Critical Pathways in Cardiology最新文献

{"title":"Various Psychiatric Comorbidities and Smoking Appear to be Associated With Takotsubo Cardiomyopathy: A Nationwide Analysis From 2016 to 2022.","authors":"Ryan Hassen, Mehrtash Hashemzadeh, Mohammad Reza Movahed","doi":"10.1097/HPC.0000000000000421","DOIUrl":"10.1097/HPC.0000000000000421","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo cardiomyopathy (TTC) is an acute heart condition in which physical or emotional stress causes left ventricular dysfunction. Psychiatric comorbidities have been linked to the precipitation of this condition, but large-scale data are limited. The goal of this study was to analyze the associations between TTC and various psychiatric conditions using nationally representative data.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted using the Nationwide Inpatient Sample database from 2016 to 2022. International Classification of Diseases, Tenth Revision code I51.81 was used to identify hospitalized patients ≥18 years with a primary diagnosis of TTC. In addition, International Classification of Diseases, Tenth Revision codes were used to identify patients diagnosed with various psychiatric comorbidities.</p><p><strong>Results: </strong>A total of 291,600 patients had a primary diagnosis of TTC. The mean age was 67.1 ± 14.26 years, and 82.04% of the population was female. The following 4 psychiatric comorbidities were found to have significant associations with TTC: nicotine dependence [17.48% of patients; P < 0.001; odds ratio (OR), 1.08; 95% confidence intervals (CI), 1.06-1.11], depressive disorders (19.20% of patients; P < 0.001; OR, 1.46; 95% CI, 1.43-1.49), anxiety (24.25% of patients; P < 0.001; OR, 1.83; 95% CI, 1.80-1.87), and post traumatic stress disorder (2.91% of patients; P < 0.001; OR, 1.25; 95% CI, 1.18-1.31). No significant associations were found for dementia, alcohol related disorders, substance use other than tobacco and alcohol, manic disorders, or schizophrenia.</p><p><strong>Conclusions: </strong>In this large, nationally representative sample, nicotine dependence, anxiety, depression, and post traumatic stress disorder were significantly associated with TTC. These findings highlight the importance of incorporating psychiatric health practices into the field of cardiology.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0421"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469402","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 Direct Oral Anticoagulants in Extended Venous Thromboembolism: A Placebo-Controlled Grade Assessed Meta-Analysis.","authors":"Zaryab Bacha, Khola Qazi, Aizaz Anwar Khalid, Zefaf Ali Shah, Muhammad Zafar Khan, Munazza Sikandar, Fatima Sajjad, Saad Saeed, Faiza Akbar, Kinza Siddique, Amina Zia Rashid, Muhammad Abdullah Ali, Muhammad Shahzad, Javeria Javed, Sajjad Ghanim Al-Badri","doi":"10.1097/HPC.0000000000000417","DOIUrl":"10.1097/HPC.0000000000000417","url":null,"abstract":"<p><p>Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism, is a major cardiovascular condition associated with substantial morbidity, mortality, and risk of recurrence. Extended anticoagulation is frequently required beyond the initial treatment phase, yet the optimal strategy remains uncertain. Direct oral anticoagulants (DOACs) provide practical advantages over vitamin K antagonists, but their role in long-term secondary prevention warrants clarification. We performed a systematic review and meta-analysis of placebo-controlled randomized controlled trials evaluating extended DOAC therapy in VTE. A comprehensive literature search identified 5 eligible trials with a total of 13,802 patients. Data were pooled using random-effects models to calculate risk ratios (RR) and 95% confidence intervals (CI). Outcomes included recurrent VTE, DVT, pulmonary embolism, mortality, stroke, cancer incidence, and bleeding events. Compared with placebo, extended DOAC therapy significantly reduced symptomatic recurrent VTE (RR, 0.26; 95% CI, 0.16-0.41), with consistent findings across sensitivity analyses. DOACs demonstrated strong protection against recurrent DVT, while results for recurrent pulmonary embolism were less consistent. No significant differences were observed in all-cause mortality, ischemic stroke, or cancer incidence. Safety analyses showed no increase in major bleeding. Extended DOAC therapy is highly effective in preventing recurrent VTE, particularly DVT, and maintains an acceptable safety profile. Despite the absence of mortality or stroke benefit, the favorable efficacy-safety balance supports DOACs as a convenient and effective option for prolonged secondary prevention in patients at ongoing risk of recurrence.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0417"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120494","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":"Impact of COVID-Era Emergency Department Bypass Suspension on ST-Segment Elevation Myocardial Infarction System Performance in Rural Practice.","authors":"Richard Mullvain, Catherine Benziger, Krysta Kaas, Ramin Artang","doi":"10.1097/HPC.0000000000000419","DOIUrl":"10.1097/HPC.0000000000000419","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, a temporary policy change required emergency medical services (EMS)-identified ST-segment elevation myocardial infarction (STEMI) patients to undergo COVID testing in the emergency department (ED) before percutaneous coronary intervention, suspending the standard ED bypass to the catheterization lab. We compared system performance metrics during this COVID-era routing to pre- and postpandemic periods in a large rural health system.</p><p><strong>Methods: </strong>This was a retrospective single-center cohort study of consecutive EMS-identified STEMI activations across 3 periods: pre-COVID (May 27, 2018-March 26, 2020), COVID-era ED routing (March 27, 2020-January 25, 2022), and post-COVID with resumed ED bypass (January 26, 2022-November 26, 2023). Primary outcomes were standard STEMI system performance metrics; the secondary outcome was in-hospital mortality.</p><p><strong>Results: </strong>A total of 373 patients were included (pre-COVID: 132; COVID: 104; post-COVID: 137). Compared to pre-COVID, the median time from EMS first medical contact to device time increased by 13 minutes ( P = 0.017). The median time from symptom onset to device time increased by 30 minutes ( P = 0.0013). The median time of first EMS electrocardiogram to device placement was increased by 14 minutes ( P = 0.013). The median door-to-device time was increased by 6 minutes ( P = 0.0007). There was a nonsignificant trend toward higher in-hospital mortality during the COVID era.</p><p><strong>Conclusions: </strong>In a rural STEMI system, pandemic-era routing of EMS-identified patients through the ED was associated with significant delays in key reperfusion metrics. While in-hospital mortality did not differ significantly, likely due to limited statistical power, these findings underscore the importance of preserving streamlined STEMI pathways. Larger multicenter studies to assess outcomes are warranted.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0419"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120529","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":"Diagnostic Yield of Transthoracic Echocardiography Among US Emergency Department Observation Unit Patients Evaluated for Transient Ischemic Attack.","authors":"Wesley H Iobst, Salvatore J Lumia, Zohayr A Khan, Stephen Sokolosky, Benjamin T Hutchison, Amy K Guzik, Mary A Wittler, Patrick S Reynolds, Nicklaus P Ashburn","doi":"10.1097/HPC.0000000000000416","DOIUrl":"10.1097/HPC.0000000000000416","url":null,"abstract":"<p><strong>Background: </strong>Patients with potential transient ischemic attacks (TIA) are often evaluated with transthoracic echocardiography (TTE) to identify cardioembolic sources. The diagnostic yield of TTE among patients in an emergency department observation unit (EDOU) with suspected TIA is unknown. We aimed to determine the diagnostic yield of TTE in a US EDOU TIA cohort.</p><p><strong>Methods: </strong>We conducted an observational cohort study using the Wake Forest Emergency Medicine TIA Registry. We included patients ≥18 years old evaluated in the EDOU TIA protocol at a large academic tertiary care center between July 1, 2021 and December 1, 2023. TTE results were reviewed for high-risk cardioembolic features, which we included as patent foramen ovale (PFO), left ventricular ejection fraction (LVEF) ≤40%, focal wall motion abnormalities, and ventricular thrombus. The diagnostic yield, defined as the proportion of patients who were found to have a high-risk cardioembolic feature on TTE, was calculated and reported with an exact 95% confidence interval (95% CI) and used to determine the number needed to test.</p><p><strong>Results: </strong>Among the 686 patients included in our cohort, 67.1% (460/686) underwent TTE. The diagnostic yield of TTE was 19.4% (95% CI, 15.7-23.0%), which corresponds to a number needed to test of 6 (95% CI, 5-7). In our cohort, TTE identified 63 PFOs, 26 instances of LVEF ≤ 40%, 6 focal wall motion abnormalities, and 0 ventricular thrombi.</p><p><strong>Conclusions: </strong>Among patients with suspected TIA in the EDOU, TTE was useful in the detection of high-risk cardioembolic features, especially PFOs and reduced LVEF. These findings support the continued use of TTE for those evaluated for TIA in the EDOU.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0416"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120491","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":"Staged Versus Immediate Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis.","authors":"Mir W Majeed, Zainab Humayun, Dhruvi K Joshi, Khubaib Mohammad Murtafa, Leo Consoli, Mohammad S Arif, Sadiya S Khanday, Rohit V Srinivasan, Mariano G Ruelas, Muhammad Waleed, Piyush Ratan, Shariq A Wani, Bismah A Ali, Saima Zehra, Omar Baqal, Mohsin R Mantoo, Khalid H Changal, Saraschandra Vallabhajosyula","doi":"10.1097/HPC.0000000000000422","DOIUrl":"10.1097/HPC.0000000000000422","url":null,"abstract":"<p><p>Complete revascularization improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD); however, the optimal timing of noninfarct-related artery intervention during the index procedure, immediate revascularization (IR) versus a staged approach (SR), remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials comparing SR and IR in patients with STEMI and MVD. The primary outcome was major adverse cardiovascular events. Secondary outcomes included all-cause and cardiovascular mortality, recurrent myocardial infarction, unplanned ischemia-driven revascularization, stent thrombosis, stroke, major bleeding, acute kidney injury, and heart failure hospitalization. Random-effects models with Hartung-Knapp adjustment were used. Trial sequential analysis assessed evidence conclusiveness, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation. Eight randomized trials, including 5077 patients (2556 SR; 2521 IR), were analyzed. No significant differences were observed between SR and IR for major adverse cardiovascular events [odds ratios (ORs), 1.07; 95% confidence intervals (CI), 0.76-1.49], recurrent myocardial infarction (OR, 1.30; 95% CI, 0.80-2.14), cardiovascular mortality (OR, 0.76; 95% CI, 0.51-1.13), or all-cause mortality (OR, 0.75; 95% CI, 0.54-1.06). Rates of stent thrombosis, stroke, unplanned ischemia-driven revascularization, major bleeding, acute kidney injury, and heart failure hospitalization were also comparable. Trial sequential analysis indicated insufficient information size to draw definitive conclusions, and the certainty of evidence ranged from very low to low. In patients with STEMI and MVD, staged and immediate complete revascularization provide comparable ischemic, safety, and mortality outcomes. Current evidence supports clinical equipoise, and revascularization timing should be individualized pending results from adequately powered trials.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":"25 2","pages":"e0422"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989458","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":"Left Bundle Branch Area Pacing Versus Biventricular Pacing in Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis.","authors":"Nomesh Kumar, Akash Kumar, Shanzay Akhtar, Ahmed Ali Khan, Rana Faheem Ullah Khan, Nimerta Lohana, Diksha Ladhani, Burhan Memon, Sriviji Senthil Kumaran, Pablo Barzallo, Jamal S Rana, Siddharth Shah, M Chadi Alraies","doi":"10.1097/HPC.0000000000000414","DOIUrl":"10.1097/HPC.0000000000000414","url":null,"abstract":"<p><p>Left bundle branch area pacing (LBBAP) has emerged as a physiologically targeted alternative to biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT). We conducted a systematic review and meta-analysis to compare the impact of LBBAP versus BiVP on clinical and procedural outcomes in patients undergoing CRT. A systematic search of PubMed, Cochrane Central, and Embase was conducted in August 2025 to identify studies comparing LBBAP and BiVP in patients undergoing CRT. Eligible studies included randomized and observational designs. Primary outcomes were all-cause mortality and heart failure (HF)-related hospitalization. Secondary outcomes included changes in QRS duration, left ventricular ejection fraction, New York Heart Association class, procedural time, and fluoroscopy time. Meta-analyses were performed using inverse-variance random-effects models. Heterogeneity was assessed using I ², and sensitivity was evaluated with leave-one-out analysis. Effect sizes were reported as relative risks (RR) or mean differences (MD) with corresponding 95% confidence intervals (CI). Eighteen studies (17 observational and 1 randomized controlled trial) encompassing 5605 patients (LBBAP = 2428 and BiVP = 3177) were included in this meta-analysis. Compared to BiVP, LBBAP was associated with a significantly lower risk of all-cause mortality (9.9% vs. 13.9%; RR = 0.68, 95% CI, 0.59-0.79; P < 0.00001; I ² = 0%) and HF-related hospitalization (RR = 0.51, 95% CI, 0.42-0.62; P < 0.00001; I ² = 42%). LBBAP was also associated with a marked improvement in mean left ventricular ejection fraction (MD = 4.71%, 95% CI, 3.80-5.61; P < 0.00001; I ² = 35%) and substantial narrowing of mean QRS duration (MD = -24.60 ms, 95% CI, -29.49 to -19.70; P < 0.00001; I ² = 94%). Functional status (mean New York Heart Association class) was significantly improved within the LBBAP group (MD = -0.31, 95% CI, -0.52 to -0.09; P = 0.005; I ² = 94%). LBBAP was also associated with significantly shorter procedural and fluoroscopy times (MD = -29.77 minutes and -8.62 minutes, respectively) compared to BiVP. This meta-analysis demonstrates that LBBAP is associated with significantly lower all-cause mortality and HF-related hospitalizations compared to BiVP in patients undergoing CRT. LBBAP also offers procedural advantages and greater improvements in electrical and functional cardiac parameters. Further large-scale randomized trials are warranted to confirm these findings.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0414"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985835","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":"Evaluating AI-Enabled Technologies for Atrial Fibrillation Detection: A Systematic Review of Diagnostic Performance.","authors":"Maddison Weber, Mason Klisares, May Li-Jedras, Amjad Kabach","doi":"10.1097/HPC.0000000000000427","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000427","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and a major contributor to stroke and cardiovascular morbidity. Conventional diagnostics, including electrocardiograms (ECG) and ambulatory monitors, are limited by accessibility and short monitoring windows, particularly in asymptomatic or paroxysmal AF. Recently, artificial intelligence (AI)-driven technologies and wearable devices have emerged as promising tools for early AF detection.</p><p><strong>Objective: </strong>This systematic review evaluates the diagnostic performance of AI-enabled and wearable technologies for AF detection in clinical and real-world settings.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Scopus, and Web of Science identified studies reporting sensitivity, specificity, predictive values, and AUC of digital AF detection tools. Platforms included smartphone apps, smartwatches, photoplethysmography (PPG), single- and multi-lead ECGs, and machine learning algorithms. Data extraction and quality assessment used QUADAS-2. Random-effects meta-analyses and subgroup analyses synthesized findings and explored heterogeneity.</p><p><strong>Results: </strong>Twenty-four studies met inclusion criteria. High-performing tools demonstrated sensitivity and specificity ≥94% and AUC ≥0.95, while consumer-grade devices, such as the Apple Heart Study, showed lower specificity (46%) and positive predictive value (7.6%), reflecting frequent false positives. Heterogeneity arose from device type, signal method (PPG vs. ECG), algorithm design, and population characteristics. Tools integrating explainable AI and multi-modal data generally outperformed simpler models.</p><p><strong>Conclusions: </strong>AI-enhanced and wearable technologies show strong potential for accurate AF detection under specific conditions. Performance variability, especially in consumer-grade devices, underscores the need for external validation, algorithm refinement, and clinical integration. Future research should assess real-world effectiveness, cost-efficiency, explainability, and long-term outcomes to support broader adoption.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations for the Adoption of Digital Algorithms and Cardiovascular Decision-Support Tools in Clinical Practice.","authors":"Christopher W Baugh, C Michael Gibson, Evangelos Giannitsis, David A Morrow, James L Januzzi, Cynthia Papendick, Hans-Peter Brunner-La Rocca, Lori B Daniels, Helena Palau, Ludovica Visciola, Martin Than","doi":"10.1097/HPC.0000000000000412","DOIUrl":"10.1097/HPC.0000000000000412","url":null,"abstract":"<p><p>Early detection of cardiovascular disease and implementation of evidence-based treatments can reduce cardiovascular morbidity and mortality. Medical algorithms and decision-making tools provide a compelling option for screening, risk prediction, and treatment management. Such digital tools have the potential to aid both healthcare professionals and patients, providing support to decrease unwarranted diagnostic and treatment variability while guiding personalized care, with the overall objective of improving clinical outcomes. However, incorporating digital tools in healthcare settings is challenging, and evidence the required to support their adoption and understand the limitations can be lacking. A multinational panel of expert cardiologists and emergency physicians across North America, Europe, and Oceania gathered to deliberate on the current landscape of digital tools and medical algorithms, drawing on prior clinical experiences and knowledge of country-specific regulations. In this viewpoint, the evidence to support and guide the adoption of digital tools in cardiovascular clinical practice and the necessary components for successful integration into clinical workflows were discussed. Digital tools must be developed with the needs of the healthcare professionals, other relevant stakeholders (eg, administration personnel), and patients in mind to give them the best chance of widespread adoption. Academia, industry, and regulatory bodies should work together to cultivate and accelerate the implementation of digital tools in healthcare. The considerations discussed here may help decision makers to determine if a digital tool has the components necessary to integrate into the clinical workflow successfully.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0412"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985815","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":"Transcatheter Aortic Valve Implantation in Patients With Super Obesity: Defining a High-Risk Phenotype.","authors":"Abdul Rasheed Bahar, Waqas Ullah, Yasemin Bahar, Sohaib Roomi, Said Ashraf, M Chadi Alraies","doi":"10.1097/HPC.0000000000000410","DOIUrl":"10.1097/HPC.0000000000000410","url":null,"abstract":"<p><strong>Background: </strong>The long-term impact of super obesity [body mass index (BMI) ≥50 kg/m²] on outcomes after transcatheter aortic valve implantation (TAVI) is not well defined.</p><p><strong>Methods: </strong>We used the 2015-2020 Nationwide Readmissions Database to identify TAVI procedures and compared patients with super obesity to those with BMI <50 kg/m². Propensity score-matched cohorts were constructed using clinical covariates. We evaluated net adverse cardiovascular events (NACE; composite of in-hospital mortality, stroke, and major bleeding), mortality, and complications during index admission and at 30 and 180 days. A prespecified subgroup analysis compared super-obese with normal-BMI patients.</p><p><strong>Results: </strong>Among 184,199 TAVI procedures, 4669 patients (2369 super-obese, 2300 nonsuper-obese) were included in the matched cohort. Super-obese TAVI volume increased over time. At index admission, super-obesity was associated with higher odds of NACE [adjusted odds ratio (aOR), 1.57; 95% CI, 1.12-2.20], in-hospital mortality (aOR, 8.08; 95% CI, 3.19-20.48), and acute kidney injury (aOR, 1.48; 95% CI, 1.25-1.74), whereas stroke and major bleeding did not differ. At 30 days, only acute kidney injury remained higher in super-obese patients, and by 180 days, only permanent pacemaker implantation was increased (aOR, 2.55; 95% CI, 1.34-4.85). In subgroup analyses restricted to super-obese versus normal-BMI patients, super-obesity was associated with higher NACE and complications at index admission and 180 days.</p><p><strong>Conclusions: </strong>Super-obese TAVI recipients have higher early risk and persistent excess risk for selected complications, indicating that extreme obesity defines a higher-risk TAVI phenotype despite broadly comparable longer-term outcomes versus patients with lower BMI.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0410"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the ABCD2 Score in a US Emergency Department Observation Unit.","authors":"Salvatore Lumia, Wesley Iobst, Zohayr Khan, Stephen Sokolosky, Benjamin T Hutchison, Amy Guzik, Mary A Wittler, Patrick S Reynolds, Nicklaus P Ashburn","doi":"10.1097/HPC.0000000000000413","DOIUrl":"10.1097/HPC.0000000000000413","url":null,"abstract":"<p><strong>Background: </strong>The ABCD2 score is a validated risk stratification tool used to quantify the risk of stroke within 48 hours among patients presenting with suspected transient ischemic attack (TIA). Limited data exist regarding its performance among patients in an emergency department observation unit (EDOU). The objective of this study was to determine the safety and efficacy of the ABCD2 score in a US EDOU cohort.</p><p><strong>Methods: </strong>We conducted an observational cohort study using the Wake Forest Emergency Medicine TIA Registry. Patients ≥18 years old who were evaluated for possible TIA in the EDOU of Atrium Health Wake Forest Baptist from July 1, 2021 to December 1, 2023 were accrued. This analysis included patients without a persistent neurologic deficit, except for amaurosis fugax, vertigo, or paresthesias, as determined by the consulting neurologist and attending emergency physician. Patients were risk-stratified using the ABCD2 score as low- (0-3), moderate- (4-5), and high- (≥6) risk for short-term stroke. The primary safety outcome was index encounter stroke, as determined by the consulting neurologist and imaging. Efficacy was defined as the proportion of patients classified to the low-risk group. Negative predictive values and positive predictive values, and negative likelihood ratios and positive likelihood ratios for the ABCD2 score were calculated for index stroke and reported with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of the 340 EDOU TIA patients, 55.9% (190/340) were female, 27.9% (95/340) were nonwhite, and the mean age was 67.1 ± 13.6 years. During the index visit, 21.8% (74/340) were diagnosed with acute stroke. The ABCD2 score classified 45.0% (153/340) as low-, 45.6% (155/340) as moderate-, and 9.4% (32/340) as high-risk. Of those identified as low-risk, 17.7% (27/153) had an index acute stroke. Negative predictive values and negative likelihood ratios of the ABCD2 score for index stroke were 63.5% (95% CI, 53.3-72.6) and 0.7 (95% CI, 0.5-1.1). Among patients classified as high-risk, 34.4% (11/32) had an index stroke, corresponding to a positive predictive value of 34.4% (95% CI, 20.9-50.9) and a positive likelihood ratio of 1.9 (95% CI, 1.0-3.7).</p><p><strong>Conclusions: </strong>Although the ABCD2 score classified approximately half of patients as low-risk, nearly 20% of this group were diagnosed with an acute stroke during EDOU evaluation. These findings suggest that the ABCD2 score is not appropriate for ruling-out acute stroke among EDOU patients as it would lead to a high rate of missed strokes.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":"25 1","pages":"e0413"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146259663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}