Rattka M, Wernhart S, Laugwitz KL
… +3 more, Halle M, Foulkes SJ, Haykowsky MJ
Int J Cardiol
· 2026 Aug · PMID 42086112
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BACKGROUND: While moderate-intensity endurance exercise is recommended in patients with and without dilated aorta, little is known about aortic physiology during isometric and resistance exercise. METHODS: We analyzed 18...BACKGROUND: While moderate-intensity endurance exercise is recommended in patients with and without dilated aorta, little is known about aortic physiology during isometric and resistance exercise. METHODS: We analyzed 18 individuals with arrhythmogenic cardiomyopathy (ACM) without valvular or aortic pathology (mean age: 43 ± 9 years). Patients underwent computer tomography of the aorta and invasive exercise right heart catheterization during moderate intensity endurance, isometric and resistance exercise: Isometric handgrip (HG) and bicep curl (BC) were performed for one minute at 70% of maximal voluntary contraction and compared to continuous supine cycle exercise at the first ventilatory threshold for twenty minutes. Circumferential ascending aortic wall stress (AWS) was calculated during these three exercise modalities using the Laplace Law incorporating resting diameter and thickness of the ascending aorta as well as systolic blood pressure values obtained at rest and during exercise. RESULTS: The mean aortic diameter and thickness were 29 ± 5 mm and 1.7 ± 0.3 mm. Systolic and diastolic blood pressure, heart rate, and AWS all significantly increased from rest across the three exercise modes. No difference in AWS was found between exercise modes. Diastolic blood pressure during cycle exercise was significantly lower than during isometric HG. Also, heart rate during cycle exercise was significantly higher than during both BC and isometric HG exercises. CONCLUSION: All exercise modes resulted in a similar increase in AWS in ACM patients. Although these findings appear to be reassuring, the long-term implications of chronic exposure to moderate-intensity resistance exercise remain to be determined.
Pesce F, Dini CS, Righini FM
… +7 more, Stefanini A, Ghionzoli N, Maielli M, Maccherini M, Bernazzali S, Cameli M, Valente S
Int J Cardiol
· 2026 Aug · PMID 42082006
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BACKGROUND: Cardiogenic shock (CS) is a life-threatening syndrome with persistently high mortality rates despite therapeutic advances. Structured regional networks may offer improved outcomes through standardized care an...BACKGROUND: Cardiogenic shock (CS) is a life-threatening syndrome with persistently high mortality rates despite therapeutic advances. Structured regional networks may offer improved outcomes through standardized care and early advanced support.This study evaluates the impact of a structured regional cardiogenic shock network on in-hospital mortality and clinical outcomes. METHODS: We conducted a prospective observational study at the University Siena Hospital, enrolling CS patients (SCAI stage C-D-E) between September 2020 and November 2024. The study population was divided into patients directly admitted to the shock center (hub group) and those initially admitted to a referring network hospital (spoke group). RESULTS: We enrolled 145 consecutive patients with CS (mean age 61.0 ± 14.2 years; 81.4% male), predominantly due to acute coronary syndrome (46.9%) or acute on chronic heart failure (32.4%). The majority (61.4%) were transferred from referring network regional hospitals. Despite a high-risk profile (SCAI stage D + E in 48.3%, phenotype II + III in 62.1%), 73.5% of patients achieved a successful outcome, defined as hospital discharge or cardiac replacement therapy (23 heart transplants, 9 LVADs). The overall in-hospital mortality was 26.5%. Mortality increased with SCAI stage (p = 0.001) according to literature data. A vaso-inotropic score (VIS score) major than 21 at 48 h after admission was predictive of mortality (AUC = 0.722). CONCLUSIONS: In this observational study CS population presented low in-hospital mortality rate without any difference in hub and spoke group. It may be determined by the benefits of a structured regional network for CS and multidisciplinary approach management with early MCS implantation.
Lombardi M, Chiabrando JG, Occhipinti G
… +11 more, Elia E, Laudani C, Garibaldi S, Audo A, Maj G, Vergallo R, Porto I, Gonzalo N, Escaned J, Patti G, Secco GG
Int J Cardiol
· 2026 Aug · PMID 42082005
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BACKGROUND: The comparative effectiveness of angiography-guided versus imaging-guided PCI relative to coronary artery bypass grafting (CABG) in left main coronary artery (LMCA) disease remains uncertain. METHODS: We perf...BACKGROUND: The comparative effectiveness of angiography-guided versus imaging-guided PCI relative to coronary artery bypass grafting (CABG) in left main coronary artery (LMCA) disease remains uncertain. METHODS: We performed a network meta-analysis of randomized controlled trials (RCTs) including patients undergoing LMCA revascularization. Pooled incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were computed. Co-primary endpoints were major adverse cardiovascular events (MACE) by trial definition and all-cause death. Secondary endpoints included myocardial infarction (MI), stroke, target vessel revascularization (TVR), repeat revascularization, and stent thrombosis or graft occlusion. RESULTS: Seventeen RCTs encompassing 7700 patients (median follow-up 2 years) were included. Angiography-guided PCI was associated with a higher risk of MACE compared with both imaging-guided PCI (IRR 1.34, 95%CI 1.05-1.72) and CABG (IRR 1.49, 95%CI 1.10-2.03). Compared with imaging-guided PCI, neither CABG (IRR 1.00 95%CI 0.81-1.24) nor angiography-guided PCI (IRR 1.04, 95%CI 0.77-1.40) differed in all-cause death. CABG was associated with a lower risk of MI, TVR and repeat revascularization, but at the expense of an increased stent thrombosis or graft occlusion. Angiography-guided PCI was associated with higher risks of TVR compared with imaging-guided PCI and a lower risk of stroke compared to both CABG and imaging-guidance. CONCLUSIONS: In patients with LMCA disease, no significant differences in MACE were observed between imaging-guided PCI and CABG, whereas angiography-guided PCI was associated with a higher risk of MACE compared either with imaging-guided PCI and CABG. PCI, regardless of guidance, achieved all-cause death comparable to surgery. Imaging guidance reduced stent thrombosis or graft occlusion, whereas CABG reduced MI and repeat revascularization. PROSPERO registration number: CRD420261283126.
Eini P, Houshmand G, Serpoush H
… +2 more, Rezayee M, Kassulke M
Int J Cardiol Cardiovasc Risk Prev
· 2026 Jun · PMID 42079359
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BACKGROUND: Accurate assessment of mitral regurgitation (MR) severity is crucial for guiding clinical management, but is often limited by the subjectivity and variability of traditional echocardiographic evaluations. Mac...BACKGROUND: Accurate assessment of mitral regurgitation (MR) severity is crucial for guiding clinical management, but is often limited by the subjectivity and variability of traditional echocardiographic evaluations. Machine learning (ML) models offer potential for automated, objective MR grading, yet their diagnostic performance remains underexplored. This systematic review and meta-analysis aim to evaluate the diagnostic accuracy of ML-based models for assessing MR severity. METHODS: We searched five different databases for studies evaluating ML algorithms (deep learning or traditional ML) for MR severity assessment in adults. Data were extracted and the risk of bias was assessed using the PROBAST + AI tool. A bivariate random-effects model was used to pool diagnostic metrics, with heterogeneity quantified via I statistics and explored through meta-regression and subgroup analyses. Publication bias was evaluated using Deeks' test and funnel plot. RESULTS: Nine studies met inclusion criteria, demonstrating strong ML performance with a pooled AUROC of 0.97 (95% CI: 0.96-0.98), sensitivity of 0.93 (95% CI: 0.83-0.97), and specificity of 0.96 (95% CI: 0.92-0.98). High heterogeneity (I > 70%) was observed, partly explained by variations in validation methods and sample size. No significant publication bias was detected (Deeks' p = 0.64). The certainty of the evidence was moderate due to heterogeneity and the retrospective study design. CONCLUSION: ML models demonstrate good diagnostic accuracy for assessing MR severity, with the potential to enhance clinical decision-making by reducing subjectivity. However, high heterogeneity and limited external validation necessitate prospective, standardized trials to ensure generalizability and clinical adoption.
Tabibian K, Chaturvedi A, Vadlakonda A
… +6 more, Balian J, Mahrokhi S, Tabibian D, Kwon OJ, Aguayo E, Benharash P
Int J Cardiol Congenit Heart Dis
· 2026 Jun · PMID 42078798
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BACKGROUND: Adults with Down syndrome (DS) have a greater likelihood of being diagnosed with congenital heart disease (CHD) and may face unique cardiovascular, respiratory, and immunologic health burdens during hospitali...BACKGROUND: Adults with Down syndrome (DS) have a greater likelihood of being diagnosed with congenital heart disease (CHD) and may face unique cardiovascular, respiratory, and immunologic health burdens during hospitalization. While CHD survival has improved in recent decades, national data on hospitalization outcomes of patients diagnosed with DS remain limited. OBJECTIVES: The present study aimed to evaluate trends in hospital admissions, inpatient management, and perioperative outcomes stratified by the presence of DS among CHD patients. METHODS: This was a retrospective cohort of the 2016-2022 National Inpatient Sample. All adult (18-64 years) hospitalizations with a diagnosis of congenital heart disease, were tabulated using previously validated International Classification of Diseases diagnosis codes. Our Primary outcome of interest was in-hospital mortality. Secondary endpoints included temporal trends in admissions, utilization of various cardiac procedures, and length of stay. RESULTS: Of an estimated 54,410 CHD patients hospitalized, 3745 (6.9%) had diagnosis of DS. During the study period, annual CHD admissions increased (nptrend<0.05), while the proportion of those with DS remained stable (6.6% to 6.2%, 2016-2022; nptrend = 0.23). Patients with DS more commonly presented as having hypothyroidism, dementia, chronic obstructive pulmonary disease (all P < 0.05) and less frequently underwent cardiac procedures (7.6 vs 23.2%, P < 0.001). Following risk-adjustment, the presence of DS remained independently associated with greater odds of mortality among all hospitalizations (AOR 2.00, 95%CI 1.40-2.88, P < 0.001). CONCLUSIONS: Adults with DS and CHD represent a clinically vulnerable population with higher in-hospital mortality and lower procedural utilization. These findings underscore the need for dedicated care pathways to improve outcomes during medical admissions.
Ali AE, Kholeif Z, Ahmed M
… +2 more, Saad S, Egbe AC
Int J Cardiol Congenit Heart Dis
· 2026 Jun · PMID 42078797
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BACKGROUND: Empirical data support the use of N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) for heart failure (HF) rule-in and rule-out in patients with acquired heart disease, but similar data are lacking...BACKGROUND: Empirical data support the use of N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) for heart failure (HF) rule-in and rule-out in patients with acquired heart disease, but similar data are lacking in adults with congenital heart disease (CHD). The purpose of this study was to assess diagnostic performance of conventional NT-proBNP cutoff points for HF diagnosis (rule-in and rule-out) in adults with CHD. METHOD: Retrospective study of adults with CHD and NT-proBNP measurement in the outpatient clinic (outpatient cohort) or in the emergency department (ED) (2003-2023). HF diagnosis was based on clinical assessment at the time of NT-proBNP measurement. Logistic regression was used to assess the diagnostic performance of conventional NT-proBNP cutoff points (<125 pg/ml for HF rule-out and ≥250 pg/ml for HF rule-in in the outpatient setting; <300 pg/ml for HF rule-out and ≥450 pg/ml for HF rule-in in the ED setting). RESULTS: The outpatient cohort comprised 3961 patients (age 45 ± 16 years), and NT-proBNP <125 pg/ml ruled-out HF with 86% sensitivity, while NT-proBNP level ≥250 pg/ml ruled-in with 68% specificity. The ED cohort comprised 687 patients (age 49 ± 16 years) and NT-proBNP level <300 pg/ml ruled-out HF with 82% sensitivity, and NT-proBNP level ≥450 pg/ml ruled-in HF with 75% specificity. CONCLUSIONS: These data support the use of these NT-proBNP levels for HF screening in the CHD population, which in turn would enable early detection and treatment of HF.
Lewis S, Mazurek R, Nemzow G
… +8 more, Hopkins K, Fiel I, Chan A, Facciuto M, Taouli B, Schiano TD, Zaidi A, Grinspan L
Int J Cardiol Congenit Heart Dis
· 2026 Jun · PMID 42078796
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BACKGROUND: Fontan-associated liver disease (FALD) is a consequence of Fontan circulation causing liver fibrosis, cirrhosis, portal hypertension, and potentially hepatocellular carcinoma (HCC), with imaging essential to...BACKGROUND: Fontan-associated liver disease (FALD) is a consequence of Fontan circulation causing liver fibrosis, cirrhosis, portal hypertension, and potentially hepatocellular carcinoma (HCC), with imaging essential to evaluation. OBJECTIVES: To describe the cross-sectional imaging features of hepatic morphology and focal liver lesions (FLLs) in patients with FALD. METHODS: This retrospective single-center study included patients post-Fontan procedure (10/2016-9/2022) who underwent CT or MRI and non-targeted liver biopsy for fibrosis staging. Two observers in consensus assessed CT/MRI for imaging findings of cirrhosis, portal hypertension, and FLL (>0.8 cm) detection and characterization, including size, enhancement pattern, and MRI characteristics. A composite reference standard (pathology, multidisciplinary tumor board, imaging characteristics, or FLL stability) informed FLL diagnosis. Biopsies were staged using the Congestive Hepatic Fibrosis Score (CHFS) [range, 0(no fibrosis)-4 (cirrhosis)]. Associations between variables were analyzed using logistic regression and Fisher's exact tests. RESULTS: Results from 41 patients [26M/15F, mean age = 29.9y, MRI, n = 24/CT, n = 17] are presented. CHFS were 1(n = 4)/2(n = 19)/3(n = 14)/4(n = 4). Imaging signs of cirrhosis were common: liver surface nodularity (n = 31) and volume redistribution (caudate lobe hypertrophy, n = 35). Varices and ascites were observed in n = 18 and n = 16 patients. 62 FLL were identified in 15 patients (mean size = 1.5 ± 0.7 cm). Diagnoses included benign-appearing enhancing lesions (n = 52 lesions/10 patients), indeterminate (n = 5 lesions/4 patients), HCC (n = 4 lesions/3 patients), and sclerosing hemangioma (n = 1). All HCC cases had CHFS = 3. No association between laboratory, CHFS, and imaging findings of cirrhosis was found (p-values>0.12). CONCLUSIONS: Imaging findings of cirrhosis are discordant with fibrosis stage in FALD. Enhancing FLLs, including HCC, are common and frequently observed in noncirrhotic liver.
Yang X, Sun Y, Zhang N
… +3 more, Xu J, Geng B, Wang Y
Int J Cardiol
· 2026 Aug · PMID 42069007
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Real-time three-dimensional (3D) fusion of cardiac computed tomography (CT) with fluoroscopy may enhance procedural guidance in left atrial appendage closure (LAAC), yet comparative data with conventional planning system...Real-time three-dimensional (3D) fusion of cardiac computed tomography (CT) with fluoroscopy may enhance procedural guidance in left atrial appendage closure (LAAC), yet comparative data with conventional planning systems are limited METHODS: In this retrospective comparative study, 109 consecutive patients undergoing LAAC were assigned to guidance using either 3D CT-fluoroscopy fusion (n = 51) or the real-time operation guidance planning system (ROGPS, n = 58). Procedural efficiency, radiation exposure, contrast use, and clinical outcomes were analyzed RESULTS: The 3D fusion group demonstrated significant reductions in contrast volume (60.2 ± 15.0 mL vs. 75.3 ± 15.0 mL, p < 0.001), fluoroscopy time (8.0 ± 3.6 min vs. 10.2 ± 3.7 min, p = 0.002), and total procedure time (62.2 ± 12.0 min vs. 68.5 ± 11.2 min, p = 0.005). Radiation dose (DAP) was also lower in the fusion group (29.8 ± 20.8 Gy·cm vs. 42.2 ± 27.7 Gy·cm, p = 0.01). Procedural success was 100% in both groups. No statistically significant differences were observed in the rates of device-related thrombosis (DRT) or peri-device leakage (PDL) CONCLUSION: 3D CT-fluoroscopy fusion imaging significantly improves procedural efficiency in LAAC compared to ROGPS, reducing contrast use, radiation exposure, and procedure time without compromising safety.
Del Torto A, Ventura E, Cannata F
… +21 more, Celeste F, Fazzari F, Frappampina A, Fusini L, Ghulam Ali S, Gripari P, Junod D, Maltagliati A, Mantegazza V, Maragna R, Stankowski K, Tassetti L, Volpe A, Annoni A, Cosentino N, Muratori M, Mushtaq S, Baggiano A, Grazi M, Assanelli E, Pontone G
Int J Cardiol
· 2026 Aug · PMID 42069006
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BACKGROUND: Microvascular obstruction (MVO) is a major prognostic determinant in STEMI. While thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) aims to reduce distal embolization and MVO, i...BACKGROUND: Microvascular obstruction (MVO) is a major prognostic determinant in STEMI. While thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) aims to reduce distal embolization and MVO, its impact on long-term myocardial scar and remodeling remains debated. The present study aimed to evaluate the impact of clinically indicated TA on myocardial scar and MVO using cardiac magnetic resonance (CMR) at baseline and 12-month follow-up in STEMI patients treated with PCI. METHODS: In this single-center observational cohort study, consecutive STEMI patients treated with primary PCI ± TA who underwent CMR at baseline and at 12 months were enrolled. CMR parameters included left ventricular volumes, ejection fraction, global longitudinal strain, infarct size (late gadolinium enhancement) and MVO. RESULTS: Among 130 STEMI patients (84 PCI + TA, 46 PCI-alone) enrolled, the TA group had higher baseline thrombus burden (TIMI Thrombus Grade 5 [5;5] vs. 3 (Henriques et al., 2002; Byrne et al., 2023 [2, 5]), p < 0.001), higher MVO prevalence (44.6% vs. 25%, p = 0.03) and larger infarct size [late gadolinium enhancement LGE: 24.2% vs 17.5% of left ventricle (LV) myocardial mass, p = 0.001]. At follow-up CMR, PCI + TA group experienced a greater reduction in myocardial scar (-5.0% [-21.8; 1.4] vs. -3.28% [-17.9; 4.6], p < 0.05), particularly in patients with a high thrombus burden (Thrombus Grade > 3) and baseline MVO (-10.3% [-19.8; -2.5] vs. -3.7% [-9.5; 1.2], p < 0.05). CONCLUSIONS: Despite worse baseline clinical and imaging characteristics, STEMI patients treated with TA showed more favorable myocardial tissue recovery at 12 months. These findings suggest that TA may optimize conditions for scar consolidation, particularly in high-risk patients with heavy thrombus burden.
Kitagawa T, Hamamoto K, Okamoto D
… +4 more, Ikegami Y, Sada Y, Tatsugami F, Nakano Y
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42063667
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BACKGROUND: There is a paucity of data regarding short-term outcomes and treatment responsiveness of myocardial T1 mapping via cardiac magnetic resonance (CMR) in patients with transthyretin amyloid cardiomyopathy (ATTR-...BACKGROUND: There is a paucity of data regarding short-term outcomes and treatment responsiveness of myocardial T1 mapping via cardiac magnetic resonance (CMR) in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) undergoing tafamidis therapy. METHODS: We retrospectively studied 60 wild-type ATTR-CM patients who underwent baseline CMR to measure native myocardial T1 value (T1) and extracellular volume fraction (ECV), followed by tafamidis treatment. Cardiac biomarkers, including high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP), were measured at baseline. We followed a one-year composite of worsening heart failure (WHF; hospitalization and/or intensification of diuretic therapy for heart failure). Additionally, 51 patients underwent follow-up CMR and measurements of cardiac biomarkers one-year after the initiation of tafamidis treatment. RESULTS: Patients with WHF (n = 12) exhibited significantly elevated baseline T1 and ECV than those without WHF, and their optimal cutoffs in predicting WHF were 1447 ms and 48.7 %, respectively. Multivariate analysis adjusted for Mayo or National Amyloidosis Center stages identified T1 of ≥ 1447 ms as an independent predictor of WHF, with hazard ratios of 15.2 and 9.3, respectively. A notable proportion of patients exhibited a reduction in T1 (39 %) and ECV (47 %) after one year of tafamidis treatment. Post-treatment changes in T1 were correlated positively with changes in NT-proBNP concentration (r = 0.40, = 0.0036). CONCLUSIONS: In wild-type ATTR-CM patients receiving tafamidis, elevated baseline T1 mapping parameters were associated with one-year WHF. T1 mapping parameters, particularly T1, may offer imaging-based evidence of alterations in myocardial characteristics induced by tafamidis.
Iwai T, Takagi K, Kitai T
… +25 more, Asaumi Y, Sumita Y, Iwanaga Y, Nakai M, Noguchi T, Miyamoto Y, Nochioka K, Nakayama M, Akashi N, Matoba T, Kohro T, Oba Y, Kabutoya T, Imai Y, Kario K, Kiyosue A, Mizuno Y, Ishii M, Nakamura T, Tsujita K, Matoba Y, Sato H, Fujita H, Nagai R, CLIDAS research group
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42063666
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BACKGROUND: Coronary artery disease (CAD) and aortic valve stenosis (AS) often coexist, with AS exacerbating myocardial ischemia and affecting prognosis. AIMS: To investigate the prognostic impact of AS stratified by pea...BACKGROUND: Coronary artery disease (CAD) and aortic valve stenosis (AS) often coexist, with AS exacerbating myocardial ischemia and affecting prognosis. AIMS: To investigate the prognostic impact of AS stratified by peak aortic jet velocity (AV-Vel) in patients undergoing PCI. METHODS AND RESULTS: We conducted retrospective multicenter observational study involving patients who underwent percutaneous coronary intervention (PCI) between April 2013 and March 2019. The patients were divided into non-AS group and AS group. The AS group was further categorized: 2.6 ≤ AV-Vel < 3.0 m/s, mild AS; 3.0 ≤ AV-Vel < 4.0 m/s, moderate AS; and AV-Vel ≥ 4.0 m/s, severe AS. The primary outcome was all-cause mortality, and the secondary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, myocardial infarction, or stroke. Multivariable Cox proportional hazards analysis was performed over 5-year observation period, with landmark analyses conducted at 30 days after PCI and from day 31 after PCI to 5 years. In total, 9,690 patients were analyzed (AS group, n = 361). Over a median follow-up of 2.57 (IQR: 0.89-4.24) years, AS group exhibited higher rates of mortality (HR: 3.06; 95% CI: 2.41-3.90; p < 0.001) and MACE (HR: 2.45; 95%CI: 1.97-3.04; p < 0.001) compared with non-AS group. Subgroup analysis revealed that patients with moderate and severe AS had worse short-term mortality and MACE within 30 days after PCI than the non-AS group, while patients with mild to severe AS showed significantly worse long-term outcomes than the non-AS group. CONCLUSIONS: AV-Vel is independently associated with both short- and long-term outcomes in patients undergoing PCI.
Ramos Cano P, Monteagudo Ruiz JM, Carrión Sanchez I
… +6 more, González Gómez A, García Martin A, Hinojar-Baydes R, Martínez-Vives P, Zamorano Gómez JL, Fernández Golfín-Lobán C
Int J Cardiol
· 2026 Aug · PMID 42061727
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BACKGROUND: Patients with significant aortic regurgitation (AR) not meeting current surgical criteria may develop heart failure with preserved ejection fraction (HFpEF). Left atrial reservoir strain (LASr) reflects atria...BACKGROUND: Patients with significant aortic regurgitation (AR) not meeting current surgical criteria may develop heart failure with preserved ejection fraction (HFpEF). Left atrial reservoir strain (LASr) reflects atrial-diastolic function and may provide prognostic information beyond conventional left ventricular (LV) metrics. METHODS: We retrospectively included 182 patients with significant AR and 182 age- and sex-matched controls who underwent transthoracic echocardiography between 2017 and 2023. LASr was quantified using automated vendor-independent software. The primary endpoint was all-cause mortality or HF hospitalization. Fine-Gray competing risk models adjusted for age, atrial fibrillation, LV ejection fraction, LV end-systolic diameter, and E/e' were used to evaluate the association of LASr with the primary endpoint. Patients were also grouped into four strata according to AR status and LASr threshold (≥40% vs <40%). RESULTS: Over a median follow-up of 38.5 months, the composite endpoint occurred in 52 AR patients (30.1%) and 30 controls (16.5%). LASr was lower in AR patients (31.6 ± 14.7% vs 35.9 ± 16.0%, p = 0.007). In AR patients, lower LASr independently predicted adverse outcomes (SHR 1.18 per 5% decrease, 95% CI 1.02-1.36, p = 0.025). In the full cohort, event rates were lowest in No-AR/LASr ≥40% (1.4%) and highest in AR/LASr <40% (36.9%; adjusted SHR 10.96, 95% CI 1.49-80.53, p = 0.019). CONCLUSIONS: Significant AR without guideline-based surgical criteria is associated with a high burden of HF events. LASr identifies an HFpEF phenotype in which atrial-diastolic dysfunction, rather than LV remodeling, is more strongly associated with clinical outcomes.
Ungethüm K, Montellano FA, Rücker V
… +9 more, Ludwig T, Wolfe CDA, Morbach C, Frantz S, Störk S, Kleinschnitz C, Haeusler KG, Heuschmann PU, SICFAIL study group
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42058759
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BACKGROUND: Systolic dysfunction, diastolic dysfunction, and clinically overt heart failure are frequently encountered after acute ischaemic stroke. We investigated whether these cardiac phenotypes, considered as distinc...BACKGROUND: Systolic dysfunction, diastolic dysfunction, and clinically overt heart failure are frequently encountered after acute ischaemic stroke. We investigated whether these cardiac phenotypes, considered as distinct entities, are associated with readmission and death within two years after stroke in the prospective SICFAIL cohort. METHODS: Adults with acute ischaemic stroke were consecutively enrolled between 01/2014 and 02/2017. Cardiac function was assessed at baseline, and patients were followed annually by mail or telephone. The primary endpoint was the composite of all-cause readmission or death. Secondary analyses considered individual endpoints and cardiovascular readmissions. Associations were estimated using multivariable Cox proportional hazards models. RESULTS: Of 696 enrolled patients, 644 (92.5%) had interpretable echocardiographic data. During two-year follow-up, 206 of 554 patients (37.1%) with complete outcome information were rehospitalised, and 63 of 577 patients (11.4%) with available vital status data died. After adjustment, systolic dysfunction and clinically overt heart failure were independently associated with the composite endpoint (systolic dysfunction: hazard ratio [HR] 1.97 (95% confidence interval [CI], 1.34-2.91); clinically overt heart failure: HR 1.62, 95% CI 1.02-2.58). Systolic dysfunction also predicted cardiovascular readmissions (HR 2.27, 95% CI 1.22-4.21). Diastolic dysfunction was not associated with adverse outcomes. CONCLUSION: In this cohort, systolic dysfunction and clinically overt heart failure at the time of ischaemic stroke independently predicted the composite of readmission or death over the subsequent two years, whereas isolated diastolic dysfunction was not prognostically informative. Routine echocardiographic assessment after stroke may therefore help identify patients who would benefit from intensified cardiac follow‑up and secondary prevention.
Baron DK, Samuel M, Crijns HJGM
… +7 more, Tieleman RG, Hemels MEW, Schotten U, Linz D, Van Gelder IC, Rienstra M, RACE V Investigators
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42058758
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BACKGROUND: Atrial Fibrillation (AF) may progress from paroxysmal AF (PAF) to more sustained forms, but predicting which patients progress remains a challenge. The RACE V study is a prospective, observational study aimin...BACKGROUND: Atrial Fibrillation (AF) may progress from paroxysmal AF (PAF) to more sustained forms, but predicting which patients progress remains a challenge. The RACE V study is a prospective, observational study aiming to characterize phenotypical differences between patients with and without AF progression. Based on interim data of the RACE V study, a clinical risk prediction model for AF progression in patients with PAF was previously developed. The aim of the current analysis is to assess its performance in the complete cohort over extended follow-up. METHODS: In the RACE V study, 612 patients with PAF were extensively phenotyped and continuously monitored using implantable loop recorders to track AF recurrences. AF progression was the primary outcome, defined as (1) progression to persistent or permanent AF, or (2) AF burden increase > 3%, during complete follow-up. The risk score incorporates five clinical predictors at baseline: sex, PR interval duration, left atrial contractile function, waist circumference, and presence of mitral valve regurgitation. Prediction model performance was assessed using receiver operating characteristic (ROC) curve-derived area under the curve (AUC). RESULTS: Patients had a median age 64 [57 - 70] years, and 42% were female. During a follow-up of 3.4 (2.8 - 3.7) years, 108 (5.2%/year) patients progressed. The risk prediction model demonstrated a C-statistic of 0.647 (95% CI: 0.590-0.707 in the full cohort, compared with 0.709 (95% CI: 0.617-0.801) in the interim cohort (DeLong's unpaired test, p = 0.656). CONCLUSIONS: The model may help clinicians identify patients at risk of progression, showing stable performance in the whole cohort over extended follow-up.
Kino T, Igarashi M, Suto Y
… +7 more, Shinoda Y, Kawamatsu N, Ogawa K, Komatsu Y, Machino-Ohtsuka T, Yamasaki H, Ishizu T
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42058757
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BACKGROUND: Atrial fibrillation (AF) is an important late complication in patients with repaired tetralogy of Fallot (TOF); however, its clinical determinants and arrhythmogenic substrates remain uncertain. Identifying h...BACKGROUND: Atrial fibrillation (AF) is an important late complication in patients with repaired tetralogy of Fallot (TOF); however, its clinical determinants and arrhythmogenic substrates remain uncertain. Identifying high-risk anatomical profiles is essential for optimal rhythm management and tailored ablation strategies. METHODS: We retrospectively analyzed 137 consecutive patients with repaired TOF followed at the University of Tsukuba Hospital (2013-2024). Clinical characteristics, echocardiographic parameters, and procedural findings were compared between patients with and without AF. Logistic regression identified independent predictors. Catheter ablation approaches and outcomes were evaluated in patients who underwent AF ablation. RESULTS: AF occurred in 14 patients (10.2%), frequently coexisting with atrial tachycardia (78.6%). Compared with patients without AF, those with AF were older, had undergone more repeat cardiac surgeries, and more commonly exhibited a persistent left superior vena cava (PLSVC), greater biatrial enlargement, and mildly reduced right ventricular function. On multivariable analysis, PLSVC remained statistically associated with AF (odds ratio 15.5, p = 0.002); however, this association was primarily driven by patients with combined AF and AT, as no PLSVC was observed in the small isolated AF subgroup. Among six patients who underwent catheter ablation, those without PLSVC were successfully treated with pulmonary vein isolation (PVI) alone, whereas two patients with PLSVC underwent right-sided ablation targeting the right atrium and coronary sinus, with no AF recurrence observed during follow-up. CONCLUSIONS: PLSVC was associated with more complex atrial tachyarrhythmias, particularly in patients with concomitant AF and AT. Recognizing this substrate may inform individualized ablation strategies beyond conventional PVI.
Ranic I, Stanke L, Jiravsky O
… +19 more, Herman D, Roubicek T, Havranek S, Chovancik J, Bulkova V, Matoulek M, Tuka V, Hozmanova J, Hozman M, Latinak A, Pidhorodecky J, Dusik M, Simek J, Jiravska-Godula B, Mohr JA, Hejdukova Z, Benesova K, Plasek J, Osmancik P
Int J Cardiol Heart Vasc
· 2026 Jun · PMID 42058756
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BACKGROUND: The PRAGUE-25 trial demonstrated catheter ablation (CA) superiority over lifestyle modification plus antiarrhythmic drugs (LFM + AAD) in obese patients with atrial fibrillation (AF). However, obese AF patient...BACKGROUND: The PRAGUE-25 trial demonstrated catheter ablation (CA) superiority over lifestyle modification plus antiarrhythmic drugs (LFM + AAD) in obese patients with atrial fibrillation (AF). However, obese AF patients represent a heterogeneous population with varying pathophysiological substrates. We hypothesized that distinct patient phenotypes may exhibit differential treatment responses. METHODS: This post-hoc analysis applied hierarchical cluster analysis (Ward's D2 method, Euclidean distance) to 122 PRAGUE-25 patients with complete data using six delta (12-month minus baseline) echocardiographic and metabolic variables (Δ-LAVI, Δ-LVEDD, Δ-NT-proBNP, Δ-triglycerides, Δ-leukocytes, Δ-platelets). Treatment effects within each phenotype were compared using Fisher's exact test and odds ratios with 95% confidence intervals. RESULTS: Three distinct phenotypes were identified: Metabolic (n = 20, 16%), characterized by highest triglycerides with minimal structural remodeling; Intermediate Remodeling (n = 67, 55%), distinguished by largest LV chamber with lowest inflammatory burden; and Advanced Neurohormonal/Inflammatory (n = 35, 29%), exhibiting highest NT-proBNP with elevated inflammatory markers. While cluster membership did not predict overall AF freedom (χ = 3.45, p = 0.178), CA superiority was statistically significant only in the Intermediate phenotype (OR 3.98, 95% CI: 1.01-15.57, p = 0.047; AF freedom 88.5% CA vs 65.9% LFM + AAD). In the Metabolic and Advanced Neurohormonal/Inflammatory phenotypes (45% of patients), no statistically significant treatment difference was observed; however, wide confidence intervals preclude conclusions of treatment equivalence in these underpowered subgroups. These findings appear to be primarily driven by the Intermediate Remodeling phenotype. CONCLUSIONS: These hypothesis-generating findings suggest phenotype-dependent treatment response heterogeneity in obese atrial fibrillation. As cluster membership can only be determined retrospectively, prospective validation using baseline predictor models is required before clinical application.
Nordenskjöld AM, Wirén A, Schef KW
… +3 more, Hakansson F, Tornvall P, Lindahl B
Int J Cardiol Cardiovasc Risk Prev
· 2026 Jun · PMID 42058513
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BACKGROUND: Knowledge on the influence of mental disorders and unfavourable sociodemographic factors in patients experiencing myocardial infarction with non-obstructive coronary arteries (MINOCA) remains limited. We inve...BACKGROUND: Knowledge on the influence of mental disorders and unfavourable sociodemographic factors in patients experiencing myocardial infarction with non-obstructive coronary arteries (MINOCA) remains limited. We investigated the prevalence of mental disorders, psychotropic drug dispensation, and sociodemographic factors in patients with MINOCA and MI with coronary artery disease (MI-CAD) and assessed their association with prognosis. METHODS AND RESULTS: In this nationwide register-based cohort study of 8367 MINOCA and 109,059 MI-CAD patients, mental disorders (4.3% vs 2.6%, p < 0.001) and psychotropic drug dispensation (26.1% vs 17.4%, p < 0.001) were more frequent in MINOCA, particularly female patients. MINOCA patients were also more often divorced (21.1% vs 19.7%, p < 0.001), widowed (6.8% vs 4.9%, p < 0.001), or on sick leave (4.4% vs 3.2%, p < 0.001). Over a median 5.5-year follow-up, a major adverse cardiovascular event (MACE) occurred in 25.5% of MINOCA and 27.8% of MI-CAD patients (p < 0.001). Adjusted analyses showed that mental disorders and dispensed psychotropic drugs independently predicted MACE in both MINOCA (HR 1.27; 95% CI 1.15-1.40) and MI-CAD (HR 1.35; 95% CI 1.31-1.39). CONCLUSION: Mental disorders and psychotropic drug dispensation were more common in MINOCA than MI-CAD, particularly in female patients. Unfavourable sociodemographic factors were common in both groups, with a modest excess in MINOCA. The association between mental health variables and adverse outcomes in both conditions suggests shared mechanisms beyond traditional cardiovascular risk factors.
Gadelmawla AF, Taha AM, Alkuwaiti FA
… +12 more, Alkuwaiti MA, Alsubaiei AA, AlSejari NY, Alsultan AM, Abdul-Hafez HA, Awashra A, Diaa A, Hageen AW, Mohamed AE, Alharran AM, Andò G, Aronow WS
Int J Cardiol
· 2026 Aug · PMID 42055091
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BACKGROUND: Microvascular obstruction (MVO) frequently occurs after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and can be classified as transient...BACKGROUND: Microvascular obstruction (MVO) frequently occurs after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and can be classified as transient or persistent based on its resolution on follow-up cardiac magnetic resonance (CMR) imaging. This meta-analysis aims to compare the prognostic significance of persistent MVO versus transient MVO and no MVO in patients with STEMI undergoing primary PCI. METHODS: we conducted a systematic search for cohort studies comparing persistent MVO to transient MVO or no MVO in patients with STEMI who underwent primary PCI and CMR imaging. For the meta-analysis, we used R software (version 4.5.0) with RStudio. RESULTS: We included seven cohort studies with a total of 2180 patients. Compared to transient MVO, persistent MVO was associated with significantly higher risks of MACE and death. Persistent MVO also demonstrated significantly lower LVEF and larger infarct size, but no significant association with recurrent MI or heart failure readmission. Compared to no-MVO, persistent MVO showed even stronger associations with adverse outcomes: MACE, death, heart failure readmission, lower LVEF, and larger infarct size. CONCLUSION: Persistent MVO may be associated with worse clinical outcomes, adverse left ventricular remodeling, and larger infarct size compared to both transient MVO and no MVO. These findings support the role of follow-up CMR for risk stratification to identify high-risk population. However, the definition and timing of persistent MVO varied considerably across studies (1 week to 12 months), which introduce clinical heterogeneity highlighting the need for future studies with standardized definitions.