Minja NW, Pulle J, Xu X
… +14 more, Rwebembera J, Atala J, Oyella LM, Kamarembo J, Odong F, Nakagaayi D, de Loizaga S, Danforth K, Longenecker CT, Sable C, Beaton AZ, Okello E, Su Y, Watkins DA
Int J Cardiol
· 2026 Jun · PMID 42320685
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BACKGROUND: Rheumatic heart disease (RHD) interventions are currently being rolled out in Northern Uganda. We recently evaluated a programme to decentralise secondary antibiotic prophylaxis (SAP) from regional hospitals...BACKGROUND: Rheumatic heart disease (RHD) interventions are currently being rolled out in Northern Uganda. We recently evaluated a programme to decentralise secondary antibiotic prophylaxis (SAP) from regional hospitals to primary clinics in Lira and Gulu districts, finding equivalent adherence and high acceptability. The present study evaluated the cost implications of the programme. METHODS: We prospectively assessed costs from the purchaser, patient, and societal perspectives, comparing unit and total costs before and after programme implementation. We used a mixed costing approach, including ingredients-based and step-down costing for direct and indirect costs (respectively) to the purchaser. We assessed patient costs through exit surveys. Cost data were analysed using descriptive statistics and t-tests for changes after implementation. A sensitivity analyses was done around indirect costs. RESULTS: The programme reduced purchaser costs for clinical services (overheads, personnel and medications) by over 50% in both districts. Likewise, it significantly reduced patient costs, by lowering transport costs and productivity losses. To enable this, substantial investments were needed for implementation strategies ("programme costs") to support SAP delivery, especially for equipment and training. Our findings were robust in the sensitivity analysis. CONCLUSION: Compared to current practice, an RHD decentralisation programme reduced the unit cost of SAP to the purchaser, though this was attenuated by higher programme costs. The programme provided financial benefit to low-income households and reduced the volume of RHD care at hospitals. Future projects could seek to reduce programme costs, by streamlining training activities. Our findings can inform the design of RHD programmes in the region.
Amorocho-Morales JD, Guevara SP, Quintero-Muñoz E
… +2 more, Dimas G, Correa-Morales JE
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42317965
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AIM: Cardiovascular disease remains the leading global cause of death, and the need for accurate, event-specific risk prediction is particularly critical in regions where long-horizon models perform poorly. We developed...AIM: Cardiovascular disease remains the leading global cause of death, and the need for accurate, event-specific risk prediction is particularly critical in regions where long-horizon models perform poorly. We developed and internally validated a probabilistic model to estimate 6- and 12-month risk of acute myocardial infarction, with exploratory 5- and 10-year horizons, using routinely collected electronic health record data from an integrated cardiovascular cohort in Colombia. METHODS: The study followed TRIPOD + AI guidance and analysed 382,589 patients contributing 3.9 million encounters. The modelling strategy combined a calibrated gradient-boosting classifier with an interpretable survival ensemble incorporating Cox regression, random survival forests, and discrete-time hazards. Primary outcomes were prediction accuracy, discrimination, calibration, and concordance with legacy score scales. RESULTS: The classifier achieved an AUC of 0.869, while 6- and 12-month survival models reached C-indices of 0.836 and 0.846. Calibration was strong, with predicted vs observed AMI counts nearly identical (O/E = 0.998). Concordance analyses demonstrated only moderate alignment with Framingham and PROCAM, indicating substantial re-ranking at short horizons compared with legacy long-term models. External, label-delayed validation (n = 5602) showed monotonic risk separation across predefined priority bands. CONCLUSION: This model provides a practical population-health stratification tool for short-term AMI risk, with particular value in resource-constrained settings. Recalibration to local incidence rates is recommended before deployment. Prospective evaluation is warranted to assess real-world clinical and operational impact.
Hou W, Ren W, Shao Z
… +7 more, Zhang S, Luo J, Wang X, Fan Z, Xu J, Sun R, Hu B
Int J Cardiol
· 2026 Oct · PMID 42314850
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BACKGROUND: Management of high-risk pulmonary embolism (HRPE) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is challenging, with limited evidence guiding optimal reperfusion strategies. This study...BACKGROUND: Management of high-risk pulmonary embolism (HRPE) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is challenging, with limited evidence guiding optimal reperfusion strategies. This study evaluated the association between different reperfusion approaches, including catheter-based embolectomy, and clinical outcomes in HRPE patients supported with VA-ECMO. METHODS: A multicenter retrospective cohort study included HRPE patients from six ICUs between January 2020 and August 2023. Patients on VA-ECMO were categorized into three groups: ECMO alone, ECMO with systemic thrombolysis, and ECMO with pulmonary artery catheter-based embolectomy. Patients managed without ECMO served as controls. The primary endpoint was 60-day all-cause mortality. RESULTS: Among 89 patients, 64 (71.9%) received VA-ECMO. Within this group, 35 (54.7%) were managed with ECMO alone, 18 (28.1%) with ECMO + thrombolysis, and 11 (17.2%) with ECMO + embolectomy. The observed 60-day mortality rates were 60.0% in non-ECMO, 42.9% in ECMO-alone, 61.1% in ECMO + thrombolysis, and significantly lower at 9.1% in ECMO + embolectomy. Multivariate Cox analysis identified renal replacement therapy (HR 2.87, P = 0.024), baseline serum lactate (HR 1.053 per mmol/L, P = 0.045), and reperfusion strategy (ECMO + embolectomy vs. others; HR 10.3, P = 0.041) as independent predictors of mortality. CONCLUSION: In HRPE patients supported with VA-ECMO, catheter-based embolectomy was associated with markedly improved 60-day survival compared to ECMO alone or with thrombolysis, suggesting a potential benefit of this intervention despite limited sample size.
Emori H, Shiono Y, Yamanobe H
… +8 more, Kawai S, Takamatsu M, Honda Y, Yamamoto K, Kuriyama N, Nishihira K, Shibata Y, Tanaka A
Int J Cardiol
· 2026 Oct · PMID 42314849
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BACKGROUND: Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are established plaque-modifying strategies for heavily calcified coronary lesions. Despite their different mechanisms, the incidence of signifi...BACKGROUND: Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are established plaque-modifying strategies for heavily calcified coronary lesions. Despite their different mechanisms, the incidence of significant periprocedural myocardial injury (PMI) and its clinical implications remain inadequately studied. This study compared the incidence of significant PMI and clinical outcomes following PCI with IVL versus RA. METHODS: We retrospectively analyzed 422 lesions (RA: 332; IVL: 90) in 398 patients who underwent PCI for moderately or severely calcified lesions between November 2019 and June 2024. High-sensitivity cardiac troponin (hs-cTn) was systematically measured after PCI. Significant PMI was defined according to the Academic Research Consortium-2 (ARC-2) criteria as post-PCI hs-cTn ≥70× the upper reference limit. The two-year incidence of target lesion failure (TLF)-a composite of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization-was assessed. RESULTS: Significant PMI (hs-cTn ≥70× URL) occurred in 25% of RA-treated lesions and 18% of IVL-treated lesions (P = 0.15). Median peak hs-cTn levels were higher after RA than after IVL (27.6 [10.7-70.9] vs. 17.7 [6.3-51.2] × URL; P = 0.024), but the difference was not significant after propensity score matching (21.3 [9.1-59.7] vs. 17.7 [6.3-51.2] × URL; P = 0.35). The two-year incidence of TLF was also similar between the two groups (RA: 9% vs. IVL: 11%; adjusted hazard ratio: 1.82; 95% CI 0.76-4.37; P = 0.17). CONCLUSION: Significant PMI was frequently observed after PCI for heavily calcified lesions treated with either IVL or RA, and the two-year TLF rates did not significantly differ between the two methods.
Yokouchi-Konishi T, Aoki-Kamiya C, Tsuritani M
… +13 more, Ishihara Y, Miyashita Y, Asano Y, Yagyu T, Matsuda H, Morisaki H, Temukai M, Sawada M, Kakigano A, Iwanaga N, Kanagawa T, Neki R, Yoshimatsu J
Int J Cardiol
· 2026 Oct · PMID 42314848
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BACKGROUND: Pregnancy in women with Marfan syndrome (MFS) increases the risk of aortic dissection, yet management based solely on aortic root diameter often fails to predict this complication, particularly Stanford type...BACKGROUND: Pregnancy in women with Marfan syndrome (MFS) increases the risk of aortic dissection, yet management based solely on aortic root diameter often fails to predict this complication, particularly Stanford type B dissection. Haploinsufficient (HI) FBN1 variants are associated with more severe aortic phenotypes. We investigated the relationship between FBN1 genotype and pregnancy-related aortic dissection in women with MFS. METHODS: We retrospectively analyzed women with genetically confirmed MFS whose pregnancies progressed beyond the second trimester and who were managed at a single tertiary referral center between 1993 and 2024. FBN1 variants were categorized as HI or non-HI. Pregnancy-related aortic dissection-defined as occurring during pregnancy or within six months postpartum-was evaluated in relation to variant type. RESULTS: Thirty-five women (15 HI, 20 non-HI) were included. Pregnancy-related aortic dissection occurred in 11 women: seven were referred after the dissection occurred and nine were Stanford type B. The incidence was higher in the HI group than in the non-HI group (9/15 [60%] vs 2/20 [10%], P = 0.002). Pre-pregnancy native aortic root diameters did not differ between those with and without dissection. Additional risk factors included undiagnosed with MFS at the time of dissection and absence of β-blocker therapy. CONCLUSIONS: HI FBN1 variants were associated with pregnancy-related aortic dissection in this cohort. Stanford type B dissection may occur even with mild aortic dilation, highlighting the limitations of diameter-based risk stratification. Incorporating FBN1 genotype into preconception counseling and pregnancy management may improve maternal outcomes. However, given the retrospective single-center design, prospective validation is warranted.
Alonso Gómez AM, Goicolea-Güemez L, Romaguera D
… +9 more, Toledo E, Tojal-Sierra L, López Rodriguez L, Ramallal R, Gonzalez-Casanova I, Zaldua-Irastorza O, Salas-Salvadó J, Fitó M, Alonso A
Int J Cardiol
· 2026 Oct · PMID 42314846
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BACKGROUND: Information on the natural history of left atrial (LA) echocardiographic parameters in patients with metabolic syndrome (MS) and obesity is limited. We investigated the association between glycemic status and...BACKGROUND: Information on the natural history of left atrial (LA) echocardiographic parameters in patients with metabolic syndrome (MS) and obesity is limited. We investigated the association between glycemic status and markers of LA structure and function. METHODS: Longitudinal, prospective, multicenter study in patients with MS and a body mass index ≥27 and < 40 kg/m, without cardiovascular disease. A central echocardiography laboratory evaluated LA echocardiographic parameters at baseline and at 3 and 5 years of follow-up. At baseline, glycemic status was categorized as normoglycemia, prediabetes, or diabetes according to established criteria. The association between glycemic status and LA structure and function was estimated using multiple regression models adjusted for potential confounders. RESULTS: We analyzed 553 participants (mean age 65 ± 5 years; 40% women) with normoglycemia (n = 68), prediabetes (n = 287), or diabetes (n = 198). Compared with baseline, at 5 years the LA volume index increased (22.9 ± 7 to 27.1 ± 8.9, p < 0.0001), LA reservoir strain decreased (27.8 ± 6.5 to 23.3 ± 6.6, p < 0.0001), LA stiffness index increased (0.35 ± 0.17 to 0.41 ± 0.26, p < 0.0001), LA function index decreased (67.3 ± 29.2 to 55.8 ± 24.3, p < 0.0001), and the left atrioventricular coupling index increased (21.7 ± 10.5 to 32.2 ± 20.3, p < 0.0001). No association was found between glycemic status and LA echocardiographic parameters of atrial function. CONCLUSIONS: In a population with MS and obesity but free of cardiovascular disease, glycemic status was not strongly associated with longitudinal changes in echocardiographic markers of LA structure or function. In all three groups, echocardiographic parameters worsened significantly during follow-up.
Jürgens F, Schindhelm F, Abusharekh M
… +7 more, Brandts CMK, Kampf J, Totzeck M, Al-Rashid F, Lüdike P, Rassaf T, Mahabadi AA
Int J Cardiol
· 2026 Oct · PMID 42314845
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BACKGROUND: Multiple grasping attempts are routinely required during mitral valve transcatheter-edge-to-edge repairs (M-TEER) to achieve optimal leaflet capture and minimize mitral regurgitation (MR). Whether extensive g...BACKGROUND: Multiple grasping attempts are routinely required during mitral valve transcatheter-edge-to-edge repairs (M-TEER) to achieve optimal leaflet capture and minimize mitral regurgitation (MR). Whether extensive grasping adversely affects procedural outcomes remains unknown. AIMS: We aimed to evaluate safety, procedural characteristics and durability of MR reduction in M-TEER procedures with low vs. high number of grasping attempts using the PASCAL system. METHODS: Consecutive patients with severe MR who underwent M-TEER using the PASCAL system between 2019 and 2024 at our center were analyzed. Procedures were stratified according to grasping attempts: ≤7 (≤80th percentile, median 4 [2;5]) vs. ≥8 (>80th percentile, median 10 [9;12], max. 22). Baseline, procedural, short- and latest outcomes, were compared between groups. RESULTS: Overall, 391 M-TEER procedures (mean age 77.7 ± 10.1 years, 57.5% male) were included. No single leaflet device attachment, leaflet injury or other device-related complication occurred in either group. Procedures with ≥8 attempts were longer (126 ± 47.6 min vs. 82.9 ± 43.3 min; p < 0.001) and associated with larger baseline EROA (0.48 [0.38;0.70] vs. 0.40 [0.30;0.50] cm; p = 0.0001). Improvement in MR severity from baseline to discharge (p = 0.116) and sustainability of MR reduction at latest follow-up (median 434 [176;699] days; p = 0.082) were comparable between groups. NYHA functional class improvement (p = 0.99 at 90 days; p = 0.78 at latest follow-up) and all-cause mortality (7.3% vs. 6.5%; p = 1.00) were also similar. CONCLUSION: Multiple grasping during M-TEER using the PASCAL system is safe and results in sustained MR reduction, high procedural success and latest outcomes comparable to procedures requiring fewer attempts.
Cui L, Zhao J, Gao Y
… +16 more, Chen Y, Guo J, Zhao R, Ma X, Dong F, Chen J, Wang Y, Li L, Chen T, Xing L, Yu H, Hou J, Dai J, Fang C, Mintz GS, Yu B
Int J Cardiol
· 2026 Oct · PMID 42309490
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BACKGROUND: This study aimed to investigate plaque characteristics and long-term outcomes associated with long non-culprit lesions (NCLs) in patients with acute myocardial infarction (AMI). METHODS: A total of 1278 AMI p...BACKGROUND: This study aimed to investigate plaque characteristics and long-term outcomes associated with long non-culprit lesions (NCLs) in patients with acute myocardial infarction (AMI). METHODS: A total of 1278 AMI patients undergoing three-vessel optical coherence tomography (OCT) were retrospectively enrolled, and 5131 NCLs were identified. A long lesion was defined as an OCT lesion ≥20 mm in length. Patients were followed for up to 5 years, and NCL-related major adverse cardiovascular events (NCL-MACE) were recorded. RESULTS: Both at the patient and lesion level, long NCLs were more stenotic and had more frequent thin-cap fibroatheroma (TCFA) and other vulnerable plaque features than short NCLs (all P < 0.001). During a median follow-up of 4.1 years, patients with ≥1 long NCL had a significantly higher incidence of NCL-MACE than patients without long NCL (7.3% vs. 2.9%, adjusted HR: 2.26, 95%CI: 1.19-4.29). Similar findings were identified when patients were grouped by angiographic lesion length. In the lesion-level analysis, OCT-detected long NCLs remained significantly associated with NCL-MACE after adjustment for TCFA (adjusted HR: 1.97, 95%CI: 1.11-3.52), whereas angiography-detected long NCLs showed no prognostic value. Notably, OCT-detected long TCFA had highest lesion-specific risk (5.4% vs. 1.1%, adjusted HR: 3.69, 95%CI: 1.87-7.27), whereas risk of OCT-detected short TCFA was comparable to that of non-TCFA (1.1% vs. 1.1%, P = 0.986). CONCLUSIONS: Long NCLs were indicative of higher levels of pancoronary plaque vulnerability, irrespective of detection via OCT or angiography. Importantly, OCT-detected long NCLs, especially long TCFA, offered significant predictive value for 5-year adverse events. However, angiography-detected long NCLs lacked prognostic significance.
Russo V, Comune A, Di Nardo G
… +10 more, Parente E, Di Marco GM, De Nigris A, Celardo N, Rago A, Papa AA, Sarubbi B, Russo MG, Brignole M, Nigro G
Int J Cardiol
· 2026 Oct · PMID 42309489
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BACKGROUND: The shortened protocol of Nitroglycerin (NTG)-potentiated head-up tilt testing (HUTT), the so-called "fast Italian protocol," has been shown to significantly reduce test duration while maintaining diagnostic...BACKGROUND: The shortened protocol of Nitroglycerin (NTG)-potentiated head-up tilt testing (HUTT), the so-called "fast Italian protocol," has been shown to significantly reduce test duration while maintaining diagnostic yield and safety in adults with suspected reflex syncope. To date, no data is available in paediatric patients. Aim of the study was to compare the positivity rate of the Fast protocol with that of the Traditional protocol in children and adolescents. METHODS: We retrospectively analyzed 302 consecutive paediatric patients (mean age 14.4 ± 2.8 years; 46.7% male) who underwent HUTT for suspected reflex syncope at two paediatric syncope units. Patients were evaluated using either a traditional NTG-potentiated protocol (n = 149) or the Fast Italian protocol (n = 153), characterized by shorter passive and active phases. Haemodynamic responses were classified according to the VASIS classification. RESULTS: HUTT was positive in 81.2% of patients undergoing the traditional protocol and in 73.2% of those undergoing the Fast protocol, with no significant difference between groups (p = 0.1). Compared with the Traditional, in the Fast protocol the positivity was lower during the passive phase (7.8% vs. 36.2%; p < 0.001) but higher during the NTG-potentiated phase (65.4% vs. 45%; p < 0.001). The overall distribution of haemodynamic response types was similar between protocols, with mixed responses being the most frequent, followed by cardioinhibitory and vasodepressive patterns. CONCLUSIONS: In paediatric patients with suspected reflex syncope, the Fast Italian HUTT provides a diagnostic yield comparable to that of the traditional nitroglycerin-potentiated protocol. Shortening the protocol does not significantly affect the distribution of haemodynamic response types.
Vadalà G, Mashayekhi K, Madaudo C
… +25 more, Behnes M, Ayoub M, Gorgulu S, Werner GS, Kalay N, Avran A, Goktekin O, Garbo R, Jaroslaw W, Zaczkiewicz M, Arnez J, Pyxaras S, Christiansen EH, Gutiérrez-Chico JL, Boudou N, Stojkovic S, Gasparini GL, Agostoni P, Diletti R, di Mario C, Maniscalco L, Bulum J, Cenko E, Galassi AR, EURO CTO investigators
Int J Cardiol
· 2026 Oct · PMID 42309488
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BACKGROUND: National income level influences the prevalence and outcomes of cardiovascular disease (CVD), with lower-income countries contributing disproportionately to the global CVD burden. Chronic total occlusion (CTO...BACKGROUND: National income level influences the prevalence and outcomes of cardiovascular disease (CVD), with lower-income countries contributing disproportionately to the global CVD burden. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) requires specialised equipment, increasing procedural costs. However, whether national income level contributes to disparities in managing patients with CTO remains unclear. OBJECTIVE: To compare the clinical profiles, procedural settings and outcomes of patients undergoing CTO-PCI in middle-income countries (MICs) and high-income countries (HICs). METHODS: This cross-sectional study included 15,329 patients who underwent CTO-PCI between 2021 and 2023. Data were obtained from the European Registry of Chronic Total Occlusions (ERCTO). Of the 24 enrolling countries, 7 were classified as MICs and 14 as HICs. RESULTS: Patients in HICs were older (67 ± 10 vs 61 ± 10 years; p < 0.001) and presented with greater CTO complexity (J-CTO score: 2.31 ± 1.25 vs 1.99 ± 1.17; p < 0.001). Conversely, patients in MICs were more likely to have diabetes (35% vs 29%; p < 0.001) and to be active smokers (59% vs 49%; p < 0.001). Patients in MICs had lower use of mechanical cardiac support (0.1% vs 0.8%; p < 0.001), advanced calcific plaque modification devices (1% vs 6.1%; p < 0.001), and intravascular ultrasound (14% vs 25%; p < 0.001). MICs achieved higher procedural success (89.5% vs 90.5%; p = 0.07) but higher mortality compared to HICs (0.6% vs 0.2%; p < 0.001). CONCLUSION: Among a selected population of patients undergoing CTO-PCI, notable clinical, anatomical, and procedural differences exist between MICs and HICs. These findings highlight the importance of tailoring public health strategies to optimise cardiovascular care across diverse economic settings.
Meems LMG, Milani P, Ohlmeier C
… +9 more, Evers T, Ciaccia A, Häckl D, Obermüller D, Vivirito A, Coleman CI, de Sanmamed Girón MF, Cipriani A, Azevedo O
Int J Cardiol
· 2026 Oct · PMID 42309487
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BACKGROUND: In patients with transthyretin amyloid cardiomyopathy (ATTR-CM), amyloid can be deposited in the peripheral nerves, causing polyneuropathy (PN). We evaluated the rate of incident PN diagnosis among ATTR-CM pa...BACKGROUND: In patients with transthyretin amyloid cardiomyopathy (ATTR-CM), amyloid can be deposited in the peripheral nerves, causing polyneuropathy (PN). We evaluated the rate of incident PN diagnosis among ATTR-CM patients. METHODS: This study utilized German claims data from January 2016-December 2023. We included adults newly diagnosed with ATTR-CM without a prior history of PN based upon International Classification of Diseases-Tenth Revision-German Modification (ICD-10-GM) diagnosis codes and coding for diagnostic testing. We identified incident PN using both a narrow (ATTR-PN-related) and broad (also including non-ATTR-specific polyneuropathies) set of ICD-10-GM codes. Incidence rates/100 person-years (PYs) with 95% confidence intervals (CIs) were calculated. RESULTS: We identified 309 newly diagnosed patients with ATTR-CM free of PN. During a median follow-up of 430 days (Q1 = 175, Q3 = 936) the rate of broadly defined incident PN was 10.8 cases/100PYs (7.9-14.3), declining to 2.4 cases/100PYs (1.2-4.1) when the narrow ATTR-related PN definition was used. CONCLUSIONS: In German routine care, the incidence of ATTR-related PN in patients with ATTR-CM was 2.4/100PYs, rising to 10.8/100PYs under a broad symptom-based definition. Although ATTR-related PN was infrequently identified in ATTR-CM, PN and ATTR-CM may coincide.
Malik M, Batista P, Lucena LA
… +5 more, Montenegro MV, Santos Silva RRA, Fischer-Bacca CO, Giorgi J, Strom J
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42305883
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BACKGROUND: Artificial intelligence-enabled quantitative coronary computed tomography angiography (AI-QCCTA) offers automated assessment of coronary plaque burden and morphology. Although AI-QCCTA has improved diagnostic...BACKGROUND: Artificial intelligence-enabled quantitative coronary computed tomography angiography (AI-QCCTA) offers automated assessment of coronary plaque burden and morphology. Although AI-QCCTA has improved diagnostic consistency and downstream testing efficiency, its prognostic value for major adverse cardiovascular events (MACE) has not been comprehensively quantified. METHODS: We systematically searched PubMed, Embase, and Cochrane through October 2025 for studies evaluating AI-based plaque analysis in patients without prior MACE undergoing CCTA. Outcomes of interest were pooled using random-effects GLMM models, and prognostic associations were synthesized using inverse-variance random-effects meta-analysis of hazard ratios (HRs). The primary endpoint was MACE; secondary outcomes included myocardial infarction (MI), revascularization, angina, stroke, and mortality. Subgroup analysis was done to identify the association of different plaque characteristics in predicting MACE/MI/Death. RESULTS: Ten studies (n = 20,195) were included. Across six cohorts (n = 18,804), pooled rates were: all-cause mortality 1.20% (95% CI 0.38-3.77%), cardiovascular mortality 0.32% (0.21-0.48%), MACE 5.07% (1.25-18.46%), MI 1.30% (0.41-3.99%), and revascularization 13.09% (6.57-24.40%). AI-enabled plaque burden predicted MACE (HR 1.95, 95% CI 1.29-2.94; I = 99%), consistent in sensitivity analysis as per same AI platform use (HR 1.88, 95% CI 1.15-3.07). Low-attenuation plaque showed the strongest association (HR 2.95, 95% CI 1.95-4.45). CONCLUSIONS: AI-QCCTA provides prognostic value beyond stenosis severity, with vulnerable plaque characteristics-particularly low-attenuation and non-calcified plaque most strongly predicting adverse cardiovascular outcomes. These findings support the integration of AI-enabled plaque analysis into contemporary risk stratification.
Modani SM, Rampelly SK, Palagiri S
… +2 more, Begum Ibrahim S, Ramachandiran S
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42305882
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BACKGROUND: South Asians experience premature acute myocardial infarction (AMI) at disproportionately high rates compared with Western populations, often despite modest LDL-cholesterol levels and contemporary lipid-lower...BACKGROUND: South Asians experience premature acute myocardial infarction (AMI) at disproportionately high rates compared with Western populations, often despite modest LDL-cholesterol levels and contemporary lipid-lowering therapy. Lipoprotein(a) [Lp(a)], a genetically determined and causally implicated atherosclerotic cardiovascular disease risk factor, may contribute through proatherogenic and prothrombotic mechanisms. We evaluated associations between Lp(a), premature AMI, coronary angiographic severity, and percutaneous coronary intervention (PCI) outcomes, with emphasis on South Asian populations. METHODS: A structured scoping review with quantitative meta-analytic components was conducted in accordance with PRISMA-ScR and PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched from inception through [Month Year]. Eligible studies included adult AMI or PCI cohorts reporting quantitative Lp(a) levels and relevant outcomes. Seventeen studies met inclusion criteria; three provided extractable data for exploratory random-effects meta-analysis using the DerSimonian-Laird method. RESULTS: Elevated Lp(a) showed a pooled risk ratio of 1.16 (95% CI 0.93-1.43; I = 24%) for major adverse cardiovascular events, with a consistent direction of effect. Qualitative synthesis linked higher Lp(a) to multivessel disease, higher SYNTAX score, greater thrombus burden, and recurrent post-PCI events. Mechanistic evidence supports roles in oxidized phospholipid transport and impaired fibrinolysis. South Asian cohorts showed higher Lp(a) levels and earlier disease onset. CONCLUSIONS: Elevated Lp(a) may contribute to angiographic severity and adverse PCI-era outcomes in premature AMI, supporting risk assessment in high-risk South Asian populations.
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42294083
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BACKGROUND: New-onset atrial fibrillation (NOAF) is a common cardiovascular complication in critically ill patients and is consistently associated with adverse outcomes. However, substantial heterogeneity exists in its c...BACKGROUND: New-onset atrial fibrillation (NOAF) is a common cardiovascular complication in critically ill patients and is consistently associated with adverse outcomes. However, substantial heterogeneity exists in its clinical presentation and prognosis. This study aimed to identify distinct clinical subtypes of NOAF and evaluate their prognostic and management-related implications. METHODS: Adult NOAF patients were extracted from the MIMIC-IV database. Demographic and laboratory data within 24 h of ICU admission were analyzed. Consensus k-means clustering was used for identifying subtypes. Survival differences were compared using Kaplan-Meier and log-rank tests, and multivariable Cox models assessed mortality risk and pharmacologic treatment associations. Key variables identified by SHAP analysis were incorporated into a simplified six-variable model, validated externally in MIMIC-III. RESULTS: Among 8472 NOAF patients, four distinct subtypes were identified from the MIMIC-IV cohort (n = 5554), showing progressively increased severity and mortality. Subtype A (30.28%) included mainly post-cardiac surgery patients with preserved homeostasis and the lowest 28-day mortality (4.9%). Subtype B (34.52%) was characterized by marked hypomagnesemia and a moderate burden of comorbid malignancy (28-day mortality 15.5%). Subtype C (19.70%) featured anemia, hypoxemia, and inflammation (28-day mortality 30.2%). Subtype D (15.50%) presented with organ failure and the highest 28-day mortality (42.7%). 28-day mortality risk increased stepwise across subtypes (HR 4.24-5.98; all P < 0.001). Pharmacologic responses, including heart rate control, sedation, and electrolyte therapy, varied across different subtypes. The simplified six-variable model demonstrated high predictive performance (AUC 0.89-0.96) in external validation. CONCLUSION: Unsupervised clustering revealed four distinct NOAF subtypes in ICU patients, characterized by heterogeneous clinical trajectories. The simplified six-variable model enabled practical bedside classification, supporting precision risk assessment and potentially informing phenotype-oriented management of NOAF in the ICU.
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42293360
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The Fontan procedure is a palliative operation for patients with univentricular physiology. Liver complications post-surgery are inevitable and include liver cirrhosis and hepatocellular carcinoma (HCC). Routine surveill...The Fontan procedure is a palliative operation for patients with univentricular physiology. Liver complications post-surgery are inevitable and include liver cirrhosis and hepatocellular carcinoma (HCC). Routine surveillance includes transient elastography (TE) and clinical assessment, however longitudinal data on Fontan-associated liver disease (FALD) is scarce. This study aimed to describe the evolution of FALD and assess the correlation between liver stiffness measurement (LSM) and hepatic decompensation. This retrospective case series comprised all adult post-Fontan patients presenting to a tertiary hospital between January 2015 and December 2024. Demographic and clinical information, serum tests, TE and echocardiograms were extracted from medical records. Endpoints assessed were decompensated cirrhosis and findings that warrant HCC multi-disciplinary team review. A derived surrogate outcome, clinically significant portal hypertension (CSPH) was assessed using the Baveno VII criteria. There were a total of 65 patients with 111 Fibroscans™. There was no significant change in LSM by TE when comparing two consecutive decade years post Fontan surgery. On echocardiography, only inferior vena-cava diameter and degree of ventricular function correlated with LSM scores (p = 0.032, p < 0.001). Twelve patients had CSPH, correlating with increased gamma-glutamyltransferase, bilirubin, international normalised ratio and aspartate aminotransferase levels (p = 0.047, 0.034, 0.012, 0.049 respectively). Four patients exhibited features of decompensated cirrhosis, eight warranted multi-disciplinary team discussion however these did not correlate with LSM or steatosis results. LSM and echocardiogram monitoring alone is insufficient for identifying FALD patients at risk of hepatic decompensation. Regular testing and multicenter research is required to develop predictive models that accurately identifies these at-risk patients.
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42293359
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BACKGROUND: Arterial tortuosity syndrome (ATS) is an ultra-rare hereditary connective tissue disorder characterized by elongation and extreme tortuosity of medium- and large-caliber arteries. Adult presentation is except...BACKGROUND: Arterial tortuosity syndrome (ATS) is an ultra-rare hereditary connective tissue disorder characterized by elongation and extreme tortuosity of medium- and large-caliber arteries. Adult presentation is exceptional, and pulmonary arterial involvement as a cause of severe precapillary pulmonary hypertension is rarely reported. CASE SUMMARY: A 47-year-old woman presented with progressive exertional dyspnea (WHO functional class II-III). Echocardiography and right heart catheterization confirmed severe precapillary pulmonary hypertension with markedly elevated pulmonary vascular resistance. Advanced vascular imaging and pulmonary angiography demonstrated bilateral pulmonary artery looping with dynamic functional stenoses, without fixed obstruction. Diffuse systemic arterial tortuosity and subsequent genetic testing, which identified a pathogenic variant in the gene, definitively confirmed the diagnosis of ATS CONCLUSIONS: Dynamic pulmonary artery tortuosity can produce severe precapillary pulmonary hypertension despite preserved distal perfusion. ATS should be considered in unexplained cases with atypical pulmonary arterial anatomy.
Levi A, Goshen D, Van Arsdell G
… +6 more, Salem M, Biniwale R, Si MS, Balasubramanya S, Levi DS, Aboulhosn J
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42293358
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BACKGROUND: Prosthetic 'tricuspid valve' placement in Bjork Fontan patients born with tricuspid atresia can transition these patients to a biventricular circulation. OBJECTIVE: Describe intermediate term results of hybri...BACKGROUND: Prosthetic 'tricuspid valve' placement in Bjork Fontan patients born with tricuspid atresia can transition these patients to a biventricular circulation. OBJECTIVE: Describe intermediate term results of hybrid prosthetic valve placement in Bjork Fontans using annuloplasty ring placement around the Bjork connection followed by transcatheter valve. METHODS: A retrospective review of hybrid attempts to valve large Bjork Fontans at UCLA. Only Bjorks that had failed balloon sizing for transcatheter valve placement or had prohibitively large dimensions on cross sectional imaging were included. All had attempted surgical placement of a non-circumferential annuloplasty ring around the Bjork Fontan and subsequent Sapien valve implant. RESULTS: Median age of the five patients was 40-years. Three had successful placement of annuloplasty rings with a 30 mm (n = 2) or a 34 mm Edwards Physio Annuloplasty ring followed by successful valving with 29 Sapien 3 valves. In two patients, attempts to place a surgical ring resulted in bleeding requiring cardiopulmonary bypass and surgical valve placement. The median follow-up time was 28.7 months. All patients had a significant decrease in CVP and were alive with improvement in their NYHA class to I at most recent follow-up. There was no evidence of valve dysfunction seen on follow up ECHO or cross-sectional imaging. CONCLUSION: Bjork Fontan patients often have connections too large for available balloon expandable valves. These patients can be treated with a hybrid incomplete annuloplasty ring placement to enable transcatheter valve placement.
Khraisat O, Messer T, Harmouch K
… +9 more, Alqaseer A, Ismail W, Samardali H, Alkhawaldeh E, Hammad A, Patel D, Sayanlar J, Ashraf M, Khraisat A
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42291445
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BACKGROUND: Atrial fibrillation (AF) clinical trials are essential for informing evidence-based care, yet many trials are discontinued or remain unpublished. This contributes to research inefficiency and reduced transpar...BACKGROUND: Atrial fibrillation (AF) clinical trials are essential for informing evidence-based care, yet many trials are discontinued or remain unpublished. This contributes to research inefficiency and reduced transparency. This study evaluated characteristics associated with discontinuation and non-publication of AF clinical trials registered on ClinicalTrials.gov. METHODS: We performed a retrospective analysis of interventional AF trials registered between 1999 and 2025 on ClinicalTrials.gov. Trials were categorized as completed or discontinued, and as published or unpublished. Trial characteristics were extracted, and multivariable logistic regression was used to identify predictors of discontinuation and non-publication. RESULTS: Among 538 AF trials, 423 trials (78.6 percent) were completed and 115 trials (21.4 percent) were discontinued. Only 153 trials (36.2 percent) were published. The estimated median time from primary completion to publication was 18.0 months (95% confidence interval, 14.0-21.0 months). Trials enrolling 100 participants or more had significantly lower odds of both discontinuation and non-publication. Multicenter trials showed higher odds of discontinuation but lower odds of non-publication. The other characteristics studied were not significant predictors. CONCLUSIONS: A substantial proportion of AF trials are discontinued or remain unpublished, revealing ongoing gaps in research transparency. Larger sample sizes support higher completion and publication rates, while a multicenter design increases discontinuation risk but improves dissemination. These findings underscore the need for strategies that strengthen trial feasibility and reporting practices.