The other side of the medallion in heart failure: Reverse metabolic syndrome.

BACKGROUND AND AIMS: Lower levels of cardiovascular risk factors are associated with an increase in mortality in H.F. To explain this paradox, the term reverse metabolic syndrome (RMetS) has recently been proposed. We suggest defining these patients with lower levels of three risk factors can be combined under the heading "RMetS." We aimed to investigate the effect of MetS and RMetS on hemodynamic parameters and prognosis in patients with H.F. and reduced ejection fraction (HFrEF). METHODS AND RESULTS: We included 304 patients who were performed right heart catheterization and followed up for a median of 16 (0-48) months. We first grouped patients according to the presence of MetS or not, then we added the RMetS category and stratified patients into three groups as MetS, RMetS, and metabolic healthy. Compared with not MetS group, Pulmonary arterial pressures and VO2 were higher in MetS group. In the second step, LVEF, CI, VO2I, O2 delivery, and LVSWI were lowest in RMetS, pulmonary artery pressures were higher in MetS group. In multivariate Cox regression analysis, being in RMetS group was associated with 2.4 times and 1.8 times increased risk for composite end point (CEP) and all-cause mortality, respectively. In Kaplan Meier analysis, RMetS had the highest all-cause mortality and CEP. CONCLUSIONS: We determined that RMetS patients had the worst prognosis with unfavorable hemodynamic profile. Hence, a better understanding of the pathophysiology of RMetS may help refine the treatment targets of CV risk factors, may yield new interventions targeting catabolic syndrome.

An Incidental Finding of a Massive Loculated Pericardial Effusion in a Patient Presenting With Inferior ST-Elevation Myocardial Infarction.

Pericardial effusion, commonly associated with malignancies such as lung, breast, and esophageal cancers through local extension, or leukemia, lymphoma, and melanoma via metastatic dissemination, is rarely observed in renal cell carcinoma (RCC). This report presents a rare case of a large loculated pericardial effusion in a 68-year-old male, potentially linked to RCC, who concurrently presented with an inferior wall ST-elevation myocardial infarction (STEMI). The patient, with a history of hypertension, hyperlipidemia, end-stage renal disease, coronary artery disease, and former smoking, exhibited symptoms including chest pain, diaphoresis, and shortness of breath, but no fever, chills, or night sweats. Diagnostic imaging revealed a significant pericardial effusion and a renal mass consistent with RCC, along with potential pulmonary metastases. Despite the complexity and high-risk nature of his condition, exacerbated by recent STEMI and dual antiplatelet therapy, a multidisciplinary approach was employed. This case emphasizes the need for careful management and tailored treatment strategies in patients with multiple coexisting conditions, highlighting the critical role of comprehensive diagnostic evaluation and collaborative care in improving patient outcomes.