapeutic decisions to improve patient outcome.