Pub Date : 2026-01-12DOI: 10.1016/j.ijcha.2025.101860
Mohammad Abumayyaleh, Tobias Schupp, Michael Behnes, Ibrahim Akin
{"title":"Cardiac conduction abnormalities in myotonic dystrophy type I: The ongoing value of the ECG","authors":"Mohammad Abumayyaleh, Tobias Schupp, Michael Behnes, Ibrahim Akin","doi":"10.1016/j.ijcha.2025.101860","DOIUrl":"10.1016/j.ijcha.2025.101860","url":null,"abstract":"","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101860"},"PeriodicalIF":2.5,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977012","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}
Pub Date : 2026-01-09DOI: 10.1016/j.ijcha.2025.101862
Sabahat Ul Ain Munir Abbasi , Riya Bhagwan , Aamna Rehman , Neha Malik , Sanya Ashraf Khaskheli , Najaf Ahmed Rajpar , Rayyan Nabi , Ayesha Amir Basra , Shehdev Meghwar , Raheel Ahmed , Kalpana Singh
Background
Anthracyclines (ANT) are widely used in chemotherapy, but their dose-dependent Cardiotoxicity limits long-term use. Carvedilol, a non-selective beta-blocker, has shown potential as a Cardioprotective agent for patients receiving ANT, though its overall effectiveness remains unclear. This systematic review and meta-analysis aimed to assess the impact of carvedilol on cardiac function and survival in patients with anthracycline-induced Cardiotoxicity.
Methods
We performed a comprehensive search of major electronic databases through March 2025 for studies comparing carvedilol with placebo or no treatment in human subjects with ANT-Induced Cardiotoxicity. Primary outcomes included left ventricular ejection fraction (LVEF), left ventricular systolic dysfunction (LVSD), left ventricular systolic and diastolic diameters (LVsD, LVdD), and mortality. Secondary outcomes included echocardiographic and Doppler parameters. Random-effects models were used to calculate standard mean differences (SMDs) and risk ratios (RR) using RevMan 5.4.
Results
A total of fourteen studies were included, thirteen in the meta-analysis and one in the systematic review only, comprising 1,245 participants (carvedilol: 679; control: 566). Carvedilol significantly preserved LVEF (SMD: 0.33, 95% CI: 0.09, 0.58) and reduced the risk of LVSD (RR: 0.26, 95% CI: 0.11, 0.62). It also decreased systolic (SMD: −0.39, 95% CI: −0.53, −0.26) as well as diastolic ventricular diameter (SMD: −0.19, 95% CI: −0.38, −0.00). However, no significant difference in short-term mortality was observed.
Conclusion
Carvedilol appears to protect cardiac function in patients undergoing ANT therapy, though it does not significantly impact mortality. Further research is needed to determine optimal dosing, timing, and long-term survival benefits.
{"title":"The efficacy of carvedilol in improving cardiac function and survival in patients with anthracycline-induced cardiotoxicity: a comprehensive systematic review and meta-analysis","authors":"Sabahat Ul Ain Munir Abbasi , Riya Bhagwan , Aamna Rehman , Neha Malik , Sanya Ashraf Khaskheli , Najaf Ahmed Rajpar , Rayyan Nabi , Ayesha Amir Basra , Shehdev Meghwar , Raheel Ahmed , Kalpana Singh","doi":"10.1016/j.ijcha.2025.101862","DOIUrl":"10.1016/j.ijcha.2025.101862","url":null,"abstract":"<div><h3>Background</h3><div>Anthracyclines (ANT) are widely used in chemotherapy, but their dose-dependent Cardiotoxicity limits long-term use. Carvedilol, a non-selective beta-blocker, has shown potential as a Cardioprotective agent for patients receiving ANT, though its overall effectiveness remains unclear. This systematic review and <em>meta</em>-analysis aimed to assess the impact of carvedilol on cardiac function and survival in patients with anthracycline-induced Cardiotoxicity.</div></div><div><h3>Methods</h3><div>We performed a comprehensive search of major electronic databases through March 2025 for studies comparing carvedilol with placebo or no treatment in human subjects with ANT-Induced Cardiotoxicity. Primary outcomes included left ventricular ejection fraction (LVEF), left ventricular systolic dysfunction (LVSD), left ventricular systolic and diastolic diameters (LVsD, LVdD), and mortality. Secondary outcomes included echocardiographic and Doppler parameters. Random-effects models were used to calculate standard mean differences (SMDs) and risk ratios (RR) using RevMan 5.4.</div></div><div><h3>Results</h3><div>A total of fourteen studies were included, thirteen in the <em>meta</em>-analysis and one in the systematic review only, comprising 1,245 participants (carvedilol: 679; control: 566). Carvedilol significantly preserved LVEF (SMD: 0.33, 95% CI: 0.09, 0.58) and reduced the risk of LVSD (RR: 0.26, 95% CI: 0.11, 0.62). It also decreased systolic (SMD: −0.39, 95% CI: −0.53, −0.26) as well as diastolic ventricular diameter (SMD: −0.19, 95% CI: −0.38, −0.00). However, no significant difference in short-term mortality was observed.</div></div><div><h3>Conclusion</h3><div>Carvedilol appears to protect cardiac function in patients undergoing ANT therapy, though it does not significantly impact mortality. Further research is needed to determine optimal dosing, timing, and long-term survival benefits.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101862"},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924276","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}
Pub Date : 2026-01-08DOI: 10.1016/j.ijcha.2026.101868
Man Huang , Yang Sun , Ke Li , Ting Yu , Hu Zhao , Min Tao , Xiuli Song , Linlin Wang , Xin Xu , Yanghui Chen , Guanglin Cui , Hu Ding , Jiangtao Yan , Jiangang Jiang , Hesong Zeng , Yan Wang , Xiaoqing Shen , Hong Wang , Dao Wen Wang
Background
Ticagrelor is recommended as the preferred antiplatelet agent for patients with acute coronary syndrome (ACS), which is controversial in East Asians, Chinese patients in particular. This study aimed to compare the efficacy and safety of ticagrelor vs. clopidogrel in Chinese ACS patients following coronary stenting.
Methods
Between August 2014 and October 2020, COSTIC recruited 9,040 patients prescribed with ticagrelor or clopidogrel. Applying propensity score matching, ticagrelor was compared with clopidogrel for 1-year risks of the primary efficacy endpoint (a composite of cardiovascular (CV) death, myocardial infarction and stroke) and bleeding endpoint.
Results
The risk of the primary efficacy endpoint was comparable between the two groups but numerically higher after clopidogrel at 6 months (HR, 1.33 [95 % CI, 0.98–1.80]; P = 0.07). Clopidogrel was associated with high incidences of CV death (HR, 1.49 [95 % CI, 1.04–2.15]; P = 0.03 at 6 months; HR, 1.42 [95 % CI, 1.04–1.93]; P = 0.02 at 12 months) and all-cause death (HR, 1.43 [95 % CI, 1.02–1.99]; P = 0.04 at 6 months). BARC type 3 or 5 bleeding (OR, 0.60 [95 % CI, 0.40–0.88]; P = 0.008 at 6 months; OR, 0.71 [95 % CI, 0.52–0.96]; P = 0.03 at 12 months) and BARC type 2 bleeding risks (OR, 0.47 [95 % CI, 0.34–0.66] at 1 month, OR, 0.41 [95 % CI, 0.32–0.52] at 6 months, OR, 0.43 [95 % CI, 0.35–0.53] at 12 months, P < 0.001 at 1, 6 and 12 months) were higher with ticagrelor, as compared to clopidogrel. In terms of the net clinical benefit events, clopidogrel was comparable to ticagrelor in the total cohort.
Conclusions
Among Chinese ACS patients with successful PCI, ticagrelor did not significantly reduce the risk of major ischemic events; instead, it was associated with a significant elevation bleeding risk.
{"title":"Comparison of efficacy and safety between TIcagrelor and clopidogrel in Chinese patients with acute coronary syndrome (COSTIC study)","authors":"Man Huang , Yang Sun , Ke Li , Ting Yu , Hu Zhao , Min Tao , Xiuli Song , Linlin Wang , Xin Xu , Yanghui Chen , Guanglin Cui , Hu Ding , Jiangtao Yan , Jiangang Jiang , Hesong Zeng , Yan Wang , Xiaoqing Shen , Hong Wang , Dao Wen Wang","doi":"10.1016/j.ijcha.2026.101868","DOIUrl":"10.1016/j.ijcha.2026.101868","url":null,"abstract":"<div><h3>Background</h3><div>Ticagrelor is recommended as the preferred antiplatelet agent for patients with acute coronary syndrome (ACS), which is controversial in East Asians, Chinese patients in particular. This study aimed to compare the efficacy and safety of ticagrelor vs. clopidogrel in Chinese ACS patients following coronary stenting.</div></div><div><h3>Methods</h3><div>Between August 2014 and October 2020, COSTIC recruited 9,040 patients prescribed with ticagrelor or clopidogrel. Applying propensity score matching, ticagrelor was compared with clopidogrel for 1-year risks of the primary efficacy endpoint (a composite of cardiovascular (CV) death, myocardial infarction and stroke) and bleeding endpoint.</div></div><div><h3>Results</h3><div>The risk of the primary efficacy endpoint was comparable between the two groups but numerically higher after clopidogrel at 6 months (HR, 1.33 [95 % CI, 0.98–1.80]; <em>P</em> = 0.07). Clopidogrel was associated with high incidences of CV death (HR, 1.49 [95 % CI, 1.04–2.15]; <em>P</em> = 0.03 at 6 months; HR, 1.42 [95 % CI, 1.04–1.93]; <em>P</em> = 0.02 at 12 months) and all-cause death (HR, 1.43 [95 % CI, 1.02–1.99]; <em>P</em> = 0.04 at 6 months). BARC type 3 or 5 bleeding (OR, 0.60 [95 % CI, 0.40–0.88]; <em>P</em> = 0.008 at 6 months; OR, 0.71 [95 % CI, 0.52–0.96]; <em>P</em> = 0.03 at 12 months) and BARC type 2 bleeding risks (OR, 0.47 [95 % CI, 0.34–0.66] at 1 month, OR, 0.41 [95 % CI, 0.32–0.52] at 6 months, OR, 0.43 [95 % CI, 0.35–0.53] at 12 months, <em>P</em> < 0.001 at 1, 6 and 12 months) were higher with ticagrelor, as compared to clopidogrel. In terms of the net clinical benefit events, clopidogrel was comparable to ticagrelor in the total cohort.</div></div><div><h3>Conclusions</h3><div>Among Chinese ACS patients with successful PCI, ticagrelor did not significantly reduce the risk of major ischemic events; instead, it was associated with a significant elevation bleeding risk.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101868"},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924278","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}
Pub Date : 2026-01-08DOI: 10.1016/j.ijcha.2025.101866
Julia M. Kröpfl , Christoph Hauser , Luca Beugger , Henner Hanssen , Fabian Schwendinger , Arno Schmidt-Trucksäss
Background
Cellular endothelial dysfunction in patients recovering from Coronavirus disease 2019 (COVID-19) remains poorly understood. This study examined circulating angiogenic progenitor cells (CAC) and mature endothelial cells (CEC) in individuals with persistent symptoms following hospitalization for COVID-19 (PH-PCS) at ≥ 18-months post-infection.
Methods
We compared PH-PCS (n = 14) to matched controls without symptomatic COVID-19 (n = 7). Examinations included macro- and microvascular structure and function and the analysis of CAC and CEC using flow cytometry.
Results
Estimates indicated somewhat lower apoptotic CAC concentrations (mean difference[md] [95 %CI] = 0.050 cells/µl [0.003, 0.137], p = 0.084) and proportions (% total CAC, 7.7 percentage points (pp) [0.3, 12.9], p = 0.066) in patients compared to controls, though estimates were imprecise. Similar results were observed for apoptotic CEC concentrations (1.202 cells/µl [0.040, 7.518], p = 0.066) and proportions (% total CEC, 2.7 pp [0.2, 23.8], p = 0.048). Live CAC (−7.6 pp [-12.7, −1.1], p = 0.084) and live CEC proportions (−4.9 pp [–23.7, −0.3], p = 0.042) were somewhat enhanced in PH-PCS. Brachial-arterial flow-mediated dilation (baFMD) and retinal vessel imaging parameters showed little evidence for differences between groups, except for maximal arteriolar constriction, where estimates suggested on average higher values in PH-PCS (md [95 %CI] = 1.64 [0.050, 3.63], p = 0.084), but estimates were uncertain. Pooling PH-PCS and controls, correlations were observed between reduced baFMD and both elevated total CEC concentrations (ρ = -0.56, p = 0.038) and decreased apoptotic CAC proportions (ρ = 0.56, p = 0.042).
Conclusions
This study suggests the possibility of unbalanced CAC and CEC apoptosis in PH-PCS, but with uncertain magnitude. The findings might inform hypothesis generation for future studies on (cellular) endothelial function in PH-PCS.
背景2019冠状病毒病（COVID-19）恢复期患者的细胞内皮功能障碍仍知之甚少。本研究检测了感染后≥18个月因COVID-19 （PH-PCS）住院后持续症状的个体的循环血管生成祖细胞（CAC）和成熟内皮细胞（CEC）。方法将PH-PCS （n = 14）与无症状的匹配对照组（n = 7）进行比较。检查包括大微血管结构和功能，流式细胞术分析CAC和CEC。结果估计显示，与对照组相比，患者的凋亡CAC浓度（平均差值[md] [95% CI] = 0.050细胞/µl [0.003, 0.137], p = 0.084）和比例（总CAC %， 7.7个百分点（pp） [0.3, 12.9], p = 0.066）有所降低，但估计不精确。凋亡的CEC浓度（1.202个细胞/µl [0.040, 7.518], p = 0.066）和比例（%总CEC， 2.7 pp [0.2, 23.8], p = 0.048）也有类似的结果。活性CAC （- 7.6 pp [-12.7, - 1.1], p = 0.084）和活性CEC比例（- 4.9 pp [-23.7, - 0.3], p = 0.042）在PH-PCS中有所提高。肱动脉血流介导的扩张（baFMD）和视网膜血管成像参数在两组之间几乎没有差异，除了最大动脉收缩，其中估计PH-PCS的平均值较高（md [95% CI] = 1.64 [0.050, 3.63], p = 0.084），但估计不确定。将PH-PCS和对照组合并，观察到baFMD降低与总CEC浓度升高（ρ = -0.56, p = 0.038）和凋亡CAC比例降低（ρ = 0.56, p = 0.042）之间的相关性。结论PH-PCS可能存在CAC和CEC不平衡凋亡，但凋亡程度不确定。这些发现可能为未来研究PH-PCS的（细胞）内皮功能提供假设。
{"title":"Circulating angiogenic progenitor cell apoptosis in Post-COVID-19 syndrome","authors":"Julia M. Kröpfl , Christoph Hauser , Luca Beugger , Henner Hanssen , Fabian Schwendinger , Arno Schmidt-Trucksäss","doi":"10.1016/j.ijcha.2025.101866","DOIUrl":"10.1016/j.ijcha.2025.101866","url":null,"abstract":"<div><h3>Background</h3><div>Cellular endothelial dysfunction in patients recovering from Coronavirus disease 2019 (COVID-19) remains poorly understood. This study examined circulating angiogenic progenitor cells (CAC) and mature endothelial cells (CEC) in individuals with persistent symptoms following hospitalization for COVID-19 (PH-PCS) at ≥ 18-months post-infection.</div></div><div><h3>Methods</h3><div>We compared PH-PCS (n = 14) to matched controls without symptomatic COVID-19 (n = 7). Examinations included macro- and microvascular structure and function and the analysis of CAC and CEC using flow cytometry.</div></div><div><h3>Results</h3><div>Estimates indicated somewhat lower apoptotic CAC concentrations (mean difference[md] [95 %CI] = 0.050 cells/µl [0.003, 0.137], p = 0.084) and proportions (% total CAC, 7.7 percentage points (pp) [0.3, 12.9], p = 0.066) in patients compared to controls, though estimates were imprecise. Similar results were observed for apoptotic CEC concentrations (1.202 cells/µl [0.040, 7.518], p = 0.066) and proportions (% total CEC, 2.7 pp [0.2, 23.8], p = 0.048). Live CAC (−7.6 pp [-12.7, −1.1], p = 0.084) and live CEC proportions (−4.9 pp [–23.7, −0.3], p = 0.042) were somewhat enhanced in PH-PCS. Brachial-arterial flow-mediated dilation (baFMD) and retinal vessel imaging parameters showed little evidence for differences between groups, except for maximal arteriolar constriction, where estimates suggested on average higher values in PH-PCS (md [95 %CI] = 1.64 [0.050, 3.63], p = 0.084), but estimates were uncertain. Pooling PH-PCS and controls, correlations were observed between reduced baFMD and both elevated total CEC concentrations (ρ = -0.56, p = 0.038) and decreased apoptotic CAC proportions (ρ = 0.56, p = 0.042).</div></div><div><h3>Conclusions</h3><div>This study suggests the possibility of unbalanced CAC and CEC apoptosis in PH-PCS, but with uncertain magnitude. The findings might inform hypothesis generation for future studies on (cellular) endothelial function in PH-PCS.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101866"},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924277","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}
Pub Date : 2026-01-08DOI: 10.1016/j.ijcha.2026.101870
Zukaï Chati , Nacima Benzaghou , Clémence Balaj , Samuel Tissier
Background
The respective roles of coronary atherosclerosis assessment and myocardial ischemia testing for cardiovascular risk stratification remain debated, particularly in real-world clinical practice where imaging strategies are guided by patient risk profile rather than random assignment.
Methods
The Nancy Ischemia Registry prospectively included 3,020 consecutive patients between February 2021 and December 2022. Patients underwent either anatomical imaging [coronary artery calcium score (CACS) or coronary CT angiography (CCTA)] or functional ischemia testing [stress echocardiography or stress cardiovascular magnetic resonance (CMR)]. Follow-up was completed through December 2023. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular death or myocardial revascularization.
Results
Anatomical imaging was used almost exclusively in primary prevention, whereas ischemia-based testing included both primary and secondary prevention populations. Kaplan–Meier analysis showed a higher cumulative incidence of MACE among patients undergoing ischemia screening (20 %) compared with anatomical screening (15 %), with divergence after approximately 500 days. However, this difference was not confirmed after multivariable adjustment (HR 1.03, 95 % CI 0.87–1.23; p = 0.73), and residual confounding related to incomplete adjustment for cardiovascular risk factors cannot be excluded. Myocardial ischemia, particularly when associated with revascularization, was strongly associated with adverse events, while total atherosclerotic burden remained independently associated with outcomes. Age and male sex were additional predictors of MACE.
Conclusions
In this real-world registry, anatomical imaging provided information on total atherosclerotic burden, whereas functional imaging identified patients with high-risk myocardial ischemia and subsequent revascularization. These findings offer real-world insights into the complementary roles of anatomical and functional imaging in distinct clinical populations and support an integrated, imaging-guided approach to personalized CAD management.
背景冠状动脉粥样硬化评估和心肌缺血检测在心血管风险分层中的各自作用仍然存在争议，特别是在现实世界的临床实践中，成像策略是由患者风险概况而不是随机分配指导的。方法在2021年2月至2022年12月期间，Nancy缺血登记处前瞻性地纳入了3020名连续患者。患者接受解剖成像[冠状动脉钙化评分（CACS）或冠状动脉CT血管造影（CCTA）]或功能缺血测试[应激超声心动图或应激心血管磁共振（CMR）]。随访完成至2023年12月。主要终点是主要不良心血管事件（MACE），定义为心血管死亡或心肌血运重建术。结果解剖成像几乎完全用于一级预防，而基于缺血的检测包括一级和二级预防人群。Kaplan-Meier分析显示，缺血筛查患者的MACE累积发生率（20%）高于解剖筛查患者（15%），在大约500天后出现差异。然而，这一差异在多变量调整后并未得到证实（HR 1.03, 95% CI 0.87-1.23; p = 0.73），并且不能排除与心血管危险因素调整不完全相关的残留混杂因素。心肌缺血，特别是与血运重建术相关的心肌缺血，与不良事件密切相关，而总的动脉粥样硬化负荷仍然与预后独立相关。年龄和男性性别是MACE的附加预测因素。结论：在现实世界中，解剖成像提供了动脉粥样硬化总负荷的信息，而功能成像识别了高危心肌缺血和随后的血运重建患者。这些发现为解剖和功能成像在不同临床人群中的互补作用提供了现实世界的见解，并支持了一种集成的、成像引导的个性化CAD管理方法。
{"title":"Coronary anatomy detects, ischemia predicts: Real-world insights from the Nancy ischemia registry","authors":"Zukaï Chati , Nacima Benzaghou , Clémence Balaj , Samuel Tissier","doi":"10.1016/j.ijcha.2026.101870","DOIUrl":"10.1016/j.ijcha.2026.101870","url":null,"abstract":"<div><h3>Background</h3><div>The respective roles of coronary atherosclerosis assessment and myocardial ischemia testing for cardiovascular risk stratification remain debated, particularly in real-world clinical practice where imaging strategies are guided by patient risk profile rather than random assignment.</div></div><div><h3>Methods</h3><div>The Nancy Ischemia Registry prospectively included 3,020 consecutive patients between February 2021 and December 2022. Patients underwent either anatomical imaging [coronary artery calcium score (CACS) or coronary CT angiography (CCTA)] or functional ischemia testing [stress echocardiography or stress cardiovascular magnetic resonance (CMR)]. Follow-up was completed through December 2023. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular death or myocardial revascularization.</div></div><div><h3>Results</h3><div>Anatomical imaging was used almost exclusively in primary prevention, whereas ischemia-based testing included both primary and secondary prevention populations. Kaplan–Meier analysis showed a higher cumulative incidence of MACE among patients undergoing ischemia screening (20 %) compared with anatomical screening (15 %), with divergence after approximately 500 days. However, this difference was not confirmed after multivariable adjustment (HR 1.03, 95 % CI 0.87–1.23; p = 0.73), and residual confounding related to incomplete adjustment for cardiovascular risk factors cannot be excluded. Myocardial ischemia, particularly when associated with revascularization, was strongly associated with adverse events, while total atherosclerotic burden remained independently associated with outcomes. Age and male sex were additional predictors of MACE.</div></div><div><h3>Conclusions</h3><div>In this real-world registry, anatomical imaging provided information on total atherosclerotic burden, whereas functional imaging identified patients with high-risk myocardial ischemia and subsequent revascularization. These findings offer real-world insights into the complementary roles of anatomical and functional imaging in distinct clinical populations and support an integrated, imaging-guided approach to personalized CAD management.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101870"},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924275","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}
Patients with heart failure (HF) often present with a relative deficiency of cyclic guanosine monophosphate (cGMP) despite elevated B-type natriuretic peptide (BNP) levels. Sacubitril/valsartan and vericiguat target the cGMP pathway, but the relative contribution of cardiac versus systemic cGMP production remains uncertain. This study evaluated the association between cGMP changes and hemodynamic changes in patients with HF with reduced ejection fraction (HFrEF) receiving these agents.
Methods
Fourteen symptomatic HFrEF patients (median age 65.0 [IQR: 56.0–72.3]years, EF 25.5 [24.0–33.3]%) and 20 control patients without HF (66.0 years, EF 66.5 %) were enrolled. Of the HFrEF patients, five received sacubitril/valsartan alone and nine received vericiguat (newly initiated or added to sacubitril/valsartan). All HFrEF patients underwent right heart catheterization before the treatment and two months after treatment. Blood samples were collected from the coronary sinus, arteries, and veins.
Results
HFrEF patients showed higher coronary sinus cGMP levels compared with controls (15.8 ± 1.7 vs. 10.9 ± 1.2 nM, p < 0.05) but a markedly lower cGMP/BNP ratio (0.09 ± 0.02 vs. 1.71 ± 0.63, p < 0.05), suggesting a relative cGMP deficiency. After the therapy, the cGMP/BNP ratio significantly increased (0.278, p < 0.05). The change in coronary sinus cGMP correlated with improvement in cardiac index (r = 0.57, p = 0.039). cGMP levels rose consistently across all sampling sites, indicating a systemic augmentation of the cGMP pathway.
Conclusion
Elevation of cGMP levels were associated with hemodynamic improvement in HFrEF patients treated with sacubitril/valsartan and vericiguat. These findings highlight the therapeutic relevance of cGMP pathway augmentation and provide mechanistic insights aligned with the known clinical effects of these agents in HFrEF.
{"title":"Association of elevated cyclic GMP levels with hemodynamic changes in HFrEF patients treated with sacubitril/valsartan and vericiguat: a pilot study","authors":"Takumi Inoue , Hiroyuki Takahama , Hideaki Suzuki , Marina Arai , Nobuhiro Kikuchi , Taijyu Satoh , Nobuhiro Yaoita , Saori Yamamoto , Kotaro Nochioka , Makoto Nakano , Shunsuke Tatebe , Jun Takahashi , Naoto Minamino , Satoshi Yasuda","doi":"10.1016/j.ijcha.2025.101863","DOIUrl":"10.1016/j.ijcha.2025.101863","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure (HF) often present with a relative deficiency of cyclic guanosine monophosphate (cGMP) despite elevated B-type natriuretic peptide (BNP) levels. Sacubitril/valsartan and vericiguat target the cGMP pathway, but the relative contribution of cardiac versus systemic cGMP production remains uncertain. This study evaluated the association between cGMP changes and hemodynamic changes in patients with HF with reduced ejection fraction (HFrEF) receiving these agents.</div></div><div><h3>Methods</h3><div>Fourteen symptomatic HFrEF patients (median age 65.0 [IQR: 56.0–72.3]years, EF 25.5 [24.0–33.3]%) and 20 control patients without HF (66.0 years, EF 66.5 %) were enrolled. Of the HFrEF patients, five received sacubitril/valsartan alone and nine received vericiguat (newly initiated or added to sacubitril/valsartan). All HFrEF patients underwent right heart catheterization before the treatment and two months after treatment. Blood samples were collected from the coronary sinus, arteries, and veins.</div></div><div><h3>Results</h3><div>HFrEF patients showed higher coronary sinus cGMP levels compared with controls (15.8 ± 1.7 vs. 10.9 ± 1.2 nM, p < 0.05) but a markedly lower cGMP/BNP ratio (0.09 ± 0.02 vs. 1.71 ± 0.63, p < 0.05), suggesting a relative cGMP deficiency. After the therapy, the cGMP/BNP ratio significantly increased (0.278, p < 0.05). The change in coronary sinus cGMP correlated with improvement in cardiac index (r = 0.57, p = 0.039). cGMP levels rose consistently across all sampling sites, indicating a systemic augmentation of the cGMP pathway.</div></div><div><h3>Conclusion</h3><div>Elevation of cGMP levels were associated with hemodynamic improvement in HFrEF patients treated with sacubitril/valsartan and vericiguat. These findings highlight the therapeutic relevance of cGMP pathway augmentation and provide mechanistic insights aligned with the known clinical effects of these agents in HFrEF.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101863"},"PeriodicalIF":2.5,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924323","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}
Pub Date : 2026-01-06DOI: 10.1016/j.ijcha.2025.101858
Jia Yi Anna Ne , Clara K. Chow , Vincent Chow , Karice Hyun , Leonard Kritharides , David Brieger , Austin Chin Chwan Ng
Background
Few studies comprehensively examine the association of atrial fibrillation (AF) status with rehospitalisation for adverse clinical outcomes in heart failure (HF) patients.
Methods
Patients admitted with a primary diagnosis of HF between 1-July-2003 and 31-March-2021 were identified from the Australian New South Wales Admission-Patient-Data-Collection database and stratified by AF status (no-AF vs new-AF vs prior-AF) (end-of-follow-up: 31-March-2022). Multivariable Cox regression and Fine-Gray competing risk methods were used to assess the association of AF status with risk of MACE/all-cause mortality and rehospitalisation for non-fatal outcomes respectively. MACE was defined as all-cause mortality, admission for myocardial infarction, ischemic stroke, HF or coronary revascularisation (percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery), whichever occurred first.
Results
The cohort comprised 152,638 admitted HF patients (median age: 80.4 years; 51.4 % males): 10.7 % New-AF; 37.0 % Prior-AF. During a median 1.24 years follow-up, compared to no-AF HF patients, new-AF and prior-AF patients had significantly higher rates of MACE (no-AF:78.5 % vs new-AF:81.7 % vs prior-AF:86.3 %) (both logrank P < 0.001). However, after adjusting for differences in baseline characteristics and admission year-groups, new-AF and prior-AF status had differential impact on MACE compared to no-AF patients (adjusted hazard ratio [aHR] = 0.93, 95 % confidence interval [CI] = 0.91–0.94; aHR = 1.14, 95 %CI = 1.13–1.16 respectively; both P < 0.001); results were similar for all-cause death. Rehospitalisation risk for most non-fatal clinical outcomes were significantly higher in HF patients with new-AF and prior-AF.
Conclusion
This study shows AF status has a differential impact on clinical outcomes in patients admitted with HF. Drivers behind these differences require further elucidation.
{"title":"Impact of atrial fibrillation status on clinical outcomes in patients admitted with heart failure","authors":"Jia Yi Anna Ne , Clara K. Chow , Vincent Chow , Karice Hyun , Leonard Kritharides , David Brieger , Austin Chin Chwan Ng","doi":"10.1016/j.ijcha.2025.101858","DOIUrl":"10.1016/j.ijcha.2025.101858","url":null,"abstract":"<div><h3>Background</h3><div>Few studies comprehensively examine the association of atrial fibrillation (AF) status with rehospitalisation for adverse clinical outcomes in heart failure (HF) patients.</div></div><div><h3>Methods</h3><div>Patients admitted with a primary diagnosis of HF between 1-July-2003 and 31-March-2021 were identified from the Australian New South Wales Admission-Patient-Data-Collection database and stratified by AF status (no-AF vs new-AF vs prior-AF) (end-of-follow-up: 31-March-2022). Multivariable Cox regression and Fine-Gray competing risk methods were used to assess the association of AF status with risk of MACE/all-cause mortality and rehospitalisation for non-fatal outcomes respectively. MACE was defined as all-cause mortality, admission for myocardial infarction, ischemic stroke, HF or coronary revascularisation (percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery), whichever occurred first.</div></div><div><h3>Results</h3><div>The cohort comprised 152,638 admitted HF patients (median age: 80.4 years; 51.4 % males): 10.7 % New-AF; 37.0 % Prior-AF. During a median 1.24 years follow-up, compared to no-AF HF patients, new-AF and prior-AF patients had significantly higher rates of MACE (no-AF:78.5 % vs new-AF:81.7 % vs prior-AF:86.3 %) (both logrank P < 0.001). However, after adjusting for differences in baseline characteristics and admission year-groups, new-AF and prior-AF status had differential impact on MACE compared to no-AF patients (adjusted hazard ratio [aHR] = 0.93, 95 % confidence interval [CI] = 0.91–0.94; aHR = 1.14, 95 %CI = 1.13–1.16 respectively; both P < 0.001); results were similar for all-cause death. Rehospitalisation risk for most non-fatal clinical outcomes were significantly higher in HF patients with new-AF and prior-AF.</div></div><div><h3>Conclusion</h3><div>This study shows AF status has a differential impact on clinical outcomes in patients admitted with HF. Drivers behind these differences require further elucidation.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101858"},"PeriodicalIF":2.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924393","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}
Pub Date : 2026-01-06DOI: 10.1016/j.ijcha.2025.101861
Rikhard Björn , Joonas Lehto , Markus Malmberg , Vesa Anttila , Jarmo Gunn , Tuomo Nieminen , Juha E.K. Hartikainen , Fausto Biancari , K.E.Juhani Airaksinen , Tuomas Kiviniemi
Background
Despite advancements in surgical techniques and perioperative care, postoperative bleeding and neurological complications remain significant concerns after bioprosthetic surgical aortic valve replacement (SAVR). The present study assessed the incidence of short-term and long-term major bleeding and strokes and their association with antithrombotic treatment after isolated bioprosthetic SAVR.
Methods
The CAREAVR study included 721 patients who underwent isolated bioprosthetic SAVR at four Finnish university hospitals between 2002 and 2014. The day-to-day information on short-term antithrombotic treatment was available from a subgroup including 227 patients.
Results
The median follow-up time was 4.9 (interquartile range 3.0–7.0) years. During the 30-day postoperative period, in the subgroup of 227 patients, 31 (13.7 %) patients experienced a major bleeding event, and 13 (5.7 %) patients a major stroke. A vast majority of the bleedings (80.6 %) occurred within two days after the surgery, and the tail effect of preoperative aspirin was present in 54.8 % of episodes, indicating unintentional antithrombotic effect. During the long-term follow-up (>30 days after the index surgery), major bleeding episodes occurred in 40 (5.5 %) patients, and 47 (6.5 %) patients experienced a major stroke. Overall, 23 (57.5 %) of the patients with major bleeding and 13 (27.7 %) of the patients experiencing major stroke were on OAC during the event.
Conclusion
The incidence of perioperative major bleeding was over two-fold compared to major stroke, the majority occurring during the tail effect of preoperatively used aspirin. During the long-term follow-up, the rates of stroke and major bleeds were similar, and most bleeding episodes occurred while on OAC.
{"title":"Major bleeding complications and antithrombotic treatment after isolated surgical bioprosthetic aortic valve replacement","authors":"Rikhard Björn , Joonas Lehto , Markus Malmberg , Vesa Anttila , Jarmo Gunn , Tuomo Nieminen , Juha E.K. Hartikainen , Fausto Biancari , K.E.Juhani Airaksinen , Tuomas Kiviniemi","doi":"10.1016/j.ijcha.2025.101861","DOIUrl":"10.1016/j.ijcha.2025.101861","url":null,"abstract":"<div><h3>Background</h3><div>Despite advancements in surgical techniques and perioperative care, postoperative bleeding and neurological complications remain significant concerns after bioprosthetic surgical aortic valve replacement (SAVR). The present study assessed the incidence of short-term and long-term major bleeding and strokes and their association with antithrombotic treatment after isolated bioprosthetic SAVR.</div></div><div><h3>Methods</h3><div>The CAREAVR study included 721 patients who underwent isolated bioprosthetic SAVR at four Finnish university hospitals between 2002 and 2014. The day-to-day information on short-term antithrombotic treatment was available from a subgroup including 227 patients.</div></div><div><h3>Results</h3><div>The median follow-up time was 4.9 (interquartile range 3.0–7.0) years. During the 30-day postoperative period, in the subgroup of 227 patients, 31 (13.7 %) patients experienced a major bleeding event, and 13 (5.7 %) patients a major stroke. A vast majority of the bleedings (80.6 %) occurred within two days after the surgery, and the tail effect of preoperative aspirin was present in 54.8 % of episodes, indicating unintentional antithrombotic effect. During the long-term follow-up (>30 days after the index surgery), major bleeding episodes occurred in 40 (5.5 %) patients, and 47 (6.5 %) patients experienced a major stroke. Overall, 23 (57.5 %) of the patients with major bleeding and 13 (27.7 %) of the patients experiencing major stroke were on OAC during the event.</div></div><div><h3>Conclusion</h3><div>The incidence of perioperative major bleeding was over two-fold compared to major stroke, the majority occurring during the tail effect of preoperatively used aspirin. During the long-term follow-up, the rates of stroke and major bleeds were similar, and most bleeding episodes occurred while on OAC.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101861"},"PeriodicalIF":2.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924392","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}
Pub Date : 2026-01-06DOI: 10.1016/j.ijcha.2025.101857
Andreas Goldschmied , Manuel Sigle , Ioannis Toskas , Mirac Senel , Livia Dingemann , Malte Kranert , Tobias Harm , Meinrad Gawaz , Michal Droppa , Andreas Brendlin , Karin Anne Lydia Mueller
Introduction
Transcutaneous cardiac pacing (TCP) is an important emergency treatment option in patients with symptomatic bradycardia. With the help of a portable pulse generator an electrical current is delivered through the patient́s thorax in order to induce ventricular contractions. Data on patients in sinus rhythm suggests favorable pacing thresholds when using an anteroposterior (AP) compared to an anterolateral (AL) pacer pad positioning. However, evidence in bradycardic patients is lacking.
Methods
We conducted a prospective crossover clinical study which included 16 patients with symptomatic bradycardia. Patients received consecutive TCP in an AP and AL position under sedoanalgesia. TCP was carried out in an AP and an AL pacer pad position if patients were hemodynamically stable (systolic blood pressure > 90 mmHg). Minimal required current and other variables were noted for both pacer pad positions and Wilcoxon Signed Rank tests were used to compare differences.
Results
We did not overserve a significant difference in minimal required pacing current between the AP and AL pacer pad position (median threshold AP = 125 mA [±48], median threshold AL = 140 mA [±78], p = 0.53). However, a linear mixed-effects model revealed higher pacing thresholds in patients on beta blockers (B = 72.1, p < 0.001, 95 % CI = 36.6–107.7) and with lower myocardial mass (B = -0.41, p < 0.001, 95 % CI = −0.59- −0.23).
Conclusion
We observed no significant difference in pacing thresholds between an AP and AL pacer pad position in patients with symptomatic bradycardia. These results do not align with prior work investigating a monitor with pulsed current delivery.
经皮心脏起搏（TCP）是症状性心动过缓患者的重要急诊治疗选择。在便携式脉冲发生器的帮助下，电流通过患者的胸腔传递，以诱导心室收缩。窦性心律患者的数据表明，与前外侧（AL）起搏器垫定位相比，采用正位（AP）起搏器定位有利于起搏阈值。然而，在心动过缓患者中缺乏证据。方法对16例症状性心动过缓患者进行前瞻性交叉临床研究。患者在sedo镇痛下连续接受AP位和AL位TCP。如果患者血流动力学稳定（收缩压>； 90 mmHg），则采用AP和AL起搏器垫位进行TCP。对起搏器垫位置的最小电流和其他变量进行了记录，并使用Wilcoxon Signed Rank检验来比较差异。结果AP和AL起搏器垫位置在最小起搏电流方面没有明显差异（AP阈值中位数为125 mA[±48]，AL阈值中位数为140 mA[±78]，p = 0.53）。然而，线性混合效应模型显示，服用受体阻滞剂的患者起搏阈值较高（B = 72.1, p < 0.001, 95% CI = 36.6-107.7），心肌质量较低（B = -0.41, p < 0.001, 95% CI = - 0.59- - 0.23）。结论：我们观察到AP和AL起搏器垫位在症状性心动过缓患者的起搏阈值无显著差异。这些结果与先前研究脉冲电流输送监测仪的工作不一致。
{"title":"Anteroposterior versus anterolateral pacer pad position in patients with symptomatic bradycardia","authors":"Andreas Goldschmied , Manuel Sigle , Ioannis Toskas , Mirac Senel , Livia Dingemann , Malte Kranert , Tobias Harm , Meinrad Gawaz , Michal Droppa , Andreas Brendlin , Karin Anne Lydia Mueller","doi":"10.1016/j.ijcha.2025.101857","DOIUrl":"10.1016/j.ijcha.2025.101857","url":null,"abstract":"<div><h3>Introduction</h3><div>Transcutaneous cardiac pacing (TCP) is an important emergency treatment option in patients with symptomatic bradycardia. With the help of a portable pulse generator an electrical current is delivered through the patient́s thorax in order to induce ventricular contractions. Data on patients in sinus rhythm suggests favorable pacing thresholds when using an anteroposterior (AP) compared to an anterolateral (AL) pacer pad positioning. However, evidence in bradycardic patients is lacking.</div></div><div><h3>Methods</h3><div>We conducted a prospective crossover clinical study which included 16 patients with symptomatic bradycardia. Patients received consecutive TCP in an AP and AL position under sedoanalgesia. TCP was carried out in an AP and an AL pacer pad position if patients were hemodynamically stable (systolic blood pressure > 90 mmHg). Minimal required current and other variables were noted for both pacer pad positions and Wilcoxon Signed Rank tests were used to compare differences.</div></div><div><h3>Results</h3><div>We did not overserve a significant difference in minimal required pacing current between the AP and AL pacer pad position (median threshold AP = 125 mA [±48], median threshold AL = 140 mA [±78], p = 0.53). However, a linear mixed-effects model revealed higher pacing thresholds in patients on beta blockers (B = 72.1, p < 0.001, 95 % CI = 36.6–107.7) and with lower myocardial mass (B = -0.41, p < 0.001, 95 % CI = −0.59- −0.23).</div></div><div><h3>Conclusion</h3><div>We observed no significant difference in pacing thresholds between an AP and AL pacer pad position in patients with symptomatic bradycardia. These results do not align with prior work investigating a monitor with pulsed current delivery.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101857"},"PeriodicalIF":2.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924394","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}
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