Brown, R D

Abstract Background Cardiac papillary fibroelastoma (PFE) is the most common benign primary cardiac tumor. Despite their benign pathology, PFEs pose a significant embolic risk, which can lead to severe neurological sequelae. However, subclinical or silent emboli often go undetected, presenting a diagnostic challenge. This study aims to assess the prevalence of silent emboli in patients with pathology-proven PFEs using brain magnetic resonance imaging (MRI). Methods We conducted a retrospective review of 385 cases of pathology-confirmed PFEs. Inclusion criteria was those with brain MRI performed within 5 years of surgical resection of the PFE and no clinical neurological events. Patients with a history of symptomatic cerebral infarction (stroke or TIA) were excluded. Patient demographics and PFE imaging features were analyzed by two cardiologists experienced in cardiac tumors. Clinical neurological data, and MRI findings were analyzed by two neurologists with expertise in cerebrovascular disease. Results Out of 385 patients, 132 underwent brain MRI. In the entire cohort, 105/385 patients (27%) experienced clinically overt embolic events. After excluding patients with symptomatic cerebral infarctions and MRI scans older than 5 years, 27 patients (mean age: 71±9.6, gender: 66% female) met the inclusion criteria. Of these, 8 patients (30%) showed signs of silent infarctions on MRI, with 4 (15%) displaying findings consistent with cerebral infarction highly suggestive for embolic source. Conclusion This study underscores the substantial risk of silent cerebral embolic events in patients with PFE. The limited availability of MRI data, largely attributable to the absence of standardized neuroimaging protocols, indicates that the true prevalence of silent embolization in this population is likely underestimated. Given the propensity of PFE to generate clinically silent emboli, systematic cerebral MRI should be strongly considered as part of the diagnostic assessment of patients with cardiac masses, irrespective of neurological symptoms. Early identification of subclinical cerebrovascular lesions may facilitate timely therapeutic decision-making and secondary prevention strategies, thereby reducing the risk of future symptomatic and potentially disabling ischemic strokes.

Abstract Background and aims Patient foramen ovale (PFO) is a stroke risk factor evaluated using transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), transcranial Doppler ultrasound (TCD), and cardiac computed tomography (CCT). TCD is non-invasive, but its diagnostic performance relative to other modalities is unclear. We hypothesized that TCD has high sensitivity but low specificity for PFO detection. Methods We conducted an IRB-approved, single-center retrospective study of patients undergoing TCD for right-to-left shunt (RLS) detection between January 2024 and April 2025. Patients were identified from the Neurosonology Laboratory Quality Database. Records were reviewed for demographics, comorbidities, and TTE, TEE, and CCT findings. Sensitivity, specificity, and positive and negative predictive values were calculated for TCD, TTE, and CCT relative to TEE, the gold standard. The sensitivity and specificity of TCD versus TTE were compared using McNemar test. Results Ninety-two patients were included. Mean age was 52.66 ± 15.78 years, and 51% were female; qualifying events included ischemic stroke or transient ischemic attack. RLS was detected in 53 patients (57.6%) by TCD, 17 (30%) by TTE, 18 (28.5%) by TEE, and 3 (21%) by CCT. TCD demonstrated 94% sensitivity and 53% specificity, (PPV 66%, NPV 89%). TTE showed 50% sensitivity and 82% specificity (PPV: 75%, NPV 61%), while CCT showed 33% sensitivity and 100% specificity (PPV 100%, NPV 33.3%). TCD had significantly higher sensitivity than TTE for RLS detection (p=0.039) with a non-significant difference in specificity (p=0.062), using TEE as the reference. Conclusions TCD has high sensitivity for RLS detection in patients with ischemic stroke or transient ischemic attack. Conflict of interest Rachel Knopp: nothing to disclose; Kelly Flemming: nothing to disclose; Eugene Scharf: nothing to disclose; Zafer Keser: nothing to disclose; Jessica Prink: nothing to disclose; Shari Johnson: nothing to disclose; Guy Reeder: nothing to disclose; Robert Brown: nothing to disclose; William Harmsen: nothing to disclose; Muhib Khan: nothing to disclose Table 1 - belongs to Results

Abstract Background Cardiovascular disease (CVD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular (CV) benefits and are recommended for T2DM patients with atherosclerotic CVD (ASCVD). However, real-world data on their adoption in high-risk populations, particularly myocardial infarction (MI) and stroke survivors, remain limited. Purpose To assess real-world utilization of GLP-1RAs and SGLT2i among T2DM patients with ASCVD focusing on trends, disparities by age, sex, and region from 2015 to 2023. Methods A nationwide cohort study using data from the National Registry of Reimbursed Health Services (2015–2023), covering all reimbursed health services in the Czech Republic. Patients with nonfatal MI (ICD-10: I21, I22) or stroke (I63, I64) and confirmed T2DM were included. Prescriptions were identified at the event or within 12 months post-event. Utilization trends were analyzed, and logistic regression was used to determine predictors of medication use. Results Among 116,218 MI patients (median age:68 years, 33.5% women), 53,128 (46%) had T2DM (median age:71 years, 37% women). Within 12 months post-MI, 2.1% received GLP-1RAs and 10.6% received SGLT2i, with increasing trends from 0.3% (2015) to 4.8% (2023) (GLP-1RAs) and 0.4% (2015) to 34.8% (2023) (SGLT2i). Women were less likely to receive SGLT2i (aOR: 0.70 [95%CI:0.65–0.74]), while no significant difference was observed for GLP-1RAs (aOR:0.98 [95%CI:0.86–1.12]). Older patients (>70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27–0.36]) and SGLT2i (aOR:0.53 [95%CI:0.50–0.56]). Prescription rates were highest in Prague (3.1% GLP-1RAs; 13.5% SGLT2i) and lowest in the Moravian-Silesian Region (1.4% GLP-1RAs; 8.8% SGLT2i). Among 164,729 stroke patients (median age:73 years, 49% women), 78,562 (48%) had T2DM (median age:75 years, 50% women). Within 12 months post-stroke, 1.2% received GLP-1RAs and 3.7% received SGLT2i, with increasing trends from 0.2% (2015) to 2.8% (2023) (GLP-1RAs) and 0.1% (2015) to 10.4% (2023) (SGLT2i). Women were less likely to receive GLP-1RAs (aOR:0.82 [95%CI:0.72–0.95]) and SGLT2i (aOR:0.57 [95%CI:0.52–0.62]). Older patients (>70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27–0.36]) and SGLT2i (aOR:0.40 [95%CI:0.37–0.44]). Regional disparities were notable, with prescription rates varying from 0.8–2.1% (GLP-1RAs) and 2.4–5.2% (SGLT2i). Conclusions Prescribing rates for GLP-1RAs and SGLT2i have increased over the past eight years but remain low, even among MI and stroke survivors. Women, older patients, and those in lower-income regions are significantly less likely to receive these therapies. Targeted interventions are needed to improve secondary prevention in high-risk diabetic populations and to address these disparities.Myocardial infarction patients Stroke patients