Obstructive sleep apnoea (OSA) is highly prevalent in Western populations, causing breathing cessation during sleep due to airway collapse. OSA is strongly associated with cardiovascular disease and arrhythmia, with several mechanisms likely to increase arrhythmia incidence. Continuous positive airway pressure (CPAP) is the mainstay of treatment, and whilst CPAP effectively treats OSA, specific arrhythmias and major adverse cardiovascular events may remain unchanged. Furthermore, arrhythmias are likely significantly underdiagnosed in this population. Meanwhile, implantable loop recorders (ILRs) are the gold-standard detection method for arrhythmias.

This review aimed to systematically evaluate observational studies using ILRs to identify the incidence of arrhythmia in treated OSA patients. We searched the Medline/Excerpta Medica Database (EMBASE) databases, identifying observational studies involving any OSA patients with no history of arrhythmia and who had ILRs inserted. Two reviewers assessed the quality of the studies and potential bias using the Observational Study Quality Evaluation (OSQE) tool.

Three studies met the criteria with 77 participants; however, the study outcomes were incomparable and could not be pooled. CPAP significantly reduced bradyarrhythmia/pauses. There was a high incidence of atrial fibrillation (AF), up to 31%, although the sample size and overall characteristics were insufficient and could not be generalized. AF and other tachyarrhythmias were likely underdiagnosed in OSA patients. CPAP did reduce bradyarrhythmia/pauses but is potentially insufficient to reduce AF or other tachyarrhythmias. Only one ongoing study was found to evaluate the incidence of arrhythmias in OSA.

We highlight the need for arrhythmia screening in OSA patients and for further studies to clarify the true incidence of arrhythmias in OSA patients. These additional studies may influence the guidelines for arrhythmia screening and identify mechanisms and therapeutic targets in OSA.

The optimal endpoint for ablation in persistent atrial fibrillation (pers-AF) remains unclear. This study aimed to systematically evaluate the prognostic value of acute AF termination in predicting the recurrence of arrhythmias.

A systematic search of the PubMed, Cochrane Library, Web of Science, and Embase databases was conducted from inception to July 2023. Only studies with reports of acute termination for pers-AF and its predictive role in arrhythmia recurrence were included. Subgroup analysis was performed to identify potential confounders for the effect of AF termination.

A total of 22 studies were included in the meta-analysis. The pooled analysis indicated that acute termination of AF is significantly associated with an increased long-term success rate (relative risk (RR), 1.53; 95% CI, 1.41–1.66; p < 0.001; I² = 35.4%). Moreover, subgroup analysis revealed that patients with an AF duration >12 months (RR, 1.92; 95% CI, 1.57–2.35; p < 0.001), aged >60 years (RR, 1.92; 95% CI, 1.60–2.31; p < 0.001) may derive benefits from AF termination during ablation. Interestingly, a significant interaction was observed in the study design subgroup, where multi-center studies showed a success rate of RR, 1.31 (95% CI, 1.14–1.50; p < 0.001), while single-center studies exhibited a higher success rate of RR, 1.65 (95% CI, 1.49–1.82; p < 0.001), with an interaction p-value of 0.008. Importantly, acute termination of AF did not significantly increase procedural complications (RR, 1.19; 95% CI, 0.59–2.39; p = 0.627; I² = 0.0%).

Our study suggests that AF acute termination during ablation for pers-AF provides a better long-term clinical outcome.

CRD42023431015, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023431015.

This study collected data on the incidence and management of anomalous aortic origin of the coronary artery (AAOCA). We described the incidence of AAOCA and the observed outcomes after management.

This retrospective study focused on patients treated for AAOCA in a tertiary hospital during the last 20 years. Patients were divided into the anomalous left coronary artery from the pulmonary artery (ALCAPA) group, the non-ALCAPA group, and the symptomatic and asymptomatic groups. Clinical manifestations and related data after surgery were compared among the different groups.

From April 2003 to July 2022, 102 patients were diagnosed with AAOCA and treated at Beijing Anzhen Hospital. ALCAPA was identified as the most prevalent anomaly. The incidence of syncope and heart failure was significantly lower and higher, respectively, in the ALCAPA group. Surgical intervention yielded immediate benefits not only for ALCAPA patients but also for patients who underwent AAOCA. In total, 64.7% of the patients underwent coronary artery osteoplasty, which provided a comprehensive surgical approach addressing all anatomical issues associated with AAOCA. Compared to preoperative measurements, there was a significant reduction in the left ventricular end-diastolic diameter (LVEDD) after surgical intervention (p < 0.001). Both the ejection fraction (EF) before and after surgery and the incidence of inter-arterial abnormal vessels in the asymptomatic group were significantly higher than those observed in the symptomatic group (p < 0.001).

ALCAPA is most frequently observed among patients with AAOCA. Thus, surgical intervention benefits AAOCA patients, particularly asymptomatic individuals.

Excessive daytime sleepiness (EDS) is a commonly observed symptom in people with obstructive sleep apnea (OSA). However, the impact of EDS on the outcome of patients with acute coronary syndrome (ACS) and OSA is not known. Therefore, this study aimed to investigate the association between OSA and cardiovascular events in ACS patients with or without EDS.

This cohort study prospectively enrolled eligible ACS patients who underwent cardiorespiratory polygraphy during hospitalization between June 2015 and January 2020. We defined OSA as an apnea–hypopnea index (AHI) ≥15 events per h. EDS was described as having an Epworth Sleepiness Scale score ≥10. Major adverse cerebrovascular and cardiovascular events (MACCEs) were the primary outcome and included cardiovascular death, stroke, myocardial infarction, ischemia-driven revascularization, or hospitalization for heart failure or unstable angina.

The final study cohort comprised 1154 participants, of whom 398 (34.5%) had EDS, and 607 (52.6%) had OSA. During the median follow-up period of 2.9 years (interquartile range 1.5, 3.6), OSA was associated with a significantly increased risk of MACCEs in patients without EDS (adjusted hazard ratio (HR) = 1.42, 95% CI: 1.01–2.02, p = 0.046), but not in patients with EDS (adjusted hazard ratio HR = 1.05, 95% CI: 0.67–1.66, p = 0.84).

OSA was associated with an elevated risk of MACCEs In ACS patients without EDS but not those with EDS. Therefore, screening for OSA should be performed in ACS patients without EDS, and future trials should prioritize such high-risk patients.

NCT03362385, https://clinicaltrials.gov/study/NCT03362385.

Abdominal aortic aneurysm (AAA) is a major public health challenge and presents high mortality due to diagnostic and therapeutic difficulties. This study investigated the role of high-mobility group box2 (HMGB2) and the HMGB2-triggering receptor expressed on the myeloid cell (TREM) pathway in male AAA patients. The goal was to evaluate HMGB2 as a novel biomarker and to elucidate its contribution to the pathogenesis of AAA. Our findings offer new insights into AAA biology and highlight the potential application of HMGB2 for early detection and therapeutic targeting.

This retrospective case–control study included 36 male AAA patients and 41 male controls with balanced baseline characteristics. HMGB1, HMGB2, soluble TREM-1 (sTREM-1), and sTREM-2 serum levels were measured by enzyme-linked immunosorbent assay (ELISA). The association between HMGB2 and AAA was analyzed using multivariate logistic regression, while the diagnostic performance of HMGB2 was assessed using receiver operating characteristic (ROC) curves.

Elevated HMGB2 and HMGB1 levels were associated with higher risks of AAA (HMGB2: OR: 1.158, 95% CI: 1.011–1.325; p < 0.05; HMGB1: OR: 1.275, 95% CI: 1.048–1.551; p < 0.05) and aneurysm rupture (HMGB2: OR: 1.117, 95% CI: 1.005–1.241; p < 0.05; HMGB1: OR: 1.212, 95% CI: 1.003–1.465; p < 0.05). Meanwhile, sTREM-1 exhibited a negative correlation with AAA (OR: 0.991, 95% CI: 0.985–0.997; p < 0.01). The odds ratios of the fourth quartile HMGB2 and HMGB1 levels for AAA were 6.925-fold and 8.621-fold higher, respectively, than the first quartile levels. The HMGB2 serum level was positively correlated with a larger AAA diameter, with the diameter increasing progressively as the HMGB2 level increased. The area under the ROC curve (AUC) for predicting AAA was 0.713 for HMGB2, 0.677 for HMGB1, and 0.665 for sTREM-1. HMGB1 and sTREM-1 both correlated with HMGB2. Each HMGB1 quartile group exhibited a significant increase as HMGB2 increased. Further, sTREM-1 significantly increased at low to moderate HMGB2 levels but decreased in the highest HMGB2 quartile.

Elevated HMGB2 serum levels are independently associated with the incidence of AAA in males. HMGB2–TREM pathway disruption may play a critical role in AAA pathogenesis.

Recently, the transcatheter aortic valve replacement (TAVR) indications have expanded; meanwhile, valve systems have continuously evolved and improved. However, coronary occlusion (CO), a rare but catastrophic consequence of TAVR surgery, limits the expansion of indications for TAVR. Moreover, comparisons between different systems remain scarce. This study aimed to evaluate the incidence of CO associated with TAVR, specifically comparing self-expanding valves (SEVs) and balloon-expandable valves (BEVs), and further assess the safety profile of these valve subtypes.

The primary outcome of interest was the incidence of CO during TAVR using BEVs or SEVs. Electronic databases were searched from January 2009 to June 2023, and this study included randomized controlled trials, observational studies, and propensity pair-matched studies. Heterogeneity and inter-study variance were assessed using Cochran’s Q, I², and τ² (Sidik–Jonkman estimator). Random effects models were used based on the Bayesian theory framework. The node-splitting approach was generated to determine study network inconsistency. The convergence of the model was evaluated using the trajectory map, density map, and the potential scale reduction factor (PSRF). Rank sort graphs illustrate the best valve deployment techniques or valve types.

A total of 830 articles were searched referring to the incidence of CO using the valve deployment system of SEVs or BEVs during the TAVR procedure, from which 51 were included (27,784 patients). The procedure incidence of coronary obstruction was 0.4% for the SEVs and 0.6% for the BEVs. Treatment ranking based on network analysis revealed SAPIEN 3 (Edwards Lifesciences (Irvine, CA, USA)) possessed the best procedural CO incidence (0.05%) performance, whereas SAPIEN (Edwards Lifesciences (Irvine, CA, USA)) produced the worst (1.04%).

Our study indicates that CO incidence was not reduced during TAVR with BEVs compared to SEVs. SAPIEN 3 and SAPIEN had the lowest and highest TAVR-associated CO rates, respectively. These findings suggest that the SAPIEN 3 valve may be the best choice for reducing CO risk, and future studies should focus on its applicability in different populations. More randomized controlled trials with head-to-head comparisons of SEVs and BEVs are needed to address this open question.

CRD42024528269, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024528269.

Evidence is needed to determine the benefits and harms of screening for atrial fibrillation (AF) in stroke prevention. This meta-analysis aimed to evaluate the benefits and issues of AF screening among older adults.

This systematic review and meta-analysis were conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We systematically searched several databases from inception through 28 March 2025, selecting randomized controlled trials (RCTs) comparing AF screening, including systematic and opportunistic screening, versus routine practice or no screening. Two reviewers independently extracted the data and appraised the risks of bias of the studies.

Thirteen articles covering 12 RCTs were included in the meta-analysis. For routine screening, systematic screening, rather than opportunistic screening, was more effective in detecting new AF cases (relative risk (RR), 2.07; 95% CI, 1.41 to 3.04; p = 0.0002). However, no difference was observed in the effectiveness of systematic and opportunistic screening in detecting AF (RR, 1.39; 95% CI, 0.59 to 3.30; p = 0.45). Compared with no screening, single-time-point screening did not improve the AF detection rate, whereas intermittent/continuous screening was associated with a greater likelihood of detecting AF (RR, 2.40; 95% CI, 1.59 to 3.64; p < 0.0001). There were no significant differences in the anticoagulation prescription rate between patients who underwent screening and routine care (RR, 1.16; 95% CI, 0.94 to 1.44; p = 0.16). Systematic screening was associated with a lower risk for the composite endpoint (combination of thrombosis-related events and mortality; RR, 0.96; 95% CI, 0.93 to 0.99; p = 0.02) but not for the individual endpoints. Compared with routine care, systematic screening did not increase the risk of major bleeding (RR, 0.88; 95% CI, 0.72 to 1.06; p = 0.18), whereas a positive screening result could promote anxiety.

Systematic screening outperformed routine care but was comparable to opportunistic screening in detecting undiagnosed AF. Systematic screening was related to a reduction in the composite endpoints of stroke and all-cause mortality without increasing the risk of bleeding.

This systematic review was prospectively registered in PROSPERO, registration number: CRD42024558614, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024558614.

Atrial fibrillation and atrial flutter (AF/AFL) disease is a common arrhythmia that poses a significant health risk to the older population. With an aging population worldwide, the incidence and mortality rates of AF/AFL show notable gender differences, presenting a challenge to public health systems. This study focused on the AF/AFL disease burden trends in high-income European Union 15+ (EU15+) countries.

Data were sourced from the Global Burden of Disease Study (GBD 2021), using age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) by gender for each year from 1990 to 2021 in EU15+ countries; the mortality-incidence index (MII) was calculated. Analyses were conducted using Joinpoint regression software and age–period–cohort (APC) models to evaluate trends in morbidity, annual changes in morbidity (net drift), annual percentage changes in age-specific morbidity (local drift), and period- and cohort-relative risks by gender, allowing the impact of age, period, and cohort effects on morbidity trends to be assessed.

The study found a declining trend in AF/AFL ASIRs and ASMRs in most EU15+ countries, though significant differences were observed between countries. Male ASIRs and ASMRs were generally higher than those of females, though older women often had higher incidence and mortality rates than men. Furthermore, advances in treatment methods, such as updated anticoagulation therapy, radiofrequency ablation, and novel rhythm control drugs, have impacted the changes in disease burden.

Although the AF/AFL disease burden has declined in more than half of the high-income EU15+ countries, there are significant differences in trend changes between countries. This decline may be due to advances in treatment, such as newer anticoagulation therapies, radiofrequency ablation techniques, and the use of novel cardioverter drugs. Trend changes with unique characteristics may be related to the healthcare system of each country, socioeconomic factors, and the promotion of health education. This study also identified gender differences, with older women at greater risk of developing AF/AFL, implying that the older female population faces the need for enhanced risk assessment and management.

Despite prior research showing that elevated BAR levels were linked to poor prognoses in several cardiovascular disease conditions, the predictive role of the blood–urea–nitrogen to serum albumin ratio (BAR) in atrial fibrillation (AF) patients admitted to the intensive care unit (ICU) remains largely unknown.

Patients diagnosed with AF were gathered from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database, and the X-tile software was used to determine the best cut-off values for BAR. The Kaplan–Meier curves and receiver operating characteristics (ROC) analyses were used to evaluate the prognostic value of the BAR. The identified prognostic indicators were used to build a nomogram model.

Finally, 13,451 AF patients were included in this study. The best BAR cut-off value was 8.9. In-hospital survival was substantially higher in the low-BAR group (BAR ≤8.9) than in the high-BAR group (BAR >8.9) (HR: 3.15, 95% CI: 2.89–3.44; p < 0.001). A nomogram model was developed using the findings of multivariable logistic regression, considering variables such as age, heart rate, albumin, white blood cell count, simplified acute physiology score II (SAPS II) score, sequential organ failure assessment (SOFA) score, mechanical ventilation, and the BAR. When forecasting the probability of death for AF patients admitted to the ICU, the nomogram showed good performance and practical application. Calibration curves evaluated the accuracy of the model, decision curve analysis evaluated the clinical use of the model, and the area under the receiver operating characteristic (AUROC) curve evaluated the discriminative capabilities of the model.

Among critically ill AF patients, the BAR, a readily available clinical measure, shows outstanding predictive ability in predicting in-hospital mortality. Additionally, in-hospital mortality could be predicted with high accuracy using a nomogram that included the BAR.

The incidence of silent myocardial infarction (SMI) is increasing. Meanwhile, due to the atypical clinical symptoms and signs associated with SMI, the prognosis for patients is often poor.

This prediction model used the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses to screen variables. Predictive accuracy was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). The clinical decision curve analysis (DCA), alongside the calibration curve and clinical impact curve (CIC) analyses, were used to assess model validity.

This study included 174 patients, 64 (36.8%) of whom experienced SMI; logistic regression analysis identified six variables: gender, age, high-density lipoprotein cholesterol (HDL-C), apolipoprotein B/apolipoprotein A1 (ApoB/A1), uric acid (UA), and triglyceride glucose–body mass index (TyG–BMI). The results identified the TyG–BMI as a predictor of SMI (odds ratios (OR) = 1.02, 95% CI: 1.01–1.03; p = 0.003). The ROC curve of the model demonstrated an AUC of 0.772 (95% CI: 0.699–0.844), which increased to 0.774 (95% CI: 0.707–0.841) following a bootstrap analysis with 1000 repetitions. The calibration curve of the model was in high agreement with the ideal curve. The DCA demonstrated that the prediction probability threshold of the model ranged from 12% to 83%, where the patient achieved a significant net clinical benefit. The CIC showed that the model effectively identified high-risk SMI patients when the threshold probability exceeded 0.7.

The TyG–BMI is an independent predictor of SMI. A prediction model based on the TyG–BMI showed good predictive ability for SMI.

Contrast-induced acute kidney injury (CI-AKI) represents a significant cause of acute kidney injury (AKI) and accounts for 11% of all cases. Conventional biomarkers, such as serum creatinine (SCr), present limitations in terms of sensitivity and specificity for the early detection of CI-AKI. Therefore, this review examines the potential of cystatin C (CysC) as a biomarker for predicting CI-AKI in patients undergoing coronary procedures and assesses its effectiveness compared to traditional markers.

This systematic review was conducted using PubMed to identify studies published between January 2020 and March 2025. The inclusion criteria focused on original studies examining CysC levels for early CI-AKI detection in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Data extraction followed a standardized charting method, focusing on key findings from the selected studies.

A total of 7 studies met the inclusion criteria from an initial pool of 410 articles, with data extracted from these seven prospective studies. Key findings indicated that elevated preoperative CysC levels correlated with a higher risk of developing CI-AKI, demonstrating greater sensitivity and specificity than the conventional SCr biomarker. The mean cut-off values for CysC varied across studies, but consistent trends highlighted its potential as an early indicator of renal dysfunction.

CysC appears to be a more sensitive biomarker than SCr for the early detection of CI-AKI. This review suggests that integrating CysC measurement into clinical practice could enhance the early diagnosis and management of CI-AKI, ultimately improving patient outcomes. Hence, future research should focus on standardizing CysC cut-off values and further explore their implications in broader clinical settings and guidelines.

Insulin resistance has been recognized as a risk factor in the pathogenesis of various diseases. The estimated glucose disposal rate (eGDR) has been widely validated as a reliable, noninvasive, and cost-effective surrogate measure of insulin resistance. However, the relationship between eGDR and abdominal aortic aneurysm (AAA) has not yet been fully elucidated. This study sought to investigate the association between the eGDR levels and the risk of AAA development.

This prospective cohort study enrolled participants from the UK Biobank who had complete eGDR measurements and no pre-existing AAA at baseline (2006–2010). Participants were stratified into quartiles according to their eGDR values. The association between eGDR and AAA was assessed using Cox proportional hazards models with results expressed as the hazard ratio (HR) and 95% confidence interval (CI). Kaplan–Meier curves were generated to visualize cumulative AAA incidence across eGDR quartiles, whereas restricted cubic splines (RCSs) were applied to characterize the exposure–response relationship. Sensitivity and subgroup analyses were conducted to assess the robustness of the findings.

The final analytical cohort comprised 416,800 participants (median age: 58.0 years (IQR: 50.0–63.0), 45.83% male). During the median follow-up of 13.6 years, 1881 incident AAA cases were recorded. The Kaplan–Meier curve analysis demonstrated a higher cumulative AAA risk with decreasing eGDR quartiles (log-rank p < 0.05). The Multivariable Cox model confirmed that lower eGDR levels were significantly associated with increased AAA risk. When eGDR was assessed as categorical variable, compared with the participants in Quartile 1 group (reference group), the adjusted HR (95% CI) for those in the Quartile 2–Quartile 4 groups were 0.76 (0.66–0.87), 0.69 (0.59–0.80), and 0.46 (0.35–0.62), respectively. When eGDR was evaluated as a continuous variable, a 1-unit increment in eGDR corresponded to a 12% reduction in AAA risk (HR: 0.88, 95% CI: 0.85–0.90). After excluding patients with pre-existing diabetes or short-term follow-up, the sensitivity analysis produced similar results. A subgroup analysis further maintained the association between eGDR and AAA. Furthermore, the RCS curve revealed a nonlinear association between eGDR and AAA incidence risk (p for nonlinearity ≤ 0.05), identifying a threshold value of 7.78.

Our study demonstrates that reduced eGDR levels are independently associated with elevated AAA risk, exhibiting a nonlinear dose–response relationship characterized by a threshold effect at 7.78. These findings position eGDR as a potentially valuable biomarker for AAA risk stratification and interventional strategies.

The hemoglobin glycation index (HGI) presents a discrepancy between observed and predicted glycosylated hemoglobin (HbA1c) and fasting blood glucose values. Meanwhile, compared to the HbA1c values, the HGI provides a more comprehensive reflection of blood glucose variability across populations. However, no studies have examined the association between the HGI and all-cause, cardiac, and cardiovascular mortalities in the general population. Hence, this study aimed to investigate these relationships using data from the National Health and Nutrition Examination Survey (NHANES) database.

Participants were stratified into four groups based on the HGI quartiles. Weighted multivariable Cox proportional hazards models were used to assess the associations between HGI and all-cause, cardiovascular, and cardiac mortality. Kaplan–Meier survival analysis based on the HGI quartiles and log-rank tests were employed to compare differences in primary and secondary endpoints. Additionally, restricted cubic spline (RCS) curves were used to explore nonlinear relationships between the HGI and endpoints, identifying inflection points. Subgroup analyses and interaction tests were conducted to assess the robustness of the findings.

In comparing the baseline characteristics of endpoints across all-cause mortality, cardiac mortality, and cardiovascular mortality, significantly higher mortality rates were observed in the high HGI quartile group (Q4) compared to the other three groups (Q1, Q2, and Q3) (p < 0.05). Kaplan–Meier curves demonstrated increased mortality risks in the high HGI group across all endpoints (p < 0.05). Multivariable Cox proportional hazards models indicated that high HGI levels were associated with all-cause mortality (Q4: hazard ratio (HR) (95% confidence interval (CI)) = 1.232 (1.065, 1.426); p = 0.005), cardiac mortality (HR (95% CI) = 1.516 (1.100, 2.088); p = 0.011) and cardiovascular mortality (HR (95% CI) = 1.334 (1.013, 1.756); p = 0.039). Low HGI was associated only with all-cause mortality (Q1: HR (95% CI) = 1.269 (1.082, 1.488); p = 0.003). RCS analysis confirmed a U-shaped relationship between the HGI and all three outcome events. Subgroup analyses and interaction tests supported the robustness of the conclusions.

This study demonstrates a U-shaped association between the HGI and overall mortality, cardiac mortality, and cardiometabolic mortality in the general population. Specifically, the high HGI value represented a risk factor for all-cause, cardiac, and cardiovascular mortality. In contrast, low HGI values were associated only with all-cause mortality in the general population.

The prevalence of tricuspid valve (TV) infective endocarditis (IE) continues to increase among patients with drug addictions and chronic vascular access or cardiac electronic devices. Moreover, long-term mortality and morbidity following surgery with conventional prostheses remain high. Allografts may represent a suitable alternative in tricuspid surgery. This study aimed to compare outcomes between stented biological valves and mitral allografts (MAs) for tricuspid valve replacement (TVR).

A total of 54 patients with IE underwent TVR using either a stented bioprosthesis (B) or MA between January 2016 and July 2024. Clinical and echocardiographic data were analyzed in accordance with the Tricuspid-Valve Academic Research Consortium (T-VARC) criteria. Early safety, clinical efficacy, and time-to-event survival were compared between the two equal B and MA groups.

There were no in-hospital or 30-day mortality, nor cardiac, cerebral, and wound complications in either group. The peak and mean pressure gradient (PG) on TV after surgery were 9.2 (6.5–12.0) and 4.0 (3.2–6.0) mmHg in the B group versus 6.0 (4.5–7.5) and 3.0 (2.0–4.0) mmHg in the MA group (p < 0.001). A T-VARC-adjusted analysis demonstrated superior freedom from cardiovascular mortality, recurrent IE, reoperation, and permanent pacemaker implantation (PPI) in the MA group 2 years after operation. Kaplan–Meier analysis revealed significantly higher freedom from cardiovascular mortality in the MA group (100% vs. 81.5%, 77.8%, 77.8%, 69.6% respectively (log-rank test, p = 0.011) at 12-, 18-, 24-, 36-months, and freedom from PPI (100% vs. 81% at all time intervals) (log-rank test, p = 0.021).

Application of contemporary endpoint criteria demonstrated superior outcomes with MA, including lower cardiovascular mortality, reduced PPI, fewer recurrent endocarditis, decreased reoperations, cardiac hospitalizations, alongside improved patient-reported outcomes. Time-to-event analysis demonstrated benefits in cardiovascular survival and PPI avoidance with allografts. Mitral allograft may be a preferable alternative valve substitute for TVR in patients with IE.

ClinicalTrials.gov ID: NCT06591000, https://clinicaltrials.gov/study/NCT06591000?term=NCT06591000&rank=1, registration date: September 19, 2024.

Ventricular fibrillation (VF) is a life-threatening complication of acute myocardial infarction (AMI), particularly in patients undergoing percutaneous coronary intervention (PCI). Early identification of high-risk patients is crucial for implementing preventive measures and improving outcomes.

This retrospective study analyzed clinical, laboratory, and angiographic data from 155 AMI patients to identify predictors of VF during PCI. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression, elastic net regression, and random forest. Independent predictors were identified through multivariable logistic regression, and a nomogram was developed and validated to predict VF risk. Model performance was assessed using receiver operating characteristic (ROC) and calibration curves.

Independent predictors of VF included diabetes (OR = 3.676 (1.365–10.668); p = 0.012), neutrophil-to-lymphocyte ratio (NLR) (odds ratio (OR) = 1.149 (1.053–1.265); p = 0.002), right coronary artery (RCA) intervention (OR = 3.185 (1.088–9.804); p = 0.037), Gensini score (OR = 1.020 (1.007–1.033); p = 0.003), and absence of beta blockers (OR = 0.168 (0.054–0.472); p = 0.001). The nomogram, incorporating these predictors, demonstrated a strong discriminative ability with an area under the ROC curve (AUC) of 0.882 (0.825–0.939) and good calibration (Hosmer–Lemeshow test, p = 0.769). The calibration curve showed a strong alignment between predicted probabilities and observed outcomes, with a mean absolute error of 0.033.

This study identified diabetes, NLR, RCA intervention, Gensini score, and absence of beta-blocker use as key predictors of VF during PCI in AMI patients. A nomogram incorporating these factors showed strong predictive performance, aiding clinicians in identifying high-risk patients for targeted preventive strategies.

Coronary heart disease (CHD) arises from a complex interplay of genetic and environmental factors. This study examines the influence of endothelial lipase gene polymorphisms (rs2000813 and rs3813082) and their interactions with traditional cardiovascular risk factors on CHD susceptibility.

This retrospective case–control study enrolled 900 CHD patients and 900 control subjects. We evaluated associations between conventional cardiovascular risk factors and polymorphisms at the rs2000813 and rs3813082 loci in the endothelial lipase gene. Multifactorial analysis was used to assess interactions between traditional risk factors and these polymorphisms. Additionally, we developed a predictive model integrating genetic variants and clinical variables to estimate CHD risk.

No significant differences were observed in the distribution of rs2000813 genotypes (CC, CT, TT) and alleles (C, T), or rs3813082 genotypes (AA, AC, CC) and alleles (A, C) between CHD and control groups, including among males. However, in females with CHD, the rs2000813CT genotype was significantly more frequent (49.30%) than in controls (37.80%), whereas the CC genotype was less frequent in the CHD group (45.00%) than in controls (55.20%). Multivariate logistic regression identified the rs2000813CT genotype, hypertension, ages ≥60 years, body mass index (BMI) values ≥28 kg/m², total cholesterol (TC) ≥6.2 mmol/L, and apolipoprotein B (ApoB) ≥1.1 g/L as potential risk factors for CHD in women (p < 0.05). Gene–environment interaction analysis revealed that BMI exerted the greatest influence (12.62%). A predictive model incorporating rs2000813 genotypes estimated CHD risk in women with an area under the curve (AUC) of 0.804.

The rs2000813CT endothelial lipase genotype is potentially associated with an increased CHD risk in females, whereas the CC genotype may confer a protective effect. Integrating endothelial lipase gene variants with traditional cardiovascular risk factors enhances CHD risk prediction in women. Synergistic interaction between endothelial lipase polymorphisms and environmental factors appears to influence CHD occurrence in this population.

Cardiovascular magnetic resonance (CMR) is a time-consuming, yet critical imaging method. In contrast, while rapid techniques accelerate image acquisition, these methods can also compromise image quality. Meanwhile, the effectiveness of Adaptive CS-Net, a vendor-supported deep-learning magnetic resonance (MR) reconstruction algorithm, for non-contrast three-dimensional (3D) whole-heart imaging using relaxation-enhanced angiography without contrast and triggering (REACT) remains uncertain.

Thirty participants were prospectively recruited for this study. Each underwent non-contrast imaging that included a modified REACT sequence and a standard 3D balanced steady-state free precession (bSSFP) sequence. The REACT data were acquired through six-fold undersampling and reconstructed offline using both conventional compressed sensing (CS) and an Adaptive CS-Net algorithm. Subjective and objective image quality assessments, as well as cross-sectional area measurements of selected vessels, were conducted to compare the REACT images reconstructed using Adaptive CS-Net against those reconstructed using conventional CS, as well as the standard bSSFP sequence. For a statistical comparison of image quality across these three image sets, the nonparametric Friedman test was performed, followed by Dunn's post-hoc test.

The Adaptive CS-Net and CS-reconstructed REACT images exhibited superior image quality for pulmonary veins, neck, and upper thoracic vessels compared to the standard 3D bSSFP sequence. Adaptive CS-Net and CS reconstructed REACT images displayed significantly higher contrast-to-noise ratio (CNR) compared to those reconstructed using the 3D bSSFP sequence (all p-values < 0.05) for the left upper (5.40, 5.53, 0.97), left lower (6.33, 5.84, 2.27), right upper (5.49, 6.74, 1.18), and right lower pulmonary veins (6.71, 6.41, 1.26). Additionally, REACT methods showed a statistically significant improvement in CNR for both the ascending aorta and superior vena cava compared to the 3D bSSFP sequence.

The Adaptive CS-Net reconstruction for the REACT images consistently delivered superior or comparable image quality compared to the CS technique. Notably, the Adaptive CS-Net reconstruction provides significantly enhanced image quality for pulmonary veins, neck, and upper thoracic vessels compared to 3D bSSFP.

The C-reactive protein-to-albumin ratio (CAR), a marker of inflammation and nutritional status (calculated as C-reactive protein [CRP]/albumin [ALB]), is associated with increased mortality in congestive heart failure (CHF). However, whether vitamin D modulates the CAR-CHF relationship remains unclear. Using data from the National Health and Nutrition Examination Survey (NHANES), this study aimed to investigate the mediating role of vitamin D in the association between CAR and CHF among older adults, with implications for cardiovascular disease prevention.

Data from NHANES 2001–2010 were analyzed, including adults aged ≥65 years. Multivariate logistic regression was used to assess the independent association of CAR and 25-hydroxyvitamin D [25(OH)D] with CHF. Pearson correlation evaluated bivariate relationships between continuous variables (vitamin D, CAR), while Spearman correlation assessed associations between the dichotomous CHF status and continuous variables (vitamin D, CAR). Mediation analysis (Hayes’ PROCESS Model 4, 5000 bootstrap samples) tested whether 25(OH)D mediated the CAR-CHF link. Subgroup analyses explored effect modification by age, sex, and comorbidities.

A total of 4128 participants (mean age: 70.0 years; 55.81% male) were included, with 247 (5.98%) diagnosed with CHF. Vitamin D deficiency (25(OH)D <20 ng/mL) and insufficiency (20–30 ng/mL) were prevalent (71.2%). Key findings included: Bivariate associations: Lower 25(OH)D correlated with higher CAR (r = –0.12, p = 0.004) and increased CHF risk (Spearman ρ = –0.061, p < 0.01), while CAR was positively correlated with CHF (Spearman ρ = 0.080, p < 0.01). Multivariate analysis: CAR was an independent risk factor for CHF (adjusted OR for highest vs. lowest quartile: 1.96, 95% confidence interval (CI): 1.31–2.95, p < 0.001; p-trend < 0.001. Vitamin D sufficiency (25(OH)D ≥30 ng/mL) was associated with a lower CHF risk compared to deficiency (25(OH)D <20 ng/mL, OR: 0.56, 95% CI: 0.38–0.83, p = 0.003), indicating that deficiency was indirectly linked to higher risk. Mediation effect: 25(OH)D partially mediated the CAR-CHF association, explaining 3.00% of the total effect (indirect effect: 0.002, 95% CI: 0.001–0.005, p = 0.039). Predictive value: CAR had modest accuracy for CHF (area under the curve (AUC) = 0.597, 95% CI: 0.560–0.634), with an optimal cut-off of 0.149 (sensitivity: 59.1%, specificity: 56.4%).

Elevated CAR and vitamin D deficiency are independently associated with increased CHF risk in older adults. Vitamin D partially mediated the association between CAR and CHF, underscoring its role in linking inflammation/nutrition status to cardiovascular risk. Clinicians should monitor both biomarkers in CHF prevention, prioritizing inflammation control and vitamin D repletion in high-risk populations.

High thoracic epidural blockade (HTEB) with local anti-sympathetic effects modulates cardiac performance in patients undergoing cardiac or non-cardiac surgeries. However, the short-term cardio-protective effects of HTEB in non-operative patients with ischemic heart disease (IHD) and heart failure (HF) remain unclear. Our study aimed to pool evidence regarding the benefits of adjunctive HTEB intervention in patients with IHD and HF.

Exposures were defined as non-operative patients with IHD and HF who received adjunctive HTEB intervention and/or conventional medical treatment (CMT). The primary outcomes were clinical recovery indicator assessments, electrocardiographic and ultrasonic index improvement, laboratory tests, and hemodynamic benefits provided by adjunctive HTEB treatment. The secondary outcome was the effectiveness rate and adverse side effects after HTEB intervention. The pooled analyses of continuous variables were conducted using a fixed-effects model and the effects were represented by the weighted mean difference (WMD) and a 95% confidence interval (CI). The effective rates of HTEB treatment were represented using odds ratios (ORs, 95% CI) or effect size (ES, 95% CI). The I² statistic was used to identify any inconsistency in the pooled results from individual trials. A meta-regression and subgroup analysis were conducted when inconsistencies in individual trials were detected.

HTEB treatment was associated with a significant 10% increase in left ventricular ejection fraction (summary WMD, 9.651 [95% CI: 9.082 to 10.220]), a decline in neuroendocrine hormone levels, myocardial ischemia relief, improvement in hemodynamics, and the reversal of decompensated cardiac remodeling. HTEB treatment is more effective than conventional medical treatment (odds ratio, 5.114 [95% CI: 3.189 to 8.203]) in treating HF and angina pectoris.

Our results suggest that HTEB intervention may be a complementary approach for cardiac rehabilitation in patients with IHD and HF. However, more data are necessary to confirm these findings due to the significant heterogeneity of the included studies.

Heart failure (HF) is a complex clinical syndrome that is associated with high morbidity and mortality. The prognosis of chronic HF in Kosovo has never been objectively assessed and compared with other countries. Thus, this study aimed to investigate the long-term prognostic value of clinical and cardiac function parameters in predicting the mortality of patients in Kosovo with chronic HF.

This study included 203 consecutive patients with chronic HF who were followed up for a mean of 86 ± 40 months. The primary outcome of the study was all-cause mortality.

During the follow-up period, there were 94 deaths (46.3%). Deceased patients were older (p < 0.001), commonly in New York Heart Association (NYHA) class ≥III (p < 0.001), had lower 6-minute walk distances (p = 0.014), higher prevalence of type 2 diabetes mellitus (T2DM) (p = 0.018), raised creatinine (p = 0.001), and lower hemoglobin (p = 0.004). Moreover, these patients often had left bundle branch block (p = 0.001), lower left ventricular (LV) ejection fraction (EF) (p < 0.001), larger left atrium (LA) (p < 0.001), lower lateral and septal mitral annular plane systolic excursion (MAPSE) values (p = 0.001 and p < 0.001, respectively), and tricuspid annular plane systolic excursion (TAPSE) (p = 0.009), reduced lateral systolic myocardial velocity (s’) (p = 0.018), early diastolic myocardial velocity (e’) (p = 0.011) and late diastolic myocardial velocity (a’) (p = 0.010) velocities, reduced septal e’ (p < 0.001) and a’ (p = 0.032) velocities, and had higher E/e’ (p = 0.021), compared to survivors. Multivariate analysis identified NYHA class ≥III (odds ratio (OR) = 5.573, 95% CI 1.688–18.39; p = 0.005), raised creatinine (OR = 1.027, 95% CI 1.006–1.047; p = 0.011), advanced age (OR = 1.069, 95% CI 1.011–1.132; p = 0.020), enlarged LA (OR = 3.279, 95% CI 1.033–10.41; p = 0.044), and left ventricular ejection fraction (LVEF) ≤45% (OR = 3.887, 95% CI 1.221–12.38; p = 0.022), as independent predictors of mortality.

In medically treated patients with chronic HF from Kosovo, worse functional NYHA class, impaired kidney function, age, compromised LV systolic function, and enlarged LA were independently associated with increased risk of long-term all-cause mortality.

Renal dysfunction is linked to both the complexity of coronary artery lesions and the prognosis of acute coronary syndrome (ACS). However, the nature of this intricate relationship remains unclear. Therefore, this study aimed to investigate the mechanisms through which coronary lesion complexity mediates the association between renal dysfunction and adverse cardiovascular outcomes in patients with ACS.

This analysis included 1400 ACS patients who underwent percutaneous coronary intervention (PCI). Renal function was assessed using the estimated glomerular filtration rate (eGFR), calculated according to the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, which incorporates both creatinine and cystatin C. Coronary lesion complexity was evaluated using the baseline SYNTAX score (bSS). The associations among eGFR, bSS, and major adverse cardiovascular events (MACEs) were examined using survival analysis, restricted cubic spline (RCS) analysis, and mediation analysis.

A total of 229 MACEs (16.4%) occurred over a median follow-up of 31.03 (27.34, 35.06) months, including 99 all-cause deaths (7.0%), 41 myocardial infarctions (2.9%), and 123 unplanned revascularizations (8.9%). After multivariate adjustment, both the eGFR and bSS significantly predicted MACEs across the total population and various subgroups. Mediation analysis showed that bSS mediated 16.49%, 14.76%, 12.87%, and 11.95% of the correlation between eGFR and MACEs in different adjusted models.

The relationship between renal dysfunction and MACEs in ACS patients is partially mediated by coronary lesion complexity. This finding underscores the importance of integrating kidney function assessments with coronary anatomical evaluations to develop individualized risk stratification strategies.

The Perceval device is a sutureless, rapid-deployment valve designed to shorten aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times, with the aim of improving postoperative outcomes in older, high-risk patients.

A systematic review was conducted for full articles published between 2020 and 2024, comparing the Perceval valve with conventionally sutured valves, with a focus on preoperative and operative data, as well as postoperative outcomes. Single-arm series were retained for the same purpose. Articles with at least 100 valves were included.

A total of six propensity score-matched series and four randomized controlled trials were identified after removing articles with data from the same patient population. Consequently, age and risk scores were comparable. The use of a minimally invasive approach and the association of other procedures, such as coronary artery bypass grafting (CABG), varied depending on the research design. Adverse postoperative events were comparable for both valve types, except for the development of conduction defects, which required the implantation of a permanent pacemaker (PPM). The initial PPM implantation rate was higher for the Perceval valve, as shown in 5 of the 14 comparative series; however, this rate decreased after the adaptation of surgical techniques. A meta-analysis showed that the CPB and ACC times were significantly shorter using the Perceval valve, at 14.9 (8.2–21.5) minutes and 16.6 (12.1–21.2) minutes, respectively. Platelet counts after implantation were lower with no clinical consequences, and the hemodynamic performance of the Perceval device was acceptable and stable over time. The survival and durability of the Perceval valve were also acceptable, with a reoperation rate of 1% at the 5-year follow-up.

The Perceval valve appears to be a suitable alternative for older, high-risk patients undergoing aortic valve replacement. Notably, the Perceval valve is associated with shorter surgical times and could facilitate the advantage of minimally invasive surgery. The need for postoperative PPM implantation remains an issue.