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Influenza virus infection is associated with significant morbidity and mortality in patients with chronic diseases including heart failure (HF). Annual influenza vaccination is recommended to prevent infection during the winter months. Data regarding its clinical benefit in HF patients are sparse. The purpose of the study was to evaluate the effect of influenza vaccination on clinical outcome in patients with HF. Consecutive patients with HF at a health maintenance organization were evaluated for influenza vaccination status during the winter season of 2017/2018 and its association with cardiac-related hospitalizations and death during 1-year after vaccination. The study cohort included 6,435 HF patients. A total of 4,440 patient were vaccinated during the winter season (69% of the HF cohort). The vast majority (96%) were vaccinated before the winter months (September to November). Patients vaccinated were older patients with more co-morbidities. Cox regression analysis after adjustment for clinically significant predictors demonstrated that vaccination was associated with reduced mortality (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.65 to 0.91, p <0.01) as well as reduced death and cardiovascular hospitalizations (HR 0.83 95% CI 0.76 to 0.90, p <0.001). Adjustment for drug therapy demonstrated a similar result with improved outcome with influenza vaccine. Propensity score matched control analysis demonstrated that vaccination was associated with improved survival (HR 0.80, 95% CI 0.67 to 0.95, p <0.01) and reduced death and cardiovascular hospitalizations (HR 0.86, 95% CI 0.79 to 0.94, p <0.001). In conclusion, Influenza vaccination in patients with HF was associated with improved clinical outcome including improved survival and reduced death and hospitalizations.

Background The European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation (non‐ST‐segment elevation myocardial infarction [NSTEMI]) has recommended immediate (<2 h) percutaneous coronary intervention (PCI) in very‐high risk patients and early (<24 h) PCI in high‐risk patients. Hypothesis To examine the ESC NSTEMI guidelines adherence in a nationwide survey in Israel using the Acute Coronary Syndrome Israeli Survey (ACSIS). We hypothesized that adherence to the guidlines' recommnded PCI timing in NSTEMI pateints will be inadequate, partly due to the inconsistent evidence regarding its effect on clinical outcomes. Methods All NSTEMI patients who underwent PCI during the ACSIS surveys in 2016 and 2018 were included in the analysis. Results Out of 1793 NSTEMI patients, 1643 (92%) patients underwent PCI, and door to balloon time was documented in 1078 of them. One hundred and fifty‐six (14.5%) patients and 922 (85.5%) patients were defined as very high‐risk and high‐risk NSTEMI patients, respectively. Of the very high‐risk NSTEMI patients, only 10 (6.4%) underwent immediate coronary angiography, and 50 (32.1%) underwent early coronary angiography. Acute heart failure 139 (89.1%) was the main reason for including NSTEMI patients in the very high‐risk category. Of the high‐risk patients, early coronary angiography was performed in only 405 (43.9%) patients. Patients in whom coronary angiography was postponed were older and had more comorbidities. Conclusions Despite guidelines recommendations for immediate and early PCI in very high‐risk and high‐risk NSTEMI patients, respectively, most patients do not undergo immediate or early PCI according to contemporary guidelines. Further studies are needed to better understand the reasons for guidelines' nonadherence in those high‐risk patients.

Global Registry of Acute Coronary Events (GRACE) risk score has been routinely used for risk stratification of acute coronary syndrome (ACS) patients. We aimed to examine whether the addition of the CHA2DS2-VASc score to the GRACE score improves risk stratification. Included were patients with ACS who were divided into high (>140), intermediate (110< GRACE score ≤140) and low (<110) GRACE score. Each group was further divided into 3 subgroups categorized according to their CHA2DS2-VASc score: 0–1, 2–3, and ≥4. Management and Outcomes were compared for each GRACE score group and CHA2DS2-VASc score subgroups. Included 6,854 ACS patients, of them 3596 (52.5%) were classified as low risk, 1,937 (28.3%) were at intermediate risk and 1,321 (19.3%) were high-risk patients. In the intermediate risk group, patients with a higher CHA2DS2-VASc score more frequently underwent percutaneous coronary revascularization. For low risk patients, 30-day mortality rates were 0.8%, 1.5%, and 1.3% (p = 0.02), and 1-year all-cause mortality rates were 1.3%, 3%, and 2.6% (p = 0.002) for CHA2DS2-VASc score 0–1, 2–3, ≥4, respectively. For intermediate risk patients, 30-day mortality rates were 2.9%, 3.4%, and 3.8% (p = 0.8), and 1-year all-cause mortality rates were 6.4%, 7.8%, and 11.2% (p = 0.01) for CHA2DS2-VASc score 0–1, 2–3, ≥4, respectively. Among patients with a GRACE score <140, each 1 point increase in the CHA2DS2-VASc score was associated with a 57% increase in 1-year mortality rates. In conclusion, the addition of the CHA2DS2-VASc score to the GRACE risk score in ACS patients improves risk stratification of patients with low and intermediate risk.

Background Timely reperfusion within 120 min is strongly recommended in patients presenting with non‐ST‐segment myocardial infarction (NSTEMI) with very high‐risk features. Evidence regarding the use of high‐sensitivity cardiac troponin (hs‐cTn) concentration upon admission for the risk‐stratification of patients presenting with NSTEMI to expedite percutaneous coronary intervention (PCI) and thus potentially improve outcomes is limited. Methods All patients admitted to a tertiary care center ICCU between July 2019 and July 2022 were included. Hs‐cTnI levels on presentaion were recorded, dividing patients into quartiles based on baseline hs‐cTnI. Association between initial hs‐cTnI and all‐cause mortality during up to 3 years of follow‐up was studied. Results A total of 544 NSTEMI patients with a median age of 67 were included. Hs‐cTnI levels in each quartile were: (a) ≤122, (b) 123–680, (c) 681–2877, and (d) ≥2878 ng/L. There was no difference between the initial hs‐cTnI level groups regarding age and comorbidities. A higher mortality rate was observed in the highest hs‐cTnI quartile as compared with the lowest hs‐cTnI quartile (16.2% vs. 7.35%, p = .03) with hazard ratio (HR) for mortality of 2.6 (95% confidence interval [CI]: 1.23–5.4; p = .012) in the unadjusted model, and HR of 2.06 (95% CI: 1.01–4.79; p = .047) with adjustment for age, gender, serum creatinine, and significant comorbidities. Conclusions Patients with NSTEMI and higher hs‐cTnI levels upon admission faced elevated mortality risk. This underscores the need for further prospective investigations into early reperfusion strategies' impact on NSTEMI patients' mortality, based on admission troponin elevation. In a study of 544 NSTEMI patients (mean age: 68; 22% females), we explored hs‐cTnI levels on admission as a prognostic marker. The highest hs‐cTnI quartile showed increased mortality (16.2% vs. 7.3%). Adjusted HR for mortality was 2.06 (p = .047). Further prospective studies are essential to assess reperfusion strategies based on initial troponin levels.

Introduction Immature platelets or reticulated platelets are newly released thrombocytes. They can be identified by their large size and high RNA cytoplasm concentration. Immature platelet fraction (IPF) represents the percentage of immature circulative platelets relative to the total number of platelets. The role of IPF in patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. The aim of the current trial was to assess the levels of IPF in patients undergoing TAVI and correlation with clinical outcomes. Material and Methods Immature platelet fraction levels were measured 3 times in all patients (preprocedure, 1-2 days post-procedure and 1-month post-procedure). Immature platelet fraction measurement was carried out using an autoanalyzer (Sysmex XE-2100). Patients were followed for 12 months. Primary outcomes were defined as complications during hospitalizations, rehospitalization, and mortality. Results Fifty-one patients were included in the study. Mean age was 79.8 (±9.6), and 28 (55%) were women. Twenty-one patients (41%) had complications: Of them, 6 of 21 (29%) occurred during hospitalizations (2—vascular complications; 2—sepsis, 2—implantation of a pacemaker), 9 of 21 (43%) patients were rehospitalized after the index admission, and 6 patients died during the follow-up period. Multivariate Cox regression analysis found that IPF < 7% in at least one of the 3 tests was associated with worse outcomes (hazard ratio 3.42; 95% CI 1.11-10.5, P = .032). Conclusion Immature platelet fraction >7% in patients undergoing TAVI is associated with worse outcomes. Further studies are needed to better understand this phenomenon.

Atrial fibrillation (AF) is a major increasing public health problem worldwide, with clinical and epidemiological differences between men and women. However, contemporary population-level data on incidence and survival are scarce. To evaluate sex-specific contemporary trends in the incidence, prevalence, and long-term survival of non-valvular AF in a real-world setting. AF patients diagnosed between 2007-2015, insured by a large, state-mandated health organization in Israel (Maccabi Healthcare Services) were included. AF was diagnosed based on registered diagnoses. Patients with valvular disease, active malignancy, cardiac surgery ≤ 6 months, or recent pregnancy, were excluded. Annual incidence rate, period prevalence, and 5-year survival for each calendar year during the study period, were calculated. A total of 15,409 eligible patients (8,288 males, 7,121 females) were identified. Males were more likely to be younger, have higher rates of underlying diseases (ischemic heart disease, heart failure, and chronic obstructive pulmonary disease), but with lower rates of hypertension and chronic kidney diseases as compared to female patients. During the study period, age-adjusted incidence decreased both in men: (-0.020/1,000-person year, p-for trend = 0.033) and, women (-0.025/1,000 person-year p = 0.009). The five-year survival rate was significantly higher among men vs. women (77.1% vs. 71.5%, respectively, p<0.001). Age-adjusted prevalence increased significantly among men (+0.102 per year, p-for trend<0.001) yet decreased among women (-0.082 per year, p-for trend = 0.005). A significant trend toward improved long-term survival was observed in women and not in men. The current study shows significant sex-related disparities in the incidence, prevalence, and survival of AF patients between 2007-2015; while the adjusted incidence of both has decreased over-time, prevalence and mortality decreased significantly only in women.

Background: Conventional echocardiography used to assess volumes of the left ventricle (LV) and left atrium (LA) along with mitral regurgitation grade is routine in studies before and after transcatheter edge-to-edge mitral valve repair (Mitral TEER). Previous studies focus on LV parameter changes and comparison of the functions before and a few months following Mitral TEER implantation, as well as LA reverse remodeling, by assessing LV volumes. However, less is known regarding LA strain changes in the early phase after the procedure. The objective of the study was to assess the effect of Mitral TEER on LA strain early after TEER procedure. Methods: The retrospective study included 44 patients who underwent Mitral TEER. LA strain and volumes were evaluated by speckle tracking echocardiography at the baseline and 24–48 h following the procedure. Demographic, echocardiographic, and clinical characteristics were obtained and statistically analyzed. Results: LA global longitudinal strain (GLS) reservoir improved significantly (from 12.2 ± 7 to 14.7 ± 6.4, p = 0.0079) after Mitral TEER. Significant improvements were also seen in LA volumes (LA maximal and minimal volume), which reduced by 17% and 22.5% respectively. LV GLS was significantly changed (from −9.8% to −12.8%, p < 0.0001) following Mitral TEER, whereas LV stroke volume was not significantly different between the baseline and post-Mitral TEER (p = 0.7798). Conclusions: After successful Mitral TEER, there was a very early improvement in LA function. Two-dimensional speckle tracking echocardiography may contribute to our understanding of LA functional changes immediately post-procedure.

Objectives: This article aims to evaluate the accuracy of the color-Doppler-based technique to evaluate residual mitral regurgitation post TEER. Background: The evaluation of residual mitral regurgitation (MR) post-mitral transcutaneous edge-to-edge repair (mitral TEER) is a critical determinant in patients’ outcomes. The common methods used today, based on the integration of color flow Doppler parameters, may be misleading because of the multiple jets and high velocities created by the TEER devices. Methods: Patients undergoing TEER at Hadassah hospital were recruited between 2015 and 2019. Post-procedural MR was evaluated using the integrated qualitative approach as recommended by the guidelines. In addition, the MR volume for each patient was calculated by subtracting the forward stroke volume (calculated by multiplying the LVOT area with the velocity time integral of the LVOT systolic flow) from the total stroke volume (calculated by the biplane Simpson method of discs). We compared the two methods for concordance. Results: Overall, 112 cases were enrolled. In 55.4% of cases, the volumetric residual MR was milder than the MR severity assessed by the guidelines’ recommended method. In 25.1%, the MR severity was similar in both methods. In 16.2%, the MR severity was worse when calculated using the volumetric method (pValue < 0.001, Kappameasure of agreement = 0.053). The lower residual MR degree using the volumetric approach was mostly observed in patients classified as “moderate” by the integrated approach. Conclusions: MR severity after TEER is often overestimated by the guideline-recommended integrative method when compared with a volumetric method. Alternative methods should be considered to assess the MR severity after mitral TEER.

Cardiogenic shock complicating acute myocardial infarction is a complex clinical condition associated with dismal prognosis. Routine early target vessel revascularization remains the most effective treatment to substantially improve outcomes, but mortality remains high. Temporary circulatory support devices have emerged with the aim to enhance cardiac unloading and improve end-organ perfusion. However, quality evidence to guide device selection, optimal installation timing, and post-implantation management are scarce, stressing the importance of multidisciplinary expert care. This review focuses on the contemporary use of short-term support devices in the setting of cardiogenic shock following acute myocardial infarction, including the common challenges associated this practice.

•There is limited research on the risk of long-term mortality post-TAVR.•Cardiac death is more likely up to 1.8 years, noncardiac is more likely long term.•There are unique predictors of cardiac versus noncardiac death.•This suggests different approaches to short and long-term follow-up. There is a paucity of literature characterizing the risk of long-term mortality and reintervention after transcatheter aortic valve implantation (TAVI). Addressing this gap has become increasingly relevant with the inclusion of intermediate and low surgical risk patients and the need for data to inform their long-term management. We sought to investigate the long-term trends and predictors of cardiovascular versus noncardiovascular mortality as well as reintervention in post-TAVI patients. Our cohort consisted of 5,406 patients who underwent TAVI in Ontario, Canada from 2011 to 2018. We used Kaplan-Meier analysis to estimate 7-year all-cause mortality and a Cox proportional hazard model to identify demographic, co-morbid, and procedural predictors. Similarly, cumulative incidence functions were used to estimate cardiovascular versus noncardiovascular mortality at 5 years, with predictors identified through Fine-Gray models. The Kaplan-Meier estimate for 7-year all-cause mortality in our cohort was 67%; this was driven by a number of co-morbidities including congestive heart failure and liver disease. We found that cardiovascular death was more likely for approximately the first 2 years post-TAVI whereas noncardiovascular death was more likely from this point to the end of the study. We identified a number of factors that uniquely modified the risk of either cardiovascular or noncardiovascular mortality. Only 1.6% of patients who underwent repeat intervention. The distinct factors associated with cardiovascular versus noncardiovascular death suggest different approaches to short-term and long-term surveillance of patients post-TAVI by both the heart team and primary care providers.