Li G, Li F, Huang M
… +7 more, Wu B, Song Z, Yan J, Liu F, Li Z, Zou Z, He Z
Int J Cardiol
· 2026 Aug · PMID 42034243
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BACKGROUND: Short-term pharmacological options for heart failure (HF) patients with hemodynamic instability remain limited, and vasoactive agents are frequently used as life-saving interventions. This study aims to inves...BACKGROUND: Short-term pharmacological options for heart failure (HF) patients with hemodynamic instability remain limited, and vasoactive agents are frequently used as life-saving interventions. This study aims to investigate the association between Blood Pressure Response Index (BPRI) and mortality in decompensated HF patients. METHODS: We conducted a retrospective cohort study in the MIMIC-IV database including HF patients requiring vasoactive drugs. BPRI was calculated hourly as the ratio of the mean arterial pressure to vasoactive-inotropic score. Predictive performance for in-hospital mortality was assessed using receiver operating characteristic curves and the nonlinear relationship was examined with restricted cubic splines. The Cox proportional hazards regression model was applied to evaluate the association between BPRI and 1-year mortality. RESULTS: Among 1871 patients, BPRI demonstrated superior prognostic value for in-hospital mortality (AUC up to 0.755). Restricted cubic splines revealed an L-shaped relationship between BPRI and in-hospital mortality with a cutoff value at 4.391. Below this value, each unit decrease in BPRI significantly increased in-hospital mortality risk (odds ratio = 1.705, 95% CI 1.447-2.021), whereas no significant association was observed above it. Similarly, an elevated BPRI was associated with a reduced 1-year mortality risk, but this protective effect gradually weakened over time. Additionally, a discharge landmark analysis revealed BPRI was not significantly associated with post-discharge mortality (HR = 1.000, 95% CI 0.991-1.009). CONCLUSIONS: By estimating the hemodynamic compensatory threshold and identifying patients with poor responsiveness to vasoactive agents support, BPRI may contribute to earlier risk stratification and more individualized short-term management in decompensated HF.
Bo K, Qu T, Wang H
… +10 more, Yue X, Qi J, Zhou Z, Zhang H, Gao Y, Li S, Zhao C, Li T, Zhang H, Xu L
Int J Cardiol
· 2026 Aug · PMID 42031064
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OBJECTIVES: To evaluate the feasibility of a non-contrast cardiac magnetic resonance (CMR)-based deep learning (DL) model for predicting left ventricular adverse remodeling (LVAR) in patients with acute ST-segment elevat...OBJECTIVES: To evaluate the feasibility of a non-contrast cardiac magnetic resonance (CMR)-based deep learning (DL) model for predicting left ventricular adverse remodeling (LVAR) in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS: A retrospective study included 252 patients with STEMI from two centers, randomized into training (n = 176) and testing (n = 76) cohorts. A two-stage DL framework was employed: (1) An architecture for coarse-to-fine myocardial localization and segmentation based on a 3D U-shaped network and (2) a classification model integrating imaging, morphological, and motion features extracted from cine CMR. The performance of different models was evaluated using the area under the curve (AUC), accuracy, sensitivity, specificity, and the F1 score. Regions influencing the decision-making process of the DL model were highlighted using guided gradient-weighted class activation mapping. RESULTS: The DL model demonstrated robust ability to predict LVAR, with an AUC of 0.865 (95% CI: 0.755-0.956), accuracy of 82.9%, sensitivity of 77.3%, specificity of 85.2% and F1 score 0.723 in the testing set. In multivariable analysis, conventional CMR parameters, including global longitudinal strain, left atrial reservoir strain, and infarct size, remained as independent predictors of LVAR. A combined model integrating DL features with conventional non-contrast CMR parameters improved the predictive performance (AUC: 0.889, 95% CI: 0.803-0.974 in the testing set), significantly outperforming both conventional non-contrast and contrast-enhanced CMR models. CONCLUSION: A non-contrast DL-CMR model effectively predicts LVAR in patients with STEMI, providing a gadolinium-free tool for risk stratification and personalized management.
Lara-González M, Muñoz P, Pedraz-Prieto Á
… +11 more, Delgado-Montero A, Cobo-Belaustegui M, Fariñas-Alvarez MC, de Alarcón A, Rodríguez-Esteban MÁ, Goenaga-Sánchez MÁ, López-Azor JC, Goikoetxea-Agirre AJ, Garcia-Alvarez L, Martínez-Sellés M, GAMES Investigators (Appendix 1)
Int J Cardiol
· 2026 Aug · PMID 42009140
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BACKGROUND: Myocardial infarction (MI) impact in the outcome of infective endocarditis (IE) is unknown. Our aim was to evaluate the prevalence and prognostic influence of previous and new MI in a national cohort of IE. M...BACKGROUND: Myocardial infarction (MI) impact in the outcome of infective endocarditis (IE) is unknown. Our aim was to evaluate the prevalence and prognostic influence of previous and new MI in a national cohort of IE. METHODS: Our data come from the Spanish endocarditis registry. We included 6392 patients with IE between 2008 and 2023. RESULTS: A total of 568 patients (8.8%) had a previous MI and 83 (1.3%) presented an acute MI (61 without MI history and 22 with reinfarction). Compared to those without previous MI, patients with previous MI had more advanced age (71 vs. 69 years, p < 0.001), were more frequently male (80.4% vs. 66.4%, p < 0.001), had higher age-adjusted Charlson Comorbidity Index (7 vs. 4, p < 0.001), and higher mortality (in-hospital 29.4% vs. 24.9%, one-year 35.4% vs. 30.7%, both p-values <0.001). However, previous MI was not an independent predictor of mortality (in-hospital odds ratio 0.90, 95% confidence interval [CI] 0.70-1.12, p = 0.42; one-year hazard ratio 0.81, 95% CI 0.64-1.02, p = 0.08). New acute MI was associated with mortality (in-hospital 48.2% vs. 25.0%, one-year 57.8% vs. 30.8%, both p-values <0.001) and was an independent predictor of mortality (in-hospital odds ratio 1.9, 95% CI 1.11-3.32, p = 0.02; one-year hazard ratio 2.26, 95% CI 1.32-3.89, p = 0.003). CONCLUSIONS: IE patients that have a previous MI present an advanced age and frequent comorbidities, and these are the two main reasons for their high mortality. New acute MI duplicates in-hospital and one-year mortality.
Lin JJ, Huang CH, Chen WT
… +5 more, Lee HY, Chen WJ, Chang WT, Ong HN, Tsai MS
Int J Cardiol
· 2026 Aug · PMID 42009139
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BACKGROUND: Accurately predicting outcomes for cardiac arrest (CA) survivors is essential. Existing severity scores reliably predict outcomes at hospital discharge, but their prognostic performance for survival at 6 mont...BACKGROUND: Accurately predicting outcomes for cardiac arrest (CA) survivors is essential. Existing severity scores reliably predict outcomes at hospital discharge, but their prognostic performance for survival at 6 months and 1 year remains unexplored. METHODS: This retrospective observational study enrolled 1773 adult nontraumatic CA patients in the emergency department of National Taiwan University Hospital between January 2011 and June 2023 without interhospital transfer. Data on clinical variables, resuscitation events, post-arrest care, and outcomes were collected, and the severity was classified using the sCAHP, rCAST, and TIMECARD scores. The outcomes included 6-month and 1-year survival. Predictive ability was evaluated using receiver operating characteristic (ROC) curves. RESULTS: Among 1773 enrolled patients, 501 (28.3%) survived to discharge, 361 (20.4%) to 6 months, and 346 (19.5%) to 1 year. The area under the ROC curves (AUCs) for 6-month survival were 0.787, 0.733, and 0.810 for the sCAHP, rCAST, and TIMECARD scores, respectively. For 1-year survival, the AUC values were 0.788, 0.734, and 0.816, respectively. sCAHP and TIMECARD scores demonstrated better discriminatory performance than did the rCAST score for both 6-month and 1-year survival. Compared with the sCAHP and rCAST scores, TIMECARD score exhibited superior discrimination for 1-year survival, particularly in patients ≤65 years, those with in-hospital CA (IHCA), and those with good pre-arrest neurological status. CONCLUSION: The sCAHP, rCAST, and TIMECARD scores demonstrated good discrimination and calibration for long-term survival. The TIMECARD score exhibited better discriminatory performance for 1-year survival, particularly in the subgroup of younger age, IHCA, and good pre-arrest neurological function.
Garatachea N, Echevarría-Polo M, Hernández-Vicente A
… +5 more, D'Ascenzi F, Fabregat-Andrés Ó, Grazioli G, de la Guía-Galipienso F, Sanchis-Gomar F
Int J Cardiol
· 2026 Aug · PMID 42001969
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BACKGROUND: Endurance athletes have an increased risk of atrial fibrillation (AF), and focal late gadolinium enhancement (LGE) is frequently detected on cardiac magnetic resonance (CMR); however, whether myocardial fibro...BACKGROUND: Endurance athletes have an increased risk of atrial fibrillation (AF), and focal late gadolinium enhancement (LGE) is frequently detected on cardiac magnetic resonance (CMR); however, whether myocardial fibrosis or diffuse myocardial abnormalities underlie AF-related functional phenotypes remains unclear. We previously described a paroxysmal AF phenotype in male endurance athletes (PAFIYAMA), characterized by reduced forward flow despite preserved global systolic function; nonetheless, the underlying myocardial substrate remains unknown. METHODS: In this observational cross-sectional study, 63 competitive male endurance athletes (PAFIYAMA n = 22; controls n = 41) underwent CMR with cine imaging, LGE, native T1, extracellular volume fraction (ECV), and T2 mapping. Training load was derived from the Lifetime Total Physical Activity Questionnaire. Group comparisons and multivariable models adjusted for age, body mass index, training load, and peak exercise blood pressure. RESULTS: Focal LGE was present in 15/63 (24%) athletes and did not differ between PAFIYAMA and controls. Among LGE-positive athletes, enhancement was predominantly hinge-point/insertional (8/15, 53.3%) or limited septal intramyocardial (6/15, 40.0%), with one subepicardial lateral case (1/15, 6.7%). Athletes with LGE had larger indexed biventricular volumes but similar native T1, ECV, and T2. Compared with controls, PAFIYAMA athletes showed lower biventricular stroke volume indices and lower left ventricle mass, with a slightly lower LVEF that remained within the normal range, and no differences in LGE prevalence or mapping indices. CONCLUSIONS: In endurance athletes with the PAFIYAMA phenotype, CMR tissue characterization does not support focal LGE or diffuse mapping abnormalities as the substrate of the functional phenotype; interpretation of LGE in athletes should integrate pattern and clinical context.
Kawaji T, Murase Y, Yamashita S
… +10 more, Yamano S, Ishida R, Naka M, Bao B, Kimura T, Hojo S, Matsuda S, Kato M, Yokomatsu T, Miki S
Int J Cardiol
· 2026 Aug · PMID 42001968
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AIMS: The Ockham AF Mapping module is a novel mapping system that identifies atrial fibrillation(AF) drivers based on short cycle lengths and localized continuous activation. This study aimed to validate the characterist...AIMS: The Ockham AF Mapping module is a novel mapping system that identifies atrial fibrillation(AF) drivers based on short cycle lengths and localized continuous activation. This study aimed to validate the characteristics of AF drivers identified by the novel module. METHODS AND RESULTS: This retrospective multicenter study enrolled 110 consecutive patients with AF who underwent ablation using the Ockham module. AF drivers were defined by a short Local Cycle Length (CL) ≤ the median of the minimum and peak CL, and a high Duty Cycle (the ratio of the electrical activation time to the Local CL) of ≥80%. A total of 112,388 beats were analyzed, identifying 517 highlighted driver areas in 226 atria. Due to inconsistent AF activation, the module could not analyze a median area of 11.9(3.6-19.0) cm per atrium, most frequently in the septal region. The median peak CL was 146(135-161) ms and was significantly shorter in the left atrium (LA) than the right atrium (RA). Following pulmonary vein isolation, the CL increased significantly in the LA but not in the RA. The module highlighted a median driver area of 11.0(6.8-18.9) cm per atrium. These areas were located most commonly in the posterior and inferior regions of the LA and the lateral region of the RA. Notably, the dominant CL of the highlighted areas showed a significant correlation with the severity of rotational activation identified by another phase-mapping system. CONCLUSIONS: The Ockham AF Mapping module reliably identified AF drivers, characterized by short Local CL and high Duty Cycle.
Jurczyk D, Paschke L, Below M
… +8 more, Mezger M, Piatek K, Gedeon N, Lemmer F, Rawish E, Fatum C, Eitel I, Paitazoglou C
Int J Cardiol
· 2026 Aug · PMID 42001967
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AIMS: Heart failure (HF) is linked to high mortality, morbidity and reduced quality of life. Despite available guideline-directed medical treatment (GDMT), underdiagnosis and undertreatment remain unsolved challenges. Am...AIMS: Heart failure (HF) is linked to high mortality, morbidity and reduced quality of life. Despite available guideline-directed medical treatment (GDMT), underdiagnosis and undertreatment remain unsolved challenges. Ambulatory real-world data from Germany are scarce. METHODS: We analyzed outpatient claims and prescription data from approximately 74.3 million statutorily health insured (SHI) Germans between 2015 and 2023. HF prevalence and comorbidities were identified in patients with ≥2 HF diagnoses and ≥ 1 relevant comorbidity documentation within one year. Utilization of outpatient drug therapy was assessed in newly diagnosed cases from the first of ≥2 HF diagnoses, followed over four subsequent quarters. RESULTS: Outpatient HF prevalence ranged about 2.2 million patients annually (3.5-3.8%), increasing sharply with age (>90 years: 27.6%) and the median annual HF incidence was 364,446 (0.61%) of 60,838,679 SHI patients. Within the HF prevalent cohort, common risk factors included arterial hypertension (90.0%), dyslipidemia (56.4%) and coronary artery disease (52.1%). HF diagnosis was primarily coded by general practitioners (69%), followed by outpatient cardiologists (23.6%). In incident HF patients prescription rates included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (59.3%), beta-blockers (55.9%), diuretics (44.3%), mineralocorticoid antagonists (15.7%), glycosides (4.7%), angiotensin-receptor-neprilysin-inhibitor (ARNI, 4.1%) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (3.3%). ARNI and SGLT2i prescriptions peaked at 9.4% and 17.6% in 2022, reflecting their recent introduction in the HF treatment guidelines as well as four-pillar therapy with 12.5%. CONCLUSION: National ambulatory data highlight the critical role of general practitioners in HF care and support a rising trend in GDMT use in Germany.
Yajima K, Nakayama T, Fujiyoshi K
… +2 more, Sugiura M, Ikehara N
Int J Cardiol
· 2026 Aug · PMID 42001966
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BACKGROUND: Pulmonary vein (PV) isolation is the cornerstone of catheter ablation for atrial fibrillation (AF), yet its efficacy remains suboptimal in persistent AF, partly due to non-PV drivers. ExTRa Mapping, a real-ti...BACKGROUND: Pulmonary vein (PV) isolation is the cornerstone of catheter ablation for atrial fibrillation (AF), yet its efficacy remains suboptimal in persistent AF, partly due to non-PV drivers. ExTRa Mapping, a real-time phase mapping system, enables visualization of spatiotemporal AF dynamics and identification of non-PV drivers. This study investigated whether ExTRa Mapping parameters predict AF recurrence after PV isolation in persistent AF. METHODS: Forty consecutive patients with symptomatic persistent AF were enrolled. All underwent extensive PV isolation followed by adjunctive ablation targeting non-PV driver regions identified by ExTRa Mapping. RESULTS: Mean AF duration was 1.3 ± 2.1 years, and mean follow-up was 2.3 ± 1.8 years. AF recurred in 20 patients. The ExTRa score, defined as the mean of the five highest non-passive activation (%NP) values, was significantly associated with AF recurrence (p = 0.0040). An ExTRa score ≥ 55.8% predicted recurrence with an area under the curve of 0.767 (log-rank p = 0.0012). Patients with the highest %NP localized to the peri-left atrial appendage region had higher recurrence rates than those with non-peri-LAA localization (p = 0.0384). The ExTRa score was significantly associated with recurrence in univariate Cox analysis (HR 4.99, p = 0.0012) and remained an independent predictor in multivariate analysis (HR 7.86, p < 0.0001). Adjunctive ablation of the top five regions did not ensure durable rhythm control. CONCLUSIONS: The ExTRa score independently predicts AF recurrence after PV isolation in persistent AF and may aid in identifying high-risk patients and optimizing individualized ablation strategies.
Pieralisi AV, Mazzitelli IG, Repetto S
… +5 more, Gili M, Gagliardi J, Goren NB, Penas FN, Cevey ÁC
Int J Cardiol
· 2026 Aug · PMID 41999955
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BACKGROUND: Chronic Chagas disease progresses through distinct clinical stages, from an asymptomatic form to severe cardiomyopathy. This multicenter, cross-sectional study aimed to characterize the systemic and cellular...BACKGROUND: Chronic Chagas disease progresses through distinct clinical stages, from an asymptomatic form to severe cardiomyopathy. This multicenter, cross-sectional study aimed to characterize the systemic and cellular immune and oxidative profiles associated with each clinical stage. METHODS: Seropositive individuals for Chagas disease were recruited through a multicentric approach across three public hospitals in Argentina and classified as having no demonstrable pathology (NDP), mild to moderate cardiomyopathy (MCC), or severe cardiomyopathy (SCC). Healthy individuals (HI), seronegative for Chagas disease were included as the control group. Plasma immune and redox status was assessed through cytokine levels, antioxidant enzyme activity, and markers of tissue damage. Using peripheral blood mononuclear cells, we evaluated oxidative stress and the expression of genes involved in pro-inflammatory, anti-inflammatory, and Nrf2-regulated antioxidant responses. Receiver Operating Characteristic (ROC) analyses were conducted to evaluate the ability of plasma Superoxide dismutase (SOD) activity to discriminate between clinical stages as a potential biomarker. RESULTS: NDP individuals displayed a pattern of selective immune activation along with increased antioxidant responses and elevated plasmatic SOD activity, suggesting a balanced systemic immuno-oxidative state. In contrast, MCC and SCC stages exhibited broader inflammatory response, higher ROS levels, and reduced antioxidant defenses. Plasma SOD activity declined with disease severity and showed strong discriminatory capacity between stages. CONCLUSIONS: These findings highlight state-associated immunoredox imbalance as a key feature of Chagas' cardiomyopathy. While further studies are needed, superoxide dismutase activity is emerging as a promising minimally invasive biomarker for monitoring the stages of this infectious disease.
Giovachini L, Ferrante A, Guedeney P
… +19 more, Rahoual G, Procopi N, Barthelemy O, Kerneis M, Zeitouni M, El Kasty M, Cayla G, Beygui F, Rangé G, Motovska Z, Laredo M, Dumaine R, Ducrocq G, Rouanet S, Portal JJ, Vicaut E, Montalescot G, Silvain J, ALPHEUS investigators* of the ACTION Group
Int J Cardiol
· 2026 Aug · PMID 41999954
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BACKGROUND: Stents characteristics can have a tremendous impact on the incidence of periprocedural ischemic events following percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS). The...BACKGROUND: Stents characteristics can have a tremendous impact on the incidence of periprocedural ischemic events following percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS). The ALPHEUS-stents study aimed to describe the association between stents lengths and characteristics on the occurrence of periprocedural ischemic events. METHODS: The study included patients with CCS undergoing elective PCI with at least one high-risk feature. The primary endpoint of the study was the composite of type 4a/4b myocardial infarction (MI) and periprocedural major myocardial injury evaluated at 48 h or discharge. First, we evaluated the association between total stent length and primary outcome using a multivariate logistic regression considering stent length as a continuous variable and adjusting for relevant covariates. Then we evaluated the associations between stent diameter, strut thickness, platform composition, polymer type, coating distribution and eluted drugs with the primary endpoint using a multivariable logistic regression model, with stent length categorized within the aforementioned subgroups. RESULTS: The primary endpoint occurred in 639 patients (35.8%). After adjustment, total stent length was significantly associated with the primary endpoint (adjusted Odds Ratio (aOR) 1.028 95%CI [1.028-1.029] per millimeter). No significant associations were observed across categories of stent diameter, strut thickness, platform composition or coating distribution. However, biolimus-eluting stents (aOR 1.051 [1.035-1.067], p = 0.006 vs other eluted drugs) were independently associated with an increased risk of the primary outcome. CONCLUSIONS: In patients undergoing elective PCI, the risk of periprocedural ischemic events is adequately captured by the total stent length. Biolimus-eluted stents might confer a higher risk of periprocedural ischemic events. CLINICALTRIALS: gov number: NCT02617290.
BACKGROUND: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical syndrome with limited evidence to guide secondary prevention. Ranolazine, a selective inhibitor of the late so...BACKGROUND: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical syndrome with limited evidence to guide secondary prevention. Ranolazine, a selective inhibitor of the late sodium current, improves coronary microvascular function and angina symptoms, yet its long-term prognostic value in MINOCA remains unclear. OBJECTIVES: To assess the association between ranolazine use and the risk of a composite outcome of all-cause mortality and heart failure exacerbation (HFE) in patients with MINOCA. METHODS: We conducted a retrospective cohort study using the TriNetX global health network, encompassing approximately 178 million patients from 156 healthcare organizations. Adults (≥18 years) diagnosed with suspected MINOCA identified based on administrative diagnostic coding between 2006 and 2025 were included. Patients treated with ranolazine were compared with non-users using 1:1 propensity score matching. The primary endpoint was a composite of all-cause mortality and HFE. Secondary endpoints included the individual components of the composite outcome. RESULTS: Among 951,660 eligible patients, 2965 received ranolazine. After matching, 5930 balanced patients were analyzed. Ranolazine use was associated with a lower 3-year risk of the composite outcome (28.0% vs. 31.4%; HR 0.87, 95% CI 0.80-0.96; P = 0.005), mainly driven by fewer HFE (16.1% vs. 18.9%; HR 0.84, 95% CI 0.75-0.95; P = 0.006). All-cause mortality showed a nonsignificant trend toward benefit (HR 0.93; P = 0.26). Subgroup and sensitivity analyses supported result robustness. CONCLUSIONS: In this real-world propensity-matched cohort, ranolazine use was associated with a significantly lower risk of the composite outcome of all-cause mortality and HFE, primarily driven by a reduction in HFE, suggesting potential prognostic benefits beyond symptom relief in MINOCA.
BACKGROUND: There are various patterns of wall motion abnormalities in neurogenic stress cardiomyopathy (NSC), each exerting different impacts on hemodynamics. This study aims to investigate the effects of each wall moti...BACKGROUND: There are various patterns of wall motion abnormalities in neurogenic stress cardiomyopathy (NSC), each exerting different impacts on hemodynamics. This study aims to investigate the effects of each wall motion abnormality pattern on hemodynamic management, thereby providing guidance for clinical management decisions. METHODS: A retrospective analysis was conducted on patients diagnosed with NSC. Based on segmental ventricular wall dyskinesia, patients were categorized into four distinct groups. Clinical data were systematically collected and compared among these groups to analyze intergroup differences. RESULTS: In terms of EF, both the biventricular type (39.9 ± 4.3%) and the mid-ventricular type (40.7 ± 1.8%) exhibited significantly lower values compared to the apical ballooning group (46.5 ± 4.7%) (all P < 0.05). The measurements of MAPSE indicated that both the biventricular type (0.9 ± 0.2 cm) and the mid-ventricular type (0.9 ± 0.2 cm) were significantly smaller than those observed in the apical ballooning group (1.3 ± 0.3 cm) (all P < 0.05). Furthermore, the levels of NT-proBNP in the mid-ventricular type group [6843.0 (5810.0, 7705.0) pg/ml] were significantly higher than those in the apical ballooning group [3130.5 (2664.8, 4327.3) pg/ml], demonstrating a statistically significant difference (P < 0.05). Additionally, the type of ventricular wall dyskinesia was significantly correlated with the incidence of shock (P < 0.05) and the improvement time of EF (P < 0.01). CONCLUSIONS: Patients with NSC can exhibit various echocardiographic patterns of ventricular wall dyskinesia, each associated with distinct hemodynamic implications. This study underscores the importance of implementing individualized hemodynamic management strategies in clinical practice, tailored to the specific classification of wall motion abnormalities observed in NSC.
Int J Cardiol
· 2026 Aug · PMID 41990974
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BACKGROUND: Poor R-wave progression (PRWP) on the 12‑lead ECG is commonly interpreted as evidence of prior anterior myocardial injury, largely on the basis of small, biased studies from the 1970s-1980s. Whether PRWP iden...BACKGROUND: Poor R-wave progression (PRWP) on the 12‑lead ECG is commonly interpreted as evidence of prior anterior myocardial injury, largely on the basis of small, biased studies from the 1970s-1980s. Whether PRWP identifies anterior-wall fibrosis on modern cardiac magnetic resonance (CMR) is unknown. METHODS: We analyzed participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Examination 5 with digital ECG and CMR. PRWP was prespecified as RV3 ≤ 3 mm with RV3 > RV2. A historical sensitivity analysis tested the Zema MI criterion (RV3 ≤ 1.5 mm or RI ≤ 4.0 mm). The strict CMR reference required ischemic and transmural scar plus either ≥2 LAD segments or LV scar burden ≥5%; the liberal CMR reference was scar in any LAD segment irrespective of transmurality or burden. RESULTS: After exclusions, 2950 participants were included; PRWP was present in 163 (5.5%). CMR-defined anterior fibrosis occurred in 21 (0.7%, strict) and 57 (1.9%, liberal). With the strict reference, modern PRWP sensitivity was 0.0% (95% CI 0.0-15.6), specificity 94.4% (94.1-94.8), LR+ 0.00, and LR- 1.06. With the liberal reference, sensitivity was 5.3% (1.1-14.6), specificity 94.4% (94.1-94.8), LR+ 0.95, LR- 1.00. The Zema MI criterion performed similarly: strict-sensitivity 14%, specificity 90%, LR+ 1.48, LR- 0.95; liberal-sensitivity 11%, specificity 90%, LR+ 1.09, LR- 0.99. CONCLUSIONS: In a large, multiethnic community cohort, isolated PRWP did not detect anterior-wall fibrosis on CMR. PRWP should not be used as a diagnostic marker of anterior myocardial fibrosis without new, rigorously designed accuracy studies.
BACKGROUND: Conduction disturbances (CD) are common in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Although various types of CD occur, the prognostic differences among CD...BACKGROUND: Conduction disturbances (CD) are common in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Although various types of CD occur, the prognostic differences among CD subtypes, including transient and persistent CD, have not been systematically evaluated. METHODS: This retrospective two-center study included 1007 patients with AS who underwent TAVI between August 2016 and September 2024. According to Valve Academic Research Consortium-3 (VARC-3) criteria, CD were defined as left or right bundle branch block, intraventricular conduction delay with QRS ≥ 120 ms, high-degree atrioventricular block (including complete atrioventricular block), or new permanent pacemaker implantation. Patients were categorized into 4 groups: pre-existing CD, transient CD (resolved by discharge or within 7 days), persistent CD (present at discharge or beyond 7 days), or no CD. The primary endpoint was a composite of cardiovascular death or heart failure hospitalization up to 2 years. RESULTS: Of the 1007 patients, 234 (23.2%) had pre-existing CD, 112 (11.1%) had persistent CD, 159 (15.8%) had transient CD, and 502 (49.9%) had no CD. During a median follow-up of 645 days, 109 patients (10.8%) experienced the primary endpoint. The persistent CD group had a higher incidence of the primary endpoint than the other groups (log-rank P = 0.023). CONCLUSIONS: Persistent CD, but not transient or pre-existing CD, independently predicted adverse outcomes after TAVI. This study highlights the prognostic importance of CD persistence for post-TAVI risk stratification.
Hussein H, Elsherif A, Mechery A
… +5 more, Lawton E, Parsley D, George S, Nadir A, Doshi SN
Int J Cardiol
· 2026 Aug · PMID 41985585
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BACKGROUND: Cardiac tamponade is an uncommon but life-threatening complication of transcatheter aortic valve implantation (TAVI). Despite advances in imaging, device design, and operator experience, it remains associated...BACKGROUND: Cardiac tamponade is an uncommon but life-threatening complication of transcatheter aortic valve implantation (TAVI). Despite advances in imaging, device design, and operator experience, it remains associated with high morbidity and mortality. METHODS: We retrospectively analyzed all consecutive TAVI procedures performed at a high-volume tertiary center between 2013 and 2025. Baseline characteristics, procedural details, mechanisms of tamponade, and outcomes were obtained from institutional databases. RESULTS: Among 2354 TAVI procedures, 29 cases of tamponade occurred (1.2%). The mean age was 78 years, and 65.5% were women. Balloon-expandable valves were used in all but one case. Annular rupture was the leading mechanism (51.7%), followed by LV and RV perforation (13.8% each), while 20.7% had an indeterminate source. Pericardiocentesis was performed in 90% of cases, and 37.9% underwent sternotomy. In-hospital and 90-day mortality were 41.4% and 51.7%, respectively. Annular rupture showed a trend toward higher 90-day mortality than ventricular perforation (66.7% vs 25%, p = 0.09). Temporal analysis demonstrated a significant decline in incidence, from 2.29% between 2013-2018 to 0.86% between 2019-2025 (p = 0.004). This reduction was mainly driven by eliminating RV perforation through adoption of LV-wire pacing. The 90-day mortality improved numerically over time (64% early vs 40% late), although not reaching statistical significance. CONCLUSIONS: In this high-volume single-center registry, the incidence of tamponade declined over time, driven mainly by a reduction in ventricular perforation. Annular rupture persisted as the dominant and most lethal mechanism, whereas ventricular perforation showed better outcomes. More advanced risk-stratification tools are needed to identify patients at heightened risk.