Fishman B, Maor E, Ashri S
… +16 more, Loutati R, Lerman TT, Tiosano S, Tsaban G, Lotan D, Much AA, Hertz A, Dray EM, Zekry SB, Hay I, Klempfner R, Fefer P, Barbash IM, Guetta V, Segev A, Kuperstein R
Int J Cardiol
· 2026 May · PMID 41747775
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BACKGROUND: Body mass index (BMI) is an independent, predictor of adverse outcomes among patients with cardiovascular diseases. Our aim was to evaluate how BMI modifies the association of severe tricuspid regurgitation (...BACKGROUND: Body mass index (BMI) is an independent, predictor of adverse outcomes among patients with cardiovascular diseases. Our aim was to evaluate how BMI modifies the association of severe tricuspid regurgitation (TR) with poor survival. METHODS: Consecutive echocardiographic reports linked to clinical data from a tertiary medical center (2007-2021) were reviewed. BMI was stratified to underweight, normal weight, overweight, and obesity with cutoffs of 18.5, 25, and 30 Kg/m2. Multivariable Cox regression models were applied to calculate adjusted hazard ratios (aHR) for all-cause mortality. RESULTS: The study population included 111,830 patients with a median age of 65 (IQR 52-76) years (58% males), 3436 (3.1%) patients had severe TR. There were 2398 (2%), 40,393 (36%), 43,790 (39%), and 25,249 (24%) individuals with underweight, normal weight, overweight, and obesity, respectively. During a median follow-up of 6 (3-10) years, 29,921 (27%) patients died. There was an interaction between BMI and TR with the outcome (p < 0.01). Severe TR was associated with mortality for patients with normal weight, overweight, and obesity, with an HR of 1.29 (95% CI 1.20-1.39), 1.26 (1.16-1.37), and 1.28 (1.15-1.43), respectively. This association was not evident among patients with underweight with an HR of 0.88 (0.64-1.22). Sub-analysis of hospitalized patients, with adjustment of the model to baseline comorbidities, including frailty, yielded similar point estimates to the main analysis. CONCLUSIONS: The association of severe TR with mortality is modified by BMI group. Severe TR is associated with mortality among patients of all BMI groups, except for individuals with underweight.
Tan C, Eaves S, Lo A
… +6 more, Mallouhi M, Vollbon W, Wahi S, Thomas L, Atherton JJ, Prasad SB
Int J Cardiol
· 2026 May · PMID 41734833
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BACKGROUND: The 2025 American Society of Echocardiography (ASE) guidelines for the assessment of diastolic dysfunction (DD) recommends a universal algorithm for all patients undergoing echocardiography. This study aimed...BACKGROUND: The 2025 American Society of Echocardiography (ASE) guidelines for the assessment of diastolic dysfunction (DD) recommends a universal algorithm for all patients undergoing echocardiography. This study aimed to evaluate the prognostic value of significant DD (grades 2 + 3) assessed with the 2025 guidelines (DD2025) compared to the 2016 guidelines (DD2016) for predicting all-cause mortality, including the subgroup with LVEF≥40%, following a first-ever myocardial infarction (MI). METHODS: Retrospective data on 808 consecutive patients with a first-ever MI between 2013 and 2021 were included. Doppler echocardiography was performed within 24 h of admission. Left atrial reservoir strain was measured retrospectively on stored DICOM images in patients who were indeterminate based on other parameters. RESULTS: At a median follow up of 4.5 years, there were 105 deaths (13.0%). DD2025 was present in 190 patients (23.5%) and DD2016 in 125 patients (15.5%), with a moderate concordance between guidelines (Cohen's Kappa 0.55,p < 0.001). On Kaplan-Meier analysis, DD2025 showed a better association with mortality (log-rank χ 48.6 versus 23.4 [both p < 0.001]). On Cox proportional hazards multivariable analysis incorporating significant clinical predictors and LVEF, both DD2025 (HR 1.93, 95%CI 1.23-2.96,p = 0.003) and DD2016 (HR 1.87, 95%CI 1.21-2.89,p = 0.005) were independent predictors of mortality and incremental to LVEF. Inter-model comparisons of model χ, Somer's D and Harrell's C-statistics favored DD2025. In the subgroup with LVEF≥40%, DD2025 remained a powerful independent predictor of mortality (HR 1.93, 95%CI1.23-3.02,p = 0.004). CONCLUSION: Significant DD assessed by the 2025 ASE guidelines is a robust independent predictor of survival following MI, including the subgroup with LVEF≥40%, and compares favourably with the 2016 guidelines.
Ghetti G, Taglieri N, Guiducci V
… +25 more, Capecchi A, Bendandi F, Nerla R, Mugnolo A, Vignali L, Franco N, Vetrugno V, Dall'Ara G, Monello A, Nardi E, Bosi D, Merani A, Arioti M, Cubich M, Venturi G, Benatti G, Menozzi M, Ruozzi M, Bruno AG, Foroni M, Bruno M, Balducelli M, Orzalkiewicz M, Palmerini T, Saia F
Int J Cardiol
· 2026 May · PMID 41730340
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BACKGROUND: Drug-coated balloon (DCB) percutaneous coronary intervention (PCI) for de-novo lesions represents a valid alternative to drug-eluting-stents in different settings. Bail-out stenting (BOS) might be applied to...BACKGROUND: Drug-coated balloon (DCB) percutaneous coronary intervention (PCI) for de-novo lesions represents a valid alternative to drug-eluting-stents in different settings. Bail-out stenting (BOS) might be applied to manage acute vessel recoil or dissections, however, its impact on clinical endpoints remains unclear. This study sought to investigate the 1-year outcomes of BOS compared to DCB-only PCI. METHODS: The present study was a multicenter, ambispective, investigator-initiated all-comer study enrolling PCI patients treated with DCB at 11 hospitals. Patients were divided into two groups: those who received DCB-only treatment and those who required BOS. Primary endpoint was 12-month target-vessel-failure (TVF) defined as a composite of target-vessel-myocardial infarction (TV-MI) and ischemia driven-target vessel revascularization (ID-TVR). RESULTS: The study included 1085 patients and 1236 lesions. BOS occurred in 11.1% of patients. The two study groups were well balanced in terms of clinical characteristics and angiographic features. Most of the lesions involved small vessels (median RVD 2.5 mm [IQR 2.0-2.5 mm]) and were classified as intermediate-high anatomical complexity (41% type B2/C). At 12-month, the occurrence of TVF was 3.2%. The primary endpoint occurred more frequently in BOS group (6.7% vs 2.8%, p-value = 0.02;), mostly due to TV-MI (4.2% vs 0.9%, p-value = 0.01). On multivariable analysis, BOS was still independently associated with the risk of the primary endpoint. (HR 2.70; 95%CI: 1.22-5.98: p-value = 0.015). CONCLUSIONS: After DCB-PCI the need for bail-out stenting is an independent risk factor of TVF at 1 year. Operators should anticipate BOS as a higher-risk scenario, imaging optimization may mitigate risks.
Hashiba M, Hansen MT, Helge JW
… +9 more, Nielsen SK, Gustavsen PH, Mohamed AA, Holt A, Elmegaard M, Petersen CS, Schou M, Lamberts MK, Wolsk E
Int J Cardiol
· 2026 May · PMID 41724449
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BACKGROUND: Peak oxygen consumption (pVO₂) is a key predictor of mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: From December 2022 to September 2023, patients with...BACKGROUND: Peak oxygen consumption (pVO₂) is a key predictor of mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: From December 2022 to September 2023, patients with new-onset HFrEF were prospectively enrolled from a heart failure outpatient clinic. All patients underwent at least 12 weeks of guideline-directed medical therapy (GDMT) initiation and management, including physical training and education. Cardiopulmonary exercise testing (CPET), medication, echocardiography, and clinical data were collected at baseline and after 12 weeks. Associations with pVO₂ changes were examined using univariable and multivariable regression analyses. RESULTS: We included 48 patients (median age 73 years, 20.8% women) with baseline left ventricular ejection fraction (LVEF) of 30% ± 7 and pVO₂ of 18.1 ± 5.6 mL/min/kg. After 12 weeks, pVO₂ increased by 2.2 mL/min/kg (95% CI: 1.3-3.1, p < 0.001) and LVEF improved to 44% (+14% [95% CI: 12-17, p < 0.001]). In the multivariable model, reductions in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and body mass index (BMI) were associated with higher pVO₂ (β = -1.11 [95% CI: -2.15 to -0.06, p = 0.039]; β = -1.62 [95% CI: -2.99 to -0.25, p = 0.023]). Higher left atrial end-systolic volume index (LAESVi) was also associated with increased pVO₂ (β = 0.23 [95% CI: 0.10-0.35, p = 0.001]). CONCLUSION: GDMT was associated with improvements in cardiorespiratory fitness and LVEF in patients with new-onset HFrEF. Reductions in NT-proBNP, decreases in BMI, and increases in LAESVi were independently associated with pVO₂ improvements after 12 weeks.
Ozaki Y, Uemura Y, Kondo T
… +8 more, Kazama S, Yamaguchi S, Okajima T, Mitsuda T, Ishikawa S, Takemoto K, Watarai M, Murohara T
Int J Cardiol
· 2026 May · PMID 41722656
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BACKGROUND: Advanced heart failure (HF) remains associated with poor outcomes despite contemporary therapies, with right ventricular dysfunction influenced by afterload. This study evaluated whether combined assessment o...BACKGROUND: Advanced heart failure (HF) remains associated with poor outcomes despite contemporary therapies, with right ventricular dysfunction influenced by afterload. This study evaluated whether combined assessment of the pulmonary artery pulsatility index (PAPi) and capacitance (PAC), and their transitions during acute-phase therapy, provides prognostic stratification in patients with advanced HF. METHODS: This post-hoc analysis of the ESCAPE trial included 146 patients with complete hemodynamic data. A bootstrap-based grid search identified prognostic cutoffs: PAPi at 2.67 and PAC at 2.03 (optimal, PAPi ≥2.67 and PAC ≥2.03; suboptimal, PAPi <2.67 or PAC <2.03). Patients were categorized based on transitions between zones from baseline to final assessment after acute-phase therapy. The primary endpoint was a composite of all-cause mortality, left ventricular assist device implantation, or heart transplantation within 6 months. RESULTS: The mean age was 56.2 years, 39 patients (26.9%) were female, and the median left ventricular ejection fraction was 20.0%. At baseline, 127 patients (87.0%) were suboptimal. Following acute-phase therapy, 33 (22.6%) transitioned to optimal, whereas 94 (64.4%) remained suboptimal. Kaplan-Meier curves demonstrated significant stratification among groups based on transitions (log-rank P = 0.016). In Cox regression models using the suboptimal→suboptimal group as reference, suboptimal→optimal transition was associated with improved prognosis (multivariable hazard ratio 0.300, 95% confidence interval 0.107-0.847, P = 0.023). CONCLUSIONS: Transitions in PAPi and PAC during acute-phase therapy were associated with subsequent outcomes in advanced HF. Combined assessment of PAPi and PAC may provide a therapeutic target for risk stratification and management in this high-risk population.
Leupp S, Sarzilla S, Caruzzo CA
… +3 more, Landi A, Valgimigli M, Milzi A
Int J Cardiol
· 2026 May · PMID 41720405
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BACKGROUND: Risk stratification in acute pulmonary embolism (PE) is essential to guide clinical management, particularly regarding the need for escalated therapies. Despite the availability of several prognostic scores,...BACKGROUND: Risk stratification in acute pulmonary embolism (PE) is essential to guide clinical management, particularly regarding the need for escalated therapies. Despite the availability of several prognostic scores, their comparative performance in unselected PE populations remains uncertain. OBJECTIVES: To compare the prognostic performance of six widely used risk assessment tools for acute PE in predicting short-term outcomes. METHODS: We retrospectively collected data from 397 consecutive patients with acute PE from a single institutional registry. Six risk scores (modified Bova, modified FAST, CPES, NEWS-2, PESI, and sPESI) were calculated at admission. The primary endpoint was the composite of in-hospital PE-related death, need for rescue thrombolysis, or severe hemodynamic instability. Secondary endpoints were the individual components of the primary endpoint and all-cause mortality up to 3 months. RESULTS: The primary endpoint occurred in 48 patients (12.1%), including PE-related death in 25 (6.3%), severe hemodynamic instability in 25 (6.3%), and systemic thrombolysis in 6 (1.5%). In-hospital mortality was 13.1% (n=52), and 3-month all-cause mortality was 16.4% (n=65). The PESI score demonstrated the highest predictive performance for all outcomes (AUC for the primary endpoint: 0.84, 95% confidence interval: 0.78-0.90), followed by NEWS-2 and sPESI. PESI and NEWS-2 consistently showed the greatest improvement over ESC classification in terms of net reclassification and increased discrimination. Bootstrap-based ranking confirmed PESI as the most likely best-performing score, while modified Bova, FAST, and CPES showed inferior performance. Findings were consistent across all ESC risk strata. CONCLUSIONS: Among commonly used prognostic scores for acute PE, PESI and NEWS-2 provide superior discrimination for short-term clinical outcomes and incremental value over ESC-based stratification. These scores may aid in refining risk assessment and guiding management in acute PE.
Li S, Huo H, Zheng Y
… +5 more, Liu S, Wu Y, Jiang X, Jin S, Liu T
Int J Cardiol
· 2026 May · PMID 41713508
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OBJECTIVE: To develop and validate non-contrast radiomics models based on cardiac magnetic resonance (CMR) native T1 mapping for detecting MI and differentiating acute from chronic lesions. METHODS: Retrospective data fr...OBJECTIVE: To develop and validate non-contrast radiomics models based on cardiac magnetic resonance (CMR) native T1 mapping for detecting MI and differentiating acute from chronic lesions. METHODS: Retrospective data from 310 MI patients (162 acute, 148 chronic) and 180 controls were analyzed. T1 Mapping and late gadolinium enhancement (LGE) images were acquired using 3.0 T CMR. Radiomics features were extracted via manual ROI delineation, and key features were selected using recursive feature elimination. Two models were developed: Model 1 for MI diagnosis and Model 2 for acute/chronic differentiation. Performance was evaluated via ROC curves, with Model 2 validated externally. RESULTS: Acute MI showed higher regional T1 values than chronic MI and controls (all P < 0.05). Radiomics models demonstrated good discriminative performance: Model 1 achieved an AUC of 0.849 (95% CI: 0.785-0.912) in the test set; Model 2 achieved AUCs of 0.833 (95% CI: 0.707-0.960) in the internal test set and 0.818 (95% CI: 0.728-0.909) in the external test set, and its incremental value was verified. CONCLUSION: Radiomics analysis based on native T1 mapping demonstrates high diagnostic accuracy for MI and effectively differentiates between acute and chronic lesions, as confirmed by multicenter validation. This approach holds promise for reducing reliance on contrast agents, thereby streamlining the imaging process and improving clinical decision-making.
Ferrera A, Di Gioia G, Daniello CD
… +5 more, Paoletti G, Spera FR, Mango F, Serdoz A, Squeo MR
Int J Cardiol
· 2026 May · PMID 41702446
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BACKGROUND: Exercise training induces structural cardiac adaptations, commonly referred to as the athlete's heart. These morphological changes are considered favorable for supporting enhanced cardiac function during effo...BACKGROUND: Exercise training induces structural cardiac adaptations, commonly referred to as the athlete's heart. These morphological changes are considered favorable for supporting enhanced cardiac function during effort. However, there are limited data directly correlating structural remodeling parameters with functional indices of cardiovascular performance, such as peak oxygen uptake (VO₂max) and oxygen pulse (O₂ pulse). METHODS: We enrolled 1033 Olympic-level athletes (46.8% female; mean age 25.6 ± 5.2 years) across 42 sporting disciplines Athletes underwent pre-participation evaluation including transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET). Echocardiographic parameters of ventricular and atrial size, mass, and function were assessed. Multivariate linear regression analyses were performed to identify independent predictors of VO₂ max and O₂ pulse. RESULTS: Athletes showed preserved systolic and diastolic function with clear evidence of structural remodeling from skill to endurance sports. At multivariate analysis, LVMi (p < 0.0001, β = 0.19) was independently and positively associated with VO₂ max while E/e' ratio (p = 0.014, β = -0.675) showed significant negative correlation. In the multivariable model for O₂ pulse, female sex (p < 0.0001, β = -3.136) and E/e' ratio (p = 0.027, β = -0.229) were for once negative correlate. Among cardiac parameters, LVMi (p < 0.0001, β = 0.055), LAVi (p < 0.0001, β = 0.131), RVEDA (p < 0.0001, β = 0.236) and TAPSE (p = 0.021, β = 0.122) contributed significantly, while EF showed no significant independent association. CONCLUSIONS: In a large cohort of elite athletes, structural cardiac remodeling parameters were independently correlated with VO₂max and O₂ pulse, indicating that morphological adaptation translates into functional performance.
Kawaji T, Aizawa T, Shizuta S
… +9 more, Nishiwaki S, Yamano S, Naka M, Bao B, Hojo S, Matsuda S, Kato M, Yokomatsu T, Miki S
Int J Cardiol
· 2026 May · PMID 41702445
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AIMS: This randomized study seeks to elucidate the efficacy of additional ablation strategies using the CARTOFINDER™ or ExTRa Mapping™ system which identify focal or rotational activation during atrial fibrillation(AF) r...AIMS: This randomized study seeks to elucidate the efficacy of additional ablation strategies using the CARTOFINDER™ or ExTRa Mapping™ system which identify focal or rotational activation during atrial fibrillation(AF) rhythm. METHODS AND RESULTS: A total of 80 patients who underwent initial catheter ablation for persistent AF and whose AF was persistent even after both CARTOFINDER™ or ExTRa Mapping™ in both atrium following pulmonary vein isolation were randomly assigned in a 1:1 ratio to the CARTOFINDER™-guided focal activation ablation group(FINDER group) or the ExTRa Mapping™-guided substrate homogenization group(ExTRa group). The primary outcome measure was recurrent atrial tachyarrhythmias after a 90-day blanking period post ablation procedure. A total of 2954 sites in both atria of 80 patients were assessed by both mapping systems. CARTOFINDER™ identified focal activations in 51.5%. of the sites, whereas ExTRa Mapping™ identified rotational activation in 33.1% of the sites, based on a high non-passively activated ratio (%NP). The 1-year event free survival from atrial tachyarrhythmia recurrence was numerically lower in the FINDER group than the ExTRa group(65.0% versus 80.0%, Log-rank P = 0.14). By multivariable analysis, a left atrial volume ≥ 150 ml(HR3.27, 95%CI1.26-9.13, P = 0.02) and low voltage(<0.25 mV) during AF rhythm(HR3.68, 95%CI1.12-13.3, P = 0.03), and CARTOFINDER™-guided focal activation ablation relative to ExTRa Mapping™-guided homogenization(HR2.84, 95%CI1.06-7.07, P = 0.03) were identified as independent risk factors for post-procedure recurrent atrial tachyarrhythmias. CONCLUSIONS: While the difference of atrial tachyarrhythmia recurrence in persistent AF patients did not reach statistical significance, CARTOFINDER™-guided focal activation ablation beyond PVI might be less effective than ExTRa mapping™-guided substrate homogenization.
Rashid R, Dimopoulos K, Constantine A
… +14 more, Bandeira LB, Clift P, Hudsmith LE, Fox CE, Moody WE, Castleman J, Thorne SA, Johnson MR, Patel R, Gatzoulis M, Li W, Nasoufidou A, Krishnathasan K, Rafiq I
Int J Cardiol
· 2026 May · PMID 41698552
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BACKGROUND: Pregnancy exacerbates left ventricular outflow tract (LVOT) gradients due to increased cardiac output (CO). This is amplified in patients with LVOT obstruction (LVOTO). Ascertaining whether gestational elevat...BACKGROUND: Pregnancy exacerbates left ventricular outflow tract (LVOT) gradients due to increased cardiac output (CO). This is amplified in patients with LVOT obstruction (LVOTO). Ascertaining whether gestational elevations in LVOT gradients are transient haemodynamic responses that regress postpartum, or predictors of disease progression or adverse outcomes, is critical. METHODS: A retrospective, observational study was conducted between 2009 and 2023 in two tertiary centres. Clinical and echocardiographic data were collected preconception, antenatally, and postpartum. Key measurements included peak and mean LVOT gradients, left ventricular ejection fraction, and aortic valve area. The primary endpoint was the need for postpartum intervention, while the secondary endpoints were a composite of adverse clinical outcomes and postpartum intervention. RESULTS: A total of 78 women with LVOTO (109 pregnancies) were included. Gestational increases in LVOT gradients were transient, regressing to baseline levels postpartum for most. Postpartum intervention was required in 11% of pregnancies within a median of 6.3 (4.4-9.2) years. Predictors of the primary endpoint were baseline LVOTO severity (HR = 29.6, p < 0.01), antenatal LVOTO severity (HR = 21.1, p < 0.01), and postpartum LVOTO severity (HR = 18.3, p < 0.01). While patients with inherently severe LVOTO at baseline (n = 8, 10%) had a significantly increased risk of postpartum intervention, those with transiently severe LVOTO during pregnancy did not. CONCLUSIONS: Pregnancy causes an increase in LVOT gradients but no significant disease progression warranting either antenatal or postpartum intervention, except in patients who had severe LVOTO preconception. The development of pregnancy-specific echocardiographic thresholds for severity is a critical need to prevent misdiagnoses and optimise maternal outcomes.
Int J Cardiol
· 2026 May · PMID 41698549
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Transthyretin cardiac amyloidosis (ATTR-CM) is increasingly recognized as a treatable cause of heart failure, while heart failure with preserved ejection fraction (HFpEF) has become one of the most common and heterogeneo...Transthyretin cardiac amyloidosis (ATTR-CM) is increasingly recognized as a treatable cause of heart failure, while heart failure with preserved ejection fraction (HFpEF) has become one of the most common and heterogeneous heart failure syndromes worldwide. Growing evidence shows that a substantial proportion of patients diagnosed with HFpEF actually harbor unrecognized ATTR-CM. Missing this diagnosis may limit the effectiveness of HFpEF therapies and delay initiation of disease-modifying treatment. Screening studies consistently demonstrate that ATTR-CM represents an important subset of HFpEF, particularly in individuals with increased left ventricular wall thickness, elevated natriuretic peptides, or unexplained conduction abnormalities. Although HFpEF and ATTR-CM share significant clinical overlap, several reproducible red-flags such as discordance between electrocardiographic voltages and wall thickness, pseudo infarct patterns, carpal tunnel syndrome, progressive troponin elevation, and apical sparing on strain imaging provide important early diagnostic clues. These features, together with emerging scoring tools, help identify patients at increased risk. In addition, bone scintigraphy has transformed the diagnostic pathway by enabling noninvasive confirmation of ATTR-CM in the absence of monoclonal protein. As disease-modifying agents such as tafamidis, acoramidis, and vutrisiran become widely available, early recognition is increasingly essential. This review synthesizes epidemiologic data on the prevalence of ATTR-CM among HFpEF cohorts, highlights key diagnostic pitfalls, and outlines practical strategies to facilitate timely detection. The aim is to support clinicians managing HFpEF by proposing a pragmatic, red-flag based screening framework that reduces missed diagnoses and enables appropriate initiation of disease-modifying therapy.
Int J Cardiol
· 2026 May · PMID 41679654
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BACKGROUND: Marfan syndrome (MFS) is a multisystemic heritable thoracic aortic disease entity characterized by progressive aortic dilatation and life-threatening cardiovascular complications. Chronic inflammation and oxi...BACKGROUND: Marfan syndrome (MFS) is a multisystemic heritable thoracic aortic disease entity characterized by progressive aortic dilatation and life-threatening cardiovascular complications. Chronic inflammation and oxidative stress are increasingly recognized in its pathophysiology, and are important drivers of telomere shortening, a hallmark of biological aging. We hypothesized that adults with MFS have shorter telomere length (TL) compared to healthy controls. METHODS: Relative average leukocyte TL was measured in 59 adults with molecularly confirmed MFS (median age 38 years, 29 females) and 59 age- and sex-matched healthy controls. TL was determined by a singleplex qPCR assay. RESULTS: Patients with MFS had shorter TL compared to healthy controls (0.99 ± 0.19 vs. 1.07 ± 0.21, p = 0.033). In univariate analysis, we found that major adverse cardiovascular events (defined as aortic dissection, arrhythmia or heart failure) were associated with shorter TL (β = -0.168, 95%CI -0.291; -0.013, p = 0.008). No other clinical or genetic variables showed significant associations in either the raw or age- and sex-adjusted TL analyses. CONCLUSION: Adults with MFS have shorter leukocyte TL, and an association was found between shorter TL and severe cardiovascular events. These findings suggest a role for accelerated aging mechanisms in the pathophysiology of the disease.
Wang Z, Hu Y, He H
… +10 more, Tu J, Lu Z, Wang W, Huang H, Chen Z, Xu D, Wang Q, Ran Z, Zhang M, Shan G
Int J Cardiol
· 2026 May · PMID 41679653
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BACKGROUND: Systemic inflammation may influence cardiac electrophysiology, but evidence on phenotype-specific links with ECG-defined conduction disorders and atrial fibrillation (AF) in China is limited. METHODS: We perf...BACKGROUND: Systemic inflammation may influence cardiac electrophysiology, but evidence on phenotype-specific links with ECG-defined conduction disorders and atrial fibrillation (AF) in China is limited. METHODS: We performed a cross-sectional analysis of 10,303 adults in the China National Health Survey. Nine inflammatory markers (neutrophils, lymphocytes, monocytes, platelets, hsCRP, NLR, SII, SIRI and PIV; log-transformed and standardized) were related to ECG-defined right bundle branch block (RBBB), intraventricular conduction delay (IVCD), left bundle branch block (LBBB), left anterior fascicular block (LAFB), atrioventricular block (AVB) and AF. Associations were estimated with Firth-penalised logistic regression with multivariable adjustment and false discovery rate control. Incremental discrimination beyond covariates was assessed by 10-fold cross-validated area under the curve (AUC). RESULTS: LBBB showed the strongest pattern: lymphocytes were inversely associated (odds ratio [OR] 0.65, 95% CI 0.50-0.84), while neutrophils (OR 5.39, 4.05-7.29), SIRI (OR 4.24, 3.34-5.44), and SII (OR 6.93, 5.17-9.52) were positively associated. LAFB and AF displayed similar signals (LAFB: lymphocytes OR 0.68, 0.55-0.86; NLR OR 1.66, 1.34-2.05; AF: monocytes OR 2.30, 1.79-2.94; SIRI OR 2.42, 1.92-3.03). RBBB showed modest links (NLR OR 1.15, 1.03-1.27); IVCD and AVB were largely null. Composite indices improved discrimination beyond covariates: SIRI yielded ΔAUC +0.163 for LBBB (final AUC 0.923), +0.098 for AF, and +0.041 for LAFB; gains for RBBB/IVCD/AVB were negligible. Sex interactions were significant: neutrophil and SIRI effects were stronger in men with LBBB (P-interaction 0.032/0.038), while lymphocytes were more protective in women with AF (OR 0.51, 0.36-0.73; P-interaction 0.001). CONCLUSIONS: Systemic inflammation showed phenotype-specific associations with ECG-defined conduction disorders and atrial fibrillation. Low-cost composite indices-especially SIRI-substantially improved discrimination of prevalent LBBB, LAFB, and AF beyond clinical covariates; prospective studies are needed to clarify temporality, validate thresholds, and assess clinical utility.
Jiang J, Sun L, Hong Q
… +5 more, Zhang J, Chen X, Kang L, Leng X, Li H
Int J Cardiol
· 2026 May · PMID 41679652
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BACKGROUND: Primary mitral regurgitation (PMR) induces right ventricular (RV) pressure and volume overload, yet RV functional assessment remains challenging with conventional echocardiography due to its complex geometry....BACKGROUND: Primary mitral regurgitation (PMR) induces right ventricular (RV) pressure and volume overload, yet RV functional assessment remains challenging with conventional echocardiography due to its complex geometry. The value of four-dimensional automated right ventricular quantification (4D-RVQ) in PMR remains underexplored. METHODS AND RESULTS: In this prospective study, 141 participants (36 mild, 31 moderate, 35 severe PMR, and 39 controls) underwent comprehensive echocardiography, including 2D speckle-tracking and 4D-RVQ. The RV-pulmonary artery (PA) coupling index was derived as the ratio of RV free wall longitudinal strain (RVFWLS) to pulmonary artery systolic pressure (PASP). Both 2D and 4D RVFWLS and RV global longitudinal strain showed a significant progressive decline with increasing PMR severity (P < 0.001), outperforming conventional parameters like TAPSE. The RV-PA coupling index demonstrated the strongest correlation with RVEF (r = -0.631, P < 0.001). 4D-RVQ parameters showed good agreement with 2D-derived values. Notably, the 4D RV-PA coupling index exhibited superior discriminatory power for moderate-or-greater PMR (AUC: 0.893, 95% CI: 0.809-0.977), slightly outperforming the 2D index. Despite the preservation of LV ejection fraction even in severe PMR, RV dysfunction was apparent by the moderate stage. CONCLUSIONS: 4D-RVQ provides a comprehensive and sensitive assessment of RV function in PMR. RV strain parameters and the RV-PA coupling index are superior to conventional measures for detecting early RV dysfunction. Its integration into clinical practice can improve the detection of right heart function with significant PMR by directly quantifying the pathophysiological hallmark of RV-PA uncoupling.
Prati F, Biccirè FG, Mallus MT
… +4 more, Mastroianni F, Gatto L, Ferrari M, Arbustini E
Int J Cardiol
· 2026 May · PMID 41662913
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Coronary inflammation is now widely recognized as a key driver of atherosclerotic plaque initiation, progression, and destabilization. Histopathological studies and advanced imaging have demonstrated the central role of...Coronary inflammation is now widely recognized as a key driver of atherosclerotic plaque initiation, progression, and destabilization. Histopathological studies and advanced imaging have demonstrated the central role of local inflammation, including extensive macrophage infiltration, cytokine activation, and perivascular adipose tissue, in promoting plaque vulnerability and acute coronary syndromes. Among systemic biomarkers, high-sensitivity C-reactive protein remains the most widely used, although its limited specificity underscores the need for more targeted inflammatory markers such as interleukin-6. Invasive intracoronary imaging with optical coherence tomography can visualize macrophage accumulation and quantify local inflammatory burden. Hybrid molecular imaging with OCT-NIRF, novel PET tracers and peri-coronary adipose tissue attenuation can provide emerging opportunities to further characterize vascular inflammation and residual risk. Anti-inflammatory therapies represent a major opportunity to improve outcomes beyond lipid lowering. Among patients with coronary artery disease, the use of colchicine has demonstrated significant risk reduction in adverse events, though with mixed results. Important randomized trials are underway to investigate the efficacy of novel monoclonal antibodies targeting interleukin pathways. In addition, GLP-1 receptor agonists, SGLT2 inhibitors, and PCSK9 inhibitors have been described to exhibit favourable vascular anti-inflammatory effects in experimental and in-vivo studies. In this comprehensive review, we provide an updated reappraisal of the available evidence unravelling how accurate identification of high-risk patients through multimodal imaging and biomarker profiling, combined with selective anti-inflammatory therapy, can represent a promising strategy for further reducing residual cardiovascular risk.
Cai ML, Shi WX, Li J
… +6 more, Li T, Zhang W, Lin CB, Wang XY, Huang YT, Qing XM
Int J Cardiol
· 2026 May · PMID 41662912
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BACKGROUND: Exercise-based cardiac rehabilitation (ExCR) is standard for secondary prevention in coronary artery disease (CAD), yet its efficacy in patients with heart failure with mildly reduced ejection fraction (HFmrE...BACKGROUND: Exercise-based cardiac rehabilitation (ExCR) is standard for secondary prevention in coronary artery disease (CAD), yet its efficacy in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after percutaneous coronary intervention (PCI) remains unclear. METHODS: In this single-center RCT, 120 stable CAD patients with HFmrEF (LVEF 40-49%) post-PCI were randomized 1:1 to receive either guideline-directed medical therapy (GDMT) plus a 52-week structured ExCR program (intervention) or GDMT alone (control). Primary outcomes-LDL-C, TG, LVEF, and LVEDD-were assessed at 4, 12, 24, and 52 weeks. Linear Mixed Models analyzed longitudinal intervention effects. RESULTS: A significant Group × Time interaction was observed for LVEF (p = .032), indicating superior recovery in the ExCR group. At 52 weeks, the ExCR group showed greater improvement in LVEF (+5.0% vs. +4.0%, p = .023) and greater reduction in LDL-C (-1.43 mmol/L vs. -1.04 mmol/L, p = .030) versus control. No between-group differences were found in TG or LVEDD. CONCLUSIONS: A 52-week structured ExCR program significantly enhances cardiac recovery and lipid control in HFmrEF patients post-PCI, providing incremental benefits beyond GDMT alone. Sustained ExCR should be considered essential in comprehensive management for this population.