Kang DO, Kim W, van Assen M
… +8 more, De Cecco CN, Her AY, Kim D, Choi KH, Song YB, Nam CW, Shin ES, Kim S
Int J Cardiol
· 2026 Oct · PMID 42288220
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BACKGROUND: Medina 0.0.1 bifurcation lesions show high target lesion failure (TLF) after drug-eluting stent (DES) percutaneous coronary intervention (PCI), highlighting an unmet need for alternative treatment strategies....BACKGROUND: Medina 0.0.1 bifurcation lesions show high target lesion failure (TLF) after drug-eluting stent (DES) percutaneous coronary intervention (PCI), highlighting an unmet need for alternative treatment strategies. METHODS AND RESULTS: We analyzed 101 patients with Medina 0.0.1 lesions treated with DCB-based PCI from the REAL-DCB registry and 95 DES-treated controls from the COBIS III registry. Primary endpoint was 2-year target lesion failure (TLF): cardiac death, target-vessel myocardial infarction, and clinically-driven target-lesion revascularization (TLR). Inverse probability of treatment weighting (IPTW) was applied to account for inter-group imbalance. DCB group, albeit slightly younger, had more complex risk profile compared to DES group. DCB-based PCI enabled one-device strategy in 96.0% of cases, requiring significantly fewer devices and shorter device lengths than DES-only PCI, in which 52.6% of lesions were treated with a two-stent strategy. Two-year TLF was lower with DCB than with DES (2.2% vs. 12.1%), and this difference remained significant after IPTW adjustment (IPTW-HR: 0.10; 95% CI: 0.02-0.46; P = 0.003), mainly due to lower TLR (IPTW-HR: 0.13; 95% CI: 0.03-0.59; P = 0.009). Target-vessel revascularization was also less frequent with DCB (IPTW-HR: 0.10; 95% CI: 0.02-0.48; P = 0.004). No target-lesion thrombosis occurred in DCB group, whereas one stent thrombosis was reported in DES group. Between-group difference was driven predominantly by TLR, whereas hard ischemic events were infrequent in both groups. CONCLUSIONS: In Medina 0.0.1 lesions, DCB-based PCI strategy was associated with lower TLF than DES-only PCI while enabling a simplified device-sparing approach. Given the observational design and limited event count, these findings should be considered hypothesis-generating.
Lipps KM, Hillerson D, Dahiya G
… +4 more, Kashani K, Ternus B, Bennett C, Jentzer JC
Int J Cardiol
· 2026 Oct · PMID 42288219
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BACKGROUND: Acute kidney injury (AKI) is prevalent in the cardiac intensive care unit (CICU) population. We evaluated the association between transthoracic echocardiogram (TTE)-derived hemodynamics and AKI among CICU pat...BACKGROUND: Acute kidney injury (AKI) is prevalent in the cardiac intensive care unit (CICU) population. We evaluated the association between transthoracic echocardiogram (TTE)-derived hemodynamics and AKI among CICU patients. METHODS: We included adults admitted to an academic CICU from 2007 to 2018 who had a consultative TTE within 24 h. De novo AKI was defined by modified Kidney Disease: Improving Global Outcomes criteria using serum creatinine. Pressure-adjusted heart rate (PAHR), in beats per minute (BPM), was defined as (right atrial pressure ÷ mean arterial pressure) × heart rate. The primary outcome was the association between TTE hemodynamics and AKI incidence, and the secondary outcome was the association between AKI and mortality. RESULTS: Among 7027 patients, AKI occurred in 2157 (30.7%), of whom 585 (8.3%) had moderate/severe AKI. More severe AKI was associated with worse left ventricular, right ventricular (RV), and biventricular function (all P < 0.001). TTE markers of RV function demonstrated greater discrimination for moderate/severe AKI compared to left-sided indices. Among TTE variables, PAHR ≥7.5 BPM provided the highest discrimination and identified a higher-risk hemodynamic phenotype for moderate/severe AKI (13.1% for PAHR ≥7.5 BPM vs. 3.8% for PAHR <7.5 BPM, P < 0.001). More severe AKI was associated with higher in-hospital and one-year mortality (both P < 0.001). CONCLUSIONS: Among CICU patients, moderate/severe AKI was associated with biventricular systolic dysfunction and congestion as assessed by TTE. PAHR demonstrated the greatest discrimination among TTE variables and identified a higher-risk hemodynamic phenotype for moderate/severe AKI. TTE measurements may facilitate early identification of patients at risk of AKI.
Maffeis C, Rossi A, Tafciu E
… +7 more, Rizzo S, De Gaspari M, Giambruno V, Di Nicola V, Luciani GB, Basso C, Ribichini FL
Int J Cardiol
· 2026 Oct · PMID 42276257
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BACKGROUND: In primary mitral regurgitation (MR) atrial dysfunction is believed to be the result of atrial interstitial fibrotic replacement, and left atrial (LA) strain has been suggested as a non-invasive tool to ident...BACKGROUND: In primary mitral regurgitation (MR) atrial dysfunction is believed to be the result of atrial interstitial fibrotic replacement, and left atrial (LA) strain has been suggested as a non-invasive tool to identify a maladaptive atrial remodelling beyond LA enlargement. We aim to investigate the association between LA function and the extent of interstitial fibrosis within the atrial wall in patients undergoing surgery, and their relation with MR characteristics and clinical profiles. METHODS: 49 consecutive patients (61 ± 10 years, men 75%) with severe primary MR due to prolapse or flail were enrolled the day before surgery and a complete echocardiographic examination with LA strain analysis was performed. During surgery, a single-site full-thickness sample of the LA free wall was obtained from each patient. RESULTS: Areas of interstitial fibrosis were detected in all atrial specimens (median degree 6.5% [4.75-9.25]). No correlation was found between fibrosis degree and echocardiographic parameters like LA strain, LA volume, quantitative parameters of MR degree, regurgitant jet direction, estimated pulmonary artery pressure (sPAP), or clinical parameters like NYHA class or NTproBNP. However, lower LA reservoir and contractile strain values were associated with higher sPAP (p = 0.002 and p = 0.01, respectively), NTproBNP values (p < 0.0001) and symptoms severity (p < 0.05). CONCLUSIONS: In this selected cohort with severe primary MR and relatively low single-site histological LA fibrosis, LA strain was associated with markers of haemodynamic burden but not with biopsy-derived fibrosis percentage.
Di Serafino L, Ciaramella L, De Rosa S
… +9 more, Torella D, Leo I, Colaiori I, Bernardi M, Loffredo FS, Vitale G, Cirillo P, Versaci F, Esposito G
Int J Cardiol
· 2026 Oct · PMID 42276256
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INTRODUCTION: Residual coronary microvascular dysfunction (CMD) is common after STEMI despite successful primary PCI and may contribute to ongoing ischemia and impaired recovery. INaMICRON will test the hypothesis that e...INTRODUCTION: Residual coronary microvascular dysfunction (CMD) is common after STEMI despite successful primary PCI and may contribute to ongoing ischemia and impaired recovery. INaMICRON will test the hypothesis that early late I current inhibition with ranolazine, added to guideline-directed medical therapy, favorably modulates microvascular function during the early post-infarction phase. METHODS AND RESULTS: INaMICRON is a prospective, multicenter, randomized (1:1), open-label phase IIb trial enrolling adults with STEMI treated with successful primary PCI and at least one significant non-culprit lesion suitable for staged PCI. Participants will be randomized to standard therapy plus ranolazine (500 mg bid for 7 days, then 750 mg bid up to 42 ± 7 days) or standard therapy alone. Coronary microvascular function will be assessed using IMR and/or angioIMR in the culprit vessel after primary PCI (baseline) and during staged PCI (follow-up); non-culprit vessel physiology will also be assessed during the staged procedure. Complementary evaluations include peripheral endothelial function testing (EndoPAT), a single CMR at 42 ± 7 days, and paired blood sampling for translational multi-omics analyses. The planned sample size is 100 patients (50 per group), and analyses will compare between-group differences in physiology and related measures and explore predefined correlations. The study is designed to estimate the magnitude of microvascular modulation in the experimental group. CONCLUSIONS: This trial will provide feasibility data and an estimate of the magnitude of microvascular modulation achievable with early ranolazine after STEMI, informing the design of larger outcome-oriented studies and future precision approaches to post-MI care.
Int J Cardiol
· 2026 Oct · PMID 42276255
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BACKGROUND: Increased right ventricular filling pressures (RVFP) are associated with increased mortality risk in children with pulmonary arterial hypertension (PAH). We aimed to investigate the correlation of echocardiog...BACKGROUND: Increased right ventricular filling pressures (RVFP) are associated with increased mortality risk in children with pulmonary arterial hypertension (PAH). We aimed to investigate the correlation of echocardiographic diastolic parameters with invasive measurements of RVFP in pediatric PAH. METHODS: We retrospectively reviewed 95 patients and 48 controls from the Hospital for Sick Children in Toronto and Children's Hospital Colorado. RV filling pressures (RVFP) were considered elevated when RV end-diastolic pressures (RVEDP) ≥8 mmHg or mean right atrial pressure (mRAP) >8 mmHg from the catheter. Echocardiographic measurements included hepatic vein A-wave reversal (HVA) velocity and duration, the ratio between HVA and HV systolic velocity (HV A/S), indexed right atrial volume (RAVi), and RV and RA diastolic strains. Logistic regression and receiver operating characteristic curve analysis were used to investigate the predictive value of echo parameters for elevated RVFP. RESULTS: PAH patients had significantly elevated HVA velocity, duration and HV A/S, enlarged RAVi, and decreased RA and RV strains. HVA velocity had the highest area under the receiver operating characteristic curve (AUC) for diagnosing elevated RVFP [AUC = 0.788 (0.570-1), p = 0.021]. The model with HVA velocity significantly predicted elevated RVFP [Nagelkerke R = 0.339, B(SE) = 0.121 (0.06), odds ratio = 1.129 (1.003-1.27), p = 0.044)]. CONCLUSIONS: Of the echo parameters studied, HVA velocity was the best predictor of elevated RVFP in pediatric PAH. But in general, echocardiographic parameters were inadequate indicators of RVFP. Further prospective studies in a larger cohort are needed to determine the association between HV Doppler and changes in RVFP, and ultimately with clinical outcomes.
Dini FL, Carluccio E, Bakalli A
… +6 more, Acquaro M, Barletta V, Galeotti G, Bajraktari G, Ghio S, Henein MY
Int J Cardiol
· 2026 Oct · PMID 42269879
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BACKGROUND: Left ventricular (LV) reverse remodelling (LVRR) is a key therapeutic objective in heart failure (HF) with reduced ejection fraction (HFrEF), yet only a subset of patients exhibit meaningful recovery despite...BACKGROUND: Left ventricular (LV) reverse remodelling (LVRR) is a key therapeutic objective in heart failure (HF) with reduced ejection fraction (HFrEF), yet only a subset of patients exhibit meaningful recovery despite guideline-directed medical therapy (GDMT). End-systolic wall stress (ESWS) and global longitudinal strain (GLS) reflect complementary aspects of myocardial mechanics. This study evaluated whether their integrated assessment predicts LVRR, therapeutic responsiveness, and clinical outcomes. METHODS: A total of 196 consecutive HFrEF patients (LV ejection fraction < 40%) were prospectively enrolled and underwent clinical and echocardiographic evaluation at baseline and after 6.5 ± 2.0 months. LVRR was defined as an absolute increase in LV ejection fraction > 10% to ≥ 35% plus a ≥ 15% reduction in end-systolic volume. ESWS was calculated using a validated meridional formula integrating brachial systolic pressure, end-systolic internal diameter, and posterior wall thickness, and GLS was derived by speckle-tracking echocardiography. Predictors of LVRR were assessed using multivariable logistic regression and receiver-operating characteristic analysis. Patients were stratified into four phenotypes based on ESWS and GLS thresholds. RESULTS: LVRR occurred in 38% of patients. GLS and ESWS were independent predictors of LVRR (area under the curve 0.82 and 0.78, respectively), with optimal cut-offs of -12.1% and 160 kdyne/cm. Patients with low ESWS and preserved GLS showed the highest probability of LVRR, the greatest improvement in haemodynamic profile, and the lowest incidence of appropriate implantable cardioverter-defibrillator shocks. Conversely, high ESWS combined with impaired GLS identified patients with a low occurrence of LVRR, persistently elevated filling pressures, reduced LV efficiency, and the poorest survival. CONCLUSIONS: Integrated stress-strain phenotyping using ESWS and GLS improves prediction of LVRR, therapeutic responsiveness, and prognosis in HFrEF, and may help identify patients with limited recovery potential who warrant earlier evaluation for advanced HF therapies.
Lepre V, Moretto N, De Martino M
… +11 more, Collini V, Tomat M, Venturelli F, Cescon L, Agrimi CV, Puppato M, Pellegrin A, Zussino G, Zuliani L, Isola M, Imazio M
Int J Cardiol
· 2026 Oct · PMID 42263952
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BACKGROUND: Pericardial late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is typically interpreted as a marker of active pericardial inflammation. However, it may also be detected incidentally during...BACKGROUND: Pericardial late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is typically interpreted as a marker of active pericardial inflammation. However, it may also be detected incidentally during CMR performed for unrelated indications, and its clinical significance remains unclear. Whether incidental pericardial LGE reflects persistent subclinical inflammation associated with adverse long-term outcomes is unknown. METHODS: We conducted a retrospective single-center study including consecutive patients undergoing clinically indicated CMR. Patients with incidentally detected pericardial LGE were identified and compared with a control population without LGE. Clinical characteristics, CMR findings, and long-term outcomes were collected. The primary endpoint was the development of constrictive pericarditis (CP) during follow-up. RESULTS: Among 590 patients, incidental pericardial LGE was identified in 31 (5.3%), while 559 patients had no LGE. During a median follow-up of 72 months, CP occurred in 2 patients (6.5%) with LGE and in none of the patients without LGE (p = 0.003). Patients with LGE more frequently had a history of pericarditis and showed higher prevalence of pericardial effusion and increased pericardial thickness on CMR. CONCLUSIONS: Incidental pericardial LGE on CMR was associated with a history of prior pericardial and myocardial inflammation, and CP occurred only among patients with LGE during follow-up. However, these findings should be interpreted cautiously, as LGE may represent a surrogate marker of an underlying inflammatory pericardial substrate rather than an independent prognostic marker. Larger prospective studies are needed to determine whether incidental pericardial LGE provides prognostic information beyond clinical history.
Sudoso AM, Ciarpaglini L, Scuppa D
… +3 more, Trasatti E, Sciandrone M, Galiuto L
Int J Cardiol
· 2026 Oct · PMID 42263950
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BACKGROUND: Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, and their risk increases with age. Biological age reflects physiological decline more accurately than chronological age and may...BACKGROUND: Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, and their risk increases with age. Biological age reflects physiological decline more accurately than chronological age and may improve cardiovascular risk prediction. Recent advances in Artificial Intelligence (AI) have enabled estimation of biological age from electrocardiograms (ECGs), imaging, biomarkers, and omics data. However, the existing evidence on AI-derived biological age in cardiovascular medicine has not been comprehensively synthesized. METHODS: PubMed and Scopus were searched for studies published between 2019 and 2025. Eligible studies included original research applying AI or machine learning to estimate biological age or aging biomarkers in human participants and relating these estimates to cardiovascular outcomes. Data were extracted on study design, AI methods, input data sources, biological age metrics, cardiovascular endpoints, and validation strategies. Findings were synthesized narratively and organized by methodological approaches. RESULTS: AI-derived biological age, particularly ECG-predicted age, consistently provided prognostic information beyond chronological age. Deep learning models identified an age gap associated with increased risks of heart failure, atrial fibrillation and stroke. Retinal imaging-based biological age and biomarker-based machine learning models further supported the systemic nature of aging. Emerging approaches such as generative models offer insights into aging trajectories and lifestyle-linked aging phenotypes. Advances in interpretability using explainable AI highlighted ECG features that contribute most to aging predictions. CONCLUSIONS: AI-based estimation of biological age is a promising biomarker for cardiovascular risk assessment. Although evidence across modalities is consistent, further standardization, prospective validation, and improved interpretability are needed to support clinical implementation.
Deharo P, Gariboldi V, Marlinge M
… +17 more, Aliouane S, Guiol C, Fromonot J, Lledo S, Kipson N, Dodivers JS, El Oufir F, Paganelli C, Kasri M, Boudouresques V, Gaudry M, Collart F, Pastene B, Cuisset T, Mottola G, Guieu R, Paganelli F
Int J Cardiol
· 2026 Oct · PMID 42263949
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BACKGROUND: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are standard revascularization strategies for chronic coronary syndrome (CCS). However, their effects on myocardial reperfus...BACKGROUND: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are standard revascularization strategies for chronic coronary syndrome (CCS). However, their effects on myocardial reperfusion have not been assessed using biological markers. Adenosine A receptor (AR) function on peripheral blood mononuclear cells (PBMCs), evaluated through cAMP production and EC-measurement, may reflect myocardial ischemia and reperfusion status. OBJECTIVES: To compare the effects of CABG and PCI on AR pharmacological profiles assessed by cAMP-production (EC) values. METHODS: Ninety patients with severe coronary artery disease (33 CABG, 57 PCI) were prospectively included. Blood samples were collected before revascularization and 3 months later. PBMCs were incubated with a full AR agonist, and cAMP production was measured. RESULTS: Baseline EC values were similar between PCI and CABG groups (0.072 ± 0.02 vs 0.078 ± 0.02 μM, p = 0.2). EC significantly increased after PCI (+52%; 0.11 ± 0.04 μM, p < 0.001) and even more after CABG (+323%; 0.33 ± 0.08 μM, p < 0.0001). CONCLUSION: Both PCI and CABG were associated with an increase in mean EC50 values, suggesting improved myocardial reperfusion. The greater EC increase after CABG may indicate more complete restoration of coronary perfusion. AR functional assessment may represent a non-invasive promising biomarker for monitoring chronic myocardial ischemia and revascularization efficacy in CCS patients.
Int J Cardiol
· 2026 Oct · PMID 42263948
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BACKGROUND: Whether dedicated tertiary heart-failure programmes in low- and middle-income countries can approach guideline-directed medical therapy (GDMT) targets, and whether temporal trends reflect prescribing optimisa...BACKGROUND: Whether dedicated tertiary heart-failure programmes in low- and middle-income countries can approach guideline-directed medical therapy (GDMT) targets, and whether temporal trends reflect prescribing optimisation or case-mix shift, remains unresolved. We characterise four-pillar GDMT adoption in an eastern Indian tertiary centre with systematic robustness testing. METHODS: Repeated cross-sectional analysis in a prospective HFrEF registry (2022-2024 primary cohort, n = 319 patients). Half-yearly adoption assessed by Cochran-Armitage trend tests (Benjamini-Hochberg FDR), MI-adjusted logistic regression (m = 20), and Bayesian regression. Robustness: delta-adjusted MI, tipping-point, FMI, sacubitril-valsartan target-dose, E-value, time-by-diabetes interaction, quarterly ITS at ≥ 8 bins. RESULTS: Four-pillar composite rose from 48.6% (H12022) to 76.3% (H2 2024); MI-adjusted OR per half-year 1.24 (95% CI 1.05-1.47; p = 0.013). SGLT2 inhibitor drove the composite (OR 1.51; 1.22-1.86; p < 0.001); RAAS-i 1.24, MRA 1.11 and beta-blocker 0.98 not significant. Bayesian regression concurred (SGLT2i posterior probability 0.972; four-pillar 0.896). SGLT2i trend was robust to delta-adjusted MI, tipping-point beyond +/- 50 mL/min/1.73 m^2, and unmeasured confounding (E-value point 1.76; CI lower 1.44). Time-by-diabetes interaction was null; sacubitril-valsartan target-dose attainment 20.0%. Quarterly ITS at ≥ 8 bins returned non-significant level and slope changes at every feasible policy event. CONCLUSIONS: Tertiary specialist care approached but did not reach the four-pillar prescription ceiling (76.3%; residual 23.7-percentage-point gap). The SGLT2i trend was robust to MNAR, unmeasured confounding, and diabetes case-mix shift; quarterly ITS at ≥ 8 bins detected no policy-event association. Sacubitril-valsartan target-dose attainment (20.0%), single-centre design, and fragile non-SGLT2i E-values constrain generalisability.
Calomeni P, Abizaid MS, Bernardi F
… +32 more, de Brito FS, Lemos PA, Feres F, Siqueira DA, Costa R, Zukowski C, Sarmento-Leite R, Mangione F, Mangione JA, Thiago LEKS, de Lima VC, Oliveira ADD, Marino MA, Cardoso CJF, Caramori PRA, Tumelero RT, Portela ALF, Prudente ML, Henriques LA, de Freitas Souza FS, Bezerra CG, de Almeida Prado Junior GF, de Freitas LZF, Nogueira EF, Meireles GCX, Pope RB, Guérios ÊE, de Andrade PB, de Moura Santos L, Esteves VBC, Abizaid A, Ribeiro HB
Int J Cardiol
· 2026 Oct · PMID 42251950
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INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has become the standard of care for elderly patients with severe aortic stenosis. While valve-in-valve TAVI (ViV-TAVI) offers a less invasive alternative to re...INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has become the standard of care for elderly patients with severe aortic stenosis. While valve-in-valve TAVI (ViV-TAVI) offers a less invasive alternative to redo surgery in patients with degenerated surgical heart valves (SHV), evidence remains limited. METHODS: This is a retrospective study based on a Brazilian clinical registry of TAVI patients between January 2009 and December 2021. We compared ViV-TAVI patients with native aortic valve (NV-TAVI) patients. Temporal trends, procedural, and in-hospital outcomes were evaluated. We performed propensity score matching (PSM) and multivariable regression to adjust comparisons. RESULTS: Among 3194 patients from 25 centers, 135 underwent ViV-TAVI. The ViV volume increased slightly over time in proportion to NV-TAVI. After PSM, there were 127 ViV and 248 NV-TAVI patients. ViV patients had lower device success (71.7% vs. 87.9%; OR 0.35; 95% CI 0.20-0.60; p < 0.01) and permanent pacemaker implantation (4.7% vs. 12.9%; OR 0.35; 95% CI 0.13-0.79; p < 0.01) compared with NV-TAVI. Valve embolization was more frequent in ViV-TAVI (3.9% vs. 0.8%; OR 4.44; 95% CI 1.03-25.59; p = 0.04). Among ViV patients, no difference in embolization risk was detected (OR 1.11; 95% CI 0.18-11.80; p = 0.91) between radiopaque vs. radiolucent SHV. Major vascular complication, major or life-threatening bleeding, stroke, and in-hospital mortality did not differ significantly between groups. CONCLUSION: During the study period, a modest but significant increase was observed in the number of ViV-TAVI procedures. Device success and PPI were lower, and valve embolization was more frequent in ViV-TAVI compared with NV-TAVI. In-hospital safety outcomes did not differ between groups.
Capranzano P, Calabrò P, Musumeci G
… +11 more, Di Mario C, Nicolini E, Mauro C, Trani C, Versaci F, Tomai F, Pepe M, Berti S, Cernetti C, Cirillo P, De Luca L
Int J Cardiol
· 2026 Oct · PMID 42242385
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BACKGROUND: The use of cangrelor in patients with reduced renal function has never been investigated. This post-hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and isc...BACKGROUND: The use of cangrelor in patients with reduced renal function has never been investigated. This post-hoc analysis of the itAlian pRospective Study on CANGrELOr (ARCANGELO) study aims to assess bleeding and ischemic outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) and transitioning from cangrelor to any oral P2Y12 inhibitors in clinical practice in subgroups stratified by renal function. METHODS: The patients were stratified according to their Estimated-Glomerular-Filtration-Rate (eGFR) value (<60 [LGFR] vs ≥60 [HGFR] mL/min). Bleeding Academic Research Consortium (BARC)-defined outcomes, Major Adverse Cardiac Events (MACEs), Intraprocedural Thrombotic Events (IPTEs), and other safety parameters were assessed in the two subgroups. RESULTS: Of 770 patients included in this post-hoc analysis, 136 (17.7%) had LGFR. These patients had a higher frequency of comorbidities, including diabetes (34.6% vs. 20.0%, p = 0.0004) and atrial fibrillation (10.3% vs. 2.4%, p = 0.0001) than those HGFR. A higher rate of LGFR patients had NSTEMI (54.4% vs. 44.5%) (p = 0.0350) and a multi-vessel coronary artery disease (67.6%) than HGFR ones (48.3%, p < 0.0001). While rates of bleeding, IPTE, and MACEs were similarly low in LGFR and HGFR patients during the 30-day observation period, a higher proportion of LGFR patients (2.2%) experienced BARC type 3-5 (moderate-severe) bleeding compared to HGFR patients (0.2%; p = 0.0188). The type and frequency of MACEs and adverse events in this fragile population were similar to those observed in the overall patients treated with cangrelor. CONCLUSIONS: These data suggest that the transition from cangrelor to any oral P2Y12 inhibitor is a safe and effective treatment in patients with acute coronary syndrome and reduced renal function undergoing PCI in the setting of routine clinical practice.
Adam R, Neculae G, Bădeliță S
… +14 more, Stassen J, Tjahjadi C, Jercan A, Cremeneanu C, Roșca M, Călin A, Beladan C, Șerban M, Coriu D, Bax J, Băicuș C, Popescu BA, Marsan NA, Jurcuț R
Int J Cardiol
· 2026 Oct · PMID 42242384
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AIMS: We aimed to investigate which parameters of left atrial (LA) structure and function could predict new-onset atrial arrhythmias (NOAA) in patients with CA, aiding in improved follow-up. METHODS AND RESULTS: We prosp...AIMS: We aimed to investigate which parameters of left atrial (LA) structure and function could predict new-onset atrial arrhythmias (NOAA) in patients with CA, aiding in improved follow-up. METHODS AND RESULTS: We prospectively included patients diagnosed with CA, both light chain (AL) and variant transthyretin (ATTRv) with no history of AA. LA mechanical dispersion (LAMD) was defined as the standard deviation of time-to-peak positive strain and reported as percentage from the R-R interval. The primary outcome was NOAA. 93 patients were included (mean age 54.3 ± 9.8, 58% males), and 44 patients (47%) developed NOAA during a median follow up of 11 (3.5-36.0) months. Patients with NOAA had heavier hearts, worse global LV function, more LV longitudinal impairment, larger atria and worse LA function. LA reservoir strain (LASr) was significantly lower and LAMD significantly higher in patients who developed NOAA. In the multivariate analysis adjusting for confounding factors, a lower LAMD was independently associated with higher risk for NOAA (HR: 1.182, 95% CI: 1.033-1.351, p = 0.015). Patients with LAMD>6.6% had a higher risk for NOAA than those with LAMD≤6.6% (P < 0.001). Furthermore, LAMD>6.6% remained an independent predictor for NOAA in both univariate and multivariate analysis. Five models were created and the model based on LA volume was significantly improved by adding LVGLS, RVFWS and LAMD, but it was not significantly improved by adding LASr. CONCLUSION: LAMD is a novel, reproducible and independent predictor of NOAA in patients with CA, being superior and incremental to other imaging predictors.
Cai L, Liang B, Zhou S
… +3 more, Xiao H, Hu Y, Ma H
Int J Cardiol
· 2026 Oct · PMID 42242383
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BACKGROUND: The extent to which achieving multiple metabolic treatment targets confers sustained cardiorenal protection across all stages of cardiovascular - kidney - metabolic (CKM) syndrome remains uncertain. METHODS:...BACKGROUND: The extent to which achieving multiple metabolic treatment targets confers sustained cardiorenal protection across all stages of cardiovascular - kidney - metabolic (CKM) syndrome remains uncertain. METHODS: This multicenter retrospective study used data from the China Renal Data System (CRDS) to investigate the association between achieving multiple metabolic targets (blood pressure, fasting blood glucose, LDL-C control) and cardiorenal outcomes across stages of CKM syndrome. RESULTS: The proportion of patients meeting all three metabolic targets decreased markedly with advancing CKM stage. Kaplan-Meier curves showed increasing risks of cardiovascular-renal events and mortality across higher stages (P < 0.001). After adjustment, higher metabolic scores were linked to lower risks: for cardiovascular-renal outcomes, HR 0.82 (95% CI 0.77-0.87) for score 1, 0.72 (0.68-0.77) for score 2, and 0.65 (0.57-0.73) for score 3. Stratified analysis showed significant risk reduction in early CKM stages but not in advanced stages. Restricted cubic spline models indicated nonlinear associations between LDL-C and both outcomes, and between FBG, systolic BP, and mortality, after full adjustment (all P < 0.05). CONCLUSIONS: The findings underscore the need for stage-specific management strategies in CKM syndrome.
Liu J, Ma L, Cui X
… +5 more, Jiang S, Zhao H, Zhao N, An Z, Wang H
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42239609
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BACKGROUND: Cardio-ankle vascular index (CAVI) is an important indicator to evaluate arteriosclerosis. This study was to explore the changes and related factors of CAVI in the elderly population, providing a certain basi...BACKGROUND: Cardio-ankle vascular index (CAVI) is an important indicator to evaluate arteriosclerosis. This study was to explore the changes and related factors of CAVI in the elderly population, providing a certain basis for the prevention and control of cardiovascular and cerebrovascular diseases. METHODS: 1117 subjects (M/F 488/629) were divided into three groups according to age: group 1: subjects with age 60-69 years; group 2: subjects with age 70-79 years; group 3: subjects with age≧80 years. CAVI value was recorded by using the VaseraVS-1000 vascular screening system. RESULTS: There were significant differences about body mass index (BMI), CAVI, systolic blood pressure (SBP), diastolic blood pressure(DBP), pulse pressure, creatinine, fasting plasma glucose (FPG), total cholesterol, high-density lipoprotein cholesterol (HDL-C) and uric acid between these three groups. CAVI value was increasing year by year, with the increasing incidence of hypertension, coronary artery disease and stroke. General Linear Model analysis showed that age, incidence of diabetes mellitus, BMI, DBP and HDL-C were independent associating factors of CAVI in elderly subjects (β = 0.048, p < 0.001; β = 0.349, p = 0.012; β = -0.060, p = 0.001; β = 0.023, p = 0.001; β = -0.530, p = 0.020; respectively). CONCLUSIONS: CAVI was increasing with ageing. The influencing factors of CAVI varied among different age groups. Subjects aged 60-69 were needed to pay close attention to blood pressure and subjects aged 70-79 were needed to focus on diabetes meillitus, providing a theoretical basis for intervening in different targets in different age groups, to reduce or delay the progression of arteriosclerosis.