Five-Minute Apgar Scores and Its Prognostic Value: A Multinational Cohort Study

The Apgar score was originally developed to standardise the
assessment of term-born infants’ clinical condition at 1 min of life. However,
accumulating research shows that the judgement at 5 and 10 min has better
predictive value for in-hospital mortality and severe neurologic and
non-neurologic morbidities in term-born infants. In very preterm (VPT) infants <32
weeks’ gestation, low 5-min Apgar scores have been consistently associated with
increased risk of mortality, but results on associations with morbidity are
contradictory. The authors from a multinational research collaboration
concluded that low Apgar scores were associated with increased risk for severe
brain injury in preterm infants 24–28weeks but not in a graded manner. The
longer-term prognostic value was called into question in extremely preterm
infants.

Key aims of the present study were to describe variations in
5- min Apgar scores <7 among VPT infants across European countries, to
assess associations with adverse neonatal outcomes and to test whether these
associations differ by country-level variations in low Apgar score prevalence.

itwasaProspective observational population-based cohort
study. In total, 7900 liveborn VPT infants from the EPICE-SHIPS study were
included. Associations between 5-min Apgar scores<7 and adverse neonatal
outcomes were estimated with adjustments for perinatal characteristics. We
tested for interactions by country-level prevalence of an Apgar score<7,
grouped into low (14%–16%), medium (19%–22%) and high (28%–40%).

20.2% of infants had 5-min Apgar score <7 with rates of
14%–40% across countries. A score <7 increased risks of in hospital
mortality, intraventricular haemorrhage (IVH), cystic periventricular
leukomalacia (cPVL), retinopathy of prematurity (ROP), bronchopulmonary
dysplasia (BPD) and length of hospital stay (LHS), but not necrotising
enterocolitis or late-onset infection (LOI). No interactions with country group
were detected for mortality, cPVL and ROP, while associations with IVH, BPD and
LHS were restricted to countries with lower prevalence of scores <7.

In a multinational cohort of VPT infants using data
abstracted following a common, standardised protocol, study provide novel
results on the association of 5-min Apgar score severe outcomes. Three findings
advance the scientific knowledge about the prognostic value of the 5-min Apgar
score in this high-risk population. First, the proportion of VPT infants with
5-min Apgar scores <7 varies largely between European countries. Second,
there is a clinically relevant association of low 5-min Apgar scores with most
adverse neonatal outcomes. This is reassuring as the Apgar score is the first
clinical assessment to judge the vitality of VPT infants after birth. The importance
arises from the fact that the score guides clinical treatment decisions for
stabilisation measures and resuscitation worldwide, although concerns of its
suitability have been raised by researchers and leading medical societies.
Lastly, the variations in strength of associations between adverse outcomes and
low 5-min Apgar score by country suggest the need for context-specific
validation of the Apgar score and risk thresholds. While mortality was not
impacted by country variations in 5-min Apgar scores, this was present for
severe IVH. The latter finding is of relevance for the long-term outcome of VPT
infants, as severe IVH constitutes one of the most devastating acute
morbidities with high impact on the psychomotor outcome.

Early prediction of adverse outcomes remains an unmet need
in research on VPT infants and clinical care. Easy-to-use bedside tests are
required that can guide prompt decisions as well as risk stratification. The
5-min Apgar score has remained a standard assessment tool for more than 70
years despite the advances in clinical care and medical knowledge. One of the
reasons is its easy applicability. Study results and others argue for its
suitability to predict adverse neonatal outcomes after VPT birth. However,
associations are too weak and variability is too high to base treatment
decisions exclusively on the 5-min Apgar score. Multivariable models, combining
the 5-min Apgar score with additional items including medical interventions
after delivery and the new features of artificial intelligence, show promise,
as established for other disease entities like sepsis. This will hopefully lead
to an easy-to-handle tool with high accuracy as established for BPD and ROP
risk calculators. Overall, results encourage initiatives to standardise Apgar
scoring within a European guideline and video tutorials.

Study results indicate that low 5-min Apgar scores <7 are
associated with an unfavourable short-term outcome in VPT infants. The
variations in Apgar scores between the countries underscore the importance of
not only focusing on baseline risks, management and outcomes, but also
considering the interaction with country in routine clinical care and research.

Source: Harald Ehrhardt, Soodabeh Behboodi,
Rolf F. Maier; BJOG: An International Journal of Obstetrics &
Gynaecology, 2025; 0:1–11 https://doi.org/10.1111/1471-0528.18291

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Weight loss trial reports success for breast cancer patients at one year mark

Breast cancer patients who participated in a remote weight loss intervention program lost an average of 4.7 percent of their baseline body weight after one year, while those in the education only control group gained an average 1 percent of their baseline weight, according to a new report from Dana-Farber Cancer Institute investigators. The findings from the Breast Cancer Weight Loss (BWEL) clinical trial set the stage for ongoing research to determine if weight loss following breast cancer treatment can reduce the risk of cancer recurrence and extend survival.

The results were published in JAMA Oncology.

“This remotely delivered intervention was successful in helping women lose weight across many different patient and treatment factors and it worked well across a large number of sites across the U.S. and Canada,” says Dana-Farber’s Jennifer Ligibel, MD, principal investigator on the study. “These results put us in a great position to be able to determine whether the weight loss program will help reduce the risk of cancer recurrence.”

Obesity is a risk factor for recurrence of breast cancer, other related health problems, and poor quality of life. There is a strong need to find an effective and reliable way to help patients lose weight after diagnosis and treatment for breast cancer.

The Breast Cancer Weight Loss (BWEL) trial, a Phase III trial supported by the National Cancer Institute and the Susan G. Komen Foundation, enrolled nearly 3,180 women from more than 637 cancer treatment centers in the U.S. and Canada. The participants, who had been diagnosed with stage 2 or 3 HER2-negative breast cancer, had completed chemotherapy and radiation therapy (if it was to be administered) and were randomly assigned to receive either a telephone-based weight-loss program plus health education or health education alone. The weight-loss program, conducted by phone, coached patients in reducing their calorie intake and increasing exercise.

In this planned analysis of results for patients after 12-months, 46.5 percent of patients on the weight loss intervention lost 5 percent of their baseline body weight and 22.5 percent lost 10 percent. In contrast, only 14.3 percent of those in the control group lost 5 percent of baseline body weight and 5 percent of controls lost 10 percent. Further, 21.9 percent of controls gained more than 5 percent of baseline body weight compared to 8.2 percent in the weight loss intervention.

“It is very hard after being diagnosed with breast cancer to lose weight and many people gain weight,” says Ligibel. “This study really underscores that it is important to help patients with their weight after a breast cancer diagnosis.”

Patients experienced weight loss on the weight loss intervention regardless of education level, socioeconomic status, and treatment types, including patients on anti-estrogen therapies. The results did show less weight loss in premenopausal, African American, and Latina patients.

“More research is needed to fine tune weight loss interventions for different groups of breast cancer survivors,” says Ligibel.

“Every person deserves the chance to be as healthy as possible after a breast cancer diagnosis. Susan G. Komen is proud to have supported Dr. Ligibel’s pioneering BWEL trial since 2016,” says Kimberly Sabelko, Ph.D., vice president of scientific strategy and programs at Susan G. Komen. “We are so grateful to the patients who are participating in it, as the findings are poised to provide us with evidence-based behavioral interventions that could help many patients live longer, better lives. This initial report demonstrating that weight loss is achievable across a diverse patient population is very encouraging, and we look forward to the long-term results.”

The study provided the intervention in both English and Spanish and provided a toolbox of recipe recommendations to support a range of dietary preferences including vegetarian, vegan, and low-carbohydrate diets. Recipes included Caribbean, Mexican, and Indian foods. Commercial partners supported the trial by donating activity monitors, wireless scales, meal replacement shakes, and food scales for patients to use if desired.

“We tried to meet people where they were as long as they were adhering to a healthy diet, the caloric restrictions, and activity levels,” says Ligibel. “Patients need support and an infrastructure, and this study offers an intervention that works across many sites and across a wide range of people.”

The long-term goal of the BWEL study will be to determine if the intervention reduces breast cancer recurrence. If it does, the program could become something more widely available to patients.

“We are working toward insurance reimbursement for weight loss programs for patients with breast cancer, making this kind of intervention available for patients regardless of their ability to pay for it themselves,” says Ligibel.

Reference:

Jennifer A. Ligibel et al, Impact of a Weight Loss Intervention on 1-Year Weight Change in Women With Stage II/III Breast Cancer, JAMA Oncology (2025). DOI: 10.1001/jamaoncol.2025.2738

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RCR Index Strong Predictor of Mortality and Disease Severity in Diabetic Nephropathy Patients: Study

China: The RCR index is linked to higher mortality in diabetic nephropathy patients and can help assess severity and guide ICU treatment.

A new retrospective analysis, published in BMC Nephrology, explored the relationship between the red blood cell distribution width to serum calcium (RCR) ratio and all-cause mortality among critically ill patients with diabetic nephropathy (DN), offering potential insights for prognostic assessment in intensive care settings.

Diabetic nephropathy, a severe complication of diabetes, significantly increases the risk of mortality, particularly among patients in intensive care units where metabolic disturbances are pronounced. Globally, the prevalence of DN is rising, imposing a growing economic and public health burden. While alterations in red blood cell distribution width (RDW) and serum calcium levels are common in critically ill patients and have been linked to DN progression, the predictive value of the RCR ratio for mortality remained largely unexplored until now.
Researchers, led by Dr. Jianlu Bi from the Endocrinology Department at Guangdong Second Hospital of Traditional Chinese Medicine, Guangzhou, China, analyzed data from the MIMIC-IV database to investigate this relationship. The study included 1,265 critically ill DN patients, with a median age of 73 years and 64.27% being male. Patients were categorized into four groups according to their RCR index, and mortality outcomes were assessed at 30, 90, 180, and 365 days. Kaplan-Meier curves, Cox proportional hazards regression, and restricted cubic spline (RCS) analyses were applied to examine the association between RCR values and all-cause mortality.
The analysis revealed the following findings:
  • Higher RCR values were associated with increased mortality risk at all assessed time points.
  • Patients in the highest RCR quartile faced significantly elevated mortality risks according to Cox regression analysis.
  • Restricted cubic spline (RCS) analysis showed a linear relationship between RCR and all-cause mortality.
  • Inflection points were identified at 2.361 for 30-day mortality and 2.098 for 365-day mortality.
  • Each unit increase in RCR below 2.361 was linked to a 414% increase in 30-day mortality.
  • Each unit increase in RCR below 2.098 was linked to a 494% increase in 365-day mortality.
  • The findings highlight the prognostic significance of the RCR index in critically ill diabetic nephropathy patients.
Despite the robust findings, the study acknowledged several limitations. Being a retrospective single-center ICU analysis, its generalizability to non-ICU populations remains uncertain. The database did not provide DN-specific mortality causes, dialysis status, or detailed renal function parameters, which may influence outcomes. Approximately 20% of variables with missing data were excluded, though interpolation methods were applied to mitigate this limitation. The authors emphasized that causal relationships could not be definitively established due to the study design.
The study highlights the clinical value of RCR as a readily available biomarker derived from routine laboratory tests. Elevated RCR levels may assist clinicians in identifying high-risk DN patients and tailoring ICU treatment strategies accordingly. The researchers advocate for larger, multicenter prospective studies to validate RCR’s utility and explore its integration into routine risk assessment for patients with diabetic nephropathy.
“The findings suggest that the RCR index could serve as an important tool in predicting mortality risk among critically ill DN patients, potentially supporting better-informed clinical decisions and improving patient outcomes in intensive care settings,” the authors concluded.
Reference:
Huang, Y., Jiang, K., Liu, Y. et al. Association between red blood cell distribution width to serum calcium ratio and all-cause mortality in critically ill patients with diabetic nephropathy: a retrospective analysis of the MIMIC-IV database. BMC Nephrol 26, 475 (2025). https://doi.org/10.1186/s12882-025-04402-x

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Vascular disease overlooked contributor to dementia, UNM researcher finds

Vascular dementia–cognitive impairment caused by disease in the brain’s small blood vessels-is a widespread problem, but it has not been as thoroughly studied as Alzheimer’s disease, in which abnormal plaques and protein tangles are deposited in neural tissue.

One researcher at The University of New Mexico hopes to change that.

In a newly published paper featured by the editors of the American Journal of Pathology, Elaine Bearer, MD, PhD, the Harvey Family Endowed and Distinguished Professor in the UNM School of Medicine’s Department of Pathology, sets out a new model for characterizing and categorizing different forms of vascular dementia.

She hopes this approach will help researchers to better understand the various forms of the disease and find effective treatments.

Conditions like hypertension, atherosclerosis and diabetes have been linked to vascular dementia, but other contributing causes, including the recent discovery of significant quantities of nano– and microplastics in human brains, remain poorly understood, Bearer said.

“We have been flying blind,” she said. “The various vascular pathologies have not been comprehensively defined, so we haven’t known what we’re treating. And we didn’t know that nano– and microplastics were in the picture, because we couldn’t see them.”

Bearer identified 10 different disease processes that contribute to vascular-based brain injury, typically by causing oxygen or nutrient deficiency, leakage of blood serum and inflammation or decreased waste elimination. These cause tiny strokes that harm neurons. She lists new and existing experimental techniques, including special stains and novel microscopy, to detect them.

For the paper, Bearer used a specialized microscope to meticulously study tissue from a repository of brains donated by the families of New Mexicans who had died with dementia, employing stains that highlighted the damaged blood vessels. Surprisingly, many patients diagnosed with Alzheimer’s disease also had disease in the small blood vessels of the brain.

“We suspect that in New Mexico maybe a half of our Alzheimer’s people also have vascular disease,” she said.

Bearer contends a methodical approach to identifying different forms of vascular dementia will help neurologists and neuropathologists more accurately score the severity of the disease in both living and deceased patients and advance the search for potential treatments — and even cures. To make that happen, the National Institutes of Health (NIH) has raised the possibility of forming a consensus group of leading neuropathologists to work out a new classification and scoring system, she said.

Meanwhile, a fresh area of concern is the unknown health consequences of nano– and microplastics in the brain, Bearer said.

“Nanoplastics in the brain represent a new player on the field of brain pathology,” she said. “All our current thinking about Alzheimer’s disease and other dementias needs to be revised in light of this discovery.”

“What I’m finding is that there’s a lot more plastics in demented people than in normal subjects,” she said. “It seems to correlate with the degree and type of dementia.”

The quantity of plastics also was associated with higher levels of inflammation, she said.

Bearer’s work builds on years of collaboration with Gary Rosenberg, MD, professor of Neurology and director of the UNM Alzheimer’s Disease Research Center (ADRC), which won a five-year $21.7 million NIH grant in 2024 that supported Bearer’s research. Rosenberg, a longtime chair of the UNM Department of Neurology and also director of the UNM Center for Memory & Aging, has published extensively on the association of vascular disease with dementia symptoms.

“When we started thinking about putting this ADRC together, I thought one of the things I should look at is the vasculature, because nobody’s done it systematically and comprehensively, and we have a world’s expert here at UNM,” Bearer said.

“Describing the pathological changes in this comprehensive way is really new. What I’m hoping will come out of this paper is working with other neuropathology ADRC cores across the country to develop consensus guidelines for classifying vascular changes and the impact of nano– and microplastics on the brain.”

Reference:

Bearer, Elaine L., Exploring Vascular Contributions to Cognitive Impairment: Small-Vessel Disease of White Matter and Microplastics/Nanoplastics, American Journal Of Pathology, DOI: 10.1016/j.ajpath.2025.07.007.

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Being too thin can be deadlier than being overweight, Danish study reveals

A massive Danish study finds that being slightly overweight-or even mildly obese-may not shorten life expectancy, while those underweight or at the low end of “normal” weight face greater risks. Credit: Shutterstock

It is possible to be “fat but fit,” new research being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria (September 15-19) suggests.

The study of tens of thousands of people in Denmark found that those with a BMI in the overweight category – and even some of those living with obesity – were no more likely to die during the five years of follow-up than those with a BMI of 22.5-<25.0 kg/m2, which is at the top end of the normal weight range.

Individuals with a BMI in the middle and lower parts of the normal weight range 18.5 to <22.5kg/m2, were also more likely to die. As were individuals with a BMI in the underweight range.

“Both underweight and obesity are major global health challenges,” says Sigrid Bjerge Gribsholt, of the Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark, who led the research. “Obesity may disrupt the body’s metabolism, weaken the immune system and lead to diseases like type 2 diabetes, cardiovascular diseases and up to 15 different cancers, while underweight is tied to malnutrition, weakened immunity and nutrient deficiencies.

“There are conflicting findings about the BMI range linked to lowest mortality. It was once thought to be 20 to 25 but it may be shifting upward over time owing to medical advances and improvements in general health.”

To provide some clarity, Dr Gribsholt, Professor Jens Meldgaard Bruun, also of the Steno Diabetes Center Aarhus, and colleagues used health data to examine the relationship between BMI and mortality in 85,761 individuals (81.4% female, median age at baseline 66.4 years).

BMI is a measure of weight to height and a score of 18.5 to <25 kg/m2 is generally considered to be of normal weight. A BMI of <18.5 kg/m2 is categorized as underweight, 25 to <30 kg/m2 is considered overweight and a BMI of 30 kg/m2 is described as obesity.

7,555 (8%) of the participants died during follow-up. The analysis found that individuals in the underweight category were almost three times more likely (2.73 times) to have died than individuals with a BMI towards the top of the healthy range (22.5 to <25.0 kg/m2, the reference population).

Similarly individuals with BMI of 40 kg/m2 and above (categorized as severe obesity) were more than twice as likely (2.1 times) to have died compared with the reference population.

However, higher mortality rates were also found for BMIs that are considered healthy.

Individuals with a BMI of 18.5 to <20.0 kg/m2, and so at the lower end of the healthy weight range, were twice as likely to have died as those in the reference population. Similarly, those with a 20.0 to <22.5 kg/m2, and so in the middle of the healthy weight range, were 27% more likely to have died than the reference population.

By contrast, individuals with a BMI in the overweight range (25 to <30 kg/m2) and those with a BMI at the lower part of the obese range (30.0 to <35.0 kg/m2) were no more likely to have died than the those in the reference population – a phenomenon sometimes referred to as being metabolically healthy or “fat but fit.”

Those with a BMI of 35 to <40.0 kg/m2 did have an increased risk of death of 23%.

All of the results were adjusted for sex, comorbidity level and education level.

A similar pattern was obtained when the researchers looked at the relationship between BMI and obesity in participants of different ages, sexes and levels of education.

The researchers were surprised to find that BMI was not associated with a higher mortality up to a BMI of 35 kg/m2 and that even a BMI 35 to <40 kg/m2 was only associated with a slightly increased risk.

Dr Gribsholt says: “One possible reason for the results is reverse causation: some people may lose weight because of an underlying illness. In those cases, it is the illness, not the low weight itself, that increases the risk of death, which can make it look like having a higher BMI is protective.

“Since our data came from people who were having scans for health reasons, we cannot completely rule this out.

“It is also possible that people with higher BMI who live longer – most of the people we studied were elderly – may have certain protective traits that influence the results.

“Still, in line with earlier research, we found that people who are in the underweight range face a much higher risk of death.”

Whatever the explanation, BMI isn’t the only indicator that an individual is carrying unhealthy levels of fat, says Professor Bruun.

He explains: “Other important factors include how the fat is distributed. Visceral fat – fat that is very metabolically active and stored deep within the abdomen, wrapped around the organs – secretes compounds that adversely affect metabolic health.

“As a result, an individual who has a BMI of 35 and is apple-shaped – the excess fat is around their abdomen – may have type 2 diabetes or high blood pressure, while another individual with the same BMI may free of these problems because the excess fat is on their hips, buttocks and thighs.

“It is clear that the treatment of obesity should be personalized to take into account factors such as fat distribution and the presence of conditions such as type 2 diabetes when setting a target weight.”

Reference:

Being too thin can be deadlier than being overweight, Danish study reveals, European Association for the Study of Diabetes, Meeting:Annual meeting of the European Association for the Study of Diabetes (EASD).

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Excessive folic acid intake in pregnancy linked to gestational diabetes: Study

New research from South Australia highlights the urgent need to establish a safe upper limit for folic acid intake during pregnancy and to improve guidelines on folic acid supplementation during pregnancy.

A study by Flinders University and Adelaide University researchers published in the journal Nutrients links the rise in gestational diabetes in part to excess maternal folate levels, due to the dual impact of folic acid (FA, or synthetic folate) in food fortification and higher-than-recommended supplementation doses during pregnancy.

National surveillance shows the incidence of gestational diabetes mellitus (GDM) in Australia has more than tripled, rising from 5.6% in 2010 to 19.3% in 2022.

The research – led by Dr Tanja Jankovic-Karasoulos, now at The University of Adelaide, and Professor Claire Roberts, at Flinders University – highlights both the need to establish a safe upper limit for FA intake during pregnancy, and to re-evaluate supplementation guidelines in the context of widespread food fortification and increased dose and duration of real-world supplementation practice.

“Our study shows that excess maternal folate significantly increases GDM risk in our post-fortification pregnancy cohort,” says Dr Jankovic-Karasoulos, from the Robinson Research Institute at University of Adelaide.

“We suspect that increased FA intake over the past 10-15 years is contributing to the steady rise in GDM prevalence in Australia.”

Adequate folate is essential for DNA formation and proper cell growth and development. Current guidelines recommend supplementation with 400–500 µg of FA daily, starting at least one month prior to conception and continuing through the first trimester to reduce the risk of neural tube defects such as spina bifida.

“Our study suggests that higher-than-recommended FA intake may have unintended consequences for pregnancy,” says Dr Jankovic-Karasoulos, who last year was awarded an NHMRC Ideas Grant, Flinders Foundation Health Seed Grant and Diabetes Australia Project Grant to further investigate the effects of high FA intake during pregnancy on placental function, maternal insulin resistance and glucose handling.

“The placenta is central to regulating maternal glucose tolerance in pregnancy, so we need to understand how high FA intake affects placental function and, in turn, insulin resistance and gestational diabetes risk.”

NHMRC Investigator Research Fellow Professor Claire Roberts, from the Pregnancy Health and Beyond Laboratory at Flinders University, says understanding the potential harms of excess FA intake is of major public health importance.

“The use of FA is widely recommended worldwide, but we need to keep investigating unexpected implications, plus how to identify women at risk of gestational diabetes early in pregnancy to protect the baby from adverse effects of high maternal blood glucose for the best start in life,” says Professor Roberts, from the Flinders Health and Medical Research Institute.

Researchers emphasise the importance of adequate folate in pregnancy but highlight the need to establish a safe upper limit of FA intake. They would also like to see improved guidelines on FA supplementation during pregnancy which would protect the fetus right at the beginning of gestation against neural tube defects but also protect the mother and fetus from adverse effects of high blood glucose.

Reference:

Jankovic-Karasoulos T, Smith MD, Leemaqz S, Mittinty M, Williamson J, McCullough D, Arthurs AL, Dekker GA, Roberts CT. Maternal Folate Excess, Placental Hormones, and Gestational Diabetes Mellitus: Findings from Prospective Cohorts Before and After Mandatory Folic Acid Food Fortification. Nutrients. 2025; 17(17):2863. https://doi.org/10.3390/nu17172863

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2025 ESC/EACTS Valvular Heart Disease Guidelines Stress Heart Team, Advanced Imaging

Switzerland: The European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) have released their updated 2025 guidelines for the management of valvular heart disease (VHD), replacing the 2021 guidelines. The new document published in the European Heart Journal aims to provide concise, practical recommendations to assist healthcare providers in their daily clinical decision-making.

A central theme of the updated guidelines is the reinforced importance of a multidisciplinary Heart Team operating within an integrated regional Heart Valve Network. This network approach, which incorporates outpatient clinics and specialist Heart Valve Centres, aims to ensure timely diagnosis and optimal patient care. The guidelines recommend that complex procedures be concentrated in high-volume, experienced centers to ensure high-quality treatment.
The 2025 update also highlights the growing importance of advanced imaging modalities. Techniques such as three-dimensional (3D) echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR) have become crucial for the screening, evaluation, and intervention planning for patients with VHD.
Significant new evidence has reshaped recommendations for specific conditions. For severe aortic stenosis (AS), intervention is now supported irrespective of symptoms, left ventricular ejection fraction, or flow reserve. The criteria for selecting between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) have been refined, incorporating a combination of age, procedural risk, anatomical suitability, and lifetime management considerations.
In mitral regurgitation (MR), the guidelines stress the importance of correctly assessing the cause and distinguishing between atrial and ventricular secondary mitral regurgitation (SMR), as this has clear implications for prognosis and management. For tricuspid regurgitation (TR), growing evidence supports concomitant TV repair during left-sided valve surgery and highlights the role of transcatheter options in improving quality of life.
The guidelines also feature updated recommendations on the use of direct oral anticoagulants (DOACs) and introduce a new dedicated section on sex-specific considerations in patients with VHD.
Key Takeaways from the 2025 ESC/EACTS VHD Guidelines:
1. Heart Team and Network: An integrated regional Heart Valve Network, with Heart Teams at its core, is essential for optimal patient care. Complex procedures should be performed in the most experienced centers.
2. Advanced Imaging: Multimodality imaging, including 3D echocardiography, CCT, and CMR, is now central to the diagnosis, planning, and guiding of interventions in VHD.
3. Aortic Stenosis (AS) Intervention: Intervention is recommended for symptomatic patients with severe AS. The choice between TAVI and SAVR is based on Heart Team assessment of age, life expectancy, procedural risk, and lifetime management. TAVI is recommended for suitable patients aged ≥70 years.
4. Asymptomatic Severe AS: For asymptomatic patients with severe, high-gradient AS and low procedural risk, early intervention should be considered as an alternative to close active surveillance.
5. Mitral Regurgitation (MR) Classification: Distinguishing between primary, ventricular secondary, and atrial secondary MR is crucial, as the evaluation and management differ for each type.
6. Secondary MR Management: Guideline-directed medical therapy is the essential first step for ventricular SMR. TEER is recommended for specific symptomatic patients to reduce heart failure hospitalizations. For atrial SMR, surgery and AF ablation should be considered.
7. Tricuspid Regurgitation (TR): Concomitant TV repair is preferred for patients with moderate or severe TR undergoing left-sided valve surgery. For high-risk patients with isolated severe TR, transcatheter treatment should be considered to improve quality of life.
8. Mixed Aortic Valve Disease: Intervention is recommended for symptomatic patients with mixed moderate AS and moderate AR if they present with a high gradient (mean gradient ≥40 mmHg or Vmax ≥4.0 m/s).
9. Mechanical Heart Valves (MHV): Lifelong anticoagulation with a Vitamin K antagonist (VKA) is required. Patient education and INR self-monitoring are recommended to improve efficacy.
10. Sex-Specific Considerations: A new dedicated section acknowledges sex-specific differences in VHD prevalence, pathophysiology, and outcomes, which may influence management strategies.
The authors stress that these recommendations support, but do not override, individual clinical judgment. By identifying key gaps in evidence, the guidelines standardize care and direct future research.
Reference:
Praz, F., Borger, M. A., Lanz, J., Abreu, A., Adamo, M., Ajmone Marsan, N., Barili, F., Bonaros, N., Cosyns, B., De Paulis, R., Gamra, H., Jahangiri, M., Jeppsson, A., Klautz, R. J., Mores, B., Pöss, J., Prendergast, B. D., Rocca, B., Rossello, X., . . . Moorjani, N. 2025 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf194

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Court cannot decide what should be taught in medical education-SC rejects change plea

The Supreme Court recently refused to entertain a Public Interest Litigation (PIL) seeking changes in the medical syllabus. While considering the issue, the Apex Court bench led by Chief Justice of India (CJI) BR Gavai clarified that the court cannot take up the responsibility to decide what should be taught in medical education.

“This is not our work. We cannot decide what syllabus should or shouldn’t be. Approach the university or govt,” remarked the top court bench comprising CJI Gavai, while further observing that syllabus-related issues fell within the domain of academic bodies and the government and therefore they must be addressed by expert authorities and not decided through judicial intervention.

For more details, check out the full story on the link mentioned below:

Court cannot decide what should be taught in medical education- SC junks plea seeking changes in medical syllabus

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Long COVID associated with abnormal uterine bleeding and cycle-phase symptom variation

The Center for Reproductive Health, University of Edinburgh reports that long COVID was associated with abnormal uterine bleeding in a UK population, with increased menstrual volume, longer duration and more intermenstrual bleeding with no impaired ovarian function, alongside differences in peripheral and endometrial inflammation.

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Hemodialysis Patients Face Higher Restenosis Risk After DCB Therapy, But Limb Salvage Remains High: POPCORN Registry

Japan: Data from the real-world POPCORN registry has revealed that peripheral artery disease (PAD) patients on hemodialysis experience worse vessel patency after drug-coated balloon (DCB) interventions compared to non-dialysis patients. However, 3-year limb salvage rates remain high, exceeding 90%.

The findings, published in JACC: Cardiovascular Interventions by Yasutaka Yamauchi of the Cardiovascular Center, Takatsu General Hospital, Kawasaki, and colleagues, suggest important insights into long-term outcomes of DCB therapy in a high-risk population that has traditionally been underrepresented in large-scale vascular studies.

The study analyzed data from a prospective, multicenter registry that included patients treated with DCBs—either Lutonix or IN.PACT Admiral—for femoropopliteal artery disease between March 2018 and December 2019. Of the 3,165 lesions treated, 991 were in patients undergoing hemodialysis. The primary outcome of interest was freedom from restenosis over three years.

The study led to the following findings:

  • After propensity score matching, the 1-year freedom from restenosis rate was 82.2% in the hemodialysis group and 85.8% in the non-dialysis group.
  • At three years, freedom from restenosis declined to 61.9% in hemodialysis patients and 66.3% in those not on dialysis.
  • Restenosis outcomes consistently favored patients not undergoing dialysis.
  • Risk factors linked to poorer vessel patency in the hemodialysis group included the absence of below-the-knee runoff, prior endovascular therapy, popliteal artery lesions, severe vascular calcification, use of the Lutonix balloon, and severe dissection after the procedure.
  • In the hemodialysis group, restenosis was observed in 363 lesions during a median follow-up of 16.2 months.
  • Despite the higher restenosis rates, over 90% of hemodialysis patients achieved limb salvage within three years.
  • The high limb preservation rate supports the role of DCB therapy as an effective option, even in complex hemodialysis patients.
  • Hemodialysis patients were generally younger (average age 72 years) compared to non-dialysis patients (76 years).
  • In the hemodialysis group, there was a higher prevalence of diabetes and chronic limb-threatening ischemia.
  • These underlying conditions may have contributed to the increased complexity and poorer patency outcomes observed in patients on dialysis.

The authors wrote, “DCB endovascular therapy represents a viable and effective treatment option for managing femoropopliteal lesions in patients undergoing hemodialysis. While the durability of vessel patency may be somewhat reduced in this high-risk group, the consistently high rates of limb preservation highlight its clinical value.”

They emphasize the importance of adopting a tailored approach to endovascular care—one that takes into account specific anatomical and procedural factors—to optimize long-term outcomes in patients on dialysis.

Reference:

Yamauchi, Y, Takahara, M, Soga, Y. et al. Vessel Patency After Femoropopliteal Drug-Coated Balloon Therapy in Patients on Hemodialysis. J Am Coll Cardiol Intv. 2025 Jul, 18 (13) 1660–1670.

https://doi.org/10.1016/j.jcin.2025.05.001

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