Pub Date : 2026-02-01Epub Date: 2026-01-17DOI: 10.1016/j.ijcha.2026.101872
Miguel Quintana , Mira Carling , Anders Olofsson , Dag Isaksson , Jenny Fahlen , Elin Kärrman , Fredrik Pihl , Roland Forsberg , Björn Persson , Alen Lovric , Thomas Gustafsson , Karin Bouma
Aims
Most published material on echocardiographic reference values includes individuals up to the age of 60–70, but reference values for older individuals remain scarce. Accurate interpretation of transthoracic echocardiographic reference values in octogenarians and older individuals requires updated values that reflect healthy ageing. This study aims to compare transthoracic echocardiographic reference values of healthy octogenarians and older individuals with those of younger age groups.
Methods and results
A total of 248 individuals were studied. The group was divided into three age categories: sexagenarians, septuagenarians, and octogenarians or older. The participants underwent a standard transthoracic echocardiographic examination according to current guidelines. The main differences between age groups were observed in values related to left ventricular diastolic function. There was a significant difference in some values related to systolic function, such as a significant decrease in mitral annular plane systolic excursion in octogenarians compared to sexagenarians and septuagenarians.
Conclusion
The present study showed statistically significant differences in some echocardiographic parameters primarily reflecting the left ventricular diastolic function. In addition, a significant difference in some values related to systolic function were also found. These findings emphasize the need for age-adapted reference values to improve diagnostic accuracy in elderly.
{"title":"Echocardiographic reference values in elderly with a focus on octogenarians and older","authors":"Miguel Quintana , Mira Carling , Anders Olofsson , Dag Isaksson , Jenny Fahlen , Elin Kärrman , Fredrik Pihl , Roland Forsberg , Björn Persson , Alen Lovric , Thomas Gustafsson , Karin Bouma","doi":"10.1016/j.ijcha.2026.101872","DOIUrl":"10.1016/j.ijcha.2026.101872","url":null,"abstract":"<div><h3>Aims</h3><div>Most published material on echocardiographic reference values includes individuals up to the age of 60–70, but reference values for older individuals remain scarce. Accurate interpretation of transthoracic echocardiographic reference values in octogenarians and older individuals requires updated values that reflect healthy ageing. This study aims to compare transthoracic echocardiographic reference values of healthy octogenarians and older individuals with those of younger age groups.</div></div><div><h3>Methods and results</h3><div>A total of 248 individuals were studied. The group was divided into three age categories: sexagenarians, septuagenarians, and octogenarians or older. The participants underwent a standard transthoracic echocardiographic examination according to current guidelines. The main differences between age groups were observed in values related to left ventricular diastolic function. There was a significant difference in some values related to systolic function, such as a significant decrease in mitral annular plane systolic excursion in octogenarians compared to sexagenarians and septuagenarians.</div></div><div><h3>Conclusion</h3><div>The present study showed statistically significant differences in some echocardiographic parameters primarily reflecting the left ventricular diastolic function. In addition, a significant difference in some values related to systolic function were also found. These findings emphasize the need for age-adapted reference values to improve diagnostic accuracy in elderly.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101872"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022360","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 : 2026-02-01Epub Date: 2025-11-24DOI: 10.1016/j.ijcha.2025.101845
Peier Xu , Xinhu Tang , Jichao Zhang , Le Zhou , Naijing Gao , Xueyun Yan , Huaming Cao
Background
Pulsed field ablation (PFA) is an emerging non-thermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF), offering enhanced tissue selectivity and reduced collateral damage compared to cryoballoon ablation (CBA).
Objective
This meta-analysis compares the mid- to long-term efficacy, safety, and procedural characteristics of PFA versus CBA in AF treatment.
Methods
A systematic search of PubMed, EMBASE, and the Cochrane Library through July 2025 identified nine comparative studies involving 2,718 patients (1,381 PFA; 1,337 CBA). Pooled risk ratios (RRs) and mean differences (MDs) were calculated using random-effects models, with subgroup analyses for paroxysmal and persistent AF.
Results
PFA showed a trend toward lower recurrence rates (RR = 0.86, 95 % CI: 0.70–1.04), particularly in paroxysmal AF (RR = 0.83, 95 % CI: 0.68–1.01), while outcomes in persistent AF were comparable (RR = 0.98, 95 % CI: 0.69–1.38). Procedure time was significantly shorter with PFA (MD = –9.59 min, 95 % CI: –17.80 to –1.37), whereas fluoroscopy duration showed no significant difference. Safety analysis revealed a non-significant trend favoring PFA (RR = 0.75, 95 % CI: 0.49–1.14), with fewer cases of phrenic nerve injury and cardiac tamponade.
Conclusion
PFA and CBA demonstrate comparable efficacy and safety in AF ablation. PFA may offer procedural advantages and improved outcomes in paroxysmal AF, supporting its expanding role in clinical practice. Further randomized trials are warranted to validate these findings and guide optimal treatment strategies.
{"title":"Comparative efficacy and safety of pulsed field ablation versus cryoballoon ablation in atrial fibrillation: A meta-analysis of mid- and long-term outcomes","authors":"Peier Xu , Xinhu Tang , Jichao Zhang , Le Zhou , Naijing Gao , Xueyun Yan , Huaming Cao","doi":"10.1016/j.ijcha.2025.101845","DOIUrl":"10.1016/j.ijcha.2025.101845","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) is an emerging non-thermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF), offering enhanced tissue selectivity and reduced collateral damage compared to cryoballoon ablation (CBA).</div></div><div><h3>Objective</h3><div>This <em>meta</em>-analysis compares the mid- to long-term efficacy, safety, and procedural characteristics of PFA versus CBA in AF treatment.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, EMBASE, and the Cochrane Library through July 2025 identified nine comparative studies involving 2,718 patients (1,381 PFA; 1,337 CBA). Pooled risk ratios (RRs) and mean differences (MDs) were calculated using random-effects models, with subgroup analyses for paroxysmal and persistent AF.</div></div><div><h3>Results</h3><div>PFA showed a trend toward lower recurrence rates (RR = 0.86, 95 % CI: 0.70–1.04), particularly in paroxysmal AF (RR = 0.83, 95 % CI: 0.68–1.01), while outcomes in persistent AF were comparable (RR = 0.98, 95 % CI: 0.69–1.38). Procedure time was significantly shorter with PFA (MD = –9.59 min, 95 % CI: –17.80 to –1.37), whereas fluoroscopy duration showed no significant difference. Safety analysis revealed a non-significant trend favoring PFA (RR = 0.75, 95 % CI: 0.49–1.14), with fewer cases of phrenic nerve injury and cardiac tamponade.</div></div><div><h3>Conclusion</h3><div>PFA and CBA demonstrate comparable efficacy and safety in AF ablation. PFA may offer procedural advantages and improved outcomes in paroxysmal AF, supporting its expanding role in clinical practice. Further randomized trials are warranted to validate these findings and guide optimal treatment strategies.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101845"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616243","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 : 2026-02-01Epub 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2026-01-06DOI: 10.1016/j.ijcha.2025.101853
Paulo Roberto Benchimol-Barbosa
{"title":"On the mh-index and simple efficiency metrics for Assessing scientific contributions","authors":"Paulo Roberto Benchimol-Barbosa","doi":"10.1016/j.ijcha.2025.101853","DOIUrl":"10.1016/j.ijcha.2025.101853","url":null,"abstract":"","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101853"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924280","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 : 2026-02-01Epub Date: 2026-01-18DOI: 10.1016/j.ijcha.2026.101871
Otto Järvinen , Jani Rankinen , Jussi Hernesniemi , Marko Virtanen , Pasi Maaranen , Markku Eskola , Niku Oksala , Juho Tynkkynen
Background
Radiographic markers such as psoas muscle area (PMA) and pleural effusion have been linked to mortality after transcatheter aortic valve implantation (TAVI). We examined their relationship with cause-specific mortality and their incremental prognostic value beyond EuroSCORE II.
Methods
This retrospective study included 1090 consecutive TAVI patients treated at Heart Hospital, Tampere University Hospital between 2008 and 2020. Preoperative CT scans were reviewed for L3-level PMA and pleural effusion (>10 mm thickness). Subdistribution hazard models adjusted for age, sex, BMI, and BSA were used to analyze cause-specific mortality. Incremental prognostic value beyond EuroSCORE II was assessed using time-dependent discrimination indexes (AUC and IDI) and net-reclassification index (NRI) at 3 years.
Results
During a median follow-up of 4.3 years (IQR 3.1–6.0), 54% (n = 590) of patients died: 64% (n = 376) from cardiovascular, 30% (n = 177) from non-cardiovascular, and 6% (n = 37) from unnatural causes. PMA and pleural effusion were associated with cardiovascular mortality (PMA: SDH/1SD 0.88, 95% CI 0.78–0.99, p = 0.037; pleural effusion: SDH 1.73, 95% CI 1.37–2.19, p < 0.001). Combined inclusion of PMA and pleural effusion improved NRI = 0.13 (p = 0.004) and IDI = 0.015 (p = 0.004) of overall mortality prediction compared to EuroSCORE II alone.
Conclusions
Psoas muscle area (PMA) and pleural effusion were independently associated with cardiovascular mortality after TAVI, whereas no significant associations were observed with non-cardiovascular deaths. Combined inclusion of these parameters led to a modest but not clinically meaningful improvement in the EuroSCORE II–based prediction of mortality.
{"title":"Prognostic value of psoas muscle area and pleural effusion in patients undergoing TAVI","authors":"Otto Järvinen , Jani Rankinen , Jussi Hernesniemi , Marko Virtanen , Pasi Maaranen , Markku Eskola , Niku Oksala , Juho Tynkkynen","doi":"10.1016/j.ijcha.2026.101871","DOIUrl":"10.1016/j.ijcha.2026.101871","url":null,"abstract":"<div><h3>Background</h3><div>Radiographic markers such as psoas muscle area (PMA) and pleural effusion have been linked to mortality after transcatheter aortic valve implantation (TAVI). We examined their relationship with cause-specific mortality and their incremental prognostic value beyond EuroSCORE II.</div></div><div><h3>Methods</h3><div>This retrospective study included 1090 consecutive TAVI patients treated at Heart Hospital, Tampere University Hospital between 2008 and 2020. Preoperative CT scans were reviewed for L3-level PMA and pleural effusion (>10 mm thickness). Subdistribution hazard models adjusted for age, sex, BMI, and BSA were used to analyze cause-specific mortality. Incremental prognostic value beyond EuroSCORE II was assessed using time-dependent discrimination indexes (AUC and IDI) and net-reclassification index (NRI) at 3 years.</div></div><div><h3>Results</h3><div>During a median follow-up of 4.3 years (IQR 3.1–6.0), 54% (n = 590) of patients died: 64% (n = 376) from cardiovascular, 30% (n = 177) from non-cardiovascular, and 6% (n = 37) from unnatural causes. PMA and pleural effusion were associated with cardiovascular mortality (PMA: SDH/1SD 0.88, 95% CI 0.78–0.99, p = 0.037; pleural effusion: SDH 1.73, 95% CI 1.37–2.19, p < 0.001). Combined inclusion of PMA and pleural effusion improved NRI = 0.13 (p = 0.004) and IDI = 0.015 (p = 0.004) of overall mortality prediction compared to EuroSCORE II alone.</div></div><div><h3>Conclusions</h3><div>Psoas muscle area (PMA) and pleural effusion were independently associated with cardiovascular mortality after TAVI, whereas no significant associations were observed with non-cardiovascular deaths. Combined inclusion of these parameters led to a modest but not clinically meaningful improvement in the EuroSCORE II–based prediction of mortality.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101871"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022361","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 : 2026-02-01Epub Date: 2026-01-06DOI: 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.
{"title":"Identification of novel candidate biomarkers for heart failure with preserved ejection fraction by the Olink proteomics platform","authors":"Huang Yimei , Chen xinyun , Hu yuchi, Dai Songyuan, Nian Siqi, Li Hongning, Weng Shenghai, He Guanghui, Hua Baotong, Zhao Lulu","doi":"10.1016/j.ijcha.2025.101859","DOIUrl":"10.1016/j.ijcha.2025.101859","url":null,"abstract":"<div><h3>Background</h3><div>The pathophysiology of heart failure with preserved ejection fraction (HFpEF) remains incompletely understood.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>This study identifies potential protein biomarkers for HFpEF diagnosis, provides new insights into its pathophysiology, and offers a practical diagnostic tool for clinical use.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101859"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924321","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 : 2026-02-01Epub Date: 2026-01-06DOI: 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
{"title":"ECG and imaging manifestations of cardiomyopathy in adults with Duchenne muscular dystrophy","authors":"Peter C. Murray , Ailis Pollock , Katie Hewitt , Jenna O’Sullivan , Aoife Sheahan , Richard Sheahan","doi":"10.1016/j.ijcha.2025.101856","DOIUrl":"10.1016/j.ijcha.2025.101856","url":null,"abstract":"<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","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101856"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","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}
Although the association between global longitudinal strain (GLS), a marker of myocardial systolic function, and prognosis in patients undergoing transcatheter aortic valve implantation (TAVI) is well-documented, the prognostic association of regional longitudinal strain (LS), such as apical LS, on patients undergoing TAVI remains underexplored.
Methods and Results
From 2015 to 2023, a total of 303 patients with aortic stenosis (AS) who underwent TAVI at Kumamoto University Hospital were screened, and excluding 4 patients with in-hospital deaths, 299 were analyzed. The median follow-up period after TAVI was 693 days (interquartile range, 435–1189 days), during which 63 deaths occurred. Pre-TAVI echocardiographic findings showed that apical LS was significantly higher in the survival group compared to the all-cause death group (15.1 ± 4.7％ vs. 13.7 ± 4.4 %, p = 0.02). Multivariable Cox proportional hazards analysis, adjusted for body mass index, aortic valve peak velocity, atrial fibrillation, high-sensitivity troponin T, tricuspid regurgitation, demonstrated that apical LS was independently associated with all-cause mortality (hazard ratio: 0.91, 95 % confidence interval: 0.88–0.99, p = 0.02). Time-dependent receiver operating characteristic (ROC) curve analysis identified apical LS to discriminate all-cause mortality (area under the curve, 0.69), with the predictive ability peaking within the first two years after TAVI. Kaplan–Meier analysis revealed significantly higher mortality rates in patients with low apical LS group (<15.4 %) (p = 0.01).
Conclusions
measurement of apical LS in patients with AS provides valuable associational prognostic information, even after adjusting for multiple clinical and echocardiographic factors, highlighting its value in enhancing risk stratification for patients undergoing TAVI.
{"title":"Apical longitudinal strain: A Key prognostic echocardiographic marker in patients undergoing transcatheter aortic valve implantation","authors":"Yuichiro Shirahama , Hiroki Usuku , Eiichiro Yamamoto , Tatsuya Yoshinouchi , Ryudai Higashi , Atsushi Nozuhara , Fumi Oike , Noriaki Tabata , Masanobu Ishii , Shinsuke Hanatani , Tadashi Hoshiyama , Hisanori Kanazawa , Yuichiro Arima , Hiroaki Kawano , Yasuhiro Izumiya , Yasuhito Tanaka , Kenichi Tsujita","doi":"10.1016/j.ijcha.2025.101844","DOIUrl":"10.1016/j.ijcha.2025.101844","url":null,"abstract":"<div><h3>Background</h3><div>Although the association between global longitudinal strain (GLS), a marker of myocardial systolic function, and prognosis in patients undergoing transcatheter aortic valve implantation (TAVI) is well-documented, the prognostic association of regional longitudinal strain (LS), such as apical LS, on patients undergoing TAVI remains underexplored.</div></div><div><h3>Methods and Results</h3><div>From 2015 to 2023, a total of 303 patients with aortic stenosis (AS) who underwent TAVI at Kumamoto University Hospital were screened, and excluding 4 patients with in-hospital deaths, 299 were analyzed. The median follow-up period after TAVI was 693 days (interquartile range, 435–1189 days), during which 63 deaths occurred. Pre-TAVI echocardiographic findings showed that apical LS was significantly higher in the survival group compared to the all-cause death group (15.1 ± 4.7％ vs. 13.7 ± 4.4 %, p = 0.02). Multivariable Cox proportional hazards analysis, adjusted for body mass index, aortic valve peak velocity, atrial fibrillation, high-sensitivity troponin T, tricuspid regurgitation, demonstrated that apical LS was independently associated with all-cause mortality (hazard ratio: 0.91, 95 % confidence interval: 0.88–0.99, p = 0.02). Time-dependent receiver operating characteristic (ROC) curve analysis identified apical LS to discriminate all-cause mortality (area under the curve, 0.69), with the predictive ability peaking within the first two years after TAVI. Kaplan–Meier analysis revealed significantly higher mortality rates in patients with low apical LS group (<15.4 %) (p = 0.01).</div></div><div><h3>Conclusions</h3><div>measurement of apical LS in patients with AS provides valuable associational prognostic information, even after adjusting for multiple clinical and echocardiographic factors, highlighting its value in enhancing risk stratification for patients undergoing TAVI.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101844"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546594","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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