International Journal of Cardiology

BackgroundHuman induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) represent a highly promising approach for cell-based replacement therapy in heart failure. However, the development of graft-related ventricular arrhythmias immediately following transplantation impedes its clinical translation. To date, there have been no reports worldwide characterizing the features of engraftment arrhythmias after hiPSC-CMs transplantation in human. Consequently, this study aims to analyze the characteristics of ventricular arrhythmias and the efficacy of antiarrhythmic drugs following hiPSC-CMs transplantation, and to identify risk factors associated with the occurrence of ventricular arrhythmias. MethodsThis study enrolled patients who underwent coronary artery bypass grafting (CABG) combined with hiPSC-CMs implantation under general anesthesia with cardiopulmonary bypass at our hospital between November 2023 and November 2025. Patients were assigned to low- and medium-dose groups based on the injected cardiomyocyte dose: 0.5x10 cells and 1.5x10 cells, respectively. Eleven patients were enrolled in each dose group. Ventricular tachycardia-related parameters were compared between the two groups after hiPSC-CMs implantation, and the characteristics of ventricular tachycardia episodes as well as the effectiveness of antiarrhythmic drugs were analyzed. A multivariate logistic regression model was applied to analyze risk factors influencing the occurrence of ventricular arrhythmias. ResultsNo statistically significant differences were observed between the two groups in terms of gender, age, LVEF, LVEDD, myocardial infarction percentage, intraoperative CPB time, mean heart rate, QRS duration, QTc interval, PVC burden, or daily dose of beta-blocker or cell viability (P > 0.05). The incidence of VT was significantly higher in the medium-dose group compared to the low-dose group (P < 0.05). No statistically significant differences were observed between the groups regarding the time interval from hiPSC-CMs implantation to initial VT onset, the slowest frequency at initial VT onset, the fastest VT frequency, or VT duration (P > 0.05). Further analysis of VT in both groups at different time points after implantation revealed that the incidence of VT in the medium-dose group was significantly higher than that in the low-dose group on days 14, 21, and 28. However, comparisons of the fastest VT frequency at various time points and the incidence of VT at day 7 between the two groups showed no statistically significant differences (P > 0.05). Among all enrolled patients, VT occurred in 12 patients (54.5%). Based on ECG localization, the origin of VT in all cases was identified at the cell injection site. The time from hiPSC-CMs injection to initial VT onset ranged from 5 to 20 days (median 8.5 days). VT persisted for 9 to 411 days (median 59 days) before spontaneous termination, with 9 patients (75% of those with VT) experiencing VT lasting more than 1 month. The slowest frequency at initial VT onset ranged from 55 to 96 bpm (72.58 {+/-} 9.86 bpm), while the fastest recorded frequency reached 111 to 185 bpm (146.33 {+/-} 21.44 bpm). Hemodynamics remained stable in all patients during increases in VT frequency. Throughout the observed VT episodes, QRS morphology was consistently monomorphic, although cycle length varied. During VT episodes, overdrive pacing via the temporary epicardial atrial lead successfully suppressed but did not terminate VT. While overdrive pacing failed to reduce the frequency of VT, it provided a critical window for optimizing antiarrhythmic drug therapy to control VT. Cardioversion also failed to terminate VT. Administration of beta-blockers, ivabradine, or amiodarone controlled the VT frequency to a range of 55-95 bpm (79.67 {+/-} 12.51 bpm) but likewise did not terminate the arrhythmia. VT terminated spontaneously in patients, after which it either did not recur, recurred intermittently, or reoccurred as sustained VT after a period of time. Multivariate logistic regression analysis indicated that the dose of hiPSC-CMs injection was an independent influencing factor for the risk of VT onset (P < 0.05). ConclusionThe ectopic arrhythmia (EA) is primarily driven by an automaticity mechanism. It is characterized by early onset (median 8.5 days) and prolonged duration (median 59 days), with the cell injection dose identified as an independent risk factor (OR=9.00). Within the controlled dose range (0.5-1.5x10 cells) and under strict clinical management, this type of arrhythmia can be effectively monitored and managed.

ObjectiveTo analyze the experience of the last six years with ECMO in Uncontrolled Donation after Circulatory Death (uDCD), assessing the clinical and logistical factors that determine donation effectiveness and the viability of retrieved organs, with the nurse perfusionist as the central figure in organ perfusion. MethodsRetrospective observational study of uDCD procedures performed at Hospital Clinic de Barcelona between June 2019 and October 2025. ResultsOf 184 out-of-hospital ECMO-CPR activations, 108 (58.7%) underwent perfusion; 72 donor cases (66.7%) were generated, and 109 kidneys (75.7%) and 3 livers (4.15%) were retrieved. The annual number of uDCD donors was heterogeneous. Compared with non-effective donors, effective donors were significantly younger (48.1 {+/-} 12.4 vs 53.0 {+/-} 10.7 years, p=0.03) and had fewer comorbidities such as hypertension (13.8% vs 33.0%, p=0.018) and diabetes (4.1% vs 16.6%, p=0.027). Although effective donors had a shorter cannulation time (25.6 {+/-} 13.9 vs 29.1 {+/-} 11.9 min, p=0.09), the difference was not statistically significant; however, cardiocompressor time did show a significant difference (58.9 {+/-} 17.7 vs 65.8 {+/-} 18.2 min, p=0.03). ConclusionsuDCD was a useful source of transplantable organs, mainly kidneys (two out of every three perfused patients became donors), in the current context of scarcity of brain-dead donors. Shorter warm ischemia times (cardiocompressor and cannulation times) were significantly associated with more effective organ donation. The multidisciplinary transplant team may benefit from perfusion professionals with expertise in extracorporeal oxygenation therapy.

BackgroundCombination therapy with atherectomy and intravascular lithotripsy (IVL) has emerged as a promising strategy for the treatment of severely calcified occlusive coronary lesions, which potentially enhances procedural efficacy without increasing complication risk. MethodsThe Dual-Prep Registry is a multicenter, prospective registry designed to evaluate the safety and efficacy of IVL after atherectomy in severely calcified lesions. Combined use was selectively applied when the risk of complications was anticipated to be high with a larger atherectomy burr size, or when it was deemed non-beneficial due to unfavorable guidewire bias. All adverse events were adjudicated by a clinical events committee. Kaplan-Meier analysis was performed to evaluate the primary endpoint of major adverse cardiovascular events (MACE; composite endpoint of cardiac death, myocardial infarction, and target vessel revascularization [TVR]) at 1 year. ResultsA total of 118 cases (120 lesions) were enrolled across 20 facilities. Significant comorbidities included diabetes in 56.8% of patients and hemodialysis-dependence in 25.4%. Calcification score after atherectomy was 4.0 in all cases, and calcified nodules were present in 56.4% (core-lab analysis) of cases. One-year follow-up was complete in 99.2% patients. MACE occurred in 7.6% patients at one year (cardiac death 2.5%, myocardial infarction 5.1%, TVR 5.1%) and stent thrombosis was observed in 1 case. ConclusionsAtherectomy followed by IVL resulted in low 1-year rates of MACE, TVR, and stent thrombosis in patients with severely calcified coronary lesions. This approach may be considered for lesions where an "IVL-first" strategy is difficult to apply. Japan Registry of Clinical Trials: jRCT1032230384. URL: https://jrct.mhlw.go.jp A Clinical Perspective1) What Is New? O_LIElective combined use of IVL and atherectomy resulted in low 1 year MACE and TLR. C_LIO_LIThe incidence of MACE was higher in cases with greater residual stenosis after the procedure and a larger baseline reference vessel diameter. C_LI 2) What Are the Clinical Implications? O_LICombining IVL with atherectomy may serve as an effective treatment strategy in cases where IVL-first approaches are difficult to apply. C_LIO_LISevere calcified lesions that are presumed to be unresponsive to RA/OA treatment or carry a high risk of RA/OA complications may be good candidates for this strategy. C_LI

BackgroundIn 2018, the United Network for Organ Sharing (UNOS) revised the donor heart allocation policy, replacing the single urgency status for left ventricular assist device (LVAD)-related complications with three distinct categories. We evaluated the impact of this policy modification on transplant access and outcomes. MethodsThe UNOS Standard Transplant Analysis and Research File was queried to identify adult patients listed for heart transplantation with a LVAD-related complication in the United States between 2018 and 2023. The cumulative incidence of heart transplantation, mortality on device, and overall mortality following complication were assessed. ResultsDuring the study period, 792 patients experienced an LVAD complication that led to an initial listing or change in urgency status. Device infection was the most frequent complication (n=472, 59.6%), followed by device malfunction (n=80, 10.1%), aortic regurgitation (n=73, 9.2%), ventricular arrhythmias (n=46, 5.8%), thrombosis/hemolysis (n=43, 5.4%), bleeding (n=42, 5.3%), and right heart failure (n=36, 4.5%). At 1 year, transplantation incidence was 71.5% (95% CI, 67.9-74.8%), mortality on device was 3.8% (95% CI, 2.5-5.4%), and overall mortality was 12.3% (95% CI, 9.9-15.1%). Right heart failure was associated with increased 1-year mortality (34.1%, 95% CI, 18.2-50.8%; adjusted HR 2.0, 95% CI, 1.1-3.8). ConclusionsThe revised allocation system provides LVAD patients with complications timely access to transplantation, reflected in high transplant rates and low mortality. Right heart failure remains a distinct subgroup, with one-third of patients not surviving to one year, suggesting this complication may warrant consideration for higher urgency status.

BackgroundCritically ill patients admitted to intensive care units (ICU) usually suffer from life-threatening illnesses, and many are hemodynamically unstable. The incidence of cardiac arrest in the ICU is approximately 22 per 1000 admissions, and survival to discharge after in-hospital cardiac arrest (IHCA) is approximately 14%. Variables associated with IHCA survival are poorly understood and the outcomes of cardiopulmonary resuscitation (CPR) in the ICU are poorly reported in the literature. We investigated the characteristics of IHCA and factors that are associated with poor IHCA survival. ResultsAfter adjusting for age, APACHE III score, and initial rhythm, every one-minute increase in CPR duration was associated with 1.161 (95% CI 1.119-1.204; p<0.0001) odds of death during resuscitation and 1.154 (95% CI 1.059-1.258; p<0.0001) odds of death at the time of ICU discharge. Hospital survivors had a lower APACHE III score (Mean=88.3, SD 29.8, IQR 66-106) and acute physiology score (Mean=75, SD 30, IQR 56-94) compared to non-survivors. Hospital survivors were also more likely than non-survivors to have a shockable rhythm at the time of arrest (20% versus 7.5%), shorter average CPR duration (5.4 minutes versus 12.8 minutes), longer length of ICU stay (14 days versus 1.8 days) and longer length of hospital stay (25 days versus 6.1 days). ConclusionBased on our retrospective analysis, we conclude that the odds of IHCA mortality is directly proportional to the duration of CPR regardless of age, initial rhythm, and severity of underlying illness.

IntroHeart failure is one of the major causes of death in the United States, characterized by high readmission rates annually. Our study sought to analyze de-identified patient data from the Atrium Health Floyd Medical Center to identify differences in readmission rates for patients based on sex and marital status and propose novel solutions to our findings. MethodsIn this retrospective cohort analysis, 1,122 HF patient discharges (obtained by reviewing heart failure specific diagnosis-related group and principal diagnosis codes) between February 1, 2023 - March 30, 2024 were analyzed to describe demographic trends of readmission and total length of stay. Such analyses included a chi-square test of independence and Kruskal Wallis Test alongside the appropriate post-hoc analyses. Univariable logistic regression analyses were used to understand the odds of readmission amongst the different groups of marital status and sex as well as between different rural/urban statuses. Regressions were visualized with forest plots. ResultsThe heart failure readmission rate was 13.25% (147/1,109). Prior to post-hoc analyses, there was a significant difference in the observed count and expected count of married female readmission (9 vs. 19.161, p=0.020), and two proportion tests revealed a significantly higher readmission rate for single females compared to married females [14.36% (56/390) vs. 6.21% (9/145); p=0.010]. Prior to correction, married females had a statistically longer total length of stay compared to single females (p=0.038). Lastly, univariable logistic regressions revealed that married males, single females, and single males all had significantly higher odds of being readmitted compared to married females (married male: OR=2.248, p=0.045; single female: OR=2.532, p=0.013; single male: OR=2.606, p=0.010). No significant relationship between marital status and sex with length of stay or between geographic classification (metropolitan, micropolitan, rural, small town) with readmission was found. ConclusionsMarried females had the lowest readmission risk, while all others experienced significantly higher odds of readmission, pointing to the potentially protective role of partner-based social support post-discharge. Length of stay was not significantly related to marital or sex groups after correction suggesting that inpatient care delivery may be less sensitive to sociodemographic factors than post-discharge recovery. These findings underscore the need for better transitional care strategies for patients who lack strong support networks at home and stronger research backing to further characterize heart failure readmissions.

BackgroundCoronary artery tortuosity (CAT) is often viewed as a benign angiographic finding; however, emerging evidence suggests its potential hemodynamic significance, particularly in non-atherosclerotic cardiomyopathies such as Takotsubo syndrome (TS). ObjectivesThis study aimed to investigate the prevalence and hemodynamic implications of CAT in patients diagnosed with Takotsubo cardiomyopathy (TCM) and to evaluate the association between the severity of tortuosity and myocardial injury markers, recovery of ventricular function, and other clinical variables. MethodsA retrospective review of 100 patients with TCM from the Baptist Memorial Hospital network (2015-2025) was conducted. Tortuosity severity was quantified using angiographic criteria per Eleid et al. (2014). Associations between CAT and biochemical or echocardiographic parameters were evaluated using multiple linear regression and non-parametric tests. ResultsCAT was highly prevalent (85.1%) in this TCM cohort, with a mean tortuosity index of 3.26--significantly higher than in general angiography populations. No significant correlations were found between tortuosity severity and peak troponin levels (p = .588) or ejection fraction (EF) at presentation (p = .820). Full EF recovery (55-65%) at [&ge;]3 months occurred in 70.7% of patients and was not significantly associated with prior cardiomyopathy, coronary artery tortuosity index or baseline troponin levels. ConclusionsCAT appears markedly more prevalent among patients with TCM, although its severity does not correlate with biomarker elevation or EF recovery. These findings suggest that coronary tortuosity may contribute to the hemodynamic environment predisposing to TS, without directly determining the extent of myocardial dysfunction or recovery.

The objective of this systematic review and meta-analysis was to identify the interventions used to manage intolerance in patients receiving statins for primary prevention of CVD and to determine the effectiveness of these interventions. This study was conducted according to the PRISMA checklist. The electronic databases MEDLINE (PubMed), SCOPUS, EMBASE, and CINAHL were searched for studies published until June 2025. Based on the NLA definition of statin intolerance, the outcomes were split into adverse effects caused by statins and statin discontinuation. In total, 1,238 studies were identified and screened. Nine studies were eligible for systematic review, and six studies were eligible for meta-analysis. The identified intervention strategies were adjuvant therapy, statin titration, replacing statins with other lipid-lowering agents and switching to different statin. The meta-analysis showed that the pooled risk ratio (RR) relative to control was 0.97 (95% CI, 0.86-1.08) in randomized controlled trials and 0.94 (95% CI, 0.63-1.42) in overall, with point estimates in favour of intervention arms. Moderate to substantial heterogeneity was observed, with I2 between 27% to 57%. Due to the smaller number of studies, no clear conclusions can be drawn regarding how the implemented interventions may affect statin discontinuation. This study showed no strong evidence that the implemented interventions reduced statin intolerance. PROSPERO registration numberCRD42024587573 HighlightsThis study found that the intervention strategies used to manage intolerance in patients receiving statins for the primary prevention of cardiovascular diseases were adjuvant therapy, statin titration, replacing statins with other lipid-lowering agents and switching to different statin. O_LIThis study showed no strong evidence that the implemented interventions reduced statin intolerance C_LIO_LIDue to the smaller number of studies, no clear conclusions can be drawn regarding how the implemented interventions may affect statin discontinuation C_LI

AbstractRespiratory training benefits chronic heart failure (CHF) patients but is underused due to multiple barriers. Lifestyle-based active pursed-lip diaphragmatic breathing (PLDB) offers a feasible, device-independent alternative. This study aimed to evaluate its impact on CHF patients exercise tolerance, cardiac function, quality of life, and clinical outcomes. A prospective cohort study enrolled 58 hospitalized CHF patients (NYHA II-IV, Jan 2023-Feb 2024). All received standard therapy and PLDB instruction. Post-discharge, patients who self-administered PLDB were monitored via WeChat and grouped by adherence: the PLDB group ([&ge;]30 breaths/day, [&ge;]3 days/week, n=20) and the Control group (non-compliant, n=38). Outcomes included 6-minute walk test (6MWT), grip strength, serum N-terminal pro-brain natriuretic peptide, left ventricular ejection fraction (LVEF), and quality of life indicators (Minnesota Living with Heart Failure Questionnaire [MLHFQ], Self-rating Somatic Symptom Scale-China [SSS-CN], Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 [GAD-7], Pittsburgh Sleep Quality Index). Clinical endpoints were rehospitalization and major adverse cardiovascular events (MACE). Over 6 months, the PLDB group showed significant improvements in 6MWT (333.75 {+/-} 148.57 m to 407.9{+/-}153.29m, p=0.012), LVEF (46.67{+/-}13.86% to 51.81{+/-}14.89%, p=0.002), and quality of life (MLHFQ: 42.25{+/-}16.00 to 18.75{+/-}13.47, p<0.001; GAD-7: 3.90{+/-}3.81 to 1.50{+/-}2.14, p=0.029; SSS-CN: 35.35{+/-}5.84 to 29.05{+/-}8.61, p=0.005), with lower MACE incidence and higher MACE-free survival. Six-month lifestyle-based active PLDB training improves exercise capacity, cardiac function, quality of life, and reduces MACE in CHF patients, serving as an effective, practical rehabilitation strategy.

BackgroundSodium glucose co-transport inhibitors (SGLT2i), although established heart failure (HF) therapy in acquired heart disease, are not well-studied in adult congenital heart disease (ACHD). We aimed to conduct a systematic review and meta-analysis of SGLT2i therapy in moderate or severe complexity ACHD. MethodsFive databases (Pubmed, Medline, Embase, SCOPUS, and Cochrane) were searched for peer-reviewed journal articles describing SGLT2i HF therapy in moderate or severe complexity ACHD. Outcomes included adverse clinical events, biochemical markers of HF (N-terminal pro-brain natriuretic peptide [NT-proBNP] or BNP), and imaging markers of cardiac function (global longitudinal strain [GLS] and fractional area change [FAC]). Forest plots demonstrated mean study effects as individual and pooled estimates. The impact of heterogeneity on the overall variance was evaluated. ResultsThe systematic review included 10 studies (n=174 patients, 60% male). SGLT2i therapy was associated with a statistically significant improvement in GLS (mean difference -1.6 [-2.4,-0.9]) but not FAC (mean difference +1.86 [-6.2,+9.9]); there was no significant post therapy change in NT-proBNP or BNP (mean difference -240 pg/mL [-516,45] and -52 pg/mL [-129,26], respectively). Heterogeneity for the pooled effects for GLS and FAC was low (I2=0%), although moderate to high for NT-proBNP and BNP (I2=47% and I2=90%, respectively). Data were insufficient for evaluation of SGLT2i impact on clinical outcomes. ConclusionsPooled results across studies suggest that SGLT2i therapy can improve GLS among people with ACHD-HF, however the clinical implications of this observation warrant further study. Randomized controlled trials are now needed to evaluate the impact of SGLT2i therapy in ACHD.

BackgroundThe optimal timing and efficacy of pharmacological rhythm control in patients with preoperative atrial fibrillation (AF) undergoing cardiopulmonary bypass (CPB) surgery remain unclear. We aimed to evaluate the effectiveness of intravenous amiodarone administration during rewarming on early cardioversion and short-term outcomes, and to develop a predictive model for postoperative AF recurrence. MethodsThis retrospective cohort study included adult patients with preoperative atrial fibrillation who underwent cardiac surgery with CPB. Patients receiving a 150 mg intravenous bolus of amiodarone via the oxygenator at systemic rewarming initiation (nasopharyngeal temperature [&ge;]32{degrees}C) during aortic cross-clamping (ACC) were defined as the amiodarone group (A group, n=423), and were compared with the non-intervention group (NI group, n=191). The primary outcome was sustained sinus rhythm within 12 hours post-cardioversion. Secondary outcomes included myocardial injury (measured by cardiac troponin I, cTnI), inflammatory response (neutrophil count, NEUT), renal function (blood urea nitrogen, BUN), use of inotropic support (milrinone, MIL) and renal replacement therapy (hemodialysis, HD), length of hospital stay (LOHS), and other short-term clinical endpoints. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline imbalances. A multivariable logistic regression model was developed and validated to predict early AF recurrence. ResultsOf 614 patients, 423 were in the A group and 191 in the NI group. After IPTW adjustment, the A group had a significantly higher rate of sustained sinus rhythm (52.5% vs. 7.8%, P<0.001). They also exhibited lower levels of cTnI, NEUT, and BUN, reduced use of MIL and HD, and shorter LOHS, along with other favorable outcomes. NT-proBNP was transiently higher in the A group. The final prediction model--incorporating age, left atrial anteroposterior diameter (LAAD), left ventricular end-diastolic diameter (LVED), right ventricular anteroposterior diameter (RVAD), serum calcium, and comorbidity grade--showed strong discrimination (AUC: 0.866 in the training cohort, 0.795 in the validation cohort). ConclusionAmiodarone administration during rewarming improves early rhythm stability and short-term clinical outcomes in patients with preoperative AF undergoing CPB surgery. A validated risk prediction model identifies patients at high risk for recurrence, supporting individualized perioperative management strategies.

BackgroundMedication non-adherence is a critical problem among patients with heart failure (HF). Current evidence has shown its association with increased morbidity, mortality and healthcare costs. Prescription discrepancy is a significant risk factor that can increase non-adherence and subsequently increases the risk of HF-related hospitalization and mortality. Current literature has not provided a clear understanding of the non-adherence problem or contributing factors among Saudi HF patients. Measuring the prevalence of non-adherence and its associated factors can direct clinicians to implement effective interventions to optimize pharmacotherapy benefits, and thus, improving outcomes. AimTo assess the Saudi Arabian population of HF patients for degree of adherence to their medications, the amount of medication discrepancies, and its association with re-hospitalization rate. MethodA prospective observational study conducted at a tertiary care hospital on eligible HF patients attending the ambulatory clinic from July 2023 through April 2024. All patients were followed for six months. Primary outcomes were percentage of patients adherent to their medications and number and type of prescription discrepancies. Secondary outcomes were degree of health literacy, prevalence of non-adherence risk factors, and HF-related re-hospitalization rate. Adherence was measured utilizing the Eight-item Morisky Medication Adherence Scale (MMAS-8). Three-item Brief Health Literacy Screen (BHLS) was used to measure health literacy. ResultA total of 202 patients were included in the study. Average age was 60 years, and 69% were males. For the primary outcomes, 43.5% of patients demonstrated high adherence, while 39.6% and 16.8% fell into medium and low adherence categories, respectively. Prescription discrepancies were identified in 51.5% of the patients. Causes of discrepancies ranged from patient generated, healthcare system generated, or multifactorial, generated by both, the patient and the system. Degree of health literacy was adequate in 23.8% of the patients, marginal and inadequate in 51.5% and 24.8%, respectively. Of potential non-adherence risk factors, polypharmacy, age [&ge;]65 years, and marginal and inadequate health literacy, were the most common. HF-related re-hospitalization occurred in 18 patients, all of which were either non-adherent or had prescription discrepancies. ConclusionAmong HF patients, medication non-adherence is a significant problem that is associated with increased morbidity and mortality. In our study, around half of the patients either experienced difficulties with adherence, prescription discrepancies, or both. Measuring the local prevalence of factors affecting non-adherence can be of use to identify strategies that suit our population the best, in order to mitigate their negative effect.

BackgroundAcute type A aortic dissection (AAAD) complicated by cardiopulmonary arrest is characterized by high mortality rates, rendering the selection of surgical candidates a subject of intense debate. Despite the necessity for cardiopulmonary resuscitation (CPR) prior to the completion of a definitive intervention, the prognostic impact of CPR duration on postoperative survival and neurological outcomes remains insufficiently elucidated. This study sought to evaluate the association between pre- and intra-operative CPR duration and the incidence of early mortality and central nervous system (CNS) complications in patients undergoing emergent surgical repair for AAAD. MethodsThis retrospective, cohort study was conducted at two tertiary community hospitals in Japan. All the patients who underwent emergency surgery for AAAD between January 2014 and December 2024 were enrolled. A multilevel Cox proportional hazards model, with each patient as level 1 and institutions as level 2, was used to evaluate the association between pre-or intra-operative CPR events and early postoperative mortality and CNS complications. ResultsOf the 880 patients enrolled, 785 (89.2%), 13 (1.5%), and 82 (9.3%) were without CPR, with CPR <15 min, and with CPR [&ge;]15 min, respectively. Among them, death within 30 days post-surgery occurred in 76/785 (9.7%), 3/13 (23.1%), and 47/82 (57.3%), respectively. CNS complications within 30 days post-surgery occurred in 141/785 (18.0%), 5/13 (38.5%), and 38/82 (46.3%) without CPR, CPR <15 min, and [&ge;]15 min, respectively. In multivariable analysis, CPR lasting [&ge;]15 min was associated with mortality within 30 days post-surgery (adjusted hazard ratio, 7.66; 95% confidence interval [CI], 3.56-16.5; P<0.001). Both CPR <15 min and [&ge;]15 min were associated with an increase in the sub-hazard ratio of CNS complications within 30 days post-surgery (adjusted sub-hazard ratios, 4.49; 95% CI, 3.92-5.11; P<0.001, and 3.62; 95% CI, 2.73-4.81; P<0.001, respectively). ConclusionA preoperative CPR duration of [&ge;]15 min prior to the initiation of cardiopulmonary bypass or extracorporeal membrane oxygenation was associated with a substantial escalation in 30-day mortality compared with patients without CPR. These findings suggest that CPR duration might serve as a pivotal prognostic indicator, necessitating careful consideration for surgical indication in patients with AAAD complicated by CPR. CLINICAL PERSPECTIVEO_ST_ABSWhat is new?C_ST_ABSO_LIPre- or intra-operative cardiopulmonary resuscitation lasting [&ge;]15 min in patients with acute type A dissection is associated with a nearly seven-fold increase in 30-day postoperative mortality. C_LIO_LIBoth short (<15 min) and prolonged ([&ge;]15 min) cardiopulmonary resuscitation are associated with a higher risk of early postoperative complications in the central nervous system. C_LI What are the clinical implications?O_LIPatients with acute type A dissection who require pre- or intra-operative cardiopulmonary resuscitation [&ge;]15 min should undergo careful multidisciplinary evaluation, as the risk of early mortality is substantially elevated. C_LIO_LIEven brief cardiopulmonary resuscitation is associated with increased neurological complications, highlighting the need for early neurological monitoring and supportive care postoperatively. C_LI

BackgroundAcute myocarditis is typically self-limiting and resolves spontaneously in most cases. However, ventricular arrhythmias (VA) complications, which may be life-threatening are associated with higher rates of in-hospital complications and mortality. Catheter ablation is occasionally required for acute myocarditis associated ventricular tachycardia (VT), but data on its procedural use and outcomes, in this setting, remain limited. We aimed to determine the prevalence of VA among patients hospitalized for acute myocarditis and to evaluate the subset who underwent in-hospital VT ablation, including their acute outcomes. MethodsRetrospective analyzed data from the National Inpatient Sample (NIS) database for U.S. hospitalizations with a diagnosis of myocarditis between 2016 and 2019. In-hospital outcomes were compared between patients with and without VA. Subgroup analysis examined patients with acute myocarditis associated VT stratified by whether VT ablation was performed. Patient demographics, comorbidities, procedures, and outcomes were identified using ICD-10-CM codes. ResultsAmong an estimated 17,845 hospitalizations for acute myocarditis, 8.4% (n=1,505) had VA (including 7.7% with VT). Patients with VA were more likely to have structural heart disease, renal disease, infectious etiologies, anemia, and atrial arrhythmias, despite lower prevalence of some traditional cardiac risk factors. VA was associated with markedly worse outcomes, including 5.5-fold higher in-hospital mortality (10% vs 1.6%; p<0.001). Multivariate analysis revealed that VA during admission for acute myocarditis was an independent significant risk factor for cardiac complications (aOR=4.8), total complications (aOR=4.2) and in hospital mortality (aOR=5.1) (p<0.001 for each analysis). Among patients with VT, catheter ablation was performed in 13.7% (n=190), more commonly with infectious etiologies. Ablated patients, compared to those without ablation, experienced significantly higher rates of in-hospital complications (73.7% vs 42.3%; p<0.001) and mortality (15.8% vs 6.7%; p<0.001). ConclusionsVA complicating acute myocarditis, portends significantly worse in-hospital outcomes. Although ablation was performed in approximately 1 in 7 patients with VT, those undergoing the procedure had less favorable acute results. Further prospective research is warranted to define optimal criteria for ablation and expected outcomes in this high-risk population.

BackgroundGuideline-directed medical therapy (GDMT) has been shown to improve mortality and/or symptoms in heart failure with reduced ejection fraction (HFrEF). Medical devices also play an important role in improved quality of life and overall symptom relief for HFrEF patients. Baroreflex Activation Therapy (BAT) increases parasympathetic nervous system activity by stimulating the carotid baroreceptors, thereby reducing symptoms. Herein, we analyzed the effects of BAT on hospitalization, atrial arrhythmia (AA), and ventricular arrhythmia (VA) rates. MethodsA retrospective cohort study was conducted consisting of HFrEF patients treated with BAT at Keck Hospital of USC between 11/2014 and 11/2022. We compared median pre-BAT hospitalization, AA, and VA rates to post-BAT rates at both 6- and 12-months using Wilcoxon Signed Rank tests. ResultsAmong 31 patients on BAT, 38.7% met criteria for receiving all four GDMT classes for at least 12 months prior to BAT. Among these, 91.7% had an implantable cardioverter defibrillator (ICD) implanted for [&ge;]12 months pre- and post-BAT. Average pre- vs. post-BAT all-cause hospitalization rates were significantly different only at 12 months [1.3 {+/-} 1.4 vs 0.3 {+/-} 0.9, respectively (p=0.05)]. Borderline significant pre-post comparisons were noted including decreased VA rate at both 6 and 12 months and increased AA rate at 12-months (p=0.06 for all). ConclusionIn HFrEF patients on full GDMT, BAT was associated with a significant reduction in hospitalization rates at 12 months. There were no significant changes in AA or VA rates.

BackgroundVentricular arrhythmias (VAs) are a proximate mechanism of sudden cardiac death, yet national patterns in place of death (POD) and their determinants remain sparsely described. We quantified 25-year trends and factors associated with POD among UAs decedents in the United States. MethodsWe analyzed CDC WONDER Multiple Cause of Death data (1999-2024) for adults [&ge;]25 years with ventricular arrhythmias (ICD-10 I47.2, I49.0) as underlying cause. POD was categorized as inpatient, outpatient/emergency department (ED), home, hospice/nursing, or other/unknown. Covariates included age, sex, race, Hispanic origin, and urbanization. We calculated Annual and Average Annual Percent Changes (AAPCs and APC) using Age-Adjusted Mortality Rates (AAMRs), and fit multinomial logistic regression (reference = inpatient) to obtain adjusted odds ratios (ORs, 95% CIs). ResultsAmong 433,988 ventricular arrhythmia (VA) deaths, POD was inpatient 62.0%, outpatient/ED 18.1%, home 11.1%, hospice/nursing 5.8%, other 3.1%. Inpatient deaths increased from 57.8% (1999) to 66.1% (2024). AAMRs declined sharply from 13.3 per 100,000 in 1999 to 6.3-6.5 during 2010-2019, then rose to 7.4 in 2021 and fell to 6.8 in 2024. In home vs inpatient: [&ge;]85 years, medium/small metropolitan counties and rural counties had higher odds of VA deaths, whereas younger age groups, females, Black, American Indian, Asian/Pacific Islander individuals and Hispanic individuals had lower odds. In outpatient/ED vs inpatient: 25-44 years, 45-64 years, males, Black, American Indian and Asian/Pacific Islander individuals had higher odds, whereas [&ge;]85 years and females had lower odds. In hospice/nursing facilities: [&ge;]85 years, females, Whites, non-Hispanic individuals, medium/small metropolitan counties and rural counties had higher odds of VA deaths, whereas younger age groups, Black, American Indian, Asian/Pacific Islander individuals and Hispanic individuals had markedly lower odds. ConclusionFrom 1999-2024, VA deaths shifted toward hospitals. Persistent disparities by age, sex, race/ethnicity, and rurality highlight the need to expand equitable advance care planning and device deactivation discussions.

BackgroundCardiac surgery significantly improves clinical endpoints but imposes challenges in postoperative recovery. Assessing patient-reported outcome is crucial for optimal care. However, no cardiac surgery-specific tools currently exist to adequately capture postoperative recovery experience. ObjectivesTo develop and validate a recovery scale after cardiac surgery (Fuwai-CRS). MethodsThis study was conducted from May 2023 to December 2024, comprising: (1) a qualitative study (Cohort 1) enrolling postoperative patients of cardiac surgery and medical staffs to develop the draft scale through literature review, semi-structured interview and Delphi consensus; and (2) a single-center prospective validation study (Cohort 2) to finalize the scale and evaluate psychometric properties. ResultsIn Cohort 1, a 17-item draft Fuwai-CRS was generated based on literature review, semi-structured interview (40 patients and medical staffs) and a Delphi study (15 experts). In Cohort 2 (n=500), a 9-item Fuwai-CRS was finalized by data distribution assessment, hierarchical cluster and factor analysis, and its understandability, reliability, validity and responsiveness were found acceptable. ConclusionsThe Fuwai-CRS is a concise and valid tool for recovery assessment after cardiac surgery.

BackgroundEvolocumab promotes coronary plaque regression in patients with coronary artery disease, but little is known regarding carotid plaques (CP). This study aimed to evaluate the impact of evolocumab on top of lipid-lowering therapy (ELLT) on carotid morphological stabilization (MS) and plaque regression (PR) compared to lipid-lowering therapy (LLT) alone. MethodsAsymptomatic patients with internal carotid stenosis[&ge;]50% and LDL-C[&ge;]100 mg/dL were randomized to ELLT or LLT and monitored by serial duplex ultrasound. The primary endpoint was a composite of 6-month-MS (i.e., switch from morphologic types I-II to III-IV) and/or 12-month-PR (i.e., reduction of carotid stenosis by at least 5% compared to baseline). The secondary endpoint was LDL-C change at 12 months. Major adverse vascular events (MAVE, i.e., cardiac death, stroke, myocardial infarction, carotid or coronary or peripheral revascularization) were recorded. ResultsA total of 170 patients were randomized. Mean carotid stenosis was 57%. At 6 months, MS occurred in the ELLT group (10.3%) only (p=0.29). At 12 months, PR was numerically more frequent in the ELLT group, without reaching statistical significance (43% versus 35.1%, p=0.42). The primary endpoint was met in 44.3% versus 35.1% (p=0.26). As compared to baseline, 6 and 12-month shifts from low to high-risk types were significantly higher in the LLT group (p=0.03). The 12-month LDL-C percentage reduction was -73.5% with ELLT, and -48.3% with LLT (p=0.0001). At 1 year, MAVE were significantly more frequent with LLT (14.6% versus 2.4%, p=0.005), and the absence of evolocumab was the only predictor (OR 7, p=0.014). ConclusionsIn patients with CP[&ge;]50% and LDL-C[&ge;]100 mg/dL, ELLT compared to LLT was associated with numerically but not statistically higher 6-month MS and/or 12-month PR. In the LLT group, 6- and 12-month changes from low to high-risk types, LDL-C, and MAVE were significantly higher. According to these results, evolocumab should be considered standard treatment for patients with CP[&ge;]50%. The study was registered at www.clinicaltrials.gov (NCT04730973) and Eudract (2020-005663-31). SHORT ABSTRACTPatients with carotid stenosis[&ge;]50% and LDL-C[&ge;]100 mg/dL were randomized to evolocumab on top of optimal lipid-lowering therapy (ELLT) or optimal lipid-lowering therapy (LLT) alone to assess the impact of ELLT on carotid plaque morphological stabilization (MS) and plaque regression (PR). At 6 and 12 months, MS and PR occurred in both groups, but were numerically higher in the ELLT group, without reaching statistical significance. In the LLT group, 6- and 12-month changes from low to high-risk types were significantly higher, and the rate of adverse vascular events was sevenfold higher. Evolocumab might become the standard treatment for patients with carotid artery stenosis [&ge;]50%. CLINICAL PERSPECTIVEO_ST_ABSWhat is new?C_ST_ABSO_LIThe CARUSO is the largest randomized trial evaluating the impact of evolocumab on top of lipid-lowering therapy (ELLT) on carotid morphological stabilization (MS) and plaque regression (PR) monitored by serial duplex ultrasound. C_LIO_LIThe primary endpoint was a composite of 6-month-MS (i.e., switch from morphologic types I-II to III-IV) and/or 12-month-PR (i.e., reduction of carotid stenosis by at least 5% compared to baseline) and was numerically higher in the ELLT group compared to lipid-lowering therapy (LLT) alone, without reaching statistical significance. C_LIO_LIThe 1-year rate of major adverse vascular events (MAVE) was sevenfold higher in the LLT group. C_LI What are the clinical implications?O_LICarotid plaque morphology is a dynamic event, and 6 and 12-month shifts from low to high-risk morphological types were significantly higher in the LLT group, thus suggesting that evolocumab added to LLT may prevent morphological deterioration. C_LIO_LIThe absence of evolocumab was the only independent predictor of MAVE; according to our results, ELLT might become the standard treatment for patients with carotid plaques [&ge;]50% and LDL-C not at target. C_LIO_LIFuture larger studies are warranted to validate our findings, assess long-term adherence to therapy, and identify subgroups with higher probability of achieving MS and PR. C_LI

BackgroundPoor adherence to guideline-directed medical therapy (GDMT) in patients with heart failure (HF) with reduced ejection fraction is associated with higher mortality and hospitalization. However, its association with malignant arrhythmias and aborted sudden cardiac death (SCD) remains unclear. This study assessed the association between GDMT adherence and these outcomes in patients with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with a defibrillator (CRT-D). MethodsPatients who had an ICD or CRT-D implanted for primary prevention were included. Those with sustained ventricular tachycardia (VT), ventricular fibrillation/flutter (VF/VFL), or an aborted SCD device before implantation were excluded. Adherence to renin-angiotensin system blockers (RASBs), beta blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) was assessed and categorized as optimal, suboptimal, or poor. The primary outcome was a composite of all-cause mortality, sustained VT, VF/VFL, and aborted SCD. ResultsAmong 3,780 patients, the prescription rates were 87.5% for RASBs, 89.7% for BBs, and 74.2% for MRAs. Compared with optimal adherence, both suboptimal and poor adherence were associated with an increased risk of the primary outcome. The adverse effects of poor adherence were most evident in patients with ischemic HF. Although lower adherence was correlated with more arrhythmic events, these associations were inconsistent when clinical factors were considered. ConclusionsLower GDMT adherence was independently associated with increased mortality despite device therapy, particularly in patients with ischemic HF. Although its relationship with arrhythmic outcomes was unclear, sustained adherence remains critical, underscoring the need for targeted interventions to enhance therapeutic continuity.

Structured abstractO_ST_ABSBackgroundC_ST_ABSTransthyretin amyloid cardiomyopathy (ATTR-CM) has historically been underdiagnosed but has recently become increasingly recognized due to advances in diagnostic techniques and heightened clinical awareness. Despite this progress, treatment options remain limited, as current approved therapies are costly and not widely accessible. Given the benefits of sodium-glucose cotransporter 2 (SGLT2) inhibitors in broader heart failure (HF) populations, we aimed to evaluate their efficacy in reducing mortality and hospitalizations in ATTR-CM. ObjectivesTo determine whether SGLT2 inhibitors reduce all-cause mortality, CV mortality, and HF hospitalizations in ATTR-CM, offering a potential adjunctive therapy for this undertreated population. MethodsWe performed a systematic review and meta-analysis of SGLT2 inhibitors against SGLT2 inhibitors-naive patients with ATTR-CM. PubMed, Embase, Scopus and Cochrane databases were searched for trials published up to January 31, 2025. Data were extracted from published reports, and quality assessment was performed per Cochrane recommendations. Risk ratios (RRs) with 95% confidence interval (CI) were pooled across trials. Outcomes included all-cause mortality, CV mortality and HF hospitalization. ResultsOut of 177 database results, four observational studies and 5039 patients were included; 2489 (49.39%) received a SGLT2 inhibitor. All-cause mortality (RR 0.44; 95% CI 0.33-0.59; p<0.00001; I{superscript 2}=54%) and CV mortality (RR 0.30; 95% CI 0.16-0.55; p=0.0001; I{superscript 2}=25%) were significantly lower in patients treated with SGLT2 inhibitors compared with control. HF hospitalization (RR 0.68; 95% CI 0.33-1.41; p=0.30; I{superscript 2}=89%) showed a downward trend, yet this was not statistically significant. ConclusionsIn patients with ATTR-CM, SGLT2 inhibitors significantly reduce both all-cause and cardiovascular mortality compared to standard care, suggesting they may serve as a valuable adjunctive therapy for this undertreated population. Although HF hospitalization showed a nonsignificant downward trend, these findings underscore the need for large randomized trials to confirm and expand on these promising results.