Pub Date : 2025-09-01DOI: 10.1016/j.hjc.2025.04.006
Nikitas Katsillis , Ourania Kariki , Gerasimos Gavrielatos , Antonios Dimopoulos , Nikolaos Papakonstantinou , Elena Bousoula , Sarantos Linardakis , Athanasios Saplaouras , John Malakos , Stylianos Dragasis , Konstantinos P. Letsas , Michael Efremidis , Nikolaos Patsourakos
A chronic total occlusion (CTO) of a coronary artery is present in almost one-fifth of patients undergoing a scheduled coronary angiography. A CTO may be classified as infarct related when there is evidence of myocardial dysfunction in the territory of the obstructed vessel or as non-infarct related when the myocardial substrate has preserved its systolic function. The presence of a CTO has been associated with an increased risk of malignant ventricular arrhythmias (VAs), appropriate ICD shocks, and cardiac mortality, with infarct-related CTOs exhibiting a worse prognosis. During the last decade, technological advancements have improved the success rates of transcatheter revascularization, a treatment that has been proven valuable for persistently symptomatic patients. However, the role of revascularization in reducing the arrhythmic burden is unclear. On the contrary, catheter ablation of VAs has been suggested to be effective, despite the presence of a CTO. As for device therapies, an increased prevalence of appropriate ICD shocks should be expected in this population, bringing into consideration the implementation of the presence of CTO as a risk modifier in sudden cardiac death prevention algorithms. The aim of this review is to present the existing literature on the role of all kinds of interventions in the management of patients with CTOs and VAs.
{"title":"Ventricular arrhythmias in patients with chronic total occlusion of coronary arteries: a review focused on interventional treatments","authors":"Nikitas Katsillis , Ourania Kariki , Gerasimos Gavrielatos , Antonios Dimopoulos , Nikolaos Papakonstantinou , Elena Bousoula , Sarantos Linardakis , Athanasios Saplaouras , John Malakos , Stylianos Dragasis , Konstantinos P. Letsas , Michael Efremidis , Nikolaos Patsourakos","doi":"10.1016/j.hjc.2025.04.006","DOIUrl":"10.1016/j.hjc.2025.04.006","url":null,"abstract":"<div><div>A chronic total occlusion (CTO) of a coronary artery is present in almost one-fifth of patients undergoing a scheduled coronary angiography. A CTO may be classified as infarct related when there is evidence of myocardial dysfunction in the territory of the obstructed vessel or as non-infarct related when the myocardial substrate has preserved its systolic function. The presence of a CTO has been associated with an increased risk of malignant ventricular arrhythmias (VAs), appropriate ICD shocks, and cardiac mortality, with infarct-related CTOs exhibiting a worse prognosis. During the last decade, technological advancements have improved the success rates of transcatheter revascularization, a treatment that has been proven valuable for persistently symptomatic patients. However, the role of revascularization in reducing the arrhythmic burden is unclear. On the contrary, catheter ablation of VAs has been suggested to be effective, despite the presence of a CTO. As for device therapies, an increased prevalence of appropriate ICD shocks should be expected in this population, bringing into consideration the implementation of the presence of CTO as a risk modifier in sudden cardiac death prevention algorithms. The aim of this review is to present the existing literature on the role of all kinds of interventions in the management of patients with CTOs and VAs.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"85 ","pages":"Pages 99-107"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.hjc.2025.02.003
Athanasios J. Manolis , Peter Collins , Manolis S. Kallistratos , Giuseppe Rosano
The updated European Society of Cardiology (ESC) guidelines empower physicians to tailor treatment plans more effectively to individual patient characteristics, preferences, and responses. With a more flexible and individualized approach to angina management, it seems that the traditional stepwise approach may not be optimal for all patients. In addition, there is a significant shift in the diagnostic approach for chronic coronary syndromes (CCS). In this review, we mainly refer to key points and queries concerning the current ESC recommendations regarding the diagnostic approach and treatment of patients with stable angina, recommending practical directions to physicians managing patients with CCS.
{"title":"Key messages and critical approach of the 2024 guidelines of the European Society of Cardiology on chronic coronary syndromes","authors":"Athanasios J. Manolis , Peter Collins , Manolis S. Kallistratos , Giuseppe Rosano","doi":"10.1016/j.hjc.2025.02.003","DOIUrl":"10.1016/j.hjc.2025.02.003","url":null,"abstract":"<div><div>The updated European Society of Cardiology (ESC) guidelines empower physicians to tailor treatment plans more effectively to individual patient characteristics, preferences, and responses. With a more flexible and individualized approach to angina management, it seems that the traditional stepwise approach may not be optimal for all patients. In addition, there is a significant shift in the diagnostic approach for chronic coronary syndromes (CCS). In this review, we mainly refer to key points and queries concerning the current ESC recommendations regarding the diagnostic approach and treatment of patients with stable angina, recommending practical directions to physicians managing patients with CCS.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"85 ","pages":"Pages 90-98"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.hjc.2024.04.007
Hazan Karadeniz , Sevcihan Kesen , Mert Burak Akhan , Serkan Unlu , Rıza Can Kardas , Aslıhan Avanoglu Guler , Derya Yıldırım , Ibrahim Vasi , Burcugul Kaya , Rahime Duran , Nurten Gizem Tore , Abdulsamet Erden , Hamit Kucuk , Berna Goker , Mehmet Akif Ozturk , Abdurrahman Tufan
Objective
The present study aims to determine the frequency of vascular calcification in Takayasu arteritis (TA) and the risk factors for it and to evaluate its relation with atherosclerotic predictors such as metabolic syndrome (MS), left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT).
Methods
A cross-sectional study was conducted in patients with TA; MS was defined according to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria. The study included 49 TA patients (22 with MS, 27 without MS) and 31 healthy controls (HCs). Non-contrast computed tomography measured calcification in coronary arteries, aorta, and branches.
Results
Forty-seven patients (95.9%) were female and mean age was 33.45 ± 8.53 years. Total calcification score (mean ± SD; 5223.9 ± 18041.1 AU vs. 35.87 ± 72.70 AU (p = 0.05)), CIMT, and LVMI were found to be significantly higher in TA patients than HCs (p < 0.05). While there was no significant difference between the total calcification score of MS (+) TA patients and MS (−) TA patients, in both patient groups, the total calcification score was found to be significantly higher than HCs. MS (+) and MS (−) groups were found to have significantly higher CIMT and LVMI values than the control group, in addition, MS (+) patients were found to have significantly higher LVMI and CIMT values than MS (−) group (p < 0.05).
Conclusion
Vascular calcification, CIMT, and LVMI are elevated in all TA patients, with greater impact in the presence of MS.
简介：本研究旨在确定高安动脉炎（TA）患者血管钙化的频率及其风险因素，并评估其与代谢综合征（MS）、左心室质量指数（LVMI）和颈动脉内膜中层厚度（CIMT）等动脉粥样硬化预测指标的关系：方法：对TA患者进行了一项横断面研究；MS是根据美国国家胆固醇教育计划/成人治疗小组III（NCEP/ATP III）标准定义的。研究对象包括 49 名 TA 患者（22 名 MS 患者，27 名非 MS 患者）和 31 名健康对照组（HCs）。非对比计算机断层扫描测量了冠状动脉、主动脉和分支的钙化情况：47名患者（95.9%）为女性，平均年龄（33.45±8.53）岁。TA患者的钙化总分（平均值±SD；5223.9±18041.1 AU vs 35.87±72.70 AU（P=0.05））、CIMT和LVMI均显著高于HC（P结论：所有TA患者的血管钙化、CIMT和LVMI均升高，MS患者的影响更大。
{"title":"Vascular calcification in Takayasu arteritis: relationship with metabolic syndrome, left ventricular mass index, and intima-media thickness","authors":"Hazan Karadeniz , Sevcihan Kesen , Mert Burak Akhan , Serkan Unlu , Rıza Can Kardas , Aslıhan Avanoglu Guler , Derya Yıldırım , Ibrahim Vasi , Burcugul Kaya , Rahime Duran , Nurten Gizem Tore , Abdulsamet Erden , Hamit Kucuk , Berna Goker , Mehmet Akif Ozturk , Abdurrahman Tufan","doi":"10.1016/j.hjc.2024.04.007","DOIUrl":"10.1016/j.hjc.2024.04.007","url":null,"abstract":"<div><h3>Objective</h3><div>The present study aims to determine the frequency of vascular calcification in Takayasu arteritis (TA) and the risk factors for it and to evaluate its relation with atherosclerotic predictors such as metabolic syndrome (MS), left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT).</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in patients with TA; MS was defined according to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria. The study included 49 TA patients (22 with MS, 27 without MS) and 31 healthy controls (HCs). Non-contrast computed tomography measured calcification in coronary arteries, aorta, and branches.</div></div><div><h3>Results</h3><div>Forty-seven patients (95.9%) were female and mean age was 33.45 ± 8.53 years. Total calcification score (mean ± SD; 5223.9 ± 18041.1 AU vs. 35.87 ± 72.70 AU (p = 0.05)), CIMT, and LVMI were found to be significantly higher in TA patients than HCs (p < 0.05). While there was no significant difference between the total calcification score of MS (+) TA patients and MS (−) TA patients, in both patient groups, the total calcification score was found to be significantly higher than HCs. MS (+) and MS (−) groups were found to have significantly higher CIMT and LVMI values than the control group, in addition, MS (+) patients were found to have significantly higher LVMI and CIMT values than MS (−) group (p < 0.05).</div></div><div><h3>Conclusion</h3><div>Vascular calcification, CIMT, and LVMI are elevated in all TA patients, with greater impact in the presence of MS.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"85 ","pages":"Pages 70-80"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.hjc.2024.12.001
George Michas , Ioannis Liatakis , Panagioula Niarchou , Dimitra Kentroti , Efstathia Prappa , Athanasios Trikas
{"title":"Depression and anxiety in patients with hypertrophic cardiomyopathy: a call for action","authors":"George Michas , Ioannis Liatakis , Panagioula Niarchou , Dimitra Kentroti , Efstathia Prappa , Athanasios Trikas","doi":"10.1016/j.hjc.2024.12.001","DOIUrl":"10.1016/j.hjc.2024.12.001","url":null,"abstract":"","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"85 ","pages":"Pages 114-115"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.hjc.2024.10.001
Nikolaos Schizas , Panagiotis Dedeilias
{"title":"New guidelines of EACTS/STS on aortic disease: a useful tool for the management of “aortic organ” disease","authors":"Nikolaos Schizas , Panagiotis Dedeilias","doi":"10.1016/j.hjc.2024.10.001","DOIUrl":"10.1016/j.hjc.2024.10.001","url":null,"abstract":"","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"84 ","pages":"Pages 110-113"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.hjc.2024.03.002
Ziyong Hao , Bin Liu , Xiaoyi Xie , Yiting Fan , Jian Wang , Qin Shao , Lisheng Jiang , Ben He
Background
The safety and efficacy of a combined approach of catheter ablation (CA) and left atrial appendage occlusion (LAAO) compared to LAAO alone remain unknown.
Methods
Patients with atrial fibrillation (AF) at increased stroke risk who underwent LAAO were divided into either combined (CA and LAAO) procedures or LAAO alone group. Propensity score matching was utilized to balance baseline characteristics. The primary endpoint of the study was a composite of death, thromboembolic events, major bleeding, heart failure (HF) rehospitalization, and major periprocedural complications.
Results
A total of 707 AF patients who underwent LAAO were included. After 1:1 propensity score matching, 166 patients who underwent LAAO alone (n = 83) or the combined procedure (n = 83) were analyzed. Successful LAAO was achieved in all (100%) patients, with a low incidence of periprocedural complications in both groups (2.4% vs. 4.8%, LAAO vs. combined, p = 0.68). The incidence of peri-device leak post-LAAO was significantly higher in the combined group (25.3% vs. 43.4%, p = 0.01). After a median follow-up of 2 years, there were no significant differences in the rates of the primary composite endpoint between the two strategies (22.2% vs. 14.3%, HR: 1.24 [95% CI: 0.51–2.97], p = 0.63). However, the rate of HF rehospitalization was significantly lower in the combined group (19.6% vs. 3.6%, HR: 4.89 [95% CI: 1.50–15.97], p = 0.024).
Conclusions
Combining CA and LAAO in a “one-stop” approach is safe and brings additional benefits in relieving symptoms of heart failure, although peri-device leak was more common compared to LAAO alone.
{"title":"Combining catheter ablation and left atrial appendage occlusion in high-risk patients with atrial fibrillation: a propensity score-matched analysis","authors":"Ziyong Hao , Bin Liu , Xiaoyi Xie , Yiting Fan , Jian Wang , Qin Shao , Lisheng Jiang , Ben He","doi":"10.1016/j.hjc.2024.03.002","DOIUrl":"10.1016/j.hjc.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><div>The safety and efficacy of a combined approach of catheter ablation (CA) and left atrial appendage occlusion (LAAO) compared to LAAO alone remain unknown.</div></div><div><h3>Methods</h3><div>Patients with atrial fibrillation (AF) at increased stroke risk who underwent LAAO were divided into either combined (CA and LAAO) procedures or LAAO alone group. Propensity score matching was utilized to balance baseline characteristics. The primary endpoint of the study was a composite of death, thromboembolic events, major bleeding, heart failure (HF) rehospitalization, and major periprocedural complications.</div></div><div><h3>Results</h3><div>A total of 707 AF patients who underwent LAAO were included. After 1:1 propensity score matching, 166 patients who underwent LAAO alone (n = 83) or the combined procedure (n = 83) were analyzed. Successful LAAO was achieved in all (100%) patients, with a low incidence of periprocedural complications in both groups (2.4% vs. 4.8%, LAAO vs. combined, p = 0.68). The incidence of peri-device leak post-LAAO was significantly higher in the combined group (25.3% vs. 43.4%, p = 0.01). After a median follow-up of 2 years, there were no significant differences in the rates of the primary composite endpoint between the two strategies (22.2% vs. 14.3%, HR: 1.24 [95% CI: 0.51–2.97], p = 0.63). However, the rate of HF rehospitalization was significantly lower in the combined group (19.6% vs. 3.6%, HR: 4.89 [95% CI: 1.50–15.97], p = 0.024).</div></div><div><h3>Conclusions</h3><div>Combining CA and LAAO in a “one-stop” approach is safe and brings additional benefits in relieving symptoms of heart failure, although peri-device leak was more common compared to LAAO alone.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"84 ","pages":"Pages 4-12"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endomyocardial biopsy (EMB) is a diagnostic tool for evaluating various cardiac conditions, such as myocarditis and myocardial infiltrative diseases. It is also the gold standard screening technique for detecting allograft rejection after heart transplantation. Despite advances in noninvasive imaging modalities for myocardial tissue characterization, EMB is still necessary for making a definitive diagnosis and determining treatment for certain conditions. Herein, we report our recent experience using EMB and its diagnostic yield.
Methods and Results
We retrospectively reviewed EMBs performed at our institution from March 2018 through March 2023. Clinical data, including patient characteristics, indication and diagnostic yield of EMB, and procedure-related complications, were collected. Histopathological findings of the biopsies were recorded and classified based on the degree to which they matched the clinical diagnosis and cardiac magnetic resonance imaging (CMR) findings. A total of 212 EMBs obtained in 178 consecutive patients were retrospectively analyzed, with 42 biopsies performed for allograft rejection surveillance (10 patients) and the remaining performed for presumptive diagnosis of acute myocarditis or unexplained cardiomyopathy. Among the non-heart transplant cases, 54.7% of EMBs provided a clear diagnosis. The most common diagnosis was myocarditis (69%), followed by cardiac amyloidosis (CA) (26%). EMB was also helpful in detecting several rare cardiac conditions, such as eosinophilic granulomatosis with polyangiitis (EGPA), Fabry disease, and cardiac sarcoidosis. In a cohort of 101 patients who underwent both CMR and EMB, the results were concordant in 66% of cases. However, in 24.7% of patients, EMB was able to identify pathological conditions where CMR results were inconclusive, highlighting its complementary role in determining an accurate diagnosis. No complications were reported in any of the 212 EMBs performed.
Conclusions
With advances in cardiac imaging modalities, EMB is not routinely indicated for the diagnosis of cardiomyopathy. However, EMB is still an important tool for diagnosing specific cardiac diseases and could be crucial for confirming the diagnosis. EMB is generally safe if performed at experienced centers.
{"title":"Endomyocardial biopsy in clinical practice: the diagnostic yield and insights from a 5-year single-center experience","authors":"Mutaz Karameh , Karen Meir , Abed Qadan , Orit Pappo , Dotan Cohen , Ronen Durst , Offer Amir , Rabea Asleh","doi":"10.1016/j.hjc.2024.03.004","DOIUrl":"10.1016/j.hjc.2024.03.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Endomyocardial biopsy (EMB) is a diagnostic tool for evaluating various cardiac conditions, such as myocarditis and myocardial infiltrative diseases. It is also the gold standard screening technique for detecting allograft rejection after heart transplantation. Despite advances in noninvasive imaging modalities for myocardial tissue characterization, EMB is still necessary for making a definitive diagnosis and determining treatment for certain conditions. Herein, we report our recent experience using EMB and its diagnostic yield.</div></div><div><h3>Methods and Results</h3><div>We retrospectively reviewed EMBs performed at our institution from March 2018 through March 2023. Clinical data, including patient characteristics, indication and diagnostic yield of EMB, and procedure-related complications, were collected. Histopathological findings of the biopsies were recorded and classified based on the degree to which they matched the clinical diagnosis and cardiac magnetic resonance imaging (CMR) findings. A total of 212 EMBs obtained in 178 consecutive patients were retrospectively analyzed, with 42 biopsies performed for allograft rejection surveillance (10 patients) and the remaining performed for presumptive diagnosis of acute myocarditis or unexplained cardiomyopathy. Among the non-heart transplant cases, 54.7% of EMBs provided a clear diagnosis. The most common diagnosis was myocarditis (69%), followed by cardiac amyloidosis (CA) (26%). EMB was also helpful in detecting several rare cardiac conditions, such as eosinophilic granulomatosis with polyangiitis (EGPA), Fabry disease, and cardiac sarcoidosis. In a cohort of 101 patients who underwent both CMR and EMB, the results were concordant in 66% of cases. However, in 24.7% of patients, EMB was able to identify pathological conditions where CMR results were inconclusive, highlighting its complementary role in determining an accurate diagnosis. No complications were reported in any of the 212 EMBs performed.</div></div><div><h3>Conclusions</h3><div>With advances in cardiac imaging modalities, EMB is not routinely indicated for the diagnosis of cardiomyopathy. However, EMB is still an important tool for diagnosing specific cardiac diseases and could be crucial for confirming the diagnosis. EMB is generally safe if performed at experienced centers.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"84 ","pages":"Pages 22-31"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.hjc.2024.03.010
Alessandro Andreis , Andrea Solano , Marco Balducci , Cristina Picollo , Margherita Ghigliotti , Mario Giordano , Alessandra Agosti , Valentino Collini , Matteo Anselmino , Gaetano Maria De Ferrari , Mauro Rinaldi , Gianluca Alunni , Massimo Imazio
Background
Diagnosis of pericarditis may be challenging because not all patients meet the conventional criteria. An overlooked diagnosis implies a longer course of symptoms and an increased risk of recurrences. C-reactive protein (CRP), widely used as an inflammation marker, has some limitations. This study aimed to assess the usefulness and prognostic value of INFLA-score, a validated index assessing low-grade inflammation, in the definite diagnosis of pericarditis.
Methods
Patients with suspected pericarditis were included. The INFLA-score was computed based on white blood cells and platelet count, neutrophil-to-lymphocyte ratio, and CRP, ranging from −16 to +16. An INFLA-score > 0 was considered positive for the presence of pericardial inflammation. The primary end point was the association of INFLA-score with diagnosis of pericarditis according to conventional criteria. The recurrence of pericarditis at 6 months was the secondary end point.
Results
A total of 202 patients were included, aged 47 ± 17 years, and 57% were females. Among 72 (36%) patients with a diagnosis of pericarditis, an INFLA-score > 0 was observed in 86% (vs. 36%, p < 0.001), abnormal CRP in 42% (vs. 10%, p < 0.001), pericardial effusion in 44% (vs. 19%, p < 0.001), abnormal electrocardiogram in 56% (vs. 24%, p < 0.001), and rubs in 5% (vs. 0.1%, p = 0.072). INFLA-score > 0 had the strongest predictive value for the diagnosis of pericarditis (hazard ratio 8.48, 95% confidence interval [CI] 3.39–21.21), with 86% sensitivity and 64% specificity, as opposed to CRP (hazard ratio 1.72, non-significant 95% CI 0.69–4.29). Recurrent pericarditis at 6 months was more frequent in patients with a positive INFLA-score (37% vs. 8%, p < 0.001, rate ratio 4.15, 95% CI 2.81–6.12). In patients with normal CRP, INFLA-score–confirmed ongoing inflammation in 78% of the cases. Compared with the conventional criteria, the INFLA-score had the highest accuracy (area under the curve = 0.82). Different cutoffs were valuable to rule out (INFLA-score > 0, sensitivity 86%, and negative likelihood ratio 0.22) or rule in (INFLA-score ≥ 10, specificity 97%, and positive likelihood ratio 13) the diagnosis.
Conclusions
The INFLA-score is a useful diagnostic tool to assess the probability of pericarditis, with a strong prognostic value for further recurrences, outperforming CRP.
{"title":"INFLA-score: A new diagnostic paradigm to identify pericarditis","authors":"Alessandro Andreis , Andrea Solano , Marco Balducci , Cristina Picollo , Margherita Ghigliotti , Mario Giordano , Alessandra Agosti , Valentino Collini , Matteo Anselmino , Gaetano Maria De Ferrari , Mauro Rinaldi , Gianluca Alunni , Massimo Imazio","doi":"10.1016/j.hjc.2024.03.010","DOIUrl":"10.1016/j.hjc.2024.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Diagnosis of pericarditis may be challenging because not all patients meet the conventional criteria. An overlooked diagnosis implies a longer course of symptoms and an increased risk of recurrences. C-reactive protein (CRP), widely used as an inflammation marker, has some limitations. This study aimed to assess the usefulness and prognostic value of INFLA-score, a validated index assessing low-grade inflammation, in the definite diagnosis of pericarditis.</div></div><div><h3>Methods</h3><div>Patients with suspected pericarditis were included. The INFLA-score was computed based on white blood cells and platelet count, neutrophil-to-lymphocyte ratio, and CRP, ranging from −16 to +16. An INFLA-score > 0 was considered positive for the presence of pericardial inflammation. The primary end point was the association of INFLA-score with diagnosis of pericarditis according to conventional criteria. The recurrence of pericarditis at 6 months was the secondary end point.</div></div><div><h3>Results</h3><div>A total of 202 patients were included, aged 47 ± 17 years, and 57% were females. Among 72 (36%) patients with a diagnosis of pericarditis, an INFLA-score > 0 was observed in 86% (vs. 36%, p < 0.001), abnormal CRP in 42% (vs. 10%, p < 0.001), pericardial effusion in 44% (vs. 19%, p < 0.001), abnormal electrocardiogram in 56% (vs. 24%, p < 0.001), and rubs in 5% (vs. 0.1%, p = 0.072). INFLA-score > 0 had the strongest predictive value for the diagnosis of pericarditis (hazard ratio 8.48, 95% confidence interval [CI] 3.39–21.21), with 86% sensitivity and 64% specificity, as opposed to CRP (hazard ratio 1.72, non-significant 95% CI 0.69–4.29). Recurrent pericarditis at 6 months was more frequent in patients with a positive INFLA-score (37% vs. 8%, p < 0.001, rate ratio 4.15, 95% CI 2.81–6.12). In patients with normal CRP, INFLA-score–confirmed ongoing inflammation in 78% of the cases. Compared with the conventional criteria, the INFLA-score had the highest accuracy (area under the curve = 0.82). Different cutoffs were valuable to rule out (INFLA-score > 0, sensitivity 86%, and negative likelihood ratio 0.22) or rule in (INFLA-score ≥ 10, specificity 97%, and positive likelihood ratio 13) the diagnosis.</div></div><div><h3>Conclusions</h3><div>The INFLA-score is a useful diagnostic tool to assess the probability of pericarditis, with a strong prognostic value for further recurrences, outperforming CRP.</div></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":"84 ","pages":"Pages 43-50"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号