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。
{"title":"Protocol for a prospective, multicenter, randomized, controlled trial comparing pulsed field ablation vs. cryoballoon ablation in patients with persistent atrial fibrillation (PEACE trial)","authors":"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","doi":"10.1016/j.ijcha.2025.101819","DOIUrl":"10.1016/j.ijcha.2025.101819","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Expected results</h3><div>We hypothesize that PFA will be non-inferior to CBA in terms of efficacy and safety.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101819"},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1016/j.ijcha.2025.101817
Yahui Li , Xindi Yue , Yidan Chen , Xuhui Liu , Xujie Wang , Ru Sun , Haojiang Li , Qingqing Li , Nianfang Luo , Feng Wang , Ling Zhou , Chunxia Zhao
Objectives
To identify predictors of intraoperative electrical cardioversion and develop a predictive model for patients undergoing radiofrequency ablation for atrial fibrillation (AF).
Methods
We retrospectively analyzed data from 1,348 patients with AF who underwent radiofrequency catheter ablation at Tongji Hospital between January 2018 and December 2023. Clinical, echocardiographic, and CT imaging data were collected. The Boruta algorithm and multivariable logistic regression were used to identify predictors and construct a nomogram. Model performance was assessed using the area under the ROC curve (AUC), calibration plots, and decision curve analysis (DCA). External validation was performed on 121 patients treated at Hubei No. 3 People’s Hospital of Jianghan University from June 2023 to February 2025.
Results
Patients were divided into training and validation sets (7:3 ratio). Five independent predictors were identified: AF type (OR = 13.63), valvular regurgitation (OR = 3.25), BMI (OR = 1.06), left atrial diameter (OR = 1.74), and systolic blood pressure (OR = 0.96). The nomogram showed excellent discriminative ability with AUCs of 0.881 (training), 0.879 (internal validation), and 0.866 (external validation). Calibration curves demonstrated good agreement between predicted and actual outcomes. DCA confirmed the model’s clinical utility.
Conclusions
The proposed nomogram accurately predicts the need for intraoperative electrical cardioversion during AF ablation and may aid in individualized procedural planning.
{"title":"Development and external validation of a nomogram to predict the need for electrical cardioversion during radiofrequency ablation in patients with atrial fibrillation","authors":"Yahui Li , Xindi Yue , Yidan Chen , Xuhui Liu , Xujie Wang , Ru Sun , Haojiang Li , Qingqing Li , Nianfang Luo , Feng Wang , Ling Zhou , Chunxia Zhao","doi":"10.1016/j.ijcha.2025.101817","DOIUrl":"10.1016/j.ijcha.2025.101817","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify predictors of intraoperative electrical cardioversion and develop a predictive model for patients undergoing radiofrequency ablation for atrial fibrillation (AF).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 1,348 patients with AF who underwent radiofrequency catheter ablation at Tongji Hospital between January 2018 and December 2023. Clinical, echocardiographic, and CT imaging data were collected. The Boruta algorithm and multivariable logistic regression were used to identify predictors and construct a nomogram. Model performance was assessed using the area under the ROC curve (AUC), calibration plots, and decision curve analysis (DCA). External validation was performed on 121 patients treated at Hubei No. 3 People’s Hospital of Jianghan University from June 2023 to February 2025.</div></div><div><h3>Results</h3><div>Patients were divided into training and validation sets (7:3 ratio). Five independent predictors were identified: AF type (OR = 13.63), valvular regurgitation (OR = 3.25), BMI (OR = 1.06), left atrial diameter (OR = 1.74), and systolic blood pressure (OR = 0.96). The nomogram showed excellent discriminative ability with AUCs of 0.881 (training), 0.879 (internal validation), and 0.866 (external validation). Calibration curves demonstrated good agreement between predicted and actual outcomes. DCA confirmed the model’s clinical utility.</div></div><div><h3>Conclusions</h3><div>The proposed nomogram accurately predicts the need for intraoperative electrical cardioversion during AF ablation and may aid in individualized procedural planning.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101817"},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267288","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}
Cardamonin is a natural chalcone compound. It has been shown to have various pharmacological properties. Cardamonin can activate the Nrf2 signaling pathway. Abdominal aortic aneurysm (AAA) is a complex degenerative aortic disease. Ruptured AAAs continue to be among the leading causes of sudden death in elderly individuals. No medical therapy has proven clinical benefits for preventing AAA progression. Therefore, an adjunctive medical therapy is essential to address this unmet clinical need.
Methods
Human aortic smooth muscle cells (HASMCs) were used to determine the molecular mechanism of cardamonin. A murine model of angiotensin II (AngII)-induced AAA was used to assess the therapeutic effects of cardamonin on AAA growth in apolipoprotein E knockout (ApoE KO) mice in vivo. Immunoblotting, senescence assays, and reactive oxygen species (ROS) production assays were used to determine the protective effects of cardamonin in vivo and in vitro.
Results
Cardamonin induced Nrf2 translocation from the cytosol to the nuclear compartment in HASMCs. Cardamonin reduced AngII-induced ROS production and matrix metalloproteinases (MMPs) overexpression through activation of the Nrf2/heme oxygenase-1 (HO-1) antioxidant pathway in HASMCs. Silencing HO-1 attenuated the anti-ROS effects of cardamonin and abolished the protective effects of cardamonin in AngII-challenged HASMCs. Cardamonin (20 mg/kg/day) reduced AngII-induced AAA in vivo. Cardamonin also reduced the overexpression of MMPs and the production of ROS and attenuated elastin degradation in aortic tissues.
Conclusion
Cardamonin inhibits the progression of AngII-induced AAA through Nrf2/HO-1-mediated antioxidant and anti-inflammatory pathways. Cardamonin could have the potential to be an adjunctive therapy for small AAAs.
小豆蔻素是一种天然查尔酮化合物。它已被证明具有多种药理特性。小豆蔻素可以激活Nrf2信号通路。腹主动脉瘤（AAA）是一种复杂的退行性主动脉疾病。AAAs破裂仍然是老年人猝死的主要原因之一。没有任何药物治疗被证实对预防AAA进展有临床益处。因此，辅助医学治疗对于解决这一未满足的临床需求至关重要。方法采用人主动脉平滑肌细胞（HASMCs）研究小豆蔻素的分子机制。采用血管紧张素II （AngII）诱导的小鼠AAA模型，在体内评估小豆蔻素对载脂蛋白E敲除（ApoE KO）小鼠AAA生长的治疗作用。采用免疫印迹、衰老测定和活性氧（ROS）产生测定来确定小豆蔻素在体内和体外的保护作用。结果scardamonin诱导Nrf2从HASMCs细胞质转移到核室。小豆蔻素通过激活Nrf2/血红素氧化酶-1 （HO-1）抗氧化途径，降低血管内皮细胞诱导的ROS生成和基质金属蛋白酶（MMPs）的过度表达。沉默HO-1可减弱小豆蔻素的抗ros作用，并消除小豆蔻素在血管损伤的HASMCs中的保护作用。小豆蔻素（20 mg/kg/day）在体内降低血管损伤诱导的AAA。小豆蔻素还能降低主动脉组织中MMPs的过表达和ROS的产生，并减弱弹性蛋白的降解。结论小豆蔻素通过Nrf2/ ho -1介导的抗氧化和抗炎途径抑制血管内皮细胞诱导的AAA的进展。小豆蔻素有可能成为小型AAAs的辅助治疗方法。
{"title":"Cardamonin attenuates angiotensin II-induced abdominal aortic aneurysms through activation of the Nrf2/HO-1 pathway","authors":"Hsiao-Ya Tsai , Yu-Juei Hsu , Chih-Yuan Lin , Po-Hsun Huang , Chin-Wang Hsu , Shih-Hung Tsai","doi":"10.1016/j.ijcha.2025.101815","DOIUrl":"10.1016/j.ijcha.2025.101815","url":null,"abstract":"<div><h3>Background</h3><div>Cardamonin is a natural chalcone compound. It has been shown to have various pharmacological properties. Cardamonin can activate the Nrf2 signaling pathway. Abdominal aortic aneurysm (AAA) is a complex degenerative aortic disease. Ruptured AAAs continue to be among the leading causes of sudden death in elderly individuals. No medical therapy has proven clinical benefits for preventing AAA progression. Therefore, an adjunctive medical therapy is essential to address this unmet clinical need.</div></div><div><h3>Methods</h3><div>Human aortic smooth muscle cells (HASMCs) were used to determine the molecular mechanism of cardamonin. A murine model of angiotensin II (AngII)-induced AAA was used to assess the therapeutic effects of cardamonin on AAA growth in apolipoprotein E knockout (ApoE KO) mice <em>in vivo</em>. Immunoblotting, senescence assays, and reactive oxygen species (ROS) production assays were used to determine the protective effects of cardamonin <em>in vivo</em> and <em>in vitro</em>.</div></div><div><h3>Results</h3><div>Cardamonin induced Nrf2 translocation from the cytosol to the nuclear compartment in HASMCs. Cardamonin reduced AngII-induced ROS production and matrix metalloproteinases (MMPs) overexpression through activation of the Nrf2/heme oxygenase-1 (HO-1) antioxidant pathway in HASMCs. Silencing HO-1 attenuated the anti-ROS effects of cardamonin and abolished the protective effects of cardamonin in AngII-challenged HASMCs. Cardamonin (20 mg/kg/day) reduced AngII-induced AAA <em>in vivo</em>. Cardamonin also reduced the overexpression of MMPs and the production of ROS and attenuated elastin degradation in aortic tissues.</div></div><div><h3>Conclusion</h3><div>Cardamonin inhibits the progression of AngII-induced AAA through Nrf2/HO-1-mediated antioxidant and anti-inflammatory pathways. Cardamonin could have the potential to be an adjunctive therapy for small AAAs.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101815"},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267287","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}
Systematic and integrated comorbidity management in patients with atrial fibrillation (AF) requires patient involvement, starting with comorbidity awareness. This study evaluates comorbidity awareness in patients with AF before and after a first nurse-led AF clinic visit and after six months. We also measured the time needed for full comorbidity mapping using the EHRA-PATHS software.
Methods
This prospective two-centre study included patients diagnosed with AF attending the AF clinic for the first time. The software systematically assessed 23 comorbidities. Patients completed a comorbidity awareness questionnaire, focusing on nine AF-related comorbidities two weeks before their first visit, less than a week after, and six months later. Patients also had a telephone consultation with the AF nurse to discuss their comorbidities 1–3 months post-visit.
Results
The study included 76 patients (mean age 68.3 ± 10.3 y). Baseline awareness of comorbidity relevance for AF ranged between 11.1–100.0 %. Awareness about own alcohol consumption was the most ‘underestimated’ comorbidity before first contact (50.0 %), while smoking was most ‘overestimated’ (55.6 %; i.e. admitted in private but not during formal evaluation by nurses). The impact of an AF clinic visit on awareness of personal comorbidities was limited (p = 0.456), and also after an additional phone consultation, awareness was suboptimal after six months (p = 0.099). AF nurses needed 18.4 ± 8.7 min to complete the software.
Conclusions
Patients’ comorbidity awareness is moderate, and more educational efforts are needed to improve their awareness. A systematic and complete comorbidity evaluation at the AF clinic using EHRA-PATHS software can be done within a reasonable time frame.
{"title":"Assessment of comorbidity awareness in patients with atrial fibrillation: The ACAPAF study","authors":"Rana Önder , Lien Desteghe , Johan Vijgen , Hein Heidbuchel","doi":"10.1016/j.ijcha.2025.101813","DOIUrl":"10.1016/j.ijcha.2025.101813","url":null,"abstract":"<div><h3>Background and aim</h3><div>Systematic and integrated comorbidity management in patients with atrial fibrillation (AF) requires patient involvement, starting with comorbidity awareness. This study evaluates comorbidity awareness in patients with AF before and after a first nurse-led AF clinic visit and after six months. We also measured the time needed for full comorbidity mapping using the EHRA-PATHS software.</div></div><div><h3>Methods</h3><div>This prospective two-centre study included patients diagnosed with AF attending the AF clinic for the first time. The software systematically assessed 23 comorbidities. Patients completed a comorbidity awareness questionnaire, focusing on nine AF-related comorbidities two weeks before their first visit, less than a week after, and six months later. Patients also had a telephone consultation with the AF nurse to discuss their comorbidities 1–3 months post-visit.</div></div><div><h3>Results</h3><div>The study included 76 patients (mean age 68.3 ± 10.3 y). Baseline awareness of comorbidity relevance for AF ranged between 11.1–100.0 %. Awareness about own alcohol consumption was the most ‘underestimated’ comorbidity before first contact (50.0 %), while smoking was most ‘overestimated’ (55.6 %; i.e. admitted in private but not during formal evaluation by nurses). The impact of an AF clinic visit on awareness of personal comorbidities was limited (p = 0.456), and also after an additional phone consultation, awareness was suboptimal after six months (p = 0.099). AF nurses needed 18.4 ± 8.7 min to complete the software.</div></div><div><h3>Conclusions</h3><div>Patients’ comorbidity awareness is moderate, and more educational efforts are needed to improve their awareness. A systematic and complete comorbidity evaluation at the AF clinic using EHRA-PATHS software can be done within a reasonable time frame.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101813"},"PeriodicalIF":2.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.ijcha.2025.101814
Paul C. Onyeji , Shivank Dani , Sonise Momplaisir-Onyeji , Miguel C. Lenzi , Paweł Łajczak , Felipe S. Passos , Leo Consoli , Hristo Kirov , Torsten Doenst , Tulio Caldonazo
Background
Aortic stenosis (AS) leads to pathological myocardial remodeling, particularly fibrosis, which contributes to adverse outcomes including heart failure, arrhythmias, and mortality. Evidence suggests sex-specific differences in fibrotic response, but individual studies are underpowered for definitive conclusions. This meta-analysis aimed to evaluate sex-related differences in myocardial fibrosis using cardiac magnetic resonance (CMR) parameters.
Methods
Three databases were searched for studies comparing male and female patients with AS reporting CMR-derived measures. The primary outcomes were late gadolinium enhancement (LGE%), infarct-related and non-infarct-related LGE, extracellular volume (ECV) and Septal E/e′. Effect sizes were expressed as risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes, each with 95% confidence intervals (CI), using random-effects models. Study quality was appraised with the Newcastle–Ottawa Scale, and certainty of evidence was graded using the GRADE framework.
Results
Seven studies (n = 2,105; 1,246 males) were included. No significant difference was observed in LGE% (MD 0.13; 95 %CI −0.93 to 1.18; p = 0.770), and risks of infarct-related LGE between sexes (RR 1.61; 95 %CI 0.90 to 2.89; p = 0.080). Males had higher risk of non-infarct LGE (RR 1.51; 95 %CI 1.34 to 1.70; p = 0.002). There were no significant differences in ECV (MD −0.45; 95 %CI −2.34 to 1.44; p = 0.506) and Septal E/e′ between sexes (MD −1.87; 95 %CI −4.05 to 0.32; p = 0.072).
Conclusion
This meta-analysis shows sex-related differences in myocardial fibrosis in AS, with men exhibiting more focal replacement fibrosis and women a tendency toward diffuse interstitial fibrosis. These patterns highlight the relevance of incorporating sex-specific factors into diagnosis and management.
主动脉狭窄（AS）导致病理性心肌重构，尤其是纤维化，导致心衰、心律失常和死亡等不良后果。证据表明，纤维化反应存在性别特异性差异，但个体研究不足以得出明确结论。本荟萃分析旨在利用心脏磁共振（CMR）参数评估心肌纤维化的性别相关差异。方法检索三个数据库，比较报告cmr衍生测量的男性和女性AS患者的研究。主要结局是晚期钆增强（LGE%）、梗死相关和非梗死相关LGE、细胞外体积（ECV）和间隔E/ E’。使用随机效应模型，用二元结果的风险比（RR）和连续结果的平均差异（MD）表示效应量，每个结果都有95%的置信区间（CI）。使用纽卡斯尔-渥太华量表评估研究质量，并使用GRADE框架对证据的确定性进行评分。结果纳入7项研究（n = 2105，男性1246）。LGE% （MD = 0.13; 95% CI = - 0.93 ~ 1.18; p = 0.770）和梗死相关LGE的风险在两性间无显著差异（RR = 1.61; 95% CI = 0.90 ~ 2.89; p = 0.080）。男性发生非梗死性LGE的风险较高（RR 1.51; 95% CI 1.34 ~ 1.70; p = 0.002）。两性间ECV （MD - 0.45, 95% CI - 2.34 ~ 1.44, p = 0.506）和鼻中隔E/ E′无显著差异（MD - 1.87, 95% CI - 4.05 ~ 0.32, p = 0.072）。这项荟萃分析显示了AS患者心肌纤维化的性别差异，男性表现出更多的局灶性替代纤维化，而女性倾向于弥漫性间质纤维化。这些模式突出了将性别特异性因素纳入诊断和管理的相关性。
{"title":"Sex-related differences in myocardial fibrosis among patients with aortic stenosis: A systematic review and meta-analysis","authors":"Paul C. Onyeji , Shivank Dani , Sonise Momplaisir-Onyeji , Miguel C. Lenzi , Paweł Łajczak , Felipe S. Passos , Leo Consoli , Hristo Kirov , Torsten Doenst , Tulio Caldonazo","doi":"10.1016/j.ijcha.2025.101814","DOIUrl":"10.1016/j.ijcha.2025.101814","url":null,"abstract":"<div><h3>Background</h3><div>Aortic stenosis (AS) leads to pathological myocardial remodeling, particularly fibrosis, which contributes to adverse outcomes including heart failure, arrhythmias, and mortality. Evidence suggests sex-specific differences in fibrotic response, but individual studies are underpowered for definitive conclusions. This <em>meta</em>-analysis aimed to evaluate sex-related differences in myocardial fibrosis using cardiac magnetic resonance (CMR) parameters.</div></div><div><h3>Methods</h3><div>Three databases were searched for studies comparing male and female patients with AS reporting CMR-derived measures. The primary outcomes were late gadolinium enhancement (LGE%), infarct-related and non-infarct-related LGE, extracellular volume (ECV) and Septal E/e′. Effect sizes were expressed as risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes, each with 95% confidence intervals (CI), using random-effects models. Study quality was appraised with the Newcastle–Ottawa Scale, and certainty of evidence was graded using the GRADE framework.</div></div><div><h3>Results</h3><div>Seven studies (n = 2,105; 1,246 males) were included. No significant difference was observed in LGE% (MD 0.13; 95 %CI −0.93 to 1.18; p = 0.770), and risks of infarct-related LGE between sexes (RR 1.61; 95 %CI 0.90 to 2.89; p = 0.080). Males had higher risk of non-infarct LGE (RR 1.51; 95 %CI 1.34 to 1.70; p = 0.002). There were no significant differences in ECV (MD −0.45; 95 %CI −2.34 to 1.44; p = 0.506) and Septal E/e′ between sexes (MD −1.87; 95 %CI −4.05 to 0.32; p = 0.072).</div></div><div><h3>Conclusion</h3><div>This <em>meta</em>-analysis shows sex-related differences in myocardial fibrosis in AS, with men exhibiting more focal replacement fibrosis and women a tendency toward diffuse interstitial fibrosis. These patterns highlight the relevance of incorporating sex-specific factors into diagnosis and management.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101814"},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/j.ijcha.2025.101804
Elfatih A. Hasabo , Niels van Royen , Ignacio J Amat-Santos , Martin Hudec , Matjaz Bunc , Alexander IJsselmuiden , Peep Laanmets , Daniel Unic , Bela Merkely , Renicus S Hermanides , Vlasis Ninios , Marcin Protasiewicz , Benno J W M Rensing , Pedro L Martin , Fausto Feres , Manuel De Sousa Almeida , Eric van Belle , Axel Linke , Alfonso Ielasi , Matteo Montorfano , Osama Soliman
Background
The quantitative videodensitometric aortography (QVDA) has reliably quantified post-TAVI aortic regurgitation (AR). However, this method has not yet been evaluated in randomized trials comparing various transcatheter heart valve (THV) systems. Here, we investigated the QVDA of AR following TAVI for severe aortic stenosis among Myval, Sapien, and Evolut THV series as part of the LANDMARK trial.
Methods
The final aortograms, either without or after balloon post-dilatation (BPD) were analyzed using the advanced CAAS-A-Valve 2.1.2 software. The regurgitant fraction (RF) was computed and categorized into none/trace AR (RF < 86 %), mild AR (6 % ≤ 8RF ≤ 817 %), and moderate/severe AR (RF > 17 %).
Results
Five hundred ninety-six final analyzable aortograms and 97 aortograms following BPD were included in the analysis. The BPD resulted in a significant reduction of RF in the Myval [12.0(6.0–18.5) vs 2.0(1.0, 5.5);p = 0.0002], Sapien[18.0(1.0–19.0) vs. 2.0(1.0–3.0); p = 0.04206] and Evolut [10.5 (6.0–15.0) vs 5.0 (1.0–8.0); p = 0.0009]. The rate of final RF > 17 % was lower in the Myval(2.0 %) compared to Evolut(8.00 %), but similar to the Sapien series (4.0 %)(PMyval-Sapien = 0.2333, PMyval-Evolut = 0.0057). In the as-treated population, the Myval series demonstrated a comparable RF to the Sapien series, but a significantly lower RF compared to the Evolut [Myval: 3.0 %(1.0–7.0), Sapien:3.0 %(1.0–7.0), Evolut:5.0 %(1.0–10.0)], PMyval-Sapien = 0.8997,PMyval-Evolut = 0.0010].
Conclusion
The QVDA highlights the superior performance of the Myval THV series compared to the Evolut THV series, with the lowest rate of moderate/severe RF among the three THV series, and could be used with echocardiography to help in detecting cases with none/trace AR.
{"title":"Quantitative videodensitometric assessment of aortic regurgitation in Myval, Sapien, and Evolut THV series: Results from the LANDMARK trial","authors":"Elfatih A. Hasabo , Niels van Royen , Ignacio J Amat-Santos , Martin Hudec , Matjaz Bunc , Alexander IJsselmuiden , Peep Laanmets , Daniel Unic , Bela Merkely , Renicus S Hermanides , Vlasis Ninios , Marcin Protasiewicz , Benno J W M Rensing , Pedro L Martin , Fausto Feres , Manuel De Sousa Almeida , Eric van Belle , Axel Linke , Alfonso Ielasi , Matteo Montorfano , Osama Soliman","doi":"10.1016/j.ijcha.2025.101804","DOIUrl":"10.1016/j.ijcha.2025.101804","url":null,"abstract":"<div><h3>Background</h3><div>The quantitative videodensitometric aortography (QVDA) has reliably quantified post-TAVI aortic regurgitation (AR). However, this method has not yet been evaluated in randomized trials comparing various transcatheter heart valve (THV) systems. Here, we investigated the QVDA of AR following TAVI for severe aortic stenosis among Myval, Sapien, and Evolut THV series as part of the LANDMARK trial.</div></div><div><h3>Methods</h3><div>The final aortograms, either without or after balloon post-dilatation (BPD) were analyzed using the advanced CAAS-A-Valve 2.1.2 software. The regurgitant fraction (RF) was computed and categorized into none/trace AR (RF < 86 %), mild AR (6 % ≤ 8RF ≤ 817 %), and moderate/severe AR (RF > 17 %).</div></div><div><h3>Results</h3><div>Five hundred ninety-six final analyzable aortograms and 97 aortograms following BPD were included in the analysis. The BPD resulted in a significant reduction of RF in the Myval [12.0(6.0–18.5) vs 2.0(1.0, 5.5);p = 0.0002], Sapien[18.0(1.0–19.0) vs. 2.0(1.0–3.0); p = 0.04206] and Evolut [10.5 (6.0–15.0) vs 5.0 (1.0–8.0); p = 0.0009]. The rate of final RF > 17 % was lower in the Myval(2.0 %) compared to Evolut(8.00 %), but similar to the Sapien series (4.0 %)(P<sub>Myval-Sapien</sub> = 0.2333, P<sub>Myval-Evolut</sub> = 0.0057). In the as-treated population, the Myval series demonstrated a comparable RF to the Sapien series, but a significantly lower RF compared to the Evolut [Myval: 3.0 %(1.0–7.0), Sapien:3.0 %(1.0–7.0), Evolut:5.0 %(1.0–10.0)], P<sub>Myval-Sapien</sub> = 0.8997,P<sub>Myval-Evolut</sub> = 0.0010].</div></div><div><h3>Conclusion</h3><div>The QVDA highlights the superior performance of the Myval THV series compared to the Evolut THV series, with the lowest rate of moderate/severe RF among the three THV series, and could be used with echocardiography to help in detecting cases with none/trace AR.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101804"},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220615","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}
{"title":"Decoding the coronary paradox of obesity: not all fat is equal!","authors":"Gaetano Santulli , Shivangi Pande , Pasquale Mone , Fahimeh Varzideh","doi":"10.1016/j.ijcha.2025.101807","DOIUrl":"10.1016/j.ijcha.2025.101807","url":null,"abstract":"","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101807"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158344","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}
Ischemic heart disease (IHD) is a disease with high mortality and disability. Numerous studies have established a significant correlation between IHD and sleep. This study aims to evaluate the quality of existing Mendelian randomization (MR) studies and integrate the results to provide an overview of the latest evidence on the causal relationship between sleep patterns and IHD. We conducted a comprehensive search of PubMed, Embase and Web of Science to identify MR studies related to IHD and sleep. Studies from database inception to September 9, 2024 were included. Following data extraction, we performed a rigorous quality evaluation and meta-analysis. Quality assessment was conducted through the Strengthening the Reporting of Observational Studies in Epidemiology using Mendelian Randomization (STROBE-MR) guidelines. Finally, we included 13 articles in the study. According to the quality assessment, the overall quality of the included literature was moderate. Meta-analysis showed that short sleep duration (≤6h, OR:1.22[1.16,1.28]; P < 0.001, I2 = 46.7 %), daytime napping (OR:1.63[1.26,2.12]; P < 0.001, I2 = 0.0 %), and sleep disorders (OR:1.44[1.29–1.60]; P < 0.001, I2 = 85.4 %) were positively associated with IHD, while extending sleep duration had a protective effect on IHD (OR:0.77[0.71,0.83]; P < 0.001, I2 = 0.0 %). These findings show the effect of sleep on IHD. Short sleep duration, daytime napping and sleep disorders increase the risk of IHD, and whereas extending sleep duration is beneficial for reducing the risk of IHD.
缺血性心脏病（IHD）是一种死亡率和致残率都很高的疾病。许多研究已经证实了IHD和睡眠之间的显著相关性。本研究旨在评估现有孟德尔随机化（MR）研究的质量，并整合研究结果，概述睡眠模式与IHD之间因果关系的最新证据。我们对PubMed， Embase和Web of Science进行了全面的搜索，以确定与IHD和睡眠相关的MR研究。纳入了从数据库建立到2024年9月9日的研究。在数据提取之后，我们进行了严格的质量评估和荟萃分析。质量评估通过孟德尔随机化（STROBE-MR）指南加强流行病学观察性研究报告进行。最后，我们纳入了13篇文章。根据质量评价，纳入文献的总体质量为中等。荟萃分析显示，短睡眠时间（≤6小时，OR:1.22[1.16,1.28]; P < 0.001, I2 = 46.7%）、白天午睡（OR:1.63[1.26,2.12]; P < 0.001, I2 = 0.0%）和睡眠障碍（OR:1.44[1.29-1.60]; P < 0.001, I2 = 85.4%）与IHD呈正相关，而延长睡眠时间对IHD有保护作用（OR:0.77[0.71,0.83]; P < 0.001, I2 = 0.0%）。这些发现显示了睡眠对IHD的影响。睡眠时间短、白天打盹和睡眠障碍会增加患IHD的风险，而延长睡眠时间则有利于降低患IHD的风险。
{"title":"Causal association between sleep duration, daytime napping, sleep disorders and ischemic heart disease: A systematic review and meta‑analysis of Mendelian randomization studies","authors":"Yi-Neng Shen , Zi-Ling Cai , Rui-Ting Jia , Ai-Song Zhu","doi":"10.1016/j.ijcha.2025.101811","DOIUrl":"10.1016/j.ijcha.2025.101811","url":null,"abstract":"<div><div>Ischemic heart disease (IHD) is a disease with high mortality and disability. Numerous studies have established a significant correlation between IHD and sleep. This study aims to evaluate the quality of existing Mendelian randomization (MR) studies and integrate the results to provide an overview of the latest evidence on the causal relationship between sleep patterns and IHD. We conducted a comprehensive search of PubMed, Embase and Web of Science to identify MR studies related to IHD and sleep. Studies from database inception to September 9, 2024 were included. Following data extraction, we performed a rigorous quality evaluation and <em>meta</em>-analysis. Quality assessment was conducted through the Strengthening the Reporting of Observational Studies in Epidemiology using Mendelian Randomization (STROBE-MR) guidelines. Finally, we included 13 articles in the study. According to the quality assessment, the overall quality of the included literature was moderate. Meta-analysis showed that short sleep duration (≤6h, OR:1.22[1.16,1.28]; <em>P</em> < 0.001, I<sup>2</sup> = 46.7 %), daytime napping (OR:1.63[1.26,2.12]; <em>P</em> < 0.001, I<sup>2</sup> = 0.0 %), and sleep disorders (OR:1.44[1.29–1.60]; <em>P</em> < 0.001, I<sup>2</sup> = 85.4 %) were positively associated with IHD, while extending sleep duration had a protective effect on IHD (OR:0.77[0.71,0.83]; <em>P</em> < 0.001, I<sup>2</sup> = 0.0 %). These findings show the effect of sleep on IHD. Short sleep duration, daytime napping and sleep disorders increase the risk of IHD, and whereas extending sleep duration is beneficial for reducing the risk of IHD.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101811"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158346","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}
{"title":"Role of ruxolitinib in preventing cardiac arrhythmias: A pooled analysis of clinical studies in hematology","authors":"Silvia Zaoli , Manish Khatri , Bjoern Holzhauer , Severine Peyrard , AnaRita Ferreira , Tommaso Stefanelli","doi":"10.1016/j.ijcha.2025.101810","DOIUrl":"10.1016/j.ijcha.2025.101810","url":null,"abstract":"","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101810"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158345","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}
Anemia is a common comorbidity associated with adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). However, the clinical relevance of new-onset anemia to sudden cardiac death (SCD) in patients with HFpEF remains unclear. This study investigated the association between new-onset anemia with ventricular arrhythmias (VAs) and SCD.
Methods
Anemia was defined as a hemoglobin (Hb) level of <13 g/dL in men and <12 g/dL in women. Patients with Hb levels above these thresholds were categorized as without anemia. We analyzed data of 686 patients with symptomatic HFpEF (ejection fraction ≥ 50 %, New York Heart Association class II–IV) without anemia at baseline from a multicenter prospective observational CHART-2 study. The primary endpoint was a composite of ventricular tachycardia, ventricular fibrillation, and SCD.
Results
At the 1-year follow-up, 109 patients developed new-onset anemia (median Hb, 11.9 g/dL), whereas 577 remained without anemia (median Hb, 14.0 g/dL). Over a median follow-up of 9.2 years, patients with new-onset anemia had a significantly higher incidence of composite outcomes (12.8 % vs. 5.2 %, P = 0.008). After adjusting for potential confounders, new-onset anemia was associated with an elevated risk of the composite outcome (adjusted hazard ratio 2.20, 95 % confidence interval 1.10–4.42, P = 0.027). The association between new-onset anemia and lethal arrhythmias was independent of heart failure hospitalization or myocardial infarction occurring before the primary endpoint.
Conclusions
New-onset anemia was significantly associated with an increased risk of VAs and SCD in patients with HFpEF, underscoring the importance of monitoring Hb levels for risk stratification.
背景：在保留射血分数（HFpEF）的心力衰竭患者中，贫血是一种常见的与不良结局相关的合并症。然而，HFpEF患者新发贫血与心源性猝死（SCD）的临床相关性尚不清楚。本研究探讨了新发贫血与室性心律失常（VAs）和SCD之间的关系。方法贫血定义为男性血红蛋白（Hb）水平为13 g/dL，女性血红蛋白（Hb）水平为12 g/dL。Hb水平高于这些阈值的患者被归类为无贫血。我们分析了来自一项多中心前瞻性观察性研究的686例基线时无贫血的症状性HFpEF（射血分数≥50%，纽约心脏协会II-IV级）患者的数据。主要终点是室性心动过速、室颤和SCD的复合。结果在1年的随访中，109例患者出现新发贫血（中位Hb为11.9 g/dL）， 577例患者未出现贫血（中位Hb为14.0 g/dL）。在9.2年的中位随访中，新发贫血患者的综合结局发生率明显更高（12.8% vs. 5.2%, P = 0.008）。在对潜在混杂因素进行校正后，新发贫血与复合结局的高风险相关（校正风险比2.20,95%置信区间1.10-4.42,P = 0.027）。新发贫血与致死性心律失常之间的关联与主要终点之前发生的心力衰竭住院或心肌梗死无关。结论HFpEF患者新发贫血与VAs和SCD风险增加显著相关，强调监测Hb水平对风险分层的重要性。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT00418041。
{"title":"New-onset anemia and its association with ventricular arrhythmias and sudden cardiac death in patients with heart failure with preserved ejection fraction","authors":"Tomohiro Ito , Kotaro Nochioka , Takashi Noda , Takashi Shiroto , Shinichi Yamanaka , Nobuhiko Yamamoto , Hiroyuki Sato , Takahiko Chiba , Makoto Nakano , Takumi Inoue , Kai Susukita , Hiroyuki Takahama , Jun Takahashi , Satoshi Miyata , Hiroaki Shimokawa , Satoshi Yasuda","doi":"10.1016/j.ijcha.2025.101812","DOIUrl":"10.1016/j.ijcha.2025.101812","url":null,"abstract":"<div><h3>Background</h3><div>Anemia is a common comorbidity associated with adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). However, the clinical relevance of new-onset anemia to sudden cardiac death (SCD) in patients with HFpEF remains unclear. This study investigated the association between new-onset anemia with ventricular arrhythmias (VAs) and SCD.</div></div><div><h3>Methods</h3><div>Anemia was defined as a hemoglobin (Hb) level of <13 g/dL in men and <12 g/dL in women. Patients with Hb levels above these thresholds were categorized as without anemia. We analyzed data of 686 patients with symptomatic HFpEF (ejection fraction ≥ 50 %, New York Heart Association class II–IV) without anemia at baseline from a multicenter prospective observational CHART-2 study. The primary endpoint was a composite of ventricular tachycardia, ventricular fibrillation, and SCD.</div></div><div><h3>Results</h3><div>At the 1-year follow-up, 109 patients developed new-onset anemia (median Hb, 11.9 g/dL), whereas 577 remained without anemia (median Hb, 14.0 g/dL). Over a median follow-up of 9.2 years, patients with new-onset anemia had a significantly higher incidence of composite outcomes (12.8 % vs. 5.2 %, P = 0.008). After adjusting for potential confounders, new-onset anemia was associated with an elevated risk of the composite outcome (adjusted hazard ratio 2.20, 95 % confidence interval 1.10–4.42, P = 0.027). The association between new-onset anemia and lethal arrhythmias was independent of heart failure hospitalization or myocardial infarction occurring before the primary endpoint.</div></div><div><h3>Conclusions</h3><div>New-onset anemia was significantly associated with an increased risk of VAs and SCD in patients with HFpEF, underscoring the importance of monitoring Hb levels for risk stratification.</div><div><strong>Registration:</strong> URL: <span><span>https://www.clinicaltrials.gov</span><svg><path></path></svg></span>; Unique identifier: NCT00418041.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101812"},"PeriodicalIF":2.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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