Hou W, Ren W, Shao Z
… +7 more, Zhang S, Luo J, Wang X, Fan Z, Xu J, Sun R, Hu B
Int J Cardiol
· 2026 Oct · PMID 42314850
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BACKGROUND: Management of high-risk pulmonary embolism (HRPE) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is challenging, with limited evidence guiding optimal reperfusion strategies. This study...BACKGROUND: Management of high-risk pulmonary embolism (HRPE) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is challenging, with limited evidence guiding optimal reperfusion strategies. This study evaluated the association between different reperfusion approaches, including catheter-based embolectomy, and clinical outcomes in HRPE patients supported with VA-ECMO. METHODS: A multicenter retrospective cohort study included HRPE patients from six ICUs between January 2020 and August 2023. Patients on VA-ECMO were categorized into three groups: ECMO alone, ECMO with systemic thrombolysis, and ECMO with pulmonary artery catheter-based embolectomy. Patients managed without ECMO served as controls. The primary endpoint was 60-day all-cause mortality. RESULTS: Among 89 patients, 64 (71.9%) received VA-ECMO. Within this group, 35 (54.7%) were managed with ECMO alone, 18 (28.1%) with ECMO + thrombolysis, and 11 (17.2%) with ECMO + embolectomy. The observed 60-day mortality rates were 60.0% in non-ECMO, 42.9% in ECMO-alone, 61.1% in ECMO + thrombolysis, and significantly lower at 9.1% in ECMO + embolectomy. Multivariate Cox analysis identified renal replacement therapy (HR 2.87, P = 0.024), baseline serum lactate (HR 1.053 per mmol/L, P = 0.045), and reperfusion strategy (ECMO + embolectomy vs. others; HR 10.3, P = 0.041) as independent predictors of mortality. CONCLUSION: In HRPE patients supported with VA-ECMO, catheter-based embolectomy was associated with markedly improved 60-day survival compared to ECMO alone or with thrombolysis, suggesting a potential benefit of this intervention despite limited sample size.
Emori H, Shiono Y, Yamanobe H
… +8 more, Kawai S, Takamatsu M, Honda Y, Yamamoto K, Kuriyama N, Nishihira K, Shibata Y, Tanaka A
Int J Cardiol
· 2026 Oct · PMID 42314849
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BACKGROUND: Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are established plaque-modifying strategies for heavily calcified coronary lesions. Despite their different mechanisms, the incidence of signifi...BACKGROUND: Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are established plaque-modifying strategies for heavily calcified coronary lesions. Despite their different mechanisms, the incidence of significant periprocedural myocardial injury (PMI) and its clinical implications remain inadequately studied. This study compared the incidence of significant PMI and clinical outcomes following PCI with IVL versus RA. METHODS: We retrospectively analyzed 422 lesions (RA: 332; IVL: 90) in 398 patients who underwent PCI for moderately or severely calcified lesions between November 2019 and June 2024. High-sensitivity cardiac troponin (hs-cTn) was systematically measured after PCI. Significant PMI was defined according to the Academic Research Consortium-2 (ARC-2) criteria as post-PCI hs-cTn ≥70× the upper reference limit. The two-year incidence of target lesion failure (TLF)-a composite of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization-was assessed. RESULTS: Significant PMI (hs-cTn ≥70× URL) occurred in 25% of RA-treated lesions and 18% of IVL-treated lesions (P = 0.15). Median peak hs-cTn levels were higher after RA than after IVL (27.6 [10.7-70.9] vs. 17.7 [6.3-51.2] × URL; P = 0.024), but the difference was not significant after propensity score matching (21.3 [9.1-59.7] vs. 17.7 [6.3-51.2] × URL; P = 0.35). The two-year incidence of TLF was also similar between the two groups (RA: 9% vs. IVL: 11%; adjusted hazard ratio: 1.82; 95% CI 0.76-4.37; P = 0.17). CONCLUSION: Significant PMI was frequently observed after PCI for heavily calcified lesions treated with either IVL or RA, and the two-year TLF rates did not significantly differ between the two methods.
Yokouchi-Konishi T, Aoki-Kamiya C, Tsuritani M
… +13 more, Ishihara Y, Miyashita Y, Asano Y, Yagyu T, Matsuda H, Morisaki H, Temukai M, Sawada M, Kakigano A, Iwanaga N, Kanagawa T, Neki R, Yoshimatsu J
Int J Cardiol
· 2026 Oct · PMID 42314848
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BACKGROUND: Pregnancy in women with Marfan syndrome (MFS) increases the risk of aortic dissection, yet management based solely on aortic root diameter often fails to predict this complication, particularly Stanford type...BACKGROUND: Pregnancy in women with Marfan syndrome (MFS) increases the risk of aortic dissection, yet management based solely on aortic root diameter often fails to predict this complication, particularly Stanford type B dissection. Haploinsufficient (HI) FBN1 variants are associated with more severe aortic phenotypes. We investigated the relationship between FBN1 genotype and pregnancy-related aortic dissection in women with MFS. METHODS: We retrospectively analyzed women with genetically confirmed MFS whose pregnancies progressed beyond the second trimester and who were managed at a single tertiary referral center between 1993 and 2024. FBN1 variants were categorized as HI or non-HI. Pregnancy-related aortic dissection-defined as occurring during pregnancy or within six months postpartum-was evaluated in relation to variant type. RESULTS: Thirty-five women (15 HI, 20 non-HI) were included. Pregnancy-related aortic dissection occurred in 11 women: seven were referred after the dissection occurred and nine were Stanford type B. The incidence was higher in the HI group than in the non-HI group (9/15 [60%] vs 2/20 [10%], P = 0.002). Pre-pregnancy native aortic root diameters did not differ between those with and without dissection. Additional risk factors included undiagnosed with MFS at the time of dissection and absence of β-blocker therapy. CONCLUSIONS: HI FBN1 variants were associated with pregnancy-related aortic dissection in this cohort. Stanford type B dissection may occur even with mild aortic dilation, highlighting the limitations of diameter-based risk stratification. Incorporating FBN1 genotype into preconception counseling and pregnancy management may improve maternal outcomes. However, given the retrospective single-center design, prospective validation is warranted.
Alonso Gómez AM, Goicolea-Güemez L, Romaguera D
… +9 more, Toledo E, Tojal-Sierra L, López Rodriguez L, Ramallal R, Gonzalez-Casanova I, Zaldua-Irastorza O, Salas-Salvadó J, Fitó M, Alonso A
Int J Cardiol
· 2026 Oct · PMID 42314846
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BACKGROUND: Information on the natural history of left atrial (LA) echocardiographic parameters in patients with metabolic syndrome (MS) and obesity is limited. We investigated the association between glycemic status and...BACKGROUND: Information on the natural history of left atrial (LA) echocardiographic parameters in patients with metabolic syndrome (MS) and obesity is limited. We investigated the association between glycemic status and markers of LA structure and function. METHODS: Longitudinal, prospective, multicenter study in patients with MS and a body mass index ≥27 and < 40 kg/m, without cardiovascular disease. A central echocardiography laboratory evaluated LA echocardiographic parameters at baseline and at 3 and 5 years of follow-up. At baseline, glycemic status was categorized as normoglycemia, prediabetes, or diabetes according to established criteria. The association between glycemic status and LA structure and function was estimated using multiple regression models adjusted for potential confounders. RESULTS: We analyzed 553 participants (mean age 65 ± 5 years; 40% women) with normoglycemia (n = 68), prediabetes (n = 287), or diabetes (n = 198). Compared with baseline, at 5 years the LA volume index increased (22.9 ± 7 to 27.1 ± 8.9, p < 0.0001), LA reservoir strain decreased (27.8 ± 6.5 to 23.3 ± 6.6, p < 0.0001), LA stiffness index increased (0.35 ± 0.17 to 0.41 ± 0.26, p < 0.0001), LA function index decreased (67.3 ± 29.2 to 55.8 ± 24.3, p < 0.0001), and the left atrioventricular coupling index increased (21.7 ± 10.5 to 32.2 ± 20.3, p < 0.0001). No association was found between glycemic status and LA echocardiographic parameters of atrial function. CONCLUSIONS: In a population with MS and obesity but free of cardiovascular disease, glycemic status was not strongly associated with longitudinal changes in echocardiographic markers of LA structure or function. In all three groups, echocardiographic parameters worsened significantly during follow-up.
Jürgens F, Schindhelm F, Abusharekh M
… +7 more, Brandts CMK, Kampf J, Totzeck M, Al-Rashid F, Lüdike P, Rassaf T, Mahabadi AA
Int J Cardiol
· 2026 Oct · PMID 42314845
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BACKGROUND: Multiple grasping attempts are routinely required during mitral valve transcatheter-edge-to-edge repairs (M-TEER) to achieve optimal leaflet capture and minimize mitral regurgitation (MR). Whether extensive g...BACKGROUND: Multiple grasping attempts are routinely required during mitral valve transcatheter-edge-to-edge repairs (M-TEER) to achieve optimal leaflet capture and minimize mitral regurgitation (MR). Whether extensive grasping adversely affects procedural outcomes remains unknown. AIMS: We aimed to evaluate safety, procedural characteristics and durability of MR reduction in M-TEER procedures with low vs. high number of grasping attempts using the PASCAL system. METHODS: Consecutive patients with severe MR who underwent M-TEER using the PASCAL system between 2019 and 2024 at our center were analyzed. Procedures were stratified according to grasping attempts: ≤7 (≤80th percentile, median 4 [2;5]) vs. ≥8 (>80th percentile, median 10 [9;12], max. 22). Baseline, procedural, short- and latest outcomes, were compared between groups. RESULTS: Overall, 391 M-TEER procedures (mean age 77.7 ± 10.1 years, 57.5% male) were included. No single leaflet device attachment, leaflet injury or other device-related complication occurred in either group. Procedures with ≥8 attempts were longer (126 ± 47.6 min vs. 82.9 ± 43.3 min; p < 0.001) and associated with larger baseline EROA (0.48 [0.38;0.70] vs. 0.40 [0.30;0.50] cm; p = 0.0001). Improvement in MR severity from baseline to discharge (p = 0.116) and sustainability of MR reduction at latest follow-up (median 434 [176;699] days; p = 0.082) were comparable between groups. NYHA functional class improvement (p = 0.99 at 90 days; p = 0.78 at latest follow-up) and all-cause mortality (7.3% vs. 6.5%; p = 1.00) were also similar. CONCLUSION: Multiple grasping during M-TEER using the PASCAL system is safe and results in sustained MR reduction, high procedural success and latest outcomes comparable to procedures requiring fewer attempts.
Cui L, Zhao J, Gao Y
… +16 more, Chen Y, Guo J, Zhao R, Ma X, Dong F, Chen J, Wang Y, Li L, Chen T, Xing L, Yu H, Hou J, Dai J, Fang C, Mintz GS, Yu B
Int J Cardiol
· 2026 Oct · PMID 42309490
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BACKGROUND: This study aimed to investigate plaque characteristics and long-term outcomes associated with long non-culprit lesions (NCLs) in patients with acute myocardial infarction (AMI). METHODS: A total of 1278 AMI p...BACKGROUND: This study aimed to investigate plaque characteristics and long-term outcomes associated with long non-culprit lesions (NCLs) in patients with acute myocardial infarction (AMI). METHODS: A total of 1278 AMI patients undergoing three-vessel optical coherence tomography (OCT) were retrospectively enrolled, and 5131 NCLs were identified. A long lesion was defined as an OCT lesion ≥20 mm in length. Patients were followed for up to 5 years, and NCL-related major adverse cardiovascular events (NCL-MACE) were recorded. RESULTS: Both at the patient and lesion level, long NCLs were more stenotic and had more frequent thin-cap fibroatheroma (TCFA) and other vulnerable plaque features than short NCLs (all P < 0.001). During a median follow-up of 4.1 years, patients with ≥1 long NCL had a significantly higher incidence of NCL-MACE than patients without long NCL (7.3% vs. 2.9%, adjusted HR: 2.26, 95%CI: 1.19-4.29). Similar findings were identified when patients were grouped by angiographic lesion length. In the lesion-level analysis, OCT-detected long NCLs remained significantly associated with NCL-MACE after adjustment for TCFA (adjusted HR: 1.97, 95%CI: 1.11-3.52), whereas angiography-detected long NCLs showed no prognostic value. Notably, OCT-detected long TCFA had highest lesion-specific risk (5.4% vs. 1.1%, adjusted HR: 3.69, 95%CI: 1.87-7.27), whereas risk of OCT-detected short TCFA was comparable to that of non-TCFA (1.1% vs. 1.1%, P = 0.986). CONCLUSIONS: Long NCLs were indicative of higher levels of pancoronary plaque vulnerability, irrespective of detection via OCT or angiography. Importantly, OCT-detected long NCLs, especially long TCFA, offered significant predictive value for 5-year adverse events. However, angiography-detected long NCLs lacked prognostic significance.
Russo V, Comune A, Di Nardo G
… +10 more, Parente E, Di Marco GM, De Nigris A, Celardo N, Rago A, Papa AA, Sarubbi B, Russo MG, Brignole M, Nigro G
Int J Cardiol
· 2026 Oct · PMID 42309489
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BACKGROUND: The shortened protocol of Nitroglycerin (NTG)-potentiated head-up tilt testing (HUTT), the so-called "fast Italian protocol," has been shown to significantly reduce test duration while maintaining diagnostic...BACKGROUND: The shortened protocol of Nitroglycerin (NTG)-potentiated head-up tilt testing (HUTT), the so-called "fast Italian protocol," has been shown to significantly reduce test duration while maintaining diagnostic yield and safety in adults with suspected reflex syncope. To date, no data is available in paediatric patients. Aim of the study was to compare the positivity rate of the Fast protocol with that of the Traditional protocol in children and adolescents. METHODS: We retrospectively analyzed 302 consecutive paediatric patients (mean age 14.4 ± 2.8 years; 46.7% male) who underwent HUTT for suspected reflex syncope at two paediatric syncope units. Patients were evaluated using either a traditional NTG-potentiated protocol (n = 149) or the Fast Italian protocol (n = 153), characterized by shorter passive and active phases. Haemodynamic responses were classified according to the VASIS classification. RESULTS: HUTT was positive in 81.2% of patients undergoing the traditional protocol and in 73.2% of those undergoing the Fast protocol, with no significant difference between groups (p = 0.1). Compared with the Traditional, in the Fast protocol the positivity was lower during the passive phase (7.8% vs. 36.2%; p < 0.001) but higher during the NTG-potentiated phase (65.4% vs. 45%; p < 0.001). The overall distribution of haemodynamic response types was similar between protocols, with mixed responses being the most frequent, followed by cardioinhibitory and vasodepressive patterns. CONCLUSIONS: In paediatric patients with suspected reflex syncope, the Fast Italian HUTT provides a diagnostic yield comparable to that of the traditional nitroglycerin-potentiated protocol. Shortening the protocol does not significantly affect the distribution of haemodynamic response types.
Vadalà G, Mashayekhi K, Madaudo C
… +25 more, Behnes M, Ayoub M, Gorgulu S, Werner GS, Kalay N, Avran A, Goktekin O, Garbo R, Jaroslaw W, Zaczkiewicz M, Arnez J, Pyxaras S, Christiansen EH, Gutiérrez-Chico JL, Boudou N, Stojkovic S, Gasparini GL, Agostoni P, Diletti R, di Mario C, Maniscalco L, Bulum J, Cenko E, Galassi AR, EURO CTO investigators
Int J Cardiol
· 2026 Oct · PMID 42309488
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BACKGROUND: National income level influences the prevalence and outcomes of cardiovascular disease (CVD), with lower-income countries contributing disproportionately to the global CVD burden. Chronic total occlusion (CTO...BACKGROUND: National income level influences the prevalence and outcomes of cardiovascular disease (CVD), with lower-income countries contributing disproportionately to the global CVD burden. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) requires specialised equipment, increasing procedural costs. However, whether national income level contributes to disparities in managing patients with CTO remains unclear. OBJECTIVE: To compare the clinical profiles, procedural settings and outcomes of patients undergoing CTO-PCI in middle-income countries (MICs) and high-income countries (HICs). METHODS: This cross-sectional study included 15,329 patients who underwent CTO-PCI between 2021 and 2023. Data were obtained from the European Registry of Chronic Total Occlusions (ERCTO). Of the 24 enrolling countries, 7 were classified as MICs and 14 as HICs. RESULTS: Patients in HICs were older (67 ± 10 vs 61 ± 10 years; p < 0.001) and presented with greater CTO complexity (J-CTO score: 2.31 ± 1.25 vs 1.99 ± 1.17; p < 0.001). Conversely, patients in MICs were more likely to have diabetes (35% vs 29%; p < 0.001) and to be active smokers (59% vs 49%; p < 0.001). Patients in MICs had lower use of mechanical cardiac support (0.1% vs 0.8%; p < 0.001), advanced calcific plaque modification devices (1% vs 6.1%; p < 0.001), and intravascular ultrasound (14% vs 25%; p < 0.001). MICs achieved higher procedural success (89.5% vs 90.5%; p = 0.07) but higher mortality compared to HICs (0.6% vs 0.2%; p < 0.001). CONCLUSION: Among a selected population of patients undergoing CTO-PCI, notable clinical, anatomical, and procedural differences exist between MICs and HICs. These findings highlight the importance of tailoring public health strategies to optimise cardiovascular care across diverse economic settings.
Meems LMG, Milani P, Ohlmeier C
… +9 more, Evers T, Ciaccia A, Häckl D, Obermüller D, Vivirito A, Coleman CI, de Sanmamed Girón MF, Cipriani A, Azevedo O
Int J Cardiol
· 2026 Oct · PMID 42309487
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BACKGROUND: In patients with transthyretin amyloid cardiomyopathy (ATTR-CM), amyloid can be deposited in the peripheral nerves, causing polyneuropathy (PN). We evaluated the rate of incident PN diagnosis among ATTR-CM pa...BACKGROUND: In patients with transthyretin amyloid cardiomyopathy (ATTR-CM), amyloid can be deposited in the peripheral nerves, causing polyneuropathy (PN). We evaluated the rate of incident PN diagnosis among ATTR-CM patients. METHODS: This study utilized German claims data from January 2016-December 2023. We included adults newly diagnosed with ATTR-CM without a prior history of PN based upon International Classification of Diseases-Tenth Revision-German Modification (ICD-10-GM) diagnosis codes and coding for diagnostic testing. We identified incident PN using both a narrow (ATTR-PN-related) and broad (also including non-ATTR-specific polyneuropathies) set of ICD-10-GM codes. Incidence rates/100 person-years (PYs) with 95% confidence intervals (CIs) were calculated. RESULTS: We identified 309 newly diagnosed patients with ATTR-CM free of PN. During a median follow-up of 430 days (Q1 = 175, Q3 = 936) the rate of broadly defined incident PN was 10.8 cases/100PYs (7.9-14.3), declining to 2.4 cases/100PYs (1.2-4.1) when the narrow ATTR-related PN definition was used. CONCLUSIONS: In German routine care, the incidence of ATTR-related PN in patients with ATTR-CM was 2.4/100PYs, rising to 10.8/100PYs under a broad symptom-based definition. Although ATTR-related PN was infrequently identified in ATTR-CM, PN and ATTR-CM may coincide.
Kang DO, Kim W, van Assen M
… +8 more, De Cecco CN, Her AY, Kim D, Choi KH, Song YB, Nam CW, Shin ES, Kim S
Int J Cardiol
· 2026 Oct · PMID 42288220
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BACKGROUND: Medina 0.0.1 bifurcation lesions show high target lesion failure (TLF) after drug-eluting stent (DES) percutaneous coronary intervention (PCI), highlighting an unmet need for alternative treatment strategies....BACKGROUND: Medina 0.0.1 bifurcation lesions show high target lesion failure (TLF) after drug-eluting stent (DES) percutaneous coronary intervention (PCI), highlighting an unmet need for alternative treatment strategies. METHODS AND RESULTS: We analyzed 101 patients with Medina 0.0.1 lesions treated with DCB-based PCI from the REAL-DCB registry and 95 DES-treated controls from the COBIS III registry. Primary endpoint was 2-year target lesion failure (TLF): cardiac death, target-vessel myocardial infarction, and clinically-driven target-lesion revascularization (TLR). Inverse probability of treatment weighting (IPTW) was applied to account for inter-group imbalance. DCB group, albeit slightly younger, had more complex risk profile compared to DES group. DCB-based PCI enabled one-device strategy in 96.0% of cases, requiring significantly fewer devices and shorter device lengths than DES-only PCI, in which 52.6% of lesions were treated with a two-stent strategy. Two-year TLF was lower with DCB than with DES (2.2% vs. 12.1%), and this difference remained significant after IPTW adjustment (IPTW-HR: 0.10; 95% CI: 0.02-0.46; P = 0.003), mainly due to lower TLR (IPTW-HR: 0.13; 95% CI: 0.03-0.59; P = 0.009). Target-vessel revascularization was also less frequent with DCB (IPTW-HR: 0.10; 95% CI: 0.02-0.48; P = 0.004). No target-lesion thrombosis occurred in DCB group, whereas one stent thrombosis was reported in DES group. Between-group difference was driven predominantly by TLR, whereas hard ischemic events were infrequent in both groups. CONCLUSIONS: In Medina 0.0.1 lesions, DCB-based PCI strategy was associated with lower TLF than DES-only PCI while enabling a simplified device-sparing approach. Given the observational design and limited event count, these findings should be considered hypothesis-generating.
Lipps KM, Hillerson D, Dahiya G
… +4 more, Kashani K, Ternus B, Bennett C, Jentzer JC
Int J Cardiol
· 2026 Oct · PMID 42288219
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BACKGROUND: Acute kidney injury (AKI) is prevalent in the cardiac intensive care unit (CICU) population. We evaluated the association between transthoracic echocardiogram (TTE)-derived hemodynamics and AKI among CICU pat...BACKGROUND: Acute kidney injury (AKI) is prevalent in the cardiac intensive care unit (CICU) population. We evaluated the association between transthoracic echocardiogram (TTE)-derived hemodynamics and AKI among CICU patients. METHODS: We included adults admitted to an academic CICU from 2007 to 2018 who had a consultative TTE within 24 h. De novo AKI was defined by modified Kidney Disease: Improving Global Outcomes criteria using serum creatinine. Pressure-adjusted heart rate (PAHR), in beats per minute (BPM), was defined as (right atrial pressure ÷ mean arterial pressure) × heart rate. The primary outcome was the association between TTE hemodynamics and AKI incidence, and the secondary outcome was the association between AKI and mortality. RESULTS: Among 7027 patients, AKI occurred in 2157 (30.7%), of whom 585 (8.3%) had moderate/severe AKI. More severe AKI was associated with worse left ventricular, right ventricular (RV), and biventricular function (all P < 0.001). TTE markers of RV function demonstrated greater discrimination for moderate/severe AKI compared to left-sided indices. Among TTE variables, PAHR ≥7.5 BPM provided the highest discrimination and identified a higher-risk hemodynamic phenotype for moderate/severe AKI (13.1% for PAHR ≥7.5 BPM vs. 3.8% for PAHR <7.5 BPM, P < 0.001). More severe AKI was associated with higher in-hospital and one-year mortality (both P < 0.001). CONCLUSIONS: Among CICU patients, moderate/severe AKI was associated with biventricular systolic dysfunction and congestion as assessed by TTE. PAHR demonstrated the greatest discrimination among TTE variables and identified a higher-risk hemodynamic phenotype for moderate/severe AKI. TTE measurements may facilitate early identification of patients at risk of AKI.
Maffeis C, Rossi A, Tafciu E
… +7 more, Rizzo S, De Gaspari M, Giambruno V, Di Nicola V, Luciani GB, Basso C, Ribichini FL
Int J Cardiol
· 2026 Oct · PMID 42276257
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BACKGROUND: In primary mitral regurgitation (MR) atrial dysfunction is believed to be the result of atrial interstitial fibrotic replacement, and left atrial (LA) strain has been suggested as a non-invasive tool to ident...BACKGROUND: In primary mitral regurgitation (MR) atrial dysfunction is believed to be the result of atrial interstitial fibrotic replacement, and left atrial (LA) strain has been suggested as a non-invasive tool to identify a maladaptive atrial remodelling beyond LA enlargement. We aim to investigate the association between LA function and the extent of interstitial fibrosis within the atrial wall in patients undergoing surgery, and their relation with MR characteristics and clinical profiles. METHODS: 49 consecutive patients (61 ± 10 years, men 75%) with severe primary MR due to prolapse or flail were enrolled the day before surgery and a complete echocardiographic examination with LA strain analysis was performed. During surgery, a single-site full-thickness sample of the LA free wall was obtained from each patient. RESULTS: Areas of interstitial fibrosis were detected in all atrial specimens (median degree 6.5% [4.75-9.25]). No correlation was found between fibrosis degree and echocardiographic parameters like LA strain, LA volume, quantitative parameters of MR degree, regurgitant jet direction, estimated pulmonary artery pressure (sPAP), or clinical parameters like NYHA class or NTproBNP. However, lower LA reservoir and contractile strain values were associated with higher sPAP (p = 0.002 and p = 0.01, respectively), NTproBNP values (p < 0.0001) and symptoms severity (p < 0.05). CONCLUSIONS: In this selected cohort with severe primary MR and relatively low single-site histological LA fibrosis, LA strain was associated with markers of haemodynamic burden but not with biopsy-derived fibrosis percentage.
Di Serafino L, Ciaramella L, De Rosa S
… +9 more, Torella D, Leo I, Colaiori I, Bernardi M, Loffredo FS, Vitale G, Cirillo P, Versaci F, Esposito G
Int J Cardiol
· 2026 Oct · PMID 42276256
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INTRODUCTION: Residual coronary microvascular dysfunction (CMD) is common after STEMI despite successful primary PCI and may contribute to ongoing ischemia and impaired recovery. INaMICRON will test the hypothesis that e...INTRODUCTION: Residual coronary microvascular dysfunction (CMD) is common after STEMI despite successful primary PCI and may contribute to ongoing ischemia and impaired recovery. INaMICRON will test the hypothesis that early late I current inhibition with ranolazine, added to guideline-directed medical therapy, favorably modulates microvascular function during the early post-infarction phase. METHODS AND RESULTS: INaMICRON is a prospective, multicenter, randomized (1:1), open-label phase IIb trial enrolling adults with STEMI treated with successful primary PCI and at least one significant non-culprit lesion suitable for staged PCI. Participants will be randomized to standard therapy plus ranolazine (500 mg bid for 7 days, then 750 mg bid up to 42 ± 7 days) or standard therapy alone. Coronary microvascular function will be assessed using IMR and/or angioIMR in the culprit vessel after primary PCI (baseline) and during staged PCI (follow-up); non-culprit vessel physiology will also be assessed during the staged procedure. Complementary evaluations include peripheral endothelial function testing (EndoPAT), a single CMR at 42 ± 7 days, and paired blood sampling for translational multi-omics analyses. The planned sample size is 100 patients (50 per group), and analyses will compare between-group differences in physiology and related measures and explore predefined correlations. The study is designed to estimate the magnitude of microvascular modulation in the experimental group. CONCLUSIONS: This trial will provide feasibility data and an estimate of the magnitude of microvascular modulation achievable with early ranolazine after STEMI, informing the design of larger outcome-oriented studies and future precision approaches to post-MI care.
Int J Cardiol
· 2026 Oct · PMID 42276255
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BACKGROUND: Increased right ventricular filling pressures (RVFP) are associated with increased mortality risk in children with pulmonary arterial hypertension (PAH). We aimed to investigate the correlation of echocardiog...BACKGROUND: Increased right ventricular filling pressures (RVFP) are associated with increased mortality risk in children with pulmonary arterial hypertension (PAH). We aimed to investigate the correlation of echocardiographic diastolic parameters with invasive measurements of RVFP in pediatric PAH. METHODS: We retrospectively reviewed 95 patients and 48 controls from the Hospital for Sick Children in Toronto and Children's Hospital Colorado. RV filling pressures (RVFP) were considered elevated when RV end-diastolic pressures (RVEDP) ≥8 mmHg or mean right atrial pressure (mRAP) >8 mmHg from the catheter. Echocardiographic measurements included hepatic vein A-wave reversal (HVA) velocity and duration, the ratio between HVA and HV systolic velocity (HV A/S), indexed right atrial volume (RAVi), and RV and RA diastolic strains. Logistic regression and receiver operating characteristic curve analysis were used to investigate the predictive value of echo parameters for elevated RVFP. RESULTS: PAH patients had significantly elevated HVA velocity, duration and HV A/S, enlarged RAVi, and decreased RA and RV strains. HVA velocity had the highest area under the receiver operating characteristic curve (AUC) for diagnosing elevated RVFP [AUC = 0.788 (0.570-1), p = 0.021]. The model with HVA velocity significantly predicted elevated RVFP [Nagelkerke R = 0.339, B(SE) = 0.121 (0.06), odds ratio = 1.129 (1.003-1.27), p = 0.044)]. CONCLUSIONS: Of the echo parameters studied, HVA velocity was the best predictor of elevated RVFP in pediatric PAH. But in general, echocardiographic parameters were inadequate indicators of RVFP. Further prospective studies in a larger cohort are needed to determine the association between HV Doppler and changes in RVFP, and ultimately with clinical outcomes.
Dini FL, Carluccio E, Bakalli A
… +6 more, Acquaro M, Barletta V, Galeotti G, Bajraktari G, Ghio S, Henein MY
Int J Cardiol
· 2026 Oct · PMID 42269879
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BACKGROUND: Left ventricular (LV) reverse remodelling (LVRR) is a key therapeutic objective in heart failure (HF) with reduced ejection fraction (HFrEF), yet only a subset of patients exhibit meaningful recovery despite...BACKGROUND: Left ventricular (LV) reverse remodelling (LVRR) is a key therapeutic objective in heart failure (HF) with reduced ejection fraction (HFrEF), yet only a subset of patients exhibit meaningful recovery despite guideline-directed medical therapy (GDMT). End-systolic wall stress (ESWS) and global longitudinal strain (GLS) reflect complementary aspects of myocardial mechanics. This study evaluated whether their integrated assessment predicts LVRR, therapeutic responsiveness, and clinical outcomes. METHODS: A total of 196 consecutive HFrEF patients (LV ejection fraction < 40%) were prospectively enrolled and underwent clinical and echocardiographic evaluation at baseline and after 6.5 ± 2.0 months. LVRR was defined as an absolute increase in LV ejection fraction > 10% to ≥ 35% plus a ≥ 15% reduction in end-systolic volume. ESWS was calculated using a validated meridional formula integrating brachial systolic pressure, end-systolic internal diameter, and posterior wall thickness, and GLS was derived by speckle-tracking echocardiography. Predictors of LVRR were assessed using multivariable logistic regression and receiver-operating characteristic analysis. Patients were stratified into four phenotypes based on ESWS and GLS thresholds. RESULTS: LVRR occurred in 38% of patients. GLS and ESWS were independent predictors of LVRR (area under the curve 0.82 and 0.78, respectively), with optimal cut-offs of -12.1% and 160 kdyne/cm. Patients with low ESWS and preserved GLS showed the highest probability of LVRR, the greatest improvement in haemodynamic profile, and the lowest incidence of appropriate implantable cardioverter-defibrillator shocks. Conversely, high ESWS combined with impaired GLS identified patients with a low occurrence of LVRR, persistently elevated filling pressures, reduced LV efficiency, and the poorest survival. CONCLUSIONS: Integrated stress-strain phenotyping using ESWS and GLS improves prediction of LVRR, therapeutic responsiveness, and prognosis in HFrEF, and may help identify patients with limited recovery potential who warrant earlier evaluation for advanced HF therapies.
Lepre V, Moretto N, De Martino M
… +11 more, Collini V, Tomat M, Venturelli F, Cescon L, Agrimi CV, Puppato M, Pellegrin A, Zussino G, Zuliani L, Isola M, Imazio M
Int J Cardiol
· 2026 Oct · PMID 42263952
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BACKGROUND: Pericardial late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is typically interpreted as a marker of active pericardial inflammation. However, it may also be detected incidentally during...BACKGROUND: Pericardial late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is typically interpreted as a marker of active pericardial inflammation. However, it may also be detected incidentally during CMR performed for unrelated indications, and its clinical significance remains unclear. Whether incidental pericardial LGE reflects persistent subclinical inflammation associated with adverse long-term outcomes is unknown. METHODS: We conducted a retrospective single-center study including consecutive patients undergoing clinically indicated CMR. Patients with incidentally detected pericardial LGE were identified and compared with a control population without LGE. Clinical characteristics, CMR findings, and long-term outcomes were collected. The primary endpoint was the development of constrictive pericarditis (CP) during follow-up. RESULTS: Among 590 patients, incidental pericardial LGE was identified in 31 (5.3%), while 559 patients had no LGE. During a median follow-up of 72 months, CP occurred in 2 patients (6.5%) with LGE and in none of the patients without LGE (p = 0.003). Patients with LGE more frequently had a history of pericarditis and showed higher prevalence of pericardial effusion and increased pericardial thickness on CMR. CONCLUSIONS: Incidental pericardial LGE on CMR was associated with a history of prior pericardial and myocardial inflammation, and CP occurred only among patients with LGE during follow-up. However, these findings should be interpreted cautiously, as LGE may represent a surrogate marker of an underlying inflammatory pericardial substrate rather than an independent prognostic marker. Larger prospective studies are needed to determine whether incidental pericardial LGE provides prognostic information beyond clinical history.
Sudoso AM, Ciarpaglini L, Scuppa D
… +3 more, Trasatti E, Sciandrone M, Galiuto L
Int J Cardiol
· 2026 Oct · PMID 42263950
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BACKGROUND: Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, and their risk increases with age. Biological age reflects physiological decline more accurately than chronological age and may...BACKGROUND: Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, and their risk increases with age. Biological age reflects physiological decline more accurately than chronological age and may improve cardiovascular risk prediction. Recent advances in Artificial Intelligence (AI) have enabled estimation of biological age from electrocardiograms (ECGs), imaging, biomarkers, and omics data. However, the existing evidence on AI-derived biological age in cardiovascular medicine has not been comprehensively synthesized. METHODS: PubMed and Scopus were searched for studies published between 2019 and 2025. Eligible studies included original research applying AI or machine learning to estimate biological age or aging biomarkers in human participants and relating these estimates to cardiovascular outcomes. Data were extracted on study design, AI methods, input data sources, biological age metrics, cardiovascular endpoints, and validation strategies. Findings were synthesized narratively and organized by methodological approaches. RESULTS: AI-derived biological age, particularly ECG-predicted age, consistently provided prognostic information beyond chronological age. Deep learning models identified an age gap associated with increased risks of heart failure, atrial fibrillation and stroke. Retinal imaging-based biological age and biomarker-based machine learning models further supported the systemic nature of aging. Emerging approaches such as generative models offer insights into aging trajectories and lifestyle-linked aging phenotypes. Advances in interpretability using explainable AI highlighted ECG features that contribute most to aging predictions. CONCLUSIONS: AI-based estimation of biological age is a promising biomarker for cardiovascular risk assessment. Although evidence across modalities is consistent, further standardization, prospective validation, and improved interpretability are needed to support clinical implementation.
Deharo P, Gariboldi V, Marlinge M
… +17 more, Aliouane S, Guiol C, Fromonot J, Lledo S, Kipson N, Dodivers JS, El Oufir F, Paganelli C, Kasri M, Boudouresques V, Gaudry M, Collart F, Pastene B, Cuisset T, Mottola G, Guieu R, Paganelli F
Int J Cardiol
· 2026 Oct · PMID 42263949
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BACKGROUND: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are standard revascularization strategies for chronic coronary syndrome (CCS). However, their effects on myocardial reperfus...BACKGROUND: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are standard revascularization strategies for chronic coronary syndrome (CCS). However, their effects on myocardial reperfusion have not been assessed using biological markers. Adenosine A receptor (AR) function on peripheral blood mononuclear cells (PBMCs), evaluated through cAMP production and EC-measurement, may reflect myocardial ischemia and reperfusion status. OBJECTIVES: To compare the effects of CABG and PCI on AR pharmacological profiles assessed by cAMP-production (EC) values. METHODS: Ninety patients with severe coronary artery disease (33 CABG, 57 PCI) were prospectively included. Blood samples were collected before revascularization and 3 months later. PBMCs were incubated with a full AR agonist, and cAMP production was measured. RESULTS: Baseline EC values were similar between PCI and CABG groups (0.072 ± 0.02 vs 0.078 ± 0.02 μM, p = 0.2). EC significantly increased after PCI (+52%; 0.11 ± 0.04 μM, p < 0.001) and even more after CABG (+323%; 0.33 ± 0.08 μM, p < 0.0001). CONCLUSION: Both PCI and CABG were associated with an increase in mean EC50 values, suggesting improved myocardial reperfusion. The greater EC increase after CABG may indicate more complete restoration of coronary perfusion. AR functional assessment may represent a non-invasive promising biomarker for monitoring chronic myocardial ischemia and revascularization efficacy in CCS patients.