The aim of this study was to assess the prognostic significance of the longitudinal tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio as a surrogate marker of right ventricular (RV) to pulmonary arterial (PA) coupling in patients with pulmonary arterial hypertension (PAH). A retrospective cohort study was conducted on patients with PAH. The TAPSE/PASP ratio at baseline and at 3 to 6 months of follow-up was evaluated along with other echocardiographic and clinical parameters. The study included 68 patients with PAH, 75% of whom were female, with a mean age of 46 years and a mean follow-up duration of 64 months. At baseline, non-survivors had higher brain natriuretic peptide levels, shorter 6-minute walk distance (6MWD), and worse hemodynamic profiles compared with survivors. A TAPSE/PASP ratio > 0.22 mm/mmHg at baseline and > 0.23 mm/mmHg at 3 to 6 months of follow-up was associated with improved survival. Compared with baseline, survivors had lower pulmonary vascular resistance, lower PASP, and reduced left ventricular eccentricity indexat follow-up. In addition, better outcomes were observed in patients with World Health Organization functional class (WHO FC) I/II and 6MWD > 390 m compared with those in WHO FC III/IV and 6MWD ≤ 390 m. The TAPSE/PASP ratio is a noninvasive marker of RV-PA coupling that can provide dynamic prognostic insights in patients with PAH. It may assist in guiding treatment escalation and individualized therapy. Further studies are needed to verify its role and integration into comprehensive PAH risk assessment frameworks.

This study aimed to evaluate the prognostic implications and optimal timing for assessing left ventricular ejection fraction (LVEF) trajectory in patients with heart failure (HF) and an LVEF < 50%. The Taiwan Society of Cardiology HF Registry 2020 is a prospective, multicenter registry of hospitalized HF patients in Taiwan. This study included patients with an LVEF < 50% during their index HF hospitalization, and at least one follow-up echocardiogram within 2 years. HF with improved EF (HFimpEF) was defined as an absolute increase in LVEF > 10% from baseline. The primary endpoints were all-cause mortality and HF hospitalization at 2 years. Predictors of an improvement in LVEF trajectory were also evaluated. A total of 1478 patients were enrolled, with 873 in the HFimpEF group and 605 in the non-HFimpEF group. HFimpEF was associated with a lower risk of mortality (hazard ratio: 0.41 [0.27-0.62], p < 0.001) and reduced HF hospitalizations (8.6% vs. 24.4%, p < 0.001) at 2 years follow-up. Subgroup analysis showed that survival benefits diverged at an LVEF improvement > 10%, emerging as early as 6 months and persisting beyond 12 months. Lower baseline LVEF was paradoxically associated with better survival. Neither maximal guideline-directed medical therapy (GDMT) score nor revascularization correlated with LVEF trajectory. However, HFimpEF patients received higher doses of renin-angiotensin system inhibitors and beta-blockers in the first year. LVEF trajectory at 6 months appears to be a valuable prognostic tool, and higher-dose fundamental HF therapy was more important than achieving a higher overall GDMT score.

The Coronavirus disease 2019 (COVID-19) pandemic necessitated rapid advances in treatment, with Paxlovid emerging as an effective oral antiviral. Despite its efficacy in reducing hospitalizations and mortality among high-risk patients, the impact of Paxlovid on cardiovascular outcomes remains unclear, especially given the increased cardiovascular risks associated with COVID-19. We conducted a retrospective cohort study using data from the Chang Gung Memorial Hospital System in Taiwan of patients admitted with COVID-19 from January 1, 2022 to December 31, 2022. Propensity score matching was used to create comparable cohorts of patients treated with Paxlovid and those not treated with Paxlovid. The primary outcomes were cardiovascular events and all-cause mortality within a 12-month follow-up period. The study analyzed 606 patients treated with Paxlovid and 1,809 matched patients who were not. Paxlovid significantly reduced all-cause mortality at 3 months (relative risk [RR] 0.75, p = 0.0216) and 6 months (RR 0.81, p = 0.0492), but this effect was not sustained at 12 months (p = 0.2069). Notably, venous thromboembolism rates were significantly higher in the Paxlovid group at 6 months (RR 4.78, p = 0.0057) and 12 months (RR 2.65, p = 0.0477). While Paxlovid treatment resulted in significant short-term survival improvements among COVID-19 patients, it was also associated with a higher incidence of venous thromboembolic complications. These findings highlight the need for careful patient selection and monitoring, particularly for those with preexisting cardiovascular conditions.

Ticagrelor provides faster and more consistent platelet inhibition than clopidogrel; however, its effect on myocardial injury during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. The aim of this pilot study was to assess the feasibility and preliminary effects of ticagrelor versus clopidogrel loading on myocardial injury in STEMI patients undergoing PCI, using cardiac magnetic resonance (CMR) imaging. Thirty STEMI patients were randomized to receive aspirin with either clopidogrel (300 mg) or ticagrelor (180 mg) before PCI, followed by standard maintenance therapy. Myocardial injury was evaluated 4-10 days post-PCI using CMR parameters (infarct size, myocardial salvage index [MSI], microvascular obstruction [MVO], and infarct transmurality). Enzymatic infarct size and 5-year clinical outcomes were also analyzed. No significant differences in infarct size, MSI, MVO, or other CMR parameters were detected between the two groups. Left ventricular volume and function were comparable, with no major adverse cardiovascular events, stent thrombosis, or major bleeding over the 5-year follow-up period. Ticagrelor and clopidogrel showed similar effects on CMR-based myocardial injury and long-term outcomes in STEMI patients undergoing PCI. These pilot findings are hypothesis-generating and support the feasibility and inform sample-size planning for future multicenter trials.

The efficacy, safety, and clinical outcomes in patients switching to generic rosuvastatin compared to those taking other brand-name atorvastatin are unclear. Electronic medical records were retrospectively collected from January 1, 2013 to December 31, 2020 of patients who switched medication because of hospital policy from brand-name to generic rosuvastatin after March 14, 2018. Only patients who had taken the medication for at least 1 year prior to and 1 year after that date were enrolled. The records of patients who consistently used brand-name atorvastatin during the same period were also collected. The efficacy of lipid control, potential adverse effects, clinical outcomes of major cardiovascular events (MACE), and medical expenses were compared between the 2 groups. Propensity score matching (PSM) was conducted to balance potential cofounders. After 1:1 PSM, 592 patients were enrolled in the rosuvastatin and atorvastatin groups, respectively. No significant differences were observed in total cholesterol level (-4.38 ± 23.0 vs. -3.72 ± 26.95 mg/dL, p = 0.702), low-density lipoprotein (-2.38 ± 19.89 vs. -2.42 ± 23.63 mg/dL, p = 0.976), or glycated hemoglobin (-0.05% ± 0.7% vs. -0.08% ± 0.76%, p = 0.543). No significant difference was noted in cumulative MACE rate (2.70% vs. 3.89%, log-rank p = 0.265) after the switch date, and each person in the generic group had a 16% average reduction in medical expenses. Switching to generic rosuvastatin led to comparable lipid-lowering efficacy, safety, and clinical outcomes and lower medical expenses compared with consistently using brand-name atorvastatin.

The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has been associated with both the functional and anatomical significance of coronary lesions. This study aimed to investigate the relationship between UHR and the severity of coronary artery disease (CAD) in patients with non-ST-elevation myocardial infarction (NSTEMI), as evaluated using the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score. This retrospective study analyzed data from 606 NSTEMI patients who underwent coronary angiography between April and December 2024. UHR was calculated by dividing serum uric acid by high-density lipoprotein cholesterol. Patients were classified into low (SYNTAX < 23) and intermediate-high severity (SYNTAX ≥ 23) groups and compared in terms of parameters including UHR. UHR showed a significant positive correlation with SYNTAX score (ρ = 0.417, p < 0.001) and emerged as an independent predictor of intermediate-high severity CAD (odds ratio: 1.069, p < 0.001). Receiver operating characteristic curve analysis yielded an area under the curve of 0.705, with a UHR cut-off of > 20.35 predicting intermediate-high severity with 49.5% sensitivity and 85.4% specificity. Left ventricular ejection fraction also independently predicted CAD severity. UHR is an easily measurable, cost-effective biomarker for assessing CAD severity in NSTEMI patients. Its integration into clinical practice may improve early risk stratification and management strategies.

This study aimed to investigate the relationship between cardiorespiratory fitness (CRF) levels and changes in arterial elasticity parameters immediately following maximal exercise in young elite athletes compared to healthy controls. Understanding how CRF influences arterial elasticity could provide insights into optimizing cardiovascular health through exercise interventions. The study population comprised 34 elite athletes and 17 healthy controls with similar demographic characteristics. All participants underwent a baseline echocardiographic assessment, followed by a cardiopulmonary exercise test. Echocardiographic measurements, including aortic elasticity parameters derived from M-mode imaging of the ascending aorta, were repeated at 5, 15, and 60 minutes post-exercise. Aortic stiffness index (ASI) was used as the primary measure of arterial elasticity. The athletes had significantly higher mean VO2max compared to the controls (50 vs. 38 ml/kg/min, p < 0.01). At rest, the athletes had lower aortic stiffness (ASI: 4.18 vs. 5.92, p < 0.01), indicating better arterial elasticity. A moderate negative correlation was observed between VO2max and resting ASI (r = -0.51; p < 0.01), suggesting that higher CRF was associated with greater arterial elasticity. Post-exercise, ASI in the athletes returned to baseline levels by 60 minutes, whereas the controls showed a significant reduction in ASI compared to baseline (-0.02 vs. -0.33; p < 0.01). These findings underscore the importance of CRF in maintaining arterial elasticity and highlight differences in vascular adaptation to exercise between athletes and healthy individuals. The results suggest that exercise interventions should be tailored to individual fitness levels to optimize cardiovascular benefits and improve arterial health.