Phantom tumour, also known as a vanishing tumour or fissural pseudotumor, is an uncommon condition that represents a localized, transudative, loculated interlobar pleural effusion. It occurs predominantly in patients with heart failure or renal dysfunction and may mimic a pulmonary neoplasm on chest radiography. Rapid resolution following diuretic therapy is characteristic and typically occurs in the setting of acute decompensated heart failure. We report the case of a 79-year-old male with a known history of ischemic heart disease who presented to the Emergency Department with acute dyspnea and orthopnea. Chest radiography demonstrated a well-circumscribed opacity in the right lung, which was initially suspicious for malignancy. The patient responded well to diuretic therapy for the fluid overload, with near-complete symptomatic improvement and complete radiographic resolution-findings that are characteristic of and confirm the diagnosis of a phantom tumour. Early recognition of phantom tumour is crucial, as misinterpretation may lead to unnecessary investigations, including contrast-enhanced computed tomography of the chest. This is particularly important because many affected patients have underlying chronic kidney disease, and exposure to iodinated contrast may worsen renal function and, in some cases, precipitate the need for renal replacement therapy. Raising awareness of this uncommon yet clinically meaningful condition among emergency physicians and radiologists is essential for optimizing patient outcomes and avoiding preventable harm.

Ambient temperature is a key environmental driver of cardiovascular health. With rising global temperatures and increasing frequency, intensity, and duration of extreme temperature events, understanding the cardiovascular impacts of nonoptimal temperature is more urgent than ever. Short-term exposures to both heat and cold increase the risk of cardiovascular events, including myocardial infarction, stroke, heart failure decompensation, arrhythmias, and sudden cardiac death. Climate, built environment, socioeconomic variables, physiological vulnerability, and systemic inequities exacerbate these risks. There is also a growing appreciation of the importance of contextual factors such as geographic location, housing, occupation, and individual-level exposure. A range of biological mechanisms, including autonomic and neurohormonal activation, endothelial dysfunction, inflammation, hemoconcentration, and impaired thermoregulation, mediate temperature-related cardiovascular risk. Nonoptimal temperatures affect not only the incidence of cardiovascular disease but also health care access and delivery. They can increase demand for emergency care, disrupt operations, and pose challenges to the resilience and sustainability of health systems. Meanwhile, cardiovascular care contributes significantly to health care-related greenhouse gas emissions, highlighting a paradox in which efforts to protect cardiovascular health can indirectly contribute to climate-driven risks. This scientific statement synthesizes current knowledge of the relationship between nonoptimal temperature and cardiovascular health, highlights inequalities in exposure and outcomes, and identifies actionable strategies at the individual, community, health system, and public policy levels. Last, this scientific statement outlines significant research gaps and future priorities, including the need for improved exposure assessment, better understanding and measurement of the impact of long-term exposures, interactions with medications and coexposures, and identification of risk modifiers. Coordinated action is needed in research, clinical practice, and policy to mitigate the rising risks of nonoptimal temperatures on cardiovascular health in a changing climate.

The prognostic significance of polycythemia in acute decompensated heart failure (ADHF) is unclear. This study aimed to evaluate the clinical profile and prognostic implications of polycythemia compared with anemia and normocythemia in patients hospitalized with ADHF. We retrospectively analyzed adult patients hospitalized with ADHF between 2007 and 2017. Patients were categorized by hemoglobin according to World Health Organization criteria: anemic (<13 g/dL men, < 12 g/dL women), normocythemic, or polycythemic (>18.5 g/dL men, > 16.5 g/dL women). Mahalanobis distance matching (MDM; 1:3:3) balanced baseline characteristics, with outcomes compared for in-hospital mortality, 30-day readmission, and long-term survival. Entropy balancing (EBAL) served as sensitivity analysis in the full cohort. Of 8,332 patients, 5,615 (67.4%) were anemic, 2,639 (31.7%) normocythemic, and 78 (0.9%) polycythemic. Polycythemic patients were younger, predominantly male, and more likely to undergo coronary interventions and receive cardioprotective discharge medications. In the matched cohort (N = 546; 234 anemic, 234 normocythemic, 78 polycythemic), in-hospital mortality rates were similar (5.6%, 3.8%, 7.7%; p = 0.381). One-year mortality was highest in anemia (27.4%) vs. normocythemia (17.5%) and polycythemia (19.2%; p = 0.030). Five-year Kaplan-Meier survival was poorest in anemia, with overlapping curves for polycythemia and normocythemia (log-rank p = 0.027). Cox analysis (reference = normocythemia) showed higher mortality with anemia (HR 1.30, 95% CI 1.03-1.63) but not polycythemia (HR 0.90, 95% CI 0.64-1.27). Post-hoc pairwise log-rank tests (Bonferroni-corrected) confirmed no difference between polycythemia and normocythemia. EBAL-weighted analysis yielded consistent results (log-rank p < 0.001; anemia HR 1.76, 95% CI 1.61-1.92; polycythemia HR 1.14, 95% CI 0.83-1.57). Polycythemia is rare in hospitalized ADHF and, unlike anemia, is not associated with adverse short- or long-term outcomes.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve cardiovascular outcomes in obesity and HFpEF; however, their safety and efficacy in heart failure with reduced ejection fraction (HFrEF) remain uncertain. We sought to evaluate the efficacy and safety of GLP-1 RAs in patients with HFrEF. We conducted a multicenter retrospective cohort study of adult patients with HFrEF (LVEF ≤40%) between 2021 and 2024. Patients receiving semaglutide, tirzepatide, or liraglutide were compared with GLP-1RA-naïve patients. Propensity score matching (PSM) (1:1; caliper 0.1) was conducted to balance demographics, comorbidities, LVEF, BMI, HbA1c, and guideline-directed medical therapy. Primary outcomes were 1-year all-cause mortality and acute decompensated HF (ADHF) hospitalizations. Secondary outcomes included new ACS, stroke/TIA, AF/flutter, and VT/VF events. A total of 127,021 patients met inclusion criteria. After PSM, 2,550 patients (n=1,275 per group) were analyzed (mean age 61.5 ±13 years, 33.5% female, 66% White, mean HbA1c 8.1 ±2.1%, mean LVEF 30 ±8.7%, mean BMI 34.5 ±8.4 kg/m2). Patients prescribed GLP-1 RAs had a lower risk of all-cause mortality (7.1% vs 10.2% OR: 0.68, 95% CI: 0.51-0.90; p=0.006). Time-to-event analysis was also consistent (matched HR: 0.54 [95% CI: 0.41-0.7]; p<0.0001). Patients in the GLP-1 RA group also had a lower risk of ADHF (27.7% vs 32.8% OR: 0.79 [95% CI: 0.66-0.93]; p=0.005). New onset ACS, stroke/TIA, AF/flutter, and VT/VF events were similar in both groups. In this real-world cohort, GLP-1RA therapy in HFrEF was associated with reduced mortality and ADHF without an increase in arrhythmic events. Prospective randomized trials are needed to validate these findings.

Ruptured Sinus of Valsalva Aneurysm: An Unexpected Cause of Respiratory Failure.

Aim. The research aims to systematize current data on the prevalence, diagnosis, and clinical significance of iron deficiency (ID) in patients with acute decompensated heart failure (ADHF). Materials and methods. A systematic analysis of studies from 2019 to 2024 in PubMed and eLibrary databases was conducted, including data from 6,500 patients with ADHF. Selection criteria were as follows: confirmed ADHF diagnosis, assessment of iron status using standard parameters (ferritin and transferrin saturation (TSAT)), and availability of clinical outcome data. Results: To differentiate the type of iron deficiency, optimal diagnostics of simultaneous assessment of ferritin and TSAT levels requires: ferritin &lt; 100 μg/L – absolute ID; ferritin 100–299 μg/L in combination with TSAT &lt; 20% – functional ID. ID was found in 45–89% of ADHF patients and was associated with: more severe disease progression (functional class III-IV according to the New York Heart Association system in 68% of cases), elevated of N-terminal propeptide of type B natriuretic peptide levels (35% higher compared to non-ID patients), reduced exercise tolerance (six-minute walk test: 278±45 m vs 342±38 m in non-ID group). Conclusion: Iron deficiency is an independent prognostic factor in ADHF. Early diagnosis and correction, particularly through intravenous ferric carboxymaltose administration, may improve clinical outcomes and reduce hospital readmission rates.

Intra-abdominal pressure and perfusion pressure in acute decompensated heart failure: clinical and prognostic insights.

Advanced heart failure in inherited arrhythmogenic cardiomyopathies poses significant therapeutic challenges, particularly in pediatric patients. Naxos syndrome represents a rare form of such cardiomyopathy, in which mechanical circulatory support may be required. We present a case of a 14-year-old girl with Naxos syndrome who developed refractory cardiac decompensation complicated by malignant ventricular arrhythmia, necessitating central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) followed by implantation of a HeartMate III left ventricular assist device (LVAD). This report highlights the multidisciplinary management, surgical decision-making, and perioperative challenges encountered during treatment, emphasizing the role of central ECMO as an effective bridge to durable LVAD support and heart transplantation in young patients with complex cardiomyopathies.

The residential environment may influence access to care and prognosis in patients with heart failure (HF). Evidence on the impact of geographic factors in Japan is limited. We investigated the association of home-to-hospital distance and residential population density with 1-year clinical outcomes in patients hospitalized for acute decompensated HF. We used the Kyoto Congestive Heart Failure registry to analyze 3,616 patients who were discharged alive after their first hospitalization. Home-to-hospital distance was calculated using road travel distance and dichotomized by the median (8.0 km). Residential density was classified as urban (densely inhabited districts [DID]) or suburban (non-DID). The primary outcome was all-cause death at 1 year, assessed using hospital-stratified Cox proportional hazards models. The median home-to-hospital distance was 8.0 km (interquartile range 4.1-14.5 km); 1,797 (49.7%) patients were in the long-distance group. The long-distance group had a higher risk of all-cause death than the short-distance group (adjusted hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.02, 1.39; P=0.02). As a continuous variable, each doubling of distance was associated with increased all-cause death (HR 1.06; 95% CI 1.02, 1.10). Suburban residence was not significantly associated with the primary outcome compared with urban residence (adjusted HR 1.18; 95% CI 0.99, 1.44; P=0.06). In Japanese patients hospitalized for acute decompensated HF, longer home-to-hospital distance, but not residential population density, was associated with a higher risk of 1-year all-cause death.

Background: Heart failure (HF) is a major public health challenge. Management at or transfer to advanced therapy centers (ATCs) is linked to greater procedural use and better outcomes for HF, however there is little data on the impact of patient sex on access to ATCs and transfer patterns. We evaluated sex-based differences in HF management and outcomes during admissions across center types and transfer status. Method: Adult HF admissions were identified in the 2016-19 Nationwide Readmissions Database. Centers performing ≥1 heart transplant or LVAD were classified as ATCs. Patients were stratified by sex and center type: (A) non-ATC admission, (B) ATC admission, (C) transfer to ATC. Multivariable regression adjusted for comorbidities and HF decompensations. Results: Among 2,872,268 weighted HF admissions (51.3% male), females were older, while males had more HF decompensations (cardiogenic shock, ventricular arrhythmias, mechanical ventilation, AKI). Females comprised only 39.6% of all transfers to ATCs (0.4% vs. 0.6%, OR 0.69, p < 0.001) and had a lower unadjusted mortality (2.6% vs. 2.8%, p < 0.001); however, rates of transfer and mortality were similar between sexes when adjusted for comorbidities and HF decompensations. Female patients were significantly less likely to receive invasive procedures (CRT/ICD, PCI, right heart catheterization, CABG, temporary mechanical support, ECMO, LVAD or heart transplant) across all hospital types and transfers. This disparity in procedural utilization persisted after multivariable adjustment and in sensitivity analysis of patients with severe HF. Conclusions: Females had lower frequency of transfer to ATCs. In-hospital mortality and transfer rates to ATCs were similar across patient sex when adjusted for comorbidities and HF decompensations. Females consistently underwent fewer diagnostic and therapeutic interventions across all center types and transfers.

ABSTRACT Study Objectives To synthesise evidence on the diagnostic, prognostic, surveillance, and monitoring potential of Cheyne-Stokes respiration (CSR) ventilatory patterns, as detected by continuous positive airway pressure (CPAP) devices, in patients with heart failure (HF) or at risk of HF - often with comorbid obstructive sleep apnoea (OSA). Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. Five electronic databases were searched (1946-2025) for studies examining CSR derived from CPAP airflow signals (CPAP-CSR), and heart-failure outcomes. Data synthesis followed Synthesis Without Meta-analysis (SWiM) guidelines across five domains: presence, burden, morphology, temporal dynamics, and aetiology. Results Five studies were included. CPAP-CSR presence was strongly associated with serious cardiac events (adjusted OR 5.74; p &amp;lt; 0.001). CPAP-CSR burden correlated with [B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and estimated glomerular filtration rate (eGFR)], HF hospitalisations, and serious cardiac events (SCE). Morphological features, specifically longer cycle lengths (˃68.9s), accurately discriminated HF-related CSR (AUC 0.954). Short-term temporal dynamics were highly prognostic; day-to-day instability (SD-CSB%) predicted acute HF decompensation (AUC 0.919), reflecting an inability to maintain normal function. Aetiological stratification revealed that progressive CPAP-CSR burden and serious cardiac events occurred exclusively in the cardiovascular-related CSR (CVD-CSR) subgroups. Conclusions CPAP-CSR is consistently associated with heart-failure status and its temporal changes, highlighting its potential as a non-invasive biomarker for disease presence and progression.

Accidental falls (AFs) occasionally occur during hospitalization in older patients with heart failure (HF); however, limited evidence exists regarding their clinical significance. We aimed to evaluate the impact of AFs on prognosis, one-year HF readmission, and associated risk factors in hospitalized patients with HF. This single-centre, retrospective, observational study included 462 patients (mean age: 83.0 years; 47% female) hospitalized with acute decompensated HF and followed for one year post-discharge. Among patients who experienced AFs (n = 32; median days to onset: 10.0 days), the incidence of the primary outcome, composite of all-cause mortality or HF readmission, was significantly higher (hazard ratio = 2.583; P = 0.002, multivariate Cox proportional hazards analysis) than in those without AFs. Patients who experienced AFs were generally older and demonstrated poorer physical function, greater frailty, and signs of malnutrition using Geriatric Nutritional Risk Index (GNRI). Significant risk factors for AFs identified via multiple logistic regression included the Kihon Checklist score [odds ratio (OR) = 1.110; P = 0.036] and a diagnosis of schizophrenia (OR = 6.560; P = 0.049). Notably, GNRI-defined malnutrition was associated with adverse outcomes only in the non-falls group. Accidental falls did not significantly affect secondary outcomes, including major adverse cardiovascular and cerebrovascular events. Accidental falls were associated with poorer prognosis and higher HF readmission risk within one year among older patients. Malnutrition may increase the risk. Pre-admission frailty and psychiatric comorbidities are key fall risk factors, suggesting that frailty interventions may reduce fall incidence and improve outcomes.

Background: Albuminuria reflects systemic endothelial dysfunction and cardiorenal interaction in heart failure (HF), yet its short-term prognostic value in acute decompensated HF (ADHF) remains incompletely characterized. Methods: We conducted a prospective observational cohort study including 144 patients with complete follow-up hospitalized for ADHF. Urinary albumin-to-creatinine ratio (ACR), NT-proBNP, and estimated glomerular filtration rate (eGFR) were measured within 24 h of admission. Prior HF hospitalization within 12 months was recorded. The primary endpoint was a 90-day post-discharge composite of all-cause mortality or HF rehospitalization. Associations were examined using logistic regression, and discrimination was assessed using ROC curves with AUC comparisons. Results: Twenty-six patients (18.1%) experienced the 90-day composite endpoint. In univariable analysis, log10-transformed ACR was strongly associated with events (OR 3.90, 95% CI 1.92-7.91; p < 0.001). In multivariable analysis, ACR remained independently associated with the endpoint in Model 1 (ACR + prior HF hospitalization: OR 4.21, 95% CI 1.93-9.17; p < 0.001) and Model 2 (additional adjustment for log10 NT-proBNP: OR 3.49, 95% CI 1.54-7.91; p = 0.003). NT-proBNP was not independently associated with outcome in the fully adjusted model (p = 0.080). Discrimination improved from AUC 0.724 for ACR alone to 0.821 for Model 1 and 0.836 for Model 2; the AUC difference between Model 1 and Model 2 was not statistically significant (p = 0.404). Conclusions: Urinary ACR independently predicts 90-day adverse outcomes after ADHF hospitalization and improves discrimination when combined with recent HF hospitalization history; NT-proBNP did not provide significant incremental discrimination beyond this model.

Aim To evaluate the impact of digital remote monitoring on the effectiveness of intensive dose titration for guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) for the achievement of target doses and the reduction of decompensated heart failure rate and all-cause mortality.Materials and methods The study utilized vital sign monitoring via a personal messenger-based questionnaire (chatbot) and weekly therapy optimization recommendations for 6 weeks following hospital discharge. The control group received standard outpatient care. The study is registered at ClinicalTrials.gov (NCT06304753). Between October 27, 2023, and December 27, 2024, 66 HFrEF patients were enrolled and randomized into a remote monitoring (RM) group (n=33) and a standard care (SC) group (n=33). The 6-week observation period was completed by 26 patients in the RM group and all 33 patients in the SC group.Results The RM group showed a statistically significant increase in the dosages of GDMT and a higher number of patients reaching target doses. In contrast, the SC group showed either no changes in therapy or a decrease in dosages of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitor (87.5 [50; 100]% vs. 25 [12.5; 25]%, p&lt;0.001); beta-blockers (100 [50; 100]% vs. 50 [25; 50]%, p&lt;0.001); and mineralocorticoid receptor antagonists (100 [100; 100]% vs. 50 [50; 100]%, p=0.005). Diuretic doses were reduced in the RM group (2 adjusted doses (AD) [1; 2] at baseline vs. 1 AD [0.5; 2] at 6 weeks; p=0.010) but remained unchanged in the SC group (2 [2; 2] AD at baseline vs. 2 [2; 2] AD at 6 weeks; p=0.9). The incidence of decompensated CHF and death was significantly higher in the SC group compared to the RM group, 16 cases (2 deaths, 14 decompensations) vs. 2 cases (0 deaths, 2 decompensations; p&lt;0.001). Intensive titration proved safe, with no statistically significant differences observed between groups at 6 weeks regarding systolic blood pressure (119 [110-130] mm Hg vs. 120 [110-130] mm Hg; p=0.9), heart rate (70.5 [62-80] bpm vs. 78 [73-91.5] bpm; p=0.062), glomerular filtration rate (65.9 [49.2-77] mL/min/1.73 m² vs. 49.6 [45.8-71.9] mL/min/1.73 m²; p=0.22), or serum potassium levels (4.39 ± 0.48 mmol/L vs. 4.218 ± 0.37 mmol/L; p=0.33).Conclusion The study confirmed the feasibility, efficacy, and safety of intensive titration of guideline-directed medical therapy for chronic heart failure using remote monitoring.

Trajectories in renal perfusion pressure during hemodynamically guided therapy are associated with worsening renal function and patient outcomes.

Influence of Baseline Smoking Status on Intensive Blood-Pressure Control: Results from the STEP Randomized Trial.

Cost-Effectiveness Analysis of Guideline-Directed Medical Therapy Uptitration After Acute Decompensated Heart Failure From US and UK perspectives.

26-CCC-17110-ACC LISTENING TO THE HEART: REMOTE IVCT MONITORING WITH HEMOTAG PREVENTS 30-DAY READMISSION IN ACUTE DECOMPENSATED HEART FAILURE

26-A-16459-ACC DYNAMIC APPLICATION OF THE SCAI SHOCK STAGING SYSTEM IN ACUTE DECOMPENSATED HEART FAILURE: A PROSPECTIVE STUDY IN VIETNAM

26-A-17084-ACC GENDER DISPARITIES IN ACUTE DECOMPENSATED HEART FAILURE: A NATIONWIDE ANALYSIS OF MAJOR INTERVENTIONS AND OUTCOMES