Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.1823
S Santillan Herrera, A C Maldonado-May, M Esquivel-Pelayo, F Bolanos-Prats, A Barron-Martinez, C A Berrio-Becerra, A D Martinez-Jimenez, K A Bravo-Gomez, H R Bojorges-Pedrero, H Gonzalez-Pacheco, D Araiza-Garaygordobil, R Gopar-Nieto, A Arias-Mendoza, J D Sierra-Laramartinez, K M Aguilar-Montano
Introduction Myocardial infarction with ST-segment elevation is a leading cause of mortality worldwide. While prompt primary percutaneous coronary intervention is the preferred reperfusion strategy, its availability may be limited in certain regions, prompting the use of pharmaco-invasive approaches. Advanced echocardiographic parameters, including strain analysis, offer a more sensitive evaluation of ventricular function than conventional measures alone, providing a deeper understanding of post-infarct cardiac mechanics. Purpose This study aimed to compare ventricular mechanics, particularly global longitudinal strain, between patients treated with primary percutaneous coronary intervention and those receiving a pharmaco-invasive strategy, in order to evaluate whether either approach leads to superior cardiac functional outcomes. Methods A prospective, observational study of adult patients presenting with myocardial infarction with ST-segment elevation within 12 hours of symptom onset was conducted. One group underwent primary percutaneous coronary intervention (PCI), whereas the other received pharmaco-invasive therapy (fibrinolysis followed by coronary angiography and potential intervention). Standard and advanced echocardiographic parameters—including left ventricle ejection fraction and global longitudinal strain—were assessed in both groups. Results A total of 105 patients were evaluated (50 in the pharmaco-invasive group and 55 in the primary percutaneous coronary intervention group). Demographic and clinical features were broadly similar. Left ventricle ejection fraction and global longitudinal strain showed no statistically significant disadvantage in the pharmaco-invasive group; in fact, for anterior infarctions, strain values showed a trend toward more favorable outcomes in the pharmaco-invasive arm. Major adverse cardiovascular events were also comparable between the two approaches. These findings indicate that both primary PCI and a pharmaco-invasive approach yield broadly comparable outcomes in ST-elevation myocardial infarction, with a modest advantage in anterior-wall strain under the latter strategy. Conclusion Primary percutaneous coronary intervention remains the standard of care where immediately available. However, these results suggest that a pharmaco-invasive strategy can yield similar cardiac functional outcomes, particularly when advanced echocardiographic measures are assessed. Adopting a pharmaco-invasive approach may therefore represent a viable and effective alternative in settings where rapid access to interventional facilities is limited.Echocardiographic Analysis Echocardiographic Parameters
{"title":"Impact of revascularization strategy on advanced left ventricular mechanics in STEMI: primary percutaneous coronary intervention versus pharmaco-invasive approach","authors":"S Santillan Herrera, A C Maldonado-May, M Esquivel-Pelayo, F Bolanos-Prats, A Barron-Martinez, C A Berrio-Becerra, A D Martinez-Jimenez, K A Bravo-Gomez, H R Bojorges-Pedrero, H Gonzalez-Pacheco, D Araiza-Garaygordobil, R Gopar-Nieto, A Arias-Mendoza, J D Sierra-Laramartinez, K M Aguilar-Montano","doi":"10.1093/eurheartj/ehaf784.1823","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.1823","url":null,"abstract":"Introduction Myocardial infarction with ST-segment elevation is a leading cause of mortality worldwide. While prompt primary percutaneous coronary intervention is the preferred reperfusion strategy, its availability may be limited in certain regions, prompting the use of pharmaco-invasive approaches. Advanced echocardiographic parameters, including strain analysis, offer a more sensitive evaluation of ventricular function than conventional measures alone, providing a deeper understanding of post-infarct cardiac mechanics. Purpose This study aimed to compare ventricular mechanics, particularly global longitudinal strain, between patients treated with primary percutaneous coronary intervention and those receiving a pharmaco-invasive strategy, in order to evaluate whether either approach leads to superior cardiac functional outcomes. Methods A prospective, observational study of adult patients presenting with myocardial infarction with ST-segment elevation within 12 hours of symptom onset was conducted. One group underwent primary percutaneous coronary intervention (PCI), whereas the other received pharmaco-invasive therapy (fibrinolysis followed by coronary angiography and potential intervention). Standard and advanced echocardiographic parameters—including left ventricle ejection fraction and global longitudinal strain—were assessed in both groups. Results A total of 105 patients were evaluated (50 in the pharmaco-invasive group and 55 in the primary percutaneous coronary intervention group). Demographic and clinical features were broadly similar. Left ventricle ejection fraction and global longitudinal strain showed no statistically significant disadvantage in the pharmaco-invasive group; in fact, for anterior infarctions, strain values showed a trend toward more favorable outcomes in the pharmaco-invasive arm. Major adverse cardiovascular events were also comparable between the two approaches. These findings indicate that both primary PCI and a pharmaco-invasive approach yield broadly comparable outcomes in ST-elevation myocardial infarction, with a modest advantage in anterior-wall strain under the latter strategy. Conclusion Primary percutaneous coronary intervention remains the standard of care where immediately available. However, these results suggest that a pharmaco-invasive strategy can yield similar cardiac functional outcomes, particularly when advanced echocardiographic measures are assessed. Adopting a pharmaco-invasive approach may therefore represent a viable and effective alternative in settings where rapid access to interventional facilities is limited.Echocardiographic Analysis Echocardiographic Parameters","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"42 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122193","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/ehaf784.791
A A Boehmer, M Rothe, P Weiss, B C Dobre, S Feickert, C Ruckes, K Dyrda, B M Kaess, S Nattel, J R Ehrlich
Background Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) are associated with increased morbidity and mortality. Radiofrequency ablation-based rhythm control has demonstrated clinical benefit by reducing all-cause mortality and heart failure events. However, no prospective data exist evaluating a pulmonary vein isolation (PVI)-only approach in patients with HFrEF or comparing ablation efficacy between patients with and without HFrEF. Methods This prospective, investigator-initiated, single-center, non-inferiority, observational study with propensity score matching aimed to assess whether a PVI-only approach using cryoballoon ablation in patients with HFrEF (LVEF ≤40%) is non-inferior to PVI-only in patients without HFrEF. The primary efficacy end point was the first documented recurrence of an atrial arrhythmia following a 90-day blanking period. The pre-specified non-inferiority margin was a hazard ratio of 1.39. Safety endpoints included all-cause death, cerebrovascular events, and procedure-related complications. Results A total of 1402 patients were enrolled and underwent PVI. After propensity score matching, 972 patients were analyzed in a 1:5 ratio. Over a mean follow-up of 2 years, the primary efficacy endpoint occurred in 75 of 162 patients with HFrEF and in 338 of 810 without HFrEF (Kaplan–Meier event rate estimates, 46.3% and 41.7%; HR 1.03; 90%CI, 0.83-1.28; P=0.01 for non-inferiority). All-cause mortality was higher in patients with HFrEF (8% vs. 3.7%, P=0.002), while no difference was observed in the incidence of procedure-related safety endpoints between patients with and without HFrEF (3.7% vs. 5.1%, P=0.50). Conclusion In patients with AF and HFrEF undergoing ablation, a PVI-only approach achieves comparable rhythm control efficacy to that in patients without HFrEF. While all-cause mortality is higher among patients with HFrEF, procedural safety is comparable between both groups. (POLAR-HF, ClinicalTrials.gov number NCT 04461691)
{"title":"Pulmonary vein isolation only for atrial fibrillation with heart failure","authors":"A A Boehmer, M Rothe, P Weiss, B C Dobre, S Feickert, C Ruckes, K Dyrda, B M Kaess, S Nattel, J R Ehrlich","doi":"10.1093/eurheartj/ehaf784.791","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.791","url":null,"abstract":"Background Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) are associated with increased morbidity and mortality. Radiofrequency ablation-based rhythm control has demonstrated clinical benefit by reducing all-cause mortality and heart failure events. However, no prospective data exist evaluating a pulmonary vein isolation (PVI)-only approach in patients with HFrEF or comparing ablation efficacy between patients with and without HFrEF. Methods This prospective, investigator-initiated, single-center, non-inferiority, observational study with propensity score matching aimed to assess whether a PVI-only approach using cryoballoon ablation in patients with HFrEF (LVEF ≤40%) is non-inferior to PVI-only in patients without HFrEF. The primary efficacy end point was the first documented recurrence of an atrial arrhythmia following a 90-day blanking period. The pre-specified non-inferiority margin was a hazard ratio of 1.39. Safety endpoints included all-cause death, cerebrovascular events, and procedure-related complications. Results A total of 1402 patients were enrolled and underwent PVI. After propensity score matching, 972 patients were analyzed in a 1:5 ratio. Over a mean follow-up of 2 years, the primary efficacy endpoint occurred in 75 of 162 patients with HFrEF and in 338 of 810 without HFrEF (Kaplan–Meier event rate estimates, 46.3% and 41.7%; HR 1.03; 90%CI, 0.83-1.28; P=0.01 for non-inferiority). All-cause mortality was higher in patients with HFrEF (8% vs. 3.7%, P=0.002), while no difference was observed in the incidence of procedure-related safety endpoints between patients with and without HFrEF (3.7% vs. 5.1%, P=0.50). Conclusion In patients with AF and HFrEF undergoing ablation, a PVI-only approach achieves comparable rhythm control efficacy to that in patients without HFrEF. While all-cause mortality is higher among patients with HFrEF, procedural safety is comparable between both groups. (POLAR-HF, ClinicalTrials.gov number NCT 04461691)","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"91 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122194","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/ehaf784.256
L Tassetti, G Piccinni, A Arcudi, M Lionti, A Baggiano, S Mushtaq, F Fazzari, L Fusini, F Cannata, A Del Torto, R Maragna, A Volpe, D Junod, M Pepi, G Pontone
Background Cardiac Magnetic Resonance(CMR) is gaining importance for diagnosis and prognosis stratification of pericarditis, and may help guide therapy especially in case of refractory symptoms. Data on quantitative evaluation of pericardial inflammation with CMR, including LGE and mapping techniques, are currently limited. Purpose to assess the utility of tissue characterization of pericardium with quantitative evaluation methods in outcome prediction of acute or recurrent pericarditis. Materials and Methods consecutive patients hospitalized or referred to our centre to perform CMR with a diagnosis of acute or recurrent pericarditis were enrolled. CMR performed within one month from diagnosis of acute/recurrent pericarditis and clinical follow up of at least 6 months were the inclusion criteria. In the postprocessing analysis of CMR images, quantitative evaluation of oedema and LGE amount on pericardium with different techniques [i.e. 5 and 6 standard deviation (SD) and full width half maximum (FWHM) methods on inversion recovery (IR) and T2weighted (T2w) sequences] and T1 and T2 maximum values measurement on inflamed pericardium with mapping were performed. Univariate/multivariate Cox regressions were performed to investigate the potential association between the different CMR quantitative parameters and the occurrence of recurrence; the propensity score based on clinical significant variables (age, gender, C-reactive protein values and therapy) was used as adjustment. Results sixty-one patients (mean age±SD: 48.43±18,2; male: 41%) who underwent CMR for acute or recurrent pericarditis were enrolled. Pericardial LGE and pericardial oedema detected on T2w were observed in 28(46%) and 31(50.8%) patients, respectively. Pericardial LGE median amount was 31.2(9.02;54.54)gr, 42.73(17.16;72.5)gr and 38.79(15.21;68.5)gr when measured with FWHM, 5SD and 6SD technique, respectively. Median pericardial T1 and T2 values were 1356(1305;1523)ms and 77(73;81)ms, respectively. During a median clinical follow up (FU) of 23(12;66) months, 17(28%) patients had a recurrence of pericarditis, 2(3%) developed constrictive pericarditis requiring pericardiectomy, 2(3%) were hospitalized for heart failure. Quantitative LGE, but neither T1 nor T2 mapping values nor T2w image, was associated to pericarditis recurrence and to composite outcome including constrictive evolution and heart failure hospitalization. The most accurate LGE method in prediction of clinical outcome was FWHM (HR 1.421; IC 1.124-1.795). Conclusion Quantitative LGE evaluation with different techniques, but not parametric mapping, showed an association with prediction of clinical recurrence of acute pericarditis, confirming LGE currently represents the most accurate imaging marker with prognostic value in this setting.CMR pericardial tissue characterization standardized HR pericarditis outcome
背景心脏磁共振（CMR）在心包炎的诊断和预后分层中越来越重要，特别是在难治性症状的情况下，它可以帮助指导治疗。用CMR定量评估心包炎症的数据，包括LGE和制图技术，目前是有限的。目的探讨心包组织特征定量评价方法在急性或复发性心包炎预后预测中的应用价值。材料和方法入选了诊断为急性或复发性心包炎的连续住院或转介到本中心进行CMR的患者。入选标准为急性/复发性心包炎诊断后1个月内进行CMR，临床随访至少6个月。在CMR图像的后处理分析中，采用不同技术[即反演恢复（IR）和T2w序列的5和6个标准差（SD）和全宽半最大值（FWHM）方法]定量评价心包的水肿和LGE量，并通过作图测量炎症心包的T1和T2最大值。采用单因素/多因素Cox回归分析不同CMR定量参数与复发率之间的潜在关联；采用基于临床显著变量（年龄、性别、c反应蛋白值和治疗）的倾向评分作为调整。结果61例因急性或复发性心包炎行CMR的患者（平均年龄±SD: 48.43±18.2；男性：41%）入选。T2w检测到心包LGE 28例（46%），心包水肿31例（50.8%）。FWHM、5SD、6SD法测量心包LGE中位值分别为31.2(9.02;54.54)gr、42.73(17.16;72.5)gr、38.79(15.21;68.5)gr。心包T1和T2中位值分别为1356(1305;1523)ms和77(73;81)ms。在23个月（12;66）个月的中位临床随访（FU）中，17例（28%）患者心包炎复发，2例（3%）患者发生缩窄性心包炎需要心包膜切除术，2例（3%）患者因心力衰竭住院。定量LGE与心包炎复发和包括收缩演变和心力衰竭住院在内的综合结局相关，但与T1、T2制图值和T2w图像均无关。LGE预测临床预后最准确的方法是FWHM （HR 1.421; IC 1.124-1.795）。结论不同技术的LGE定量评估与预测急性心包炎临床复发相关，但没有参数制图，证实LGE目前是最准确的影像学标志物，具有预后价值。CMR心包组织特征标准化HR心包炎结局
{"title":"Pericardial tissue characterization with quantitative methods in cardiac magnetic resonance in acute or recurrent pericarditis","authors":"L Tassetti, G Piccinni, A Arcudi, M Lionti, A Baggiano, S Mushtaq, F Fazzari, L Fusini, F Cannata, A Del Torto, R Maragna, A Volpe, D Junod, M Pepi, G Pontone","doi":"10.1093/eurheartj/ehaf784.256","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.256","url":null,"abstract":"Background Cardiac Magnetic Resonance(CMR) is gaining importance for diagnosis and prognosis stratification of pericarditis, and may help guide therapy especially in case of refractory symptoms. Data on quantitative evaluation of pericardial inflammation with CMR, including LGE and mapping techniques, are currently limited. Purpose to assess the utility of tissue characterization of pericardium with quantitative evaluation methods in outcome prediction of acute or recurrent pericarditis. Materials and Methods consecutive patients hospitalized or referred to our centre to perform CMR with a diagnosis of acute or recurrent pericarditis were enrolled. CMR performed within one month from diagnosis of acute/recurrent pericarditis and clinical follow up of at least 6 months were the inclusion criteria. In the postprocessing analysis of CMR images, quantitative evaluation of oedema and LGE amount on pericardium with different techniques [i.e. 5 and 6 standard deviation (SD) and full width half maximum (FWHM) methods on inversion recovery (IR) and T2weighted (T2w) sequences] and T1 and T2 maximum values measurement on inflamed pericardium with mapping were performed. Univariate/multivariate Cox regressions were performed to investigate the potential association between the different CMR quantitative parameters and the occurrence of recurrence; the propensity score based on clinical significant variables (age, gender, C-reactive protein values and therapy) was used as adjustment. Results sixty-one patients (mean age±SD: 48.43±18,2; male: 41%) who underwent CMR for acute or recurrent pericarditis were enrolled. Pericardial LGE and pericardial oedema detected on T2w were observed in 28(46%) and 31(50.8%) patients, respectively. Pericardial LGE median amount was 31.2(9.02;54.54)gr, 42.73(17.16;72.5)gr and 38.79(15.21;68.5)gr when measured with FWHM, 5SD and 6SD technique, respectively. Median pericardial T1 and T2 values were 1356(1305;1523)ms and 77(73;81)ms, respectively. During a median clinical follow up (FU) of 23(12;66) months, 17(28%) patients had a recurrence of pericarditis, 2(3%) developed constrictive pericarditis requiring pericardiectomy, 2(3%) were hospitalized for heart failure. Quantitative LGE, but neither T1 nor T2 mapping values nor T2w image, was associated to pericarditis recurrence and to composite outcome including constrictive evolution and heart failure hospitalization. The most accurate LGE method in prediction of clinical outcome was FWHM (HR 1.421; IC 1.124-1.795). Conclusion Quantitative LGE evaluation with different techniques, but not parametric mapping, showed an association with prediction of clinical recurrence of acute pericarditis, confirming LGE currently represents the most accurate imaging marker with prognostic value in this setting.CMR pericardial tissue characterization standardized HR pericarditis outcome","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"111 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121912","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/ehaf784.3848
C Helmark, R Ahm, A Brandes, S J Skovbakke, J C Nielsen, L Frostholm, R S Taylor, S S Pedersen
Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia with a lifetime estimated incidence of one in three. AF can cause severe burdens on the patient, both in terms of physical symptoms like palpitations and fatigue, but also in terms of psychological issues like reduced quality of life, anxiety and depression. Depression in cardiac patients is associated with poor health outcomes and increased societal costs, therefore there is a need to develop interventions to prevent depression. Purpose We examined the feasibility of a psychological personalized online intervention, aiming to prevent depression in patients with AF. Methods The study was conducted using a pre-post study design and mixed-methods approach. The HOPE-AF intervention was developed in collaboration with patients using a participatory design. The intervention was personalized and consisted of 4-12 modules, all including psychological tasks. Modules were assigned based on the individual risk profile of the patient, patient preferences and therapist assessment. The intervention was guided by a personal therapist, communicating through text messages, video and phone calls and provided on a secure platform. Therapists were psychologists or psychology students who were trained in cardiac psychology and delivering the intervention. We included 28 patients diagnosed with AF from 3 university hospitals. The primary feasibility outcome was drop-out, with a drop-out of <25% being considered acceptable. We used descriptive analyses to determine changes in the pre- and post-test questionnaires with a 3-month follow-up. The Hospital Anxiety and Depression Scale was used for assessment of anxiety and depression while the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) was used for AF specific domains. Qualitative methods consisted of thematic analyses of semi-structured interviews with 10 patients. Results The drop-out rate was 7% (2/28). The mean change in depression score was -0.5 (standard deviation (SD): 1.3) and the mean change in anxiety score was -1.3 (SD: 2.7). AFEQT showed a mean change of 17.2 (14.6) for the global score, 15.0 (16.9) for symptoms, 19.3 (19.1) for daily activities, and 15.9 (17.0) for treatment concern, respectively. The qualitative analysis identified four themes: meaningful content, communication, technicalities, and personal gain. Overall, the patients found the intervention meaningful and felt safe due to cardiac-specific competencies among therapists. Patients felt engaged in the planning of their intervention and were satisfied with choice of video- or phone consultations. Patients found it easy to navigate on the intervention platform. Receiving psychological tools was perceived useful. Conclusion Our study showed that the research design and HOPE-AF intervention were feasible and acceptable and support progression to a fully powered randomized controlled trial to determine clinical effectiveness of the HOPE-AF intervention.
{"title":"Prevention of depression in patients with atrial fibrillation using an online intervention, the HOPE-AF feasibility study","authors":"C Helmark, R Ahm, A Brandes, S J Skovbakke, J C Nielsen, L Frostholm, R S Taylor, S S Pedersen","doi":"10.1093/eurheartj/ehaf784.3848","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.3848","url":null,"abstract":"Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia with a lifetime estimated incidence of one in three. AF can cause severe burdens on the patient, both in terms of physical symptoms like palpitations and fatigue, but also in terms of psychological issues like reduced quality of life, anxiety and depression. Depression in cardiac patients is associated with poor health outcomes and increased societal costs, therefore there is a need to develop interventions to prevent depression. Purpose We examined the feasibility of a psychological personalized online intervention, aiming to prevent depression in patients with AF. Methods The study was conducted using a pre-post study design and mixed-methods approach. The HOPE-AF intervention was developed in collaboration with patients using a participatory design. The intervention was personalized and consisted of 4-12 modules, all including psychological tasks. Modules were assigned based on the individual risk profile of the patient, patient preferences and therapist assessment. The intervention was guided by a personal therapist, communicating through text messages, video and phone calls and provided on a secure platform. Therapists were psychologists or psychology students who were trained in cardiac psychology and delivering the intervention. We included 28 patients diagnosed with AF from 3 university hospitals. The primary feasibility outcome was drop-out, with a drop-out of &lt;25% being considered acceptable. We used descriptive analyses to determine changes in the pre- and post-test questionnaires with a 3-month follow-up. The Hospital Anxiety and Depression Scale was used for assessment of anxiety and depression while the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) was used for AF specific domains. Qualitative methods consisted of thematic analyses of semi-structured interviews with 10 patients. Results The drop-out rate was 7% (2/28). The mean change in depression score was -0.5 (standard deviation (SD): 1.3) and the mean change in anxiety score was -1.3 (SD: 2.7). AFEQT showed a mean change of 17.2 (14.6) for the global score, 15.0 (16.9) for symptoms, 19.3 (19.1) for daily activities, and 15.9 (17.0) for treatment concern, respectively. The qualitative analysis identified four themes: meaningful content, communication, technicalities, and personal gain. Overall, the patients found the intervention meaningful and felt safe due to cardiac-specific competencies among therapists. Patients felt engaged in the planning of their intervention and were satisfied with choice of video- or phone consultations. Patients found it easy to navigate on the intervention platform. Receiving psychological tools was perceived useful. Conclusion Our study showed that the research design and HOPE-AF intervention were feasible and acceptable and support progression to a fully powered randomized controlled trial to determine clinical effectiveness of the HOPE-AF intervention.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121962","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/ehaf784.260
T W Wimalanathan, J S Sulkowska, A M Melles, M P Paus, J B S Brox Skranes, T B Berge, A T Tveit, H R Rosjo, M N L Nakrem Lyngbakken, T O Omland, S L H Lagethon Heck, T H A K S H Wimalanathan
Background Both focal and diffuse myocardial fibrosis may impair myocardial contractility and cause mechanical alterations that can be measured by novel cardiac magnetic resonance (CMR) techniques like CMR feature tracking (CMR-FT) and strain encoded (fast-SENC) sequences. Associations between myocardial fibrosis and impaired strain have been shown in different cardiomyopathies. The relationship between focal and diffuse fibrosis and strain assessed by novel CMR imaging has not yet been studied in an elderly general population cohort. Purpose To investigate the relationship between diffuse and focal myocardial fibrosis and left ventricular (LV) strain using state-of-the-art CMR imaging in an elderly general population cohort. Methods Two hundred community-dwellers born in 1950 without known coronary artery disease were recruited and examined with a 1.5-T Philips MRI scanner. Diffuse fibrosis was estimated by septal extracellular volume (ECV) fraction and focal fibrosis was quantified by late gadolinium enhancement (LGE). LV global longitudinal strain (GLS) and global circumferential strain (GCS) were obtained by both CMR-FT and fast-SENC. Fast-SENC was assessed as percentage of segments with strain ≤-17% (% normal myocardium). Linear models were used to assess the association between myocardial strain (CMR-FT and fast-SENC) and diffuse and focal fibrosis. Nonlinear associations were evaluated with restricted cubic splines with 3 knots. Likelihood Ratio Test was used to evaluate whether the fully adjusted models with splines provided a better fit than the linear model. Results The median age was 69 (68.6-69.3) and 52% were male. Presence and volume of LGE was associated with GLS assessed by CMR-FT and fast-SENC % normal myocardium in all models. The association between LGE and GCS by CMR-FT was attenuated when adjusting for indexed LV end diastolic volume (LVEDVi). There was a significant non-linear association between ECV and both GLS and GCS (Table) with worsening strain at ECV values above 26 % (Figure). There were no significant associations between ECV and fast-SENC % normal myocardium (Table). Conclusion(s) In an elderly general population cohort, focal myocardial fibrosis is associated with worse LV strain assessed by CMR-FT and fast-SENC % normal myocardium. The non-linear association between diffuse fibrosis and CMR-FT strain reveals worse cardiac function beyond a threshold value.
局灶性和弥漫性心肌纤维化都可能损害心肌收缩性并引起机械改变，这可以通过CMR特征跟踪（CMR- ft）和应变编码（fast-SENC）序列等新型心脏磁共振（CMR）技术来测量。在不同的心肌病中，心肌纤维化和受损应变之间存在关联。新型CMR成像评估的局灶性和弥漫性纤维化与应变之间的关系尚未在老年普通人群队列中进行研究。目的研究老年人群中弥漫性和局灶性心肌纤维化与左室（LV）应变之间的关系。方法对200名1950年出生、无冠状动脉疾病的社区居民进行1.5 t Philips MRI扫描。弥漫性纤维化通过间隔细胞外体积（ECV）分数评估，局灶性纤维化通过晚期钆增强（LGE）量化。利用CMR-FT和fast-SENC分别获得了LV整体纵向应变（GLS）和整体周向应变（GCS）。Fast-SENC以应变≤-17%（正常心肌百分比）的节段百分比进行评估。采用线性模型评估心肌应变（CMR-FT和fast-SENC）与弥漫性和局灶性纤维化之间的关系。非线性关联用3节受限三次样条进行了评估。采用似然比检验来评价充分调整的样条模型是否比线性模型提供更好的拟合。结果中位年龄为69岁（68.6 ~ 69.3岁），男性占52%。通过CMR-FT和fast-SENC %正常心肌评估LGE的存在和体积与GLS相关。当调整索引左室舒张末期容积（LVEDVi）时，CMR-FT测量的LGE和GCS之间的相关性减弱。ECV与GLS和GCS之间存在显著的非线性关联（表），ECV值高于26%时应变恶化（图）。ECV和fast-SENC %正常心肌之间无显著相关性（表）。结论：在老年普通人群队列中，CMR-FT和fast-SENC %正常心肌评估的局灶性心肌纤维化与较差的左室应变相关。弥漫性纤维化与CMR-FT应变之间的非线性关联表明心功能恶化超过阈值。
{"title":"Worse left ventricular strain assessed by novel CMR imaging reflects myocardial fibrosis in the general population","authors":"T W Wimalanathan, J S Sulkowska, A M Melles, M P Paus, J B S Brox Skranes, T B Berge, A T Tveit, H R Rosjo, M N L Nakrem Lyngbakken, T O Omland, S L H Lagethon Heck, T H A K S H Wimalanathan","doi":"10.1093/eurheartj/ehaf784.260","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.260","url":null,"abstract":"Background Both focal and diffuse myocardial fibrosis may impair myocardial contractility and cause mechanical alterations that can be measured by novel cardiac magnetic resonance (CMR) techniques like CMR feature tracking (CMR-FT) and strain encoded (fast-SENC) sequences. Associations between myocardial fibrosis and impaired strain have been shown in different cardiomyopathies. The relationship between focal and diffuse fibrosis and strain assessed by novel CMR imaging has not yet been studied in an elderly general population cohort. Purpose To investigate the relationship between diffuse and focal myocardial fibrosis and left ventricular (LV) strain using state-of-the-art CMR imaging in an elderly general population cohort. Methods Two hundred community-dwellers born in 1950 without known coronary artery disease were recruited and examined with a 1.5-T Philips MRI scanner. Diffuse fibrosis was estimated by septal extracellular volume (ECV) fraction and focal fibrosis was quantified by late gadolinium enhancement (LGE). LV global longitudinal strain (GLS) and global circumferential strain (GCS) were obtained by both CMR-FT and fast-SENC. Fast-SENC was assessed as percentage of segments with strain ≤-17% (% normal myocardium). Linear models were used to assess the association between myocardial strain (CMR-FT and fast-SENC) and diffuse and focal fibrosis. Nonlinear associations were evaluated with restricted cubic splines with 3 knots. Likelihood Ratio Test was used to evaluate whether the fully adjusted models with splines provided a better fit than the linear model. Results The median age was 69 (68.6-69.3) and 52% were male. Presence and volume of LGE was associated with GLS assessed by CMR-FT and fast-SENC % normal myocardium in all models. The association between LGE and GCS by CMR-FT was attenuated when adjusting for indexed LV end diastolic volume (LVEDVi). There was a significant non-linear association between ECV and both GLS and GCS (Table) with worsening strain at ECV values above 26 % (Figure). There were no significant associations between ECV and fast-SENC % normal myocardium (Table). Conclusion(s) In an elderly general population cohort, focal myocardial fibrosis is associated with worse LV strain assessed by CMR-FT and fast-SENC % normal myocardium. The non-linear association between diffuse fibrosis and CMR-FT strain reveals worse cardiac function beyond a threshold value.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"42 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122066","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/ehaf784.3840
A Hatziyianni, M Botis, D Tsiachris, A Stylianou, D Konstantinidis, F Tatakis, K Pamporis, P Theofilis, S Drogkaris, K Dimitriadis, K Tsioufis
Background Depression and anxiety are common problems among hypertensive patients and are associated with increased mortality, greater health care expenditures and reduced quality of life. Purpose We sought to evaluate the association of anxiety and depression, as measured by the Hospital Anxiety and Depression (HADS) score, and blood pressure control, among hypertensive patients. Methods A total of 202 outpatients, suffering from primary hypertension (47.3 % women, median age 69.5, IQR 15.7) of a tertiary center in Cyprus were included. 188 patients (93%) had controlled hypertension, while 14 patients (7%) suffered from resistant hypertension. HADS score was recorded, along with its two subscales, HADS-D and HADS-A, measuring the components of depression and anxiety, respectively. Socioeconomic status variables, along with cardiovascular comorbidities, were also recorded (Table). Results Univariate logistic regression was applied (Table). HADS- T score and HADS- A were positively associated with uncontrolled hypertension (Odds Ratio 1.08, 95% CI 1.01 – 1.15, and Odds Ratio 1.15, 95% CI 1.03 – 1.28, per point increase, respectively). Diabetes mellitus and chronic kidney disease were also associated with resistant hypertension (Odds Ratio 9.03, 95% CI 2.37 – 59.16 and Odds Ratio 31.16, 95% CI 2.79 – 699, per point increase, respectively). Conclusion HADS score is associated with resistant hypertension. The anxiety component seems to be more pronounced that the depression component, along with the well- established risk factors of chronic kidney disease and diabetes mellitus.
背景：抑郁和焦虑是高血压患者的常见问题，与死亡率增加、医疗保健支出增加和生活质量下降有关。目的：通过医院焦虑和抑郁（HADS）评分评估高血压患者焦虑和抑郁与血压控制之间的关系。方法收集202例塞浦路斯某三级医疗中心原发性高血压门诊患者（女性47.3%，中位年龄69.5岁，IQR 15.7）。控制性高血压188例（93%），顽固性高血压14例（7%）。记录HADS评分及其两个子量表，HADS- d和HADS- a，分别测量抑郁和焦虑的成分。社会经济地位变量以及心血管合并症也被记录下来（表）。结果采用单因素logistic回归（表）。HADS- T评分和HADS- A评分与未控制的高血压呈正相关（比值比分别为1.08,95% CI 1.01 - 1.15和1.15,95% CI 1.03 - 1.28，每增加1分）。糖尿病和慢性肾脏疾病也与顽固性高血压相关（优势比分别为9.03,95% CI 2.37 - 59.16和31.16,95% CI 2.79 - 699，每增加一个点）。结论HADS评分与顽固性高血压相关。焦虑成分似乎比抑郁成分更明显，以及慢性肾脏疾病和糖尿病等已确定的危险因素。
{"title":"Psychological distress and blood pressure control: the association of anxiety, depression, and resistant hypertension","authors":"A Hatziyianni, M Botis, D Tsiachris, A Stylianou, D Konstantinidis, F Tatakis, K Pamporis, P Theofilis, S Drogkaris, K Dimitriadis, K Tsioufis","doi":"10.1093/eurheartj/ehaf784.3840","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.3840","url":null,"abstract":"Background Depression and anxiety are common problems among hypertensive patients and are associated with increased mortality, greater health care expenditures and reduced quality of life. Purpose We sought to evaluate the association of anxiety and depression, as measured by the Hospital Anxiety and Depression (HADS) score, and blood pressure control, among hypertensive patients. Methods A total of 202 outpatients, suffering from primary hypertension (47.3 % women, median age 69.5, IQR 15.7) of a tertiary center in Cyprus were included. 188 patients (93%) had controlled hypertension, while 14 patients (7%) suffered from resistant hypertension. HADS score was recorded, along with its two subscales, HADS-D and HADS-A, measuring the components of depression and anxiety, respectively. Socioeconomic status variables, along with cardiovascular comorbidities, were also recorded (Table). Results Univariate logistic regression was applied (Table). HADS- T score and HADS- A were positively associated with uncontrolled hypertension (Odds Ratio 1.08, 95% CI 1.01 – 1.15, and Odds Ratio 1.15, 95% CI 1.03 – 1.28, per point increase, respectively). Diabetes mellitus and chronic kidney disease were also associated with resistant hypertension (Odds Ratio 9.03, 95% CI 2.37 – 59.16 and Odds Ratio 31.16, 95% CI 2.79 – 699, per point increase, respectively). Conclusion HADS score is associated with resistant hypertension. The anxiety component seems to be more pronounced that the depression component, along with the well- established risk factors of chronic kidney disease and diabetes mellitus.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"22 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121911","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/ehaf784.2572
E Ammirati, I Cartella, F Loffredo, M Ciabatti, G Peretto, A Caputo, P Pedrotti, P Gentile, A Garascia, N Conti, M Ciliberti, M Palazzini, M L Narducci
Background Most patients with inflammatory cardiomyopathies are diagnosed non-invasively by cardiac magnetic resonance imaging (CMRI) or less frequently by fluorodeoxyglucose-positron emission tomography (FDG-PET) scan. No specific immunosuppressive treatments are recommended for patients with chronic inflammatory cardiomyopathy with left ventricular (LV) systolic dysfunction/heart failure (HF) or arrhythmic phenotype and evidence of inflammation on imaging. Purpose to assess the efficacy of colchicine (0.5 mg in patients of <70 kg or 1 mg if ≥70 kg) administered for 6 months on top of optimized medical therapy in patients with inflammatory cardiomyopathy. Methods A multicenter single-blinded randomized controlled trial that screens patients diagnosed with inflammatory cardiomyopathy based on CMRI or FDG-PET scan is ongoing. Eligibility is defined by the presence >1 month of: (1) high burden of premature ventricular complexes (PVCs) on 24-hour ECG ambulatory monitoring or presence of non-sustained ventricular tachycardia (NSVT), or sustained ventricular tachycardia (SVT), (2) LV ejection fraction (EF)<50% on echocardiogram or <60% on CMRI, or (3) increased levels of natriuretic peptides. Key exclusion criteria: coronary artery disease, cardiomyopathy due to specific causes, known systemic autoimmune disorders where immunosuppression may be beneficial, advanced HF, ongoing immunosuppressive therapies. Assuming an increase in the likelihood of reaching the primary endpoint at 6 months from 33% in the placebo group to 66% in the colchicine group, a planned sample size of 80 patients (40 per group) will allow achieving a power of 0.80 with an overall type I error of 0.025 using one-sided Fisher's Exact test (Figure). Results To assess the efficacy of colchicine, the primary endpoint of the trial is the proportion of patients who are alive free from any clinical worsening, arrhythmic burden or adverse imaging outcomes, and who demonstrate improvement in imaging or arrhythmic outcomes. Clinical worsening is defined as: cardiac death, HF hospitalization or arrhythmic events. Worsening arrhythmic burden is defined as a 50% increase in the PVC burden, a 30% increase in NSVT compared to baseline, or SVT. Worsening imaging outcomes are defined as a reduction in LVEF>10% or the appearance of new areas of edema on CMRI or FDG-PET scan. Improvement in imaging outcome is defined as (1) reduction in edema on CMRI or FDG uptake and no troponin increase or (2) the complete resolution of edema. Improvement in the arrhythmic outcomes is defined as (1) a 70% reduction in PVC burden with no NSVT or SVT. Currently, there are 10 active centers, and 16 (20%) patients out of 80 have been randomized since December 2023. The trial is expected to be completed by the end of 2026. Conclusion The results of the CMP-MYTHiC trial can define the role of colchicine in treating patients with inflammatory cardiomyopathy who show evidence of inflamma
{"title":"Rationale and study design of the multicenter randomized control trial CardioMyoPathy with MYocarditis THerapy with Colchicine: the CMP-MYTHiC trial","authors":"E Ammirati, I Cartella, F Loffredo, M Ciabatti, G Peretto, A Caputo, P Pedrotti, P Gentile, A Garascia, N Conti, M Ciliberti, M Palazzini, M L Narducci","doi":"10.1093/eurheartj/ehaf784.2572","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.2572","url":null,"abstract":"Background Most patients with inflammatory cardiomyopathies are diagnosed non-invasively by cardiac magnetic resonance imaging (CMRI) or less frequently by fluorodeoxyglucose-positron emission tomography (FDG-PET) scan. No specific immunosuppressive treatments are recommended for patients with chronic inflammatory cardiomyopathy with left ventricular (LV) systolic dysfunction/heart failure (HF) or arrhythmic phenotype and evidence of inflammation on imaging. Purpose to assess the efficacy of colchicine (0.5 mg in patients of &lt;70 kg or 1 mg if ≥70 kg) administered for 6 months on top of optimized medical therapy in patients with inflammatory cardiomyopathy. Methods A multicenter single-blinded randomized controlled trial that screens patients diagnosed with inflammatory cardiomyopathy based on CMRI or FDG-PET scan is ongoing. Eligibility is defined by the presence &gt;1 month of: (1) high burden of premature ventricular complexes (PVCs) on 24-hour ECG ambulatory monitoring or presence of non-sustained ventricular tachycardia (NSVT), or sustained ventricular tachycardia (SVT), (2) LV ejection fraction (EF)&lt;50% on echocardiogram or &lt;60% on CMRI, or (3) increased levels of natriuretic peptides. Key exclusion criteria: coronary artery disease, cardiomyopathy due to specific causes, known systemic autoimmune disorders where immunosuppression may be beneficial, advanced HF, ongoing immunosuppressive therapies. Assuming an increase in the likelihood of reaching the primary endpoint at 6 months from 33% in the placebo group to 66% in the colchicine group, a planned sample size of 80 patients (40 per group) will allow achieving a power of 0.80 with an overall type I error of 0.025 using one-sided Fisher's Exact test (Figure). Results To assess the efficacy of colchicine, the primary endpoint of the trial is the proportion of patients who are alive free from any clinical worsening, arrhythmic burden or adverse imaging outcomes, and who demonstrate improvement in imaging or arrhythmic outcomes. Clinical worsening is defined as: cardiac death, HF hospitalization or arrhythmic events. Worsening arrhythmic burden is defined as a 50% increase in the PVC burden, a 30% increase in NSVT compared to baseline, or SVT. Worsening imaging outcomes are defined as a reduction in LVEF&gt;10% or the appearance of new areas of edema on CMRI or FDG-PET scan. Improvement in imaging outcome is defined as (1) reduction in edema on CMRI or FDG uptake and no troponin increase or (2) the complete resolution of edema. Improvement in the arrhythmic outcomes is defined as (1) a 70% reduction in PVC burden with no NSVT or SVT. Currently, there are 10 active centers, and 16 (20%) patients out of 80 have been randomized since December 2023. The trial is expected to be completed by the end of 2026. Conclusion The results of the CMP-MYTHiC trial can define the role of colchicine in treating patients with inflammatory cardiomyopathy who show evidence of inflamma","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":"146122069","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/ehaf784.426
Y Tezuka, K Minami, K Ishigami, K Doi, T Yoshizawa, Y Ide, A Fujino, M Ishii, M Iguchi, N Masunaga, M Esato, H Wada, K Hasegawa, M Abe, M Akao
Background Hypertension is the commonest aetiological cause of atrial fibrillation (AF). Heart failure (HF) is a more frequent cardiovascular complication of AF than stroke. Blood vessels have the Windkessel effect and are involved in blood circulation, and an increased stiffness of the aorta and large arteries leads to an increase in pulse pressure (PP). We previously reported that PP was independently associated with cardiovascular events among patients with AF (The 85th Annual Scientific Meeting of the Japanese Circulation Society 2021). However, little is known about the impact of PP on HF in patients with AF. We investigated the relationship between PP and incidence of hospitalization for HF in patients without pre-existing HF, using data from the Fushimi AF Registry. Methods The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in the community. Follow-up data were available for 4,496 patients as of February 2022, and the median follow-up period was 2,096 days. Of them, we excluded 1,231 patients with pre-existing HF at baseline. Among 3,265 patients without pre-existing HF, data including PP at the baseline were available for 3,231 patients. We divided these patients into three groups according to PP tertile (T1:<47 mmHg; n=1,001, T2: 47–58; n=1,111, T3: 59 or above; n=1,119), and compared the baseline clinical characteristics and incidence of hospitalization for HF. Results Age (70.7±11.4 vs. 71.7±11.0 vs. 74.6±9.6 years ; p<0.01), systolic blood pressure (111.6±13.7 vs. 124.7±12.3 vs. 141.7±16.3 mmHg ; p<0.01), distolic blood pressure (73.4±13.0 vs. 72.2±11.8 vs. 71.0±13.2 mmHg ; p<0.01), prevalence of hypertension (50.9 vs. 61.9 vs. 73.5 %; p<0.01) , diabetes (19.4 vs.20.7 vs. 28.4 %; p<0.01), paroxysmal AF (50.7 vs. 57.5 vs. 58.5 %; p<0.01), prior catheter ablation (9.8 vs. 6.6 vs. 5.9 %; p<0.01), left atrial diameter (42.0±7.5 vs. 41.8±7.5 vs. 43.0±7.6 mm; p<0.01) and N-terminal pro-brain natriuretic peptide level (543 vs. 494 vs. 425 pg/ml; p<0.01) were different among groups. Prevalence of organic heart disease, the prescription of oral diuretics and left ventricular ejection fraction were comparable among groups. In Kaplan-Meier analysis, the incidence of HF was different among the groups during the median follow-up period of 2,155 days (T1 vs. T2 vs T3; 1.41% vs. 1.75% vs. 2.26% per person-year; p=0.002, by log-rank test) (Figure). PP (hazard ratio [95% confidential interval]: T3/T1 1.89 [1.15–3.09]; p=0.01, T2/T1 1.42 [0.86–2.33]; p=0.17) was an independent predictor of the incidence of hospitalization for HF after adjustment for various potential confounders including the components of H2ARDD score (organic heart disease, anemia, chronic kidney disease, diabetes and diuretic use) (Table). Conclusion PP was independently associated with incidence of first hospitalization for HF among Japanese AF patients wi
高血压是心房颤动（AF）最常见的病因。心衰（HF）是房颤比中风更常见的心血管并发症。血管具有Windkessel效应，参与血液循环，主动脉和大动脉硬度的增加导致脉压（PP）的增加。我们之前报道过，PP与AF患者的心血管事件独立相关（日本循环学会2021年第85届年度科学会议）。然而，关于PP对房颤患者HF的影响知之甚少。我们利用Fushimi AF Registry的数据，研究了PP与无房颤患者HF住院发生率之间的关系。方法Fushimi AF Registry是一项以社区为基础的前瞻性调查，旨在招募社区所有AF患者。截至2022年2月，共有4496例患者获得随访数据，中位随访时间为2096天。其中，我们排除了1231例基线时已存在HF的患者。在3265名没有既往HF的患者中，3231名患者的基线数据包括PP。我们将这些患者根据PP值分为三组（T1: 47 mmHg; n= 1001, T2: 47 - 58; n= 1111， T3: 59及以上；n= 1119），比较HF的基线临床特征和住院发生率。结果年龄(70.7±11.4和71.7±11.0和74.6±9.6年;p&肝移植;0.01),收缩压(111.6±13.7和124.7±12.3和141.7±16.3毫米汞柱,p&肝移植;0.01),distolic血压(73.4±13.0和72.2±11.8和71.0±13.2毫米汞柱,p&肝移植;0.01),高血压患病率(50.9 vs 61.9和73.5%;p&肝移植;0.01)、糖尿病(19.4 vs.20.7比28.4%;p&肝移植;0.01),阵发性房颤(50.7 vs 57.5和58.5%;p&肝移植;0.01),前导管消融(9.8 vs 6.6和5.9%;p amp;lt;0.01)、左心房内径（42.0±7.5 vs. 41.8±7.5 vs. 43.0±7.6 mm; p amp;lt;0.01）和n端脑利钠肽前体水平（543 vs. 494 vs. 425 pg/ml; p amp;lt;0.01）组间存在差异。器质性心脏病的患病率、口服利尿剂的处方和左心室射血分数在组间具有可比性。Kaplan-Meier分析显示，在中位随访2155天期间，两组患者HF的发生率存在差异（T1 vs T2 vs T3; 1.41% vs 1.75% vs 2.26% /人/年；log-rank检验p=0.002）（图）。PP（风险比[95%可信区间]:T3/T1 1.89 [1.15-3.09]; p=0.01, T2/T1 1.42 [0.86-2.33]; p=0.17）在校正H2ARDD评分成分（器质性心脏病、贫血、慢性肾病、糖尿病和利尿剂使用）等各种潜在混杂因素后，是心衰住院发生率的独立预测因子（表）。结论PP与日本房颤患者首次住院HF的发生率独立相关。
{"title":"Association of pulse pressure with incidence of hospitalization for heart failure in atrial fibrillation patients without heart failure: the Fushimi AF Registry","authors":"Y Tezuka, K Minami, K Ishigami, K Doi, T Yoshizawa, Y Ide, A Fujino, M Ishii, M Iguchi, N Masunaga, M Esato, H Wada, K Hasegawa, M Abe, M Akao","doi":"10.1093/eurheartj/ehaf784.426","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.426","url":null,"abstract":"Background Hypertension is the commonest aetiological cause of atrial fibrillation (AF). Heart failure (HF) is a more frequent cardiovascular complication of AF than stroke. Blood vessels have the Windkessel effect and are involved in blood circulation, and an increased stiffness of the aorta and large arteries leads to an increase in pulse pressure (PP). We previously reported that PP was independently associated with cardiovascular events among patients with AF (The 85th Annual Scientific Meeting of the Japanese Circulation Society 2021). However, little is known about the impact of PP on HF in patients with AF. We investigated the relationship between PP and incidence of hospitalization for HF in patients without pre-existing HF, using data from the Fushimi AF Registry. Methods The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in the community. Follow-up data were available for 4,496 patients as of February 2022, and the median follow-up period was 2,096 days. Of them, we excluded 1,231 patients with pre-existing HF at baseline. Among 3,265 patients without pre-existing HF, data including PP at the baseline were available for 3,231 patients. We divided these patients into three groups according to PP tertile (T1:&lt;47 mmHg; n=1,001, T2: 47–58; n=1,111, T3: 59 or above; n=1,119), and compared the baseline clinical characteristics and incidence of hospitalization for HF. Results Age (70.7±11.4 vs. 71.7±11.0 vs. 74.6±9.6 years ; p&lt;0.01), systolic blood pressure (111.6±13.7 vs. 124.7±12.3 vs. 141.7±16.3 mmHg ; p&lt;0.01), distolic blood pressure (73.4±13.0 vs. 72.2±11.8 vs. 71.0±13.2 mmHg ; p&lt;0.01), prevalence of hypertension (50.9 vs. 61.9 vs. 73.5 %; p&lt;0.01) , diabetes (19.4 vs.20.7 vs. 28.4 %; p&lt;0.01), paroxysmal AF (50.7 vs. 57.5 vs. 58.5 %; p&lt;0.01), prior catheter ablation (9.8 vs. 6.6 vs. 5.9 %; p&lt;0.01), left atrial diameter (42.0±7.5 vs. 41.8±7.5 vs. 43.0±7.6 mm; p&lt;0.01) and N-terminal pro-brain natriuretic peptide level (543 vs. 494 vs. 425 pg/ml; p&lt;0.01) were different among groups. Prevalence of organic heart disease, the prescription of oral diuretics and left ventricular ejection fraction were comparable among groups. In Kaplan-Meier analysis, the incidence of HF was different among the groups during the median follow-up period of 2,155 days (T1 vs. T2 vs T3; 1.41% vs. 1.75% vs. 2.26% per person-year; p=0.002, by log-rank test) (Figure). PP (hazard ratio [95% confidential interval]: T3/T1 1.89 [1.15–3.09]; p=0.01, T2/T1 1.42 [0.86–2.33]; p=0.17) was an independent predictor of the incidence of hospitalization for HF after adjustment for various potential confounders including the components of H2ARDD score (organic heart disease, anemia, chronic kidney disease, diabetes and diuretic use) (Table). Conclusion PP was independently associated with incidence of first hospitalization for HF among Japanese AF patients wi","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"31 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122108","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/ehaf784.1980
L Di Vito, F Di Giusto, G Scalone, F Bruscoli, S Silenzi, A Selimi, A Massari, D Delfino, F Guerra, P Grossi
Background The term "residual risk" after acute coronary syndromes (ACS) refers to the occurrence of cardiovascular events in individuals on lipid-lowering medications. Several factors affect residual risk, as consistent literature has shown. A greater burden of cardiovascular risk factors increases the residual risk and exposes patients to a higher risk of subsequent cardiovascular events. However, less is known about the distinctive pathophysiological mechanism that characterizes each residual risk determinant and the specific clinical, angiographic, and bio-humoral consequences. Purpose We investigated how female gender, non-ST-segment elevation myocardial infarction (NSTEMI) as a type of ACS, diabetes mellitus (DM), and chronic kidney disease (CKD) differently impacted coronary atherosclerosis extent, culprit plaque location, and bio-humoral data. The rate of both major adverse cardiovascular events (MACE) and non-fatal recurrent coronary events (RCE) was also assessed. Methods We enrolled 1,404 ACS patients and followed them for up to 5 years. Coronary culprit and non-culprit plaques were analyzed using angiography. Patients were discharged on high-intensity statin and ezetimibe treatments. Bio-humoral results were assessed at admission as well as at 1 month and 12 months after discharge. Patients were compared based on gender, type of ACS, DM, and CKD presence. Results NSTEMI patients had a higher number of total coronary plaques (3.5 vs. 3.3, p=0.013) and non-culprit plaques (2.3 vs. 1.6, p=0.0001). Non-culprit plaque stenosis was significantly greater in NSTEMI patients as compared to STEMI patients (57.9% vs. 47.1%, p=0.0001). DM patients had a higher frequency of bifurcation lesions (41% vs. 25%, p=0.0001). CKD patients more frequently presented with left main coronary artery disease (3.4% vs. 1.5%, p= 0.038). Female patients had higher LDL cholesterol values at 1 month and 12 months (Figure). The mean follow-up duration was 61.3 months ±13.6 for the entire studied population. NSTEMI, DM, and baseline creatinine values were independent predictors of MACE. Female gender was not an independent predictor of MACE (Table). NSTEMI patients showed a significantly higher risk of non-fatal RCE as compared to STEMI patients (17.3% vs 6.1%, 0=0.0001), and a non-significant trend toward a higher risk was also observed for DM patients as compared to non-DM patients (13.4% vs 10.0%, p=0.089). Conclusions NSTEMI patients had a greater extent of coronary atherosclerosis. Culprit lesions more commonly involved bifurcation sites in DM subjects, while CKD patients showed a greater prevalence of left main coronary artery disease. NSTEMI, DM, and creatinine levels at admission were independent predictors of MACE at the 5-year follow-up time. Female gender was not an independent predictor after correcting for comorbidities. Female patients had higher LDL cholesterol values despite receiving high-intensity lipid-lowering therapy.Figure.LDL changes on treatmen
背景：急性冠脉综合征（ACS）后的“剩余风险”是指服用降脂药物的个体发生心血管事件。正如一致的文献所显示的那样，有几个因素影响剩余风险。心血管危险因素负担加重会增加剩余风险，并使患者面临更高的后续心血管事件风险。然而，人们对每种残余风险决定因素的独特病理生理机制以及具体的临床、血管造影和生物体液后果知之甚少。目的研究女性性别、非st段抬高型心肌梗死（NSTEMI） （ACS的一种）、糖尿病（DM）和慢性肾脏疾病（CKD）对冠状动脉粥样硬化程度、罪魁祸首斑块位置和生物体液数据的不同影响。主要不良心血管事件（MACE）和非致死性复发冠状动脉事件（RCE）的发生率也进行了评估。方法纳入1404例ACS患者，随访5年。冠脉罪状斑块和非罪状斑块采用血管造影分析。患者出院时接受高强度他汀类药物和依折麦布治疗。在入院时以及出院后1个月和12个月评估生物体液结果。根据性别、ACS类型、DM和CKD的存在对患者进行比较。结果NSTEMI患者的总冠状动脉斑块数量（3.5 vs 3.3, p=0.013）和非罪魁祸首斑块数量（2.3 vs. 1.6, p=0.0001）较高。非罪魁祸首斑块狭窄在NSTEMI患者中明显大于STEMI患者（57.9% vs. 47.1%, p=0.0001）。DM患者出现分叉病变的频率更高（41% vs. 25%, p=0.0001）。CKD患者更常出现左主干冠状动脉病变（3.4% vs. 1.5%, p= 0.038）。女性患者在1个月和12个月时LDL胆固醇值较高（图）。整个研究人群的平均随访时间为61.3个月±13.6个月。NSTEMI、DM和基线肌酐值是MACE的独立预测因子。女性性别不是MACE的独立预测因子（表）。与STEMI患者相比，NSTEMI患者的非致死性RCE风险明显更高（17.3% vs 6.1%, 0=0.0001）， DM患者的非致死性RCE风险也高于非DM患者（13.4% vs 10.0%, p=0.089）。结论NSTEMI患者冠状动脉粥样硬化程度较大。罪魁祸首病变在糖尿病患者中更常涉及分叉部位，而CKD患者显示出更普遍的左主干冠状动脉疾病。入院时的NSTEMI、DM和肌酐水平是5年随访时MACE的独立预测因子。校正合并症后，女性性别不是独立的预测因子。尽管接受了高强度的降脂治疗，女性患者的低密度脂蛋白胆固醇值仍较高。梅斯预测
{"title":"Impact of residual risk determinants on coronary atherosclerosis extent, culprit plaque location, bio-humoral data, and long-term outcomes","authors":"L Di Vito, F Di Giusto, G Scalone, F Bruscoli, S Silenzi, A Selimi, A Massari, D Delfino, F Guerra, P Grossi","doi":"10.1093/eurheartj/ehaf784.1980","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.1980","url":null,"abstract":"Background The term \"residual risk\" after acute coronary syndromes (ACS) refers to the occurrence of cardiovascular events in individuals on lipid-lowering medications. Several factors affect residual risk, as consistent literature has shown. A greater burden of cardiovascular risk factors increases the residual risk and exposes patients to a higher risk of subsequent cardiovascular events. However, less is known about the distinctive pathophysiological mechanism that characterizes each residual risk determinant and the specific clinical, angiographic, and bio-humoral consequences. Purpose We investigated how female gender, non-ST-segment elevation myocardial infarction (NSTEMI) as a type of ACS, diabetes mellitus (DM), and chronic kidney disease (CKD) differently impacted coronary atherosclerosis extent, culprit plaque location, and bio-humoral data. The rate of both major adverse cardiovascular events (MACE) and non-fatal recurrent coronary events (RCE) was also assessed. Methods We enrolled 1,404 ACS patients and followed them for up to 5 years. Coronary culprit and non-culprit plaques were analyzed using angiography. Patients were discharged on high-intensity statin and ezetimibe treatments. Bio-humoral results were assessed at admission as well as at 1 month and 12 months after discharge. Patients were compared based on gender, type of ACS, DM, and CKD presence. Results NSTEMI patients had a higher number of total coronary plaques (3.5 vs. 3.3, p=0.013) and non-culprit plaques (2.3 vs. 1.6, p=0.0001). Non-culprit plaque stenosis was significantly greater in NSTEMI patients as compared to STEMI patients (57.9% vs. 47.1%, p=0.0001). DM patients had a higher frequency of bifurcation lesions (41% vs. 25%, p=0.0001). CKD patients more frequently presented with left main coronary artery disease (3.4% vs. 1.5%, p= 0.038). Female patients had higher LDL cholesterol values at 1 month and 12 months (Figure). The mean follow-up duration was 61.3 months ±13.6 for the entire studied population. NSTEMI, DM, and baseline creatinine values were independent predictors of MACE. Female gender was not an independent predictor of MACE (Table). NSTEMI patients showed a significantly higher risk of non-fatal RCE as compared to STEMI patients (17.3% vs 6.1%, 0=0.0001), and a non-significant trend toward a higher risk was also observed for DM patients as compared to non-DM patients (13.4% vs 10.0%, p=0.089). Conclusions NSTEMI patients had a greater extent of coronary atherosclerosis. Culprit lesions more commonly involved bifurcation sites in DM subjects, while CKD patients showed a greater prevalence of left main coronary artery disease. NSTEMI, DM, and creatinine levels at admission were independent predictors of MACE at the 5-year follow-up time. Female gender was not an independent predictor after correcting for comorbidities. Female patients had higher LDL cholesterol values despite receiving high-intensity lipid-lowering therapy.Figure.LDL changes on treatmen","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"3 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122315","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/ehaf784.4030
H Triantafyllidi, D Benas, G Pavlidis, I Ikonomidis, A Attilakos, E Iliodromitis, E Dretsiou
Baseline: The presence of obesity or/and arterial hypertension in young adults represent well recognized risk factors for later cardiovascular (CV) events during adult life. Obesity and arterial hypertension contribute to increased arterial stiffness, another important CV risk factor. The integrity of endothelial glycocalyx (EG), as part of the endothelium, plays a vital role in vascular permeability, inflammation, and elasticity and finally to CV disease. We investigated the relationship between obesity and arterial hypertension to target organ damage (TOD) as arterial stiffness and endothelial function in young adults. Methods: A group of 66 healthy young adults, 16-26 years old, was evaluated regarding the presence of CV risk factors [obesity, systolic (SBP) and diastolic (DBP) blood pressure] and TOD (arterial stiffness, EG integrity). Carotid-femoral arterial stiffness (PWV) was measured by Complior apparatus. Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (5-25 micrometers) was measured as a non-invasive accurate index of reduced EG thickness and subsequent endothelial dysfunction. Results: Population was divided in Group A (young males, n=33, 20+2 years, BMI=27+5) and Group B (young females, n=33, 20+2 years, BMI=24+4). Young males had increased BMI (27+5 vs. 24+4, p=0.02), elevated SBP (124+9 vs. 111+8, p<0.001), increased PWV (8+1 vs. 7+1m/sec, p=0.002) and reduced PBR5-25 (1.79+0.2 vs. 1.98+2μm, p=0.001) compared to young females. In the whole population, i. weight was related to PBR5-25 (ρ=-0.23, p=0.05), SBP (r=0.60, p<0.001), DBP (ρ=0.27, p=0.03) and PWV (r=.33, p=0.007) and ii. SBP was related to PBR5-25 (r=-0.34, p=0.005) and PWV (r=0.57, p<0.001). In a multiple regression analysis (age, weight and SBP were inserted as independent variables), we found that PBR5-9 was independently associated with SBP (beta=-0.59, p<0.001) and weight (beta=0.43, p=0.004) while PWV was independently associated with SBP (beta=0.56, p<0.001) Conclusions: In early adulthood, independent associations between CV risk factors (obesity and arterial hypertension), and TOD (arterial stiffness and endothelial function) already exist. However, endothelial glycocalyx integrity remains despite weight and blood pressure increase. Our results underscore the need of primary prevention of future CV events by keeping body weight and BP within optimal levels, even in young adults.
基线：年轻成人中肥胖或/和动脉高血压的存在是成年后心血管（CV）事件的公认危险因素。肥胖和动脉高血压会增加动脉僵硬度，这是另一个重要的心血管危险因素。内皮糖萼（endothelial glycocalyx， EG）的完整性作为内皮的一部分，在血管通透性、炎症、弹性以及心血管疾病中起着至关重要的作用。我们研究了肥胖和动脉高血压之间的关系，以动脉僵硬和内皮功能为目标器官损伤（TOD）。方法：对66名年龄在16-26岁的健康年轻人进行心血管危险因素[肥胖、收缩压（SBP）和舒张压（DBP）]和TOD（动脉僵硬度、EG完整性）的评估。颈股动脉僵硬度（PWV）用Complior仪测定。测量舌下动脉微血管（5-25微米）灌注边界区（PBR）的增加，作为EG厚度减少和随后内皮功能障碍的无创准确指标。结果：将人群分为A组（年轻男性，n=33, 20+2岁，BMI=27+5）和B组（年轻女性，n=33, 20+2岁，BMI=24+4）。与年轻女性相比，年轻男性BMI增加（27+5 vs. 24+4, p=0.02）， SBP升高（124+9 vs. 111+8, p=0.001）， PWV增加（8+1 vs. 7+1m/sec, p=0.002）， PBR5-25降低（1.79+0.2 vs. 1.98+2μm, p=0.001）。在整个人群中，体重与PBR5-25 （ρ=-0.23, p=0.05）、收缩压（r=0.60, p<0.001）、DBP （ρ=0.27, p=0.03）和PWV （r= 0.33, p=0.007）相关；收缩压与PBR5-25 （r=-0.34, p=0.005）和PWV （r=0.57, p amp;lt;0.001）相关。在多元回归分析（将年龄、体重和收缩压作为自变量）中，我们发现PBR5-9与收缩压（beta=-0.59, p= 0.001）和体重（beta=0.43, p=0.004）独立相关，而PWV与收缩压独立相关（beta=0.56, p amp;lt;0.001）结论：在成年早期，CV危险因素（肥胖和动脉高血压）与TOD（动脉硬度和内皮功能）之间已经存在独立关联。然而，尽管体重和血压升高，内皮糖萼的完整性仍然存在。我们的研究结果强调了通过将体重和血压保持在最佳水平来一级预防未来心血管事件的必要性，即使在年轻人中也是如此。
{"title":"Interrelationship of cardiovascular risk factors in early adulthood. The role of endothelial glycocalyx","authors":"H Triantafyllidi, D Benas, G Pavlidis, I Ikonomidis, A Attilakos, E Iliodromitis, E Dretsiou","doi":"10.1093/eurheartj/ehaf784.4030","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4030","url":null,"abstract":"Baseline: The presence of obesity or/and arterial hypertension in young adults represent well recognized risk factors for later cardiovascular (CV) events during adult life. Obesity and arterial hypertension contribute to increased arterial stiffness, another important CV risk factor. The integrity of endothelial glycocalyx (EG), as part of the endothelium, plays a vital role in vascular permeability, inflammation, and elasticity and finally to CV disease. We investigated the relationship between obesity and arterial hypertension to target organ damage (TOD) as arterial stiffness and endothelial function in young adults. Methods: A group of 66 healthy young adults, 16-26 years old, was evaluated regarding the presence of CV risk factors [obesity, systolic (SBP) and diastolic (DBP) blood pressure] and TOD (arterial stiffness, EG integrity). Carotid-femoral arterial stiffness (PWV) was measured by Complior apparatus. Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (5-25 micrometers) was measured as a non-invasive accurate index of reduced EG thickness and subsequent endothelial dysfunction. Results: Population was divided in Group A (young males, n=33, 20+2 years, BMI=27+5) and Group B (young females, n=33, 20+2 years, BMI=24+4). Young males had increased BMI (27+5 vs. 24+4, p=0.02), elevated SBP (124+9 vs. 111+8, p&lt;0.001), increased PWV (8+1 vs. 7+1m/sec, p=0.002) and reduced PBR5-25 (1.79+0.2 vs. 1.98+2μm, p=0.001) compared to young females. In the whole population, i. weight was related to PBR5-25 (ρ=-0.23, p=0.05), SBP (r=0.60, p&lt;0.001), DBP (ρ=0.27, p=0.03) and PWV (r=.33, p=0.007) and ii. SBP was related to PBR5-25 (r=-0.34, p=0.005) and PWV (r=0.57, p&lt;0.001). In a multiple regression analysis (age, weight and SBP were inserted as independent variables), we found that PBR5-9 was independently associated with SBP (beta=-0.59, p&lt;0.001) and weight (beta=0.43, p=0.004) while PWV was independently associated with SBP (beta=0.56, p&lt;0.001) Conclusions: In early adulthood, independent associations between CV risk factors (obesity and arterial hypertension), and TOD (arterial stiffness and endothelial function) already exist. However, endothelial glycocalyx integrity remains despite weight and blood pressure increase. Our results underscore the need of primary prevention of future CV events by keeping body weight and BP within optimal levels, even in young adults.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"241 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121863","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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