Extracorporeal cardiopulmonary resuscitation offers a potentially revolutionary improvement in the historically poor outcomes for refractory cardiac arrest. Current evidence has only demonstrated efficacy in single high volume centres in Europe and the USA and important logistical and health economic considerations remain for a country wide roll out. In this article we will review the evidence and equitable delivery of extracorporeal cardiopulmonary resuscitation in the context of the principles of the United Kingdom healthcare system for a general medical audience.

Superior hypophyseal artery aneurysms are rare. Symptomatic superior hypophyseal artery aneurysm commonly presents with subarachnoid hemorrhage, uncommonly with cranial nerve deficits, and very rarely with visual impairment. Microsurgical management of such aneurysms is quite complex considering the anatomical structures in the paraclinoid region. A 43-year male presented with decreased visual acuity in both eyes. The patient was diagnosed with left supraclinoid partially thrombosed unruptured aneurysm with mass effect over optic chiasm and optic nerves on magnetic resonance imaging of the brain. He underwent clipping of the aneurysm with an aneurysmectomy. At the six-month clinical follow-up, the right eye vision had significantly improved.

Medical futility in the cardiovascular care of older adults presents unique challenges that necessitate a nuanced understanding of both clinical and ethical dimensions. This state-of-the-art review explores the evolving concept of futility in the context of an ageing patient population and expanding armamentarium purported to treat even the most dire of cardiovascular diseases. The first objective is to delineate a framework for clinicians to elicit the different dimensions of futility, their relative importance to the patient, and their potential for improvement with the intervention being considered. Definitions are elaborated for quantitative futility-interventions with statistically negligible benefits-and qualitative futility-interventions misaligned with patient-specific goals and values. The second objective is to highlight the determinants of prohibitive risk, from the cardiovascular disease and procedural morbidity, to competing non-cardiovascular risks and frailty. A distinction is made between frailty and futility, and manifestations of severe frailty are reviewed based on the A-B-C-D-E mnemonic. The third and final objective is to discuss strategies and actionable approaches to care for patients once futility has been invoked. In addition to ongoing compassionate dialogue with the patient and family members, early initiation and aggressive pursuit of palliative care measures is beneficial for symptom control and quality of life. Ultimately, informed shared decision-making with a patient-centered philosophy is essential to uphold dignity and enhance the quality of life for older adults facing complex cardiovascular conditions.

People with HIV (PWH) have an increased risk of cardiovascular disease, and many receive lipid-lowering therapy (LLT). However, it is unknown if PWH treated with LLT remain at a higher residual cardiovascular risk than persons from the general population. We investigated the risk of elevated biomarkers of inflammation and dyslipidemia associated with cardiovascular disease, among PWH and controls receiving LLT.

In this cross-sectional study, we included PWH from the Copenhagen Comorbidity in HIV infection (COCOMO) study and population controls from the Copenhagen General Population Study (CGPS), frequency matched 1:4 on age and sex. Among these, 142 PWH and 428 controls reported current treatment with LLT and were included in the analysis.

We used multivariable logistic regression models to assess the association between HIV and biomarkers including high-sensitivity C-reactive protein (hs-CRP) ≥3.0 mg/L, low-density lipoprotein cholesterol (LDL-C) ≥2.6mmol/L, and triglycerides (TG) ≥2.26 mmol/L combined with high-density lipoprotein cholesterol (HDL-C) ≤1.03 mmol/L.

PWH had a higher risk of elevated hs-CRP (adjusted odds ratio (aOR) 1.97 [1.17-3.32], p  =  0.01) and of elevated TG (aOR 3.36 [1.94-5.81], p  <  0.01). No difference according to LDL-C risk was found. Our findings remained robust in sensitivity analyses adjusting for SCORE2 category, physical activity and exposure to thymidine analogues, and in subgroup analyses by antiretroviral therapy regimen, except for hs-CRP among PWH on protease inhibitor-based regimens.

PWH receiving LLT had higher risk of elevated hs-CRP and TG compared to controls. This warrants increased attention and monitoring of treatment goals in PWH receiving LLT.

Skeletal muscle area (MA) and muscle density (MD) are key determinants of physical function and typically decline with increasing age. Statins have well-known musculoskeletal effects but whether statins impact MA or MD is not well established, especially in the setting of randomized treatment.

REPRIEVE is a double-blind randomized trial evaluating the effect of pitavastatin for primary prevention of major adverse cardiovascular events in people with HIV (PWH). Thoracic paraspinal, pectoralis, and infraspinatus MA and MD were assessed among Mechanistic Substudy participants with CT at baseline and month 24.

Of 804 substudy participants, 510 remained on study treatment and had imaging at baseline and month 24. Median age was 51 years; 17% were natal female, 35% Black, and 27% Hispanic. There were no apparent changes in muscle measures from baseline to month 24 within the treatment groups. The estimated treatment group differences in baseline-adjusted month 24 outcomes were minimal (within 0.5 cm2/m for height-adjusted MA with 95% CI bounds within <1 cm2/m, and within 1 Hounsfield units (HU) for MD with 95% CI bounds within <3 HU; all p > 0.2). Findings were generally consistent in subgroup analyses.

Pitavastatin was associated with no apparent change in muscle measures over 24 months, and with no evidence of detrimental effect among PWH.

Dolutegravir (DTG) is recommended in WHO guidelines and has reportedly been associated with excess gain in body weight (BW).

In the prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we evaluated changes in BW and blood pressure (BP) of people living with HIV (PLHIV) who had initiated tenofovir (TDF)/lamivudine (3TC)/efavirenz (EFV; TLE). Follow-up continued after participants had been switched to TDF/3TC/DTG (TLD) in 2019.

From the electronic medical record system, we retrieved data on BW and systolic BP of LighTen Cohort Study participants (age ≥18 years), who were still in care. We modelled BW and systolic BP over time utilizing interrupted time series (ITS) considering repeated measurements and adjusting for age and sex. Incident hypertension was defined as office BP ≥140/90 mmHg using ≥2 measurements on ≥2 consecutive visits.

Data of 543 PLHIV (317 females) were analysed. ITS showed an increase in BW of 1.24 kg/year on TLE with a minimal contribution (36.5 g/year) during DTG treatment, in contrast to the change in systolic BP: 0.33mmHg/year on TLE vs. 2.63mmHg/year on DTG. Incident hypertension in previously normotensive PLHIV was confirmed in 5.4% (while on TLE) versus 11.0% (while on TLD).

Following the initial increase in BW on TLE, a larger increase in BP and a higher risk of incident hypertension was associated with switching antiretroviral therapy from TLE to TLD. Focussing on BP control while on DTG and timely initiation of antihypertensive drug therapy can help to reduce the burden of hypertension in PLHIV with their inherent increased cardiovascular risk.

Female athletes exhibit lower rates of atrial fibrillation (AF) and sudden cardiac death compared with male athletes, but the mechanisms behind this sex disparity in arrhythmia risk remain unclear.

This study analyzed findings from Holter monitors, echocardiograms, and cardiac magnetic resonance imaging in a cohort of 397 endurance athletes enriched with prevalent AF. Athletes with cardiomyopathies, channelopathies, pre-excitation, and/or myocardial infarction were excluded.

Female athletes (n = 125; age 27 [18-47] years) had a lower prevalence of AF (6% vs 31%; P < 0.001) and nonsustained ventricular tachycardia (2% vs 11%; P = 0.004) than male athletes (n = 272; age 44 [22-61] years). Despite comparable exercise volume and sports duration, female athletes had lower maximal oxygen consumption. Female athletes had smaller age-adjusted left atrial volume (40 [34-47] mL/m² vs 44 [37-52] mL/m²; P = 0.007) and ventricular volume (indexed left ventricular end-diastolic volume: 98 ± 16 mL/m² vs 109 ± 21 mL/m²; P < 0.001; indexed right ventricular end-diastolic volume: 109 ± 20 mL/m² vs 123 ± 23 mL/m²; P < 0.001). Age-adjusted hinge (13% vs 24%; P = 0.120) and non-hinge-point (12% vs 20%; P = 0.875) fibrosis were equally prevalent between the sexes. Lower left ventricular mass, similar native T1 times, and higher extracellular volume in female athletes suggested less cardiomyocyte hypertrophy than in male athletes. Compared with a subset of 125 age-matched male athletes, female athletes had a similar prevalence of atrial and ventricular ectopy. Less bradycardia and lower resting and peak exercise blood pressure in female athletes suggested additional modulating factors.

Lower rates of AF and nonsustained ventricular tachycardia in female athletes may be attributed to smaller atrial and ventricular volumes and reduced cardiomyocyte hypertrophy, although there are likely additional modulating factors. A comparable prevalence of ectopy suggests that the disparity in arrhythmia risk may be more attributable to differences in underlying substrate than arrhythmogenic triggers.

Differences in long-term clinical outcomes following transcatheter aortic valve replacement (TAVR) in different anatomical subtypes of aortic valve stenosis (AS), specifically tricuspid aortic valves (TAV) and bicuspid aortic valves (BAV) of types 0 (BAV-0) and 1 (BAV-1), are not well understood.

We sought to report and compare the long-term clinical outcomes among patients with different anatomical subtypes of AS undergoing TAVR.

We conducted an international retrospective cohort study involving patients who underwent TAVR for severe AS at 3 large, high-volume heart centers in China, Germany, and Denmark before October 2018. Five-year follow-up ended on October 30, 2023, and the primary endpoint was all-cause mortality.

A total of 2,553 AS patients (BAV-0: n = 134; BAV-1: n = 305; TAV: n = 2,114) who underwent TAVR more than 5 years ago were included. The mean age of this cohort was 79.9 ± 6.8 years, and the median Society of Thoracic Surgeons score was 3.6% [Q1-Q3: 2.4%-5.4%]. The median follow-up time was 3.24 years (Q1-Q3: 1.25-5.00 years). At 5 years, BAV-1 (adjusted HR: 2.38 [95% CI: 1.32-4.28]; P = 0.004) and TAV (adjusted HR: 3.02 [95% CI: 1.71-5.31]; P < 0.001) had a higher risk for all-cause mortality after TAVR compared with BAV-0. BAV patients who were treated with balloon-expandable valves had a higher long-term all-cause mortality (41.7% [28.5%-52.5%] vs 23.6% [17.9%-28.8%]; HR: 1.63 [95% CI: 1.05-2.51]; P = 0.028) compared with those with self-expanding valves.

Among patients with severe AS undergoing TAVR, BAV-0 was associated with a better long-term prognosis compared with TAV and BAV-1.

Patients with cardiovascular disease (CVD) often rely on informal caregivers to promote healthy dietary intake and compliance. Dyadic interventions show potential for enhancing patients' healthy diets, yet the effectiveness remains unexplored. A systematic review and meta-analysis were conducted. PubMed, Cochrane Library, Embase, CINAHL Plus, PsycINFO, and Web of Science were searched up to January 10, 2025. This review included 29 articles (i.e., 25 studies) involving 3039 patients and 2706 caregivers. Dyadic interventions significantly reduced patients' sodium intake, fat intake, body mass index, and improved self-care behavior, quality of life, heart disease knowledge, self-efficacy, and perceived support. However, the interventions did not improve patients' blood lipid profiles. Insufficient studies prevented meta-analyses for patients' blood pressure and blood sugar levels, health motivation, communication, mutuality, caregivers' self-care behavior, disease knowledge, quality of life, self-efficacy/caregiver mastery, and caregiver burden. Dyadic interventions showed preliminary evidence for improving CVD patients' diets. High-quality dyadic research is needed to validate current findings, assess the effectiveness on other dietary outcomes, and explore effective intervention characteristics. Trial Registration: PROSPERO number: CRD42023473308 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=473308).