Pub Date : 2025-12-01Epub Date: 2025-10-26DOI: 10.1016/j.ijcha.2025.101830
Mengyuan Che , Liuliu Feng , Xinbing Liu , Liangfeng Zhao , Suying Zhou , Xinyu Zhong , Lingsen You , Yu Wang
The occurrence of in-stent restenosis (ISR) is closely associated with abnormal distribution of endothelial shear stress (ESS), and optimizing stent design is crucial for improving patient prognosis. This review aims to comprehensively explore how stent design parameters—including geometric structure and surface functionalization—influence neointimal hyperplasia and thrombosis by modulating ESS, while also summarizing the latest technological strategies. A detailed discussion is provided on the design evolution from traditional coronary stents to for non-coronary arteries (cerebral aneurysm) micro-woven stents, analyzing the mechanisms by which factors such as streamlined profiles, reduced strut thickness, and optimized spacing improve hemodynamics. Furthermore, the article critically evaluates the advantages and current limitations of cutting-edge technologies such as computational fluid dynamics (CFD)-based optimization and endothelialization-promoting functional coatings. We conclude that multidimensional stent design optimization represents a future trend in regulating ESS and suppressing restenosis. Future research should focus on integrating personalized design with highly biocompatible materials to advance the clinical translation of next-generation vascular stents.
{"title":"Multidimensional optimization of stent design for endothelial shear stress regulation: Geometric structuring, surface functionalization strategies to mitigate thrombosis and restenosis","authors":"Mengyuan Che , Liuliu Feng , Xinbing Liu , Liangfeng Zhao , Suying Zhou , Xinyu Zhong , Lingsen You , Yu Wang","doi":"10.1016/j.ijcha.2025.101830","DOIUrl":"10.1016/j.ijcha.2025.101830","url":null,"abstract":"<div><div>The occurrence of in-stent restenosis (ISR) is closely associated with abnormal distribution of endothelial shear stress (ESS), and optimizing stent design is crucial for improving patient prognosis. This review aims to comprehensively explore how stent design parameters—including geometric structure and surface functionalization—influence neointimal hyperplasia and thrombosis by modulating ESS, while also summarizing the latest technological strategies. A detailed discussion is provided on the design evolution from traditional coronary stents to for non-coronary arteries (cerebral aneurysm) micro-woven stents, analyzing the mechanisms by which factors such as streamlined profiles, reduced strut thickness, and optimized spacing improve hemodynamics. Furthermore, the article critically evaluates the advantages and current limitations of cutting-edge technologies such as computational fluid dynamics (CFD)-based optimization and endothelialization-promoting functional coatings. We conclude that multidimensional stent design optimization represents a future trend in regulating ESS and suppressing restenosis. Future research should focus on integrating personalized design with highly biocompatible materials to advance the clinical translation of next-generation vascular stents.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101830"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416940","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":"2025-12-01","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}
Pub Date : 2025-12-01Epub Date: 2025-09-13DOI: 10.1016/j.ijcha.2025.101798
Ya-li Zhu , Lai Wei , Xu Wang , Yong Zhou , Jun Pu
Background
Systemic immune-inflammation index (SII), calculated as platelet count × neutrophil count/lymphocyte count, is a novel and easily accessible inflammatory marker. Its prognostic value in predicting infarct size and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains to be fully explored.
Methods
We analyzed 421 patients who underwent primary percutaneous coronary intervention (PCI) within 12 h of symptom onset, enrolled in a prospective multicenter registry (NCT03768453).All patients received immediate admission blood tests for SII calculation (platelet × neutrophil/lymphocyte counts) and completed standardized CMR imaging within 10 days post-PCI.Receiver operating characteristic (ROC) analysis identified the optimal SII cut-off value (914) to predict large infarct size (≥20 % of left ventricular mass). Patients were stratified into high (≥914) and low (<914) SII groups. The relationships between SII, infarct size, and MACE were analyzed using multivariate logistic and Cox regression models.
Results
Patients with high SII had significantly larger infarct size (median 29.0 % vs. 22.3 %, p < 0.001). SII ≥ 914 was independently associated with large infarct size (OR 1.889, 95 %CI: 1.100–3.242, p = 0.021) and higher incidence of MACE (HR 1.874, 95 % CI: 1.255–2.796, p = 0.002).
Conclusions
Elevated SII (≥914) independently associates with larger infarct size and increased MACE risk post-PCI, suggesting potential utility in risk stratification.
系统免疫炎症指数（SII）是一种新的、容易获得的炎症标志物，由血小板计数×中性粒细胞计数/淋巴细胞计数计算而成。其预测st段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后梗死面积和主要不良心血管事件（MACE）的预后价值仍有待充分探讨。方法：我们分析了421例在症状出现12小时内接受了原发性经皮冠状动脉介入治疗（PCI）的患者，这些患者被纳入前瞻性多中心登记（NCT03768453）。所有患者在pci术后10天内立即接受血液检查进行SII计算（血小板×中性粒细胞/淋巴细胞计数），并完成标准化CMR成像。受试者工作特征（ROC）分析确定了预测大面积梗死（≥左心室质量的20%）的最佳SII临界值（914）。将患者分为高（≥914）和低（<914） SII组。采用多变量logistic和Cox回归模型分析SII、梗死面积和MACE之间的关系。结果SII高的患者梗死面积明显增大（中位数分别为29.0%和22.3%,p < 0.001）。SII≥914与较大的梗死面积（OR 1.889, 95% CI: 1.100-3.242, p = 0.021）和较高的MACE发生率（HR 1.874, 95% CI: 1.255-2.796, p = 0.002）独立相关。结论SII升高（≥914）与pci后梗死面积增大和MACE风险增加独立相关，提示在风险分层中有潜在的应用价值。
{"title":"Prognostic impact of systemic immune-inflammation index (SII) on infarct size and clinical outcomes in patients with ST-segment elevation myocardial infarction","authors":"Ya-li Zhu , Lai Wei , Xu Wang , Yong Zhou , Jun Pu","doi":"10.1016/j.ijcha.2025.101798","DOIUrl":"10.1016/j.ijcha.2025.101798","url":null,"abstract":"<div><h3>Background</h3><div>Systemic immune-inflammation index (SII), calculated as platelet count × neutrophil count/lymphocyte count, is a novel and easily accessible inflammatory marker. Its prognostic value in predicting infarct size and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains to be fully explored.</div></div><div><h3>Methods</h3><div>We analyzed 421 patients who underwent primary percutaneous coronary intervention (PCI) within 12 h of symptom onset, enrolled in a prospective multicenter registry (NCT03768453).All patients received immediate admission blood tests for SII calculation (platelet × neutrophil/lymphocyte counts) and completed standardized CMR imaging within 10 days post-PCI.Receiver operating characteristic (ROC) analysis identified the optimal SII cut-off value (914) to predict large infarct size (≥20 % of left ventricular mass). Patients were stratified into high (≥914) and low (<914) SII groups. The relationships between SII, infarct size, and MACE were analyzed using multivariate logistic and Cox regression models.</div></div><div><h3>Results</h3><div>Patients with high SII had significantly larger infarct size (median 29.0 % vs. 22.3 %, p < 0.001). SII ≥ 914 was independently associated with large infarct size (OR 1.889, 95 %CI: 1.100–3.242, p = 0.021) and higher incidence of MACE (HR 1.874, 95 % CI: 1.255–2.796, p = 0.002).</div></div><div><h3>Conclusions</h3><div>Elevated SII (≥914) independently associates with larger infarct size and increased MACE risk post-PCI, suggesting potential utility in risk stratification.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101798"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049167","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 : 2025-12-01Epub Date: 2025-11-08DOI: 10.1016/j.ijcha.2025.101841
Massimo Imazio , Francesco Venturelli , Maria Cristina Tomat , Giulio Savonitto , Davide Stolfo , Valentino Collini
Pericarditis is an inflammation of the pericardial sac with different aetiologies. While often self-limited, up to 30 % of cases recur or become chronic, causing significant morbidity. Traditional treatments – nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids – have important limitations, including steroid dependence, high recurrence rates, and side effects. Accordingly, new targeted immunomodulatory therapies are under investigation to improve outcomes in refractory pericarditis. This review outlines the epidemiology and burden of pericarditis, current management and its shortcomings, and the rationale for novel therapies. We then discuss emerging therapeutic agents in development (biologics and small molecules), focusing on phase II/III candidates. The central role of interleukin-1 (IL-1) and related inflammasome pathways in pericardial inflammation provides a strong rationale for these targeted treatments. Key trials of IL-1 inhibitors (anakinra, rilonacept, canakinumab, goflikicept) have demonstrated dramatic reductions in recurrence rates, validating IL-1 as a therapeutic target. Other innovative approaches – such as NLRP3 inflammasome inhibitors and a cannabinoid-based agent – offer the prospect of oral, steroid-sparing therapy. We highlight the current challenges in developing these therapies, including heterogeneous disease causes, safety concerns, and trial design issues. Overall, the therapeutic pipeline for pericarditis is robust and poised to transform management. In the coming years, integration of targeted biologics and small molecules alongside conventional anti-inflammatories may significantly improve outcomes in recurrent pericarditis, moving towards more precise and effective treatment strategies.
{"title":"Pericarditis at the crossroads: Unlocking the next wave of therapies","authors":"Massimo Imazio , Francesco Venturelli , Maria Cristina Tomat , Giulio Savonitto , Davide Stolfo , Valentino Collini","doi":"10.1016/j.ijcha.2025.101841","DOIUrl":"10.1016/j.ijcha.2025.101841","url":null,"abstract":"<div><div>Pericarditis is an inflammation of the pericardial sac with different aetiologies. While often self-limited, up to 30 % of cases recur or become chronic, causing significant morbidity. Traditional treatments – nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids – have important limitations, including steroid dependence, high recurrence rates, and side effects. Accordingly, new targeted immunomodulatory therapies are under investigation to improve outcomes in refractory pericarditis. This review outlines the epidemiology and burden of pericarditis, current management and its shortcomings, and the rationale for novel therapies. We then discuss emerging therapeutic agents in development (biologics and small molecules), focusing on phase II/III candidates. The central role of interleukin-1 (IL-1) and related inflammasome pathways in pericardial inflammation provides a strong rationale for these targeted treatments. Key trials of IL-1 inhibitors (anakinra, rilonacept, canakinumab, goflikicept) have demonstrated dramatic reductions in recurrence rates, validating IL-1 as a therapeutic target. Other innovative approaches – such as NLRP3 inflammasome inhibitors and a cannabinoid-based agent – offer the prospect of oral, steroid-sparing therapy. We highlight the current challenges in developing these therapies, including heterogeneous disease causes, safety concerns, and trial design issues. Overall, the therapeutic pipeline for pericarditis is robust and poised to transform management. In the coming years, integration of targeted biologics and small molecules alongside conventional anti-inflammatories may significantly improve outcomes in recurrent pericarditis, moving towards more precise and effective treatment strategies.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101841"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-20DOI: 10.1016/j.ijcha.2025.101836
Riaz Jiffry , Ankit Gupta , Jeisun Poornaselvan , Valerie Mok , Arkadeep Dhali , Aditi Gupta , Tong Liu , Gary Tse , Helen Ye Rim Huang
Fatty acid-binding proteins (FABPs) are intracellular lipid-binding proteins that significantly contribute to the transport and metabolism of long-chain fatty acids and other hydrophobic ligands. In this review, we focus on the role of heart-type FABP (H-FABPs) as diagnostic and prognostic biomarkers in several cardiovascular diseases. Despite its advantages over troponins and other cardiac biomarkers, H-FABP remains underutilized in clinical practice. The aim of this review is to reassess the role of H-FABPs across various cardiovascular pathologies and promote their adoption into standard clinical practice. Elevated H-FABP levels have been associated with worse outcomes in CAD and serve as sensitive markers for myocardial injury during the early stages of MI and reperfusion. Furthermore, we discuss the potential of H-FABPs in risk stratification for stable CAD and their utility in predicting long-term outcomes post-MI. The prognostic value of H-FABP in cardiac events such as heart failure, pulmonary embolism, and arrhythmias, alongside its application in peripheral arterial disease and non-ischemic dilated cardiomyopathy, highlights its importance in cardiovascular medicine. Given the global burden of cardiovascular diseases, understanding and utilising H-FABPs could enhance patient management through better risk assessment and early diagnosis.
{"title":"Diagnostic and prognostic utility of heart-type fatty acid binding proteins in cardiovascular diseases and risk factors − an updated review of the literature","authors":"Riaz Jiffry , Ankit Gupta , Jeisun Poornaselvan , Valerie Mok , Arkadeep Dhali , Aditi Gupta , Tong Liu , Gary Tse , Helen Ye Rim Huang","doi":"10.1016/j.ijcha.2025.101836","DOIUrl":"10.1016/j.ijcha.2025.101836","url":null,"abstract":"<div><div>Fatty acid-binding proteins (FABPs) are intracellular lipid-binding proteins that significantly contribute to the transport and metabolism of long-chain fatty acids and other hydrophobic ligands. In this review, we focus on the role of heart-type FABP (H-FABPs) as diagnostic and prognostic biomarkers in several cardiovascular diseases. Despite its advantages over troponins and other cardiac biomarkers, H-FABP remains underutilized in clinical practice. The aim of this review is to reassess the role of H-FABPs across various cardiovascular pathologies and promote their adoption into standard clinical practice. Elevated H-FABP levels have been associated with worse outcomes in CAD and serve as sensitive markers for myocardial injury during the early stages of MI and reperfusion. Furthermore, we discuss the potential of H-FABPs in risk stratification for stable CAD and their utility in predicting long-term outcomes post-MI. The prognostic value of H-FABP in cardiac events such as heart failure, pulmonary embolism, and arrhythmias, alongside its application in peripheral arterial disease and non-ischemic dilated cardiomyopathy, highlights its importance in cardiovascular medicine. Given the global burden of cardiovascular diseases, understanding and utilising H-FABPs could enhance patient management through better risk assessment and early diagnosis.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101836"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684761","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 : 2025-12-01Epub Date: 2025-09-25DOI: 10.1016/j.ijcha.2025.101805
Yu-Shan Huang , Li-Wei Lo , Tsung-Ying Tsai , Hsin-Bang Leu , Shih-Ann Chen
Background
Although air pollutants are linked to cardiopulmonary mortality, their impact on cardiac arrhythmias is not well understood. This study examines the short-term effects of air pollution on emergency admissions for acute atrial fibrillation (AF) in Taiwan.
Methods
This study used Taiwan’s National Health Insurance Research Database, including 16,778,374 participants aged 20 and older, residing in the same districts during 10-year follow-ups from 2008 to 2017. Hourly air pollutant exposure data were obtained from the Taiwan Environmental Protection Administration Database. Records of patients with ICD-9 code 427.31 (AF) as the primary diagnosis from emergency departments were extracted. Emergency visits for AF were compared across exposures to pollutants such as particulate matter PM2.5, PM10, Nitrogen Dioxide (NO2), Nitrogen Oxide (NO), Nitrogen Oxides (NOX), Sulphur Dioxide (SO2), Carbon monoxide (CO) and Ozone (O3).
Results
In our study cohort of 16,778,374 patients, 129,595 (0.77 %) were admitted to emergency departments for initial AF episodes. Significant associations were found between AF visits and PM2.5 (1.01 %; CI: 1.00–1.02 %; P = 0.003), PM10 (1.01 %; CI: 1.00–1.01 %; P = 0.001), NO2 (1.02 %; CI: 1.00–1.03 %; P = 0.001), NO (1.02 %; CI: 1.00–1.04 %; P = 0.016), NOx (1.01 %; CI: 1.00–1.01 %; P = 0.002), CO (1.05 %; CI: 1.00–1.11 %; P < 0.0001), with exposure levels on the event day compared to the previous 5 days. Except for O3, patients without comorbidities like coronary artery disease, heart failure, chronic kidney disease, and thyroid disease were more susceptible to air pollution.
Conclusions
High concentrations of ambient air pollutants with short-term exposure are linked to an increased number of emergency room visits for acute AF attacks.
虽然空气污染物与心肺死亡有关，但其对心律失常的影响尚不清楚。本研究探讨空气污染对台湾急症心房颤动（AF）入院的短期影响。方法本研究使用台湾全民健康保险研究数据库，包括16778374名20岁及以上的参与者，他们在2008年至2017年的10年随访期间居住在同一地区。每小时空气污染物暴露数据来自台湾环境保护署数据库。提取急诊科以ICD-9编码427.31 （AF）为首发诊断的患者记录。在暴露于PM2.5、PM10、二氧化氮（NO2）、氮氧化物（NO）、氮氧化物（NOX）、二氧化硫（SO2）、一氧化碳（CO）和臭氧（O3）等污染物的情况下，比较了房颤的急诊就诊情况。结果在我们的研究队列中，16778,374例患者中，129,595例（0.77%）因房颤发作入院急诊。与前5天的暴露水平相比，AF就诊与PM2.5 （1.01%, CI: 1.00 - 1.02%, P = 0.003）、PM10 （1.01%, CI: 1.00 - 1.01%, P = 0.001）、NO2 （1.02%, CI: 1.00 - 1.03%, P = 0.001）、NO （1.02%, CI: 1.00 - 1.04%, P = 0.016）、NOx （1.01%, CI: 1.00 - 1.04%, P = 0.002）、CO （1.05%, CI: 1.00 - 1.11%, P < 0.0001）存在显著相关性。除O3外，无冠状动脉疾病、心力衰竭、慢性肾脏疾病和甲状腺疾病等合并症的患者更容易受到空气污染的影响。结论短期暴露于高浓度环境空气污染物与急性房颤急诊次数增加有关。
{"title":"Short‑term effects of ambient air pollution exposure on hospital emergency room visits for atrial fibrillation: a nationwide cohort study","authors":"Yu-Shan Huang , Li-Wei Lo , Tsung-Ying Tsai , Hsin-Bang Leu , Shih-Ann Chen","doi":"10.1016/j.ijcha.2025.101805","DOIUrl":"10.1016/j.ijcha.2025.101805","url":null,"abstract":"<div><h3>Background</h3><div>Although air pollutants are linked to cardiopulmonary mortality, their impact on cardiac arrhythmias is not well understood. This study examines the short-term effects of air pollution on emergency admissions for acute atrial fibrillation (AF) in Taiwan.</div></div><div><h3>Methods</h3><div>This study used Taiwan’s National Health Insurance Research Database, including 16,778,374 participants aged 20 and older, residing in the same districts during 10-year follow-ups from 2008 to 2017. Hourly air pollutant exposure data were obtained from the Taiwan Environmental Protection Administration Database. Records of patients with ICD-9 code 427.31 (AF) as the primary diagnosis from emergency departments were extracted. Emergency visits for AF were compared across exposures to pollutants such as particulate matter PM<sub>2.5</sub>, PM<sub>10</sub>, Nitrogen Dioxide (NO<sub>2</sub>), Nitrogen Oxide (NO), Nitrogen Oxides (NO<sub>X</sub>), Sulphur Dioxide (SO<sub>2</sub>), Carbon monoxide (CO) and Ozone (O<sub>3</sub>).</div></div><div><h3>Results</h3><div>In our study cohort of 16,778,374 patients, 129,595 (0.77 %) were admitted to emergency departments for initial AF episodes. Significant associations were found between AF visits and PM<sub>2.5</sub> (1.01 %; CI: 1.00–1.02 %; P = 0.003), PM<sub>10</sub> (1.01 %; CI: 1.00–1.01 %; P = 0.001), NO<sub>2</sub> (1.02 %; CI: 1.00–1.03 %; P = 0.001), NO (1.02 %; CI: 1.00–1.04 %; P = 0.016), NO<sub>x</sub> (1.01 %; CI: 1.00–1.01 %; P = 0.002), CO (1.05 %; CI: 1.00–1.11 %; P < 0.0001), with exposure levels on the event day compared to the previous 5 days. Except for O<sub>3</sub>, patients without comorbidities like coronary artery disease, heart failure, chronic kidney disease, and thyroid disease were more susceptible to air pollution.</div></div><div><h3>Conclusions</h3><div>High concentrations of ambient air pollutants with short-term exposure are linked to an increased number of emergency room visits for acute AF attacks.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101805"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158347","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 : 2025-12-01Epub Date: 2025-09-24DOI: 10.1016/j.ijcha.2025.101809
Marius Mølsted Flege , Theresa Kleinschmidt , Susanne Hansen , Kristoffer Jarlov Jensen , Henrik Kjærulf Jensen , Morten Krogh Christiansen , Charlotte Ottar Merland , Janne Petersen
Background
Following myocardial infarction (MI), patients are recommended to lower their low-density lipid cholesterol (LDL-C) levels and undergo cardiac rehabilitation to prevent recurrent events. Although lowering LDL-C is vital post-MI, many patients fail reaching sufficient levels, resulting in recurrent cardiovascular events. The aim of the study was therefore to investigate the follow-up and the utilisation of lipid lowering therapy one year after MI.
Methods
This register-based nationwide Danish observational study included all hospitalized patients with an incident MI from 2018 to 2021, discharged alive. Patients were followed for one year after discharge with respect to LDL-C measurements, contacts with different healthcare actors, and lipid lowering therapy.
Results
A total of 24,977 patients were included. During follow-up, the incidence of having an LDL-C measured once and twice were 87 % and 67 %, respectively. The incidence of patients visiting a cardiology department, general practitioner with an LDL-C measurement, and having an acute hospital contact were 66 %, 70 %, and 48 %. Statin therapy was redeemed by most patients at least once (87 %) or twice (82 %), while ezetimibe (16 %) and other drugs were prescribed less frequently. Younger, higher educated, less comorbid males with LDL-C ≥ 1.4 mmol/L at hospitalization were more likely to be followed-up with LDL-C measurement or visit to a cardiology department post-MI.
Conclusion
These findings show that a large proportion of patients are not receiving lipid lowering therapy or are not monitored according to guidelines one year after an MI. This suggests a further need for monitoring MI patients with LDL-C levels and healthcare visits.
{"title":"Care pathway in patients after myocardial infarction in Denmark − healthcare and drug utilization","authors":"Marius Mølsted Flege , Theresa Kleinschmidt , Susanne Hansen , Kristoffer Jarlov Jensen , Henrik Kjærulf Jensen , Morten Krogh Christiansen , Charlotte Ottar Merland , Janne Petersen","doi":"10.1016/j.ijcha.2025.101809","DOIUrl":"10.1016/j.ijcha.2025.101809","url":null,"abstract":"<div><h3>Background</h3><div>Following myocardial infarction (MI), patients are recommended to lower their low-density lipid cholesterol (LDL-C) levels and undergo cardiac rehabilitation to prevent recurrent events. Although lowering LDL-C is vital post-MI, many patients fail reaching sufficient levels, resulting in recurrent cardiovascular events. The aim of the study was therefore to investigate the follow-up and the utilisation of lipid lowering therapy one year after MI.</div></div><div><h3>Methods</h3><div>This register-based nationwide Danish observational study included all hospitalized patients with an incident MI from 2018 to 2021, discharged alive. Patients were followed for one year after discharge with respect to LDL-C measurements, contacts with different healthcare actors, and lipid lowering therapy.</div></div><div><h3>Results</h3><div>A total of 24,977 patients were included. During follow-up, the incidence of having an LDL-C measured once and twice were 87 % and 67 %, respectively. The incidence of patients visiting a cardiology department, general practitioner with an LDL-C measurement, and having an acute hospital contact were 66 %, 70 %, and 48 %. Statin therapy was redeemed by most patients at least once (87 %) or twice (82 %), while ezetimibe (16 %) and other drugs were prescribed less frequently. Younger, higher educated, less comorbid males with LDL-C ≥ 1.4 mmol/L at hospitalization were more likely to be followed-up with LDL-C measurement or visit to a cardiology department post-MI.</div></div><div><h3>Conclusion</h3><div>These findings show that a large proportion of patients are not receiving lipid lowering therapy or are not monitored according to guidelines one year after an MI. This suggests a further need for monitoring MI patients with LDL-C levels and healthcare visits.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101809"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118218","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 : 2025-12-01Epub Date: 2025-10-30DOI: 10.1016/j.ijcha.2025.101831
Shay Zvi Cherevatsky , Marlon V. Gatuz , Adam Folman , Maguli S. Barel , Rami Abu-Fanne , Dmitry Abramov , Mamas A. Mamas , Ariel Roguin , Ofer Kobo
Background
Pulmonary embolism (PE) is a life-threatening condition with high morbidity and mortality rates. Cardiovascular-Kidney-Metabolic (CKM) syndrome, representing a complex interplay of cardiovascular disease, kidney dysfunction, and metabolic disorders, may significantly impact PE outcomes. This study investigates the influence of CKM syndrome staging on clinical outcomes and management strategies in acute PE patients.
Methods
This retrospective study analyzed 725,725 adult patients hospitalized with a primary diagnosis of PE between 2016 and 2019 using the National Inpatient Sample database. Patients were categorized into five CKM groups (0,1,2/3,4a, 4b) based on staging criteria. Multivariable logistic regression models were used to assess the relationship between in-hospital outcomes and CKM stages.
Results
As CKM stages advanced, patients exhibited distinct profiles characterized by older age, male predominance and a higher prevalence of comorbidities. Multivariate analysis revealed that advanced CKM stages were less likely to receive invasive treatments (systemic thrombolysis: aOR 0.86, 95 % CI 0.81–0.92, p < 0.001) but had higher odds of adverse outcomes, including MACCE (aOR 1.53, 95 % CI 1.45–1.60, p < 0.001), mortality (aOR 1.33, 95 % CI 1.25–1.41, p < 0.001), and major bleeding (aOR 1.15, 95 % CI 1.08–1.23, p < 0.001). All odds ratios were computed using CKM stage 0 as the reference group.
Conclusion
CKM syndrome staging significantly impacts clinical outcomes and management strategies in patients with PE. Advanced CKM stages are associated with higher risks of adverse events, including increased mortality and major bleeding complications. Paradoxically, these high-risk patients were less likely to receive invasive treatments, highlighting a critical gap in care.
肺栓塞（PE）是一种危及生命的疾病，具有很高的发病率和死亡率。心血管-肾-代谢（CKM）综合征是心血管疾病、肾功能障碍和代谢紊乱的复杂相互作用，可能会显著影响PE的预后。本研究探讨CKM综合征分期对急性PE患者临床结局和治疗策略的影响。方法：本回顾性研究使用全国住院患者样本数据库，分析了2016年至2019年期间725,725例原发性PE住院患者。根据分期标准将患者分为5组（0、1、2/3、4a、4b）。采用多变量logistic回归模型评估住院预后与CKM分期之间的关系。结果随着CKM分期的进展，患者表现出明显的特征，即年龄较大、男性居多、合并症发生率较高。多因素分析显示，CKM晚期患者接受侵入性治疗的可能性较小（全体性溶栓：aOR 0.86, 95% CI 0.81-0.92, p < 0.001），但不良结局的发生率较高，包括MACCE （aOR 1.53, 95% CI 1.45-1.60, p < 0.001）、死亡率（aOR 1.33, 95% CI 1.25-1.41, p < 0.001）和大出血（aOR 1.15, 95% CI 1.08-1.23, p < 0.001）。以CKM 0期为参照组计算所有比值比。结论ckm综合征分期对PE患者的临床结局和治疗策略有显著影响。CKM晚期与较高的不良事件风险相关，包括死亡率增加和主要出血并发症。矛盾的是，这些高风险患者不太可能接受侵入性治疗，这凸显了护理方面的严重差距。
{"title":"Impact of cardiovascular-kidney-metabolic syndrome staging on clinical outcomes and management of acute pulmonary embolism: A comprehensive analysis","authors":"Shay Zvi Cherevatsky , Marlon V. Gatuz , Adam Folman , Maguli S. Barel , Rami Abu-Fanne , Dmitry Abramov , Mamas A. Mamas , Ariel Roguin , Ofer Kobo","doi":"10.1016/j.ijcha.2025.101831","DOIUrl":"10.1016/j.ijcha.2025.101831","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary embolism (PE) is a life-threatening condition with high morbidity and mortality rates. Cardiovascular-Kidney-Metabolic (CKM) syndrome, representing a complex interplay of cardiovascular disease, kidney dysfunction, and metabolic disorders, may significantly impact PE outcomes. This study investigates the influence of CKM syndrome staging on clinical outcomes and management strategies in acute PE patients.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 725,725 adult patients hospitalized with a primary diagnosis of PE between 2016 and 2019 using the National Inpatient Sample database. Patients were categorized into five CKM groups (0,1,2/3,4a, 4b) based on staging criteria. Multivariable logistic regression models were used to assess the relationship between in-hospital outcomes and CKM stages.</div></div><div><h3>Results</h3><div>As CKM stages advanced, patients exhibited distinct profiles characterized by older age, male predominance and a higher prevalence of comorbidities. Multivariate analysis revealed that advanced CKM stages were less likely to receive invasive treatments (systemic thrombolysis: aOR 0.86, 95 % CI 0.81–0.92, p < 0.001) but had higher odds of adverse outcomes, including MACCE (aOR 1.53, 95 % CI 1.45–1.60, p < 0.001), mortality (aOR 1.33, 95 % CI 1.25–1.41, p < 0.001), and major bleeding (aOR 1.15, 95 % CI 1.08–1.23, p < 0.001). All odds ratios were computed using CKM stage 0 as the reference group.</div></div><div><h3>Conclusion</h3><div>CKM syndrome staging significantly impacts clinical outcomes and management strategies in patients with PE. Advanced CKM stages are associated with higher risks of adverse events, including increased mortality and major bleeding complications. Paradoxically, these high-risk patients were less likely to receive invasive treatments, highlighting a critical gap in care.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101831"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416825","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 : 2025-12-01Epub Date: 2025-10-16DOI: 10.1016/j.ijcha.2025.101800
Xiaoling Liu , Ziwei Shan , Ting Shen , Megan Lo , Lin Luo , Qifan Sun , Lemin Wang , Guanghe Li , Yumei Jiang , Dejie Li , Mengyi Zhan , Liang Zheng , Jiankang Wu , Yuqin Shen
Background
The autonomic imbalance and low vagal tone are common characteristic among patients with chronic heart failure (CHF). It is hypothesized that CHF rehabilitation programs targeting autonomic nerves system (ANS) function may offer greater efficacy for CHF management. This trial represents the first attempt to investigate such an approach.
Methods
This is a randomized controlled trial aimed to examine the effectiveness of individualized paced deep breathing training (IBT) in CHF patients, with ANS measures as rehabilitation targets. Patients in the IBT group received an additional 4-week program of IBT alongside their standard rehabilitation care. The cardiopulmonary resonance index (CRI), 6-Minute Walking Distance (6MWD) and the Minnesota Quality of Life Score Questionnaire (MLHFQ) were assessed at baseline (T1) and after 4 weeks (T2).
Results
All 38 participants completed the trial successfully. Participants in the IBT group showed significant improvements in CRI, including enhancements in respiratory stability (RS), cardiopulmonary resonance amplitude (CRA), cardiopulmonary resonance factor (CRF), cardiopulmonary coupling coefficient (CPC), and the Spearman’s Rank Correlation Coefficient between Respiratory Rate and Heart Rate (CRS). Further, improvements in both 6MWD and MLHFQ scores were observed. [Multiple linear regression analysis results showed correlations between RS and white blood cell (r = 0.924), CRF and procalcitonin (r = 0.733) and serum creatinine (r = 0.494), as well as CRS and glycosylated hemoglobin (r = 0.819)].
Conclusions
These findings demonstrate that IBT is a feasible and effective rehabilitation approach for CHF patients with ANS measures as target. The IBT program here also showed therapist efficiency and good patients compliance.
{"title":"Individualized paced deep breathing training with autonomic nervous function as rehab targets in patients with chronic heart failure: a randomized clinical trial","authors":"Xiaoling Liu , Ziwei Shan , Ting Shen , Megan Lo , Lin Luo , Qifan Sun , Lemin Wang , Guanghe Li , Yumei Jiang , Dejie Li , Mengyi Zhan , Liang Zheng , Jiankang Wu , Yuqin Shen","doi":"10.1016/j.ijcha.2025.101800","DOIUrl":"10.1016/j.ijcha.2025.101800","url":null,"abstract":"<div><h3>Background</h3><div>The autonomic imbalance and low vagal tone are common characteristic among patients with chronic heart failure (CHF). It is hypothesized that CHF rehabilitation programs targeting autonomic nerves system (ANS) function may offer greater efficacy for CHF management. This trial represents the first attempt to investigate such an approach.</div></div><div><h3>Methods</h3><div>This is a randomized controlled trial aimed to examine the effectiveness of individualized paced deep breathing training (IBT) in CHF patients, with ANS measures as rehabilitation targets. Patients in the IBT group received an additional 4-week program of IBT alongside their standard rehabilitation care. The cardiopulmonary resonance index (CRI), 6-Minute Walking Distance (6MWD) and the Minnesota Quality of Life Score Questionnaire (MLHFQ) were assessed at baseline (T1) and after 4 weeks (T2).</div></div><div><h3>Results</h3><div>All 38 participants completed the trial successfully. Participants in the IBT group showed significant improvements in CRI, including enhancements in respiratory stability (RS), cardiopulmonary resonance amplitude (CRA), cardiopulmonary resonance factor (CRF), cardiopulmonary coupling coefficient (CPC), and the Spearman’s Rank Correlation Coefficient between Respiratory Rate and Heart Rate (CRS). Further, improvements in both 6MWD and MLHFQ scores were observed. [Multiple linear regression analysis results showed correlations between RS and white blood cell (r = 0.924), CRF and procalcitonin (r = 0.733) and serum creatinine (r = 0.494), as well as CRS and glycosylated hemoglobin (r = 0.819)].</div></div><div><h3>Conclusions</h3><div>These findings demonstrate that IBT is a feasible and effective rehabilitation approach for CHF patients with ANS measures as target. The IBT program here also showed therapist efficiency and good patients compliance.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101800"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320620","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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