IJC Heart and Vasculature最新文献

{"title":"Genetic anticipation and cardiac conduction abnormalities in myotonic dystrophy type 1: implications for early stratification from a multicenter registry","authors":"Rebeca Lorca ,&nbsp;Alberto Alen ,&nbsp;Carlos Moliner-Abós ,&nbsp;Fernando de Frutos ,&nbsp;Néstor Báez-Ferrer ,&nbsp;María Luisa Peña-Peña ,&nbsp;Eduardo Villacorta ,&nbsp;Tomas Ripoll-Vera ,&nbsp;Esther Zorio ,&nbsp;Aaron Martínez-Gimeno ,&nbsp;José Bermúdez-Jiménez ,&nbsp;Javier Limeres ,&nbsp;Coloma Tiron ,&nbsp;José M. Larrañaga-Moreira ,&nbsp;Eva Cabrera-Romero ,&nbsp;Pablo García-Pavía ,&nbsp;María Angeles Espinosa ,&nbsp;Jesús Piqueras ,&nbsp;Soledad García-Hernández ,&nbsp;Julián Palomino-Doza ,&nbsp;Carmen Muñoz","doi":"10.1016/j.ijcha.2025.101851","DOIUrl":"10.1016/j.ijcha.2025.101851","url":null,"abstract":"<div><h3>Background</h3><div>DM1 is an autosomal dominant disorder caused by unstable CTG repeats that expand over lifetime and in successive generations, contributing to genetic anticipation. Cardiac conduction abnormalities (CCAs) are a major source of morbidity and premature death in DM1, yet the influence of age at diagnosis, generation, and CTG repeat length on the timing and progression of cardiac involvement remains poorly defined.</div></div><div><h3>Method</h3><div>This multicentric retrospective study included 549 adult DM1 patients from 16 hospitals in Spain. The primary composite endpoint comprised significant CCAs, device implantation, malignant ventricular arrhythmias and cardiac syncope. Patients were stratified by age‑at‑diagnosis (&lt;40, 40–59, and ≥60 years); birth generation (1920–1965, 1966–1990, 1991–2015), and CTG repeat length (&lt;100, 100–599, and ≥600).</div></div><div><h3>Results</h3><div>During follow‑up, 33.1 % of patients experienced the primary endpoint. This risk was 4.7‑fold higher in the youngest group versus the oldest group (HR 4.70; p &lt; 0.001); 35‑fold higher in the 3rd generation versus the 1st and increased progressively with longer CTG expansions. Device implantation rates were likewise higher in younger patients, later generations, and those with larger repeat lengths.</div></div><div><h3>Conclusion</h3><div>The results demonstrate a striking anticipation pattern in the cardiac phenotype of DM1, with progressively earlier and more severe electrical disease paralleling CTG expansion across generations. Incorporating age at diagnosis, generational cohort, and genetic repeat burden into clinical assessment may enhance risk stratification and enable earlier, targeted rhythm surveillance and device therapy to prevent sudden cardiac death in DM1.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101851"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737407","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}

{"title":"Acute pulmonary vasoreactivity: a simple test revisited in the contemporary era − a narrative review","authors":"Juan C Grignola ,&nbsp;Pedro Trujillo ,&nbsp;Julio Sandoval ,&nbsp;Enric Domingo","doi":"10.1016/j.ijcha.2025.101847","DOIUrl":"10.1016/j.ijcha.2025.101847","url":null,"abstract":"<div><div>The acute vasodilator challenge during right heart catheterization (RHC) provides a deeper understanding of the pulmonary circulation by assessing vasoreactivity. The current criteria for a positive acute vasoreactivity test (AVT) are simplified to steady-state metrics, based on cutoff points derived from expert opinion. A positive AVT identifies a specific, but very rare, PH phenotype that may respond long-term to calcium-channel blockers. Growing evidence supports updating the role and criteria of AVT in pulmonary arterial hypertension, broadening its use to other PH groups, and potentially offering new insights for predicting risk and/or treatment outcomes.</div><div>This study aims to revisit the uses, criteria, and goals of AVT in patients with PH beyond group 1 and to propose a new approach for phenotyping the pulmonary vascular response to the acute vasodilator challenge during diagnostic RHC. We propose a continuous multi-parameter criterion to evaluate the entire right ventricular afterload during AVT, such as the pulmonary vascular resistance-pulmonary arterial capacitance curve and alpha distensibility coefficient. AVT could assess the residual vasoreactive reserve of the pulmonary circulation as a provocative test for predicting risk outcomes and/or treatment responses.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101847"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684636","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}

{"title":"The role of quantitative cardiovascular MRI and late gadolinium enhancement patterns in differentiating late-onset Anderson-Fabry disease (c.640–801G > A) from hypertrophic cardiomyopathy: a case-control study","authors":"Yilin Xu ,&nbsp;Rui Chen ,&nbsp;Xinglu Li ,&nbsp;Huihua Lin ,&nbsp;Lirong Lin ,&nbsp;Lihong Lu ,&nbsp;XiaoMin Dai ,&nbsp;Yingbin Yu ,&nbsp;YuYing Lin ,&nbsp;Lei Yin ,&nbsp;Mingping Ma","doi":"10.1016/j.ijcha.2026.101869","DOIUrl":"10.1016/j.ijcha.2026.101869","url":null,"abstract":"<div><h3>Aims</h3><div>To evaluate the utility of cardiovascular magnetic resonance imaging (CMR) in distinguishing Anderson-Fabry disease (AFD) harboring the c.640–801G &gt; A mutation from hypertrophic cardiomyopathy (HCM).</div></div><div><h3>Methods and results</h3><div>We enrolled 30 AFD patients, 30 age- and sex-matched HCM patients, and 30 healthy controls (HC). All participants underwent CMR (3.0 T). Left ventricular hypertrophy (LVH) prevalence was high in both AFD and HCM groups (P = 0.12). AFD patients exhibited significantly greater left ventricular lateral wall thickness compared to both HCM and HC (P &lt; 0.001), and a significantly lower interventricular septal to lateral wall thickness ratio (IVS/LW) than HCM (P &lt; 0.001). Late gadolinium enhancement (LGE) was significantly more frequent in the basal inferolateral and apical segments in AFD compared to HCM (P &lt; 0.001 and P = 0.039, respectively). Native T1 values were significantly lower in AFD than HCM in the global LV, septal LV, and within LGE regions (all P &lt; 0.001). Compared to HC, AFD patients had significantly lower septal native T1 (P &lt; 0.001), but comparable global LV native T1 (P = 0.155). Native T1 cut-offs effectively discriminated AFD from HCM: septal native T1 ≤ 1247 ms, global native T1 ≤ 1256 ms, and LGE region native T1 ≤ 1334 ms. Septal native T1 demonstrated the strongest discriminatory capacity.</div></div><div><h3>Conclusion</h3><div>CMR effectively differentiates AFD patients with the c.640–801G &gt; A mutation from HCM. Key discriminators include lower native T1 values (Caution against pseudo-normalization), higher prevalence of basal inferolateral LGE, and more symmetric LVH in AFD.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101869"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172857","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}

{"title":"Prognostic value of liver shear wave elastography after transcatheter aortic valve implantation in severe aortic stenosis","authors":"Yutaro Sato ,&nbsp;Akihiko Sato ,&nbsp;Kazuya Sakamoto ,&nbsp;Yuuki Muto ,&nbsp;Yu Sato ,&nbsp;Tetsuro Yokokawa ,&nbsp;Takeshi Shimizu ,&nbsp;Tomofumi Misaka ,&nbsp;Takashi Kaneshiro ,&nbsp;Masayoshi Oikawa ,&nbsp;Atsushi Kobayashi ,&nbsp;Akiomi Yoshihisa ,&nbsp;Yasuchika Takeishi","doi":"10.1016/j.ijcha.2025.101864","DOIUrl":"10.1016/j.ijcha.2025.101864","url":null,"abstract":"<div><h3>Background</h3><div>Shear wave elastography (SWE) is a noninvasive ultrasound technique that quantifies liver stiffness. Previous studies have suggested that liver SWE can serve as an indirect marker of hepatic congestion. However, it remains unclear whether liver SWE measured after transcatheter aortic valve implantation (TAVI) is associated with clinical outcomes.</div></div><div><h3>Methods</h3><div>A total of 127 consecutive patients with severe aortic stenosis who underwent TAVI and had liver SWE measured using abdominal ultrasonography at discharge were enrolled. Liver SWE was obtained from the right hepatic lobe via an intercostal approach. Patients were stratified by the median liver SWE value (1.36 m/s): low-SWE group (&lt; 1.36 m/s; <em>n</em> = 59) and high-SWE group (≥ 1.36 m/s; <em>n</em> = 68). The primary endpoint was a composite of all-cause death and heart failure (HF) rehospitalization.</div></div><div><h3>Results</h3><div>All 127 patients were followed for 24 months, during which 21 (16.5 %) experienced the primary endpoint. Kaplan–Meier analysis showed a higher cumulative incidence of the primary endpoint in the high-SWE group than in the low-SWE group (log-rank <em>P</em> = 0.019). In Cox proportional hazards models adjusted using inverse probability of treatment weighting, high liver SWE was independently associated with an increased risk of the primary endpoint (hazard ratio 3.66; 95 % confidence interval 1.30–10.32; <em>P</em> = 0.014).</div></div><div><h3>Conclusion</h3><div>High liver SWE after TAVI was independently associated with an increased 24-month risk of all-cause death and HF rehospitalization.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101864"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022366","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}

{"title":"Visual coronary calcium scoring to support opportunistic CAD screening: comparative evaluation of three established systems and introduction of a novel scoring system","authors":"Philipp Nicol ,&nbsp;Rafael Adolf ,&nbsp;Salvatore Cassese ,&nbsp;Adnan Kastrati ,&nbsp;Michael Joner ,&nbsp;Heribert Schunkert ,&nbsp;Martin Hadamitzky ,&nbsp;Leif-Christopher Engel","doi":"10.1016/j.ijcha.2026.101875","DOIUrl":"10.1016/j.ijcha.2026.101875","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery calcium (CAC) scoring is an established marker of atherosclerotic burden and cardiovascular risk. While the Agatston score is the clinical gold standard, alternative visual scoring methods—including the Visual Ordinal Score, Weston Score, and Vessel-specific extent-based score—are increasingly used, particularly in non-gated or opportunistic CT imaging. This study aimed to compare the diagnostic performance, inter-observer reliability, and correlation of different visual scoring methods against the Agatston score.</div></div><div><h3>Methods</h3><div>A total of 299 cases were evaluated using ECG-gated CT scans. Each case was independently scored in a blinded fashion by two observers using three visual methods: (1) Visual Ordinal Score (VS), (2) Weston Score (WS) and (3) Vessel-specific extent-based score (VSES). A novel visual CAC score was derived by combining Weston and Vessel-specific extent-based scoring (= Weston Extent Score, WES). Cohen’s Kappa and Intraclass Correlation Coefficients (ICC) were used for inter-observer agreement. Classification performance was assessed against Agatston-based categories (No CAC, Mild, Moderate, Severe), including accuracy, precision, sensitivity, and specificity. Correlation analyses were conducted using Pearson and Spearman coefficients.</div></div><div><h3>Results</h3><div>All scoring methods showed high correlation with the Agatston score (Spearman ρ &gt; 0.87; p &lt; 0.001). Visual scoring demonstrated the highest inter-observer agreement (Kappa = 0.94, ICC = 0.97), followed by Weston (Kappa = 0.90) and Vessel-Specific scores (Kappa = 0.77). Visual scoring also yielded the highest accuracy (Observer 1: 91.3 %, Observer 2: 90.0 %) The newly derived WES score achieved 80.9 % accuracy, with macro-averaged specificity of 93.8 % and improving diagnostic accuracy compared to WS and VSES.</div></div><div><h3>Discussion</h3><div>Different visual scoring offers excellent reproducibility and diagnostic accuracy for CAC classification, with strong correlation to the Agatston score. The newly-derived WES score could be useful in providing a practical balance regarding volumetric information (CAC densitiy) and anatomical distribution of CAC. These findings support the implementation of structured visual CAC scoring in clinical and opportunistic CT settings.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101875"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022367","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}

{"title":"Major bleeding complications and antithrombotic treatment after isolated surgical bioprosthetic aortic valve replacement","authors":"Rikhard Björn ,&nbsp;Joonas Lehto ,&nbsp;Markus Malmberg ,&nbsp;Vesa Anttila ,&nbsp;Jarmo Gunn ,&nbsp;Tuomo Nieminen ,&nbsp;Juha E.K. Hartikainen ,&nbsp;Fausto Biancari ,&nbsp;K.E.Juhani Airaksinen ,&nbsp;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 (&gt;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":"2026-02-01","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}

{"title":"Impact of atrial fibrillation status on clinical outcomes in patients admitted with heart failure","authors":"Jia Yi Anna Ne ,&nbsp;Clara K. Chow ,&nbsp;Vincent Chow ,&nbsp;Karice Hyun ,&nbsp;Leonard Kritharides ,&nbsp;David Brieger ,&nbsp;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 &lt; 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 &lt; 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":"2026-02-01","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}

{"title":"Serum aminoterminal type III procollagen peptide reflects increased vascular thickness in healthy, young adults","authors":"Manar Bitar ,&nbsp;Dieter Samyn ,&nbsp;Madeleine Helgesson ,&nbsp;Martin Vink ,&nbsp;Paul Pettersson-Pablo","doi":"10.1016/j.ijcha.2026.101876","DOIUrl":"10.1016/j.ijcha.2026.101876","url":null,"abstract":"<div><h3>Background</h3><div>Procollagen III, aminoterminal peptide (PIIINP) is a degradation product of collagen type III-synthesis. Collagen type III is distributed in many tissues, and an increase in serum PIIINP could reflect an increase in collagen turnover and pro-fibrotic activity. In this study, on a population of younger, healthy adults, we examined whether serum PIIINP correlates with early markers of vascular health, to evaluate its potential as a biomarker for early screening of preclinical cardiovascular risk.</div></div><div><h3>Methods</h3><div>PIIINP levels, pulse wave velocity (PWV) and Carotid-intima media thickness (cIMT) was measured in 834 healthy, non-smoking, individuals aged 18–26. In univariable and multivariable linear regression models, we examined the association between PIIINP and vascular measurements, PWV and cIMT with adjustment for serum lipids, liver enzymes and systolic blood pressure.</div></div><div><h3>Results</h3><div>The average of PIIINP, PWV and cIMT measurements in this population, were low (7.1 and 7.3 µg/L, 5.5 and 5.2 m/s, and 0.50 and 0.49 mm for men and women, respectively). In univariable analyses, PIIINP correlated positively with cIMT (p = 0.0061) and negatively with PWV (p = 0.0069). In multivariable analyses, a statistically significant association remained between PIIINP and cIMT (p &lt; 0.001), but not with PWV.</div></div><div><h3>Conclusion</h3><div>Serum PIIINP correlates with cIMT in a healthy population, indicating its potential as a biomarker of cardiovascular risk at a preclinical stage. PIIINP measurement being easier to perform and less examiner dependent than the more time consuming and cumbersome cIMT, are suggestive of its possible merits as an early screening tool for cardiovascular disease.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101876"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022368","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}

{"title":"Prognostic significance of subsequent decline in LVEF in heart failure with improved ejection fraction − A report from the CHART-2 study −","authors":"Takuya Takigahira ,&nbsp;Kotaro Nochioka ,&nbsp;Satoshi Miyata ,&nbsp;Takashi Shiroto ,&nbsp;Takumi Inoue ,&nbsp;Kai Susukita ,&nbsp;Hideka Hayashi ,&nbsp;Hiroyuki Takahama ,&nbsp;Jun Takahashi ,&nbsp;Hiroaki Shimokawa ,&nbsp;Satoshi Yasuda","doi":"10.1016/j.ijcha.2026.101877","DOIUrl":"10.1016/j.ijcha.2026.101877","url":null,"abstract":"<div><h3>Background</h3><div>Some patients of heart failure with improved ejection fraction (HFimpEF) have subsequent decline in left ventricular ejection fraction (LVEF) after improvement, and their prognosis is uncertain.</div></div><div><h3>Aims</h3><div>We aimed to examine the clinical characteristics and long-term prognosis of this sub-population of HFimpEF.</div></div><div><h3>Methods</h3><div>We examined 399 consecutive patients with HF with reduced ejection fraction (HFrEF, LVEF ≤ 40 %) with LVEF data at both baseline and follow-up in the CHART-2 Study. We classified them as follows; persistent HFrEF group (LVEF ≤ 40 % at 1-year and 2-year follow-up, n = 238), temporary HFimpEF group (≥10 % increase from baseline with LVEF &gt; 40 % at 1-year follow-up but LVEF ≤ 40 % at 2-year follow-up, n = 22), and persistent HFimpEF group (≥10 % increase from baseline with LVEF &gt; 40 % at 1-year follow-up, and LVEF &gt; 40 % at 2-year follow-up, n = 139).</div></div><div><h3>Results</h3><div>The temporary HFimpEF group (adjusted hazard ratio: 2.95; 95 % CI: 1.55–5.63) and the persistent HFrEF group (2.53; 1.75–3.67) were associated with increased risks for the composite of cardiovascular death and HF hospitalization. The risk factors for decline in LVEF included LVEF (adjusted odds ratio: 0.80; 95 %CI: 0.69–0.90), LV end-diastolic dimension (LVDd) (1.14; 1.05–1.25), B-type natriuretic peptide (BNP) levels (1.04 per 10 pg/mL increase; 1.00–1.08), estimated glomerular filtration rate (eGFR) levels (0.95; 0.92–0.99) and serum sodium levels (0.70; 0.50–0.91) at 1-year follow-up.</div></div><div><h3>Conclusions</h3><div>These results indicate that patients with HFrecEF account for 23% of those with HFrEF and that 12% of them have subsequent decline in LVEF associated with similar worse prognosis as in those with persistent HFrEF.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101877"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022365","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}

{"title":"Combining topical and intravenous tranexamic acid in cardiac surgery: does it really matter? – a systematic review and meta-analysis","authors":"Paul C. Onyeji ,&nbsp;Leo Consoli ,&nbsp;Amrinder Kaur ,&nbsp;Shivank Dani ,&nbsp;Sonise Momplaisir-Onyeji ,&nbsp;Felipe S. Passos ,&nbsp;Hristo Kirov ,&nbsp;Torsten Doenst ,&nbsp;Tulio Caldonazo","doi":"10.1016/j.ijcha.2025.101848","DOIUrl":"10.1016/j.ijcha.2025.101848","url":null,"abstract":"<div><h3>Background</h3><div>The benefit-to-risk ratio of administration of intravenous (IV) and topical tranexamic acid (TXA) together in cardiac surgery has not yet been determined. This study aims to evaluate whether the combined approach (IV plus topical TXA) offers superior bleeding control compared to IV TXA alone, while maintaining an acceptable safety profile.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and <em>meta</em>-analysis of randomized controlled trials (RCTs) and observational studies comparing combined topical and intravenous TXA administration versus IV TXA alone in patients undergoing cardiac surgery. The primary outcome was cumulative blood loss. Secondary outcomes included all-cause mortality, transfusion-free status, and the number of transfused blood products. A random-effects model was used for all pooled analyses.</div></div><div><h3>Results</h3><div>We included a total of five studies (four RCTs, one observational; n = 880). Pooled analysis showed that the combined approach significantly, but modest, reduced total blood loss when compared to an IV-only TXA strategy (MD −39.84, 95 %CI −74.80 to −4.88; p = 0.03; I² = 39 %). However, this benefit did not translate into a significant reduction in transfusion requirements (OR 1.00, 95 %CI 0.72 to 1.37; p = 0.98; I² = 0 %), volume of blood products used (MD −0.01, 95 %CI −0.04 to 0.02; p = 0.51; I² = 0 %), or all-cause mortality (OR 0.85, 95 %CI 0.24 to 3.08; p = 0.81; I² = 0 %).</div></div><div><h3>Conclusion</h3><div>Combined topical and IV TXA application is associated with reduced total blood loss after cardiac surgery compared to an IV-only approach. However, no significant differences were observed in transfusion rates, blood product utilization, or mortality.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101848"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684635","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}