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。
{"title":"Impact of low blood pressure on implementation of guideline-directed medical therapy and prognosis after Acute Heart Failure in Patients with Heart Failure with Reduced Ejection Fraction","authors":"A. Bouchlarhem, Z. Bazid, N. Ismaili, E.O. Noha","doi":"10.1016/j.acvd.2025.10.060","DOIUrl":"10.1016/j.acvd.2025.10.060","url":null,"abstract":"<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 ","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S33"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903942","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.2025.10.063
H. Guillermou , G. Mercier , B. Litovsky , L. Papinaud , F. Roubille
Introduction
Pneumococcal vaccination rates are critically low among high-risk patients, particularly those with heart failure (HF), who face increased risk of severe infections and complications.
Objective
A prospective interventional trial was designed to evaluate the impact of an incentive campaign carried out by the French health insurance.
Method
Is study was an open-label pragmatic cluster randomized controlled trial involving general practitioners (GPs) and their related patients with chronic HF in a French region, identified through the regional health insurance database. HF patients were assigned to intervention or control groups based on the randomized allocation of their treating GPs. In the intervention group, both GPs and their patients received two vaccination incentive letters, whereas the control group was only observed.
Results
3952 GPs and 12,285 corresponding patients with HF were included between Mar 23, 2023 and Mar 23, 2024. The pneumococcal vaccination rate at one year was 35% in the intervention group (n = 6140) versus 3.5% in the control group (n = 5937). Multivariable analyses showed a 15-fold higher probability of vaccination in patients receiving the intervention. The vaccination rate increased with male patients, female GP, and previous influenza vaccination but decreased in younger (<70 years) and older patient age (>85 years). The pneumococcal vaccination was associated with a notable reduction in overall mortality (Fig. 1).
Conclusion
This randomized study demonstrated the effectiveness of a mail-in promotion to sustainably increase pneumococcal vaccination coverage in a frail high-risk population. Furthermore, pneumococcal vaccination was associated with a notable reduction in overall mortality.
{"title":"Impact of a pneumococcal vaccination incentive campaign in chronic heart failure patients in France: A cluster-randomized trial","authors":"H. Guillermou , G. Mercier , B. Litovsky , L. Papinaud , F. Roubille","doi":"10.1016/j.acvd.2025.10.063","DOIUrl":"10.1016/j.acvd.2025.10.063","url":null,"abstract":"<div><h3>Introduction</h3><div>Pneumococcal vaccination rates are critically low among high-risk patients, particularly those with heart failure (HF), who face increased risk of severe infections and complications.</div></div><div><h3>Objective</h3><div>A prospective interventional trial was designed to evaluate the impact of an incentive campaign carried out by the French health insurance.</div></div><div><h3>Method</h3><div>Is study was an open-label pragmatic cluster randomized controlled trial involving general practitioners (GPs) and their related patients with chronic HF in a French region, identified through the regional health insurance database. HF patients were assigned to intervention or control groups based on the randomized allocation of their treating GPs. In the intervention group, both GPs and their patients received two vaccination incentive letters, whereas the control group was only observed.</div></div><div><h3>Results</h3><div>3952 GPs and 12,285 corresponding patients with HF were included between Mar 23, 2023 and Mar 23, 2024. The pneumococcal vaccination rate at one year was 35% in the intervention group (<em>n</em> <!-->=<!--> <!-->6140) versus 3.5% in the control group (<em>n</em> <!-->=<!--> <!-->5937). Multivariable analyses showed a 15-fold higher probability of vaccination in patients receiving the intervention. The vaccination rate increased with male patients, female GP, and previous influenza vaccination but decreased in younger (<70 years) and older patient age (>85 years). The pneumococcal vaccination was associated with a notable reduction in overall mortality (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>This randomized study demonstrated the effectiveness of a mail-in promotion to sustainably increase pneumococcal vaccination coverage in a frail high-risk population. Furthermore, pneumococcal vaccination was associated with a notable reduction in overall mortality.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S35"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903970","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.2025.10.055
P. Gautier , M. Elbaz , J. Bezin , C. Delmas , M. Cherbi , F. Bouisset , C. Vindis , A. Renoux , M. Lafaurie , F. Montastruc
Introduction
Sodium-Glucose cotransporter-2 inhibitors (SGLT-2i) has demonstrated substantial benefit in heart failure (HF) patients in clinical trials. However, the real-life effectiveness of SGLT-2i in HF patients remains unexplored.
Objective
This study aims to compare, in HF patients, SGLT-2i initiation with standard care regarding all-cause mortality and HF hospitalization.
Method
A nationwide, population-based cohort study was conducted with a new-user design, using the French National Healthcare Database “Système National des Données de Santé” (SNDS) from January 2021 to December 2023. Patients with first hospitalization for HF and initiating SGLT-2i at discharge versus standard of care were matched using a 1:1 calendar-time-specific propensity score. The primary outcome was a composite of all-cause death and hospitalization for HF. Secondary outcomes were the individual determinants of the primary outcome.
Results
After matching, 52,838 patients (56.4% males, median age 79 years) were followed over a mean duration of 9.0 months. Initiation of SGLT-2i was associated with a lower rate of all-cause mortality or hospitalization for HF (adjusted hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.67 to 0.75) compared to standard of care. The adjusted HR for all-cause mortality was 0.70 (95% CI 0.65–0.74) and 0.71 (95% CI 0.64–0.78) for HF hospitalization. Results were consistent across subgroups, including SGLT-2i agents (empagliflozin and dapagliflozin), left ventricular ejection fraction (LVEF), age, sex and diabetes.
Conclusion
This large population-based cohort study of HF patients reported that SGLT-2i reduced the composite of all-cause mortality and hospitalization for HF, regardless of diabetes, age, LVEF and SGLT-2i agent (empagliflozin and dapagliflozin). These findings support their broader use in patients with HF, including in older people.
钠-葡萄糖共转运蛋白-2抑制剂（SGLT-2i）在心力衰竭（HF）患者的临床试验中显示出实质性的益处。然而，SGLT-2i在心衰患者中的实际疗效仍未探明。目的：本研究旨在比较在HF患者中，SGLT-2i起始治疗与标准治疗对全因死亡率和HF住院率的影响。方法采用新用户设计，于2021年1月至2023年12月使用法国国家医疗保健数据库“system National des donnsam”（SNDS）进行了一项全国性的、基于人群的队列研究。首次住院治疗HF并在出院时开始SGLT-2i与标准治疗的患者使用1:1的日历-时间特异性倾向评分进行匹配。主要结局是全因死亡和心衰住院的综合结果。次要结局是主要结局的个体决定因素。结果匹配后，52,838例患者（男性56.4%，中位年龄79岁）被随访，平均时间9.0个月。与标准治疗相比，SGLT-2i治疗与较低的HF全因死亡率或住院率相关（校正风险比[HR] 0.71, 95%可信区间[CI] 0.67至0.75）。HF住院的全因死亡率调整后的HR为0.70 （95% CI 0.65-0.74）和0.71 （95% CI 0.64-0.78）。不同亚组的结果一致，包括SGLT-2i药物（恩格列净和达格列净）、左室射血分数（LVEF）、年龄、性别和糖尿病。结论：这项以人群为基础的HF患者队列研究报告称，SGLT-2i降低了HF的全因死亡率和住院率，与糖尿病、年龄、LVEF和SGLT-2i药物（恩格列净和达格列净）无关。这些发现支持其在心衰患者（包括老年人）中的广泛应用。
{"title":"Effectiveness of sodium-glucose cotransporter-2 inhibitors in heart failure patients: A nationwide population-based cohort study","authors":"P. Gautier , M. Elbaz , J. Bezin , C. Delmas , M. Cherbi , F. Bouisset , C. Vindis , A. Renoux , M. Lafaurie , F. Montastruc","doi":"10.1016/j.acvd.2025.10.055","DOIUrl":"10.1016/j.acvd.2025.10.055","url":null,"abstract":"<div><h3>Introduction</h3><div>Sodium-Glucose cotransporter-2 inhibitors (SGLT-2i) has demonstrated substantial benefit in heart failure (HF) patients in clinical trials. However, the real-life effectiveness of SGLT-2i in HF patients remains unexplored.</div></div><div><h3>Objective</h3><div>This study aims to compare, in HF patients, SGLT-2i initiation with standard care regarding all-cause mortality and HF hospitalization.</div></div><div><h3>Method</h3><div>A nationwide, population-based cohort study was conducted with a new-user design, using the French National Healthcare Database “Système National des Données de Santé” (SNDS) from January 2021 to December 2023. Patients with first hospitalization for HF and initiating SGLT-2i at discharge versus standard of care were matched using a 1:1 calendar-time-specific propensity score. The primary outcome was a composite of all-cause death and hospitalization for HF. Secondary outcomes were the individual determinants of the primary outcome.</div></div><div><h3>Results</h3><div>After matching, 52,838 patients (56.4% males, median age 79 years) were followed over a mean duration of 9.0 months. Initiation of SGLT-2i was associated with a lower rate of all-cause mortality or hospitalization for HF (adjusted hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.67 to 0.75) compared to standard of care. The adjusted HR for all-cause mortality was 0.70 (95% CI 0.65–0.74) and 0.71 (95% CI 0.64–0.78) for HF hospitalization. Results were consistent across subgroups, including SGLT-2i agents (empagliflozin and dapagliflozin), left ventricular ejection fraction (LVEF), age, sex and diabetes.</div></div><div><h3>Conclusion</h3><div>This large population-based cohort study of HF patients reported that SGLT-2i reduced the composite of all-cause mortality and hospitalization for HF, regardless of diabetes, age, LVEF and SGLT-2i agent (empagliflozin and dapagliflozin). These findings support their broader use in patients with HF, including in older people.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S30"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903979","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.2025.10.017
M.H. Abaydi , I. Mouhrach , A. Ech-Chenbouli , B. El Boussaadani , L. Bouguenouch , K. Ouldim , Z. Raissouni
Introduction
Acute coronary syndrome (ACS) remains a major cause of cardiovascular morbidity and mortality. While classical risk factors such as hypertension, diabetes, and smoking are well established, genetic susceptibility is increasingly recognized in atherosclerosis. This pilot study aims to explore the association between specific gene polymorphisms and ACS in a northern Moroccan population.
Objective
To assess the prevalence of polymorphisms in TGFB1, IGF1, PDGFB, VEGFA, and FGF2 genes among patients with ACS and controls, and explore interactions with traditional risk factors.
Method
A case-control study included 64 patients with ACS (STEMI and NSTEMI) and 48 healthy controls. Patients were stratified into STEMI and NSTEMI groups. Mean age was 61 years; 70.3% were male (74% in STEMI, 68% in NSTEMI). Genotyping was performed for TGFB1 (rs1800470), IGF1 (rs35767), VEGFA (rs699947), PDGFB (rs2285094), and FGF2 (rs308395). Allelic and genotypic frequencies were compared between groups, and the sequencing workflow is illustrated in Fig. 1.
Results
TGFB1: G allele present in 39% of cases, absent in controls. Genotypes: A/A (34%), A/G (53%), G/G (12%) in cases; A/A (100%) in controls. IGF1: G allele detected in 83% of cases, 0% of controls. G/G genotype in 69% of cases; A/A in 100% of controls. PDGFB: T and C alleles evenly distributed. Cases: C/C (23%), T/C (50%), T/T (27%); controls: C/C (17%), T/C (62%), T/T (21%). FGF2: C allele more frequent in cases (72%) than in controls (57%). Genotypes in cases: C/C (50%), C/G (44%), G/G (6%); in controls: C/C (27%), C/G (61%), G/G (12%). VEGFA: C allele less frequent in cases (62%) than controls (78%). Case genotypes: A/A (16%), C/A (45%), C/C (39%); controls: A/A (15%), C/A (15%), C/C (71%).
Conclusion
This pilot study reveals significant associations between ACS and genetic polymorphisms, notably in TGFB1 and IGF1. Despite the modest sample size, the findings contribute to understanding genetic risk factors in North African populations and support further research into personalized cardiovascular prevention.
{"title":"Genetic variants associated with acute coronary syndrome: A pilot study in a northern Moroccan population","authors":"M.H. Abaydi , I. Mouhrach , A. Ech-Chenbouli , B. El Boussaadani , L. Bouguenouch , K. Ouldim , Z. Raissouni","doi":"10.1016/j.acvd.2025.10.017","DOIUrl":"10.1016/j.acvd.2025.10.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute coronary syndrome (ACS) remains a major cause of cardiovascular morbidity and mortality. While classical risk factors such as hypertension, diabetes, and smoking are well established, genetic susceptibility is increasingly recognized in atherosclerosis. This pilot study aims to explore the association between specific gene polymorphisms and ACS in a northern Moroccan population.</div></div><div><h3>Objective</h3><div>To assess the prevalence of polymorphisms in <em>TGFB1</em>, <em>IGF1</em>, <em>PDGFB</em>, <em>VEGFA</em>, and <em>FGF2</em> genes among patients with ACS and controls, and explore interactions with traditional risk factors.</div></div><div><h3>Method</h3><div>A case-control study included 64 patients with ACS (STEMI and NSTEMI) and 48 healthy controls. Patients were stratified into STEMI and NSTEMI groups. Mean age was 61 years; 70.3% were male (74% in STEMI, 68% in NSTEMI). Genotyping was performed for <em>TGFB1</em> (rs1800470), <em>IGF1</em> (rs35767), <em>VEGFA</em> (rs699947), <em>PDGFB</em> (rs2285094), and <em>FGF2</em> (rs308395). Allelic and genotypic frequencies were compared between groups, and the sequencing workflow is illustrated in <span><span>Fig. 1</span></span>.</div></div><div><h3>Results</h3><div><em>TGFB1</em>: G allele present in 39% of cases, absent in controls. Genotypes: A/A (34%), A/G (53%), G/G (12%) in cases; A/A (100%) in controls. <em>IGF1</em>: G allele detected in 83% of cases, 0% of controls. G/G genotype in 69% of cases; A/A in 100% of controls. <em>PDGFB</em>: T and C alleles evenly distributed. Cases: C/C (23%), T/C (50%), T/T (27%); controls: C/C (17%), T/C (62%), T/T (21%). <em>FGF2</em>: C allele more frequent in cases (72%) than in controls (57%). Genotypes in cases: C/C (50%), C/G (44%), G/G (6%); in controls: C/C (27%), C/G (61%), G/G (12%). <em>VEGFA</em>: C allele less frequent in cases (62%) than controls (78%). Case genotypes: A/A (16%), C/A (45%), C/C (39%); controls: A/A (15%), C/A (15%), C/C (71%).</div></div><div><h3>Conclusion</h3><div>This pilot study reveals significant associations between ACS and genetic polymorphisms, notably in <em>TGFB1</em> and <em>IGF1</em>. Despite the modest sample size, the findings contribute to understanding genetic risk factors in North African populations and support further research into personalized cardiovascular prevention.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S13"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904044","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.2025.10.073
J. Florence , S. Ploux , R. Eschalier
Introduction
Medically underserved areas (MUA) are associated with higher rates of adverse health outcomes, such as preventable hospitalizations, emergency department visits and death. While remote management (RM) programs can reduce unplanned hospitalizations for heart failure (HF) and all-cause mortality, its effectiveness has not been evaluated in MUA.
Objective
To describe the effect of an RM program on a composite outcome including all-cause mortality and HF hospitalizations among chronic HF patients in MUA.
Method
Between April 2020 and December 2022 we included all consecutive patients in the same multiparametric heart failure RM program of two French University Hospitals. Follow-up data were collected until February 2023. Inclusion criteria were chronic HF with New York Heart Association ≥ II and an elevated B-type natriuretic peptide (BNP > 100 pg/mL or N-terminal-pro-BNP > 1000 pg/mL) and/or at least an episode of HF hospitalization within the last year. Patient assessments were performed remotely and included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. We used the national definition of the French Government to define MUA. The primary outcome was the association of HF hospitalization and all-cause mortality.
Results
A total of 1040 patients (72 ± 12 years old, 70% male), were followed for a median [IQR] of 20 [10; 24] months with a mean adherence to the remote management program of 69 ± 29%. The annualized rate of the primary outcome was 13.7% in the overall population, without significant difference between MUA and no MUA patients (13.5%/year vs 13.9%/year; P = 0.852). In multivariable Cox analysis, baseline dose of furosemide, NYHA status > II, eGFR and NTproBNP were significantly associated with the primary outcome in the overall population. However, MUA was not associated with the primary outcome (adjusted HR: 0.93 [95% CI: (0.68–1.27)]; P = 0.839). Using Kaplan-Meier analysis, unadjusted survival curves for MUA showed no difference in risk of the primary outcome (log-rank P = 0.831; Fig. 1).
Conclusion
Our study suggests that the expansion of heart failure RM in MUA has the potential to reduce preventable hospitalizations and deaths in these areas.
{"title":"Remote management of heart failure patients in medically underserved areas","authors":"J. Florence , S. Ploux , R. Eschalier","doi":"10.1016/j.acvd.2025.10.073","DOIUrl":"10.1016/j.acvd.2025.10.073","url":null,"abstract":"<div><h3>Introduction</h3><div>Medically underserved areas (MUA) are associated with higher rates of adverse health outcomes, such as preventable hospitalizations, emergency department visits and death. While remote management (RM) programs can reduce unplanned hospitalizations for heart failure (HF) and all-cause mortality, its effectiveness has not been evaluated in MUA.</div></div><div><h3>Objective</h3><div>To describe the effect of an RM program on a composite outcome including all-cause mortality and HF hospitalizations among chronic HF patients in MUA.</div></div><div><h3>Method</h3><div>Between April 2020 and December 2022 we included all consecutive patients in the same multiparametric heart failure RM program of two French University Hospitals. Follow-up data were collected until February 2023. Inclusion criteria were chronic HF with New York Heart Association<!--> <!-->≥<!--> <!-->II and an elevated B-type natriuretic peptide (BNP<!--> <!-->><!--> <!-->100<!--> <!-->pg/mL or N-terminal-pro-BNP<!--> <!-->><!--> <!-->1000<!--> <!-->pg/mL) and/or at least an episode of HF hospitalization within the last year. Patient assessments were performed remotely and included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. We used the national definition of the French Government to define MUA. The primary outcome was the association of HF hospitalization and all-cause mortality.</div></div><div><h3>Results</h3><div>A total of 1040 patients (72<!--> <!-->±<!--> <!-->12 years old, 70% male), were followed for a median [IQR] of 20 [10; 24] months with a mean adherence to the remote management program of 69<!--> <!-->±<!--> <!-->29%. The annualized rate of the primary outcome was 13.7% in the overall population, without significant difference between MUA and no MUA patients (13.5%/year vs 13.9%/year; <em>P</em> <!-->=<!--> <!-->0.852). In multivariable Cox analysis, baseline dose of furosemide, NYHA status<!--> <!-->><!--> <!-->II, eGFR and NTproBNP were significantly associated with the primary outcome in the overall population. However, MUA was not associated with the primary outcome (adjusted HR: 0.93 [95% CI: (0.68–1.27)]; <em>P</em> <!-->=<!--> <!-->0.839). Using Kaplan-Meier analysis, unadjusted survival curves for MUA showed no difference in risk of the primary outcome (log-rank <em>P</em> <!-->=<!--> <!-->0.831; <span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Our study suggests that the expansion of heart failure RM in MUA has the potential to reduce preventable hospitalizations and deaths in these areas.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S41-S42"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904083","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.2025.10.076
A. Unger , S. Toupin , S. Duhamel , P. Garot , F. Sanguineti , T. Hovasse , M. Akodad , T. Goncalves , E. Gall , A. Léquipar , J. Hudelo , J.-G. Dillinger , P. Henry , A. Bondue , V. Bousson , J. Garot , T. Pezel
Introduction
The role of cardiovascular magnetic resonance (CMR) in guiding coronary revascularisation based on myocardial viability remains debated, particularly after the REVIVED trial. Our group has recently introduced the concept of “late gadolinium enhancement (LGE) granularity”, incorporating LGE extent and location to refine myocardial characterization.
Objective
To assess whether CMR-guided coronary revascularisation, based on the LGE granularity, predicts mortality in patients with ischaemic cardiomyopathy (ICM), reduced left ventricular ejection fraction (LVEF < 50%), and viable myocardium (ischaemic-LGE transmurality < 50%).
Method
We conducted a retrospective analysis of a multicentre study including consecutive ICM patients referred for CMR-based viability assessment between 2008 and 2022. Eligibility criteria included left ventricular ejection fraction (LVEF) < 50%, viable myocardium, and at least one of the following: ≥ 70% stenosis in ≥ 1 epicardial coronary artery, prior myocardial infarction, or previous coronary revascularization. LGE parameters and revascularization within 90 days of CMR were collected. The primary endpoint was all-cause mortality. Cox proportional hazards regression analysis was performed to assess the predictive value of LGE parameters and revascularization status for all-cause mortality.
Results
Among 1698 patients (mean age 64 ± 12 years; 74% male), 1502 (88%) underwent revascularisation within 90 days. LGE extent was low (1–2 segments) in 729 (43%), moderate (3–5 segments) in 922 (54%), and high (≥6 segments) in 47 (3%). Antero-septal LGE was present in 318 patients (19%). Over a median follow-up of 8.9 years (IQR 6.7–11.5 years), 79 patients (4.7%) died. In univariate analysis, revascularisation was associated with lower mortality (HR: 0.28, 95% CI: 0.17–0.45, P < 0.001). Subgroup analyses revealed that revascularisation particularly improved survival in patients with moderate LGE extent (3–5 segments, P = 0.002) and antero-septal LGE (P < 0.001, Fig. 1).
Conclusion
Using the LGE granularity concept, we showed that in ICM patients with viable myocardium, revascularisation was associated with improved survival, particularly in those with moderate ischaemic LGE extent and an antero-septal distribution.
{"title":"Can LGE granularity inform revascularization strategies in ischemic cardiomyopathy?","authors":"A. Unger , S. Toupin , S. Duhamel , P. Garot , F. Sanguineti , T. Hovasse , M. Akodad , T. Goncalves , E. Gall , A. Léquipar , J. Hudelo , J.-G. Dillinger , P. Henry , A. Bondue , V. Bousson , J. Garot , T. Pezel","doi":"10.1016/j.acvd.2025.10.076","DOIUrl":"10.1016/j.acvd.2025.10.076","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of cardiovascular magnetic resonance (CMR) in guiding coronary revascularisation based on myocardial viability remains debated, particularly after the REVIVED trial. Our group has recently introduced the concept of “late gadolinium enhancement (LGE) granularity”, incorporating LGE extent and location to refine myocardial characterization.</div></div><div><h3>Objective</h3><div>To assess whether CMR-guided coronary revascularisation, based on the LGE granularity, predicts mortality in patients with ischaemic cardiomyopathy (ICM), reduced left ventricular ejection fraction (LVEF<!--> <!--><<!--> <!-->50%), and viable myocardium (ischaemic-LGE transmurality<!--> <!--><<!--> <!-->50%).</div></div><div><h3>Method</h3><div>We conducted a retrospective analysis of a multicentre study including consecutive ICM patients referred for CMR-based viability assessment between 2008 and 2022. Eligibility criteria included left ventricular ejection fraction (LVEF)<!--> <!--><<!--> <!-->50%, viable myocardium, and at least one of the following:<!--> <!-->≥<!--> <!-->70% stenosis in<!--> <!-->≥<!--> <!-->1 epicardial coronary artery, prior myocardial infarction, or previous coronary revascularization. LGE parameters and revascularization within 90 days of CMR were collected. The primary endpoint was all-cause mortality. Cox proportional hazards regression analysis was performed to assess the predictive value of LGE parameters and revascularization status for all-cause mortality.</div></div><div><h3>Results</h3><div>Among 1698 patients (mean age 64<!--> <!-->±<!--> <!-->12 years; 74% male), 1502 (88%) underwent revascularisation within 90 days. LGE extent was low (1–2 segments) in 729 (43%), moderate (3–5 segments) in 922 (54%), and high (≥6 segments) in 47 (3%). Antero-septal LGE was present in 318 patients (19%). Over a median follow-up of 8.9 years (IQR 6.7–11.5 years), 79 patients (4.7%) died. In univariate analysis, revascularisation was associated with lower mortality (HR: 0.28, 95% CI: 0.17–0.45, <em>P</em> <!--><<!--> <!-->0.001). Subgroup analyses revealed that revascularisation particularly improved survival in patients with moderate LGE extent (3–5 segments, <em>P</em> <!-->=<!--> <!-->0.002) and antero-septal LGE (<em>P</em> <!--><<!--> <!-->0.001, <span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Using the LGE granularity concept, we showed that in ICM patients with viable myocardium, revascularisation was associated with improved survival, particularly in those with moderate ischaemic LGE extent and an antero-septal distribution.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S43-S44"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904086","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.2025.10.011
A. Granier , A. Trimaille , A. Carmona , A. Elidrissi , M.C. Vu , K. Roulot , M. Kibler , L. Jesel , P. Ohlmann , O. Morel
Introduction
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of type 2 myocardial infarction, primarily affecting middle-age women with few cardiovascular risk factors. Although recent research has increased, SCAD management remains uncertain. Current guidelines generally advocate for conservative treatment due to high complication rates with percutaneous coronary intervention (PCI) but these recommendations are largely based on expert consensus and there remains a critical gap in long-term outcome data.
Objective
To compare clinical profiles, management strategies, and outcomes of SCAD patients with those of patients with atherosclerotic acute coronary syndrome (ACS).
Method
This retrospective, observational and single-center study included all patients hospitalized for SCAD at Strasbourg University Hospital between March 13, 2009, and July 20, 2022. Clinical, biological, angiographic, and prognostic data were compared to patients admitted for atherosclerotic ACS. Propopensity score matching (1:3) was performed based on age, sex, and follow-up duration.
Results
We included 42 SCAD and 891 patients. SCAD patients were younger, predominantly female, and had fewer traditional cardiovascular risk factors. Unlike the ACS group, in which all patients underwent revascularization, over half of the SCAD patients (54.8%) were managed conservatively. Among those treated with PCI, SCAD patients required significantly longer stent lengths. After propensity score matching, no significant differences were observed in all-cause or cardiovascular mortality between groups. Recurrent myocardial infarction was more frequent in the atherosclerotic cohort (16 vs 0 P = 0.012). No stent thrombosis occured in the SCAD group; only one case of in-stent restenosis was reported. The median follow-up duration was 1507 days, allowing for robust long-term outcome assessment.
Conclusion
SCAD mainly affects younger women with few traditional cardiovascular risk factors. Although concerns persist regarding PCI in this population, our findings suggest that when revascularization is required, outcomes are comparable to those in patients with atherosclerotic ACS. Furthermore, complications such as stent thrombosis and restenosis were more common in the atherosclerotic group. These findings supports the individualized management in SCAD and challenge the blanket recommendation for conservative treatment in all cases.
自发性冠状动脉夹层（SCAD）是一种未被确诊的2型心肌梗死病因，主要影响心血管危险因素较少的中年女性。尽管最近的研究有所增加，但SCAD的管理仍然不确定。由于经皮冠状动脉介入治疗（PCI）的高并发症发生率，目前的指南通常提倡保守治疗，但这些建议主要基于专家共识，长期结果数据仍存在严重差距。目的比较SCAD患者与动脉粥样硬化性急性冠状动脉综合征（ACS）患者的临床特点、治疗策略和预后。方法回顾性、观察性、单中心研究纳入2009年3月13日至2022年7月20日在斯特拉斯堡大学医院收治的所有SCAD患者。将临床、生物学、血管造影和预后数据与因动脉粥样硬化性ACS入院的患者进行比较。根据年龄、性别和随访时间进行倾向评分匹配（1:3）。结果纳入SCAD患者42例，891例。SCAD患者较年轻，以女性为主，具有较少的传统心血管危险因素。与ACS组不同，所有患者都接受了血运重建术，超过一半的SCAD患者（54.8%）接受了保守治疗。在接受PCI治疗的患者中，SCAD患者需要更长的支架长度。倾向评分匹配后，各组之间的全因死亡率或心血管死亡率无显著差异。复发性心肌梗死在动脉粥样硬化队列中更为常见（16 vs 0 P = 0.012）。SCAD组无支架血栓形成；仅报道1例支架内再狭窄。中位随访时间为1507天，允许进行可靠的长期结果评估。结论scad多发生于年轻女性，传统心血管危险因素较少。尽管对这一人群PCI的担忧仍然存在，但我们的研究结果表明，当需要血运重建术时，结果与动脉粥样硬化性ACS患者的结果相当。此外，支架血栓形成和再狭窄等并发症在动脉粥样硬化组更为常见。这些发现支持了SCAD的个体化治疗，并对所有病例保守治疗的一揽子推荐提出了挑战。
{"title":"Spontaneous coronary artery dissection vs atherosclerostic acute coronary syndrome: A propensity-matched study of long-term prognosis","authors":"A. Granier , A. Trimaille , A. Carmona , A. Elidrissi , M.C. Vu , K. Roulot , M. Kibler , L. Jesel , P. Ohlmann , O. Morel","doi":"10.1016/j.acvd.2025.10.011","DOIUrl":"10.1016/j.acvd.2025.10.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of type 2 myocardial infarction, primarily affecting middle-age women with few cardiovascular risk factors. Although recent research has increased, SCAD management remains uncertain. Current guidelines generally advocate for conservative treatment due to high complication rates with percutaneous coronary intervention (PCI) but these recommendations are largely based on expert consensus and there remains a critical gap in long-term outcome data.</div></div><div><h3>Objective</h3><div>To compare clinical profiles, management strategies, and outcomes of SCAD patients with those of patients with atherosclerotic acute coronary syndrome (ACS).</div></div><div><h3>Method</h3><div>This retrospective, observational and single-center study included all patients hospitalized for SCAD at Strasbourg University Hospital between March 13, 2009, and July 20, 2022. Clinical, biological, angiographic, and prognostic data were compared to patients admitted for atherosclerotic ACS. Propopensity score matching (1:3) was performed based on age, sex, and follow-up duration.</div></div><div><h3>Results</h3><div>We included 42 SCAD and 891 patients. SCAD patients were younger, predominantly female, and had fewer traditional cardiovascular risk factors. Unlike the ACS group, in which all patients underwent revascularization, over half of the SCAD patients (54.8%) were managed conservatively. Among those treated with PCI, SCAD patients required significantly longer stent lengths. After propensity score matching, no significant differences were observed in all-cause or cardiovascular mortality between groups. Recurrent myocardial infarction was more frequent in the atherosclerotic cohort (16 vs 0 <em>P</em> <!-->=<!--> <!-->0.012). No stent thrombosis occured in the SCAD group; only one case of in-stent restenosis was reported. The median follow-up duration was 1507 days, allowing for robust long-term outcome assessment.</div></div><div><h3>Conclusion</h3><div>SCAD mainly affects younger women with few traditional cardiovascular risk factors. Although concerns persist regarding PCI in this population, our findings suggest that when revascularization is required, outcomes are comparable to those in patients with atherosclerotic ACS. Furthermore, complications such as stent thrombosis and restenosis were more common in the atherosclerotic group. These findings supports the individualized management in SCAD and challenge the blanket recommendation for conservative treatment in all cases.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S10-S11"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904132","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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