Background: Clinical outcomes among older adults hospitalized with heart failure with preserved ejection fraction (HFpEF) in the setting of metabolically healthy obesity (MHO) remain insufficiently explored. This study aimed to evaluate whether MHO status is associated with different rates of major adverse cardiac and cerebrovascular events (MACCEs) during HFpEF-related hospitalizations compared to patients without MHO. Methods: Data from the 2019 National Inpatient Sample (NIS) database was analyzed using relevant ICD-10 codes to identify HFpEF admissions in older adults. Propensity score matching (1:1) was applied to generate balanced cohorts of patients with and without MHO. Multivariable adjustments were performed to assess primary outcomes, including MACCEs, all-cause mortality (ACM), acute myocardial infarction (AMI), dysrhythmia, cardiac arrest (CA), and stroke. Statistical significance was set at p < 0.05. Results: Each MHO cohort included 22,405 patients with a median age of 75 years. The MHO+ group demonstrated a significantly higher risk of dysrhythmia (OR 1.32, 95% CI 1.21–1.43, p < 0.001). Interestingly, an “obesity paradox” was observed, as the MHO+ cohort had lower odds of MACCEs (OR 0.70, 95% CI 0.61–0.81, p < 0.001), ACM (OR 0.66, 95% CI 0.54–0.82, p < 0.001), and AMI (OR 0.71, 95% CI 0.59–0.86, p = 0.001) compared to MHO−. No significant differences were found for CA or stroke between the groups. Conclusions: Although the MHO+ group had an elevated risk of dysrhythmia, they exhibited more favorable outcomes in terms of MACCEs, ACM, and AMI—supporting the concept of an “obesity paradox.” Further research is needed to better understand the role of MHO as a comorbid condition in patients with HFpEF.

Background and Objective: Rheumatoid arthritis (RA) is a chronic, autoimmune disease primarily influencing the synovial joints resulting in joint destruction. Systemic manifestations associated with RA have been implicated with recent evidence suggesting a pertinent role of RA in cardiovascular health. Epicardial adipose tissue (EAT), the layer of fat surrounding the heart, has been found to be an emerging diagnostic marker for cardiovascular conditions associated with RA given its role in proinflammatory cytokine release. However, given the novelty of EAT, its utility required further appraisal. This review aims to evaluate the role of EAT as a diagnostic and prognostic marker for cardiovascular involvement in RA and to explore its potential as a therapeutic target to mitigate cardiometabolic risk. Methods: PubMed and EMBASE were searched from July to October 2024 yielding relevant studies that examined the role of EAT as a clinical tool for RA associated cardiometabolic diseases. Key Content and Findings: Evidence has implicated greater EAT thickness and higher disease activity in RA. Elevated levels of adipokines, secreted by the adipose tissue, and found in association with EAT, play a key role in regulating inflammatory diseases such as RA. Since EAT could be promoting atherosclerosis, it could be a useful tool for early identification of cardiovascular conditions in RA and anti-inflammatory therapies controlling systemic inflammation may indirectly reduce EAT. Conclusions: Given the clinical modifiability of EAT, it holds promise as a viable risk stratification tool and as a potential therapeutic target for reducing cardiovascular complications in RA.

Background: Transcatheter aortic valve replacement (TAVR) thrombosis is a known complication, but its association with vascular endothelial growth factor inhibitors has not been previously reported. Case Summary: A 69-year-old male with previous TAVR developed new-onset prosthetic valve dysfunction after receiving bevacizumab for age-related macular degeneration. Echocardiography revealed moderate aortic stenosis with significantly elevated gradients compared to baseline. Following discontinuation of bevacizumab and initiation of systemic anticoagulation, valve function normalized at three-month follow-up. Discussion: This first reported case of TAVR thrombosis potentially linked to bevacizumab therapy demonstrates a temporal relationship between drug administration and valve dysfunction, with subsequent resolution upon drug discontinuation and anticoagulation. Conclusion: Clinicians should be aware of potential thrombotic complications when prescribing bevacizumab to patients with bioprosthetic valves and maintain regular echocardiographic surveillance. Prompt anticoagulation and medication adjustment may reverse valve dysfunction. Further studies are needed to determine a causal relationship between TAVR thrombosis and VEGF inhibitors.

Bi-atrial thrombi with bilateral pulmonary embolism (PE) through a patent foramen ovale (PFO) is rare and life-threatening, requiring urgent management due to embolization risk. We present a 53-year-old female with left lower extremity extensive deep vein thrombosis (DVT), bilateral PE, and bi-atrial thrombi straddling a PFO. She underwent thrombectomy, PFO closure, and pulmonary embolectomy but later experienced recurrent DVT and PE. Anticoagulation was limited due to bleeding risk given a recent neurosurgery. Literature lacks clear guidelines for managing such cases necessitating individualized treatment. This case highlights the complexity of bi-atrial thrombi with PFO and the need for further research to optimize management strategies.