International journal of cardiology最新文献

Coronary inflammation is now widely recognized as a key driver of atherosclerotic plaque initiation, progression, and destabilization. Histopathological studies and advanced imaging have demonstrated the central role of local inflammation, including extensive macrophage infiltration, cytokine activation, and perivascular adipose tissue, in promoting plaque vulnerability and acute coronary syndromes. Among systemic biomarkers, high-sensitivity C-reactive protein remains the most widely used, although its limited specificity underscores the need for more targeted inflammatory markers such as interleukin-6. Invasive intracoronary imaging with optical coherence tomography can visualize macrophage accumulation and quantify local inflammatory burden. Hybrid molecular imaging with OCT-NIRF, novel PET tracers and peri-coronary adipose tissue attenuation can provide emerging opportunities to further characterize vascular inflammation and residual risk. Anti-inflammatory therapies represent a major opportunity to improve outcomes beyond lipid lowering. Among patients with coronary artery disease, the use of colchicine has demonstrated significant risk reduction in adverse events, though with mixed results. Important randomized trials are underway to investigate the efficacy of novel monoclonal antibodies targeting interleukin pathways. In addition, GLP-1 receptor agonists, SGLT2 inhibitors, and PCSK9 inhibitors have been described to exhibit favourable vascular anti-inflammatory effects in experimental and in-vivo studies. In this comprehensive review, we provide an updated reappraisal of the available evidence unravelling how accurate identification of high-risk patients through multimodal imaging and biomarker profiling, combined with selective anti-inflammatory therapy, can represent a promising strategy for further reducing residual cardiovascular risk.

Background: Exercise-based cardiac rehabilitation (ExCR) is standard for secondary prevention in coronary artery disease (CAD), yet its efficacy in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after percutaneous coronary intervention (PCI) remains unclear.

Methods: In this single-center RCT, 120 stable CAD patients with HFmrEF (LVEF 40-49%) post-PCI were randomized 1:1 to receive either guideline-directed medical therapy (GDMT) plus a 52-week structured ExCR program (intervention) or GDMT alone (control). Primary outcomes-LDL-C, TG, LVEF, and LVEDD-were assessed at 4, 12, 24, and 52 weeks. Linear Mixed Models analyzed longitudinal intervention effects.

Results: A significant Group × Time interaction was observed for LVEF (p = .032), indicating superior recovery in the ExCR group. At 52 weeks, the ExCR group showed greater improvement in LVEF (+5.0% vs. +4.0%, p = .023) and greater reduction in LDL-C (-1.43 mmol/L vs. -1.04 mmol/L, p = .030) versus control. No between-group differences were found in TG or LVEDD.

Conclusions: A 52-week structured ExCR program significantly enhances cardiac recovery and lipid control in HFmrEF patients post-PCI, providing incremental benefits beyond GDMT alone. Sustained ExCR should be considered essential in comprehensive management for this population.

Background: Heart failure (HF) patients experience elevated sympathetic tone and abnormal peripheral chemoreceptor (PChR) function (elevated sensitivity [PChS] and tonicity [PChT]), which can be attributed to a reduction in cardiac output (CO) and resultant hypoperfusion of the carotid bodies. Left ventricular assist devices (LVADs) are known to increase CO, and can be used as a unique model to examine the impact of acute hemodynamic changes on PChR.

Methods and results: Fourteen HF patients with LVADs underwent assessment of PChS (using the transient hypoxia test) and PChT (using low-dose dopamine infusion) under different LVAD flow parameters, previously determined using right heart catheterization to achieve significantly distinct CO levels. PChS did not differ between the low- vs high-flow conditions (0.61 [0.49;0.74] vs. 0.67 [0.33;0.9] L/min/SpO2%, p = 0.36) as well as PChT (0.97 [-0.36;1.96] vs. 0.81 [-1.67;2.2] L/min-1, p = 0.81).). In 9 patients, central venous pressure (CVP) decreased in response to higher pump speeds. In this group, PChS more frequently increased and was significantly higher than in the remaining patients. ΔCVP was also inversely related to ΔHVR (R = 0.75, p = 0.002).

Conclusions: Acute changes in CO, as well as pulse pressure, did not affect PChS or PChT. Surprisingly, we observed a strong correlation between a decrease in CVP in response to higher LVAD speed and an increase in PChS, which can be explained by the function of low-pressure baroreceptors. These findings provide unique data on PChR function under different hemodynamic conditions in the LVAD population.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous condition with variable outcomes. The prognostic value of common clinical risk factors for major adverse cardiac events (MACEs) and all-cause mortality remains unclear. This study systematically evaluates associations between traditional risk factors and adverse outcomes in MINOCA.

Methods: A systematic review and meta-analysis was conducted to assess pooled hazard ratios (HRs) for clinical variables associated with MACEs and all-cause mortality. Eligible studies reporting HRs with at least 6 months of follow-up were included. Random-effects models were used to derive pooled estimates.

Results: Eleven studies including 12,081 patients were analyzed. Over a mean follow-up of 49.2 months, pooled MACEs incidence was 17% (95% CI: 11-26%) and all-cause mortality was 10% (95% CI: 8-14%). Older age increased the risk of MACEs (HR: 1.02; 95% CI: 1.01-1.04), while higher BMI was protective (HR: 0.92; 95% CI: 0.86-0.99). For all-cause mortality, significant predictors included age (HR: 1.04 per year), diabetes (HR: 1.33; 95% CI: 1.07-1.64), creatinine (HR: 1.01; 95% CI: 1.0009-1.02), and STEMI-pattern presentation (HR: 2.85; 95% CI: 1.09-7.44). Higher BMI (HR: 0.89; 95% CI: 0.82-0.98) and dyslipidemia (HR: 0.83; 95% CI: 0.76-0.90) were associated with lower mortality.

Conclusion: Only select clinical variables predict outcomes in MINOCA, while many traditional MI risk factors do not. These findings highlight the need for MINOCA-specific risk models and targeted management strategies.

Background: Coronary vasomotor dysfunction, diagnosed by coronary function testing (CFT), has only recently been recognized as important contributor to chronic coronary syndromes, exposing knowledge gaps on sex and age differences. Therefore, these differences are evaluated in the Dutch national CFT registry (NL-CFT).

Methods: Included were 1008 patients (83% women, 60 ± 9.6 years old) with angina and non-obstructive coronary arteries (ANOCA) undergoing CFT between 2020 and 2024. CFT consisted of coronary vasospasm provocation testing and reduced microvascular vasodilatory capacity assessment, a decreased coronary flow reserve (CFR) and/or increased microvascular resistance (MR). Patients were allocated into three age groups based on quartiles: young (≤54 years, Q1), intermediate (>54 to <67 years, Q2-Q3), and elderly (≥67 years, Q4).

Results: The prevalence of coronary vasomotor dysfunction was high, and similar (76%) between sexes. However, endotype prevalences differed: epicardial spasm was more prevalent in men in young and intermediate age groups (37%vs61%, p = 0.007 and 36%vs54%, p = 0.002), but not in elderly (44%vs32%, p = 0.096). Microvascular spasm was more prevalent in women in younger and intermediate groups (31%vs6%, p = 0.002 and 28%vs10%, p < 0.001), but not in elderly (27%vs22%, p = 0.493). Functional reduced microvascular vasodilatory capacity (abnormal CFR) was more prevalent in women (15%vs9%, p = 0.044), while structural reduced microvascular vasodilatory capacity (abnormal CFR and MR) prevalences were similar between sexes, across age groups.

Conclusion: In ANOCA patients referred for CFT, epicardial spasm was more prevalent among men and microvascular spasm in women Functional reduced microvascular vasodilatory capacity was more common in women in all age groups while structural reduced microvascular vasodilatory capacity was similar between sexes.

Introduction: Blood speckle imaging (BSI) in paediatrics is a promising novel echocardiography technique that allows complex blood flow assessment via qualitative visualization and analysis of vorticity, energy gloss and kinetic energy. However, velocity quantification has scarcely been studied in vivo, albeit in children at the aortic valve level.

Methodology: Comparison of conventional Doppler and BSI velocities at the aortic valve level in healthy children by echocardiography. BSI maximal velocity was extracted via a custom code in Python. Analysis was performed using Pearson correlation and Bland Altman analysis. An inter-observer study variability for BSI analysis was also performed in a randomly selection of subjects.

Results: A total of 77 Doppler acquisitions in 33 patients were obtained. The median age was 84 months, and maximal velocity was 1.19 m/s. Modest correlation (R = 0.53, p-value<0.001) was found between maximal velocity by BSI and Doppler. When age-stratified, the younger subgroup (<6.5 years) showed good correlation (R = 0.59, p-value<0.001) whereas it was not significant in the older subjects. A non-significant trend towards BSI underestimating velocities was found, more marked in the older subgroup. Also, discrepancies between BSI and Doppler were higher in the older subjects. There was good inter-observer reproducibility of BSI analysis (R = 0.7, p-value = 0.006).

Discussion and conclusion: The BSI technique shows moderate correlation with Doppler in healthy children, with better performance at lower body size. A non-significant trend towards greater discrepancies at higher velocities was observed. Good BSI analysis inter-observer variability was found. The BSI echocardiography allows quantification of aortic valve maximum velocity in healthy children.

Background: We aimed to develop a novel cardiac magnetic resonance (CMR)-based method for quantifying myocardial synchrony and evaluate its diagnostic value in detecting myocardial dysfunction of coronary artery disease (CAD).

Methods: Consecutive participants with anatomically/angiographically obstructive CAD (n = 112) and healthy participants (n = 87) undergoing CMR imaging were prospectively enrolled. Myocardial strain was analyzed using feature-tracking, and myocardial synchrony was quantified via Pearson correlation coefficients of segmental strain time series across the cardiac cycle. Machine learning models (strain-only, synchrony-only, combined) were developed and validated in an independent external cohort.

Results: Healthy participants exhibited high left ventricular myocardial synchrony (radial: 0.91 [IQR: 0.88, 0.93]; circumferential: 0.90 ± 0.04; longitudinal: 0.97 ± 0.02), significantly reduced in participants with CAD (radial: 0.84 [IQR: 0.75, 0.89]; circumferential: 0.81 ± 0.12; longitudinal: 0.90 ± 0.08), including those with preserved left ventricular ejection fraction (LVEF ≥50%) (radial: 0.86 [IQR: 0.82, 0.90]; circumferential: 0.86 ± 0.07; longitudinal: 0.91 ± 0.07), all p < 0.001. In model analysis, the combined model significantly outperformed individual models (AUC: 0.94 [95% CI: 0.89-1.00] vs. 0.84 [0.75-0.94] for strain model, p = 0.037; vs. 0.79 [0.68-0.90] for synchrony model, p = 0.001). Superiority persisted in CAD with preserved LVEF (AUC: 0.91 [95% CI: 0.83-1.00]) and external validation (AUC: 0.93 [95% CI: 0.84-1.00]).

Conclusions: This CMR-derived approach demonstrated the high degree of left ventricular synchrony in healthy populations and significant dyssynchrony in CAD, even in those with preserved LVEF. Integrating myocardial synchrony with strain significantly enhanced CAD myocardial dysfunction detection relative to strain alone, with robust diagnostic performance maintained in CAD with preserved LVEF.