BACKGROUND: Proximal left anterior descending (LAD) artery disease is associated with adverse clinical outcomes. Ostial proximal LAD (O-pLAD) lesions represent a technically challenging subset, yet data comparing outcome...BACKGROUND: Proximal left anterior descending (LAD) artery disease is associated with adverse clinical outcomes. Ostial proximal LAD (O-pLAD) lesions represent a technically challenging subset, yet data comparing outcomes with non-ostial proximal LAD (NO-pLAD) lesions are limited. This study aimed to compare 2-year clinical outcomes following percutaneous coronary intervention (PCI) for O-pLAD versus NO-pLAD lesions. METHODS: We conducted a single-center retrospective cohort study including patients who underwent PCI of a significant proximal LAD lesion between June 2017 and September 2023. O-pLAD stenosis was defined as ≥70% diameter stenosis within 5 mm of the LAD ostium; NO-pLAD lesions were defined as ≥70% stenosis distal to this segment and proximal to the first major septal or diagonal branch. The primary endpoint was target lesion failure (TLF), a composite of target lesion revascularization (TLR), target vessel myocardial infarction, and cardiac death, assessed at a maximum follow-up of 730 days. Multivariable Cox regression was performed to adjust for relevant clinical and procedural confounders. RESULTS: A total of 1229 patients were included (522 O-pLAD, 707 NO-pLAD). Patients with O-pLAD lesions were older and had more multivessel disease and lesion calcification. At median follow-up of 730 days, TLF occurred more frequently in the O-pLAD group than in the NO-pLAD group (14.6% vs. 7.9%). NO-pLAD lesions were associated with significantly lower TLF after IPTW weighted analyis. TLR was significantly lower in the NO-pLAD group and remained so after adjustment. No significant differences were observed in cardiac death, target-vessel myocardial infarction, or major adverse cardiovascular events. CONCLUSIONS: Compared with ostial proximal LAD lesions, non-ostial proximal LAD stenting is associated with lower rates of target lesion failure and target lesion revascularization at 2 years. Ostial involvement may be an important consideration when selecting revascularization strategies for proximal LAD disease.
Arai M, Suzuki S, Hirota N
… +16 more, Motogi J, Takayanagi T, Umemoto T, Nakai H, Arita T, Yagi N, Kishi M, Kano H, Matsuno S, Kato Y, Otsuka T, Yajima J, Uejima T, Okumura Y, Oikawa Y, Yamashita T
AIMS: A low estimated glomerular filtration rate (eGFR) is the primary diagnostic criterion for chronic kidney disease (CKD), a known risk factor for cardiovascular disease (CVD). Artificial intelligence-enhanced electro...AIMS: A low estimated glomerular filtration rate (eGFR) is the primary diagnostic criterion for chronic kidney disease (CKD), a known risk factor for cardiovascular disease (CVD). Artificial intelligence-enhanced electrocardiography (AI-ECG) has demonstrated high diagnostic performance for CKD. However, it remains unclear whether the diagnostic probability derived from AI-ECG for CKD (AIECG-CKD-DP) can also predict future cardiovascular events. METHODS AND RESULTS: We analysed data from 16,984 patients in the Shinken Database who underwent AI-ECG and were followed up. Based on their baseline AIECG-CKD-DP, they were divided into two groups, Low-DP (<0.6, n = 10,031) and High-DP (≥0.6, n = 6953) groups, and we compared their clinical characteristics and the incidence of cardiovascular events. Patients in the High-DP group were more likely to be male (65.4% vs. 62.4%), older (69.1 vs. 55.2 years), and had lower eGFR (60.5 vs. 74.5 mL/min/1.73m). AIECG-CKD-DP inversely correlated with eGFR (r = -0.461, P < 0.001). During the follow-up period, 894 cardiovascular events were recorded. The incidences of cardiovascular events were 1.14% and 4.73% per year for the Low-DP and High-DP groups, respectively. Multivariable Cox regression analysis generated hazard ratios (HRs) for the High-DP and Low-DP groups of 1.802 (95% confidence interval (CI), 1.512-2.148) and 1.292 (95% CI, 1.114-1.499) for CKD, respectively. When analysed as continuous variables, the HRs per standard deviation were 1.523 (95% CI, 1.368-1.695) for AIECG-CKD-DP and 0.979 (95% CI, 0.910-1.052) for eGFR. CONCLUSION: AIECG-CKD-DP is independently associated with future cardiovascular events and outperforms eGFR and CKD classification as a predictor in a specialist cardiovascular cohort.
Ski CF, Thompson DR, Jennings CS
… +35 more, Kotseva K, McEvoy JW, De Backer G, Erlund I, Ganly S, Vihervaara T, Lip GYH, Ray KK, Rydén L, Adamska A, Abreu A, Almahmeed W, Ambari AM, Ge J, Hasan-Ali H, Huo Y, Jankowski P, Jimenez RM, Li Y, Zuhdi ASM, Makubi A, Mbakwem AC, Mbau L, Estrada JLN, Ogah OS, Ogola EN, Quintero-Baiz A, Sani MU, Liprandi MIS, Tan JWC, Triana MAU, Yeo TJ, Wood DA, De Bacquer D, INTERASPIRE Investigators
Int J Cardiol
· 2026 Oct · PMID 42167412
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BACKGROUND: Optimizing health-related quality of life (HRQoL) is a goal of preventive and therapeutic cardiovascular care worldwide, yet sex disparities in HRQoL remain insufficiently explored at a population level. The...BACKGROUND: Optimizing health-related quality of life (HRQoL) is a goal of preventive and therapeutic cardiovascular care worldwide, yet sex disparities in HRQoL remain insufficiently explored at a population level. The objective of this study was to examine sex differences in HRQoL in relation to secondary prevention in patients with CHD across all six World Health Organization regions. METHODS: Cross-sectional analysis of the INTERASPIRE study of adults hospitalized in the preceding six to 24 months with CHD who underwent standardized interview and examination across 14 countries. Endpoints were HRQoL (EQ-5D-5L; HeartQoL), and an INTERASPIRE-Guideline Target Score (GTS); a 10-point assessment of achieving secondary prevention lifestyle, risk factor, and therapeutic targets. Analyses were adjusted for age and country-level clustering. RESULTS: A total of 4546 patients (21.1% women) were interviewed. Compared to men, women had lower HRQoL across all assessments (p < 0.001) e.g., mean HeartQoL global score 2.1 vs 2.6; EQ-5D-5L self-care 17.8% vs 9.2%, and usual activities 39.1% vs 22.4%. Positive correlations (p < 0.001) were identified between HRQoL and INTERASPIRE-GTS. Female sex was independently associated with poor HRQoL (p < 0.001), either expressed by EQ-5D-5L index score or the HeartQoL overall and subscale scores. CONCLUSIONS: Female sex was independently associated with poorer HRQoL in patients with CHD. Higher HRQoL was associated with ability to achieve secondary prevention guideline targets. Routine integration of HRQoL assessment into secondary prevention programs can inform individualized clinical care and assist in reducing sex-based disparities in cardiovascular outcomes.
Cartledge S, Lucas M, Dinh D
… +12 more, Brennan A, Lefkovits J, Gauci S, Thomas EE, Miranda PC, Livori A, Gallagher R, O'Neil A, Redfern J, Reid CM, Driscoll A, Stub D
BACKGROUND: Cardiac rehabilitation is a key component of secondary prevention following percutaneous coronary intervention (PCI), yet participation remains suboptimal. Linked health datasets offer an opportunity to bette...BACKGROUND: Cardiac rehabilitation is a key component of secondary prevention following percutaneous coronary intervention (PCI), yet participation remains suboptimal. Linked health datasets offer an opportunity to better understand attendance patterns and associated outcomes across the care continuum. METHODS: A retrospective, observational cohort study was conducted using linked health data from 13 public hospitals between 2019 and 2021. Cardiac rehabilitation attendance was defined as participation in ≥1 session. Predictors of cardiac rehabilitation attendance and 12-month outcomes were assessed. A dose-response analysis was also performed, categorizing participants by cardiac rehabilitation session frequency as non-attenders, low attendance (1-5 sessions) and high attendance (≥6 sessions). RESULTS: Adults undergoing PCI (n = 37,191) were identified, of whom 7126 were successfully linked to the Victorian Integrated Non-Admitted Health (VINAH) dataset. Cardiac rehabilitation attendance was observed in 19.3% of the cohort. Key predictors of attendance were STEMI (OR 1.59, 95% CI 1.32-1.93), NSTEMI (OR 1.24, 95% CI 1.05-1.46), rural/regional program location (OR 1.48, 95% CI 1.25-1.75), and length of stay >3 days (OR 1.04, 95% CI 1.02-1.07). At 12 months, cardiac rehabilitation attendees had lower mortality (1.0% vs 4.9%, p < 0.001) and fewer unplanned readmissions (p = 0.038). A dose-response relationship was found for 12-month mortality. A dose-response relationship was evident for mortality, with lowest rates among high-attendance participants (0.6%), compared with low-attendance (1.5%) and non-attenders (2.9%) (p < 0.001). CONCLUSIONS: Linking Victorian datasets is feasible and provides valuable insights. Cardiac rehabilitation attendance is low, yet participation, particularly at higher doses, is associated with significantly improved outcomes.
BACKGROUND AND AIMS: The timing of aortic valve replacement (AVR) in severe asymptomatic aortic stenosis (AS) remains debated. Preserved ejection fraction (EF) may mask subclinical dysfunction, while global longitudinal...BACKGROUND AND AIMS: The timing of aortic valve replacement (AVR) in severe asymptomatic aortic stenosis (AS) remains debated. Preserved ejection fraction (EF) may mask subclinical dysfunction, while global longitudinal strain (GLS), brain natriuretic peptide (BNP), and diastolic indices (E/E') provide complementary prognostic information. A predictive model for adverse outcomes after AVR integrating GLS, BNP, and E/E' has not been previously investigated. METHODS: Ninety-six patients with severe asymptomatic AS and preserved EF (>50%) undergoing AVR were assessed at baseline and 1, 3, and 6 months. Echocardiography (GLS, EF, LVMI, IVSd, LVIDd, E/E'), BNP, and clinical outcomes were analyzed. Primary endpoint was LV remodeling; secondary endpoint was major adverse cardiovascular events (MACE). RESULTS: Despite preserved EF, 76% had impaired GLS (<15%), and 64% remained in negative remodeling at 6 months. Baseline GLS ≤15% was the only independent predictor of adverse remodeling in multivariable logistic regression (OR 4.7 at 3 months; OR 3.5 at 6 months). For MACE, baseline E/E' >13 was the strongest independent predictor (OR 3.15, 95% CI 1.58-7.57, p = 0.004). The integrated GLS-BNP-E/E' model demonstrated superior predictive strength compared with individual parameters, with Nagelkerke R values of 0.41 for remodeling and 0.31 for MACE. CONCLUSION: A multimodal risk model integrating GLS, BNP, and E/E' predicts adverse remodeling and MACE in severe asymptomatic AS. These findings highlight the complementary role of imaging and biomarkers in risk stratification before AVR-a concept that warrants confirmation in future multicenter studies.
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a common cardiac disease clinically-recognized worldwide; however, limited information is available concerning the demographic profile and significance of its evolving pee...BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a common cardiac disease clinically-recognized worldwide; however, limited information is available concerning the demographic profile and significance of its evolving peer-reviewed literature. OBJECTIVES: Assess the global distribution and characteristics of the HCM-related literature from 1960 to 2024 . METHODS: Publications describing HCM were retrieved from the National Library of Medicine via PubMed from 1960 to 2025. Changes in publication counts across the 66 years were quantified. Additionally, trends were stratified by country of origin and geographic region. RESULTS: The number of HCM publications increased significantly over time (P < 0.001), from 59 in 1960-1965 to 6454 in 2020-2025, a 109-fold increase that notably exceeded the increase in overall cardiovascular publications during the same time-period. The number of countries from which papers originated also increased significantly (P < 0.001), from 11 in 1960-1965 to 78 in 2020-2025, a 7-fold increase. Overall, the largest contributor was the U.S. (n = 5513 publications comprising 30% of the literature), followed by China (n = 1819, 10%), Japan (n = 1729, 9%), Italy (n = 1302, 7%), and United Kingdom (n = 1194, 7%). Notably, publications from China increased by 203-fold from 1960 to 2000 to 2020-2025, with Asia becoming the predominant continent in 2025. Fifty-percent of publications from countries contributing only >2010 were not original investigations, and none appeared in high-impact journals. CONCLUSIONS: While the US has remained the largest contributor of HCM-related publications >65 years, the peer-reviewed literature has become increasingly diverse, now including almost 100 countries globally and an increasingly substantial proportion from China and the Asian continent. This evolving profile has allowed for enhanced understanding of HCM and its particularly broad clinical spectrum, likely improving care for patients with this disease worldwide. However, sparse data from several populous regions constitute an unmet need in HCM.
BACKGROUND: Heart failure with preserved ejection fraction is common, obesity-related, and associated with high symptom burden and healthcare use. Tirzepatide, a dual GIP/GLP-1 receptor agonist, improved symptoms and out...BACKGROUND: Heart failure with preserved ejection fraction is common, obesity-related, and associated with high symptom burden and healthcare use. Tirzepatide, a dual GIP/GLP-1 receptor agonist, improved symptoms and outcomes in SUMMIT, but its acquisition cost raises concerns about value and affordability. METHODS: We developed a Markov model comparing tirzepatide versus placebo, both added to standard care, in the SUMMIT population from the German statutory health insurance perspective. The model used monthly cycles over 5 years with four Kansas City Cardiomyopathy Questionnaire clinical summary score-defined health states (Q1-Q4) plus death. Arm-specific transitions and rates of all-cause death and worsening heart failure were derived from SUMMIT. Deterministic and probabilistic sensitivity analyses, including tirzepatide price-reduction scenarios, were conducted to explore parameter uncertainty and price thresholds simultaneously. A prevalence-based budget impact analysis extrapolated results to the German HFpEF-obesity population under alternative eligibility (SUMMIT-like vs broad) and uptake (30%, 50%, 100%) scenarios. RESULTS: Discounted per-patient costs were €5827 (placebo) and €31,052 (tirzepatide), with quality-adjusted life years of 3.539 and 3.638. Tirzepatide generated 0.100 additional quality-adjusted life years at an incremental cost of €25,225, yielding an incremental cost-effectiveness ratio of 252,611€/quality-adjusted life year, with low probability of cost-effectiveness at €100,000/QALY. Five-year incremental spending was ∼€1.9-6.2 billion with SUMMIT-like and ∼ €3.8-12.6 billion with broad eligibility, depending on uptake. CONCLUSIONS: Tirzepatide provides modest quality-adjusted life year gains at substantially higher costs and, at current price, appears neither cost-effective nor affordable at scale in German care. Substantial price reductions would be required to improve economic attractiveness and budgetary impact.
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) reduce sudden cardiac death in selected populations. However, their long-term prognosis may differ according to the underlying cardiomyopathy. We aimed to evalua...BACKGROUND: Implantable cardioverter-defibrillators (ICDs) reduce sudden cardiac death in selected populations. However, their long-term prognosis may differ according to the underlying cardiomyopathy. We aimed to evaluate long-term survival after ICD implantation according to cardiomyopathy etiology and to contextualize outcomes relative to the expected survival of the general population. METHODS: This retrospective cohort included 1091 consecutive adults who underwent ICD implantation at the regional referral center in Asturias, Spain, between 2015 and 2024. Patients were classified as ischemic cardiomyopathy (ICM, n = 588), non-ischemic dilated cardiomyopathy (NI-DCM, n = 332), or other arrhythmogenic cardiac conditions (ACC, n = 171), including hypertrophic cardiomyopathy (HCM). Observed survival was estimated using Kaplan-Meier methods. Expected survival was derived from national life tables matched by age, sex, calendar year, and region. Relative survival and excess mortality were calculated using the Ederer II method at 4, 8, and 12 years. Multivariable Cox regression analysis was performed to adjust for major clinical confounders. RESULTS: The cohort was predominantly male (82.1%), with a mean age of 63.1 ± 13.1 years and mean LVEF of 37.9 ± 19.3%. ICD implantation was performed for primary prevention in 75.6% of patients. ICM was the most frequent substrate (53.9%), followed by NI-DCM (30.4%) and ACC (15.7%). ICM patients showed the poorest prognosis, with excess mortality compared with the general population. NI-DCM demonstrated intermediate outcomes, whereas ACC showed survival trajectories closely approximating expected population survival. CONCLUSIONS: Long-term survival after ICD implantation differed according to cardiomyopathy etiology. These findings support an etiology-informed approach to risk stratification, patient selection, and long-term management beyond a purely LVEF-based strategy.
BACKGROUND: Red blood cell distribution width (RDW), a routine and inexpensive blood parameter, is widely available and may serve as a useful screening marker for heart failure (HF). This study aims to evaluate RDW's pre...BACKGROUND: Red blood cell distribution width (RDW), a routine and inexpensive blood parameter, is widely available and may serve as a useful screening marker for heart failure (HF). This study aims to evaluate RDW's predictive value for new-onset HF in the general population and examine its incremental predictive performance alongside NT-proBNP. METHODS: From a prospective population-based cohort, RDW and NT-proBNP were available for 5814 and 3393 individuals without prior HF, respectively. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Fully adjusted model included variables from the Pooled Cohort Equations (PCE): age, sex, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking, and antihypertensive medication use. Predictive improvement was assessed using the Δc-statistic. RESULTS: Over a median follow-up of 7 years, 433 individuals developed HF (incidence rate: 10.4 per 1000 person-years). Each 1% increase in RDW was associated with a 22% higher HF risk (HR 1.22, 95%CI, 1.12-1.32), and those in the highest RDW quartile had a 71% higher risk (HR 1.71, 95%CI, 1.29-2.25). NT-proBNP showed similar associations (HR 1.68, 95%CI, 1.40-2.01 per 1-unit increase). Adding RDW to the PCE model significantly improved predictive performance (Δc-statistic = 0.008), comparable to NT-proBNP (Δc-statistic = 0.014). CONCLUSIONS: RDW is a robust and accessible predictor of incident HF. Its predictive value, low costs, and routine availability highlight its potential as a useful biomarker for HF risk stratification in the general population. The design and findings are summarized in the graphical abstract.
INTRODUCTION: Cascade testing in gene-positive cardiomyopathy families facilitates the identification of relatives at risk of cardiomyopathy. Conventional clinical screening is often unremarkable, particularly in younger...INTRODUCTION: Cascade testing in gene-positive cardiomyopathy families facilitates the identification of relatives at risk of cardiomyopathy. Conventional clinical screening is often unremarkable, particularly in younger individuals. This study evaluated the potential role of cardiopulmonary exercise testing (CPET) in detecting subclinical disease among gene-positive phenotype-negative (G + P-) relatives. METHODS: In this single-centre case series, relatives of probands with likely/definite pathogenic cardiomyopathy variants underwent cascade testing. Gene-positive relatives underwent extensive phenotyping (ECG, echocardiography, holter monitor, cardiac MRI). Individuals with morpho-functional abnormalities suggestive of early cardiomyopathy and those fulfilling diagnostic criteria were excluded. Consecutively recruited (March 2017-December 2024) G + P- relatives underwent CPET ergometry. Those who completed a maximal test were included. A cardiac limitation was defined as VO2MAX <80% and/or ≥ 2 abnormal CPET variables. RESULTS: Twenty-two subjects were included (59.1% female, mean age of 32.1 ± 16.0 years). Most had a TTN (27.3%), ACTC1 (22.7%) and DSG2 (22.7%) variant. All subjects are under follow-up (42.4 ± 24.0 months). Nearly ¾ (72.7%) had evidence of cardiac limitation during CPET, irrespective of haemoglobin, creatinine and body mass index. More than a third (40.9%) had a reduced VO2MAX. Two thirds (59.1%) had abnormal stroke volume kinetics (O2/pulse). Nearly half (45.5%) had reduced ventilatory efficiency (VE/VCO2) and two thirds (63.6%) had reduced aerobic efficiency (VO2/WR). A fifth (22.7%) had ventricular arrhythmias at peak exercise. CONCLUSION: This is the first proof-of-concept study to demonstrate that CPET in cardiomyopathy families can identify a considerable proportion of G + P- relatives with early cardiac functional limitations. Long-term surveillance, and larger prospective studies are warranted to validate these findings.
Massalha E, Dakka A, Marai I
… +12 more, Michowitz Y, Glikson M, Konstantino Y, Haim M, Luria D, Omelchenko A, Laish-Farkash A, Suleiman M, Furer A, Nof E, Beinart R, Israeli Working Group on Pacing Electrophysiology
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42125252
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INTRODUCTION: Pulmonary hypertension (PH) is associated with an increased risk of atrial fibrillation (AF), and AF onset in PH may signal advanced disease. While catheter ablation (CA) offers clinical benefits, post-abla...INTRODUCTION: Pulmonary hypertension (PH) is associated with an increased risk of atrial fibrillation (AF), and AF onset in PH may signal advanced disease. While catheter ablation (CA) offers clinical benefits, post-ablation recurrence remains a challenge. We evaluated whether systolic pulmonary artery pressure (sPAP) predicts AF recurrence following pulmonary vein isolation (PVI). METHODS: Data from the prospective, multicenter Israeli Catheter Ablation Registry (ICAR) included 485 patients undergoing PVI between January 2019 and December 2021, all with echocardiographic sPAP measurements. Patients were stratified into two groups based on sPAP values: high-probability PH (sPAP > 45 mmHg) and low/intermediate probability PH (sPAP ≤ 45 mmHg). AF recurrence within 12 months was assessed, along with subgroup analyses and evaluation of procedural complications. RESULTS: Patients with high-probability PH were older (69.05 ± 8.75 vs. 64.34 ± 11.27 years; p < 0.01) and had more comorbidities. Cryoballoon ablation was utilized in 387 patients (79.8%). High-probability PH patients had significantly higher 12-month AF recurrence rates (30.4% vs. 17.2%; p = 0.029), despite similar acute procedural success and overall periprocedural complication rates. A Cox proportional hazards model identified sPAP > 45 mmHg as an independent predictor of recurrence (adjusted HR 2.55; p < 0.01), while spline analysis demonstrated a dose-dependent relationship between rising sPAP values and recurrence. CONCLUSION: This study emphasizes the importance of PH, evaluated through echocardiographic sPAP values, in predicting post-PVI AF recurrence. These findings support incorporating echocardiographic sPAP into pre-procedural risk assessment to guide customized post-ablation monitoring.
Chen R, Adi D, Keremu M
… +3 more, Ding SY, Ma YT, Li XL
Int J Cardiol Cardiovasc Risk Prev
· 2026 Sep · PMID 42124907
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OBJECTIVE: The study aimed to evaluate the prognostic value of 9 immune-inflammatory markers based on blood cell counts in patients with dilated cardiomyopathy (DCM). METHODS: A total of 953 DCM patients from the First A...OBJECTIVE: The study aimed to evaluate the prognostic value of 9 immune-inflammatory markers based on blood cell counts in patients with dilated cardiomyopathy (DCM). METHODS: A total of 953 DCM patients from the First Affiliated Hospital of Xinjiang Medical University from 2017 to 2021 were selected. Clinical data and test results were collected for retrospective analysis to assess the relationship between various combinations of inflammatory biomarkers derived from neutrophil count, lymphocyte count, monocyte count, and platelet count with the 3-year all-cause mortality risk of DCM. Logistic regression, receiver operating characteristic curve analysis (ROC), restricted cubic spline (RCS) curve analysis were used to evaluate the association between different inflammatory markers and survival outcomes. The net reclassification index (NRI) and integrated discrimination improvement (IDI) were employed to assess the enhancement of each inflammatory index on the Meta-Analysis Global Group in Chronic Heart Failure Risk Score (MAGGIC). RESULTS: A total of 105 patients (11.02%) with DCM experienced all-cause mortality within 3 years. Multivariate logistic regression analysis suggested that NM (OR: 1.18, 95% CI: 1.05 ∼ 1.33, P = 0.005), NP (OR: 1.01, 95% CI: 1.01 ∼ 1.01, P < 0.001), MP (OR: 1.01, 95% CI: 1.01 ∼ 1.01, P = 0.004), NLR (OR: 1.44, 95% CI: 1.29 ∼ 1.60, P < 0.001), MLR (OR: 14.58, 95% CI: 5.30 ∼ 40.09, P < 0.001), PLR (OR: 1.01, 95% CI: 1.01-1.02, P < 0.001), SIRI (OR: 1.46, 95% CI: 1.29 ∼ 1.66, P < 0.001) and SII (OR: 1.00, 95% CI: 1.00-1.00, P < 0.001), AIRI (OR: 1.01, 95% CI: 1.01 ∼ 1.01, P < 0.001) were important risk factors for all-cause mortality in DCM. NLR, PLR, SII, SIRI and AIRI showed good predictive capability (AUC all >0.70), and RCS curve analysis indicated an overall upward trend in mortality risk with increasing NLR, PLR, SII, SIRI, and AIRI (P < 0.05). Incorporating NLR, PLR, SIRI, SII, and AIRI into the MAGGIC score substantially enhanced its predictive capacity (P < 0.05), as evidenced by notable increases in NRI and IDI levels (P < 0.05). CONCLUSION: The immune-inflammation indices derived from blood cell counts were closely linked to the 3-year all-cause mortality risk in patients with DCM. The integration of MAGGIC with NLR, PLR, SIRI, SII, and AIRI provides a more precise prediction of DCM prognosis.
Sakamoto D, Matsuoka Y, Nakatani D
… +18 more, Okada K, Sunaga A, Mas HK, Sato T, Kitamura T, Tamaki S, Seo M, Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Yasumura Y, Yamada T, Ohtani T, Hikoso S, Sotomi Y, Sakata Y, OCVC-Heart Failure Investigators
BACKGROUND: In heart failure with preserved ejection fraction (HFpEF), the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and echocardiographic parameters and the influence of atrial fib...BACKGROUND: In heart failure with preserved ejection fraction (HFpEF), the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and echocardiographic parameters and the influence of atrial fibrillation (AF) on the relationship remain poorly understood. METHODS: This study analyzed data from the Prospective mUlticenteR obServational stUdy of patIenTs with HFpEF (PURSUIT HFpEF). Patients hospitalized for acute decompensated HF with a left ventricular ejection fraction (LVEF) ≥ 50% were included. The association between longitudinal NT-proBNP levels and echocardiographic parameters was assessed using linear mixed-effects models, with further stratification by AF status. RESULTS: Of 1238 enrolled patients (median age 83[77, 87] years; 551[45%] male), 617 patients with longitudinal NT-proBNP data available (407 without AF, 210 with AF) were analyzed. In patients without AF, even after covariates adjusted, NT-proBNP levels were positively associated with left ventricular diastolic diameter (β-coefficient: 1.878 ± 0.736, P < 0.001), left ventricular mass index (β-coefficient: 1.467 ± 0.280, P < 0.001), left atrial volume index (β-coefficient: 0.795 ± 0.232, P < 0.001), E/e' (β-coefficient: 1.041 ± 0.214, P < 0.001), and tricuspid regurgitation pressure gradient (TRPG) (β-coefficient: 0.849 ± 0.261, P < 0.001). Conversely, left ventricular ejection fraction was negatively associated (β-coefficient: -1.632 ± 0.607, P < 0.001). However, in patients with AF, most of these parameters except for E/e', TRPG, and interventricular septal thickness at end-diastole had no correlation with NT-proBNP levels. CONCLUSIONS: In HFpEF patients without AF, longitudinal NT-proBNP levels were broadly associated with both structural and functional echocardiographic parameters. Whereas, patients with AF showed limited associations. Notably, E/e' and TRPG remained associated with NT-proBNP irrespective of AF status. TRIAL REGISTRATION: UMIN-CTR ID: UMIN000021831.
BACKGROUND: Commercially available NT-proBNP assays can underestimate concentration as the detecting antibody binds to NT-proBNP glycosylated epitopes, thereby underestimating the total NT-proBNP, impairing diagnostic an...BACKGROUND: Commercially available NT-proBNP assays can underestimate concentration as the detecting antibody binds to NT-proBNP glycosylated epitopes, thereby underestimating the total NT-proBNP, impairing diagnostic and prognostic performance in heart failure (HF) patients. OBJECTIVES: To explore glycosylatated and unglycosylatated, total NT-proBNP (tNT-proBNP) research-assay and associations with clinical characteristics and outcomes compared to NT-proBNP in HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction. METHODS: In HFpEF (LVEF≥45%, NT-proBNP≥300 pg/ml) and HFrEF (LVEF<40%) patients tNT-proBNP and NT-proBNP were measured, associations with clinical characteristics and composite outcomes assessed and prognostic accuracy compared. RESULTS: Patients with HFpEF (n = 83) vs. patients with HFrEF (n = 82), were older (73 vs. 63 years) and more often female (51% vs. 18%). tNT-proBNP and NT-proBNP were lower in HFpEF 3830(1990;6482) and 1055(466;2344)pg/ml vs. HFrEF 10,468(4667;21,007) and 3196(1423;6967)pg/ml, all p < 0.001. There was a strong association between tNT-proBNP and NT-proBNP (HFpEF;β = 0.762;p < 0.001, HFrEF β = 0.819;p < 0.001). NT-proBNP/tNT-proBNP was lower in HFpEF vs. HFrEF (0.27 vs. 0.32;p = 0.019). Higher tNT-proBNP was independently associated with outcome in both HFpEF (HR 1.77 [95% CI 1.08-2.88];p = 0.022) and HFrEF (HR 1.94 [95% CI 1.36-2.76];p < 0.001). In the overall cohort AUROC was higher for tNT-proBNP (0.710) vs. NT-proBNP (0.682;p = 0.068) with similar trends in HFpEF and HFrEF. CONCLUSION: This first report of tNT-proBNP by LVEF categories displays similar associations with clinical characteristics and outcomes in HFpEF and HFrEF. Proportion of glycosylated NT-proBNP was higher in HFpEF vs HFrEF. tNT-proBNP trended to have superior prognostic ability regardless of LVEF and may be a superior risk marker especially in HF populations with high prevalence of glucose perturbations. CLINICAL TRIAL REGISTRATION: ClinicalTrials.govNCT00774709https://clinicaltrials.gov.