Yoshida Y, Jin Z, Homma S
… +5 more, Mannina C, Nakanishi K, Rundek T, Elkind MSV, Di Tullio MR
Int J Cardiol Cardiovasc Risk Prev
· 2026 Jun · PMID 42052173
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BACKGROUND: Short or long sleep duration is associated with hypertension in middle-aged populations. However, this association, and its possible effect on cardiovascular outcomes, is not established in older adults, desp...BACKGROUND: Short or long sleep duration is associated with hypertension in middle-aged populations. However, this association, and its possible effect on cardiovascular outcomes, is not established in older adults, despite age-related changes in the role of systolic (SBP) and diastolic (DBP) blood pressure as cardiovascular risk factors, and the increased predictive role of pulse pressure (PP) in the elderly. We investigated the association of sleep duration with BP levels by 24-h ambulatory BP monitoring (ABPM) and with incident cardiovascular outcomes. METHODS: 828 participants (mean age 71 years, 60% women) were evaluated. Self-reported short sleep was defined as the lowest quintile (≤7 h) and long sleep as the highest quintile (>10 h); intermediate duration was reference. Outcomes were ischemic stroke, myocardial infarction, cardiovascular death, and composite outcome (any of the 3). RESULTS: Long sleepers had substantially higher daytime and 24-h PP than the reference group (both P < 0.05). There were no differences in SBP and DBP values. Over 11.3 years of follow-up, 214 (25.8%) participants developed cardiovascular events. Long sleep was independently associated with ischemic stroke (adjusted hazard ratios [aHR] 1.76, 95% confidence interval [CI], 1.02-3.04; p = 0.044), cardiovascular death (aHR 1.56, 95% CI, 1.03-2.37; p = 0.035) and composite outcome (aHR 1.41, 95% CI, 1.01-1.98; p = 0.046). PP was also independently associated with cardiovascular events. Short sleep was associated with increased PP in the elderly. CONCLUSIONS: Long sleep duration was associated with increased PP and subsequent cardiovascular events, suggesting the importance of PP for cardiovascular risk in the middle-aged and elderly long sleepers.
Kroll C, Hubert A, Saccardi L
… +5 more, Martínez Pereyra V, Seitz A, Sechtem U, Bekeredjian R, Ong P
Int J Cardiol
· 2026 Aug · PMID 42049126
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BACKGROUND: In patients with angina despite non-obstructive coronary arteries (ANOCA), coronary vasomotion disorders (CVD) are a common cause for their symptoms. Due to the heterogeneous clinical presentation resulting f...BACKGROUND: In patients with angina despite non-obstructive coronary arteries (ANOCA), coronary vasomotion disorders (CVD) are a common cause for their symptoms. Due to the heterogeneous clinical presentation resulting from a broad spectrum of endotypes, symptom management still remains a major challenge. We aimed to demonstrate that endotype-based pharmacotherapy can improve angina severity and quality of life (QoL) outcomes in these patients. METHODS: Between 04/2021-02/2022 we enrolled 50 ANOCA-patients (56% women, 63 ± 14 years) with confirmed diagnosis of CVD (coronary spasm: n = 30; microvascular vasodilatation disorder: n = 3; combined endotype: n = 17). All patients received an individual endotype-adapted antianginal pharmacotherapy. Efficacy and tolerability were closely monitored and adjusted during a 3-month follow-up period, accompanied by a symptom diary which served as a patient-reported outcome measure (PROM). QoL was assessed using the Seattle Angina Questionnaire-7 (SAQ7) monthly during the 3-month therapy adjustment and at long-term follow-up after 3 years. RESULTS: After targeted pharmacotherapy for 3 months, 70% of patients showed a clinically relevant improvement in the SAQ7-Summary score (62 ± 22 from 47 ± 18; p < 0.001). PROM-scores showed a significant decrease in monthly number of chest pain attacks by 38% (p = 0.041) and nitroglycerine intake by 67% (p = 0.004) accompanied by a significant PROM mood-score improvement (0.5 points within a 1-5 scale; p < 0.001). Long-term follow-up after 3 years (n = 40) revealed that 81% of the patients with isolated coronary spasm or vasodilation disorder benefited sustainably from endotype-based therapy with an improved SAQ7-Summary score. CONCLUSION: Endotype-based pharmacotherapy can contribute decisively to long-term symptom and QoL improvement, particularly in ANOCA-patients with isolated endotypes.
Poller A, Jha S, Thorleifsson SJ
… +9 more, Espinosa AS, Sevastianova V, Molander L, Andersson EA, Zeijlon R, Simons K, Omerovic E, Bech-Hanssen O, Redfors B
Int J Cardiol
· 2026 Aug · PMID 42044717
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BACKGROUND: Left ventricular diastolic dysfunction following Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) is a marker of impaired myocardial relaxation and reduced ventricular compliance and is...BACKGROUND: Left ventricular diastolic dysfunction following Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) is a marker of impaired myocardial relaxation and reduced ventricular compliance and is associated with adverse outcomes. We hypothesized that differences in diastolic function explain the better hemodynamic profile seen in TS compared to STEMI despite similar or more extensive cardiac systolic dysfunction. METHODS: Daily echocardiographic examinations including diastolic function parameters were made in women with TS (N = 69) or anterior STEMI (N = 43), starting on the day of symptom onset. The primary endpoints were a set of diastolic indices at 24 h after symptom onset. Women were also classified into diastolic subgroups based on the 2025ASE recommendations on evaluation of left ventricular diastolic function. RESULTS: TS and STEMI were balanced in age (69.4 ± 11.1 versus 69.5 ± 11.0), baseline risk factors and pre-admission cardiovascular medications. Women with TS had significantly lower S/D(p = 0.05), and higher E/é-lateral(p = 0.04), and LAVI(p = 0.05) compared to STEMI 24 h after admission. But there were no significant differences between the groups in diastolic grade, after 24 h. Longitudinal analyses of diastolic parameters over the course of the study period did not reveal any pattern suggestive of systematically worse or better diastolic function in TS than STEMI. Diastolic function parameters and diastolic function grade were similar also at 30-days follow-up in both groups. CONCLUSION: This study is the first to evaluate left ventricular diastolic function with repeated echocardiography. Because diastolic indices were similar or more impaired in TS than in STEMI, our findings do not support the hypothesis.
Tobe A, Smits PC, van Royen N
… +39 more, Amat-Santos IJ, Hudec M, Bunc M, Van den Branden BJL, Laanmets P, Unic D, Merkely B, Hermanides RS, Ninios V, Protasiewicz M, Rensing BJWM, Martin PL, Feres F, Almeida MS, van Belle E, Linke A, Ielasi A, Montorfano M, Webster M, Toutouzas K, Teiger E, Bedogni F, Voskuil M, Pan M, Angerås O, Kim WK, Rothe J, Kristić I, Peral V, Garg S, Versteeg GAA, García-Gómez M, Tsai TY, Thakkar A, Chandra U, Morice MC, Onuma Y, Baumbach A, Serruys PW
Int J Cardiol
· 2026 Aug · PMID 42044716
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BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of...BACKGROUND: Conduction system disturbances resulting in permanent pacemaker implantation (PPI) are common complications after transcatheter aortic valve implantation (TAVI). In some patients, there is delayed recovery of the conduction system post-procedure. This study aims to report the incidence and predictors of ventricular pacing (VP) rate≦1% at 1 year after TAVI. METHODS: This is a post-hoc sub-study of the LANDMARK multicentre trial, which randomized 768 patients in a 2:1:1 ratio to the Myval (n = 384) transcatheter heart valve (THV) series or contemporary THVs (Sapien [n = 192] and Evolut [n = 192] series) for the treatment of severe aortic stenosis. Overall, 122 (15.9%) patients underwent PPI within 30 days after TAVI, and 1-year pacemaker follow-up data were retrospectively collected in 99 patients. Pacemaker recovery (PMR) was defined as a VP rate ≦1% at follow-up. RESULTS: PMR occurred in 18% (18/99) of patients. The PMR group was younger than the non-PMR group (78.6 ± 3.0 vs 81.1 ± 5.1 years, p = 0.045). Implantation depth under the non-coronary cusp did not differ between groups (5.7 ± 3.5 vs 5.8 ± 2.8 mm, p = 0.94). There were no significant differences in PMR rates based on THV type: Myval 25% (11/44), Sapien 19% (5/27), and Evolut 7% (2/28) (p = 0.16). In multivariable logistic regression, atrial fibrillation was associated with lower odds of PMR (odds ratio 0.09, 95% confidence interval 0.00-0.77, p = 0.02. CONCLUSIONS: At 1 year, conduction system recovery (VP≦1%) was observed in 18% of patients who underwent PPI after TAVI, with no significant difference among the Myval, Sapien and Evolut series. Atrial fibrillation was associated with lower odds of recovery.
Santoro F, Arcari L, Sasso C
… +12 more, D'Elia G, D'Alessandro D, Benvenga RM, Migliarino S, Di Peppo M, Molinari M, Mordecchi A, Cacciotti L, Eitel I, Cameli M, Brunetti ND, Citro R
Int J Cardiol
· 2026 Aug · PMID 42035838
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AIMS: This study aims to investigate left atrial (LA) functional recovery following a TTS episode and assess its association with long-term major adverse cardiovascular events (MACE). METHODS AND RESULTS: In a multicente...AIMS: This study aims to investigate left atrial (LA) functional recovery following a TTS episode and assess its association with long-term major adverse cardiovascular events (MACE). METHODS AND RESULTS: In a multicenter, prospective study, 98 consecutive TTS patients (mean age 71 ± 11 years; 94.9% women) with adequate six months left atrial strain imaging were included. LA reservoir (LASr) and contractile strain (LASct) were assessed and compared with 82 healthy controls. A longitudinal strain analysis was performed in a subset of 40 patients evaluated during the acute phase and at six months. MACE were recorded during 45 ± 14 months follow-up. Despite normalization of LV ejection fraction, at six months LASr and LASct were significantly lower compared with controls (32.9 ± 11.8% vs 42.4 ± 10.9%, p < 0.01; 17.2 ± 7.3% vs 20.9 ± 9.7%, p = 0.02). In the longitudinal subset, LV strain improved significantly over time, whereas LA strain showed no recovery. During follow-up 14 patients (14%) experienced MACE. In multivariable Cox regression analysis including age, sex, physical stressor, and admission LV ejection fraction, the addition of LASr at six months significantly improved model fit (Δχ = 6.6, p = 0.01). LASr emerged as the only independent predictor of long-term MACE (HR 0.93, 95% CI 0.88-0.98; p = 0.01). An LASr <30% identified a high-risk subgroup with reduced event-free survival (log-rank p < 0.01). CONCLUSIONS: Impaired LASr at six months is associated with long-term MACE in Takotsubo syndrome despite recovery of left ventricular systolic function.
Chu SN, Zhang J, Yan ZC
… +7 more, Ren QW, Huang JY, Gu WL, Guo R, Xuan HC, Lui CL, Yiu KH
Int J Cardiol
· 2026 Aug · PMID 42034244
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BACKGROUND: Mixed aortic valve disease (MAVD), combining aortic stenosis (AS) and regurgitation (AR), is prevalent yet understudied at mild-to-moderate severity. OBJECTIVES: We aimed to compare clinical outcomes of mild-...BACKGROUND: Mixed aortic valve disease (MAVD), combining aortic stenosis (AS) and regurgitation (AR), is prevalent yet understudied at mild-to-moderate severity. OBJECTIVES: We aimed to compare clinical outcomes of mild-to-moderate MAVD versus isolated AS, hypothesizing more adverse effects due to dual hemodynamic stress. METHODS: This retrospective cohort study analysed 1590 patients (mean age 75.3 ± 12.2 years, 45% male) with mild-to-moderate AS (aortic valve area 1.0-2.0 cm) and preserved left ventricular systolic function (LVEF ≥50%) at Queen Mary Hospital (2003-2021). Mild-to-moderate MAVD was defined as a combination of mild-to-moderate AS and mild-to-moderate AR (≤grade 2). Endpoints included all-cause mortality, aortic valve replacement (AVR), and major adverse cardiovascular events (MACE). RESULTS: MAVD patients were younger (73.2 ± 13.2 vs 75.7 ± 12.0 years; p = 0.004) and less diabetic (14% vs 23%; p = 0.003) than those with isolated AS. MAVD exhibited greater LV dilation (LV end-diastolic diameter 4.39 ± 0.67 vs 4.15 ± 0.63 cm; p < 0.001) and hypertrophy (LV mass index 133.82 ± 41.48 vs 110.38 ± 28.87 g/m; p < 0.001) than those with isolated AS. MAVD increased AVR risk by 42% (adjusted HR 1.42; 95% CI 1.01-1.99; p = 0.048) and MACE by 28% (adjusted HR 1.28; 95% CI 1.02-1.60; p = 0.035), with no mortality difference (adjusted HR 1.09; 95% CI 0.91-1.32; p = 0.4). CONCLUSIONS: Mild-to-moderate MAVD is associated with more adverse LV remodelling and worse clinical outcomes-notably higher rates of AVR and MACE-than isolated AS of comparable severity. These findings challenge its benign perception, advocating closer surveillance to optimize care in this underrecognized population.
Li G, Li F, Huang M
… +7 more, Wu B, Song Z, Yan J, Liu F, Li Z, Zou Z, He Z
Int J Cardiol
· 2026 Aug · PMID 42034243
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BACKGROUND: Short-term pharmacological options for heart failure (HF) patients with hemodynamic instability remain limited, and vasoactive agents are frequently used as life-saving interventions. This study aims to inves...BACKGROUND: Short-term pharmacological options for heart failure (HF) patients with hemodynamic instability remain limited, and vasoactive agents are frequently used as life-saving interventions. This study aims to investigate the association between Blood Pressure Response Index (BPRI) and mortality in decompensated HF patients. METHODS: We conducted a retrospective cohort study in the MIMIC-IV database including HF patients requiring vasoactive drugs. BPRI was calculated hourly as the ratio of the mean arterial pressure to vasoactive-inotropic score. Predictive performance for in-hospital mortality was assessed using receiver operating characteristic curves and the nonlinear relationship was examined with restricted cubic splines. The Cox proportional hazards regression model was applied to evaluate the association between BPRI and 1-year mortality. RESULTS: Among 1871 patients, BPRI demonstrated superior prognostic value for in-hospital mortality (AUC up to 0.755). Restricted cubic splines revealed an L-shaped relationship between BPRI and in-hospital mortality with a cutoff value at 4.391. Below this value, each unit decrease in BPRI significantly increased in-hospital mortality risk (odds ratio = 1.705, 95% CI 1.447-2.021), whereas no significant association was observed above it. Similarly, an elevated BPRI was associated with a reduced 1-year mortality risk, but this protective effect gradually weakened over time. Additionally, a discharge landmark analysis revealed BPRI was not significantly associated with post-discharge mortality (HR = 1.000, 95% CI 0.991-1.009). CONCLUSIONS: By estimating the hemodynamic compensatory threshold and identifying patients with poor responsiveness to vasoactive agents support, BPRI may contribute to earlier risk stratification and more individualized short-term management in decompensated HF.
Bo K, Qu T, Wang H
… +10 more, Yue X, Qi J, Zhou Z, Zhang H, Gao Y, Li S, Zhao C, Li T, Zhang H, Xu L
Int J Cardiol
· 2026 Aug · PMID 42031064
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OBJECTIVES: To evaluate the feasibility of a non-contrast cardiac magnetic resonance (CMR)-based deep learning (DL) model for predicting left ventricular adverse remodeling (LVAR) in patients with acute ST-segment elevat...OBJECTIVES: To evaluate the feasibility of a non-contrast cardiac magnetic resonance (CMR)-based deep learning (DL) model for predicting left ventricular adverse remodeling (LVAR) in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS: A retrospective study included 252 patients with STEMI from two centers, randomized into training (n = 176) and testing (n = 76) cohorts. A two-stage DL framework was employed: (1) An architecture for coarse-to-fine myocardial localization and segmentation based on a 3D U-shaped network and (2) a classification model integrating imaging, morphological, and motion features extracted from cine CMR. The performance of different models was evaluated using the area under the curve (AUC), accuracy, sensitivity, specificity, and the F1 score. Regions influencing the decision-making process of the DL model were highlighted using guided gradient-weighted class activation mapping. RESULTS: The DL model demonstrated robust ability to predict LVAR, with an AUC of 0.865 (95% CI: 0.755-0.956), accuracy of 82.9%, sensitivity of 77.3%, specificity of 85.2% and F1 score 0.723 in the testing set. In multivariable analysis, conventional CMR parameters, including global longitudinal strain, left atrial reservoir strain, and infarct size, remained as independent predictors of LVAR. A combined model integrating DL features with conventional non-contrast CMR parameters improved the predictive performance (AUC: 0.889, 95% CI: 0.803-0.974 in the testing set), significantly outperforming both conventional non-contrast and contrast-enhanced CMR models. CONCLUSION: A non-contrast DL-CMR model effectively predicts LVAR in patients with STEMI, providing a gadolinium-free tool for risk stratification and personalized management.
Abdullah M, Thalib HI, Tahir MB
… +9 more, Khalid N, Mushtaq A, Afzal MA, Moore MD, Sharma N, Muddassir S, Ayers MP, Albaghdadi M, Aronow WS
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42028306
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BACKGROUND: Non-obstructive hypertrophic cardiomyopathy (nHCM) remains a therapeutic challenge, with limited pharmacological options beyond symptomatic management. Mavacamten, a selective allosteric cardiac myosin inhibi...BACKGROUND: Non-obstructive hypertrophic cardiomyopathy (nHCM) remains a therapeutic challenge, with limited pharmacological options beyond symptomatic management. Mavacamten, a selective allosteric cardiac myosin inhibitor, has shown benefit in obstructive HCM, but its role in nHCM is uncertain. METHODS: A systematic search of PubMed, Embase, CENTRAL, and ClinicalTrials.gov was conducted up to November 2025 for placebo-controlled randomized controlled trials (RCTs) enrolling patients with nHCM. Outcomes included Kansas City Cardiomyopathy Questionnaire (KCCQ) score, peak oxygen consumption (pVO), New York Heart Association (NYHA) functional class, and treatment-emergent adverse events (TEAEs). Pooled mean differences (MDs) and risk ratios (RRs) were estimated using random- or fixed-effects models based on heterogeneity. RESULTS: Two RCTs (n = 639) met inclusion criteria. Mavacamten showed a nonsignificant improvement in KCCQ (MD: 2.12; 95% CI: -0.98 to 5.22; I = 0%) and peak oxygen consumption (MD: 0.36 mL/kg/min; 95% CI: -0.20 to 0.92; I = 0%). No significant difference was observed in NYHA class improvement (RR: 1.15; 95% CI: 0.93 to 1.43; I = 0%). TEAE incidence was similar between groups (RR: 1.11; 95% CI: 0.34 to 3.58; I = 40.8%). Atrial fibrillation occurred more frequently with mavacamten (RR: 1.41; 95% CI: 1.28 to 1.56), whereas palpitations and dizziness did not differ significantly. CONCLUSIONS: Mavacamten does not significantly enhance symptoms, functional capacity, or health status in nHCM, though safety is comparable to placebo. Ongoing monitoring for arrhythmias and reduced ejection fraction is essential. Larger, longer-term studies are needed to clarify its role in this population.
Ielasi A, Caminiti R, Pellicano M
… +5 more, Marrone A, Pellegrini D, Banfi C, Glauber M, Tespili M
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42028305
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BACKGROUND: the treatment of high-risk or inoperable patients with severe, pure native non calcified aortic regurgitation (NCAR) poses unique procedural challenges for the -catheter technologies. In particular the lack o...BACKGROUND: the treatment of high-risk or inoperable patients with severe, pure native non calcified aortic regurgitation (NCAR) poses unique procedural challenges for the -catheter technologies. In particular the lack of leaflet calcification and dilated aortic anatomies increase the risk of technical failure with the currently available -catheter heart valves (THV). This study sought to evaluate the feasibility, safety, and clinical outcomes following the off-label usage of the Myval Octacor and Octapro balloon-expandable (BE) THV in patients with pure NCAR. METHODS: a retrospective cohort analysis was performed on consecutive high-risk surgical patients with severe, pure NCAR who underwent TAVI between January 2023 and June 2025 with the second (Octacor) and third (Octapro) generation of the Myval BE THV. Main end-points were technical and device success according to the Valve Academic Research Consortium (VARC) 3 criteria. The rates of permanent pace-maker implantation (PPI) and moderate-to-severe residual AR both, in-hospital and at the longest available follow-up were also evaluated. RESULTS: during the study period, 32 patients (Octacor, n = 21 and Octapro, n = 11) with pure, NCAR were treated. Mean age was 79.3 ± 7.6 years while 81.2% were male. The mean left ventricular ejection fraction was 43.1 ± 7.4%. An XL size was implanted in 21 patients of whom 15 were 32 mm. The average percentage of THV oversize was 19.7 ± 6.9. Technical success was achieved in 87.5% of the cases due to partial migration of 4 THVs (all 32 mm implanted in large annuli) into the LVOT requiring rescue implantation of a second prosthesis. This strategy was effective in achieving a good result in 2 cases while in the remaining 2, the THVs embolized in the left ventricle requiring surgical conversion. No intraprocedural death or disabling strokes were reported. PPI rate at discharge was 9.4% while moderate residual AR was reported in 1 patient (including patient underwent successful rescue THV-in-THV). Device success was 87.5%. At 1-year follow-up, mortality and PPI rates were 3.1% and 15.6%, respectively with no severe residual AR cases reported. CONCLUSIONS: Octacor and Octapro BE THVs implantation in patients with pure NCAR is feasible and yields acceptable clinical outcomes in a high-risk population. Further studies are warranted to better understand the potential role of these THVs in this complex scenario.
Bugge C, Five CK, Ahmed T
… +8 more, Skar PMJ, Castrini AI, Ribe M, Hasselberg NE, Dejgaard LA, Stokke MK, Haugaa KH, Aabel EW
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42028304
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BACKGROUND: Patients with mitral valve prolapse (MVP) are at risk of ventricular arrhythmias (VAs), ranging from premature ventricular complexes (PVCs) to life-threatening VAs. The association between PVC burden and hear...BACKGROUND: Patients with mitral valve prolapse (MVP) are at risk of ventricular arrhythmias (VAs), ranging from premature ventricular complexes (PVCs) to life-threatening VAs. The association between PVC burden and heart rate in patients with MVP is not known. We aimed to identify the association between PVC burden and heart rate in patients with MVP. METHODS: In this this cross-sectional ambispective case control study we included MVP patients with available Holter monitorings. We defined PVC profiles as fast-heart-rate-dependent-PVC (F-HR-PVC) in case of positive correlation with heart rate, slow-heart-rate-dependent-PVC (S-HR-PVC) in case of negative correlation, and independent-heart-rate-PVC (I-HR-PVC) when no correlation was found. For comparison, we included a control group of age- and sex-matched patients with idiopathic PVCs. RESULTS: We included 70 patients with MVP (48 years [interquartile range 35-58], 79% female) and 70 age- and sex-matched patients with idiopathic PVCs. A total of 153 Holter monitorings from patients with MVP were analysed and compared to 70 Holter monitorings from patients with idiopathic PVCs. In the MVP group, we found F-HR-PVC in 44 (63%) patients, I-HR-PVC in 24 (34%) and S-HR-PVC in 2 (3%). MVP patients had more frequently F-HR-PVC and less frequently S-HR-PVC than the control group (p < 0.05 for both). MVP patients with F-HR-PVC had higher rate of NSVTs (incidence rate ratio 2.9 [95% confidence interval 1.1-7.8], p = 0.03) compared to I-HR-PVC. CONCLUSION: Fast-heart-rate-dependent-PVC was the most common PVC profile in MVP patients, and slow-heart-rate-dependent-PVC was rare. These findings suggest a catecholamine-sensitive mechanism acting as trigger for ventricular arrhythmias in MVP patients.
Ali SKM, Elnaem BH, Abdullah MA
… +1 more, D'Agostino EM
Int J Cardiol Cardiovasc Risk Prev
· 2026 Jun · PMID 42027675
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Childhood obesity is increasing alarmingly and cardiovascular disease (CVD), a major complication of obesity, is documented to begin early during childhood and has detectable, preventable stages. The current guidelines f...Childhood obesity is increasing alarmingly and cardiovascular disease (CVD), a major complication of obesity, is documented to begin early during childhood and has detectable, preventable stages. The current guidelines for mitigating CVD prevalence do not incorporate tests for diagnosis of subclinical atherosclerosis. A literature search under the key words "obesity, children, cardiovascular, subclinical atherosclerosis, vascular health, cardiometabolic" was conducted to cover the period from 2010 to 2025 in PubMed and the Cochrane Database of Systematic Reviews for articles published up to October 1, 2025, using combinations of terms such as "child", "adolescent", "obesity", "epidemiology", "etiology", "complications", "cardiovascular", "treatment", "atherosclerosis", "prevention", "endothelial function", "pharmacotherapy", and "BMI". Data about the diagnosis, and management of obesity and its CVD complications were summarized in this paper. Atherosclerosis is documented to have detectable subclinical, potentially reversible stages during childhood. The current guidelines for risk stratification do not account for the cumulative vascular burden of obesity leaving early subclinical stages undetected. While tools such as carotid intima-media thickness and carotid-femoral pulse wave velocity show clear associations with obesity and cardiometabolic risk, there is still lack of consensus on their use in routine care. More research is needed to identify tools that can be incorporated into clinical guidelines for diagnosis of subclinical CVD in children with obesity.
Cherdo C, Mirea C, Zamperini C
… +3 more, Brouder S, Stephan D, Cordeanu EM
Int J Cardiol Cardiovasc Risk Prev
· 2026 Jun · PMID 42023078
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BACKGROUND: Primary aldosteronism (PA) is the most common cause of secondary hypertension, associated with disproportionate cardiovascular morbidity. The 2025 Endocrine Society (ES) guidelines revised diagnostic criteria...BACKGROUND: Primary aldosteronism (PA) is the most common cause of secondary hypertension, associated with disproportionate cardiovascular morbidity. The 2025 Endocrine Society (ES) guidelines revised diagnostic criteria, allowing diagnosis based on a biochemical triad (suppressed renin, elevated aldosterone and aldosterone-to-renin ratio, ARR) without mandatory confirmatory testing. We compared PA detection and diagnostic performance using ES 2016 versus ES 2025 algorithms in hypertensive patients referred to a specialized center. METHODS: We retrospectively analyzed 137 consecutive patients referred for secondary hypertension work-up to Strasbourg University Hospital (June 2024 - June 2025). All underwent standardized hormonal evaluation and saline infusion testing (SIT). PA was defined according to ES 2016 (ARR >23 ng/mUI with aldosterone ≥200 ng/L, or 90-200 ng/L with positive saline test) and ES 2025 criteria with locally adapted thresholds (ARR >18.7 ng/ng, renin ≤6.15 ng/L, aldosterone ≥75 ng/L). RESULTS: PA prevalence increased from 8.8% (n = 12) with ES 2016 to 16.1% (n = 22) with ES 2025 criteria (p = 0.009). Diagnostic concordance was high (91.7%, κ = 0.61). Net reclassification improvement ranged from +148% to +175%. Newly identified patients exhibited milder PA phenotypes with less severe/resistant hypertension (27% vs 73%, p = 0.03), lower aldosterone levels (95 vs 185 ng/L, p < 0.001), and predominantly negative SIT (82%). Despite a 50% false-negative rate, positive SIT remained the only independent predictor of PA diagnosis (OR = 3.25, 95%CI 1.22-8.67, p = 0.019). CONCLUSION: ES 2025 criteria increase PA detection by identifying milder forms not captured by previous algorithms. These findings support a phenotype-based diagnostic approach and question the systematic use of confirmatory testing.
Eguchi S, Orihara Y, Eguchi A
… +4 more, Pfeiffer M, Iii JG, Boehmer J, Wilson R
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42016517
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If an apical or near apical electrode position is discovered or extrasystoles occur during echocardiography in patients with the WiSE-CRT System, the ultrasound probe should be removed, and the alternative protocol shoul...If an apical or near apical electrode position is discovered or extrasystoles occur during echocardiography in patients with the WiSE-CRT System, the ultrasound probe should be removed, and the alternative protocol should be applied.
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42016516
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BACKGROUND: Conduction disturbances requiring permanent pacemaker implantation (PPI) remain common after transcatheter aortic valve replacement (TAVR). This study evaluated whether pre-procedural CT-derived basal muscula...BACKGROUND: Conduction disturbances requiring permanent pacemaker implantation (PPI) remain common after transcatheter aortic valve replacement (TAVR). This study evaluated whether pre-procedural CT-derived basal muscular interventricular septal (IVS) thickness predicts PPI within 1 month post-TAVR in patients with preexisting right bundle branch block (RBBB). METHODS: In 66 TAVR patients with severe aortic stenosis and preexisting RBBB, IVS thickness was measured at 2, 4, 6 and 8 mm below the membranous septum (MS) on CT coronal views. Univariate /multivariate logistic regression were used to identify predictors, and receiver operating characteristic (ROC) analysis evaluated predictive performance. RESULTS: PPI was required in 28 patients (42.4%). The PPI group exhibited significantly thinner IVS across all measured levels (all P < 0.05). Univariate analysis revealed that every 1-mm increase in IVS thickness at 2 mm below MS, the risk of PPI was markedly reduced (OR 0.003, 95% CI: 0.001-0.059). Multivariate analysis adjusting for age, implantation depth, and membranous septum length (MSL) confirmed that IVS thickness < 4.35 mm at 2 mm below MS (adjusted OR 0.05, 95% CI: 0.01-0.32, P = 0.002) and lower MSL-implantation depth difference (MSL-ID) were independent predictors of PPI. The model incorporating IVS thickness showed excellent discrimination (AUC 0.91, 95% CI: 0.84-0.98), superior to the model without it (AUC 0.82, 95% CI: 0.71-0.92). CONCLUSIONS: Pre-procedural CT-derived basal IVS thickness independently predicts post-TAVR PPI in patients with preexisting RBBB. Thinner IVS may reflect less anatomical protection for the conduction system during valve deployment. Integrating IVS thickness into risk assessment could improve patient stratification and procedural planning.