Cardiology最新文献

{"title":"SGLT2 Inhibitor Therapy and Risk of Incident Atrial Fibrillation in Patients With HFpEF and Type 2 Diabetes.","authors":"Irene Animah Acheampong, George Blankson, Dennis Danso Kumi, Esther Bajo Tetteh, Adama Seidu, Claire Sullivan, Michael Zacharias","doi":"10.1159/crd/absag026","DOIUrl":"https://doi.org/10.1159/crd/absag026","url":null,"abstract":"<p><p>Background Atrial fibrillation (AF) frequently coexists with Heart Failure with Preserved Ejection Fraction, particularly in patients with Type 2 Diabetes, due to shared cardiometabolic and inflammatory mechanisms. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefit in HFpEF, but data regarding prevention of incident AF remain limited. Objectives To evaluate the association between SGLT2 inhibitor therapy and incident atrial fibrillation/flutter in patients with HFpEF and diabetes mellitus. Methods We performed a retrospective propensity score-matched cohort study using the TriNetX Research Network. Adults aged ≥18 years with HFpEF and diabetes mellitus receiving oral antihyperglycemic therapy were identified. Patients receiving SGLT2 inhibitors were matched 1:1 with those receiving Dipeptidyl peptidase-4 inhibitors. The primary outcome was incident AF/flutter. Secondary outcomes included all-cause mortality, ischemic stroke, and composite major adverse cardiovascular events (cMACE; all-cause mortality, ischemic stroke, or acute myocardial infarction). Associations were assessed using hazard ratios (HRs) and risk ratios (RRs). Results After propensity matching, 37,108 patients were included (18,554 per group). Compared with DPP4 inhibitor therapy, SGLT2 inhibitor use was associated with lower incidence of AF/flutter (17.8% vs 19.2%; HR 0.84, RR 0.93), all-cause mortality (12.5% vs 21.4%; HR 0.53, RR 0.59), ischemic stroke (7.4% vs 8.7%; HR 0.78, RR 0.85), and cMACE (24.4% vs 33.0%; HR 0.66, RR 0.74). Conclusions In patients with HFpEF and diabetes mellitus, SGLT2 inhibitor therapy was associated with lower rates of incident AF/flutter and adverse cardiovascular outcomes, supporting a potential role for SGLT2 inhibitors in modifying arrhythmic risk in addition to established cardiometabolic benefits.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premenopausal Depression and Risk of Cardiovascular Disease After Menopause: A Large Real-world Cohort Study.","authors":"Priyanka Raju, Lemuel Frederic Jiang, Anugraha Kutty, Matthew Nudy","doi":"10.1159/crd/absag025","DOIUrl":"https://doi.org/10.1159/crd/absag025","url":null,"abstract":"<p><strong>Objective: </strong>While depression has been linked to adverse cardiometabolic profiles in postmenopausal women, its temporal relationship with cardiovascular disease (CVD) when occurring before menopause remains unclear. This study examined whether depression diagnosed prior to menopause was associated with incident CVD after menopause.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Postmenopausal women were assigned to two cohorts: cohort 1 included women with depression diagnosed before menopause and without preexisting CVD, premature menopause, or conventional CVD risk factors (smoking, diabetes mellitus, hypertension, dyslipidemia, overweight/obesity, or family history of ischemic heart disease); cohort 2 included comparable women without premenopausal depression. Propensity score matching balanced baseline characteristics, including age at menopause, current age, and ethnicity. Risk differences and risk ratios (RRs) with 95% confidence intervals(CIs) were calculated to compare incident CVD (myocardial infarction, coronary heart disease, stroke, heart failure, or cardiovascular death). Time-to-event outcomes were assessed using Kaplan-Meier curves and log-rank testing, and hazard ratios (HRs) were estimated using Cox proportional hazards regression.</p><p><strong>Results: </strong>Initial queries identified 90,638 women in cohort 1 and 1,237,202 in cohort 2. After matching, 88,884 women remained in each cohort, with a mean (SD) age of 57.6(11.4) years. Follow-up varies according to database entry time, with maximum follow-up of 20 years. Women with premenopausal depression had a higher incidence of postmenopausal CVD than those without depression (4.0% vs. 3.3%; RR,1.23; 95% CI, 1.17-1.29; p<.001), corresponding to an absolute risk difference of 0.7% (95% CI, 0.6%-0.9%). Because the proportional hazards assumption was not satisfied, the Cox hazard ratio was interpreted as a secondary average time-to-event summary rather than as the primary effect estimate. The estimated hazard ratio for incident CVD was 1.21 (95% CI, 1.15-1.27; log-rank p<.001), representing an average association across the follow-up period rather than a constant hazard over time.</p><p><strong>Conclusion: </strong>Women with premenopausal depression had a higher cumulative incidence of postmenopausal cardiovascular disease than matched women without depression, suggesting that premenopausal depression may represent a marker of increased cardiovascular vulnerability in midlife women.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Anomalous Aortic Origin of Right Coronary Artery from the Left Coronary Sinus.","authors":"Taeil Yang, Joonpyo Lee, Kil Yoon Pack, Kyung Eun Ha, Youngwoo Jang, Woong Chol Kang, Jeonggeun Moon","doi":"10.1159/crd/absag018","DOIUrl":"https://doi.org/10.1159/crd/absag018","url":null,"abstract":"<p><strong>Introduction: </strong>Anomalous Aortic Origin of Right Coronary Artery (AAORCA) is a rare congenital anomaly that may be associated with adverse cardiac events, including sudden cardiac death. Surgical correction is commonly recommended in patients with AAORCA. Coronary computed tomography angiography (CCTA) is a prevalent diagnostic modality, which increases AAORCA detection. However, the clinical significance of incidentally detected AAORCA remains unclear.</p><p><strong>Methods: </strong>This non-randomized retrospective analysis included 10,134 patients who underwent CCTA between January 2014 and December 2022, either for suspected coronary artery disease (CAD) or a medical check-up. Three groups were created: patients with normal coronary anatomy (normal), with AAORCA (anomaly), and CAD without AAORCA (CAD). CAD was defined as a percentage diameter stenosis of ≥50% in one or more segments. Cardiac mortality was this study's primary endpoint.</p><p><strong>Results: </strong>Normal, anomaly, and CAD group comprised 7592 (74.9%), 66 (0.7%), and 2476 (24.4%) patients, respectively. During a median follow-up of 33.7 months (IQR: 13.2-53.4), Kaplan-Meier analysis revealed no significant difference in the cardiac death occurrence between the normal (15 events, 0.2%) and anomaly groups (0 events, 0%) (log-rank p=0.685). Cox proportional hazards model revealed no difference in mortality in the anomaly group compared with normal group.</p><p><strong>Conclusions: </strong>In our cohort, incidentally detected AAORCA in adults did not demonstrate a clearly elevated cardiac death risk relative to CAD during mid-term follow-up. However, given the small number of events, these findings should be interpreted as descriptive rather than confirmatory evidence of a benign natural course, particularly in populations at higher risk of exertional sudden cardiac death.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation: A Systematic Review and Meta-analysis.","authors":"Ahmad Al-Abdouh, Omar Obeidat, Khaled Alabdallah, Mahir Yilmaz, Ibrahim Mortada, Daoud Eldawud, Mohammed Mhanna, Laith Alhuneafat, Fares Ghanem, Amartya Kundu, Ahmad Jabri, Khalil Anouti, Dustin Staloch, Arun Narayanan, Muhie Dean Sabayon","doi":"10.1159/crd/absag019","DOIUrl":"https://doi.org/10.1159/crd/absag019","url":null,"abstract":"<p><strong>Background: </strong>The use of anticoagulation in patients with atrial fibrillation is often limited by the significant risk of bleeding, and difficulties maintaining consistent adherence over time. These challenges have led to the development of left atrial appendage closure (LAAC) as an alternative stroke prevention strategy in this patient population. Our study aimed to evaluate LAAC versus medical therapy in patients with atrial fibrillation.</p><p><strong>Methods: </strong>A comprehensive search was conducted using PubMed, Embase, and Cochrane Library from database inception through April 1, 2026. The predefined endpoints were composite outcome of systemic embolism, cardiovascular mortality, or stroke in addition to other endpoints including all-cause mortality, cardiovascular mortality, strokes, and major bleeding. All outcomes were pooled using a random effect Mantel-Haenszel model. The between-study variance (τ2) was estimated using the Paul Mendel method, which is the preferred method when the number of included studies is small.</p><p><strong>Results: </strong>A total of five randomized controlled trials, 5,404 patients were analyzed; 2,878 underwent LAAC and 2,526 received medical therapy. The median follow-up across studies was 4 years. LAAC met noninferiority compared with medical therapy in atrial fibrillation for major bleeding (RR 0.86; 95% CI 0.59-1.26) and all-cause mortality (RR 0.93; 95% CI 0.71-1.22). In contrast, noninferiority was not met for the composite outcome (RR 0.97; 95% CI 0.64-1.47), cardiovascular mortality (RR 0.86; 95% CI 0.51-1.42), systemic embolism (RR 1.93; 95% CI 0.21-17.5), and all stroke (RR 1.11; 95% CI 0.73-1.67).</p><p><strong>Conclusion: </strong>This meta-analysis showed that LAAC was noninferior to anticoagulation for all-cause mortality and major bleeding, but it did not meet noninferiority for the other assessed outcomes, including stroke, cardiovascular mortality, and/or systemic embolism.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure of P-Wave Duration as a Surrogate Marker for Left Atrial Enlargement in African Americans: Insights from the Jackson Heart Study.","authors":"Daniel Teixeira de Campos E Barreiro, João Vitor Gardelli Trindade, Wlamir Batista Ribeiro, Eraldo Ribeiro Ferreira Leão de Moraes, José Nunes de Alencar","doi":"10.1159/crd/absag021","DOIUrl":"https://doi.org/10.1159/crd/absag021","url":null,"abstract":"<p><strong>Introduction: </strong>Electrocardiographic (ECG) criteria for left atrial enlargement (LAE) serve as clinical surrogates for structural and hemodynamic left atrial (LA) overload. Their diagnostic performance compared to echocardiography remains suboptimal, and African Americans are consistently underrepresented in relevant diagnostic accuracy studies.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of the Jackson Heart Study (JHS), a large community-based cohort of African American adults (aged 21-94 years). P-wave duration was evaluated as the index test across continuous thresholds using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) with 95% confidence intervals (95% CI). The main reference standard was echocardiographic LAE defined by American Society of Echocardiography (ASE) sex-specific left atrial (LA) two-dimensional (2D) diameter thresholds (>40 mm in men; >38 mm in women).</p><p><strong>Results: </strong>A total of 3,572 participants were included, of whom 647 (18.1%) met ASE diameter criteria for LAE. Overall discriminatory performance was poor (AUC 0.603; 95% CI 0.580-0.627). At the traditional ≥120 ms threshold, sensitivity (Sn) was 58.3% (95% CI 54.4-62.1%), specificity (Sp) was 56.8% (95% CI 55.0-58.6%), positive likelihood ratio (LR+) was 1.35 (95% CI 1.25-1.46), and negative likelihood ratio (LR-) was 0.73 (95% CI 0.67-0.81), reflecting limited capacity to rule in or out LAE.</p><p><strong>Conclusion: </strong>In this cohort, P-wave duration demonstrated poor diagnostic accuracy for diameter-defined echocardiographic LAE. These findings highlight the inadequacy of this ECG criterion as a surrogate marker across a historically underrepresented population. Machine learning models may offer a path forward for higher performance of ECG as a screening tool for LAE in African Americans.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative assessment of myocardial dysfunction in mild focal left ventricular hypertrophy using CMR feature tracking.","authors":"Xiaowei Wang, Yao Yao, Wei Yang, Keshan Ji, Hu Chen, Bin Qin","doi":"10.1159/crd/absag024","DOIUrl":"https://doi.org/10.1159/crd/absag024","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate cardiac dysfunction in patients with mild focal left ventricular hypertrophy (MF-LVH) by analyzing the left ventricular (LV) and left atrial (LA) deformation parameters derived from cardiac magnetic resonance feature tracking (CMR-FT).</p><p><strong>Methods: </strong>This retrospective study included 36 patients with MF-LVH, 44 patients with HCM without late gadolinium enhancement (HCM-non-LGE), and 32 healthy controls who were examined between November 2020 and August 2025. The LA and LV strain parameters were obtained using CMR-FT. Statistical comparisons, multivariable logistic regression, and receiver operating characteristic (ROC) curve analyses were conducted.</p><p><strong>Results: </strong>While conventional parameters showed no difference, all global LV strains and most strain rate parameters were significantly impaired in both patient groups, showing a stepwise decline with advancing hypertrophy severity. In multivariable analyses, the peak diastolic radial strain rate (PD-RSR) was the primary discriminator distinguishing MF-LVH from controls, and LV global longitudinal strain (LV-GLS) was the key discriminator differentiating MF-LVH from HCM-non-LGE. LV-GLS and LA minimal volume index (LAVImin) were the key discriminators for HCM-non-LGE versus controls. ROC analysis confirmed LV-GLS as an excellent discriminator (AUC 0.85 for MF-LVH vs. HCM-non-LGE; AUC 0.96 for HCM-non-LGE vs. controls), with notably similar optimal cutoff values (-13.94% and -13.99%, respectively). PD-RSR showed good accuracy in identifying MF-LVH.</p><p><strong>Conclusion: </strong>PD-RSR indicates early diastolic impairment, and LV-GLS sensitively detects systolic dysfunction in patients with MF-LVH. The overlapping LV-GLS values between patients with MF-LVH and HCM-non-LGE suggest a potential pathophysiological continuum. CMR-FT enables early detection of subclinical myocardial dysfunction in this population.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of 24-Hour Anion Gap Difference with Short-Term Mortality in Critically Ill Patients with Heart Failure and Infection.","authors":"Xinyuan Gong, Jinfeng Yang, Shuang Yang, Mengmeng Dou","doi":"10.1159/crd/absag022","DOIUrl":"https://doi.org/10.1159/crd/absag022","url":null,"abstract":"<p><p>Introduction High anion gap (AG) indicates poor prognosis in critical illness. However, the prognostic significance of dynamic early AG changes in patients with concurrent heart failure and infection remains unclear. We aimed to evaluate the association between the 24-hour AG difference and short-term mortality in this population. Methods This retrospective cohort study utilized the Zigong Fourth People's Hospital database. Patients with HF and infection admitted to the intensive care unit (ICU) were included. A 24-hour landmark analysis was applied. The AG difference was categorized based on the change (ΔAG) from admission to 24 hours: Decreasing (ΔAG < -2 mmol/L), Stable (-2 to 2 mmol/L), and Increasing (ΔAG > 2 mmol/L). The primary outcome was 7-day all-cause mortality. Results A total of 299 patients were included. The 7-day mortality was 24.1%. In multivariable Cox analysis adjusted for confounders including baseline lactate and renal function, the Stable difference was significantly associated with increased 7-day mortality compared to the Decreasing group (HR 2.43, 95% CI 1.27-4.63, p=0.007). The Increasing group showed a trend toward higher risk (HR 1.74, p=0.126). Subgroup analyses revealed significant interactions, where the risk of an increasing difference was amplified in patients with hyperlactatemia (>2.0 mmol/L, HR 2.65), or renal dysfunction (eGFR <60, HR 6.27). Albumin-corrected AG sensitivity analysis confirmed these findings. Conclusion Failure to decrease the anion gap within the first 24 hours of ICU admission is associated with a higher risk of short-term mortality in patients with HF and infection. The prognostic value of AG difference is particularly pronounced in high-risk subgroups with hemodynamic or metabolic instability.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 'First-Time-Right' strategy in secondary prevention of coronary artery disease: Rationale and design of the prospective, temporally controlled observational GOLDEN study.","authors":"Manon van den Bogaart, Lucas W Bollen, Jurriën Ten Berg, Ronaldus J G Peters, Jeanine Roeters van Lennep, Johannes G P Tijssen, Frank Lj Visseren, Iris Westendorp, Marjolein Snaterse, Harald T Jørstad, Fabrice M A C Martens","doi":"10.1159/crd/absag017","DOIUrl":"https://doi.org/10.1159/crd/absag017","url":null,"abstract":"<p><p>Introduction After an acute coronary syndrome (ACS) or coronary revascularisation, the risk of recurrent vascular events remain substantial. Despite clear guideline recommendations, secondary prevention and long-term adherence to preventive treatment is often suboptimal. Current secondary prevention strategies typically involve initiating a limited number of pharmacologic therapies during hospitalisation, followed by sequential intensification after discharge to achieve individualized guideline-recommended targets. However, this strategy is prone to therapeutic inertia and negatively affects patient motivation and long-term adherence. We hypothesise that a 'first-time-right' strategy, where individualised, guideline-based pharmacological treatment is proactively initiated during hospitalisation, can improve risk factor control and adherence compared to current practice, and thereby reduce major cardiovascular events. Methods and analysis GOLDEN (Guided Optimisation for Long-term Disease rEduction in secoNdary Prevention of cardiovascular disease) is a prospective, temporally controlled observational cohort study aiming to include 5,586 patients hospitalised for ACS or coronary revascularisation. A guidelines-based 'first-time-right' pharmacological optimisation strategy will be compared to current practice on the 3-year incidence of cardiovascular death, myocardial infarction, stroke, or ischemia-driven revascularisation (4-point MACE). This strategy targets both patients and healthcare professionals and aims to utilise the teachable moment during hospitalisation to optimise pharmacological strategies, apply key behavioural principles to improve adherence, and reframe follow-up from reactive up-titration to proactive de-escalation. A pocket card and online tool will be provided to check applicable guidelines during hospitalisation and formulate follow-up recommendations. An on-site training visit and communication aids are intended to support implementation and promote adherence. Summary This study will evaluate the effects of a 'first-time-right' strategy - focused on early in-hospital initiation and optimisation of guideline-based pharmacotherapy after acute coronary syndrome or coronary revascularisation - on the risk of recurrent MACE compared to current practice.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semaglutide in Heart Failure with Preserved Ejection Fraction and Obesity: The Gap Between Discussion and Use.","authors":"Ivana Jurin, Tomislav Jakljevic","doi":"10.1159/crd/absag023","DOIUrl":"https://doi.org/10.1159/crd/absag023","url":null,"abstract":"<p><strong>Introduction: </strong>Semaglutide improves symptoms and physical function in heart failure with preserved ejection fraction (HFpEF) and obesity. Whether discussion of treatment is accompanied by its use in routine care is less well understood.</p><p><strong>Methods: </strong>We retrospectively assessed treatment discussion, follow-up medication records and documented reasons for non-initiation in 159 patients from a prospective registry. Available follow-up information was retained when assessment dates were incompletely transcribed. Associations with registry-recorded diabetes or prediabetes were explored using Firth logistic regression.</p><p><strong>Results: </strong>Semaglutide was discussed or offered in 148/159 patients (93.1%). Among 148 baseline nonusers with subsequent medication information, it was newly recorded in 23 (15.5%). Recorded diabetes or prediabetes was associated with this outcome (adjusted odds ratio 3.76, 95% confidence interval 1.08-19.93), but a sensitivity analysis restricting the reference group by glycated haemoglobin was inconclusive. Among 125 patients without subsequently recorded semaglutide, affordability concerns were documented in 55 (44.0%), safety concerns in 48 (38.4%), and both in 38 (30.4%).</p><p><strong>Conclusion: </strong>Frequent discussion of semaglutide coexisted with infrequent documentation of subsequent use. Financial and medication-related concerns commonly overlapped. These findings identify a gap in routine care without establishing its causal determinants or verifying treatment initiation.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory Sex-Stratified Associations of Postoperative Visual and Auditory Hallucinations After Cardiac Surgery: Insights from the VAACS Study.","authors":"Nizar Abu Hamdeh, Hamza A Abdul-Hafez, Mohammad Alnees, Duha Najajra, Wafiq Othman, Abdalaziz Darwish, Yahya Z Fraitekh, Kareem Ibraheem, Omar Al-Haj, Omar Rabi, Amal M Shawabka, Taha Z Makhlouf, Reem J Saad, Anwar Zahran, Omar Qasem Heih, Basem Bali, Osama Ewidat, Mahdi Awwad, Yazan Hamdan, Ahmed Salous, Baraa Emran, Bahaa Arafat, Mohammed Dibas, Laith Ahmad, Shymai Osama Abdallah, Qais Salahat, Alaa Dabash, Mohammad Masu Apos D, Oday Nana, Qassem Hamoudy, Feras Zorba, Ashraf Hijjawi, Moath Nairat, Issa Al-Khdour, Ahmad Darwazah, Nuha Riyad, Hasan Alkhatib, Helmi Mahmoud Tamimi, Haitham Abu Khadija","doi":"10.1159/crd/absag015","DOIUrl":"https://doi.org/10.1159/crd/absag015","url":null,"abstract":"<p><p>Background Postoperative hallucination experiences are distressing but under-recognized complications of cardiac surgery. This study investigated whether sex differences exist in their incidence and in the factors associated with postoperative visual and auditory hallucination experiences. Methods We conducted a prospective multicenter cohort study of 1,331 adults (1,000 males and 331 females) undergoing isolated coronary artery bypass grafting or isolated valve surgery at 10 cardiac surgery centers in the West Bank, Palestine (September 2022-May 2025). Postoperative visual (VH) and auditory hallucination (AH) experiences were assessed using daily QPE interviews through postoperative day 4, followed by clinical checks or telephone follow-up through day 7, with QPE-based confirmation of newly reported experiences. Sex-stratified multivariable Cox proportional hazards models evaluated associated factors within an exploratory, hypothesis-generating framework. This study was conducted as part of the VAACS Study (https://www.isrctn.com/ISRCTN18368253). Results Within the first postoperative week, 155 patients (11.6%) experienced visual hallucination experiences (11.2% of males vs. 13.0% of females), and 92 (6.9%) experienced auditory hallucination experiences (7.0% vs. 6.6%). Among males, lower body mass index (adjusted HR 0.91; 95% CI 0.83-0.99; P = 0.034), higher EuroSCORE II (adjusted HR 1.03; 95% CI 1.02-1.04; P < 0.001), higher serum creatinine (adjusted HR 1.21; 95% CI 1.15-1.27; P < 0.001), and postoperative blood transfusion (adjusted HR 1.65; 95% CI 1.20-2.28; P = 0.002) were associated with visual hallucination experiences. Among females, higher EuroSCORE II (adjusted HR 1.05; 95% CI 1.04-1.06; P < 0.001) and longer postoperative ventilation duration (adjusted HR 0.93; 95% CI 0.89-0.97; P < 0.001) were associated with visual hallucination experiences. Higher EuroSCORE II (adjusted HR 1.07; 95% CI 1.04-1.10; P < 0.001) and longer postoperative ventilation duration (adjusted HR 0.91; 95% CI 0.83-0.99; P = 0.029) were associated among males; intraoperative fentanyl exposure did not reach statistical significance (adjusted HR 0.51; 95% CI 0.26-1.02; P = 0.057). Among females, lower age (adjusted HR 0.98; 95% CI 0.97-1.00; P = 0.007), higher EuroSCORE II (adjusted HR 1.08; 95% CI 1.07-1.10; P < 0.001), and postoperative noradrenaline requirement (adjusted HR 4.35; 95% CI 2.18-8.68; P < 0.001) were associated with auditory hallucination experiences; this model included only 22 events. Conclusions Postoperative hallucination experiences captured by the QPE occurred at similar rates in male and female patients after cardiac surgery, but exploratory sex-stratified association patterns differed by hallucination modality. These findings should be interpreted irrespective of delirium status and require confirmation in future studies incorporating structured delirium assessment.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1"},"PeriodicalIF":1.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}