IJC Heart and Vasculature最新文献_第7页

Role of miR-21-5p in the pathogenesis of abdominal aortic aneurysm regarding the Th17 pathway miR-21-5p在腹主动脉瘤Th17通路发病中的作用

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-09 DOI: 10.1016/j.ijcha.2025.101821

Dorota Studzińska , Sabina Lichołai , Kamil Polok , Hanna Plutecka , Piotr Kica , Piotr Grazda , Maciej Chwała , Marek Sanak , Wojciech Szczeklik

Background and aims

The interplay between Th17-related immune activity and miRNA-driven regulation in abdominal aortic aneurysm (AAA) pathogenesis remains poorly understood. In this prospective study, we aimed to assess the potential role of miR-21-5p corresponding to the Th17 pathway disturbances in the development of AAA.

Methods

Biological samples were collected from patients with true infrarenal AAA, undergoing elective open abdominal aortic surgery, and patients with peripheral arterial disease (PAD) without concomitant aneurysms on the day of hospital admission for surgery. A fragment of aneurysmal abdominal aortic tissue was collected from patients intraoperatively. Total RNA was extracted from the samples, and the expression level of miR-21-5p and selected markers associated with Th17 pathway were assessed using quantitative real-time PCR (RT-qPCR) and Luminex assays, respectively. Moreover, we performed an in vitro model using human endothelial cells, transfected with a synthetic miR-21-5p mimic.

Results

We included 60 patients (30 in the study group and 30 in the control group, selected based on the propensity score matching method). Circulating miR-21-5p levels were significantly higher in AAA patients compared to controls. miR-21-5p downregulates genes involved in endothelial development, regulation of vascular permeability, or endothelial cell response to growth factors. We demonstrated that the Th17 circulating mediators were higher among AAA patients compared to controls, and were higher in the middle part of the aneurysmal aorta when compared to its upper pole.

Conclusion

Our study showed that, regarding AAA pathogenesis, endothelial dysfunction followed by inflammation could be mediated by an increased level of miR-21-5p.

背景与目的在腹主动脉瘤（AAA）发病机制中，th17相关免疫活性与mirna驱动调控之间的相互作用尚不清楚。在这项前瞻性研究中，我们旨在评估Th17通路紊乱对应的miR-21-5p在AAA发展中的潜在作用。方法在住院当天收集真肾下AAA患者、择期腹主动脉开腹手术患者和未伴有动脉瘤的外周动脉疾病（PAD）患者的生物学样本。术中收集患者腹主动脉动脉瘤组织碎片。从样本中提取总RNA，分别使用实时荧光定量PCR （RT-qPCR）和Luminex检测方法评估miR-21-5p和Th17通路相关标记物的表达水平。此外，我们使用人内皮细胞进行了体外模型，转染了合成的miR-21-5p模拟物。结果纳入60例患者，其中研究组30例，对照组30例，采用倾向评分匹配法。与对照组相比，AAA患者的循环miR-21-5p水平显著升高。miR-21-5p下调参与内皮发育、血管通透性调节或内皮细胞对生长因子反应的基因。我们发现，AAA患者的Th17循环介质含量高于对照组，动脉瘤主动脉中部的Th17循环介质含量高于上极。结论我们的研究表明，在AAA的发病机制中，miR-21-5p水平升高可能介导内皮功能障碍随后的炎症。

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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 : 2025-10-08 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

Left atrial appendage thrombi despite oral anticoagulation in transthyretin amyloid cardiomyopathy patients undergoing electrical cardioversion for atrial fibrillation or − flutter 经甲状腺蛋白淀粉样心肌病患者因房颤或心房扑动而接受电转复的左心房附件血栓，尽管口服抗凝

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-08 DOI: 10.1016/j.ijcha.2025.101790

Michael Poledniczek , Christina Kronberger , Bernhard Gregshammer, Luca List, Robin Willixhofer, Nikita Ermolaev, Franz Duca, René Rettl, Christina Binder, Luciana Camuz Ligios, Christian Nitsche, Mahshid Eslami, Senta Graf, Stefan Kastl, Johannes Kastner, Roza Badr Eslam, Christian Hengstenberg, Andreas Kammerlander, Jutta Bergler-Klein

Background

Patients with cardiac amyloidosis undergoing direct current electrical cardioversion (DCCV) are at risk of left atrial appendage thrombus (LAAT). We investigated LAAT formation rates, success rates, and long-term recurrence rates in transthyretin amyloid cardiomyopathy (ATTR-CM) patients.

Methods

ATTR-CM patients scheduled to undergo DCCV were included in the study. LAAT exclusion was performed utilizing transesophageal echocardiography or computed tomography.

Results

A total of 62 (1.35 per patient) DCCVs were recorded among 46 patients (77 ± 6.5 years, 89 % male) with ATTR-CM. In 39 DCCVs, LAAT exclusion was performed (62.9 %). In total, 10 DCCVs (16.1 %) were canceled due to (I) spontaneous conversion to sinus rhythm (n = 2, 5.1 %) or (II) definitive/suspected LAAT (n = 8, 20.5 %). Of these, five patients with LAAT had been receiving sufficient doses of oral anticoagulants for more than three weeks prior to DCCV. The immediate success rate was 92.3 %, and 3-month rhythm control was achieved in 27 (62.8 %) procedures. Notably, one stroke event was recorded two months following DCCV.

Conclusion

A high rate of left atrial appendage thrombus was observed in ATTR-CM, leading to DCCV cancellation in 20.5% of patients. Despite a high immediate success rate (92.3%), sustained sinus rhythm control was achieved in only 62.8% following DCCV. These findings advise using TEE or CT prior to DCCV to exclude LAAT in ATTR-CM patients, even in those with oral anticoagulation.

背景：心脏淀粉样变性患者行直流电转复术（DCCV）有左房附件血栓（LAAT）的危险。我们研究了转甲状腺素淀粉样心肌病（atr - cm）患者的LAAT形成率、成功率和长期复发率。方法纳入计划行DCCV的sattr - cm患者。利用经食管超声心动图或计算机断层扫描进行LAAT排除。结果46例atr - cm患者（77±6.5岁，男性89%）共发生62例（1.35例/例）dccv。在39例dccv中，LAAT排除（62.9%）。总共有10例dccv（16.1%）由于(I)自发转化为窦性心律（n = 2,5.1%）或（II）明确/疑似LAAT （n = 8,20.5%）而取消。其中，5例LAAT患者在DCCV前已接受足量口服抗凝剂治疗超过3周。即刻成功率为92.3%，27例（62.8%）手术实现3个月节律控制。值得注意的是，DCCV后两个月记录了一次中风事件。结论atr - cm患者左心耳血栓发生率高，导致20.5%的患者DCCV取消。尽管即时成功率很高（92.3%），但DCCV后持续窦性心律控制仅为62.8%。这些发现建议在DCCV之前使用TEE或CT来排除atr - cm患者的LAAT，即使是口服抗凝的患者。

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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 : 2025-10-07 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

Development and external validation of a nomogram to predict the need for electrical cardioversion during radiofrequency ablation in patients with atrial fibrillation 开发和外部验证的nomogram预测心房颤动患者在射频消融期间是否需要电复律

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-06 DOI: 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.

目的确定术中电转复的预测因素，并建立心房颤动（AF）射频消融患者的预测模型。方法回顾性分析2018年1月至2023年12月在同济医院接受射频导管消融治疗的1348例房颤动患者的资料。收集临床、超声心动图和CT影像资料。使用Boruta算法和多变量逻辑回归来识别预测因子并构建模态图。采用ROC曲线下面积（AUC）、校正图和决策曲线分析（DCA）来评估模型的性能。对2023年6月至2025年2月在江汉大学湖北省第三人民医院就诊的121例患者进行外部验证。结果将患者分为训练组和验证组（比例为7:3）。确定了5个独立预测因素：房颤类型（OR = 13.63）、瓣膜反流（OR = 3.25）、BMI （OR = 1.06）、左房内径（OR = 1.74）和收缩压（OR = 0.96）。模态图的auc分别为0.881（训练）、0.879（内部验证）和0.866（外部验证）。校正曲线显示预测结果与实际结果吻合良好。DCA证实了该模型的临床实用性。结论所建立的心电图准确预测心房颤动消融术中是否需要电复律，有助于个体化手术计划。

{"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}

引用次数: 0

Cardamonin attenuates angiotensin II-induced abdominal aortic aneurysms through activation of the Nrf2/HO-1 pathway 小豆蔻素通过激活Nrf2/HO-1通路减轻血管紧张素ii诱导的腹主动脉瘤

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-06 DOI: 10.1016/j.ijcha.2025.101815

Hsiao-Ya Tsai , Yu-Juei Hsu , Chih-Yuan Lin , Po-Hsun Huang , Chin-Wang Hsu , Shih-Hung Tsai

Background

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。

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引用次数: 0

Assessment of comorbidity awareness in patients with atrial fibrillation: The ACAPAF study 房颤患者合并症意识评估：ACAPAF研究

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-10-02 DOI: 10.1016/j.ijcha.2025.101813

Rana Önder , Lien Desteghe , Johan Vijgen , Hein Heidbuchel

Background and aim

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.

背景与目的房颤（AF）患者系统、综合的合并症管理需要患者的参与，从合并症意识开始。本研究评估了房颤患者在第一次护士主导的房颤门诊就诊前后和6个月后的合并症意识。我们还测量了使用EHRA-PATHS软件绘制完整共病图所需的时间。方法本前瞻性双中心研究纳入首次就诊的房颤患者。该软件系统地评估了23种合并症。患者在首次就诊前两周、就诊后不到一周和6个月完成了一份合并症意识问卷，重点关注9种房颤相关合并症。访视后1-3个月，患者与房颤护士进行电话咨询，讨论其合并症。结果共纳入76例患者，平均年龄68.3±10.3岁。对房颤合并症相关性的基线认知在11.1 - 100.0%之间。在第一次接触之前，对自己饮酒的认识是最被“低估”的共病（50.0%），而吸烟是最被“高估”的（55.6%；即私下承认，但没有在护士的正式评估期间）。房颤门诊就诊对个人合并症意识的影响有限（p = 0.456），而且在额外的电话咨询后，六个月后的意识也不理想（p = 0.099）。房颤护士完成软件的时间为18.4±8.7 min。结论患者的合并症知晓率一般，需加大教育力度提高合并症知晓率。在合理的时间框架内，使用EHRA-PATHS软件在房颤诊所进行系统和完整的合并症评估。

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引用次数: 0

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-30 DOI: 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。

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引用次数: 0

Quantitative videodensitometric assessment of aortic regurgitation in Myval, Sapien, and Evolut THV series: Results from the LANDMARK trial Myval、Sapien和Evolut THV系列患者主动脉反流的定量视频密度评估：LANDMARK试验的结果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-29 DOI: 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 %)(P_Myval-Sapien = 0.2333, P_Myval-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)], P_Myval-Sapien = 0.8997,P_Myval-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.

定量视频密度主动脉造影（QVDA）可靠地量化了tavi后主动脉反流（AR）。然而，这种方法尚未在比较各种经导管心脏瓣膜（THV）系统的随机试验中得到评价。在这里，作为LANDMARK试验的一部分，我们研究了Myval、Sapien和Evolut THV系列患者在TAVI后急性主动脉瓣狭窄的QVDA。方法采用先进的CAAS-A-Valve 2.1.2软件对无球囊扩张或球囊扩张后的最终主动脉图像进行分析。计算返流分数（RF）并将其分为无/微量AR （RF < 86%）、轻度AR（6%≤8RF≤817%）和中度/重度AR （RF > 17%）。结果596张最终可分析主动脉图和97张BPD后主动脉图纳入分析。BPD导致Myval的RF显著降低[12.0(6.0-18.5)vs 2.0(1.0, 5.5)]；p = 0.0002),组成[18.0(1.0 - -19.0)和2.0 (1.0 - -3.0);p = 0.04206)和Evolut[10.5(6.0 - -15.0)和5.0 (1.0 - -8.0);p = 0.0009]。Myval的最终RF率（2.0%）低于Evolut(8.00%)，但与Sapien系列（4.0%）相似（PMyval-Sapien = 0.2333, PMyval-Evolut = 0.0057）。在处理后的种群中，Myval系列显示出与Sapien系列相当的RF，但与Evolut系列相比显着降低RF [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]。结论QVDA显示Myval THV系列优于Evolut THV系列，在3种THV系列中，中/重度射频发生率最低，可与超声心动图配合使用，帮助发现无/微量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}

引用次数: 0

Decoding the coronary paradox of obesity: not all fat is equal! 解读肥胖的冠状动脉悖论：并非所有脂肪都是一样的！

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature

Pub Date : 2025-09-27 DOI: 10.1016/j.ijcha.2025.101807

Gaetano Santulli , Shivangi Pande , Pasquale Mone , Fahimeh Varzideh

引用次数: 0