Long-term dynamic changes in the left atrium (LA) following radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) remain unclear. We aimed to unveil the temporary dynamics of LA reverse remodeling and the optimal echocardiographic indicator and timing for evaluating RFCA outcomes in this 3-year longitudinal study.

Data were retrospectively collected from 400 consecutive patients undergoing RFCA for AF (paroxysmal 71%). Echocardiographic examinations were performed at 1 day, and 1, 3, 6, 12, 18, 24, 30, and 36 months after RFCA. Patients were classified into three groups based on RFCA outcomes. We constructed mean response curves to visualize the tendency between echocardiographic indicators and time across groups. Proportional odds models were built to determine the optimal echocardiographic indicator and follow-up time point for distinguishing the outcome group.

After a mean follow-up duration of 81 ± 24 months, free of AF was achieved in 357 patients. Mean response curves of echocardiographic indicators differed between patients with and without AF recurrence. A flat slope of mean response curves in the first 3 months and deterioration of echocardiographic indices starting 18 months after RFCA indicated higher risks of AF recurrence. LA linear ablation didn't affect the longitudinal trend of echocardiographic indicators in paroxysmal AF, but retarded LA reverse remodeling process in persistent AF. LAEF at 36 months had the highest c-index for predicting AF recurrence during a median follow-up period of 80 months.

The longitudinal trend of echocardiographic indicators reflects long-term LA remodeling and can provide important information for individualized treatment strategies.

Infective endocarditis (IE) is associated with high morbidity and mortality. However, the impact of geriatric syndromes on clinical outcomes in elderly patients with IE remains insufficiently characterized. The aim was to assess the prevalence of geriatric syndromes; focusing on frailty, functional dependence, comorbidity and malnutrition; and their association with in-hospital mortality in advanced-age patients with infective endocarditis.

This prospective multicenter observational registry included patients aged ≥ 75 years with possible or definitive IE. Comprehensive geriatric assessment was performed after IE diagnosis using the Clinical Frailty Scale (CFS), FRAIL scale, Mini Nutritional Assessment Short Form (MNA-SF), Barthel index, and age-adjusted Charlson comorbidity index. Patients were classified as frail (CFS ≥ 4) or non-frail (CFS < 4).

Among 115 patients (median age 81 [78-85] years, 70.4% male), 52 (45.2%) were classified as frail. Despite similar surgical indications, frail patients underwent surgery less frequently than non-frail patients (10 (19.2%) vs. 30 (47.6%), P = 0.001) and presented higher in-hospital mortality (19 (36.5%) vs. 10 (15.9%), P = 0.011). Multivariate analysis identified malnutrition risk (MNA-SF: OR = 0.712, 95% CI: 0.516-0.983, P = 0.039) and comorbidity (adjusted Charlson: OR = 1.623, 95% CI: 1.108-2.379, P = 0.013) as independent predictors of in-hospital mortality. Frailty was significantly associated with mortality in a separate model excluding malnutrition, suggesting overlap between both constructs.

Geriatric syndromes, particularly comorbidity and malnutrition, are highly prevalent in elderly patients with IE and independently predict in-hospital mortality. Comprehensive geriatric assessment should be integrated into clinical decision-making for this population.

The influence of sleep duration on vulnerable coronary plaques, as evaluated via optical coherence tomography (OCT), has not been clearly defined in coronary artery disease (CAD). Here, the relationships between habitual sleep duration and thin-cap fibroatheroma (TCFA) detected by OCT were investigated in individuals with CAD. We further investigated whether systemic inflammation, represented by the neutrophil-to-lymphocyte ratio (NLR), represents a mediator of this association.

Overall, 1,178 patients with angiographically confirmed CAD who underwent OCT imaging and completed standardized sleep questionnaires were enrolled. Participants were categorized according to reported sleep duration. Multivariable logistic regression modeling was employed to assess the link between sleep duration and TCFA. Linear regression analyses assessed the association between sleep duration and NLR. Restricted cubic spline (RCS) modeling was applied as a means of detecting possible nonlinear associations between NLR and TCFA. Mediation analyses were then conducted to determine whether NLR functioned as an intermediate variable linking sleep duration and plaque vulnerability.

These results offer the first clinical evidence of the link between sleep duration and TCFA presence in individuals with CAD, with the TCFA risk in the abnormal sleep duration group being 2.16 times that of the normal group (95% CI: 1.63-2.88, P < 0.001). Sleep duration was also independently correlated with NLR, and RCS analysis highlighted a nonlinear relationship between NLR levels and TCFA risk (P < 0.001). Importantly, mediation analysis demonstrated that NLR partially mediated the effect of sleep duration on TCFA, supporting the existence of a sleep-inflammation-plaque vulnerability axis.

The sleep duration has been shown to be significantly associated with the risk of developing TCFA. In addition, a partial mediating effect of NLR on this relationship has been found.

Guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) relies on quadruple therapy, including beta-blockers (BB), angiotensin receptor-neprilysin inhibitors (ARNi), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Elderly patients with HF represent a high-risk population and often face therapeutic inertia but also more adverse events. We aimed to assess the efficacy and safety of an intensive titration program (ITP) for elderly HFrEF patients.

We conducted a prospective, single-center, observational study including HFrEF patients aged ≥ 75 years managed with an ITP between January 2024 and February 2025. The primary outcome was the prescription rate of quadruple GDMT at 3 months, irrespective of dose. Secondary outcomes included prescription of quadruple therapy at ≥ 50% of GDMT target doses and identification of predictors of limited implementation. Safety outcomes included adverse events occurring during titration and within 3 months after completion.

Sixty-four patients were included (Median age 80 years, 70% male, 28% diabetes, median eGFR 50 mL/min). The mean titration period was 100 days (14 weeks). At 3 months, 33% of patients were prescribed quadruple therapy, with 5% achieving ≥50% of the recommended target dose in each drug class. Target dose achievement improved across all drug classes between baseline and 3 months: ARNi (1% vs. 31%), MRA (1% vs. 14%), and BB (3% vs. 5%) (all P < 0.05). These improvements were associated with short-term clinical and biological benefits (NT-proBNP reduction, improved left ventricular ejection fraction). Reported adverse events included symptomatic hypotension (8% with treatment discontinuation) and acute kidney injury (8% requiring hospitalization). Older age and chronic kidney disease were associated with limited initiation of quadruple therapy.

An intensive titration program for HFrEF therapy appears feasible and relatively safe in elderly patients.

To compare outcomes of coronary revascularization with coronary artery bypass grafting (CABG) or complex or multivessel percutaneous coronary intervention (MV PCI) in patients with dementia.

We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with Alzheimer's disease and related dementias (ADRD) who underwent coronary artery bypass grafting (CABG) or MV PCI from January 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were inpatient and 90-day complications and 90-day readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care.

8,939 patients with ADRD undergoing revascularization with CABG MV PCI met study criteria. Of these, 3,510 (39.3%) underwent CABG and 5,429 (60.7%) underwent MV PCI. Patients with ADRD who underwent MV PCI were more likely to be older (81.0 vs. 76.7, P < 0.001), women (44.1% vs. 29.4%, P < 0.001), frail (82.4% vs. 75.0%, P < 0.001), and have moderate to severe dementia (64.4% vs. 54.6%, P < 0.001). One-year mortality was higher among patients undergoing MV PCI (OR = 2.0, 95% CI: 1.8-2.3) but inpatient and 90-day major complications were lower (OR = 0.3, 95% CI: 0.3-0.3 and OR = 0.5, 95% CI: 0.4-0.5, respectively). Patients with ADRD undergoing MV PCI were less likely to be discharged to a higher level of care (OR = 0.2, 95% CI: 0.2-0.2) and had higher time-at-home ratios (Mean Difference 4.2, 95% CI: 2.4-6.0).

Patients with ADRD undergoing MV PCI demonstrate higher 1-year mortality but lower short-term complications. Patient-centered outcomes of time-at-home ratio and risk for discharge to a higher level of care were more favorable with MV PCI compared to CABG. These data should be used by patients, their families, and physicians to facilitate goal-concordant care especially when optimization of patient-centered outcomes is desired.

Sarcopenia is a progressive age-related skeletal muscle disorder characterized by the loss of muscle mass, strength, and physical performance. Increasing evidence suggests that activation of the renin-angiotensin system (RAS) contributes to muscle wasting through promotion of protein degradation and impairment of anabolic signaling. Azilsartan (AZL), a highly selective angiotensin Ⅱ type 1 receptor (AT1R) blocker, has demonstrated pleiotropic effects beyond blood pressure control. However, its effects on skeletal muscle atrophy and the underlying mechanisms remain incompletely understood.

We combined a prospective observational study with mechanistic investigations in animal and cellular models. Older adults with hypertension and sarcopenia received AZL (40 mg/day) or other antihypertensive therapies for 6 months, and muscle strength, gait speed, and appendicular skeletal muscle mass were assessed. Moreover, Ang Ⅱ-induced skeletal muscle atrophy models were established in mice and C2C12 myotubes to evaluate the effects of AZL on muscle morphology and signaling pathways.

AZL treatment was associated with significant improvements in handgrip strength, gait speed, and appendicular skeletal muscle mass in older hypertensive patients. In experimental models, Ang Ⅱ induced skeletal muscle dysfunction and atrophy, characterized by reduced exercise capacity, decreased grip strength, and muscle fiber loss, were attenuated by AZL treatment. Mechanistically, AZL restored PI3K/Akt/FOXO3a signaling and suppressed the expression of the muscle-specific ubiquitin ligases Atrogin-1 and MuRF1. The protective effects of AZL were abolished by the AT1R agonist TRV120027 in both in vivo and in vitro models and were further attenuated by the PI3K inhibitor LY294002 in C2C12 myotubes.

AZL attenuates Ang Ⅱ-induced skeletal muscle atrophy through AT1R blockade and subsequent activation of PI3K/Akt/FOXO3a signaling, thereby suppressing ubiquitin-proteasome system-mediated muscle protein degradation. These findings provide mechanistic and translational evidence supporting the potential of AZL as a therapeutic strategy for preserving skeletal muscle health in older adults with hypertension.

Diabetes is an established risk factor for atrial fibrillation (AF). However, whether prediabetes is also a risk factor for AF is unclear. This meta-analysis examined the relationship between prediabetes and AF risk.

EMBASE, MEDLINE, and Publicly Available Contents (from Jan. 1, 1950 to Jan. 29, 2025) were used to comprehensively search for observational studies of the incidence or prevalence of AF among those with prediabetes or normoglycemia. Each relative risk (RR) for prediabetes vs. normoglycemia and the population attributable fraction (PAF) of prediabetes to AF incidence in longitudinal studies and the odds ratio (OR) for prediabetes vs. normoglycemia in cross-sectional studies were pooled with a random-effects model.

Identified were 46 eligible studies. Pooled RR and PAF (95% confidence interval [CI]) were 1.12 (1.06-1.18) and 2.7% (1.4%-4.0%), respectively. Pooled crude RR and crude OR (95% CI) were 1.49 (1.37-1.62) and 1.42 (1.23-1.64), respectively. Higher RR was revealed in populations ≥ 65 years old vs. < 65 years old (P = 0.02) and in Asian vs. non-Asian countries (P = 0.047). Higher PAF was revealed in studies with a population ≥ 65 years old vs. < 65 years old (P < 0.001) and in male-dominant vs. female-dominant studies (P < 0.001). Only by examining the RR for both diabetes and prediabetes vs. normoglycemia, the pooled RR/PAF (95% CI) was 1.12 (1.15-1.20)/1.6% (0.9%-2.3%) for prediabetes and 1.15 (1.10-1.20)/1.0% (0.7%-13%) for diabetes.

Prediabetes is a modest but significant risk factor for AF, comparable to that of diabetes. The impact of prediabetes was strong among the elderly, males, and Asian people.