Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.044
F. Yahia, Y. Ayadi, A. Dhifi, E.H. Aymen, S. Ben Farhat, H. Ghardallou, H. Thabet, M. Slim, R. Gribaa, N. Elyes
Introduction
Frank's sign (diagonal earlobe crease, DELC) has been described as a dermatological marker for coronary artery disease.
Objective
This study investigates its correlation with the complexity of coronary lesions assessed by SYNTAX score.
Method
Prospective observational study conducted from May to September 2024 at Sahloul Hospital's Cardiology Department. Patients undergoing coronary angiography were enrolled after consent. Frank's sign was analyzed using Prangenberg's classification (grades 1–3). SYNTAX scores were stratified into three levels: low (≤ 22), intermediate (23–32), and high (> 33).
Results
A total of 92 patients were included (61% male, median age: 63 years). Frank's sign was present in 80% of patients. No significant correlation was found between age and the presence of the sign (P = 0.2). The prevalence of Frank's sign was significantly higher in patients with intermediate and high SYNTAX scores compared to those with low scores (P = 0.021). Mean SYNTAX scores: 8.16 ± 1.9 (absence of sign), 10.5 ± 2.4 (grade 1), 18.17 ± 3.14 (grade 2), 19.35 ± 3.11 (grade 3), and 15.4 ± 2.4 (grade 4) (Fig. 1). The association between the grade of Frank's sign and SYNTAX score was not statistically significant (P = 0.18).
Conclusion
Frank's sign may serve as a simple clinical marker predictive of complex coronary lesions. This correlation could be explained by the similar vascular anatomy of the earlobe and heart, both supplied by terminal arteries without collateral circulation. A larger multicenter study is needed to confirm this association.
{"title":"Association between Frank's sign and complexity of coronary artery lesions","authors":"F. Yahia, Y. Ayadi, A. Dhifi, E.H. Aymen, S. Ben Farhat, H. Ghardallou, H. Thabet, M. Slim, R. Gribaa, N. Elyes","doi":"10.1016/j.acvd.2025.10.044","DOIUrl":"10.1016/j.acvd.2025.10.044","url":null,"abstract":"<div><h3>Introduction</h3><div>Frank's sign (diagonal earlobe crease, DELC) has been described as a dermatological marker for coronary artery disease.</div></div><div><h3>Objective</h3><div>This study investigates its correlation with the complexity of coronary lesions assessed by SYNTAX score.</div></div><div><h3>Method</h3><div>Prospective observational study conducted from May to September 2024 at Sahloul Hospital's Cardiology Department. Patients undergoing coronary angiography were enrolled after consent. Frank's sign was analyzed using Prangenberg's classification (grades 1–3). SYNTAX scores were stratified into three levels: low (≤<!--> <!-->22), intermediate (23–32), and high (><!--> <!-->33).</div></div><div><h3>Results</h3><div>A total of 92 patients were included (61% male, median age: 63 years). Frank's sign was present in 80% of patients. No significant correlation was found between age and the presence of the sign (<em>P</em> <!-->=<!--> <!-->0.2). The prevalence of Frank's sign was significantly higher in patients with intermediate and high SYNTAX scores compared to those with low scores (<em>P</em> <!-->=<!--> <!-->0.021). Mean SYNTAX scores: 8.16<!--> <!-->±<!--> <!-->1.9 (absence of sign), 10.5<!--> <!-->±<!--> <!-->2.4 (grade 1), 18.17<!--> <!-->±<!--> <!-->3.14 (grade 2), 19.35<!--> <!-->±<!--> <!-->3.11 (grade 3), and 15.4<!--> <!-->±<!--> <!-->2.4 (grade 4) (<span><span>Fig. 1</span></span>). The association between the grade of Frank's sign and SYNTAX score was not statistically significant (<em>P</em> <!-->=<!--> <!-->0.18).</div></div><div><h3>Conclusion</h3><div>Frank's sign may serve as a simple clinical marker predictive of complex coronary lesions. This correlation could be explained by the similar vascular anatomy of the earlobe and heart, both supplied by terminal arteries without collateral circulation. A larger multicenter study is needed to confirm this association.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S25"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903911","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.064
G. Bonnans , R. Engel , H. Malerbi , E. Cariou , S. Cazalbou , E. Cassol , Y. Lavie-Badie , P. Fournier , O. Lairez
Introduction
Transthyretin cardiomyopathy (ATTR-CM) and aortic stenosis (AS) are two frequently associated pathologies. The diagnosis of ATTR-CM can be made by performing a cardiac amyloid radionuclide imaging (CARI) with a computed tomography (CT) scan to localize the signal, which allows to see aortic valve calcifications (AVC).
Objective
To determine whether AVC on the CT scan performed at the time of the CARI for the diagnosis of ATTR-CM were predictive of AS and had an impact on prognosis.
Method
Consecutive patients referred to nuclear medicine and diagnosed with ATTR-CM on bone scintigraphy after exclusion of monoclonal gammopathy were included. Patients with a history of aortic valve replacement were excluded. CT images performed for signal localization were reviewed for the presence of aortic calcifications. In the presence of calcifications, a calcium score was calculated from axial slices using a threshold of 130 Hounsfield units. Calcium score results were compared with aortic valve hemodynamic parameters assessed by transthoracic echocardiography to classify patients according to the presence and severity of AS. A three-stage visual score was developed to assess the extent of aortic valve calcifications (score 0: absence or spotty calcification; score 1: < 50% of annulus circumference; score 2: ≥ 50%). Receiver operating characteristic (ROC) analysis and Cox proportional hazards models were used for statistical analysis.
Results
Two hundred and sixty-three patients were included. Aortic calcifications based on visual score > 0 were present in 153 (58%) patients. Among them, the median calcium score was 430 [200–1140]. A cut-off calcium score ≥ 380 predicted AS with an area under the ROC curve of 0.93 (P < 0.0001), sensitivity 91%, specificity 81%. For severe AS, a threshold ≥ 1690 yielded an AUC of 0.98 (P < 0.0001), allowing a sensitivity of 94% and a specificity of 96%. A visual score of 2 predicted severe AS with 94% sensitivity and 90% specificity. Both the aortic valve calcium score and visual score were independent predictors of all-cause mortality during follow-up (Fig. 1).
Conclusion
Aortic calcifications on CT scan of bone scintigraphy are found in almost two-thirds of patients with ATTR-CM. Assessed using both a semi-quantitative visual score and a calcium score, they are strong predictors of AS severity and mortality. A calcium score ≥ 1690 and visual score 2 reliably identify severe AS.
{"title":"Aortic valve calcium score from computed tomography for signal localization by cardiac amyloid radionuclide imaging to predict aortic stenosis and assess prognosis in patients with transthyretin cardiomyopathy","authors":"G. Bonnans , R. Engel , H. Malerbi , E. Cariou , S. Cazalbou , E. Cassol , Y. Lavie-Badie , P. Fournier , O. Lairez","doi":"10.1016/j.acvd.2025.10.064","DOIUrl":"10.1016/j.acvd.2025.10.064","url":null,"abstract":"<div><h3>Introduction</h3><div>Transthyretin cardiomyopathy (ATTR-CM) and aortic stenosis (AS) are two frequently associated pathologies. The diagnosis of ATTR-CM can be made by performing a cardiac amyloid radionuclide imaging (CARI) with a computed tomography (CT) scan to localize the signal, which allows to see aortic valve calcifications (AVC).</div></div><div><h3>Objective</h3><div>To determine whether AVC on the CT scan performed at the time of the CARI for the diagnosis of ATTR-CM were predictive of AS and had an impact on prognosis.</div></div><div><h3>Method</h3><div>Consecutive patients referred to nuclear medicine and diagnosed with ATTR-CM on bone scintigraphy after exclusion of monoclonal gammopathy were included. Patients with a history of aortic valve replacement were excluded. CT images performed for signal localization were reviewed for the presence of aortic calcifications. In the presence of calcifications, a calcium score was calculated from axial slices using a threshold of 130 Hounsfield units. Calcium score results were compared with aortic valve hemodynamic parameters assessed by transthoracic echocardiography to classify patients according to the presence and severity of AS. A three-stage visual score was developed to assess the extent of aortic valve calcifications (score 0: absence or spotty calcification; score 1:<!--> <!--><<!--> <!-->50% of annulus circumference; score 2:<!--> <!-->≥<!--> <!-->50%). Receiver operating characteristic (ROC) analysis and Cox proportional hazards models were used for statistical analysis.</div></div><div><h3>Results</h3><div>Two hundred and sixty-three patients were included. Aortic calcifications based on visual score<!--> <!-->><!--> <!-->0 were present in 153 (58%) patients. Among them, the median calcium score was 430 [200–1140]. A cut-off calcium score<!--> <!-->≥<!--> <!-->380 predicted AS with an area under the ROC curve of 0.93 (<em>P</em> <!--><<!--> <!-->0.0001), sensitivity 91%, specificity 81%. For severe AS, a threshold<!--> <!-->≥<!--> <!-->1690 yielded an AUC of 0.98 (<em>P</em> <!--><<!--> <!-->0.0001), allowing a sensitivity of 94% and a specificity of 96%. A visual score of 2 predicted severe AS with 94% sensitivity and 90% specificity. Both the aortic valve calcium score and visual score were independent predictors of all-cause mortality during follow-up (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Aortic calcifications on CT scan of bone scintigraphy are found in almost two-thirds of patients with ATTR-CM. Assessed using both a semi-quantitative visual score and a calcium score, they are strong predictors of AS severity and mortality. A calcium score<!--> <!-->≥<!--> <!-->1690 and visual score 2 reliably identify severe AS.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S35-S36"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903971","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.081
C. Darricaud , B. Guyomarch , D. Kraiche , T. Aurélie , E. Panaioli , J.-N. Trochu , V. Probst , K. Wahbi , N. Piriou
Introduction
Cardiac laminopathy is associated with a high burden of life-threatening ventricular tachyarrhythmias (LTVTA). A LMNA-LTVTA risk calculator was previously validated and implantable cardioverter defibrillator is recommended in patients with a 5 years calculated risk ≥ 10%, but additional prognostic markers in patients with lower risk are missing.
Objective
To study the potential additive value of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) for LTVTA risk stratification in laminopathy.
Method
LMNA pathogenic variant carriers with CMR data available including patients with cardiac laminopathy and asymptomatic relatives were included in a retrospective multicentric study. LGE phenotype was compared to cardiac laminopathy characteristics. The additive prognostic value of LGE presence on the risk of occurrence of the composite endpoint of cardiovascular death and LTVTA was studied.
Results
121 patients were included (38 ± 16 years old, 47% males), among which 81 (67%) had a cardiac laminopathy phenotype. 51 (42%) exhibited LGE. Patients with LGE had more atrioventricular blocks and more reduced LVEF at the time of CMR than patients without (53% vs 38% P = 0.03; 49 ± 14% vs 60 ± 10% P < 0.0001). 61% of patients with LGE had a calculated LMNA-LTVTA risk ≥ 10% versus 25% without (P = 0.0003) (Fig. 1), but LTVTA history was not more frequent in LGE patients (8% vs 11% in patients without, P = 0.5). During a median follow-up of 4 years (range 1-25), 38 patients (31%) experienced LTVTA (n = 29, 24%) or cardiovascular death (n = 9, 7%). On multivariate analysis, LGE presence did not provide additional prognostic value to LMNA-LTVTA calculated risk (Table 1).
Conclusion
LGE did not provide additional prognostic value to the LMNA-LTVTA risk calculator for LTVTA or cardiovascular death risk prediction.
心脏板层病与危及生命的室性心动过速（LTVTA）的高负担相关。LMNA-LTVTA风险计算器先前已被验证，并且在5年计算风险≥10%的患者中推荐植入式心律转复除颤器，但在风险较低的患者中缺少其他预后标志物。目的探讨心脏磁共振（CMR）晚期钆增强（LGE）对椎板病LTVTA危险分层的潜在附加价值。方法采用回顾性多中心研究方法，对具有CMR数据的lmna致病变异携带者，包括心脏板层病患者和无症状亲属。将LGE表型与心肌板层病特征进行比较。研究LGE存在对心血管死亡和LTVTA复合终点发生风险的附加预后价值。结果121例患者（38±16岁，男性47%），其中81例（67%）有心肌板层病表型。51例（42%）出现LGE。在CMR时，LGE患者比无LGE患者有更多的房室传导阻滞和更多的LVEF降低（53% vs 38% P = 0.03; 49±14% vs 60±10% P < 0.0001）。61%的LGE患者的LMNA-LTVTA风险≥10%，而非LGE患者的LMNA-LTVTA风险为25% (P = 0.0003)（图1），但LGE患者的LTVTA病史并不更常见（8% vs 11%, P = 0.5）。在中位随访4年（1-25年）期间，38名患者（31%）出现LTVTA （n = 29.24%）或心血管死亡（n = 9.7%）。在多变量分析中，LGE的存在并没有为LMNA-LTVTA计算风险提供额外的预后价值（表1）。结论lge对LMNA-LTVTA风险计算器在LTVTA或心血管死亡风险预测方面没有提供额外的预后价值。
{"title":"Potential additive prognostic value of late gadolinium enhancement to the risk prediction score for life-threatening ventricular tachyarrhythmias in laminopathy: A multicentric retrospective study","authors":"C. Darricaud , B. Guyomarch , D. Kraiche , T. Aurélie , E. Panaioli , J.-N. Trochu , V. Probst , K. Wahbi , N. Piriou","doi":"10.1016/j.acvd.2025.10.081","DOIUrl":"10.1016/j.acvd.2025.10.081","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac laminopathy is associated with a high burden of life-threatening ventricular tachyarrhythmias (LTVTA). A LMNA-LTVTA risk calculator was previously validated and implantable cardioverter defibrillator is recommended in patients with a 5 years calculated risk<!--> <!-->≥<!--> <!-->10%, but additional prognostic markers in patients with lower risk are missing.</div></div><div><h3>Objective</h3><div>To study the potential additive value of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) for LTVTA risk stratification in laminopathy.</div></div><div><h3>Method</h3><div>LMNA pathogenic variant carriers with CMR data available including patients with cardiac laminopathy and asymptomatic relatives were included in a retrospective multicentric study. LGE phenotype was compared to cardiac laminopathy characteristics. The additive prognostic value of LGE presence on the risk of occurrence of the composite endpoint of cardiovascular death and LTVTA was studied.</div></div><div><h3>Results</h3><div>121 patients were included (38<!--> <!-->±<!--> <!-->16 years old, 47% males), among which 81 (67%) had a cardiac laminopathy phenotype. 51 (42%) exhibited LGE. Patients with LGE had more atrioventricular blocks and more reduced LVEF at the time of CMR than patients without (53% vs 38% <em>P</em> <!-->=<!--> <!-->0.03; 49<!--> <!-->±<!--> <!-->14% vs 60<!--> <!-->±<!--> <!-->10% <em>P</em> <!--><<!--> <!-->0.0001). 61% of patients with LGE had a calculated LMNA-LTVTA risk ≥ 10% versus 25% without (<em>P</em> <!-->=<!--> <!-->0.0003) (<span><span>Fig. 1</span></span>), but LTVTA history was not more frequent in LGE patients (8% vs 11% in patients without, <em>P</em> <!-->=<!--> <!-->0.5). During a median follow-up of 4 years (range 1-25), 38 patients (31%) experienced LTVTA (<em>n</em> <!-->=<!--> <!-->29, 24%) or cardiovascular death (<em>n</em> <!-->=<!--> <!-->9, 7%). On multivariate analysis, LGE presence did not provide additional prognostic value to LMNA-LTVTA calculated risk (<span><span>Table 1</span></span>).</div></div><div><h3>Conclusion</h3><div>LGE did not provide additional prognostic value to the LMNA-LTVTA risk calculator for LTVTA or cardiovascular death risk prediction.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S46-S47"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904047","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.082
A. Hacil , Y. Antakly Hanon , J.S. Vidal , A. Lacour , O. Hanon
Introduction
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown beneficial effects in heart failure (HF) management, but data on their use in geriatric populations with high comorbidity remain limited.
Objective
This observational study aimed to assess the real-world efficacy and safety of SGLT2i in elderly patients with HF.
Method
This prospective multicenter study included 496 patients hospitalized for acute heart failure (AHF) across three geriatric units. The mean age was 90 years, and the mean Charlson Comorbidity Index score was 8.2. Participants were divided into two groups: the “SGLT2i group” (n = 260) receiving SGLT2i (empagliflozin or dapagliflozin) alongside standard HF treatment, and the “Control group” (n = 236) receiving only standard HF treatment. The primary outcomes were all-cause mortality, HF rehospitalizations, and adverse events over one year.
Results
SGLT2i use was associated with lower risks of all-cause mortality (HR 0.67 [95% CI 0.46–0.98], P = 0.031), HF rehospitalization (HR 0.64 [95% CI 0.42–0.97], P = 0.037), and the composite outcome (HR 0.60 [95% CI 0.44–0.82], P = 0.001) at one year, after multivariable adjustment. No significant interaction was observed between LVEF status and SGLT2i use (P for interaction = 0.12). Although urinary and genital infections were more frequently reported in the SGLT2i group, treatment discontinuation remained low (2.7%) (Fig. 1).
Conclusion
In this very elderly population with high comorbidity, SGLT2i therapy was associated with substantial reductions in mortality and HF rehospitalization, and showed good tolerability and an acceptable safety profile.
钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）已显示出对心力衰竭（HF）治疗的有益效果，但其在高合并症老年人群中的应用数据仍然有限。目的：本观察性研究旨在评估SGLT2i治疗老年心衰患者的实际疗效和安全性。方法本前瞻性多中心研究纳入496例急性心力衰竭（AHF）住院患者，来自3个老年科室。平均年龄90岁，Charlson共病指数平均评分8.2。参与者被分为两组：“SGLT2i组”（n = 260）接受SGLT2i（恩格列净或达格列净）和标准HF治疗，“对照组”（n = 236）只接受标准HF治疗。主要结局是全因死亡率、心衰再住院和一年内的不良事件。结果经多变量调整后，ssglt2i的使用与一年后全因死亡（HR 0.67 [95% CI 0.46-0.98], P = 0.031）、HF再住院（HR 0.64 [95% CI 0.42-0.97], P = 0.037）和综合结局（HR 0.60 [95% CI 0.44-0.82], P = 0.001）的风险降低相关。在LVEF状态和SGLT2i使用之间没有观察到显著的相互作用（相互作用P = 0.12）。尽管在SGLT2i组中泌尿和生殖器感染的报道更为频繁，但停药率仍然很低（2.7%）（图1）。结论：在高合并症的高龄人群中，SGLT2i治疗可显著降低死亡率和HF再住院率，并具有良好的耐受性和可接受的安全性。
{"title":"Efficacy and safety of SGLT2 inhibitors in heart failure: Real-world evidence in geriatric patients","authors":"A. Hacil , Y. Antakly Hanon , J.S. Vidal , A. Lacour , O. Hanon","doi":"10.1016/j.acvd.2025.10.082","DOIUrl":"10.1016/j.acvd.2025.10.082","url":null,"abstract":"<div><h3>Introduction</h3><div>Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown beneficial effects in heart failure (HF) management, but data on their use in geriatric populations with high comorbidity remain limited.</div></div><div><h3>Objective</h3><div>This observational study aimed to assess the real-world efficacy and safety of SGLT2i in elderly patients with HF.</div></div><div><h3>Method</h3><div>This prospective multicenter study included 496 patients hospitalized for acute heart failure (AHF) across three geriatric units. The mean age was 90 years, and the mean Charlson Comorbidity Index score was 8.2. Participants were divided into two groups: the “SGLT2i group” (<em>n</em> <!-->=<!--> <!-->260) receiving SGLT2i (empagliflozin or dapagliflozin) alongside standard HF treatment, and the “Control group” (<em>n</em> <!-->=<!--> <!-->236) receiving only standard HF treatment. The primary outcomes were all-cause mortality, HF rehospitalizations, and adverse events over one year.</div></div><div><h3>Results</h3><div>SGLT2i use was associated with lower risks of all-cause mortality (HR 0.67 [95% CI 0.46–0.98], <em>P</em> <!-->=<!--> <!-->0.031), HF rehospitalization (HR 0.64 [95% CI 0.42–0.97], <em>P</em> <!-->=<!--> <!-->0.037), and the composite outcome (HR 0.60 [95% CI 0.44–0.82], <em>P</em> <!-->=<!--> <!-->0.001) at one year, after multivariable adjustment. No significant interaction was observed between LVEF status and SGLT2i use (<em>P</em> for interaction<!--> <!-->=<!--> <!-->0.12). Although urinary and genital infections were more frequently reported in the SGLT2i group, treatment discontinuation remained low (2.7%) (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>In this very elderly population with high comorbidity, SGLT2i therapy was associated with substantial reductions in mortality and HF rehospitalization, and showed good tolerability and an acceptable safety profile.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S47"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904048","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.071
E. Tebache , J.M. Tartière , Y. Fedali , N. Hammoudi , M.S. Lounes
<div><h3>Introduction</h3><div>Diabetic cardiomyopathy represents a critical stage in the progression towards preventable functional decline. Currently, the value of screening for Stage B heart failure (HF) in asymptomatic Type 2 diabetes (T2D) patients remains undefined. Developing a standardized diagnostic model, focusing on the relationship between the left ventricle and arterial tree via ventriculo-arterial coupling (VAC), may help slow or prevent HF progression well before symptom onset.</div></div><div><h3>Objective</h3><div>This study aims to evaluate the diagnostic utility of pressure-volume loops at rest and after an isometric handgrip test (IHGT) in predicting the onset of HF with preserved ejection fraction (HFpEF) in T2D patients as part of primary cardiovascular prevention.</div></div><div><h3>Method</h3><div>This prospective, observational, single-center study was conducted at the Central Army Hospital University. From March 2022 to March 2024, 325 patients were included and followed for 12 months. At baseline and after 12 months, patients underwent a transthoracic echocardiography session, complemented by a three-minute IHGT. Diastolic function at rest was defined using the 2016 ASE/EACVI guidelines, and HFpEF diagnosis was determined via the ESC HFA-PEFF score. The Chen method was used for VAC calculation.</div></div><div><h3>Results</h3><div>After 12 months, 43 patients (13.23%) developed HFpEF. In bivariate analysis, hemodynamic parameters predicting HFpEF occurrence included: At rest: arterial elastance (Ea<!--> <!-->=<!--> <!-->1.89<!--> <!-->±<!--> <!-->0.2, <em>P</em> <!-->=<!--> <!-->0.0001), ejection time (Tej<!--> <!-->=<!--> <!-->0.294<!--> <!-->±<!--> <!-->0.03 s, <em>P</em> <!-->=<!--> <!-->0.001), and the pre-ejection time/ejection time ratio (Tpej/Tej<!--> <!-->=<!--> <!-->0.33<!--> <!-->±<!--> <!-->0.07, <em>P</em> <!-->=<!--> <!-->0.02). Post-IHGT: arterial elastance (Ea<!--> <!-->=<!--> <!-->1.92<!--> <!-->±<!--> <!-->0.2, <em>P</em> <!-->=<!--> <!-->0.0001) and VAC (CVA<!--> <!-->=<!--> <!-->1.84<!--> <!-->mmHg/ml<!--> <!-->±<!--> <!-->0.8, <em>P</em> <!-->=<!--> <!-->0.053). In multivariate analysis, the predictive parameters were: At rest: global longitudinal strain (GLS), left atrial volume (LAV), pre-ejection time/ejection time ratio, and NTproBNP levels. Post-IHGT: VAC and the E/e’ ratio. Ventricular elastance (Es) at rest and under stress did not predict HFpEF progression (<em>P</em> <!-->=<!--> <!-->0.21, <em>P</em> <!-->=<!--> <!-->0.47, respectively).</div></div><div><h3>Conclusion</h3><div>Arterial elastance at rest and during IHGT was a predictor of HFpEF in bivariate analysis but not in multivariate analysis. VAC during IHGT emerged as a predictor in both analyses. The hemodynamic response to diastolic stress testing allowed us to categorize our diabetic cohort into two groups: those at high risk of HFpEF progression, indicated by increased VAC, and those at lower risk, marked by stabilized or decreas
{"title":"Hemodynamic impact in single-beat at rest and after diastolic stress in diabetic patients at risk of developing heart failure","authors":"E. Tebache , J.M. Tartière , Y. Fedali , N. Hammoudi , M.S. Lounes","doi":"10.1016/j.acvd.2025.10.071","DOIUrl":"10.1016/j.acvd.2025.10.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetic cardiomyopathy represents a critical stage in the progression towards preventable functional decline. Currently, the value of screening for Stage B heart failure (HF) in asymptomatic Type 2 diabetes (T2D) patients remains undefined. Developing a standardized diagnostic model, focusing on the relationship between the left ventricle and arterial tree via ventriculo-arterial coupling (VAC), may help slow or prevent HF progression well before symptom onset.</div></div><div><h3>Objective</h3><div>This study aims to evaluate the diagnostic utility of pressure-volume loops at rest and after an isometric handgrip test (IHGT) in predicting the onset of HF with preserved ejection fraction (HFpEF) in T2D patients as part of primary cardiovascular prevention.</div></div><div><h3>Method</h3><div>This prospective, observational, single-center study was conducted at the Central Army Hospital University. From March 2022 to March 2024, 325 patients were included and followed for 12 months. At baseline and after 12 months, patients underwent a transthoracic echocardiography session, complemented by a three-minute IHGT. Diastolic function at rest was defined using the 2016 ASE/EACVI guidelines, and HFpEF diagnosis was determined via the ESC HFA-PEFF score. The Chen method was used for VAC calculation.</div></div><div><h3>Results</h3><div>After 12 months, 43 patients (13.23%) developed HFpEF. In bivariate analysis, hemodynamic parameters predicting HFpEF occurrence included: At rest: arterial elastance (Ea<!--> <!-->=<!--> <!-->1.89<!--> <!-->±<!--> <!-->0.2, <em>P</em> <!-->=<!--> <!-->0.0001), ejection time (Tej<!--> <!-->=<!--> <!-->0.294<!--> <!-->±<!--> <!-->0.03 s, <em>P</em> <!-->=<!--> <!-->0.001), and the pre-ejection time/ejection time ratio (Tpej/Tej<!--> <!-->=<!--> <!-->0.33<!--> <!-->±<!--> <!-->0.07, <em>P</em> <!-->=<!--> <!-->0.02). Post-IHGT: arterial elastance (Ea<!--> <!-->=<!--> <!-->1.92<!--> <!-->±<!--> <!-->0.2, <em>P</em> <!-->=<!--> <!-->0.0001) and VAC (CVA<!--> <!-->=<!--> <!-->1.84<!--> <!-->mmHg/ml<!--> <!-->±<!--> <!-->0.8, <em>P</em> <!-->=<!--> <!-->0.053). In multivariate analysis, the predictive parameters were: At rest: global longitudinal strain (GLS), left atrial volume (LAV), pre-ejection time/ejection time ratio, and NTproBNP levels. Post-IHGT: VAC and the E/e’ ratio. Ventricular elastance (Es) at rest and under stress did not predict HFpEF progression (<em>P</em> <!-->=<!--> <!-->0.21, <em>P</em> <!-->=<!--> <!-->0.47, respectively).</div></div><div><h3>Conclusion</h3><div>Arterial elastance at rest and during IHGT was a predictor of HFpEF in bivariate analysis but not in multivariate analysis. VAC during IHGT emerged as a predictor in both analyses. The hemodynamic response to diastolic stress testing allowed us to categorize our diabetic cohort into two groups: those at high risk of HFpEF progression, indicated by increased VAC, and those at lower risk, marked by stabilized or decreas","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S40-S41"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904071","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.093
S. Istratoaie , A. Zygouri , M. Bézard , J. Antonelli , S. Vesa , E. Donal
Introduction
Cardiac amyloidosis (CA) is increasingly acknowledged as a primary cause of conduction abnormalities such as bradyarrhythmias. However, current guidelines do not differentiate pacemaker (PM) implantation criteria for CA patients from those applied to the general population. Identifying specific indicators that predict pacing needs could aid in early risk stratification and targeted follow-up.
Objective
To investigate clinical and imaging predictors of pacemaker implantation in transthyretin amyloidosis (ATTR) patients and to determine cutoff values that could support early identification of individuals at risk for future pacing.
Method
We retrospectively analyzed a cohort of consecutive ATTR patients diagnosed between 2016 and 2023 at a single specialized center. Clinical, biochemical, and echocardiographic parameters were assessed. Patients with a pacemaker at the time of ATTR diagnosis (n = 54) were excluded. The primary endpoint was new PM implantation during follow-up.
Results
A total of 269 patients were included (median age 83 years; 84.4% male). Over a fixed 24-month follow-up, 50 patients (18.6%) underwent PM implantation, with a median time to implantation of 6 months [1.75;11.25]. The most frequent indications were complete AV block (26%), advanced conduction disorders (26%), CRT-P indication (16%), symptomatic AF with bradycardia (16%), and AF resistant to rhythm/rate control (16%).
Key factors associated with increased risk of PM implantation included a history of atrial fibrillation, QRS duration > 128 ms, LAVI > 50 ml/m2, IVS thickness > 18 mm, NT-proBNP > 2200 pg/ml, and E/e’ > 11. On multivariate analysis, the strongest independent predictors were QRS > 128 ms (HR 2.669, 95% CI 1.487–4.792; P < 0.001), IVS > 18 mm (HR 2.744, 95% CI 1.533–4.911), and E/e’ > 11 (HR 4.298, 95% CI 1.029–17.942).
Conclusion
Nearly one in five ATTR patients required pacemaker implantation within two years of diagnosis. Prolonged QRS, increased septal wall thickness, and elevated E/e’ ratio emerged as robust predictors of pacing necessity, offering valuable markers for refining patient monitoring and management strategies.
心脏淀粉样变性（CA）越来越被认为是传导异常（如慢速心律失常）的主要原因。然而，目前的指南并没有将CA患者的起搏器（PM）植入标准与适用于一般人群的起搏器植入标准区分开来。确定预测起搏需求的具体指标有助于早期风险分层和有针对性的随访。目的探讨甲状腺素淀粉样变性（ATTR）患者起搏器植入的临床和影像学预测因素，并确定临界值，以支持早期识别未来起搏风险个体。方法回顾性分析2016年至2023年在单一专科中心诊断的连续ATTR患者队列。评估临床、生化和超声心动图参数。排除ATTR诊断时装有起搏器的患者（n = 54）。随访期间主要终点为新的PM植入。结果共纳入269例患者，中位年龄83岁，男性84.4%。在24个月的固定随访中，50例患者（18.6%）接受了PM植入，中位植入时间为6个月[1.75;11.25]。最常见的适应症是完全房室传导阻滞（26%）、晚期传导障碍（26%）、CRT-P适应症（16%）、症状性房颤伴心动过缓（16%）和房颤对节律/速率控制的抵抗（16%）。与PM植入风险增加相关的关键因素包括房颤史、QRS持续时间128 ms、LAVI 50 ml/m2、IVS厚度18 mm、NT-proBNP 2200 pg/ml和E/ E ' 11。在多变量分析中，最强的独立预测因子为QRS >； 128 ms （HR 2.669, 95% CI 1.487-4.792; P < 0.001）、IVS > 18 mm （HR 2.744, 95% CI 1.533-4.911）和E/ E >； 11 （HR 4.298, 95% CI 1.029-17.942）。结论近1 / 5的ATTR患者在诊断两年内需要植入起搏器。QRS延长、间隔壁厚度增加和E/ E比值升高是起搏必要性的可靠预测指标，为改进患者监测和管理策略提供了有价值的指标。
{"title":"Predictive markers and thresholds for pacemaker implantation in patients with ATTR amyloidosis","authors":"S. Istratoaie , A. Zygouri , M. Bézard , J. Antonelli , S. Vesa , E. Donal","doi":"10.1016/j.acvd.2025.10.093","DOIUrl":"10.1016/j.acvd.2025.10.093","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac amyloidosis (CA) is increasingly acknowledged as a primary cause of conduction abnormalities such as bradyarrhythmias. However, current guidelines do not differentiate pacemaker (PM) implantation criteria for CA patients from those applied to the general population. Identifying specific indicators that predict pacing needs could aid in early risk stratification and targeted follow-up.</div></div><div><h3>Objective</h3><div>To investigate clinical and imaging predictors of pacemaker implantation in transthyretin amyloidosis (ATTR) patients and to determine cutoff values that could support early identification of individuals at risk for future pacing.</div></div><div><h3>Method</h3><div>We retrospectively analyzed a cohort of consecutive ATTR patients diagnosed between 2016 and 2023 at a single specialized center. Clinical, biochemical, and echocardiographic parameters were assessed. Patients with a pacemaker at the time of ATTR diagnosis (<em>n</em> <!-->=<!--> <!-->54) were excluded. The primary endpoint was new PM implantation during follow-up.</div></div><div><h3>Results</h3><div>A total of 269 patients were included (median age 83 years; 84.4% male). Over a fixed 24-month follow-up, 50 patients (18.6%) underwent PM implantation, with a median time to implantation of 6 months [1.75;11.25]. The most frequent indications were complete AV block (26%), advanced conduction disorders (26%), CRT-<em>P</em> indication (16%), symptomatic AF with bradycardia (16%), and AF resistant to rhythm/rate control (16%).</div><div>Key factors associated with increased risk of PM implantation included a history of atrial fibrillation, QRS duration<!--> <!-->><!--> <!-->128<!--> <!-->ms, LAVI<!--> <!-->><!--> <!-->50<!--> <!-->ml/m<sup>2</sup>, IVS thickness<!--> <!-->><!--> <!-->18<!--> <!-->mm, NT-proBNP<!--> <!-->><!--> <!-->2200<!--> <!-->pg/ml, and E/e’<!--> <!-->><!--> <!-->11. On multivariate analysis, the strongest independent predictors were QRS<!--> <!-->><!--> <!-->128<!--> <!-->ms (HR 2.669, 95% CI 1.487–4.792; <em>P</em> <!--><<!--> <!-->0.001), IVS<!--> <!-->><!--> <!-->18<!--> <!-->mm (HR 2.744, 95% CI 1.533–4.911), and E/e’<!--> <!-->><!--> <!-->11 (HR 4.298, 95% CI 1.029–17.942).</div></div><div><h3>Conclusion</h3><div>Nearly one in five ATTR patients required pacemaker implantation within two years of diagnosis. Prolonged QRS, increased septal wall thickness, and elevated E/e’ ratio emerged as robust predictors of pacing necessity, offering valuable markers for refining patient monitoring and management strategies.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S53"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904119","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.008
F. Boukerche
Introduction
Calcification is a signature of advanced atherosclerosis, and the presence and the extent of calcification is strongly associated with poor prognosis.
Objective
Little is known about the impact of coronary calcification on long term outcomes in patients presenting in the setting of acute coronary syndromes.
Method
Patients admitted for NSTE-ACS and indication for coronary angiography were prospectively evaluated. Patients were divided into 2 groups according to whether infarct-related-artery lesions were vs. were not moderately/severely calcified. Major outcomes were assessed at 10 years.
Results
A total of 292 patients were evaluated: mean age was 62 ± 12 years and 58% were male. The 10-year mortality was 21.9% (64 patients) and the 10-year MACCE was 38.4% (112 patients). The calcified group included 121 patients (42.2%). The ten-year mortality and MACCE in the patients of calcified group was significantly higher (33.1% vs. 14.0%; P < 10−3) (Fig. 1) and (55.4% vs. 26.3%; P < 10−3) respectively.
Conclusion
In patients with NSTE-ACS, the calcified infarct-related-artery lesion is a characteristic, which is strongly predictive of worst outcome. Novel approaches are needed to improve the prognosis in this high–risk lesion subset.
钙化是晚期动脉粥样硬化的标志，钙化的存在和程度与不良预后密切相关。目的目前尚不清楚急性冠脉综合征患者冠状动脉钙化对其长期预后的影响。方法前瞻性评价因NSTE-ACS入院的患者及其冠状动脉造影适应证。根据梗死相关动脉病变是否存在中度/重度钙化，将患者分为两组。主要结果在10年进行评估。结果共纳入292例患者，平均年龄62±12岁，男性占58%。10年死亡率为21.9%（64例），10年MACCE为38.4%（112例）。钙化组121例（42.2%）。钙化组患者的10年死亡率和MACCE分别显著高于（33.1% vs. 14.0%; P < 10−3）（图1）和（55.4% vs. 26.3%; P < 10−3）。结论在NSTE-ACS患者中，钙化的梗死相关动脉病变是一个特征，这是预测最坏结局的重要因素。需要新的方法来改善这一高危病变亚群的预后。
{"title":"Long term prognostic impact of calcified infarct-related artery lesion in NSTE-ACS patients","authors":"F. Boukerche","doi":"10.1016/j.acvd.2025.10.008","DOIUrl":"10.1016/j.acvd.2025.10.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Calcification is a signature of advanced atherosclerosis, and the presence and the extent of calcification is strongly associated with poor prognosis.</div></div><div><h3>Objective</h3><div>Little is known about the impact of coronary calcification on long term outcomes in patients presenting in the setting of acute coronary syndromes.</div></div><div><h3>Method</h3><div>Patients admitted for NSTE-ACS and indication for coronary angiography were prospectively evaluated. Patients were divided into 2 groups according to whether infarct-related-artery lesions were vs. were not moderately/severely calcified. Major outcomes were assessed at 10 years.</div></div><div><h3>Results</h3><div>A total of 292 patients were evaluated: mean age was 62<!--> <!-->±<!--> <!-->12 years and 58% were male. The 10-year mortality was 21.9% (64 patients) and the 10-year MACCE was 38.4% (112 patients). The calcified group included 121 patients (42.2%). The ten-year mortality and MACCE in the patients of calcified group was significantly higher (33.1% vs. 14.0%; <em>P</em> <!--><<!--> <!-->10<sup>−3</sup>) (<span><span>Fig. 1</span></span>) and (55.4% vs. 26.3%; <em>P</em> <!--><<!--> <!-->10<sup>−3</sup>) respectively.</div></div><div><h3>Conclusion</h3><div>In patients with NSTE-ACS, the calcified infarct-related-artery lesion is a characteristic, which is strongly predictive of worst outcome. Novel approaches are needed to improve the prognosis in this high–risk lesion subset.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S9"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904133","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.048
Y. Daoudi , H. Kamri , L. Samy , O. Taoussi , G. Bennis , S. Hafid , F.Z. Merzouk , G. Bennouna
Introduction
In-stent restenosis remains a significant long-term complication following coronary revascularisation with drug-eluting stents, primarily due to neointimal hyperplasia. Despite advances in stent technology, the identification of clinical predictors for ISR remains critical for risk stratification and management.
Objective
This study seeks to evaluate the determinants of ISR in a contemporary cohort from a tertiary care center.
Method
We conducted a retrospective, observational study of 140 patients undergoing PCI with DES implantation. Patients were stratified into ISR and non-ISR groups. Comprehensive clinical, angiographic, and biochemical data were analyzed. Logistic regression models were applied to identify independent predictors of ISR.
Results
Diabetes mellitus (OR 3.45, CI 2.11–3.94) and hypertension (OR 2.94, CI 1.32–3.04) were significantly associated with ISR. Although statin use was higher in the ISR group, serum lipid levels, including LDL and total cholesterol, were not independently predictive of restenosis. HDL levels were inversely associated with ISR. Smoking and complex bifurcation lesions trended higher in ISR patients.
Conclusion
In our study, risk factors such as hypertension, diabetes, smoking, and gender have a significant association with ISR. Further research should explore additional factors like genetics and stent characteristics to enhance preventive strategies and optimize patient outcomes post-revascularization.
支架内再狭窄仍然是药物洗脱支架冠脉重建术后一个重要的长期并发症，主要是由于内膜增生。尽管支架技术取得了进步，但确定ISR的临床预测因素对于风险分层和管理仍然至关重要。目的本研究旨在评估来自三级医疗中心的当代队列中ISR的决定因素。方法对140例PCI合并DES植入术患者进行回顾性观察研究。将患者分为ISR组和非ISR组。综合临床、血管造影和生化数据进行分析。采用Logistic回归模型确定ISR的独立预测因子。结果糖尿病（OR 3.45, CI 2.11-3.94）和高血压（OR 2.94, CI 1.32-3.04）与ISR显著相关。尽管他汀类药物在ISR组的使用率较高，但血脂水平，包括LDL和总胆固醇，并不能独立预测再狭窄。HDL水平与ISR呈负相关。吸烟和复杂分叉病变在ISR患者中呈上升趋势。结论在我们的研究中，高血压、糖尿病、吸烟和性别等危险因素与ISR有显著相关。进一步的研究应探索遗传学和支架特性等其他因素，以加强预防策略并优化患者血运重建术后的预后。
{"title":"Coronary stent stenosis, a case control study","authors":"Y. Daoudi , H. Kamri , L. Samy , O. Taoussi , G. Bennis , S. Hafid , F.Z. Merzouk , G. Bennouna","doi":"10.1016/j.acvd.2025.10.048","DOIUrl":"10.1016/j.acvd.2025.10.048","url":null,"abstract":"<div><h3>Introduction</h3><div>In-stent restenosis remains a significant long-term complication following coronary revascularisation with drug-eluting stents, primarily due to neointimal hyperplasia. Despite advances in stent technology, the identification of clinical predictors for ISR remains critical for risk stratification and management.</div></div><div><h3>Objective</h3><div>This study seeks to evaluate the determinants of ISR in a contemporary cohort from a tertiary care center.</div></div><div><h3>Method</h3><div>We conducted a retrospective, observational study of 140 patients undergoing PCI with DES implantation. Patients were stratified into ISR and non-ISR groups. Comprehensive clinical, angiographic, and biochemical data were analyzed. Logistic regression models were applied to identify independent predictors of ISR.</div></div><div><h3>Results</h3><div>Diabetes mellitus (OR 3.45, CI 2.11–3.94) and hypertension (OR 2.94, CI 1.32–3.04) were significantly associated with ISR. Although statin use was higher in the ISR group, serum lipid levels, including LDL and total cholesterol, were not independently predictive of restenosis. HDL levels were inversely associated with ISR. Smoking and complex bifurcation lesions trended higher in ISR patients.</div></div><div><h3>Conclusion</h3><div>In our study, risk factors such as hypertension, diabetes, smoking, and gender have a significant association with ISR. Further research should explore additional factors like genetics and stent characteristics to enhance preventive strategies and optimize patient outcomes post-revascularization.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S27"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904134","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.096
A. Ben Halima , W. Souissi , Z. Ibn El Hadj , O. Ferchichi , B. Emna , I. Kammoun
<div><h3>Introduction</h3><div>Heart failure with reduced ejection fraction (HFrEF) is a major cause of morbidity and mortality, often linked to abnormal cardiac repolarization and an increased risk of arrhythmias. Dapagliflozin, an SGLT2 inhibitor, has demonstrated potential benefits in managing heart failure, but its effects on repolarization markers in HFrEF patients remain unclear. This study aims to evaluate the impact of dapagliflozin on QT interval and other repolarization markers, and to explore their association with reverse remodeling.</div></div><div><h3>Objective</h3><div>The aim of the study is to evaluate the effect of dapagliflozin on ventricular repolarization markers in patients with HFrEF, and to assess whether these changes are associated with reverse remodeling.</div></div><div><h3>Method</h3><div>This retrospective study included patients referred to our cardiology department between February 2022 and June 2023 for the evaluation of HFrEF. Electrocardiograms (ECGs) were performed before the initiation of dapagliflozin and 6 months later to assess ventricular repolarization parameters, including the QT interval, QTc (corrected using the Bazett formula), QT dispersion (QTd), QTc dispersion (QTc-d), Tpeak to Tend (Tp-e) interval, as well as Tp-e/QT and Tp-e/QTc ratios.</div></div><div><h3>Results</h3><div>A total of 50 patients in sinus rhythm were included. The mean age was 60.88<!--> <!-->±<!--> <!-->11.36 years old, and 11 (22%) were female patients. The mean ejection fraction was 30.86<!--> <!-->±<!--> <!-->7.2%. After introduction of Dapagliflozin we noticed a significant decrease in QTc intervals (430.74<!--> <!-->±<!--> <!-->33.81<!--> <!-->ms vs 408.74<!--> <!-->±<!--> <!-->32.45<!--> <!-->ms; <em>P</em> <!--><<!--> <!-->0.001), QT-d (54<!--> <!-->±<!--> <!-->19.24<!--> <!-->ms vs 36.2<!--> <!-->±<!--> <!-->11.8<!--> <!-->ms; <em>P</em> <!--><<!--> <!-->0.001), and Tp-e interval (95.8<!--> <!-->±<!--> <!-->24.83<!--> <!-->ms vs 74.8<!--> <!-->±<!--> <!-->22.87<!--> <!-->ms; <em>P</em> <!--><<!--> <!-->0.001). There was no significant difference in the variation of repolarization markers between patients who had reverse remodeling (17 patients) and those who did not (33 patients). Specifically, ΔQTc (<em>P</em> <!-->=<!--> <!-->0.728), ΔQTd (<em>P</em> <!-->=<!--> <!-->0.849), ΔQTc-d (<em>P</em> <!-->=<!--> <!-->0.377), ΔTpTe (<em>P</em> <!-->=<!--> <!-->0.103), ΔTpTe/QT (<em>P</em> <!-->=<!--> <!-->0.07), and Δf(QRS-T) (<em>P</em> <!-->=<!--> <!-->0.51) showed no significant difference between the two groups.</div></div><div><h3>Conclusion</h3><div>The introduction of dapagliflozin in patients with HFrEF resulted in significant improvements in repolarization markers. However, the variation in these markers did not significantly differ between patients with and without reverse remodeling, These findings suggest that dapagliflozin may influence cardiac electrophysiology, but its effects on repolarization markers a
心力衰竭伴射血分数降低（HFrEF）是发病率和死亡率的主要原因，通常与心脏复极异常和心律失常风险增加有关。达格列净是一种SGLT2抑制剂，已被证明在治疗心力衰竭方面有潜在的益处，但其对HFrEF患者复极化标志物的影响尚不清楚。本研究旨在评价达格列净对QT间期及其他复极指标的影响，并探讨其与逆转重构的关系。目的评价达格列净对HFrEF患者心室复极标志物的影响，并评估这些变化是否与反向重构有关。方法本回顾性研究纳入了2022年2月至2023年6月至我院心内科进行HFrEF评估的患者。在开始服用达格列净前和6个月后进行心电图（ECGs），评估心室复极参数，包括QT间期、QTc（使用Bazett公式校正）、QT离散度（QTd）、QTc离散度（QTc-d）、Tpeak to Tend （Tp-e）间期以及Tp-e/QT和Tp-e/QTc之比。结果共纳入50例窦性心律失常患者。平均年龄60.88±11.36岁，女性11例（22%）。平均射血分数为30.86±7.2%。引入Dapagliflozin后，我们注意到QTc间隔（430.74±33.81 ms vs 408.74±32.45 ms; P < 0.001）、QT-d间隔（54±19.24 ms vs 36.2±11.8 ms; P < 0.001）和Tp-e间隔（95.8±24.83 ms vs 74.8±22.87 ms; P < 0.001）显著降低。反向重构患者（17例）和非反向重构患者（33例）复极标记物的变化无显著差异。其中ΔQTc （P = 0.728）、ΔQTd （P = 0.849）、ΔQTc-d （P = 0.377）、ΔTpTe （P = 0.103）、ΔTpTe/QT （P = 0.07）、Δf(QRS-T) （P = 0.51）两组间差异无统计学意义。结论在HFrEF患者中引入达格列净可显著改善复极标志物。然而，这些标记物的变化在有和没有反向重构的患者之间没有显著差异。这些发现表明，达格列净可能影响心脏电生理，但其对复极标记物的影响似乎与该队列中的反向重构无关。
{"title":"Impact of dapagliflozin on ventricular repolarization markers in patients with reduced ejection fraction: Association with reverse remodeling","authors":"A. Ben Halima , W. Souissi , Z. Ibn El Hadj , O. Ferchichi , B. Emna , I. Kammoun","doi":"10.1016/j.acvd.2025.10.096","DOIUrl":"10.1016/j.acvd.2025.10.096","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure with reduced ejection fraction (HFrEF) is a major cause of morbidity and mortality, often linked to abnormal cardiac repolarization and an increased risk of arrhythmias. Dapagliflozin, an SGLT2 inhibitor, has demonstrated potential benefits in managing heart failure, but its effects on repolarization markers in HFrEF patients remain unclear. This study aims to evaluate the impact of dapagliflozin on QT interval and other repolarization markers, and to explore their association with reverse remodeling.</div></div><div><h3>Objective</h3><div>The aim of the study is to evaluate the effect of dapagliflozin on ventricular repolarization markers in patients with HFrEF, and to assess whether these changes are associated with reverse remodeling.</div></div><div><h3>Method</h3><div>This retrospective study included patients referred to our cardiology department between February 2022 and June 2023 for the evaluation of HFrEF. Electrocardiograms (ECGs) were performed before the initiation of dapagliflozin and 6 months later to assess ventricular repolarization parameters, including the QT interval, QTc (corrected using the Bazett formula), QT dispersion (QTd), QTc dispersion (QTc-d), Tpeak to Tend (Tp-e) interval, as well as Tp-e/QT and Tp-e/QTc ratios.</div></div><div><h3>Results</h3><div>A total of 50 patients in sinus rhythm were included. The mean age was 60.88<!--> <!-->±<!--> <!-->11.36 years old, and 11 (22%) were female patients. The mean ejection fraction was 30.86<!--> <!-->±<!--> <!-->7.2%. After introduction of Dapagliflozin we noticed a significant decrease in QTc intervals (430.74<!--> <!-->±<!--> <!-->33.81<!--> <!-->ms vs 408.74<!--> <!-->±<!--> <!-->32.45<!--> <!-->ms; <em>P</em> <!--><<!--> <!-->0.001), QT-d (54<!--> <!-->±<!--> <!-->19.24<!--> <!-->ms vs 36.2<!--> <!-->±<!--> <!-->11.8<!--> <!-->ms; <em>P</em> <!--><<!--> <!-->0.001), and Tp-e interval (95.8<!--> <!-->±<!--> <!-->24.83<!--> <!-->ms vs 74.8<!--> <!-->±<!--> <!-->22.87<!--> <!-->ms; <em>P</em> <!--><<!--> <!-->0.001). There was no significant difference in the variation of repolarization markers between patients who had reverse remodeling (17 patients) and those who did not (33 patients). Specifically, ΔQTc (<em>P</em> <!-->=<!--> <!-->0.728), ΔQTd (<em>P</em> <!-->=<!--> <!-->0.849), ΔQTc-d (<em>P</em> <!-->=<!--> <!-->0.377), ΔTpTe (<em>P</em> <!-->=<!--> <!-->0.103), ΔTpTe/QT (<em>P</em> <!-->=<!--> <!-->0.07), and Δf(QRS-T) (<em>P</em> <!-->=<!--> <!-->0.51) showed no significant difference between the two groups.</div></div><div><h3>Conclusion</h3><div>The introduction of dapagliflozin in patients with HFrEF resulted in significant improvements in repolarization markers. However, the variation in these markers did not significantly differ between patients with and without reverse remodeling, These findings suggest that dapagliflozin may influence cardiac electrophysiology, but its effects on repolarization markers a","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S54"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904149","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 : 2026-01-01DOI: 10.1016/j.acvd.2025.10.036
A. Mounssif, Z. Moulay Rchid, A. Arous
Introduction
Rheumatic heart disease (RHD) remains a leading cause of valvular pathology in low- and middle-income countries. Characterizing its epidemiological and echocardiographic profile is essential to improve screening strategies and guide interventions.
Objective
This study aimed to describe the demographic and echocardiographic characteristics of patients with rheumatic valvular disease in a Moroccan tertiary care setting.
Method
We conducted a retrospective analysis of 408 patients admitted to Casablanca University Hospital for rheumatic valvular heart disease between 2019 and 2025. Data included demographic information, clinical presentation, and transthoracic echocardiography findings.
Results
Among the 408 patients, the mean age was 56.4 years, and 78% were female (n = 318). The mitral valve was the most frequently involved, with a predominance of moderate to severe mitral stenosis. Many patients also presented with mixed valvular lesions. Left ventricular ejection fraction was generally preserved. Surprisingly, no documented atrial fibrillation was reported at admission, despite significant left atrial remodeling in several cases (Fig. 1).
Conclusion
This study highlights the ongoing burden of rheumatic valvular disease in Moroccan patients, particularly among women. Despite relatively young age, patients frequently present with advanced mitral valve disease. These findings support the urgent need for earlier detection, community awareness, and systematic screening in high-risk populations.
{"title":"Epidemiological and echocardiographic profile of rheumatic valvular heart disease in a Moroccan population: Insights from a 408-patient retrospective cohort","authors":"A. Mounssif, Z. Moulay Rchid, A. Arous","doi":"10.1016/j.acvd.2025.10.036","DOIUrl":"10.1016/j.acvd.2025.10.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Rheumatic heart disease (RHD) remains a leading cause of valvular pathology in low- and middle-income countries. Characterizing its epidemiological and echocardiographic profile is essential to improve screening strategies and guide interventions.</div></div><div><h3>Objective</h3><div>This study aimed to describe the demographic and echocardiographic characteristics of patients with rheumatic valvular disease in a Moroccan tertiary care setting.</div></div><div><h3>Method</h3><div>We conducted a retrospective analysis of 408 patients admitted to Casablanca University Hospital for rheumatic valvular heart disease between 2019 and 2025. Data included demographic information, clinical presentation, and transthoracic echocardiography findings.</div></div><div><h3>Results</h3><div>Among the 408 patients, the mean age was 56.4 years, and 78% were female (<em>n</em> <!-->=<!--> <!-->318). The mitral valve was the most frequently involved, with a predominance of moderate to severe mitral stenosis. Many patients also presented with mixed valvular lesions. Left ventricular ejection fraction was generally preserved. Surprisingly, no documented atrial fibrillation was reported at admission, despite significant left atrial remodeling in several cases (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>This study highlights the ongoing burden of rheumatic valvular disease in Moroccan patients, particularly among women. Despite relatively young age, patients frequently present with advanced mitral valve disease. These findings support the urgent need for earlier detection, community awareness, and systematic screening in high-risk populations.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S22-S23"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904253","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}
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