Clinical Medicine Insights. Cardiology最新文献

{"title":"Unsupervised Phenotyping of Atrial Fibrillation Using Variational Autoencoders in a Critical Care Cohort: The ATLAS-AF Study.","authors":"Samer G Salman, Akhil Javvadi, Zane G Salman, Sai Madhav Yedupati, Alessandra Pina, Prashanthan Sanders, Sainyam Galhotra, Ajay Tripuraneni","doi":"10.1177/11795468261490000","DOIUrl":"10.1177/11795468261490000","url":null,"abstract":"<p><strong>Objective: </strong>Atrial fibrillation (AF) is a heterogeneous disorder associated with substantial morbidity and mortality, yet management remains largely guided by traditional classifications and risk scores. We aimed to identify distinct AF phenotypes using variational autoencoder (VAE)-based unsupervised learning and to evaluate differences in mortality, healthcare utilization, and treatment patterns across them.</p><p><strong>Methods: </strong>Retrospective observational cohort study in MIMIC-IV v3.1, a single-center critical care database, restricted to the 2014 to 2016, 2017 to 2019, and 2020 to 2022 anchor year groups. In 13,967 patients with AF, a patient-level matrix of 35 demographic, comorbidity, medication, laboratory, AF characteristic, and utilization features was used to train a VAE for nonlinear dimensionality reduction, followed by K-means clustering at k = 6. Phenotypes were compared by Kaplan-Meier and Cox analysis of all-cause mortality, with Phenotype 4 (High AF Chronicity) as the reference because it had the longest reverse Kaplan-Meier follow-up, and by incremental discrimination beyond routinely available variables. Reproducibility was assessed by two-level bootstrap resampling against a permuted-data null.</p><p><strong>Results: </strong>Six phenotypes were identified (n = 1,906 to 2,925): Phenotype 1 (Cerebrovascular-Predominant), Phenotype 2 (Hypoalbuminemic-Anemic), Phenotype 3 (Low Comorbidity Burden), Phenotype 4 (High AF Chronicity), Phenotype 5 (Warfarin-Predominant Anticoagulation), and Phenotype 6 (Renal Dysfunction). All-cause mortality differed across phenotypes (log-rank p<0.001), with 14 of 15 pairwise comparisons significant after Bonferroni correction. Observed-death proportions ranged from 11.1% to 48.1%, but accrued over markedly unequal observation windows (reverse Kaplan-Meier median follow-up 5.3 to 854.9 days) and are not comparable risks. Phenotype membership remained associated with mortality after adjustment for age and sex, the adjustment set that minimizes overlap with the phenotype-defining features. Adding phenotype to a model of age, sex, CHA<sub>2</sub>DS<sub>2</sub>-VASc, and three routine laboratory values raised the concordance index from 0.683 to 0.733, although a conventional model containing utilization variables and no phenotype term reached 0.745. Thirty-day readmission ranged from 13.0% to 42.1% and intensive care admission from 33.6% to 77.8%; because utilization variables also helped define the clusters, these are descriptive characteristics of the phenotypes rather than independent outcomes, and rebuilding the phenotypes without those variables halved the intensive care spread to 25.1 percentage points.</p><p><strong>Conclusion: </strong>VAE-based unsupervised learning identified six AF phenotypes with substantial differences in mortality, healthcare utilization, and treatment patterns, highlighting clinically meaningful heterogeneity within AF. Cluster separation met","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261490000"},"PeriodicalIF":2.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the Unknown: A Case Report of Undifferentiated Pleomorphic Sarcoma in the Heart.","authors":"Dina Fa Alwaheidi, Mohd Lateef Wani, Ashfaq Patel","doi":"10.1177/11795468251408695","DOIUrl":"10.1177/11795468251408695","url":null,"abstract":"<p><p>Undifferentiated pleomorphic sarcoma (UPS) of the heart is an exceedingly rare and highly aggressive tumor. We present the case of a 66-year-old male with a history of stage I prostatic acinar adenocarcinoma who was incidentally found to have a left atrial mass during cancer workup. Multimodal imaging (echocardiography, CMR, PET-CT) initially suggested a benign lesion. The patient underwent surgical excision of the mass, which revealed UPS confirmed by histopathology and immunohistochemistry. Postoperatively, the patient experienced right-sided heart failure, recurrent skin ulcers requiring grafting, and atrial arrhythmia. Despite complications, he stabilized and started chemotherapy and oncologic follow-up. This case highlights the diagnostic pitfalls of cardiac UPS, the necessity for tissue confirmation, and the role of coordinated multidisciplinary care.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468251408695"},"PeriodicalIF":2.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting Frailty-Depression Overlap When Cardiovascular Disease Enters the Frailty Construct.","authors":"Güney Sarıoğlu","doi":"10.1177/11795468261488708","DOIUrl":"10.1177/11795468261488708","url":null,"abstract":"","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261488708"},"PeriodicalIF":2.0,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial Metabolic Profiling of Human Atrial Tissue in Atrial Fibrillation Using DESI-MSI: An Exploratory Pilot Study.","authors":"Beatrice Bacchi, Fabrizio Rosati, Camila Mayorga Palacios, Martin Kaufmann, Kevin Ren, John F Rudan, Gianluigi Bisleri","doi":"10.1177/11795468261486227","DOIUrl":"10.1177/11795468261486227","url":null,"abstract":"<p><strong>Background: </strong>Structural remodeling and atrial fibrosis are hallmarks of atrial fibrillation (AF), yet molecular alterations associated with atrial remodeling remain incompletely characterized, particularly their spatial distribution within human atrial tissue. Desorption Electrospray Ionization Mass Spectrometry Imaging (DESI-MSI) enables spatially resolved metabolic profiling of tissue sections and may provide insight into metabolic alterations associated with atrial remodeling in AF. This study investigated whether DESI-MSI could identify distinct metabolic signatures in atrial tissue from patients with AF.</p><p><strong>Methods: </strong>In this exploratory pilot study, atrial tissue samples from 10 patients undergoing cardiac surgery (4 with AF and 6 controls) underwent DESI-MSI analysis across an m/z range of 50-1200, followed by histologic assessment with hematoxylin-eosin staining. Metabolic profiles were analyzed using principal component analysis (PCA) and linear discriminant analysis (LDA) to explore group-specific metabolic patterns.</p><p><strong>Results: </strong>Histologic evaluation demonstrated minimal fibrosis without significant differences between AF and control samples. In contrast, DESI-MSI identified distinct metabolic features associated with AF. Arachidonic acid (m/z 303.2) and phosphatidylinositol species (m/z 885.5) demonstrated spatial correspondence with myocardial architecture and contributed to metabolic separation between groups. Exploratory supervised multivariate analysis showed partial separation between AF and control spectra, while LD loading plots identified differential lipid-related ion patterns associated with AF samples.</p><p><strong>Conclusions: </strong>In this exploratory pilot cohort, DESI-MSI demonstrated preliminary metabolic differences between AF and control atrial tissues despite limited histologic remodeling. These findings should be considered hypothesis-generating and will require validation in larger, adequately matched cohorts integrating metabolic, histologic, and clinical phenotypes. Although they do not establish that metabolic remodeling precedes fibrosis, they raise the possibility that DESI-MSI may detect metabolic differences in atrial tissue exhibiting minimal histologic remodeling.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261486227"},"PeriodicalIF":2.0,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatic Heart Disease in Pregnancy in Sub-Saharan Africa: A Case Series Emphasizing Gaps in Access to Definitive Care.","authors":"Pearson Mwemezi, Gissela B Nyakunga, Alex F Lwiza, Simon C Peter, Hendrina Lazarus, Hellen Kyilyosudu, Beatrice Kabuka, Abid M Sadiq","doi":"10.1177/11795468261479407","DOIUrl":"https://doi.org/10.1177/11795468261479407","url":null,"abstract":"<p><p>Rheumatic heart disease (RHD) remains a major cause of maternal cardiovascular morbidity and mortality in low-resource settings, particularly among women of reproductive age. Physiological changes during pregnancy can unmask previously undiagnosed disease or precipitate decompensation in those with established valvular lesions. We present a case series of three women with RHD during pregnancy and the early postpartum period, highlighting the burden, clinical presentation, and management challenge in a resource-limited setting. All patients presented with advanced disease, including severe mitral stenosis, atrial fibrillation, and heart failure, with one case complicated by multivalvular involvement and reduced left ventricular function. Management focused on hemodynamic stabilization using diuretics, rate control, anticoagulation, and multidisciplinary care. Definitive interventions such as percutaneous balloon mitral valvotomy or valve replacement were indicated but deferred due to limited availability and financial constraints. All three mothers were clinically stabilized and remained alive at short-term follow-up, although one preterm neonate died from respiratory distress syndrome and Case 3 required readmission because of medication nonadherence. This series underscores the persistent burden of RHD in pregnancy in sub-Saharan Africa and highlights critical gaps in access to definitive cardiac interventions and anticoagulation monitoring. Strengthening health systems, improving access to specialized cardiac care, and implementing preventive strategies are essential to reduce morbidity and mortality associated with RHD in pregnancy in resource-limited settings.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261479407"},"PeriodicalIF":2.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Chronic Risk Meets Acute Strain: Sudden Cardiac Death and Cardiovascular Vulnerability in Firefighters.","authors":"Ibrahim Mortada, Ebrahim Adel Elkolaly, Aaron W Lee, Dalton Buckingham, Diann Gaalema, Mostafa Shalaby, Michael C Boyars, Thomas A Blackwell, Hani Jneid","doi":"10.1177/11795468261479323","DOIUrl":"10.1177/11795468261479323","url":null,"abstract":"<p><p>Cardiovascular disease remains the leading cause of line-of-duty mortality among firefighters. Sudden cardiac death occurs disproportionately during emergency operations, particularly fire suppression, suggesting an interaction between occupational stressors and underlying cardiovascular vulnerability. This narrative review integrates epidemiologic, mechanistic, and clinical data from observational studies, systematic reviews, and contemporary cardiovascular guidelines. A structured literature search of PubMed and Google Scholar identified studies addressing cardiovascular disease, sudden cardiac death, occupational stress, and autonomic regulation in firefighters. Autopsy and case-control data indicate that most duty-related sudden cardiac deaths occur in the presence of underlying coronary atherosclerosis. Firefighters exhibit a high prevalence of cardiovascular risk factors, including hypertension (10%-44%), obesity (14%-60%), dyslipidemia (20%-56%), and metabolic syndrome (∼22%); these rates exceed those reported in age-matched general-population samples. Emergency operations are associated with marked sympathetic activation, hemodynamic stress, and circadian perturbation, which may promote plaque destabilization, myocardial ischemia, and ventricular arrhythmia. Additionally, occupational stress and sleep disturbance are linked to autonomic imbalance, potentially increasing arrhythmic susceptibility. Sudden cardiac death in firefighters reflects the interaction between baseline cardiometabolic risk and intermittent high-intensity physiologic stress rather than a distinct occupational disease entity. Early risk identification, guideline-directed therapy, and recognition of occupational stressors are central to cardiovascular risk reduction in this population.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261479323"},"PeriodicalIF":2.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148719837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overlap of Frailty and Depression and Its Association With Cardiovascular Disease: A Population-Based Study.","authors":"Diego Armando Pérez Covo, Cristian Orlando Porras Bueno, Diego Alejandro Ortega Gomez, Sofía Rodríguez Urrego, Ana Sofía Trujillo Henao, Andres Felipe Camargo Abello, Catalina Arbelaez Hoyos, Fabian Gil, Rodrigo Castro Paris, Edward Andres Cáceres Méndez, Ángel Alberto García Peña","doi":"10.1177/11795468261475707","DOIUrl":"10.1177/11795468261475707","url":null,"abstract":"<p><strong>Background: </strong>Depression and frailty are prevalent geriatric syndromes. Their co-occurrence may define a phenotype of heightened cardiovascular disease (CVD). In Latin America the joint association of these syndromes with CVD has not been previously characterised.</p><p><strong>Objective: </strong>To evaluate the association between the overlap of depression and frailty and the prevalence of CVD in older adults.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using data from the 2015 SABE Colombia study. Adults aged ≥60 years with complete information on depression, frailty, and history of acute myocardial infarction or stroke defined as CVD were included. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using bivariate and multivariate log-binomial regression models.</p><p><strong>Results: </strong>18,973 participants were analysed (mean age 69.3 ± 7.1 years; 56% women). The prevalence of depression, frailty, and CVD was 57.3%, 3.5%, and 15.4%, respectively. In bivariate analyses, depression (PR 1.83, 95% CI 1.51-2.23), prefrailty (PR 1.61, 95% CI 1.50-1.73), and frailty (PR 2.91, 95% CI 2.57-3.28) were associated with CVD. In multivariate model, the overlap of depression and frailty demonstrated the strongest association with CVD (PR 4.86; 95% CI 3.37-7.01), exceeding that of depression with prefrailty and each condition individually. This association persisted after adjustment for traditional cardiovascular risk factors (PR 2.05, 95% CI 1.05-3.97).</p><p><strong>Conclusion: </strong>In older adults, the overlap of depression and frailty remained associated with a higher prevalence of CVD after adjustment for traditional cardiovascular risk factors. Although the association was attenuated after adjustment, the coexistence of both conditions remained associated with increased cardiovascular burden.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261475707"},"PeriodicalIF":2.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13434886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Men Fare Worse: Understanding Gender Disparities in Systemic Sclerosis-Associated Pulmonary Hypertension.","authors":"Francesca Coppi, Gianluca Pagnoni, Ashraf Nassar, Marco de Pinto, Amelia Spinella, Stefania Cerri, Valentina Selleri, Daniela Aschieri, Anna Vittoria Mattioli, Giuseppe Boriani, Francesco Fedele, Dilia Giuggioli, Marcello Pinti","doi":"10.1177/11795468251396355","DOIUrl":"10.1177/11795468251396355","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates gender disparities in clinical outcomes among patients with systemic sclerosis (SSc)-associated pulmonary arterial hypertension (PAH), focusing on cardiovascular events, right ventricular function, and survival.</p><p><strong>Introduction: </strong>PAH is a severe and life-threatening complication of SSc, with male patients often experiencing worse outcomes despite its higher prevalence in women. Comparative data on gender differences in this population remain limited.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study including 61 patients with SSc-associated PAH (52 women, 9 men), confirmed by right heart catheterization. Clinical, serological, pulmonary, and echocardiographic data were analyzed. Differences between sexes in cardiovascular events, right ventricular dilation, and survival were evaluated using appropriate statistical methods.</p><p><strong>Results: </strong>Male patients had a significantly higher incidence of cardiovascular events (median: 2.00 vs 1.00 in women; <i>P</i> = .031) and a greater prevalence of right ventricular dilation (100.00% vs 44.23%; <i>P</i> = .002). Kaplan-Meier analysis demonstrated reduced cardiovascular event-free survival (<i>P</i> = .001) and overall survival (<i>P</i> = .014) in men. Although mortality was higher in men (88.89%) than in women (57.69%), the difference was not statistically significant (<i>P</i> = .134).</p><p><strong>Conclusion: </strong>Men with SSc-associated PAH experience worse clinical outcomes, including more frequent cardiovascular events and reduced survival. The absence of estrogen's protective effects and the adverse influence of testosterone on cardiac remodeling may contribute to these disparities. These findings highlight the importance of early gender-specific risk stratification and the need for tailored therapeutic strategies to improve outcomes in this high-risk group.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468251396355"},"PeriodicalIF":2.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter-2 Inhibitors Following Acute Myocardial Infarction in Patients Without Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials.","authors":"Muhammad Ahmed, Muhammad Hamza Shuja, Shajia Shakil, Huzaifa Ul Haque Ansari, Firzah Shakil, Muhammad Abdullah Naveed, Syed Atta Ur Rehman, Narmeen Shaikh, Syed Hassaan Ali, Haya Waseem Ansari, Faiza Sajid, Mustafa Murtaza, Muhammad Usman, Biruk Demisse Ayalew","doi":"10.1177/11795468261469143","DOIUrl":"10.1177/11795468261469143","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose transporter 2 (SGLT2) inhibitors have shown significant cardiovascular benefits in heart failure (HF) patients with diabetes mellitus or chronic kidney disease. However, their safety and efficacy in non-diabetic patients without HF presenting with acute myocardial infarction (AMI) remain understudied.</p><p><strong>Methods: </strong>Databases including MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov were queried through August 2025 to identify randomized controlled trials (RCTs). Data were pooled using a random-effects model using risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Five RCTs involving 9,135 patients (SGLT2i: 4,581 and placebo: 4,554) were included. On pooled analysis, SGLT2 inhibitors were associated with significantly reduced first HF hospitalization (RR: 0.74, p=0.02), improved LVEF (MD: 2.08; p=0.002), and reduced NT-proBNP levels (MD: 12.81; p < 0.0001). No significant differences were noted in all-cause mortality and the composite of first HF hospitalization with all-cause mortality.</p><p><strong>Conclusion: </strong>In non-diabetic patients without HF, SGLT2 inhibitors significantly reduce the first HF hospitalization and improve LVEF following AMI. The findings of this meta-analysis suggest that future research should evaluate the cardiovascular benefits of SGLT2 inhibitors in this patient population.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261469143"},"PeriodicalIF":2.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Implantable Left Ventricular Assist Devices for Destination Therapy: A Peruvian Health Technology Assessment.","authors":"Carlos J Toro-Huamanchumo, Andrea M Rivera-Santillán, Carolay Z Vasquez-Quispe, Julissa E Venancio-Huerta, Lucy J Gendrau-Castillo, Verónica Peralta, Maribel M Castro-Reyes, José A Zavala-Loayza","doi":"10.1177/11795468261433692","DOIUrl":"10.1177/11795468261433692","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the efficacy and safety of the HeartMate 3 (HM3) left ventricular assist device (LVAD) as a destination therapy (DT) for patients with end-stage heart failure (HF) ineligible for transplantation, from a Peruvian healthcare perspective.</p><p><strong>Methods: </strong>A health technology assessment (HTA) was conducted, which included a systematic review of clinical effectiveness and safety, complemented by a critical appraisal of relevant evidence. Searches were performed in 3 databases, complemented by manual searches in HTA organizations and clinical practice guidelines (CPGs) repositories. The search included CPGs, HTAs, randomized clinical trials (RCTs), and high-quality observational studies evaluating LVADs for DT. Cost-effectiveness analyses and device costs specific to the Peruvian context were also reviewed.</p><p><strong>Results: </strong>All the CPGs supported the use of the HM3 LVAD, emphasizing its significant survival benefits demonstrated in primary studies. The HM3 showed a 5-year survival rate exceeding 50%, compared to 25% at 1 year and 8% at 2 years with optimal medical therapy (OMT). Functional and quality of life outcomes also improved significantly. However, common adverse events included bleeding and infections. Cost-effectiveness analyses from high-income settings indicated that the HM3 exceeded conventional willingness-to-pay thresholds but highlighted its critical clinical benefits for high-risk patients with no alternative therapies.</p><p><strong>Conclusion: </strong>The HM3 LVAD offers significant survival and quality of life improvements for patients with end-stage HF ineligible for transplantation. Despite challenges in cost-effectiveness, the adoption of the HM3 as DT in Peru is justified to address a critical unmet clinical need, provided robust medical device surveillance is implemented.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"20 ","pages":"11795468261433692"},"PeriodicalIF":2.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}