Said Alsidawi

Aims: The aims of this study were to evaluate the association between the red cell distribution width (RDW)–albumin ratio (RAR) and subclinical myocardial impairment, as assessed by left ventricular global longitudinal strain (LVGLS), and to examine the relationships between the RAR, heart failure (HF) hospitalization, and all-cause mortality. Methods: We conducted a retrospective cohort study on adults who underwent transthoracic echocardiography (TTE) with LVGLS assessment across three Mayo Clinic centers (2017–2024) and who had RDW and serum albumin measured on the same day or within seven days. The RAR was calculated as RDW/albumin and categorized into the following tertiles: 3.48. Impaired LVGLS was defined as >−18%. Associations between the RAR and outcomes were assessed using multivariable logistic regression (LVGLS) and Cox models (HF and mortality), adjusting for demographics and comorbidities. Results: Among 5069 patients, 39.7% had impaired LVGLS, and its prevalence increased across RAR tertiles (26.8%, 41.9%, and 51.1%). Adjusted odds ratios for impaired LVGLS were 1.74 and 2.30 for tertiles 2 and 3, respectively. A higher RAR was associated with increased risk of HF hospitalization (aHR 2.54 and 4.48) and all-cause mortality (aHR 2.39 and 7.30). These associations persisted after adjusting for LVGLS. The effect of the RAR on mortality was stronger in patients with normal LVGLS compared to those with impaired LVGLS (p for interaction = 0.0004). Conclusions: A higher RAR was associated with abnormal LVGLS, HF hospitalization, and all-cause mortality after adjustment for clinical risk factors. However, the RAR did not provide discriminative value beyond its individual components.

IntroductionStructural valve degeneration (SVD) remains a major limitation of bioprosthetic heart valves (BHVs), particularly among patients with diabetes mellitus, in whom inflammation, oxidative stress, and advanced glycation accelerate valve deterioration. Sodium-glucose cotransporter-2 (SGLT2) inhibitors exert pleiotropic anti-inflammatory and anti-fibrotic effects that may favorably influence SVD. We evaluated the association between SGLT2 inhibitor use, valve re-intervention and cardiovascular outcomes in patients with diabetes and BHVs.MethodsWe performed a retrospective multicenter cohort study using the TriNetX federated electronic health record network. Adults (≥18 years) with diabetes who underwent surgical or transcatheter BHV implantation between 2014 and 2023 were included. Patients were stratified by post-procedural SGLT2 inhibitor use. Primary outcome was repeat valve intervention. Secondary outcomes included acute heart failure hospitalization, myocardial infarction, ventricular tachycardia, cardiac arrest, and atrial fibrillation. Propensity score matching (1:1) was performed. Time-to-event and logistic regression analyses were conducted.ResultsAmong 28,575 eligible patients, 1,958 received SGLT2 inhibitors. After matching, 1,832 patients remained in each group. Over approximately 2.5 years of follow-up, repeat valve intervention occurred in 2.5% of SGLT2 inhibitor users versus 3.7% of non-users (OR 0.67, 95% CI 0.46–0.98). SGLT2 inhibitor use was also associated with lower odds of cardiac arrest (OR 0.55), atrial fibrillation (OR 0.78), heart failure hospitalization (OR 0.63), and myocardial infarction (OR 0.64).ConclusionsIn patients with diabetes and BHVs, SGLT2 inhibitor use was associated with reduced valve re-intervention and fewer adverse cardiovascular events. These findings support a potential role for SGLT2 inhibitors in improving BHV durability and clinical outcomes.

Aims: Obesity is linked with worse outcomes in hypertrophic cardiomyopathy (HCM). While both bariatric surgery (BS) and GLP-1 receptor agonists (GLP-1RA) promote weight loss and may improve cardiometabolic risk, their comparative outcomes in HCM remain unclear. Methods and results: Adults with HCM and body mass index (BMI) ≥ 30 kg/m were divided into two cohorts: (i) GLP-1 RA users who never had BS, and (ii) BS patients who never received GLP-1 RA. Propensity score matching (1:1) was performed to balance demographics, comorbidities, and medications. Outcomes over 24 months include all-cause mortality, acute heart failure (HF) hospitalization, arrhythmias, change in BMI, and cardiovascular symptoms. Hazard ratios with 95% confidence intervals were estimated using Cox models. Of 5002 patients, 955 were included in each matched cohort after matching (mean age 54 ± 13 years, 70% female, BMI 40.0 kg/m). GLP-1 RA was associated with a significantly lower observed rate of all-cause mortality compared with BS (2.0% vs. 4.4%; HR 0.46; 95% CI 0.27–0.80; P = 0.004) and HF hospitalization (8.7% vs. 14.0%; HR 0.60; 95% CI 0.46–0.79; P < 0.001). Similarly, GLP-1 RA use was associated with a lower incidence of composite cardiovascular outcomes (10.7% vs. 17.2%; HR 0.60; 95% CI 0.47–0.77; P < 0.001). Rates of arrhythmia and cardiovascular symptoms were comparable between the two groups. BMI reduction was greater after bariatric surgery (−4.0 vs. −2.6 kg/m; P < 0.001). Conclusion: In obese patients with HCM, GLP-1 RA therapy was associated with lower all-cause mortality and fewer HF events compared with BS. Future studies are warranted to confirm our findings.

Background.: Liver transplant recipients face high risks of cardiometabolic events after transplant, driven by posttransplant weight gain, diabetes, hypertension, as well as immunosuppression-related side effects. Glucagon-like peptide-1 receptor agonists (GLP1RAs) improve metabolic and cardiorenal outcomes in nontransplant populations, but their role in liver transplant recipients remains understudied. Methods.: This retrospective cohort study used TriNetX data (January 2010–December 2023) to compare outcomes in liver transplant recipients prescribed GLP1RAs (semaglutide, dulaglutide, liraglutide) within 1-mo posttransplant (n = 546) versus nonusers (n = 37 153). Propensity score matching (1:1) balanced demographics, comorbidities, and medications (n = 541 per group). Outcomes included mortality, hospitalizations, cardiovascular/renal/respiratory events, and graft outcomes. Results.: Over a mean follow-up 838.5 d (SD 291.9) in the GLP1RA cohort and 884.3 d (SD 313.7) in the non-GLP1RA group, GLP1RA use was associated with a 43% lower all-cause mortality (7.0% versus 12.9%; hazard ratio [HR], 0.566; 95% confidence interval [CI], 0.381-0.841) and 39% fewer hospitalizations (60.4% versus 74.5%; HR, 0.613; 95% CI, 0.530-0.710). Acute heart failure (HR, 0.386; 95% CI, 0.285-0.524), renal failure/dialysis (HR, 0.489; 95% CI, 0.413-0.579), and respiratory failure (HR, 0.484; 95% CI, 354-0.662) risks were significantly reduced. No differences were observed in graft failure/rejection, myocardial infarction, stroke, atrial fibrillation/flutter, ventricular tachycardia, or ischemic optic neuropathy. Conclusions.: Early GLP1RA initiation in liver transplant recipients was associated with reduced mortality, hospitalizations, respiratory, and cardiorenal complications without compromising graft safety. These findings support GLP1RAs as a promising adjunct therapy, warranting prospective trials to confirm benefits in this high-risk population.

Key Points: Atrial fibrillation after kidney transplantation is common and is associated with poor prognosis. Artificial intelligence applied to 12-lead electrocardiograms pretransplant accurately predicts the risk of new-onset atrial fibrillation in our cohort. High-risk artificial intelligence electrocardiography score was independently associated with increased risk of mortality and allograft failure. Background: Incident atrial fibrillation (AF) is common after kidney transplantation (KTx) and is associated with worse clinical outcomes. Artificial intelligence electrocardiography (AI-ECG) algorithms have demonstrated efficacy in predicting risk of new-onset AF in the general population; however, their prognostic value in KTx recipients is relatively unknown. Methods: Retrospective analysis was conducted on KTx recipients without AF, with at least one pretransplant ECG between 2011 and 2021 across three tertiary centers in the United States (Mayo Clinic sites in MN, AZ, and FL). A previously validated AI-ECG algorithm estimated the probability of incident AF for each patient. Based on AI-ECG probabilities, patients were categorized into high-risk and low-risk groups, with the optimal AI-ECG score cutoff determined. The incidence of new-onset AF, allograft failure, and mortality was compared between groups. Results: Overall, 6246 patients (age 53.5±13.8 years; 58.9% male) were included. Pretransplant AI-ECG probability of AF ≥5% was the optimal cutoff for high risk of incident AF (sensitivity 72%, specificity 62%). High-risk scores were associated with true new-onset AF at 30 days (adjusted hazard ratio [aHR], 2.89; 95% confidence intervals [CI], 2.05 to 4.09; P < 0.001), 3 years (aHR, 2.54; 95% CI, 1.99 to 3.26, P < 0.001), and 5 years post-transplant (aHR, 2.48; 95% CI, 1.99 to 3.09, P < 0.001). High-risk AI-ECG scores were also associated with increased mortality (aHR, 1.56; 95% CI, 1.30 to 1.88, P < 0.001) and overall allograft failure (aHR, 1.50; 95% CI, 1.30 to 1.75, P < 0.001) through the 5-year follow-up. Conclusions: This pretransplant AI-ECG parameter identified patients at increased risk of new-onset AF post-KTx and provided prognostic utility. Overall, this easy to obtain tool allows for risk stratification of patients who may benefit from closer monitoring, targeted risk factor modification, and early intervention.