Shitan H, Patel V, Suruga K
… +10 more, Guo Y, Ng D, Cole B, Gupta A, Chakravarty T, Cheng W, Okada Y, Jilaihawi H, Nakamura M, Makkar RR
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42375598
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BACKGROUND: Long-term clinical outcomes after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis who received dialysis remain poorly investigated. Therefore, we aimed to evaluate long-t...BACKGROUND: Long-term clinical outcomes after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis who received dialysis remain poorly investigated. Therefore, we aimed to evaluate long-term outcomes after TAVR using a contemporary balloon-expandable valve (BEV) in patients who received dialysis compared with those who did not. METHODS: In this single-center study, 143 patients who received dialysis were identified among 3189 patients who underwent TAVR with a contemporary BEV between June 2015 and February 2024. After propensity score matching, long-term outcomes were compared between 139 patients who received dialysis and 139 patients who did not. Causes of death after TAVR and predictors of mortality in the dialysis group were also investigated. RESULTS: Patients who received dialysis had higher 5-year mortality (adjusted HR: 2.38; 95% CI: 1.40-4.04; < 0.001) than those who did not. Most deaths in the dialysis group occurred within 3 years after TAVR, and over 50% of the deaths were noncardiac-related, with infection as the leading cause. No significant differences were observed between the two groups in 5-year heart failure rehospitalization (subdistribution HR [sHR]: 1.20; 95% CI: 0.56-2.54; = 0.640), aortic valve reintervention (sHR: 2.47; 95% CI: 0.40-15.19; = 0.330), or disabling stroke (sHR: 0.35; 95% CI: 0.07-1.70; = 0.190). In the dialysis group, baseline moderate or severe tricuspid regurgitation was independently associated with all-cause mortality. CONCLUSIONS: Patients who received dialysis had higher 5-year mortality than those who did not, with an increase in noncardiac deaths, particularly due to infection.
Gold C, Falagkari A, Post F
… +10 more, Johnson V, Roth E, Kühn SJ, Linz D, Dobrev D, Erath-Honold J, Rottner L, Leistner DM, Kupusovic J, Wakili R
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42375597
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BACKGROUND: Randomized trials have demonstrated safety and efficacy of pulsed field ablation (PFA) for atrial fibrillation (AF) using the FARAPULSE™ system (PFA-F). We evaluated implementation of the PulseSelect™ system...BACKGROUND: Randomized trials have demonstrated safety and efficacy of pulsed field ablation (PFA) for atrial fibrillation (AF) using the FARAPULSE™ system (PFA-F). We evaluated implementation of the PulseSelect™ system (PFA-P) in a PFA-F experienced center. METHODS: This single-center study included 150 consecutive patients undergoing first pulmonary vein isolation (PVI) with PFA-P ( = 75) or PFA-F (n = 75). Procedural characteristics, acute efficacy, safety endpoints, AF recurrence rate, myocardial, neural and hemolysis biomarkers (high-sensitive troponin T, creatine kinase (CK), creatine kinase MB, bilirubin, haptoglobin, lactate dehydrogenase and S100) post ablation were analyzed and compared. RESULTS: Baseline characteristics were comparable, except for a higher proportion of males in the PFA-F group. Acute PVI was comparable between groups (98% vs. 100%). Skin-to-skin time and radiation dose were similar, while fluoroscopy (14.3 vs. 11.9 min, = 0.009) and LA-dwell time (18 vs. 14 min, < 0.001) were higher in PFA-P. No major complication occurred, while minor complication rates were comparable. Cardiac biomarker release was significantly higher in PFA-P (ΔCK: 203 vs. 127 U/l = 0.005; Δtroponin: 1212 vs. 1014 pg/ml, = 0.035 (day 1)), whereas neural injury markers were similar. Hemolysis markers indicated greater changes with PFA-F (Δbilirubin: 0.3 vs. 0.2 mg/dl, = 0.004; Δhaptoglobin: -46.5 vs. -27.5 mg/dl, = 0.001 (day1)). Procedural parameters improved with increasing PFA-P experience. CONCLUSION: Implementation of PFA-P is feasible with an evident learning curve in a PFA-F experienced center. Higher post-procedural cardiac biomarker levels may suggest a greater extent of local myocardial tissue damage after PFA-P. The impact of biomarkers on long-term outcome requires further studies.
Martini M, Masini M, Rigato I
… +13 more, Parodi A, Brizzi LF, Iezzi L, Marra MP, De Gaspari M, Pinci S, Cecere A, Celeghin R, Marinas MB, Basso C, Corrado D, Pilichou K, Bauce B
Int J Cardiol
· 2026 Jun · PMID 42372975
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BACKGROUND: Arrhythmogenic cardiomyopathy (ACM) is a genetic heart muscle disease primarily associated with life-threatening ventricular arrhythmias. Improved arrhythmic risk stratification and therapies have enhanced su...BACKGROUND: Arrhythmogenic cardiomyopathy (ACM) is a genetic heart muscle disease primarily associated with life-threatening ventricular arrhythmias. Improved arrhythmic risk stratification and therapies have enhanced survival, making heart failure (HF) an increasingly relevant clinical issue. This study aims to characterize HF in ACM patients and identify variables associated with its occurrence. METHODS: This retrospective, single-center study included 657 ACM patients diagnosed according to the 2010 Revised Task Force Criteria and Padua criteria. HF was defined as hospitalization due to HF symptoms. Clinical, electrocardiographic, imaging and genetic data were compared between patients with and without HF. RESULTS: HF occurred in 48 patients (7.3%). Those with HF were more often probands (p = 0.007) and showed more ECG abnormalities, including T-wave inversions in right (p = 0.004) and lateral leads (p < 0.001) and low QRS voltages in precordial and peripheral leads (p < 0.001). Genetic analysis revealed a higher prevalence of Desmoplakin (DSP) (p = 0.03) and Desmin (p = 0.002) genetic variants. Imaging showed increased ventricular volumes and reduced biventricular systolic function (p < 0.001). The arrhythmic burden was also higher (p = 0.022). Variables associated with HF occurrence were DSP genetic variants (OR = 3.08, p = 0.01), low QRS voltages in peripheral leads (OR = 3.76, p = 0.002), and reduced left ventricular ejection fraction (EF) (OR = 0.89, p < 0.001) and right ventricular EF (OR = 0.93, p < 0.001). CONCLUSIONS: HF in ACM reflects a more severe phenotype with biventricular dysfunction and high arrhythmic burden. Genetic (DSP), electrocardiographic, and imaging markers may contribute to early identification of patients at higher risk and support earlier intervention strategies.
Ma H, Wang L, Mao C
… +6 more, Hu Y, Guo X, Li L, Wang F, Guan R, Zheng L
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42368870
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PURPOSE: (Pro) renin receptor (PRR) is a newly recognized element of the renin-angiotensin system associated with cardiovascular diseases. Nevertheless, the exact roles of PRR in adriamycin-induced cardiomyopathy (ADR-CM...PURPOSE: (Pro) renin receptor (PRR) is a newly recognized element of the renin-angiotensin system associated with cardiovascular diseases. Nevertheless, the exact roles of PRR in adriamycin-induced cardiomyopathy (ADR-CM), represented as decreased heart function or symptoms or signs of heart failure, remain incompletely understood. METHODS: A rat model of ADR-CM was established by intraperitoneally injecting adriamycin (ADR). Primary neonatal rat cardiomyocytes (NRCMs) and cardiac fibroblasts (NRCFs) were stimulated with ADR. PRR inhibitor PRO20 was synthesized and utilized to assess its effects on ADR-CM rats. PRR gene overexpression and silencing were achieved through transfecting recombinant adenoviruses containing PRR and PRR-shRNA in rats and cells. The ERK inhibitor PD98059 was used to suppress phosphorylated ERK1/2 (pERK1/2) in cells. RESULTS: PRR was significantly upregulated in ADR-CM and ADR-stimulated NRCMs and NRCFs. In vivo experiments demonstrated that PRR overexpression exacerbated ADR-induced cardiac dysfunction and myocardial hypertrophy, while systemic administration of PRO20 attenuated ADR-induced this effect. In vivo and vitro experiments, systemic PRO20 administration and PRR gene knockdown attenuated ADR-induced fibrosis, inflammatory response, apoptosis and oxidative stress, whereas PRR overexpression had the opposite effects. Inhibition of PRR decreased ADR-induced cardiac renin activity, angiotensin II (Ang II) concentration and pERK1/2 protein level, while overexpression of PRR increased these indices in the presence of ADR. PD98059 attenuated cardiomyocyte fibrosis, inflammatory response, apoptosis, and reduced NOX2 abundance and NOX activity in ADR-treated NRCFs. CONCLUSION: PRR is involved in the pathological progression of ADR-CM, and inhibition of PRR may represent a novel and promising therapeutic strategy for ADR-CM.
Maggioni AP, Orso F, Lucci D
… +2 more, De Luca L, Colivicchi F
Int J Cardiol
· 2026 Jun · PMID 42361988
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BACKGROUND AND AIM: Randomised clinical trials (SELECT and SOUL) demonstrated that semaglutide, a GLP-1 receptor agonist, reduces the combined outcome measure of atherothrombotic events or cardiovascular mortality in pat...BACKGROUND AND AIM: Randomised clinical trials (SELECT and SOUL) demonstrated that semaglutide, a GLP-1 receptor agonist, reduces the combined outcome measure of atherothrombotic events or cardiovascular mortality in patients with coronary artery disease, both with and without diabetes. Because real-world populations may differ from trial cohorts, we assessed the proportion of patients potentially eligible for semaglutide using the criteria set out by the regulatory authorities based on the SELECT and SOUL results. METHODS AND RESULTS: Patients whose clinical characteristics were comparable to those of patients enrolled in the SELECT and SOUL trials were identified within the START and BRING-UP prevention registries. Among 12,430 patients, 623 were excluded because of severe renal impairment or ongoing GLP-1 receptor agonist therapy. The final population included 11,807 patients: 8682 without diabetes and 3125 with diabetes. Among non-diabetic patients, 3689 (42.5%) were SELECT-like, defined as overweight or obese individuals with established coronary disease. Among diabetic patients, 3059 (97.9%) were SOUL-like, defined as individuals aged ≥50 years with cardiovascular disease. Overall, 6748 of 12,430 patients (54.3%) theoretically fulfilled eligibility criteria for semaglutide treatment in real-world cardiology practice. CONCLUSIONS: According to the criteria set out by the regulatory authorities based on the SELECT and SOUL trial results, a large proportion of patients with coronary artery disease managed by cardiologists may be potentially eligible for semaglutide therapy. Identifying the target population for this therapeutic strategy may help clinicians and healthcare authorities estimate unmet clinical needs and evaluate the sustainability of innovative approaches for secondary cardiovascular prevention.
Simioni L, Loureiro T, Faucherre Y
… +9 more, Cioffi GM, Jelisejevas J, Bennar W, Beretta GS, Puricel S, Meier P, Togni M, Cook S, Skalidis I
Int J Cardiol
· 2026 Jun · PMID 42361987
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BACKGROUND: Obesity is increasing in all regions of Switzerland. Multiple studies have described the "obesity paradox" suggesting a protective effect of obesity on the occurrence of major adverse cardiovascular events (M...BACKGROUND: Obesity is increasing in all regions of Switzerland. Multiple studies have described the "obesity paradox" suggesting a protective effect of obesity on the occurrence of major adverse cardiovascular events (MACE) after ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). OBJECTIVE: This study aimed to assess the impact of obesity on MACE in STEMI patients undergoing PCI. METHODS: We analyzed data from the Fribourg STEMI Fast-Track prospective registry in a retrospective, single-center cohort study. Adult patients were classified as obese (BMI ≥ 30 kg/m) or non-obese (BMI < 30 kg/m) and followed for 12 months. The primary endpoint was a composite MACE including all-cause death, recurrent acute coronary syndrome (ACS) (STEMI, NSTEMI and unstable angina (UA)), stroke, stent thrombosis, unscheduled revascularisation, and major bleeding (BARC 3-5). Secondary endpoints included stratification according three obesity stages to evaluate 1-year MACE-free survival, as well as assessment of individual MACE components, delays in care, mode of presentation, and clinical and procedural characteristics. Kaplan-Meier analysis with log-rank testing and Cox regression were used to evaluate outcomes. RESULTS: A total of 1043 patients were included between June 2008 and October 2025, of whom 214 (21%) were obese and 829 (79%) were non-obese. Obese patients were slightly younger (60.00 (53.00, 70.00) vs 62.00 (53.00, 72.00) years, p = 0.037), with a similar proportion of women (21% vs 25%, p = 0.299). At 12 months, MACE-free survival was similar between groups (log-rank p = 0.76), and obesity was not associated with MACE after adjustment. No differences were observed in individual components of the composite endpoint. Pre-hospital delay was comparable, whereas first medical contact-to-revascularisation (FMC-to-REVASC) time was longer in obese patients (0.78 vs 0.57 h, p < 0.001), with no difference in total ischemic time. Obese patients were less likely to present via ambulance (31% vs 38%) and more likely to self-present to the emergency department (32% vs 24%; p = 0.037). Clinical presentation, procedural characteristics, and coronary anatomy were similar between groups. CONCLUSIONS: In this contemporary STEMI cohort, obese patients treated with primary PCI did not experience higher 1-year MACE rates than non-obese patients. However, obesity was associated with differences in care pathways and longer in-hospital delays, without impact on clinical outcomes.
Komura N, Sugano T, Suzuki T
… +16 more, Ono F, Abe M, Yamamoto U, Sekiya K, Kodama S, Minegishi S, Kato S, Okada K, Hosoda J, Konishi M, Otsuka F, Iwahashi N, Ishigami T, Utsunomiya D, Mo M, Hibi K
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42358916
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BACKGROUND: Selexipag has been approved for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in Japan since April 2021; however, its hemodynamic effects in treatment-naïve patients with inoperable C...BACKGROUND: Selexipag has been approved for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in Japan since April 2021; however, its hemodynamic effects in treatment-naïve patients with inoperable CTEPH prior to balloon pulmonary angioplasty (BPA) remain unclear. This study evaluated the impact of selexipag monotherapy on pulmonary hemodynamics before first BPA. METHODS: Between August 2021 and February 2024, 40 newly diagnosed, treatment-naïve patients with inoperable CTEPH undergoing their initial BPA session were screened at Yokohama City University Hospital. After excluding three patients in the riociguat group due to insufficient titration time, 30 patients (15 selexipag, 15 riociguat) were included in this retrospective observational study. Hemodynamic parameters were assessed before and after pharmacotherapy and compared within and between groups. RESULTS: The selexipag group included 10 women (mean age 66.5 years; average dose 2.2 mg/day). Selexipag significantly reduced mean pulmonary arterial pressure (mPAP) from 39.0 to 33.6 mmHg (-5.4 ± 6.7 mmHg; = 0.008) and pulmonary vascular resistance (PVR) from 8.07 to 6.69 Wood units (WU; -1.38 ± 1.2 WU; = 0.001), without a significant change in cardiac output (CO). Riociguat significantly reduced mPAP (-7.8 ± 8.5 mmHg; = 0.003) and PVR (-2.57 ± 2.4 WU; P = 0.001) and increased CO (+0.81 ± 1.0 L/min; = 0.006). Changes in mPAP and PVR did not differ significantly between groups, whereas CO increased significantly more with riociguat ( = 0.04). CONCLUSIONS: In this exploratory, hypothesis-generating retrospective study, selexipag monotherapy was associated with reductions in mPAP and PVR in treatment-naïve patients with inoperable CTEPH before BPA, whereas riociguat showed greater CO improvement. These findings warrant prospective validation in selected patients before broader clinical application.
Meucci MC, Pontecorvo S, Di Brango C
… +9 more, Lillo R, Iannaccone G, Luigetti M, Recupero C, Locorotondo G, Lanza GA, Lombardo A, Burzotta F, Graziani F
Int J Cardiol
· 2026 Jun · PMID 42349692
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BACKGROUND: Left atrioventricular coupling index (LACI) has emerged as a powerful marker of cardiac remodeling across a variety of cardiac diseases, however its prognostic value in the setting of transthyretin amyloid ca...BACKGROUND: Left atrioventricular coupling index (LACI) has emerged as a powerful marker of cardiac remodeling across a variety of cardiac diseases, however its prognostic value in the setting of transthyretin amyloid cardiomyopathy (ATTR-CM) remains largely unexplored. METHODS: Patients with ATTR-CM who underwent prospective evaluation comprising full echocardiographic assessment between 2021 and 2025 were included. LACI was measured as the ratio between the left atrial (LA) and the left ventricular (LV) end-diastolic volumes. The population was stratified based on LACI terciles. The study endpoint was all-cause mortality. RESULTS: A total of 202 patients (median age 80 years, 80% male) were included, with a predominance of wild-type subtype (70%). LACI terciles cutoffs were: ≤59.5% (first tercile), from 59.5% to 88.1% (second tercile) and > ≥88.1% (third tercile). Higher LACI terciles were associated with a greater prevalence of wild-type disease and atrial fibrillation (AF) and more advanced NAC stage. Higher LACI terciles were associated with significantly smaller LV volumes and larger LA volumes, as well as worse parameters of LV systolic and diastolic function. Three-year survival rates progressively declined across increasing LACI terciles (97%, 68% and 55%, p < 0.001). LACI demonstrated higher discriminatory power for predicting 3-year mortality (AUC 0.789, 95% CI 0.717-0.861), in comparison to LA dimensional parameters. After adjusting for age, NAC stage, AF and LV longitudinal strain, LACI terciles remained significantly associated with all-cause mortality (adjusted HR 1.942, 95% CI 1.078-3.499; p = 0.027). CONCLUSIONS: In patients with ATTR-CM, increasing LACI is associated with markers of disease severity and worse long-term survival.
Lenselink C, Lau YH, Huang W
… +9 more, Ewe SH, Chiong SC, Ng CT, Ricken K, Lipsic E, Voors A, Lam CSP, Yeo KK, Yap J
Int J Cardiol
· 2026 Oct · PMID 42331183
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BACKGROUND: Early risk stratification in patients after acute myocardial infarction (AMI) is critical for guiding therapy and resource allocation. While left ventricular ejection fraction (LVEF) is routinely assessed by...BACKGROUND: Early risk stratification in patients after acute myocardial infarction (AMI) is critical for guiding therapy and resource allocation. While left ventricular ejection fraction (LVEF) is routinely assessed by echocardiography, novel markers offer additional prognostic utility but are not widely assessed due to time constraints or limited expertise. Artificial intelligence (AI) enables rapid, fully automated analysis of echocardiograms, producing standardized, comprehensive measurements. We evaluated the utility of AI-derived echocardiographic parameters on top of clinical variables in predicting outcomes post-AMI. METHODS: Consecutive AMI patients undergoing invasive coronary angiogram were included. Echocardiograms were analyzed using Us2.ai software. Independent predictors of one-year all-cause mortality and major adverse cardiac events (MACE) were assessed using Cox regression. Clinical, echocardiographic, and combined models were compared. RESULTS: Among 1001 patients, aged 64 years (54, 72) and predominantly male (78.1%), 161 (16.1%) died during follow-up. AI-echocardiographic markers independently associated with one-year all-cause mortality or MACE included lower LVEF, greater LV wall thickness, lower LV mass, greater LA area, lower LA reservoir strain and lower aortic valve area. For one-year mortality, the combined model demonstrated superior discrimination compared with the clinical model alone (AUC 0.85 vs. 0.81; p = 0.018). Similarly, for one-year MACE, the combined model showed improved discrimination compared with the clinical model (AUC 0.80 vs. 0.74; p < 0.001) and yielded the lowest Akaike's and Bayesian Informations. CONCLUSION: Combining AI-derived echocardiographic parameters, together with traditional clinical risk factors, provides incremental prognostic value post-AMI. AI tools that automate complex assessments accurately and reproducibly may enhance risk stratification.
Int J Cardiol
· 2026 Jun · PMID 42331182
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AIMS: Diseases of the aorta are driven by chronic inflammation and matrix metalloproteinase activity. Vaccines such as Yellow Fever (YF) and BCG may be associated with vascular protection through "trained immunity", epig...AIMS: Diseases of the aorta are driven by chronic inflammation and matrix metalloproteinase activity. Vaccines such as Yellow Fever (YF) and BCG may be associated with vascular protection through "trained immunity", epigenetic reprogramming of innate immune cells that attenuates systemic inflammatory responses. We investigated the association between population-level vaccination coverage and aortic mortality using contemporary causal inference methods. METHODS AND RESULTS: This ecological study analyzed 27 Brazilian states over 29 years (1994-2022), encompassing 783 state-year observations and 185,429 deaths. Poisson fixed-effects models with state and year intercepts were employed to isolate within-state effects. States with high YF coverage (>80%) showed a 16% lower age-standardized aortic mortality compared to low-coverage states (IRR 0.84; 95% CI 0.76-0.93; P = 0.001). E-value analysis for this association was 1.67, indicating robustness against moderate unmeasured confounding. For BCG, associations followed a biologically plausible lag structure, peaking at 15 years post-vaccination (IRR 0.91 per 10 pp. increase; 95% CI 0.85-0.98; P = 0.009). Negative control analysis using Diphtheria-Tetanus-Pertussis (DTP) vaccine, which lacks trained immunity effects, showed no association with aortic mortality (IRR 1.02; P = 0.578), arguing against residual confounding from healthcare access. Causal mediation analysis suggested that 65% of the YF vaccine's association operated through pathways independent of infectious disease reduction. CONCLUSION: Population-level vaccination with YF and BCG is associated with lower aortic mortality in this ecological analysis. These hypothesis-generating findings, supported by negative control validation and temporal consistency across three decades, are compatible with a trained immunity pathway but require confirmation in prospective individual-level studies before causal conclusions can be drawn.
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42327960
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BACKGROUND: The autonomic imbalance can negatively affect left ventricular (LV) remodeling following a myocardial infarction (MI). Ganglionated plexi (GP) play a crucial role in autonomic nervous system imbalance. Cardia...BACKGROUND: The autonomic imbalance can negatively affect left ventricular (LV) remodeling following a myocardial infarction (MI). Ganglionated plexi (GP) play a crucial role in autonomic nervous system imbalance. Cardiac sympathetic afferent denervation (CSAD) has been shown to have beneficial effects in addressing this imbalance. OBJECTIVES: This study aimed to evaluate the effects of the ablation of cardiac sympathetic sensory neurons on LV remodeling. Resiniferatoxin (RTX), a neurotoxic transient receptor potential vanilloid (TRPV1) antagonist, was used to achieve it. METHODS AND RESULTS: A total of 31 beagle dogs were randomly assigned to three groups: MI group ( = 12), CSAD group (MI with CSAD; = 10), and Control group (sham surgery without CSAD; = 9). In the CSAD group, RTX was injected into the anterior right ganglionated plexi (ARGP) only once. After a 4-week follow-up period, CSAD treatment resulted in a significant decrease in left stellate ganglion (LSG) activity, improved LSG remodeling, reduced LV dilation, and improved LV function. Furthermore, CSAD treatment significantly attenuated LV remodeling in post-MI LV tissue. The treatment also showed positive effects on high-sensitivity C-reactive protein (hs-CRP), norepinephrine (NE), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and Neuropeptide Y (NPY) levels. CONCLUSIONS: In conscious dogs with healed MI, CSAD led to a reduction in cardiac sympathetic tone and an improvement in ventricular remodeling. This suggests that targeting cardiac sympathetic sensory neurons through CSAD may have therapeutic benefits in managing LV remodeling after MI.
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42327959
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Takotsubo syndrome (TTS) has traditionally been regarded as a diagnosis of exclusion requiring the absence of obstructive coronary artery disease. However, increasing evidence suggests that acute myocardial infarction (A...Takotsubo syndrome (TTS) has traditionally been regarded as a diagnosis of exclusion requiring the absence of obstructive coronary artery disease. However, increasing evidence suggests that acute myocardial infarction (AMI) and TTS may coexist as a combined overlap phenotype. We refer to this entity as STAMI (Superimposed Takotsubo and Acute Myocardial Infarction). This review summarizes currently available evidence regarding the clinical characteristics, imaging findings, mechanisms, and outcomes of this underrecognized syndrome. A systematic review of published case reports and case series identified 48 patients with simultaneous AMI and TTS reported between 2000 and 2025. The mean age was 67 years and 69% were women. STEMI was present in 57% and NSTEMI in 41% of cases. Although atherosclerotic plaque rupture was the predominant infarct mechanism, vasospasm and spontaneous coronary artery dissection accounted for more than 20% of presentations. A consistent finding across reports was an anatomical-functional mismatch in which wall-motion abnormalities extended beyond the culprit coronary territory, most commonly manifesting as apical ballooning. Marked QTc prolongation and disproportionately elevated natriuretic peptide levels were recurrent features. Initial left ventricular dysfunction was often severe but demonstrated substantial recovery during follow-up, supporting the presence of reversible stress-induced myocardial stunning in addition to ischemic injury. Cardiogenic shock occurred in approximately 10% of patients, while in-hospital mortality was 6.3%. Recognition of STAMI is clinically important because ventricular dysfunction frequently exceeds the expected infarct territory and may influence diagnostic interpretation, risk stratification, and therapeutic management strategies.
Kinoshita H, Kimura K, Masada K
… +2 more, Shimonaga T, Sugino H
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42327958
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BACKGROUND: Vericiguat and sacubitril/valsartan both modulate the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate signaling pathway and may improve myocardial function in patients with heart failure...BACKGROUND: Vericiguat and sacubitril/valsartan both modulate the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate signaling pathway and may improve myocardial function in patients with heart failure. OBJECTIVES: To compare the effects of vericiguat, sacubitril/valsartan, and their combination on left ventricular function and clinical outcomes in heart failure with nonpreserved ejection fraction patients. METHODS: In this retrospective real-world study, patients were classified into three groups: vericiguat added to guideline-directed medical therapy (vericiguat group), sacubitril/valsartan-based therapy (sacubitril/valsartan group), and combined sacubitril/valsartan plus vericiguat therapy (add-vericiguat group). Changes in left ventricular ejection fraction (ΔLVEF), in stroke volume (ΔSV), and in log-transformed N-terminal pro-B-type natriuretic peptide (ΔLog NT-pro BNP) from baseline to 1 year were evaluated. Clinical outcomes were also assessed. RESULTS: At 1 year, LVEF significantly improved in both the vericiguat group ( = 0.02) and the sacubitril/valsartan group ( < 0.001). There was no significant difference in ΔLVEF between these two groups ( = 0.25). In contrast, the add-vericiguat group demonstrated a significantly greater improvement in ΔLVEF compared with the vericiguat group ( = 0.01). CONCLUSIONS: In a real-world setting, vericiguat was associated with improvements in left ventricular function comparable to those of sacubitril/valsartan, and combination therapy provided incremental benefits. Vericiguat may serve as an alternative or adjunctive treatment option, particularly in patients unable to tolerate or maintain angiotensin receptor-neprilysin inhibitor therapy.
Cheng JF, Tsai CT, Lee CL
… +9 more, Chiang JY, Liu SC, Chang CJ, Lin CP, Huang CH, Liou JT, Tsai CT, Wang YC, Hwang JJ
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42327957
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BACKGROUND: The impact of small vessel size on chronic total occlusions (CTO) interventions remains underexplored. We compared revascularization feasibility and follow-up outcomes between patients with small- and non-sma...BACKGROUND: The impact of small vessel size on chronic total occlusions (CTO) interventions remains underexplored. We compared revascularization feasibility and follow-up outcomes between patients with small- and non-small vessel de novo CTOs. METHODS: In total, 493 consecutive patients (64.0 ± 11.4 years, 432 men) undergoing wiring-based de novo CTO interventions were divided into two groups: small vessels (reference vessel diameter < 2.75 mm, = 245) and non-small vessels ( = 248). Procedural success and guidewire crossing time were compared. Among 449 patients with successful recanalization, long-term outcomes including target lesion failure [cardiac death, target vessel myocardial infarction (TVMI), and target lesion revascularization] were assessed over a median follow-up of 57.4 (30.2-87.3) months. RESULTS: With increased J-CTO score, the procedural success rates remained comparable in the small vessel CTO group but declined significantly in non-small vessel CTO group when the score was ≥3 (82 vs. small vessel: 93%, = 0.008). For lesions with a J-CTO score ≥ 3, multivariate analyses showed that the presence of small vessel was independently associated with procedural success (OR = 8.2, 95% CI = 3.2-21.1, < 0.001), and a successful guidewire crossing time ≥ 30 min (OR = 3.0, 95% CI = 1.6-5.6, = 0.001). Cox' regression model showed that successfully recanalized small vessel CTOs was independently accompanied by a lower long-term risk of TVMI (HR = 0.10, 95% CI = 0.01-0.79, = 0.029). CONCLUSION: Despite the longer guidewire crossing time for small vessel CTOs with higher complexity, we demonstrated greater procedural feasibility and better long-term TVMI-free survival for small vessel CTO interventions. However, long-term outcomes of small vessels can be clinically silent and therefore might affect the study results.