Pub Date : 2025-12-03DOI: 10.1016/j.ijcha.2025.101847
Juan C Grignola , Pedro Trujillo , Julio Sandoval , Enric Domingo
The acute vasodilator challenge during right heart catheterization (RHC) provides a deeper understanding of the pulmonary circulation by assessing vasoreactivity. The current criteria for a positive acute vasoreactivity test (AVT) are simplified to steady-state metrics, based on cutoff points derived from expert opinion. A positive AVT identifies a specific, but very rare, PH phenotype that may respond long-term to calcium-channel blockers. Growing evidence supports updating the role and criteria of AVT in pulmonary arterial hypertension, broadening its use to other PH groups, and potentially offering new insights for predicting risk and/or treatment outcomes.
This study aims to revisit the uses, criteria, and goals of AVT in patients with PH beyond group 1 and to propose a new approach for phenotyping the pulmonary vascular response to the acute vasodilator challenge during diagnostic RHC. We propose a continuous multi-parameter criterion to evaluate the entire right ventricular afterload during AVT, such as the pulmonary vascular resistance-pulmonary arterial capacitance curve and alpha distensibility coefficient. AVT could assess the residual vasoreactive reserve of the pulmonary circulation as a provocative test for predicting risk outcomes and/or treatment responses.
{"title":"Acute pulmonary vasoreactivity: a simple test revisited in the contemporary era − a narrative review","authors":"Juan C Grignola , Pedro Trujillo , Julio Sandoval , Enric Domingo","doi":"10.1016/j.ijcha.2025.101847","DOIUrl":"10.1016/j.ijcha.2025.101847","url":null,"abstract":"<div><div>The acute vasodilator challenge during right heart catheterization (RHC) provides a deeper understanding of the pulmonary circulation by assessing vasoreactivity. The current criteria for a positive acute vasoreactivity test (AVT) are simplified to steady-state metrics, based on cutoff points derived from expert opinion. A positive AVT identifies a specific, but very rare, PH phenotype that may respond long-term to calcium-channel blockers. Growing evidence supports updating the role and criteria of AVT in pulmonary arterial hypertension, broadening its use to other PH groups, and potentially offering new insights for predicting risk and/or treatment outcomes.</div><div>This study aims to revisit the uses, criteria, and goals of AVT in patients with PH beyond group 1 and to propose a new approach for phenotyping the pulmonary vascular response to the acute vasodilator challenge during diagnostic RHC. We propose a continuous multi-parameter criterion to evaluate the entire right ventricular afterload during AVT, such as the pulmonary vascular resistance-pulmonary arterial capacitance curve and alpha distensibility coefficient. AVT could assess the residual vasoreactive reserve of the pulmonary circulation as a provocative test for predicting risk outcomes and/or treatment responses.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101847"},"PeriodicalIF":2.5,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684636","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 : 2025-12-01DOI: 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 : 2025-12-01DOI: 10.1016/j.ijcha.2025.101848
Paul C. Onyeji , Leo Consoli , Amrinder Kaur , Shivank Dani , Sonise Momplaisir-Onyeji , Felipe S. Passos , Hristo Kirov , Torsten Doenst , Tulio Caldonazo
Background
The benefit-to-risk ratio of administration of intravenous (IV) and topical tranexamic acid (TXA) together in cardiac surgery has not yet been determined. This study aims to evaluate whether the combined approach (IV plus topical TXA) offers superior bleeding control compared to IV TXA alone, while maintaining an acceptable safety profile.
Methods
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing combined topical and intravenous TXA administration versus IV TXA alone in patients undergoing cardiac surgery. The primary outcome was cumulative blood loss. Secondary outcomes included all-cause mortality, transfusion-free status, and the number of transfused blood products. A random-effects model was used for all pooled analyses.
Results
We included a total of five studies (four RCTs, one observational; n = 880). Pooled analysis showed that the combined approach significantly, but modest, reduced total blood loss when compared to an IV-only TXA strategy (MD −39.84, 95 %CI −74.80 to −4.88; p = 0.03; I2 = 39 %). However, this benefit did not translate into a significant reduction in transfusion requirements (OR 1.00, 95 %CI 0.72 to 1.37; p = 0.98; I2 = 0 %), volume of blood products used (MD −0.01, 95 %CI −0.04 to 0.02; p = 0.51; I2 = 0 %), or all-cause mortality (OR 0.85, 95 %CI 0.24 to 3.08; p = 0.81; I2 = 0 %).
Conclusion
Combined topical and IV TXA application is associated with reduced total blood loss after cardiac surgery compared to an IV-only approach. However, no significant differences were observed in transfusion rates, blood product utilization, or mortality.
{"title":"Combining topical and intravenous tranexamic acid in cardiac surgery: does it really matter? – a systematic review and meta-analysis","authors":"Paul C. Onyeji , Leo Consoli , Amrinder Kaur , Shivank Dani , Sonise Momplaisir-Onyeji , Felipe S. Passos , Hristo Kirov , Torsten Doenst , Tulio Caldonazo","doi":"10.1016/j.ijcha.2025.101848","DOIUrl":"10.1016/j.ijcha.2025.101848","url":null,"abstract":"<div><h3>Background</h3><div>The benefit-to-risk ratio of administration of intravenous (IV) and topical tranexamic acid (TXA) together in cardiac surgery has not yet been determined. This study aims to evaluate whether the combined approach (IV plus topical TXA) offers superior bleeding control compared to IV TXA alone, while maintaining an acceptable safety profile.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and <em>meta</em>-analysis of randomized controlled trials (RCTs) and observational studies comparing combined topical and intravenous TXA administration versus IV TXA alone in patients undergoing cardiac surgery. The primary outcome was cumulative blood loss. Secondary outcomes included all-cause mortality, transfusion-free status, and the number of transfused blood products. A random-effects model was used for all pooled analyses.</div></div><div><h3>Results</h3><div>We included a total of five studies (four RCTs, one observational; n = 880). Pooled analysis showed that the combined approach significantly, but modest, reduced total blood loss when compared to an IV-only TXA strategy (MD −39.84, 95 %CI −74.80 to −4.88; p = 0.03; I<sup>2</sup> = 39 %). However, this benefit did not translate into a significant reduction in transfusion requirements (OR 1.00, 95 %CI 0.72 to 1.37; p = 0.98; I<sup>2</sup> = 0 %), volume of blood products used (MD −0.01, 95 %CI −0.04 to 0.02; p = 0.51; I<sup>2</sup> = 0 %), or all-cause mortality (OR 0.85, 95 %CI 0.24 to 3.08; p = 0.81; I<sup>2</sup> = 0 %).</div></div><div><h3>Conclusion</h3><div>Combined topical and IV TXA application is associated with reduced total blood loss after cardiac surgery compared to an IV-only approach. However, no significant differences were observed in transfusion rates, blood product utilization, or mortality.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101848"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684635","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 : 2025-11-28DOI: 10.1016/j.ijcha.2025.101846
P. Tornvall , P. Svensson , J. Alfredsson , L. Jonasson , L. Nilsson , R. Hofmann , SK. Merid
Introduction
Oxygen therapy does not benefit normoxemic patients with suspected myocardial infarction and may instead enhance the inflammatory response triggered by the tissue necrosis caused by the myocardial infarction. In the present study, we tested the hypothesis that oxygen therapy aggravates systemic inflammation in normoxemic healthy individuals in a human model of experimental inflammation.
Methods
Proteomic and gene expression data from healthy subjects vaccinated against Salmonella Typhii and exposed to oxygen therapy or ambient air were investigated. A multi-omics approach with factor analysis to identify common sources of variation in the systemic inflammatory response associated with oxygen exposure was used.
Results
Oxygen therapy showed a statistically nominal tendency toward aggravation determined by ELISA (IL-6) and proximity extension assay (IL-8). The factor analysis revealed a pro-inflammatory feature that included increases in (CXCL 6, 10 and 11) with decreased small nucleolar RNA.
Conclusion
The results indicate that oxygen therapy enhances experimental systemic inflammation. The mechanism is not clear but future studies should address small nucleolar RNA.
{"title":"Oxygen therapy enhances the systemic inflammatory response in a human model of experimental inflammation","authors":"P. Tornvall , P. Svensson , J. Alfredsson , L. Jonasson , L. Nilsson , R. Hofmann , SK. Merid","doi":"10.1016/j.ijcha.2025.101846","DOIUrl":"10.1016/j.ijcha.2025.101846","url":null,"abstract":"<div><h3>Introduction</h3><div>Oxygen therapy does not benefit normoxemic patients with suspected myocardial infarction and may instead enhance the inflammatory response triggered by the tissue necrosis caused by the myocardial infarction. In the present study, we tested the hypothesis that oxygen therapy aggravates systemic inflammation in normoxemic healthy individuals in a human model of experimental inflammation.</div></div><div><h3>Methods</h3><div>Proteomic and gene expression data from healthy subjects vaccinated against Salmonella Typhii and exposed to oxygen therapy or ambient air were investigated. A multi-omics approach with factor analysis to identify common sources of variation in the systemic inflammatory response associated with oxygen exposure was used.</div></div><div><h3>Results</h3><div>Oxygen therapy showed a statistically nominal tendency toward aggravation determined by ELISA (IL-6) and proximity extension assay (IL-8). The factor analysis revealed a pro-inflammatory feature that included increases in (CXCL 6, 10 and 11) with decreased small nucleolar RNA.</div></div><div><h3>Conclusion</h3><div>The results indicate that oxygen therapy enhances experimental systemic inflammation. The mechanism is not clear but future studies should address small nucleolar RNA.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101846"},"PeriodicalIF":2.5,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616294","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 : 2025-11-24DOI: 10.1016/j.ijcha.2025.101845
Peier Xu , Xinhu Tang , Jichao Zhang , Le Zhou , Naijing Gao , Xueyun Yan , Huaming Cao
Background
Pulsed field ablation (PFA) is an emerging non-thermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF), offering enhanced tissue selectivity and reduced collateral damage compared to cryoballoon ablation (CBA).
Objective
This meta-analysis compares the mid- to long-term efficacy, safety, and procedural characteristics of PFA versus CBA in AF treatment.
Methods
A systematic search of PubMed, EMBASE, and the Cochrane Library through July 2025 identified nine comparative studies involving 2,718 patients (1,381 PFA; 1,337 CBA). Pooled risk ratios (RRs) and mean differences (MDs) were calculated using random-effects models, with subgroup analyses for paroxysmal and persistent AF.
Results
PFA showed a trend toward lower recurrence rates (RR = 0.86, 95 % CI: 0.70–1.04), particularly in paroxysmal AF (RR = 0.83, 95 % CI: 0.68–1.01), while outcomes in persistent AF were comparable (RR = 0.98, 95 % CI: 0.69–1.38). Procedure time was significantly shorter with PFA (MD = –9.59 min, 95 % CI: –17.80 to –1.37), whereas fluoroscopy duration showed no significant difference. Safety analysis revealed a non-significant trend favoring PFA (RR = 0.75, 95 % CI: 0.49–1.14), with fewer cases of phrenic nerve injury and cardiac tamponade.
Conclusion
PFA and CBA demonstrate comparable efficacy and safety in AF ablation. PFA may offer procedural advantages and improved outcomes in paroxysmal AF, supporting its expanding role in clinical practice. Further randomized trials are warranted to validate these findings and guide optimal treatment strategies.
{"title":"Comparative efficacy and safety of pulsed field ablation versus cryoballoon ablation in atrial fibrillation: A meta-analysis of mid- and long-term outcomes","authors":"Peier Xu , Xinhu Tang , Jichao Zhang , Le Zhou , Naijing Gao , Xueyun Yan , Huaming Cao","doi":"10.1016/j.ijcha.2025.101845","DOIUrl":"10.1016/j.ijcha.2025.101845","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) is an emerging non-thermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF), offering enhanced tissue selectivity and reduced collateral damage compared to cryoballoon ablation (CBA).</div></div><div><h3>Objective</h3><div>This <em>meta</em>-analysis compares the mid- to long-term efficacy, safety, and procedural characteristics of PFA versus CBA in AF treatment.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, EMBASE, and the Cochrane Library through July 2025 identified nine comparative studies involving 2,718 patients (1,381 PFA; 1,337 CBA). Pooled risk ratios (RRs) and mean differences (MDs) were calculated using random-effects models, with subgroup analyses for paroxysmal and persistent AF.</div></div><div><h3>Results</h3><div>PFA showed a trend toward lower recurrence rates (RR = 0.86, 95 % CI: 0.70–1.04), particularly in paroxysmal AF (RR = 0.83, 95 % CI: 0.68–1.01), while outcomes in persistent AF were comparable (RR = 0.98, 95 % CI: 0.69–1.38). Procedure time was significantly shorter with PFA (MD = –9.59 min, 95 % CI: –17.80 to –1.37), whereas fluoroscopy duration showed no significant difference. Safety analysis revealed a non-significant trend favoring PFA (RR = 0.75, 95 % CI: 0.49–1.14), with fewer cases of phrenic nerve injury and cardiac tamponade.</div></div><div><h3>Conclusion</h3><div>PFA and CBA demonstrate comparable efficacy and safety in AF ablation. PFA may offer procedural advantages and improved outcomes in paroxysmal AF, supporting its expanding role in clinical practice. Further randomized trials are warranted to validate these findings and guide optimal treatment strategies.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101845"},"PeriodicalIF":2.5,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616243","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}
Although the association between global longitudinal strain (GLS), a marker of myocardial systolic function, and prognosis in patients undergoing transcatheter aortic valve implantation (TAVI) is well-documented, the prognostic association of regional longitudinal strain (LS), such as apical LS, on patients undergoing TAVI remains underexplored.
Methods and Results
From 2015 to 2023, a total of 303 patients with aortic stenosis (AS) who underwent TAVI at Kumamoto University Hospital were screened, and excluding 4 patients with in-hospital deaths, 299 were analyzed. The median follow-up period after TAVI was 693 days (interquartile range, 435–1189 days), during which 63 deaths occurred. Pre-TAVI echocardiographic findings showed that apical LS was significantly higher in the survival group compared to the all-cause death group (15.1 ± 4.7％ vs. 13.7 ± 4.4 %, p = 0.02). Multivariable Cox proportional hazards analysis, adjusted for body mass index, aortic valve peak velocity, atrial fibrillation, high-sensitivity troponin T, tricuspid regurgitation, demonstrated that apical LS was independently associated with all-cause mortality (hazard ratio: 0.91, 95 % confidence interval: 0.88–0.99, p = 0.02). Time-dependent receiver operating characteristic (ROC) curve analysis identified apical LS to discriminate all-cause mortality (area under the curve, 0.69), with the predictive ability peaking within the first two years after TAVI. Kaplan–Meier analysis revealed significantly higher mortality rates in patients with low apical LS group (<15.4 %) (p = 0.01).
Conclusions
measurement of apical LS in patients with AS provides valuable associational prognostic information, even after adjusting for multiple clinical and echocardiographic factors, highlighting its value in enhancing risk stratification for patients undergoing TAVI.
{"title":"Apical longitudinal strain: A Key prognostic echocardiographic marker in patients undergoing transcatheter aortic valve implantation","authors":"Yuichiro Shirahama , Hiroki Usuku , Eiichiro Yamamoto , Tatsuya Yoshinouchi , Ryudai Higashi , Atsushi Nozuhara , Fumi Oike , Noriaki Tabata , Masanobu Ishii , Shinsuke Hanatani , Tadashi Hoshiyama , Hisanori Kanazawa , Yuichiro Arima , Hiroaki Kawano , Yasuhiro Izumiya , Yasuhito Tanaka , Kenichi Tsujita","doi":"10.1016/j.ijcha.2025.101844","DOIUrl":"10.1016/j.ijcha.2025.101844","url":null,"abstract":"<div><h3>Background</h3><div>Although the association between global longitudinal strain (GLS), a marker of myocardial systolic function, and prognosis in patients undergoing transcatheter aortic valve implantation (TAVI) is well-documented, the prognostic association of regional longitudinal strain (LS), such as apical LS, on patients undergoing TAVI remains underexplored.</div></div><div><h3>Methods and Results</h3><div>From 2015 to 2023, a total of 303 patients with aortic stenosis (AS) who underwent TAVI at Kumamoto University Hospital were screened, and excluding 4 patients with in-hospital deaths, 299 were analyzed. The median follow-up period after TAVI was 693 days (interquartile range, 435–1189 days), during which 63 deaths occurred. Pre-TAVI echocardiographic findings showed that apical LS was significantly higher in the survival group compared to the all-cause death group (15.1 ± 4.7％ vs. 13.7 ± 4.4 %, p = 0.02). Multivariable Cox proportional hazards analysis, adjusted for body mass index, aortic valve peak velocity, atrial fibrillation, high-sensitivity troponin T, tricuspid regurgitation, demonstrated that apical LS was independently associated with all-cause mortality (hazard ratio: 0.91, 95 % confidence interval: 0.88–0.99, p = 0.02). Time-dependent receiver operating characteristic (ROC) curve analysis identified apical LS to discriminate all-cause mortality (area under the curve, 0.69), with the predictive ability peaking within the first two years after TAVI. Kaplan–Meier analysis revealed significantly higher mortality rates in patients with low apical LS group (<15.4 %) (p = 0.01).</div></div><div><h3>Conclusions</h3><div>measurement of apical LS in patients with AS provides valuable associational prognostic information, even after adjusting for multiple clinical and echocardiographic factors, highlighting its value in enhancing risk stratification for patients undergoing TAVI.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101844"},"PeriodicalIF":2.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546594","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 : 2025-11-14DOI: 10.1016/j.ijcha.2025.101838
Chaoyang Lin , Enhao Wei , Qianyao Lai , Hangpan Jiang , Maosen Lin , Feng Hu , Lin Fan , Enhui Yao
Background
Although prior studies have linked frailty and accelerated biological aging to aortic stenosis, comprehensive evidence across the spectrum of degenerative valvular diseases (VHD) and related clinical events remains unclear in middle-aged adults.
Methods
We analyzed 408,783 UK Biobank participants free of baseline valvular disease. Biological age accelerations (BAA) measures were derived from clinical traits using Phenotypic Age (PhenoAge) algorithm and the Klemera-Doubal method Biological Age (KDM-BA). Outcomes included incident aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), and related interventions or mortality.
Results
Over a median follow-up of 13.9 years, 10,364 incident degenerative VHD events (2.5 %) were documented, comprising 4602 AS, 1678 AS-related events, 1639 AR, and 4903 MR cases. Elevated BAA was significantly associated with higher AS risk. For PhenoAge, adjusted AS incidence rates (per 10,000 person-years; 95 % confidence interval) across quartiles (Q1–Q4) were 3.73 (3.37–4.12), 4.44 (4.05–4.88), 5.11 (4.67–5.59), and 7.79 (7.18–8.46), yielding an adjusted hazard ratio (HR) of 2.15 (1.96–2.35) for Q4. Comparable trends were observed for KDM-BA, with an adjusted HR of 1.98 (1.83–2.15) for Q4 vs Q1. AS-related events followed a similar pattern, with HRs of 1.80 (1.55–2.09) for PhenoAge Q4 and 2.22 (1.94–2.54) for KDM-BA Q4. Significant associations were also found for AR, AR-related events, and MR, but not for MR-related events.
Conclusions
Among middle-aged adults, both BAA metrics were associated with increased risks of degenerative VHD and related adverse events, except for MR-related events. These findings highlight BAA as a potential tool for early risk stratification and targeted prevention.
{"title":"Accelerated biological aging and incident degenerative valvular heart disease: Findings from 408,783 UK Biobank participants","authors":"Chaoyang Lin , Enhao Wei , Qianyao Lai , Hangpan Jiang , Maosen Lin , Feng Hu , Lin Fan , Enhui Yao","doi":"10.1016/j.ijcha.2025.101838","DOIUrl":"10.1016/j.ijcha.2025.101838","url":null,"abstract":"<div><h3>Background</h3><div>Although prior studies have linked frailty and accelerated biological aging to aortic stenosis, comprehensive evidence across the spectrum of degenerative valvular diseases (VHD) and related clinical events remains unclear in middle-aged adults.</div></div><div><h3>Methods</h3><div>We analyzed 408,783 UK Biobank participants free of baseline valvular disease. Biological age accelerations (BAA) measures were derived from clinical traits using Phenotypic Age (PhenoAge) algorithm and the Klemera-Doubal method Biological Age (KDM-BA). Outcomes included incident aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), and related interventions or mortality.</div></div><div><h3>Results</h3><div>Over a median follow-up of 13.9 years, 10,364 incident degenerative VHD events (2.5 %) were documented, comprising 4602 AS, 1678 AS-related events, 1639 AR, and 4903 MR cases. Elevated BAA was significantly associated with higher AS risk. For PhenoAge, adjusted AS incidence rates (per 10,000 person-years; 95 % confidence interval) across quartiles (Q1–Q4) were 3.73 (3.37–4.12), 4.44 (4.05–4.88), 5.11 (4.67–5.59), and 7.79 (7.18–8.46), yielding an adjusted hazard ratio (HR) of 2.15 (1.96–2.35) for Q4. Comparable trends were observed for KDM-BA, with an adjusted HR of 1.98 (1.83–2.15) for Q4 vs Q1. AS-related events followed a similar pattern, with HRs of 1.80 (1.55–2.09) for PhenoAge Q4 and 2.22 (1.94–2.54) for KDM-BA Q4. Significant associations were also found for AR, AR-related events, and MR, but not for MR-related events.</div></div><div><h3>Conclusions</h3><div>Among middle-aged adults, both BAA metrics were associated with increased risks of degenerative VHD and related adverse events, except for MR-related events. These findings highlight BAA as a potential tool for early risk stratification and targeted prevention.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101838"},"PeriodicalIF":2.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519471","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 : 2025-11-10DOI: 10.1016/j.ijcha.2025.101842
Rodolfo Caminiti , Alfonso Ielasi , Giampaolo Vetta , Antonio Parlavecchio , Domenico Giovanni Della Rocca , Silvia Moscardelli , Andrea Marrone , Giulia Laterra , Maurizio Tespili , Giampiero Vizzari , Marco Barbanti , Antonio Micari
Background
Cerebral embolism remains a concern during transcatheter aortic valve replacement (TAVR). Cerebral embolic protection (CEP) devices have been developed to mitigate this risk, but their clinical benefit remains unclear.
Methods
We conducted a systematic review and meta-analysis of randomized controlled trials comparing TAVR with and without CEP devices. Primary endpoint was overall stroke; secondary endpoints included disabling stroke, all-cause mortality, life-treating bleeding, vascular complications related to CEP access and acute kidney injury.
Results
Eight trials comprising 11,625 patients (group CEP, n = 5,843 patients; group NCEP, n = 5,782 patients, 57.3 % male, 81.5 mean age years) were included. No significant differences were found for primary endpoint, overall stroke (RR 1.03, 95 % CI 0.82–1.29), and secondary outcomes between CEP and non-CEP groups at 30 days follow-up. Complications related to CEP access were minimal, 1.1 % (95 % CI: −0.6 to 2.8).
Conclusions
CEP devices do not significantly reduce short-term stroke or major complications after TAVR. However, given the prevalence of silent cerebral ischemia, further studies are needed to assess long-term neurological outcomes and identify high-risk subgroups who may benefit.
{"title":"Effectiveness of cerebral embolic protection during transcatheter aortic valve replacement: A systematic review and meta-analysis of randomized trials","authors":"Rodolfo Caminiti , Alfonso Ielasi , Giampaolo Vetta , Antonio Parlavecchio , Domenico Giovanni Della Rocca , Silvia Moscardelli , Andrea Marrone , Giulia Laterra , Maurizio Tespili , Giampiero Vizzari , Marco Barbanti , Antonio Micari","doi":"10.1016/j.ijcha.2025.101842","DOIUrl":"10.1016/j.ijcha.2025.101842","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral embolism remains a concern during transcatheter aortic valve replacement (TAVR). Cerebral embolic protection (CEP) devices have been developed to mitigate this risk, but their clinical benefit remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and <em>meta</em>-analysis of randomized controlled trials comparing TAVR with and without CEP devices. Primary endpoint was overall stroke; secondary endpoints included disabling stroke, all-cause mortality, life-treating bleeding, vascular complications related to CEP access and acute kidney injury.</div></div><div><h3>Results</h3><div>Eight trials comprising 11,625 patients (group CEP, n = 5,843 patients; group NCEP, n = 5,782 patients, 57.3 % male, 81.5 mean age years) were included. No significant differences were found for primary endpoint, overall stroke (RR 1.03, 95 % CI 0.82–1.29), and secondary outcomes between CEP and non-CEP groups at 30 days follow-up. Complications related to CEP access were minimal, 1.1 % (95 % CI: −0.6 to 2.8).</div></div><div><h3>Conclusions</h3><div>CEP devices do not significantly reduce short-term stroke or major complications after TAVR. However, given the prevalence of silent cerebral ischemia, further studies are needed to assess long-term neurological outcomes and identify high-risk subgroups who may benefit.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"61 ","pages":"Article 101842"},"PeriodicalIF":2.5,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519487","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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