{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T21:37:43Z","timestamp":1792705063514,"version":"4.5.0"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare perioperative cardiovascular outcomes between patients with heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) following transforaminal or posterior lumbar interbody fusion (TLIF\/PLIF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The TriNetX Research Network was used to identify patients undergoing elective TLIF or PLIF between 2011 and 2025. Cohorts were defined by heart failure phenotype and propensity score\u2013matched (PSM) 1:1 for baseline demographics and comorbidities. Outcomes included postoperative atrial fibrillation or flutter (AF\/AFL), myocardial infarction (MI), and secondary complications within 90 days. Odds ratios with 95% confidence intervals were calculated. Significance was defined as p &lt; 0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 46,431 patients, 1,253 (2.7%) had HFrEF, 1,920 (4.1%) had HFpEF, and 43,258 (93.2%) had no heart failure. After PSM, both phenotypes carried elevated risk relative to non-HF controls across measured complications, including acute respiratory failure, pneumonia, AF\/AFL, acute kidney injury, venous thromboembolism, and 90-day emergency department visits (all p&lt;0.05). In the direct phenotype comparison (1,217 matched pairs), acute MI occurred more frequently in HFrEF than HFpEF patients (14.4% vs. 8.7%, p&lt;0.001). HFrEF was associated with greater odds of acute MI (OR 1.760 [95% CI: 1.363, 2.273], p&lt;0.001) and AF\/AFL (OR 1.278 [95% CI: 1.079, 1.513], p=0.005) compared with HFpEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among patients with heart failure undergoing TLIF or PLIF, those with HFrEF are at increased risk of postoperative AF\/AFL and MI compared with HFpEF patients. These findings highlight the importance of distinguishing heart failure phenotype during preoperative risk stratification and may support enhanced perioperative precautions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261501004","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T18:33:44Z","timestamp":1792434824000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Heart Failure With Reduced Ejection Fraction Is Associated With Greater Cardiovascular Risk Following Lumbar Interbody Fusion"],"prefix":"10.1177","author":[{"given":"Shankar S.","family":"Thiru","sequence":"first","affiliation":[{"name":"Georgetown University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4004-0202","authenticated-orcid":false,"given":"Haseeb E.","family":"Goheer","sequence":"additional","affiliation":[{"name":"Virginia Tech"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin J.","family":"Harris","sequence":"additional","affiliation":[{"name":"Virginia Tech"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Nazif","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9799-6067","authenticated-orcid":false,"given":"Mina","family":"Botros","sequence":"additional","affiliation":[{"name":"University of Rochester Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3473-5203","authenticated-orcid":false,"given":"Jonathan J.","family":"Carmouche","sequence":"additional","affiliation":[{"name":"Virginia Tech"},{"name":"Carilion Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2025.07.007"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2025.09.1503"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19063721"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.2.SPINE181383"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-21-00850"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1100910"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.0156"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000116"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2019.2110"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004044"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.06.013"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.09.026"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16607"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0000000000000335"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf559"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.7840"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001024"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2019.10.005"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.12.033"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.04.029"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.07.022"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/2192568217694144"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/2192568219882346"}],"container-title":["Global 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