Pan T, Liu Y, Li CY
… +3 more, Dong SB, Zhang D, Han XN
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42239608
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OBJECTIVE: To quantitatively measure gender-specific anatomical structures of the right atrial appendage (RAA) and right atrium (RA) in atrial fibrillation (AF) patients, and explore their clinical significance for post-...OBJECTIVE: To quantitatively measure gender-specific anatomical structures of the right atrial appendage (RAA) and right atrium (RA) in atrial fibrillation (AF) patients, and explore their clinical significance for post-radiofrequency ablation (RFA) recurrence using 256-slice spiral Computed Tomography (CT). METHOD: This study included 321 AF patients (184 males and 137 females) undergoing RFA for the first time. All patients underwent a 256-slice spiral CT examination before surgery. The volume of the RA, RAA, and left atrium (LA); RAA height; short diameter, long diameter, area, and circumference of RAA base; RA anteroposterior diameter, tricuspid annulus diameter, crista terminalis, and cavo-tricuspid isthmus (CTI) were measured, and clinical data were collected. RESULTS: After body surface area normalization, the RA volume and RA anteroposterior diameter in female patients with AF showed more significant structural remodeling than those in male patients. Both male and female patients with recurrent AF showed larger RAA and RA structural parameters. In females, short diameter of RAA base, crista terminalis thickness and persistent AF were independent recurrence predictors post-RFA, while short diameter of RAA base and AF duration were independent predictors in males (all < 0.05). ROC analysis showed that short diameter of RAA base served as the strongest predictor of AF recurrence in both genders. The optimal cutoff values were 26.95 mm for females (sensitivity = 0.696, specificity = 0.824, AUC = 0.811, P = 0.000) and 25.55 mm for males (sensitivity = 0.700, specificity = 0.746, AUC = 0.786, P = 0.000). CONCLUSION: The short diameter of the RAA base had the highest predictive value for postoperative recurrence in both male and female patients.
He P, Liu Y, Zeng W
… +4 more, Sun Y, Wang Y, Li X, Zhao W
Int J Cardiol Cardiovasc Risk Prev
· 2026 Jun · PMID 42238102
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OBJECTIVES: While the Global Burden of Disease (GBD) study has extensively assessed various cardiovascular conditions, the epidemiological profile of pulmonary arterial hypertension-related heart failure (PAH-HF) across...OBJECTIVES: While the Global Burden of Disease (GBD) study has extensively assessed various cardiovascular conditions, the epidemiological profile of pulmonary arterial hypertension-related heart failure (PAH-HF) across the G20 remains uncharacterized. STUDY DESIGN: This study assessed the burden trends and distribution of the disease in China and G20 countries, analyzed the key drivers, projected future burden changes. METHODS: Using the GBD 2023 database, we assessed the burden of PAH-HF in China and G20 countries (1990-2023) by integrating trend, age-period-cohort (APC), decomposition, and ARIMA forecasting analyses. RESULTS: In 2023, the age-standardized prevalence rate (ASPR) was 2.35 per 100,000 in the G20, with a higher burden in females. China's increase (EAPC = 0.31%, 95% CI 0.24-0.39) was 5.17 times greater than the G20 average (0.06%, 0.04-0.09). Decomposition attributed 59.7% of China's rise to population aging versus 52.2% to population growth in the G20. Projections indicate stable age-standardized rates (ASR) in China and a declining disability burden in the G20 by 2050. CONCLUSION: The burden of PAH-HF is characterized by stable rates but rising absolute numbers, predominantly driven by demographic shifts and exhibiting significant heterogeneity. Targeted risk interventions, precision diagnostics, and strengthened multinational collaboration are needed to mitigate the future disease burden.
Sato K, Takeda M, Ikeda S
… +14 more, Kanaji Y, Hada M, Kakuta T, Kiyooka T, Ozaki Y, Tanaka A, Kawase Y, Matsuo H, Mitsutake Y, Fukumoto Y, Miyata S, Aoki H, Shimokawa H, Japanese association of coronary microvascular dysfunction (J-CMD)
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42237996
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BACKGROUND: Coronary microvascular dysfunction (CMD) is increasingly recognized as a key contributor to angina and non-obstructive coronary arteries (ANOCA) and adverse cardiovascular outcomes. Despite its clinical impor...BACKGROUND: Coronary microvascular dysfunction (CMD) is increasingly recognized as a key contributor to angina and non-obstructive coronary arteries (ANOCA) and adverse cardiovascular outcomes. Despite its clinical importance, the molecular basis of CMD remains to be fully elucidated. CMD is known to be associated with systemic microvascular endothelial dysfunction. METHODS: We examined serum levels of molecules crucial for endothelium-dependent vasodilation, especially nitric oxide (NO)- mediated responses and endothelium-dependent hyperpolarizing responses. These included caveolin-1 (Cav1), endothelial NO synthase (eNOS), and Cu,Zn-superoxide dismutase (Cu,Zn-SOD) in patients with ANOCA enrolled in the nationwide registry by the Japanese Association of CMD. RESULTS: This multicenter study included 295 ANOCA patients (M/F 134/161, mean age 63.7 ± 13.9 years). All patients underwent coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) measurements for CMD diagnosis. Serum Cav1, eNOS, and Cu,Zn-SOD levels were quantified by enzyme-linked immunosorbent assay. CMD was identified in 43% of patients who showed significantly lower Cu,Zn-SOD levels than non-CMD patients (P = 0.001). In patients with abnormal IMR, Cu,Zn-SOD was particularly reduced, while those with both abnormal CFR and IMR had reduced Cav1. In contrast, eNOS levels did not differ significantly between groups. Multivariable logistic regression analysis revealed that Cu,Zn-SOD levels below the cut-off value (97.2 ng/ml) independently predicted CMD [odds ratio (95% confidence interval) 2.71 (1.56-4.74), P < 0.001]. CONCLUSIONS: Reduced Cu,Zn-SOD levels are associated with CMD, suggesting enhanced systemic oxidative stress. This reduction may impair the endothelium-derived hyperpolarizing factor pathway, thereby contributing to CMD pathophysiology.
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42232513
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BACKGROUND: Oxidative stress underlies both metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular disease (CVD). The oxidative balance score (OBS) quantifies systemic oxidative stress from p...BACKGROUND: Oxidative stress underlies both metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular disease (CVD). The oxidative balance score (OBS) quantifies systemic oxidative stress from pro-/antioxidant exposures, but its role in MASLD-CVD comorbidity is unknown. METHODS: We analyzed 19,993 adults from NHANES 1999-2018. Multinomial logistic and Cox regression assessed OBS associations with comorbidity risk and all-cause mortality. Machine learning and SHAP interpretability analysis identified key predictors, and bioinformatics explored mechanistic pathways. RESULTS: Lower OBS quartiles were associated with higher odds of prevalent MASLD (Q1 OR = 1.31), CVD (Q1 OR = 1.95), and MASLD-CVD comorbidity (Q1 OR = 2.15). Each unit increase in OBS reduced mortality risk (MASLD-CVD: HR = 0.98; MASLD: HR = 0.98; CVD: HR = 0.99). Critical OBS thresholds were identified: OBS<8.73 increased mortality risk in MASLD patients (HR = 1.09), while OBS≥8.73 was protective (HR = 0.96). For MASLD-CVD, OBS = 21 optimally stratified mortality risk (log-rank P = 0.0018). SHAP analysis revealed the nonlinear contributions of key dietary/lifestyle factors. The key pro-oxidant factors may contribute to comorbidity development through IL-17 and insulin resistance pathways, as suggested by bioinformatics analysis. CONCLUSIONS: OBS enables risk stratification for MASLD-CVD comorbidity, but external validation is required before clinical application.
Onyeji PC, Momplaisir-Onyeji S, Majumdar A
… +7 more, Nowakowski P, Passos FS, Kirov H, Treml RE, Doenst T, Tkebuchava S, Caldonazo T
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42232351
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: Minimally invasive mitral valve surgery (MIMVS) is increasingly used as an alternative to conventional sternotomy for patients with mitral valve pathologies. This systematic review and meta-analysis aimed to evaluate w...: Minimally invasive mitral valve surgery (MIMVS) is increasingly used as an alternative to conventional sternotomy for patients with mitral valve pathologies. This systematic review and meta-analysis aimed to evaluate whether obesity (BMI ≥30 kg/m) is associated with different perioperative and postoperative outcomes in patients undergoing MIMVS. : MEDLINE, EMBASE, and Cochrane Library were systematically searched to identify studies comparing outcomes between BMI groups in patients undergoing MIMVS. The primary outcome was in-hospital mortality. The secondary outcomes were stroke, re-exploration for bleeding, intensive care unit (ICU) length of stay (LOS), hospital LOS, postoperative atrial fibrillation (POAF), requirement of permanent pacemaker implantation (PPI), duration of mechanical ventilation, and wound complications. A random-effects model was performed. Results Six studies comprising 5,925 patients met the inclusion criteria. Compared with BMI <30 kg/m, obesity was not associated with higher in-hospital mortality (RR 1.29; 95%CI 0.67 to 2.48; p=0.446; I=31.6%). However, obese patients had significantly higher rates of postoperative atrial fibrillation (RR 1.28; 95%CI 1.12 to 1.46; p<0.001; I=0%), longer intubation duration (MD 0.88; 95%CI 0.11 to 1.65; p=0.02; I=35.7%), longer hospital LOS (MD 0.51; 95%CI 0.04 to 0.99; p=0.03; I=82.3%), and higher requirement for permanent pacemaker implantation (RR 1.43; 95%CI 1.01 to 2.01; p=0.043; I=0%). No significant differences were observed in stroke, ICU LOS, re-exploration for bleeding, or wound complications. Sensitivity analyses confirmed the robustness of the pooled estimates. Conclusions In patients undergoing MIMVS, obesity was associated with higher rates of POAF and modestly prolonged postoperative recovery, without increased in-hospital mortality.
Song C, Huang X, Cui J
… +3 more, Zheng X, Yang Q, Wang S
Int J Cardiol Heart Vasc
· 2026 Aug · PMID 42232162
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BACKGROUND: The prognostic role of endothelin-1 (ET-1) in patients with obstructive hypertrophic cardiomyopathy (oHCM) who underwent septal myectomy remains unclear. We aimed to assess its prognostic importance in patien...BACKGROUND: The prognostic role of endothelin-1 (ET-1) in patients with obstructive hypertrophic cardiomyopathy (oHCM) who underwent septal myectomy remains unclear. We aimed to assess its prognostic importance in patients undergoing septal myectomy. METHODS: We recruited 1207 oHCM patients for this analysis. The participants were divided into three groups according to the tertile of big ET-1. Cox regression analyses were conducted to assess the prognostic value of big ET-1 on all-cause death and cardiovascular death. RESULTS: The mean age of the participants was 49.9 ± 12.0 years, 713 (59%) study patients were male. female (adjusted coefficient 0.106, 95% CI: 0.053-0.158) and left atrial dimension (adjusted coefficient 0.005, 95%CI: 0.001-0.009) were significantly associated with big ET-1 levels. During mean 3.8 years follow-up, 35 patients died including 27 cardiovascular deaths. Multivariate Cox regression analyses showed that patients with highest tertile had the highest incidence of all-cause mortalities (adjusted HR = 3.483, 95% CI: 1.365-8.887, P = 0.009) and cardiovascular mortalities (adjusted HR = 8.328, 95%CI: 1.883-36.828, P = 0.005), compared to the referenced patients with lowest tertile. When Big ET-1 was evaluated as a continuous variable, data showed that the big ET-1 was correlated with higher risks of all-cause deaths (adjusted HR = 1.588, 95%CI: 1.148-2.196, P = 0.005) and cardiovascular deaths (adjusted HR = 1.757, 95%CI: 1.250-2.470, P = 0.001). Furthermore, interactions were detected in the subgroups of gender, and maximum wall thickness. CONCLUSION: Our study revealed that high level of plasma big ET-1 could predict worse clinical outcomes for oHCM patients undergoing myectomy.
Aggarwal P, Derti S, Yannamani A
… +5 more, Newman JS, Tuli R, Dargan P, Indaram M, Kassis-George H
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42211739
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BACKGROUND: Hypertensive disorders of pregnancy (HDP) are established precursors to future cardiovascular disease. Current guidelines endorse labetalol, nifedipine, and methyldopa as first-line antihypertensive therapies...BACKGROUND: Hypertensive disorders of pregnancy (HDP) are established precursors to future cardiovascular disease. Current guidelines endorse labetalol, nifedipine, and methyldopa as first-line antihypertensive therapies, but data on long-term maternal cardiovascular risk are limited. OBJECTIVES: We evaluated five-year postpartum outcomes of HDP patients who were exposed to nifedipine or labetalol during pregnancy. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Patients were identified using ICD-10-CM codes for HDP-excluding those with pre-existing hypertension-and categorized by treatment with labetalol or nifedipine. Patients exposed to amlodipine or methyldopa were excluded. After 1:1 propensity score matching, we compared cardiovascular and renal outcomes over five years. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI) and as hazard ratios (HR) from Kaplan-Meier survival analysis. RESULTS: After matching, 11,764 patients remained in each cohort (23,528 total). Nifedipine exposure was associated with lower odds of chronic hypertension (CH, aOR 0.835, 95% CI [0.778, 0.896], p < 0.001), heart failure (HF, aOR 0.699, 95% CI [0.527, 0.926], p = 0.012), HF with reduced ejection fraction (HFrEF, aOR 0.608, 95% CI [0.418, 0.886], p = 0.009), and chronic kidney disease (CKD, aOR 0.653, 95% CI [0.492, 0.867], p = 0.003) compared to labetalol. Time-to-event analysis confirmed these findings. CONCLUSION: Among HDP patients, nifedipine exposure during the index pregnancy was associated with lower five-year risks of CH, HF, HFrEF, and CKD compared with labetalol. These findings suggest that antihypertensive choice in pregnancy may differentially affect long-term maternal cardiovascular health.
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42211250
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BACKGROUND: Fractional flow reserve (FFR) is widely used to guide percutaneous coronary intervention (PCI) as a surrogate of inducible myocardial ischemia (IMI). However, the relationship between very low FFR, electrical...BACKGROUND: Fractional flow reserve (FFR) is widely used to guide percutaneous coronary intervention (PCI) as a surrogate of inducible myocardial ischemia (IMI). However, the relationship between very low FFR, electrically manifest ischemia, and subsequent symptomatic benefit remains incompletely understood. METHODS: We investigated stress-induced ischemic electrocardiographic changes in 79 patients with FFR ≤ 0.60, comparing acute coronary syndrome (ACS) and stable coronary artery disease (CAD), and its association with post-PCI symptom improvement. IMI was defined by ischemic ST-segment changes during adenosine stress testing. Pressure-derived physiologic indices, including the instantaneous wave-free ratio (iFR) and resting Pd/Pa, were measured, and angina-related symptoms were assessed using the Seattle Angina Questionnaire. RESULTS: IMI was present in all patients with ACS but was absent in 40 % of patients with stable CAD ( < 0.001). Despite similar angiographic severity and mean FFR values, iFR and resting Pd/Pa were significantly lower in ACS. In multivariate analyses, ACS and lower iFR or resting Pd/Pa independently predicted IMI. Although angina symptoms improved overall after PCI, the greatest improvement occurred in patients with ACS or IMI. CONCLUSIONS: At extremely low FFR values (≤0.60), substantial discordance exists between pressure-derived physiology and IMI, which is closely related to clinical presentation and symptomatic benefit after PCI.
Zhang R, Sun X, Liu Y
… +4 more, Meng Y, Zheng Y, Zhang C, Wang S
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42211249
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Hemodynamic factors are essential in influencing cellular behaviors and facilitating the restoration of tissue structure and function through mechanotransduction pathways. This review explores the pivotal role of hemodyn...Hemodynamic factors are essential in influencing cellular behaviors and facilitating the restoration of tissue structure and function through mechanotransduction pathways. This review explores the pivotal role of hemodynamics in the development of myocardial tissue and the remodeling processes involved in tissue regeneration. We systematically analyze the regulatory effects of hemodynamic conditions during embryonic heart development, adult cardiac regeneration, and pathological remodeling processes. The review summarizes the latest research findings and potential therapeutic strategies aimed at harnessing hemodynamic influences for the treatment of cardiovascular diseases. By shedding light on these mechanisms, we aim to provide a theoretical foundation to inform future therapeutic approaches in cardiovascular medicine.
Song X, Yang J, Li Y
… +5 more, Zhao Z, Xu D, Wang J, Wang X, Zhang J
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42211248
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BACKGROUND: Accurate assessment of thrombus risk in atrial fibrillation (AF) requires the integration of structural and metabolic factors, which are insufficiently addressed by current clinical risk scores. We developed...BACKGROUND: Accurate assessment of thrombus risk in atrial fibrillation (AF) requires the integration of structural and metabolic factors, which are insufficiently addressed by current clinical risk scores. We developed a model that added LAA morphology and metabolic markers, and compared it with the CHADS‑VA score. METHODS: This retrospective cohort study included 418 participants (262 AF patients without thrombus and 156 AF patients with thrombus). Data on medical history, contrast‑enhanced computed tomography with three‑dimensional reconstruction, and metabolic profiling were retrospectively collected. RESULTS: The final model comprised six independent predictors: non‑paroxysmal AF, CHADS‑VA score ≥ 2, anticoagulation use, AF duration, LAA orifice ellipticity index (LAA OEI), and lipoprotein(a) (Lp(a)). The model demonstrated excellent discrimination (AUC = 0.861, 95% CI 0.829-0.892) and good calibration (Hosmer‑Lemeshow test p = 0.462). It significantly outperformed the CHADS‑VA score (AUC = 0.643; ΔAUC = 0.2186; p < 0.0001), with a net reclassification improvement of 0.844 (p < 0.001) and an integrated discrimination improvement of 0.311 (p < 0.001). CONCLUSIONS: Integrating LAA OEI and Lp(a) with clinical factors improves thrombus risk stratification in patients with AF compared with the CHADS‑VA score alone.
Int J Cardiol
· 2026 Oct · PMID 42208867
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BACKGROUND: There is increasing clinical focus on chronic coronary disease (CCD) yet limited population-level data on CCD epidemiology. We evaluated admission patterns and characteristics of hospitalised CCD patients and...BACKGROUND: There is increasing clinical focus on chronic coronary disease (CCD) yet limited population-level data on CCD epidemiology. We evaluated admission patterns and characteristics of hospitalised CCD patients and assessed the impact of definitions of episodes of care on CCD surveillance. METHODS: We used person-linked hospitalisation data from Western Australia, 2005-2022, to identify CCD (stable angina, ICD-10-AM I20.1-I20.9; chronic ischaemic heart disease, IHD, I25). Baseline episodes and 28-day, 3-month and 6-month duration-specific episodes were created for each subgroup, stratified by recent acute coronary syndrome (ACS). Age-standardised and sex-stratified hospitalisation rates were calculated, with age-adjusted annual changes estimated from Poisson regression models. RESULTS: From 2005 to 2022, 50,384 stable angina and 65,278 chronic IHD baseline episodes were identified. Nearly 10% had a recent ACS admission. Patient characteristics were similar by subgroup, although chronic IHD admissions were predominantly for invasive angiography +/- revascularisation (95% vs stable angina 61%). When 28-day and 3-month episodes were imposed, stable angina counts were 7.0% and 11.6% lower than baseline episodes, with a similar pattern for chronic IHD (9.2% and 14.6% lower). Most patients had ≥1 coronary-related readmission in the 6-months following their CCD admission (68.2%), with >80% for angiography +/- revascularisation. Marginal declines in overall CCD rates were underpinned by reductions in stable angina (-6.1%/year, 95% CI -6.3, -5.9) and increasing chronic IHD (3.3%/year, 95% CI 3.2, 3.5). CONCLUSIONS: Small declines in CCD hospitalisation rates masked differing trends in stable angina and chronic IHD. Differences in patient management indicate that subgroup stratification is needed when using hospitalisation data for CCD.
Nordberg Backelin C, Bobbio E, Bollano E
… +8 more, Rawshani A, Wideqvist M, Björkenstam M, Romeo S, Fu M, Andersson B, Bergh N, Ljungman C
Int J Cardiol
· 2026 Oct · PMID 42208866
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BACKGROUND: Sex-related differences in cardiomyopathy (CMP) may influence clinical presentation, diagnostic evaluation, access to advanced therapies and outcomes. Despite this, women remain substantially underrepresented...BACKGROUND: Sex-related differences in cardiomyopathy (CMP) may influence clinical presentation, diagnostic evaluation, access to advanced therapies and outcomes. Despite this, women remain substantially underrepresented in CMP research. OBJECTIVES: To examine sex differences in distribution, clinical presentation, comorbidities, diagnostic evaluation, advanced therapies and outcomes across CMPs. Further to identify sex-specific predictors of prognosis. METHODS: Adults (≥18 years) with suspected CMPs were prospectively enrolled and diagnosed with arrhythmogenic right heart cardiomyopathy (ARVC), dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), myocarditis, restrictive cardiomyopathy (RCM), or other CMPs. The primary composite outcome included mechanical circulatory support (MCS), heart transplantation (HTx), or death. Age-adjusted Cox regression, and machine-learning survival models identified key outcome predictors. RESULTS: Among 641 patients (mean age 54.4 ± 16.5 years; 72% men) women had lower diastolic blood pressure, lower body mass index and more often endocrine comorbidities (p < 0.008). Women more often presented with fatigue and men with ventricular arrhythmias (p < 0.013). DCM was the most common CMP in both sexes, while HCM was more frequent in women and RCM in men (p < 0.009). Women more often underwent genetic evaluation but no other statistically significant differences in diagnostic assessments were observed. Use of device therapies and outcome did not differ significantly by sex. Gradient-boosted machine analyses identified NTproBNP, right atrial mean pressure and disease duration as the strongest predictors of outcome in both sexes. CONCLUSION: Despite differences in phenotype and presentation no significant differences in outcomes were observed between sexes, indicating that disease severity, not sex, drives prognosis.
Upadhyay N, Batra K, Le L
… +6 more, Steffens A, Carlyle M, Song R, Horstman T, Ye W, Plat A
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42205687
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INTRODUCTION: Obesity-related HFpEF is linked to worse quality of life and health outcomes; however, the association of obesity with real-world healthcare resource utilization (HCRU) and economic burden in HFpEF is unkno...INTRODUCTION: Obesity-related HFpEF is linked to worse quality of life and health outcomes; however, the association of obesity with real-world healthcare resource utilization (HCRU) and economic burden in HFpEF is unknown. This study assessed the association between BMI and HCRU- and cost-related outcomes among patients with HFpEF. METHODS: This claims-based study utilized the Optum Market Clarity database to identify adult commercial, Medicare, and Medicaid patients with HFpEF based on EF ≥ 50% and ≥ 1 diagnosis of HF from Oct 01, 2016 to Mar 31, 2023. Baseline clinical characteristics, post-index rehospitalization rates, and per-patient-per-year HCRU and cost data were described. Associations between BMI and HCRU and cost outcomes was examined using generalized linear models adjusted for baseline characteristics. RESULTS: A total of 95,070 patients were included; 14.4% were with normal weight, 26.1% with overweight, 23.8% Class 1 obesity, 15.9% Class 2 obesity, and 19.9% Class 3 obesity. Across cohorts, patients with Class 2 and Class 3 obesity had high rates of all-cause and HF-related rehospitalizations. Patients with Class 2 and Class 3 obesity had higher rates of HF-related hospitalization/ER visits (both p < 0.001), compared to the overweight cohort, when adjusted for baseline covariates. Across comparisons, patients with Class 3 obesity had numerically higher HF-related costs compared with the overweight cohort. CONCLUSIONS: This study demonstrated that patients with HFpEF and Class 3 obesity incurred higher healthcare costs, more frequent all-cause and HF-related acute care encounters, in general, and increased readmissions rates, compared to patients in other BMI groups.
Freddo AM, Eron M, Mondal A
… +12 more, Tomlinson AZ, Denduluri S, Farkas I, Partington S, Ruckdeschel E, Tsao AL, Mavroudis CD, Nuri M, Fuller S, Ortega-Legaspi JM, Kim YY, Vaikunth S
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42205242
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BACKGROUND: There are limited data on pharmacologic management of adults living with Fontan circulation. OBJECTIVES: We planned to define changes in pharmacologic management of adults living with Fontan circulation seen...BACKGROUND: There are limited data on pharmacologic management of adults living with Fontan circulation. OBJECTIVES: We planned to define changes in pharmacologic management of adults living with Fontan circulation seen at our adult congenital heart disease (ACHD) center and evaluate the association between medication changes and outcomes. METHODS: We conducted a single center retrospective study. Patient characteristics, cardiac medications, and medication start dates were abstracted by electronic medical record review. Outcomes investigated were new-onset arrhythmia, first time heart failure hospitalization, and transplant-free survival. Outcomes were compared between patients who started medications while under ACHD care with those who did not. RESULTS: The most common cardiac medication class prescribed to patients prior to establishing care was angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) (51.0%), followed by loop diuretics (28.2%) and mineralocorticoid receptor antagonists (MRA) (18.6%). There was a higher incidence of first time heart failure hospitalization and heart transplant or death in patients started on nearly all cardiac medication classes compared to those who were not. Patients started on anti-arrhythmics, loop diuretics, MRA, pulmonary vasodilators, and warfarin had the lowest 5-year transplant-free survival from medication start date. CONCLUSIONS: We report commonly utilized cardiac medication classes in adults living with Fontan circulation, with our data suggesting that patients starting anti-arrhythmics, loop diuretics, MRA, pulmonary vasodilators, and warfarin may have decreased 5-year transplant-free survival from medication initiation. These medications were often started in patients with Fontan circulatory failure and/or cirrhosis, suggesting these patients constitute a sicker subset of adults living with Fontan circulation.
BACKGROUND: Epicardial collaterals represent a conduit for retrograde crossing in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but carry higher procedural risk compared with septal or bypass gr...BACKGROUND: Epicardial collaterals represent a conduit for retrograde crossing in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but carry higher procedural risk compared with septal or bypass graft crossing. METHODS: We analyzed 1527 CTO PCI cases attempted via epicardial collaterals between January 2012 and March 2026 from the PROGRESS-CTO multicenter registry (49 centers). Temporal trends were assessed using logistic regression. Technical success, procedural success, and in-hospital major adverse cardiac events (MACE) were evaluated. RESULTS: Mean patient age was 65 ± 10 years; 86.4% were men. Lesion complexity was high (mean J-CTO score 3.16 ± 1.02). Use of the retrograde approach overall and via epicardial collaterals decreased significantly over time (both p < 0.001). Epicardial collateral crossing success increased (p < 0.001), while MACE rates did not change significantly (p = 0.085). Technical and procedural success were 77.0% and 74.4%, respectively. In-hospital MACE occurred in 3.8% of cases. Coronary perforation occurred in 13.8% of procedures and was strongly associated with MACE (15.2% vs. 2.0%, p < 0.001). CONCLUSIONS: In a large contemporary multicenter registry, while use of retrograde CTO PCI via epicardial collaterals declined over time, crossing success improved without a significant increase in complications, suggesting improved case selection and procedural expertise.
Gopal A, Kamrada C, Awad A
… +3 more, Chalhoub M, Basit J, Alraies MC
Int J Cardiol
· 2026 Oct · PMID 42203004
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BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality, and comorbid major depressive disorder (MDD) is linked to worse cardiovascular outcomes. The association bet...BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality, and comorbid major depressive disorder (MDD) is linked to worse cardiovascular outcomes. The association between selective serotonin reuptake inhibitors (SSRIs), first-line therapy for MDD, and clinical outcomes in patients with STEMI remains incompletely defined. METHODS: We performed a retrospective cohort study using the TriNetX Research Network. Adult patients with STEMI and MDD were stratified by SSRI exposure at or prior to the index STEMI event. Propensity score matching was used to balance demographic characteristics, cardiovascular comorbidities, psychiatric conditions, and cardiac medications. Primary outcome was all-cause mortality at 1 month, 1 year, and 3 years. RESULTS: Among 22,427 patients with STEMI and MDD, 18.9% had documented SSRI use at their baseline. After propensity score matching, baseline SSRI use was not associated with recurrent myocardial infarction or ischemic stroke at any time point. Baseline SSRI use was associated with lower all-cause mortality from 30 days to 1 year and 3 years post-STEMI. Baseline SSRI therapy was additionally associated with higher rates of of major bleeding at 3 years post-STEMI and hospital readmission at 1 year post-STEMI. CONCLUSIONS: In this large, propensity-matched cohort of patients with STEMI and MDD, baseline SSRI use was associated with a lower all-cause mortality without higher rates of recurrent myocardial infarction or stroke. These findings suggest an association between SSRI use and favorable mortality outcomes in this population, although residual confounding cannot be ruled out.
BACKGROUND: Elevated lipoprotein(a) [Lp(a)] is a well-established, genetically mediated risk factor for atherosclerotic cardiovascular disease (ASCVD), yet effective therapies targeting Lp(a) remain limited. Glucagon-lik...BACKGROUND: Elevated lipoprotein(a) [Lp(a)] is a well-established, genetically mediated risk factor for atherosclerotic cardiovascular disease (ASCVD), yet effective therapies targeting Lp(a) remain limited. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide cardiometabolic benefits in high-risk populations, but their impact among patients with elevated Lp(a) levels is not well defined. METHODS: We conducted a retrospective cohort study to evaluate cardiovascular outcomes associated with GLP-1RA therapy in adults with Lp(a) >50 mg/dL and comorbid obesity or type 2 diabetes. Patients were categorized into GLP-1RA users versus non-users and matched 1:1 using propensity scores based on demographics, cardiovascular risk factors, and baseline comorbidities. The primary outcome was all-cause mortality; secondary outcomes included major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, and coronary revascularization). Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional hazards models. RESULTS: Among 24,185 eligible patients, 3791 received a GLP-1RA. After matching, 3310 patients remained in each cohort with balanced baseline characteristics. Over a median follow-up of approximately two years, GLP-1RA use was associated with significantly lower all-cause mortality (HR 0.66, 95% CI 0.48-0.90) and reduced MACE (HR 0.68, 95% CI 0.60-0.76). Individual components, including myocardial infarction, ischemic stroke, and cardiovascular death, were also significantly decreased among GLP-1RA users. CONCLUSION: In patients with elevated Lp(a), GLP-1RA therapy was associated with substantial reductions in mortality and cardiovascular events. These findings suggest potential cardioprotective effects of GLP-1RAs in a high-risk population with limited therapeutic options and support further prospective evaluation.