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Introduction and objectives: Brugada syndrome (BS) is a channelopathy associated with an increased risk of sudden cardiac death (SCD). Intense physical activity is a recognised trigger of life-threatening arrhythmias in long QT syndrome, catecholaminergic ventricular tachycardia syndrome and arrhythmogenic cardiomyopathy, but it is believed to be safe in BS. The objective of this study is to assess the impact of regular physical activity on the expression and prognosis of BS.

Methods: 286 consecutive BS patients (aged 39.1±17.8 years old, 70.6% men) were included. Patients were classified according to the level of exercise and main discipline of sport they had practised.

Results: 190 (66.4%) were sedentary, 27 (9.4%) practised light exercise, 59 (20.6%) moderate and 10 (5.3%) intense. Patients engaged in 'mixed or endurance' types of exercise were diagnosed earlier than sedentary ones (HR: 2.1; 95% CI: 1.5 to 2.9; p<0.001) and experienced syncope at a younger age (24.9±16.2 vs 37.4±18.2 years; p=0.04). Physical activity was associated with ECG sport-related changes like bradycardia (Δ 6 bpm) and a shorter QTc (Δ 21 ms) and also to a higher ST elevation in right precordial leads (Δ 0.5 mm). Physical activity was not a predictor of arrhythmic events or SCD.

Conclusions: Regular physical activity was associated with a younger diagnosis and an earlier occurrence of syncopal episodes. BS patients engaged in 'mixed or endurance' sports have ECG changes associated with sport adaptation and higher ST segment elevation. Nevertheless, physical activity was not related to a higher arrhythmic risk in our cohort of patients with BS.

Background: The role of mineralocorticoid receptor antagonists (MRAs) in acute myocardial infarction (MI) remains controversial, with conflicting evidence from landmark trials. We aimed to assess the impact of MRAs on mortality and cardiovascular outcomes post-acute MI.

Methods: We systematically searched PubMed, Embase and Cochrane CENTRAL databases up to February 2025 for randomised controlled trials comparing MRAs with placebo or standard care in adults experiencing acute MI. Primary outcome was all-cause mortality; secondary outcomes included cardiovascular mortality, heart failure, recurrent MI and ventricular arrhythmia. Data were pooled using random-effects models, with heterogeneity explored via subgroup analyses and meta-regression.

Results: 15 trials (n=18 471) were included. MRA therapy demonstrated non-significant reductions in all-cause mortality (OR 0.80, 95% CI 0.55 to 1.18), cardiovascular mortality (OR 0.84, 95% CI 0.59 to 1.18), heart failure (OR 0.76, 95% CI 0.52 to 1.12), recurrent MI (OR 0.92, 95% CI 0.67 to 1.27) and ventricular arrhythmia (OR 0.83, 95% CI 0.47 to 1.47). Subgroup analyses revealed that trials with >6 months follow-up demonstrated modest cardiovascular mortality reduction (OR 0.86, 95% CI 0.75 to 0.99). Effects were consistent across MRA types, left ventricular ejection fraction categories and initiation timing. Meta-regression showed no significant effect modifiers among baseline characteristics or concomitant therapies.

Conclusions: In MI populations, MRA therapy did not significantly improve mortality or cardiovascular outcomes in the short term. However, a significant reduction in cardiovascular mortality emerged after 6 months, alongside a non-significant trend towards less heart failure, indicating potential benefits for high-risk patients with longer-term treatment rather than routine use in all acute MI cases.

Objective: The optimal technique for harvesting the saphenous vein (SVG) in coronary artery bypass grafting (CABG) remains undetermined. This study aimed to assess the efficacy of open vein harvesting (OVH), endoscopic vein harvesting (EVH) and no-touch vein harvesting (NT) in CABG using a network meta-analysis of randomised controlled trials (RCTs).

Methods: RCTs evaluating the outcomes in patients undergoing CABG with the SVG using OVH, EVH or NT were identified through a systematic search of PubMed, Web of Science and the Cochrane Central Registry up to August 2025. The outcomes analysed included graft failure, graft occlusion, mortality, revascularisation, myocardial infarction (MI) and leg wound infection rates.

Results: Data from 26 RCTs involving 7254 patients meeting the inclusion criteria were analysed. The network meta-analysis indicated that the graft failure rate in the NT group was significantly lower than in the OVH group (relative risk (RR) 0.62; 95% CI 0.40 to 0.96) and the EVH group (RR 0.41; 95% CI 0.21 to 0.80). The graft occlusion rate in the NT group was significantly lower than in the OVH group (RR 0.66, 95% CI 0.52 to 0.84). However, the leg wound infection rate in the NT group was the highest. No significant differences were observed in mortality, revascularisation and MI rates among the three groups.

Conclusion: NT was associated with lower graft failure and graft occlusion rates, yet it had higher leg wound infection rates, while mortality, revascularisation and MI rates remained comparable among the three techniques. These findings require cautious interpretation, and it is important to balance harvest site complications and the desirability of long-term graft patency.

Background: Hypertension is a major cause of premature death worldwide, controlled by only one in five adults. Two trials (Australia and USA) found a single quadpill containing a quarter dosage of four classes of medication effective in reducing blood pressure (BP) among participants with hypertension. By pooling these trials, we can estimate the overall benefit of the quadpill and its heterogeneity across subgroups and two important barriers for BP control: clinician medication inertia and participant medication adherence.

Methods: In a prespecified pooled individual participant data analysis of two QUARTET randomised, multicentre, double-blinded trials in people with hypertension using ≤1medication, quadpill (irbesartan (37.5 mg) (Australia)/candesartan (2 mg) (USA)), amlodipine (1.25 mg), indapamide (0.625 mg), bisoprolol (2.5 mg) unattended office systolic BP (SBP) at 12 weeks was compared with initial monotherapy (irbesartan (150 mg) (Australia), candesartan (8 mg) (USA)). Heterogeneity was assessed using an interaction term in the mixed cox model. Adherence, ≥80% pill count and treatment inertia were estimated.

Results: In 653 participants (Australia, 591 (91%); USA, 62 (9%)) a significant drop in mean SBP (6.5 mm Hg (95% CI 4.8 to 8.8; p<0·001)) and diastolic BP (5.6 mm Hg (95% CI 4.5 to 6.9; p<0.001)) in favour of the quadpill was found, with less need for uptitration (p<0.001) and less treatment inertia (non-significant: p=0.303). Adherence was high for both treatment arms (over 80%). Compared with monotherapy, the quadpill effect varied by ethnicity (SBP reduced by White (6.9 mm Hg; 95% CI 4.7 to 9.2), Hispanic (3.3 mm Hg; 95% CI 4.0 to 10.6), Asian (12.3 mm Hg; 95% CI 6.2 to 18.5) and Black/other (1.4 mm Hg; 95% CI -9.0 to 6.3), interaction p=0.032).

Conclusion: This prospective individual participant data pooled analysis provides further evidence that the quadpill strategy is superior to initial monotherapy by virtue of improved BP-lowering, less need for uptitration and being associated with less treatment inertia.

Background: Predicting progression to aortic valve replacement (AVR) in moderate aortic stenosis (AS) is challenging. This study explored whether haemodynamic parameters from four-dimensional flow MRI (4D flow MRI) are associated with the potential progression to AVR.

Methods: 15 patients with moderate AS underwent baseline 4D flow MRI and echocardiography, with repeat echocardiography within 2 years. Patients were categorised into AVR (n=8) or no-AVR (n=7) groups based on whether they underwent AVR during follow-up.

Results: AVR occurred a mean of 396±156 days after baseline. The AVR group had higher follow-up peak velocity (p=0.001), mean pressure gradient (p=0.022) and smaller valve area (p=0.004). Baseline peak vortex volume was greater in the AVR group (p=0.009) and was associated with AVR with an area under the curve of 0.88 (95% CI 0.82 to 1.00). Peak vortex volume moderately correlated with baseline (r=0.69) and follow-up (r=0.63) peak velocity and baseline mean pressure gradient (r=0.59) measured by echocardiography.

Conclusion: Abnormal vortex formation may reflect haemodynamic alterations associated with AS progression and eventual AVR. These exploratory results should be validated in larger cohorts to define the potential role of 4D flow MRI-based vortex assessments in AS evaluation.

Objective: Identify predictors for mortality and clinical short-term outcomes in patients with left-sided infective endocarditis (IE).

Methods: This study was a retrospective cohort investigating 376 patients who experienced left-sided IE between 1 January 2013 and 31 December 2022, at the National Cardiovascular Center Harapan Kita Hospital. Bivariate and multivariate statistical analyses were conducted to identify predictors of short-term clinical outcomes.

Results: The study comprised 376 patients with left-sided IE who received standardised antibiotic therapy, with 56.6% of them undergoing surgical intervention. The observed short-term mortality rate was 18.6%. Furthermore, the morbidity profile during the treatment phase revealed the following incidences: sepsis in 27.1% of cases, intensive care unit stay exceeding 10 days in 18.6% of cases, mechanical ventilation for more than 7 days in 11.4% of cases, stroke in 28.5% of cases and acute renal failure in 57.7% of cases.

Conclusion: Predictors of short-term mortality outcomes in patients with left-sided IE included New York Heart Association functional class III-IV, aortic valve vegetation involvement, vegetation size ≥10 mm, incomplete antibiotic administration, sepsis and the requirement for renal replacement therapy.

Background: Previous epidemiological studies demonstrated that premature atrial contractions (PACs) and premature ventricular contractions (PVCs) detected by single 12-lead ECGs can predict incident cardiovascular disease and death. The determinants of cardiac ectopy remain unknown, with some evidence that hypertension may contribute.

Objective: To determine if intensive blood pressure (BP) control reduces the incidence of cardiac ectopy.

Methods: We performed a post-hoc analysis of the Systolic Blood Pressure Intervention trial, which randomised hypertensive participants to standard treatment (BP target <140 mm Hg) or intensive treatment (<120 mm Hg) with ECGs obtained at baseline, 2 years, 4 years and 5 years. The primary outcomes were incidence of ectopy (PACs or PVCs) as coded by Minnesota ECG classification, censoring for pacing, atrioventricular block, pre-excitation or atrial fibrillation/flutter. We performed Cox proportional hazards regression to determine the association of treatment group with outcomes.

Results: The analysis cohort comprised 3910 participants randomised to standard treatment and 3911 to intensive treatment, of whom 452 had ectopy on baseline ECG. After excluding those with baseline ectopy, there was no significant difference in the incidence of ectopy (incidence rate ratio 0.93 (95% CI 0.81 to 1.05)). There was no significant association between treatment group and ectopy incidence, with an unadjusted Cox HR of 0.93 (95% CI 0.82 to 1.07), and HR of 1 (95% CI 0.81 to 1.25) after adjusting for covariates.

Conclusion: Intensive BP control did not reduce the incidence of cardiac ectopy in patients with hypertension. Given the variable nature of PAC and PVC burden, further studies with continuous monitoring or more frequent sampling in larger populations are warranted.

Aims: To evaluate the effect of combining real-time deep learning (DL)-based guiding and automated measurements of left ventricular (LV) volumetric measurements and strain.

Methods and results: Patients (n=47) with mixed cardiac pathology were examined by two sonographers and one reference cardiologist. A real-time DL guiding tool to avoid LV foreshortening was used by one sonographer only per patient. Automated DL-based measurements from the sonographer using the guiding tool were paired with automated measurements from the reference cardiologist (artificial intelligence (AI)-assisted echocardiography), while manual measurements from the sonographer not using the guiding tool were paired with manual measurements from the reference cardiologist (standard echocardiography). The variability of LV EDV, LV ESV, ejection fraction (LV EF) and global longitudinal strain (LV GLS) was compared for standard echocardiography versus AI-assisted echocardiography. Coefficients of variation were lower for AI-assisted echocardiography compared with standard echocardiography (6% vs 15% for LV EDV (p<0.001), 10% vs 19% for ESV (p<0.001) and 7% vs 11% for GLS (p=0.047), respectively). For LV EF, the coefficients of variation were similar across groups (8% vs 9%, p=0.503, respectively). In exploratory analyses, automated measurements alone (all p≤0.002) but not the guiding tool (all ≥0.199) explained the improved variability for LV EDV, ESV and GLS.

Conclusions: AI-assisted echocardiography combining DL-based real-time guiding and automated measurements significantly reduced the variability of LV EDV, ESV and GLS when compared to standard echocardiography. Among experienced operators, automated measurements were more beneficial than real-time guiding.

Trial registration number: ClinicalTrials.gov, ID: NCT04580095.

Aim: To systematically evaluate whether relationships between cardiac rehabilitation participation and clinical outcomes, return to work, or knowledge about cardiovascular disease vary across socioeconomic indicators.

Methods: A systematic review was conducted using CENTRAL, CINAHL, Embase and Medline up to 1 November 2024. Studies were included if they compared outcomes between participants who received cardiac rehabilitation and those who did not or received an exercise programme. Outcomes included all-cause death, all-cause and cardiovascular-related rehospitalisation, return to work and cardiovascular knowledge, stratified by socioeconomic indicators. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies-of Interventions-I tool.

Results: Six studies involving 555 731 participants were included. Compared with non-participants, cardiac rehabilitation participants had lower rates of all-cause death (12.3%-16.9%) and all-cause rehospitalisation (15.2%-16.1%), with incidence rate differences in cardiovascular-related rehospitalisation reaching up to 27.8 fewer events/100 person-years. Some of the greatest differences were among participants residing in more disadvantaged areas, although this was not consistent across studies. No significant differences were observed in the combined outcome of all-cause death and cardiovascular-related rehospitalisation when stratified by educational attainment levels. Return to work and knowledge outcomes showed greater variation across education and income subgroups, with higher values consistently observed among cardiac rehabilitation participants from less disadvantaged backgrounds. All studies were observational and had moderate risk of bias.

Conclusions: Cardiac rehabilitation improves clinical and functional outcomes across socioeconomic subgroups, although disparities in participation and outcomes persist. Tailoring programme delivery to be more flexible and responsive to literacy needs may help ensure its benefits are equitably achieved across patient subgroups.

Prospero registration number: CRD42022332355.

Background: Hypertension is a significant risk factor for cardiovascular disease, dementia and chronic kidney disease (CKD). Older adults bear the brunt of these conditions, and managing hypertension can be especially challenging in this cohort. In this study, we apply the European Society of Cardiology (ESC) hypertension guidelines to adults ≥50 years participating in a nationally-representative longitudinal study on ageing, providing crucial context for guideline implementation among older adults.

Methods: Data from waves 1 (2009-2010), 3 (2014-2015) and 6 (2021-2023) of The Irish Longitudinal Study on Ageing were analysed. Hypertension (blood pressure (BP) ≥140/90 mm Hg) prevalence, awareness, treatment, control (on-treatment BP <130/80 mm Hg) and adherence to ESC recommendations were assessed. Subgroup analyses included people aged ≥85 years, adults with frailty, with CKD and with home BP measurements. Data were analysed using Stata V.15.1 applying inverse probability weighting.

Results: From wave 3 (n=5329), weighted hypertension prevalence was 64.0% (62.4-65.6%). Of these, 55.5% were aware and 70.3% were on antihypertensive treatment. 32.2% on treatment had controlled BP, 20.9% were on dual therapy and 55.2% were taking one ESC-recommended agent. 87.8%, 77.1% and 76.7% of those with hypertension at waves 1, 3 and 6 were undiagnosed, untreated or uncontrolled. Hypertension prevalence was 91.1% (84.7-95.0%) in people ≥85 years and 75.9% (69.3-81.5%) in moderate-severe frailty.

Conclusions: In a nationally-representative sample of older Irish adults, there is a high prevalence of hypertension, with low awareness, control and adherence to ESC guidelines.