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T. Marwick

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Open access Aug 2026

COVID-19 Vaccination and Risk of Post-COVID-19 Cardiovascular Disease: A Population-Based Cohort and Target Trial Emulation Study.

BACKGROUND Whether COVID-19 vaccination is associated with lower long-term cardiovascular risk after SARS-CoV-2 infection and how much infection prevention mediates this association remain unclear. OBJECTIVE To evaluate associations of vaccination, including its timing relative to SARS-CoV-2 infection, with post-COVID-19 cardiovascular disease (CVD), and quantify the contribution of infection prevention. METHODS This statewide population-based cohort study used linked administrative health data for 2,391,456 adults in Victoria, Australia (2019-2025). Associations of pre- or post-infection vaccination with major adverse cardiovascular events (MACE; primary outcome), stroke, heart failure, acute myocardial infarction (AMI), acute coronary syndrome (ACS), atrial fibrillation (AF), and venous thromboembolism (VTE) were evaluated using time-varying Cox proportional hazards regression, causal mediation analysis, and target trial emulation. RESULTS Vaccination was associated with lower hazards of MACE and all secondary outcomes. Estimated absolute risk reductions for MACE were 0.21% with pre-infection vaccination and 0.24% with post-infection vaccination. Three or more vaccine doses were associated with progressively lower hazards across cardiovascular outcomes. Mediation analysis suggested that approximately 68% of the estimated association between vaccination and lower post-COVID cardiovascular risk was not explained by prevention of SARS-CoV-2 infection. CONCLUSION Vaccination before or after SARS-CoV-2 infection was associated with lower hazards of post-COVID-19 cardiovascular outcomes, with stronger observed associations at higher dose numbers. Most of the estimated association was not explained by infection prevention alone. These findings support COVID-19 vaccination as an important component of strategies to reduce the burden of post-COVID-19 CVD while highlighting the need for further studies to clarify the mechanisms underlying these associations.

B. Seboka, D. Magliano, T. Marwick et al. · European Heart Journal - Qua... · 0 citations

Open access Jul 2026

Predictive profiles for poor functional improvement and mortality after transcatheter aortic valve replacement. Value of 6-minute walk test and myocardial work analysis.

BACKGROUND Clinical improvement and survival after transcatheter aortic valve replacement (TAVR) remain difficult to predict. Although multiple predictors of both outcomes have been identified, prognostic algorithms for patients undergoing TAVR are not well established. AIMS This study aimed to identify factors associated with the lack of meaningful improvement in exercise capacity after TAVR and to determine whether the predictive profile for poor functional response (PFR) also relates to mortality. METHODS We enrolled 220 patients (78.0 [6.4] years) with severe aortic stenosis undergoing TAVR. Pre‑ and post-procedural (3 months) assessments included clinical evaluation, echocardiography with myocardial work analysis, and the 6‑minute walk test (6MWT). PFR was defined as an increase in 6MWT distance <40 m. RESULTS Only age and atrial fibrillation independently predicted both mortality and PFR. Mortality was associated with lower global work index (HR, 0.99; P <0.001) and shorter 6MWT distance (HR, 0.99; P = 0.008). PFR was associated with higher global wasted work (OR, 1.003; P = 0.04) and less impaired baseline 6MWT relative to predicted values (OR, 0.29; P <0.001 for <80% predicted). Unsupervised machine‑learning analysis (Partition Around Medoids) identified clusters linked to mortality but not to PFR. CONCLUSIONS Predictive profiles for PFR and mortality after TAVR show limited overlap, indicating that these outcomes require distinct prognostic approaches. The 6MWT may inform both endpoints: lower absolute values predict mortality, whereas higher percentage‑predicted values identify patients less likely to experience significant symptomatic improvement. Myocardial work analysis may further refine prognostic assessment in this population.

J. Rychlewski, M. Przewłocka-Kosmala, T. Marwick et al. · Kardiologia polska · 0 citations