Cardiology Research And Practice[JOURNAL]
Sun
200 papers
Sex related differences in acute and recurrent pericarditis: A narrative review.
Alanazi N
Am Heart J Plus · 2026 Jul · PMID 42292689 · Full text
BACKGROUND: Acute and recurrent pericarditis represent significant clinical challenges, with growing evidence suggesting important sex-related differences in their presentation, etiology, and course. This review synthesi...
BACKGROUND: Acute and recurrent pericarditis represent significant clinical challenges, with growing evidence suggesting important sex-related differences in their presentation, etiology, and course. This review synthesizes current knowledge on these disparities. METHODS: Given the heterogeneity of available evidence and the limited number of studies with sex-specific analyses, this review was conducted in a narrative format. DISCUSSION: While acute pericarditis is more prevalent in men, particularly at a younger age and often due to idiopathic or viral causes, women are more frequently affected at an older age and similarly mostly due to viral or idiopathic causes; however, women exhibit a stronger association with autoimmune etiologies compared to men. The clinical presentation also diverges, with men more often presenting with classic features like chest pain, pericardial rub, and characteristic electrocardiographic changes, whereas women may present with atypical features. A critical finding is that women face a higher burden of recurrent pericarditis, experiencing more frequent and severe episodes, which may be linked to their higher prevalence of autoimmune conditions and the subsequent greater use of corticosteroid therapy, which is a known risk factor for recurrence. CONCLUSION: Distinct sex-related patterns in acute and recurrent pericarditis necessitate a more tailored diagnostic and therapeutic approach. Further large-scale studies are warranted to definitively establish the links between sex hormones, autoimmune predisposition, and treatment outcomes to optimize patient care for both men and women.
Septic cardiomyopathy: Fact or fiction?
Naimi A, Rodriguez M, Qadeer YK … +5 more , Virk HUH, Khawaja M, Tang WHW, Strauss M, Krittanawong C
Am Heart J Plus · 2026 Jul · PMID 42292688 · Full text
UNLABELLED: Septic cardiomyopathy (SCM) represents a dynamic form of myocardial dysfunction occurring in the setting of sepsis. Unlike chronic ischemic or structural heart disease, SCM arises acutely due to a complex int...
UNLABELLED: Septic cardiomyopathy (SCM) represents a dynamic form of myocardial dysfunction occurring in the setting of sepsis. Unlike chronic ischemic or structural heart disease, SCM arises acutely due to a complex interplay of inflammatory, metabolic, endothelial, and microvascular mechanisms and often, though not always, demonstrates reversibility within days.'' Despite increasing recognition, SCM remains poorly defined due to the absence of standardized diagnostic criteria and substantial overlap with other acute cardiomyopathies, including Takotsubo cardiomyopathy and myocarditis. Current diagnostic approaches rely primarily on echocardiography, strain imaging, biomarkers, and clinical trajectory, while emerging modalities such as cardiac magnetic resonance imaging may provide additional insight into myocardial inflammation, edema, and fibrosis. Management remains largely supportive and centered on treatment of the underlying septic process, with ongoing uncertainty regarding targeted heart failure therapies and adjunctive interventions. This review summarizes current understanding of SCM pathophysiology, diagnosis, imaging findings, and management while critically examining whether SCM represents a distinct disease entity or part of a broader stress-inflammatory cardiomyopathy spectrum. OBJECTIVES: The objectives include: proposing a broad definition and description of septic cardiomyopathy, providing a comprehensive literature review on current diagnostic and management options available for septic cardiomyopathy, and describing the limitations and gaps in this diagnosis and possible direction of future studies.
Periodontal inflammation: A clinically significant and underrecognized cardiovascular risk factor-The Endothelial Risk Score (ERS): A narrative review with conceptual framework development.
Nwhator SO, Ogunwemimo MT, Akinyele OA … +8 more , Adetunji TA, Onabanjo OA, Ogunleye BA, Adewole KO, Adewole OM, Ojo IO, Ogundiran T, Nwhator PA
Am Heart J Plus · 2026 Jul · PMID 42292687 · Full text
Periodontitis is a chronic inflammatory disease affecting the tooth-supporting structures and has been consistently associated with endothelial dysfunction, the earliest detectable stage of atherosclerosis. This article...
Periodontitis is a chronic inflammatory disease affecting the tooth-supporting structures and has been consistently associated with endothelial dysfunction, the earliest detectable stage of atherosclerosis. This article is a narrative review with conceptual framework development - not a systematic review or meta-analysis. We synthesize evidence from key studies to propose a hypothesis-generating heuristic: the Endothelial Risk Score (ERS). Despite robust biological plausibility and supportive clinical evidence, a critical translational gap persists: no quantitative framework integrates continuous periodontal inflammation with established cardiovascular risk factors. Clinicians cannot answer: "How much endothelial dysfunction is explained by periodontal inflammation?" This review synthesises evidence from mechanistic studies, clinical association studies, intervention trials, and established cardiovascular risk frameworks to propose the ERS. The ERS is a hypothesis-generating heuristic that integrates Periodontal Inflamed Surface Area (PISA) with age, sex, systolic blood pressure, smoking pack-years, diabetes status, and hs-CRP into a four-strata scoring system (Low, Moderate, High, Very High vascular burden). All point assignments are evidence-informed heuristics, not empirically derived coefficients. The proposed ERS is not a validated prediction tool; it is a conceptual framework to structure existing evidence, guide patient education, foster interdisciplinary collaboration, and define testable hypotheses for future empirical validation. A detailed validation blueprint is provided.
Magnetocardiography Combined With the SYNTAX Score for Exploratory Modeling of Clinician-Selected Revascularization Category in Three-Vessel Coronary Artery Disease: A Single-Center Pilot Study.
An Z, Wang S, Zhang M … +9 more , Zhang M, Xu F, Feng L, Ma Z, Zhang H, Yang S, Tu C, Song X, Zhang H
Cardiol Res Pract · 2026 · PMID 42290967 · Full text
BACKGROUND: Three-vessel coronary artery disease (3V-CAD) often requires revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The SYNTAX score is widely used f...
BACKGROUND: Three-vessel coronary artery disease (3V-CAD) often requires revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The SYNTAX score is widely used for anatomical risk stratification, but whether magnetocardiography (MCG) provides incremental information beyond anatomical assessment remains uncertain. OBJECTIVES: To evaluate, in an exploratory pilot analysis, whether MCG-derived parameters add information beyond the SYNTAX score for modeling clinician-selected revascularization category in 3V-CAD and to examine the noncausal association between model-treatment concordance and major adverse cardiovascular and cerebrovascular events (MACCEs). METHODS: Prospective cohort data were analyzed retrospectively. Candidate MCG parameters were screened using Pearson correlation, random forest analysis, and stepwise logistic regression, and selected variables were combined with the SYNTAX score. Model discrimination, calibration, bootstrap internal validation, and LASSO penalized logistic regression sensitivity analysis were assessed. Model-treatment concordance was explored using Kaplan-Meier analysis and multivariable Cox regression. RESULTS: Among 544 patients, 543 complete cases were available for model evaluation, including 42 CABG events. In the overall cohort, the combined MCG-SYNTAX model did not materially improve discrimination compared with the SYNTAX-only model (AUC, 0.853 vs. 0.847; = 0.628). Discrimination was also similar in the low-risk subgroup (SYNTAX < 22; AUC, 0.824 vs. 0.848; = 0.540). In the intermediate-high-risk subgroup (SYNTAX ≥ 22), the combined model had a numerically higher apparent AUC, but this finding was considered hypothesis-generating. Bootstrap internal validation did not support a maintained incremental value of the combined model (optimism-corrected AUC, 0.834 vs. 0.848 for the SYNTAX-only model). In LASSO sensitivity analysis using all appended MCG-derived candidate variables, only the SYNTAX score was retained. The exploratory follow-up analysis showed an unadjusted difference in MACCE-free survival between concordance groups, but this association was not retained after multivariable adjustment and was not interpreted causally. CONCLUSIONS: In this single-center pilot modeling study, selected MCG parameters showed limited and unstable incremental value beyond the SYNTAX score for modeling clinician-selected revascularization category in 3V-CAD. These findings do not support clinical implementation at this stage and require external validation. Chinese Clinical Trial Registry: ChiCTR2200066942.
Prediction of Ascending Aortic Dilation and Analysis of Influencing Factors in Bicuspid Aortic Valve Patients Using an Explainable Machine Learning Model.
He S, Yan N, Nie G … +4 more , Wang F, Yang X, Wang L, Na L
Cardiol Res Pract · 2026 · PMID 42290966 · Full text
OBJECTIVE: Developing a machine learning (ML) model to predict the risk of ascending aortic dilation in patients with a bicuspid aortic valve (BAV). Using SHapley Additive exPlanations (SHAP) to interpret and visualize t...
OBJECTIVE: Developing a machine learning (ML) model to predict the risk of ascending aortic dilation in patients with a bicuspid aortic valve (BAV). Using SHapley Additive exPlanations (SHAP) to interpret and visualize the model. METHODS: This study enrolled 102 BAV patients, who were divided into two subgroups based on ascending aorta diameter (dilated and nondilated). All participants underwent routine echocardiography, clinical baseline data collection, and measurement of plasma matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Feature selection was performed using univariate analysis followed by the least absolute shrinkage and selection operator (LASSO)-logistic regression (LR) method. Five common ML prediction models were developed: support vector machine (SVM), LR, gradient-boosting machine (GBM), neural network (NNET), and Naïve Bayes (NB) classifier. To identify the best-performing predictive model for ascending aortic dilation in BAV patients, an evaluation of predictive efficacy was carried out by employing ROC curves, calibration curves, and DCA curves. Finally, the optimal model's predictions were interpreted using SHAP. RESULTS: Random allocation of the entire patient population resulted in a training set ( = 72) and a test set ( = 30). Application of LASSO-LR analysis revealed age, plasma MMP-2, and peak aortic valve velocity (Vmax AV) as independent factors influencing ascending aortic dilation in BAV patients. These predictors were integrated into the subsequent ML model. GBM model achieved the optimal overall performance after 5-fold cross-validation. It attained an AUC of 0.982 on the training set, alongside an AUC of 0.915 on the test set. Calibration curves and DCA curves further demonstrate that the model exhibits good calibration and clinical net benefit. According to SHAP analysis, elevated plasma MMP-2 contributed the most to the GBM model's predictions, followed by increased age and elevated Vmax AV. CONCLUSIONS: The GBM model offers a valuable tool for predicting ascending aortic dilation in BAV patients. Moreover, SHAP analysis enhances the model's utility by providing clear, actionable insights for clinical management.
Association Between Obesity Indices and Heart Rate Variability: A Cross-Sectional Study in Asian Young College Students.
Wang J, Ding X, Wang J … +4 more , Wu J, Zhu D, Chen J, Peng Z
Cardiol Res Pract · 2026 · PMID 42290965 · Full text
OBJECTIVE: This study aimed to evaluate the associations of various traditional and novel obesity indices with heart rate variability (HRV) in Asian young college students, assessing their relative importance and potenti...
OBJECTIVE: This study aimed to evaluate the associations of various traditional and novel obesity indices with heart rate variability (HRV) in Asian young college students, assessing their relative importance and potential sex differences. METHODS: In this cross-sectional study of 3180 Asian young college students (mean age 19.6 years), we measured eight obesity indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and body fat percentage (BFP). HRV was assessed from a 5-min resting electrocardiogram and analyzed across three autonomic domains derived from principal component analysis. We employed sex-stratified linear models followed by a multimodel approach (best subset selection, relative importance analysis, and elastic net regression) to control for collinearity. All analyses were adjusted for age, heart rate, physical activity, and measurement time. RESULTS: BFP demonstrated the strongest associations with HRV parameters, showing significant negative correlation with SDNN ( = -1.76) and positive correlations with LF/HF ( = 0.123) and LFnorm ( = 1.84) (all FDR < 0.001). Relative importance analysis showed that BFP contributed most to predicting LF/HF (38.1%), significantly exceeding WC (17.5%) and BMI (13.9%). The addition of BMI to BFP was associated with improved prediction for LF/HF and LFnorm (Δ > 0.03). Subgroup analysis showed that overweight/obese individuals with elevated BFP had significantly impaired HRV across all indices, while those with normal BFP showed reduced SDNN only. ROC analysis gave a BFP cutoff of 27.3% for identifying low HRV risk. No significant sex interactions were observed. CONCLUSION: BFP was identified as the primary obesity indicator for autonomic function assessment in Asian young college students, while traditional indices (BMI, WC) provide valuable incremental information. Integrating body composition measurement into youth cardiovascular risk screening is recommended.
Artificial Intelligence-Enhanced Electrocardiography for the Diagnosis of Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis.
Murray CP, Temperley HC, Doyle RS … +3 more , Khair A, Devitt P, Asgedom S
Cardiol Res Pract · 2026 · PMID 42253322 · Full text
BACKGROUND: Accounting for approximately 50% of heart failure, heart failure with preserved ejection fraction (HFpEF) is becoming increasingly common as populations age and multimorbidity grows. Diagnosis remains challen...
BACKGROUND: Accounting for approximately 50% of heart failure, heart failure with preserved ejection fraction (HFpEF) is becoming increasingly common as populations age and multimorbidity grows. Diagnosis remains challenging, requiring multimodal testing with echocardiography, biomarkers and sometimes invasive haemodynamics. Artificial intelligence applied to the electrocardiogram (AI-ECG) offers a low-cost, scalable means of detecting HFpEF by extracting patterns beyond human interpretation. METHODS: We conducted a systematic review and meta-analysis in accordance with PRISMA, registered prospectively with PROSPERO. PubMed, Embase, Web of Science, and IEEE Xplore were searched to 1 August 2025 for studies evaluating AI/ML models applied to ECGs for the diagnosis of HFpEF or left ventricular diastolic dysfunction (LVDD). Eligible studies reported diagnostic performance compared with a recognized reference standard. Risk of bias was assessed with QUADAS-AI. AUROC values were pooled using a logit transformation and random-effects model, with results back-transformed for interpretability. RESULTS: Ten studies (2021-2025) met inclusion criteria, encompassing > 270,000 participants across diverse populations. Seven studies provided sufficient data for pooling, contributing 11 independent cohorts. The pooled AUROC was 0.84 (95% CI 0.78-0.88), indicating good discriminatory ability, though heterogeneity was extreme (I = 100%). Three additional studies reported diagnostic metrics without AUROC variance and were synthesized narratively. Risk of bias was moderate to high in several domains, driven by selective cohorts, inconsistent reference standards, and incomplete reporting. CONCLUSIONS: AI-ECG shows promise for the detection of HFpEF, but the current evidence base is predominantly retrospective, methodologically heterogeneous, and limited by variable reference standards and insufficient external validation. No prospective, outcome-based studies have yet established its clinical utility, and real-world implementation remains untested.
Handling persistent cardiac troponin elevation in asymptomatic athletes: The role of macrocomplexes.
Wernhart S, Halle M, Zenk S
Am Heart J Plus · 2026 Jul · PMID 42253289 · Full text
STUDY OBJECTIVE: Return-to-play (RTP) decision includes cardiac troponin I returning to baseline. Formation of antibodies to cardiac troponin I (macrocomplexes) may lead to persistent, false positively elevated cardiac t...
STUDY OBJECTIVE: Return-to-play (RTP) decision includes cardiac troponin I returning to baseline. Formation of antibodies to cardiac troponin I (macrocomplexes) may lead to persistent, false positively elevated cardiac troponin I and may induce unnecessary exclusion from competitive sports. DESIGN: Single-centre retrospective study. SETTING: Sports cardiological outpatient clinic. PARTICIPANTS: We investigated 12 asymptomatic athletes who had clinically recovered from their first episode of acute myocarditis, but who showed persistently elevated cardiac troponin I levels without kinetics. INTERVENTIONS: Testing for the presence of macrocomplexes using an Abbott high-sensitivity cardiac troponin I assay with and without polyethylene glycol (PEG) precipitation to precipitate any potential macrocomplexes present in the samples. MAIN OUTCOME MEASURES: Prevalence of a cardiac troponin I recovery rate in PEG precipitation. RESULTS: 13 samples from 12 athletes (mean age 36.2 ± 12.3 years) were examined with a cardiac troponin I range from 35.4 ng/L to 951 ng/L. After PEG precipitation, a measurable cardiac troponin I concentration was detected in only two cases. In 12 of the 13 samples examined, the cardiac troponin I recovery rate was below 35%, which suggests the presence of macrocomplexes. Mean time from diagnosis of acute myocarditis to assessment of macrocomplexes was 6.2 ± 3.6 months. CONCLUSION: Formation of macrocomplexes seems to be highly prevalent in athletes who have clinically recovered from acute myocarditis. PEG precipitation may be a feasible laboratory approach to help in the clinical decision-making of athletes to avoid unnecessary exclusion from competitive sports.
Body composition changes during cardiac rehabilitation and long-term cardiovascular outcomes in patients with coronary artery disease.
Kumar A, Van C, Shahrvini T … +2 more , Srikanthan P, Horwich TB
Am Heart J Plus · 2026 Jul · PMID 42238967 · Full text
AIMS: This study assesses whether changes in body composition - lean body mass (LBM) and body fat % (BF%) - and body mass index (BMI), in patients undergoing cardiac rehabilitation (CR), are associated with long-term out...
AIMS: This study assesses whether changes in body composition - lean body mass (LBM) and body fat % (BF%) - and body mass index (BMI), in patients undergoing cardiac rehabilitation (CR), are associated with long-term outcomes. METHODS: In this cohort study of 1234 adults with coronary artery disease (CAD) who participated in CR from April 2012 to June 2024, bioelectric impedance analysis was used at baseline and after CR to assess body composition. Outcomes assessed included net adverse cardiovascular events (NACE) and all-cause mortality. RESULTS: Subjects were followed for a mean of 5.9 years (SD 3.2). We found that those who had an increase in BF% during CR had a higher risk of NACE (adjusted HR 1.44, 95% CI: 1.10, 1.90) compared to those who had a decrease in BF%. There was also a trend towards decreased mortality in patients with a moderate increase in LBM (adjusted HR 0.49, 95% CI 0.23, 1.02). There were no associations between changes in body mass index and any outcomes. When the cohort was stratified by sex, both males and females had higher adjusted risk of NACE with BF% increase, but the finding was only statistically significant in males. CONCLUSION: An increase in BF% during CR was associated with increased NACE in patients with CAD. Overall, these findings suggest that interventions to address body composition change, particularly decreasing BF%, may be important in mitigating cardiovascular events in patients undergoing CR.
Geriatric Nutritional Risk Index and risks of all-cause, cardiovascular, and diabetes-related mortality in adults with obesity: A nationally representative cohort study.
Yang X, Na K, Yan C … +1 more , Han Y
Am Heart J Plus · 2026 Jul · PMID 42238966 · Full text
OBJECTIVES: This study aimed to examine the association between the Geriatric Nutritional Risk Index (GNRI) and mortality outcomes, encompassing all-cause, cardiovascular, and diabetes-associated deaths, among adults liv...
OBJECTIVES: This study aimed to examine the association between the Geriatric Nutritional Risk Index (GNRI) and mortality outcomes, encompassing all-cause, cardiovascular, and diabetes-associated deaths, among adults living with obesity. METHODS: This prospective cohort analysis employed nationally representative survey information from 8834 adults with obesity (BMI ≥30 kg/m) enrolled in ten consecutive cycles of the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. Vital status was determined via linkage to the National Death Index, with follow-up extending through December 31, 2019. Multivariate Cox proportional hazards models, restricted cubic spline analyses, and stratified subgroup evaluations were performed. RESULTS: Throughout the observation period, 2110 deaths from all causes, 715 cardiovascular-related deaths, and 111 diabetes-attributed deaths were recorded. Following comprehensive covariate adjustment, low GNRI (<98) exhibited markedly higher risks of all-cause death (hazard ratio [HR]: 1.67; 95% confidence interval [CI]: 1.43, 1.96), cardiovascular death (HR: 1.61; 95% CI: 1.20, 2.13), and diabetes-associated death (HR: 2.44; 95% CI: 1.41, 4.17) relative to those with high GNRI (≥98). Non-linear relationships were detected for all-cause and cardiovascular mortality, with threshold values identified at GNRI levels of 100.5 and 98.7, respectively. The observed associations persisted consistently across the majority of demographic and clinical strata. CONCLUSIONS: Lower GNRI scores demonstrated independent associations with heightened mortality among adults with obesity. These results offer supportive evidence for incorporating nutritional risk screening into routine clinical management approaches for this patient population.
Ventricular preexcitation-induced subclinical LV dysfunction: Insights from pressure-strain loop imaging.
Li M, Chen F, Yao J … +6 more , Chen X, Wang X, Ge B, Xu F, Zhang P, Wang S
Am Heart J Plus · 2026 Jul · PMID 42238965 · Full text
BACKGROUND: Ventricular preexcitation causes subclinical LV dysfunction despite preserved LVEF. Pressure-strain loop (PSL) analysis, a novel method, sensitively quantifies myocardial work to assess such functional altera...
BACKGROUND: Ventricular preexcitation causes subclinical LV dysfunction despite preserved LVEF. Pressure-strain loop (PSL) analysis, a novel method, sensitively quantifies myocardial work to assess such functional alterations. This study evaluated global and segmental myocardial work alterations by PSL in these patients.MethodsSeventy-seven patients with ventricular preexcitation (stratified into right-AP [ = 33], left-AP [ = 16], and septal-AP [ = 28] groups) and 25 controls underwent speckle-tracking echocardiography. Global longitudinal strain (GLS) and mechanical dyssynchrony indices-the standard deviation of time-to-peak strain (PSD) and maximal temporal difference (ΔT)-were quantified. PSL analysis derived myocardial work parameters (work efficiency [WE], constructive work [CW], wasted work [WW]) at global, basal-apex, and segmental levels, with focused assessment of six basal LV segments. RESULTS: Septal AP and right AP demonstrated significantly increased global and basal-middle ventricular WW along with reduced WE compared to controls (all < 0.01). Additionally, the GLS in right AP was mildly less negative than in controls ( < 0.05). PSD and ΔT were significantly elevated in the basal-middle ventricular levels of septal and right AP compared to controls (P < 0.05). Furthermore, PSD exhibited a moderate negative correlation with GWE ( = -0.59, < 0.001). Multivariate linear regression analysis identified PSD as an independent factor associated with increased GWW (β = 1.71, = 0.03), decreased GWE (β = -0.136, < 0.001), and reduced GCW (β = -7.93, P < 0.001). CONCLUSION: PSL analysis effectively identifies subclinical left ventricular dysfunction in ventricular preexcitation patients with preserved LVEF, particularly pronounced in right-sided and septal accessory pathway subgroups. Ventricular mechanical dyssynchrony emerges as a key mechanistic contributor to these functional impairments, highlighting its pivotal role in early-stage electromechanical uncoupling.
Pregnancy and lactation as window to maternal cardiovascular health.
Chatham CE, Prewit EB, Crousillat D … +2 more , Parker AM, Louis-Jacques AF
Am Heart J Plus · 2026 Jun · PMID 42238687 · Full text
Abstract loading — click title to view on PubMed.
Leveraging natural language processing artificial intelligence for automated data extraction of ejection fraction and strain from cardiovascular imaging reports.
Brown SA, BagheriMohamadiPour M, Sparapani R … +7 more , Osinski K, Zhang J, Echefu G, Stowe I, Hamid A, Kothari A, Cardio-Oncology Artificial Intelligence Informatics Precision & Equity (CAIPE) Research Team Investigators
Am Heart J Plus · 2026 Jul · PMID 42232873 · Full text
STUDY OBJECTIVE: To determine the feasibility of using natural language processing (NLP) to extract ejection fraction (EF) and related cardiac imaging parameters for cancer survivors, across multiple imaging modalities,...
STUDY OBJECTIVE: To determine the feasibility of using natural language processing (NLP) to extract ejection fraction (EF) and related cardiac imaging parameters for cancer survivors, across multiple imaging modalities, over a 20-year period. DESIGN: Retrospective observational study applying NLP to multi-modality cardiovascular imaging reports. SETTING: Large academic medical center with electronic health records spanning 2000-2020. PARTICIPANTS: More than 4000 patients with multi-modality cardiac imaging reports, including echocardiography, nuclear cardiology, and cardiac magnetic resonance (CMR). INTERVENTIONS: Application of NLP algorithms to extract EF and related measurements from free-text cardiac imaging reports. Manual review was performed to assess and resolve discrepancies. MAIN OUTCOME MEASURES: Applicability of NLP for extracting EF across echocardiography, nuclear cardiology, and CMR reports. RESULTS: NLP successfully extracted EF values across all imaging modalities. The method demonstrated comparable performance in echocardiography, nuclear cardiology, and CMR reports. Discrepancies identified through manual review highlighted the importance of algorithm training to accommodate modality-specific terminology and improve sensitivity. CONCLUSION: NLP offers a scalable approach for extracting EF and related parameters from large volumes of unstructured imaging reports across multiple modalities. While NLP is modality-agnostic, algorithm training and manual review are essential. This approach can facilitate longitudinal analyses of cardiac function in cancer survivors and other patient populations.
The inflammatory storm: Targeting residual risk in combined ASCVD and CKD.
Mohandas R, Dass B, Ejaz AA
Am Heart J Plus · 2026 Jun · PMID 42212187 · Full text
The study by Nanna et al. in this issue leverages the National Health and Nutrition Examination Survey (NHANES) data to quantify the burden of systemic inflammation among adults with coexisting atherosclerotic cardiovasc...
The study by Nanna et al. in this issue leverages the National Health and Nutrition Examination Survey (NHANES) data to quantify the burden of systemic inflammation among adults with coexisting atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD). The authors demonstrate that 59.3% of individuals with ASCVD and CKD, representing approximately 2% of the general US adult population, have evidence of inflammation (high-sensitivity C-reactive protein >2 mg/L). We discuss the implications of these findings in the context of current guideline-directed medical therapy for CKD. We also review the potential role of specific anti-inflammatory agents, including emerging therapies. These findings strengthen the rationale for inflammation-focused risk stratification and support systemic inflammation as a central therapeutic target at the intersection of cardiovascular and kidney disease.
Imaging-defined subclinical atherosclerosis in subclinical hypothyroidism: Prevalence, associated factors, and preventive implications.
Albulushi A, Hasan MS, Alazawi RS … +11 more , Al Sarmi M, Al-Mandhari H, AlShaharli A, Hasan AS, Al-Helli Y, Allo A, Abdelazim E, Taha T, Sena A, Alhazmi AM, Alfehaid LS
Am Heart J Plus · 2026 Jun · PMID 42205860 · Full text
BACKGROUND: Subclinical hypothyroidism (SCH) has been linked to adverse cardiovascular profiles; however, the burden of subclinical atherosclerosis detected by imaging and its associated drivers remain insufficiently cha...
BACKGROUND: Subclinical hypothyroidism (SCH) has been linked to adverse cardiovascular profiles; however, the burden of subclinical atherosclerosis detected by imaging and its associated drivers remain insufficiently characterized, particularly in real-world Middle Eastern populations. OBJECTIVES: To quantify the prevalence of imaging-defined subclinical atherosclerosis in adults with SCH and to identify clinical and biochemical factors independently associated with its presence. METHODS: We conducted a cross-sectional study of 500 adults with SCH (TSH 4.5-10 mIU/L with normal free T4) evaluated at a tertiary cardiac center in Oman (December 2023-September 2025). Participants underwent fasting lipid assessment, high-sensitivity C-reactive protein (hs-CRP), carotid ultrasound (carotid plaque and intima-media thickness [CIMT]), and coronary artery calcium (CAC) scoring. The primary outcome was imaging-defined subclinical atherosclerosis, defined as the presence of at least one of the following: CIMT >1.0 mm, carotid plaque, or CAC >100. Multivariable logistic regression was performed using prespecified clinically relevant covariates, including age, sex, body mass index, metabolic syndrome, LDL-C, hs-CRP, and TSH category. RESULTS: Overall, 46% of patients demonstrated imaging-defined subclinical atherosclerosis. The prevalence of CIMT >1.0 mm, carotid plaque, and CAC >100 was 26%, 29%, and 22%, respectively. Imaging-defined subclinical atherosclerosis was substantially more frequent among individuals with metabolic syndrome (72% vs. 33%, < 0.001). In adjusted models, LDL-C > 160 mg/dL (OR 2.1, 95% CI 1.5-2.9), hs-CRP >3 mg/L (OR 1.9, 95% CI 1.4-2.5), TSH >7 mIU/L (OR 1.7, 95% CI 1.2-2.3), and metabolic syndrome (OR 2.5, 95% CI 1.8-3.5) were independently associated with imaging-defined subclinical atherosclerosis. CONCLUSIONS: Nearly half of adults with SCH exhibit imaging evidence of subclinical atherosclerosis. Higher LDL-C, systemic inflammation, higher TSH, and metabolic syndrome identified a subgroup with a disproportionately greater burden of imaging-defined subclinical atherosclerosis. These findings support a more individualized cardiometabolic risk assessment strategy in SCH and justify prospective studies evaluating whether targeted preventive strategies improve long-term outcomes.
Clinical outcomes following transcatheter aortic valve replacement in patients with concordant versus discordant aortic stenosis.
Hundal P, Abood Z, Zlochiver V … +7 more , Boulware D, Osman M, Jain R, Allaqaband S, Bajwa T, Tajik AJ, Jan MF
Am Heart J Plus · 2026 Jul · PMID 42200151 · Full text
STUDY OBJECTIVE: This study aimed to evaluate clinical outcomes of patients with symptomatic discordant (aortic stenosis) AS following transcatheter aortic valve replacement (TAVR). DESIGN: This is a retrospective cohort...
STUDY OBJECTIVE: This study aimed to evaluate clinical outcomes of patients with symptomatic discordant (aortic stenosis) AS following transcatheter aortic valve replacement (TAVR). DESIGN: This is a retrospective cohort study. SETTING: Patients who underwent a TAVR for severe symptomatic native AS with preserved left ventricular ejection fraction ≥50% from 2012 to 2022 at our institution were included. PARTICIPANTS: Patients were divided into two cohorts, concordant AS (met all AS criteria) and discordant AS (< 3 criteria). INTERVENTIONS: TAVR. MAIN OUTCOMES MEASURES: The primary endpoint was all cause mortality and secondary outcomes were hospital readmissions for myocardial infarction (MI) and stroke. RESULTS: This study evaluated 2021 patients; the median age was 82.6 (77.0-87.2) years, and 53% were female. There was no difference in long-term mortality between discordant or concordant AS (HR: 0.89 [95% CI: 0.77-1.02]; = 0.09). However, the discordant group had a higher 1-year mortality rate than the concordant group (14.5% vs 10.1%, respectively; = 0.0054) and comparable mortality rates at 5 years (52.0% vs 50.5%, respectively; = 0.18). The long-term readmission rate for MI was higher for the discordant group (HR: 0.47 [95% CI: 0.27-0.80]; = 0.005), and there was no difference in readmission for stroke or transient ischemic attack (HR: 1.33 [95% CI: 0.92-1.94]; = 0.133). CONCLUSIONS: Patients with symptomatic severe AS with discordant echocardiographic findings may have similar survival outcomes than those with concordant AS after undergoing TAVR.
Interleukin-17, Interleukin-18, T Regulatory Cells, and T-Helper 17 (Th17) Cells Play a Role in Heart Failure: A Systematic Review and Meta-Analysis.
Sharma S, Seth J, Leong CJ … +1 more , Rabkin SW
Cardiol Res Pract · 2026 · PMID 42199693 · Full text
BACKGROUND: The objective of this study was to assess whether interleukin-17 or 18 (IL-17 or IL-18), regulatory T cells (Tregs), and T helper17 (Th17) serum concentrations were different in chronic heart failure not asso...
BACKGROUND: The objective of this study was to assess whether interleukin-17 or 18 (IL-17 or IL-18), regulatory T cells (Tregs), and T helper17 (Th17) serum concentrations were different in chronic heart failure not associated with myocarditis compared to healthy individuals. METHODS: We searched MEDLINE and Embase for studies with data on IL-17 or IL-18 serum concentrations in patients with chronic heart failure. Forest plots were used to quantify results and depict the standard difference of means, 95% confidence interval (CI), and value. Continuous outcomes were assessed as weighted mean differences (WMD) with their 95% CI. RESULTS: IL-17 was significantly ( < 0.05) higher in patients with heart failure. The combined effect size under the random effects model (MD = 40.00 pg/mL, 95% CI [6.04, 73.96], < 0.001) showed a significant overall increase in IL-17 serum levels in heart failure. Th17 was significantly ( < 0.05) higher in patients with heart failure, and Tregs are significantly lower compared to persons without heart failure. The random effects model indicates an MD of 1.59 pg/mL (95% CI [0.88, 2.30]), highlighting significant elevation of TH17 levels in heart failure. For Tregs, the random effects model presented an MD of -2.96 pg/mL (95% CI [-4.52, -1.40]), both indicating a significant decrease in Treg levels in HF. Additionally, serum IL-17 concentrations correlated with the severity of the reduction in LV ejection fraction. For IL-18, all (five) studies reported a statistically significant increase in IL-18 levels in HF. The pooled mean difference was 251.59 pg/mL (95% CI: 177.24-325.93 pg/mL) with a random effects model. CONCLUSION: Serum IL-17, IL-18 Th17, and Treg count have utility for risk stratification for patients with heart failure, as biomarkers for heart failure severity and potential target pathways for treatment.
Combined effects of heavy metals and volatile organic compounds on oxidative stress and cardiovascular risk.
Scardino B, Xing D, Agrawal A … +7 more , Bhuiyan MS, Conrad SA, Vanchiere JA, Bhuiyan MMR, Orr AW, Kevil CG, Bhuiyan MAN
Am Heart J Plus · 2026 Jun · PMID 42199297 · Full text
BACKGROUND: Oxidative stress contributes to early cardiovascular disease (CVD) but is rarely assessed clinically. Oxidative balance score (OBS) summarizes pro-/antioxidant factors, yet its relevance to CVD is understudie...
BACKGROUND: Oxidative stress contributes to early cardiovascular disease (CVD) but is rarely assessed clinically. Oxidative balance score (OBS) summarizes pro-/antioxidant factors, yet its relevance to CVD is understudied. Additionally, pollutants such as heavy metals (HMs) and volatile organic compounds (VOCs) raise oxidative stress but are often studied individually, limiting real-world applicability. The study aims to determine associations of HM + VOC exposures with OBS, and OBS with CVD. METHODS: We analyzed NHANES 2011-2020 adults aged ≥20. Exposure to HMs + VOCs was determined via urine metabolites. OBS was calculated using 24-h dietary recall, physical activity, BMI, and serum cotinine. Associations between OBS and HM + VOC exposure were assessed using quantile g-computation and Bayesian Kernel Machine Regression, with subgroup analyses for age, sex, race/ethnicity, and monthly poverty level index. The relationship between OBS and CVD was determined via adjusted logistic regression, and mediation between OBS and CVD by various atherogenic indices was tested. RESULTS: Among 6516 participants, higher OBS (lower oxidative stress) was associated with lower odds of CVD (OR = 0.969), with significant mediation via atherogenic indices. Combined HM + VOC exposure was significantly associated with reduced OBS (higher oxidative stress) with stronger associations among those who were female, aged 20-59, Mexican American, Non-Hispanic Asian, and with the highest income. Cadmium, -acetyl-S-(2-hydroxyethyl)-L-cysteine, and -acetyl-S-(2-carbamoyl-2-hydroxyethyl)-L-cysteine showed the strongest inverse associations with OBS. CONCLUSION: HM + VOC mixture exposure was significantly associated with OBS, indicating increased oxidative stress as pollutant exposure increases. Higher OBS was significantly associated with lower odds of CVD. Future studies should investigate causal mechanisms underlying pollutants, OBS, and CVD.
Patient characteristics and incidence of in-hospital events in spontaneous coronary artery dissection and suspected concurrent Takotsubo syndrome: A report of the iSCAD registry.
Chi G, Kim ESH, Gornik HL … +19 more , Grodzinsky A, Wells BJ, Lewey J, Kadian-Dodov D, Taylor AM, Hess CN, Tam LM, Mauricio R, Henkin S, Lindley KJ, Orford JL, Tolani S, Alkhalfan F, Reyes C, Gibson CM, Leon KK, Naderi S, Scott NS, Wood MJ
Am Heart J Plus · 2026 Jun · PMID 42199296 · Full text
BACKGROUND AND OBJECTIVES: Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are both more common in middle-aged women and often share similar triggers, such as emotional or physical stress. This...
BACKGROUND AND OBJECTIVES: Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are both more common in middle-aged women and often share similar triggers, such as emotional or physical stress. This study aimed to examine the characteristics and in-hospital prognosis of patients with SCAD and possible concomitant TTS. METHODS: Patients from the iSCAD Registry with completed questionnaires, case report forms, and available coronary angiography and ventriculography adjudicated by a core lab were included. In the absence of follow-up imaging confirming resolution of the wall motion abnormalities a definitive diagnosis of TTS cannot be established, therefore this pattern will be referred to throughout the manuscript as TTS-like angiographic pattern (TVP). Coexistent TVP was defined by classic apical ballooning or wall motion abnormalities discordant with the dissected coronary territory. In-hospital events included recurrent myocardial infarction (MI), cerebrovascular accident, heart failure (HF) requiring diuretics, and new arrhythmias. Patient characteristics and in-hospital events were compared between TVP and non-TVP groups. RESULTS: Among 259 study participants, 44 (17.0%) were identified with coexistent TVP. There were no significant differences in age, cardiovascular risk factors, anxiety or depression history, recreational substance use, emotional or physical stressors, or extracoronary vascular abnormalities between the TVP and non-TVP groups. Patients with TVP were more likely to present with ST-segment elevation MI, left ventricular dysfunction, left anterior descending artery involvement, and abnormal myocardial perfusion compared to non-TVP patients. Furthermore, TVP patients had a higher incidence of experiencing in-hospital events (34.1% vs. 13.1%; < 0.001), primarily driven by new arrhythmias (21.4% vs. 6.4%; = 0.002) and HF (10.0% vs. 2.0%; = 0.010). After multivariable adjustment, coexistent TVP remained associated with in-hospital events. CONCLUSIONS: In this SCAD cohort, patients with concurrent TVP had a greater risk of new arrhythmias or HF during hospitalization. STUDY REGISTRATION: URL: http://www.clinicaltrials.gov. Identifier: NCT04496687.
Tolerability of SGLT2 inhibitors in patients with Fabry disease: An observational study.
Mattig I, Zirkelbach B, Bonnekoh C … +5 more , Stangl K, Hindricks G, Knebel F, Canaan-Kühl S, Spethmann S
Am Heart J Plus · 2026 Jun · PMID 42180598 · Full text
Cardiac involvement of Fabry disease (FD) includes heart failure (HF) treated according to general guideline recommendations. The retrospective study investigates HF medication in FD focusing on sodium glucose cotranspor...
Cardiac involvement of Fabry disease (FD) includes heart failure (HF) treated according to general guideline recommendations. The retrospective study investigates HF medication in FD focusing on sodium glucose cotransporter 2 (SGLT2) inhibitors. HF medication, laboratory and echocardiographic measurements as well as side effects of SGLT2 inhibitors were analyzed at baseline and the last available follow-up. The analysis included 99 FD patients treated with angiotensin converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blocker (ARB) (50%), beta-blocker (31%), SGLT2 inhibitors (20%), diuretics (12%), angiotensin receptor-neprilysin inhibitors (ARNI) (2%), and mineralocorticoid receptor antagonists (MRA) (1%). After 663 (457-725) days, 15 FD patients treated with SGLT2 inhibitors showed stable cardiac and renal biomarkers. Echocardiographic parameters did not reveal a consistent pattern: Left ventricular ejection fraction (LVEF) showed a slight decrease in the SGLT2 inhibitor group and a significant reduction in patients without SGLT2 inhibitors. Left atrial volume index (LAVI) and tricuspid annular plane systolic excursion (TAPSE) showed an upward trend in the SGLT2 inhibitor group, whereas LAVI declined and TAPSE remained unchanged in patients without SGLT2 inhibitors. After propensity score matching, there were no inter- or intragroup differences. The most common side effects comprised polyuria, hypovolemia, and vertigo. Overall, these exploratory findings suggest an acceptable safety profile of SGLT2 inhibitors in this FD cohort, without allowing clear conclusions regarding clinical benefit.
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