Search Results (1,837)

Background/Objectives: Coronary artery disease (CAD) is highly prevalent in patients undergoing vascular surgery and is a major determinant of postoperative morbidity and mortality. Preoperative anemia is a well-recognized risk factor for adverse outcomes, including major adverse cardiac events (MACEs), but its independent impact in patients with CAD undergoing abdominal aortic aneurysm (AAA) repair remains unclear. Methods: We conducted a retrospective cohort study of 410 consecutive patients undergoing open AAA repair at a tertiary vascular center between 2023 and 2025. Preoperative anemia was defined as hemoglobin < 130 g/L and significant CAD as ≥70% luminal narrowing for non-left main disease or ≥50% for left main disease. The primary outcome was MACE (cardiovascular death, myocardial infarction, or stroke) during hospitalization. Baseline covariates included age, sex, diabetes mellitus (DM), chronic kidney disease (CKD), congestive heart failure (CHF), peripheral artery disease (PAD), and other relevant comorbidities. Multivariable logistic regression models were used to evaluate associations of anemia, CAD, and their interaction with MACE. Additionally, a composite risk group was created to examine MACE rates across mutually exclusive subgroups. Results: Among 410 patients, 314 (76.6%) had CAD and 116 (28.3%) had preoperative anemia. Overall, 67 patients (16.3%) experienced MACE. In the reduced model including only anemia and CAD, anemia remained a strong independent predictor of a MACE (OR 4.46, 95% CI 2.57–7.72, p < 0.001), and CAD was also independently associated (OR 2.20, 95% CI 1.00–4.72, p = 0.044). In the full multivariable model adjusting for DM, CHF, CKD, PAD, and age, anemia was the strongest predictor (OR 4.53, 95% CI 2.49–8.26, p < 0.001), while CAD showed a borderline association (OR 2.07, 95% CI 0.94–4.57, p = 0.071). Interaction analysis indicated no statistically significant modification in risk by the combination of anemia and CAD. The composite risk group variable was omitted due to collinearity with its components. Conclusions: Preoperative anemia, particularly in patients with CAD, is a significant and independent predictor of major adverse cardiac events following open AAA repair. These findings support the importance of early identification and correction of anemia before surgery to improve perioperative cardiac outcomes in this high-risk population. Full article

Background/Objectives: Sacubitril/Valsartan is a cornerstone therapy to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate the effect of Sacubitril/Valsartan on cardiac autonomic balance using physiological sensor data obtained from implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds). Methods: This observational study involved 54 ICD and CRT-D patients who initiated Sacubitril/Valsartan therapy to treat HFrEF. The evaluated key parameters included heart rate variability (HRV), 24 h mean heart rate (24 h-HR), and nocturnal heart rate (nHR). Device electrical parameters and ventricular arrhythmias were also assessed. The data were collected by remote monitoring and averaged over a 7-day window at baseline (before treatment) and at 3 and 12 months after treatment initiation. Results: Sacubitril/Valsartan significantly improved HRV at 3 months (from 78.6 ms [interquartile range: 54.2–104.6] to 80.8 ms [60.8–108.0]; p = 0.041), reduced 24 h-HR (from 73.2 bpm [67.3–77.7] to 69.9 bpm [64.2–75.7]; p = 0.016), and reduced nHR (from 63.0 bpm [58.1–70.0] to 60.4 bpm [56.0–68.6]; p = 0.028). No significant changes in HRV, 24 h-HR, and nHR were observed between 3- and 12-month follow-up. The device electrical parameters were not influenced by the treatment. While the overall ventricular arrhythmia burden did not change post-treatment, patients with pre-treatment arrhythmias experienced a significant reduction in episodes from 2.97 (pre-treatment) to 0.82 (post-treatment) events per 100 patient years (p = 0.008). Conclusions: Sacubitril/Valsartan therapy in HFrEF patients was associated with statistically significant changes in cardiac autonomic indices, including a small increase in HRV and a slight reduction in heart rate, mainly during the first three months of treatment. Full article

Background/Objectives: Cardiac sarcoidosis (CS) is a challenging diagnosis due to its subclinical progression and the limitations of existing screening tools. Cardiac magnetic resonance (CMR) and PET/CT imaging have improved diagnosis and detection. Aldosterone, a hormone with known profibrotic effects, may offer additional diagnostic value. We therefore aimed to determine whether plasma aldosterone level is associated with myocardial fibrosis, independent of active inflammation, in CS. Methods: This observational study included 541 patients with biopsy-proven sarcoidosis and preserved left ventricular ejection fraction (LVEF ≥ 50%). All underwent CMR with extracellular volume (ECV) mapping and 18F-FDG PET/CT to assess myocardial fibrosis and inflammation, respectively. Plasma aldosterone levels were also measured. Results: Plasma aldosterone levels were significantly higher in patients with cardiac sarcoidosis (172 [IQR 106–235] pg/mL) compared to those without cardiac involvement (143 [100–205] pg/mL, p = 0.02). Aldosterone was independently associated with the presence of late gadolinium enhancement (LGE) on CMR (OR 1.002 per 1 pg/mL increase; 95% CI 1.001–1.004, p = 0.04) and with higher ECV values (β = 0.008 per 1 pg/mL, p = 0.001). Regression analysis showed that aldosterone is associated with ECV (b-0.009, CI: 0.002–0.016, p = 0.009) and there was no interaction according to LGE status indicating a relationship with diffuse myocardial fibrosis even in the absence of visible scarring. No association was observed with T1-, T2-, or PET/CT-defined inflammation. Conclusions: Plasma aldosterone is a robust marker of myocardial fibrosis in sarcoidosis, particularly in early or subclinical stages. Its correlation with ECV—but not with inflammatory imaging markers—suggests its link with myocardial diffuse fibrotic remodeling before, and independently of, overt scarring or inflammation. Full article

Background/Objectives: Blood renin and electrolyte levels are associated with blood pressure and hypertension. While sex-specific effects of such factors have been investigated, exact comparisons of the factors between the sexes have been scarce. Methods: Using cohort data from the Korean Genome and Environmental Study (KoGES), the study population that did not receive any interventions for blood pressure was determined. Blood levels of renin and electrolytes, including sodium, potassium, chloride, and calcium, were used to test their relationship with hypertension and blood pressure. Confounding variables, including age, body mass index (BMI), waist-to-hip ratio, family history of hypertension, alcohol consumption, smoking, blood urea nitrogen, creatinine, protein, and albumin levels, were used for adjustment in the multiple regression analysis. Results: In the single-variable analysis, sodium levels were significantly higher in the female population, and showed strong associations in the multiple regression analysis. Blood potassium levels showed no significant sex-specific differences. Among these factors, renin showed the greatest significance in both the total population and sex-specific groups. Moreover, in the development of hypertension, the effect size of renin was significantly different between sexes. Additionally, BMI tended to show stronger associations in females. Conclusions: This study identified sex-specific differential effects of renin and other electrolytes that are important in the pathophysiology of blood pressure. These findings provide clues for the more precise management of hypertension. Full article

Background: Cardiovascular diseases (CVD) are the leading global cause of death, disproportionately affecting Latin America. This study evaluated the impact of a contextualized workplace intervention, adapted from the Diabetes Prevention Program (DPP), on reducing cardiovascular risk (CVR) in a Latin American population. Methods: A quasi-experimental, pre-post study was conducted with 100 adults (34 males, 66 females) affiliated with the social security system. The 16-week “Transforma tu vida con cambios diarios” program, included ten sessions focused on motivation, healthy eating and physical activity. Sociodemographic, anthropometric, clinical, and biochemical parameters were measured before and after the intervention. CVR was estimated as a 10-year risk percentage using the non-laboratory Globorisk model. Analysis included paired t-test and Cohen’s d effect sizes. Results: Significant improvements (p < 0.05) were associated with the intervention. The predicted mean CVR score decreased from 8.03% to 6.71% (p = 0.03, d = 0.658). Reductions were observed in weight (73.1 to 71.7 kg, p < 0.001, d = 0.424), BMI (29.0 to 28.5 kg/m², p < 0.001, d = 0.363), and physical inactivity (60% to 39%, p = 0.001). A moderate-low clinical impact was found for systolic blood pressure (124.9 to 121.2 mmHg; p = 0.003, d = 0.301) and glucose (103.3 to 101.1 mg/dL; p = 0.04, d = 0.218) and HDL cholesterol (51.5 to 54.9 mg/dL; p = 0.02, d = −0.286) showed significant but small effects. Conclusions: The intervention was associated with favorable changes in clinical and anthropometric indicators. The results provide preliminary evidence that logistical adaptation to the workplace can effectively reach at-risk Latino populations, with weight and BMI improvements reflecting the program’s strong physical activity component. Full article

Obesity is a multidimensional condition characterized by autonomic imbalance, metabolic inflexibility, impaired physical resilience, and ectopic adiposity, pathophysiological alterations that arise long before overt cardiometabolic disease becomes clinically detectable. Despite this, current cardiometabolic risk scores continue to rely predominantly on biochemical and anthropometric variables, such as BMI, waist circumference, glucose, and lipid levels. While these markers are practical, inexpensive, and validated across large population cohorts, growing evidence shows that they offer limited incremental predictive value and fail to capture early functional and structural abnormalities. The recent literature highlights the prognostic importance of autonomic dysfunction, reduced metabolic flexibility, diminished cardiorespiratory fitness, impaired muscular strength, and ectopic fat depots including visceral and epicardial adiposity, independently of the traditional anthropometric indices. The domains remain absent from traditional algorithms such as the Metabolic Syndrome criteria, the Framingham Risk Score, and SCORE2. As a result, cardiometabolic risk is frequently underestimated in key subgroups, including young adults with obesity, individuals with high visceral adiposity but normal BMI, those with subclinical myocardial dysfunction, and metabolically unhealthy normal-weight phenotypes. This narrative review synthesizes current evidence on obesity-related cardiometabolic impairment, highlights major gaps in established risk scores, and supports the conceptual development of the C.O.R.E. (Cardio-Obesity Risk Evaluation) Indicator Model—a hypothesis-generating, non-validated multidomain framework integrating autonomic, metabolic, functional, and structural markers to enable earlier risk phenotyping in future studies. Full article

Objective: Prolongation of the QTc interval (QTc) is a known risk factor for ventricular arrhythmias and sudden cardiac death (SCD). Although ankylosing spondylitis (AS) is associated with systemic inflammation and metabolic alterations, data on the relationship between noninvasive fibrosis markers and QTc are limited. This study aimed to investigate the association between the FIB-4 index and QTc in patients with AS. Methods: A total of 82 consecutive patients with AS were enrolled in the study. Demographic characteristics, comorbidities, laboratory parameters, and medication use were also recorded. The FIB-4 index was calculated for each patient in the study. Surface 12-lead electrocardiograms were obtained, and the QTc was measured. Correlation analyses and multivariable linear regression models were used to identify the independent predictors of QTc. Results: The mean age of the study population was 42.4 ± 11.7 years, and 57.3% of the patients were men. Correlation analysis revealed significant associations between QTc and age, sex, the FIB-4 index, body mass index (BMI), hypertension, hyperlipidemia, and cardiovascular medication use, whereas hemoglobin and estimated glomerular filtration rate (eGFR) were negatively correlated with QTc. In the multivariable analysis, only sex (β = −0.306, p = 0.001) and the FIB-4 index (β = 0.379, p < 0.001) remained independently associated with QTc. Conclusion: Our findings demonstrate that the FIB-4 index is independently associated with the QTc in patients with AS. These results suggest that noninvasive fibrosis markers may provide additional insights into cardiovascular risk stratification in this population. Full article

Background: Cardiovascular risk models, such as the Framingham and atherosclerotic cardiovascular disease (ASCVD) calculators, have improved risk prediction but often fail to identify individuals who experience ASCVD events despite low or intermediate predicted risk. This suggests that underrecognized, non-traditional risk factors may contribute significantly to the development of atherosclerosis. Objective: This narrative review synthesizes and summarizes recent evidence on high-yield non-traditional risk factors for atherosclerosis, with a focus on clinically significant, emerging, and applicable contributors beyond conventional frameworks. This review is distinct in that it aggregates a wide array of non-traditional risk factors while also consolidating recent data on ASCVD in more vulnerable populations. Unlike the existing literature, this manuscript integrates in a single comprehensive review various domains of non-traditional atherosclerotic risk factors, including inflammatory, metabolic, behavioral, environmental, and physical pathways. An additional unique highlight in the same manuscript is the discussion of non-traditional risk factors for atherosclerosis in more vulnerable populations, specifically South Asians. We also focus on clinically actionable factors that can guide treatment decisions for clinicians. Results: Key non-traditional risk factors identified include inflammation and biomarker-based risk factors such as C-reactive protein or interleukin-6 levels, metabolic and microbial risk factors, behavioral factors such as E-cigarette use, and environmental or infectious risk factors such as air and noise pollution. We explore certain physical exam findings associated with atherosclerotic burden, such as Frank’s sign and Achilles tendon thickness. Conclusions: Atherosclerosis is a multifactorial process influenced by diverse and often overlooked factors. Integrating non-traditional risks into clinical assessment may improve early detection, guide prevention and personalize care. Future risk prediction models should incorporate molecular, behavioral, and environmental data to reflect the complex nature of cardiovascular disease. Full article

Background: Heart re-transplantation represents an effective option in selected patients with graft failure. Although the results of heart re-transplantation have improved in recent years, little is known about the outcomes in patients requiring late (>1 year) re-transplantation or about the effects of prolonged exposure to immunosuppression on multiorgan function. Methods: Among all the heart re-transplantations performed, from November 1988 to April 2025, a total of 30 patients underwent late re-transplantation. Since literature data on late re-HTx are generally limited to those performed within 20 years, patients were divided according to the interval from primary to re-transplantation: <20 (Group A) or ≥20 years (Group B). Results: Group A included 17 patients re-transplanted after a median time of 15 years, and Group B 13 patients after a median time of 23 years. Group B patients were more commonly affected by severe chronic kidney disease and received more combined heart and kidney transplantation. Overall survival at 1, 5 and 10 years was 80%, 68% and 60%, and did not differ between Groups A and B (p = 0.5). However, Group B recipients were more commonly affected by malignancies (p < 0.01). Compared to primary heart transplantation in the same population, re-transplantation was associated with higher, albeit not statistically significantly, rates of infections, grade ≥ 2 rejections and malignancies. Conclusions: Late heart re-transplantation is associated with satisfactory outcomes and could be effectively considered in patients with late graft dysfunction. However, the prolonged exposure to immunosuppression requires particular attention in early pharmacological management as well as a close follow-up, especially in patients requiring heart re-transplantation after >20 years. Full article

Objectives: This study evaluated the anatomical suitability of two single-branched thoracic stent grafts—the Castor (Endovastec, China) and the Thoracic Branch Endoprosthesis (TBE, Gore, USA)—for proximal landing in aortic arch zone 2, including the left subclavian artery (LSA), in patients with acute type B aortic dissection (TBAD). While the TBE is currently available as an off-the-shelf device (26 main bodies, 8 branch configurations), the study also aimed to define the minimal number of configurations needed to treat most patients. The same approach was applied to the Castor stent graft, currently only available as a custom-made device (CMD), to assess its potential for off-the-shelf adaptation. Methods: A retrospective analysis was performed on computed tomographic angiographies of TBAD patients treated between 2004 and 2023. Exclusion criteria included type A or non-A-non-B dissections, isolated abdominal dissections, intramural hematomas, and lack of consent. Morphometric measurements were conducted using centerline analysis software. Suitability was defined per manufacturers’ criteria and reported with 95% confidence intervals. Results: Among 100 TBAD cases, 82% (95% CI: 73.3–88.3%) were suitable for the Castor CMD with 74 configurations. Main causes of exclusion were short landing zones and atypical arch anatomies. With adjunctive procedures, 13 Castor configurations covered all morphologies; 34% could be treated off-the-shelf, and 48% required additional interventions. For the TBE, off-the-shelf suitability was 22%, increasing to 78% with adjunctive procedures (six main bodies, five branches). Conclusions: Both stent grafts are promising for proximal extension in TBAD. Reduced configuration availability necessitates more adjunctive procedures, impacting efficiency and cost. Full article

Background/Objectives: The aim of this study was to evaluate the usefulness of selected predictive parameters obtainable from cardiac multidetector computed tomography for assessing the severity of aortic valve stenosis in patients scheduled for transcatheter aortic valve implantation (TAVI). Methods: A detailed retrospective analysis was performed on 105 patients with a bicuspid aortic valve (BAV), selected from a cohort of 1000 patients with BAV confirmed on ECG-gated CT, and on 105 patients with a tricuspid aortic valve (TAV) matched for sex and age. All patients included in both groups had significant aortic stenosis confirmed on transthoracic echocardiography. Results: Across the entire cohort, a trend toward higher aortic valve calcium scores was observed in patients with bicuspid compared to tricuspid aortic valves (4194.8 ± 2748.7 vs. 3335.0 ± 1618.8), although this difference did not reach statistical significance (p = 0.080). However, sex-stratified analysis showed higher calcium scores in males with BAV than with TAV (5596.8 ± 2936.6 vs. 4061.4 ± 1659.8, p = 0.002), with no significant difference observed among females (p > 0.05). Univariate regression analysis showed that the aortic valve calcium score was the strongest statistically significant predictor of aortic stenosis severity in both groups, with R² = 0.224 for BAV and R² = 0.479 for TAV. In the multiple regression model without interaction terms, the explanatory power increased to R² = 0.280 for BAV and R² = 0.495 for TAV. Conclusions: In patients scheduled for TAVI, linear regression models assess the severity of aortic stenosis more accurately than any individual predictive parameter obtainable from ECG-CT, with the aortic valve Agatston score emerging as the most reliable single CT-derived predictor of stenosis severity in both TAV and BAV subgroups. Full article

Aortic and iliac artery aneurysms are potentially fatal conditions requiring precise timing for intervention. Current guidelines for repair, including those from SVS, ESVS, and ACC/AHA, rely on fixed diameter thresholds primarily derived from Western populations. However, growing evidence shows that both aortic and iliac dimensions vary significantly among racial and ethnic groups. East Asian individuals generally present with smaller baseline vessel diameters and may be at risk of rupture at smaller sizes, while African American and Hispanic populations exhibit distinct remodeling patterns and risk profiles. This narrative review synthesizes the current literature on variations in aortic and iliac artery diameters, aneurysm prevalence, and rupture risk across racial groups. It examines the limitations of universal thresholds for repair, highlights the underrepresentation of non-Caucasian populations in early imaging registries, and introduces alternative, population-specific definitions of aneurysmal disease. Full article

Background/Objectives: Aortic valve therapy increasingly follows a lifetime management concept. As all bioprostheses ultimately degenerate, optimal outcomes rely on the appropriate selection and timing of treatment modality. This study evaluates outcomes of redo surgical aortic valve replacement (redo-SAVR) and valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) in a consecutive, unselected real-world cohort treated for bioprosthetic valve failure (BVF). Methods: A single-center retrospective analysis of all patients undergoing redo-SAVR or ViV-TAVR for BVF between June 2019 and December 2024 was conducted. The primary endpoint was survival at 30 days and at 1, 3, and 5 years; the secondary endpoint was time to reintervention. Cox proportional hazards models were used; proportionality was tested; subgroups were defined by indication and presence of concomitant procedures. Results: Eighty-three patients were included (redo-SAVR n = 42; ViV-TAVR n = 41). All active endocarditis cases were managed surgically. In isolated procedures, 30-day survival was 95.5% after redo-SAVR (100% when excluding endocarditis) and 100% after ViV-TAVR; 5-year survival was 81.3% and 94.1%, respectively (94.4% for isolated redo-SAVR excluding endocarditis). Because hazards were non-proportional and risk sets were sparse beyond 5 years, we fitted a time-split Cox model (0–5 years). In multivariable analysis, endocarditis (HR 4.45, 95% CI 1.16–17.04) and NYHA IV (HR 4.87, 95% CI 0.98–24.17)—not treatment modality—were associated with mortality. Conclusions: In a real-world, all-comers setting, early outcomes for isolated reinterventions were favorable with both pathways. Mortality patterns were case-mix driven—especially by endocarditis and the need for concomitant surgery. Accordingly, ViV-TAVR and redo-SAVR should be viewed not as competing procedures but as complementary, scenario-specific options within a lifetime management strategy. Full article

Background/Objective: Leadless pacemakers (LPs, Micra™, Medtronic) offer a safe alternative to traditional transvenous systems. However, optimal implantation site within the right ventricular septum (RVS) and its effect on long-term pacing threshold stability remains under debate. The aim was to evaluate the relationship between pacing site within the RVS and pacing threshold stability following leadless pacemaker implantation. Methods: We retrospectively analyzed 36 patients who underwent LP implantation at two centers between 2022 and 2023. Patients were classified into two groups based on final device position by fluoroscopy: Group A (mid or upper RVS, n = 8) and Group B (low or apical RVS, n = 28). Pacing threshold, QRS duration, and left ventricular ejection fraction (LVEF) were assessed over 6 months. Results: At the 6-month follow-up, Group A demonstrated significantly lower and more stable pacing thresholds compared to Group B (0.57 ± 0.09 mV vs. 1.55 ± 0.97 mV, p < 0.001). No significant differences were observed in QRS duration or LVEF changes between groups. Echocardiography did not reveal new-onset tricuspid regurgitation. Conclusions: Given the small sample size, particularly in the mid/high septal group, these findings should be interpreted as hypothesis-generating and require confirmation in larger prospective studies. These findings highlight the importance of careful anatomical targeting during LP implantation. Prospective studies incorporating advanced imaging are warranted to confirm these results and evaluate long-term clinical outcomes. Full article

Background: atrial fibrillation (AF) patients with obesity and high thromboembolic risk need oral anticoagulant therapy. Limited data are available on direct oral anticoagulants (DOACs) in this population, and a point-of-care method has been validated to support rapid clinical decisions and to identify on-off plasma concentration thresholds. Methods: This is a monocentric, cross-sectional diagnostic accuracy study on obese AF outpatients referred to Policlinico Umberto I of Rome. Urinary Dipsticks were assessed with separate pads for factor Xa (FXA-i) and thrombin inhibitor (THR-i) and compared to the reference standard of trough and peak plasma concentrations with chromogenic assays/dTT and prespecified plasma thresholds for each DOAC. Study endpoints were the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of DOACs Dipstick compared to plasma concentrations. Sub-analyses according to obesity severity and type of DOAC were performed. Results: 320 paired plasma and urine samples were available from 160 enrolled patients (mean age 73.2 ± 9.1 years). Compared to trough plasma concentrations, DOACs Dipstick showed a sensitivity of 99.24% (mean, 95% confidence interval, CI 95.82–99.98), specificity of 6.89% (0.85–22.76), PPV 82.80% (81.32–84.18), NPV 66.67% (15.79–95.52). On the other hand, compared to peak plasma concentrations, DOACs Dipstick showed a sensitivity of 97.8% (93.7–99.5), specificity of 0% (0.0–15.4), and PPV of 85.9% (85.6–86.2). Urinary Dipstick showed a sensitivity of 99.10% (95.4–100.0), specificity of 4.70% (0.60–16.20) and a PPV and NPV of 74.50% (73.2–75.8) and 66.70 (15.7–95.6), compared to plasma thresholds > 30 ng/mL of FXA-I and THR-I. Sub-analyses showed similar results between FXA-i and THR-i. Conclusions: The urine point-of-care has high sensitivity, acceptable PPV, but low specificity and NPV in AF obese patients and may be useful only in selected clinical scenarios. Full article