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Background Cardiogenic shock (CS) is associated with significant morbidity and mortality. The impact of beta-blocker (BB) use on patients who develop CS remains unknown. We sought to evaluate the clinical outcomes and hemodynamic response profiles in patients treated with BB in the 24 h prior to the development of CS. Methods Patients with CS enrolled in the DObutamine compaREd to MIlrinone trial were analyzed. The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, need for cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite and hemodynamic response profiles derived from pulmonary artery catheters. Results Among 192 participants, 93 patients (48%) had received BB therapy. The primary outcome occurred in 47 patients (51%) in the BB group and in 52 (53%) in the no BB group (RR 0.96; 95% CI 0.73–1.27; P  = 0.78) throughout the in-hospital period. There were fewer early deaths in the BB group (RR 0.41; 95% CI 0.18–0.95; P  = 0.03). There were no differences in other individual components of the primary outcome or in hemodynamic response between the two groups throughout the remainder of the hospitalization. Conclusions BB therapy in the 24 h preceding the development of CS did not negatively influence clinical outcomes or hemodynamic parameters. On the contrary, BB use was associated with fewer deaths in the early resuscitation period, suggesting a paradoxically protective effect in patients with CS. Trial registration ClinicalTrials.gov Identifier: NCT03207165

Anti-inflammatory therapies have been increasingly investigated for the reduction of cardiovascular (CV) events. The objective of this paper was to summarize and compare the relative effectiveness of anti-inflammatory medications for the reduction of CV events in patients with known coronary artery disease (CAD), either acute coronary syndromes (ACS) or stable CAD. Systematic review and network meta-analysis of randomised controlled trials (RCTs) that included at least one anti-inflammatory treatment and involved patients with CAD. Databases searched: Medline, Embase, Cochrane Central Register of Controlled Trials, clinical trial registry websites, Europe PMC, and conference abstracts. Bayesian network meta-analysis was performed to calculate risk estimates using fixed-effects analyses in patients with ACS and stable CAD. Risk of bias assessments were performed using the Cochrane Risk of Bias 2 (RoB2) tool. 17,021 studies were screened; 41 met inclusion criteria. 29,487 patients were included in the ACS network and 41,791 in the stable CAD network. In the ACS network analysis, both non-steroidal anti-inflammatory drugs [OR: 0.30, 95% Credible Limits (CrI): 0.11-0.74] and colchicine (OR: 0.77, CrI: 0.62-0.95) were associated with a significant reduction in major adverse cardiac events (MACE) compared to control. In the stable CAD analysis, both corticosteroids (OR: 0.44, 95% CrI: 0.26-0.72) and colchicine (OR: 0.65, CrI: 0.54-0.77) were associated with a significant reduction in MACE compared to control. In patients with ACS, colchicine was associated with a reduction in MACE, while observed associations for NSAIDs were derived from sparse and predominantly indirect evidence. In patients with stable CAD, colchicine and corticosteroids were associated with a reduction in MACE, although these findings were informed largely by indirect comparisons. Identifier CRD42022303289.

Background Acute Heart Failure (AHF) is a potentially lethal pathology and is often encountered in the prehospital setting. Although an association between prehospital arterial hypercapnia in AHF patients and admission in high-dependency and intensive care units has been previously described, there is little data to support an association between prehospital arterial hypercapnia and mortality in this population. Methods This was a retrospective study based on electronically recorded prehospital medical files. All adult patients with AHF were included. Records lacking arterial blood gas data were excluded. Other exclusion criteria included the presence of a potentially confounding diagnosis, prehospital cardiac arrest, and inter-hospital transfers. Hypercapnia was defined as a PaCO 2 higher than 6.0 kPa. The primary outcome was in-hospital mortality, and secondary outcomes were 7-day mortality and emergency room length of stay (ER LOS). Univariable and multivariable logistic regression models were used. Results We included 225 patients in the analysis. Prehospital hypercapnia was found in 132 (58.7%) patients. In-hospital mortality was higher in patients with hypercapnia (17.4% [23/132] versus 6.5% [6/93], p  = 0.016), with a crude odds-ratio of 3.06 (95%CI 1.19–7.85). After adjustment for pre-specified covariates, the adjusted OR was 3.18 (95%CI 1.22–8.26). The overall 7-day mortality was also higher in hypercapnic patients (13.6% versus 5.5%, p  = 0.044), and ER LOS was shorter in this population (5.6 h versus 7.1 h, p  = 0.018). Conclusion Prehospital hypercapnia is associated with an increase in in-hospital and 7-day mortality in patient with AHF.

Purpose 11 C-acetate PET is used to measure biventricular oxygen myocardial consumption rate (MVO 2 ) and myocardial blood flow (MBF) changes associated with right ventricular (RV) remodelling. We studied PET reproducibility and repeatability for such RV assessments. Procedures 10 pulmonary hypertension (PH) patients underwent 11 C-acetate PET. Five of these patients also had a repeat scan after 26 ± 2 weeks. A one-tissue compartment model was used to measure the myocardial tissue-activity washout rate (k2 [1/min] for MVO 2 estimation) and the blood-to-tissue activity flux (K1 [1/min] for MBF calculation). Values were measured by 2 blinded observers and analyzed by ANOVA and Bland–Altman tests. The interquartile ranges (IQR), within-subject coefficients of variation (wCV), and intraclass correlation coefficients (ICC) were reported. Results All patients had stable PH with the clinical assessments showed comparable biventricular function and size between baseline and follow-up. The k2-derived MVO 2 and K1-derived MBF values were consistently higher in the LV than RV. The high inter- and intra-observer reproducibility (for biventricular MVO 2 and MBF) was indicated by low IQR (≤ 7.6%) and wCV (≤ 8%) as well as high ICC (≥ 95%). The test–retest (baseline to follow-up) repeatability showed larger IQR (≤ 35.4%) and wCV (≤ 29%) but consistently high ICC (= 95%). Conclusions MVO 2 and MBF values measured in the RV of patients with PH were highly reproducible and repeatable. This can help inform the design of clinical research studies using serial 11 C-acetate PET imaging to evaluate RV metabolism.

Dementia is a major global health challenge and lifestyle modification is a key prevention strategy. Cardiovascular disease (CVD) is hypothesized to mediate lifestyle–dementia relationships, but empirical evidence is unclear. Mediation analysis offers insight into causal mechanisms beyond traditional associations. This scoping review synthesizes the limited available studies applying mediation analysis to examine whether CVD mediates associations between lifestyle factors (smoking, alcohol use, diet, physical activity) and cognitive outcomes in adults aged 45 and older. Of 1309 records screened, five studies met the inclusion criteria, reflecting a small, heterogeneous evidence base. Most examined physical activity (n = 4), with two reporting partial mediation by composite CVD risk scores. Evidence for diet (n = 2) and alcohol (n = 1) was inconclusive, and no studies assessed smoking. Overall, evidence for CVD as a mediator remains tentative, sparse, and inconsistent, highlighting major methodological gaps and an urgent need for robust studies to clarify whether cardiovascular health underpins lifestyle‐related dementia risk. Highlights Five studies were identified that used mediation analysis to explore the role of cardiovascular disease in the relationship between lifestyle risk factors and dementia. Cardiovascular disease may partially mediate the impact of physical activity on brain health. Diet and alcohol consumption showed no clear mediation effects by cardiovascular disease on cognition. Longitudinal, well‐powered studies with robust mediation frameworks are urgently needed to evaluate vascular pathways and optimize dementia prevention strategies targeting modifiable lifestyle factors.

C-acetate PET is used to measure biventricular oxygen myocardial consumption rate (MVO ) and myocardial blood flow (MBF) changes associated with right ventricular (RV) remodelling. We studied PET reproducibility and repeatability for such RV assessments. 10 pulmonary hypertension (PH) patients underwent C-acetate PET. Five of these patients also had a repeat scan after 26 ± 2 weeks. A one-tissue compartment model was used to measure the myocardial tissue-activity washout rate (k2 [1/min] for MVO estimation) and the blood-to-tissue activity flux (K1 [1/min] for MBF calculation). Values were measured by 2 blinded observers and analyzed by ANOVA and Bland-Altman tests. The interquartile ranges (IQR), within-subject coefficients of variation (wCV), and intraclass correlation coefficients (ICC) were reported. All patients had stable PH with the clinical assessments showed comparable biventricular function and size between baseline and follow-up. The k2-derived MVO and K1-derived MBF values were consistently higher in the LV than RV. The high inter- and intra-observer reproducibility (for biventricular MVO and MBF) was indicated by low IQR (≤ 7.6%) and wCV (≤ 8%) as well as high ICC (≥ 95%). The test-retest (baseline to follow-up) repeatability showed larger IQR (≤ 35.4%) and wCV (≤ 29%) but consistently high ICC (= 95%). MVO and MBF values measured in the RV of patients with PH were highly reproducible and repeatable. This can help inform the design of clinical research studies using serial C-acetate PET imaging to evaluate RV metabolism.

BackgroundInflammation is a key mediator in the development and progression of the atherosclerotic disease process as well as its resultant complications, like myocardial infarction (MI), stroke and cardiovascular (CV) death, and is emerging as a novel treatment target. Trials involving anti-inflammatory medications have demonstrated outcome benefit in patients with known CV disease. In this regard, colchicine appears to hold great promise. However, there are potential drawbacks to colchicine use, as some studies have identified an increased risk of infection, and a non-significant trend for increased all-cause mortality. Thus, a more thorough understanding of the underlying mechanism of action of colchicine is needed to enable a better patient selection for this novel CV therapy.ObjectiveThe primary objective of the Canadian Study of Arterial Inflammation in Patients with Diabetes and Recent Vascular Events, Evaluation of Colchicine Effectiveness (CADENCE) trial is to assess the effect of colchicine on vascular inflammation in the carotid arteries and ascending aorta measured with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in patients with type 2 diabetes mellitus (T2DM) or pre-diabetes who have experienced a recent vascular event (acute coronary syndrome (ACS)/MI, transient ischaemic attack (TIA) or stroke). Secondary objectives include determining colchicine’s effect on inflammatory biomarkers (high-sensitivity C reactive protein (hs-CRP) and interleukin-6 (IL-6)). Additionally, we will assess if baseline inflammation imaging or biomarkers are associated with a treatment response to colchicine determined by imaging. Exploratory objectives will look at: (1) the difference in the inflammatory response to colchicine in patients with coronary events compared with patients with cerebral events; (2) the difference in the inflammatory response to colchicine in different vascular beds; (3) the relationship of FDG-PET imaging markers with serum biomarkers and (4) assessment of quality-of-life changes.Methods and designCADENCE is a multicentre, prospective, randomised, double-blinded, placebo-controlled study to determine the effect of colchicine on arterial inflammation as assessed with imaging and circulatory biomarkers, specifically carotid arteries and aortic FDG uptake as well as hs-CRP and IL-6 among others. Patients with T2DM or pre-diabetes who have recently experienced a CV event (within 30–120 days after an ACS (ie, ST-elevation MI (STEMI) or non-STEMI)) or TIA/stroke with documented large vessel atherosclerotic disease will be randomised to treatment with either colchicine 0.6 mg oral daily or placebo. Participants will undergo baseline clinical evaluation including EQ5D assessment, blood work for inflammatory markers and FDG PET/CT scan of the ascending aorta and left and right carotid arteries. Patients will undergo treatment for 6 months and have repeat clinical evaluation including EQ5D assessment, blood work for inflammatory markers and FDG PET/CT scan at the conclusion of the study. The primary outcome will be the change in the maximum target to background ratio (TBRmax) in the ascending aorta (or carotid arteries) from baseline to follow-up on FDG PET/CT imaging.DiscussionColchicine is an exciting potential new therapy for CV risk reduction. However, its use is associated with side effects and greater understanding of its underlying mechanism of action is needed. Importantly, the current study will determine whether its anti-inflammatory action is an indirect systemic effect, or a more local plaque action that decreases inflammation. The results will also help identify patients who will benefit most from such therapy.Trial registration numberNCT04181996.