Pub Date : 2025-02-01DOI: 10.1016/j.ijcha.2024.101597
Danny Veen , Ziliang Ye , Mathijs S. van Schie , Paul Knops , Maryam Kavousi , Lara Vos , Vehpi Yildirim , Yannick J.H.J. Taverne , Natasja M.S de Groot
Background
Areas of conduction disorders play an important role in both initiation and perpetuation of AF and can be recognized by specific changes in unipolar potential morphology. For example, EGM fractionation may be caused by asynchronous activation of adjacent cardiomyocytes because of structural barriers such as fibrotic strands. However, it is unknown whether there are sex differences in unipolar potential morphology. Therefore, atrial potential morphologies during sinus rhythm (SR) were compared between male and female patients.
Methods
Based on propensity score matching, 62 male and female patients in whom high-resolution mapping of the right atrium (RA), left atrium (LA), and pulmonary vein area (PVA) including Bachmann’s bundle (BB) was performed during coronary bypass grafting surgery and/or valvular heart surgery. Unipolar potentials were classified as single potentials (SPs), short double potentials (SDPs), long double potentials (LDP), fractionated potentials (FPs) and fraction duration (FD). The proportion of conduction block lines was also determined.
Results
Female patients had a higher proportion of SDPs, LDPs and FPs at the RA, and SDPs at BB. At the PVA, there were less SPs and more SDPs and FPs. In females, FDs were longer at the RA and PVA, and potential voltages of only SPs were lower at the RA (all P < 0.05). Females also had more CB at the RA and at PVA (P < 0.05).
Conclusion
In females, the proportion of single unipolar potentials indicative of smooth conduction, was lower compared to males, at the RA and PVA and to a lesser degree at BB. Females also had more CB at RA and PVA. Hence, these results may reflect sex-differences in the degree of electrical remodeling.
{"title":"Sex differences in atrial potential morphology","authors":"Danny Veen , Ziliang Ye , Mathijs S. van Schie , Paul Knops , Maryam Kavousi , Lara Vos , Vehpi Yildirim , Yannick J.H.J. Taverne , Natasja M.S de Groot","doi":"10.1016/j.ijcha.2024.101597","DOIUrl":"10.1016/j.ijcha.2024.101597","url":null,"abstract":"<div><h3>Background</h3><div>Areas of conduction disorders play an important role in both initiation and perpetuation of AF and can be recognized by specific changes in unipolar potential morphology. For example, EGM fractionation may be caused by asynchronous activation of adjacent cardiomyocytes because of structural barriers such as fibrotic strands. However, it is unknown whether there are sex differences in unipolar potential morphology. Therefore, atrial potential morphologies during sinus rhythm (SR) were compared between male and female patients.</div></div><div><h3>Methods</h3><div>Based on propensity score matching, 62 male and female patients in whom high-resolution mapping of the right atrium (RA), left atrium (LA), and pulmonary vein area (PVA) including Bachmann’s bundle (BB) was performed during coronary bypass grafting surgery and/or valvular heart surgery. Unipolar potentials were classified as single potentials (SPs), short double potentials (SDPs), long double potentials (LDP), fractionated potentials (FPs) and fraction duration (FD). The proportion of conduction block lines was also determined.</div></div><div><h3>Results</h3><div>Female patients had a higher proportion of SDPs, LDPs and FPs at the RA, and SDPs at BB. At the PVA, there were less SPs and more SDPs and FPs. In females, FDs were longer at the RA and PVA, and potential voltages of only SPs were lower at the RA (all P < 0.05). Females also had more CB at the RA and at PVA (P < 0.05).</div></div><div><h3>Conclusion</h3><div>In females, the proportion of single unipolar potentials indicative of smooth conduction, was lower compared to males, at the RA and PVA and to a lesser degree at BB. Females also had more CB at RA and PVA. Hence, these results may reflect sex-differences in the degree of electrical remodeling.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101597"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijcha.2024.101592
Shihao Fu , Zian Feng , Ao Li , Zhenxiao Ma , Haiyang Zhang , Zhiwei Zhao
Atrial fibrillation (AF) is the most common tachyarrhythmia and seriously affects human health. Key targets of AF bioinformatics analysis can help to better understand the pathogenesis of AF and develop therapeutic targets. The left atrial appendage tissue of 20 patients with AF and 10 patients with sinus rhythm were collected for sequencing, and the expression data of the atrial tissue were obtained. Based on this, 2578 differentially expressed genes were obtained through differential analysis. Different express genes (DEGs) were functionally enriched on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), mainly focusing on neuroactive ligand-receptor interactions, neuronal cell body pathways, regulation of neurogenesis, and neuronal death, regulation of neuronal death, etc. Secondly, 14 significant module genes were obtained by analyzing the weighted gene co-expression network of DEGs. Next, LASSO and SVM analyzes were performed on the differential genes, and the results were in good agreement with the calibration curve of the nomogram model for predicting AF constructed by the weighted gene co-expression network key genes. The significant module genes obtained by the area under the ROC curve (AUC) analysis were analyzed. Through crossover, two key disease characteristic genes related to AF, HOXA2 and RND2, were screened out. RND2 was selected for further research, and qPCR verified the expression of RND2 in sinus rhythm patients and AF patients. Patients with sinus rhythm were significantly higher than those in AF patients. Our research indicates that RND2 is significantly associated with the onset of AF and can serve as a potential target for studying its pathogenesis.
{"title":"Using integrative bioinformatics approaches and machine–learning strategies to identify potential signatures for atrial fibrillation","authors":"Shihao Fu , Zian Feng , Ao Li , Zhenxiao Ma , Haiyang Zhang , Zhiwei Zhao","doi":"10.1016/j.ijcha.2024.101592","DOIUrl":"10.1016/j.ijcha.2024.101592","url":null,"abstract":"<div><div>Atrial fibrillation (AF) is the most common tachyarrhythmia and seriously affects human health. Key targets of AF bioinformatics analysis can help to better understand the pathogenesis of AF and develop therapeutic targets. The left atrial appendage tissue of 20 patients with AF and 10 patients with sinus rhythm were collected for sequencing, and the expression data of the atrial tissue were obtained. Based on this, 2578 differentially expressed genes were obtained through differential analysis. Different express genes (DEGs) were functionally enriched on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), mainly focusing on neuroactive ligand-receptor interactions, neuronal cell body pathways, regulation of neurogenesis, and neuronal death, regulation of neuronal death, etc. Secondly, 14 significant module genes were obtained by analyzing the weighted gene co-expression network of DEGs. Next, LASSO and SVM analyzes were performed on the differential genes, and the results were in good agreement with the calibration curve of the nomogram model for predicting AF constructed by the weighted gene co-expression network key genes. The significant module genes obtained by the area under the ROC curve (AUC) analysis were analyzed. Through crossover, two key disease characteristic genes related to AF, HOXA2 and RND2, were screened out. RND2 was selected for further research, and qPCR verified the expression of RND2 in sinus rhythm patients and AF patients. Patients with sinus rhythm were significantly higher than those in AF patients. Our research indicates that RND2 is significantly associated with the onset of AF and can serve as a potential target for studying its pathogenesis.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101592"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijcha.2024.101587
Ying Wang , Dingxin Zhang , Runzhe Zhou , Xiangjie Yang , Xiaoxia Wang , Yuxin Jiang , Xinyuan Zhou , Dashan Li , Jin Zhang , Yonggui Wu
Background
Heart failure (HF) is a significant cause of death among patients with chronic kidney disease (CKD). Emerging data suggest a crucial role of fibroblast growth factor 23 (FGF23) in the pathogenesis of HF in CKD patients. The present study aimed to investigate whether the serum intact FGF23 (iFGF23) level is elevated when ejection fraction (EF) is preserved and to evaluate its predictive value for incident HF and cardiac mortality in CKD patients with preserved EF.
Methods and results
We prospectively recruited 209 patients (mean age 52.7 ± 11.9 years, 37.3 % male) with CKD stages 3–5 and preserved EF, including those on peritoneal dialysis (PD) from a nephropathy center from November 2020 until July 2024.
Results
Over a median follow-up of 29 (IQR 24–35) months, 60 (28.7 %) patients met the primary composite endpoints, including 53 (25.4 %) incident HF events and 7 (3.3 %) cardiac deaths. The cumulative incidence of composite endpoints was approximately 2-fold higher in patients with the highest quartile (Q4) level of lgiFGF23, compared with the lower quartiles (Q1-3). Baseline iFGF23 concentration was significantly associated with an increased risk of composite endpoint in the multivariable-adjusted Cox model, independent of kidney function, traditional cardiovascular risk factors, echocardiographic parameters, and α-Klotho. In a competing risk analysis, the Q4 level of lgiFGF23 (HR 2.43, 95 %CI 1.44–4.11; P = 0.001) was independently associated with HF and cardiac death.
Conclusion
In CKD patients with preserved EF, serum iFGF23 was elevated before LVEF declined. A higher baseline serum iFGF23 level is significantly associated with the incidence of HF and cardiovascular mortality over a 3-year follow-up, demonstrating independent and incremental predictive value beyond traditional risk factors.
{"title":"Baseline fibroblast growth factor 23 predicts incident heart failure and cardiovascular mortality in patients with chronic kidney disease: A 3-year follow-up study","authors":"Ying Wang , Dingxin Zhang , Runzhe Zhou , Xiangjie Yang , Xiaoxia Wang , Yuxin Jiang , Xinyuan Zhou , Dashan Li , Jin Zhang , Yonggui Wu","doi":"10.1016/j.ijcha.2024.101587","DOIUrl":"10.1016/j.ijcha.2024.101587","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) is a significant cause of death among patients with chronic kidney disease (CKD). Emerging data suggest a crucial role of fibroblast growth factor 23 (FGF23) in the pathogenesis of HF in CKD patients. The present study aimed to investigate whether the serum intact FGF23 (iFGF23) level is elevated when ejection fraction (EF) is preserved and to evaluate its predictive value for incident HF and cardiac mortality in CKD patients with preserved EF.</div></div><div><h3>Methods and results</h3><div>We prospectively recruited 209 patients (mean age 52.7 ± 11.9 years, 37.3 % male) with CKD stages 3–5 and preserved EF, including those on peritoneal dialysis (PD) from a nephropathy center from November 2020 until July 2024.</div></div><div><h3>Results</h3><div>Over a median follow-up of 29 (IQR 24–35) months, 60 (28.7 %) patients met the primary composite endpoints, including 53 (25.4 %) incident HF events and 7 (3.3 %) cardiac deaths. The cumulative incidence of composite endpoints was approximately 2-fold higher in patients with the highest quartile (Q4) level of lgiFGF23, compared with the lower quartiles (Q1-3). Baseline iFGF23 concentration was significantly associated with an increased risk of composite endpoint in the multivariable-adjusted Cox model, independent of kidney function, traditional cardiovascular risk factors, echocardiographic parameters, and α-Klotho. In a competing risk analysis, the Q4 level of lgiFGF23 (HR 2.43, 95 %CI 1.44–4.11; <em>P</em> = 0.001) was independently associated with HF and cardiac death.</div></div><div><h3>Conclusion</h3><div>In CKD patients with preserved EF, serum iFGF23 was elevated before LVEF declined. A higher baseline serum iFGF23 level is significantly associated with the incidence of HF and cardiovascular mortality over a 3-year follow-up, demonstrating independent and incremental predictive value beyond traditional risk factors.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101587"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijcha.2024.101585
Mariana Tinoco, Julio Echarte-Morales, Claudio E. Guerreiro, Erick M. Ávila Gil, Berenice Caneiro-Queija, Manuel Barreiro-Pérez, Rocío González-Ferreiro, Saleta Fernández, Alberto Ortiz-Saez, Víctor Alfonso Jiménez-Díaz, Francisco Calvo-Iglesias, Antonio A. de Miguel-Castro, Carina González-Ríos, Guillermo Bastos-Fernández, José Antonio Baz-Alonso, Rodrigo Estévez-Loureiro , Andrés Íñiguez-Romo
Introduction and objectives
Percutaneous left atrial appendage occlusion (LAAO) is a viable option to mitigate bleeding and stroke risks in patients with atrial fibrillation (AF) who are not eligible for oral anticoagulation. Its safety and efficacy in cancer patients remain unclear due to their exclusion from trials. This study aimed to compare short- and long-term LAAO outcomes between cancer and non-cancer patients.
Methods
Retrospective single centre study of 361 consecutive patients who underwent LAAO between april-2010 and december-2023 were included. Short-term outcomes included periprocedural complications, 30-day hospital readmission and mortality. Long-term outcomes included the composite of stroke, bleeding, and mortality and each component assessed separately.
Results
The study included 93 cancer patients (54 % active, 46 % in remission) and 268 non-cancer patients. Baseline characteristics were similar, including ischemic and bleeding risk profiles (CHA2DS2-VASc: 4.5 ± 1.4 vs. 4.4 ± 1.5; HAS-BLED: 3.3 ± 0.9 vs. 3.2 ± 0.9), previous stroke and total bleeding events. Short-term outcomes showed no significant differences in periprocedural complications (7 % vs. 6 %), 30-day readmission (2 % vs. 3 %), or 30-day mortality (0 % vs. 1.5 %). Over 32 months, there was no significant difference regarding the composite endpoint (p = 0.067), stroke (SHR 0.54; p = 0.25) or bleeding events (SHR 1.36; p = 0.35). LAAO was effective in terms of stroke reduction in cancer and non-cancer patients (p = 0.027 and p = 0.006, respectively). All-cause mortality rates were higher in cancer patients (p = 0.002), mainly due to cancer progression and infections.
Conclusions
LAAO procedure was safe and effective in both populations. Cancer patients experienced higher rates of all-cause mortality, with no differences in stroke and bleeding outcomes between groups.
简介和目的：经皮左心耳闭塞术（LAAO）是减轻不适合口服抗凝治疗的房颤（AF）患者出血和卒中风险的可行选择。由于癌症患者被排除在试验之外，其安全性和有效性尚不清楚。这项研究旨在比较癌症和非癌症患者之间的短期和长期LAAO结果。方法：对2010年4月至2023年12月期间连续361例LAAO患者进行回顾性单中心研究。短期结果包括围手术期并发症、30天住院再入院和死亡率。长期结果包括卒中、出血和死亡率的综合结果，并对每个组成部分分别进行评估。结果：该研究包括93例癌症患者（54%为活跃期，46%为缓解期）和268例非癌症患者。基线特征相似，包括缺血和出血风险概况(CHA2DS2-VASc: 4.5±1.4 vs 4.4±1.5；HAS-BLED: 3.3±0.9 vs. 3.2±0.9)，既往卒中和总出血事件。短期结果显示围手术期并发症（7% vs. 6%）、30天再入院（2% vs. 3%）或30天死亡率（0% vs. 1.5%）无显著差异。32个月后，两组在综合终点（p = 0.067）、卒中(SHR 0.54；p = 0.25)或出血事件(SHR 1.36；p = 0.35)。LAAO在减少癌症和非癌症患者中风方面是有效的（p = 0.027和p = 0.006）。癌症患者的全因死亡率更高（p = 0.002），主要是由于癌症进展和感染。结论：LAAO手术在两种人群中安全有效。癌症患者的全因死亡率更高，两组之间的中风和出血结果没有差异。
{"title":"Short- and long-term outcomes of percutaneous left atrial appendage occlusion in cancer patients","authors":"Mariana Tinoco, Julio Echarte-Morales, Claudio E. Guerreiro, Erick M. Ávila Gil, Berenice Caneiro-Queija, Manuel Barreiro-Pérez, Rocío González-Ferreiro, Saleta Fernández, Alberto Ortiz-Saez, Víctor Alfonso Jiménez-Díaz, Francisco Calvo-Iglesias, Antonio A. de Miguel-Castro, Carina González-Ríos, Guillermo Bastos-Fernández, José Antonio Baz-Alonso, Rodrigo Estévez-Loureiro , Andrés Íñiguez-Romo","doi":"10.1016/j.ijcha.2024.101585","DOIUrl":"10.1016/j.ijcha.2024.101585","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Percutaneous left atrial appendage occlusion (LAAO) is a viable option to mitigate bleeding and stroke risks in patients with atrial fibrillation (AF) who are not eligible for oral anticoagulation. Its safety and efficacy in cancer patients remain unclear due to their exclusion from trials. This study aimed to compare short- and long-term LAAO outcomes between cancer and non-cancer patients.</div></div><div><h3>Methods</h3><div>Retrospective single centre study of 361 consecutive patients who underwent LAAO between april-2010 and december-2023 were included. Short-term outcomes included periprocedural complications, 30-day hospital readmission and mortality. Long-term outcomes included the composite of stroke, bleeding, and mortality and each component assessed separately.</div></div><div><h3>Results</h3><div>The study included 93 cancer patients (54 % active, 46 % in remission) and 268 non-cancer patients. Baseline characteristics were similar, including ischemic and bleeding risk profiles (CHA<sub>2</sub>DS<sub>2</sub>-VASc: 4.5 ± 1.4 vs. 4.4 ± 1.5; HAS-BLED: 3.3 ± 0.9 vs. 3.2 ± 0.9), previous stroke and total bleeding events. Short-term outcomes showed no significant differences in periprocedural complications (7 % vs. 6 %), 30-day readmission (2 % vs. 3 %), or 30-day mortality (0 % vs. 1.5 %). Over 32 months, there was no significant difference regarding the composite endpoint (p = 0.067), stroke (SHR 0.54; p = 0.25) or bleeding events (SHR 1.36; p = 0.35). LAAO was effective in terms of stroke reduction in cancer and non-cancer patients (p = 0.027 and p = 0.006, respectively). All-cause mortality rates were higher in cancer patients (p = 0.002), mainly due to cancer progression and infections.</div></div><div><h3>Conclusions</h3><div>LAAO procedure was safe and effective in both populations. Cancer patients experienced higher rates of all-cause mortality, with no differences in stroke and bleeding outcomes between groups.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101585"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijcha.2024.101580
Diantha J.M. Schipaanboord , Tijn P.J. Jansen , Luuk Scherpenhuijzen , Caïa Crooijmans , Aukelien C. Dimitriu-Leen , Pim van der Harst , Tim P. van de Hoef , René van Es , Hester M. den Ruijter , Peter Damman , N. Charlotte Onland-Moret , Suzette E. Elias-Smale , on behalf of the IMPRESS consortium
Background
Recently it has been suggested that coronary microvascular dysfunction (CMD) may explain the high false-positive rate of exercise electrocardiographic stress testing (EST). However, patients with angina but non-obstructive coronary artery disease (ANOCA) present with a broader spectrum of coronary vasomotor dysfunction (CVDys), namely coronary artery spasm (CAS), CMD or a combination of both. We aim to investigate the diagnostic value of EST for the entire CVDys spectrum.
Methods
We included patients who underwent coronary function testing (CFT) in the Radboud University Medical Center. For each patient we requested the most recent EST report. ESTs were denoted as positive for ischemia if clinically significant ST-segment depression was detected. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals for the diagnosis of CVDys and its endotypes.
Results
Of the 105 included patients (87 % women, mean age 57 (±8) years), 22 (21 %) had ischemia during EST. CVDys was diagnosed in 94 patients (90 %), of whom 58 patients had an isolated endotype (CAS: n = 51, CMD: n = 7) and 36 patients had CAS and CMD. Ischemia during EST yielded a high specificity and PPV for CVDys (specificity: 100 % (71.5–100 %), PPV: 100 % (84.6–100 %)), which remained reasonably similar for CAS (specificity: 94.4 % (72.7–99.9 %), PPV: 95.5 % (77.2–99.9 %)), but was lower for CMD (specificity: 85.5 % (74.2–93.1 %), PPV: 59.1 % (36.4–79.3 %)).
Conclusions
Ischemia during EST is highly specific for CVDys in general and can be an indicator for CAS and to a lesser extent for CMD in patients with ANOCA.
{"title":"Ischemia during exercise stress testing, an indication of coronary vasomotor dysfunction?","authors":"Diantha J.M. Schipaanboord , Tijn P.J. Jansen , Luuk Scherpenhuijzen , Caïa Crooijmans , Aukelien C. Dimitriu-Leen , Pim van der Harst , Tim P. van de Hoef , René van Es , Hester M. den Ruijter , Peter Damman , N. Charlotte Onland-Moret , Suzette E. Elias-Smale , on behalf of the IMPRESS consortium","doi":"10.1016/j.ijcha.2024.101580","DOIUrl":"10.1016/j.ijcha.2024.101580","url":null,"abstract":"<div><h3>Background</h3><div>Recently it has been suggested that coronary microvascular dysfunction (CMD) may explain the high false-positive rate of exercise electrocardiographic stress testing (EST). However, patients with angina but non-obstructive coronary artery disease (ANOCA) present with a broader spectrum of coronary vasomotor dysfunction (CVDys), namely coronary artery spasm (CAS), CMD or a combination of both. We aim to investigate the diagnostic value of EST for the entire CVDys spectrum.</div></div><div><h3>Methods</h3><div>We included patients who underwent coronary function testing (CFT) in the Radboud University Medical Center. For each patient we requested the most recent EST report. ESTs were denoted as positive for ischemia if clinically significant ST-segment depression was detected. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals for the diagnosis of CVDys and its endotypes.</div></div><div><h3>Results</h3><div>Of the 105 included patients (87 % women, mean age 57 (±8) years), 22 (21 %) had ischemia during EST. CVDys was diagnosed in 94 patients (90 %), of whom 58 patients had an isolated endotype (CAS: n = 51, CMD: n = 7) and 36 patients had CAS and CMD. Ischemia during EST yielded a high specificity and PPV for CVDys (specificity: 100 % (71.5–100 %), PPV: 100 % (84.6–100 %)), which remained reasonably similar for CAS (specificity: 94.4 % (72.7–99.9 %), PPV: 95.5 % (77.2–99.9 %)), but was lower for CMD (specificity: 85.5 % (74.2–93.1 %), PPV: 59.1 % (36.4–79.3 %)).</div></div><div><h3>Conclusions</h3><div>Ischemia during EST is highly specific for CVDys in general and can be an indicator for CAS and to a lesser extent for CMD in patients with ANOCA.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101580"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijcha.2025.101613
David Molnar , Elias Björnson , Ola Hjelmgren , Martin Adiels , Fredrik Bäckhed , Göran Bergström
Background
The quantification of coronary artery calcifications (CAC) is a mainstay in radiological assessment of coronary atherosclerosis and cardiovascular risk, but reflect advanced, possibly late-stage changes in the arteries. Increased volume and changes in attenuation of the epicardial adipose tissue (EAT) on computed tomography (CT) have been linked to adverse cardiovascular events, and these changes in the EAT might reflect earlier stages of the processes leading to clinically manifest atherosclerosis. The relationship between EAT and CAC is subject to a knowledge gap, especially in individuals with no previously known coronary artery disease.
Methods
Fully automated EAT analysis with an artificial intelligence-based model was performed in a population sample enriched for pre-diabetics, comprising a total of 1,945 individuals aged 50–64 years, where non-contrast CT images, anthropometric and laboratory data was available on established cardiovascular risk factors. Uni- and multivariable linear regression, gradient-boosting and correlation analyses were performed to determine the explanatory value of EAT volume and attenuation data with regards to CAC data.
Results
Neither EAT volume nor EAT attenuation was associated with the presence or severity of CAC, when adjusting for established cardiovascular risk factors, and had only weak explanatory value in gradient-boosting and correlation analyses. Age was the strongest predictor of CAC in both sexes.
Conclusion
No independent association was found between CAC and total EAT volume or attenuation. Importantly, these findings do not rule out early stage or local effects on coronary atherosclerosis from the EAT immediately surrounding the coronary arteries.
{"title":"Coronary artery calcifications are not associated with epicardial adipose tissue volume and attenuation on computed tomography in 1,945 individuals with various degrees of glucose disorders","authors":"David Molnar , Elias Björnson , Ola Hjelmgren , Martin Adiels , Fredrik Bäckhed , Göran Bergström","doi":"10.1016/j.ijcha.2025.101613","DOIUrl":"10.1016/j.ijcha.2025.101613","url":null,"abstract":"<div><h3>Background</h3><div>The quantification of coronary artery calcifications (CAC) is a mainstay in radiological assessment of coronary atherosclerosis and cardiovascular risk, but reflect advanced, possibly late-stage changes in the arteries. Increased volume and changes in attenuation of the epicardial adipose tissue (EAT) on computed tomography (CT) have been linked to adverse cardiovascular events, and these changes in the EAT might reflect earlier stages of the processes leading to clinically manifest atherosclerosis. The relationship between EAT and CAC is subject to a knowledge gap, especially in individuals with no previously known coronary artery disease.</div></div><div><h3>Methods</h3><div>Fully automated EAT analysis with an artificial intelligence-based model was performed in a population sample enriched for pre-diabetics, comprising a total of 1,945 individuals aged 50–64 years, where non-contrast CT images, anthropometric and laboratory data was available on established cardiovascular risk factors. Uni- and multivariable linear regression, gradient-boosting and correlation analyses were performed to determine the explanatory value of EAT volume and attenuation data with regards to CAC data.</div></div><div><h3>Results</h3><div>Neither EAT volume nor EAT attenuation was associated with the presence or severity of CAC, when adjusting for established cardiovascular risk factors, and had only weak explanatory value in gradient-boosting and correlation analyses. Age was the strongest predictor of CAC in both sexes.</div></div><div><h3>Conclusion</h3><div>No independent association was found between CAC and total EAT volume or attenuation. Importantly, these findings do not rule out early stage or local effects on coronary atherosclerosis from the EAT immediately surrounding the coronary arteries.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101613"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijcha.2024.101570
Xinling Xu , Angela Silveira , Pia Lundman , Afsar Rahbar , Cecilia Söderberg-Nauclér
Background
Efforts to understand atherosclerosis, a major cause of ischemic heart disease, have linked several lifestyle factors to increased risk for developing cardiovascular disease. Some studies suggest that cytomegalovirus (CMV), a widely prevalent herpesvirus, is reactivated in atherosclerotic plaques and associated with higher cardiovascular mortality risk. We aimed to explore whether CMV seropositivity and CMV-IgG antibody levels correlate with relevant biomarkers in a cohort of patients with myocardial infarction (MI) and matched controls.
Methods and results
We analyzed a dataset from 324 survivors of MI treated in Stockholm between 1996 and 2001. Blood samples collected three months after MI were used to measure protective Apo B100 autoantibodies, metabolic, and inflammatory biomarkers. CMV serology was performed on stored serum samples. Correlation analyses were conducted between biomarkers and CMV serostatus in 324 patients and age- and sex-matched controls. While CMV seroprevalence was equal, the CMV-IgG levels were higher in controls. Among various factors examined, CMV seropositive MI patients had elevated levels of plasminogen activator inhibitor-1 (PAI-1) and interleukin-6, along with lower levels of MMP-3, than CMV seronegative MI patients. CMV-IgG levels correlated positively with PAI-1 levels in patients. Although CMV seropositivity was associated with increased proinsulin levels, there was no correlation with diabetes diagnosis.
Conclusions
Our findings suggest an enhanced inflammatory and prothrombotic state in CMV seropositive patients after MI. Notably, patients had lower levels of CMV IgG than controls.
{"title":"Enhanced levels of IL-6 and PAI-1 and decreased levels of MMP-3 in cytomegalovirus seropositive patients with prior myocardial infarction","authors":"Xinling Xu , Angela Silveira , Pia Lundman , Afsar Rahbar , Cecilia Söderberg-Nauclér","doi":"10.1016/j.ijcha.2024.101570","DOIUrl":"10.1016/j.ijcha.2024.101570","url":null,"abstract":"<div><h3>Background</h3><div>Efforts to understand atherosclerosis, a major cause of ischemic heart disease, have linked several lifestyle factors to increased risk for developing cardiovascular disease. Some studies suggest that cytomegalovirus (CMV), a widely prevalent herpesvirus, is reactivated in atherosclerotic plaques and associated with higher cardiovascular mortality risk. We aimed to explore whether CMV seropositivity and CMV-IgG antibody levels correlate with relevant biomarkers in a cohort of patients with myocardial infarction (MI) and matched controls.</div></div><div><h3>Methods and results</h3><div>We analyzed a dataset from 324 survivors of MI treated in Stockholm between 1996 and 2001. Blood samples collected three months after MI were used to measure protective Apo B100 autoantibodies, metabolic, and inflammatory biomarkers. CMV serology was performed on stored serum samples. Correlation analyses were conducted between biomarkers and CMV serostatus in 324 patients and age- and sex-matched controls. While CMV seroprevalence was equal, the CMV-IgG levels were higher in controls. Among various factors examined, CMV seropositive MI patients had elevated levels of plasminogen activator inhibitor-1 (PAI-1) and interleukin-6, along with lower levels of MMP-3, than CMV seronegative MI patients. CMV-IgG levels correlated positively with PAI-1 levels in patients. Although CMV seropositivity was associated with increased proinsulin levels, there was no correlation with diabetes diagnosis.</div></div><div><h3>Conclusions</h3><div>Our findings suggest an enhanced inflammatory and prothrombotic state in CMV seropositive patients after MI. Notably, patients had lower levels of CMV IgG than controls.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101570"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijcha.2025.101606
Ines Valenta , Salwa Mikhail , Ashwin Singh Parihar , Sudhir Jain , Thomas H. Schindler
Background
The aim was to investigate whether functional and/or structural impairment of flow-mediated epicardial vasodilation (IEV) may precede coronary microvascular dysfunction (CMD) in a cardiometabolic risk population.
Methods
13N-ammonia positron emission tomography/computed tomography evaluated global and longitudinal myocardial blood flow (MBF) during pharmacologically induced hyperemia and at rest. Normal coronary microvascular function (nCMF) was defined by a myocardial flow reserve (MFR = MBFstress/MBFrest) of ≥ 2.0, while an abnormal MFR of < 2.0 (predominantly due to decreases in hyperemic MBF) denoted classical CMD. Normal flow-mediated epicardial vasodilation (NEV) was defined as longitudinal hyperemic MBF gradient < -0.10 mL/g/min, whereas a value ≥ -0.10 mL/g/min signifiedIEV. Patients were grouped as follows: group 1 (G1): nCMF and NEV (n = 93); group 2 (G2): nCMF and IEV (n = 62), and group 3 (G3): CMD and IEV (n = 78). From non-gated CT, a semiquantitative four-point scoring system was used to indicate coronary artery calcifications score (CCS).
Results
The prevalence of diffuse coronary artery calcification was highest in G1 with 51 %, followed by G3 with 46 % and G2 with 34 %. The extent of CCS was mild-to-moderate and did not differ significantly among groups (p = 0.222). Overall, IEV was present in 60 %, while there was a comparable prevalence of IEV between G2 and G3 (27 % and 33 %, p = 0.27). The hyperemic MBF gradient was highest in G2, intermediate in G3, and lowest in G1 (−0.22 ± 0.11 and −0.18 ± 0.10 vs. 0.03 ± 0.08 mL/g/min; p < 0.001, respectively).
Conclusions
In this cardio-metabolic risk population, in about one third of these symptomatic patients functional and/or structural impairment of flow-mediated epicardial vasodilation may precede coronary microvascular dysfunction.
{"title":"Functional or structural impairment of flow-mediated epicardial vasodilation may precede coronary microvascular dysfunction","authors":"Ines Valenta , Salwa Mikhail , Ashwin Singh Parihar , Sudhir Jain , Thomas H. Schindler","doi":"10.1016/j.ijcha.2025.101606","DOIUrl":"10.1016/j.ijcha.2025.101606","url":null,"abstract":"<div><h3>Background</h3><div>The aim was to investigate whether functional and/or structural impairment of flow-mediated epicardial vasodilation (IEV) may precede coronary microvascular dysfunction (CMD) in a cardiometabolic risk population.</div></div><div><h3>Methods</h3><div><sup>13</sup>N-ammonia positron emission tomography/computed tomography evaluated global and longitudinal myocardial blood flow (MBF) during pharmacologically induced hyperemia and at rest. Normal coronary microvascular function (nCMF) was defined by a myocardial flow reserve (MFR = MBFstress/MBFrest) of ≥ 2.0, while an abnormal MFR of < 2.0 (predominantly due to decreases in hyperemic MBF) denoted classical CMD. Normal flow-mediated epicardial vasodilation (NEV) was defined as longitudinal hyperemic MBF gradient < -0.10 mL/g/min, whereas a value ≥ -0.10 mL/g/min signifiedIEV. Patients were grouped as follows: group 1 (G1): nCMF and NEV (n = 93); group 2 (G2): nCMF and IEV (n = 62), and group 3 (G3): CMD and IEV (n = 78). From non-gated CT, a semiquantitative four-point scoring system was used to indicate coronary artery calcifications score (CCS).</div></div><div><h3>Results</h3><div>The prevalence of diffuse coronary artery calcification was highest in G1 with 51 %, followed by G3 with 46 % and G2 with 34 %. The extent of CCS was mild-to-moderate and did not differ significantly among groups (p = 0.222). Overall, IEV was present in 60 %, while there was a comparable prevalence of IEV between G2 and G3 (27 % and 33 %, p = 0.27). The hyperemic MBF gradient was highest in G2, intermediate in G3, and lowest in G1 (−0.22 ± 0.11 and −0.18 ± 0.10 vs. 0.03 ± 0.08 mL/g/min; p < 0.001, respectively).</div></div><div><h3>Conclusions</h3><div>In this cardio-metabolic risk population, in about one third of these symptomatic patients functional and/or structural impairment of flow-mediated epicardial vasodilation may precede coronary microvascular dysfunction.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101606"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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