Daily Cardiology Research Analysis

BACKGROUND: Discontinuing statin therapy before pregnancy remains challenging, especially in high-risk women. We evaluated the risks of maternal cardiovascular, gestational, and fetal outcomes associated with continuing versus discontinuing statin therapy before the last menstrual period (LMP). METHODS: We conducted a nationwide cohort study using data from the National Health Insurance Database of South Korea collected between 2009 and 2023. Women who used statins for 12 to 24 weeks before their LMP between 2010 and 2022 were stratified by whether they discontinued statins before their LMP. Maternal cardiovascular outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), a composite of myocardial infarction, stroke, coronary revascularization, and cardiovascular death. Gestational and fetal outcomes included preterm delivery, pre-eclampsia/eclampsia, other hypertensive disorders of pregnancy, gestational diabetes, nonlive birth, major congenital malformations, and low birth weight. Propensity scores were estimated from potential confounders, and overlap weighting was applied to control for confounding factors. The weighted hazard ratio for MACCE was estimated using a Cox proportional hazards model. Weighted risk ratios for gestational outcomes were estimated using generalized linear models with 95% CIs. RESULTS: Among 13 374 women with preconception statin use, 7493 (56.0%) continued statin therapy beyond their LMP, and 5881 (44.0%) discontinued statin therapy before their LMP. Compared with continued statin, discontinued statin before the LMP was not associated with an increased risk of maternal MACCE (hazard ratio, 1.00 [95% CI, 0.72-1.37]). Even among women with established familial hypercholesterolemia (n=2435; hazard ratio, 0.92 [95% CI, 0.46-1.85]) or atherosclerotic cardiovascular disease (n=1879; hazard ratio, 0.83 [95% CI, 0.46-1.49]), there was no significant difference in the risk of MACCE between the 2 groups. Statin discontinuation was associated with a lower risk of nonlive birth (risk ratio, 0.89 [95% CI, 0.82-0.95]) and low birth weight (risk ratio, 0.88 [95% CI, 0.78-0.99]). CONCLUSIONS: In this nationwide cohort, discontinuation of statins at pregnancy was not associated with increased maternal cardiovascular risk, including among high-risk women. Secondary analyses suggested differences in fetal outcomes between groups; however, these findings should be interpreted cautiously given the observational design.

We conducted a prospective consecutive-patient neuromonitoring trial to assess brain function and flow during heart retrieval using thoracoabdominal normothermic regional perfusion (TA-NRP). Bispectral Index™ (BIS), quantitative pupillometry, and transcranial Doppler (TCD) were employed at multiple timepoints including: 1) before withdrawal of life-sustaining treatments (WLST) and 2) after exclusion of the circulation to the brain and TA-NRP initiation at three-time intervals: 1, 5, and 10 minutes. A total of 43 TANRP heart donors were included in this study. Post-NRP initiation, NPI was 0 for both pupils for all donors. TCD showed flow in at least one vessel for all donors prior to WLST, and no flow in any vessel for all donors post-NRP. Median BIS was 31 (24, 37) before WLST, and reached 0 for all donors post-NRP. Larger-scale multi-center studies are needed to definitively confirm these findings. Such validation is essential for providing necessary reassurance that TA-NRP does not restore brain blood flow nor brain functions.

BACKGROUND: Pulsed field energy is an increasingly adopted technology for ablation of atrial fibrillation (AF). Although clinical data on pulsed field ablation (PFA) is positive, data on ischemic cerebral lesions (ICLs) after PFA is limited. Because the individual PFA systems differ substantially in pulse characteristics, cerebral safety should be studied separately for each system. OBJECTIVES: This study sought to assess the incidence of ICLs after PFA for AF using a variable-loop circular catheter. METHODS: The study was designed as a prospective, observational, cohort, single-center study. In patients with nonparoxysmal AF, pulmonary vein and left atrial posterior wall isolation were performed. National Institutes of Health Stroke Scale scores were assessed within 24 hours post ablation. Brain magnetic resonance imaging (1.5T, diffusion-weighted imaging included) was conducted 1 day before and 24 hours after the procedure to detect acute ICL. The study initially aimed to enroll 40 patients but was terminated early because of safety concerns. RESULTS: Twenty-one patients were enrolled (age 66.1 ± 9.0 years, 38% women, all with nonparoxysmal AF). ICLs occurred in 14 (66.7%) patients, with a median of 2 (IQR: 0, 3) lesions per patient, and a median cumulative lesion burden of 10.5 mm (6.3, 19.3). Most ICLs (28; 55.8%) were localized in the posterior territory. One patient experienced a transient ischemic attack, and 1 patient suffered a major peri-procedural stroke (National Institutes of Health Stroke Scale = 6; modified Rankin scale = 3 at the day 30 clinical follow-up). CONCLUSIONS: PFA using a variable-loop circular catheter was associated with a high rate of ICLs. More than half of the lesions were in the posterior cerebrovascular territory. (Cerebral Safety After Pulsed-Field Ablation of Atrial Fibrillation; NCT06786988).