Background: Both atrial cardiopathy and impaired renal function are independently associated with increased mortality, but their interrelationship and combined impact remain uncertain. Methods: We analyzed 6573 participants from NHANES-III (mean age 57 years; 50.5% women; 74.6% White) with available electrocardiograms (ECGs). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Atrial cardiopathy was defined by any of the following ECG markers: abnormal P-wave axis (75°), deep terminal negativity in lead V1 (>100 µV), or prolonged P-wave duration in lead II (>120 ms). Participants with eGFR <15 mL/min/1.73 m² or major ECG abnormalities were excluded. Logistic regression assessed the association between impaired renal function (eGFR < 45 vs. ≥45 mL/min/1.73 m²) and atrial cardiopathy. Cox models evaluated independent and joint associations of impaired renal function and atrial cardiopathy with all-cause mortality. Results: About 47.9% (n = 3151) had atrial cardiopathy at baseline, of whom 161 (4.7%) had impaired renal function. Impaired renal function was associated with higher odds of atrial cardiopathy (OR 1.44; 95% CI 1.16–1.78). Over a median follow-up of 18.1 years, 3076 deaths occurred. Compared with participants without either condition, those with both had the highest mortality risk (HR 1.68; 95% CI 1.46–1.94), exceeding risks from atrial cardiopathy alone (HR 1.10; 95% CI 1.02–1.18) or impaired renal function alone (HR 1.42; 95% CI 1.18–1.70; p = 0.011 for interaction). Conclusions: Impaired renal function is associated with a greater prevalence of atrial cardiopathy. Their coexistence exerts a synergistic effect, substantially amplifying mortality risk beyond either condition alone.

Background: The combined impact of impaired kidney function and subclinical myocardial injury (SCMI) on cardiovascular (CV) mortality has not been well studied. We aimed to evaluate their individual and joint associations with cardiovascular mortality. Methods: We analyzed data from 6057 participants (mean age 57.0 ± 13.0 years) in the U.S. Third National Health and Nutrition Examination Survey. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Electrocardiographic SCMI was defined as a cardiac infarction/injury score ≥ 10. CV mortality was determined from the National Death Index. Multivariable logistic regression assessed baseline cross-sectional associations between eGFR and SCMI. Cox proportional hazards models were used to examine the individual and combined associations of eGFR and SCMI with CV mortality. Results: At baseline, 1297 participants (21.4%) had SCMI. In multivariable logistic regression analysis, eGFR < 45 mL/min/1.73 m² (vs. ≥45) was not associated with SCMI (OR [95% CI]: 1.10 [0.84–1.45]). Over a median follow-up of 18.4 years, 690 CV deaths occurred. In separate Cox models, both SCMI (vs. no SCMI) and eGFR < 45 (vs. ≥45) were associated with increased CV mortality risk (HR [95% CI]: 1.36 [1.16–1.60] and 1.56 [1.24–1.99], respectively). Compared with participants with eGFR ≥ 45 and no SCMI, those with both eGFR < 45 and SCMI had the highest CV mortality risk (HR [95% CI]: 2.36 [1.65–3.36]), followed by eGFR < 45 alone (1.47 [1.09–1.96]) and SCMI alone (1.33 [1.11–1.58]). Conclusions: Both reduced eGFR and SCMI were independently associated with CV mortality. Their coexistence showed the highest risk, but without statistical significance compared with each alone, possibly reflecting limited power and distinct mechanisms.

Background: The combined impact of impaired kidney function and subclinical myocardial injury (SCMI) on cardiovascular (CV) mortality has not been well studied. Methods: We analyzed data from 6,057 participants (mean age 57.0 ± 13.0 years) in the U.S. Third National Health and Nutrition Examination Survey. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Electrocardiographic SCMI was defined as a cardiac infarction/injury score ≥10. CV mortality was determined from the National Death Index. Multivariable logistic regression assessed baseline cross-sectional associations between eGFR and SCMI. Cox proportional hazards models were used to examine the individual and combined associations of eGFR and SCMI with CV mortality. Results: At baseline, 1,297 participants (21.4%) had SCMI. In multivariable logistic regression analysis, eGFR <45 mL/min/1.73 m² (vs. ≥45) was not associated with SCMI (OR [95% CI]:1.10[0.84–1.45]). Over a median follow-up of 18.4 years, 690 CV deaths occurred. In separate Cox models, both SCMI (vs. no SCMI) and eGFR <45 (vs. ≥45) were associated with increased CV mortality risk (HR [95% CI]: 1.36[1.16–1.60] and 1.56 [1.24–1.99], respectively). Compared with participants with eGFR ≥45 and no SCMI, those with both eGFR <45 and SCMI had the highest CV mortality risk (HR[95% CI]:2.36[1.65–3.36]), followed by eGFR <45 alone (1.47[1.09–1.96]) and SCMI alone (1.33[1.11–1.58]). Conclusions: Both reduced eGFR and SCMI are independently associated with increased CV mortality. Their combined effect appears synergistic, possibly reflecting distinct underlying mechanisms, as suggested by their lack of significant association with each other at baseline.

Background: Both atrial cardiopathy and impaired renal function are independently associated with increased mortality, but their interrelationship and combined impact remain uncertain. Methods: We analyzed 6,573 participants from NHANES-III (mean age 57 years; 50.5% women; 74.6% White) with available electrocardiograms (ECGs). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Atrial cardiopathy was defined by any of the following ECG markers: abnormal P-wave axis (< 0° or >75°), deep terminal negativity in lead V1 (>100 µV), or prolonged P-wave duration in lead II (>120 ms). Participants with eGFR < 15 mL/min/1.73 m² or major ECG abnormalities were excluded. Logistic regression assessed the association between impaired renal function (eGFR < 45 vs ≥45 mL/min/1.73 m²) and atrial cardiopathy. Cox models evaluated independent and joint associations of impaired renal function and atrial cardiopathy with all-cause mortality. Results: About 47.9% (n=3,151) had atrial cardiopathy at baseline, of whom 161(4.7%) had impaired renal function. Impaired renal function was associated with higher odds of atrial cardiopathy (OR 1.44; 95% CI 1.16–1.78). Over a median follow-up of 18.1 years, 3,076 deaths occurred. Compared with participants without either condition, those with both had the highest mortality risk (HR 1.68; 95% CI 1.46–1.94), exceeding risks from atrial cardiopathy alone (HR 1.10; 95% CI 1.02–1.18) or impaired renal function alone (HR 1.42; 95% CI 1.18–1.70; p=0.011 for interaction). Conclusions: Impaired renal function is associated with a greater prevalence of atrial cardiopathy. Their coexistence exerts a synergistic effect, substantially amplifying mortality risk beyond either condition alone.

Background: Electrocardiographic markers of atrial cardiomyopathy (AtCM) are associated with adverse cardiovascular outcomes. Whether AtCM further refines cardiovascular disease (CVD) mortality risk across increasing cardiometabolic risk factor (CMRF) burden is unclear. Methods: We analyzed 7,083 adults free of baseline CVD. AtCM was defined by the presence of ≥1 ECG marker: prolonged P-wave duration ≥120 ms in lead II, abnormal P-wave axis outside 0-75, or deep terminal negativity of the P wave in V1 <-100 μV. CMRF burden was defined as the presence of 0, 1, or ≥2 of hypertension, diabetes, and obesity. CVD mortality was ascertained through December 31, 2006. Results: Among 7,083 participants (mean age 58 years and 48% men), CVD mortality rates increased progressively across the six combined exposure groups. In a multivariable adjusted Cox proportional hazard analysis, AtCM identified higher-risk subgroups within each CMRF burden category, with risk increasing progressively across combined exposure groups and highest among participants with ≥2 risk factors and AtCM (HR 2.25, 95% CI 1.75-2.87). In secondary analyses, a similar pattern was observed for individual CMRFs, with the combination of AtCM and hypertension, diabetes, or obesity conferring the highest risk compared with participants with neither condition (HR (95% CI): 1.58 (1.31-1.89); 2.08 (1.62-2.68); and 1.47 (1.19-1.82), respectively). Conclusions: ECG-defined AtCM refined CVD mortality risk across increasing CMRF burden. Individuals with both AtCM and multiple CMRFs had the highest risk. These findings support the potential role of ECG-based AtCM assessment as a scalable approach to improve cardiovascular risk stratification among individuals with CMRFs.

Pheochromocytoma is an uncommon adrenal medulla tumor that secretes catecholamines. It is usually a benign condition and is generally treated with adrenalectomy; in a small proportion of cases, however, it might return or spread. Pheochromocytoma is uncommon to recur or metastasize, meaning every reported case is clinically relevant. A 46-year-old Caucasian woman initially presented with conventional catecholamine excess symptoms—refractory hypertension, palpitations, diaphoresis, and headaches. Imaging showed a sizable right adrenal mass; biochemical testing indicated very high plasma metanephrines. A medical decision was made to perform a right adrenalectomy; pathology confirmed a benign pheochromocytoma. After surgery, her symptoms went away, but she was missed for follow-up. Four years later, she came back with comparable symptoms; biochemical screening found increased metanephrines once more, and a computed tomography (CT) scan revealed local recurrence in the right adrenal bed. Notably, the CT also disclosed a lytic lesion in a lumbar vertebra and evidence of bone metastases from the pheochromocytoma. This instance highlights a rare situation in which a pheochromocytoma, initially thought to be innocuous, reoccurred with distant skeletal involvement. In conclusion, a very rare, recurrent pheochromocytoma with bone metastases underscores the importance of continuous monitoring even after complete tumor removal. Early recognition of metastasis or relapse can significantly impact therapy and outcomes. This case highlights the necessity of ongoing follow-up in patients with pheochromocytoma and alerts individuals to potential late metastatic symptoms.