IJC Heart and Vasculature最新文献_第5页

Ascending aortic length across a large population presenting to the emergency room, a retrospective cross-sectional study 在急诊室对大量人群的升主动脉长度进行回顾性横断面研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2026-02-01 Epub Date: 2026-01-18 DOI: 10.1016/j.ijcha.2026.101874

Thomas Saliba , Gabriella Giandotti Gomar , Olivier Cappeliez , Yasser Alemán-Gómez , Guillaume Fahrni , David Rotzinger

Background

Aortic dissection often occurs at diameters below surgical thresholds, underscoring the need for better predictive markers. Ascending aortic length has emerged as a potential morphologic risk factor, but normal population data are limited. This study aimed to establish normative aortic length values by age and sex and develop a tool to predict dissection risk.

Methods

We retrospectively analyzed 1030 (986 without and 44 with type A dissection) emergency room patients (from 1,445 screened) who underwent ECG-gated thoracic CT angiography between 2019 and 2025, excluding those with prior aortic surgery or disease. Ascending aortic length, from the sinotubular junction to the brachiocephalic trunk, was measured using semi-automated centerline tools. Logistic and LASSO regression models estimated type A dissection probability based on aortic length, age, height, and sex.

Results

Mean ascending aortic length was 70.7 ± 11.6 mm in men and 64.1 ± 11.4 mm in women. Patients with acute type A dissection (n = 44) had significantly longer aortas (men: 93.9 ± 20.5 mm; women: 90.0 ± 18.5 mm; p < 0.001). Aortic length was the strongest independent predictor (OR = 1.13, 95 % CI 1.10–1.17, p < 0.001). A reduced model including only aortic length showed excellent discrimination (AUC = 0.871; sensitivity = 0.773; specificity = 0.867; PPV = 0.206; NPV = 0.988).

Conclusion

Ascending aortic length increases with age and is markedly greater in patients with acute type A dissection. We provide normative reference tables by age and sex and a logistic model for individualized risk estimation of dissection at the time of the exam.

背景：主动脉夹层通常发生在直径低于手术阈值的地方，因此需要更好的预测指标。升主动脉长度已成为潜在的形态学危险因素，但正常人群的数据有限。本研究旨在根据年龄和性别建立主动脉长度的标准值，并开发一种预测夹层风险的工具。方法回顾性分析2019年至2025年期间接受心电图门控胸部CT血管造影的1030例（986例无夹层，44例有A型夹层）急诊患者（筛选1445例），不包括既往主动脉手术或疾病患者。用半自动中心线工具测量从窦管交界处到头臂干的升主动脉长度。Logistic和LASSO回归模型根据主动脉长度、年龄、身高和性别估计A型夹层的概率。结果男性平均升主动脉长度为70.7±11.6 mm，女性平均升主动脉长度为64.1±11.4 mm。急性A型夹层患者（n = 44）主动脉明显较长（男性：93.9±20.5 mm；女性：90.0±18.5 mm; p < 0.001）。主动脉长度是最强的独立预测因子（OR = 1.13, 95% CI 1.10-1.17, p < 0.001）。仅包括主动脉长度的简化模型具有很好的鉴别效果（AUC = 0.871，灵敏度= 0.773，特异性= 0.867,PPV = 0.206, NPV = 0.988）。结论升主动脉长度随年龄增长而增加，急性A型夹层患者升主动脉长度明显增大。我们提供了按年龄和性别划分的规范性参考表，并建立了一个逻辑模型，用于在检查时进行个体化的解剖风险评估。

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引用次数: 0

Diagnostic performance and risk assessment of combined copeptin and high-sensitivity cardiac troponin I in Chinese emergency department 中国急诊科联合copeptin与高敏心肌肌钙蛋白I的诊断表现及风险评估

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-12-01 Epub Date: 2025-09-08 DOI: 10.1016/j.ijcha.2025.101793

Juan Sun , Xingtong Chen , Yitong Huang , Yongcai Tang , Yan Du , Xiaofan Gu , Jun Liao

Background

Rapid and early identification of acute myocardial infarction (AMI) is crucial for initiating timely treatment and assessing post-discharge risks. Copeptin’s unique release profile may help detect early myocardial damage, particularly when high-sensitivity cardiac troponin I (hs-cTnI) is undetectable. However, there is a limited understanding of copeptin’s application in the Chinese population, highlighting the need for further research.

Methods

A prospective cohort study was conducted, enrolling 414 consecutive patients presenting to the emergency department (ED) within 6 h of chest pain onset. Baseline clinical characteristics were recorded, and copeptin and hs-cTnI levels were measured from the initial blood draw. Patients were followed for 180 days to determine the occurrence of major adverse cardiovascular events (MACE). The final diagnosis was independently adjudicated by a panel of cardiologists blinded to copeptin results.

Results

Of 414 Chinese patients, 112 (27.05 %) had AMI. In hs-cTnI-undetectable patients, median copeptin was 290 pmol/L (IQR: 211–547) in STEMI and 130 pmol/L (IQR: 47.8–184) in NSTEMI. DBRS (copeptin/hs-cTnI dual-negative biomarker rule-out strategy) had higher AUC than single biomarkers (P < 0.05), with 100 % NPV (95 % CI: 95.86–100) for chest pain (3/6 h). Elevated copeptin (Hazard Ratio (HR) 3.65, 95 % CI: 2.35–5.67) and hs-cTnI (HR 1.69, 95 % CI: 1.36–2.10) independently predicted 180-day MACE (P < 0.001).

Conclusions

In Chinese patients, DBRS provided a safe and effective strategy for ruling out AMI. In addition, Combined negative results predicted safer 180-day post-discharge outcomes.

背景：快速和早期识别急性心肌梗死（AMI）对于及时开始治疗和评估出院后风险至关重要。Copeptin独特的释放谱可能有助于检测早期心肌损伤，特别是当高敏心肌肌钙蛋白I （hs-cTnI）检测不到时。然而，对copeptin在中国人群中的应用了解有限，需要进一步研究。方法进行前瞻性队列研究，纳入414例胸痛发作6小时内就诊于急诊科（ED）的患者。记录基线临床特征，并从首次抽血开始测量copeptin和hs-cTnI水平。随访180天，观察主要心血管不良事件（MACE）的发生情况。最终的诊断是由一组对copeptin结果不知情的心脏病专家独立裁决的。结果414例中国患者中有112例（27.05%）发生AMI。在hs- ctni未检测到的患者中，STEMI患者中位copeptin为290 pmol/L (IQR: 211-547)， NSTEMI患者中位copeptin为130 pmol/L （IQR: 47.8-184）。DBRS （copeptin/hs-cTnI双阴性生物标志物排除策略）的AUC高于单一生物标志物（P < 0.05），胸痛（3/6 h）的NPV为100% （95% CI: 95.86-100）。copeptin升高（风险比（HR） 3.65, 95% CI: 2.35-5.67）和hs-cTnI（风险比（HR） 1.69, 95% CI: 1.36-2.10）独立预测180天MACE （P < 0.001）。结论在中国患者中，DBRS为排除AMI提供了安全有效的策略。此外，综合阴性结果预测出院后180天的预后更安全。

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引用次数: 0

Atorvastatin pretreatment, ST-segment resolution and long-term prognosis for ST-segment elevation myocardial infarction with primary percutaneous coronary intervention 经皮冠状动脉介入治疗后st段抬高型心肌梗死的阿托伐他汀预处理、st段消退及远期预后

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-12-01 Epub Date: 2025-09-19 DOI: 10.1016/j.ijcha.2025.101808

Chao Wu , Pei Gao , Tiange Chen , Haiyan Xu , Xiang Li , Yan Wang , Honglei Zhao , Zhifang Wang , Guotong Xie , Yuejin Yang , Xiaojin Gao , Jingang Yang

Background

The benefit of statin pretreatment before primary percutaneous coronary intervention (PCI) on myocardial reperfusion and prognosis in ST-segment elevation myocardial infarction (STEMI) remains unclear. In this study, we evaluated whether atorvastatin pretreatment could improve ST-segment resolution (STR) and long-term clinical outcomes in this setting.

Methods

From the China Acute Myocardial Infarction Registry, we conducted propensity score matching to compare STR and 2-year major adverse cardiovascular events (MACE, all-cause death, reinfarction, and stroke) in 2426 STEMI patients undergoing primary PCI (1213 patients per group).

Results

Within the pretreatment group, 75, 726, 60, and 691 patients received 20 mg, 40 mg, 60 mg or 80 mg atorvastatin respectively. In the matched cohort of 2426 patients with available STR data (1213 pretreated), STR < 50 % occurred in 258 (21 %) patients in the control group versus 159 (13 %) in the pretreatment group (adjusted hazard ratio [HR]: 0.53; 95 % CI: 0.41–0.70). Multivariable analysis showed that atorvastatin pretreatment was significantly associated with lower 2-year MACE rates (6.9 % vs 8.7 %; adjusted HR: 0.68; 95 % CI: 0.48–0.97), which were consistent across multiple subgroups.

Conclusion

A single dose of atorvastatin pretreatment before primary PCI significantly improves myocardial reperfusion parameters and may be associated with long-term clinical benefits, supporting further validation in randomized trials.

背景：st段抬高型心肌梗死（STEMI）经皮冠状动脉介入治疗（PCI）前他汀类药物预处理对心肌再灌注和预后的益处尚不清楚。在这项研究中，我们评估了阿托伐他汀预处理是否可以改善st段分辨率（STR）和这种情况下的长期临床结果。方法来自中国急性心肌梗死登记，我们对2426例接受初级PCI治疗的STEMI患者（每组1213例）进行倾向评分匹配，比较STR和2年主要不良心血管事件（MACE、全因死亡、再梗死和卒中）。结果预处理组中，分别有75例、726例、60例和691例患者接受了20 mg、40 mg、60 mg或80 mg的阿托伐他汀治疗。在可获得STR数据的2426例患者（1213例预处理）的匹配队列中，对照组258例（21%）患者发生了50%的STR，而预处理组159例（13%）患者发生了50%的STR（校正风险比[HR]: 0.53; 95% CI: 0.41-0.70）。多变量分析显示，阿托伐他汀预处理与较低的2年MACE发生率显著相关（6.9% vs 8.7%；调整HR: 0.68; 95% CI: 0.48-0.97），这在多个亚组中是一致的。结论首次PCI术前单剂量阿托伐他汀预处理可显著改善心肌再灌注参数，可能与长期临床获益相关，支持在随机试验中进一步验证。

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引用次数: 0

Factor XIII and cardiovascular disease: biomarker, culprit or victim in acute myocardial infarction outcomes? 因子XIII与心血管疾病：急性心肌梗死结局的生物标志物、罪魁祸首还是受害者？

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-12-01 Epub Date: 2025-10-24 DOI: 10.1016/j.ijcha.2025.101827

Florian Bruns , Dobromir Dobrev , Anke C. Fender

引用次数: 0

Thoracic endovascular aortic repair for traumatic and non-traumatic rupture of the descending thoracic aorta: A 15-year single-centre experience 胸降主动脉外伤性和非外伤性破裂的血管内主动脉修复：15年的单中心经验

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-12-01 Epub Date: 2025-10-16 DOI: 10.1016/j.ijcha.2025.101818

Ricarda Berkenheide , Rolf Alexander Jánosi , Fadi Al-Rashid , Daniel Messiha , Konstantinos Tsagakis , Christos Rammos , Sharaf-Eldin Shehada , Payam Akhyari , Thomas Schlosser , Tienush Rassaf , Julia Lortz

Background

Ruptures of the descending thoracic aorta are life-threatening emergencies with traumatic and non-traumatic causes. Thoracic endovascular aortic repair (TEVAR) has become a key treatment, but long-term outcome data remain limited. This study aimed to review our experience with TEVAR in patients with traumatic or non-traumatic rupture and identify factors associated with post-TEVAR survival.

Methods

Between 2001 and 2016, 56 patients (21 with traumatic rupture and 35 with non-traumatic rupture) underwent TEVAR at the West-German Heart and Vascular Center Essen, Germany. Data examined included demographics, comorbidities, biomarker levels, imaging results, intervention details, complications, and outcomes (30 days and follow-up).

Results

Patients with non-traumatic rupture were significantly older and had more cardiovascular comorbidities. Patients with traumatic rupture presented more frequently with hemodynamic shock and mediastinal hematoma (47 %). Left subclavian artery coverage was more common in traumatic rupture (57.1 % vs. 18.2 %). Long-term aortic complications were more frequent in non-traumatic rupture (33.3 % vs. 0 %). Patients with traumatic rupture showed significantly longer survival. The overall 30-day mortality was 14.3 % (4.7 % in traumatic rupture patients vs. 20 % in non-traumatic rupture patients) and long-term mortality was 64.5 % (33.3 % in traumatic rupture patients vs. 84.2 % in non-traumatic rupture patients). Age, hypertension, complications, and the aetiology of aortic rupture significantly affected survival.

Conclusion

Patients with traumatic aortic rupture are younger, have healthier vessels, and show better outcomes after TEVAR. This may allow longer follow-up intervals in selected cases, while closer monitoring remains necessary for non-traumatic ruptures.

背景：胸降主动脉破裂是危及生命的紧急情况，有创伤性和非创伤性原因。胸主动脉血管内修复术（TEVAR）已成为一种关键的治疗方法，但长期疗效数据仍然有限。本研究旨在回顾我们在外伤性或非外伤性破裂患者中使用TEVAR的经验，并确定与TEVAR后生存相关的因素。方法2001年至2016年，56例患者（21例外伤性破裂，35例非外伤性破裂）在德国埃森西德心脏血管中心接受TEVAR治疗。检查的数据包括人口统计学、合并症、生物标志物水平、成像结果、干预细节、并发症和结果（30天和随访）。结果非外伤性破裂患者年龄较大，心血管合并症较多。外伤性破裂患者更常出现血流动力学休克和纵隔血肿（47%）。左侧锁骨下动脉覆盖在外伤性破裂中更为常见（57.1%对18.2%）。非外伤性主动脉破裂的长期并发症更为常见（33.3%比0%）。外伤性破裂患者的生存时间明显延长。总的30天死亡率为14.3%（创伤性破裂患者为4.7%，非创伤性破裂患者为20%），长期死亡率为64.5%（创伤性破裂患者为33.3%，非创伤性破裂患者为84.2%）。年龄，高血压，并发症和主动脉破裂的病因显著影响生存。结论外伤性主动脉破裂患者更年轻，血管更健康，TEVAR治疗效果更好。这可能允许更长的随访间隔在选定的情况下，而密切监测是非创伤性破裂仍然是必要的。

{"title":"Thoracic endovascular aortic repair for traumatic and non-traumatic rupture of the descending thoracic aorta: A 15-year single-centre experience","authors":"Ricarda Berkenheide , Rolf Alexander Jánosi , Fadi Al-Rashid , Daniel Messiha , Konstantinos Tsagakis , Christos Rammos , Sharaf-Eldin Shehada , Payam Akhyari , Thomas Schlosser , Tienush Rassaf , Julia Lortz","doi":"10.1016/j.ijcha.2025.101818","DOIUrl":"10.1016/j.ijcha.2025.101818","url":null,"abstract":"<div><h3>Background</h3><div>Ruptures of the descending thoracic aorta are life-threatening emergencies with traumatic and non-traumatic causes. Thoracic endovascular aortic repair (TEVAR) has become a key treatment, but long-term outcome data remain limited. This study aimed to review our experience with TEVAR in patients with traumatic or non-traumatic rupture and identify factors associated with post-TEVAR survival.</div></div><div><h3>Methods</h3><div>Between 2001 and 2016, 56 patients (21 with traumatic rupture and 35 with non-traumatic rupture) underwent TEVAR at the West-German Heart and Vascular Center Essen, Germany. Data examined included demographics, comorbidities, biomarker levels, imaging results, intervention details, complications, and outcomes (30 days and follow-up).</div></div><div><h3>Results</h3><div>Patients with non-traumatic rupture were significantly older and had more cardiovascular comorbidities. Patients with traumatic rupture presented more frequently with hemodynamic shock and mediastinal hematoma (47 %). Left subclavian artery coverage was more common in traumatic rupture (57.1 % vs. 18.2 %). Long-term aortic complications were more frequent in non-traumatic rupture (33.3 % vs. 0 %). Patients with traumatic rupture showed significantly longer survival. The overall 30-day mortality was 14.3 % (4.7 % in traumatic rupture patients vs. 20 % in non-traumatic rupture patients) and long-term mortality was 64.5 % (33.3 % in traumatic rupture patients vs. 84.2 % in non-traumatic rupture patients). Age, hypertension, complications, and the aetiology of aortic rupture significantly affected survival.</div></div><div><h3>Conclusion</h3><div>Patients with traumatic aortic rupture are younger, have healthier vessels, and show better outcomes after TEVAR. This may allow longer follow-up intervals in selected cases, while closer monitoring remains necessary for non-traumatic ruptures.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101818"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320617","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 : 2025-12-01 Epub 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":"2025-12-01","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

Transcatheter tricuspid valve intervention versus optimal medical therapy alone for severe tricuspid regurgitation: an updated meta-analysis with reconstructed time-to-event data 经导管三尖瓣干预与最佳药物治疗单独治疗严重三尖瓣反流：重建事件时间数据的最新荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-12-01 Epub Date: 2025-09-13 DOI: 10.1016/j.ijcha.2025.101794

Ahmed Ibrahim , Laila Shalabi , Sofian Zreigh , Shrouk Ramadan , Ahmed Samir , Mohamed Adel Elsawy , Mohamed Mahmoud Fathy , Belal Mohamed Hamed , Hossam Elbenawi , Mustafa Turkmani , Ahmed Y. Azzam , Hani Mahmoud-Elsayed , Islam Y. Elgendy

Background

Severe tricuspid regurgitation (TR) is strongly associated with high mortality and morbidity. This meta-analysis aims to compare the outcomes of transcatheter tricuspid valve intervention (TTVI) versus optimal medical treatment (OMT) alone among patients with severe TR.

Methods

Electronic databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched observational studies comparing TTVI with OMT. The primary outcome was all-cause mortality. Summary estimates were calculated using a random-effects model.

Results

Five studies (3 RCTs, 2 observational; n = 1988 patients) were included. TTVI was associated with a nonsignificant trend toward a lower incidence of all-cause mortality (risk ratio [RR]: 0.70, 95 % confidence interval [CI] 0.48–1.03; P = 0.071), primarily driven by observational studies. TTVI demonstrated significant benefits in terms of TR severity reduction (RR: 7.82, 95 % CI 5.60–10.93; P < 0.0001), enhanced health status as measured by the Kansas City Cardiomyopathy Questionnaire (mean difference: +14.46 points, 95 % CI 11.55–17.38; p < 0.0001), and reduced heart failure (HF) hospitalization rates (RR: 0.73, 95 % CI 0.56–0.96; P = 0.025). However, TTVI was associated with an increased risk of major bleeding (RR: 3.21, 95 % CI 1.61–6.39; P = 0.0009).

Conclusion

Among patients with severe TR, TTVI was not statistically associated with a lower incidence of all-cause mortality but was associated with a reduced risk of HF hospitalization, significant reduction in TR severity, and improved quality of life. Future large RCTs with extended follow-up are needed to confirm these findings and identify the subset of patients who benefit the most.

Systematic review protocol: CRD420251002402 (PROSPERO)

背景：严重三尖瓣反流（TR）与高死亡率和发病率密切相关。本荟萃分析旨在比较经导管三尖瓣介入治疗（TTVI）与单纯最佳药物治疗（OMT）在严重tr患者中的疗效。方法系统检索电子数据库，以确定比较TTVI与OMT的随机对照试验（rct）和倾向评分匹配的观察性研究。主要结局为全因死亡率。使用随机效应模型计算总估计值。结果共纳入5项研究（3项随机对照试验，2项观察性研究，n = 1988例）。TTVI与全因死亡率降低的无显著趋势相关（风险比[RR]: 0.70, 95%可信区间[CI] 0.48-1.03; P = 0.071），主要由观察性研究驱动。TTVI在TR严重程度降低（RR: 7.82, 95% CI 5.60-10.93; P < 0.0001）、堪萨斯城心肌病问卷测量的健康状况改善（平均差异：+14.46点，95% CI 11.55-17.38; P < 0.0001）和降低心力衰竭（HF）住院率方面显示出显著的益处（RR: 0.73, 95% CI 0.56-0.96; P = 0.025）。然而，TTVI与大出血风险增加相关（RR: 3.21, 95% CI 1.61-6.39; P = 0.0009）。结论在严重TR患者中，TTVI与全因死亡率的降低无统计学相关性，但与HF住院风险降低、TR严重程度显著降低和生活质量改善相关。未来需要大规模的随机对照试验来证实这些发现，并确定受益最大的患者亚群。系统评价方案：CRD420251002402 （PROSPERO）

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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 : 2025-12-01 Epub 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。

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引用次数: 0

Protocol for a prospective, multicenter, randomized, controlled trial comparing pulsed field ablation vs. cryoballoon ablation in patients with persistent atrial fibrillation (PEACE trial) 一项前瞻性、多中心、随机、对照试验，比较脉冲场消融与低温球囊消融治疗持续性房颤的方案（PEACE试验）

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-12-01 Epub Date: 2025-10-07 DOI: 10.1016/j.ijcha.2025.101819

Hidehira Fukaya , Jun Oikawa , Tomoharu Yoshizawa , Akira Satoh , Wataru Shinkai , Megumi Toraiwa , Sho Ogiso , Daiki Saito , Gen Matsuura , Shuhei Kobayashi , Yuki Arakawa , Hironori Nakamura , Naruya Ishizue , Jun Kishihara , Junya Ako

Background

Catheter ablation has become a standard treatment for atrial fibrillation (AF). However, evidence regarding the efficacy and safety of pulsed field ablation (PFA) in patients with persistent AF (PeAF) remains limited. The PEACE trial aims to evaluate the efficacy and safety of PFA compared to cryoballoon ablation (CBA) in PeAF.

Methods

This prospective, multicenter, open-label, randomized controlled, non-inferiority trial (NCT07064616, UMIN000057896) will enroll 300 patients with PeAF, randomly assigned (1:1) to undergo either PFA using the PulseSelect™ or cryoballoon ablation (CBA) using the Arctic Front Advance™. The primary efficacy endpoint is atrial tachyarrhythmia recurrence within 12 months. The primary safety endpoint is procedure-related complications within 30 days. Secondary outcomes include early recurrence, changes in LA diameter, natriuretic peptide levels, and patient-reported symptoms.

Expected results

We hypothesize that PFA will be non-inferior to CBA in terms of efficacy and safety.

Conclusions

The PEACE trial will provide essential data regarding the efficacy and safety of PFA compared to CBA in patients with PeAF, potentially informing future clinical practice.

背景：导管消融已成为房颤（AF）的标准治疗方法。然而，关于脉冲场消融（PFA）治疗持续性房颤（PeAF）的有效性和安全性的证据仍然有限。PEACE试验旨在评估PFA与低温球囊消融（CBA）在PeAF中的疗效和安全性。方法：这项前瞻性、多中心、开放标签、随机对照、非效性试验（NCT07064616, UMIN000057896）将招募300名PeAF患者，随机分配（1:1）接受使用PulseSelect™的PFA或使用Arctic Front Advance™的冷冻球球消融（CBA）。主要疗效终点为12个月内房性心动过速复发。主要安全终点是30天内手术相关并发症。次要结局包括早期复发、LA直径改变、利钠肽水平和患者报告的症状。预期结果我们假设PFA在疗效和安全性方面不逊于CBA。PEACE试验将提供关于PFA与CBA在PeAF患者中的疗效和安全性的基本数据，可能为未来的临床实践提供信息。

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引用次数: 0

Increased dipeptidyl peptidase 4 in patients with concomitant transthyretin cardiac amyloidosis and severe aortic stenosis 二肽基肽酶4在合并转甲状腺素型心脏淀粉样变性和严重主动脉瓣狭窄患者中的升高

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-12-01 Epub Date: 2025-10-08 DOI: 10.1016/j.ijcha.2025.101820

Margrethe Flesvig Holt , Annika E. Michelsen , August Flø , Kristoffer Russell , Jan Otto Beitnes , Sophie Foss Kløve , Anders Hodt , Lars Gullestad , Pål Aukrust , Einar Gude , Kaspar Broch , Thor Ueland

Background

Due to overlapping symptoms and signs, it can be challenging to diagnose transthyretin amyloid cardiomyopathy (ATTR-CM) in the setting of concomitant aortic stenosis. Biomarkers may discriminate between heart failure with ATTR-CM and heart failure without ATTR-CM, but it is not known if these markers can differentiate between AS with and AS without concomitant ATTR-CM.

Methods

In 9 patients with ATTR-CM and AS, 161 patients with lone AS, and 23 healthy controls, we measured 8 plasma proteins previously identified by proteomic analysis as potential candidates for diagnosing ATTR-CM. We assessed differences between groups and association with indices of heart failure and AS severity.

Results

Plasma levels of dipeptidyl peptidase 4 (DPP4) were significantly higher in patients with AS and ATTR-CM than in patients with lone AS and in healthy controls. Lower levels of DPP4 were also associated with worse left ventricular function, higher New York Heart Association functional class, and low-flow, low-gradient aortic stenosis.

Conclusions

Our findings suggest that DPP4 may be a marker of ATTR-CM in patients with severe AS. In all AS patients, those with and without coexisting ATTR-CM, high DPP4 levels were asociated with better cardiac function.

背景：由于症状和体征重叠，在合并主动脉狭窄的情况下诊断转甲状腺素淀粉样心肌病（atr - cm）可能具有挑战性。生物标志物可以区分合并atr - cm的心力衰竭和不合并atr - cm的心力衰竭，但尚不清楚这些标志物是否可以区分合并atr - cm的AS和不合并atr - cm的AS。方法在9例atr - cm合并AS患者、161例单独AS患者和23例健康对照中，检测了8种先前通过蛋白质组学分析确定的可能用于诊断atr - cm的血浆蛋白。我们评估了各组之间的差异以及与心力衰竭和AS严重程度指标的关联。结果AS合并atr - cm患者血浆二肽基肽酶4 （DPP4）水平明显高于单纯AS患者和健康对照组。较低水平的DPP4也与较差的左心室功能、较高的纽约心脏协会功能等级和低流量、低梯度主动脉瓣狭窄相关。结论DPP4可能是重度AS患者atr - cm的标志物。在所有AS患者中，无论是否伴有atr - cm，高DPP4水平与更好的心功能相关。

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引用次数: 0