Citations

This retrospective propensity-matched cohort study assessed the association between sodium-glucose co-transporter-2 inhibitor (SGLT2i) use and cardiovascular outcomes in patients with acute myocardial infarction (AMI) without a history of heart failure. Using the TriNetX U.S. Collaborative Network, we identified 1440 matched patients (720 SGLT2i+ vs 720 SGLT2i−) with preserved ejection fraction and no prior heart failure. Nearly 90% of patients had diabetes. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of MI, stroke, heart failure, and all-cause mortality. At 1 year, MACE occurred in 17.4% of SGLT2i+ versus 22.0% of SGLT2i− patients (odds ratio [OR] 0.746, 95% CI 0.574-0.969; P = .028), and all-cause mortality occurred in 3.1% versus 7.6%, respectively (OR 0.389, 95% CI 0.234-0.645; P < .001). SGLT2i use was also associated with lower risks of major bleeding. Findings were consistent over long-term follow-up. While the observed associations suggest potential cardioprotective effects of SGLT2i post-MI in patients without heart failure, residual confounding cannot be excluded. The observed reduction in bleeding events is novel and warrants further investigation in prospective studies.

Abstract Background and Aims The TRISCEND II trial demonstrated superior clinical benefits for patients with ≥severe tricuspid regurgitation (TR) treated with the EVOQUE transcatheter tricuspid valve replacement (TTVR) system plus medical therapy vs medical therapy alone. This work reports 1-year and 18-month outcomes in patients stratified by baseline TR severity. Methods The multicentre, prospective TRISCEND II trial enrolled 400 patients with symptomatic, ≥severe TR, and randomized 2:1 to TTVR (n = 267) or control (n = 133). In a post hoc analysis, patients were stratified into severe TR (n = 172) and massive/torrential TR (n = 220) cohorts. Clinical and quality-of-life outcomes were reported at 1 year, with Kaplan–Meier estimates for all-cause mortality and heart failure (HF) hospitalization assessed at 18 months. Study oversight included an independent echocardiographic core laboratory, clinical events committee, and data safety monitoring board. Results One year after TTVR, TR was ≤mild in 95.2% of severe TR and 95.3% of massive/torrential TR patients. The primary safety and effectiveness endpoint (win ratio) favoured TTVR over control regardless of baseline TR severity: severe {1.64 [95% confidence interval (CI): 1.11, 2.43]} and massive/torrential [2.20 (1.55, 3.14)]. At 18 months, TTVR patients had similar mortality to controls [rate difference: severe 0.2% (−11.6, 11.9), massive/torrential −5.8% (−17.6, 6.0)], whereas HF hospitalization rates favoured TTVR in the massive/torrential cohort [vs control, severe 9.8% (−3.0, 22.7), massive/torrential -15.2% (−28.9, −1.5)]. Conclusions Patients with ≥severe TR benefit from TTVR, experiencing improvements in TR severity, functional capacity, and quality of life regardless of baseline TR severity, with a signal for greater benefit in patients with more advanced disease.

There is an increased clinical use of elbow orthoses. It is important to consider patient experiences in their use. Patient-reported outcome measures (PROMs) serve as essential tools for gathering patient perspectives. This review provides a comprehensive list of PROMs used in clinical trials of elbow orthoses, and documents their properties, uses, and quality. A systematic literature search across PubMed, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science identified 31 clinical trials of elbow orthoses that used PROMs as outcome measures. Subsequently, manual searches were conducted to report on each PROM's characteristics. A total of 15 different PROMs were used as outcome measurements in clinical trials that used an elbow orthosis as an intervention for 11 different conditions. Researchers can use this review to aid in making informed decisions about which PROMs to use for future clinical trials.

Introduction: Periaortitis is a rare inflammatory condition with both infectious and non-infectious aetiologies, often presenting a diagnostic challenge. A comprehensive evaluation—including history, physical examination, imaging, and a broad infectious work-up—is essential, as negative blood cultures do not rule out infection, and premature use of glucocorticoids may be harmful in cases of infectious periaortitis. Case description: We report the case of a 70-year-old man presenting with flank pain and periaortitis, in whom positron emission tomography/computed tomography (PET/CT) scan revealed moderate-to-severe 18F-fluorodeoxyglucose (FDG) uptake. Despite negative cultures, a Karius test and urine antigen confirmed Streptococcus pneumoniae as the causative agent. The patient underwent successful open surgical repair of a mycotic pararenal abdominal aortic aneurysm, followed by targeted antibiotic therapy. Discussion: Pneumococcal periaortitis is a rare condition with few reported cases, though S. pneumoniae has been implicated in various vascular infections including mycotic aneurysms, and diagnostic challenges persist, especially when blood cultures are negative. The Karius SpectrumTM, despite its cost and limited guidance for use, and FDG-PET/CT imaging have emerged as helpful tools in identifying infectious aetiologies, with high maximum standardized uptake value values favouring infection over autoimmune causes, as seen in this case. Conclusion: Infectious periaortitis should be suspected when there is a high uptake of FDG on PET/CT prompting an infectious disease work-up which may include a Karius test.

Abstract Background: Understanding of the diagnosis and treatment of adults with community-acquired pneumonia (CAP) has evolved thanks to new evidence, experience, and emerging technologies. This document updates evidence-based clinical practice guidelines on four key questions for the diagnosis and management of adult patients with CAP. Methods: A multidisciplinary panel integrated systematic reviews of comparative evidence with other relevant research and clinical experience, then applied Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to produce recommendations using the Evidence to Decision Framework. Results: The panel formulated clinical recommendations that address questions related to CAP, including lung ultrasound for diagnosis, empiric antibacterial therapy if a test for a respiratory virus is positive, antibiotic duration, and the use of systemic corticosteroids. Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with CAP.

Abstract Background and Aims Truncating variants in the TTN gene (TTNtv) are the most common genetic cause of dilated cardiomyopathy (DCM) but also occur as incidental findings in the general population. This study investigated factors associated with the clinical manifestation of TTNtv. Methods An international multicentre retrospective observational study was performed in families with TTNtv-related DCM. Shared frailty models were used to estimate associations of variant characteristics with lifetime risk of DCM, and logistic regression to estimate odds ratios (ORs) for individual-level clinical risk factor profiles (cardiac conditions, cardiovascular comorbidities, lifestyle) and DCM. Results A total of 3158 subjects in 1043 families with TTNtv-related DCM were studied. TTNtv-positive subjects were 21-fold more likely to develop DCM [OR, 21.21; 95% confidence interval (CI), 14.80–30.39]. Disease onset was earlier in males, but was similar for TTNtv of different types and locations. The presence of clinical risk factors was associated with earlier DCM onset (OR, 3.41; 95% CI, 2.06–5.64), with a prior history of atrial fibrillation having a two-fold increased odds of DCM (OR, 2.05; 95% CI, 1.27–3.32). The prevalence of clinical risk factors increased with age; however, the strength of the DCM association was greatest for young-onset (&lt;30 years) disease (OR, 4.75; 95% CI, 2.35–9.60). Administration of beta-adrenergic receptor or renin-angiotensin system-blocking drugs prior to overt DCM was associated with 87% reduced odds of DCM (OR, .13; 95% CI, .08–.23). Conclusions Disease onset in TTNtv-associated familial DCM is dependent on individual patient context and is potentially modifiable by risk factor management and prophylactic therapeutic intervention.

Introduction: Amyloidosis complicated by heart failure (HF) poses significant mortality. We sought to identify trends in comorbid amyloidosis and HF mortality in the recent 22- year period. Methods: Mortality due to amyloid and HF as contributors of death were queried from death certificates using the CDC database from 1999 to 2020. Mortality rates and their 95% confidence intervals were adjusted for age (AAMR) through the Direct method and compared by demographic subpopulations. The Monte-Carlo permutation test was used to estimate the annual percentage change (APC). Log-linear regression models were utilized to assess temporal variation in mortality. Results: Age-adjusted mortality rates (AAMR) increased from 0.09 [0.08-0.10] in 1999 to 0.27 [0.25-0.29] in 2020. Mortality increased from 1999 to 2013 (APC +1.4, p=0.048) with an accelerating inflection point in 2013 to 2020 (APC +13.3, p<0.001). AAMR was higher among male populations (AAMR 0.20 [0.20-0.21]) compared to female populations (AAMR 0.07 [0.07- 0.07]). A significant inflection point in uprising mortality rates was observed for both male and female populations in 2013 (p<0.001). Mortality was highest among Black populations (AAMR 0.33), followed by White (AAMR 0.10), Asian/Pacific Islander (AAMR 0.06), and American Indian/Alaska Native populations (AAMR 0.04). Among Black populations, mortality remained consistent from 1999 to 2012 (APC +1.1, p=0.184), followed by an increase from 2012 to 2020 (APC +14.0, p<0.001). Among White populations, mortality remained stagnant from 1999 to 2013 (APC +0.7, p=0.302), followed by an increase starting in 2013 to 2020 (APC +13.5, p<0.001). Discussion: Our findings of a marked rise in HF-related mortality in patients with amyloidosis since 2013 highlighted the profound impact of enhanced diagnostic awareness, novel imaging techniques, and emerging therapeutics. Our analysis also showed mortality disparities between sexes, and geographic locations, races, and ethnicity that warrant targeted public health interventions. Conclusions: Amyloid and HF mortality increased in the recent 22-year period, primarily starting in 2013, emphasizing the urgent need for targeted intervention to address these disparities.

ImportanceThe Ophthalmic Knowledge Assessment Program (OKAP) has been widely used to determine readiness to take the high-stakes Written Qualifying Examination (WQE). However, it is unclear how well OKAP performance can predict WQE outcomes.ObjectiveTo examine the association between the OKAP and WQE nationally.Design, Setting, and ParticipantsThis was a retrospective cohort study conducted from 2017 to 2022. This national data analysis included residents from ophthalmology residency programs in the US. Study data were analyzed June 2023 to December 2024.ExposuresOKAP and WQE data.Main Outcomes and MeasuresThe national OKAP examination data and the WQE data were matched. Candidates who had complete data for the OKAP during postgraduate year (PGY) 2, 3, and 4 and completed the WQE were included in the study. Two-sample t tests, logistic regression analysis, receiver operating characteristic curves, and confusion matrix were used to examine the association of various test scores (PGY-2 OKAP, PGY-3 OKAP, PGY-4 OKAP, minimum OKAP, maximum OKAP, average OKAP) as predictors for WQE outcomes (pass or fail). Multiple logistic regression analyses were also used to assess the association of gender, time since graduation, program size, and WQE pass/fail outcomes.ResultsA total of 1597 residents (907 male [56.8%]) from 117 residency programs were included in this study. First-time pass rate of the WQE was 89% (1418 of 1597 residents). OKAP scores, particularly average OKAP, maximum OKAP, and PGY-4 OKAP scores (all had area under the curve = 0.88), were the most useful predictor of WQE outcomes. PGY-4 OKAP scores were used for the rest of the analysis for simplicity. A PGY-4 OKAP scaled score of 550 corresponded to 94% of candidates passing the WQE. Using PGY-4 OKAP scores to predict passing/failing, the WQE had 90.7% accuracy. Gender (odds ratio [OR], 1.50; 95% CI, 1.01-2.26; P = .048), program size (OR, 1.55; 95% CI, 0.98-2.41; P = .06), and time since residency graduation (OR, 1.00; 95% CI, 1.00-1.00; P = .14) were not included in the logistic regression model investigating the association of PGY-4 OKAP scores with the likelihood of passing the WQE.Conclusions and RelevanceResults suggest that OKAP examination scores were associated with passing the WQE after adjusting for program size, gender, and time since residency graduation. Further analyses may be warranted to predict failing the WQE so that potential interventions can be attempted.