Tissue remodelling and extracellular matrix (ECM) changes are primary consequences of ST-elevated myocardial infarction (STEMI), leading to an increased risk of developing heart failure and mortality. Collagen type I is the top constituent of the cardiac ECM and is rapidly degraded at sites of tissue injury occurring in STEMI. We aimed to investigate the prognostic potential of a novel biomarker of a collagen type I-derived signalling peptide (C1SIG) shown to be involved in left ventricular remodelling after MI and compare this against another collagen type I fragment quantified by the established C1M assay in a large STEMI cohort. Plasma C1SIG and C1M were quantified using specific enzyme-linked immunosorbent assays in 1616 individuals upon admittance to hospital with STEMI. Patients were then followed up for all-cause mortality over 1year, and survival analyses were performed. Short-term biomarker changes assessed in a subgroup (n = 140) showed increased circulating C1M and C1SIG in the short period from admission with STEMI up to 12h post-admission (both, p < 0.0001). High C1M levels, defined by the highest quartile, and high C1SIG levels, defined by the median, were associated with reduced survival probability at 1year (both, p < 0.0001) post-admission. The association was further supported in univariate and maintained for C1M only in multivariate Cox proportional hazard regression models adjusted for multiple confounders (HR [95% CI] 1.46 [1.15-1.85]). Added value analysis determined the additional predictive value of C1M to the clinically used GRACE risk score for cardiovascular event prediction (p = 0.0002). C1M and C1SIG are dynamic biomarkers of collagen type I degradation, where C1SIG is also suspected to be a collagen signal. C1M is an independent predictor of all-cause mortality within a year of a MI.

To investigate the long-term outcomes and risk factors for morbidity and mortality in patients with Ebstein's anomaly, including the effects of type and timing of valve surgery. For this retrospective, record-based study, all patients with Ebstein's anomaly enrolled in the German National Register for Congenital Heart Defects up to June 2021 were eligible for inclusion. Non-surgical patients (n = 194/49% of 398 patients) had less tricuspid valve regurgitation (p < 0.001) and heart failure symptoms (p < 0.001) than surgical patients (n = 204/51%). Postoperative survival at 10, 20, and 30years was 97%, 93%, and 80%. Eighty-one (40%) patients underwent multiple surgeries. Re-operation rates were lowest in patients with first valve surgery during adolescence (p = 0.0076). Postoperative NYHA class > I was more frequent with surgery delayed to older age (p < 0.001). Initial corrective surgery was complicated by complete atrioventricular block (CAVB) in 17 (9%) of patients. CAVB was more likely with older age (p = 0.001), and tricuspid valve replacement compared to reconstruction (p = 0.029). CAVB was associated with all-cause death (p < 0.001). Cone reconstruction reduced the risk of CAVB (p = 0.008) and tricuspid valve regurgitation (p < 0.001) compared to monocusp reconstruction. This registry-based study of Ebstein's anomaly corroborates good surgical long-term results, while re-operation rates remain high. Patients operated before adolescence were at the highest risk of re-operation, while older age at the time of the first surgery increased the risk of CAVB. The cone reconstruction was associated with improved tricuspid valve function and a lower risk of CAVB compared to monocusp reconstructions. Choosing an optimal time window for surgery and use of the cone reconstruction may therefore further improve outcomes.

Structural remodeling of the left atrium contributes to the progression of heart failure (HF), even in the absence of atrial fibrillation (AF). However, the underlying mechanisms and extent of atrial remodeling across the spectrum of left ventricular ejection fraction (LVEF) remain poorly defined. This study aimed to characterize anatomical and functional left atrial changes using multimodal imaging and biomarker profiling in patients with HF without AF. A total of 264 ambulatory patients with HF and no prior AF, all under continuous rhythm monitoring, were prospectively studied. All underwent transthoracic echocardiography with functional analysis of the left atrium and plasma biomarker assessment. Patients were classified according to LVEF into three groups: preserved, mildly reduced, and reduced. Correlations between echocardiographic parameters and circulating biomarkers were analyzed. Patients with reduced LVEF showed larger atrial volumes, lower reservoir strain, impaired conduit function, and higher atrial stiffness. Biomarker profiling revealed increased levels of natriuretic peptides and extracellular matrix proteins, along with moderate elevations in inflammation-related markers. Atrial strain was significantly correlated with markers of fibrosis, inflammation, and wall stress, particularly in patients with lower LVEF. In patients with HF without AF, the severity of atrial remodeling increases as LVEF declines and aligns with biomarkers of hemodynamic overload and fibrosis. The integration of imaging and molecular parameters may improve risk stratification and phenotyping in HF.

Heart failure with reduced ejection fraction (HFrEF) causes reduced functional capacity, impaired quality of life, and frequent rehospitalisation. Although guidelines recommend cardiac rehabilitation (CardRehab), referral rates remain low. The MEDIAN Heart Failure Registry evaluated short- and midterm outcomes of inpatient CardRehab in routine practice. A prospective multicentre registry included 808 patients with clinically stable HFrEF (LVEF ≤ 40%) undergoing inpatient cardiac rehabilitation across 17 German centres (2019-2020). Clinical outcomes-6-min walk test, bicycle ergometry, echocardiographic LVEF, NYHA class, NT-proBNP (subset), and patient-reported outcomes (KCCQ, HADS)-were assessed at admission, discharge, and 6months post-discharge. A structured follow-up survey evaluated adherence to lifestyle changes and the sustainability of effects after the 22.8-day inpatient stay. A total of 808 patients (mean age, 65years; 16.6% females) showed significant improvements in physical and psychosocial parameters. Mean LVEF increased from 31.1% (SD 9.0) to 35.9% (SD 10.7; p < 0.01), mean 6-min walk distance from 306m (SD 136) to 388m (SD 158; p < 0.01), and mean bicycle ergometry from 27.8 W (SD 15.4) to 49.5 W (SD 26.4; p < 0.01). Mean NT-proBNP decreased (p < 0.01). KCCQ and HADS scores improved significantly. Inpatient mortality rate during rehabilitation was 0.6% (5/808), and the rehospitalisation rate due to heart failure was 2.8% (23/808). There were two documented cancellations of rehabilitation. At 6-month follow-up, benefits remained stable with high adherence to recommended behaviours. Cardiac rehabilitation was associated with improvements in physical capacity, left ventricular function, psychological well-being, and quality of life in patients with chronic heart failure, alongside low observed rehospitalisation rates during follow-up.

Bacterial infections are a serious global health problem, especially for older and critically ill patients, who are at increased risk of complications and mortality. Traditional tools like APACHE II and SOFA scores are widely used to predict outcomes in sepsis, but recent attention has focused on the right heart function-specifically, the tricuspid annular plane systolic excursion (TAPSE)-as a simple, bedside marker with potential prognostic value. This systematic review and meta-analysis aimed to explore the prognostic value of TAPSE in patients with sepsis or septic shock, focusing on its predictive ability compared to established clinical indices such as APACHE II, SOFA and left ventricular ejection fraction (LVEF). A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library and Web of Science up to April 2025. Studies assessing TAPSE in septic patients were included according to predefined criteria. Data on mortality, TAPSE, APACHE II, SOFA and LVEF were extracted and analyzed. Study quality was assessed using the Newcastle-Ottawa Scale. Ten studies with a total of 1812 patients have been included. The analysis revealed that lower TAPSE values were significantly associated with higher mortality (mean difference -0.50cm; 95% CI: -0.57 to -0.43; p < 0.00001). Similarly, APACHE II scores were higher in non-survivors (mean difference 4.62; 95% CI: 3.17 to 6.07; p < 0.00001). In contrast, LVEF showed no significant correlation with mortality (mean difference -1.46; p = 0.20). Despite variability among studies, the prognostic value of TAPSE remained consistently evident. TAPSE emerges as a practical, non-invasive tool for assessing right ventricular function and predicting mortality in patients with sepsis. Its simplicity and bedside availability make it a valuable complement to traditional severity scores like APACHE II. Unlike LVEF, which appears less informative in this setting, TAPSE could enhance early risk stratification and guide clinical decision-making, particularly in vulnerable populations such as the elderly and critically ill.

Left ventricular heart failure (LVHF) remains a major contributor to morbidity and mortality, with sex-specific differences. This study investigates the influence of sex and New York Heart Association (NYHA) classification on clinical outcomes and healthcare costs. We analyzed data from 2,616,462 LVHF hospitalization cases in Germany (2014-2022), sourced from the Research Data Centre of the Federal Statistical Office and Statistical Offices of the Federal States (DESTATIS). Cases were stratified by sex and NYHA stages. Baseline characteristics, comorbidities, in-hospital outcomes, and healthcare costs were assessed. Multivariable logistic regression evaluated in-hospital survival. Women were more frequently diagnosed at earlier NYHA stages; men dominated in advanced stages. In-hospital mortality was higher among women (8.34% (108,461) vs. 7.90% (103,883)). However, stratified analyses showed higher mortality rates for men across most age and NYHA groups, except for men aged 80-89 in NYHA I, < 40 in NYHA III, and 40-59 in NYHA IV. Despite being younger and hospitalized for shorter or equal durations, men incurred higher costs in NYHA III (2,931.34 vs. 2,922.67) and NYHA IV (2,960.72 vs. 2,923.36). NYHA stage was the strongest predictor of in-hospital mortality (NYHA II: OR 1.596; NYHA III: OR 5.290; NYHA IV: OR 22.533]; all p < 0.001), while female sex (OR 0.841) and obesity (OR 0.751) were associated with lower mortality. LVHF outcomes and costs differ by sex and NYHA stage. Though women had higher overall mortality, men showed worse outcomes in most subgroups. These findings stress the importance of sex- and stage-specific LVHF management strategies.

Several studies have investigated the efficacy of additional left atrial (LA) roof ablation to pulmonary vein isolation (PVI) using cryoballoon for persistent atrial fibrillation (AF). However, the evidence from randomized controlled trials regarding adjunctive LA roof ablation with cryoballoon remains unclear. This study aimed to prospectively evaluate the efficacy and safety of adding LA roof ablation to PVI using cryoballoon in patients with persistent AF. A total of 106 patients with persistent AF who underwent an initial catheter ablation using cryoballoon were randomly assigned in a 1:1 ratio to either PVI plus LA roof ablation (53 patients) or PVI alone (53 patients). The primary outcome was freedom from recurrence of atrial tachyarrhythmia lasting ≥ 30s at 12months after a single ablation procedure. The secondary outcome was procedure-related complications. No significant differences were observed in baseline characteristics between the PVI-plus group and the PVI-alone group. PVI was successfully performed in all patients. In the PVI-plus group, LA roof ablation was completed successfully in all cases. There was no significant difference in the recurrence-free rate between the two groups (P = 0.071, log-rank test). In addition, no significant differences were observed in procedure-related complications between the two groups. The addition of LA roof ablation to PVI did not demonstrate superiority to PVI alone in patients with persistent AF undergoing cryoballoon ablation. However, it did not increase the risk of procedure-related complications.