Publications by authors named "Thomas A Zelniker"
Background: Immune checkpoint inhibitors (ICIs) have improved outcomes for several malignancies, but cancer patients face an increased risk of cardiovascular disease due to shared risk factors, similar biological mechanisms, and cardiotoxic side effects of therapy. Effective risk stratification strategies are urgently needed.
Objectives: This study explored the association between the biomarkers with the risks of acute cardiovascular hospitalizations and death in cancer patients receiving ICI therapy.
Isolated Atrial Myocarditis With Atrial Standstill.
JACC Case Rep
July 2025
Background: Myocarditis typically affects ventricles, whereas isolated atrial myocarditis is rare, causing conduction abnormalities, atrial standstill, and right heart failure.
Case Summary: Two weeks after a respiratory infection, a 35-year-old man developed dyspnea, leg edema, and bradycardia. Electrocardiogram revealed a narrow QRS escape rhythm without P waves, and N-terminal pro-B-type natriuretic peptide was elevated.
Diabetic cardiomyopathy revisited: The interplay between diabetes and heart failure.
Int J Cardiol
November 2025
Diabetic cardiomyopathy is a complex condition characterized by structural and functional changes in the heart, which are not explained by other known cardiovascular risk factors in patients with diabetes. Since Rubler first described this condition in 1972, there has been significant progress in understanding the multifactorial mechanisms that contribute to the development and progression of heart failure in diabetic patients. In this review, we provide a comprehensive discussion of the key mechanisms that underlie the development of diabetic cardiomyopathy, including chronic hyperglycemia, autonomic neuropathy, altered substrate utilization, and dysregulated insulin pathways.
View Article and Find Full Text PDFBackground: The association between cardiovascular disease and advanced liver disease is incompletely understood. To explore this interaction, we compared management, clinical outcomes, readmission rates, and resource utilization in ST-elevation myocardial infarction (STEMI) patients with and without liver disease.
Methods: The Nationwide Readmissions Database (2016-2020) was queried to identify hospitalizations for STEMI.
Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy (HCM) remains challenging. Late gadolinium enhancement (LGE) on cardiac MRI signifies myocardial fibrosis and is linked to adverse outcomes in HCM. However, the threshold of LGE that is clinically significant remains a subject of debate.
View Article and Find Full Text PDFCirculating Autoantibodies Against Vasoactive Biomarkers Related to Orthostatic Intolerance in Long COVID Patients Compared to No-Long-COVID Populations: A Case-Control Study.
Biomolecules
February 2025
Endothelial dysfunction mediated by elevated levels of autoantibodies against vasoactive peptides occurring after COVID-19 infection is proposed as a possible pathomechanism for orthostatic intolerance in long COVID patients. This case-control study comprised 100 long COVID patients from our prospective POSTCOV registry and three control groups, each consisting of 20 individuals (Asymptomatic post-COVID group; Healthy group = pan-negative for antispike protein of SARS-CoV-2; Vaccinated healthy group = no history of COVID-19 and vaccinated). Autoantibodies towards muscarinic acetylcholine receptor M3, endothelin type A receptor (ETAR), beta-2 adrenergic receptor (Beta-2 AR), angiotensin II receptor 1 and angiotensin 1-7 (Ang1-7) concentrations were measured by enzyme-linked immunosorbent assay in long COVID patients and controls.
View Article and Find Full Text PDFSoluble ST2 in Heart Failure: A Clinical Role beyond B-Type Natriuretic Peptide.
J Cardiovasc Dev Dis
November 2023
Soluble (s)ST2 has been proposed as a useful biomarker for heart failure (HF) patient management. Myocardial damage or mechanical stress stimulate sST2 release. ST2 competes with a membrane bound receptor (ST2 ligand, or ST2L) for interleukin-33 (IL-33) binding, inhibiting the effects induced by the ST2L/IL-33 interaction so that excessive sST2 may contribute to myocardial fibrosis and ventricular remodeling.
View Article and Find Full Text PDFTemporal trends and outcomes of patients with chronic limb-threatening ischemia with and without history of coronary artery disease: insights from the us national inpatient sample database.
J Invasive Cardiol
October 2023
Article Synopsis
- - The study examines the rising prevalence of coronary artery disease (CAD) in adults with chronic limb-threatening ischemia (CLTI) from 2000 to 2018, finding that about 23% of CLTI patients also had CAD, which increased over the years from 15.3% to 23.1%.
- - It reports that individuals with CLTI and CAD have a higher risk of in-hospital mortality and complications, such as bleeding requiring transfusion, compared to those without CAD.
- - The research highlights a shift in treatment methods, showing an increase in endovascular procedures over surgical ones for patients with both CAD and CLTI, and suggests a need for improved interventions for this vulnerable group.
Epstein-Barr virus (EBV) reactivation may be involved in long-COVID symptoms, but reactivation of other viruses as a factor has received less attention. Here we evaluated the reactivation of parvovirus-B19 and several members of the Herpesviridae family (DNA viruses) in patients with long-COVID syndrome. We hypothesized that monovalent COVID-19 vaccines inhibit viral interference between SARS-CoV-2 and several DNA viruses in patients with long-COVID syndrome, thereby reducing clinical symptoms.
View Article and Find Full Text PDFArticle Synopsis
- Myocardial infarction frequently leads to out-of-hospital cardiac arrests (OHCA), yet the long-term effects of early coronary angiography for patients without ST-segment elevation are unknown.
- The TOMAHAWK trial compared the outcomes of early unselective angiography versus delayed/selective angiography in 554 patients who were successfully resuscitated from OHCA with suspected cardiac causes.
- Results were measured after one year, focusing on all-cause mortality, severe neurological deficits, myocardial infarction rates, and rehospitalization among survivors.
Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials.
Clin Res Cardiol
April 2024
Article Synopsis
- Recent trials indicate that early coronary angiography (CAG) doesn't improve survival outcomes compared to delayed CAG in patients with out-of-hospital cardiac arrest (OHCA) without ST elevation, although the effects on specific subgroups are still uncertain.
- An analysis of 1,512 patients from five trials showed no significant difference in overall death rates between early and delayed CAG strategies, regardless of factors like age and prior heart issues.
- Interestingly, women appeared to have higher odds of death with early CAG, suggesting that gender may influence outcomes in this context.
Mid-regional pro-adrenomedullin and lactate levels for risk stratification in patients with out-of-hospital cardiac arrest.
Eur Heart J Acute Cardiovasc Care
June 2023
Aims: Adrenomedullin (ADM) is a free-circulating peptide that regulates endothelial barrier function and vascular tone. Here, we sought to study the relationship of ADM in combination with lactate and the risk of death in patients with out-of-hospital cardiac arrest (OHCA).
Methods And Results: Mid-regional pro-adrenomedullin (MR-proADM) and lactate concentrations were measured in patients with OHCA who survived at least 24 h after the return of spontaneous circulation.
Effects of dapagliflozin on hospitalisations in people with type 2 diabetes: post-hoc analyses of the DECLARE-TIMI 58 trial.
Lancet Diabetes Endocrinol
April 2023
Article Synopsis
- * Conducted as part of the DECLARE-TIMI 58 trial, the research involved over 17,000 participants, comparing the effects of dapagliflozin to a placebo in a double-blind, randomized setup.
- * The findings highlighted that while dapagliflozin significantly reduced the risk of heart failure hospitalizations, its overall impact on hospitalizations for all causes, particularly in those without cardiovascular disease, remains less clear.
Article Synopsis
- - Dapagliflozin is shown to lower the chances of hospitalization due to heart failure and slow chronic kidney disease progression in patients with or without type 2 diabetes (T2D), though its effect on reducing atherosclerotic events is less certain.
- - The study aimed to determine if levels of NT-proBNP and hsTnT could help identify T2D patients at higher risk of atherosclerotic events who may benefit more from dapagliflozin treatment.
- - In a secondary analysis of the DECLARE-TIMI 58 trial involving over 14,000 patients, both NT-proBNP and hsTnT were significantly linked to the risk of major adverse cardiovascular events (MACE)
Background Fibroblast growth factor 23 (FGF-23) is crucial in regulating phosphate and vitamin D metabolism and is moreover associated with an increased cardiovascular risk. The specific objective of this study was to investigate the influence of FGF-23 on cardiovascular outcomes, including hospitalization for heart failure (HHF), postoperative atrial fibrillation, and cardiovascular death, in an unselected patient population after cardiac surgery. Methods and Results Patients undergoing elective coronary artery bypass graft and/or cardiac valve surgery were prospectively enrolled.
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- Managing low-density lipoprotein cholesterol (LDL-C) is crucial for preventing heart disease, but there's still a risk due to high triglyceride levels.
- Recent research has identified ANGPTL3 as a potential target for lowering cardiovascular risks, as its absence is linked to lower LDL-C and triglycerides.
- New treatments like monoclonal antibodies and gene editing are showing promise in safely reducing these levels and have been approved for certain patients, but more research is needed to confirm long-term benefits.
Comparison of the prevalence of SARS-CoV-2 nucleoprotein antibodies in healthcare workers and an unselected adult and paediatric all-comer patient population: insights from a longitudinal study of healthcare workers and concurrent serial cross-sectional studies of patients at an academic medical centre in Austria.
BMJ Open
January 2023
Article Synopsis
- The study aimed to compare the presence of antibodies against the SARS-CoV-2 virus in healthcare workers versus a general patient population in an Austrian medical center.
- It involved testing 812 healthcare workers and 8451 patients over multiple time periods during the pandemic to measure the seroprevalence of the antibodies.
- Results showed similar rates of antibodies (around 12%) in both groups, indicating that healthcare workers and patients had comparable exposure to the virus throughout the pandemic.
Aims: Left ventricular ejection fraction (LVEF) ≤ 40% is a well-established risk factor for mortality after acute coronary syndromes (ACS). However, the long-term prognostic impact of mildly reduced ejection fraction (EF) (LVEF 41-49%) after ACS remains less clear.
Methods And Results: This was a retrospective study enrolling patients admitted with ACS included in a single-centre databank.
Biomarker Prediction of Complex Coronary Revascularization Procedures in the FOURIER Trial.
J Am Coll Cardiol
August 2022
Background: Biomarkers are known to predict major adverse cardiovascular events. However, the association of biomarkers with complex coronary revascularization procedures or high-risk coronary anatomy at the time of revascularization is not understood.
Objectives: We examined the associations between baseline biomarkers and major coronary events (MCE) and complex revascularization procedures.
Objective: In patients with moderate to severe albuminuric kidney disease, sodium-glucose cotransporter 2 inhibitors reduce the risk of kidney disease progression. These post hoc analyses assess the effects of dapagliflozin on kidney function decline in patients with type 2 diabetes (T2D), focusing on populations with low kidney risk.
Research Design And Methods: In the Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58 (DECLARE-TIMI 58) trial, patients with T2D at high cardiovascular risk were randomly assigned to dapagliflozin versus placebo.
Article Synopsis
- The study aimed to compare the effectiveness and safety of P2Y inhibitors versus aspirin alone for preventing further heart problems in patients with atherosclerotic cardiovascular disease (ASCVD).
- Researchers analyzed 9 randomized trials involving over 61,000 patients, focusing on major adverse cardiac events (MACE) and other outcomes like myocardial infarction (MI), stroke, and major bleeding.
- Results showed P2Y inhibitors reduced the risk of MACE by 11% and MI by 19% compared to aspirin, with no significant difference in stroke, all-cause mortality, or major bleeding, suggesting P2Y inhibitors may be a better option for secondary prevention.
Article Synopsis
- - The study investigates how heart failure (HF) and diabetes relate to cardiovascular (CV) death and hospitalization for heart failure (HHF) in patients with atrial fibrillation (AF) over a 4.5-year period.
- - Researchers analyzed data from 7,412 patients and found that both diabetes and HF significantly increase the risk of CV death and HHF, with HF patients facing a higher risk of HHF.
- - The N-terminal pro-B-type natriuretic peptide (NT-proBNP) was effective in assessing risk, improving predictive performance when added to traditional risk factors, indicating its clinical value in this patient population.