IJC Heart and Vasculature最新文献

Beyond circulating cGMP: revisiting compartmentalized signaling in HFrEF 超越循环cGMP：重新审视HFrEF中的区隔化信号

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-04-01 Epub Date: 2026-01-27 DOI: 10.1016/j.ijcha.2026.101880

Rene Pütz , Melissa Herwig , Simin Delalat , Innas Sultana , Ibrahim Akin , Nazha Hamdani , Ibrahim El-Battrawy

引用次数: 0

Rhythm control in persistent atrial fibrillation improves endothelial function without uniform anti-inflammatory effects: A 9-month prospective cohort study 一项为期9个月的前瞻性队列研究：持续性心房颤动的心律控制可改善内皮功能，但不具有均匀的抗炎作用

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-04-01 Epub Date: 2026-01-23 DOI: 10.1016/j.ijcha.2026.101879

Maximilian Seidel, David Bogdahn, Felix S. Seibert, Moritz Anft, Sarah Skrzypczyk, Ulrik Stervbo, Eva Kohut, Kamil Rosiewicz, Benjamin Sasko, Christian Ukena, Nina Babel, Timm H. Westhoff

Background

Atrial fibrillation (AF) is associated with systemic inflammation, endothelial dysfunction, and adverse cardiovascular outcomes. While there is robust evidence, that inflammation contributes to AF pathogenesis, the existence of a reverse relation – whether AF contributes to inflammation − remains elusive. This study therefore evaluates the impact of rhythm control on systemic inflammation and endothelial function.

Methods

In this prospective observational study, 124 patients with persistent AF undergoing successful rhythm control therapy (electrical cardioversion or catheter ablation) were followed for nine months. Various Cytokines, high-sensitivity C-reactive protein (hsCRP), flow-mediated dilation (FMD) and additional inflammatory biomarkers were measured at baseline, 1 week, 1 month, 3 months, and 9 months. FMD was assessed by high-resolution brachial artery ultrasound. Patients with AF recurrence throughout the follow-up period were excluded from primary analysis.

Results

In patients without AF recurrence, FMD improved significantly from 6.3 % (4.6–8.3) to 7.6 % (5.1–8.8) (p < 0.001). HsCRP, IL-8 and fibrinogen declined modestly (p = 0.002, p < 0.001 and p < 0.001, respectively), whereas IL-2, IP-10, IL-12p70, MCP-1 and TNF-α increased significantly over time (all p < 0.001). Elevated pre-treatment hsCRP was weakly associated with AF recurrence (r = 0.20, p = 0.023; AUC = 0.61). IL-6 showed temporal variation but no sustained change from baseline.

Conclusion

Rhythm control therapy in persistent AF is associated with an improvement of endothelial function but not with a homogeneous improvement of systemic inflammatory serological profiles. Thus, the improvement in FMD appears to be mediated primarily by hemodynamic restoration rather than anti-inflammatory effects.

背景：房颤（AF）与全身炎症、内皮功能障碍和不良心血管结局相关。虽然有强有力的证据表明，炎症有助于房颤的发病机制，但房颤是否与炎症有关的反向关系仍然难以捉摸。因此，本研究评估了节律控制对全身炎症和内皮功能的影响。方法在这项前瞻性观察研究中，124例持续性房颤患者接受了成功的心律控制治疗（心律转复或导管消融），随访9个月。在基线、1周、1个月、3个月和9个月时测量各种细胞因子、高敏c反应蛋白（hsCRP）、血流介导扩张（FMD）和其他炎症生物标志物。采用高分辨率肱动脉超声评估FMD。在随访期间房颤复发的患者被排除在初步分析之外。结果无房颤复发患者FMD由6.3%（4.6 ~ 8.3）显著改善至7.6% (5.1 ~ 8.8)（p < 0.001）。随着时间的推移，HsCRP、IL-8和纤维蛋白原略有下降（分别为p = 0.002、p <； 0.001和p <； 0.001），而IL-2、IP-10、IL-12p70、MCP-1和TNF-α显著升高（均p <； 0.001）。治疗前hsCRP升高与房颤复发呈弱相关（r = 0.20, p = 0.023; AUC = 0.61）。IL-6有时间变化，但与基线没有持续变化。结论：持续性房颤的节律控制治疗与内皮功能的改善有关，但与全身炎症血清学特征的改善不一致。因此，FMD的改善似乎主要是通过血流动力学恢复而不是抗炎作用介导的。

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引用次数: 0

Comparing Physical, Pharmacological, Pacemaker, and Cardioneuroablation Therapies for Patients with Vasovagal Syncope: A systematic review and network meta-analysis 比较血管迷走神经性晕厥患者的物理、药物、起搏器和心血管消融术治疗：系统综述和网络荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-04-01 Epub Date: 2026-02-10 DOI: 10.1016/j.ijcha.2026.101885

Haozhe Wang , Yike Zhang , Siyi Liao , Hao Zhang , Xinmiao Huang

Background

Vasovagal syncope (VVS) represents the most frequent syncope subtype, but evidence comparing treatment strategies remains limited. This network meta-analysis (NMA) evaluates physical, pharmacological, pacemaker, and cardioneuroablation (CNA) therapies for VVS.

Methods

We conducted a Bayesian NMA of randomized controlled trials (RCTs) from PubMed, Embase, and Web of Science. The primary outcome was spontaneous syncope recurrence, and the secondary outcome was head-up tilt test (HUTT) positivity. Network geometry and treatment rankings were evaluated using Surface Under the Cumulative Ranking values.

Results

A total of 49 RCTs involving 2,798 patients assigned to various treatments were included. For spontaneous syncope recurrence, CNA [OR = 0.077, 95% CrI (0.015, 0.403)], pacing [OR = 0.075, 95% CrI (0.023, 0.22)], pharmacological [OR = 0.33, 95% CrI (0.11, 0.94)], and physical [OR = 0.27, 95% CrI (0.13, 0.57)] therapies were all superior to conventional therapy. Regarding HUTT outcomes, only pharmacological [OR = 5.5, 95% CrI (2.6, 12.0)] and physical [OR = 12, 95% CrI (2.9, 50.0)] therapies showed significant differences compared with placebo. Subgroup analysis identified dual-chamber pacing with closed-loop stimulation (DDD-CLS) as the highest-ranked therapy. Midodrine was the superior pharmacological option, and selective serotonin reuptake inhibitors demonstrated efficacy.

Conclusions

This NMA supports a stratified management approach for VVS. Physical and conventional therapies should be first-line. DDD-CLS pacing shows superior efficacy for cardioinhibitory VVS, while midodrine is the preferred pharmacological option. Although CNA demonstrates promise, it is constrained by limited direct evidence and should be considered hypothesis-generating, underscoring the need for head-to-head RCTs with long-term follow-up.

迷走神经性晕厥（VVS）是最常见的晕厥亚型，但比较治疗策略的证据仍然有限。该网络荟萃分析（NMA）评估了VVS的物理、药理学、起搏器和心血管消融术（CNA）治疗。方法对来自PubMed、Embase和Web of Science的随机对照试验（RCTs）进行贝叶斯NMA分析。主要转归是自发性晕厥复发，次要转归是直立倾斜试验（HUTT）阳性。使用Surface Under Cumulative Ranking值评估网络几何形状和处理排名。结果共纳入49项随机对照试验，涉及2798例患者。对于自发性晕厥复发，CNA [OR = 0.077, 95% CrI(0.015, 0.403)]、起搏[OR = 0.075, 95% CrI(0.023, 0.22)]、药物治疗[OR = 0.33, 95% CrI(0.11, 0.94)]、物理治疗[OR = 0.27, 95% CrI(0.13, 0.57)]均优于常规治疗。在HUTT结局方面，只有药理学[OR = 5.5, 95% CrI(2.6, 12.0)]和物理[OR = 12, 95% CrI(2.9, 50.0)]治疗与安慰剂相比有显著差异。亚组分析确定双室起搏加闭环刺激（DDD-CLS）是排名最高的治疗方法。Midodrine是较好的药物选择，选择性血清素再摄取抑制剂显示出疗效。结论NMA支持VVS的分层管理方法。物理和常规治疗应该是第一线的。DDD-CLS起搏对心脏抑制性VVS有较好的疗效，而midodrine是首选药物。虽然CNA显示出了希望，但它受到有限的直接证据的限制，应该被认为是假设生成，强调需要长期随访的头对头随机对照试验。

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引用次数: 0

Holter features to detect coronary artery spasm in ANOCA patients: A pilot study 动态心电图特征检测ANOCA患者冠状动脉痉挛：一项初步研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-04-01 Epub Date: 2026-02-12 DOI: 10.1016/j.ijcha.2026.101884

Diantha JM Schipaanboord , Caïa Crooijmans , Nicole S Erler , Peter David Faasse , Tijn PJ Jansen , Timo Nijkamp , Saskia ZH Rittersma , Tim P van de Hoef , Pim van der Harst , Aukelien C Dimitriu-Leen , Peter Damman , Suzette E Elias-Smale , René van Es , N Charlotte Onland-Moret , Hester M den Ruijter , on behalf of the IMPRESS consortium

Background

Coronary artery spasm (CAS), which can be epicardial and/or microvascular, is highly prevalent in patients with angina and non-obstructive coronary artery disease (ANOCA) undergoing coronary function testing (CFT). The CFT is invasive and limits larger diagnostics studies. We studied if Holter monitoring with symptom tracking identifies Holter-based CAS features with diagnostic potential in ANOCA patients.

Methods

42 ANOCA patients (88% female) were recruited in the UMCU-IMPRESS pilot study and wore a 12-lead Holter device for 2–7 days prior to CFT, with simultaneous symptom tracking. We compared symptoms and Holter-ECG characteristics between patients with and without CAS and calculated diagnostic measures for CAS using several thresholds for ischemia-related parameters.

Results

33 Patients were diagnosed with CAS (79%). These patients more often had ≥ 1 min of ST depression in total per day compared to patients without CAS (≥0.035 mV: 88% vs 44%, p = 0.013; ≥0.040 mV: 73% vs 33%, p = 0.049), but discriminative ability was limited (AUC (95% CI): 0.65 (0.48–0.68)). Furthermore, patients with CAS had periods of lower heart rates and longer PQ and QT times than patients without CAS, most evident at night and early morning.

Conclusions

Patients with CAS more often demonstrated at least one minute of ST depression in total per day and exhibited periods of lower heart rates and longer PQ times mainly during the night and early morning compared to patients without CAS. Although discriminative ability was limited, we show that Holter monitoring may reveal signals in CAS patients, substantiating the need of large (AI-based) studies.

背景冠状动脉痉挛（CAS）可发生在心外膜和/或微血管，在接受冠状动脉功能检测（CFT）的心绞痛和非阻塞性冠状动脉疾病（ANOCA）患者中非常普遍。CFT是侵入性的，限制了更大规模的诊断研究。我们研究了霍尔特监测和症状追踪是否能识别基于霍尔特的CAS特征，并在ANOCA患者中具有诊断潜力。方法将42例ANOCA患者（88%为女性）纳入UMCU-IMPRESS试点研究，并在CFT前2-7天佩戴12导联霍尔特装置，同时进行症状追踪。我们比较了有和没有CAS患者的症状和动态心电图特征，并使用几个缺血相关参数的阈值计算了CAS的诊断措施。结果33例患者确诊为CAS（79%）。与没有CAS的患者相比，这些患者每天总ST段抑郁≥1分钟的频率更高（≥0.035 mV: 88% vs 44%, p = 0.013;≥0.040 mV: 73% vs 33%, p = 0.049），但鉴别能力有限(AUC （95% CI): 0.65(0.48-0.68)）。此外，与非CAS患者相比，CAS患者心率更低，PQ和QT时间更长，最明显的是在夜间和清晨。结论与非CAS患者相比，CAS患者更常表现出每天至少1分钟的ST段压抑，并且主要在夜间和清晨表现出较低的心率和较长的PQ时间。尽管鉴别能力有限，但我们发现动态心电图监测可能会揭示CAS患者的信号，这证实了大规模（基于人工智能的）研究的必要性。

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引用次数: 0

Outcomes of durable versus biodegradable polymer drug-eluting stents in patients with coronary artery disease 耐用与可生物降解聚合物药物洗脱支架在冠状动脉疾病患者中的效果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-04-01 Epub Date: 2026-02-06 DOI: 10.1016/j.ijcha.2026.101882

Christof Skos , Jovan Rogozarski , Al Medina Dizdarevic , Gloria M.Steiner-Gager , Marek Postula , Ceren Eyileten , Aurel Toma , Walter S. Speidl , Nika Skoro-Sajer , Christian Gerges , Irene M. Lang , Jolanta M. Siller-Matula

Background

Percutaneous coronary intervention (PCI) is among the most common cardiovascular procedures, but stents still pose risks of restenosis or thrombosis. Drug-eluting stents (DES) with polymer coatings have improved long-term outcomes.

Aim

This study evaluated whether the latest biodegradable polymer DES (BP-DES) offer improved safety over durable polymer DES (DP-DES).

Methods

Data were collected from a single-centre registry at the Medical University of Vienna, including patients who underwent PCI between 2015 and 2020. Patients were categorized by stent type and PCI indication (All Comer, CCS-PCI, ACS-PCI). The primary endpoint comprised of major adverse cardiac events (MACE), including target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis (ST), and all-cause death.

Results

2118 patients were eligible for further analysis. 1232 patients (58.2%) received a DP-DES. In the all-comer cohort, 5-year MACE rates were 12% for BP-DES vs 14.5% for DP-DES. Multivariate analysis showed no significant difference in MACE for the use of BP-DES (OR 0.941, 95% CI 0.734–1.207, p = 0.631). However, TLR rates were significantly lower in patients treated with BP-DES (3.4% vs 6.8%, OR 0.567, 95% CI 0.372–0.865, p = 0.008), mainly driven by lower rates of TLR within the ACS PCI cohort (1.5% vs 4.9%, OR 0.364, 95% CI 0.158–0.841, p = 0.018). In CCS PCI patients, MACE and TLR rates demonstrated no significant differences.

Conclusion

BP-DES and DP-DES show a similar long-term safety profile regarding MACE. BP-DES demonstrate a lower risk of TLR in the all-comer cohort, driven by reduced rates in ACS-PCI patients.

背景：经皮冠状动脉介入治疗（PCI）是最常见的心血管手术之一，但支架仍然存在再狭窄或血栓形成的风险。聚合物涂层药物洗脱支架（DES）改善了长期疗效。目的评价最新的生物降解聚合物DES （BP-DES）是否比耐用聚合物DES （DP-DES）具有更高的安全性。数据来自维也纳医科大学的单中心注册中心，包括2015年至2020年间接受PCI治疗的患者。患者按支架类型和PCI适应证（All Comer、CCS-PCI、ACS-PCI）进行分类。主要终点包括主要心脏不良事件（MACE），包括靶病变血运重建术（TLR）、靶血管血运重建术（TVR）、支架血栓形成（ST）和全因死亡。结果2118例患者符合进一步分析的条件。1232例（58.2%）患者接受了DP-DES治疗。在所有患者队列中，BP-DES的5年MACE率为12%，DP-DES为14.5%。多因素分析显示BP-DES的MACE差异无统计学意义（OR 0.941, 95% CI 0.734-1.207, p = 0.631）。然而，BP-DES治疗患者的TLR率显著降低（3.4% vs 6.8%, OR 0.567, 95% CI 0.372-0.865, p = 0.008），主要是由于ACS PCI队列中TLR率较低（1.5% vs 4.9%, OR 0.364, 95% CI 0.158-0.841, p = 0.018）。在CCS PCI患者中，MACE和TLR率无显著差异。结论bp - des和DP-DES在MACE方面具有相似的长期安全性。由于ACS-PCI患者的TLR发生率降低，BP-DES在所有患者中显示出较低的TLR风险。

{"title":"Outcomes of durable versus biodegradable polymer drug-eluting stents in patients with coronary artery disease","authors":"Christof Skos , Jovan Rogozarski , Al Medina Dizdarevic , Gloria M.Steiner-Gager , Marek Postula , Ceren Eyileten , Aurel Toma , Walter S. Speidl , Nika Skoro-Sajer , Christian Gerges , Irene M. Lang , Jolanta M. Siller-Matula","doi":"10.1016/j.ijcha.2026.101882","DOIUrl":"10.1016/j.ijcha.2026.101882","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) is among the most common cardiovascular procedures, but stents still pose risks of restenosis or thrombosis. Drug-eluting stents (DES) with polymer coatings have improved long-term outcomes.</div></div><div><h3>Aim</h3><div>This study evaluated whether the latest biodegradable polymer DES (BP-DES) offer improved safety over durable polymer DES (DP-DES).</div></div><div><h3>Methods</h3><div>Data were collected from a single-centre registry at the Medical University of Vienna, including patients who underwent PCI between 2015 and 2020. Patients were categorized by stent type and PCI indication (All Comer, CCS-PCI, ACS-PCI). The primary endpoint comprised of major adverse cardiac events (MACE), including target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis (ST), and all-cause death.</div></div><div><h3>Results</h3><div>2118 patients were eligible for further analysis. 1232 patients (58.2%) received a DP-DES. In the all-comer cohort, 5-year MACE rates were 12% for BP-DES vs 14.5% for DP-DES. Multivariate analysis showed no significant difference in MACE for the use of BP-DES (OR 0.941, 95% CI 0.734–1.207, p = 0.631). However, TLR rates were significantly lower in patients treated with BP-DES (3.4% vs 6.8%, OR 0.567, 95% CI 0.372–0.865, p = 0.008), mainly driven by lower rates of TLR within the ACS PCI cohort (1.5% vs 4.9%, OR 0.364, 95% CI 0.158–0.841, p = 0.018). In CCS PCI patients, MACE and TLR rates demonstrated no significant differences.</div></div><div><h3>Conclusion</h3><div>BP-DES and DP-DES show a similar long-term safety profile regarding MACE. BP-DES demonstrate a lower risk of TLR in the all-comer cohort, driven by reduced rates in ACS-PCI patients.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"63 ","pages":"Article 101882"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association between treatment-induced changes in the Kansas City Cardiomyopathy Questionnaire and clinical outcomes in chronic heart failure: a trial-level meta-regression analysis 堪萨斯城心肌病调查问卷中治疗引起的变化与慢性心力衰竭临床结果之间的关系：一项试验水平的meta回归分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-04-01 Epub Date: 2026-01-27 DOI: 10.1016/j.ijcha.2026.101881

Hidekatsu Fukuta , Toshihiko Goto

Background

Patient-reported outcomes such as the Kansas City Cardiomyopathy Questionnaire (KCCQ) are increasingly recognized for their prognostic value. While the composite endpoint of cardiovascular death and heart failure (HF) hospitalization is the standard primary outcome in contemporary HF trials, the potential for KCCQ changes to serve as an intermediate endpoint for these clinical events requires further evaluation.

Methods

We conducted a trial-level meta-regression analysis of phase 3 randomized controlled trials (RCTs) evaluating pharmacological therapies for chronic HF that reported both changes in KCCQ and the primary composite endpoint of cardiovascular death and HF hospitalization. Weighted random-effects meta-regression models were used to assess the association between changes in KCCQ scores and treatment effects on clinical outcomes.

Results

Twelve phase 3 RCTs were included, comprising eight enrolling patients with HF with reduced ejection fraction and four enrolling those with preserved ejection fraction. Changes in KCCQ scores were significantly associated with treatment effects on the primary composite endpoint (regression coefficient [95% CI] = −0.0611 [−0.0930, −0.0292]; p = 0.001; I² = 2.2%), cardiovascular death (−0.0676 [−0.1099, −0.0254]; p = 0.004; I² = 0%), and HF hospitalization (−0.0700 [−0.1322, −0.0775]; p = 0.031; I² = 54%).

Conclusion

Treatment-induced changes in KCCQ scores are significantly correlated with clinical outcomes in phase 3 HF trials. These findings support KCCQ as a promising candidate intermediate endpoint that provides supportive evidence for the clinical benefit of HF therapies. However, our results remain hypothesis-generating, and further validation using individual patient data and cross-mechanism studies is warranted before KCCQ can be formally established as a regulatory surrogate endpoint.

堪萨斯城心肌病问卷（KCCQ）等患者报告的结果越来越被认为具有预后价值。虽然心血管死亡和心力衰竭住院治疗的复合终点是当代心力衰竭试验的标准主要终点，但KCCQ变化作为这些临床事件的中间终点的潜力需要进一步评估。方法：我们对评估慢性心衰药物治疗的3期随机对照试验（rct）进行了试验水平的荟萃回归分析，这些试验报告了KCCQ的变化以及心血管死亡和心衰住院的主要复合终点。采用加权随机效应元回归模型评估KCCQ评分变化与治疗效果对临床结果的影响之间的关系。结果纳入12项3期随机对照试验，其中8例纳入射血分数降低的HF患者，4例纳入射血分数保持的HF患者。KCCQ评分的变化与主要复合终点的治疗效果（回归系数[95% CI] = - 0.0611 [- 0.0930, - 0.0292]; p = 0.001; I2 = 2.2%）、心血管死亡（- 0.0676 [- 0.1099,- 0.0254];p = 0.004; I2 = 0%）和HF住院（- 0.0700 [- 0.1322,- 0.0775];p = 0.031; I2 = 54%）显著相关。结论治疗诱导的KCCQ评分变化与HF 3期临床结果显著相关。这些发现支持KCCQ作为一个有希望的候选中间终点，为心衰治疗的临床益处提供了支持性证据。然而，我们的结果仍然是假设生成的，在KCCQ可以正式确立为监管替代终点之前，需要使用个体患者数据和跨机制研究进一步验证。

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引用次数: 0

Staging of Fabry cardiomyopathy in clinical practice: an algorithm proposal 法布里心肌病的临床分期：一种算法建议

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-04-01 Epub Date: 2026-02-09 DOI: 10.1016/j.ijcha.2025.101852

Inês Fortuna , Janete Santos , Raquel Machado , André Lobo , Conceição Queirós , Cristina Gavina , Natália António , Patrícia Rodrigues , Ricardo Fontes-Carvalho , Sofia Correia , Giuseppe Limongelli , Elisabete Martins

Purpose

Fabry disease (FD) is characterized by hypertrophic cardiomyopathy and early diagnosis is essential, considering the response to enzyme replacement or chaperone therapies. Recently, a new clinical staging for Fabry cardiomyopathy suggested five stages (0A, 0B, IA, IB, II, III), where the imaging characterization of hypertrophy and fibrosis are critical key items. Our study aimed to evaluate the applicability of the recent proposal of Meucci et al. 2024 in patients with FD, considering the last imaging cardiac evaluations.

Methods

This retrospective observational study collected clinical data from patients diagnosed with FD. Staging system followed a hierarchical flowchart, staging patients based on LVEF, LGE, LV wall thickness, and other cardiac findings (symptoms, ECG/Echo/CMR abnormalities).

Results

We included 53 FD patients. As cardiac magnetic resonance and echocardiogram parameters are essential to complete staging, the algorithm was fully applied to 44 patients. Among these patients, the majority (29,5%) were in the non-hypertrophic stage 0. In hypertrophic stage I, 27,2% of patients were classified according to the maximum wall thickness. The hypertrophic fibrotic stage II included 29,5% of the patients. Patients in stage III (13,6%) presented diffuse myocardial fibrosis ≥ 3 LV segments and/or impaired systolic function (LVEF < 50%).

Conclusion

The staging scheme allows us to classify different stages of FD cardiomyopathy. Most patients were in early disease stages, probably related to the diagnosis in the context of familial screening. The stepwise algorithm proposal helped apply the staging in clinical practice; however, it must be validated in more extensive and prospective studies.

目的fabry病（FD）以肥厚性心肌病为特征，考虑到对酶替代或伴侣治疗的反应，早期诊断至关重要。最近，一种新的法布里心肌病临床分期提出了5个阶段（0A、0B、IA、IB、II、III），其中肥大和纤维化的影像学特征是关键项目。我们的研究旨在评估Meucci et al. 2024最近提出的建议在FD患者中的适用性，并考虑到最后的成像心脏评估。方法回顾性观察性研究收集FD患者的临床资料。分期系统遵循分层流程图，根据LVEF、LGE、左室壁厚度和其他心脏表现（症状、ECG/Echo/CMR异常）对患者进行分期。结果纳入53例FD患者。由于心脏磁共振和超声心动图参数对完成分期至关重要，因此该算法在44例患者中得到了充分应用。在这些患者中，大多数（29.5%）处于非肥厚期0。在肥厚I期，27.2%的患者根据最大壁厚进行分类。肥厚性纤维化II期患者占29.5%。III期患者（13.6%）表现为弥漫性心肌纤维化≥3个左室段和/或收缩功能受损（LVEF < 50%）。结论该分期方案可对FD型心肌病进行分期。大多数患者处于疾病早期阶段，可能与家族筛查中的诊断有关。逐步算法的提出有助于分期在临床的应用；然而，它必须在更广泛和前瞻性的研究中得到验证。

{"title":"Staging of Fabry cardiomyopathy in clinical practice: an algorithm proposal","authors":"Inês Fortuna , Janete Santos , Raquel Machado , André Lobo , Conceição Queirós , Cristina Gavina , Natália António , Patrícia Rodrigues , Ricardo Fontes-Carvalho , Sofia Correia , Giuseppe Limongelli , Elisabete Martins","doi":"10.1016/j.ijcha.2025.101852","DOIUrl":"10.1016/j.ijcha.2025.101852","url":null,"abstract":"<div><h3>Purpose</h3><div>Fabry disease (FD) is characterized by hypertrophic cardiomyopathy and early diagnosis is essential, considering the response to enzyme replacement or chaperone therapies. Recently, a new clinical staging for Fabry cardiomyopathy suggested five stages (0A, 0B, IA, IB, II, III), where the imaging characterization of hypertrophy and fibrosis are critical key items. Our study aimed to evaluate the applicability of the recent proposal of Meucci et al. 2024 in patients with FD, considering the last imaging cardiac evaluations.</div></div><div><h3>Methods</h3><div>This retrospective observational study collected clinical data from patients diagnosed with FD. Staging system followed a hierarchical flowchart, staging patients based on LVEF, LGE, LV wall thickness, and other cardiac findings (symptoms, ECG/Echo/CMR abnormalities).</div></div><div><h3>Results</h3><div>We included 53 FD patients. As cardiac magnetic resonance and echocardiogram parameters are essential to complete staging, the algorithm was fully applied to 44 patients. Among these patients, the majority (29,5%) were in the non-hypertrophic stage 0. In hypertrophic stage I, 27,2% of patients were classified according to the maximum wall thickness. The hypertrophic fibrotic stage II included 29,5% of the patients. Patients in stage III (13,6%) presented diffuse myocardial fibrosis ≥ 3 LV segments and/or impaired systolic function (LVEF < 50%).</div></div><div><h3>Conclusion</h3><div>The staging scheme allows us to classify different stages of FD cardiomyopathy. Most patients were in early disease stages, probably related to the diagnosis in the context of familial screening. The stepwise algorithm proposal helped apply the staging in clinical practice; however, it must be validated in more extensive and prospective studies.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"63 ","pages":"Article 101852"},"PeriodicalIF":2.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The impact of pullback measurement on treatment decision in significant coronary artery disease: Insights from a retrospective multicentric study 回拉测量对重大冠状动脉疾病治疗决策的影响：来自一项回顾性多中心研究的见解

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-04-01 Epub Date: 2026-02-10 DOI: 10.1016/j.ijcha.2026.101887

Roberto Bova , Matteo Betti , Samuel Heuts , Pieter A. Vriesendorp , Alexander J.J. Ijsselmuiden , Saman Rasoul , Mustafa Ilhan , Jindra Vainer , Ralph A.L.J. Theunissen , Leo F. Veenstra , Patty Winkler , Mera Stein , Alexander Ruiters , Daniek P.J. Slegers , Arnoud W.J. van ’t Hof , Arpad Lux

Background

Optimal management of coronary artery disease (CAD) requires tailoring treatment strategies to lesion characteristics. Intracoronary pullback enables hemodynamic mapping of coronary lesions, potentially improving therapeutic decision-making, particularly in distinguishing focal from diffuse disease.

Objectives

To evaluate how pullback measurement influences overall treatment strategy—optimal medical therapy (OMT), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG)—in patients with significant CAD.

Methods

We conducted a retrospective, multicenter cohort study including 842 patients with stable angina, unstable angina, or non-ST-elevation myocardial infarction (NSTEMI) and functionally significant left anterior descending artery (LAD) disease. Patients were stratified into two groups: one group (PB group, n = 561) had pullback measurement, and the other (Conventional group, n = 281) not. Outcomes included treatment strategy, major adverse cardiovascular events (MACE), and all-cause mortality at 1 year.

Results

Pullback led to more Heart Team discussions (66.3% vs. 58.7%; p = 0.033), greater adoption of OMT (51.5% vs. 40.9%; p = 0.004), and lower PCI rates (27.1% vs. 36.3%; p = 0.007). CABG rates remained unaffected. Pullback independently increased the odds of OMT and reduced the odds of PCI (OR = 0.58, p = 0.003), while three-vessel disease strongly predicted CABG (OR = 2.51; p < 0.001). At 1 year, the PB group had higher mortality (4.3% vs. 1.1%, p = 0.013), but similar MACE compared to the Conventional group. However, clinical outcomes did not differ between treatment groups.

Conclusions

Intracoronary pullback favours a conservative treatment strategy. MACE rates are not increased at 1 year.

背景：冠状动脉疾病（CAD）的最佳管理需要根据病变特征定制治疗策略。冠状动脉内回拉使得冠状动脉病变的血流动力学制图，潜在地改善治疗决策，特别是在区分局灶性疾病和弥漫性疾病方面。目的评估回拉测量对严重CAD患者的整体治疗策略——最佳药物治疗（OMT）、经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）的影响。方法我们进行了一项回顾性、多中心队列研究，纳入了842例稳定性心绞痛、不稳定性心绞痛或非st段抬高型心肌梗死（NSTEMI）和功能显著的左前降支（LAD）疾病患者。将患者分为两组：一组（PB组，n = 561）有回拉测量，另一组（常规组，n = 281）没有。结果包括治疗策略、主要不良心血管事件（MACE）和1年时的全因死亡率。结果回撤导致更多的心脏小组讨论（66.3%对58.7%,p = 0.033），更多的采用OMT(51.5%对40.9%,p = 0.004)，更低的PCI率（27.1%对36.3%,p = 0.007）。CABG率未受影响。回拉独立增加了OMT的几率，降低了PCI的几率（OR = 0.58, p = 0.003），而三支血管疾病强烈预测CABG （OR = 2.51; p < 0.001）。1年时，PB组死亡率较高（4.3% vs. 1.1%, p = 0.013），但MACE与常规组相似。然而，临床结果在治疗组之间没有差异。结论冠状动脉后撤有利于保守治疗。MACE利率在1年内不会增加。

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引用次数: 0

Oxygen therapy enhances the systemic inflammatory response in a human model of experimental inflammation 氧治疗增强了人体实验炎症模型的全身炎症反应

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-02-01 Epub Date: 2025-11-28 DOI: 10.1016/j.ijcha.2025.101846

P. Tornvall , P. Svensson , J. Alfredsson , L. Jonasson , L. Nilsson , R. Hofmann , SK. Merid

Introduction

Oxygen therapy does not benefit normoxemic patients with suspected myocardial infarction and may instead enhance the inflammatory response triggered by the tissue necrosis caused by the myocardial infarction. In the present study, we tested the hypothesis that oxygen therapy aggravates systemic inflammation in normoxemic healthy individuals in a human model of experimental inflammation.

Methods

Proteomic and gene expression data from healthy subjects vaccinated against Salmonella Typhii and exposed to oxygen therapy or ambient air were investigated. A multi-omics approach with factor analysis to identify common sources of variation in the systemic inflammatory response associated with oxygen exposure was used.

Results

Oxygen therapy showed a statistically nominal tendency toward aggravation determined by ELISA (IL-6) and proximity extension assay (IL-8). The factor analysis revealed a pro-inflammatory feature that included increases in (CXCL 6, 10 and 11) with decreased small nucleolar RNA.

Conclusion

The results indicate that oxygen therapy enhances experimental systemic inflammation. The mechanism is not clear but future studies should address small nucleolar RNA.

氧疗对怀疑心肌梗死的等氧血症患者没有益处，反而可能增强心肌梗死引起的组织坏死引发的炎症反应。在本研究中，我们在实验炎症的人体模型中验证了氧气治疗加重等氧血症健康个体全身性炎症的假设。方法对接种伤寒沙门菌和暴露于氧疗或环境空气的健康受试者进行蛋白质组学和基因表达分析。采用多组学方法和因子分析来确定与氧暴露相关的全身炎症反应的常见变异源。结果ELISA （IL-6）和邻近扩展试验（IL-8）检测结果显示，氧治疗有统计学意义上的加重倾向。因子分析显示促炎特征包括（cxcl6、10和11）增加，小核仁RNA减少。结论氧疗可增强实验性全身炎症反应。其机制尚不清楚，但未来的研究应针对小核RNA。

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引用次数: 0

Alcohol use disorder and use of rhythm control therapies in patients with atrial fibrillation: A nationwide cohort study 房颤患者的酒精使用障碍和心律控制疗法的使用：一项全国性队列研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-02-01 Epub Date: 2025-12-17 DOI: 10.1016/j.ijcha.2025.101854

Miika Vanhanen , Jussi Jaakkola , Juhani K.E. Airaksinen , Olli Halminen , Jukka Putaala , Pirjo Mustonen , Jari Haukka , Juha Hartikainen , Alex Luojus , Mikko Niemi , Miika Linna , Mika Lehto , Konsta Teppo

Objective

Patients with alcohol use disorder (AUD) often receive inferior treatment for somatic comorbidities. We aimed to examine whether AUD is associated with disparities in the use of antiarrhythmic therapies (AAT) for rhythm control in atrial fibrillation (AF) patients, using a nationwide registry.

Methods

The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry includes all 229,565 patients with incident AF diagnosed in Finland between 2007 and 2018, identified from comprehensive national healthcare registries. The primary outcome was initiation of rhythm control therapies, including antiarrhythmic drugs, cardioversion, and catheter ablation, in patients with and without AUD.

Results

The mean age was 72.7 years, 50 % were female and 4.7 % had AUD. Rhythm control was initiated less often in patients with AUD compared to those without (13.6 % vs. 21.8 %, p < 0.001). After adjustment for comorbidities and socioeconomic status, AUD remained associated with lower use of rhythm control therapies (HR 0.65; 95 % CI 0.62–0.69). This disparity was consistent across all modalities of rhythm control (antiarrhythmic drugs, cardioversion and catheter ablation). While no significant interaction was observed with sex or age, income modified the association (p < 0.001), with the lowest income tertile showing the greatest disparity (HR 0.37; 95 % CI 0.32–0.42).

Conclusions

AUD is independently associated with markedly lower use of rhythm control therapies in AF patients. These disparities are most pronounced among socioeconomically disadvantaged individuals, highlighting the need for targeted interventions to ensure equitable treatment access.

目的：酒精使用障碍（AUD）患者的躯体合并症往往得不到较好的治疗。我们的目的是研究AUD是否与心房颤动（AF）患者使用抗心律失常治疗（AAT）控制心律的差异有关，使用全国登记。芬兰房颤抗凝（FinACAF）登记包括2007年至2018年在芬兰诊断的所有229,565例房颤事件患者，这些患者来自全国综合医疗保健登记。主要结局是开始心律控制治疗，包括抗心律失常药物、心律转复和导管消融，在有和没有AUD的患者中。结果患者平均年龄72.7 岁，女性50 %，AUD 4.7 %。与没有AUD的患者相比，AUD患者开始节律控制的频率更低（13.6 %对21.8 %,p <； 0.001）。在对合并症和社会经济状况进行调整后，AUD仍然与较低的节律控制疗法使用相关（HR 0.65; 95 % CI 0.62-0.69）。这种差异在所有心律控制方式（抗心律失常药物、心律转复和导管消融）中都是一致的。虽然没有观察到与性别或年龄的显著相互作用，但收入改变了这种关联（p <； 0.001），收入最低的tile表现出最大的差异（HR 0.37; 95% % CI 0.32-0.42）。结论：房颤患者心律控制治疗的使用率明显降低与aud独立相关。这些差异在社会经济上处于不利地位的个人中最为明显，这突出表明需要采取有针对性的干预措施，以确保公平获得治疗。

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引用次数: 0