Pub Date : 2026-02-05DOI: 10.1093/eurheartj/ehaf784.385
C Espersen, D Modin, B Claggett, S D Solomon, R Trebbien, T G Krause, J U S Jensen, M P Andersen, G M Marcus, G Gislason, T Biering-Soerensen
Background Patients with atrial fibrillation (AF) may face an elevated risk of influenza-related complications, including cardiovascular and respiratory adverse outcomes. However, limited knowledge exists regarding the excess burden of hospitalizations and mortality due to influenza activity among patients with AF at a population level. Purpose We sought to estimate the excess number of deaths and hospitalizations associated with influenza activity among individuals with AF in Denmark. Methods Data on weekly number of deaths and hospitalizations among patients with AF in Denmark were collected from the nationwide registries. Weekly estimates of influenza circulation were based on the proportion of positive influenza samples analyzed at all hospitals in Denmark during the study period. We used a time-series linear regression model to correlate the weekly estimates of influenza circulation with the weekly number of deaths and hospitalizations to estimate the annual excess number of deaths and hospitalizations associated with influenza circulation among patients with AF in Denmark. The model also incorporated data on weekly mean temperature in Denmark and restricted cubic spline terms to account for seasonal changes and trends over time. Confidence intervals were derived using block bootstrapping. Results During the study period encompassing 8 influenza seasons from 2010-2018, an annual mean of 141,746 patients were living with AF. An annual mean of 25,181 samples were tested for influenza at all Danish hospitals with a mean proportion of positive samples of 7.9% (Figure 1). Based on our model, influenza activity was associated with an annual excess of 298 all-cause deaths (95% CI 126-564 deaths) and 86 cardiovascular deaths (95% CI 45-204 deaths) corresponding to 2.3% of all all-cause deaths (95% CI 1.0-4.3% deaths) and 1.8% of all cardiovascular deaths (95% CI 1.0-4.3% deaths) in patients with AF in Denmark (Figure 1). Influenza activity was also associated with an annual excess of 387 hospitalizations for pneumonia or influenza (95% CI 148-667 hospitalizations for pneumonia or influenza) corresponding to 5.5% of all hospitalizations for pneumonia or influenza (95% CI 2.3-8.8%) among patients with AF. Conclusions Based on the results of our model, approximately 2.3% of all deaths and 5.5% of all hospitalizations for pneumonia or influenza may be attributed to influenza activity among patients with AF in Denmark, suggesting substantial morbidity and mortality associated with influenza in patients with AF.Figure 1.
背景：房颤（AF）患者可能面临流感相关并发症的高风险，包括心血管和呼吸不良后果。然而，在人群水平上，关于房颤患者因流感活动引起的住院负担和死亡率的知识有限。目的：我们试图估计丹麦房颤患者中与流感活动相关的过量死亡和住院人数。方法收集丹麦全国房颤患者每周死亡和住院人数的数据。每周流感传播的估计是基于研究期间在丹麦所有医院分析的流感阳性样本的比例。我们使用了一个时间序列线性回归模型，将流感循环的周估计与每周死亡和住院人数联系起来，以估计丹麦AF患者中与流感循环相关的年超额死亡和住院人数。该模型还纳入了丹麦每周平均温度的数据，并限制了三次样条项，以解释季节变化和随时间的趋势。置信区间采用分块自举法推导。在2010-2018年8个流感季节的研究期间，平均每年有141,746名AF患者。丹麦所有医院平均每年检测25,181份流感样本，平均阳性样本比例为7.9%（图1）。根据我们的模型，流感活动与每年298例全因死亡（95% CI 126-564例死亡）和86例心血管死亡（95% CI 45-204例死亡）相关，对应于丹麦AF患者中2.3%的全因死亡（95% CI 1.0-4.3%死亡）和1.8%的心血管死亡（95% CI 1.0-4.3%死亡）（图1）。流感活动还与每年超过387例肺炎或流感住院相关（95% CI为148-667例肺炎或流感住院），相当于房颤患者中所有肺炎或流感住院的5.5% （95% CI为2.3-8.8%）。在丹麦，房颤患者中约有2.3%的死亡和5.5%的肺炎或流感住院可归因于流感活动，这表明房颤患者中与流感相关的发病率和死亡率很高。
{"title":"Excess morbidity and mortality associated with seasonal influenza in patients with atrial fibrillation","authors":"C Espersen, D Modin, B Claggett, S D Solomon, R Trebbien, T G Krause, J U S Jensen, M P Andersen, G M Marcus, G Gislason, T Biering-Soerensen","doi":"10.1093/eurheartj/ehaf784.385","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.385","url":null,"abstract":"Background Patients with atrial fibrillation (AF) may face an elevated risk of influenza-related complications, including cardiovascular and respiratory adverse outcomes. However, limited knowledge exists regarding the excess burden of hospitalizations and mortality due to influenza activity among patients with AF at a population level. Purpose We sought to estimate the excess number of deaths and hospitalizations associated with influenza activity among individuals with AF in Denmark. Methods Data on weekly number of deaths and hospitalizations among patients with AF in Denmark were collected from the nationwide registries. Weekly estimates of influenza circulation were based on the proportion of positive influenza samples analyzed at all hospitals in Denmark during the study period. We used a time-series linear regression model to correlate the weekly estimates of influenza circulation with the weekly number of deaths and hospitalizations to estimate the annual excess number of deaths and hospitalizations associated with influenza circulation among patients with AF in Denmark. The model also incorporated data on weekly mean temperature in Denmark and restricted cubic spline terms to account for seasonal changes and trends over time. Confidence intervals were derived using block bootstrapping. Results During the study period encompassing 8 influenza seasons from 2010-2018, an annual mean of 141,746 patients were living with AF. An annual mean of 25,181 samples were tested for influenza at all Danish hospitals with a mean proportion of positive samples of 7.9% (Figure 1). Based on our model, influenza activity was associated with an annual excess of 298 all-cause deaths (95% CI 126-564 deaths) and 86 cardiovascular deaths (95% CI 45-204 deaths) corresponding to 2.3% of all all-cause deaths (95% CI 1.0-4.3% deaths) and 1.8% of all cardiovascular deaths (95% CI 1.0-4.3% deaths) in patients with AF in Denmark (Figure 1). Influenza activity was also associated with an annual excess of 387 hospitalizations for pneumonia or influenza (95% CI 148-667 hospitalizations for pneumonia or influenza) corresponding to 5.5% of all hospitalizations for pneumonia or influenza (95% CI 2.3-8.8%) among patients with AF. Conclusions Based on the results of our model, approximately 2.3% of all deaths and 5.5% of all hospitalizations for pneumonia or influenza may be attributed to influenza activity among patients with AF in Denmark, suggesting substantial morbidity and mortality associated with influenza in patients with AF.Figure 1.","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":"146122191","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/ehaf784.357
K Smirnov, E L Zaslavskaia, V A Ionin
Aim To establish association of metabolic syndrome (MS), epicardial fat thickness (EFT), concentration of galectin-3 and transforming growth factor-beta1 (TGF-b1) in blood serum with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Materials and methods Ninety five (n = 95) of 258 examined patients with AF underwent PVI due to ineffectiveness of the antiarrhythmic therapy. Average patient age was 54.2 ± 8.2 years. MS was diagnosed according to International Diabetes Federation (IDF) criteria. EFT was detected by means of transthoracic echocardiography. Galectin-3 and TGF-b1 serum levels were determined by enzyme-linked immunosorbent assay (ELISA). Results After one year of prospective post-PVI observation all patients were divided into 2 groups: Group I included 59 patients (62.1%) without arrhythmia recurrence, and Group II comprised 36 patients (37.9%) with AF recurrence. MS prevalence reached 80.6% among patients with AF relapse and only 33.9% – in patients without AFrecurrence. EFT in patients with AF recurrence was greater than in patients without AF recurrence (5.8 ± 1.8 mm and 4.9 ± 1.9 mm, p = 0.0187). Galectin-3 concentration in patients with AF recurrence was higher than in patients without AF recurrence (0.85 [0.68; 0.96] ng / ml and 0.72 [0.62; 0.85] ng / ml, p = 0.01). The concentration of TGF-b1 did not significantly differ in patients with and without AF recurrence (3586.9 [1841.0; 5545.8] pg/ml and 2581.3 [1896.4; 3177.4] pg/ml, p = 0.21). Logistic regression method allowed us to establish that the risk of AF recurrence after PVI was 8-hold higher in patients with MS (OS = 8.08, 95% CI 3.01-21.65; p = 0.001). According to the ROC analysis, the EFT threshold value of 4.5 mm or more (AUC = 0.653 ± 0.059, p = 0.014) increases the likelihood of AF recurrence after PVI by 1.32-fold (OR = 1.316 95% CI 1.053-1.645; p = 0.016 ); galectin-3 concentration level 0.77 ng/ml or more (AUC = 0.646 ± 0.060, p = 0.019) increases the risk of AF recurrence after PVI by 5.65-fold (OR = 5.65, 95% CI 1.153-27.762 ; p = 0.033). The change in TGF-b1 concentration did not affect AF recurrence. Conclusion Metabolic syndrome presence, high epicardial fat thickness and elevated level of galectin-3 serum concentration are independent predictors of ineffectiveness of radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
目的探讨肺静脉分离（PVI）后心房颤动（AF）复发与代谢综合征（MS）、心外膜脂肪厚度（EFT）、血清半凝集素-3和转化生长因子- β 1 （TGF-b1）浓度的关系。材料与方法258例房颤患者中95例（n = 95）因抗心律失常治疗无效而发生PVI。患者平均年龄54.2±8.2岁。根据国际糖尿病联合会（IDF）的标准诊断多发性硬化症。经胸超声心动图检测EFT。采用酶联免疫吸附试验（ELISA）检测血清半乳糖凝集素-3和TGF-b1水平。结果经1年pvi术后前瞻性观察，所有患者分为2组：I组无心律失常复发59例（62.1%），II组房颤复发36例（37.9%）。在房颤复发患者中，MS患病率为80.6%，而在非房颤复发患者中，MS患病率仅为33.9%。房颤复发患者的EFT大于未复发患者（5.8±1.8 mm和4.9±1.9 mm, p = 0.0187）。AF复发患者的半凝集素-3浓度高于未复发患者（分别为0.85 [0.68；0.96]ng / ml和0.72 [0.62;0.85]ng / ml, p = 0.01）。TGF-b1浓度在AF复发患者和非AF复发患者中无显著差异（3586.9 [1841.0；5545.8]pg/ml和2581.3 [1896.4;3177.4]pg/ml, p = 0.21）。Logistic回归方法证实，MS患者PVI后房颤复发的风险比MS患者高8% （OS = 8.08, 95% CI 3.01-21.65; p = 0.001）。根据ROC分析，EFT阈值≥4.5 mm （AUC = 0.653±0.059,p = 0.014）使PVI后AF复发的可能性增加1.32倍（or = 1.316, 95% CI 1.053 ~ 1.645; p = 0.016）；半凝集素-3浓度≥0.77 ng/ml （AUC = 0.646±0.060,p = 0.019）使PVI术后AF复发风险增加5.65倍（or = 5.65, 95% CI 1.153 ~ 27.762; p = 0.033）。TGF-b1浓度变化对房颤复发无影响。结论存在代谢综合征、心外膜脂肪厚度高、血清半乳糖凝集素-3水平升高是肺静脉射频隔离治疗无效的独立预测因素。
{"title":"Predictors of atrial fibrillation recurrence after radiofrequency pulmonary vein isolation: metabolic syndrome, epicardial fat thickness, what else?","authors":"K Smirnov, E L Zaslavskaia, V A Ionin","doi":"10.1093/eurheartj/ehaf784.357","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.357","url":null,"abstract":"Aim To establish association of metabolic syndrome (MS), epicardial fat thickness (EFT), concentration of galectin-3 and transforming growth factor-beta1 (TGF-b1) in blood serum with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Materials and methods Ninety five (n = 95) of 258 examined patients with AF underwent PVI due to ineffectiveness of the antiarrhythmic therapy. Average patient age was 54.2 ± 8.2 years. MS was diagnosed according to International Diabetes Federation (IDF) criteria. EFT was detected by means of transthoracic echocardiography. Galectin-3 and TGF-b1 serum levels were determined by enzyme-linked immunosorbent assay (ELISA). Results After one year of prospective post-PVI observation all patients were divided into 2 groups: Group I included 59 patients (62.1%) without arrhythmia recurrence, and Group II comprised 36 patients (37.9%) with AF recurrence. MS prevalence reached 80.6% among patients with AF relapse and only 33.9% – in patients without AFrecurrence. EFT in patients with AF recurrence was greater than in patients without AF recurrence (5.8 ± 1.8 mm and 4.9 ± 1.9 mm, p = 0.0187). Galectin-3 concentration in patients with AF recurrence was higher than in patients without AF recurrence (0.85 [0.68; 0.96] ng / ml and 0.72 [0.62; 0.85] ng / ml, p = 0.01). The concentration of TGF-b1 did not significantly differ in patients with and without AF recurrence (3586.9 [1841.0; 5545.8] pg/ml and 2581.3 [1896.4; 3177.4] pg/ml, p = 0.21). Logistic regression method allowed us to establish that the risk of AF recurrence after PVI was 8-hold higher in patients with MS (OS = 8.08, 95% CI 3.01-21.65; p = 0.001). According to the ROC analysis, the EFT threshold value of 4.5 mm or more (AUC = 0.653 ± 0.059, p = 0.014) increases the likelihood of AF recurrence after PVI by 1.32-fold (OR = 1.316 95% CI 1.053-1.645; p = 0.016 ); galectin-3 concentration level 0.77 ng/ml or more (AUC = 0.646 ± 0.060, p = 0.019) increases the risk of AF recurrence after PVI by 5.65-fold (OR = 5.65, 95% CI 1.153-27.762 ; p = 0.033). The change in TGF-b1 concentration did not affect AF recurrence. Conclusion Metabolic syndrome presence, high epicardial fat thickness and elevated level of galectin-3 serum concentration are independent predictors of ineffectiveness of radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"301 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122014","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/ehaf784.3610
B Pashaee, N Nasibi, A Mueller, V Namdarizandi, T Zamani, T Char, E Argulian, J Leipsic, J Narula, A Ahmadi
Introduction Patients with rheumatological conditions have an increased risk of cardiovascular disease, yet traditional risk stratification tools may underestimate their atherosclerotic burden. Imaging modalities such as coronary computed tomography angiography (CCTA), coronary artery calcium (CAC) scoring, and carotid ultrasound may improve risk assessment and optimize lipid-lowering therapy (LLT). Purpose This study evaluates the role of imaging-guided lipid-lowering therapy (LLT) in rheumatology-referred patients, aiming to determine its impact on risk stratification, treatment modification, and clinical outcomes. Methods A retrospective cohort analysis was conducted on 121 patients referred by rheumatologists for cardiovascular risk assessment. Cardiovascular risk factors, lipid profiles, and ASCVD risk estimates were obtained. Patients underwent imaging based on an age- and symptom-stratified protocol: CCTA, CAC scoring, or carotid ultrasound. LLT was initiated or adjusted based on imaging findings, targeting an LDL goal of ≤70 mg/dL for patients with atherosclerosis and ≤130 mg/dL for those without. The primary endpoint was LDL reduction, and secondary outcomes included reclassification rates and cardiovascular event occurrence. Results Atherosclerosis was detected in 85 patients (70%), despite only 69 (57%) having an ASCVD risk ≥5% per standard calculators. Imaging led to reclassification in 25.6% of patients, resulting in LLT intensification in 42.4% of patients not indicated for treatment per AHA guidelines and de-escalation in 19.3% of those previously indicated for treatment. Post-treatment, LDL reduction was 35.9% in atherosclerotic patients, compared to 17.9% in non-atherosclerotic patients. Over a mean follow-up of 4.8 ± 1.4 years, no major cardiovascular events (myocardial infarction [MI], cerebrovascular accident [CVA], or unplanned revascularization) were observed, despite an expected event rate of 3.4%–7.6% based on five different risk estimation models. Conclusion Incorporating atherosclerosis imaging into routine evaluation for individuals with rheumatological conditions enhances risk stratification, allows for personalized treatment strategies, and was associated with a lower rate of cardiovascular events compared with what was predicted by traditional risk-based approaches.
{"title":"Imaging-guided lipid-lowering therapy in rheumatology patients at cardiovascular risk","authors":"B Pashaee, N Nasibi, A Mueller, V Namdarizandi, T Zamani, T Char, E Argulian, J Leipsic, J Narula, A Ahmadi","doi":"10.1093/eurheartj/ehaf784.3610","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.3610","url":null,"abstract":"Introduction Patients with rheumatological conditions have an increased risk of cardiovascular disease, yet traditional risk stratification tools may underestimate their atherosclerotic burden. Imaging modalities such as coronary computed tomography angiography (CCTA), coronary artery calcium (CAC) scoring, and carotid ultrasound may improve risk assessment and optimize lipid-lowering therapy (LLT). Purpose This study evaluates the role of imaging-guided lipid-lowering therapy (LLT) in rheumatology-referred patients, aiming to determine its impact on risk stratification, treatment modification, and clinical outcomes. Methods A retrospective cohort analysis was conducted on 121 patients referred by rheumatologists for cardiovascular risk assessment. Cardiovascular risk factors, lipid profiles, and ASCVD risk estimates were obtained. Patients underwent imaging based on an age- and symptom-stratified protocol: CCTA, CAC scoring, or carotid ultrasound. LLT was initiated or adjusted based on imaging findings, targeting an LDL goal of ≤70 mg/dL for patients with atherosclerosis and ≤130 mg/dL for those without. The primary endpoint was LDL reduction, and secondary outcomes included reclassification rates and cardiovascular event occurrence. Results Atherosclerosis was detected in 85 patients (70%), despite only 69 (57%) having an ASCVD risk ≥5% per standard calculators. Imaging led to reclassification in 25.6% of patients, resulting in LLT intensification in 42.4% of patients not indicated for treatment per AHA guidelines and de-escalation in 19.3% of those previously indicated for treatment. Post-treatment, LDL reduction was 35.9% in atherosclerotic patients, compared to 17.9% in non-atherosclerotic patients. Over a mean follow-up of 4.8 ± 1.4 years, no major cardiovascular events (myocardial infarction [MI], cerebrovascular accident [CVA], or unplanned revascularization) were observed, despite an expected event rate of 3.4%–7.6% based on five different risk estimation models. Conclusion Incorporating atherosclerosis imaging into routine evaluation for individuals with rheumatological conditions enhances risk stratification, allows for personalized treatment strategies, and was associated with a lower rate of cardiovascular events compared with what was predicted by traditional risk-based approaches.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"57 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121859","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/ehaf784.259
C Perez Garcia, V Fuster, G Garcia-Marti, A Moreno-Arciniegas, S Gomez-Talavera, G Pizarro, A Devesa, B Oliva, R Vazirani, A Navarro-Guzman, J Sanchez-Gonzalez, H Bueno, B Ibanez, I Garcia-Lunar, A Garcia-Alvarez
Background Right ventricular (RV) dysfunction is a relevant prognostic factor in different cardiovascular conditions, but its early determinants remain unclear. Purpose This study aimed to identify the main determinants of RV performance through CMR in a large cohort of asymptomatic middle-aged individuals. Methods A subgroup of asymptomatic middle-aged participants from the PESA cardiovascular cohort underwent RV assessment by CMR-strain and a comprehensive screening of all possible factors that may influence RV performance (including demographics, cardiometabolic risk factors, physical activity objectively measured by accelerometry, and laboratory parameters). To further understand the mechanism through which RV performance may be affected, subjects additionally underwent stress CMR to assess myocardial perfusion reserve and tissue characterization; 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to quantify bone marrow metabolic activity, and non-contrast cardiac computed tomography (CT) to measure epicardial adiposity. RV free wall longitudinal strain was calculated through myocardial tagging, and participants were divided into tertiles based on strain values. Age and sex-adjusted trend analyses were conducted, followed by multivariate lineal regression to identify independent predictors of RV strain. Subsequently, mediators of the association between obesity and RV strain were investigated. Results 609 individuals (mean age 52.7 years; 82.8% male) were included with a median RV ejection fraction of 59.4% [56.2–62.8] and RV strain -21.3% [-23.5 to -18.3]. After adjusting for age and sex, RV strain positively correlated with body mass index (BMI), waist circumference, non-alcoholic fatty liver disease, fasting glucose, and glycated hemoglobin (HbA1c) and negatively with left ventricular (LV) ejection fraction. Interestingly, bone marrow uptake (surrogate of increased hematopoietic activity) showed a significant positive linear association with RV strain (Table). In multivariable analysis, male sex, BMI, and lower LVEF remained independent predictors of RV strain (Figure). To further understand the association between obesity and RV performance, individuals were recategorized based on BMI tertiles. Higher BMI tertiles were linked to increased bone marrow FDG uptake, lower T1 values, larger epicardial adipose tissue volume, and reduced septal myocardial perfusion reserve, suggesting exacerbated hematopoiesis, myocardial adipose infiltration, epicardial compression and coronary microvascular dysfunction as intermediate mechanisms (Figure). Conclusions In asymptomatic middle-aged individuals, obesity emerged as a key determinant of subclinical RV dysfunction, alongside with male sex and LVEF. Increased hematopoietic activity, myocardial adipose infiltration, epicardial compression and coronary microvascular dysfunction were identified as intermediate mechanisms of this association. Figure
{"title":"Obesity determines right ventricular subclinical dysfunction in middle-aged individuals","authors":"C Perez Garcia, V Fuster, G Garcia-Marti, A Moreno-Arciniegas, S Gomez-Talavera, G Pizarro, A Devesa, B Oliva, R Vazirani, A Navarro-Guzman, J Sanchez-Gonzalez, H Bueno, B Ibanez, I Garcia-Lunar, A Garcia-Alvarez","doi":"10.1093/eurheartj/ehaf784.259","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.259","url":null,"abstract":"Background Right ventricular (RV) dysfunction is a relevant prognostic factor in different cardiovascular conditions, but its early determinants remain unclear. Purpose This study aimed to identify the main determinants of RV performance through CMR in a large cohort of asymptomatic middle-aged individuals. Methods A subgroup of asymptomatic middle-aged participants from the PESA cardiovascular cohort underwent RV assessment by CMR-strain and a comprehensive screening of all possible factors that may influence RV performance (including demographics, cardiometabolic risk factors, physical activity objectively measured by accelerometry, and laboratory parameters). To further understand the mechanism through which RV performance may be affected, subjects additionally underwent stress CMR to assess myocardial perfusion reserve and tissue characterization; 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to quantify bone marrow metabolic activity, and non-contrast cardiac computed tomography (CT) to measure epicardial adiposity. RV free wall longitudinal strain was calculated through myocardial tagging, and participants were divided into tertiles based on strain values. Age and sex-adjusted trend analyses were conducted, followed by multivariate lineal regression to identify independent predictors of RV strain. Subsequently, mediators of the association between obesity and RV strain were investigated. Results 609 individuals (mean age 52.7 years; 82.8% male) were included with a median RV ejection fraction of 59.4% [56.2–62.8] and RV strain -21.3% [-23.5 to -18.3]. After adjusting for age and sex, RV strain positively correlated with body mass index (BMI), waist circumference, non-alcoholic fatty liver disease, fasting glucose, and glycated hemoglobin (HbA1c) and negatively with left ventricular (LV) ejection fraction. Interestingly, bone marrow uptake (surrogate of increased hematopoietic activity) showed a significant positive linear association with RV strain (Table). In multivariable analysis, male sex, BMI, and lower LVEF remained independent predictors of RV strain (Figure). To further understand the association between obesity and RV performance, individuals were recategorized based on BMI tertiles. Higher BMI tertiles were linked to increased bone marrow FDG uptake, lower T1 values, larger epicardial adipose tissue volume, and reduced septal myocardial perfusion reserve, suggesting exacerbated hematopoiesis, myocardial adipose infiltration, epicardial compression and coronary microvascular dysfunction as intermediate mechanisms (Figure). Conclusions In asymptomatic middle-aged individuals, obesity emerged as a key determinant of subclinical RV dysfunction, alongside with male sex and LVEF. Increased hematopoietic activity, myocardial adipose infiltration, epicardial compression and coronary microvascular dysfunction were identified as intermediate mechanisms of this association. Figure","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"29 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121968","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/ehaf784.2540
S Moscatelli, G Norrish, E Field, L Luedke, L Thorogood, A Barnes, J P Kaski
Background Arrhythmogenic cardiomyopathy is an umbrella term that encompasses various cardiomyopathy phenotypes, including dilated cardiomyopathy(DCM), nondilated left ventricular cardiomyopathy(NDLVC), and arrhythmogenic right ventricular cardiomyopathy(ARVC). Data on these conditions in the paediatric population remain limited. This study describes the clinical characteristics of children with genetic and gene-elusive NDLVC, ARVC, DCM. Methods Data on clinical presentation; genetic background; resting, signal-averaged and ambulatory electrocardiogram (ECG); exercise test (ETT); cardiac magnetic resonance (CMR); and outcomes from patients aged≤18 y evaluated in a single tertiary referral centre were collected. Results A total of 183 patients [mean age 16.4±4.6 y; 107 (58%) female] were included. 78 (42.6%) carried a desmosomal gene variant, 25 (13.7%)LMNA, 11 (6.0%)FLNC, 3 (1.6%)RBM20, 2 (1.1%)PLN, 2 (1.1%) SCN5A, 2 (1.1%)DES, 1 (0.5%)EDM, and 59 (32.2%) had no disease-causing gene variant identified. 71 individuals (38.8%) had no phenotypic features, 42 (23%) had non-diagnostic ‘early’ phenotypic features, and 70 (38.3%) fulfilled conventional diagnostic criteria, including: 34 (48.6%) DCM, 26 (37.1%) ARVC [10 (14.3%) definite, 10 (14.3%) borderline, 6 (8.6%) possible] and 10 (14.3%) NDLVC. Among affected patients, arrhythmias were observed in 34 (48.6%): ventricular arrythmias in 28 (40%) [non-sustained ventricular tachycardia (NSVT) 17 (24.3%), ventricular tachycardia (VT) 9 (12.9%), ventricular fibrillation (VF) 2 (2.9%)] and atrial tachycardia in 7 (10%). Frequent ventricular ectopy (VE) was found on ambulatory ECG monitoring in 26 cases (37.1%) and ETT-induced VE in 19 (27.1%). SAECG was positive in 17 (24.3%); resting ECG abnormalities were present in 38 (54.3%), and CMR structural abnormalities in 46 (65.7%). 17 patients (24.3%) underwent implantable cardioverter defibrillator (ICD) insertion (including 2 for secondary prevention), 9 (12.9%) underwent heart transplantation and 2 (2.9%) died (1 on the transplant list and 1 following transplantation). Among those with ‘early’ phenotype expression, arrhythmias were present in 23 (54%): NSVT 9 (39%), sustained VT 2 (9%), supraventricular tachycardia 6 (26%), and 1st-degree AV block 4 (17%). Frequent VE was found in 11 cases (26%) and ETT-induced VE in 6 (14%). SAECG was positive in 7 cases (16%), and resting ECG abnormalities were seen in 14 (33%). CMR abnormalities were found in 13 (29%). 2 patients (4.8%) underwent primary prevention ICD implantation. Conclusion This study shows a high burden of arrhythmic and structural disease and early phenotypic expression in children with arrhythmogenic cardiomyopathy phenotypes. These findings suggest that current diagnostic criteria may not adequately detect disease features in the paediatric population; future studies to determine paediatric and gene-specific diagnostic criteria for arrhythmogenic cardiomyopathy phenotypes are required.
{"title":"Clinical characteristics of genetic and gene-elusive arrhythmogenic cardiomyopathy phenotypes in children","authors":"S Moscatelli, G Norrish, E Field, L Luedke, L Thorogood, A Barnes, J P Kaski","doi":"10.1093/eurheartj/ehaf784.2540","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.2540","url":null,"abstract":"Background Arrhythmogenic cardiomyopathy is an umbrella term that encompasses various cardiomyopathy phenotypes, including dilated cardiomyopathy(DCM), nondilated left ventricular cardiomyopathy(NDLVC), and arrhythmogenic right ventricular cardiomyopathy(ARVC). Data on these conditions in the paediatric population remain limited. This study describes the clinical characteristics of children with genetic and gene-elusive NDLVC, ARVC, DCM. Methods Data on clinical presentation; genetic background; resting, signal-averaged and ambulatory electrocardiogram (ECG); exercise test (ETT); cardiac magnetic resonance (CMR); and outcomes from patients aged≤18 y evaluated in a single tertiary referral centre were collected. Results A total of 183 patients [mean age 16.4±4.6 y; 107 (58%) female] were included. 78 (42.6%) carried a desmosomal gene variant, 25 (13.7%)LMNA, 11 (6.0%)FLNC, 3 (1.6%)RBM20, 2 (1.1%)PLN, 2 (1.1%) SCN5A, 2 (1.1%)DES, 1 (0.5%)EDM, and 59 (32.2%) had no disease-causing gene variant identified. 71 individuals (38.8%) had no phenotypic features, 42 (23%) had non-diagnostic ‘early’ phenotypic features, and 70 (38.3%) fulfilled conventional diagnostic criteria, including: 34 (48.6%) DCM, 26 (37.1%) ARVC [10 (14.3%) definite, 10 (14.3%) borderline, 6 (8.6%) possible] and 10 (14.3%) NDLVC. Among affected patients, arrhythmias were observed in 34 (48.6%): ventricular arrythmias in 28 (40%) [non-sustained ventricular tachycardia (NSVT) 17 (24.3%), ventricular tachycardia (VT) 9 (12.9%), ventricular fibrillation (VF) 2 (2.9%)] and atrial tachycardia in 7 (10%). Frequent ventricular ectopy (VE) was found on ambulatory ECG monitoring in 26 cases (37.1%) and ETT-induced VE in 19 (27.1%). SAECG was positive in 17 (24.3%); resting ECG abnormalities were present in 38 (54.3%), and CMR structural abnormalities in 46 (65.7%). 17 patients (24.3%) underwent implantable cardioverter defibrillator (ICD) insertion (including 2 for secondary prevention), 9 (12.9%) underwent heart transplantation and 2 (2.9%) died (1 on the transplant list and 1 following transplantation). Among those with ‘early’ phenotype expression, arrhythmias were present in 23 (54%): NSVT 9 (39%), sustained VT 2 (9%), supraventricular tachycardia 6 (26%), and 1st-degree AV block 4 (17%). Frequent VE was found in 11 cases (26%) and ETT-induced VE in 6 (14%). SAECG was positive in 7 cases (16%), and resting ECG abnormalities were seen in 14 (33%). CMR abnormalities were found in 13 (29%). 2 patients (4.8%) underwent primary prevention ICD implantation. Conclusion This study shows a high burden of arrhythmic and structural disease and early phenotypic expression in children with arrhythmogenic cardiomyopathy phenotypes. These findings suggest that current diagnostic criteria may not adequately detect disease features in the paediatric population; future studies to determine paediatric and gene-specific diagnostic criteria for arrhythmogenic cardiomyopathy phenotypes are required.","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":"146122018","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/ehaf784.4314
Z Yin, X N Liu, Z F Li, S Zhang, X Li, W J Zhang, M Y Lu, Y L Xu, H T Zhang, H Qiu, J L Zhao, J J Li, K F Dou, N Q Wu
Background Coronary heart disease (CHD) is a leading cause of death among patients with glucose metabolism disorders. Previous studies have demonstrated that sodium-dependent glucose transporter 2 inhibitors (SGLT2i) offer cardiovascular benefits in diabetes patients at high cardiovascular risk. However, the effect of SGLT2i on triglyceride-derived indices among them remains unclear. Methods This prospective study analyzed data from 550 CHD patients from August 2020 to August 2021. Among those patients, 223 received SGLT2i, and 327 did not. Patients were categorized into three groups by diabetes control status based on fasting blood glucose (FBG) levels during hospitalization: well-controlled diabetes (FBG < 6.1 mmol/L), moderately controlled diabetes (FBG between 6.1 mmol/L to 7.0 mmol/L) and poorly controlled diabetes (FBG > 7.0 mmol/L). Baseline demographic data and biochemical indices, including plasma lipid profiles and remnant cholesterol and triglyceride (TG)-derived metabolic indicators were collected. The TG-derived metabolic indicators includes the atherogenic index of plasma (AIP) and the triglyceride-glucose (TyG) index. The AIP and TyG were calculated via the following formulas: AIP: Lg [TG (mg/dl)/HDL (mg/dl)], TyG: Ln [TG (mg/dL) × FPG (mg/dL)/2]. Multiple linear regression, logistic regression, subgroup analysis and sensitivity analysis were adopted to reveal the associations among biochemical indicators, SGLT2i and diabetes control status. Results The study included 550 CHD patients with an average age of 60.2 years, 21.8% of whom were female. Multiple linear regression indicated a significant positive effect of SGLT2i on changing AIP (β=-0.052, 95% CI, -0.096 to -0.009, P=0.018) and TG levels (β=-0.089, 95% CI, -0.177 to -0.004, P=0.039). The interaction between SGLT2i use and diabetes control status was statistically significant for AIP changes (P for interaction = 0.041), with greater benefits observed in patients with poorly controlled diabetes (β=-0.080, 95% CI, -0.138 to -0.023, P=0.007). Logistic regression revealed higher SGLT2i prescription rates linked to significant AIP reduction (Q1 vs Q4: odds ratio, 1.887, 95% CI, 1.149 to 3.100, P=0.012; P for trend = 0.035). Sensitivity analysis confirmed these findings in patients with hypertension and high BMI. Conclusions SGLT2i improved the AIP and TG levels in CHD patients with diabetes, regardless of background hypoglycemic and lipid-lowering drugs. Moreover, patients with poorly controlled diabetes might benefit more from SGLT2i treatment.Figure 1-6 Table 1&2
{"title":"Effects of SGLT2 inhibitors on triglyceride-derived indices among coronary heart disease patients with varying diabetes control status: a prospective cohort study","authors":"Z Yin, X N Liu, Z F Li, S Zhang, X Li, W J Zhang, M Y Lu, Y L Xu, H T Zhang, H Qiu, J L Zhao, J J Li, K F Dou, N Q Wu","doi":"10.1093/eurheartj/ehaf784.4314","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4314","url":null,"abstract":"Background Coronary heart disease (CHD) is a leading cause of death among patients with glucose metabolism disorders. Previous studies have demonstrated that sodium-dependent glucose transporter 2 inhibitors (SGLT2i) offer cardiovascular benefits in diabetes patients at high cardiovascular risk. However, the effect of SGLT2i on triglyceride-derived indices among them remains unclear. Methods This prospective study analyzed data from 550 CHD patients from August 2020 to August 2021. Among those patients, 223 received SGLT2i, and 327 did not. Patients were categorized into three groups by diabetes control status based on fasting blood glucose (FBG) levels during hospitalization: well-controlled diabetes (FBG &lt; 6.1 mmol/L), moderately controlled diabetes (FBG between 6.1 mmol/L to 7.0 mmol/L) and poorly controlled diabetes (FBG &gt; 7.0 mmol/L). Baseline demographic data and biochemical indices, including plasma lipid profiles and remnant cholesterol and triglyceride (TG)-derived metabolic indicators were collected. The TG-derived metabolic indicators includes the atherogenic index of plasma (AIP) and the triglyceride-glucose (TyG) index. The AIP and TyG were calculated via the following formulas: AIP: Lg [TG (mg/dl)/HDL (mg/dl)], TyG: Ln [TG (mg/dL) × FPG (mg/dL)/2]. Multiple linear regression, logistic regression, subgroup analysis and sensitivity analysis were adopted to reveal the associations among biochemical indicators, SGLT2i and diabetes control status. Results The study included 550 CHD patients with an average age of 60.2 years, 21.8% of whom were female. Multiple linear regression indicated a significant positive effect of SGLT2i on changing AIP (β=-0.052, 95% CI, -0.096 to -0.009, P=0.018) and TG levels (β=-0.089, 95% CI, -0.177 to -0.004, P=0.039). The interaction between SGLT2i use and diabetes control status was statistically significant for AIP changes (P for interaction = 0.041), with greater benefits observed in patients with poorly controlled diabetes (β=-0.080, 95% CI, -0.138 to -0.023, P=0.007). Logistic regression revealed higher SGLT2i prescription rates linked to significant AIP reduction (Q1 vs Q4: odds ratio, 1.887, 95% CI, 1.149 to 3.100, P=0.012; P for trend = 0.035). Sensitivity analysis confirmed these findings in patients with hypertension and high BMI. Conclusions SGLT2i improved the AIP and TG levels in CHD patients with diabetes, regardless of background hypoglycemic and lipid-lowering drugs. Moreover, patients with poorly controlled diabetes might benefit more from SGLT2i treatment.Figure 1-6 Table 1&2","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"48 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122064","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/ehaf784.306
Y Kadoya, E Silva, N Heiji, L Altakroni, K Boczar, B Chow, R Dekemp, R Terrence, R Beanlands, G Small
Background In patients with prior coronary artery bypass grafting (CABG), the utility of quantitative positron emission tomography (PET) perfusion parameters remains unestablished. While quantitative PET overcomes the limitations of relative perfusion imaging in multivessel coronary artery disease by assessing myocardial blood flow (MBF), its prognostic relevance is less well explored. Purpose We sought to evaluate the prognostic value of PET-derived myocardial flow reserve (MFR) to assess epicardial coronary disease and coronary vascular resistance (CVR) for microvascular disease in CABG patients. Methods This retrospective study included consecutive patients undergoing Rubidium-82 PET myocardial perfusion imaging between May 2017 and November 2023. MFR was defined as stress/rest MBF, with a cut-off of 2.0 for impaired MFR. CVR was calculated as mean arterial pressure divided by stress MBF, with an optimal cut-off of 60 mmHg·min·g/mL determined by area under the curve analysis. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality and nonfatal myocardial infarction. Associations were assessed using multivariable Cox proportional hazards models after adjusting for clinical variables and PET parameters. Results A total of 556 patients (median age 72 years, 79% male) were included. Over a median follow-up of 676 (482–1077) days, 71 patients (12.8%) experienced MACE. Patients with impaired MFR or CVR had significantly higher MACE rates (both p<0.001) (Figure 1). Stratifying by preserved or impaired MFR and CVR revealed significant differences in MACE incidence across the four combination groups (p<0.001) (Figure 2). Both MFR (<2.0) and CVR (≥60) independently predicted MACE, with adjusted hazard ratios of 3.204 (95% CI, 1.777–5.777; p<0.001) and 2.350 (95% CI, 1.308–4.223; p=0.004), respectively. Conclusions PET-derived MFR and CVR provide independent and incremental prognostic value, enhancing risk stratification beyond conventional perfusion and function parameters in CABG patients.Figure 1 Figure 2
{"title":"Prognostic utility of quantitative positron emission tomography in patients with prior coronary artery bypass grafting: incremental value of myocardial flow reserve and coronary vascular resistance","authors":"Y Kadoya, E Silva, N Heiji, L Altakroni, K Boczar, B Chow, R Dekemp, R Terrence, R Beanlands, G Small","doi":"10.1093/eurheartj/ehaf784.306","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.306","url":null,"abstract":"Background In patients with prior coronary artery bypass grafting (CABG), the utility of quantitative positron emission tomography (PET) perfusion parameters remains unestablished. While quantitative PET overcomes the limitations of relative perfusion imaging in multivessel coronary artery disease by assessing myocardial blood flow (MBF), its prognostic relevance is less well explored. Purpose We sought to evaluate the prognostic value of PET-derived myocardial flow reserve (MFR) to assess epicardial coronary disease and coronary vascular resistance (CVR) for microvascular disease in CABG patients. Methods This retrospective study included consecutive patients undergoing Rubidium-82 PET myocardial perfusion imaging between May 2017 and November 2023. MFR was defined as stress/rest MBF, with a cut-off of 2.0 for impaired MFR. CVR was calculated as mean arterial pressure divided by stress MBF, with an optimal cut-off of 60 mmHg·min·g/mL determined by area under the curve analysis. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality and nonfatal myocardial infarction. Associations were assessed using multivariable Cox proportional hazards models after adjusting for clinical variables and PET parameters. Results A total of 556 patients (median age 72 years, 79% male) were included. Over a median follow-up of 676 (482–1077) days, 71 patients (12.8%) experienced MACE. Patients with impaired MFR or CVR had significantly higher MACE rates (both p&lt;0.001) (Figure 1). Stratifying by preserved or impaired MFR and CVR revealed significant differences in MACE incidence across the four combination groups (p&lt;0.001) (Figure 2). Both MFR (&lt;2.0) and CVR (≥60) independently predicted MACE, with adjusted hazard ratios of 3.204 (95% CI, 1.777–5.777; p&lt;0.001) and 2.350 (95% CI, 1.308–4.223; p=0.004), respectively. Conclusions PET-derived MFR and CVR provide independent and incremental prognostic value, enhancing risk stratification beyond conventional perfusion and function parameters in CABG patients.Figure 1 Figure 2","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"34 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122138","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/ehaf784.4398
A Morales-Galan, P Lopez-Gutierrez, J Garrido-Oliver, L Dux-Santoy, H Majul, L Rivas-Catoni, S Martin-Grieve, M Bragulat-Arevalo, M Ferrer-Cornet, A Catala-Santarrufina, G Teixido-Tura, L Galian-Gay, I Ferreira-Gonzalez, J Rodriguez-Palomares, A Guala
Background Left-ventricular (LV) size and ejection fraction (LVEF) play a crucial role in the diagnosis and risk stratification of several cardiovascular diseases. Their current assessment on echocardiography images has substantial inter-observer variability, possibly impacting patients management. Full-automatization by artificial intelligence (AI) models may improve LV size and LVEF reproducibility and permit their quantification by non-experts. Purpose To develop AI models for the identification of relevant echocardiography views, segment the LV in 2, 3 and 4-chamber views and compute LVEF. Methods Fifteen thousand echocardiography studies obtained during patients care were retrospectively identified, retrieved and anonymized. Via commercial clinical software, 619 videos (14082 frames) of 2-, 3- and 4-chamber views were annotated for LV internal and external borders, creating three regions of interest (LV cavity, LV wall and overall LV), and divided into independent training (465 videos) and testing (154) sets. LV volumes on 4-chamber views were used to assess LVEF, which was validated against clinical report data in an internal cohort of 488 patients and in an external cohort of 500 patients from the CAMUS open dataset. Results Demographic and clinical characteristics of the 488 internal cohort patients are included in Table 1. View detection was obtained with 93% accuracy. The segmentation of LV cavity, overall LV and LV wall were good in 2-chamber (Dice score of 0,86[0,79;0,90], 0,91[0,86;0,93], 0,79[0,74;0,83], respectively), 3-chamber (0,88[0,84;0,91], 0,91[0,90;0,93], 0,81[0,77;0,83]) and 4-chamber (0,90[0,86;0,93], 0,92[0,88;0,94], 0,82[0,79;0,85]) views. Error analysis revealed that segmentation performance was lower in images with low quality and in patients with atrial fibrillation, with no differences between sexes. Similarly, performance of these segmentation tasks was good in the external validation cohort, with Dice score of 0,91[0,87;0,94] and 0,80[0,73;0,84] for whole LV and LV cavity in 2 and 4-chamber views, respectively. LVEF predictions showed an acceptable linear association (p<0.001) but substantial underestimation (mean error = 12%) in the internal validation set, and a good linear association (p<0.001) and minimal underestimation (mean error = 2.2%) in the external validation set. Conclusions AI models perform well in echocardiography views identification and LV segmentation, resulting in LVEF predictions with errors in the order of inter-observer variability. Biases may be present in patients with atrial fibrillation or in videos of limited image quality.Table 1.Demographic and clinical data
{"title":"Automatic left-ventricular view detection and ejection fraction assessment by artificial intelligence models in echocardiography","authors":"A Morales-Galan, P Lopez-Gutierrez, J Garrido-Oliver, L Dux-Santoy, H Majul, L Rivas-Catoni, S Martin-Grieve, M Bragulat-Arevalo, M Ferrer-Cornet, A Catala-Santarrufina, G Teixido-Tura, L Galian-Gay, I Ferreira-Gonzalez, J Rodriguez-Palomares, A Guala","doi":"10.1093/eurheartj/ehaf784.4398","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.4398","url":null,"abstract":"Background Left-ventricular (LV) size and ejection fraction (LVEF) play a crucial role in the diagnosis and risk stratification of several cardiovascular diseases. Their current assessment on echocardiography images has substantial inter-observer variability, possibly impacting patients management. Full-automatization by artificial intelligence (AI) models may improve LV size and LVEF reproducibility and permit their quantification by non-experts. Purpose To develop AI models for the identification of relevant echocardiography views, segment the LV in 2, 3 and 4-chamber views and compute LVEF. Methods Fifteen thousand echocardiography studies obtained during patients care were retrospectively identified, retrieved and anonymized. Via commercial clinical software, 619 videos (14082 frames) of 2-, 3- and 4-chamber views were annotated for LV internal and external borders, creating three regions of interest (LV cavity, LV wall and overall LV), and divided into independent training (465 videos) and testing (154) sets. LV volumes on 4-chamber views were used to assess LVEF, which was validated against clinical report data in an internal cohort of 488 patients and in an external cohort of 500 patients from the CAMUS open dataset. Results Demographic and clinical characteristics of the 488 internal cohort patients are included in Table 1. View detection was obtained with 93% accuracy. The segmentation of LV cavity, overall LV and LV wall were good in 2-chamber (Dice score of 0,86[0,79;0,90], 0,91[0,86;0,93], 0,79[0,74;0,83], respectively), 3-chamber (0,88[0,84;0,91], 0,91[0,90;0,93], 0,81[0,77;0,83]) and 4-chamber (0,90[0,86;0,93], 0,92[0,88;0,94], 0,82[0,79;0,85]) views. Error analysis revealed that segmentation performance was lower in images with low quality and in patients with atrial fibrillation, with no differences between sexes. Similarly, performance of these segmentation tasks was good in the external validation cohort, with Dice score of 0,91[0,87;0,94] and 0,80[0,73;0,84] for whole LV and LV cavity in 2 and 4-chamber views, respectively. LVEF predictions showed an acceptable linear association (p&lt;0.001) but substantial underestimation (mean error = 12%) in the internal validation set, and a good linear association (p&lt;0.001) and minimal underestimation (mean error = 2.2%) in the external validation set. Conclusions AI models perform well in echocardiography views identification and LV segmentation, resulting in LVEF predictions with errors in the order of inter-observer variability. Biases may be present in patients with atrial fibrillation or in videos of limited image quality.Table 1.Demographic and clinical data","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"301 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122140","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/ehaf784.3579
I Shehata, M Gouda, A Ammar
Background Reactive oxygen species (ROS) play a crucial role in cellular functions and contribute to the development of atherosclerosis, particularly in individuals with risk factors such as hypercholesterolemia, diabetes, and smoking. This study explores the correlation between salivary hydrogen peroxide levels and the severity of coronary artery disease, offering insights into the combined effects of these risk factors on disease progression. Purpose To examine the potential of hydrogen peroxide (H₂O₂) as a biomarker for diagnosing and preventing vascular diseases, with a focus on coronary artery disease (CAD). Methods This study involved 84 patients experiencing typical chest pain, primarily male, with an average age of 55.65 ± 8.98 years. Patients were categorized based on risk factors such as diabetes mellitus (DM) and smoking and further divided into four subgroups. A comprehensive assessment included demographic data collection, medical history review, clinical examinations, and laboratory investigations. Results Salivary hydrogen peroxide levels were significantly higher in diabetic smokers compared to other patient groups. A strong positive correlation was observed between salivary hydrogen peroxide levels and the severity of atherosclerotic coronary artery disease (CAD) in diabetic smokers. Additionally, salivary hydrogen peroxide demonstrated high diagnostic accuracy in identifying CAD in this patient subgroup. Conclusion The findings support incorporating salivary hydrogen peroxide assessment into clinical practice, particularly for CAD patients with a history of diabetes and smoking. However, limitations include the widespread use of statins among patients and the reliance on data from a single medical center. Further research in molecular cardiology and pharmacogenetics is necessary to optimize antioxidant interventions for this specific patient group.
{"title":"Salivary hydrogen peroxide as a predictor of atherosclerotic coronary artery disease in diabetic patients, smokers, and diabetic smokers","authors":"I Shehata, M Gouda, A Ammar","doi":"10.1093/eurheartj/ehaf784.3579","DOIUrl":"https://doi.org/10.1093/eurheartj/ehaf784.3579","url":null,"abstract":"Background Reactive oxygen species (ROS) play a crucial role in cellular functions and contribute to the development of atherosclerosis, particularly in individuals with risk factors such as hypercholesterolemia, diabetes, and smoking. This study explores the correlation between salivary hydrogen peroxide levels and the severity of coronary artery disease, offering insights into the combined effects of these risk factors on disease progression. Purpose To examine the potential of hydrogen peroxide (H₂O₂) as a biomarker for diagnosing and preventing vascular diseases, with a focus on coronary artery disease (CAD). Methods This study involved 84 patients experiencing typical chest pain, primarily male, with an average age of 55.65 ± 8.98 years. Patients were categorized based on risk factors such as diabetes mellitus (DM) and smoking and further divided into four subgroups. A comprehensive assessment included demographic data collection, medical history review, clinical examinations, and laboratory investigations. Results Salivary hydrogen peroxide levels were significantly higher in diabetic smokers compared to other patient groups. A strong positive correlation was observed between salivary hydrogen peroxide levels and the severity of atherosclerotic coronary artery disease (CAD) in diabetic smokers. Additionally, salivary hydrogen peroxide demonstrated high diagnostic accuracy in identifying CAD in this patient subgroup. Conclusion The findings support incorporating salivary hydrogen peroxide assessment into clinical practice, particularly for CAD patients with a history of diabetes and smoking. However, limitations include the widespread use of statins among patients and the reliance on data from a single medical center. Further research in molecular cardiology and pharmacogenetics is necessary to optimize antioxidant interventions for this specific patient group.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"40 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146122343","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/ehag030
Rui Baptista, Ana Maria Rodrigues, Filipa Bernardo, Lígia Lopes Mendes, Fátima Franco, Joana Pimenta, Sara Gonçalves, Ana Rita Henriques, Jorge M Mendes, Ana Teresa Timóteo, Aurora Andrade, Brenda Moura, Cândida Fonseca, Carlos Aguiar, Dulce Brito, Jorge Ferreira, Marisa Peres, Paulo Santos, Pedro Moraes Sarmento, Rui Cernadas, Mário Santos, Ricardo Fontes-Carvalho, Marisa Pardal, Adalberto Campos Fernandes, Hugo Martinho, José R González-Juanatey, Luís Filipe Pereira, Cláudia Raquel Marques, Luís Filipe Azevedo, Helena Canhão, José Silva-Cardoso, Victor Machado Gil, Gianluigi Savarese, Cristina Gavina
Background and aims: Heart failure (HF) is a major global health burden, yet its true prevalence remains uncertain due to heterogeneous study designs and evolving diagnostic criteria. The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) aimed to estimate the prevalence and phenotypic distribution of HF in community-dwelling adults aged ≥50 years in mainland Portugal.
Methods: PORTHOS was a cross-sectional, population-based study with a two-stage design. Stage 1 randomly selected community-dwelling individuals aged ≥50 years via structured interviews and point-of-care N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. Individuals with NT-proBNP ≥125 pg/mL and/or a self-reported HF diagnosis, plus a random 5% of screen-negatives, proceeded to stage 2. This confirmatory stage included clinical assessment, electrocardiogram, and echocardiography. HF diagnosis required the presence of symptoms, NT-proBNP ≥125 pg/mL, and echocardiographic criteria. HF was defined as per the 2021 ESC and HFA-PEFF guidelines.
Results: Of 6189 participants, 2249 screened positive and 1136 were diagnosed with HF. The estimated HF prevalence was 16.54%, increasing with age (from 4.01% in 50-59 years old to 30.68% in those ≥70) and higher in females than males (21.00% vs 10.47%). Notably, 93.4% had HF with preserved ejection fraction (HFpEF), and 90% were previously undiagnosed. HFpEF was independently associated with older age, female sex, type 2 diabetes, atrial fibrillation, and dyslipidaemia.
Conclusions: HF affects approximately one in six Portuguese adults aged ≥50 years, with HFpEF accounting for over 90% of cases, most previously undiagnosed. These findings support NT-proBNP-based screening combined with echocardiographic evaluation to improve early HF detection in ageing populations.
背景和目的：心力衰竭（HF）是一个主要的全球健康负担，但其真正的患病率仍不确定，由于异质的研究设计和不断发展的诊断标准。葡萄牙心力衰竭患病率观察研究（PORTHOS）旨在估计葡萄牙大陆≥50岁社区居民HF的患病率和表型分布。方法：PORTHOS是一项横断面、以人群为基础的两阶段设计研究。第一阶段通过结构化访谈和现场n端前b型利钠肽（NT-proBNP）检测随机选择年龄≥50岁的社区居民。NT-proBNP≥125 pg/mL和/或自我报告HF诊断的个体，加上随机5%的筛查阴性，进入第二阶段。这一确认阶段包括临床评估、心电图和超声心动图。HF诊断需要出现症状、NT-proBNP≥125 pg/mL和超声心动图标准。HF是根据2021年ESC和HFA-PEFF指南定义的。结果：在6189名参与者中，2249名筛查阳性，1136名诊断为HF。估计HF患病率为16.54%，随年龄增长而增加（从50-59岁的4.01%增加到≥70岁的30.68%），女性高于男性（21.00% vs 10.47%）。值得注意的是，93.4%的患者患有HF并保留射血分数（HFpEF）， 90%的患者以前未被诊断。HFpEF与老年、女性、2型糖尿病、心房颤动和血脂异常独立相关。结论：HF影响大约六分之一的葡萄牙≥50岁的成年人，HFpEF占90%以上的病例，大多数以前未被诊断。这些发现支持以nt - probnp为基础的筛查结合超声心动图评估来改善老年人群早期心衰的检测。
{"title":"Heart failure in the Portuguese population aged ≥50 years: prevalence and phenotypes in the PORTHOS study.","authors":"Rui Baptista, Ana Maria Rodrigues, Filipa Bernardo, Lígia Lopes Mendes, Fátima Franco, Joana Pimenta, Sara Gonçalves, Ana Rita Henriques, Jorge M Mendes, Ana Teresa Timóteo, Aurora Andrade, Brenda Moura, Cândida Fonseca, Carlos Aguiar, Dulce Brito, Jorge Ferreira, Marisa Peres, Paulo Santos, Pedro Moraes Sarmento, Rui Cernadas, Mário Santos, Ricardo Fontes-Carvalho, Marisa Pardal, Adalberto Campos Fernandes, Hugo Martinho, José R González-Juanatey, Luís Filipe Pereira, Cláudia Raquel Marques, Luís Filipe Azevedo, Helena Canhão, José Silva-Cardoso, Victor Machado Gil, Gianluigi Savarese, Cristina Gavina","doi":"10.1093/eurheartj/ehag030","DOIUrl":"https://doi.org/10.1093/eurheartj/ehag030","url":null,"abstract":"<p><strong>Background and aims: </strong>Heart failure (HF) is a major global health burden, yet its true prevalence remains uncertain due to heterogeneous study designs and evolving diagnostic criteria. The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) aimed to estimate the prevalence and phenotypic distribution of HF in community-dwelling adults aged ≥50 years in mainland Portugal.</p><p><strong>Methods: </strong>PORTHOS was a cross-sectional, population-based study with a two-stage design. Stage 1 randomly selected community-dwelling individuals aged ≥50 years via structured interviews and point-of-care N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. Individuals with NT-proBNP ≥125 pg/mL and/or a self-reported HF diagnosis, plus a random 5% of screen-negatives, proceeded to stage 2. This confirmatory stage included clinical assessment, electrocardiogram, and echocardiography. HF diagnosis required the presence of symptoms, NT-proBNP ≥125 pg/mL, and echocardiographic criteria. HF was defined as per the 2021 ESC and HFA-PEFF guidelines.</p><p><strong>Results: </strong>Of 6189 participants, 2249 screened positive and 1136 were diagnosed with HF. The estimated HF prevalence was 16.54%, increasing with age (from 4.01% in 50-59 years old to 30.68% in those ≥70) and higher in females than males (21.00% vs 10.47%). Notably, 93.4% had HF with preserved ejection fraction (HFpEF), and 90% were previously undiagnosed. HFpEF was independently associated with older age, female sex, type 2 diabetes, atrial fibrillation, and dyslipidaemia.</p><p><strong>Conclusions: </strong>HF affects approximately one in six Portuguese adults aged ≥50 years, with HFpEF accounting for over 90% of cases, most previously undiagnosed. These findings support NT-proBNP-based screening combined with echocardiographic evaluation to improve early HF detection in ageing populations.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":""},"PeriodicalIF":35.6,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117906","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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