BMC Cardiovascular Disorders[JOURNAL]
Sun
200 papers
Prognostic value of the NAPLES score in patients undergoing LVAD implantation: comparison with established nutritional indices.
Karaçam M, Tanyeri S, Güneş A … +9 more , Kültürsay B, Kaya A, Kovancı T, İgit F, Çiçek V, Doğan C, Gürcü E, Kırali K, Acar RD
BMC Cardiovasc Disord · 2026 Jul · PMID 42393531 · Full text
BACKGROUND: Nutritional status plays a critical role in patients with advanced heart failure (HF) undergoing left ventricular assist device (LVAD) implantation. However, the comparative prognostic value of different nutr...
BACKGROUND: Nutritional status plays a critical role in patients with advanced heart failure (HF) undergoing left ventricular assist device (LVAD) implantation. However, the comparative prognostic value of different nutritional and inflammatory indices in this population remains unclear. The present study aimed to evaluate the prognostic value of the NAPLES score and compare its performance with other established nutritional and inflammatory indices in patients undergoing LVAD implantation. METHODS: We retrospectively analyzed consecutive patients who underwent LVAD implantation at a tertiary center. Nutritional indices, including the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score and NAPLES score, were calculated using preoperative laboratory data. The primary outcome was all-cause mortality. Competing risk analyses were performed using Fine-Gray models, accounting for heart transplantation as a competing event. Multivariable models were adjusted for clinically relevant covariates. RESULTS: A total of 190 patients were included. During follow-up, all-cause mortality occurred more frequently in patients with higher NAPLES scores. In univariate analysis, several nutritional indices were associated with mortality; however, in multivariable analysis, the NAPLES score remained the most robust predictor. Patients in the high NAPLES group had a significantly increased risk of mortality compared to those in the low-risk group. When analyzed as a continuous variable, higher NAPLES scores were independently associated with increased mortality risk. In contrast, the predictive value of CONUT and HALP scores was attenuated after adjustment. CONCLUSIONS: Among commonly used nutritional and inflammatory indices, the NAPLES score demonstrated the strongest and most consistent association with all-cause mortality in patients undergoing LVAD implantation. Incorporating the NAPLES score into routine preoperative assessment may improve risk stratification in this high-risk population.
Clinical observation of renal artery stenosis treated with PCSK9 inhibitor.
Zhao F, Gao Q, Jiang B … +3 more , Li H, Wu Y, Yang W
BMC Cardiovasc Disord · 2026 Jul · PMID 42393528 · Full text
BACKGROUND: Renal artery stenosis (RAS) is a major cause of atherosclerotic secondary hypertension, and interventional therapy carries notable risks. This study evaluated the effects of the PCSK9 inhibitor evolocumab plu...
BACKGROUND: Renal artery stenosis (RAS) is a major cause of atherosclerotic secondary hypertension, and interventional therapy carries notable risks. This study evaluated the effects of the PCSK9 inhibitor evolocumab plus statin therapy on lipid profiles, renal artery hemodynamics, and renal function in patients with coronary artery disease (CAD) and RAS. METHODS: In this single-center retrospective cohort, 57 CAD patients with RAS (July 2019-May 2025) underwent bilateral renal artery ultrasonography and ≥ 1 month follow-up. Patients received either PCSK9 inhibitor therapy (n = 25; evolocumab 140 mg biweekly + atorvastatin 20 mg/day) or standard statin therapy alone (n = 32; atorvastatin 20 mg/day as control). Changes in LDL-C, TC, TG, Lp(a), serum creatinine (Cr), and RAU_RRA/RAU_LRA were compared. Analyses included hierarchical clustering, principal component analysis (PCA), t-tests, and Spearman correlation. RESULTS: Between-group comparisons after treatment showed that the combination therapy group was significantly superior to the control group in terms of lipids, creatinine, and renal artery parameters (all P < 0.05), while Lp(a) showed an increasing trend. Within-group pre-post comparisons showed improving trends in various indicators, but only some lipid parameters reached statistical significance. CONCLUSION: In this exploratory study, evolocumab plus statin was associated with improved lipids, renal artery hemodynamics, and potential renal benefit. Due to the small sample size, non-randomized design, and non-significant within-group creatinine change, results should be interpreted cautiously and validated in prospective studies.
Risk factor target achievement in relation to incident cardiovascular disease among individuals with cardiovascular-kidney-metabolic syndrome stage 1-3: results from a nationwide cohort study.
He BB, Wu GY
BMC Cardiovasc Disord · 2026 Jul · PMID 42387418 · Full text
BACKGROUND AND OBJECTIVE: The association between risk factor target achievement and the risk of incident cardiovascular disease (CVD) among individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 1-3 rema...
BACKGROUND AND OBJECTIVE: The association between risk factor target achievement and the risk of incident cardiovascular disease (CVD) among individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 1-3 remains unclear. We investigated this association within the China Health and Retirement Longitudinal Study (CHARLS) cohort. METHODS: This study included 6,501 individuals with CKM stages 1-3. The exposure of interest was the number of risk factor targets achieved at baseline, including systolic blood pressure (SBP) < 130 mm Hg, fasting blood glucose < 6.1 mmol/L, low-density lipoprotein cholesterol (LDL-C) < 2.6 mmol/L, and moderate-to-vigorous physical activity. Cox proportional hazards regression models were used to analyse the association between the number of targets achieved and the risk of CVD. RESULTS: During a median follow-up of 9.0 years, 1,221 incident CVD events and 539 stroke events were documented. Compared with participants achieving no risk factor targets at baseline, those achieving all four targets had a significantly lower risk of both CVD (adjusted hazard ratio [aHR]: 0.40, 95% CI: 0.26-0.62) and stroke (aHR: 0.39, 95% CI: 0.20-0.75). Stratified analyses indicated that the inverse association between the number of achieved targets and CVD risk was stronger among participants younger than 60 years than among those aged 60 years or older (P for interaction < 0.05). CONCLUSION: A greater number of risk factor targets achieved at baseline was associated with a lower subsequent risk of CVD in individuals with CKM stages 1-3.
Association of routine inflammatory biomarkers and derived indices with heart failure progression in preserved ejection fraction.
Zorlu Ç, Ömür SE, Yılmaz V … +1 more , Güngör G
BMC Cardiovasc Disord · 2026 Jul · PMID 42387409 · Full text
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is driven by systemic inflammation, yet the prognostic utility of routine inflammatory biomarkers and derived indices remains underexplored. This study e...
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is driven by systemic inflammation, yet the prognostic utility of routine inflammatory biomarkers and derived indices remains underexplored. This study evaluates the association of high-sensitivity C-reactive protein (hsCRP), albumin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), and pan-immune-inflammatory value (PIV) with HFpEF outcomes. METHODS: In a retrospective cohort of 312 HFpEF patients (mean age 72.6 ± 10.1 years, 54% female) from Tokat Gaziosmanpasa University Hospital (2018-2022), we analyzed baseline and longitudinal trends in biomarkers using electronic health records. Multivariable Cox models assessed associations with heart failure hospitalization and all-cause mortality, with subgroup analyses in obese, diabetic, and high-inflammatory (hsCRP > 3 mg/L) patients. A composite inflammatory score (hsCRP, SII, PIV) was evaluated for predictive accuracy. RESULTS: Over a median 22-month follow-up, 82 patients (26.3%) experienced hospitalization, and 48 (15.4%) died. Baseline hsCRP (HR 1.09 per mg/L, p = 0.011), NLR (HR 1.14 per unit, p = 0.002), and lower albumin (HR 0.68 per g/dL, p = 0.020) predicted hospitalization, as did longitudinal increases in hsCRP and NLR (p < 0.001). SII and PIV were significant in diabetic and high-inflammatory subgroups, respectively. The composite score improved hospitalization prediction (AUC 0.78 vs. 0.71 for hsCRP, p = 0.042). CONCLUSION: Routine inflammatory biomarkers, particularly their longitudinal trends, predict HFpEF progression. The composite score offers a practical tool for risk stratification, guiding personalized management in community settings.
Measuring left ventricular global longitudinal strain in different contrast-enhanced echocardiography modes: a feasibility study.
Zhu J, Miao Y, Zhou H … +6 more , Han G, Wang J, Tong Q, Zhang X, Wang X, Yin H
BMC Cardiovasc Disord · 2026 Jul · PMID 42387403 · Full text
BACKGROUND: Left ventricular global longitudinal strain (LVGLS) is an important parameter to evaluate left ventricular (LV) systolic function, which is more sensitive and reproducible than left ventricular ejection fract...
BACKGROUND: Left ventricular global longitudinal strain (LVGLS) is an important parameter to evaluate left ventricular (LV) systolic function, which is more sensitive and reproducible than left ventricular ejection fraction (LVEF). However, whether LVGLS can be accurately measured with ultrasound enhancing agent (UEA) remains controversial. The aim of this study was to verify the feasibility and reproducibility of LVGLS in different contrast-enhanced echocardiography (CE) modes. METHODS: Two-dimensional speckle tracking echocardiography (2D-STE) was used to measure LVGLS on 75 patients included in this study. Patients were divided into optimal group (n = 33) and suboptimal group (n = 42) according to image quality. LVGLS measurements were performed in 2D mode, left ventricular opacification (LVO) mode, and myocardial contrast echocardiography (MCE) mode. 2D mode LVGLS measurements of the optimal group were used as a reference standard. The comparisons among different modes of each group included Bland-Altman analysis, linear regression and intra-class correlation (ICC). 20 patients were randomly selected from each group to analyze the inter- and intra-observer variability. RESULTS: The LVO and MCE modes of optimal group had similar LVGLS measurements with 2D mode (-14.30 ± 4.73% vs. -15.32 ± 4.78% vs. -15.36 ± 5.41%, ICC: 0.814 vs. 0.781, P < 0.001). There was good agreement between LVO and MCE mode in two groups (ICC: 0.855 vs. 0.935, P < 0.001). In suboptimal group, both LVO and MCE mode had poor agreement with 2D mode in terms of LVGLS measurements (-13.86 ± 5.46% vs. -15.39 ± 7.74% vs. -15.66 ± 7.78%, ICC: 0.739 vs. 0.687 P < 0.001). CE improved inter-observer variability in suboptimal group (ICC: 0.630 vs. 0.864 vs. 0.830, P = 0.022, P < 0.001, P = 0.001, respectively). CONCLUSIONS: It is feasible to measure LVGLS in different CE modes, even in patients with suboptimal acoustic windows, which can reduce the impact of image quality on LVGLS measurements.
Veno-arterial ECMO in fulminant myocarditis: a retrospective single-center case series.
Mercado-Díaz M, Quecano-Rosas C, Tuta-Quintero E … +5 more , Cortes-Salinas J, Garzon-Ruiz J, Mercado-Rey K, Poveda-Henao C, Robayo-Amortegui H
BMC Cardiovasc Disord · 2026 Jul · PMID 42387399 · Full text
INTRODUCTION: Fulminant myocarditis (FM) is a life-threatening condition that may require veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Evidence from Latin America remains limited. METHODS: We conducted a...
INTRODUCTION: Fulminant myocarditis (FM) is a life-threatening condition that may require veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Evidence from Latin America remains limited. METHODS: We conducted a retrospective case series of adult patients with FM requiring VA-ECMO support at a high-complexity center. Clinical, hemodynamic, metabolic, and echocardiographic variables were analyzed descriptively. RESULTS: This case series included 16 patients with a mean age of 39.03 years (SD 12.93), with an equal number of male and female patients. Twenty-eight-day survival was 68.75% (11/16). According to the Charlson Comorbidity Index, 70% (11/16) of the patients had a score of 0. The median survival after veno-arterial ECMO (SAVE) score was 1.5 (interquartile range [IQR] 1-3). Lactate levels and vasoactive-inotropic score (VIS) reduced from 3.79 (IQR: 1.68-8.46) mmoL/L and 68 (IQR: 54-113) pre-ECMO to 1.52 (IQR: 1.26-2.03) mmoL/L and 20 (IQR: 13-45) post-ECMO, respectively. In contrast, PaO₂/FiO₂ ratio, left ventricular ejection fraction, and fractional area change (FAC) increased from 186 (IQR: 126-245) mmHg, 16.5% (IQR: 10%-34%), and 29.5% (IQR: 19-33) pre-ECMO to 260 (IQR: 178-307) mmHg, 51.5% (IQR: 45%-55%), and 42% (IQR: 37-45) post-ECMO, respectively. Complications included renal events in 56.25% (9/16), bleeding 37.5% (6/16), cardiovascular complications in 31.25% (5/16) and infectious complications in 33.33% (5/16) of the participants. CONCLUSIONS: In this cohort of patients with FM supported with VA-ECMO, changes in hemodynamic, metabolic, and echocardiographic parameters were observed following support initiation, with survival rates comparable to prior reports.
The prognostic value of the prognostic nutritional index for short- and long-term outcomes in coronary care unit patients.
Zhang Q, Song D, Wu C … +4 more , Hu Z, Xue Y, Ji K, Chen Y
BMC Cardiovasc Disord · 2026 Jul · PMID 42387392 · Full text
BACKGROUND: Systemic inflammation is associated with the outcomes of coronary care unit (CCU) patients. We sought to assess the prognostic implication of the prognostic nutritional index (PNI), a surrogate marker of infl...
BACKGROUND: Systemic inflammation is associated with the outcomes of coronary care unit (CCU) patients. We sought to assess the prognostic implication of the prognostic nutritional index (PNI), a surrogate marker of inflammation in CCU patients. METHODS: The study included 1,158 participants from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and 342 from the Second Affiliated Hospital of Wenzhou Medical University (WMU), participants were subsequently grouped based on the PNI threshold. Key endpoints were 30-day mortality and major adverse cardiovascular events (MACEs) at 1-year follow-up and were examined with propensity score matching (PSM) and Cox regression analysis. The prognostic implications of PNI and other inflammatory markers were compared using an area under the curve (AUC). RESULTS: A total of 285 participants in the MIMIC-IV cohort developed 30-day mortality, and 139 developed MACEs in WMU, of which 103 (30.12%) died, 19 (5.56%) experienced non-fatal myocardial infarction, and 29 (8.48%) experienced non-fatal stroke. PNI was significantly associated with short-term mortality (HR 0.64, 95% CI: 0.48-0.87; HR 0.62, 95% CI: 0.42-0.92) and MACEs (HR 0.56, 95% CI: 0.36-0.87; HR 0.44, 95% CI: 0.23-0.88). PNI exhibited a negative correlation with the C-reactive protein (CRP)/NRS-2002 score according to Spearman's analysis. Notably, PNI exhibited a slightly higher AUC (0.70) than other inflammatory markers, although the difference was modest. Adding PNI to sequential organ failure assessment yielded an AUC of 0.818, marginally higher than SOFA alone (AUC = 0.805; P < 0.05), suggesting a modest but statistically significant improvement in discrimination. CONCLUSION: PNI emerges as a potential prognostic marker for anticipating adverse outcomes in CCU patients, the intrinsic cause may attribute to malnourished status and inflammation.
Prognostic value of the TAPSE/PASP-ratio in patients with severe mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair.
Ausbuettel F, Kano F, Patsalis N … +3 more , Fichera C, Divchev D, Fichera CF
BMC Cardiovasc Disord · 2026 Jul · PMID 42387387 · Full text
BACKGROUND: Transcatheter edge-to-edge mitral valve repair (M-TEER) represents an effective treatment modality for high-grade mitral valve regurgitation. The right ventricle (RV) to pulmonary artery (PA) coupling ratio h...
BACKGROUND: Transcatheter edge-to-edge mitral valve repair (M-TEER) represents an effective treatment modality for high-grade mitral valve regurgitation. The right ventricle (RV) to pulmonary artery (PA) coupling ratio has been indicated as a marker of right ventricular dysfunction (RVD), but evidence among M-TEER patients remains inconsistent to date due to divergent definitions. We therefore aimed to shed light on the impact of RV-PA uncoupling on survival following M-TEER. METHODS: Data from all patients who underwent M-TEER and provided sufficient echocardiographic data were investigated. RV-PA uncoupling was defined as the ratio of tricuspid annular pulse systolic excursion (TAPSE) and to the Doppler echocardiographic-derived pulmonary artery systolic pressure (D-PASP) < 0.37 mm/mmHg. The difference in long-term survival between patients with and without RV-PA uncoupling were analyzed via the Kaplan-Meier method, and independent predictors of mortality were identified via uni- and multivariable Cox regression analyses. RESULTS: A total of 158 patients were eligible for analysis, and RV-PA uncoupling was present in 32.3% of the patients (51/158). Patients with RV-PA uncoupling presented significantly advanced congestive heart failure stages. While M-TEER was performed equally safely in patients with RV-PA uncoupling (odds ratio for procedural success: 0.95, 95% confidence interval [CI] 0.29-2.77, p = 0.9), their long-term survival three years after M-TEER was significantly worse (50.9% (26/51) vs. 61.7% (66/107), p = 0.01). In this regard, a TAPSE/D-PASP ratio < 0.37 mm/mmHg proved to be a more consistent discriminator of long-term survival than a TAPSE < 18 mm alone. CONCLUSION: RV-PA uncoupling, defined as a TAPSE/D-PASP ratio of < 0.37 mm/mmHg, is a feasible and reproducible parameter, which also serves as a marker for advanced congestive heart failure and worse survival outcomes.
Frailty and prefrailty are associated with increased risk of aortic aneurysm but not aortic dissection: a prospective cohort study of UK biobank participants.
Yang M, Zhang J, Chen J … +8 more , Teng Y, Ye X, Li Q, Zhang L, Zhang K, Wang Y, Dang A, Feng W
BMC Cardiovasc Disord · 2026 Jul · PMID 42387383 · Full text
BACKGROUND: Frailty is a well-established determinant of adverse outcomes in patients with aortic disease, but its role in incident aortic aneurysm (AA) and aortic dissection (AD) remains unclear. We examined the associa...
BACKGROUND: Frailty is a well-established determinant of adverse outcomes in patients with aortic disease, but its role in incident aortic aneurysm (AA) and aortic dissection (AD) remains unclear. We examined the associations of frailty with long-term risks of AA and AD in a large community-based cohort. METHODS: We included 474,302 UK Biobank participants free of AA/AD at baseline. Frailty was assessed using physical frailty and the frailty index, categorized as non-frail, prefrail, or frail. The primary outcomes were AA, with secondary outcomes, including abdominal AA (AAA), thoracic AA (TAA) and AD, ascertained through linkage to hospital and death records. RESULTS: During a median follow-up of 15.1 years, 3,675 AA, 2,289 AAA, 1,114 TAA, and 310 AD events occurred. After multivariable adjustment, both prefrailty (physical frailty: HR 1.24, 95% CI 1.16-1.33; frailty index: HR 1.67, 95% CI 1.55-1.80) and frailty (physical frailty: HR 1.50, 95% CI 1.28-1.76; frailty index: HR 2.22, 95% CI 1.96-2.51) were associated with higher risk of AA versus non-frailty. Similar results were observed for AAA. For TAA, the frailty index remained significant (prefrailty: HR 1.47, 95% CI 1.29-1.67; frailty: HR 1.61, 95% CI 1.25-2.07), whereas physical frailty was not. Neither frailty measure was associated with AD. Subgroup analyses suggested stronger associations for AAA in younger participants and those without diabetes. CONCLUSIONS: Frailty was associated with a higher risk of incident AA, particularly AAA, but not AD. Frailty assessment may help improve phenotype-specific risk stratification and inform preventive strategies for aortic disease.
Age, rather than hypertension duration, drives coronary endothelial degradation: an in situ post-mortem analysis.
Samchuk O, Panasyuk Y, Bardash V … +3 more , Zolotukhin O, Sklyarov E, Skrypnyk I
BMC Cardiovasc Disord · 2026 Jul · PMID 42380896 · Full text
BACKGROUND: Arterial hypertension drives coronary vascular remodeling, yet disentangling the independent effects of physiological aging and chronic hemodynamic overload on the endothelium (CD31) and glycocalyx (CD138) in...
BACKGROUND: Arterial hypertension drives coronary vascular remodeling, yet disentangling the independent effects of physiological aging and chronic hemodynamic overload on the endothelium (CD31) and glycocalyx (CD138) in situ remains challenging. Most clinical studies evaluate soluble circulating markers, while direct morphological evidence of tissue-level spatial degradation is scarce. METHODS: This observational post-mortem study evaluated coronary artery fragments from 30 deceased patients (10 controls, 20 with essential hypertension) using immunohistochemistry and digital pathology. To mitigate confounding bias caused by age discrepancies and acute pre-mortem systemic stressors in the control group (e.g., fatal trauma), multivariable linear regression modeling with robust standard errors was applied exclusively to the hypertensive cohort to isolate the independent impacts of chronological age and hypertension duration. RESULTS: Within the hypertensive cohort, chronological age emerged as a significant independent factor inversely associated with CD31 expression area (β = -0.74, 95% CI: -0.98 to -0.50, p = 0.016). The duration of hypertension was not independently associated with CD31 loss (p = 0.076). Furthermore, the multivariable model for CD138 did not reach overall statistical significance (for age: β = -0.17, 95% CI: -0.42 to 0.07, p = 0.200; for hypertension duration: β = 0.21, 95% CI: -0.06 to 0.48, p = 0.130). However, a robust positive correlation was observed between CD31 and CD138 tissue expression levels (R = 0.50, p = 0.025), indicating synchronized structural degradation. CONCLUSIONS: Chronological age, rather than the chronicity of hypertension, is significantly associated with reduced CD31 expression in the coronary arteries of hypertensive patients. The positive correlation between CD31 and CD138 expression highlights a synchronized spatial degradation of the endothelium and its protective glycocalyx. These findings highlight the critical necessity of isolating physiological senescence from pathological remodeling in vascular research.
Association of serum essential and non-essential elements with dyslipidemia in patients with cardiovascular disease in Western Iran: an application of Bayesian kernel machine regression.
Nakhaee S, Manoochehri Z, Mahjoubian M … +2 more , Khodamoradi M, Mansouri B
BMC Cardiovasc Disord · 2026 Jun · PMID 42380862 · Full text
BACKGROUND: Dyslipidemia poses a significant challenge to public health worldwide. Many researchers have suggested that nutritional and environmental factors contribute to dyslipidemia. This study aimed to examine the re...
BACKGROUND: Dyslipidemia poses a significant challenge to public health worldwide. Many researchers have suggested that nutritional and environmental factors contribute to dyslipidemia. This study aimed to examine the relationship between serum levels of selected essential and non-essential elements, calcium (Ca), cobalt (Co), magnesium (Mg), potassium (K), lithium (Li), boron (B), and aluminum (Al) and dyslipidemia. Additionally, we aimed to explore the interactions between these elements in various mixtures using the Bayesian Kernel Machine Regression (BKMR) model. METHODS: This cross-sectional analytical study was conducted among the Kurdish population in western Iran, using data from the Ravansar non-communicable diseases (RaNCD) study. A total of 224 participants aged between 35 and 65 years were included. Data collection included demographic information and blood samples, which were analyzed for selected elements using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). We applied logistic regression and BKMR models to analyze the effects of the studied serum elements on dyslipidemia. RESULTS: Among 224 participants, dyslipidemia prevalence was 54.9%, higher in cardiovascular disease (CVD) patients (61.8%) than in non-CVDs (49.2%). Individuals with dyslipidemia had significantly higher age, body mass index (BMI), and blood pressure, while no significant differences were found in sex, residence, marital status, or education level. The logistic regression analysis, after adjusting for confounding factors in the CVD subgroup, indicated that higher serum Ca concentrations were associated with higher odds of dyslipidemia compared with lower concentrations. In contrast, higher serum Co and Mg concentrations were associated with lower odds of dyslipidemia. The BKMR model revealed that the serum levels of B in all subjects, and K, Co, and Ca in the CVD group, as well as B and Co in the non-CVD group, exhibited the highest posterior inclusion probability (PIP) values. CONCLUSION: This study suggests a potential association between serum levels of Ca, Co, Mg, and dyslipidemia in a representative sample of patients with CVD.
Arterial stiffness in patients with moderate to severe psoriasis on long term treatment with infliximab.
Hagenes JS, Linde A, Tveit KS … +2 more , Kringeland E, Midtbø H
BMC Cardiovasc Disord · 2026 Jul · PMID 42380859 · Full text
BACKGROUND: Systemic anti-inflammatory therapies reduce arterial stiffness during short term treatment in patients with psoriasis, but less is known about their long-term effects. We assessed arterial stiffness in patien...
BACKGROUND: Systemic anti-inflammatory therapies reduce arterial stiffness during short term treatment in patients with psoriasis, but less is known about their long-term effects. We assessed arterial stiffness in patients with psoriasis on long-term treatment with infliximab. METHODS: Forty-eight patients with psoriasis (age 46 ± 14 years, 31% women) receiving treatment with infliximab were matched to 103 controls based on age, sex and body mass index (BMI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Psoriasis severity was assessed by the psoriasis area and severity index (PASI). RESULTS: The patients had been treated with infliximab for 4.9 ± 3.9 years and 85% were also treated with methotrexate. Current PASI-score was 0.79 ± 0.75, indicating well treated psoriasis. The prevalence of metabolic syndrome (42%), hypertension (50%) and diabetes (4%) were similar between patients and controls, while a higher proportion of patients were smokers (40% vs. 16%, p = 0.003). Average cfPWV was 7.9 ± 1.6 m/s in the psoriasis group and 7.3 ± 1.5 m/s in the control group (p = 0.049), both reflecting normal values. In multivariable linear regression analysis in the total study population, having psoriasis remained associated with higher cfPWV (β 0.40, p = 0.010) after adjusting for age, sex, systolic blood pressure (SBP), heart rate, BMI and smoking. In patients with psoriasis, higher SBP (β 0.33, p = 0.009) and BMI (β 0.27, p = 0.021) were associated with higher cfPWV after adjustment for PASI score, age and sex. CONCLUSION: In patients with psoriasis on long-term treatment with systemic therapies, arterial stiffness was slightly higher than in matched controls, despite excellent response to treatment and low PASI score.
Conservative management of iatrogenic pulmonary vein obstruction following transcatheter sinus venosus ASD repair: a case insight and literature review.
Khajali Z, Kian N, Firouzi A … +2 more , Pouraliakbar H, Salari S
BMC Cardiovasc Disord · 2026 Jul · PMID 42380818 · Full text
BACKGROUND: Iatrogenic pulmonary vein obstruction (PVO) is a rare but serious complication that may occur following transcatheter correction of sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary...
BACKGROUND: Iatrogenic pulmonary vein obstruction (PVO) is a rare but serious complication that may occur following transcatheter correction of sinus venosus atrial septal defect (SVASD) with partial anomalous pulmonary venous connection (PAPVC) using covered stents. This procedure has gained increasing acceptance in recent years. The optimal management strategy, particularly the role of conservative therapy, remains poorly defined. A 42-year-old man with a 1.5 × 1.0 cm superior vena cava (SVC)-type SVASD, PAPVC, and severe pulmonary arterial hypertension (PAH) underwent transcatheter repair after six months of targeted vasodilator therapy. Under fluoroscopic and transesophageal echocardiographic (TEE) guidance, a 57 mm long Optimus-CVS PTFE-covered XXL stent (AndraTec, Germany) was deployed, internally telescoped with a 45 mm long bare-metal CP stent (NuMED, USA) for cranial anchoring. Intra-procedural TEE showed correct stent position and unobstructed pulmonary venous flow. However, 24 h later, the patient developed acute hypoxemia. Computed tomography angiography revealed complete occlusion of the anterior segment of the right upper pulmonary vein with associated thrombosis. Because the patient remained hemodynamically stable, conservative management was initiated with corticosteroids, diuretics, and therapeutic anticoagulation (apixaban plus aspirin). Within five days, oxygen saturation normalized to 90% on room air, and chest imaging confirmed resolution of pulmonary infiltrates. Follow-up at six months showed a stable stent position and no residual obstruction. CONCLUSION: PVO following transcatheter SVASD repair may not be diagnosed immediately after stent deployment, as it can present with delayed onset due to progressive thrombosis formation. Normal intra-procedural imaging does not exclude subsequent PVO, and vigilant post-procedural monitoring is essential. In carefully selected, hemodynamically stable patients, conservative management with corticosteroids, anticoagulation, and diuretics can lead to complete clinical and radiographic recovery, restoring pulmonary venous drainage and potentially avoiding reintervention or surgery.
Staged TAVR and TEER for complex multivalvular disease in advanced heart failure: a case report.
Deng H, Li Y, Zhao C … +5 more , Zhou B, Zhou Y, Wang L, Xuan Q, Qian X
BMC Cardiovasc Disord · 2026 Jun · PMID 42380813 · Full text
BACKGROUND: Multivalvular heart disease complicated by advanced heart failure in elderly patients represents a major therapeutic challenge, particularly in the presence of complex anatomy, severe ventricular remodeling,...
BACKGROUND: Multivalvular heart disease complicated by advanced heart failure in elderly patients represents a major therapeutic challenge, particularly in the presence of complex anatomy, severe ventricular remodeling, and high surgical risk. Staged transcatheter strategies may offer a less invasive and individualized therapeutic alternative. An elderly patient with end-stage heart failure and severe ventricular remodeling was diagnosed with Sievers type I bicuspid aortic valve with mixed stenosis and severe regurgitation, complicated by functional moderate-to-severe mitral regurgitation. Given the patient's high surgical risk (STS-PROM 12%; EuroSCORE II 15%), a staged transcatheter strategy was adopted. Transfemoral TAVR was first performed with good prosthetic valve function and clinical improvement. Due to persistent symptomatic functional MR, subsequent transcatheter edge-to-edge repair (TEER) was performed three months later, resulting in significant MR reduction, symptomatic improvement, and favorable hemodynamic outcomes at follow-up. DISCUSSION: This case demonstrates the feasibility and clinical value of a staged transcatheter strategy in high-risk elderly patients with complex multivalvular disease and advanced heart failure. Sequential intervention allows reassessment of residual valve pathology, reduces procedural complexity, and lowers procedural risk compared with simultaneous multivalvular intervention. TAKE-HOME MESSAGE: A staged transcatheter strategy combining TAVR followed by TEER represents a safe, feasible, and effective therapeutic option for selected high-risk patients with complex multivalvular disease and advanced heart failure, offering individualized treatment and meaningful symptomatic improvement when surgical risk is prohibitive.
'Aspirin versus ticagrelor for the management after coronary revascularization - a systematic review and meta‑analysis of randomised trials'.
Regmi DR, Regmi S, Upreti S … +1 more , Gautam N
BMC Cardiovasc Disord · 2026 Jul · PMID 42380776 · Full text
OBJECTIVE: To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization. METHODS: We conducted a systematic review...
OBJECTIVE: To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization. METHODS: We conducted a systematic review and meta-analysis of RCTs comparing ticagrelor monotherapy with aspirin monotherapy after PCI or CABG. MEDLINE, Embase, Cochrane Central, Scopus, ClinicalTrials.gov and Google Scholar were searched up to 19th January 2026. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction and stroke. Secondary outcomes included all-cause mortality, myocardial infarction, stroke, major bleeding, repeat revascularization and stent thrombosis. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model with restricted maximum likelihood estimation and Knapp-Hartung adjustment. RESULTS: Five randomised trials involving 25,994 participants were included, of whom 12,998 received ticagrelor monotherapy and 12,996 received aspirin monotherapy. Ticagrelor monotherapy was associated with a significantly lower risk of MACE than aspirin monotherapy (RR 0.86, 95% CI 0.78 to 0.95; p = 0.012; I² = 0%). All-cause mortality was also reduced with ticagrelor (RR 0.86, 95% CI 0.77 to 0.97; p = 0.023; I² = 0%). No significant differences were observed for myocardial infarction (RR 0.87, 95% CI 0.70 to 1.07; p = 0.138; I² = 0%), stroke (RR 1.01, 95% CI 0.85 to 1.19; p = 0.913; I²=0%), major bleeding (RR 1.00, 95% CI 0.84 to 1.20; p = 0.976; I² = 0%), repeat revascularization (RR 0.89, 95% CI 0.58 to 1.37; p = 0.452; I² = 45.8%) or stent thrombosis (RR 0.88, 95% CI 0.20 to 3.90; p = 0.481; I² = 0%). CONCLUSION: Ticagrelor monotherapy was associated with a potential reduction in MACE and all-cause mortality compared with aspirin monotherapy after coronary revascularisation, without increasing major bleeding. However, these findings were driven primarily by PCI trials, particularly the GLOBAL LEADERS and GLASSY trial program, and should be interpreted cautiously because PCI and CABG populations were analyzed together. TRIAL REGISTRATRION: CRD420261286239.
Right heart catheterization via hemiazygos-azygos collaterals in the setting of inferior vena cava stenosis.
Shah AK, Ponnada RB, Pujari B … +7 more , Bhagwat AM, Peddada V, Jain P, Chitturu N, Quach T, Shoela R, Lin CJ
BMC Cardiovasc Disord · 2026 Jun · PMID 42380774 · Full text
BACKGROUND: In cases of inferior vena cava (IVC) obstruction, venous collaterals involving the hemiazygos and azygos veins can provide venous return to the right atrium. This can lead to procedural challenges in right he...
BACKGROUND: In cases of inferior vena cava (IVC) obstruction, venous collaterals involving the hemiazygos and azygos veins can provide venous return to the right atrium. This can lead to procedural challenges in right heart catheterization (RHC). CASE PRESENTATION: A 54-year-old male with end stage renal disease and severe aortic regurgitation underwent RHC for valve replacement planning. Swan Ganz catheter, via left femoral vein, would not advance beyond the distal IVC despite an inflated balloon. It was advanced over a V18 wire, taking a tortuous path to the right ventricle. Imaging revealed infrarenal IVC stenosis due to a dialysis catheter, with venous return through a dilated lumbar vein and hemiazygos and azygos collaterals. CONCLUSION: When catheter advancement fails, IVC stenosis and collateral pathways should be considered. Wire-guided navigation allows completion of RHC in these settings. Familiarity with venous anatomy enables successful RHC despite IVC obstruction. Early recognition and guidewire use can prevent procedural delays.
Fulminant cholesterol crystal embolism syndrome triggered by Vein of Marshall ethanol infusion: a case report.
Yu B, Tang J, Zhang J
BMC Cardiovasc Disord · 2026 Jun · PMID 42380766 · Full text
BACKGROUND: Cholesterol crystal embolism syndrome (CCES) represents a catastrophic complication of endovascular procedures. While mechanical trauma during left atrial catheter ablation acts as a known trigger, the specif...
BACKGROUND: Cholesterol crystal embolism syndrome (CCES) represents a catastrophic complication of endovascular procedures. While mechanical trauma during left atrial catheter ablation acts as a known trigger, the specific embolic risks associated with Vein of Marshall ethanol infusion (VOM-EI) remain unexplored. CASE PRESENTATION: A 66-year-old male with severe atherosclerosis and chronic kidney disease underwent persistent atrial fibrillation ablation involving VOM-EI (8 mL of ≥ 99.7% dehydrated ethanol). Six hours post-procedure, he developed extensive, non-pruritic livedo reticularis. He remained hemodynamically stable (lowest blood pressure 111/78 mmHg) but rapidly progressed to anuric acute kidney injury (creatinine peaking at 542 µmol/L) and severe systemic inflammation. Diagnostic evaluation effectively ruled out contrast-induced nephropathy, hypotensive acute tubular necrosis, and autoimmune vasculitis. Given the rapid deterioration, specific eosinophiluria testing and renal biopsy were deferred; however, sterile pyuria, classic skin lesions, and recent vascular intervention established a highly probable clinical diagnosis of CCES. Treatment with intermittent hemodialysis and high-dose intravenous methylprednisolone (40 mg/day) rapidly suppressed the inflammatory storm and facilitated substantial renal recovery. CONCLUSIONS: In patients with severe aortic plaque burden, VOM-EI, alongside established factors like transseptal catheter manipulation and systemic anticoagulation, may act as a potential trigger for CCES. Although a definitive diagnosis via biopsy was not feasible, we believe that early recognition and prompt corticosteroid therapy contributed substantially to the patient's clinical recovery.
The COPD-augmented R₂CHA₂DS₂-VA score: development and internal assessment for predicting one-year outcomes after transcatheter aortic valve implantation.
Boyaci F, Sahin MK, Akcay M … +11 more , Yanik A, Yenercag M, Seker OO, Ucar M, Kokcu HI, Ozturk B, Kaya E, Caglioglu H, Yilmaz M, Öztürk EF, Civici H
BMC Cardiovasc Disord · 2026 Jun · PMID 42374241 · Full text
BACKGROUND: Existing CHA₂DS₂-VASc-based scores incompletely capture the prognostic impact of chronic obstructive pulmonary disease (COPD) and of graded renal dysfunction in patients undergoing transcatheter aortic valve...
BACKGROUND: Existing CHA₂DS₂-VASc-based scores incompletely capture the prognostic impact of chronic obstructive pulmonary disease (COPD) and of graded renal dysfunction in patients undergoing transcatheter aortic valve implantation (TAVI). We acknowledge that the score's development in a high-risk, high-comorbidity cohort may produce optimistic performance estimates that require attenuation through external validation. We aimed to develop a novel COPD-augmented R₂CHA₂DS₂-VA (COPD-R₂CHA₂DS₂-VA) score that systematically integrates quantitative renal function and COPD, and to internally assess its discriminative performance for one-year all-cause mortality and major adverse cardiovascular events (MACE). METHODS: In this single-center, retrospective cohort study, 622 consecutive patients undergoing TAVI for severe aortic stenosis (2018-2024) were analyzed. The COPD-R₂CHA₂DS₂-VA score was constructed as a prespecified clinical tool by augmenting the R₂CHA₂DS₂-VA framework with COPD (1 point) and refining renal dysfunction into two graded estimated glomerular filtration rate strata (eGFR 30-59 mL/min/1.73 m²: 1 point; eGFR < 30: 2 points). Discriminative performance was evaluated using receiver operating characteristic curve analysis with bootstrap internal validation (2,000 resamples) and compared with established CHA₂DS₂-VASc-based scores. Multivariable logistic regression assessed the independent prognostic value of the score treated as a continuous variable. RESULTS: The COPD-R₂CHA₂DS₂-VA score demonstrated encouraging discriminative ability for one-year all-cause mortality (apparent area under the curve [AUC] 0.946, 95% CI 0.926-0.971). As a prespecified tool with fixed component weights, bootstrap internal validation confirmed negligible optimism (mean optimism - 0.00014), with bias-corrected AUC identical to the apparent value. The addition of COPD significantly improved mortality discrimination over the R₂CHA₂DS₂-VA score (ΔAUC + 0.033, p = 0.0001). For one-year MACE, the apparent AUC was 0.806 (95% CI 0.765-0.852); the addition of COPD did not significantly enhance MACE discrimination (ΔAUC + 0.001, p = 0.853). In multivariable analysis, each one‑point increase in the COPD-R₂CHA₂DS₂-VA score was independently associated with 3.52-fold higher odds of one-year mortality (95% CI 2.45-5.06, p < 0.001) and 2.02-fold higher odds of MACE (95% CI 1.67-2.46, p < 0.001). The bias-corrected AUC of the full multivariable model was 0.973 (95% CI 0.962-0.984) for mortality and 0.795 (95% CI 0.752-0.841) for MACE. CONCLUSIONS: The COPD-R₂CHA₂DS₂-VA score demonstrated encouraging discriminative ability for one-year all-cause mortality after TAVI in this single-center development cohort (apparent AUC 0.946). However, this high discriminative performance is likely influenced by the elevated comorbidity burden in our cohort and the single-center design, and should be interpreted as an upper-bound estimate. The addition of COPD provides a statistically significant but clinically modest incremental improvement for mortality (ΔAUC + 0.033, p = 0.0001), with no significant enhancement for MACE (ΔAUC + 0.001, p = 0.853). These findings are preliminary and hypothesis-generating; urgent external validation in diverse, prospective cohorts is essential before any clinical application can be considered. At present, this score should be regarded as a development-phase, hypothesis-generating tool that complements rather than replaces guideline-recommended instruments such as STS-PROM and EuroSCORE II. The score's clinical utility remains unproven.
Age- and sex-specific normative values for reticulocyte indices and their relation to early-stage CKM syndrome.
Huang L, Lin B, Zhu G … +8 more , Mu Y, Li Y, Fan Y, Shan G, Li Y, Shi M, Xia Y, Song Z
BMC Cardiovasc Disord · 2026 Jun · PMID 42374229 · Full text
BACKGROUND: Reticulocyte-related indices reflect erythropoietic activity and red blood cell maturation and may provide insight into systemic metabolic and inflammatory states. Cardiovascular-kidney-metabolic (CKM) syndro...
BACKGROUND: Reticulocyte-related indices reflect erythropoietic activity and red blood cell maturation and may provide insight into systemic metabolic and inflammatory states. Cardiovascular-kidney-metabolic (CKM) syndrome is a progressive systemic disorder driven by interacting metabolic, renal, and cardiovascular abnormalities. This study aimed to establish age- and sex-specific normative values for reticulocyte-related indices and to explore their cross-sectional associations with early-stage CKM syndrome. METHODS: A total of 5,692 adults aged 20-80 years from the China National Health Survey were included in this cross-sectional study for the final analysis. The Lambda-Mu-Sigma method was used to generate age- and sex-specific smoothed percentiles for reticulocyte indices, including RET# (reticulocyte count), RET% (reticulocyte percentage), LFR (low fluorescence reticulocytes), MFR (medium fluorescence reticulocytes), HFR (high fluorescence reticulocytes), IRF (immature reticulocyte fraction), RET-HE (reticulocyte hemoglobin equivalent), and RPI (reticulocyte production index), with percentile estimates at P1, P5, P25, P50, P75, P95, and P99. Differences across early CKM stages were assessed using one-way analysis of variance, chi-square tests, and analysis of covariance. Receiver operating characteristic analysis was used to evaluate discriminative performance. RESULTS: Reticulocyte-related indices showed significant sex-specific and age-specific variation, generally increasing in younger and middle-aged adults and then plateauing or declining in older adults. Several indices were associated with CKM stage progression. In particular, RET#, RET%, and RPI increased across CKM stages, whereas LFR decreased. ROC analysis showed that RET# provided good discrimination between CKM stage 0 and stages 1-2, with improved performance after adjustment for age and sex. CONCLUSION: Reticulocyte-related indices exhibit distinct age- and sex-specific distributions and are associated with early CKM stage status in this cross-sectional population. These findings provide normative reference data and suggest that reticulocyte indices may serve as exploratory indicators of systemic metabolic status, although prospective studies are needed to establish clinical utility.
In-hospital SGLT2 inhibitor initiation, prescribing gaps, and 30-day all-cause readmission in heart failure with reduced ejection fraction: a US post-guideline cohort study.
Pulatov O, Kim SY, Grossman Z … +7 more , Noor F, Salam B, Khan T, Matam A, Wang S, Caraccio T, Marzo KP
BMC Cardiovasc Disord · 2026 Jun · PMID 42374214 · Full text
BACKGROUND: Heart failure accounts for more than one million US hospitalizations annually, with 30-day all-cause readmission approaching 25% and triggering CMS Hospital Readmissions Reduction Program penalties. The 2022...
BACKGROUND: Heart failure accounts for more than one million US hospitalizations annually, with 30-day all-cause readmission approaching 25% and triggering CMS Hospital Readmissions Reduction Program penalties. The 2022 ACC/AHA/HFSA guideline and the 2023 ESC focused update elevated SGLT2 inhibitors to Class I therapy for heart failure with reduced ejection fraction (HFrEF) [1, 2]. The DAPA ACT HF-TIMI 68 prespecified meta-analysis demonstrated reductions in cardiovascular death or worsening heart failure (HR 0.71) and all-cause mortality (HR 0.57). Real-world prescribing patterns and 30-day readmission outcomes in the post-guideline US era are not well characterized. The relative contribution of clinical stability variables versus co-prescribed guideline-directed medical therapy (GDMT) to confounding has not been directly quantified in this setting. METHODS: We conducted a retrospective cohort study at four NYU Langone Health hospitals from January 2023 to January 2026. Adults with a primary heart failure discharge diagnosis were included. The prespecified primary analysis was in the HFrEF subgroup (LVEF ≤ 40%). The primary outcome was 30-day all-cause readmission. Stabilized inverse probability of treatment weighting (IPTW) was the primary adjustment, with overlap weighting (ATO) as sensitivity analysis. Hierarchical logistic regression decomposed the confounding contribution of clinical stability parameters relative to GDMT. The E-value assessed robustness to unmeasured confounding. RESULTS: Among 438 patients, 122 (27.9%) received in-hospital SGLT2 inhibitor initiation. The HFrEF rate was 41.6%, a sixfold increase from 6.6% reported in INSIGHT-HF (2020-2021). Patients with prior heart failure hospitalization received SGLT2 inhibitors at 11.4% versus 29.7% in those without (p < 0.001). In HFrEF (n = 221), 30-day readmission was 12.1% versus 31.8% (crude OR 0.29, 95% CI 0.14-0.61). The primary IPTW estimate was OR 0.34 (95% CI 0.13-0.91, p = 0.032). Sensitivity analyses were directionally consistent. Clinical stability parameters contributed only 9.3% confounding attenuation; GDMT was the dominant confounder. CONCLUSIONS: In a contemporary US post-guideline cohort, in-hospital SGLT2 inhibitor initiation reached 41.6% in HFrEF but remained low in patients with recent heart failure hospitalization. In-hospital SGLT2 inhibitor initiation was associated with lower 30-day all-cause readmission, though initiation was strongly bundled with discharge GDMT optimization and cannot be distinguished from a GDMT optimization effect with this study design. These findings should be considered hypothesis-generating. Because short-term safety events and post-discharge persistence were not systematically captured, these findings should not be interpreted as establishing the benefit-risk profile of inpatient SGLT2 inhibitor initiation. The prescribing gap in high-risk patients is an actionable quality-improvement target.
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