Clinical Cardiology

Background Atrial fibrillation (AF) is a significant contributor to ischemic stroke risk and mortality, particularly in aging populations. This study examines mortality trends from ischemic stroke secondary to AF in the U.S. from 1999 to 2020, focusing on demographic and regional disparities. Methods Using data from the CDC WONDER database, this cross‐sectional analysis included individuals aged ≥ 65 years with death certificates indicating ischemic stroke (ICD I63) and AF (ICD I48) as contributing causes. Age‐adjusted mortality rates (AAMR) were calculated, and temporal trends were analyzed using join‐point regression to estimate annual percentage changes (APC). Data were stratified by age, sex, race/ethnicity, urbanization, and geographic regions. Results From 1999 to 2020, ischemic stroke with AF caused 62,443 deaths (AAMR: 6.75/100,000; 95% CI: 6.70–6.80). Mortality rates increased significantly after 2010, peaking between 2014 and 2017 (APC: 31.3 for females, 28.1 for males). Older adults (≥ 85 years) exhibited the highest AAMR (43.2/100,000; 95% CI: 41.6–44.8). Nonmetropolitan areas consistently showed higher mortality compared to metropolitan regions. Demographic disparities were evident, with higher AAMRs in females, Whites, and the Western U.S., though Hispanics had the sharpest APC increase during 2014–2017. Conclusion Mortality rates from ischemic stroke with AF are rising in older adults, with significant demographic and regional disparities. The findings underscore the need for targeted public health strategies to mitigate AF‐related stroke risks and improve healthcare equity.

Background Recent guidelines for acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD) recommend revascularization of non‐culprit lesions following primary percutaneous coronary intervention (PCI). However, the optimal timing for this procedure—whether immediate or staged—remains uncertain. Methods A comprehensive search using PubMed (MEDLINE), Cochrane Central, and Google Scholar was conducted to identify studies comparing clinical outcomes between immediate and staged revascularization approaches in patients with MVD undergoing PCI. A random effects model was used to calculate risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). The primary outcome was 1‐year all‐cause mortality. Results A total of 10 randomized controlled trials (RCTs), comprising 3886 patients (1964 in the immediate revascularization group and 1940 in the staged revascularization group), with a median follow‐up of 12 months, were included in the analysis. No significant difference in the risk of 1‐year mortality was noted between the two approaches. The risk of target vessel revascularization (TVR) at 1‐year follow‐up was significantly lower in the immediate revascularization group compared to the staged revascularization group (RR: 0.64; 95% CI: 0.47–0.86; I²: 0%; p = 0.03). Additionally, the immediate revascularization group had a significantly lower risk of myocardial infarction (MI) at 1‐year follow‐up than the staged approach (RR: 0.57; 95% CI: 0.37–0.88; I²: 10%; p = 0.01). Conclusion This meta‐analysis suggests that immediate revascularization is associated with a significantly lower risk of TVR and MI at 1‐year compared to staged revascularization.

Background To assess in‐hospital outcomes in patients undergoing urgent versus non‐urgent transcatheter mitral edge‐to‐edge repair (TEER). Methods We used the NIS database 2016−2019 to include admissions who underwent TEER. Inverse probability of treatment weighting (IPTW) was used to compare urgent versus non‐urgent groups. Results A total of 29 730 weighted admissions were included, of whom 21.6% were urgent admissions. Urgent admissions had a higher risk of in‐hospital mortality (risk ratio [RR] 3.67, 95% confidence interval [CI] 2.39−5.62), cardiogenic shock (RR 4.95, 95% CI 3.73−6.57), intra‐aortic balloon pump (RR 3.97, 95% CI 2.53−6.23), percutaneous ventricular assist device (RR 17.24, 95% CI 6.37−46.66), mechanical ventilation (RR 3.79, 95% CI 2.80−5.11), acute stroke (RR 2.56, 95% CI 1.32−4.97), in‐hospital cardiac arrest (RR 2.25, 95% CI 1.08−4.69), major bleeding (RR 5.18, 95% CI 2.97−9.06), increased length of stay (6 vs. 2 days, p < 0.001), and higher total costs ($229 160 vs.$164 653, p < 0.01) compared to non‐urgent admissions. There was no difference between both groups for renal replacement therapy and pericardial complication. Conclusion Our results suggest that urgent TEER implantation was associated with an increased risk of in‐hospital death and other short‐term complications.

Background Left atrium (LA) is an integral component of left heart remodeling, reflecting hemodynamics and ventricular status. It remains uncertain whether left atrial diameter (LAD) can be utilized for predicting and evaluating the occurrence of heart failure (HF) in middle‐aged and elderly individuals. Methods The study aimed to explore the correlation between LAD and HF in middle‐aged and elderly individuals, elucidating the timing of occurrence HF in relation to LAD. The retrospective‐prospective study investigated 4025 patients who underwent echocardiography at Zhongshan Hospital's Cardiovascular Department from January 2015 to December 2017. Patients were continuously monitored for HF until January 31, 2024. Cox regression analyses related baseline LAD to HF incidence, adjusted for known risk factors. Results A total of 4025 individuals (mean age: 55 years, 45.29% male) were studied, spanning ages 45–91. Fifty‐one developed HF during a median follow‐up of 4.36 years. Cox regression model demonstrated the association between HF and LAD (HR = 5.721, 95% CI 3.768–8.687, p < 0.001) even after adjusting for covariates (age, weight, eGFR, HDL‐C, lymphocyte count, systolic blood pressure, FPG, HbA1C, waist circumference, hip circumference, valvular disease history, atrial fibrillation history). Conclusions The link between LAD and future HF occurrence risk among middle‐aged and older adults shows a dose–response pattern. This relationship persists post‐adjustment for HF‐related factors, highlighting the predictive value of LAD in forecasting HF incidence.

Background and Objective Atrial fibrillation (AF), a common arrhythmic disorder, is increasing in prevalence annually and has become an important public health problem that jeopardizes human health. Metabolites are small molecules produced in the process of metabolic reactions, and they can affect the risk of disease and possibly become targets for disease management. Methods We used two‐sample and bidirectional MR to explore potential causal associations between lipid groups and AF. Two‐step MR analysis was used to explore whether plasma metabolites mediated a causal effect from lipidomes to AF. Result We assessed the effect of 179 lipids on AF using IVW models and observed that 8 lipids were associated significantly with AF (p < 0.05). Likewise, we assessed the effect of 1091 metabolites and 309 metabolite ratios on AF and observed that 22 metabolites were significantly associated with AF (p < 0.05). We analyzed the blood metabolites above as mediators in the pathway from the lipidomes above to AF. We found that levels. Of lipid sterol ester (27:1/18:3) were associated with lower homoarginine levels, and lower metabolite homoarginine levels were associated with an increased risk of AF. Conclusion Our study identified a causal relationship between plasma liposomes and AF, and additionally found that the plasma metabolite homoarginine levels can act as a mediator of the lipid sterol ester in its effect on AF.

Objectives To elucidating the linkage between obesity‐associated body fat indicators and atrial fibrillation (AF) using Mendelian Randomization (MR) and mediation analysis. Methods The study utilized three independent genome‐wide association study (GWAS) datasets, with containing over 450 000 individuals each, to represent body fat indicators as the exposure variable. Additionally, two summary genetic datasets of AF were utilized as the clinical outcome. Single nucleotide polymorphisms (SNPs) with p‐values less than 5 × 10⁻¹⁰ were identified as instrumental variables (IVs) for MR analysis. The primary analysis method employed was the inverse‐variance weighting (IVW) model, supplemented by three additional models: MR‐Egger regression, weighted median, and maximum likelihood. Sensitivity analysis was conducted, encompassing tests for heterogeneity and horizontal pleiotropy, utilizing Cochran's Q, MR‐Egger intercept, and MR‐PRESSO tests to validate the reliability of the findings. Furthermore, a mediation analysis was conducted to explore potential mediators involved in the pathogenesis of AF. Results The IVW model demonstrated that per 1‐SD increase in body fat indicators (body fat percentage, whole body fat mass, and trunk fat mass) is associated with an elevated risk of AF, with values of 63.1%, 55.0%, and 55.8% respectively. All three supplementary models arrived comparable conclusions with IVW model. The sensitivity analysis confirmed the absence of horizontal pleiotropy, thereby validating the reliability of the findings. Additionally, the mediation study indicates that hypertension and sleep apnea syndrome are identified as significant mediators during the pathogenesis of AF. Conclusions The study reveals that individuals with a higher body fat percentage tend to exhibit a heightened genetic predisposition for susceptibility to AF. Meanwhile, hypertension and sleep apnea syndrome have been identified as key mediators contributing to the pathogenesis of AF.

Background Arrhythmias are a significant cause of cardiovascular mortality in the U.S. This study examines trends in arrhythmia‐related mortality from 1999 to 2023, focusing on gender, racial, regional disparities, and specific arrhythmic conditions. Objective To analyze trends and disparities in arrhythmia‐related mortality among U.S. adults aged ≥ 35 years from 1999 to 2023, with a focus on the impact of sex, race, geographic location, and urbanization. Methods We analyzed mortality data from the CDC WONDER database, focusing on deaths where arrhythmias were a contributing cause. Age‐adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, state, and region. The annual percentage change (APC) and average annual percentage change (AAPC) were estimated using Joinpoint regression. Results A total of 5,050,271 arrhythmia‐related deaths were recorded, with the overall AAMR increasing from 111.4 in 1999 to 137.3 in 2023. Mortality rates declined significantly from 1999 to 2009 (APC: −1.04%; p = 0.003) but rose sharply from 2009 to 2018 (APC: 1.69%; p = 0.003), peaking in 2021 during the COVID‐19 pandemic (APC: 8.63%; p < 0.001). A subsequent decline was observed from 2021 to 2023 (APC: −3.91%; p = 0.044). Males consistently exhibited higher AAMRs than females (137.2 vs. 95.3), as did non‐Hispanic White individuals compared to other racial groups. Geographic disparities revealed higher mortality rates in Nonmetropolitan areas and the Midwest, with the highest AAMR observed in Oregon and the lowest in Hawaii. Conclusion Despite an overall decline in arrhythmia‐related mortality, recent increases, especially in West Virginia and among certain racial groups, highlight the need for targeted public health interventions.

Background Heart failure as an advanced cardiac disease has a high incidence and prevalence in all societies nowadays. Many drugs and treatment methods have been discovered for improving heart failure patients' conditions till now in this way melatonin therapy is one of the less‐known methods rarely used by clinicians. Methods To investigate the positive effect of melatonin on heart failure development, we conducted a systematic review and meta‐analysis by searching valid databases with keywords based on the protocol. Based on the eligible criteria, four articles were selected for data synthesis and analysis after scanning the title and/or abstract and reading full‐text. Results As a result of analysis, increasing ejection fraction (Mean difference: 2.39 [−1.82, 6.59] p = 0.27), NYHA (New York Heart Association Functional Class) (Odds ratio: 4.84 [1.00, 23.44] p = 0.05), and significant elevation of quality of life (Mean difference: −5.95 [−9.54, −2.35] p = 0.001) were observed. As the effect of melatonin, fatigue, and NT‐Pro BNP were reduced but on the contrary sleep quality, appetite, and FMD (Flow‐Mediated Dilation) significantly increased. Conclusion Thus, melatonin, by increasing psychologic parameters and cardiac potency, could be advised as a novel drug for treatment and palliating heart failure patients.

Introduction Acute heart failure (AHF) is associated with a dismal prognosis that is even poorer than the majority of cancer types. Therefore, clinical indicators that can aid in determining the prognosis of heart failure are of interest. Multiple risk prediction tools with varying sensitivity and specificities have been introduced before. In the current study, we aimed to evaluate whether the HALP score could accurately predict in‐hospital mortality in patients with AHF. Methods We evaluated the medical records of a total of 153 patients admitted to our institution between August 2016–May 2018 for acute heart failure. The patients were divided into two groups: Group 1 (patients who died during hospital admission) and Group 2 (patients who were discharged from the hospital). The HALP score was calculated as: hemoglobin (g/L) x albumin (g/L) x lymphocytes (/L)/platelets (/L) for each patient. The two groups were compared in terms of HALP scores. The receiver operator characteristic (ROC) curve was utilized to assess the predictive performance of HALP on in‐hospital mortality in AHF. Results Patients who died during admission had lower HALP scores compared with the patients who were discharged uneventfully. A ROC curve analysis was performed to predict the optimal cut‐off value of the HALP score. The area under the curve (AUC), sensitivity, specificity, and the cut‐off value were 0.650, 43%, 57%, 21,5 respectively (p = 0.014). Conclusion Despite all evolving treatment modalities, heart failure‐related mortality rates remain high. Prompt recognition of patients with an unfavorable prognosis is vital for the timely implementation of disease‐modifying therapeutic interventions. The HALP score, being a readily calculable tool, serves as an effective means to pinpoint individuals at a heightened risk of in‐hospital mortality. We believe that the HALP score holds promise as a practical tool for predicting in‐mortality among patients admitted for AHF.

Background Although some guidelines recommend Renal denervation (RDN) as an alternative to anti‐HTN medications, there are concerns about its efficacy and safety. We aimed to evaluate the benefits and harms of RDN in a systematic review and meta‐analysis of sham‐controlled randomized clinical trials (RCT). Methods Databases were searched until September 10th, 2024, to identify RCTs evaluating RDN for treating URH versus sham control. The primary outcomes were the change in office and ambulatory 24‐h systolic (SBP) and diastolic blood pressure (DBP). Secondary outcomes were changes in daytime and nighttime SBP and DBP, home BP, number of anti‐HTN drugs, and related complications. Mean differences (MD) and relative risks (RR) described the effects of RDN on BP and complications, respectively, using random effects meta‐analyses. GRADE methodology was used to assess the certainty of evidence (COE). Results We found 16 included sham‐controlled RCTs [RDN (n = 1594) vs. sham (n = 1225)]. RDN significantly reduced office SBP (MD −4.26 mmHg, 95% CI: −5.68 to −2.84), 24 h ambulatory SBP (MD −2.63 mmHg), office DBP (MD −2.15 mmHg), 24‐h ambulatory DBP (MD −1.27 mmHg), and daytime SBP and DBP (MD −3.29 and 2.97 mmHg), compared to the sham. The rate of severe complications was low in both groups (0%–2%). The heterogeneity was high among most indices, and CoE was very low for most outcomes. Conclusion RDN significantly reduced several SBP and DBP outcomes versus sham without significantly increasing complications. This makes RDN a potentially effective alternative to medications in URH.

Background Randomized clinical trials demonstrated similar efficacy and improved safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation (AF). Long‐term data in routine clinical practice are needed. Hypothesis Patients with AF receiving edoxaban at baseline continue to have low annualized effectiveness and safety event rates in the second year of follow‐up, with regional variations observed. Methods The Global ETNA‐AF program is a prospective, noninterventional study of patients with AF receiving edoxaban. Patient characteristics and annualized clinical event rates were assessed overall and by region across the 2‐year follow‐up. Annualized event rates of bleeding and thromboembolic events were assessed within the first year and conditionally in patients who were event‐free up to 12 months in the second year. Results This analysis comprised 26 805 patients from Europe (n = 13 164), Japan (n = 10 342), and non‐Japanese Asian regions (n = 3299). Patients from Europe had the highest burden of comorbidities. The annualized event rates for major bleeding, any stroke, all‐cause death, and cardiovascular death varied by region. The global annualized event rates in the first and second year were 1.31%/year and 0.86%/year for major bleeding, 1.06%/year and 0.65%/year for any stroke, 0.84%/year and 0.73%/year for cardiovascular death, and 3.05%/year and 3.18%/year for all‐cause death. Conclusion Annualized event rates for any stroke and major bleeding remained low through 2‐year follow‐up for patients with AF receiving edoxaban at baseline. Differences in annualized event rates for all‐cause and cardiovascular mortality between Europe, Japan, and non‐Japanese Asian regions may reflect variations in baseline characteristics. Trial Registration Europe, NCT02944019; Japan, UMIN000017011; Korea/Taiwan, NCT02951039; Hong Kong, NCT03247582; and Thailand, NCT03247569.

Background Postural orthostatic tachycardia syndrome (POTS) is characterized by symptoms of orthostatic intolerance and is frequently observed in post‐COVID conditions. Objectives We conducted controlled, prospective, and randomized clinical trials to explore the potential therapeutic benefits of low‐level tragus stimulation (LL‐TS) in patients with POTS following COVID‐19 infection. Methods This study enrolled 57 participants with confirmed post‐acute COVID‐19 who had been diagnosed with POTS. The ear clip was attached to the right tragus of the patients for stimulation (20 Hz with a 1‐ms duration) or sham stimulation. They were divided into two groups: the sham LL‐TS group (sham stimulation, n = 26) and the LL‐TS group (stimulation for 1 month, n = 31). LL‐TS was performed 1 h twice daily for 1 month. Postural tachycardia was evaluated at baseline, 1‐month visit, and 1‐year visit. Heart rate variability (HRV) and plasma neuropeptide Y (NPY) were evaluated at respective time points. Results The mean age of participants was 31.9 ± 7.2 years (61.4% female). LL‐TS significantly attenuated the increase in heart rate from supine to a 10‐min stand, as well as the average and maximum heart rates after 1 month of treatment. LL‐TS also significantly reduced NPY levels. In addition, LL‐TS significantly increased the high frequency (HF), but decreased the low frequency (LF) and LF/HF ratio during the postural test (all p < 0.01). These effects persisted during the 1‐year follow‐up. Conclusion LL‐TS may be a promising therapeutic approach for attenuating autonomic imbalance in patients with POTS following COVID‐19 infection.

Background Disparities in invasive cardiovascular care and outcomes in rural and urban hospitals across the United States have been reported. However, studies investigating disparities regarding leadless pacemaker outcomes and complications based on hospital location are lacking. Objective To evaluate differences in outcomes and complications related to leadless pacemaker implantations among rural and urban hospitals. Methods The National Inpatient Sample was used to identify patients who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study endpoints assessed included procedural complications and inpatient outcomes of leadless pacemaker implantations among rural and urban hospitals. Results From 2016 to 2020, there were a total of 28 340 and 665 leadless pacemaker implantations in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with notable exceptions of higher rates of coagulopathies (13.2% vs. 6.8%, p < 0.001) and peripheral vascular disorders (10.4% vs. 4.5%, p < 0.001) among urban patients. After multivariable adjustment for confounding variables, leadless pacemaker placements occurring in rural hospitals had lower odds of major complications (aOR 0.59, 95% CI 0.41–0.86), but increased odds of inpatient mortality (aOR 1.70, 95% CI 1.21–2.40). Overall, rural leadless pacemaker recipients experienced lower rates of discharge to home, as well as lower costs and length of stay. Conclusions A majority of leadless pacemaker implantations occurred in urban hospitals in the United States. Important differences in outcomes were described based on urban and rural hospital location. Further investigation and policy changes are encouraged to promote improved cardiovascular care and outcomes in rural residents.

Background Transcatheter aortic valve replacement (TAVR) has emerged as a well‐established treatment option for patients with aortic valve stenosis and/or regurgitation. However, risk stratification in patients indicated for TAVR remains challenging. This study aimed to evaluate the predictive value of the platelet‐albumin‐bilirubin (PALBI) score on post‐TAVR mortality. Methods A total number of 812 patients with aortic stenosis and/or aortic regurgitation who underwent TAVR were consecutively enrolled in this study. PALBI score was calculated based on preoperative baseline bilirubin levels, albumin levels, and platelet counts. Patients were categorized into two groups according to the median PALBI score. Results The median age of the study population at baseline was 74 (IQR: 69.00–80.00) years, and 58.6% were male. During the whole follow‐up period, all‐cause death was observed in 60 (7.4%) patients and 30 (3.7%) patients died due to cardiovascular events. According to multivariate analysis, a high PALBI score was independently associated with all‐cause mortality (HR = 2.679, 95% CI: 1.456–4.930, p = 0.002) and cardiovascular mortality (HR = 2.785, 95% CI: 1.133–6.849, p = 0.026). ROC curve analysis showed a significant predictive value of the PALBI score for all‐cause mortality (AUC = 0.633, 95% CI: 0.563–0.704, p = 0.001). Furthermore, the PALBI score strengthens the predictive value of the Society of Thoracic Surgeons (STS) score for all‐cause death after TAVR (STS score vs. PALBI score + STS score: AUC: 0.742 vs. 0.768). Conclusion A high PALBI score was associated with increased all‐cause and cardiovascular mortality in patients after TAVR. PALBI score can further enhance the predictive potential of STS score for all‐cause mortality.

Objective This study aims to evaluate the clinical efficacy and safety of ultrasound‐guided percutaneous septal precision chemical ablation in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Methods From December 2020 to July 2024, 27 patients with HOCM without large target septal branches (diffuse multiple branches, all less than 1 mm in diameter) were enrolled and underwent ultrasound‐guided percutaneous septal chemical ablation. Intraoperative left ventricular outflow tract gradient (LVOTG), postoperative cardiac troponin I (cTnI), complications, and changes in the 36‐Item Short Form Survey (SF‐36) score, New York Heart Association (NYHA) functional classification and echocardiography parameters in 1 year post‐PTSMA were monitored and analyzed. Results Immediate postoperative LVOTG values monitored by catheter and echocardiography were both significantly decreased (both p < 0.05) in the 27 patients, whereas the cTnI level was increased after PTSMA treatment (p < 0.05). One patient developed transient complete right bundle branch block during the procedure. At the 1‐year follow‐up, these patients showed significantly increased scores in all the eight domains of the SF‐36 scale, and markedly improvement in echocardiography‐based LVOTG value (p < 0.05) and NYHA functional classification (p < 0.05). However, no significant change were observed in the mean interventricular septal thickness (IVSTh) and left ventricular ejection fraction (LVEF) before and after operation (p > 0.05). Conclusion Ultrasound‐guided precision PTSMA with gelatin sponge is a safe and effective treatment approach for HOCM patients, which can reduce the left ventricular outflow tract obstruction and greatly improve the life quality of the patients.

Introduction Arrhythmia‐induced cardiomyopathy (AIC) is an underrecognized condition resulting in left ventricular systolic dysfunction (LVSD) that is primarily caused by atrial fibrillation (AFib). The relationship between AIC, right ventricular (RV) function, and quality of life (QoL) has not been well studied. Methods We performed a post‐hoc analysis of our AIC trial in which we prospectively screened for patients with tachyarrhythmia and newly diagnosed, otherwise unexplained LVSD. Following rhythm restoration, patients were followed up at 2, 4, and 6 months. Only patients with persistent sinus rhythm were analyzed. RV function was assessed via echocardiography (tricuspid annular plane systolic excursion [TASPE] and fractional area change [FAC]) and QoL by the Minnesota Living with Heart Failure Questionnaire. Results Of a total of 50 patients recovering from LVSD, 41 were diagnosed with AIC and 9 with non‐AIC. Initially, RV function was reduced in the AIC group and recovered after rhythm restoration, whereas no relevant changes were noted in the non‐AIC group. QoL was reduced in both groups and also improved after rhythm restoration. Regression analysis identified low TAPSE as a predictive parameter for AIC diagnosis and worse QoL in AIC patients. Conclusion We demonstrated that RV function and QoL are impaired in patients with AIC. Six months after rhythm restoration, TAPSE may serve as an early indicator of AIC while also correlating with QoL. This underscores the importance of detailed echocardiographic evaluation with a focus on RV function in patients with concomitant tachyarrhythmia and LVSD.

Background Systemic inflammation plays a central role in atrial fibrillation (AF). The neutrophil‐to‐lymphocyte ratio (NLR) is a simple hematological index that has been shown to be associated with prognosis in different pathologies. Hypothesis The NLR is associated with an increased risk of adverse events in patients with AF. Methods We included a prospective cohort of AF patients who started vitamin K antagonists (VKAs) therapy between July 2016 and June 2018. NLR was assessed at baseline and classified into three categories: low (< 3), moderate (3–5), and high (> 5). During a 2‐year follow‐up period, all cardiovascular deaths, all‐cause deaths, and net clinical outcomes (NCO; either ischemic stroke/transient ischemic attack, major bleeding or all‐cause death), were recorded. Results A total of 1050 patients were included (51.4% women; median age 77 years). NLR was available in 936 patients: 507 (54.2%) had low NLR (< 3), 239 (25.5%) had moderate NLR (3–5), and 190 (20.3%) had high NLR (> 5). The primary endpoint was significantly increased in the high NLR category (p = 0.002 for cardiovascular death; p < 0.001 for all‐cause mortality, and p < 0.001 for NCO), with higher IRRs (all p < 0.001). Multivariate Cox regression analyses showed that high NLR was independently associated with an increased risk of cardiovascular death (aHR: 2.02; 95% CI: 1.04–3.92), all‐cause mortality (aHR: 2.51; 95% CI: 1.58–3.97), and NCO (aHR: 1.99; 95% CI: 1.37–2.87), compared to low NLR. Conclusions In this prospective AF cohort receiving VKAs, elevated NLR was significantly associated with an increased risk of adverse clinical outcomes. NLR has independent prognostic value beyond other classical risk factors.

Background The rapid assessment of the conditions is crucial for the prognosis of atrial fibrillation (AF) patients admitted to the emergency department (ED). We aim to derive and validate a more accurate and simplified scoring model to optimize the triage of AF patients in the ED. Materials and Methods We conducted a retrospective study using data from the Medical Information Mart for Intensive Care (MIMIC‐IV) database and developed scoring models employing the Random Forest algorithm. The area under the receiver operating characteristic (ROC) curve (AUC) was used to measure the performance of the prediction for intensive care unit (ICU) stay, and the death likelihood within 3, 7, and 30 days following the ED admission. Results The study included 30 366 AF patients, randomly divided into training, validation, and testing cohorts at a 7:1:2 ratio. The training set consisted of 21 257 patients, the validation set included 3036 patients, and the remaining 6073 patients were classified as the validation set. Among the cohorts, 9594 patients (32%) required ICU transfers, with mortality rates of 1% at 3 days, 3% at 7 days, and 6% at 30 days. In the testing set, the scoring models demonstrated strong discriminative ability with AUCs of 0.724 for ICU stay, 0.782 for 3‐day mortality, 0.755 for 7‐day mortality, and 0.767 for 30‐day mortality. Conclusion We derived and validated novel simplified scoring models with good discriminative performance to predict the likelihood of ICU stay, 3‐day, 7‐day, and 30‐day death in AF patients after ED admission.

Aims Approximately 10% of patients with myocardial infarction present with non‐obstructive coronary arteries (MINOCA), whose characteristics differ from those with obstructive coronary lesions (MICAD). Inflammation plays a key role in myocardial infarction. This study aims to develop a biomarker‐based index for accurate differentiation between MINOCA and MICAD. Methods A prospective, observational cohort study including 111 patients admitted for myocardial infarction: 46 with MINOCA and 65 with MICAD. Blood samples were collected within the first 24 h to measure high‐sensitivity C‐reactive protein, interleukin‐6, asymmetric dimethylarginine, and peak high‐sensitivity troponin T. The association of these biomarkers with MICAD risk was analyzed using logistic regression. Scoring systems were developed using optimization algorithms to predict the diagnosis before coronary angiography, applied to both individual biomarkers and a combined index. Results Patients had a mean age of 67 years (SD 13.3), with a male predominance (68.5%). Higher levels of IL‐6 and high‐sensitivity troponin T were significantly associated with increased MICAD risk (OR: 1.58; 95% CI: 1.01–2.46, and OR: 2.27; 95% CI: 1.61–3.26, respectively). As score increases, interleukin‐6 and high‐sensitivity troponin T increase the likelihood of MICAD classification, while higher asymmetric dimethylarginine levels reduce it. Each one‐point increase in the combined index multiplies MICAD risk by six (OR:6.16, 95%CI: 2.72–13.95; p < 0.001). While individual indexes improved the diagnostic performance of biomarkers, the combined index demonstrated superior accuracy (AUC: 0.918). Conclusions A biomarker‐based scoring system was developed, achieving superior discriminatory capacity for differentiating MINOCA from MICAD compared to the individual analysis of biomarkers in absolute values or independent indexes.

Background In the aftermath of the Covid19 pandemic and lockdowns, there has been a growing population awaiting transthoracic echocardiograms for potential valvular heart disease. Conducting comprehensive echocardiograms for all individuals may no longer be practical, leading to substantial delays in obtaining the necessary scans. This paper explores an alternative approach, suggesting the consideration of dedicated and shorter scans specifically for patients suspected of having valvular heart disease. Hypothesis To address the increasing waiting times and improve heart valve disease detection, the British Heart Valve Society recommends a tiered approach to echocardiograms. Methods This approach includes basic/level 1, focused, minimum standard, and disease‐specific scans. Urgency recommendations vary, with individuals experiencing exertional chest pain or pre‐syncope requiring prompt scanning within 2 weeks, ideally at a valve clinic. Results Patients without known valve disease but with a murmur and stable breathlessness should be scanned as soon as possible, within a maximum of 6 weeks, balancing local demand and capacity. For those with an asymptomatic murmur and no prior scan, a basic/level 1 study is recommended to triage the necessity for a minimum standard study. Emphasizing appropriate triage for all requests, the statement guides decisions on the necessity for echocardiography, urgency level, and the required scan type. Conclusion This practical Consensus Statement from the British Heart Valve Society aims to support appropriate shorter transthoracic echocardiography for patients referred for suspected valvular heart disease. The goal is to enhance capacity in a secure manner, thereby minimizing the risks associated with delays in obtaining timely scans.

Background Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has emerged as a novel therapeutic option for the management of patients with diabetes, chronic kidney disease, or heart failure. We seek to summarize the evidence on the drug's effectiveness regarding cardiovascular (CV) outcomes. Methods We conducted a literature search of Pubmed, Cochrane CENTRAL, Embase, and ClinicalTrials.gov from inception to September 2024. Trials exploring the effects of finerenone on CV outcomes were extracted and analyzed. The results of pooled analyses were presented as risk ratios (RRs) with 95% confidence intervals (CIs). Results A total of eight trials, incorporating 21 200 patients, were included. The pooled analysis demonstrated a significant reduction in all‐cause death (RR 0.92, 95% CI: 0.85–0.99), major adverse CV events (RR 0.85, 95% CI: 0.81–0.90), heart failure‐related hospitalizations or unplanned hospital visits (RR 0.82, 95% CI: 0.76–0.87) with finerenone administration compared to control. Finerenone use was associated with a trend of reduced risk of CV death without reaching statistical significance (RR 0.90, 95% CI: 0.81–1.00). The risk of myocardial infarction (RR 0.91, 95% CI: 0.74–1.12), adverse events (RR 0.96, 95% CI: 0.89–1.03), adverse events leading to discontinuation (RR 1.06, 95% CI: 0.96–1.17) remained comparable across both groups. However, an increased risk of hyperkalemia (RR 2.07, 95% CI: 1.88–2.27) was observed with finerenone therapy compared to the control group. Conclusion Finerenone administration was associated with improved CV outcomes in the CV‐renmetabolic conditions compared to the control group.