Prolonged QT Elevates Recurrent Stroke Risk by 73% 02/21/26
Welcome to Cardiology Today â Recorded February 21, 2026. This episode summarizes 5 key cardiology studies on topics like venoarterial extracorporeal membrane oxygenation and calcific aortic valve disease. Key takeaway: Prolonged QT Elevates Recurrent Stroke Risk by 73%.
Article Links:
Article 1: HEV-Targeted Antibody-Drug Conjugate Promotes Long-Term Cardiac Allograft Acceptance. (Circulation)
Article 2: Aspirin use, lipoprotein(a), and calcific aortic valve disease: the Multi-ethnic Study of Atherosclerosis. (European heart journal)
Article 3: Temporal Hemodynamic Patterns in Cardiogenic Shock Treated with Isolated PVAD and Combined Therapy with VA-ECMO. (Journal of cardiac failure)
Article 4: Prolonged QT interval and risk of recurrent stroke in the Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) trial. (Heart (British Cardiac Society))
Article 5: Predictors of Stroke Volume Improvement with AV-Optimised Conduction System Pacing in Patients with AV Dromotropathy. (ESC heart failure)
Full episode page: https://podcast.explainheart.com/podcast/prolonged-qt-elevates-recurrent-stroke-risk-by-73-02-21-26/
đ Featured Articles
Article 1: HEV-Targeted Antibody-Drug Conjugate Promotes Long-Term Cardiac Allograft Acceptance.
Journal: Circulation
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/41717681
Summary: An antibody-drug conjugate targeting high endothelial venules in lymph nodes has been shown to promote long-term cardiac allograft acceptance. This therapeutic strategy leverages the crucial role of high endothelial venules in mediating naive T cell entry into lymph nodes, a vital step for transplant acceptance under costimulatory blockade. The conjugate specifically targets a glycoprotein containing 6-sulfo sialyl Lewis X on these venules, which forms the binding site for L-selectin on naive T cells. This approach offers a novel mechanism to prevent immune rejection in heart transplant recipients.
Article 2: Aspirin use, lipoprotein(a), and calcific aortic valve disease: the Multi-ethnic Study of Atherosclerosis.
Journal: European heart journal
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/41721439
Summary: In this observational study of up to 6598 participants, lipoprotein(a) and L. D. L. cholesterol were confirmed as causally linked to aortic valve calcium and aortic stenosis. The analysis found that aspirin use was not associated with incident aortic valve calcium or aortic stenosis. This lack of association held true regardless of baseline lipoprotein(a) or L. D. L. cholesterol levels. The data suggests that aspirin does not mitigate the risk of calcific aortic valve disease in individuals with high lipoprotein(a).
Article 3: Temporal Hemodynamic Patterns in Cardiogenic Shock Treated with Isolated PVAD and Combined Therapy with VA-ECMO.
Journal: Journal of cardiac failure
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/41720453
Summary: This study described the temporal hemodynamic patterns observed in cardiogenic shock patients receiving either an isolated microaxial flow pump or combined therapy with venoarterial extracorporeal membrane oxygenation. Hemodynamic indices were analyzed from pre-device installation, post-installation, and 24 hours after, up to device explantation, using data from the U. N. L. O. A. D. E. R. S.-P. VAD Registry. The study characterized these hemodynamic trends for both treatment groups. Hospital survival was also analyzed in relation to these patterns, providing comparative data on mechanical circulatory support strategies in cardiogenic shock.
Article 4: Prolonged QT interval and risk of recurrent stroke in the Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) trial.
Journal: Heart (British Cardiac Society)
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/41720625
Summary: A secondary analysis of the A. R. C. A. D. I. A. trial found that a prolonged Q. T. interval independently predicted an increased risk of recurrent stroke or systemic embolism in patients with cryptogenic stroke and atrial cardiopathy. This association held true for both the apixaban arm, with a hazard ratio of 1.70 (95 percent confidence interval 1.05-2.75), and the aspirin arm, showing a hazard ratio of 1.76 (95 percent confidence interval 1.05-2.95). The overall adjusted hazard ratio for this risk was 1.73 (95 percent confidence interval 1.25-2.38), with no significant interaction between Q. T. interval prolongation and treatment assignment (P value 0.95). This data demonstrates that prolonged Q. T. interval is an independent predictor of recurrent stroke regardless of antithrombotic treatment.
Article 5: Predictors of Stroke Volume Improvement with AV-Optimised Conduction System Pacing in Patients with AV Dromotropathy.
Journal: ESC heart failure
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/41711207
Summary: This study identified electrocardiographic and echocardiographic predictors of acute stroke volume improvement with A. V.-optimized conduction system pacing in 19 symptomatic first-degree atrioventricular block patients. Electrocardiographic predictors included a Q. R. S. duration greater than or equal to 120 milliseconds, with an odds ratio of 17.5, and a prolonged P. R. interval, with an odds ratio of 1.05. Echocardiographic predictors encompassed a reduced left ventricular ejection fraction less than 50 percent, mechanical atrioventricular dyssynchrony, and left ventricular diastolic dysfunction, with odds ratios of 25.0, 20.0, and 15.0 respectively. These findings demonstrate that specific electrocardiogram and echocardiogram parameters can identify patients likely to acutely benefit from A. V.-optimized conduction system pacing for stroke volume improvement.
đ Transcript
Today’s date is February 21, 2026. Welcome to Cardiology Today. Here are the latest research findings.
Article number one. HEV-Targeted Antibody-Drug Conjugate Promotes Long-Term Cardiac Allograft Acceptance. An antibody-drug conjugate targeting high endothelial venules in lymph nodes has been shown to promote long-term cardiac allograft acceptance. This therapeutic strategy leverages the crucial role of high endothelial venules in mediating naive T cell entry into lymph nodes, a vital step for transplant acceptance under costimulatory blockade. The conjugate specifically targets a glycoprotein containing 6-sulfo sialyl Lewis X on these venules, which forms the binding site for L-selectin on naive T cells. This approach offers a novel mechanism to prevent immune rejection in heart transplant recipients.
Article number two. Aspirin use, lipoprotein(a), and calcific aortic valve disease: the Multi-ethnic Study of Atherosclerosis. In this observational study of up to 6598 participants, lipoprotein(a) and L. D. L. cholesterol were confirmed as causally linked to aortic valve calcium and aortic stenosis. The analysis found that aspirin use was not associated with incident aortic valve calcium or aortic stenosis. This lack of association held true regardless of baseline lipoprotein(a) or L. D. L. cholesterol levels. The data suggests that aspirin does not mitigate the risk of calcific aortic valve disease in individuals with high lipoprotein(a).
Article number three. Temporal Hemodynamic Patterns in Cardiogenic Shock Treated with Isolated PVAD and Combined Therapy with VA-ECMO. This study described the temporal hemodynamic patterns observed in cardiogenic shock patients receiving either an isolated microaxial flow pump or combined therapy with venoarterial extracorporeal membrane oxygenation. Hemodynamic indices were analyzed from pre-device installation, post-installation, and 24 hours after, up to device explantation, using data from the U. N. L. O. A. D. E. R. S.-P. VAD Registry. The study characterized these hemodynamic trends for both treatment groups. Hospital survival was also analyzed in relation to these patterns, providing comparative data on mechanical circulatory support strategies in cardiogenic shock.
Article number four. Prolonged QT interval and risk of recurrent stroke in the Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) trial. A secondary analysis of the A. R. C. A. D. I. A. trial found that a prolonged Q. T. interval independently predicted an increased risk of recurrent stroke or systemic embolism in patients with cryptogenic stroke and atrial cardiopathy. This association held true for both the apixaban arm, with a hazard ratio of 1.70 (95 percent confidence interval 1.05-2.75), and the aspirin arm, showing a hazard ratio of 1.76 (95 percent confidence interval 1.05-2.95). The overall adjusted hazard ratio for this risk was 1.73 (95 percent confidence interval 1.25-2.38), with no significant interaction between Q. T. interval prolongation and treatment assignment (P value 0.95). This data demonstrates that prolonged Q. T. interval is an independent predictor of recurrent stroke regardless of antithrombotic treatment.
Article number five. Predictors of Stroke Volume Improvement with AV-Optimised Conduction System Pacing in Patients with AV Dromotropathy. This study identified electrocardiographic and echocardiographic predictors of acute stroke volume improvement with A. V.-optimized conduction system pacing in 19 symptomatic first-degree atrioventricular block patients. Electrocardiographic predictors included a Q. R. S. duration greater than or equal to 120 milliseconds, with an odds ratio of 17.5, and a prolonged P. R. interval, with an odds ratio of 1.05. Echocardiographic predictors encompassed a reduced left ventricular ejection fraction less than 50 percent, mechanical atrioventricular dyssynchrony, and left ventricular diastolic dysfunction, with odds ratios of 25.0, 20.0, and 15.0 respectively. These findings demonstrate that specific electrocardiogram and echocardiogram parameters can identify patients likely to acutely benefit from A. V.-optimized conduction system pacing for stroke volume improvement.
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đ Keywords
venoarterial extracorporeal membrane oxygenation, calcific aortic valve disease, electrocardiogram, atrioventricular dyssynchrony, atrial cardiopathy, heart transplant, echocardiogram, aortic stenosis, conduction system pacing, first-degree atrioventricular block, cardiac allograft acceptance, cardiogenic shock, systemic embolism, lipoprotein(a), hemodynamic patterns, aortic valve calcium, recurrent stroke, mechanical circulatory support, antibody-drug conjugate, Q. T. interval prolongation, aspirin, apixaban, left ventricular ejection fraction, cryptogenic stroke, microaxial flow pump, stroke volume, T cell rejection, high endothelial venules.
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