Composite Outcome Of All-cause Mortality Research Articles

Classification of primary mitral regurgitation using extramitral cardiac involvement in patients undergoing transcatheter edge-to-edge repair.

An enhanced classification of primary mitral regurgitation (PMR) based on extramitral cardiac involvement may refine patient selection and optimize the timing of transcatheter edge-to-edge repair (TEER). This study aimed to assess the prognostic significance of a recently established classification system that characterizes the extent of extramitral cardiac damage in patients undergoing TEER for PMR. Consecutive PMR patients who received MitraClip implantation were categorized according to the presence of extramitral cardiac damage, determined through preprocedural echocardiography. The classifications included no damage or only left ventricular dilatation (group 0), left atrial involvement (group 1), right ventricular volume/pressure overload (group 2), right ventricular failure (group 3), or left ventricular failure (group 4). Cox-proportional hazard models were used to ascertain the impact of PMR groups on the primary composite outcome of all-cause mortality or rehospitalization for heart failure (HHF) over 2 years. In a cohort of 322 eligible PMR patients undergoing TEER (median age: 83 years; 41% female) between 2013 and 2020, the following distribution emerged: group 0 (10 patients, 3%), group 1 (96 patients, 30%), group 2 (117 patients, 36%), group 3 (56 patients, 18%), and group 4 (43 patients, 13%). Kaplan-Meier analysis demonstrated a significant decline in freedom from the primary outcome as group severity increased (log-rank p = 0.030). On multivariate analysis, the degree of extramitral cardiac involvement was significantly associated with the primary outcome (HR: 1.30; 95% CI: 1.02-1.67; p = 0.043), primarily driven by HHF. This innovative classification system for PMR, based on extramitral cardiac involvement, carries significant prognostic implications for clinical outcomes following TEER. Integrating this classification system into clinical decision-making could enhance risk stratification and optimize the timing of TEER in these patients.

Prognostic value of left atrial strain in patients with moderate to severe mitral stenosis

Abstract Background Mitral stenosis causes an inflow restriction during diastole and is characterized by an increase in left atrial (LA) pressure with reduced cardiac output. Pressure overload of the LA can lead to atrial fibrosis and remodeling, resulting in a loss of LA reservoir and compliance capacity that can lead to backward load on the pulmonary circulation. To date, there are limited studies evaluating the impact of LA strain on prognosis of mitral stenosis patients. Purpose The aim of this study was to assess the prognostic value of LA strain in patients with moderate to severe mitral stenosis using two-dimensional (2D) strain imaging. Methods This was a single-center retrospective study, 237 patients with moderate or severe mitral stenosis were enrolled from January 2010 to December 2022. Baseline clinical and echocardiographic parameters were collected, LA strain measurements with reference time point at end diastole for reservoir strain (LASr), conduit strain (LAScd) and contraction strain (LASct) were analyzed using TOMTEC software. The endpoint was a composite outcome of all-cause mortality, heart failure hospitalization and valve intervention (percutaneous transvenous mitral commissurotomy and surgical intervention). All the LA parameters were analyzed separately to avoid collinearity. Results A total of 237 patients were included in the study. The patients had a mean age was 66.56 ± 13.61 years-old and were predominantly female (67.9%) with median follow up duration is 4.54 years (IQR 1.44 – 6.44). Mean left ventricular ejection fraction (LVEF) was 56.86 ± 10.51%, mean left atrium volume index (LAVI) was 73.94 ± 55.46 ml/m2, mean for LASr, LAScd and LASct were 11.81 ± 8.89%, -6.19 ± 4.50%, and -5.58 ± 6.05% respectively. LASr with a cut-off < 15.8% was independently associated with the composite outcome of all-cause mortality, heart failure hospitalization and valve intervention on multivariable Cox regression analysis (HR 2.51, 95% CI 1.54 - 4.10, p < 0.001). LAScd, LASct and LA volume index did not demonstrate any significant association with the endpoint. Conclusion LASr was independently associated with all-cause mortality, heart failure hospitalization and valve intervention in patients with moderate to severe mitral stenosis.

Implementation of prasugrel and prognostic outcomes after percutaneous coronary intervention for myocardial infarction: a nationwide observational study

Abstract Background Prasugrel has shown superior efficacy and similar safety compared to ticagrelor for patients with acute coronary syndrome treated with percutaneous coronary intervention (PCI) in a randomised setting. Since 2020, prasugrel has been recommended over ticagrelor in our country. It remains unknown if these recommendations have been implemented, and if the findings from the randomised trial can be expanded to an all-comer population. Purpose To assess the implementation of prasugrel and compare effectiveness and safety between prasugrel and ticagrelor in PCI-treated, all-comer patients with myocardial infarction (MI). Methods From January 1st, 2019, to December 31st, 2021 patients with MI treated with PCI were identified by use of nationwide health registries. We included patients who were alive and claimed a prescription of prasugrel or ticagrelor within 7 days from discharge. Incidence rates per 100 person-years (IRs) 6 months from discharge were calculated for a composite outcome of all-cause mortality, recurrent MI (>28 days after index MI), and stroke (MACE), all-cause mortality alone, ischaemic events (a composite of recurrent MI and stroke) and bleeding leading to hospitalisation. We illustrated a Kaplan Meier curve with log-rank test and a cumulative incidence curve with Gray’s test and performed Cox models to assess adjusted comparative differences of the outcomes between prasugrel and ticagrelor after adjusting for age, sex, relevant comorbidities, and calendar year. Results We identified 14,365 PCI-treated patients with MI, of whom 13,887 (96.7%) were alive 7 days from discharge. After excluding patients who did not collect a P2Y12 inhibitor (n=1097 [7.9%]) or collected clopidogrel within 7 days from discharge (n=2696 [21.1%]), the final study population counted 10,094 patients of whom 2045 (20.3%) patients collected prasugrel and 8049 (79.7%) ticagrelor. Figure 1 shows the temporal use of P2Y12 inhibitors. The mean age was 64.4 (±11.7) years and 23.9% were female. Patients with prasugrel were less often ≥75 years old (16.3% vs. 23.2%), female (22.1% vs. 24.3%), and had fewer comorbidities (hypertension, hypercholesterolemia, diabetes, stroke or transient ischaemic attack, bleeding, and prior PCI) than ticagrelor-treated patients. Figure 2 illustrates IRs of the outcomes and Kaplan Meier and cumulative incidence curves. Prasugrel treatment was associated with reduced risk of MACE (HR 0.67 [95% CI 0.47-0.95]) and ischaemic events (HR 0.68 [0.47-0.97]) compared with ticagrelor after adjustment, and there were no differences in all-cause mortality or bleeding (Figure 2). Conclusion Prasugrel use increased from 1% to 44% from 2019 to 2021, but most all-comer patients with MI were treated with ticagrelor after PCI. Prasugrel showed lower risk of MACE and ischaemic events without excess in bleeding 6 months post-discharge compared to ticagrelor, consistent with the findings of a previous randomised trial.Temporal use of potent P2Y12 inhibitorsSix-months outcomes of potent P2Y12i

Prognosis in patients with residual pulmonary hypertension after transcatheter edge-to-edge repair for secondary mitral regurgitation

Abstract Background Pulmonary hypertension (PH) is an independent prognostic predictor in patients with heart failure (HF). Recently, transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation (MR) has been reported to reduce HF hospitalizations and mortality. Elevated pulmonary artery pressure (PAP) before TEER is associated with a poor prognosis; however, the impact of residual PH after TEER on clinical events has not been investigated. Purpose The purpose of this study is to clarify whether residual PH influences outcomes in patients with HF treated by TEER for secondary MR. Methods We included 63 patients who underwent TEER for severe secondary MR and post-procedural right heart catheterization in our institute from January 2016 to August 2023. Mean PAP after TEER was categorized as increased (>20mmHg) versus not increased (≤20mmHg), and we investigated the clinical outcomes between the two groups. The primary endpoint is a composite outcome of all-cause mortality and HF hospitalization. Results Among 63 patients, the average age was 78 years, and 60.3% were male. All patients had Secondary MR, and 52 patients (82.6%) had ventricular Secondary MR—right heart catheterization after TEER revealed a mean PAP of 21.6±7.7 mmHg, pulmonary vascular resistance (PVR) of 2.7±1.4 wood unit (WU), and pulmonary artery wedge pressure (PAWP) of 12.2±5.9 mmHg. Patients with residual PH had higher composite outcome rates of death from any cause or HF hospitalization compared to those without PH (56.1% vs. 19.5%; hazard ratio: 2.62; 95% confidence interval: 1.1 to 6.9; p=0.03). Multivariate Cox regression analysis showed that residual PH and higher PAWP after TEER were associated with higher mortality (hazard ratio: 1.14; 95% confidence interval: 1.03 to 1.28; p=0.01). Conclusion Our results suggest that patients with residual PH after TEER have a poor prognosis. Residual PH and high PAWP after TEER are associated with mortality.

Prediction of outcome in malignant hypertension patients using machine learning: a report from the West Birmingham malignant hypertension registry

Abstract Objectives Malignant hypertension (MHT) is a rare, yet severe condition characterized by high morbidity and mortality rates. This study aimed to assess the potential of machine learning (ML) algorithms in forecasting prognostic outcomes in MHT patients. Methods The dataset from the West Birmingham MHT Registry was used. We evaluated the efficacy of 9 ML algorithms, CatBoost, Decision Tree (DT), Light-Gradient Boosting Machine (LightGBM), K-Nearest Neighbors (KNN), Logistic Regression (LR), Multi-Layer Perceptron (MLP), Random Forest (RF), Support Vector Machine (SVM) and XGBoost, in predicting a composite outcome of all-cause mortality or dialysis. Evaluation metrics included the area under the receiver operating characteristic curve (AUC) and the F1 score. The SHapley Additive exPlanations values were employed to quantify the importance of each feature in the models. Results The study cohort comprised 385 individuals diagnosed with MHT (mean age of 48±13 years, 66% male). During a median follow-up period of 11 years (interquartile range: 3-18 years), 282 patients (73%) experienced the composite outcome. From 24 demographic and clinical variables, 16 were selected into the ML models. Among 9 models, the SVM and LR models exhibited robust predictive performance, achieving AUCs of 0.86 (95% CI: 0.76-0.93) and 0.81 (95% CI: 0.72-0.93), respectively. Furthermore, these models demonstrated high F1 scores (SVM: 0.89, LR: 0.85) and sensitivity (SVM: 0.89, LR: 0.83) (Table). Age, smoking history, systolic blood pressure at follow-up and baseline creatinine levels were commonly identified as primary prognostic features in both SVM and LR models (Figure). Conclusions The application of ML algorithms facilitates effective prediction of prognostic outcomes in patients with MHT, illustrating their potential utility in clinical decision-making through more targeted risk stratification and individualized patient care in these high-risk patients.

Impact of late reperfusion therapy in patients with inferior ST-segment elevation myocardial infarction and right ventricular dysfunction: one size never fits all

Abstract Background A significant proportion of ST-segment elevation myocardial infarction (STEMI) patients present late to the emergency room with limited evidence of benefit of reperfusion after 12 hours of symptom onset. Inferior myocardial infarction (MI) with right ventricle (RV) dysfunction is associated with high morbidity and mortality, however, the RV has a unique physiology that allows it to withstand ischemia better and recover faster. Purpose To compare adverse in-hospital cardiovascular events in latecomers with inferior STEMI and RV dysfunction admitted to a cardiovascular intensive care unit (CICU) from a low-to-middle-income country, who underwent late reperfusion treatment versus conservative treatment. Methods A retrospective cohort study was conducted from March 2022 to April 2023. Patients with inferior STEMI and RV dysfunction who received late reperfusion treatment were included. RV dysfunction was defined as a TAPSE <17 mm, tricuspid annular systolic velocity on TDI <9.5 cm/s, or a fractional area change <35%. Late reperfusion was defined as primary percutaneous coronary intervention (PCI) performed after 12 hours of symptom onset or rescue PCI after 12 hours of failed fibrinolysis. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were cardiovascular death, reinfarction, stroke, cardiogenic shock, and mechanical complications. Results During the specified period, a total of 106 patients met the inclusion criteria from a total of 1,786 patients admitted to the CICU in our center. Only 60 patients underwent late PCI, accounting for 56% of the cases, with a median time of onset of symptoms to reperfusion of 19.4 hours (IQR: 15.7, 30.2). The average age was 66.5 ± 10.4 years, and 28% were women. Although the all-cause death rate was lower among late PCI group (13.3% vs 26.1%; p=0.096), this difference did not reach statistical significance in the bivariate analysis. Stratified by cardiogenic shock, a lower rate of all-cause mortality was also observed (33% vs 55%, p=0.15). The incidence of reinfarction was significantly lower in the late PCI group (0% vs 13%, p=0.004). In the multivariate analysis, adjusting for those who underwent PCI between 12-48 hours, revascularization of latecomers was independently associated with a significant reduction of mortality (adjusted OR 0.22; 95% CI 0.05-0.92; p=0.038). In a post-hoc analysis, late PCI showed a lower association with the composite outcome of all-cause mortality and reinfarction (adjusted OR 0.16, 95% CI 0.04-0.56; P=0.004). Conclusion(s) Our study demonstrates that implementing a reperfusion strategy in latecomers with inferior STEMI and RV dysfunction significantly reduces the risk of in-hospital mortality and reinfarction. This suggests a potential benefit of expanding the therapeutic window for PCI in this high-risk population. However, prospective studies are needed to conclude these preliminary findings.

Prognostic value of right ventricular-pulmonary arterial coupling indices in patients with moderate to severe mitral stenosis

Abstract Background Right ventricular-pulmonary arterial (RV-PA) coupling represents the relationship of RV contractility and RV afterload. The ability of RV to adapt to changes in RV afterload (i.e. increased pulmonary arterial (PA) loading) has prognostic implications in various cardiovascular diseases such as heart failure and pulmonary arterial hypertension. RV-PA uncoupling occurs when RV contractility cannot match RV afterload, resulting in right heart dysfunction. However, RV-PA coupling has not been investigated in mitral stenosis patients. Purpose To evaluate the prognostic significance of various non-invasive RV-PA coupling parameters (TAPSE/PASP and RVFWLS/PASP) in patients with moderate to severe mitral stenosis. Methods This was a single-center retrospective study of 237 patients with moderate or severe mitral stenosis enrolled between January 2010 to December 2022. Baseline clinical and echocardiographic parameters were collected. RV free wall longitudinal strain (RVFWLS) was subsequently analyzed using TOMTEC software. Echocardiography-derived RV-PA coupling parameters were collected, including TAPSE/PASP and RVFWLS/PASP. The primary endpoint was a composite outcome of all-cause mortality, heart failure hospitalization and valve intervention (percutaneous transvenous mitral commissurotomy and surgical intervention). RV parameters were analyzed separately to avoid collinearity. Results A total of 237 patients were included in the study. The patients had a mean age was 66.56 ± 13.61 years-old and were predominantly female (67.9%). The median follow-up duration was 4.54 years (IQR 1.44 – 6.44). Mean left ventricular ejection fraction (LVEF) was 56.86 ± 10.51%, mean TAPSE 18.29 ± 5.36 mm and mean RVFWLS was -23.60 ± 7.96 %. In separate multivariable Cox regression models after adjustment for age , sex and mitral stenosis severity, TAPSE/PASP ratio < 0.36mm/mmHg (HR 2.025 , 95% CI 1.395-2.939, p < 0.001 ) and RVFWLS/PASP ratio ≥ - 0.5%/mm Hg (HR 2.031 95% CI 1.404 – 2.938 , p< 0.001) remained independently associated with mortality , heart failure hospitalization and valve intervention. Conclusion TAPSE/PASP and RVFWLS/PASP were independently associated with all-cause mortality, heart failure hospitalization and valve intervention in patients with moderate to severe mitral stenosis.

Contemporary use of beta-blockers in the outpatient treatment of heart failure with atrial fibrillation

Abstract Background Evidence of the effectiveness of β-blockers in heart failure (HF) and atrial fibrillation (AF) in a contemporary cohort is controversial. This study investigated the association between the use of β-blockers and prognosis in outpatients across a broad spectrum of HF with AF. Methods Patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between 2014 and 2021. Associations of β-blocker use at discharge and prognosis were compared by propensity score matching among the AF or non-AF group. A multilevel mixed-effects survival model was used with hazard ratio (HR) and 95% confidence interval (CI). Results Among 428,650 patients discharged with HF in 4,433 hospitals, 175,174 (40.9%) were ≥85 years old, 151,873 (35.4%) had complicated AF, and 236,457 (55.2%) were β-blocker users. In a matched AF group, β-blocker use was associated with a lower composite outcome of all-cause mortality or HF rehospitalization (HR [95% CI], 0.95 [0.93–0.97]). A similar result was obtained in a matched non-AF group (0.95 [0.94–0.96]). In addition, the HRs in patients aged ≥85 years and female patients were 1.00 [0.98–1.02] and 1.01 [0.98–1.03] in the AF group and 1.03 [1.01–1.05] and 0.98 [0.97–1.00] in the non-AF group, respectively (Figure). Conclusions The favorable prognostic associations of β-blocker use were observed regardless of AF in outpatients across a broad spectrum of HF in a superaged society. However, β-blocker use may not be effective in older or female patients.

Older women with non-ST-elevation acute coronary syndrome undergoing invasive or conservative management: an individual patient data meta-analysis

Abstract Aims Women and older patients are underrepresented in randomised controlled trials (RCTs) investigating treatment strategies following acute coronary syndrome. To evaluate the benefit of invasive versus conservative strategy of older women with non-ST-elevation acute coronary syndrome (NSTEACS). Methods This analysis from an individual patient data meta-analysis included six RCTs comparing an invasive management with a conservative management in older NSTEACS patients. The primary endpoint was the composite of all-cause mortality or myocardial infarction (MI). Secondary endpoints included all-cause mortality, cardiovascular death, MI, urgent revascularisation and stroke. Follow-up time was censored at 1 year. Results In total, 717 women (median age 84.0 [interquartile range 81.0-87.0] years) were included. The primary endpoint occurred in 21.0% in the invasive strategy versus 27.8% in the conservative strategy (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.52-1.13, P=0.160 using random effect) at 1-year follow-up. The invasive management was associated with reduced risk of MI (HR 0.49, 95% CI 0.32-0.73, P<0.001) and urgent revascularisation (HR 0.44, 95% CI 0.20-0.98, P=0.045). No significant differences were identified in the risk of all-cause mortality, cardiovascular death and stroke. Among males, there was no significant association between the treatment strategy and primary or secondary endpoints. Conclusions An invasive strategy compared to a conservative strategy did not reduce the composite outcome of all-cause mortality or MI in older NSTEACS women at 1-year follow-up. An invasive strategy reduced the individual risk of MI and urgent revascularisation. Our results support the beneficial role of the invasive strategy in older NSTEACS women. Registration This meta-analysis is registered with PROSPERO (CRD42023379819).

Depressive symptomatology, NT-proBNP levels and health status in patients with heart failure: a prospective observational study

BackgroundDepressive symptoms frequently occur in patients with heart failure (HF). However, research on the relationship between these symptoms and N-terminal pro-brain natriuretic peptide (NT-proBNP), a key biomarker for HF severity...

A comprehensive assessment tool of acute-phase rehabilitation is associated with clinical outcomes in patients after cardiovascular surgery.

Perme intensive care unit (ICU) mobility score is a comprehensive mobility assessment tool; however, its usefulness and validity for patients after cardiovascular surgery remain unclear. We investigated the association between the Perme Score and clinical outcomes after cardiovascular surgery. We retrospectively enrolled 249 consecutive patients admitted to the ICU after cardiac and/or major vascular surgery. The Perme Score contains categories on mental status, potential mobility barriers, muscle strength and mobility level and was assessed within 2days after surgery. The outcomes of physical recovery were the number of days until 100-m ambulation achievement and 6-min walk distance (6MWD) at hospital discharge. The endpoint was a composite outcome of all-cause mortality and/or all-cause unplanned readmission. We analyzed the associations of the Perme Score with physical recovery and the incidence of clinical events. After adjusting for clinical confounding factors, a higher Perme Score was an independent factor of earlier achievement of 100-m ambulation (hazard ratio: 1.039, 95% confidence interval [CI]: 1.012-1.066) and higher 6MWD (β: 0.293, P = .001). During the median follow-up period of 1.1years, we observed an incidence rate of 19.4/100 person-years. In the multivariate Poisson regression analysis, a higher Perme Score was significantly and independently associated with lower rates of all-cause death/readmission (incident rate ratio: 0.961, 95% CI: 0.930-0.992). The Perme Score within 2days after cardiovascular surgery was associated with physical recovery during hospitalization and clinical events after discharge. Thus, it may be useful for predicting clinical outcomes.

Mechanical versus Biological Valve Prostheses for Infective Endocarditis Presenting with Stroke.

Objectives: This study aimed to compare the clinical outcomes of mechanical and biological valve prostheses in patients with infective endocarditis presenting with stroke. Methods: Ninety-five adults with infective endocarditis complicated by stroke at baseline who underwent aortic and/or mitral valve replacement were analyzed retrospectively. The primary outcome was a composite outcome of all-cause mortality, ischemic stroke, hemorrhagic stroke, and re-endocarditis. Secondary outcomes included the individual components of the composite outcome and modified Rankin scale deterioration during follow-up. Results: Among the study cohort, 34 patients (35.8%) received mechanical valve prostheses and 61 (64.2%) received biological valve prostheses. Implantation of a mechanical valve prosthesis seems to be associated with a decreased risk of attaining the composite outcome (adjusted HR 0.46, 95% CI 0.22-0.96, and p = 0.037). Analyses of the individual components of the composite outcome showed that implantation of a mechanical valve prosthesis might not be associated with an increased risk of ischemic stroke, hemorrhagic stroke, and all-cause mortality during the follow-up period. Further, the risk of re-endocarditis was significantly lower in recipients of a mechanical valve prosthesis (adjusted HR 0.15, 95% CI 0.06-0.77, p = 0.026). Notably, a trend toward decreased risk of modified Rankin scale deterioration throughout the follow-up period was observed in this group (adjusted odds ratio 0.22, 95% CI 0.05-1.02, p = 0.053). Conclusions: Implantation of mechanical valve prostheses in patients presenting with infective endocarditis complicated by stroke seems to be beneficial in terms of a reduced risk of experiencing a composite outcome. Analyses of larger cohorts are required to validate our findings.

Clinical impact of diastolic dysfunction and atrial fibrillation before and after initiating hemodialysis in patients with end-stage kidney disease

Background Diastolic dysfunction with left ventricular hypertrophy and myocardial fibrosis is an important characteristic of uremic cardiomyopathy in end-stage kidney disease (ESKD). Few studies explored the relationship between changes in diastolic dysfunction and the risk of mortality or cardiovascular outcome in patients with ESKD. We investigated the clinical impact of diastolic dysfunction and atrial fibrillation (AF) on patients starting hemodialysis (HD). Methods A total of 718 patients who started HD between 2010 and 2020 were included. We classified patients according to the pre- and post-HD diastolic dysfunction grades (DDG) evaluated by echocardiography. Patients with AF were classified separately. The primary outcome was a composite outcome of all-cause mortality and cardiac complication. Results The median age was 63 years, and 61.4% were male. Patients were divided into four groups based on pre-HD echocardiography findings. After initiating HD, the patients were classified according to changes in DDG and AF. Composite outcomes were significantly higher in the pre-HD AF groups. However, after adjusting for age and history of ischemic heart disease, pre-HD AF did not affect the composite outcomes. Patients with normal post-HD diastolic function had better outcomes than those with diastolic dysfunction or AF. Furthermore, the deterioration of diastolic dysfunction after HD was associated with an increased risk of composite outcomes. Conclusions The deterioration of diastolic dysfunction and newly development of AF after initiating HD were identified as risk factors for mortality and cardiac complications, supporting the clinical importance of the appropriate management of diastolic dysfunction and AF in patients with ESKD.

Serum Soluble Corin and Long-Term Clinical Outcomes After Acute Ischemic Stroke.

Corin plays important roles in the regulation of blood volume and pressure and cardiac function by activating natriuretic peptide pathway, exerting multiple cardioprotective effects. But the impacts of soluble corin on clinical outcomes after ischemic stroke are unclear. We aimed to investigate the associations between serum soluble corin and long-term clinical outcomes after acute ischemic stroke. We measured the concentrations of serum soluble corin in 3162 participants (2010 men and 1152 women) from the China Antihypertensive Trial in Acute Ischemic Stroke. The clinical outcomes were recurrent stroke, cardiovascular events, all-cause mortality, and unfavorable functional outcome within 24 months after stroke. Risk reclassification for study clinical outcomes of models with soluble corin were evaluated. Serum soluble corin was inversely associated with recurrent stroke, cardiovascular events, and unfavorable functional outcome after ischemic stroke. After adjusting for multiple covariates, each additional SD of log-corin was associated with a 21% (95% CI, 11-30), 16% (95% CI, 6-26), and 12% (95% CI, 3-21) decreased risk for recurrent stroke, cardiovascular events, and unfavorable functional outcome, respectively. Furthermore, the addition of soluble corin to the basic model with conventional risk factors significantly improved risk discrimination for recurrent stroke, cardiovascular events, and the composite outcome of all-cause mortality and cardiovascular events, as shown by C-statistics (all P<0.05). Serum soluble corin was associated with decreased risks of long-term clinical outcomes, and may be a promising prognostic biomarker for risk stratification in patients with acute ischemic stroke.

Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database.

Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS. This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI). Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, p < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, p < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, p < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, p < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, p < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, p < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups. Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.

Controlling Nutritional Status Score Predicts 1-Year Outcomes in Chronic Thromboembolic Pulmonary Hypertension.

The prognosis for patients with chronic thromboembolic pulmonary hypertension (CTEPH) using their nutritional status has not been established. We investigated the relationship between the prognosis of patients with CTEPH and the Controlling Nutritional Status (CONUT) score, which is a nutritional assessment tool. A total of 157 patients with CTEPH was enrolled in the study. The primary outcome was defined as the composite outcome of all-cause mortality and non-elective hospitalization due to heart failure. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff CONUT score for predicting the 1-year rate of the primary outcome. Patients were divided into 2 groups according to the significant cutoff value and compared. Undernutrition was observed in 51.6% of patients. ROC analysis revealed a significant cutoff CONUT score of 3.5 (area under the curve=0.789). The incidence rate of the primary composite outcome was higher in the high CONUT group (score ≥4) than in the low CONUT group (score ≤3; 20% vs. 2.2%; P<0.001). Cox analysis revealed the CONUT score per point increase was an independent risk factor for the primary composite outcomes (hazard ratio 2.301; 95% confidence interval 1.081-4.895; P=0.031). The CONUT score can predict the 1-year rate of all-cause death and non-elective hospitalization in patients with CTEPH.

Transcatheter tricuspid valve intervention versus medical therapy for symptomatic tricuspid regurgitation: a meta-analysis of reconstructed time-to-event data

Background: Transcatheter tricuspid valve intervention (TTVI) has demonstrated safety and efficacy in treating high-risk patients with tricuspid regurgitation (TR). We aimed to perform a meta-analysis based on reconstructed time-to-event data to compare the clinical benefit of TTVI with medical therapy (MED). Methods: A systematic literature search was conducted in major databases, including PubMed, Embase, and the Cochrane Library, until October 20, 2023. All studies comparing the outcomes between TTVI and MED were included. The primary outcome was all-cause mortality. The secondary outcomes included heart failure (HF) hospitalization and the composite outcome of all-cause mortality and HF hospitalization. Results: Five studies covering 3826 patients (1146 received TTVI and 2680 received MED) were identified. At 1-year follow-up, TTVI significantly reduced the risk of all-cause mortality compared with MED [(hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.39–0.74, P=0.0001)]. There was a trend in favor of TTVI in HF hospitalization, although without significant difference (HR 0.70, 95% CI 0.42–1.18, P=0.18). TTVI was also associated with a decreased risk of composite outcome (HR 0.57, 95% CI 0.38–0.86, P=0.007). Reconstructed Kaplan-Meier curves illustrated a 1-year overall survival rate of 83.1% in the TTVI group and 68.8% in the MED group. The subgroup analysis of device types yielded consistent results. Conclusions: Compared with MED, TTVI was associated with greater 1-year benefits for patients with symptomatic moderate or greater TR from the aspects of all-cause mortality and HF hospitalization.

Five-year outcomes of transcarotid transcatheter aortic valve replacement

BackgroundTranscarotid transcatheter aortic valve replacement (TC-TAVR) has emerged as an alternative access route for transcatheter aortic valve replacement (TAVR). However, scarce data exist on long-term outcomes following TC-TAVR. This study aimed to evaluate clinical outcomes at 5 years after TC-TAVR. MethodsA total of 110 consecutive patients who underwent TC-TAVR were included. Baseline, procedural, and follow-up data were collected prospectively in a dedicated database. The primary endpoint was the incidence of a composite outcome of all-cause mortality, stroke, and repeat hospitalization at 5-year follow-up. Echocardiography results, New York Heart Association (NYHA) class, and quality of life (QoL) as assessed with the EuroQol visual analog scale (EQ-VAS) were examined over the 5-year follow-up. ResultsThe median patient age was 77 years (interquartile range [IQR], 72-82.2 years), 42.3% were women, and the median Society of Thoracic Surgeons (STS) risk score was 5.02% (IQR, 3.4%-7.5%). The incidence of the composite primary endpoint was 54.5%. Death from any cause occurred in 45.6% of patients (11.9 per 100 patient-years); stroke in 8.2% (1.9 per 100 patient-years); disabling stroke in 2.7% (0.7 per 100 patient-years); and rehospitalization in 27.2%. The improvements in valve hemodynamics, NYHA class, and EQ-VAS following the procedure persisted at 5-year follow-up (P < .001). The incidence of bioprosthetic valve failure was 0.9%. ConclusionsAbout half of the moderate-to high-risk patients undergoing TC-TAVR survived with no major cardiovascular events at the 5-year follow-up. The yearly incidence of stroke events was low, and early improvements in valve hemodynamics, functional status, and QoL persisted at 5 years. These results suggest the long-term safety and efficacy of TC-TAVR and would support this approach as an alternative to surgery in non-transfemoral candidates.

Relation of myocardial dysfunction to biomarkers, COVID-19 severity and all-cause mortality.

The COVID-19 infection has been described as affecting myocardial injury. However, the relation between left ventricular global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), disease severity and all-cause mortality in COVID-19 is unclear. The study consisted of 220 patients with COVID-19, including 127 (57.5%) with mild, 43 (19.5%) with moderate and 50 (22.7%) with severe/critical conditions. Myocardial dysfunction was analysed by GLS, GCS and GRS using two-dimensional speckle-tracking echocardiography. Hazard ratios and Kaplan-Meier curves were produced to assess the association between strains and cardiac biomarker indices with a composite outcome of all-cause mortality. With an average follow-up period of 11days, 19 patients reached the endpoint (death). Significant associations were found for the three strain parameters and the levels of blood urea nitrogen (BUN) (r=0.206, 0.221 and 0.355, respectively). Cardiac troponin I (cTnI) was closely related to the GLS and GCS (r=0.240 and 0.324, respectively). In multivariable Cox regression, GCS>-21.6% was associated with all-cause death {hazard ratio, 4.007 [95% confidence interval (CI), 11.347-11.919]}. GLS, GCS and GRS are significantly related to myocardial dysfunction in patients with COVID-19. Worsening GCS poses an increased risk of death in COVID-19.

Prophylactic-dose direct oral anticoagulants for non-hospitalised people with COVID-19: A meta-analysis of randomised controlled trials.

Several reviews have been conducted on thromboprophylaxis in non-hospitalised patients with coronavirus disease 2019 (COVID-19). In this systematic review and meta-analysis, we sought to investigate the impact of prophylactic-dose direct oral anticoagulants (DOACs) in this population. We searched PubMed, Web of Science, EMBASE and Cochrane Library for randomised controlled trials (RCTs) comparing prophylactic-dose DOACs with placebo or no treatment in non-hospitalised patients with COVID-19 until September 2023. The primary efficacy outcome was a composite of all-cause mortality and thromboembolic events, while major bleeding events were the primary safety outcome. We expressed continuous outcome data as mean differences (MDs) with 95% confidence intervals (CIs) and dichotomous outcome data as risk ratios (RRs) with 95% CIs. We included six RCTs involving 4307 patients. Prophylactic-dose DOAC therapy compared with placebo or no treatment was associated with significantly decreased risks of the composite outcome of all-cause mortality and thromboembolic events (1.43% vs 2.67% (RR = 0.53; 95% CI = 0.34-0.82, P = 0.004, I2 = 3%)). Major bleeding events were infrequent, and we detected no significant differences between patients assigned to prophylactic-dose DOACs vs placebo or no treatment (0.19% vs 0.05% (RR = 2.50; 95% CI = 0.49-12.87, P = 0.27, I2 = 0%)). The use of prophylactic-dose DOACs was also associated with a reduction in venous thromboembolism, with no difference in all-cause mortality, arterial thromboembolism, hospitalisations, and clinically relevant nonmajor bleeding between two groups. Sensitivity analyses with the leave-one-out method for the primary efficacy and safety outcome did not change the effect estimate substantially. We found that prophylaxis-dose DOACs could significantly improve clinical outcomes and reduce venous thrombotic events without increasing the risk of major bleeding events compared with placebo or no treatment in non-hospitalised patients with COVID-19. PROSPERO: CRD42023466889.