BACKGROUND: Cardiac injury is common in severe coronavirus disease 2019 (COVID-19) and is associated with poor outcomes. We aimed to study predictors of in-hospital death, characteristics of arrhythmias and the effects of QT-prolonging therapy in patients with cardiac injury. METHODS: We conducted a retrospective cohort study involving patients with severe COVID-19 who were admitted to Tongji Hospital in Wuhan, China, between Jan. 29 and Mar. 8, 2020. Among patients who had cardiac injury, which we defined as an elevated level of cardiac troponin I (cTnI), we identified demographic and clinical characteristics associated with mortality and need for invasive ventilation. RESULTS: Among 1284 patients with severe COVID-19, 1159 had a cTnI level measured on admission to hospital, of whom 170 (14.7%) had results that showed cardiac injury. We found that mortality was markedly higher in patients with cardiac injury (71.2% v. 6.6%, p < 0.001). We determined that initial cTnI (per 10-fold increase, hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.06–1.66) and peak cTnI level during illness (per 10-fold increase, HR 1.70, 95% CI 1.38–2.10) were associated with poor survival. Peak cTnI was also associated with the need for invasive ventilation (odds ratio 3.02, 95% CI 1.92–4.98). We found arrhythmias in 44 of the 170 patients with cardiac injury (25.9%), including 6 patients with ventricular tachycardia or fibrillation, all of whom died. We determined that patients who received QT-prolonging drugs had longer QTc intervals than those who did not receive them (difference in medians, 45 ms, p = 0.01), but such treatment was not independently associated with mortality (HR 1.04, 95% CI 0.69–1.57). INTERPRETATION: We found that in patients with COVID-19 and cardiac injury, initial and peak cTnI levels were associated with poor survival, and peak cTnI was a predictor of need for invasive ventilation. Patients with COVID-19 warrant assessment for cardiac injury and monitoring, especially if therapy that can prolong repolarization is started. Trial registration: Chinese Clinical Trial Registry, No. ChiCTR2000031301.

Background: Frailty and cardiovascular disease (CVD) are increasingly recognized as interconnected conditions that significantly impact aging populations. This review synthesizes evidence from studies published between 2000 and 2025, identified through Google Scholar and PubMed using keywords such as “frailty”, “CVD”, “frailty assessment”, and “multicomponent interventions”. Frailty, characterized by reduced physiological resilience and increased vulnerability to stressors, affects 10%–15% of community-dwelling older adults and is associated with adverse CVD outcomes. Main body: Our analysis demonstrates that frailty and CVD share common pathophysiological mechanisms, including chronic inflammation (“inflammaging”), mitochondrial dysfunction, and endothelial impairment. The reviewed literature reveals frailty prevalence varies substantially by CVD subtype, ranging from 30% in patients with coronary artery disease (CAD) to 80% in those with heart failure (HF). Frailty independently predicts adverse outcomes, conferring a 2.5–3.5-fold higher mortality risk. While multiple assessment tools exist (e.g., Fried Phenotype, Clinical Frailty Scale), this review highlights the absence of a gold standard assessment tool for cardiovascular populations. A critical challenge is that traditional cardiovascular risk scores often fail to account for frailty, leading to significant treatment disparities. Effective management requires a paradigm shift towards multimodal interventions. Evidence supports combined exercise and nutritional programs (e.g., VIVIFRAIL, SPRINT-T), which improve physical function and frailty severity. Recent guidelines now recommend such rehabilitation. Emerging therapeutic strategies—including senolytics (e.g., dasatinib plus quercetin), stem cell mobilization, and angiogenic gene therapy—show promise for targeting shared biological pathways of vascular decline. Conclusion: The synthesis of recent evidence underscores the necessity of routine frailty assessment in cardiovascular care. Integrating validated frailty measures can improve risk stratification and enable personalized treatment. Future research should focus on standardizing assessment in cardiology and developing targeted interventions for shared pathways. Addressing frailty as a modifiable risk factor could significantly improve outcomes for older adults with CVD.

Rationale: In recent decades, the incidence of advanced syphilis has declined due to early recognition and the application of effective antibiotics. Advanced syphilis often manifests in the cardiovascular system as simple aortitis, aortic valve insufficiency, coronary artery stenosis or obstruction, Aortic aneurysm and mucinous myocarditis. In most case reports on the subject, acute myocardial infarction caused by syphilis was reported to be due to aortic valve insufficiency and coronary stenosis as a result of the involvement of the aorta. Patient concerns: The patient was a 48-year-old woman. She was admitted to our hospital because of intermittent upper abdominal pain with chest tightness for 3 hours. The patient reported a past syphilis infection, when she was hospitalized for hysteromyoma surgery four years ago, and had no related treatment. Diagnosis: According to the characteristics of coronary angiography and results of lab tests and echocardiography, she was finally diagnosed with myocardial infarction associated with syphilis. Interventions: At the first diagnosis of syphilis, the patient did not received antibiotics treatment. After the diagnosis of myocardial infarction, she received the percutaneous coronary intervention (PCI) operation assisted by extracorporeal membrane oxygenation (ECMO) technology, successfully got drug -eluted stents in right coronary artery ostium and left main ostium. Then the patient received penicillin to treat the syphilis infection. Outcomes: After coronary revascularization, the cardiac function of the patients was gradually improved, and the left ventricular ejection fraction was gradually improved after combined with optimized drug therapy. Lessons: The cardiovascular system is often involved in the stages of advanced syphilis with severe complications like myocardial infarction. Standard treatment should be given as soon as syphilis is diagnosis. For stenosis of coronary ostium, the PCI assisted by ECMO technology did not only ensure the effectiveness of the treatment, but also reduce the surgical risk of the patient. This case indicated the effectiveness of ECMO-assisted PCI, and thus may provide a reference for future patient treatment.

Rhythm control is the core part of the integrated management of atrial fibrillation (AF), especially in the early stages. Despite advances in catheter ablation (CA), the recurrence rate of AF after CA remains high. As a result, stratification and early management of AF recurrence after CA are critical. Currently, predictors of recurrence of AF after CA are mostly based on dysfunction caused by structural remodeling, apart from traditional risk factors. Atrial strain is a recently developed important parameter for detecting the deformability of atrial myocardium during the cardiac cycle prior to atrial remodeling. Although there is only preliminary evidence, atrial strain is still a promising parameter in predicting the recurrence of AF after CA at an early stage. This review focuses on the evaluation of atrial strain, the current applications of atrial strain in assessing atrial function, and predicting the recurrence of AF after CA. We summarize the contents related as follows: (1) CA for rhythm control in AF; (2) Evaluation methods of atrial strain; (3) Atrial strain in the remodeling and reverse remodeling of AF; and (4) Clinical applications of atrial strain in predicting the recurrence of AF after CA. Although there is accumulating evidence on the role of decreased atrial strain in the early prediction of AF recurrence, atrial strain is limited in clinical practice for lacking exact cut-off values and difficulty in distinguishing specific function phases of the atrium. More research is needed in the future to add strength to the early prediction value of atrial strain in AF recurrences.