Yong Peng

Background/Objectives: Preprocedural red cell distribution width (RDW) is associated with mortality after transcatheter aortic valve replacement (TAVR), but the prognostic relevance of serial measurements and native leaflet morphology remains uncertain. Methods: This single-center retrospective cohort included 1369 patients who underwent native-valve TAVR from January 2019 to October 2023. The primary analysis evaluated baseline RDW-coefficient of variation (RDW-CV) and mortality in the overall cohort. Exploratory landmark analyses examined postprocedural RDW-CV changes among survivors with repeat measurements. Valve-disease phenotype and leaflet morphology were evaluated as potential effect modifiers. Results: During a median reverse Kaplan–Meier follow-up of 58.7 months, 196 patients died. Higher baseline RDW-CV was associated with mortality over all follow-up (adjusted HR per 1-SD increase, 1.17; 95% CI, 1.02–1.34; p = 0.022). After adjustment for baseline RDW-CV and clinical covariates, greater increases at 3 months (HR per window-specific 1-SD increase, 1.53; 95% CI, 1.20–1.94; p < 0.001) and 6 months (HR, 1.37; 95% CI, 1.08–1.73; p = 0.009) were associated with subsequent mortality. Exploratory analysis suggested a stronger 6-month association in bicuspid than tricuspid valves (HR, 2.47 [95% CI, 1.65–3.69] vs. 1.02 [0.75–1.40]; interaction p = 0.002). Adding 6-month RDW-CV change increased the cross-validated 2-year AUC from 0.628 to 0.651. Conclusions: Baseline RDW-CV was associated with mortality after TAVR. Among patients with repeat testing, increases at 3 and 6 months were associated with subsequent mortality, with an exploratory stronger association in bicuspid aortic valve. Standardized prospective sampling is required to confirm these longitudinal findings.

Background: Comparisons between transcatheter and surgical aortic valve replacement (TAVR or SAVR) in younger aortic stenosis (AS) patients are scarce. The aim of the study was to evaluate the 5-year outcomes of AS patients n = 808) or SAVR (n = 838) were finally included. At baseline, TAVR patients had an older age [(67.9 ± 5.2) vs. (56.5 ± 9.6) years, p < 0.001] and a higher surgical risk score [(3.1 ± 1.5) vs. (2.1 ± 1.0) %, p < 0.001] than SAVR patients, which was well balanced after IPTW. The 5-year adjusted risk of the primary outcome was similar (TAVR 45.9% vs. SAVR 43.4%, weighted hazard ratio, 1.00, 95% confidence interval, 0.64–1.54, p = 0.986), which stayed comparable between TAVR and mechanical or bioprosthetic SAVR separately. In BAV patients (n = 516), the risk of death was 8.3% in the TAVR group and 3.4% in the SAVR group (p = 0.349). The risk of bioprosthetic structural valve deterioration at 5 years was comparable between groups in the overall cohort (5.7% vs. 8.4%, p = 0.478) and BAV patients (7.8% vs. 13.2%, p = 0.345). Conclusions: In this retrospective study of patients aged <75 years, the risk-adjusted 5-year major clinical outcomes were statistically similar between TAVR and SAVR. However, given the inherent historical imbalances, these exploratory findings should be interpreted with caution, and dedicated prospective studies are still needed in younger and BAV populations.

Background Residual left ventricular (LV) hypertrophy and incomplete reverse remodelling after transcatheter aortic valve replacement (TAVR) are associated with adverse outcomes. Whether renin-angiotensin system inhibitors (RASi) promote reverse remodelling in patients with heart failure and LV ejection fraction (LVEF) ≥40% following TAVR remains uncertain. Methods In this multicentre, prospective, randomised, open-label, blinded-endpoint trial, patients aged ≥60 years with symptomatic severe aortic stenosis, LVEF ≥40% and successful TAVR were randomly assigned (1:1) to standard care alone or standard care plus RASi (ACE inhibitor, angiotensin II receptor blocker or angiotensin receptor-neprilysin inhibitor). The primary endpoint was change in LV mass index (LVMI) at 12 months. Secondary endpoints included changes in LV volumes, LVEF, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and functional status. Results A total of 200 patients were randomised; 194 were included in the modified intention-to-treat analysis (RASi n=95; control n=99). At 12 months, RASi therapy was associated with a greater reduction in LVMI compared with control (adjusted mean difference −12.77 g/m², 95% CI −24.73 to −0.81; p=0.036). Consistent improvements were observed in LV end-diastolic and end-systolic volumes. Functional status (New York Heart Association class) improved modestly in the RASi group. No significant differences were observed in LVEF or NT-proBNP. Conclusion In patients with heart failure and LVEF ≥40% following TAVR, RAS inhibition led to enhanced reverse LV remodelling over 12 months, reflected by greater regression of LV mass and volumes. These findings support the potential role for RASi in modifying post-TAVR myocardial remodelling, although larger trials are required to determine whether these structural benefits translate into improved clinical outcomes. Trial registration number ChiCTR2100042266.

Background: The impact of aortic valve morphology on outcomes after transcatheter aortic valve replacement in patients with mixed aortic valve disease, characterized by the coexistence of aortic stenosis and regurgitation, remains poorly defined. This study aimed to compare outcomes of transcatheter aortic valve replacement between bicuspid and tricuspid aortic valve morphologies in patients with mixed aortic valve disease. Methods: We retrospectively analyzed 282 patients with mixed aortic valve disease who underwent transcatheter aortic valve replacement between January 2019 and June 2024, including 82 with bicuspid aortic valve and 200 with tricuspid aortic valve. Propensity score matching at a 1:1 ratio yielded 82 well‐balanced pairs. The primary end point was all‐cause death, and secondary end points included technical success, paravalvular leak, clinical adverse events, hemodynamic performance, and left ventricular reverse remodeling. Results: Both groups achieved high technical success rates (97.6% versus 93.9%; P =0.443) with comparable procedural outcomes. Although mild or greater paravalvular leak occurred more frequently in the bicuspid aortic valve group, this difference did not translate into higher 1‐year all‐cause death (3.7% versus 3.7%; P >0.999) or adverse events. Hemodynamic performance and left ventricular remodeling improved significantly in both groups; however, patients with bicuspid aortic valve showed more pronounced increase in left ventricular ejection fraction (median, 6.5% [interquartile range, −2.0% to 15.5%] versus 0.5% [interquartile range, −5.0% to 12.0%]; P =0.023), whereas the degree of reverse remodeling was less evident (median, −7.0 [interquartile range, −17.0 to −3.0] versus −11.0 [interquartile range, −20.0 to −6.0] mm; P =0.045). Conclusions: In patients with mixed aortic valve disease undergoing transcatheter aortic valve replacement, bicuspid aortic valve morphology was associated with more mild or greater paravalvular leak but similar procedural safety, hemodynamic outcomes, and clinical prognosis compared with tricuspid aortic valve, with distinct left ventricular recovery patterns.

BACKGROUND Solid fuel use for cooking and heating is a major environmental risk factor, yet its association with new-onset heart disease (HD) remains unclear. The aim of this study was to investigate the relationship between solid fuel exposure and new-onset HD in a large cohort. METHODS Multivariable logistic regression models assessed associations between cooking/heating fuel types (coal, crop residue/wood, liquefied petroleum gas, natural gas, and others) and new-onset HD. Subgroup analyses explored effect modification by age, sex, education, smoking, alcohol use, and region. RESULTS A prospective cohort study included 5915 participants, with 781 participants (13.2%) developing new-onset HD. Coal use for cooking showed an initial association with new-onset HD risk (OR = 1.41, 95% CI: 1.06–1.86, P = 0.02), which attenuated after full adjustment (OR = 1.28, 95% CI: 0.96–1.72, P = 0.10). Coal use for heating demonstrated robust associations across all models (OR = 1.86, 95% CI: 1.42–2.43, P < 0.001). Crop residue/wood burning for heating was also significant (Model 2: OR = 1.40, 95% CI: 1.06–1.86, P = 0.02). Subgroup analyses revealed stronger associations among females, non-smokers, non-drinkers, and less-educated participants. Geographic stratification showed significant associations in southern but not northern regions. CONCLUSIONS Solid fuel use, particularly coal for heating, is associated with increased new-onset HD risk. Reducing solid fuel exposure is crucial for HD prevention in low-resource settings.

Background: Chronic inflammation is a driver of cardiovascular diseases, including valvular calcification. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil percentage-to-albumin ratio (NPAR) are promising markers of systemic inflammation. However, research on the predictive value of dynamic changes in these indices for clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) remains limited. Materials and methods: This study employed a retrospective single-center cohort (2012–2023, n = 1629) with validation in a prospective multicenter cohort (2023–2024, n = 443). The primary endpoint was all-cause mortality. All participants were stratified into tertiles based on pre- and post-TAVR values of NLR, PLR, and NPAR. Multivariate Cox proportional hazards regression models and restricted cubic spline (RCS) models were used to assess associations of pre-TAVR, post-TAVR, and dynamic changes in these three composite inflammatory markers with mortality. Receiver operating characteristic (ROC) curves and time-dependent Harrell’s C-index were applied to evaluate the time-varying predictive value of these markers for mortality. Results: Multivariable-adjusted Cox regression models showed that the highest tertile of inflammatory markers (both pre- and post-TAVR) was associated with a higher risk of all-cause mortality than the lowest tertile (pre-TAVR: NLR, aHR = 1.61, P = 0.032; PLR, aHR = 1.88, P = 0.003; NPAR, aHR = 1.69, P = 0.027). Multivariable-adjusted Cox regression and ROC analysis showed that post-TAVR inflammatory markers demonstrated a greater predictive value for mortality than pre-TAVR values. Time-dependent Harrell’s C-index analysis showed high and time-constant predictive values of the pre- and post-TAVR NLR, PLR, and NPAR for mortality. An increase in post-TAVR inflammatory markers from baseline was associated with a sharp rise in mortality risk. Replicate analyses in the multicenter prospective cohort validated the robustness of the findings from our single-center analysis. Conclusions: Post-TAVR NLR, PLR, and NPAR exhibit superior predictive value for mortality compared to pre-TAVR values, with NPAR being the most powerful predictor. Measurement of these three blood cell-based composite inflammatory markers enables precise risk stratification of TAVR patients. Further interventional studies targeting these markers, especially NPAR, are warranted.

Background: The relationship between improved glycemic control and mortality reduction in diabetes remains controversial. This study aimed to examine the temporal trends and association between haemoglobin A1c (HbA1c) control status and mortality risk among adults with diabetes. Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2014. The statistical significance of linear or nonlinear trends was evaluated using logistic regression. Nonlinear temporal trends were evaluated by including quadratic terms for time in the regression models. To explore the relationships between HbA1c and mortality, the study employed the Cox proportional hazards model for multivariate analysis, along with Kaplan-Meier survival curves for univariate visualization. Results: With 6,516 participants, the study showed a significant improvement in the control rate of HbA1c among diabetic patients, increasing from 41.61% in 1999 to 58.72% in 2014 (PConclusions: Despite significant improvements in HbA1c control rates among US adults with diabetes from 1999 to 2014, we observed no corresponding reduction in 5-year mortality risks. Achieving HbA1c <7.0% was not associated with lower mortality risk in this population. These findings suggest that improvements in glycemic control alone may be insufficient to reduce mortality in diabetic populations, highlighting the need for a more comprehensive approach to diabetes management.