BACKGROUND: Management of hypertension (HTN) in obstructive hypertrophic cardiomyopathy (oHCM) is challenging because blood pressure (BP)-directed therapies may exacerbate left ventricular outflow tract (LVOT) obstructio...BACKGROUND: Management of hypertension (HTN) in obstructive hypertrophic cardiomyopathy (oHCM) is challenging because blood pressure (BP)-directed therapies may exacerbate left ventricular outflow tract (LVOT) obstruction. Cardiac myosin inhibitors (CMIs), such as mavacamten, reduce hypercontractility and LVOT gradients, but management of concomitant BP-directed therapies in routine practice remains uncertain. METHODS: We conducted a retrospective single-center cohort study of adults with oHCM treated with mavacamten. Patients were stratified by pre-existing HTN status, with clinical, medication, BP, and echocardiographic data collected at baseline and approximately three months. BP-directed therapies included renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and diuretics. Beta-blockers and calcium channel blockers were described separately because of their common use for LVOT obstruction, symptom control, or arrhythmia/rate control. RESULTS: Among 34 patients, 23 (67.6%) had pre-existing HTN. At three months, BP-directed therapies among patients with HTN included renin-angiotensin system inhibitors in 11, mineralocorticoid receptor antagonists in 11, and diuretics in 4; no patient without baseline HTN received BP-directed therapy. LVOT gradients decreased significantly in the HTN and non-HTN groups, from 77.1 to 27.0 mmHg and from 66.3 to 19.3 mmHg, respectively (both p < 0.05). Systolic and diastolic BP remained stable in both groups, and no patient developed incident HTN. CONCLUSION: Following mavacamten initiation, LVOT gradients improved and BP remained stable in patients with and without HTN. These findings suggest that individualized BP management is feasible during CMI therapy and support prospective evaluation.
BACKGROUND: Kawasaki disease (KD) is associated with various myocardial injuries, including myocardial perfusion abnormality. This study aims to assess the distribution of myocardial perfusion abnormality in patients wit...BACKGROUND: Kawasaki disease (KD) is associated with various myocardial injuries, including myocardial perfusion abnormality. This study aims to assess the distribution of myocardial perfusion abnormality in patients with KD and explore their relationships with left ventricular (LV) remodeling. METHODS: This prospective single-center study enrolled children with KD who underwent fully quantitative CMR rest perfusion. Myocardial blood flow (MBF) was measured and corrected based on the heart rate-blood pressure product (MBFcor). Statistical analyses included ANOVA, Pearson correlation and multivariate linear regression. RESULTS: Eighty-seven patients with KD (mean age, 7.5 ± 2.2 years) and 33 age- and sex-matched controls (mean age, 8.2 ± 2.8 years) were included. Global MBFcor was lower in patients than in controls, especially among patients during the acute phase. Subgroup analysis showed that patients with Z score ≥ 5 had significant decreases in global MBFcor, as well as regional MBFcor in the territories of the left anterior descending artery (LAD) and left circumflex artery (LCX) (p < 0.05 for all). Global MBFcor and regional MBFcor in the territories of the LAD and LCX were correlated with Z score among patients with KD. Covariate-adjusted multivariable regression analyses demonstrated that Z score and the acute phase were independently associated with global MBFcor. Furthermore, global MBFcor was negatively associated with increased LV mass index. CONCLUSIONS: Fully quantitative CMR rest first-pass perfusion revealed decreased myocardial perfusion in children with KD. Z score and the acute phase were independently associated with decreased myocardial perfusion; decreased MBFcor was associated with LV mass index.
BACKGROUND: Medication non-adherence is a major challenge in stroke prevention in atrial fibrillation (AF), yet no validated tool exists to identify patients at risk of non-adherence at the time of oral anticoagulation (...BACKGROUND: Medication non-adherence is a major challenge in stroke prevention in atrial fibrillation (AF), yet no validated tool exists to identify patients at risk of non-adherence at the time of oral anticoagulation (OAC) initiation. METHODS: In this retrospective cohort study at a large tertiary centre in New York City (2015-2023), adults with AF and a CHA₂DS₂-VASc score ≥ 2 initiating OAC were included. Predicted medication adherence was quantified using the Medication Adherence Score (MAS), a validated algorithm incorporating demographic, socioeconomic, and geographic attributes, dichotomised as high (MAS ≥80) or low (MAS <80). The primary outcome was ischaemic stroke within 12 months, analysed using Fine-Gray competing-risk regression. RESULTS: Of 11,233 eligible patients, 4035 (35.9%) had high and 7198 (64.1%) had low predicted adherence. Most patients received a direct oral anticoagulant (DOAC, 70.3%), 10.7% received warfarin, and 19.0% switched agents. Ischaemic stroke occurred in 6.2% of patients. High predicted adherence was associated with significantly lower stroke risk (sHR 0.67; 95% CI 0.56-0.80), with 12-month cumulative incidences of 5.08% vs. 7.97%. Continuously modelled MAS confirmed a dose-response relationship (HR 0.98 per unit increase; 95% CI 0.97-0.99). Results were consistent after excluding patients with prior stroke (sHR 0.66; 95% CI 0.53-0.83). CONCLUSIONS: In AF patients initiating OAC, low predicted medication adherence is independently associated with increased ischaemic stroke risk. The MAS may support early identification of high-risk patients, enabling targeted adherence interventions at OAC initiation.
BACKGROUND: Severe tricuspid regurgitation (TR) is increasingly recognized as a major determinant of outcomes, yet its mechanistic trajectory under contemporary medical therapy remains insufficiently defined. OBJECTIVES:...BACKGROUND: Severe tricuspid regurgitation (TR) is increasingly recognized as a major determinant of outcomes, yet its mechanistic trajectory under contemporary medical therapy remains insufficiently defined. OBJECTIVES: To characterize the longitudinal evolution of severe TR managed conservatively and to define a reproducible congestion-right ventricle-renal phenotype associated with clinical outcomes. METHODS: We conducted a longitudinal observational cohort including 40 consecutive patients with at least severe TR. Serial assessments at baseline and 6, 12, 18, and 24 months included clinical status, echocardiography, biomarkers, and treatment data. The primary endpoint was a composite of heart failure hospitalization or all-cause death. Associations between right ventricular (RV) function, NT-proBNP, diuretic intensity, and renal function were evaluated. RESULTS: Patients were elderly (78.5 ± 5.5 years), predominantly female, with atrial functional TR (95%) and atrial fibrillation (93%). Persistent congestion was observed throughout follow-up, with sustained high-dose diuretic use (≥80 mg/day in 57.5% at baseline, remaining stable over time). Renal function declined progressively (eGFR 50.2 ± 10 to 43.5 ± 11 mL/min/1.73 m; p < 0.01), while NT-proBNP increased significantly (median ~ 1700 to >3000 pg/mL; p < 0.01). During longitudinal follow-up, recurrent heart failure events and progressive renal impairment were frequently observed. Renal impairment and diuretic intensity were independently associated with adverse outcomes. Strong correlations linked RV dysfunction, biomarker activation, diuretic burden, and renal decline. CONCLUSIONS: Severe TR follows a structured, congestion-driven trajectory linking venous congestion, RV dysfunction, renal impairment, and clinical events. This study defines a reproducible cardiorenal phenotype and supports earlier, mechanism-based intervention strategies.
Peeters DAM, Woelders ECI, Janssen S
… +12 more, Azzahhafi J, Chan Pin Yin DRPP, van den Broek WWA, van de Pol QYF, Cetinyurek-Yavuz A, Winkler PJC, Damman P, Luijkx JJP, Remkes WS, Van't Hof AWJ, Ten Berg JM, van Geuns RJM
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42389740
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BACKGROUND: Lipid-lowering therapy (LLT) is recommended in all patients undergoing percutaneous coronary intervention (PCI), but its prescription remains suboptimal. Omission of LLT, particularly in elderly patients, is...BACKGROUND: Lipid-lowering therapy (LLT) is recommended in all patients undergoing percutaneous coronary intervention (PCI), but its prescription remains suboptimal. Omission of LLT, particularly in elderly patients, is less well studied. We investigated the prevalence of LLT omission and its association with one-year major adverse cardiovascular and cerebral events (MACCE) in a real-world ACS population, with prespecified focus on elderly through a subgroup analysis. METHODS: Data from the South-east Netherlands Heart Registry (ZON-HR) were merged with the Future Optimal Research and Care Evaluation (FORCE) ACS registry. ACS patients undergoing PCI with known discharge medication and one-year follow-up were included. Associations between LLT prescription at discharge and MACCE, individual components and all-cause death were compared with cox proportional hazard models. RESULTS: Of 9.495 patients (mean age 65.8, 73.2% male), 720 (7.6%) did not receive LLT. In the elderly population (≥70) this was even higher (10%). Patients without LLT had a higher burden of risk factors. At one year, LLT omission was associated with a higher hazard of MACCE (adjusted HR = 2.70, 95%CI: 2.29-3.18). A comparable association was observed in elderly (adjusted HR of 2.70, 95%CI: 2.18-3.34). Absolute event rates were higher in elderly compared with younger patients (11.4% vs. 7.1%, < 0.001). CONCLUSION: In this real-world ACS population, omission of LLT at discharge was common and associated with higher rates of MACCE at one year. While relative associations were similar across age groups, elderly patients experienced higher absolute event rates. These findings may reflect both gaps in care and underlying patient vulnerability.
Ibrahim A, Butt H, Khan S
… +14 more, Kharoud D, Xue Q, Sajjad U, Movio G, Clesham G, Demir OM, Cook C, Ansell E, McGarvey M, Jones R, Karamasis GV, Davies JR, Pareek N, Keeble TR
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42389739
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BACKGROUND: Near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) allows simultaneous assessment of plaque composition and vessel structure. The lipid core burden index (LCBI) and the maximum lipi...BACKGROUND: Near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) allows simultaneous assessment of plaque composition and vessel structure. The lipid core burden index (LCBI) and the maximum lipid core burden index over 4 mm (LCBI) are established markers of lipid-rich and potentially vulnerable plaques. However real-world reproducibility data for these indices using the contemporary Dualpro™ NIRS-IVUS catheter is unknown. This study aimed to evaluate the reproducibility of LCBI and LCBI across repeated NIRS-IVUS pullbacks performed within the same coronary segment using the current-generation catheter system. METHODS: This single-center study included consecutive patients who underwent percutaneous coronary intervention (PCI) with adjunctive NIRS-IVUS imaging and had repeated pullbacks of the same coronary segment during the procedure. LCBI and LCBI were recorded for each pullback. Reproducibility was assessed using Spearman correlation and intraclass correlation coefficients (ICC), and consistency for the clinically relevant thresholds of LCBI was evaluated. RESULTS: A total of 87 paired pullbacks were analyzed (37 pre-PCI, 15 post-lesion preparation, and 35 post-stenting). LCBI demonstrated excellent reproducibility (ρ = 0.95; ICC = 0.95) and LCBI also showed strong reproducibility (ρ = 0.90; ICC = 0.91). The threshold of LCBI > 400 was concordant between runs in 90% of cases, and the post-stent threshold of >200 showed concordance in 89% of cases. CONCLUSION: The contemporary Dualpro™ NIRS-IVUS catheter provides highly reproducible measurements of both LCBI and LCBI. These findings support the reliability of NIRS-IVUS for identifying lipid-rich plaques and strengthen its suitability for research and clinical applications focused on plaque vulnerability.
Villaschi A, Oreni ML, Toccafondi A
… +9 more, Cusmano I, Gonella S, Gonella R, Coni G, Torri A, Grati P, Ambrosetti M, Cianflone D, Morici N
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42389738
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BACKGROUND AND AIMS: To provide a contemporary description of patients referred to cardiac rehabilitation (CR) in Italy after hospitalization for acute heart failure (HF), focusing on the use and optimization of guidelin...BACKGROUND AND AIMS: To provide a contemporary description of patients referred to cardiac rehabilitation (CR) in Italy after hospitalization for acute heart failure (HF), focusing on the use and optimization of guideline-directed medical therapy (GDMT) across the spectrum of left-ventricular ejection fraction (LVEF). METHODS: PROMETEO is a prospective, multicentre Italian registry enrolling consecutive adult patients admitted to CR after acute HF. Patients were stratified as HFrEF (LVEF <40%) or HFmrEF/HFpEF (LVEF ≥40%). RESULTS: Among 263 patients with available LVEF, median age was 68.7 years, 21.7% were female, and 74.9% had HFrEF. Compared with HFmrEF/HFpEF, HFrEF were younger, less frequently female and with higher NT-proBNP levels. At CR admission, 72.1% of HFrEF patients received ACEi/ARB/ARNI, 91.9% beta-blockers, 79.2% MRAs, and 66.0% SGLT2 inhibitors, with a median GDMT score of 6 (IQR 4-8). At discharge, ARNI use increased significantly (58.9%) and the median GDMT score increased to 7 (IQR 4-8; = 0.013), alongside higher beta-blocker dosing and reduced loop diuretic use. Chronic kidney disease and higher baseline GDMT score were negatively associated with GDMT optimization, while higher BMI showed a positive association. In HFmrEF/HFpEF patients, SGLT2 inhibitor use increased from 28.8% to 47.0% ( = 0.010), with a concomitant reduction in loop diuretic prescription and dose. CONCLUSION: Patients referred to CR after acute HF are mainly male with HFrEF and show substantial comorbidity and treatment complexity. Residential CR represents a key opportunity for GDMT optimization across the HF spectrum.
Said Deheye A, Ali AO, Mahamud Ileye A
… +2 more, Alaleh HO, Mahamoud MF
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42388274
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OBJECTIVE: This study aimed to identify the lifestyle and socioeconomic determinants of glycemic control among patients with Type 2 Diabetes Mellitus (T2DM) in Borama, Somaliland, and a region with limited data on non-co...OBJECTIVE: This study aimed to identify the lifestyle and socioeconomic determinants of glycemic control among patients with Type 2 Diabetes Mellitus (T2DM) in Borama, Somaliland, and a region with limited data on non-communicable diseases. METHODS: A hospital-based, cross-sectional study was conducted from March 2023 to September 2023 at Borama Regional Hospital, involving 152 adult T2DM patients selected via systematic random sampling. Data on sociodemographics, lifestyle factors (physical activity, dietary habits, tobacco use), and glycemic control (HbA1c dichotomized as ≤7.0% for good control and >7.0% for poor control) were collected using structured questionnaires and medical record reviews. Multivariate binary logistic regression was performed to identify independent predictors of poor glycemic control. RESULTS: The prevalence of poor glycemic control was high, affecting 63.8% of participants. Multivariate analysis revealed that poor physical activity (Adjusted Odds Ratio [AOR] = 3.85, 95% CI: 1.62-9.14, p = 0.002), unhealthy dietary habits (AOR = 4.51, 95% CI: 1.89-10.78, p < 0.001), unemployment or casual employment status (AOR = 2.98, 95% CI: 1.25-7.11, p = 0.014) and lower educational attainment (χ = 6.45, p = 0.011) were independent predictors of poor glycemic control. Gender, and age were not significant independent predictors in the adjusted model. CONCLUSION: A substantial proportion of T2DM patients in Borama experience poor glycemic control, strongly influenced by modifiable lifestyle factors and socioeconomic status. Interventions targeting improved physical activity, healthier dietary practices, and socioeconomic support for unemployed individuals are crucial for enhancing diabetes management outcomes in this setting and aligning with global health targets like Sustainable Development Goal 3 (SDG 3).
BACKGROUND: Ischemic heart disease (IHD) presents a growing global health burden across diverse geographic and socioeconomic settings. Clinical practice guidelines are typically developed by professional societies in hig...BACKGROUND: Ischemic heart disease (IHD) presents a growing global health burden across diverse geographic and socioeconomic settings. Clinical practice guidelines are typically developed by professional societies in high-income countries, often with limited consideration of implementation barriers in other healthcare settings. We sought to understand clinicians' use of IHD guidelines in their practice, perceived deficiencies, implementation barriers, and differences between doctors practicing in high-income countries (HIC) or in low-/middle-income countries (LMIC). METHODS: An internet-based, international survey of physicians treating patients with IHD, (July 26, 2025-November 15, 2025), inquiring about participants' demographics, experience, and views of IHD guidelines as related to their practice. RESULTS: Responses were provided by 587 clinicians from 97 countries. Approximately half (51.8%) considered the IHD guidelines as mostly or fully applicable in their country, a view more preponderant in HIC (67.3%) than in LMIC (48.8%; p = 0.0125). Most (63.2%) thought IHD guidelines were highly applicable in HIC, but only 9.0% deemed the same for LMIC. The greatest barriers to guideline implementation were their being mostly relevant for HIC (72%), and cost, with the latter selected more frequently by the LMIC than the HIC group (61.7% v 20.4%; p < 0.00001). Desires for future guidelines included availability in digital format, and inclusion of co-authors from LMIC. CONCLUSIONS: Survey respondents indicated that current IHD guidelines do not address the needs of clinicians and patients in LMIC as effectively as they do for those in HIC. Respondents advocated for future guidelines to have specific recommendations for differing socio-economic environments, and consideration of cost reimbursement.
BACKGROUND: In patients with hypertrophic cardiomyopathy (HCM), identifying the underlying mechanism of unexplained syncope is crucial for preventing sudden cardiac death (SCD) and managing recurrences. We evaluated the...BACKGROUND: In patients with hypertrophic cardiomyopathy (HCM), identifying the underlying mechanism of unexplained syncope is crucial for preventing sudden cardiac death (SCD) and managing recurrences. We evaluated the effectiveness of a novel stepwise diagnostic algorithm for the etiological assessment of syncope in a clinical HCM cohort. METHODS: We retrospectively applied the algorithm to consecutive HCM patients with unexplained syncope referred to the Syncope or Cardiomyopathy Units at Careggi University Hospital (Florence, Italy) between May 2004 and July 2024. RESULTS: Among 43 patients (mean age 54.9 ± 17.4 years; 56% male), the cause of syncope was identified at Step 1 (initial evaluation) in 22 cases (51.2%): hypotensive in 18 and arrhythmic in 4. An obstructive mechanism (LVOTO) was the primary cause in 1 additional case (2.3%). Autonomic assessment (Step 3: Tilt Testing, Carotid Sinus Massage, and ABPM) provided diagnostic findings in 11 patients (25.5%). Implantable Loop Recorders (ILR, Step 4) were deployed in 13 patients (30.2%), revealing significant asystole in 2 (15.3%) and excluding arrhythmia in 1 (7.6%) during recurrences. Overall, the algorithm established a diagnosis in 88.3% of cases. Over a mean follow-up of 82.8 ± 50.6 months, no SCD occurred; 6 patients received an ICD. CONCLUSION: A structured, stepwise diagnostic approach clarified the cause of syncope in nearly 90% of HCM patients, potentially optimizing long-term risk stratification and reducing unnecessary device implantation.
BACKGROUND: Identifying patients with nonischemic dilated cardiomyopathy (NIDCM) who are at increased risk for life-threatening ventricular arrhythmias remains a clinical challenge. The Fibrosis-4 (FIB-4) index, a noninv...BACKGROUND: Identifying patients with nonischemic dilated cardiomyopathy (NIDCM) who are at increased risk for life-threatening ventricular arrhythmias remains a clinical challenge. The Fibrosis-4 (FIB-4) index, a noninvasive marker originally developed to evaluate liver fibrosis, has been shown to be associated with increased risk of adverse events in several cardiovascular diseases. This study aimed to investigate the relationship between FIB-4 levels and arrhythmic risk in patients diagnosed with NIDCM. METHODS: A total of 1233 consecutive patients with NIDCM (714 men; 59.6 ± 12.4 years) were evaluated. The primary endpoint was the composite major arrhythmic event, including sudden cardiac death (SCD), documented sustained ventricular tachycardia or fibrillation, or appropriate implantable cardioverter defibrillator (ICD) therapy. Cardiovascular death and all-cause death were also evaluated as the secondary endpoints. RESULTS: During a median follow-up period of 70 months (interquartile range: 60 to 85 months), the primary endpoint was developed in 367(29.8%) patients. ROC analysis showed that using a cut-off level of 1.67, FIB-4 predicted the occurrence of the composite primary endpoint with a sensitivity of 66% and specificity of 81%. On multivariate analysis, after adjusting for other confounding factors, FIB-4 ≥ 1.67 remained independently associated with arrhythmic risk (HR: 4.88, 95% CI: 3.92-6.07, p < 0.001). CONCLUSIONS: This study showed that the FIB-4 index is an independent predictor of major arrhythmic events and death in patients with NIDCM. As a readily available index, FIB-4 may offer additional value in identifying high-risk patients who may benefit from closer monitoring or prophylactic interventions in this patient population.
Cohen BD, Eluri N, Levine S
… +3 more, Miller L, Roma N, Durkin M
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42382912
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BACKGROUND: Atrial fibrillation (AF) and cardiovascular (CV) comorbidities are prevalent in acute pancreatitis (AP) and may compromise hemodynamic tolerance of systemic inflammation. Their independent contributions to in...BACKGROUND: Atrial fibrillation (AF) and cardiovascular (CV) comorbidities are prevalent in acute pancreatitis (AP) and may compromise hemodynamic tolerance of systemic inflammation. Their independent contributions to in-hospital mortality in AP have not been quantified nationally. METHODS: We analyzed discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), 2016-2022. Adult AP hospitalizations were identified by primary ICD-10-CM diagnosis. Twelve CV risk factors were examined. Survey-weighted logistic regression generated unadjusted, adjusted, and fully adjusted odds ratios (ORs) for in-hospital mortality. A cumulative risk factor count was constructed. RESULTS: Among 1,919,159 weighted AP hospitalizations, overall mortality was 0.59%. On full multivariable adjustment, cerebrovascular disease (OR 2.83, 95% CI 2.33-3.44), AF (2.10, 1.85-2.37), CKD (1.89, 1.68-2.12), MI (1.86, 1.56-2.23), and heart failure (1.79, 1.56-2.05) were the strongest independent CV-comorbidity predictors of in-hospital death. Weighted mortality rose progressively from 0.21% at zero to 3.03% at seven cumulative risk factors; per additional risk factor the crude OR was 1.47 (1.45-1.50, p < 0.001). The dose-response gradient persisted after full adjustment, with integer-level adjusted ORs rising from 1.25 at one risk factor to 5.05 at seven, and a binary cutoff at three or more versus two or fewer risk factors carrying an adjusted OR of 2.01 (1.80-2.25, p < 0.001). CONCLUSIONS: Cerebrovascular disease, AF, CKD, MI, and heart failure independently predict in-hospital mortality in AP, with a robust adjusted dose-response by cumulative CV burden. These associative findings are hypothesis-generating; prospective studies are needed to determine whether structured cardiovascular risk assessment improves outcomes in this population.
Shojaei Y, Roohafza H, Mehrabani-Zeinabad K
… +4 more, Soleimani A, Yazdekhasti S, Sadri M, Sadeghi M
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42382911
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BACKGROUND: Psychological factors influence prognosis after ST-elevation myocardial infarction (STEMI), yet the long-term prognostic role of depression and health anxiety remains incompletely defined. We investigated whe...BACKGROUND: Psychological factors influence prognosis after ST-elevation myocardial infarction (STEMI), yet the long-term prognostic role of depression and health anxiety remains incompletely defined. We investigated whether these factors identify patients at increased mortality risk following STEMI. METHODS: This secondary analysis included 759 patients from the SEMI-CI cohort, admitted between October 2015 and October 2016 and followed for five years. Depression was assessed at baseline using the Patient Health Questionnaire-9 (PHQ-9), and health anxiety was measured using four items from the Diagnostic Criteria for Psychosomatic Research (DCPR). The primary outcome was cardiovascular mortality. Associations were evaluated using Cox proportional hazards models adjusting for demographic, clinical, and cardiovascular risk factors. Health anxiety was treated as an exploratory predictor given limited measurement validity. Sensitivity analyses accounted for available covariates. RESULTS: Among 759 participants, 189 (24.9%) died from cardiovascular causes over five years. Mortality was higher among patients with depression (60/189, 31.7%) compared to those without depression (115/570, 20.2%). Health anxiety was present in 42 patients (all of them also had depression), 18 (42.9%) of whom died. In fully adjusted Cox models, compared to patients with neither condition, mortality risk was significantly higher in those with only depression (HR 2.45, 95% CI 1.84-3.03) and those with concurrent depression and health anxiety (HR 2.11, 95% CI 0.11-4.09). CONCLUSIONS: In this cohort of STEMI patients, baseline depression was strongly associated with higher five-year cardiovascular mortality, while health anxiety showed a moderate association. These findings highlight the importance of assessing psychological factors as part of post-MI risk stratification, without implying causal relationships.
Yin K, Li Y, Zhao H
… +6 more, Xu J, Yang H, Meng Y, Sun Y, Wang S, Zhou Z
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42382315
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BACKGROUND: This study characterized the clinical and genetic features of Danon disease (DD), focusing on participants harboring frameshift variants at the 325th amino acid position (p.Leu325fs), and explored their card...BACKGROUND: This study characterized the clinical and genetic features of Danon disease (DD), focusing on participants harboring frameshift variants at the 325th amino acid position (p.Leu325fs), and explored their cardiac implications. These frameshift variants result in loss of functional LAMP2 protein through premature termination, thereby impairing lysosomal function. Although the association between variants and DD is established, the cardiac phenotype specifically associated with p.Leu325fs variants remains incompletely characterized. METHODS: We conducted a retrospective analysis of nine patients with DD diagnosed at the Fuwai Hospital of the Chinese Academy of Medical Sciences, Beijing, China. Comprehensive clinical data, including biochemical markers, electrocardiographic findings, and imaging studies (echocardiography and cardiac magnetic resonance imaging), were collected. Pathogenic variants were confirmed through exome sequencing or clinical genetic testing. RESULTS: All participants carried pathogenic frameshift variants at p.Leu325fs, presenting with prominent cardiac manifestations including myocardial hypertrophy or dilation, impaired systolic function, and arrhythmias. Electrocardiographic abnormalities, notably intraventricular conduction block and ST-T segment changes, were observed in all participants. Elevated N-terminal prohormone of brain natriuretic peptide and lactate dehydrogenase levels were observed in all participants, consistent with advanced heart failure and myocardial injury. CONCLUSIONS: Our findings suggest that p.Leu325fs pathogenic variants in DD are associated with a predominantly cardiac phenotype, characterized by universal intraventricular conduction block, ST-T segment changes, progressive myocardial fibrosis, and impaired systolic function. These results support the clinical value of integrating genetic testing, cardiac MRI, and electrocardiographic monitoring into the early diagnosis, risk stratification, and management of patients with DD.
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42376566
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INTRODUCTION: Poverty is linked to an increased risk of acquired heart disease, but its impact on outcomes in adults with congenital heart disease (CHD) is not well defined. Medicaid insurance is a strong proxy for pover...INTRODUCTION: Poverty is linked to an increased risk of acquired heart disease, but its impact on outcomes in adults with congenital heart disease (CHD) is not well defined. Medicaid insurance is a strong proxy for poverty in United States. We characterize population characteristics and healthcare utilization among adults with CHD on Medicaid insurance, both overall and by CHD disease complexity. METHODS: The Transformed Medicaid Statistical Information System (T-MSIS) collects comprehensive public health insurance data from all 50 states and territories (Medicaid and Children's Health Insurance Program). We identified 260,535 adults (>18 years of age) with ICD-10 diagnosis codes consistent with CHD across the years 2016-2018. Descriptive statistics were used to compare groups. RESULTS: Of 260,535 adults with CHD studied, 63.1% were female with a mean age of 40.2 ± 19.1 years. 44.5% had moderate or complex CHD, and 5.8% died during the study period. Medical and cardiac comorbidities were common: rhythm disorders (46.7%), mental health diagnoses (44.9%), hypertension (44.6%), and metabolic syndrome (42.4%). One quarter (24.8%) had a disability, 15.5% had a diagnosis consistent with substance abuse, and 17.7% used nicotine. 23.9% had incidence equivalents of one or more hospitalizations per year, and 32.1% had incidence equivalents of ≥5 emergency department visits in three years. CONCLUSION: We characterized the population of adults with CHD on Medicaid and found high rates of medical comorbidities, disability, smoking, substance use, and utilization of emergency department services. This vulnerable population may benefit from targeted interventions aimed at reducing comorbid conditions and thus improving long term outcomes.
Kholeif Z, Ellabbad M, Miranda WR
… +2 more, Connolly HM, Egbe AC
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42376565
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BACKGROUND: Heart failure (HF) hospitalization is a marker of HF progression, and it is associated with mortality in adults with congenital heart disease (CHD). The purpose of this study was to assess the effect of guide...BACKGROUND: Heart failure (HF) hospitalization is a marker of HF progression, and it is associated with mortality in adults with congenital heart disease (CHD). The purpose of this study was to assess the effect of guideline directed medical therapy (GDMT) on HF readmission and mortality in CHD patients with HF with reduced ejection fraction (HFrEF). We hypothesized that higher GDMT use was associated with lower risk of HF readmission and mortality. METHOD: Retrospective study of CHD patients and HFrEF, admitted for HF (2003-2023). GDMT use was assessed at hospital discharge (baseline) and 1-year follow-up using a standardized GDMT score. GDMT uptitration was assessed as difference between GDMT score at baseline versus 1-year follow-up. RESULTS: Of 153 patients (age 51 ± 15 years, 39% males, left ventricular EF 29 ± 7%), the median baseline GDMT score was 2 (1, 3). Baseline GDMT score was associated with lower risk of HF readmission (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.54, 0.92, p < 0.001) and mortality (HR 0.71, 95%CI 0.50, 0.93, p < 0.001) per 1-unit increase in baseline GDMT score. Among patients with 1-year follow-up (N = 128), GDMT uptitration was associated with lower risk of HF readmission (HR 0.72, 95%CI 0.49, 0.94, p < 0.001) and mortality (HR 0.69, 95%CI 0.41, 0.92, p = 0.02) per 1-unit increase. Patients with GDMT uptitration (N = 49, 38%) had greater improvement in neurohormonal activation and left ventricular systolic function, consistent with a lower risk of HF readmission and mortality in that group. CONCLUSIONS: GDMT optimization was associated with lower risk of HF readmission and all-cause mortality amongst adults with CHD. Further studies are required to determine whether strategies to improve GDMT optimization would improve clinical outcomes in this population.