To compare long-term outcomes of patients with Takotsubo syndrome (TTS) and heart failure (HF). This retrospective observational study used the TriNetX global federated research network. Adult patients (≥18 years) discharged with a diagnosis of TTS (ICD-10-CM I51.81) or HF (I50.x) between 2018 and 2022 were identified. Primary outcomes were three-year risk of all-cause death, major adverse cardiovascular events (MACE; myocardial infarction or ischemic stroke), and acute HF. Secondary outcomes included myocardial infarction, ischemic stroke, ventricular arrhythmias (ventricular tachycardia), malignant arrhythmias (ventricular fibrillation or cardiac arrest), and new-onset atrial fibrillation (AF). Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) before and after 1:1 propensity score matching (PSM). Subgroup analyses were performed by HF phenotype, age (≥65 vs <65 years), and mental health status. The study included 2,240 patients with TTS (mean age 62.6 ± 17.3 years; 73.7% female) and 265,564 patients with HF (69.3 ± 14.7 years; 45.8% female). After PSM, TTS was associated with a lower risk of acute HF (HR 0.622, 95% CI 0.539-0.717), ventricular arrhythmias (HR 0.637, 95% CI 0.441-0.919), malignant arrhythmias (HR 0.656, 95% CI 0.571-0.754), new-onset AF (HR 0.672, 95% CI 0.517-0.875), and myocardial infarction (HR 0.818, 95% CI 0.687-0.974), with no significant differences in the remaining outcomes. Differences were greater when TTS was compared with heart failure with reduced ejection fraction. TTS is associated with lower risk of adverse events than HF. Further research is needed on mental health in its pathogenesis and prognosis.

Cardiogenic shock (CS) represents an ominous complication of acute myocardial infarction (AMI) with mortality rate exceeding 50%. The aim of the study was to evaluate current management, outcomes and risk factors of mortality of AMI-related CS. This snap-shot registry evaluated all patients with AMI-related CS hospitalized in 9 cardiology centers across Poland between January and December 2023. The inclusion criteria involved CS defined as prolonged (>20 min) hypotension with signs of peripheral hypoperfusion and diagnosis of AMI qualified for urgent coronary angiography. The primary endpoint was in-hospital mortality. The study comprised 141 patients (72.3% men; mean age was 69.2 [14] years). The majority of patients were in Society for Cardiovascular Angiography and Interventions class C (n=71,50.4%), followed by class D (n=46,32.6%) and class E (n=24,17.0%). Percutaneous coronary intervention was performed in 133 cases (94.3%) while coronary artery bypass graft in 5 (3.5%). Mechanical circulatory support (MCS) was used in 33 patients (23.4%) and involved intra-aortic balloon pump (n=26,18.4%), Impella CP (n=6,4.3%), Impella 5.5 (n=2,1.4%) and veno-arterial extracorporeal membrane oxygenation (n=10,7.1%). In-hospital mortality rate was 47.5% (n=67), while 30-day mortality was 51.8% (n=73). Cox proportional hazards model showed that non-ST-elevation AMI (HR=2.38,95%CI:1.19-4.75), lack of the need for antibiotic therapy (HR=2.61, 95%CI:1.26-5.39), elevated lactates (unit HR per 1 mmol/l=1.19, 95%CI:1.11-1.27) and age (unit HR=1.05; 95%CI:1.02-1.07) were independent predictors of in-hospital mortality. Short-term mortality rate of AMI-related CS still amounts to 50%, which advocates in favor of further research evaluating the true role of MCS in this population.

This real-world, retrospective study aimed to evaluate clinical outcomes and healthcare costs in advanced heart failure (HF) patients treated at Helsinki University Hospital with heart transplantation (HTx) or elective or urgent left ventricular assist device (LVAD) therapy over three years. Data were extracted from electronic medical records and validated through clinician review. Patients (n=78) were categorised into three groups: Group 1, HTx as first procedure, stratified into those without (1a, n=25) and with (1b, n=11) prior LVAD; Group 2, elective LVAD (n=30); and Group 3, urgent LVAD (n=12). Study endpoints included survival, six-minute walk test (6MWT) results, and healthcare costs at 3, 6, 12 and 24 months. Outcomes and costs were indirectly compared to explore their implications for future patient selection strategies.Survival exceeded 80% in groups 1 and 2. Group 1a had a 24-month survival rate of 84.0% (95% CI: 0.628-0.937), with most deaths (3 of 4) occurring within the first three months. Group 1b showed 100% survival throughout follow-up and group 2 stabilized at 93.4% (95% CI: 0.759-0.983) after two early deaths. Group 3 had progressive decline to 62.5% at 24 months (95% CI: 0.268-0.846). The confidence intervals between these groups overlap due to small sample size in group 3. Observed six-minute walking test (6MWT) performance improved steadily over the first year in all groups, with increases in distance walked and percentage of predicted values observed increasing between baseline and 12 months.Most healthcare expenses were concentrated within the first three months post-surgery. At 3 months, median costs per patient were €177,380 [IQR €121,900] (1a), €207,826 [IQR €83,398] (1b), €187,558 [IQR €67,664] (2), and €293,355 [IQR €67,664] (3). Group 3 incurred significantly higher costs compared to groups 1a (p=0.004) and 2 (p=0.003). While no significant difference was observed between group 3 and group 1b (p=0.335), difference was observed when group 1a and b were pooled. These trends were consistent at 6 months. The differences were no longer statistically significant at 12 and 24 months which may be due to wider cost variation or diminishing sample size. Elective LVAD in patients with advanced HF offers survival outcomes comparable to HTx and incurs similar costs and is preferable to urgent LVAD, which is associated with higher costs and may lead to poorer outcomes. These findings support more proactive patient selection and care pathway optimisation in advanced HF.

Acute myocarditis can lead to chronic inflammatory cardiomyopathy (Infl-CMP), a condition characterized by increased risk of ventricular arrhythmias (VA), left ventricular (LV) systolic dysfunction (LVSD), and heart failure (HF). Immunosuppressive therapy is generally not recommended for Infl-CMP when diagnosed non-invasively by cardiac magnetic resonance imaging (CMRI) or fluorodeoxyglucose-positron emission tomography (FDG-PET). We are assessing, in the CMP-MYTHiC trial, whether colchicine (0.5 mg in patients <70 kg or 1 mg in patients ≥70 kg), an immunomodulatory drug with a good safety profile, can reduce myocardial inflammation in patients with Infl-CMP. The CMP-MYTHiC, a multicenter investigator-initiated single-blinded randomized controlled trial, screens adult patients diagnosed with infl-CMP by CMRI or FDG-PET within the prior 3 months at 12 Italian centers. Eligibility is further defined by the presence of VA or LVSD/HF phenotype. VA phenotype is determined by a high burden of premature ventricular complexes (PVCs) on baseline 24-hour ECG ambulatory monitoring, non-sustained ventricular tachycardia (NSVT), or sustained ventricular tachycardia (SVT). The LVSD/HF phenotype is characterized by reduced LV ejection fraction (LVEF<50% on echocardiogram or <60% on CMRI) or elevated natriuretic peptide levels. Key exclusion criteria include a history of myocardial infarction, cardiomyopathy attributed to other specific causes, and systemic autoimmune disorders. The efficacy of colchicine compared to placebo will be assessed when CMRI or FDG-PET scans and 24-h ambulatory ECG monitoring are repeated at 6 months after randomization. The primary endpoint of the trial analyzed according to the intention-to-treat population is the proportion of patients who are alive and free from any clinical (cardiac death or hospitalization due to HF or VA episodes), arrhythmic (PVC burden increase ≥50%, NSVT increase ≥30%, or any SVT), or imaging (LVEF reduction >10% or new areas of edema plus increased inflammation) worsening, and who demonstrate improvement in either imaging (reduction in edema on CMRI or FDG uptake) or arrhythmic (PVC burden reduction ≥70% with no NSVT/SVT) outcomes at 6 months. Assuming 80% power with an overall type I error of 0.025 using one-sided Fisher's Exact test, 40 patients per group are required to demonstrate that the primary endpoint will be reached in 66% of patients in the colchicine group compared to 33% in the placebo. Twenty-nine patients were randomized since December 2023, and the conclusion is expected in 2029. The results can define the role of colchicine in treating patients with Infl-CMP noninvasively diagnosed by CMRI or FDG-PET. NCT06158698.

Peripartum cardiomyopathy (PPCM) is an idiopatic form of heart failure occuring in the peripartum phase. Elevated circulating levels of the senescence-associated-secretory-phenotype (SASP) factor Activin-A have been associated with heart failure severity in acute PPCM patients at baseline diagnosis. Here, we investigated Activin-A serum levels in the German PPCM registry in acute PPCM and during left ventricular (LV) recovery. Clinical data including LV ejection fraction (LVEF) and Activin-A serum levels were assessed at initial diagnosis (baseline [BL], ) and during follow-up (FU) at 3 months (M) and 6M in PPCM patients from the German PPCM Registry (n=151, mean age 33±5 years) compared to postpartum healthy controls (n=27, mean age 32±5 years). Activin-A serum levels at BL were elevated (404pg/ml; interquartile range [IQR]: 197-815, n=151) compared to healthy postpartum controls (240 pg/ml, IQR:148-446, n=27; P<0.01) and remained persistently elevated above postpartum healthy controls at 3M (418 pg/ml, IQR: 169-806, n=100) and 6M-FU (520 pg/ml, IQR: 214-1131, n=104). Activin-A levels at BL did not correlate with LVEF (Spearman r=0.10, p=0.2416, n=139), NT-proBNP (r=0.096, p=0.2766, n=131), CRP (r=-0.0008, p= 0.9933; n=110) or PPCM biomarker plasminogen-activator-inhibitor-1 (PAI-1) (r=0.095, p=0.3273, n=109). The majority of PPCM patients showed LV recovery 6M after initial diagnosis, indicated by improved LVEF (PPCM BL: 25%, IQR: 20-33, n=152; 6M-FU: 52% IQR: 45-56, n=128, P<0.0001). Activin-A levels did not differ between full or incomplete LV recovery, or between patients with hypertensive pregnancy disorders. In PPCM patients from the German PPCM registry Activin-A serum levels were elevated at diagnosis, remained persistently high after 3M- and 6M-FU but were not associated with LV recovery.

Heart failure (HF) management guidelines offer evidence-based recommendations but can be difficult to implement in primary care. This randomised controlled trial evaluated a multifaceted intervention to improve adherence to pharmacological and non-pharmacological HF management guidelines in primary care. Patients hospitalised with HF were randomised 1:1 to an intervention or control group. The intervention group received guideline-based inpatient education, a post-discharge plan including referral to cardiac rehabilitation (CR) and scheduled general practitioner follow-ups at 1 and 4 weeks, and 3 months, supported by a cardiologist-approved medication titration plan. The control group received usual care. The primary outcome, measured at 6 months, was adherence to five recommended treatments: i) ACEI/ARB/ARNI ≥50% target dose, ii) beta blocker ≥50% target dose, iii) MRA at any dose, iv) anticoagulation for atrial fibrillation, and v) CR referral. Adherence was compared using Chi-squared tests and logistic regression.Of 225 participants (25% female), a greater proportion in the intervention group achieved the primary outcome (61.8% vs. 28.7%; p<0.01). The unadjusted odds ratio showed that the intervention group was 6.27 times more likely to achieve the outcome compared to the control group (95% CI, 3.35-11.76, p<0.01). This difference was driven by higher prescription rates of ACEI/ARB/ARNI and beta blocker, and higher referral rates to CR. Hospital-based support for HF-management in primary care improved adherence to pharmacological and non-pharmacological components of guideline-recommended care. Greater implementation of transitional care processes of this nature has the potential to improve clinical outcomes for patients with HF.

The impact of diabetes on non-atherosclerotic cardiac disease has not been studied extensively. We aimed to assess the in-hospital and long-term effects of diabetes in patients hospitalized for myocarditis. The Nationwide Readmissions Database (2016-2020) was used to identify adults hospitalized with a primary diagnosis of myocarditis. Patients were stratified by the presence of diabetes, and those discharged alive were followed for a calendar year. The primary outcome was in-hospital mortality. Secondary outcomes included in-hospital ventricular fibrillation, ventricular tachycardia, acute renal failure, cardiogenic shock, heart failure, and one-year all-cause readmission, readmission for heart failure, and mortality. Multivariable logistic and Cox regression models were applied, and propensity score matching was performed as a sensitivity analysis. Among 8,826 adults with myocarditis, 951 (11%) had diabetes. Compared with patients without diabetes, those with diabetes were older, had a higher prevalence of comorbidities, and showed an increased adjusted risk of in-hospital acute renal failure [aOR=1.74 (95% CI: 1.42-2.12)], heart failure [aOR=1.62 (95% CI: 1.37-1.91)], cardiogenic shock [aOR=1.36 (95% CI: 1.04-1.78)], but not of mortality, ventricular fibrillation, and ventricular tachycardia. In one year, diabetes was not associated with higher adjusted risks of all-cause readmission or mortality [aHR=0.81 (95% CI: 0.41-1.60) and aHR=0.81 (95% CI: 0.68-0.97), respectively]. However, it was associated with a higher risk of readmission for heart failure [aHR=1.16 (95% CI: 1.02-1.31)]. These associations remained consistent in propensity score-matched analyses. Diabetes independently increases the risk of in-hospital and one-year heart failure in patients with myocarditis.

To evaluate whether discharge neutrophil-to-lymphocyte ratio (NLR) and its in-hospital trajectory predict 30-day outcomes after acute decompensated heart failure (ADHF) hospitalization, and to compare discharge NLR with admission NLR and with serial NLR measurement. Retrospective cohort of 6,784 ADHF discharges (2007-2017; median age 78 [IQR 69-85] years; 48.8% women). Patients were classified by discharge NLR (<5 vs ≥5) and by NLR trajectory (low→low, low→high, high→low, high→high). Primary endpoints were 30-day all-cause readmission and 30-day all-cause mortality. Multivariable Cox models adjusted for age, sex, anemia, chronic kidney disease, diabetes, ischemic heart disease, atrial fibrillation, peripheral vascular disease, and COPD. Discrimination was assessed using AUCs from adjusted logistic models. High discharge NLR (≥5) was present in 2,258/6,784 (33.3%). Event rates were higher with high vs low discharge NLR for readmission (25.5% vs 19.7%, p<0.001) and mortality (7.8% vs 2.8%, p<0.001). High discharge NLR was independently associated with readmission (HR 1.21, 95% CI 1.05-1.40, p=0.007) and mortality (HR 1.92, 95% CI 1.46-2.53, p<0.001). Trajectory further stratified risk: high→high had the greatest risk (readmission HR 1.42, 95% CI 1.25-1.62, p<0.001; mortality HR 3.42, 95% CI 2.53-4.62, p<0.001); low→high was also high-risk (readmission HR 1.46, 95% CI 1.20-1.77, p<0.001; mortality HR 3.05, 95% CI 2.00-4.65, p<0.001). High→low showed reduced but residual risk vs low→low (readmission HR 1.07, 95% CI 0.93-1.23, p=0.321; mortality HR 1.52, 95% CI 1.06-2.16, p=0.021). Discharge NLR outperformed admission NLR (mortality AUC 0.731 vs 0.705; readmission AUC 0.573 vs 0.564). Serial NLR added minimal discrimination beyond discharge NLR alone (mortality AUC 0.736 vs 0.734; readmission AUC 0.571 for both). Discharge NLR is an independently prognostic, routinely available biomarker for 30-day readmission and mortality after ADHF. Persistently elevated or rising NLR identifies patients at highest short-term risk, while normalization attenuates but does not eliminate risk. A single discharge measurement performs comparably to serial assessment, supporting practical integration of discharge NLR into risk-stratified follow-up, including in resource-limited settings.

Patients with first-degree atrioventricular (AV) block and mechanical AV dyssynchrony can present with heart failure (HF)-like symptoms. AV-optimised conduction system pacing (CSP) can improve haemodynamics and symptoms, but selection criteria remain uncertain. We aimed to identify electrocardiographic and echocardiographic predictors of an acute haemodynamic response to AV-optimised CSP in symptomatic first-degree AV block. Nineteen patients (mean age 60.5 ± 21.1 years; 37% female) with symptomatic first-degree AV block underwent baseline electrocardiography and echocardiography followed by AV-optimised conduction system pacing and repeat echocardiographic assessment. Electrocardiographic parameters (PR interval, P wave duration/PR interval ratio) and echocardiographic indices (E/A wave confluence, A-Q interval, and DFT/RR ratio) were tested for association with change in left ventricular stroke volume (LVSV).The mean PR interval was 395 ± 61 ms, the mean A-Q interval 155±65 ms, and the mean DFT/RR ratio 0.34 ± 0.1. E/A wave confluence was present in 15 patients (79%). AV-optimised pacing increased LVSV by 7.8 ± 3.9 ml, corresponding to an 11.8 ± 5.7 % relative increase (p < 0.01). Echocardiographic parameters were associated with LVSV response, including A-Q interval (r = 0.63, p = 0.004), DFT/RR ratio (r = -0.59, p = 0.008) and E/A wave confluence (r = 0.57, p = 0.01). Electrocardiographic parameters were not associated with LVSV change. Echocardiographically assessed mechanical AV dyssynchrony, rather than electrocardiographic parameters, is associated with an acute haemodynamic response to pacing. Echocardiographic evaluation may help identify patients with prolonged PR interval who could benefit from AV-optimised CSP.