Archives of Cardiovascular Diseases最新文献_第4页

From ACS to stable angina: How do Sirolimus and Paclitaxel DCBs perform in daily practice? 从ACS到稳定型心绞痛：西罗莫司和紫杉醇dcb在日常实践中的表现如何？

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 10.1016/j.acvd.2025.10.027

M.M. Baouni, A. Makhloufi, A. Allouache, N. Dahimene, F. Chaouat, S. Bachtarzi, D. Djermane, Z. Benoui, Y. Aoudia

Introduction

Drug-coated balloons (DCB) are increasingly used as a therapeutic strategy for coronary artery disease, especially in small vessel lesions or situations where stent implantation is not desirable. However, real-world comparative data between paclitaxel- and sirolimus-coated DCBs, especially in acute coronary syndrome (ACS) versus stable coronary syndrome (SCS), remain scarce.

Objective

To compare the angiographic performance of paclitaxel- and sirolimus-coated DCBs based on clinical presentation and procedural strategy.

Method

This was a single-center retrospective study including 15 patients treated with DCBs between 2022 and 2024 for coronary lesions in the context of ACS or SCS. Clinical, angiographic, and procedural data were collected. The primary endpoint was acute lumen gain (ALG), expressed as a percentage. Analyses were stratified by DCB type, clinical context, gender, use of 1:1 pre-dilatation, and number of balloons used.

Results

In this monocentric retrospective study including 15 patients treated with drug-coated balloons (DCB) for coronary lesions, the average age was 59.8 years and 73% were male. Paclitaxel-based DCBs were used in 60% of cases, and sirolimus-based DCBs in 40%. The mean acute lumen gain (ALG) was 114.4% ± 112.6, with a final minimal lumen diameter of 1.73 mm, a reference vessel diameter of 2.39 mm, and a residual stenosis of 57.7%. Sirolimus DCBs showed higher ALG in acute coronary syndrome (ACS) settings (129.3%) compared to chronic coronary syndrome (CCS, 49.0%), while paclitaxel DCBs were more effective in CCS (130.3%). ALG was higher in patients who did not undergo 1:1 pre-dilatation (125.9% vs. 82.7%). Most treated vessels were marginal branches, distal LAD, and diagonal branches. Using a single balloon was the most common strategy (60%) with a corresponding ALG of 92.6% (Fig. 1).

Conclusion

Both paclitaxel- and sirolimus-coated DCBs demonstrated significant efficacy with high acute lumen gain. Sirolimus DCBs appeared more effective in ACS, while paclitaxel DCBs showed more consistent results in SCS. These findings support the value of DCBs within a “leave nothing behind” strategy, consistent with current ESC guidelines and major trials such as PEPCAD II and BASKET-SMALL 2.

药物包被球囊（DCB）越来越多地被用作冠状动脉疾病的治疗策略，特别是在小血管病变或不需要支架植入的情况下。然而，紫杉醇包被DCBs和西罗莫司包被DCBs，特别是急性冠状动脉综合征（ACS）和稳定冠状动脉综合征（SCS）的实际比较数据仍然很少。目的比较紫杉醇包膜dcb与西罗莫司包膜dcb的临床表现和手术策略。方法本研究是一项单中心回顾性研究，纳入了15例在ACS或SCS背景下接受DCBs治疗的冠状动脉病变患者。收集临床、血管造影和手术资料。主要终点是急性管腔增益（ALG），以百分比表示。根据DCB类型、临床背景、性别、1:1预扩张的使用和使用的球囊数量对分析进行分层。结果15例冠状动脉病变患者采用药物包被球囊（DCB）治疗，平均年龄59.8岁，男性占73%。60%的病例使用基于紫杉醇的dcb， 40%的病例使用基于西罗莫司的dcb。平均急性管腔增益（ALG）为114.4%±112.6，最终最小管腔直径为1.73 mm，参考血管直径为2.39 mm，残余狭窄为57.7%。与慢性冠脉综合征（CCS, 49.0%）相比，西罗莫司dcb在急性冠脉综合征（ACS）中显示更高的ALG(129.3%)，而紫杉醇dcb在CCS中更有效（130.3%）。未进行1:1预扩张的患者ALG较高（125.9% vs. 82.7%）。大多数治疗血管为边缘分支、LAD远端分支和对角分支。使用单个球囊是最常见的策略（60%），相应的ALG为92.6%（图1）。结论紫杉醇包被dcb和西罗莫司包被dcb疗效显著，急性管腔增益高。西罗莫司dcb在ACS中更有效，而紫杉醇dcb在SCS中表现出更一致的结果。这些发现支持dcb在“不留下任何东西”策略中的价值，与当前ESC指南和主要试验（如PEPCAD II和BASKET-SMALL 2）一致。

{"title":"From ACS to stable angina: How do Sirolimus and Paclitaxel DCBs perform in daily practice?","authors":"M.M. Baouni, A. Makhloufi, A. Allouache, N. Dahimene, F. Chaouat, S. Bachtarzi, D. Djermane, Z. Benoui, Y. Aoudia","doi":"10.1016/j.acvd.2025.10.027","DOIUrl":"10.1016/j.acvd.2025.10.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Drug-coated balloons (DCB) are increasingly used as a therapeutic strategy for coronary artery disease, especially in small vessel lesions or situations where stent implantation is not desirable. However, real-world comparative data between paclitaxel- and sirolimus-coated DCBs, especially in acute coronary syndrome (ACS) versus stable coronary syndrome (SCS), remain scarce.</div></div><div><h3>Objective</h3><div>To compare the angiographic performance of paclitaxel- and sirolimus-coated DCBs based on clinical presentation and procedural strategy.</div></div><div><h3>Method</h3><div>This was a single-center retrospective study including 15 patients treated with DCBs between 2022 and 2024 for coronary lesions in the context of ACS or SCS. Clinical, angiographic, and procedural data were collected. The primary endpoint was acute lumen gain (ALG), expressed as a percentage. Analyses were stratified by DCB type, clinical context, gender, use of 1:1 pre-dilatation, and number of balloons used.</div></div><div><h3>Results</h3><div>In this monocentric retrospective study including 15 patients treated with drug-coated balloons (DCB) for coronary lesions, the average age was 59.8 years and 73% were male. Paclitaxel-based DCBs were used in 60% of cases, and sirolimus-based DCBs in 40%. The mean acute lumen gain (ALG) was 114.4%±112.6, with a final minimal lumen diameter of 1.73mm, a reference vessel diameter of 2.39mm, and a residual stenosis of 57.7%. Sirolimus DCBs showed higher ALG in acute coronary syndrome (ACS) settings (129.3%) compared to chronic coronary syndrome (CCS, 49.0%), while paclitaxel DCBs were more effective in CCS (130.3%). ALG was higher in patients who did not undergo 1:1 pre-dilatation (125.9% vs. 82.7%). Most treated vessels were marginal branches, distal LAD, and diagonal branches. Using a single balloon was the most common strategy (60%) with a corresponding ALG of 92.6% (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>Both paclitaxel- and sirolimus-coated DCBs demonstrated significant efficacy with high acute lumen gain. Sirolimus DCBs appeared more effective in ACS, while paclitaxel DCBs showed more consistent results in SCS. These findings support the value of DCBs within a “leave nothing behind” strategy, consistent with current ESC guidelines and major trials such as PEPCAD II and BASKET-SMALL 2.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Page S18"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904131","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}

引用次数: 0

Left main revascularisation: Study of two techniques; angioplasty and bypass surgery 左主干血运重建：两种技术的研究血管成形术和搭桥手术

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 10.1016/j.acvd.2025.10.028

O. Garci , S. Boudiche , M.S. Mourali

Introduction

Several randomized clinical trials have shown that percutaneous coronary intervention in unprotected left main coronary artery is an efficient approach, paving the way for remarkable changes in recent guidelines.

Objective

To evaluate short and long-term clinical outcomes following percutaneous interventions and coronary artery bypass grafting in left main disease.

Method

From 2012 to 2018, consecutive patients with unprotected left main disease treated by percutaneous intervention or bypass grafting were included in this registry after excluding highly instable patients namely revascularization in the settings of ST elevation myocardial infarction or cardiogenic shock. A sub-study to get in line with landmark randomized trials design with propensity score analysis in order to adjust for baseline differences in overall cohort was performed to compare the two techniques in this real-world registry.

Results

During study period, 308 patients were included: 159 vs. 149 in percutaneous and surgical groups respectively (Fig. 1). During in-hospital stay, major adverse cerebrovascular and cardiac events occurred in 1.9% vs. 12.1%, P = 0.001. Difference was driven by in-hospital deaths 1.3% vs. 10.1%, P = 0.001. At median follow-up of 48 months, major adverse cardio and cerebrovascular events occurred in 28.9% vs. 36.2%, P = 0.077. Components of major events were as follows: all-cause deaths 15.7% vs. 24.8%, P = 0.027; cardiac deaths 10.7% vs. 17.4%, P = 0.047; myocardial infarction 8.2% vs. 5.3%, P = 0.496; Cerebrovascular accidents 1.3% vs. 3.3%, P = 0.21 and ischemia-driven target vessel revascularization 13.8% vs. 8.0%, P = 0.106. 89 matched pairs were identified for propensity matching score after excluding patients with left ventricle ejection fraction ≤ 30%, eGFR ≤ 30 mL/min and SYNTAX score ≥ 33 and any bare metal stent use. At median follow-up of 42 months there was a significant difference in favor of percutaneous coronary interventions in terms of all-cause death (Hazard Ratio: 0.3, 95% CI [0.1–0.8]; P = 0.004) and cardiac death (Hazard Ratio: 0.1, 95% CI [0.1–0.5]; P = 0.001).

Conclusion

In-hospital mortality after bypass grafting for unprotected left main disease was the major difference when comparing this real-world registry with landmark randomized clinical trials supporting current guidelines.

几项随机临床试验表明，经皮冠状动脉介入治疗无保护的左冠状动脉主干是一种有效的方法，为近期指南的显著变化铺平了道路。目的评价经皮冠状动脉旁路移植术治疗左主干病变的近期和长期临床效果。方法2012年至2018年，排除ST段抬高型心肌梗死或心源性休克情况下血运重建术等高度不稳定患者，纳入连续经皮介入或旁路移植术治疗的无保护左主干疾病患者。为了调整整个队列的基线差异，进行了一项符合里程碑式随机试验设计的子研究，以比较这两种技术在现实世界的注册表中。结果研究期间共纳入308例患者：经皮组159例，手术组149例（图1）。住院期间发生的主要脑血管和心脏不良事件分别为1.9%和12.1%,P = 0.001。差异是由院内死亡造成的，分别为1.3%和10.1%,P = 0.001。中位随访48个月时，主要心脑血管不良事件发生率为28.9% vs. 36.2%, P = 0.077。主要事件组成如下：全因死亡15.7% vs. 24.8%, P = 0.027；心脏死亡10.7%对17.4%,P = 0.047；心肌梗死8.2%比5.3%,P = 0.496；脑血管意外1.3%比3.3%,P = 0.21；缺血驱动靶血管重建术13.8%比8.0%,P = 0.106。在排除左心室射血分数≤30%、eGFR≤30 mL/min、SYNTAX评分≥33和任何裸金属支架使用的患者后，确定89对匹配的倾向匹配评分。中位随访42个月时，经皮冠状动脉介入治疗在全因死亡（风险比：0.3,95% CI [0.1 - 0.8]; P = 0.004）和心脏性死亡（风险比：0.1,95% CI [0.1 - 0.5]; P = 0.001）方面有显著差异。结论：与支持现行指南的具有里程碑意义的随机临床试验相比，无保护左主干疾病旁路移植术后的住院死亡率是主要差异。

{"title":"Left main revascularisation: Study of two techniques; angioplasty and bypass surgery","authors":"O. Garci , S. Boudiche , M.S. Mourali","doi":"10.1016/j.acvd.2025.10.028","DOIUrl":"10.1016/j.acvd.2025.10.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Several randomized clinical trials have shown that percutaneous coronary intervention in unprotected left main coronary artery is an efficient approach, paving the way for remarkable changes in recent guidelines.</div></div><div><h3>Objective</h3><div>To evaluate short and long-term clinical outcomes following percutaneous interventions and coronary artery bypass grafting in left main disease.</div></div><div><h3>Method</h3><div>From 2012 to 2018, consecutive patients with unprotected left main disease treated by percutaneous intervention or bypass grafting were included in this registry after excluding highly instable patients namely revascularization in the settings of ST elevation myocardial infarction or cardiogenic shock. A sub-study to get in line with landmark randomized trials design with propensity score analysis in order to adjust for baseline differences in overall cohort was performed to compare the two techniques in this real-world registry.</div></div><div><h3>Results</h3><div>During study period, 308 patients were included: 159 vs. 149 in percutaneous and surgical groups respectively (<span><span>Fig. 1</span></span>). During in-hospital stay, major adverse cerebrovascular and cardiac events occurred in 1.9% vs. 12.1%, <em>P</em>  =0.001. At median follow-up of 48 months, major adverse cardio and cerebrovascular events occurred in 28.9% vs. 36.2%, <em>P</em>  =0.027; cardiac deaths 10.7% vs. 17.4%, <em>P</em>  =0.496; Cerebrovascular accidents 1.3% vs. 3.3%, <em>P</em>  =0.106. 89 matched pairs were identified for propensity matching score after excluding patients with left ventricle ejection fraction≤30%, eGFR≤30mL/min and SYNTAX score≥33 and any bare metal stent use. At median follow-up of 42 months there was a significant difference in favor of percutaneous coronary interventions in terms of all-cause death (Hazard Ratio: 0.3, 95% CI [0.1–0.8]; <em>P</em>  =0.001).</div></div><div><h3>Conclusion</h3><div>In-hospital mortality after bypass grafting for unprotected left main disease was the major difference when comparing this real-world registry with landmark randomized clinical trials supporting current guidelines.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S18-S19"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904136","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}

引用次数: 0

Early heart failure detection using a Heart Failure Symptom Questionnaire and NT-proBNP Fingerstick Testing: A multicenter study (DEP'IC FR 2024) 使用心力衰竭症状问卷和NT-proBNP手指棒检测早期心力衰竭：一项多中心研究（dep&# 39;IC FR 2024）

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 10.1016/j.acvd.2025.10.097

E. Berthelot , N. Mewton , D. Logeart , N. Mansencal , A. Jagu , L. Legrand , C. Fauvel , O. Lairez , F. Roubille , T. Damy

Introduction

Heart failure (HF) remains underdiagnosed in primary care, often due to the nonspecific nature of symptoms and limited access to diagnostic tools. The acronym “EPOF” (dyspnea, weight gain, oedema, fatigue) is used in France to raise awareness of HF-related symptoms, but its diagnostic value has not been formally assessed. We aimed to evaluate the association between EPOF symptoms and elevated NT-proBNP levels in a population without known HF participating in a national screening campaign.

Objective

In this study, we sought to determine whether EPOF symptoms are associated with elevated NT-proBNP levels in a population of adults with no known history of HF, who voluntarily participated in a national HF awareness and screening campaign. The primary objective was to assess the diagnostic value of individual and combined symptoms in identifying NT-proBNP > 125 pg/mL, the commonly used threshold for suspecting HF in ambulatory settings.

Method

We conducted a prospective, multicenter screening study across 21 French hospitals and clinics. Adults at steady state with no prior history of HF underwent NT-proBNP testing via fingerstick and completed a symptom questionnaire. The primary outcome was the diagnostic performance of all four clinical “EPOF” signs to detect patients with elevated NT-proBNP defined as > 125 pg/mL.

Results

Of 2481 participants, 419 (16.9%) had NT-proBNP > 125 pg/mL. Age, previous cardiology consultation, and history of coronary artery disease were independently associated with elevated NT-proBNP. Among the four symptoms, dyspnea was the most sensitive (47.7%) while weight gain was the most specific (84.7%) to detect NTproBNP > 125 pg/mL. The presence of ≥ 1 symptom yielded a sensitivity of 63.2% and negative predictive value of 85.0%, but specificity remained low (42.4%) for the primary outcome. When all four symptoms were present, specificity increased to 96.1% but sensitivity dropped to 7.1% (Fig. 1).

Conclusion

In a nationwide screening population without known HF, NT-proBNP > 125 pg/mL was present in 16.9%. EPOF symptoms were more frequent in individuals with elevated NT-proBNP, but their individual diagnostic performance was limited. Combining symptom-based screening with NT-proBNP testing may help guide earlier identification and referral of patients at risk of HF in primary care.

心力衰竭（HF）在初级保健中仍未得到充分诊断，这通常是由于症状的非特异性和诊断工具的有限获取。缩写词“EPOF”（呼吸困难、体重增加、水肿、疲劳）在法国被用来提高对hf相关症状的认识，但其诊断价值尚未得到正式评估。我们的目的是评估EPOF症状和NT-proBNP水平升高之间的关系，在一个没有已知HF的人群中参与全国筛查活动。在这项研究中，我们试图确定EPOF症状是否与NT-proBNP水平升高有关，这些患者是自愿参加全国HF意识和筛查活动的无已知HF病史的成年人。主要目的是评估个体和联合症状在鉴别NT-proBNP （125pg /mL）中的诊断价值，这是在门诊环境中怀疑HF的常用阈值。方法我们在21家法国医院和诊所进行了一项前瞻性、多中心筛选研究。无心衰病史的稳定状态成人，采用指戳法进行NT-proBNP检测，并填写症状问卷。主要终点是检测NT-proBNP升高（定义为125 pg/mL）患者的所有四种临床“EPOF”体征的诊断性能。结果在2481名参与者中，419名（16.9%）NT-proBNP为125 pg/mL。年龄、既往心脏病咨询和冠状动脉病史与NT-proBNP升高独立相关。四种症状中，呼吸困难最敏感（47.7%），体重增加最特异（84.7%）检测到NTproBNP >； 125 pg/mL。存在≥1种症状的敏感性为63.2%，阴性预测值为85.0%，但对主要结局的特异性仍然很低（42.4%）。当所有四种症状都出现时，特异性增加到96.1%，但敏感性下降到7.1%（图1）。结论：在全国范围内没有已知HF的筛查人群中，16.9%的人NT-proBNP >； 125 pg/mL。EPOF症状在NT-proBNP升高的个体中更为常见，但其个体诊断能力有限。将基于症状的筛查与NT-proBNP检测相结合，可能有助于在初级保健中早期识别和转诊有HF风险的患者。

{"title":"Early heart failure detection using a Heart Failure Symptom Questionnaire and NT-proBNP Fingerstick Testing: A multicenter study (DEP'IC FR 2024)","authors":"E. Berthelot , N. Mewton , D. Logeart , N. Mansencal , A. Jagu , L. Legrand , C. Fauvel , O. Lairez , F. Roubille , T. Damy","doi":"10.1016/j.acvd.2025.10.097","DOIUrl":"10.1016/j.acvd.2025.10.097","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) remains underdiagnosed in primary care, often due to the nonspecific nature of symptoms and limited access to diagnostic tools. The acronym “EPOF” (dyspnea, weight gain, oedema, fatigue) is used in France to raise awareness of HF-related symptoms, but its diagnostic value has not been formally assessed. We aimed to evaluate the association between EPOF symptoms and elevated NT-proBNP levels in a population without known HF participating in a national screening campaign.</div></div><div><h3>Objective</h3><div>In this study, we sought to determine whether EPOF symptoms are associated with elevated NT-proBNP levels in a population of adults with no known history of HF, who voluntarily participated in a national HF awareness and screening campaign. The primary objective was to assess the diagnostic value of individual and combined symptoms in identifying NT-proBNP>125pg/mL, the commonly used threshold for suspecting HF in ambulatory settings.</div></div><div><h3>Method</h3><div>We conducted a prospective, multicenter screening study across 21 French hospitals and clinics. Adults at steady state with no prior history of HF underwent NT-proBNP testing via fingerstick and completed a symptom questionnaire. The primary outcome was the diagnostic performance of all four clinical “EPOF” signs to detect patients with elevated NT-proBNP defined as>125pg/mL.</div></div><div><h3>Results</h3><div>Of 2481 participants, 419 (16.9%) had NT-proBNP>125pg/mL. Age, previous cardiology consultation, and history of coronary artery disease were independently associated with elevated NT-proBNP. Among the four symptoms, dyspnea was the most sensitive (47.7%) while weight gain was the most specific (84.7%) to detect NTproBNP>125pg/mL. The presence of≥1 symptom yielded a sensitivity of 63.2% and negative predictive value of 85.0%, but specificity remained low (42.4%) for the primary outcome. When all four symptoms were present, specificity increased to 96.1% but sensitivity dropped to 7.1% (<span><span>Fig. 1</span></span>).</div></div><div><h3>Conclusion</h3><div>In a nationwide screening population without known HF, NT-proBNP>125pg/mL was present in 16.9%. EPOF symptoms were more frequent in individuals with elevated NT-proBNP, but their individual diagnostic performance was limited. Combining symptom-based screening with NT-proBNP testing may help guide earlier identification and referral of patients at risk of HF in primary care.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"119 1","pages":"Pages S54-S55"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904150","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}

引用次数: 0

Santé cardiovasculaire : prévenir, innover, partager 预防、创新和分享心血管健康

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 10.1016/j.acvd.2025.12.005

Pr Victor Aboyans (Secrétaire scientifique des JESFC), Pr Anne Bernard (Secrétaire scientifique adjointe, chargée du village de la simulation), Pr Stéphane Lafitte (chargé du DPC et du village numérique), Pr Hélène Eltchaninoff (Présidente-élue de la SFC), Pr Christophe Leclercq (Past-président de la SFC), Pr Bernard Iung (Président de la SFC)

引用次数: 0

France TAVI: The odyssey 法国TAVI：奥德赛

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 10.1016/j.acvd.2025.11.005

Romain Didier , Martine Gilard

引用次数: 0

Cardiovascular risk assessment in young adults: A pilot study 年轻人心血管风险评估：一项初步研究

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 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.

虽然传统上被认为是老年人的疾病，但动脉粥样硬化性心血管疾病（ASCVD）仍然是全球主要的死亡原因。心血管疾病（CVD）在年轻人群中的发病率不断上升，这凸显了当前风险分层工具的一个关键缺陷，这些工具往往低估了这一群体的心血管（CV）风险。本研究的主要目的是通过开发和验证一种专门为18-35岁的年轻人量身定制的新型心血管风险评估模型来解决这一缺陷。次要目标包括评估该人群中亚临床心血管危险因素的患病率，并评估结构性心脏病标志物和血管生物标志物与基于人工智能的分析相结合时的附加预测价值。方法：我们启动了一项试点、多中心、前瞻性观察性临床研究——solution（罗马尼亚年轻人动脉粥样硬化风险评分）——在罗马尼亚18-35岁的代表性队列中首次进行全面的心血管风险筛查。参与者被分为四个不同的风险类别（无风险、低、中、高），基于一种新的风险评估模型，该模型整合了先进的预后指标，如结构性心脏病（SHD）和血管生物标志物，并辅以人工智能（AI）分析。结果对311例个体的分析显示，没有人具有完全正常的生物标志物，大多数人出现6个异常参数。主要发现包括炎症综合征（分别为17.8%和42.7%）、高血压（16.2%）、肥胖（8.7%）、吸烟（89.39%）、血脂异常（甘油三酯升高42.76%、总胆固醇高50.48%）和II型糖尿病（1.28%）发生率升高。结合SHD参数，新提出的解决方案风险评分（SRS）与传统评分系统相比，显示出更好的粒度和预测能力。结论：这些令人担忧的趋势强调了SRS在这一未被充分认识的年龄组中的重要性。通过整合SHD标志物，SRS可以提高早期发现，促进实施有针对性的预防策略和及时干预。在更大的队列中进行更广泛的验证仍然是建立其普遍性的必要条件。

{"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}

引用次数: 0

Trade-off between bleeding and ischemic risk after percutaneous coronary intervention in a Tunisian acute coronary syndrome population 突尼斯急性冠脉综合征人群经皮冠状动脉介入治疗后出血和缺血性风险的权衡

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 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.

在急性冠脉综合征（ACS）患者接受经皮冠状动脉介入治疗（PCI）时，平衡缺血和出血风险仍然具有挑战性。关于北非ACS患者pci后出血和缺血风险概况以及抗血小板管理策略的数据有限。本研究旨在利用经验证的2023 ESC指南风险标准分析突尼斯队列中因ACS接受PCI的出血和血栓形成风险，并在12个月的随访期间评估口服抗凝（OAC）患者的短期双重抗血小板治疗（DAPT）和三重抗血栓治疗（TAT）方案的安全性。方法一项前瞻性观察性研究纳入了2023年12月1日至2024年2月29日在突尼斯三级心内科连续出现ACS的患者。根据ARC-HBR标准，将患者分为高出血风险（HBR）或低出血风险（LBR），根据第二种抗栓药物延长治疗的标准，将患者分为高（HTR）或中度（MTR）血栓形成风险。出院时评估主要出血事件（根据BARC标准）和主要不良心脑血管事件（MACCE），并进行12个月的随访。结果249例ACS患者中，194例（78%）行PCI。60例（30.9%）为HBR。根据血栓形成风险，将患者分为四个亚组：LBR/MTR组75例（38.7%）；LBR/HTR 59例（30.4%）；HBR/HTR 45例（23.2%），HBR/MTR风险概况15例（7.7%）。具有LBR风险概况的亚组接受12个月的DAPT治疗，如果他们有OAC适应症和HTR特征，则接受1个月的TAT治疗。少数HBR和MTR患者（15例；7.7%）接受6个月DAPT或1周TAT治疗。在12个月的随访中，接受缩短DAPT/TAT方案的HBR/MIR患者没有MACCE，与接受较长DAPT方案的HBR/HTR相比，主要出血事件显著减少（P < 0.001）。总体而言，8.2%的患者发生大出血（BARC 3或5），主要发生在HBR/HTR亚组（68.75%）。结论2023年ACS ESC指南提出的arc - hbr和高血栓形成风险标准可有效识别不同的出血和血栓形成风险亚组。对于高出血和中度缺血性风险的患者，缩短抗血栓治疗方案似乎是安全的，可以减少出血并发症而不增加缺血性事件。

{"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}

引用次数: 0

Impact of Tafamidis on survival in elderly patients in a real-world setting: Insights from the Healthcare European Amyloidosis Registry 在现实世界中，他法非地对老年患者生存的影响：来自欧洲淀粉样变性登记中心的见解

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 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 80/61mg, 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 80/61mg, 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), as was the average level of high-sensitivity troponin T (55 vs. 74ng/ml, <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}

引用次数: 0

Real-world outcomes of SGLT2 inhibitors in very elderly patients with heart failure with preserved ejection fraction SGLT2抑制剂治疗射血分数保留的高龄心力衰竭患者的实际结果

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 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.

心力衰竭伴射血分数保留（HFpEF）在老年人群中很普遍，但钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）在90岁以上患者中的应用证据有限。目的本研究通过调查与死亡率或心力衰竭（HF）再住院相关的因素，评估SGLT2i对高龄HFpEF患者的实际影响。该前瞻性多中心研究纳入了298例连续患者（平均年龄：90岁，平均Charlson评分：8.29），于2021年4月至2023年7月在法国巴黎的3个老年病房接受急性HFpEF治疗。统计资料、合并症和出院药物。主要终点是一年内全因死亡率或心衰再住院的综合结果。采用多变量Cox回归分析确定与综合结果相关的因素。结果出院时，49.6%的患者接受SGLT2i治疗。1年死亡率28.1%，再住院率22.8%。使用SGLT2i显著降低了综合结局风险（HR: 0.43; 95% CI: 0.29-0.66）， SGLT2i组的事件发生率为29.7%，而未使用SGLT2i组的事件发生率为56.6% （P < 0.001）。肾素-血管紧张素系统阻滞剂也显示出显著的风险降低（HR: 0.56; 95% CI: 0.38-0.82）。严重营养不良、高血压和静脉注射高剂量速尿与较差的结果相关（图1）。结论：本研究提供了强有力的观察性证据，支持SGLT2i治疗具有高合并症负担的高龄HFpEF患者。高龄和多发病不应妨碍SGLT2i在这一人群中的治疗。

{"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}

引用次数: 0

Sex differences in cardiac amyloidosis: A clustering-based analysis 心脏淀粉样变性的性别差异：基于聚类的分析

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases

Pub Date : 2026-01-01 DOI: 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.

心脏淀粉样变性（CA）包括一组异质性的浸润性心肌病，主要包括轻链（AL）淀粉样变性和甲状腺转蛋白淀粉样变性（ATTR），后者又细分为野生型（ATTRwt）和遗传或变异型（ATTRv）。在这个复杂的谱系中，性别相关因素可能影响临床表型、疾病进展和预后。目的假设无监督聚类分析可以根据性别识别出不同的表现和进化模式。方法对2233例患者（男性1659例，女性574例）进行队列分析。使用自组织图（SOMs）对男性、女性和总体人群分别进行聚类分析。结果将男性和女性分别分为A、B、C、D、E、F 6类。AL淀粉样变性在女性中更为普遍，特别是在系统性累及的群集中（E， F），而attrt在男性中占主导地位（A， B， C）。ATTRv在男性中也更为常见。男性表现出更高的合并症和更严重的心脏受累。一些聚类在性别上表现出很强的相似性，例如聚类A（中年，高attrt患病率，类似死亡率~ 23%）和聚类F（年轻患者，低attrt患病率，类似死亡率~ 25.8%）。其他组存在明显的性别差异（图1），E组（AL患病率和系统性累及较高，合并症较差）和D组（表型最严重，男性生存率明显较差[76.1%]）。男性在晚期疾病（D组）中生存率较差，而女性在中年组中死亡率较高，尽管心脏受累程度较轻。聚类分析突出了CA中不同的性别特异性表型。在晚期疾病中，男性表现出更严重的心脏受累和更差的生存率，而在中年集群中，女性尽管心脏特征较轻，但死亡率更高。这些发现强调了个性化、针对性别的风险分层和治疗策略的必要性。

{"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}

引用次数: 0