Pub Date : 2026-01-01DOI: 10.1016/j.acvd.2025.10.047
M. Dorobantu , L. Stanciulescu , D. Sararu , A. Streinu-Cercel , C. Deleanu , C. Duduianu , L. Itu , C. Hatfaludi , I.A. Tabacu , O. Gheorghe-Fronea
Introduction
Although traditionally regarded as a disease of older adults, atherosclerotic cardiovascular disease (ASCVD) continues to be a leading global cause of mortality. A growing incidence of cardiovascular disease (CVD) in younger populations highlights a critical gap in current risk stratification tools, which often underestimate cardiovascular (CV) risk in this group.
Objective
The primary objective of this study was to address this deficiency, by developing and validating a novel cardiovascular risk assessment model tailored specifically for young adults aged 18–35 years. Secondary objectives included evaluating the prevalence of subclinical cardiovascular risk factors in this demographic and assessing the added predictive value of structural heart disease markers and vascular biomarkers when integrated with artificial intelligence-based analysis.
Method
We initiated a pilot, multicenter, prospective observational clinical study—SOLUTION (Atherosclerotic Risk Score for Young Adults in Romania)—representing the first comprehensive CV risk screening in a representative Romanian cohort aged 18–35 years. Participants were stratified into four distinct risk categories (no risk, low, medium, and high) based on a novel risk assessment model integrating advanced prognostic indicators, such as structural heart disease (SHD) and vascular biomarkers, augmented with artificial intelligence (AI) analytics.
Results
Analysis of 311 individuals revealed that none had a completely normal biomarker profile, with the majority presenting six abnormal parameters. Key findings included elevated rates of inflammatory syndrome (17.8% and 42.7%, respectively), hypertension (16.2%), obesity (8.7%), smoking (89.39%), dyslipidemia (42.76% with elevated triglycerides; 50.48% with high total cholesterol), and type II diabetes mellitus (1.28%). Incorporating SHD parameters, the newly proposed Solution Risk Score (SRS) demonstrated improved granularity and predictive capacity compared to traditional scoring systems.
Conclusion
These alarming trends underscore the relevance of the SRS in this under-recognized age group. By integrating SHD markers, the SRS may enhance early detection and facilitate the implementation of targeted preventive strategies and timely interventions. Broader validation in larger cohorts remains essential to establish its generalizability.
{"title":"Cardiovascular risk assessment in young adults: A pilot study","authors":"M. Dorobantu , L. Stanciulescu , D. Sararu , A. Streinu-Cercel , C. Deleanu , C. Duduianu , L. Itu , C. Hatfaludi , I.A. Tabacu , O. Gheorghe-Fronea","doi":"10.1016/j.acvd.2025.10.047","DOIUrl":"10.1016/j.acvd.2025.10.047","url":null,"abstract":"<div><h3>Introduction</h3><div>Although traditionally regarded as a disease of older adults, atherosclerotic cardiovascular disease (ASCVD) continues to be a leading global cause of mortality. A growing incidence of cardiovascular disease (CVD) in younger populations highlights a critical gap in current risk stratification tools, which often underestimate cardiovascular (CV) risk in this group.</div></div><div><h3>Objective</h3><div>The primary objective of this study was to address this deficiency, by developing and validating a novel cardiovascular risk assessment model tailored specifically for young adults aged 18–35 years. Secondary objectives included evaluating the prevalence of subclinical cardiovascular risk factors in this demographic and assessing the added predictive value of structural heart disease markers and vascular biomarkers when integrated with artificial intelligence-based analysis.</div></div><div><h3>Method</h3><div>We initiated a pilot, multicenter, prospective observational clinical study—SOLUTION (Atherosclerotic Risk Score for Young Adults in Romania)—representing the first comprehensive CV risk screening in a representative Romanian cohort aged 18–35 years. Participants were stratified into four distinct risk categories (no risk, low, medium, and high) based on a novel risk assessment model integrating advanced prognostic indicators, such as structural heart disease (SHD) and vascular biomarkers, augmented with artificial intelligence (AI) analytics.</div></div><div><h3>Results</h3><div>Analysis of 311 individuals revealed that none had a completely normal biomarker profile, with the majority presenting six abnormal parameters. Key findings included elevated rates of inflammatory syndrome (17.8% and 42.7%, respectively), hypertension (16.2%), obesity (8.7%), smoking (89.39%), dyslipidemia (42.76% with elevated triglycerides; 50.48% with high total cholesterol), and type II diabetes mellitus (1.28%). Incorporating SHD parameters, the newly proposed Solution Risk Score (SRS) demonstrated improved granularity and predictive capacity compared to traditional scoring systems.</div></div><div><h3>Conclusion</h3><div>These alarming trends underscore the relevance of the SRS in this under-recognized age group. By integrating SHD markers, the SRS may enhance early detection and facilitate the implementation of targeted preventive strategies and timely interventions. Broader validation in larger cohorts remains essential to establish its generalizability.</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":"145903914","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.2025.10.030
S. Boudiche , S. Hachicha , F. Boudiche El Ayech , Z. Jebbari , K. Ezzaouia , F. Daly , A. Ben Salem , A. Farhati , F. Mghaieth , S. Ouali , M. Ben Halima , M.S. Mourali
Introduction
Balancing ischemic and hemorrhagic risks remains challenging in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Data on bleeding and ischemic risks profiles and antiplatelet management strategies post-PCI for ACS in North African populations are limited.
Objective
This study aimed to profile hemorrhagic and thrombotic risks using validated 2023 ESC guidelines risk criteria in a Tunisian cohort undergoing PCI for ACS, and to assess safety of short-duration dual antiplatelet therapy (DAPT) and triple antithrombotic therapy (TAT) regimens for patients on oral anticoagulation (OAC) during a 12-month follow-up.
Method
A prospective observational study enrolled consecutive patients presenting with ACS from December 1st, 2023, to February 29th, 2024, at a tertiary cardiology department in Tunis. Patients were classified at high bleeding risk (HBR) or low bleeding risk (LBR) using ARC-HBR criteria and at high (HTR) or moderate (MTR) thrombotic risks according to the criteria for extended treatment with a second antithrombotic agent. Major bleeding events (per BARC criteria), and major adverse cardiovascular and cerebrovascular events (MACCE) were evaluated at discharge, and 12-month follow-up.
Results
Among 249 patients with ACS, 194 (78%) underwent PCI. 60 (30.9%) of these patients were HBR. According to thrombotic risk, patients were stratified into four subgroups: 75 (38.7%) with LBR/MTR; 59 (30.4%) with LBR/HTR; 45 (23.2%) with HBR/HTR and 15 (7.7%) with HBR/MTR risk profile. Subgroups with LBR risk profile received 12 months of DAPT or one-month TAT regimens if they had OAC indication and HTR features. The minority of patients with HBR and MTR (15; 7.7%) received 6 months DAPT or one week TAT. At 12-month follow-up, patients with HBR/MIR who received shortened DAPT/TAT strategies had no MACCE and significantly fewer major bleeding events compared to HBR/HTR with mandated longer DAPT regimens (P < 0.001). Overall, major bleeding (BARC 3 or 5) occurred in 8.2% of patients, predominantly in the HBR/HTR subgroup (68.75%).
Conclusion
ARC-HBR and high thrombotic risk criteria proposed by 2023 ACS ESC guidelines effectively identified distinct bleeding and thrombotic risk subgroups. Shortened antithrombotic regimens for patients with high bleeding and moderate ischemic risk profile appear to be safe, reducing hemorrhagic complications without increasing ischemic events.
{"title":"Trade-off between bleeding and ischemic risk after percutaneous coronary intervention in a Tunisian acute coronary syndrome population","authors":"S. Boudiche , S. Hachicha , F. Boudiche El Ayech , Z. Jebbari , K. Ezzaouia , F. Daly , A. Ben Salem , A. Farhati , F. Mghaieth , S. Ouali , M. Ben Halima , M.S. Mourali","doi":"10.1016/j.acvd.2025.10.030","DOIUrl":"10.1016/j.acvd.2025.10.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Balancing ischemic and hemorrhagic risks remains challenging in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Data on bleeding and ischemic risks profiles and antiplatelet management strategies post-PCI for ACS in North African populations are limited.</div></div><div><h3>Objective</h3><div>This study aimed to profile hemorrhagic and thrombotic risks using validated 2023 ESC guidelines risk criteria in a Tunisian cohort undergoing PCI for ACS, and to assess safety of short-duration dual antiplatelet therapy (DAPT) and triple antithrombotic therapy (TAT) regimens for patients on oral anticoagulation (OAC) during a 12-month follow-up.</div></div><div><h3>Method</h3><div>A prospective observational study enrolled consecutive patients presenting with ACS from December 1st, 2023, to February 29th, 2024, at a tertiary cardiology department in Tunis. Patients were classified at high bleeding risk (HBR) or low bleeding risk (LBR) using ARC-HBR criteria and at high (HTR) or moderate (MTR) thrombotic risks according to the criteria for extended treatment with a second antithrombotic agent. Major bleeding events (per BARC criteria), and major adverse cardiovascular and cerebrovascular events (MACCE) were evaluated at discharge, and 12-month follow-up.</div></div><div><h3>Results</h3><div>Among 249 patients with ACS, 194 (78%) underwent PCI. 60 (30.9%) of these patients were HBR. According to thrombotic risk, patients were stratified into four subgroups: 75 (38.7%) with LBR/MTR; 59 (30.4%) with LBR/HTR; 45 (23.2%) with HBR/HTR and 15 (7.7%) with HBR/MTR risk profile. Subgroups with LBR risk profile received 12 months of DAPT or one-month TAT regimens if they had OAC indication and HTR features. The minority of patients with HBR and MTR (15; 7.7%) received 6 months DAPT or one week TAT. At 12-month follow-up, patients with HBR/MIR who received shortened DAPT/TAT strategies had no MACCE and significantly fewer major bleeding events compared to HBR/HTR with mandated longer DAPT regimens (<em>P</em> <!--><<!--> <!-->0.001). Overall, major bleeding (BARC 3 or 5) occurred in 8.2% of patients, predominantly in the HBR/HTR subgroup (68.75%).</div></div><div><h3>Conclusion</h3><div>ARC-HBR and high thrombotic risk criteria proposed by 2023 ACS ESC guidelines effectively identified distinct bleeding and thrombotic risk subgroups. Shortened antithrombotic regimens for patients with high bleeding and moderate ischemic risk profile appear to be safe, reducing hemorrhagic complications without increasing ischemic events.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S20"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903916","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.2025.10.057
A. Jobbé Duval , M. Kharoubi , F. Bauer , A. Broussier , A. Bisson , O. Bouchot , P. Charron , J. Costa , P.Y. Courrand , C. Dagrenat , A. Fraix , J.-P. Gueffet , G. Habib , J. Inamo , J. Jeanneteau , B. Mouhat , N. Piriou , A. Zaroui , O. Lairez , T. Damy
Introduction
Cardiac transthyretin amyloidosis (ATTR-CM) is a life threatening cardiomyopathy. Tafamidis has been demonstrated to be an effective treatment. The impact on the elderly remains debated.
Objective
Our aim was to analyze clinica characteristics and survival of patients with ATTR-CM aged ≥ 80 years diagnosed after November 2018, treated with tafamidis 80/61 mg, and compare them with a non treated group diagnosed before that date.
Method
Data from the two groups were extracted from the Healthcare European Amyloidosis Registry (HEAR) and analyzed according to age subgroups (80–85 vs > 85years) and heart failure severity (NYHA I-II vs III-IV).
Results
Out of 1380 patients, 1194 were treated with tafamidis 80/61 mg, while 186 were not treated. Treated patients were significantly less severe at baseline, with a lower occurrence of NYHA class III-IV compared to the untreated group (24 vs. 46%, P < 0.001). The median NT-proBNP at baseline was lower in the treated group (2330 vs.4854 pg/ml, P < 0.001), as was the average level of high-sensitivity troponin T (55 vs. 74 ng/ml, P < 0.001), and the interventricular septal thickness (16 vs. 18 mm, P < 0.001). The 3-year survival rate for treated patients was 57%, and 40% for untreated patients. In the treated group, the 3-year survival rate was 68% for patients aged 80–85 years and 58% for those over 85 years. Survival rates were confirmed after propensity score analyses (Fig. 1).
Conclusion
Survival in ATTR-CM patients has significantly improved in the recent period, both because of earlier diagnosis and because of tafamidis treatment, even in elderly patients.
心脏转甲状腺素淀粉样变性（atr - cm）是一种危及生命的心肌病。Tafamidis已被证明是一种有效的治疗方法。对老年人的影响仍存在争议。目的：分析2018年11月以后诊断的年龄≥80岁的atr - cm患者的临床特征和生存率，并将其与在该日期之前诊断的未治疗组进行比较。方法从欧洲淀粉样变性登记（HEAR）中提取两组数据，并根据年龄亚组（80-85岁vs 85岁）和心力衰竭严重程度（NYHA I-II vs III-IV）进行分析。结果在1380例患者中，1194例患者接受了80/61 mg他非他胺的治疗，186例患者未接受治疗。治疗组患者在基线时的严重程度明显减轻，NYHA III-IV级的发生率低于未治疗组（24%对46%，P < 0.001）。治疗组基线时NT-proBNP中位数较低（2330 vs.4854 pg/ml, P < 0.001），高敏感性肌钙蛋白T的平均水平较低（55 vs. 74 ng/ml, P < 0.001），室间隔厚度较低（16 vs. 18 mm, P < 0.001）。治疗组3年生存率为57%，未治疗组为40%。在治疗组中，80-85岁患者的3年生存率为68%，85岁以上患者的3年生存率为58%。在倾向评分分析后确认生存率（图1）。结论atr - cm患者的生存率在最近一段时间内显著提高，无论是早期诊断还是他非他汀治疗，即使是老年患者。
{"title":"Impact of Tafamidis on survival in elderly patients in a real-world setting: Insights from the Healthcare European Amyloidosis Registry","authors":"A. Jobbé Duval , M. Kharoubi , F. Bauer , A. Broussier , A. Bisson , O. Bouchot , P. Charron , J. Costa , P.Y. Courrand , C. Dagrenat , A. Fraix , J.-P. Gueffet , G. Habib , J. Inamo , J. Jeanneteau , B. Mouhat , N. Piriou , A. Zaroui , O. Lairez , T. Damy","doi":"10.1016/j.acvd.2025.10.057","DOIUrl":"10.1016/j.acvd.2025.10.057","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac transthyretin amyloidosis (ATTR-CM) is a life threatening cardiomyopathy. Tafamidis has been demonstrated to be an effective treatment. The impact on the elderly remains debated.</div></div><div><h3>Objective</h3><div>Our aim was to analyze clinica characteristics and survival of patients with ATTR-CM aged<!--> <!-->≥<!--> <!-->80 years diagnosed after November 2018, treated with tafamidis 80/61<!--> <!-->mg, and compare them with a non treated group diagnosed before that date.</div></div><div><h3>Method</h3><div>Data from the two groups were extracted from the Healthcare European Amyloidosis Registry (HEAR) and analyzed according to age subgroups (80–85 vs ><!--> <!-->85years) and heart failure severity (NYHA I-II vs III-IV).</div></div><div><h3>Results</h3><div>Out of 1380 patients, 1194 were treated with tafamidis 80/61<!--> <!-->mg, while 186 were not treated. Treated patients were significantly less severe at baseline, with a lower occurrence of NYHA class III-IV compared to the untreated group (24 vs. 46%, <em>P</em> <!--><<!--> <!-->0.001). The median NT-proBNP at baseline was lower in the treated group (2330 vs.4854<!--> <!-->pg/ml, <em>P</em> <!--><<!--> <!-->0.001), as was the average level of high-sensitivity troponin T (55 vs. 74<!--> <!-->ng/ml, <em>P</em> <!--><<!--> <!-->0.001), and the interventricular septal thickness (16 vs. 18<!--> <!-->mm, <em>P</em> <!--><<!--> <!-->0.001). The 3-year survival rate for treated patients was 57%, and 40% for untreated patients. In the treated group, the 3-year survival rate was 68% for patients aged 80–85 years and 58% for those over 85 years. Survival rates were confirmed after propensity score analyses (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Survival in ATTR-CM patients has significantly improved in the recent period, both because of earlier diagnosis and because of tafamidis treatment, even in elderly patients.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S31-S32"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903940","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.2025.10.065
A. Hacil , Y. Antakly Hanon , A. Lacour , J.S. Vidal , O. Hanon
Introduction
Heart failure with preserved ejection fraction (HFpEF) is prevalent in geriatric populations, but evidence for sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients over 90 years old is limited.
Objective
This study evaluated the real-world impact of SGLT2i in very old HFpEF patients by investigating factors associated with mortality or heart failure (HF) rehospitalizations.
Method
This prospective multicenter study included 298 consecutive patients (mean age: 90 years, mean Charlson score: 8.29) admitted with acute HFpEF to three geriatric units in Paris, France, between April 2021 and July 2023. Demographics, comorbidities, and discharge medications were collected. The primary outcome was a composite of all-cause mortality or HF rehospitalization at one year. Multivariate Cox regression analysis was used to identify factors associated with the composite outcome.
Results
At discharge, 49.6% received SGLT2i. One-year mortality was 28.1%, and the HF rehospitalization rate was 22.8%. SGLT2i use significantly reduced the composite outcome risk (HR: 0.43; 95% CI: 0.29–0.66), with event rates of 29.7% in the SGLT2i group versus 56.6% without (P < 0.001). Renin-angiotensin system blockers also showed a significant risk reduction (HR: 0.56; 95% CI: 0.38–0.82). Severe malnutrition, hypertension, and high intravenous furosemide doses were associated with worse outcomes (Fig. 1).
Conclusion
This study provides robust observational evidence supporting the use of SGLT2i therapy in very old HFpEF patients with high comorbidity burdens. Advanced age and multimorbidity should not preclude SGLT2i therapy in this population.
{"title":"Real-world outcomes of SGLT2 inhibitors in very elderly patients with heart failure with preserved ejection fraction","authors":"A. Hacil , Y. Antakly Hanon , A. Lacour , J.S. Vidal , O. Hanon","doi":"10.1016/j.acvd.2025.10.065","DOIUrl":"10.1016/j.acvd.2025.10.065","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure with preserved ejection fraction (HFpEF) is prevalent in geriatric populations, but evidence for sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients over 90 years old is limited.</div></div><div><h3>Objective</h3><div>This study evaluated the real-world impact of SGLT2i in very old HFpEF patients by investigating factors associated with mortality or heart failure (HF) rehospitalizations.</div></div><div><h3>Method</h3><div>This prospective multicenter study included 298 consecutive patients (mean age: 90 years, mean Charlson score: 8.29) admitted with acute HFpEF to three geriatric units in Paris, France, between April 2021 and July 2023. Demographics, comorbidities, and discharge medications were collected. The primary outcome was a composite of all-cause mortality or HF rehospitalization at one year. Multivariate Cox regression analysis was used to identify factors associated with the composite outcome.</div></div><div><h3>Results</h3><div>At discharge, 49.6% received SGLT2i. One-year mortality was 28.1%, and the HF rehospitalization rate was 22.8%. SGLT2i use significantly reduced the composite outcome risk (HR: 0.43; 95% CI: 0.29–0.66), with event rates of 29.7% in the SGLT2i group versus 56.6% without (<em>P</em> <!--><<!--> <!-->0.001). Renin-angiotensin system blockers also showed a significant risk reduction (HR: 0.56; 95% CI: 0.38–0.82). Severe malnutrition, hypertension, and high intravenous furosemide doses were associated with worse outcomes (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>This study provides robust observational evidence supporting the use of SGLT2i therapy in very old HFpEF patients with high comorbidity burdens. Advanced age and multimorbidity should not preclude SGLT2i therapy in this population.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S36"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903972","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.2025.10.066
A. Zaroui , C. Lafont , M. Kharoubi , A. Galat , E. Itti , F. Canoui-Poitrine , E. Audureau , T. Damy
Introduction
Cardiac amyloidosis (CA) encompasses a heterogeneous group of infiltrative cardiomyopathies, primarily including light-chain (AL) amyloidosis and transthyretin amyloidosis (ATTR), the latter subdivided into wild-type (ATTRwt) and hereditary or variant forms (ATTRv). In this complex spectrum, sex-related factors may influence clinical phenotype, disease progression, and prognosis.
Objective
We hypothesized that unsupervised clustering analysis could identify distinct patterns of presentation and evolution according to sex.
Method
A cohort of 2233 patients (1659 men, 574 women) was analyzed. Clustering analysis, using self-organizing maps (SOMs), was conducted separately for men, women, and the overall population.
Results
Men and women were categorized into six clusters each (A, B,C, D,E and F). AL amyloidosis was more prevalent in women, particularly in clusters with systemic involvement (E, F), while ATTRwt dominated in men (A, B, C). ATTRv was also more common in men. Men exhibited higher comorbidities and more severe cardiac involvement. Some clusters showed strong similarities across sexes, such as Cluster A (middle aged, high ATTRwt prevalence, comparable mortality ∼23%) and Cluster F (younger patients, lower ATTRwt prevalence, similar mortality ∼25.8%). Others had marked sex-based differences (Fig. 1), Cluster E (higher AL prevalence and systemic involvement, worse comorbidities) and Cluster D (most severe phenotype, with men experiencing significantly worse survival [76.1%]). Men had worse survival in advanced disease (Cluster D), while women had higher mortality in mid-life clusters despite milder cardiac involvement.
Conclusion
Clustering analysis highlights distinct sex-specific phenotypes in CA. Men exhibit more severe cardiac involvement and worse survival in advanced disease, whereas women have higher mortality despite milder cardiac features in mid-life clusters. These findings emphasize the need for personalized, gender-specific risk stratification and treatment strategies.
{"title":"Sex differences in cardiac amyloidosis: A clustering-based analysis","authors":"A. Zaroui , C. Lafont , M. Kharoubi , A. Galat , E. Itti , F. Canoui-Poitrine , E. Audureau , T. Damy","doi":"10.1016/j.acvd.2025.10.066","DOIUrl":"10.1016/j.acvd.2025.10.066","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac amyloidosis (CA) encompasses a heterogeneous group of infiltrative cardiomyopathies, primarily including light-chain (AL) amyloidosis and transthyretin amyloidosis (ATTR), the latter subdivided into wild-type (ATTRwt) and hereditary or variant forms (ATTRv). In this complex spectrum, sex-related factors may influence clinical phenotype, disease progression, and prognosis.</div></div><div><h3>Objective</h3><div>We hypothesized that unsupervised clustering analysis could identify distinct patterns of presentation and evolution according to sex.</div></div><div><h3>Method</h3><div>A cohort of 2233 patients (1659 men, 574 women) was analyzed. Clustering analysis, using self-organizing maps (SOMs), was conducted separately for men, women, and the overall population.</div></div><div><h3>Results</h3><div>Men and women were categorized into six clusters each (A, B,C, D,E and F). AL amyloidosis was more prevalent in women, particularly in clusters with systemic involvement (E, F), while ATTRwt dominated in men (A, B, C). ATTRv was also more common in men. Men exhibited higher comorbidities and more severe cardiac involvement. Some clusters showed strong similarities across sexes, such as Cluster A (middle aged, high ATTRwt prevalence, comparable mortality ∼23%) and Cluster F (younger patients, lower ATTRwt prevalence, similar mortality ∼25.8%). Others had marked sex-based differences (<span><span>Fig. 1</span></span>), Cluster E (higher AL prevalence and systemic involvement, worse comorbidities) and Cluster D (most severe phenotype, with men experiencing significantly worse survival [76.1%]). Men had worse survival in advanced disease (Cluster D), while women had higher mortality in mid-life clusters despite milder cardiac involvement.</div></div><div><h3>Conclusion</h3><div>Clustering analysis highlights distinct sex-specific phenotypes in CA. Men exhibit more severe cardiac involvement and worse survival in advanced disease, whereas women have higher mortality despite milder cardiac features in mid-life clusters. These findings emphasize the need for personalized, gender-specific risk stratification and treatment strategies.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S36-S37"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903973","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.2025.10.070
C. Morbach , J. Endo , J. González-Costello , F. Capelli , W.E. Moody , E. Klimova , G. Habib
Introduction
Transthyretin amyloidosis (ATTR) is a progressive, fatal disease often leading to a mixed phenotype with polyneuropathy and cardiomyopathy (CM). ATTR with CM (ATTR-CM) results in progressive heart failure (HF), decline in health status and quality of life, and increased hospitalisation rate and mortality.
Objective
Assess clinical characteristics and treatment landscape in ATTR-CM (wild-type [wtATTR-CM] or hereditary [hATTR-CM]) from real-world clinical practice across 6 different countries.
Method
Study was conducted in France, Germany, Italy, Japan, Spain, and the UK between September–October 2023. Cardiologists completed a 45-minute online survey, reporting data for ≥ 1–6 patients with ATTR-CM they had seen in the previous 12 months. The qualifying criteria for cardiologists from the IQVIA database included ≥ 3 years practicing medicine, ≥20% time in patient care, and ≥ 1 wtATTR-CM patient followed in the last 12 months.
Results
Data from 242 cardiologists and 965 patient record forms were included. Overall, 63–71% of patients were male, 78–86% had wtATTR-CM, and the majority (59–90%) were aged ≥ 65 years. For patients with hATTR-CM, the most common variant was V30 M in France (58%) and Spain (42%); V122I in Italy (37%) and the UK (44%); and V30 M and V122I in Germany (both 32%). The most common clinical presentation was HF (35–58%) with most patients in New York Heart Association class II (48–66%). More than 47% of patients reported at least one neuropathy symptom. Reported symptoms were generally similar across countries. The proportion of patients on pharmacological treatment ranged from 39% in Spain to 73% in France. Of patients on TTR targeted treatment, the majority received tafamidis 61 mg (ranging from 47% in the UK to 82% in Germany). For most patients, physicians reported an inadequate response to treatment, with cardiologists often reporting a persistence or progression of symptoms (Fig. 1).
Conclusion
These data show reported clinical characteristics of real-world patients and the treatment landscape of the respective patients with ATTR-CM in 5 European countries and Japan. Characteristics were generally similar across countries and reflect the multi-organ impairment in ATTR. Most patients showed persistence or progression of HF symptoms, considered a partial or no response to their current treatment by the reporting physicians, reflecting an unmet need for more available and effective treatment options in ATTR-CM.
{"title":"Clinical presentation and treatment landscape of patients with transthyretin amyloidosis with cardiomyopathy: A real-world study in five European countries and Japan","authors":"C. Morbach , J. Endo , J. González-Costello , F. Capelli , W.E. Moody , E. Klimova , G. Habib","doi":"10.1016/j.acvd.2025.10.070","DOIUrl":"10.1016/j.acvd.2025.10.070","url":null,"abstract":"<div><h3>Introduction</h3><div>Transthyretin amyloidosis (ATTR) is a progressive, fatal disease often leading to a mixed phenotype with polyneuropathy and cardiomyopathy (CM). ATTR with CM (ATTR-CM) results in progressive heart failure (HF), decline in health status and quality of life, and increased hospitalisation rate and mortality.</div></div><div><h3>Objective</h3><div>Assess clinical characteristics and treatment landscape in ATTR-CM (wild-type [wtATTR-CM] or hereditary [hATTR-CM]) from real-world clinical practice across 6 different countries.</div></div><div><h3>Method</h3><div>Study was conducted in France, Germany, Italy, Japan, Spain, and the UK between September–October 2023. Cardiologists completed a 45-minute online survey, reporting data for<!--> <!-->≥<!--> <!-->1–6 patients with ATTR-CM they had seen in the previous 12 months. The qualifying criteria for cardiologists from the IQVIA database included<!--> <!-->≥<!--> <!-->3 years practicing medicine, ≥20% time in patient care, and<!--> <!-->≥<!--> <!-->1 wtATTR-CM patient followed in the last 12 months.</div></div><div><h3>Results</h3><div>Data from 242 cardiologists and 965 patient record forms were included. Overall, 63–71% of patients were male, 78–86% had wtATTR-CM, and the majority (59–90%) were aged<!--> <!-->≥<!--> <!-->65 years. For patients with hATTR-CM, the most common variant was V30<!--> <!-->M in France (58%) and Spain (42%); V122I in Italy (37%) and the UK (44%); and V30<!--> <!-->M and V122I in Germany (both 32%). The most common clinical presentation was HF (35–58%) with most patients in New York Heart Association class II (48–66%). More than 47% of patients reported at least one neuropathy symptom. Reported symptoms were generally similar across countries. The proportion of patients on pharmacological treatment ranged from 39% in Spain to 73% in France. Of patients on TTR targeted treatment, the majority received tafamidis 61<!--> <!-->mg (ranging from 47% in the UK to 82% in Germany). For most patients, physicians reported an inadequate response to treatment, with cardiologists often reporting a persistence or progression of symptoms (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>These data show reported clinical characteristics of real-world patients and the treatment landscape of the respective patients with ATTR-CM in 5 European countries and Japan. Characteristics were generally similar across countries and reflect the multi-organ impairment in ATTR. Most patients showed persistence or progression of HF symptoms, considered a partial or no response to their current treatment by the reporting physicians, reflecting an unmet need for more available and effective treatment options in ATTR-CM.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S39-S40"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904117","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.2025.10.023
F. Zampetakis , I. Mixaki , M. Prokopakis , V. Prokopakis
Introduction
Atherosclerosis is a systemic disease affecting multiple vascular territories. While coronary artery calcium (CAC) scoring is a validated method for assessing coronary atherosclerotic burden, it is costly, irradiating, and less accessible. Intima-media thickness (IMT) measurement of peripheral arteries, particularly the carotid and femoral arteries, is a non-invasive, inexpensive, and widely available technique that may serve as a surrogate marker for subclinical atherosclerosis.
Objective
To compare the utility of peripheral arterial IMT measurement with coronary artery calcium (CAC) score in identifying subclinical atherosclerosis in patients referred for coronary imaging.
Method
A total of 126 consecutive patients referred for coronary CT between June and November 2021 underwent CAC scoring using a Siemens Somatom Definition 128 × 2 CT scanner and IMT evaluation of the carotid and femoral arteries via high-resolution B-mode ultrasound (Mindray and Aloka A7 systems, 7.5 MHz linear probes), according to ESC guidelines. IMT was measured semi-automatically at the peak of the R-wave in arterial segments free of plaque. Thresholds of 0.7 mm for women and 0.8 mm for men were used, representing the 80th–90th percentiles for age.
Results
Among 45 women, 27 had a CAC score of zero and IMT below 0.7 mm. However, 7 women had a CAC score of zero but positive IMT (≥0.7 mm). Of the 11 women with positive CAC scores, 8 also had elevated IMT. Among 81 men, 20 out of 21 with CAC = 0 had IMT < 0.8 mm. In contrast, 14 men had CAC = 0 but positive IMT, while 14 had positive CAC and negative IMT. Overall, IMT in the femoral artery was more strongly correlated with CAC than carotid IMT. Based on the chosen thresholds, 22 out of 27 women and 27 out of 32 men could potentially have avoided CAC scoring if IMT of the femoral artery alone had been used as a screening tool.
Conclusion
In this study, IMT thresholds of 0.7 mm for women and 0.8 mm for men effectively identified most patients with zero CAC scores, and higher IMTs were associated with positive CAC. Femoral artery IMT demonstrated stronger correlation with CAC than carotid IMT. IMT measurement is a simple, non-invasive, and cost-effective method that can serve as a valuable tool for cardiovascular risk stratification.
{"title":"Comparison Between Peripheral Arterial Intima-Media Thickness (IMT) and Coronary Artery Calcium (CAC) Score in Cardiovascular Risk Assessment in Asymptomatic Patients","authors":"F. Zampetakis , I. Mixaki , M. Prokopakis , V. Prokopakis","doi":"10.1016/j.acvd.2025.10.023","DOIUrl":"10.1016/j.acvd.2025.10.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Atherosclerosis is a systemic disease affecting multiple vascular territories. While coronary artery calcium (CAC) scoring is a validated method for assessing coronary atherosclerotic burden, it is costly, irradiating, and less accessible. Intima-media thickness (IMT) measurement of peripheral arteries, particularly the carotid and femoral arteries, is a non-invasive, inexpensive, and widely available technique that may serve as a surrogate marker for subclinical atherosclerosis.</div></div><div><h3>Objective</h3><div>To compare the utility of peripheral arterial IMT measurement with coronary artery calcium (CAC) score in identifying subclinical atherosclerosis in patients referred for coronary imaging.</div></div><div><h3>Method</h3><div>A total of 126 consecutive patients referred for coronary CT between June and November 2021 underwent CAC scoring using a Siemens Somatom Definition 128<!--> <!-->×<!--> <!-->2 CT scanner and IMT evaluation of the carotid and femoral arteries via high-resolution B-mode ultrasound (Mindray and Aloka A7 systems, 7.5<!--> <!-->MHz linear probes), according to ESC guidelines. IMT was measured semi-automatically at the peak of the R-wave in arterial segments free of plaque. Thresholds of 0.7<!--> <!-->mm for women and 0.8<!--> <!-->mm for men were used, representing the 80th–90th percentiles for age.</div></div><div><h3>Results</h3><div>Among 45 women, 27 had a CAC score of zero and IMT below 0.7<!--> <!-->mm. However, 7 women had a CAC score of zero but positive IMT (≥0.7<!--> <!-->mm). Of the 11 women with positive CAC scores, 8 also had elevated IMT. Among 81 men, 20 out of 21 with CAC<!--> <!-->=<!--> <!-->0 had IMT<!--> <!--><<!--> <!-->0.8<!--> <!-->mm. In contrast, 14 men had CAC<!--> <!-->=<!--> <!-->0 but positive IMT, while 14 had positive CAC and negative IMT. Overall, IMT in the femoral artery was more strongly correlated with CAC than carotid IMT. Based on the chosen thresholds, 22 out of 27 women and 27 out of 32 men could potentially have avoided CAC scoring if IMT of the femoral artery alone had been used as a screening tool.</div></div><div><h3>Conclusion</h3><div>In this study, IMT thresholds of 0.7<!--> <!-->mm for women and 0.8<!--> <!-->mm for men effectively identified most patients with zero CAC scores, and higher IMTs were associated with positive CAC. Femoral artery IMT demonstrated stronger correlation with CAC than carotid IMT. IMT measurement is a simple, non-invasive, and cost-effective method that can serve as a valuable tool for cardiovascular risk stratification.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S16"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904168","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.2025.10.041
H. Touati, M.A. Almi, N. Manai, Z. Oumayma, M. Rabhi, S. Kasbaoui, M.A. Tekaya, A. Ben Halima, B. Emna, I. Kammoun
<div><h3>Introduction</h3><div>Non-ST-segment elevation myocardial infarction (NSTEMI) in patients with type 2 diabetes mellitus (T2DM) is frequently associated with increased inflammation and myocardial injury. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) show cardiovascular benefits in chronic care, but their role in acute ischemia remains uncertain.</div></div><div><h3>Objective</h3><div>To assess whether chronic use of SGLT2-I in T2DM patients admitted for NSTEMI is associated with reduced systemic inflammation, infarct size, and improved left ventricular function.</div></div><div><h3>Method</h3><div>This retrospective, monocentric study included 60 T2DM patients hospitalized for NSTEMI at Abderrahmen Mami Hospital between December 2024 and April 2025. Patients were divided into two groups: 21 on chronic SGLT2-I (Dapagliflozin, ≥<!--> <!-->3 months use) and 39 without prior SGLT2-I therapy, initiation of SGLT2-I was planned upon discharge. Inflammatory markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)), infarct size (peak troponin, affected myocardial segments), and left ventricular ejection fraction (LVEF) were assessed. HbA1c and renal function (eGFR) were also evaluated.</div></div><div><h3>Results</h3><div>SGLT2-I users had significantly lower CRP (17.8<!--> <!-->±<!--> <!-->20.1 vs 35.7<!--> <!-->±<!--> <!-->32.8<!--> <!-->mg/L, <em>P</em> <!-->=<!--> <!-->0.011), NLR (2.9<!--> <!-->±<!--> <!-->1.1 vs 3.9<!--> <!-->±<!--> <!-->1.6, <em>P</em> <!-->=<!--> <!-->0.02), and PLR (102.5<!--> <!-->±<!--> <!-->35.2 vs 132.1<!--> <!-->±<!--> <!-->48.7, <em>P</em> <!-->=<!--> <!-->0.03) (<span><span>Fig. 1</span></span>). Peak troponin was markedly reduced (1273.6<!--> <!-->±<!--> <!-->1473, median: 500<!--> <!-->ng/L vs 6100.2<!--> <!-->±<!--> <!-->10824<!--> <!-->ng/L, median: 1200<!--> <!-->ng/L, <em>P</em> <!-->=<!--> <!-->0.009). LVEF, assessed by the Simpson biplane method, was significantly higher in the SGLT2-I group: 53.0<!--> <!-->±<!--> <!-->9.4% (median: 52.7%), with 71.4% of patients having LVEF<!--> <!-->><!--> <!-->50%, compared to 48.0<!--> <!-->±<!--> <!-->10.1% (median: 47.7%) and 38.5% with LVEF<!--> <!-->><!--> <!-->50% in the non-SGLT2-I group (<em>P</em> <!-->=<!--> <!-->0.002), with fewer affected myocardial segments (1.6 vs 2.4). HbA<sub>1C</sub> was lower (7.7<!--> <!-->±<!--> <!-->1.5% vs 8.5<!--> <!-->±<!--> <!-->1.2%, <em>P</em> <!-->=<!--> <!-->0.16), though not significant. Renal function was assessed using the MDRD formula. Two patients (3.3%) had an estimated glomerular filtration rate below 30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, both from the non-SGLT2-I group. Overall, 96.7% of patients had an eGFR above 30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>.</div></div><div><h3>Conclusion</h3><div>Chronic SGLT2-I use in T2DM with NSTEMI may be associated with reduced inflammation, smaller infarcts, and better cardiac function.</div><
2型糖尿病（T2DM）患者的非st段抬高型心肌梗死（NSTEMI）通常与炎症和心肌损伤增加相关。钠-葡萄糖共转运蛋白2抑制剂（SGLT2-I）在慢性护理中显示心血管益处，但其在急性缺血中的作用仍不确定。目的评估因非stemi入院的T2DM患者长期使用SGLT2-I是否与全身炎症、梗死面积减少和左心室功能改善相关。方法本回顾性单中心研究纳入了2024年12月至2025年4月在Abderrahmen Mami医院因非stemi住院的60例T2DM患者。患者分为两组：21例接受慢性SGLT2-I治疗（达格列净，使用≥3个月），39例未接受SGLT2-I治疗，出院时计划开始SGLT2-I治疗。评估炎症标志物（c反应蛋白（CRP）、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR））、梗死面积（肌钙蛋白峰值、受影响的心肌节段）和左心室射血分数（LVEF）。同时评估HbA1c和肾功能（eGFR）。ResultsSGLT2-I用户显著降低CRP(17.8±20.1 vs 35.7±32.8 mg / L, P = 0.011), NLR(2.9±1.1 vs 3.9±1.6,P = 0.02),和PLR(102.5±35.2 vs 132.1±48.7,P = 0.03)(图1)。肌钙蛋白峰值明显降低（1273.6±1473，中位数：500 ng/L vs 6100.2±10824 ng/L，中位数：1200 ng/L， P = 0.009）。Simpson双翼面法评估的LVEF在SGLT2-I组显著更高：53.0±9.4%（中位数：52.7%），其中71.4%的患者LVEF >； 50%，而非SGLT2-I组为48.0±10.1%（中位数：47.7%）和38.5%的患者LVEF >； 50% (P = 0.002)，受影响的心肌节段较少（1.6 vs 2.4）。HbA1C较低（7.7±1.5% vs 8.5±1.2%,P = 0.16），但差异无统计学意义。采用MDRD公式评估肾功能。2例患者（3.3%）估计肾小球滤过率低于30 mL/min/1.73 m2，均来自非sglt2 - i组。总体而言，96.7%的患者eGFR高于30 mL/min/1.73 m2。结论慢性SGLT2-I用于T2DM合并NSTEMI可能与炎症减轻、梗死面积缩小和心功能改善有关。
{"title":"Effects of SGLT2 inhibitors on inflammation and infarct size in diabetic patients with acute myocardial infarction","authors":"H. Touati, M.A. Almi, N. Manai, Z. Oumayma, M. Rabhi, S. Kasbaoui, M.A. Tekaya, A. Ben Halima, B. Emna, I. Kammoun","doi":"10.1016/j.acvd.2025.10.041","DOIUrl":"10.1016/j.acvd.2025.10.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-ST-segment elevation myocardial infarction (NSTEMI) in patients with type 2 diabetes mellitus (T2DM) is frequently associated with increased inflammation and myocardial injury. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) show cardiovascular benefits in chronic care, but their role in acute ischemia remains uncertain.</div></div><div><h3>Objective</h3><div>To assess whether chronic use of SGLT2-I in T2DM patients admitted for NSTEMI is associated with reduced systemic inflammation, infarct size, and improved left ventricular function.</div></div><div><h3>Method</h3><div>This retrospective, monocentric study included 60 T2DM patients hospitalized for NSTEMI at Abderrahmen Mami Hospital between December 2024 and April 2025. Patients were divided into two groups: 21 on chronic SGLT2-I (Dapagliflozin, ≥<!--> <!-->3 months use) and 39 without prior SGLT2-I therapy, initiation of SGLT2-I was planned upon discharge. Inflammatory markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)), infarct size (peak troponin, affected myocardial segments), and left ventricular ejection fraction (LVEF) were assessed. HbA1c and renal function (eGFR) were also evaluated.</div></div><div><h3>Results</h3><div>SGLT2-I users had significantly lower CRP (17.8<!--> <!-->±<!--> <!-->20.1 vs 35.7<!--> <!-->±<!--> <!-->32.8<!--> <!-->mg/L, <em>P</em> <!-->=<!--> <!-->0.011), NLR (2.9<!--> <!-->±<!--> <!-->1.1 vs 3.9<!--> <!-->±<!--> <!-->1.6, <em>P</em> <!-->=<!--> <!-->0.02), and PLR (102.5<!--> <!-->±<!--> <!-->35.2 vs 132.1<!--> <!-->±<!--> <!-->48.7, <em>P</em> <!-->=<!--> <!-->0.03) (<span><span>Fig. 1</span></span>). Peak troponin was markedly reduced (1273.6<!--> <!-->±<!--> <!-->1473, median: 500<!--> <!-->ng/L vs 6100.2<!--> <!-->±<!--> <!-->10824<!--> <!-->ng/L, median: 1200<!--> <!-->ng/L, <em>P</em> <!-->=<!--> <!-->0.009). LVEF, assessed by the Simpson biplane method, was significantly higher in the SGLT2-I group: 53.0<!--> <!-->±<!--> <!-->9.4% (median: 52.7%), with 71.4% of patients having LVEF<!--> <!-->><!--> <!-->50%, compared to 48.0<!--> <!-->±<!--> <!-->10.1% (median: 47.7%) and 38.5% with LVEF<!--> <!-->><!--> <!-->50% in the non-SGLT2-I group (<em>P</em> <!-->=<!--> <!-->0.002), with fewer affected myocardial segments (1.6 vs 2.4). HbA<sub>1C</sub> was lower (7.7<!--> <!-->±<!--> <!-->1.5% vs 8.5<!--> <!-->±<!--> <!-->1.2%, <em>P</em> <!-->=<!--> <!-->0.16), though not significant. Renal function was assessed using the MDRD formula. Two patients (3.3%) had an estimated glomerular filtration rate below 30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, both from the non-SGLT2-I group. Overall, 96.7% of patients had an eGFR above 30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>.</div></div><div><h3>Conclusion</h3><div>Chronic SGLT2-I use in T2DM with NSTEMI may be associated with reduced inflammation, smaller infarcts, and better cardiac function.</div><","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S24-S25"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904258","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.2025.10.046
H. Kamri , I. Zarhloule , Y. Daoudi , O. Taoussi , S. Hafid , M. Ghayate , H. Rabii , S. Benkirane , A. El Ouarradi , F.Z. Merzouk , G. Bennouna
Introduction
Acute coronary syndrome with normal or non-obstructive coronary arteries (ACSNNOCA) represents a heterogeneous and under-recognized clinical entity that poses a diagnostic and therapeutic challenge. Despite its growing recognition globally, this subgroup remains insufficiently explored within our Moroccan population. Traditional diagnostic approaches often fall short in elucidating the underlying etiology in such patients, leading to potential delays in appropriate management. Cardiac magnetic resonance imaging (CMR) has emerged as a pivotal tool in the evaluation of ACSNNOCA, offering superior tissue characterization, detection of myocardial edema, fibrosis, and scar, as well as the ability to distinguish ischemic from non-ischemic injury.
Objective
In this study, we aim to assess the diagnostic utility and clinical impact of CMR in this particular subset of patients, focusing on its role not only in establishing a definitive diagnosis but also in guiding follow-up and long-term management.
Method
This is a descriptive, retrospective study over a period of three and a half years of 57 patients presenting with acute coronary syndrome and non-significative coronary lesions on angiography.
Results
The mean age in our population is 46 ± 19.6 years with a male predominance. We found a mean left ventricular end-diastolic diameter at 47.3 ± 6.6 mm; a mean left ventricular end-systolic diameter at 29.6 ± 6.2 mm; a mean left ventricular end-diastolic ejection volume at 68 ± 16.7 ml; a mean left ventricular end-systolic ejection volume at 60 ± 20 ml/m2; a mean left ventricle ejection fraction at 58 ± 10.7%; a mean right ventricle ejection fraction at 54.6%; a mean left ventricle myocardial mass 59.9 ± 16 g/m2. Late gadolinium enhancement was found in 77.2% of patients. Late gadolinium enhancement of the pericardium was found in 14% des patients. Elevated T1 mapping was found in 9 patients of the 11 that benefited of mapping sequences; ECV was equally elevated. A diagnostic was possible in 79% of the population through MRI.
Conclusion
Cardiac MRI plays a pivotal role in the assessment of cardiac morphology and function, as well as the diagnostic and risk stratification of patients presenting with ACSNNOCA. It also provides important information guiding clinicians in their therapeutic management and follow-up.
{"title":"Cardiac magnetic resonance imaging in acute coronary syndrome with non-obstructive coronary arteries: Diagnostic and therapeutic value","authors":"H. Kamri , I. Zarhloule , Y. Daoudi , O. Taoussi , S. Hafid , M. Ghayate , H. Rabii , S. Benkirane , A. El Ouarradi , F.Z. Merzouk , G. Bennouna","doi":"10.1016/j.acvd.2025.10.046","DOIUrl":"10.1016/j.acvd.2025.10.046","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute coronary syndrome with normal or non-obstructive coronary arteries (ACSNNOCA) represents a heterogeneous and under-recognized clinical entity that poses a diagnostic and therapeutic challenge. Despite its growing recognition globally, this subgroup remains insufficiently explored within our Moroccan population. Traditional diagnostic approaches often fall short in elucidating the underlying etiology in such patients, leading to potential delays in appropriate management. Cardiac magnetic resonance imaging (CMR) has emerged as a pivotal tool in the evaluation of ACSNNOCA, offering superior tissue characterization, detection of myocardial edema, fibrosis, and scar, as well as the ability to distinguish ischemic from non-ischemic injury.</div></div><div><h3>Objective</h3><div>In this study, we aim to assess the diagnostic utility and clinical impact of CMR in this particular subset of patients, focusing on its role not only in establishing a definitive diagnosis but also in guiding follow-up and long-term management.</div></div><div><h3>Method</h3><div>This is a descriptive, retrospective study over a period of three and a half years of 57 patients presenting with acute coronary syndrome and non-significative coronary lesions on angiography.</div></div><div><h3>Results</h3><div>The mean age in our population is 46<!--> <!-->±<!--> <!-->19.6 years with a male predominance. We found a mean left ventricular end-diastolic diameter at 47.3<!--> <!-->±<!--> <!-->6.6<!--> <!-->mm; a mean left ventricular end-systolic diameter at 29.6<!--> <!-->±<!--> <!-->6.2<!--> <!-->mm; a mean left ventricular end-diastolic ejection volume at 68<!--> <!-->±<!--> <!-->16.7<!--> <!-->ml; a mean left ventricular end-systolic ejection volume at 60<!--> <!-->±<!--> <!-->20<!--> <!-->ml/m<sup>2</sup>; a mean left ventricle ejection fraction at 58<!--> <!-->±<!--> <!-->10.7%; a mean right ventricle ejection fraction at 54.6%; a mean left ventricle myocardial mass 59.9<!--> <!-->±<!--> <!-->16<!--> <!-->g/m<sup>2</sup>. Late gadolinium enhancement was found in 77.2% of patients. Late gadolinium enhancement of the pericardium was found in 14% des patients. Elevated T1 mapping was found in 9 patients of the 11 that benefited of mapping sequences; ECV was equally elevated. A diagnostic was possible in 79% of the population through MRI.</div></div><div><h3>Conclusion</h3><div>Cardiac MRI plays a pivotal role in the assessment of cardiac morphology and function, as well as the diagnostic and risk stratification of patients presenting with ACSNNOCA. It also provides important information guiding clinicians in their therapeutic management and follow-up.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S26"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903913","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.2025.10.060
A. Bouchlarhem, Z. Bazid, N. Ismaili, E.O. Noha
<div><h3>Introduction</h3><div>Low blood pressure (BP) is a real challenge in the management of patients with chronic heart failure, given its prognostic impact, and especially in the initiation and titration of guideline-directed medical therapy.</div></div><div><h3>Objective</h3><div>We analyzed the impact of low BP defined as Systolic BP(SBP)<!--> <!--><<!--> <!-->100<!--> <!-->mm<!--> <!-->Hg on all-cause mortality during follow-up and on the implementation of GDMTs at discharge.</div></div><div><h3>Method</h3><div>We prospectively analyzed data from patients admitted for acute heart failure to our unit over a 2-year period from 2022. We excluded patients with cardiogenic shock and patients with an ejection Fraction<!--> <!-->><!--> <!-->40%.</div></div><div><h3>Results</h3><div>We included 516 patients who met the inclusion criteria. Low SBP was found in 111 (21.5%). No differences were observed in mean age (SBP<!--> <!--><<!--> <!-->100<!--> <!-->mm<!--> <!-->Hg vs SBP<!--> <!-->><!--> <!-->100<!--> <!-->mm<!--> <!-->Hg; 64.27 vs 66.15 years; <em>P</em> <!-->=<!--> <!-->0.158), female sex (40.5% vs 38%; <em>P</em> <!-->=<!--> <!-->0.353), diabetes (49.5% vs 56.5%; <em>P</em> <!-->=<!--> <!-->0.114). Ejection fraction was more impaired in this group (29% vs. 34%; <em>P</em> <!--><<!--> <!-->0. 001), with more elevated systolic pulmonary pressure (45.5<!--> <!-->mm<!--> <!-->Hg vs. 35.8<!--> <!-->mm<!--> <!-->Hg; <em>P</em> <!--><<!--> <!-->0.001),and higher Pro-BNP levels (8991 vs. 4462<!--> <!-->ng/ml; <em>P</em> <!--><<!--> <!-->0.001).Regarding the implementation of guideline-guided treatments, a SBP<!--> <!--><<!--> <!-->100<!--> <!-->mm<!--> <!-->Hg was a real obstacle, as betablockers were introduced in only 45.5% vs. 81.7% (<em>P</em> <!--><<!--> <!-->0.001), renin angiotensin system inhibitors in (63.6% vs. 80.6%, <em>P</em> <!-->=<!--> <!-->0.04), mineralocorticoid receptor antagonist in (33.3% vs. 65.6%; <em>P</em> <!--><<!--> <!-->0.001). However, ISGLT2s introduction were not affected by SBP<!--> <!--><<!--> <!-->100<!--> <!-->mm<!--> <!-->Hg (57.6% vs 57%; <em>P</em> <!-->=<!--> <!-->0.560). After a mean follow-up of 22 months, the primary endpoint was observed in 95 patients (18.4%), with significantly higher mortality in the SBP<!--> <!--><<!--> <!-->100<!--> <!-->mm<!--> <!-->Hg group (35.1% vs. 13.8%; <em>P</em> <!--><<!--> <!-->0.001). In multivariate adjusted Cox proportional hazards analysis, SBP<!--> <!--><<!--> <!-->100<!--> <!-->mm<!--> <!-->Hg was independently associated with all-cause mortality with (HR at 2. 23; 95%CI; 1.436–3.483; <em>P</em> <!--><<!--> <!-->0.001), as well as with a significant difference on Kaplein meirer survival analysis (Log-rank test <em>P</em> <!-->=<!--> <!-->0.002) (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>The results of our study support the hypothesis that low arterial pressure remains a real obstacle to the
鉴于其对预后的影响，特别是在指南指导的药物治疗的开始和滴定中，低血压（BP）是慢性心力衰竭患者管理的真正挑战。目的分析收缩压(SBP)≤100 mm Hg的低血压对随访期间全因死亡率和出院时gdmt实施的影响。方法前瞻性分析从2022年起2年内我科收治的急性心力衰竭患者的数据。我们排除了心源性休克患者和射血分数为40%的患者。结果纳入516例符合纳入标准的患者。111例（21.5%）出现低收缩压。在平均年龄（SBP < 100 mm Hg vs SBP > 100 mm Hg; 64.27 vs 66.15岁；P = 0.158）、女性（40.5% vs 38%; P = 0.353）、糖尿病（49.5% vs 56.5%; P = 0.114）方面均无差异。该组的射血分数受损更严重(29% vs. 34%; P < 0。0.001)，收缩压升高（45.5 mm Hg vs 35.8 mm Hg; P < 0.001）， Pro-BNP水平升高（8991 vs 4462 ng/ml; P < 0.001）。关于指南指导治疗的实施，收缩压100毫米汞柱是一个真正的障碍，因为β受体阻滞剂只有45.5%对81.7% (P < 0.001)，肾素血管紧张素系统抑制剂（63.6%对80.6%,P = 0.04），矿皮质激素受体拮抗剂（33.3%对65.6%,P < 0.001）。然而，ISGLT2s的引入不受收缩压和血压100 mm Hg的影响（57.6% vs 57%; P = 0.560）。平均随访22个月后，95例患者（18.4%）观察到主要终点，收缩压100 mm Hg组的死亡率明显更高（35.1%比13.8%;P < 0.001）。在多因素调整的Cox比例风险分析中，收缩压和100 mm Hg与全因死亡率独立相关，HR为2。23;95%可信区间;1.436 - -3.483;P < 0.001)，并且在Kaplein - meier生存分析中存在显著差异（Log-rank检验P = 0.002）（图1）。结论我们的研究结果支持了低动脉压仍然是GDTMs植入的真正障碍的假设，并具有显著的预后影响。然而，SGLT2s抑制剂的引入不受血压降低的影响。
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