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Background: The triglyceride-glucose (TyG) index is a surrogate indicator of insulin resistance. Therefore, we aimed to determine the association between TyG index and heart failure (HF) with preserved ejection fraction (HFpEF) in patients with coronary heart disease (CHD) and to explore whether such associations would be modified by different metabolic states. Methods: Among 107,301 CHD patients, 62,794 were included to analyze the relationship between the TyG index and HF. Among them, 8,606 patients who had undergone echocardiography were included to identify different types of HF, including HF with reduced ejection fraction (HFrEF), HF with intermediate-range ejection fraction (HFmrEF), and HFpEF. Among them, 1896 patients were diagnosed with HFpEF. Logistic regression was used to analyze the relationship between the TyG index and HFpEF in CHD patients. In addition, the association between TyG index and HFpEF according to sex, age, blood lipids, and blood pressure was assessed. Results: A baseline analysis of CHD patients divided into four groups according to the tertile level of the TyG index showed significant differences in the related parameters between the groups. In the multi-adjusted models, the TyG index was significantly associated with the risk of HFpEF (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 1.09–1.25). After adjustment for multivariates, TyG index levels for T2 (OR: 1.33; 95% CI: 1.16–1.52) and T3 (OR: 1.52; 95% CI: 1.32–1.74) were associated with increased OR in HFpEF. In addition, the TyG index of CHD patients was significantly associated with HFpEF in older adults aged > 60 years (OR: 1.20; 95% CI: 1.11–1.29), hypertension (OR: 1.27; 95% CI: 1.17–1.37), and dyslipidemia (OR: 1.15; 95% CI: 1.08–1.24). Moreover, the OR (OR: 1.23; 95% CI: 1.11–1.36) in women is higher than in men (OR: 1.17; 95% CI: 1.02–1.22, indicating a stronger association between TyG index and HFpEF in women. Conclusions: Our findings demonstrated a significant association between TyG index and HFpEF in CHD patients. Furthermore, TyG index was independently associated with HFpEF in hypertension, dyslipidemia, and older patients (aged > 60 years). In addition, the association between the TyG index and HFpEF in CHD patients differed according to sex. [ABSTRACT FROM AUTHOR]

BACKGROUND: Whether transcatheter mitral-valve repair improves outcomes in patients with heart defailure and functional mitral regurgitation is uncertain. METHODS: We conducted a randomized, controlled trial involving patients with heart failure and moderate to severe functional mitral regurgitation from 30 sites in nine countries. The patients were assigned in a 1:1 ratio to either transcatheter mitral-valve repair and guideline-recommended medical therapy (device group) or medical therapy alone (control group). The three primary end points were the rate of the composite of first or recurrent hospitalization for heart failure or cardiovascular death during 24 months; the rate of first or recurrent hospitalization for heart failure during 24 months; and the change from baseline to 12 months in the score on the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS; scores range from 0 to 100, with higher scores indicating better health status). RESULTS: A total of 505 patients underwent randomization: 250 were assigned to the device group and 255 to the control group. At 24 months, the rate of first or recurrent hospitalization for heart failure or cardiovascular death was 3ZO events per 100 patient-years in the device group and 58.9 events per 100 patient-years in the control group (rate ratio, 0.64; 95% confidence interval [CI], 0.48 to 0.85; P=0.002). The rate of first or recurrent hospitalization for heart failure was 26.9 events per 100 patient-years in the device group and 46.6 events per 100 patient-years in the control group (rate ratio, 0.59; 95% CI, 0.42 to 0.82; P=0.002). The KCCQ-OS score increased by a mean (iSD) of 21.6126.9 points in the device group and 8.01:24.5 points in the control group (mean difference, 10.9 points; 95% CI, 6.8 to 15.0; P<0.001). Device-specific safety events occurred in 4 patients (1.6°/o). CONCLUSIONS: Among patients with heart failure with moderate to severe functional mitral regurgitation who received medical therapy, the addition of transcatheter mitral-valve repair led to a lower rate of first or recurrent hospitalization for heart failure or cardiovascular death and a lower rate of first or recurrent hospitalization for heart failure at 24 months and better health status at 12 months than medical therapy alone. [ABSTRACT FROM AUTHOR]

This paper presents a methodological insight in using the Interpretative Phenomenological Analysis (IPA) method in a study of young adults with chronic congenital heart disease (ACHD). It is not well understood how young adults with CHD make sense of their lives beyond the existing quality of life measures. Exploring this research topic guided by the three principles of IPA: (a) phenomenology, (b) hermeneutics, and (c) idiography, we found our study elucidated one's sense making growing up with a pediatric chronicity; particularly the role of researcher 'as instrument' for its centrality as an authentic representation of the lived 'CHD' experience unfolded. Decisions relevant to data collection and the analytical phase of the research are presented. Insight further involves discussing methodological integrity and the ethical considerations associated with implementing IPA as the foundational framework. We believe using IPA in a cohort of adult congenital heart disease patients provided an in-depth exploration into the meaningfulness of these individuals' lives. Our study highlights the value of using hermeneutics to advance the growing body of ACHD evidence and other disease-related research studies. Moreover, using the IPA approach contributes to methodological development by promoting interdisciplinary scholarship that disseminates practical, real-world knowledge. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of cardiac rehabilitation prescriptions on medication complications, Endothelin 1 (ET-1), and Wall Motion Score Index (WMSI) in elderly patients with coronary heart disease. Methods: 98 elderly patients with coronary heart disease admitted to the Department of Cardiology of a hospital from January 2020 to June 2022 are selected. According to the red and blue ball method, 98 research subjects are divided into a control group and an observation group. The control group receives routine treatment and exercise intervention, while the observation group receives cardiac rehabilitation prescriptions. After a follow-up of 6 months, the incidence of medication complications between the two groups is compared. The changes in ET-1 and WMSI levels are compared before treatment, 1 month, 3 months, and 6 months after treatment. Results: The two groups had no significant difference in ET-1 and WMSI levels before intervention. After intervention, both groups showed significant reductions in ET-1 and WMSI compared with baseline. The ET-1 of the observation group decreased significantly faster than the control group after 1 month, 3 months, and 6 months of intervention. The WMSI decreased more significantly at 6 months. The repeated measurement variance showed that there was a significant difference in the trend of ET-1 changes between the two groups, while the difference between the WMSI groups was not significant. The incidence of medication complications in the observation group was 10.20%, significantly lower than the 26.53% in the control group. Conclusion: Cardiac rehabilitation prescriptions can reduce the incidence of medication complications in elderly patients with coronary heart disease. It can reduce ET-1 levels faster, improve myocardial motor function, which has better myocardial function and medication safety than conventional treatment. [ABSTRACT FROM AUTHOR]

Background: Heart disease patients necessitate precise monitoring to ensure the safety and efficacy of their physical activities when managing conditions such as hypertension or heart failure. This study, therefore, aimed to evaluate the accuracy of photoplethysmography (PPG)-based monitoring of pulse rate (PR), interbeat-intervals (IB-I) and oxygen saturation (SpO2) during high-intensity interval training (HIIT). Methods: Between January and March 2024, healthy volunteers were subjected to a cycling HIIT workout with bike resistance increments to evaluate performance within different heart rate ranges. To determine the accuracy of PPG-based measurements for PR, IB-I, and SpO2 using the CardioWatch 287–2 (Corsano Health, the Netherlands), measurements throughout these ranges were compared to paired reference values from the Covidien Nellcor pulse oximeter (PM10N) and Vivalink's wearable ECG patch monitor. Subgroups were defined for Fitzpatrick skin type and gender. Results: In total, 35 healthy individuals participated, resulting in 7183 paired measurements for PR, 22,713 for IB-I, and 41,817 for SpO2. The PR algorithm showed an average root mean square (Arms) of 2.51 beats per minute (bpm), bias at 0.05 bpm, and limits of agreement (LoA) from −4.87 to 4.97 bpm. The IB-I algorithm achieved an Arms of 23.00 ms, a bias of 1.00 ms, and LoA from −43.82 to 46.21 ms. Finally, the SpO2 algorithm showed an Arms of 1.28%, a bias of 0.13%, and LoA from −2.37% to 2.62%. The results were consistent across different demographic subgroups. Conclusions: This study demonstrates that the PPG-based CardioWatch 287–2 can accurately monitor PR, IB-I, and SpO2 during HIIT. However, further research is recommended to evaluate the algorithm's performance in heart disease patients during demanding exercise. [ABSTRACT FROM AUTHOR]

Introduction and Purpose: Cardiac rehabilitation (CR) is a critical component in the management of patients recovering from cardiac events and procedures. This review aims to critically analyze the clinical effectiveness of exercise-based interventions within cardiac rehabilitation programs. State of Knowledge: Recent studies have highlighted the role of structured exercise programs in improving cardiovascular health metrics, such as blood pressure, lipid profile, and cardiac function. Exercise-based CR has shown significant benefits in reducing mortality, improving exercise capacity, and enhancing the quality of life in cardiac patients. Challenges persist, however, in the adoption of uniform protocols and the integration of these programs into standard care. The review discusses various types of exercises included in CR, such as aerobic, resistance, and flexibility training, and evaluates their effectiveness based on recent clinical trials and cohort studies. Summary: Exercise-based cardiac rehabilitation is an effective strategy for enhancing cardiac health and patient recovery post-cardiac event. It is imperative that healthcare providers advocate for and integrate comprehensive exercise programs into the rehabilitation process. Future research should focus on optimizing exercise protocols and expanding access to these vital services to improve outcomes across diverse patient populations. This review underscores the importance of exercise therapy in cardiac rehabilitation and advocates for its broader implementation within healthcare systems. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of esketamine hydrochloride in combination with ultrasound-guided transverse thoracic muscle plane block on stress response and inflammatory levels in patients undergoing cardiac valve replacement under general anesthesia. Methods A total of 120 patients who underwent elective extra-corporeal circulation-supported median open heart valve replacement were selected and randomly assigned into four groups using the random number table method: general anesthesia alone (Group G), general anesthesia with intravenous administration of esketamine (Group E), general anesthesia with transverse thoracic plane block (Group T), and esketamine combined with transverse thoracic muscle plane block (Group ET) ; each group consisted of 30 cases. Patients in group E and group ET received a continuous infusion of esketamine hydrochloride injection at a rate of 0.2 mg/kg-1 ⋅ h-1 until the completion of the surgical procedure, while patients in group G and group T received an equivalent volume of saline solution until the completion of the surgical procedure. After the induction of general anesthesia, patients in group T and group ET underwent ultrasound-guided bilateral transverse thoracic muscle plane block, while patients in group G and group E did not receive any specific intervention. All four groups received identical protocols for anesthesia induction and maintenance, with self- controlled intravenous analgesic pumps administered to all patients postoperatively. The following time points were recorded: 1 day prior to surgery (T0), pre-induction of anesthesia (T1), 1 minute post-tracheal intubation (T2), 1 minute post-median sternotomy (T3), 1 minute prior to initiation of cardiopulmonary circulation (T4), 1 minute after cessation of cardiopulmonary circulation (T5 ), 1 minute after completion of surgery (T6), 1 day post-surgery (T7), 2 days post-surgery (T8), and 3 days post-surgery(T9). Mean Arterial Pressure (MAP) and Heart Rate (HR) were continuously monitored from T1 to T6. The levels of blood glucose and lactate were measured and recorded at T1, T4 to T6. The levels of White Blood Cells (WBC) and C-Reactive Protein (CRP) were assessed at T0, as well as at T7 to T9. The occurrence of postoperative adverse reactions was documented in all four groups. Results (1) Comparison of hemodynamics among the four groups: Compared with group G, there was a significant decrease in MAP and HR at T3 in group T (P < 0.05). At the T5 time point, MAP was lower in group ET compared to group E, while HR was higher in group ET compared to group T (P < 0.05). (2) The lactate and blood glucose levels of the four patient groups after extracorporeal circulation transfer were higher than those at the T1 time point (P < 0.05). Patients in group E had lower lactate values at the T5 time point and lower blood glucose values at the T6 time point compared to group G (P < 0.05). Additionally, patients in group E exhibited lower lactate and blood glucose values at both the T5 and T6 time points compared to those in group T (P < 0.05). (3) Compared to T0, the levels of white blood cells (WBC) and C-reactive protein (CRP) were increased in all four groups after surgery (P < 0.05). At the T7 time point, the WBC levels in group E and group T were significantly lower than those in group G (P < 0.05). Furthermore, compared to group E and group T, the level of WBC in group ET was significantly lower at T7, while the level of CRP was significantly lower at T8 (P < 0.05). (4) There were no significant differences observed in postoperative adverse reactions among the four groups (P > 0.05). Conclusion Combining low-dose esketamine hydrochloride with transverse thoracic muscle plane block under general anesthesia during open heart valve replacement surgery can effectively stabilize the patient's hemodynamics, mitigate perioperative stress response and postoperative inflammation levels, thereby demonstrating significant clinical utility. [ABSTRACT FROM AUTHOR]

ABSTRACT Atrial and ventricular arrhythmias are common in patients with Infiltrative heart diseases. This review discusses ablative techniques for arrhythmias in amyloidosis, sarcoidosis, hemochromatosis, and glycogen storage disorders, primarily focusing on atrial fibrillation (AF). A thorough literature review was conducted on the MEDLINE database to synthesize current knowledge and propose future research directions. AF is the most common arrhythmia identified in patients with amyloidosis due to cellular infiltration and atrial dilation. While catheter ablation is associated with a significantly lower rate of all‐cause mortality and admission rate, conflicting data exist regarding the higher risk of pericardial effusion, in‐hospital mortality, length of stay, and cost of hospitalization. Cardiac sarcoid predisposes AF due to granulomas, atrial dilation, and scarring. Studies demonstrate encouraging outcomes and low recurrence rates in these patients who undergo ablation for AF, with no difference in complications compared to those without sarcoidosis. AF is the most common arrhythmia in hereditary hemochromatosis (HH), secondary to increased myocardial iron stores and elevated oxidative stress, and is primarily managed by chelation. Scant reports regarding ablation are described for HH and glycogen storage disorders. Catheter ablation is a safe and effective modality for the treatment of AF in infiltrative cardiomyopathy. Future large‐scale trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: To review the utility of galectin-3 (Gal-3) as a biomarker for postoperative adverse outcomes in patients undergoing cardiac surgery. Method: This review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic database search was conducted in October 2023. Studies that measured pre- and/or postoperative plasma Gal-3 levels in adult patients undergoing cardiac surgery were included. Primary outcomes included postoperative morbidity and mortality. Results: Out of 391 studies screened, eight studies met the inclusion criteria. Two of the three studies showed that preoperative plasma levels of Gal-3 were associated with acute kidney injury (AKI) after cardiac surgery. Two of the three studies reported a significant increase in preoperative Gal-3 levels in patients who developed postoperative atrial fibrillation (POAF). The addition of Gal-3 to the EuroSCORE II model was found to statistically improve the prediction of both AKI and POAF. Three of the five studies suggested that Gal-3 levels can predict postoperative mortality. Finally, one study suggested that lower preoperative Gal-3 levels was associated with a higher likelihood of achieving left ventricular reverse remodeling (LVRR) after surgery. Conclusions: Gal-3 may play a promising role in predicting adverse outcomes in patients undergoing cardiac surgery. The addition of Gal-3 to clinical risk prediction scores may improve their discriminatory power in this group of patients. Future studies are warranted to justify its incorporation into routine clinical practice. Galectin-3 (Gal-3) is an inflammatory protein that has recently emerged in literature as a potential biomarker for predicting mortality and cardiovascular events in cardiac surgery patients. Our review article consolidates landmark studies on the association between Gal-3 and several post-surgery outcomes such as kidney injury, atrial fibrillation, mortality, and left ventricular remodeling in adult patients. Incorporating Gal-3 in established clinical risk models such as the Society of Thoracic Surgeons (STS) scores and EuroSCORE may improve their predictive ability in diverse patient populations. [ABSTRACT FROM AUTHOR]

Objective: To determine the extent of iron induced organ damage in patients of Haematological disorders who are transfusion dependent, presenting in the emergency department of SZH, Lahore. Study Design: Cross Sectional study. Setting: Department of Emergency, Shaikh Zayed Hospital, Lahore. Period: December 25, 2020 to June 24, 2021. Methods: A total of 100 patients aged 10-60 years, of both genders, diagnosed with haematological disorders, and receiving multiple blood transfusions were included in this study. Demographic details were noted including name, age, sex, diagnosis, duration of receiving transfusions and number of transfusions received per month. Patients were evaluated clinically for organ damage including pulmonary, hepatic, renal, and cardiac organs using Denver MOF score. Results: Mean age of patients was 35.33±14.27 years. Mean duration of receiving transfusion was 6.69±2.71 months. There were 67 (67%) males and 33 (33%) female patients. Primary diagnosis was Autoimmune Haemolytic Anemia (AIHA) in 18 (18.00%) patients, Aplastic anemia in 34 (34%) patients, Thalassemia in 37 (37%) patients and Myelodysplastic syndrome (MDS) in 11 (11%) patients. Multiple organ damage was found in 23 (23%) patients. Pulmonary damage was diagnosed in 21 (21%) patients, hepatic damage in 21 (21 %) patients, renal damage in 20 (20%) patients and cardiac damage in 15 (15%) patients. Conclusion: There is a high frequency of multi-organ damage in patients of Haematological disorders requiring chronic blood transfusions. In this study, multi-organ damage was diagnosed in 23% patients requiring chronic blood transfusion. [ABSTRACT FROM AUTHOR]

Postoperative critical care management of congenital heart disease patients requires prompt intervention when the patient deviates significantly from clinician‐determined vital sign and hemodynamic goals. Current monitoring systems only allow for static thresholds to be set on individual variables, despite the expectations that these signals change as the patient recovers and that variables interact. To address this incongruency, we have employed statistical process monitoring (SPM) techniques originally developed to monitor batch industrial processes to monitor high‐frequency vital sign and hemodynamic data to establish multivariate trajectory maps for patients with d‐transposition of the great arteries following the arterial switch operation. In addition to providing multivariate trajectory maps, the multivariate control charts produced by the SPM framework allow for assessment of adherence to the desired trajectory at each time point as the data is collected. Control charts based on slow feature analysis were compared with those based on principal component analysis. Alarms generated by the multivariate control charts are discussed in the context of the available clinical documentation. [ABSTRACT FROM AUTHOR]

Minimal residual disease (MRD) is of growing interest in light chain (AL) amyloidosis and is associated with higher rates of cardiac response. A new graded cardiac response criteria has been proposed for better assessment of cardiac improvement. We evaluated MRD status in 63 patients with cardiac AL amyloidosis using next generation flow cytometry (sensitivity ≥ 1*10–5) within four cycles after treatment initiation and cardiac response kinetics. All patients were treated with first-line proteasome inhibitor (100%) and predominantly bortezomib (87.3%). The overall early MRD negative rates were 33.3%. Patients who achieved early MRD negativity were less likely to harbor t(11;14) (21.1% vs 57.5%, P = 0.009). The MRD negative rates amongst patients in hematologic complete response were 66.7% (14/21), and in very good partial response 29.2% (7/24). Early MRD negativity was associated with a higher likelihood of achieving ≥ cardiac partial response (≥ CarPR) (66.7% vs 38.1%, P = 0.032) and ≥ cardiac very good partial response (≥ CarVGPR) (38.1% vs 11.9%, P = 0.023) throughout first-line therapy. The cumulative incidence curve of achieving ≥ CarPR (P = 0.034) and ≥ CarVGPR (P = 0.026) showed significant difference between early MRD negative and positive group. After a median follow-up time of 27.2 months, the median progression free survival was longer in early MRD negative group (not reached vs 31.3 months, P = 0.033). Early MRD eradication in cardiac AL amyloidosis generated deeper and faster cardiac organ response. [ABSTRACT FROM AUTHOR]

Congenital heart defects (CHD) appear in almost one percent of live births. Asian countries have the highest birth prevalence of CHD in the world. Recessive genotypes may represent a CHD risk factor in Asian populations with a high degree of consanguineous marriages. Genetic analysis of consanguineous families may represent a relatively unexplored source for investigating CHD etiology. To obtain insight into the contribution of recessive genotypes in CHD we analysed a cohort of forty-nine Pakistani CHD probands, originating from consanguineous unions. The majority (82%) of patient's malformations were septal defects. We identified protein altering, rare homozygous variants (RHVs) in the patient's coding genome by whole exome sequencing. The patients had a median of seven damaging RHVs each, and our analysis revealed a total of 758 RHVs in 693 different genes. By prioritizing these genes based on variant severity, loss-of-function intolerance and specific expression in the developing heart, we identified a set of 23 candidate disease genes. These candidate genes were significantly enriched for genes known to cause heart defects in recessive mouse models (P < 2.4e−06). In addition, we found a significant enrichment of cilia genes in both the initial set of 693 genes (P < 5.4e−04) and the 23 candidate disease genes (P < 5.2e−04). Functional investigation of ADCY6 in cell- and zebrafish-models verified its role in heart development. Our results confirm a significant role for cilia genes in recessive forms of CHD and suggest important functions of cilia genes in cardiac septation. [ABSTRACT FROM AUTHOR]

Background: Two common indications for pediatric heart transplantation are congenital heart disease and cardiomyopathy. Prior studies suggest differences in chronotropy on cardiopulmonary exercise testing outcomes depending on indication for heart transplantation. We aimed to determine whether the number of pretransplant sternotomies is associated with differences in heart rate response during exercise testing. Methods: A retrospective analysis of our institutional pediatric heart transplant data between 2004 and 2022 was performed. Patients were categorized by indication for transplantation into a cardiomyopathy (CM) group if they had a congenital or acquired cardiomyopathy or a congenital heart disease (CHD) group including all other forms of congenital cardiac anatomic abnormalities. Results: CHD patients (n = 40) differed from CM patients (n = 53) by mean number of sternotomies prior to transplant (2.4 ± 1.8 vs. 0.5 ± 0.9, p < 0.001). There were no significant differences in echocardiographic function or catheterization hemodynamics. In cardiopulmonary exercise testing performance, the congenital heart disease group had a significantly higher resting heart rate (91.8 ± 11.2 vs. 86.4 ± 10.2 bpm, p = 0.019), lower percent predicted age‐predicted maximal heart rate achieved (78.3 ± 8.5% vs. 83.2 ± 11.4%, p = 0.032), and lower heart rate reserve (68.6 ± 19.8 vs. 84.4 ± 24.0 bpm, p = 0.001) despite a similar age and average time from transplantation. Regression analysis confirmed number of pretransplant sternotomies as a main predictor of heart rate metrics. Conclusions: There is greater chronotropic incompetence in patients who underwent transplantation due to congenital heart disease compared to cardiomyopathy. The groups differ significantly by number of sternotomies, potentially supporting the hypothesis that prior surgical disruption of cardiac innervation may cause decreased chronotropic response to exercise following transplantation. [ABSTRACT FROM AUTHOR]

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Patients with congenital heart disease are living longer due to improved medical and surgical care. Congenital heart disease encompasses a wide spectrum of defects with varying pathophysiology and unique anesthetic challenges. These patients often present for noncardiac surgery before or after surgical repair and are at increased risk for perioperative morbidity and mortality. Although there is no singular safe anesthetic technique, identifying potential error traps and tailoring perioperative management may help reduce morbidity and mortality. In this article, we discuss five error traps based on the collective experience of the authors. These error traps can occur when providing perioperative care to patients with congenital heart disease for noncardiac surgery and we present potential solutions to help avoid adverse outcomes. [ABSTRACT FROM AUTHOR]

The role of serotonin in pulmonary arterial hypertension has been extensively studied in recent decades, with preclinical data strongly indicating involvement in disease pathogenesis; however, clinical studies have yielded mixed results. ELEVATE-2 was a phase 2b dose-ranging, randomised, double-blind, placebo-controlled, multicentre trial investigating rodatristat ethyl as a treatment for patients with pulmonary arterial hypertension. The study was conducted at 64 sites across 16 countries in Europe and North America. Eligible participants were aged 18 years or older, had pulmonary arterial hypertension with WHO functional class II or III symptom severity, and had received a stable dose and regimen of one or more pulmonary arterial hypertension treatments for at least 12 weeks. Participants were randomly assigned 1:1:1 to receive two placebo tablets, one placebo and one rodatristat ethyl 300 mg tablet, or two rodatristat ethyl 300 mg tablets twice daily using an interactive response system. Participants, investigators, site personnel, and sponsors were masked to treatment allocation. Participants who completed the 24 week treatment period were invited to continue in an open-label extension. The primary endpoint was percent change in pulmonary vascular resistance (PVR) from baseline to week 24. Primary efficacy analyses were conducted on the intention-to-treat population and analyses of harms were conducted in the safety population, which included all patients who received any amount of the study drug. This trial is registered with ClinicalTrials.gov , NCT04712669 , and is now complete. Between March 18, 2021 and Dec 13, 2022, 108 participants were enrolled and randomly assigned. 36 participants received placebo, 36 received rodatristat ethyl 300 mg, and 36 received rodatristat ethyl 600 mg twice daily. Overall, 85 (79%) of participants were female and 23 (21%) were male. The mean age was 52·8 years (SD 14·7) in the full analysis set. In the open-label extension phase, 62 (82%) of participants were female and 14 (18%) were male, and the mean age was 52·8 years (SD 14·7); this phase was terminated following sponsor review of unmasked main study results. Least-squares mean percent change in PVR from baseline to week 24 favoured placebo and was 5·8% (SE 18·1) for the placebo group, 63·1% (18·5) for the rodatristat ethyl 300 mg group, and 64·2% (18·0) for the rodatristat ethyl 600 mg group. Treatment-emergent adverse events (TEAE) were reported for 29 (81%) patients in the placebo group, 33 (92%) patients in the rodatristat ethyl 300 mg group, and all 36 (100%) patients in the rodatristat ethyl 600 mg group. TEAE leading to study discontinuation were reported for three (8%) patients in the placebo group, four (11%) patients in the rodatristat ethyl 300 mg group, and four (11%) in the rodatristat ethyl 600 mg group. There was one (3%) TEAE leading to death in the rodatristat ethyl 300 mg group. Our results indicate that reducing peripheral serotonin concentrations via rodatristat ethyl has a negative effect on pulmonary haemodynamics and cardiac function in patients with pulmonary arterial hypertension. This finding suggests that manipulating this pathway might not be a suitable option for pulmonary arterial hypertension therapy. Enzyvant Therapeutics (now Sumitomo Pharma America). [ABSTRACT FROM AUTHOR]

The prevalence and mortality related to end-stage liver disease (ESLD) continue to rise globally. Liver transplant (LT) recipients continue to be older and have inherently more comorbidities. Among these, cardiac disease is one of the three main causes of morbidity and mortality after LT. Several reasons exist including the high prevalence of associated risk factors, which can also be attributed to the rise in the proportion of patients undergoing LT for metabolic dysfunction-associated steatohepatitis (MASH). Additionally, as people age, the prevalence of now treatable cardiac conditions, including coronary artery disease (CAD), cardiomyopathies, significant valvular heart disease, pulmonary hypertension, and arrhythmias rises, making the need to treat these conditions critical to optimize outcomes. There is an emerging body of literature regarding CAD screening in patients with ESLD, however, there is a paucity of strong evidence to support the guidance regarding the management of cardiac conditions in the pre-LT and perioperative settings. This has resulted in significant variations in assessment strategies and clinical management of cardiac disease in LT candidates between transplant centres, which impacts LT candidacy based on a transplant centre's risk tolerance and comfort level for caring for patients with concomitant cardiac disease. Performing a comprehensive assessment and understanding the potential approaches to the management of ESLD patients with cardiac conditions may increase the acceptance of patients, who appear too complex, but rather require extra evaluation and may be reasonable candidates for LT. The unique physiology of ESLD can profoundly influence preoperative assessment, perioperative management, and outcomes associated with underlying cardiac pathology, and requires a thoughtful multidisciplinary approach. The strategies proposed in this manuscript attempt to review the latest expert experience and opinions and provide guidance to practicing clinicians who assess and treat patients being considered for LT. These topics also highlight the gaps that exist in the comprehensive care of LT patients and the need for future investigations in this field. [ABSTRACT FROM AUTHOR]

People who experience out-of-hospital cardiac arrest often require care at a regional center for continued treatment after resuscitation, but many do not initially present to the hospital where they will be admitted. For patients who require interfacility transport after cardiac arrest, the decision to transfer between centers is complex and often based on individual clinical characteristics, resources at the presenting hospital, and available transport resources. Once the decision has been made to transfer a patient after cardiac arrest, there is little direct guidance on how best to provide interfacility transport. Accepting centers depend on transferring emergency departments and emergency medical services professionals to make important and nuanced decisions about postresuscitation care that may determine the efficacy of future treatments. The consequences of early care are greater when transport delays occur, which is common in rural areas or due to inclement weather. Challenges of providing interfacility transfer services for patients who have experienced cardiac arrest include varying expertise of clinicians, differing resources available to them, and nonstandardized communication between transferring and receiving centers. Although many aspects of care are insufficiently studied to determine implications for specific out-of-hospital treatment on outcomes, a general approach of maintaining otherwise recommended postresuscitation care during interfacility transfer is reasonable. This includes close attention to airway, vascular access, ventilator management, sedation, cardiopulmonary monitoring, antiarrhythmic treatments, blood pressure control, temperature control, and metabolic management. Patient stability for transfer, equity and inclusion, and communication also must be considered. Many of these aspects can be delivered by protocol-driven care. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis, a life-threatening syndrome, is often accompanied by tachycardia in spite of hypovolemia and hypotension have been corrected. Recently, relevant studies have shown that sustained tachycardia in sepsis was related to high mortality, and appropriate control of heart rate (HR) could improve prognosis. Ivabradine reduces HR directly without a negative inotropic effect through inhibition of the If ionic current, which is different from the traditional rate control drug (beta-blockers). Methods and analysis: This is a prospective, multicenter, randomized, open label study designed to investigate the effect of heart rate control with ivabradine on hemodynamic in patients with sepsis. Our study will enroll 172 patients with sepsis as defined by The Third International Consensus Definitions for Sepsis and Septic Shock criteria with sinus rate of 95 bpm or higher despite a hemodynamic optimization. Patients will be randomly assigned to standard treatment group (GS) or ivabradine group (GI, standard treatment for sepsis plus enteral ivabradine). Patients in GI will receive ivabradine to maintain HR between 70 and 94 bpm. The primary outcome is the difference of a reduction in HR below 95 bpm and the effect of ivabradine on hemodynamics between GI and GS group within the first 96 h after randomization. The secondary outcomes include organ function measures, the difference in SOFA score, incidence of adverse events, need for organ support, length of ICU stay, and 28-day overall mortality. Discussion: There are limited studies on ivabradine to control heart rate in patients with sepsis. Our study aims to evaluate whether direct sinus node inhibition can improve hemodynamics, as well as its impact on organ function and prognosis in patients with sepsis, so as to provide evidence for the safe usage in clinical practice. Trial registration: ClinicalTrials.gov NCT05882708. Registered on May 11, 2023, https://clinicaltrials.gov/ct2/show/NCT05882708. [ABSTRACT FROM AUTHOR]

Background: Depression, anxiety and high-sensitivity C-reactive protein (hs-CRP) are individually associated with poor prognosis in patients with coronary heart disease (CHD). However, the combined effects of depression with inflammation or anxiety with inflammation on the prognosis have been rarely explored. Methods: This prospective cohort study included 414 patients diagnosed with CHD. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. A score ≥ 5 points was defined as elevated depression or anxiety. High hs-CRP was defined as ≥ 3 mg/L. Follow-up was performed 2 years after the patients were discharged. The clinical results included noncardiac readmission, cardiac readmission, major cardiovascular events (MACEs), and composite events. The composite events included noncardiac readmission and MACEs. The Cox proportional hazard regression model was used to analyze the prognostic risk. Results: After full adjustment, patients with elevated depression and high hs-CRP had a higher risk in predicting noncardiac readmission (hazard ratio (HR) = 3.87, 95% confidence interval (CI) = 1.10–9.02, p = 0.002) and composite events (HR = 1.93, 95% CI = 1.13–3.30, p = 0.016) than those with high hs-CRP alone. For the anxiety and hs-CRP group, high hs-CRP alone predicted a higher risk of noncardiac readmission (HR = 3.32, 95% CI = 1.57–7.03, p = 0.002) and composite events (HR = 1.75, 95% CI = 1.12–2.76, p = 0.015) than references. Elevated anxiety had no significant effects on all the endpoints. Furthermore, we didn't find interactions between depression and hs-CRP or anxiety and hs-CRP. Conclusion: In patients with CHD, elevated depression with high hs-CRP was found to be significant in predicting the risk of noncardiac readmission and composite events. Early diagnosis and treatment of depression with inflammation are necessary in CHD patients. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To systematically evaluate the effect of frailty on the prognosis of patients with heart failure.Computer searches were conducted on PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang Data Knowledge Service platform, Weipu full‐text database of Chinese scientific and technological journals, and Chinese biomedical literature database from August 12, 2022. After literature screening was completed by two researchers, the data extraction (such as study type, sample size, age of included patients, New York Heart Association (NYHA) Functional Classification, frailty assessment tool, frailty positive rate, outcome indicators, etc.) was performed and the risk of bias in the included studies was assessed. Meta‐analysis was performed using Revman 5.4 and Stata 14.0 software.A total of 32 studies were included, including 406,269 patients with heart failure. All included studies were rated high overall quality. The results of meta‐analysis showed: Frailty increases the risk of all‐cause death in patients with heart failure (hazard ratio [HR] = 1.73, 95% confidence interval [CI]: 1.50 – 2.00, p < 0.001), unplanned readmission (HR = 1.96, 95% CI: 1.21 – 3.17, p = 0.006), and joint endpoint risk (HR = 1.66, 95% CI: 1.48 – 1.86, p < 0.001).Current evidence suggests that frailty increases the risk of all‐cause death, unplanned readmission, and joint endpoints in patients with heart failure. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose Methods Results Conclusions Trial registration The study aims to assess cardiac synchrony under different left bundle branch area pacing (LBBAP) and evaluate the relationship between different surface or intracardiac electrical parameters and mechanical synchrony.Eighty‐two patients with successful LBBAP were recruited. The electrical synchrony, evaluated by paced QRS duration (pQRSD) and Stim‐LVAT (stimulus to left ventricular activation time), and mechanical synchrony, evaluated by the standard deviation of the time‐to‐peak contraction velocity in 12 left ventricular segments (Tsd‐12‐LV), were compared between groups in patients underwent LBBAP. To investigate the relationship between different electrical parameters with mechanical synchrony under LBBAP, patients were divided into subgroups according to left ventricular activation time (LVAT, < 60, 60–70, and > 70 ms), presence of left bundle branch (LBB) potential (positive, negative), QRS axis (normal, left axis deviation [LAD]), and potential to ventricular interval (PVI, < 20 and > 20 ms). Mechanical synchrony was compared among the subgroups respectively 3 days post LBBAP procedure.No statistically significant differences were documented in electrical synchrony, evaluated by pQRSD, and mechanical synchrony, evaluated by Tsd‐12‐LV among the subgroups divided by the stim‐LVAT, LBB potential, PVI duration, or paced QRS axis in the LBBAP group.LBB potential, PVI, or normal paced QRS axis is not the prerequisite for successful LBBAP and optimal cardiac synchrony. Adopting a Stim‐LVAT value of less than 75 ms to attain ideal electrical and mechanical synchrony during the LBBAP procedure may be applicable.http://www.chictr.org.cn/index.aspx. ClinicalTrials.gov identifier: ChiCTR1800021104 [ABSTRACT FROM AUTHOR]

We evaluated alterations in cerebrospinal fluid (CSF) flow based on the neurological prognosis of out-of-hospital cardiac arrest (OHCA) patients. This prospective observational study was conducted from May 2023 to June 2024. Stroke distance was measured using magnetic resonance imaging flowmetry immediately and at 72 h after return of spontaneous circulation (ROSC), with negative values indicating caudocranial direction. The caudocranial direction of CSF flow was observed in 17 (56.7%) patients immediately after ROSC, and in 20 (66.7%) patients at 72 h after ROSC. There was no significant difference in the occurrence of caudocranial CSF flow immediately after ROSC between the groups with good and poor neurological prognosis [6 (50.0%) vs. 11 (61.1%); p = 0.55]. However, the occurrence of caudocranial CSF flow at 72 h after ROSC was significantly higher in the group with poor neurological prognosis compared to the group with good neurological prognosis [3 (25.0%) vs. 17 (94.4%); p < 0.001]. This study demonstrated that the occurrence of caudocranial CSF flow at 72 h after ROSC was significantly higher in the group with poor neurological prognosis compared to the group with good neurological prognosis. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment and cardiovascular disease often coexist, and nurses are ideally positioned to detect and manage cognitive impairment in cardiac patients.Objectives: This study explored nurses' perspectives on understanding, detecting, and acting on cognitive impairment in cardiac patients.Design and Methods: Using an exploratory descriptive design, nurses from acute and outpatient cardiac units were interviewed. Data were thematically analyzed.Results: Sixteen nurses were interviewed, working in acute cardiology (n=7), cardiothoracic and intensive care (n=4), and cardiac rehabilitation (n=5). Three themes emerged: (1) Cognitive screening was not routine, with no clear protocols on who, when, and how to screen; (2) Nurses had varying understanding of cognitive impairment, dementia, and delirium; (3) Nurses acted on suspected cognitive changes to ensure patient safety, including referrals and care modifications.Conclusions: Cognitive screening was inconsistent, with barriers, such as workload and lack of education. Guidelines for feasible screening across settings are needed. [ABSTRACT FROM AUTHOR]

Background: Tricuspid regurgitation (TR) is common in patients evaluated by echocardiography. However, the prevalence and contributing factors of the disease remain limited. This hospital-based study was designed to analyze adult patients first diagnosed with tricuspid regurgitation by Doppler echocardiography to determine the prevalence and characteristics of clinically meaningful TR. Methods: A total of 22,317 patients over the age of 18 who underwent echocardiography at the Cardiac Ultrasound Center of the First Affiliated Hospital of Guangdong Pharmaceutical University from July 1, 2015 to December 31, 2019 were collected. We collected basic information about the patients, including age, gender, history of heart disease, etc. Patients with valvular heart disease were assessed by transthoracic echocardiography. According to the degree of regurgitation and regurgitation, TR was divided into 6 grades (0–5). Pericardial effusion was recorded and bilateral atrial and ventricular diameters were measured. Logistic regression analysis was used to assess risk factors for significant TR (≥ grade 2 reflux). Results: A total of 2299 significant TR cases were found in people over 18 years old, accounting for 10.3% of the total population. The occurrence of TR was found to be closely related to age. The prevalence rates of significant TR in different groups were: 3.3% in the younger than 45-year-old group, 4.1% in the 46-55-year-old group, 5.8% in the 56-65-year-old group, 10.1% in the 66-75-year-old group, and the prevalence of significant TR rose directly to 22.3% in patients over 75-year-old group. Further logistic regression analysis showed that male, age, pacemaker, congenital heart disease, pericardial effusion, pulmonary hypertension, mitral regurgitation, left ventricular diastolic dysfunction and aortic regurgitation were associated with the occurrence of significant TR. Both RVD and RA-1 were effective predictors of significant TR, with RVD ≥ 33.5 mm having a sensitivity of 0.638, specificity of 0.675, and ROC curve area of 0.722. The sensitivity of RA1 ≥ 45.5 mm was 0.652, the specificity was 0.699, and the area under the ROC curve was 0.736. Conclusions: TR is common in people undergoing echocardiography. Gender, age, pacemaker implantation, congenital heart disease, pericardial effusion, pulmonary hypertension, mitral insufficiency, and aortic insufficiency are the influencing factors of TR. [ABSTRACT FROM AUTHOR]

Thoracic bulky esophageal cancer shrinks during radiotherapy, changing the location and shape of the surrounding heart and lungs. The current study aimed to explore how replanning by volumetric-modulated arc radiotherapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT) influences the target coverage and dose to organs at risk in locally advanced unresectable middle to lower thoracic esophageal cancer. We retrospectively collected CT simulation images of initial and boost radiotherapy plans for locally advanced unresectable thoracic esophageal cancer in 17 consecutive patients. First, we created boost plans of 20 Gy using 3DCRT and VMAT on the initially acquired CT images. Second, we replicated the process on CT images acquired after 20–40 Gy of radiotherapy. We then compared non-replanned boost radiotherapy plans with replanned boost plans. Replanned radiotherapy delivered more conformal doses to the target and reduced heart and lung doses. VMAT reduced more irradiated mean doses to the heart than 3DCRT in the case of replanning (1.7 and 1.1 Gy, p < 0.001). Replanning to accommodate tumor shrinkage during radiotherapy effectively lowers the irradiated doses to the heart and lungs in patients with locally advanced unresectable middle to lower thoracic esophageal cancer, especially those treated with VMAT. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose Methods Results Conclusions Implications for Clinical Practice Patient Contribution Patients with coronary heart disease (CHD) will have a series of sexual problems, and their sexual life quality can be affected. However, a standardised evaluation tool for patients with CHD was lacking. Therefore, this study aimed to develop a sexual life quality questionnaire for patients with CHD and to evaluate its psychometric properties.Based on previous phenomenological studies, literature analysis and group discussion, questionnaire items were formed. After two rounds of expert consultation and pre‐survey, the questionnaire items were modified. Items were screened by item analysis. Exploratory factor analysis and confirmatory factor analysis were used to explore and confirm the structure of the questionnaire. Content validity and criterion validity were evaluated using the expert consultation and correlation analysis, respectively. The questionnaire reliability was evaluated using internal consistency, split half reliability, and test‐retest reliability.The sexual life quality questionnaire of patients with CHD was developed, which included two versions: male version and female version. The male version of the questionnaire contains 3 dimensions and 20 items, while the female version contains 3 dimensions and 17 items. After reliability and validity test, the two versions of the questionnaire have good reliability and validity.In this study, the sexual life quality questionnaire of patients with CHD was developed and its psychometric properties were confirmed, which can be used to evaluate the sexual life quality of patients with CHD.The development of a sexual life quality evaluation tool for patients with coronary heart disease to provide objective and quantitative tools for clinical staff to evaluate patients' sexual life status.Patients were invited to participate in a questionnaire survey for this study. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of preoperative HbA1c levels on postoperative complications in coronary heart disease patients undergoing coronary artery bypass grafting (CABG). Methods: From September 2020 to November 2022, 98 patients with coronary heart disease who were preparing to receive CABG treatment in a cardiac surgery department of a certain hospital were included in the study using the retrospective analysis. According to the preoperative serum hemoglobin A1C (HbA1c) test results, patients were divided into a low-level group (HbA1c < 5.7%, 20 cases), a medium level group (HbA1c: 5.7% ~ 7.0%, 59 cases), and a high level group (> 7%, 19 cases). The surgical outcomes and postoperative complications among the three groups were compared. Results: There was no statistically significant difference in the number of bypass grafts, mechanical ventilation time, and hospitalization time among the three groups of patients (P > 0.05). The high-level group stayed in the ICU longer than the other two groups, while the middle level group had a longer stay than the low-level group (P < 0.05). Within one year of postoperative follow-up, the occurrence of postoperative complications was 20.00%, 32.20%, and 47.37%, respectively, with no statistically significant difference (P > 0.05). Among them, the incidence of acute kidney injury in the high-level group was higher than that in the other groups (P < 0.05), but the correlation difference between the middle and low level groups is P > 0.05. The incidence of infection in the middle level group was higher than that in the low level group (P < 0.05), but the incidence of infection in the high and low level groups was P > 0.05 compared to the medium level group. Conclusion: For patients with coronary heart disease undergoing CABG, the higher the preoperative HbA1c level, the longer their postoperative stay in the ICU, and the higher the risk of acute renal function damage. [ABSTRACT FROM AUTHOR]

Objective: To assess differences in right ventricular function between the primary angioplasty and pharmacoinvasive groups using echocardiographic parameters. Method: Observational, retrospective, and cross-sectional study conducted on 111 patients in a cardiac care unit, where ventricular function was evaluated through transthoracic echocardiography. Results: There were no significant differences in right ventricular function parameters (TAPSE, FAC, S’ wave, RV Tei index, right V/A coupling) between both groups. As a notable finding, the pharmacoinvasive group exhibited better LVEF and smaller volumes at the end of diastole and systole. Conclusions: In patients with STEMI undergoing the pharmacoinvasive strategy compared to those receiving primary angioplasty, there is no significant difference in the main right ventricular function parameters assessed by transthoracic echocardiography. [ABSTRACT FROM AUTHOR]

Objective: SARS-CoV-2 infection induces an immune response that causes excessive inflammation damaging cardiac tissue and vascular endothelium. The objective of this study is to review a series of cases of hospitalized patients with pre-existing cardiac disease to describe the clinical behavior and highlight the low frequency of morbidity and mortality. Method: Retrospective study of 17 patients with a confirmed diagnosis of COVID-19 by polymerase chain reaction test or antigen test, a history of cardiovascular disease with or without comorbidities, and a history of at least one dose of the vaccine for COVID-19, during the period between December 30, 2021 and March 17, 2022 at the Ignacio Chávez National Institute of Cardiology in Mexico City. Results: The most frequent cardiac pathology was acute myocardial infarction (31.25%) and the most common arrhythmia was atrial fibrillation (25%). The median number of days of hospital stay was 10 days (interquartile range: 4-14). Regarding the outcomes, 94% of the patients were discharged due to clinical improvement, and only one patient died during his hospitalization. Conclusions: It is crucial to continue investigating SARS-CoV-2 effects in patients pre-existing heart disease and in those with persistent symptoms after infection. This will allow the development of more effective strategies for the treatment and prevention of cardiovascular complications associated with COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: While the assessment of the diaphragm in different clinical scenarios is quite frequent, there remains a scarcity of studies focused on assessing diaphragm dysfunction using ultrasound in cardiac surgery patients. We investigated the impact of cardiopulmonary bypass (CPB) surgery on diaphragm function and evaluated its effects on mechanical ventilation. Methodology: A prospective cohort study, on 100 consecutive adult cardiac surgery patients, was conducted at National Heart Institute. Diaphragmatic displacement (DD) or excursion and diaphragmatic thickening fraction (DTF) were measured using motion-mode ultrasound during quite normal breathing pre-operatively (the day before surgery) and post-operatively on mechanical ventilation, while the patient was fully conscious and spontaneously breathing on continuous positive airway pressure (CPAP) mode + pressure support 10 cmH2O. Then, the results were correlated to CBP time and important patient outcomes. Results: Post-operative DD was significantly less as compared to the pre-operative reading; (1.39 ± 0.42 cm vs. 2.3 ± 0.52 cm; P < 0.001), as was DTF (23% ± 10% vs. 40% ± 13%; P < 0.001). The incidence of diaphragmatic dysfunction post-cardiac surgery was 17% by the definition of DD < 1 cm, and 49% by the definition of DTF ≤ 20%. DD was positively correlated with CBP time, as well as total ventilation time and ICU stay, indicating a negative impact on overall patient outcomes. Conclusion: The results suggest that diaphragmatic dysfunction is positively correlated with CPB time, total ventilation time and ICU stay, underscoring the importance of monitoring diaphragmatic function in post-operative patients, who are difficult to wean from mechanical ventilation with apparently normal chest X-ray, particularly those with prolonged CPB time. [ABSTRACT FROM AUTHOR]

Besides being one of the causes of death in the world, adult congenital heart disease sufferers seem to be forgotten and neglected from what is called depression and anxiety. Not much has been described about depressive psychopathology in adult congenital heart disease patients. The purpose of this study was to analyze the factors associated with depressive syndrome in congenital heart disease patients. This cross-sectional study was conducted by 97 adult congenital heart disease patients recruited sequentially, consisting of 8 independent variables and 1 dependent variable. Depression scores were assessed using the BDI-II measuring instrument. Most sexes were female, with as many as 59 subjects (60.2 %). The most marital status was 66 subjects (67.3 %). The most occupations were those who worked as many as 70 subjects (71.4 %), the most previous history of surgery/intervention were those who did not have a history of prior surgery/intervention as many as 56 subjects (57.1 %), the most comorbid diseases were those who did not have a history of comorbid diseases as many as 86 subjects (87.8 %), age with a median value of 33 (18 - 45), the median value of education for adult CHD patients was 15 (12 - 18), the median NYHA grade value of adult CHD patients is 2 (1 - 4). The characteristics of patients who are highly educated, NYHA classmates, and who have jobs should be a concern because they will be more likely to experience depressive syndrome. [ABSTRACT FROM AUTHOR]

Statin‐associated muscle symptoms are frequently reported and often lead to discontinuation of statin therapy with an increased risk of cardiovascular events. In vitro studies suggest that statin‐mediated inhibition of the mevalonate pathway leads to muscle cell toxicity. We aimed to determine the relationship between mevalonate, LDL‐cholesterol, and atorvastatin metabolites in patients with coronary heart disease and self‐perceived muscle side effects. Furthermore, we assessed the correlation between mevalonate in blood and muscle and the relationship to statin intolerance due to muscle symptoms. We used blood plasma from a randomized crossover trial (n = 70) and muscle biopsies and plasma from a subgroup in a subsequent open intervention study (n = 26). Both studies tested atorvastatin 40 mg/day. Seven patients did not tolerate ≥3 statins throughout the follow‐up and were classified as statin‐intolerant. Mevalonate in blood plasma decreased during atorvastatin treatment (median difference −38%, range −77% to 43%, p < 0.001), whereas mevalonate in muscle tissue was not lowered (0.05%, range −47% to 145%). Mevalonate correlated poorly with LDL‐cholesterol and atorvastatin metabolites (Spearman's rho −0.28 to 0.10). The statin‐intolerant patients had a smaller reduction in circulating mevalonate compared with the tolerant patients; median difference −8.1 (−22 to 3.5) nmol/L versus −25 (−93 to 12) nmol/L, p = 0.028. A similar observation was made for LDL‐cholesterol. Cutoffs based on these biomarkers classified >50% correctly as tolerant. Inhibition of the mevalonate pathway does not appear to be the mechanism underlying statin intolerance in the present study. Further studies of mevalonate as a biomarker for statin tolerance are needed to clarify the potential. [ABSTRACT FROM AUTHOR]

Background and Aim: There is a scarcity of Indian studies on infective endocarditis. Additionally, the majority of research has focused on the paediatric age group. The purpose of this study was to investigate the microorganisms responsible for infective endocarditis in patients with rheumatic heart disease in patients attending Medicine OPD of Smt NHL Municipal Medical College, Ahmedabad. Additionally, the study aimed to assess the effectiveness of medical treatment and evaluate the prognosis of the cases. Material and Methods: Our study took place at the Department of General Medicine, a Smt. NHL Municipal Medical College, Ahmedabad, over the course of one year. We thoroughly investigated patients who were clinically suspected of having infective endocarditis. A study was conducted on 40 patients with Rheumatic heart disease who met the diagnostic criteria for infective endocarditis. A comprehensive set of medical tests were performed, including a complete hemogram, urinalysis specifically to check for microscopic haematuria, chest Xray, and EGG. Prior to starting treatment, blood cultures were collected. A comprehensive M mode and 2 D echocardiographic examination was conducted for all individuals suspected of having the condition, with additional TEE performed for cases that required further clarification. Results: A significant number of patients presented with a combination of mitral and aortic valve lesions. The most frequently observed combined lesions in our patients were mitral and aortic regurgitation. The patients included in our study experienced mild to moderate grade fever. At the time of admission, nineteen patients in the study group had a leukocyte count exceeding 10,000 cells per cubic millimetre. The majority of patients in the study group exhibited elevated ESR levels. Out of the total 40 patients, 11 had a positive blood culture (27.5%). Surprisingly, in 29 patients, the blood culture remained negative even after multiple sample collections and a seven-day incubation period. Most patients initially received a standard recommended dose of injection Penicillin G and Gentamicin on an empirical basis. However, as per the sensitivity pattern, appropriate antibiotics were administered thereafter. Conclusion: Treatment of endocarditis was more successful when suitable antibiotics were started after culture and sensitivity rather than the empirical treatment. [ABSTRACT FROM AUTHOR]

Introduction: This multi‐centre retrospective cohort study aimed to determine whether the cause of an undiagnosed pleural effusion differed depending on if a patient presented as an outpatient or inpatient. Methods: A total of 1080 adult patients (556 inpatients and 524 outpatients) presenting primarily with an undiagnosed pleural effusion from 1 January 2021 to 31 December 2022 from four UK hospitals were included. Results: We found malignant effusions were more common in outpatients compared to inpatients (48.3% vs. 36.0% p < 0.0001). Infection was common in inpatients but uncommon in outpatients (36.2% vs. 5.0% p < 0.0001). Other causes in all patients included heart and/or renal failure (13.1%) and non‐specific pleuritis (5.6%). No diagnosis was possible in 11.8% of patients referred. Conclusion: Investigative pathways should vary depending on whether patients present as an inpatient or outpatient. [ABSTRACT FROM AUTHOR]

Background: Heart attack, as a threatening event, affects patients' mental health, thus causing symptoms of anxiety and depression. The current research was conducted with the aim to evaluate the relationship between different psychological coping strategies, and anxiety and depression levels in heart attack patients. Methods: The current research was a cross-sectional study. In 2021, 237 heart attack patients were referred to Ibn Al-Bitar Specialized Hospital for Cardiac Surgery, Al Budoor Hospital, and Saint Raphael (Al Rahibat) Hospital in Baghdad, Iraq. A simple random sampling method was used to select a statistical sample of 114 patients. The Pearson correlation coefficient method was utilized. The collected data were analyzed in SPSS software. The statistical findings were considered significant at the 0.05 level. Results: There was a significant negative correlation between anxiety and self-reliant (r = -0.538; P < 0.01), optimistic (r = -0.483; P < 0.01), supporting (r = -0.467; P < 0.01), and confronting (r = -0.391; P < 0.05) coping strategies. In addition, there was a significant negative correlation between depression and self-reliant (r = -0.342; P < 0.01), confronting (r = -0.317; P < 0.01), supporting (r = -0.292; P < 0.01), and optimistic (r = -0.209; P < 0.05) coping strategies. Moreover, the results indicated a significant positive correlation between the fatalistic coping strategy and the anxiety (r = 0.429; P < 0.01) and depression (r = 0.214; P < 0.05) variables. Conclusion: Coping strategies are one of the main methods of improving life expectancy and well-being, and are essential in positive disease adaptation and reducing anxiety and depression levels in heart attack patients. [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety are among the underlying factors and effects of heart attack. Reducing these patients' levels of depression and anxiety is crucial for reducing recurrent strokes and enhancing their quality of life (QOL). The current study was conducted to examine the effect of cognitive behavioral therapy (CBT) on depression and anxiety in heart attack patients. Methods: The current experimental study was conducted on a community of heart attack patients in 2021. The statistical population consisted of 197 patients admitted to the CCU of Yarmouk Teaching Hospital and Baghdad Teaching Hospital, Iraq. Using a simple random sampling method, 84 patients were chosen and divided into experimental and control groups (42 patients in each group). For data collection, the Symptom Checklist-90-Revised (SCL-90-R) was utilized. The data were analyzed using the analysis of covariance (ANCOVA) in SPSS software. The significance level was considered to be equal to 0.05. Results: The mean depression score in the control group (1.27 ± 0.52) was significantly higher after the intervention compared to the experimental group (0.68 ± 0.29) (P < 0.001). In addition, the experimental group's depression score in the posttest stage was significantly lower than in the pretest stage (P < 0.001). ANCOVA showed a statistically significant difference in the mean posttest score of the dependent variables of depression (F = 129.48; P < 0.001) and anxiety (F = 123.99; P < 0.001) in heart attack patients who received the intervention. Conclusion: CBT intervention was impressive in the treatment of anxiety and depression in heart attack patients, resulting in a significant decrease in anxiety and depression and a reduction in the likelihood of future heart attacks. [ABSTRACT FROM AUTHOR]

Background: The acute hemodynamic response to isometric exercise in hypertensive patients' ischemic heart disease (IHD) has been poorly investigated. The aim of this study was to assess acute changes in left ventricular myocardial work (MW) during isometric bilateral knee extension in patients with IHD. Methods: Twenty stable hypertensive patients with IHD and ten healthy, age-matched controls (HC) were enrolled. All subjects performed an isometric knee extension exercise at 30% of their maximal voluntary contraction. The effort was maintained for three minutes or until exhaustion. At baseline, at peak exercise, and after 10 min of recovery, echocardiography evaluation was performed and blood pressure (BP) and heart rate (HR) were measured. Results: The exercise was well tolerated by all subjects. At peak exercise, systolic BP in the IHD was significantly higher than HC (37.6 ± 7.2 vs. 8.4 ± 2.3 mmHg; p 0.002). The HC group had a greater increase in HR than IHD (19.7 ± 6.2 vs. 8.4 ± 2.2 bpm; p 0.009). The E/E′ ratio increased in IHD and was unchanged in the control group. The global work index increased significantly in IHD compared to HC (+15% vs. +3%; p 0.026). Global constructive work increased significantly in IHD compared to HC (+29.8% vs. +7.4 respectively, p 0.031). Global wasted work increased by 92.3% in IHD and was unchanged in HC. The global work efficiency decreased in IHD (−18%), but was unchanged in HC (between-groups p 0.019). Stroke volume decreased in IHD and was unchanged in HC. Cardiac output was unchanged in IHD, while it increased in HC. Conclusion: In patients with hypertension and underlying IHD, an acute isometric load causes a great increase in systolic BP and LV filling pressure. It follows a mostly ineffective increase in MW that fails to maintain stroke volume. [ABSTRACT FROM AUTHOR]

Background: The surgical ablation (SA) of atrial fibrillation (AF) during cardiac surgery is performed in only 8–40% of patients. We performed a subgroup analysis of the 1-year follow-up from the German CArdioSurgEry Atrial Fibrillation (CASE-AF) registry to determine how preoperative sinus rhythm (SR) prior to SA affected the outcomes. Methods: The CASE-AF registry enrolled AF patients scheduled for cardiac surgery with concomitant SA. The in-hospital and one-year follow-up data were collected prospectively and analyzed retrospectively. Results: From September 2016 to August 2020, 964 patients were enrolled in the CASE-AF registry. Among them, 333 patients were in SR immediately before surgery (study cohort). A complete follow-up was achieved for 95.6%. Both the severity of the AF (modified European Heart Rhythm Association symptom classification, p < 0.001) and the frequency of AF symptoms (p = 0.006) were significantly reduced at one year compared to the preoperative baseline. Almost 90 percent of the patients underwent left atrial appendage occlusion (LAAO) during the procedure. The one-year mortality (4.1%) and stroke rates (3.2%) were low. SR was evident in 70.3% of the patients at the one-year follow-up. Conclusions: Patients with AF who have SR at the time of surgery should not be excluded from SA, as it appears to be a safe and effective procedure. [ABSTRACT FROM AUTHOR]

Patients with congenital heart disease (CHD) demonstrate altered structural brain network connectivity. However, there is large variability between reported results and little information is available to identify those patients at highest risk for brain alterations. Thus, we aimed to investigate if network connectivity measures were associated with the individual patient's cumulative load of clinical risk factors and with family‐environmental factors in a cohort of adolescents with CHD. Further, we investigated associations with executive function impairments. In 53 adolescents with CHD who underwent open‐heart surgery during infancy, and 75 healthy controls, diffusion magnetic resonance imaging and neuropsychological assessment was conducted at a mean age of 13.2 ± 1.3 years. Structural connectomes were constructed using constrained spherical deconvolution tractography. Graph theory and network‐based statistics were applied to investigate network connectivity measures. A cumulative clinical risk (CCR) score was built by summing up binary risk factors (neonatal, cardiac, neurologic) based on clinically relevant thresholds. The role of family‐environmental factors (parental education, parental mental health, and family function) was investigated. An age‐adjusted executive function summary score was built from nine neuropsychological tests. While network integration and segregation were preserved in adolescents with CHD, they showed lower edge strength in a dense subnetwork. A higher CCR score was associated with lower network segregation, edge strength, and executive function performance. Edge strength was particularly reduced in a subnetwork including inter‐frontal and fronto‐parietal‐thalamic connections. There was no association with family‐environmental factors. Poorer executive functioning was associated with lower network integration and segregation. We demonstrated evidence for alterations of network connectivity strength in adolescents with CHD — particularly in those patients who face a cumulative exposure to multiple clinical risk factors over time. Quantifying the cumulative load of risk early in life may help to better predict trajectories of brain development in order to identify and support the most vulnerable patients as early as possible. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Dofetilide is a class III antiarrhythmic agent approved for the treatment of atrial fibrillation and atrial flutter. Given the efficacy of other class III agents, it has been used off‐label for the treatment of premature ventricular complexes (PVCs) and ventricular tachycardias (VTs).The purpose of this study was to determine the efficacy and safety of dofetilide for ventricular arrythmias (VAs).In this retrospective cohort study, 81 patients (59 men; age = 60 ± 14 years; LVEF = 0.34 ± 0.16) were admitted for dofetilide initiation to treat PVCs (29), VTs (42) or both (10). A ≥ 80% decrease in PVC burden was defined as a satisfactory response. An ICD was present in 72 patients (89%). Another antiarrhythmic was previously used in 50 patients (62%). Prior catheter ablation had been performed in 33 patients (41%).During intitiation, dofetilide was discontinued in 12 patients (15%) due to QT prolongation (8) and inefficacy to suppress VAs (4). Among the 32 patients with PVCs who successfully started dofetilide, the mean PVC burden decreased from 20 ± 10% to 8 ± 8% at a median follow‐up of 2.6 months (p < .001). PVC burden was reduced by ≥80% in only 11/32 patients (34%). During 7 ± 1 years of follow‐up, 41/69 patients (59%) continued to have VAs and received appropriate ICD therapies for monomorphic VTs (35) and polymorphic VT/VF (6) at a median of 8.0 (IQR 2.6–33.2) months. Dofetilide had to be discontinued in 50/69 patients (72%) due to inefficacy or intolerance. The composite outcome of VT/VF recurrence, heart transplantation, or death occurred in 6/12 patients (50%) without dofetilide and 49/69 patients (71%) with dofetilide. The event free survival was similar between patients treated with and without dofetilide (log‐rank p = .55).Treatment with dofetilide was associated with a decrease in PVCs, however clinically significant suppression occurred in a minority of patients. Dofetilide failed to suppress the occurrence of VTs in a majority of patients. [ABSTRACT FROM AUTHOR]

Purpose: Left ventricular assisting device (LVAD) is a vital mechanical circulatory assist device for patients with end-stage heart disease, serving as either a bridge to transplantation or palliative destination therapy. Yet device infection represents a major lethal complication, warranting a multi-step, complex therapy approach including an urgent device exchange or heart transplantation. Still, timely diagnosis of site and extent of VAD-specific infection for a proper therapy planning poses challenges in regular clinical care. This single-center, retrospective study aimed to evaluate the impact of volumetric PET parameters with different thresholding compared to semiquantitative PET parameters for accurate diagnosis of VAD-specific infection. Procedures: Seventeen patients (1 female, 16 males; mean age 57 ± 11 years) underwent [18F]FDG imaging for suspected VAD-specific infection between April 2013 and October 2023. Various metabolic and volumetric PET parameters with different thresholding were collected for specific LVAD components including driveline entry point, subcutaneous driveline, pump pocket, inner cannula and outflow tract. Microbiology and clinical follow-up were used as the final diagnosis standard. Results: Nine of eleven patients with VAD-specific infection underwent urgent heart transplantation, and one had a surgical revision of LVAD. Two patients had non-VAD specific infections, and two had non-VAD related infections. Metabolic burden determination using a fixed absolute threshold provided the best outcome compared to relative thresholding or other metabolic SUV parameters. The total metabolic tumor volume (MTV) cutoff value was 9.3 cm3, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.43%, 82.5%, and 0.814 (95% CI 0.555–0.958), respectively. The total lesion glycolysis (TLG) was 30.6, and the corresponding sensitivity, specificity, accuracy, and AUC were 90.0%, 71.4%, 82.5%, and 0.829 (95% CI 0.571–0.964), respectively. Conclusions: Volumetric PET parameters with fixed absolute thresholding appear to be a valuable auxiliary tool in the evaluation of [18F]FDG imaging to enhance the diagnostic accuracy of VAD-specific infection. [ABSTRACT FROM AUTHOR]

Introduction: Despite proven benefits, patients with coronary heart disease (CHD) typically fail to participate in sufficient physical activity (PA). Effective interventions should be implemented to help patients maintain a healthy lifestyle and modify their present behavior. Gamification is the use of game design features (such as points, leaderboards, and progress bars) to improve motivation and engagement. It shows the potential for encouraging patients to engage in PA. However, empirical evidence on the efficacy of such interventions among patients with CHD is still emerging. Purpose: The aim of the study is to explore whether a smartphone-based gamification intervention could increase PA participation and other physical and psychological outcomes in CHD patients. Methods: Participants with CHD were randomly assigned to three groups (control group, individual group, and team group). The individual and team groups received gamified behavior intervention based on behavioral economics. The team group combined gamified intervention with social interaction. The intervention lasted for 12 weeks, and the follow-up was12 weeks. The primary outcomes included the change in daily steps and the proportion of patient days that step goals were achieved. The secondary outcomes included competence, autonomy, relatedness, and autonomous motivation. Results: For the individual group, smartphone-based gamification intervention significantly increased PA among CHD patients over the 12-week period (step count difference 988; 95% CI 259−1717; p < 0.01) and had a good maintenance effect during the follow-up period (step count difference 819; 95% CI 24−1613; p < 0.01). There are also significant differences in competence, autonomous motivation, body mass index (BMI), and waist circumference in 12 weeks between the control group and individual group. For the team group, gamification intervention with collaboration didn't result in significant increases in PA. But patients in this group had a significant increase in competence, relatedness, and autonomous motivation. Conclusion: A smartphone-based gamification intervention was proven to be an effective way to increase motivation and PA engagement, with a substantial maintenance impact (Chinese Clinical Trial Registry Identifier: ChiCTR2100044879). [ABSTRACT FROM AUTHOR]

Percutaneous mitral balloon commissurotomy (PMBC) is the standard treatment option for patients with rheumatic mitral stenosis (MS), according to current guidelines. This study aimed to compare the outcomes of rheumatic mitral valve repair (rMVR) and PMBC in this patient population. Baseline, clinical, and follow-up data from 703 patients with rheumatic heart disease who underwent PMBC or rMVR at the current centre were collected and analysed. A 1:1 propensity score (PS) matching method was used to balance the differences in baseline characteristics between the two groups. The primary outcome was mitral valve reoperation, and the secondary outcome was all-cause mortality. Propensity score matching generated 101 patient pairs for comparison. In the matched population, there were no significant differences in the early clinical outcomes between the groups. The median follow-up time was 40.9 months. Overall, patients in the rMVR group had a statistically significantly lower risk of mitral valve reoperation than those in the PMBC group (HR 0.186; 95% CI 0.041–0.835; p=0.028). Regarding all-cause mortality, no statistically significant differences were observed between the rMVR and PMBC groups (HR 4.065; 95% CI 0.454–36.374; p=0.210). Compared with PMBC, rMVR has more advantages for the correction of valve lesions; therefore, it may offer a better prognosis than PMBC in select patients with rheumatic MS. However, this finding needs to be verified in future studies with larger sample sizes and longer follow-up periods. [ABSTRACT FROM AUTHOR]

MicroRNA(miR)-143 and miR-145 are mainly expressed in vascular smooth muscle cells. However, the relationship between plasma miR-143 or miR-145 levels and the left ventricular (LV) function in patients with heart diseases remains unclear. Blood samples were taken from the antecubital vein in patients with heart diseases (n = 52), such as coronary artery disease, old myocardial infarction, cardiomyopathy, and valvular heart disease, and controls without heart diseases (n = 22). We measured plasma miR-143 and -145 levels by quantitative RT–PCR using TaqMan MicroRNA Assays and THUNDERBIRD Probe qPCR Mix. Plasma BNP levels were also measured. Echocardiography was performed to measure the LV ejection fraction (LVEF) and LV dilation. Plasma miR-143 and miR-145 levels were significantly higher in patients with heart diseases than in controls, respectively. Plasma miR-143 and miR-145 levels were significantly higher in patients with LVEF < 50% than in those with LVEF ≧ 50%, respectively. Plasma miR-143 and miR-145 levels were inversely correlated with LVEF, respectively. Plasma miR-143 and miR-145 levels were positively correlated with LV end-systolic dimension, respectively. Plasma miR-143 and -145 levels were positively correlated with plasma BNP levels, respectively. Plasma BNP levels were inversely correlated with LVEF. Plasma miR-143 and miR-145 levels are elevated in patients with LV dysfunction and may counteract LV dysfunction. [ABSTRACT FROM AUTHOR]

Asymptomatic paroxysmal atrial fibrillation (AF) is often found in patients implanted with cardiac implantable electronic devices (CIEDs). Second-generation atrial antitachycardia pacing (A-ATP) is effective in managing AF in patients implanted with CIEDs. The purpose of this study was to evaluate the efficacy and safety of A-ATP in patients implanted with CIEDs. This was a single-center retrospective study involving 91 patients (male 46 patients, mean age 74 ± 9 years) implanted with Reactive A-ATP equipped devices (84 patients with pacemakers, 6 with ICDs, and 1 with a CRT-D). The AF burden, rate of AF termination, and details of the activation of the A-ATP were analyzed in each patient. During a mean follow-up period of 21 ± 13 months, A-ATP was activated in 45 of 91 patients (49.5%). No patients had adverse events. Although the efficacy of the A-ATP varied among the patients, the median rate of AF termination was 44%. In comparison to the A-ATP start time, "0 min" had a higher AF termination rate by the A-ATP (39.4% vs. 24.4%, P = 0.011). The rate of termination by the A-ATP was high for AF with a long cycle length and a relatively regular rhythm. A-ATP successfully terminated AF episodes in some patients implanted with CIEDs. The optimal settings of the A-ATP will be determined in future studies. [ABSTRACT FROM AUTHOR]

Background Atrioventricular block is common with adult congenital heart disease and pacemaker implantation is challenging. Atrioventricular synchronous pacing is important for better haemodynamics. This case reports the implantation of a dual-chamber leadless pacemaker in a patient with univentricular heart physiology and contributes to the literature regarding the management option in complex adult congenital heart disease patients with conduction abnormalities. Case summary A 25-year-old male with double inlet left ventricular, transposition of great arteries, hypoplastic aortic arch receive multiple surgeries including the Glenn shunt at the age of 1. He presented with 2:1 and 3:1 heart block at the age of 13 with a transvenous dual-chamber pacemaker implanted by pacing the superior vena cava stump and puncturing the Glenn shunt for the ventricular lead. A decade later, lead malfunctioned and the patient progressed to complete heart block. A subcutaneous implantable cardioverter defibrillator was implanted when he was 23 for monomorphic ventricular tachycardia. Given the anticipated challenges with transvenous lead extraction and epicardial pacemaker implantation, we implanted the novel dual-chamber leadless pacemakers which resulted in satisfactory atrioventricular synchronous pacing performance immediately post-op and 2 weeks after the procedure. Discussion We present a case of a novel dual-chamber leadless pacemaker implantation to maintain atrioventricular synchrony in the patient with complete heart block and univentricular physiology. This case illustrates an additional pacing option in complex adult congenital heart to maintain atrioventricular synchrony. [ABSTRACT FROM AUTHOR]

Aims: Individuals with congenital heart disease (CHD) are at an increased risk for cancer. As cancer survival rates improve, the prevalence of late side effects, such as heart failure (HF), is becoming more evident. This study aims to evaluate the risk of developing HF following a cancer diagnosis in patients with CHD, compared with those without CHD and with CHD patients who do not have cancer. Methods: CHD patients (n = 69 799) and randomly selected non‐CHD controls (n = 650 406), born in Sweden between 1952 and 2017, were identified from the Swedish National Health Registers and Total Population Register (excluding those with syndromes and transplant recipients). CHD patients who developed cancer (n = 1309) were propensity score‐matched with non‐CHD patients who developed cancer (n = 9425), resulting in a cohort of 1232 CHD patients with cancer and 2602 non‐CHD controls with cancer (after exclusion of individuals with HF prior to cancer diagnosis). In a separate analysis, CHD patients with cancer were propensity score‐matched with CHD patients without cancer (n = 68 490). A total of 1233 CHD patients with cancer and 2257 CHD patients without cancer were included in the study. Results: Among CHD patients with cancer, 73 (5.9%) developed HF during a mean follow‐up time of 8.5 ± 8.7. Comparatively, in the propensity‐matched control population, 29 (1.1%) non‐CHD cancer patients (mean follow‐up time of 7.3 ± 7.5) and 101 (4.5%) CHD patients without cancer (mean follow‐up time of 9.9 ± 9.2) developed HF. CHD patients exhibited a significantly higher risk of HF post‐cancer diagnosis compared with the non‐CHD control group [hazard ratio (HR) 4.39, 95% confidence interval (CI) 2.83–6.81], after adjusting for age at cancer diagnosis and comorbidities. In the analysis between CHD patients with cancer and those without cancer, the results indicated a significantly higher risk of developing HF in CHD patients with cancer (HR 1.53, 95% CI 1.13–2.07). Conclusions: CHD patients face a more than four‐fold increased risk of developing HF after a cancer diagnosis compared with cancer patients without CHD. Among CHD patients, the risk of HF is only modestly higher for those with cancer than for those without cancer. This suggests that the increased HF risk in CHD patients with cancer, relative to non‐CHD cancer patients, may be more attributable to CHD itself than to cancer treatment‐related side effects. [ABSTRACT FROM AUTHOR]