Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis (EBV-HLH) is a common subtype of HLH with heterogeneous clinical presentations from self-limited to death, of which adults are...

To assess and compare the clinical outcomes of His bundle pacing (HBP) versus right ventricular pacing (RVP) in patients who develop conduction disturbances following transcatheter aortic valve replacement (TAVR). In this retrospective study, 120 patients who developed CD following TAVR were enrolled, and were implanted with HBP or RVP between January 2015 and December 2024. To adjust for variations in initial risk factors and baseline characteristics between patients who underwent HBP or RVP, we employed the propensity score matching. Each patient was matched in a 1:1 ratio with replacement. Patients who either received HBP or RVP, but could not be adequately matched, were excluded from the study population. Procedural and clinical outcomes were compared among different modalities at pacing implantation and12-month follow-up. Paced QRS duration, R-wave amplitude at implantation and at follow-up, impedance at follow-up were lower in HBP group compared to RVP group. At12-month follow-up, the decrease in pacing burden was significantly greater in the HBP group than in the RVP group. Pacing threshold at implantation and at follow-up and capture threshold at implantation and at follow-up were higher in HBP group compared to RVP group. During follow-up, the left ventricular ejection fraction (LVEF) and tricuspid regurgitation (TR) area in the HBP group showed a significant improvement compared to preoperative values, while no significant increase in LVEF was observed in the RVP group, with a clear statistical difference between the two groups. At 12-month follow-up, NT-proBNP levels in the HBP group were significantly lower than those in the RVP group. The rates of NYHA functional class II were higher, while the rates of NYHA functional class III and MACE were lower in the HBP group compared to the RVP group during follow-up. HBP was feasible and safe in patients after TAVR, demonstrating a reduction in the composite outcome of MACE and better cardiac function compared to RVP.

The need for primary percutaneous coronary intervention (PCI) and staged PCI strategy for ST-segment elevation myocardial infarction (STEMI) with multivessel coronary disease is well documented. This study aimed to evaluate the efficiency, safety, and cost benefit of quantitative flow ratio (QFR)-guided staged PCI in patients with STEMI. We conducted a retrospective study involving 2256 patients meeting STEMI criteria having at least one lesion (≥50 %) in non-infarct-related (NIR) arteries. These patients had undergone primary PCI for infarct-related (IR) arteries and staged PCI for NIR arteries. Patients were categorized into two groups based on the strategy guided either by QFR or quantitative coronary angiography (QCA) as determined by the clinicians during primary PCI in real-world. For patients guided by QFR, a threshold of ≤0.80 serves as the cut-off value for determining the need for PCI. We recorded the demographics, clinical data, and QFR values of none-infarct-related arteries. The efficiency, safety, and cost benefit of the QFR-guided staged PCI were evaluated. The QCA-guided group had a higher rate of Killip II. In the QFR-guided group, there was a higher proportion of left anterior descending coronary artery lesions in infarct-related arteries. The mean QFR value of non-infarct-related (NIR) arteries remained consistent at 0.83 across both groups, irrespective of whether the measurement was taken during the primary PCI or the staged PCI phase. Among patients with QFR ≤0.8, the QFR values during staged PCI were significantly higher than that during primary PCI, with a significantly greater increase compared to patients with QFR >0.8. The proportion of staged PCI, number of stents per patient, and cost of staged PCI per patient were significantly lower in the QFR-guided group compared to the QCA-guided group. In the long-term follow-up period, there were no statistically significant differences between the two groups in terms of major adverse cardiac events and clinic visits, except for target vessel revascularization. QFR resulted in a reduction in the proportion of STEMI patients with multivessel coronary disease undergoing invasive coronary angiography and staged PCI. Furthermore, it decreased the incidence of target vessel revascularization (TVR) and medical costs, without increasing major adverse cardiovascular events. Our future work will focus on large multi-center perspective studies for the feasibility of QFR guided staged PCI in patients with STEMI.

Right ventricular (RV) strain is an important factor in evaluating RV function. This study aimed to predict mortality in patients with pulmonary hypertension (PH) and right heart failure (RHF) using an artificial intelligence (AI)-assisted multimodal echocardiography approach. A total of 586 patients with PH and RHF were enrolled. Transthoracic echocardiography (TTE) was performed either before hospital admission in the outpatient department or after admission in the inpatient unit. RV structure and function were assessed using two-dimensional measurements and speckle tracking strain analysis of septal and the free-wall segments. A multimodal deep-learning framework, integrating clinical variables, conventional echocardiographic indices, and AI-extracted RV strain features was developed to predict in-hospital and follow-up mortality. Model performance was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). The death group had significantly higher NT-proBNP levels, pulmonary artery systolic pressure (PASP), and average RV longitudinal strain (RVLS) than the survival group. Logistic regression identified PASP and average RVLS as independent predictors of in-hospital mortality, while Cox regression confirmed average RVLS as an independent predictor of follow-up mortality. The testing AUC for the AI model was 0.823 (0.741–0.905). The AI-guided TTE framework provides an effective and efficient method for mortality prediction in patients with PH and RHF, supporting personalized clinical decision-making and risk stratification.