Identification of nondialysis chronic kidney disease (CKD) patients at a higher risk of end-stage kidney disease (ESKD) or adverse cardiovascular events is the first essential step to optimize management. We evaluated the role of left ventricular ejection fraction (LVEF) in predicting cardiac and renal outcome in CKD.

We prospectively studied 580 consecutive patients with nondialysis CKD followed in two Italian renal clinics in order to evaluate the association between LVEF as either continuous variable or categories (>60, 50-60 and <50%) and adjusted risks (hazard ratio, 95% confidence interval) of either cardiovascular (composite of fatal and nonfatal cardiovascular events) or renal events (composite of ESKD and all-cause death before ESKD).

The mean age of participants was 65.0 ± 13.5 years, 62% men, eGFR 41.3 ± 21.1 ml/min/1.73 m 2 , LVEF 60.6 ± 8.1% and left ventricular mass index (LVMI) 59.3 ± 17.6 g/m 2.7 . LVEF more than 60%, 50-60% and <50% was recorded in 274, 234 and 72 patients, respectively. Patients with LVEF less than 50% were predominantly men with more frequent history of cardiovascular disease and lower eGFR; in addition, they had higher 24 h, daytime and nighttime blood pressure. During the follow-up (median 5.0 years, IQR 4.9-7.1), cardiovascular and renal endpoints were registered in 113 and 228 patients, respectively. LVEF as a continuous variable was inversely associated with the adjusted risk of either cardiovascular (0.97, 0.95-0.99) or renal endpoint (0.98, 0.97-0.995). In comparison with patients with LVEF more than 60%, the risk of cardiovascular events was increased in patients with LVEF 50-60% (1.64, 1.06-2.53) and less than 50% (2.17, 1.27-3.72). The same occurred for renal endpoint (1.68, 1.24-2.27 and 1.73, 1.15-2.59 for LVEF 50-60% and <50%, respectively).

In CKD patients, lower LVEF is associated with worse cardiorenal prognosis, independently from LVMI.

Primary hyperparathyroidism (PHPT) is associated with hypertension, left ventricular hypertrophy, and myocardial and valvular calcifications, leading to increased mortality rates. While the association between PHPT and diastolic dysfunction has been well-documented, data on systolic dysfunction and its reversal after curative parathyroidectomy (PTX) remains limited.

To evaluate the effect of PTX on cardiovascular parameters, especially systolic dysfunction, in PHPT patients using conventional and speckle-tracking echocardiography (STE).

This prospective study was conducted at a tertiary care hospital from August 2016 to September 2019; 59 patients underwent successful PTX based on standard criteria, with 58 completing the study. Preoperative and 6-month postoperative biochemical and cardiovascular evaluations, including echocardiography, were performed. Global longitudinal strain (GLS) was assessed using speckle-tracking echocardiography (STE).

The mean age of subjects was 45.2 ± 10.4 years with a male-to-female ratio of 1.5:1. Normalization of serum calcium and phosphorus with significant reductions in serum intact PTH, alkaline phosphate, total cholesterol, HDL, and uric acid levels (p ≤ 0.0001) were seen after curative PTX. Echocardiographic evaluations significantly improved diastolic parameters, including E velocity (cm/s) and E/A(atrial) ratio. Systolic dysfunction also showed significant improvement on conventional echocardiography and STE, as evidenced by reduced left ventricular (LV) mass, ejection fraction (EF), and postoperative GLS. Although a relative drop in EF was noted postprocedure, STE findings suggested a significant improvement in systolic dysfunction, signifying GLS as a more appropriate means of assessing systolic dysfunction. Serum PTH demonstrated a strong positive correlation (r = 0.638, p < 0.001) with changes in GLS, while serum calcium showed a weak correlation (r = 0.291, p = 0.027) with changes in GLS following surgery.

This study demonstrates significant improvements in diastolic and systolic functions, as evidenced by conventional echocardiography and STE, and suggests that PTX benefits cardiovascular health in PHPT patients.

Previous studies have explored tools for evaluating the effects of positive fluid balance, with recent emphasis, and controversies, on venous ultrasound parameters and composite scores. The portal vein pulsatility index and the renal venous pattern have emerged as the most promising indicators of volume-induced venous congestion. But in the general intensive care unit (ICU), numerous factors influence cardiovascular homeostasis, affecting venous function.

This study aimed to evaluate the factors associated with portal vein pulsatility index in general ICU patients. Secondary objectives were to examine the correlations between pulsatility index and additional markers of congestion.

This exploratory study was a post hoc analysis of a prospective, multicentric, observational database.

The data collection was performed in four ICUs in university-affiliated or tertiary hospitals.

This study included adult patients within 24 h of general ICU admission with an expected ICU length of stay of more than 2 days.

Patients underwent clinical, biological, and echocardiographic assessments at several times: ICU admission, day 1, day 2, day 5 and the last day of ICU.

The study primary endpoint was the portal vein pulsatility index during the course of the patients' stay on the ICU.

One hundred forty-five patients and 514 haemodynamic evaluations were analysed. The mean age of the patients was 64 ± 15 years, 41% were women, with a median [IQR] admission simplified acute physiology score II of 46 [37 to 59]. The univariable followed by multivariable mixed-effects linear regression analyses demonstrated an association between portal vein pulsatility index, heart rate [estimate -0.002 (95% CI, -0.003 to -0.001), P  < 0.001] and the cumulative fluid balance [estimate 0.0007 (95% CI, 0.00007 to 0.001), P  = 0.024]. Portal vein pulsatility index showed no agreement with CVP of at least 12 mmHg (kappa correlation -0.008, P  = 0.811), negative passive leg raising (kappa correlation -0.036, P  = 0.430), mean inferior vena caval (IVC) diameter greater than 2 cm (kappa correlation -0.090, P  = 0.025), maximal IVC diameter greater than 2 cm (kappa correlation -0.010, P  = 0.835), hepatic vein systolic/diastolic ratio less than 1 (kappa correlation 0.043, P  = 0.276), or renal vein pulsatile pattern (kappa correlation -0.243, P  < 0.001).

The study findings emphasise the unique sensitivity of portal vein pulsatility index in assessing fluid balance in general ICU patients. The lack of correlation between portal vein pulsatility index and other parameters of venous congestion underscores its potential to provide distinctive insights into venous congestion.

Differentiation of tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DCM) in patients admitted for heart failure (HF) with left ventricular dysfunction and supraventricular tachyarrhythmia (SVT) remains challenging. The role of tissue tracking (TT) in this setting remains unknown.

Forty-three consecutive patients admitted for HF due to SVT with left ventricular ejection fraction (LVEF) < 50% undergoing CMR were retrospectively included. Those eventually evolving to LVEF > 50% at follow-up were classified as TIC and those maintaining a LVEF < 50% were classified as DCM. Clinical, echocardiography, and CMR findings, including TT, were analyzed to predict LVEF recovery.

Twenty-five (58%) patients were classified as TIC. Late gadolinium enhancement (LGE) was more frequent in DCM group (61% vs 16%, p = 0.004). Left ventricle (LV) peak systolic radial velocity and peak diastolic radial strain rate were lower in DCM group (7.24 ± 4.44 mm/s vs 10.8 ± 4.5 mm/s; p = 0.015 and -0.12 ± 0.33 1/s vs -0.48 ± 0.51 1/s; p = 0.016, respectively). Right ventricle (RV) peak circumferential displacement was lower in patients with TIC (0.2 ± 1.3 vs 1.3 ± 0.9°; p = 0.009). In the multivariate analysis, diabetes (p = 0.046), presence of LGE (p = 0.028), LV peak systolic radial velocity < 7.5 mm/s (p = 0.034), and RV peak circumferential displacement > 0.5° (p = 0.028) were independent predictors of lack of LVEF recovery.

In the setting of acute HF with LV dysfunction related to SVT, diabetes, LGE, LV peak systolic velocity, and RV peak circumferential displacement are independent predictors of lack of LVEF recovery and, therefore, represent clinically useful parameters to differentiate TIC from DCM.

Color tissue Doppler imaging (TDI) M-mode can be used to measure the cardiac time intervals including the isovolumic contraction time (IVCT), the left ventricular ejection time (LVET), the isovolumic relaxation time (IVRT), and the combination of all the cardiac time intervals in the myocardial performance index (MPI) defined as [(IVCT + IVRT)/LVET]. The aim of this study was to establish normal age- and sex-based reference ranges for the cardiac time intervals.

A total of 1969 participants free of cardiovascular diseases and risk factors from the general population with limited age range underwent an echocardiographic examination including TDI. The median age was 46 years (25th-75th percentile: 33-58 years), and 61.5% were females. In the entire study population, the IVCT was observed to be 40 ± 10 ms [95% prediction interval (PI) 20-59 ms], the LVET 292 ± 23 ms (95% PI 248-336 ms), the IVRT 96 ± 19 ms (95% PI 59-134 ms) and MPI 0.47 ± 0.09 (95% PI 0.29-0.65). All the cardiac time intervals differed significantly between females and males. With increasing age, the IVCT increased in females, but not in males. The LVET did not change with age in both sexes, while the IVRT increased in both sexes with increasing age. Furthermore, we developed regression equations relating the heart rate to the cardiac time intervals and age- and sex-based normal reference ranges corrected for heart rate.

In this study, we established normal age- and sex-based reference ranges for the cardiac time intervals. These normal reference ranges differed significantly with sex.

This study aimed to compare two-dimensional, M-mode, color, pulsed-wave Doppler (PWD) and continuous-wave Doppler (CWD) echocardiography, and PWD ultrasonography of the caudal common carotid artery (CCA) in horses with aortic regurgitation (AR).

Warmblood horses without (n = 20) and with mild, moderate, and severe AR (n = 60) were included in the study.

A retrospective descriptive study focused on cardiac dimensions, aortic and CCA Doppler flow. Non-invasive blood pressure and presence of ventricular arrhythmia were recorded. Groups were compared using analysis of variance, chi-square, Spearman's rho, and Kruskal-Wallis tests.

Maximal aortic antegrade flow velocity was higher in horses with moderate and severe AR than in normal horses and higher in those with severe AR than in those with mild AR (P<0.001). Mean (standard deviation) antegrade CCA flow velocities were 0.9 m/s (0.3 m/s) in normal horses and 1.0 m/s (0.2 m/s), 1.2 m/s (0.3 m/s), and 1.5 m/s (0.4 m/s) in horses with mild, moderate, and severe AR, respectively. Retrograde mid-to-end diastolic PWD ultrasonography of the common carotid artery (PWD-CCA) flow occurred in horses with moderate (6/20) and severe (13/20) AR. The presence of pathologic retrograde PWD-CCA flow was associated with presence of increased left ventricular dimensions and pulse pressures >60 mmHg. The CWD regurgitant jet pressure half-time failed to differentiate between AR severity grades.

The limitations of this study included retrospective design with missing values, AR classification system not validated by longitudinal follow-up, and CCA retrograde velocities <10 cm/s not measured.

Pulsed-wave Doppler ultrasonography of the common carotid artery identifies moderate and severe AR in horses with hemodynamic overload. Presence of retrograde PWD-CCA flow was associated with moderate and severe AR and with left ventricular dilation. Quantification of CWD pressure half-time appeared unreliable for AR severity assessment.

Data on the clinical profiles of patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM) in the post-approval era of tafamidis 61 mg are lacking. Study aims were characterization of contemporary ATTR-CM patients, analysis of potential eligibility for the 'Transthyretin Amyloidosis Cardiomyopathy Clinical Trial' (ATTR-ACT) and identification of factors associated with the decision on tafamidis 61 mg treatment.

This retrospective study analysed ATTR-CM patients seen at eight University Hospitals in the first year after approval of tafamidis 61 mg for ATTR-CM in Germany (April 2020 to March 2021). The cohort comprised 366 patients (median age 79 [74; 82] years, 84% male), with 47% and 45% of the cohort being in National Amyloidosis Centre ATTR stage ≥ II and NYHA class ≥ III, respectively. Sixty-four per cent of patients met key eligibility criteria of the pivotal ATTR-ACT. In recently diagnosed patients (58% with diagnosis ≤6 months), the rate of variant ATTR was significantly lower than in patients diagnosed more than 6 months ago (9.3% vs. 19.7%). Of the 293 patients without prior ATTR specific treatment, tafamidis 61 mg was newly initiated in 77%. Patients with tafamidis 61 mg treatment were significantly younger, were more often eligible for ATTR-ACT, had lower NYHA class and higher serum albumin levels. These variables explained 16% of the variance of treatment decision. Unadjusted survival was higher in patients with than those without treatment (1-year survival 98.6% vs. 87.3%, P < 0.001).

Wild-type ATTR was the primary aetiology amongst contemporary ATTR-CM patients and almost two-thirds of patients were in an advanced disease stage. Clinical profiles of 64% of patients in routine care matched those of the ATTR-ACT. Further effort is needed to detect patients at an earlier disease stage and to validate criteria justifying treatment initiation.

Cardio-mechanical models can be used to support clinical decision-making. Unfortunately, the substantial computational effort involved in many cardiac models hinders their application in the clinic, despite the fact that they may provide valuable information. In this work, we present a probabilistic reduced-order modeling (ROM) framework to dramatically reduce the computational effort of such models while providing a credibility interval. In the online stage, a fast-to-evaluate generalized one-fiber model is considered. This generalized one-fiber model incorporates correction factors to emulate patient-specific attributes, such as local geometry variations. In the offline stage, Bayesian inference is used to calibrate these correction factors on training data generated using a full-order isogeometric cardiac model (FOM). A Gaussian process is used in the online stage to predict the correction factors for geometries that are not in the training data. The proposed framework is demonstrated using two examples. The first example considers idealized left-ventricle geometries, for which the behavior of the ROM framework can be studied in detail. In the second example, the ROM framework is applied to scan-based geometries, based on which the application of the ROM framework in the clinical setting is discussed. The results for the two examples convey that the ROM framework can provide accurate online predictions, provided that adequate FOM training data is available. The uncertainty bands provided by the ROM framework give insight into the trustworthiness of its results. Large uncertainty bands can be considered as an indicator for the further population of the training data set.

Recent studies have indicated an association between periodontitis and atrial fibrillation (AF), although the underlying mechanisms remain unclear. Porphyromonas gingivalis is a causative agent of periodontal disease and is highly pathogenic. This study focused on P gingivalis and aimed to investigate the relationship among periodontitis, atrial translocation of P gingivalis, and atrial fibrosis and AF.

An experiment was conducted using P gingivalis-infected C57BL/6J mice, in which P gingivalis was inoculated into the pulp of the molars. Immunohistochemistry was used to visualize the localization of P gingivalis, and loop-mediated isothermal amplification was employed to detect P gingivalis DNA in the left atrium. AF inducibility was examined by intracardiac stimulation. Moreover, left atrial appendage specimens were obtained from 68 patients with AF. A periodontal examination was conducted before the surgery, and the periodontal epithelial surface area and periodontal inflamed surface area, which are quantitative indices used to determine the clinical severity of periodontitis, were measured. The bacterial number of P gingivalis in human atrial tissue was analyzed via quantitative polymerase chain reaction. Atrial fibrosis was assessed using Azan-Mallory staining.

The translocation path of P gingivalis from the dental granuloma to the left atrium via the circulatory system was demonstrated by immunohistochemistry and loop-mediated isothermal amplification in P gingivalis-infected mice, which showed a higher degree of atrial fibrosis (21.9% versus 16.3%; P=0.0003) and a higher AF inducibility (30.0% versus 5.0%; P=0.04) than the control mice. Upregulation of GAL3 (galectin 3) and transforming growth factor-beta 1 in the left atrium was observed in P gingivalis-infected mice. Moreover, immunohistochemistry revealed that P gingivalis was also present in human atrial tissue. The number of P gingivalis in the human atrial tissue was positively correlated with periodontal epithelial surface area (ρ=0.35; P=0.004), periodontal inflamed surface area (ρ=0.52, P<0.0001), and the degree of atrial fibrosis (ρ=0.38; P=0.002).

P gingivalis translocation to the left atrium correlates with the clinical severity of periodontitis, which may exacerbate atrial fibrosis and AF. Atrial translocation of P gingivalis is a potential pathway explaining the causal relationship between periodontitis and AF.

Little is known about the very long-term outcome in Tetralogy of Fallot (ToF) patients.

To prospectively evaluate clinical outcome and quality-of-life after surgical repair of ToF.

Single-centre, longitudinal cohort-study evaluating every decade 144 ToF patients who underwent surgical repair <15 years of age between 1968 and 1980.

Evaluated were 66 patients (92 %) of the 72 eligible survivors (58 % male, median age at study 48.5 years) with a median follow-up of 45 (range 39-52) years. Cumulative survival at 50 years was 71 % and 84 % when excluding 30-days mortality, while event-free survival was 9 %. Reintervention (40 %) and symptomatic arrhythmias (21 %) were the most common complications, although ventricular tachycardia (VT) was rare (7 %). Cardiac magnetic resonance imaging showed a right ventricular ejection fraction <45 % in 45 % of the cohort and 42 % had a diminished left ventricular function. The aortic root diameter increased over time to >40 mm in 45 % of patients. VO2max was reduced in 53 % of patients but stable over time. Self-perceived quality-of-life was stable and comparable to the general Dutch population. Early post-operative arrhythmias, pre-operative low oxygen saturation of the left atrium, VT and declining exercise capacity over time were predictive for mortality, transannular patch for both arrhythmia and pulmonary valve replacement. Surgery post-1975 was protective for pulmonary valve replacement.

Only 9 % of ToF patients is alive without a major event at 50 years after surgical repair. Reintervention and symptomatic arrhythmias are especially common, although symptomatic VT is rare. Exercise capacity and self-perceived quality-of-life remained stable.

Thoracic aortic aneurysm is a life-threatening disease due to the risk for acute aortic syndromes, and subjects with dilated ascending aortas are recommended surveillance imaging to assess the need for preventive surgery. Our objectives were to investigate the progression of dilated ascending aortas and risk factors for rapid progression in a prospectively enrolled general population-based cohort of subjects aged 50-65 years.

From the 5058 subjects prospectively enrolled in the general population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) in Linköping, we followed all 74 subjects (22% female, mean age 59±4 years) with ascending aortic dilation (≥40 mm) identified by CT angiography, thoracic CT or transthoracic echocardiography. Office and home blood pressure (BP), pulse wave velocity, coronary artery calcification and carotid plaques were assessed at baseline. Transthoracic echocardiography was used to follow ascending aortic diameters over time.

Three subjects underwent acute or elective aortic repair before the first follow-up examination. Among the remaining subjects, the mean progression rate of ascending aortic diameter was 0.4 mm/year (range 0-1.8 mm/year) during a mean follow-up of 6.1±1.3 years. In 10 (14%) subjects, all men, no progression was seen. In multivariable analysis, higher 7-day home systolic BP was the only factor associated with faster progression rate.

Progression of mild to moderate ascending aortic dilation was in general slow. Our findings emphasise the benefit of home BP measurements over office BP and underline the importance of BP control in subjects with a dilated ascending aorta.

The location of thrombus in acute pulmonary embolism (PE) is a debatable prognostic factor. We compared the characteristics and outcomes of hospitalized patients with central versus peripheral PE.

This retrospective study evaluated patients with acute PE diagnosed by CT pulmonary angiography who were hospitalized between 01/01/2016 and 31/12/2022. We compared patients with central (pulmonary trunk/main pulmonary artery) and peripheral (lobar/segmental/subsegmental) PE.

We studied 438 patients (median age: 63 years; PE diagnosis in the Emergency Department: 64.8%; PE peripheral in 305 patients [69.6%] and central in 133 [30.4%]). Patients with central PE had higher levels of troponin I and brain natriuretic peptide and more frequent right ventricular strain by CT pulmonary angiography/ echocardiography (72.1% versus 33.3%, p < 0.0001). PE mortality risk could be classified in 355 patients; 24.4% of the 238 patients with peripheral PE were intermediate-high/ high-risk compared with 63.3% of the 117 patients with central PE. Patients with central PE had more systemic thrombolysis (13/133 [9.8%] versus 6/305 [2.0%], p < 0.0001) and more advanced endovascular therapy (15/133 [11.3%] versus 2/305 [0.7%], p < 0.0001). All-cause hospital mortality rate was similar in patients with central and peripheral PE (5.3% and 6.6%, respectively; p = 0.61). On multivariable logistic regression analysis, central versus peripheral PE was not associated with hospital mortality (odds ratio 0.392, 95% confidence interval 0.128, 1.199).

The majority of patients with central PE and a minority of those with peripheral PE were classified as intermediate-high/ high-risk, however, the central thrombus location was not associated with an increased risk of mortality.

Sex differences in patients with hypertrophic cardiomyopathy have been elaborated by many studies. However, large studies of the association of patient sex with outcomes after surgical myectomy are scarce. This study evaluated sex disparities in a large Chinese cohort undergoing hypertrophic cardiomyopathy surgery.

The cohort encompassed 1613 patients, including 627 (38.9%) women who underwent septal myectomy between 2009 and 2018.

At the time of surgery, women were 6 years older and had 1 year longer disease onset-to-surgery delay than men. They were more frequently in New York Heart Association class III/IV and had more severe left ventricular outflow tract obstruction. Compared with men, women had a notably higher left ventricular wall thickness index and a lower extent of late gadolinium enhancement. Women also had more mutations in MYH7 and fewer in MYBPC3. Postoperatively, women had a higher operative mortality rate (1.3% versus 0.1%, P=0.006). The follow-up results showed no significant difference between the sexes in all-cause death (hazard ratio [HR], 0.67 [95% CI, 0.38-1.18]; P=0.166). A U-shaped association was observed between age and death in the overall population. However, women exhibited this association more obviously at age ≥55 years and men at <35 years. Moreover, women also had a higher risk of cardiovascular rehospitalization after surgery (HR, 1.40 [95% CI, 1.03-1.89]; P=0.030).

In patients with obstructive hypertrophic cardiomyopathy, women had a similar fatal outcome but a worse nonfatal outcome than men after surgery. Measures improving quality of life may further enhance the event-free survival of female patients. Close monitoring and follow-up are warranted, especially in younger men and older women.

Objective: To investigate the predictive value of nutritional status in heart failure (HF) patients with an implantable cardioverter defibrillator (ICD), and to identify factors associated with ICD discharge and mortality. Methods: This retrospective study was conducted by analyzing data from 2017 to 2021. HF patients who underwent ICD implantation for primary prevention were included. Follow-up visits were continued until December 2022. Patients were examined based on ICD shock occurrence (ICD-A: appropriate shock), ICD non-discharge (ICD-X), and mortality. Nutritional status was assessed by the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) scores. Results: A total of 221 patients were included in the study, 86 of whom were in the ICD-A group (135 in the ICD-X group). Age and sex distribution were similar in these groups. The all-cause mortality rate was 20.36%. A PNI with a cut-off value of <47.25 and a CONUT score with a cut-off value of >2.5 were able to significantly predict all-cause mortality. The PNI had a greater area under the curve compared to the CONUT. Non-ischemic cardiomyopathy and high left-ventricle end-systolic diameter (ESD) were independently associated with appropriate ICD shock. Low systolic blood pressure, high ESD, low sodium, low total cholesterol, low (<47.25) PNI, and ICD shock were independently associated with all-cause mortality. Conclusions: Malnutrition appears to be associated with mortality in patients with primary-prevention ICDs, and the PNI appears to be a more useful indicator than the CONUT for determining the risk of mortality in these patients.

Currently, simple clinical parameters indicating disease progression are lacking in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). This study aimed to evaluate the prognostic value of outpatient diuretic intensification (ODI) in ATTR-CM patients.

This retrospective study examined ATTR-CM patients at a tertiary care center between August 1, 2020, and June 30, 2023. ODI was defined as any loop diuretic increase within 6 months after baseline visit, and its impact on all-cause mortality and hospitalization for heart failure (HF) was analyzed.

Altogether, 182 patients were included (median age 80 [76; 84] years; 88% male), and 25% experienced ODI (median increase 10 [10; 40] mg furosemide equivalent). Independent predictors of ODI were higher baseline New York Heart Association (NYHA) class and polyneuropathy. Both any ODI and the magnitude of furosemide equivalent increase were significantly associated with mortality and HF hospitalization during a median follow-up of 17 months. After adjusting for baseline NYHA class and National Amyloidosis Centre stage, significantly increased risk of all-cause mortality (hazard ratio [HR] 2.38, 95% confidence interval [CI] 1.03-5.53; p = 0.043) and HF hospitalization (HR 3.27, 95% CI 1.41-7.60; p = 0.006) persisted in patients with ODI. Its prognostic value was similar in strata of age, ATTR subtype, previous cardiac decompensation, biomarkers, left ventricular ejection fraction, six-minute walk distance, and tafamidis treatment.

ODI occurred in one in four ATTR-CM patients within 6 months and was associated with more severe baseline amyloid organ manifestations. ODI and the magnitude of diuretic dose increase provide easily assessable clinical markers of disease progression in patient monitoring.

Ultrasound-guided fluid management is increasingly used in the intensive care unit, yet it's benefits in septic shock remains unknown.

To evaluate the use of critical care ultrasound for individualized volume management in septic shock patients.

A single-center, randomized controlled, prospective study was conducted on patients with septic shock admitted to the intensive care unit in Xi'an Daxing Hospital, Xi'an City, China, from September 2022 to December 2023. Upon intensive care unit admission, the patients were resuscitated according to the latest sepsis and septic shock guidelines and early goal-directed therapy. The study group additionally underwent critical care ultrasound examination to monitor and guide the adjustment of fluid resuscitation in real-time. The two groups' physiological and biochemical indexes and prognoses were compared before (T0) and 6 hours after (T6) fluid resuscitation.

A total of 113 patients with septic shock were selected and randomly allocated into study (n = 57) and control (n = 56) groups. The central venous oxygen saturation, heart rate, mean arterial pressure, blood lactate, and lactate clearance rate of the two groups at T6 were significantly improved compared to T0 (P < .05). At T6, the study group's blood lactate was significantly lower and the lactate clearance was significantly higher than the control group (P < .05). At T6, the incidence of pulmonary edema, incidence of left heart failure, Sequential Organ Failure Assessment (SOFA) score and length of the intensive care unit hospitalization in the study group were significantly lower than the control group (P < .05).

The application of critical care ultrasound improved the outcome and helped guide individualized management of patients with septic shock.

Asymptomatic left ventricular systolic dysfunction (ALVSD) affects 7 million globally, leading to delayed diagnosis and treatment, high mortality, and substantial downstream health care costs. Current detection methods for ALVSD are inadequate, necessitating the development of improved diagnostic tools. Recently, electrocardiogram-based algorithms have shown promise in detecting ALVSD.

The authors developed and validated a convolutional neural network (CNN) model using single-lead electrocardiogram and phonocardiogram inputs captured by a digital stethoscope to assess its utility in detecting individuals with actionably low ejection fractions (EF) in a large cohort of patients.

2,960 adults undergoing echocardiography from 4 U.S. health care networks were enrolled in this multicenter observational study. Patient data were captured using a digital stethoscope, and echocardiograms were performed within 1 week of data collection. The algorithm's performance was compared against echocardiographic EF (EF measurements, categorizing EF as normal and mildly reduced [>40%] or moderate and severely reduced [≤40%]).

The CNN model demonstrated an area under the receiver operating characteristic curve of 0.85, with a sensitivity of 77.5%, specificity of 78.3%, positive predictive value of 20.3%, and negative predictive value of 98.0%. Among those with an abnormal artificial intelligence screen but EF >40% (false positives), 25% had an EF between 41%-49% and 63% had conduction/rhythm abnormalities. Subgroup analyses indicated consistent performance across various demographics and comorbidities.

The CNN model, utilizing a digital stethoscope, offers a noninvasive and scalable method for early detection of individuals with EF ≤40%. This technology has the potential to facilitate early diagnosis and treatment of heart failure, thereby improving patient outcomes.

In the individualized treatment of a patient with Coarctation of the Aorta (CoA), a non-severe case which initially exhibits no symptoms, and thus requires no treatment, could potentially become severe over time. This progression can be attributed to insufficient growth at the coarctation site relative to the overall growth of the child. Therefore, an agent-based model (ABM) to predict the aortic growth of a CoA patient is introduced. The multi-scale approach combines Computational Fluid Dynamics (CFD) and ABM to study systems that are influenced by both mechanical stimuli and biochemical responses characteristic of growth. Our focus is on ABM development; thus, CFD insights were applied solely to enhance the ABM framework. Comparative medicine was leveraged to develop a species-specific ABM by considering the rat and porcine species commonly used in cardiovascular research together with data from healthy human toddlers. The ABM luminal radius prediction accuracy was observed to be 79% for rat, above 95% for porcine and 91. 6% for the healthy toddler; while that observed for the growth rate was 38.7%, 90% and 64.3% respectively. Given its performance, the ABM was adapted to a 2.5-year-old patient-specific CoA. Subsequently, the model predicted that by age 3, the condition would worsen, marked by persistent CoA enhanced by the predicted least growth compared to growth predicted in the rest of the aorta, hypertension, and increased turbulent flow; thus, increased vessel injury risk. The findings advise for incorporating vascular remodelling into the ABM to enhance its predictive capability for intervention planning.

The association between valvular heart disease and obesity is poorly documented. The present study evaluated the prevalence and worsening over time of valvular regurgitation by obesity category.

This cohort study included 11385 patients who underwent two echocardiographic examinations at least 1 year apart. Mitral, tricuspid, and aortic regurgitation were graded at the first and last visits. Regurgitation worsening was defined as those going from non/trace to moderate/severe or from moderate to severe. Frequency and worsening of regurgitant valvular heart disease were evaluated across body mass index (BMI) categories and adjusted for age, sex, follow-up time, and significant regurgitation at first exam.

Patients aged 63 ± 15 years old at the last visit (43 % women, 29 % with obesity, median follow-up time of 3 years [interquartile range 2-6]). Valve regurgitation was more common in patients without obesity than in those with obesity across all age groups. The prevalence of mitral, tricuspid and aortic valve regurgitations at the last visit diminished for increased BMI categories: 24 %, 19 %, 16 % and 14 % for patients with normal weight, overweight, obesity and severe obesity, respectively (p < 0.001). The regurgitation worsening observed in any valve followed a similar trend: 14 %, 11 %, 9 % and 8 %, respectively (p < 0.001). These inverse associations with BMI remained significant after adjustments for cofactors.

Obesity was associated with lower valvular regurgitation prevalence and worsening that persisted in the mitral and tricuspid valves after adjusting for confounders and excluding patients changing weight over time, suggesting the existence of an obesity paradox in valvular heart diseases.

Liver transplantation has traditionally been performed through a large, bilateral subcostal incision. Recently, liver transplant programs across the world, including our own, have reported successful liver transplants via total robotic approaches on recipients with low Model for End-stage Liver Disease scores and preexisting abdominal wall laxity. This review discusses the unique anesthetic considerations of robotic liver transplantation based on our group's initial experience with this novel surgical approach. Robotic liver transplantation presents a unique set of considerations and challenges for the anesthesiologist, and a thorough understanding of liver disease, liver transplant surgery, venovenous bypass, and the various implications of robotic surgery is essential to ensure optimal patient outcomes. Specific management topics discussed here include appropriate patient selection, preoperative assessment, and intraoperative management. We also discuss certain theoretical and actual challenges that our group has experienced.

To date, little is known about correlations between liver dysfunction and circulatory and cardiac abnormalities (e.g.,: mitral valve, MV) in patients with chronic liver disease (CLD). This study aimed to assess a potential parallelism between liver dysfunction and cardiovascular involvement and identify the factors associated with structural and functional MV disorders.

Among 995 patients with CLD, 346 were enrolled and compared with 168 controls without liver disease. According to the degree of liver disease, patients were classified as patients with chronic hepatitis (142) or with liver cirrhosis (Child-A: 70; Child-B: 65; Child-C: 69).

Among the chronic hepatitis group, resting heart rate (HR) and left ventricular (LV) mass were higher than in the control group (p = 0.0008), whereas systemic vascular resistance (SVR) was lower (p = 0.01). Among cirrhotic patients, resting HR, left atrium dimensions/volumes, LV walls thickness, LV mass, cardiac output (CO), isovolumetric relaxation time (IVRT), deceleration time (DT) and prevalence of aortic stenosis were higher than in non-cirrhotic patients (p = 0.02), whereas the e/a ratio and SVR were lower (p = 0.0001). Among Child-B/C, CO, IVRT, DT, prevalence of MV regurgitation and MV calcification score were higher than in the remaining patients (p = 0.02), whereas SVR was lower (p < 0.0001). Among cirrhotic patients with MV regurgitation, Child-Pugh score, liver disease duration, resting HR, left chambers dimensions/mass, CO, IVRT, DT and MV calcification score were higher compared to patients without regurgitation (p < 0.000), whereas mean blood pressure, e/a ratio and SVR were lower (p = 0.008). At multivariate analysis, Child-Pugh score, liver disease duration, left chambers volume/mass and MV calcification score were independently associated with MV regurgitation in cirrhotic patients. Child-Pugh score and MV calcification score strongly correlated in cirrhotic patients (r = 0.68, 95% CI 0.60-0.75, p < 0.0001).

The magnitude of cardiac morpho/functional abnormalities is associated with the severity of liver dysfunction. Structural and functional MV abnormalities could represent a novel sign of cardiac involvement in liver cirrhosis. The severity and duration of liver disease, the enlargement of cardiac chambers and leaflet calcium accumulation could play a key role.

Stress phase bandwidth (SPBW), assessed using single-photon emission computed tomography (SPECT), is considered to be a useful indicator of left ventricular dyssynchrony. However, few reports have examined whether it can be used as an indicator for improvement of left ventricular ejection fraction (LVEF) in new-onset heart failure with reduced ejection fraction (HFrEF).

A total of 64 patients (mean age 56 years, 39 male) who were admitted to our hospital with new-onset non-ischemic HFrEF (median LVEF 24.7%) from January 2018 to December 2022 in the SAKURA-HF registry and underwent SPECT were enrolled. The relationship between SPBW in the acute phase and LVEF improvement in the chronic phase was retrospectively investigated in the present study. LVEF improved significantly in the 36 patients (from 27.1 to 62.8%, p < 0.001). Guideline-directed medical therapy in both groups was comparable. SPBW was significantly lower in the group with improved LVEF (median 55.5° vs. 79.0°, p = 0.010). Logistic regression analysis revealed that SPBW was an independent predictor for LVEF improvement. Moreover, an SPBW of 71.0° was suggested as a possible cut-off value.

SPBW may predict the improvement of LVEF in new-onset non-ischemic HFrEF, suggesting its potential utility in heart failure management.

It remains challenging to determine which hypertrophic cardiomyopathy (HCM) family members will subsequently develop HCM. Standard 2-dimensional and conventional Doppler echocardiography have been unable to reliably distinguish HCM genotype-positive and phenotype-negative (G+P-) from genotype-negative and phenotype-negative (G-P-) family members. We aimed to determine if advanced echocardiographic modalities can discriminate HCM G+P- from G-P- individuals.

Comprehensive echocardiography including speckle tracking evaluation of myocardial deformation and color M-mode were performed in 199 participants aged ≥16 years who had undergone genetic testing from families with a known HCM pathogenic variant: 58 G+P-, 39 G-P-, and 102 overt patients with HCM (genotype-positive and phenotype-positive). The primary analysis compared these measures in all G+P- and G-P- individuals. A secondary analysis was undertaken in younger subjects (age ≤40 years).

Comparing G+P- and G-P- individuals, there were no significant differences in left ventricular ejection fraction, cavity size, wall thickness and outflow tract gradient, and tissue Doppler-derived myocardial velocities; however, septal/posterior wall thickness ratio was higher (1.06±0.09 versus 1.02±0.04, P=0.007). G+P- individuals had significantly lower color M-mode flow propagation velocity (color M-mode velocity propagation, 42.6 cm/s [interquartile range, 34.5-48.5 cm/s] versus 51.0 cm/s [interquartile range, 45.2-61.0 cm/s]; P<0.001) and higher global longitudinal strain (P=0.021), circumferential strain (P=0.003), and peak apical rotation (P=0.005). Multivariable logistic regression identified 2 independent predictors (color M-mode velocity propagation and peak apical rotation). A derived regression equation allowed reasonable discrimination of G+P- individuals with a sensitivity of 82.6% and specificity of 72.2% (P<0.0001) at the optimal cutoff. Similar findings were demonstrated when the analysis was restricted to younger subjects, although in addition to color M-mode velocity propagation and apical rotation, left ventricular ejection fraction was also independently predictive.

In HCM family members, color M-mode velocity propagation and apical rotation provide good sensitivity and specificity for identifying mutation carriers and may represent early disease markers before the onset of hypertrophy. Longitudinal studies involving larger cohorts are required to validate these findings.

The most common cause of morbidity and mortality in type 1 diabetes mellitus is cardiovascular system involvement. Sudden death has been reported in type 1 diabetes mellitus patients. To analyse the use of the cardiac electrophysiological balance index in predicting ventricular arrhythmias in children with type 1 diabetes mellitus disease.

One hundred type 1 diabetes mellitus paediatric patients and 100 healthy children, divided into three groups according to their haemoglobin A1C levels, were included in the study. All participants were evaluated with transthoracic echocardiography, 12-lead electrocardiography, and 24-h Holter after a detailed physical examination. Systolic and diastolic function parameters, electrocardiography intervals, and heart rate variability parameters were evaluated.

The mean age in the type 1 diabetes mellitus and control groups was 11.52 (± 3.52) and 11.78 (± 3.45) years, respectively. In total, 57% of the type 1 diabetes mellitus group and 56% of the control group were male. The mean haemoglobin A1C value was 9.14% (± 1.79) and the disease duration was 3.71 years (± 3.13). The type 1 diabetes mellitus group had a higher QTc duration, deceleration time duration, A velocity, and a lower E/A ratio than the control group. In the type 1 diabetes mellitus group, Tpe, Tpe/QT ratio, QTc/QRS ratio, Tpe/QRS ratio, Tpe/(QT × QRS) ratio values were significantly higher than in the control group.

Children with type 1 diabetes mellitus are at risk for atrial and ventricular arrhythmias without valvular disease, ischemic heart disease, or diastolic dysfunction despite normal systolic function. No correlation was found between disease duration, metabolic control, autonomic function parameters, and arrhythmia risk; however, it was associated with diastolic function parameters.

Predictors of the clinical characteristics of pregnant women at risk of peripartum cardiomyopathy (PPCM) remain unclear.

We enrolled 450 cases of high-risk pregnancy with any risk factor from among ≥35 years of age, hypertensive disorders of pregnancy (HDP), multiple gestation, or other systemic or obstetric complications except for a history of cardiac disease. All the women underwent echocardiography and plasma B-type natriuretic peptide (BNP) measurement during the second/third trimester and the early/late postpartum period. Logistic regression analyses identified clinical factors associated with left ventricular (LV) dysfunction. The incidence of PPCM was 0.89%, which was higher than in previous reports. Early diastolic mitral annular velocity (e') was significantly negatively associated with the occurrence of PPCM, and the BNP level showed a significant positive association with the occurrence of PPCM. The percentages of cases of e' <7 cm/s, and BNP level ≥100 pg/mL were 25.3%, and 20.4%, respectively. Multivariate regression analysis revealed that HDP was independently associated with e'. A negative correlation between e' and BNP level was observed in HDP.

High-risk pregnancy was associated with an increased incidence of PPCM. Measurement of BNP levels and echocardiographic assessment of LV diastolic function during pregnancy may be useful in predicting PPCM.

Although cardiac auscultation plays an essential role in detecting valvular heart diseases, false-positive rates due to innocent heart murmurs remain a concern because accelerated transaortic valve blood flow can be a major contributor to systolic heart murmurs. In this study we investigated the effect of transaortic valve flow velocity on the development of systolic heart murmurs.

Cardiac auscultation was performed in 571 patients referred for echocardiography and systolic heart murmur was detected in 103 (18.0%). Maximum transaortic valve flow velocity was higher in patients with murmurs than in those without (2.02 vs. 1.34 m/s, P<0.001; area under the receiver operating characteristic curve, 0.82). A cutoff maximum transaortic flow velocity of 1.7 m/s predicted systolic heart murmurs (sensitivity, 65%; specificity, 88%). The incidence of heart murmur was associated with higher maximum transaortic valve flow velocity (<1.7 m/s, 7.3%; 1.7-2.5 m/s, 50.0%; >2.5 m/s, 73.5%). Multivariate analysis revealed the maximum transaortic valve flow velocity as an independent predictor of systolic heart murmurs (hazard ratio, 9.18; 95% confidence interval, 5.35-15.75; P<0.001).

Accelerated transaortic valve flow velocity is an important determinant of systolic heart murmurs. Systolic heart murmurs can be heard before the transaortic valve flow velocity reaches the clinically significant aortic stenosis criterion, which can constitute a considerable number of innocent heart murmurs.

Background: The purpose of this study is the evaluation of imaging findings of acute-phase cardiac CT (cCT) in stroke patients with large vessel occlusion (LVO) to identify potential cardioembolic sources (CES) in patients without intracardiac thrombi and atrial fibrillation (AF). Material and Methods: This retrospective study included 315 patients with LVO who underwent cCT imaging in the acute stroke setting. The images were analysed for 15 imaging findings following the established minor and major cardioembolic risk factors. The final stroke aetiology was determined using the TOAST classification through interdisciplinary consensus following a thorough clinical evaluation. Multivariate regression analysis was performed to identify imaging findings associated with CES. Results: A cardioembolic aetiology was identified on cardiac CT in 211 cases (70%). After adjustment for AF and intracardiac thrombi, the multivariate regression analysis revealed significant associations with left ventricular dilation (adjusted odds-ratio (AOR) 32.4; 95% CI 3.0-349; p = 0.004), visible interatrial right-to-left shunt (AOR 30.8; 95% CI 2.7-341.3; p = 0.006), valve implants (AOR 24.5; 95% CI 2.2-270.9; p = 0.009), aortic arch atheroma grade > II (AOR 6.9; 95% CI 1.5-32.8; p = 0.015) and post-ischaemic myocardial scars (AOR 6.3, 95% CI 1.2-34.1; p = 0.032) as independent risk factors for a cardioembolic aetiology. The combined model achieved an area under the ROC curve of 0.83. Conclusions: In patients with LVO without AF and intracardiac thrombi as a cause, the presence of left ventricular dilatation, interatrial right-to-left shunts, valve implants, post-ischaemic myocardial scarring and advanced aortic arch atheroma (grade > 2) in particular is significantly associated with a cardioembolic cause of stroke and should be add-on evaluated in acute-phase cCT. Further investigations are warranted to confirm these associations.

To examine the association and magnitude of agreement between intraoperative transesophageal echocardiography (TEE) and cardiac magnetic resonance imaging (CMR) on aortic diameter measurements, to guide perioperative decision making for ascending aortic aneurysms.

This prospective study included patients with an ascending aortic aneurysm undergoing surgical ascending aortic repair using a prosthetic graft between February 2018 and December 2019. Intraoperative TEE in 2-dimensional (2D) and 3-dimensional (3D) views were obtained and assessed relative to preoperative cine-CMR and contrast-enhanced 3D magnetic resonance angiography.

Weill Cornell Medicine, a single large academic medical center.

Thirty patients undergoing ascending aortic repair using a prosthetic graft (polyethylene terephthalate [Dacron]) without severe aortic valve disease (stenosis or regurgitation).

CMR, TEE, and ascending aortic repair using prosthetic grafts.

TEE-derived measurements correlated significantly with CMR at all aortic segments: root (r = 0.94-0.97; p < 0.001 for all), ascending (r = 0.95-0.98; p < 0.001 for all), arch (r = 0.88; p < 0.001), and descending (r = 0.91; p < 0.001). Bland-Altman analyses showed small mean differences between 2D and 3D TEE versus CMR (range, 0.05-0.22 cm and 0.04-0.18 cm, respectively), with narrow limits of agreement at all segments, although TEE underestimated CMR-derived measurements.

This study demonstrates the feasibility of intraoperative TEE to accurately measure aortic diameters in patients with ascending aortic aneurysms. The excellent correlations with CMR and small mean differences with narrow limits of agreement support intraoperative TEE to guide surgical decision making for possible aortic replacement.

Chemotherapy-induced cardiotoxicity is a concern for patients with gynecologic cancer. This study aimed to assess left ventricular (LV) myocardial deformation in patients with gynecologic cancer undergoing chemotherapy and to investigate the association between myocardial deformation and chemotherapy factors.

Cardiac magnetic resonance (CMR) was performed to assess LV deformation parameters using CMR tissue tracking based on cine images. Serum myocardial injury biomarker were measured. Deformation parameters were compared between healthy controls and patients. Changes in deformation were assessed as chemotherapy progressed. Correlations between LV deformation parameters, clinical characteristics, and serum myocardial injury biomarkers were also analyzed.

A total of 86 patients with gynecologic cancer and 30 normal controls were included. Among the patients, 41 completed CMR follow-up with a median interval of 6 months. Compared to the controls, patients exhibited lower absolute value of global radial strain (GRS) (37.30 ± 8.94% vs. 44.32 ± 8.44%), global circumferential strain (GCS) (-22.12 ± 3.05% vs. -24.08 ± 2.13%) and global longitudinal strain (GLS) (median -15.72% [IQR-17.13 to -13.58%] vs. -17.51 ± 2.00 %) (all p < 0.05). Patients with preserved LV ejection fraction (LVEF) also showed impaired global strain (all p < 0.05). GRS (39.71 ± 8.09% vs. median 30.56% [IQR 26.52 to 38.15%]; p = 0.001), GCS (-23.45 ± 2.09% vs. median -19.71% [IQR -21.71 to -19.10%]; p < 0.001) and GLS (-16.17 ± 2.42% vs. median -12.12% [IQR -14.10 to -8.53%]; p< 0.001) further decreased as the number of chemotherapy cycles increased during follow-up (all p < 0.05). Multivariate analysis showed that GCS was independently associated with the number of chemotherapy regimens (Standard regression coefficient [β] = 0.397, p < 0.001).

Myocardial deformation is more sensitive than LVEF in detecting subclinical left ventricular dysfunction in patients with gynecologic cancer undergoing chemotherapy. GCS was associated with the number of chemotherapy regimens.

Tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease in adults, has excellent long-term survival. However, many patients (30-45%) develop late arrhythmias. Previous studies have identified predictors of arrhythmia (atrial or ventricular) using clinical markers that predate arrhythmia onset by many years. Our objective was to develop a predictive model for incident atrial arrhythmias within two years of clinical evaluation and diagnostic testing. A single-center nested unmatched case-control study of 174 adults with repaired TOF. We included only patients with results from ECG and echocardiogram data in the required time interval (3-24 months before first arrhythmia for cases; 24 months of follow-up for controls). A predictive multivariable model for risk of incident atrial arrhythmia was developed using logistic regression with a least absolute shrinkage and selection operator (LASSO). Of 41 demographic, surgical, and diagnostic variables, six were selected as having predictive value for atrial arrhythmia based on cross validation. The factors with the greatest predictive value in decreasing order were moderate / severe tricuspid regurgitation (adjusted odds ratio (OR) 149.42), QRS fragmentation (OR 28.08), severe pulmonary regurgitation (OR 8.22), RV systolic dysfunction (OR 2.95), 1st degree AV block (OR 2.59), and age at time of surgical repair (OR 1.02). Predictors for atrial arrhythmia in our study suggested abnormal right ventricle anatomical function and electrophysiologic properties (conduction and repolarization) as the primary underlying substrate.

Heart failure with preserved ejection fraction (HFpEF) is a growing concern among the elderly population, significantly impacting morbidity and mortality rates. This study aimed to screen and investigate the characteristics and prognosis of early-stage HFpEF in the elderly.

A total of 1789 community-dwelling individuals aged over 65 from northern Shanghai were enrolled. According to American Heart Association (AHA) guidelines, participants were classified into four groups: HFpEF stage 0, HFpEF stage A, HFpEF stage B and HFpEF stage C. Major endpoints included major adverse cardiovascular events (MACEs), all-cause death and cardiovascular death.

After a mean follow-up period of 7.10 ± 1.27 years, 1623 elderly subjects were included [HFpEF stage 0 (10.3%), HFpEF stage A (16.3%), HFpEF stage B (60.6%) and HFpEF stage C (12.8%)]. Patients with HFpEF stage A, HFpEF stage B and HFpEF stage C exhibited more MACEs than those in HFpEF stage 0 (P < 0.01). Patients with HFpEF stage C had a significantly higher cardiovascular (P < 0.001) and all-cause death ratio (P < 0.01). With HFpEF stage 0 as a reference, the increases in MACEs were significantly associated with HFpEF stage A [hazard ratio (HR): 2.97, 95% confidence interval (CI) (1.13, 7.82), P < 0.05], HFpEF stage B [HR: 2.69, 95% CI (1.09, 6.64), P < 0.05] and HFpEF stage C [HR: 4.86, 95% CI (1.88, 12.59), P < 0.01] in the Cox regression analysis. Our finding remains unaltered in the sensitivity analysis, with no interaction for effectiveness.

Compared with those with HFpEF stage 0, patients with HFpEF, whether in stage B or C, exhibit significantly higher cardiovascular and all-cause mortality in the elderly. This study underscores the importance of early-stage HFpEF screening, particularly in older, asymptomatic stage B individuals.

Atrial fibrillation (AF) and heart failure (HF) with preserved ejection fraction (HFpEF) are interlinked and frequently coexisting conditions. To date, patients with AF and HFpEF have limited evidence guiding their management. This study aimed to investigate the predictors of adverse outcomes among patients with AF and HFpEF.

The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. From the registry, we explored predictors for a composite of cardiac death or HF hospitalization among AF patients with HFpEF (defined as having a prior HF hospitalization or New York Heart Association class ≥2 in association with heart disease and left ventricular ejection fraction ≥50%). Besides, we investigated whether the scoring using the predictors identified by the Fushimi AF Registry could stratify the outcomes in patients with AF and HFpEF registered in another independent Kyoto Congestive Heart Failure Registry.

Of 755 patients with AF and HFpEF [mean age: 77.5 ± 9.9 years; female: 391 (52%); paroxysmal AF: 258 (34%); and mean CHA2DS2-VASc score: 4.5 ± 1.5], cardiac death or HF hospitalization occurred in 246 patients (33%) during the median follow-up period of 4.4 years in the Fushimi AF Registry. Using multivariate Cox regression analysis, age ≥75 years [hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.26-2.36] and non-cardiovascular comorbidities such as anaemia (HR: 1.83, 95% CI: 1.37-2.46), chronic kidney disease (HR: 1.69, 95% CI: 1.27-2.26), diabetes mellitus (HR: 1.55, 95% CI: 1.15-2.09) and chronic obstructive pulmonary disease (HR: 1.87, 95% CI: 1.08-3.22) were independent predictors of adverse outcomes. Meanwhile, cardiovascular comorbidities including coronary artery disease, valvular heart disease or cardiomyopathy were not significantly associated with adverse outcomes. These results were also the case when analysed for patients with AF and HFpEF who registered in the Kyoto Congestive Heart Failure registry (N = 878). The score assigning 1 point for each five predictors (age, anaemia, chronic kidney disease, diabetes mellitus and chronic obstructive pulmonary disease; ranging 0-5 points) stratified the incidence of adverse outcomes among patients with AF and HFpEF registered in the Kyoto Congestive Heart Failure Registry as well as among those in the Fushimi AF Registry (both log-rank; P < 0.001).

Non-cardiovascular comorbidities such as anaemia, diabetes mellitus and kidney or pulmonary disease in addition to advanced age were independent predictors of adverse outcomes in patients with AF and HFpEF. Our study suggests the importance of focusing on these non-cardiovascular comorbidities for individualized risk stratification and optimal management in patients with AF and HFpEF.

The frequent association between transthyretin wild-type (TTRwt) cardiac amyloidosis (CA) and aortic stenosis (AS) suggests a bidirectional relationship: TTRwt-CA could induce AS and vice versa. Systemic manifestations may highlight this interaction: systemic amyloidogenesis would lead to systemic symptoms, CA, and AS, whereas the myocardial stresses induced by degenerative AS might promote local amyloidogenesis without systemic symptoms. Carpal tunnel syndrome (CTS) is the most frequently reported extracardiac symptom. Through a comparison of TTRwt-CA patients with and without CTS, we sought to determine whether CTS serves as a reliable indicator of systemic involvement and its impact on cardiac and valvular characteristics.

A total of 411 consecutive patients with TTRwt-CA were included. CTS, present in 70.3%, was associated with a younger age (80 vs. 84 years, p < 0.001), more extracardiac symptoms, and advanced CA, with greater cardiac remodeling and a higher heart-to-mediastinum ratio (1.63 vs. 1.54; p = 0.012) compared to patients without CTS. AS was present in 21% and 31% of patients with and without CTS, respectively (p = 0.024). Except for AS, these associations remained significant after adjusting for confounding factors. In severe AS, patients with CTS exclusively exhibited low-flow low-gradient (LFLG) AS and less severe class of aortic valvular calcium score (5.6% vs. 60%; p = 0.006) compared to those without CTS.

Our findings suggest that CTS may delineate two phenotypes in TTRwt-CA: a systemic phenotype associated with advanced CA and poorly calcified LFLG AS, and a cardiac phenotype characterized by less severe CA and a mixed pattern of highly calcified AS, suggesting disparate pathophysiologies.

This study evaluated the safety and efficacy of isoproterenol administration as an adjunct for achievement of target heart rate (HR) during dobutamine stress echocardiography (DSE).

In DSE, optimal accuracy is achieved when a target HR of 85% of maximal predicted heart rate (MPHR) is attained. Although rarely studied, intravenous isoproterenol has been used as an adjunct therapy to dobutamine and atropine to increase chronotropic response during pharmacologic stress testing.

We identified 5569 DSE studies during which 264 received isoproterenol at MedStar Georgetown University Hospital from August 2011 to March 2023. Of the studies receiving isoproterenol, we collected clinical and echocardiographic parameters from each study to assess the effects of isoproterenol administration, including downstream events.

In 264 examinations with isoproterenol, 169 (64%) achieved 85% MPHR. Among these, 103 (39%) developed premature ventricular contractions, 79 (30%) developed symptoms including nausea/vomiting in 44 (17%), and chest pain in 15 (6%). There was a hypertensive response to stress in 53 studies (20%) and a hypotensive response in 37 studies (14%). There was no significant increase in 30-day and 1-year death when compared to studies that did not receive isoproterenol.

Isoproterenol can effectively be used as an adjunctive agent in DSE to achieve the requisite hemodynamic stress for evaluation of ischemia, with a similar rate of side effects and complications compared to dobutamine and atropine stress testing.