BACKGROUND: Commercially available NT-proBNP assays can underestimate concentration as the detecting antibody binds to NT-proBNP glycosylated epitopes, thereby underestimating the total NT-proBNP, impairing diagnostic an...BACKGROUND: Commercially available NT-proBNP assays can underestimate concentration as the detecting antibody binds to NT-proBNP glycosylated epitopes, thereby underestimating the total NT-proBNP, impairing diagnostic and prognostic performance in heart failure (HF) patients. OBJECTIVES: To explore glycosylatated and unglycosylatated, total NT-proBNP (tNT-proBNP) research-assay and associations with clinical characteristics and outcomes compared to NT-proBNP in HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction. METHODS: In HFpEF (LVEF≥45%, NT-proBNP≥300 pg/ml) and HFrEF (LVEF<40%) patients tNT-proBNP and NT-proBNP were measured, associations with clinical characteristics and composite outcomes assessed and prognostic accuracy compared. RESULTS: Patients with HFpEF (n = 83) vs. patients with HFrEF (n = 82), were older (73 vs. 63 years) and more often female (51% vs. 18%). tNT-proBNP and NT-proBNP were lower in HFpEF 3830(1990;6482) and 1055(466;2344)pg/ml vs. HFrEF 10,468(4667;21,007) and 3196(1423;6967)pg/ml, all p < 0.001. There was a strong association between tNT-proBNP and NT-proBNP (HFpEF;β = 0.762;p < 0.001, HFrEF β = 0.819;p < 0.001). NT-proBNP/tNT-proBNP was lower in HFpEF vs. HFrEF (0.27 vs. 0.32;p = 0.019). Higher tNT-proBNP was independently associated with outcome in both HFpEF (HR 1.77 [95% CI 1.08-2.88];p = 0.022) and HFrEF (HR 1.94 [95% CI 1.36-2.76];p < 0.001). In the overall cohort AUROC was higher for tNT-proBNP (0.710) vs. NT-proBNP (0.682;p = 0.068) with similar trends in HFpEF and HFrEF. CONCLUSION: This first report of tNT-proBNP by LVEF categories displays similar associations with clinical characteristics and outcomes in HFpEF and HFrEF. Proportion of glycosylated NT-proBNP was higher in HFpEF vs HFrEF. tNT-proBNP trended to have superior prognostic ability regardless of LVEF and may be a superior risk marker especially in HF populations with high prevalence of glucose perturbations. CLINICAL TRIAL REGISTRATION: ClinicalTrials.govNCT00774709https://clinicaltrials.gov.
Ishii Y, Watabe H, Usami K
… +5 more, Terauchi T, Yaguchi T, Hiraya D, Hoshi T, Ishizu T
Int J Cardiol
· 2026 Aug · PMID 42106075
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BACKGROUND: This study aimed to investigate the association between high-intensity plaque (HIP) on cardiac magnetic resonance (CMR) imaging and pericoronary adipose tissue attenuation (PCATA) and plaque burden on coronar...BACKGROUND: This study aimed to investigate the association between high-intensity plaque (HIP) on cardiac magnetic resonance (CMR) imaging and pericoronary adipose tissue attenuation (PCATA) and plaque burden on coronary computed tomography angiography (CCTA) in patients with chronic coronary syndrome (CCS). METHODS: We retrospectively analyzed 104 coronary lesions in 86 patients with CCS who underwent CMR imaging and CCTA before elective percutaneous coronary intervention. HIP was defined as a plaque-to-myocardium signal intensity ratio (PMR) of ≥1.4 on T1-weighted CMR imaging. The PCATA of the target lesion was assessed, and the mean value was used for the analysis. The plaque morphology and volume of the target lesion were assessed on CCTA based on attenuation values and stratified into calcified, fibrous, fibrous-fatty, and low-attenuation plaques (LAPs). RESULTS: Forty-five lesions were assigned to the HIP group (43%). The PCATA and LAP volume on CCTA were significantly higher in the HIP group than those in the non-HIP group (-69.3 Hounsfield units [HU] vs. -73.9 HU; p = 0.022; 27.4 mm vs. 7.2 mm; p < 0.001). PMR was correlated with both PCATA and LAP volume. On adjusted multiple regression analysis, PCATA ≥ -67 HU and LAP volume were associated with HIP. The prevalence of HIP on CMR was the highest in the high PCATA and high LAP volume group and the lowest in the low PCATA and low LAP volume group. CONCLUSIONS: HIP on CMR is associated with higher PCATA and larger LAP volume, linking coronary inflammation with plaque vulnerability.
Ledingham L, Conroy S, Kanwar K
… +5 more, Wood P, Cripe L, Gunsaulus M, Hor K, Mah ML
Int J Cardiol
· 2026 Aug · PMID 42106074
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BACKGROUND: Female Duchenne and Becker muscular dystrophy carriers (MDC) have heterozygous dystrophin mutations with an unclear disease phenotype. While cardiomyopathy is the leading cause of death in affected males, the...BACKGROUND: Female Duchenne and Becker muscular dystrophy carriers (MDC) have heterozygous dystrophin mutations with an unclear disease phenotype. While cardiomyopathy is the leading cause of death in affected males, the natural history of MDC is not known. We describe changes in ventricular volumes, function, and fibrosis by late‑gadolinium enhancement (LGE) using cardiac MRI (CMR) in a prospective cohort of MDC and non-carrier females. METHODS: 75 genetically-confirmed MDC and 22 non-carriers underwent CMR at three annual visits. RESULTS: Follow-up included 85 (65 MDC, 20 non-carriers) and 62 (46 MDC, 16 non-carriers) subjects who underwent CMR at visits 2 and 3, respectively. Mean ejection fraction and LV volumes remained within normal limits for both cohorts and did not show evidence of different slope of change. 36/75 MDC and 1/22 non-carriers had LGE at visit 1. In those with LGE positivity at visit 1, 13/28 progressed extent of LGE within 2 years. Non-progressors and progressors had similar characteristics of age, cardiac medications and LV function and volume. CONCLUSION: Longitudinal changes in cardiac volumes and function in MDC are similar to non-carrier controls. Subjects free of LGE at visit 1 remained free of LGE through the study period. In subjects with LGE positivity at first CMR, half progressed in LGE extent. Current CMR screening guidelines for MDC of 3-5 years appears appropriate for those without fibrosis and with normal LVEF and LV volumes. For those with fibrosis on imaging, surveillance intervals should be shorter based on findings of progression in a 2 year period.
Alarfaj M, Mohamad Alahmad MA, Wallisch WJ
… +4 more, Flynn BC, Rali AS, Tonna JE, Shah Z
Int J Cardiol
· 2026 Aug · PMID 42097309
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BACKGROUND: Despite advancements in management strategies, patients with refractory cardiogenic shock (CS) have high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized as temp...BACKGROUND: Despite advancements in management strategies, patients with refractory cardiogenic shock (CS) have high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized as temporary mechanical support in these patients. Current predictive models for mortality suffer from practical limitations, including complexity and the extensive variables required. OBJECTIVES: We aimed to develop a simplified, practical predictive model, the Extracorporeal Life Support Outcome score (ELSO-Score), using readily available pre-ECMO variables to predict in-hospital mortality among VA-ECMO patients. METHODS: This retrospective study utilized data from 8495 VA-ECMO patients collected by the Extracorporeal Life Support Organization (ELSO) registry between January 2017 and December 2022. We developed a simple neural predictive model, validated on training, validation, and test cohorts. RESULTS: The training cohort comprised 6029 analyzed cases, with an overall in-hospital mortality rate of 55.5%. Significant predictors of mortality were elevated lactate levels, age, bilirubinemia, acute kidney injury, and the requirement for renal replacement therapy at the time of ECMO cannulation. The predictive model demonstrated moderate discriminatory performance, achieving area under the ROC curve values of 0.70, 0.69, and 0.68, 95% CI [0.63-0.73], in the training, validation, and test cohorts, respectively. CONCLUSIONS: Our study demonstrates that the ELSO-Score may be a practical and effective predictive tool facilitating informed clinical decision-making and resource allocation for patients considered for VA-ECMO therapy.
Rattka M, Wernhart S, Laugwitz KL
… +3 more, Halle M, Foulkes SJ, Haykowsky MJ
Int J Cardiol
· 2026 Aug · PMID 42086112
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BACKGROUND: While moderate-intensity endurance exercise is recommended in patients with and without dilated aorta, little is known about aortic physiology during isometric and resistance exercise. METHODS: We analyzed 18...BACKGROUND: While moderate-intensity endurance exercise is recommended in patients with and without dilated aorta, little is known about aortic physiology during isometric and resistance exercise. METHODS: We analyzed 18 individuals with arrhythmogenic cardiomyopathy (ACM) without valvular or aortic pathology (mean age: 43 ± 9 years). Patients underwent computer tomography of the aorta and invasive exercise right heart catheterization during moderate intensity endurance, isometric and resistance exercise: Isometric handgrip (HG) and bicep curl (BC) were performed for one minute at 70% of maximal voluntary contraction and compared to continuous supine cycle exercise at the first ventilatory threshold for twenty minutes. Circumferential ascending aortic wall stress (AWS) was calculated during these three exercise modalities using the Laplace Law incorporating resting diameter and thickness of the ascending aorta as well as systolic blood pressure values obtained at rest and during exercise. RESULTS: The mean aortic diameter and thickness were 29 ± 5 mm and 1.7 ± 0.3 mm. Systolic and diastolic blood pressure, heart rate, and AWS all significantly increased from rest across the three exercise modes. No difference in AWS was found between exercise modes. Diastolic blood pressure during cycle exercise was significantly lower than during isometric HG. Also, heart rate during cycle exercise was significantly higher than during both BC and isometric HG exercises. CONCLUSION: All exercise modes resulted in a similar increase in AWS in ACM patients. Although these findings appear to be reassuring, the long-term implications of chronic exposure to moderate-intensity resistance exercise remain to be determined.
Pesce F, Dini CS, Righini FM
… +7 more, Stefanini A, Ghionzoli N, Maielli M, Maccherini M, Bernazzali S, Cameli M, Valente S
Int J Cardiol
· 2026 Aug · PMID 42082006
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BACKGROUND: Cardiogenic shock (CS) is a life-threatening syndrome with persistently high mortality rates despite therapeutic advances. Structured regional networks may offer improved outcomes through standardized care an...BACKGROUND: Cardiogenic shock (CS) is a life-threatening syndrome with persistently high mortality rates despite therapeutic advances. Structured regional networks may offer improved outcomes through standardized care and early advanced support.This study evaluates the impact of a structured regional cardiogenic shock network on in-hospital mortality and clinical outcomes. METHODS: We conducted a prospective observational study at the University Siena Hospital, enrolling CS patients (SCAI stage C-D-E) between September 2020 and November 2024. The study population was divided into patients directly admitted to the shock center (hub group) and those initially admitted to a referring network hospital (spoke group). RESULTS: We enrolled 145 consecutive patients with CS (mean age 61.0 ± 14.2 years; 81.4% male), predominantly due to acute coronary syndrome (46.9%) or acute on chronic heart failure (32.4%). The majority (61.4%) were transferred from referring network regional hospitals. Despite a high-risk profile (SCAI stage D + E in 48.3%, phenotype II + III in 62.1%), 73.5% of patients achieved a successful outcome, defined as hospital discharge or cardiac replacement therapy (23 heart transplants, 9 LVADs). The overall in-hospital mortality was 26.5%. Mortality increased with SCAI stage (p = 0.001) according to literature data. A vaso-inotropic score (VIS score) major than 21 at 48 h after admission was predictive of mortality (AUC = 0.722). CONCLUSIONS: In this observational study CS population presented low in-hospital mortality rate without any difference in hub and spoke group. It may be determined by the benefits of a structured regional network for CS and multidisciplinary approach management with early MCS implantation.
Lombardi M, Chiabrando JG, Occhipinti G
… +11 more, Elia E, Laudani C, Garibaldi S, Audo A, Maj G, Vergallo R, Porto I, Gonzalo N, Escaned J, Patti G, Secco GG
Int J Cardiol
· 2026 Aug · PMID 42082005
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BACKGROUND: The comparative effectiveness of angiography-guided versus imaging-guided PCI relative to coronary artery bypass grafting (CABG) in left main coronary artery (LMCA) disease remains uncertain. METHODS: We perf...BACKGROUND: The comparative effectiveness of angiography-guided versus imaging-guided PCI relative to coronary artery bypass grafting (CABG) in left main coronary artery (LMCA) disease remains uncertain. METHODS: We performed a network meta-analysis of randomized controlled trials (RCTs) including patients undergoing LMCA revascularization. Pooled incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were computed. Co-primary endpoints were major adverse cardiovascular events (MACE) by trial definition and all-cause death. Secondary endpoints included myocardial infarction (MI), stroke, target vessel revascularization (TVR), repeat revascularization, and stent thrombosis or graft occlusion. RESULTS: Seventeen RCTs encompassing 7700 patients (median follow-up 2 years) were included. Angiography-guided PCI was associated with a higher risk of MACE compared with both imaging-guided PCI (IRR 1.34, 95%CI 1.05-1.72) and CABG (IRR 1.49, 95%CI 1.10-2.03). Compared with imaging-guided PCI, neither CABG (IRR 1.00 95%CI 0.81-1.24) nor angiography-guided PCI (IRR 1.04, 95%CI 0.77-1.40) differed in all-cause death. CABG was associated with a lower risk of MI, TVR and repeat revascularization, but at the expense of an increased stent thrombosis or graft occlusion. Angiography-guided PCI was associated with higher risks of TVR compared with imaging-guided PCI and a lower risk of stroke compared to both CABG and imaging-guidance. CONCLUSIONS: In patients with LMCA disease, no significant differences in MACE were observed between imaging-guided PCI and CABG, whereas angiography-guided PCI was associated with a higher risk of MACE compared either with imaging-guided PCI and CABG. PCI, regardless of guidance, achieved all-cause death comparable to surgery. Imaging guidance reduced stent thrombosis or graft occlusion, whereas CABG reduced MI and repeat revascularization. PROSPERO registration number: CRD420261283126.
Yang X, Sun Y, Zhang N
… +3 more, Xu J, Geng B, Wang Y
Int J Cardiol
· 2026 Aug · PMID 42069007
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Real-time three-dimensional (3D) fusion of cardiac computed tomography (CT) with fluoroscopy may enhance procedural guidance in left atrial appendage closure (LAAC), yet comparative data with conventional planning system...Real-time three-dimensional (3D) fusion of cardiac computed tomography (CT) with fluoroscopy may enhance procedural guidance in left atrial appendage closure (LAAC), yet comparative data with conventional planning systems are limited METHODS: In this retrospective comparative study, 109 consecutive patients undergoing LAAC were assigned to guidance using either 3D CT-fluoroscopy fusion (n = 51) or the real-time operation guidance planning system (ROGPS, n = 58). Procedural efficiency, radiation exposure, contrast use, and clinical outcomes were analyzed RESULTS: The 3D fusion group demonstrated significant reductions in contrast volume (60.2 ± 15.0 mL vs. 75.3 ± 15.0 mL, p < 0.001), fluoroscopy time (8.0 ± 3.6 min vs. 10.2 ± 3.7 min, p = 0.002), and total procedure time (62.2 ± 12.0 min vs. 68.5 ± 11.2 min, p = 0.005). Radiation dose (DAP) was also lower in the fusion group (29.8 ± 20.8 Gy·cm vs. 42.2 ± 27.7 Gy·cm, p = 0.01). Procedural success was 100% in both groups. No statistically significant differences were observed in the rates of device-related thrombosis (DRT) or peri-device leakage (PDL) CONCLUSION: 3D CT-fluoroscopy fusion imaging significantly improves procedural efficiency in LAAC compared to ROGPS, reducing contrast use, radiation exposure, and procedure time without compromising safety.
Del Torto A, Ventura E, Cannata F
… +21 more, Celeste F, Fazzari F, Frappampina A, Fusini L, Ghulam Ali S, Gripari P, Junod D, Maltagliati A, Mantegazza V, Maragna R, Stankowski K, Tassetti L, Volpe A, Annoni A, Cosentino N, Muratori M, Mushtaq S, Baggiano A, Grazi M, Assanelli E, Pontone G
Int J Cardiol
· 2026 Aug · PMID 42069006
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BACKGROUND: Microvascular obstruction (MVO) is a major prognostic determinant in STEMI. While thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) aims to reduce distal embolization and MVO, i...BACKGROUND: Microvascular obstruction (MVO) is a major prognostic determinant in STEMI. While thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) aims to reduce distal embolization and MVO, its impact on long-term myocardial scar and remodeling remains debated. The present study aimed to evaluate the impact of clinically indicated TA on myocardial scar and MVO using cardiac magnetic resonance (CMR) at baseline and 12-month follow-up in STEMI patients treated with PCI. METHODS: In this single-center observational cohort study, consecutive STEMI patients treated with primary PCI ± TA who underwent CMR at baseline and at 12 months were enrolled. CMR parameters included left ventricular volumes, ejection fraction, global longitudinal strain, infarct size (late gadolinium enhancement) and MVO. RESULTS: Among 130 STEMI patients (84 PCI + TA, 46 PCI-alone) enrolled, the TA group had higher baseline thrombus burden (TIMI Thrombus Grade 5 [5;5] vs. 3 (Henriques et al., 2002; Byrne et al., 2023 [2, 5]), p < 0.001), higher MVO prevalence (44.6% vs. 25%, p = 0.03) and larger infarct size [late gadolinium enhancement LGE: 24.2% vs 17.5% of left ventricle (LV) myocardial mass, p = 0.001]. At follow-up CMR, PCI + TA group experienced a greater reduction in myocardial scar (-5.0% [-21.8; 1.4] vs. -3.28% [-17.9; 4.6], p < 0.05), particularly in patients with a high thrombus burden (Thrombus Grade > 3) and baseline MVO (-10.3% [-19.8; -2.5] vs. -3.7% [-9.5; 1.2], p < 0.05). CONCLUSIONS: Despite worse baseline clinical and imaging characteristics, STEMI patients treated with TA showed more favorable myocardial tissue recovery at 12 months. These findings suggest that TA may optimize conditions for scar consolidation, particularly in high-risk patients with heavy thrombus burden.
Ramos Cano P, Monteagudo Ruiz JM, Carrión Sanchez I
… +6 more, González Gómez A, García Martin A, Hinojar-Baydes R, Martínez-Vives P, Zamorano Gómez JL, Fernández Golfín-Lobán C
Int J Cardiol
· 2026 Aug · PMID 42061727
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BACKGROUND: Patients with significant aortic regurgitation (AR) not meeting current surgical criteria may develop heart failure with preserved ejection fraction (HFpEF). Left atrial reservoir strain (LASr) reflects atria...BACKGROUND: Patients with significant aortic regurgitation (AR) not meeting current surgical criteria may develop heart failure with preserved ejection fraction (HFpEF). Left atrial reservoir strain (LASr) reflects atrial-diastolic function and may provide prognostic information beyond conventional left ventricular (LV) metrics. METHODS: We retrospectively included 182 patients with significant AR and 182 age- and sex-matched controls who underwent transthoracic echocardiography between 2017 and 2023. LASr was quantified using automated vendor-independent software. The primary endpoint was all-cause mortality or HF hospitalization. Fine-Gray competing risk models adjusted for age, atrial fibrillation, LV ejection fraction, LV end-systolic diameter, and E/e' were used to evaluate the association of LASr with the primary endpoint. Patients were also grouped into four strata according to AR status and LASr threshold (≥40% vs <40%). RESULTS: Over a median follow-up of 38.5 months, the composite endpoint occurred in 52 AR patients (30.1%) and 30 controls (16.5%). LASr was lower in AR patients (31.6 ± 14.7% vs 35.9 ± 16.0%, p = 0.007). In AR patients, lower LASr independently predicted adverse outcomes (SHR 1.18 per 5% decrease, 95% CI 1.02-1.36, p = 0.025). In the full cohort, event rates were lowest in No-AR/LASr ≥40% (1.4%) and highest in AR/LASr <40% (36.9%; adjusted SHR 10.96, 95% CI 1.49-80.53, p = 0.019). CONCLUSIONS: Significant AR without guideline-based surgical criteria is associated with a high burden of HF events. LASr identifies an HFpEF phenotype in which atrial-diastolic dysfunction, rather than LV remodeling, is more strongly associated with clinical outcomes.
Gadelmawla AF, Taha AM, Alkuwaiti FA
… +12 more, Alkuwaiti MA, Alsubaiei AA, AlSejari NY, Alsultan AM, Abdul-Hafez HA, Awashra A, Diaa A, Hageen AW, Mohamed AE, Alharran AM, Andò G, Aronow WS
Int J Cardiol
· 2026 Aug · PMID 42055091
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BACKGROUND: Microvascular obstruction (MVO) frequently occurs after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and can be classified as transient...BACKGROUND: Microvascular obstruction (MVO) frequently occurs after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and can be classified as transient or persistent based on its resolution on follow-up cardiac magnetic resonance (CMR) imaging. This meta-analysis aims to compare the prognostic significance of persistent MVO versus transient MVO and no MVO in patients with STEMI undergoing primary PCI. METHODS: we conducted a systematic search for cohort studies comparing persistent MVO to transient MVO or no MVO in patients with STEMI who underwent primary PCI and CMR imaging. For the meta-analysis, we used R software (version 4.5.0) with RStudio. RESULTS: We included seven cohort studies with a total of 2180 patients. Compared to transient MVO, persistent MVO was associated with significantly higher risks of MACE and death. Persistent MVO also demonstrated significantly lower LVEF and larger infarct size, but no significant association with recurrent MI or heart failure readmission. Compared to no-MVO, persistent MVO showed even stronger associations with adverse outcomes: MACE, death, heart failure readmission, lower LVEF, and larger infarct size. CONCLUSION: Persistent MVO may be associated with worse clinical outcomes, adverse left ventricular remodeling, and larger infarct size compared to both transient MVO and no MVO. These findings support the role of follow-up CMR for risk stratification to identify high-risk population. However, the definition and timing of persistent MVO varied considerably across studies (1 week to 12 months), which introduce clinical heterogeneity highlighting the need for future studies with standardized definitions.
Kroll C, Hubert A, Saccardi L
… +5 more, Martínez Pereyra V, Seitz A, Sechtem U, Bekeredjian R, Ong P
Int J Cardiol
· 2026 Aug · PMID 42049126
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BACKGROUND: In patients with angina despite non-obstructive coronary arteries (ANOCA), coronary vasomotion disorders (CVD) are a common cause for their symptoms. Due to the heterogeneous clinical presentation resulting f...BACKGROUND: In patients with angina despite non-obstructive coronary arteries (ANOCA), coronary vasomotion disorders (CVD) are a common cause for their symptoms. Due to the heterogeneous clinical presentation resulting from a broad spectrum of endotypes, symptom management still remains a major challenge. We aimed to demonstrate that endotype-based pharmacotherapy can improve angina severity and quality of life (QoL) outcomes in these patients. METHODS: Between 04/2021-02/2022 we enrolled 50 ANOCA-patients (56% women, 63 ± 14 years) with confirmed diagnosis of CVD (coronary spasm: n = 30; microvascular vasodilatation disorder: n = 3; combined endotype: n = 17). All patients received an individual endotype-adapted antianginal pharmacotherapy. Efficacy and tolerability were closely monitored and adjusted during a 3-month follow-up period, accompanied by a symptom diary which served as a patient-reported outcome measure (PROM). QoL was assessed using the Seattle Angina Questionnaire-7 (SAQ7) monthly during the 3-month therapy adjustment and at long-term follow-up after 3 years. RESULTS: After targeted pharmacotherapy for 3 months, 70% of patients showed a clinically relevant improvement in the SAQ7-Summary score (62 ± 22 from 47 ± 18; p < 0.001). PROM-scores showed a significant decrease in monthly number of chest pain attacks by 38% (p = 0.041) and nitroglycerine intake by 67% (p = 0.004) accompanied by a significant PROM mood-score improvement (0.5 points within a 1-5 scale; p < 0.001). Long-term follow-up after 3 years (n = 40) revealed that 81% of the patients with isolated coronary spasm or vasodilation disorder benefited sustainably from endotype-based therapy with an improved SAQ7-Summary score. CONCLUSION: Endotype-based pharmacotherapy can contribute decisively to long-term symptom and QoL improvement, particularly in ANOCA-patients with isolated endotypes.
Poller A, Jha S, Thorleifsson SJ
… +9 more, Espinosa AS, Sevastianova V, Molander L, Andersson EA, Zeijlon R, Simons K, Omerovic E, Bech-Hanssen O, Redfors B
Int J Cardiol
· 2026 Aug · PMID 42044717
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BACKGROUND: Left ventricular diastolic dysfunction following Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) is a marker of impaired myocardial relaxation and reduced ventricular compliance and is...BACKGROUND: Left ventricular diastolic dysfunction following Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) is a marker of impaired myocardial relaxation and reduced ventricular compliance and is associated with adverse outcomes. We hypothesized that differences in diastolic function explain the better hemodynamic profile seen in TS compared to STEMI despite similar or more extensive cardiac systolic dysfunction. METHODS: Daily echocardiographic examinations including diastolic function parameters were made in women with TS (N = 69) or anterior STEMI (N = 43), starting on the day of symptom onset. The primary endpoints were a set of diastolic indices at 24 h after symptom onset. Women were also classified into diastolic subgroups based on the 2025ASE recommendations on evaluation of left ventricular diastolic function. RESULTS: TS and STEMI were balanced in age (69.4 ± 11.1 versus 69.5 ± 11.0), baseline risk factors and pre-admission cardiovascular medications. Women with TS had significantly lower S/D(p = 0.05), and higher E/é-lateral(p = 0.04), and LAVI(p = 0.05) compared to STEMI 24 h after admission. But there were no significant differences between the groups in diastolic grade, after 24 h. Longitudinal analyses of diastolic parameters over the course of the study period did not reveal any pattern suggestive of systematically worse or better diastolic function in TS than STEMI. Diastolic function parameters and diastolic function grade were similar also at 30-days follow-up in both groups. CONCLUSION: This study is the first to evaluate left ventricular diastolic function with repeated echocardiography. Because diastolic indices were similar or more impaired in TS than in STEMI, our findings do not support the hypothesis.
Tobe A, Smits PC, van Royen N
… +39 more, Amat-Santos IJ, Hudec M, Bunc M, Van den Branden BJL, Laanmets P, Unic D, Merkely B, Hermanides RS, Ninios V, Protasiewicz M, Rensing BJWM, Martin PL, Feres F, Almeida MS, van Belle E, Linke A, Ielasi A, Montorfano M, Webster M, Toutouzas K, Teiger E, Bedogni F, Voskuil M, Pan M, Angerås O, Kim WK, Rothe J, Kristić I, Peral V, Garg S, Versteeg GAA, García-Gómez M, Tsai TY, Thakkar A, Chandra U, Morice MC, Onuma Y, Baumbach A, Serruys PW
Int J Cardiol
· 2026 Aug · PMID 42044716
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BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of...BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of the conduction system post-procedure. This study aims to report the incidence and predictors of ventricular pacing (VP) rate≦1% at 1 year after TAVI. METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1% at follow-up. RESULTS: PMR occurred in 18% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25% (11/44), Sapien 19% (5/27), and Evolut 7% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95% confidence interval 0.00-0.77, p = 0.02. CONCLUSIONS: At 1 year, conduction system recovery (VP≦1%) was observed in 18% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.
Santoro F, Arcari L, Sasso C
… +12 more, D'Elia G, D'Alessandro D, Benvenga RM, Migliarino S, Di Peppo M, Molinari M, Mordecchi A, Cacciotti L, Eitel I, Cameli M, Brunetti ND, Citro R
Int J Cardiol
· 2026 Aug · PMID 42035838
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AIMS: This study aims to investigate left atrial (LA) functional recovery following a TTS episode and assess its association with long-term major adverse cardiovascular events (MACE). METHODS AND RESULTS: In a multicente...AIMS: This study aims to investigate left atrial (LA) functional recovery following a TTS episode and assess its association with long-term major adverse cardiovascular events (MACE). METHODS AND RESULTS: In a multicenter, prospective study, 98 consecutive TTS patients (mean age 71 ± 11 years; 94.9% women) with adequate six months left atrial strain imaging were included. LA reservoir (LASr) and contractile strain (LASct) were assessed and compared with 82 healthy controls. A longitudinal strain analysis was performed in a subset of 40 patients evaluated during the acute phase and at six months. MACE were recorded during 45 ± 14 months follow-up. Despite normalization of LV ejection fraction, at six months LASr and LASct were significantly lower compared with controls (32.9 ± 11.8% vs 42.4 ± 10.9%, p < 0.01; 17.2 ± 7.3% vs 20.9 ± 9.7%, p = 0.02). In the longitudinal subset, LV strain improved significantly over time, whereas LA strain showed no recovery. During follow-up 14 patients (14%) experienced MACE. In multivariable Cox regression analysis including age, sex, physical stressor, and admission LV ejection fraction, the addition of LASr at six months significantly improved model fit (Δχ = 6.6, p = 0.01). LASr emerged as the only independent predictor of long-term MACE (HR 0.93, 95% CI 0.88-0.98; p = 0.01). An LASr <30% identified a high-risk subgroup with reduced event-free survival (log-rank p < 0.01). CONCLUSIONS: Impaired LASr at six months is associated with long-term MACE in Takotsubo syndrome despite recovery of left ventricular systolic function.
Chu SN, Zhang J, Yan ZC
… +7 more, Ren QW, Huang JY, Gu WL, Guo R, Xuan HC, Lui CL, Yiu KH
Int J Cardiol
· 2026 Aug · PMID 42034244
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BACKGROUND: Mixed aortic valve disease (MAVD), combining aortic stenosis (AS) and regurgitation (AR), is prevalent yet understudied at mild-to-moderate severity. OBJECTIVES: We aimed to compare clinical outcomes of mild-...BACKGROUND: Mixed aortic valve disease (MAVD), combining aortic stenosis (AS) and regurgitation (AR), is prevalent yet understudied at mild-to-moderate severity. OBJECTIVES: We aimed to compare clinical outcomes of mild-to-moderate MAVD versus isolated AS, hypothesizing more adverse effects due to dual hemodynamic stress. METHODS: This retrospective cohort study analysed 1590 patients (mean age 75.3 ± 12.2 years, 45% male) with mild-to-moderate AS (aortic valve area 1.0-2.0 cm) and preserved left ventricular systolic function (LVEF ≥50%) at Queen Mary Hospital (2003-2021). Mild-to-moderate MAVD was defined as a combination of mild-to-moderate AS and mild-to-moderate AR (≤grade 2). Endpoints included all-cause mortality, aortic valve replacement (AVR), and major adverse cardiovascular events (MACE). RESULTS: MAVD patients were younger (73.2 ± 13.2 vs 75.7 ± 12.0 years; p = 0.004) and less diabetic (14% vs 23%; p = 0.003) than those with isolated AS. MAVD exhibited greater LV dilation (LV end-diastolic diameter 4.39 ± 0.67 vs 4.15 ± 0.63 cm; p < 0.001) and hypertrophy (LV mass index 133.82 ± 41.48 vs 110.38 ± 28.87 g/m; p < 0.001) than those with isolated AS. MAVD increased AVR risk by 42% (adjusted HR 1.42; 95% CI 1.01-1.99; p = 0.048) and MACE by 28% (adjusted HR 1.28; 95% CI 1.02-1.60; p = 0.035), with no mortality difference (adjusted HR 1.09; 95% CI 0.91-1.32; p = 0.4). CONCLUSIONS: Mild-to-moderate MAVD is associated with more adverse LV remodelling and worse clinical outcomes-notably higher rates of AVR and MACE-than isolated AS of comparable severity. These findings challenge its benign perception, advocating closer surveillance to optimize care in this underrecognized population.