BMC Cardiovascular Disorders[JOURNAL]
Sun
200 papers
HALP score adds prognostic information beyond STS for 2-year mortality after transcatheter aortic valve implantation: a two-center retrospective cohort study.
Ertop ZST, Süygün H, Polat M … +3 more , Güney MC, Akdi A, Bozkurt E
BMC Cardiovasc Disord · 2026 Jun · PMID 42374204 · Full text
BACKGROUND: Conventional risk scores such as the Society of Thoracic Surgeons (STS) score are widely used for risk assessment in patients undergoing transcatheter aortic valve implantation (TAVI), yet they may not fully...
BACKGROUND: Conventional risk scores such as the Society of Thoracic Surgeons (STS) score are widely used for risk assessment in patients undergoing transcatheter aortic valve implantation (TAVI), yet they may not fully capture systemic inflammatory and nutritional burden. The hemoglobin-albumin-lymphocyte-platelet (HALP) score is an integrated biomarker reflecting inflammation and nutritional reserve. OBJECTIVES: To investigate the association between HALP and 2-year mortality after TAVI and to evaluate whether HALP provides incremental prognostic information beyond STS. METHODS: This two-center retrospective cohort included 544 consecutive TAVI patients. The primary endpoint was all-cause death within 2 years after TAVI (binary outcome: yes/no). Independent predictors were assessed using multivariable logistic regression (HALP scaled per 10-unit increase). Discrimination was evaluated by receiver operating characteristic (ROC) analyses for HALP, STS, and a combined STS+HALP model. RESULTS: Within 2 years, 154 patients (28.3%) died. Patients who died had higher STS scores and lower HALP scores. HALP showed weak negative correlations with STS and EuroSCORE II (r ≈ - 0.11). In multivariable analysis, HALP remained independently associated with mortality (per 10-unit increase: OR 0.859, 95% CI 0.770-0.960; p = 0.007), while STS score was also independent (OR 1.112, 95% CI 1.045-1.184; p = 0.001). Discrimination was modest for HALP (AUC 0.591) and STS (AUC 0.622), and higher for the combined model (AUC 0.663). CONCLUSIONS: HALP is independently associated with 2-year all-cause mortality after TAVI and yielded a higher AUC when incorporated into the STS model, suggesting incremental prognostic information beyond conventional risk assessment.
Predictive value of the novel cardiometabolic index for reduced aerobic capacity in patients with coronary heart disease: a clinical comparative study of 378 cases.
Huang H, Ma J, Zhao G … +1 more , Jiang S
BMC Cardiovasc Disord · 2026 Jun · PMID 42374201 · Full text
BACKGROUND: Coronary heart disease(CHD) is an important cause of cardiovascular diseases and, under adverse conditions such as arteriosclerosis, will raise the risk of death significantly. Due to the shortcomings of trad...
BACKGROUND: Coronary heart disease(CHD) is an important cause of cardiovascular diseases and, under adverse conditions such as arteriosclerosis, will raise the risk of death significantly. Due to the shortcomings of traditional adiposity indices when assessing aerobic capacity (AC), this paper intended to explore whether the novel cardiometabolic index (CMI) could predict lower AC in patients with coronary heart disease. METHODS: A retrospective analysis was performed on 378 hospitalized patients with coronary heart disease who underwent treatment and completed cardiopulmonary exercise testing. Patients were grouped according to AC levels and CMI levels, and the baseline characteristics of both groups were assessed.Three multivariable binary logistic regression models were constructed to evaluate the associations of the CMI, body mass index (BMI), and waist-to-height ratio (WHtR) with reduced AC. Receiver operating characteristic (ROC) curve analysis was performed to assess and compare the predictive performance of the three models, including the area under the curve (AUC). Model fit was further evaluated using the - 2 log-likelihood, Akaike Information Criterion (AIC), and Bayesian Information Criterion (BIC). Calibration of each model was assessed using the Hosmer-Lemeshow test, and DeLong's test was used to compare differences in AUC values between models. RESULTS: Three multivariable logistic regression models were constructed, each incorporating different core variables (BMI, WHtR, and CMI) along with other relevant covariates. Variance inflation factor (VIF) analysis confirmed the absence of significant multicollinearity among variables. Model performance evaluation demonstrated that Model 3, which included CMI, had the best fit, with the lowest - 2 log-likelihood, AIC, and BIC values, good calibration (Hosmer-Lemeshow test, P = 0.441), and the highest AUC (0.671, 95% CI: 0.605-0.736). However, DeLong's test revealed that the difference in AUC between Model 3 and Model 1, as well as between Model 3 and Model 2, did not reach statistical significance (P = 0.062 and P = 0.110, respectively). CONCLUSION: CMI demonstrates clinical potential in evaluating the decline of AC in patients with CHD.
Structural equation modeling of the association between factors related to medication adherence, perceived social support, and patients' resilience to hypertension: a cross-sectional study.
Tahmasbi S, Faraji A, Alavi A
BMC Cardiovasc Disord · 2026 Jun · PMID 42374195 · Full text
BACKGROUND: Hypertension affects over a billion people in the world, despite this prevalence, poor adherence to antihypertensive medication remains the main problem in low-income regions. Social support and resilience mi...
BACKGROUND: Hypertension affects over a billion people in the world, despite this prevalence, poor adherence to antihypertensive medication remains the main problem in low-income regions. Social support and resilience might influence adherence to antihypertensive medication.This cross-sectional study investigated the associations among perceived social support, resilience, and antihypertensive medication adherence in hypertensive patients in Izeh County, Iran. METHODS: This descriptive-analytical cross-sectional study was conducted, from April to December 2024 among adults with hypertension selected through a two-stage cluster sampling method from urban and rural health centers in Izeh County. Of the 600 initially enrolled participants (350 urban, 250 rural), 70 were excluded due to more than two missing items on the MMAS-8 questionnaire, leaving 530 participants for analysis. Data were collected using self-administered validated questionnaires under researcher supervision at urban and rural health centers, including the Morisky Medication Adherence Scale (MMAS-8), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Resilience Questionnaire.No resilience subscales were removed due to intellectual property restrictions, and potential conceptual overlap was statistically controlled. Analyses were conducted using SPSS 24 and AMOS 20, applying regression, path analysis, and structural equation modeling (SEM) to assess direct and indirect pathways. RESULTS: Perceived social support showed a significant positive effect on resilience (β = 0.43, p < 0.001) and an indirect effect on medication adherence (β = 0.10, p < 0.001). Resilience had a significant direct effect on medication adherence (β = 0.19, p = 0.002). The direct effect of social support on medication adherence was not statistically significant (p = 0.070). Among social support dimensions, family support was the strongest (M = 15.82, SD = 2.82). The SEM model demonstrated The model demonstrated an acceptable fit to the observed data (RMSEA = 0.054; CFI = 0.91). CONCLUSION: These findings bring out the imperative of social support and resilience to medication adherence among hypertensive patients. It is important to strengthen the social networks and psychological resilience to improve adherence to antihypertensive medication and overall disease management,Psychosocial strategies should thus be incorporated into future interventions to improve adherence to antihypertensive medication within resource-limited settings.
Combined impact of microalbuminuria and obesity on cardiovascular outcomes in hospitalized heart failure patients: a cohort study.
Ai G, Zhou Q, Huang Y … +4 more , Zhai M, Zhao X, Zhang Y, Zhang J
BMC Cardiovasc Disord · 2026 Jun · PMID 42374188 · Full text
BACKGROUND: Microalbuminuria is proven to be an early indicator of poor prognosis in patients with heart failure (HF), while the role of obesity in predicting progression and outcomes of HF is faced with controversies. E...
BACKGROUND: Microalbuminuria is proven to be an early indicator of poor prognosis in patients with heart failure (HF), while the role of obesity in predicting progression and outcomes of HF is faced with controversies. Evidence probing into the combined effect of microalbuminuria and obesity on cardiovascular outcomes in hospitalized HF patients is still lacking. METHODS: Consecutive patients hospitalized for HF were retrospectively enrolled from the Heart Failure Care Unit of Fuwai Hospital. The primary outcome was a composite of cardiovascular death and rehospitalization for heart failure. Patients were classified into four categories based on BMI and UACR: (1) Nonobese/nUACR, (2) Nonobese/hUACR, (3) Obese/nUACR, and (4) Obese/hUACR. RESULTS: Ultimately, 2228 patients with HF were enrolled. Cox regression analysis confirmed that microalbuminuria was independently associated with the primary outcome (HR 1.28, 95%CI 1.01-1.62, p = 0.038). Obesity was independently associated with the primary outcome in main analysis (HR 1.42, 95% CI 1.08-1.86, p = 0.013), but the association became insignificant after excluding NT-proBNP from covariates. Using Nonobese/nUACR as reference, Obese/nUACR and Obese/hUACR were related to an equally 61% increase in risk of the primary outcome (HR 1.61, 95% CI 1.1-2.37, p = 0.015; HR 1.61, 95% CI 1.1-2.34, p = 0.014, respectively), higher than Nonobese/hUACR. Component analysis showed that Obese/hUACR was associated with a significantly increased risk of rehospitalization (HR 1.89, 95% CI 1.06-3.4, p = 0.032) but not with cardiovascular death after adjustment. Restricted cubic spline (RCS) demonstrated nonlinear relationships of UACR elevation and risk (p < 0.001). In the subgroup of HFpEF, the association of Obese/hUACR with the primary outcome persisted (HR 3.81, 95% CI 1.87-7.76, p < 0.001, p for interaction = 0.241). CONCLUSIONS: Overlapping of obesity and microalbuminuria is relatively common (8.7%) in hospitalized HF patients. The coexistence of obesity and microalbuminuria is an independent risk factor for poor outcomes but in obese patients, the addition of microalbuminuria may not provide incremental prognostic information. The association with primary composite outcome appears to be primarily driven by rehospitalization rather than cardiovascular death. Subgroup findings in HFpEF population may be valuable but still warrant validation. (NCT02664818).
Diagnostic value of systemic immune-inflammation composite index combined with triglyceride-glucose index in type 2 diabetes patients with coronary heart disease: a retrospective diagnostic model study.
Li R, Deng W, Zhang W … +1 more , Zhang Y
BMC Cardiovasc Disord · 2026 Jun · PMID 42374186 · Full text
BACKGROUND: The prevalence of coronary heart disease (CHD) among patients with type 2 diabetes mellitus (T2DM) has increased substantially. Early identification of high-risk individuals is critical for improving clinical...
BACKGROUND: The prevalence of coronary heart disease (CHD) among patients with type 2 diabetes mellitus (T2DM) has increased substantially. Early identification of high-risk individuals is critical for improving clinical outcomes. This study aimed to evaluate the diagnostic value of the systemic immune-inflammation composite index (SIICI) and the triglyceride-glucose (TyG) index for CHD in patients with T2DM, and to develop and validate a combined diagnostic model incorporating these indices. METHODS: We retrospectively enrolled 599 patients with T2DM who underwent coronary angiography and divided them into CHD (n = 371) and non-CHD (n = 228) groups based on angiographic findings. Using stratified 7:3 sampling according to CHD status, the cohort was randomly split into training (n = 439) and validation (n = 160) sets. Clinical and laboratory data were collected. Univariate logistic regression (P < 0.1) followed by backward stepwise multivariate logistic regression was performed to construct the diagnostic model. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS: Compared with the non-CHD group, patients with CHD had significantly higher median levels of SIICI [5.24 (3.54, 8.05) vs. 3.75 (2.63, 4.76), P < 0.001] and TyG index [9.36 (8.96, 9.77) vs. 8.89 (8.60, 9.27), P < 0.001]. Multivariate logistic regression identified SIICI (OR = 1.347, 95% CI: 1.190-1.524) and TyG (OR = 2.843, 95% CI: 1.794-4.507) as independent risk factors for CHD. The combined model achieved an area under the curve (AUC) of 0.840 (95% confidence interval [CI]: 0.803-0.877) in the training set, with a sensitivity of 72.8% and specificity of 80.4%; in the validation set, the AUC was 0.851 (95% CI: 0.794-0.908), with a sensitivity of 75.8% and specificity of 80.0%. Calibration curves demonstrated good agreement (Hosmer-Lemeshow test: P = 0.597). DCA revealed positive net clinical benefit across a threshold probability range of 10-56%. CONCLUSIONS: Both SIICI and TyG are independent risk factors for CHD in patients with T2DM. The combined diagnostic model exhibits excellent discriminative ability, good calibration, and stable generalizability. While head-to-head comparisons with traditional risk scores are needed, this model offers a non-invasive tool that integrates inflammatory and metabolic information for cardiovascular risk stratification in T2DM patients.
Inferior ST-segment elevation as a diagnostic pitfall in proximal LAD occlusion: insights from a wrapped left anterior descending artery--a case report.
Zhang YS, Cao JQ, Liao YX … +8 more , Zheng QY, Bian ZH, He J, Shen L, Zhu QY, Ouyang MQ, Tang JJ, Chen YQ
BMC Cardiovasc Disord · 2026 Jun · PMID 42374185 · Full text
BACKGROUND: Electrocardiographic localization of the infarct-related artery in ST-segment elevation myocardial infarction is generally reliable; however, coronary anatomical variants and dynamic ischemic processes may re...
BACKGROUND: Electrocardiographic localization of the infarct-related artery in ST-segment elevation myocardial infarction is generally reliable; however, coronary anatomical variants and dynamic ischemic processes may result in misleading initial ECG patterns. CASE PRESENTATION: We describe a clinical scenario in which isolated inferior ST-segment elevation was the initial ECG manifestation of acute myocardial infarction, while coronary angiography revealed complete occlusion of the proximal left anterior descending artery. Subsequent angiography demonstrated a wrapped left anterior descending artery extending beyond the apex and supplying the inferior wall. Serial electrocardiograms showed a sequential evolution, with resolution of inferior ST-segment elevation after reperfusion followed by the emergence of anterior changes, rather than simultaneous multiterritory involvement. CONCLUSION: Awareness of this dynamic ECG phenomenon is essential to avoid diagnostic delay in high-risk presentations.
Depression trajectory modifies the association between estimated glucose disposal rate and incident stroke: a prospective cohort study.
Yu X, Chen J
BMC Cardiovasc Disord · 2026 Jun · PMID 42366357 · Full text
BACKGROUND: Insulin resistance is an established risk factor for stroke. The estimated glucose disposal rate (eGDR) serves as a surrogate marker for insulin sensitivity. Depression is linked to both insulin resistance an...
BACKGROUND: Insulin resistance is an established risk factor for stroke. The estimated glucose disposal rate (eGDR) serves as a surrogate marker for insulin sensitivity. Depression is linked to both insulin resistance and cerebrovascular disease. However, whether depression trajectories modify the association between eGDR and stroke risk remains unknown. METHODS: This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS). Participants aged ≥ 45 years with baseline eGDR measurements (2011), complete depression assessments (2011, 2013, 2015), no prevalent stroke (2011-2015), and follow-up data (2018 or 2020) were included. Depression trajectories were identified using latent class growth analysis based on the 10-item Center for Epidemiologic Studies Depression Scale. Covariates were selected a priori with the aid of a directed acyclic graph. Multivariable logistic regression estimated odds ratios (ORs) for incident stroke, stratified by depression trajectory; the primary model adjusted for sociodemographic and lifestyle factors. Interaction was assessed using likelihood ratio tests. RESULTS: Among 4,592 participants (mean age 58.3 years; 54.9% female), 430 stroke cases (9.4%) occurred. Three trajectories were identified: Low (65.1%), Moderate (28.1%), and High (6.8%). In the primary model (Model 2 adjusted for age, sex, marital status, education, residence, smoking status, and alcohol consumption), each standard deviation increase in eGDR was associated with lower stroke odds overall (OR = 0.66, 95% CI: 0.60-0.73). This inverse association was strongest in the Low trajectory (OR = 0.58, 95% CI: 0.50-0.67) and was attenuated in the Moderate (OR = 0.74, 95% CI: 0.63-0.88) and High (OR = 0.74, 95% CI: 0.55-0.99) trajectories. The attenuation with greater cumulative depressive burden was supported by significant interactions using binary trajectory classification (Low vs. Moderate/High; P = 0.021) and continuous mean CESD-10 score (P = 0.035); the three-class interaction test was borderline (P = 0.067). CONCLUSIONS: Higher eGDR was associated with reduced stroke risk; this protective association was progressively attenuated with greater cumulative depressive symptom burden, being strongest among individuals with persistently low depressive symptoms. These findings suggest that cumulative depressive burden may attenuate the inverse association between insulin sensitivity and stroke risk.
Plasma cyclophilin a as a novel predictor of major adverse cardiac events in patients with acute myocardial injury cohort study.
Zhang C, Zhong W, Tang X … +1 more , Sun X
BMC Cardiovasc Disord · 2026 Jun · PMID 42366350 · Full text
BACKGROUND: Cyclophilin A (CypA) is a multifaceted immunophilin implicated in cardiovascular disease; however, its predictive value for Major Adverse Cardiac Events (MACEs) after acute myocardial injury remains poorly de...
BACKGROUND: Cyclophilin A (CypA) is a multifaceted immunophilin implicated in cardiovascular disease; however, its predictive value for Major Adverse Cardiac Events (MACEs) after acute myocardial injury remains poorly defined. PURPOSE: The study aimed to analyze whether admission Plasma CyPA independently predicts MACEs and to assess its predictive feasibility beyond recognized clinical risk factors. METHOD: In this cohort study, 217 adults with an acute myocardial injury diagnosis exhibiting symptom onset within 24 hours and high cardiac troponin 1 were included. Plasma CyPA concentrations were evaluated using enzyme-linked immunosorbent assay. Participants were closely followed up for 6 months to determine MACEs, defined as all-cause mortality, ischemic stroke, nonfatal myocardial infarction, or unexpected heart failure hospitalization. Receiver Operating Characteristic (ROC) analysis, multivariable Cox proportional hazard models, Kaplan-Meier survival curves, and calibration analysis were conducted with adjusted standard covariates. RESULT: 30% of participants experienced MACEs, with significantly higher CyPA concentrations among those with events than among those without (median 1.942 vs. 1.026 ng/mL; p < 0.001). CyPA demonstrated good discriminatory ability (AUC 0.755; 95% CI: 0.680-0.830), with an optimal cutoff of 1.651 ng/mL. Higher CyPA levels were associated with significantly lower event-free survival. In multivariable analysis, CyPA remained an independent predictor of MACEs (HR 1.698; 95% CI: 1.462-1.973; p < 0.001). The overall Brier score was 0.158, reinforcing satisfactory precision of absolute risk prediction. CONCLUSION: Integration of CyPA into the baseline model significantly enhanced analytical performance, improving the C-index from 0.632 to 0.770. These conclusions suggest that CyPA may be a promising biomarker for risk stratification in acute myocardial injury and warrants external validation.
Longitudinal changes and cumulative exposure of cardiometabolic index predict cardiovascular disease risk in middle-aged and older adults: a national prospective cohort study.
Liu X, Yin L, Hao X
BMC Cardiovasc Disord · 2026 Jun · PMID 42365234 · Full text
BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among aging populations. Single-time-point risk assessments may not reflect dynamic cardiometabolic changes. The cardiometabol...
BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among aging populations. Single-time-point risk assessments may not reflect dynamic cardiometabolic changes. The cardiometabolic index (CMI), integrating triglyceride-to-HDL cholesterol ratio and waist-to-height ratio, reflects both atherogenic dyslipidemia and central adiposity, but its longitudinal prognostic value remains unclear. Thus, this study aims to evaluate the associations of baseline CMI, longitudinal change patterns, cumulative exposure, and absolute change (ΔCMI) with incident CVD among Chinese adults aged ≥ 45 years. METHODS: Data from the China Health and Retirement Longitudinal Study (CHARLS). Baseline analyses included 9120 participants. Longitudinal analyses included 6164 participants. CVD (including heart diseases and stroke) was ascertained during follow-up. Multivariable Cox proportional hazard models were fitted with adjustment for confounding factors. RESULTS: Higher baseline CMI was independently associated with increased CVD risk with a non-linear association and an inflection point at 0.42. Compared with stable low CMI, participants with persistently high CMI showed the highest CVD risk (HR = 1.31; 95%CI: 1.14, 1.50), followed by progression from low-to-high CMI (HR = 1.23; 95%CI: 1.04, 1.46), whereas improvement from high-to-low was not associated with excess risk. Among participants with low baseline CMI, higher cumulative CMI and less favorable ΔCMI were associated with increased CVD risk. Incorporating longitudinal CMI changes modestly but significantly improved risk discrimination and reclassification beyond baseline assessment. CONCLUSIONS: CMI is a dynamic, threshold-dependent predictor of CVD, independent of LDL-C and hsCRP. Longitudinal monitoring enhances risk stratification beyond single measurements.
Validating predictive models on EHRs data : lessons learnt from the NCDR-IMPACT-score applied on a French cardiac catheterization cohort.
Quennelle S, Malekzadeh-Milani S, Garcelon N … +3 more , Burgun A, Bonnet D, Neuraz A
BMC Cardiovasc Disord · 2026 Jun · PMID 42365230 · Full text
OBJECTIVE: We present a natural language processing pipeline to extract and re-compute a pre-existing score, the IMPACT-score, in a children's hospital belonging to the APHP hospitals. MATERIALS AND METHODS: Predictive v...
OBJECTIVE: We present a natural language processing pipeline to extract and re-compute a pre-existing score, the IMPACT-score, in a children's hospital belonging to the APHP hospitals. MATERIALS AND METHODS: Predictive variables and adverse events occurrences were extracted from the EHR of each patient. Data extraction involved rule-based and machine learning approaches depending on the format of the data. The machine learning text-classifiers were trained on active learning annotated dataset. Once the registry was automatically populated, we computed the IMPACT-score model in our patients and we performed a logistic regression analysis to find the specific odd ratio fitting our cohort and obtain the IMPACT-score-Necker. RESULTS: We extracted clinical data from 2,980 patients. When applied to our hospital cohort, the IMPACT-score-Necker achieved an AUC of 0.719 whereas the original IMPACT-score achieved an AUC of 0.642. As a reminder, the IMPACT-score achieved an AUC of 0.752 in the NCDR-IMPACT validation cohort. DISCUSSION: Local calibration of the IMPACT-score on our cohort enhanced predictive accuracy, improving the AUC from 0.642 to 0.719, and addressing differences between our population and the original NCDR-IMPACT cohort. This reinforces the need for model adaptation to local data, as patient demographic and clinical variations can significantly impact performance. Local EHR data warehouses could be leveraged for recalibration and continuous monitoring, ensuring that AI tools remain accurate, ethical, and practical for clinicians in their clinical practice. CONCLUSION: Our results underscore the need for real-world model validation, and EHRs offer a reliable source for training and validating AI models.
Zinc deficiency in patients with type 2 diabetes increases risk of cardiovascular diseases: Tehran Lipid and Glucose Study.
Bahadoran Z, Ghafouri-Taleghani F, Azizi F
BMC Cardiovasc Disord · 2026 Jun · PMID 42365226 · Full text
BACKGROUND AND AIM: This study aimed to assess the prospective association between zinc (Zn) deficiency and the risk of cardiovascular diseases (CVD), CVD mortality and all-cause mortality in adults with type 2 diabetes...
BACKGROUND AND AIM: This study aimed to assess the prospective association between zinc (Zn) deficiency and the risk of cardiovascular diseases (CVD), CVD mortality and all-cause mortality in adults with type 2 diabetes (T2DM). METHOD: This prospective cohort study, embedded in the Tehran Lipid and Glucose Study (TLGS), including 632 adults with T2DM (mean age = 59.6 ± 12.4 years, 38% men) enrolled at 2009-2011 and followed until 2020. Serum zinc (SZn) concentrations were measured using flame atomic absorption spectrometry (FAAS), and Zn deficiency was defined as SZn < 85 µg/dL. Multivariable Cox proportional hazard models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of outcomes in the Zn-deficient compared to Zn-sufficient group. RESULTS: Mean baseline SZn concentration was 116 ± 44.5 µg/dL, and 22% were Zn-deficient. Over a median follow-up of 9.3 years, 34.7% of participants experienced incident CVD events, while 6.3% and 18.5% died from CVD and all causes, respectively. Zn deficiency was associated with a significantly increased risk of CVD events (HR = 1.86, 95%CI = 1.06-3.28, P = 0.031) in the fully adjusted model. Each 10 µg/dL increase in SZn was associated with a borderline-significant reduced risk of CVD (HR = 0.97, 95%CI = 0.93-1.00, P = 0.050). Zn status was not associated with CVD mortality or all-cause mortality. CONCLUSION: Zn deficiency is associated with a significantly increased risk of CVD events in patients with T2DM. Increased SZn concentration was associated with reduced risk of CVD events in patients with T2DM.
Association between asymmetric dimethylarginine level and central obesity among patients with acute myocardial infarction: exploratory cross-sectional study.
Naser IA, AbuSaada AMA, Al Qedra RK
BMC Cardiovasc Disord · 2026 Jun · PMID 42363082 · Full text
BACKGROUND: Asymmetric dimethylarginine (ADMA), a competitive inhibitor of endothelial nitric oxide synthase (eNOS), has been implicated in atherosclerotic cardiovascular disease. However, the prognostic significance of...
BACKGROUND: Asymmetric dimethylarginine (ADMA), a competitive inhibitor of endothelial nitric oxide synthase (eNOS), has been implicated in atherosclerotic cardiovascular disease. However, the prognostic significance of baseline ADMA in the context of central obesity among patients with acute myocardial infarction (AMI) remains insufficiently characterized. OBJECTIVES: This study aimed to investigate whether central obesity (CO) is associated with elevated ADMA levels among patients with AMI in the Gaza Strip, Palestine. METHODS: A comparative cross-sectional study was conducted at four governmental hospitals in the Gaza Strip. One hundred and twenty patients with a confirmed diagnosis of AMI aged 30-65 years were recruited via convenience sampling between January 2023 and October 2023. Anthropometric parameters, including Body Mass Index (BMI) and Waist Circumference (WC), biochemical measurements such as ADMA, homocysteine (Hcy), and lipid profile, and lifestyle factors were assessed. Group differences were evaluated using independent-samples t-tests. Pearson correlations and Multiple linear regression were employed to explore inter-variable relationships. RESULTS: Of 120 AMI patients, 102 (85.0%) were male, and 18 (15.0%) were female (mean age 53.49 ± 7.35 years). Central obesity (WC >102 cm in men; >88 cm in women) was present in 53.3% of participants. Statistically significant differences between the centrally obese and non-obese groups were observed for total cholesterol (P = 0.030), triglycerides (P = 0.048), and HDL-c (P = 0.043). ADMA and Hcy levels were significantly higher in the centrally obese group than in the non-obese group (differences: 35.1 ng/mL and 7.7 µmol/L, respectively; P = 0.040 and P = 0.009). Multiple Linear Regression identified WC as the only significant independent predictor of ADMA (β = 1.22, 95% CI 0.003- 2.445, P = 0.049). CONCLUSIONS: WC was significantly associated with elevated ADMA levels in patients with AMI. Given the cross-sectional design, these findings should be regarded as preliminary, and further longitudinal studies are needed to confirm whether central obesity contributes to elevated ADMA and cardiovascular risk.
Association of athlete's heart and ACE I/D genotype with later-life left ventricular hypertrophy: a retrospective cohort study.
Someya Y, Miyamoto-Mikami E, Takaragawa M … +2 more , Fuku N, Naito H
BMC Cardiovasc Disord · 2026 Jun · PMID 42363073 · Full text
BACKGROUND: "Athlete's heart" refers to the physiological cardiac hypertrophy observed in competitive athletes, which reverts to normal after retirement from competition. However, few studies have examined long-term foll...
BACKGROUND: "Athlete's heart" refers to the physiological cardiac hypertrophy observed in competitive athletes, which reverts to normal after retirement from competition. However, few studies have examined long-term follow-up. This study investigated whether former college athletes with a history of an athlete's heart have a higher risk of developing heart disease later in life and examined its association with angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) polymorphisms. METHODS: A total of 980 participants (mean age, 52.0 ± 15.7 years) from the Juntendo University Alumni Study were analyzed. Information on Athlete's heart during college and subsequent heart disease, including left ventricular hypertrophy, was obtained through self-administered questionnaires in 2018. The ACE I/D genotype was determined based on the rs4341 C/G polymorphism. RESULTS: Of all participants, 177 (18.1%) reported Athlete's heart during college, and 15 (1.5%) were diagnosed with left ventricular hypertrophy later in life. Former athletes with Athlete's heart had a 7.3-fold higher prevalence of left ventricular hypertrophy than those without such a history. Moreover, carriers of the D allele showed a further increased risk (odds ratio, 13.63; 95% confidence interval, 1.31-142.41). CONCLUSIONS: These findings suggest that regular cardiac monitoring may be warranted to identify potential late-onset cardiac remodeling in former athletes with Athlete's heart carrying the ACE D allele.
Association between hemoglobin A1c to HDL cholesterol ratio and hypertension in middle-aged and older Chinese adults: a cross-sectional study.
Si W, Lai W, Wu L … +6 more , Du S, Wu Y, Li X, Zhao W, Wu L, Zhou B
BMC Cardiovasc Disord · 2026 Jun · PMID 42363064 · Full text
INTRODUCTION: The hemoglobin A1c to high-density lipoprotein cholesterol ratio (HHR) is a novel composite index reflecting both chronic glycemic exposure and lipid metabolism. However, its association with hypertension r...
INTRODUCTION: The hemoglobin A1c to high-density lipoprotein cholesterol ratio (HHR) is a novel composite index reflecting both chronic glycemic exposure and lipid metabolism. However, its association with hypertension remains unclear. This study aimed to investigate the independent association between HHR and hypertension prevalence in middle-aged and older Chinese adults. METHODS: This cross-sectional study analyzed data from the 2011 and 2015 biomarker waves of the China Health and Retirement Longitudinal Study (CHARLS). Among 25,873 initially identified participants, 11,797 were ultimately included after applying the inclusion and exclusion criteria. Multivariable logistic regression and restricted cubic spline analyses were conducted to assess the association between HHR and hypertension prevalence, adjusting for sociodemographic, lifestyle, and metabolic confounding factors. RESULTS: HHR was positively associated with hypertension. In the fully adjusted model, each 0.1-unit increase in HHR was associated with higher odds of hypertension (OR = 1.02, 95% CI: 1.01-1.04). Participants in the high HHR group had significantly higher odds of hypertension than those in the low HHR group (OR = 1.38, 95% CI: 1.24-1.54). Restricted cubic spline analysis showed a significant nonlinear association between HHR and hypertension. CONCLUSION: Elevated HHR was associated with hypertension in a nonlinear pattern among middle-aged and older Chinese adults. Given the cross-sectional design, these findings should be interpreted as evidence of association rather than prediction or causality. Further prospective studies are warranted to determine whether HHR provides incremental value for hypertension risk assessment.
Bone marrow-derived stem cells for acute myocardial infarction: a systematic review and meta-analysis on efficacy and safety.
Gu X, Sun L, Yang X … +3 more , Wang X, Wang X, Cai M
BMC Cardiovasc Disord · 2026 Jun · PMID 42363037 · Full text
BACKGROUND: Acute myocardial infarction (AMI) is one of the main causes of global morbidity and mortality. Stem cell-based therapy offers a promising approach for myocardial regeneration and tissue repair. Among them, bo...
BACKGROUND: Acute myocardial infarction (AMI) is one of the main causes of global morbidity and mortality. Stem cell-based therapy offers a promising approach for myocardial regeneration and tissue repair. Among them, bone marrow-derived stem cells (BMSCs) have shown remarkable therapeutic benefits in various clinical scenarios. Therefore, this study aimed to systematically evaluate the efficacy and safety of BMSCs in patients with AMI. METHODS: The computer retrieved the Cochrane Library, PubMed, Web of Science and Wiley Online Library databases, collected the randomized controlled trials on BMSCs for the treatment of AMI published in October 2025, and conducted data analysis using RevMan 5.4 and Stata 18.0. RESULTS: We enrolled 25 trials with 1822 patients, 960 patients in the BMSCs group, and 862 patients in the conventional treatment group. Meta-analysis findings indicated that BMSCs transplantation significantly enhanced left ventricular ejection fraction (LVEF) of patients with AMI relative to controls (MD = 2.45, 95% CI: 1.39 to 3.51) and reduced wall motion score index (WMSI) (SMD = -0.32, 95% CI: -0.49 to -0.15). For left ventricular end-diastolic volume (LVEDV) (SMD = -0.01, 95% CI: -0.16 to 0.13), left ventricular end-systolic volume (LVESV) (SMD = -0.04, 95% CI: -0.13 to 0.06) and myocardial infarct size (SMD = 0.01, 95% CI: -0.14 to 0.15), there was a trend toward improvement after infusion of BMSCs, but the difference was not statistically significant. In terms of safety, BMSCs transplantation did not increase the risk of major adverse cardiovascular events (MACEs) (OR = 0.80, 95% CI: 0.57 to 1.12). CONCLUSION: BMSCs can effectively improve cardiac function in patients with AMI and demonstrate a favorable safety profile. However, their effect on ventricular remodeling remains uncertain, warranting further high-quality evidence to assess long-term outcomes. TRIAL REGISTRATION: CRD420251147871.
Discordance between remnant cholesterol and low-density lipoprotein cholesterol predicts incident hypertension: a 9-year prospective cohort study in Chinese adults.
Wu XF, Ma CF, Zhang YC … +3 more , Liu S, Yan B, Li XX
BMC Cardiovasc Disord · 2026 Jun · PMID 42351038 · Full text
BACKGROUND: Hypertension (HTN), a primary driver of cardiovascular disease (CVD) progression, shares etiological links with dyslipidemia. While low-density lipoprotein cholesterol (LDL-C) remains a cornerstone biomarker...
BACKGROUND: Hypertension (HTN), a primary driver of cardiovascular disease (CVD) progression, shares etiological links with dyslipidemia. While low-density lipoprotein cholesterol (LDL-C) remains a cornerstone biomarker for CVD risk, emerging evidence implicates remnant cholesterol (RC)-a triglyceride-rich lipoprotein component-in HTN pathogenesis. This study aimed to examine the association between RC (independent of LDL-C) and incident HTN among Chinese adults aged 45 years and older. METHODS: We analyzed 4,508 normotensive participants from the China Health and Retirement Longitudinal Study (CHARLS). Incident HTN served as the primary endpoint. RC was derived by subtracting directly measured LDL-C from non-high-density lipoprotein cholesterol (non-HDL-C). Adjusted Cox proportional hazards models evaluated the relationship between natural log-transformed RC (ln RC) levels and HTN risk. Discordance analyses categorized participants into RC-LDL-C concordant/discordant groups using percentile differences (> 15 units), median splits, and guideline-based LDL-C thresholds. Subgroup analyses validated the robustness of the results. RESULTS: During a median follow-up of 9 years, 39.88% (n = 1,798) of participants developed incident HTN. RC-LDL-C discordance was observed in 58.23% of the cohort, comprising 37.18% with discordantly low RC and 21.05% with discordantly high RC. After multivariable adjustment, each 1 standard deviation increase in baseline ln RC was associated with a 7% elevated HTN risk (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.02-1.12). Restricted cubic spline (RCS) analysis revealed a linear dose-response relationship between continuous ln RC levels and HTN risk (P for trend = 0.013; P for nonlinearity = 0.233). Participants in the discordantly high RC group exhibited a 17% higher HTN risk compared with the discordantly low group (HR 1.17, 95% CI 1.04-1.32). Stratification by three LDL-C clinical thresholds and the median value showed that low LDL-C/high RC individuals had higher HTN risk than the low LDL-C/low RC reference group in the fully adjusted model, with statistically significant associations at 113 and 130 mg/dL. Subgroup analyses supported these findings. CONCLUSIONS: In normotensive populations, higher RC concentrations were independently linked to incident HTN, irrespective of LDL-C levels. The pathophysiological pathways underlying this RC-HTN association-distinct from LDL-C-mediated mechanisms-and the clinical utility of RC-targeted interventions in primary prevention strategies warrant further investigation.
Radial arterial versus left ventricular dP/dt for assessment of contractility in patients undergoing transcatheter aortic valve replacement: a retrospective observational study.
Garcia S, Tsang E, Chen J … +1 more , Fleming NW
BMC Cardiovasc Disord · 2026 Jun · PMID 42351014 · Full text
BACKGROUND: Left ventricular (LV) contractility is a core characterization of cardiac function that provides therapeutic guidance in both chronic and acute patient care. Measurement of the change in pressure over time in...
BACKGROUND: Left ventricular (LV) contractility is a core characterization of cardiac function that provides therapeutic guidance in both chronic and acute patient care. Measurement of the change in pressure over time in the left ventricle (LV dP/dt) is a clinical gold standard for evaluating cardiac contractility but is invasive and has associated risks. Measurement of dP/dt from a radial arterial pressure catheter offers a less invasive and safer alternative. Studies comparing these two measurements are limited and have conflicting conclusions. The objective of this study was to evaluate the correlations between LV and radial arterial dP/dt and clarify the clinical utility of radial dP/dt. METHODS: This was a retrospective observational study carried out at a large tertiary academic medical center. Data was collected from the electronic medical records of patients who underwent transcatheter aortic valve replacement (TAVR) with an Edwards Acumen IQ transducer attached to the radial arterial catheter to measure dP/dt. Concurrent measurements of dP/dt were recorded from LV and radial arterial catheters before and after TAVR. Comparisons included Bland-Altman analysis, concordance changes following TAVR, Spearman correlations and linear regression analysis. RESULTS: Bland-Altman analysis before TAVR demonstrated a bias between LV and radial measurements of 621 ± 396 mmHg/s with 95% limits of agreement from - 155 to 1397 mmHg/s. After TAVR, the bias decreased to 54 ± 412 mmHg/s, with 95% limits of agreement from - 754 to 862 mmHg/s. Concordance analysis of the changes following TAVR demonstrated an inverse relationship with a decrease in LV dP/dt and an increase in radial dP/dt observed in 73% of the patients. Correlation analysis before TAVR revealed Spearman r = 0.16 (95% CI: -0.06,0.37). After TAVR there was no significant change in the correlation coefficient, Spearman r = 0.09 (95% CI: -0.14, 0.31), but the slope of the best-fit regression line increased from 0.48 (95% CI: 0.44, 0.53) to 0.88 (95%CI: 0.80, 0.97). CONCLUSION: Severe aortic stenosis impacts the relationship between LV and radial measurements of dP/dt. Following TAVR the correlation remains poor, but linear regression analysis suggests radial measurement of dP/dt may have the clinical utility to characterize directional changes of contractility within an individual patient. TRIAL REGISTRATION: Clinical trial Number: not applicable. The study protocol was reviewed by the institutional human subjects research committee, which waived the need for written, informed consent. As a quality improvement project designed to evaluate the clinical utility of radial arterial dP/dt measurement it was not registered on the ClinicalTrials.gov website.
Serial cardiac MR assessment and histopathological evaluation of doxorubicin-induced cardiomyopathy in a miniature swine model.
Shi R, Zeng W, Shen LT … +6 more , Xu R, Liu X, Li Y, Li ZL, Xia CC, Yang ZG
BMC Cardiovasc Disord · 2026 Jun · PMID 42351006 · Full text
OBJECTIVE: Doxorubicin-induced cardiomyopathy remains challenging to detect at an early stage. This study aims to assess cardiac MR changes and their pathological correlates in a swine model of doxorubicin-induced cardio...
OBJECTIVE: Doxorubicin-induced cardiomyopathy remains challenging to detect at an early stage. This study aims to assess cardiac MR changes and their pathological correlates in a swine model of doxorubicin-induced cardiomyopathy. METHODS: Miniature pigs received repeated intravenous doxorubicin administration and underwent serial cardiac MR examinations from baseline to 32 weeks. Left ventricular function, global strain, and T2 relaxation time were assessed longitudinally. Histological and ultrastructural analyses were performed at predefined time points to evaluate myocardial injury. RESULTS: LVEF remained relatively preserved during doxorubicin administration and showed only a non-significant declining trend during follow-up. LVGLS showed a non-significant decreasing trend during the treatment (weeks 0-8, P = 0.068) and stabilized during the follow-up period (weeks 8-32, P = 0.35); GCS demonstrated deterioration (week 4: P = 0.006; week 32: P < 0.001); while GRS exhibited significant impairment, with maximal reduction at week 20 (β=-12.87, P = 0.04) that persisted through week 32 (P = 0.001). T2 mapping analysis showed significant elevation during active treatment (χ²=10.5, P = 0.033), followed by partial recovery by the final follow-up (week 32: 36.74 ± 2.80 ms, P = 0.020). Histopathological evaluation demonstrated mitochondrial swelling/vacuolization during treatment, with substantial resolution by week 32. However, persistent abnormalities in myocardial fiber architecture were observed at the study endpoint. CONCLUSIONS: In this miniature swine model, T2 prolongation during doxorubicin treatment was temporally associated with mitochondrial-related ultrastructural alterations and may reflect potentially reversible components of myocardial injury. Persistent strain abnormalities despite T2 normalization suggest incomplete structural recovery, mainly reflecting ultrastructural alterations rather than fibrotic progression. Combined T2 mapping and strain assessment may provide complementary information for characterizing doxorubicin-related myocardial injury in preclinical settings.
Unruptured congenital sinus of Valsalva aneurysm causing right ventricular outflow tract obstruction associated with hidden ventricular septal defect: a case report.
Majadla S, Majadleh S, Nairat M … +2 more , Alkhdour I, Daralammouri Y
BMC Cardiovasc Disord · 2026 Jun · PMID 42350997 · Full text
BACKGROUND: Sinus of Valsalva aneurysms are rare congenital lesions. Unruptured aneurysms are often silent, but when they are large, they can cause symptoms by compressing nearby structures. This case is notable because...
BACKGROUND: Sinus of Valsalva aneurysms are rare congenital lesions. Unruptured aneurysms are often silent, but when they are large, they can cause symptoms by compressing nearby structures. This case is notable because an unruptured aneurysm from the right sinus produced severe right ventricular outflow tract obstruction and concealed a ventricular septal defect that was not detected on preoperative imaging. CASE PRESENTATION: A 45-year-old man with a remote history of congenital heart disease and no follow-up presented with three weeks of progressive shortness of breath, which was consistent with New York Heart Association classes II to III. He was stable but had signs of right-sided heart failure, including elevated jugular venous pressure and bilateral leg edema. Transthoracic echocardiography revealed a large saccular aneurysm arising from the right sinus of Valsalva and protruding into the right ventricle with severe right ventricular outflow tract obstruction and a peak systolic gradient of 80 mmHg. Transesophageal echocardiography confirmed the aneurysm and obstruction; an agitated saline study did not demonstrate intracardiac shunting. Cardiac computed tomography confirmed the aneurysm anatomy and vascular dilation, and coronary angiography showed normal coronary arteries. The patient underwent surgical repair with excision of the large aneurysmal sac, closure of an intraoperatively discovered ventricular septal defect using a pericardial patch, and valve-sparing aortic root reimplantation with a tube graft and aortic valve repair. He was discharged five days after surgery without complications. At one month, echocardiography revealed preserved left ventricular function, relief of outflow obstruction, no residual shunt, decreased pulmonary artery dilation, and mild residual aortic regurgitation. CONCLUSIONS: A large unruptured sinus of Valsalva aneurysm can cause severe right ventricular outflow tract obstruction and can mask an associated ventricular septal defect despite negative shunt assessment. Surgeons and imagers should anticipate occult associated defects when planning repair.
Development and validation of a hypertension risk prediction model using electronic health records data from general practices in Hampshire and Isle of Wight integrated care system.
Gammall J, Ruffini D, Parmar S … +5 more , Mastellos N, Beegan L, Griffiths K, Gibbons C, Betteridge R
BMC Cardiovasc Disord · 2026 Jun · PMID 42350976 · Full text
BACKGROUND: Hypertension is a major risk factor for heart, stroke and kidney disease. Identifying patients at risk of developing hypertension early and applying preventative measures can reduce the disease burden and imp...
BACKGROUND: Hypertension is a major risk factor for heart, stroke and kidney disease. Identifying patients at risk of developing hypertension early and applying preventative measures can reduce the disease burden and improve outcomes. This study aimed to develop and validate a hypertension risk prediction model utilising data from electronic health records in Hampshire and Isle of Wight Integrated Care System. METHODS: We conducted a retrospective study using data from the Oracle Health Data Intelligence platform. We used an observation period of all history up to 31st July 2017 and a prediction period in the following five years, up to 31st July 2022. We included all adult patients registered with a general practitioner without existing hypertension and other cardiovascular disease. We considered a total of 54 predictors and used feature selection based on a combination of random forest feature importance and feature significance in backwards stepwise logistic regression. The outcome was a new development of hypertension within the 5-year prediction period. We evaluated three types of predictive models, logistic regression, decision tree and random forest. The hypertension prediction model was further redeveloped by applying the same methodology to a different geographic population of patients registered to practices within Lewisham and Greenwich. RESULTS: We included 569,405 patients, and of those 58,833 (10.3%) developed hypertension within five years. A total of 39 predictive factors were included following feature selection. The logistic regression model slightly outperformed the other two models and achieved a ROC-AUC of 0.82 within both the training and testing cohort. The model achieved a sensitivity of 75.82% and specificity of 73.67% within the training cohort. Additional model on new geographic population achieved a ROC-AUC of 0.82 within the training cohort and 0.83 within the testing cohort. CONCLUSIONS: The model was developed using a substantially larger number of patients compared with existing models and demonstrated good performance. It is used to identify persons at high risk of developing hypertension and support the provision of prophylactic interventions with model outputs presented as a percentage risk score within population health management tools. Further research could include an assessment of the impact of this model in clinical practice.
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