Mauro A, Mascolo R, Bizzi E
… +24 more, Sandini M, Collini V, Caorsi R, La Torre F, Celani C, Cattalini M, Giani T, Del Giudice E, Rigante D, Maggio MC, Trotta L, Pancrazi M, Ceriani E, Berra S, Agozzino F, Mannarino S, Pasquinucci M, Insalaco A, Lubrano R, Simonini G, Gattorno M, Bernardo L, Imazio M, Brucato A
BACKGROUND AND OBJECTIVES: Recurrent pericarditis (RP) guidelines are based on adult studies. We aimed to compare RP in pediatric and adult patients. METHODS: This observational longitudinal multicentric cohort study stu...BACKGROUND AND OBJECTIVES: Recurrent pericarditis (RP) guidelines are based on adult studies. We aimed to compare RP in pediatric and adult patients. METHODS: This observational longitudinal multicentric cohort study studied 442 patients with idiopathic or post-pericardiotomy RP: 133 pediatric (<18 years) and 309 adult (≥18 years) patients. RESULTS: Children showed a male predominance (90 males, 67.7%). Chest pain was most common in children [129/133 (97%) vs. 217/309 (70.2%) p < 0.001], as fever and pleural effusion [85/133 (63.9%) vs. 136/309 (44%), p < 0.05; 68/133 (51.1%) vs. 106/309 (34.3%), p < 0.001], while pericardial effusion occurred with a similar frequency: 99/133 (74.4%) vs. 249/309 (80.6%). Children exhibited a pronounced inflammatory response, with higher neutrophilia (p = 0.031). The clinical course was more favorable with a lower recurrence rate [median (IQR) 0.5 (0.27 to 0.87) vs. 0.87 (0.43 to 1.56) episodes/year, p < 0.001] and a longer disease-free interval, with a median (IQR) of 20.5 (11 to 30.6) months vs. 12.3 (7.4 to 23.6) months (p < 0.001). Glucocorticoid use was more frequent in adults [231/309 (74.8%) vs. 66/133 (49.6%), p < 0.001], as well as colchicine [306/309 (99%) vs. 120/133 (90%), p < 0.001]. Anakinra was more frequently prescribed in pediatric patients [60/133 (45.1%) vs. 73/309 (23.6%), p < 0.001]. Only 5/60 (8.3%) pediatric subjects were able to stop anakinra. Eleven patients (8.3%) had disease onset before 6 years. CONCLUSIONS: Pediatric idiopathic RP exhibits distinct features compared to adult cases, with a more intense inflammatory profile but a more favorable clinical course. IL-1 inhibitors were more commonly used in pediatric subjects.
INTRODUCTION: The Italian pre-participation screening (PPS) protocol includes family and personal medical history, physical examination, and a 12‑lead electrocardiogram (ECG). The aim of this study was to evaluate the pr...INTRODUCTION: The Italian pre-participation screening (PPS) protocol includes family and personal medical history, physical examination, and a 12‑lead electrocardiogram (ECG). The aim of this study was to evaluate the prevalence of selected ECG abnormalities in an unselected athletic population from a multicenter Italian registry, and to assess their association with at-risk cardiovascular conditions. METHODS: This multicenter registry prospectively enrolled 12,758 elite and amateur athletes (62% males; median age 22.5 years, range 14-55 years) undergoing PPS according to the Italian national protocol (COCIS, 2017). ECGs were interpreted according to the International Criteria for Electrocardiographic Interpretation in Athletes, with the addition of selected markers (low QRS voltages, QRS fragmentation, and early repolarization with horizontal or descending ST segment). ECG patterns suggestive of Brugada syndrome and ventricular pre-excitation, although observed, were not included in the analysis. All subjects with ECG abnormalities underwent a second-line diagnostic work-up. RESULTS: A total of 129 abnormal ECGs were identified (1.01%). Among these, 25 athletes (19.3%) were disqualified because of an at-risk cardiovascular condition. CONCLUSION: The prevalence of selected ECG abnormalities in this multicenter registry was lower than that reported in previous studies. However, this finding should be interpreted in the light of the selective ECG criteria adopted. The abnormalities investigated showed a relevant predictive value for identifying at-risk conditions in a real-world, predominantly non-elite population.
Ishii T, Anzai T, Uchida K
… +25 more, Hosokawa S, Sumitomo NF, Ishida H, Hirono K, Muneuchi J, Chida-Nagai A, Inuzuka R, Sawada H, Suzuki S, Maeda J, Aoki H, Lin L, Murakami T, Nakano Y, Onishi T, Wakamiya T, Inai K, Takatsuki S, Yao A, Kogaki S, Fukushima H, Tamura Y, Takahashi K, Yamagishi H, Doi S
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42199920
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BACKGROUND: Pulmonary hypertension (PH) is a major determinant of outcomes in congenital heart disease (CHD), yet tools for individualized prognostic estimation are limited. This study aimed to develop an exploratory, cl...BACKGROUND: Pulmonary hypertension (PH) is a major determinant of outcomes in congenital heart disease (CHD), yet tools for individualized prognostic estimation are limited. This study aimed to develop an exploratory, clinically oriented prediction model for estimating cardiac event-free survival in patients with CHD-PH. METHODS: Data from the nationwide Japanese Association of CHD-PH Registry were analyzed in a retrospective cohort derived from a prospectively maintained registry. Cardiac event-free survival was evaluated using Cox proportional hazards models incorporating prespecified, routinely available clinical and hemodynamic variables. Cardiac events were defined as death, transplantation, clinical worsening requiring treatment escalation, or PH-related hospitalization. RESULTS: A total of 224 patients were included, and 23 experienced 29 cardiac events during a median follow-up of 1.5 years. These included 7 cardiovascular deaths, 1 lung transplantation, and 1 atrial septostomy, 13 cases of clinical worsening. The cardiac event-free survival rates were 94.0% and 86.2% at 1 and 2 years, respectively. In multivariable analysis, trisomy 21 (hazard ratio [HR] 3.63), elevated pulmonary vascular resistance index (PVRI; HR 13.2), and elevated central venous pressure (CVP; HR 3.27) were associated with worse outcomes. These associations were consistent in sensitivity and subgroup analyses. Model-based estimates demonstrated risk gradients across clinically relevant profiles and were incorporated into a prototype prediction tool. CONCLUSIONS: An exploratory pragmatic prediction model for cardiac event-free survival in CHD-PH was developed using nationwide registry data. These findings support the feasibility of a registry-based prognostic framework; however, further validation is required before clinical application.
Giamberti A, Caldaroni F, Guglielmi G
… +5 more, Veljkovic S, Perunicic A, Brida M, Chessa M, Nikolic A
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42199919
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BACKGROUND: In 2014 a professional collaboration was established between IRCCS Policlinico San Donato, Milan, Italy (PSD) and the Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia (ICDD) to support and impro...BACKGROUND: In 2014 a professional collaboration was established between IRCCS Policlinico San Donato, Milan, Italy (PSD) and the Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia (ICDD) to support and improve the care of adult patients with congenital heart disease (ACHD) in the country. Since 2018, this collaboration has become more structured, with a specific focus on surgery for adults with complex congenital heart disease (CHD). Aim of the study was to evaluate the outcomes of this collaboration. METHODS: We conducted a retrospective study on all consecutive adult patients (aged over 18 years) with CHD who underwent surgery at the Institute for Cardiovascular Disease Dedinje (ICDD) over a ten-year period, from January 2014 to December 2024. Collected data included number of cases, mean age at surgery, types of surgical procedures performed, number of previous operations, distribution of cases based on complexity, patient outcomes, and follow-up. RESULTS: Between 2014 and 2024, a total of 244 ACHD patients underwent surgery at ICDD. Eighty-eight of these patients (88/244 = 36%) required complex procedures and were referred to the visiting PSD cardiac surgeon. Mean age at surgery was 34.8 years (±14 years). The most common diagnosis was right ventricular outflow tract (RVOT) pathology, accounting for 89% of cases. Seventy patients (80%) underwent reoperations following previous procedures. In-hospital mortality was 4.5% (4 patients). No additional deaths or reoperations occurred during a mean follow-up of 58 months (2-122 months). CONCLUSIONS: This ten-year international partnership demonstrates that high-quality ACHD surgical care can be delivered sustainably in countries with limited case volumes and expertise. By combining local access with external specialist support, the model has achieved outcomes comparable to high-volume Western European centres. Increased access to ACHD surgery in their home country and reduced financial burden suggests that this model of care may potentially serve in other countries facing similar healthcare challenges.
William MB, Mashuda F, Chami N
… +5 more, Msanga DR, Kabirigi J, Kayange N, Mhada T, Masoza T
Int J Cardiol Congenit Heart Dis
· 2026 Sep · PMID 42199917
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INTRODUCTION: There is paucity of epidemiological data on neonatal congenital heart disease (CHD) in Tanzania, hindering evidence based policy or protocol development and resources allocation to improve health care servi...INTRODUCTION: There is paucity of epidemiological data on neonatal congenital heart disease (CHD) in Tanzania, hindering evidence based policy or protocol development and resources allocation to improve health care services. Consequently, neonates with CHD are subjected to late referrals, disease complications and high treatment costs. This study aimed to determine prevalence, patterns, and factors associated with CHD among neonates admitted to a tertiary hospital, northwestern-Tanzania. METHODOLOGY: A cross-sectional study was conducted from November 2022 to March 2023 involving 513 admitted neonates. Detailed physical examination and screening echocardiography was done to all participants. Data was analyzed using STATA version 13. RESULTS: The overall prevalence of CHD was 20.3% (104/513) which decreased to 10.3% (53/513) after excluding small defects with high likelihood of spontaneous closure. From the overall CHD, acyanotic CHD were the commonest by 83.7% (87/104). Severe CHD accounted for 6.8% (35/513). History of residing near mining areas (OR 2.9[CI: 1.2-6.9], P-0.017) and lack of folic acid supplementation during the first trimester (OR 2.5[CI: 1.4-4.4], P- 0.001) were significant maternal risk factors. While, Pre-ductal oxygen saturation of <90% (OR 3.2[CI: 1.4-7.3], P-0.005), tachycardia (OR 2.8[CI: 1.3-5.9], P-0.007), and presence of central cyanosis (OR 3.9[CI: 1.1-13.6], P-0.031) were significant clinical predictors. CONCLUSION: Strategies are needed to strengthen reproductive health services among women of child bearing age and promote environmental health policies in mining and nearby areas. Clinicians are urged to perform thorough cardiovascular examination together with diagnostic services to facilitate early detection of CHD, timely referrals and appropriate management.
Elsaid B, Kopaliani I, Seif A
… +2 more, Speier S, Deussen A
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42199624
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INTRODUCTION: Estrogen protects vascular function, likely via adrenergic modulation. Previous studies of estrogen and beta-adrenoceptor (β-AR) interactions relied on non-coronary or animal models, limiting relevance to h...INTRODUCTION: Estrogen protects vascular function, likely via adrenergic modulation. Previous studies of estrogen and beta-adrenoceptor (β-AR) interactions relied on non-coronary or animal models, limiting relevance to human coronary endothelium. This study aimed to characterize estrogen receptor (ER) and β-AR expression in human coronary artery endothelial cells (HCAECs), evaluate inter-donor variability, and determine whether ER stimulation alters β-AR gene expression. METHODS: HCAECs from female donors were analyzed for expression of ERs (ERα, ERβ, GPER), and β-ARs (β-, β-, β-AR) at mRNA and protein levels using RT-qPCR, western blotting, and immunofluorescence, with assessment of inter-donor variability. To investigate estrogen-β-AR interactions, cells were treated with 1 and 10 nM 17β-estradiol or 10 nM selective ER agonists; PPT (Propylpyrazoletriol, ERα), DPN (Diarylpropionitrile, ERβ), G-1 (G protein-coupled estrogen receptor, GPER) for 4, 12, and 24 h, and β-AR mRNA expression was measured. RESULTS: Immunofluorescence revealed presence of all three ERs and β-ARs in the HCAECs. ERα had the lowest mRNA expression, while GPER was the most abundant, with donor-dependent variability. ERβ and GPER proteins were slightly higher than ERα. β-AR exhibited the lowest mRNA, β-AR was the highest, and donor-specific differences were observed. Stimulation with 17β-estradiol or selective ER agonists did not alter β-AR mRNA expression. CONCLUSION: These findings demonstrate donor variability in ER and β-AR expression in HCAECs, limiting generalization. Under the tested conditions estrogen and ER agonists did not alter β-AR mRNA levels, suggesting that short-term ER stimulation is unlikely to regulate β-AR expression at the transcriptional level within this experimental setting.
AIMS: Takotsubo syndrome is an acute cardiac syndrome that mimics myocardial infarction. Despite its transient nature, substantial early morbidity may occur, while predictors of short-term recovery and adverse in-hospita...AIMS: Takotsubo syndrome is an acute cardiac syndrome that mimics myocardial infarction. Despite its transient nature, substantial early morbidity may occur, while predictors of short-term recovery and adverse in-hospital outcomes remain incompletely characterized. METHODS: We performed a retrospective study of consecutive adults diagnosed with Takotsubo syndrome at a tertiary center between 2011 and 2024. Patients with pre-existing cardiomyopathy or heart failure with reduced ejection fraction were excluded. Clinical, electrocardiographic, echocardiographic, and laboratory data, as well as in-hospital outcomes, were analyzed. Early left ventricular recovery was defined as achieving an ejection fraction ≥50% at discharge. Associations with recovery and major in-hospital complications were evaluated using univariate and exploratory multivariable analyses. RESULTS: A total of 189 patients were included (median age 69 years; 99% women). ST-segment elevation was present in 32%, and QTc prolongation exceeding 20% from baseline occurred in 18%. Median ejection fraction improved from 35% (IQR 30-45%) on admission to 45% (IQR 35-60%) at discharge (p < 0.01). Moderate-to-severe mitral regurgitation declined from 5.8% to 1.6% by discharge. Early left ventricular recovery during hospitalization was observed in only 31% of patients. Shorter QT and PR intervals at discharge were associated with concurrent myocardial recovery. In-hospital arrhythmias occurred in 12%, vasopressor use in 21%, and mechanical support in 1%. Mortality was 2.6% in-hospital and 4.9% at one year. Older age, higher admission troponin levels, prolonged QTc interval, and lower admission LVEF were independently associated with major in-hospital complications. CONCLUSIONS: Takotsubo syndrome is associated with substantial early morbidity and incomplete in-hospital recovery in most patients. These findings reinforce the concept that recovery may be incomplete during the early in-hospital phase and highlight the need for closer monitoring and early risk stratification during the acute phase.
BACKGROUND: Adverse left ventricular (LV) remodelling is associated with increased mortality and heart failure following ST-segment elevation myocardial infarction (STEMI). Prior studies on the prognostic value of LV glo...BACKGROUND: Adverse left ventricular (LV) remodelling is associated with increased mortality and heart failure following ST-segment elevation myocardial infarction (STEMI). Prior studies on the prognostic value of LV global longitudinal strain (GLS), left atrial (LA) strain, and left atrioventricular coupling index (LACI) are promising, but it remains unclear which CMR-derived functional parameter is optimal. This study aimed to investigate the prognostic significance of atrial and ventricular function parameters to predict early adverse LV remodelling in patients with anterior STEMI. METHODS AND RESULTS: A post-hoc analysis of the EURO-ICE trial was performed, including 200 patients with anterior wall STEMI who underwent cardiovascular magnetic resonance (CMR) at baseline and 3-month follow-up. Predictors of adverse LV remodelling were identified. LV GLS was the strongest predictor, respectively odds ratio (OR) 1.162; 95% confidence interval (CI) 1.060-1.274; p = 0.001 and OR 1.155; 95% CI 1.007-1.326; p = 0.040. Its significance remained after adjusting for clinical risk factors (OR 1.216; 95% CI 1.096-1.349; p < 0.001), but not after adjusting for infarct size and microvascular obstruction (MVO) (OR 1.063; 95% CI 0.959-1.178; p = 0.246). LA strain and LACI did not have additional prognostic value. CONCLUSIONS: CMR-derived LV GLS is the strongest functional parameter associated with adverse LV remodelling anterior STEMI patients, remaining significant after adjusting for clinical risk factors, but not beyond infarct size and MVO, indicating that its prognostic value is largely mediated by myocardial injury burden. No significant association was found between LA strain or LACI and adverse LV remodelling. LV GLS may add value when contrast agents cannot be used.
The success of congenital heart surgery and care has created a rapidly expanding population of adults with congenital heart disease. Many individuals who underwent atrial switch procedures for transposition of the great...The success of congenital heart surgery and care has created a rapidly expanding population of adults with congenital heart disease. Many individuals who underwent atrial switch procedures for transposition of the great arteries in infancy have now reached middle adulthood, where excellent early surgical outcomes contrast with the long-term vulnerability of a systemic right ventricle. This article draws on a unique longitudinal narrative centred on an individual first documented as a newborn with transposition of the great arteries in a remarkable 1976 medical documentary. Now followed in adulthood at the same tertiary ACHD centre, his life course illustrates the evolving clinical challenges faced by this generation of patients, including arrhythmia, systemic right ventricular dysfunction, and heart failure. Using this rare historical perspective, we highlight how modifiable lifestyle and psychosocial factors interact with congenital physiology to influence long-term outcomes, and argue for a model of lifelong ACHD care that extends beyond anatomical repair to sustained lifestyle support and prevention.
BACKGROUND: The surrogacy of modern composite endpoints for cardiovascular and all-cause mortality is unknown. METHODS: We reviewed all primary publications of RCTs for non-acute atherosclerotic cardiovascular disease ut...BACKGROUND: The surrogacy of modern composite endpoints for cardiovascular and all-cause mortality is unknown. METHODS: We reviewed all primary publications of RCTs for non-acute atherosclerotic cardiovascular disease utilizing composite endpoints published 2019-2023 in first tier journals, and included all trials utilizing composite outcomes of ≥3 components. Trial-level surrogacy of outcomes was assessed using the R coefficient of determination, with a threshold for validating surrogacy at R = 0.8. RESULTS: Forty-five (n = 45) RCTs met the inclusion criteria, of which 19 (42%) tested secondary prevention strategies. The median sample size was 6033 (Q1-Q3, 3684-11,287), median patient age was 64 (Q1-Q3, 62-67), and most participants were males (69%, Q1-Q3 55%-74%). Half (n = 22, 49%) of the RCTs were funded by industry sponsors and the remainder by government agencies. None of the components of the published composite endpoints reached the pre-specified threshold of 0.8 for surrogacy for all-cause mortality. The correlation coefficient for cardiovascular death was 0.54 (95% CI: 0.36-0.72); other correlation coefficients were notably lower. Similar lack of correlation was observed between cardiovascular death and MI, stroke, unstable angina, revascularization and HF. CONCLUSIONS: Large ASCVD RCTs published in high-impact journals use composite endpoints components that do not correlate with patient prognosis. Journal editors, regulators and healthcare professionals should demand clinical trials provide evidence that is better aligned with patient outcomes to improve informed decision making for cardiovascular patients.
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42179977
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Atherosclerosis is a complex chronic inflammatory disease that affects the larger arteries. Early atherogenesis involves a group of pathological processes including endothelial activation and dysfunction, lipoprotein tra...Atherosclerosis is a complex chronic inflammatory disease that affects the larger arteries. Early atherogenesis involves a group of pathological processes including endothelial activation and dysfunction, lipoprotein transcytosis and modification, monocyte recruitment and transmigration, and foam cell formation, culminating in fatty streak formation. These processes are mediated by numerous molecules, which could be considered potential diagnostic and therapeutic targets. Atherogenic processes are also driven by several risk factors, including the demographic factors age and sex; family history; dyslipidemia and related chronic lifestyle diseases; unhealthy behaviors related to exercise, diet, alcohol intake, smoking, and sleep; microbial activity; air pollution; and disturbed hemodynamics including low or oscillatory wall shear stress. However, despite our growing knowledge of atherogenesis, the etiology of atherosclerosis remains unsettled. This review first describes early atherogenic processes and their key mediators. The complexity of atherogenesis is then briefly explored to illustrate the uncertainties surrounding the initiation of atherogenesis, including the complex relationships between the evidence-based risk factors identified and atherogenic processes. Finally, the etiology of this important pathology is explored by applying established criteria for causation, including temporality, strength of association, plausibility, and experimental evidence, to the identified risk factors. The review concludes that of all the evidence-based risk factors identified, disturbed wall shear stress is the only one that approximates the criteria for causation, and ends with an overview of the implications.
Eini P, Eini P, Serpoush H
… +2 more, Rezayee M, Tremblay J
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42179976
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BACKGROUND: MicroRNAs (miRNAs) are critical regulators of vascular biology and have been implicated in the pathogenesis of abdominal aortic aneurysm (AAA). However, the diversity of study designs and heterogeneous findin...BACKGROUND: MicroRNAs (miRNAs) are critical regulators of vascular biology and have been implicated in the pathogenesis of abdominal aortic aneurysm (AAA). However, the diversity of study designs and heterogeneous findings has limited their clinical translation. This study aimed to systematically review available evidence on miRNA expression in AAA, both in aortic tissue and circulating blood, and to explore their potential regulatory pathways. METHODS: We conducted a comprehensive literature search across five databases -PubMed, Scopus, Embase, Web of Science (WoS), and EBSCO - up to June 2025, following the PRISMA guidelines. Eligible studies included those reporting differential miRNA expression in human AAA samples, whether tissue or blood, with validated results. Data on expression direction, sample type, pathways, and target genes were extracted and synthesized. RESULTS: A total of 39 studies were included reported diagnostic performance varied substantially across studies. Circulating miRNAs in AAA patients exhibited distinct dysregulation patterns, reflecting disease-associated vascular and inflammatory processes. Key Up-regulated miRNAs included miR-21, miR-146a, miR-155, miR-1281, and miR-34a, while prominent Down-regulated candidates comprised miR-15a, miR-29, miR-150-5p, miR-27a-3p, and let-7 family members. These alterations were observed in plasma, serum, and specific cell types, suggesting possible utility as non-invasive biomarker candidates for AAA detection and disease monitoring, although external validation remains limited. CONCLUSION: Our systematic review highlights a panel of consistently dysregulated miRNAs in AAA, with roles in inflammation, extracellular matrix remodeling, and vascular cell regulation, and they may represent promising candidates for future screening and diagnostic evaluation, pending standardization and prospective validation.
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42179975
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BACKGROUND: Systemic metabolic and inflammatory disturbances play a critical role in the pathogenesis and prognosis of heart failure (HF). However, it remains uncertain whether these processes consistently predict mortal...BACKGROUND: Systemic metabolic and inflammatory disturbances play a critical role in the pathogenesis and prognosis of heart failure (HF). However, it remains uncertain whether these processes consistently predict mortality across both population-based and critical-care settings. METHODS: This study integrated data from the National Health and Nutrition Examination Survey (NHANES) and the eICU Collaborative Research Database to independently derive and examine the construct-level consistency of a Metabolic-Inflammatory Burden (MIB) index. MIB was independently derived in each cohort using principal component analysis (PCA) of available standardized metabolic and inflammatory biomarkers. Cox proportional-hazards regression was applied in the NHANES cohort (outcome: all-cause mortality), and logistic regression with XGBoost in the eICU cohort (outcome: 28-day mortality). To assess incremental prognostic value beyond ICU severity scores, nested model comparisons were performed. Cross-database construct-level integration was conducted to examine the directional consistency of MIB-mortality associations. RESULTS: In the NHANES cohort (n = 29,400), individuals with HF exhibited less favorable metabolic-inflammatory profiles and higher mortality compared to those without HF (all p < 0.001). Higher MIB was independently associated with increased all-cause mortality. In the eICU cohort (n = 12,946), non-survivors showed similar metabolic-inflammatory elevations. XGBoost achieved the best performance in mortality prediction (AUC = 0.883), with SHAP analysis identifying acute severity scores and metabolic-inflammatory parameters as key contributors. Cross-database integration revealed consistent positive directional associations between MIB and mortality across both settings (NHANES: HR = 1.03, 95% CI: 1.00-1.05; eICU: OR = 1.32, 95% CI: 1.16-1.40), supporting construct-level coherence of the MIB framework. CONCLUSIONS: Elevated metabolic-inflammatory burden (MIB) consistently predicts mortality in both population and critical-care HF cohorts. The consistent directional associations across heterogeneous clinical databases underscore a shared metabolic-inflammatory axis linking chronic metabolic stress with acute deterioration, supporting the prognostic relevance of MIB in diverse HF populations.
Esser R, Harboun M, Ben Ghezala W
… +7 more, Mondragon A, Larbaneix M, Farges C, Esteban M, Nisse-Durgeat S, Palermo V, Maurou O
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42179445
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Heart failure in older adults increasingly occurs in the context of frailty, multimorbidity, and declining physiological reserve. In this population, therapeutic efficacy demonstrated in selected clinical trial populatio...Heart failure in older adults increasingly occurs in the context of frailty, multimorbidity, and declining physiological reserve. In this population, therapeutic efficacy demonstrated in selected clinical trial populations does not automatically translate into meaningful clinical benefit. This discrepancy may create tension between guideline-driven care and goal-concordant prescribing. This narrative review proposes a conceptual framework to distinguish therapeutic efficacy from clinical relevance in ageing heart failure populations. Using tafamidis for transthyretin cardiac amyloidosis and apixaban for atrial fibrillation as illustrative paradigms, we examine how frailty severity, competing risks, life expectancy, and therapy-specific time-to-benefit influence the likelihood that a treatment will provide meaningful benefit for an individual patient. Disease-modifying therapies with delayed benefit may lose proportionality when lag-time-to-benefit exceeds the patient's anticipated window of preserved survival or functional autonomy. In contrast, preventive strategies that rapidly reduce autonomy-threatening events may retain broader clinical relevance across vulnerability strata, although individualized reassessment remains essential. We introduce the concept of temporal therapeutic mismatch, defined as a situation in which expected therapeutic benefit occurs beyond the patient's remaining functional trajectory or life expectancy. A pragmatic framework integrating frailty severity, estimated life expectancy, competing risks, therapy-specific time-to-benefit, and patient-defined goals is proposed to support proportional prescribing. In ageing cardiovascular populations, high-quality care requires moving beyond efficacy alone toward frailty-informed clinical relevance. Structured reassessment-including consideration of non-initiation or deprescribing when appropriate-represents a key component of patient-centered cardiovascular care.
BACKGROUND: Despite major advances in the acute management of ST-segment elevation myocardial infarction (STEMI), long-term outcomes remain suboptimal, largely due to persistent gaps in secondary prevention. The IMPACS s...BACKGROUND: Despite major advances in the acute management of ST-segment elevation myocardial infarction (STEMI), long-term outcomes remain suboptimal, largely due to persistent gaps in secondary prevention. The IMPACS study was designed to evaluate a standardized, intensified outpatient management strategy during the first year following STEMI. METHODS: IMPACS is a national, prospective, multicentre study comparing an intensified outpatient disease-management program with standard care. Consecutive STEMI patients were enrolled at four PCI centres. The intervention includes four structured outpatient visits within one year of discharge, focusing on clinical assessment, pharmacotherapy optimisation, and comprehensive risk-factor management. The primary endpoint is a composite of all-cause mortality and cardiovascular hospitalisations, compared with matched administrative-data controls from the six remaining PCI centres nationwide. RESULTS: A total of 1031 patients were included. The mean age was 62 years, and 75% were male. Primary PCI was performed in 96% of patients. Anterior-wall STEMI occurred in 43%, and 6% presented with advanced Killip class (III or IV). The median left ventricular ejection fraction was 45%. Cardiovascular risk factors were highly prevalent: hypertension in 73%, high LDL-C in 75%, diabetes mellitus in 23%, and current smoking in 49%. Prescription of guideline-directed medical therapy at discharge was high, with dual antiplatelet therapy in 95% and statins in 99% of patients. CONCLUSION: IMPACS represents a novel approach to post-ACS care. Baseline findings indicate a relatively young STEMI population with a high burden of cardiovascular risk factors, supporting the need for intensified secondary prevention strategies. Ongoing follow-up will determine its impact on long-term clinical outcomes.
BACKGROUND: Microvascular injury (MVI), commonly assessed on cardiac magnetic resonance (CMR) as microvascular obstruction (MVO), is frequently observed in patients with ST-elevation myocardial infarction (STEMI) despite...BACKGROUND: Microvascular injury (MVI), commonly assessed on cardiac magnetic resonance (CMR) as microvascular obstruction (MVO), is frequently observed in patients with ST-elevation myocardial infarction (STEMI) despite timely primary percutaneous coronary intervention (PPCI), and is key to adverse left ventricular (LV) remodelling and poor outcomes. Established invasive indices, such as the index of microvascular resistance (IMR), are obtained after reperfusion and therefore do not capture microvascular compromise present during coronary occlusion. Coronary wedge pressure (CWP), obtained during balloon occlusion, is a simple invasive marker of microvascular function, but its clinical value remains uncertain. OBJECTIVES: To determine whether pre-reperfusion CWP, coronary flow pressure index (CFPI) and related pressure-derived indices are associated with (i) the presence of CMR-defined MVO and (ii) MVO extent in anterior STEMI patients treated with selective intracoronary hypothermia (SIH). Secondary objectives were associations with intramyocardial haemorrhage (IMH) and myocardial salvage index (MSI). METHODS: In this EUROICE substudy, distal coronary pressure was recorded during culprit LAD occlusion in patients randomised to selective intracoronary hypothermia. Systolic, diastolic and mean CWP, CFPI and outflow time (τ) were derived. CMR at 2-7 days quantified MVO, intramyocardial haemorrhage (IMH) and myocardial salvage index (MSI). Associations were analysed using Spearman correlation, parsimonious multivariable logistic regression, and receiver operating characteristic analysis. RESULTS: Of 94 patients randomised to selective intracoronary hypothermia, 82 had paired pre-reperfusion physiology and CMR data available, of whom 65 had interpretable coronary pressure traces. Mean wedge pressure was 21.4 ± 11.0 mmHg, CFPI 0.24 ± 0.11, and τ 5.2 ± 2.6 s. MVO was present in 64% of patients (mean extent 2.7 ± 4.6% of LV mass). Lower CWP and CFPI were associated with MVO presence and extent (CFPI ρ = -0.33, p = 0.008), whereas τ was not. Lower CWP and CFPI were inversely related to IMH, but not to MSI. In complete-case multivariable models, lower CFPI remained associated with MVO presence (adjusted OR 0.91 per 0.01 increase, 95% CI 0.86-0.97, p = 0.002), as did lower mean CWP (adjusted OR 0.91 per 1 mmHg increase, 95% CI 0.85-0.97, p = 0.003). CFPI showed moderate discrimination for MVO, with an AUC of 0.74 (95% CI 0.61-0.87), while mean CWP showed similar discrimination, with an AUC of 0.74 (95% CI 0.61-0.86). CONCLUSIONS: Lower CWP before reperfusion and CFPI during balloon occlusion were associated with greater MVO and IMH on early CMR in anterior STEMI. These indices support the feasibility of pre-reperfusion physiological phenotyping to aid on-table microvascular risk stratification.