Metab Syndr Relat Disord. 2025 Jun 17. doi: 10.1089/met.2025.0028. Online ahead of print.
ABSTRACT
Background: Metabolic syndrome (MetS) is increasingly prevalent globally and is linked to inflammation in cardiac tissues. Cardiac allograft vasculopathy (CAV) is a significant inflammatory condition and a leading cause of graft failure after orthotopic heart transplantation (OHT). The relationship between MetS and CAV remains poorly understood. Methods: A literature search was conducted from inception to September 2024, including studies that reported associations between MetS or its components (obesity, hypertension, dyslipidemia, and diabetes mellitus) and CAV. The primary endpoint was the development of CAV after OHT. Results were presented as odds ratios (OR) or hazard ratios (HR) with 95% confidence intervals (CI), employing both random and fixed-effect models based on heterogeneity. Results: A total of 16 studies involving 3,366 patients were included. The prevalence of MetS was high before OHT (32%, 95% CI: 24-41%, I2 = 75%) and increased after OHT (37%, 95% CI: 18-61%, I2 = 83%). MetS was significantly associated with CAV (OR = 1.99, 95% CI: 1.28-3.09, I2 = 36%). Key components of MetS linked to CAV included obesity (OR = 1.54, 95% CI: 1.11-2.13, I2 = 0%) and dyslipidemia (OR = 1.87, 95% CI: 1.49-2.36, I2 = 0%). New-onset diabetes mellitus after transplantation increases the risk of CAV with an HR of 1.71 (95% CI: 1.56-1.88, I2 = 0%). Conclusion: The high prevalence of MetS both before and after OHT is associated with an increased risk of CAV, highlighting the need for targeted interventions to manage MetS in heart transplant recipients.
PMID:40526466 | DOI:10.1089/met.2025.0028
Eur J Heart Fail. 2025 Jun 17. doi: 10.1002/ejhf.3691. Online ahead of print.
ABSTRACT
AIMS: The European Heart Failure (HF) Survey was developed by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) to map HF management resources, reimbursement of drugs/devices for HF treatment, and structure and activities of HF professional and patient organizations.
METHODS AND RESULTS: The survey encompassed 43 ESC member countries. The median number of hospitals with dedicated HF centres was 2.6 (interquartile range [IQR] 0.9-4.7) per million people. Natriuretic peptide assessment was available at a median of 6.1 (IQR 1.8-10.6) emergency departments and 8.2 (IQR 1.3-14.7) hospitals per million people, respectively, whilst cardiac magnetic resonance was available at a median of 2.0 (IQR 0.9-3.8) hospitals per million people. Short-term and long-term mechanical circulatory support and heart transplantation were available at a median of 1.1 (IQR 0.5-2.4), 0.4 (IQR 0.0-0.5) and 0.3 (0.2-0.5) hospitals per million people, respectively. Whilst essential HF medications were mostly available and reimbursed, gaps were observed in availability and funding of newer and advanced therapies. Density of all diagnostic and therapeutic capabilities was greater in countries with more favourable socioeconomic status. National HF societies were reported in 98% of countries, whilst HF patient organizations in 45% of countries.anaemia.
CONCLUSIONS: The European HF Survey is the result of long-standing HFA/ESC efforts to monitor HF epidemiology, management resources, educational and awareness activities. It offers a valuable assessment of current management capabilities, highlighting challenges in providing contemporary standards of care. It also provides insights into future directions needed to address these gaps.
PMID:40526007 | DOI:10.1002/ejhf.3691
World J Pediatr Congenit Heart Surg. 2025 Jun 17:21501351251340669. doi: 10.1177/21501351251340669. Online ahead of print.
ABSTRACT
Background: The Fontan operation is typically performed between two and five years-of-age in the United States. In this study, we analyzed the immediate outcomes of the Fontan operation performed beyond the first decade of life in the United States using a large administrative database. Methods: Kids' Inpatient Database (2003-2019) and Nationwide Inpatient Sample (2016-2021) datasets were used; 10,245 pediatric patients undergoing the Fontan operation were identified. The cohort was divided into: Traditional Fontan (TF, 2-5 years-of-age, n = 9,900) and Late Fontan (LF, ≥10 years-of-age, n = 345); Survivor and non-survivor status were based on discharge mortality. Demographic and clinical characteristics were assessed using standard statistical tests. Results: Only 3% of the Fontan procedures (n = 345/10,245) belonged to the LF group. LF was comprised predominantly of non-Caucasian ethnicity, higher socioeconomic class, and had a greater comorbidity burden. Heterotaxy syndrome and total anomalous pulmonary venous return were more common in the LF group as compared with hypoplastic left heart syndrome in the TF group. Patients in the LF group experienced higher postoperative morbidity but similar mortality and often required specialized healthcare post-discharge. Multivariate regression analysis revealed inferior survival among Fontan patients with ECMO use, atrioventricular septal defect, coagulopathy, acute kidney injury, infection, prolonged mechanical ventilation, but not age at Fontan. Conclusion: The proportion of patients undergoing LF compared with TF has decreased over time signalling a move toward earlier timing of the Fontan procedure. However, within the LF group, the number of LF patients has increased over time signifying an extended application of the Fontan operation. The patients in the LF group experienced greater postoperative morbidity with an associated higher baseline comorbidity but not short-term mortality after the Fontan procedure.
PMID:40525532 | DOI:10.1177/21501351251340669
Artif Organs. 2025 Jun 17. doi: 10.1111/aor.15044. Online ahead of print.
NO ABSTRACT
PMID:40525466 | DOI:10.1111/aor.15044