IJC Heart and Vasculature最新文献_第5页

Corrigendum to “Effectiveness of cerebral embolic protection during transcatheter aortic valve replacement: a systematic review and meta-analysis of randomized trials”. [IJC Heart Vasculature 61 (2025) 101842] “经导管主动脉瓣置换术中脑栓塞保护的有效性：随机试验的系统回顾和荟萃分析”的更正。[IJC心脏血管61 (2025)101842]

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-22 DOI: 10.1016/j.ijcha.2025.101843

Rodolfo Caminiti , Alfonso Ielasi , Giampaolo Vetta , Antonio Parlavecchio , Domenico Giovanni Della Rocca , Silvia Moscardelli , Andrea Marrone , Giulia Laterra , Maurizio Tespili , Giampiero Vizzari , Marco Barbanti , Antonio Micari

引用次数: 0

Apical longitudinal strain: A Key prognostic echocardiographic marker in patients undergoing transcatheter aortic valve implantation 心尖纵向应变：经导管主动脉瓣植入术患者预后的关键超声心动图指标

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-19 DOI: 10.1016/j.ijcha.2025.101844

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

Background

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.

背景：虽然经导管主动脉瓣植入术（TAVI）患者的心肌收缩功能指标——整体纵向应变（GLS）与预后之间的关系已得到充分证实，但局部纵向应变（LS）（如根尖LS）与TAVI患者预后的关系仍未得到充分探讨。方法与结果对2015 - 2023年在熊本大学医院行TAVI手术的主动脉瓣狭窄患者303例进行筛查，剔除4例院内死亡，共分析299例。TAVI后的中位随访期为693天（四分位数间距为435-1189天），期间发生63例死亡。tavi前超声心动图结果显示，生存组的根尖LS明显高于全因死亡组（15.1±4.7%比13.7±4.4%,p = 0.02）。多变量Cox比例风险分析，校正体重指数、主动脉瓣峰值速度、心房颤动、高敏感性肌钙蛋白T、三尖瓣反流，显示根尖性LS与全因死亡率独立相关（风险比：0.91,95%可信区间：0.88-0.99,p = 0.02）。时间依赖的受试者工作特征（ROC）曲线分析发现，尖顶LS可以区分全因死亡率（曲线下面积，0.69），预测能力在TAVI后的前两年达到峰值。Kaplan-Meier分析显示，低根尖LS组患者的死亡率显著高于对照组（< 15.4%）（p = 0.01）。结论即使在调整了多种临床和超声心动图因素后，AS患者的根尖LS测量也提供了有价值的相关预后信息，突出了其在加强TAVI患者风险分层方面的价值。

{"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":"2025-11-19","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}

引用次数: 0

Accelerated biological aging and incident degenerative valvular heart disease: Findings from 408,783 UK Biobank participants 加速生物老化和退行性瓣膜病的发生：来自408,783名英国生物银行参与者的研究结果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-14 DOI: 10.1016/j.ijcha.2025.101838

Chaoyang Lin , Enhao Wei , Qianyao Lai , Hangpan Jiang , Maosen Lin , Feng Hu , Lin Fan , Enhui Yao

Background

Although prior studies have linked frailty and accelerated biological aging to aortic stenosis, comprehensive evidence across the spectrum of degenerative valvular diseases (VHD) and related clinical events remains unclear in middle-aged adults.

Methods

We analyzed 408,783 UK Biobank participants free of baseline valvular disease. Biological age accelerations (BAA) measures were derived from clinical traits using Phenotypic Age (PhenoAge) algorithm and the Klemera-Doubal method Biological Age (KDM-BA). Outcomes included incident aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), and related interventions or mortality.

Results

Over a median follow-up of 13.9 years, 10,364 incident degenerative VHD events (2.5 %) were documented, comprising 4602 AS, 1678 AS-related events, 1639 AR, and 4903 MR cases. Elevated BAA was significantly associated with higher AS risk. For PhenoAge, adjusted AS incidence rates (per 10,000 person-years; 95 % confidence interval) across quartiles (Q1–Q4) were 3.73 (3.37–4.12), 4.44 (4.05–4.88), 5.11 (4.67–5.59), and 7.79 (7.18–8.46), yielding an adjusted hazard ratio (HR) of 2.15 (1.96–2.35) for Q4. Comparable trends were observed for KDM-BA, with an adjusted HR of 1.98 (1.83–2.15) for Q4 vs Q1. AS-related events followed a similar pattern, with HRs of 1.80 (1.55–2.09) for PhenoAge Q4 and 2.22 (1.94–2.54) for KDM-BA Q4. Significant associations were also found for AR, AR-related events, and MR, but not for MR-related events.

Conclusions

Among middle-aged adults, both BAA metrics were associated with increased risks of degenerative VHD and related adverse events, except for MR-related events. These findings highlight BAA as a potential tool for early risk stratification and targeted prevention.

尽管先前的研究已经将身体虚弱和加速的生物衰老与主动脉瓣狭窄联系起来，但中年人退行性瓣膜疾病（VHD）和相关临床事件的全面证据仍不清楚。方法我们分析了408,783名无基线瓣膜疾病的英国生物银行参与者。采用表型年龄（phenotype age）算法和klemera - double方法生物年龄（KDM-BA）从临床特征中得出生物年龄加速（BAA）指标。结果包括主动脉瓣狭窄（AS）、主动脉瓣反流（AR）、二尖瓣反流（MR）以及相关干预措施或死亡率。结果在13.9年的中位随访中，记录了10,364例退行性VHD事件（2.5%），包括4602例AS， 1678例AS相关事件，1639例AR和4903例MR。BAA升高与AS风险升高显著相关。对于PhenoAge，四分位数（Q1-Q4）的调整后AS发病率（每10,000人年；95%可信区间）分别为3.73（3.37-4.12）、4.44（4.05-4.88）、5.11（4.67-5.59）和7.79(7.18-8.46)，第四季度的调整后风险比（HR）为2.15（1.96-2.35）。KDM-BA也有类似的趋势，第四季度与第一季度的调整后风险比为1.98（1.83-2.15）。与as相关的事件遵循类似的模式，表型Q4的hr为1.80 (1.55-2.09)，KDM-BA Q4的hr为2.22（1.94-2.54）。AR、AR相关事件和MR也有显著相关性，但MR相关事件没有显著相关性。结论：在中年人中，BAA指标与退行性VHD和相关不良事件的风险增加相关，mr相关事件除外。这些发现强调了BAA作为早期风险分层和有针对性预防的潜在工具。

{"title":"Accelerated biological aging and incident degenerative valvular heart disease: Findings from 408,783 UK Biobank participants","authors":"Chaoyang Lin , Enhao Wei , Qianyao Lai , Hangpan Jiang , Maosen Lin , Feng Hu , Lin Fan , Enhui Yao","doi":"10.1016/j.ijcha.2025.101838","DOIUrl":"10.1016/j.ijcha.2025.101838","url":null,"abstract":"<div><h3>Background</h3><div>Although prior studies have linked frailty and accelerated biological aging to aortic stenosis, comprehensive evidence across the spectrum of degenerative valvular diseases (VHD) and related clinical events remains unclear in middle-aged adults.</div></div><div><h3>Methods</h3><div>We analyzed 408,783 UK Biobank participants free of baseline valvular disease. Biological age accelerations (BAA) measures were derived from clinical traits using Phenotypic Age (PhenoAge) algorithm and the Klemera-Doubal method Biological Age (KDM-BA). Outcomes included incident aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), and related interventions or mortality.</div></div><div><h3>Results</h3><div>Over a median follow-up of 13.9 years, 10,364 incident degenerative VHD events (2.5 %) were documented, comprising 4602 AS, 1678 AS-related events, 1639 AR, and 4903 MR cases. Elevated BAA was significantly associated with higher AS risk. For PhenoAge, adjusted AS incidence rates (per 10,000 person-years; 95 % confidence interval) across quartiles (Q1–Q4) were 3.73 (3.37–4.12), 4.44 (4.05–4.88), 5.11 (4.67–5.59), and 7.79 (7.18–8.46), yielding an adjusted hazard ratio (HR) of 2.15 (1.96–2.35) for Q4. Comparable trends were observed for KDM-BA, with an adjusted HR of 1.98 (1.83–2.15) for Q4 vs Q1. AS-related events followed a similar pattern, with HRs of 1.80 (1.55–2.09) for PhenoAge Q4 and 2.22 (1.94–2.54) for KDM-BA Q4. Significant associations were also found for AR, AR-related events, and MR, but not for MR-related events.</div></div><div><h3>Conclusions</h3><div>Among middle-aged adults, both BAA metrics were associated with increased risks of degenerative VHD and related adverse events, except for MR-related events. These findings highlight BAA as a potential tool for early risk stratification and targeted prevention.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101838"},"PeriodicalIF":2.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519471","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

Linking high-sensitivity CRP levels to cardiac dysfunction in patients with psoriasis 银屑病患者高敏CRP水平与心功能障碍的关系

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-12 DOI: 10.1016/j.ijcha.2025.101839

Tobias Schupp, Mohammad Abumayyaleh, Michael Behnes, Ibrahim Akin

引用次数: 0

Effectiveness of cerebral embolic protection during transcatheter aortic valve replacement: A systematic review and meta-analysis of randomized trials 经导管主动脉瓣置换术中脑栓塞保护的有效性：随机试验的系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-10 DOI: 10.1016/j.ijcha.2025.101842

Rodolfo Caminiti , Alfonso Ielasi , Giampaolo Vetta , Antonio Parlavecchio , Domenico Giovanni Della Rocca , Silvia Moscardelli , Andrea Marrone , Giulia Laterra , Maurizio Tespili , Giampiero Vizzari , Marco Barbanti , Antonio Micari

Background

Cerebral embolism remains a concern during transcatheter aortic valve replacement (TAVR). Cerebral embolic protection (CEP) devices have been developed to mitigate this risk, but their clinical benefit remains unclear.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials comparing TAVR with and without CEP devices. Primary endpoint was overall stroke; secondary endpoints included disabling stroke, all-cause mortality, life-treating bleeding, vascular complications related to CEP access and acute kidney injury.

Results

Eight trials comprising 11,625 patients (group CEP, n = 5,843 patients; group NCEP, n = 5,782 patients, 57.3 % male, 81.5 mean age years) were included. No significant differences were found for primary endpoint, overall stroke (RR 1.03, 95 % CI 0.82–1.29), and secondary outcomes between CEP and non-CEP groups at 30 days follow-up. Complications related to CEP access were minimal, 1.1 % (95 % CI: −0.6 to 2.8).

Conclusions

CEP devices do not significantly reduce short-term stroke or major complications after TAVR. However, given the prevalence of silent cerebral ischemia, further studies are needed to assess long-term neurological outcomes and identify high-risk subgroups who may benefit.

背景：在经导管主动脉瓣置换术（TAVR）中，脑栓塞仍然是一个值得关注的问题。脑栓塞保护（CEP）装置已被开发出来以减轻这种风险，但其临床益处尚不清楚。方法：我们对随机对照试验进行了系统回顾和荟萃分析，比较了使用和不使用CEP装置的TAVR。主要终点为总卒中；次要终点包括致残性卒中、全因死亡率、生命治疗出血、与CEP相关的血管并发症和急性肾损伤。结果纳入8项试验，共纳入11625例患者（CEP组，n = 5843例；NCEP组，n = 5782例，男性57.3%，平均年龄81.5岁）。随访30天，CEP组和非CEP组的主要终点、总卒中（RR 1.03, 95% CI 0.82-1.29）和次要结局无显著差异。与CEP通路相关的并发症最少，为1.1% （95% CI: - 0.6至2.8）。结论scep装置不能显著减少TAVR术后的短期卒中或主要并发症。然而，鉴于无症状性脑缺血的普遍存在，需要进一步的研究来评估长期的神经预后并确定可能受益的高危亚群。

{"title":"Effectiveness of cerebral embolic protection during transcatheter aortic valve replacement: A systematic review and meta-analysis of randomized trials","authors":"Rodolfo Caminiti , Alfonso Ielasi , Giampaolo Vetta , Antonio Parlavecchio , Domenico Giovanni Della Rocca , Silvia Moscardelli , Andrea Marrone , Giulia Laterra , Maurizio Tespili , Giampiero Vizzari , Marco Barbanti , Antonio Micari","doi":"10.1016/j.ijcha.2025.101842","DOIUrl":"10.1016/j.ijcha.2025.101842","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral embolism remains a concern during transcatheter aortic valve replacement (TAVR). Cerebral embolic protection (CEP) devices have been developed to mitigate this risk, but their clinical benefit remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and <em>meta</em>-analysis of randomized controlled trials comparing TAVR with and without CEP devices. Primary endpoint was overall stroke; secondary endpoints included disabling stroke, all-cause mortality, life-treating bleeding, vascular complications related to CEP access and acute kidney injury.</div></div><div><h3>Results</h3><div>Eight trials comprising 11,625 patients (group CEP, n = 5,843 patients; group NCEP, n = 5,782 patients, 57.3 % male, 81.5 mean age years) were included. No significant differences were found for primary endpoint, overall stroke (RR 1.03, 95 % CI 0.82–1.29), and secondary outcomes between CEP and non-CEP groups at 30 days follow-up. Complications related to CEP access were minimal, 1.1 % (95 % CI: −0.6 to 2.8).</div></div><div><h3>Conclusions</h3><div>CEP devices do not significantly reduce short-term stroke or major complications after TAVR. However, given the prevalence of silent cerebral ischemia, further studies are needed to assess long-term neurological outcomes and identify high-risk subgroups who may benefit.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101842"},"PeriodicalIF":2.5,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519487","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

Incidence of acute heart failure with and without concomitant pulmonary disease 急性心力衰竭伴或不伴肺部疾病的发生率

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-09 DOI: 10.1016/j.ijcha.2025.101837

Ida Arentz Taraldsen , Jasmin Dam Lukoschewitz , Aginsha Kandiah , Frederik Dencker Wisborg , Mohammed El-Sheikh , Nora Olsen El Caidi , Ove Andersen , Jens Dahlgaard Hove , Johannes Grand

Background

Acute heart failure (AHF) is the primary diagnosis in over one million emergency department (ED) hospitalizations each year in the United States (USA). The patients are often comorbid, with several competing causes for their symptoms, especially pulmonary diseases. The purpose of this study is to investigate the incidence and characteristics of patients admitted with AHF with and without concomitant pulmonary disease, compared to patients without AHF, in a large hospital in Denmark. Secondly, to investigate the mortality rate in AHF and how it is influenced by concomitant pulmonary disease.

Methods

We conducted a prospective cohort study at the medical ED at a large university hospital in Denmark in a two-year period during the Corona Virus Disease pandemic. Patient records were screened by trained cardiologists, to identify patients admitted with AHF. The cohort was stratified by AHF status and concomitant pulmonary disease.

Results

We included 7258 patients, of whom found 408 (5.6 %) patients had AHF. In the group with AHF, 106 patients (26 %) had a competing concomitant pulmonary cause of admission. The incidence rate for admission with AHF was 91/100.000 inhabitants/year. In a multivariable cox regression model, AHF was independently associated with mortality with an adjusted hazard ratio of 1.34 (1.13–1.58), p value <0.001. Pulmonary disease was associated with a worse prognosis in the group with AHF (HR_adj 1.74 (1.24–2.44), p-value < 0.001).

Conclusion

In this prospective observational cohort study, 5–7 % of all admissions to the medical ED was caused by AHF, and was associated with worse outcomes than patients without AHF. Concomitant pulmonary admission disease was associated with a worse prognosis among patients with AHF.

背景：急性心力衰竭（AHF）是美国每年超过100万急诊住院患者的主要诊断。这些患者通常是合并症，他们的症状有几个相互竞争的原因，尤其是肺部疾病。本研究的目的是调查丹麦一家大医院AHF合并和不合并肺部疾病患者与不合并AHF患者的发病率和特征。其次，探讨AHF的死亡率及其与合并肺部疾病的关系。方法在冠状病毒病大流行期间，我们在丹麦一家大型大学医院的内科急诊科进行了为期两年的前瞻性队列研究。患者记录由训练有素的心脏病专家筛选，以确定患有AHF的患者。该队列根据AHF状况和合并肺部疾病进行分层。结果共纳入7258例患者，其中408例（5.6%）为AHF。在AHF组中，106例患者（26%）有竞争合并肺部入院原因。住院AHF的发病率为91/10万居民/年。在多变量cox回归模型中，AHF与死亡率独立相关，校正风险比为1.34 (1.13-1.58)，p值<；0.001。肺部疾病与AHF组较差的预后相关（HRadj 1.74 (1.24-2.44)， p值<； 0.001）。结论：在这项前瞻性观察队列研究中，5 - 7%的内科急症是由AHF引起的，与无AHF的患者相比，这些患者的预后更差。合并肺部入院疾病与AHF患者较差的预后相关。

{"title":"Incidence of acute heart failure with and without concomitant pulmonary disease","authors":"Ida Arentz Taraldsen , Jasmin Dam Lukoschewitz , Aginsha Kandiah , Frederik Dencker Wisborg , Mohammed El-Sheikh , Nora Olsen El Caidi , Ove Andersen , Jens Dahlgaard Hove , Johannes Grand","doi":"10.1016/j.ijcha.2025.101837","DOIUrl":"10.1016/j.ijcha.2025.101837","url":null,"abstract":"<div><h3>Background</h3><div>Acute heart failure (AHF) is the primary diagnosis in over one million emergency department (ED) hospitalizations each year in the United States (USA). The patients are often comorbid, with several competing causes for their symptoms, especially pulmonary diseases. The purpose of this study is to investigate the incidence and characteristics of patients admitted with AHF with and without concomitant pulmonary disease, compared to patients without AHF, in a large hospital in Denmark. Secondly, to investigate the mortality rate in AHF and how it is influenced by concomitant pulmonary disease.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study at the medical ED at a large university hospital in Denmark in a two-year period during the Corona Virus Disease pandemic. Patient records were screened by trained cardiologists, to identify patients admitted with AHF. The cohort was stratified by AHF status and concomitant pulmonary disease.</div></div><div><h3>Results</h3><div>We included 7258 patients, of whom found 408 (5.6 %) patients had AHF. In the group with AHF, 106 patients (26 %) had a competing concomitant pulmonary cause of admission. The incidence rate for admission with AHF was 91/100.000 inhabitants/year. In a multivariable cox regression model, AHF was independently associated with mortality with an adjusted hazard ratio of 1.34 (1.13–1.58), p value <0.001. Pulmonary disease was associated with a worse prognosis in the group with AHF (HR<sub>adj</sub> 1.74 (1.24–2.44), p-value < 0.001).</div></div><div><h3>Conclusion</h3><div>In this prospective observational cohort study, 5–7 % of all admissions to the medical ED was caused by AHF, and was associated with worse outcomes than patients without AHF. Concomitant pulmonary admission disease was associated with a worse prognosis among patients with AHF.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101837"},"PeriodicalIF":2.5,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519472","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

Pericarditis at the crossroads: Unlocking the next wave of therapies 十字路口的心包炎：开启下一波治疗浪潮

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-08 DOI: 10.1016/j.ijcha.2025.101841

Massimo Imazio , Francesco Venturelli , Maria Cristina Tomat , Giulio Savonitto , Davide Stolfo , Valentino Collini

Pericarditis is an inflammation of the pericardial sac with different aetiologies. While often self-limited, up to 30 % of cases recur or become chronic, causing significant morbidity. Traditional treatments – nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids – have important limitations, including steroid dependence, high recurrence rates, and side effects. Accordingly, new targeted immunomodulatory therapies are under investigation to improve outcomes in refractory pericarditis. This review outlines the epidemiology and burden of pericarditis, current management and its shortcomings, and the rationale for novel therapies. We then discuss emerging therapeutic agents in development (biologics and small molecules), focusing on phase II/III candidates. The central role of interleukin-1 (IL-1) and related inflammasome pathways in pericardial inflammation provides a strong rationale for these targeted treatments. Key trials of IL-1 inhibitors (anakinra, rilonacept, canakinumab, goflikicept) have demonstrated dramatic reductions in recurrence rates, validating IL-1 as a therapeutic target. Other innovative approaches – such as NLRP3 inflammasome inhibitors and a cannabinoid-based agent – offer the prospect of oral, steroid-sparing therapy. We highlight the current challenges in developing these therapies, including heterogeneous disease causes, safety concerns, and trial design issues. Overall, the therapeutic pipeline for pericarditis is robust and poised to transform management. In the coming years, integration of targeted biologics and small molecules alongside conventional anti-inflammatories may significantly improve outcomes in recurrent pericarditis, moving towards more precise and effective treatment strategies.

心包炎是一种病因不同的心包囊炎症。虽然通常是自限性的，但高达30%的病例会复发或变成慢性疾病，造成严重的发病率。传统的治疗方法——非甾体抗炎药（NSAIDs）、秋水仙碱和皮质类固醇——有重要的局限性，包括类固醇依赖性、高复发率和副作用。因此，新的靶向免疫调节疗法正在研究中，以改善难治性心包炎的预后。这篇综述概述了心包炎的流行病学和负担，目前的管理和缺点，以及新疗法的基本原理。然后，我们讨论了正在开发的新兴治疗药物（生物制剂和小分子），重点是II/III期候选药物。白细胞介素-1 （IL-1）和相关炎性体通路在心包炎症中的核心作用为这些靶向治疗提供了强有力的理论依据。IL-1抑制剂（anakinra, rilonacept, canakinumab, goflikicept）的关键试验显示复发率显着降低，验证了IL-1作为治疗靶点。其他创新方法，如NLRP3炎性体抑制剂和一种基于大麻素的药物，提供了口服类固醇治疗的前景。我们强调了目前开发这些疗法的挑战，包括异质性疾病病因、安全性问题和试验设计问题。总的来说，心包炎的治疗途径是稳健的，并准备改变管理。在未来几年，靶向生物制剂和小分子药物与传统抗炎药的结合可能会显著改善复发性心包炎的预后，朝着更精确和有效的治疗策略发展。

{"title":"Pericarditis at the crossroads: Unlocking the next wave of therapies","authors":"Massimo Imazio , Francesco Venturelli , Maria Cristina Tomat , Giulio Savonitto , Davide Stolfo , Valentino Collini","doi":"10.1016/j.ijcha.2025.101841","DOIUrl":"10.1016/j.ijcha.2025.101841","url":null,"abstract":"<div><div>Pericarditis is an inflammation of the pericardial sac with different aetiologies. While often self-limited, up to 30 % of cases recur or become chronic, causing significant morbidity. Traditional treatments – nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids – have important limitations, including steroid dependence, high recurrence rates, and side effects. Accordingly, new targeted immunomodulatory therapies are under investigation to improve outcomes in refractory pericarditis. This review outlines the epidemiology and burden of pericarditis, current management and its shortcomings, and the rationale for novel therapies. We then discuss emerging therapeutic agents in development (biologics and small molecules), focusing on phase II/III candidates. The central role of interleukin-1 (IL-1) and related inflammasome pathways in pericardial inflammation provides a strong rationale for these targeted treatments. Key trials of IL-1 inhibitors (anakinra, rilonacept, canakinumab, goflikicept) have demonstrated dramatic reductions in recurrence rates, validating IL-1 as a therapeutic target. Other innovative approaches – such as NLRP3 inflammasome inhibitors and a cannabinoid-based agent – offer the prospect of oral, steroid-sparing therapy. We highlight the current challenges in developing these therapies, including heterogeneous disease causes, safety concerns, and trial design issues. Overall, the therapeutic pipeline for pericarditis is robust and poised to transform management. In the coming years, integration of targeted biologics and small molecules alongside conventional anti-inflammatories may significantly improve outcomes in recurrent pericarditis, moving towards more precise and effective treatment strategies.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101841"},"PeriodicalIF":2.5,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465378","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

Prognostic impact of the number and Temporality of heart failure Hospitalisations: Analysis of a National healthcare database 心力衰竭住院人数和时间对预后的影响：对国家卫生保健数据库的分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-08 DOI: 10.1016/j.ijcha.2025.101833

Damien Logeart , François Roubille , Muriel Salvat , Christophe Tribouilloy , Fabrice Bauer , Jean-Christophe Eicher , François Picard , Jean-Jacques Von Hunolstein , Jean-Noël Trochu , Pascal de Groote , Emmanuelle Berthelot , Francis Fagnani , Leila Batel , Maxime Doublet , Thibaud Damy , Richard Isnard

Aims

To assess the prognostic impact of both the frequency and timing of prior heart failure (HF) hospitalisations on outcomes in patients with reduced left ventricular ejection fraction (LVEF).

Methods and results

This nationwide retrospective cohort study used the French national health insurance database to identify 730,052 adults with HF in 2017. A validated algorithm classified 226,747 as HF with reduced LVEF (<45 %), of whom 54,504 (24 %) had at least one HF-related hospitalisation >24 h within the preceding 24 months (worsening HF group). Patients were stratified by (1) time since the last HF hospitalisation (0–6, 6–24 months) and (2) number of hospitalisations (1, 2, ≥3). Mean age was 76 ± 15 years. Prior HF hospitalisation was the strongest predictor of mortality among all variables. After multivariable adjustment, prior hospitalisation was associated with increased risk of all-cause death (HR 1.61, 95 % CI 1.56–1.65), all-cause hospitalisation (HR 1.34, 95 % CI 1.32–1.37), and recurrent HF hospitalisation (HR 2.51, 95 % CI 2.43–2.59). Risks were greatest when the most recent hospitalisation occurred within 6 months and rose progressively with the number of prior events.

Conclusion

In patients with reduced LVEF, both recent and recurrent HF hospitalisations are strong predictors of mortality and rehospitalisation. These two simple markers identify highly vulnerable patients and should trigger intensified follow-up, optimisation of guideline-directed therapies, and implementation of transitional care and remote monitoring programs.

目的评估心力衰竭（HF）住院次数和时间对左室射血分数（LVEF）降低患者预后的影响。方法和结果：这项全国性的回顾性队列研究使用法国国家健康保险数据库，在2017年确定了730,052名HF成年人。经过验证的算法将226,747例患者归类为LVEF降低的HF(45%)，其中54,504例（24%）在过去24个月内至少有一次与HF相关的住院治疗（24小时）（恶化型HF组）。患者按(1)自上次HF住院时间（0-6个月、6-24个月）和(2)住院次数（1、2、≥3）进行分层。平均年龄76±15岁。在所有变量中，既往心力衰竭住院是死亡率最强的预测因子。多变量调整后，既往住院与全因死亡（HR 1.61, 95% CI 1.56-1.65）、全因住院（HR 1.34, 95% CI 1.32-1.37）和复发性心衰住院（HR 2.51, 95% CI 2.43-2.59）的风险增加相关。当最近一次住院发生在6个月内时，风险最大，并随着先前事件的次数逐渐增加。结论在LVEF降低的患者中，近期和复发心衰住院是死亡率和再住院的重要预测因素。这两种简单的标记物可识别高度脆弱的患者，并应加强随访，优化指导治疗，实施过渡护理和远程监测计划。

{"title":"Prognostic impact of the number and Temporality of heart failure Hospitalisations: Analysis of a National healthcare database","authors":"Damien Logeart , François Roubille , Muriel Salvat , Christophe Tribouilloy , Fabrice Bauer , Jean-Christophe Eicher , François Picard , Jean-Jacques Von Hunolstein , Jean-Noël Trochu , Pascal de Groote , Emmanuelle Berthelot , Francis Fagnani , Leila Batel , Maxime Doublet , Thibaud Damy , Richard Isnard","doi":"10.1016/j.ijcha.2025.101833","DOIUrl":"10.1016/j.ijcha.2025.101833","url":null,"abstract":"<div><h3>Aims</h3><div> <!-->To assess the prognostic impact of both the frequency and timing of prior heart failure (HF) hospitalisations on outcomes in patients with reduced left ventricular ejection fraction (LVEF).</div></div><div><h3>Methods and results</h3><div>This nationwide retrospective cohort study used the French national health insurance database to identify 730,052 adults with HF in 2017. A validated algorithm classified 226,747 as HF with reduced LVEF (<45 %), of whom 54,504 (24 %) had at least one HF-related hospitalisation >24 h within the preceding 24 months (<em>worsening HF group</em>). Patients were stratified by (1) time since the last HF hospitalisation (0–6, 6–24 months) and (2) number of hospitalisations (1, 2, ≥3). Mean age was 76 ± 15 years. Prior HF hospitalisation was the strongest predictor of mortality among all variables. After multivariable adjustment, prior hospitalisation was associated with increased risk of all-cause death (HR 1.61, 95 % CI 1.56–1.65), all-cause hospitalisation (HR 1.34, 95 % CI 1.32–1.37), and recurrent HF hospitalisation (HR 2.51, 95 % CI 2.43–2.59). Risks were greatest when the most recent hospitalisation occurred within 6 months and rose progressively with the number of prior events.</div></div><div><h3>Conclusion</h3><div>In patients with reduced LVEF, both recent and recurrent HF hospitalisations are strong predictors of mortality and rehospitalisation. These two simple markers identify highly vulnerable patients and should trigger intensified follow-up, optimisation of guideline-directed therapies, and implementation of transitional care and remote monitoring programs.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101833"},"PeriodicalIF":2.5,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519546","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

Integrated proteomics and metabolomics analyses reveal potential molecular signatures of rabbit atherosclerotic plaques 综合蛋白质组学和代谢组学分析揭示了兔动脉粥样硬化斑块的潜在分子特征

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-08 DOI: 10.1016/j.ijcha.2025.101840

Chunfang Zan , Tianxiong Ji , Xinyu Zhang , Min-Fu Yang , Zhifang Wu , Sijin Li

Objective

This study aims to explore potential mechanisms associated with differentially abundant proteins and metabolites in rabbit plaques through integrated proteomics and untargeted metabolomics analyses.

Methods

Experimental rabbits were randomly divided into the model group and the sham group. Abdominal aortas were isolated, collected, and treated with proteinase K. Subsequently, a tandem mass tag (TMT)-labeled quantitative proteomics analysis and an untargeted metabolomics analysis via liquid chromatography-mass spectrometry (LC-MS) of abdominal aortas were performed to evaluate the possible protein and metabolite fingerprints in arterial plaques. Acquired data were analyzed using uni‐ and multivariate statistics. The correlation between differentially abundant proteins and metabolites was analyzed using the Pearson correlation coefficient strategy, and their possibly involved functional pathways were predicted by Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis.

Results

Advanced plaques develop in the model group. A total of 207 proteins are significantly altered in injured aortas compared to uninjured ones, with 133 upregulated and 74 downregulated proteins (fold changes > 1.2, P < 0.05). In plaques, 234 metabolites are significantly changed under the positive ion mode, and 187 under the negative ion mode. Notably, increases are observed in phosphatidylcholines (PCs) [PC 9:0] and lysophosphatidylcholines (LPCs) [LPC 20:2], two key lipid components. These metabolites are involved in some key metabolic pathways, including purine metabolism and vascular smooth muscle contraction.

Conclusions

The results confirm the potential of integrated proteomics and untargeted metabolomics in exploring the molecular characteristics of atherosclerosis. Identified proteins and metabolites may serve as promising biomarkers for plaque diagnosis.

目的本研究旨在通过综合蛋白质组学和非靶向代谢组学分析，探索兔斑块中差异丰富的蛋白质和代谢物的潜在机制。方法将实验兔随机分为模型组和假手术组。分离、收集腹主动脉并用蛋白酶k处理，随后对腹主动脉进行串联质量标签（TMT）标记的定量蛋白质组学分析和液相色谱-质谱（LC-MS）的非靶向代谢组学分析，以评估动脉斑块中可能的蛋白质和代谢物指纹图谱。使用单变量和多变量统计分析获得的数据。利用Pearson相关系数分析差异丰富蛋白与代谢物之间的相关性，并利用京都基因基因组百科全书（KEGG）富集分析预测其可能参与的功能通路。结果模型组出现晚期斑块。损伤主动脉与未损伤主动脉相比，共有207个蛋白发生显著改变，其中133个蛋白上调，74个蛋白下调（fold changes > 1.2, P < 0.05）。在斑块中，234种代谢物在正离子模式下发生显著变化，187种在负离子模式下发生显著变化。值得注意的是，两种关键的脂质成分磷脂酰胆碱（PCs） [pc9:0]和溶血磷脂酰胆碱（LPCs） [LPC 20:2]的含量均有所增加。这些代谢物参与一些关键的代谢途径，包括嘌呤代谢和血管平滑肌收缩。结论综合蛋白质组学和非靶向代谢组学在探索动脉粥样硬化分子特征方面具有一定的潜力。鉴定的蛋白质和代谢物可能作为斑块诊断的有希望的生物标志物。

{"title":"Integrated proteomics and metabolomics analyses reveal potential molecular signatures of rabbit atherosclerotic plaques","authors":"Chunfang Zan , Tianxiong Ji , Xinyu Zhang , Min-Fu Yang , Zhifang Wu , Sijin Li","doi":"10.1016/j.ijcha.2025.101840","DOIUrl":"10.1016/j.ijcha.2025.101840","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to explore potential mechanisms associated with differentially abundant proteins and metabolites in rabbit plaques through integrated proteomics and untargeted metabolomics analyses.</div></div><div><h3>Methods</h3><div>Experimental rabbits were randomly divided into the model group and the sham group. Abdominal aortas were isolated, collected, and treated with proteinase K. Subsequently, a tandem mass tag (TMT)-labeled quantitative proteomics analysis and an untargeted metabolomics analysis via liquid chromatography-mass spectrometry (LC-MS) of abdominal aortas were performed to evaluate the possible protein and metabolite fingerprints in arterial plaques. Acquired data were analyzed using uni‐ and multivariate statistics. The correlation between differentially abundant proteins and metabolites was analyzed using the <em>Pearson</em> correlation coefficient strategy, and their possibly involved functional pathways were predicted by Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis.</div></div><div><h3>Results</h3><div>Advanced plaques develop in the model group. A total of 207 proteins are significantly altered in injured aortas compared to uninjured ones, with 133 upregulated and 74 downregulated proteins (fold changes > 1.2, <em>P</em> < 0.05). In plaques, 234 metabolites are significantly changed under the positive ion mode, and 187 under the negative ion mode. Notably, increases are observed in phosphatidylcholines (PCs) [PC 9:0] and lysophosphatidylcholines (LPCs) [LPC 20:2], two key lipid components. These metabolites are involved in some key metabolic pathways, including purine metabolism and vascular smooth muscle contraction.</div></div><div><h3>Conclusions</h3><div>The results confirm the potential of integrated proteomics and untargeted metabolomics in exploring the molecular characteristics of atherosclerosis. Identified proteins and metabolites may serve as promising biomarkers for plaque diagnosis.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101840"},"PeriodicalIF":2.5,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519603","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

Thromboembolic risk of electrical cardioversion in patients with cardiogenic shock 心源性休克患者电转复的血栓栓塞风险

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-11-06 DOI: 10.1016/j.ijcha.2025.101835

Jonas Gmeiner , Lea Haag , Enzo Lüsebrink , Jan-Philipp Simon , Felix Michelson , Elina Oesterhaus , Wolf-Stephan Rudi , Ludwig Weckbach , Stefan Kääb , Michael Näbauer , Sven Peterß , Christopher Stremmel , Steffen Massberg , Martin Orban , Moritz F. Sinner , Clemens Scherer

Background

Cardiogenic shock patients with atrial fibrillation or flutter often require acute cardioversion despite absence of sufficient anticoagulation or the possibility to rule out left atrial appendage thrombus. Thromboembolic risk in these patients is unknown.

Methods

In this study, all cardiogenic shock patients from the LMUshock registry undergoing electrical cardioversion for atrial fibrillation or atrial flutter were included. The primary endpoint was new thromboembolic stroke or systemic embolism at 30 days. Secondary endpoints included performance of transesophageal echocardiography, all-cause mortality and bleeding according to BARC.

Results

Of 140 patients undergoing electrical cardioversion, 36 had preexisting and 104 experienced new onset of atrial fibrillation or flutter during ICU stay. Of these, 87.1 % had anticoagulation with unfractionated heparin and anticoagulation was adjudicated sufficient in 44.3 % at the time of cardioversion. Transesophageal echocardiography was performed in 37.9 % of patients before cardioversion. The primary endpoint was met in 3 patients (2.1 %), all of which had insufficient anticoagulation. All-cause mortality at 30 days was 37.9 % and bleeding ≥ BARC type 3a was found in 12.9 %.

Conclusions

Thromboembolic risk of electrical cardioversion was low despite the limited utilization of transesophageal echocardiography. This may be attributed to the routine administration of therapeutic anticoagulation in this study, but a high incidence of bleeding was observed.

背景：心源性休克合并心房颤动或扑动的患者，尽管没有足够的抗凝治疗或排除左心房附件血栓的可能性，但往往需要急性心律转复。这些患者的血栓栓塞风险尚不清楚。方法本研究纳入lmusshock登记的所有因心房颤动或心房扑动而接受电复律治疗的心源性休克患者。主要终点是30天内新的血栓栓塞性卒中或全身性栓塞。次要终点包括经食管超声心动图表现、全因死亡率和根据BARC的出血。结果140例电复律患者中，36例已存在心房颤动或扑动，104例在ICU住院期间新发。其中，87.1%的患者使用了未分级肝素抗凝治疗，44.3%的患者在复律时认为抗凝治疗是充分的。37.9%的患者在复律前进行了经食管超声心动图检查。3例（2.1%）患者达到了主要终点，所有患者抗凝治疗不足。30天全因死亡率为37.9%，出血≥BARC 3a型占12.9%。结论尽管经食管超声心动图的应用有限，但电转复的血栓栓塞风险较低。这可能是由于在本研究中常规给予治疗性抗凝，但观察到出血的发生率很高。

{"title":"Thromboembolic risk of electrical cardioversion in patients with cardiogenic shock","authors":"Jonas Gmeiner , Lea Haag , Enzo Lüsebrink , Jan-Philipp Simon , Felix Michelson , Elina Oesterhaus , Wolf-Stephan Rudi , Ludwig Weckbach , Stefan Kääb , Michael Näbauer , Sven Peterß , Christopher Stremmel , Steffen Massberg , Martin Orban , Moritz F. Sinner , Clemens Scherer","doi":"10.1016/j.ijcha.2025.101835","DOIUrl":"10.1016/j.ijcha.2025.101835","url":null,"abstract":"<div><h3>Background</h3><div>Cardiogenic shock patients with atrial fibrillation or flutter often require acute cardioversion despite absence of sufficient anticoagulation or the possibility to rule out left atrial appendage thrombus. Thromboembolic risk in these patients is unknown.</div></div><div><h3>Methods</h3><div>In this study, all cardiogenic shock patients from the LMUshock registry undergoing electrical cardioversion for atrial fibrillation or atrial flutter were included. The primary endpoint was new thromboembolic stroke or systemic embolism at 30 days. Secondary endpoints included performance of transesophageal echocardiography, all-cause mortality and bleeding according to BARC.</div></div><div><h3>Results</h3><div>Of 140 patients undergoing electrical cardioversion, 36 had preexisting and 104 experienced new onset of atrial fibrillation or flutter during ICU stay. Of these, 87.1 % had anticoagulation with unfractionated heparin and anticoagulation was adjudicated sufficient in 44.3 % at the time of cardioversion. Transesophageal echocardiography was performed in 37.9 % of patients before cardioversion. The primary endpoint was met in 3 patients (2.1 %), all of which had insufficient anticoagulation. All-cause mortality at 30 days was 37.9 % and bleeding ≥ BARC type 3a was found in 12.9 %.</div></div><div><h3>Conclusions</h3><div>Thromboembolic risk of electrical cardioversion was low despite the limited utilization of transesophageal echocardiography. This may be attributed to the routine administration of therapeutic anticoagulation in this study, but a high incidence of bleeding was observed.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101835"},"PeriodicalIF":2.5,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466032","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