Background: Low cardiorespiratory fitness is an established risk predictor for chronic non-communicable diseases. We aimed to investigate the prognostic significance of fitness level on the risk of major adverse cardiac events (MACE, the composite of myocardial infarction, stroke, or all-cause death), in a contemporary cohort of middle-aged subjects without cardiovascular disease. Methods: Retrospective analysis of patients aged 40–60 years without a history of cardiovascular disease. Degree of fitness was determined according to a graded, maximal treadmill exercise stress testing (EST) time achieved, classified into age- and sex-specific quintiles (Q), and categorized as low (Q1), moderate (Q2–Q4) or high (Q5) fitness groups. A multivariable Cox proportional hazard regression model was used to assess the association of fitness level with the risk of MACE. Results: A total of 6836 patients were included, of which 44.5% were women, and the mean age was 52 years. Overall, 289 MACE events occurred during a median follow-up of 7 years. Level of fitness was inversely associated with the presence of cardiovascular risk factors. The multivariable adjusted hazard ratio (95% confidence interval) for MACE was 1.65 (1.12–2.44) and 2.17 (1.40–3.38) in those at moderate and low fitness levels, compared to the high-fitness group (reference), respectively. For each decrease of one metabolic equivalent (MET) unit achieved at peak exercise, the relative risk for MACE increased by 18%. The association between low fitness and MACE was not modified by other risk factors (P-for-interaction non-significant). Conclusions: Low fitness level, as captured by a maximal treadmill EST, is an independent risk predictor for MACE among middle-age individuals without known cardiovascular disease. The association of low fitness with high burden of cardiometabolic risk factors highlight the importance of lifestyle intervention in this patient population.

Cardiac tamponade complicating transcatheter aortic valve replacement (TAVR) typically results from right ventricular (RV) injury induced by a pacemaker electrode, left ventricular (LV) injury induced by guidewires and catheters used during the procedure, and rupture of the aortic annulus during valve implantation. We retrospectively analysed our institutional TAVR database to gain mechanistic insights relating to this complication. A total of 1247 TAVR procedures were performed from 2010 to 2024. Cardiac tamponade complicated 21 (1.7%) of these procedures. There was a nonsignificant reduction in occurrence of tamponade (1.9% among the first 623 cases vs 1.4% among the subsequent 624 cases; P = 0.44). Tamponade was caused by LV perforation in 10 cases (48%), pacemaker-induced RV perforation in 8 cases (38%), and annular rupture in 3 cases (14%). We identified 2 mechanisms causing LV perforation: The stiff guidewire used for valve delivery caused myocardial injury in 7 cases, and in the other 3 cases, LV perforation occurred before insertion of the stiff guidewire and was attributed to insertion of soft guidewires. No additional such cases occurred after implementation of a protocol for meticulous guidewire insertion into the LV. Pericardiocentesis was performed with tamponade in 20 patients and with cardiac surgery in 13. Nine patients (43%) died during the index hospitalisation. Mortality did not differ between cases with RV perforation and left-side perforation. Periprocedural cardiac tamponade during TAVR may be caused by various mechanisms. Careful guidewire manipulation may decrease occurrence of LV perforation.

Background: Real-world data on the implementation and prognostic impact of glucose-lowering drugs with proven cardiovascular benefits in patients with type 2 diabetes (T2D) following acute coronary syndrome (ACS) are limited. We investigated the utilization and treatment patterns of sodium–glucose contrasporter-2 inhibitors (SGLT2Is) and glucagon-like peptide-1 recepto-agonists (GLP1RAs) in patients with T2D experiencing ACS and analyzed their association with mortality and major adverse cardiovascular events (MACEs) including recurrent ACS, acute revascularization, heart failure, or ischemic stroke. Methods: We carried out a retrospective analysis of 9756 patients with T2D from a nationwide healthcare organization in Israel who were hospitalized with ACS between 01/2019 and 01/2022. Drug prescriptions were estimated pre-hospitalization, 90 days, and 1 year following hospitalization. The association between SGLT2I and/or GLP1RA treatment with MACE and mortality was investigated using a time-dependent Cox regression analysis with multivariable adjustment. Results: The prescription rates (pre-hospitalization, 90 days, and 1 year post-hospitalization) of GLP1RAs were 13%, 13.2%, and 18%, and those of SGLT2Is were 23.9%, 33.6%, and 42.7%, respectively. At 1 year, 13.9% of patients were prescribed both treatments. The use of SGLT2Is and/or GLP1RAs was higher in younger age groups and increased from 2019 to 2021 (38.1% to 59.2%). The adjusted hazard ratio for the association of pre- or post-hospitalization SGLT2I and/or GLP1RA treatment with mortality and MACE was 0.724 (0.654–0.801) and 0.974 (0.909–1.043), respectively. Conclusions: In the real-world practice of treating patients with T2D experiencing ACS, the implementation of SGLT2Is, particularly GLP1RAs, was suboptimal when prescribed both early and 1 year following hospitalization, emphasizing the need to improve medical care. Treatment with SGLT2Is and/or GLP1RAs was associated with a favorable impact on mortality but not MACE.

Background: Type 2 diabetes mellitus (T2DM) is common among patients with chronic obstructive pulmonary disease (COPD). We examined the association between glycemic control and clinical outcomes in patients with COPD exacerbation and T2DM. Methods: A retrospective study of patients with T2DM and COPD exacerbation comparing controlled (HbA1c < 7.5%) to uncontrolled (HbA1c ≥ 7.5%) glycemia prior to admission. The primary endpoint is defined as a composite of 6-month rehospitalization/mortality. Secondary endpoints included 6-month mortality and 6-month readmission. Results: Of 426 admissions, 179 (42%) had uncontrolled glycemia. The risk of rehospitalization/mortality was significantly increased in the uncontrolled group in univariate (HR1.6, 95%CI 1.11–2.3, p = 0.01) and multivariate (HR 1.82, 95%CI 1.24–2.67, p = 0.002) analyses. The risk of 6-month rehospitalization was increased in the uncontrolled group in both univariate (HR1.94, 95%CI 1.16–3.23, p = 0.011) and multivariate (HR1.98, 95%CI 1.19–3.27, p = 0.008) analyses. No difference was found between 6-month mortality risks. Conclusions: Optimal glycemic control may improve COPD management and reduce adverse outcomes.