Cardiovascular Mortality Research Articles

Integrated Care in Atrial Fibrillation: A Multidisciplinary Approach to Improve Clinical Outcomes and Quality of Life

Background: Atrial fibrillation (AF) is the most common arrhythmia globally, associated with serious complications such as stroke and heart failure, as well as significant impacts on patients’ quality of life. Objectives: This theoretical article explores the role of integrated care in the management of AF, highlighting the need for a multidisciplinary approach that goes beyond rhythm and heart rate control. Methods: Through a review of the literature, this article explores the prevalence of AF, the challenges of diagnosis, the socioeconomic and psychological impact, as well as the benefits of integrating medical, psychological, and social interventions, drawing on insights from studies about integrative care in AF. Results: The findings highlight the challenges of managing AF, including its high prevalence, complex diagnosis, and significant socioeconomic and psychological impacts on patients. Integrated care models, combining medical, psychological, and social interventions, improve treatment adherence, reduce complications like stroke and heart failure, and enhance patient quality of life. Conclusions: Integrated care models hold significant promise in improving outcomes in AF patients through structured, multidisciplinary approaches. Evidence supports reductions in cardiovascular events, hospitalizations, and mortality when adhering to clinical guidelines, emphasizing patient education, and implementing individualized care strategies. Despite challenges, like regional disparities and suboptimal implementation, the integration of multidisciplinary teams and emerging technologies offers a way to enhance care delivery and accessibility. Future efforts should focus on personalizing care, promoting professional collaboration, and taking advantage of technological advances to optimize AF management and promote sustainable health systems.

Tissue Doppler echocardiography predicts long-term cardiovascular mortality: the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) legacy 20-year follow-up study

BackgroundLeft ventricular diastolic function as assessed by tissue Doppler echocardiography predicts cardiovascular event rates at 4 years of follow-up in patients with hypertension. Our aim was to evaluate whether this...

The association of lipid accumulation product with inflammatory parameters and mortality: evidence from a large population-based study

BackgroundObesity is closely associated with lipid metabolism, and the accumulation of lipids leads to low-level inflammation in the body, which can trigger cardiovascular disease. This study aimed to explore the association between a novel marker of lipid accumulation, the abdominal volume index (AVI), inflammatory parameters, and mortality.MethodsThis study enrolled 2,109 older adult senior citizens (aged over 60 years) with hypertension from the National Health and Nutrition Examination Survey. The primary endpoints included all-cause mortality and cardiovascular mortality, which were assessed by linking the data to the National Death Index records. Cox regression model and subgroup analysis were constructed to investigate the associations between AVI and both all-cause and cardiovascular mortality. Restricted cubic splines were employed to further explore the relationships among AVI, inflammatory parameters, and mortality. By considering inflammatory factors as mediators, we investigate the mediating effects of AVI on mortality.ResultsAfter a median follow-up of 69 months, there were 1,260 deaths, with 337 attributed to cardiovascular causes within the older adult population studied. In the multivariable-adjusted model, AVI was positively associated with both all-cause and cardiovascular mortality [Hazard Ratio (HR) = 1.09, 95% CI = 1.06–1.11 for all-cause mortality; HR = 1.07, 95% CI = 1.03–1.12 for cardiovascular mortality]. Kaplan-Meier survival plots indicated an overall median survival time of 144 months. Mediation analysis revealed that Systemic Inflammatory Response Index (SIRI), Monocyte-to-HDL ratio (MHR), and Neutrophil-to-Lymphocyte ratio (NLR) mediated 27.15%, 35.15%, and 16.55%, respectively, of the association between AVI and all-cause mortality.ConclusionAVI is positively associated with all-cause mortality in older adults with hypertension, and this association appears to be partially mediated by inflammatory parameters.

Atrioventricular Block Treatment: Pacing Site, AV Synchrony, or Both?

Background/Objectives: Right ventricular pacing (RVP), leadless pacing (LL), and conduction system pacing (CSP) are treatment options for atrioventricular block (AVB), each with distinct characteristics. However, the long-term outcomes of these pacing strategies remain insufficiently compared. This study evaluates clinical and echocardiographic outcomes of patients with AVB treated with dual chamber RVP, His bundle pacing (HBP), or LL. Methods: This single-center observational registry study included 22 consecutive patients receiving LL with atrioventricular resynchronization functionality (October 2020 to October 2022), matched with 66 control patients receiving either RVP (33 patients) or HBP (33 patients) using propensity score matching (2:3:3 ratio). Primary and secondary endpoints included all-cause mortality, cardiovascular mortality, heart failure, and echocardiographic outcomes. Atrioventricular synchrony in the LL group was assessed. Results: At two years, all-cause mortality was significantly higher in the LL group compared to RVP (36.4% vs. 6.1%, p = 0.002) and HBP (36.4% vs. 12.1%, p = 0.03), but LL had a more severe clinical profile. Cardiovascular mortality and heart failure incidence showed no significant differences. Patients receiving RVP showed a significant decrease in left ventricular ejection fraction and an increase in ventricular volumes. In contrast, HBP patients exhibited favorable cardiac remodeling. Stratification based on atrial sensing showed that LL patients with >66% AV synchrony had a lower mortality (p = 0.02). Conclusions: CSP offers superior results compared to other pacing methods in terms of ventricular function owing to a physiological ventricular activation and maintenance of AV synchrony. However, LL may be a viable alternative for frail and high-risk patients, as the suboptimal AV synchrony is traded off with lesser ventricular dyssynchrony.

Lower time-averaged serum uric acid was associated with increased mortality in peritoneal dialysis patients.

The relationship between time-averaged serum uric acid (TA-SUA) levels and prognosis in peritoneal dialysis (PD) patients are rarely discussed. This was a retrospective cohort study. PD patients recruited from January 1, 2011, to December 31, 2020, were included. Baseline and follow-up uric acid levels over 1 year were collected to calculate time-averaged serum uric acid (TA-SUA) levels. Patients were divided into four groups based on TA-SUA quartiles: Q1 (<5.1 mg/dl), Q2 (5.1-5.8 mg/dl), Q3 (5.8-6.8 mg/dl), and Q4 (>6.8 mg/dl). A total 487 PD patients with a mean age of 52.0 ± 14.2 were enrolled, including114 (23.4%) diabetes. Q1 (n = 121, 24.8%), Q2 (n = 118, 24.2%), Q3 (n = 125, 25.7%), and Q4 (n = 123, 25.3%). The Q1 group exhibited characteristics of increased age, malnutrition, and a higher prevalence of diabetes. During the 48.1 months follow-up time, 197 (35.8%) died, 109 (55.3%) cardiovascular disease (CVD), 38 (19.3%) infections. Kaplan-Meier analysis revealed that both all-cause mortality and cardiovascular mortality were significantly higher in the Q1 and Q4 groups (log-rank = 24.373, p < 0.001). COX regression analysis showed that decreased TA-SUA level was an independent risk factor for all-cause mortality in PD patients after adjustment for confounding factors. Each 1 mg/dl decrease in TA-SUA level was associated with a 23.46% increase in all-cause mortality (HR = 0.81, 95% CI, 0.71-0.94; p = 0.004*). Lower serum albumin level was associated with increased all-cause mortality. PD patients with lower TA-SUA were older and had a higher proportion of diabetes and malnourishment than those with higher TA-SUA. Long-term exposure to low TA-SUA levels was an independent predictor of all-cause and cardiovascular mortality in PD patients.

Neural network-based prediction of incident atrial fibrillation using the trans-thoracic echocardiography parameters: a prospective study

Background: Myocardial remodeling facilitates the development and maintenance of atrial fibrillation (AF). Trans-thoracic echocardiography (TTE) is an available and easily reproducible method for assessment of patients with cardiovascular disorders. The evaluation of TTE parameters with a neural network-based program (NN) could be used for early detection of AF in asymptomatic patients. Aim: To establish the potential of a previously developed NN to predict the incident AF in the patients with no past history of heart arrhythmias. Methods: The study was based on the electrocardiographic data from electronic case record forms of 256 patients (mean age 63.47 ± 16.21 years, 151 (58.98%) women) with no past history of AF, who were treated in the in-patient Department of Cardiology in 2022. The TTE parameters (ascending aorta and left atrium diameters, left ventricular end-diastolic size, pulmonary artery diameter, maximal thickness of the anterior and posterior left ventricular walls in the diastole, transverse diameter of the right atrium, aortal, mitral and tricuspid valve regurgitation grade, left ventricular ejection fraction) were processed by the NN “Prediction of atrial fibrillation based on the trans-thoracic echocardiography data” (Russian state registration certificate for the computer software #2023662423 from 07.06.2023). Depending on the NN output values, the patients were divided into three groups: with a high probability of incident AF (n = 48; NN output value ≤ 0.33), with an intermediate probability of incident AF (n = 185, NN output value 0.34 to 0.66), and with a low probability (n = 23, NN output values ≥ 0.67). The patients were followed up to March 1, 2024 based on their electronic medical records (endpoints: referrals due to AF, AF mentioned as a complication of the underlying disease or as a concomitant disorder, cardiovascular death). Results: The median time of the follow-up was 16 [14; 21] months. During the study period, AF developed in 8/48 (16%) patients with the NN values ≤ 0.33 and in 4/185 (2.16%) patients with the NN values of 0.34 to 0.66, whereas no AF cases were registered in those with the NN values ≥ 0.67 (0/23). The cardiovascular death rate in the study groups was 17/48 (31.25%), 13/185 (3.78%), and 0/23 (0%), respectively (р 0.05). The area under the ROC curve (AUC) for incident AF was 0.85, for death 0.84, and for the combination endpoint of incident AF + death 0.86. Conclusion: The NN used in the study meets the goal of the binary differentiation, i. e. it allows to differentiate the heart structure and function typical for AF from those not typical for AF. Heart chamber dilatation, left ventricular systolic function and valvular regurgitation grade are associated with an increased risk of AF and death. The analysis of TTE parameters by the NN can be used for identification of patients at risk of incident AF with the goal of their additional work-up and monitoring.

Exploring Resting Sinus Tachycardia in Cancer Care: A Comprehensive Review

Resting sinus tachycardia is frequently encountered in cancer patients. It affects a wide variety of cancer patients and is associated with distressing symptoms. Cancer-associated resting sinus tachycardia varies in its underlying mechanism. It can stem from the tumor burden or the side effects of chemotherapy/radiotherapy, or it can be secondary to paraneoplastic syndrome or the sequalae of cancer itself (infection, anemia, thrombosis, etc.). The clinical significance of resting sinus tachycardia extends beyond mere symptomatology, as it can potentially indicate severe complications which may facilitate or exacerbate a new or underlying cardiovascular dysfunction. Therefore, this necessitates thorough diagnostic tools to discern the underlying cause and tailor appropriate management strategies, whether pharmacological, non-pharmacological, or conservative. While resting sinus tachycardia has been extensively investigated in the context of cardiovascular disease, its underlying etiology, clinical implication, prognostic value, and treatment options remain vague in the context of cancer. This review aims to explore the topic of resting sinus tachycardia in cancer patients through delving deeper into its underlying mechanism, presenting the current evidence on its effect on cancer-independent cardiovascular and all-cause mortality, as well as providing some insight into the currently available treatment options. It will also propose therapeutic interventions and strategies aimed at optimizing cancer patient care. Lastly, it will highlight research gaps which need to be addressed further, as future research is needed to refine the diagnostic criteria, develop targeted therapies, find alternative cardioprotective/cardio-neutral chemotherapy options, and establish evidence-based guidelines to improve outcomes in this vulnerable patient population.

Exercise-based cardiac rehabilitation for patients with coronary artery operation: a systematic review and meta-analysis based on current randomized controlled trials

Background: Currently, exercise-based cardiac rehabilitation (CR) has been given increasing interest for its potentially beneficial effects on the health related quality of life (HRQoL) and outcomes of patients with coronary heart disease (CHD). The aim of this study was to evaluate the effect of exercise-based CR on patients after coronary artery bypass graſt (CABG) and percutaneous coronary interventions (PCI). Methods: We searched PubMed, Embase, Cochrane Library and Web of Science from inception to 1 December 2023 for relevant studies that evaluated the effect of exercise-based CR on patients after CABG and PCI. Our primary outcomes included the mortality, complications, hospital admissions and HRQoL between patients receiving exercise-based CR and usual care. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0. Results: We finally indicated and included 25 randomized controlled trials (RCTs) with 4106 participants for the present analysis. Our pooled results indicated that, compared to usual care, exercise-based CR did not increasing the all-cause (RR 0.84; 95% CI 0.54 ‒ 1.31) and cardiovascular (RR 0.98; 95% CI 0.38 ‒ 2.54) mortality for patients after coronary artery operation. Similarly, exercise-based CR had equal effect on coronary artery complications for patients after coronary artery surgery, including CABG (RR 0.60; 95% CI 0.32 ‒ 1.15) and PCI (RR 0.92; 95% CI 0.55 ‒ 1.54). It was indicated that exercise-based CR significantly reduced the incidence of myocardial infarction (MI) by half with a RR of 0.50 (95% CI 0.28 ‒ 0.90). In addition, exercise-based CR also significantly reduced all-cause hospital admissions with a RR of 0.74 (95% CI 0.62 ‒ 0.88). Compared with usual care, exercise-based CR obviously improved HRQoL of patients after coronary artery operation evaluated with SF-36 summary scores (SMD 0.24; 95% CI 0.11 ‒ 0.38) and SF-36 8 domains (SMD 0.35; 95% CI 0.24 ‒ 0.46) respectively. Conclusions: Our analysis indicated that exercise-based CR had significant effect on the improvement of HRQoL of patients after coronary artery operation without increasing the mortality or incidence of re-intervention with operation.

Leptin receptor downregulation in the carotid body treats obesity-induced hypertension.

Obesity and co-morbid sleep disordered breathing lead to high cardiovascular morbidity and mortality via multiple mechanisms including hypertension. Obesity also leads to high levels of leptin, which is produced in adipocytes. Increased leptin levels have also been implicated in increased sympathetic activity and the pathogenesis of hypertension in obesity. However, mechanisms for the effects of leptin on blood pressure are unclear. The carotid bodies (CB) express leptin receptor (Leprb), and diet-induced obesity (DIO) increases Leprb expression levels, but the mechanisms and consequences of leptin action in CB are poorly understood. We hypothesize that leptin signaling in CB in obesity leads to hypertension, which can be treated by Leprb knockdown specifically in CB. DIO male and female mice and lean male C57BL/6J mice were implanted with telemetry in the left femoral artery for continuous blood pressure monitoring. The adenoviral vectors carrying anti-sense RNA, Ad-LepR shRNA or Ad-scrambled control shRNA, were administered locally to the CB region. Blood pressure measurements were performed at baseline and 9-11 days after CB infection with the adenoviral vector. DIO male mice showed increased blood pressure compared to lean males and DIO females. Ad-LepR shRNA induced a 2-fold decrease in Leprb mRNA level in CB and abolished obesity-induced hypertension. Leprb knockdown was particularly effective during the light phase, when animals were predominantly asleep, decreasing mean arterial pressure by 8.5 mmHg. Control shRNA had no effect on DIO-induced hypertension. We conclude that inhibition of Leprb in the carotid bodies abolished obesity-induced hypertension.

Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis.

Cardiac autonomic neuropathy (CAN) is an underdiagnosed complication of type 2 diabetes mellitus(T2DM) and is associated with cardiovascular morbidity and mortality. Cardiac autonomic reflex tests (CARTs) are the gold standard; they are non-invasive and clinically feasible for screening CAN. The objective of the present meta-analysis was to examine exercise's effect on cardiac autonomic function using CARTs in T2DM. The Preferred Reporting Items for Systematic Review and Meta-Analysis Checklist (PRISMA) was used. Electronic databases were systematically used to retrieve relevant studies after title and abstract screening. Studies utilizing exercise training with cardiac autonomic function (CARTs) outcomes in individuals with type 2 diabetes mellitus were included. The meta-analysis was conducted using RevMan 5.4.1, usingthe random effects model, and appropriate tests for heterogeneity. The Cohrane ROB-2 tool was used for randomized controlled trials (RCTs) and theROBINS-I tool for non-RCT for risk of bias assessment were used. Three studies were included (two for meta-analysis), considering the outcome of the E:I ratio, 30:15 ratio, and Valsalva ratio. The studies did not show any influence on the E:I and 30:15 ratio in the pooled analysis witha low risk of ineffectiveness for the exercise intervention. Exercise training significantly affected the Valsalva ratio. A different type of exercise intervention was utilized in all three studies. There was a low to moderate certainty for the evidence. The results indicate that further robust and high-quality randomized controlled trials utilizing cardiac autonomic reflex tests (which have clinical and physiological relevance) in type 2 diabetes mellitus are required for drawing conclusions. PROSPERO CRD42023445561.

A Body Shape Index as a Simple Anthropometric Marker for the Risk of Cardiovascular Events.

To provide an overview of the predictive value of A Body Shape Index (ABSI) for the risk of cardiovascular events. ABSI has been reported to have an association with development of cardiovascular diseases, and its usefulness for predicting major cardiovascular events including cardiovascular mortality, nonfatal coronary syndrome and nonfatal stroke has been investigated. The formula for ABSI includes waist circumference, which is not included in the conventional calculation of body mass index (BMI), along with BMI and height. High ABSI is independently associated with a high incidence of cardiovascular events. ABSI with specific cutoff values can be a useful tool for cardiovascular risk stratification by detecting the presence of abdominal obesity and it can be used for evaluation of the risk of cardiovascular events. Nonetheless, other factors such as race, gender, age, and physical, environmental and socioeconomic purviews also need be taken into consideration.

A comparative study of surgery versus radiation therapy on the risk of cardiovascular disease mortality in patients with early-stage non-small cell lung cancer

Objective: Non-small cell lung cancer (NSCLC) lung cancer continues to be a substantial issue in public health, and cardiovascular disease (CVD) is also an important cause of death in NSCLC patients. There is a lack of studies comparing the effects of surgery and radiation therapy on the risk of CVD-mortality in patients with early-stage NSCLC. This study planned to compare the effects of surgery alone and radiation therapy alone on the risk of CVD-mortality in patients with early-stage NSCLC. Methods: In this cohort study, the data of 32896 participants with NSCLC at stage I or stage II in 2010-2015 were retrieved from the surveillance, epidemiology, and end results (SEER) database. The primary endpoint of this study was CVD mortality, indicating patients died of CVDs and the follow-up was ended in 2020. Univariable Cox regression model was applied to identify covariates. The associations of surgery or radiation therapy with CVD-mortality in in patients with early-stage NSCLC were evaluated via univariable and multivariable Cox regression models and Fine-Gray competitive risk model. Hazards ratio (HR) and confidence interval (CI) were computed. Results: The median follow-up time was 48.00 (17.00, 60.00) months. There were 854 (6.45%) participants died of CVD in the radiation therapy group and 729 (5.35%) participants died of CVD in the surgery group. After adjusting for confounding factors, the elevated risk of CVD mortality in patients with early-stage NSCLC was observed in patients receiving radiation therapy compared to those receiving surgery (HR=2.33, 95%CI: 2.02-2.69). In the competing risk model, the risk of CVD mortality in patients with early-stage NSCLC was also increased in patients receiving radiation therapy (HR=1.37, 95%CI: 1.2.6-1.55). In the PSM group, the risk of CVD mortality in patients with early-stage NSCLC was also increased in patients who underwent radiation therapy (HR=2.62, 95%CI: 2.12-3.24). Subgroup analysis also revealed that radiation therapy was correlated with increased risk of CVD mortality in NSCLC patients with tumor size ≥50 mm or &lt;50 mm, the original primary site in the left or right, histologic types of squamous cell NSCLC or adenocarcinoma NSCLC, stage I and II, and patients ≥ 65 years or &lt; 65 years. Conclusions: Radiation therapy was associated with elevated risk of CVD mortality compared to surgery in patients with early-stage NSCLC.

Understanding the Augmented Blood Pressure Variability as a Clinical Marker of Cardiovascular Risk and Mortality

Understanding the Augmented Blood Pressure Variability as a Clinical Marker of Cardiovascular Risk and Mortality

Translational regulation of SND1 governs endothelial homeostasis during stress.

Translational control shapes the proteome and is particularly important in regulating gene expression under stress. A key source of endothelial stress is treatment with tyrosine kinase inhibitors (TKIs), which lowers cancer mortality but increases cardiovascular mortality. Using a human induced pluripotent stem cell-derived endothelial cell (hiPSC-EC) model of sunitinib-induced vascular dysfunction combined with ribosome profiling, we assessed the role of translational control in hiPSC-ECs in response to stress. We identified staphylococcal nuclease and tudor domain-containing protein 1 (SND1) as a sunitinib-dependent translationally repressed gene. SND1 translational repression was mediated by the mTORC1/4E-BP1 pathway. SND1 inhibition led to endothelial dysfunction, whereas SND1 OE protected against sunitinib-induced endothelial dysfunction. Mechanistically, SND1 transcriptionally regulated UBE2N, an E2-conjugating enzyme that mediates K63-linked ubiquitination. UBE2N along with the E3 ligases RNF8 and RNF168 regulated the DNA damage repair response pathway to mitigate the deleterious effects of sunitinib. In silico analysis of FDA-approved drugs led to the identification of an ACE inhibitor, ramipril, that protected against sunitinib-induced vascular dysfunction in vitro and in vivo, all while preserving the efficacy of cancer therapy. Our study established a central role for translational control of SND1 in sunitinib-induced endothelial dysfunction that could potentially be therapeutically targeted to reduce sunitinib-induced vascular toxicity.

Environment-wide association study of cardiovascular and all-cause mortality: analysis of the National Health and Nutrition Examination Survey, 1999-2018.

Environmental toxicants are increasingly suspected to influence cardiovascular (CV) and all-cause mortality, but previous studies mostly focused on one or a few chemicals. We examined the associations of a wide array of environmental chemicals with CV and all-cause mortality using an exposome-wide approach and the potential mediating role of inflammation in these associations. Data from the National Health and Nutrition Examination Survey (1999-2018) were randomly 60:40 split into a training set and a test set. The mortality rates were determined by the National Center for Health Statistics through a process of correlation with the National Death Index records. Based on the 10th revision of (ICD-10) codes, deaths due to heart disease (ICD 100-I09, I11, I13, and I20-I51) or cerebrovascular disease (I60-I69) were defined as CV mortality. Using the NHANES data, with a median 9.42-year follow-up period, we found that higher concentrations of 2-hydroxynaphthalene (2-NAP) (HR: 1.32, 95%CI: 1.06, 1.64, P-value = 0.014) and 2-hydroxyfluorene (2-FLU) (HR: 1.4, 95%CI: 1.14, 1.73, P-value = 0.002) in the urine, heavy metal cadmium (Cd), and cotinine in the blood were associated with increased risks of both CV and all-cause mortality. We further found 16 chemicals, including polycyclic aromatic hydrocarbons (1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene and 9-hydroxyfluorene), heavy metals in the urine Cd, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), cotinine and hydroxycotinine, heavy metals in the blood including lead and Cd), volatile organic compounds (benzene, ethylbenzene, styrene, toluene and 2,5-Dimethylfuran) were positively associated with all-cause mortality. Furthermore, we found that C-reactive protein levels partially mediate those associations. In summary, exposure to certain environmental chemicals was associated with CV and all-cause mortality, and C-reactive protein plays a mediation role in those associations. Our findings provided more evidence for preventing and controlling important environmental chemicals to improve people's health.

Cardiovascular MRI-derived Right Atrial Strain for Improved Risk Stratification in Patients with Severe Aortic Stenosis.

Purpose To assess the prognostic implications of cardiac MRI-derived imaging markers in individuals with severe aortic stenosis (AS). Materials and Methods This prospective study (German Clinical Trials Register, DRKS00024479) enrolled individuals with severe AS who underwent cardiac MRI before transcatheter aortic valve replacement (TAVR) from January 2017 to March 2022. Image analyses included myocardial volumes, cardiac MRI feature tracking-derived left atrial (LA) and right atrial (RA) as well as left ventricular (LV) and right ventricular (RV) strain, myocardial T1 mapping, and late gadolinium enhancement analyses. Cardiovascular (CV) mortality was defined as primary clinical end point. Cox proportional hazards models were used to determine the association between cardiac MRI-derived parameters and CV mortality. Results The final analysis included 145 participants (median age, 80 years [IQR, 75-83 years]; 91 male). Participants who experienced CV death during follow-up had significantly enlarged RV end-diastolic volumes (median, 82.9 [IQR, 70.8-96.0] mL/m2 vs 62.8 [54.7-76.0] mL/m2; P < .001) and impaired strain values of all cardiac chambers compared with those who survived (LV global longitudinal strain [GLS], -18.1% [-13.1% to -20.4%] vs -22.5% [-16.1% to -27.3%], P = .02; RV GLS, -22.9% [-18.6% to -25.4%] vs -27.9% [-22.9% to -32.0%], P = .002; LA atrial reservoir strain [Es], 9.5% [7.2%-15.4%] vs 14.3% [9.0%-18.1%], P = .04; RA Es, 12.4% [6.8%-14.4%] vs 16.2% [11.2%-22.1%], P < .001). RA reservoir strain independently helped predict CV mortality after adjustment for other cardiac MRI markers and clinical parameters of heart failure (hazard ratio, 0.82 [95% CI: 0.71, 0.95]; P = .008). Within the subgroup of participants with high extracellular volume values, RA strain further identified participants with AS at high risk for CV mortality (P = .001 on log-rank testing). Conclusion In individuals with AS undergoing TAVR, several cardiac MRI parameters were significantly associated with CV mortality. RA strain was an independent predictor of CV mortality and may provide more optimized patient management. Keywords: Cardiac MRI, Aortic Stenosis, TAVR, Risk Assessment, Strain Analyses German Clinical Trials Register no. DRKS00024479 Supplemental material is available for this article. © RSNA, 2025.

Phenomapping the Response of Patients With Ischemic Cardiomyopathy With Reduced Ejection Fraction to Surgical Revascularization.

Coronary artery bypass grafting (CABG) has demonstrated long-term mortality benefits in patients with HFREF and obstructive coronary artery disease (CAD), but whether phenotypic heterogeneity influences the benefits of CABG is unknown. We applied clustering analysis to STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study) to identify phenogroups with different long-term risk profiles and investigate differences in CABG benefits between phenogroups. STICHES was a randomized controlled trial evaluating the effect of CABG in addition to medical therapy versus medical therapy alone. We split the STICHES participants into derivation (n = 753) and validation (n = 459) cohorts. We phenomapped the derivation cohort using penalized model-based clustering. We fit multivariable Cox models to investigate long-term differences in all-cause mortality, cardiovascular (CV) mortality, and a composite of all-cause mortality/CV hospitalization between phenogroups and whether phenogroup assignment modified the effects of CABG on these outcomes. Findings were internally validated on the validation cohort. Four phenogroups were identified in the derivation cohort. The highest-risk group was at a twofold greater risk of death (HR: 2.0, 95% CI: 1.4-2.9, p < 0.001) and CV death (HR: 2.0, 95% CI: 1.3-3.1, p = 0.002), and a 1.5-fold greater risk for death/CV hospitalization (HR: 1.5, 95% CI: 1.1-2.1, p = 0.016). Phenogroup assignment did not modify the effects of CABG on the outcomes (p > 0.05 for all). Similar results were obtained in the validation cohort. The beneficial effects of CABG on all-cause mortality, CV mortality, and a composite of all-cause mortality and CV hospitalization persist despite phenotypic heterogeneity in HFREF and CAD.

Vitamin and dietary supplements are not associated with total or cardiovascular mortality in Switzerland: the CoLaus|PsyCoLaus prospective study

PurposeVitamin-mineral and dietary supplements (VMDS) are taken by a large fraction of the population. Whether their long-term consumption impacts mortality and cardiovascular disease (CVD) has seldom been studied.MethodsProspective study from a population-based cohort from Lausanne, Switzerland. Participants were categorized as non-users (no consumption at baseline and first follow-up), persistent users (consumption at baseline and follow-up), and occasional users (consumption either at baseline or follow-up). Incidence of CVD and of total mortality was assessed after the first follow-up.ResultsData from 4261 participants (57.4 ± 10.4 years, 55% females) was used. Median follow-up was 9 years (interquartile range 7.0–9.2) After multivariable analysis, no association was found between VMDS use and total mortality: hazard ratio and (95% confidence interval) 0.95 (0.71–1.28) and 0.83 (0.55–1.26) for occasional and persistent consumers, respectively, CVD mortality: 1.00 (0.47–2.11) and 1.30 (0.53–3.18), or CVD events: 0.96 (0.72–1.27) and 0.95 (0.64–1.42). Similar findings were obtained after inverse probability weighting, using only vitamin-mineral supplement users, or considering only participants at baseline. When CVD events were split into coronary heart disease (CHD) or stroke, persistent use of VMDS was associated with a higher risk of CHD in females: 3.12 (1.52–6.41), p = 0.002, but not in males, 0.25 (0.03–1.82), p = 0.171, p for interaction < 0.05. No association was found between VMDS use and incidence of stroke in both sexes.ConclusionWe found no association between vitamin and dietary supplement use and total or CVD mortality, or CVD events. The higher risk of CHD for persistent use in females should be further explored.

Baseline fibroblast growth factor 23 predicts incident heart failure and cardiovascular mortality in patients with chronic kidney disease: A 3-year follow-up study

Baseline fibroblast growth factor 23 predicts incident heart failure and cardiovascular mortality in patients with chronic kidney disease: A 3-year follow-up study

Redefining outcomes of ventricular arrhythmia for SGLT2 inhibitor medication in heart failure patients: a meta-analysis of randomized controlled trials

BackgroundSodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to lower the risk of re-hospitalization and cardiovascular mortality among heart failure (HF) patients. Nevertheless, the impact of these agents on ventricular arrhythmias (VAs) has not been thoroughly investigated. To assess the beneficial impact of SGLT2 inhibitors on VAs in patients at various stages of HF, a systematic review and meta-analysis of randomized controlled trials involving SGLT2 inhibitors in this patient population was performed.MethodsA comprehensive search of the PubMed, Embase, Ovid, ProQuest, Scopus, and Cochrane databases was performed for clinical trials published up to November 21, 2024. The primary outcomes of interest were incidences of VAs and sudden cardiac death (SCD) between the groups receiving SGLT2 inhibitors and the control drugs. For the outcomes observed in the populations of the included trials and in specific subgroups, hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled and meta-analysed across the analyses.ResultsA total of 23 randomized trials (22 placebo-controlled trials and 1 active-controlled trial) involving 74,380 patients (37,372 receiving SGLT2 inhibitors and 37,008 in the control group) were included. The analysed SGLT2 inhibitors included canagliflozin, dapagliflozin, empagliflozin, bexagliflozin, sotagliflozin, and ertugliflozin. The participants were non-advanced HF patients, including at-risk for HF, pre-HF, and symptomatic HF, with follow-up duration ranging from 12 to 296 weeks. Compared with the control, treatment with SGLT2 inhibitors was associated with significantly reduced risk of VAs (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.74–0.98; P = 0.02) and SCD (RR 0.79, 95% CI 0.64–0.98; P = 0.03). Subgroup analyses indicated that longer follow-up (≥ 1 year) taking SGLT2 inhibitors can still reduce the risk of VAs (RR 0.79, 95% CI 0.65–0.96; P = 0.02) and SCD (RR 0.80, 95% CI 0.65–0.99; P = 0.04).ConclusionSGLT2 inhibitors have beneficial effects on lowering risks of VAs and SCD in patients with type 2 diabetes, cardiovascular diseases, heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and heart failure with mildly reduced ejection fraction (HFmrEF), with longer follow-up duration reinforcing these findings. However, future prospective trials are needed to verify the effects of SGLT2 inhibitors on VAs and SCD.Systematic review registrationPROSPERO (CRD42024601914)