Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.1932
S Lalani, M Yordanova, M D'angelo, N Bottega
Background Worldwide, cardiovascular disease remains a primary cause of death, with notable differences between sexes. While sex differences in Type 1 myocardial infarction (T1MI) are well recognized, those in Type 2 myocardial infarction (T2MI) are less understood and may influence clinical practice and provide valuable prognostic insights. Purpose We aimed to provide a comprehensive overview of sex-based differences in incidence, comorbidities, clinical management, and outcomes of T2MI. Methods A systematic-scoping review of retrospective and prospective studies examining the differences in T2MI by sex was conducted by three-independent reviewers. Six databases were included in the search strategy (Web of Science, OVID, SCOPUS, EMBASE, CINAHL, PUBMED), and were last searched on November 29, 2024. Pooled odds ratios (OR) with 95% confidence interval (CI) of T2MI gender differences were calculated using aggregated meta-analyses in Stata. Results The search strategy resulted in 1388 articles and 28 studies were included after the full-text screening (Figure 1). Thirteen of these were included in the meta-analysis on the likelihood of T2MI by gender, with 3,292,727 participants in total (618,535 T2MI, of which 47.5% were female). Meta-analysis displayed that men were significantly less likely than women to have T2MI (OR 0.69; 95% CI, 0.63-0.74; P<0.001) (Figure 2). Women with T2MI were generally older and had a higher prevalence of hypertension than men (n=5). While some studies found higher diabetes rates in men (n=2), others reported a greater history of prior PCI or CABG in this group (n=4). Coronary artery disease (CAD) was less frequently observed on angiography in women (n=3) compared to men. Mortality, both short- and long-term, was higher in men (n=4), though one study contradicted this finding (n=1). Although data on treatment differences were limited, some evidence suggested greater ASA use in men (n=2). Conclusion This is the first comprehensive overview of sex-based differences in T2MI. Our study demonstrated that T2MIs are more prevalent in females, highlighting key differences among genders. In sum, data is limited, and further research is needed on gender-specific factors in T2MI to improve diagnosis, management, and mortality rates.Figure 1:PRISMA Diagram Figure 2:Forest plot of unadjusted odd
在世界范围内，心血管疾病仍然是死亡的主要原因，性别之间存在显著差异。虽然1型心肌梗死（T1MI）的性别差异是公认的，但2型心肌梗死（T2MI）的性别差异知之甚少，可能影响临床实践并提供有价值的预后见解。目的：我们旨在全面概述T2MI在发病率、合并症、临床管理和结局方面的性别差异。方法由三名独立评论者对T2MI的性别差异进行回顾性和前瞻性研究的系统综述。6个数据库被纳入检索策略（Web of Science、OVID、SCOPUS、EMBASE、CINAHL、PUBMED），最后一次检索时间为2024年11月29日。使用Stata的汇总meta分析计算T2MI性别差异的合并优势比（OR）和95%置信区间（CI）。全文筛选后，共纳入1388篇文献，其中28篇研究（图1）。其中13人被纳入了按性别划分的T2MI可能性的荟萃分析，共有3292727名参与者（618535名T2MI患者，其中47.5%为女性）。荟萃分析显示，男性患T2MI的可能性明显低于女性（OR 0.69; 95% CI, 0.63-0.74; P<0.001）（图2）。女性T2MI患者一般年龄较大，高血压患病率高于男性（n=5）。虽然一些研究发现男性糖尿病发病率较高（n=2），但其他研究报告了该组患者既往PCI或CABG病史较高（n=4）。与男性相比，冠状动脉疾病（CAD）在女性血管造影中较少被观察到（n=3）。男性的短期和长期死亡率都较高（n=4），尽管一项研究与此发现相矛盾（n=1）。虽然关于治疗差异的数据有限，但一些证据表明，男性使用ASA更多（n=2）。结论：本文首次对T2MI的性别差异进行了全面综述。我们的研究表明，t2mi在女性中更为普遍，突出了性别之间的关键差异。总之，数据有限，需要进一步研究T2MI的性别因素，以改善诊断、管理和死亡率。图1:PRISMA图2：未调整奇数的森林样地
{"title":"A systematic-scoping review on sex-based differences in type-2 myocardial infarction (T2MI)","authors":"S Lalani, M Yordanova, M D'angelo, N Bottega","doi":"10.1093/eurheartj/ehaf784.1932","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.1932","url":null,"abstract":"Background Worldwide, cardiovascular disease remains a primary cause of death, with notable differences between sexes. While sex differences in Type 1 myocardial infarction (T1MI) are well recognized, those in Type 2 myocardial infarction (T2MI) are less understood and may influence clinical practice and provide valuable prognostic insights. Purpose We aimed to provide a comprehensive overview of sex-based differences in incidence, comorbidities, clinical management, and outcomes of T2MI. Methods A systematic-scoping review of retrospective and prospective studies examining the differences in T2MI by sex was conducted by three-independent reviewers. Six databases were included in the search strategy (Web of Science, OVID, SCOPUS, EMBASE, CINAHL, PUBMED), and were last searched on November 29, 2024. Pooled odds ratios (OR) with 95% confidence interval (CI) of T2MI gender differences were calculated using aggregated meta-analyses in Stata. Results The search strategy resulted in 1388 articles and 28 studies were included after the full-text screening (Figure 1). Thirteen of these were included in the meta-analysis on the likelihood of T2MI by gender, with 3,292,727 participants in total (618,535 T2MI, of which 47.5% were female). Meta-analysis displayed that men were significantly less likely than women to have T2MI (OR 0.69; 95% CI, 0.63-0.74; P&lt;0.001) (Figure 2). Women with T2MI were generally older and had a higher prevalence of hypertension than men (n=5). While some studies found higher diabetes rates in men (n=2), others reported a greater history of prior PCI or CABG in this group (n=4). Coronary artery disease (CAD) was less frequently observed on angiography in women (n=3) compared to men. Mortality, both short- and long-term, was higher in men (n=4), though one study contradicted this finding (n=1). Although data on treatment differences were limited, some evidence suggested greater ASA use in men (n=2). Conclusion This is the first comprehensive overview of sex-based differences in T2MI. Our study demonstrated that T2MIs are more prevalent in females, highlighting key differences among genders. In sum, data is limited, and further research is needed on gender-specific factors in T2MI to improve diagnosis, management, and mortality rates.Figure 1:PRISMA Diagram Figure 2:Forest plot of unadjusted odd","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"89 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.4452
D Hu, K Liu, K E Mangold, T Wagner, S Awasthi, J C Cruz, M K Ranganathan, A J Deshmukh, F Lopez-Jimenez, P A Friedman, P A Noseworthy, Z I Attia
Background Artificial intelligence (AI) models trained on 12-lead ECGs effectively detect left ventricular systolic dysfunction (LVSD; left ventricular ejection fraction [LVEF] <=40%). Continuous ECG monitoring via Holter recordings provides an opportunity for opportunistic screening for structural heart disease beyond rhythm disorders. We hypothesized that a lead-invariant version of the 12-lead AI model would enable a Holter monitor to screen for both arrhythmias and ventricular dysfunction. Methods We retrospectively analyzed continuous Holter ECGs from 17,665 patients who underwent a Holter and transthoracic echocardiogram (TTE) within 30 days of each other at Mayo Clinic. From each Holter, a random 20-minute of valid (non-flatline/lead disconnect) ECG segment was extracted and analyzed for LVSD detection using the adapted lead-invariant AI model. To evaluate stability, we examined model performance across different time points of the day, presenting results as area under the receiver operating characteristic curve (AUC) over time. Moreover, we illustrated the model’s robustness to noisy data by comparing its performance on raw ECG signals with that on bandpass-filtered inputs. Results Among 17,665 patients (mean age 59 years, 48.57% female), 4.96% had an LVEF <=40%. The AI model demonstrated strong predictive performance (20-minute segment AUC 0.90, mean prediction of 24-hour AUC 0.92). Analysis of results over time (Figure) revealed temporal patterns in predictive accuracy, with specific time periods showing greater stability. Despite modest variability, model performance remained consistently high throughout the day, confirming robustness across different physiological states. The predictions remained robust with noisy input. We did not observe performance improvement when the baseline wander and high frequency noise are removed by the bandpass filter. Conclusion Applying a 12-lead AI ECG model with a lead-invariant framework to a continuous Holter ECG enables effective screening for left ventricular dysfunction. This suggests that AI-based analysis of Holter-monitors can facilitate opportunistic screening of ventricular dysfunction and may enable assessment of an arrhythmia’s impact on LVEF, as well as the relationship between arrhythmia burden and LVEF.Figure 1.Mean prediction AUC of the day Figure 2.AUC for different time point
{"title":"Adapting AI for 24/7 ECG monitoring: Holter-based detection of LV dysfunction","authors":"D Hu, K Liu, K E Mangold, T Wagner, S Awasthi, J C Cruz, M K Ranganathan, A J Deshmukh, F Lopez-Jimenez, P A Friedman, P A Noseworthy, Z I Attia","doi":"10.1093/eurheartj/ehaf784.4452","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4452","url":null,"abstract":"Background Artificial intelligence (AI) models trained on 12-lead ECGs effectively detect left ventricular systolic dysfunction (LVSD; left ventricular ejection fraction [LVEF] &lt;=40%). Continuous ECG monitoring via Holter recordings provides an opportunity for opportunistic screening for structural heart disease beyond rhythm disorders. We hypothesized that a lead-invariant version of the 12-lead AI model would enable a Holter monitor to screen for both arrhythmias and ventricular dysfunction. Methods We retrospectively analyzed continuous Holter ECGs from 17,665 patients who underwent a Holter and transthoracic echocardiogram (TTE) within 30 days of each other at Mayo Clinic. From each Holter, a random 20-minute of valid (non-flatline/lead disconnect) ECG segment was extracted and analyzed for LVSD detection using the adapted lead-invariant AI model. To evaluate stability, we examined model performance across different time points of the day, presenting results as area under the receiver operating characteristic curve (AUC) over time. Moreover, we illustrated the model’s robustness to noisy data by comparing its performance on raw ECG signals with that on bandpass-filtered inputs. Results Among 17,665 patients (mean age 59 years, 48.57% female), 4.96% had an LVEF &lt;=40%. The AI model demonstrated strong predictive performance (20-minute segment AUC 0.90, mean prediction of 24-hour AUC 0.92). Analysis of results over time (Figure) revealed temporal patterns in predictive accuracy, with specific time periods showing greater stability. Despite modest variability, model performance remained consistently high throughout the day, confirming robustness across different physiological states. The predictions remained robust with noisy input. We did not observe performance improvement when the baseline wander and high frequency noise are removed by the bandpass filter. Conclusion Applying a 12-lead AI ECG model with a lead-invariant framework to a continuous Holter ECG enables effective screening for left ventricular dysfunction. This suggests that AI-based analysis of Holter-monitors can facilitate opportunistic screening of ventricular dysfunction and may enable assessment of an arrhythmia’s impact on LVEF, as well as the relationship between arrhythmia burden and LVEF.Figure 1.Mean prediction AUC of the day Figure 2.AUC for different time point","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"87 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.1547
A Bielka, M Kalinowski, R Antonczyk, M Herdynska-Was, T Hrapkowicz, P Przybylowski
Introduction Owing to increasing numbers of heart failure (HF) patients (pts) the need for left ventricular assist device (LVAD) expands. Although this therapy improves survival in severe HF pts it is not free from limitations. Background The purpose of this study was to analyze outcomes of fully magnetically levitated LVAD implantations in our institution. Methods We retrospectively analyzed data of all consecutive 113 HeartMate3 LVAD pts (90% male; mean age-56 y; mean BMI- 28.1; median INTERMACS profile -3.1, other patient characteristics depicted in Table 1) implanted in our institution within years 2016-2024. The mean time of LVAD support was 833 days (median 619, range 1-2837). The probability of survival (Kaplan-Meier) was 0.88; 0.77; 0.69; 0.54; 0.4; 0.31 and 0.23 for 1,6,12,24,36,48, 60 months respectively (Figure 1). Patients were followed to death, heart transplantation, LVAD explantation or to the end of observation in our institution. 26 pts (23%) were transplanted, 52(46%) died during LVAD support and no pumps were explanted or de-activated. Results Early right ventricular failure (RVF) occurred in 32 (28% ) of pts, while late RVF only in 9 (8%). Right ventricular assist device (RVAD) was used in 10 pts(9%); concomitant valvular surgery was performed in 16 pts(14%). Drive-line infection (DLI), defined as at least one positive wound culture, was found in 47 pts(42%), while recurrent DLI in 36 pts( 32%). At least one positive blood culture during LVAD support occurred in 34 pts(30%). Ischemic stroke (IS) affected 11 pts(10%), hemorrhagic stroke (HS) – 7 pts(6%), gastrointestinal bleeding (GIB) - 13 pts(11%), pump thrombosis - 1 patient, outflow graft obstruction (OGO) - 3 pts(2.6% ). Mean time to death was 484 days (median 202, range 1-2446), while time to first positive drive-line wound culture - 571 (median 452, range 11-2043), time to first positive blood culture- 362 (median 41, range 5-2504), to IS- 82 (median 1 day, range 0-830); HS- 693 (median 449, range 5-2444), GIB- 297 (median 49, range 3-1227). We found statistically significant correlations (by use of log-rank test) between death during LVAD support and ischemic HF, HS, GIB, early and late RVF, RVAD use, DLI or recurrent DLI ( p respectively: 0.012, 0.019, 0.044, 0.006, 0.009, <0.001, 0.033, 0.01). No statistically significant relations were found between death and non-ischemic HF, IS, positive blood culture during LVAD support and concomitant valvular procedure at LVAD implantation ( p respectively: 0.72, 0.57, 0.49, 0.074). Conclusions Despite evident progress of LVAD support outcomes and significant reduction of hemocompatibility related events with fully magnetically levitated pumps, DLI and early RVF still remain major complications while hemorrhagic adverse events have a negative impact on survival of LVAD recipients. Further research is needed to achieve improvement in this area including establishment of optimal antithrombotic therapy and device innovations.
{"title":"Real-world long-term one-centre experience with the use of 113 fully magnetically levitated continuous flow left ventricular assist devices","authors":"A Bielka, M Kalinowski, R Antonczyk, M Herdynska-Was, T Hrapkowicz, P Przybylowski","doi":"10.1093/eurheartj/ehaf784.1547","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.1547","url":null,"abstract":"Introduction Owing to increasing numbers of heart failure (HF) patients (pts) the need for left ventricular assist device (LVAD) expands. Although this therapy improves survival in severe HF pts it is not free from limitations. Background The purpose of this study was to analyze outcomes of fully magnetically levitated LVAD implantations in our institution. Methods We retrospectively analyzed data of all consecutive 113 HeartMate3 LVAD pts (90% male; mean age-56 y; mean BMI- 28.1; median INTERMACS profile -3.1, other patient characteristics depicted in Table 1) implanted in our institution within years 2016-2024. The mean time of LVAD support was 833 days (median 619, range 1-2837). The probability of survival (Kaplan-Meier) was 0.88; 0.77; 0.69; 0.54; 0.4; 0.31 and 0.23 for 1,6,12,24,36,48, 60 months respectively (Figure 1). Patients were followed to death, heart transplantation, LVAD explantation or to the end of observation in our institution. 26 pts (23%) were transplanted, 52(46%) died during LVAD support and no pumps were explanted or de-activated. Results Early right ventricular failure (RVF) occurred in 32 (28% ) of pts, while late RVF only in 9 (8%). Right ventricular assist device (RVAD) was used in 10 pts(9%); concomitant valvular surgery was performed in 16 pts(14%). Drive-line infection (DLI), defined as at least one positive wound culture, was found in 47 pts(42%), while recurrent DLI in 36 pts( 32%). At least one positive blood culture during LVAD support occurred in 34 pts(30%). Ischemic stroke (IS) affected 11 pts(10%), hemorrhagic stroke (HS) – 7 pts(6%), gastrointestinal bleeding (GIB) - 13 pts(11%), pump thrombosis - 1 patient, outflow graft obstruction (OGO) - 3 pts(2.6% ). Mean time to death was 484 days (median 202, range 1-2446), while time to first positive drive-line wound culture - 571 (median 452, range 11-2043), time to first positive blood culture- 362 (median 41, range 5-2504), to IS- 82 (median 1 day, range 0-830); HS- 693 (median 449, range 5-2444), GIB- 297 (median 49, range 3-1227). We found statistically significant correlations (by use of log-rank test) between death during LVAD support and ischemic HF, HS, GIB, early and late RVF, RVAD use, DLI or recurrent DLI ( p respectively: 0.012, 0.019, 0.044, 0.006, 0.009, &lt;0.001, 0.033, 0.01). No statistically significant relations were found between death and non-ischemic HF, IS, positive blood culture during LVAD support and concomitant valvular procedure at LVAD implantation ( p respectively: 0.72, 0.57, 0.49, 0.074). Conclusions Despite evident progress of LVAD support outcomes and significant reduction of hemocompatibility related events with fully magnetically levitated pumps, DLI and early RVF still remain major complications while hemorrhagic adverse events have a negative impact on survival of LVAD recipients. Further research is needed to achieve improvement in this area including establishment of optimal antithrombotic therapy and device innovations.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"17 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.396
A Borrow, C Chen, V Caso, R Smolnik, J Antonio Gordillo De Souza, R De Caterina, M Unverdorben
Introduction Clinical practice guidelines are intended to improve patients’ outcomes by helping clinicians make the best evidence-based decisions in a time-efficient manner. The ESC Clinical Practice Guidelines for the management of atrial fibrillation (AF), revised in 2024, provide updated recommendations for the diagnosis and management of AF. Purpose To assess physicians’ reactions to and adoption of the 2024 guidelines for the management of AF and to identify remaining unanswered practical, clinical questions. Methods A 4-question poll was conducted between 4 November–4 December 2024 on the social media news feed of registered users of a closed, physician-only, social media platform. Registered platform users from 10 European and 4 Asian countries who were cardiologists, neurologists, or primary care physicians (PCPs) were asked about the importance of the new ESC guidelines for their own clinical practice, guideline topics of greatest interest, remaining uncertainties/unanswered clinical questions about AF and direct oral anticoagulant (DOAC) management, and preferred sources for clinical decision-making. Poll participation was voluntary and no financial compensation was provided to respondents. Descriptive analyses of responses were performed by speciality and by country, and responses to questions permitting multiple answers were rank ordered by proportion of respondents. Results A total of 433 physicians responded to the poll (26% cardiologists, 7% neurologists, 67% PCPs). Respondents were from Spain (33%), Germany (23%), Italy (18%), France (14%), and China (6%). Nearly all respondents (91%; N=417) considered the guidelines as very important or important for their clinical practice (very important: 76% cardiologists, 48% neurologists, 57% PCPs; important: 19% cardiologists, 45% neurologists, 32% PCPs). The 3 specialties (N=344) were largely aligned in their topics of interest, with greatest interest in comorbidity/risk factor management (Figure 1a). By specialty, cardiologists were most interested in CHA2DS2-VASc vs CHA2DS2-VA, neurologists in recommended DOAC dosing, and PCPs in rate vs rhythm control. Across specialties (N=262), the most common remaining uncertainties/unanswered clinical questions were for patients who were very elderly and/or frail, have chronic kidney disease/renal impairment, or have cancer (Figure 1b). Clinical guidelines (European and local), review articles, and congress-based information (both from congress and symposia attendance) were the most useful sources of information for clinical decision-making (N=268; Figure 2). Conclusions The 2024 ESC Clinical Practice Guidelines for AF management were considered important and useful for clinical practice by almost all respondents. Of particular interest were topics related to risk factor management, symptom control, and DOAC dosing. Additional guidance would be welcome on the management of patients with AF in high-risk groups.
{"title":"The 2024 ESC Guidelines for the Management of Atrial Fibrillation serve physicians well but leave a few questions unanswered: a social media-based poll of 433 European and Asian physicians","authors":"A Borrow, C Chen, V Caso, R Smolnik, J Antonio Gordillo De Souza, R De Caterina, M Unverdorben","doi":"10.1093/eurheartj/ehaf784.396","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.396","url":null,"abstract":"Introduction Clinical practice guidelines are intended to improve patients’ outcomes by helping clinicians make the best evidence-based decisions in a time-efficient manner. The ESC Clinical Practice Guidelines for the management of atrial fibrillation (AF), revised in 2024, provide updated recommendations for the diagnosis and management of AF. Purpose To assess physicians’ reactions to and adoption of the 2024 guidelines for the management of AF and to identify remaining unanswered practical, clinical questions. Methods A 4-question poll was conducted between 4 November–4 December 2024 on the social media news feed of registered users of a closed, physician-only, social media platform. Registered platform users from 10 European and 4 Asian countries who were cardiologists, neurologists, or primary care physicians (PCPs) were asked about the importance of the new ESC guidelines for their own clinical practice, guideline topics of greatest interest, remaining uncertainties/unanswered clinical questions about AF and direct oral anticoagulant (DOAC) management, and preferred sources for clinical decision-making. Poll participation was voluntary and no financial compensation was provided to respondents. Descriptive analyses of responses were performed by speciality and by country, and responses to questions permitting multiple answers were rank ordered by proportion of respondents. Results A total of 433 physicians responded to the poll (26% cardiologists, 7% neurologists, 67% PCPs). Respondents were from Spain (33%), Germany (23%), Italy (18%), France (14%), and China (6%). Nearly all respondents (91%; N=417) considered the guidelines as very important or important for their clinical practice (very important: 76% cardiologists, 48% neurologists, 57% PCPs; important: 19% cardiologists, 45% neurologists, 32% PCPs). The 3 specialties (N=344) were largely aligned in their topics of interest, with greatest interest in comorbidity/risk factor management (Figure 1a). By specialty, cardiologists were most interested in CHA2DS2-VASc vs CHA2DS2-VA, neurologists in recommended DOAC dosing, and PCPs in rate vs rhythm control. Across specialties (N=262), the most common remaining uncertainties/unanswered clinical questions were for patients who were very elderly and/or frail, have chronic kidney disease/renal impairment, or have cancer (Figure 1b). Clinical guidelines (European and local), review articles, and congress-based information (both from congress and symposia attendance) were the most useful sources of information for clinical decision-making (N=268; Figure 2). Conclusions The 2024 ESC Clinical Practice Guidelines for AF management were considered important and useful for clinical practice by almost all respondents. Of particular interest were topics related to risk factor management, symptom control, and DOAC dosing. Additional guidance would be welcome on the management of patients with AF in high-risk groups.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"24 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.2924
Y Kim, J Lim, S Bang, H Shin, J Yang, I Kang, J Song, H Kim, D Kim, S Chang
Background The role of prostacyclin is critical in pulmonary arterial hypertension (PAH) and parenteral prostacyclin is an essential treatment option for high-risk patients. However, its real-world utilization remains limited due to physician unfamiliarity and high costs. Comprehensive analysis of real-world treprostinil use has been scarce. Purpose This study aimed to investigate the treatment patterns and clinical response to treprostinil in real-world practice. Methods Patients prescribed treprostinil for PAH from 2011 to 2024 at two tertiary referral centers were identified. Clinical characteristics, treatment response and survival outcomes were analyzed. We categorized the study populations into three groups based on the timing of treprostinil initiation: optimal sequential combination therapy (when the patient reached intermediate to high risk), early triple combination (in high-risk patients), and delayed sequential combination therapy (delayed initiation of treprostinil in already diagnosed PAH when they reached the functional class IV or definite indication for lung transplantation). Results A total of 94 patients were identified, with 35 (37.2%) in optimal sequential combination therapy group, 12 (12.8%) in early triple combination therapy group, and 47 (50.0%) in delayed sequential combination therapy group. Hemodynamic characteristics and risk profiles for PAH were similar among the study groups except for functional class. The cumulative 1-year mortality rate in the overall population was 35.1%. 1-year mortality was significantly higher in delayed sequential combination therapy group (53.2%) compared to optimal sequential combination therapy group (20.0%) and early triple combination therapy group (8.3%) (p<0.001). Optimal sequential combination and early triple combination therapy over delayed sequential combination therapy were identified as independent predictor for death at 1 year (adjusted HR 0.239, 95% CI 0.096-0.599, p=0.002; adjusted HR 0.107, 95% CI 0.014-0.811, p=0.031). The treatment response to treprostinil was significantly lower in the delayed sequential combination therapy group (40.4%) compared to the optimal sequential combination (85.7%) and early triple combination therapy group (75.0%) (p<0.001). Optimal sequential combination and early triple combination therapy were associated with higher rates of successful transition to oral maintenance therapy (40.0% and 91.7%, respectively), whereas 8.5% of patients in the delayed sequential combination therapy group maintained therapy (p<0.001). Conclusions Although the guideline recommends the optimal timing for intervention with parenteral prostacyclin, it is frequently delayed in real-world clinics. Treatment outcomes show dramatic differences based on the timing—early, optimal, and delayed. Furthermore, a transition to an oral IP3 receptor agonist was even possible for some patients who survived due to early intervention with parenteral prostacyclin
背景：前列环素在肺动脉高压（PAH）中的作用至关重要，对于高危患者，肠外注射前列环素是必不可少的治疗选择。然而，由于医生的不熟悉和高昂的成本，其在现实世界中的应用仍然有限。对真实世界曲前列汀使用情况的综合分析很少。目的本研究旨在探讨现实世界中曲前列氨酯的治疗模式和临床反应。方法对2011 - 2024年在两家三级转诊中心使用曲前列替尼治疗PAH的患者进行分析。分析两组患者的临床特点、治疗效果及生存结局。我们根据曲前列替尼起始时间将研究人群分为三组：最佳序贯联合治疗（当患者达到中高风险时）、早期三联治疗（高危患者）和延迟序贯联合治疗（当已诊断为PAH的患者达到功能级IV或明确的肺移植指证时延迟曲前列替尼起始治疗）。结果94例患者中，最佳顺序联合治疗组35例（37.2%），早期三联治疗组12例（12.8%），延迟顺序联合治疗组47例（50.0%）。除功能组别外，各研究组的血流动力学特征和多环芳烃风险概况相似。总体人群1年累计死亡率为35.1%。延迟顺序联合治疗组的1年死亡率（53.2%）明显高于最佳顺序联合治疗组（20.0%）和早期三联治疗组（8.3%）（p<0.001）。最佳序贯组合和早期三联治疗优于延迟序贯组合治疗是1年死亡的独立预测因子（调整后HR 0.239, 95% CI 0.096 ~ 0.599, p=0.002；调整后HR 0.107, 95% CI 0.014 ~ 0.811, p=0.031）。延迟顺序联合治疗组对曲前列地尼的治疗反应（40.4%）明显低于最佳顺序联合治疗组（85.7%）和早期三联治疗组（75.0%）（p<0.001）。最佳顺序联合治疗和早期三联治疗与较高的成功过渡到口服维持治疗的比例相关（分别为40.0%和91.7%），而延迟顺序联合治疗组的患者维持治疗的比例为8.5% （p<0.001）。结论：尽管指南建议肠外注射前列环素干预的最佳时机，但在现实世界的临床中，它经常被推迟。治疗结果根据治疗时间的不同表现出显著差异——早期、最佳和延迟。此外，对于一些由于早期肠外注射前列环素干预而存活的患者，甚至可能过渡到口服IP3受体激动剂。
{"title":"Dramatic differences resulting from treatment timing of treprostinil in high-risk patients: a real-world data analysis","authors":"Y Kim, J Lim, S Bang, H Shin, J Yang, I Kang, J Song, H Kim, D Kim, S Chang","doi":"10.1093/eurheartj/ehaf784.2924","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.2924","url":null,"abstract":"Background The role of prostacyclin is critical in pulmonary arterial hypertension (PAH) and parenteral prostacyclin is an essential treatment option for high-risk patients. However, its real-world utilization remains limited due to physician unfamiliarity and high costs. Comprehensive analysis of real-world treprostinil use has been scarce. Purpose This study aimed to investigate the treatment patterns and clinical response to treprostinil in real-world practice. Methods Patients prescribed treprostinil for PAH from 2011 to 2024 at two tertiary referral centers were identified. Clinical characteristics, treatment response and survival outcomes were analyzed. We categorized the study populations into three groups based on the timing of treprostinil initiation: optimal sequential combination therapy (when the patient reached intermediate to high risk), early triple combination (in high-risk patients), and delayed sequential combination therapy (delayed initiation of treprostinil in already diagnosed PAH when they reached the functional class IV or definite indication for lung transplantation). Results A total of 94 patients were identified, with 35 (37.2%) in optimal sequential combination therapy group, 12 (12.8%) in early triple combination therapy group, and 47 (50.0%) in delayed sequential combination therapy group. Hemodynamic characteristics and risk profiles for PAH were similar among the study groups except for functional class. The cumulative 1-year mortality rate in the overall population was 35.1%. 1-year mortality was significantly higher in delayed sequential combination therapy group (53.2%) compared to optimal sequential combination therapy group (20.0%) and early triple combination therapy group (8.3%) (p&lt;0.001). Optimal sequential combination and early triple combination therapy over delayed sequential combination therapy were identified as independent predictor for death at 1 year (adjusted HR 0.239, 95% CI 0.096-0.599, p=0.002; adjusted HR 0.107, 95% CI 0.014-0.811, p=0.031). The treatment response to treprostinil was significantly lower in the delayed sequential combination therapy group (40.4%) compared to the optimal sequential combination (85.7%) and early triple combination therapy group (75.0%) (p&lt;0.001). Optimal sequential combination and early triple combination therapy were associated with higher rates of successful transition to oral maintenance therapy (40.0% and 91.7%, respectively), whereas 8.5% of patients in the delayed sequential combination therapy group maintained therapy (p&lt;0.001). Conclusions Although the guideline recommends the optimal timing for intervention with parenteral prostacyclin, it is frequently delayed in real-world clinics. Treatment outcomes show dramatic differences based on the timing—early, optimal, and delayed. Furthermore, a transition to an oral IP3 receptor agonist was even possible for some patients who survived due to early intervention with parenteral prostacyclin","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"30 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.4035
M Sandini, A Mauro, E Bizzi, R Mascolo, V Collini, L Bernardo, M Imazio, A Brucato
Background Current guidelines for diagnosis and treatment of recurrent pericarditis are based on adult populations. Aims Due to limited pediatric data, this study aims to highlight clinical, laboratory, and therapeutic differences between idiopathic recurrent pericarditis in children and adults to optimize pediatric disease management. Methods and Results This retrospective multicentric cohort study analyzed data from patients with recurrent pericarditis (idiopathic or post-cardiac injury). Clinical, laboratory, and outcome data were compared between pediatric (<18 years) and adult (>18 years) patients. A total of 61 children and 289 adults were included. Follow-up was significantly longer in children (8 vs. 4 years, p < 0.001). Males were predominantly affected in pediatric patient’s cohort (30.3% female vs 69.7% male), while gender distribution was similar in adults (51.6% female vs. 48.4% male). Children were hospitalized more frequently than adult (81.8% vs. 58.5%, p < 0.05). From the clinical point of view, chest pain was the most common symptom in both group (100% vs. 57.1%), whereas dyspnea was exclusive to adults (31.5%, p < 0.05). Pericardial effusion was less common in children (63.6% vs. 80.6%, p < 0.05) and no pediatric patients developed constrictive pericarditis requiring pericardiectomy. Pediatric patient’s cohort had a higher incidence of ST-segment elevation on ECG (64.7% vs. 32.4%, p < 0.01) and a higher relative lymphocyte count (p < 0.05) with a lower neutrophil-to-lymphocyte ratio (3.65 vs. 4.71, p < 0.05). Although the difference is not statistically significant, the troponin levels were found to be lower in children compared with adults (29 ng/L vs 72.6 ng/L, p=0.294). Recurrence of pericarditis was more frequent in adults (9.59 vs. 4.4 episodes/10 years, p < 0.001), but children had significantly longer relapse-free periods (68.31 vs. 31.72 months, p < 0.001). There were no significant differences observed in the treatment between the two groups. A total of 48 children (78.8%) and 237 adults (82.0%) were treated with NSAIDs. Colchicine was prescribed to 22 children (36.4%) and 136 adults (47.1%), while 15 children (24.2%) and 73 adults (25.3%) received Anakinra. The only notable difference was in the dosage of prednisone, with children receiving significantly higher doses compared to adults (37.25 mg vs. 25 mg, p = 0.023). Conclusions Recurrent pericarditis in children follows a different course than in adults, with fewer recurrences, prolonged symptom-free periods, and typical ECG abnormalities. The higher corticosteroid use in children raises some concerns because of its potential side effects, including growth impairment and osteoporosis. IL-1 inhibitors should be considered to minimize corticosteroid administration. These findings emphasize the importance of developing a pediatric age-specific guideline.
背景：目前复发性心包炎的诊断和治疗指南是基于成人人群的。由于儿科数据有限，本研究旨在突出儿童和成人特发性复发性心包炎的临床、实验室和治疗差异，以优化儿科疾病管理。方法和结果本回顾性多中心队列研究分析了复发性心包炎（特发性或心脏后损伤）患者的数据。比较儿科（18岁）和成人（18岁）患者的临床、实验室和结局数据。共有61名儿童和289名成人被纳入研究。儿童的随访时间明显更长（8年vs. 4年，p < 0.001）。在儿科患者队列中，男性主要受影响（女性占30.3%，男性占69.7%），而成人患者的性别分布相似（女性占51.6%，男性占48.4%）。儿童住院率高于成人（81.8%比58.5%,p < 0.05）。从临床角度来看，胸痛是两组患者最常见的症状（100% vs. 57.1%），而呼吸困难是成人所特有的（31.5%,p < 0.05）。心包积液在儿童中较少见（63.6%对80.6%,p < 0.05），没有儿童患者发生缩窄性心包炎需要心包切除术。儿童患者队列心电图st段抬高发生率较高（64.7% vs. 32.4%, p < 0.01），相对淋巴细胞计数较高（p < 0.05），中性粒细胞与淋巴细胞比值较低（3.65 vs. 4.71, p < 0.05）。虽然差异无统计学意义，但发现儿童肌钙蛋白水平低于成人（29 ng/L vs 72.6 ng/L, p=0.294）。心包炎的复发在成人中更为常见（9.59 vs 4.4次/10年，p < 0.001），但儿童的无复发期明显更长（68.31 vs 31.72个月，p < 0.001）。两组治疗效果无明显差异。共有48名儿童（78.8%）和237名成人（82.0%）接受了非甾体抗炎药治疗。22名儿童（36.4%）和136名成人（47.1%）使用秋水仙碱，15名儿童（24.2%）和73名成人（25.3%）使用阿那白。唯一的显著差异是泼尼松的剂量，儿童接受的剂量明显高于成人（37.25 mg vs. 25 mg, p = 0.023）。结论：儿童心包炎复发的病程与成人不同，复发较少，无症状期延长，心电图异常典型。儿童使用较多的皮质类固醇引起了一些担忧，因为它可能产生副作用，包括生长障碍和骨质疏松症。应考虑使用IL-1抑制剂来减少皮质类固醇的使用。这些发现强调了制定针对儿童年龄的指南的重要性。
{"title":"Idiopathic recurrent pericarditis in children and adults:clinical and diagnostic differences","authors":"M Sandini, A Mauro, E Bizzi, R Mascolo, V Collini, L Bernardo, M Imazio, A Brucato","doi":"10.1093/eurheartj/ehaf784.4035","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4035","url":null,"abstract":"Background Current guidelines for diagnosis and treatment of recurrent pericarditis are based on adult populations. Aims Due to limited pediatric data, this study aims to highlight clinical, laboratory, and therapeutic differences between idiopathic recurrent pericarditis in children and adults to optimize pediatric disease management. Methods and Results This retrospective multicentric cohort study analyzed data from patients with recurrent pericarditis (idiopathic or post-cardiac injury). Clinical, laboratory, and outcome data were compared between pediatric (&lt;18 years) and adult (&gt;18 years) patients. A total of 61 children and 289 adults were included. Follow-up was significantly longer in children (8 vs. 4 years, p &lt; 0.001). Males were predominantly affected in pediatric patient’s cohort (30.3% female vs 69.7% male), while gender distribution was similar in adults (51.6% female vs. 48.4% male). Children were hospitalized more frequently than adult (81.8% vs. 58.5%, p &lt; 0.05). From the clinical point of view, chest pain was the most common symptom in both group (100% vs. 57.1%), whereas dyspnea was exclusive to adults (31.5%, p &lt; 0.05). Pericardial effusion was less common in children (63.6% vs. 80.6%, p &lt; 0.05) and no pediatric patients developed constrictive pericarditis requiring pericardiectomy. Pediatric patient’s cohort had a higher incidence of ST-segment elevation on ECG (64.7% vs. 32.4%, p &lt; 0.01) and a higher relative lymphocyte count (p &lt; 0.05) with a lower neutrophil-to-lymphocyte ratio (3.65 vs. 4.71, p &lt; 0.05). Although the difference is not statistically significant, the troponin levels were found to be lower in children compared with adults (29 ng/L vs 72.6 ng/L, p=0.294). Recurrence of pericarditis was more frequent in adults (9.59 vs. 4.4 episodes/10 years, p &lt; 0.001), but children had significantly longer relapse-free periods (68.31 vs. 31.72 months, p &lt; 0.001). There were no significant differences observed in the treatment between the two groups. A total of 48 children (78.8%) and 237 adults (82.0%) were treated with NSAIDs. Colchicine was prescribed to 22 children (36.4%) and 136 adults (47.1%), while 15 children (24.2%) and 73 adults (25.3%) received Anakinra. The only notable difference was in the dosage of prednisone, with children receiving significantly higher doses compared to adults (37.25 mg vs. 25 mg, p = 0.023). Conclusions Recurrent pericarditis in children follows a different course than in adults, with fewer recurrences, prolonged symptom-free periods, and typical ECG abnormalities. The higher corticosteroid use in children raises some concerns because of its potential side effects, including growth impairment and osteoporosis. IL-1 inhibitors should be considered to minimize corticosteroid administration. These findings emphasize the importance of developing a pediatric age-specific guideline.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"87 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.2056
A Sakalidis, K Dimitriadis, E Adamopoulou, A Koulouriotis, P Iliakis, M Bora, S Drogkaris, A E Karanikola, K Papadomarkaki, A Lazarou, S Soulaidopoulos, I Leontsinis, I Kontonasakis, C Fragkoulis, K Tsioufis
Background Recent studies indicate that patients with Ischemia with Non-Obstructive Coronary Arteries (INOCA) constitute a heterogeneous population at heightened risk of cardiovascular events. Nevertheless, there remains a paucity of scientific evidence investigating the potential presence of widespread microangiopathy in this distinct patient cohort. Purpose This study aims to evaluate nailfold capillary density in patients with INOCA compared to individuals without evidence of coronary microvascular dysfunction (CMD). Methods This single-center, prospective, observational study enrolled patients with INOCA. In the absence of significant coronary artery stenosis, functional coronary circulation was assessed in all patients. Coronary flow reserve (CFR) and the index of microvascular resistance (IMR) were invasively measured using the thermodilution technique with a temperature/pressure sensor-tipped guidewire in the left anterior descending coronary artery. Patients with CMD were further classified into two subgroups based on structural and functional endotypes, using CFR <2.5 and IMR ≥25 as tresholds to define abnormal values. Nailfold capillary circulation was evaluated in all participants using videocapillaroscopy, a non-invasive technique that assesses small vessels in the nailfold microcirculation, performed with a stereomicroscope. Results A total of 82 participants were enrolled in the study, including 36 controls without coronary microvascular dysfunction (non-CMD group) (16 female, 44%; mean age: 55.7 ± 7 years) and 46 patients with ischemia and non-obstructive coronary arteries (CMD group) (32 female, 69%; mean age: 51.9 ± 8.7 years). In the CMD group, the mean coronary flow reserve (CFR) and index of microvascular resistance (IMR) values were 1.68 ± 0.6 and 28 ± 23, respectively. Capillary density was significantly reduced in CMD patients compared to non-CMD participants (9.3 ± 2.9 vs. 11 ± 1.8 capillaries/mm, p = 0.04). This difference remained statistically significant after adjustment for multiple comparisons (p < 0.05). No significant differences were observed between the CMD endotypes (functional vs. structural) regarding capillary circulation function (p = NS). Conclusions Patients with coronary microvascular dysfunction exhibit a significantly lower nailfold capillary density compared to individuals without CMD. These findings suggest a potential association between vascular abnormalities at both the coronary microcirculatory and peripheral vascular levels. The observed reduction in nailfold capillary density underscores its potential utility as a diagnostic marker for identifying coronary microvascular dysfunction in clinical practice. This parameter may be particularly valuable for risk stratification and guiding management strategies in the heterogeneous population of patients with INOCA.CMD correlation with capillary density CMD assessed by bolus thermodilution
最近的研究表明，非阻塞性冠状动脉缺血（INOCA）患者构成了心血管事件高风险的异质人群。然而，在这一独特的患者队列中，仍然缺乏科学证据来调查广泛存在微血管病变的可能性。目的：本研究旨在评价冠状动脉微血管功能障碍（CMD）患者与无冠状动脉微血管功能障碍患者的甲襞毛细血管密度。方法本研究为单中心、前瞻性、观察性研究，纳入了INOCA患者。在没有明显冠状动脉狭窄的情况下，评估所有患者的冠状动脉循环功能。采用有创热稀释技术，在冠状动脉左前降支内置入温度/压力传感器导丝，测量冠状动脉血流储备（CFR）和微血管阻力指数（IMR）。根据结构型和功能型将CMD患者进一步分为2个亚组，以CFR &；lt；2.5和IMR≥25为阈值定义异常值。所有参与者的甲襞毛细血管循环使用视频毛细血管镜进行评估，这是一种非侵入性技术，可以评估甲襞微循环中的小血管，并在体视显微镜下进行。结果共纳入82例受试者，包括36例无冠状动脉微血管功能障碍的对照组（非CMD组）（16例女性，44%，平均年龄55.7±7岁）和46例冠状动脉缺血非阻塞性患者（CMD组）（32例女性，69%，平均年龄51.9±8.7岁）。CMD组平均冠状动脉血流储备（CFR）为1.68±0.6，微血管阻力指数（IMR）为28±23。与非CMD患者相比，CMD患者的毛细血管密度显著降低（9.3±2.9 vs 11±1.8毛细血管/mm， p = 0.04）。经多次比较调整后，这一差异仍具有统计学意义（p < 0.05）。在毛细血管循环功能方面，CMD内型（功能性与结构性）之间没有显著差异（p = NS）。结论冠状动脉微血管功能障碍患者甲襞毛细血管密度明显低于非CMD患者。这些发现提示在冠状动脉微循环和外周血管水平的血管异常之间存在潜在的关联。观察到甲襞毛细血管密度的降低强调了其在临床实践中作为诊断冠状动脉微血管功能障碍的潜在用途。这一参数可能特别有价值的风险分层和指导管理策略，在异质人群的INOCA患者。CMD与毛细管密度的相关性
{"title":"Association between peripheral microangiopathy and coronary microvascular dysfunction in patients with ischemia and non-obstructive coronary arteries","authors":"A Sakalidis, K Dimitriadis, E Adamopoulou, A Koulouriotis, P Iliakis, M Bora, S Drogkaris, A E Karanikola, K Papadomarkaki, A Lazarou, S Soulaidopoulos, I Leontsinis, I Kontonasakis, C Fragkoulis, K Tsioufis","doi":"10.1093/eurheartj/ehaf784.2056","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.2056","url":null,"abstract":"Background Recent studies indicate that patients with Ischemia with Non-Obstructive Coronary Arteries (INOCA) constitute a heterogeneous population at heightened risk of cardiovascular events. Nevertheless, there remains a paucity of scientific evidence investigating the potential presence of widespread microangiopathy in this distinct patient cohort. Purpose This study aims to evaluate nailfold capillary density in patients with INOCA compared to individuals without evidence of coronary microvascular dysfunction (CMD). Methods This single-center, prospective, observational study enrolled patients with INOCA. In the absence of significant coronary artery stenosis, functional coronary circulation was assessed in all patients. Coronary flow reserve (CFR) and the index of microvascular resistance (IMR) were invasively measured using the thermodilution technique with a temperature/pressure sensor-tipped guidewire in the left anterior descending coronary artery. Patients with CMD were further classified into two subgroups based on structural and functional endotypes, using CFR &lt;2.5 and IMR ≥25 as tresholds to define abnormal values. Nailfold capillary circulation was evaluated in all participants using videocapillaroscopy, a non-invasive technique that assesses small vessels in the nailfold microcirculation, performed with a stereomicroscope. Results A total of 82 participants were enrolled in the study, including 36 controls without coronary microvascular dysfunction (non-CMD group) (16 female, 44%; mean age: 55.7 ± 7 years) and 46 patients with ischemia and non-obstructive coronary arteries (CMD group) (32 female, 69%; mean age: 51.9 ± 8.7 years). In the CMD group, the mean coronary flow reserve (CFR) and index of microvascular resistance (IMR) values were 1.68 ± 0.6 and 28 ± 23, respectively. Capillary density was significantly reduced in CMD patients compared to non-CMD participants (9.3 ± 2.9 vs. 11 ± 1.8 capillaries/mm, p = 0.04). This difference remained statistically significant after adjustment for multiple comparisons (p &lt; 0.05). No significant differences were observed between the CMD endotypes (functional vs. structural) regarding capillary circulation function (p = NS). Conclusions Patients with coronary microvascular dysfunction exhibit a significantly lower nailfold capillary density compared to individuals without CMD. These findings suggest a potential association between vascular abnormalities at both the coronary microcirculatory and peripheral vascular levels. The observed reduction in nailfold capillary density underscores its potential utility as a diagnostic marker for identifying coronary microvascular dysfunction in clinical practice. This parameter may be particularly valuable for risk stratification and guiding management strategies in the heterogeneous population of patients with INOCA.CMD correlation with capillary density CMD assessed by bolus thermodilution","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"8 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.1612
J Jannink, J Van Der Veen, J W Eikelboom, J H Cornel, T J S Opstal, C A Budgeon, S M Nidorf, F L J Visseren, F M A C Martens, A T L Fiolet, A Mosterd
Background Recent trials have demonstrated that low-dose colchicine can reduce the risk of cardiovascular events in patients with coronary artery disease.(1) However, discontinuation rates of trial medication ranged from 10.1% to 25.9%, potentially reducing its effectiveness.(2,3) The role of side effects in this remains unclear. Purpose To evaluate the incidence and type of side effects that led to premature discontinuation of trial medication in participants with chronic coronary syndromes in the Low-Dose Colchicine 2 (LoDoCo2) trial. Methods We evaluated the incidence of side effects leading to discontinuation of trial medication in the LoDoCo2 trial, which consisted of a 30-day run-in phase during which all participants received colchicine 0.5 mg once daily, followed by randomization to colchicine or placebo. Side effects of colchicine were evaluated at the end of the run-in phase (early side effects, within 30 days) and during the randomization phase (late side effects, median follow-up: 29.5 months). Cumulative incidences of side effects are presented using Kaplan-Meier curves and compared by treatment arm using Cox proportional hazards modelling. Results Trial medication was discontinued by 997 of 6519 (15.3%) participants during the run-in phase, of whom 618 (9.5%) participants reported early side effects. After randomization, 273 (10.0%) participants in the colchicine group and 281 (10.3%) participants in the placebo group discontinued trial medication. Among those who stopped trial medication, 114 participants in the colchicine group reported side effects (4.2%, 1.6 events per 100 person-years), compared to 120 participants in the placebo group (4.4%, 1.7 events per 100 person-years, hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.73–1.22). Gastrointestinal upset and myalgia were the most common side effects (2.0% and 1.2% in the colchicine group and 1.7% and 1.6% in the placebo group, respectively), with no differences between treatment groups. Female sex was independently associated with an increased risk of both early- and late side effects, irrespective of treatment allocation. Statin use was independently associated with lower rates of late side effects, with no difference between colchicine and placebo. Conclusion After the open-label run-in phase, the incidence of late side effects in participants with chronic coronary syndromes did not differ between patients randomized to low-dose colchicine or placebo.
{"title":"Side effects of low-dose colchicine in chronic coronary syndromes, the LoDoCo2 trial","authors":"J Jannink, J Van Der Veen, J W Eikelboom, J H Cornel, T J S Opstal, C A Budgeon, S M Nidorf, F L J Visseren, F M A C Martens, A T L Fiolet, A Mosterd","doi":"10.1093/eurheartj/ehaf784.1612","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.1612","url":null,"abstract":"Background Recent trials have demonstrated that low-dose colchicine can reduce the risk of cardiovascular events in patients with coronary artery disease.(1) However, discontinuation rates of trial medication ranged from 10.1% to 25.9%, potentially reducing its effectiveness.(2,3) The role of side effects in this remains unclear. Purpose To evaluate the incidence and type of side effects that led to premature discontinuation of trial medication in participants with chronic coronary syndromes in the Low-Dose Colchicine 2 (LoDoCo2) trial. Methods We evaluated the incidence of side effects leading to discontinuation of trial medication in the LoDoCo2 trial, which consisted of a 30-day run-in phase during which all participants received colchicine 0.5 mg once daily, followed by randomization to colchicine or placebo. Side effects of colchicine were evaluated at the end of the run-in phase (early side effects, within 30 days) and during the randomization phase (late side effects, median follow-up: 29.5 months). Cumulative incidences of side effects are presented using Kaplan-Meier curves and compared by treatment arm using Cox proportional hazards modelling. Results Trial medication was discontinued by 997 of 6519 (15.3%) participants during the run-in phase, of whom 618 (9.5%) participants reported early side effects. After randomization, 273 (10.0%) participants in the colchicine group and 281 (10.3%) participants in the placebo group discontinued trial medication. Among those who stopped trial medication, 114 participants in the colchicine group reported side effects (4.2%, 1.6 events per 100 person-years), compared to 120 participants in the placebo group (4.4%, 1.7 events per 100 person-years, hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.73–1.22). Gastrointestinal upset and myalgia were the most common side effects (2.0% and 1.2% in the colchicine group and 1.7% and 1.6% in the placebo group, respectively), with no differences between treatment groups. Female sex was independently associated with an increased risk of both early- and late side effects, irrespective of treatment allocation. Statin use was independently associated with lower rates of late side effects, with no difference between colchicine and placebo. Conclusion After the open-label run-in phase, the incidence of late side effects in participants with chronic coronary syndromes did not differ between patients randomized to low-dose colchicine or placebo.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"56 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.2740
J D Gillmore, M Grogan, T Sutton, M Dupont, N M Fine, K Bhatt, D Delgado, C Chen, J F Tamby, S Siddhanti, J C Fox, M Fontana
Background The National Amyloidosis Centre (NAC) staging system for transthyretin amyloid cardiomyopathy (ATTR-CM) is used to classify patients into prognostic categories based on N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and estimated glomerular filtration rate (eGFR). The NAC staging system has been shown to predict ongoing survival throughout the course of ATTR-CM, with survival progressively decreasing from stage I to stage III. Acoramidis, a highly selective, oral transthyretin stabilizer that achieves near-complete (≥90%) transthyretin stabilization, has recently been approved in Europe and the USA for the treatment of wild-type or variant ATTR-CM in adults. In the phase 3 ATTRibute-CM study, acoramidis treatment was well tolerated and led to a 42% relative risk reduction in the composite of all-cause mortality and recurrent cardiovascular hospitalizations over 30 months compared with placebo (p=0.0005). Purpose To evaluate the ability of acoramidis treatment, as compared with placebo, to stabilize or improve NAC stage after 30 months in participants with ATTR-CM from the ATTRibute-CM study. Methods Participants in ATTRibute-CM were randomized 2:1 to receive acoramidis or placebo for 30 months. Efficacy analyses were conducted in the modified intention-to-treat population, which consisted of all randomized participants who had received at least one dose of acoramidis or placebo, had at least one efficacy evaluation after baseline and had a baseline eGFR ≥30 mL/min/1.73 m2. NAC stage at baseline and Month 30 was assessed. Changes from baseline to Month 30 were categorized as "stable", "improved" or "worsened". The "stable" category comprised participants who stayed within the same NAC stage at baseline and Month 30. The "improved" category comprised participants who moved from a higher NAC stage at baseline to a lower stage at Month 30. The "worsened or missing" category comprised participants who moved from a lower NAC stage at baseline to a higher stage at Month 30 and participants whose Month 30 NAC stage was missing. The change in NAC stage was compared between treatment groups using a stratified Cochran-Mantel-Haenszel test with stratification factors of genotype, NT-proBNP level and eGFR as recorded in the interactive voice/web response system at randomization. Results Overall, 611 participants were analysed (acoramidis: n=409; placebo: n=202). Baseline characteristics were comparable between treatment groups. Most participants had NAC stage I at baseline (acoramidis: 58.9%; placebo: 59.4%; Table). At Month 30, NAC stage remained stable or improved in 52.1% of acoramidis participants compared with 43.1% of placebo participants (p=0.0351; Figure). Conclusions Acoramidis treatment resulted in a greater proportion of participants whose NAC stage improved or remained stable at Month 30 compared with placebo, indicating better stabilization of their disease.
{"title":"Acoramidis has a beneficial effect compared with placebo on change from baseline in NAC ATTR stage at month 30 in patients with ATTR-CM: results from the ATTRibute-CM study","authors":"J D Gillmore, M Grogan, T Sutton, M Dupont, N M Fine, K Bhatt, D Delgado, C Chen, J F Tamby, S Siddhanti, J C Fox, M Fontana","doi":"10.1093/eurheartj/ehaf784.2740","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.2740","url":null,"abstract":"Background The National Amyloidosis Centre (NAC) staging system for transthyretin amyloid cardiomyopathy (ATTR-CM) is used to classify patients into prognostic categories based on N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and estimated glomerular filtration rate (eGFR). The NAC staging system has been shown to predict ongoing survival throughout the course of ATTR-CM, with survival progressively decreasing from stage I to stage III. Acoramidis, a highly selective, oral transthyretin stabilizer that achieves near-complete (≥90%) transthyretin stabilization, has recently been approved in Europe and the USA for the treatment of wild-type or variant ATTR-CM in adults. In the phase 3 ATTRibute-CM study, acoramidis treatment was well tolerated and led to a 42% relative risk reduction in the composite of all-cause mortality and recurrent cardiovascular hospitalizations over 30 months compared with placebo (p=0.0005). Purpose To evaluate the ability of acoramidis treatment, as compared with placebo, to stabilize or improve NAC stage after 30 months in participants with ATTR-CM from the ATTRibute-CM study. Methods Participants in ATTRibute-CM were randomized 2:1 to receive acoramidis or placebo for 30 months. Efficacy analyses were conducted in the modified intention-to-treat population, which consisted of all randomized participants who had received at least one dose of acoramidis or placebo, had at least one efficacy evaluation after baseline and had a baseline eGFR ≥30 mL/min/1.73 m2. NAC stage at baseline and Month 30 was assessed. Changes from baseline to Month 30 were categorized as \"stable\", \"improved\" or \"worsened\". The \"stable\" category comprised participants who stayed within the same NAC stage at baseline and Month 30. The \"improved\" category comprised participants who moved from a higher NAC stage at baseline to a lower stage at Month 30. The \"worsened or missing\" category comprised participants who moved from a lower NAC stage at baseline to a higher stage at Month 30 and participants whose Month 30 NAC stage was missing. The change in NAC stage was compared between treatment groups using a stratified Cochran-Mantel-Haenszel test with stratification factors of genotype, NT-proBNP level and eGFR as recorded in the interactive voice/web response system at randomization. Results Overall, 611 participants were analysed (acoramidis: n=409; placebo: n=202). Baseline characteristics were comparable between treatment groups. Most participants had NAC stage I at baseline (acoramidis: 58.9%; placebo: 59.4%; Table). At Month 30, NAC stage remained stable or improved in 52.1% of acoramidis participants compared with 43.1% of placebo participants (p=0.0351; Figure). Conclusions Acoramidis treatment resulted in a greater proportion of participants whose NAC stage improved or remained stable at Month 30 compared with placebo, indicating better stabilization of their disease.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"2 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.2337
I Cohen, J G Malins, M Cohen-Shelly, Y Asaf, M Fiman, K Faierstein, K Sudri, E Zimlichman, E Schwammenthal, R Klempfner, E Maor
Background Mitral regurgitation (MR) and tricuspid regurgitation (TR) are prevalent valvular heart diseases associated with significant morbidity and mortality. Traditional echocardiography faces limitations in availability, cost, consistency, and reliability, leading to misdiagnosis and undertreatment. The application of artificial intelligence (AI) to echocardiographic scans has the potential to address these challenges. Methods This study evaluates the performance of an AI algorithm on an external population. The algorithm utilizes deep learning networks to analyze echocardiographic exams for diagnosing atrioventricular valve disorders. We tested the algorithm on transthoracic echocardiography data collected from a single center between 2013 and 2023. The model's performance was compared to ground truth values using two classification schemes: distinguishing between normal-mild and moderate-severe regurgitation, and categorizing results into four groups: normal, mild, moderate, and severe. Results The MR cohort included 280 patients, while the TR cohort comprised 298 patients. The model demonstrated a robust ability to identify clinically significant (moderate and above) atrioventricular valve regurgitation. The MR model achieved an area under the curve (AUC) of 0.98 (95% CI: 0.97–0.99), with 91% accuracy, 95% sensitivity, and 89% specificity. In comparison, the TR model exhibited an AUC of 0.96 (95% CI: 0.94–0.98), with 84% accuracy, 91% sensitivity, and 80% specificity. Conclusion The model demonstrated high diagnostic accuracy and reliability in assessing atrioventricular valve regurgitation severity, highlighting its potential as a valuable clinical tool. The findings underscore the role of AI in complementing expert evaluations and improving access to effective diagnostics, with future applications potentially including point-of-care diagnosis and monitoring of disease progression.
{"title":"Deep learning for atrioventricular regurgitation diagnosis: an external validation study","authors":"I Cohen, J G Malins, M Cohen-Shelly, Y Asaf, M Fiman, K Faierstein, K Sudri, E Zimlichman, E Schwammenthal, R Klempfner, E Maor","doi":"10.1093/eurheartj/ehaf784.2337","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.2337","url":null,"abstract":"Background Mitral regurgitation (MR) and tricuspid regurgitation (TR) are prevalent valvular heart diseases associated with significant morbidity and mortality. Traditional echocardiography faces limitations in availability, cost, consistency, and reliability, leading to misdiagnosis and undertreatment. The application of artificial intelligence (AI) to echocardiographic scans has the potential to address these challenges. Methods This study evaluates the performance of an AI algorithm on an external population. The algorithm utilizes deep learning networks to analyze echocardiographic exams for diagnosing atrioventricular valve disorders. We tested the algorithm on transthoracic echocardiography data collected from a single center between 2013 and 2023. The model's performance was compared to ground truth values using two classification schemes: distinguishing between normal-mild and moderate-severe regurgitation, and categorizing results into four groups: normal, mild, moderate, and severe. Results The MR cohort included 280 patients, while the TR cohort comprised 298 patients. The model demonstrated a robust ability to identify clinically significant (moderate and above) atrioventricular valve regurgitation. The MR model achieved an area under the curve (AUC) of 0.98 (95% CI: 0.97–0.99), with 91% accuracy, 95% sensitivity, and 89% specificity. In comparison, the TR model exhibited an AUC of 0.96 (95% CI: 0.94–0.98), with 84% accuracy, 91% sensitivity, and 80% specificity. Conclusion The model demonstrated high diagnostic accuracy and reliability in assessing atrioventricular valve regurgitation severity, highlighting its potential as a valuable clinical tool. The findings underscore the role of AI in complementing expert evaluations and improving access to effective diagnostics, with future applications potentially including point-of-care diagnosis and monitoring of disease progression.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"9 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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