BMC Cardiovascular Disorders[JOURNAL]
Sun
200 papers
Combined associations of the metabolic score for insulin resistance and estimated glucose disposal rate with cardio-renal-metabolic multimorbidity: evidence from two large population studies.
Yang FM, Song ZP, Qiao FY
BMC Cardiovasc Disord · 2026 Jul · PMID 42402555 · Full text
OBJECTIVES: The estimated glucose disposal rate (eGDR) and the metabolic score for insulin resistance (METS-IR) are widely used and reliable clinical indicators of IR. However, how their combined effect influences the ri...
OBJECTIVES: The estimated glucose disposal rate (eGDR) and the metabolic score for insulin resistance (METS-IR) are widely used and reliable clinical indicators of IR. However, how their combined effect influences the risk of cardio-renal-metabolic multimorbidity (CRMM) has not been well characterized. This study sought to evaluate both the individual and synergistic associations of eGDR and METS-IR with CRMM risk. METHODS: Data analyzed in the present study were sourced from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). We employed multivariable logistic regression models to examine the relationships of eGDR and METS-IR, both individually and jointly, with the risk of CRMM. Predictive performance was measured via the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), as well as integrated discrimination improvement (IDI). For validation, the main findings were reproduced in an independent population from the National Health and Nutrition Examination Survey (NHANES, 2007-2018). RESULTS: Among 7,149 participants in the final analytical sample, eGDR was inversely associated with the risk of incident CRMM (hazard ratio [HR] = 0.82, 95% confidence interval [CI]: 0.78-0.84), whereas METS-IR was positively associated with CRMM risk (HR = 1.05, 95% CI: 1.04-1.05). In the joint classification analysis, participants with low eGDR and high METS-IR had a higher risk of incident CRMM than those with high eGDR and low METS-IR (HR = 2.94, 95% CI: 2.47-3.51). The addition of eGDR and METS-IR to the baseline model was associated with statistically significant improvements in predictive performance for CRMM (AUC = 0.662, NRI = 0.427, IDI = 0.037; all P-value < 0.001). Sensitivity analyses yielded generally consistent results. CONCLUSIONS: Higher METS-IR and lower eGDR were associated with an increased risk of incident CRMM, and their joint assessment provided additional risk-related information. Although the combined model showed statistically significant incremental predictive value, its clinical applicability requires further validation.
Silent cerebral infarction after proximal thoracic aortic surgery under deep hypothermic circulatory arrest: an exploratory prospective DW-MRI study.
Bozkurt B, Akıncı O, Kuş MK … +5 more , Ören C, Yıldız Z, Yeşilkaya İ, Ertürk O, Kaplan M
BMC Cardiovasc Disord · 2026 Jul · PMID 42402559 · Full text
BACKGROUND: Deep hypothermic circulatory arrest (DHCA) is widely used in proximal thoracic aortic surgery; however, its association with subclinical cerebral ischemic changes remains poorly understood. Diffusion-weighted...
BACKGROUND: Deep hypothermic circulatory arrest (DHCA) is widely used in proximal thoracic aortic surgery; however, its association with subclinical cerebral ischemic changes remains poorly understood. Diffusion-weighted magnetic resonance imaging (DW-MRI) enables sensitive detection of silent cerebral infarction (SCI), which may occur in the absence of overt neurological deficits. METHODS: This prospective observational study included 35 consecutive adult patients undergoing proximal thoracic aortic surgery under DHCA at 18 °C without selective cerebral perfusion. Preoperative and postoperative DW-MRI scans were obtained in all patients. Silent cerebral infarction (SCI) was defined as the presence of at least one new ischemic lesion on postoperative DW-MRI not present preoperatively. Perioperative neuron-specific enolase (NSE) levels and intraoperative near-infrared spectroscopy (NIRS) measurements were recorded. Factors associated with SCI were explored using univariable and multivariable logistic regression analysis. RESULTS: Postoperative silent cerebral infarction was detected in 19 patients (54.3%), whereas no ischemic lesions were observed on preoperative DW-MRI. In univariable analysis, increasing age (OR 1.06, 95% CI 1.01-1.13; p = 0.021), Cardiopulmonary bypass time (CPB time) (OR 1.01, 95% CI 1.00-1.03; p = 0.024), and aortic cross-clamp time (CC time) (OR 1.04, 95% CI 1.01-1.07; p = 0.006) were associated with SCI. In age-adjusted multivariable models constructed separately for operative time variables, CC time remained independently associated with SCI (OR 1.03, 95% CI 1.01-1.06; p = 0.015), whereas CPB time did not retain statistical significance (OR 1.02, 95% CI 0.99-1.03; p = 0.089). Additional collinearity assessment showed a strong correlation between CPB time and CC time, and sensitivity analyses supported the persistence of the association between CC time and SCI. DHCA time, NIRS parameters, and NSE changes were not significantly associated with SCI. Although postoperative NSE levels increased compared with preoperative values, the change in NSE did not predict the occurrence of SCI. CONCLUSIONS: Silent cerebral infarction was frequently detected on postoperative DW-MRI following proximal thoracic aortic surgery performed under DHCA. Aortic cross-clamp time was associated with SCI development; however, this association should be interpreted cautiously, as it may reflect procedural complexity, cumulative aortic manipulation, and embolic burden rather than the isolated effect of circulatory arrest time. TRIAL REGISTRATION: NCT04755439. Date of trial registration: February 17, 2021.
Identifying risk individuals for heart failure diagnosis within two years in the adult population in southern Sweden using gender, age, multimorbidity level, and socioeconomic status.
Scholten M, Halling A
BMC Cardiovasc Disord · 2026 Jul · PMID 42402558 · Full text
BACKGROUND: Heart failure (HF) is a common disease among older individuals and is associated with poor quality of life and prognosis. Individuals at risk of developing HF are usually already patients in primary healthcar...
BACKGROUND: Heart failure (HF) is a common disease among older individuals and is associated with poor quality of life and prognosis. Individuals at risk of developing HF are usually already patients in primary healthcare, but diagnosing HF at an early stage can be challenging. Identifying patients at risk of HF and initiating early treatment is crucial for their outcomes. Using the variables gender, age, multimorbidity (MM) level, and socioeconomic status (SES), we aimed to study the possibility of identifying individuals at high risk of HF diagnosis within two years. METHODS: A longitudinal registry-based study, including 961,190 inhabitants aged from 20 years onwards without a HF diagnosis living in southern Sweden during 2015. Logistic regression was applied to estimate the OR of HF diagnosis within two years by adjusting for the variables gender, age, MM level, and SES. Linear predictions were made based on models by adding these variables in steps. Each model was compared with the previous model using a likelihood-ratio test. The optimal cutoff point for sensitivity and specificity was calculated using the Youden method. RESULTS: Age had the highest OR of HF diagnosis within two years, followed by MM level, gender, and SES. ROC (Receiver Operating Characteristic) analysis, including these variables in steps, generated an increasing AUC (area under the curve), from 0.5144 to 0.9379. When all four variables were included in the model, an optimal cutoff point according to Youden was established at 1.15%, which predicted the probability with a sensitivity of 87.69% and specificity of 78.48%. The positive predictive value was 4.78%, and the negative predictive value was 99.81% for the whole adult population; for those aged 70 years and older, it was 21.02% and 98.99%; and for those aged 80 years and older, it was 33.62% and 98.09%, respectively. CONCLUSIONS: Age was the most important factor for predicting the probability of HF diagnosis within two years in our study, followed by MM level, gender, and SES. These findings may help identify population groups at increased risk of HF in whom targeted case-finding strategies could be evaluated in future studies.
Elevated plasma TMAO levels associated with all-cause mortality in CAD patients in South China.
Zhang H, Peng YY, Lu XY … +5 more , Li YX, Li WZ, Hu Y, Wan L, Chen BL
BMC Cardiovasc Disord · 2026 Jul · PMID 42401844 · Full text
BACKGROUND: Coronary artery disease (CAD) is a prevalent cardiovascular condition worldwide. Trimethylamine N-oxide (TMAO), a metabolite produced by gut microbiota, plays a crucial role in the pathogenesis and progressio...
BACKGROUND: Coronary artery disease (CAD) is a prevalent cardiovascular condition worldwide. Trimethylamine N-oxide (TMAO), a metabolite produced by gut microbiota, plays a crucial role in the pathogenesis and progression of CAD. However, the association between plasma TMAO and all‑cause mortality in Chinese CAD patients remains to be fully explored. METHODS: In this observational cohort study, 389 hospitalized CAD patients, confirmed via coronary angiography at Xiangya Hospital in 2022, were enrolled. Plasma TMAO levels were measured using liquid chromatography-tandem mass spectrometry. All-cause mortality events were identified through telephone interviews, hospital outpatient visits, and official hospital records, conducted semi-annually. Kaplan-Meier analysis and Cox regression analysis were employed to investigate the relationship between TMAO levels and all-cause mortality. RESULTS: Among 364 CAD patients who completed the median follow-up period of 39 months (IQR: 37-42 months), 40 patients (11.0%) experienced all-cause mortality. Patients with elevated TMAO levels, based on the optimal cutoff value of 317.62 ng/mL, had a significantly higher mortality rate compared to those with lower levels (P < 0.0001). After adjusting for conventional risk factors, including diabetes, elevated TMAO levels showed a significant association of all-cause mortality (hazard ratio [HR] 2.657; 95% CI: 1.389 to 5.084; P = 0.003). CONCLUSIONS: Elevated plasma TMAO levels are significantly associated with increased all-cause mortality over a median follow-up of 39 months in CAD patients from South China.
Balloon aortic valvuloplasty for critical aortic stenosis in neonates and infants: early outcomes from a single-center cohort.
Imanov E, Nasibova EM, Nasibova EM
BMC Cardiovasc Disord · 2026 Jul · PMID 42401830 · Full text
BACKGROUND: Critical aortic valve stenosis in neonates and infants is a life-threatening congenital heart disease characterized by severe left ventricular outflow tract obstruction and compromised systemic perfusion. Bal...
BACKGROUND: Critical aortic valve stenosis in neonates and infants is a life-threatening congenital heart disease characterized by severe left ventricular outflow tract obstruction and compromised systemic perfusion. Balloon aortic valvuloplasty (BAV) has become an established initial treatment option; however, data on early outcomes in this vulnerable population remain relatively limited. METHODS: This retrospective single-center study included 30 neonates and infants (≤ 12 months) with critical aortic valve stenosis who underwent balloon aortic valvuloplasty between 2016 and 2024. Clinical, echocardiographic, and hemodynamic parameters were analyzed before and after the procedure. Early procedural success, complications, and short-term outcomes were assessed. RESULTS: Balloon aortic valvuloplasty resulted in a significant immediate reduction in transaortic pressure gradients (p < 0.05), indicating effective relief of left ventricular outflow tract obstruction. Left ventricular systolic function improved or remained stable in the majority of patients. New-onset or increased aortic regurgitation occurred in some cases, predominantly mild to moderate in severity, while severe regurgitation was uncommon. Early mortality was low, and most patients demonstrated favorable early clinical stabilization. Some patients required reintervention or surgical referral because of residual stenosis or progressive aortic regurgitation. CONCLUSIONS: Balloon aortic valvuloplasty is a safe and effective first-line treatment for critical aortic valve stenosis in neonates and infants, providing rapid hemodynamic improvement with acceptable early outcomes. The procedure represents an important therapeutic strategy in the initial management of this high-risk pediatric population.
Association between glucose-to-platelet ratio and all-cause mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study.
Zhang X, Liang D, Luo X … +2 more , Zhao L, Peng J
BMC Cardiovasc Disord · 2026 Jul · PMID 42401828 · Full text
BACKGROUND: Acute myocardial infarction (AMI) in critically ill patients is associated with high mortality. The glucose-to-platelet ratio (GPR), derived from routine early glucose and platelet measurements, may provide a...
BACKGROUND: Acute myocardial infarction (AMI) in critically ill patients is associated with high mortality. The glucose-to-platelet ratio (GPR), derived from routine early glucose and platelet measurements, may provide additional prognostic information, but its value in ICU patients with AMI remains unclear. METHODS: This retrospective cohort study included 4,676 adult ICU patients with AMI from the MIMIC-IV version 3.1 database. GPR was calculated as the mean glucose concentration during the first 24 h after ICU admission divided by the first platelet count recorded within the same period. Outcomes were 30-day and 360-day all-cause mortality from ICU admission. Associations were assessed using multivariable Cox proportional hazards models, restricted cubic splines, and exploratory internally validated prediction models. RESULTS: Among 4,676 patients, the 30-day and 360-day mortality rates were 19.6% and 29.1%, respectively. In the fully adjusted model, each 1-unit increase in GPR was associated with higher 30-day mortality (HR, 1.10; 95% CI, 1.05-1.15) and 360-day mortality (HR, 1.12; 95% CI, 1.07-1.16; both P < 0.001). Compared with the lowest tertile, the highest GPR tertile was associated with increased 30-day mortality (HR, 1.60; 95% CI, 1.35-1.90) and 360-day mortality (HR, 1.29; 95% CI, 1.12-1.47; both P < 0.001). Spline analyses suggested nonlinearity only for 30-day mortality. In exploratory internal validation, ridge regression incorporating GPR achieved an area under the receiver operating characteristic curve of 0.816. CONCLUSIONS: Higher GPR was independently associated with increased short- and long-term all-cause mortality in critically ill patients with AMI. GPR may complement conventional variables for early ICU risk stratification.
Association of lipoprotein(a) with left ventricular dysfunction in patients with chronic total occlusion of the coronary artery.
Xu S, Zhuo Y, Jing L … +1 more , Zhang W
BMC Cardiovasc Disord · 2026 Jul · PMID 42401818 · Full text
BACKGROUND: Lipoprotein(a) [Lp(a)] has been established as a significant prognostic marker in patients with chronic total occlusion (CTO) of the coronary artery. Left ventricular systolic dysfunction (LVSD) is a common a...
BACKGROUND: Lipoprotein(a) [Lp(a)] has been established as a significant prognostic marker in patients with chronic total occlusion (CTO) of the coronary artery. Left ventricular systolic dysfunction (LVSD) is a common and serious complication associated with CTO. This study aimed to explore the relationship between Lp(a) and LVSD in patients with CTO. METHODS AND RESULTS: A total of 309 patients with CTO who underwent elective percutaneous coronary intervention were consecutively enrolled in the study. The patients were stratified by left ventricular ejection fraction (LVEF) into the LVSD group (LVEF < 50%, n = 80) and preserved systolic function group (LVEF ≥ 50%, n = 229). The mean age of the cohort was 61.5 ± 11.3 years, 83.8% were males, and the prevalence of LVSD was 25.9%. Compared with patients with preserved systolic function, those with LVSD tended to be older, had a higher prevalence of arrhythmia, a history of myocardial infarction, and multivessel CTO disease, and exhibited more severe calcified lesions, while having a lower prevalence of hypertension. They also exhibited higher levels of Lp(a), NT-proBNP, and neutrophils, but had a lower body mass index, lower albumin levels, and a reduced LVEF (all P < 0.05). Multivariate regression analysis revealed that Lp(a) was significantly associated with LVSD, with an odds ratio (OR) per 100 mg/L of 1.149 (95% CI: 1.042-1.267; P = 0.005) after adjusting for potential confounding factors. Furthermore, incorporating Lp(a) into a model based on traditional risk factors significantly improved its discriminatory ability for LVSD (AUC = 0.839, 95% CI: 0.786-0.891, P < 0.001). Subgroup analysis indicated that the association between Lp(a) and LVSD was more pronounced in patients with multivessel CTO disease (P for interaction = 0.034). CONCLUSION: Elevated Lp(a) levels were significantly associated with LVSD in patients with CTO of the coronary artery.
Ten-year trends in cardiovascular risk factors among patients hospitalised with acute myocardial infarction in Estonia: a retrospective nationwide observational study.
Al-Dawoudi A, Dalain M, Varlamov D … +2 more , Alhallak S, Nanna M
BMC Cardiovasc Disord · 2026 Jul · PMID 42401815 · Full text
INTRODUCTION: Cardiovascular risk-factor profiles among patients hospitalised with acute myocardial infarction (AMI) can inform surveillance of a high-risk clinical cohort, but do not directly represent risk-factor preva...
INTRODUCTION: Cardiovascular risk-factor profiles among patients hospitalised with acute myocardial infarction (AMI) can inform surveillance of a high-risk clinical cohort, but do not directly represent risk-factor prevalence in the general population. METHODS: We analysed aggregate annual Estonian AMI registry data for hospitalised AMI patients during 2015-2024. AMI04 risk-factor trends were assessed using ordinary least squares regression, with sensitivity analyses for known status, age-sex standardisation to the pooled hospitalised AMI cohort, COVID-period exclusion, AMI case mix, and national hospitalised AMI burden. RESULTS: Documented smoking increased from 25.5% in 2015 to 28.1% in 2024 (β = 0.302% points/year; 95% CI 0.014 to 0.590; p = 0.042). The smoking trend remained significant in known-status analyses and after age-sex standardisation, although the crude observed trend became borderline after excluding 2020-2021. Documented dyslipidaemia increased descriptively, but full-period crude and age-sex-standardised trends were borderline, and unknown dyslipidaemia status decreased over time. Annual AMI attacks and national hospitalised AMI burden declined, with concurrent changes in sex and age composition. CONCLUSION: Among hospitalised AMI patients in Estonia, documented smoking increased during 2015-2024 and remained consistent in known-status and age-sex-standardised sensitivity analyses. Dyslipidaemia trends require cautious interpretation because unknown status changed over time. These aggregate registry findings describe a selected hospitalised AMI cohort and should not be interpreted as direct evidence of national prevention-policy success or failure.
Oral anticoagulant prescribing and DOAC dosing appropriateness in patients with non-valvular atrial fibrillation: a retrospective study from Vietnam.
Hoang VA, Le TM, Nong MV … +6 more , Bui VT, Tran TNA, Nguyen HTT, Dao XC, Vu VG, Do D
BMC Cardiovasc Disord · 2026 Jul · PMID 42401804 · Full text
BACKGROUND: Direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, real-world prescribing patterns an...
BACKGROUND: Direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, real-world prescribing patterns and dosing appropriateness in low- and middle-income countries remain poorly characterized. This study evaluated patterns of oral anticoagulant use and identified clinical determinants of suboptimal prescribing in a tertiary cardiovascular center in Vietnam. METHODS: We conducted a retrospective observational study of 209 patients with NVAF who received oral anticoagulation at a tertiary cardiovascular center between 2023 and 2024. Data were extracted from electronic medical records, including demographics, comorbidities, renal function, bleeding history, and prescribed anticoagulants. Multivariable logistic regression was used to identify factors associated with anticoagulant selection, defined as DOAC versus VKA use. DOAC dosing appropriateness was assessed according to the 2021 European Heart Rhythm Association Practical Guide, and predictors of potentially inappropriate dose reduction were evaluated. RESULTS: DOACs were prescribed in 77.0% of patients, most commonly rivaroxaban, which accounted for 55.3% of all anticoagulant prescriptions. VKAs were prescribed in 23.0% of patients. Among VKA users, 85.4% had INR values outside the therapeutic range at admission, largely due to subtherapeutic international normalized ratio values. Reduced DOAC doses were prescribed in 88 of 161 DOAC users (54.7%). Among 85 assessable reduced-dose DOAC users, 42 (49.4%) were classified as having potentially inappropriate dose reduction. In the parsimonious multivariable model, age ≥ 75 years was associated with higher odds of DOAC use (odds ratio [OR] 5.08; 95% confidence interval [CI] 1.95-13.23; p = 0.001), whereas female sex (OR 0.43; 95% CI 0.21-0.91; p = 0.027), heart failure (OR 0.23; 95% CI 0.09-0.59; p = 0.002), and prior bleeding (OR 0.20; 95% CI 0.05-0.87; p = 0.031) were associated with lower odds of DOAC use. CONCLUSION: In this single-center retrospective study from Vietnam, oral anticoagulant prescribing in patients with NVAF showed several areas for optimization, including frequent INR values outside the therapeutic range at admission among VKA users and frequent potentially inappropriate DOAC dose reduction. These findings support the need for improved dose optimization, and monitoring strategies, but should be interpreted cautiously give the observational design and inpatients data source.
Computational fluid dynamics evaluation of physician-modified stent graft repair for distal residual stanford type B aortic dissection.
Liu W, Cui C
BMC Cardiovasc Disord · 2026 Jul · PMID 42399855 · Full text
BACKGROUND: Few studies have focused on physician-modified stent grafts (PMEGs) for treating distal residual dissection in type B aortic dissection (TBAD). This study aimed to assess the usage of PMEGs in the treatment o...
BACKGROUND: Few studies have focused on physician-modified stent grafts (PMEGs) for treating distal residual dissection in type B aortic dissection (TBAD). This study aimed to assess the usage of PMEGs in the treatment of distal residual dissection of TBAD by analyzing the relevant hemodynamical indicators. METHODS: Patients with TBAD underwent thoracic endovascular aortic repair surgery in the first stage, and in the second stage PMEGs were used to repair the residual dissection. Computational fluid dynamics and three-dimensional structural analyses were performed, based on computed tomography angiography datasets. The prognostic post-implantation improvement was studied using both quantitative and qualitative functional analysis. RESULTS: A total of 30 patients with TBAD were enrolled. Following the PMEGs procedure, peak systolic pressure in all aortic segments trended downward without statistical significance. Overall time-averaged wall shear stress (TAWSS) increased significantly (P = 0.007), especially in the S2 segment (P = 0.005), while overall oscillatory shear index decreased significantly (P = 0.010). Superior mesenteric artery blood flow was significantly higher postoperatively (P = 0.005), with no significant differences in other visceral branches. At 1‑year follow-up, false lumen volume was markedly reduced (P < 0.001) and true lumen volume increased, suggesting favorable aortic remodeling. CONCLUSIONS: The PMEGs technique effectively ameliorates hemodynamic parameters in patients with residual distal dissection following TBAD. However, long-term follow-up of the increase in TAWSS is still required.
Predictive value of multivariate models of quantitative myocardial movement parameters for acute myocardial infarction in elderly patients with coronary artery disease.
Chen Q, Li B, Zhu X … +3 more , Jiang L, Liu C, Zhu J
BMC Cardiovasc Disord · 2026 Jul · PMID 42399842 · Full text
OBJECTIVE: This study aimed to investigate the association of multivariate models encompassing quantitative myocardial movement parameters with the risk of subsequent acute myocardial infarction (AMI) within 3 months in...
OBJECTIVE: This study aimed to investigate the association of multivariate models encompassing quantitative myocardial movement parameters with the risk of subsequent acute myocardial infarction (AMI) within 3 months in elderly patients with coronary artery disease (CAD), and to explore their potential predictive value. METHODS: We conducted a retrospective case-control study involving 280 elderly patients diagnosed with CAD, 110 of whom developed AMI within three months post examination (AMI group) and 170 who did not developed AMI. The two groups underwent echocardiographic measurements of several parameters. RESULTS: Significant differences were observed in echocardiographic parameters between the AMI and non-AMI groups. Parameters such as ejection fraction, stroke volume, end-systolic volume, end-diastolic volume, and left ventricular wall measurements effectively distinguished patients who developed AMI from those who did not. A joint model yielded an AUC value of 0.985 in the ROC analysis, indicating good predictive performance. Internal validation using bootstrap gave an optimism-corrected AUC of 0.901 (95% CI: 0.872-0.926). The Hosmer‑Leme show test indicated good calibration (χ²=8.32, p = 0.402), and decision curve analysis demonstrated potential clinical usefulness across a range of threshold probabilities. CONCLUSION: Our results suggest a potential for using multivariate models of myocardial movement parameters to predict the risk of AMI in CAD patients. However, owing to the retrospective design and the lack of external validation, these findings should be considered hypothesis‑generating and require prospective validation in independent cohorts. Incorporation of these echocardiographic measurements into routine medical assessments may offer a potentially effective, non-invasive way to improve early detection and management of AMI in patients with CAD.
Novel precordial mid-T-wave inversion: a pulsation artifact mimicking myocardial ischemia and proposed mechanisms.
Ji Y, Liu C, Li P … +4 more , Wang C, Xie H, Li Y, Ding H
BMC Cardiovasc Disord · 2026 Jul · PMID 42399816 · Full text
BACKGROUND: Electrocardiographic (ECG) artifacts mimicking acute coronary syndrome (ACS) pose a risk of misdiagnosis and unnecessary procedures. While arterial pulsation artifacts are known to cause limb-lead ST-T change...
BACKGROUND: Electrocardiographic (ECG) artifacts mimicking acute coronary syndrome (ACS) pose a risk of misdiagnosis and unnecessary procedures. While arterial pulsation artifacts are known to cause limb-lead ST-T changes adhering to the "single-limb lead exemption principle," their potential to induce specific repolarization abnormalities in precordial leads remains unreported. CASE PRESENTATION: A 66-year-old woman presented with chest tightness. The initial ECG showed ST-segment elevation in leads III and aVF, depression in I and aVL, and a previously undescribed pattern of isolated mid-portion T-wave inversions in precordial leads V2-V6, with preserved initial T-wave morphology. Suspected ACS was reconsidered after a senior physician noted atypical features. The diagnosis of radial artery pulsation artifact was confirmed after repositioning the limb electrodes away from the radial pulse, which normalized all ECG abnormalities Coronary computed tomography angiography revealed only mild atherosclerosis, ruling out acute ischemia. CONCLUSION: To our knowledge, this case is the first to describe a previously unreported variant manifestation of arterial pulsation artifact featuring isolated mid-portion T-wave inversions in precordial leads. We propose a potential mechanism via propagation of limb-derived interference currents through the Wilson Central Terminal, combined with an electromechanical hypothesis. This pattern, especially when combined with the limb lead exemption principle (spared lead II localizing the source to the left arm), suggests a potential electrocardiographic sign for differentiating artifact from true pathology. We also propose a practical bedside approach integrating lead-specific analysis and electrode repositioning to prevent misdiagnosis.
Iron deficiency in primary care patients with heart failure: a cross-sectional study of the heart failure in Southern Sweden (HISS) cohort.
Vinge F, Braun O, Wolff M … +3 more , Smith JG, Sundquist K, Nymberg VM
BMC Cardiovasc Disord · 2026 Jul · PMID 42399800 · Full text
BACKGROUND: Iron deficiency is a common and clinically relevant comorbidity in heart failure, associated with reduced functional capacity, higher symptom burden, and increased hospitalisation risk. Most evidence on iron...
BACKGROUND: Iron deficiency is a common and clinically relevant comorbidity in heart failure, associated with reduced functional capacity, higher symptom burden, and increased hospitalisation risk. Most evidence on iron deficiency in heart failure originates from hospital-based cohorts, whereas the epidemiology and clinical implications in primary care populations remain poorly described. This study aimed to determine the prevalence of iron deficiency among primary care patients with heart failure in southern Sweden and to examine its association with symptom severity. METHODS: This cross-sectional analysis used baseline data from the Heart Failure in Southern Sweden study, a prospective intervention project conducted at 20 primary health care centres. Adult patients with heart failure across all left ventricular ejection fraction categories were included. Iron deficiency was defined as transferrin saturation < 20%. RESULTS: In total, 466 primary care patients with heart failure were included, of whom 124 (26.7%) had iron deficiency. Symptom severity was higher in patients with iron deficiency: 35.5% were classified as New York Heart Association (NYHA) class III-IV, compared with 18.7% among patients without iron deficiency. Similar findings were observed in the subgroup with left ventricular ejection fraction below 50%, where 25.2% had iron deficiency and 42.6% were classified as NYHA III-IV compared with 18.4% among patients without iron deficiency. In multivariable analysis adjusting for clinically relevant covariates, iron deficiency remained associated with NYHA class III-IV (OR 1.97, 95% CI 1.18-3.31, p = 0.010). CONCLUSIONS: Iron deficiency is common among patients with heart failure managed in primary care and remained associated with higher symptom burden after adjustment for prespecified covariates. These findings highlight the potential clinical relevance of assessment of iron status in primary care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04129658. Registered on 15 October 2019.
Expression and clinical significance of the HIF-1α/VEGF signalling pathway in elderly patients with acute myocardial infarction.
Teng T, Xue Y, Cai W
BMC Cardiovasc Disord · 2026 Jul · PMID 42399793 · Full text
OBJECTIVE: To investigate the expression level of hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway in elderly patients with acute myocardial infarction (AMI), and to analyz...
OBJECTIVE: To investigate the expression level of hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway in elderly patients with acute myocardial infarction (AMI), and to analyze its relationship with the prognosis of AMI. METHODS: A total of 160 elderly patients with AMI were selected from October 2023 to September 2024 in Nanjing Medical University Affiliated Wuxi People's Hospital as the study group, 160 individuals who underwent physical examination during the same period were selected as the control group according to the 1:1 matching principle. The levels of serum HIF-1α and VEGF were compared between the two groups. The study group was treated with percutaneous coronary intervention (PCI). According to the prognosis of patients at 12 months after operation, they were divided into good subgroup and poor subgroup. The clinical data, serum HIF-1α and VEGF levels of the two subgroups were compared. The effect of serum HIF-1α and VEGF on prognosis and its predictive value were analyzed. The accuracy-recall rate (PR) curve was drawn to evaluate the performance of combined prediction. The area under the curve (AUC) was calculated, the DeLong test was used to compare AUCs, and the precision-recall (PR) curve was drawn to evaluate the performance of combined prediction. RESULTS: The levels of serum HIF-1α and VEGF in the study group were higher than those in the control group (P < 0.05). The time from onset to admission, the proportion of Killip class IV, the proportion of multivessel disease, N-terminal pro-brain natriuretic peptide (NT-proBNP), HIF-1α and VEGF in the poor subgroup were higher than those in the good subgroup, while left ventricular ejection fraction was lower (P < 0.05). Before and after correction of multivessel disease and NT-proBNP, serum HIF-1α and VEGF levels were the influencing factors of prognosis in patients with AMI (P < 0.05). The AUC of serum HIF-1α and VEGF levels alone and combined prediction were 0.717,0.748 and 0.900, respectively, the AUC of combined prediction was significantly higher than that of the two alone (Z = 3.315,2.832, P = 0.001,0.005), and the best sensitivity and specificity were 83.33% and 84.87%. The DCA curve showed that the combined prediction of serum HIF-1α and VEGF levels in the probability range of 5%-70% could obtain significant positive net benefits. The PR curve showed that the PR-AUC value of serum HIF-1α and VEGF levels in evaluating prognosis was 0.767, which had a high recall rate and accuracy rate. CONCLUSION: Serum HIF-1α and VEGF levels are highly expressed in elderly patients with AMI, and are closely related to the prognosis of patients. The combination of the two can be used to predict the prognosis of patients, provide a reference for the assessment and prognosis of elderly patients with AMI, facilitate early identification of high-risk groups, and provide a reference for subsequent personalized program development.
Comparison of preoperative and postoperative ct foot perfusion in patients undergoing infrapopliteal bypass for peripheral arterial disease.
Yaman O, Zor MH, Demirtaş H … +4 more , Kılıç ACK, Özbek SK, Öncü F, Narin M
BMC Cardiovasc Disord · 2026 Jul · PMID 42393572 · Full text
INTRODUCTION: The evaluation of revascularization at the tissue level in patients undergoing infrapopliteal bypass is challenging due to the unreliability of ankle-brachial index (ABI) measurements in patients with wides...
INTRODUCTION: The evaluation of revascularization at the tissue level in patients undergoing infrapopliteal bypass is challenging due to the unreliability of ankle-brachial index (ABI) measurements in patients with widespread arterial disease. This study investigated the potential of dynamic volume foot computed tomografhy (CT) perfusion to quantitatively assess surgical revascularization at the tissue level. MATERIALS AND METHODS: This study retrospectively reviewed 20 patients who underwent infrapopliteal bypass between January 2023 and November 2024. Of the 13 patients had chronic limb-threatening ischemia (CLTI), and 7 patients had plantar claudication. Dynamic volume perfusion CT scans were performed 1-3 days before and 7-30 days after the surgical procedure. Blood flow (BF), blood volume (BV), mean transit time (MTT), and time to maximum (Tmax) were quantitatively assessed in six different angiographic regions of the leg. Clinical findings were compared with ABI and perfusion parameters. RESULTS: Following surgical revascularization, mean BF increased by approximately 140% and BV increased by approximately 150% (p < 0.001 for all). A significant decrease in Tmax was observed (mean 1.72 s; p < 0.001). No significant change was observed in MTT (p = 0.267). Significant improvement was seen in BF, BV, and Tmax parameters in both the CLTI and plantar claudication groups. Although postoperative ABI values increased significantly (p < 0.001) no significant correlation was found between ABI and perfusion parameters. The improvement in perfusion parameters was consistent with clinical improvement. CONCLUSION: Dynamic volume perfusion CT can quantitatively demonstrate tissue-level improvement after infrapopliteal bypass. It can be used as a supportive tool in postoperative evaluation and clinical decision-making by providing data consistent with clinical findings, especially in patients where ABI measurement is unreliable.
Electroanatomical properties and high-density mapping guided targeted isolation of superior vena cava.
Maslova V, Budke H, Zaman A … +3 more , Spehlmann ME, Frank D, Lian E
BMC Cardiovasc Disord · 2026 Jul · PMID 42393551 · Full text
INTRODUCTION: Superior vena cava isolation (SVCI) is associated with complications such as sinus node (SN) and phrenic nerve (PN) injury or SVC stenosis. Our study assessed the electrophysiological properties of the SVC...
INTRODUCTION: Superior vena cava isolation (SVCI) is associated with complications such as sinus node (SN) and phrenic nerve (PN) injury or SVC stenosis. Our study assessed the electrophysiological properties of the SVC and use of high-density mapping for targeted SVCI by ablating preferential conduction sites to avoid these complications. METHODS: Eighty-three consecutive patients, undergoing HD mapping of the SVC during AF re-ablation procedures were prospectively included. Conduction block (CB) lines between the right atrium and SVC, location of the sinus node (SN) and phrenic nerve (PN), and their spatial relationship to the ablation line (AbL) were assessed. RESULTS: CB lines were present in 98% of patients, with gaps identified in all SVC segments, most frequently posterior (73%), with a median gap width of 23.9 (14.3-37.8) mm. All gaps expressed decremental properties in the EP study. Ablation was performed in 35 (42%) patients and was achieved in all cases using targeted segmental ablation, closing the gaps between the CB lines.Median ablation duration was 88 (66; 161) seconds with a median of 8 (6-12) radiofrequency applications. SN was separated from SVC with CB line in 98% of cases, what excluded necessity to ablate in this area, distance from the AbL to the SN exit zone was 8.9 (6-14.7) mm. PN was located outside the areas of preferential conduction in all cases, distance from AbL to the PN was 10.4 (6.7-12.1) mm. No complications occurred. CONCLUSIONS: HD mapping-guided, targeted segmental SVCI using RF energy is feasible and safe.
Development and validation of a prediction model for atrial fibrillation recurrence after radiofrequency ablation: integrating echocardiographic and clinical indicators.
Congying D, Muqi Y, Dinghua W … +2 more , Sheng G, Chengcheng L
BMC Cardiovasc Disord · 2026 Jul · PMID 42393548 · Full text
BACKGROUND: Radiofrequency ablation (RFA) is an established treatment for symptomatic atrial fibrillation (AF), yet post-ablation recurrence remains a significant clinical challenge. This study aimed to develop and inter...
BACKGROUND: Radiofrequency ablation (RFA) is an established treatment for symptomatic atrial fibrillation (AF), yet post-ablation recurrence remains a significant clinical challenge. This study aimed to develop and internally validate a prediction model for post-RFA AF recurrence by integrating echocardiographic parameters and clinical indicators, and to explore potential nonlinear associations of key indices for risk stratification. METHODS: A total of 532 consecutive patients who underwent first-time RFA for AF between January 2022 and October 2024 were retrospectively enrolled. The database was locked on October 31, 2025, ensuring a complete 12-month follow-up for all patients. Post-ablation recurrence was defined as any documented AF episode lasting ≥ 30 s on electrocardiogram (ECG) or 24-hour Holter monitoring, occurring after a 3-month blanking period. Independent predictors were identified by forward stepwise multivariable logistic regression (α-in = 0.05, α-out = 0.10), and a nomogram was constructed for model visualization. Internal validation was performed using 1000 bootstrap resamples. Model performance was assessed by the area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis (DCA), and clinical impact curves (CIC). Restricted cubic spline (RCS) analysis with 3 quantile knots was used to explore the non-linear associations between left atrial diameter (LAD), left atrial sphericity index (LASI) and post-ablation recurrence risk. Inter- and intra-observer consistency of echocardiographic measurements was verified by intraclass correlation coefficient (ICC). RESULTS: LAD, LASI (per 0.1 unit increase), AF duration category, and CHA₂DS₂-VASc score were identified as independent predictors of post-RFA AF recurrence (CHA₂DS₂-VASc, LAD, AF duration: all P < 0.001; LASI: P = 0.001). The model equation was: logit(p) = -9.093 + 0.281 × (CHA₂DS₂-VASc score) + 0.081 × (LAD) + 0.569 × (LASI, per 0.1 unit) + Σβk × (AF duration group). The model exhibited moderate discriminatory ability (AUC = 0.752; 95% CI: 0.708-0.796). DCA showed higher net benefit than the treat-all and treat-none strategies across threshold probabilities of 0.10-0.60, and CIC indicated that at thresholds between 0.10 and 0.30 the model identified approximately 250-330 true positive cases per 1000 patients. At the Youden‑based optimal cut-off (0.35), PPV and NPV were 48.2% and 82.5%. RCS analysis revealed a nonlinear threshold effect for LAD, with recurrence risk increasing sharply above 50 mm (inter-observer ICC = 0.92; intra-observer ICC = 0.95). For LASI, the association was predominantly linear, with a visual bend near 0.78 that lacked statistical support (nonlinearity P = 0.9516; inter-observer ICC = 0.90; intra-observer ICC = 0.93). CONCLUSIONS: This internally validated prediction model, integrating LAD, LASI, AF duration category, and CHA₂DS₂-VASc score, demonstrated moderate discrimination and adequate calibration, with higher net benefit than default strategies on decision curve analysis. LAD showed an exploratory nonlinear inflection near 50 mm, whereas LASI showed a predominantly linear association; the bend near 0.78 is only a hypothesis-generating observation. These findings require rigorous external validation before any clinical application. The nomogram offers a tool for research-oriented risk estimation, pending multicenter confirmation.
Demographic and clinical characteristics and factors associated with complications following permanent pacemaker implantation at a cardiac center in Addis Ababa, Ethiopia: a four-year retrospective record review.
Urgesa EA, Woldegeorgis BZ, Hailu M … +2 more , Shashu BA, Yadeta D
BMC Cardiovasc Disord · 2026 Jul · PMID 42393547 · Full text
BACKGROUND: Permanent cardiac pacemaker implantation is an increasingly common, lifesaving intervention for patients with symptomatic bradyarrhythmias, yet data on patient characteristics and outcomes remain limited in E...
BACKGROUND: Permanent cardiac pacemaker implantation is an increasingly common, lifesaving intervention for patients with symptomatic bradyarrhythmias, yet data on patient characteristics and outcomes remain limited in Ethiopia. This study aimed to assess the demographic and clinical characteristics of patients and the factors associated with complications following permanent pacemaker implantation at a cardiac center in Ethiopia. METHODS: This retrospective record review was conducted at Gesund Cardiac and Medical Center using a semi-structured data extraction tool to collect data from electronic medical records. A total of 159 patients who underwent pacemaker implantation between July 2018 and June 2022 were included in the study. Data were analyzed using the Statistical Package for the Social Sciences version 26.0. Descriptive statistics were used to summarize patient characteristics, and binary logistic regression was performed to identify factors associated with complications, after checking model fitness and assessing multicollinearity. Adjusted odds ratio with 95% confidence interval was used as an indicator of the strength of association, and statistical significance was set at a P-value < 0.05. RESULTS: The mean (± standard deviation) age of patients was 70 ± 10.9 years, and more than half, 90 (56.6%), were female. Fatigue was the most common presenting symptom (135, 84.9%). Comorbidities were present in 139 (87.4%) of patients, with systemic hypertension being the most common, accounting for 119 (74.8%). Complications occurred in 13 (8.2%) of patients, with hematoma and pocket-site infection being the most common, each observed in three (1.9%) patients. Pneumothorax, deep vein thrombosis and death each occurred in two (1.3%) patients, while lead dislodgement was observed in one (0.6%) patient. Diabetes mellitus (DM) was significantly associated with increased odds of developing complications (adjusted odds ratio: 3.85; 95% confidence interval: 1.11-13.38; P = 0.03). CONCLUSIONS: Permanent pacemaker implantation was performed predominantly in elderly female patients. The overall complication rate was relatively low, and DM was identified as a significant independent factor associated with complications. Close monitoring and tailored management of DM patients are recommended to minimize complication risk, improve procedural outcomes, and inform clinical protocols at cardiac centers in Ethiopia and similar resource-limited settings.
Development and validation of a triglyceride-glucose index-based nomogram for predicting risk in STEMI patients undergoing primary PCI.
Huang J, Zhang J, Li L … +8 more , Chen M, Li Y, Yu X, Dong S, Wang Q, Chen J, Yang Q, Xu S
BMC Cardiovasc Disord · 2026 Jul · PMID 42393542 · Full text
BACKGROUND: The triglyceride-glucose (TyG) index, a widely recognized surrogate marker of insulin resistance, has been extensively studied in the context of cardiovascular diseases. This study aimed to develop and valida...
BACKGROUND: The triglyceride-glucose (TyG) index, a widely recognized surrogate marker of insulin resistance, has been extensively studied in the context of cardiovascular diseases. This study aimed to develop and validate a nomogram that predicts the prognosis of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), utilizing the TyG index alongside readily available clinical data. METHODS: This retrospective study analyzed 1022 STEMI patients, divided into a training cohort (n = 715) and a validation cohort (n = 307). Potential risk factors were identified, and a predictive nomogram was constructed using least absolute shrinkage and selection operator (LASSO)-penalized Cox regression. Model performance was evaluated through receiver operating characteristic (ROC) curve analysis, calibration plots, Harrell's C-index, and decision curve analysis (DCA). RESULTS: The nomogram incorporated five predictors: residual SYNTAX score (rSS), number of affected coronary vessels (VDn), high-sensitivity C-reactive protein (hsCRP), TyG index, and B-type natriuretic peptide (BNP). Harrell's C-index values of 0.73 (95% CI: 0.70-0.75) in the training cohort and 0.80 (95% CI: 0.76-0.83) in the validation cohort demonstrated strong discrimination. The area under the curve (AUC) for 1-year and 2-year major adverse cardiovascular events (MACE) predictions were 0.77 and 0.77 in the training cohort, and 0.86 and 0.85 in the validation cohort, highlighting excellent predictive accuracy. Subgroup analysis confirmed consistent model performance across age groups (< 65 years and ≥ 65 years), with AUC values ranging from 0.74 to 0.87. Calibration plots demonstrated excellent agreement between predicted and observed outcomes, and DCA highlighted the model's clinical utility by quantifying net benefits across a range of threshold probabilities. CONCLUSIONS: This study developed and validated a novel predictive nomogram that integrates the TyG index with key inflammatory (hsCRP), anatomical (rSS and VDn), and functional (BNP) markers to stratify MACE risk in STEMI patients after PCI. The model demonstrated robust predictive performance and clinical utility, offering a practical tool for precise risk stratification and facilitating personalized treatment strategies to improve long-term outcomes.
Relationship between serum phosphate trajectories and mortality in patients with acute myocardial infarction: a retrospective cohort study based on the MIMIC-IV database.
Huang S, Wang W, Tang K … +1 more , Huang S
BMC Cardiovasc Disord · 2026 Jul · PMID 42393537 · Full text
BACKGROUND: Serum phosphate concentrations have been shown to significantly predict clinical outcomes among critically ill populations; however, their association with mortality following acute myocardial infarction (AMI...
BACKGROUND: Serum phosphate concentrations have been shown to significantly predict clinical outcomes among critically ill populations; however, their association with mortality following acute myocardial infarction (AMI) is not well established. This research seeks to examine how early trajectories of serum phosphate relate to prognosis in individuals diagnosed with AMI. METHODS: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A latent growth mixture modeling (LGMM) approach was utilized to examine changes in mean serum phosphate concentrations, which were assessed at 24-hour intervals during the initial 96-hour period following intensive care unit (ICU) admission among AMI patients, thereby classifying their longitudinal trajectory profiles. Using a landmark analysis design, we applied Cox proportional hazards regression models to evaluate the association between trajectory patterns and mortality after the 96-hour landmark. To evaluate the incremental prognostic value of phosphate trajectories beyond conventional clinical variables, Harrell's C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated. RESULTS: This study included 1,522 patients with AMI. The LGMM model classified serum phosphate trajectories into three distinct patterns. Patients with different trajectories exhibited significant differences in prognosis. Compared with Trajectory 1 (normal stable), patients in Trajectory 3 (persistently elevated) had the poorest prognosis, with significantly increased 28-day mortality risk after the landmark (HR = 1.60, 95% CI: 1.21-2.11; P = 0.001) and 1-year mortality risk after the landmark (HR = 1.71, 95% CI: 1.33-2.20; P < 0.001). For Trajectory 2 (highly fluctuating), the association with 28-day mortality after the landmark was not statistically significant in the fully adjusted model, while the risk for 1-year mortality after the landmark remained significantly elevated (adjusted HR = 1.42, 95% CI: 1.04-1.94; P = 0.026). The addition of phosphate trajectories provided modest but significant improvement in risk discrimination(ΔC = 0.007, IDI and NRI both P < 0.05). Similar improvements were observed for 1-year mortality after the landmark. CONCLUSION: Persistently elevated serum phosphate trajectories during the early ICU period were associated with increased short-term and long-term mortality in patients with AMI. These findings suggest that dynamic monitoring of serum phosphate may provide additional prognostic information beyond traditional clinical indicators. However, given the observational design and the requirement for survival during the initial 96-hour trajectory window, the findings should be interpreted as associations rather than causal relationships.
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