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The role of membranous septum length as a predictor for post-TAVR pacemaker implantation in patients with pre-existing RBBB 膜间隔长度作为预先存在RBBB患者tavr后起搏器植入的预测因子的作用
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-06 DOI: 10.1016/j.ijcha.2025.101855
Ayman Jubran , Raumil V Patel , Denis Qeska , Ragavie Manoragavan , Issac Yang , Anastasia Oikonomou , Harindra C Wijeysundera
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引用次数: 0
Syndecan-1, endocan and non-culprit coronary plaque composition following non-ST elevation myocardial infarction 非st段抬高型心肌梗死后Syndecan-1、内源性和非罪魁祸首冠状动脉斑块组成
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-06 DOI: 10.1016/j.ijcha.2025.101865
Naomi E. Wattchow , Thalia Salagaras , Mau T. Nguyen , Lauren Y.J. Sandeman , Gemma A. Figtree , Giuseppe Di Giovanni , Dennis T.L. Wong , Stephen J. Nicholls , Christina A. Bursill , Peter J. Psaltis

Background

Syndecan-1 and endocan are biomarkers of endothelial damage, which associate with worse outcomes after myocardial infarction (MI). As it is unclear how this is mediated, we investigated how they associate with the composition of residual, non-culprit coronary atherosclerotic plaques following acute MI.

Methods

This post hoc analysis of the COCOMO-ACS trial used serum samples from forty-five patients with non-ST elevation MI who underwent blood collection and optical coherence tomography (OCT) imaging of non-culprit, lipid-rich coronary plaques at baseline and after a median of 17.8 months. Serum syndecan-1 and endocan concentrations at both time-points were measured by ELISA. Relationships between these biomarkers and OCT parameters of rupture-prone plaque were examined.

Results

Serum levels of syndecan-1 (median 161.0 ng/mL at baseline vs 93.5 ng/mL at follow-up, P < 0.0001) and endocan (225.7 pg/mL vs 191.2 pg/mL, P = 0.003) both decreased from time of MI to follow-up, with strong correlation between their changes (R2 = 0.64, P < 0.0001). Only syndecan-1 showed a weak negative correlation with minimum fibrous cap thickness at baseline (R2 = 0.10, P = 0.03) and a weak positive correlation with maximum lipid arc at follow-up (R2 = 0.14, P = 0.01). While syndecan-1 and endocan showed no relationship with plasma lipid concentrations, there were weak associations between follow-up syndecan-1 and interleukin-1-beta (R2 = 0.21, P = 0.001), and follow-up endocan and interleukin-6 (R2 = 0.15, P = 0.008).

Conclusions

Although serum syndecan-1 and endocan levels decreased in peripheral blood over time post-MI on guideline-directed therapy, this study identified only modest relationships between syndecan-1 (and not endocan) and OCT compositional characteristics of lipid-rich, rupture-prone plaque.
syndecan -1和endocan是内皮损伤的生物标志物,与心肌梗死(MI)后较差的预后相关。由于尚不清楚这是如何介导的,我们研究了它们与急性心肌梗死后残留的非罪魁祸首冠状动脉粥样硬化斑块的组成之间的关系。方法对COCOMO-ACS试验进行的事后分析使用了45例非st段抬高心肌梗死患者的血清样本,这些患者在基线和中位时间17.8个月后接受了采血和光学相干断层扫描(OCT)对非罪魁祸首、富含脂质的冠状动脉斑块进行了成像。ELISA法测定两个时间点血清syndecan-1和endocan浓度。研究了这些生物标志物与易破裂斑块OCT参数之间的关系。结果血清syndecan-1水平(基线时中位数为161.0 ng/mL,随访时中位数为93.5 ng/mL, P < 0.0001)和endocan水平(225.7 pg/mL,随访时中位数为191.2 pg/mL, P = 0.003)从心肌梗死到随访期间均下降,两者变化具有很强的相关性(R2 = 0.64, P < 0.0001)。只有syndecan-1与基线时最小纤维帽厚度呈弱负相关(R2 = 0.10, P = 0.03),与随访时最大脂质弧呈弱正相关(R2 = 0.14, P = 0.01)。虽然syndecan-1和endocan与血浆脂质浓度无相关性,但随访时syndecan-1与白细胞介素-1- β (R2 = 0.21, P = 0.001)、endocan与白细胞介素-6 (R2 = 0.15, P = 0.008)存在弱相关性。结论:尽管经指导治疗的心肌梗死后,外周血中血清syndecan-1和endocan水平随着时间的推移而下降,但本研究仅发现syndecan-1(而非endocan)与富含脂质、易破裂斑块的OCT组成特征之间存在适度关系。
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引用次数: 0
On the mh-index and simple efficiency metrics for Assessing scientific contributions 论科学贡献评价的h-指数和简单效率指标
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-06 DOI: 10.1016/j.ijcha.2025.101853
Paulo Roberto Benchimol-Barbosa
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引用次数: 0
Identification of novel candidate biomarkers for heart failure with preserved ejection fraction by the Olink proteomics platform 通过Olink蛋白质组学平台鉴定具有保留射血分数的心力衰竭新的候选生物标志物
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-06 DOI: 10.1016/j.ijcha.2025.101859
Huang Yimei , Chen xinyun , Hu yuchi, Dai Songyuan, Nian Siqi, Li Hongning, Weng Shenghai, He Guanghui, Hua Baotong, Zhao Lulu

Background

The pathophysiology of heart failure with preserved ejection fraction (HFpEF) remains incompletely understood.

Objective

This study aimed to identify potential protein biomarkers for the accurate diagnosis and phenotyping of HFpEF and to construct a machine learning-based diagnostic model incorporating these biomarkers and key clinical features.

Methods

In a cross-sectional study of 249 cardiac patients, HFpEF-associated plasma proteins were identified using Olink PEA and validated by ELISA. A machine learning nomogram was developed and its diagnostic performance was evaluated.

Results

Analysis identified 92 plasma proteins,among which Serine protease 27(PRSS27), P-selectin glycoprotein ligand 1 (PSGL-1), Biregional Cell Adhesion Molecule-related (BOC), NF-κB essential modulator (NEMO), Glyoxalase 1(GLO1))) were specifically expressed in HFpEF group. Enrichment analysis indicated these differential proteins were primarily involved in inflammatory response, immune response, and the Phosphatidylinositol 3-kinase-AKT serine/threonine kinase (PI3K-AKT) signaling pathway. A diagnostic model integrating three proteins with clinical features (LDL-C, ALB) demonstrated excellent performance (AUC: 0.895), showing strong discriminatory power, good calibration, and potential clinical applicability.

Conclusion

This study identifies potential protein biomarkers for HFpEF diagnosis, provides new insights into its pathophysiology, and offers a practical diagnostic tool for clinical use.
背景:保留射血分数(HFpEF)心力衰竭的病理生理机制尚不完全清楚。目的寻找可用于HFpEF准确诊断和分型的潜在蛋白生物标志物,并结合这些生物标志物和关键临床特征构建基于机器学习的诊断模型。方法对249例心脏病患者进行横断面研究,采用Olink PEA鉴定hfpef相关血浆蛋白,并进行ELISA验证。开发了机器学习模态图,并对其诊断性能进行了评估。结果鉴定出92种血浆蛋白,其中丝氨酸蛋白酶27(PRSS27)、p选择素糖蛋白配体1(PSGL-1)、双区域细胞粘附分子相关(BOC)、NF-κB必需调节剂(NEMO)、乙二醛酶1(GLO1))在HFpEF组中特异性表达。富集分析表明,这些差异蛋白主要参与炎症反应、免疫反应和磷脂酰肌醇3-激酶- akt丝氨酸/苏氨酸激酶(PI3K-AKT)信号通路。将三种蛋白与临床特征(LDL-C、ALB)整合的诊断模型表现出优异的诊断性能(AUC: 0.895),具有较强的鉴别能力、较好的校准性和潜在的临床适用性。结论本研究确定了HFpEF诊断的潜在蛋白生物标志物,为其病理生理提供了新的认识,为临床提供了实用的诊断工具。
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引用次数: 0
ECG and imaging manifestations of cardiomyopathy in adults with Duchenne muscular dystrophy 成人杜氏肌营养不良患者心肌病的心电图和影像学表现
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-06 DOI: 10.1016/j.ijcha.2025.101856
Peter C. Murray , Ailis Pollock , Katie Hewitt , Jenna O’Sullivan , Aoife Sheahan , Richard Sheahan
<div><h3>Background / Aims</h3><div>Cardiomyopathy is universally penetrant in young adults with Duchenne muscular dystrophy (DMD), and is increasingly the preponderant cause of death. We describe the ECG, echocardiography and cardiac MRI (CMR) findings associated with this disease, and the level of agreement between imaging modalities, highlighting the obstacles encountered in high rates of failed diagnostic cardiac imaging in our DMD multidisciplinary care centre.</div></div><div><h3>Methods and results</h3><div>We followed all patients attending a Comprehensive Multidisciplinary Adult DMD clinic over 4 years. All attendees underwent transthoracic echocardiography (TTE) and were offered referral for cardiac MRI (CMR). We recorded baseline demographics, ECG characteristics and imaging findings, comparing TTE and CMR derived LVEF. A total of 33 patients enrolled, median age 20, with mean follow-up of 3 years and 3 months. Common ECG abnormalities were dominant R in V1, pathological Q waves and right axis deviation. Mean LVEF was 51 % at enrollment and 45 % at follow-up by TTE. Presence of any degree of mitral regurgitation correlated strongly to left ventricular systolic dysfunction. CMR was completed in just 25 % of patients, all of whom had extensive midwall fibrosis. Of those in whom CMR failed, 52 % were unable to lie flat or position correctly for scanning, predominantly due to muscle contractures. Despite suboptimal TTE imaging in 75 %, there was good agreement in LVEF between CMR and TTE.</div></div><div><h3>Conclusion</h3><div>We found a high rate of failure to complete diagnostic cardiac imaging in this group of patients with impaired mobility predominantly due to fixed flexion deformities, inability to lay flat or to tolerate the scan. Our study highlights the critical need to provided specially trained Echo and CMR sonographers who understand the challenges to optimal quality imaging in these patients, and who are appropriately supported by Health Care Assistants (HCA) who are familiar with careful positioning to facilitate optimal imaging. Never the less, the study highlights the importance of multimodality imaging, and practical strategies to overcome environmental obstacles to diagnostic imaging, to better guide aggressiveness of treatment for DMD and its inherent cardiomyopathy.</div><div>Key Learning Points.</div><div>What is already known:<ul><li><span>•</span><span><div>In addition to significant mobility impairment, Duchenne muscular dystrophy (DMD) is associated with development of severe cardiomyopathy in childhood / early adulthood. Due to relatively recent improvements in survival, the evolution of ECG and imaging correlates in adulthood are poorly described.</div></span></li><li><span>•</span><span><div>The accuracy and degree of correlation between transthoracic echocardiography (TTE) and cardiac MRI (CMR) in this cohort is not known. Myocardial fibrosis, not evaluated on TTE, can be seen on cardiac CMR, and is thought to
背景/目的心肌病在患有杜氏肌营养不良症(DMD)的年轻人中普遍存在,并且越来越多地成为死亡的主要原因。我们描述了与该疾病相关的心电图、超声心动图和心脏MRI (CMR)结果,以及成像方式之间的一致程度,强调了在我们的DMD多学科护理中心,心脏成像诊断失败率高所遇到的障碍。方法和结果我们对所有在综合多学科成人DMD诊所就诊的患者进行了为期4年的随访。所有的参与者都接受了经胸超声心动图(TTE)和心脏MRI (CMR)转诊。我们记录了基线人口统计学、心电图特征和影像学结果,比较了TTE和CMR衍生的LVEF。共纳入33例患者,中位年龄20岁,平均随访3年零3个月。常见的心电图异常有V1、病理性Q波、右轴偏移为主。平均LVEF在入组时为51%,在TTE随访时为45%。任何程度的二尖瓣反流都与左心室收缩功能障碍密切相关。只有25%的患者完成了CMR,所有患者都有广泛的中壁纤维化。在CMR失败的患者中,52%的患者无法平躺或正确定位扫描,主要是由于肌肉挛缩。尽管75%的TTE成像不理想,但CMR和TTE在LVEF上有很好的一致性。结论:我们发现,在这组患者中,由于固定屈曲畸形、无法平躺或无法忍受扫描而导致活动能力受损的患者,完成心脏影像学诊断的失败率很高。我们的研究强调了提供经过专门训练的Echo和CMR超声技师的迫切需要,他们了解这些患者获得最佳成像质量的挑战,并得到卫生保健助理(HCA)的适当支持,他们熟悉仔细定位以促进最佳成像。然而,该研究强调了多模态成像的重要性,以及克服诊断成像环境障碍的实用策略,以更好地指导DMD及其固有心肌病的积极治疗。学习要点。•除了严重的运动障碍外,杜氏肌营养不良症(DMD)与儿童/成年早期严重心肌病的发展有关。由于最近生存率的提高,心电图和成人期相关成像的演变描述很少。•在该队列中,经胸超声心动图(TTE)和心脏MRI (CMR)的准确性和相关性程度尚不清楚。心肌纤维化,没有在TTE上评估,可以在心脏CMR上看到,并且被认为是早期和更严重的心肌病表型的预测。其在这种形式的心肌病中的患病率尚不清楚。•由于条件固有的因素以及环境障碍,DMD患者可能在实现诊断性心脏成像方面遇到困难,并且在具有独特实际挑战和成像结果的特定患者群体中没有很好地定义最佳成像策略。研究补充内容:•我们描述了一组DMD心肌病成年患者的典型和常见ECG、TTE和CMR结果,以及完成这些调查的障碍。•100%的扫描患者在CMR上可见广泛的中壁纤维化,支持普遍渗透性心肌病的假设,以及所有患者在症状出现之前早期药物治疗的策略。•我们报告了TTE与CMR衍生的LVEF之间的良好相关性,因此强调了多模态成像的重要性,在该队列中采用个性化的方法,以指导围绕治疗升级、ICD植入和预后的决策。
{"title":"ECG and imaging manifestations of cardiomyopathy in adults with Duchenne muscular dystrophy","authors":"Peter C. Murray ,&nbsp;Ailis Pollock ,&nbsp;Katie Hewitt ,&nbsp;Jenna O’Sullivan ,&nbsp;Aoife Sheahan ,&nbsp;Richard Sheahan","doi":"10.1016/j.ijcha.2025.101856","DOIUrl":"10.1016/j.ijcha.2025.101856","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background / Aims&lt;/h3&gt;&lt;div&gt;Cardiomyopathy is universally penetrant in young adults with Duchenne muscular dystrophy (DMD), and is increasingly the preponderant cause of death. We describe the ECG, echocardiography and cardiac MRI (CMR) findings associated with this disease, and the level of agreement between imaging modalities, highlighting the obstacles encountered in high rates of failed diagnostic cardiac imaging in our DMD multidisciplinary care centre.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods and results&lt;/h3&gt;&lt;div&gt;We followed all patients attending a Comprehensive Multidisciplinary Adult DMD clinic over 4 years. All attendees underwent transthoracic echocardiography (TTE) and were offered referral for cardiac MRI (CMR). We recorded baseline demographics, ECG characteristics and imaging findings, comparing TTE and CMR derived LVEF. A total of 33 patients enrolled, median age 20, with mean follow-up of 3 years and 3 months. Common ECG abnormalities were dominant R in V1, pathological Q waves and right axis deviation. Mean LVEF was 51 % at enrollment and 45 % at follow-up by TTE. Presence of any degree of mitral regurgitation correlated strongly to left ventricular systolic dysfunction. CMR was completed in just 25 % of patients, all of whom had extensive midwall fibrosis. Of those in whom CMR failed, 52 % were unable to lie flat or position correctly for scanning, predominantly due to muscle contractures. Despite suboptimal TTE imaging in 75 %, there was good agreement in LVEF between CMR and TTE.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;We found a high rate of failure to complete diagnostic cardiac imaging in this group of patients with impaired mobility predominantly due to fixed flexion deformities, inability to lay flat or to tolerate the scan. Our study highlights the critical need to provided specially trained Echo and CMR sonographers who understand the challenges to optimal quality imaging in these patients, and who are appropriately supported by Health Care Assistants (HCA) who are familiar with careful positioning to facilitate optimal imaging. Never the less, the study highlights the importance of multimodality imaging, and practical strategies to overcome environmental obstacles to diagnostic imaging, to better guide aggressiveness of treatment for DMD and its inherent cardiomyopathy.&lt;/div&gt;&lt;div&gt;Key Learning Points.&lt;/div&gt;&lt;div&gt;What is already known:&lt;ul&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;div&gt;In addition to significant mobility impairment, Duchenne muscular dystrophy (DMD) is associated with development of severe cardiomyopathy in childhood / early adulthood. Due to relatively recent improvements in survival, the evolution of ECG and imaging correlates in adulthood are poorly described.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;•&lt;/span&gt;&lt;span&gt;&lt;div&gt;The accuracy and degree of correlation between transthoracic echocardiography (TTE) and cardiac MRI (CMR) in this cohort is not known. Myocardial fibrosis, not evaluated on TTE, can be seen on cardiac CMR, and is thought to","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101856"},"PeriodicalIF":2.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924322","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
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 Pub 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。
{"title":"Alcohol use disorder and use of rhythm control therapies in patients with atrial fibrillation: A nationwide cohort study","authors":"Miika Vanhanen ,&nbsp;Jussi Jaakkola ,&nbsp;Juhani K.E. Airaksinen ,&nbsp;Olli Halminen ,&nbsp;Jukka Putaala ,&nbsp;Pirjo Mustonen ,&nbsp;Jari Haukka ,&nbsp;Juha Hartikainen ,&nbsp;Alex Luojus ,&nbsp;Mikko Niemi ,&nbsp;Miika Linna ,&nbsp;Mika Lehto ,&nbsp;Konsta Teppo","doi":"10.1016/j.ijcha.2025.101854","DOIUrl":"10.1016/j.ijcha.2025.101854","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 &lt; 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 &lt; 0.001), with the lowest income tertile showing the greatest disparity (HR 0.37; 95 % CI 0.32–0.42).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101854"},"PeriodicalIF":2.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789550","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
Genetic anticipation and cardiac conduction abnormalities in myotonic dystrophy type 1: implications for early stratification from a multicenter registry 1型强直性肌营养不良的遗传预测和心脏传导异常:来自多中心登记的早期分层的含义
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-11 DOI: 10.1016/j.ijcha.2025.101851
Rebeca Lorca , Alberto Alen , Carlos Moliner-Abós , Fernando de Frutos , Néstor Báez-Ferrer , María Luisa Peña-Peña , Eduardo Villacorta , Tomas Ripoll-Vera , Esther Zorio , Aaron Martínez-Gimeno , José Bermúdez-Jiménez , Javier Limeres , Coloma Tiron , José M. Larrañaga-Moreira , Eva Cabrera-Romero , Pablo García-Pavía , María Angeles Espinosa , Jesús Piqueras , Soledad García-Hernández , Julián Palomino-Doza , Carmen Muñoz

Background

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.

Method

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 (<40, 40–59, and ≥60 years); birth generation (1920–1965, 1966–1990, 1991–2015), and CTG repeat length (<100, 100–599, and ≥600).

Results

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 < 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.

Conclusion

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.
ddm1是一种常染色体显性遗传病,由不稳定的CTG重复序列在一生中和连续几代中扩展引起,有助于遗传预期。心传导异常(CCAs)是DM1发病和过早死亡的主要原因,但诊断年龄、世代和CTG重复长度对心脏受累时间和进展的影响仍不明确。方法本多中心回顾性研究纳入西班牙16家医院549例成年DM1患者。主要复合终点包括显著cca、器械植入、恶性室性心律失常和心源性晕厥。患者按诊断年龄分层(40岁、40 - 59岁和≥60岁);出生世代(1920-1965、1966-1990、1991-2015)和CTG重复长度(<;100、100 - 599和≥600)。结果在随访期间,33.1%的患者达到了主要终点。这一风险在最年轻组比最年长组高4.7倍(HR 4.70; p < 0.001);第三代比第一代高35倍,并随着CTG扩展时间的延长而逐渐增加。同样,在年轻患者、后代患者和重复长度较大的患者中,器械植入率也较高。结果表明,DM1的心脏表型具有显著的预测模式,随着CTG的代际扩展,电性疾病的发生时间越来越早,越来越严重。将诊断年龄、世代队列和遗传重复负担纳入临床评估可能会加强风险分层,并使早期、有针对性的节律监测和器械治疗成为可能,以预防DM1的心源性猝死。
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引用次数: 0
Sex differences in the presentation and management of acute coronary syndrome patients: Insights from the FORCE-ACS registry 急性冠状动脉综合征患者表现和治疗的性别差异:来自FORCE-ACS登记的见解
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-10 DOI: 10.1016/j.ijcha.2025.101849
Shabiga Sivanesan , Aleksandra Gąsecka , Niels M.R. van der Sangen , Wout W.A. van den Broek , Jaouad Azzahhafi , Dean R.P.P. Chan Pin Yin , Qiu Ying F. van de Pol , Ronald J. Walhout , Melvyn Tjon Joe Gin , Ron Pisters , Deborah M. Nicastia , Gerben J. de Roest , Georgios J. Vlachojannis , Rutger J. van Bommel , Wouter J. Kikkert , José P.S. Henriques , Jurriën M. ten Berg , Yolande Appelman

Aims

This study reports sex differences in the clinical presentation, treatment management and outcomes of patients with acute coronary syndrome (ACS) in The Netherlands, using data from the FORCE-ACS registry.

Methods

A prospective analysis was conducted using data from 5023 patients admitted with ACS between 2015 and 2019, with complete three-year follow-up. Demographic data, clinical characteristics, in-hospital treatment and outcomes were compared by sex. Multivariable regression analyses explored associations between sex and clinical outcomes.

Results

Of the 5023 patients, 29 % were women. Women were generally older, with a significantly higher prevalence of hypertension (61.7 % vs 54.2 %), chronic kidney disease (25.7 % vs. 18.5 %) and myocardial infarction with non-obstructive coronary arteries (MINOCA) (13.5 % vs. 6.5 %). Women less frequently underwent revascularisation, even after excluding those with non-obstructive coronary artery disease, and received less medical treatment compared to their male counterparts. At 36 months, women had higher unadjusted mortality rate (13.7 % vs. 11.0 %, OR 1.28, 95 % CI: 1.07–1.54) and bleeding events (26.2 % vs. 22.3 %, OR 1.24, 95 % CI: 1.08–1.43). However, after adjustment for age and baseline characteristics, these differences were no longer statistically significant. Recurrent ACS and stroke remained similar in both groups, also after correction.

Conclusion

Differences between women and men were observed in clinical presentation, interventional treatment, pharmacotherapy and outcomes among ACS patients in The Netherlands. Despite receiving less guideline-recommended care, women had similar adjusted 36-month outcomes as men. These findings show that there is room for improvement in the management of ACS, with a focus on optimized treatment strategies for women.
目的:本研究报告了荷兰急性冠脉综合征(ACS)患者临床表现、治疗管理和结局的性别差异,使用的数据来自FORCE-ACS登记。方法前瞻性分析2015年至2019年收治的5023例ACS患者的数据,并进行为期三年的完整随访。按性别比较人口统计数据、临床特征、住院治疗和结果。多变量回归分析探讨了性别与临床结果之间的关系。结果5023例患者中,29%为女性。女性普遍年龄较大,高血压(61.7%对54.2%)、慢性肾病(25.7%对18.5%)和非阻塞性冠状动脉(MINOCA)心肌梗死(13.5%对6.5%)的患病率明显较高。即使排除非阻塞性冠状动脉疾病,女性接受血管重建的频率也较低,而且与男性相比,她们接受的医疗较少。在36个月时,女性的未调整死亡率更高(13.7%对11.0%,OR 1.28, 95% CI: 1.07-1.54)和出血事件(26.2%对22.3%,OR 1.24, 95% CI: 1.08-1.43)。然而,在调整了年龄和基线特征后,这些差异不再具有统计学意义。两组的ACS复发和卒中发生率相似,校正后也是如此。结论荷兰ACS患者在临床表现、介入治疗、药物治疗及转归方面存在男女差异。尽管接受指南推荐的护理较少,但女性36个月的调整后结果与男性相似。这些发现表明,ACS的管理仍有改进的空间,重点是优化女性的治疗策略。
{"title":"Sex differences in the presentation and management of acute coronary syndrome patients: Insights from the FORCE-ACS registry","authors":"Shabiga Sivanesan ,&nbsp;Aleksandra Gąsecka ,&nbsp;Niels M.R. van der Sangen ,&nbsp;Wout W.A. van den Broek ,&nbsp;Jaouad Azzahhafi ,&nbsp;Dean R.P.P. Chan Pin Yin ,&nbsp;Qiu Ying F. van de Pol ,&nbsp;Ronald J. Walhout ,&nbsp;Melvyn Tjon Joe Gin ,&nbsp;Ron Pisters ,&nbsp;Deborah M. Nicastia ,&nbsp;Gerben J. de Roest ,&nbsp;Georgios J. Vlachojannis ,&nbsp;Rutger J. van Bommel ,&nbsp;Wouter J. Kikkert ,&nbsp;José P.S. Henriques ,&nbsp;Jurriën M. ten Berg ,&nbsp;Yolande Appelman","doi":"10.1016/j.ijcha.2025.101849","DOIUrl":"10.1016/j.ijcha.2025.101849","url":null,"abstract":"<div><h3>Aims</h3><div>This study reports sex differences in the clinical presentation, treatment management and outcomes of patients with acute coronary syndrome (ACS) in The Netherlands, using data from the FORCE-ACS registry.</div></div><div><h3>Methods</h3><div>A prospective analysis was conducted using data from 5023 patients admitted with ACS between 2015 and 2019, with complete three-year follow-up. Demographic data, clinical characteristics, in-hospital treatment and outcomes were compared by sex. Multivariable regression analyses explored associations between sex and clinical outcomes.</div></div><div><h3>Results</h3><div>Of the 5023 patients, 29 % were women. Women were generally older, with a significantly higher prevalence of hypertension (61.7 % vs 54.2 %), chronic kidney disease (25.7 % vs. 18.5 %) and myocardial infarction with non-obstructive coronary arteries (MINOCA) (13.5 % vs. 6.5 %). Women less frequently underwent revascularisation, even after excluding those with non-obstructive coronary artery disease, and received less medical treatment compared to their male counterparts. At 36 months, women had higher unadjusted mortality rate (13.7 % vs. 11.0 %, OR 1.28, 95 % CI: 1.07–1.54) and bleeding events (26.2 % vs. 22.3 %, OR 1.24, 95 % CI: 1.08–1.43). However, after adjustment for age and baseline characteristics, these differences were no longer statistically significant. Recurrent ACS and stroke remained similar in both groups, also after correction.</div></div><div><h3>Conclusion</h3><div>Differences between women and men were observed in clinical presentation, interventional treatment, pharmacotherapy and outcomes among ACS patients in The Netherlands. Despite receiving less guideline-recommended care, women had similar adjusted 36-month outcomes as men. These findings show that there is room for improvement in the management of ACS, with a focus on optimized treatment strategies for women.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101849"},"PeriodicalIF":2.5,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737345","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
Acute pulmonary vasoreactivity: a simple test revisited in the contemporary era − a narrative review 急性肺血管反应性:一个简单的测试在当代重新审视-叙述回顾
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-03 DOI: 10.1016/j.ijcha.2025.101847
Juan C Grignola , Pedro Trujillo , Julio Sandoval , Enric Domingo
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.
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.
在右心导管(RHC)急性血管扩张剂挑战提供了一个更深入的了解肺循环通过评估血管反应性。目前急性血管反应试验(AVT)阳性的标准被简化为稳态指标,基于专家意见得出的截止点。AVT阳性可识别一种特定但非常罕见的PH表型,这种表型可能对钙通道阻滞剂有长期反应。越来越多的证据支持更新AVT在肺动脉高压中的作用和标准,将其应用于其他PH组,并可能为预测风险和/或治疗结果提供新的见解。本研究旨在重新审视AVT在1组以上PH患者中的用途、标准和目标,并提出一种新的方法,用于诊断RHC时肺血管对急性血管扩张剂挑战的反应。我们提出了一个连续的多参数标准来评估AVT期间整个右心室后负荷,如肺血管阻力-肺动脉电容曲线和α扩张系数。AVT可以评估肺循环的剩余血管反应储备,作为预测风险结局和/或治疗反应的刺激试验。
{"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":"2025-12-03","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}
引用次数: 0
Diagnostic and prognostic utility of heart-type fatty acid binding proteins in cardiovascular diseases and risk factors − an updated review of the literature 心脏型脂肪酸结合蛋白在心血管疾病和危险因素中的诊断和预后应用——最新文献综述
IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1016/j.ijcha.2025.101836
Riaz Jiffry , Ankit Gupta , Jeisun Poornaselvan , Valerie Mok , Arkadeep Dhali , Aditi Gupta , Tong Liu , Gary Tse , Helen Ye Rim Huang
Fatty acid-binding proteins (FABPs) are intracellular lipid-binding proteins that significantly contribute to the transport and metabolism of long-chain fatty acids and other hydrophobic ligands. In this review, we focus on the role of heart-type FABP (H-FABPs) as diagnostic and prognostic biomarkers in several cardiovascular diseases. Despite its advantages over troponins and other cardiac biomarkers, H-FABP remains underutilized in clinical practice. The aim of this review is to reassess the role of H-FABPs across various cardiovascular pathologies and promote their adoption into standard clinical practice. Elevated H-FABP levels have been associated with worse outcomes in CAD and serve as sensitive markers for myocardial injury during the early stages of MI and reperfusion. Furthermore, we discuss the potential of H-FABPs in risk stratification for stable CAD and their utility in predicting long-term outcomes post-MI. The prognostic value of H-FABP in cardiac events such as heart failure, pulmonary embolism, and arrhythmias, alongside its application in peripheral arterial disease and non-ischemic dilated cardiomyopathy, highlights its importance in cardiovascular medicine. Given the global burden of cardiovascular diseases, understanding and utilising H-FABPs could enhance patient management through better risk assessment and early diagnosis.
脂肪酸结合蛋白(Fatty acid-binding protein, FABPs)是细胞内脂质结合蛋白,对长链脂肪酸和其他疏水配体的转运和代谢有重要作用。在这篇综述中,我们重点关注心脏型FABP (h -FABP)作为几种心血管疾病的诊断和预后生物标志物的作用。尽管它比肌钙蛋白和其他心脏生物标志物有优势,但H-FABP在临床实践中仍未得到充分利用。本综述的目的是重新评估H-FABPs在各种心血管疾病中的作用,并促进其进入标准临床实践。H-FABP水平升高与冠心病预后较差有关,并可作为心肌梗死和再灌注早期心肌损伤的敏感标志物。此外,我们讨论了h - fabp在稳定CAD风险分层中的潜力及其在预测心肌梗死后长期预后方面的应用。H-FABP在心力衰竭、肺栓塞和心律失常等心脏事件中的预后价值,以及它在外周动脉疾病和非缺血性扩张型心肌病中的应用,凸显了它在心血管医学中的重要性。鉴于心血管疾病的全球负担,了解和利用h - fabp可以通过更好的风险评估和早期诊断来加强患者管理。
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引用次数: 0
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